How can we optimize the diagnostic and therapeutic approach to pneumonia? Expert opinion-based recommendations.

Pneumonia continues to be one of the most frequent infectious syndromes and a relevant cause of death and health resources utilization. The OPENIN ("Optimización de procesos clínicos para el diagnóstico y tratamiento de infecciones") Group is composed of Infectious Diseases specialists and Microbiologists and aims at generating recommendations that can contribute to improve the approach to processes with high impact on the health system. Such task relies on a critical review of the available scientific evidence. The first Group meeting (held in October 2023) aimed at answering the following questions: Can we optimize the syndromic and microbiological diagnosis of pneumonia? Is it feasible to safely shorten the length of antibiotic therapy? And, is there any role for the immunomodulatory strategies based on the adjuvant use of steroids, macrolides or immunoglobulins? The present review summarizes the literature reviewed for that meeting and offers a series of expert recommendations.

Risk factors for bloodstream infections due to carbapenem-resistant Enterobacterales: a nested case-control-control study.

BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSIs) are a major threat to patients. To date, data on risk factors have been limited, with low internal and external validity. In this multicentre study, risk factors for CRE BSI were determined by comparison with two control groups: patients with carbapenem-susceptible Enterobacterales (CSE) BSI, and patients without Enterobacterales infection (uninfected patients). METHODS: A multicentre, case-control-control study was nested in a European prospective cohort study on CRE (EURECA). CRE BSI:CSE BSI matching was 1:1, CRE BSI:Uninfected patients matching was 1:3, based on hospital, ward and length of stay. Conditional logistic regression was applied. RESULTS: From March 2016 to November 2018, 73 CRE BSIs, 73 CSE BSIs and 219 uninfected patients were included from 18 European hospitals. For CRE versus CSE BSI, previous CRE colonization/infection [incidence rate ratio (IRR) 7.32; 95% CI 1.65-32.38) increased the risk. For CRE versus uninfected controls, independent risk factors included: older age (IRR 1.03; 95% CI 1.01-1.06), patient referral (long-term care facility: IRR 7.19; 95% CI 1.51-34.24; acute care hospital: IRR 5.26; 95% CI 1.61-17.11), previous colonization/infection with other MDR organisms (MDROs) (IRR 9.71; 95% CI 2.33-40.56), haemodialysis (IRR 8.59; 95% CI 1.82-40.53), invasive procedures (IRR 5.66; 95% CI 2.11-15.16), and ß-lactam/ß-lactamase inhibitor combinations (IRR 3.92; 95% CI 1.68-9.13) or third/fourth generation cephalosporin (IRR 2.75; 95% CI 1.06-7.11) exposure within 3 months before enrolment. CONCLUSIONS: Evidence of previous CRE colonization/infection was a major risk factor for carbapenem resistance among Enterobacterales BSI. Compared with uninfected patients, evidence of previous MDRO colonization/infection and healthcare exposure were important risk factors for CRE BSI. Targeted screening, infection prevention and antimicrobial stewardship should focus on these high-risk patients.

Invasive aspergillosis in liver transplant recipients in the current era.

Invasive aspergillosis (IA) is a rare but fatal disease among liver transplant recipients (LiTRs). We performed a multicenter 1:2 case-control study comparing LiTRs diagnosed with proven/probable IA and controls with no invasive fungal infection. We included 62 IA cases and 124 matched controls. Disseminated infection occurred only in 8 cases (13%). Twelve-week all-cause mortality of IA was 37%. In multivariate analyses, systemic antibiotic usage (adjusted odds ratio [aOR], 4.74; P = .03) and history of pneumonia (aOR, 48.7; P = .01) were identified as independent risk factors associated with the occurrence of IA. Moreover, reoperation (aOR, 5.99; P = .01), systemic antibiotic usage (aOR, 5.03; P = .04), and antimold prophylaxis (aOR, 11.9; P = .02) were identified as independent risk factors associated with the occurrence of early IA. Among IA cases, Aspergillus colonization (adjusted hazard ratio [aHR], 86.9; P < .001), intensive care unit stay (aHR, 3.67; P = .02), disseminated IA (aHR, 8.98; P < .001), and dialysis (aHR, 2.93; P = .001) were identified as independent risk factors associated with 12-week all-cause mortality, while recent receipt of tacrolimus (aHR, 0.11; P = .001) was protective. Mortality among LiTRs with IA remains high in the current era. The identified risk factors and protective factors may be useful for establishing robust targeted antimold prophylactic and appropriate treatment strategies against IA.

