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Shabana NS, Seeber G, Soriano A, Jutte PC, Westermann S, Mithoe G, Pirii L, Siebers T, Have BT, Zijlstra W, Lazovic D, Wouthuyzen-Bakker M. The Clinical Outcome of Early Periprosthetic Joint Infections Caused by Staphylococcus epidermidis and Managed by Surgical Debridement in an Era of Increasing Resistance. Antibiotics (Basel) 2022; 12:antibiotics12010040. [PMID: 36671241 PMCID: PMC9854449 DOI: 10.3390/antibiotics12010040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION A risk factor for the failure of surgical debridement in patients with early periprosthetic joint infections (PJI) is the presence of multidrug-resistant microorganisms. Staphylococcus epidermidis is one of the most isolated microorganisms in PJI and is associated with emerging resistance patterns. We aimed to assess the antibiotic resistance patterns of S. epidermidis in early PJIs treated with surgical debridement and correlate them to clinical outcomes. MATERIAL AND METHODS A retrospective multicentre observational study was conducted to evaluate patients with an early PJI (within 3 months after the index arthroplasty) by S. epidermidis with at least two positive intraoperative cultures. Clinical failure was defined as the need for additional surgical intervention or antibiotic suppressive therapy to control the infection. RESULTS A total of 157 patients were included. The highest rate of resistance was observed for methicillin in 82% and ciprofloxacin in 65% of the cases. Both were associated with a higher rate of clinical failure (41.2% vs. 12.5% (p 0.048) and 47.3% vs. 14.3% (p 0.015)), respectively. Furthermore, 70% of the cases had reduced susceptibility to vancomycin (MIC ≥ 2), which showed a trend towards a higher failure rate (39.6% vs. 19.0%, NS). Only 7% of the cases were rifampin-resistant. Only the resistance to fluoroquinolones was an independent risk factor for clinical failure in the multivariate analysis (OR 5.45, 95% CI 1.67-17.83). CONCLUSION S. epidermidis PJIs show a high rate of resistance. Resistance to fluoroquinolones is associated with clinical failure. Alternative prophylactic antibiotic regimens and optimising treatment strategies are needed to improve clinical outcomes.
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Affiliation(s)
- Nada S. Shabana
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
| | - Gesine Seeber
- Department of Orthopaedic Surgery, Universitätsklinik für Orthopädie und Unfallchirurgie, Pius-Hospital Oldenburg, 26121 Oldenburg, Germany
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, 08007 Barcelona, Spain
| | - Paul C. Jutte
- Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Silvia Westermann
- Department of Orthopaedic Surgery, Universitätsklinik für Orthopädie und Unfallchirurgie, Pius-Hospital Oldenburg, 26121 Oldenburg, Germany
| | - Glenn Mithoe
- Certe, Department of Medical Microbiology, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Loredana Pirii
- Izore, Centre for Infectious Diseases Friesland, 8917 EN Leeuwarden, The Netherlands
| | - Théke Siebers
- Certe, Department of Medical Microbiology, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Bas ten Have
- Department of Orthopaedic Surgery, Martini Hospital, 9728 NT Groningen, The Netherlands
| | - Wierd Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands
| | - Djordje Lazovic
- Department of Orthopaedic Surgery, Universitätsklinik für Orthopädie und Unfallchirurgie, Pius-Hospital Oldenburg, 26121 Oldenburg, Germany
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
- Correspondence: ; Tel.: +31-50-361-6161
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Soriano A, Puzniak LA, Paterson D, Thalhammer F, Kluge S, Viale P, Watanabe AH, Obi EN, Kaul S. 673. Study of Prescribing patterns and Effectiveness of Ceftolozane/Tazobactam Real-world Analysis (SPECTRA): Results from a multi-national, multicenter observational study. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Ceftolozane/tazobactam (C/T) has demonstrated efficacy to treat complicated intra-abdominal infections (cIAI), complicated urinary tract infections (cUTI) and hospital acquired bacterial and ventilator-associated bacterial pneumonia. However, physicians, providers, and other stakeholders including payers want broader real-world evidence to inform clinical decisions and optimize healthcare resource use.
Methods
SPECTRA is a multi-national, multicenter, retrospective, inpatient, observational study of patients treated with C/T in Australia, Austria, Germany, Italy, Mexico, Spain and The United Kingdom. Adult inpatients treated with ≥48 hours of C/T were included. Demographics, clinical characteristics, treatment management patterns, and outcomes were analyzed.
Results
There were 687 patients from 38 participating hospitals in 7 countries. The average age was 57.6 years (±17.3 [SD]) and most were male 456 (66.4%). The majority had at least one comorbidity 563 (82.0%), with the most common being heart disease 208 (30.3%), immunocompromised state 207 (30.1%) and chronic pulmonary disease 195 (28.4%). The most common indications were pneumonia 204 (29.7%), sepsis 147 (21.4%), and cIAI 106 (15.4%); 162 (23.6%) had multiple sites of infection and 245 (35.7%) were polymicrobial infections. Median C/T treatment was 12.0 days (11.0 [IQR]). Half of the patients were admitted to the ICU 343 (49.9%), 43.4% of which was related to the infection. Clinical success was 66.1%. All-cause in-hospital mortality was 22.0% with 8.7% being infection related. 30-day all-cause readmission was 9.8% and 4.7% were infection related.
Conclusion
C/T was used to treat infections among critically ill patients and for multi-source, polymicrobial infections. Despite the complexity of the patients in this real-world analysis, most C/T patients had beneficial outcomes that are similar to results of controlled clinical trials.
Disclosures
Alex Soriano, MD, MSD, Pfizer, Shionogi, Angelini, Menarini, Gilead: Honoraria Laura A. Puzniak, MPH, PhD, Merck & Co., Inc.: former employee and stockholder David Paterson, MBBS, Accelerate: Honoraria|bioMerieux: Honoraria|Entasis: Advisor/Consultant|Janssen-Cilag: Grant/Research Support|MSD: Advisor/Consultant|MSD: Grant/Research Support|MSD: Honoraria|Pfizer: Grant/Research Support|Pfizer: Honoraria|PPD: Grant/Research Support|Shionogi: Grant/Research Support|VenatoRx: Advisor/Consultant Stefan Kluge, MD, Astrazeneca: Lecture fees|Biotest: Lecture fees|Cytosorbents: Grant/Research Support|Cytosorbents: Lecture fees|Daiichi Sankyo: Grant/Research Support|Daiichi Sankyo: Lecture fees|Fresenius Medical Care: Advisor/Consultant|Fresenius Medical Care: Lecture fees|Gilead: Advisor/Consultant|Gilead: Lecture fees|Mitsubishi Tanabe Pharma: Lecture fees|MSD: Advisor/Consultant|MSD: Lecture fees|Pfizer: Advisor/Consultant|Pfizer: Lecture fees|Phillips: Lecture fees|Zoll: Lecture fees Alexandre H. Watanabe, PharmD, Merck & Co., Inc.: Employee Engels N. Obi, PhD, Merck & Co., Inc.: Employee|Merck & Co., Inc.: Stocks/Bonds Sunny Kaul, BSc, MBChB, PHD, FRCP, FFICM, Chiesi: Speaker fees|Gilead: Speaker fees|GlaxoSmithKline: Speaker fees|MSD: Grant/Research Support|MSD: Speaker fees|Shionogi: Speaker fees|Vifor Pharma: Grant/Research Support.
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Affiliation(s)
- Alex Soriano
- Hospital Clínic de Barcelona , Barcelona, Catalonia , Spain
| | | | - David Paterson
- The University of Queensland , Brisbane, Queensland , Australia
| | | | - Stefan Kluge
- University Medical Center Hamburg-Eppendorf , Martinistrasse, Hamburg , Germany
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna , Bologna, Italy, Bologna, Emilia-Romagna , Italy
| | | | | | - Sunny Kaul
- Royal Brompton & Harefield NHS Foundation Trust , London, England , United Kingdom
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Thompson GR, Soriano A, Cornely OA, Kullberg BJ, Kollef M, Vazquez JA, Das AF, Locke JB, Sandison T, Pappas PG. 231. Outcomes by Baseline Pathogen and Susceptibility in the ReSTORE Phase 3 Trial of Rezafungin Once Weekly Compared with Caspofungin Once Daily in Patients with Candidemia and/or Invasive Candidiasis. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Rezafungin is a next-generation, once-weekly echinocandin in development for treatment of candidemia and invasive candidiasis (IC), and for prevention of invasive fungal diseases caused by Candida, Aspergillus, and Pneumocystis in allogeneic blood and marrow transplant recipients (Fig 1). ReSTORE (NCT03667690) is a global, double-blind, double-dummy, 1:1 randomized, controlled, Phase 3 non-inferiority trial that evaluated the efficacy and safety of rezafungin once weekly (QWk) versus caspofungin once daily (QD) in patients with candidemia and/or IC. This analysis of the completed ReSTORE trial was conducted to evaluate outcomes by baseline pathogen and susceptibility.
Methods
In ReSTORE, adults (≥18 y) with systemic signs and mycological confirmation of candidemia and/or IC received either rezafungin QWk (400 mg Week 1, then 200 mg QWk) or caspofungin QD for ≥14 days (up to 4 weeks) with optional oral fluconazole step-down in the caspofungin arm. The primary endpoints were global cure at day (D) 14 (per Data Review Committee confirmation of investigator-assessed clinical cure [and radiological cure for IC) + mycological eradication]) and all-cause mortality (ACM) at D30 (Fig 2). Secondary endpoints included mycological eradication at D14. For this analysis, D14 global cure and mycological eradication by treatment group were analyzed by Candida species and in vitro susceptibility at baseline (CLSI broth microdilution MIC values; M27 Ed4) (Fig 3).
Results
A total of 204 Candida isolates were recovered in 187 patients across both treatment groups. Of the 204 isolates, C. albicans was the most common species, followed by C. glabrata, C. tropicalis, and C. parapsilosis; 61% of all baseline isolates were non-albicans Candida (Fig 3). The rates of D14 global cure and mycological eradication by pathogen are shown in Tables 1 and 2. Overall, outcomes by Candida species and MIC did not appear to be affected by MIC values for either rezafungin or caspofungin (Table 3).
Conclusion
Rezafungin was efficacious across multiple Candida species in the Phase 3 ReSTORE trial that demonstrated non-inferiority of rezafungin to caspofungin. There was no clear correlation between increased MIC values and clinical outcomes.
Disclosures
George R. Thompson, III, MD, Amplyx: Advisor/Consultant|Amplyx: Grant/Research Support|Astellas: Advisor/Consultant|Astellas: Grant/Research Support|Cidara: Advisor/Consultant|Cidara: Grant/Research Support|F2G: Advisor/Consultant|F2G: Grant/Research Support|Merck: Grant/Research Support|Pfizer: DSMB|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support Alex Soriano, MD, MSD, Pfizer, Shionogi, Angelini, Menarini, Gilead: Honoraria Oliver A. Cornely, Prof. Dr., Abbott: Honoraria|Abbvie: Advisor/Consultant|Actelion: Board Member|Al-Jazeera Pharmaceuticals: Honoraria|Allecra Therapeutics: Board Member|Amplyx: Advisor/Consultant|Amplyx: Grant/Research Support|Astellas: Honoraria|Basilea: Advisor/Consultant|Basilea: Grant/Research Support|Biocon: Advisor/Consultant|Biosys: Advisor/Consultant|BMBF: Grant/Research Support|Cidara: Advisor/Consultant|Cidara: Board Member|Cidara: Expert Testimony|Cidara: Grant/Research Support|CoRe Consulting: Stocks/Bonds|Da Volterra: Advisor/Consultant|DLR: Grant/Research Support|DZIF: Grant/Research Support|Entasis: Board Member|EU Directorate-General for Resarch and Innovation: Grant/Research Support|F2G: Grant/Research Support|German Patent and Trade Mark Office: German patent (DE 10 2021 113 007.7)|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Grupo Biotoscana/United Medical/Knight: Honoraria|Hikma: Honoraria|IQVIA: Board Member|Janssen: Board Member|Matinas: Advisor/Consultant|Matinas: Grant/Research Support|MedPace: Advisor/Consultant|MedPace: Grant/Research Support|MedScape: Honoraria|MedUpdate: Honoraria|Menarini: Advisor/Consultant|Merck/MSD: Grant/Research Support|Merck/MSD: Honoraria|Molecular Partners: Advisor/Consultant|MSG-ERC: Advisor/Consultant|Mundipharma: Grant/Research Support|Mylan: Honoraria|Noxxon: Advisor/Consultant|Octapharma: Advisor/Consultant|Octapharma: Grant/Research Support|Paratek: Board Member|Pardes: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Projektträger Jülich: Grant/Research Support|PSI: Advisor/Consultant|PSI: Board Member|Pulmocide: Board Member|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Seres: Advisor/Consultant|Shionogi: Board Member|Wiley (Blackwell): Editor-in-Chief, Mycoses Bart-Jan Kullberg, MD, FRCP, FIDSA, Cidara: Independent Data Review Committee Jeffrey B. Locke, PhD, Cidara Therapeutics: Employee|Cidara Therapeutics: Stocks/Bonds Taylor Sandison, MD, MPH, Cidara Therapeutics: Employee|Cidara Therapeutics: Stocks/Bonds.
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Affiliation(s)
- George R Thompson
- University of California Davis Medical Center , Sacramento, California
| | - Alex Soriano
- Hospital Clínic de Barcelona , Barcelona, Catalonia , Spain
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne , Cologne, Nordrhein-Westfalen , Germany
| | - Bart-Jan Kullberg
- Radboud University Medical Center , Nijmegen, Gelderland , Netherlands
| | - Marin Kollef
- Washington University , St. Louis Missouri, St Louis, Missouri
| | | | | | | | | | - Peter G Pappas
- University of Alabama at Birmingham , Birmingham, Alabama
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Fontseré N, Soriano A, Mestres G, Bermudez P, Zarco F, Lozano V, Rodas L, Broseta J, Arias M, Maduell F. Efficacy of systematic catheter locks solution of taurolidine/heparin versus taurolidine/urokinase in end-stage renal insufficiency stage 5D. Nefrologia 2022; 42:611-613. [PMID: 36669952 DOI: 10.1016/j.nefroe.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 06/17/2023] Open
Affiliation(s)
- Néstor Fontseré
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, Spain.
