[Consensus opinion on antifungal prophylaxis in haematologic patients: Results of the PROMIC project]. / Posicionamiento y actitudes de manejo sobre la profilaxis antifúngica en el paciente hematológico (proyecto PROMIC).

OBJECTIVE: Invasive fungal disease (IFD) is an important cause of morbidity and mortality in haematological patients. Antifungal prophylaxis (AFP) is indicated for a number of clinical scenarios in this group of patients. The aim of this study was to reach a consensus on IFD prophylaxis in haematological patients in order to optimize their management. METHODS: A committee of experts in haematology and infectious diseases compiled a survey of 79 items with controversial aspects about antifungal prophylaxis in haematological patients. The survey was evaluated in two rounds by a panel of experts following a modified Delphi methodology. RESULTS: Forty-four experts in haematology and infectious diseases answered the survey. After two evaluation rounds, consensus was reached in 67 of the 79 items (84.8%), specifically 48 items were consensually agreed on (60.7%) and 19 were disagreed on (24.0%). Consensus was reached on prophylaxis candidates profiles and questions related to indications, mechanisms of action, spectrum of activity, toxicity and interactions of antifungal were elucidated. The usefulness of micafungin in IFD prophylaxis was particularly analysed. The consensus reached was that micafungin is an antifungal to be considered in this context as its safety profile and lower interaction potential may be advantageous. CONCLUSIONS: A broad consensus was found in the management of IFD prophylaxis in the haematological patient. This consensus provides practical indications about its optimal management and can help determine the profile of patients eligible for this type of intervention.

Impacto de la implantación de un Código Sepsis intrahospitalario en la prescripción de antibióticos y los resultados clínicos en una unidad de cuidados intensivos / Impact of the implementation of a Sepsis Code hospital protocol in antibiotic prescription and clinical outcomes in an intensive care unit

INTRODUCCIÓN: Se analiza el impacto de un Código Sepsis intrahospitalario sobre el uso y consumo de antibióticos, la estancia hospitalaria y la mortalidad. DISEÑO: Estudio retrospectivo cuasiexperimental observacional. Ámbitos: UCI polivalente de 11 camas en un hospital de tercer nivel. PACIENTES: Pacientes ingresados en UCI con diagnóstico de sepsis grave o shock séptico. INTERVENCIONES: Un grupo postintervención (POST-CS) (septiembre 2012-agosto 2013) se comparó con un grupo histórico (PRE-CS) control (enero-diciembre 2010). VARIABLES: Tipo de tratamiento antibiótico, estrategia terapéutica antibiótica y resultados clínicos. El consumo de antibióticos fue expresado en dosis diarias definidas/100 estancias. RESULTADOS: Se incluyeron 42 pacientes con sepsis grave/shock séptico en el grupo POST-CS y 50 en el grupo PRE-CS. El consumo total de antibióticos (dosis diarias definidas) fue similar en ambos grupos. En el grupo POST-CS la tasa de desescalamiento fue significativamente mayor (75 vs. 30,8%, p < 0,005), mientras que la prescripción de antibióticos de uso restringido fue significativamente menor (74 vs. 52%, p = 0,031). Finalmente, el grupo de pacientes POST-CS presentó una mortalidad intrahospitalaria y a 28 días significativamente menor (23 vs. 44% [p = 0,035] y 31 vs. 56% [p = 0,01]), así como una disminución de la estancia en UCI en el límite de la significación estadística (5 vs. 10,5 días, p = 0,05). CONCLUSIÓN: La implantación de un programa de Código Sepsis intrahospitalario se asoció a una mejor utilización del tratamiento antibiótico, incrementándose significativamente el desescalamiento terapéutico y disminuyendo el uso de antibióticos de uso restringido, así como a una significativa disminución de la mortalidad y una tendencia hacia una menor estancia en UCI

