1
|
Osorio J, Madrazo Z, Videla S, Sainz B, Rodríguez-González A, Campos A, Santamaría M, Pelegrina A, González-Serrano C, Aldeano A, Sarriugarte A, Gómez-Díaz CJ, Ruiz-Luna D, García-Ruiz-de-Gordejuela A, Gómez-Gavara C, Gil-Barrionuevo M, Vila M, Clavell A, Campillo B, Millán L, Olona C, Sánchez-Cordero S, Medrano R, López-Arévalo CA, Pérez-Romero N, Artigau E, Calle M, Echenagusia V, Otero A, Tebe C, Pallares N, Biondo S. Analysis of outcomes of emergency general and gastrointestinal surgery during the COVID-19 pandemic. Br J Surg 2021; 108:1438-1447. [PMID: 34535796 DOI: 10.1093/bjs/znab299] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/25/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Few surgical studies have provided adjusted comparative postoperative outcome data among contemporary patients with and without COVID-19 infection and patients treated before the pandemic. The aim of this study was to determine the impact of performing emergency surgery in patients with concomitant COVID-19 infection. METHODS Patients who underwent emergency general and gastrointestinal surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective study (COVID-CIR). The main outcome was 30-day mortality. Secondary outcomes included postoperative complications and failure to rescue (mortality among patients who developed complications). Propensity score-matched comparisons were performed between patients who were positive and those who were negative for COVID-19; and between COVID-19-negative cohorts before and during the pandemic. RESULTS Some 5307 patients were included in the study (183 COVID-19-positive and 2132 COVID-19-negative during pandemic; 2992 treated before pandemic). During the pandemic, patients with COVID-19 infection had greater 30-day mortality than those without (12.6 versus 4.6 per cent), but this difference was not statistically significant after propensity score matching (odds ratio (OR) 1.58, 95 per cent c.i. 0.88 to 2.74). Those positive for COVID-19 had more complications (41.5 versus 23.9 per cent; OR 1.61, 1.11 to 2.33) and a higher likelihood of failure to rescue (30.3 versus 19.3 per cent; OR 1.10, 0.57 to 2.12). Patients who were negative for COVID-19 during the pandemic had similar rates of 30-day mortality (4.6 versus 3.2 per cent; OR 1.35, 0.98 to 1.86) and complications (23.9 versus 25.2 per cent; OR 0.89, 0.77 to 1.02), but a greater likelihood of failure to rescue (19.3 versus 12.9 per cent; OR 1.56, 95 per cent 1.10 to 2.19) than prepandemic controls. CONCLUSION Patients with COVID-19 infection undergoing emergency general and gastrointestinal surgery had worse postoperative outcomes than contemporary patients without COVID-19. COVID-19-negative patients operated on during the COVID-19 pandemic had a likelihood of greater failure-to-rescue than prepandemic controls.
Collapse
Affiliation(s)
- J Osorio
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Z Madrazo
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
| | - S Videla
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - B Sainz
- Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - A Campos
- Department of Surgery, Parc Taulí Health Corporation, Sabadell Hospital, Sabadell, Spain
| | - M Santamaría
- Department of Surgery, Arnau de Vilanova University Hospital, Lleida, Spain
| | - A Pelegrina
- Department of Surgery, Hospital del Mar University Hospital, Barcelona, Spain
| | | | - A Aldeano
- Department of Surgery, Granollers General Hospital, Granollers, Spain
| | - A Sarriugarte
- Department of Surgery, Cruces University Hospital, Bilbao, Spain
| | - C J Gómez-Díaz
- Department of Surgery, Althaia Foundation, Manresa, Spain
| | - D Ruiz-Luna
- Department of Surgery, Terrassa Health Consortium, Terrassa Hospital, Terrassa, Spain
| | | | - C Gómez-Gavara
- Hepatobiliopancreatic Surgery and Transplantation Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | | | - M Vila
- Department of Surgery, Mataró Hospital, Maresme Health Consortium, Mataró, Spain
| | - A Clavell
- Department of Surgery, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - B Campillo
- Department of Surgery, Sant Joan de Deu Hospital Foundation, Martorell, Spain
| | - L Millán
- Department of Surgery, Dr José Molina Orosa Hospital, Lanzarote, Spain
| | - C Olona
- Department of Surgery, Joan XXIII University Hospital, Tarragona, Spain
| | - S Sánchez-Cordero
- Department of Surgery, Igualada University Hospital, Anoia Health Consortium, Igualada, Spain
| | - R Medrano
- Department of Surgery, Sant Pau University Hospital, Barcelona, Spain
| | - C A López-Arévalo
- Department of Surgery, Moisès Broggi Hospital, Sant Joan Despí, Spain
| | - N Pérez-Romero
