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Lázaro C, Llauradó A, Sánchez-Tejerina D, Cabirta A, Carpio C, Sotoca J, Salvadó M, Raguer N, Restrepo J, Juntas R. [Guillain-Barre syndrome and thrombocytopenia after SARS-CoV-2 vaccination with Moderna. A case report]. Rev Neurol 2022; 75:247-250. [PMID: 36218255 DOI: 10.33588/rn.7508.2022138] [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: 06/16/2023]
Abstract
INTRODUCTION The massive vaccination against the SARS-CoV-2 virus has demonstrated to be one of the major measures for the reduction of the morbidity and mortality that this virus causes. However, during the last months the administration of the vaccine has been also associated with some rare, but life-threatening, adverse effects. CASE REPORT In this article we describe the case of a patient that developed a Guillain-Barre syndrome and an Idiopathic thrombocytopenic purpura nine days after the vaccination with the third dose for the SARS-CoV-2 virus (Moderna). He had received previously two doses of the AstraZeneca vaccine. Moreover, the patient was positive for auto-antibodies anti-SSA/Ro60 and auto-antibodies IgG anti-GM1 and IgG anti-GM3. DISCUSSION Even though it is not possible to stablish a clear relation of causality between the administration of the vaccine booster for SARS-CoV-2 and the diseases developed by the patient, the association of two concomitant autoimmune processes is remarkable. As well as the positivity for the auto-antibodies anti-SSA/Ro60, which have been described in the bibliography in cases of SARS-CoV-2 infection.
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Affiliation(s)
- C Lázaro
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
| | - A Llauradó
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
| | | | - A Cabirta
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
| | - C Carpio
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
| | - J Sotoca
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
| | - M Salvadó
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
| | - N Raguer
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
| | - J Restrepo
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
| | - R Juntas
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
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Prieto E, Jabaloyas E, Casanovas R, Rovira C, Salvadó M. Set up of a gamma spectrometry mobile unit equipped with LaBr3(Ce) detectors for radioactivity monitoring. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Prieto E, Casanovas R, Salvadó M. Calibration and performance of a real-time gamma-ray spectrometry water monitor using a LaBr 3 (Ce) detector. Radiat Phys Chem Oxf Engl 1993 2018. [DOI: 10.1016/j.radphyschem.2017.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Prieto E, Casanovas R, Salvadó M. Spectral windows analysis method for monitoring anthropogenic radionuclides in real-time environmental gamma-ray scintillation spectrometry. J Radiol Prot 2018; 38:229-246. [PMID: 29154260 DOI: 10.1088/1361-6498/aa9b9c] [Citation(s) in RCA: 1] [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: 06/07/2023]
Abstract
This paper proposes an analysis methodology based on the spectral windows technique aimed for environmental real-time gamma-ray spectra obtained with scintillation detectors. The method permits us to monitor activity concentrations of selected isotopes, such as anthropogenic radionuclides like 137Cs and 131I, by removing the Compton scattering plus other external contributions and resolving peak overlapping within any window. Activity concentrations are presented for 137Cs, 131I, 214Bi, and 214Pb when applying the method to a monitor using a LaBr3(Ce) detector. The method avoids false-positive and false-negative results of anthropogenic radionuclides in the presence of radiation from natural origins by obtaining activity concentrations that correspond to those obtained by a Gaussian fitting commercial software.
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Puigvehí M, Hernández J, Broquetas T, Coll S, Garcia-Retortillo M, Cañete N, Giménez MD, Garcia M, Bory F, Salvadó M, Solà R, Carrión JA. Diagnostic Accuracy of the Enhanced Liver Fibrosis (ELF®) Score Using HCV-Infected Serum Samples Cryopreserved for up to 25 Years. PLoS One 2016; 11:e0164883. [PMID: 27984583 PMCID: PMC5161309 DOI: 10.1371/journal.pone.0164883] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/03/2016] [Indexed: 01/11/2023] Open
Abstract
Introduction & Aims Cryopreservation of serum samples is a standard procedure for biomedical research in tertiary centers. However, studies evaluating the long-term biological stability of direct liver fibrosis markers using cryopreserved samples are scarce. Methods We compared the stability of hyaluronic acid (HA), tissue inhibitor of metalloproteinases (TIMP-1) and amino-terminal propeptide of type III procollagen (PIIINP) in 225 frozen serum samples of HCV-infected patients with a paired liver biopsy for up to 25 years (1990–2014). Moreover, we assessed the diagnostic accuracy (AUROC) of the Enhanced Liver Fibrosis (ELF®) score to identify significant fibrosis (F2-4) and its predictive capacity to identify clinical events during follow-up. Results Seventy-six patients (39,8%) had mild fibrosis (F0-1) and 115 (60,2%) significant fibrosis (F2-4). HA, PIIINP and TIMP-1 values remained stable during the period from 1995 to 2014 while those of 1990–94 were slightly higher. We did not find significant differences in the median ELF® values during the 20-year period from 1995–2014 in patients with mild (from 8,4 to 8,7) and significant fibrosis (from 9,9 to 10,9) (p = ns between periods and fibrosis stages). The AUROCs of ELF® to identify significant fibrosis were high in all the periods (from 0,85 to 0,91). The ELF® score showed a good predictive capability to identify clinical events during follow-up. Conclusions The biological stability of direct serum markers (HA, PIIINP and TIMP-1) using HCV-infected samples cryopreserved for 20 years is good. Therefore, the diagnostic accuracy of the ELF® score to identify significant fibrosis and clinical events during follow-up is very high.
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Affiliation(s)
- Marc Puigvehí
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Teresa Broquetas
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Susanna Coll
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Montserrat Garcia-Retortillo
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Nuria Cañete
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Maria Dolors Giménez
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Mar Garcia
- Pathology Department, Hospital del Mar, Barcelona, Spain
| | - Felipe Bory
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
| | | | - Ricard Solà
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - José A. Carrión
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- * E-mail:
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Martínez-Roig A, Salvadó M, Caballero-Rabasco MA, Sánchez-Buenavida A, López-Segura N, Bonet-Alcaina M. Viral coinfection in childhood respiratory tract infections. Arch Bronconeumol 2015; 51:5-9. [PMID: 24666712 PMCID: PMC7105245 DOI: 10.1016/j.arbres.2014.01.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 12/31/2013] [Accepted: 01/27/2014] [Indexed: 12/02/2022]
Abstract
INTRODUCTION The introduction of molecular techniques has enabled better understanding of the etiology of respiratory tract infections in children. The objective of the study was to analyze viral coinfection and its relationship to clinical severity. METHODS Hospitalized pediatric patients with a clinical diagnosis of respiratory infection were studied during the period between 2009-2010. Clinical and epidemiological data, duration of hospitalization, need for oxygen therapy, bacterial coinfection and need for mechanical ventilation were collected. Etiology was studied by multiplex PCR and low-density microarrays for 19 viruses. RESULTS A total of 385 patients were positive, 44.94% under 12 months. The most frequently detected viruses were RSV-B: 139, rhinovirus: 114, RSV-A: 111, influenza A H1N1-2009: 93 and bocavirus: 77. Coinfection was detected in 61.81%, 36.36% with 2 viruses, 16.10% and 9.35% with 3 to 4 or more. Coinfection was higher in 2009 with 69.79 vs. 53.88% in 2010. Rhinovirus/RSV-B on 10 times and RSV-A/RSV-B on 5 times were the most detected coinfections. Hospitalization decreased with greater number of viruses (P<0,001). Oxygen therapy was required by 26.75% (one virus was detected in 55.34% of cases). A larger number of viruses resulted in less need for oxygen (P<0,001). Ten cases required mechanical ventilation, 4 patients with bacterial coinfection and 5 with viral coinfection (P=0,69). CONCLUSIONS An inverse relationship was found between the number of viruses detected in nasopharyngeal aspirate, the need for oxygen therapy and hospitalization days. More epidemiological studies and improved quantitative detection techniques are needed to define the role of viral coinfections in respiratory disease and its correlation with the clinical severity.
