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Estévez A, Machado M, Valerio M, Sánchez C, Marín M, Adán I, Bouza E, Hualde AM, Pinilla B, Muñoz P. Endocarditis polimicrobiana, ¿una entidad real? Análisis de nuestra cohorte de endocarditis HGUGM 2008-2020. Cirugía Cardiovascular 2022. [DOI: 10.1016/j.circv.2022.03.015] [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: 10/17/2022] Open
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Márquez DF, Garzón ME, Renna NF, Baroni M, Berger A, Caruso G, Ferretti V, Sabio R, König F, Marín M, Romero CA. [Argentine registry of office blood pressure monitoring. RAMPAC study]. Hipertens Riesgo Vasc 2022; 39:62-68. [PMID: 35305932 DOI: 10.1016/j.hipert.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Hypertension (HTN) is the leading cause of mortality and disability in the world. In Argentina, almost 44% of hypertensives do not know about their condition and this may be due to the low rate of blood pressure (BP) measurements during the office visit. Our hypothesis is that the measurement and electronic recording of BP (BPMR) is not a routine practice in Argentina. OBJECTIVE To describe the rate of office BP measurement in Argentina. METHODS This is a retrospective, multicentre, point prevalence study. We analysed all office visits on 9/19/2019 at 9 medical institutions in 6 provinces of Argentina. RESULTS Two thousand and eighty-two office visits were analysed. The patients' mean age was 52.1 years (18-103), 1790 (59.7%) were female, and 702 (36.1%) were hypertensives. BP was measured in 420 visits (14.1%; 95% CI 12.8-15.4). In a multivariate logistic regression model, history of HTN (OR 1.91, P<.001) and previous cardiovascular event (OR 1.76, P<.001) were associated with more odds of BPMR. The presence of cancer was associated with fewer odds of BPMR (OR .51, P<.01). Cardiology measured BP up to 49.5% (144/291 visits), followed by internal medicine 30% (152/507 visits). CONCLUSION BPMR during office visits is deficient in Argentina and represents a missed healthcare opportunity. Different strategies are needed to detect hypertensive patients and reduce cardiovascular events.
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Affiliation(s)
- D F Márquez
- Unidad de Hipertensión Arterial, Hospital San Bernardo, Salta, Argentina; Instituto de NefroUrología y Nutrición de Salta, Salta, Argentina
| | - M E Garzón
- Servicio de Clínica Médica, Hospital Ferreyra, Córdoba, Argentina; Servicio de Clínica Médica, Hospital Privado, Córdoba, Argentina
| | - N F Renna
- Departamento de Cardiología, Hospital Español, Mendoza, Argentina
| | - M Baroni
- Facultad de Ciencias Médicas, Universidad Nacional de Cuyo-Mendoza, Servicio de Cardiología, Instituto Modelo de Cardiología, Córdoba, Argentina
| | - A Berger
- Servicio de Clínica Médica, Hospital Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - G Caruso
- Servicio de Clínica Médica, Hospital Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - V Ferretti
- Servicio de Clínica Médica, Sanatorio Norte, Rosario, Argentina
| | - R Sabio
- Hospital de Alta Complejidad, SAMIC-El Calafate, Santa Cruz, Argentina
| | - F König
- Unidad de Hipertensión Arterial, Hospital San Bernardo, Salta, Argentina
| | - M Marín
- Unidad de Hipertensión Arterial, Hospital Italiano de San Justo, Buenos Aires, Argentina
| | - C A Romero
- Servicio de Clínica Médica, Hospital Privado, Córdoba, Argentina; Emory University School of Medicine, Renal Division, Atlanta, EE. UU..
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Fendrich M, Becker J, Ives M, Rodis E, Marín M. Treatment Retention in Opioid Dependent Clients Receiving Medication-Assisted Treatment: Six-Month Rate and Baseline Correlates. Subst Use Misuse 2021; 56:1018-1023. [PMID: 33843448 DOI: 10.1080/10826084.2021.1906276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the current opioid overdose epidemic, treatment retention among clients receiving medication-assisted treatment (MAT) for opioid dependence is a significant and growing concern among treatment providers, policymakers, and researchers. Methods: We examined a sample of clients enrolled in a federally funded MAT expansion program implemented in four sites in Connecticut. Program participants received MAT for their opioid use disorders (OUDs). All program sites utilized a person in recovery from OUD (a recovery support coach, RSC) as part of the treatment team. By performing bivariate analyses and multivariate logistic regression models, we evaluated the association of 6-month retention and program site, gender, age, race/ethnicity, and past month substance use. Results: At 6-month follow-up, 58.9% of participants were classified as "retained." Multivariate logistic regression analysis revealed that participants who were older, reported no past month cocaine/crack use, or reported any illegal drug use other than cocaine/crack, were significantly more likely to be retained in treatment at follow-up. Conclusions: Retention rates were relatively high in these Connecticut sites compared to those examined in previous literature. Findings suggest that efforts for enhancing retention and successful treatment outcomes need to consider and potentially address the unique needs, problems, and risks of younger clients and clients with crack/cocaine involvement. The importance of drug use screening for those entering MAT is underscored. Future research needs to explore how levels of client involvement in adjunctive therapies may impact their retention.
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Affiliation(s)
- Michael Fendrich
- University of Connecticut, School of Social Work, Hartford, Connecticut, USA
| | - Jessica Becker
- University of Connecticut, School of Social Work, Hartford, Connecticut, USA
| | - Melissa Ives
- University of Connecticut, School of Social Work, Hartford, Connecticut, USA.,Connecticut Department of Mental Health and Addiction Services, Hartford, Connecticut, USA
| | - Eleni Rodis
- University of Connecticut, School of Social Work, Hartford, Connecticut, USA.,Connecticut Department of Mental Health and Addiction Services, Hartford, Connecticut, USA
| | - Martha Marín
- University of Connecticut, School of Social Work, Hartford, Connecticut, USA.,Connecticut Department of Mental Health and Addiction Services, Hartford, Connecticut, USA
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Rodriguez-Manfredi JA, de la Torre Juárez M, Alonso A, Apéstigue V, Arruego I, Atienza T, Banfield D, Boland J, Carrera MA, Castañer L, Ceballos J, Chen-Chen H, Cobos A, Conrad PG, Cordoba E, del Río-Gaztelurrutia T, de Vicente-Retortillo A, Domínguez-Pumar M, Espejo S, Fairen AG, Fernández-Palma A, Ferrándiz R, Ferri F, Fischer E, García-Manchado A, García-Villadangos M, Genzer M, Giménez S, Gómez-Elvira J, Gómez F, Guzewich SD, Harri AM, Hernández CD, Hieta M, Hueso R, Jaakonaho I, Jiménez JJ, Jiménez V, Larman A, Leiter R, Lepinette A, Lemmon MT, López G, Madsen SN, Mäkinen T, Marín M, Martín-Soler J, Martínez G, Molina A, Mora-Sotomayor L, Moreno-Álvarez JF, Navarro S, Newman CE, Ortega C, Parrondo MC, Peinado V, Peña A, Pérez-Grande I, Pérez-Hoyos S, Pla-García J, Polkko J, Postigo M, Prieto-Ballesteros O, Rafkin SCR, Ramos M, Richardson MI, Romeral J, Romero C, Runyon KD, Saiz-Lopez A, Sánchez-Lavega A, Sard I, Schofield JT, Sebastian E, Smith MD, Sullivan RJ, Tamppari LK, Thompson AD, Toledo D, Torrero F, Torres J, Urquí R, Velasco T, Viúdez-Moreiras D, Zurita S. The Mars Environmental Dynamics Analyzer, MEDA. A Suite of Environmental Sensors for the Mars 2020 Mission. Space Sci Rev 2021; 217:48. [PMID: 34776548 PMCID: PMC8550605 DOI: 10.1007/s11214-021-00816-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 05/16/2023]
Abstract
NASA's Mars 2020 (M2020) rover mission includes a suite of sensors to monitor current environmental conditions near the surface of Mars and to constrain bulk aerosol properties from changes in atmospheric radiation at the surface. The Mars Environmental Dynamics Analyzer (MEDA) consists of a set of meteorological sensors including wind sensor, a barometer, a relative humidity sensor, a set of 5 thermocouples to measure atmospheric temperature at ∼1.5 m and ∼0.5 m above the surface, a set of thermopiles to characterize the thermal IR brightness temperatures of the surface and the lower atmosphere. MEDA adds a radiation and dust sensor to monitor the optical atmospheric properties that can be used to infer bulk aerosol physical properties such as particle size distribution, non-sphericity, and concentration. The MEDA package and its scientific purpose are described in this document as well as how it responded to the calibration tests and how it helps prepare for the human exploration of Mars. A comparison is also presented to previous environmental monitoring payloads landed on Mars on the Viking, Pathfinder, Phoenix, MSL, and InSight spacecraft.
