Quantitative hepatitis B surface antigen (qHBsAg) is increasingly recognized as a key biomarker for chronic hepatitis B (CHB) management. This study aimed to assess the adoption, practices, and barriers to qHBsAg testing in Spanish clinical microbiology laboratories. A cross-sectional survey was distributed through the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) Viral Hepatitis Study Group (GEHEP). Clinical microbiology laboratory professionals across Spain were invited to complete an anonymous online questionnaire. The survey collected information on qHBsAg implementation, technical practices, barriers, and patient-related data. Descriptive statistics were applied. Of 118 laboratories invited, 91 responded (77.1%); only 37.4% performed qHBsAg. Among non-performing centers, 86% did not refer samples, mainly due to perceived low clinical demand (57.1%), plus lack of equipment/resources. Implementation correlated with hospital size (p=0.041): 0% (<200 beds), 23.3% (200-500), 44.9% (500-1000), 62.5% (≥1000). Among performing labs, 57.6% quantified after a positive qualitative test, 27.3% on request, and 15.2% as initial screening. Proactive reporting was 69.7%, and 81.8% diluted samples above limits. In the last year, 40.7% of results were <100IU/mL and 27.1% >3000IU/mL; over five years (≈14,500 tests), 29.5% >3000IU/mL and 27.3% <100IU/mL, supporting the clinical relevance of these thresholds. qHBsAg testing is not uniformly implemented across Spanish clinical microbiology laboratories and workflows and reporting practices are heterogeneous. Given the descriptive design and potential selection bias, these results should be interpreted as a baseline assessment to inform harmonization efforts and future evaluations linking testing availability to clinical decision-making.
Given the increased incidence of syphilis in Spain, the objective is to analyze the clinical presentation, diagnosis, treatment, and outcomes of neurosyphilis cases managed in our unit. Retrospective descriptive study (2012-2023) including patients older than 14 years classified as early, late, or asymptomatic clinical forms. Demographic, clinical, and outcome variables were analyzed. Seventeen cases were included (94.1% male), with HIV coinfection in 29.4%. The predominant forms were syphilitic dementia and ocular syphilis (29.4%). Detection of CSF RPR (Rapid Plasma Reagin) was positive in 64.2%. Intravenous penicillin G was administered in 82.3% of cases; two early forms had been treated with intramuscular penicillin. Clinical improvement was observed in 47.1% of patients. An increase in neurosyphilis cases was observed, with acceptable CSF RPR sensitivity. Early forms showed a better prognosis, highlighting the need for clinical follow-up due to the possibility of symptomatic relapses.
Antimicrobial resistance (AMR) is a global health challenge. Clinical trials are essential for evaluating novel and alternative therapeutic strategies. However, conducting randomized clinical trials (RCTs) in infectious diseases faces regulatory, logistical, and financial barriers, as well as challenges in patient recruitment. Collaborative research networks have demonstrated their effectiveness in overcoming these limitations. This study evaluates the capacity of Spanish medical centers to participate in RCTs on infectious diseases and AMR. A structured feasibility survey was developed to assess infrastructure, research experience, patient recruitment potential, and willingness to collaborate in Spanish hospitals. Responses were collected using the REDCap platform and analyzed using Microsoft Excel, with results expressed as percentages. Of 90 centers contacted, 65 centers from 17 autonomous communities responded. The majority (78.5%) had dedicated infectious disease departments or units, and 36.9% reported over 1000 annual hospital admissions for infectious diseases. Research experience was strongest in antimicrobial-resistant Gram-negative (84.6%) and Gram-positive bacteria (78.5%). Phase II-IV RCTs were the most conducted trials, predominantly funded by private sources. While 75.4% of centers reported available human resources for research, specialized roles such as project managers (18.5%) and monitors (12.3%) were less common. Notably, 90% of centers expressed willingness to participate in a collaborative network for conducting unfunded RCTs. The results highlight Spain's strong research infrastructure and expertise in infectious diseases, providing a solid foundation for establishing a national collaborative clinical trials network. However, variations in specialized research personnel and the low frequency of academic trials indicate areas for improvement.
