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Azanza JR, Mensa J, Barberán J, Vázquez L, Pérez de Oteyza J, Kwon M, Yáñez L, Aguado JM, Cubillo Gracian A, Solano C, Ruiz Camps I, Fortún J, Salavert Lletí M, Gudiol C, Olave Rubio T, Solano C, García-Vidal C, Rovira Tarrats M, Suárez-Lledó Grande M, González-Sierra P, Dueñas Gutiérrez C. Recommendations on the use of azole antifungals in hematology-oncology patients. Rev Esp Quimioter 2023; 36:236-258. [PMID: 37017117 DOI: 10.37201/req/013.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
The administration of antifungals for therapeutic and, especially, prophylactic purposes is virtually a constant in patients requiring hematology-oncology treatment. Any attempt to prevent or treat Aspergillus or Mucor infections requires the administration of some drugs in the azole group, which include voriconazole, posaconazole and isavuconazole, noted for their activity against these pathogens. One very relevant aspect is the potential risk of interaction when associated with one of the antineoplastic drugs used to treat hematologic tumors, with serious complications. In this regard, acalabrutinib, bortezomib, bosutinib, carfilzomib, cyclophosphamide, cyclosporine A, dasatinib, duvelisib, gilteritinib, glasdegib, ibrutinib, imatinib, nilotinib, ponatinib, prednisone, ruxolitinib, tacrolimus, all-transretinoic acid, arsenic trioxide, venetoclax, or any of the vinca alkaloids, are very clear examples of risk, in some cases because their clearance is reduced and in others because of increased risk of QTc prolongation, which is particularly evident when the drug of choice is voriconazole or posaconazole.
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Affiliation(s)
- J R Azanza
- José Ramón Azanza,Servicio de Farmacología Clínica. Clínica Universitaria de Navarra. Pamplona. Spain.
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Azanza JR, Mensa J, González Del Castillo J, Linares Rufo M, Molero JM, Madero Valle N, Barberán J. Interactions listed in the Paxlovid fact sheet, classified according to risks, pharmacological groups, and consequences. Rev Esp Quimioter 2022; 35:357-361. [PMID: 35822605 PMCID: PMC9333114 DOI: 10.37201/req/054.2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Paxlovid (nirmatrelvir plus ritonavir) is a new oral antiviral therapeutic for the treatment of COVID-19. Nirmatrelvir is an inhibitor of SARS-CoV-2 main protease, while ritonavir is used as a CYP3A inhibitor in low doses to slow the metabolism of nirmatrelvir, thus enhancing their therapeutic effect. The iso-enzyme CYP3A4 is responsible for at least part of the oxidative metabolism of approximately 60% of available medications and ritonavir is therefore a significant source of drug interactions. We describe here the drugs that are contraindicated or should be used with or without precautions when Paxlovid (nirmaltrevir plus ritonavir) should be administered according to each fact sheet in force at the Spanish Agency for Medicines and Health Products.
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Affiliation(s)
- J R Azanza
- José Ramón Azanza, Servicio de Farmacología Clínica. Clínica Universitaria de Navarra. Pamplona. Spain.
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Mensa J, Barberán J, Ferrer R, Borges M, Rascado P, Maseda E, Oliver A, Marco F, Adalia R, Aguilar G, Estella A, León López R, Robles Marcos MS, González de Molina FJ, Serrano García R, Salavert M, Fernández Gómez J, Poliakova Y, Pasquau J, Azanza JR, Bou Arévalo G, LLinares Mondéjar P, Cardinal-Fernández P, Soriano A. Recommendations for antibiotic selection for severe nosocomial infections. Rev Esp Quimioter 2021; 34:511-524. [PMID: 34693705 PMCID: PMC8638841 DOI: 10.37201/req/126.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Severe infection and its evolution to sepsis are becoming more prevalent every day and are among the leading causes of critical illness and mortality. Proper management is crucial to improve prognosis. This document addresses three essential points that have a significant impact on this objective: a) early recognition of patients with sepsis criteria, b) identification of those patients who suffer from an infection and have a high risk of progressing to sepsis, and c) adequate selection and optimization of the initial antimicrobial treatment.
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Affiliation(s)
| | - J Barberán
- José Barberán, Servicio de Medicina Interna - Enfermedades Infecciosas. Hospital Universitario HM Montepríncipe. Universidad San Pablo CEU. Spain.
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Abstract
Ceftazidime is a 3rd generation cephalosporin active against Pseudomonas aeruginosa. Avibactam is an inhibitor of class A, C and some class D β-lactamases. The antibacterial spectrum of ceftazidime-avibactam covers 95% of P. aeruginosa isolates and >99% of enterobacteria, including strains carrying extended-spectrum β-lactamases (ESBLs). Selection of resistant mutants in Klebsiella pneumoniae and Enterobacter cloacae strains producing KPC-3 or KPC-2 after exposure to ceftazidime-avibactam has been described by the appearance of one or more amino acid changes in the Ω-loop of the β-lactamase. These strains usually regain susceptibility to meropenem. There is evidence of a shorter multidrug-resistant organisms colonization period in patients treated with this antimicrobial, which could be beneficial in the treatment of infections caused by bacteria carrying ESBLs or carbapenemases.
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Affiliation(s)
- M Matesanz
- Mayra Matesanz, Hospital at Home Unit. Department of Internal Medicine. Hospital clínico San Carlos. Madrid. Spain.
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Moreno-García E, Rico E, Albiach L, Agüero D, Ambrosioni J, Bodro M, Cardozo C, Chumbita M, De la Mora M, García-Pouton N, Garcia-Vidal C, González-Cordón A, Hernández-Meneses M, Inciarte A, Laguno M, Leal L, Linares L, Macay I, Meira F, Mensa J, Moreno A, Morata L, Puerta-Alcalde P, Rojas J, Solá M, Torres B, Torres M, Tomé A, Tuset M, Castro P, Fernández S, Nicolás JM, Almuedo-Riera A, Muñoz J, Fernandez-Pittol M, Marcos MA, Soy D, Martínez JA, García F, Soriano A. Tocilizumab reduces the risk of ICU admission and mortality in patients with SARS-CoV-2 infection. Rev Esp Quimioter 2021; 34:238-244. [PMID: 33829722 PMCID: PMC8179941 DOI: 10.37201/req/037.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objectives In some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management around the world; therefore, clinical strategies to avoid ICU admission are needed. We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients. Material and methods A retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first. Results A total of 77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P=0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In the multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0.1, P=0.0001) of ICU admission or death. Conclusions Tocilizumab in early stages of the inflammatory flare could reduce an important number of ICU admissions and mechanical ventilation. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports. This is a non-randomized study and the results should be interpreted with caution.
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Affiliation(s)
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- Alex Soriano, Department of Infectious Diseases, Hospital Clínic of Barcelona. Carrer de Villarroel 170, 08036, Barcelona, Spain.
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Garcia-Vidal C, Meira F, Cózar-Llistó A, Dueñas G, Puerta-Alcalde P, Garcia-Pouton N, Chumbita M, Cardozo C, Hernandez-Meneses M, Alonso-Navarro R, Rico V, Agüero D, Bodro M, Morata L, Jordan C, Lopera C, Ambrosioni J, Segui F, Grafia N, Castro P, García F, Mensa J, Martínez JA, Sanjuan G, Soriano A. Real-life use of remdesivir in hospitalized patients with COVID-19. Rev Esp Quimioter 2021; 34:136-140. [PMID: 33675220 PMCID: PMC8019465 DOI: 10.37201/req/018.2021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective Controversial results on remdesivir efficacy have been reported. We aimed to report our real-life experience with the use of remdesivir from its availability in Spain. Methods We performed a descriptive study of all patients admitted for ≥48 hours with confirmed COVID-19 who received remdesivir between the 1st of July and the 30th of September 2020. Results A total of 123 patients out of 242 admitted with COVID-19 at our hospital (50.8%) received remdesivir. Median age was 58 years, 61% were males and 56.9 % received at least one anti-inflammatory treatment. No adverse events requiring remdesivir discontinuation were reported. The need of intensive care unit admission, mechanical ventilation and 30-days mortality were 19.5%, 7.3% and 4.1%, respectively. Conclusion In our real-life experience, the use of remdesivir in hospitalized patients with COVID-19 was associated with a low mortality rate and good safety profile.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - A Soriano
- Dr. Alex Soriano, Department of Infectious Diseases, Hospital Clinic of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain.