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Affiliation(s)
| | | | | | - V. Apéstigue
- Instituto Nacional de Técnica Aeroespacial (INTA), Madrid, Spain
| | - I. Arruego
- Instituto Nacional de Técnica Aeroespacial (INTA), Madrid, Spain
| | - T. Atienza
- Universidad Politécnica de Cataluña, Barcelona, Spain
| | - D. Banfield
- Cornell Center for Astrophysics and Planetary Science, Cornell University, Ithaca, NY USA
| | - J. Boland
- Jet Propulsion Laboratory/California Institute of Technology, Pasadena, CA USA
| | | | - L. Castañer
- Universidad Politécnica de Cataluña, Barcelona, Spain
| | - J. Ceballos
- Instituto de Microelectrónica de Sevilla (US-CSIC), Seville, Spain
| | - H. Chen-Chen
- Universidad del País Vasco (UPV/EHU), Bilbao, Spain
| | - A. Cobos
- CRISA-Airbus, Tres Cantos, Spain
| | | | - E. Cordoba
- Jet Propulsion Laboratory/California Institute of Technology, Pasadena, CA USA
| | | | | | | | - S. Espejo
- Instituto de Microelectrónica de Sevilla (US-CSIC), Seville, Spain
| | - A. G. Fairen
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | | | - R. Ferrándiz
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | - F. Ferri
- Università degli Studi di Padova, Padova, Italy
| | - E. Fischer
- University of Michigan, Ann Arbor, MI USA
| | | | | | - M. Genzer
- Finnish Meteorological Institute, Helsinki, Finland
| | - S. Giménez
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | - J. Gómez-Elvira
- Instituto Nacional de Técnica Aeroespacial (INTA), Madrid, Spain
| | - F. Gómez
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | | | - A.-M. Harri
- Finnish Meteorological Institute, Helsinki, Finland
| | - C. D. Hernández
- Jet Propulsion Laboratory/California Institute of Technology, Pasadena, CA USA
| | - M. Hieta
- Finnish Meteorological Institute, Helsinki, Finland
| | - R. Hueso
- Universidad del País Vasco (UPV/EHU), Bilbao, Spain
| | - I. Jaakonaho
- Finnish Meteorological Institute, Helsinki, Finland
| | - J. J. Jiménez
- Instituto Nacional de Técnica Aeroespacial (INTA), Madrid, Spain
| | - V. Jiménez
- Universidad Politécnica de Cataluña, Barcelona, Spain
| | - A. Larman
- Added-Value-Solutions, Elgoibar, Spain
| | - R. Leiter
- Jet Propulsion Laboratory/California Institute of Technology, Pasadena, CA USA
| | - A. Lepinette
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | | | - G. López
- Universidad Politécnica de Cataluña, Barcelona, Spain
| | - S. N. Madsen
- Jet Propulsion Laboratory/California Institute of Technology, Pasadena, CA USA
| | - T. Mäkinen
- Finnish Meteorological Institute, Helsinki, Finland
| | - M. Marín
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | | | - G. Martínez
- Lunar and Planetary Institute, Houston, TX USA
| | - A. Molina
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | | | | | - S. Navarro
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | | | - C. Ortega
- Added-Value-Solutions, Elgoibar, Spain
| | - M. C. Parrondo
- Instituto Nacional de Técnica Aeroespacial (INTA), Madrid, Spain
| | - V. Peinado
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | - A. Peña
- CRISA-Airbus, Tres Cantos, Spain
| | | | | | | | - J. Polkko
- Finnish Meteorological Institute, Helsinki, Finland
| | - M. Postigo
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | | | | | - M. Ramos
- Universidad de Alcalá, Alcalá de Henares, Spain
| | | | - J. Romeral
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | - C. Romero
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | | | - A. Saiz-Lopez
- Dept. of Atmospheric Chemistry and Climate, Institute of Physical Chemistry Rocasolano, CSIC, Madrid, Spain
| | | | - I. Sard
- Added-Value-Solutions, Elgoibar, Spain
| | - J. T. Schofield
- Jet Propulsion Laboratory/California Institute of Technology, Pasadena, CA USA
| | - E. Sebastian
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | - M. D. Smith
- NASA Goddard Space Flight Center, Greenbelt, MD USA
| | - R. J. Sullivan
- Cornell Center for Astrophysics and Planetary Science, Cornell University, Ithaca, NY USA
| | - L. K. Tamppari
- Jet Propulsion Laboratory/California Institute of Technology, Pasadena, CA USA
| | - A. D. Thompson
- Jet Propulsion Laboratory/California Institute of Technology, Pasadena, CA USA
| | - D. Toledo
- Instituto Nacional de Técnica Aeroespacial (INTA), Madrid, Spain
| | | | - J. Torres
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | - R. Urquí
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | | | | | - S. Zurita
- Centro de Astrobiología (INTA-CSIC), Madrid, Spain
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Luque L, Rodrigo T, García-García JM, Casals M, Millet JP, Caylà J, Orcau A, Agüero R, Alcázar J, Altet N, Altube L, Álvarez F, Anibarro L, Barrón M, Bermúdez P, Bikuña E, Blanquer R, Borderías L, Bustamante A, Calpe J, Caminero J, Cañas F, Casas F, Casas X, Cases E, Castejón N, Castrodeza R, Cebrián J, Cervera A, Ciruelos J, Delgado A, De Souza M, Díaz D, Domínguez M, Fernández B, Gallardo J, Gallego M, Clemente MG, García C, García F, Garros F, Gort A, Guerediaga A, Gullón J, Hidalgo C, Iglesias M, Jiménez G, Jiménez M, Kindelan J, Laparra J, López I, Lera R, Lloret T, Marín M, Lacasa XM, Martínez E, Martínez A, Medina J, Melero C, Milà C, Millet J, Mir I, Molina F, Morales C, Morales M, Moreno A, Moreno V, Muñoz A, Muñoz C, Muñoz J, Muñoz L, Oribe M, Parra I, Penas A, Pérez J, Rivas P, Rodríguez J, Ruiz-Manzano J, Sala J, Sandel D, Sánchez M, Sánchez M, Sánchez P, Santamaría I, Sanz F, Serrano A, Somoza M, Tabernero E, Trujillo E, Valencia E, Valiño P, Vargas A, Vidal I, Vidal R, Villanueva M, Villar A, Vizcaya M, Zabaleta M, Zubillaga G. Factors Associated With Extrapulmonary Tuberculosis in Spain and Its Distribution in Immigrant Population. Open Respiratory Archives 2020. [DOI: 10.1016/j.opresp.2020.04.004] [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: 12/16/2022] Open
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Reigadas E, Bouza E, Olmedo M, Vázquez-Cuesta S, Villar-Gómara L, Alcalá L, Marín M, Rodríguez-Fernández S, Valerio M, Muñoz P. Faecal microbiota transplantation for recurrent Clostridioides difficile infection: experience with lyophilized oral capsules. J Hosp Infect 2019; 105:319-324. [PMID: 31883938 DOI: 10.1016/j.jhin.2019.12.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 10/07/2019] [Accepted: 12/18/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Faecal microbiota transplantation (FMT) is a highly effective approach for refractory and recurrent Clostridioides difficile infection (CDI). Despite its excellent efficacy, FMT is not yet a routine procedure in most centres. There is very little experience with FMT based on lyophilized capsules, and data from European institutions are lacking. This article describes our experience with FMT to treat recurrent CDI using lyophilized oral capsules. METHODS A prospectively recorded single-centre case series of patients with recurrent CDI who underwent FMT between January 2018 and May 2019 were analysed. The primary outcome was defined as resolution of CDI without recurrences over a two-month period. Overall resolution was defined as resolution of diarrhoea without recurrence of CDI within two months after a further cycle of FMT. The FMT process involved oral ingestion of four or five lyophilized capsules in a single dose. All stool donors were rigorously screened. FINDINGS FMT was performed in 32 patients. Primary cure was achieved in 81.3% of patients, and the overall cure rate was 87.5%. FMT via lyophilized capsules was well tolerated. No FMT procedure-related adverse events and no further complications were observed for lyophilized-capsule FMT. CONCLUSIONS This initial clinical experience suggests that FMT based on oral lyophilized preparations is a safe, well-tolerated, and highly effective treatment for recurrent CDI. Administration of oral lyophilized capsules seems feasible in hospital routine and will enable FMT to be more widely used.
