Hospital Universitario Príncipe de Asturias

<h3>Background and Importance</h3> Overuse of antibiotics increases resistance, prompting the World Health Organisation to create AWaRe guidelines that classify antibiotics into Access, Watch, and Reserve groups. Carbapenems, in the Watch group, require careful monitoring as part of antimicrobial resistance strategies. Used for specific infections, these broad-spectrum antibiotics should be de-escalated whenever possible to help prevent resistance. <h3>Aim and Objectives</h3> The objective of this study is to evaluate the degree of de-escalation of a specific carbapenem, meropenem, in a secondary care hospital where 61 carbapenemases were isolated in 2024 (44 OXA48; 6 VIM; 3 KPC; 1 NDM; 4 OXA48 and NDM; 3 OXA48 and VIM). <h3>Material and Methods</h3> Descriptive, observational, retrospective study from the last quarter of 2024. It included all patients treated with meropenem who had an available antibiogram. Exclusion criteria were absence of culture, negative culture, or death during infection. De-escalation was considered indicated if the antibiogram showed sensitivity to a narrower-spectrum antibiotic to which the patient was not allergic and, in addition, the patient had not had a culture with a multidrug-resistant microorganism in the last 4 months. To conduct the study, the patients‘ electronic medical records were reviewed, collecting demographic variables (sex and age) and clinical variables (prescribing service, duration of treatment, and type of infection). For quantitative variables, measures of central tendency and dispersion were used, and for categorical variables, absolute frequencies. <h3>Results</h3> A total of 192 patients were reviewed, of whom only 93 met the inclusion criteria, with a median age of 72 years (IQR: 58.75-83.25), 63.4% of them being men. The predominant type of infection was respiratory in origin 37/93 (39.8%), followed by urinary 23/93 (24.7%). The majority of prescriptions were from internal medicine (34.4%), followed by haematology and the ICU (8,6% each). The average treatment duration was 5 days (IQR: 2.83-8.23). Of 93 patients, 11 (11.8%) were ineligible for de-escalation. Among eligible patients, only 61% underwent de-escalation, which means 32 (39%) completed treatment with meropenem even though a narrower-spectrum antibiotic was effective. <h3>Conclusion and Relevance</h3> The results indicate that antibiotic de-escalation was not performed correctly in all patients analysed, which implies that antibiotic prescribing did not comply with the recommendations made by the AWaRe guidelines. <h3>Conflict of Interest</h3> No conflict of interest

A 54-year-old woman with systemic lupus erythematosus, displaying arthritis, interstitial lung disease, upper trunk cutaneous lesions, hypocomplementemia and anti-double-stranded DNA antibodies, presented with worsening skin lesions and asthenia.

Human immunodeficiency virus (HIV) and other sexually transmitted infections (STI) are a major public health concern. Primary care (PC) is the ideal setting for their diagnosis. Designing effective strategies requires a thorough understanding of the problems these patients face when seeking care. To identify barriers and facilitators to the diagnosis of HIV and STIs in PC and classify them according to the theoretical Capability, Opportunity, and Motivation model of Behaviour (COM-B model). The review's findings will inform the development of specific intervention strategies. We conducted a systematic review (SR) of qualitative studies of barriers and facilitators to the diagnosis of HIV/STI. A systematic literature search, without publication date limitation, was performed in Embase, Cochrane Library, and Medline via PubMed. The Joanna Briggs Institute (JBI) scale was used to assess the risk of bias of the included studies. The results were synthesised and presented according to the dimensions of the COM-B model. Of the 1,366 records from the initial search strategy, 70 articles met all inclusion criteria, covering all HIV/STIs and different risk groups. Barriers and facilitators to diagnosis were identified at three levels: patients, professionals, and health system. Patient barriers included confidentiality issues, lack of risk perception, shame and stigma, and access. The barriers at the level of professionals were lack of training, time constraints, and scarcity of resources. Among the facilitators, the most notable were minimally invasive sampling methods, ensuring confidentiality, standardisation of tests, fast and efficient entry points, and professional training. This SR provides information on barriers and facilitators to HIV/STI diagnosis in PC and across the different stakeholders involved (patients, providers, system). The results are grouped into the different dimensions of a behavioural model (capability, opportunity, and motivation). A thorough understanding of the complexity of the behaviour of people diagnosed with HIV/STIs and all those involved in their management will enable the development of effective intervention strategies to diagnose and prevent these processes, thereby reducing the associated disease burden. Registration: International Prospective Register of Systematic Reviews (PROSPERO: CRD42023404578).