QuantiFERON-CMV assay by chemiluminescence immunoassay: Is it more suitable for real-live monitoring of transplant patients?

BACKGROUND: The QuantiFERONCMV (QF-CMV) assay is an interferon-gamma release assay (IGRA) used to monitor CMV-specific cell-mediated immunity (CMV-CMI) by ELISA in transplant patients. However, a chemiluminescent immunoassay (CLIA) has been developed to quantify IFNG in the QuantiFERON-Tuberculosis (TB) to detect latent TB infection. OBJECTIVES: The aim of this work is to compare the results of QF-CMV by ELISA with those obtained by CLIA in an automated Liaison XL analyzer using the QuantiFERON-TB Gold Plus reagents. STUDY DESIGN: The QF-CMV assay had been performed by ELISA in kidney and lung transplant patients between July 2019-April 2023 at the IMIBIC/Reina Sofía Hospital (Cordoba, Spain). The remaining QF-CMV supernatants had been preserved at -80 ºC from then. Now, the IFNG levels in the same samples were determined by CLIA. RESULTS: One hundred and three QF-CMV supernatants from kidney (n = 50) and lung (n = 53) transplant patients were selected. An agreement of 87.4 % (kappa coefficient 0.788) between CLIA and ELISA was observed. Thirteen (12.6 %) discrepant results were detected. Some Indeterminate results by ELISA converted to Non-reactive by CLIA (0.53-0.92 IU/mL for Mitogen-Nil values). Likewise, borderline Non-reactive results by ELISA were above the 0.2 IU/mL cut-off by CLIA and then were Reactive (0.21-0.31 for CMV-Nil values). CONCLUSION: CLIA shows substantial concordance with ELISA and acceptable discrepancies. The possible higher sensitivity of CLIA returns a higher number of Reactive results, which entails potential clinical consequences. Therefore, a new threshold to confer protection against CMV infection after transplantation needs to be defined.

A Randomized, Double-Blind, Phase 3 Safety and Efficacy Study of Ridinilazole Versus Vancomycin for Treatment of Clostridioides difficile Infection: Clinical Outcomes With Microbiome and Metabolome Correlates of Response.

BACKGROUND: Exposure to antibiotics predisposes to dysbiosis and Clostridioides difficile infection (CDI) that can be severe, recurrent (rCDI), and life-threatening. Nonselective drugs that treat CDI and perpetuate dysbiosis are associated with rCDI, in part due to loss of microbiome-derived secondary bile acid (SBA) production. Ridinilazole is a highly selective drug designed to treat CDI and prevent rCDI. METHODS: In this phase 3 superiority trial, adults with CDI, confirmed with a stool toxin test, were randomized to receive 10 days of ridinilazole (200 mg twice daily) or vancomycin (125 mg 4 times daily). The primary endpoint was sustained clinical response (SCR), defined as clinical response and no rCDI through 30 days after end of treatment. Secondary endpoints included rCDI and change in relative abundance of SBAs. RESULTS: Ridinilazole and vancomycin achieved an SCR rate of 73% versus 70.7%, respectively, a treatment difference of 2.2% (95% CI: -4.2%, 8.6%). Ridinilazole resulted in a 53% reduction in recurrence compared with vancomycin (8.1% vs 17.3%; 95% CI: -14.1%, -4.5%; P = .0002). Subgroup analyses revealed consistent ridinilazole benefit for reduction in rCDI across subgroups. Ridinilazole preserved microbiota diversity, increased SBAs, and did not increase the resistome. Conversely, vancomycin worsened CDI-associated dysbiosis, decreased SBAs, increased Proteobacteria abundance (∼3.5-fold), and increased the resistome. CONCLUSIONS: Although ridinilazole did not meet superiority in SCR, ridinilazole greatly reduced rCDI and preserved microbiome diversity and SBAs compared with vancomycin. These findings suggest that treatment of CDI with ridinilazole results in an earlier recovery of gut microbiome health. Clinical Trials Registration.Ri-CoDIFy 1 and 2: NCT03595553 and NCT03595566.

