Incidence of valganciclovir-related leukopenia and neutropenia in solid organ transplant recipients at high risk of cytomegalovirus disease.

BACKGROUND: Valganciclovir (VGCV) prophylaxis is associated with an increased risk of hematologic side effects. We analyzed the impact of VGCV prophylaxis on leukopenia and neutropenia rates and explored risk factors for its occurrence. METHODS: Retrospective cohort study of adult cytomegalovirus (CMV)-seronegative solid organ transplantation (SOT) recipients of either CMV-seropositive (CMV D+/R-) or CMV-seronegative (CMV D-/R-) donors between July 2005 and March 2019. CMV D+/R- SOT recipients received 3-12 months of VGCV prophylaxis whereas CMV D-/R- SOT recipients received no VGCV prophylaxis. Competing risk regression was used to calculate risk factors for significant neutropenia (neutrophil count < 1000/µL). RESULTS: A total of 430 CMV-seronegative SOT recipients (median age of 52.1 years, 76.5% males) were included, of which 203 (47.2%) were CMV D+/R- and 227 (52.8%) CMV D-/R-. The unadjusted incidence rate ratio of significant neutropenia attributable to VGCV exposure in the first year post-transplant was 13.50 (95% confidence interval 7.36-27.11). Acute rejection occurred more frequently in neutropenic patients at 32.5% compared to 19.1% in those without neutropenia (p = .033). On multivariate analysis, VGCV prophylaxis for 1-90 days and 91-180 days versus no VGCV were the strongest risk factors for significant neutropenia with a sub-distribution hazard ratio of 39.6 (95% CI, 8.57-182.6) and 13.2 (95% CI, 5.46-32.0), respectively. CONCLUSIONS: VGCV prophylaxis is limited by high rates of neutropenia. Future prospective studies are needed to assess alternative CMV prophylactic strategies in SOT recipients.

Cytomegalovirus surveillance after antiviral prophylaxis in CMV mismatched transplant patients: Does recurrent cytomegalovirus DNAemia impact patient survival?

BACKGROUND: Cytomegalovirus (CMV) mismatched, donor IgG-positive/recipient IgG-negative, solid organ transplant recipients (SOTRs) are at high risk of CMV invasive disease. Post-prophylaxis disease is an issue in this population. Some programs employ surveillance after prophylaxis (SAP) to limit the incidence of post-prophylaxis disease. METHODS: This was a single-center retrospective cohort study that included all CMV mismatched SOTRs from 2003 to 2017. Patients underwent SAP with weekly CMV plasma viral load for 12 weeks. The subjects were classified into three post-prophylaxis DNAemia patterns: no DNAemia, one episode of DNAemia, and multiple episodes of DNAemia. We calculated the cumulative incidence of each DNAemia pattern. We also determined 5-year mortality based on DNAemia pattern stratified by organ transplant type. RESULTS: Post-prophylaxis recurrent DNAemia occurred in 63% of lung recipients and 32% of non-lung recipients (p =  .003). Tissue invasive CMV disease was diagnosed in 3% of the population and CMV syndrome was diagnosed in 33%. Recurrent DNAemia was not associated with 5-year mortality. CONCLUSION: In this cohort, undergoing SAP tissue invasive disease was uncommon and CMV DNAemia recurrence did not have an impact on long-term mortality.

A twist for tunable electronic and thermal transport properties of nanodevices.

Twisted graphene-layered materials with nonzero interlayer twist angles (θ) have recently become appealing, as they exhibit a range of attractive physical properties, which include a Mott insulating phase and superconductivity. In this study, we consider nanodevices constructed from zigzag graphene nanoribbons with a top rectangular benzenoid [6,3]-flake. Using density functional theory and a non-equilibrium Green's function approach, we explore how the electronic and thermal transport properties in such nanodevices can be tuned through a twist of the top flake by an angle 0° ≤ θ ≤ 8.8° for different stacking configurations. We found a strong dependency of the electronic structure on the stacking type, as well as on the twisting regime, specifically in AA-stacking devices. Electron and hole van Hove singularities (vHSs), which originate, respectively, from the flatness of the top of the valence band for the minor-spin component and the bottom of the conduction band for the major-spin component, are found very close to the Fermi level in the density of states and electronic transmission spectra of AA-stacking devices with a twist angle of 1.1°. We establish that these vHSs in AA-1.1° devices are stable at higher temperatures and, with the increased number of available states, lead to larger values of electron thermal conductivity and finally total thermal conductivity in AA-1.1°. Our work highlights the essential role of twisting and stacking for the fabrication of nanoscale charge and heat switches and spurs future studies of twisted layered structures.

The impact of colonization by multidrug resistant bacteria on graft survival, risk of infection, and mortality in recipients of solid organ transplant: systematic review and meta-analysis.