- Department of Surgery, Mútua de Terrassa University Hospital, Terrassa, Spain
| | - E Artigau
- Department of Surgery, Girona Dr Josep Trueta University Hospital, Girona, Spain
| | - M Calle
- Department of Surgery, Alto Deba Hospital, Mondragon, San Sebastián, Spain
| | - V Echenagusia
- Department of Surgery, Araba University Hospital, Txagorritxu Hospital, Vitoria, Spain
| | - A Otero
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Tebe
- Statistical Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - N Pallares
- Statistical Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Biondo
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
| | | |
Collapse
|
2
|
Robinson DE, Ali MS, Pallares N, Tebé C, Elhussein L, Abrahamsen B, Arden NK, Ben-Shlomo Y, Caskey FJ, Cooper C, Dedman D, Delmestri A, Judge A, Pérez-Sáez MJ, Pascual J, Nogues X, Diez-Perez A, Strauss VY, Javaid MK, Prieto-Alhambra D. Safety of Oral Bisphosphonates in Moderate-to-Severe Chronic Kidney Disease: A Binational Cohort Analysis. J Bone Miner Res 2021; 36:820-832. [PMID: 33373491 DOI: 10.1002/jbmr.4235] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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] [Received: 06/05/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022]
Abstract
Bisphosphonates are the first-line treatment for preventing fractures in osteoporosis patients. However, their use is contraindicated or to be used with caution in chronic kidney disease (CKD) patients, primarily because of a lack of information about their safety and effectiveness. We aimed to investigate the safety of oral bisphosphonates in patients with moderate to severe CKD, using primary-care electronic records from two cohorts, CPRD GOLD (1997-2016) and SIDIAP (2007-2015) in the UK and Catalonia, respectively. Both databases were linked to hospital records. SIDIAP was also linked to end-stage renal disease registry data. Patients with CKD stages 3b to 5, based on two or more estimated glomerular filtration rate measurements less than 45 mL/min/1.73 m2 , aged 40 years or older were identified. New bisphosphonate users were propensity score-matched with up to five non-users to minimize confounding within this population. Our primary outcome was CKD stage worsening (estimated glomerular filtration rate [eGFR] decline or renal replacement therapy). Secondary outcomes were acute kidney injury, gastrointestinal bleeding/ulcers, and severe hypocalcemia. Hazard ratios (HRs) were estimated using Cox regression and Fine and Gray sub-HRs were calculated for competing risks. We matched 2447 bisphosphonate users with 8931 non-users from CPRD and 1399 users with 6547 non-users from SIDIAP. Bisphosphonate use was associated with greater risk of CKD progression in CPRD (sub-HR [95% CI]: 1.14 [1.04, 1.26]) and SIDIAP (sub-HR: 1.15 [1.04, 1.27]). No risk differences were found for acute kidney injury, gastrointestinal bleeding/ulcers, or hypocalcemia. Hence, we can conclude a modest (15%) increased risk of CKD progression was identified in association with bisphosphonate use. No other safety concerns were identified. Our findings should be considered before prescribing bisphosphonates to patients with moderate to severe CKD. © 2020 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Danielle E Robinson
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - M Sanni Ali
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,Faculty of Epidemiology and Population Health, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Public Health, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Natalia Pallares
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL) L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristian Tebé
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL) L'Hospitalet de Llobregat, Barcelona, Spain.,Basic Medical Sciences Department, Rovira Virgili University, Tarragona, Spain
| | - Leena Elhussein
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Bo Abrahamsen
- NDORMS, University of Oxford, Oxford, UK.,OPEN, Department of Health, University of Southern Denmark, Odense, Denmark.,Holbaek Hospital, Department of Medicine, Holbaek, Denmark
| | - Nigel K Arden
- Sport, Exercise and Arthritis Centre: Versus Arthritis, University of Oxford, Oxford, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,North Bristol NHS Trust, Bristol, UK
| | - Cyrus Cooper
- NDORMS, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Daniel Dedman
- Clinical Practice Research Datalink (CPRD), London, UK
| | - Antonella Delmestri
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Andrew Judge
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Xavier Nogues
