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Trigo-Rodríguez M, Cárcel S, Navas A, Espíndola-Gómez R, Garrido-Gracia JC, Esteban Moreno MÁ, León-López R, Pérez-Crespo PMM, Aguilar Alonso E, Vinuesa García D, Romero-Palacios A, Pérez-Camacho I, Gutiérrez-Gutiérrez B, Martínez-Marcos FJ, Fernández-Roldán C, León E, Caño AA, Corzo-Delgado JE, Perez-Nadales E, Riazzo C, de la Fuente C, Jurado A, Torre-Cisneros J, Merchante N. Role of IP-10 to predict clinical progression and response to IL-6 blockade with Sarilumab in early COVID-19 pneumonia. A subanalysis of the SARICOR clinical trial. Open Forum Infect Dis 2023; 10:ofad133. [PMID: 37035487 PMCID: PMC10077828 DOI: 10.1093/ofid/ofad133] [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: 11/03/2022] [Accepted: 03/10/2023] [Indexed: 03/13/2023] Open
Abstract
Abstract
Background
Clinical Trial of Sarilumab in Adults With COVID-19 (SARICOR) showed that patients with COVID-19 pneumonia and increased levels of interleukin (IL)-6 might benefit from blockade of IL6-pathway. However, the benefit from this intervention might not be uniform. In this subanalysis, we sought to determine if other immunoactivation markers, besides IL-6, could identify which subgroup of patients benefit the most of this intervention.
Methodology
The SARICOR trial was a phase II, open-label, multicentre, controlled (July 2020-March 2021) in which patients were randomized to receive usual care (UC) (control group); UC plus single dose of Sarilumab 200 mg (Sarilumab-200 group) or UC plus single dose of Sarilumab 400 mg (Sarilumab-400 group). Patients who had baseline serum samples for cytokine determination (IL-8, IL-10, MCP-1, IP-10) were included in this secondary analysis. Progression to ARDS according to cytokine levels and treatment received was evaluated.
Results
101 (88%) of 115 patients enrolled in the SARICOR trial had serum samples (control group: n=33; Sarilumab-200: n=33; Sarilumab-400 n=35). Among all evaluated biomarkers, IP-10 showed the strongest association with treatment outcome. Patients with IP-10 ≥ 2500 pg/ml treated with Sarilumab-400 had a lower probability of progression (13%) compared to the control group (58%) (HR 0.19; 95% CI: 0.04-0.90; p=0.04). Conversely, patients with IP-10 < 2500 pg/ml did not show these differences.
Conclusions
IP-10 may predict progression to ARDS in patients with COVID-19 pneumonia and IL-6 levels > 40 pg/ml. Importantly, IP-10 value < 2500 pg/ml might discriminate those individuals who might not benefit of Sarilumab therapy besides high IL-6 levels.
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Affiliation(s)
- Marta Trigo-Rodríguez
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Universidad de Sevilla, Instituto de Investigaciones Biomédicas de Sevilla, IBIS (Universidad de Sevilla , Junta de Andalucía, CSIC) Sevilla , Spain
| | - Sheila Cárcel
- Unidad de Gestión Clínica de Cuidados Intensivos, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO) , Córdoba , Spain
| | - Ana Navas
- Unidad de Inmunología y Alergia, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO) , Córdoba , Spain
| | - Reinaldo Espíndola-Gómez
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Universidad de Sevilla, Instituto de Investigaciones Biomédicas de Sevilla, IBIS (Universidad de Sevilla , Junta de Andalucía, CSIC) Sevilla , Spain
| | - José Carlos Garrido-Gracia
- Unidad de Ensayos Clínicos, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO) , Córdoba , Spain
| | | | - Rafael León-López
- Unidad de Gestión Clínica de Cuidados Intensivos, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO) , Córdoba , Spain
| | - Pedro María Martínez Pérez-Crespo
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Universidad de Sevilla, Instituto de Investigaciones Biomédicas de Sevilla, IBIS (Universidad de Sevilla , Junta de Andalucía, CSIC) Sevilla , Spain
| | | | - David Vinuesa García
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Clínico San Cecilio , Granada , Spain
| | - Alberto Romero-Palacios
- Unidad de Enfermedades Infecciosas, Hospital Universitario Puerto Real, Instituto de Investigacion Biomédica de Cádiz (INiBICA) , Cádiz , Spain
| | - Inés Pérez-Camacho
- Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA) , Málaga , Spain
| | - Belén Gutiérrez-Gutiérrez
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBIS) , Seville , Spain