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Bouza E, Aguado JM, Alcalá L, Almirante B, Alonso-Fernández P, Borges M, Cobo J, Guardiola J, Horcajada JP, Maseda E, Mensa J, Merchante N, Muñoz P, Pérez Sáenz JL, Pujol M, Reigadas E, Salavert M, Barberán J. Recommendations for the diagnosis and treatment of Clostridioides difficile infection: An official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR). Rev Esp Quimioter 2020; 33:151-175. [PMID: 32080996 PMCID: PMC7111242 DOI: 10.37201/req/2065.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/26/2020] [Indexed: 12/12/2022]
Abstract
This document gathers the opinion of a multidisciplinary forum of experts on different aspects of the diagnosis and treatment of Clostridioides difficile infection (CDI) in Spain. It has been structured around a series of questions that the attendees considered relevant and in which a consensus opinion was reached. The main messages were as follows: CDI should be suspected in patients older than 2 years of age in the presence of diarrhea, paralytic ileus and unexplained leukocytosis, even in the absence of classical risk factors. With a few exceptions, a single stool sample is sufficient for diagnosis, which can be sent to the laboratory with or without transportation media for enteropathogenic bacteria. In the absence of diarrhoea, rectal swabs may be valid. The microbiology laboratory should include C. difficile among the pathogens routinely searched in patients with diarrhoea. Laboratory tests in different order and sequence schemes include GDH detection, presence of toxins, molecular tests and toxigenic culture. Immediate determination of sensitivity to drugs such as vancomycin, metronidazole or fidaxomycin is not required. The evolution of toxin persistence is not a suitable test for follow up. Laboratory diagnosis of CDI should be rapid and results reported and interpreted to clinicians immediately. In addition to the basic support of all diarrheic episodes, CDI treatment requires the suppression of antiperistaltic agents, proton pump inhibitors and antibiotics, where possible. Oral vancomycin and fidaxomycin are the antibacterials of choice in treatment, intravenous metronidazole being restricted for patients in whom the presence of the above drugs in the intestinal lumen cannot be assured. Fecal material transplantation is the treatment of choice for patients with multiple recurrences but uncertainties persist regarding its standardization and safety. Bezlotoxumab is a monoclonal antibody to C. difficile toxin B that should be administered to patients at high risk of recurrence. Surgery is becoming less and less necessary and prevention with vaccines is under research. Probiotics have so far not been shown to be therapeutically or preventively effective. The therapeutic strategy should be based, rather than on the number of episodes, on the severity of the episodes and on their potential to recur. Some data point to the efficacy of oral vancomycin prophylaxis in patients who reccur CDI when systemic antibiotics are required again.
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Affiliation(s)
- E Bouza
- Emilio Bouza MD, PhD, Instituto de Investigación Sanitaria Gregorio Marañón, Servicio de Microbiología Clínica y E. Infecciosas C/ Dr. Esquerdo, 46 - 28007 Madrid, Spain.
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8
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Mensa J, Dueñas Gutiérrez C, Cardozo C, Rodríguez Fernández L, Kestler M, Muñoz P, Bouza E. Neck infection after allogenic hematopoietic progenitors transplantation. Rev Esp Quimioter 2020; 33:130-136. [PMID: 32056419 PMCID: PMC7111238 DOI: 10.37201/req/100.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J Mensa
- Dr. Josep Mensa, Infectious Disease Service, Hospital Clinic I Provincial, Barcelona, Spain.
| | | | | | | | | | | | - E Bouza
- Dr. Emilio Bouza, Instituto de Investigación Sanitaria Gregorio Marañón, C/ Dr. Esquerdo, 46, 28007 Madrid, Spain.
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Llinares P, Barberán J, Mensa J. Introduction. Rev Esp Quimioter 2019; 32 Suppl 3:1-2. [PMID: 31364334 PMCID: PMC6755347] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- P Llinares
- Coordinación de docencia de la Sociedad Española de Quimioterapia. A Coruña, Spain.
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10
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Viasus D, Puerta-Alcalde P, Cardozo C, Suárez-Lledó M, Rodríguez-Núñez O, Morata L, Fehér C, Marco F, Chumbita M, Moreno-García E, Fernández-Avilés F, Gutiérrez-Garcia G, Martínez JA, Mensa J, Rovira M, Esteve J, Soriano A, Garcia-Vidal C. Predictors of multidrug-resistant Pseudomonas aeruginosa in neutropenic patients with bloodstream infection. Clin Microbiol Infect 2019; 26:345-350. [PMID: 31295551 DOI: 10.1016/j.cmi.2019.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/07/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To assess risk factors for multidrug-resistant Pseudomonas aeruginosa (MDR-PA) infection in neutropenic patients. METHODS Single-centre retrospective analysis of consecutive bloodstream infection (BSI) episodes (2004-2017, Barcelona). Two multivariate regression models were used at BSI diagnosis and P. aeruginosa detection. Significant predictors were used to establish rules for stratifying patients according to MDR-PA BSI risk. RESULTS Of 661 Gram-negative BSI episodes, 190 (28.7%) were caused by P. aeruginosa (70 MDR-PA). Independent factors associated with MDR-PA among Gram-negative organisms were haematological malignancy (OR 3.30; 95% CI 1.15-9.50), pulmonary source of infection (OR 7.85; 95% CI 3.32-18.56), nosocomial-acquired BSI (OR 3.52; 95% CI 1.74-7.09), previous antipseudomonal cephalosporin (OR 13.66; 95% CI 6.64-28.10) and piperacillin/tazobactam (OR 2.42; 95% CI 1.04-5.63), and BSI occurring during ceftriaxone (OR 4.27; 95% CI 1.15-15.83). Once P. aeruginosa was identified as the BSI aetiological pathogen, nosocomial acquisition (OR 7.13; 95% CI 2.87-17.67), haematological malignancy (OR 3.44; 95% CI 1.07-10.98), previous antipseudomonal cephalosporin (OR 3.82; 95% CI 1.42-10.22) and quinolones (OR 3.97; 95% CI 1.37-11.48), corticosteroids (OR 2.92; 95% CI 1.15-7.40), and BSI occurring during quinolone (OR 4.88; 95% CI 1.58-15.05) and β-lactam other than ertapenem (OR 4.51; 95% CI 1.45-14.04) were independently associated with MDR-PA. Per regression coefficients, 1 point was assigned to each parameter, except for nosocomial-acquired BSI (3 points). In the second analysis, a score >3 points identified 60 (86.3%) out of 70 individuals with MDR-PA BSI and discarded 100 (84.2%) out of 120 with non-MDR-PA BSI. CONCLUSIONS A simple score based on demographic and clinical factors allows stratification of individuals with bacteraemia according to their risk of MDR-PA BSI, and may help facilitate the use of rapid MDR-detection tools and improve early antibiotic appropriateness.
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Affiliation(s)
- D Viasus
- Health Sciences Division, Universidad del Norte, and Hospital Universidad del Norte, Barranquilla, Colombia
| | - P Puerta-Alcalde
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - C Cardozo
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - M Suárez-Lledó
- Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - O Rodríguez-Núñez
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - L Morata
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - C Fehér
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - F Marco
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Microbiology Department, Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
| | - M Chumbita
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - E Moreno-García
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | | | - G Gutiérrez-Garcia
- Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - J A Martínez
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - J Mensa
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - M Rovira
- Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - J Esteve
- Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - A Soriano
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - C Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain.
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Puerta-Alcalde P, Cardozo C, Suárez-Lledó M, Rodríguez-Núñez O, Morata L, Fehér C, Marco F, Del Río A, Martínez JA, Mensa J, Rovira M, Esteve J, Soriano A, Garcia-Vidal C. Current time-to-positivity of blood cultures in febrile neutropenia: a tool to be used in stewardship de-escalation strategies. Clin Microbiol Infect 2018; 25:447-453. [PMID: 30096417 DOI: 10.1016/j.cmi.2018.07.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 05/04/2018] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVES We aimed to describe the current time-to-positivity (TTP) of blood cultures in individuals with onco-haematological diseases with febrile neutropenia. We assessed the probability of having a multidrug-resistant Gram-negative bacilli (MDR-GNB) bloodstream infection (BSI) 24 h after cultures were taken, to use this information for antibiotic de-escalation strategies. METHODS BSI episodes were prospectively collected (2003-2017). When a patient experienced more than one BSI, only one episode was randomly chosen. Time elapsed from the beginning of incubation to a positive reading was observed; TTP was recorded when the first bottle had a positive result. RESULTS Of the 850 patient-unique episodes, 323 (38%) occurred in acute leukaemia, 185 (21.8%) in non-Hodgkin's lymphoma and 144 (16.9%) in solid neoplasms. Coagulase-negative staphylococci (225; 26.5%), Escherichia coli (207; 26.1%), Pseudomonas aeruginosa (136; 16%), Enterococcus spp. (81; 9.5%) and Klebsiella pneumoniae (67; 7.9%), were the most frequent microorganisms isolated. MDR-GNB were documented in 126 (14.8%) episodes. Median TTP was 12 h (interquartile range 9-16.5 h). Within the first 24 h, 92.1% of blood cultures were positive (783/850). No MDR-GNB was positive over 24 h. Of the 67 (7.9%) episodes with a TTP ≥24 h, 25 (37.3%) occurred in patients who were already receiving active antibiotics against the isolated pathogen. Most common isolations with TTP ≥24 h were coagulase-negative staphylococci, candidaemia and a group of anaerobic GNB. CONCLUSIONS Currently, the vast majority of BSI in individuals with onco-haematological diseases with febrile neutropenia have a TTP <24 h, including all episodes caused by MDR-GNB. Our results support reassessing empiric antibiotic treatment in neutropenic patients at 24 h, to apply antibiotic stewardship de-escalation strategies.
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Affiliation(s)
- P Puerta-Alcalde
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - C Cardozo
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - M Suárez-Lledó
- Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - O Rodríguez-Núñez
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - L Morata
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - C Fehér
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - F Marco
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Microbiology Department, Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
| | - A Del Río
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - J A Martínez
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - J Mensa
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - M Rovira
- Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - J Esteve
- Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - A Soriano
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - C Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain.