BACKGROUND: The Global increase in colonization by multidrug-resistant (MDR) bacteria poses a significant concern. The precise impact of MDR colonization in solid organ transplant recipients (SOTR) remains not well established. OBJECTIVES: To assess the impact of MDR colonization on SOTR's mortality, infection, or graft loss. METHODS AND DATA SOURCES: Data from PROSPERO, OVID Medline, OVID EMBASE, Wiley Cochrane Library, ProQuest Dissertations, Theses Global, and SCOPUS were systematically reviewed, spanning from inception until 20 March 2023. The study protocol was registered with PROSPERO (CRD42022290011) and followed the PRISMA guidelines. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, INTERVENTIONS, AND ASSESSMENT OF RISK OF BIAS: Cohorts and case-control studies that reported on adult SOTR colonized by Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum ß-lactamase (ESBL) or carbapenem-resistant Enterobacteriaceae. (CRE), or MDR-pseudomonas, and compared to noncolonized, were included. Two reviewers assessed eligibility, conducted a risk of bias evaluation using the Newcastle-Ottawa Scale, and rated certainty of evidence using the GRADE approach. METHODS OF DATA SYNTHESIS: We employed RevMan for a meta-analysis, using random-effects models to compute pooled odds ratios (OR) and 95% confidence intervals (CI). Statistical heterogeneity was determined using the I2 statistic. RESULTS: 15,202 SOTR (33 cohort, six case-control studies) were included, where liver transplant and VRE colonization (25 and 14 studies) were predominant. MDR colonization significantly increased posttransplant 1-year mortality (OR, 2.35; 95% CI, 1.63-3.38) and mixed infections (OR, 10.74; 95% CI, 7.56-12.26) across transplant types (p < 0.001 and I2 = 58%), but no detected impact on graft loss (p 0.41, I2 = 0). Subgroup analysis indicated a higher association between CRE or ESBL colonization with outcomes (CRE: death OR, 3.94; mixed infections OR, 24.8; ESBL: mixed infections OR, 10.3; no mortality data) compared to MRSA (Death: OR, 2.25; mixed infection: OR, 7.75) or VRE colonization (Death: p 0.20, mixed infections: OR, 5.71). CONCLUSIONS: MDR colonization in SOTR, particularly CRE, is associated with increased mortality. Despite the low certainty of the evidence, actions to prevent MDR colonization in transplant candidates are warranted.

Cell-mediated Immunity to Guide Primary Prophylaxis for CMV Infection in Organ Transplant Recipients: A Multicenter Single-arm Prospective Study.

BACKGROUND: There are few interventional studies using CMV cell-mediated immunity (CMI) to guide antiviral prophylaxis. We assessed the Quantiferon-CMV (QTF-CMV) assay to guide CMV prophylaxis duration in high-risk organ transplant recipients. METHODS: A single-arm, multicenter, prospective interventional study including high-risk kidney, pancreas, liver, and heart transplant recipients who were either donor CMV-seropositive, recipient-seronegative (D+/R-) or recipient-seropositive with antithymocyte globulin (R+/ATG) induction. CMI testing was performed using the QTF-CMV assay at months 3, 4, 5, and 6 posttransplant. Prophylaxis was discontinued for a positive CMI but continued for a negative result up to a maximum of 6 mo. The primary endpoint was CMV viremia ≥1000 IU/mL up to 1 y posttransplant. RESULTS: One hundred eight patients were included, comprising kidney (n = 89), kidney-pancreas (n = 7), liver (n = 10), and heart (n = 2) transplants. Eighty-nine patients (82.4%) completed the study protocol (n = 39 D+/R- and n = 50 R+/ATG). In the D+/R- group, only 1 of 39 patients (2.6%) had a positive QTF-CMV result. In the R+/ATG group, 33 of 50 patients (66%) had a positive QTF-CMV result before 6 mo, allowing for early discontinuation of prophylaxis (28 at month 3, 4 at month 4, and 1 at month 5). During the follow-up, CMV viremia ≥1000 IU/mL occurred in only 4 of 33 patients (12.1%) who discontinued prophylaxis early compared with 6 of 17 patients (35.3%) with negative QTF-CMV results and continued prophylaxis (hazard ratio 0.31; 95% confidence interval, 0.09-1.09; P = 0.07). No R+ patient developed CMV disease. CONCLUSIONS: QTF-CMV-guided prophylaxis appears useful in R+ patients who may benefit from a tailored duration of prophylaxis. This strategy does not appear to be useful in D+/R- patients.

Statistical field theory of polarizable polymer chains with nonlocal dipolar interactions.

