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San-Juan R, Navarro D, García-Reyne A, Montejo M, Muñoz P, Carratala J, Len O, Fortun J, Muñoz-Cobo B, Gimenez E, Eworo A, Sabe N, Meije Y, Martín-Davila P, Andres A, Delgado J, Jimenez C, Amat P, Fernández-Ruiz M, López-Medrano F, Lumbreras C, Aguado JM. Effect of long-term prophylaxis in the development of cytomegalovirus-specific T-cell immunity in D+/R- solid organ transplant recipients. Transpl Infect Dis 2015; 17:637-46. [PMID: 26134282 DOI: 10.1111/tid.12417] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 01/22/2015] [Revised: 04/04/2015] [Accepted: 06/17/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aimed to characterize the dynamics of acquisition of cytomegalovirus (CMV)-specific cell-mediated immunity (CMI) in CMV donor positive/recipient negative solid organ transplant (SOT) patients receiving long-term antiviral prophylaxis, and to determine whether development of CMI confers protection against CMV disease. METHODS A prospective multicenter study was conducted in Spain from September 2009 to September 2012. Whole blood specimens were prospectively collected at 30, 90, 120, 200, and 365 days after SOT, and CMI was determined by enumeration of CMV pp65 and IE-1-specific CD69(+) /interferon-γ-producing CD8(+) and CD4(+) T cells by flow cytometry for intracellular cytokine staining. As part of a simultaneous clinical trial, patients received either early prophylaxis (in the first 3 days after transplantation) in the first period of the study or delayed prophylaxis (initiated at day 14) during the second period of the study. The impact of the dynamics of acquisition of CMV-specific CMI on the incidence of CMV disease was evaluated by Kaplan-Meier survival analysis. RESULTS A total of 95 SOT recipients were recruited. CMV infection and disease occurred in 38 (40%) and 26 (27.4%) patients, respectively. The proportion of patients achieving any detectable CMV-specific CMI response at each of the different monitoring points was higher in liver transplant recipients, as compared to kidney or heart transplant recipients. The presence of any detectable response at day 120 or 200 was protective against the development of CMV disease (positive predictive values 92% and 93%, respectively). CONCLUSIONS The rate of acquisition of CMV-specific CMI in SOT recipients undergoing antiviral prophylaxis differed significantly between different SOT populations. Patients developing any detectable CMI response were protected against the occurrence of CMV disease.
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Affiliation(s)
- R San-Juan
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
| | - D Navarro
- Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Valencia, Spain
| | - A García-Reyne
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
| | - M Montejo
- Unit of Infectious Diseases, Hospital Universitario de Cruces, Bilbao, Spain
| | - P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - J Carratala
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - O Len
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Fortun
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - B Muñoz-Cobo
- Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Valencia, Spain
| | - E Gimenez
- Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Valencia, Spain
| | - A Eworo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - N Sabe
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Y Meije
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Martín-Davila
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A Andres
- Department of Nephrology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
| | - J Delgado
- Unit of Heart Transplantation, Department of Cardiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
| | - C Jimenez
- Department of Abdominal Organ Transplantation and General and Digestive Surgery, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
| | - P Amat
- Department of Hematology and Medical Oncology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Valencia, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
| | - F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
| | - C Lumbreras
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
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San-Juan R, Navarro D, García-Reyne A, Montejo M, Muñoz P, Carratala J, Len O, Fortun J, Muñoz-Cobo B, Gimenez E, Eworo A, Sabe N, Meije Y, Martin-Davila P, Andres A, Delgado J, Jimenez C, Amat P, Fernández-Ruiz M, López-Medrano F, Lumbreras C, Aguado JM. Effect of delaying prophylaxis against CMV in D+/R- solid organ transplant recipients in the development of CMV-specific cellular immunity and occurrence of late CMV disease. J Infect 2015; 71:561-70. [PMID: 26183297 DOI: 10.1016/j.jinf.2015.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/29/2014] [Revised: 04/12/2015] [Accepted: 06/11/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Evaluate the protective effect against late CMV disease of delaying antiviral prophylaxis initiation in D+/R- patients receiving solid organ transplant (SOT). METHODS Prospective multicenter study in D+/R- SOT recipients in Spain (Sept/09-Sept/12). Whole blood specimens were prospectively collected after Tx for CMV-specific cell-mediated immunity (CMI) determination. Two prophylaxis strategies were compared: early prophylaxis (EP; starting within the first 3 days after Tx) and delayed prophylaxis (DP; starting 14 days after Tx). Risk factors for the occurrence of CMV disease were determined by survival analysis and proportional risk Cox regression models. RESULTS We included 95 patients (50 EP V 45 DP). Twenty six patients (27.4%) developed CMV disease: 32.7% EP vs. 20% DP; (p = 0.2). No cases of CMV disease were reported previously to beginning delayed prophylaxis. The percentage of individuals with detectable CMI response was higher in patients with DP although differences did not reach statistic significance (42% vs 29.6% at day 200 after Tx; p = 0.4). There was a clear trend towards less end-organ CMV disease in patients receiving DP (18.2% EP vs 5% DP; p = 0.09) and DP was the only protective factor in the multivariate analysis (HR: 0.26; CI: 0.05-1.2; p = 0.09). CONCLUSIONS A 14-day delay in CMV prophylaxis in D+/R- SOT recipients is safe and may reduce the incidence of late CMV end-organ disease although correlation of this effect with CMI responses was not complete.
