Estudio farmacocinético de una pauta alternativa de dalbavancina para el tratamiento de infecciones osteoarticulares

Diferentes regímenes terapéuticos con dalbavancina se han propuesto para tratamientos prolongados de las infecciones osteoarticulares, pero no se ha definido una pauta estandarizada. Basándonos en un estudio previo (Dunne et al. Antimicrob Agents Chemother. 2015), que mostraba concentraciones óseas adecuadas 14 días después de administrar 1 g de dalbavancina intravenosa, decidimos utilizar 1 g/14d como tratamiento estándar. El objetivo del estudio fue evaluar su concentración plasmática máxima (Cmax) y mínima (Cmin) en pacientes con infección osteoarticular tratados con 1g / 14d. Se realizó un estudio retrospectivo entre marzo/2018 y diciembre/2020 en el que se incluyeron pacientes con infecciones osteoarticulares que recibieron un régimen de 1g/14d. La Cmax se midió después de la 1ª y la 3ª dosis y la Cmin antes de la 2ª y la 3ª dosis. Las concentraciones séricas se analizaron mediante un método de cromatografía líquida acoplada a espectrometría de masas (LC/MS/MS), previamente validado en nuestro laboratorio. También se evaluó el impacto de la rifampicina en las concentraciones de dalbavancina Como principales conclusiones, las concentraciones de dalbavancina fueron homogéneas, lo que sugiere una baja variabilidad interindividual. El régimen propuesto de 1g/14d fue clínicamente eficaz y bien tolerado. La rifampicina concomitante no influyó en las concentraciones séricas de dalbavancina.Title: Pharmacokinetic study of an alternative regimen of dalbavancin for the treatment of osteoarticular infections Background: Different therapeutic regimens have been proposed for long-term treatment of osteoarticular infections with dalbavancin, but a standardized regimen has not been defined. According to a previous study (Dunne et al. Antimicrob Agents Chemother. 2015) showing adequate bone concentrations 14 days after 1g, we decided to use 1g/14d as standard of care. The aim of the study was to evaluate its maximum (Cmax) and minimum (Cmin) plasma concentration in patients with osteoarticular infections treated with 1g/14d. Methods: A retrospective study was carried out between March/2018 and December/2020 in which patients with osteoarticular infections who received a regimen of 1g/14d were included. Cmax was measured after the 1st and 3th doses and Cmin before 2nd and 3th doses. Serum concentractions were analyzed by using a liquid chromatography method coupled to mass spectrometry (LC/MS/MS), previously validated in our laboratory. The impact of rifampin on dalbavancin concentrations was also evaluated. Results: 11 patients were included with a median age of 75 years, 8 were men. One had osteomyelitis, 6 had a chronic prosthetic infection, and 4 had an acute prosthetic infection. The most frequent microorganism isolated was S. epidermidis (6 of 11, 55%). The surgical technique used was replacement in 1 stage (5 out of 10, 50%), followed by DAIR (debridement with implant retention, in 3 out of 10, 30%) and replacement in 2 stages with spacer (2 out of 10, 20%). Mean Cmax was 228.1 and 234.4 mg/L on day 1 and 28, respectively. Mean Cmin was 20.4 and 27.5 mg/L on day 14 and 28, respectively. No diferences were observed when rifampin was added. All patients were cure, with a median follow up of 6.9 (4.8-20.2) months. No adverse effects were documented. Conclusions: Dalbavancin concentrations were homogeneous suggesting low interindividual variability. The proposed regimen of 1gr/14d was effective and welltolerated. Concomitant rifampin did not influence on serum concentrations of dalbavanci

Shock séptico y tóxico secundario a fascitis necrotizante facial por estreptococo betahemolítico del grupo A en un paciente inmunocompetente

We present the case of a 74 year-old male with previous history of chronic global respiratory failure that was admitted for fever, pain and swelling in the area around the left eye. The clinical picture rapidly progressed in a few hours, affecting the contralateral face and progressing towards the supraclavicular zone. Streptococcus pyogenes was confirmed and the patient required emergent surgical treatment, where he developed hemodynamic instability in the form of septic shock.Se expone el caso de un varón de 74 años con historia previa de insuficiencia respiratoria global crónica que acude por episodio de fiebre, dolor e inflamación a nivel periorbitario izquierdo. El cuadro clínico progresó de forma muy llamativa en pocas horas, afectando a la hemicara contralateral y extendiéndose hacia región supraclavicular ipsilateral. Se confirmó la presencia de Streptococcus pyogenes y el paciente requirió tratamiento quirúrgico urgente, donde presentó inestabilidad hemodinámica en forma de shock séptico

Risk categories in COVID-19 based on degrees of inflammation: data on more than 17,000 patients from the Spanish SEMI-COVID-19 registry

Background: the inflammation or cytokine storm that accompanies COVID-19 marks the prognosis. This study aimed to identify three risk categories based on inflammatory parameters on admission. Methods: retrospective cohort study of patients diagnosed with COVID-19, collected and followed-up from 1 March to 31 July 2020, from the nationwide Spanish SEMI-COVID-19 Registry. The three categories of low, intermediate, and high risk were determined by taking into consideration the terciles of the total lymphocyte count and the values of C-reactive protein, lactate dehydrogenase, ferritin, and D-dimer taken at the time of admission. Results: a total of 17,122 patients were included in the study. The high-risk group was older (57.9 vs. 64.2 vs. 70.4 years; p < 0.001) and predominantly male (37.5% vs. 46.9% vs. 60.1%; p < 0.001). They had a higher degree of dependence in daily tasks prior to admission (moderate-severe dependency in 10.8% vs. 14.1% vs. 17%; p < 0.001), arterial hypertension (36.9% vs. 45.2% vs. 52.8%; p < 0.001), dyslipidemia (28.4% vs. 37% vs. 40.6%; p < 0.001), diabetes mellitus (11.9% vs. 17.1% vs. 20.5%; p < 0.001), ischemic heart disease (3.7% vs. 6.5% vs. 8.4%; p < 0.001), heart failure (3.4% vs. 5.2% vs. 7.6%; p < 0.001), liver disease (1.1% vs. 3% vs. 3.9%; p = 0.002), chronic renal failure (2.3% vs. 3.6% vs. 6.7%; p < 0.001), cancer (6.5% vs. 7.2% vs. 11.1%; p < 0.001), and chronic obstructive pulmonary disease (5.7% vs. 5.4% vs. 7.1%; p < 0.001). They presented more frequently with fever, dyspnea, and vomiting. These patients more frequently required high flow nasal cannula (3.1% vs. 4.4% vs. 9.7%; p < 0.001), non-invasive mechanical ventilation (0.9% vs. 3% vs. 6.3%; p < 0.001), invasive mechanical ventilation (0.6% vs. 2.7% vs. 8.7%; p < 0.001), and ICU admission (0.9% vs. 3.6% vs. 10.6%; p < 0.001), and had a higher percentage of in-hospital mortality (2.3% vs. 6.2% vs. 23.9%; p < 0.001). The three risk categories proved to be an independent risk factor in multivariate analyses. Conclusion: the present study identifies three risk categories for the requirement of high flow nasal cannula, mechanical ventilation, ICU admission, and in-hospital mortality based on lymphopenia and inflammatory parameters

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries