Experience in the use of remdesivir in patients with SARS-CoV-2 pneumonia.

OBJECTIVE: To describe the effectiveness and safety of remdesivir in patients with SARS-CoV-2 pneumonia in real-world clinical practice  conditions. METHOD: Retrospective observational study that included all adults with  SARS-CoV-2 pneumonia admitted at the Moisès Broggi Hospital and  treated with remdesivir between July 1st and November 7th, 2020.  Efficacy outcomes were time to recovery, 28-day mortality, length of  hospital stay, and the need of mechanical ventilation after treatment. The  main safetyrelated endpoint was elevation of transaminases after  treatment. RESULTS: A total of 111 patients were included of whom 97 (87.4%) were receiving low-flow oxygen therapy. Median time to recovery was 9  days [6-14]. Seven patients (6.3%) died at 28 days' follow-up. Median  length of hospital stay was 12 days [9-22] and 15 patients (13.5%)  needed mechanical ventilation after treatment with remdesivir. Severe  hypertransaminasemia was observed in 4 patients (4%). CONCLUSIONS: Clinical outcomes of patients with SARS-CoV-2 pneumonia on low-flow oxygen therapy treated with remdesivir were  similar to those published in clinical trials, both in terms of time to  recovery and 28-day mortality.

Objetivo: Describir la efectividad y seguridad de remdesivir en pacientes con neumonía por SARS-CoV-2 en condiciones de práctica clínica real.Método: Estudio observacional retrospectivo que incluyó a todos los pacientes tratados con remdesivir en el Hospital Moisès Broggi entre el 1 de julio y el 7 de noviembre de 2020. Como variables de efectividad se registraron el tiempo hasta la recuperación, la mortalidad a  los 28 días, la estancia hospitalaria y la proporción de pacientes que  requirió ventilación mecánica invasiva tras el tratamiento. Como variable  de seguridad se registró la alteración en las transaminasas tras el  tratamiento.Resultados: Se incluyeron 111 pacientes, 97 (87,4%) con oxigenoterapia de bajo flujo. El tiempo hasta la recuperación fue de 9 días [6-14] de  mediana y 7 pacientes (6,3%) habían fallecido a los 28 días de seguimiento. La estancia hospitalaria fue de 12 días [9-22] de mediana. Un total de 15 pacientes (13,5%) requirió ventilación mecánica  invasiva tras el tratamiento y 4 pacientes (4%) presentaron una alteración grave de las transaminasas.Conclusiones: El tratamiento con remdesivir en la práctica clínica habitual presenta resultados similares a los publicados en los ensayos  clínicos en el subgrupo de pacientes con oxigenoterapia de bajo flujo,  tanto en el tiempo hasta la recuperación como en la mortalidad a los 28  días.

Three-year multicenter surveillance of community-acquired Listeria monocytogenes meningitis in adults.

BACKGROUND: Listeria monocytogenes is the third most frequent cause of bacterial meningitis. The aim of this study is to know the incidence and risk factors associated with development of acute community-acquired Lm meningitis in adult patients and to evaluate the clinical features, management, and outcome in this prospective case series. METHODS: A descriptive, prospective, and multicentric study carried out in 9 hospitals in the Spanish Network for Research in Infectious Diseases (REIPI) over a 39-month period. All adults patients admitted to the participating hospitals with the diagnosis of acute community-acquired bacterial meningitis (Ac-ABM) were included in this study. All these cases were diagnosed on the basis of a compatible clinical picture and a positive cerebrospinal fluid (CSF) culture or blood culture. The patients were followed up until death or discharge from hospital. RESULTS: Two hundred and seventy-eight patients with Ac-ABM were included. Forty-six episodes of Lm meningitis were identified in 46 adult patients. In the multivariate analysis only age (OR 1.026; 95% CI 1.00-1.05; p = 0.042), immunosuppression (OR 2.520; 95% CI 1.05-6.00; p = 0.037), and CSF/blood glucose ratio (OR 39.42; 95% CI 4.01-387.50; p = 0.002) were independently associated with a Lm meningitis. The classic triad of fever, neck stiffness and altered mental status was present in 21 (49%) patients, 32% had focal neurological findings at presentation, 12% presented cerebellum dysfunction, and 9% had seizures. Twenty-nine (68%) patients were immunocompromised. Empirical antimicrobial therapy was intravenous ampicillin for 34 (79%) of 43 patients, in 11 (32%) of them associated to aminoglycosides. Definitive ampicillin plus gentamicin therapy was significantly associated with unfavourable outcome (67% vs 28%; p = 0.024) and a higher mortality (67% vs 32%; p = 0.040).The mortality rate was 28% (12 of 43 patients) and 5 of 31 (16.1%) surviving patients developed adverse clinical outcome. CONCLUSIONS: Elderly or immunocompromised patients, and a higher CSF/blood glucose ratio in patients with Ac-ABM must alert clinicians about Lm aetiology. Furthermore, we observed a high incidence of acute community-acquired Lm meningitis in adults and the addition of aminoglycosides to treatment should be avoid in order to improve the patients' outcome. Nevertheless, despite developments in intensive care and antimicrobial therapy, this entity is still a serious disease that carries high morbidity and mortality rates.

[Prevalence of arterial hypertension and lipid profile in HIV patients]. / Prevalencia de hipertensión arterial y perfil lipídico en pacientes con infección por el virus de la inmunodeficiencia humana.

BACKGROUND AND OBJECTIVE: It is not known whether human immunodeficiency virus (HIV)-infected patients present, compared to non-HIV controls, higher vascular risk factors. Our objective was to analyze whether there are differences in blood pressure in HIV patients compared to non-HIV controls. PATIENTS AND METHOD: We retrospectively analyzed all HIV patients controlled in our centre, who were compared with a control group of blood donors, matched for age and sex, blood pressure and lipid profile. We evaluated the following variables: demographic data, date of HIV diagnosis, presence of lipodystrophy, antiretroviral treatment, duration of this treatment, and vascular risk factors. RESULTS: We evaluated 740 patients (mean age: 41.8 years; 75% men). We detected a higher prevalence of hypertension in the HIV group (25% vs. 15%) with a significant difference in the mean systolic/diastolic blood pressure between both groups (p < 0.0001). In the HIV group, hypertensives were older than normotensives, and had higher prevalence of lipodystrophy and higher total cholesterol with a shorter disease duration (75 vs 85 months). In the total group of hypertensives, HIV patients were younger than non-HIV (44.2 vs 47.9 years; p < 0.009) and had higher total cholesterol values (5.44 vs 5.18 mmol/l; p < 0.052). CONCLUSIONS: We found a higher prevalence of hypertension in HIV patients compared with matched controls, as well as a higher prevalence of lipodystrophy and vascular risk factors in hypertensive HIV patients compared with non-hypertensive.