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Affiliation(s)
- R San-Juan
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.
| | - D Navarro
- Microbiology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - A García-Reyne
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - M Montejo
- Unit of Infectious Diseases, University Hospital de Cruces, Bilbao, Spain
| | - P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, University Hospital Gregorio Marañon, Madrid, Spain
| | - J Carratala
- Department of Infectious Diseases, Department of Infectious Diseases, University Hospital Bellvitge-IDIBELL, Universidad de Barcelona, Barcelona, Spain
| | - O Len
- Department of Infectious Diseases, University Hospital Vall d'Hebron, Barcelona, Spain
| | - J Fortun
- Infectious Diseases Unit, University Hospital Ramon y Cajal, Madrid, Spain
| | - B Muñoz-Cobo
- Microbiology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - E Gimenez
- Microbiology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - A Eworo
- Department of Clinical Microbiology and Infectious Diseases, University Hospital Gregorio Marañon, Madrid, Spain
| | - N Sabe
- Department of Infectious Diseases, Department of Infectious Diseases, University Hospital Bellvitge-IDIBELL, Universidad de Barcelona, Barcelona, Spain
| | - Y Meije
- Department of Infectious Diseases, University Hospital Vall d'Hebron, Barcelona, Spain
| | - P Martin-Davila
- Infectious Diseases Unit, University Hospital Ramon y Cajal, Madrid, Spain
| | - A Andres
- Nephrology Service, Kidney Transplant Unit, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - J Delgado
- Cardiology Service, Heart Transplant Unit, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - C Jimenez
- General Abdominal Surgery Service, Intra-abdominal Transplant Unit, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - P Amat
- Haematology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - F López-Medrano
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - C Lumbreras
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
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del Río A, Gasch O, Moreno A, Peña C, Cuquet J, Soy D, Mestres CA, Suárez C, Pare JC, Tubau F, Garcia de la Mària C, Marco F, Carratalà J, Gatell JM, Gudiol F, Miró JM, del Rio A, Moreno A, Pericas JM, Cervera C, Gatell JM, Marco F, de la Maria CG, Armero Y, Almela M, Mestres CA, Pare JC, Fuster D, Cartana R, Ninot S, Azqueta M, Sitges M, Heras M, Pomar JL, Ramirez J, Brunet M, Soy D, Llopis J, Gasch O, Suarez C, Pena C, Pujol M, Ariza J, Carratala J, Gudiol F, Cuquet J, Marti C, Mijana M. Efficacy and safety of fosfomycin plus imipenem as rescue therapy for complicated bacteremia and endocarditis due to methicillin-resistant Staphylococcus aureus: a multicenter clinical trial. Clin Infect Dis 2014; 59:1105-12. [PMID: 25048851 DOI: 10.1093/cid/ciu580] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is an urgent need for alternative rescue therapies in invasive infections caused by methicillin-resistant Staphylococcus aureus (MRSA). We assessed the clinical efficacy and safety of the combination of fosfomycin and imipenem as rescue therapy for MRSA infective endocarditis and complicated bacteremia. METHODS The trial was conducted between 2001 and 2010 in 3 Spanish hospitals. Adult patients with complicated MRSA bacteremia or endocarditis requiring rescue therapy were eligible for the study. Treatment with fosfomycin (2 g/6 hours IV) plus imipenem (1 g/6 hours IV) was started and monitored. The primary efficacy endpoints were percentage of sterile blood cultures at 72 hours and clinical success rate assessed at the test-of-cure visit (45 days after the end of therapy). RESULTS The combination was administered in 12 patients with endocarditis, 2 with vascular graft infection, and 2 with complicated bacteremia. Therapy had previously failed with vancomycin in 9 patients, daptomycin in 2, and sequential antibiotics in 5. Blood cultures were negative 72 hours after the first dose of the combination in all cases. The success rate was 69%, and only 1 of 5 deaths was related to the MRSA infection. Although the combination was safe in most patients (94%), a patient with liver cirrhosis died of multiorgan failure secondary to sodium overload. There were no episodes of breakthrough bacteremia or relapse. CONCLUSIONS Fosfomycin plus imipenem was an effective and safe combination when used as rescue therapy for complicated MRSA bloodstream infections and deserves further clinical evaluation as initial therapy in these infections.
