In vitro Activity of Pentamidine Alone and in Combination With Aminoglycosides, Tigecycline, Rifampicin, and Doripenem Against Clinical Strains of Carbapenemase-Producing and/or Colistin-Resistant Enterobacteriaceae.

Enterobacteriaceae cause different types of community- and hospital-acquired infections. Moreover, the spread of multidrug-resistant Enterobacteriaceae is a public health problem and the World Health Organization pointed them among the pathogens in which the search of new antibiotics is critical. The objective of this study was to analyze the in vitro activity of pentamidine alone and in combination with gentamicin, tobramycin, amikacin, tigecycline, rifampicin, or doripenem against eight clinical strains of carbapenemase-producing and/or colistin-resistant Enterobacteriaceae: five carbapenemase-producing Klebsiella pneumoniae, one carbapenemase-producing Escherichia coli, and two colistin-resistant Enterobacter cloacae. MIC and MBC were determined following standard protocols. MIC results were interpreted for all the antibiotics according to the EUCAST breakpoints but for rifampicin in which the French FSM breakpoint was used. Bactericidal and synergistic activity of pentamidine alone and in combination with antibiotics at concentrations of 1xMIC was measured by time-kill curves. For one selected strain, K. pneumoniae OXA-48/CTX-M-15 time-kill curves were performed also at 1/2xMIC of pentamidine. All studies were performed in triplicate. Pentamidine MIC range was 200-800 µg/mL. The 50, 12.5, 62.5, 87.5, and 62.5% of the strains were susceptible to gentamicin, tobramycin, amikacin, tigecycline, and doripenem, respectively. Only the two E. cloacae strains were susceptible to rifampicin. Pentamidine alone at 1xMIC showed bactericidal activity against all strains, except for the E. cloacae 32 strain. The bactericidal activity of pentamidine alone was also observed in combination. The combinations of pentamidine were synergistic against E. cloacae 32 with amikacin and tobramycin at 24 h and with tigecycline at 8 h. Pentamidine plus rifampicin was the combination that showed synergistic activity against more strains (five out of eight). Pentamidine plus doripenem did not show synergy against any strain. At 1/2xMIC, pentamidine was synergistic with all the studied combinations against the K. pneumoniae OXA-48/CTX-M-15 strain. In summary, pentamidine alone and in combination shows in vitro activity against carbapenemase-producing and/or colistin-resistant Enterobacteriaceae. Pentamidine appears to be a promising option to treat infections caused by these pathogens.

Hepatitis aguda grave y anemia hemolítica por crioaglutininas secundarias a primoinfección por virus Epstein-Barr / Severe acute hepatitis and cold agglutinin-related hemolytic anemia secondary to prime infection with Epstein-Barr virus

El virus Ebstein-Barr, miembro de la familia Herpesviridae, es responsable del síndrome clínico conocido como mononucleosis infecciosa, que consiste principalmente en la triada faringitis, fiebre y linfadenopatía, tras un periodo de incubación de entre 30 y 50 días. La afectación hepática suele darse en el 80-90% de los pacientes de forma autolimitada y transitoria, mientras que es bastante menos frecuente que se produzca ictericia (5%). Desde el punto de vista hematológico puede cursar con anemia hemolítica, anemia aplásica, neutropenia y trombocitopenia. Presentamos un caso clínico de mononucleosis infecciosa que cursó con hepatitis aguda grave y asoció anemia hemolítica severa secundaria a crioaglutininas. Tras descartar otras etiologías y ante la sospecha clínica y posterior confirmación analítica de la asociación antes mencionada, se instauró tratamiento empírico con antivirales (aciclovir + valganciclovir) y corticoides, objetivando mejoría progresiva hasta la resolución completa del cuadro clínico. Creemos, por tanto, que este caso sirve para reforzar el cuerpo de evidencia clínica que apoya esta terapia conjunta en los casos más graves de mononucleosis infecciosa como paso previo al trasplante hepático (AU)