INTRODUCTION: A study was performed to analyze the impact of an in-hospital Sepsis Code (SC) program on use of antibiotic and clinical outcomes. DESIGN: Quasi-experimental observational retrospective study. SETTING: Polyvalent 11 beds ICU belonging to a tertiary Universitary hospital. PATIENTS: Patients admitted consecutively to the ICU with diagnosis of severe sepsis or septic shock. INTERVENTIONS: A post intervention group (POST-SC) (September 2012-August 2013) was compared with a historical group (PRE-SC) used as control (January-December 2010). VARIABLES: Antibiotic treatment, therapeutic antibiotic strategy, mortality and length of stay. Antibiotic consumption was expressed as defined daily doses (DDD)/ 100 stays. RESULTS: 42 patients with SS/SS in POST-SC group and 50 patients in PRE-SC group were consecutively recluted and further analyzed. Total antibiotic consumption (DDD) was similar in both groups. Rate of de-escalation therapy was significantly higher in POST-SC group (75% vs 30,8%, p < 0,005) while prescription of restricted antibiotics was significantly lower (74% vs 52%, p = 0,031). Finally POST-SC patients showed a significantly decrease in hospital and 28 days mortality rates [23% vs 44%, (p = 0,035) and 31% vs 56% (p = 0,014) respectively] as well as a reduction in ICU length of stay compared to PRE-SC cohort (5 days vs 10,5 days, p = 0,05). CONCLUSION: The implementation of a Sepsis Code-hospital protocol is associated to an improvement in the management of antibiotic therapy with a significant increase in de-escalation therapy and lesser utilization of restricted use antibiotics, as well as a significant reduction in mortality, and a tendency towards shorter ICU length stay

Impact of the implementation of a Sepsis Code hospital protocol in antibiotic prescription and clinical outcomes in an intensive care unit. / Impacto de la implantación de un Código Sepsis intrahospitalario en la prescripción de antibióticos y los resultados clínicos en una unidad de cuidados intensivos.

INTRODUCTION: A study was performed to analyze the impact of an in-hospital Sepsis Code (SC) program on use of antibiotic and clinical outcomes. DESIGN: Quasi-experimental observational retrospective study. SETTING: Polyvalent 11 beds ICU belonging to a tertiary Universitary hospital. PATIENTS: Patients admitted consecutively to the ICU with diagnosis of severe sepsis or septic shock. INTERVENTIONS: A post intervention group (POST-SC) (September 2012-August 2013) was compared with a historical group (PRE-SC) used as control (January-December 2010). VARIABLES: Antibiotic treatment, therapeutic antibiotic strategy, mortality and length of stay. Antibiotic consumption was expressed as defined daily doses (DDD)/ 100 stays. RESULTS: 42 patients with SS/SS in POST-SC group and 50 patients in PRE-SC group were consecutively recluted and further analyzed. Total antibiotic consumption (DDD) was similar in both groups. Rate of de-escalation therapy was significantly higher in POST-SC group (75% vs 30,8%, p<0,005) while prescription of restricted antibiotics was significantly lower (74% vs 52%, p=0,031). Finally POST-SC patients showed a significantly decrease in hospital and 28 days mortality rates [23% vs 44%, (p=0,035) and 31% vs 56% (p=0,014) respectively] as well as a reduction in ICU length of stay compared to PRE-SC cohort (5 days vs 10,5 days, p=0,05). CONCLUSION: The implementation of a Sepsis Code-hospital protocol is associated to an improvement in the management of antibiotic therapy with a significant increase in de-escalation therapy and lesser utilization of restricted use antibiotics, as well as a significant reduction in mortality, and a tendency towards shorter ICU length stay.

Economic assessment of fidaxomicin for the treatment of Clostridium difficile infection (CDI) in special populations (patients with cancer, concomitant antibiotic treatment or renal impairment) in Spain.

