{"id":65520,"date":"2022-12-22T19:21:51","date_gmt":"2022-12-22T17:21:51","guid":{"rendered":"https:\/\/blog.cofb.cat\/?p=65520"},"modified":"2023-10-09T10:51:59","modified_gmt":"2023-10-09T10:51:59","slug":"els-farmaceutics-hospitalaris-sactualitzen-en-labordatge-de-les-infeccions-multiresistents","status":"publish","type":"post","link":"https:\/\/www.cofb.org\/ca\/2022\/12\/22\/els-farmaceutics-hospitalaris-sactualitzen-en-labordatge-de-les-infeccions-multiresistents\/","title":{"rendered":"Els farmac\u00e8utics hospitalaris s’actualitzen en l’abordatge de les infeccions multiresistents"},"content":{"rendered":"\n

El passat 13 de desembre, el Col\u00b7legi Oficial de Farmac\u00e8utics de Barcelona (COFB)<\/strong> i la Societat Catalana de Farm\u00e0cia Cl\u00ednica (SCFC)<\/a><\/strong> van organitzar l\u2019activitat \u201cRevisi\u00f3 de l\u2019abordatge de les infeccions multiresistents\u201d<\/strong>, amb el patrocini de Shionogi<\/a><\/strong>. La formaci\u00f3, que es va realitzar en format presencial i en format webinar, va ser presentada i moderada per Daniel Echevarria<\/strong>, farmac\u00e8utic adjunt del Servei de Farm\u00e0cia de l’Hospital del Mar i primer farmac\u00e8utic hospitalari de l\u2019Estat acreditat pel Board Certified Pharmacist en Malalties Infeccioses. La sessi\u00f3 va comptar amb la microbi\u00f2loga del Servei de Microbiologia de l\u2019Hospital Cl\u00ednic de Barcelona, Cristina Pitart<\/strong>; el Consultor S\u00e8nior de Malalties Infeccioses de l\u2019Hospital Universitari Vall d’Hebron, Benito Almirante<\/strong>; i amb el farmac\u00e8utic del Servei de Farm\u00e0cia de l\u2019Hospital Universitari de la Vall d\u2019Hebron, David Campany<\/strong>.<\/p>\n\n\n\n

\"\"<\/a>
Un moment de la formaci\u00f3: \u201cRevisi\u00f3 de l\u2019abordatge de les infeccions multiresistents\u201d. <\/figcaption><\/figure>\n\n\n\n

Els objectius principals<\/strong> de la formaci\u00f3, adre\u00e7ada als farmac\u00e8utics hospitalaris<\/strong>, eren donar a con\u00e8ixer<\/strong> quina problem\u00e0tica de tractament generen els bacteris gramnegatius multiresistents<\/strong>; revisar<\/strong> els nous antibi\u00f2tics aprovats contra bacteris gramnegatius<\/strong>, la gesti\u00f3 del tractament<\/strong> en circumst\u00e0ncies especials i resoldre problemes farmacoterap\u00e8utics<\/strong> relacionats amb tractaments antiinfecciosos; i saber com afrontar les dificultats de tractament<\/strong>.<\/p>\n\n\n\n

El farmac\u00e8utic, Daniel Echeverr\u00eda<\/strong>, va iniciar la sessi\u00f3 assegurant que actualment \u201cestem davant una nova pand\u00e8mia per tot el tema de les multiresist\u00e8ncies\u201d<\/strong>; i va afegir que recentment \u201cha sortit publicat un article<\/a> que estima que les morts atribu\u00efbles a aquests bacteris multiresistents, dels quals hi ha quatre per gramnegatius, ha suposat la mort d’1,27 milions de persones l\u2019any 2019\u201d<\/strong>.<\/p>\n\n\n\n

La pand\u00e8mia silenciosa de les resist\u00e8ncies antimicrobianes<\/strong><\/h2>\n\n\n\n

