1
|
Salmanton-García J, Marchesi F, Farina F, Weinbergerová B, Itri F, Dávila-Valls J, Martín-Pérez S, Glenthøj A, Hersby DS, Gomes da Silva M, Nunes Rodrigues R, López-García A, Córdoba R, Bilgin YM, Falces-Romero I, El-Ashwah S, Emarah Z, Besson C, Kohn M, Van Doesum J, Ammatuna E, Marchetti M, Labrador J, Zambrotta GPM, Verga L, Jaksic O, Nucci M, Piukovics K, Cabirta-Touzón A, Jiménez M, Arellano E, Espigado I, Blennow O, Nordlander A, Meers S, van Praet J, Aiello TF, Garcia-Vidal C, Fracchiolla N, Sciumè M, Seval GC, Žák P, Buquicchio C, Tascini C, Gräfe SK, Schönlein M, Adžić-Vukičević T, Bonuomo V, Cattaneo C, Nizamuddin S, Čerňan M, Plantefeve G, Prin R, Szotkovski T, Collins GP, Dargenio M, Petzer V, Wolf D, Čolović N, Prezioso L, Valković T, Passamonti F, Méndez GA, Sili U, Vena A, Bavastro M, Limongelli A, Duarte RF, Ledoux MP, Cvetanoski M, Stojanoski Z, Machado M, Batinić J, Magliano G, Biernat MM, Pantić N, Poulsen CB, Cuccaro A, Del Principe MI, Kulasekararaj A, Ormazabal-Vélez I, Busca A, Demirkan F, Ijaz M, Klimko N, Stoma I, Khostelidi S, Fernández N, Omrani AS, Bergantim R, De Jonge N, Fouquet G, Navrátil M, Abu-Zeinah G, Samarkos M, Maertens J, De Ramón C, Guidetti A, Magyari F, González-López TJ, Lahmer T, Finizio O, Ali N, Pinczés LI, Lavilla-Rubira E, Romano A, Merelli M, Delia M, Calbacho M, Meletiadis J, Antić D, Hernández-Rivas JÁ, Marques de Almeida J, Al-Khabori M, Hoenigl M, Tisi MC, Khanna N, Barać A, Eisa N, Di Blasi R, Liévin R, Miranda-Castillo C, Bahr NC, Lamure S, Papa MV, Yahya A, Aujayeb A, Novák J, Erben N, Fernández-Galán M, Ribera-Santa Susana JM, Rinaldi I, Fazzi R, Piedimonte M, Duléry R, Gonzaga Y, Soto-Silva A, Sapienza G, Serris A, Drgoňa Ľ, Groh A, Serrano L, Gavriilaki E, Tragiannidis A, Prattes J, Coppola N, Otašević V, Mladenović M, Mitrović M, Mišković B, Jindra P, Zompi S, Sacchi MV, Krekeler C, Infante MS, García-Bordallo D, Çolak GM, Mayer J, Nygaard M, Hanáková M, Ráčil Z, Bonanni M, Koehler P, Rahimli L, Cornely OA, Pagano L. Decoding the historical tale: COVID-19 impact on haematological malignancy patients-EPICOVIDEHA insights from 2020 to 2022. EClinicalMedicine 2024; 71:102553. [PMID: 38533127 PMCID: PMC10963230 DOI: 10.1016/j.eclinm.2024.102553] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/28/2024] Open
Abstract
Background The COVID-19 pandemic heightened risks for individuals with hematological malignancies due to compromised immune systems, leading to more severe outcomes and increased mortality. While interventions like vaccines, targeted antivirals, and monoclonal antibodies have been effective for the general population, their benefits for these patients may not be as pronounced. Methods The EPICOVIDEHA registry (National Clinical Trials Identifier, NCT04733729) gathers COVID-19 data from hematological malignancy patients since the pandemic's start worldwide. It spans various global locations, allowing comprehensive analysis over the first three years (2020-2022). Findings The EPICOVIDEHA registry collected data from January 2020 to December 2022, involving 8767 COVID-19 cases in hematological malignancy patients from 152 centers across 41 countries, with 42% being female. Over this period, there was a significant reduction in critical infections and an overall decrease in mortality from 29% to 4%. However, hospitalization, particularly in the ICU, remained associated with higher mortality rates. Factors contributing to increased mortality included age, multiple comorbidities, active malignancy at COVID-19 onset, pulmonary symptoms, and hospitalization. On the positive side, vaccination with one to two doses or three or more doses, as well as encountering COVID-19 in 2022, were associated with improved survival. Interpretation Patients with hematological malignancies still face elevated risks, despite reductions in critical infections and overall mortality rates over time. Hospitalization, especially in ICUs, remains a significant concern. The study underscores the importance of vaccination and the timing of COVID-19 exposure in 2022 for enhanced survival in this patient group. Ongoing monitoring and targeted interventions are essential to support this vulnerable population, emphasizing the critical role of timely diagnosis and prompt treatment in preventing severe COVID-19 cases. Funding Not applicable.
Collapse
Affiliation(s)
- Jon Salmanton-García
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Barbora Weinbergerová
- Masaryk University and University Hospital Brno - Department of Internal Medicine, Hematology and Oncology, Brno, Czech Republic
| | - Federico Itri
- San Luigi Gonzaga Hospital - Orbassano, Orbassano, Italy
| | | | | | - Andreas Glenthøj
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ditte Stampe Hersby
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | | | - Alberto López-García
- Fundación Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Raúl Córdoba
- Fundación Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | | | - Iker Falces-Romero
- Microbiology and Parasitology Department, University Hospital La Paz, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Ziad Emarah
- Oncology Center, Mansoura University, Mansoura, Egypt
- King Abdullah Medical City, Makkah, Saudi Arabia
| | - Caroline Besson
- Centre Hospitalier de Versailles, Le Chesnay, France
- Université Paris-Saclay, UVSQ, Inserm, Équipe “Exposome et Hérédité”, CESP, Villejuif, France
| | - Milena Kohn
- Centre Hospitalier de Versailles, Le Chesnay, France
- Université Paris-Saclay, UVSQ, Inserm, Équipe “Exposome et Hérédité”, CESP, Villejuif, France
| | | | | | - Monia Marchetti
- Hematology and Transplant Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Jorge Labrador
- Department of Hematology, Research Unit, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Luisa Verga
- Azienda Ospedaliera San Gerardo - Monza, Monza, Italy
- Università Milano-Bicocca, Milan, Italy
| | | | - Marcio Nucci
- Department of Internal Medicine, Federal University of Rio de Janeiro and Grupo Oncoclinicas, Rio de Janeiro, Brazil
| | - Klára Piukovics
- Department of Internal Medicine, South Division Faculty of Medicine University of Szeged, Szeged, Hungary
| | - Alba Cabirta-Touzón
- Department of Hematology, Vall d’Hebron Hospital Universitari, Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Moraima Jiménez
- Department of Hematology, Vall d’Hebron Hospital Universitari, Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Elena Arellano
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC), Universidad de Sevilla (Departamento de Medicina), Seville, Spain
| | - Ildefonso Espigado
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC), Universidad de Sevilla (Departamento de Medicina), Seville, Spain
| | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Nordlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jens van Praet
- Department of Nephrology and Infectious diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | - Tommaso Francesco Aiello
- Department of Infectious Diseases, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Nicola Fracchiolla
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariarita Sciumè
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Pavel Žák
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | | | - Carlo Tascini
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | | | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Summiya Nizamuddin
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Martin Čerňan
- University Hospital Olomouc, Olomouc, Czech Republic
| | - Gaëtan Plantefeve
- Head ICU and CRC, Centre Hospitalier Victor DUPOUY, Argenteuil, France
| | - Romane Prin
- CRA from CRC Centre Hospitalier Victor DUPOUY, Argenteuil, France
| | | | | | | | - Verena Petzer
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Dominik Wolf
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | | | - Lucia Prezioso
- Hospital University of Parma - Hematology and Bone Marrow Unit, Parma, Italy
| | - Toni Valković
- University Hospital Centre Rijeka, Rijeka, Croatia
- Croatian Cooperative Group for Hematological Diseases (CROHEM), Croatia
- Faculty of Medicine and Faculty of Health Studies of University of Rijeka, Rijeka, Croatia
| | - Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | | | - Uluhan Sili
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Turkey
| | | | | | | | | | | | | | | | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Josip Batinić
- Croatian Cooperative Group for Hematological Diseases (CROHEM), Croatia
- University Hospital Centre Zagreb, Zagreb, Croatia
- Faculty of Medicine University of Zagreb, Zagreb, Croatia
| | | | | | - Nikola Pantić
- University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Annarosa Cuccaro
- Hematology Unit, Center for Translational Medicine, Azienda USL Toscana NordOvest, Livorno, Italy
- National Cancer Institute, Fondazione ‘G. Pascale’, IRCCS, Hematology-Oncology and Stem Cell Transplantation Unit, Naples, Italy
| | | | - Austin Kulasekararaj
- Department of Hematological Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta’ della Salute e della Scienza, Turin, Italy
| | - Fatih Demirkan
- Dokuz Eylul University, Division of Hematology, Izmir, Turkey
| | - Marriyam Ijaz
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Nikolai Klimko
- North-Western State Medical University Named after Iliá Ilich Méchnikov, Saint-Petersburg, Russia
| | - Igor Stoma
- Gomel State Medical University, Gomel, Belarus
| | - Sofya Khostelidi
- North-Western State Medical University Named after Iliá Ilich Méchnikov, Saint-Petersburg, Russia
| | - Noemí Fernández
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Rui Bergantim
- Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Nick De Jonge
- Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | | | | | | | - Michail Samarkos
- Laikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Anna Guidetti
- University of Milan and Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Ferenc Magyari
- Division of Hematology, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Tobias Lahmer
- Medizinische Klinik II, Klinikum Rechts der Isar, TU München, Munich, Germany
| | | | | | - László Imre Pinczés
- Division of Hematology, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | | | | | - Maria Merelli
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Mario Delia
- Hematology and Stem Cell Transplantation Unit, AOUC Policlinico, Bari, Italy
| | | | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Darko Antić
- University Clinical Center of Serbia, Belgrade, Serbia
| | | | | | | | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center for Clinical Mycology, Department of Internal Medicine, Medical University of Graz, Austria
- BioTechMed, Graz, Austria
| | | | - Nina Khanna
- University Hospital of Basel, Basel, Switzerland
| | | | - Noha Eisa
- Aseer Central Hospital, Abha, Saudi Arabia
- Oncology Center Mansoura University, Mansoura, Egypt
| | | | | | | | - Nathan C. Bahr
- University of Kansas Medical Center, Kansas City, United States
| | - Sylvain Lamure
- Department of Clinical Hematology, Montpellier University Hospital, IGMM UMR5535 CNRS, University of Montpellier, Montpellier, France
| | | | - Ayel Yahya
- Aseer Central Hospital, Abha, Saudi Arabia
| | | | - Jan Novák
- University Hospital of Královské Vinohrady, Prague, Czech Republic
| | - Nurettin Erben
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | | | | | - Rita Fazzi
- Hematology and Stem Cell Transplant Unit, Osperadiela University Pisana Company, Pisa, Italy
| | | | - Rémy Duléry
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Inserm UMRs 938, Paris, France
| | - Yung Gonzaga
- Instituto Nacional do Cancer, Rio de Janeiro, Brazil
| | - Andrés Soto-Silva
- Faculty of Medicine, University of Chile. Infectious Diseases Unity, Salvador Hospital of Santiago, Santiago de Chile, Chile
| | - Giuseppe Sapienza
- Azienda Ospedaliera “Ospedali Riuniti Villa Sofia-Cervello”, Palermo, Italy
| | | | - Ľuboš Drgoňa
- Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Ana Groh
- Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Germany
| | | | - Eleni Gavriilaki
- General Hospital of Thessaloniki “George Papanikolaou”, Thessaloniki, Greece
| | | | | | - Nicola Coppola
- Department of Mental Health and Public Medicine, University of Campania, Naples, Italy
| | | | | | | | - Bojana Mišković
- Center for Radiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Pavel Jindra
- University Hospital Pilsen, Pilsen, Czech Republic
| | - Sofia Zompi
- Stem Cell Transplant Center, AOU Citta’ della Salute e della Scienza, Turin, Italy
| | - Maria Vittoria Sacchi
- Hematology and Transplant Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Carolin Krekeler
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
| | | | | | - Gökçe Melis Çolak
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Jiří Mayer
- Masaryk University and University Hospital Brno - Department of Internal Medicine, Hematology and Oncology, Brno, Czech Republic
| | | | - Michaela Hanáková
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Zdeněk Ráčil
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Matteo Bonanni
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
- Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Philipp Koehler
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Laman Rahimli
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Oliver A. Cornely
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
| | - Livio Pagano
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
- Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
2
|
Aiello TF, Salmanton-Garcia J, Marchesi F, Weinbergerova B, Glenthoj A, Van Praet J, Farina F, Davila-Valls J, Martin-Perez S, El-Ashwah S, Schonlein M, Falces-Romero I, Labrador J, Sili U, Buquicchio C, Vena A, Plantefeve G, Petzer V, Biernat MM, Lahmer T, Espigado I, Van Doesum J, Blennow O, Piukovics K, Tascini C, Samarkos M, Bilgin YM, Fianchi L, Itri F, Valković T, Fracchiolla NS, Dargenio M, Jimenez M, Magyari F, Lopez-Garcia A, Prezioso L, Čolović N, Shumilov E, Abu-Zeinah G, Krekeler C, Lavilla-Rubira E, Papa MV, Gonzalez-Lopez TJ, Pinczes LI, Demirkan F, Ali N, Besson C, Fouquet G, Romano A, Hernandez-Rivas JA, Del Principe MI, Aujayeb A, Merelli M, Lamure S, De Almeida JM, Da Silva MG, Eisa N, Meletiadis J, Rinaldi I, Finizio O, Jaksic O, Delia M, Nizamuddin S, Marchetti M, Ijaz M, Machado M, Bailen-Almorox R, Čerňan M, Coppola N, Gavriilaki E, Cattaneo C, Groh A, Stojanoski Z, Erben N, Pantic N, Mendez GA, Di Blasi R, Meers S, De Ramon C, Bahr NC, Emarah Z, Varricchio G, Cvetanoski M, Garcia-Sanz R, Mitrovic M, Lievin R, Hanakova M, Račil Z, Vehreschild M, Tragiannidis A, Rodrigues RN, Garcia-Bordallo D, Cordoba R, Cabirta A, Nordlander A, Ammatuna E, Arellano E, Wolf D, Prin R, Limongelli A, Bavastro M, Colak GM, Grafe S, Hersby DS, Rahimli L, Cornely OA, Garcia-Vidal C, Pagano L. Dexamethasone treatment for COVID-19 is related to increased mortality in hematologic malignancy patients: results from the EPICOVIDEHA Registry. Haematologica 2024. [PMID: 38572549 DOI: 10.3324/haematol.2023.284678] [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] [Received: 12/12/2023] [Indexed: 04/05/2024] Open
Abstract
Not available.
Collapse
Affiliation(s)
- Tommaso Francesco Aiello
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona
| | - Jon Salmanton-Garcia
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne.