| | - Alex Soriano
- Unidad Funcional de Acceso Vascular, Servicio de Enfermedades Infecciosas, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Gaspar Mestres
- Unidad Funcional de Acceso Vascular, Servicio de Cirugía Vascular, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Patricia Bermudez
- Unidad Funcional de Acceso Vascular, Servicio de Radiología Vascular Intervencionista, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Federico Zarco
- Unidad Funcional de Acceso Vascular, Servicio de Radiología Vascular Intervencionista, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Valentín Lozano
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Lida Rodas
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Jose Broseta
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Marta Arias
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Francisco Maduell
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, Spain
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Pathak GA, Karjalainen J, Stevens C, Neale BM, Daly M, Ganna A, Andrews SJ, Kanai M, Cordioli M, Polimanti R, Harerimana N, Pirinen M, Liao RG, Chwialkowska K, Trankiem A, Balaconis MK, Nguyen H, Solomonson M, Veerapen K, Wolford B, Roberts G, Park D, Ball CA, Coignet M, McCurdy S, Knight S, Partha R, Rhead B, Zhang M, Berkowitz N, Gaddis M, Noto K, Ruiz L, Pavlovic M, Hong EL, Rand K, Girshick A, Guturu H, Baltzell AH, Niemi MEK, Rahmouni S, Guntz J, Beguin Y, Cordioli M, Pigazzini S, Nkambule L, Georges M, Moutschen M, Misset B, Darcis G, Guiot J, Azarzar S, Gofflot S, Claassen S, Malaise O, Huynen P, Meuris C, Thys M, Jacques J, Léonard P, Frippiat F, Giot JB, Sauvage AS, Frenckell CV, Belhaj Y, Lambermont B, Nakanishi T, Morrison DR, Mooser V, Richards JB, Butler-Laporte G, Forgetta V, Li R, Ghosh B, Laurent L, Belisle A, Henry D, Abdullah T, Adeleye O, Mamlouk N, Kimchi N, Afrasiabi Z, Rezk N, Vulesevic B, Bouab M, Guzman C, Petitjean L, Tselios C, Xue X, Afilalo J, Afilalo M, Oliveira M, Brenner B, Brassard N, Durand M, Schurr E, Lepage P, Ragoussis J, Auld D, Chassé M, Kaufmann DE, Lathrop GM, Adra D, Hayward C, Glessner JT, Shaw DM, Campbell A, Morris M, Hakonarson H, Porteous DJ, Below J, Richmond A, Chang X, Polikowski H, Lauren PE, Chen HH, Wanying Z, Fawns-Ritchie C, North K, McCormick JB, Chang X, Glessner JR, Hakonarson H, Gignoux CR, Wicks SJ, Crooks K, Barnes KC, Daya M, Shortt J, Rafaels N, Chavan S, Timmers PRHJ, Wilson JF, Tenesa A, Kerr SM, D’Mellow K, Shahin D, El-Sherbiny YM, von Hohenstaufen KA, Sobh A, Eltoukhy MM, Nkambul L, Elhadidy TA, Abd Elghafar MS, El-Jawhari JJ, Mohamed AAS, Elnagdy MH, Samir A, Abdel-Aziz M, Khafaga WT, El-Lawaty WM, Torky MS, El-shanshory MR, Yassen AM, Hegazy MAF, Okasha K, Eid MA, Moahmed HS, Medina-Gomez C, Ikram MA, Uitterlinden AG, Mägi R, Milani L, Metspalu A, Laisk T, Läll K, Lepamets M, Esko T, Reimann E, Naaber P, Laane E, Pesukova J, Peterson P, Kisand K, Tabri J, Allos R, Hensen K, Starkopf J, Ringmets I, Tamm A, Kallaste A, Alavere H, Metsalu K, Puusepp M, Batini C, Tobin MD, Venn LD, Lee PH, Shrine N, Williams AT, Guyatt AL, John C, Packer RJ, Ali A, Free RC, Wang X, Wain LV, Hollox EJ, Bee CE, Adams EL, Palotie A, Ripatti S, Ruotsalainen S, Kristiansson K, Koskelainen S, Perola M, Donner K, Kivinen K, Palotie A, Kaunisto M, Rivolta C, Bochud PY, Bibert S, Boillat N, Nussle SG, Albrich W, Quinodoz M, Kamdar D, Suh N, Neofytos D, Erard V, Voide C, Bochud PY, Rivolta C, Bibert S, Quinodoz M, Kamdar D, Neofytos D, Erard V, Voide C, Friolet R, Vollenweider P, Pagani JL, Oddo M, zu Bentrup FM, Conen A, Clerc O, Marchetti O, Guillet A, Guyat-Jacques C, Foucras S, Rime M, Chassot J, Jaquet M, Viollet RM, Lannepoudenx Y, Portopena L, Bochud PY, Vollenweider P, Pagani JL, Desgranges F, Filippidis P, Guéry B, Haefliger D, Kampouri EE, Manuel O, Munting A, Papadimitriou-Olivgeris M, Regina J, Rochat-Stettler L, Suttels V, Tadini E, Tschopp J, Van Singer M, Viala B, Boillat-Blanco N, Brahier T, Hügli O, Meuwly JY, Pantet O, Gonseth Nussle S, Bochud M, D’Acremont V, Estoppey Younes S, Albrich WC, Suh N, Cerny A, O’Mahony L, von Mering C, Bochud PY, Frischknecht M, Kleger GR, Filipovic M, Kahlert CR, Wozniak H, Negro TR, Pugin J, Bouras K, Knapp C, Egger T, Perret A, Montillier P, di Bartolomeo C, Barda B, de Cid R, Carreras A, Moreno V, Kogevinas M, Galván-Femenía I, Blay N, Farré X, Sumoy L, Cortés B, Mercader JM, Guindo-Martinez M, Torrents D, Garcia-Aymerich J, Castaño-Vinyals G, Dobaño C, Gori M, Renieri A, Mari F, Mondelli MU, Castelli F, Vaghi M, Rusconi S, Montagnani F, Bargagli E, Franchi F, Mazzei MA, Cantarini L, Tacconi D, Feri M, Scala R, Spargi G, Nencioni C, Bandini M, Caldarelli GP, Canaccini A, Ognibene A, D’Arminio Monforte A, Girardis M, Antinori A, Francisci D, Schiaroli E, Scotton PG, Panese S, Scaggiante R, Monica MD, Capasso M, Fiorentino G, Castori M, Aucella F, Biagio AD, Masucci L, Valente S, Mandalà M, Zucchi P, Giannattasio F, Coviello DA, Mussini C, Tavecchia L, Crotti L, Rizzi M, Rovere MTL, Sarzi-Braga S, Bussotti M, Ravaglia S, Artuso R, Perrella A, Romani D, Bergomi P, Catena E, Vincenti A, Ferri C, Grassi D, Pessina G, Tumbarello M, Pietro MD, Sabrina R, Luchi S, Furini S, Dei S, Benetti E, Picchiotti N, Sanarico M, Ceri S, Pinoli P, Raimondi F, Biscarini F, Stella A, Zguro K, Capitani K, Nkambule L, Tanfoni M, Fallerini C, Daga S, Baldassarri M, Fava F, Frullanti E, Valentino F, Doddato G, Giliberti A, Tita R, Amitrano S, Bruttini M, Croci S, Meloni I, Mencarelli MA, Rizzo CL, Pinto AM, Beligni G, Tommasi A, Sarno LD, Palmieri M, Carriero ML, Alaverdian D, Busani S, Bruno R, Vecchia M, Belli MA, Mantovani S, Ludovisi S, Quiros-Roldan E, Antoni MD, Zanella I, Siano M, Emiliozzi A, Fabbiani M, Rossetti B, Bergantini L, D’Alessandro M, Cameli P, Bennett D, Anedda F, Marcantonio S, Scolletta S, Guerrini S, Conticini E, Frediani B, Spertilli C, Donati A, Guidelli L, Corridi M, Croci L, Piacentini P, Desanctis E, Cappelli S, Verzuri A, Anemoli V, Pancrazzi A, Lorubbio M, Miraglia FG, Venturelli S, Cossarizza A, Vergori A, Gabrieli A, Riva A, Paciosi F, Andretta F, Gatti F, Parisi SG, Baratti S, Piscopo C, Russo R, Andolfo I, Iolascon A, Carella M, Merla G, Squeo GM, Raggi P, Marciano C, Perna R, Bassetti M, Sanguinetti M, Giorli A, Salerni L, Parravicini P, Menatti E, Trotta T, Coiro G, Lena F, Martinelli E, Mancarella S, Gabbi C, Maggiolo F, Ripamonti D, Bachetti T, Suardi C, Parati G, Bottà G, Domenico PD, Rancan I, Bianchi F, Colombo R, Barbieri C, Acquilini D, Andreucci E, Segala FV, Tiseo G, Falcone M, Lista M, Poscente M, Vivo OD, Petrocelli P, Guarnaccia A, Baroni S, Hayward C, Porteous DJ, Fawns-Ritchie C, Richmond A, Campbell A, van Heel DA, Hunt KA, Trembath RC, Huang QQ, Martin HC, Mason D, Trivedi B, Wright J, Finer S, Akhtar S, Anwar M, Arciero E, Ashraf S, Breen G, Chung R, Curtis CJ, Chowdhury M, Colligan G, Deloukas P, Durham C, Finer S, Griffiths C, Huang QQ, Hurles M, Hunt KA, Hussain S, Islam K, Khan A, Khan A, Lavery C, Lee SH, Lerner R, MacArthur D, MacLaughlin B, Martin H, Mason D, Miah S, Newman B, Safa N, Tahmasebi F, Trembath RC, Trivedi B, van Heel DA, Wright J, Griffiths CJ, Smith AV, Boughton AP, Li KW, LeFaive J, Annis A, Niavarani A, Aliannejad R, Sharififard B, Amirsavadkouhi A, Naderpour Z, Tadi HA, Aleagha AE, Ahmadi S, Moghaddam SBM, Adamsara A, Saeedi M, Abdollahi H, Hosseini A, Chariyavilaskul P, Jantarabenjakul W, Hirankarn N, Chamnanphon M, Suttichet TB, Shotelersuk V, Pongpanich M, Phokaew C, Chetruengchai W, Putchareon O, Torvorapanit P, Puthanakit T, Suchartlikitwong P, Nilaratanakul V, Sodsai P, Brumpton BM, Hveem K, Willer C, Wolford B, Zhou W, Rogne T, Solligard E, Åsvold BO, Franke L, Boezen M, Deelen P, Claringbould A, Lopera E, Warmerdam R, Vonk JM, van Blokland I, Lanting P, Ori APS, Feng YCA, Mercader J, Weiss ST, Karlson EW, Smoller JW, Murphy SN, Meigs JB, Woolley AE, Green RC, Perez EF, Wolford B, Zöllner S, Wang J, Beck A, Sloofman LG, Ascolillo S, Sebra RP, Collins BL, Levy T, Buxbaum JD, Sealfon SC, Jordan DM, Thompson RC, Gettler K, Chaudhary K, Belbin GM, Preuss M, Hoggart C, Choi S, Underwood SJ, Salib I, Britvan B, Keller K, Tang L, Peruggia M, Hiester LL, Niblo K, Aksentijevich A, Labkowsky A, Karp A, Zlatopolsky M, Zyndorf M, Charney AW, Beckmann ND, Schadt EE, Abul-Husn NS, Cho JH, Itan Y, Kenny EE, Loos RJF, Nadkarni GN, Do R, O’Reilly P, Huckins LM, Ferreira MAR, Abecasis GR, Leader JB, Cantor MN, Justice AE, Carey DJ, Chittoor G, Josyula NS, Kosmicki JA, Horowitz JE, Baras A, Gass MC, Yadav A, Mirshahi T, Hottenga JJ, Bartels M, de geus EEJC, Nivard MMG, Verma A, Ritchie MD, Rader D, Li B, Verma SS, Lucas A, Bradford Y, Abedalthagafi M, Alaamery M, Alshareef A, Sawaji M, Massadeh S, AlMalik A, Alqahtani S, Baraka D, Harthi FA, Alsolm E, Safieh LA, Alowayn AM, Alqubaishi F, Mutairi AA, Mangul S, Almutairi M, Aljawini N, Albesher N, Arabi YM, Mahmoud ES, Khattab AK, Halawani RT, Alahmadey ZZ, Albakri JK, Felemban WA, Suliman BA, Hasanato R, Al-Awdah L, Alghamdi J, AlZahrani D, AlJohani S, Al-Afghani H, AlDhawi N, AlBardis H, Alkwai S, Alswailm M, Almalki F, Albeladi M, Almohammed I, Barhoush E, Albader A, Alotaibi S, Alghamdi B, Jung J, fawzy MS, Alrashed M, Zeberg H, Nkambul L, Frithiof R, Hultström M, Lipcsey M, Tardif N, Rooyackers O, Grip J, Maricic T, Helgeland Ø, Magnus P, Trogstad LIS, Lee Y, Harris JR, Mangino M, Spector TD, Emma D, Moutsianas L, Caulfield MJ, Scott RH, Kousathanas A, Pasko D, Walker S, Stuckey A, Odhams CA, Rhodes D, Fowler T, Rendon A, Chan G, Arumugam P, Karczewski KJ, Martin AR, Wilson DJ, Spencer CCA, Crook DW, Wyllie DH, O’Connell AM, Atkinson EG, Kanai M, Tsuo K, Baya N, Turley P, Gupta R, Walters RK, Palmer DS, Sarma G, Solomonson M, Cheng N, Lu W, Churchhouse C, Goldstein JI, King D, Zhou W, Seed C, Daly MJ, Neale BM, Finucane H, Bryant S, Satterstrom FK, Band G, Earle SG, Lin SK, Arning N, Koelling N, Armstrong J, Rudkin JK, Callier S, Bryant S, Cusick C, Soranzo N, Zhao JH, Danesh J, Angelantonio ED, Butterworth AS, Sun YV, Huffman JE, Cho K, O’Donnell CJ, Tsao P, Gaziano JM, Peloso G, Ho YL, Smieszek SP, Polymeropoulos C, Polymeropoulos V, Polymeropoulos MH, Przychodzen BP, Fernandez-Cadenas I, Planas AM, Perez-Tur J, Llucià-Carol L, Cullell N, Muiño E, Cárcel-Márquez J, DeDiego ML, Iglesias LL, Soriano A, Rico V, Agüero D, Bedini JL, Lozano F, Domingo C, Robles V, Ruiz-Jaén F, Márquez L, Gomez J, Coto E, Albaiceta GM, García-Clemente M, Dalmau D, Arranz MJ, Dietl B, Serra-Llovich A, Soler P, Colobrán R, Martín-Nalda A, Martínez AP, Bernardo D, Rojo S, Fiz-López A, Arribas E, de la Cal-Sabater P, Segura T, González-Villa E, Serrano-Heras G, Martí-Fàbregas J, Jiménez-Xarrié E, de Felipe Mimbrera A, Masjuan J, García-Madrona S, Domínguez-Mayoral A, Villalonga JM, Menéndez-Valladares P, Chasman DI, Sesso HD, Manson JE, Buring JE, Ridker PM, Franco G, Davis L, Lee S, Priest J, Sankaran VG, van Heel D, Biesecker L, Kerchberger VE, Baillie JK. A first update on mapping the human genetic architecture of COVID-19. Nature 2022; 608:E1-E10. [PMID: 35922517 PMCID: PMC9352569 DOI: 10.1038/s41586-022-04826-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/29/2022] [Indexed: 01/04/2023]
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Aiello TF, Puerta-Alcalde P, Chumbita M, Monzó P, Lopera C, Hurtado JC, Meira F, Mosquera M, Santos M, Fernandez-Pittol M, Mensa J, Martínez JA, Soriano A, Marcos MA, Garcia-Vidal C. Infection with the Omicron variant of SARS-CoV-2 is associated with less severe disease in hospitalized patients with COVID-19. J Infect 2022; 85:e152-e154. [PMID: 35940349 PMCID: PMC9355741 DOI: 10.1016/j.jinf.2022.07.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Tommaso Francesco Aiello
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, C/ Villarroel 170, Barcelona 08036, Spain.
| | - Pedro Puerta-Alcalde
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, C/ Villarroel 170, Barcelona 08036, Spain
| | - Mariana Chumbita
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, C/ Villarroel 170, Barcelona 08036, Spain
| | - Patricia Monzó
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, C/ Villarroel 170, Barcelona 08036, Spain
| | - Carlos Lopera
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, C/ Villarroel 170, Barcelona 08036, Spain
| | - Juan Carlos Hurtado
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Fernanda Meira
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, C/ Villarroel 170, Barcelona 08036, Spain
| | - Mar Mosquera
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Marta Santos
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | | | - Josep Mensa
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, C/ Villarroel 170, Barcelona 08036, Spain
| | - José Antonio Martínez
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, C/ Villarroel 170, Barcelona 08036, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, C/ Villarroel 170, Barcelona 08036, Spain
| | - Ma Angeles Marcos
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, C/ Villarroel 170, Barcelona 08036, Spain.
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Ferrer R, Soriano A, Cantón R, Del Pozo JL, García-Vidal C, Garnacho-Montero J, Larrosa N, Rascado P, Salavert M, Pintado V, Giró-Perafita N, Badia X. A systematic literature review and expert consensus on risk factors associated to infection progression in adult patients with respiratory tract or rectal colonisation by carbapenem-resistant Gram-negative bacteria. Rev Esp Quimioter 2022; 35:455-467. [PMID: 35859521 DOI: 10.37201/req/062.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Risk factors (RFs) associated with infection progression in patients already colonised by carbapenem-resistant Gram-negative bacteria (CRGNB) have been addressed in few and disperse works. The aim of this study is to identify the relevant RFs associated to infection progression in patients with respiratory tract or rectal colonisation. METHODS A systematic literature review was developed to identify RFs associated with infection progression in patients with CRGNB respiratory tract or rectal colonisation. Identified RFs were then evaluated and discussed by the expert panel to identify those that are relevant according to the evidence and expert's experience. RESULTS A total of 8 articles were included for the CRGNB respiratory tract colonisation and 21 for CRGNB rectal colonisation, identifying 19 RFs associated with pneumonia development and 44 RFs associated with infection progression, respectively. After discussion, the experts agreed on 13 RFs to be associated with pneumonia development after respiratory tract CRGNB colonisation and 33 RFs to be associated with infection progression after rectal CRGNB colonisation. Respiratory tract and rectal colonisation, previous stay in the ICU and longer stay in the ICU were classified as relevant RF independently of the pathogen and site of colonisation. Previous exposure to antibiotic therapy or previous carbapenem use were also common relevant RF for patients with CRGNB respiratory tract and rectal colonisation. CONCLUSIONS The results of this study may contribute to the early identification of CRGNB colonized patients at higher risk of infection development, favouring time-to-effective therapy and improving health outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - X Badia
- Xavier Badia, Omakase Consulting S.L., Barcelona, Spain.
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58
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Aira A, Rubio E, Ruiz A, Vergara A, Casals-Pascual C, Rico V, Suñé-Negre JM, Soriano A. New Procedure to Maintain Fecal Microbiota in a Dry Matrix Ready to Encapsulate. Front Cell Infect Microbiol 2022; 12:899257. [PMID: 35755849 PMCID: PMC9226551 DOI: 10.3389/fcimb.2022.899257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Fecal microbiota transplantation (FMT) is one of the recommended treatments for recurrent Clostridioides difficile infection, but endoscopy and available oral formulations still have several limitations in their preparation, storage, and administration. The need for a viable oral formulation that facilitates the implementation of this highly effective therapy in different settings has led us to test the microcrystalline cellulose particles as an adsorbent of concentrated filtered fresh feces in comparison to lyophilized feces. This free-flowing material can provide protection to bacteria and results in a dried product able to maintain the viability of the microbiota for a long time. Adsorbate formulation showed a stabilizing effect in gut microbiota, maintaining bacteria viability and preserving its diversity, and is a competitive option for lyophilized capsules.
