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Resumen El Comite Espanol del Antibiograma (COESANT) presenta en este documento una sencilla «hoja de ruta» en forma de decalogo de recomendaciones cuya finalidad es facilitar la transicion de la normativa del Clinical and Laboratory Standards Institute (CLSI) a la del European Committee on Antimirobial Susceptibility Testing (EUCAST) en los Servicios y Unidades de Microbiologia Clinica que aun emplean los criterios del CLSI. Su objetivo es adaptar las directrices europeas, mas proximas a la realidad clinico-epidemiologica espanola, y conseguir una implantacion de los criterios del EUCAST en la totalidad de los laboratorios de Microbiologia en Espana.

The relevance of tuberculosis in solid organ transplant recipients stems from the difficulties in the diagnosis, which delay the start of treatment, and the associated toxicity of pharmacological therapy. These facts are responsible for the large number of clinical complications and the high mortality in this population. This Consensus Document from GESITRA (Spanish Transplantation Infection Study Group) defines the indications for prophylaxis of latent tuberculosis infection in patients undergoing solid organ transplantation, in particular those with a high risk of pharmacological toxicity, as is the case of liver transplant recipients. This Consensus Document also establishes recommendations for the choice of drugs to use and duration of treatment for tuberculosis in solid organ transplant recipients, with special mention of vigilance for the development of pharmacological interactions between rifampin and immunosuppressive drugs (cyclosporine, tacrolimus, rapamycin, and steroids).

Objetivo En 1995 se creo un servicio de hospitalizacion a domicilio especializado en enfermedades infecciosas con la finalidad de mejorar la calidad de vida, reducir la estancia hospitalaria de los pacientes que precisan antibioterapia parenteral prolongada y mejorar el control del paciente al alta con vigilancia clinico-analitica. Revisamos la experiencia de dicho servicio entre 1995 y 2002 a partir de datos recogidos prospectivamente. Metodos Analisis del numero de pacientes incluidos por ano, el numero de pacientes con infeccion por el virus de la inmunodeficiencia humana (VIH), el diagnostico de enfermedad infecciosa, el servicio de origen, el tratamiento antimicrobiano administrado, el destino al alta y el motivo de reingreso hospitalario. Resultados El numero de pacientes incluidos cada ano durante el periodo de 1995 a 2002 fue: 52, 55, 77, 232, 213, 321, 280 y 219, respectivamente. El porcentaje de pacientes con infeccion por el VIH incluidos en el programa paso del 90% en el ano 1995 al 23% en el 2002. La causa principal de inclusion en el programa ha cambiado desde la sustitucion del hospital de dia para administracion de tratamiento, a la consecucion de un alta hospitalaria precoz. Mientras que la infeccion por citomegalovirus (CMV) fue el proceso tratado con mayor frecuencia durante el periodo 1995-1998, en los anos siguientes fueron las infecciones bacterianas el diagnostico de inclusion mas frecuente. En 148 episodios la autoadministracion y las bombas de infusion portatiles fueron utilizadas para administrar los antimicrobianos. La autoadministracion se asocio a un mayor riesgo de complicaciones (24% frente a 12%; odds ratio [OR]: 2,3; intervalo de confianza del 95% [IC 95%]: 1,5-3,6; p Conclusiones El porcentaje de pacientes con infeccion por el VIH incluidos en el programa ha disminuido progresivamente desde 1996 probablemente en relacion con la introduccion de la terapia antirretroviral de alta eficacia y un mejor control de las infecciones oportunistas. Las infecciones bacterianas son actualmente las infecciones mas frecuentes atendidas en este servicio. El alta hospitalaria precoz es el principal motivo de inclusion en el programa.

Recent years have witnessed a growing interest in the role of human herpesvirus (HHV) type 6 and type 7 as emerging pathogens or copathogens in transplant recipients. Both HHV-6 and HHV-7 belong to the beta-herpesvirus family and are closely related to another member of the family, cytomegalovirus. After the primary infection, these viruses remain latent in the human host and can reactivate after transplantation. Various clinical processes such as fever, rash, pneumonitis, encephalitis, hepatitis, and myelosuppression have been described in association with herpesvirus. Moreover, a growing body of evidence suggests that the major impact of HHV-6 and HHV-7 reactivation in transplantation is related to indirect effects, such as their association with cytomegalovirus disease, increased opportunistic infections, and graft dysfunction and rejection. The pathogenesis of HHV-6 and HHV-7 during the post-transplantation period, the methods used for their diagnosis, and the evaluation of antiviral drugs and strategies for their prevention and treatment are now the subject of extensive research.