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Affiliation(s)
| | - M Salvadó
- Departamento de Genética y Microbiología, Laboratorio de Referencia de Cataluña, Barcelona, España
| | | | | | - N López-Segura
- Servicio de Pediatría, Hospital del Mar, Barcelona, España
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Portillo ME, Salvadó M, Alier A, Martínez S, Sorli L, Horcajada JP, Puig L. Advantages of sonication fluid culture for the diagnosis of prosthetic joint infection. J Infect 2014; 69:35-41. [DOI: 10.1016/j.jinf.2014.03.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/25/2014] [Accepted: 03/01/2014] [Indexed: 12/18/2022]
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Abstract
Introduction The introduction of molecular techniques has enabled better understanding of the etiology of respiratory tract infections in children. The objective of the study was to analyze viral coinfection and its relationship to clinical severity. Methods Hospitalized pediatric patients with a clinical diagnosis of respiratory infection were studied during the period between 2009 and 2010. Clinical and epidemiological data, duration of hospitalization, need for oxygen therapy, bacterial coinfection and need for mechanical ventilation were collected. Etiology was studied by multiplex PCR and low-density microarrays for 19 viruses. Results A total of 385 patients were positive, 44.94% under 12 months. The most frequently detected viruses were RSV-B: 139, rhinovirus: 114, RSV-A: 111, influenza A H1N1-2009: 93 and bocavirus: 77. Coinfection was detected in 61.81%, 36.36% with two viruses, 16.10% and 9.35% with three to four or more. Coinfection was higher in 2009 with 69.79 vs 53.88% in 2010. Rhinovirus/RSV-B on 10 times and RSV-A/RSV-B on five times were the most detected coinfections. Hospitalization decreased with greater number of viruses (P<.001). Oxygen therapy was required by 26.75% (one virus was detected in 55.34% of cases). A larger number of viruses resulted in less need for oxygen (P<.001). Ten cases required mechanical ventilation, four patients with bacterial coinfection and five with viral coinfection (P=.69). Conclusions An inverse relationship was found between the number of viruses detected in nasopharyngeal aspirate, the need for oxygen therapy and hospitalization days. More epidemiological studies and improved quantitative detection techniques are needed to define the role of viral coinfections in respiratory disease and its correlation with the clinical severity.
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Affiliation(s)
| | - M Salvadó
- Departamento de Genética y Microbiología, Laboratorio de Referencia de Cataluña, Barcelona, España
| | | | | | - N López-Segura
- Servicio de Pediatría, Hospital del Mar, Barcelona, España
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Moure R, Español M, Tudó G, Vicente E, Coll P, Gonzalez-Martin J, Mick V, Salvadó M, Alcaide F. Characterization of the embB gene in Mycobacterium tuberculosis isolates from Barcelona and rapid detection of main mutations related to ethambutol resistance using a low-density DNA array. J Antimicrob Chemother 2013; 69:947-54. [PMID: 24216765 DOI: 10.1093/jac/dkt448] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Ethambutol resistance has mostly been related to mutations in the embB gene. The objective of the present study was to characterize the embB gene in a collection of ethambutol-resistant and ethambutol-susceptible isolates of Mycobacterium tuberculosis complex (MTBC) from Barcelona, and to develop a DNA microarray for the rapid detection of embB mutations in our area. METHODS Fifty-three ethambutol-resistant and 702 ethambutol-susceptible isolates of MTBC were sequenced in internal 982-1495 bp fragments of the embB gene. In addition, a low-cost, low-density array was designed to include the embB codons identified as being most frequently mutated in our area (LD-EMB array). RESULTS The global prevalence of embB mutations found among the ethambutol-resistant isolates was 77.4% (41/53). Substitutions in embB306 were the most common [53.7% (22/41)], followed by substitutions in embB406 [26.8% (11/41)]. The presence of mutations in embB406 was related to higher levels of ethambutol resistance and to multidrug resistance. Among unrelated isolates (from 24-locus MIRU-VNTR genotyping), the percentage of embB-mutated isolates was 72.9% (27/37)--59.3% (16/27) in embB306 and 25.9% (7/27) in embB406. None of the ethambutol-susceptible isolates studied showed a mutation in codon 306 or 406. The LD-EMB array showed 100% sensitivity and specificity in identifying the main embB substitutions in our area. CONCLUSIONS Mutations at codons 306 and 406 of embB have a relevant role in resistance to ethambutol in our area. The LD-EMB array developed in this study would appear to be a good molecular test for rapid detection of ethambutol resistance.
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Affiliation(s)
- Raquel Moure
- Servei de Microbiologia, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, Barcelona, Spain
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Portillo ME, Salvadó M, Alier A, Sorli L, Martínez S, Horcajada JP, Puig L. Prosthesis failure within 2 years of implantation is highly predictive of infection. Clin Orthop Relat Res 2013; 471:3672-8. [PMID: 23904245 PMCID: PMC3792275 DOI: 10.1007/s11999-013-3200-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 07/19/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The outcome of revision surgery depends on accurate determination of the cause of prosthesis failure because treatment differs profoundly among aseptic loosening, mechanical failure, and prosthetic joint infections (PJI). QUESTIONS/PURPOSES We sought to determine (1) the predictive role of the interval from primary to revision surgery in determining the reason for prosthesis failure of a hip, knee, shoulder, or elbow arthroplasty, and (2) whether positive cultures during revision surgery for aseptic loosening were associated with shorter event-free survival of the prosthesis. METHODS All patients undergoing revision surgery between July 2010 and January 2012 were included in a prospective cohort of 112 patients, and were classified as having had failure from aseptic loosening (56%), mechanical failure (15%), or PJI (29%). To make the diagnosis of PJI, at surgery we used a standardized enhanced diagnostic approach in all patients including sampling of five periprosthetic tissue specimens, sonication of removed prosthetic components, prolonged incubation of aerobic and anaerobic cultures, and multiplex PCR of sonication fluid in aseptic loosening cases. Kaplan-Meier survival and Cox proportional hazards regression analysis were performed. RESULTS The median time from primary to revision surgery was (p < 0.001) longer for patients with aseptic loosening (7.8 years) than for patients with mechanical failure (1.6 years) or PJI (2 years). No difference in the time to revision was observed for patients with aseptic loosening with positive or negative microbiological cultures (p = 0.594). Propionibacterium acnes was cultured below the established microbiological criteria for positivity in 12 (19%) procedures that had been presumed to have been revisions for aseptic loosening. CONCLUSIONS PJI should be considered in all revisions performed within 2 years of implantation even in the absence of clinical or laboratory findings suggestive for infection. However, the growth of low-virulence microorganisms below the cut-off in revisions for apparent aseptic loosening is not associated with early prosthesis failure.
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Affiliation(s)
- María Eugenia Portillo
- />Microbiology Laboratory, Laboratori de Referència de Catalunya, Carrer de la Selva, 10, Edifici Inblau A. Parc de Negocis Mas Blau, 08820 El Prat de Llobregat, Barcelona, Spain
| | - Margarita Salvadó
- />Microbiology Laboratory, Laboratori de Referència de Catalunya, Carrer de la Selva, 10, Edifici Inblau A. Parc de Negocis Mas Blau, 08820 El Prat de Llobregat, Barcelona, Spain
| | - Albert Alier
- />Department of Orthopedic Surgery, Hospital del Mar, Barcelona, Spain
| | - Lluisa Sorli
- />Infectious Diseases Service, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Santos Martínez
- />Department of Orthopedic Surgery, Hospital del Mar, Barcelona, Spain
| | - Juan Pablo Horcajada
- />Infectious Diseases Service, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Lluis Puig
- />Department of Orthopedic Surgery, Hospital del Mar, Barcelona, Spain
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Moure R, Tudó G, Medina R, Vicente E, Caldito JM, Codina MG, Coll P, Español M, Gonzalez-Martin J, Rey-Jurado E, Salvadó M, Tórtola MT, Alcaide F. Detection of streptomycin and quinolone resistance in Mycobacterium tuberculosis by a low-density DNA array. Tuberculosis (Edinb) 2013; 93:508-14. [PMID: 23906937 DOI: 10.1016/j.tube.2013.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 03/22/2013] [Revised: 06/11/2013] [Accepted: 07/08/2013] [Indexed: 11/19/2022]
Abstract
In cases of multidrug-resistant tuberculosis, it is crucial to rule out resistance to second-line antituberculous (anti-TB) agents. In the present study, a low-cost low-density DNA array including four genetic regions (rrs 530 loop, rrs 1400, rpsL and gyrA) was designed for the rapid detection of the most important mutations related to anti-TB injectable drugs (mainly streptomycin) and fluoroquinolone resistance (LD-SQ array). A total of 108 streptomycin- and/or ofloxacin-resistant and 20 streptomycin- and ofloxacin-susceptible Mycobacterium tuberculosis clinical isolates were analysed with the array. The results obtained were compared with sequencing data and phenotypic susceptibility pattern. The LD-SQ array offered a good sensitivity compared to sequencing, especially among resistant strains: 92.5% (37/40) for streptomycin and 87.5% (7/8) for fluoroquinolones. Therefore, this array could be considered a good approach for the rapid detection of mutations related to streptomycin and fluoroquinolone resistance. On the other hand, there were discordant results in 16 resistant strains and six susceptible isolates, mostly concerning the gyrA region, in which the existence of polymorphisms next to informative positions might cause cross-hybridization. These discrepancies were caused by some technical limitations; consequently, the present array should be considered as a first-step prior to a forthcoming optimized version of the array.
