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Marques Vidas M, Muñez Rubio E, Quiroga B, Montejano R, Morales E, Candel FJ. Strategies for prevention and treatment of SARS-COV-2 infection in patients with chronic kidney disease: Literature review. Nefrologia 2024; 44:150-158. [PMID: 38575481 DOI: 10.1016/j.nefroe.2024.03.010] [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: 05/09/2023] [Accepted: 10/06/2023] [Indexed: 04/06/2024] Open
Abstract
COVID-19 has proven to be particularly aggressive in patients with chronic kidney disease (CKD). The lower immune response rate and the greater susceptibility to progress to severe forms of the disease have contributed to this phenomenon, which has persisted in the post-vaccination era of the pandemic. Paradoxically, CKD has been excluded from most clinical trials of the main therapeutic tools developed against SARS-CoV-2. However, experience in the use of these drugs has been accumulating in different stages of CKD, supporting their use with guarantees of efficacy and safety. The objective of this review is to gather all treatment indications for COVID-19 in the different phases of the disease, tailored to CKD in its various stages, including renal replacement therapy.
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Affiliation(s)
- María Marques Vidas
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Elena Muñez Rubio
- Unidad de Enfermedades Infecciosas, Servicio Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Borja Quiroga
- ISS-La Princesa, Servicio de Nefrología, Hospital Universitario de la Princesa, Madrid, Spain
| | - Rocío Montejano
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario La Paz, CIBER-INFEC, Madrid, Spain
| | - Enrique Morales
- Servicio de Nefrología, Hospital Universitario 12 de Octubre; Instituto de Investigación i+12 del Hospital Universitario 12 de Octubre; Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Javier Candel
- Enfermedades Infecciosas y Microbiología Clínica, Coordinación de Trasplantes, Banco de Tejidos, IdISSC, Hospital Universitario Clínico San Carlos, Departamento de Medicina, Universidad Complutense, Madrid, Spain
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Lopez NV, Parra JC, Serrano AM, Villanueva AG, de la Fuente Moral S, Moreno-Torres V, Rubio EM, Martínez AR. Effect of the implementation of clinical guidelines on management of candidemia in elderly patients. Mycoses 2023. [PMID: 37264489 DOI: 10.1111/myc.13621] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Mortality from candidemia is higher in elderly population than in younger patients, which may be related to suboptimal management. The aim of the present study is to evaluate adherence to the recommendations for the clinical management of candidemia in a population over 75 years before and after implementing specific training. PATIENTS AND METHODS We recorded retrospectively data from candidemia episodes in elderly patients during two periods of time: 2010-2015 years (before training) and 2017-2022 years (after training), as well as adherence to the recommendations of the clinical practice guidelines, mortality and consultation to infectious disease specialists. RESULTS Forty-five episodes of candidemia were recorded in the first period and 29 episodes in the second period. A better compliance to the recommendations of the clinical practice guidelines was observed in the second period: echocardiogram performance (75.9% vs. 48.9% p = .021), fundoscopy (65.5% vs. 44.4% p = .076), follow-up blood cultures (72.4% vs. 42.2% p = .011), removal of central venous catheter (80% vs. 52.9% p = .080) and adequate antifungal treatment (82.6% vs. 52.6% p = .018). A trend towards lower mortality was observed during the second period (27.6% vs. 44.4% p = .144). CONCLUSION The improvement of knowledge of clinical guidelines on candidemia and the participation of infectious disease specialists may increase the quality of care in elderly patients with candidemia. It would be necessary to enlarge the sample size to evaluate the real impact of this intervention on mortality.
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Affiliation(s)
- Natalia Vicente Lopez
- Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Jorge Calderon Parra
- Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | | | | | - Victor Moreno-Torres
- Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- UNIR Health Sciences School, Logroño, Spain
| | - Elena Muñez Rubio
- Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Antonio Ramos Martínez
- Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
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Ferre Aracil C, El Hajra Martínez I, Vera Mendoza MS, Ramos Martínez A, Muñez Rubio E, Fernández-Cruz A, Matallana Royo V, García-Maseda S, Sánchez Romero I, Martínez Ruiz R, Calleja Panero JL. Faecal Microbiota Transplantation is a simple, effective and safe treatment in the management of C. difficile infection in daily clinical practice. Enferm Infecc Microbiol Clin (Engl Ed) 2023; 41:206-210. [PMID: 36681571 DOI: 10.1016/j.eimce.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/19/2022] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Faecal microbiota transplantation (FMT) is a treatment supported by wide scientific evidence and proved to be very effective in the management of Clostridioides difficile infection (CDI). The objective of this study is to analyze its effectiveness and safety in a real clinical practice setting. METHODS Retrospective, single-center and descriptive observational study in which all FMT performed between May 2016 and December 2020 were included. Technical success was defined as the successful administration of the faecal preparation in the patient's gastrointestinal tract and clinical success the disappearance of diarrhoea in the first 72 h after the procedure with no relapse within the following 8 weeks after the therapy was started. RESULTS 15 FMT were performed in 13 patients. Median age was 79 years (range: 40-98 years); being 60% women and 33.3% depedent persons. The indication for FMT was recurrent CDI in 84.6%. All FMTs were performed by colonoscopy and from related donors. With a first procedure, the FMT was effective in 11 of 13 patients (84.61%; 95% CI; 54.55-98.07). Time until resolution of symptoms was less than 48 h in all cases. Post-transplant follow-up was 25.66 ± 17.5 months. No significant short or long-term complications were recorded at follow-up. CONCLUSION TMF is a simple, effective and safe procedure in CD infection, even in elderly patients or those with great comorbidities.