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De la Calle C, Ternavasio-de la Vega HG, Morata L, Marco F, Cardozo C, García-Vidal C, Del Rio A, Cilloniz C, Torres A, Martínez JA, Mensa J, Soriano A. Effectiveness of combination therapy versus monotherapy with a third-generation cephalosporin in bacteraemic pneumococcal pneumonia: A propensity score analysis. J Infect 2018; 76:342-347. [PMID: 29360520 DOI: 10.1016/j.jinf.2018.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 06/29/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Combining a macrolide or a fluoroquinolone to beta-lactam regimens in the treatment of patients with moderate to severe community-acquired pneumonia is recommended by the international guidelines. However, the information in patients with bacteraemic pneumococcal pneumonia is limited. METHODS A propensity score technique was used to analyze prospectively collected data from all patients with bacteraemic pneumococcal pneumonia admitted from 2000 to 2015 in our institution, who had received empirical treatment with third-generation cephalosporin in monotherapy or plus macrolide or fluoroquinolone. RESULTS We included 69 patients in the monotherapy group and 314 in the combination group. After adjustment by PS for receiving monotherapy, 30-day mortality (OR 2.89; 95% CI 1.07-7.84) was significantly higher in monotherapy group. A higher 30-day mortality was observed in monotherapy group in both 1:1 and 1:2 matched samples although it was statistically significant only in 1:2 sample (OR: 3.50 (95% CI 1.03-11.96), P = 0.046). CONCLUSIONS Our study suggests that in bacteraemic pneumococcal pneumonia, empirical therapy with a third-generation cephalosporin plus a macrolide or a fluoroquinolone is associated with a lower mortality rate than beta-lactams in monotherapy. These results support the recommendation of combination therapy in patients requiring admission with moderate to severe disease.
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Affiliation(s)
- C De la Calle
- Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain.
| | | | - L Morata
- Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain
| | - F Marco
- Department of Microbiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - C Cardozo
- Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain
| | - C García-Vidal
- Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain
| | - A Del Rio
- Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain
| | - C Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona, University of Barcelona (UB), Barcelona, Spain
| | - A Torres
- Department of Pneumology, Hospital Clinic of Barcelona, University of Barcelona (UB), Barcelona, Spain
| | - J A Martínez
- Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain
| | - J Mensa
- Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain
| | - A Soriano
- Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain
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Cobos-Triguero N, Zboromyrska Y, Morata L, Alejo I, De La Calle C, Vergara A, Cardozo C, Arcas MP, Soriano A, Marco F, Mensa J, Almela M, Martínez JA. Time-to-positivity, type of culture media and oxidase test performed on positive blood culture vials to predict Pseudomonas aeruginosa in patients with Gram-negative bacilli bacteraemia. Rev Esp Quimioter 2017; 30:9-13. [PMID: 27897434] [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: 06/06/2023]
Abstract
OBJECTIVE The aim of this study was to determine the usefulness of oxidase test and time-to-positivity (TTP) in aerobic and anaerobic blood culture vials to detect the presence of Pseudomonas aeruginosa in patients with Gram-negative bacilli (GNB) bacteraemia. METHODS TTP was recorded for each aerobic and anaerobic blood culture vial of monomicrobial bacteraemia due to GNB. Oxidase test was performed in a pellet of the centrifuged content of the positive blood culture. An algorithm was developed in order to perform the oxidase test efficiently taking into account TTP and type of vial. RESULTS A total of 341 episodes of GNB bacteraemia were analysed. Sensitivity, specificity, positive predictive value and negative predictive value of the oxidase test performed on positive vials with GNB to predict P. aeruginosa were 95%, 99%, 91%, and 99%, respectively. When growth was first or exclusively detected in anaerobic vials, P. aeruginosa was never identified hence the performance of the oxidase test could be avoided. When growth was only or first detected in aerobic vials, a TTP≥8h predicted P. aeruginosa in 37% or cases (63 of 169), therefore oxidase test is highly recommended. CONCLUSIONS Oxidase test performed onto positive blood culture vials previously selected by TTP and type of vials is an easy and inexpensive way to predict P. aeruginosa. In most cases, this can lead to optimization of treatment in less than 24 hours.
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Affiliation(s)
- N Cobos-Triguero
- Nazaret Cobos-Trigueros. Department of Infectious Diseases, Hospital Clínic. Villarroel 170, 08036, Barcelona, Spain.
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14
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Morata L, De la Calle C, Gómez-Cerquera JM, Manzanedo L, Casals G, Brunet M, Cobos-Trigueros N, Martínez JA, Mensa J, Soriano A. Risk factors associated with high linezolid trough plasma concentrations. Expert Opin Pharmacother 2016; 17:1183-7. [PMID: 27156708 DOI: 10.1080/14656566.2016.1182154] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM The major concern of linezolid is the adverse events. High linezolid trough serum concentration (Cmin) has been associated with toxicity. The aim of this study was to analyze factors associated with high Cmin. METHODS Main clinical characteristics of 104 patients treated with 600 mg/12 hours of linezolid were retrospectively reviewed. Samples were obtained just before the next dose after at least three doses and within the first 8 days of treatment. High Cmin was considered when it was >8 mg/L. Univariate and multivariate analysis were performed. RESULTS 34.6% patients had a Cmin >8 mg/L, and they were older and had more frequently an estimated glomerular filtration by MDRD <40 mL/min. There were more patients co-treated with rifampin in the group with low Cmin. The only factor independently associated with Cmin >8 was the renal function. Patients with an eGF < 40 mL/min had significantly higher Cmin than those with eGF > 80 mL/min (OR: 4.273) and there was a trend towards a high Cmin in patients with eGF between 40-80 mL/min (OR: 2.109). CONCLUSIONS High Cmin were frequent, especially in patients with MDRD <40 mL/min. Therapeutic drug monitoring could be useful to avoid toxicity in patients with renal dysfunction.
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Affiliation(s)
- L Morata
- a Department of Infectious Diseases , Hospital Clínic of Barcelona , Barcelona , Spain
| | - C De la Calle
- a Department of Infectious Diseases , Hospital Clínic of Barcelona , Barcelona , Spain
| | - J M Gómez-Cerquera
- a Department of Infectious Diseases , Hospital Clínic of Barcelona , Barcelona , Spain
| | - L Manzanedo
- a Department of Infectious Diseases , Hospital Clínic of Barcelona , Barcelona , Spain
| | - G Casals
- b Department of Pharmacology and Toxicology , Hospital Clínic of Barcelona , Barcelona , Spain
| | - M Brunet
- b Department of Pharmacology and Toxicology , Hospital Clínic of Barcelona , Barcelona , Spain
| | - N Cobos-Trigueros
- a Department of Infectious Diseases , Hospital Clínic of Barcelona , Barcelona , Spain
| | - J A Martínez
- a Department of Infectious Diseases , Hospital Clínic of Barcelona , Barcelona , Spain
| | - J Mensa
- a Department of Infectious Diseases , Hospital Clínic of Barcelona , Barcelona , Spain
| | - A Soriano
- a Department of Infectious Diseases , Hospital Clínic of Barcelona , Barcelona , Spain
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15
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De la Calle C, Morata L, Cobos-Trigueros N, Martinez JA, Cardozo C, Mensa J, Soriano A. Staphylococcus aureus bacteremic pneumonia. Eur J Clin Microbiol Infect Dis 2016; 35:497-502. [PMID: 26780692 DOI: 10.1007/s10096-015-2566-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/21/2015] [Indexed: 01/21/2023]
Abstract
Staphylococcus aureus bacteremic pneumonia is an uncommon cause of hospitalization, with a high mortality rate. However, published reports are scarce and have included a small number of cases. All patients with S. aureus bacteremic pneumonia were prospectively collected in our institution from 2000 to 2014, and a retrospective revision was performed to identify risk factors associated with methicillin resistance and to update the mortality of this entity. A total of 98 patients were admitted: 57.1 % were due to methicillin-susceptible S. aureus (MSSA) and 42.8 % due to methicillin-resistant S. aureus (MRSA). In 40 patients (40.8 %), the infection was community acquired. Thirteen were ventilator-associated pneumonia episodes. The most frequent comorbidities were chronic lung disease (34.7 %), chronic renal failure (31.6 %), diabetes mellitus (29.6 %), and cardiovascular disease (31.6 %). Septic shock was present in 46 patients (46.9 %). The 30-day mortality was 46.9 %. MRSA infections occurred in older patients, more frequently with cardiovascular diseases, and they had received antibiotic treatment in the previous month more often than MSSA-infected patients. Patients with infection due to MSSA presented more frequently with septic shock, but they received more frequently appropriate empirical antibiotic therapy than patients with MRSA pneumonia (96 % vs. 38.1 %), and no differences in mortality were observed between both groups. In conclusion, S. aureus bacteremic pneumonia is a severe infection that, nowadays, affects people with comorbidities and the mortality is still high.