The objective of this paper was to assess the cost-utility of fidaxomicin versus vancomycin in the treatment of Clostridium difficile infection (CDI) in three specific CDI patient subgroups: those with cancer, treated with concomitant antibiotic therapy or with renal impairment. A Markov model with six health states was developed to assess the cost-utility of fidaxomicin versus vancomycin in the patient subgroups over a period of 1 year from initial infection. Cost and outcome data used to parameterise the model were taken from Spanish sources and published literature. The costs were from the Spanish hospital perspective, in Euros (€) and for 2013. For CDI patients with cancer, fidaxomicin was dominant versus vancomycin [gain of 0.016 quality-adjusted life-years (QALYs) and savings of €2,397 per patient]. At a cost-effectiveness threshold of €30,000 per QALY gained, the probability that fidaxomicin was cost-effective was 96 %. For CDI patients treated with concomitant antibiotic therapy, fidaxomicin was the dominant treatment versus vancomycin (gain of 0.014 QALYs and savings of €1,452 per patient), with a probability that fidaxomicin was cost-effective of 94 %. For CDI patients with renal impairment, fidaxomicin was also dominant versus vancomycin (gain of 0.013 QALYs and savings of €1,432 per patient), with a probability that fidaxomicin was cost-effective of 96 %. Over a 1-year time horizon, when fidaxomicin is compared to vancomycin in CDI patients with cancer, treated with concomitant antibiotic therapy or with renal impairment, the use of fidaxomicin would be expected to result in increased QALYs for patients and reduced overall costs.

Levofloxacino en el tratamiento de infecciones nosocomiales en pacientes críticos / Levofloxacin in the treatment of nosocomial infection in critically ill patients

Introducción. El levofloxacino (LVX) es uno de los antibióticosmás utilizados en pacientes críticos ingresados enServicios o Unidades de Cuidados Intensivos (UCI) españolas.Su utilización en infecciones comunitarias está ampliamentedocumentada, mientras que su uso en infecciones nosocomiales(IN) es menos frecuente y conocido.Objetivo. Describir las indicaciones y formas de empleode LVX en el tratamiento de IN en pacientes ingresados enUCI españolas.Material y método. Estudio abierto, retrospectivo, observacionaly multicéntrico. Se han incluido todos los pacientesingresados en UCI que en los años 2004-2005 recibieron LVXpara el tratamiento de IN. Se ha cumplimentado un cuadernode recogida de datos (CRD) que incluye variables demográficas,de la infección, del tratamiento y de la evolución del proceso infeccioso y del paciente. Se describe la utilizaciónde LVX dependiendo de la IN. Se realiza análisis de regresión logística para identificar las variables relacionadas con respuesta satisfactoria. Los resultados se expresan mediante laodds ratio (OR) y el intervalo de confianza (IC) del 95%.Resultados. Se han incluido 949 pacientes en 87 UCIque han recibido LVX para el tratamiento de 1.103 IN: 460(41,7%) neumonías no relacionadas con ventilación mecánica,256 (23,2%) neumonías relacionadas con ventilación mecánica,107 (9,7%) bacteriemias primarias o relacionadas con catéteresvasculares, 47 (4,3%) infecciones urinarias relacionadascon sonda uretral, 42 (3,8%) infecciones quirúrgicas profundaso de órgano-espacio y 191 (17,3 %) otras infecciones.APACHE II al ingreso de 19,6 (desviación estándar [DE]: 8) yrespuesta sistémica de sepsis grave o shock séptico en el 50,4% de los casos. En 776 (82,7%) ocasiones se ha iniciado el tratamiento de forma empírica y en 589 (62,1%) casos la dosisde elección ha sido de 0,5 g/12 h, con una duración media de 9 días (AU)

Introduction. Levofloxacin (LVX) is one of the most frequentlyused antibiotics in critical patients admitted to SpanishIntensive Care Units (ICU). Their use in communityacquiredinfections has been widely documented, while it is less frequent and known in nosocomial infections (NI).Objective. To describe the indications and utilizationpatterns of LVX in the treatment of NI in patients admittedto Spanish ICU.Material and methods. Open-label, retrospective, observational and multicenter study. All patients admittedto ICU and who were being treated for NI with LVX in the years 2004-2005 were included. A case reportform (CRF) was drawn up and included demographic, infection, treatment, infectious process and patient development variables. NI-dependent LVX usage was described.A logistical regression analysis was carried out in order to identify the variables associated with a satisfactoryresponse. Results are expressed by means of the odds ratio and a 95% confidence interval.Results. A total of 949 patients who were given LVXfor the treatment of 1,103 NI were recruited in 87 ICU:460 (41.7%) with non-mechanical ventilation associatedpneumonia, 256 (23.2 %) mechanical-ventilation associatedpneumonia, 107 (9.7 %) with primary or vascularcatheter-related bacteremia, 47 (4.3 %) with urethral catheter-related urinary infections, 42 (3.8%) with organspaceor deep surgical infections and 191 (17.3%) whohad other types of infection. An APACHE II upon admissionof 19.6 (SD: 8) and severe sepsis or septic shocksystemic response in 50.4% of all cases. On 776 (82.7%)occasions treatment was initiated on an empirical basisand in 589 (62.1%) cases the dose of choice was of 0.5 g/12 h, with a mean duration of 9 days (AU)