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Affiliation(s)
- Andrea Aira
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Elisa Rubio
- Department of Clinical Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Andrea Vergara
- Department of Clinical Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Climent Casals-Pascual
- University of Barcelona, Barcelona, Spain.,Department of Clinical Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain.,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Verónica Rico
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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59
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Huguet S, Bernaus M, Gómez L, Cuchí E, Soriano A, Font-Vizcarra L. Role of joint aspiration before re-implantation in patients with a cement spacer in place. World J Orthop 2022; 13:615-621. [PMID: 35949711 PMCID: PMC9244963 DOI: 10.5312/wjo.v13.i6.615] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/04/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The usefulness of a mandatory joint aspiration before re-implantation in patients with a cement spacer already in place is unclear.
AIM To evaluate the role of culturing synovial fluid obtained by joint aspiration before re-implantation in patients who underwent a two-stage septic revision.
METHODS A retrospective observational study was conducted, including patients that underwent a two-stage septic revision (hip or knee) from 2010 to 2017. After the first stage revision and according to intraoperative culture results, all patients were treated with an antibiotic protocol for 6-8 wk. Following 2 wk without antibiotics, a culture of synovial fluid was obtained. The results of these cultures were recorded and compared with cultures obtained during re-implantation surgery.
RESULTS Forty-one patients (20 hip and 21 knee spacers) were included in the final analysis. In 39 cases, the culture of synovial fluid was negative, while in the remaining 2 cases (knee spacers) no analysis was possible due to dry tap. In 5 of the patients, two or more intraoperative cultures taken during the re-implantation surgery were positive.
CONCLUSION We found no evidence to support mandatory joint aspiration before re-implantation in patients with a cement spacer in place.
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Affiliation(s)
- Sandra Huguet
- Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Terrassa 08221, Spain
- Department of Traumatology and Orthopaedics, Consorci Sanitari de l’Alt Penedès - Garraf, Vilafranca del Penedès 08720, Spain
| | - Martí Bernaus
- Department of Traumatology and Orthopaedics, Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Terrassa 08221, Spain
| | - Lucía Gómez
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Terrassa 08221, Spain
| | - Eva Cuchí
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Terrassa 08221, Spain
- Department of Microbiology, CATLAB, Viladecavalls 08232, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Osteoarticular Infections Unit, Hospital Clínic, Barcelona 08036, Spain
| | - Lluís Font-Vizcarra
- Department of Traumatology and Orthopaedics, Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Terrassa 08221, Spain
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Beldman M, Löwik C, Soriano A, Albiach L, Zijlstra WP, Knobben BAS, Jutte P, Sousa R, Carvalho A, Goswami K, Parvizi J, Belden KA, Wouthuyzen-Bakker M. Correction to: If, When, and How to Use Rifampin in Acute Staphylococcal Periprosthetic Joint Infections, a Multicentre Observational Study. Clin Infect Dis 2022; 74:1890. [PMID: 35445710 PMCID: PMC9155623 DOI: 10.1093/cid/ciac149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mark Beldman
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Claudia Löwik
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Alex Soriano
- Department of Infectious Diseases, University of Barcelona, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Laila Albiach
- Department of Infectious Diseases, University of Barcelona, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Wierd P Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Bas A S Knobben
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - Paul Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ricardo Sousa
- Department of Orthopaedic Surgery, Centro Hospitalar do Porto, Porto, Portugal
| | - André Carvalho
- Department of Orthopaedic Surgery, Centro Hospitalar do Porto, Porto, Portugal
| | - Karan Goswami
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Katherine A Belden
- Department of Infectious Diseases, Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Moreno-García E, Puerta-Alcalde P, Gariup G, Fernández-Ruiz M, López Cortés LE, Cuervo G, Salavert M, Merino P, Machado M, Guinea J, García-Rodríguez J, Garnacho-Montero J, Cardozo C, Peman J, Montejo M, Fortún J, Almirante B, Castro C, Rodríguez-Baño J, Aguado JM, Martínez JA, Carratalà J, Soriano A, Garcia-Vidal C. Correction to: Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies. Open Forum Infect Dis 2022; 9:ofac180. [PMID: 35615301 PMCID: PMC9126489 DOI: 10.1093/ofid/ofac180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - G Gariup
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - M Fernández-Ruiz
- Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas+12), Universidad Complutense, Madrid, Spain
| | - L E López Cortés
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, CSIC, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - G Cuervo
- Hospital Universitari de Bellvitge, IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain
| | - M Salavert
- Hospital Universitari i Politecnic "La Fe", Valencia, Spain
| | - P Merino
- Hospital Universitario Clínico "San Carlos", Madrid, Spain
| | - M Machado
- Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - J Guinea
- Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | - J Garnacho-Montero
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario "Virgen Macarena", Sevilla, Spain
| | - C Cardozo
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - J Peman
- Hospital Universitari i Politecnic "La Fe", Valencia, Spain
| | - M Montejo
- Hospital Universitario "Cruces", Bilbao, Spain
| | - J Fortún
- Hospital Universitario "Ramón y Cajal", Madrid, Spain
| | - B Almirante
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Castro
- Hospital Universitario de Valme, Sevilla, Spain
| | - J Rodríguez-Baño
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, CSIC, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - J M Aguado
- Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas+12), Universidad Complutense, Madrid, Spain
| | - J A Martínez
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - J Carratalà
- Hospital Universitari de Bellvitge, IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain
| | - A Soriano
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - C Garcia-Vidal
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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Rico-Caballero V, Fernández M, Hurtado JC, Marcos MA, Cardozo C, Albiach L, Agüero D, Ambrosioni J, Bodro M, Chumbita M, De la Mora L, Garcia-Pouton N, Gonzalez-Cordón A, Dueñas G, Hernandez-Meneses M, Inciarte A, Laguno M, Leal L, Macaya I, Martínez MJ, Cuesta G, Meira F, Morata L, Puerta-Alcalde P, Rojas J, Torres B, Castro P, Muñoz J, Mensa J, Martínez JA, Sanjuan G, Vila J, García F, Garcia-Vidal C, Soriano A. Impact of SARS-CoV-2 viral load and duration of symptoms before hospital admission on the mortality of hospitalized COVID-19 patients. Infection 2022; 50:1321-1328. [PMID: 35562568 PMCID: PMC9105593 DOI: 10.1007/s15010-022-01833-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
Abstract
Purpose Assess the impact of viral load estimated by cycle threshold (Ct) of reverse transcription real time-polymerase chain reaction (rRT-PCR) and the days from symptoms onset on mortality in hospitalized patients with COVID19. Methods Retrospective observational study of 782 patients with a positive rRT-PCR from a nasopharyngeal swab was performed within the first 24 h from admission. Demographic data, clinical manifestations and laboratory parameters were collected. Uni- and multivariate analyses were performed to identify factors associated with mortality at 60 days. Results Ct was divided into three groups and the mortality rate decreased from 27.3 to 20.7% and 9.8% for Ct values of ≤ 20, 21–25 and > 25, respectively (P = 0.0001). The multivariate analysis identified as predictors of mortality, a Ct value < 20 (OR 3.13, CI 95% 1.38–7.10), between 21–25 (OR 2.47, CI 95% 1.32–4.64) with respect to a Ct value > 25. Days from symptoms onset is a variable associated with mortality as well (DSOA) ≤ 6 (OR 1.86, CI 95% 1.00–3.46), among other factors. Patients requiring hospital admission within 6 DSOA with a Ct value ≤ 25 had the highest mortality rate (28%). Conclusions The inclusion of Ct values and DSOA in the characterization of study populations could be a useful tool to evaluate the efficacy of antivirals.
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Affiliation(s)
- Verónica Rico-Caballero
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Mariana Fernández
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain.,Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | - Juan C Hurtado
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain.,Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | - M Angeles Marcos
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain.,Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | - Celia Cardozo
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Laia Albiach
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Daiana Agüero
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Juan Ambrosioni
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Mariana Chumbita
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Lorena De la Mora
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Nicole Garcia-Pouton
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Ana Gonzalez-Cordón
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Gerard Dueñas
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Marta Hernandez-Meneses
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Alexy Inciarte
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Montse Laguno
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Lorna Leal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Irene Macaya
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Miguel J Martínez
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain.,Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | - Genoveva Cuesta
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain.,Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | - Fernanda Meira
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - John Rojas
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Berta Torres
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jose Muñoz
- Centre for Research in International Health (CRESIB), Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Josep Mensa
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - José Antonio Martínez
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Gemma Sanjuan
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain.,Computer System Unit, Hospital Clinic, Barcelona, Spain
| | - Jordi Vila
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain.,Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | - Felipe García
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain.
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Camprubí D, Almuedo-Riera A, Martí-Soler H, Soriano A, Hurtado JC, Subirà C, Grau-Pujol B, Krolewiecki A, Muñoz J. Correction: Lack of efficacy of standard doses of ivermectin in severe COVID-19 patients. PLoS One 2022; 17:e0268667. [PMID: 35551297 PMCID: PMC9098077 DOI: 10.1371/journal.pone.0268667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Del Risco Zevallos J, Molina-Andujar A, Piñeiro G, Fernando Quintana Porras L, Blasco M, Morata L, Soriano A, Poch E. MO783: Reduction of the Incidence of Dialysis Catheter-Associated Bacteraemia in Intensive Care Units after Systematic Application of Taurolock in the Sealing of the Catheter. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac080.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Dialysis catheter-associated bacteraemia in Intensive Care Units (ICUs) increases morbidity and mortality, prolongs hospital admission and increases admission costs. TauroLock™ is a lock solution containing (cyclo)-taurolidine (1.35%) and citrate (4%). (Cyclo)-taurolidine has broad antimicrobial activity against gram-positive and gram-negative bacteria and fungi. The objective of this study was to analyse the effect of systematic sealing of haemodialysis catheters in the ICUs of the Hospital Clínic de Barcelona on the incidence of bacteraemia associated with haemodialysis catheters (BACH).
METHOD
BACH episodes of patients who underwent intermittent haemodialysis (IHD) during ICU admission were reviewed. The period analysed as pre-Taurolock™ was from 2010 to 2014 and post-TauroLock™ from 2015 to 2018. Patients who only received renal replacement therapy with continuous techniques were excluded.
RESULTS
A total of 279 patients received IHD in the pre-TauroLock™ period and 331 in the post-TauroLock™ period. The number of BACH in the pre-TauroLock™ period was 18 (6.45%) and 9 (2.72%) in the post-TauroLock™ period. All infections were from percutaneous catheters (acute patients) except three catheters that were tunnelled. In the pre-TauroLock™ period, femoral catheters predominated (61.1%) while in the post-TauroLock they were jugular (66.7%). There was no association between the location of the catheter and the incidence of BACH. Of the 27 patients with BACH, 14 (51.8%) were men with a mean age of 63 years, with no significant differences between the two groups. The most frequent reasons for admission to the ICU in the pre-TauroLock™ period were post-cardiac surgery, cardiogenic, septic or hypovolemic shock and acute myocardial infarction (3 patients per group) and in the post-TauroLock™ period, septic shock and pancreatitis (3 and 2 patients respectively). The most frequent isolated bacteria were Gram-positive (in total 48.38%: pre-TauroLock™ 47.61% and post-TauroLock™ 50%), with a global predominance of staphylococcus epidermidis (32.25%) (Table). There were no significant differences in the median days from the start of haemodialysis to bacteraemia (23.5 pre-TauroLock™ versus 21 post-TauroLock™). There were also no significant differences between the days of ICU stay in the BACH in both groups or in mortality, being the overall mortality of 70.4%.
CONCLUSION
In our cohort, the systematic application of TauroLock™ in the sealing of dialysis catheters in critically ill patients reduces the incidence of BACH in ICUs.
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Affiliation(s)
| | - Alicia Molina-Andujar
- Hospital Clínic de Barcelona, Nephrology and Kidney Transplantation Department, Barcelona, Spain
| | - Gaston Piñeiro
- Hospital Clínic de Barcelona, Nephrology and Kidney Transplantation Department, Barcelona, Spain
| | | | - Miquel Blasco
- Hospital Clínic de Barcelona, Nephrology and Kidney Transplantation Department, Barcelona, Spain
| | - Laura Morata
- Hospital Clínic de Barcelona, Infectious Diseases Department, Barcelona, Spain
| | - Alex Soriano
- Hospital Clínic de Barcelona, Infectious Diseases Department, Barcelona, Spain
| | - Esteban Poch
- Hospital Clínic de Barcelona, Nephrology and Kidney Transplantation Department, Barcelona, Spain
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Ezure Y, Rico V, Paterson DL, Hall L, Harris PNA, Soriano A, Roberts JA, Bassetti M, Roberts MJ, Righi E, Wright H. Efficacy and Safety of Carbapenems vs New Antibiotics for Treatment of Adult Patients With Complicated Urinary Tract Infections: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2022; 9:ofaa480. [PMID: 35474756 PMCID: PMC9031024 DOI: 10.1093/ofid/ofaa480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022] Open
Abstract
This systematic review and meta-analysis evaluated the clinical efficacy and safety of carbapenems for the treatment of complicated urinary tract infections (cUTIs), with the comparators being new antibiotics evaluated for this indication. We searched 13 electronic databases for published randomized controlled trials (RCTs) and completed and/or ongoing trials. The search terms were developed using the Population, Intervention, Comparison, Outcomes, and Study framework. Pooled efficacy estimates of composite cure (clinical success and microbiological eradication) favored the new antibiotic groups, although this was not statistically significant (risk ratio [RR], 0.91; 95% CI, 0.79–1.04). A pooled estimate examining clinical response alone showed no difference between treatment arms (RR, 1.00; 95% CI, 0.96–1.05), however, new antibiotic treatments were superior to carbapenems for microbiological response (RR, 0.85; 95% CI, 0.79–0.91). New antibiotic treatments demonstrated a superior microbiological response compared with carbapenems in clinical trials of cUTI, despite an absence of carbapenem resistance. However, it is noteworthy that the clinical response and safety profile of new antibiotics were not different from those of carbapenems.
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Affiliation(s)
- Yukiko Ezure
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Veronica Rico
- Department of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - David L Paterson
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
- Infectious Diseases Unit, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Lisa Hall
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Patrick N A Harris
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
- Central Microbiology Laboratory, Pathology Queensland, Brisbane, Australia
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jason A Roberts
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
- Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia
- Division of Anaesthesiology, Critical Care Emergency, and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Matteo Bassetti
- Infectious Diseases Clinic, Hospital Policlinico San Martino—IRCCS, Genoa, Italy
| | - Matthew J Roberts
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
- Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Elda Righi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Hugh Wright
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
- Infectious Diseases Unit, Royal Brisbane and Women’s Hospital, Brisbane, Australia
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Sanz C, Nomdedeu M, Pereira A, Sauleda S, Alonso R, Bes M, Brillembourg H, García‐Vidal C, Millan A, Martínez‐Llonch N, Pirón M, Puerta‐Alcalde P, Puig L, Rico V, Soriano A. Efficacy of early transfusion of convalescent plasma with high-titer SARS-CoV-2 neutralizing antibodies in hospitalized patients with COVID-19. Transfusion 2022; 62:974-981. [PMID: 35338710 PMCID: PMC9115410 DOI: 10.1111/trf.16863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite most controlled trials have shown no measurable benefit of COVID-19 convalescent plasma (CCP) in patients with COVID-19, some studies suggest that early administration of CCP with high-titer anti-SARS-CoV-2 can be beneficial in selected patients. We investigated the efficacy of early administration of high-titer CCP to patients with COVID-19 who required hospitalization, STUDY DESIGN AND METHODS: Observational, propensity score (PS) matched case-control study of COVID-19 patients treated with CCP within 72 h of hospital admission and untreated controls from August 2020 to February 2021. All CCP donations had a Euroimmun anti-SARS-CoV-2 sample-to-cutoff ratio ≥3. PS matching was based on prognostic factors and presented features with high-standardized differences between the treated and control groups. The primary endpoint was mortality within 30 days of diagnosis. RESULTS A total of 1604 patients were analyzed, 261 of whom received CCP, most (82%) within 24 h after admission. Median age was 67 years (interquartile range: 56-79), and 953 (60%) were men. Presenting factors independently associated with higher 30-day mortality were increased age, cardiac disease, hypoxemic respiratory failure, renal failure, and plasma d-dimer >700 ng/ml. After PS matching, transfusion of CCP was associated with a significant reduction in the 30-day mortality rate (odds ratio [OR]; 0.94, 95% confidence interval [CI]: 0.91-0.98; p = .001) that extended to the 60th day after COVID-19 diagnosis (OR: 0.95; 95% CI: 0.92-0.99; p = .01). CONCLUSION Our results suggest that CCP can still be helpful in selected patients with COVID-19 and call for further studies before withdrawing CCP from the COVID-19 therapeutic armamentarium.