Epstein-Barr virus, a member of the Herpesviridae family, is responsible for the infectious mononucleosis clinical syndrome, which mainly includes the pharyngitis, fever, and lymphadenopathy triad after incubation for 30-50 days. The liver is involved in 80-90% of patients in a self-limiting transient manner, with jaundice being much more uncommon (5%). From a hematological standpoint it may manifest aplastic anemia, neutropenia, and thrombocytopenia. We report a case of infectious mononucleosis that included severe acute hepatitis and was associated with severe hemolytic anemia secondary to cold agglutinins. After exclusion of other etiologies, and given the clinical suspicion of the above association, which was later confirmed by lab tests, empiric therapy was initiated with antiviral agents (aciclovir + valganciclovir) and corticoids, which resulted in a progressive clinical improvement until complete remission. Therefore, we believe that this case report will reinforce the clinical evidence in support of the above combined therapy for serious infectious mononucleosis as a step prior to liver transplantation (AU)

Urinary tract infection in kidney transplant recipients / Infección del Tracto Urinario en el Paciente Trasplantado Renal

Infectious complications remain a major cause of morbidity and mortality among transplant recipients. Urinary tract infection (UTI) is the most common infectious complication in kidney transplant recipients with a reported incidence from 25% to 75%, varies widely likely due to differences in definition, diagnostic criteria, study design, and length of observation. We sought reviews the incidence and importance of urinary tract infection on graft survival, the microbiology with special emphasis on multidrug resistant microorganisms, the therapeutic management of UTI and the prophylaxis of recurrent UTI among solid organ transplant recipients, highlighting the need for prospective clinical trials to unify the clinical management in this population

Las complicaciones infecciosas siguen siendo una causa importante de morbimortalidad entre los pacientes trasplantados de órgano sólido. La infección del tracto urinario (ITU) es la complicación infecciosa más frecuente en los trasplantados renales con una incidencia que varía entre el 25 y el 75% según los estudios, debido a diferencias en la definición, criterios diagnósticos, diseño de los estudios y tiempo de seguimiento. Revisamos la incidencia e importancia de la ITU en la supervivencia del injerto, la microbiología, con especial énfasis en los microorganismos multirresistentes, el manejo terapéutico de la ITU y la profilaxis de la infección urinaria recurrente en los receptores de trasplante renal destacando la necesidad de ensayos clínicos prospectivos que unifiquen el manejo clínico en esta población

Urinary tract infection in kidney transplant recipients.

Infectious complications remain a major cause of morbidity and mortality among transplant recipients. Urinary tract infection (UTI) is the most common infectious complication in kidney transplant recipients with a reported incidence from 25% to 75%, varies widely likely due to differences in definition, diagnostic criteria, study design, and length of observation. We sought reviews the incidence and importance of urinary tract infection on graft survival, the microbiology with special emphasis on multidrug resistant microorganisms, the therapeutic management of UTI and the prophylaxis of recurrent UTI among solid organ transplant recipients, highlighting the need for prospective clinical trials to unify the clinical management in this population.

Esquemas de prevención de la infección por citomegalovirus: terapia anticipada frente a profilaxis universal / Prevention of cytomegalovirus infection: preemptive therapy versus universal prophylaxis

A pesar de los avances en el diagnóstico y tratamiento de la infección por citomegalovirus (CMV), ésta sigue siendo una importante causa de morbilidad en el receptor de trasplante de órgano sólido (TOS). Las 2 principales estrategias para la prevención de la enfermedad por CMV son la profilaxis universal y el tratamiento anticipado. Ambas estrategias, comparadas con placebo, son eficaces en la prevención de la enfermedad por CMV en los receptores de TOS, según varios metaanálisis, y cada una de ellas presenta ventajas e inconvenientes. No obstante hay pocos estudios que hayan comparado ambas aproximaciones a la prevención de la enfermedad por CMV en el receptor de TOS. En este artículo se realiza una revisión de las indicaciones de cada una de estas estrategias y de los principales estudios donde se fundamentan (AU)