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Affiliation(s)
- E Reigadas
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - M Olmedo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - S Vázquez-Cuesta
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - L Villar-Gómara
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - L Alcalá
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - M Marín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - S Rodríguez-Fernández
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Valerio
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
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Reigadas E, Alcalá L, Marín M, Martin A, Muñoz P, Bouza E. Prediction of poor outcome in Clostridioides difficile infection: A multicentre external validation of the toxin B amplification cycle. Anaerobe 2019; 61:102079. [PMID: 31356959 DOI: 10.1016/j.anaerobe.2019.102079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 02/08/2023]
Abstract
Classification of patients according to their risk of poor outcomes in Clostridioides difficile infection (CDI) would enable implementation of costly new treatment options in a subset of patients at higher risk of poor outcome. In a previous study, we found that low toxin B amplification cycle thresholds (Ct) were independently associated with poor outcome CDI. Our objective was to perform a multicentre external validation of a PCR-toxin B Ct as a marker of poor outcome CDI. We carried out a multicentre study (14 hospitals) in which the characteristics and outcome of patients with CDI were evaluated. A subanalysis of the results of the amplification curve of real-time PCR gene toxin B (XpertTM C. difficile) was performed. A total of 223 patients were included. The median age was 73.0 years, 50.2% were female, and the median Charlson index was 3.0. The comparison of poor outcome and non-poor outcome CDI episodes revealed, respectively, the following results: median age (years), 77.0 vs 72.0 (p = 0.009); patients from nursing homes, 24.4% vs 10.8% (p = 0.039); median leukocytes (cells/μl), 10,740.0 vs 8795.0 (p = 0.026); and median PCR-toxin B Ct, 23.3 vs 25.4 (p = 0.004). Multivariate analysis showed that a PCR-toxin B Ct cut-off <23.5 was significantly and independently associated with poor outcome CDI (p = 0.002; OR, 3.371; 95%CI, 1.565-7.264). This variable correctly classified 68.5% of patients. The use of this microbiological marker could facilitate early selection of patients who are at higher risk of poor outcome and are more likely to benefit from newer and more costly therapeutic options.
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Affiliation(s)
- E Reigadas
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - L Alcalá
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - M Marín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - A Martin
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain.
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Rejili M, Msaddak A, Filali I, Benabderrahim MA, Mars M, Marín M. New chromosomal lineages within Microvirga and Bradyrhizobium genera nodulate Lupinus angustifolius growing on different Tunisian soils. FEMS Microbiol Ecol 2019; 95:5537381. [DOI: 10.1093/femsec/fiz118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
ABSTRACTThirty-one rhizobial isolates nodulating native Lupinus angustifolius (blue lupine) plants growing in Northern Tunisian soils were isolated and analysed using different chromosomal and symbiotic gene markers. Phylogenetic analyses based on recA partial sequences grouped them into at least five groups: four of them within the genus Bradyrhizobium (26 isolates) and one into the genus Microvirga (5 isolates). Representative strains were analysed by multilocus sequence analysis of three housekeeping genes rrs-recA-glnII and rrs-gyrB-dnaK for Bradyrhizobium and Microvirga isolates, respectively. Based on this analysis, eight isolates clustered with the previously described strains Bradyrhizobium lupini USDA3051 and Bradyrhizobium canariense BTA-1. However, five of the isolates clustered separately and may constitute a new species within the Bradyrhizobium genus. The remaining five isolates were closely related to the strain Microvirga sp. LmiM8 and may constitute a new Microvirga species. The analysis of the nodC gene showed that all Bradyrhizobium strains nodulating blue lupine belong to the symbiovar genistearum, whereas the Microvirga isolates are associated with the symbiovar mediterranense. The results of this study support that the L. angustifolius root nodule symbionts isolated in Northern Tunisia belong mostly to the B. canariense/B. lupini lineages. However, new clades of Bradyrhizobium and Microvirga have been identified as L. angustifolius endosymbionts.
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Affiliation(s)
- M Rejili
- Laboratory of Biodiversity and Valorization of Arid Areas Bioresources (BVBAA) – Faculty of Sciences of Gabes, University of Gabes, Erriadh, Zrig 6072, Gabes, Tunisia
| | - A Msaddak
- Laboratory of Biodiversity and Valorization of Arid Areas Bioresources (BVBAA) – Faculty of Sciences of Gabes, University of Gabes, Erriadh, Zrig 6072, Gabes, Tunisia
| | - I Filali
- College of Computer and Information Sciences, Princess Nourah bint Abdulrahman University, Riyadh PO Box 84428, Saudi Arabia
| | - M A Benabderrahim
- Arid and Oases Cropping Laboratory, Arid Area Institute, Gabes 6051, Tunisia
| | - M Mars
- Laboratory of Biodiversity and Valorization of Arid Areas Bioresources (BVBAA) – Faculty of Sciences of Gabes, University of Gabes, Erriadh, Zrig 6072, Gabes, Tunisia
| | - M Marín
- Institute of Genetics, Ludwig Maximilians University of Munich (LMU), Grosshaderner Str. 2–4, D-82152 Martinsried, Germany
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Delucchi A, Marín M, Páez O, Bendersky M, Rodríguez P. Principales conclusiones del Consenso Argentino de Hipertensión Arterial. Hipertensión y Riesgo Vascular 2019; 36:96-109. [DOI: 10.1016/j.hipert.2019.01.001] [Citation(s) in RCA: 4] [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] [Received: 09/01/2018] [Revised: 11/28/2018] [Accepted: 01/07/2019] [Indexed: 01/13/2023]
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Acosta F, Pérez-Lago L, Ruiz Serrano M, Marín M, Kohl T, Lozano N, Niemann S, Valerio M, Olmedo M, Pérez-Granda M, Pérez Pérez M, Bouza E, Muñoz P, García de Viedma D. Fast update of undetected Mycobacterium chimaera infections to reveal unsuspected cases. J Hosp Infect 2018; 100:451-455. [DOI: 10.1016/j.jhin.2018.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
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11
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Marín M, Ruiz A, Iglesias C, Quiroga L, Cercenado E, Martín-Rabadán P, Bouza E, Rodríguez-Sánchez B. Identification of Nocardia species from clinical isolates using MALDI-TOF mass spectrometry. Clin Microbiol Infect 2018; 24:1342.e5-1342.e8. [PMID: 29933050 DOI: 10.1016/j.cmi.2018.06.014] [Citation(s) in RCA: 24] [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: 02/02/2018] [Revised: 05/10/2018] [Accepted: 06/09/2018] [Indexed: 11/18/2022]
Abstract
The identification of Nocardia isolates still represents a challenge for matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) despite its acceptance for most bacterial and fungal isolates. In this study we evaluate the identification of Nocardia isolates using direct spotting and an updated database. Overall, 82 Nocardia isolates belonging to 13 species were identified by DNA sequence analysis of the 16S rRNA and secA1 genes. Nine of these well-characterized isolates from 6 Nocardia species were used to create an in-house library. The remaining 73 isolates were directly spotted on the target plate and on-plate protein extraction was performed. The protein spectra obtained were analyzed by MALDI-TOF MS using the BDAL database (Bruker Daltonics) updated with 6,903 MSPs or the combination of this commercial database and our in-house library. As a result, the use of the commercial database alone and in combination with the in-house library yielded 94.5% and 95.9% of correct species-level identifications, respectively, No isolate was misidentified at the genus level with either database. Besides, the use of the in-house library allowed the species-level identification of a N. otitidiscaviarum isolate that could only be identified at the genus-level with a score value <1.6 using the commercial database. In conclusion, the implementation of the direct spotting method and the in-house database provided a high rate of correct species assignment of Nocardia isolates despite the low number of isolates added. Further addition of well-characterized Nocardia isolates may ensure the rapid, accurate and inexpensive identification of most isolates encountered in the routine of the microbiology laboratory.
