La neutrop\u00e8nia febril \u00e9s una complicaci\u00f3 freq\u00fcent en pacients oncohematol\u00f2gics que, per exemple, acaben de rebre un tractament de quimioter\u00e0pia o un trasplantament de c\u00e8l\u00b7lules mare hematopo\u00e8tiques. Es tracta d\u2019un quadre cl\u00ednic heterogeni i la sospita inicial \u00e9s que estigui causada per una infecci\u00f3 que, en aquests pacients immunodeprimits, pot acabar sent fatal. \u00c9s per aix\u00f2 que es tracta com una emerg\u00e8ncia: davant d\u2019un cas de neutrop\u00e8nia febril, cal administrar antibi\u00f2tics el m\u00e9s r\u00e0pid possible. Els betalact\u00e0mics s\u00f3n el tractament d\u2019elecci\u00f3 i cal assegurar-se que la concentraci\u00f3 d\u2019antibi\u00f2tic en sang es mant\u00e9 a nivells prou alts, per sobre de la concentraci\u00f3 m\u00ednima inhibit\u00f2ria (CMI), durant el major temps possible. Una forma de proporcionar una concentraci\u00f3 d\u2019antibi\u00f2tic constant al llarg del temps \u00e9s l\u2019\u00fas de perfusions esteses o prolongades, enlloc d\u2019intermitents. Fins ara, l\u2019evid\u00e8ncia de la seva efic\u00e0cia i seguretat en aquest camp era molt escassa i provenia principalment d\u2019estudis observacionals.<\/p>\n
Ara, els resultats d\u2019un assaig cl\u00ednic multic\u00e8ntric dut a terme en quatre centres estatals i publicat recentment a Clinical Microbiology and Infection aporten m\u00e9s informaci\u00f3 sobre el tema. Els autors, membres del grup de recerca en infeccions respirat\u00f2ries i en l\u2019hoste immunocomprom\u00e8s de l\u2019IDIBELL, del Servei de Malalties Infeccioses, Microbiologia i Farm\u00e0cia de l\u2019Hospital Universitari de Bellvitge i professionals de l\u2019Institut Catal\u00e0 d\u2019Oncologia i la Universitat de Barcelona, han analitzat un grup de 150 pacients sotmesos a trasplantament de c\u00e8l\u00b7lules mare hematopo\u00e8tiques o amb quimioter\u00e0pia per leuc\u00e8mia aguda que requerien tractament antibi\u00f2tic emp\u00edric per neutrop\u00e8nia febril. Es van separar en dos grups de forma aleat\u00f2ria i un va rebre antibi\u00f2tics en perfusi\u00f3 estesa, mentre que els altres van seguir el m\u00e8tode convencional. Els resultats no han mostrat difer\u00e8ncies significatives entre els dos grups ni en termes d\u2019\u00e8xit terap\u00e8utic, ni esdeveniments adversos ni mortalitat als 30 dies. S\u00ed que es va aconseguir demostrar, per\u00f2, que la perfusi\u00f3 estesa aconsegueix mantenir concentracions de betalact\u00e0mic per sobre de la CMI durant m\u00e9s temps que l\u2019administraci\u00f3 convencional.<\/p>\n
La l\u00edder de l\u2019estudi, la Dra. Carlota Gudiol, investigadora de l\u2019IDIBELL, l\u2019Hospital de Bellvitge i l\u2019ICO, considera que \u201cels resultats d\u2019aquest assaig no donen suport a l’\u00fas de la perfusi\u00f3 estesa d\u2019antibi\u00f2tics betalact\u00e0mics de forma rutin\u00e0ria en el maneig dels pacients amb neutrop\u00e8nia febril, per\u00f2 s\u00ed que podria ser una estrat\u00e8gia \u00fatil en casos amb infeccions produ\u00efdes per microorganismes menys sensibles als antibi\u00f2tics betalact\u00e0mics, tot i que calen m\u00e9s estudis per poder-ho demostrar\u201d.<\/p>\n
<\/p>\n
L\u2019Institut d\u2019Investigaci\u00f3 Biom\u00e8dica de Bellvitge (IDIBELL) \u00e9s un centre de recerca en biomedicina creat l\u2019any 2004. Est\u00e0 participat per l\u2019Hospital Universitari de Bellvitge i l\u2019Hospital de Viladecans de l\u2019Institut Catal\u00e0 de la Salut, l\u2019Institut Catal\u00e0 d\u2019Oncologia, la Universitat de Barcelona i l\u2019Ajuntament de l\u2019Hospitalet de Llobregat.<\/em><\/p>\n L\u2019IDIBELL \u00e9s membre del Campus d\u2019Excel\u00b7l\u00e8ncia Internacional de la Universitat de Barcelona HUBc i forma part de la instituci\u00f3 CERCA de la Generalitat de Catalunya. L\u2019any 2009 es va convertir en un dels cinc primers centres d\u2019investigaci\u00f3 espanyols acreditats com a institut d\u2019investigaci\u00f3 sanit\u00e0ria per l\u2019Instituto de Salud Carlos III. A m\u00e9s, forma part del programa \u201cHR Excellence in Research\u201d de la Uni\u00f3 Europea i \u00e9s membre de EATRIS i REGIC. Des de l\u2019any 2018, l\u2019IDIBELL \u00e9s un Centro Acreditado de la Fundaci\u00f3n Cient\u00edfica AECC (FCAECC).<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" Un equip de recerca de Bellvitge ha realitzat un assaig cl\u00ednic aleatoritzat en pacients hematol\u00f2gics amb neutrop\u00e8nia febril per valorar l\u2019efic\u00e0cia de la perfusi\u00f3 estesa d\u2019antibi\u00f2tics betalact\u00e0mics <\/p>\n Els resultats mostren que la perfusi\u00f3 estesa pot ser \u00fatil per combatre algunes infeccions, per\u00f2 no recolzen la introducci\u00f3 d\u2019aquesta t\u00e8cnica a la pr\u00e0ctica cl\u00ednica di\u00e0ria per al tractament emp\u00edric de la neutrop\u00e8nia febril. 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