Impact of ceftazidime/avibactam versus best available therapy on mortality from infections caused by carbapenemase-producing Enterobacterales (CAVICOR study).

BACKGROUND: Infections caused by carbapenemase-producing Enterobacterales (CPE) are not well represented in pivotal trials with ceftazidime/avibactam. The best strategy for the treatment of these infections is unknown. METHODS: We conducted a multicentre retrospective observational study of patients who received ≥48 h of ceftazidime/avibactam or best available therapy (BAT) for documented CPE infections. The primary outcome was 30 day crude mortality. Secondary outcomes were 21 day clinical response and microbiological response. A multivariate logistic regression model was used to identify factors predictive of 30 day crude mortality. A propensity score to receive treatment with ceftazidime/avibactam was used as a covariate in the analysis. RESULTS: The cohort included 339 patients with CPE infections. Ceftazidime/avibactam treatment was used in 189 (55.8%) patients and 150 (44.2%) received BAT at a median of 2 days after diagnosis of infection. In multivariate analysis, ceftazidime/avibactam treatment was associated with survival (OR 0.41, 95% CI 0.20-0.80; P = 0.01), whereas INCREMENT-CPE scores of >7 points (OR 2.57, 95% CI 1.18-1.5.58; P = 0.01) and SOFA score (OR 1.20, 95% CI 1.08-1.34; P = 0.001) were associated with higher mortality. In patients with INCREMENT-CPE scores of >7 points, ceftazidime/avibactam treatment was associated with lower mortality compared with BAT (16/73, 21.9% versus 23/49, 46.9%; P = 0.004). Ceftazidime/avibactam was also an independent factor of 21 day clinical response (OR 2.43, 95% CI 1.16-5.12; P = 0.02) and microbiological eradication (OR 0.40, 95% CI 0.18-0.85; P = 0.02). CONCLUSIONS: Ceftazidime/avibactam is an effective alternative for the treatment of CPE infections, especially in patients with INCREMENT-CPE scores of >7 points. A randomized controlled trial should confirm these findings.

[Constitutional syndrome: clinical entity or a mixed bag]. / Síndrome constitucional: entidad clínica o cajón de sastre.

Fatigue, anorexia and involuntary weight loss have been included under the term constitutional syndrome. These manifestations accompany many diseases in which the diagnosis is made by specific symptoms and signs. However, these events are generally the main reason for consultation and the patient does not report other specific data. This forces us to rigorously investigate the possible causes of the disorder. Usually, three manifestations coexist: asthenia, anorexia and weight loss, but sometimes the patient has only one or two of them. The causes of constitutional symptoms are varied and can be divided into three groups: psychiatric diseases, neoplasms and non-neoplastic diseases. The etiological identification is usually done with a simple protocol, which rules out malignancy; the rest of the cases of uncertain etiology are subject to evolution. The constitutional syndrome correlates well with good prognosis or medical functional processes. Although no clinical guidelines have been developed, score scales may help for the etiological assessment. Given the myriad of different causes of the constitutional syndrome, the treatment of this illness depends primarily on the etiology.

Bajo el término de síndrome constitucional se engloba la manifestación de astenia, anorexia y pérdida involuntaria de peso. Por separado o juntas, estas manifestaciones acompañan a muchas enfermedades cuyo diagnóstico se formula por otros síntomas y signos específicos. Sin embargo, en ocasiones, son el motivo principal de consulta, sin que el paciente refiera otros datos orientadores. Ello obliga a indagar de forma rigurosa las posibles causas del trastorno. Por lo general coexisten las tres manifestaciones (astenia, anorexia y pérdida de peso), pero a veces solo existe una o dos. Las causas del síndrome constitucional son variadas, pero en una primera aproximación pueden dividirse en tres grandes grupos: psiquiátricas, neoplásicas y orgánicas no neoplásicas. Generalmente la identificación etiológica se realiza con un protocolo sencillo que descarta neoplasia; algunos casos de etiología incierta se correlacionan con enfermedades médicas de buen pronóstico o con procesos funcionales. Aunque no existen guías de estudio, se han creado tablas de puntuación que ayudan a la valoración etiológica. Dada la miríada de causas de naturaleza diversa, el tratamiento del síndrome constitucional depende básicamente de su etiología.

Helicobacter pylori and cagA seroprevalence in sub-Saharan inmigrants recently arrived to Gran Canaria (Spain).

Non-ulcerous dyspepsia is common among sub-Saharan people migrating into Spain. Given the high prevalence of H. pylori (HP) infection in their countries of origin, we studied the prevalence of infection in this population, and specifically the prevalence of infection by the more virulent, cagA-positive strains (CAP). 140 sub-Saharan immigrants recently arrived to Gran Canaria (Canary Islands, Spain) were studied. 80.7% were male, with a mean age of 24.2 y. 90.7% tested seropositive for HP and 72.2% of them carried antibodies against the 'pathogenicity island' cagA. We did not find any relationship between the presence of these antibodies and the clinical variables studied. We can conclude that HP infection is virtually universal in this population, with a high percentage of infection by CAP strains.