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Affiliation(s)
- M Marín
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - A Ruiz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - C Iglesias
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - L Quiroga
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - E Cercenado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - P Martín-Rabadán
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Emilio Bouza
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Belén Rodríguez-Sánchez
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
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Marín M, Gudiol C, Castet F, Oliva M, Peiró I, Royo-Cebrecos C, Carratalà J, Mesia R. Bloodstream infection in patients with head and neck cancer: a major challenge in the cetuximab era. Clin Transl Oncol 2018; 21:187-196. [PMID: 29948973 DOI: 10.1007/s12094-018-1905-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 05/28/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the impact of bloodstream infection (BSI) in patients with head and neck cancer (HNC) in the cetuximab era. METHODS We prospectively analysed the epidemiology, microbiology and outcomes of 51 BSI episodes occurring in 48 patients with HNC (2006-2017). We performed a retrospective matched-cohort study (1:2) to determine the risk factors for BSI. Finally, we compared patients who died with those who survived to identify risk factors for mortality. RESULTS The most frequent HNC localization was the oropharynx (43%), and pneumonia was the most frequent source (25%). Gram-positive BSI occurred in 55% cases, mainly due to Streptococcus pneumoniae (21%), and among Gram-negatives, Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the most frequent. Hypoalbuminemia (OR 8.4; 95% CI, 3.5-19.9), previous chemotherapy (OR, 3.2; 95% CI, 1.3-7.4) and cetuximab therapy (OR, 2.8; 95% CI, 1.6-6.7) were significant risk factors for BSI. Patients with BSI had a higher overall case-fatality rate than patients without BSI (OR, 4.4; 95% CI, 1.7-11.8). Hypoalbuminemia was an independent risk factor for the early (7 day) and overall (30 day) case-fatalities, with ORs of 0.8 (95% CI, 0.6-0.9) and 0.8 (95% CI, 0.7-0.97), respectively. The presence of comorbidities (OR, 7; 95% CI, 1.4-34) was also an independent risk factor for overall case-fatality. CONCLUSIONS BSI causes high mortality in patients with HNC and is most often secondary to pneumonia. It occurs mainly among patients with hypoalbuminemia who receive treatment with cetuximab or chemotherapy. The development of BSI in patients with HNC impairs their outcome, especially in the presence of hypoalbuminemia and comorbidities.
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Affiliation(s)
- M Marín
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet, Barcelona, Spain.,IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), L'Hospitalet, Barcelona, Spain
| | - C Gudiol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain. .,IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), L'Hospitalet, Barcelona, Spain. .,REIPI (Spanish Network for Research in Infectious Diseases), Barcelona, Spain. .,Department of Medicine, University of Barcelona, Barcelona, Spain.
| | - F Castet
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet, Barcelona, Spain.,IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), L'Hospitalet, Barcelona, Spain
| | - M Oliva
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet, Barcelona, Spain.,IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), L'Hospitalet, Barcelona, Spain
| | - I Peiró
- IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), L'Hospitalet, Barcelona, Spain.,Clinical Nutrition Unit, Catalan Institute of Oncology (ICO), L'Hospitalet, Barcelona, Spain
| | - C Royo-Cebrecos
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain.,IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), L'Hospitalet, Barcelona, Spain.,REIPI (Spanish Network for Research in Infectious Diseases), Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain.,IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), L'Hospitalet, Barcelona, Spain.,REIPI (Spanish Network for Research in Infectious Diseases), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - R Mesia
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet, Barcelona, Spain.,IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), L'Hospitalet, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
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Reigadas E, Muñoz-Pacheco P, Vázquez-Cuesta S, Alcalá L, Marín M, Martin A, Bouza E. Rifaximin-resistant Clostridium difficile strains isolated from symptomatic patients. Anaerobe 2017; 48:269-272. [PMID: 28988773 DOI: 10.1016/j.anaerobe.2017.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 07/28/2017] [Revised: 09/14/2017] [Accepted: 10/05/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Rifaximin has been proposed as an alternative treatment for specific cases of Clostridium difficile infection (CDI) and intestinal decontamination. Rifaximin-resistant C. difficile has occasionally been reported. Antibiotic susceptibility testing relies on anaerobic agar dilution (reference method), which is cumbersome and not routinely used. There is no commercial test for detection of resistance to rifaximin. OBJECTIVES To assess resistance to rifaximin by C. difficile and to evaluate the correlation between the results of the rifampicin E-test and susceptibility to rifaximin. METHODS We compared the in vitro susceptibility of clinical CDI isolates to rifaximin over a 6-month period using the agar dilution method with susceptibility to rifampicin using the E-test. All isolates were characterized using PCR-ribotyping. Clinical data were recorded prospectively. RESULTS We recovered 276 consecutive C. difficile isolates and found that 32.2% of episodes were caused by rifaximin-resistant strains. The MICs for rifaximin ranged from <0.0009-256 mg/L, with a geometric mean (GM) of 0.256 mg/L, an MIC50/90 of 0.015/>256 mg/L. Rifaximin and rifampicin MICs were comparable, and all strains classed as resistant by agar dilution were correctly classified as resistant by E-test. The most common ribotypes were 001 (37.2%), 078/126 (14.3%), and 014 (12.0%). Ribotype 001 exhibited the highest MICs for rifaximin. CONCLUSIONS Resistance to rifaximin was common; resistance rates were higher in ribotype 001 strains. Susceptibility to rifaximin determined by agar dilution correlated with susceptibility to rifampicin determined using the E-test, including rifaximin-resistant strains. Our results suggest that the rifampicin E-test is a valid method for the prediction of rifaximin-resistant C. difficile.
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Affiliation(s)
- E Reigadas
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - P Muñoz-Pacheco
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - S Vázquez-Cuesta
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - L Alcalá
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - M Marín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - A Martin
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain.
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Martinez Vila C, Fernández-Morales LA, Oliveres H, Marín M, Ribera P, Pardo JC, Dalmau E, Segui MA. Fulvestrant plus LHRH analogues in male with synchronous breast and prostate cancer. Ann Oncol 2017; 28:2027-2028. [PMID: 28444131 DOI: 10.1093/annonc/mdx198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- C Martinez Vila
- Department of Oncology, Corporacio Sanitaria Parc Tauli, Sabadell, Spain
| | | | - H Oliveres
- Department of Oncology, Corporacio Sanitaria Parc Tauli, Sabadell, Spain
| | - M Marín
- Department of Oncology, Corporacio Sanitaria Parc Tauli, Sabadell, Spain
| | - P Ribera
- Department of Oncology, Corporacio Sanitaria Parc Tauli, Sabadell, Spain
| | - J C Pardo
- Department of Oncology, Corporacio Sanitaria Parc Tauli, Sabadell, Spain
| | - E Dalmau
- Department of Oncology, Corporacio Sanitaria Parc Tauli, Sabadell, Spain
| | - M A Segui
- Department of Oncology, Corporacio Sanitaria Parc Tauli, Sabadell, Spain
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Reigadas E, Alcalá L, Marín M, Martín A, Bouza E. C. difficile PCR-ribotype 023 might go undetected when using ChromId C. difficile agar. Anaerobe 2017; 44:34-35. [PMID: 28108388 DOI: 10.1016/j.anaerobe.2017.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/16/2016] [Revised: 01/10/2017] [Accepted: 01/14/2017] [Indexed: 01/05/2023]
Abstract
We compared the performance of the new chromogenic medium ChromID C. difficile with that of CLO agar. ChromID C. difficile agar is a sensitive medium that can accelerate the presumptive identification of C. difficile, however ribotype 023 might go undetected when using this chromogenic medium.
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Affiliation(s)
- E Reigadas
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - L Alcalá
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - M Marín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - A Martín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain.
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Vena A, Muñoz P, Valerio M, Rodríguez-Creixéms M, Marín M, Martínez Jiménez M, Martínez Sellés M, Rodríguez Abella H, Bouza E. 11. Endocarditis fúngica: aún muchas controversias pendientes. Cirugía Cardiovascular 2017. [DOI: 10.1016/j.circv.2016.11.035] [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: 10/20/2022] Open
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Barbosa E, Marín M, Giraldo CE, Uribe S, Freitas A. Corrigendum. Neotropical Biodiversity 2017. [DOI: 10.1080/23766808.2017.1383668] [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: 10/18/2022] Open
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Reigadas E, Alcalá L, Marín M, Pelaéz T, Martin A, Iglesias C, Bouza E. In vitro activity of surotomycin against contemporary clinical isolates of toxigenic Clostridium difficile strains obtained in Spain. J Antimicrob Chemother 2016; 71:3319. [PMID: 27402007 DOI: 10.1093/jac/dkw267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Reigadas E, Alcalá L, Valerio M, Marín M, Martin A, Bouza E. Toxin B PCR cycle threshold as a predictor of poor outcome of Clostridium difficile infection: a derivation and validation cohort study. J Antimicrob Chemother 2016; 71:1380-5. [PMID: 26869691 DOI: 10.1093/jac/dkv497] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/19/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Prediction of patients with poor outcome is necessary in order to plan the proper management of Clostridium difficile infection (CDI); however, clinical criteria are insufficient. In a previous study, we observed that high toxigenic C. difficile cfu stool counts at diagnosis were associated with a poor outcome. Our objective was to investigate the role of the PCR toxin B amplification cycle threshold (Ct) in the prediction of CDI poor outcome and to derive and validate a high-risk prediction rule using this marker. METHODS We prospectively included patients with CDI (derivation cohort, January 2013 to June 2014; and validation cohort, December 2014 to May 2015), who were followed for at least 2 months after their last episode/recurrence. All samples were tested with Xpert™ C. difficile. RESULTS For the derivation cohort (n = 129) toxin B Ct was independently associated with poor outcome (P < 0.001). The receiver operating characteristic (ROC) curve yielded an AUC of 0.816. Using a cut-off of <23.5 cycles for high risk of poor outcome, the diagnostic accuracy was 81.4%, the sensitivity was 46.5% (95% CI 32.5-61.1) and the specificity was 98.8% (95% CI 93.7-99.8). For the validation cohort (n = 170), the diagnostic accuracy was 81.8%, the sensitivity was 88.4% (95% CI 75.5-94.9) and the specificity was 79.5% (95% CI 71.7-85.6). The ROC curve yielded an AUC of 0.857. CONCLUSIONS Low toxin B Ct values from samples collected at the initial moment of diagnosis appears to be a strong marker for poor outcome. This available test may identify, at an early stage, patients who are at higher risk of a poor outcome CDI.
