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Mancheño-Losa M, Lora-Tamayo J, Fernández-Sampedro M, Rodríguez-Pardo D, Muñoz-Mahamud E, Soldevila L, Palou M, Barbero J, Del Toro MD, Iribarren J, Benito N, Sobrino B, Rico-Nieto A, Guío-Carrión L, Gómez L, Escudero-Sánchez R, García-País MJ, Jover-Sáenz A, Praena J, Baraia-Etxaburu JM, Auñón Á, Múñez-Rubio E, Murillo O. Corrigendum to "Prognosis of unexpected positive intraoperative cultures in arthroplasty revision: A large multicenter cohort" [Journal of Infection 83 (2021) 542-549]. J Infect 2022; 84:747. [PMID: 35105460 DOI: 10.1016/j.jinf.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Mikel Mancheño-Losa
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica "imas12"Hospital 12 de Octubre, Av. de Córdoba s/n, Madrid, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Jaime Lora-Tamayo
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica "imas12"Hospital 12 de Octubre, Av. de Córdoba s/n, Madrid, Spain; Spanish Network for the Study of Infectious Diseases / Red Española de Investigación en Patología Infecciosa (REIPI), Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; CIBER de Enfermedades Infecciosas, Instuto de Salud Carlos III, Madrid, Spain.
| | - Marta Fernández-Sampedro
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Dolors Rodríguez-Pardo
- Department of Infectious Diseases, Vall d'Hebron Hospital Universitari, Barcelona, Spain; Spanish Network for the Study of Infectious Diseases / Red Española de Investigación en Patología Infecciosa (REIPI), Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Ernesto Muñoz-Mahamud
- Department of Orthopedics and Trauma Surgery, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Laura Soldevila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Mariona Palou
- Department of Infectious Diseases, Hospital Universitari Parc Taulí, Sabadell, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - JoséMaría Barbero
- Department of Internal Medicine, Hospital Universitario Príncipe de Asturias, Alcaláde Henares, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - María Dolores Del Toro
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, University of Seville, Institute of Biomedicine of Seville (IBiS), Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - JoséAntonio Iribarren
- Department of Infectious Diseases, Hospital Universitario Donostia, IIS BioDonostia, San Sebastián, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau - Institut d'InvestigacióBiomèdica Sant Pau, Barcelona, Spain
| | - Beatriz Sobrino
- Department of Infectious Diseases, Hospital Regional Universitario de Málaga, Málaga, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Alicia Rico-Nieto
- Department of Infectious Diseases, Hospital Universitario La Paz, Madrid, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Laura Guío-Carrión
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Lucía Gómez
- Department of Infectious Diseases, Hospital Universitari Mútua Terrassa, Terrassa, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Rosa Escudero-Sánchez
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain; Spanish Network for the Study of Infectious Diseases / Red Española de Investigación en Patología Infecciosa (REIPI), Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - María José García-País
- Department of Infectious Diseases, Hospital Universitario Lucus Augusti, Lugo, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Alfredo Jover-Sáenz
- Department of Infectious Diseases, Hospital Universitari Arnau de Vilanova, Lleida, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Julia Praena
- Department of Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Josu Miren Baraia-Etxaburu
- Department of Infectious Diseases, Hospital Universitario de Basurto, Bilbao, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Álvaro Auñón
- Department of Orthopedics and Trauma Surgery, Hospital Universitario Fundación Jiménez-Díaz, Madrid, Spain; CIBER de Enfermedades Infecciosas, Instuto de Salud Carlos III, Madrid, Spain
| | - Elena Múñez-Rubio
- Department of Infectious Diseases, Hospital Universitario Puerta de Hierro, Madrid, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Oscar Murillo
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Spanish Network for the Study of Infectious Diseases / Red Española de Investigación en Patología Infecciosa (REIPI), Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; CIBER de Enfermedades Infecciosas, Instuto de Salud Carlos III, Madrid, Spain
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Larrosa MN, Canut-blasco A, Benito N, Cantón R, Cercenado E, Docobo-pérez F, Fernández-cuenca F, Fernández-domínguez J, Guinea J, López-navas A, Moreno MÁ, Morosini MI, Navarro F, Martínez-martínez L, Oliver A. Recomendaciones del Comité Español del Antibiograma (COESANT) para la realización de los Informes de Sensibilidad Antibiótica Acumulada. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Wouthuyzen-Bakker M, Sebillotte M, Arvieux C, Fernandez-Sampedro M, Senneville E, Barbero JM, Lora-Tamayo J, Aboltins C, Trebse R, Salles MJ, Kramer TS, Ferrari M, Garcia-Cañete J, Benito N, Diaz-Brito V, del Toro MD, Scarborough M, Soriano A. How to Handle Concomitant Asymptomatic Prosthetic Joints During an Episode of Hematogenous Periprosthetic Joint Infection, a Multicenter Analysis. Clin Infect Dis 2021; 73:e3820-e3824. [PMID: 32813012 PMCID: PMC9187975 DOI: 10.1093/cid/ciaa1222] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Prosthetic joints are at risk of becoming infected during an episode of bacteremia, especially during Staphylocococcus aureus bacteremia. However, it is unclear how often asymptomatic periprosthetic joint infection (PJI) occurs, and whether additional diagnostics should be considered. METHODS In this multicenter study, we retrospectively analyzed a cohort of patients with a late acute (hematogenous) PJI between 2005-2015 who had concomitant prosthetic joints in situ. Patients without at least 1 year of follow-up were excluded. RESULTS We included 91 patients with a hematogenous PJI and 108 concomitant prosthetic joints. The incident PJI was most frequently caused by Staphylococcus aureus (43%), followed by streptococci (26%) and Gram-negative rods (18%). Of 108 concomitant prosthetic joints, 13 were symptomatic, of which 10 were subsequently diagnosed as a second PJI. Of the 95 asymptomatic prosthetic joints, 1 PJI developed during the follow-up period and was classified as a "missed" PJI at the time of bacteremia with S. aureus (1.1%). Infected prosthetic joints were younger than the noninfected ones in 67% of cases, and prosthetic knees were affected more often than prosthetic hips (78%). CONCLUSIONS During an episode of hematogenous PJI, concomitant asymptomatic prosthetic joints have a very low risk of being infected, and additional diagnostic work-up for these joints is not necessary.