Recomendaciones SER sobre prevención de infección en enfermedades reumáticas autoinmunes sistémicas / Recommendations for prevention of infection in systemic autoimmune rheumatic diseases

Objetivo: Elaborar recomendaciones para la prevención de infección en pacientes adultos con enfermedades reumáticas autoinmunes sistémicas (ERAS). Métodos: Un panel de expertos, seleccionados con base en su currículum y experiencia, identificó preguntas clínicas de investigación relevantes para el objetivo del documento. Se realizaron revisiones sistemáticas de la evidencia, que se graduó de acuerdo con los criterios del Scottish Intercollegiate Guidelines Network. Tras ello, se formularon las recomendaciones. Resultados: Se seleccionaron cinco preguntas, referentes a la prevención de infección por Pneumocystis jirovecii con trimetoprim-sulfametoxazol, medidas profilácticas contra el virus de la hepatitis B, vacunación contra el virus del papiloma humano, vacunación contra el Streptococcus pneumoniae y vacunación contra el virus de la gripe. Se formularon un total de 18 recomendaciones, estructuradas por pregunta, con base en la evidencia encontrada para las diferentes ERAS y/o consenso de expertos. Conclusiones: Existe suficiente evidencia sobre la seguridad y eficacia de las vacunaciones y otras medidas profilácticas frente a los microrganismos revisados en este documento como para ser recomendadas específicamente en pacientes con ERAS.(AU)

Objectives: To develop recommendations for the prevention of infection in adult patients with systemic autoimmune rheumatic diseases (SARD). Methods: Clinical research questions relevant to the objective of the document were identified by a panel of experts selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network criteria. Specific recommendations were made. Results: Five questions were selected, referring to prevention of infection by Pneumocystis jirovecii with trimethoprim/sulfamethoxazole, primary and secondary prophylactic measures against hepatitis B virus, vaccination against human papillomavirus, vaccination against Streptococcus pneumoniae and vaccination against influenza virus, making a total of 18 recommendations, structured by question, based on the evidence found for the different SARD and/or expert consensus. Conclusions: There is enough evidence on the safety and efficacy of vaccinations and other prophylactic measures against the microorganisms reviewed in this document to specifically recommend them for patients with SARD.(AU)

La formación de grado en enfermedades infecciosas, resistencia y uso de antibióticos desde la perspectiva de los estudiantes de Medicina / Perspective of Spanish medical students regarding undergraduate education in infectious diseases, bacterial resistance and antibiotic use

Introducción: Una de las principales herramientas para optimizar el uso de los antibióticos es la formación de los prescriptores. El objetivo de este trabajo es conocer la opinión de los estudiantes de Medicina españoles sobre la formación en enfermedades infecciosas. Material y métodos: Se distribuyó un cuestionario on line anonimizado entre estudiantes de sexto curso a través de distintos canales. El cuestionario incluyó 45 preguntas sobre conocimientos, actitudes y percepciones sobre el diagnóstico, resistencia antimicrobiana, uso de antibióticos y la formación de pregrado en enfermedades infecciosas. Resultados: Se recibieron un total de 441 encuestas de 21 facultades. Se obtuvieron 374 respuestas (84,8%) de las 8 facultades más representadas, con una tasa de respuesta del 28,9%. La mayoría de los alumnos se sentían preparados para identificar los signos clínicos de infección (418; 94,8%) y para interpretar correctamente las pruebas de laboratorio (382; 86,6%). Reconocieron saber elegir un antibiótico con seguridad sin consultar libros ni guías (178; 40,4%). Solo 107 alumnos (24,3%) consideraron haber recibido suficiente formación en el uso prudente de los antimicrobianos. Respecto a los métodos de aprendizaje, se percibieron como más útiles la discusión de casos clínicos, los rotatorios en servicios o unidades de enfermedades infecciosas y los talleres de pequeños grupos: se evaluaron favorablemente en un 76,9; en un 76 y en un 68,8% de los casos, respectivamente. Conclusión: Los estudiantes de Medicina se encuentran más seguros en el diagnóstico de enfermedades infecciosas que en el tratamiento antibiótico. Asimismo, sienten la necesidad de recibir mayor formación en antibioterapia y uso prudente en antibióticos

