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Background and Objectives: The possible renal toxicity of certain antibiotics (AB) is well known. The objective of our work is to know the possible effect of AB treatments in the development of renal failure (RF) in patients with infective endocarditis (IE)., Material and Method: Collection from a national multi-centre registry of collection on renal function, both prior and its impairment, if any, during the treatment of IE and in relation to possible causative factors, including the use of AB., Results: Between 2008 and 2012, 1,853 episodes of IE reported from 26 Spanish centres were analysed. Of these, 21.6% had prior RF. They developed new RF or impairment of renal function in 38.7% of the cases. In patients with prior RF, impairment was more frequent (64 vs. 31.7%, P<.001). Overall, patients with RF were older (70.6 vs. 67 years, P<.01), had more comorbidities (Charlson index 5 vs. 4, P<.01), and IE by Staphylococcus aureus (32.1 vs. 16.5%, P<.01). Potentially nephrotoxic AB use was only associated with RF in patients without prior RF (aminoglycosides: OR=1.47 [95% CI 1.096-1.988], P=.010; aminoglycosides with vancomycin: OR=1.49 [95% CI 1.069-2.09], P=.019)., Conclusions: In patients without prior RF, the use of nephrotoxic AB is associated with impairment of renal function. In patients with RF prior to the IE episode, impairment of renal function was more frequent but appears to be more related to the severity of infection., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)

Introduction: Approximately 4% to 8% of patients with HIV-1 treated with abacavir present a hypersensitivity reaction (HSR). Various studies have shown a direct association between human leukocyte antigen (HLA)-B*5701 and HSR to abacavir. The objective of this study was to analyze whether systematic HLA-B*5701 testing to prevent HSR in patients treated with abacavir is a cost-effective option for the Spanish National Health System., Methods: An analytical decision-making model was constructed as a decision tree model for a simulated cohort of 1000 HIV patients to evaluate whether HLA-B*5701 testing to prevent HSR to abacavir was cost effective compared with not performing the test. The parameters included in the model and the use of healthcare resources should the patient develop HSR were taken from the PREDICT-1 study and the opinion of clinical experts. The principal result obtained was the incremental cost per HSR avoided. The time horizon of the analysis was to 2 months [corrected] . All costs were expressed in 2008 Euros., Results: The analysis showed that the total direct healthcare costs per patient were €1344 and €1322 with and without HLA-B*5701 testing respectively, and that 36 cases of HSR were prevented per 1000 screened patients. These results yielded a cost per HSR avoided of €630. The sensitivity analysis showed that the results were sensitive to the cost of the test, with an economic saving of €102 or a cost-effectiveness ratio of €4234., Conclusions: The model predicts that generalized use of the HLA-B*5701 test before prescribing abacavir in HIV+ patients could represent an economic saving or a limited additional cost for the National Health System which may be counterbalanced by the benefits in terms of a lower incidence of HSR., (Copyright © 2009 Elsevier España, S.L. All rights reserved.)

This paper includes a brief summary of the clinical history of the diagnosis and treatment of infectious diseases in Spain. Firstly, the origins of a specialty arising from the need for specialists to attend to, in a practical and modern form, the different health problems of patients affected by infectious diseases, are described. Secondly, the appearance of AIDS, at the beginning of the 1980's, prompted the creation of specific units dedicated to the care of problems associated with human immunodeficiency virus (HIV) infection and the concomitant opportunistic infections arising from the immunodeficiency arising from the HIV infection. Thirdly, in the last decades and even today, nosocomial infections have appeared as an alarming problem, needing the presence of specialist physicians in this field. Finally, emigration and international travel require specialists in infectious diseases with specific expertise in international health, once more highlighting the importance of the specialty of Infectious Diseases.

In the last few years, research in pharmacogenetics and pharmacogenomics has identified distinct variants or markers that can help to define the benefits and risk of patients requiring antiretroviral treatment. The beneficial effect of the deletion 32 allele of the CCR5 coreceptor on the natural history of HIV infection and, to a certain extent, on treatment response is well known. The bases of immune reconstitution after initiation of antiretroviral therapy, although the subject of intense study, are probably multifactorial and polygenetic and consequently conclusions with clear applicability to clinical practice are currently lacking. Among the risks, no significant progress has been made in lipodystrophy. The origin of dyslipidemia associated with antiretroviral treatment and the excess cardiovascular risk conferred by some antiretroviral drugs is probably polygenetic and, at present, poorly defined. The genetic bases of efavirenz-induced neurological toxicity and of hyperbilirubinemia secondary to atazanavir are fairly well known, although their application in daily clinical practice has not been adequately assessed. Some aspects that help to understand the molecular bases of hypersensitivity reaction to nevirapine and of nevirapine-induced hepatotoxicity have been described but are not applicable in most cases and consequently further studies are required. Some data correlate tenofovir-induced renal toxicity with genetic variations in some transport proteins. The most significant advance for clinical practice is the correlation between the presence of the HLA-B*5701 allele and hypersensitivity reaction to abacavir. In particular, one clinical trial with a large number of patients from distinct ethnic groups found that the probability of not developing hypersensitivity reaction (immunologically confirmed) was 100% if the patient was HLA-B*5701-negative. These data suggest the need to implement this test in daily clinical practice.

Objective: Descriptive study of severe respiratory infections caused by Pseudomonas aeruginosa in patients with HIV infection., Methods: Review of clinical records of HIV-positive patients admitted in a tertiary hospital from 1-1-1990 to 9-30-1995. The patients included in this study were those with P. aeruginosa recovered from respiratory or blood samples and respiratory symptoms., Results: Forty patients suffered 77 episodes. The incidence in the HIV-positive admitted population during the study period was 2.6% but 3.2% in the last year. Ninety-seven percent of patients met criteria for AIDS. Twenty-eight patients (70%) had other bacterial infections. In 78% of patients no classical predisposing factor was found for this infection. Twenty-seven patients (67.5%) came regularly to the day hospital or had been previously admitted to the hospital (recent hospitalization). Twenty-five episodes (32.5%) were tracheo-bronchitis and 50 pneumonias (65%), of which 14 (28%) were cavitated and 7 (14%) bacteremic. Forty-nine percent of episodes were recurrences. Ten out of 15 tracheo-bronchitis in the first episode recurred; the new episode was more severe in 7 patients. Five patients received secondary prophylaxis after the second episode (4 with tobramycin in aerosol and 1 with colistin in aerosol). Two patients had recurrences after 86 and 62 days (mean: 74; SD: 12). Eight out of the 11 patients who did not receive prophylaxis (73%) had recurrence after a mean of 23 days (SD: 10) (p = 0.002). The mortality rate associated with P. aeruginosa was 22.5%., Conclusions: The incidence of P. aeruginosa infections in our HIV-positive patients was 2.6% (3.2% in the last year). It is associated with severe immunosuppression and previous bacterial infection. The subacute involvement of the lower respiratory tract is most common. Over 50% of infections tend to recur more severely. The secondary prophylaxis increased the symptom-free period, although the number of patients who received it was small.