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Ruiz R, Montagud-Martínez R, Dorta-Gorrín A, Pablo-Marcos D, Gozalo M, Calvo-Montes J, Navas J, Rodrigo G. Rapid and Accurate Detection of the SARS-CoV-2 Omicron Variant with a CRISPR-Cas12a Reaction in the RT-qPCR Pot. ACS Omega 2024; 9:18046-18050. [PMID: 38680362 PMCID: PMC11044157 DOI: 10.1021/acsomega.3c09717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 05/01/2024]
Abstract
Gene sequencing in back of reverse transcription-quantitative polymerase chain reaction (RT-qPCR) is the current approach for discriminating infections produced by different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants in the clinic. However, sequencing is often a time-consuming step, which hinders the deployment of a very fast response during a pandemic. Here, we propose to run a CRISPR-Cas12a reaction after completing the RT-qPCR and in the very same pot to detect with high specificity genetic marks characterizing variants of concern. A crRNA was appropriately designed to detect the S gene of the SARS-CoV-2 Omicron BA.1 variant. A significant response with >20-fold dynamic range was obtained for the Omicron BA.1 S gene, while the Delta S gene did not produce any detectable signal. The sensitivity of the method was analyzed with a series of diluted samples and different Cas12a nucleases. A correlation between the RT-qPCR CT values and the CRISPR-Cas12a reaction signals was observed. Variant discrimination with the CRISPR-Cas12a reaction was possible in some minutes with high accuracy from patient samples. In conclusion, CRISPR-Cas systems seem ready to be exploited in the clinic to boost personalized diagnoses and accelerate epidemiological surveillance in a cost-effective way.
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Affiliation(s)
- Raúl Ruiz
- Instituto
de Biología Integrativa de Sistemas (I2SysBio), CSIC—Universitat de València, 46980 Paterna, Spain
| | - Roser Montagud-Martínez
- Instituto
de Biología Integrativa de Sistemas (I2SysBio), CSIC—Universitat de València, 46980 Paterna, Spain
| | - Alexis Dorta-Gorrín
- Facultad
de Medicina, Universidad de Cantabria, 39011 Santander, Spain
- Instituto
de Investigación Sanitaria Marqués de Valdecilla (IDIVAL), 39011 Santander, Spain
| | - Daniel Pablo-Marcos
- Servicio
de Microbiología, Hospital Universitario
Marqués de Valdecilla, 39008 Santander, Spain
| | - Mónica Gozalo
- Instituto
de Investigación Sanitaria Marqués de Valdecilla (IDIVAL), 39011 Santander, Spain
- Servicio
de Microbiología, Hospital Universitario
Marqués de Valdecilla, 39008 Santander, Spain
- Centro
de Investigación Biomédica en Red de Enfermedades Infecciosas
(CIBERINFEC), Instituto de Salud Carlos
III, 28029 Madrid, Spain
| | - Jorge Calvo-Montes
- Instituto
de Investigación Sanitaria Marqués de Valdecilla (IDIVAL), 39011 Santander, Spain
- Servicio
de Microbiología, Hospital Universitario
Marqués de Valdecilla, 39008 Santander, Spain
- Centro
de Investigación Biomédica en Red de Enfermedades Infecciosas
(CIBERINFEC), Instituto de Salud Carlos
III, 28029 Madrid, Spain
| | - Jesús Navas
- Facultad
de Medicina, Universidad de Cantabria, 39011 Santander, Spain
- Instituto
de Investigación Sanitaria Marqués de Valdecilla (IDIVAL), 39011 Santander, Spain
| | - Guillermo Rodrigo
- Instituto
de Biología Integrativa de Sistemas (I2SysBio), CSIC—Universitat de València, 46980 Paterna, Spain
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2
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García-Fernández S, Pablo-Marcos D, de la Fuente SV, Rodríguez MJR, Gozalo M, Rodríguez-Lozano J, Méndez-Legaza JM, Calvo J. Evaluation of the rapid antigen detection test STANDARD F COVID-19 Ag FIA for diagnosing SARS-CoV-2: Experience from an Emergency Department. Diagn Microbiol Infect Dis 2022; 103:115683. [PMID: 35421760 PMCID: PMC8931994 DOI: 10.1016/j.diagmicrobio.2022.115683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/28/2022] [Accepted: 03/13/2022] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to assess the clinical performance of STANDARD F COVID-19 Ag FIA (SD Biosensor Inc., Gyeonggi-do, Republic of Korea), a rapid antigen detection test (RADT) for diagnosing SARS-CoV-2, in patients attended at the Emergency Department with signs or symptoms compatible with COVID-19 that had started in the last 5 days. The clinical performance of the antigen test was compared with RT-PCR, the reference standard. We included 663 specimens from non-repetitive patients. Clinical sensitivity and specificity were 84.0% (95% CI 76.1−89.7) and 99.6% (95% CI 98.5−99.9), respectively. The positive and negative predictive values were 98.1% (95% CI 92.7−99.7) and 96.4% (95% CI 94.4−97.7), respectively. The kappa index agreement between RT-PCR and the RADT was 0.89 (95% CI 0.84−0.93). We concluded that STANDARD F COVID-19 Ag FIA is an excellent first-line RADT method to diagnose symptomatic patients in the emergency department.