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Affiliation(s)
- Marjan Wouthuyzen-Bakker
- Correspondence: M. Wouthuyzen-Bakker, Infectious Disease Specialist, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands ()
| | - Marine Sebillotte
- Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France
| | - Cédric Arvieux
- Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France
- Great West Reference centers for Complex Bone and Joint Infections (CRIOGO), Rennes, France
| | - Marta Fernandez-Sampedro
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Instituto de investigación sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Eric Senneville
- Department of Infectious Diseases, Lille, University Hospital Gustave Dron Hospital, Tourcoing, France
| | - José Maria Barbero
- Department of Internal Medicine. Hospital Universitario Principe de Asturias, Madrid, Spain
| | - Jaime Lora-Tamayo
- Department of Internal Medicine. Hospital Universitario 12 de Octubre. Instituto de Investigación i+12. Madrid, Spain
| | - Craig Aboltins
- The Department of Infectious Diseases, Northern Health, Melbourne, Australia
- The University of Melbourne, Northern Clinical School, Melbourne, Australia
| | - Rihard Trebse
- Service for Bone Infections, Valdoltra Orthopaedic Hospital, the Faculty of Medicine, University of Ljublijana, Ankaran, Slovenia
| | - Mauro José Salles
- Santa Casa de São Paulo School of Medical Sciences and Musculoskeletal infection group, Federal University of São Paulo, Brasil
| | - Tobias Siegfried Kramer
- Institute for hygiene and environmental medicine Charité-Universitätsmedizin Berlin, Germany
- Evangelisches Waldkrankenhaus Spandau, BerlinGermany
| | - Matteo Ferrari
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Joaquín Garcia-Cañete
- Department of Internal Medicine-Emergency, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain
- Department of Medicine. Universitat Autònoma de Barcelona, Spain
| | - Vicens Diaz-Brito
- Infectious Diseases Unit, Parc Sanitari Sant Joan de Deu, Sant Boi, Barcelona, Spain
| | - Maria Dolores del Toro
- Unidad Clínica de Enfermedades Infecciosa y Microbiología. Universidad de Sevilla. Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| | - Matthew Scarborough
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, England
| | - Alex Soriano
- Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Gómez-Zorrilla S, Becerra-Aparicio F, López Montesinos I, Ruiz de Gopegui E, Grau I, Pintado V, Padilla B, Benito N, Boix-Palop L, Fariñas MC, Peñaranda M, Gamallo MR, Martinez JA, Morte-Romea E, Del Pozo JL, Durán-Jordá X, Díaz-Regañón J, López-Mendoza D, Cantón R, Oliver A, Ruiz-Garbajosa P, Horcajada JP. A Large Multicenter Prospective Study of Community-Onset Healthcare Associated Bacteremic Urinary Tract Infections in the Era of Multidrug Resistance: Even Worse than Hospital Acquired Infections? Infect Dis Ther 2021; 10:2677-2699. [PMID: 34626347 PMCID: PMC8572918 DOI: 10.1007/s40121-021-00537-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/14/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Healthcare-associated (HCA) infections represent a growing public health problem. The aim of this study was to compare community-onset healthcare associated (CO-HCA) bacteremic urinary tract infections (BUTI) and hospital-acquired (HA)-BUTI with special focus on multidrug resistances (MDR) and outcomes. METHODS ITUBRAS-project is a prospective multicenter cohort study of patients with HCA-BUTI. All consecutive hospitalized adult patients with CO-HCA-BUTI or HA-BUTI episode were included in the study. Exclusion criteria were: patients < 18 years old, non-hospitalized patients, bacteremia from another source or primary bacteremia, non-healthcare-related infections and infections caused by unusual pathogens of the urinary tract. The main outcome variable was 30-day all-cause mortality with day 1 as the first day of positive blood culture. Logistic regression was used to analyze factors associated with clinical cure at hospital discharge and with receiving inappropriate initial antibiotic treatment. Cox regression was used to evaluate 30-day all-cause mortality. RESULTS Four hundred forty-three episodes were included, 223 CO-HCA-BUTI. Patients with CO-HCA-BUTI were older (p < 0.001) and had more underlying diseases (p = 0.029) than those with HA-BUTI. The severity of the acute illness (Pitt score) was also higher in CO-HCA-BUTI (p = 0.026). Overall, a very high rate of MDR profiles (271/443, 61.2%) was observed, with no statistical differences between groups. In multivariable analysis, inadequate empirical treatment was associated with MDR profile (aOR 3.35; 95% CI 1.77-6.35), Pseudomonas aeruginosa (aOR 2.86; 95% CI 1.27-6.44) and Charlson index (aOR 1.11; 95% CI 1.01-1.23). Mortality was not associated with the site of acquisition of the infection or the presence of MDR profile. However, in the logistic regression analyses patients with CO-HCA-BUTI (aOR 0.61; 95% CI 0.40-0.93) were less likely to present clinical cure. CONCLUSION The rate of MDR infections was worryingly high in our study. No differences in MDR rates were found between CO-HCA-BUTI and HA-BUTI, in the probability of receiving inappropriate empirical treatment or in 30-day mortality. However, CO-HCA-BUTIs were associated with worse clinical cure.
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Affiliation(s)
- Silvia Gómez-Zorrilla
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain.
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
| | - Federico Becerra-Aparicio
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Inmaculada López Montesinos
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Ruiz de Gopegui
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Service, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Inmaculada Grau
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Service, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Vicente Pintado
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Service, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Belén Padilla
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Service, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Natividad Benito
- Infectious Diseases Service, Hospital de la Santa Creui Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lucía Boix-Palop
- Infectious Diseases Service, Hospital Mutua de Terrassa, Barcelona, Spain
| | - Maria Carmen Fariñas
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - María Peñaranda
- Infectious Diseases Service, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Maria Rocío Gamallo
- Infectious Diseases Service, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Jose Antonio Martinez
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Service, Hospital Clinic, Barcelona, Spain
| | - Elena Morte-Romea
- Infectious Diseases Service, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain
| | - Jose Luis Del Pozo
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Xavier Durán-Jordá
- Methodology and Biostatistics Support Unit, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | | | | | - Rafael Cantón
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Antonio Oliver
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Service, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Patricia Ruiz-Garbajosa
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Juan Pablo Horcajada
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain.
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
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Affiliation(s)
- Pere Domingo
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Sant Quintí, 89, Barcelona 08041, Spain.
| | - Natividad de Benito
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Sant Quintí, 89, Barcelona 08041, Spain
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Gutiérrez-Villanueva A, Muñoz P, Delgado-Montero A, Olmedo-Samperio M, de Alarcón A, Gutiérrez-Carretero E, Zarauza J, García I Pares D, Goenaga MÁ, Ojeda-Burgos G, Goikoetxea-Agirre AJ, Reguera-Iglesias JM, Ramos A, Fernández-Cruz A. Mural Endocarditis: The GAMES Registry Series and Review of the Literature. Infect Dis Ther 2021; 10:2749-2764. [PMID: 34312819 PMCID: PMC8572950 DOI: 10.1007/s40121-021-00490-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Mural infective endocarditis (MIE) is a rare type of endovascular infection. We present a comprehensive series of patients with mural endocarditis. METHODS Patients with infectious endocarditis (IE) from 35 Spanish hospitals were prospectively included in the GAMES registry between 2008 and 2017. MIEs were compared to non-MIEs. We also performed a literature search for cases of MIE published between 1979 and 2019 and compared them to the GAMEs series. RESULTS Twenty-seven MIEs out of 3676 IEs were included. When compared to valvular IE (VIE) or device-associated IE (DIE), patients with MIE were younger (median age 59 years, p < 0.01). Transplantation (18.5% versus 1.6% VIE and 2% DIE, p < 0.01), hemodialysis (18.5% versus 4.3% VIE and 4.4% DIE, p = 0.006), catheter source (59.3% versus 9.7% VIE and 8.8% DIE, p < 0.01) and Candida etiology (22.2% versus 2% DIE and 1.2% VIE, p < 0.01) were more common in MIE, whereas the Charlson Index was lower (4 versus 5 in non-MIE, p = 0.006). Mortality was similar. MIE from the literature shared many characteristics with MIE from GAMES, although patients were younger (45 years vs. 56 years, p < 0.001), the Charlson Index was lower (1.3 vs. 4.3, p = 0.0001), catheter source was less common (13.9% vs. 59.3%) and there were more IVDUs (25% vs. 3.7%). S. aureus was the most frequent microorganism (50%, p = 0.035). Systemic complications were more common but mortality was similar. CONCLUSION MIE is a rare entity. It is often a complication of catheter use, particularly in immunocompromised and hemodialysis patients. Fungal etiology is common. Mortality is similar to other IEs.
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Affiliation(s)
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - María Olmedo-Samperio
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - Encarnación Gutiérrez-Carretero
- Cardiac Surgery Department, CIBERCV, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - Jesús Zarauza
- Cardiology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Delia García I Pares
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- Internal Medicine Service, Clinica Sagrada Familia, Barcelona, Spain
| | - Miguel Ángel Goenaga
- Infectious Diseases Department, Hospital Universitario Donosti, ISS Biodonostia, San Sebastián, Spain
| | - Guillermo Ojeda-Burgos
- Infectious Diseases Clinical Unit, Hospital Universitario Virgen de La Victoria, Málaga, Spain
| | | | | | - Antonio Ramos
- Infectious Diseases Unit, Internal Medicine Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Ana Fernández-Cruz
- Infectious Diseases Unit, Internal Medicine Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain.
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Babich T, Naucler P, Valik JK, Giske CG, Benito N, Cardona R, Rivera A, Pulcini C, Abdel Fattah M, Haquin J, MacGowan A, Grier S, Gibbs J, Chazan B, Yanovskay A, Ami RB, Landes M, Nesher L, Zaidman-Shimshovitz A, McCarthy K, Paterson DL, Tacconelli E, Buhl M, Mauer S, Rodriguez-Bano J, Morales I, Oliver A, Ruiz de Gopegui E, Cano A, Machuca I, Gozalo-Marguello M, Martinez LM, Gonzalez-Barbera EM, Alfaro IG, Salavert M, Beovic B, Saje A, Mueller-Premru M, Pagani L, Vitrat V, Kofteridis D, Zacharioudaki M, Maraki S, Weissman Y, Paul M, Dickstein Y, Leibovici L, Yahav D. Combination versus monotherapy as definitive treatment for Pseudomonas aeruginosa bacteraemia: a multicentre retrospective observational cohort study. J Antimicrob Chemother 2021; 76:2172-2181. [PMID: 33993273 DOI: 10.1093/jac/dkab134] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/31/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pseudomonas aeruginosa bacteraemia is a common and serious infection. No consensus exists regarding whether definitive combination therapy is superior to monotherapy. We aimed to evaluate the impact of combination therapy on mortality. METHODS This was a multicentre retrospective study (nine countries, 25 centres), including 1277 patients with P. aeruginosa bacteraemia during 2009-15. We evaluated the association between β-lactam plus aminoglycoside or quinolone combination therapy versus β-lactam monotherapy and mortality. The primary outcome was 30 day all-cause mortality. Univariate and multivariate Cox regression analyses were conducted, introducing combination as a time-dependent variable. Propensity score was conducted to adjust for confounding for choosing combination therapy over monotherapy. RESULTS Of 1119 patients included, 843 received definitive monotherapy and 276 received combination therapy (59% aminoglycoside and 41% quinolone). Mortality at 30 days was 16.9% (189/1119) and was similar between combination (45/276; 16.3%) and monotherapy (144/843; 17.1%) groups (P = 0.765). In multivariate Cox regression, combination therapy was not associated with reduced mortality (HR 0.98, 95% CI 0.64-1.53). No advantage in terms of clinical failure, microbiological failure or recurrent/persistent bacteraemia was demonstrated using combination therapy. Likewise, adverse events and resistance development were similar for the two regimens. CONCLUSIONS In this retrospective cohort, no mortality advantage was demonstrated using combination therapy over monotherapy for P. aeruginosa bacteraemia. Combination therapy did not improve clinical or microbiological failure rates, nor affect adverse events or resistance development. Our finding of no benefit with combination therapy needs confirmation in well-designed randomized controlled trials.