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Affiliation(s)
- Raquel Moure
- Servei de Microbiologia, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona UB, Barcelona, Spain
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Casanovas R, Morant JJ, Salvadó M. Implementation of gamma-ray spectrometry in two real-time water monitors using NaI(Tl) scintillation detectors. Appl Radiat Isot 2013; 80:49-55. [PMID: 23827508 DOI: 10.1016/j.apradiso.2013.06.003] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 05/30/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
Abstract
In this study, the implementation of gamma-ray spectrometry in two real-time water monitors using 2 in. × 2 in. NaI(Tl) scintillation detectors is described. These monitors collect the water from the river through a pump and it is analyzed in a vessel, which is shielded with Pb. The full calibration of the monitors was performed experimentally, except for the efficiency curve, which was set using validated Monte Carlo simulations with the EGS5 code system. After the calibration, the monitors permitted the identification and quantification of the involved isotopes in a possible radioactive increment and made it possible to discard possible leaks in the nuclear plants. As an example, a radiological increment during rain is used to show the advantages of gamma-ray spectrometry. To study the capabilities of the monitor, the minimum detectable activity concentrations for (131)I, (137)Cs and (40)K are presented for different integration times.
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Affiliation(s)
- R Casanovas
- Unitat de Física Mèdica, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, ES-43201 Reus (Tarragona), Spain.
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Puig-Verdié L, Alentorn-Geli E, González-Cuevas A, Sorlí L, Salvadó M, Alier A, Pelfort X, Portillo ME, Horcajada JP. Implant sonication increases the diagnostic accuracy of infection in patients with delayed, but not early, orthopaedic implant failure. Bone Joint J 2013; 95-B:244-9. [DOI: 10.1302/0301-620x.95b2.30486] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to compare the diagnostic accuracy for the detection of infection between the culture of fluid obtained by sonication (SFC) and the culture of peri-implant tissues (PITC) in patients with early and delayed implant failure, and those with unsuspected and suspected septic failure. It was hypothesised that SFC increases the diagnostic accuracy for infection in delayed, but not early, implant failure, and in unsuspected septic failure. The diagnostic accuracy for infection of all consecutive implants (hardware or prostheses) that were removed for failure was compared between SFC and PITC. This prospective study included 317 patients with a mean age of 62.7 years (9 to 97). The sensitivity for detection of infection using SFC was higher than using PITC in an overall comparison (89.9% versus 67%, respectively; p < 0.001), in unsuspected septic failure (100% versus 48.5%, respectively; p < 0.001), and in delayed implant failure (88% versus 58%, respectively; p < 0.001). PITC sensitivity dropped significantly in unsuspected compared with suspected septic failure (p = 0.007), and in delayed compared with early failure (p = 0.013). There were no differences in specificity. Sonication is mainly recommended when there is implant failure with no clear signs of infection and in patients with delayed implant failure. In early failure, SFC is not superior to PITC for the diagnosis of infection and, therefore, is not recommended as a routine diagnostic test in these patients. Cite this article: Bone Joint J 2013;95-B:244–9.
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Affiliation(s)
- L. Puig-Verdié
- Hospital del Mar – Parc de Salut Mar, Department
of Orthopaedic Surgery, Passeig Marítim 25-29, E-08003
Barcelona, Spain
| | - E. Alentorn-Geli
- Hospital del Mar – Parc de Salut Mar, Department
of Orthopaedic Surgery, Passeig Marítim 25-29, E-08003
Barcelona, Spain
| | - A. González-Cuevas
- Laboratori de Referència de Catalunya, C/
de la Selva, 10, E-08820
El Prat de Llobregat, Spain
| | - L. Sorlí
- Hospital del Mar – Parc de Salut Mar, Service
of Internal Medicine and Infectious Diseases, Passeig
Marítim 25-29, E-08003 Barcelona, Spain
| | - M. Salvadó
- Laboratori de Referència de Catalunya, C/
de la Selva, 10, E-08820
El Prat de Llobregat, Spain
| | - A. Alier
- Hospital del Mar – Parc de Salut Mar, Department
of Orthopaedic Surgery, Passeig Marítim 25-29, E-08003
Barcelona, Spain
| | - X. Pelfort
- Hospital del Mar – Parc de Salut Mar, Department
of Orthopaedic Surgery, Passeig Marítim 25-29, E-08003
Barcelona, Spain
| | - M. E. Portillo
- Laboratori de Referència de Catalunya, C/
de la Selva, 10, E-08820
El Prat de Llobregat, Spain
| | - J. P. Horcajada
- Hospital del Mar – Parc de Salut Mar, Service
of Internal Medicine and Infectious Diseases, Passeig
Marítim 25-29, E-08003 Barcelona, Spain
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Morant JJ, Salvadó M, Hernández-Girón I, Casanovas R, Ortega R, Calzado A. Dosimetry of a cone beam CT device for oral and maxillofacial radiology using Monte Carlo techniques and ICRP adult reference computational phantoms. Dentomaxillofac Radiol 2012; 42:92555893. [PMID: 22933532 PMCID: PMC3667542 DOI: 10.1259/dmfr/92555893] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [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: 04/18/2012] [Revised: 06/14/2012] [Accepted: 06/30/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to calculate organ and effective doses for a range of available protocols in a particular cone beam CT (CBCT) scanner dedicated to dentistry and to derive effective dose conversion factors. METHODS Monte Carlo simulations were used to calculate organ and effective doses using the International Commission on Radiological Protection voxel adult male and female reference phantoms (AM and AF) in an i-CAT CBCT. Nine different fields of view (FOVs) were simulated considering full- and half-rotation modes, and also a high-resolution acquisition for a particular protocol. Dose-area product (DAP) was measured. RESULTS Dose to organs varied for the different FOVs, usually being higher in the AF phantom. For 360°, effective doses were in the range of 25-66 μSv, and 46 μSv for full head. Higher contributions to the effective dose corresponded to the remainder (31%; 27-36 range), salivary glands (23%; 20-29%), thyroid (13%; 8-17%), red bone marrow (10%; 9-11%) and oesophagus (7%; 4-10%). The high-resolution protocol doubled the standard resolution doses. DAP values were between 181 mGy cm(2) and 556 mGy cm(2) for 360°. For 180° protocols, dose to organs, effective dose and DAP were approximately 40% lower. A conversion factor (DAP to effective dose) of 0.130 ± 0.006 μSv mGy(-1) cm(-2) was derived for all the protocols, excluding full head. A wide variation in dose to eye lens and thyroid was found when shifting the FOV in the AF phantom. CONCLUSIONS Organ and effective doses varied according to field size, acquisition angle and positioning of the beam relative to radiosensitive organs. Good positive correlation between calculated effective dose and measured DAP was found.
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Affiliation(s)
- J J Morant
- Universitat Rovira i Virgili. Servei de Protecci Radiològica Sant Llorenç 21, 43201 Reus, Spain.