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Affiliation(s)
- Sergio García-Fernández
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
| | - Daniel Pablo-Marcos
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | | | - Mónica Gozalo
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Jesús Rodríguez-Lozano
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | - Jorge Calvo
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
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Berastegui-Cabrera J, Salto-Alejandre S, Valerio M, Pérez-Palacios P, Revillas FADL, Abelenda-Alonso G, Oteo-Revuelta JA, Carretero-Ledesma M, Muñoz P, Pascual Á, Gozalo M, Rombauts A, Alba J, García-Díaz E, Rodríguez-Ferrero ML, Valiente A, Fariñas MC, Carratalà J, Santibáñez S, Camacho-Martínez P, Pachón J, Cisneros JM, Cordero E, Sánchez-Céspedes J. SARS-CoV-2 RNAemia is associated with severe chronic underlying diseases but not with nasopharyngeal viral load. J Infect 2021; 82:e38-e41. [PMID: 33248220 PMCID: PMC7688428 DOI: 10.1016/j.jinf.2020.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/22/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Judith Berastegui-Cabrera
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain
| | - Sonsoles Salto-Alejandre
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain
| | - Maricela Valerio
- Service of Clinical Microbiology and Infectious Diseases, Sanitary Research Institute, Gregorio Marañón University Hospital, Madrid, Spain
| | - Patricia Pérez-Palacios
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine. Virgen Macarena University Hospital, Seville, Spain
| | - Francisco Arnaiz-De Las Revillas
- Service of Infectious Diseases, Marqués de Valdecilla University Hospital, Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Gabriela Abelenda-Alonso
- Service of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Marta Carretero-Ledesma
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain
| | - Patricia Muñoz
- Service of Clinical Microbiology and Infectious Diseases, Sanitary Research Institute, Gregorio Marañón University Hospital, Madrid, Spain; CIBERES (CB06/06/0058), Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Álvaro Pascual
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain; Unit of Infectious Diseases, Microbiology, and Preventive Medicine. Virgen Macarena University Hospital, Seville, Spain
| | - Mónica Gozalo
- Service of Microbiology, Marqués de Valdecilla University Hospital, Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Alexander Rombauts
- Service of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Jorge Alba
- Department of Infectious Diseases, San Pedro-CIBIR University Hospital, Logroño, La Rioja, Spain
| | - Emilio García-Díaz
- Unit of Emergencies, Virgen del Rocío University Hospital, Seville, Spain
| | - María Luisa Rodríguez-Ferrero
- Service of Clinical Microbiology and Infectious Diseases, Sanitary Research Institute, Gregorio Marañón University Hospital, Madrid, Spain
| | - Adoración Valiente
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine. Virgen Macarena University Hospital, Seville, Spain
| | - María Carmen Fariñas
- Service of Infectious Diseases, Marqués de Valdecilla University Hospital, Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Jordi Carratalà
- Service of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Sonia Santibáñez
- Department of Infectious Diseases, San Pedro-CIBIR University Hospital, Logroño, La Rioja, Spain
| | - Pedro Camacho-Martínez
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - Jerónimo Pachón
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain; Department of Medicine, University of Seville, Sevilla, Spain
| | - José Miguel Cisneros
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain
| | - Elisa Cordero
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain; Department of Medicine, University of Seville, Sevilla, Spain.