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Affiliation(s)
- C De la Calle
- Department of Infectious Diseases Hospital Clínic, Barcelona, Spain.
| | - L Morata
- Department of Infectious Diseases Hospital Clínic, Barcelona, Spain
| | | | - J A Martinez
- Department of Infectious Diseases Hospital Clínic, Barcelona, Spain
| | - C Cardozo
- Department of Infectious Diseases Hospital Clínic, Barcelona, Spain
| | - J Mensa
- Department of Infectious Diseases Hospital Clínic, Barcelona, Spain
| | - A Soriano
- Department of Infectious Diseases Hospital Clínic, Barcelona, Spain
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16
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Ortega M, Soriano A, Marco F, Almela M, Martínez JA, Morata L, Cobos-Trigueros N, de la Calle C, Mensa J. Risk factors for the isolation of a third generation cephalosporin resistant strain in patients with community-acquired Enterobacteriaceae bacteraemia. J Infect 2015; 72:268-71. [PMID: 26702739 DOI: 10.1016/j.jinf.2015.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 11/25/2015] [Accepted: 11/28/2015] [Indexed: 10/22/2022]
Affiliation(s)
- M Ortega
- Emergency Department and Infectious Diseases Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - A Soriano
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - F Marco
- Service of Clinical Microbiology, Barcelona Centre for International Health Research (CRESIB, Hospital Clínic, University of Barcelona), Barcelona, Spain
| | - M Almela
- Service of Clinical Microbiology, Barcelona Centre for International Health Research (CRESIB, Hospital Clínic, University of Barcelona), Barcelona, Spain
| | - J A Martínez
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - L Morata
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - N Cobos-Trigueros
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - C de la Calle
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - J Mensa
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Lucena CM, Torres A, Rovira M, Marcos MA, de la Bellacasa JP, Sánchez M, Domingo R, Gabarrus A, Mensa J, Agustí C. Pulmonary complications in hematopoietic SCT: a prospective study. Bone Marrow Transplant 2014; 49:1293-9. [PMID: 25046219 PMCID: PMC7094728 DOI: 10.1038/bmt.2014.151] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 05/25/2014] [Accepted: 06/03/2014] [Indexed: 01/04/2023]
Abstract
Pulmonary complications are common and often lethal in hematopoietic SCT recipients. The objective of this prospective interventional study was to evaluate the etiology, diagnostic procedures, risk factors and outcome of pulmonary complications in a cohort of hematopoietic SCT recipients followed up for 1 year. For patients suffering from a pulmonary complication, a diagnostic algorithm that included non-invasive and bronchoscopic procedures was performed. We identified 73 pulmonary complications in 169 patients: 50 (68%) were pneumonias; 21 (29%) were non-infectious complications and 2 (3%) were undiagnosed. Viruses (particularly Rhinovirus) and bacteria (particularly P. aeruginosa) (28 and 26%, respectively) were the most common causes of pneumonia. A specific diagnosis was obtained in 83% of the cases. A non-invasive test gave a specific diagnosis in 59% of the episodes. The diagnostic yield of bronchoscopy was 67 and 78% in pulmonary infections. Early bronchoscopy (⩽5 days) had higher diagnostic yield than late bronchoscopy (78 vs 23%; P=0.02) for pulmonary infections. Overall mortality was 22 and 32% of all fatalities were due to pulmonary complications. Pulmonary complications are common and constitute an independent risk factor for mortality, stressing the importance of an appropriate clinical management.
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Affiliation(s)
- C M Lucena
- 1] Pneumology Department, Hospital Clínic, Barcelona, Spain [2] Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - A Torres
- 1] Pneumology Department, Hospital Clínic, Barcelona, Spain [2] Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain [3] University of Barcelona, Barcelona, Spain [4] Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - M Rovira
- 1] Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain [2] HSCT unit, Hematology Department, Hospital Clínic, Barcelona, Spain
| | - M A Marcos
- Microbiology Department, Hospital Clínic, Barcelona, Spain
| | | | - M Sánchez
- 1] Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain [2] Radiology Department, Hospital Clínic, Barcelona, Spain
| | - R Domingo
- 1] Pneumology Department, Hospital Clínic, Barcelona, Spain [2] Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - A Gabarrus
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J Mensa
- 1] Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain [2] Infectious Diseases Department, Hospital Clínic, Barcelona, Spain
| | - C Agustí
- 1] Pneumology Department, Hospital Clínic, Barcelona, Spain [2] Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Fontsere N, Mestres G, Burrel M, Barrufet M, Montana X, Arias M, Ojeda R, Maduell F, Campistol JM, Nagaraja P, Rees D, Husein T, Chess J, Lin CC, Yang WC, Khosravi M, Kandil H, Cross J, Hopkins S, Collier S, Lopes D, Pereira S, Gomes AM, Ventura A, Martins V, Seabra J, Rothuizen TC, Damanik F, Visser MJT, Lavrijsen T, Cox MAJ, Moroni L, Rabelink TJ, Rotmans JI, Fontsere N, Cardozo C, Donate J, Soriano A, Muros M, Pons M, Mensa J, Campistol JM, Navarro-Gonzalez JF, Maduell F, Wijewardane A, Murley A, Powers S, Allen C, Baharani J, Wilmink T, Esenturk M, Zengin M, Dal M, Tahtal N, Shibata K, Shinzato T, Satta H, Nishihara M, Koguchi N, Kuji T, Kawata S, Kaneda T, Yasuda G, Scrivano J, Pettorini L, Rutigliano T, Ciavarella GM, De Biase L, Punzo G, Mene P, Pirozzi N, El Haggan W, Belazrague K, Ehoussou S, Foucher V, El Salhy M, Ouellet G, Davis J, Caron P, Leblanc M, Pettorini L, Romitelli F, Fazzari L, Scrivano J, Ortu G, Di Stasio E, Punzo G, Mene P, Pirozzi N, Loizzo G, Vigano SM, Bacchini G, Rocchi E, Sala V, Pontoriero G, Letachowicz K, Go biowski T, Kusztal M, Letachowicz W, Weyde W, Klinger M, Murley A, Wijewardane A, Powers S, Allen C, Hollingsworth L, Wilmink T, Baharani J, Roca-Tey R, Samon R, Ibrik O, Roda A, Gonzalez-Oliva JC, Martinez-Cercos R, Viladoms J, Renaud CJ, Lim EK, Seow TY, Teh HS, Tosic J, Jankovic A, Djuric P, Radovic Maslarevic V, Popovic J, Dimkovic N, Kazantzi A, Trigka K, Buono F, Laurino S, Toriello G, Di Luccio R, Galise A, Kim YO, Yoon SA, Kim YS, Choi SJ, Min JW, Cheong MA, Asano M, Oguchi K, Saito A, Onishi Y, Yamamoto Y, Fukuhara S, Akiba T, Akizawa T, Kurokawa K, Guedes Marques M, Ibeas J, Maia P, Ponce P, Chang KY, Park HS, Kim HW, Choi BS, Park CW, Yang CW, Jin DC, Likaj E, Seferi S, Caco G, Petrela E, Barbullushi M, Idrizi A, Thereska N, Lomonte C, Casucci F, Libutti P, Lisi P, Basile C, Ancarani P, Valsuani G, Cavallo L, Parodi D, Lorusso C, Renaud C, Lai BC, Tho S, Yeoh L, Guedes Marques M, Botelho C, Maia P, Ponce P, Yankovoy A, Alexandr S, Smoliacov A, Stepanov V, Rees D, Parker C, Davies P, Taylor S, Mikhail A, Kim YO, Yoon SA, Kim YS, Choi SJ, Min JW, Cheong MA, Gubensek J, Persic V, Vajdic B, Ponikvar R, Buturovic-Ponikvar J, Hadimeri U, Warme AV, Stegmayr B, Jankovic A, Suvakov S, Tosic J, Damjanovic T, Djuric P, Bajcetic S, Radovic-Maslarevic V, Popovic J, Simic T, Dimkovic N, Likaj E, Seferi S, Petrela E, Idrizi A, Rroji M, Barbullushi M, Thereska N, Chua HL, Kanda H, See SL, Liew NC, Tsuchida K, Tomo T, Fukasawa M, Kawashima S, Minakuchi J, Thanaraj V, Dhaygude A, Ikeda K, Forneris G, Cecere P, Pozzato M, Trogolo M, Vallero A, Mesiano P, Roccatello D, Esenturk M, Zengin M, Keskin L, Loizzo G, Vigano SM, Bacchini G, Rocchi E, Sala V, Pontoriero G, Casey JR, Hanson CS, Winkelmayer WC, Craig J, Palmer S, Strippoli G, Tong A, Ferrara D, Scamarda S, Bernardino L, Amico L, Lorito MC, Incalcaterra F, Visconti L, Visconti G, Valenza F, D'Amato F, Di Napoli A, Tazza L, Chicca S, Lapucci E, Silvestri P, Di Lallo D, Michelozzi P, Davoli M. DIALYSIS VASCULAR ACCESS. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cilloniz C, Torres A, Polverino E, Gabarrus A, Amaro R, Moreno E, Villegas S, Ortega M, Mensa J, Marcos MA, Moreno A, Miro JM. Community-acquired lung respiratory infections in HIV-infected patients: microbial aetiology and outcome. Eur Respir J 2014; 43:1698-708. [DOI: 10.1183/09031936.00155813] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rinaudo M, Cobos-Trigueros N, Solé M, Castro P, Hernández C, Nicolas JM, Vila J, Morata L, Pumarol J, Soriano A, Mensa J, Martínez JA. Comparison of acquisition of resistant microorganisms and infections in critically-ill patients with and without malignancies. Minerva Anestesiol 2013; 79:1217-1228. [PMID: 23752716] [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: 06/02/2023]
Abstract
BACKGROUND Patients with malignancies are often considered at risk of acquiring infections by resistant or potentially resistant microorganisms (RPRMs). However, data supporting this contention is scarce. We have compared critically ill patients with haematological malignancies (HM), solid tumours (ST) and without cancer (NC) in terms of acquisition of RPRMs, infections and mortality. METHODS Observational, prospective cohort study of patients admitted to a medical intensive care unit (ICU). Swabbing of nares, pharynx and rectum, and culture of respiratory secretions were obtained within 48 h of admission and thrice weekly thereafter. Clinical samples were obtained as deemed necessary by the attending physician. Clinical variables, severity scores on admission and exposures during ICU stay were also collected. Multivariable logistic regression analysis was used to evaluate ICU mortality. RESULTS Out of 969 included patients 127 (13.1%) had HM and 93 (9.6%) had ST. Patients with malignancies were more frequently exposed to central venous catheterization, methylprednisolone, and any antipseudomonal antibiotic whereas they were less commonly exposed to invasive mechanical ventilation. Patients with HM were more often admitted with an infection. There were no differences among groups in terms of RPRMs acquisition during ICU stay or prevalence of ICU-acquired infections due to any microorganism, including RPRMs. Having a HM was an independent predictor of mortality regardless of APACHE II score. CONCLUSION Critically ill cancer patients did not show a higher rate of RPRMs acquisition nor ICU-acquired infections. Mortality was higher in the HM group and it was not accurately predicted on admission by APACHE II score.