Despite the advances made in the diagnosis and treatment of cytomegalovirus (CMV) infection, this pathogen continues to cause substantial morbidity in solid organ transplant (SOT) recipients. The two main strategies for the prevention of CMV disease are universal prophylaxis and preemptive therapy. Several meta-analyses have found that both strategies are effective in the prevention of CMV disease in SOT recipients compared with placebo, each with its own advantages and disadvantages. Nevertheless, few studies have compared the two approaches to CMV disease in SOT recipients. The present article provides a review of the indications of each of these strategies and the main studies on which they are based (AU)

[Prevention of cytomegalovirus infection: preemptive therapy versus universal prophylaxis]. / Esquemas de prevención de la infección por citomegalovirus: terapia anticipada frente a profilaxis universal.

Despite the advances made in the diagnosis and treatment of cytomegalovirus (CMV) infection, this pathogen continues to cause substantial morbidity in solid organ transplant (SOT) recipients. The two main strategies for the prevention of CMV disease are universal prophylaxis and preemptive therapy. Several meta-analyses have found that both strategies are effective in the prevention of CMV disease in SOT recipients compared with placebo, each with its own advantages and disadvantages. Nevertheless, few studies have compared the two approaches to CMV disease in SOT recipients. The present article provides a review of the indications of each of these strategies and the main studies on which they are based.

Neumonitis asociada a everolimus en un receptor de trasplante hepático / Everolimus-associated pneumonitis in adult liver transplant hepatic

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Estudio y tratamiento de las neumonías de adquisición comunitaria en adultos / Clinical management of community- acquired pneumonia in adults

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[Clinical and therapeutic management of respiratory tract infections. Consensus document of the Andalusian infectious diseases society and the Andalusian family and comunitary medicine society]. / Aproximación clínica y terapéutica a las infecciones de las vías respiratorias. Documento de Consenso de la Sociedad Andaluza de Enfermedades Infecciosas y de la Sociedad Andaluza de Medicina Familiar y Comunitaria.

Respiratory tract infections are frequent and they are one of the commonest causes of antibiotic prescription. However, there are few clinical guidelines that consider this group of infections. This document has been written by the Andalusian Infectious Diseases Society and the Andalusian Family and Community Medicine Society. The primary objective has been to define the recommendations for the diagnosis and antibiotic treatment of respiratory tract infections apart from pneumonia. The clinical syndromes evaluated have been: a) pharyngitis; b) sinusitis; c) acute otitis media and otitis externa; d) acute bronchitis, laryngitis, epiglottitis; e) acute exacerbation of chronic bronchitis; and f) respiratory infectious in patients with bronchiectasis. This document has focused on immunocompetent patients.

Aproximación clínica y terapéutica a las infecciones de las vías respiratorias. Documento de Consenso de la Sociedad Andaluza de Enfermedades Infecciosas y de la Sociedad Andaluza de Medicina Familiar y Comunitaria / Clinical and therapeutic management of respiratory tract infections. Consensus document of the Andalusian Infectious Diseases Society and the Andalusian Family and Comunitary Medicine Society

Las infecciones respiratorias distintas de la neumonía son frecuentes y una de las causas más comunes de prescripción de tratamiento antibiótico. A pesar de ello, hay escasos documentos o guías de práctica clínica que aborden en su conjunto este grupo de infecciones. Este Documento de Consenso ha sido realizado por la Sociedad Andaluza de Enfermedades Infecciosas y la Sociedad Andaluza de Medicina de Familia y Comunitaria. El objetivo primario ha sido definir las indicaciones terapéuticas y el diagnóstico de las infecciones respiratorias tratadas. Desde este punto de vista, el documento se ha estructurado en varias partes cada una de las cuáles se ocupa de un síndrome clínico: a) faringoamigdalitis; b) sinusitis; c) otitis aguda media y externa; d) bronquitis aguda, laringitis aguda y epiglotitis; e) tratamiento antimicrobiano de la exacerbación aguda de la bronquitis crónica, y f) infecciones respiratorias en pacientes con bronquiectasias. Este documento se ha centrado en pacientes inmunocompetentes (AU)