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Affiliation(s)
- Tanya Babich
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Pontus Naucler
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - John Karlsson Valik
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Christian G Giske
- Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Natividad Benito
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ruben Cardona
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alba Rivera
- Department of Microbiology, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Celine Pulcini
- Université de Lorraine, APEMAC, F-54000, Nancy, France
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000, Nancy, France
| | - Manal Abdel Fattah
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000, Nancy, France
| | - Justine Haquin
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000, Nancy, France
| | - Alasdair MacGowan
- Department of Infection Sciences, Pathology Sciences Building, Southmead Hospital, Bristol, UK
| | - Sally Grier
- Department of Infection Sciences, Pathology Sciences Building, Southmead Hospital, Bristol, UK
| | - Julie Gibbs
- Department of Infection Sciences, Pathology Sciences Building, Southmead Hospital, Bristol, UK
| | - Bibiana Chazan
- Infectious Diseases Unit, Emek Medical Center, Afula, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Anna Yanovskay
- Infectious Diseases Unit, Emek Medical Center, Afula, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ronen Ben Ami
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- Infectious Diseases Unit, Sourasky Medical Center, Tel-Aviv, Israel
| | - Michal Landes
- Infectious Diseases Unit, Sourasky Medical Center, Tel-Aviv, Israel
| | - Lior Nesher
- Infectious Disease Institute, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Adi Zaidman-Shimshovitz
- Infectious Disease Institute, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Kate McCarthy
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - David L Paterson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Evelina Tacconelli
- Division of Infectious Diseases, Tuebingen University Hospital, Tuebingen, Germany
| | - Michael Buhl
- Division of Infectious Diseases, Tuebingen University Hospital, Tuebingen, Germany
| | - Susanna Mauer
- Division of Infectious Diseases, Tuebingen University Hospital, Tuebingen, Germany
| | - Jesus Rodriguez-Bano
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Isabel Morales
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Antonio Oliver
- Servicio de Microbiología & Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Enrique Ruiz de Gopegui
- Servicio de Microbiología & Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Angela Cano
- Infectious Diseases Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Spain
| | - Isabel Machuca
- Infectious Diseases Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Spain
| | | | - Luis Martinez Martinez
- Microbiology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | | | - Miguel Salavert
- Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Bojana Beovic
- Department of Infectious Diseases, University Medical Centre, Ljubljana; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Andreja Saje
- Department of Infectious Diseases, University Medical Centre, Ljubljana; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Manica Mueller-Premru
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Virginie Vitrat
- Infectious Diseases Unit, Annecy-Genevois Hospital Center (CHANGE), Annecy, France
| | - Diamantis Kofteridis
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Maria Zacharioudaki
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Sofia Maraki
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Yulia Weissman
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Mical Paul
- Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Yaakov Dickstein
- Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Leonard Leibovici
- Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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Domingo P, Pomar V, Mur I, Castellví I, Corominas H, de Benito N. Not all COVID-19 pandemic waves are alike. Clin Microbiol Infect 2021; 27:1040.e7-1040.e10. [PMID: 33887469 PMCID: PMC8054531 DOI: 10.1016/j.cmi.2021.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We aimed to assess differences in patients' profiles in the first two surges of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in Barcelona, Spain. METHODS We prospectively collected data from all adult patients with SARS-CoV-2 infection diagnosed at the Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. All the patients were diagnosed through nasopharyngeal swab PCR. The first surge spanned from 1st March to 13th August 2020, while surge two spanned from 14th August to 8th December 2020. RESULTS There were 2479 and 852 patients with microbiologically proven SARS-CoV-2 infection in surges one and two, respectively. Patients from surge two were significantly younger (median age 52 (IQR 35) versus 59 (40) years, respectively, p < 0.001), had fewer comorbidities (379/852, 44.5% versus 1237/2479, 49.9%, p 0.007), and there was a shorter interval between onset of symptoms and diagnosis (median 3 (5) versus 4 (5) days, p < 0.001). All-cause in-hospital mortality significantly decreased for both the whole population (24/852, 2.8% versus 218/2479, 8.8%, p < 0.001) and hospitalized patients (20/302, 6.6% versus 206/1570, 13.1%, p 0.012). At adjusted logistic regression analysis, predictors of in-hospital mortality were older age (per year, adjusted odds ratio (aOR) 1.079, 95%CI 1.063-1.094), male sex (aOR 1.476, 95%CI 1.079-2.018), having comorbidities (aOR 1.414, 95%CI 0.934-2.141), ICU admission (aOR 3.812, 95%CI 1.875-7.751), mechanical ventilation (aOR 2.076, 95%CI 0.968-4.454), and coronavirus disease 2019 (COVID-19) during surge one (with respect to surge two) (aOR 2.176, 95%CI 1.286-3.680). CONCLUSIONS First-wave SARS-CoV-2-infected patients had a more than two-fold higher in-hospital mortality than second-wave patients. The causes are likely multifactorial.
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Affiliation(s)
- Pere Domingo
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Virgina Pomar
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Isabel Mur
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ivan Castellví
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Héctor Corominas
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Natividad de Benito
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Gutiérrez-Gutiérrez B, Del Toro MD, Borobia AM, Carcas A, Jarrín I, Yllescas M, Ryan P, Pachón J, Carratalà J, Berenguer J, Arribas JR, Rodríguez-Baño J. Identification and validation of clinical phenotypes with prognostic implications in patients admitted to hospital with COVID-19: a multicentre cohort study. Lancet Infect Dis 2021; 21:783-792. [PMID: 33636145 PMCID: PMC7906623 DOI: 10.1016/s1473-3099(21)00019-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [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] [Received: 10/04/2020] [Revised: 12/06/2020] [Accepted: 01/06/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The clinical presentation of COVID-19 in patients admitted to hospital is heterogeneous. We aimed to determine whether clinical phenotypes of patients with COVID-19 can be derived from clinical data, to assess the reproducibility of these phenotypes and correlation with prognosis, and to derive and validate a simplified probabilistic model for phenotype assignment. Phenotype identification was not primarily intended as a predictive tool for mortality. METHODS In this study, we used data from two cohorts: the COVID-19@Spain cohort, a retrospective cohort including 4035 consecutive adult patients admitted to 127 hospitals in Spain with COVID-19 between Feb 2 and March 17, 2020, and the COVID-19@HULP cohort, including 2226 consecutive adult patients admitted to a teaching hospital in Madrid between Feb 25 and April 19, 2020. The COVID-19@Spain cohort was divided into a derivation cohort, comprising 2667 randomly selected patients, and an internal validation cohort, comprising the remaining 1368 patients. The COVID-19@HULP cohort was used as an external validation cohort. A probabilistic model for phenotype assignment was derived in the derivation cohort using multinomial logistic regression and validated in the internal validation cohort. The model was also applied to the external validation cohort. 30-day mortality and other prognostic variables were assessed in the derived phenotypes and in the phenotypes assigned by the probabilistic model. FINDINGS Three distinct phenotypes were derived in the derivation cohort (n=2667)-phenotype A (516 [19%] patients), phenotype B (1955 [73%]) and phenotype C (196 [7%])-and reproduced in the internal validation cohort (n=1368)-phenotype A (233 [17%] patients), phenotype B (1019 [74%]), and phenotype C (116 [8%]). Patients with phenotype A were younger, were less frequently male, had mild viral symptoms, and had normal inflammatory parameters. Patients with phenotype B included more patients with obesity, lymphocytopenia, and moderately elevated inflammatory parameters. Patients with phenotype C included older patients with more comorbidities and even higher inflammatory parameters than phenotype B. We developed a simplified probabilistic model (validated in the internal validation cohort) for phenotype assignment, including 16 variables. In the derivation cohort, 30-day mortality rates were 2·5% (95% CI 1·4-4·3) for patients with phenotype A, 30·5% (28·5-32·6) for patients with phenotype B, and 60·7% (53·7-67·2) for patients with phenotype C (log-rank test p<0·0001). The predicted phenotypes in the internal validation cohort and external validation cohort showed similar mortality rates to the assigned phenotypes (internal validation cohort: 5·3% [95% CI 3·4-8·1] for phenotype A, 31·3% [28·5-34·2] for phenotype B, and 59·5% [48·8-69·3] for phenotype C; external validation cohort: 3·7% [2·0-6·4] for phenotype A, 23·7% [21·8-25·7] for phenotype B, and 51·4% [41·9-60·7] for phenotype C). INTERPRETATION Patients admitted to hospital with COVID-19 can be classified into three phenotypes that correlate with mortality. We developed and validated a simplified tool for the probabilistic assignment of patients into phenotypes. These results might help to better classify patients for clinical management, but the pathophysiological mechanisms of the phenotypes must be investigated. FUNDING Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Fundación SEIMC/GeSIDA.
