DOMINGO FERNÁNDEZ VECILLA, PAULA BELÉN BLASCO PALACIO, MIREN JOSEBE UNZAGA BARAÑANO, JOSÉ LUIS DÍAZ DE TUESTA
Published: 3 December 2020
http://www.doi.org/10.37201/req/078.2020
CARTA AL DIRECTOR
Rev Esp Quimioter 2021; 34(1): 67-69 [Texto completo PDF]
FERNANDA ROMBINI, DIEGO M. CECCHINI, JAMILE BALLIVIAN, MARA HUBERMAN, ANALÍA URUEÑA, ISABEL CASSETTI
Published: 3 December 2020
http://www.doi.org/10.37201/req/090.2020
Objective. There are generic fixed-dose combinations (FDCs) of ritonavir-boosted darunavir (DRV/r) available in Argentina. Experiences with these FDCs in dual therapy remain limited in clinical practice. We aimed to describe clinical and virologic outcomes in patients exposed to FDC DRV/r + raltegravir (RAL) 400 mg every 12 h in a real-life setting.
Patients and methods. Retrospective analysis of electronic medical records of HIV-infected patients under FDC DRV/r + RAL in an HIV clinic in Argentina (2014-2018). Individuals were classified as “switch group” (SG, undetectable viral load [VL] with any toxicity/comorbidity) and “virologic group· (VG, detectable viremia and infection by multidrug-resistant HIV).
Results. Of 7,380 patients on ART, 116 (1.5%) received FDC DRV/r + RAL, being 58% in SG. Sixty percent received DRV/r 800/100 mg dose (rest, 600/100 mg). The median (IQR) age and CD4+ T-cell count were: 52 (42-58) years, and 373 cell/µL (202-642). Ninety-eight percent were ART-experienced with a median of 3 (IQR 2-5) prior treatments. Main reasons for switch (SG) were renal (57%), cardiovascular (54%) and bone (14%) comorbidities. Median exposure to DRV/r + RAL was 18 months. Among patients in SG, 98% and 96% had undetectable VL at 6 and 12 months; in the VG, 89% and 87% had undetectable VL at 6 and 12 months. No patient required suspension due to toxicity/ intolerance.
Conclusion. In this cohort of mostly experienced HIV-infected patients, FDC DRV/r + RAL was effective and safe. Such therapy may be considered an option for patients with comorbid conditions and/or with multidrug-resistant HIV.
Rev Esp Quimioter 2021; 34(1): 56-60 [Full-text PDF]
MARÍA ESTEBAN-RIHUETE, LUIS MORENO-BORRAZ, DIEGO RODRÍGUEZ-GASCÓN, JULIO CÉSAR GARCÍA-HERRERO, JUAN MANUEL GARCÍA-LECHUZ, ÁNGEL GARCÍA-FORCADA
Published: 1 December 2020
http://www.doi.org/10.37201/req/085.2020
Objective. The aim of the study was to know the characteristics and risk factors of Clostridioides difficile infection (CDI) in a long-term hospital is key to improve its management.
Material and methods. Retrospective study with 37 patients, along 43 months. We describe demographic variables, clinical data, time to diagnosis, treatment, and evolution.
Results. Analysis of 46 episodes (37 patients, mean age=82.2 years). 77.8% were absolutely dependent, 41.7% had chronic kidney disease, 64.9% had received antibiotics in the previous three months, 40.5% received antibiotics at diagnosis. It was the first episode in 78.4%, and first recurrence in 21.6%. Therapy was started in the first 24 hours after diagnosis in 89.2%, mostly metronidazole. 83.3% recovered, 3 patients died from CDI, diagnosis was registered in the discharge report in 91.1%.
Conclusions. Previous antibiotic therapy, high grade of dependency and renal failure were the main risk factors. There is room for improvement in CDI management at our hospital.
Rev Esp Quimioter 2021; 34(1): 51-55 [Full-text PDF]
VICTORIA GARCÍA ZAFRA, ALICIA HERNÁNDEZ TORRES, ELISA GARCÍA VÁZQUEZ, TERESA SORIA COGOLLOS, MANUEL CANTERAS JORDANA, JOAQUÍN RUIZ GÓMEZ, JOAQUÍN GÓMEZ GÓMEZ, ANTONIO HERNÁNDEZ MARTÍNEZ, JOSÉ BARBERÁN
Published: 27 November 2020
http://www.doi.org/10.37201/req/101.2020
Purpose. Methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) may complicate the treatment of diabetic foot infections (DFIs). The aim of this study was to determine the risk factors for these pathogens in DFIs.
Material and methods. This was a prospective observational study of 167 consecutive adult patients with DFIs. The diagnosis and severity of DFIs were based on the Infectious Disease Society of America (IDSA) classification system. Multivariate analyses were performed in order to identify risk factors for MRSA and ESBL-E infections.
Results. S. aureus was the most isolated pathogen (n=82, 37.9 %) followed by Escherichia coli (n= 40, 18.5%). MRSA accounted for 57.3% of all S. aureus and 70% of Klebsiella pneumoniae and 25% of E. coli were ESBL producers, respectively. Deep ulcer [OR 8,563; 95% CI (1,068-4,727)], previous use of fluoroquinolones [OR 2,78; 95% CI (1,156-6,685)] and peripheral vasculopathy [OR 2,47; 95% CI (1.068-4.727)] were the independent predictors for MRSA infections; and osteomyelitis [OR 6,351; 95% CI (1,609-25,068)] and previous use of cephalosporins [OR 5,824; 95% CI (1,517-22,361)] for ESBL-E infections.
Conclusions. MRSA and ESBL-E have adquired a great clinical relevance in DFIs. The availability of their risk factors is very convenient to choose the empirical treatment in severe forms.