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome
| | - Barbora Weinbergerova
- Department of Internal Medicine - Hematology and Oncology, Masaryk University Hospital Brno, Brno, Czech Republic
| | - Andreas Glenthoj
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jens Van Praet
- Department of Nephrology and Infectious diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge
| | | | | | | | | | - Martin Schonlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Iker Falces-Romero
- La Paz University Hospital, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid
| | - Jorge Labrador
- Department of Hematology, Research Unit, Hospital Universitario de Burgos, Burgos
| | - Uluhan Sili
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul
| | | | | | | | - Verena Petzer
- Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Monika M Biernat
- Department of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Tobias Lahmer
- Medizinische Klinik II, Klinikum rechts der Isar, TU Munchen, Munich
| | - Ildefonso Espigado
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBIS / CSIC), Universidad de Sevilla, Seville
| | | | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Klara Piukovics
- Department of Internal Medicine, South Division Faculty of Medicine University of Szeged, Szeged, Hungary
| | - Carlo Tascini
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine
| | | | | | - Luana Fianchi
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome
| | | | - Toni Valković
- University Hospital Centre Rijeka, Rijeka, Croatia; Croatian Cooperative Group for Hematological Diseases (CROHEM) Faculty of Medicine and Faculty of Health Studies University of Rijeka, Rijeka, Croatia
| | | | | | - Moraima Jimenez
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autonoma de Barcelona, Bellaterra
| | - Ferenc Magyari
- Division of Hematology, Institution of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Alberto Lopez-Garcia
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid
| | - Lucia Prezioso
- Hospital University of Parma - Hematology and Bone Marrow Unit, Parma
| | - Natasha Čolović
- University Clinical Center Serbia, Medical Faculty University Belgrade, Belgrade, Serbia
| | | | - Ghaith Abu-Zeinah
- Division of Hematology and Oncology, Weill Cornell Medicine, New York
| | - Carolin Krekeler
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Munster (UKM), Munster
| | | | | | | | - Laszlo Imre Pinczes
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | | | - Caroline Besson
- Centre Hospitalier de Versailles, Le Chesnay, France; Universite Paris-Saclay, UVSQ, Inserm, Equipe "Exposome et Heredite", CESP, Villejuif
| | | | | | | | | | | | - Maria Merelli
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine
| | - Sylvain Lamure
- Department of Clinical Hematology, Montpellier University Hospital, IGMM UMR5535 CNRS, University of Montpellier, Montpellier
| | | | | | | | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Medical School, "Attikon" University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ikhwan Rinaldi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Ozren Jaksic
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Mario Delia
- Hematology and Stem Cell Transplantation Unit, AOUC Policlinico, Bari
| | | | - Monia Marchetti
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria
| | - Marriyam Ijaz
- Memorial Cancer Hospital and Research Centre, Lahore
| | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Maranon, Madrid
| | | | - Martin Čerňan
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, University of Campania, Naples
| | - Eleni Gavriilaki
- General Hospital of Thessaloniki "George Papanikolaou", Thessaloniki, Greece
| | | | - Ana Groh
- Infektiologie, Universitatsklinikum Frankfurt am Main, Frankfurt am Main
| | | | - Nurettin Erben
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine Eskisehir Osmangazi University, Eskisehir
| | - Nicola Pantic
- University Clinical Center Serbia, Medical Faculty University Belgrade, Belgrade, Serbia
| | | | - Roberta Di Blasi
- Service d'Hematologie-Oncologie, Hopital St Louis, Assistance Publique - Hopitaux de Paris; Universite de Paris Diderot, Paris
| | | | - Cristina De Ramon
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain; IBSAL, Centro de Investigacion del Cancer-IBMCC (USAL-CSIC), Salamanca
| | | | - Ziad Emarah
- Oncology Center, Mansoura University, Mansoura, Egypt
| | | | | | - Ramon Garcia-Sanz
- Hematology Department, Hospital Universitario de Salamanca, Salamanca
| | - Mirjana Mitrovic
- University Clinical Center Serbia, Medical Faculty University Belgrade, Belgrade, Serbia
| | | | - Michaela Hanakova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Zdeněk Račil
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Maria Vehreschild
- Infektiologie, Universitatsklinikum Frankfurt am Main, Frankfurt am Main
| | | | | | | | - Raul Cordoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid
| | - Alba Cabirta
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona
| | - Anna Nordlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Elena Arellano
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBIS / CSIC), Universidad de Sevilla, Seville
| | - Dominik Wolf
- Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | | | | | | | - Gokce Melis Colak
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul
| | - Stefanie Grafe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne
| | - Ditte Stampe Hersby
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Laman Rahimli
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid.
| | - Livio Pagano
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome
| |
Collapse
|
3
|
Gallardo-Pizarro A, Peyrony O, Chumbita M, Monzo-Gallo P, Aiello TF, Teijon-Lumbreras C, Gras E, Mensa J, Soriano A, Garcia-Vidal C. Improving management of febrile neutropenia in oncology patients: the role of artificial intelligence and machine learning. Expert Rev Anti Infect Ther 2024; 22:179-187. [PMID: 38457198 DOI: 10.1080/14787210.2024.2322445] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Artificial intelligence (AI) and machine learning (ML) have the potential to revolutionize the management of febrile neutropenia (FN) and drive progress toward personalized medicine. AREAS COVERED In this review, we detail how the collection of a large number of high-quality data can be used to conduct precise mathematical studies with ML and AI. We explain the foundations of these techniques, covering the fundamentals of supervised and unsupervised learning, as well as the most important challenges, e.g. data quality, 'black box' model interpretation and overfitting. To conclude, we provide detailed examples of how AI and ML have been used to enhance predictions of chemotherapy-induced FN, detection of bloodstream infections (BSIs) and multidrug-resistant (MDR) bacteria, and anticipation of severe complications and mortality. EXPERT OPINION There is promising potential of implementing accurate AI and ML models whilst managing FN. However, their integration as viable clinical tools poses challenges, including technical and implementation barriers. Improving global accessibility, fostering interdisciplinary collaboration, and addressing ethical and security considerations are essential. By overcoming these challenges, we could transform personalized care for patients with FN.
Collapse
Affiliation(s)
| | - Olivier Peyrony
- Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Mariana Chumbita
- Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | | | - Emmanuelle Gras
- Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Josep Mensa
- Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | |
Collapse
|
4
|
Garcia-Vidal C, Teijón-Lumbreras C, Aiello TF, Chumbita M, Menendez R, Mateu-Subirà A, Peyrony O, Monzó P, Lopera C, Gallardo-Pizarro A, Méndez R, Calbo E, Xercavins M, Cuesta-Chasco G, Martínez JA, Marcos MA, Mensa J, Soriano A. K-Means Clustering Identifies Diverse Clinical Phenotypes in COVID-19 Patients: Implications for Mortality Risks and Remdesivir Impact. Infect Dis Ther 2024:10.1007/s40121-024-00938-x. [PMID: 38489118 DOI: 10.1007/s40121-024-00938-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION The impact of remdesivir on mortality in patients with COVID-19 is still controversial. We aimed to identify clinical phenotype clusters of COVID-19 hospitalized patients with highest benefit from remdesivir use and validate these findings in an external cohort. METHODS We included consecutive patients hospitalized between February 2020 and February 2021 for COVID-19. The derivation cohort comprised subjects admitted to Hospital Clinic of Barcelona. The validation cohort included patients from Hospital Universitari Mutua de Terrassa (Terrassa) and Hospital Universitari La Fe (Valencia), all tertiary centers in Spain. We employed K-means clustering to group patients according to reverse transcription polymerase chain reaction (rRT-PCR) cycle threshold (Ct) values and lymphocyte counts at diagnosis, and pre-test symptom duration. The impact of remdesivir on 60-day mortality in each cluster was assessed. RESULTS A total of 1160 patients (median age 66, interquartile range (IQR) 55-78) were included. We identified five clusters, with mortality rates ranging from 0 to 36.7%. Highest mortality rate was observed in the cluster including patients with shorter pre-test symptom duration, lower lymphocyte counts, and lower Ct values at diagnosis. The absence of remdesivir administration was associated with worse outcome in the high-mortality cluster (10.5% vs. 36.7%; p < 0.001), comprising subjects with higher viral loads. These results were validated in an external multicenter cohort of 981 patients. CONCLUSIONS Patients with COVID-19 exhibit varying mortality rates across different clinical phenotypes. K-means clustering aids in identifying patients who derive the greatest mortality benefit from remdesivir use.
Collapse
Affiliation(s)
- Carolina Garcia-Vidal
- Infectious Disease Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain.
- CIBERINF, Barcelona, Spain.
| | - Christian Teijón-Lumbreras
- Infectious Disease Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Tommaso Francesco Aiello
- Infectious Disease Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain.
| | - Mariana Chumbita
- Infectious Disease Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Rosario Menendez
- Respiratory Department, Hospital Universitari La Fe, Valencia, Spain
| | - Aina Mateu-Subirà
- Infectious Disease Department, Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | - Olivier Peyrony
- Emergency Department, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Patricia Monzó
- Infectious Disease Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Carlos Lopera
- Infectious Disease Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Antonio Gallardo-Pizarro
- Infectious Disease Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Raúl Méndez
- Respiratory Department, Hospital Universitari La Fe, Valencia, Spain
| | - Esther Calbo
- Infectious Disease Department, Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mariona Xercavins
- CATLAB. Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Genoveva Cuesta-Chasco
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - José A Martínez
- Infectious Disease Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
- CIBERINF, Barcelona, Spain
| | - Ma Angeles Marcos
- CIBERINF, Barcelona, Spain
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Josep Mensa
- Infectious Disease Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Alex Soriano
- Infectious Disease Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
- CIBERINF, Barcelona, Spain
| |
Collapse
|
5
|
Garcia-Pouton N, Ortiz-Maldonado V, Peyrony O, Chumbita M, Aiello TF, Monzo-Gallo P, Lopera C, Puerta-Alcalde P, Magnano L, Martinez-Cibrian N, Pitart C, Juan M, Delgado J, Fernandez De Larrea C, Soriano Á, Urbano-Ispizua Á, Garcia-Vidal C. Infection epidemiology in relation to different therapy phases in patients with haematological malignancies receiving CAR T-cell therapy. Eur J Haematol 2024; 112:371-378. [PMID: 37879842 DOI: 10.1111/ejh.14122] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND We described the real-life epidemiology and causes of infections on the different therapy phases in patients undergoing chimeric antigen receptor (CAR) T-cells directed towards CD19+ or BCMA+ cells. METHODS All consecutive patients receiving CAR T-cell therapy at our institution were prospectively followed-up. We performed various comparative analyses of all patients and subgroups with and without infections. RESULTS Ninety-one adults mainly received CAR T-cell therapy for acute leukaemia (53%) and lymphoma (33%). We documented a total of 77 infections in 47 (52%) patients, 37 (48%) during the initial neutropenic phase and 40 (52%) during the non-neutropenic phase. Infections during the neutropenic phase were mainly due to bacterial (29, 78%): catheter infections (11 [38%] cases), endogenous source (5 [17%]), and Clostridioides difficile (5 [17%]). Patients receiving corticosteroids after CAR T-cell therapy had a higher risk of endogenous infection (100% vs. 16%; p = .006). During the non-neutropenic phase, bacterial infections remained very frequent (24, 60%), mainly with catheter source (8, 33%). Respiratory tract infections were common (17, 43%). CONCLUSIONS Infections after CAR T-cell therapy were frequent. During the neutropenic phase, it is essential to prevent nosocomial infections and balance the use of antibiotics to lower endogenous bacteraemia and Clostridial infection rates.
Collapse
Affiliation(s)
- Nicol Garcia-Pouton
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Oliver Peyrony
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mariana Chumbita
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Tommaso Francesco Aiello
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Patricia Monzo-Gallo
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carlos Lopera
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Laura Magnano
- Haematology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Nuria Martinez-Cibrian
- Haematology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Cristina Pitart
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Manel Juan
- Immunology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Julio Delgado
- Haematology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Álex Soriano
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBERINF, CIBER in Infectious Diseases, Barcelona, Spain
| | - Álvaro Urbano-Ispizua
- Haematology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBERINF, CIBER in Infectious Diseases, Barcelona, Spain
| |
Collapse
|
6
|
Lahmer T, Salmanton-García J, Marchesi F, El-Ashwah S, Nucci M, Besson C, Itri F, Jaksic O, Čolović N, Weinbergerová B, Seval GC, Adžić-Vukičević T, Szotkowski T, Sili U, Dargenio M, van Praet J, van Doesum J, Schönlein M, Ráčil Z, Žák P, Poulsen CB, Magliano G, Jiménez M, Bonuomo V, Piukovics K, Dragonetti G, Demirkan F, Blennow O, Valković T, Gomes Da Silva M, Maertens J, Glenthøj A, Fernández N, Bergantim R, Verga L, Petzer V, Omrani AS, Méndez GA, Machado M, Ledoux MP, Bailén R, Duarte RF, Del Principe MI, Farina F, Martín-Pérez S, Dávila-Valls J, Marchetti M, Bilgin YM, Fracchiolla NS, Cattaneo C, Espigado I, Cordoba R, Collins GP, Labrador J, Falces-Romero I, Prezioso L, Meers S, Passamonti F, Buquicchio C, López-García A, Kulasekararaj A, Ormazabal-Vélez I, Cuccaro A, Garcia-Vidal C, Busca A, Navrátil M, de Jonge N, Biernat MM, Guidetti A, Abu-Zeinah G, Samarkos M, Anastasopoulou A, de Ramón C, González-López TJ, Hoenigl M, Finizio O, Pinczés LI, Ali N, Vena A, Tascini C, Stojanoski Z, Merelli M, Emarah Z, Kohn M, Barać A, Mladenović M, Mišković B, Ilhan O, Çolak GM, Čerňan M, Gräfe SK, Ammatuna E, Hanakova M, Víšek B, Cabirta A, Nordlander A, Nunes Rodrigues R, Hersby DS, Zambrotta GPM, Wolf D, Núñez-Martín-Buitrago L, Arellano E, Aiello TF, García-Sanz R, Prattes J, Egger M, Limongelli A, Bavastro M, Cvetanoski M, Dibos M, Rasch S, Rahimli L, Cornely OA, Pagano L. Need for ICU and outcome of critically ill patients with COVID-19 and haematological malignancies: results from the EPICOVIDEHA survey. Infection 2024:10.1007/s15010-023-02169-7. [PMID: 38388854 DOI: 10.1007/s15010-023-02169-7] [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: 11/10/2023] [Accepted: 12/23/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Tobias Lahmer
- Medizinische Klinik II, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Jon Salmanton-García
- Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Herderstraße 52-54, 50931, Cologne, Germany.
- Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Marcio Nucci
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Caroline Besson
- Centre Hospitalier de Versailles, Le Chesnay, France; Université Paris-Saclay, UVSQ, Inserm, Équipe "Exposome et Hérédité", CESP, Villejuif, France
| | - Federico Itri
- San Luigi Gonzaga Hospital - Orbassano, Orbassano, Italy
| | - Ozren Jaksic
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Natasha Čolović
- University Clinical Center Serbia, Medical Faculty University Belgrade, Belgrade, Serbia
| | - Barbora Weinbergerová
- Department of Internal Medicine - Hematology and Oncology, Masaryk University Hospital Brno, Brno, Czech Republic
| | | | | | | | - Uluhan Sili
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Michelina Dargenio
- Hematology and Stem Cell Transplan Unit, Vito Fazzi Hospital, Lecce, Italy
| | - Jens van Praet
- Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | | | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zdeněk Ráčil
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Pavel Žák
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | | | | | - Moraima Jiménez
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Valentina Bonuomo
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Klára Piukovics
- Department of Internal Medicine, South Division Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Giulia Dragonetti
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | - Fatih Demirkan
- Division of Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Toni Valković
- University Hospital Centre Rijeka, Rijeka, Croatia
- Croatian Cooperative Group for Hematological Diseases (CROHEM), Faculty of Medicine and Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
| | | | - Johan Maertens
- Department of Microbiology, Immunology, and Transplantation, KULeuven, Leuven and Department of Hematology, UZ Leuven, Louvain, Belgium
| | - Andreas Glenthøj
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Noemí Fernández
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Rui Bergantim
- Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Luisa Verga
- Azienda Ospedaliera San Gerardo - Monza, Monza, Italy
- Università Milano-Bicocca, Milan, Italy
| | - Verena Petzer
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Ali S Omrani
- Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Rebeca Bailén
- Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | - Monia Marchetti
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Yavuz M Bilgin
- Department of Internal Medicine, ADRZ, Goes, Netherlands
| | | | | | - Ildefonso Espigado
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS / CSIC), Universidad de Sevilla (Departamento de Medicina), Seville, Spain
| | - Raul Cordoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Graham P Collins
- NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - Jorge Labrador
- Department of Hematology, Research Unit, Hospital Universitario de Burgos, Burgos, Spain
- Facultad de Ciencias de la Salud, Universidad Isabel I, Burgos, Spain
| | - Iker Falces-Romero
- La Paz University Hospital, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Lucia Prezioso
- Hospital University of Parma - Hematology and Bone Marrow Unit, Parma, Italy
| | | | - Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | | | - Alberto López-García
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | | | | | - Annarosa Cuccaro
- Hematology Unit, Center for Translational Medicine, Azienda USL Toscana NordOvest, Leghorn, Italy
| | | | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Milan Navrátil
- Head of the ICU and Transplant Unit, Department of Hematooncology, University Hospital of Ostrava, Ostrava-Poruba, Czech Republic
| | - Nick de Jonge
- Amsterdam UMC, location VUmc, Amsterdam, Netherlands
| | - Monika M Biernat
- Department of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Guidetti
- University of Milan and Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Ghaith Abu-Zeinah
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, USA
| | | | | | - Cristina de Ramón
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
- IBSAL, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | | | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
| | | | - László Imre Pinczés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | | | - Carlo Tascini
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | | | - Maria Merelli
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Ziad Emarah
- Oncology Center, Mansoura University, Mansoura, Egypt
| | - Milena Kohn
- Centre Hospitalier de Versailles, Versailles, France
| | - Aleksandra Barać
- Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miloš Mladenović
- COVID hospital ""Batajnica"", Belgrade, Serbia
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Bojana Mišković
- Center for Radiology, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Gökçe Melis Çolak
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Martin Čerňan
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Stefanie K Gräfe
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Michaela Hanakova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Benjamín Víšek
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Alba Cabirta
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Anna Nordlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Ditte Stampe Hersby
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Dominik Wolf
- Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Elena Arellano
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS / CSIC), Universidad de Sevilla (Departamento de Medicina), Seville, Spain
| | | | - Ramón García-Sanz
- Head of Molecular Biology an HLA Unit, Department of Hematology, University Hospital of Salamanca (HUS/IBSAL/CIBERONC), Salamanca, Spain
| | | | - Matthias Egger
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | | | | | - Miriam Dibos
- Medizinische Klinik II, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Sebastian Rasch
- Medizinische Klinik II, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Laman Rahimli
- Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Herderstraße 52-54, 50931, Cologne, Germany
- Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Oliver A Cornely
- Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Herderstraße 52-54, 50931, Cologne, Germany
- Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
- Faculty of Medicine, and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
- Faculty of Medicine, and University Hospital Cologne, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Livio Pagano
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
- Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
7
|
López N, Cuesta G, Rodríguez-Vega S, Rosas E, Chumbita M, Casals-Pascual C, Morata L, Vergara A, Bodro M, Bosch J, Herrera S, Martínez JA, Mensa J, Garcia-Vidal C, Marcos MÁ, Vila J, Soriano A, Puerta-Alcalde P. Multiplex real-time PCR FilmArray performance in the diagnosis of meningoencephalitis: lights and shadows. Infection 2024; 52:165-172. [PMID: 37515691 PMCID: PMC10810907 DOI: 10.1007/s15010-023-02076-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE We aimed to evaluate the performance of the FilmArray (FA) meningitis/encephalitis (ME) panel. Secondarily, we analyzed the false positive (FP) and false negative (FN) results, as well as the predictive values of the technique, regarding the cerebrospinal fluid (CSF) characteristics. METHODS FA is a multiplex real-time PCR detecting 14 of the most common ME pathogens in CSF. All FA performed at our hospital (2018-2022) were retrospectively reviewed. FA was compared to conventional techniques and its performance was assessed based on the final diagnosis of the episode. RESULTS FA was performed in 313 patients with suspicion of ME. Most patients had altered mental status (65.2%) and fever (61%). Regarding CSF characteristics, 49.8% and 53.7% presented high CSF proteins and pleocytosis, respectively. There were 84 (26.8%) positive FA results, mainly for HSV-1 (10.9%), VZV (5.1%), Enterovirus (2.6%), and S. pneumoniae (1.9%). In the 136 cases where both FA and routine methods were performed, there was a 25.7% lack of agreement. We identified 6.6% FN results, but 28.6% FP, mainly due to HSV-1. This resulted in a high negative predictive value (NPV) of 93.4%, but a positive predictive value (PPV) of 73%. Remarkably, PPV as low as 36.9%, and 70.2%, were found in cases without pleocytosis, or lack of high CSF protein levels, respectively. CONCLUSION FA was associated with high NPV, but frequent FP results and low PPV, particularly for HSV-1, and especially in patients without high CSF protein levels or pleocytosis.
Collapse
Affiliation(s)
- Néstor López
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Genoveva Cuesta
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | | | - Enric Rosas
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Mariana Chumbita
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Climent Casals-Pascual
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Laura Morata
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Andrea Vergara
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Jordi Bosch
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Sabina Herrera
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Jose Antonio Martínez
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Josep Mensa
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - María Ángeles Marcos
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Jordi Vila
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain.
- Universitat de Barcelona (UB), Barcelona, Spain.
| |
Collapse
|
8
|
Musto P, Salmanton-García J, Sgherza N, Bergantim R, Farina F, Glenthøj A, Cengiz Seval G, Weinbergerová B, Bonuomo V, Bilgin YM, van Doesum J, Jaksic O, Víšek B, Falces-Romero I, Marchetti M, Dávila-Valls J, Martín-Pérez S, Nucci M, López-García A, Itri F, Buquicchio C, Verga L, Piukovics K, Navrátil M, Collins GP, Jiménez M, Fracchiolla NS, Labrador J, Prezioso L, Rossi E, Čolović N, Meers S, Kulasekararaj A, Cuccaro A, Blennow O, Valković T, Sili U, Ledoux MP, Batinić J, Passamonti F, Machado M, Duarte RF, Poulsen CB, Méndez GA, Espigado I, Demirkan F, Čerňan M, Cattaneo C, Petzer V, Magliano G, Garcia-Vidal C, El-Ashwah S, Gomes-Da-Silva M, Vena A, Ormazabal-Vélez I, van Praet J, Dargenio M, De-Ramón C, Del Principe MI, Marques-De-Almeida J, Wolf D, Szotkowski T, Obr A, Çolak GM, Nordlander A, Izuzquiza M, Cabirta A, Zambrotta GPM, Cordoba R, Žák P, Ammatuna E, Mayer J, Ilhan O, García-Sanz R, Quattrone M, Arellano E, Nunes-Rodrigues R, Emarah Z, Aiello TF, Hanakova M, Ráčil Z, Bavastro M, Limongelli A, Rahimli L, Marchesi F, Cornely OA, Pagano L. Survival in multiple myeloma and SARS-COV-2 infection through the COVID-19 pandemic: Results from the EPICOVIDEHA registry. Hematol Oncol 2024; 42:e3240. [PMID: 38050405 DOI: 10.1002/hon.3240] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/17/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023]
Abstract
Patients affected by multiple myeloma (MM) have an increased risk of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection and subsequent coronavirus (20)19 disease (COVID-19)-related death. The changing epidemiological and therapeutic scenarios suggest that there has been an improvement in severity and survival of COVID-19 during the different waves of the pandemic in the general population, but this has not been investigated yet in MM patients. Here we analyzed a large cohort of 1221 patients with MM and confirmed SARS-CoV-2 infection observed between February 2020, and August 2022, in the EPICOVIDEHA registry from 132 centers around the world. Median follow-up was 52 days for the entire cohort and 83 days for survivors. Three-hundred and three patients died (24%) and COVID-19 was the primary reason for death of around 89% of them. Overall survival (OS) was significantly higher in vaccinated patients with both stable and active MM versus unvaccinated, while only a trend favoring vaccinated patients was observed in subjects with responsive MM. Vaccinated patients with at least 2 doses showed a better OS than those with one or no vaccine dose. Overall, according to pandemic waves, mortality rate decreased over time from 34% to 10%. In multivariable analysis, age, renal failure, active disease, hospital, and intensive care unit admission, were independently associated with a higher number of deaths, while a neutrophil count above 0.5 × 109 /L was found to be protective. This data suggests that MM patients remain at risk of SARS-CoV-2 infection even in the vaccination era, but their clinical outcome, in terms of OS, has progressively improved throughout the different viral phases of the pandemic.
Collapse
Affiliation(s)
- Pellegrino Musto
- Department of Precision and Regenerative Medicine and Ionian Area, "Aldo Moro" University School of Medicine, Bari, Italy
- Hematology and Stem Cell Transplantation Unit, AOUC Policlinico, Bari, Italy
| | - Jon Salmanton-García
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Nicola Sgherza
- Hematology and Stem Cell Transplantation Unit, AOUC Policlinico, Bari, Italy
| | - Rui Bergantim
- Centro Hospitalar e Universitário São João, Porto, Portugal
| | | | - Andreas Glenthøj
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Barbora Weinbergerová
- Department of Internal Medicine - Hematology and Oncology, Masaryk University Hospital Brno, Brno, Czech Republic
| | - Valentina Bonuomo
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Yavuz M Bilgin
- Department of Internal Medicine, ADRZ, Goes, Netherlands
| | | | - Ozren Jaksic
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Benjamín Víšek
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Iker Falces-Romero
- La Paz University Hospital, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Monia Marchetti
- Azienda Ospedaliera Nazionale SS, Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | - Marcio Nucci
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alberto López-García
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Federico Itri
- San Luigi Gonzaga Hospital - Orbassano, Orbassano, Italy
| | | | - Luisa Verga
- Azienda Ospedaliera San Gerardo - Monza, Monza, Italy
- Università Milano-Bicocca, Milan, Italy
| | - Klára Piukovics
- Department of Internal Medicine, South Division Faculty of Medicine University of Szeged, Szeged, Hungary
| | - Milan Navrátil
- Head of the ICU and Transplant Unit, Department of Hematooncology, University Hospital of Ostrava, Ostrava-Poruba, Czech Republic
| | - Graham P Collins
- NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - Moraima Jiménez
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | | | - Jorge Labrador
- Department of Hematology, Research Unit, Hospital Universitario de Burgos, Burgos, Spain
| | - Lucia Prezioso
- Hospital University of Parma - Hematology and Bone Marrow Unit, Parma, Italy
| | - Elena Rossi
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | - Natasha Čolović
- University Clinical Center Serbia, Medical Faculty University Belgrade, Belgrade, Serbia
| | | | | | - Annarosa Cuccaro
- Hematology Unit, Center for Translational Medicine, Azienda USL Toscana NordOvest, Livorno, Italy
| | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Toni Valković
- University Hospital Centre Rijeka, Rijeka, Croatia
- Croatian Cooperative Group for Hematological Diseases (CROHEM), Faculty of Medicine and Faculty of Health Studies University of Rijeka, Rijeka, Croatia
| | - Uluhan Sili
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Turkey
| | | | - Josip Batinić
- University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine University of Zagreb, Zagreb, Croatia
| | - Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - Ildefonso Espigado
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS / CSIC), Universidad de Sevilla (Departamento de Medicina), Seville, Spain
| | - Fatih Demirkan
- Division of Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Martin Čerňan
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | | | - Verena Petzer
- Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | | | | | | | | | - Antonio Vena
- Clinica Malattie Infettive. Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Jens van Praet
- Department of Nephrology and Infectious diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | | | - Cristina De-Ramón
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
- IBSAL, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | | | | | - Dominik Wolf
- Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Aleš Obr
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Gökçe Melis Çolak
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Anna Nordlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Macarena Izuzquiza
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Alba Cabirta
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Raul Cordoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Pavel Žák
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | | | - Jiří Mayer
- Department of Internal Medicine - Hematology and Oncology, Masaryk University Hospital Brno, Brno, Czech Republic
| | | | - Ramón García-Sanz
- IBSAL, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
- Head of Molecular Biology an HLA Unit, Department of Hematology, University Hospital of Salamanca (HUS/IBSAL/CIBERONC), Salamanca, Spain
| | - Martina Quattrone
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | - Elena Arellano
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS / CSIC), Universidad de Sevilla (Departamento de Medicina), Seville, Spain
| | | | - Ziad Emarah
- Oncology Center, Mansoura University, Mansoura, Egypt
| | | | - Michaela Hanakova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Zdeněk Ráčil
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Martina Bavastro
- Clinica Malattie Infettive. Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Alessandro Limongelli
- Clinica Malattie Infettive. Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Laman Rahimli
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Molecular Medicine Cologne (CMMC), Cologne, Germany
| | - Livio Pagano
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| |
Collapse
|
9
|
Téllez Santoyo A, Lopera C, Ladino Vásquez A, Seguí Fernández F, Grafiá Pérez I, Chumbita M, Aiello TF, Monzó P, Peyrony O, Puerta-Alcalde P, Cardozo C, Garcia-Pouton N, Castro P, Fernández Méndez S, Nicolas Arfelis JM, Soriano A, Garcia-Vidal C. Identifying the most important data for research in the field of infectious diseases: thinking on the basis of artificial intelligence. Rev Esp Quimioter 2023; 36:592-596. [PMID: 37575020 DOI: 10.37201/req/032.2023] [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] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Clinical data on which artificial intelligence (AI) algorithms are trained and tested provide the basis to improve diagnosis or treatment of infectious diseases (ID). We aimed to identify important data for ID research to prioritise efforts being undertaken in AI programmes. METHODS We searched for 1,000 articlesfrom high-impact ID journals on PubMed, selecting 288 of the latest articles from 10 top journals. We classified them into structured or unstructured data. Variables were homogenised and grouped into the following categories: epidemiology, admission, demographics, comorbidities, clinical manifestations, laboratory, microbiology, other diagnoses, treatment, outcomes and other non-categorizable variables. RESULTS 4,488 individual variables were collected, from the 288 articles. 3,670 (81.8%) variables were classified as structured data whilst 818 (18.2%) as unstructured data. From the structured data, 2,319 (63.2%) variables were classified as direct-retrievable from electronic health records-whilst 1,351 (36.8%) were indirect. The most frequent unstructured data were related to clinical manifestations and were repeated across articles. Data on demographics, comorbidities and microbiology constituted the most frequent group of variables. CONCLUSIONS This article identified that structured variables have comprised the most important data in research to generate knowledge in the field of ID. Extracting these data should be a priority when a medical centre intends to start an AI programme for ID. We also documented that the most important unstructured data in this field are those related to clinical manifestations. Such data could easily undergo some structuring with the use of semi-structured medical records focusing on a few symptoms.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - C Garcia-Vidal
- Carolina Garcia-Vidal, MD, PhD. Infectious Diseases Department, Hospital Clínic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain. and
| |
Collapse
|
10
|
Egger M, Salmanton-García J, Barac A, Gangneux JP, Guegan H, Arsic-Arsenijevic V, Matos T, Tomazin R, Klimko N, Bassetti M, Hammarström H, Meijer EFJ, Meis JF, Prattes J, Krause R, Resat Sipahi O, Scharmann U, White PL, Desoubeaux G, García-Rodríguez J, Garcia-Vidal C, Martín-Pérez S, Ruiz M, Tumbarello M, Talento AF, Rogers B, Lagrou K, van Praet J, Arikan-Akdagli S, Arendrup MC, Koehler P, Cornely OA, Hoenigl M. Predictors for Prolonged Hospital Stay Solely to Complete Intravenous Antifungal Treatment in Patients with Candidemia: Results from the ECMM Candida III Multinational European Observational Cohort Study. Mycopathologia 2023; 188:983-994. [PMID: 37566212 PMCID: PMC10687104 DOI: 10.1007/s11046-023-00776-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND To date, azoles represent the only viable option for oral treatment of invasive Candida infections, while rates of azole resistance among non-albicans Candida spp. continue to increase. The objective of this sub-analysis of the European multicenter observational cohort study Candida III was to describe demographical and clinical characteristics of the cohort requiring prolonged hospitalization solely to complete intravenous (iv) antifungal treatment (AF Tx). METHODS Each participating hospital (number of eligible hospitals per country determined by population size) included the first ~ 10 blood culture proven adult candidemia cases occurring consecutively after July 1st, 2018, and treating physicians answered the question on whether hospital stay was prolonged only for completion of intravenous antifungal therapy. Descriptive analyses as well as binary logistic regression was used to assess for predictors of prolonged hospitalization solely to complete iv AF Tx. FINDINGS Hospital stay was prolonged solely for the completion of iv AF Tx in 16% (100/621) of candidemia cases by a median of 16 days (IQR 8 - 28). In the multivariable model, initial echinocandin treatment was a positive predictor for prolonged hospitalization to complete iv AF Tx (aOR 2.87, 95% CI 1.55 - 5.32, p < 0.001), while (i) neutropenia, (ii) intensive care unit admission, (iii) catheter related candidemia, (iv) total parenteral nutrition, and (v) C. parapsilosis as causative pathogen were found to be negative predictors (aOR 0.22 - 0.45; p < 0.03). INTERPRETATION Hospital stays were prolonged due to need of iv AF Tx in 16% of patients with candidemia. Those patients were more likely to receive echinocandins as initial treatment and were less severely ill and less likely infected with C. parapsilosis.