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Affiliation(s)
- Belén Gutiérrez-Gutiérrez
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain; Departamento de Medicina, Universidad de Sevilla, Seville, Spain; Instituto de Biomedicina de Sevilla, Seville, Spain
| | - María Dolores Del Toro
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain; Departamento de Medicina, Universidad de Sevilla, Seville, Spain; Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Alberto M Borobia
- Departamento de Farmacología Clínica, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación La Paz, Madrid, Spain
| | - Antonio Carcas
- Departamento de Farmacología Clínica, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación La Paz, Madrid, Spain
| | - Inmaculada Jarrín
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Pablo Ryan
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Jerónimo Pachón
- Departamento de Medicina, Universidad de Sevilla, Seville, Spain; Instituto de Biomedicina de Sevilla, Seville, Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Jordi Carratalà
- Servei de Malalties Infeccioses, Hospital Universitari de Bellvitge, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Juan Berenguer
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Jose Ramón Arribas
- Instituto de Investigación La Paz, Madrid, Spain; Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain; Departamento de Medicina, Universidad de Sevilla, Seville, Spain; Instituto de Biomedicina de Sevilla, Seville, Spain.
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Corominas H, Castellví I, Diaz-Torné C, Matas L, de la Rosa D, Mangues MA, Moya P, Pomar V, Benito N, Moga E, Sosa NHD, Casademont J, Domingo P. Sarilumab (IL-6R antagonist) in critically ill patients with cytokine release syndrome by SARS-CoV2. Medicine (Baltimore) 2021; 100:e25923. [PMID: 34106658 PMCID: PMC8133253 DOI: 10.1097/md.0000000000025923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/12/2021] [Indexed: 02/05/2023] Open
Abstract
Blocking IL-6 pathways with sarilumab, a fully human anti-IL-6R antagonist may potentially curb the inflammatory storm of SARS-CoV2. In the present emergency scenario, we used "off-label" sarilumab in 5 elderly patients in life-threatening condition not candidates to further active measures. We suggest that sarilumab can modulate severe COVID-19-associated Cytokine Release Syndrome.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ester Moga
- Servei Immunologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
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Vilchez HH, Escudero-Sanchez R, Fernandez-Sampedro M, Murillo O, Auñón Á, Rodríguez-Pardo D, Jover-Sáenz A, del Toro MD, Rico A, Falgueras L, Praena-Segovia J, Guío L, Iribarren JA, Lora-Tamayo J, Benito N, Morata L, Ramirez A, Riera M. Prosthetic Shoulder Joint Infection by Cutibacterium acnes: Does Rifampin Improve Prognosis? A Retrospective, Multicenter, Observational Study. Antibiotics (Basel) 2021; 10:antibiotics10050475. [PMID: 33919103 PMCID: PMC8143127 DOI: 10.3390/antibiotics10050475] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023] Open
Abstract
This retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of C. acnes-related prosthetic joint infection (PJI) and the potential benefit of rifampin-based therapies. Patients with C. acnes-related PJI who were diagnosed and treated between January 2003 and December 2016 were included. We analyzed 44 patients with C. acnes-related PJI (median age, 67.5 years (IQR, 57.3-75.8)); 75% were men. The majority (61.4%) had late chronic infection according to the Tsukayama classification. All patients received surgical treatment, and most antibiotic regimens (43.2%) included β-lactam. Thirty-four patients (87.17%) were cured; five showed relapse. The final outcome (cure vs. relapse) showed a nonsignificant trend toward higher failure frequency among patients with previous prosthesis (OR: 6.89; 95% CI: 0.80-58.90) or prior surgery and infection (OR: 10.67; 95% IC: 1.08-105.28) in the same joint. Patients treated with clindamycin alone had a higher recurrence rate (40.0% vs. 8.8%). Rifampin treatment did not decrease recurrence in patients treated with β-lactams. Prior prosthesis, surgery, or infection in the same joint might be related to recurrence, and rifampin-based combinations do not seem to improve prognosis. Debridement and implant retention appear a safe option for surgical treatment of early PJI.
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Affiliation(s)
- Helem H. Vilchez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Fundació Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain;
- Correspondence: ; Tel.: +34-653419331
| | - Rosa Escudero-Sanchez
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | - Marta Fernandez-Sampedro
- Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marqués de Valdecilla-IDIVAL, 39008 Cantabria, Spain;
| | - Oscar Murillo
- Infectious Diseases Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain;
| | - Álvaro Auñón
- Bone and Joint Infection Unit, Department of Orthopaedic Surgery, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Dolors Rodríguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
| | - Alfredo Jover-Sáenz
- Unit of Nosocomial Infection, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain;
| | - Mª Dolores del Toro
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena CSIC, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, 41009 Sevilla, Spain;
| | - Alicia Rico
- Infectious Diseases Unit and Clinical Microbiology, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Luis Falgueras
- Infectious Diseases Department, Corporació Sanitària Parc Taulí, 08208 Barcelona, Spain;
| | - Julia Praena-Segovia
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio, 41013 Sevilla, Spain;
| | - Laura Guío
- Infectious Diseases Department, Hospital Universitario Cruces, 48903 Vizcaya, Spain;
| | - José A. Iribarren
- Infectious Diseases Department, Hospital Universitario Donostia, Instituto BioDonostia, 20014 San Sebastián, Spain;
| | - Jaime Lora-Tamayo
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre “i + 12”, 28041 Madrid, Spain;
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau-Institut d’Investigació Biomèdica Sant Pau, Departament of Medicine, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain;
| | - Antonio Ramirez
- Microbiologic Department, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain;
| | - Melchor Riera
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Fundació Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain;
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12
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Corominas H, Castellví I, Pomar V, Antonijoan R, Mur I, Matas L, Gich I, de Benito N, Laiz A, Castillo D, Villamarin L, Filella D, Millán AM, Quijada MÁ, Puig M, Casademont J, Domingo P. Effectiveness and safety of intravenous tocilizumab to treat COVID-19-associated hyperinflammatory syndrome: Covizumab-6 observational cohort. Clin Immunol 2021; 223:108631. [PMID: 33189888 PMCID: PMC7658611 DOI: 10.1016/j.clim.2020.108631] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 02/05/2023]
Abstract
Although the starting event in COVID-19 is a viral infection some patients present with an over-exuberant inflammatory response, leading to acute lung injury (ALI) and adult respiratory distress syndrome (ARDS). Since IL-6 plays a critical role in the inflammatory response, we assessed the efficacy and safety of tocilizumab (TCZ) in this single-centre, observational study in all Covid-19 in-patient with a proven SARS-CoV-2 rapidly progressing infection to prevent ALI and ARDS. 104 patients with COVID-19 treated with TCZ had a lower mortality rate (5·8%) compared with the regional mortality rate (11%), hospitalized patient's mortality (10%), and slightly lower than hospitalized patients treated with our standard of care alone (6%). We found that TCZ rapidly decreased acute phase reactants, ferritin and liver release of proteins. D-Dimer decreased slowly. We did not observe specific safety concerns. Early administration of IL6-R antagonists in COVID-19 patients with impending hyperinflammatory response, may be safe and effective treatment to prevent, ICU admission and further complications.