The electromechanical response of polymeric soft matter to applied electric fields is of fundamental scientific interest as well as relevant to technologies for sensing and actuation. Several existing theoretical and numerical approaches for polarizable polymers subject to a combined applied electric field and stretch are based on discrete monomer models. In these models, accounting for the interactions between the induced dipoles on monomers is challenging due to the nonlocality of these interactions. On the other hand, the framework of statistical field theory provides a continuous description of polymer chains that potentially enables a tractable way to account for these interactions. However, prior formulations using this framework have been restricted to the case of weak anisotropy of the monomer polarizability. This paper formulates a general approach based in the framework of statistical field theory to account for the nonlocal nature of the dipolar interactions without any restrictions on the anisotropy or nonlinearity of the polarizability of the monomer. The approach is based on three key elements: (1) the statistical field theory framework, in which the discrete monomers are regularized to a continuous dipole distribution, (2) a replacement of the nonlocal dipole-dipole interactions by the local electrostatics partial differential equation with the continuous dipole distribution as the forcing, and (3) the use of a completely general relation between the polarization and the local electric field. Rather than treat the dipole-dipole interactions directly, the continuous description in the field theory enables the computationally tractable nonlocal-to-local transformation. Further, it enables the use of a realistic statistical-mechanical ensemble wherein the average far-field applied electric field is prescribed, rather than prescribing the applied field at every point in the polymer domain. The model is applied, using the finite element method, to study the electromechanical response of a polymer chain in the ensemble with fixed far-field applied electric field and fixed chain stretch. The nonlocal dipolar interactions are found to increase, over the case where dipole-dipole interactions are neglected, the magnitudes of the polarization and electric field by orders of magnitude as well as significantly change their spatial distributions. Next, the effect of the relative orientation between the applied field and the chain on the local electric field and polarization is studied. The model predicts that the elastic response of the polymer chain is linear, consistent with the Gaussian approximation, and largely unchanged by the orientation of the applied electric field, though the polarization and local electric field distributions are significantly impacted.

Candida norvegensis fungemia in a liver transplant recipient / Fungemia por Candida norvegensis en un receptor de trasplante hepático

Background: The incidence of candidemia due to non-Candida albicans Candida species has been progressively increasing in recent years. The use of fluconazole as antifungal prophylaxis has been described as a risk factor for the development of infections by fluconazole resistant Candida strains. We report a case of Candida norvegensis bloodstream infection in a liver transplant recipient. Case report: A 61-year-old man, who received a third liver allograft and became worse with the onset of ischemic cholangiopathy and recurrent episodes of cholangitis, was admitted to our hospital due to the development of intra-abdominal abscesses. He received multiple antibiotic schemes, and after 3 months he was discharged, maintaining parenteral antibiotic at home. While he was on fluconazole prophylaxis, a breakthrough candidemia due to C. norvegensis occurred. In vitro susceptibilities of the isolate to several antifungal agents were as follows: amphotericin B MIC 0.5 mg/l, flucytosine 64 mg/l, fluconazole 64 mg/l, itraconazole 4 mg/l, voriconazole 0.75 mg/l, and caspofungin 0.047 mg/l. He was treated with anidulafungin with resolution of candidemia. Conclusions: The use of fluconazole for antifungal prophylaxis may lead to the emergence of fluconazoleresistant Candida infections, with C. norvegensis being a possible emerging pathogen in organ transplant recipients (AU)

Antecedentes: En los últimos años ha aumentado la incidencia de candidemia causada por especies del género Candida distintas de Candida albicans. Se ha descrito el uso de profilaxis antifúngica con fluconazol como factor de riesgo para el desarrollo de infecciones por cepas de Candida resistentes a este antifúngico. Se describe un caso de fungemia por Candida norvegensis en un receptor de un trasplante hepático. Caso clínico: Un varón de 61 años, receptor de un tercer trasplante hepático que se complica con una colangiopatía isquémica y episodios de colangitis de repetición, ingresó en nuestro hospital por presentar abscesos intraabdominales. Recibió múltiples esquemas antibióticos y, tras 3 meses de ingreso, se dio de alta manteniendo un tratamiento antibiótico parenteral en domicilio. Mientras recibía pro- filaxis con fluconazol, desarrolló una candidemia de brecha por C. norvegensis. Los valores de CMI in vitro del aislamiento para algunos antifúngicos fueron los siguientes: anfotericina B 0,5 mg/l, flucitosina 64 mg/l, fluconazol 64 mg/l, itraconazol 4 mg/l, voriconazol 0,75 mg/l y caspofungina 0,047 mg/l. El paciente recibió tratamiento con anidulafungina, con resolución de la candidemia. Conclusiones: El uso de fluconazol como profilaxis antifúngica puede conllevar la aparición de infecciones por especies de Candida resistentes a este antifúngico, siendo C. norvegensis un posible patógeno emergente en pacientes receptores de un órgano sólido (AU)

Management of urinary tract infection in solid organ transplant recipients: Consensus statement of the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI) / Tratamiento de la infección del tracto urinario en los receptores de trasplantes de órganos sólidos: Declaración de consenso del Grupo de Estudio de Infección en receptores de trasplantes (GESITRA) de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) y la Red Española de Investigación en Patología Infecciosa (REIPI)