Respiratory tract infections are frequent and they are one of the commonest causes of antibiotic prescription. However, there are few clinical guidelines that consider this group of infections. This document has been written by the Andalusian Infectious Diseases Society and the Andalusian Family and Community Medicine Society. The primary objective has been to define the recommendations for the diagnosis and antibiotic treatment of respiratory tract infections apart from pneumonia. The clinical syndromes evaluated have been: a) pharyngitis; b) sinusitis; c) acute otitis media and otitis externa; d) acute bronchitis, laryngitis, epiglottitis; e) acute exacerbation of chronic bronchitis; and f) respiratory infectious in patients with bronchiectasis. This document has focused on immunocompetent patients (AU)

Aproximación clínica y terapéutica a las infecciones de las vías respiratorias. Documento de Consenso de la Sociedad Andaluza de Enfermedades Infecciosas y de la Sociedad Andaluza de Medicina Familiar y Comunitaria / Clinical and therapeutic management of respiratory tract infections. Consensus document of the Andalusian Infectious Diseases Society and the Andalusian Family and Comunitary Medicine Society

Las infecciones respiratorias distintas de la neumonía son frecuentes y una de las causas más comunes de prescripción de tratamiento antibiótico. A pesar de ello, hay escasos documentos o guías de práctica clínica que aborden en su conjunto este grupo de infecciones. Este Documento de Consenso ha sido realizado por la Sociedad Andaluza de Enfermedades Infecciosas y la Sociedad Andaluza de Medicina de Familia y Comunitaria. El objetivo primario ha sido definir las indicaciones terapéuticas y el diagnóstico de las infecciones respiratorias tratadas. Desde este punto de vista, el documento se ha estructurado en varias partes cada una de las cuáles se ocupa de un síndrome clínico: a) faringoamigdalitis; b) sinusitis; c) otitis aguda media y externa; d) bronquitis aguda, laringitis aguda y epiglotitis; e) tratamiento antimicrobiano de la exacerbación aguda de la bronquitis crónica, y f) infecciones respiratorias en pacientes con bronquiectasias. Este documento se ha centrado en pacientes inmunocompetentes

Respiratory tract infections are frequent and they are one of the commonest causes of antibiotic prescription. However, there are few clinical guidelines that consider this group of infections. This document has been written by the Andalusian Infectious Diseases Society and the Andalusian Family and Community Medicine Society. The primary objective has been to define the recommendations for the diagnosis and antibiotic treatment of respiratory tract infections apart from pneumonia. The clinical syndromes evaluated have been: a) pharyngitis; b) sinusitis; c) acute otitis media and otitis externa; d) acute bronchitis, laryngitis, epiglottitis; e) acute exacerbation of chronic bronchitis; and f) respiratory infectious in patients with bronchiectasis. This document has focused on immunocompetent patients

[Clinical and therapeutic management of respiratory tract infections. Consensus document of the Andalusian Infectious Diseases Society and the Andalusian Family and Community Medicine Society]. / Aproximación clínica y terapéutica a las infecciones de las vías respiratorias. Documento de Consenso de la Sociedad Andaluza de Enfermedades Infecciosas y de la Sociedad Andaluza de Medicina Familiar y Comunitaria.

Respiratory tract infections are frequent and they are one of the commonest causes of antibiotic prescription. However, there are few clinical guidelines that consider this group of infections. This document has been written by the Andalusian Infectious Diseases Society and the Andalusian Family and Community Medicine Society. The primary objective has been to define the recommendations for the diagnosis and antibiotic treatment of respiratory tract infections apart from pneumonia. The clinical syndromes evaluated have been: a) pharyngitis; b) sinusitis; c) acute otitis media and otitis externa; d) acute bronchitis, laryngitis, epiglottitis; e) acute exacerbation of chronic bronchitis; and f) respiratory infectious in patients with bronchiectasis. This document has focused on immunocompetent patients.