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Salvadó M, Plasencia V, Segura C, Gómez J, Medina MJ, Sáez-Nieto JA, Castellanos S, Horcajada JP. Infection due to Actinobaculum spp: report of 12 patients in Spain. J Infect 2012; 66:107-9. [PMID: 22750149 DOI: 10.1016/j.jinf.2012.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 06/22/2012] [Accepted: 06/23/2012] [Indexed: 11/27/2022]
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Morales E, Cots F, Sala M, Comas M, Belvis F, Riu M, Salvadó M, Grau S, Horcajada JP, Montero MM, Castells X. Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition. BMC Health Serv Res 2012; 12:122. [PMID: 22621745 PMCID: PMC3412693 DOI: 10.1186/1472-6963-12-122] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 05/23/2012] [Indexed: 11/29/2022] Open
Abstract
Background We aimed to assess the hospital economic costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition. Methods A retrospective study of all hospital admissions between January 1, 2005, and December 31, 2006 was carried out in a 420-bed, urban, tertiary-care teaching hospital in Barcelona (Spain). All patients with a first positive clinical culture for P. aeruginosa more than 48 h after admission were included. Patient and hospitalization characteristics were collected from hospital and microbiology laboratory computerized records. According to antibiotic susceptibility, isolates were classified as non-resistant, resistant and multi-drug resistant. Cost estimation was based on a full-costing cost accounting system and on the criteria of clinical Activity-Based Costing methods. Multivariate analyses were performed using generalized linear models of log-transformed costs. Results Cost estimations were available for 402 nosocomial incident P. aeruginosa positive cultures. Their distribution by antibiotic susceptibility pattern was 37.1% non-resistant, 29.6% resistant and 33.3% multi-drug resistant. The total mean economic cost per admission of patients with multi-drug resistant P. aeruginosa strains was higher than that for non-resistant strains (15,265 vs. 4,933 Euros). In multivariate analysis, resistant and multi-drug resistant strains were independently predictive of an increased hospital total cost in compared with non-resistant strains (the incremental increase in total hospital cost was more than 1.37-fold and 1.77-fold that for non-resistant strains, respectively). Conclusions P. aeruginosa multi-drug resistance independently predicted higher hospital costs with a more than 70% increase per admission compared with non-resistant strains. Prevention of the nosocomial emergence and spread of antimicrobial resistant microorganisms is essential to limit the strong economic impact.
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Affiliation(s)
- Eva Morales
- Health Services Evaluation and Clinical Epidemiology Department, Hospital del Mar-IMIM, Barcelona, Spain
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Sorlí L, Puig L, Torres-Claramunt R, González A, Alier A, Knobel H, Salvadó M, Horcajada JP. The relationship between microbiology results in the second of a two-stage exchange procedure using cement spacers and the outcome after revision total joint replacement for infection: the use of sonication to aid bacteriological analysis. ACTA ACUST UNITED AC 2012; 94:249-53. [PMID: 22323695 DOI: 10.1302/0301-620x.94b2.27779] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patients with infected arthroplasties are normally treated with a two-stage exchange procedure using polymethylmethacrylate bone cement spacers impregnated with antibiotics. However, spacers may act as a foreign body to which micro-organisms may adhere and grow. In this study it was hypothesised that subclinical infection may be diagnosed with sonication of the surface biofilm of the spacer. The aims were to assess the presence of subclinical infection through sonication of the spacer at the time of a second-stage procedure, and to determine the relationship between subclinical infection and the clinical outcome. Of 55 patients studied, 11 (20%) were diagnosed with subclinical infection. At a mean follow-up of 12 months (interquartile range 6 to 18), clinical failure was found in 18 (32.7%) patients. Of the patients previously diagnosed with subclinical infection, 63% (7 of 11) had failed compared with 25% (11 of 44) of those without subclinical infection (odds ratio 5.25, 95% confidence interval 1.29 to 21.4, p = 0.021). Sonication of the biofilm of the surface of the spacer is useful in order to exclude subclinical infection and therefore contributes to improving the outcome after two-stage procedures.
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Affiliation(s)
- L Sorlí
- Parc de Salut Mar, Service of Internal Medicine and Infectious Diseases, Passeig Marítim 25-29, Passeig Marítim 25-29, E-08003 Barcelona, Spain.
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Sagristà M, Martin-Ezquerra G, Gallardo F, Membrilla E, Salazar AJ, Salvadó M, Gómez J, Pujol RM. Inguinal syndrome secondary to Prevotella bivia after accidental bite in orogenital sex. Sex Transm Infect 2012; 88:250-1. [PMID: 22375046 DOI: 10.1136/sextrans-2011-050348] [Citation(s) in RCA: 4] [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: 11/04/2022] Open
Abstract
The authors report a case of an inguinal bubo in a young man caused by an anaerobe, Prevotella bivia, which was acquired during oral sexual intercourse. As far as the authors know, this is the first reported case of a sexually transmitted infection by Prevotella. Prevotella spp. inhabit the oral cavity and are highly prevalent in bacterial vaginosis, a polymicrobial syndrome resulting from replacement of the normal vaginal Lactobacillus spp. flora by high concentrations of anaerobic microorganisms such as Prevotella spp., Mobiluncus spp., Gardnerella vaginalis and other uncultivated anaerobes.
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Affiliation(s)
- Marc Sagristà
- Department of Dermatology, Sexually Transmitted Infections Unit, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29 Barcelona 08003, Spain.
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Aguilar-Duran S, Horcajada JP, Sorlí L, Montero M, Salvadó M, Grau S, Gómez J, Knobel H. Community-onset healthcare-related urinary tract infections: comparison with community and hospital-acquired urinary tract infections. J Infect 2012; 64:478-83. [PMID: 22285591 DOI: 10.1016/j.jinf.2012.01.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 01/06/2012] [Accepted: 01/14/2012] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To analyze the characteristics of infection, adequacy of empirical treatment and outcome of patients with community-onset healthcare-associated (HCA) urinary tract infections (UTI) and compare them with hospital (HA) and community-acquired (CA) UTI. METHODS Prospective observational cohort study performed at a university 600-bed hospital between July 2009 and February 2010. Patients with UTI requiring hospital admission were included. Epidemiological, clinical and outcome data were recorded. RESULTS 251 patients were included. Patients with community-onset HCA UTI were older, had more co-morbidities and had received previous antimicrobial treatment more frequently than CA UTI (p = 0.02, p = 0.01 and p < 0.01). ESBL-Escherichia coli and Pseudomonas aeruginosa infections were more frequent in HCA than in CA UTI (p = 0.03 and p < 0.01). Inadequate empirical treatment was not significantly different between community-onset HCA and CA. Factors related to mortality were P. aeruginosa infection (OR 6.51; 95%CI: 1.01-41.73), diabetes mellitus (OR 22.66; 95%CI: 3.61-142.21), solid neoplasia (OR 22.48; 95%CI: 3.38-149.49) and age (OR 1.15; 95%CI 1.03-1.28). CONCLUSIONS Epidemiological, clinical and microbiological features suggest that community-onset HCA UTI is different from CA and similar to HA UTI. However, in our series inadequate empirical antimicrobial therapy and mortality were not significantly higher in community-onset HCA than in CA UTI.
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Affiliation(s)
- Silvia Aguilar-Duran
- Service of Internal Medicine and Infectious Diseases, Hospital Universitari del Mar, Parc de Salut MAR, Barcelona, Spain.
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Casanovas R, Morant JJ, López M, Hernández-Girón I, Batalla E, Salvadó M. Performance of data acceptance criteria over 50 months from an automatic real-time environmental radiation surveillance network. J Environ Radioact 2011; 102:742-748. [PMID: 21570164 DOI: 10.1016/j.jenvrad.2011.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 02/21/2011] [Accepted: 04/01/2011] [Indexed: 05/30/2023]
Abstract
The automatic real-time environmental radiation surveillance network of Catalonia (Spain) comprises two subnetworks; one with 9 aerosol monitors and the other with 8 Geiger monitors together with 2 water monitors located in the Ebre river. Since September 2006, several improvements were implemented in order to get better quality and quantity of data, allowing a more accurate data analysis. However, several causes (natural causes, equipment failure, artificial external causes and incidents in nuclear power plants) may produce radiological measured values mismatched with the own station background, whether spurious without significance or true radiological values. Thus, data analysis for a 50-month period was made and allowed to establish an easily implementable statistical criterion to find those values that require special attention. This criterion proved a very useful tool for creating a properly debugged database and to give a quick response to equipment failures or possible radiological incidents. This paper presents the results obtained from the criterion application, including the figures for the expected, raw and debugged data, percentages of missing data grouped by causes and radiological measurements from the networks. Finally, based on the discussed information, recommendations for the improvement of the network are identified to obtain better radiological information and analysis capabilities.