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Affiliation(s)
- Ana del Río
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Oriol Gasch
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, Sabadell
| | - Asunción Moreno
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Carmen Peña
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - Jordi Cuquet
- Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona
| | - Dolors Soy
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Carlos A Mestres
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Cristina Suárez
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - Juan C Pare
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Fe Tubau
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat CIBERES (CIBER de Enfermedades Respiratorias), ISCIII, Madrid
| | | | - Francesc Marco
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Spain
| | - Jordi Carratalà
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - José M Gatell
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Francisco Gudiol
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - José M Miró
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
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Garcia-Vidal C, Barba P, Arnan M, Moreno A, Ruiz-Camps I, Gudiol C, Ayats J, Orti G, Carratala J. Invasive Aspergillosis Complicating Pandemic Influenza A (H1N1) Infection in Severely Immunocompromised Patients. Clin Infect Dis 2011; 53:e16-9. [DOI: 10.1093/cid/cir485] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Falguera M, Carratala J, Bielsa S, Garcia-Vidal C, Ruiz-Gonzalez A, Chica I, Gudiol F, Porcel JM. Predictive factors, microbiology and outcome of patients with parapneumonic effusion. Eur Respir J 2011; 38:1173-9. [DOI: 10.1183/09031936.00000211] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gudiol C, Tubau F, Calatayud L, Garcia-Vidal C, Cisnal M, Sanchez-Ortega I, Duarte R, Calvo M, Carratala J. Bacteraemia due to multidrug-resistant Gram-negative bacilli in cancer patients: risk factors, antibiotic therapy and outcomes. J Antimicrob Chemother 2010; 66:657-63. [DOI: 10.1093/jac/dkq494] [Citation(s) in RCA: 176] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Fortun J, Martin-Davila P, Pascual J, Cervera C, Moreno A, Gavalda J, Aguado J, Pereira P, Gurguí M, Carratala J, Fogueda M, Montejo M, Blasco F, Bou G, Torre-Cisneros J. Immunosuppressive therapy and infection after kidney transplantation. Transpl Infect Dis 2010; 12:397-405. [DOI: 10.1111/j.1399-3062.2010.00526.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Garcia-Vidal C, Ardanuy C, Tubau F, Viasus D, Dorca J, Linares J, Gudiol F, Carratala J. Pneumococcal pneumonia presenting with septic shock: host- and pathogen-related factors and outcomes. Thorax 2009; 65:77-81. [DOI: 10.1136/thx.2009.123612] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Blancas D, Santin M, Olmo M, Alcaide F, Carratala J, Gudiol F. Group B Streptococcal Disease in Nonpregnant Adults: Incidence, Clinical Characteristics, and Outcome. Eur J Clin Microbiol Infect Dis 2004; 23:168-73. [PMID: 14986167 DOI: 10.1007/s10096-003-1098-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [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: 10/26/2022]
Abstract
A retrospective review of 150 cases of group B streptococcal disease in nonpregnant adults over an 8-year period was performed in a single tertiary-care teaching hospital to determine the incidence, clinical spectrum, and outcome of the disease. Incidence increased from 0.53 cases per 1,000 admissions in the 1993-1994 period to 0.96 cases per 1,000 admissions in 1999-2000 (P=0.013, chi-square test for trend). Bacteremia also increased from 0.15 to 0.42 cases per 1,000 admissions over the same period of time (P=0.005, chi-square test for trend). The mean age of the patients was 61.4 years, and 92% had at least one underlying disease. Bacteremia was detected in 60.9% of patients in whom blood cultures were performed. Fourteen (9.3%) patients died. Factors independently associated with an increased risk of dying were shock at diagnosis (OR, 23.96; 95%CI, 3.44-166.57; P=0.001) and cancer (OR, 4.96; 95%CI, 1.43-17.20; P=0.012). Group B streptococcal disease in nonpregnant adults is on the rise in the hospital investigated, particularly in persons with underlying conditions. The clinical spectrum of the disease ranges from localized to severe bacteremic infections. Shock at diagnosis and cancer are factors independently associated with a higher fatality rate.