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Affiliation(s)
- Cristina Sanz
- Blood Bank and Transfusion ServiceHospital Clínic de BarcelonaBarcelonaSpain
| | - Meritxell Nomdedeu
- Hemathology and Hemotherapy ServiceHospital Clínic de BarcelonaBarcelonaSpain
| | - Arturo Pereira
- Blood Bank and Transfusion ServiceHospital Clínic de BarcelonaBarcelonaSpain
| | | | - Rodrigo Alonso
- Infectious Diseases DepartmentHospital Clínic‐IDIBAPS, University of BarcelonaBarcelonaSpain
| | - Marta Bes
- Banc de Sang i TeixitsBarcelonaSpain
| | - Helena Brillembourg
- Blood Bank and Transfusion ServiceHospital Clínic de BarcelonaBarcelonaSpain
| | - Carolina García‐Vidal
- Infectious Diseases DepartmentHospital Clínic‐IDIBAPS, University of BarcelonaBarcelonaSpain
| | | | | | | | - Pedro Puerta‐Alcalde
- Infectious Diseases DepartmentHospital Clínic‐IDIBAPS, University of BarcelonaBarcelonaSpain
| | | | - Veronica Rico
- Infectious Diseases DepartmentHospital Clínic‐IDIBAPS, University of BarcelonaBarcelonaSpain
| | - Alex Soriano
- Infectious Diseases DepartmentHospital Clínic‐IDIBAPS, University of BarcelonaBarcelonaSpain
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67
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Garcia-Vidal C, Puerta-Alcalde P, Mateu A, Cuesta-Chasco G, Meira F, Lopera C, Monzo P, Santos-Bravo M, Duenas G, Chumbita M, Garcia-Pouton N, Gaya A, Bodro M, Herrera S, Mosquera M, Fernandez-Aviles F, Martinez JA, Mensa J, Gine E, Marcos MA, Soriano A. Prolonged viral replication in patients with hematologic malignancies hospitalized with COVID-19. Haematologica 2022; 107:1731-1735. [PMID: 35295080 PMCID: PMC9244835 DOI: 10.3324/haematol.2021.280407] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona.
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona
| | - Aina Mateu
- Department of Internal Medicine, Hospital Universitari Mutua Terrassa, Terrassa
| | | | - Fernanda Meira
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona
| | - Carlos Lopera
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona
| | - Patricia Monzo
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona
| | | | - Gerard Duenas
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona
| | - Mariana Chumbita
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona
| | - Nicole Garcia-Pouton
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona
| | - Anna Gaya
- Department of Hematology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona
| | - Sabina Herrera
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona
| | - Mar Mosquera
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona
| | | | - Jose Antonio Martinez
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona
| | - Josep Mensa
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona
| | - Eva Gine
- Department of Hematology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona
| | | | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona
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68
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Moreno-García E, Puerta-Alcalde P, Letona L, Meira F, Dueñas G, Chumbita M, Garcia-Pouton N, Monzó P, Lopera C, Serra L, Cardozo C, Hernandez-Meneses M, Rico V, Bodro M, Morata L, Fernandez-Pittol M, Grafia I, Castro P, Mensa J, Martínez JA, Sanjuan G, Marcos MA, Soriano A, Garcia-Vidal C. Bacterial co-infection at hospital admission in patients with COVID-19. Int J Infect Dis 2022; 118:197-202. [PMID: 35257905 PMCID: PMC8896874 DOI: 10.1016/j.ijid.2022.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/31/2022] [Accepted: 03/01/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives We described the current incidence and risk factors of bacterial co-infection in hospitalized patients with COVID-19. Methods Observational cohort study was performed at the Hospital Clinic of Barcelona (February 2020–February 2021). All patients with COVID-19 who were admitted for >48 hours with microbiological sample collection and procalcitonin (PCT) determination within the first 48 hours were included. Results A total of 1125 consecutive adults met inclusion criteria. Co-infections were microbiologically documented in 102 (9.1%) patients. Most frequent microorganisms were Streptococcus pneumoniae (79%), Staphylococcus aureus (6.8%), and Haemophilus influenzae (6.8%). Test positivity was 1% (8/803) for blood cultures, 10.1% (79/780) for pneumococcal urinary antigen test, and 11.4% (15/132) for sputum culture. Patients with PCT higher than 0.2, 0.5, 1, and 2 ng/mL had significantly more co-infections than those with lower levels (p=0.017, p=0.031, p<0.001, and p<0.001, respectively). In multivariate analysis, oxygen saturation ≤94% (OR 2.47, CI 1.57–3.86), ferritin levels <338 ng/mL (OR 2.63, CI 1.69–4.07), and PCT higher than 0.2 ng/mL (OR 1.74, CI 1.11–2.72) were independent risk factors for co-infection at hospital admission owing to COVID-19. Conclusions Bacterial co-infection in patients hospitalized for COVID-19 is relatively common. However, clinicians could spare antibiotics in patients with PCT values <0.2, especially with high ferritin values and oxygen saturation >94%.
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Affiliation(s)
- Estela Moreno-García
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
| | - Laura Letona
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Fernanda Meira
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Gerard Dueñas
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Mariana Chumbita
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Nicole Garcia-Pouton
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Patricia Monzó
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Carlos Lopera
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Laia Serra
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Celia Cardozo
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Marta Hernandez-Meneses
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Verónica Rico
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Laura Morata
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | | | - Ignacio Grafia
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Josep Mensa
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - José Antonio Martínez
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Gemma Sanjuan
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Mª Angeles Marcos
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain.; Medical Intensive Care Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain..
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69
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Garcia-Vidal C, Iglesias-Caballero M, Puerta-Alcalde P, Mas V, Cuesta-Chasco G, Garcia-Pouton N, Varona S, Pozo F, Vázquez-Morón S, Marcos MA, Soriano A, Casas I. Emergence of Progressive Mutations in SARS-CoV-2 From a Hematologic Patient With Prolonged Viral Replication. Front Microbiol 2022; 13:826883. [PMID: 35308337 PMCID: PMC8927661 DOI: 10.3389/fmicb.2022.826883] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/24/2022] [Indexed: 12/19/2022] Open
Abstract
We documented a hematologic patient with prolonged SARS-CoV-2 viral replication in whom emergence of viral mutations was documented after the consecutive use of antivirals and convalescent plasma. The virus detected in the last of 12 clinical samples (day 237) had accumulated 22 changes in amino acids and 29 in nucleotides. Some of these changes, such as the E484Q, were mutations of concern as defined by WHO. This finding represents an enormous epidemiological threat and poses a major clinical challenge. Combined antiviral strategies, as well as specific strategies related to the diagnostic approach of prolonged infections for this specific population, may be needed.
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Affiliation(s)
- Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - María Iglesias-Caballero
- Respiratory Virus and Influenza Unit, National Center of Microbiology, National Influenza Center, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
- *Correspondence: Pedro Puerta-Alcalde,
| | - Vicente Mas
- Respiratory Virus and Influenza Unit, National Center of Microbiology, National Influenza Center, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Genoveva Cuesta-Chasco
- Department of Microbiology, ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Nicole Garcia-Pouton
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Sarai Varona
- Bioinformatics Unit, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Francisco Pozo
- Respiratory Virus and Influenza Unit, National Center of Microbiology, National Influenza Center, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sonia Vázquez-Morón
- Respiratory Virus and Influenza Unit, National Center of Microbiology, National Influenza Center, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Maria Angeles Marcos
- Department of Microbiology, ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Inmaculada Casas
- Respiratory Virus and Influenza Unit, National Center of Microbiology, National Influenza Center, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Torres A, Soriano A, Rivolo S, Remak E, Peral C, Kantecki M, Ansari W, Charbonneau C, Hammond J, Grau S, Wilcox M. Ceftaroline Fosamil for the Empiric Treatment of Hospitalized Adults with cSSTI: An Economic Analysis from the Perspective of the Spanish National Health System. CEOR 2022; 14:149-161. [PMID: 35330907 PMCID: PMC8939869 DOI: 10.2147/ceor.s329494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/03/2022] [Indexed: 12/21/2022] Open
Abstract
Purpose Complicated skin and soft tissue infections (cSSTI) are associated with high healthcare resource use and costs. The emergency nature of cSSTI hospitalizations requires starting immediate empiric intravenous (IV) antibiotic treatment, making the appropriate choice of initial antibiotic therapy crucial. Patients and Methods The use of ceftaroline fosamil (CFT) as an alternative to other IV antibiotic therapies for the empiric treatment of hospitalized adults with cSSTI (vancomycin, linezolid, daptomycin, cloxacillin, tedizolid) was evaluated through cost consequences analysis. The model structure was a decision tree accounting for four different pathways: patients demonstrating early response (ER) either discharged early (with oral antibiotic) or remaining in hospital to continue the initial therapy; non-responders either remaining on the initial IV therapy or switching to a second-line antibiotic. The model perspective was the Spanish National Health System. Results CFT resulted in average percentage of patients discharged early (PDE) of 24.6% (CI 19.49–30.2%) with average total cost per patient of €6763 (€6268–€7219). Vancomycin, linezolid, daptomycin and tedizolid resulted in average PDE of 22% (17.34–27.09%), 26.4% (20.5–32.32%), 28.6% (22.08–35.79%) and 26.5% (20.39–33.25%), respectively, for a total cost per patient of €6,619 (€5,902–€6,929), €6,394 (€5,881–€6,904), €6,855 (€5,800–€7,410) and €7,173 (€6,608–€7,763), respectively. Key model drivers were ER and antibiotic treatment duration, with hospital costs accounting for over 83% of the total expenditures. Conclusion Given its clinical and safety profile, CFT is an acceptable choice for cSSTI empiric therapy providing comparable ER and costs to other relevant antibiotic options.
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Affiliation(s)
- Antoni Torres
- Servei de Pneumologia Hospital Clinic, University of Barcelona, IDIPAPS, CIBERES, ICREA, Barcelona, Spain
| | - Alex Soriano
- Hospital Clínic of Barcelona,University of Barcelona, IDIBAPS, Barcelona, Spain
| | | | - Edit Remak
- Formerly Modeling and Simulation, Evidera, Budapest, Hungary
| | - Carmen Peral
- Health Economics and Outcomes Research, Pfizer, Madrid, Spain
| | | | - Wajeeha Ansari
- Patient & Health Impact, Pfizer, New York, NY, USA
- Correspondence: Wajeeha Ansari, Tel +1 212 733 5001, Email
| | | | | | - Santiago Grau
- Hospital del Mar,Universitat Pompeu Fabra, Barcelona, Spain
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Cilloniz C, Mendez R, Peroni H, Garcia-Vidal C, Rico V, Gabarrus A, Menéndez R, Torres A, Soriano A. Impact on in-hospital mortality of ceftaroline versus standard of care in community-acquired pneumonia: a propensity-matched analysis. Eur J Clin Microbiol Infect Dis 2022; 41:271-279. [PMID: 34767120 PMCID: PMC8588767 DOI: 10.1007/s10096-021-04378-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to evaluate the in-hospital mortality of community-acquired pneumonia (CAP) treated with ceftaroline in comparison with standard therapy. This was a retrospective observational study in two centers. Hospitalized patients with CAP were grouped according to the empiric regimen (ceftaroline versus standard therapy) and analyzed using a propensity score matching (PSM) method to reduce confounding factors. Out of the 6981 patients enrolled, 5640 met the inclusion criteria, and 89 of these received ceftaroline. After PSM, 78 patients were considered in the ceftaroline group (cases) and 78 in the standard group (controls). Ceftaroline was mainly prescribed in cases with severe pneumonia (67% vs. 56%, p = 0.215) with high suspicion of Staphylococcus aureus infection (9% vs. 0%, p = 0.026). Cases had a longer length of hospital stay (13 days vs. 10 days, p = 0.007), while an increased risk of in-hospital mortality was observed in the control group compared to the case group (13% vs. 21%, HR 0.41; 95% CI 0.18 to 0.62, p = 0.003). The empiric use of ceftaroline in hospitalized patients with severe CAP was associated with a decreased risk of in-hospital mortality.
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Affiliation(s)
- Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain.
| | - Raúl Mendez
- Department of Pneumology, Hospital La Fe de Valencia, Valencia, Spain
| | - Héctor Peroni
- Internal Medicine Department, Respiratory Medicine Unit and Emergency Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Verónica Rico
- Department of Infectious Diseases, Hospital Clinic of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Albert Gabarrus
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Rosario Menéndez
- Department of Pneumology, Hospital La Fe de Valencia, Valencia, Spain
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain.
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Aiello TF, García-Vidal C, Soriano A. Antiviral drugs against SARS-CoV-2. Rev Esp Quimioter 2022; 35 Suppl 3:10-15. [PMID: 36285850 PMCID: PMC9717461 DOI: 10.37201/req/s03.03.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The use of antiviral drugs represents an important progress in the therapeutic management of COVID-19, leading to a substantial reduction of SARS-CoV-2-related complications and mortality. In immunocompetent host, peak viral replication occurs around the symptom's onset, and it prolongs for 5 to 7 days that is the window of opportunity for giving an antiviral. Accordingly, early and rapid diagnostic of the infection in the outpatient clinic is essential as well as the availability of oral agents that can be easily prescribe. Remdesivir has demonstrated its efficacy in hospitalized patients requiring oxygen support and in mild/moderate cases to avoid the hospitalization, however, the intravenous administration limits its use among outpatients. Molnupiravir and nirmatrelvir/ritonavir are potent oral antiviral agents. In the present review we discuss the potential targets against SARS-CoV-2, and an overview of the main characteristics and clinical results with the available antiviral agents for the treatment of SARS-CoV-2.
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Affiliation(s)
| | | | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic of Barcelona.,CIBERINF,Correspondence: Alex Soriano Department of Infectious Diseases, Hospital Clínic of Barcelona C/Villarroel 170, Barcelona 08036, Spain
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Soriano A, Mensa J. Mechanism of action of cefiderocol. Rev Esp Quimioter 2022; 35 Suppl 2:16-19. [PMID: 36193980 PMCID: PMC9632059 DOI: 10.37201/req/s02.02.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Gram-negative bacilli are intrinsically resistant to many antibiotics due to the low permeability of their outer membrane. The most effective strategy to solve this problem has been the design of antibiotics that cross the membrane using specific transport systems. This is the case of cefiderocol, which, unlike cefepime or ceftazidime, has a chlorocatechol group at the end of the C-3 side chain. This group is recognized by transporters located in the outer membrane that allow cefiderocol to accumulate in the periplasmic space. Furthermore, cefiderocol is not a substrate for efflux pumps and the configuration of the side chains at C-7 and in particular at C-3 confer it a high stability against hydrolysis by most beta-lactamases of clinical interest including class A (KPC, BLEEs), C (ampC) or D (OXA-48) serine beta-lactamases and metallo-betalactamases (NDM, VIM. IMP). In order to better understand the mechanism of action of cefiderocol, the importance of iron in bacterial metabolism and the competition for iron between bacteria and host are reviewed.The indiscriminate and massive antibiotic use in the clinical practice and in agriculture or cattle during the past few decades has produced a serious world health problem that entails high morbidity and mortality: the antibiotic multi-drug resistance. In 2017 and 2019, the World Health Organization published a list of urgent threats and priorities in the context of drug resistance, which only included Gram-negative bacteria and specially focused on carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, as well as carbapenem and third generation cephalosporin-resistant Enterobacteriaceae. This scenario emphasizes the need of developing and testing new antibiotics from different families, such as new beta-lactams, highlighting cefiderocol and its original mechanism of action; new beta-lactamase inhibitors, with vaborbactam or relebactam among others; new quinolones such as delafloxacin, and also omadacycline or eravacycline, as members of the tetracycline family. The present work reviews the importance and impact of Gram-negative bacterial infections and their resistance mechanisms, and analyzes the current therapeutic paradigm as well as the role of new antibiotics with a promising future in the era of multi and pan-drug resistance.
