Vacunación sublingual con bacterias inactivadas en pacientes nefrológicos con infección urinaria recurrente: experiencia en un centro de España / Sublingual vaccination with inactivated bacteria in recurrent urinary tract infection of nephrologic patients: experience in a center in Spain

Resumen Introducción: las infecciones del tracto urinario (ITU) son frecuentes en pacientes con enfermedad renal crónica (ERC). Una opción de tratamiento cuando estas infecciones son recurrentes es la vacunación bacteriana sublingual. Objetivo: determinar la respuesta a la vacunación bacteriana sublingual en pacientes nefrológicos con ITU recurrente. Materiales y métodos: estudio cuasi experimental en el que se evaluó la evolución en 15 meses de los pacientes con ITU recurrente que asistieron a consulta externa de nefrología. Tras recibir tratamiento antibiótico según antibiograma para cada ITU, los participantes tomaron un ciclo de la vacuna sublingual bacteriana Uromune® durante tres meses. Se recogieron datos sociodemográficos y sobre factores de riesgo asociados, análisis de sangre y orina, episodios de ITU en los seis meses previos y posteriores, microorganismos causantes, tratamiento antibiótico concomitante, respuesta al tratamiento y resolución de la ITU. Resultados: se incluyeron 26 pacientes (80,8 % mujeres) con una media de edad de 61,9±18,4 años, de los cuales el 46,2 % tenía diabetes y el 47,7 %, afectación de la función renal. La media de ITU fue 3,62±1,77 (rango: 1 -7) antes de la vacuna y de 1,69±1,77 (rango: 0-5) después. Se recogieron 184 urocultivos: 74,9 % positivos, 16,9 % negativos y 8,2 % contaminados. Las bacterias más frecuentes fueron Escherichia coli (55,4 %), Enterococcus faecalis (6 %) y Enterobacter cloacae (2,7 %). El 50 % de los participan- tes presentó síndrome miccional, que se asoció inversamente con la edad (p<0,05). El 26,9 % no volvió a tener ITU y el 73,1 % tuvo menos episodios. Los pacientes con ERC avanzada (estadios IV-V) respondieron peor a la vacuna (92,9 % vs 50 %, p=0,025). Conclusiones: la vacunación bacteriana sublingual es una buena opción de tratamiento para la ITU recurrente de pacientes con ERC, siendo más eficaz en los que presentan mejor función renal.

Abstract Introduction: Urinary tract infections (UTIs) are common in patients with chronic kidney disease. A treatment option in recurrent UTI is sublingual bacterial vaccination. The objective of this study was to determine the response to vaccination in nephrologic patients with recurrent UTI. Method: Quasi-experimental study before-after (15 months) in patients with recurrent UTI from the outpatient nephrology consultation. After receiving antibiotic treatment for each UTI, patients took one cycle of the sublingual bacterial vaccine Uromune? for three months. Sociodemographic data, associated risk factors, analysis, UTI in the previous and subsequent six months, microorganisms, concomitant antibiotic treatment, response to treatment and resolution of UTI were collected. Results: Twenty-six patients (80.8% female) of 61.9 ±18.4 years, 46.2% with diabetes and 47.7% with impaired renal function were included. The episodes of UTI were 3.62 ±1.77 (1-7) before and 1.69 ± 1.77 (0-5) after vaccination. In total, 184 urine cultures were collected: 74.9% positive, 16.9% negative and 8.2% contaminated. The most frequent bacteria were Escherichia coli (55.4%), Enterococcus faecalis (6%) and Enterobacter cloacae (2.7%). Fifty percent had voiding syndrome, which was inversely associated with age (p < 0.05); 26.9% did not have a UTI again and 73.1% had fewer episodes. Patients with advanced chronic disease (stages 4-5) reponded worse to the vaccine (92.9% vs 50%, p =0.025). Conclusions: Sublingual bacterial vaccination is a good treatment option in recurrent UTI of nephrologic patients, being more effective in those with better renal function.

Estudio de las infecciones del tracto urinario por Streptococcus gallolyticus subespecie pasteurianus / A study of urinary tract infections by Streptococcus gallolyticus ssp. pasteurianus

No disponible

Thrombotic microangiopathy and accelerated hypertension after treatment with interferon beta / Microangiopatía trombótica e hipertensión acelerada tras tratamiento con interferón beta

No disponible

[The effectiveness of levetiracetam in the treatment of neuropathic pain]. / Eficacia del levetiracetam en el tratamiento del dolor neuropático.

