(Importance of blood cultures results: and special attention for applicants from the Emergency Departament)
RAFAEL RUBIO DÍAZ, ISABEL NIETO ROJAS, AGUSTÍN JULIÁN-JIMÉNEZ
Published: 10 September 2020
http://www.doi.org/10.37201/req/075.2020
LETTER TO THE EDITOR
Rev Esp Quimioter 2020; 33(6): 459-461 [Texto completo PDF]
EMILIO BOUZA, FRANCISCO JOSÉ BRENES, JAVIER DÍEZ DOMINGO, JOSÉ MARÍA EIROS BOUZA, JOSÉ GONZÁLEZ, DIEGO GRACIA, RICARDO JUÁREZ GONZÁLEZ, PATRICIA MUÑOZ, ROBERTO PETIDIER TORREGROSSA, JOSÉ MANUEL RIBERA CASADO, PRIMITIVO RAMOS CORDERO, EDUARDO RODRÍGUEZ ROVIRA, MARÍA EVA SÁEZ TORRALBA, JOSÉ ANTONIO SERRA REXACH, JAVIER TOVAR GARCÍA, CARLOS VERDEJO BRAVO, ESTEBAN PALOMO
Published: 8 September 2020
http://www.doi.org/10.37201/req/057.2020
Infection in the elderly is a huge issue whose treatment usually has partial and specific approaches. It is, moreover, one of the areas where intervention can have the most success in improving the quality of life of older patients. In an attempt to give the widest possible focus to this issue, the Health Sciences Foundation has convened experts from different areas to produce this position paper on Infection in the Elderly, so as to compare the opinions of expert doctors and nurses, pharmacists, journalists, representatives of elderly associations and concluding with the ethical aspects raised by the issue. The format is that of discussion of a series of pre-formulated questions that were discussed by all those present. We begin by discussing the concept of the elderly, the reasons for their predisposition to infection, the most frequent infections and their causes, and the workload and economic burden they place on society. We also considered whether we had the data to estimate the proportion of these infections that could be reduced by specific programmes, including vaccination programmes. In this context, the limited presence of this issue in the media, the position of scientific societies and patient associations on the issue and the ethical aspects raised by all this were discussed.
Rev Esp Quimioter 2020; 33(5): 327-349 [Full-text PDF]
ALEJANDRO DE ARRIBA-FERNÁNDEZ, MANUEL JESÚS MOLINA-CABRILLANA, ANA HERNÁNDEZ-ACEITUNO, FERNANDO JOSÉ GARCÍA-LÓPEZ
Published: 12 August 2020
http://www.doi.org/10.37201/req/066.2020
Background. Antibiotic resistance is a threat to global public health. This situation makes essential to establish programs to optimize antimicrobial use (PROA). Training needs are identified in the PROA of resident physicians and the results of the analysis of the associations between study variables and training in the rational and prudent use of antibiotics are presented in this analysis.
Methods. Cross-sectional and analytical study through a self-administered questionnaire to a group of 506 medical residents of the province of Las Palmas. The association between resident’s characteristics and PROA training was calculated through logistic regression.
Results. The associations between response variance and speciality were observed in most of the core component analysis (opportunity p=0.003, training p=0.007, motivation p=0.055 and hand hygiene p=0.044), followed by variance according to sex (capacity p=0.028, theoretical knowledge p=0.013, hand hygiene p=0.002). Very few differences were associated with age (capacity p=0,051 and hand hygiene p=0,054) or the year of expertise (hand hygiene p=0,032).
Conclusions. The main training needs of resident physicians include one health, motivation, training, hand hygiene and information. The type of speciality followed by sex are the most important determinants on antibiotic use and resistance for resident physicians.
Rev Esp Quimioter 2020; 33(6): 399-409 [Texto completo PDF] [Material suplementario]
(Enfermedades infecciosas emergentes: Meningitis por Streptococcus suis)
JORGE JOVER-GARCÍA, CELIA LÓPEZ-MILLÁN, JESÚS J. GIL-TOMÁS
Published: 7 August 2020
http://www.doi.org/10.37201/req/055.2020
LETTER TO THE EDITOR
Rev Esp Quimioter 2020; 33(5): 385-386 [Full-text PDF]
JULIO VILLANUEVA, LARA MONTES-ANDUJAR, ORVILLE V BAEZ-PRAVIA, ERIC JORGE GARCÍA-LAMBERECHTS, JUAN GONZÁLEZ DEL CASTILLO, ANDRÉS RUIZ, CARMEN ZURDO, JOSÉ BARBERÁN, JUSTO MENÉNDEZ, PABLO CARDINAL-FERNÁNDEZ
Published: 5 August 2020
http://www.doi.org/10.37201/req/063.2020
Introduction. The aims of the study were: to develop a predictive model for hospital mortality and another for hospital re-admission, to identify the impact of antibiotic delay in the mortality rate and, to report the rate of inappropriate antibiotic therapy.