A phase 2 trial was conducted to evaluate the safety and efficacy of convalescent plasma (CP) for patients admitted with COVID-19 in the pre-vaccine era. CP was compared to standard of care (SoC) in a randomized clinical trial in patients admitted with COVID-19 pneumonia and with either hypoxia and/or some underlying condition from April to December 2020 in 15 hospitals in Andalusia, Spain. The primary endpoints were adverse events and failure (all-cause death and need for mechanical ventilation during the first 21 days). The procedure for CP was developed and worked properly. Overall, 72 patients of 88 evaluated were recruited (37 and 35) assigned to CP and SoC. Median duration of COVID-19 related symptoms was 7 and 6 days, and median oxygen saturation at randomization was 93% and 92.5% in experimental and control arms, respectively. Overall, 8 (21.6%) patients in the experimental CP group (non related to CP) and 8 (22.9%) in the control group developed grade 3 adverse events (relative risk [RR] 0.94; 95% CI: 0.39-2.24); failure occurred in 3 (8.1%) and 4 (11.4%) patients, respectively ([RR] 0.94, CI: 0.14-6.35 for both events). No differences in secondary endpoints (change in inflammatory parameters, negativization of SARS-CoV-2 PCR or duration of hospital stay) were found. The results suggested that CP is safe for use in COVID-19 patients, although no significant efficacy signal could be observed. A successful regional system for CP administration was developed.
The clinical relevance and prognostic value of serum (1,3)-beta-D-glucan (BDG) in patients with intra-abdominal candidiasis (IAC) remains poorly characterized. We conducted a retrospective single-center study (2020-2025) in adult patients with IAC who had a BDG measurement (Fujifilm Wako β-glucan test) within ±3 days of a positive culture. Demographic, clinical, and microbiological data were collected. Outcomes included end-of-treatment and 30-day mortality, and recurrence. Statistical analyses were performed using STATA, and BDG results stratified patients. Among 18 IAC patients, BDG showed a sensitivity of 66.6% (95%CI: 41-86.7%). Negative BDG results were associated with a higher prevalence of Nakaseomyces glabratus (57.1% vs. 33.3%), lower end-of-treatment mortality (0% vs. 50%, P=0.05), and shorter ICU stays (median 14.5 vs. 29.5 days, P=0.01) compared with BDG-positive patients. The BDG shows limited sensitivity in IAC. Negative BDG may indicate lower fungal burden and better outcomes. Despite its limitations, BDG may represent a valuable prognostic marker.
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Mucormycosis are invasive fungal infections caused by fungi of the order Mucorales that classically affect profoundly immunosuppressed patients. Recently, cases have emerged in patients receiving Bruton tyrosine kinase inhibitors like Ibrutinib, used for chronic lymphocytic leukemia (CLL). We report a 58-year-old man with CLL on Ibrutinib and Venetoclax who developed a rapidly progressing necrotic ulcer on his leg after minor trauma. Histopathology revealed angioinvasive, non-septate hyphae; Rhizopus spp. was confirmed by culture. He was treated with surgical debridement, liposomal amphotericin B, and isavuconazole, with good outcome. We also reviewed published cases of cutaneous mucormycosis in Ibrutinib-treated patients. Including our case, seven patients were identified. Most presented with single necrotic limb lesions after minor trauma. Median age was 69.5 years; median Ibrutinib exposure was 3 years. Liposomal amphotericin B was the most used antifungal; surgery was performed in over half of the patients. Cutaneous mucormycosis is an emerging complication in Ibrutinib-treated patients. Early diagnosis and combined antifungal and surgical treatment are crucial.
