Treatment guidelines for multidrug-resistant Gram-negative microorganisms

RAFAEL CANTÓN, PATRICIA RUIZ-GARBAJOSA

Published: 24 November 2023

http://www.doi.org/10.37201/req/s01.11.2023

ABSTRACT
In recent years, new antimicrobials have been introduced in therapeutics, including new beta-lactam-beta-lactamase inhibitor combinations and cefiderocol in response to therapeutic needs in the face of increasing resistance. There are also different treatment guidelines for infections caused by these microorganisms that have been approved by different professional societies, including those of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the Infectious Disease Society of America (IDSA) and the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). All of them are based on scientific evidence, but with differences in the weight of expert opinion in their recommendations. Both ESCMID and IDSA include recommendations for the treatment of extended-spectrum beta-lactamase-producing microorganisms. The IDSA is the only one including AmpC producers, all address the treatment of infections caused by carbapenem-resistant Enterobacterales and Acinetobacter baumannii and multidrug-resistant or difficult-to-treat Pseudomonas aeruginosa, and the IDSA and SEIMC include recommendations on the treatment of Stenotrophomonas maltophilia. Future guidelines should integrate new antimicrobials and new innovative management options not covered by current guidelines.

Rev Esp Quimioter 2023; 36(Suppl.1):46-51 [Full-text PDF]

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Group A Streptococcus invasive infection in children: Epidemiologic changes and implications

JOSÉ TOMÁS RAMOS AMADOR, ARANTXA BERZOSA SÁNCHEZ, MARTA ILLÁN RAMOS

Published: 24 November 2023

http://www.doi.org/10.37201/req/s01.09.2023

ABSTRACT
Group A Streptococcus (GAS) can cause a broad array of clinical manifestations and complications. Recently, in post COVID-19 postpandemic months, there has been an increased incidence and severity of invasive infections in the pediatric age group in Spain and other European countries with high morbidity, affecting mostly to young children, associated with seasonal peaks in incidence of viral respiratory pathogens. The increased in incidence and severity has not been associated with predominant GAS strains, but rather to the lack of immunity to both GAS and common viral respiratory infections due to isolation measures to prevent COVID-19. Due to the nonspecific initial clinical manifestations a high index of suspicion is necessary in order to initiate a prompt medical and surgical treatment when necessary to improve the outcome. Prevention strategies are needed as well as continuous microbiological surveillance of iGAS strains.

Rev Esp Quimioter 2023; 36(Suppl.1):33-36 [Full-text PDF]

Clinical experience in the treatment of COVID-19 with monoclonal antibodies in solid organ transplant recipients

ELENA MÚÑEZ-RUBIO, JORGE CALDERÓN-PARRA, ANDREA GUTIÉRREZ-VILLANUEVA, ANA FERNÁNDEZ-CRUZ, ANTONIO RAMOS-MARTÍNEZ

Published: 24 November 2023

http://www.doi.org/10.37201/req/s01.07.2023

ABSTRACT
Solid organ transplant (SOT) recipients are at high risk for complications from coronavirus disease 2019 (COVID-19). SOT recipients mount lower immunological responses to vaccines than general population and are at high risk for breakthrough COVID-19 infections. Passive immunotherapy in the form of anti-Spike monoclonal antibodies (MoAbs) may be an alternative for the prophylaxis and treatment of COVID-19 in these patients. SARS-CoV-2 has evolved by accumulating resistance mutations that have escaped the neutralizing action of most MoAbs. However, MoAbs directed at more conserved epitopes and that maintain effector functions could maintain efficacy in the treatment of these patients. According to published data, SOT recipients with low anti-spike antibody responses to vaccination could benefit from the use of MoAbs in pre-exposure prophylaxis, in the treatment of COVID-19 mild to moderate and severe COVID-19 with less than 15 days of symptom duration and low oxygen requirements. Combination therapy could be more effective than monotherapy for the treatment of mild-to-moderate SARS-CoV-2 infection.

Rev Esp Quimioter 2023; 36(Suppl.1):25-28 [Full-text PDF]

Therapeutic strategy in the transplanted patients

MARIA JOSÉ NÚÑEZ-ORANTOS, AGUSTÍN JULIÁN-JIMÉNEZ, FRANCISCO JAVIER CANDEL, JUAN GONZÁLEZ DEL CASTILLO

Published: 24 November 2023

http://www.doi.org/10.37201/req/s01.05.2023

ABSTRACT
The SARS-CoV-2 infection prognosis has dramatically changed as a result of population vaccination and the surge of omicron. However, there are still specific populations at risk of progression to severe diseases that require hospitalization or even at risk of death. The kidney transplant population is one of them. Consequently, when compatible symptoms appear, an early diagnosis should be sought in order to start specific antiviral treatment as soon as possible to avoid clinical deterioration of the patient. Antivirals have shown, in transplant patients, a decrease in the rate of hospitalization and death, especially with their early administration.

Rev Esp Quimioter 2023; 36(Suppl.1):18-21 [Full-text PDF]

Nosocomial pneumonia: Current etiology and impact on antimicrobial therapy

JULIO JAVIER GAMAZO, FRANCISCO JAVIER CANDEL, JUAN GONZÁLEZ DEL CASTILLO

Published: 24 November 2023

http://www.doi.org/10.37201/req/s01.03.2023

ABSTRACT
Nosocomial pneumonia is an infection with high clinical impact and high morbimortality in which Pseudomonas aeruginosa plays a priority role, especially in the critically ill patient. Conventional antipseudomonal treatments, historically considered as standard, are currently facing important challenges due to the increase of antimicrobial resistance. In recent years, new antimicrobials have been developed with attractive sensitivity profiles and remarkable efficacy in clinical scenarios of nosocomial pneumonia including bacteremia, mechanical ventilation, infections with multidrug-resistant organisms or situations of therapeutic failure. This new evidence underscores the need to update current clinical guidelines for the antimicrobial treatment of nosocomial pneumonia, especially in the most critically ill patients.

Rev Esp Quimioter 2023; 36(Suppl.1):9-14 [Full-text PDF]