| | | | | | - Eva León
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Universidad de Sevilla, Instituto de Investigaciones Biomédicas de Sevilla, IBIS (Universidad de Sevilla , Junta de Andalucía, CSIC) Sevilla , Spain
| | | | - Juan E Corzo-Delgado
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Universidad de Sevilla, Instituto de Investigaciones Biomédicas de Sevilla, IBIS (Universidad de Sevilla , Junta de Andalucía, CSIC) Sevilla , Spain
| | - Elena Perez-Nadales
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Grupo de Enfermedades Infecciosas, Instituto de Investigaciones Biomédicas de Córdoba, Hospital Universitario Reina Sofía, Universidad de Córdoba (IMIBIC/HURS/UCO), Córdoba, España; Departamento de Química Agrícola, Edafología y Microbiología, Universidad de Córdoba , Córdoba , Spain
| | - Cristina Riazzo
- Servicio de Microbiología. Hospital Universitario Reina Sofía-IMIBIC , Cordoba , Spain
| | - Carmen de la Fuente
- Unidad de Gestión Clínica de Cuidados Intensivos, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO) , Córdoba , Spain
| | - Aurora Jurado
- Unidad de Inmunología y Alergia, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO) , Córdoba , Spain
| | - Julián Torre-Cisneros
- Servicio de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO) , Córdoba , Spain
| | - Nicolás Merchante
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Universidad de Sevilla, Instituto de Investigaciones Biomédicas de Sevilla, IBIS (Universidad de Sevilla , Junta de Andalucía, CSIC) Sevilla , Spain
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Palacios-Baena ZR, Valiente de Santis L, Maldonado N, Rosso-Fernández CM, Borreguero I, Herrero-Rodríguez C, López-Cárdenas S, Martínez-Marcos FJ, Martín-Aspas A, Jiménez-Aguilar P, Castón JJ, Anguita-Santos F, Ojeda-Burgos G, Aznarte-Padial MP, Praena-Segovia J, Corzo-Delgado JE, Esteban-Moreno MÁ, Rodríguez-Baño J, Retamar P. Quasiexperimental intervention study protocol to optimise the use of new antibiotics in Spain: the NEW_SAFE project. BMJ Open 2020; 10:e035460. [PMID: 32737088 PMCID: PMC7398103 DOI: 10.1136/bmjopen-2019-035460] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/27/2020] [Accepted: 06/30/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Ceftaroline, tedizolid, dalbavancin, ceftazidime-avibactam and ceftolozane-tazobactam are novel antibiotics used to treat infections caused by multidrug-resistant pathogens (MDR). Their use should be supervised and monitored as part of an antimicrobial stewardship programme (ASP). Appropriate use of the new antibiotics will be improved by including consensual indications for their use in local antibiotic guidelines, together with educational interventions providing advice to prescribers to ensure that the recommendations are clearly understood. METHODS AND ANALYSIS This study will be implemented in two phases. First, a preliminary historical cohort (2017-2019) of patients from 13 Andalusian hospitals treated with novel antibiotics will be analysed. Second, a quasiexperimental intervention study will be developed with an interrupted time-series analysis (2020-2021). The intervention will consist of an educational interview between prescribers and ASP leaders at each hospital to reinforce the proper use of novel antibiotics. The educational intervention will be based on a consensus guideline designed and disseminated by leaders after the retrospective cohort data have been analysed. The outcomes will be acceptance of the intervention and appropriateness of prescription. Incidence of infection and colonisation with MDR organisms as well as incidence of Clostridioides difficile infection will also be analysed. Changes in prescription quality between periods and the safety profile of the antibiotics in terms of mortality rate and readmissions will also be measured. ETHICS AND DISSEMINATION Ethical approval will be obtained from the Andalusian Coordinating Institutional Review Board. The study is being conducted in compliance with the protocol and regulatory requirements consistent with International Council of Harmonisation E6 Good Clinical Practice and the ethical principles of the latest version of the Declaration of Helsinki. The results will be published in peer-reviewed journals and disseminated at national and international conferences. TRIAL REGISTRATION NUMBER NCT03941951; Pre-results.