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Affiliation(s)
- Hèctor Corominas
- Servei de Reumatologia, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain.
| | - Ivan Castellví
- Servei de Reumatologia, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain
| | - Virginia Pomar
- Servei de Medicina Interna, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain
| | - Rosa Antonijoan
- Servei de Farmacología (CIBERSAM), Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain
| | - Isabel Mur
- Servei de Medicina Interna, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Laia Matas
- Servei de Medicina Interna, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain
| | - Ignasi Gich
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain
| | - Natividad de Benito
- Servei de Medicina Interna, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain
| | - Ana Laiz
- Servei de Reumatologia, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain
| | - Diego Castillo
- Servei de Respiratori, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain
| | - Laura Villamarin
- Servei de Farmàcia, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | - David Filella
- Servei de Medicina Interna, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain
| | - Ana Milena Millán
- Servei de Reumatologia, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | - María Ángeles Quijada
- Servei de Farmacología (CIBERSAM), Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Mireia Puig
- Servei d'Urgències, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain
| | - Jordi Casademont
- Servei de Medicina Interna, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain
| | - Pere Domingo
- Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
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Gómez-Junyent J, Lora-Tamayo J, Baraia-Etxaburu J, Sánchez-Somolinos M, Iribarren JA, Rodriguez-Pardo D, Praena-Segovia J, Sorlí L, Bahamonde A, Riera M, Rico A, del Toro MD, Morata L, Cobo J, Falgueras L, Benito N, Muñez E, Jover-Sáenz A, Pigrau C, Ariza J, Murillo O. Implant Removal in the Management of Prosthetic Joint Infection by Staphylococcus aureus: Outcome and Predictors of Failure in a Large Retrospective Multicenter Study. Antibiotics (Basel) 2021; 10:antibiotics10020118. [PMID: 33530523 PMCID: PMC7911003 DOI: 10.3390/antibiotics10020118] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To compare the characteristics and outcomes of cases with acute prosthetic joint infection (PJI; early post-surgical or hematogenous) by Staphylococcus aureus managed with implant removal (IRm) or debridement and retention (DAIR). To analyze the outcomes of all cases managed with IRm (initially or after DAIR failure). METHODS Retrospective, multicenter, cohort study of PJI by S. aureus (2003-2010). Overall failure included mortality within 60 days since surgery and local failure due to staphylococcal persistence/relapse. RESULTS 499 cases, 338 initially managed with DAIR, 161 with IRm. Mortality was higher in acute PJI managed initially with IRm compared to DAIR, but not associated with the surgical procedure, after propensity score matching. Underlying conditions, hemiarthroplasty, and methicillin-resistant S. aureus were risk factors for mortality. Finally, 249 cases underwent IRm (88 after DAIR failure); overall failure was 15.6%. Local failure (9.3%) was slightly higher in cases with several comorbidities, but independent of previous DAIR, type of IRm, and rifampin treatment. CONCLUSIONS In a large multicenter study of S. aureus PJI managed with IRm, failure was low, but mortality significant, especially in cases with acute PJI and underlying conditions, but not associated with the IRm itself. Rifampin efficacy was limited in this setting.
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Affiliation(s)
- Joan Gómez-Junyent
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain; (J.G.-J.); (J.A.)
| | - Jaime Lora-Tamayo
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Josu Baraia-Etxaburu
- Department of Infectious Diseases, Hospital Universitario de Basurto, 48013 Bilbao, Spain;
| | - Mar Sánchez-Somolinos
- Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain;
| | - Jose Antonio Iribarren
- Department of Infectious Diseases, Hospital Universitario Donostia, Universidad del País Vasco (EHU/UPV), 20014 San Sebastián, Spain;
- IIS BioDonostia, 20014 San Sebastián, Spain
| | - Dolors Rodriguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (D.R.-P.); (C.P.)
| | - Julia Praena-Segovia
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain;
| | - Luisa Sorlí
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
| | - Alberto Bahamonde
- Department of Internal Medicine, Hospital El Bierzo, 24411 Ponferrada, Spain;
| | - Melchor Riera
- Fundació Institut d’Investigació Sanitària Illes Balears, Hospital Universitari Son Espases, 07120 Palma, Spain;
| | - Alicia Rico
- Unit of Infectious Diseases and Clinical Microbiology, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Mª Dolores del Toro
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, Department of Medicine, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS), 41009 Seville, Spain;
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, 08036 Barcelona, Spain;
| | - Javier Cobo
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | - Luis Falgueras
- Department of Infectious Diseases, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain;
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau- Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain;
- Department of Medicine, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
| | - Elena Muñez
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario Puerta de Hierro, 28220 Madrid, Spain;
| | - Alfredo Jover-Sáenz
- Territorial Unit of Nosocomial Infections, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain;
| | - Carles Pigrau
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (D.R.-P.); (C.P.)
| | - Javier Ariza
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain; (J.G.-J.); (J.A.)
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0005), 41071 Sevilla, Spain
| | - Oscar Murillo
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain; (J.G.-J.); (J.A.)
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0005), 41071 Sevilla, Spain
- Correspondence: ; Tel.: +34-93-260-76-25
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Del Toro López MD, Arias Díaz J, Balibrea JM, Benito N, Canut Blasco A, Esteve E, Horcajada JP, Ruiz Mesa JD, Vázquez AM, Muñoz Casares C, Del Pozo JL, Pujol M, Riera M, Jimeno J, Rubio Pérez I, Ruiz-Tovar Polo J, Serrablo A, Soriano A, Badia JM. Executive summary of the Consensus Document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and of the Spanish Association of Surgeons (AEC) in antibiotic prophylaxis in surgery. Enferm Infecc Microbiol Clin 2021; 39:29-40. [PMID: 32709452 DOI: 10.1016/j.eimc.2020.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 02/05/2023]
Abstract
Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and bacterial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. La Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery.
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Affiliation(s)
- Mª Dolores Del Toro López
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Universidad de Sevilla, IBIS, Sevilla, Spain.
| | - Javier Arias Díaz
- Servicio de Cirugía, Hospital Clínico San Carlos, y Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - José M Balibrea
- Servicio de Cirugía Gastrointestinal ICMDM, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Natividad Benito
- Unidad de Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrés Canut Blasco
- Servicio de Microbiología, Hospital Universitario de Álava, Vitoria-Gasteiz, Spain
| | - Erika Esteve
- Servicio de Enfermedades Infecciosas, Hospital Del Mar, IMIM, Barcelona, Spain
| | | | - Juan Diego Ruiz Mesa
- Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Alba Manuel Vázquez
- Servicio de Cirugía General, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - Jose Luis Del Pozo
- Servicio de Enfermedades Infecciosas y Microbiología, Clínica Universidad de Navarra, Universidad de Navarra, Spain
| | - Miquel Pujol
- Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Melchor Riera
- Servicio de Enfermedades Infecciosas, Hospital Son Espases, Palma de Mallorca, Spain
| | - Jaime Jimeno
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Inés Rubio Pérez
- Servicio de Cirugía General, Hospital Universitario La Paz, Madrid, Spain
| | | | - Alejandro Serrablo
- Servicio de Cirugía General, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Alex Soriano
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Josep M Badia
- Servicio de Cirugía General, Hospital General de Granollers, Universitat Internacional de Catalunya, Spain
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Pericàs JM, Ambrosioni J, Muñoz P, de Alarcón A, Kestler M, Mari-Hualde A, Moreno A, Goenaga MÁ, Fariñas MC, Rodríguez-Álvarez R, Ojeda-Burgos G, Gálvez-Acebal J, Hidalgo-Tenorio C, Noureddine M, Miró JM. Prevalence of Colorectal Neoplasms Among Patients With Enterococcus faecalis Endocarditis in the GAMES Cohort (2008-2017). Mayo Clin Proc 2021; 96:132-146. [PMID: 33413809 DOI: 10.1016/j.mayocp.2020.06.056] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/08/2020] [Accepted: 06/01/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To investigate the rate of colorectal neoplasms (CRNs) in patients who have Enterococcus faecalis infective endocarditis (EFIE) with available colonoscopies and to assess whether this is associated with the identification of a focus the infection. PATIENTS AND METHODS Retrospective analysis of data from a prospective multicenter study involving 35 centers who are members of the Grupo de Apoyo para el Manejo de la Endocarditis en España [Support Group for the Management of Infective Endocarditis in Spain] cohort. A specific set of queries regarding information on colonoscopy and histopathology of colorectal diseases was sent to each participating center. Four-hundred sixty-seven patients with EFIE were included from January 1, 2008, to December 31, 2017, from whom data on colonoscopy performance and results were available in 411 patients. RESULTS One hundred forty-two (34.5%) patients had a colonoscopy close to the EFIE episode. The overall rate of colorectal diseases was 70.4% (100 of 142), whereas the prevalence of CRN (advanced adenomas and colorectal carcinoma) was 14.8% (21 of 142), with no significant differences between the group of EFIE of unknown focus and that with an identified focus. CONCLUSION Our study adds to prior evidence suggesting a much higher rate of CRN among patients with EFIE than in the general population of the same age and sex. In addition, our findings suggest that this phenomenon might take place both in EFIE with an unknown and an identified source of infection.
