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Rev Esp Quimioter 2021;34(5):459-467

Influence of CMO pharmaceutical care model-based intervention on readmission rate in high risk HIV patients: the INFARDAR study

MARIA ISABEL GUZMÁN RAMOS, MERCEDES MANZANO GARCIA, Mª DE LAS AGUAS ROBUSTILLO-CORTÉS, ANTONIO GUTIÉRREZ PIZARRAYA, RAMÓN MORILLO-VERDUGO

Published: 7 July 2021

http://www.doi.org/10.37201/req/025.2021

Background. Many studies have indicated that hospitalization and readmissions occur frequently, especially among people living with HIV. The aim of the study was to determine the effectiveness of a programmed and structured pharmaceutical intervention, based on “CMO PC model” to reduce the readmission rate in high-risk HIV patients.
Material and methods. This was a single-center, prospective study based on a structured health intervention conducted between March-2017 and March-2018 with 12 months of follow-up at outpatient pharmacy services. At discharge, HIV patients included were classified according to the risk of readmission as low or high risk patients, being the latter proposed to participate. The selected patients were randomly assigned to a control group (usual care) or intervention group (including stratification-motivational interview and new technologies: CMO pharmaceutical care). The primary endpoint was readmission rate at one year of follow-up in each group.
Results. A total of 39 patients were included. As regards the main variable, in the intervention group, 21,4% (n=3) of patients were readmitted in the first year after discharge vs. 66,7% (n=6) in the control group (p=0,042).
Conclusions. Tailored pharmaceutical care based on risk stratification, motivational interviewing, and new technologies has a positive influence to reduce the percentage of readmission in high risk HIV patients.

Rev Esp Quimioter 2021;34(5):459-467 [Full-text PDF]


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Rev Esp Quimioter 2021;34(5):506-508

Shock séptico y empiema por Pasteurella multocida

DOMINGO FERNÁNDEZ VECILLA, MIREN JOSEBE UNZAGA BARAÑANO, CRISTINA ASPICHUETA, JOSÉ LUIS DÍAZ DE TUESTA

Published: 5 July 2021

http://www.doi.org/10.37201/req/047.2021

LETTER TO THE EDITOR

Rev Esp Quimioter 2021;34(5):506-508 [Texto completo PDF]


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Rev Esp Quimioter 2021;34(5):500-501

Candida bracarensis, an emerging yeast involved in human infections

SARAY MORMENEO BAYO, MARÍA PILAR PALACIÁN RUÍZ, ROSA MARÍA MARTÍNEZ ÁLVAREZ, CONCHA LÓPEZ GÓMEZ, SILVIA LOSCOS ARANDA, MARÍA CRUZ VILLUENDAS USÓNZ

Published: 5 July 2021

http://www.doi.org/10.37201/req/020.2021

LETTER TO THE EDITOR

Rev Esp Quimioter 2021;34(5):500-501[Full-text PDF]


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Rev Esp Quimioter 2021;34(5):476-482

Relevance of empirical antibiotic treatment in the evolution of prosthetic joint infection treated with implant retention

JOSÉ MARÍA BARBERO ALLENDE, MARTA GARCÍA SÁNCHEZ, MIGUEL VACAS CÓRDOBA, EDUARDO MONTERO RUIZ, DIANA BARREIRA HERNÁNDEZ

Published: 5 July 2021

http://www.doi.org/10.37201/req/033.2021

Introduction. Several factors have been associated with the prognosis of prosthetic joint infection (PJI) treated with surgical debridement, antibiotic therapy, and implant retention (DAIR). There is no evidence about the right empirical antibiotic treatment when the causal microorganism is not still identified.
Material and methods. We conducted a retrospective observational study in patients with PJI treated with DAIR between 2009 and 2018 in our center. We analyze the risk factors related with their prognosis and the influence of active empirical antibiotic therapy against causative microorganisms in final outcomes.
Results. A total of 80 PJI cases treated with DAIR, from 79 patients (58.7% women, mean age 76.3 years), were included in the study period. Among the cases in which empirical antibiotic therapy were active against the causative microorganisms, the success rate was 46/65 (69.2%) vs 1/15 when not (6.7%, OR 31.5, p = 0.001). Factors related to the success or failure of the DAIR were analyzed with multivariate analysis. We found that active empirical antibiotic treatment remained statistically significant as a good prognostic factor (OR 0.04, p <0.01).
Conclusions. Empirical antibiotic treatment could be an important factor in the prognosis of PJI treated with DAIR. To identify cases at risk of infection by multidrug resistant microorganisms could be useful to guide empirical antibiotic therapy