BACKGROUND: Urinary tract infections (UTIs) are one of the most common infections in solid organ transplant (SOT) recipients. METHODS: Experienced SOT researchers and clinicians have developed and implemented this consensus document in support of the optimal management of these patients. A systematic review was conducted, and evidence levels based on the available literature are given for each recommendation. This article was written in accordance with international recommendations on consensus statements and the recommendations of the Appraisal of Guidelines for Research and Evaluation II (AGREE II). RESULTS: Recommendations are provided on the management of asymptomatic bacteriuria, and prophylaxis and treatment of UTI in SOT recipients. The diagnostic-therapeutic management of recurrent UTI and the role of infection in kidney graft rejection or dysfunction are reviewed. Finally, recommendations on antimicrobials and immunosuppressant interactions are also included. CONCLUSIONS: The latest scientific information on UTI in SOT is incorporated in this consensus document

ANTECEDENTES: Las infecciones del tracto urinario (ITU) son muy frecuentes en los receptores de un trasplante de órgano sólido (TOS). MÉTODOS: Investigadores y clínicos con experiencia en el TOS han desarrollado este documento de consenso para el mejor abordaje de estos pacientes. Hemos realizado una revisión sistemática y se ha especificado el nivel de evidencia para cada recomendación basado en la literatura disponible. Este artículo se ha redactado de acuerdo con las recomendaciones internacionales sobre documentos de consenso y las recomendaciones del Instrumento para Evaluación de Guías de Práctica Clínica II (AGREE II). RESULTADOS: Se realizan recomendaciones sobre el abordaje de la bacteriuria asintomática y sobre la profilaxis y tratamiento de las ITU en receptores de TOS. Se han revisado el abordaje diagnóstico-terapéutico de las ITU recurrentes y el papel de la ITU en el rechazo o disfunción del injerto renal. Finalmente, se incluyen recomendaciones sobre las interacciones entre antimicrobianos e inmunosupresores. CONCLUSIONES: Se incorpora a este documento la información científica más actualizada sobre la ITU en el contexto del TOS

Executive summary. Management of urinary tract infection in solid organ transplant recipients: Consensus statement of the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI) / Abordaje de la infección urinaria en receptores de trasplante de órgano sólido: documento de consenso del Grupo de Estudio de la Infección en Receptores de Trasplante (GESITRA) de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) y la Red Española para el Estudio de Patología Infecciosa (REIPI)

Urinary tract infections (UTI) are one of the most common infections in solid organ transplant (SOT) recipients. A systematic review was performed to assess the management of UTI in SOT recipients. Recommendations are provided on the management of asymptomatic bacteriuria, and prophylaxis and treatment of UTI in SOT recipients. The diagnostic–therapeutic management of recurrent UTI and the role of infection in kidney graft rejection or dysfunction are reviewed. Finally, recommendations on antimicrobials and immunosuppressant interactions are also included

Las infecciones del tracto urinario (ITU) son muy frecuentes en los receptores de un trasplante de órgano sólido (TOS). Hemos realizado una revisión sistemática para determinar el abordaje de la ITU en receptores de TOS. Se realizan recomendaciones sobre el abordaje de la bacteriuria asintomática y sobre la profilaxis y tratamiento de las ITU en receptores de TOS. Se han revisado el abordaje diagnóstico-terapéutico de las ITU recurrentes y el papel de la ITU en el rechazo o disfunción del injerto renal. Finalmente, se incluyen recomendaciones sobre las interacciones entre antimicrobianos e inmunosupresores

Brucelosis ocular / Ocular brucellosis

No disponible

Trasplante hepático en pacientes infectados por el VIH-1 / Liver Transplantation in HIV-1 infected patients

Actualmente la enfermedad hepática es una de las causas más importantes de morbilidad y mortalidad en los pacientes con infección por VIH. La supervivencia de los pacientes con enfermedad hepática terminal es más corta comparada con la de las personas no infectadas. La infección por VIH ha dejado de ser una contraindicación para el trasplante de órganos sólidos...

Currently, liver disease is one of the most important cause of morbidity and mortality in HIV-1 infected patients. Survival of HIV-coinfected patients with end-stage liver disease (ESLD) is poor and shorter than that of the non-HIV-infected population. HIV infections is no longer a contraindication to solid organ transplantation...