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Affiliation(s)
- Juan M Pericàs
- Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Vall d'Hebron Institute for Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Juan Ambrosioni
- Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Martha Kestler
- Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Amaia Mari-Hualde
- Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Asunción Moreno
- Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Miguel Á Goenaga
- Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital Universitario Donostia, Donostia, Spain
| | | | | | | | | | | | - Mariam Noureddine
- Hospital Universitario Virgen de la Macarena, Universidad de Sevilla, Seville, Spain
| | - José M Miró
- Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
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Del Toro López MD, Arias Díaz J, Balibrea JM, Benito N, Canut Blasco A, Esteve E, Horcajada JP, Ruiz Mesa JD, Manuel Vázquez A, Muñoz Casares C, Del Pozo JL, Pujol M, Riera M, Jimeno J, Rubio Pérez I, Ruiz-Tovar Polo J, Serrablo A, Soriano A, Badia JM. Executive summary of the Consensus Document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and of the Spanish Association of Surgeons (AEC) in antibiotic prophylaxis in surgery. Cir Esp 2021; 99:11-26. [PMID: 32736791 DOI: 10.1016/j.ciresp.2020.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/01/2020] [Indexed: 02/08/2023]
Abstract
Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and antimicrobial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. The Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis in surgery to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery.
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Affiliation(s)
- M Dolores Del Toro López
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Universidad de Sevilla, IBIS, Sevilla, España.
| | - Javier Arias Díaz
- Servicio de Cirugía, Hospital Clínico San Carlos, y Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - José M Balibrea
- Servicio de Cirugía Gastrointestinal ICMDM, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - Natividad Benito
- Unidad de Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Andrés Canut Blasco
- Servicio de Microbiología, Hospital Universitario de Álava, Vitoria-Gasteiz, Álava, España
| | - Erika Esteve
- Servicio de Enfermedades Infecciosas, Hospital del Mar, IMIM, Barcelona, España
| | | | - Juan Diego Ruiz Mesa
- Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, IBIMA, Málaga, España
| | - Alba Manuel Vázquez
- Servicio de Cirugía General, Hospital Universitario de Guadalajara, Guadalajara, España
| | | | - Jose Luis Del Pozo
- Servicio de Enfermedades Infecciosas y Microbiología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, España
| | - Miquel Pujol
- Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Melchor Riera
- Servicio de Enfermedades Infecciosas, Hospital Son Espases, Palma, Mallorca, España
| | - Jaime Jimeno
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - Inés Rubio Pérez
- Servicio de Cirugía General, Hospital Universitario La Paz, Madrid, España
| | - Jaime Ruiz-Tovar Polo
- Servicio de Cirugía General, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España
| | - Alejandro Serrablo
- Servicio de Cirugía General, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Alex Soriano
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Josep M Badia
- Servicio de Cirugía General, Hospital General de Granollers, Universitat Internacional de Catalunya, Granollers, Barcelona, España
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17
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Rivera A, Sánchez A, Luque S, Mur I, Puig L, Crusi X, González JC, Sorlí L, González A, Horcajada JP, Navarro F, Benito N. Intraoperative Bacterial Contamination and Activity of Different Antimicrobial Prophylaxis Regimens in Primary Knee and Hip Replacement. Antibiotics (Basel) 2020; 10:antibiotics10010018. [PMID: 33375415 PMCID: PMC7823842 DOI: 10.3390/antibiotics10010018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 02/05/2023] Open
Abstract
Surgical antimicrobial prophylaxis (SAP) is important for the prevention of prosthetic joint infections (PJIs) and must be effective against the microorganisms most likely to contaminate the surgical site. Our aim was to compare different SAP regimens (cefazolin, cefuroxime, or vancomycin, alone or combined with gentamicin) in patients undergoing total knee (TKA) and hip (THA) arthroplasty. In this preclinical exploratory analysis, we analyzed the results of intraoperative sample cultures, the ratio of plasma antibiotic levels to the minimum inhibitory concentrations (MICs) for bacteria isolated at the surgical wound and ATCC strains, and serum bactericidal titers (SBT) against the same microorganisms. A total of 132 surgical procedures (68 TKA, 64 THA) in 128 patients were included. Cultures were positive in 57 (43.2%) procedures (mostly for coagulase-negative staphylococci and Cutibacterium spp.); the rate was lower in the group of patients receiving combination SAP (adjusted OR 0.475, CI95% 0.229-0.987). The SAP regimens evaluated achieved plasma levels above the MICs in almost all of intraoperative isolates (93/94, 98.9%) and showed bactericidal activity against all of them (SBT range 1:8-1:1024), although SBTs were higher in patients receiving cefazolin and gentamicin-containing regimens. The potential clinical relevance of these findings in the prevention of PJIs remains to be determined.
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Affiliation(s)
- Alba Rivera
- Department of Microbiology, Hospital de la Santa Creu i Sant Pau—Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (A.R.); (A.S.); (F.N.)
- Department of Genetic and Microbiology, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Alba Sánchez
- Department of Microbiology, Hospital de la Santa Creu i Sant Pau—Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (A.R.); (A.S.); (F.N.)
- Department of Genetic and Microbiology, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Sonia Luque
- Department of Pharmacy, Hospital del Mar—Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Isabel Mur
- Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (I.M.); (J.P.H.)
- Infectious Disease Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau—Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain
- Bone and Joint Infection Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), 28003 Madrid, Spain;
| | - Lluís Puig
- Department of Orthopedic Surgery and Traumatology, Hospital del Mar—Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Xavier Crusi
- Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau—Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (X.C.); (J.C.G.); (A.G.)
| | - José Carlos González
- Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau—Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (X.C.); (J.C.G.); (A.G.)
| | - Luisa Sorlí
- Bone and Joint Infection Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), 28003 Madrid, Spain;
- Department of Infectious Diseases, Hospital del Mar—Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
| | - Aránzazu González
- Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau—Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (X.C.); (J.C.G.); (A.G.)
| | - Juan Pablo Horcajada
- Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (I.M.); (J.P.H.)
- Department of Infectious Diseases, Hospital del Mar—Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Ferran Navarro
- Department of Microbiology, Hospital de la Santa Creu i Sant Pau—Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (A.R.); (A.S.); (F.N.)
- Department of Genetic and Microbiology, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Natividad Benito
- Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (I.M.); (J.P.H.)
- Infectious Disease Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau—Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain
- Bone and Joint Infection Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), 28003 Madrid, Spain;
- Correspondence:
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Mur I, Jordán M, Rivera A, Pomar V, González JC, López-Contreras J, Crusi X, Navarro F, Gurguí M, Benito N. Do Prosthetic Joint Infections Worsen the Functional Ambulatory Outcome of Patients with Joint Replacements? A Retrospective Matched Cohort Study. Antibiotics (Basel) 2020; 9:antibiotics9120872. [PMID: 33291401 PMCID: PMC7762011 DOI: 10.3390/antibiotics9120872] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To assess the effect on the functional ambulatory outcome of postoperative joint infection (PJI) cured at the first treatment attempt versus not developing PJI in patients with hip and knee prostheses. METHODS In a single-hospital retrospectively matched cohort study, each patient with PJI between 2007 and 2016 was matched on age, sex, type of prosthesis and year of implantation with two other patients with uninfected arthroplasties. The definition of a PJI cure included infection eradication, no further surgical procedures, no PJI-related mortality and no suppressive antibiotics. Functional ambulatory status evaluated one year after the last surgery was classified into four simple categories: able to walk without assistance, able to walk with one crutch, able to walk with two crutches, and unable to walk. Patients with total hip arthroplasties (THA), total knee arthroplasties (TKA) and partial hip arthroplasty (PHA) were analysed separately. RESULTS A total of 109 PJI patients (38 TKA, 41 THA, 30 PHA) and 218 non-PJI patients were included. In a model adjusted for clinically relevant variables, PJI was associated with a higher risk of needing an assistive device for ambulation (vs. walking without aid) among THA (adjusted odds ratio (OR) 3.10, 95% confidence interval (95% CI) 1.26-7.57; p = 0.014) and TKA patients (OR 5.40, 95% CI 2.12-13.67; p < 0.001), and with requiring two crutches to walk or being unable to walk (vs. walking unaided or with one crutch) among PHA patients (OR 3.05, 95% CI 1.01-9.20; p = 0.047). CONCLUSIONS Ambulatory outcome in patients with hip and knee prostheses with postoperative PJI is worse than in patients who do not have PJI.