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Affiliation(s)
- Alex Soriano
- Correspondence: Alex Soriano Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Universidad de Barcelona E-mail:
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Ferry T, Lustig S, Laurent F, Soriano A. Editorial: Innovative Approaches in the Management of Bone and Joint Infection. Front Med (Lausanne) 2021; 8:789092. [PMID: 34869506 PMCID: PMC8639186 DOI: 10.3389/fmed.2021.789092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Tristan Ferry
- Infectious and Tropical Diseases Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Sébastien Lustig
- Université Claude Bernard Lyon 1, Lyon, France.,Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Orthopaedic and Sport Surgery Unit, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- Université Claude Bernard Lyon 1, Lyon, France.,Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France.,Institut des Agents Infectieux, Hôpital de la Croix Rousse, Lyon, France
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic, IDIBAPS, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
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Wouthuyzen-Bakker M, Sebillotte M, Arvieux C, Fernandez-Sampedro M, Senneville E, Barbero JM, Lora-Tamayo J, Aboltins C, Trebse R, Salles MJ, Kramer TS, Ferrari M, Garcia-Cañete J, Benito N, Diaz-Brito V, del Toro MD, Scarborough M, Soriano A. How to Handle Concomitant Asymptomatic Prosthetic Joints During an Episode of Hematogenous Periprosthetic Joint Infection, a Multicenter Analysis. Clin Infect Dis 2021; 73:e3820-e3824. [PMID: 32813012 PMCID: PMC9187975 DOI: 10.1093/cid/ciaa1222] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Prosthetic joints are at risk of becoming infected during an episode of bacteremia, especially during Staphylocococcus aureus bacteremia. However, it is unclear how often asymptomatic periprosthetic joint infection (PJI) occurs, and whether additional diagnostics should be considered. METHODS In this multicenter study, we retrospectively analyzed a cohort of patients with a late acute (hematogenous) PJI between 2005-2015 who had concomitant prosthetic joints in situ. Patients without at least 1 year of follow-up were excluded. RESULTS We included 91 patients with a hematogenous PJI and 108 concomitant prosthetic joints. The incident PJI was most frequently caused by Staphylococcus aureus (43%), followed by streptococci (26%) and Gram-negative rods (18%). Of 108 concomitant prosthetic joints, 13 were symptomatic, of which 10 were subsequently diagnosed as a second PJI. Of the 95 asymptomatic prosthetic joints, 1 PJI developed during the follow-up period and was classified as a "missed" PJI at the time of bacteremia with S. aureus (1.1%). Infected prosthetic joints were younger than the noninfected ones in 67% of cases, and prosthetic knees were affected more often than prosthetic hips (78%). CONCLUSIONS During an episode of hematogenous PJI, concomitant asymptomatic prosthetic joints have a very low risk of being infected, and additional diagnostic work-up for these joints is not necessary.
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Affiliation(s)
- Marjan Wouthuyzen-Bakker
- Correspondence: M. Wouthuyzen-Bakker, Infectious Disease Specialist, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands ()
| | - Marine Sebillotte
- Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France
| | - Cédric Arvieux
- Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France
- Great West Reference centers for Complex Bone and Joint Infections (CRIOGO), Rennes, France
| | - Marta Fernandez-Sampedro
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Instituto de investigación sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Eric Senneville
- Department of Infectious Diseases, Lille, University Hospital Gustave Dron Hospital, Tourcoing, France
| | - José Maria Barbero
- Department of Internal Medicine. Hospital Universitario Principe de Asturias, Madrid, Spain
| | - Jaime Lora-Tamayo
- Department of Internal Medicine. Hospital Universitario 12 de Octubre. Instituto de Investigación i+12. Madrid, Spain
| | - Craig Aboltins
- The Department of Infectious Diseases, Northern Health, Melbourne, Australia
- The University of Melbourne, Northern Clinical School, Melbourne, Australia
| | - Rihard Trebse
- Service for Bone Infections, Valdoltra Orthopaedic Hospital, the Faculty of Medicine, University of Ljublijana, Ankaran, Slovenia
| | - Mauro José Salles
- Santa Casa de São Paulo School of Medical Sciences and Musculoskeletal infection group, Federal University of São Paulo, Brasil
| | - Tobias Siegfried Kramer
- Institute for hygiene and environmental medicine Charité-Universitätsmedizin Berlin, Germany
- Evangelisches Waldkrankenhaus Spandau, BerlinGermany
| | - Matteo Ferrari
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Joaquín Garcia-Cañete
- Department of Internal Medicine-Emergency, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain
- Department of Medicine. Universitat Autònoma de Barcelona, Spain
| | - Vicens Diaz-Brito
- Infectious Diseases Unit, Parc Sanitari Sant Joan de Deu, Sant Boi, Barcelona, Spain
| | - Maria Dolores del Toro
- Unidad Clínica de Enfermedades Infecciosa y Microbiología. Universidad de Sevilla. Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| | - Matthew Scarborough
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, England
| | - Alex Soriano
- Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Raffi F, Arber N, Rokx C, Assoumou L, Shah PL, De Castro N, Bakhai A, Soriano A, Mateu L, Lumbreras C, Estrada V, Curran A, Sellier PO, Duffy A, Fletcher C, Mozaffari E, Haubrich R, Hodgkins P, Pozniak A. 536. Clinical Outcomes of Hospitalized COVID-19 Patients Treated with Remdesivir-NEAT ID 909REM Study. Open Forum Infect Dis 2021. [PMCID: PMC8644799 DOI: 10.1093/ofid/ofab466.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background There are few real-world data on the use of remdesivir (RDV) looking at timing of initiation in relation to symptom onset and severity of presenting disease. Methods We conducted multi-country retrospective study of clinical practice and use of RDV in COVID-19 patients. De-identified medical records data were entered into an e-CRF. Primary endpoints were all-cause mortality at day 28 and hospitalization duration. We assessed time from symptom onset to RDV start and re-admission. We included adults with PCR-confirmed symptomatic COVID-19 who were hospitalized after Aug 31, 2020 and received at least 1 dose of RDV. Descriptive analyses were conducted. Kaplan-Meier methods were used to calculate the mortality rate, LogRank test to compare groups defined by severity of disease. Competing risk regression with discharge and death as competing events was used to estimate duration of hospitalization, and Gray’s test to compare the groups. Results 448 patients in 5 countries (12 sites) were included. Demographics are summarized (table) by 3 disease severity groups at baseline: no supplemental oxygen (NSO), low flow oxygen ≤6 L/min (LFO), and high-flow oxygen > 6L/min (HFO). No demographic differences were found between groups except for the higher percentage of cancer/chemotherapy patients in NSO group. Corticosteroids use was HFO 73.6%, LFO 62.7%, NSO 58.0%. Mortality rate was significantly lower in NSO, and LFO groups compared with HFO (6.2%, 10.2%, 23.6%, respectively; Fig1). Median duration of hospitalization was 9 (95%CI 8-10), 9 (8-9), 13 (10-15) days, respectively (Fig2). Median time from first symptom to RDV start was 7 days in all 3 groups. Patients started RDV on day 1 of hospitalization in HFO and LFO and day 2 on NSO groups. And received a 5 day course (median). Readmission within 28-days of discharge was < 5% and similar across all 3 groups. Table 1. Patients baseline characteristics and primary and secondary outcomes ![]()
Figure 1. Kaplan-Meier estimates of mortality ![]()
Figure 2. Competing-risks regression of discharge from hospital ![]()
Conclusion In this real-world cohort of COVID-19 positive hospitalized patients, RDV use was consistent across countries. RDV was started within a median of 7 days from symptom within 2 days of admission and given for a median of 5 days. Higher mortality rate and duration of hospitalization was seen in the HFO group and similar rates seen in the LFO and NSO groups. Readmission was consistently low across all 3 groups. Disclosures François Raffi, MD, PhD, Gilead Sciences (Consultant, Scientific Research Study Investigator, Advisor or Review Panel member)Janssen (Consultant)MSD (Consultant, Scientific Research Study Investigator, Advisor or Review Panel member)Roche (Consultant)Theratechnologies (Advisor or Review Panel member)ViiV (Consultant, Scientific Research Study Investigator, Advisor or Review Panel member) Nadir Arber, MD, MSc, MHA, Check cap (Consultant)Coved cd 24 (Board Member)Israel Innovation Authority (Research Grant or Support)Nucleix (Advisor or Review Panel member)Zion Pharmaceuticals (Advisor or Review Panel member) Casper Rokx, MD PhD, Gilead Sciences (Grant/Research Support, Advisor or Review Panel member, Research Grant or Support)Merck (Grant/Research Support, Research Grant or Support)ViiV (Grant/Research Support, Advisor or Review Panel member, Research Grant or Support) Ameet Bakhai, MBBS, MD, FRCP, FESC, Bayer AG (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker's Bureau, Independent Contractor)Boehringer Ingelheim (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker's Bureau, Independent Contractor)Bristol-Myers Squibb (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker's Bureau, Independent Contractor)Daiichi-Sankyo Europe (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker's Bureau, Independent Contractor)Gilead Sciences (Grant/Research Support, Scientific Research Study Investigator)Janssen (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker's Bureau, Independent Contractor)Johnson & Johnson (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker's Bureau, Independent Contractor)MSD (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker's Bureau, Independent Contractor)Novartis (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker's Bureau, Independent Contractor)Pfizer (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker's Bureau, Independent Contractor)Roche (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker's Bureau, Independent Contractor)Sanofi (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker's Bureau, Independent Contractor) Alex Soriano, MD, Angelini (Speaker's Bureau)Gilead Sciences (Research Grant or Support, Speaker's Bureau)Menarini (Speaker's Bureau)MSD (Research Grant or Support, Speaker's Bureau)Pfizer (Research Grant or Support, Speaker's Bureau)Shionogi (Speaker's Bureau) Carlos Lumbreras, MD, PhD, Gilead Sciences (Grant/Research Support)MSD (Consultant) Vicente Estrada, MD, PhD, Gilead Sciences (Consultant, Grant/Research Support)Janssen (Advisor or Review Panel member)MSD (Consultant, Grant/Research Support)Theratechnologies (Consultant)ViiV (Consultant) Adrian Curran, MD, PhD, Gilead Sciences (Advisor or Review Panel member, Research Grant or Support)Janssen (Advisor or Review Panel member, Research Grant or Support)MSD (Advisor or Review Panel member, Research Grant or Support)ViiV (Advisor or Review Panel member, Research Grant or Support) Essy Mozaffari, PharmD, MPH, MBA, Gilead Sciences (Employee, Shareholder) Richard Haubrich, MD, Gilead Sciences (Employee, Shareholder) Paul Hodgkins, PhD, MSc, Gilead Sciences (Employee, Shareholder) Anton Pozniak, MD, FRCP, Gilead Sciences (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support)Janssen (Grant/Research Support, Research Grant or Support)Merck (Advisor or Review Panel member)Theratec (Grant/Research Support, Advisor or Review Panel member, Research Grant or Support)ViiV (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support)
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Affiliation(s)
- François Raffi
- Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | | | - Casper Rokx
- Erasmus University Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Lambert Assoumou
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Paris, Ile-de-France, France
| | - Pallav L Shah
- Chelsea & Westminster Hospital, National Heart & Lung Institute, Imperial College, London, UK
| | | | - Ameet Bakhai
- Royal Free London NHS Foundation Trust, London, UK
| | - Alex Soriano
- Hospital Clinic de Barcelona, Barcelona, Catalonia, Spain
| | - Lourdes Mateu
- Germans Trias I Pujol Hospital, Barcelona, Catalonia, Spain
| | | | | | - Adrian Curran
- Hospital Universitari Vall d’Hebron, Barcelona, Catalonia, Spain
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Alegre-González D, Herrera S, Bernal J, Soriano A, Bodro M. Disseminated Cryptococcus neoformans infection associated to COVID-19. Med Mycol Case Rep 2021; 34:35-37. [PMID: 34703755 PMCID: PMC8531235 DOI: 10.1016/j.mmcr.2021.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/24/2021] [Accepted: 10/11/2021] [Indexed: 12/12/2022] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a novel coronavirus associated with immune dysregulation. The use of immunosuppressant drugs as part of COVID-19 treatment (such as Tocilizumab or high -dose corticosteroids) increases the risk of opportunistic infections. Here we present a case of a patient without prior immunosuppression that developed a serious fungal infection after the use of high dose corticosteroids in the setting of severe COVID-19 and cryptogenic organizing pneumonia.
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Affiliation(s)
| | - Sabina Herrera
- Department of Infectious Diseases, Hospital Clinic, Barcelona, 08036, Spain
| | - Javier Bernal
- Department of Infectious Diseases, Hospital Clinic, Barcelona, 08036, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic, Barcelona, 08036, Spain
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic, Barcelona, 08036, Spain
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Soriano A, Carmeli Y, Omrani AS, Moore LSP, Tawadrous M, Irani P. Ceftazidime-Avibactam for the Treatment of Serious Gram-Negative Infections with Limited Treatment Options: A Systematic Literature Review. Infect Dis Ther 2021; 10:1989-2034. [PMID: 34379310 PMCID: PMC8355581 DOI: 10.1007/s40121-021-00507-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION A systematic literature review was undertaken to evaluate real-world use of ceftazidime-avibactam for infections due to aerobic Gram-negative organisms in adults with limited treatment options. METHODS Literature searches retrieved peer-reviewed publications and abstracts from major international infectious disease congresses from January 2015 to February 2021. Results were screened using pre-defined criteria to limit the dataset to relevant publications (notable exclusions were paediatric data and outcomes data for bacteria intrinsically resistant to ceftazidime-avibactam). Data for included publications were subjected to qualitative synthesis. RESULTS Seventy-three relevant publications (62 peer-reviewed articles; 10 abstracts) comprising 1926 patients treated with ceftazidime-avibactam (either alone or combined with other antimicrobials) and 1114 comparator/control patients were identified. All patients were hospitalised for serious illness and most had multiple comorbidities. The most common infections were pneumonia, bacteraemia, and skin/soft tissue, urinary tract, or abdominal infections; smaller numbers of patients with meningitis, febrile neutropenia, osteomyelitis, and cystic fibrosis were also included. Carbapenem-resistant or carbapenemase-producing Enterobacterales (CRE; n = 1718) and carbapenem-resistant, multidrug-resistant (MDR), and extensively drug-resistant Pseudomonas aeruginosa (n = 150) were the most common pathogens. Most publications reported positive outcomes for ceftazidime-avibactam treatment (clinical success rates ranged from 45 to 100% and reported 30-day mortality from 0 to 63%), which were statistically superior versus comparators in some studies. ceftazidime-avibactam resistance emergence occurred infrequently and mostly in Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae strains. CONCLUSION This review provides qualitative evidence of successful use of ceftazidime-avibactam for the treatment of hospitalised patients with CRE and MDR P. aeruginosa infections with limited treatment options.
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Affiliation(s)
- Alex Soriano
- Division of Infectious Diseases, Hospital Clínic de Barcelona, Carrer de Villarroel 170, 08036, Barcelona, Spain.
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
| | - Yehuda Carmeli
- Division of Epidemiology, The National Center for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ali S Omrani
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Luke S P Moore
- Chelsea & Westminster NHS Foundation Trust, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | | | - Paurus Irani
- Global Medical Affairs, Anti-infectives, Pfizer, Tadworth, Surrey, UK
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79
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Herrera S, Colmenero J, Pascal M, Escobedo M, Castel MA, Sole-González E, Palou E, Egri N, Ruiz P, Mosquera M, Moreno A, Juan M, Vilella A, Soriano A, Farrero M, Bodro M. Cellular and humoral immune response after mRNA-1273 SARS-CoV-2 vaccine in liver and heart transplant recipients. Am J Transplant 2021; 21:3971-3979. [PMID: 34291552 PMCID: PMC9800111 DOI: 10.1111/ajt.16768] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/02/2021] [Accepted: 07/17/2021] [Indexed: 01/25/2023]
Abstract
Recently published studies have found an impaired immune response after SARS-CoV-2 vaccination in solid organ recipients. However, most of these studies have not assessed immune cellular responses in liver and heart transplant recipients. We prospectively studied heart and liver transplant recipients eligible for SARS-CoV-2 vaccination. Patients with past history of SARS-CoV-2 infection or SARS-CoV-2 detectable antibodies (IgM or IgG) were excluded. We assessed IgM/IgG antibodies and ELISpot against the S protein 4 weeks after receiving the second dose of the mRNA-1273 (Moderna) vaccine. Side effects, troponin I, liver tests and anti-HLA donor-specific antibodies (DSA) were also assessed. A total of 58 liver and 46 heart recipients received two doses of mRNA-1273 vaccine. Median time from transplantation to vaccination was 5.4 years (IQR 0.3-27). Sixty-four percent of the patients developed SARS-CoV-2 IgM/IgG antibodies and 79% S-ELISpot positivity. Ninety percent of recipients developed either humoral or cellular response (87% in heart recipients and 93% in liver recipients). Factors associated with vaccine unresponsiveness were hypogammaglobulinemia and vaccination during the first year after transplantation. Local and systemic side effects were mild or moderate, and none presented DSA or graft dysfunction after vaccination. Ninety percent of our patients did develop humoral or cellular responses to mRNA-1273 vaccine. Factors associated with vaccine unresponsiveness were hypogammaglobulinemia and vaccination during the first year after transplantation, highlighting the need to further protect these patients.