Candidemia y candidiasis invasora en el adulto. Formas clínicas y tratamiento / Candidemia and invasive candidiasis in the adult: Clinical forms and treatment

La infección invasiva por Candida es una complicación cada vez más frecuente en el paciente adulto hospitalizado. La disponibilidad de nuevos antifúngicos con menor toxicidad y gran eficacia ha añadido gran complejidad al tratamiento de la infección fúngica. De forma paralela, los costes derivados de dicho tratamiento se han incrementado de forma considerable. Encontrar el equilibrio entre el mayor beneficio para el paciente con el menor coste es en la actualidad uno de los objetivos de las recomendaciones en el tratamiento de la candidiasis invasiva. En esta revisión se analizan dichas recomendaciones para el tratamiento de la candidemia y otras como la esofagitis, peritonitis, candidiasis ocular, osteoarticular, cardiovascular, del sistema nervioso central, infección urinaria y candidiasis crónica diseminada (AU)

Invasive candidiasis is progressively increasing in frequency as a complication of the hospitalised adultpatient. The availability of new antifungal drugs with lower toxicity and high efficacy has increased thecomplexity of managing of these infections. In parallel, the costs of the treatment of invasive fungal infections have considerably increased. Finding of a balance between the best benefit for the patient with theless costs is, nowadays, one of the main objectives of the current recommendations for the management of invasive candidiasis. In this review, the recommendations for the management of candidemiaand other forms of invasive candidiasis (esophagitis, peritonitis, ocular, cardiovascular and osteoarticularcandidiasis, central nervous system and urinary tract candidiasis, and chronic disseminated candidiasis)are analysed (AU)

Tratamiento con daptomicina en pacientes con bacteriemia / Daptomycin in outpatient antimicrobial parenteral therapy

Las bacteriemias comunitarias asociadas a cuidados sanitarios y, muy especialmente, las de origen nosocomial están causadas principalmente por microorganismos grampositivos, destacando dentro de este grupo Staphylococcus spp., con una incidencia de resistencia a meticilina de alrededor del 30% en S. aureus y del 70% en estafilococos coagulasa negativa, que es superior en pacientes ingresados en unidades de cuidados intensivos. Vancomicina ha sido el antibiótico más utilizado en estas situaciones, pero su toxicidad, especialmente renal, y las comunicaciones de fracasos al utilizar este antibiótico para el tratamiento de la bacteriemia por S. aureus resistente a la meticilina (SARM) y con concentración mínima inhibitoria (CMI) de vancomicina > 1 mg/l ha llevado a la búsqueda de otros tratamientos. Daptomicina es un nuevo antibiótico lipopéptido que ha demostrado no inferioridad a vancomicina en un ensayo clínico pivotal en pacientes con bacteriemia y endocarditis derecha por S. aureus. Guías y consensos recientes posicionan a daptomicina como la alternativa ideal en estas situaciones, indicando su utilización en la bacteriemia por SARM, con una CMI a vancomicina > 1 mg/l, así como en pacientes donde la disfunción renal desaconseje la utilización de vancomicina. La evidencia de peor pronóstico en la bacteriemia por SARM cuando el tratamiento empírico es inadecuado, lleva a la recomendación de utilizar daptomicina como primera elección en pacientes críticos con sospecha de infección bacteriémica por grampositivos con disfunción renal y/o en hospitales, donde la prevalencia de SARM con CMI > 1 mg/l sea elevada. Las dosis recomendadas en pacientes graves deben ser superiores a 6 mg/kg/día (AU)

Community-acquired bacteremias assciated with healthcare and, especially, those of nosocomial origin, are mainly caused by Gram-positive microorganisms. Notable among this group are Staphylococcus spp, with an incidence of methicillin resistance of approximately 30% in S. aureus and of 70% in coagulase-negative staphylococcus, which is higher in patients admitted to intensive care units. Vancomycin has been the most widely used antibiotic in these situations but its toxicity, especially in the kidney, and reports of failure when used for the treatment of methicillin-resistant S. aureus (MRSA) and with a vancomycin MIC > 1 mg/L have led to the search for other treatments. Daptomycin is a new lipopeptide antibiotic that has been shown to be not inferior to vancomycin in a pivotal clinical trial in patients with bacteremia and right endocarditis due to S. aureus. Recent guidelines and consensus documents place daptomycin as an ideal alternative in these situations, indicating its use in MRSA bacteremia with a vancomycin MIC > 1 mg/L, as well as in patients whose renal dysfunction excludes the use of vancomycin therapy. Evidence of worse prognosis in MRSA bacteremia when empirical treatment is inappropriate has led to the recommendation of daptomycin as the first-choice drug in critically ill patients with suspected Gram-positive bacteremic infection and renal dysfunction and/or in hospitals where there is a high prevalence of MRSA with a MIC > 1 mg/L. The recommended dose in severely ill patients should be higher than 6 mg/kg/day (AU)

Daptomicina en el tratamiento antimicrobiano parenteral ambulatorio / Daptomycin in outpatient antimicrobial parenteral therapy