- Internal Medicine, IMIM (Hospital del Mar Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona, Spain.,Hospital del Mar Institute of Medical Research Autonomous University of Barcelona Research Network on Frailty and Healthy Aging (CIBERFES) Instituto Carlos III, Barcelona, Spain
| | - Adolfo Diez-Perez
- Internal Medicine, IMIM (Hospital del Mar Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona, Spain
| | - Victoria Y Strauss
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | | | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor (GREMPAL) Research Group and CIBERFes, University Institute for Primary Care Research (IDIAP) Jordi Gol, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| |
Collapse
|
3
|
Alarkawi D, Ali MS, Bliuc D, Pallares N, Tebe C, Elhussein L, Caskey FJ, Arden NK, Ben-Shlomo Y, Abrahamsen B, Diez-Perez A, Pascual J, Pérez-Sáez MJ, Center JR, Judge A, Cooper C, Javaid MK, Prieto-Alhambra D. Oral Bisphosphonate Use and All-Cause Mortality in Patients With Moderate-Severe (Grade 3B-5D) Chronic Kidney Disease: A Population-Based Cohort Study. J Bone Miner Res 2020; 35:894-900. [PMID: 31968134 DOI: 10.1002/jbmr.3961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Received: 04/29/2019] [Revised: 12/05/2019] [Accepted: 01/09/2020] [Indexed: 11/11/2022]
Abstract
Oral bisphosphonates (oBPs) have been associated with reduced fractures and mortality. However, their risks and benefits are unclear in patients with moderate-severe CKD. This study examined the association between oBPs and all-cause mortality in G3B-5D CKD. This is a population-based cohort study including all subjects with an estimated glomerular filtration rate (eGFR) <45/mL/min/1.73 m2 (G3B: eGFR <45/mL/min/1.73 m2 G4: eGFR 15-29/mL/min/1.73 m2 G5: eGFR <15/mL/min/1.73 m2 G5D: hemodialysis) aged 40+ years from the UK Clinical Practice Research Datalink (CPRD) and the Catalan Information System for Research in Primary Care (SIDIAP). Previous and current users of other anti-osteoporosis drugs were excluded. oBP use was modeled as a time-varying exposure to avoid immortal time bias. Treatment episodes in oBP users were created by concatenating prescriptions until patients switched or stopped therapy or were censored or died. A washout period of 180 days was added to (date of last prescription +180 days). Propensity scores (PSs) were calculated using prespecified predictors of mortality including age, gender, baseline eGFR, socioeconomic status, comorbidities, previous fracture, co-medications, and number of hospital admissions in the previous year. Cox models were used for PS adjustment before and after PS trimming (the first and last quintiles). In the CPRD, of 19,351 oBP users and 210,954 non-oBP users, 5234 (27%) and 85,105 (40%) deaths were recorded over 45,690 and 915,867 person-years of follow-up, respectively. oBP users had 8% lower mortality risk compared to non-oBP users (hazard ratio [HR] 0.92; 95% CI, 0.89 to 0.95). Following PS trimming, this became nonsignificant (HR 0.98; 95% CI, 0.94 to 1.04). In the SIDIAP, of 4146 oBP users and 86,127 non-oBP users, 1330 (32%) and 36,513 (42%) died, respectively. oBPs were not associated with mortality in PS adjustment and trimming (HR 1.04; 95% CI, 0.99 to 1.1 and HR 0.95; 95% CI, 0.89 to 1.01). In this observational, patient-based cohort study, oBPs were not associated with increased mortality among patients with moderate-severe CKD. However, further studies are needed on other effects of oBPs in CKD patients. © 2020 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Dunia Alarkawi
- Bone Biology Division, Garvan Institute of Medical Research, School of Medicine, University of New South Wales, Sydney, Australia
| | - M Sanni Ali
- Centre for Statistics in Medicine and Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Dana Bliuc
- Bone Biology Division, Garvan Institute of Medical Research, School of Medicine, University of New South Wales, Sydney, Australia
| | - Natalia Pallares
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL) L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristian Tebe
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL) L'Hospitalet de Llobregat, Barcelona, Spain
| | - Leena Elhussein
- Centre for Statistics in Medicine and Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, UK.,UK Renal Registry, Bristol, UK
| | - Nigel K Arden
- Centre for Statistics in Medicine and Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Bo Abrahamsen
- Centre for Statistics in Medicine and Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark.,Department of Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Adolfo Diez-Perez