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Affiliation(s)
- Carlos Ferre Aracil
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | - Ismael El Hajra Martínez
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Antonio Ramos Martínez
- Servicio de Medicina Interna - Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Elena Muñez Rubio
- Servicio de Medicina Interna - Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ana Fernández-Cruz
- Servicio de Medicina Interna - Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Virginia Matallana Royo
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Sarela García-Maseda
- Servicio de Microbiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Isabel Sánchez Romero
- Servicio de Microbiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Rocío Martínez Ruiz
- Servicio de Microbiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - José Luis Calleja Panero
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Ferre-Aracil C, El Hajra Martínez I, Vera Mendoza MI, Ramos Martínez A, Muñez Rubio E, Fernández-Cruz A, Matallana Royo V, García-Maseda S, Sánchez Romero I, Martínez Ruiz R, Calleja Panero JL. El trasplante de microbiota fecal es un tratamiento sencillo, efectivo y seguro en el manejo de la infección por C. difficile en la práctica clínica diaria. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bendala Estrada AD, Calderón Parra J, Fernández Carracedo E, Muiño Míguez A, Ramos Martínez A, Muñez Rubio E, Rubio-Rivas M, Agudo P, Arnalich Fernández F, Estrada Perez V, Taboada Martínez ML, Crestelo Vieitez A, Pesqueira Fontan PM, Bustamante M, Freire SJ, Oriol-Bermúdez I, Artero A, Olalla Sierra J, Areses Manrique M, Carrasco-Sánchez HFJ, Vento VC, García García GM, Cubero-Morais P, Casas-Rojo JM, Núñez-Cortés JM. Inadequate use of antibiotics in the covid-19 era: effectiveness of antibiotic therapy. BMC Infect Dis 2021; 21:1144. [PMID: 34749645 PMCID: PMC8575150 DOI: 10.1186/s12879-021-06821-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 02/15/2021] [Accepted: 10/19/2021] [Indexed: 01/08/2023] Open
Abstract
Background Since December 2019, the COVID-19 pandemic has changed the concept of medicine. This work aims to analyze the use of antibiotics in patients admitted to the hospital due to SARS-CoV-2 infection.
Methods This work analyzes the use and effectiveness of antibiotics in hospitalized patients with COVID-19 based on data from the SEMI-COVID-19 registry, an initiative to generate knowledge about this disease using data from electronic medical records. Our primary endpoint was all-cause in-hospital mortality according to antibiotic use. The secondary endpoint was the effect of macrolides on mortality.
Results Of 13,932 patients, antibiotics were used in 12,238. The overall death rate was 20.7% and higher among those taking antibiotics (87.8%). Higher mortality was observed with use of all antibiotics (OR 1.40, 95% CI 1.21–1.62; p < .001) except macrolides, which had a higher survival rate (OR 0.70, 95% CI 0.64–0.76; p < .001). The decision to start antibiotics was influenced by presence of increased inflammatory markers and any kind of infiltrate on an x-ray. Patients receiving antibiotics required respiratory support and were transferred to intensive care units more often. Conclusions Bacterial co-infection was uncommon among COVID-19 patients, yet use of antibiotics was high. There is insufficient evidence to support widespread use of empiric antibiotics in these patients. Most may not require empiric treatment and if they do, there is promising evidence regarding azithromycin as a potential COVID-19 treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06821-1.