Rev Esp Quimioter 2021;34(5):476-482 [Texto completo PDF]


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Rev Esp Quimioter 2021;34(6):559-598

Vaccine against COVID-19

JUAN J. PICAZO

Published: 28 June 2021

http://www.doi.org/10.37201/req/085.2021

The COVID-19 pandemic has produced a huge health, economic and psychological collapse in our society. Health workers have had to face one of the greatest challenges in history, trying to show the population how to deal with this disease. We have learned that vaccines are the great instrument for the fight against infectious diseases and a large number of them began to appear, not as a product of chance but as a product of the enormous progress experienced in recent years with vaccines against new infectious diseases, against other diseases such as Alzheimer’s and especially against cancer. All this knowledge has been applied to this disease. Practitioners lamented the little information available to them when asked questions from patients. This document wanted to be a response to these concerns, with a scientific desire, with evidence that put aside unverified data and hoaxes. Faced with an avalanche of information, most of it without the appropriate “peer review” as indicated in the introduction, any publication becomes obsolete at the time of publication, and we opted for an “online” publication, with the incorporation of versions. This online publication has been published in the documents of Spanish Society of Chemotherapy, at https://seq.es/vacunacion-covid-19

Rev Esp Quimioter 2021;34(6):559-598 [Texto completo PDF]


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Rev Esp Quimioter 2021;34(5):441-449

Utilization study in real clinical practice of ceftolozane/tazobactam vs aminoglycosides and/or colistin in the treatment of multirresistant or extremely resistant Pseudomonas aeruginosa 

ANDREA PINILLA-RELLO, RAFAEL HUARTE-LACUNZA, ARANTXA MAGALLÓN-MARTÍNEZ, LUCÍA CAZORLA-PODEROSO, OLGA PEREIRA-BLANCO, MARÍA PÉREZ-MORENO, ITZIAR LARRODÉ-LECIÑENA, ROSA MARÍA MARTÍNEZ-ÁLVAREZ, ANA ISABEL LÓPEZ-CALLEJA

Published: 22 June 2021

http://www.doi.org/10.37201/req/006.2021

Introduction. Comparative “real life” data on the effectiveness and safety of ceftolozane/tazobactam (C/T) versus other regimens (aminoglycosides/colistin/combination), in the treatment of multi-resistant (MDR) and extremely resistant (XDR) Pseudomonas aeruginosa (PA), are needed to establish positions.
Material and methods. Observational, retrospective study of patients with microbiological confirmation of MDR and XDR PA from July 2016 up to December 2018 in a tertiary hospital. Variables: age, sex, comorbidities, risk factors for multidrug resistance, variables related to infection, source of infection, microorganism and type of sample, antibiotic treatment, clinical cure, microbiological cure, recurrence, mortality on admission and 30 days post-discharge. Patients were classified according to received antibiotic treatment, C/T or aminoglycosides/colistin/combination
Results. A total of 405 patients with PA MDR and XDR infection (73.1% men, mean age 63 ± 15 years) were studied. An 87.1% of PA XDR and a 12.9% MDR were observed. All patients received C/T as targeted therapy and in the aminoglycosides/colistin/combination group were 73.5%. Patients in the C/T group present worse prognostic factors: septic shock (30.0%) and catheterization (90.0%) (p<0.05). There were not statistically significant differences in microbiological cure (p=0.412), recurrence (p=0.880) and clinical cure (p=0.566). There were not statistically significant differences in mortality at admission (p=0.352) or at 30 days after discharge (p=0.231). A 17.2% of the patients with aminoglycosides/colistin/combination had acute kidney injury according to RIFLE criteria and 4.3% with C/T.
Conclusions. The data obtained suggest that there have been no differences in effectiveness (clinical or microbiological cure) in favour of C/T, although, in the period studied, it was used in most cases in multitreated patients with a worse prognosis. Randomized and prospective studies would be needed to establish an adequate positioning.