- Hospital del Mar Institute of Medical Investigation Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), University of Barcelona (UAB), Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | | | - Jacqueline R Center
- Bone Biology Division, Garvan Institute of Medical Research, School of Medicine, University of New South Wales, Sydney, Australia.,Clinical School, St Vincent's Hospital, Sydney, Australia
| | - Andrew Judge
- Centre for Statistics in Medicine and Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre Translational Health Sciences, University of Bristol, Bristol, UK.,Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Cyrus Cooper
- Centre for Statistics in Medicine and Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Muhammad K Javaid
- Centre for Statistics in Medicine and Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine and Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,Grup de Recerca en Epidemiologia de les Malalties Prevalents de l'Aparell Locomotor (GREMPAL) Research Group, Idiap Jordi Gol Primary Care Research Institute, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Universitat Autonoma de Barcelona, Barcelona, Spain
| |
Collapse
|
4
|
Pujol M, Miro JM, Shaw E, Aguado JM, Garrido RSJ, Puig M, Pigrau C, Calbo E, Montejo JM, Rodriguez R, Garcia-Pais MJ, Pintado V, Escudero R, Lopez-Contreras J, Morata L, Montero M, Andres M, Pasquau J, Padilla B, Murillas J, Jover A, Lopez-Cortes LE, Garcia-Pardo G, Gasch O, Videla S, Tebe C, Pallares N, Hereu P, Sanllorente M, Dominguez MA, Camara J, Padulles A, Carratala J. LB3. Daptomycin Plus Fosfomycin vs. Daptomycin Monotherapy for Methicillin-Resistant Staphylococcus aureus Bacteremia: A Multicenter, Randomized, Clinical Trial. Open Forum Infect Dis 2018. [PMCID: PMC6253582 DOI: 10.1093/ofid/ofy229.2177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Daptomycin plus fosfomycin combination has demonstrated synergistic and bactericidal effect in animal models of methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), but there is lack of data in humans.
Method
A randomized (1:1), open-label, clinical trial involving adults with MRSAB was conducted at 18 medical centers in Spain. Patients were assigned to receive daptomycin, 10 mg/kg IV daily plus fosfomycin, 2 g IV/6 hour (combination therapy) or to receive daptomycin 10 mg/kg/24 h IV (monotherapy) during 10 up to 14 days for uncomplicated bacteremia and 28 up to 42 days for complicated bacteremia. The primary efficacy endpoints were: (a) treatment success at Test-of-Cure visit (ToC: 6 weeks after end of therapy) and (b) treatment success at 7 days (defined as alive at day 7 and clearance of bacteremia without relapse from 8 to 90 days after randomization), according with the proposed primary endpoints for use in clinical trials in bloodstream infections in adults.
Result
Between December 2013 and November 2017, 674 patients with MRSAB were evaluated and 155 patients were randomized: 74 received combination therapy and 81 monotherapy. In intention-to-treat analysis, (a) at ToC visit successful outcome was achieved in 40 of 74 patients (54,1%) who received combination therapy as compared with 34 of 81 patients (42%) who were given monotherapy (54.1% vs. 42.0%; absolute difference, 12.1%; 95% confidence interval, 0%-27.0%); (b) at 7 days after starting the therapy: a successful outcome was achieved in 69 of 74 patients who received combination therapy as compared with 62 out of 81 patients who received monotherapy (93.2% vs. 76.5%; absolute difference, 16.7%; 95% confidence interval, 5.4%–27.7%). Combination therapy was associated with lower rates of microbiologic failure than monotherapy at ToC visit (0 vs. 9 patients, P = 0.009). Combination therapy, as compared with daptomycin monotherapy, was associated with a nonsignificantly higher rate of adverse events due to study medication leading to treatment failure and discontinuation of therapy: 6/74 (8.1%) vs. 3/81 (3.7%) (P = 0.31).
Conclusion
The combination of daptomycin plus fosfomycin was more effective than daptomycin alone for treating MRSAB (NCT01898338).
Disclosures
All authors: No reported disclosures.
Collapse
Affiliation(s)
- Miquel Pujol
- Infectious Diseases Department, Hospital de Bellvitge, L’Hospitalet llobregat, Spain
| | | | - Evelyn Shaw
- Hospital de Bellvitge, L’Hospitalet llobregat, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cristian Tebe
- Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), L’Hospitalet llobregat, Spain
| | - Natalia Pallares
- Institud d’Investigacions Biomèdiques de Bellvitge (IDIBELL), L’Hospitalet llobregat, Spain
| | - Pilar Hereu
- Hospital de Bellvitge, L’Hospitalet llobregat, Spain
| | | | | | - Jordi Camara
- Hospital de Bellvitge, L’Hospitalet llobregat, Spain
| | | | | |
Collapse
|