Collapse
Affiliation(s)
- Matthias Egger
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Biotech Med, Graz, Austria
- Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
| | - Jon Salmanton-García
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jean-Pierre Gangneux
- CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en santé, environnement et travail), Univ Rennes, UMR_S 1085, 35000, Rennes, France
| | - Hélène Guegan
- CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en santé, environnement et travail), Univ Rennes, UMR_S 1085, 35000, Rennes, France
| | - Valentina Arsic-Arsenijevic
- Faculty of Medicine, Institute of Microbiology and Immunology, Medical Mycology Reference Laboratory (MMRL), University of Belgrade, Belgrade, Serbia
- Centre for Microbiology, Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | - Tadeja Matos
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rok Tomazin
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nikolai Klimko
- Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University, St Petersburg, Russia
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Infectious Diseases Unit, Genoa, Italy
| | - Helena Hammarström
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eelco F J Meijer
- Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, the Netherlands
- Center of Expertise for Mycology Radboudumc-CWZ, Nijmegen, the Netherlands
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacques F Meis
- Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, the Netherlands
- Center of Expertise for Mycology Radboudumc-CWZ, Nijmegen, the Netherlands
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Juergen Prattes
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Biotech Med, Graz, Austria
- Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Biotech Med, Graz, Austria
- Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
| | - Oguz Resat Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ulrike Scharmann
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - P Lewis White
- Public Health Wales, Center for Trials Research/Division of Infection/Immunity, Microbiology Cardiff and Cardiff University, Cardiff, UK
| | - Guillaume Desoubeaux
- Department of Parasitology-Mycology-Tropical Medicine, CHRU de Tours, Tours, France
| | | | | | | | - Maite Ruiz
- Unit of Infectious Diseases and Microbiology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocio, Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | | | | | - Benedict Rogers
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Louvain, Belgium
- Department of Laboratory Medicine, and National Reference Centre for Mycosis, University Hospitals Leuven, Louvain, Belgium
| | - Jens van Praet
- Nephrology and Infectious Diseases, AZ Sint-Jan Brugge Oostende AV, Brugge, Belgium
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey
| | - Maiken C Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Philipp Koehler
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
- Biotech Med, Graz, Austria.
- Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria.
| |
Collapse
|
11
|
Rossi G, Salmanton-García J, Cattaneo C, Marchesi F, Dávila-Valls J, Martín-Pérez S, Itri F, López-García A, Glenthøj A, Gomes da Silva M, Besson C, Marchetti M, Weinbergerová B, Jaksic O, Jiménez M, Bilgin YM, Van Doesum J, Farina F, Žák P, Verga L, Collins GP, Bonuomo V, Van Praet J, Nucci M, Meers S, Espigado I, Fracchiolla NS, Valković T, Poulsen CB, Čolović N, Dragonetti G, Ledoux MP, Tascini C, Buquicchio C, Blennow O, Passamonti F, Machado M, Labrador J, Duarte RF, Schönlein M, Prezioso L, Falces-Romero I, Kulasekararaj A, Garcia-Vidal C, Fernández N, Abu-Zeinah G, Ormazabal-Vélez I, Adžić-Vukičević T, Piukovics K, Stoma I, Cuccaro A, Magliano G, Szotkowski T, González-López TJ, El-Ashwah S, Bergantim R, Sili U, Maertens J, Demirkan F, De Ramón C, Petzer V, Del Principe MI, Navrátil M, Dargenio M, Seval GC, Samarkos M, Ráčil Z, Pinczés LI, Lahmer T, Busca A, Méndez GA, Vena A, Biernat MM, Merelli M, Calbacho M, Barać A, Bavastro M, Limongelli A, Ilhan O, Wolf D, Çolak GM, García-Sanz R, Emarah Z, Mišković B, Gräfe SK, Mladenović M, Aiello TF, Núñez-Martín-Buitrago L, Nordlander A, Arellano E, Zambrotta GPM, Ammatuna E, Cabirta A, Sacchi MV, Nunes Rodrigues R, Hersby DS, Hanakova M, Rahimli L, Cordoba R, Cornely OA, Pagano L. Age, successive waves, immunization, and mortality in elderly COVID-19 hematological patients: EPICOVIDEHA findings. Int J Infect Dis 2023; 137:98-110. [PMID: 37863310 DOI: 10.1016/j.ijid.2023.10.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/16/2023] [Accepted: 10/13/2023] [Indexed: 10/22/2023] Open
Abstract
OBJECTIVES Elderly patients with hematologic malignancies face the highest risk of severe COVID-19 outcomes. The infection's impact on different age groups remains unstudied in detail. METHODS We analyzed elderly patients (age groups: 65-70, 71-75, 76-80, and >80 years old) with hematologic malignancies included in the EPICOVIDEHA registry between January 2020 and July 2022. Univariable and multivariable Cox regression models were conducted to identify factors influencing death in COVID-19 patients with hematological malignancy. RESULTS The study included data from 3,603 elderly patients (aged 65 or older) with hematological malignancy, with a majority being male (58.1%) and a significant proportion having comorbidities. The patients were divided into four age groups, and the analysis assessed COVID-19 outcomes, vaccination status, and other variables in relation to age and pandemic waves. The 90-day survival rate for patients with COVID-19 was 71.2%, with significant differences between groups. The pandemic waves had varying impacts, with the first wave affecting patients over 80 years old, the second being more severe in 65-70, and the third being the least severe in all age groups. Factors contributing to 90-day mortality included age, comorbidities, lymphopenia, active malignancy, acute leukemia, less than three vaccine doses, severe COVID-19, and using only corticosteroids as treatment. CONCLUSION These data underscore the heterogeneity of elderly hematological patients, highlight the different impacts of COVID-19 waves and the pivotal importance of vaccination, and may help in planning future healthcare efforts.
Collapse
Affiliation(s)
| | - Jon Salmanton-García
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
| | | | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Federico Itri
- San Luigi Gonzaga Hospital - Orbassano, Orbassano, Italy
| | - Alberto López-García
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Andreas Glenthøj
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Caroline Besson
- Centre Hospitalier de Versailles, Le Chesnay, France; Université Paris-Saclay, UVSQ, Inserm, Équipe "Exposome et Hérédité", CESP, Villejuif, France
| | - Monia Marchetti
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Barbora Weinbergerová
- Department of Internal Medicine - Hematology and Oncology, Masaryk University Hospital Brno, Brno, Czech Republic
| | - Ozren Jaksic
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Moraima Jiménez
- Department of Hematology, Vacute lymphoid leukaemia d'Hebron Hospital Universitari, Experimental Hematology, Vacute lymphoid leukaemia d'Hebron Institute of Oncology (VHIO), Vacute lymphoid leukaemia d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Yavuz M Bilgin
- Department of Internal Medicine, ADRZ, Goes, Netherlands
| | | | | | - Pavel Žák
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Luisa Verga
- Azienda Ospedaliera San Gerardo - Monza, Monza, Italy; Università Milano-Bicocca, Milan, Italy
| | - Graham P Collins
- NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, United Kingdom
| | - Valentina Bonuomo
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy; Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Jens Van Praet
- Department of Nephrology and Infectious diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | - Marcio Nucci
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Ildefonso Espigado
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS / CSIC), Universidad de Sevilla (Departamento de Medicina), Seville, Spain
| | | | - Toni Valković
- University Hospital Centre Rijeka, Rijeka, Croatia; Croatian Cooperative Group for Hematological Diseases (CROHEM), Faculty of Medicine and Faculty of Health Studies University of Rijeka, Rijeka, Croatia
| | | | - Natasha Čolović
- University Clinical Center Serbia, Medical Faculty University Belgrade, Belgrade, Serbia
| | - Giulia Dragonetti
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | | | - Carlo Tascini
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | | | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge Labrador
- Department of Hematology, Research Unit, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lucia Prezioso
- Hospital University of Parma - Hematology and Bone Marrow Unit, Parma, Italy
| | - Iker Falces-Romero
- La Paz University Hospital, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Austin Kulasekararaj
- King's College Hospital, London, United Kingdom; King's College London, London, United Kingdom
| | | | - Noemí Fernández
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ghaith Abu-Zeinah
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, United States
| | | | | | - Klára Piukovics
- Department of Internal Medicine, South Division Faculty of Medicine University of Szeged, Szeged, Hungary
| | - Igor Stoma
- Gomel State Medical University, Gomel, Belarus
| | - Annarosa Cuccaro
- Hematology Unit, Center for Translational Medicine, Azienda USL Toscana NordOvest, Livorno, Italy
| | | | | | | | | | - Rui Bergantim
- Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Uluhan Sili
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Johan Maertens
- Department of Microbiology, Immunology, and Transplantation, KULeuven, Leuven and Department of Hematology, UZ Leuven, Leuven, Belgium
| | - Fatih Demirkan
- Dokuz Eylul University, Division of Hematology, Izmir, Turkey
| | - Cristina De Ramón
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain; IBSAL, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Verena Petzer
- Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Milan Navrátil
- Head of the ICU and Transplant Unit, Department of Hematooncology, University Hospital of Ostrava, Ostrava-Poruba, Czech Republic
| | | | | | | | - Zdeněk Ráčil
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - László Imre Pinczés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tobias Lahmer
- Medizinische Klinik II, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy
| | | | - Antonio Vena
- IRCCS AOU San Martino (IRCCS Ospedale Policlinico San Martino), Genova, Italia
| | - Monika M Biernat
- Department of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Maria Merelli
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | | | - Aleksandra Barać
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia
| | - Martina Bavastro
- IRCCS AOU San Martino (IRCCS Ospedale Policlinico San Martino), Genova, Italia
| | | | | | - Dominik Wolf
- Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gökçe Melis Çolak
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ramón García-Sanz
- IBSAL, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain; Head of Molecular Biology an HLA Unit, Department of Hematology, University Hospital of Salamanca (HUS/IBSAL/CIBERONC), Salamanca, Spain
| | - Ziad Emarah
- Oncology Center, Mansoura University, Mansoura, Egypt
| | - Bojana Mišković
- Hospital Clinic, Barcelona, Spain; Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Stefanie K Gräfe
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Anna Nordlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Elena Arellano
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS / CSIC), Universidad de Sevilla (Departamento de Medicina), Seville, Spain
| | | | | | - Alba Cabirta
- Department of Hematology, Vacute lymphoid leukaemia d'Hebron Hospital Universitari, Experimental Hematology, Vacute lymphoid leukaemia d'Hebron Institute of Oncology (VHIO), Vacute lymphoid leukaemia d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Vittoria Sacchi
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Ditte Stampe Hersby
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Michaela Hanakova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Laman Rahimli
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Raul Cordoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany; University of Cologne, Faculty of Medicine, and University Hospital Cologne, Center for Molecular Medicine Cologne (CMMC), Cologne, Germany
| | - Livio Pagano
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy; Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
12
|
Puerta-Alcalde P, Garcia-Vidal C, Soriano A. Prevention and treatment of C. difficile in cancer patients. Curr Opin Infect Dis 2023; 36:473-480. [PMID: 37527003 DOI: 10.1097/qco.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW We provide an update on the recent literature on Clostridioides difficile infection (CDI) in cancer patients. RECENT FINDINGS Distinguishing between colonization and infection remains challenging in cancer patients. Many patients with negative toxin analysis are still treated for CDI, and some meet criteria for severe cases. The incidence of CDI is high in cancer patients, especially those with haematological malignancies. Disruption of the gut microbiome due to antibiotic consumption, chemotherapy and radiotherapy is the primary factor contributing to CDI development. The severity of CDI in cancer patients is often unclear due to the absence of well-defined severity criteria. Certain microbiome species predominance and specific ribotypes have been associated with worse outcomes. Whole genome sequencing could be helpful for differentiating recurrence from reinfection and exploring potential nosocomial transmission. While certain new drugs such as fidaxomicin or bezlotoxumab show promise, the optimal treatment and prevention strategies for CDI in cancer patients remain uncertain. Faecal microbiota transplantation (FMT) holds potential for reducing CDI recurrence rates. SUMMARY Further studies are needed to provide robust recommendations for diagnosis, grading severity, and therapeutic management of CDI in cancer patients. Recurrences are particularly concerning due to subsequent exposition to CDI risk factors.
Collapse
|
13
|
García-Poutón N, Peyrony O, Chumbita M, Aiello F, Monzo P, Gallardo-Pizarro A, Garcia-Vidal C. Post-CART-T Cell Infection: Etiology, pathogenesis, and therapeutic approaches. Rev Esp Quimioter 2023; 36 Suppl 1:52-53. [PMID: 37997872 PMCID: PMC10793555 DOI: 10.37201/req/s01.12.2023] [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] [Indexed: 11/25/2023]
Abstract
Chimeric antigen receptor (CAR) T cell therapy targeting CD-19 has revolutionized the treatment of refractory B-cell malignancies. However, patients undergoing this therapy face an increased risk of infections due to compromised immune function, lymphodepleting chemotherapy, hospitalization, and therapy-related complications such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome. Patients with systemic corticosteroid use, low immunoglobulin levels, and severe CRS, are at higher risk of infection. This review article highlights the spectrum of infections encountered in CAR T cell therapy, including bacterial, viral, and fungal infections. Following consensus guidelines for vaccination and immunoglobulin replacement is recommended. Clear criteria for antibiotic usage and vaccinating household members against respiratory viruses are crucial. Understanding the risk factors, spectrum of infections, and implementing appropriate prophylactic measures are essential to optimize outcomes in patients undergoing CAR T cell therapy. By prioritizing infection prevention strategies, healthcare professionals can effectively improve patient care.
Collapse
Affiliation(s)
| | | | | | | | | | | | - C Garcia-Vidal
- Carolina Garcia-Vidal, Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain. Carrer de Villarroel 170, 08036, Barcelona, Spain. and
| |
Collapse
|
14
|
Cilloniz C, Motos A, Canseco J, Peñasco Y, Ricart P, Abril E, García JMG, Ortiz AB, Mateo NG, Sánchez-Miralles Á, Franco N, Riera J, Ferrer R, Bustamante-Munguira E, Caballero J, Gándara AMDL, Sancho S, Masclans JR, Urrelo-Cerrón L, Carbonell N, Socías L, Barberà C, Lorente JA, Rodríguez ÓP, Menéndez R, de Gonzalo-Calvo D, Ceccato A, Fernandez-Barat L, Garcia-Gasulla D, Gabarrus A, Garcia-Vidal C, Moreno A, Barbé F, Miro JM, Torres A. Clinical Outcomes of Critical COVID-19 in HIV-Infected Adults: A Propensity Score Matched Analysis. Arch Bronconeumol 2023; 59:772-778. [PMID: 37661559 DOI: 10.1016/j.arbres.2023.07.029] [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: 07/20/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Catia Cilloniz
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain; University of Barcelona, Spain; Faculty of Health Sciences, Continental University, Huancayo, Peru.
| | - Anna Motos
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain; University of Barcelona, Spain
| | - Joan Canseco
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain
| | - Yhivian Peñasco
- Intensive Medicine Department, Hospital Universitario Marqués of Valdecilla, Santander, Spain
| | - Pilar Ricart
- Intensive Medicine Department, Hospital Universitari Germans Trias, Badalona, Spain
| | - Elena Abril
- Hospital Universitario Torrejón, Madrid, Spain
| | | | - Aaron Blandino Ortiz
- Intensive Care Department, Hospital Universitario Ramón y Cajal, Madrid, Spain; Universidad de Alcalá, Madrid, Spain
| | - Nadia García Mateo
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, Salamanca, Spain
| | | | | | - Jordi Riera
- Intensive Care Department, Vall d'Hebron Hospital Universitari, SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron Hospital Universitari, SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | | | - Jesús Caballero
- Critical Care Department, Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain
| | | | - Susana Sancho
- Critical Care Department, Hospital Universitario y Politecnico de La Fe, Valencia, Spain
| | - Joan-Ramon Masclans
- Critical Care Department, Hospital del Mar, Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - Nieves Carbonell
- Intensive Care Unit, Hospital Clinico Universitario de Valencia, Spain
| | - Lorenzo Socías
- Intensive Care Unit, Hospital Son Llàtzer, Palma de Mallorca, Illes Balears, Spain
| | | | - José A Lorente
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; Hospital Universitario de Getafe, Madrid, Spain
| | - Óscar Peñuelas Rodríguez
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; Hospital Universitario de Getafe, Madrid, Spain
| | - Rosario Menéndez
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; Pulmonology Service, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - David de Gonzalo-Calvo
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; Hospital Santa Maria, IRBLleida, Lleida, Spain
| | - Adrian Ceccato
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; Critical Care Center, ParcTaulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain; Intensive Care Unit, Hospital Universitari Sagrat Cor, Grupo Quironsalud, Barcelona, Spain
| | - Laia Fernandez-Barat
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain; University of Barcelona, Spain
| | | | - Albert Gabarrus
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ferran Barbé
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; Pulmonary Department, Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Spain
| | - José M Miro
- Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
| | - Antoni Torres
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain; University of Barcelona, Spain; Pulmonology Department, Hospital Clinic of Barcelona, Spain
| |
Collapse
|
15
|
Contejean A, Maillard A, Canouï E, Kernéis S, Fantin B, Bouscary D, Parize P, Garcia-Vidal C, Charlier C. Advances in antibacterial treatment of adults with high-risk febrile neutropenia. J Antimicrob Chemother 2023; 78:2109-2120. [PMID: 37259598 DOI: 10.1093/jac/dkad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND High-risk febrile neutropenia (HR-FN) is a life-threatening complication in patients with haematological malignancies or receiving myelosuppressive chemotherapy. Since the last international guidelines were published over 10 years ago, there have been major advances in the understanding and management of HR-FN, including on antibiotic pharmacokinetics and discontinuation/de-escalation strategies. OBJECTIVES Summarizing major advances in the field of antibacterial therapy in patients with HR-FN: empirical therapy, pharmacokinetics of antibiotics and antibiotic stewardship. SOURCES Narrative review based on literature review from PubMed. We focused on studies published between 2010 and 2023 about the pharmacokinetics of antimicrobials, management of antimicrobial administration, and discontinuation/de-escalation strategies. We did not address antimicrobial prophylaxis, viral or fungal infections. CONTENT Several high-quality publications have highlighted important modifications of antibiotic pharmacokinetics in HR-FN, with standard dosages exposing patients to underdosing. These recent clinical and population pharmacokinetics studies help improve management protocols with optimized initial dosing and infusion rules for β-lactams, vancomycin, daptomycin and amikacin; they highlight the potential benefits of therapeutic drug monitoring. A growing body of evidence also shows that antibiotic discontinuation/de-escalation strategies are beneficial for bacterial ecology and patients' outcome. We further discuss methods and limitations for implementation of such protocols in haematology. IMPLICATIONS We highlight recent information about the management of antibacterial therapy in HR-FN that might be considered in updated guidelines for HR-FN management.