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Affiliation(s)
- Sabina Herrera
- Department of Infectious Diseases, Hospital Clínic, University of Barcelonae, Barcelona, Spain
| | - Jordi Colmenero
- Liver Transplantation, Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Mariona Pascal
- Department of Immunology, CDB, Hospital Clínic, Barcelona, Spain,Immunoal·lergia Clínica Respiratoria i Experimental (IRCE), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Red Nacional de Alergia, Asma, Reacciones Adversas y Alérgicas (ARADyAL), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Miguel Escobedo
- Liver Transplantation, Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - María A. Castel
- Unit for Heart Failure and Heart Transplantation, Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - Eduard Sole-González
- Unit for Heart Failure and Heart Transplantation, Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - Eduard Palou
- Department of Immunology, CDB, Hospital Clínic, Barcelona, Spain,Immunoal·lergia Clínica Respiratoria i Experimental (IRCE), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Red Nacional de Alergia, Asma, Reacciones Adversas y Alérgicas (ARADyAL), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Natalia Egri
- Department of Immunology, CDB, Hospital Clínic, Barcelona, Spain
| | - Pablo Ruiz
- Liver Transplantation, Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Mar Mosquera
- Department of Microbiology, Hospital Clínic, Barcelona, Spain
| | - Asunción Moreno
- Department of Infectious Diseases, Hospital Clínic, University of Barcelonae, Barcelona, Spain
| | - Manel Juan
- Department of Immunology, CDB, Hospital Clínic, Barcelona, Spain,Immunoal·lergia Clínica Respiratoria i Experimental (IRCE), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Red Nacional de Alergia, Asma, Reacciones Adversas y Alérgicas (ARADyAL), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Anna Vilella
- Department of Preventive Medicine and Epidemiology, Hospital Clinic, University of barcelonae, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic, University of Barcelonae, Barcelona, Spain
| | - Marta Farrero
- Unit for Heart Failure and Heart Transplantation, Department of Cardiology, Hospital Clínic, Barcelona, Spain,Correspondence Marta Bodro and Marta Farrero, Department of Infectious Diseases and Unit for Heart Failure and Heart Transplantation, Hospital Clínic of Barcelona, Carrer Villarroel, Barcelona, Spain. (M. B.) and (M. F.)
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clínic, University of Barcelonae, Barcelona, Spain,Correspondence Marta Bodro and Marta Farrero, Department of Infectious Diseases and Unit for Heart Failure and Heart Transplantation, Hospital Clínic of Barcelona, Carrer Villarroel, Barcelona, Spain. (M. B.) and (M. F.)
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80
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Garcia-Vidal C, Alonso R, Camon AM, Cardozo C, Albiach L, Agüero D, Marcos MA, Ambrosioni J, Bodro M, Chumbita M, de la Mora L, Garcia-Pouton N, Dueñas G, Hernandez-Meneses M, Inciarte A, Cuesta G, Meira F, Morata L, Puerta-Alcalde P, Herrera S, Tuset M, Castro P, Prieto-Gonzalez S, Almuedo-Riera A, Mensa J, Martínez JA, Sanjuan G, Nicolas JM, Del Rio A, Muñoz J, Vila J, Garcia F, Soriano A. Impact of remdesivir according to the pre-admission symptom duration in patients with COVID-19. J Antimicrob Chemother 2021; 76:3296-3302. [PMID: 34473275 PMCID: PMC8499897 DOI: 10.1093/jac/dkab321] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/08/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The use of remdesivir has demonstrated a significant reduction in the time to recovery in patients with COVID-19. However, the impact on mortality is still controversial. Therefore, it is necessary to evaluate whether there is a specific subgroup of patients in whom an active antiviral therapy also reduces the mortality. METHODS Patients admitted for >48 h in our hospital for a SARS-CoV-2 confirmed or suspected infection from February 2020 to February 2021 were retrospectively analysed. The primary outcome of the study was mortality at 30 days. Univariate and multivariate analyses were performed to identify predictors of mortality. RESULTS In total, 2607 patients (438 receiving remdesivir and 2169 not) were included with a median (IQR) age of 65 (54-77) years and 58% were male. Four hundred and seventy-six were admitted to the ICU (18.3%) and 264 required invasive mechanical ventilation (10.1%). The global 30 day mortality rate was 10.7%. Pre-admission symptom duration of 4-6 days and ≤3 days was associated with a 1.5- and 2.5-fold increase in the mortality rate, respectively, in comparison with >6 days and treatment with remdesivir was independently associated with a lower mortality rate (OR = 0.382, 95% CI = 0.218-0.671). The analysis showed that the major difference was among patients with shorter pre-admission symptom duration (<6 days). CONCLUSIONS Patients with ≤3 days and 4-6 days from symptom onset to admission are associated with a 2.5- and 1.5-fold higher risk of death, respectively. Remdesivir was associated with 62% reduced odds of death versus standard-of-care and its survival benefit increased with shorter duration of symptoms.
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Affiliation(s)
- Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Rodrigo Alonso
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ana M Camon
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Celia Cardozo
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Laia Albiach
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Daiana Agüero
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M Angeles Marcos
- Department of Microbiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Juan Ambrosioni
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Mariana Chumbita
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Lorena de la Mora
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Nicole Garcia-Pouton
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Gerard Dueñas
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Marta Hernandez-Meneses
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alexy Inciarte
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Genoveva Cuesta
- Department of Microbiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Fernanda Meira
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Sabina Herrera
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Montse Tuset
- Department of Pharmacy, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Sergio Prieto-Gonzalez
- Department of Internal Medicine, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alex Almuedo-Riera
- Institute for Global Health (ISGlobal), Barcelona, Spain.,Department of International Health, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Josep Mensa
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - José Antonio Martínez
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Gemma Sanjuan
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain.,Computer System Unit, Hospital Clinic, Barcelona, Spain
| | - J M Nicolas
- Medical Intensive Care Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Del Rio
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - José Muñoz
- Institute for Global Health (ISGlobal), Barcelona, Spain.,Department of International Health, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jordi Vila
- Department of Microbiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Felipe Garcia
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
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81
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Martínez MJ, Basile L, Sisó-Almirall A, Cristino V, Cuesta G, Hurtado JC, Fernandez-Pittol M, Mosquera MM, Soriano A, Martínez A, Marcos MA, Vila J, Casals-Pascual C. Lack of Prognostic Value of SARS-CoV2 RT-PCR Cycle Threshold in the Community. Infect Dis Ther 2021; 11:587-593. [PMID: 34762246 PMCID: PMC8582337 DOI: 10.1007/s40121-021-00561-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
The immense impact of the COVID-19 pandemic on health systems has motivated the scientific community to search for clinical prognostic factors for SARS-CoV-2 infection. Low cycle threshold values (Ct) of diagnostic real-time RT-PCR assays in hospitalized patients have been associated with a poor prognosis in several studies, whereas other studies did not find this association. We explored whether SARS-CoV-2 Ct values at diagnosis were associated with a poor outcome (admission to hospital and death) in 604 community patients diagnosed at primary health centers. Although lower Ct values were found in patients who died of COVID-19, the Ct value was not significantly associated with a worse outcome in a multivariate analysis, while age remained an independent prognostic factor. We did not find evidence to support the role of Ct values as a prognostic factor of COVID-19 in community cases.
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Affiliation(s)
- Miguel J Martínez
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Luca Basile
- Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
| | - Antoni Sisó-Almirall
- Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Victor Cristino
- Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
| | - Genoveva Cuesta
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Juan Carlos Hurtado
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | | | - María Mar Mosquera
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ana Martínez
- Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
| | - Mª Angeles Marcos
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Jordi Vila
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Climent Casals-Pascual
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain. .,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.
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82
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Mensa J, Barberán J, Ferrer R, Borges M, Rascado P, Maseda E, Oliver A, Marco F, Adalia R, Aguilar G, Estella A, León López R, Robles Marcos MS, González de Molina FJ, Serrano García R, Salavert M, Fernández Gómez J, Poliakova Y, Pasquau J, Azanza JR, Bou Arévalo G, LLinares Mondéjar P, Cardinal-Fernández P, Soriano A. Recommendations for antibiotic selection for severe nosocomial infections. Rev Esp Quimioter 2021; 34:511-524. [PMID: 34693705 PMCID: PMC8638841 DOI: 10.37201/req/126.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Severe infection and its evolution to sepsis are becoming more prevalent every day and are among the leading causes of critical illness and mortality. Proper management is crucial to improve prognosis. This document addresses three essential points that have a significant impact on this objective: a) early recognition of patients with sepsis criteria, b) identification of those patients who suffer from an infection and have a high risk of progressing to sepsis, and c) adequate selection and optimization of the initial antimicrobial treatment.
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Affiliation(s)
| | - J Barberán
- José Barberán, Servicio de Medicina Interna - Enfermedades Infecciosas. Hospital Universitario HM Montepríncipe. Universidad San Pablo CEU. Spain.
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83
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Huguet S, Bernaus M, Gómez L, Cuchí E, Soriano A, Font-Vizcarra L. Role of bacterial colonisation of vancomycin-gentamicin spacers in two-stage arthroplasty revision surgery: the usefulness of spacer sonication. Eur J Orthop Surg Traumatol 2021; 32:1661-1669. [PMID: 34677662 DOI: 10.1007/s00590-021-03151-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/11/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE In two-stage replacements for septic loosening, some studies have suggested an association between bacterial colonisation of spacers and a higher number of complications after implantation of the definitive prosthesis. Our study aimed to determine the reoperation rate of patients undergoing two-stage revision surgery according to the culture results of spacer sonication. METHODS A retrospective observational study was conducted in which hip or knee spacers implanted at our institution with a diagnosis of periprosthetic joint infection from 2010 to 2018 were analysed. Patients were grouped into three categories: A. Patients with positive spacer sonication fluid culture, with or without positive cultures of the rest of the samples. B. Patients with negative spacer sonication culture and negative cultures of the rest of intraoperative samples. C. Patients with negative spacer sonication culture but positive cultures of the rest of intraoperative samples. RESULTS A total of 45 spacers were analysed: 10 were included in group A, 24 in group B and 11 in group C. The reoperation rate during the first year after the 2-stage revision surgery was 20%, 29.2% and 54.5% for each group, respectively, due to an infection in 10%, 20.8% and 45.5%. Spacers were colonised in all cases by low virulent micro-organisms. CONCLUSION In our study, bacterial colonisation of the spacer is not associated with a higher rate of reoperation. The group of patients with positive intraoperative cultures during the second-stage had the highest reoperation rate.
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Affiliation(s)
- Sandra Huguet
- Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Barcelona, Spain.
- Department of Traumatology and Orthopaedics, Consorci Sanitari de l'Alt Penedès - Garraf, Barcelona, Spain.
| | - Martí Bernaus
- Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Lucía Gómez
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Infectious Diseases Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Eva Cuchí
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Department of Microbiology, CATLAB, Viladecavalls, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases - Osteoarticular Infections Unit, Hospital Clínic, Barcelona, Spain
| | - Lluís Font-Vizcarra
- Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
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84
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Abstract
Community-acquired pneumonia (CAP) is one of the leading causes of admission to emergency departments. Ceftaroline is a fifth-generation cephalosporin with a potent In vitro activity against Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus, the three most important pathogens causing CAP. Three randomized and double-blind clinical trials compared the efficacy of ceftaroline versus ceftriaxone in patients with CAP and the results of each trial and a meta-analysis, concluded the superiority of ceftaroline in terms of clinical success. In particular, the major difference was observed among patients with CAP caused by S. aureus. Accordingly, ceftaroline has been included as a first-line option in the recent clinical guidelines for the management of CAP.
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Affiliation(s)
- A Soriano
- Alex Soriano, Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Spain.
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85
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Lensen KJDF, Escudero-Sanchez R, Cobo J, Trebše R, Gubavu C, Tedeschi S, Lomas JM, Arvieux C, Rodriguez-Pardo D, Fantoni M, Pais MJG, Jover F, Salles MJC, Sancho I, Sampedro MF, Soriano A, Wouthuyzen-Bakker M, Escmid Study Group Of Implant Associated Infections Esgiai. The efficacy of suppressive antibiotic treatment in patients managed non-operatively for periprosthetic joint infection and a draining sinus. J Bone Jt Infect 2021; 6:313-319. [PMID: 34422548 PMCID: PMC8375509 DOI: 10.5194/jbji-6-313-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/03/2021] [Indexed: 12/22/2022] Open
Abstract
Objectives: Patients with prosthetic joint infections (PJIs) not suitable for curative surgery may benefit from suppressive antibiotic therapy (SAT). However, the usefulness of SAT in cases with a draining sinus has never been investigated. Methods: A multicentre, retrospective observational cohort study was performed in which patients with a PJI and a sinus tract were eligible for inclusion if managed conservatively and if sufficient follow-up data were available (i.e. at least 2 years). SAT was defined as a period of > 6 months of oral antibiotic therapy. Results: SAT was initiated in 63 of
72 (87.5 %) included patients. Implant retention during follow-up was the
same in patients receiving SAT vs. no SAT (79.4 % vs. 88.9 %;
p=0.68). In total, 27 % of patients using SAT experienced side effects. In addition, the occurrence of prosthetic loosening in initially fixed implants, the need for surgical debridement, or the occurrence of bacteremia during follow-up could not be fully prevented with the use of SAT, which still occurred in 42 %, 6.3 %, and 3.2 % of cases, respectively. However, the
sinus tract tended to close more often (42 % vs. 13 %; p=0.14), and a
higher resolution of pain was observed (35 % vs. 14 %; p=0.22) in
patients receiving SAT. Conclusions: SAT is not able to fully prevent complications in patients with a draining sinus. However, it may be beneficial in a subset of patients, particularly in those with pain or the hindrance of a draining sinus. A future prospective study, including a higher number of patients not receiving SAT, is needed.
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Affiliation(s)
- Karel-Jan Dag François Lensen
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Javier Cobo
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Rihard Trebše
- Service for Bone Infections, Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
| | - Camelia Gubavu
- Department of Infectious and Tropical Diseases, CHR Orléans, Orléans, France
| | - Sara Tedeschi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Bologna Policlinico di Sant Orsola, Bologna, Italy
| | - Jose M Lomas
- Department of Infectious Diseases, Virgen del Rocio University Hospital, Seville, Spain
| | - Cedric Arvieux
- Department of Infectious Diseases and Intensive Care, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Dolors Rodriguez-Pardo
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Massimo Fantoni
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Jose Garcia Pais
- Infectious Diseases Unit, Hospital Universitario Lucus Augusti, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Lugo, Spain
| | - Francisco Jover
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Mauro José Costa Salles
- Unit of Infectious Diseases, Department of Internal Medicine, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Ignacio Sancho
- Department of Infectious Diseases, Hospital Reina Sofía de Tudela, Navarra, Spain
| | - Marta Fernandez Sampedro
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic, IDIBAPS, Catalonia, Barcelona, Spain
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Inciarte A, Cardozo C, Chumbita M, Alcubilla P, Torres B, González Cordón A, Rico V, Aguero D, García-Pouton N, Hernández-Meneses M, Albiach L, Meira F, De la Mora L, Linares L, Puerta-Alcalde P, Macaya I, Mensa J, Laguno M, Ambrosioni J, Ramos A, Morata L, Bodro M, Moreno-García E, Moreno A, Sola M, Rojas J, Leal L, Torres M, Garcia-Vidal C, Martínez JA, Alobid I, Soriano A, Garcia F. Gustatory and olfactory dysfunctions in hospitalised patients with COVID-19 pneumonia: a prospective study. BMJ Open 2021; 11:e040775. [PMID: 34404693 PMCID: PMC8375450 DOI: 10.1136/bmjopen-2020-040775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 04/28/2021] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Identifying undetected clinical signs is imperative in the prevention of SARS-CoV-2. OBJECTIVE To establish the prevalence of clinical gustatory and olfactory dysfunctions in patients with COVID-19 pneumonia. Clinical outcomes and recovery rates associated with gustatory and olfactory dysfunctions were also assessed. DESIGN A prospective study was performed in 80 patients admitted to Hospital Clínic of Barcelona (Spain) for COVID-19 pneumonia. Patients were re-evaluated in the ward daily until discharge. Gustatory and olfactory dysfunction symptoms were retrospectively collected from emergency room (ER) charts after first assessments. Follow-up was performed in telemedicine consultation. SETTING The single-centre study was performed in a hospitalisation ward at a university hospital. PARTICIPANTS Consecutive patients meeting hospitalisation criteria for COVID-19 pneumonia were eligible. Study exclusion criteria were patients who could not speak, had previous gustatory and olfactory dysfunctions or whose PCR tests for SARS-CoV-19 were negative. INTERVENTIONS Systematic assessment of gustatory and olfactory symptoms with standardised questions. OUTCOMES Prevalence of gustatory and olfactory dysfunctions in patients with COVID-19 pneumonia. RESULTS Of the 80 study subjects, 62.5% were male and the median age was 57 years. Half of the cohort (n=40) presented with comorbidities. The prevalence of chemosensitive disorder was 73.8% (n=59) (95% CI: 63.8 to 83.8), although self-reported symptoms were recorded in only 26.3% (n=21) of patients in the ER. Gustatory and olfactory dysfunctions were observed in 58.8% (n=47) and 55% (n=44) of cases, respectively. They were also the first symptoms in 25% (n=20) of patients. Anosmia was associated with ageusia, OR: 7, 95% CI: 2.3 to 21.8, p=0.001). No differences in clinical outcomes were observed when patients with and without gustatory and olfactory dysfunctions were compared. Recovery rates were 20% (n=10) and 85% (n=42) at days 7 and 45, respectively. CONCLUSION The prevalence of gustatory and olfactory dysfunctions in COVID-19 pneumonia was much higher than in self-report. Presence of gustatory and olfactory dysfunctions was not a predictor of clinical outcomes.