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Affiliation(s)
- R Casanovas
- Unitat de Física Mèdica, Universitat Rovira i Virgili, Reus (Tarragona), Spain.
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Rey-Jurado E, Tudó G, Borrell S, Alcaide F, Coll P, Español M, Martín-Casabona N, Mick V, Montemayor M, Moure R, Salvadó M, Vicente E, González-Martín J. Impaired fitness of Mycobacterium tuberculosis resistant isolates in a cell culture model of murine macrophages. J Antimicrob Chemother 2011; 66:2277-80. [PMID: 21791442 DOI: 10.1093/jac/dkr288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We analysed the ability of Mycobacterium tuberculosis clinical isolates to penetrate and grow inside murine macrophages as a surrogate of fitness. METHODS Thirty-five drug-resistant and 10 drug-susceptible M. tuberculosis isolates were studied in a murine macrophage model from the J774.2 cell line in a 6 day protocol, performing semi-quantitative counts in Middlebrook 7H11 medium. The mycobacterial penetration index (MPI) after infection and the mycobacterial growth ratio (MGR) inside the macrophages were determined to evaluate the fitness of isolates. RESULTS Isolates with the katG S315T mutation and multidrug-resistant (MDR) isolates had a significantly lower MGR compared with drug-susceptible isolates. The MPI of the isolates with the katG S315T mutation showed a significant decrease compared with the MPI of those without this mutation. A trend to significantly lower values was also observed on comparing the MPI of the MDR isolates with that of the drug-susceptible isolates and the isolates resistant to isoniazid. CONCLUSIONS The isoniazid-resistant and MDR isolates with mutations in the katG gene showed decreased multiplication inside murine macrophages, suggesting a lower fitness of M. tuberculosis with these resistance patterns.
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Affiliation(s)
- Emma Rey-Jurado
- Servei de Microbiologia, CDB, Hospital Clínic de Barcelona-IDIBAPS, Universitat de Barcelona (UB), Barcelona, Spain
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Portillo ME, Sánchez F, Vicente E, Salvadó M. [Trochanteric bursitis due to Mycobacterium xenopi in a patient with pharmacological immunosuppression]. Enferm Infecc Microbiol Clin 2011; 29:399-401. [PMID: 21470717 DOI: 10.1016/j.eimc.2011.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 01/26/2011] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
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Borrell S, Tudó G, Rey E, González-Martín J, Español M, March F, Coll P, Orcau A, Caylà J, Jansà J, Alcaide F, Martín-Casabona N, Salvadó M, Martinez J, Vidal R, Sanchez F, Altet N. Tuberculosis transmission patterns among Spanish-born and foreign-born populations in the city of Barcelona. Clin Microbiol Infect 2010; 16:568-74. [DOI: 10.1111/j.1469-0691.2009.02886.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [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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Horcajada JP, Busto M, Grau S, Sorlí L, Terradas R, Salvadó M, Lorente JA, González A, Knobel H. High prevalence of extended-spectrum beta-lactamase-producing enterobacteriaceae in bacteremia after transrectal ultrasound-guided prostate biopsy: a need for changing preventive protocol. Urology 2009; 74:1195-9. [PMID: 19811805 DOI: 10.1016/j.urology.2009.06.061] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [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: 05/29/2009] [Revised: 06/25/2009] [Accepted: 06/26/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine whether the incidence of bacteremia after transrectal ultrasound-guided prostate biopsy (TRUSGPB) significantly diminishes with the setting up of a new preventive protocol. This protocol was set up after detecting an augmented incidence of bacteremia after TRUSGPB with a high prevalence of antibiotic-resistant microorganisms. METHODS Retrospective descriptive and prospective intervention study performed at a University Hospital. PARTICIPANTS Patients undergoing TRUSGPB under the old preventive protocol (January 2006-February 2007), that is, amoxicillin-clavulanate 500 mg tid the day before, the day of the procedure, and 1 day after the procedure, and after setting up a new protocol (March 2007-April 2008), that is, 2 g cefoxitin 1 hour before the procedure and ciprofloxacin 750 mg p.o. bid the day before, the day of the procedure, and 3 days after the procedure; dipstick urinalysis was performed before the procedure, and patients with positive results were not biopsied. RESULTS Incidence of bacteremia with old and new protocols: 9 of 204 procedures (4.4%) vs 2 of 207 (0.9%), (P = .03). Four isolates (44.4%) under the old protocol produced extended-spectrum beta-lactamase (ESBL). With the new protocol, 2 (0.9%) cases of non-ESBL Escherichia coli bacteremia were observed. Sixty-five (23.8%) cases were not biopsied because of positive result of dipstick urinalysis, lack of antibiotic prophylaxis adherence, or altered coagulation parameters. CONCLUSIONS Antibiotic prophylaxis for TRUSGPB should take into account local resistance patterns. Cefoxitin could be used as prophylaxis in centers with high prevalence of ESBL enterobacteriaceae. Before TRUSGPB, excluding patients with positive results of dipstick urinalysis is an advisable practice.
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Affiliation(s)
- Juan P Horcajada
- Service of Internal Medicine and Infectious Diseases, Hospital Universitario del Mar IMAS, Barcelona, Spain.
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Salvadó M, Barreiro B, González C. Derrame pleural asociado al tratamiento con pergolida. Arch Bronconeumol 2009; 45:62-3. [DOI: 10.1016/j.arbres.2008.02.002] [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: 02/13/2008] [Accepted: 02/25/2008] [Indexed: 10/21/2022]
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Pelfort X, Horcajada JP, Puig L, Salvadó M. [Pain, swelling, and progressive weakness of the left knee over 6 years]. Enferm Infecc Microbiol Clin 2008; 26:595-6. [PMID: 19100182 DOI: 10.1157/13128279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Xavier Pelfort
- Servicios de Cirugía Ortopédica y Traumatología, Hospitales IMAS, Passeig Marítim 25-29, Barcelona, Spain.
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Montero M, Domínguez M, Orozco-Levi M, Salvadó M, Knobel H. Mortality of COPD patients infected with multi-resistant Pseudomonas aeruginosa: a case and control study. Infection 2008; 37:16-9. [PMID: 19139809 DOI: 10.1007/s15010-008-8125-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Accepted: 07/14/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The incidence of infections caused by multiresistant Pseudomonas aeruginosa (MDRP) is increasing, especially in critically ill patients. The relevance of MDRP in the prognosis of chronic obstructive pulmonary disease (COPD) acute exacerbation in patients admitted to the hospital's general ward is not well known. PATIENTS AND METHODS Case and control study. Cases were patients admitted for COPD acute exacerbation in which a MDRP was isolated from spontaneous sputum. MDRP was defined as the absence of susceptibility to three or more antibiotic families (betalactams, quinolones, carbapenems and aminoglycosides). Patients currently or previously admitted to the intensive care unit (ICU), who had a recent surgery, neoplasia or immunosuppressive treatment were excluded from the study. Patients from the control group were admitted for COPD acute exacerbation and matched 1:1 with each case-patient in terms of age, sex, date of admission and degree of airway obstruction. Pseudomonas aeruginosa susceptible to all antimicrobials or other microorganisms was isolated from sputum. RESULTS During the study period (2000-2005), 50 case-patients and 50 controls were included. Crude mortality at 2 years was 60% for the case-patients and 28% for the control group. In the logistic regression analysis adjusted for age, FEV(1) and number of previous hospital admissions, MDRP infection was associated to an increased mortality in comparison to patients without MDRP (OR = 6.2; IC 95%: 1.7-22.1; p < 0.01). CONCLUSIONS In COPD patients admitted to the general ward, acute exacerbation with MDRP in sputum was associated with higher mortality.
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Affiliation(s)
- M Montero
- Department of Internal Medicine and Infectious Diseases, Hospital del Mar, Autonomous University of Barcelona, Paseo Marítimo 25-29, 08003, Barcelona, Spain.
