ABSTRACT
OBJECTIVE: Infectious complications are an important cause of morbidity and mortality in haematological patients with febrile neutropenia. The aim of this study was to develop a consensus document of recommendations to optimize the management of febrile neutropenic patients with haematological or vascular catheter infections in areas where there is no solid scientific evidence. METHODS: After reviewing the scientific evidence, a scientific committee composed of experts in haematology and infectious diseases developed a survey with 55 statements. A two- round modified Delphi method was used to achieve consensus. RESULTS: The online survey was answered by 52 experts in the field of haematology and infectious diseases. After two rounds of evaluation, a consensus was possible in 43 of the 55 statements (78.2%): 40 in agreement and 3 in disagreement. Recommendations are given related to empirical antibiotic treatment of patients with febrile neutropenia, mechanisms of action, toxicity and synergism of antibiotics in this context, modifications of antibiotic treatment in the course of febrile neutropenia, and the management of central vascular catheter infections in the haematological setting. CONCLUSIONS: There is a high degree of agreement among experts on some controversial issues concerning the management of febrile neutropenia and catheter infection in hematologic patients. This agreement has resulted in recommendations that may be useful in clinical practice.
Subject(s)
Bacteremia/therapy , Catheter-Related Infections/therapy , Hematologic Diseases/complications , Patient Positioning , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/therapeutic use , Bacteremia/drug therapy , Catheter-Related Infections/drug therapy , Consensus , Delphi Technique , Drug Synergism , Drug Therapy, Combination , Health Care Surveys , Hematologic Diseases/therapy , Humans , Neutropenia/drug therapy , Neutropenia/etiologyABSTRACT
Introducción. Las complicaciones infecciosas son una causa importante de morbi-mortalidad en los pacientes hematológicos con neutropenia febril. El objetivo del presente trabajo fue desarrollar un documento de recomendaciones consensuado para optimizar el manejo del paciente hematológico con neutropenia febril o infecciones por catéteres vasculares en áreas en las que no se dispone de una sólida evidencia científica. Material y métodos. Tras la revisión de las evidencias científico-médicas, un comité científico formado por especialistas expertos en hematología y enfermedades infecciosas elaboró una encuesta con 55 aseveraciones. Para el consenso se utilizó un método Delphi modificado con dos rondas de evaluación. Resultados. La encuesta fue respondida online por 52 especialistas en hematología y en enfermedades infecciosas. Tras las dos rondas de evaluación fue posible el consenso en 43 de los 55 ítems planteados (un 78,2%): 40 en el acuerdo y 3 en el desacuerdo. Con ello, se proporcionan una serie de recomendaciones relativas al tratamiento antibiótico empírico del paciente con neutropenia febril, a cuestiones relacionadas con mecanismos de acción, toxicidad y sinergia de los antibióticos en este contexto, a las modificaciones del tratamiento antibiótico en el curso de la neutropenia febril y al manejo de las infecciones de catéter vascular central en el ámbito hematológico. Conclusiones. Existe un alto grado de acuerdo entre los expertos consultados sobre algunos aspectos controvertidos relativos al manejo de la neutropenia febril y la infección por catéter en pacientes hematológicos. Este acuerdo se ha traducido en unas recomendaciones que pueden ser de utilidad en la práctica clínica (AU)
Introduction. Infectious complications are an important cause of morbidity and mortality in haematological patients with febrile neutropenia. The aim of this study was to develop a consensus document of recommendations to optimize the management of febrile neutropenic patients with haematological or vascular catheter infections in areas where there is no solid scientific evidence. Materials and Methods. After reviewing the scientific evidence, a scientific committee composed of experts in haematology and infectious diseases developed a survey with 55 statements. A two- round modified Delphi method was used to achieve consensus. Results. The online survey was answered by 52 experts in the field of haematology and infectious diseases. After two rounds of evaluation, a consensus was possible in 43 of the 55 statements (78.2%): 40 in agreement and 3 in disagreement. Recommendations are given related to empirical antibiotic treatment of patients with febrile neutropenia, mechanisms of action, toxicity and synergism of antibiotics in this context, modifications of antibiotic treatment in the course of febrile neutropenia, and the management of central vascular catheter infections in the haematological setting. Conclusions. There is a high degree of agreement among experts on some controversial issues concerning the management of febrile neutropenia and catheter infection in hematologic patients. This agreement has resulted in recommendations that may be useful in clinical practice (AU)