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Affiliation(s)
- E Reigadas
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - L Alcalá
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - M Valerio
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - M Marín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - A Martin
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
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Reigadas E, Alcalá L, Marín M, Muñoz-Pacheco P, Catalán P, Martin A, Bouza E. Clinical significance of direct cytotoxicity and toxigenic culture in Clostridium difficile infection. Anaerobe 2016; 37:38-42. [DOI: 10.1016/j.anaerobe.2015.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 02/07/2023]
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Vallejo J, Marín M, Sánchez L, Saldarriaga A. Clear cell hipernefroma in horseshoe kidney – mandibular metastases. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.362] [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: 10/22/2022]
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Reigadas E, Alcalá L, Marín M, Pelaéz T, Martin A, Iglesias C, Bouza E. In vitro activity of surotomycin against contemporary clinical isolates of toxigenic Clostridium difficile strains obtained in Spain. J Antimicrob Chemother 2015; 70:2311-5. [PMID: 25876881 DOI: 10.1093/jac/dkv092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/18/2015] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Clostridium difficile infection (CDI) is the leading cause of hospital-acquired diarrhoea in developed countries. Metronidazole and vancomycin are the mainstay of treatment, although they are associated with treatment failure and recurrence. Novel agents have emerged to address these shortcomings. We investigated the in vitro activity of a novel agent, surotomycin (formerly CB-183,315), and seven other antimicrobial agents against clinical C. difficile isolates. METHODS Antimicrobial susceptibility to surotomycin, fidaxomicin, metronidazole, vancomycin, clindamycin, rifaximin, moxifloxacin and tigecycline was determined for 100 contemporary clinical isolates of C. difficile collected in 2013. MICs were determined by agar dilution according to CLSI procedures. In addition, 10 strains with reduced susceptibility to metronidazole (n = 6) and vancomycin (n = 4) were also tested. Strains were PCR ribotyped. RESULTS The MICs of surotomycin for the 100 isolates ranged from ≤0.06 to 2 mg/L, with a geometric mean (GM) of 0.31 mg/L and an MIC50/90 of 0.25/0.5 mg/L. The MIC range of surotomycin was 0.25-1 mg/L (GM = 0.45 mg/L) for isolates with reduced metronidazole susceptibility and 0.125-0.5 mg/L (GM = 0.25 mg/L) for isolates with reduced vancomycin susceptibility. The three most common ribotypes were 001 (31.0%), 014/020 (17.0%) and 078/126 (17.0%). Ribotype 014/020 exhibited the lowest MICs of surotomycin (GM = 0.22 mg/L); the highest MICs were for ribotype 078/126 (GM = 0.72 mg/L). CONCLUSIONS Surotomycin exhibited potent in vitro activity against all the isolates tested, including those with elevated metronidazole and vancomycin MICs. The potential role of this agent in the treatment of CDI requires further clinical evaluation.
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Affiliation(s)
- E Reigadas
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - L Alcalá
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - M Marín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - T Pelaéz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - A Martin
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - C Iglesias
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
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Dávila Fajardo CL, Díaz Villamarín X, Morón Romero R, Gonzalez Medina M, Marín M, Cabeza Barrera J. CP-014 Parenteral nutrition, is standarization acceptable? Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.14] [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: 11/04/2022] Open
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Bouza E, Rodríguez-Créixems M, Alcalá L, Marín M, De Egea V, Braojos F, Muñoz P, Reigadas E. Is Clostridium difficile infection an increasingly common severe disease in adult intensive care units? A 10-year experience. J Crit Care 2015; 30:543-9. [PMID: 25791766 DOI: 10.1016/j.jcrc.2015.02.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 10/22/2014] [Revised: 01/29/2015] [Accepted: 02/20/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE Despite the high concentration of patients with known risk factors for Clostridium difficile infection (CDI) in intensive care units (ICUs), data on ICU patients are scarce. The aim of this study was describe the incidence, clinical characteristics, and evolution of CDI in critically ill patients. MATERIALS AND METHODS From 2003 to 2012, adult patients admitted to an ICU (A-ICU) and positive for CDI were included and classified as follows: pre-ICU, if the positive sample was obtained within ±3 days of ICU admission; in-ICU, if obtained after 3 days of ICU admission and up to 3 days after ICU discharge. RESULTS We recorded 4095 CDI episodes, of which 328 were A-ICU (8%). Episodes of A-ICU decreased from 19.4 to 8.7 per 10000 ICU days of stay (P < .0001). Most A-ICU CDIs (66.3%) were mild to moderate. Pre-ICU episodes accounted for 16.2% and were more severe complicated than in-ICU episodes (11% vs 0%; P = .020). Overall mortality was 28.6%, and CDI-attributable mortality was only 3%. CONCLUSION The incidence of A-ICU CDI has decreased steadily over the last 10 years. A significant proportion of A-ICU CDI episodes are pre-ICU and are more severe than in-ICU CDI episodes. Most episodes of A-ICU CDI were nonsevere, with low associated mortality.
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Affiliation(s)
- E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio, Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio, Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058), Palma de Mallorca, Spain.
| | - M Rodríguez-Créixems
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio, Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio, Marañón, Madrid, Spain
| | - L Alcalá
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio, Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio, Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058), Palma de Mallorca, Spain
| | - M Marín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio, Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio, Marañón, Madrid, Spain
| | - V De Egea
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio, Marañón, Madrid, Spain
| | - F Braojos
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio, Marañón, Madrid, Spain
| | - P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio, Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio, Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058), Palma de Mallorca, Spain
| | - E Reigadas
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio, Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio, Marañón, Madrid, Spain.
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Marín M, Gudiol C, Ardanuy C, Garcia-Vidal C, Jimenez L, Domingo-Domenech E, Pérez FJ, Carratalà J. Factors influencing mortality in neutropenic patients with haematologic malignancies or solid tumours with bloodstream infection. Clin Microbiol Infect 2015; 21:583-90. [PMID: 25680311 DOI: 10.1016/j.cmi.2015.01.029] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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: 10/09/2014] [Revised: 01/09/2015] [Accepted: 01/30/2015] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to identify factors influencing mortality in neutropenic patients with haematologic malignancies or solid tumours with bloodstream infection (BSI). All episodes of BSI occurring in adult neutropenic patients with haematologic malignancies or solid tumours were prospectively recorded from January 2006 to December 2013. We analysed the factors influencing mortality in both groups of patients. We documented 602 consecutive episodes of BSI; 510 occurred in patients with haematologic malignancies and 92 in patients with solid tumours. The overall case-fatality rates were 12% and 36%, respectively. Independent risk factors associated with a higher case-fatality rate in patients with haematologic malignancies were: intensive care unit admission (odds ratio (OR), 15.2; 95% confidence interval (CI), 5.4-42.7), advanced neoplasm (OR, 8.7; 95% CI, 2.9-25.7), corticosteroid therapy (OR, 7.0; 95% CI, 3-16.4), multidrug-resistant Gram-negative BSI (OR, 3.8; 95% CI, 1.2-11.8) and a Multinational Association for Supportive Care in Cancer risk score of <21 (OR, 3.1; 95% CI, 1.3-7.4). By contrast, coagulase-negative staphylococci BSI (OR, 0.04; 95% CI, 0.004-0.5) and empirical antibiotic combination therapy (OR, 0.1; 95% CI, 0.05-0.3) were found to be protective. Independent risk factors for overall case-fatality rate in patients with solid tumours were: shock at presentation (OR, 14.3; 95% CI, 3.2-63.8), corticosteroid therapy (OR, 10; 95% CI, 2.3-44) and advanced neoplasm (OR, 7.8; 95% CI, 1.4-41.4). Prognostic factors identified in this study may help to detect those patients at higher risk of death in each group. Medical intervention addressing some of these factors might improve the outcome of BSI in neutropenic patients with haematologic malignancies or solid tumours.