Daptomicina es un lipopéptido cíclico con una actividad rápidamente bactericida frente a bacterias grampositivas. Su farmacocinética permite administrarla una vez al día en forma de bolo intravenoso (incluyendo bolo rápido de 2 min). Ello, unido a su excelente perfil de seguridad, la convierte en un fármaco de primera línea para su uso como tratamiento antibiótico parenteral a domicilio (TADE). La mayor evidencia de daptomicina en TADE la encontramos en infección de piel y tejidos blandos, complicada o no, e infección osteoarticular por bacterias grampositivas. Para el resto de indicaciones, el uso de daptomicina en TADE deberá ser evaluado de forma individualizada. Los datos del EUCORE español reflejan el uso de daptomicina en nuestro país, con un alto índice de éxito terapéutico, tanto en el paciente hospitalizado como en los pacientes que reciben el fármaco en régimen de hospitalización a domicilio (AU)

Daptomycin is a cyclic lipopeptide with a rapid bactericidal effect against Gram-positive bacteria. The pharmacokinetic properties of this drug allow once-daily intravenous infusion as the best posology (including a 2-minute bolus). Because of its ease of administration and excellent safety profile, daptomycin is a first-line agent for use as outpatient antimicrobial parenteral therapy (OPAT). The best evidence supporting this indication exists for the treatment of complicated and uncomplicated skin and soft tissue infections, as well as osteoarticular infections caused by Gram-positive bacteria. For the remaining indications, the use of daptomycin as OPAT should be analyzed in each patient. Information from the EUCORE Registry in Spain indicates that daptomycin has high rates of treatment success in both hospitalized patient and in those included in OPAT programs (AU)

Multidrug-resistant bacterial infection in solid organ transplant recipients

The most frequent complication from infection after solid organ transplantation is bacterial infection. This complication is more frequent in organ transplantation involving the abdominal cavity, such as liver or pancreas transplantation, and less frequent in heart transplant recipients. The sources, clinical characteristics, antibiotic resistance and clinical outcomes vary according to the time of onset after transplantation. Most bacterial infections during the first month post-transplantation are hospital acquired, and there is usually a high incidence of multidrug-resistant bacterial infections. The higher incidence of complications from bacterial infection in the first month post-transplantation may be associated with high morbidity. Of special interest due to their frequency are infections by S. aureus, enterococci, Gram-negative enteric and non-fermentative bacilli. Opportunistic bacterial infections may occur at any time on the posttransplant timeline, but are more frequent between months two and six, the period in which immunosuppression is higher. The most frequent bacterial species causing opportunistic infections in organ transplant recipients are Listeria monocytogenes and Nocardia spp. After month six, posttransplantation solid organ transplant patients usually develop conventional community-acquired bacterial infections, especially urinary tract infections by E. coli and S. pneumoniae pneumonia. In this article we review the clinical characteristics, epidemiology, diagnosis and prognosis of bacterial infections in solid organ transplant patients (AU)

La infección bacteriana es la complicación infecciosa más frecuente tras el trasplante de órgano sólido. Esta complicación es más frecuente en el trasplante de órgano que involucra la cavidad abdominal, como por ejemplo el trasplante de hígado o de páncreas, y menos frecuente en los receptores de trasplante cardíaco. Las fuentes, características clínicas, resistencia a antibiótico y resultados clínicos varían de acuerdo con el momento del comienzo de la infección tras el trasplante. Muchas infecciones bacterianas durante el primer mes tras el trasplante son adquiridas en el hospital, habitualmente asociadas con una alta incidencia de infecciones por bacterias multirresistentes. La mayor incidencia de infección bacteriana ocurre durante el primer mes tras el trasplante y esta complicación puede amenazar la vida del paciente y estar asociada a una alta mortalidad. Debido a su frecuencia son de especial interés las infecciones por S. aureus, enterococos, Gram-negativos entéricos y bacilos no fermentativos. Las infecciones bacterianas oportunistas pueden ocurrir en cualquier momento tras el trasplante, pero son más frecuentes de los 2 a los 6 meses, período en el cual la inmunosupresión es más alta. Las especies bacterianas causantes de infección oportunista en los receptores de trasplante de órgano más frecuentes son Listeria monocytogenes y Nocardia spp. Tras el sexto mes después del trasplante los pacientes sometidos a trasplante de órgano sólido habitualmente desarrollan las convencionales infecciones bacterianas adquiridas en la comunidad, especialmente infecciones del tracto urinario por E. coli y neumonía por S. pneumoniae. En este artículo revisamos las características clínicas, epidemiología, diagnóstico y pronóstico de las infecciones bacterianas en los pacientes sometidos a trasplante de órgano sólido (AU)

Factores de riesgo de la enfermedad por citomegalovirus en el receptor de un trasplante de órgano sólido / Risk factors for cytomegalovirus in solid organ transplant recipients

