Résumé
Aumento del riesgo de infecciones prevenibles y sus complicaciones en pacientes con enfermedades reumáticas inflamatorias crónicas (ERICA), con y sin tratamiento con inmunosupresores (IS), y beneficios de la vacunación.
Sujets)
Rhumatismes , Vaccins , Immunisation , ConsensusRésumé
ABSTRACT Introduction: Multidrug-resistant gram-negative rods (MDR GNR) represent a growing threat for patients with cancer. Our objective was to determine the characteristics of and risk factors for MDR GNR bacteremia in patients with cancer and to develop a clinical score to predict MDR GNR bacteremia. Material and Methods: Multicenter prospective study analyzing initial episodes of MDR GNR bacteremia. Risk factors were evaluated using a multiple logistic regression (forward-stepwise selection) analysis including variables with a p < 0.10 in univariate analysis. Results: 394 episodes of GNR bacteremia were included, with 168 (42.6 %) being MDR GNR. Five variables were identified as independent risk factors: recent antibiotic use (OR = 2.8, 95 % CI 1.7-4.6, p = 0.001), recent intensive care unit admission (OR = 2.9, 95 % CI 1.1-7.8, p = 0.027), hospitalization ≥ 7 days prior to the episode of bacteremia (OR = 3.5, 95 % CI 2-6.2, p = 0.005), severe mucositis (OR = 5.3, 95 % CI 1.8-15.6, p = 0.002), and recent or previous colonization/infection with MDR GNR (OR = 2.3, 95 % CI 1.2-4.3, p = 0.028). Using a cut-off value of two points, the score had a sensitivity of 66.07 % (95 % CI 58.4-73.2 %), a specificity of 77.8 % (95 % CI 71.4-82.7 %), a positive predictive value of 68 % (95 % CI 61.9-73.4 %), and a negative predictive value of 75.9 % (95 % CI 71.6-79.7 %). The overall performance of the score was satisfactory (AUROC 0.78; 95 % CI 0.73-0.82). In the cases with one or none of the risk factors identified, the negative likelihood ratio was 0.18 and the post-test probability of having MDR GNR was 11.68 %. Conclusions: With the growing incidence of MDR GNR as etiologic agents of bacteremia in cancer patients, the development of this score could be a potential tool for clinicians.
Sujets)
Humains , Mâle , Femelle , Adulte , Adulte d'âge moyen , Jeune adulte , Infections bactériennes à Gram négatif/étiologie , Bactériémie/étiologie , Appréciation des risques/méthodes , Multirésistance bactérienne aux médicaments , Bactéries à Gram négatif/effets des médicaments et des substances chimiques , Tumeurs/microbiologie , Argentine , Facteurs temps , Modèles logistiques , Analyse multifactorielle , Valeur prédictive des tests , Études prospectives , Facteurs de risque , Infections bactériennes à Gram négatif/traitement médicamenteux , Statistique non paramétrique , Antibactériens/usage thérapeutique , Tumeurs/complicationsRésumé
El creciente interés ante el uso de modificadores de la respuesta biológica, en todas las disciplinas, motivó la revisión del tema y la discusión con la comunidad científica analizando el tema. En el presente documento desarrollaremos los agentes más importantes tales como anti-TNF, anti-citoquinas, bloqueadores de la señal coestimulada, bloqueadores de las moléculas de adhesión, bloqueadores de la proliferación de linfocitos, deplecionadores de linfocitos T y B; enfocado a los cuidados, monitoreos, quimioprofilaxis y vacunación necesaria ante cada agente en especial para evitar infecciones en este grupo de pacientes
The growing interest for the use of biological drugs, in all disciplines,led the review of the literature and discussion with the scientific com-munity analyzing this issue. This paper deals with the most importantagents such as anti-TNF, anti-cytokines, blockers of the co-stimulat-ed signal, blockers of adhesion molecules, blockers of the prolifera-tion of lymphocytes, agents against T and B lymphocytes. We wouldfocuse on daily care, monitoring, chemoprophylaxis and vaccinationrequired for each particular agent to prevent infections in this groupof patients