With antiretroviral therapy (ART), people living with HIV (PLHIV) live longer and face age-related health challenges. The long-term evolution of non-AIDS comorbidities in this population remains unclear. We assessed temporal trends in incidence and age at onset of major age-related outcomes in PLHIV. We conducted a longitudinal study using CoRIS, a nationwide cohort of ART-naive PLHIV in Spain. Participants were grouped into three calendar periods (2006-2011, 2012-2017, 2018-2023). The primary outcome was serious non-AIDS events (SNAEs), including major cardiovascular events, non-AIDS malignancies, and non-AIDS deaths. Secondary outcomes were hypertension, diabetes, dyslipidemia, heart failure, fracture, chronic kidney disease, dementia, and polypharmacy. Incidence was analyzed with Kaplan-Meier and Cox models, age at onset with adjusted linear regression. Analyses were stratified by sex. Among 18,659 participants (55,133 person-years), 85% were male, median age 35 years. SNAE incidence declined (adjusted HR for 2018-2023 vs 2006-2011: 0.68, 95%CI 0.50-0.92), with delayed predicted age at first event (42.2 to 48.6 years, p<0.001). Secondary comorbidity incidence was largely stable, while polypharmacy rose, especially in older adults and women. Women showed smaller reductions in SNAE incidence (from 9.3 to 6.5 per 1,000 person-years vs. 13.0 to 6.4 per 1,000 person-years in men) and higher rates of hypertension and diabetes. In Spain, serious age-related outcomes among PLHIV have declined with delayed onset, consistent with improvements in HIV management and prevention of comorbidities. However, persistent comorbidity burden and rising polypharmacy-particularly among women-highlight the need for targeted strategies.

Abstract Background and Aims Renal sarcoidosis is a rare and underdiagnosed manifestation of systemic sarcoidosis, primarily presenting as tubulointerstitial nephritis (TIN) with or without granulomas. Due to the lack of large-scale studies, treatment remains empirical, mainly relying on corticosteroids. However, the optimal therapeutic approach and factors influencing long-term outcomes remain unclear. This study evaluates clinical outcomes, relapse risk factors, and the impact of different immunosuppressive regimens. Method A multicenter, retrospective cohort study was conducted across multiple Spanish hospitals. We included patients with biopsy-confirmed renal sarcoidosis, analyzing clinical, histopathological, and treatment-related prognostic factors. Primary outcomes included renal recovery, relapse rates, and treatment-associated complications. Results The study included 60 patients (mean age 56.8 ± 15.6 years, 70% male). At diagnosis, mean eGFR was 26.9 ± 21 mL/min/1.73 m², with 80% showing interstitial nephritis and 23.3% glomerular involvement. Despite differences in clinical presentation and renal recovery, histological patterns did not significantly impact relapse rates or susceptibility to infections. Patients receiving intravenous steroid boluses had significantly greater and faster renal recovery, with sustained eGFR improvement (&amp;gt;50%) at follow-up. However, this benefit diminished after adjusting for baseline renal function. No significant differences were observed in renal outcomes based on corticosteroid-sparing agents. Additionally, no differences were found in recovery rates or infection risk between initial prednisone doses above or below 0.8 mg/kg. Relapses occurred in 38.3% of patients, predominantly affecting the kidneys (65.3%). Patients who relapsed had more severe pulmonary disease, with a higher prevalence of stage II (34.7% vs 25.7%, P = 0.046) and stage III involvement (13% vs 0%). There was also a trend toward increased cutaneous involvement in the relapsing group (34.7% vs 14.2%, P = 0.067). Complete renal function remission was achieved in 58.6% of patients. Baseline eGFR, histological pattern, and granuloma presence were key predictors for achieving &amp;gt;50% eGFR improvement (Table 1). Logistic regression confirmed granulomas as an independent factor for better renal recovery (OR: 6.310, 95% CI: 1.719–23.156, P = 0.005). Conclusion Histological patterns, including interstitial involvement and granulomas, play a key role in prognosis and treatment response. Lower initial corticosteroid doses appear as effective as higher doses, and bolus therapy may accelerate renal recovery. Additionally, further investigation into the prognostic role of histopathological features is necessary to refine treatment strategies.

