Use of Monoclonal Antibodies in Immunocompromised Patients Hospitalized with Severe COVID-19: A Retrospective Multicenter Cohort.

OBJECTIVE: We aim to describe the safety and efficacy of sotrovimab in severe cases of COVID-19 in immunocompromised hosts. METHODS: We used a retrospective multicenter cohort including immunocompromised hospitalized patients with severe COVID-19 treated with sotrovimab between October 2021 and December 2021. RESULTS: We included 32 patients. The main immunocompromising conditions were solid organ transplantation (46.9%) and hematological malignancy (37.5%). Seven patients (21.9%) had respiratory progression: 12.5% died and 9.4% required mechanical ventilation. Patients treated within the first 14 days of their symptoms had a lower progression rate: 12.0% vs. 57.1%, p = 0.029. No adverse event was attributed to sotrovimab. CONCLUSIONS: Sotrovimab was safe and may be effective in its use for immunocompromised patients with severe COVID-19. More studies are needed to confirm these preliminary data.

Study of a Cohort of Patients With Cystic Fibrosis and Isolation of Scedosporium spp. / Estudio de una cohorte de paciente con fibrosis quística y Scedosporium spp.

INTRODUCTION: In recent years an increase in the prevalence of colonization and infection by Scedosporium spp. in patients with cystic fibrosis (CF) has been observed. In this article, we study the frequency of isolation of Scedosporium spp. in an adult CF Unit, analyzing characteristics of the patients and predisposing factors. METHODS: A retrospective observational study was conducted in 87 adult CF patients in whom the presence of positive culture for Scedosporium spp. was tested for a 5-year period (January 2012-July 2017). We recorded the following clinical variables: age, sex, body mass index, genotype, presence of pancreatic insufficiency, bacterial colonization, lung function, other complications, exacerbations and treatment, and the modified Bhalla score from the last high-resolution computed tomography. Results were analyzed with IBM SPSS Statistics Version 22.0 software. RESULTS: Scedosporium spp. was isolated in 25.3% of patients. In the bivariate analysis, these patients showed a higher rate of Pseudomonas aeruginosa infection, worse score in the Bhalla classification (highlighting the following items: bronchiectasis, mucus plugs and bronchial generations), a slight decrease in the lung diffusion capacity and more frequently received inhaled antibiotics. In the logistic regression multivariate analysis, only the bronchial generations item was significant. CONCLUSION: Scedosporium spp. must be considered an emerging opportunistic pathogen in patients with CF whose clinical involvement, risk factors or need for treatment is unknown.

Sotrovimab: una opción terapéutica en trasplante pulmonar / Sotrovimab: a therapeutic option in lung transplant patients

Antecedentes: Los trasplantados pulmonares son un grupo con mayor riesgo de desarrollar enfermedad por coronavirus 2019 (COVID-19) grave. El sotrovimab demostró reducir el riesgo de progresión de enfermedad y ha sido utilizado en pacientes con trasplante de órgano sólido, pero no ha sido estudiado en trasplantados pulmonares. Objetivo: Describir la evolución de la COVID-19 en trasplantados pulmonares tratados con sotrovimab. Material y métodos: Estudio observacional retrospectivo que incluyó trasplantados pulmonares que recibieron sotrovimab para la COVID-19 entre 2021 y 2022. Resultados: Se estudiaron 33 pacientes, 19 varones, con edad media de 61 años, 24 de ellos trasplantados bipulmonares, siendo las causas más frecuentes la enfermedad pulmonar intersticial difusa y la enfermedad pulmonar obstructiva crónica. El 90% requirieron ingreso. La mayoría necesitó algún tipo de soporte respiratorio, pudiéndose manejar el 39% con bajo flujo. El 42% presentaron sobreinfecciones, el 12% tromboembolia pulmonar y el 58% insuficiencia renal aguda. Seis pacientes fallecieron. Conclusiones: Este estudio presenta resultados similares a otros realizados en pacientes con trasplante de otro órgano sólido que recibieron sotrovimab respecto a tasas de hospitalización, mortalidad y seguridad. Se describe una menor mortalidad respecto a estudios previos de trasplantados pulmonares con infección por coronavirus 2 del síndrome respiratorio agudo grave previo al uso de sotrovimab. Este estudio sugiere que el sotrovimab es una opción terapéutica válida para la COVID-19 en trasplantados pulmonares. (AU)

