Real-life experience in two cases of secondary prophylaxis with letermovir for CMV infection in solid organ transplantation.

IMPORTANCE: This observation provides comprehensive data on the clinical correlates of both cytomegalovirus (CMV) genotypic follow-up and clinical monitoring and outcomes for two different solid organ transplantation recipients that received letermovir as secondary prophylaxis. Our study emphasizes that monitoring of CMV disease in the patient and early genotypic detection of resistance mutations are essential when using new antiviral drugs for off-label indication in patients experiencing CMV relapses or not responding to standard antiviral therapy. These cases and the bibliography reviewed can be helpful for other researchers and clinicians working in the field to optimize the use of new treatments for transplant recipients since drug-resistant CMV infection is an important emerging problem even with new developments in antiviral treatment.

Candidemias: análisis multicéntrico en 16 hospitales andaluces / Candidemias: multicentre analysis in 16 hospitals in Andalusia (Spain)

Introducción La candidemia es una infección nosocomial con elevada mortalidad. Los cambios clínicos y microbiológicos descritos en otras áreas y las novedades terapéuticas de los últimos años hacen preciso conocer si la epidemiología clínica de las candidemias en nuestro medio ha cambiado. Material y métodos Estudio prospectivo, multicéntrico y observacional de todos los episodios de candidemia en pacientes adultos atendidos entre el 1 octubre 2005 y el 30 septiembre 2006 en 17 hospitales de Andalucía. Resultados El número total de episodios fue de 220, la incidencia de 0,58 episodios/por cada 1.000 altas. Candida albicans fue la etiología más frecuente (53%). El 89% de las cepas fueron sensibles a fluconazol. La sepsis fue la presentación clínica más frecuente (65,7%). El tratamiento empírico fue inapropiado en el 38,7%. La mortalidad global (..) (AU)

Introduction: Candidemia is a nosocomial infection with high associated mortality. There have been changes in microbiology, epidemiology and treatment over the last few years, which has led us to analyse our own situation. Material and methods: Prospective, multicentre and observational study. All episodes of candidemia in adult patients seen in 17 Andalusian hospitals from 1 October 2005 to 30 September 2006 were included. Results: Were detected 220 cases, the incidence was 0.58 cases/1,000 hospital discharges. Candida albicans was the most frequent species (53% of cases). The majority of isolates (89%) was susceptibility to fluconazole. Sepsis was the most frequent clinical manifestation (65.7%). The treatment was inadequate in b38.7% of cases. Overall mortality was 40%.On univarite analysis (..) (AU)

[Candidemias: multicentre analysis in 16 hospitals in Andalusia (Spain)]. / Candidemias: análisis multicéntrico en 16 hospitales andaluces.

INTRODUCTION: Candidemia is a nosocomial infection with high associated mortality. There have been changes in microbiology, epidemiology and treatment over the last few years, which has led us to analyse our own situation. MATERIAL AND METHODS: Prospective, multicentre and observational study. All episodes of candidemia in adult patients seen in 17 Andalusian hospitals from 1 October 2005 to 30 September 2006 were included. RESULTS: Were detected 220 cases, the incidence was 0.58 cases/1,000 hospital discharges. Candida albicans was the most frecuent species (53% of cases). The majority of isolates (89%) was susceptibility to fluconazole. Sepsis was the most frequent clinical manifestation (65.7%). The treatment was inadequate in 38.7% of cases. Overall mortality was 40%. On univarite analysis death was found to be significantly associated with: aged > 60 years, unknown candidemia focus, Pitt score ≥ 2, APACHE II, shock at onset, persistents positive second blood cultures, non-removal of the central venous catheter and Candida species different of C. parasilopsis, among others. In the multivariate analysis death was found to be significantly associated with: aged > 60 years, Pitt score ≥ 2, Candida species different of C.parasilopsis and inadequate treatment. CONCLUSIONS: The candidemia clinical epidemiology in our region is similar to other areas and receiving inadequate treatment is the only modifiable risk factor associated with higher odds of mortality. Therefore, this modifiable factor needs to be improved to reduce the mortality.

Tratamiento con PGE1 (Alprostadil alfadex) del embolismo por cristales de colesterol / Cholesterol crystals atheroembolic: treatment with PGE1 (Alprostadil alfadex)

Presentamos un caso de enfermedad ateroembólica por cristales de colesterol que fue tratado con prostaglandinas durante 90 días consiguiendo un resultado favorable. Indicamos el planteamiento diagnóstico y terapéutico en esta difícil patología

This paper reports on a case of cholesterol crystal embolization treated with prostaglandins over a 90-day period with a favourable outcome. The diagnostic and therapeutic approach to this complex pathology is discussed

Prevalencia de mutaciones primarias en el virus de la inmunodeficiencia humana que confieren resistencia a análogos de nucleósidos en pacientes de Andalucía no tratados previamente / Prevalence of primary mutations in human immunodeficiency virus with resistance to nucleoside analogues in naive human immunodeficiency virus-infected patients from Andalucía (Spain)

Fundamento: Analizar la frecuencia de mutaciones primarias del VIH a análogos de los nucleósidos en Andalucía. Pacientes y método: A 106 pacientes con infección por el VIH nunca tratados, con carga viral mayor de 5.000 copias ARN/ml, procedentes de 12 hospitales andaluces, se les realizó un estudio genotípico (ensayo LiPA) de mutaciones en los codones M41L, T69D, K70R, L74V, M184V, T215Y/F y RT75G-S. Resultados: En 96 pacientes se obtuvieron resultados evaluables, y se encontraron 12 mutaciones en muestras de 11 pacientes (11,45 por ciento): dos en la posición 41, cuatro en la 70, tres en la 184 y tres en la 215; un paciente presentaba dos mutaciones genotípicas (posiciones 41 y 215). La presencia de mutaciones sólo se relacionó con tener pareja y con transmisión por vía sexual (p < 0,05). Conclusiones: La incidencia de mutaciones primarias que confieren resistencia a los nucleósidos en pacientes con infección por el VIH de Andalucía fue del 11,45 por ciento, siendo los fármacos principalmente relacionados con ellas AZT y 3TC. No se encontraron mutaciones de resistencia a ddC, ddI o D4T. (AU)