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Arboviral diseases are viral infections primarily transmitted by mosquitoes, with a growing global impact. Dengue and chikungunya virus have shown sustained expansion over recent decades, affecting regions previously considered non-endemic. The Region of Murcia presents factors that favour introduction and potential local transmission, including suitable climatic conditions, established presence of Aedes albopictus, and a high flow of travellers to areas with high incidence. Evaluating their evolution and epidemiological characteristics is essential to guide surveillance and support control efforts. We analysed epidemiological surveillance data and clinical records of laboratory-confirmed acute dengue or chikungunya infections diagnosed in the Region of Murcia between 2014 and 2024. A total of 49 acute dengue infections were reported, showing an upward trend with a peak in 2024 (17 cases). Travel was related to 40.8% of cases for tourism and 44.9% for visits to friends and relatives, and two autochthonous cases were identified (2018). The most frequent regions of acquisition were Central America and the Caribbean (35%), South America (27%), and Southeast Asia (22%). For chikungunya, seven imported acute infections were recorded, with no autochthonous transmission and sporadic cases throughout the period, mostly acquired in Central and South America. The sustained increase in imported dengue cases and the detection of isolated autochthonous transmission indicate a growing risk for the Region of Murcia. These findings highlight the need to strengthen epidemiological surveillance, vector control strategies, and preventive measures for travellers and the resident population, as well as early detection and management to prevent potential autochthonous transmission.
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The aging of people living with HIV (PLWH) poses new clinical and social challenges, particularly in rural settings. Loneliness, social isolation, and frailty have been identified as key risk factors in this population. The aim of this study is to describe the sociodemographic, clinical, and psychometric characteristics of PLWH aged ≥65 years in a geographically dispersed rural area, and to analyze factors associated with loneliness, social isolation, affective symptoms, and frailty. Cross-sectional observational study including 60 patients aged ≥65 years followed at the University Hospital of Toledo. Validated scales were used: UCLA-3 (loneliness), LSNS-R (social isolation), HADS (anxiety/depression), and Fried (frailty). Sociodemographic, clinical, and immunovirological variables were analyzed using bivariate/multivariate models. Twenty percent of participants reported feeling lonely, and 5% had significant loneliness. Social isolation was observed in 21.7%, depressive symptoms in 18.3%, and clinically relevant anxiety in 16.7%. Frailty was present in 31.7% of the cohort. In multivariate analysis, living alone was associated with increased loneliness (OR: 5.57; p=0.0038) and frailty (OR 6.91; p=0.029). Psychotropic drug use was linked to greater perceived loneliness (OR 6.89; p=0.043). Women showed higher scores in loneliness (p<0.002) and greater use of antidepressants and benzodiazepines (p=0.011). No differences were observed between rural and urban populations. Historical severe immunosuppression was associated with greater frailty (p=0.0096). PLWH aged ≥65 years show a high prevalence of loneliness and frailty, associated with social vulnerability and cumulative immunological damage. Multidimensional care strategies should address psychosocial factors and the long-term impact of immune damage.
Rothia spp. are commensal organisms involved in serious infections such as infective endocarditis (IE). There is a significant lack of information regarding de clinical course and management of Rothia spp. IE in immunocompetent patients. This study describes 11 cases of Rothia spp. bacteremia over a 10-year period in a secondary hospital, analyzing clinical, demographic, and microbiological data. True infection was defined based on clinical signs, microbiological criteria, and radiological evidence. Three cases (27.3%) were confirmed as true infections, all presenting as infective endocarditis. All three infections were caused by Rothia mucilaginosa in non-immunocompromised patients. Identified risk factors included type 2 diabetes, pre-existing valvular disease, prosthetic implants, and odontogenic foci. 100% of cases developed severe central nervous system complications. Total bacterial eradication without recurrence was achieved, and no acute valve surgery was required. Rothia spp. can cause true bacteremia and IE in non-immunocompromised patients. Time to positivity (TTP) and clinical correlation are fundamental to distinguish between true infection and contamination. Individualized shorter antibiotic regimens might be explored in selected cases, although conventional durations remain the standard due to the severity of complications.