Material and methods. A cohort and retrospective study was conducted at the HM Sanchinarro University Hospital during the period September 1st, 2012 to March 31th, 2013. The inclusion criteria were: age> 18 years, hospital admission from the ED with a diagnosis of bacterial infection. The exclusion criteria were: suspected viral infection, negative bacteriological cultures, life expectancy less than 6 months, lack of clinical information, assistance exclusively by the trauma emergency department. Two logistic models were made (hospital mortality and hospital re-admission).
Results. A total of 517 patients were included. The final mortality model (30 deaths) include the following variables: respiratory rate (OR 1.12; IC95% 1.02; 1.22), oxygen saturation (OR 0.92; IC95% 0.87; 0.98), creatinine (OR 2.33; IC95% 1.62; 3.36), COPD (OR 3.02; IC95% 1.06; 8.21), cancer (OR 3.34; IC95% 1.07; 9.98) and chemotherapy in the last 3 months (OR 4.83; IC95% 1.54; 16.41). The final model for hospital re-admission (28 re-admissions) include the following variables: hepatopathy (OR 5.51; IC95% 1.57; 16.88), GPT (OR 1.005; IC95% 1.003; 1.008), history of stroke (OR 5.06; IC95% 1.04; 18.80) and arterial hypertension (OR 3.15; IC95% 1.38; 7.56). The antibiotic therapy delays not influenced the mortality or re-admission rate. In 24.3% the causative microorganism was identified and antibiotic treatment was inappropriate 19.6%.
Conclusion. Hospital mortality rate was 5.8% and readmission rate was 5.7%. Variables associated with mortality differ from those associated with re-admission. The delay in the antibiotic initiation was not associated with a deleterious effect. Antibiotic therapy was inadequate in almost 20% of patients.
Rev Esp Quimioter 2020; 33(5): 350-357 [Texto completo PDF]
YOLANDA HERNÁNDEZ-HERMIDA, NEREA LÓPEZ-MUÑOZ, JUAN-IGNACIO ALÓS
Published: 3 August 2020
http://www.doi.org/10.37201/req/068.2020
Objective. The aim of the study wat to analyze the antibiotic susceptibility of the pathogens causing urinary tract infection (UTI) and to stratify the results in function of patient´s clinical and demographic dates.
Material and methods. The susceptibility of the pathogens isolated in the urine of 144 patients with UTI randomly chosen was analyzed. The results were stratified in function of sex, age, type of UTI, previous UTI and previous antibiotic treatment.
Results. The susceptibility of the all isolates and of the Escherichia coli isolates was analyzed. There were significant differences between groups in function of sex (fluoroquinolones), age (cefuroxime, ertapenem and gentamicin), type of UTI (cefuroxime, cefotaxime, ertapenem and fluoroquinolones), previous UTI and previous antibiotic treatment (cefotaxime, fluoroquinolones and fosfomycin).
Conclusions. The use of clinical and demographic data according to population and local resistance epidemiology of the pathogen causing UTI may help to select an adequate empirical treatment for UTI.
Rev Esp Quimioter 2020; 33(5): 379-382 [Texto completo PDF]
(Differential diagnosis of pneumonia at the time of COVID-19)
MARCOS FRAGIEL, JESÚS CANORA LEBRATO, FRANCISCO JAVIER CANDEL, ANTONIO ZAPATERO GAVIRIA, JAVIER MARCO MARTÍNEZ, JUAN GONZÁLEZ DEL CASTILLO
Published: 3 August 2020
http://www.doi.org/10.37201/req/058.2020
LETTER TO THE EDITOR
Rev Esp Quimioter 2020; 33(5): 387-389 [Texto completo PDF]
PATRICIA MUÑOZ, ALICIA GALAR, PILAR CATALÁN, MARICELA VALERIO, TERESA ALDAMIZ-ECHEVARRÍA, CARLOS CÓLLIGA, EMILIO BOUZA, ON BEHALF OF THE GREGORIO MARAÑÓN MICROBIOLOGY-ID COVID 19 STUDY GROUP
Published: 30 July 2020
http://www.doi.org/10.37201/req/072.2020
Background. There are few descriptions of the clinical presentation and evolution of consecutive SARS-CoV-2 infections with a long-enough follow up.
Methods. Description of the first consecutive 100 patients with microbiologically-proven COVID-19 in a large hospital in Madrid, Spain including a minimum of two-month follow up.