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Affiliation(s)
- D Blancas
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain
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Karthaus M, Carratala J. [Changes in the epidemiology of infections in patients with febrile neutropenia]. Wien Med Wochenschr 2002; 151:47-52. [PMID: 11789419] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Over the last years, advances in the treatment and supportive care of patients with cancer have led to substantial improvement in long-term survival. Nevertheless, bacterial infection continues to contribute significantly to illness and death in patients developing chemotherapy-induced neutropenia. In this severely ill population, the early administration of appropriate empirical antibiotic therapy for febrile episodes is crucial. This therapeutic approach has been shown to decrease morbidity and mortality due to infections caused by gram negative bacilli. However, in recent years, gram positive pathogens have been recovered at a notably increased rate from neutropenic patients with cancer. Although mortality associated to gram positive bacteremia is commonly lower than that caused by gram negative bacilli, an increasing frequency of serious complications of bacteremia due to viridans group streptococci has been observed in some institutions. Moreover, the emerging problems of bacterial resistance to various antimicrobial agents is of great concern. Herein, we examine major changes in the epidemiology of bacterial infections in neutropenic patients with cancer and some clinical aspects of infections caused by most frequent pathogens.
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Affiliation(s)
- M Karthaus
- Medizinische Klinik für Palliativmedizin, Evangelisches Johannes-Krankenhaus, Schildescher Strasse 99, D-33611 Bielefeld, Deutschland.
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Rigual ME, Corbella X, Montero A, Marrón A, Carratala J. [Pubic osteitis caused by Pseudomonas aeruginosa in a patient addicted to intravenous drugs]. Enferm Infecc Microbiol Clin 1997; 15:223. [PMID: 9312284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Alcaide F, Carratala J, Liñares J, Gudiol F, Martin R. In vitro activities of eight macrolide antibiotics and RP-59500 (quinupristin-dalfopristin) against viridans group streptococci isolated from blood of neutropenic cancer patients. Antimicrob Agents Chemother 1996; 40:2117-20. [PMID: 8878591 PMCID: PMC163483 DOI: 10.1128/aac.40.9.2117] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [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: 02/02/2023] Open
Abstract
From January 1988 to December 1994, 66 consecutive blood culture isolates of viridans group streptococci collected from febrile neutropenic cancer patients were tested for antimicrobial susceptibilities by the agar dilution method. The antibiotics studied were erythromycin, clarithromycin, roxithromycin, dirithromycin, azithromycin, josamycin, diacetyl-midecamycin, spiramycin, and quinupristin-dalfopristin. A total of 26 (39.4%) strains were resistant to erythromycin with an MIC range of 0.5 to > 128 micrograms/ml. The strains were classified into three groups according to their penicillin susceptibility: 42 (63.6%) were susceptible, 8 (12.1%) were intermediately resistant, and 16 (24.3%) were highly resistant. The percentages of erythromycin-resistant strains in each group were 23.8, 62.5, and 68.8%, respectively. Streptococcus mitis was the species most frequently isolated (83.3%) and showed the highest rates of penicillin (40%) and erythromycin (43.6%) resistance. MICs of all macrolide antibiotics tested and of quinupristin-dalfopristin were higher for penicillin-resistant strains than for penicillin-susceptible strains. All macrolide antibiotics tested had cross-resistance to erythromycin, which was not observed with quinupristin-dalfopristin. Our study shows a high rate of macrolide resistance among viridans group streptococci isolated from blood samples of neutropenic cancer patients, especially those infected with penicillin-resistant strains. These findings make macrolides unsuitable prophylactic agents against viridans group streptococcal bacteremia in this patient population.