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Affiliation(s)
- M Rinaudo
- Medical Intensive Care Unit, Hospital Clínic-IDIBAPS, Barcelona Centre for International Health Research (CRESIB, Universitat de Barcelona), Barcelona, Spain -
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Cobos-Trigueros N, Rinaudo M, Solé M, Castro P, Pumarol J, Hernández C, Fernández S, Nicolás JM, Mallolas J, Vila J, Morata L, Gatell JM, Soriano A, Mensa J, Martínez JA. Acquisition of resistant microorganisms and infections in HIV-infected patients admitted to the ICU. Eur J Clin Microbiol Infect Dis 2013; 33:611-20. [DOI: 10.1007/s10096-013-1995-5] [Citation(s) in RCA: 3] [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] [Received: 07/27/2013] [Accepted: 10/07/2013] [Indexed: 11/29/2022]
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Santos J, Aguilar L, García-Méndez E, Siquier B, Custardoy J, García-Rey C, Pallarés R, Blanquer R, Caminero J, Dal-Ré R, Durán J, Gil-Aguado A, Grau I, Ibáñez D, Llorca E, Martínez J, Molinos L, Mensa J, Moreno S, Palacios R, Vidal J. Clinical Characteristics and Response to Newer Quinolones inLegionellaPneumonia: A Report of 28 Cases. J Chemother 2013; 15:461-5. [PMID: 14598938 DOI: 10.1179/joc.2003.15.5.461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Twenty-eight (11.6%) out of 241 Spanish patients enrolled in an international phase III clinical trial of mild to moderate community-acquired pneumonia (CAP) comparing gemifloxacin vs. trovafloxacin were diagnosed of Legionnaires' disease. A definite diagnosis was established by seroconversion in 13 patients of whom only 2 had a positive Legionella urinary antigen. The remaining 15 patients were possible Legionella infections based on a single elevated IgG titer (> or = 1:512). All patients had a radiologically confirmed diagnosis of pneumonia, 5 (19%) patients were older than 65, comorbidity was present in 9 (33%), and 10 (36%) had to be hospitalized. Fifteen patients were treated with oral gemifloxacin (320 mg/day) and 13 with oral trovafloxacin (200 mg/day). Overall, clinical success occurred in 25 (89.3%) patients after 7 days of treatment and only 1 patient needed a 14-day treatment. There were only one adverse event withdrawal and one clinical failure, and no patients died. In light of the favorable clinical outcome, the use of newer fluoroquinolones seems adequate for the treatment of suspected or proven Legionella pneumonia.
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Affiliation(s)
- J Santos
- Infectious Diseases Unit, Hospital Virgen de la Victoria, Málaga, Spain
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Ortega M, Marco F, Soriano A, Almela M, Martínez JA, Pitart C, Mensa J. Epidemiology and prognostic determinants of bacteraemic catheter-acquired urinary tract infection in a single institution from 1991 to 2010. J Infect 2013; 67:282-7. [PMID: 23774535 DOI: 10.1016/j.jinf.2013.06.003] [Citation(s) in RCA: 26] [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: 01/29/2013] [Revised: 05/04/2013] [Accepted: 06/05/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the epidemiology of bacteraemic Catheter-Acquired Urinary Tract Infection (CA-UTI) and to identify independent predictors of mortality. METHODS This study was part of a bloodstream infection surveillance study that prospectively collected data on consecutive patients with bacteraemia in our institution from 1991 to 2010. Factors associated with 30-day mortality were determined. RESULTS CA-UTI was the confirmed source of 1007 bacteraemias. The most common microorganisms isolated were Escherichiacoli (42%), Klebsiella spp (15%), Enterococcus faecalis (12%) and Pseudomonas aeruginosa (12%). Along the 2006-2010 periods, antibiotic-resistant E. coli and Klebsiella spp isolates accounted for 49% of the bacteraemia due to CA-UTI. Shock and mortality accounted for 125 and 92 cases, respectively (12% and 9%). Factors associated with mortality were: inappropriate empirical treatment (OR: 1.86, 95% CI: 1.48-2.44), ultimately or rapidly fatal prognosis of underlying disease (OR: 2.56, 95% CI: 1.48-4.44) and shock on presentation (OR: 12.62, 95% CI: 7.61-20.95). Inappropriate empirical treatment was most frequent in cases of bacteraemia produced by antibiotic-resistant E. coli or Klebsiella spp, Enterococcus spp. and P. aeruginosa. Factors associated with the isolation of a microorganism of this type were previous antibiotic therapy and healthcare-associated bacteraemia (OR: 1.50, 95% CI: 1.16-2.14 and OR: 3.03, 95% CI: 2.22-4.01, respectively). CONCLUSIONS In cases of previous antibiotic therapy or healthcare-associated bacteraemic CA-UTI may indicate the need to initiate empirical therapy activity against antibiotic-resistant Enterobacteriaceae, E. faecalis and P. aeruginosa.
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Affiliation(s)
- M Ortega
- Emergency Department and Infectious Diseases Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Ortega M, Marco F, Soriano A, Almela M, Martínez J, Pitart C, Mensa J. Epidemiology and prognostic determinants of bacteremic acute pyelonephritis in women. J Infect 2013; 66:193-6. [DOI: 10.1016/j.jinf.2012.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/08/2012] [Accepted: 10/10/2012] [Indexed: 10/27/2022]
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Jaén N, Martínez-Pastor JC, Muñoz-Mahamud E, García-Ramiro S, Bosch J, Mensa J, Soriano A. Long-term outcome of acute prosthetic joint infections due to gram-negative bacilli treated with retention of prosthesis. Rev Esp Quimioter 2012; 25:194-198. [PMID: 22987265] [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: 06/01/2023]
Abstract
OBJECTIVE To update the clinical information of the 47 patients with a prosthetic joint infection due to Gram-negative bacilli included in a previous study and to reassess the predictors of failure after a longer follow-up. METHODS Using the electronic files of our hospital, all the information regarding readmissions to the hospital, new surgical procedures and the reason for the new surgery (infection, aseptic loosening), and the last visit in the hospital were registered. The medical chart of the 35 patients that were considered in remission in the previous publication was reviewed. RESULTS In 30 patients no clinical evidence of failure was detected and no additional surgery on the previously infected prosthesis was necessary and they were considered in long-term remission. In 5 cases a late complication was identified. One case had a reinfection due to coagulase-negative staphylococci after 22 months from the open debridement and required a 2-stage revision surgery. The other 4 cases developed an aseptic loosening and it was necessary to perform a 1-stage exchange. Receiving a fluoroquinolone when all the Gram-negatives involved in the infection were susceptible to fluoroquinolones was the only factor associated with remission in the univariate analysis (p=0.002). CONCLUSION After a long-term follow-up, our results support the importance of using fluoroquinolones in acute PJI due to Gram-negative bacilli.
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Affiliation(s)
- N Jaén
- Department of Infectious Diseases, Hospital Clínic of Barcelona, Barcelona, Spain.
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Soriano A, Marcos M, Martinez JA, Mensa J. Changing epidemiology of central venous catheter-related bloodstream infections: increasing prevalence of Gram-negative pathogens-authors' response. J Antimicrob Chemother 2012. [DOI: 10.1093/jac/dks093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ortega M, Marco F, Soriano A, Almela M, Martínez JA, López J, Pitart C, Mensa J. Epidemiology and prognostic determinants of bacteraemic biliary tract infection. J Antimicrob Chemother 2012; 67:1508-13. [PMID: 22408140 DOI: 10.1093/jac/dks062] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To determine the epidemiology of bacteraemia due to biliary tract infection (BTI) and to identify independent predictors of mortality. METHODS This study was part of a bloodstream infection surveillance study that prospectively collected data on consecutive patients with bacteraemia in our institution from 1991 to 2010. BTI was the confirmed source of 1373 patients with bacteraemia, and the independent prognostic factors of 30 day mortality were determined. RESULTS The mean age of patients with biliary sepsis was 71 years (± 14 years). The most frequent comorbidities were biliary lithiasis and solid-organ cancer [484 cases (35%) and 362 cases (26%), respectively]. The BTI was healthcare-associated in 33% of patients. Shock and mortality accounted for 209 and 126 cases, respectively (15% and 9%). The most frequent microorganisms isolated were Escherichia coli (749, 55%), Klebsiella spp. (240, 17%), Enterococcus spp. (171, 12%), Pseudomonas aeruginosa (86, 6%) and Enterobacter spp. (63, 5%). There were 47 (3%) cefotaxime-resistant (CTX-R) E. coli or Klebsiella spp. Inappropriate empirical antibiotic treatment was an independent factor associated with mortality (OR 1.4, 95% CI 1.1-1.7). Inappropriate empirical treatment was more frequent in P. aeruginosa and CTX-R Enterobacteriaceae bacteraemia. These microorganisms were significantly more common in patients with previous antibiotic therapy, solid-organ cancer or transplantation and in healthcare-associated bacteraemia. CONCLUSIONS In patients with bacteraemic BTI, inappropriate empirical therapy was more frequent in P. aeruginosa and CTX-R Enterobacteriaceae infection and was associated with a higher mortality rate. In patients with bacteraemia due to BTI and solid-organ cancer or transplantation, healthcare-associated infection or previous antibiotic treatment, initial therapy with piperacillin/tazobactam or a carbapenem would be advisable.