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Affiliation(s)
- Isabel Mur
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (I.M.); (V.P.); (J.L.-C.); (M.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Bone and Joint Infection Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), 28003 Madrid, Spain
| | - Marcos Jordán
- Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (M.J.); (J.C.G.); (X.C.)
| | - Alba Rivera
- Department of Microbiology, Hospital Santa Creu i Sant Pau, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; (A.R.); (F.N.)
| | - Virginia Pomar
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (I.M.); (V.P.); (J.L.-C.); (M.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - José Carlos González
- Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (M.J.); (J.C.G.); (X.C.)
| | - Joaquín López-Contreras
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (I.M.); (V.P.); (J.L.-C.); (M.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Bone and Joint Infection Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), 28003 Madrid, Spain
| | - Xavier Crusi
- Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (M.J.); (J.C.G.); (X.C.)
| | - Ferran Navarro
- Department of Microbiology, Hospital Santa Creu i Sant Pau, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; (A.R.); (F.N.)
| | - Mercè Gurguí
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (I.M.); (V.P.); (J.L.-C.); (M.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Natividad Benito
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (I.M.); (V.P.); (J.L.-C.); (M.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Bone and Joint Infection Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), 28003 Madrid, Spain
- Correspondence: ; Tel.: +34-93-556-56-24; Fax: +34-93-553-71-40
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Berenguer J, Ryan P, Rodríguez-Baño J, Jarrín I, Carratalà J, Pachón J, Yllescas M, Arriba JR. Characteristics and predictors of death among 4035 consecutively hospitalized patients with COVID-19 in Spain. Clin Microbiol Infect 2020; 26:1525-1536. [PMID: 32758659 PMCID: PMC7399713 DOI: 10.1016/j.cmi.2020.07.024] [Citation(s) in RCA: 201] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/06/2020] [Accepted: 07/16/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To analyse the characteristics and predictors of death in hospitalized patients with coronavirus disease 2019 (COVID-19) in Spain. METHODS A retrospective observational study was performed of the first consecutive patients hospitalized with COVID-19 confirmed by real-time PCR assay in 127 Spanish centres until 17 March 2020. The follow-up censoring date was 17 April 2020. We collected demographic, clinical, laboratory, treatment and complications data. The primary endpoint was all-cause mortality. Univariable and multivariable Cox regression analyses were performed to identify factors associated with death. RESULTS Of the 4035 patients, male subjects accounted for 2433 (61.0%) of 3987, the median age was 70 years and 2539 (73.8%) of 3439 had one or more comorbidity. The most common symptoms were a history of fever, cough, malaise and dyspnoea. During hospitalization, 1255 (31.5%) of 3979 patients developed acute respiratory distress syndrome, 736 (18.5%) of 3988 were admitted to intensive care units and 619 (15.5%) of 3992 underwent mechanical ventilation. Virus- or host-targeted medications included lopinavir/ritonavir (2820/4005, 70.4%), hydroxychloroquine (2618/3995, 65.5%), interferon beta (1153/3950, 29.2%), corticosteroids (1109/3965, 28.0%) and tocilizumab (373/3951, 9.4%). Overall, 1131 (28%) of 4035 patients died. Mortality increased with age (85.6% occurring in older than 65 years). Seventeen factors were independently associated with an increased hazard of death, the strongest among them including advanced age, liver cirrhosis, low age-adjusted oxygen saturation, higher concentrations of C-reactive protein and lower estimated glomerular filtration rate. CONCLUSIONS Our findings provide comprehensive information about characteristics and complications of severe COVID-19, and may help clinicians identify patients at a higher risk of death.
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Affiliation(s)
- Juan Berenguer
- Hospital General Universitario Gregorio Marañón, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Spain.
| | - Pablo Ryan
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Spain; Hospital Universitario Infanta Leonor, Spain
| | - Jesús Rodríguez-Baño
- Hospital Universitario Virgen Macarena, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; Department of Medicine, Universidad de Sevilla, Spain
| | - Inmaculada Jarrín
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Spain
| | - Jordi Carratalà
- Hospital Universitario de Bellvitge, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Spain; Universitat de Barcelona, Barcelona, Spain
| | - Jerónimo Pachón
- Instituto de Biomedicina de Sevilla (IBiS), Spain; Department of Medicine, Universidad de Sevilla, Spain; Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - José Ramón Arriba
- Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Instituto de Investigación Hospital Universitario La Paz, La Paz, Spain
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Domingo P, Mur I, Pomar V, Corominas H, Casademont J, de Benito N. The four horsemen of a viral Apocalypse: The pathogenesis of SARS-CoV-2 infection (COVID-19). EBioMedicine 2020; 58:102887. [PMID: 32736307 PMCID: PMC7387269 DOI: 10.1016/j.ebiom.2020.102887] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023] Open
Abstract
The pathogenesis of coronavirus disease 2019 (COVID-19) may be envisaged as the dynamic interaction between four vicious feedback loops chained or happening at once. These are the viral loop, the hyperinflammatory loop, the non-canonical renin-angiotensin system (RAS) axis loop, and the hypercoagulation loop. Severe acute respiratory syndrome (SARS)-coronavirus (CoV)-2 lights the wick by infecting alveolar epithelial cells (AECs) and downregulating the angiotensin converting enzyme-2 (ACE2)/angiotensin (Ang-1-7)/Mas1R axis. The viral feedback loop includes evading the host's innate response, uncontrolled viral replication, and turning on a hyperactive adaptative immune response. The inflammatory loop is composed of the exuberant inflammatory response feeding back until exploding in an actual cytokine storm. Downregulation of the ACE2/Ang-(1-7)/Mas1R axis leaves the lung without a critical defense mechanism and turns the scale to the inflammatory side of the RAS. The coagulation loop is a hypercoagulable state caused by the interplay between inflammation and coagulation in an endless feedback loop. The result is a hyperinflammatory and hypercoagulable state producing acute immune-mediated lung injury and eventually, adult respiratory distress syndrome.
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Affiliation(s)
- Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret, 167, 08025 Barcelona, Spain.
| | - Isabel Mur
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret, 167, 08025 Barcelona, Spain
| | - Virginia Pomar
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret, 167, 08025 Barcelona, Spain
| | - Héctor Corominas
- Departments of Rheumatology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jordi Casademont
- Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Natividad de Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret, 167, 08025 Barcelona, Spain
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Babich T, Naucler P, Valik JK, Giske CG, Benito N, Cardona R, Rivera A, Pulcini C, Abdel Fattah M, Haquin J, Macgowan A, Grier S, Gibbs J, Chazan B, Yanovskay A, Ben Ami R, Landes M, Nesher L, Zaidman-Shimshovitz A, McCarthy K, Paterson DL, Tacconelli E, Buhl M, Mauer S, Rodriguez-Bano J, Morales I, Oliver A, Ruiz De Gopegui E, Cano A, Machuca I, Gozalo-Marguello M, Martinez Martinez L, Gonzalez-Barbera EM, Alfaro IG, Salavert M, Beovic B, Saje A, Mueller-Premru M, Pagani L, Vitrat V, Kofteridis D, Zacharioudaki M, Maraki S, Weissman Y, Paul M, Dickstein Y, Leibovici L, Yahav D. Ceftazidime, Carbapenems, or Piperacillin-tazobactam as Single Definitive Therapy for Pseudomonas aeruginosa Bloodstream Infection: A Multisite Retrospective Study. Clin Infect Dis 2020; 70:2270-2280. [PMID: 31323088 DOI: 10.1093/cid/ciz668] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 07/16/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The optimal antibiotic regimen for Pseudomonas aeruginosa bacteremia is controversial. Although β-lactam monotherapy is common, data to guide the choice between antibiotics are scarce. We aimed to compare ceftazidime, carbapenems, and piperacillin-tazobactam as definitive monotherapy. METHODS A multinational retrospective study (9 countries, 25 centers) including 767 hospitalized patients with P. aeruginosa bacteremia treated with β-lactam monotherapy during 2009-2015. The primary outcome was 30-day all-cause mortality. Univariate and multivariate, including propensity-adjusted, analyses were conducted introducing monotherapy type as an independent variable. RESULTS Thirty-day mortality was 37/213 (17.4%), 42/210 (20%), and 55/344 (16%) in the ceftazidime, carbapenem, and piperacillin-tazobactam groups, respectively. Type of monotherapy was not significantly associated with mortality in either univariate, multivariate, or propensity-adjusted analyses (odds ratio [OR], 1.14; 95% confidence interval [CI], 0.52-2.46, for ceftazidime; OR, 1.3; 95% CI, 0.67-2.51, for piperacillin-tazobactam, with carbapenems as reference in propensity adjusted multivariate analysis; 542 patients). No significant difference between antibiotics was demonstrated for clinical failure, microbiological failure, or adverse events. Isolation of P. aeruginosa with new resistance to antipseudomonal drugs was significantly more frequent with carbapenems (36/206 [17.5%]) versus ceftazidime (25/201 [12.4%]) and piperacillin-tazobactam (28/332 [8.4%] (P = .007). CONCLUSIONS No significant difference in mortality, clinical, and microbiological outcomes or adverse events was demonstrated between ceftazidime, carbapenems, and piperacillin-tazobactam as definitive treatment of P. aeruginosa bacteremia. Higher rates of resistant P. aeruginosa after patients were treated with carbapenems, along with the general preference for carbapenem-sparing regimens, suggests using ceftazidime or piperacillin-tazobactam for treating susceptible infection.