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Terradas R, Grau S, Knobel H, Álvarez-Lerma F, Riu M, Salvadó M. Bacteriemia comunitaria tratada o identificada de forma ambulatoria tras el alta de un servicio de urgencias. Med Clin (Barc) 2007; 129:652-4. [DOI: 10.1157/13112093] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Salvadó M, Arauzo V, Calbo E, Vazquez P, Freixes N, Riera M, Xercavins M, Nicolás C, Garau J. P1255 Risk factors for polymicrobial blood stream infections of biliary origin. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71095-6] [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: 11/15/2022]
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Salvadó M, Garcia-Vidal C, Martinez-Lacasa J, Rodriguez-Carballeira M, Freixas N, Riera M, Nicolás C, Garau J. O470 Tuberculosis in the very old: a ten-year experience. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70314-x] [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: 10/23/2022]
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Grau S, Antonio JMD, Ribes E, Salvadó M, Garcés JM, Garau J. Impact of rifampicin addition to clarithromycin in Legionella pneumophila pneumonia. Int J Antimicrob Agents 2006; 28:249-52. [PMID: 16870401 DOI: 10.1016/j.ijantimicag.2006.03.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [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: 03/03/2006] [Accepted: 03/27/2006] [Indexed: 11/25/2022]
Abstract
We evaluated the effectiveness and safety of rifampicin addition to clarithromycin in the treatment of Legionnaires' disease. An observational cohort study was conducted on patients assigned to a Legionnaires' disease outbreak. Of 32 patients with confirmed Legionella pneumonia, 11 received clarithromycin monotherapy and 21 received combination therapy of clarithromycin with rifampicin. Both groups had similar baseline characteristics and all patients were cured. Patients who received rifampicin had a 50% longer length of stay (P=0.035) and a trend towards higher bilirubin levels (P=0.053). Length of stay was directly correlated with the duration of rifampicin treatment (P=0.001). Combination therapy of clarithromycin and rifampicin had no additional benefit compared with clarithromycin monotherapy and could prolong the length of stay owing to possible negative drug interactions that could also affect other antibiotics.
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Affiliation(s)
- Santiago Grau
- Pharmacy Department, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain.
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Sierra JM, Sánchez F, Castro P, Salvadó M, de la Red G, Libois A, Almela M, March F, Español M, Sambeat MA, Romeu J, Brugal MT, de Olalla PG, Gatell JM, Vila J, García F, Colomés JLL, Caylà JA, Coll P. Group A streptococcal infections in injection drug users in Barcelona, Spain: epidemiologic, clinical, and microbiologic analysis of 3 clusters of cases from 2000 to 2003. Medicine (Baltimore) 2006; 85:139-146. [PMID: 16721256 DOI: 10.1097/01.md.0000224707.24392.52] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
An unexplained resurgence of Group A streptococci (GAS) infections has been observed since the mid-1980s in the United States and Europe, particularly among intravenous drug users (IDUs). Several risk factors have been identified. Mutations in the capsule synthesis regulator genes (csrRS) have been associated with an increase in virulence. From January 1998 to December 2003, we conducted a prospective and retrospective descriptive analysis of invasive GAS soft-tissue infections in IDUs in Barcelona, Spain. Clinical features were collected, and we conducted a surveillance study to identify risk factors associated with GAS soft-tissue infections. We analyzed chromosomal DNA by low cleavage restriction enzymes and used pulsed-field gel electrophoresis (PFGE) and variable gene sequence typing (VGST) of the emm gene to disclose the epidemiologic relationship between the strains. We analyzed the influence of clonality (M-type) and mutations in csrRS genes of these strains on clinical features. We identified 44 cases, all of which were grouped in 3 clusters: fall 2000, fall 2002, and fall 2003. Cellulitis with or without abscesses (75%) and fever (90.9%) were the most common clinical manifestations. Distant septic complications were infrequent (18.2%). Although all patients had severe infections (mainly bacteremic needle abscesses), their outcome with antibiotic therapy, usually beta-lactam, was successful in all cases. However, surgery was needed in 40.9% of patients. Through the surveillance study we found that infected patients had a higher number of drug injections per day (odds ratio [OR], 18.84; 95% confidence interval [CI], 4.83-79.4; p<0.00001), shared paraphernalia for drug use more frequently (OR, 11.11; 95% CI, 3.24-39.04; p<0.0001), were in a higher proportion both currently unemployed and homeless (OR, 4.22; 95% CI, 1.5-12.15; p<0.0001), were not in a methadone maintenance program (OR, 0.03; 95% CI, 0-0.19; p<0.00001), and more often bought drugs at a specific site (OR, 33.92; 95% CI, 7.44-174.93; p<0.00001) and from a specific dealer (OR, 72; 95% CI, 8-3090; p<0.00001), compared with patients not infected. The fall 2000 cluster was polyclonal, whereas the other 2 clusters were mainly due to the same strain of GAS (emm 25.2), and were defined as epidemic outbreaks. Clinically, the cases due to the clonal strain presented abscesses and needed surgery more frequently (p<0.001 and p=0.005, respectively). On the other hand, mutations in the csrRS genes were not associated with invasive GAS soft-tissue infection. There has been an increase in the number of cases of invasive GAS soft-tissue infections in IDUs in Barcelona, which seems to be related to drug users' habits and their socioeconomic status. Clonality (emm 25.2) but not mutations in the csrRS genes was associated with more severe GAS soft-tissue infections.
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Affiliation(s)
- Josep M Sierra
- From Service of Infectious Diseases and Service of Microbiology, Hospital Clínic Universitari, Barcelona (JMS, P. Castro, GR, AL, MA, JMG, JV, FG); Infectious Disease Unit, Hospital del Mar, Barcelona (FS, JLLC); Service of Microbiology, Laboratori de Referència de Catalunya, El Prat de Llobregat (MS); Service of Infectious Diseases and Service of Microbiology, Hospital de Sant Pau, Barcelona (FM, ME, MAS, P. Coll); Service of Internal Medicine, Hospital Germans Trias i Pujol, Badalona (JR); and Service of Epidemiology, Agèencia de Salut, Barcelona (MTB, PGO, JAC), Spain
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Coll P, Aragón LM, Alcaide F, Espasa M, Garrigó M, González J, Manterola JM, Orús P, Salvadó M. Molecular analysis of isoniazid and rifampin resistance in Mycobacterium tuberculosis isolates recovered from Barcelona. Microb Drug Resist 2005; 11:107-14. [PMID: 15910223 DOI: 10.1089/mdr.2005.11.107] [Citation(s) in RCA: 20] [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: 11/12/2022] Open
Abstract
We studied the presence of mutations in the whole katG gene and specific regions of the oxyR-ahpC and mabA-inhA regulatory region in 61 Mycobacterium tuberculosis isoniazid-resistant isolates. An 81-bp region of the rpoB gene was also sequenced in 17 rifampin-resistant strains. Alterations in the katG gene were detected in 55% of the isolates. Mutation in codon 315 was the most prevalent (32%). Strains showed a high level of resistance, and most maintained a substantial catalase-peroxidase activity. Three strains with an isoniazid MIC of >or=32 microg/ml lacked catalase-peroxidase activity. Two of them had deletions in the catalytic domain of the KatG protein. One strain with deletion and three strains with mutations in the C-terminal domain showed low-level resistance and conserved the catalase-peroxidase activity. Mutations in the mabA-inhA regulatory region were identified in 32% of the isolates. All had low-level resistance, and the vast majority conserved catalase-peroxidase activity. Seventeen percent of the isoniazid-resistant isolates had no detectable alterations at the studied loci. Resistance to rifampin was associated with mutations in the 81-bp of the rpoB gene in all cases. IS6110 analysis indicated that recent transmission contributed substantially to the emergence of isoniazid- resistant tuberculosis in Barcelona through short transmission chains. A rapid genotypic assay, including the 315-katG codon and the -15 nucleotide of the mabA-inhA regulatory region, may cover 62% of isoniazid- resistant strains in Barcelona. In contrast, the targeting of the 81-bp region of rpoB would detect all our rifampin-resistant isolates.
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Affiliation(s)
- Pere Coll
- Servei de Microbiología, Hospital de la Santa Creu i Sant Pau, Barcelona.