Introduction: One of the main tools to optimize antibiotics use is education of prescribers. The aim of this article is to study undergraduate education in the field of infectious diseases, antimicrobial resistance and antibiotic stewardship from the perspective of Spanish medical students. Material and methods: An anonymous online questionnaire was distributed among sixth grade students using different channels in Europe, within the ESGAP Student-Prepare survey. The questionnaire included 45 questions about knowledge, attitudes and perceptions about diagnosis, bacterial resistance, use of antibiotics and undergraduate training in infectious diseases. We present here the Spanish results. Results: A total of 441 surveys were received from 21 medical schools. A total of 374 responses (84.8%) were obtained from the 8 most represented faculties, with a response rate of 28.9%. Most students felt adequately prepared to identify clinical signs of infection (418; 94.8%) and to accurately interpret laboratory tests (382; 86.6%). A total of 178 (40.4%) acknowledged being able to choose an antibiotic with confidence without consulting books or guidelines. Only 107 (24.3%) students considered that they had received sufficient training in judicious use of antibiotics. Regarding learning methods, the discussion of clinical cases, infectious diseases units rotatories and small group workshops were considered the most useful, being evaluated favorably in 76.9%, 76% and 68.8% of the cases. Conclusion: Medical students feel more confident in the diagnosis of infectious diseases than in antibiotic treatment. They also feel the need to receive more training in antibiotics and judicious antibiotic use

Aspergilosis invasora en el receptor de trasplante de órgano sólido / Invasive aspergillosis in solid organ transplantation

Los receptores de un trasplante de órgano sólido (TOS) tienen un riesgo significativo de desarrollar infecciones fúngicas invasivas (IFI). El tratamiento es difícil debido a las potenciales interacciones existentes entre los antifúngicos y los inmunosupresores, así como por el riesgo de hepatotoxicidad y de daño renal asociados al uso del voriconazol y de la anfotericinaB, respectivamente. El isavuconazol es un nuevo antifúngico triazólico con excelente biodisponibilidad oral, farmacocinética predecible y lineal, buena tolerancia y escasos efectos adversos que ha sido aprobado para el tratamiento de la aspergilosis invasiva (AI) y de la mucormicosis. Se ha revisado la experiencia existente con el uso del isavuconazol en pacientes con TOS. De acuerdo con los estudios publicados, y a pesar de que existe una importante variabilidad entre pacientes y entre los distintos tipos de TOS, el isavuconazol presenta una significativa menor interacción con el tacrolimus y es menos hepatotóxico que el voriconazol. El isavuconazol puede ser una alternativa al voriconazol para reducir de forma significativa los efectos secundarios asociados al tratamiento de la IFI en el TOS. Sería de gran interés la realización de futuros ensayos clínicos con este antifúngico tanto para el tratamiento como para la profilaxis de la IFI en estos pacientes

Solid organ transplant (SOT) recipients have a high risk for developing invasive fungal infections (IFI). Treatment is difficult due to the interaction between the antifungal and immunosuppressant drugs, as well as the risk of hepatotoxicity and kidney failure associated with voriconazole and amphotericinB, respectively. Isavuconazole is a new antifungal triazole agent with excellent oral bioavailability, predictable and linear pharmacokinetics, good tolerance and low adverse effects. It has been approved for the treatment of invasive aspergillosis and mucormycosis. A review is presented of the reported experience in the use of isavuconazole in SOT. According to the published studies, isavuconazole has a significantly lower risk of interaction with tacrolimus, and is less hepatotoxic than voriconazole. Nevertheless, there is a significant variability between patients, and between each type of SOT. Isavuconazole reduces the side effects associated with the treatment of IFI in SOT. It would be of great interest the implementation of future clinical trials with isavuconazole for the treatment and/or prophylaxis of IFI in these patients

Tuberculosis en pacientes inmunodeprimidos / Tuberculosis in immunosuppressed patients

La tuberculosis (TB) es una de las infecciones más importantes en pacientes inmunodeprimidos debido a su elevada frecuencia y alta morbimortalidad. La TB es la principal causa de muerte entre pacientes infectados por VIH. El diagnóstico y tratamiento precoz de la infección tuberculosa latente es clave para evitar su progresión a enfermedad. Del mismo modo, el diagnóstico precoz de la TB es clave para mejorar el pronóstico de los pacientes y evitar su transmisión. La expresión clínica de la TB en pacientes inmunodeprimidos está condicionada por el grado de inmunodepresión de los pacientes. Es importante tener presente esta peculiaridad para no retrasar el diagnóstico de sospecha de TB. Las bases del tratamiento de la TB en inmunodeprimidos son las mismas que en la población general. Sus peculiaridades derivan principalmente de las interacciones farmacológicas. Examinamos las bases de diagnóstico y tratamiento de la TB y la infección tuberculosa latente en pacientes inmunodeprimidos