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Affiliation(s)
- Tanya Babich
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Pontus Naucler
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - John Karlsson Valik
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Christian G Giske
- Department of Laboratory Medicine, Karolinska Institutet, and Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Natividad Benito
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ruben Cardona
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alba Rivera
- Department of Microbiology, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Celine Pulcini
- APEMAC, France
- CHRU-Nancy, Infectious Diseases Department, Université de Lorraine, France
| | - Manal Abdel Fattah
- CHRU-Nancy, Infectious Diseases Department, Université de Lorraine, France
| | - Justine Haquin
- CHRU-Nancy, Infectious Diseases Department, Université de Lorraine, France
| | - Alasdair Macgowan
- Department of Infection Sciences, Southmead Hospital, Bristol, United Kingdom
| | - Sally Grier
- Department of Infection Sciences, Southmead Hospital, Bristol, United Kingdom
| | - Julie Gibbs
- Department of Infection Sciences, Southmead Hospital, Bristol, United Kingdom
| | - Bibiana Chazan
- Infectious Diseases Unit, Emek Medical Center, Afula, Rappaport Faculty of Medicine, Technion, Haifa
| | - Anna Yanovskay
- Infectious Diseases Unit, Emek Medical Center, Afula, Rappaport Faculty of Medicine, Technion, Haifa
| | - Ronen Ben Ami
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- Infectious Diseases Unit Sourasky Medical Center, Tel-Aviv
| | - Michal Landes
- Infectious Diseases Unit Sourasky Medical Center, Tel-Aviv
| | - Lior Nesher
- Infectious Disease Institute, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Adi Zaidman-Shimshovitz
- Infectious Disease Institute, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Kate McCarthy
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - David L Paterson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | | | - Michael Buhl
- Division of Infectious Diseases, Tübingen University Hospital, Germany
| | - Susanna Mauer
- Division of Infectious Diseases, Tübingen University Hospital, Germany
| | - Jesus Rodriguez-Bano
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla
| | - Isabel Morales
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla
| | - Antonio Oliver
- Servicio de Microbiología and Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca
| | - Enrique Ruiz De Gopegui
- Servicio de Microbiología and Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca
| | - Angela Cano
- Infectious Diseases Unit, Maimonides Biomedical Research Institute of Cordoba, Reina Sofia University Hospital, University of Cordoba, University Hospital Marqués de Valdecilla-IDIVAL, Santander
| | - Isabel Machuca
- Infectious Diseases Unit, Maimonides Biomedical Research Institute of Cordoba, Reina Sofia University Hospital, University of Cordoba, University Hospital Marqués de Valdecilla-IDIVAL, Santander
| | | | | | | | | | - Miguel Salavert
- Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Bojana Beovic
- Department of Infectious Diseases, University Medical Centre, Faculty of Medicine, University of Ljubljana
| | - Andreja Saje
- Department of Infectious Diseases, University Medical Centre, Faculty of Medicine, University of Ljubljana
| | - Manica Mueller-Premru
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Slovenia
| | | | - Virginie Vitrat
- Infectious Diseases Unit, Annecy-Genevois Hospital Center, Annecy, France
| | - Diamantis Kofteridis
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - Maria Zacharioudaki
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - Sofia Maraki
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - Yulia Weissman
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Mical Paul
- Infectious Diseases Unit, Rambam Health Care Campus, Haifa
| | | | | | - Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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Sánchez A, Benito N, Rivera A, García L, Miró E, Mur I, González Y, Gutiérrez C, Horcajada JP, Espinal P, Navarro F. Pathogenesis of Staphylococcus epidermidis in prosthetic joint infections: Can identification of virulence genes differentiate between infecting and commensal strains? J Hosp Infect 2020; 105:S0195-6701(20)30201-2. [PMID: 32339618 DOI: 10.1016/j.jhin.2020.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/17/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Staphylococcus epidermidis is a commensal of human skin flora and a frequent causative microorganism in prosthetic joint infections (PJIs). To date, no single marker has been identified to distinguish infecting strains from commensal S. epidermidis populations. AIM We aimed to find possible genetic markers to distinguish between the two populations. METHODS We analyzed 50 S. epidermidis strains from patients with PJIs, 50 from skin of healthy individuals (commensal strains) and 17 from the surgical field of patients undergoing primary arthroplasty. In these three groups we studied the antimicrobial susceptibility profile, sequence type, biofilm formation, and virulence factors. Strains from the surgical field have not been compared previously with strains from the other two groups. FINDINGS S. epidermidis strains from PJI patients were significantly more antibiotic resistant than commensal strains and surgical field strains. A wide variety of sequences types was found in commensal and surgical field strains. The predominant sequence type was ST2 and it was only present in PJI strains (44%). Differences in biofilm production did not differ between populations. Virulence genes sdrF and bhp, the complete ica operon, and the insertion sequence IS256 were significantly predominant in PJI strains. In contrast, embp and hld genes and the mobile element ACME were more prevalent in commensal strains. Surgical field strains could be a valid control group to discriminate between infecting and commensal strains. CONCLUSION A combination of characteristic features can differentiate between infecting and commensal S. epidermidis strains in PJI, while a single marker cannot.
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Affiliation(s)
- Alba Sánchez
- Department of Microbiology, Hospital de La Santa Creu I Sant Pau, Institut D'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain; Genetics and Microbiology Department. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de La Santa Creu I Sant Pau, Institut D'Investigació Biomèdica Sant Pau (IIB Sant Pau), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Rivera
- Department of Microbiology, Hospital de La Santa Creu I Sant Pau, Institut D'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Lucas García
- Department of Microbiology, Hospital de La Santa Creu I Sant Pau, Institut D'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Elisenda Miró
- Department of Microbiology, Hospital de La Santa Creu I Sant Pau, Institut D'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Isabel Mur
- Infectious Diseases Unit, Hospital de La Santa Creu I Sant Pau, Institut D'Investigació Biomèdica Sant Pau (IIB Sant Pau), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yesica González
- Department of Microbiology, Hospital de La Santa Creu I Sant Pau, Institut D'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Cristina Gutiérrez
- Department of Microbiology, Hospital de La Santa Creu I Sant Pau, Institut D'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Paula Espinal
- Department of Microbiology, Hospital de La Santa Creu I Sant Pau, Institut D'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Ferran Navarro
- Department of Microbiology, Hospital de La Santa Creu I Sant Pau, Institut D'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain; Genetics and Microbiology Department. Universitat Autònoma de Barcelona, Barcelona, Spain.
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Pomar V, de Benito N, Mauri A, Coll P, Gurguí M, Domingo P. Characteristics and outcome of spontaneous bacterial meningitis in patients with diabetes mellitus. BMC Infect Dis 2020; 20:292. [PMID: 32312231 PMCID: PMC7171854 DOI: 10.1186/s12879-020-05023-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/08/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Studies on bacterial meningitis in diabetics patients versus non-diabetics are scarce. In patients with diabetes, bacterial meningitis may have a different presentation, etiology and course. We analyzed and compared the characteristics and outcome of spontaneous BM in adult patients with and without diabetes mellitus (DM). METHODS We performed a single-center, prospective observational cohort study, conducted between 1982 and 2017, in a tertiary university hospital in Barcelona (Spain). The primary outcome measure was in-hospital mortality. RESULTS We evaluated 715 episodes of bacterial meningitis; 106 patients (15%) had diabetes mellitus. Patients with diabetes were older (median 67 [IQR 17] vs 49 [IQR 40] years, p < 0.001) and more often had a Charlson comorbidity score of ≥3 (40% vs 15%, p < 0.001). Neck stiffness (56% vs 75%, p < 0.001), headache (41% vs 78%) p < 0.001), nausea and/or vomiting (32% vs 56% p < 0.001), and rash (12% vs 26%, p = 0.007) were less frequent in diabetics, whereas altered mental status was more common. Streptococcus pneumoniae and Listeria meningitis were the most common etiologic agents (24 and 18%, respectively). