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.

Diagnóstico y tratamiento antimicrobiano de las sinusitis / Diagnosis and antimicrobial treatment for sinusitis

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Neumonía que requiere ingreso. Análisis de 582 casos atendidos en servicios de urgencias españoles / Pneumonia requiring admission. Analysis of 582 cases seen at Spanish Emergency Services

Objetivos: Conocer los factores de riesgo existentes, las características clínicas, los microorganismos causales y su sensibilidad a los antibióticos habitualmente utilizados, ver la evolución y proponer pautas de actuación en las neumonías que requieren ingreso hospitalario, independientemente de la existencia de criterios de gravedad. Métodos: Entre enero y marzo de 2000 se recogieron en el servicio de urgencias de 16 hospitales españoles los enfermos diagnosticados de neumonía que ingresaron y habían sido dados de alta en los diez días anteriores, y/o procedían de residencia de ancianos, y/o presentaban una neumonía por aspiración, y/o padecían una inmunodeficiencia o presentaban comorbilidad. En todos los casos se recogió al menos una muestra para estudio etiológico de la neumonía, realizándose, si el cultivo era positivo, antibiograma frente a amoxicilina/clavulánico, cefotaxima, ceftriaxona, clindamicina, levofloxacino y piperacilina/tazobactam. Se completó una hoja de recogida de datos en la que se incluía la evolución. Resultados: Se estudiaron 582 enfermos. La edad media fue 65.88 años. Un 96 por ciento presentaban un proceso patológico de base. Un 24 por ciento habían recibido antibióticos previamente. Todas las manifestaciones clínicas habían mejorado a los 3-5 días de ingresar. Un 42 por ciento presentaba inmunodepresión, un 29 por ciento comorbilidad, un 21 por ciento procedían de residencia de ancianos o habían estado ingresados. La muestra más frecuentemente obtenida para cultivo fue sangre (420 casos). El 26 por ciento de los 822 cultivos fueron positivos. El agente infeccioso aislado más frecuentemente fue neumococo (27 por ciento), seguido de Pseudomonas aeruginosa (9 por ciento). El antibiótico investigado al que eran más sensibles fue piperacilina/tazobactam (91 por ciento de las Pseudomonas spp y 89 por ciento de los neumococos). Un 73 por ciento de los enfermos evolucionó favorablemente. Conclusiones: En la neumonía que requiere ingreso por la existencia de inmunosupresión, comorbilidad, broncoaspiración, estancia hospitalaria previa o procedencia de residencia de ancianos, hay que tener en cuenta que el neumococo es el germen más frecuentemente aislado, seguido de Pseudomonas spp. Por ello, si el enfermo además tiene criterios de gravedad, el tratamiento debe incluir un antibiótico activo frente a Pseudomonas spp. Si el enfermo no tiene inicialmente criterios de gravedad, debe individualizarse cada caso, eligiendo entre la alternativa indicada anteriormente o seguir las recomendaciones habituales, cambiando éstas si la evolución no es buena en 48-72 horas o se aisla una bacteria resistente al tratamiento iniciado (AU)

[Sweet's syndrome: report of two cases (author's transl)]. / Síndrome de Sweet. Presentación de dos casos.

In 1964 Sweet described a new syndrome, characterized by the association of fever, neutrophilic leukocytosis, erythematous plaque affecting the extremities, neck and face, with histologically verified polymorphonuclear perivascular dermal infiltrates and a rapid response to corticosteroids. Although some 100 cases have since then been described the pathogenesis remains obscure. We present two cases which showed all criteria for Sweet's syndrome, in which the initial presentation of acute onset with fever, multiple skin lesions and especially the poor general state on one, made use at first think of an infectious process such as staphylococcal or gonococcal sepsis, in which case diagnosis must be differential. Only when the causal agent is known and an early skin biopsy is done can correct diagnosis and treatment be established.

[Tricuspid endocarditis in heroin addicts (author's transl)]. / Endocarditis tricuspídea en los heroinómanos.

Two cases of tricuspid endocarditis due to Staphylococcus aureus in two young heroin addicts are reported. In one of them there was concomitant aortic valve involvement. The clinical picture was typical. Tricuspid and aortic valve vegetations were demonstrated by cardiac ultrasonography. The relatively good prognosis of tricuspid endocarditis due to Staphylococcus aureus was confirmed in one of the cases in whom an excellent response to therapy with cephalothin and gentamicin was obtained. Simultaneous aortic involvement worsens the prognosis considerably. The clinical features characteristic of endocarditis in heroin addicts are reviewed, with emphasis in those that permit to distinguish them from endocarditis in the general population. Although only indirect data are available the disease will probably be seen with increasing frequency in Spain.

[Infectious endocarditis in idiopathic hypertrophic subaortic stenosis. Report of a case (author's transl)]. / Endocarditis infecciosa en estenosis subaórtica hipertrófica idiopática. A propósito de una observación.

A case is reported of aortic valve endocarditis in a 53 year-old female patient with idiopathic hypertrophic subaortic stenosis. Emphasis is made on the value of ultrasonography in the diagnosis of both conditions. Ecography has also prognostic interest when big vegetations are found. A comment is made on the need for early surgical replacement of the aortic valve when valvular insufficiency is present.