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Affiliation(s)
- F Alcaide
- Department of Microbiology, Hospital Prínceps d'Espanya, Ciutot Sanitària i Universitària de Bellvitge, Barcelona, Spain
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Carratala J, Fernandez-Sevilla A, Tubau F, Dominguez MA, Gudiol F. Emergence of fluoroquinolone-resistant Escherichia coli in fecal flora of cancer patients receiving norfloxacin prophylaxis. Antimicrob Agents Chemother 1996; 40:503-5. [PMID: 8834911 PMCID: PMC163147 DOI: 10.1128/aac.40.2.503] [Citation(s) in RCA: 73] [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: 02/02/2023] Open
Abstract
We studied 122 stool samples collected from 25 patients with hematologic malignancies who received prophylactic norfloxacin. Fecal samples were obtained at admission and twice weekly thereafter during prophylaxis. Fluoroquinolone-resistant Escherichia coli strains were isolated from the feces of 10 (40%) of the patients; two patients had fluoroquinolone-resistant E. coli strains prior to beginning norfloxacin treatment, and in the other eight patients, the strains appeared subsequently. One patient developed fluoroquinolone-resistant E. coli bacteremia after 10 days of norfloxacin administration.
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Affiliation(s)
- J Carratala
- Services of Infectious Diseases, University of Barcelona, Spain
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Jucglà A, Sais G, Carratala J, Moreno A, Fernandez-Sevilla A, Peyri J. A papular eruption secondary to infection with Corynebacterium jeikeium, with histopathological features mimicking botryomycosis. Br J Dermatol 1995; 133:801-4. [PMID: 8555040 DOI: 10.1111/j.1365-2133.1995.tb02762.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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: 01/31/2023]
Abstract
Corynebacterium jeikeium has been increasingly recognized as a pathogen, particularly in immunocompromised patients and in those with a prosthetic heart valve. Although cutaneous manifestations of C. jeikeium infection have been described, we have only found two case reports that give an histological description of the lesions. We present three patients with haematological malignancies who developed infection with C. jeikeium and a papular eruption. Skin biopsy disclosed similar histological features in all three patients, namely numerous Gram-positive bacteria enclosed in an eosinophilic matrix, with a minimal inflammatory response. C. jeikeium was cultured from cutaneous lesions in two cases.
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Affiliation(s)
- A Jucglà
- Department of Dermatology, Ciutat Sanitària i Universitària de Bellvitge, Universitat de Barcelona, Spain
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Alcaide F, Liñares J, Pallares R, Carratala J, Benitez MA, Gudiol F, Martin R. In vitro activities of 22 beta-lactam antibiotics against penicillin-resistant and penicillin-susceptible viridans group streptococci isolated from blood. Antimicrob Agents Chemother 1995; 39:2243-7. [PMID: 8619576 PMCID: PMC162923 DOI: 10.1128/aac.39.10.2243] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.9] [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: 01/31/2023] Open
Abstract
A total of 410 strains of viridans group streptococci isolated consecutively from blood were tested by the microdilution method for in vitro susceptibility to 22 beta-lactam antibiotics. One hundred thirty-eight strains (33.6%) were resistant to penicillin with a MIC range of 0.25 to 8 micrograms/ml. MICs of all beta-lactam agents tested were higher for penicillin-resistant strains than for susceptible strains. These antibiotics were classified into three groups according to their in vitro activities (MICs at which 50 and 90% of the isolates are inhibited). Beta-Lactams of the first group (these included imipenem, cefpirome, FK-037, cefditoren, cefotaxime, ceftriaxone, and cefepime) showed activities higher than or similar to that of penicillin against penicillin-resistant viridans group streptococci. However, 80% of highly penicillin-resistant Streptococcus mitis organisms required cefotaxime and ceftriaxone MICs of > or = 2 micrograms/ml (range, 2 to 16 micrograms/ml). Beta-Lactams of the second group (cefpodoxime, ampicillin, amoxicillin-clavulanate, piperacillin, and cefuroxime) showed lower activities than penicillin. Finally, antibiotics of the third group (cephalothin, oxacillin, ceftazidime, cefixime, cefaclor, cefetamet, cefadroxil, cephalexin, and ceftibuten) showed poor in vitro activities. Therefore, some of the beta-lactam agents included in the first group could be an acceptable alternative in the treatment of serious infections due to strains highly resistant to penicillin, although clinical experience is needed.