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Affiliation(s)
- M Ortega
- Emergency Department and Infectious Diseases Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Cillóniz C, Ewig S, Polverino E, Muñoz-Almagro C, Marco F, Gabarrús A, Menéndez R, Mensa J, Torres A. Pulmonary complications of pneumococcal community-acquired pneumonia: incidence, predictors, and outcomes. Clin Microbiol Infect 2011; 18:1134-42. [PMID: 22044658 DOI: 10.1111/j.1469-0691.2011.03692.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the clinical characteristics, predictors and outcomes of pneumococcal pneumonia developing pulmonary complications and the distribution of pneumococcal serotypes. It was a prospective study including all adult patients admitted to the Hospital Clinic of Barcelona, Spain (2001-2009) with the diagnosis of pneumococcal pneumonia. Microbiological investigation was systematically performed, including antimicrobial susceptibility and serotype distribution (only invasive strains isolated during 2006-2009). Complicated pneumonia was defined as the presence of one or more pulmonary complications: pleural effusion, empyema, or multilobar infiltrates. We included 626 patients, and 235 (38%) had the following pulmonary complications: pleural effusion, 122 (52%); empyema, 18 (8%); and multilobar infiltration, 151 (64%). Forty-six (20%) patients had more than one complication. Patients with pulmonary complications showed a higher rate of intensive-care unit admission (34% vs. 13%, p <0.001), a higher rate of shock (16% vs. 7%, p <0.001), a longer length of stay (9 days vs. 6 days, p <0.001), and a lower rate of penicillin resistance (14% vs. 25%, p 0.013), but similar mortality (9% vs. 8%). No significant differences were observed in the serotype distribution between complicated and uncomplicated pneumonia. Chronic obstructive pulmonary disease (COPD) (OR 0.38, 95% CI 0.23-0.63; p <0.001) was a protective factor against pulmonary complications, whereas chronic liver disease (OR 3.60, 95% CI 1.71-7.60; p 0.001), admission C-reactive protein level ≥18 mg/dL (OR 2.77, 95% CI 1.91-4.00; p <0.001) and admission creatinine level >1.5 mg/dL (OR 2.01, 95% CI 1.31-3.08; p 0.001) were risk factors for pulmonary complications. Complicated pneumonia was characterized by a more severe clinical presentation, but was not associated with increased mortality. Resistance to antibiotics was lower in complicated cases. No significant differences were observed in the serotype distribution between complicated and uncomplicated pneumonia. In the multivariate analysis, COPD was a protective factor against pulmonary complications.
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Affiliation(s)
- C Cillóniz
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona, Villarroel 170, Barcelona, Spain
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Liapikou A, Polverino E, Ewig S, Cillóniz C, Marcos M, Mensa J, Bello S, Martin-Loeches I, Menéndez R, Torres A. Severity and outcomes of hospitalised community-acquired pneumonia in COPD patients. Eur Respir J 2011; 39:855-61. [DOI: 10.1183/09031936.00067111] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sousa R, López R, Martínez-Pastor JC, Cervera C, Bori G, García-Ramiro S, Mensa J, Soriano A. Usefulness of monitoring linezolid trough serum concentration in prolonged treatments. Rev Esp Quimioter 2011; 24:151-153. [PMID: 21947098] [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: 05/31/2023]
Abstract
Linezolid has proven valuable in musculoskeletal infections, however, failure and resistance have been described and toxicity is worrisome when more than 28 days are necessary. We describe the first 5 cases in whom linezolid trough serum concentrations were weekly measured and its relationship with clinical outcome and toxicity.
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Affiliation(s)
- R Sousa
- Orthopaedics Department, Hospital Santo António - Centro Hospitalar do Porto, Oporto, Portugal
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31
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Marcos M, Soriano A, Inurrieta A, Martinez JA, Romero A, Cobos N, Hernandez C, Almela M, Marco F, Mensa J. Changing epidemiology of central venous catheter-related bloodstream infections: increasing prevalence of Gram-negative pathogens. J Antimicrob Chemother 2011; 66:2119-2125. [DOI: 10.1093/jac/dkr231] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Muñoz-Mahamud E, García S, Bori G, Martínez-Pastor JC, Zumbado JA, Riba J, Mensa J, Soriano A. Comparison of a low-pressure and a high-pressure pulsatile lavage during débridement for orthopaedic implant infection. Arch Orthop Trauma Surg 2011; 131:1233-8. [PMID: 21387137 DOI: 10.1007/s00402-011-1291-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The aim of our study was to compare the effectiveness of high-pressure pulsatile lavage and low-pressure lavage in patients with an orthopaedic implant infection treated with open débridement followed by antibiotic treatment. PATIENTS AND METHODS Patients with an orthopaedic implant infection requiring open débridement from January 2008 to August 2009 were randomized prospectively to a low-pressure or a high-pressure pulsatile lavage arm. Relevant information about demographics, co-morbidity, type of implant, microbiology data, surgical treatment, and outcome were recorded. Comparison of proportions was made using χ(2) test or Fisher exact test when necessary. The Kaplan-Meier survival method was used to estimate the cumulative probability of treatment failure from open débridement to the last visit. RESULTS Seventy-nine patients were included. There were no differences between the main characteristics between both groups (p > 0.05). Mean (SD) age of the whole cohort was 70.2 (11.9) years. There were 46 infections on knee prosthesis, 17 on hip prosthesis, 7 on hip hemiarthroplasties and 9 on osteosynthesis devices. There were 69 acute post-surgical infections, 8 acute haematogenous infections and 2 chronic infections. The most common microorganisms isolated were coagulase-negative Staphylococci in 34 cases, Staphylococcus aureus in 26 and Escherichia coli in 19 cases. There were 30 polymicrobial infections. A total of 42 and 37 patients were randomized to a high-pressure pulsatile or a low-pressure lavage, respectively. There was no difference in the success rate between both arms (80.9 vs. 86.5%, p = 0.56). CONCLUSION The use of a high-pressure pulsatile lavage during open débridement of implant infections had a similar success rate as a low-pressure lavage.
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Affiliation(s)
- E Muñoz-Mahamud
- Department of Orthopaedic and Trauma Surgery, Bone and Joint Infection Unit, Hospital Clínic of Barcelona, University of Barcelona, Spain.
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Marcos M, Fernández C, Soriano À, Marco F, Martínez JA, Almela M, Cervera R, Mensa J, Espinosa G. Epidemiology and clinical outcomes of bloodstream infections among lupus patients. Lupus 2011; 20:965-71. [DOI: 10.1177/0961203311403345] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infection is an important cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). This study was aimed at characterizing bloodstream infections in these patients and analysing factors associated with long term outcome. For this purpose, episodes of significant bacteraemia diagnosed from January 1991 to December 2006 among patients with SLE at a single centre were identified through a central database and clinical and analytical variables were recorded regarding short- and long-term follow-up. Univariate and multivariable analysis were performed to identify factors associated with long-term outcome. Thirty-eight SLE patients had 48 episodes of significant bacteraemia, with a 30-day mortality rate of 6.25%. Escherichia coli and Staphylococcus aureus were the leading Gram-negative and Gram-positive pathogens, respectively. After a median follow-up of 25 months, eight of these 38 patients (21.1%) had a further episode of bacteraemia and 13 of them (34.21%) died. Community-acquired bacteraemia and C reactive protein levels lower than 8 mg/dl during episodes were factors associated with lower long-term mortality. These results reinforce previous findings suggesting that lupus patients with bacteraemia episodes have poor long-term outcomes
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Affiliation(s)
- M Marcos
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
| | - C Fernández
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
| | - À Soriano
- Department of Infectious Diseases, Hospital Clinic, Barcelona, Spain
| | - F Marco
- Department of Clinical Microbiology, Hospital Clinic, Barcelona, Spain
| | - JA Martínez
- Department of Infectious Diseases, Hospital Clinic, Barcelona, Spain
| | - M Almela
- Department of Clinical Microbiology, Hospital Clinic, Barcelona, Spain
| | - R Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
| | - J Mensa
- Department of Infectious Diseases, Hospital Clinic, Barcelona, Spain
| | - G Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
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Vilchez F, Martínez-Pastor JC, García-Ramiro S, Bori G, Maculé F, Sierra J, Font L, Mensa J, Soriano A. Outcome and predictors of treatment failure in early post-surgical prosthetic joint infections due to Staphylococcus aureus treated with debridement. Clin Microbiol Infect 2011; 17:439-44. [PMID: 20412187 DOI: 10.1111/j.1469-0691.2010.03244.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Experience with debridement and prosthesis retention in early prosthetic joint infections (PJI) due to Staphylococcus aureus is scarce. The present study aimed to evaluate the outcome and predictors of failure. Patients prospectively registered with an early PJI due to S. aureus and 2 years of follow-up were reviewed. Demographics, co-morbidity, type of implant, clinical manifestations, surgical treatment, antimicrobial therapy and outcome were recorded. Remission was defined when the patient had no symptoms of infection, the prosthesis was retained and C-reactive protein (CRP) was ≤ 1 mg/dL. Univariate and multivariate analysis were performed. Fifty-three patients with a mean ± SD age of 70 ± 10.8 years were reviewed. Thirty-five infections were on knee prosthesis and 18 were on hip prosthesis. The mean ± SD duration of intravenous and oral antibiotics was 10.6 ± 6.7 and 88 ± 45.9 days, respectively. After 2 years of follow-up, 40 (75.5%) patients were in remission. Variables independently associated with failure were the need for a second debridement (OR 20.4, 95% CI 2.3-166.6, p 0.006) and a CRP > 22 mg/dL (OR 9.8, 95% CI 1.5-62.5, p 0.01). The onset of the infection within the 25 days after joint arthroplasty was at the limit of significance (OR 8.3, 95% CI 0.8-85.6, p 0.07). Debridement followed by a short period of antibiotics is a reasonable treatment option in early PJI due to S. aureus. Predictors of failure were the need for a second debridement to control the infection a CRP > 22 mg/dL and the infection onset within the first 25 days after joint arthroplasty.