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Affiliation(s)
- M Marín
- Oncology Department, Institut Català d'Oncologia-ICO, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain.
| | - C Gudiol
- Infectious Disease Service, IDIBELL, Hospital Universitari de Bellvitge, Spain; Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos IIII, Madrid, Spain
| | - C Ardanuy
- Microbiology Department, IDIBELL, Hospital Universitari de Bellvitge, Spain
| | - C Garcia-Vidal
- Infectious Disease Service, IDIBELL, Hospital Universitari de Bellvitge, Spain; Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos IIII, Madrid, Spain
| | - L Jimenez
- Oncology Department, Institut Català d'Oncologia-ICO, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
| | - E Domingo-Domenech
- Hematology Department, Institut Català d'Oncologia-ICO, IDIBELL, University of Barcelona, Barcelona, Spain
| | - F J Pérez
- Clinical Research Unit, Institut Català d'Oncologia-ICO, IDIBELL, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Infectious Disease Service, IDIBELL, Hospital Universitari de Bellvitge, Spain; Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos IIII, Madrid, Spain
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Abstract
The use of culture-dependent and -independent techniques to study the human milk microbiota and microbiome has revealed a complex ecosystem with a much greater diversity than previously anticipated. The potential role of the milk microbiome appears to have implications not only for short- and long-term infant health but also for mammary health. In fact, mammary disbiosis, which may be triggered by a variety of host, microbial and medical factors, often leads to acute, subacute or subclinical mastitis, a condition that represents the first medical cause for undesired weaning. Multiresistance to antibiotics, together with formation of biofilms and mechanisms for evasion of the host immune response, is a common feature among the bacterial agents involved. This explains why this condition uses to be elusive to antibiotic therapy and why the development of new strategies for mastitis management based on probiotics is particularly appealing. In fact, selected lactobacilli strains isolated from breast milk have already shown a high efficacy for treatment.
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Affiliation(s)
- L Fernández
- Department of Nutrition, Food Science and Food Technology, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain Probisearch SL, C/ Santiago Grisolía 2, 28760 Tres Cantos, Spain
| | - R Arroyo
- Department of Nutrition, Food Science and Food Technology, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain
| | - I Espinosa
- Probisearch SL, C/ Santiago Grisolía 2, 28760 Tres Cantos, Spain
| | - M Marín
- Department of Nutrition, Food Science and Food Technology, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain
| | - E Jiménez
- Department of Nutrition, Food Science and Food Technology, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain
| | - J M Rodríguez
- Department of Nutrition, Food Science and Food Technology, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain Probisearch SL, C/ Santiago Grisolía 2, 28760 Tres Cantos, Spain
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Reigadas E, Alcalá L, Marín M, Burillo A, Muñoz P, Bouza E. Missed diagnosis of Clostridium difficile infection; a prospective evaluation of unselected stool samples. J Infect 2014; 70:264-72. [PMID: 25452039 DOI: 10.1016/j.jinf.2014.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/25/2014] [Accepted: 10/19/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Clostridium difficile infection (CDI) is the leading cause of hospital-acquired diarrhoea in developed countries, however a high proportion of CDI episodes go undiagnosed, either because physicians do not request identification of toxigenic C. difficile or microbiologists do not perform the appropriate tests. OBJECTIVE To investigate the clinical characteristics of patients with CDI within a non-selected population and to determine risk factors for clinical underdiagnosis. METHODS We conducted a prospective study in which systematic testing for toxigenic C. difficile on all diarrhoeic stool samples was performed regardless of the clinician's request. Patients aged >2 years positive for toxigenic C. difficile and diarrhoea were enrolled (Jan-June 2013) and monitored at least 2 months after their last episode. RESULTS We identified 204 cases of CDI, of which three-quarters were healthcare-associated. Most cases were mild to moderate (83.8%), the recurrence rate was 16.2%, and CDI-related mortality was low (2.5%). A significant proportion (12.7%) of CDI cases would have been missed owing to lack of clinical suspicion. Community-acquired cases and young age were risk factors for clinical underdiagnosis. CONCLUSION Our data support the introduction of a systematic search for toxigenic C. difficile in all diarrhoeic stools from inpatients and outpatients older than 2 years.
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Affiliation(s)
- E Reigadas
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - L Alcalá
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - M Marín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - A Burillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain.
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Rodríguez-Sánchez B, Sánchez-Carrillo C, Ruiz A, Marín M, Cercenado E, Rodríguez-Créixems M, Bouza E. Direct identification of pathogens from positive blood cultures using matrix-assisted laser desorption-ionization time-of-flight mass spectrometry. Clin Microbiol Infect 2014; 20:O421-7. [DOI: 10.1111/1469-0691.12455] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/06/2013] [Accepted: 11/11/2013] [Indexed: 11/27/2022]
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Marín M, Suni M. CARACTERIZACIÓN ANATÓMICA DEL DESARROLLO DE LA RAÍZ RESERVANTE DE CAMOTES PERUANOS (IPOMOEA BATATAS (L.) LAM., CONVOLVULACEAE). Rev peru biol 2014. [DOI: 10.15381/rpb.v7i2.6812] [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: 12/01/2022] Open
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Zafrilla G, Iglesias A, Marín M, Torralba L, Dorado-Morales P, Racero JL, Alcaina JJ, Morales LJ, Martínez L, Collantes M, Gómez L, Vilanova C, Porcar M. Towards light-mediated sensing of bacterial comfort. Lett Appl Microbiol 2014; 59:127-32. [PMID: 24785827 DOI: 10.1111/lam.12255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/25/2014] [Accepted: 03/19/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED Bacterial comfort is central to biotechnological applications. Here, we report the characterization of different sensoring systems, the first step within a broader synthetic biology-inspired light-mediated strategy to determine Escherichia coli perception of environmental factors critical to bacterial performance. We did so by directly 'asking' bacterial cultures with light-encoded questions corresponding to the excitation wavelength of fluorescent proteins placed under the control of environment-sensitive promoters. We built four genetic constructions with fluorescent proteins responding to glucose, temperature, oxygen and nitrogen; and a fifth construction allowing UV-induced expression of heterologous genes. Our engineered strains proved able to give feedback in response to key environmental factors and to express heterologous proteins upon light induction. This light-based dialoguing strategy reported here is the first effort towards developing a human-bacteria interphase with both fundamental and applied implications. SIGNIFICANCE AND IMPACT OF THE STUDY The results we present here are at the core of a larger synthetic biology research effort aiming at establishing a dialogue with bacteria. The framework is to convert the human voice into electric pulses, these into light pulses exciting bacterial fluorescent proteins, and convert light-emission back into electric pulses, which will be finally transformed into synthetic voice messages. We report here the first results of the project, in the form of light-based determination of key parameters for bacterial comfort. The ultimate goal of this strategy is to combine different engineered populations to have a combined feedback from the pool.
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Affiliation(s)
- G Zafrilla
- Universitat de València (Cavanilles Institute of Biodiversity and Evolutionary Biology), Valencia, Spain
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Cerón I, Muñoz P, Marín M, Segado A, Roda J, Valerio M, Bouza E. Efficacy of daptomycin in the treatment of enterococcal endocarditis: a 5 year comparison with conventional therapy. J Antimicrob Chemother 2014; 69:1669-74. [PMID: 24532682 DOI: 10.1093/jac/dku004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Enterococcus spp. account for 10% of infective endocarditis (IE). Although daptomycin is a bactericidal drug with in vitro activity against Enterococcus, there is little experience of its use in IE. We analysed the effectiveness of daptomycin in the treatment of enterococcal IE (EIE). METHODS This was a retrospective descriptive study comparing the efficacy of daptomycin versus ampicillin/ceftriaxone versus conventional antibiotic regimens (ampicillin or vancomycin ± gentamicin) in EIE. RESULTS From January 2007 to December 2011, 6 patients with EIE treated with daptomycin monotherapy were compared with 21 patients treated with ampicillin/ceftriaxone and 5 patients treated with ampicillin or vancomycin ± gentamicin. The three groups had similar epidemiological and clinical characteristics. Daptomycin indications were allergy to β-lactams (n = 3), therapy simplification (n = 2), renal failure (n = 2) and Enterococcus faecium resistant to ampicillin/gentamicin (n = 1). Daptomycin MICs ranged from 1 to 2 mg/L and the doses were 6-10 mg/kg/day intravenously. Daptomycin patients had longer duration of bacteraemia (6 versus 1 day, P < 0.01) and greater need of therapy switch due to complications (66.7% versus 0%, P < 0.01). There were no differences regarding duration of hospital stay or mortality. CONCLUSIONS Daptomycin-treated patients more frequently required a therapeutic change due to worse microbiological and clinical response, although mortality was not increased. Our findings do not support the use of daptomycin as single therapy in the treatment of EIE. Its role in combined strategies should be further investigated.