Results. The median age of the patients (52% males) was 61.5 years (IQR=39.5-82.0) and the median BMI was 28.8 kg/m2 (IQR=24.7-33.7). Overall 72% of the patients had one or more co-morbid conditions with a median age-adjusted Charlson index of 2 (IQR=0-5.7). Five patients (5%) were immunosuppressed. The most common symptoms at the time of diagnosis were fever (80.0%), cough (53.0%) and dyspnea (23.0%). The median O2 saturation at the time of first examination was 94% (IQR=90-97). Chest X-ray on admission was compatible with pneumonia in 63% of the cases (bilateral in 42% and unilateral in 21%). Overall, 30% were managed at home and 70% were admitted to the hospital. Thirteen patients were admitted to the ICU with a median of 11 days of stay in the Unit (IQR=6.0-28.0). CALL score of our population ranged from 4 to 13. Overall, 60.0% of patients received antibiotic treatment and 66.0%, empirical antiviral treatment, mainly with lopinavir/ritonavir (65%) or hydroxychloroquine (42%). Mortality, with a minimum of 60 days of follow up, was 23%. The median age of the deceased patients was 85 years (IQR=79-93).
Conclusions. We found a high mortality in the first 100 patients diagnosed with COVID-19 at our institution, associated with advanced age and the presence of serious underlying diseases.
Rev Esp Quimioter 2020; 33(5): 369-378 [Full-text PDF]
FRANCISCO ARNAÍZ DE LAS REVILLAS, DOLORES SOUSA, CARMEN ARDANUY, CAROLINA GARCÍA-VIDAL, MIGUEL MONTEJO, REGINO RODRÍGUEZ-ÁLVAREZ, JUAN PASQUAU, EMILIO BOUZA, JOSÉ A. OTEO, CÉSAR BALSEIRO, CRISTINA MÉNDEZ, NADIA LWOFF, PEDRO LLINARES, MARÍA CARMEN FARIÑAS, ON BEHALF OF THE SOCRATES STUDY GROUP
Published: 22 July 2020
http://www.doi.org/10.37201/req/067.2020
Objective. The aim of the study was to describe the epidemiological characteristics and factors related to outcome in Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated pneumonia (HCAP).
Patients and method. A 3-year prospective observational epidemiological case study of HCAP was conducted in seven Spanish hospitals. Microbiological and patient characteristics and outcomes were collected and classified by causative pathogen into 4 categories: “S. pneumoniae”, “MRSA”, “Others” and “Unknown”. Patients were followed up 30 days after discharge.
Results. A total of 258 (84.6%) patients were enrolled (170 were men [65.9%]). Mean age was 72.4 years ± 15 years (95% CI [70.54-74.25]). The etiology of pneumonia was identified in 73 cases (28.3%): S. pneumoniae in 35 patients (13.6%), MRSA in 8 (3.1%), and other microorganisms in 30 patients (11.6%). Significant differences in rates of chronic obstructive pulmonary disease (p < 0.05), previous antibiotic treatment (p< 0.05), other chronic respiratory diseases, inhaled corticosteroids (p < 0.01), and lymphoma (p < 0.05) were observed among the four groups. Patients with MRSA pneumonia had received more previous antibiotic treatment (87.5%). Thirty-three (12.8%) patients died during hospitalisation; death in 27 (81.2%) was related to pneumonia.
Conclusions. The etiology of HCAP was identified in only one quarter of patients, with S. pneumoniae being the most prevalent microorganism. Patients with chronic respiratory diseases more frequently presented HCAP due to MRSA than to S. pneumoniae. Death at hospital discharge was related in most cases to pneumonia.
Rev Esp Quimioter 2020; 33(5): 358-368 [Full-text PDF]
NOELIA RODRÍGUEZ-BLANCO, IRENE VEGARA-LOPEZ, LORETO ALEO-GINER, JOSÉ TUELLS
Published: 20 July 2020
http://www.doi.org/10.37201/req/064.2020
Background. The appearance of new infectious diseases, such as COVID-19, poses a challenge in monitoring pregnancy and preventing obstetric and neonatal complications. A scoping review has the objective to review the information available in pregnant women infected with the MERS-CoV, SARSCoV, SARS-CoV-2 coronaviruses to assess the similarities in terms of and differences in the clinical characteristics of the mothers and neonatal outcomes.
Methods. We carried out a bibliographic search (scoping review) according to the PRISMA guidelines between March and April 2020 in the MEDLINE, SciELO, and CUIDEN databases and the Elsevier COVID-19 Information Center.
Results. We analyzed 20 articles with a total of 102 cases. 9 of MERS-CoV, 14 of SARS-CoV and 79 of SARS-CoV-2. Fever (75.5%) and pneumonia (73.5%) were the most frequent symptoms in infected pregnant women. The most frequent obstetric complications were the threat of premature delivery (23.5%) and caesarean section (74.5%). No vertical transmission was documented in any of the infants.
Conclusions. All three coronaviruses produce pneumonia with very similar symptoms, being milder in the case of SARSCoV2. Despite documented obstetric complications, neonatal outcomes are mostly favorable. Increased knowledge is needed to improve and prevent obstetric and neonatal complications from these infections in pregnant women.
Rev Esp Quimioter 2020; 33(5): 313-326 [Texto completo PDF]