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Affiliation(s)
- F Vilchez
- Department of Orthopedics of Hospital Clínic of Barcelona, Spain.
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Rodríguez D, Almirante B, Cuenca-Estrella M, Rodríguez-Tudela JL, Mensa J, Ayats J, Sanchez F, Pahissa A. Predictors of candidaemia caused by non-albicans Candida species: results of a population-based surveillance in Barcelona, Spain. Clin Microbiol Infect 2011; 16:1676-82. [PMID: 20219079 DOI: 10.1111/j.1469-0691.2010.03208.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although Candida albicans (CA) is the most common cause of Candida bloodstream infections (BSIs), recent studies have observed an increasing percentage of candidaemias caused by non-albicans Candida species (NAC). In the present study, we attempted to identify the predictors of candidaemia due to NAC compared to CA. We analyzed data from an active population-based surveillance in Barcelona (Spain) from January 2002 to December 2003. Factors associated with NAC fungaemia were determined by multivariate analysis. A total of 339 episodes of Candida BSI, in 336 patients (median age 63 years, interquartile range: 41-72 years), were included. CA was the most commonly isolated (52%), followed by Candida parapsilosis (23%), Candida tropicalis (10%), Candida glabrata (8.6%), Candida krusei (3.4%) and other NAC spp. (3%).Overall, 48% of cases were due to NAC spp. Multivariate logistic regression analysis identified factors associated with a risk of BSI due to NAC spp.: having received a haematologic transplant (OR 10.8; 95% CI 1.31-90.01; p 0.027), previous fluconazole exposure (OR 4.47; 95% CI 2.12-9.43; p <0.001) and neonatal age (OR 4.42; 95% CI 1.63-12.04; p 0.004). Conversely, previous CA colonization (OR 0.33; 95% CI 0.19-0.57; p 0.001) and previous antibiotic use (OR 0.42; 95% CI 0.21-0.85; p 0.017) were associated with CA fungaemia compared to NAC. In conclusion, NAC candidaemia comprised 48% of cases in our series. Predictors of NAC include having received a haematologic transplant, neonatal age and previous fluconazole use.
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Affiliation(s)
- D Rodríguez
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
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García-Oltra E, García-Ramiro S, Martínez JC, Tibau R, Bori G, Bosch J, Mensa J, Soriano A. [Prosthetic joint infection by Candida spp.]. Rev Esp Quimioter 2011; 24:37-41. [PMID: 21412668] [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: 05/30/2023]
Abstract
INTRODUCTION Fungal periprosthetic infectionis a rare entity. The aim of this report was to review our experience in two different educational hospitals. MATERIAL AND METHODS patients with documented prosthetic joint infection due to Candida spp. from February 2002 to October 2010 were retrospectively reviewed. Demographics, microbiological data, treatment and outcome of each patient was recorded. RESULTS Ten patients, 8 women and 2 men, with a meanage of 77.7 (range 66-92) years were identified. Nine patients had previous bacterial infection, received antibiotic treatment for more than 15 days and required multiple surgeries. The most frequent species was C. albicans with 6 cases. All patients received fluconazole and surgical treatment consisted of debridement without removing the implant in 3 cases and 2-stage exchange with a spacer in 7. The first surgical and antifungal approach failed in all cases and a second debridement was necessary in one case, a resection arthroplasty in 8 and chronic suppressive treatment with fluconazol in one. After a mean follow-up of 31 (range 2-67) months, two patients were free of infection. CONCLUSION Prosthetic joint infection was associated with long-term antibiotic treatment and multiples previous surgeries. Treatment with fluconazol and debridement or two stage replacement with a spacer was associated with a high failure rate.
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Affiliation(s)
- E García-Oltra
- Servicio de Cirugía Ortopédica y Traumatología. Hospital Clínic de Barcelona, Spain
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Ortega M, Marco F, Soriano A, Almela M, Martínez J, López J, Pitart C, Mensa J. Candida species bloodstream infection: epidemiology and outcome in a single institution from 1991 to 2008. J Hosp Infect 2011; 77:157-61. [DOI: 10.1016/j.jhin.2010.09.026] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 09/10/2010] [Indexed: 11/30/2022]
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Candel FJ, Martínez-Sagasti F, Borges M, Maseda E, Herrera-Gutiérrez M, Garnacho-Montero J, Maynar FJ, Zaragoza R, Mensa J, Azanza JR. [Endotoxin adsortion as adjuvant therapy in gram negative severe sepsis]. Rev Esp Quimioter 2010; 23:115-121. [PMID: 20844841] [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: 05/29/2023]
Abstract
The mortality rate of severe sepsis and septic shock remains still high. Within the last years a better knowledge of its physiopathology and the implementation of a group of measures addressed to a fast identification and early treatment of the septic patients have proved to reduce mortality rate. Likewise, it continues being investigated in modulating the inflammatory response and limiting the harmful action of the bacterial products on the immune system. As a result of this research some endotoxin adsorber devices have been designed to control one of the most important targets that start the inflammatory cascade when gram negative microorganisms are involved.The usefulness that these endotoxin removal devices might have as adjuvant treatment in the Septic Syndrome and its applicability are reviewed in this paper. Likewise a profile of patient that might be to the benefit of this therapy is suggested according to the current knowledge.
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Affiliation(s)
- F J Candel
- Servicio de Microbiología Clínica, Hospital Clinico Universitario San Carlos, Madrid, Spain.
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Cobos-Triguero N, Pitart C, Marco F, Martínez JA, Almela M, López J, Ortega M, Soriano A, Mensa J. [Epidemiology and clinical presentation of Panton-Valentin leukocidin positive methicillin-resistant Staphylococcus aureus]. Rev Esp Quimioter 2010; 23:93-99. [PMID: 20559608] [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: 05/29/2023]
Abstract
INTRODUCTION the aim of our study was to review the epidemiology and clinical manifestations of infections due to Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus (PVL-MRSA). MATERIAL AND METHODS Medical history of patients infected by MRSA-PVL admitted to our hospital from January 2007 to July 2009 was reviewed. PVL and the type of cromosomic cassette were determined in all strains by PCR. RESULTS A total of 37 cases were included. Seventy percent were males and the median age was 39 years. Sixtytwo percent were Spanish, 14 (37.8%) were HIV-positive and 11 (29.7%) were homosexual. The source of the infection was the skin and soft tissue in 36 cases and pneumonia in 1. Sixteen patients were hospitalized, 5 had bacteremia and 5 developed septic metastasis. The relapse rate was 24% (9 cases). The prevalence during the study period was 11.2% of all MRSA isolated (37 out of 329). All the strains had a cromosomic cassette type IV and were susceptible to cotrimoxazole, rifampin, vancomyin, daptomycin and linezolid. The MIC of vancomycin, measured by E-test, was ≥ 1.5 mg/L in 28 out of 34 cases (82.3%). CONCLUSIONS Eleven percent of the MRSA strains isolated in our hospital are PVL positive. In general, skin and soft tissue infections are the most common and bacteremia or septic metastasis are frequent. In contrast to previous Spanish studies, more cases are observed in patients born in Spain and the infections are more severe.
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Affiliation(s)
- N Cobos-Triguero
- Servicio de Enfermedades Infecciosas. Hospital Clínic de Barcelona, Barcelona
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Polverino E, Dambrava P, Cilloniz C, Balasso V, Marcos MA, Esquinas C, Mensa J, Ewig S, Torres A. Nursing home-acquired pneumonia: a 10 year single-centre experience. Thorax 2010; 65:354-9. [DOI: 10.1136/thx.2009.124776] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ortega M, Marco F, Soriano A, Almela M, Martinez JA, Pitart C, Mensa J. Candida spp. bloodstream infection: influence of antifungal treatment on outcome. J Antimicrob Chemother 2010; 65:562-8. [DOI: 10.1093/jac/dkp495] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Guirao X, Arias J, Badía JM, García-Rodríguez JA, Mensa J, Alvarez-Lerma F, Borges M, Barberán J, Maseda E, Salavert M, Llinares P, Gobernado M, García Rey C. [Guidelines for the empirical antibiotic treatment of intra-abdominal infections]. Rev Esp Anestesiol Reanim 2010; 57:41-60. [PMID: 20196521] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- X Guirao
- Sección de Infección Quirúrgica de la AEC.