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Affiliation(s)
- I Cerón
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain CIBERES, Palma de Mallorca, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - M Marín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain CIBERES, Palma de Mallorca, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - A Segado
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Roda
- Department of Cardiovascular Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Valerio
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain CIBERES, Palma de Mallorca, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
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Rico M, Martínez E, Pellejero S, Arias F, Eito C, Mora I, Errasti M, Barrado M, Marín M, Mañeru F, Domínguez M. Stereotactic body radiation therapy for lung tumours: Initial experience of a centre. Rep Pract Oncol Radiother 2013. [DOI: 10.1016/j.rpor.2013.03.559] [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: 11/30/2022] Open
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Verdura E, Marín M, Ballesteros D, Ramos I, Sanz-Fuentenebro J. 1999 – Continuation (C-ECT) and maintenance (M-ECT) electroconvulsive therapy as an alternative treatment to pharmacotherapy: a review. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76935-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Graciano R, Marín M, Londinsky M. Opciones de cobertura para defectos en codo. Cir plást iberolatinoam 2012. [DOI: 10.4321/s0376-78922012000400008] [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: 11/11/2022] Open
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Oliveira L, Lisboa B, Lopez I, Marín M, Carraro D, Coudry R. 495 P72R and PIN3 TP53 Polymorphisms and Colorectal Cancer Risk. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71165-6] [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: 10/28/2022]
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Alcalá L, Martín A, Marín M, Sánchez-Somolinos M, Catalán P, Peláez T, Bouza E. The undiagnosed cases of Clostridium difficile infection in a whole nation: where is the problem? Clin Microbiol Infect 2012; 18:E204-13. [PMID: 22563775 DOI: 10.1111/j.1469-0691.2012.03883.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Underdiagnosis of Clostridium difficile infection (CDI) because of lack of clinical suspicion or the use of non-sensitive diagnostic techniques is a known problem whose real magnitude has not yet been quantified. In order to estimate the extent of this underdiagnosis, we performed C. difficile cultures on all unformed stool specimens sent-irrespective of the type of request-to a series of laboratories in Spain on a single day. The specimens were cultured, and isolates were characterized at a central reference laboratory. A total of 807 specimens from 730 patients aged ≥ 2 years were selected from 118 laboratories covering 75.4% of the Spanish population. The estimated rate of hospital-acquired CDI was 2.4 episodes per 1000 admissions or 3.8 episodes per 10,000 patient-days. Only half of the episodes occurred in patients hospitalized for >2 days. Two of every three episodes went undiagnosed or were misdiagnosed, owing to non-sensitive diagnostic tests (19.0%) or lack of clinical suspicion and request (47.6%; mostly young people or non-hospitalized patients). The main ribotypes were 014/020 (20.5%), 001 (18.2%), and 126/078 (18.2%). No ribotype 027 strains were detected. Strains were fully susceptible to metronidazole and vancomycin. CDI was underdiagnosed in diarrhoeic stools in a high proportion of episodes, owing to the use of non-sensitive techniques or lack of clinical suspicion, particularly in people aged <65 years or patients with community-acquired diarrhoea. C. difficile toxins should be routinely sought in unformed stools of any origin sent for microbiological diagnosis. The ribotype 027 clone has not yet disseminated in Spain.
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Affiliation(s)
- L Alcalá
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Alcalá L, Martín A, Marín M, Sánchez-Somolinos M, Catalán P, Peláez T, Bouza E. The undiagnosed cases of Clostridium difficile infection in a whole nation: where is the problem? Clin Microbiol Infect 2012. [PMID: 22563775 DOI: 10.1111/j.1469-0691.2012.03883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Underdiagnosis of Clostridium difficile infection (CDI) because of lack of clinical suspicion or the use of non-sensitive diagnostic techniques is a known problem whose real magnitude has not yet been quantified. In order to estimate the extent of this underdiagnosis, we performed C. difficile cultures on all unformed stool specimens sent-irrespective of the type of request-to a series of laboratories in Spain on a single day. The specimens were cultured, and isolates were characterized at a central reference laboratory. A total of 807 specimens from 730 patients aged ≥ 2 years were selected from 118 laboratories covering 75.4% of the Spanish population. The estimated rate of hospital-acquired CDI was 2.4 episodes per 1000 admissions or 3.8 episodes per 10,000 patient-days. Only half of the episodes occurred in patients hospitalized for >2 days. Two of every three episodes went undiagnosed or were misdiagnosed, owing to non-sensitive diagnostic tests (19.0%) or lack of clinical suspicion and request (47.6%; mostly young people or non-hospitalized patients). The main ribotypes were 014/020 (20.5%), 001 (18.2%), and 126/078 (18.2%). No ribotype 027 strains were detected. Strains were fully susceptible to metronidazole and vancomycin. CDI was underdiagnosed in diarrhoeic stools in a high proportion of episodes, owing to the use of non-sensitive techniques or lack of clinical suspicion, particularly in people aged <65 years or patients with community-acquired diarrhoea. C. difficile toxins should be routinely sought in unformed stools of any origin sent for microbiological diagnosis. The ribotype 027 clone has not yet disseminated in Spain.
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Affiliation(s)
- L Alcalá
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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López Roa P, Sánchez Carrillo C, Marín M, Romero F, Cercenado E, Bouza E. Value of matrix-assisted laser desorption ionization-time of flight for routine identification of viridans group streptococci causing bloodstream infections. Clin Microbiol Infect 2012; 19:438-44. [PMID: 22510157 DOI: 10.1111/j.1469-0691.2012.03837.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Phenotypic tests do not always unequivocally identify some species of viridans group streptococci (VGS). sodA sequence analysis is the most accurate method for identification, although it requires specialized personnel and has not been applied systematically in clinical microbiology laboratory routines. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) is emerging as a rapid alternative for bacterial identification. This study assesses the ability of MALDI-TOF and the API 20 Strep system to identify VGS isolates recovered from blood cultures using sodA sequence analysis as the reference method. All clinically significant VGS isolates recovered from blood cultures between January 2007 and January 2010 were identified by sodA sequence analysis and API 20 Strep. The strains were then tested by MALDI-TOF. Agreement between API 20 Strep/MALDI-TOF and sodA sequence analysis was determined. We examined 124 clinical isolates. Sensitivities of API 20 strep and MALDI-TOF for the species level identification of VGS isolates were, respectively, as follows: 60.5% and 73.4%. Sensitivities of API 20 strep and MALDI-TOF for the group level identification were, respectively, as follows: 70% and 94.3%. The turnaround times to identify VGS isolates by sodA sequence analysis, API 20 Strep and MALDI-TOF were 12-24, 24-48 h and 15 min, respectively. API 20 Strep cannot accurately identify all isolates of VGS. MALDI-TOF appeared to be a rapid and reliable alternative for identification of VGS strains to group level, but was not able to discriminate closely related species of certain groups.
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Affiliation(s)
- P López Roa
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Alcalá L, Marín M, Martín A, Sánchez-Somolinos M, Catalán P, Peláez M, Bouza E. Laboratory diagnosis of Clostridium difficile infection in Spain: a population-based survey. J Hosp Infect 2011; 79:13-7. [DOI: 10.1016/j.jhin.2011.05.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Accepted: 05/11/2011] [Indexed: 11/30/2022]
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Sanz J, Cercenado E, Marín M, Ramos B, Ardanuy C, Rodríguez-Avial I, Bouza E. Multidrug-resistant pneumococci (serotype 8) causing invasive disease in HIV+ patients. Clin Microbiol Infect 2011; 17:1094-8. [DOI: 10.1111/j.1469-0691.2011.03495.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Orts J, Pitarch I, Muñoz S, Marín M. Dim light melatonin onset in healthy children. Clin Biochem 2011. [DOI: 10.1016/j.clinbiochem.2011.03.095] [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: 11/24/2022]
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Marín M, García A, Troyano Y. ¿Aprende en Grupo el Alumnado Mayor? Aspectos Psicosociales del Aprendizaje Activo-Cooperativo. Revista de Psicologia da IMED 2010. [DOI: 10.18256/2175-5027/psico-imed.v2n1p358-368] [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: 11/24/2022] Open
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Gómez Candela C, Olivar Roldán J, García M, Marín M, Madero R, Pérez-Portabella C, Planás M, Mokoroa A, Pereyra F, Martín Palmero A. [Assessment of a malnutrition screening tool in cancer patients]. NUTR HOSP 2010; 25:400-405. [PMID: 20593122] [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] [Received: 04/18/2009] [Accepted: 06/03/2009] [Indexed: 05/29/2023] Open
Abstract
UNLABELLED 40-80% of cancer patients suffer from diverse degrees of malnutrition, depending on tumor subtype, location and staging and treatment strategy. Malnutrition is associated with increased morbidity and mortality in cancer patients. Both the high prevalence and prognostic significance of malnutrition imply the need for accurate malnutrition screening in cancer patients, which could select those patients at risk of nutritional derangements who would benefit from nutritional therapy. Patient-generated subjective global screening (VSG-GP) remains the reference malnutrition screening method, but its complexity and training requirements prevent wider applicability by oncologists. Thus, easier, more clinic-based malnutrition screening tools are required for cancer patients. In this article we propose a basic screening tool based on three items: weight loss, changes in physical activity and decrease in food intake. Two affirmative responses out of the three questions is considered as a positive response, and would prompt expert nutritional assessment. RESULTS Our screening interview showed positive correlation with VSG-GP (ROC 0.85, p<0.001) and allowed for a rapid and accurate identification of patients with cancer-related malnutrition.