Rev Esp Quimioter 2021; 34(5):441-449 [Texto completo PDF]


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Rev Esp Quimioter 2021;34(5):468-475

Prevalence of microbiologically-confirmed influenza in patients with influenza-like illness in primary care and clinical and epidemiological characteristics

ANA MORAGAS, ANA GARCIA-SANGENÍS, ALEX PRATS ESCUDERO, CAROLINA BAYONA FARO, ROSARIO HERNÁNDEZ IBÁÑEZ, CARLOS BROTONS, TERESA VILELLA, MIREIA PUIG, ROSA FREIXEDAS CASAPONSA, SILVIA COBO GUERRERO, HELENA PERA, ALIKE W VAN DER VELDEN, CHRISTOPHER C. BUTLER, CARLES LLOR

Published: 13 June 2021

http://www.doi.org/10.37201/req/032.2021

Objectives. We evaluated the prevalence of microbiologically-confirmed influenza infection among patients with influenza-like symptoms and compared the clinical and epidemiological characteristics of patients with and without influenza infection.
Methods. Retrospective study of a cohort of patients with influenza-like symptoms from 2016 to 2018 who participated in a clinical trial in thirteen urban primary centres in Catalonia. Different epidemiological data were collected. Patients rated the different symptoms and signs on a Likert scale (absent, little problem, moderate problem and severe problem) and self-reported the measure of health status with the EuroQol visual analogue scale. A nasopharyngeal swab was taken for microbiological isolation of influenza and other microorganisms.
Results. A total of 427 patients were included. Microbiologically confirmed influenza was found in 240 patients (56.2%). The percentage of patients with moderate-to-severe cough, muscle aches, tiredness and dizziness was greater among patients with microbiologically confirmed influenza. The self-reported health status was significantly lower among patients with true flu infection (mean of 36.3 ± 18.2 vs 41.7 ± 17.8 in patients without influenza; p<0.001).
Conclusion. Clinical findings are not particularly useful for confirming or excluding the diagnosis of influenza when intensity is not considered. However, the presence of moderate-to-severe cough, myalgias, tiredness and dizziness along with a poor health status is more common in patients with confirmed flu infection.

Rev Esp Quimioter 2021;34(5):468-475 [Texto completo PDF]


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Rev Esp Quimioter 2021;34(5):450-458

Infections in patients colonized with carbapenem-resistant Gram-negative bacteria in a medium Spanish city

CARMEN SORIA-SEGARRA, MERCEDES DELGADO-VALVERDE, MARÍA LUISA SERRANO-GARCÍA, INMACULADA LÓPEZ-HERNÁNDEZ, JOSÉ MARÍA NAVARRO-MARÍ, JOSÉ GUTIÉRREZ-FERNÁNDEZ

Published: 8 June 2021

http://www.doi.org/10.37201/req/021.2021

Objective. Because there are few studies on the clinical implications of colonization by carbapenem-resistant gram-negative bacteria (CRB) this was analyzed in rectal smears (RS) and pharyngeals (PS) and its ability to predict infection/colonization.
Methodology. A cross-sectional, retrospective study from adult inpatients between January 2016 and December 2019 was conducted. The isolates were characterized by MicroScan and spectrometry of masses applying EUCAST 2018 cutoff points. The detection of carbapenemases was performed by PCR and Sanger sequencing; sequencies was assigned by MLST. The genetic relationship between the clinical isolates was made by pulsed field electrophoresis using the enzymes Xbal, Spel or Apal.
Results. A total of 308 (86.03%) RS and 50 (13.97%) positive PS were detected, the RS had a 85% sensibility, 100% specificity, 100% positive predictive value and 97% negative predictive value. In RS, the following were isolated: 44% (n=135) Acinetobacter baumannii, 26% (n =80) Enterobacterales (20 KPC, 29 OXA-48, 22 VIM, 2 IMP, 7 NDM), 17% (n=53) Pseudomonas aeruginosa and 13% (n=40) Stenotrophomonas maltophilia. In the PS were isolated 44% (n=22) S. maltophilia, 40% (n = 20) A. baumannii, 8% (n=4) P. aeruginosa and 8% (n=4) Enterobacterales (3 VIM, 1 OXA). From the patients with simultaneous RS and PS, 41 (40.6%) had positivity in both smears, 45 (44.6%) only in RS and 15 (14.9%) only in PS. Colonization preceded infection in 81.3% (n=13) of the isolates; association between infection and colonization was found (p<0.001; χ2); and the episodes where the information was found all the isolates from the clinical samples and from the smears were similar.
Conclusions. The probability of predicting infection through the CRB colonized in different clinical samples is feasible. The RS has a major sensibility to detect colonization.