La microbi\u00f2loga del Servei de Microbiologia de l\u2019Hospital Cl\u00ednic de Barcelona, Cristina Pitart<\/strong>, va abordar quina \u00e9s la problem\u00e0tica dels bacteris gramnegatius multiresistents<\/strong>. Pitart va comen\u00e7ar la seva pon\u00e8ncia fent refer\u00e8ncia a l\u2019informe de 2016<\/strong> Tackling Drug-resistant infections globally. Review on Antimicrobial Resistance<\/a>,<\/em> de l\u2019economista Jim O\u2019Neill<\/strong>, en qu\u00e8 \u201cva estimar qu\u00e8 passaria si no hi haguessin nous antibi\u00f2tics a partir de 2017<\/strong>\u201d. Segons Pitart, una de les conclusions de l\u2019estudi va ser que \u201cl\u2019any 2050, 10 milions de persones moririen a causa de la resist\u00e8ncia als antibi\u00f2tics\u201d.<\/strong> La microbi\u00f2loga va voler diferenciar aquest informe de l\u2019article que havia referenciat Echevarr\u00eda, ja que l\u2019article es basa en xifres reals de l\u2019any 2019: \u201c1,27 milions de morts per davant de la sida, del c\u00e0ncer de mama i de la mal\u00e0ria; aquests s\u00f3n n\u00fameros molt alarmants\u201d<\/strong>, va sentenciar.<\/p>\n\n\n\n

\"La<\/a>
La microbi\u00f2loga, Cristina Pitart, durant la seva intervenci\u00f3.<\/figcaption><\/figure>\n\n\n\n

Aquestes xifres la microbi\u00f2loga les va mostrar en un mapa d\u2019Europa, en qu\u00e8 es podia observar com ha augmentat la resist\u00e8ncia als carbapenems des del 2005 al 2020<\/strong>. Segons Pitart, aquest augment \u201ces deu al mal \u00fas dels antibi\u00f2tics en humans\u201d<\/strong> i va afegir que \u201caquest no \u00e9s l\u2019\u00fanic fet responsable, sin\u00f3 tamb\u00e9 el mal \u00fas que s\u2019ha fet en animals\u201d<\/strong>. <\/p>\n\n\n\n

Els microorganismes que preocupen<\/strong> s\u00f3n els anomenats ESCAPE<\/strong>, que \u00e9s l\u2019acr\u00f2nim de: Enterococcus resistent a vancomicina, MRSA, K. pneumoniae, Acinetobacter baumannii, P. aeruginosa MR o XDR i l\u2019Enterobacterales.<\/p>\n\n\n\n

Abordatge terap\u00e8utic des del punt de vista cl\u00ednic<\/strong><\/h2>\n\n\n\n

Pel que fa a l\u2019abordatge terap\u00e8utic de les infeccions per bacteris gramnegatius multiresistents<\/strong>, des de la visi\u00f3 cl\u00ednica, el Consultor S\u00e8nior de Malalties Infeccioses de l\u2019Hospital Universitari Vall d’Hebron, Benito Almirante<\/strong>, va comentar que \u201c\u00e9s una problem\u00e0tica universal\u201d <\/strong>i a m\u00e9s a m\u00e9s \u201camb una gran repercussi\u00f3 cl\u00ednica\u201d<\/strong>. Almirante va explicar que \u201caquesta problem\u00e0tica<\/strong> amb aquests bacteris (Enterobacterales, P. aeruginosa MR o XDR i l\u2019Acinetobacter baumannii) \u00e9s especialment rellevant en pacients cr\u00edtics<\/strong> i en els que tenen alguna infecci\u00f3 produ\u00efda per algun d\u2019aquests bacteris\u201d.<\/p>\n\n\n\n

El doctor va destacar que aquestes infeccions per BGN s\u00f3n importants i va detallar com afecta en el pron\u00f2stic a les UCIs: \u201cla mortalitat dels pacients amb infecci\u00f3 es duplica dels no infectats;<\/strong> la mortalitat en pacients amb bacteri\u00e8mia per BGN,<\/strong> resistents a carbapenemas, \u00e9s molt superior a la dels pacients sense bacteri\u00e8mia<\/strong>; la bacteri\u00e8mia per BGN MR allarga fins a 3 vegades l\u2019estada mitjana a l\u2019UCI<\/strong>; i la infecci\u00f3 causada per un BGN MR \u00e9s un factor independent de mortalitat intra-UCI\u201d.<\/p>\n\n\n\n