Tuberculosis (TB) is one of the most significant infections in immunosuppressed patients due to its high frequency and high morbidity and mortality. TB is the leading cause of death among HIV-infected patients. The diagnosis and early treatment of latent tuberculosis infection is vital to preventing it progression to disease. Similarly, the early diagnosis of TB is key to improving the prognosis of patients and preventing its transmission. The clinical expression of TB in immunosuppressed patients is conditioned by the patient's degree of immunosuppression. It is important to keep this peculiarity in mind so as not to delay the diagnosis of suspected TB. TB treatment is basically the same in immunosuppressed patients as in the general population and any differences mainly derive from pharmacological interactions. We examined the diagnosis and treatment of TB and latent tuberculosis infection in immunosuppressed patients

Ceftazidima/avibactam en el tratamiento de infecciones urinarias complicadas / Ceftazidime/avibactam in the treatment of complicated urinary tract infections

Las infecciones urinarias complicadas merecen especial atención en la época de las multirresistencias debido a su elevada frecuencia y al progresivo aumento de uropatógenos resistentes a los antibióticos habituales. Entre los mecanismos de resistencia a los antibióticos utilizados para el tratamiento de las infecciones urinarias complicadas destacan las betalactamasas de espectro extendido, las betalactamasas de tipo AmpC plasmídicas y las carbapenemasas. También están aumentando las resistencias de Pseudomonas aeruginosa. Ceftazidima/avibactam posee un espectro antimicrobiano ideal para afrontar esta nueva situación, dado que combina la acción antipseudomónica y de actividad frente a enterobacterias de la ceftazidima con un excelente efecto inhibidor de avibactam frente a la mayoría de las betalactamasas de espectro extendido, AmpC y carbapenemasas de las clases A y D de Ambler, pero no frente a las metalobetalactamasas. Las características farmacocinéticas de los 2 compuestos de ceftazidima/avibactam son similares y ofrecen una ventaja en el tratamiento de las infecciones urinarias complicadas, dada su casi total eliminación renal en forma activa no metabolizada. En modelos animales de infecciones urinarias complicadas, ceftazidima/ avibactam ha demostrado ser eficaz frente a distintas especies de enterobacterias, así como frente a uropatógenos multirresistentes. En ensayos clínicos fases II y III de infecciones urinarias complicadas, ceftazidima/avibactam ha demostrado no inferioridad frente a los comparadores, con tasas de curación clínica de alrededor del 90% y de erradicación microbiológica del 74%, con buena tolerancia y sin efectos adversos graves (AU)

Complicated urinary tract infections (cUTI) deserve special attention in the era of multiresistance due to their high frequency and the progressive increase of uropathogens resistant to routine antibiotics. Notable among the mechanisms of resistance of antibiotics used for the treatment of cUTI are broad spectrum beta-lactamases (BSBL), plasmid-mediated AmpC beta-lactamases, and carbapenemases. Pseudomonas aeruginosa resistance is on the increase. Ceftazidime/avibactam (CAZ/AVI) has the ideal antimicrobial spectrum to successfully meet this challenging new situation, given that it combines the antipseudomonal activity of ceftazidime against Enterobacter species with the excellent inhibitory effect of avibactam against the majority of BSBL, AmpC and Ambler class A and D carbapenemases, but not against metallo-beta-lactamases. The pharmacokinetic characteristics of the two compounds of CAZ/AVI are similar. The advantage of this combination in cUTI is that it is excreted mainly by the kidneys. In animal models of cUTI, CAZ/AVI has been shown to be effective against various Enterobacteriaceae species, as well as multiresistant uropathogens. In phase II and III clinical trials of cUTI, CAZ/AVI has shown noninferiority to comparator drugs with clinical cure rates of around 90% and a microbiological eradication rate of 74%, with good tolerance and without severe adverse effects (AU)

Sepsis neumocócica del adulto: ¿debemos descartar una asplenia congénita? / Adult pneumoccocical sepsis: Should we rule out congenital anesplenia?

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Infección por citomegalovirus en el adulto. ¿Se ha de tratar? / Cytomegalovirus infection in adults. Must it be treated?

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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

Future alternatives for the treatment of infections caused by carbapenemaseproducing Enterobacteriaceae: What is in the pipeline? / Alternativas futuras para el tratamiento de las infecciones causadas por enterobacterias productoras de carbapenemasas: ¿qué hay en proyecto?