Background: Lung transplant recipients are a group at higher risk of developing severe coronavirus disease 2019 (COVID-19). Sotrovimab has demonstrated a reduction in the risk of disease progression and has been used in solid organ transplant patients, but it has not been studied in lung transplant recipients. Objective: To describe the course of COVID-19 in lung transplant recipients treated with sotrovimab. Material and methods: Retrospective observational study included lung transplant recipients who received sotrovimab for COVID-19 between 2021 and 2022. Results: Thirty-three patients were studied, 19 males, with an average age of 61 years, and 24 of them had received bilateral lung transplants, with the most common causes being diffuse interstitial lung disease and chronic obstructive pulmonary disease; 90% required hospitalization. The majority needed some form of respiratory support, with 39% manageable with low-flow oxygen. Superinfections were observed in 42% of cases, pulmonary embolism in 12%, and acute renal failure in 58%. Six patients died. Conclusions: This study presents results similar to those conducted in patients with transplants of other solid organs who received sotrovimab in terms of hospitalization rates, mortality, and safety. A lower mortality rate is described compared to previous studies of lung transplant recipients with severe acute respiratory syndrome coronavirus 2 infection before the use of sotrovimab. This study suggests that sotrovimab is a valid therapeutic option for COVID-19 in lung transplant recipients. (AU)

Deterioro clínico por Exophiala dermatitidis en un paciente con fibrosis quística / Clinical Deterioration Due to Exophiala Dermatitidis in a Patient with Cystic Fibrosis

No disponible

Actinomicosis pulmonar en paciente con neumonía eosinófila crónica en tratamiento con omalizumab / Pulmonary Actinomycosis in a Patient with Chronic Eosinophilic Pneumonia treated with Omalizumab

No disponible

Adecuación del nivel de intervención en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) según la estratificación de riesgo propuesta por la Guía española de la EPOC (GesEPOC) versión 2017 / Adjusting the Level of Intervention in Patients with Chronic Obstructive Pulmonary Disease According to the Risk Stratification Proposed by the Spanish COPD Guidelines (GesEPOC) Version 2017

No disponible

Estudio de una cohorte de paciente con fibrosis quística y Scedosporium spp / Study of a Cohort of Patients With Cystic Fibrosis and Isolation of Scedosporium spp

Introducción: En los últimos años se observa un aumento de la prevalencia de colonización e infección por Scedosporium spp. en pacientes con fibrosis quística (FQ). En el presente estudio se registra la frecuencia de aislamiento de Scedosporium spp. en una Unidad de FQ de adultos, analizándose las características de los pacientes y los factores predisponentes. Métodos: Se realizó un estudio observacional retrospectivo en 87 pacientes adultos con FQ en los que se valoró la presencia de cultivo positivo para Scedosporium spp. durante 5 años (enero de 2012-julio de 2017). Se recogieron las siguientes variables clínicas: edad, sexo, índice de masa corporal, genotipo, presencia de insuficiencia pancreática, colonizaciones bacterianas, función pulmonar, complicaciones, exacerbaciones y tratamiento, así como puntuación Bhalla modificada de la última tomografía computarizada axial de alta resolución. Los resultados se analizaron con el paquete estadístico IBM SPSS Statistics Version 22.0. Resultados: En un 25,3% de los pacientes se aisló Scedosporium spp. En el análisis bivariante se observó en estos enfermos más frecuencia de Pseudomonas aeruginosa, peor puntuación en la clasificación de Bhalla (destacando los ítems presencia de bronquiectasias, tapones mucosos y generaciones bronquiales), un descenso leve en la capacidad de difusión pulmonar (DLCO) y que recibían con más frecuencia antibioterapia inhalada. En el análisis multivariante de regresión logística únicamente el ítem generaciones bronquiales fue significativo. Conclusiones: Scedosporium spp. debe considerarse un patógeno oportunista emergente en pacientes con FQ del que se desconoce su implicación clínica, factores de riesgo o necesidad de tratamiento

Introduction: In recent years an increase in the prevalence of colonization and infection by Scedosporium spp. in patients with cystic fibrosis (CF) has been observed. In this article, we study the frequency of isolation of Scedosporium spp. in an adult CF Unit, analyzing characteristics of the patients and predisposing factors. Methods: A retrospective observational study was conducted in 87 adult CF patients in whom the presence of positive culture for Scedosporium spp. was tested for a 5-year period (January 2012-July 2017). We recorded the following clinical variables: age, sex, body mass index, genotype, presence of pancreatic insufficiency, bacterial colonization, lung function, other complications, exacerbations and treatment, and the modified Bhalla score from the last high-resolution computed tomography. Results were analyzed with IBM SPSS Statistics Version 22.0 software. Results: Scedosporium spp. was isolated in 25.3% of patients. In the bivariate analysis, these patients showed a higher rate of Pseudomonas aeruginosa infection, worse score in the Bhalla classification (highlighting the following items: bronchiectasis, mucus plugs and bronchial generations), a slight decrease in the lung diffusion capacity and more frequently received inhaled antibiotics. In the logistic regression multivariate analysis, only the bronchial generations item was significant. Conclusion: Scedosporium spp. must be considered an emerging opportunistic pathogen in patients with CF whose clinical involvement, risk factors or need for treatment is unknown