\"\"<\/a>
El Dr. Benito Almirante durant la seva explicaci\u00f3 sobre l’abordatge terap\u00e8utic de les infeccions per bacteris gramnegatius multiresistents.<\/figcaption><\/figure>\n\n\n\n

Despr\u00e9s d\u2019explicar les opcions terap\u00e8utiques<\/strong> per tractar les infeccions per BGN productors de carbapenemas, el paper dels nous antimicrobians<\/strong> i les diferents estrat\u00e8gies de tractament<\/strong>; Almirante va cloure la seva presentaci\u00f3 aportant algunes conclusions com que \u201cel tractament de les infeccions produ\u00efdes per BGN multiresistents ha de ser individualitzat, <\/strong>segons la comorbiditat del pacient, el tipus d\u2019infecci\u00f3, la gravetat cl\u00ednica i el tipus de bacteri resistent, entre d\u2019altres.<\/p>\n\n\n\n

Noves opcions farmacol\u00f2giques<\/strong><\/h2>\n\n\n\n

En la darrera part de la sessi\u00f3, el farmac\u00e8utic del Servei de Farm\u00e0cia de l\u2019Hospital Universitari de la Vall d\u2019Hebron, David Campany<\/strong>, va detallar les noves opcions farmacol\u00f2giques per al tractament de les infeccions produ\u00efdes per bacteris gramnegatius productors de carbapenemases<\/strong>, que s\u2019han incorporat. El farmac\u00e8utic va comentar que \u201cactualment es disposa de tres antibi\u00f2tics beta-lact\u00e0mics<\/strong>: la ceftazidima\/avibactam (\u00b1 aztreonam)<\/strong>, el meropenem\/vaborbactam<\/strong> i el cefiderocol<\/strong>\u201d. Pel que fa a aquests tractaments, Campany creu que \u201cel meropenem vaborbactam<\/strong> \u00e9s una opci\u00f3 especialment interessant en infeccions produ\u00efdes per soques d\u2019entorobacteris productores de carbapenemases tipus KPC\u201d; i que el \u201cCefiderocol<\/strong> ofereix bona activitat enfront dels BGN productors de carbapenemases, especialment en soques productores de MBL\u201d.<\/p>\n\n\n\n

\"El<\/a>
El farmac\u00e8utic, David Campany, durant la seva exposici\u00f3.<\/figcaption><\/figure>\n\n\n\n

A banda va oferir el seu punt de vista sobre l\u2019\u00fas d\u2019antibi\u00f2tics actius enfront dels BGN productors de carbapenemases a unitats d’hospitalitzaci\u00f3 domicili\u00e0ria<\/strong>, el farmac\u00e8utic creu que \u201cs\u2019ha de donar prioritat en la utilitzaci\u00f3 de bombes elastom\u00e8riques i conservaci\u00f3 a nevera\u201d.<\/strong> Finalment, va afegir que \u201chi ha diverses l\u00ednies de desenvolupament de nous antibi\u00f2tics amb activitat enfront de BGN productors de MCP<\/strong>: monobactams; combinacions \u03b2-lact\u00e0mics\/inhibidors carbapenmaes (\u00b1MCP)\u201d.<\/p>\n\n\n\n

\n
<\/div>\n\n\n\n
<\/div>\n\n\n\n
\n

Amb el patrocini de:<\/strong><\/p>\n\n\n\n

\"\"<\/a><\/figure>\n<\/div>\n<\/div>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

El passat 13 de desembre, el Col\u00b7legi Oficial de Farmac\u00e8utics de Barcelona (COFB) i la Societat Catalana de Farm\u00e0cia Cl\u00ednica (SCFC) van organitzar l\u2019activitat \u201cRevisi\u00f3 de l\u2019abordatge de les infeccions multiresistents\u201d, amb el patrocini de Shionogi. La formaci\u00f3, que es va realitzar en format presencial i en format webinar, va […]<\/p>\n","protected":false},"author":1,"featured_media":67798,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_uag_custom_page_level_css":"","site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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