[Levofloxacin in the treatment of nosocomial infection in critically ill patients]. / Levofloxacino en el tratamiento de infecciones nosocomiales en pacientes críticos.

INTRODUCTION: Levofloxacin (LVX) is one of the most frequently used antibiotics in critical patients admitted to Spanish Intensive Care Units (ICU). Their use in community-acquired infections has been widely documented, while it is less frequent and known in nosocomial infections (NI). OBJECTIVE: To describe the indications and utilization patterns of LVX in the treatment of NI in patients admitted to Spanish ICU. MATERIAL AND METHODS: Open-label, retrospective, observational and multicenter study. All patients admitted to ICU and who were being treated for NI with LVX in the years 2004-2005 were included. A case report form (CRF) was drawn up and included demographic, infection, treatment, infectious process and patient development variables. NI-dependent LVX usage was described. A logistical regression analysis was carried out in order to identify the variables associated with a satisfactory response. Results are expressed by means of the odds ratio and a 95% confidence interval. RESULTS: A total of 949 patients who were given LVX for the treatment of 1,103 NI were recruited in 87 ICU: 460 (41.7%) with non-mechanical ventilation associated pneumonia, 256 (23.2 %) mechanical-ventilation associated pneumonia, 107 (9.7 %) with primary or vascular catheter-related bacteremia, 47 (4.3 %) with urethral catheter-related urinary infections, 42 (3.8%) with organspace or deep surgical infections and 191 (17.3%) who had other types of infection. An APACHE II upon admission of 19.6 (SD: 8) and severe sepsis or septic shock systemic response in 50.4% of all cases. On 776 (82.7%) occasions treatment was initiated on an empirical basis and in 589 (62.1%) cases the dose of choice was of 0.5 g/ 12 h, with a mean duration of 9 days. In 738 (77.8 %) patients, LVX was used in association with other antibiotics. The clinical response by treatment end was rated as satisfactory in 67.4 % of all NI. Factors related to a non-satisfactory response were as follows: APACHE II (OR: 1.05; 95% CI: 1.028-1.078); septic shock (OR: 2.62; 95 % CI: 1.623-4.219); the requirement for changes in treatment due to poor clinical progress (OR: 66.67; 95% CI: 15.384-250), the presence of non-covered microorganisms (OR: 6.58; 95% CI: 3.663-11.765), the appearance of new resistant pathogens (OR: 6.94; 95 % CI: 2.445- 19.608) or the diagnosis of a new infection (OR: 3.68; 95% CI: 1.504-8.929); solid neoplasm (OR: 1.98; 95% CI: 1.156-3.899); chronic liver disease (OR: 3.11; 95 % CI: 1.429-8.475) and the absence of etiology confirmation (OR: 2.39; 95 % CI: 1.624-3.510). One or more adverse events which were possibly or probably related to the use of LVX were detected in 104 (11.0%) patients. Total intra-ICU mortality amounted to 26.1%, while the accumulated in-hospital mortality was 33.8%. CONCLUSIONS: LVX is a common therapeutic option in the treatment of nosocomial infections in critical patients. It is predominantly used in an empirical manner, at a dose of 0.5 g every 12 hours and in combination with other antibiotics.