Rev Esp Quimioter 2021;34(5):450-458 [Texto completo PDF]


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Rev Esp Quimioter 2021; 34(4): 371-375

Reverse transcriptase and protease inhibitors mutational viral load in HIV infected pregnant women with transmitted drug resistance in Argentina

DIEGO CECCHINI, JAVIER SFALCIN, INÉS ZAPIOLA, ALAN GÓMEZ, SILVINA FERNÁNDEZ GIULIANO, LILIA MAMMANA, ANALÍA SERAVALLE, CLAUDIA RODRÍGUEZ, FABIAN FAY, MARÍA BELÉN BOUZAS

Published: 4 June 2021

http://www.doi.org/10.37201/req/022.2021

Objective. Argentina has reported high levels of transmitted drug resistance (TDR), in HIV-infected pregnant women by population sequencing. We aimed to describe, in patients with TDR, the percentage of quasispecies harboring resistance mutations (RAMs) and mutational load (ML).
Patients and Methods. Retrospective study in a cohort of 40 naïve HIV-infected pregnant women, whose pretreatment samples had been genotyped by TRUGENE (period 2008-2014). Samples were re-sequenced with Ultra-deep Sequencing and ML was calculated considering baseline HIV-1 RNA load multiplied by the frequency of quasispecies harboring RAMs.
Results. TDR for NNRTIs, NRTIs and PIs was 17.5% (n=7 patients), 10% (n=4), 12.5% (n=5) respectively. Predominant NNRTI RAMs were K103N (n=4; 10%) and G190A/E/S (n=3; 7.5%). For NNRTIs, 78% of RAMs were present in >93.5% of viral population and ML was >1000 copies/mL (c/mL) for 89%, with a median (IQR) of 8330 c/ml (7738-29796). The following NRTI RAMs were described (per patient: % of quasispecies, ML): T215I (99.7%, 11014 c/ml); D67G (1.28%, 502 c/mL); M41L (79.8%, 88578 c/mL) and M184I (1.02%, 173 c/mL). Most frequent PI-RAMs were I85V, M46I, I50V and L90M (n=2, 5% each). For PIs, quasispecies with RAMs were <2.3% of viral population and ML was <350 c/mL for 77.8% of them.
Conclusion. NNRTI-RAMs are predominant within the viral population, usually exceeding the threshold of 1000 c/mL, indicating potential higher risk of perinatal transmission. Conversely, PI mutations appear mostly as minority variants, with potential lower risk of transmission. Among NRTI, quasispecies harboring RAMs and ML values were variable.

Rev Esp Quimioter 2021; 34(4): 371-375 [Full-text PDF]


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Rev Esp Quimioter 2021; 34(4): 400-401

Bacteriemia de origen urinario por Lactobacillus delbrueckii ssp. sunkii

MIKELE MACHO-AIZPURUA, ITZIAR ANGULO-LÓPEZ, JESÚS-MARÍA ARCINIEGA-GARCÍA, JOSÉ-LUIS DÍAZ-DE-TUESTA DEL-ARCO

Published: 3 June 2021

http://www.doi.org/10.37201/req/029.2021

LETTER TO THE EDITOR

Rev Esp Quimioter 2021; 34(4): 400-401 [Texto completo PDF]

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