Rev Esp Quimioter 2020; 33(6): 430-435 [Full-text PDF]
M. DOLORES FOLGUEIRA LÓPEZ
Published: 24 November 2020
http://www.doi.org/10.37201/req/127.2020
Rev Esp Quimioter 2020; 33(6): 390-391 [Texto completo PDF]
ALICIA GODOY HURTADO, CARMEN LIÉBANA MARTOS, PATRICK BARTSCHI, RAJAB AL-GHANEM, JOSÉ MANUEL GALICIA BULNES, JAZMÍN SALDÍVAR GÓMEZ
Published: 23 November 2020
http://www.doi.org/10.37201/req/069.2020
Rev Esp Quimioter 2021; 34(1): 61-63 [Texto completo PDF]
CRISTIAN ROSAS ESPINOZA, JOSÉ MANUEL CARO TELLER, GUILLERMO MAESTRO DE LA CALLE, MARÍA ARRIETA LOITEGUI, JOSÉ MIGUEL FERRARI PIQUERO
Published: 19 November 2020
http://www.doi.org/10.37201/req/082.2020
Objectives. The increase in infections with multidrug resistant bacteria has forced to return to the use of colistin, antibiotic with known nephrotoxicity. The aim of the study is to determine the incidence of colistin nephrotoxicity nowadays.
Material and methods. Retrospective-observational-unicentric study was collected hospitalized patients in intravenous colistin treatment during the years 2018-2019. Nephrotoxicity was defined according to the RIFLE scale. The variables to determine it were serum creatinine (sCr) and glomerular filtration (GF). The variables analyzed were age, sex, treatment duration, loading and cumulative dose, empirical/targeted treatment, chronic kidney disease, concomitant use of intravenous contrast and nephrotoxic drugs.
Results. A total of 90 patients (60% men) were included, with an average age of 58.2±18.1 years. The mean duration of treatment was 9±8.3 days, with an average cumulative dose of 69.8±71MU. There were no differences between sCr and GF at the beginning and end of treatment. The incidence of nephrotoxicity was 1.73 cases/100 days of treatment (prevalence of 15.56%).
Conclusions. Colistin nephrotoxicity has an important incidence, without developing severe illness.
Rev Esp Quimioter 2021; 34(1): 12-17 [Texto completo PDF]
RAÚL ORTIZ DE LEJARAZU, FEDERICO MARTINÓN TORRES, ÁNGEL GIL DE MIGUEL, JAVIER DÍEZ DOMINGO, ESTHER REDONDO MARGUELLO
Published: 19 November 2020
http://www.doi.org/10.37201/req/110.2020
Adults aged 65 years or older suffer the most severe health effects of seasonal flu. Although the influenza vaccine is effective in preventing influenza virus infection and its complications, it is not as effective in the elderly due to
age-associated immunosenescence phenomenon. Since 2009, a high-dose trivalent influenza vaccine has been approved in the United States for the immunization of people ≥ 65 years with an antigen concentration four times higher than the standard vaccine. Multiple clinical trials carried out over different seasons, and using different methodologies, have shown that the high-dose trivalent influenza vaccine is not only more effective, but it also has a similar safety profile and is more immunogenic than the standard dose vaccine in the prevention of flu and its complications in the elderly. This document reviews the current scientific evidence on the safety and immunogenicity of high-dose influenza vaccine in people aged 65 years and over, and includes information from randomized clinical trials, observational studies with data from real clinical practice, and systematic reviews, and meta-analysis.
Rev Esp Quimioter 2021; 34(1): 1-11 [Texto completo PDF]
REYES SERRANO GIMÉNEZ, JARA GALLARDO ANCIANO, MARÍA AGUAS ROBUSTILLO CORTÉS, JOSÉ RAMÓN BLANCO RAMOS, ANTONIO GUTIÉRREZ PIZARRAYA, RAMÓN MORILLO VERDUGO
Published: 16 November 2020
http://www.doi.org/10.37201/req/084.2020
Objectives. HIV population is aging at an earlier age than those uninfected, requiring more non-HIV medications to treat noncommunicable diseases. In the context of chronic HIV infection, the next therapeutic change would be the polymedication control. This paper has the purpose of explore the attitudes of older people living with HIV toward deprescribing.
Material and methods. This was an observational, prospective and multicenter study conducted from March-April, 2018. People living with HIV (PLWH) on highly active antiretroviral therapy and older than 65 years were included. In addition to demographic and pharmacotherapeutic data, attitudes regarding deprescribing were collected through the “Revised Patients’ Attitudes Towards Deprescribing Questionnaire”.
Results. A total of 42 patients were included in this study. Regarding their attitudes in relation to deprescription, there were three statements with the most consensuses. The first (“I have a good understanding of the reasons I was prescribed each of my medicines”) had 91.9% consensus. The second and third questions showed 89.2% consensus in both cases; “Overall, I am satisfied with my current medicines” and “I like to be involved in making decisions about my medicines with my doctors”.
Conclusions. This study is the first to explore the beliefs and attitudes of older PLWH in relation to deprescription process. There are positive attitudes regarding medication knowledge but there also is a percentage of patients who had a negative opinion regarding deprescription. We must study and go deeper in our knowledge of techniques that could help us to better understand their preferences, in order to establish effective and successful deprescription strategies.
Rev Esp Quimioter 2021; 34(1): 18-27 [Full-text PDF]
MARÍA JOSÉ GONZÁLEZ-ABAD, MERCEDES ALONSO SANZ
Published: 3 November 2020
http://www.doi.org/10.37201/req/094.2020
Rev Esp Quimioter 2020; 33(6): 464-465 [Texto completo PDF]