Recomendaciones para el tratamiento de infecciones por cocos grampositivos en pacientes críticos. De la teoría a la práctica / Recommendations for the treatment of gram positive coccal infections in critical patients. From theory to practice

No disponible

Resumen de las recomendaciones GEIPC-SEIMC y GTEISEMICYUC para el tratamiento antibiótico de infecciones por cocos gram positivos en el paciente crítico / No disponible

Objetivo: En los últimos años se ha constatado un incremento en las infecciones causadas por cocos gram positivos en pacientes críticos, junto a un rápido desarrollo de resistencias a los antibióticos habitualmente empleados para su tratamiento. El objetivo es elaborar una guía de tratamiento antibiótico de las infecciones más frecuentes causadas por cocos gram positivos en pacientes críticos, que ayude a la toma de decisiones asistenciales.Método: Expertos de dos grupos de trabajo de dos sociedades científicas, pertenecientes al Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC (GEIPC-SEIMC) y al Grupo de Trabajo de Enfermedades Infecciosas de la SEMICYUC (GTEI-SEMICYUC),se reunieron con el objetivo de elaborar un documento de consenso. Se hizo una revisión sistemática de la literatura publicada hasta septiembre de 2006 referida a estas infecciones, y con los tratamientos antibióticos comercializados hasta entonces. Se aplicó un sistema de graduación de la evidencia según la fuerza de la recomendación (categorías A, B o C) y el grado de evidencia (categorías I, II o III). Se realizaron las recomendaciones por consenso entre los expertos de ambas sociedades.Resultados: Se presentan en forma de tablas las pautas antibióticas recomendadas para el tratamiento de las infecciones causadas por cocos gram positivos, reflejando el grado de recomendación. Se expresan las alternativas para el caso de pacientes alérgicos. En el texto se razona la base científica sobre la que se sustentan dichas recomendaciones citando las referencias en las que se apoyan.Conclusiones: Se presenta el resumen de una guía práctica, basada en la evidencia, para el tratamiento antibiótico de infecciones por cocos gram positivos en el paciente crítico

Objective: In recent years there has been an increase in infections caused by gram-positive cocci in critical patients, together with a rapid development of resistance to the antibiotics which arenormally used to treat them. The objective is to prepare an antibiotic treatment guide for the most common infections caused bygram positive cocci in critical patients. This guide will help in the decision-making process regarding the care of such patients.Method: Experts from two scientific societies worked together to prepare a consensus document. They were members of the Study Group on Infections in Critical Patients (GEIPC), which is part of the Spanish Society of Infectious Diseases and Clinical Microbiology(SEIMC), and the Infectious Diseases Working Group (GTEI), belonging to the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC). There was a systematic review of the literature published up to September 2006 regarding this type of infections and the antibiotic treatments marketed to that date. An evidence grading system was applied according to the strength of the recommendation (categories A, B or C) and the level of evidence (categories I, II or III). Recommendations were given if there was consensus among the experts from both societies.Results: The antibiotic regimens recommended for treatinginfections caused by gram-positive cocci were presented in the form of tables, showing the recommendation grade. Alternatives were given for allergic patients. The scientific basis supporting the aforementioned recommendations is explained within the text and the references upon which they are based are cited.Conclusions: A summary of an evidence-based practicalguide for the treatment of infections caused by gram-positive cocci in critical patients is presented

[GEIPC-SEIMC and GTEI-SEMICYUC recommendations for antibiotic treatment of gram positive coccal infections in the critical patient]. / Recomendaciones GEIPC-SEIMC y GTEI-SEMICYUC para el tratamiento antibiótico de infecciones por cocos grampositivos en el paciente crítico.

In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Critico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients.

Recomendaciones GEIPC-SEIMC y GTEI-SEMICYUC para el tratamiento antibiótico de infecciones por cocos grampositivos en el paciente crítico / GEIPC-SEIMC and GTEI-SEMICYUC recommendations for antibiotic treatment of gram positive coccal infections in the critical patient