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Affiliation(s)
- Alexy Inciarte
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | - Celia Cardozo
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Mariana Chumbita
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | - Pau Alcubilla
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Berta Torres
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | - Ana González Cordón
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | - Veronica Rico
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Daiana Aguero
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - Laia Albiach
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | - Fernanda Meira
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | - Lorena De la Mora
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | - Laura Linares
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | | | - Irene Macaya
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Josep Mensa
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Montse Laguno
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Angela Ramos
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Laura Morata
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | | | - Antonio Moreno
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Montse Sola
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Jhon Rojas
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Lorna Leal
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | - Manuel Torres
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | - Jose Antonio Martínez
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | - Isam Alobid
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | - Felipe Garcia
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
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88
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Meira F, Albiach L, Carbonell C, Martín-Oterino JA, Martín-Ordiales M, Linares L, Macaya I, Agüero D, Ambrosioni J, Bodro M, Cardozo C, Chumbita M, De la Mora M, García-Pouton N, Garcia-Vidal C, González-Cordón A, Hernández-Meneses M, Inciarte A, Laguno M, Leal L, Morata L, Puerta-Alcalde P, Rico V, Letona L, Cózar-Llistó A, Dueñas G, Solá M, Torres B, Rojas J, Moreno A, Moreno-García E, Torres M, Martínez JA, Soriano A, García F. Experience with the use of siltuximab in patients with SARS-CoV-2 infection. Rev Esp Quimioter 2021; 34:337-341. [PMID: 33982984 PMCID: PMC8329576 DOI: 10.37201/req/045.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/04/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The study aims to describe characteristics and clinical outcome of patients with SARS-CoV-2 infection that received siltuximab according to a protocol that aimed to early block the activity of IL-6 to avoid the progression of the inflammatory flare. METHODS Retrospective review of the first 31 patients with SARS-CoV-2 treated with siltuximab, in Hospital Clinic of Barcelona or Hospital Universitario Salamanca, from March to April 2020 with positive polymerase-chain reaction (PCR) from a nasopharyngeal swab. RESULTS The cohort included 31 cases that received siltuximab with a median (IQR) age of 62 (56-71) and 71% were males. The most frequent comorbidity was hypertension (48%). The median dose of siltuximab was 800 mg ranging between 785 and 900 mg. 7 patients received siltuximab as a salvage therapy after one dose of tocilizumab. At the end of the study, a total of 26 (83.9) patients had been discharged alive and the mortality rate was 16.1% but only 1 out of 24 that received siltuximab as a first line option (4%). CONCLUSIONS Siltuximab is a well-tolerated alternative to tocilizumab when administered as a first line option in patients with COVID-19 pneumonia within the first 10 days from symptoms onset and high C-reactive protein.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - A Soriano
- Alex Soriano, Department of Infectious Diseases, Hospital Clínic of Barcelona. Carrer de Villarroel 170, 08036, Barcelona, Spain.
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89
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Ferrer R, Soriano A, Cantón R, Del Pozo JL, García-Vidal C, Garnacho-Montero J, Larrosa N, Rascado P, Salavert M, Pintado V, Pellicer B, Badía X. [A systematic review and expert's analysis of risk factors of infections in adults due to carbapenem-resistant Pseudomonas aeruginosa or Acinetobacter baumannii in Spain]. Rev Esp Quimioter 2021; 34:298-307. [PMID: 33913312 PMCID: PMC8329577 DOI: 10.37201/req/034.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of the study is to identify risk factors associated to infections caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-resistant Acinetobacter baumannii (CRAB) in adult patients through a systematic literature review, classify them according to their importance and provide recommendations by experts in the Spanish context. METHODS We developed a systematic literature review to identify risk factors associated to CRPA or CRAB infections and they were evaluated and discussed by a multidisciplinary panel of experts. RESULTS There were included 29 studies for P. aeruginosa and 23 for A. baumannii out of 593 identified through systematic literature review. We identified 38 risk factors for P. aeruginosa and 36 for A. baumannii. After risk factor evaluation by the panel of experts, results for CRPA were: 11 important, 10 slightly important and 15 unimportant risk factors; and for CRAB were: 9 important, 5 slightly important and 19 unimportant risk factors. For both pathogens, previous use of antibiotics and hospitalization were important risk factors. CONCLUSIONS We could identify the main risk factors associated to CRPA and CRAB through literature review. There is a need for developing additional studies with higher levels of evidence to identify sooner and better infected patients through associated risk factors.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - X Badía
- Xavier Badia, Omakase Consulting, Barcelona, Spain.
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90
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Barbeta E, Benegas M, Sánchez M, Motos A, Ferrer M, Ceccato A, Lopez R, Bueno L, -Artigas RM, Ferrando C, Fernández-Barat L, Albacar N, Badia JR, López T, Sandoval E, Toapanta D, Castro P, Soriano A, Torres A. [Risk Factors and Clinical Impact of Fibrotic-Like Changes and the Organizing Pneumonia Pattern in Patients with COVID-19- and Non-COVID-19-induced Acute Respiratory Distress Syndrome.]. Arch Bronconeumol 2021; 58:183-187. [PMID: 34108796 PMCID: PMC8177312 DOI: 10.1016/j.arbres.2021.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Enric Barbeta
- Pulmonology and Respiratory Intensive Care Unit. Respiratory Institute. Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Spain.,Intensive Care Unit. Sagrat Cor University Hospital, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Mariana Benegas
- Radiology Department. Centre de Diagnòstic per la Imatge Clínic. Hospital Clinic of Barcelona, Barcelona, Spain
| | - Marcelo Sánchez
- Radiology Department. Centre de Diagnòstic per la Imatge Clínic. Hospital Clinic of Barcelona, Barcelona, Spain
| | - Anna Motos
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Spain.,University of Barcelona, Barcelona, Spain
| | - Miquel Ferrer
- Pulmonology and Respiratory Intensive Care Unit. Respiratory Institute. Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Spain.,University of Barcelona, Barcelona, Spain
| | - Adrián Ceccato
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Spain.,Intensive Care Unit. Sagrat Cor University Hospital, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Rubén Lopez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Spain.,University of Barcelona, Barcelona, Spain
| | - Leticia Bueno
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Spain.,University of Barcelona, Barcelona, Spain
| | - Ricard Mellado -Artigas
- Anesthesiology and Surgical Intensive Care Unit. Hospital Clinic of Barcelona, Barcelona, Spain
| | - Carlos Ferrando
- Anesthesiology and Surgical Intensive Care Unit. Hospital Clinic of Barcelona, Barcelona, Spain
| | - Laia Fernández-Barat
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Spain.,University of Barcelona, Barcelona, Spain
| | - Nuria Albacar
- Pulmonology and Respiratory Intensive Care Unit. Respiratory Institute. Hospital Clinic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Joan Ramon Badia
- Pulmonology and Respiratory Intensive Care Unit. Respiratory Institute. Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Spain.,University of Barcelona, Barcelona, Spain
| | - Teresa López
- Cardiac Intensive Care Unit, Cardiology. Cardiovascular Institute. Hospital Clinic of Barcelona, Barcelona, Spain
| | - Elena Sandoval
- Cardiac Surgery Intensive Care Unit. Cardiovascular Institute. Hospital Clinic of Barcelona, Barcelona, Spain
| | - David Toapanta
- Liver Intensive Care Unit. Metabolic and Digestive Disease Institute. Hospital Clinic of Barcelona, Barcelona, Spain
| | - Pedro Castro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Medical Intensive Care Unit. Internal Medicine and Dermatology Institute. Hospital Clinic of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department. Internal Medicine and Dermatology Institute. Hospital Clinic of Barcelona, Barcelona, Spain
| | - Antoni Torres
- Pulmonology and Respiratory Intensive Care Unit. Respiratory Institute. Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Spain.,University of Barcelona, Barcelona, Spain
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91
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Citriniti G, Soriano A, Bertolini E, Sandri G, Bertani A, Tinazzi I, Martinis F, Girolimetto N, Salvarani C, Beltrami M, Macchioni P. POS0265 CLINICAL AND ULTRASONOGRAPHIC ENTHESITIS IN INFLAMMATORY BOWEL DISEASE WITH AND WITHOUT PSORIASIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Previous studies have reported an association between psoriasis (PsO) and inflammatory bowel disease (IBD). Coexistence of IBD and PsO has been associated with significant higher prevalence of enthesitis and dactylitis1.Objectives:To compare the prevalence of clinical and ultrasonographic peripheral enthesis abnormalities in a consecutive series of patients with IBD and psoriasis (PsO) as compared to a group of IBD patients without psoriasis (IBD).Methods:One-hundred seventy-four IBD consecutive patients [36 PsO and 138 IBD, M/F 91/83, mean age 42.6±14.7 years, mean disease duration 110 ±12.3 months] entered the study. A complete clinical examination, including rheumatological history, 66/68 peripheral joint count, MASES and LEI scores, BASDAI, and dactylitis count, was performed at study entry. Laboratory test (ESR, CRP, Hb, fecal calprotectin) were collected. Axial or peripheral SpA diagnosis was made using ASAS criteria 2.US examination was executed by a rheumatologist blind to clinical data, using an Esaote MyLabClass, 18-6MHz linear multifrequence transducer both in B-mode and PD-mode. The following sites were examined bilaterally: lateral epicondyle of the humerus, distal quadriceps femoris insertion into the patella, inferior pole of the patella, tibial distal insertion of the patellar tendon, calcaneal insertion of the Achilles tendon, and plantar aponeurosis insertion. Knee and ankle joints were evaluated for synovial hypertrophy, PD signal and fluid effusion. Enthesitis was defined according to OMERACT 3 and scored as 0-36 for GUESS and 0-136 for MASEI.Results:PsO patients had later IBD onset (mean age 39±14.7 vs 33 ± 13.2 in IBD group, p=0.02). There weren’t observed any significant differences in IBD duration and Crohn/UC prevalence.No significant difference between the two groups in rheumatological history and clinical examination was detected, except for familiar history of psoriasis (PsO 44% vs IBD 16%, p <0.001). Prevalence of SpA was 33,3% in PsO group and 37% in IBD group (p = 0.687).146 patients (83.4%) showed structural damage at ≥ 1 enthesis, 44 patients (25%) had at least 1 active enthesitis, with no significant difference between the two groups. PsO group showcased a significantly increased prevalence of patients having ≥ 1 thickened enthesis (86.1% vs 63.9%, p=0.009) and of PD signal at knee examination (11.1% vs 2.2%, p= 0.034). Higher values of GUESS score were observed in PsO (8.1±5.1 vs 5.8±3.9, p=0.017). Enthesis hypoechogenicity was more prevalent in IBD group (27.5% vs 11.1%, p=0.049).Enthesis thickness was significantly increased in PsO, in every examined site. Enthesophyte length was significantly increased in PsO group at quadriceps tendon, patellar distal insertion and Achilles tendon.Conclusion:No differences in clinical manifestation and rheumatological history between IBD and PsO patients were observed. Subclinical (US) abnormalities were significantly increased in IBD patients with associated PsO, as compared to patients affected by IBD.References:[1]Cantini, F. et al. J. Rheumatol.44, 1341–1346 (2017).[2]Rudwaleit, M. et al. Ann. Rheum. Dis.68, 777–783 (2009).[3]Balint, P. V. et al. Ann. Rheum. Dis.77, 1730–1735 (2018).Acknowledgements:Abbvie provided funding for medical writingDisclosure of Interests:Giorgia Citriniti: None declared, Alessandra Soriano: None declared, Elena Bertolini: None declared, Gilda Sandri: None declared, Angela Bertani: None declared, Ilaria Tinazzi: None declared, Federica Martinis: None declared, Nicolò Girolimetto: None declared, Carlo Salvarani: None declared, Marina Beltrami Grant/research support from: Abbvie provided funding for medical writing, Pierluigi Macchioni: None declared
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92
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Aira A, Rubio E, Vergara Gómez A, Fehér C, Casals-Pascual C, González B, Morata L, Rico V, Soriano A. rUTI Resolution After FMT for Clostridioides difficile Infection: A Case Report. Infect Dis Ther 2021; 10:1065-1071. [PMID: 33136261 PMCID: PMC8116417 DOI: 10.1007/s40121-020-00365-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/21/2020] [Indexed: 01/05/2023] Open
Abstract
Clostridioides difficile infection (CDI) is the leading cause of nosocomial infectious diarrhea. Fecal microbiota transplantation (FMT) is a successful treatment for recurrent CDI (rCDI), and in some patients FMT has been associated with the resolution of recurrent urinary tract infections (rUTI). Recent evidence suggests that the origin of most bacterial infections in the urinary tract is the gut. Thus, the possibility of using FMT to displace pathogens commonly involved in rUTIs has major therapeutic implications. We report the case of a 93-year-old female patient with a rCDI and rUTI that underwent FMT and reported a complete clinical resolution of CDI; unexpectedly, no new symptomatic UTI episodes were diagnosed post-FMT. We characterized the gut microbiota of the stool donor and of the patient before and after the procedure. Our patient presented a dysbiosis with clear predominance of Enterobacteriaceae (74%) before FMT, which was significantly reduced to 0.07% after FMT. These findings were maintained for almost a year. We also observed an increase in microbial diversity indices compared with the pre-FMT sample reaching diversity values comparable to the donor stool samples. We reasoned that the disappearance of UTIs in our patient resulted from the reduction of Enterobacteriaceae in the gut microbiota. Our findings support previous evidence suggesting the potential of FMT for rUTI, particularly in cases due to multi-drug resistant pathogens where conventional antibiotic treatment is not an option.
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Affiliation(s)
- Andrea Aira
- Department of Infectious Diseases, Hospital Clinic, Barcelona, Spain
| | - Elisa Rubio
- Department of Microbiology, Hospital Clinic, Barcelona, Spain
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain
| | - Andrea Vergara Gómez
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Molecular Biology CORE, CDB, Hospital Clinic, Barcelona, Spain
| | - Csaba Fehér
- Department of Infectious Diseases, Hospital Clinic, Barcelona, Spain
| | - Climent Casals-Pascual
- Department of Microbiology, Hospital Clinic, Barcelona, Spain
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain
| | - Begoña González
- Department of Gastroenterology, Hospital Clinic, Barcelona, Spain
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clinic, Barcelona, Spain
| | - Verónica Rico
- Department of Infectious Diseases, Hospital Clinic, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain.
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Puerta-Alcalde P, Ambrosioni J, Chumbita M, Hernández-Meneses M, Garcia-Pouton N, Cardozo C, Moreno-García E, Marco F, Mensa J, Rovira M, Esteve J, Martínez JA, García F, Mallolas J, Soriano A, Miró JM, Garcia-Vidal C. Clinical Characteristics and Outcome of Bloodstream Infections in HIV-Infected Patients with Cancer and Febrile Neutropenia: A Case-Control Study. Infect Dis Ther 2021; 10:955-970. [PMID: 33840061 PMCID: PMC8116456 DOI: 10.1007/s40121-021-00445-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/27/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION We aimed to compare the clinical characteristics and outcomes of bloodstream infections (BSI) in cancer patients presenting febrile neutropenia with and without HIV infection, and analyze the prognostic factors for mortality. METHODS BSI episodes in febrile neutropenic patients following chemotherapy were prospectively collected (1997-2018). A case (HIV-infected)-control (non-HIV-infected) sub-analysis was performed (1:2 ratio), matching patients by age, gender, baseline disease, and etiological microorganism. RESULTS From 1755 BSI episodes in neutropenic cancer patients, 60 (3.4%) occurred in those with HIV. HIV characteristics: 51.7% were men who have sex with men; 58.3% had < 200 CD4; 51.7% had a detectable HIV-1 RNA viral load before the BSI episode; 70.0% met AIDS-defining criteria; and 93.3% were on antiretroviral therapy, with a protease inhibitor-based regimen being the most common (53.0%). HIV-infected patients were younger, more frequently male and more commonly presenting chronic liver disease (p < 0.001 for all). BSI due to Enterococcus spp. was significantly more frequent among patients with HIV (p = 0.017) with no differences in other pathogens. HIV-infected patients with cancer presented with shock more frequently (p = 0.014) and had higher mortality (31.7% vs. 18.1%, p = 0.008). In the case-control analysis, cases (HIV-infected) had chronic liver disease (p = 0.003) more frequently, whereas acute leukemia (p = 0.013) and hematopoietic stem-cell transplant (p = 0.023) were more common among controls. There was a non-significant trend for cases to have higher mortality (p = 0.084). However, in multivariate analysis, HIV infection was not associated with mortality (p = 0.196). CONCLUSION HIV-infected patients with cancer developing febrile neutropenia and BSI have different epidemiological and clinical profiles, and experience higher mortality. However, HIV infection by itself was not associated with mortality.