Collapse
Affiliation(s)
- Adrien Contejean
- Service d'Hématologie, Centre Hospitalier Annecy Genevois, 1 Avenue de l'hôpital, F-74370 Epagny Metz-Tessy, France
- Équipe Mobile d'Infectiologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
- Université Paris Cité, Faculté de Médecine, F-75006 Paris, France
| | - Alexis Maillard
- Équipe Mobile d'Infectiologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
| | - Etienne Canouï
- Équipe Mobile d'Infectiologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
| | - Solen Kernéis
- Université Paris Cité, Faculté de Médecine, F-75006 Paris, France
- Équipe de Prévention du Risque Infectieux, AP-HP, Hôpital Bichat, F-75018 Paris, France
- Université Paris Cité, INSERM, IAME, F-75018 Paris, France
| | - Bruno Fantin
- Université Paris Cité, Faculté de Médecine, F-75006 Paris, France
- Département de Médecine Interne, AP-HP, Hôpital Beaujon, F-92110, Clichy, France
| | - Didier Bouscary
- Université Paris Cité, Faculté de Médecine, F-75006 Paris, France
- Service d'Hématologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
| | - Perrine Parize
- Service de Maladies Infectieuses, AP-HP, APHP.CUP, Hôpital Necker-Enfants Malades, F-75015 Paris, France
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- CIBERINF, Madrid, Spain
| | - Caroline Charlier
- Équipe Mobile d'Infectiologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
- Université Paris Cité, Faculté de Médecine, F-75006 Paris, France
- National Reference Center Listeriosis WHO Collaborating Center, Institut Pasteur, F-75015 Paris, France
- Biology of Infection Unit, Inserm U1117 Institut Pasteur, F-75015 Paris, France
| |
Collapse
|
16
|
Grafia I, Chumbita M, Seguí E, Cardozo C, Laguna JC, García de Herreros M, Garcia-Pouton N, Villaescusa A, Pitart C, Rico-Caballero V, Marco-Hernández J, Zamora C, Viladot M, Padrosa J, Tuca A, Mayor-Vázquez E, Marco F, Martínez JA, Mensa J, Garcia-Vidal C, Soriano A, Puerta-Alcalde P. Epidemiology and risk factors for recurrence in biliary source bloodstream infection episodes in oncological patients. Microbiol Spectr 2023; 11:e0214223. [PMID: 37610217 PMCID: PMC10580831 DOI: 10.1128/spectrum.02142-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023] Open
Abstract
We aimed to describe the characteristics and outcomes of biliary source bloodstream infections (BSIs) in oncological patients. Secondarily, we analyzed risk factors for recurrent BSI episodes. All episodes of biliary source BSIs in oncological patients were prospectively collected (2008-2019) and retrospectively analyzed. Logistic regression analyses were performed. A rule to stratify patients into risk groups for recurrent biliary source BSI was conducted. Four hundred biliary source BSIs were documented in 291 oncological patients. The most frequent causative agents were Escherichia coli (42%) and Klebsiella spp. (27%), and 86 (21.5%) episodes were caused by multidrug-resistant Gram-negative bacilli (MDR-GNB). The rates of MDR-GNB increased over time. Overall, 73 patients developed 118 recurrent BSI episodes. Independent risk factors for recurrent BSI episodes were prior antibiotic therapy (OR 3.781, 95% CI 1.906-7.503), biliary prosthesis (OR 2.232, 95% CI 1.157-4.305), prior admission due to suspected biliary source infection (OR 4.409, 95% CI 2.338-8.311), and BSI episode caused by an MDR-GNB (OR 2.857, 95% CI 1.389-5.874). With these variables, a score was generated that predicted recurrent biliary source BSI with an area under the receiver operating characteristic (ROC) curve of 0.819. Inappropriate empirical antibiotic treatment (IEAT) was administered in 23.8% of patients, and 30-d mortality was 19.5%. As a conclusion, biliary source BSI in oncological patients is mainly caused by GNB, with high and increasing MDR rates, frequent IEAT, and high mortality. Recurrent BSI episodes are frequent. A simple score to identify recurrent episodes was developed to potentially establish prophylactic strategies. IMPORTANCE This study shows that biliary source bloodstream infections (BSIs) in oncological patients are mainly caused by Gram-negative bacilli (GNB), with high and increasing rates of multidrug resistance. Importantly, recurrent biliary source BSI episodes were very frequent and associated with delays in chemotherapy, high rates of inappropriate empirical antibiotic therapy, and high 30-d mortality (19.5%). Using the variable independently associated with recurrent BSI episodes, a score was generated that predicted recurrent biliary source BSI with high accuracy. This score could be used to establish prophylactic strategies and lower the risk of relapsing episodes and the associated morbidity and mortality.
Collapse
Affiliation(s)
- Ignacio Grafia
- Medical Oncology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Mariana Chumbita
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Elia Seguí
- Medical Oncology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Celia Cardozo
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | | | | | | | - Ana Villaescusa
- Medical Oncology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Cristina Pitart
- Microbiology Department, Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
| | | | - Javier Marco-Hernández
- Internal Medicine Department, Supportive and Palliative Care in Cancer Unit, Hospital Clínic, Barcelona, Spain
| | - Carles Zamora
- Medical Oncology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Margarita Viladot
- Medical Oncology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Joan Padrosa
- Medical Oncology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Albert Tuca
- Medical Oncology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Eric Mayor-Vázquez
- Medical Intensive Care Unit, Internal Medicine Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Francesc Marco
- Microbiology Department, Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Jose A. Martínez
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Josep Mensa
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- CIBERINF, CIBER in Infectious Diseases, Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- CIBERINF, CIBER in Infectious Diseases, Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| |
Collapse
|
17
|
Chumbita M, Puerta-Alcalde P, Yáñez L, Angeles Cuesta M, Chinea A, Español-Morales I, Fernandez-Abellán P, Gudiol C, González-Sierra P, Rojas R, Sánchez-Pina JM, Vadillo IS, Sánchez M, Varela R, Vázquez L, Guerreiro M, Monzo P, Lopera C, Aiello TF, Peyrony O, Soriano A, Garcia-Vidal C. High Rate of Inappropriate Antibiotics in Patients with Hematologic Malignancies and Pseudomonas aeruginosa Bacteremia following International Guideline Recommendations. Microbiol Spectr 2023; 11:e0067423. [PMID: 37367629 PMCID: PMC10434044 DOI: 10.1128/spectrum.00674-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/27/2023] [Indexed: 06/28/2023] Open
Abstract
Optimal coverage of Pseudomonas aeruginosa is challenging in febrile neutropenic patients due to a progressive increase in antibiotic resistance worldwide. We aimed to detail current rates of resistance to antibiotics recommended by international guidelines for P. aeruginosa isolated from bloodstream infections (BSI) in patients with hematologic malignancies. Secondarily, we aimed to describe how many patients received inappropriate empirical antibiotic treatment (IEAT) and its impact on mortality. We conducted a retrospective, multicenter cohort study of the last 20 BSI episodes caused by P. aeruginosa in patients with hematologic malignancies from across 14 university hospitals in Spain. Of the 280 patients with hematologic malignancies and BSI caused by P. aeruginosa, 101 (36%) had strains resistant to at least one of the β-lactam antibiotics recommended in international guidelines, namely, cefepime, piperacillin-tazobactam, and meropenem. Additionally, 21.1% and 11.4% of the strains met criteria for MDR and XDR P. aeruginosa, respectively. Even if international guidelines were followed in most cases, 47 (16.8%) patients received IEAT and 66 (23.6%) received inappropriate β-lactam empirical antibiotic treatment. Thirty-day mortality was 27.1%. In the multivariate analysis, pulmonary source (OR 2.22, 95% CI 1.14 to 4.34) and IEAT (OR 2.67, 95% CI 1.37 to 5.23) were factors independently associated with increased mortality. We concluded that P. aeruginosa-causing BSI in patients with hematologic malignancies is commonly resistant to antibiotics recommended in international guidelines, which is associated with frequent IEAT and higher mortality. New therapeutic strategies are needed. IMPORTANCE Bloodstream infection (BSI) caused by P. aeruginosa is related with an elevated morbidity and mortality in neutropenic patients. For this reason, optimal antipseudomonal coverage has been the basis of all historical recommendations in the empirical treatment of febrile neutropenia. However, in recent years the emergence of multiple types of antibiotic resistances has posed a challenge in treating infections caused by this microorganism. In our study we postulated that P. aeruginosa-causing BSI in patients with hematologic malignancies is commonly resistant to antibiotics recommended in international guidelines. This observation is associated with frequent IEAT and increased mortality. Consequently, there is a need for a new therapeutic strategy.
Collapse
Affiliation(s)
- Mariana Chumbita
- Hospital Clínic de Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Hospital Clínic de Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Lucrecia Yáñez
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | - Carlota Gudiol
- Hospital Universitario de Bellvitge, Institut Català d'Oncologia, IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Rafael Rojas
- Hospital Universitario Reina Sofia, Córdoba, Spain
| | | | | | | | | | - Lourdes Vázquez
- Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Patricia Monzo
- Hospital Clínic de Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Carlos Lopera
- Hospital Clínic de Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | | | - Oliver Peyrony
- Hospital Clínic de Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alex Soriano
- Hospital Clínic de Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Hospital Clínic de Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas, Barcelona, Spain
| |
Collapse
|
18
|
Puerta-Alcalde P, Monzó-Gallo P, Aguilar-Guisado M, Ramos JC, Laporte-Amargós J, Machado M, Martin-Davila P, Franch-Sarto M, Sánchez-Romero I, Badiola J, Gómez L, Ruiz-Camps I, Yáñez L, Vázquez L, Chumbita M, Marco F, Soriano A, González P, Fernández-Cruz A, Batlle M, Fortún J, Guinea J, Gudiol C, García J, Ruiz Pérez de Pipaón M, Alastruey-Izquierdo A, Garcia-Vidal C. Breakthrough invasive fungal infection among patients with haematologic malignancies: A national, prospective, and multicentre study. J Infect 2023; 87:46-53. [PMID: 37201859 DOI: 10.1016/j.jinf.2023.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVES We describe the current epidemiology, causes, and outcomes of breakthrough invasive fungal infections (BtIFI) in patients with haematologic malignancies. METHODS BtIFI in patients with ≥ 7 days of prior antifungals were prospectively diagnosed (36 months across 13 Spanish hospitals) according to revised EORTC/MSG definitions. RESULTS 121 episodes of BtIFI were documented, of which 41 (33.9%) were proven; 53 (43.8%), probable; and 27 (22.3%), possible. The most frequent prior antifungals included posaconazole (32.2%), echinocandins (28.9%) and fluconazole (24.8%)-mainly for primary prophylaxis (81%). The most common haematologic malignancy was acute leukaemia (64.5%), and 59 (48.8%) patients had undergone a hematopoietic stem-cell transplantation. Invasive aspergillosis, principally caused by non-fumigatus Aspergillus, was the most frequent BtIFI with 55 (45.5%) episodes recorded, followed by candidemia (23, 19%), mucormycosis (7, 5.8%), other moulds (6, 5%) and other yeasts (5, 4.1%). Azole resistance/non-susceptibility was commonly found. Prior antifungal therapy widely determined BtIFI epidemiology. The most common cause of BtIFI in proven and probable cases was the lack of activity of the prior antifungal (63, 67.0%). At diagnosis, antifungal therapy was mostly changed (90.9%), mainly to liposomal amphotericin-B (48.8%). Overall, 100-day mortality was 47.1%; BtIFI was either the cause or an essential contributing factor to death in 61.4% of cases. CONCLUSIONS BtIFI are mainly caused by non-fumigatus Aspergillus, non-albicans Candida, Mucorales and other rare species of mould and yeast. Prior antifungals determine the epidemiology of BtIFI. The exceedingly high mortality due to BtIFI warrants an aggressive diagnostic approach and early initiation of broad-spectrum antifungals different than those previously used.
Collapse
Affiliation(s)
| | | | - Manuela Aguilar-Guisado
- Hospital Universitario Virgen del Rocío, IBIS (Instituto de Biomedicina de Sevilla), Universidad de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), (CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Júlia Laporte-Amargós
- Hospital Universitari de Bellvitge, IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain; Institut Català d'Oncologia, Barcelona, Spain
| | - Marina Machado
- Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | | | | | - Jon Badiola
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Lucia Gómez
- Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Isabel Ruiz-Camps
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lucrecia Yáñez
- Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | - Mariana Chumbita
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Francesc Marco
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Alex Soriano
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), (CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro González
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | - Jesús Fortún
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jesús Guinea
- Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Carlota Gudiol
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), (CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitari de Bellvitge, IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain; Institut Català d'Oncologia, Barcelona, Spain
| | | | - Maite Ruiz Pérez de Pipaón
- Hospital Universitario Virgen del Rocío, IBIS (Instituto de Biomedicina de Sevilla), Universidad de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), (CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Alastruey-Izquierdo
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), (CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain; Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Carolina Garcia-Vidal
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), (CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
19
|
Aiello TF, Puerta-Alcalde P, Chumbita M, Lopera C, Monzó P, Cortes A, Fernández-Avilés F, Suárez-Lledó M, Correa J, Ortiz-Maldonado V, Cuesta G, Martinez-Cibrian N, Esteve J, Marcos MÁ, Mensa J, Soriano A, Garcia-Vidal C. Current outcomes of SARS-CoV-2 Omicron variant infection in high-risk haematological patients treated early with antivirals. J Antimicrob Chemother 2023; 78:1454-1459. [PMID: 37051877 DOI: 10.1093/jac/dkad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/17/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES We aimed to describe the clinical outcomes and duration of viral shedding in high-risk patients with haematological malignancies hospitalized with COVID-19 during Omicron variant predominance who received early treatment with antivirals. METHODS We conducted a prospective observational study on high-risk haematological patients admitted in our hospital between December 2021 and March 2022. We performed detection techniques on viral subgenomic mRNAs until negative results were obtained to document active, prolonged viral replication. RESULTS This analysis included 60 consecutive adults with high-risk haematological malignancies and COVID-19. All of these patients underwent early treatment with remdesivir. Thirty-two (53%) patients received combined antiviral strategies, with sotrovimab or hyperimmune plasma being added to remdesivir. The median length of viral replication-as measured by real-time RT-PCR and/or subgenomic RNA detection-was 20 (IQR 14-28) days. Prolonged viral replication (6 weeks after diagnosis) was documented in six (10%) patients. Only two patients had prolonged infection for more than 2 months. Overall mortality was 5%, whereas COVID-19-related mortality was 0%. CONCLUSIONS Current outcomes of high-risk patients with haematological malignancies hospitalized with COVID-19 during Omicron variant predminance are good with the use of early antiviral strategies. Persistent viral shedding is uncommon.