En los últimos años se ha constatado un incremento en las infecciones causadas por cocos grampositivos tanto en infecciones comunitarias como nosocomiales. En algunos países, se ha observado un rápido desarrollo de resistencias a los antibióticos habitualmente empleados para su tratamiento, y se supone que esa situación puede llegar en el futuro a nuestro país. Se están desarrollando nuevos antimicrobianos específicamente dirigidos para el tratamiento de estas infecciones, pero es necesario profundizar en el conocimiento de las propiedades farmacocinéticas de los antibióticos tanto antiguos como nuevos, para aprovechar al máximo sus cualidades frente a estos patógenos y evitar en lo posible su toxicidad. En el paciente crítico estos problemas son más acuciantes, ya que la inadecuación del tratamiento, tanto en la elección del antibiótico como en la dosis y en la administración, se acompañan frecuentemente de fracasos terapéuticos y por tanto de mal pronóstico. Expertos de dos grupos de trabajo de dos Sociedades científicas, pertenecientes al Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC (GEIPC-SEIMC) y al Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC (GTEI- SEMICYUC) se han reunido con el objetivo de elaborar un documento de consenso, basado en la evidencia científica, que recoge las recomendaciones para el tratamiento antibiótico de las infecciones graves causadas por cocos grampositivos en el paciente crítico y que ayude en la toma de decisiones asistenciales

In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Critico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients

Recomendaciones GEIPC-SEIMC y GTEI-SEMICYUC para el tratamiento antibiótico de infecciones por cocos grampositivos en el paciente crítico / GEIPC-SEIMC and GTEI-SEMICYUC recommendations for antibiotic treatment of gram positive coccal infections in the critical patient

En los últimos años se ha constatado un incremento en las infecciones causadas por cocos grampositivos tanto en infecciones comunitarias como nosocomiales. En algunos países, se ha observado un rápido desarrollo de resistencias a los antibióticos habitualmente empleados para su tratamiento, y se supone que esa situación puede llegar en el futuro a nuestro país. Se están desarrollando nuevos antimicrobianos específicamente dirigidos para el tratamiento de estas infecciones, pero es necesario profundizar en el conocimiento de las propiedades farmacocinéticas de los antibióticos tanto antiguos como nuevos, para aprovechar al máximo sus cualidades frente a estos patógenos y evitar en lo posible su toxicidad. En el paciente crítico estos problemas son más acuciantes, ya que la inadecuación del tratamiento, tanto en la elección del antibiótico como en la dosis y en la administración, se acompañan frecuentemente de fracasos terapéuticos y por tanto de mal pronóstico. Expertos de dos grupos de trabajo de dos Sociedades científicas, pertenecientes al Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC (GEIPC-SEIMC) y al Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC (GTEI-SEMICYUC) se han reunido con el objetivo de elaborar un documento de consenso, basado en la evidencia científica, que recoge las recomendaciones para el tratamiento antibiótico de las infecciones graves causadas por cocos grampositivos en el paciente crítico y que ayude en la toma de decisiones asistenciales (AU)

In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired-infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients (AU)

[Summary of the GEIPC-SEIMC and GTEI-SEMICYUC recommendations for the treatment of infections caused by gram positive cocci in critical patients]. / Resumen de las recomendaciones GEIPC-SEIMC y GTEI-SEMICYUC para el tratamiento antibiótico de infecciones por cocos gram positivos en la paciente crítico

OBJECTIVE: In recent years there has been an increase in infections caused by gram-positive cocci in critical patients, together with a rapid development of resistance to the antibiotics which are normally used to treat them. The objective is to prepare an antibiotic treatment guide for the most common infections caused by gram positive cocci in critical patients. This guide will help in the decision-making process regarding the care of such patients. METHOD: Experts from two scientific societies worked together to prepare a consensus document. They were members of the Study Group on Infections in Critical Patients (GEIPC), which is part of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and the Infectious Diseases Working Group (GTEI), belonging to the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC). There was a systematic review of the literature published up to September 2006 regarding this type of infections and the antibiotic treatments marketed to that date. An evidence grading system was applied according to the strength of the recommendation (categories A, B or C) and the level of evidence (categories I, II or III). Recommendations were given if there was consensus among the experts from both societies. RESULTS: The antibiotic regimens recommended for treating infections caused by gram-positive cocci were presented in the form of tables, showing the recommendation grade. Alternatives were given for allergic patients. The scientific basis supporting the aforementioned recommendations is explained within the text and the references upon which they are based are cited. CONCLUSIONS: A summary of an evidence-based practical guide for the treatment of infections caused by gram-positive cocci in critical patients is presented.