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Affiliation(s)
- Pedro Puerta-Alcalde
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain.
| | - Juan Ambrosioni
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain.
| | - Mariana Chumbita
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
| | - Marta Hernández-Meneses
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
| | - Nicole Garcia-Pouton
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
| | - Celia Cardozo
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
| | - Estela Moreno-García
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
| | - Francesc Marco
- Microbiology Department, Centre Diagnòstic Biomèdic, Hospital Clinic, Barcelona, Spain
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Josep Mensa
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
| | - Montserrat Rovira
- Hematology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Jordi Esteve
- Hematology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Jose A Martínez
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Felipe García
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Josep Mallolas
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - José M Miró
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
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94
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Fontseré N, Soriano A, Mestres G, Bermudez P, Zarco F, Lozano V, Rodas L, Broseta J, Arias M, Maduell F. Efficacy of systematic catheter locks solution of taurolidine/heparin versus taurolidine/urokinase in end-stage renal insufficiency stage 5D. Nefrologia 2021; 42:S0211-6995(21)00087-4. [PMID: 34034903 DOI: 10.1016/j.nefro.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Néstor Fontseré
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, España.
| | - Alex Soriano
- Unidad Funcional de Acceso Vascular, Servicio de Enfermedades Infecciosas, Hospital Clínico de Barcelona, Barcelona, España
| | - Gaspar Mestres
- Unidad Funcional de Acceso Vascular, Servicio de Cirugía Vascular, Hospital Clínico de Barcelona, Barcelona, España
| | - Patricia Bermudez
- Unidad Funcional de Acceso Vascular, Servicio de Radiología Vascular Intervencionista, Hospital Clínico de Barcelona, Barcelona, España
| | - Federico Zarco
- Unidad Funcional de Acceso Vascular, Servicio de Radiología Vascular Intervencionista, Hospital Clínico de Barcelona, Barcelona, España
| | - Valentín Lozano
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, España
| | - Lida Rodas
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, España
| | - Jose Broseta
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, España
| | - Marta Arias
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, España
| | - Francisco Maduell
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, España
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Moreno-García E, Puerta-Alcalde P, Gariup G, Fernández-Ruiz M, López Cortés LE, Cuervo G, Salavert M, Merino P, Machado M, Guinea J, García-Rodríguez J, Garnacho-Montero J, Cardozo C, Peman J, Montejo M, Fortún J, Almirante B, Castro C, Rodríguez-Baño J, Aguado JM, Martínez JA, Carratalà J, Soriano A, Garcia-Vidal C. Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies. Open Forum Infect Dis 2021; 8:ofab250. [PMID: 34104670 PMCID: PMC8180243 DOI: 10.1093/ofid/ofab250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background There are no clear criteria for antifungal de-escalation after initial empirical treatments. We hypothesized that early de-escalation (ED) (within 5 days) to fluconazole is safe in fluconazole-susceptible candidemia with controlled source of infection. Methods This is a multicenter post hoc study that included consecutive patients from 3 prospective candidemia cohorts (2007–2016). The impact of ED and factors associated with mortality were assessed. Results Of 1023 candidemia episodes, 235 met inclusion criteria. Of these, 54 (23%) were classified as the ED group and 181 (77%) were classified as the non-ED group. ED was more common in catheter-related candidemia (51.9% vs 31.5%; P = .006) and episodes caused by Candida parapsilosis, yet it was less frequent in patients in the intensive care unit (24.1% vs 39.2%; P = .043), infections caused by Nakaseomyces glabrata (0% vs 9.9%; P = .016), and candidemia from an unknown source (24.1% vs 47%; P = .003). In the ED and non-ED groups, 30-day mortality was 11.1% and 29.8% (P = .006), respectively. Chronic obstructive pulmonary disease (odds ratio [OR], 3.97; 95% confidence interval [CI], 1.48–10.61), Pitt score > 2 (OR, 4.39; 95% CI, 1.94–9.20), unknown source of candidemia (OR, 2.59; 95% CI, 1.14–5.86), candidemia caused by Candida albicans (OR, 3.92; 95% CI, 1.48–10.61), and prior surgery (OR, 0.29; 95% CI, 0.08–0.97) were independent predictors of mortality. Similar results were found when a propensity score for receiving ED was incorporated into the model. ED had no significant impact on mortality (OR, 0.50; 95% CI, 0.16–1.53). Conclusions Early de-escalation is a safe strategy in patients with candidemia caused by fluconazole-susceptible strains with controlled source of bloodstream infection and hemodynamic stability. These results are important to apply antifungal stewardship strategies.
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Affiliation(s)
| | | | - G Gariup
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - M Fernández-Ruiz
- Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas+12), Universidad Complutense, Madrid, Spain
| | - L E López Cortés
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, CSIC, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - G Cuervo
- Hospital Universitari de Bellvitge, IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain
| | - M Salavert
- Hospital Universitari i Politecnic "La Fe", Valencia, Spain
| | - P Merino
- Hospital Universitario Clínico "San Carlos", Madrid, Spain
| | - M Machado
- Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - J Guinea
- Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | - J Garnacho-Montero
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario "Virgen Macarena", Sevilla, Spain
| | - C Cardozo
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - J Peman
- Hospital Universitari i Politecnic "La Fe", Valencia, Spain
| | - M Montejo
- Hospital Universitario "Cruces", Bilbao, Spain
| | - J Fortún
- Hospital Universitario "Ramón y Cajal", Madrid, Spain
| | - B Almirante
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Castro
- Hospital Universitario de Valme, Sevilla, Spain
| | - J Rodríguez-Baño
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, CSIC, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - J M Aguado
- Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas+12), Universidad Complutense, Madrid, Spain
| | - J A Martínez
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - J Carratalà
- Hospital Universitari de Bellvitge, IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain
| | - A Soriano
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - C Garcia-Vidal
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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96
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Beldman M, Löwik C, Soriano A, Albiach L, Zijlstra WP, Knobben BAS, Jutte P, Sousa R, Carvalho A, Goswami K, Parvizi J, Belden KA, Wouthuyzen-Bakker M. If, when, and how to use rifampin in acute staphylococcal periprosthetic joint infections, a multicentre observational study. Clin Infect Dis 2021; 73:1634-1641. [PMID: 33970214 PMCID: PMC8563307 DOI: 10.1093/cid/ciab426] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Indexed: 11/15/2022] Open
Abstract
Background Rifampin is generally advised in the treatment of acute staphylococcal periprosthetic joint infections (PJI). However, if, when, and how to use rifampin remains a matter of debate. We evaluated the outcome of patients treated with and without rifampin, and analyzed the influence of timing, dose and co-antibiotic. Methods Acute staphylococcal PJIs treated with surgical debridement between 1999 and 2017, and a minimal follow-up of 1 year were evaluated. Treatment failure was defined as the need for any further surgical procedure related to infection, PJI-related death or the need for suppressive antimicrobial treatment. Results A total of 669 patients were analyzed. Treatment failure was 32.2% (131/407) in patients treated with rifampin and 54.2% (142/262) in whom rifampin was withheld (P < .001). The most prominent effect of rifampin was observed in knees (treatment failure 28.6% versus 63.9%, respectively, P < .001). The use of rifampin was an independent predictor of treatment success in the multi-variate analysis (OR 0.30, 95% CI 0.20 – 0.45). In the rifampin group, the use of a co-antibiotic other than a fluoroquinolone or clindamycin (OR 10.1, 95% CI 5.65 – 18.2) and the start of rifampin within 5 days after surgical debridement (OR 1.96, 95% CI 1.08 – 3.65) were predictors of treatment failure. The dosing of rifampin had no effect on outcome. Conclusions Our data supports the use of rifampin in acute staphylococcal PJIs treated with surgical debridement, particularly in knees. Immediate start of rifampin after surgical debridement should probably be discouraged, but requires further investigation.
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Affiliation(s)
- Mark Beldman
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Claudia Löwik
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Alex Soriano
- Department of Infectious Diseases, University of Barcelona, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Laila Albiach
- Department of Infectious Diseases, University of Barcelona, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Wierd P Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Bas A S Knobben
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - Paul Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ricardo Sousa
- Department of Orthopaedic Surgery, Centro Hospitalar do Porto, Porto, Portugal
| | - André Carvalho
- Department of Orthopaedic Surgery, Centro Hospitalar do Porto, Porto, Portugal
| | - Karan Goswami
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Katherine A Belden
- Department of Infectious Diseases, Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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97
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Wouthuyzen-Bakker M, Shohat N, Parvizi J, Soriano A. Risk Scores and Machine Learning to Identify Patients With Acute Periprosthetic Joints Infections That Will Likely Fail Classical Irrigation and Debridement. Front Med (Lausanne) 2021; 8:550095. [PMID: 34012968 PMCID: PMC8126631 DOI: 10.3389/fmed.2021.550095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 03/23/2021] [Indexed: 11/24/2022] Open
Abstract
The most preferred treatment for acute periprosthetic joint infection (PJI) is surgical debridement, antibiotics and retention of the implant (DAIR). The reported success of DAIR varies greatly and depends on a complex interplay of several host-related factors, duration of symptoms, the microorganism(s) causing the infection, its susceptibility to antibiotics and many others. Thus, there is a great clinical need to predict failure of the “classical” DAIR procedure so that this surgical option is offered to those most likely to succeed, but also to identify those patients who may benefit from more intensified antibiotic treatment regimens or new and innovative treatment strategies. In this review article, the current recommendations for DAIR will be discussed, a summary of independent risk factors for DAIR failure will be provided and the advantages and limitations of the clinical use of preoperative risk scores in early acute (post-surgical) and late acute (hematogenous) PJIs will be presented. In addition, the potential of implementing machine learning (artificial intelligence) in identifying patients who are at highest risk for failure of DAIR will be addressed. The ultimate goal is to maximally tailor and individualize treatment strategies and to avoid treatment generalization.
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Affiliation(s)
- Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Noam Shohat
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zriffin, Israel.,Department of Orthopaedic Surgery, Tel Aviv University, Tel Aviv, Israel
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Alex Soriano
- Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
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98
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Löwik CAM, Parvizi J, Jutte PC, Zijlstra WP, Knobben BAS, Xu C, Goswami K, Belden KA, Sousa R, Carvalho A, Martínez-Pastor JC, Soriano A, Wouthuyzen-Bakker M. Debridement, Antibiotics, and Implant Retention Is a Viable Treatment Option for Early Periprosthetic Joint Infection Presenting More Than 4 Weeks After Index Arthroplasty. Clin Infect Dis 2021; 71:630-636. [PMID: 31504331 DOI: 10.1093/cid/ciz867] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/30/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The success of debridement, antibiotics, and implant retention (DAIR) in early periprosthetic joint infection (PJI) largely depends on the presence of a mature biofilm. At what time point DAIR should be disrecommended is unknown. This multicenter study evaluated the outcome of DAIR in relation to the time after index arthroplasty. METHODS We retrospectively evaluated PJIs occurring within 90 days after surgery and treated with DAIR. Patients with bacteremia, arthroscopic debridements, and a follow-up <1 year were excluded. Treatment failure was defined as (1) any further surgical procedure related to infection; (2) PJI-related death; or (3) use of long-term suppressive antibiotics. RESULTS We included 769 patients. Treatment failure occurred in 294 patients (38%) and was similar between time intervals from index arthroplasty to DAIR: the failure rate for Week 1-2 was 42% (95/226), the rate for Week 3-4 was 38% (143/378), the rate for Week 5-6 was 29% (29/100), and the rate for Week 7-12 was 42% (27/65). An exchange of modular components was performed to a lesser extent in the early post-surgical course compared with the late course (41% vs 63%, respectively; P < .001). The causative microorganisms, comorbidities, and durations of symptoms were comparable between time intervals. CONCLUSIONS DAIR is a viable option in patients with early PJI presenting more than 4 weeks after index surgery, as long as DAIR is performed within at least 1 week after the onset of symptoms and modular components can be exchanged.
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Affiliation(s)
- Claudia A M Löwik
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wierd P Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Bas A S Knobben
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Chi Xu
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Karan Goswami
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Katherine A Belden
- Department of Infectious Diseases, Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ricardo Sousa
- Department of Orthopaedic Surgery, Centro Hospitalar do Porto, Porto, Portugal
| | - André Carvalho
- Department of Orthopaedic Surgery and Traumatology, University of Barcelona, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Juan Carlos Martínez-Pastor
- Department of Orthopaedic Surgery and Traumatology, University of Barcelona, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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99
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Marcos M, Belhassen-García M, Sánchez-Puente A, Sampedro-Gomez J, Azibeiro R, Dorado-Díaz PI, Marcano-Millán E, García-Vidal C, Moreiro-Barroso MT, Cubino-Bóveda N, Pérez-García ML, Rodríguez-Alonso B, Encinas-Sánchez D, Peña-Balbuena S, Sobejano-Fuertes E, Inés S, Carbonell C, López-Parra M, Andrade-Meira F, López-Bernús A, Lorenzo C, Carpio A, Polo-San-Ricardo D, Sánchez-Hernández MV, Borrás R, Sagredo-Meneses V, Sanchez PL, Soriano A, Martín-Oterino JÁ. Development of a severity of disease score and classification model by machine learning for hospitalized COVID-19 patients. PLoS One 2021; 16:e0240200. [PMID: 33882060 PMCID: PMC8059804 DOI: 10.1371/journal.pone.0240200] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/08/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Efficient and early triage of hospitalized Covid-19 patients to detect those with higher risk of severe disease is essential for appropriate case management. METHODS We trained, validated, and externally tested a machine-learning model to early identify patients who will die or require mechanical ventilation during hospitalization from clinical and laboratory features obtained at admission. A development cohort with 918 Covid-19 patients was used for training and internal validation, and 352 patients from another hospital were used for external testing. Performance of the model was evaluated by calculating the area under the receiver-operating-characteristic curve (AUC), sensitivity and specificity. RESULTS A total of 363 of 918 (39.5%) and 128 of 352 (36.4%) Covid-19 patients from the development and external testing cohort, respectively, required mechanical ventilation or died during hospitalization. In the development cohort, the model obtained an AUC of 0.85 (95% confidence interval [CI], 0.82 to 0.87) for predicting severity of disease progression. Variables ranked according to their contribution to the model were the peripheral blood oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio, age, estimated glomerular filtration rate, procalcitonin, C-reactive protein, updated Charlson comorbidity index and lymphocytes. In the external testing cohort, the model performed an AUC of 0.83 (95% CI, 0.81 to 0.85). This model is deployed in an open source calculator, in which Covid-19 patients at admission are individually stratified as being at high or non-high risk for severe disease progression. CONCLUSIONS This machine-learning model, applied at hospital admission, predicts risk of severe disease progression in Covid-19 patients.
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Affiliation(s)
- Miguel Marcos
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Moncef Belhassen-García
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Antonio Sánchez-Puente
- Department of Cardiology, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Sampedro-Gomez
- Department of Cardiology, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Raúl Azibeiro
- Department of Hematology, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Pedro-Ignacio Dorado-Díaz
- Department of Cardiology, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Edgar Marcano-Millán
- Department of Intensive Care Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Carolina García-Vidal
- Department of Infectious Diseases, Hospital Clínic-Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - María-Teresa Moreiro-Barroso
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Noelia Cubino-Bóveda
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - María-Luisa Pérez-García
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Beatriz Rodríguez-Alonso
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Daniel Encinas-Sánchez
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Sonia Peña-Balbuena
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Eduardo Sobejano-Fuertes
- Department of Hematology, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Sandra Inés
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Cristina Carbonell
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Miriam López-Parra
- Department of Hematology, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Fernanda Andrade-Meira
- Department of Infectious Diseases, Hospital Clínic-Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Amparo López-Bernús
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Catalina Lorenzo
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Adela Carpio
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - David Polo-San-Ricardo
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | | | - Rafael Borrás
- Department of Emergency Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Víctor Sagredo-Meneses
- Department of Intensive Care Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Pedro-Luis Sanchez
- Department of Cardiology, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic-Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - José-Ángel Martín-Oterino
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
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100
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Moreno-García E, Rico E, Albiach L, Agüero D, Ambrosioni J, Bodro M, Cardozo C, Chumbita M, De la Mora M, García-Pouton N, Garcia-Vidal C, González-Cordón A, Hernández-Meneses M, Inciarte A, Laguno M, Leal L, Linares L, Macay I, Meira F, Mensa J, Moreno A, Morata L, Puerta-Alcalde P, Rojas J, Solá M, Torres B, Torres M, Tomé A, Tuset M, Castro P, Fernández S, Nicolás JM, Almuedo-Riera A, Muñoz J, Fernandez-Pittol M, Marcos MA, Soy D, Martínez JA, García F, Soriano A. Tocilizumab reduces the risk of ICU admission and mortality in patients with SARS-CoV-2 infection. Rev Esp Quimioter 2021; 34:238-244. [PMID: 33829722 PMCID: PMC8179941 DOI: 10.37201/req/037.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objectives In some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management around the world; therefore, clinical strategies to avoid ICU admission are needed. We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients. Material and methods A retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first. Results A total of 77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P=0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In the multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0.1, P=0.0001) of ICU admission or death. Conclusions Tocilizumab in early stages of the inflammatory flare could reduce an important number of ICU admissions and mechanical ventilation. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports. This is a non-randomized study and the results should be interpreted with caution.
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Affiliation(s)
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- Alex Soriano, Department of Infectious Diseases, Hospital Clínic of Barcelona. Carrer de Villarroel 170, 08036, Barcelona, Spain.
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