Are there differences between ceftolozane/tazobactam and ceftazidime/avibactam in treating patients with complicated abdominal infections? Evidence from clinical trials.

Ceftolozane/tazobactam (C/T) and ceftazidime/avibactam (CZA) are new possibilities of antimicrobial treatment that combined a ß-lactam with a ß-lactamase inhibitor. The United States (US) and European regulatory agencies approved their clinical use in adults with complicated intra-abdominal infections. This study aims to know if one of the two antibiotics obtain better efficacy in adults with complicated intra-abdominal infections and by specific pathogens such as P. aeruginosa or E. coli. A search of all trials in MEDLINE, Scopus, and Web of Science comparing a C/T or CZA based antimicrobial regimen with other treatments in patients with intraabdominal infections until August 2021 was performed. To make indirect comparisons, we used a frequentist approach using the R package netmeta.The effects have been expressed through the relative risk (RR) with its confidence interval. Considering the clinical cure and failure rates between the different trial populations (mMITT, CE, ME) and the mortality at the end of the study, we have not found significant differences between CZA and C/T. In the case of Pseudomonas, the RR of treatment failure between these two antibiotics is 1 (95% CI 0.55-1.18). In the case of E. Coli, although it seems that CZA would have a worse result than C/T, differences did not reach statistical significance (RR1.06; 95% CI 0.9-1.14). In conclusion, we have not found statistically significant differences between ceftolozane-tazobactam and ceftazidime-avibactam in treating cIAI. In regards to E. Coli, our results do not reach significance, but it would be possible that C/T and meropenem had better results than CZA. Perhaps new trials would allow a better profile of the role in different types of patients or infections caused by specific microorganisms in the future.

Aneurisma micótico de la arteria ilíaca izquierda en el contexto de una bacteriemia / Mycotic aneurism of the left iliac artery in the context of a bacteriemia

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Lesión necrótica en cuero cabelludo tras traumatismo / Necrotic lesion in scalp after injury

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Gonartritis séptica en paciente con fractura de fémur hace 13 años / Septic gonarthritis in a patient with femur fracture 13 years later

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Vacunaciones en el adulto

En nuestro entorno sanitario, la vacunación del adulto no recibe las mismas prioridades que la infantil. Esta situación se debe en gran parte a una falta de planificación de la vacunación y a una formación inadecuada sobre las indicaciones, beneficios y disponibilidad de la vacunación en el adulto, así como a una sobrevaloración de sus efectos secundarios y contraindicaciones (AU)

Abscesos de partes blandas secundarios a sacroileítis brucelar

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[Glucocorticoid treatment improves glucose tolerance in patients with temporal arteritis or polymyalgia rheumatica]. / El tratamiento con glucocorticoides mejora la tolerancia a la glucosa en pacientes con arteritis de la temporal o polimialgia reumática.

BACKGROUND: Corticosteroid therapy has been shown to improve glucose tolerance in some connective tissue diseases. This fact has been inadequately investigated in vasculitis. OBJECTIVE: To evaluate the effect of glucocorticoid therapy on glucose tolerance in patients with temporal arteritis (TA) or polymyalgia rheumatica (PR). MATERIALS AND METHODS: An oral test with glucose overload (OGO) was performed before and after one month of initiating therapy with corticosteroids in 14 patients with TA or PR (TA/PR group) and in nine patients with other chronic inflammatory diseases (control group). RESULTS: After treatment, patients with TA/PR experienced a decrease in the area under the glucose curve and in serum glucose values at minutes 0, 90, and 120 of the OGTT. Also, a decrease was observed for the area under the insulin curve and for plasma insulin levels at minutes 90 and 120 after OGO. CONCLUSIONS: Therapy with corticosteroids improves glucose tolerance in TA/PR with no increase in insulin secretion.

An open comparison of the diabetogenic effect of deflazacort and prednisone at a dosage ratio of 1.5 mg:1 mg.

OBJECTIVE: To compare the diabetogenic effects of deflazacort (D) versus prednisone (PN) using a dosage ratio of 1.5 mg deflazacort:1 mg prednisone. METHODS: Thirty-three patients suffering from various active connective tissue or chronic inflammatory diseases were randomized to be treated with D or PN, assuming a therapeutic equipotency ratio of 1.5 mg D:1 mg PN. Neither dosage nor glucocorticoid employed were modified during the study. Patients had not received steroid treatment during the month prior to their inclusion date. Fasting glucose, glycosylated haemoglobin and fructosamine were determined before and after 1 month of treatment. Non-diabetic patients were also submitted to an oral glucose tolerance test (OGTT) at entry and after 1 month. Results were compared by univariate, and multivariate tests to correct the effects of age, body mass index and diagnosis. RESULTS: After 1 month of treatment there were no differences between D and PN in fasting glucose, glycosylated haemoglobin, or fructosamine. OGTT performed after treatment showed similar glucose values for both treatment groups. Patients treated with D had insulin levels at min 60 of the post-treatment OGTT which were higher than those treated with PN [114.1 (62.8) mcUI x ml(-1) versus 73.5 (32.7) mcUI x ml(-1), P = 0.049], but the difference lost its statistical significance in the multivariate analysis. CONCLUSION: D and PN have similar effects on glucose tolerance when an equipotency ratio of 1.5 mg D:1 mg PN is employed. Previous studies employing a ratio of 1.2:1 mg may have underestimated the adverse effects of D on glucose metabolism.