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Affiliation(s)
| | - Jorge Calderón Parra
- Internal Medicine Department, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | | | - Antonio Muiño Míguez
- Internal Medicine Department, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Antonio Ramos Martínez
- Internal Medicine Department, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Elena Muñez Rubio
- Internal Medicine Department, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Manuel Rubio-Rivas
- Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paloma Agudo
- Internal Medicine Department, 12 de Octubre University Hospital, Madrid, Spain
| | | | | | | | | | | | - Marta Bustamante
- Internal Medicine Department, La Princesa University Hospital, Madrid, Spain
| | - Santiago J Freire
- Internal Medicine Department, A Coruña University Hospital, A Coruña, Spain
| | - Isabel Oriol-Bermúdez
- Infectious Diseases, Internal Medicine Department, Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | - Arturo Artero
- Internal Medicine Department, Dr. Peset University Hospital, Valencia, Spain
| | | | | | | | | | | | - Pablo Cubero-Morais
- Internal Medicine Department, Río Hortega University Hospital, Regional Health Management of Castilla y Leon (SACYL), Valladolid, Spain
| | - José-Manuel Casas-Rojo
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, Madrid, Spain
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Ortiz Balbuena J, Muñez Rubio E, Ramos Martínez A. Tuberculosis peritoneal en pacientes con artritis reumatoide en tratamiento con adalimumab. Med Clin (Barc) 2017; 149:368. [DOI: 10.1016/j.medcli.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
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Moral L, Rubio EM, Moya M. A leishmanin skin test survey in the human population of l'Alacantí region (Spain): implications for the epidemiology of Leishmania infantum infection in southern Europe. Trans R Soc Trop Med Hyg 2002; 96:129-32. [PMID: 12055798 DOI: 10.1016/s0035-9203(02)90278-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [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: 11/19/2022] Open
Abstract
A study of leishmanin skin test reactors was carried out in 1997 and 1998 in an endemic region in southeast Spain, to estimate the magnitude of and the factors related to subclinical Leishmania infantum infection. In the main focus of leishmaniasis in the region, 11.5% of the children and 52.8% of the adults reacted to the skin test. Among the adults, the response was significantly greater for males and for those who had resided in the area for > or = 15 years. In the whole region, 3.7% 14-year-old students reacted to the skin test, with no gender differences. The main factors related to a positive skin test result were having a parent or sibling recovered from leishmaniasis (relative risk = 14) and living in the rural periphery of the region as opposed to the metropolitan area (relative risk = 4). These results indicate a high frequency of subclinical leishmaniasis in the region. We postulate that the decline in childhood visceral leishmaniasis in southern Europe in the second half of the 20th century is related to social changes, which gave rise to a less frequent exposure at a young age as well as a lowered susceptibility to disease through nutritional and immune improvements.
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Affiliation(s)
- L Moral
- Department of Paediatrics, Miguel Hernández University, Carretera Alicante-Valencia, s/n, E-03550 San Juan de Alicante, Spain.
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Gil LM, Rubio EM. Exclusion of convalescent excretors of Salmonella from preschool. Pediatr Infect Dis J 2001; 20:1184. [PMID: 11740335 DOI: 10.1097/00006454-200112000-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The case is reported of a 20-month-old girl admitted to our centre for group B streptococcal endocarditis who died of complete atrioventricular block after a week of treatment. There was no history pointing to the presence of a heart disorder. Necropsy disclosed the surprising existence of a vast rheumatic carditis involving essentially the aortic and mitral valves, with bacterial superinfection of the former. The double rheumatic and infectious lesion in such a young patient with infective pseudo-aneurysms of the sinuses of Valsalva makes this an exceptional case.
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Affiliation(s)
- L Moral
- Servicio de Pediatría, Hospital Materno-Infantil Valle de Hebrón, Barcelona, Spain
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Ruiz JM, Arteaga E, Martinez J, Rubio EM, Torres JM. Cutaneous and renal geotrichosis in a giant tortoise (Geochelone elephantopus). Sabouraudia 1980; 18:51-9. [PMID: 7368044 DOI: 10.1080/00362178085380091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A case of cutaneous and renal geotrichosis in a giant tortoise, Geochelone elephantopus, at the Zoological Park of Barcelona is reported. Fungal hyphae and spores were seen in skin and kidney. Culture of these tissues yielded Geotrichum candidum. This fungus was isolated from the faeces of 5 other giant tortoises that were housed with the dead animal and from specimens of corn hydroponic culture which is part of their diet. Arthrospore suspensions of the 2 strains isolated from the dead animal's skin and kidney were experimentally inoculated into mice and turtles (Testudo horsfiedi) in order to determine the pathogenicity of G. candidum for animal tissues. Our results confirm its low pathogenicity.
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de Araujo CG, Rubio EM. [Hemorrhage and hemodilution]. AMB Rev Assoc Med Bras 1977; 23:182. [PMID: 302972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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