Collapse
Affiliation(s)
- Tommaso-Francesco Aiello
- 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
| | - Mariana Chumbita
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carlos Lopera
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Patricia Monzó
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Albert Cortes
- Department of Haematology, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Department of Haematology, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - María Suárez-Lledó
- Department of Haematology, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Juan Correa
- Department of Haematology, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Valentín Ortiz-Maldonado
- Department of Haematology, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Genoveva Cuesta
- Department of Microbiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Nuria Martinez-Cibrian
- Department of Haematology, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jordi Esteve
- Department of Haematology, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Maria Ángeles Marcos
- Department of Microbiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Josep Mensa
- 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
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| |
Collapse
|
20
|
Soriano A, Honore PM, Puerta-Alcalde P, Garcia-Vidal C, Pagotto A, Gonçalves-Bradley DC, Verweij PE. Invasive candidiasis: current clinical challenges and unmet needs in adult populations. J Antimicrob Chemother 2023:7176280. [PMID: 37220664 DOI: 10.1093/jac/dkad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Invasive candidiasis (IC) is a serious infection caused by several Candida species, and the most common fungal disease in hospitals in high-income countries. Despite overall improvements in health systems and ICU care in the last few decades, as well as the development of different antifungals and microbiological techniques, mortality rates in IC have not substantially improved. The aim of this review is to summarize the main issues underlying the management of adults affected by IC, focusing on specific forms of the infection: IC developed by ICU patients, IC observed in haematological patients, breakthrough candidaemia, sanctuary site candidiasis, intra-abdominal infections and other challenging infections. Several key challenges need to be tackled to improve the clinical management and outcomes of IC patients. These include the lack of global epidemiological data for IC, the limitations of the diagnostic tests and risk scoring tools currently available, the absence of standardized effectiveness outcomes and long-term data for IC, the timing for the initiation of antifungal therapy and the limited recommendations on the optimal step-down therapy from echinocandins to azoles or the total duration of therapy. The availability of new compounds may overcome some of the challenges identified and increase the existing options for management of chronic Candida infections and ambulant patient treatments. However, early identification of patients that require antifungal therapy and treatment of sanctuary site infections remain a challenge and will require further innovations.
Collapse
Affiliation(s)
- Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, CIBERINF, University of Barcelona, Barcelona, Spain
| | - Patrick M Honore
- CHU UCL Godinne Namur, UCL Louvain Medical School, Namur, Belgium
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, CIBERINF, University of Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, CIBERINF, University of Barcelona, Barcelona, Spain
| | | | | | - Paul E Verweij
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
| |
Collapse
|
21
|
Cillóniz C, Greenslade L, Dominedò C, Garcia-Vidal C. Correction: Promoting the use of social networks in pneumonia. Pneumonia (Nathan) 2023; 15:9. [PMID: 37085933 PMCID: PMC10120189 DOI: 10.1186/s41479-023-00111-x] [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] [Indexed: 04/23/2023] Open
Affiliation(s)
- Catia Cillóniz
- August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain.
- Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), the Association of Support and Information for Family Members and Patients With Pneumonia (NEUMOAI), Barcelona, Spain.
| | | | - Cristina Dominedò
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | | |
Collapse
|
22
|
Herrera S, Torralbo B, Herranz S, Bernal-Maurandi J, Rubio E, Pitart C, Fortes I, Valls S, Rodríguez L, Santana G, Bodro M, Garcia-Vidal C, Hernández-Meneses M, Puerta P, Morata L, Villella A, Bertran MJ, Brey M, Soriano A, Del Río A, Martinez JA. Carriage of multidrug-resistant Gram-negative bacilli: duration and risk factors. Eur J Clin Microbiol Infect Dis 2023; 42:631-638. [PMID: 36964885 DOI: 10.1007/s10096-023-04581-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/24/2023] [Indexed: 03/26/2023]
Abstract
Identification of risk factors influencing the duration of carriage of multidrug-resistant Gram-negative bacilli (MDR-GNB) may be useful for infection control. The aim of this study is to estimate the impact of several factors collected for routine hospital surveillance on the duration of carriage of selected MDR-GNB. From January 2015 to July 2021, patients with at least two clinical/surveillance samples positive for MDR-GNB different from ESBL-producing E. coli or AmpC - exclusively producing Enterobacterales were assessed. Microorganisms, age, number of admissions, clinical or rectal sample, sex, and admission service were evaluated as risk factors. Multivariate analysis was performed by a Cox proportional hazard model. A total of 1981 episodes of colonization were included. Involved microorganisms were ESBL-Klebsiella pneumoniae (KP) in 1057 cases (53.4%), other ESBL-non-E. coli Enterobacterales in 91 (4.6%), OXA-48-KP in 263 (13.3%), KPC-KP in 90 (4.5%), VIM-KP in 29 (1.5%), carbapenemase-producing non-KP Enterobacterales (CP-non-KP) in 124 (6.3%), and MDR Pseudomonas aeruginosa (MDR-PAER) in 327 (16.5%). No differences in duration of colonization were observed among ESBL-KP (median colonization time 320 days), ESBL-non-E. coli Enterobacterales (226 days), OXA48-KP (305 days), and MDR-PAER (321 days). For each group, duration of colonization was significantly longer than that of KPC-KP (median colonization time 60 days), VIM-KP (138 days), and CP-non-KP (71 days). Male sex (HR = 0.88; 95% CI 0.78-0.99), detection in Hepatology-Gastroenterology (HR = 0.71; 95% CI 0.54-0.93), clinical sample (HR = 0.61; 95% CI 0.53-0.69), and > 2 admissions after first detection (HR = 0.47; 95% CI 0.42-0.52) were independent predictors of longer carriage, whereas VIM-KP (HR = 1.61; 95% CI 1.04-2.48), KPC-KP (HR = 1.85; 95% CI 1.49-2.3), and CP-non-KP (HR = 1.92; 95% CI 1.49-2.47) were associated with shorter colonization time. Duration of colonization was significantly longer for ESBL-KP, other ESBL-non-E. coli Enterobacterales, OXA-48-KP, and MDR-PAER. For these microorganisms, prolonging surveillance up to 2.5-3 years should be considered. Male sex, clinical sample, multiple readmissions, admission service, and type of microorganism are independent predictors of the duration of carriage.
Collapse
Affiliation(s)
- S Herrera
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - B Torralbo
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - S Herranz
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - J Bernal-Maurandi
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - E Rubio
- Department of Microbiology, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - C Pitart
- Department of Microbiology, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - I Fortes
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - S Valls
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - L Rodríguez
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - G Santana
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - M Bodro
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - C Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - M Hernández-Meneses
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - P Puerta
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - L Morata
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - A Villella
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - M J Bertran
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - M Brey
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - A Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - A Del Río
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - J A Martinez
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain.
| |
Collapse
|
23
|
Monzó-Gallo P, Chumbita M, Lopera C, Aiello TF, Peyrony O, Bodro M, Herrera S, Sempere A, Fernández-Pittol M, Cuesta G, Simó S, Benegas M, Fortuny C, Mensa J, Soriano A, Puerta-Alcalde P, Marco F, Garcia-Vidal C. Real-life epidemiology and current outcomes of hospitalized adults with invasive fungal infections. Med Mycol 2023; 61:7067261. [PMID: 36861308 DOI: 10.1093/mmy/myad021] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/07/2023] [Accepted: 02/28/2023] [Indexed: 03/03/2023] Open
Abstract
We aimed to describe the current epidemiology of both hosts with invasive fungal infections (IFIs) and causative fungi. And, detail outcomes of these infections at 12 weeks in a real-life cohort of hospitalized patients. The study was retrospective and observational to describe IFI diagnosed in a tertiary hospital (February 2017-December 2021). We included all consecutive patients meeting criteria for proven or probable IFI according to EORTC-MSG and other criteria. A total of 367 IFIs were diagnosed. 11.7% were breakthrough infections, and 56.4% were diagnosed in the intensive care unit. Corticosteroid use (41.4%) and prior viral infection (31.3%) were the most common risk factors for IFI. Lymphoma and pneumocystis pneumonia were the most common baseline and fungal diseases. Only 12% of IFI occurred in patients with neutropenia. Fungal cultures were the most important diagnostic tests (85.8%). The most frequent IFIs were candidemia (42.2%) and invasive aspergillosis (26.7%). Azole-resistant Candida strains and non-fumigatus Aspergillus infections represented 36.1% and 44.5% of the cases, respectively. Pneumocystosis (16.9%), cryptococcosis (4.6%), and mucormycosis (2.7%) were also frequent, as well as mixed infections (3.4%). Rare fungi accounted for 9.5% of infections. Overall, IFI mortality at 12 weeks was 32.2%; higher rates were observed for Mucorales (55.6%), Fusarium (50%), and mixed infections (60%). We documented emerging changes in both hosts and real-life IFI epidemiology. Physicians should be aware of these changes to suspect infections and be aggressive in diagnoses and treatments. Currently, outcomes for such clinical scenarios remain extremely poor.
Collapse
Affiliation(s)
- Patricia Monzó-Gallo
- 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
| | - Carlos Lopera
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Tommaso Francesco Aiello
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Oliver Peyrony
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
- Emergency Department, Hôpital Saint Louis, Paris, France
| | - Marta Bodro
- 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
| | - Abiu Sempere
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Genoveva Cuesta
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Silvia Simó
- Department of Pediatrics, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Mariana Benegas
- Department of Radiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Claudia Fortuny
- Department of Pediatrics, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Josep Mensa
- 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
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Francesc Marco
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| |
Collapse
|
24
|
Herrera S, Morata L, Sempere A, Verdejo M, Del Rio A, Martínez JA, Cuervo G, Hernández-Meneses M, Chumbita M, Pitart C, Puerta P, Monzó P, Lopera C, Aiello F, Mendoza S, Garcia-Vidal C, Soriano A, Bodro M. Pseudomonas aeruginosa Bloodstream Infection, Resistance, and Mortality: Do Solid Organ Transplant Recipients Do Better or Worse? Antibiotics (Basel) 2023; 12:antibiotics12020380. [PMID: 36830291 PMCID: PMC9952642 DOI: 10.3390/antibiotics12020380] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/27/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The prevalence of antimicrobial resistance of Pseudomonas aeruginosa (P. aeruginosa) in solid organ transplant (SOT) recipients is higher than that of the general population. However, the literature supporting this statement is scarce. Identifying patients at risk of carbapenem resistance (CR) is of great importance, as CR strains more often receive inappropriate empiric antibiotic therapy, which is independently associated with mortality in bloodstream infections (BSIs). METHODS We prospectively recorded data from all consecutive BSIs from January 1991 to July 2019 using a routine purpose-designed surveillance database. The following variables were included: age, sex, type of transplant, use of vascular and urinary catheters, presence of neutropenia, period of diagnosis, treatment with steroids, origin of BSI, source of bacteremia, septic shock, ICU admission, mechanical ventilation, previous antibiotic treatment, treatment of bacteremia, and 30-day all-cause mortality. RESULTS We identified 2057 episodes of P. aeruginosa BSI. Of these, 265 (13%) episodes corresponded to SOT recipients (130 kidney transplants, 105 liver, 9 hearts, and 21 kidney-pancreas). Hematologic malignancy [OR 2.71 (95% CI 1.33-5.51), p = 0.006] and prior carbapenem therapy [OR 2.37 (95% CI 1.46-3.86), p < 0.001] were associated with a higher risk of having a CR P. aeruginosa BSI. Age [OR 1.03 (95% CI 1.02-1.04) p < 0.001], urinary catheter [OR 2.05 (95% CI 0.37-3.06), p < 0.001], shock at onset [OR 6.57 (95% CI 4.54-9.51) p < 0.001], high-risk source [OR 4.96 (95% CI 3.32-7.43) p < 0.001], and bacteremia caused by CR strains [OR 1.53 (95% CI 1.01-2.29) p = 0.036] were associated with increased mortality. Correct empirical therapy was protective [OR 0.52 (95% CI 0.35-0.75) p = 0.001]. Mortality at 30 days was higher in non-SOT patients (21% vs. 13%, p = 0.002). SOT was not associated with a higher risk of having a CR P. aeruginosa BSI or higher mortality. CONCLUSIONS In our cohort of 2057 patients with P. aeruginosa BSIs, hematologic malignancies and previous carbapenem therapy were independently associated with a risk of presenting CR P. aeruginosa BSI. Age, urinary catheter, high-risk source, bacteremia caused by carbapenem-resistant strains, and severity of the infection were independently associated with mortality, whereas correct empirical therapy was a protective factor. An increasing trend in the resistance of P. aeruginosa was found, with >30% of the isolates being resistant to carbapenems in the last period. SOT was not associated with a higher risk of carbapenem-resistant BSIs or higher mortality.
Collapse
Affiliation(s)
- Sabina Herrera
- Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain
| | - Abiu Sempere
- Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain
| | - Miguel Verdejo
- Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain
| | - Ana Del Rio
- Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain
| | | | - Guillermo Cuervo
- Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain
| | | | - Mariana Chumbita
- Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain
| | - Cristina Pitart
- Department of Microbiology, Hospital Clínic, 08036 Barcelona, Spain
| | - Pedro Puerta
- Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain
| | - Patricia Monzó
- Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain
| | - Carles Lopera
- Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain
| | - Francesco Aiello
- Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain
| | - Scarleth Mendoza
- Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain
- Centro de Investigación Biomedical en Red en Enfermedades Infecciosas CIBERINFEC, 28029 Madrid, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain
- Centro de Investigación Biomedical en Red en Enfermedades Infecciosas CIBERINFEC, 28029 Madrid, Spain
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain
- Centro de Investigación Biomedical en Red en Enfermedades Infecciosas CIBERINFEC, 28029 Madrid, Spain
- Correspondence:
| |
Collapse
|
25
|
Cilloniz C, Ward L, Mogensen ML, Pericàs JM, Méndez R, Gabarrús A, Ferrer M, Garcia-Vidal C, Menendez R, Torres A. Machine-Learning Model for Mortality Prediction in Patients With Community-Acquired Pneumonia: Development and Validation Study. Chest 2023; 163:77-88. [PMID: 35850287 DOI: 10.1016/j.chest.2022.07.005] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Artificial intelligence tools and techniques such as machine learning (ML) are increasingly seen as a suitable manner in which to increase the prediction capacity of currently available clinical tools, including prognostic scores. However, studies evaluating the efficacy of ML methods in enhancing the predictive capacity of existing scores for community-acquired pneumonia (CAP) are limited. We aimed to apply and validate a causal probabilistic network (CPN) model to predict mortality in patients with CAP. RESEARCH QUESTION Is a CPN model able to predict mortality in patients with CAP better than the commonly used severity scores? STUDY DESIGN AND METHODS This was a derivation-validation retrospective study conducted in two Spanish university hospitals. The ability of a CPN designed to predict mortality in sepsis (SepsisFinder [SeF]), and adapted for CAP (SeF-ML), to predict 30-day mortality was assessed and compared with other scoring systems (Pneumonia Severity Index [PSI], Sequential Organ Failure Assessment [SOFA], quick Sequential Organ Failure Assessment [qSOFA], and CURB-65 criteria [confusion, urea, respiratory rate, BP, age ≥ 65 years]). The SeF models are proprietary software. Differences between receiver operating characteristic curves were assessed by the DeLong method for correlated receiver operating characteristic curves. RESULTS The derivation cohort comprised 4,531 patients, and the validation cohort consisted of 1,034 patients. In the derivation cohort, the areas under the curve (AUCs) of SeF-ML, CURB-65, SOFA, PSI, and qSOFA were 0.801, 0.759, 0.671, 0.799, and 0.642, respectively, for 30-day mortality prediction. In the validation study, the AUC of SeF-ML was 0.826, concordant with the AUC (0.801) in the derivation data (P = .51). The AUC of SeF-ML was significantly higher than those of CURB-65 (0.764; P = .03) and qSOFA (0.729, P = .005). However, it did not differ significantly from those of PSI (0.830; P = .92) and SOFA (0.771; P = .14). INTERPRETATION SeF-ML shows potential for improving mortality prediction among patients with CAP, using structured health data. Additional external validation studies should be conducted to support generalizability.