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Espasa M, González-Martín J, Alcaide F, Aragón LM, Lonca J, Manterola JM, Salvadó M, Tudó G, Orús P, Coll P. Direct detection in clinical samples of multiple gene mutations causing resistance of Mycobacterium tuberculosis to isoniazid and rifampicin using fluorogenic probes. J Antimicrob Chemother 2005; 55:860-5. [PMID: 15879493 DOI: 10.1093/jac/dki132] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study evaluates a method based on real-time PCR for direct detection in clinical samples of the common mutations responsible for isoniazid and rifampicin resistance of Mycobacterium tuberculosis. METHODS Six pairs of fluorogenic 5' exonuclease probes (Taqman), mutated and wild-type, were designed for six targets: codon 315 of katG, substitution C209T in the regulatory region of inhA, and codons 513, 516, 526 and 531 of rpoB. RESULTS A total of 98 clinical samples harbouring resistant bacilli from 55 patients and 126 samples harbouring susceptible bacilli from 126 patients were processed. The isolates from samples were tested for drug susceptibility with the radiometric method and sequenced for the same genetic targets. Among the samples, 93 harboured isoniazid-resistant bacilli. According to the sequencing results, 30 had mutations in katG, 30 in inhA and 33 (35.4%) had no mutations in these targets. All 27 clinical specimens harbouring rifampicin-resistant bacilli showed mutations in rpoB. The detection threshold of this method in detecting target genes in serial dilutions of artificial samples was 1.5 x 10(3) cfu/mL. In clinical samples, the sensitivity ranged from 30.4 to 35.3% for smear-negative samples and from 95.1 to 99.2% for smear-positive samples, with a specificity of 100%. In this study, the overall sensitivity in detecting patients having the target mutations was 74.3%. CONCLUSIONS The main advantage of the described method is the possibility of detecting rifampicin and isoniazid resistance within 48-72 h after sample collection, with a sensitivity of nearly 100% in smear-positive samples if the chosen target is responsible for the resistance.
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Affiliation(s)
- Mateu Espasa
- Departament de Microbiologia, Centre de Diagnòstic Biomèdic, Hospital Clinic-IDIBAPS
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Salvadó M, López M, Morant JJ, Calzado A. Monte Carlo calculation of radiation dose in CT examinations using phantom and patient tomographic models. Radiat Prot Dosimetry 2005; 114:364-8. [PMID: 15933138 DOI: 10.1093/rpd/nch516] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
By using a voxel-based Monte Carlo simulation technique, we developed and validated a method to calculate radiation-absorbed dose in the computed tomography (CT) examinations from the images of phantoms and patients. The ionising radiation transport was simulated using the EGS4 code system. The geometry of the X-ray beam (focus-to-axis distance, field of view, collimation, and primary and beam-shaper filtration) and the X-ray spectral distribution (HiSpeed LX/i) were included in the simulation. Each axial CT image was reduced to a 256 x 256 matrix and stacked in a volume. The patient images were segmented before the simulation of radiation transport by using four categories of materials, such as air, lung, muscle and bone. To test the voxel-based method, the values of the radiation dose derived from a simulated CT exposure were calculated and compared with those obtained from the measurements performed within the dosimetry phantoms. To complete the scope of the work, series of CT scans of the trunk of an anthropomorphic phantom and patients were simulated to calculate the average dose in each 1-cm-wide transverse slice (ADS). The comparison between the simulated and measured dose data for the CT indices showed a difference of <5% in all the cases. The estimated mean values of ADS from the chest, abdomen and pelvis of the anthropomorphic phantom were approximately 1.7-2 times the weighted CT dose index (CTDI(w)) value, whereas the mean ADS values for these anatomical areas were 1.3-2 times the CTDI(w) of patients. The voxel-based simulation method provided a technique for estimating the individual patient doses in the CT examinations.
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Affiliation(s)
- M Salvadó
- Física Mèdica, Universitat Rovira i Virgili, 43201 Reus, Spain.
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Nolla-Salas J, Almela M, Gasser I, Latorre C, Salvadó M, Coll P. Spontaneous Listeria monocytogenes peritonitis: a population-based study of 13 cases collected in Spain. Am J Gastroenterol 2002; 97:1507-11. [PMID: 12094874 DOI: 10.1111/j.1572-0241.2002.05798.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We aimed to assess the incidence, demographic data, clinical features, and outcome of peritoneal infections due to Listeria monocytogenes in individuals with cirrhosis. METHODS During a 10-yr study period, 153 cases of invasive listeriosis were recorded in a prospective population-based surveillance project carried out in Barcelona, Spain. RESULTS Thirteen cases were of spontaneous bacterial peritonitis by L. monocytogenes. Ages of the patients ranged between 29 and 85 yr. In addition to cirrhosis, underlying conditions included diabetes mellitus in four and malignancy in three. Bacteremia was present in six cases (46%). Only one patient with bacteremia developed meningitis. Analysis of the peritoneal fluid showed a mean (SD) protein content of 21.5 (9.6) g/L and leukocyte count of 7,273 (9,171) cells/ml. L. monocytogenes serotype 4b was the serogroup predominantly isolated (61%). The mortality rate was 30.7%. Eight patients received empirical antibiotic treatment with cephalosporins. CONCLUSIONS In geographical areas with a high incidence of listeriosis, L. monocytogenes should be suspected as a causative pathogen of spontaneous bacterial peritonitis in cirrhosis. Early adjustment of antibiotic therapy is essential to reduce mortality.
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Martin-Casabona N, Alcaide F, Coll P, González J, Manterola JM, Salvadó M, Caylà JA. [Drug resistance in Mycobacterium tuberculosis. A multicenter study of the Barcelona area. Grupo de Trabajo sobre Resistencias en Tuberculosis]. Med Clin (Barc) 2000; 115:493-8. [PMID: 11386223 DOI: 10.1016/s0025-7753(00)71603-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [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: 11/17/2022]
Abstract
BACKGROUND The aims of this multicenter study was to establish the level of primary and acquired drug resistance of M. Tuberculosis strains isolated in Barcelona and to identify possible risk groups using clinical data. PATIENTS AND METHODS All tuberculosis patients with isolation and identification of M. tuberculosis strains from October 1995 to September 1997 were included. Susceptibility tests isoniazid, rifampin, ethambutol, streptomycin and pyrazinamide were performed using the Bactec 460 system and the proportions method on solid medium. Logistic progression was used for statistical analysis. RESULTS The total number of patients included was 1,749 (1,535 non-treated and 214 previously treated). Primary drug resistance was 5.7% (isoniazid 3.8%; rifampin 1.0%, streptomycin 2.1%, ethambutol 0.3% and pyrazinamide 1.0%). Acquired drug resistance was 20.5% (isoniazid 17.3%, rifampin 9.8%, ethambutol 1.9%, streptomycin 4.7% and pyrazinamide 6.5%). Primary drug resistance was associated with people over 60 years old and women. CONCLUSIONS The low level of drug resistance enables antituberculosis treatment of non-treated patients to start with the standardised three-drug regimes except in the case of foreign people from countries with a high level of drug resistance. Susceptibility tests are recommended on all M. tuberculosis strains isolated, together with controlled studies of drug resistance surveillance.
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Affiliation(s)
- N Martin-Casabona
- Servicio de Microbiologia, Ciutat Sanitària, Universitària Vall dHebron, Barcelona, Spain
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Solsona Peiró J, López Colomés J, Knobel H, Minguella JL, Salvadó M. [Surgical treatment of multiresistant tuberculosis. Report of a case]. Rev Clin Esp 2000; 200:233-4. [PMID: 10857413 DOI: 10.1016/s0014-2565(00)70615-1] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Saballs-Radresa P, Torres-Rodríguez JM, Salvadó M, Sales P, Gimeno-Bayón JL, Knobel H, López-Colomés JL, Serrano C, Drobnic L. [Candidemia in AIDS. A retrospective study of nine cases]. Rev Iberoam Micol 2000; 17:2-5. [PMID: 15762785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Prevalence of candidemia has increased during the last decade, numerous predisposing factors are invoked, like parenteral drug abuse in the case of brown heroin syndrome, neutropenia, prolonged antibiotic therapeutics and immunosupression. Only a few articles are published about candidemia. Candidemia in AIDS patients seems very low; its incidence is estimated approximately one candidemia per 120 patients.