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Affiliation(s)
- C Gómez Candela
- Unidad de Nutrición, Hospital Universitario La Paz, Madrid, Spain
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Menárguez C, Muñoz P, Sanchez C, Bermejo J, Fernández-Cruz A, Rodríguez-Créixems M, Pinilla B, Roda J, Segado A, Ramallo V, Pinto A, Martínez-Sellés M, Valerio M, Giannella M, Bouza E, Marín M, González-Ramallo V. 066 THE ROLE OF THE MICROBIOLOGY DEPARTMENT IN THE ALERT FOR DETECTION OF INFECTIVE ENDOCARDITIS (IE). Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70085-8] [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] [Indexed: 11/17/2022]
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Fernández-Lobato B, Díaz-Carrasco M, Pareja A, Marín M, Vila N, de la Rubia A. Uso terapéutico y perfil de toxicidad del esquema FOLFOX4. Farmacia Hospitalaria 2009. [DOI: 10.1016/s1130-6343(09)70993-6] [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] [Indexed: 12/27/2022] Open
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Fernández-Lobato B, Díaz-Carrasco MS, Pareja A, Marín M, Vila N, de la Rubia A. [Therapeutic use and profile of toxicity of the FOLFOX4 regimen]. Farm Hosp 2009; 33:89-95. [PMID: 19480796] [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: 05/27/2023] Open
Abstract
INTRODUCTION Since the publication of the MOSAIC test results in 2004, the FOLFOX4 regimen has been established as an adjuvant treatment which is recommended in stage III colorectal cancer. The aim of this study is to assess the use of this regimen in our field and to describe its toxicity. METHODS Descriptive study of treatments with FOLFOX4 prescribed between April 2005 and March 2007. The data was obtained from the Farhos Oncología programme and clinical records. The following data was collected: age, gender, diagnosis, stage of the illness (TNM classification) and adverse reactions, expressing severity according to Common Toxicity Criteria 2.0. RESULTS The FOLFOX4 regimen was prescribed for 39 patients (24 men and 15 women) with an average age of 59. The diagnoses were: 28 colon cancer (4 stage II, 17 stage III, and 7 stage IV), 10 rectal cancer (1 stage II, 4 stage III, and 5 stage IV) and 1 stage IV gastric cancer. The most frequent adverse reactions were peripheral neuropathy (82 %), neutropenia (56.4 %) and diarrhoea (53.9 %.) When the study was completed, 9 patients continued active treatment with the regimen (average 6.8 cycles.) Of the 30 remaining patients only 16 people completed the 12 planned cycles. 14 patients stopped their treatment (an average of 8.1 cycles) due to toxicity in 10 cases, clinical progression in 3 cases and one patient died. Of the total 368 cycles administered, 68 suffered administration delays and 22 had the dosage reduced. CONCLUSION The use of the FOLFOX4 regimen has been adjusted to uses with some solid scientific evidence, but its toxicity has limited its use and has made administering the planned dosage levels difficult.
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Affiliation(s)
- B Fernández-Lobato
- Servicio de Farmacia, Hospital Universitario Virgen de la Arrixaca, Murcia, España
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Bouza E, Pérez-Parra A, Rosal M, Martín-Rabadán P, Rodríguez-Créixems M, Marín M. Tsukamurella: a cause of catheter-related bloodstream infections. Eur J Clin Microbiol Infect Dis 2008; 28:203-10. [DOI: 10.1007/s10096-008-0607-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Accepted: 07/25/2008] [Indexed: 10/21/2022]
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Guembe M, Cercenado E, Alcalá L, Marín M, Insa R, Bouza E. Evolution of antimicrobial susceptibility patterns of aerobic and facultative gram-negative bacilli causing intra-abdominal infections: results from the SMART studies 2003-2007. Rev Esp Quimioter 2008; 21:166-173. [PMID: 18792817] [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: 05/26/2023]
Abstract
Study for Monitoring Antimicrobial Resistance Trends (SMART) is an ongoing global antimicrobial surveillance program focused on clinical isolates from intra-abdominal infections (IAI). The objective of this subanalysis was to assess the evolution of the antimicrobial susceptibility patterns among aerobic and facultative gram-negative bacilli (GNB) recovered over a 5-year period at our institution. We tested the in vitro activity of the antimicrobials, commonly used to treat IAI, against consecutive unique isolates from IAI using microdilution techniques according to the CLSI guidelines for MIC testing. All isolates were screened phenotypically for extended-spectrum beta-lactamase (ESBL) production. Isolates recovered within 48 h of hospitalization were considered community-acquired (CA). Over the study period a total of 572 aerobic and facultative gram-negative bacilli were recovered from 510 patients, of which 258 (45%) were CA. Enterobacteriaceae composed 91% of the total isolates. Escherichia coli was the most common isolated species (52%). Susceptibility rates of Enterobacteriaceae ranged from 96.5 %-100 % to ertapenem, 96.5 %-100 % to imipenem, 87.7%-94.3% to piperacillin-tazobactam, 85.1%-94.3% to cefotaxime, 89.5%-100% to cefepime, 76.3%-84.8% to ciprofloxacin, and 93.8%-100% to amikacin. ESBL were detected in 6.3% of E. coli, 5.7% of Klebsiella spp. and 2.7% of Enterobacter spp. ESBL producers generally had a more antibiotic- resistant profile than non-ESBL producers and 16% of them were CA. Susceptibility rates to ertapenem, imipenem, piperacillin-tazobactam, ceftazidime, cefepime, ciprofloxacin and amikacin were, respectively, for P. aeruginosa: 28.2 %, 58.9%, 82%, 84.6 %, 76.9 %, 71.8% and 82%; for Acinetobacter baumannii: 33.3 %, 100 %, 66.6 %, 66.6 %, 66.6%, 66.6% y 66.6%, and for Stenotrophomonas maltophilia: 0%, 0%, 0%, 28.6%, 0%, 42.9% and 14.3%. Over the 5 year-study period we have not observed significant increases in resistance of aerobic and facultative GNB causing IAI to commonly used beta-lactam antimicrobial drugs. A minority of ESBL-producing Enterobacteriaceae were CA. Carbapenems, including group I agents like ertapenem, were the most reliably active drugs in vitro against isolates producing IAI.
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Affiliation(s)
- M Guembe
- Servicio de Microbiología, Hospital General Universitario Gregorio Marañón, Madrid (Spain)
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Caramelo C, Albalate M, Tejedor A, Alcázar R, Baldoví S, García Pérez A, Marín M. [Current use of acetazolamide as a diuretic: usefulness in refractory edema and in aldosterone-antagonist-related hyperkalemia]. Nefrologia 2008; 28:234-238. [PMID: 18454727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- C Caramelo
- Servicio de Nefrología, Fundación Jiménez Díaz-Capio, Madrid
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Abstract
Linezolid is not yet recognised as a standard therapy for infective endocarditis. This report describes nine patients with endocarditis treated with linezolid and 33 similar cases from the medical literature. The majority of cases involved multiresistant strains, and the reasons for administering linezolid were refractory disease (60%), intolerance (28%), sequential therapy (12%) and a resistant pathogen (1%). Linezolid was administered for a mean of 37 days, with a successful outcome in 79% of cases. Reversible adverse effects were described in ten cases. The mean follow-up period was 8.5 months. Further data from randomised controlled clinical trials are needed to determine the efficacy and safety of linezolid for treating endocarditis.
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Affiliation(s)
- P Muñoz
- Department of Clinical Microbiology-Infectious Diseases, Madrid, Spain.
| | | | - M Moreno
- Department of Cardiology and Internal Medicine, Hospital General Universitario Gregorio Marañón, University of Madrid, Madrid, Spain
| | - M Marín
- Department of Clinical Microbiology-Infectious Diseases, Madrid, Spain
| | - V Ramallo
- Department of Cardiology and Internal Medicine, Hospital General Universitario Gregorio Marañón, University of Madrid, Madrid, Spain
| | - E Bouza
- Department of Clinical Microbiology-Infectious Diseases, Madrid, Spain
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