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Affiliation(s)
- F Alcaide
- Service of Microbiology, Hospital Prínceps d'Espanya, Ciutat Sanitària i Universitària de Bellvitge, Barcelona, Spain
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16
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Carratala J, Gudiol F, Pallares R, Dorca J, Verdaguer R, Ariza J, Manresa F. Risk factors for nosocomial Legionella pneumophila pneumonia. Am J Respir Crit Care Med 1994; 149:625-9. [PMID: 8118629 DOI: 10.1164/ajrccm.149.3.8118629] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.2] [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: 01/28/2023] Open
Abstract
Over a 5-yr period, from January 1985 to January 1990, we prospectively studied 300 episodes of nosocomial pneumonia in a 1,000-bed teaching hospital. All cases had an accurate bacteriologic diagnosis obtained by means of highly reliable techniques. Legionella pneumophila caused a total of 36 episodes; 22 were endemic and 14 occurred during an epidemic outbreak. No patient with Legionella pneumonia had been intubated before infection. To identify risk factors for nosocomial L. pneumophila pneumonia, we compared the 22 endemic cases of nosocomial pneumonia due to L. pneumophila with the 264 cases due to other bacteria. After adjusting for other variables by means of logistic regression analysis, cytotoxic chemotherapy (OR = 5.2; 95% CI, 1.5 to 17.9) and use of corticosteroids (OR = 4.6; 95% CI, 1.5 to 14.1) were positively associated with L. pneumophila pneumonia, whereas previous antibiotic therapy (OR = 0.2; 95% CI, 0.1 to 0.8) and lowered consciousness (OR = 0.2; 95% CI, 0.07 to 0.8) were negatively associated. The major risk factors for Legionella pneumonia delineated in this study should be considered in the clinical approach to and empiric therapy of patients with suspected nosocomial pneumonia.
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Affiliation(s)
- J Carratala
- Service of Infectious Disease, Hospital de Bellvitge, University of Barcelona, Spain
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Abstract
Concurrent with the AIDS epidemic, an increasing incidence of tuberculosis has been noted. In HIV-infected patients with immunodeficiency, atypical forms of tuberculosis are seen. A case of disseminated tuberculosis with septic shock in an elderly patient with previously unknown HIV infection is reported.
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Affiliation(s)
- M Vadillo
- Department of Infectious Diseases, Bellvitge Hospital, University of Barcelona, Spain
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Corbella X, Carratala J, Rufi G, Gudiol F. Unusual manifestations of miliary tuberculosis: cutaneous lesions, phalanx osteomyelitis, and paradoxical expansion of tenosynovitis. Clin Infect Dis 1993; 16:179-80. [PMID: 8448305 DOI: 10.1093/clinids/16.1.179] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Pujol M, Corbella X, Carratala J, Gudiol F. Community-acquired bacteremic Pseudomonas cepacia pneumonia in an immunocompetent host. Clin Infect Dis 1992; 15:887-8. [PMID: 1280168 DOI: 10.1093/clind/15.5.887] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Abstract
We report a case of Torulopsis glabrata upper urinary tract infection causing ureteral obstruction. The infection was successfully treated with fluconazole, a new triazole derivative, combined with ureteral catheterization.
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Affiliation(s)
- X Corbella
- Department of Infectious Disease, Bellvitge Hospital, University of Barcelona, Spain
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Carratala J, Lacasa JM, Mascaro J, Torras JT. AIDS presenting as duodenal perforation due to Kaposi's sarcoma. AIDS 1992; 6:241-2. [PMID: 1558729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Carratala J, Corbella X, Dominguez A, Gudiol F. Development of resistance to ciprofloxacin during therapy for a Pseudomonas aeruginosa lung abscess. Rev Infect Dis 1991; 13:764-5. [PMID: 1781856 DOI: 10.1093/clinids/13.4.764-a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Gudiol F, Pallares R, Carratala J, Bolao F, Ariza J, Rufi G, Viladrich PF. Randomized double-blind evaluation of ciprofloxacin and doxycycline for Mediterranean spotted fever. Antimicrob Agents Chemother 1989; 33:987-8. [PMID: 2669629 PMCID: PMC284272 DOI: 10.1128/aac.33.6.987] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.3] [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: 01/02/2023] Open
Abstract
A study of 43 patients with Mediterranean spotted fever showed that a 2-day course of ciprofloxacin or a 2-day course of doxycycline may be an effective mode of therapy. All patients in both arms of the study were cured; however, doxycycline produced a more rapid defervescence.
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Affiliation(s)
- F Gudiol
- Department of Medicine, Bellvitge Hospital, University of Barcelona, Spain
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Carratala J, Moreno R, Cabellos C, Miquel Nolla J, Pac V, Moga I. Neisseria meningitis monoarthritis revealing systemic lupus erythematosus. J Rheumatol 1988; 15:532-3. [PMID: 3379634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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