The emergence and spread of carbapenemase-producing Enterobacteriaceae is an important and very concerning problem. There is an urgent need of new antibimicrobials for treating these infections. Currently there are some options in the pipeline. Several new beta-lactamase and carbapenemase inhibitors as avibactam and MK-7655, combined with old or new betalactams are a very interesting option. Some combinations as ceftazidime-avibactam are in the late stages of clinical development and could reach the market in the next years. New aminoglycosides as plazomicin, tetracycline derivates as eravacycline, and several other new molecules as monosulfactams are currently in different stages of development (AU)

La aparición y diseminación de enterobacterias productoras de carbapenemasas es un problema importante y muy preocupante. Existe una necesidad urgente de nuevos antimicrobianos para tratar estas infecciones. Actualmente hay varias opciones en desarrollo. Varios inhibidores nuevos de betalactamasas y de carbapenemasas, como el avibactam y el MK-7665, combinados con betalactámicos antiguos y nuevos son una opción interesante. Algunas combinaciones como ceftazidima-avibactam están en las últimas fases del desarrollo clínico y podrían llegar al mercado en los próximos años. Otros compuestos que están en diferentes fases de desarrollo son aminoglucósidos nuevos, como la plazomicina, derivados de las tetraciclinas como la eravacilina, y otras moléculas nuevas como los monosulfactams (AU)

Foliculitis del jacuzzi: descripción de un brote de 6 casos / Whirlpool folliculitis: 6 cases outbreak report

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Sustained virological response to pegylated interferon plus ribavirin leads to normalization of liver stiffness in hepatitis C virus-infected patients / Respuesta viral sostenida con interferón pegilado y ribavirina conduce a la normalización de la rigidez hepática en pacientes infectados por el virus de la hepatitis C

INTRODUCTION: Pegylated interferon plus ribavirin (Peg-IFN/RBV) therapy leads to improvements in liver stiffness measurements (LSM) in hepatitis C virus (HCV)-infected patients. However, the rate of LSM return to normal values in response to Peg-IFN/RBV is unclear. Thus, our aim was to assess the probability and factors associated with LSM normalization in HCV-infected patients receiving Peg-IFN/RBV. METHODS: This prospective observational longitudinal study included 160 HCV-infected patients, 111 (69%) with human immunodeficiency virus and receiving Peg-IFN/RBV, with baseline LSM ≥ 7kPa. The outcome variable was LSM normalization, i.e. a stable decrease in LSM below 7kPa after starting Peg-IFN/RBV. RESULTS: After starting Peg-IFN/RBV, 56 [35%, 95% confidence interval (95% CI): 28-42%] patients showed LSM normalization. The probability of LSM normalization was 21% (95% CI: 13.2-32.4%) at 12 months, and 51.3% (95% CI: 39.9-63.9%) at 24 months after Peg-INF/RBV initiation for individuals with sustained virological response (SVR), and 8.3% (95% CI: 4-16.6%) at 12 months and 11.3% (95% CI: 6-20.7%) at 24 months for those without SVR (p < 0.001). For individuals with LSM ≥7kPa 24 weeks after the pre-planned end of treatment, LSM normalizations were only observed among those with SVR. Achievement of SVR [Hazard ratio (HR, 95% CI): 6.84 (3.39-13.81)] and lack of baseline cirrhosis [HR (95% CI): 4.17 (1.69-10)] were independently associated with LSM normalization after starting Peg-IFN/RBV. CONCLUSIONS: LSM normalizations during Peg-IFN/RBV treatment are more likely, and occur earlier among patients with SVR. In addition, LSM normalizations continue 24 weeks after the scheduled end of therapy, but only among individuals who reach SVR