Tratamiento de las infecciones por microorganismos productores de betalactamasas de espectro extendido: un nuevo reto terapéutico / Treatment of infections by wide spectrum betalactamase - producing microorganisms: a new therapeutic challenge

No disponible

Probable síndrome serotoninérgico por interacción entre amitriptilina, paroxetina y linezolid / Likely serotoninergic syndrome from an interaction between amitryptiline, paroxetine, and linezolid

No disponible

[Economic evaluation of voriconazole versus amphotericin B in the treatment of invasive aspergilosis]. / Evaluación económica del uso de voriconazol versus anfotericina B en el tratamiento de la aspergilosis invasiva.

OBJECTIVE: Invasive aspergillosis is an infection with high incidence and mortality. Voriconazole is a new antifungal agent that presents a high efficacy against Aspergillus. The aim of this evaluation was to carry out a pharmacoeconomic analysis of the use of voriconazole versus amphotericin B deoxycholate in the treatment of invasive aspergillosis in Spain. MATERIAL AND METHODS: A cost-effectiveness analysis has been performed by building a decision analytical model. Effectiveness data, probabilities of the different branches of the decision tree and consumption of healthcare resources were obtained from a clinical trial that compared voriconazole versus amphotericin B in the treatment of invasive aspergillosis and from a local expert panel in order to incorporate the model in the daily medical practice in our country. Only direct medical costs were included in the model (drug acquisition, length of hospital stay, analytical tests and treatment of therapeutic failures). The perspective chosen for this analysis was hospital assistance and the time horizon selected was 12 weeks, the maximum time that patients were followed up in the referenced clinical trial. RESULTS: Therapeutic success was reached in 52.8% of patients treated with voriconazole and in 31.6% of the group treated with amphotericin B. The cost of treating a patient with voriconazole or amphotericin B was of 56,296 and 56,382 Euros respectively, while the cost/effectiveness ratio was of 106,621 and 178,424 Euros. The incremental analysis performed shows how the use of voriconazole versus amphotericin B produces a healthcare resources saving of 406 Euros per patient. CONCLUSIONS: Voriconazole is more efficient than amphotericin B deoxycholate in the treatment of invasive aspergillosis, (thus) resulting in healthcare resources saving due to better clinical results with lower associated costs.

Evaluación económica del uso de voriconazol versus anfotericina B en el tratamiento de la aspergilosis invasiva / Economic evaluation of voriconazole versus amphotericin B in the treatment of invasive aspergilosis

Introducción: La aspergilosis invasiva es una infección con una incidencia creciente y una elevada mortalidad asociada. Voriconazoles un antifúngico que ha demostrado una alta eficacia en el tratamiento de esta enfermedad. El objetivo de este estudio ha sido efectuar un análisis farmacoeconómico del uso de voriconazol versus anfotericina B deoxicolato, en el tratamiento de la aspergilosis invasiva en nuestro país. Material y métodos: Se ha elaborado un análisis coste-efectividad empleando un modelo farmacoeconómico elaborado a través de un análisis de decisión. Los datos de efectividad, las probabilidades del árbol de decisión y el consumo de recursos, fueron obtenidos de un ensayo clínico que comparó ambas alternativas terapéuticas y de un panel de expertos local, con el fin de incorporar el modelo a la práctica médica habitual de nuestro medio. Solamente se han incluido en este análisis los costes médicos directos (coste de la medicación, días de hospitalización, analíticas y tratamiento del fallo terapéutico).La perspectiva elegida para el análisis ha sido el hospital, y el horizonte temporal escogido ha sido de 12 semanas, tiempo máximo que los pacientes fueron seguidos en el ensayo clínico de referencia. Resultados: En el estudio de referencia, los pacientes tratados con voriconazol presentaron éxito terapéutico en el 52,8 frente al31,6% en el grupo tratado con anfotericina B deoxicolato. El coste de tratar un paciente con voriconazol o con anfotericina B deoxicolato, fue de 56.296 y 56.382 € respectivamente, mientras que el cociente coste/efectividad medio fue de 106.621 y 178.424 €, al emplear ambas opciones en evaluación. El análisis coste-efectividad incremental efectuado muestra queel uso de voriconazol versus el de anfotericina B deoxicolato,supone un ahorro de recursos sanitarios de 406 € por paciente. Conclusiones: Voriconazol es una opción más eficiente que la anfotericina B deoxicolato en el tratamiento de la aspergilosis invasiva, lo que se traduce en un ahorro de recursos, derivado de producir mejores resultados clínicos con costes asociados más bajos