Infection due to cytomegalovirus (CMV) frequently complicates the course of solid organ transplantation (SOT). The use of currently available antivirals is often limited due to toxicity. Maribavir (MBV) has demonstrated efficacy in clearing CMV DNAemia, with a favorable safety profile in SOT recipients. Nevertheless, real-life experience outside the clinical trial setting is still scarce. A retrospective observational study was conducted including adult SOT recipients who experienced CMV infection and were treated with MBV at our institution between April 2023 and March 2025. Nineteen episodes of CMV infection diagnosed in 16 SOT (mostly lung [57.9%] and heart [26.3%]) recipients were treated with MBV (median duration of 48 days [interquartile range: 18.5-63]), primarily as salvage therapy due to previous toxicity (36.8%) or refractoriness or resistance (31.6%). The initial dose had to be subsequently increased (to 800 or 1200mg BID) in 36.8% of episodes. Transient CMV DNAemia blips were common (21.1%) but not associated to treatment failure. Breakthrough DNAemia while on MBV occurred in 36.8% of episodes. Antiviral resistance testing was performed in four episodes, with one case (25.0%) of documented resistance to MBV and ganciclovir. Clinical response was achieved in 72.2% of episodes, and treatment failure occurred in 26.3%. Treatment-emergent adverse events were rare (10.5%). All-cause mortality was 21.1%, with no CMV-attributable deaths. In the present real-life experience, MBV appears to be a viable and safe alternative as salvage therapy for CMV infection in SOT recipients, although cases of clinical failure and treatment-emergent resistance were observed.
Tuberculosis (TB) in the elderly poses unique challenges, especially in low-incidence areas. This study examines the characteristics, diagnostic processes, and outcomes of TB cases in individuals over 65 years in our centre over the last 15 years. Our objective was to identify factors influencing TB outcomes in the elderly to improve clinical management and highlight risk factors for poor evolution in our environment. We conducted a retrospective cohort study from 2010 to 2024, involving patients over 65 years with culture-confirmed TB. Data on demographics, clinical presentation, diagnostics, treatment, and outcomes were collected and analysed. Among 821 TB cases, 130 (15.83%) involved patients over 65, of them 124 were included for the analysis. The median age was 78 years, with a male predominance (54.8%). Atypical presentations were frequent (75%) leading to prolonged diagnostic delays, median 84 days. Only 47.6% cases were exclusively pulmonary disease, while 23.4% were extrapulmonary and 19.4% disseminated. Overall mortality was 23.4%. Of these deaths, 18.5% were directly attributable to tuberculosis. Being older than 85 years, chronic kidney disease (CKD), and disseminated disease were independent predictors of mortality. Tuberculosis in elderly patients is linked to elevated mortality rates and frequently presents with atypical clinical features, leading to delays in diagnosis and suboptimal outcomes. Enhanced awareness, improved diagnostic approaches, and multidisciplinary management are essential in our context.
Follicular conjunctivitis caused by Chlamydia trachomatis is an uncommon infection and represents an extragenital manifestation of sexual transmission, and it may be underdiagnosed. To confirm the presence of C. trachomatis in adults with follicular conjunctivitis and to describe its clinical and epidemiological characteristics. Retrospective descriptive study (2024-2025) in patients ≥18 years old with suspected follicular conjunctivitis caused by C. trachomatis. Detection was carried out using real-time PCR (FluoroType® STI VER 1.0, Hain Lifescience). A total of 9,430 NAATs were performed on genital samples in adult patients; 414 tested positive for C. trachomatis. Of these patients with confirmed genital infection, 19 presented clinical suspicion of follicular conjunctivitis and underwent NAAT on conjunctival exudate, confirming the presence of C. trachomatis. The mean age (SD) was 30.1 (10.2) years; among the positives with follicular conjunctivitis, 53.3% were men. All showed clinical resistance to common antibiotic eye drops and improved after systemic treatment. Although infections by C. trachomatis have increased, their presentation as follicular conjunctivitis continues to be rare in Spain.
This executive summary presents the updated Consensus Document on the Diagnosis and Treatment of Sexually Transmitted Infections (STIs) in Spain, promoted by the Ministry of Health and the Spanish Society of Infectious Diseases and Clinical Microbiology. The document is the result of a multidisciplinary collaboration aimed at establishing a national reference guide for the comprehensive and equitable management of these infections, to provide a practical tool to improve STI control and reduce associated stigma and social inequalities. Methodologically, it is based on scientific evidence graded by the strength of recommendation. The document harmonizes clinical and microbiological procedures, prioritizing an etiological approach over a syndromic one. It also incorporates new chapters (viral hepatitis, STIs in children and adolescents, sexual assault, among others) and highlights the role of community organizations. As a dynamic document, it will be updated periodically as new evidence emerges in the field of public health.