INTRODUCCIÓN: El retorno de la rigidez hepática (RH) a valores normales en respuesta al tratamiento de la infección por hepatitis C (VHC) con Peg-IFN/RBV no está claro. Por ello, evaluamos la probabilidad y los factores asociados con la normalización de la RH en pacientes tratados con Peg-IFN/RBV. MÉTODOS: Se incluyeron 160 pacientes infectados por VHC en este estudio longitudinal prospectivo, 111 (69%) de ellos por el virus de la inmunodeficiencia humana, con RH basal ≥ 7kPa y que recibieron Peg-IFN/RBV. La variable principal fue la disminución estable de la RH < 7kPa. RESULTADOS: Después de iniciar Peg-IFN/RBV, 56 (35%; intervalo de confianza del 95% [IC 95%]: 28-42%) pacientes normalizaron la RH. La probabilidad de la normalización de la RH fue del 21% (IC 95%: 13,2-32,4%) 12 meses y del 51,3% (IC 95%: 39,9-63,9%) 24 meses después de iniciar Peg-IFN/RBV en los pacientes con respuesta viral sostenida (RVS), y del 8,3% (IC 95%: 4-16,6%) 12 meses y del 11,3% (IC 95%: 6-20,7%) 24 meses en los sin RVS (p < 0,001). La normalización de la RH en los pacientes con ≥ 7kPa 24 semanas después de finalizar el tratamiento se observó solo en aquellos con RVS. La RVS (hazard ratio [HR]: 6,84; IC 95%: 3,39-13,81) y la ausencia de cirrosis [HR (95%IC): 4.17 (1.69-10)] se asociaron independientemente con la normalización de la RH después de iniciar Peg-IFN/RBV. CONCLUSIONES: La normalización de la RH durante la terapia con Peg-IFN/RBV es más probable y ocurre más temprano en los pacientes con RVS; además, continúa 24 semanas después del fin de tratamiento, pero solo en aquellos con RVS

Factores clínicos asociados a aspergilosis pulmonar invasiva en pacientes con neumopatías crónicas y aislamiento respiratorio de Aspergillus spp / Clinical factors associated with invasive pulmonary aspergillosis in patients with chronic pneumopathies and respiratory isolation of Aspergillus spp

Fundamento y objetivo: Determinar variables clínicas para distinguir colonización de aspergilosis pulmonar invasiva (API) en pacientes con neumopatías crónicas y aislamiento respiratorio de Aspergillus spp. Pacientes y método: Estudio retrospectivo de cohortes donde se incluyeron pacientes con aislamiento respiratorio de Aspergillus spp. durante un período de 10 años. La API se definió mediante los criterios de Bulpa. Para determinar los factores de riesgo de API se recogieron variables clínicas y se realizó un análisis de regresión logística múltiple. Resultados: Se incluyeron 83 pacientes con aislamiento de Aspergillus spp. El 68,7% (n=57) de los pacientes presentaba enfermedad pulmonar respiratoria crónica, el 18% (n=15) fibrosis pulmonar y el 13,3% (n=11) asma bronquial. Veintidós pacientes (26,6%) reunieron criterios de API. El fluconazol (OR 4,49; IC 95% 1,5-13,4; p=0,007), la insuficiencia respiratoria grave (OR 4,64; IC 95% 1,46-14,72; p=0,009) y el tiempo de hospitalización (OR 1,05; IC 95% 1,01-1,1 p=0,006) se asociaron con mayor riesgo de API. Conclusiones: En los pacientes con neumopatías crónicas con aislamiento respiratorio de Aspergillus spp., el uso de fluconazol, la insuficiencia respiratoria grave y el tiempo de hospitalización se asocian con mayor riesgo de que el aislamiento se corresponda con API(AU)

Background and objective: To determine clinical variables to distinguish invasive pulmonary aspergillosis (IPA) from colonization in patients with chronic pneumopathies with positive culture of Aspergillus spp. in respiratory samples. Patients and methods: Retrospective cohort study including patients with respiratory isolations of Aspergillus spp. during a period of 10 years. IPA was evaluated according to the Bulpa criteria. Clinical variables were collected and a multiple logistic regression analysis was carried out. Results: Eighty-three patients with isolation of Aspergillus spp. from respiratory samples were included; 68.7% (n=57) of the patients had chronic obstructive pulmonary disease, 18% (n=15) pulmonary fibrosis and 13.3% (n=11) bronchial asthma. Twenty-two patients (26.6%) had IPA. The use of fluconazole (OR 4.49; CI 95% 1.5-13.4; P=0.007), severe respiratory failure (OR 4.64; CI 95% 1.46-14.72; P=0.009) and hospitalization time (OR 1.05; CI 95% 1.01-1.1; P=0.006) were associated with IPA. Conclusions: Prior use of fluconazole, severe respiratory failure and hospitalization time are associated with IPA in patients with chronic pneumopathies with respiratory isolation of Aspergillus spp(AU)

Respuesta: Bacteriemia por Staphylococcus aureus resistente a meticilina de origen respiratorio / Reply: Meticillin resistant Staphylococcus aureus bacteremia of respiratory origin

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