Citomegalovirus (CMV) es el patógeno oportunista más importante en el paciente sometido a un trasplante de órgano, incrementando la mortalidad del paciente debido a efectos directos e indirectos. El factor de riesgo más importante para el desarrollo de enfermedad por CMV es la discordancia serológica para CMV entre donante y receptor (donante positivo y receptor negativo), que supone un riesgo de más del 50% de desarrollo de enfermedad por CMV si no se administra profilaxis. El uso de fármacos antivirales muy potentes para la profilaxis de esta complicación en pacientes de alto riesgo ha modificado las características de la enfermedad por CMV en esta población. Otros factores de riesgo clásicos para el desarrollo de enfermedad por CMV incluyen el desarrollo de rechazo agudo del injerto, tipo de órgano trasplantado, coinfección con otros herpesvirus y el tipo de inmunosupresores empleado. Recientemente se han descrito nuevos factores de riesgo para el desarrollo de esta complicación que incluyen las variaciones de genotipo de CMV entre donante y receptor, y alteraciones genéticas de la inmunidad innata en el receptor. En esta revisión se abordan los factores de riesgo clásicos y los últimos hallazgos descritos para el desarrollo de enfermedad por CMV en el receptor de un trasplante de órgano (AU)

Cytomegalovirus (CMV) is the most important opportunistic pathogen in patients undergoing solid organ transplantation and increases mortality due to both direct and indirect effects. The most important risk factor for the development of CMV disease is discordant donor-recipient CMV serology (positive donor and negative recipient), which confers more than 50% risk of developing CMV disease if no prophylaxis is given. The use of highly potent antiviral agents for CMV prophylaxis in high-risk patients has changed the characteristics of CMV disease in this population. Other classical risk factors for CMV disease include acute graft rejection, the type of organ transplanted, coinfection with other herpesviruses and the type of immunosuppressive agents employed. New risk factors for this complication have recently been described, including variations in the CMV genotype between donor and recipient and genetic alterations in the recipient’s innate immunity. The present review discusses classical risk factors and the latest findings reported on the development of CMV in organ transplant recipient (AU)

Usefulness of monitoring linezolid trough serum concentration in prolonged treatments

Linezolid ha demostrado ser eficaz en el tratamiento de infecciones musculo-esqueléticas, sin embargo, se han descrito casos de fracaso, desarrollo de resistencia y toxicidad en tratamientos de más de 28 días. Describimos nuestra experiencia en 5 casos consecutivos en los que la concentración de linezolid se determinó semanalmente y su relación con la respuesta clínica y la toxicidad(AU)

Linezolid has proven valuable in musculoskeletal infections, however, failure and resistance have been described and toxicity is worrisome when more than 28 days are necessary. We describe the first 5 cases in whom linezolid trough serum concentrations were weekly measured and its relationship with clinical outcome and toxicity(AU)

Efficacy and safety of outpatient parenteral antibiotic therapy for infective endocarditis: a ten-year prospective study

Background: The length of treatment of infective endocarditis (IE) with parenteral antibiotics varies from2 to 6 weeks. Although several studies indicate that outpatient parenteral antibiotic treatment (OPAT)could be safe for uncomplicated viridans-group streptococci (VGS) IE, the experience in Spain is limited and data on other types of endocarditis and OPAT are scarce worldwide. Methods: Prospective single center study of a cohort including all patients with IE admitted to the Hospital Clinic of Barcelona OPAT program from January 1997 to December 2006.Results: During the study period, 392 consecutive episodes of IE in non-drug abusers were attended to.Of these, 73 episodes (42 native-valve, 23 prosthetic-valve, and 8 pacemaker-lead) were admitted to the OPAT program (19%). The percentage of inclusion was higher for viridans group streptococci (VGS) or Streptococcus bovis (S. bovis) IE (32% of all VGS or S. bovis IE episodes diagnosed vs. 14% of the remainingetiologies, P<.001). Twelve patients (16%) were readmitted due to complications, of which 3 died (4%).Glycopeptides use was the only predictor factor of hospital readmission (OR 4.5, 95% confidence interval1.2; 16.8, P=.026). No differences in OPAT outcome were found between VGS plus S. bovis IE and Staphylococcusaureus (S. aureus) plus coagulase-negative staphylococci IE. Patients spent a median of 17 dayon OPAT (interquartile range 11-26.5), which enabled 1,466 days of hospital stay to be saved. Conclusions: These data suggest that OPAT for IE may be a safe and effective therapeutic approach in the treatment of selected patients with types of endocarditis other than uncomplicated VGS or S. bovisendocarditis, although patients taking glycopeptides need close clinical OPAT monitoring (AU)