To assess compliance with GeSIDA pneumococcal and HBV vaccination indicators among people living with HIV (PLWH) followed at a Spanish hospital and identify clinical and organizational factors associated with complete vaccination coverage. Retrospective study including 198 adult PLWH from the Infectious Diseases Unit at Hospital Clínico Universitario San Juan. We analysed pneumococcal and HBV vaccination coverage, Preventive Medicine (MPRE) referral and attendance, demographic variables (age, sex, nationality), clinical parameters (baseline and referral CD4 count, viral load, ART, ACRG3 complexity), and organizational factors using univariate analysis and multivariate logistic regression. Complete vaccination coverage was 60.8% for pneumococcus (108/178 eligible patients) and 72.6% for HBV (114/157 eligible). Missed vaccination opportunities reached 23.7% for pneumococcus (unvaccinated) and 27.4% for HBV. Univariate analysis showed significant associations between complete vaccination and MPRE referral (p < 0.001 both vaccines), MPRE attendance (p < 0.001), and time since HIV diagnosis (p = 0.030 HBV). Multivariate analysis identified no independent significant variables for pneumococcal vaccination; HBV showed complete separation due to MPRE attendance. Although better than previous studies, vaccination coverage remains below GeSIDA standards. MPRE referral and attendance represent the main organizational barriers. Targeted interventions to optimize care pathways are needed to improve vaccine protection in this vulnerable population.
The main objective of the study is to evaluate the performance of the FilmArray® Pneumonia Plus (FA-PP) panel in critically ill patients with suspected pneumonia compared to conventional culture, in both pandemic and pospandemic periods, and its impact on therapeutic decision-making. Observational study including 225 patients (314 samples) during COVID-19 pandemic and post-pandemic periods. FA-PP and culture results were compared assessing sensitivity (Se), specificity, predictive values, level of concordance between them and the impact on antibiotic prescription. FA-PP detected 133% more bacterial targets than culture and 48% more positive samples. Excluding off-panel bacteria, the panel showed high sensitivity of up to 100% in patients with pneumonia and a negative predictive value (NPV) of over 98%. In the post-pandemic period, the overall Se (78.6%) and Se in patients with pneumonia (81%), as well as the overall NPV and in pneumonia (94%), were higher than in the pandemic period, with significant differences (p<0.05). Twenty-six per cent of pneumonia episodes involved bacteria not included in the panel. The positive concordance between the two tests was 72%. In 56% of cases with pneumonia, antibiotic was modified after the results. During the pandemic period, the panel served to modify treatment towards initiation or escalation. The FA-PP is a valuable tool for optimizing the diagnosis and management of pneumonia in the ICU, with a clinical impact on the appropriateness of antibiotic treatment. There were differences in the impact of the panel between the pandemic and post-pandemic periods.
People living with HIV (PLHIV) in situations of vulnerability in Catalonia, including those born outside Spain, at risk of social exclusion, or older adults, face greater barriers related to social determinants, mental health, stigma, and clinical complexity, which affect their adherence to ART and continuity of care. ActHIVa Cataluña was created with the objective of identifying strategic priorities, aligned with the Pla d'acció enfront del VIH i altres ITS 2021-2030, aimed at improving their comprehensive care and long-term quality of life. A multidisciplinary group of 16 experts was convened to identify and prioritise lines of action through consensus, alongside conducting a Health Impact Assessment (HIA) to evaluate the potential impacts on health and equity of the proposed actions. Twelve actions were agreed upon and grouped into four strategic objectives: early detection of risk determinants; assessment of quality of life and comprehensive care; strengthening of sociosanitary coordination; and involvement of PLHIV in decision-making. In a second phase, an HIA of the prioritized initiatives was carried out to estimate their potential effects on population health from an equity perspective. The results highlight the potential of the proposed actions to strengthen comprehensive care and improve the quality of life of vulnerable PLHIV, enhancing their ART adherence and continuity of care, and supporting progress toward a more equitable, person-centred, and sustainable care model in Catalonia.