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Segura C, Salvadó M, Collado I, Chaves J, Coira A. Contribution of beta-lactamases to beta-lactam susceptibilities of susceptible and multidrug-resistant Mycobacterium tuberculosis clinical isolates. Antimicrob Agents Chemother 1998; 42:1524-6. [PMID: 9624510 PMCID: PMC105638 DOI: 10.1128/aac.42.6.1524] [Citation(s) in RCA: 28] [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: 02/07/2023] Open
Abstract
The beta-lactamases in 154 clinical Mycobacterium tuberculosis strains were studied. Susceptibilities to beta-lactam antibiotics, their combination with clavulanate (2:1), and two fluoroquinolones were determined in 24 M. tuberculosis strains susceptible to antimycobacterial drugs and in nine multiresistant strains. All 154 M. tuberculosis isolates showed a single chromosomal beta-lactamase pattern (pI 4.9 and 5.1). M. tuberculosis beta-lactamase hydrolyzes cefotaxime with a maximum rate of 22.5 +/- 2.19 IU/liter (strain 1382). Neither amoxicillin, carbenicillin, cefotaxime, ceftriaxone, nor aztreonam was active alone. Except for aztreonam, beta-lactam combinations with clavulanate produced better antimycobacterial activity.
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Affiliation(s)
- C Segura
- Laboratori de Referència de Catalunya, Universitat Autònoma de Barcelona, Spain.
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Minguez S, Carratalá C, Aguirre A, Knobel H, Salvadó M, Lonca J. [Mycobacterium simiae disseminated infection in HIV patient]. Enferm Infecc Microbiol Clin 1997; 15:564-5. [PMID: 9522528] [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: 02/06/2023]
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Abstract
Urinary tract infections (UTI) include a wide range of clinical entities. Starting from this situation, have been differentiated each of the UTI depending on location, age and sex, among other factors. Therefore, UTI have been classified and studied as follows: UTI in women, in men, in elderly people, in catheterized patients and in children. The different pharmacotherapeutic alternatives have been assessed and the classic agents compared with the most recent molecules.
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Affiliation(s)
- S Grau
- Pharmacy Department, Hospital Universitari del Mar
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Segura C, Salvadó M. Beta-lactamases of Mycobacterium tuberculosis and Mycobacterium kansasii. Microbiologia 1997; 13:331-6. [PMID: 9353752] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Re-emergence of infectious diseases caused by mycobacteria as well as the emergence of multiresistant strains of Mycobacterium has promoted the research on the use of beta-lactames in the treatment of such diseases. Mycobacteria produce beta-lactamases: M. tuberculosis produces a wide-spectrum beta-lactamase whose behaviour mimicks those of Gram-negative bacteria. M. kansasii produces also beta-lactamase which can be inhibited by clavulanic acid. An overview on beta-lactamases from both species is reported.
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Affiliation(s)
- C Segura
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Spain
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Knobel H, Supevía A, Salvadó M, Gimeno JL, López-Colomes JL, Saballs P, Drobnic L, Díez A. [Fever of unknown origin in patients with human immunodeficiency virus infection. Study of 100 cases]. Rev Clin Esp 1996; 196:349-53. [PMID: 8767068] [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: 02/02/2023]
Abstract
BACKGROUND Fever of unknown origin (FUO) has been insufficiently studied in patients infected with HIV. The aim of this study was to determine the incidence, mean hospital stay, etiology, diagnostic methods and clinical course in patients infected with HIV and FUO. METHODS Descriptive prospective study of patients infected with HIV and with FUO for a period of 24 months (February 1993-February 1995). Out of a total of 1,202 admissions, 100 were prompted by FUO in 95 patients (61 males, 34 women). Sixty-six per cent were parenteral drug abusers or had been so and the mean T CD4+ lymphocyte count was 0.061 x 10(9)/1 +/- 0.075 x 10(9)/1. RESULTS The incidence of FUO was 8.3 every 100 patients/year. The mean hospital stay was 31.3 +/- 17.8 days, compared with an overall mean stay for HIV-positive patients of 14.6 +/- 8 days (p < 0.001). An etiologic diagnosis was achieved in 90% of cases. Pulmonary or extrapulmonary tuberculosis accounted for approximately 50% of cases, whereas non tuberculous mycobacteria (MAI and M. kansasii) for 20%. The other etiologies (CMV, visceral leishmaniasis, PCP, toxoplasmosis, cryptococcosis, lymphoma) accounted each for less than 5% of diagnoses. In 14 occasions there were two concomitant diagnoses. Mortality rate was 22%, which was higher when two simultaneous diagnosis were present [RR: 3.17 (1.5-6.6)]. In 45% of fatal cases one of the diagnoses went undiagnosed premortem. The highest diagnostic yield was obtained with sputum culture (34.2% of diagnosis) and blood culture (21.5%). CONCLUSIONS FUO in common in patients infected with HIV, with important health resources consumption associated. The obtention of diagnosis was possible in a high percentage of patients. It is associated with a high hospital mortality rate. The most common diagnoses were tuberculosis and infections by other mycobacteria. It is possible to obtain the diagnosis with non-invasive procedures in 75% of cases.
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Affiliation(s)
- H Knobel
- Servicio de Medicina Interna. Enfermedades Infecciosas, Hospital del Mar, Barcelona
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Affiliation(s)
- G Figueras
- Department of Pediatrics, Hospital del Mar, Barcelona, Spain
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Abstract
Beta-lactamase activity was studied in 142 non-tuberculosis mycobacterial strains. The distribution according to species was as follows: four M. avium, 14 M. chelonae, 10 M. fortuitum, 59 M. gordonae, 55 M. kansasii. The spectrum of hydrolysis of the beta-lactamases was screened using an acidimetric method and the characterization was performed by analytical isoelectric focusing.
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Affiliation(s)
- A Coira
- Institut Municipal d'Investigació Mèdica, Universitat Autònoma de Barcelona, Spain
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Salvadó M, Segura C, Baró T, Torrella MT, Tirado M, Chaves J. [Pseudomonas aeruginosa serotype 0:12 in a general hospital in the Barcelona area]. Enferm Infecc Microbiol Clin 1994; 12:269-70. [PMID: 8049293] [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: 01/28/2023]
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Knobel H, Salvadó M, Plass E, Orfila A, Llorach I, Díez A. [Nosocomial epidemic outbreak of diarrhea from Clostridium difficile. Comparative study of diarrhea associated with the use of antibiotics]. Med Clin (Barc) 1994; 102:165-8. [PMID: 8127164] [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: 01/28/2023]
Abstract
BACKGROUND Clostridium difficile is considered as one of the principal enteropathogens of nosocomial origin in developed countries in the last decade. No nosocomial outbreaks have been described in Spain. METHODS A descriptive study of a nosocomial outbreak of diarrhea by C. difficile (DCD) which was produced during two months in a general hospital of 250 beds was carried out. The risk factors, clinical and analytical characteristics were compared with the cases of diarrhea associated to the use of antibiotics (DAA) produced during the same period. RESULTS Of the 23 diarrheas studied, 17 (74%) corresponded to DAA and 6 (26%) to DCD, four of which were of nosocomial origin and were detected in the department of Nephrology. The incidence of DAA was 44/1000 patients who received antibiotic treatment per month and the incidence of DCD was 15.5/1000 patients/month. The patients with DAA received a mean of 1.82 antimicrobians per patient and in DCD 2.16 per patient (p: NS). The only differences found between DAA and DCD were: length of the symptoms (16.5 days in DCD, 8.5 days in DAA, p < 0.01) and the presence of blood in the feces (66.6% in DCD and 0 in DAA p < 0.01). No differences were observed in age, sex, base disease, mucous diarrhea, fever, mortality, high VSG and leucocytosis. Surveillance and control measures were effective in combating the epidemic outbreak. CONCLUSIONS The diagnosis of diarrhea by C. difficile requires a high index of suspicion given the difficulty in differentiating the same from diarrhea associated to antibiotic use. The clinical profile and risk factors do not differ to those described in other geographic areas. The isolation and/or detection of toxins of C. difficile is recommended in patients submitted to antibiotic treatment and diarrhea of more than 72 hours of evolution.
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Affiliation(s)
- H Knobel
- Unidad de Enfermedades Infecciosas, Hospital del Mar, Barcelona
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Vallés J, Betriu N, Morales C, Salvadó M. [Serogroup Y meningococcal meningitis in Spain: apropos of a case]. Med Clin (Barc) 1987; 88:39. [PMID: 3102864] [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: 01/04/2023]
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