Subject(s)
Humans , Male , Female , Bacteremia/complications , Bacteremia/drug therapy , Bacteremia/epidemiology , Health Knowledge, Attitudes, Practice , Catheter-Related Infections/complications , Catheter-Related Infections/drug therapy , Catheter-Related Infections/epidemiology , Anti-Bacterial Agents/therapeutic use , Consensus Development Conferences as Topic , Surveys and Questionnaires , Data Collection/methods , Febrile Neutropenia/drug therapy , Febrile Neutropenia/epidemiology , Hematology , Hematology/statistics & numerical dataABSTRACT
No disponible
Subject(s)
Adult , Humans , Male , Salmonella enterica/pathogenicity , Salmonella enterica/isolation & purification , Salmonella Food Poisoning/drug therapy , Turtles , 24457 , Epidemiological Monitoring/trends , Malaria, Falciparum/diagnosis , Malaria, Falciparum/drug therapy , Microbial Sensitivity Tests , Spain/epidemiology , New Guinea/ethnologySubject(s)
Fever of Unknown Origin/etiology , Food Microbiology , Meat/microbiology , Salmonella Food Poisoning/microbiology , Salmonella enterica/isolation & purification , Turtles/microbiology , Adult , Animals , Equatorial Guinea/ethnology , Feces/microbiology , Humans , Malaria, Falciparum/complications , Male , Salmonella Food Poisoning/complications , Salmonella enterica/classification , Spain , Syphilis/complicationsABSTRACT
BACKGROUND: We analyzed differences in response to combined antiretroviral therapy (cART) according to sex and geographic origin in a retrospective comparative study of Spanish-born and immigrant patients initiating cART. METHODS: The primary endpoint was time to treatment failure (TTF), defined as virological failure, death, opportunistic infection, interruption of cART, or loss to follow-up. Late diagnosis was defined as a CD4+ cell count ≤ 200 cells/mm3 and/or AIDS at initiation of cART. Survival was analyzed using Kaplan-Meier analysis and Cox regression. RESULTS: We followed 1,090 patients, of whom 318 were women (45.6% immigrant women [IW]). At initiation of treatment, women had a higher CD4+ count than men (217 vs 190 cells/mm3), a lower viral load (4.7 vs 5 log), and fewer were late starters (49% vs 59%). The adjusted risk of TTF between women and men was not significantly different (hazard ratio [HR], 1.10; 95% CI, 0.79-1.53). TTF was shorter among IW than Spanish-born women (124 weeks [95% CI, 64-183] vs 151 [95% CI, 127-174]) and loss to follow-up was double that of Spanish-born women (25.5% vs 11.6%). CONCLUSIONS: Although response to cART was similar for both sexes, men started treatment later. IW were more frequently lost to follow-up and switched treatment. Measures to improve medical follow-up after initiation of cART should be promoted among this minority group.
Subject(s)
Anti-HIV Agents/administration & dosage , HIV Infections/drug therapy , Adult , CD4 Lymphocyte Count , Cohort Studies , Drug Therapy, Combination , Emigrants and Immigrants , Female , HIV Infections/immunology , HIV Infections/mortality , HIV Infections/virology , Humans , Male , Proportional Hazards Models , Retrospective Studies , Sex Characteristics , Spain , Time Factors , Treatment FailureSubject(s)
Humans , Male , Adult , Malaria/diagnosis , Malaria/pathology , Immunologic Tests/methods , Immunologic Tests/trends , Clinical Diagnosis/trends , Malaria/therapy , Malaria/transmission , /immunology , /isolation & purification , /pathogenicity , Diagnostic Techniques and Procedures/trendsABSTRACT
Initially described in travelers, outbreaks of cyclosporiasis were soon linked to imported food products. An outbreak of cyclosporiasis in Spanish travelers is described. After identification of Cyclospora cayetanensis in stool analyses, a specific questionnaire was completed. Pyrosis was described in 57% of cases (4/7). Peptic symptoms can be a useful clue to indicate the diagnosis of cyclosporiasis in patients with travelers' diarrhea.
Subject(s)
Cyclosporiasis/epidemiology , Diarrhea/etiology , Disease Outbreaks , Food Contamination , Food Parasitology , Travel , Adult , Animals , Cuba/epidemiology , Cyclospora/isolation & purification , Cyclosporiasis/drug therapy , Cyclosporiasis/transmission , Diarrhea/parasitology , Female , Heartburn/drug therapy , Heartburn/etiology , Humans , Male , Middle Aged , Spain , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
The clinical manifestations of HIV infection vary widely in distinct geographical areas. While HIV-related disease has been well characterized in western countries, relatively few publications have described the clinical manifestations of these diseases in tropical areas, where the vast majority of HIV-infected people are concentrated. In addition, HIV infection may alter the natural history of tropical diseases in several ways and tropical diseases influence the course of HIV infection. The present review describes the major opportunistic infections afflicting people with HIV/AIDS in Africa, Latin America, and Asia and discusses the mutual interactions between HIV and the major tropical diseases.