Antecedentes: La duración del tratamiento antibiótico endovenoso de la endocarditis infecciosa (EI) oscila entre 2 y 6 semanas. Aunque varios estudios indican que el tratamiento antibiótico a domicilio endovenoso (TADE) es seguro para el tratamiento domiciliario de la EI sobre válvula nativa no complicada por estreptococos del grupo viridans (EGV) la experiencia en España con TADE en la EI es limitada y los datos sobre otros tipos de endocarditis y TADE son escasos en todo el mundo. Métodos Estudio unicéntrico, prospectivo, de una cohorte de todos los pacientes con EI admitidos en el programa TADE en el Hospital Clínico de Barcelona entre enero de 1997 y diciembre de 2006.ResultadosDurante el período de estudio se diagnosticaron 392 episodios consecutivos de EI en pacientes no consumidores de drogas, de los cuales 73 episodios (19%) fueron admitidos en el programa de TADE: 42 EI sobre válvula nativa, 23 EI sobre válvula protésica y 8 EI sobre cable de marcapasos. El porcentaje de inclusión en la TADE fue mayor para la EI por EGV o Streptococcus bovis (S. bovis) (32%) que para el resto de etiologías (14%; p < 0,001). Doce pacientes (16%) fueron reingresados debido a las complicaciones de los cuales tres fallecieron (4%). El uso de glucopéptidos fue el único factor predictor de reingreso hospitalario (OR [intervalo de confianza del 95%] 4,5 [1,2; 16,8] p = 0,026). No se observaron diferencias entre las EI por EGV y S. bovis y las EI estafilocócicas (Staphylococcus aureus y estafilococos coagulasa-negativos) incluidas en el TADE. Los pacientes incluidos estuvieron una mediana de 17 días en tratamiento domiciliario (rango intercuartílico de 11 a 26,5), lo que permitió un ahorro de 1.466 días de estancia hospitalaria (..) (AU)

Recomendaciones sobre el tratamiento de la enfermedad fúngica invasiva por Aspergillus spp. y otros hongos filamentosos de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC). Actualización 2011 (AU) / Guidelines for the Treatment of Invasive Fungal Disease by Aspergillus spp. and Other Fungi Issued by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). 2011 Update

El presente trabajo actualiza las recomendaciones para el tratamiento de la aspergilosis invasiva y las infecciones producidas por otros hongos filamentosos, elaboradas por el Grupo de Estudio de Micología Médica (GEMICOMED), incluido dentro de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC). Se analiza el tratamiento de estas infecciones en cuatro grupos de patologías médicas: oncohematología, trasplante de órgano sólido, paciente crítico ingresado en cuidados intensivos y pediatría. Se realiza una revisión exhaustiva de las novedades terapéuticas y de los niveles de evidencia. Estas guías han sido elaboradas, siguiendo las normativas de la SEIMC, por un grupo de trabajo formado por especialistas en enfermedades infecciosas, microbiología clínica, medicina intensiva, pediatría y oncohematología. Se proporciona también unas recomendaciones para la prevención de estas infecciones (AU)

The guidelines on the treatment of invasive fungal disease by Aspergillus spp. and other fungi issuedby the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) are presented. These recommendations are focused on four clinical categories: oncology-haematology patients, solid organtransplant recipients, patients admitted to intensive care units, and children. An extensive review ismade of therapeutical advances and scientific evidence in these settings. These guidelines have been prepared according the SEIMC consensus rules by a working group composed of specialists in infectious diseases, clinical microbiology, critical care medicine, paediatrics and oncology-haematology. Specific recommendations on the prevention of fungal infections in these patients are included (AU)

Recomendaciones GESITRA-SEIMC/REIPI para el manejo de la infección por citomegalovirus en pacientes trasplantados de órgano sólido / GESITRA-SEIMC/REIPI recommendations for the management of cytomegalovirus infection in solid-organ transplant patients

La infección por citomegalovirus (CMV) constituye una complicación importante en los pacientes sometidos a trasplante de órgano sólido (TOS). En el año 2005 el Grupo de Estudio de Infección en el Trasplante (GESITRA) de la Sociedad Española de Microbiología Clínica y Enfermedades Infecciosas (SEIMC) elaboró un documento de consenso para la profilaxis y el tratamiento de la infección por CMV en pacientes sometidos a TOS. Desde entonces han sido numerosas las publicaciones que o bien han aclarado, o bien han planteado nuevas dudas respecto a los aspectos tratados en el anterior documento. Entre estos aspectos se encuentran las situaciones y poblaciones que deben recibir profilaxis y su duración, la elección de la mejor técnica para el diagnóstico y monitorización y la elección de la mejor estrategia terapéutica. Todo ello justifica la necesidad de elaborar un nuevo documento de consenso que incluya las últimas recomendaciones en el manejo de la infección por CMV post-trasplante en base a las nuevas evidencias disponibles (AU)

Abstract Cytomegalovirus infection remains a major complication of solid organ transplantation. In 2005 the Spanish Transplantation Infection Study Group (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) developed consensus guidelines for the prevention and treatment of CMV infection in solid organ transplant recipients. Since then, numerous publications have clarified or questioned the aspects covered in the previous document. These aspects include the situations and populations who must receive prophylaxis and its duration, the selection of the best diagnosis and monitoring technique and the best therapeutic strategy. For these reasons, we have developed new consensus guidelines to include the latest recommendations on post-transplant CMV management based on new evidence available (AU)