The relevance of tuberculosis in solid organ transplant recipients stems from the difficulties in the diagnosis, which delay the start of treatment, and the associated toxicity of pharmacological therapy. These facts are responsible for the large number of clinical complications and the high mortality in this population. This Consensus Document from GESITRA (Spanish Transplantation Infection Study Group) defines the indications for prophylaxis of latent tuberculosis infection in patients undergoing solid organ transplantation, in particular those with a high risk of pharmacological toxicity, as is the case of liver transplant recipients. This Consensus Document also establishes recommendations for the choice of drugs to use and duration of treatment for tuberculosis in solid organ transplant recipients, with special mention of vigilance for the development of pharmacological interactions between rifampin and immunosuppressive drugs (cyclosporine, tacrolimus, rapamycin, and steroids).

In 1995 a specialized home care service for infectious diseases was created in our institution. The aim was to improve the quality of life of patients with prolonged parenteral antimicrobial therapy requirements, reduce the length of hospital stay, and improve the care received after discharge by clinical and analytical surveillance. This study reviews the experience of this service from 1995 to 2002 using prospectively recorded data.An analysis was performed of the number of patients included in the home care program per year, number of patients with HIV infection, infectious disease diagnosed, department referring the patient, antimicrobial treatment administered, destination at discharge, and reason for hospital re-admission.The number of patients included each year from 1995 to 2002 was 52, 55, 77, 232, 213, 321, 280 and 219, respectively. The percentage of HIV-infected patients decreased from 90% in 1995 to 23% in 2002. The main reason for referral to the program changed from substitution of day-care hospital treatment to early discharge from hospitalization. Whereas CMV infection was the most frequent infection treated during the 1995-1998 period, bacterial infections predominated in the following years. In 148 episodes, self-administration or a portable infusion pump was used for drug administration. Self-administration was associated with a greater risk of complications (24% vs. 12%, OR 2.3, 95% CI 1.5-3.6, P0.001) and catheter-related sepsis (4% vs. 0%, OR 12.9, 95% CI 10.9-15.3, P0.001). HIV-infected patients were re-hospitalized due to complications unrelated to the home care service more frequently than HIV-uninfected patients.The percentage of HIV-infected patients included in the infectious disease home care service has progressively decreased since 1996, a fact likely to be related to the introduction of highly active antiretroviral therapy and better control of opportunistic infections. Currently, bacterial infections are the most frequent infections treated in the service. Early hospital discharge is now the main reason for referral to the home program.

Recent years have witnessed a growing interest in the role of human herpesvirus (HHV) type 6 and type 7 as emerging pathogens or copathogens in transplant recipients. Both HHV-6 and HHV-7 belong to the beta-herpesvirus family and are closely related to another member of the family, cytomegalovirus. After the primary infection, these viruses remain latent in the human host and can reactivate after transplantation. Various clinical processes such as fever, rash, pneumonitis, encephalitis, hepatitis, and myelosuppression have been described in association with herpesvirus. Moreover, a growing body of evidence suggests that the major impact of HHV-6 and HHV-7 reactivation in transplantation is related to indirect effects, such as their association with cytomegalovirus disease, increased opportunistic infections, and graft dysfunction and rejection. The pathogenesis of HHV-6 and HHV-7 during the post-transplantation period, the methods used for their diagnosis, and the evaluation of antiviral drugs and strategies for their prevention and treatment are now the subject of extensive research.

The characteristics of two cases of histoplasmosis in AIDS patients in our institution are presented together with a review of the 11 cases published in Spain since 1988 in addition to the current knowledge on histoplasmosis in patients with human immunodeficiency virus infection (HIV). In all except 2 of the 13 patients there was epidemiologic history of a stay in a country in which histoplasmosis is endemic. The 12 cases described in which this information is available had CD4 counts under 100/microL. The clinical manifestations of presentation were fever (92.3%) associated or not with other unspecific symptoms (asthenia, anorexia, cough, diarrhea) with a subacute course of two or three months. Physical examination demonstrated hepatosplenomegaly in 76.9% of the cases and 61.5% of the patients presented cutaneous lesions. Thoracic radiography was abnormal in 55% (61.5% had respiratory symptoms). Diagnosis was achieved by isolation of the fungus in the cutaneous biopsies in all the patients with dermatologic involvement and in 7 cases identification was performed in the bone marrow. In all the cases induction treatment was with anphotericin B and in those who reached the maintenance phase itraconazol was used in 7 cases and ketoconazol in one case. None of the patients treated with itraconazol, including the two in our center, presented recurrence at the time of completion of follow up. In conclusion, histoplasmosis is frequently presented as a prolonged febrile syndrome with unspecific characteristics, thus emphasizing the importance of including travel history to other countries in the anamnesis. The increase in journeys to endemic countries and immigration from these areas had led to an increase in the number of cases of histoplasmosis in patients with HIV infection in Spain.