Collapse
Affiliation(s)
- Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain; Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain; Faculty of Health Sciences, Continental University, Huancayo, Peru
| | | | | | - Juan M Pericàs
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain; Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institute for Research (VHIR), Barcelona, Spain
| | - Raúl Méndez
- Department of Pneumology, University Hospital La Fe of Valencia, Valencia, Valencia
| | - Albert Gabarrús
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain; Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Miquel Ferrer
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain; Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | | | - Rosario Menendez
- Department of Pneumology, University Hospital La Fe of Valencia, Valencia, Valencia
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain; Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.
| |
Collapse
|
26
|
Abstract
Non-Aspergillus filamentous fungi causing invasive mould infections have increased over the last years due to the widespread use of anti-Aspergillus prophylaxis and increased complexity and survival of immunosuppressed patients. In the few studies that have reported on invasive mould infection epidemiology, Mucorales are the most frequently isolated group, followed by either Fusarium spp. or Scedosporium spp. The overall incidence is low, but related mortality is exceedingly high. Patients with haematological malignancies and haematopoietic stem cell transplant recipients comprise the classical groups at risk of infection for non-Aspergillus moulds due to profound immunosuppression and the vast use of anti-Aspergillus prophylaxis. Solid organ transplant recipients also face a high risk, especially those receiving lung transplants, due to direct exposure of the graft to mould spores with altered mechanical and immunological elimination, and intense, associated immunosuppression. Diagnosing non-Aspergillus moulds is challenging due to unspecific symptoms and radiological findings, lack of specific biomarkers, and low sensitivity of cultures. However, the advent of molecular techniques may prove helpful. Mucormycosis, fusariosis and scedosporiosis hold some differences regarding clinical paradigmatic presentations and preferred antifungal therapy. Surgery might be an option, especially in mucormycosis. Finally, various promising strategies to restore or enhance the host immune response are under current evaluation.
Collapse
|
27
|
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.
| |
Collapse
|
28
|
Fernandez-Pittol M, Alejo-Cancho I, Rubio-García E, Cardozo C, Puerta-Alcalde P, Moreno-García E, Garcia-Pouton N, Garrido M, Villanueva M, Alastruey-Izquierdo A, Pitart C, Garcia-Vidal C, Marco F. Aspergillosis by cryptic Aspergillus species: A case series and review of the literature. Rev Iberoam Micol 2022; 39:44-49. [PMID: 35753971 DOI: 10.1016/j.riam.2022.04.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/10/2022] [Accepted: 04/13/2022] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND The cryptic Aspegillus species are rare, these microorganisms are usually more resistant to common antifungal therapies. Therefore, a correct identification is important when evaluating the impact of such species in aspergillosis. AIMS We aimed to describe the frequency, clinical and microbiological characteristics, and the outcomes of those cases of aspergillosis caused by cryptic species in a tertiary hospital. METHODS We retrospectively identified all microbiologically documented cases of aspergillosis between January 2013 and December 2018. Definitive species identification of clinically significant isolates was achieved via sequencing methods. The polymerase chain reaction (PCR) products were sequenced, and the results obtained were compared to sequences deposited in GenBank. Antifungal susceptibility testing was performed using the Sensititre® YeastOne® panel. RESULTS A total of 679 Aspergillus isolates were recovered from 489 patients, of which 109 were clinically relevant. Ten (9.2%) isolates were identified as cryptic species: Aspergillus arcoverdensis (2), Aspergillus lentulus (2), Aspergillus ellipticus (2), Aspergillus alliaceus (1), Aspergillus nomius (1), Aspergillus tubingensis (1) and Aspergillus montevidensis (1). Most patients already suffered some type of immunosuppression. Half of these patients had required intensive care before the infection showed up, and most of them had a pulmonary infection. Mortality at the 100-day follow-up was 40%. Antifungal susceptibility testing was performed on three of the isolates (A. arcoverdensis, A. tubingensis and A. nomius), which showed high minimum inhibitory concentrations (MIC) for azoles and amphotericin B. CONCLUSIONS The frequency of cryptic species in our centre was 9.2%. Most patients had some degree of immunosuppression, and the mortality rate was 40%.
Collapse
Affiliation(s)
- Mariana Fernandez-Pittol
- Department of Microbiology, Hospital Clinic, Barcelona, Spain; ISGlobal, Barcelona, Institute for Global health, Universitat de Barcelona, Barcelona, Spain.
| | | | - Elisa Rubio-García
- Department of Microbiology, Hospital Clinic, Barcelona, Spain; ISGlobal, Barcelona, Institute for Global health, Universitat de Barcelona, Barcelona, Spain
| | - Celia Cardozo
- Infectious Disease Department, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Infectious Disease Department, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Estela Moreno-García
- Infectious Disease Department, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Nicole Garcia-Pouton
- Infectious Disease Department, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Miriam Garrido
- Department of Microbiology, Hospital Clinic, Barcelona, Spain
| | | | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Cristina Pitart
- Department of Microbiology, Hospital Clinic, Barcelona, Spain; ISGlobal, Barcelona, Institute for Global health, Universitat de Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Disease Department, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Francesc Marco
- Department of Microbiology, Hospital Clinic, Barcelona, Spain; ISGlobal, Barcelona, Institute for Global health, Universitat de Barcelona, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
29
|
Blennow O, Salmanton-García J, Nowak P, Itri F, Van Doesum J, López-García A, Farina F, Jaksic O, Pinczés LI, Bilgin YM, Falces-Romero I, Jiménez M, Ormazabal-Vélez I, Weinbergerová B, Duléry R, Stojanoski Z, Lahmer T, Fernández N, Hernández-Rivas JÁ, Petzer V, De Jonge N, Glenthøj A, De Ramón C, Biernat MM, Fracchiolla N, Aujayeb A, Van Praet J, Schönlein M, Méndez GA, Cattaneo C, Guidetti A, Sciumè M, Ammatuna E, Cordoba R, García-Poutón N, Gräfe S, Cabirta A, Wolf D, Nordlander A, García-Sanz R, Delia M, Berg Venemyr C, Brones C, Di Blasi R, De Kort E, Meers S, Lamure S, Serrano L, Merelli M, Coppola N, Bergantim R, Besson C, Kohn M, Petiti J, Garcia-Vidal C, Dargenio M, Danion F, Machado M, Bailén-Almorox R, Hoenigl M, Dragonetti G, Chai LYA, Kho CS, Bonanni M, Liévin R, Marchesi F, Cornely OA, Pagano L. Outcome of infection with omicron SARS-CoV-2 variant in patients with hematological malignancies: An EPICOVIDEHA survey report. Am J Hematol 2022; 97:E312-E317. [PMID: 35702878 PMCID: PMC9349555 DOI: 10.1002/ajh.26626] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jon Salmanton-García
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Piotr Nowak
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Federico Itri
- Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital - Orbassano, Orbassano, Italy
| | - Jaap Van Doesum
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Alberto López-García
- Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - Francesca Farina
- U.O. Ematologia e Trapianto Midollo, Dipartimento di Oncologia Istituto Scientifico San Raffaele, Milan, Italy
| | - Ozren Jaksic
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - László Imre Pinczés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Yavuz M Bilgin
- Department of Internal Medicine/Hematology, ADRZ, Goes, Netherlands
| | - Iker Falces-Romero
- Microbiology and Parasitology Department, University Hospital La Paz, Madrid, Spain.,CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Moraima Jiménez
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | | | - Barbora Weinbergerová
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Rémy Duléry
- INSERM UMRs 938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Zlate Stojanoski
- University Clinic for Hematology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, North Macedonia
| | - Tobias Lahmer
- Medizinische Klinik II, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Noemí Fernández
- Department of Hematology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Verena Petzer
- Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nick De Jonge
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Andreas Glenthøj
- Department of Hematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Cristina De Ramón
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain.,Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), IBSAL, Salamanca, Spain
| | - Monika M Biernat
- Department of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Nicola Fracchiolla
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare, Newcastle, UK
| | - Jens Van Praet
- Department of Nephrology and Infectious diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gustavo-Adolfo Méndez
- Servicio de Infectología y Control de Infecciones, Hospital Escuela de Agudos Dr. Ramón Madariaga, Posadas, Misiones, Argentina
| | | | - Anna Guidetti
- Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mariarita Sciumè
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Ammatuna
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Raul Cordoba
- Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - Nicole García-Poutón
- Department of Infectious Diseases, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Stefanie Gräfe
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - Alba Cabirta
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Dominik Wolf
- Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Nordlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Ramón García-Sanz
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain.,Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), IBSAL, Salamanca, Spain
| | - Mario Delia
- Hematology and Stem Cell Transplantation Unit, AOUC Policlinico, Bari, Italy
| | - Caroline Berg Venemyr
- Department of Hematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Clara Brones
- Service d'Hématologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | | | - Elizabeth De Kort
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stef Meers
- Department Oncology, AZ KLINA, Brasschaat, Belgium
| | - Sylvain Lamure
- Department of Clinical Hematology, Montpellier University Hospital, IGMM UMR5535 CNRS, University of Montpellier, Montpellier, France
| | - Laura Serrano
- Deparment of Hematology, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Maria Merelli
- Infectious Diseas Clinic, ASU FC Udine Hospital, Udine, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Universitry of Campania, Naples, Italy
| | - Rui Bergantim
- Department of Hematology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Caroline Besson
- Service d'Hématologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Milena Kohn
- Service d'Hématologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Jessica Petiti
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Michelina Dargenio
- Hematology and Stem Cell Transplant Unit, "Vito Fazzi" Hospital, Lecce, Italy
| | - François Danion
- Department of Infectious Diseases, CHU de Strasbourg, Strasbourg, France
| | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rebeca Bailén-Almorox
- Department of Hematology and Hemotherapy, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Martin Hoenigl
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA.,Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, California, USA.,Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Giulia Dragonetti
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | - Louis Yi Ann Chai
- National University Health System, University Medicine Center, Division of Infectious Diseases, Singapore
| | - Chi Shan Kho
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong SAR
| | - Matteo Bonanni
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy.,Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Raphaël Liévin
- Hemato-Oncology Department, Hopital Saint Louis, Paris, France
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Livio Pagano
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy.,Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
30
|
Puerta-Alcalde P, Ruiz-Camps I, Gudiol C, Salavert M, Barba P, Morandeira F, Jarque I, Cuervo G, Ayats J, Carratalà J, Garcia-Vidal C. Cytokine response as a biomarker for early diagnosis and outcome prediction of stem cell transplant recipients and acute leukemia patients with invasive aspergillosis. Med Mycol 2022; 60:6598867. [PMID: 35652817 DOI: 10.1093/mmy/myac038] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/13/2022] [Accepted: 05/30/2022] [Indexed: 11/12/2022] Open
Abstract
We aimed to determine the role of serum cytokine expression in invasive aspergillosis (IA) diagnosis and outcome prediction in hematologic patients. In this multicenter study, serum cytokines (IL6, IL10, INF-gamma, IL12, IL4, TNF-alpha, IL17 and IL23) were prospectively recruited from all consecutive patients with hematologic malignances at IA diagnosis and compared to control patients matched by center, age, baseline disease and therapeutic regimen. We included 36 patients with IA and 36 controls. Serum levels of IL6 and IL10 cytokines on day 0 were significantly increased in patients with IA when compared to controls (p = 0.001 and p = 0.025, respectively), even in those who were neutropenic. No differences were observed for the other cytokines. IL6 and IL10 predicted IA with an area under the ROC curve of 0.74 (95% CI 0.62-0.86) and 0.64 (95% CI 0.51-0.77), respectively. The best cut-off point in predicting IA was 20.85 pg/mL for IL6 (sensitivity 72.2%; specificity 77.8%; PPV 76.5% and NPV 73.7%), and 0.045 pg/mL for IL10 (sensitivity 62.9%; specificity 63.9%; PPV 62.9% and NPV 63.9%). IL6 levels were associated with increased mortality, with the best cut-off value being 65.59 pg/mL in mortality prediction. In conclusion, in addition to current tests in place, IL6 and IL10 levels-as measured in plasma-may help clinicians diagnose IA. High levels of IL6 at IA diagnosis are related with worse outcomes.
Collapse
Affiliation(s)
- Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Isabel Ruiz-Camps
- Hospital Universitari de la Vall d'Hebron, Universitat Auntònoma de Barcelona, Barcelona, Spain
| | - Carlota Gudiol
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Pere Barba
- Hospital Universitari de la Vall d'Hebron, Universitat Auntònoma de Barcelona, Barcelona, Spain
| | - Francisco Morandeira
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Guillermo Cuervo
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Josefina Ayats
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Carratalà
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | |
Collapse
|
31
|
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
| |
Collapse
|
32
|
Garcia-Vidal C, Sanguinetti M. When and which patients should receive remdesivir? Lancet 2022; 399:1918-1920. [PMID: 35512729 PMCID: PMC9060604 DOI: 10.1016/s0140-6736(22)00789-9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona 08036, Spain.
| | - Maurizio Sanguinetti
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| |
Collapse
|
33
|
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.
Collapse
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.
| | | |
Collapse
|
34
|
Maschmeyer G, Bullinger L, Garcia-Vidal C, Herbrecht R, Maertens J, Menna P, Pagano L, Thiebaut-Bertrand A, Calandra T. Correction: Infectious complications of targeted drugs and biotherapies in acute leukemia. Clinical practice guidelines by the European Conference on Infections in Leukemia (ECIL), a joint venture of the European Group for Blood and Marrow Transplantation (EBMT), the European Organization for Research and Treatment of Cancer (EORTC), the International Immunocompromised Host Society (ICHS) and the European Leukemia Net (ELN). Leukemia 2022; 36:1450. [PMID: 35440692 PMCID: PMC9061292 DOI: 10.1038/s41375-022-01570-9] [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: 11/27/2022]
Affiliation(s)
- Georg Maschmeyer
- Certified Cancer Center, Klinikum Ernst von Bergmann, Charlottenstrasse 72, D-14467, Potsdam, Germany.
| | - Lars Bullinger
- Department of Hematology, Oncology and Tumor Immunology, Campus Virchow, Charité - Universitätsmedizin Berlin, German Cancer Consortium (DKTK), Partner Site Berlin, Berlin, Germany
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Villarroel 170, BCN 08036, Barcelona, Spain
| | - Raoul Herbrecht
- Department of Hematology, Institut de Cancérologie Strasbourg.Europe (ICANS) and Université de Strasbourg, Inserm, UMR-S1113/IRFAC, Strasbourg, France
| | - Johan Maertens
- Department of Microbiology, Immunology, and Transplantation, KULeuven, Leuven and Department of Hematology, UZLEUVEN, Leuven, Belgium
| | - Pierantonio Menna
- Department of Sciences and Technologies for Humans and the Environment, University Campus Bio-Medico of Rome, University Hospital Foundation Campus Bio-Medico of Rome, Rome, Italy
| | - Livio Pagano
- Hematology Division, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli - IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, University of Lausanne, CH-1011, Lausanne, Switzerland
| |
Collapse
|
35
|
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
| |
Collapse
|
36
|
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%.
Collapse
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..
| |
Collapse
|
37
|
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.
Collapse
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
| | | |
Collapse
|
38
|
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.
Collapse
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.
| |
Collapse
|
39
|
Chumbita M, Monzo-Gallo P, Lopera-Mármol C, Aiello TF, Puerta-Alcalde P, Garcia-Vidal C. New treatments for multidrug-resistant non-fermenting Gram-negative bacilli Infections. Rev Esp Quimioter 2022; 35 Suppl 3:51-53. [PMID: 36285859 PMCID: PMC9717454 DOI: 10.37201/req/s03.12.2022] [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
Ceftolozane/tazobactam, ceftazidime/avibactam and cefiderocol belong to a novel generation of antibiotics that correspond with the β-lactam family. It is necessary to having new options in treating infections caused by Gram-negative, non-fermenting multidrug-resistant bacilli due to the significant increase in multidrug resistance in the last decades. Knowing the main characteristics of each drug is key for correct use.