INTRODUCTION: Pharmacological treatment is the first that should be taken into account in dealing with neuropathic pain, antiepileptic drugs being one of the leading options. Levetiracetam is a state of the art antiepileptic drug that has displayed antinociceptive activity in experimental models of pain and clinical effectiveness as an analgesic in series of patients with neuropathic pain. AIM: To analyse the effectiveness of levetiracetam as an analgesic in the treatment of neuropathic pain by means of a systematic review of the literature. PATIENTS AND METHODS: The Medline/PubMed database was used in the study and the search criteria included three fundamental elements: levetiracetam, neuropathic pain and patients. The studies identified were those published before 31st January 2011. The selected studies were submitted to a quality analysis according to the Physiotherapy Evidence Database scale (0-10). RESULTS: Three series of cases, two open non-controlled pilot studies and four randomised clinical trials (RCT) were selected. Only the RCT met acceptable quality criteria. The aetiology of the neuropathic pain was different in each of the RCT analysed. Levetiracetam proved to be effective in the treatment of neuropathic pain in the studies with a low level of methodological quality (case series and pilot studies) and in one RCT aimed at patients with central neuropathic pain due to multiple sclerosis. CONCLUSIONS: Few clinical trials with a high level of methodological quality have been conducted to evaluate the effectiveness of levetiracetam in the treatment of neuropathic pain and most of those that have been carried out do not show any benefit in comparison to the use of a placebo.

Eficacia del levetiracetam en el tratamiento del dolor neuropático / The effectiveness of levetiracetam in the treatment of neuropathic pain

Introducción. El tratamiento farmacológico es la primera opción que se debe considerar en el tratamiento del dolor neuropático, en el que los antiepilépticos ocupan un lugar destacado. El levetiracetam es un antiepiléptico de última generación que ha mostrado actividad antinociceptiva en modelos experimentales de dolor y eficacia clínica analgésica en series de pacientes con dolor neuropático. Objetivo. Analizar la eficacia analgésica del levetiracetam en el tratamiento del dolor neuropático mediante una revisión sistemática de la bibliografía.Pacientes y métodos. Se ha utilizado la base de datos Medline/PubMed. Los criterios de búsqueda reunieron tres elementos fundamentales: levetiracetam, dolor neuropático y pacientes. Se han identificado los estudios hasta el 31 de enero de 2011. Los estudios seleccionados se sometieron a un análisis de calidad según la escala Physiotherapy Evidence Database (0-10). Resultados. Se seleccionaron tres series de casos, dos estudios pilotos abiertos y no controlados y cuatro ensayos clínicos aleatorizados (ECA). Sólo los ECA reunieron criterios de calidad aceptables. La etiología del dolor neuropático era diferente en los distintos ECA analizados. El levetiracetam mostró eficacia en el tratamiento del dolor neuropático en los estudios con calidad metodológica baja (series de casos y estudios pilotos) y en un ECA dirigido a pacientes con dolor neuropático central debido a esclerosis múltiple. onclusiones. Hay escasos ensayos clínicos de calidad metodológica alta que evalúen la eficacia del levetiracetam en el tratamiento del dolor neuropático y la mayoría de ellos no demuestra beneficio en relación con el placebo (AU)

Introduction. Pharmacological treatment is the first that should be taken into account in dealing with neuropathic pain, antiepileptic drugs being one of the leading options. Levetiracetam is a state of the art antiepileptic drug that has displayed antinociceptive activity in experimental models of pain and clinical effectiveness as an analgesic in series of patients with neuropathic pain. Aim. To analyse the effectiveness of levetiracetam as an analgesic in the treatment of neuropathic pain by means of a systematic review of the literature. Patients and methods. The Medline/PubMed database was used in the study and the search criteria included three fundamental elements: levetiracetam, neuropathic pain and patients. The studies identified were those published before 31st January 2011. The selected studies were submitted to a quality analysis according to the Physiotherapy Evidence Database scale (0-10). Results. Three series of cases, two open non-controlled pilot studies and four randomised clinical trials (RCT) were selected. Only the RCT met acceptable quality criteria. The aetiology of the neuropathic pain was different in each of the RCT analysed. Levetiracetam proved to be effective in the treatment of neuropathic pain in the studies with a low level of methodological quality (case series and pilot studies) and in one RCT aimed at patients with central neuropathic pain dueto multiple sclerosis. Conclusions. Few clinical trials with a high level of methodological quality have been conducted to evaluate the effectiveness of levetiracetam in the treatment of neuropathic pain and most of those that have been carried out do not show any benefit in comparison to the use of a placebo (AU)