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Menéndez R, Martinez R, Reyes S, Mensa J, Polverino E, Filella X, Esquinas C, Martinez A, Ramirez P, Torres A. Stability in community-acquired pneumonia: one step forward with markers? Thorax 2009; 64:987-92. [PMID: 19762338 DOI: 10.1136/thx.2009.118612] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Biological markers as an expression of systemic inflammation have been recognised as useful for evaluating the host response in community-acquired pneumonia (CAP). The objective of this study was to evaluate whether the biological markers procalcitonin (PCT) and C-reactive protein (CRP) might reflect stability after 72 h of treatment and the absence of subsequent severe complications. METHODS A prospective cohort study was performed in 394 hospitalised patients with CAP. Clinical stability was evaluated using modified Halm's criteria: temperature <or=37.2 degrees C; heart rate <or=100 beats/min; respiratory rate <or=24 breaths/min; systolic blood pressure >or=90 mm Hg; oxygen saturation >or=90%; or arterial oxygen tension >or=60 mm Hg. PCT and CRP levels were measured on day 1 and after 72 h. Severe complications were defined as mechanical ventilation, shock and/or intensive care unit (ICU) admission, or death after 72 h of treatment. RESULTS 220 patients achieved clinical stability at 72 h and had significantly lower levels of CRP (4.2 vs 7 mg/dl) and of PCT (0.33 vs 0.48 ng/ml). Regression logistic analyses were performed to calculate several areas under the ROC curve (AUC) to predict severe complications. The AUC for clinical stability was 0.77, 0.84 when CRP was added (p = 0.059) and 0.77 when PCT was added (p = 0.45). When clinical stability was achieved within 72 h and marker levels were below the cut-off points (0.25 ng/ml for PCT and 3 mg/dl for CRP), no severe complications occurred. CONCLUSIONS Low levels of CRP and PCT at 72 h in addition to clinical criteria might improve the prediction of absence of severe complications.
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Affiliation(s)
- R Menéndez
- Servicio de Neumología, Universitary Hospital La Fe, Ciber de enfermedades respiratorias (CIBERES), Valencia, Spain.
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Guirao X, Arias J, Badía JM, García-Rodríguez JA, Mensa J, Alvarez-Lerma F, Borges M, Barberán J, Maseda E, Salavert M, Llinares P, Gobernado M, García Rey C. [Recommendations in the empiric anti-infective agents of intra-abdominal infection]. Rev Esp Quimioter 2009; 22:151-172. [PMID: 19662549] [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: 05/28/2023]
Abstract
A significant number of patients with abdominal infection develop advanced stages of infection and mortality is still above 20%. Failure is multifactorial and is associated with an increase of bacterial resistance, inappropriate empirical treatment, a higher comorbidity of patients and poor source control of infection. These guidelines discuss each of these problems and propose measures to avoid the failure based on the best current scientific evidence.
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Affiliation(s)
- X Guirao
- Sección de Infección Quirúrgica, Asociación Española de Cirujanos, Madrid.
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Barberán J, Mensa J. [Cefditoren and community-acquired lower respiratory tract infections (corrected)]. Rev Esp Quimioter 2009; 22:144-150. [PMID: 19662548] [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: 05/28/2023]
Abstract
Cefditoren is a third-generation oral cephalosporin with good activity against respiratory tract pathogens, including penicillin-intermediate and -resistant strains of S. pneumoniae, and beta-lactamase producing strains of H. influenzae and M. catarrhalis. Its bacterial activity, measured by minimum inhibitory concentration (MIC), is similar or superior to that of many other commonly used antibiotics (penicillins, cephalosporins and fluoroquinolones). Considering the target attainment of T > MIC of >or= 40% a more reliable predictor of clinical and microbiologic outcomes, cefditoren covers strains of S. pneumoniae with MIC values <or= 0.5 microg/mL and <or= 1 microg/mL in the case of doses of 200 mg and 400 mg, respectively, and all strains of H. influenzae. Cefditoren has been associated with high rates of bacteriologic response among the main causative pathogens in lower respiratory tract infection ( approximately 85% against H. influenzae and approximately 90% against S. pneumoniae, including penicillin-intermediate and penicillin-resistant strains). It is a reliable option for switch therapy in case of treatment with third-generation intravenous cephalosporin. Cefditoren is currently approved in Spain for the treatment of adults and adolescents with acute exacerbations of chronic bronchitis (AECB) and community-acquired pneumonia (CAP), two of the lower respiratory tract infections most commonly encountered in clinical practice.
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Affiliation(s)
- J Barberán
- Servicio de Enfermedades Infecciosas, Hospital Central de la Defensa "Gómez Ulla" Madrid.
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Serrano R, Capdevila JA, Mensa J, Barberán J. [Multicenter national survey on infection management in patients with penicillin allergy]. Rev Esp Quimioter 2009; 22:10-19. [PMID: 19308741] [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: 05/27/2023]
Abstract
INTRODUCTION Beta-lactam antibiotics are widely prescribed to treat many infections because of efficacy, spectrum and safety. Their use is limited in patients with resistant microbial agents and in those with a history of penicillin allergy (HPA) because of cross-reactivity risk. Accurate clinical assessment of possible HPA requires specialized resources not always available in clinical practice. We intended to get to know the opinion of Spanish physicians about frequency and methods of evaluation of the patients with HPA as well as the preferences in the use of antimicrobial alternatives for common infectious diseases in patients with HPA. METHODS Multicentric cross-sectional descriptive study ran by the Infectious Diseases Study Group of the Spanish Society for Internal Medicine based on the accomplishment of a survey of 10 questions of opinion to specialist doctors who work in Spanish medical centers. RESULTS A total of 311 doctors responded to the survey (92.2% Internal Medicine specialists) distributed by all the Spanish territory. An average of 10.7% of patients self-reported having HPA although only an average of 10.8% of them gave documentation on the matter. Patients were sent for specific allergy tests in an average of 33.6%. Desensitization treatments were performed in 4.3% of cases. The preferences for alternative antibiotic therapy to beta-lactam widely varied according to the infectious picture and the communitarian or nosocomial origin, and they included quinolones, macrolides, glycopeptides, lincosamides, oxazolidinones and tigecycline. CONCLUSIONS Perception about frequency and evaluation of patients with HPA is very variable, but in more than half the cases it is above 10% of the patients. Yet, only one third are sent for in-depth study for allergy confirmation, and less than 5% are desensitized. Nosocomial infections and the possibility of multiresistant bacteria make substantially difficult the management of patients with HPA.
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Affiliation(s)
- R Serrano
- Grupo de Trabajo en Enfermedades Infecciosas (GTEI) de la Sociedad Española de Medicina Interna
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Menendez R, Martinez R, Reyes S, Mensa J, Filella X, Marcos MA, Martinez A, Esquinas C, Ramirez P, Torres A. Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax 2009; 64:587-91. [DOI: 10.1136/thx.2008.105312] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ortega M, Marco F, Soriano A, Almela M, Martínez JA, Muñoz A, Mensa J. Analysis of 4758 Escherichia coli bacteraemia episodes: predictive factors for isolation of an antibiotic-resistant strain and their impact on the outcome. J Antimicrob Chemother 2009; 63:568-74. [DOI: 10.1093/jac/dkn514] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [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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Mensa J, Barberán J, Llinares P, Picazo J, Bouza E, Alvarez-Lerma F, Borges M, Serrano R, León C, Guirao X, Arias J, Carreras E, Sanz M, García-Rodríguez J. [Guidelines for the treatment on infections caused by methicillin-resistant Staphylococcus aureus]. Rev Esp Quimioter 2008; 21:234-258. [PMID: 19031124] [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: 05/27/2023]
Abstract
Infections due to methicillin-resistant Staphylococcus aureus (MRSA) have undergone important changes in the last five years that have influenced the choice of therapy: i) increase of their frequency in hospital-associated settings and, more recently, in community settings; ii) better knowledge of clinical implications of the pharmacokinetic and pharmacodynamic properties of vancomycin; iii) improvement of current standard methods for rapid detection of MRSA in clinical samples; iv) clear evidence that vancomycin is losing efficacy against MRSA with MIC > 1 microg/mL; and v) appearance of new antibiotics suitable for use in these infections (linezolid, daptomycin, tigecyclin). Under this situation guidelines for the treatment of common infections caused by MRSA appear to be necessary to improve the efficacy and reduce the mortality.
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Affiliation(s)
- J Mensa
- Sociedad Española de Quimioterapia (SEQ), Servicio de Enfermedades Infecciosas, Hospital Clinic, Barcelona, Espana.
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Fuster D, Duch J, Soriano A, García S, Setoain X, Bori G, Rubí S, Rodríguez D, Doménech B, Piera C, Mensa J, Pons F. Valor de la gammagrafía de médula macrofágica en el diagnóstico de infección de prótesis total de cadera estudiada con leucocitos 99mTc-HMPAO. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s0212-6982(08)75530-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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