BackgroundWhile triple-drug regimens (3DR) have long been the standard of care for HIV infection, two-drug regimens (2DR), particularly dolutegravir/lamivudine (DTG/3TC), have emerged as viable first-line options. However, there is limited understanding of how baseline clinical profiles associated with regimen choice relate to underlying inflammatory states and long-term immune trajectories.MethodsWe performed a retrospective observational study using data from the Spanish CoRIS cohort, including ART-naive individuals who initiated either DTG/3TC or bictegravir/emtricitabine/tenofovir alafenamide (BIC/F/TAF) between 2016 and 2023. We applied propensity score modeling to identify predictors of regimen choice. In a matched subset of participants with plasma samples at baseline and 24 months post-ART, we carried out longitudinal inflammatory profiling using the Olink Target 96 Inflammation panel. We then conducted differential expression and enrichment analyses and explored associations between clinical variables and proteomic changes over time.ResultsAmong 3145 participants (69.5% on BIC/F/TAF and 20.5% on DTG/3TC), those with higher baseline HIV-1 RNA and lower CD4+ T-cell counts were more likely to initiate BIC/F/TAF. In a matched subset (n = 174), 11 proteins were significantly overexpressed at baseline in the BIC/F/TAF group, suggesting a heightened inflammatory state. Both regimens led to significant downregulation of inflammatory markers over 2 years, though each displayed distinct proteins and functional pathways. Baseline viral load and CD4+ counts correlated with specific proteomic profiles and predicted longitudinal changes, particularly in the BIC/F/TAF group.ConclusionsRegimen selection was associated with baseline disease severity and inflammatory burden. Despite being used in patients with more advanced profiles, BIC/F/TAF effectively reduced systemic inflammation over 2 years. Both regimens attenuated inflammatory activity, though with distinct trajectories that may carry implications for immune recovery and long-term outcomes.

The combined use of serum and CSF biomarkers for prognostic stratification in multiple sclerosis (MS) remains underexplored. This multicenter observational study investigated associations between serum neurofilament light chain (sNfL), glial fibrillary acidic protein (sGFAP), and CSF lipid-specific IgM oligoclonal bands (LS-OCMB) with different forms of disability worsening, such as relapse-associated worsening (RAW), active progression independent of relapse activity (aPIRA), and non-active PIRA (naPIRA). A total of 535 patients with MS were included, all sampled within one year of disease onset. Biomarkers were quantified using single-molecule array and immunoblotting techniques, and CSF cell subsets were analyzed by flow cytometry. High sNfL z-scores and LS-OCMB positivity were independently associated with increased risk of RAW and aPIRA, collectively termed inflammatory-associated worsening (IAW), while elevated sGFAP levels predicted naPIRA. Patients with both high sNfL and LS-OCMB positivity had the highest risk of IAW. Among LS-OCMB-positive patients, higher regulatory T cell percentages were associated with lower sNfL levels, suggesting a protective role. Conversely, in LS-OCMB-negative patients, sNfL levels correlated with CSF C3 concentrations. These findings support the complementary role of sNfL, sGFAP, and LS-OCMB in identifying distinct mechanisms of disease worsening and may inform early personalized management strategies in MS.