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Affiliation(s)
- Zaira R Palacios-Baena
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/ Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Lucia Valiente de Santis
- Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario Regional de Málaga, Málaga, Spain
| | - Natalia Maldonado
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/ Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Clara M Rosso-Fernández
- Unidad de Investigación Clínica y Ensayos Clínicos (CTU), Hospital Universitario Virgen del Rocío-Macarena, Seville, Spain
| | - Irene Borreguero
- Unidad de Investigación Clínica y Ensayos Clínicos (CTU), Hospital Universitario Virgen del Rocío-Macarena, Seville, Spain
| | | | | | | | - Andrés Martín-Aspas
- Unidad Clínica de Enfermedades Infecciosas, Hospital Puerta del Mar, Cádiz, Spain
| | | | - Juan J Castón
- Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | | | - Guillermo Ojeda-Burgos
- Unidad Clínica de Enfermedades Infecciosas, Hospital Virgen de la Victoria, Málaga, Spain
| | | | - Julia Praena-Segovia
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío/ Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Juan E Corzo-Delgado
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Seville, Spain
| | - M Ángeles Esteban-Moreno
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital de Torrecárdenas, Almería, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/ Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - Pilar Retamar
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/ Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
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García-García JA, Santos-Morano J, Castro C, Bayoll-Serradilla E, Martín-Ponce ML, Vergara-López S, Martín-Rodríguez LM, Mateos-Gómez A, de la Cueva J, Martín-Mazuelos E, Gómez-Mateos JM, Corzo-Delgado JE. [Prevalence and risk factors of methicillin-resistant Staphylococcus aureus colonization among residents living in long-term care facilities in southern Spain]. Enferm Infecc Microbiol Clin 2011; 29:405-10. [PMID: 21349606 DOI: 10.1016/j.eimc.2010.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 12/16/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) has become the most important problem related to multiresistant microorganisms in the health care system. Long-term-care facilities (LTCFs) are one of the main reservoirs of this microorganism. The objective of our study was to determine the prevalence and factors associated with MRSA colonization among subjects living in LTCFs in southern Spain. METHODS During the period from 1st April 2009 to 30th June 2010, all subjects living in 17 LTCFs of our area were included in a cross-sectional study. Patients were screened by using nasal swabs and these were cultured in a chromogenic media. Suspected S. aureus colonies were identified by the latex agglutination test. Testing for antimicrobial identification and susceptibility was performed by an automated system. A logistic regression model was built, in which to be colonized by MRSA was the dependent variable, and covariates were entered if a difference with P<.2 was detected in the bivariate analysis. Residents were classified as MRSA carriers, methicillin-susceptible S. aureus carriers and non-carriers. RESULTS Seven hundreds and forty-four subjects were included. There were 481 (65%) females. The median (Q1-Q3) age was 81 (74-86) years. Seventy-nine (10.6%) and 67 (9%) were colonized by MRSA and methicillin-susceptible S. aureus, respectively. Significant risk factors for MRSA carriers were recent antibiotic use, previous hospital admission in the last three months, a high comorbidity measured by Charlson index and a history of colonization by MRSA. CONCLUSIONS The prevalence of MRSA colonization in the LTCFs of our area is similar to that described in others European countries. In our institutions, subjects with recent antibiotic use, a high comorbidity, a history of MRSA colonization and a hospital admission in the last three months are more susceptible to be colonized by MRSA.
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Ferrete-Morales C, Vázquez-Pérez MA, Sánchez-Berna M, Gilabert-Cerro I, Corzo-Delgado JE, Pineda-Vergara JA, Vergara-López S, Gómez-Mateos J. [Incidence of phlebitis due to peripherally inserted venous catheters: impact of a catheter management protocol]. Enferm Clin 2010; 20:3-9. [PMID: 20106690 DOI: 10.1016/j.enfcli.2009.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 06/30/2009] [Accepted: 10/21/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the impact on the incidence of PPIVC by implementing a catheter management protocol and to determine risk factors for PPIVC development in hospitalized patients. METHOD A total of 3978 episodes of venous catheterization were prospectively included from September 2002 to December 2007. A catheter management protocol was implemented during this period of time. The incidence and variables associated to the occurrence of PPIVC were determined. RESULTS The incidence of PPIVC from 2002 to 2007 was 4.8%, 4.3%, 3.6%, 2.5%, 1.3% and 1.8% (p<0.001). Perfusion of amiodarone [adjusted OR (AOR) 25.97; 95% CI=7.29-92.55, p=0.0001] and cefotaxime (AOR 2.90; 95% CI=1.29-6.52, p=0.01) and the shift when the catheters were placed (AOR for morning vs. night shift 0.60; 95% CI=0.35-1.02, p=0.063) were independently associated to the development of PPIVC. A history of phlebitis was the only factor independently associated to phlebitis due to peripherally inserted central venous catheters (AOR 3.24; CI at 95% CI= 1.05-9.98, p=0.04). CONCLUSIONS A catheter management protocol decreases the incidence of PPIVC in hospitalized patients. The risk of PPIVC increases for peripherally inserted central venous catheters when the patients have a history of phlebitis and for peripheral venous catheters when amiodarone or cefotaxime are infused. Catheterization of peripheral veins performed during morning shifts is associated with a lower incidence of PPIVC when compared with night shift catheterizations.
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Affiliation(s)
- C Ferrete-Morales
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Sevilla, España.
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