Antimicrobial resistance claimed an estimated 4.95 million lives in 2019. When clinicians prescribe empiric therapy that follows guidelines, mortality drops by roughly a third; when they de-escalate on the basis of culture results, it drops by more than half. Yet the document that should drive both decisions, the antibiogram, is often read superficially or misinterpreted, particularly by physicians without infectious-disease training. Existing stewardship frameworks address prescribing principles, timing, or ecological impact, but none walks the clinician step by step through an individual susceptibility report and out the other side with a treatment plan. PRECISE is a seven-step mnemonic designed for that purpose. Each letter corresponds to a clinical action: Pathogen assessment, Resistance phenotype interpretation, Evaluate MIC, Curtail spectrum, Individualize PK/PD, Switch route, and Endpoint optimization. Three clinical vignettes (including one in which the steps deliberately collide) illustrate how the framework operates in practice.
INTRODUCTION:Antimicrobial resistance is a major global public health challenge with particular implications in pediatrics. Antimicrobial stewardship programs (ASPs) require structured tools to assess prescribing quality, especially in complex clinical scenarios such as bloodstream infections and multidrug-resistant organism infections. The aim of this study was to design and implement a structured support program for managing these infections in a pediatric hospital, including an evaluation tool, a standard operating procedure, and its integration into the electronic health record. MATERIAL AND METHODS:The program was developed in 2025 within the ASP team of a tertiary pediatric hospital. Two evaluation tools were designed based on the AFinf methodology of the Spanish Society of Hospital Pharmacy and quality indicators reported in the literature. A standard operating procedure was developed in accordance with the PROA certification standards, and the tools were integrated into the hospital's electronic prescribing system. RESULTS:Two structured evaluation tools were obtained (23 items for bloodstream infections and 21 for multidrug-resistant organisms), organized across four dimensions: patient identification, diagnostic adequacy, antimicrobial treatment adequacy, and ASP intervention. A multidisciplinary care pathway was formalized, and electronic integration was completed, enabling systematic data analysis. CONCLUSIONS:The program represents a feasible strategy aligned with current ASP certification standards, with the added value of being specifically designed for the pediatric population, a setting where dedicated and validated tools remain a pressing need.
INTRODUCTION:Given the current increase in the incidence of Neisseria gonorrhoeae infection, a rise in disseminated forms of the disease may also be expected. Within disseminated gonococcal disease, gonococcal arthritis has specific clinical, diagnostic and therapeutic characteristics. METHODS:A retrospective search was conducted for synovial fluid samples that tested positive for N. gonorrhoeae by culture or molecular biology techniques between 2013 and 2023 at several hospitals in northern Spain. A descriptive analysis was subsequently performed. RESULTS:Fifteen patients were analysed. Monoarthritis was the most frequent presentation (60%), followed by polyarthritis, predominantly affecting the wrist or knee. Arthralgia or tenosynovitis at other sites, particularly the wrist, was common. Microbiological identification was performed by conventional culture (12/14) or PCR (7/7). Repeated ultrasound-guided drainage or surgical washout was required in 30% of cases. The mean duration of intravenous antibiotic therapy was 12 days, while the mean total duration of antibiotic therapy was 22 days. The clinical response was favourable in all cases. CONCLUSION:In the current context of increasing gonococcal infection incidence, gonococcal arthritis should be considered in patients with septic monoarthritis or polyarthritis and concomitant tenosynovitis, particularly when the radiocarpal joint is involved. Molecular biology techniques may be useful for identifying N. gonorrhoeae in suspected cases. The clinical course may vary and may require surgical washout and prolonged treatment.
Hantaviruses are rodent-borne zoonotic RNA viruses with a worldwide distribution and the capacity to cause severe human disease. More than 40 hantavirus species have been identified, of which over 20 are known to be pathogenic to humans. Old World hantaviruses are classically associated with Hemorrhagic Fever with Renal Syndrome (HFRS), whereas New World hantaviruses predominantly cause Hantavirus Cardiopulmonary Syndrome (HCPS), a condition characterized by rapid progression to respiratory failure, shock, and substantial mortality. Human infection is usually acquired through the inhalation of aerosols contaminated with excreta from infected reservoir animals, primarily rodents, although person-to-person transmission has been demonstrated for the Andes virus. This review summarizes current knowledge on hantavirus biology, reservoirs, transmission, epidemiology, clinical manifestations, laboratory diagnosis, treatment, prognosis, and prevention, with particular emphasis on the situation in Spain. Worldwide, hantavirus infections remain underdiagnosed because many cases are asymptomatic or present with nonspecific clinical manifestations. Diagnosis relies mainly on serological and molecular methods. No universally effective antiviral therapy is currently available for hantavirus disease, and management remains largely supportive, with intensive care and extracorporeal membrane oxygenation playing a crucial role in severe cases. Evidence accumulated over the last three decades confirms the circulation of hantaviruses in Spain, both in animal reservoirs and in humans. Although clinically recognized disease remains uncommon, serological and ecological studies demonstrate that these infections are present in the country. Continued surveillance, improved diagnostic awareness, and the development of effective preventive and therapeutic strategies remain important public health priorities.