Collapse
Affiliation(s)
| | | | | | | | | | - Carolina Garcia-Vidal
- Correspondence: Dr. Carolina Garcia-Vidal Department of Infectious Diseases, Hospital Clinic of Barcelona C/ Villarroel 170, 08036 Barcelona, Spain Tel: (+34) 93-227-5400, ext. 2887 E-mail:
| |
Collapse
|
40
|
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.
Collapse
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
| | | |
Collapse
|
41
|
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.
Collapse
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
| |
Collapse
|
42
|
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.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - A Soriano
- Alex Soriano, Department of Infectious Diseases, Hospital Clínic of Barcelona. Carrer de Villarroel 170, 08036, Barcelona, Spain.
| | | |
Collapse
|
43
|
Stern A, Alonso CD, Garcia-Vidal C, Cardozo C, Slavin M, Yong MK, Ho SA, Mehta Steinke S, Avery RK, Koehler P, Scheid C, Cornely OA, Maertens J, Abi Aad Y, Epstein DJ, Papanicolaou GA, Neofytos D. Safety and efficacy of intravenously administered cidofovir in adult haematopoietic cell transplant recipients: a retrospective multicentre cohort study. J Antimicrob Chemother 2021; 76:3020-3028. [PMID: 34324678 DOI: 10.1093/jac/dkab259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/25/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To evaluate the safety and efficacy of cidofovir for the treatment of double-stranded DNA (dsDNA) viral infections following allogeneic haematopoietic cell transplant (HCT). METHODS This was a retrospective multicentre cohort study including adult HCT recipients who received ≥1 dose of IV-administered cidofovir for any dsDNA viral infection from 2006 to 2019. The objectives were to describe the rate of and risk factors for nephrotoxicity and virological response by the end of treatment (EOT). RESULTS We included 165 patients from nine centres. Cidofovir was administered at 5 mg/kg/week (N = 115; 69.7%), 1 mg/kg/week (18; 10.9%), 3 mg/kg/week (12; 7.3%) or 1 mg/kg three times/week (11; 6.7%). Cidofovir was administered for adenovirus, cytomegalovirus (CMV) and BK virus infection in 75 (45.5%), 64 (38.8%) and 51 (30.9%) patients, respectively. Among 158 patients with renal function data at baseline and EOT, 40 (25.3%) developed nephrotoxicity. In multivariable analyses, age (OR 1.04; P = 0.05), weight (OR 1.05; P = 0.01), CMV infection (OR 3.6; P = 0.02), liposomal amphotericin B (OR 8.06; P = 0.05) and IV voriconazole/posaconazole (OR 13.0; P = 0.003) were predictors of nephrotoxicity. Creatinine concentration was significantly higher at EOT (1.16 ± 0.95 mg/dL) compared with baseline (0.91 ± 0.39 mg/dL; P < 0.001), but improved by 2 weeks (0.91 ± 0.84 mg/dL; P = 0.007) and 4 weeks (0.96 ± 0.89 mg/dL; P = 0.03) post-EOT. Median viral load significantly declined for patients with adenovirus DNAaemia by EOT (P < 0.0001) and for patients with CMV DNAaemia by EOT + 4 weeks (P = 0.003), but not for patients with BK virus DNAaemia. CONCLUSIONS One in four HCT recipients treated with IV cidofovir developed largely reversible nephrotoxicity. Careful selection of patients and close follow-up of renal function may minimize toxicity.
Collapse
Affiliation(s)
- Anat Stern
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Carolyn D Alonso
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, USA
| | | | - Celia Cardozo
- Division of Infectious Diseases, Hospital Clinic, Barcelona, Spain
| | - Monica Slavin
- Department of Infectious Disease and the National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michelle K Yong
- Department of Infectious Disease and the National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Su Ann Ho
- Department of Infectious Disease and the National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Seema Mehta Steinke
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Robin K Avery
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Philipp Koehler
- Faculty of Medicine and University Hospital Cologne, Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Christof Scheid
- Faculty of Medicine and University Hospital Cologne, Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | | | - Yasmine Abi Aad
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
| | - David J Epstein
- Division of Infectious Diseases, Stanford University, Stanford, CA, USA
| | | | - Dionysios Neofytos
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
| |
Collapse
|
44
|
Nucci M, Jenks J, Thompson GR, Hoenigl M, Dos Santos MC, Forghieri F, Rico JC, Bonuomo V, López-Soria L, Lass-Flörl C, Candoni A, Garcia-Vidal C, Cattaneo C, Buil J, Rabagliati R, Roiz MP, Gudiol C, Fracchiolla N, Campos-Herrero MI, Delia M, Farina F, Fortun J, Nadali G, Sastre E, Colombo AL, Pérez Nadales E, Alastruey-Izquierdo A, Pagano L. Do high MICs predict the outcome in invasive fusariosis? J Antimicrob Chemother 2021; 76:1063-1069. [PMID: 33326585 DOI: 10.1093/jac/dkaa516] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/13/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Invasive fusariosis (IF) affects mostly severely immunocompromised hosts and is associated with poor outcome. Since Fusarium species exhibit high MICs for most antifungal agents, this could explain the poor prognosis. However, a clear-cut correlation between MIC and outcome has not been established. OBJECTIVE To evaluate the correlation between MIC and outcome (6 week death rate) in patients with IF. METHODS We performed a multicentre retrospective study of patients with IF who received treatment and had MIC levels determined by EUCAST or CLSI for the drug(s) used during treatment. We compared the MIC50 and MIC distribution among survivors and patients who died within 6 weeks from the diagnosis of IF. RESULTS Among 88 patients with IF, 74 had haematological diseases. Primary treatment was monotherapy in 52 patients (voriconazole in 27) and combination therapy in 36 patients (liposomal amphotericin B + voriconazole in 23). The MIC50 and range for the five most frequent agents tested were: voriconazole 8 mg/L (range 0.5-64), amphotericin B 2 mg/L (range 0.25-64), posaconazole 16 mg/L (range 0.5-64), itraconazole 32 mg/L (range 4-64), and isavuconazole 32 mg/L (range 8-64). There was no difference in MIC50 and MIC distribution among survivors and patients who died. By contrast, persistent neutropenia and receipt of corticosteroids were strong predictors of 6 week mortality. CONCLUSIONS Our study did not show any correlation between MIC and mortality at 6 weeks in patients with IF.
Collapse
Affiliation(s)
- Marcio Nucci
- University Hospital, Universidade Federal do Rio de Janeiro - Rua Prof Rodolpho Paulo Rocco 255, 21941-913 Rio de Janeiro, Brazil
| | - Jeffrey Jenks
- Division of Infectious Diseases and Global Public Health, University of California, San Diego - 9500 Gilman Drive MC 0507 La Jolla, CA, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases and Department of Medical Microbiology and Immunology, University of California-Davis - 3146 Tupper Hall, 1 Shields Ave., Davis, CA, USA
| | - Martin Hoenigl
- Division of Infectious Diseases and Global Public Health, University of California, San Diego - 9500 Gilman Drive MC 0507 La Jolla, CA, USA.,Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz - Auenbruggerpl. 2, 8036 Graz, Austria
| | - Marielle Camargo Dos Santos
- Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo - Rua Botucatu, 740, 04023-062 - São Paulo, Brazil
| | - Fabio Forghieri
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia - Via Università, 4, 41121 Modena, Italy
| | - Juan Carlos Rico
- Division of Infectious Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock - 4301 W Markham St, Little Rock, AR 72205, USA
| | - Valentina Bonuomo
- Hematology Unit, Azienda Ospedaliera Universitaria Integrata di Verona - Piazzale Aristide Stefani, 1, 37126 Verona, Italy
| | - Leyre López-Soria
- Servicio de Microbiología, Hospital Universitario Cruces, Barakaldo - Cruces Plaza, S/N, 48903 Barakaldo, Bizkaia, Spain
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck - Christoph-Probst-Platz 1, Innrain 52, A - 6020 Innsbruck, Austria
| | - Anna Candoni
- Division of Haematology, Santa Maria Della Misericordia University Hospital of Udine - Piazzale Santa Maria Della Misericordia, 15, 33100 Udine, Italy
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona - C. de Villarroel, 170, 08036 Barcelona, Spain
| | - Chiara Cattaneo
- Haematology Unit, Spedali Civili di Brescia, Via del Medolo, 2, 25123 Brescia, Italy
| | - Jochem Buil
- Center of Expertise in Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital - Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands
| | - Ricardo Rabagliati
- Department of Infectious Diseases, Faculty of Medicine, Pontificia Universidad Católica de Chile - Av Libertador Bernardo O'Higgins 340, Santiago, Región Metropolitana, Chile
| | - Maria Pia Roiz
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla - Av. de Valdecilla, 25, 39008 Santander, Cantabria, Spain
| | - Carlota Gudiol
- Department of Infectious Diseases, Bellvitge University Hospital - Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nicola Fracchiolla
- Unità di Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Via della Commenda, 10, 20122, Milano, Italy
| | - Maria Isolina Campos-Herrero
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria - Calle Plaza Barranco de la Ballena, s/n, 35010 Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Mario Delia
- Sezione di Ematologia, Dipartimento dell'Emergenza e dei Trapianti d'Organo, Università di Bari - Piazza Umberto I, 1, 70121, Bari, Italy
| | - Francesca Farina
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute - Via Olgettina, 60, 20132, Milano, Italy
| | - Jesus Fortun
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal - M-607, km. 9, 100, 28034, Madrid, Spain
| | - Gianpaolo Nadali
- Hematology Unit, Azienda Ospedaliera Universitaria Integrata di Verona - Piazzale Aristide Stefani, 1, 37126 Verona, Italy
| | - Enric Sastre
- Department of Infectious Diseases, Bellvitge University Hospital - Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arnaldo L Colombo
- Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo - Rua Botucatu, 740, 04023-062 - São Paulo, Brazil
| | - Elena Pérez Nadales
- Hospital Universitario Reina Sofia, Universidad de Córdoba - Av. Menendez Pidal, s/n, 14004 Córdoba, Spain
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III - Ctra. de Pozuelo, 28, 28222 Majadahonda, Madrid, Spain
| | - Livio Pagano
- Istituto di Ematologia, Fondazione Policlinico Universitario A. Gemelli-IRCCS-Università Cattolica del Sacro Cuore - Largo Francesco Vito, 1, 00168 Roma RM, Italy
| |
Collapse
|
45
|
Garcia-Vidal C, Lewis RE, Kontoyiannis DP. Combination antifungal therapy for breakthrough invasive mould disease in patients with haematological malignancies: when management reasoning eclipses evidence-based medicine. J Antimicrob Chemother 2021; 75:3096-3098. [PMID: 32719877 DOI: 10.1093/jac/dkaa281] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Timely diagnosis and treatment of invasive mould disease is challenging in severely immunocompromised patients, particularly for patients who develop breakthrough infections while on antifungal prophylaxis. Currently, there are no high-quality data on how to best diagnose and treat these infections. Many essential decisions affecting the management of breakthrough mould disease are made before a definitive diagnosis is established. In this scenario, sound management reasoning often favours the use of combination antifungal therapy, especially when antifungal resistance, suspicion of undetected sites of infection or pharmacokinetic/pharmacodynamic limitations at the site of infection are likely. In these scenarios, pre-emptive use of antifungal combination therapy with frequent re-evaluation with an aim of de-escalation could be justified for many high-risk patients.
Collapse
Affiliation(s)
- C Garcia-Vidal
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - R E Lewis
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - D P Kontoyiannis
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| |
Collapse
|
46
|
Cilloniz C, Simonds A, Hansen K, Alouch J, Zar H, Nakanishi Y, Levine S, Cohen M, Dela Cruz C, Evans SE, Sanguinetti M, Vila J, Díez Manglano J, Ferrer R, Criado L, Polo García J, Correcher Z, Rodriguez-Hurtado D, Terrazas C, Muñoz-Almagro C, Garcia-Vidal C, Aoun Z, Amirav I. Pulse oximetry is an essential tool that saves lives: a call for standardisation. Eur Respir J 2021; 57:57/6/2100815. [PMID: 34088755 DOI: 10.1183/13993003.00815-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/15/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Catia Cilloniz
- Pulmonology Dept, Hospital Clinic of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Anita Simonds
- Sleep and Ventilation Unit, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, London, UK
| | - Kjeld Hansen
- Copenhagen Business School, Frederiksberg, Copenhagen, Denmark.,Kristiania University College, Oslo, Norway
| | - Josep Alouch
- Dept of Medicine, University of Nairobi, Nairobi, Kenya
| | - Heather Zar
- Dept of Paediatrics and Child Health and SA Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Yoichi Nakanishi
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Kitakyushu City Hospital Organisation, Fukuoka, Japan
| | - Stephanie Levine
- University of Texas Health San Antonio and the South Texas Veterans Healthcare System, San Antonio, TX, USA
| | - Mark Cohen
- Pulmonary and Intensive Care Unit, Centro Medico Hospital, Guatemala, Guatemala
| | - Charles Dela Cruz
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Scott E Evans
- Dept of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Centre, Houston, TX, USA
| | | | - Jordi Vila
- Microbiology Dept, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Ricard Ferrer
- Intensive Care Dept, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Lucio Criado
- Dept of Medicine, Hospital del Bicentenario, Ituzaingo, Argentina
| | | | - Zaira Correcher
- General University Hospital and CS Almassora, Castello, Spain
| | - Diana Rodriguez-Hurtado
- Dept of Medicine, National Hospital 'Arzobispo Loayza', Peruvian University 'Cayetano Heredia', Lima, Perú
| | | | | | | | - Zeina Aoun
- Dept of Pulmonary and Critical Care, Hôtel Dieu de France University Hospital, Beirut, Lebanon
| | - Israel Amirav
- Paediatric Dept, University of Alberta, Edmonton, AB, Canada.,Paediatric Pulmonology Unit, Ichilov Tel-Aviv Medical Centre, Tel-Aviv, Israel
| |
Collapse
|
47
|
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.
Collapse
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
| |
Collapse
|
48
|
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.
Collapse
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
| |
Collapse
|
49
|
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.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - A Soriano
- Alex Soriano, Department of Infectious Diseases, Hospital Clínic of Barcelona. Carrer de Villarroel 170, 08036, Barcelona, Spain.
| |
Collapse
|
50
|
Lehrnbecher T, Averbuch D, Castagnola E, Cesaro S, Ammann RA, Garcia-Vidal C, Kanerva J, Lanternier F, Mesini A, Mikulska M, Pana D, Ritz N, Slavin M, Styczynski J, Warris A, Groll AH. 8th European Conference on Infections in Leukaemia: 2020 guidelines for the use of antibiotics in paediatric patients with cancer or post-haematopoietic cell transplantation. Lancet Oncol 2021; 22:e270-e280. [PMID: 33811814 DOI: 10.1016/s1470-2045(20)30725-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/27/2022]
Abstract
Paediatric patients with cancer and those undergoing haematopoietic cell transplantation are at high risk of bacterial infections. The 8th European Conference on Infections in Leukaemia (ECIL-8) convened a Paediatric Group to review the literature and to formulate recommendations for the use of antibiotics according to the European Society of Clinical Microbiology and Infectious Diseases grading system. The evaluation of antibacterial prophylaxis included mortality, bloodstream infection, febrile neutropenia, emergence of resistance, and adverse effects as endpoints. Initial antibacterial therapy and antibiotic de-escalation or discontinuation focused on patients with a clinically stable condition and without previous infection or colonisation by resistant bacteria, and on patients with a clinically unstable condition or with previous infection or colonisation by resistant bacteria. The final considerations and recommendations of the ECIL-8 Paediatric Group on antibacterial prophylaxis, initial therapy, and de-escalation strategies are summarised in this Policy Review.
Collapse
Affiliation(s)
- Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany.
| | - Dina Averbuch
- Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Elio Castagnola
- Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Roland A Ammann
- Pediatric Hematology and Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jukka Kanerva
- Division of Hematology-Oncology and Stem Cell Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Fanny Lanternier
- Infectious Diseases Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Alessio Mesini
- Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Dorothea Pana
- Department of Medicine, European University of Cyprus, Nicosia, Cyprus
| | - Nicole Ritz
- Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Monica Slavin
- Department of Infectious Diseases and National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Adilia Warris
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | | |
Collapse
|