Objective: Invasive aspergillosis is an infection with high incidence and mortality. Voriconazole is a new antifungal agent that presents a high efficacy against Aspergillus. The aim of this evaluation was to carry out a pharmacoeconomic analysis of the use of voriconazole versus amphotericin B deoxycholate in the treatment of invasive aspergillosis in Spain. Material and methods: A cost-effectiveness analysis has been performed by building a decision analytical model. Effectiveness data, probabilities of the different branches of the decision tree and consumption of healthcare resources were obtained from a clinical trial that compared voriconazole versus amphotericin B in the treatment of invasive aspergillosis and from a local expert panel in order to incorporate the model in the daily medical practice in our country. Only direct medical costs were included in the model (drug acquisition, length of hospital stay, analytical tests and treatmentof therapeutic failures).The perspective chosen for this analysis was hospital assistance and the time horizon selected was 12 weeks, the maximum time that patients were followed up in the referenced clinical trial. Results: Therapeutic success was reached in 52.8% of patients treated with voriconazole and in 31.6% of the group treated with amphotericin B. The cost of treating a patient with voriconazole or amphotericinB was of 56,296 and 56,382 € respectively, while the cost/effectiveness ratio was of 106,621 and 178,424 €.The incremental analysis performed shows how the use of voriconazole versus amphotericin B produces a healthcare resources saving of 406 € per patient. Conclusions: Voriconazole is more efficient than amphotericin B deoxycholate in the treatment of invasive aspergillosis, (thus)resulting in healthcare resources saving due to better clinical results with lower associated costs

[Lung aspergillosis. Role of the corticoids as associated risk factor in the patient with chronic bronchitis]. / Aspergilosis pulmonar. Papel de los corticoides como factor de riesgo asociado en el bronquítico crónico.

BASIS: Description of a situation of incidence increase of bronchial secretions with positive cultures for Aspergillus fumigatus, and analysis of the related risk factors in the invasive aspergillosis. METHODS: Between January 1999 and February 2000, a prospective study of the patients was conducted with culture of bronchial secretions and with positive result for A. fumigatus. VARIABLES STUDIED: age, sex, primary diagnosis, type of cultivated sample, clinical interpretation (colonization/infection), probable source (community/nosocomial), situation of the patient after discharge, and risk factors for opportunistic infection. The results were compared among the colonized and infected patients. RESULTS: Fifty-two patients showed positive cultures of bronchial secretions to A. fumigatus, 43 (82.6%) colonized and 9 (17.3%) infected. Cultivated sputum sample on 30 occasions (57.6%) and bronchial aspiration in 22 (42.3%). Median age: 70 years (31-84). Sex: 40 men (76.9%). Probable source of infection/colonization: nosocomial in 18 cases (34.6%), community in 3 (5.7%) and unknown in 31 (59.6%). Mortality: 15 patient colonized (34.8%) and 8 infected (88.8%). Risk factors with statistical significance for invasive infection by A. fumigatus: diagnosis of chronic bronchopathy (COPD) (p=0.007) and treatment with prednisone in dose higher than 60 mg/day (p=0.0005). CONCLUSIONS: The patients with positive culture of bronchial secretions to A. fumigatus with COPD and treatment with prednisone in dose higher than 60 mg/day should be considered with a greater risk for infection by this pathogen. A more restricted use and adequate of the corticoids in these patients, and an early diagnosis and treatment in light of the suspicion of infection by A. fumigatus in patients with COPD, it could imply a reduction of morbidity and mortality.