| | - Javier Sánchez-Céspedes
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain.
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4
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Pablo-Marcos D, Rodríguez-Fernández A, Gozalo M, Agüero J, Arnaiz de Las Revillas F, Calvo J. Description of Influenza B in seasonal epidemic in Cantabria during the beginning of the pandemia due to SARS-CoV-2. Rev Esp Quimioter 2020; 33:444-447. [PMID: 32957746 PMCID: PMC7712335 DOI: 10.37201/req/077.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction. Co-circulation of the two Influenza B lineages hinders forecast of strain to include in trivalent vaccine. Autonomous Communities such as Cantabria continue without supplying tetravalent vaccine. The aim of this study was to analyse epidemiological characteristics of influenza type B in Cantabria (2019-2020 season) as well as to establish the predominant lineage and its relation to the recommended vaccine.
Methods. Retrospective study whereby flu diagnosis and lineage analysis were determined by RT-PCR.
Results. All samples belonged to the Victoria lineage. Most prevalent viral co-infection was due to SARS-CoV-2. The population affected by influenza B was mainly paediatric and non-vaccinated patients more frequently required hospital admittance.
Conclusions. Influenza type B has a higher incidence in the paediatric population and type A affects more the adult population. Only 28.8% of patients with Influenza B that presented with some underlying condition or risk factor were vaccinated. This shows the need to increase coverage with tetravalent vaccines in order to reduce the burden of disease associated with the Influenza B virus.
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Affiliation(s)
- D Pablo-Marcos
- Daniel Pablo Marcos, Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL. Santander, Spain.
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5
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Collado-Mateo D, Villafaina S, Fernández-González E, Gozalo M, Fuentes JP, Gusi N. Efectos de la tarea dual sobre el tiro libre en baloncesto. RICCAFD 2019. [DOI: 10.24310/riccafd.2019.v8i2.6447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
El objetivo de este estudio fue estudiar los efectos de una tarea dual en el tiro libre en baloncesto, comparando esa influencia en función de la categoría y el sexo de los jugadores. Los resultados muestran que existe un descenso del rendimiento provocado por la tarea dual de los baloncestistas de categoría infantil y junior (p<0,05), no observándose lo mismo en la categoría senior. Tampoco se detectaron diferencias significativas entre el rendimiento de hombres y mujeres. Puede afirmarse, por tanto, que las tareas duales provocan un descenso en el rendimiento, sobre todo en etapas de formación, posiblemente por la automatización del patrón motor debido a un mayor tiempo de práctica en categorías senior. Por ello, las tareas duales pueden ser incluidas en los entrenamientos para crear situaciones estresantes y bajo presión similares a las que se pueden encontrar los deportistas en situaciones competitivas reales.
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6
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Palacios-Baena ZR, Delgado-Valverde M, Valiente Méndez A, Almirante B, Gómez-Zorrilla S, Borrell N, Corzo JE, Gurguí M, De la Calle C, García-Álvarez L, Ramos L, Gozalo M, Morosini MI, Molina J, Causse M, Pascual Á, Rodríguez-Baño J, de Cueto M, Planes Reig AM, Tubau Quintano F, Peña C, Galán Otalora ME, Ruíz de Alegría C, Cantón R, Lepe JA, Cisneros JM, Torre-Cisneros J, Lara R. Impact of De-escalation on Prognosis of Patients With Bacteremia due to Enterobacteriaceae: A Post Hoc Analysis From a Multicenter Prospective Cohort. Clin Infect Dis 2018; 69:956-962. [DOI: 10.1093/cid/ciy1032] [Citation(s) in RCA: 10] [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] [Received: 09/22/2018] [Accepted: 12/04/2018] [Indexed: 12/31/2022] Open
Abstract
Abstract
Background
More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. The aims of this study were to investigate predictors of de-escalation and its impact on the outcome of patients with bloodstream infection due to Enterobacteriaceae (BSI-E).
Methods
A post hoc analysis was performed on a prospective, multicenter cohort of patients with BSI-E initially treated with ertapenem or antipseudomonal β-lactams. Logistic regression was used to analyze factors associated with early de-escalation (EDE) and Cox regression for the impact of EDE and late de-escalation (LDE) on 30-day all-cause mortality. A propensity score (PS) for EDE vs no de-escalation (NDE) was calculated. Failure at end of treatment and length of hospital stay were also analyzed.
Results
Overall, 516 patients were included. EDE was performed in 241 patients (46%), LDE in 95 (18%), and NDE in 180 (35%). Variables independently associated with a lower probability of EDE were multidrug-resistant isolates (odds ratio [OR], 0.50 [95% confidence interval {CI}, .30–.83]) and nosocomial infection empirically treated with imipenem or meropenem (OR, 0.35 [95% CI, .14–.87]). After controlling for confounders, EDE was not associated with increased risk of mortality; hazard ratios (HR) (95% CIs) were as follows: general model, 0.58 (.25–1.31); model with PS, 0.69 (.29–1.65); and PS-based matched pairs, 0.98 (.76–1.26). LDE was not associated with mortality. De-escalation was not associated with clinical failure or length of hospital stay.
Conclusions
De-escalation in patients with monomicrobial bacteremia due to Enterobacteriaceae was not associated with a detrimental impact on clinical outcome.
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Affiliation(s)
- Zaira R Palacios-Baena
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Departamentos de Medicina y Microbiología, Universidad de Sevilla and Instituto de Biomedicina de Sevilla
| | - Mercedes Delgado-Valverde
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Departamentos de Medicina y Microbiología, Universidad de Sevilla and Instituto de Biomedicina de Sevilla
| | - Adoración Valiente Méndez
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Departamentos de Medicina y Microbiología, Universidad de Sevilla and Instituto de Biomedicina de Sevilla
| | - Benito Almirante
- Servei de Malalties Infeccioses, Hospital Universitari Vall d’Hebron, Barcelona
| | | | - Núria Borrell
- Servicio de Microbiología, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares
| | - Juan E Corzo
- Unidad Clínica Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla
| | - Mercedes Gurguí
- Unitat de Malaties Infeccioses, Hospital de la Santa Creu i Sant Pau
| | | | - Lara García-Álvarez
- Departamento de Enfermedades Infecciosas, Hospital San Pedro-Centro de Investigación Biomédica de La Rioja, Logroño
| | - Lucía Ramos
- Servicio de Microbiología, Hospital Universitario A Coruña, Santander
| | - Mónica Gozalo
- Servicio de Microbiología, Hospital Marqués de Valdecilla-Instituto de Investigación Sanitaria Valdecilla, Santander
| | | | - José Molina
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Universidad de Sevilla and Instituto de Biomedicina de Sevilla
| | - Manuel Causse
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Clínica, Universidad de Córdoba, Spain
| | - Álvaro Pascual
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Departamentos de Medicina y Microbiología, Universidad de Sevilla and Instituto de Biomedicina de Sevilla
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Departamentos de Medicina y Microbiología, Universidad de Sevilla and Instituto de Biomedicina de Sevilla
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7
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Russo A, Falcone M, Gutiérrez-Gutiérrez B, Calbo E, Almirante B, Viale PL, Oliver A, Ruiz-Garbajosa P, Gasch O, Gozalo M, Pitout J, Akova M, Peña C, Cisneros JM, Hernández-Torres A, Farcomeni A, Prim N, Origüen J, Bou G, Tacconelli E, Tumbarello M, Hamprecht A, Karaiskos I, de la Calle C, Pérez F, Schwaber MJ, Bermejo J, Lowman W, Hsueh PR, Mora-Rillo M, Rodriguez-Gomez J, Souli M, Bonomo RA, Paterson DL, Carmeli Y, Pascual A, Rodríguez-Baño J, Venditti M. Predictors of outcome in patients with severe sepsis or septic shock due to extended-spectrum β-lactamase-producing Enterobacteriaceae. Int J Antimicrob Agents 2018; 52:577-585. [PMID: 29969692 DOI: 10.1016/j.ijantimicag.2018.06.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE There are few data in the literature regarding sepsis or septic shock due to extended-spectrum β-lactamases (ESBL)-producing Enterobacteriaceae (E). The aim of this study was to assess predictors of outcome in septic patients with bloodstream infection (BSI) caused by ESBL-E. METHODS Patients with severe sepsis or septic shock and BSI due to ESBL-E were selected from the INCREMENT database. The primary endpoint of the study was the evaluation of predictors of outcome after 30 days from development of severe sepsis or septic shock due to ESBL-E infection. Three cohorts were created for analysis: global, empirical-therapy and targeted-therapy cohorts. RESULTS 367 septic patients were analysed. Overall mortality was 43.9% at 30 days. Escherichia coli (62.4%) and Klebsiella pneumoniae (27.2%) were the most frequent isolates. β-lactam/β-lactamase inhibitor (BLBLI) combinations were the most empirically used drug (43.6%), followed by carbapenems (29.4%). Empirical therapy was active in vitro in 249 (67.8%) patients, and escalation of antibiotic therapy was reported in 287 (78.2%) patients. Cox regression analysis showed that age, Charlson Comorbidity Index, McCabe classification, Pitt bacteremia score, abdominal source of infection and escalation of antibiotic therapy were independently associated with 30-day mortality. No differences in survival were reported in patients treated with BLBLI combinations or carbapenems in empirical or definitive therapy. CONCLUSIONS BSI due to ESBL-E in patients who developed severe sepsis or septic shock was associated with high 30-day mortality. Comorbidities, severity scores, source of infection and antibiotic therapy escalation were important determinants of unfavorable outcome.
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Affiliation(s)
- A Russo
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - M Falcone
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - B Gutiérrez-Gutiérrez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena / Universidad de Sevilla / Instituto de Biomedicina de Sevilla, Seville, Spain
| | - E Calbo
- Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - B Almirante
- Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - P L Viale
- Teaching Hospital Policlinico S. Orsola Malpighi, Bologna, Italy
| | - A Oliver
- Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | | | - O Gasch
- Corporacio Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - M Gozalo
- Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain
| | - J Pitout
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Akova
- Hacettepe University School of Medicine, Ankara, Turkey
| | - C Peña
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J M Cisneros
- Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocio, CSIC, University of Seville, Seville, Spain
| | | | - A Farcomeni
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - N Prim
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Origüen
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Bou
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - E Tacconelli
- Universitätsklinikum Tübingen, Tübingen, Germany
| | - M Tumbarello
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Hamprecht
- Institut für Mikrobiologie, Immunologie und Hygiene Universitätsklinikum Köln, Cologne, Germany
| | | | | | - F Pérez
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - M J Schwaber
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, and National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Bermejo
- Hospital Español, Rosario, Argentina
| | - W Lowman
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - P-R Hsueh
- National Taiwan University Hospital, National Taiwan University Hospital College of Medicine, Taipei, Taiwan
| | - M Mora-Rillo
- Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - J Rodriguez-Gomez
- Intensive Care Unit. Biomedical Research Institute of Cordoba (IMIBIC)/ Reina Sofia University Hospital/University of Cordoba, Córdoba, Spain
| | - M Souli
- University General Hospital Attikon, Chaidari, Greece
| | - R A Bonomo
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA; Departments of Medicine, Pharmacology, Biochemistry, Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland Ohio, USA
| | - D L Paterson
- University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, Australia
| | - Y Carmeli
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, and National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Pascual
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena / Universidad de Sevilla / Instituto de Biomedicina de Sevilla, Seville, Spain
| | - J Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena / Universidad de Sevilla / Instituto de Biomedicina de Sevilla, Seville, Spain
| | - M Venditti
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy.
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Shaw E, Benito N, Rodríguez-Baño J, Padilla B, Pintado V, Calbo E, Pallarés MA, Gozalo M, Ruiz-Garbajosa P, Horcajada JP. Risk factors for severe sepsis in community-onset bacteraemic urinary tract infection: impact of antimicrobial resistance in a large hospitalised cohort. J Infect 2015; 70:247-54. [PMID: 25305497 DOI: 10.1016/j.jinf.2014.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 05/29/2014] [Revised: 09/12/2014] [Accepted: 09/15/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine risks factors associated with severe sepsis or septic shock (SS) at admission in patients with community-onset bacteraemic urinary tract infection (CO-BUTI) including the impact of multidrug-resistant (MDR) bacteria. METHODS We analysed a prospective cohort of all consecutive episodes of CO-BUTI requiring hospitalisation in 8 tertiary hospitals of Spain between October 2010 and June 2011. RESULTS Of an overall of 525 CO-BUTI episodes, 175 (33%) presented with SS at admission. MDR bacteria were isolated in 29% (51/175) of episodes with SS and in 33% (117/350) of those without SS (p = 0.32). The main MDR microorganism was Escherichia coli in both groups (25% and 28% respectively). Independent risk factors associated with SS at admission were: having fatal underlying conditions, McCabe score II/III (OR 1.90; 95%CI 1.23-2.92; p = 0.004), presence of an indwelling urethral catheter (OR 3.01; 95%CI 1.50-6.03; p = 0.002) and a history of urinary tract obstruction (OR 1.56; 95%CI 1.03-2.34; p = 0.03). After considering interactions, indwelling urethral catheters were a risk factor only for patients without fatal underlying conditions. CONCLUSIONS SS at hospital admission occurred in a third of CO-BUTI. Mainly host factors, and not the causative microorganisms or antimicrobial resistance patterns had an impact on the presence of SS.
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Affiliation(s)
- Evelyn Shaw
- Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain.
| | - Natividad Benito
- Servicio de Enfermedades Infecciosas, Hospital de Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - Belén Padilla
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital Gregorio Marañón, Madrid, Spain
| | - Vicente Pintado
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain
| | - Esther Calbo
- Servicio de Medicina Interna, Hospital Mútua de Terrassa, Barcelona, Spain
| | | | - Mónica Gozalo
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Juan Pablo Horcajada
- Servicio de Enfermedades Infecciosas, Hospital Universitari del Mar and Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
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Horcajada JP, Shaw E, Padilla B, Pintado V, Calbo E, Benito N, Gamallo R, Gozalo M, Rodríguez-Baño J. Healthcare-associated, community-acquired and hospital-acquired bacteraemic urinary tract infections in hospitalized patients: a prospective multicentre cohort study in the era of antimicrobial resistance. Clin Microbiol Infect 2013; 19:962-8. [PMID: 23279375 DOI: 10.1111/1469-0691.12089] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/25/2012] [Accepted: 10/25/2012] [Indexed: 02/05/2023]
Abstract
The clinical and microbiological characteristics of community-onset healthcare-associated (HCA) bacteraemia of urinary source are not well defined. We conducted a prospective cohort study at eight tertiary-care hospitals in Spain, from October 2010 to June 2011. All consecutive adult patients hospitalized with bacteraemic urinary tract infection (BUTI) were included. HCA-BUTI episodes were compared with community-acquired (CA) and hospital-acquired (HA) BUTI. A logistic regression analysis was performed to identify 30-day mortality risk factors. We included 667 episodes of BUTI (246 HCA, 279 CA and 142 HA). Differences between HCA-BUTI and CA-BUTI were female gender (40% vs 69%, p <0.001), McCabe score II-III (48% vs 14%, p <0.001), Pitt score ≥2 (40% vs 31%, p 0.03), isolation of extended spectrum β-lactamase-producing Enterobacteriaciae (13% vs 5%, p <0.001), median hospital stay (9 vs 7 days, p 0.03), inappropriate empirical antimicrobial therapy (21% vs 13%, p 0.02) and mortality (11.4% vs 3.9%, p 0.001). Pseudomonas aeruginosa was more frequently isolated in HA-BUTI (16%) than in HCA-BUTI (4%, p <0.001). Independent factors for mortality were age (OR 1.04; 95% CI 1.01-1.07), McCabe score II-III (OR 3.2; 95% CI 1.8-5.5), Pitt score ≥2 (OR 3.2 (1.8-5.5) and HA-BUTI OR 3.4 (1.2-9.0)). Patients with HCA-BUTI are a specific group with significant clinical and microbiological differences from patients with CA-BUTI, and some similarities with patients with HA-BUTI. Mortality was associated with patient condition, the severity of infection and hospital acquisition.
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Affiliation(s)
- J P Horcajada
- Hospital Universitari del Mar, Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
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Rodríguez-Baño J, Miró E, Villar M, Coelho A, Gozalo M, Borrell N, Bou G, Conejo MC, Pomar V, Aracil B, Larrosa N, Agüero J, Oliver A, Fernández A, Oteo J, Pascual A, Navarro F. Colonisation and infection due to Enterobacteriaceae producing plasmid-mediated AmpC β-lactamases. J Infect 2011; 64:176-83. [PMID: 22138600 DOI: 10.1016/j.jinf.2011.11.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/15/2011] [Accepted: 11/17/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To investigate the epidemiology and clinical features of infections caused by Enterobacteria producing plasmid-mediated AmpC β-lactamases (pAmpC), which are emerging as a cause of resistance to extended-spectrum cephalosporins. METHODS A prospective multicentre cohort of patients with infection/colonisation due to pAmpC-producing Enterobacteriaceae was performed in 7 Spanish hospitals from February throughout July 2009. pAmpCs were characterised by PCR and sequencing. RESULTS 140 patients were included; organisms isolated were Escherichia coli (n = 100), Proteus mirabilis (n = 20), Klebsiella pneumoniae (n = 17), and others (n = 3). Overall, 90% had a chronic underlying condition. The acquisition was nosocomial in 43%, healthcare-associated in 41% (14% of those were nursing home residents), and community in 16%. Only 5% of patients had no predisposing feature for infection with multidrug-resistant bacteria. Nineteen percent of patients were bacteraemic. Inappropriate empirical therapy was administered to 81% of bacteraemic patients, who had a crude mortality rate of 48%. The most frequent enzyme was CMY-2 (70%, predominantly in E. coli and P. mirabilis) followed by DHA-1 (19%, predominantly in K. pneumoniae). CONCLUSION pAmpC-producing Enterobacteriaceae caused nosocomial, healthcare-associated and community infections mainly in predisposed patients. Invasive infections were associated with high mortality which might be partly related to inappropriate empirical therapy.
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Affiliation(s)
- Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Avda Dr Fedriani 3, 41009 Sevilla, Spain.
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