Subject(s)
HIV Infections/diagnosis , Africa , Asia , Caribbean Region , Global Health , HIV Infections/complications , Humans , Latin AmericaABSTRACT
Descritos inicialmente en viajeros, los brotes epidémicos de Cyclospora cayetanensis fueron posteriormente asociados a productos alimentarios importados. En este artículo se describe un brote de ciclos poriasis en viajeros españoles. Se rellenó un cuestionario específico, tras la identificación de Cyclospora en heces. Los síntomas de pirosis aparecieron en el 57% de los casos (4/7). La presencia de sintomatología péptica durante la diarrea del viajero puede hacer sospechar la presencia deciclosporiasis (AU)
Initially described in travelers, outbreaks of cyclosporiasis were soon linked to imported food products. An outbreak of cyclosporiasis in Spanish travelers is described. After identification of Cyclospora cayetanensis in stool analyses, a specific questionnaire was completed. Pyrosis was described in 57% of cases (4/7). Peptic symptoms can bea useful clue to indicate the diagnosis of cyclosporiasis in patients with travelers diarrhea (AU)
Subject(s)
Humans , Cyclospora/isolation & purification , Cyclosporiasis/epidemiology , Cyclospora/pathogenicity , Disease Outbreaks/statistics & numerical data , Heartburn/epidemiology , Cuba/epidemiology , Diarrhea/microbiology , Human MigrationABSTRACT
Las manifestaciones clínicas de la infección por el virus de la inmunodeficiencia humana (VIH) varían considerablemente según las diferentes áreas geográficas. Mientras en los países occidentales las enfermedades relacionadas con el VIH son bien conocidas, hay relativamente pocos estudios que describan las manifestaciones clínicas del VIH en países tropicales, donde vive la gran mayoría de los pacientes infectados por el VIH. Además, el VIH puede variar la historia natural de las enfermedades tropicales de diversas maneras, y éstas pueden tener un impacto en el curso de la infección por el VIH. En esta revisión, se describen las enfermedades oportunistas más relevantes que aparecen en pacientes con infección por el VIH/sida en África, América Latina y Asia, y se revisan las interacciones mutuas entre el VIH y las principales enfermedades tropicales propias de cada región
The clinical manifestations of HIV infection vary widely in distinct geographical areas. While HIV-related disease has been well characterized in western countries, relatively few publications have described the clinical manifestations of these diseases in tropical areas, where the vast majority of HIV-infected people are concentrated. In addition, HIV infection may alter the natural history of tropical diseases in several ways and tropical diseases influence the course of HIV infection. The present review describes the major opportunistic infections afflicting people with HIV/AIDS in Africa, Latin America, and Asia and discusses the mutual interactions between HIV and the major tropical diseases
Subject(s)
Humans , Acquired Immunodeficiency Syndrome/complications , AIDS-Related Opportunistic Infections/epidemiology , Acquired Immunodeficiency Syndrome/diagnosis , AIDS-Related Opportunistic Infections/diagnosis , Malaria/etiology , Demography , Acquired Immunodeficiency Syndrome/transmissionABSTRACT
OBJECTIVE: To analyze the safety and effectiveness of abacavir, lamivudine, and zidovudine (ABC/3TC/ZDV) in antiretroviral therapy (ART)-naive HIV-infected patients. DESIGN: Retrospective observational cohort study. METHODS: We analyzed all consecutive ART-naive HIV-infected patients who initiated ABC/3TC/ZDV in 71 centers throughout Spain and had a clinical visit and laboratory data at least 16 weeks after initiating this regimen. We assessed safety, mortality, new AIDS-defining conditions (ADCs) and treatment failure, the latter defined by any of the following: (1) reduction in plasma HIV-1 viral load (pVL) <1 log during the first 12 weeks of ART, unless it was less than the lower limit of quantification (LOQ); (2) failure to achieve a pVL Subject(s)
Anti-HIV Agents/therapeutic use
, Dideoxynucleosides/therapeutic use
, HIV Infections/drug therapy
, HIV-1
, Lamivudine/therapeutic use
, Zidovudine/therapeutic use
, Adult
, Anti-HIV Agents/adverse effects
, Cohort Studies
, Dideoxynucleosides/adverse effects
, Drug Therapy, Combination
, Female
, Humans
, Hypersensitivity/etiology
, Lamivudine/adverse effects
, Male
, Patient Compliance
, Retrospective Studies
, Spain
, Treatment Failure
, Zidovudine/adverse effects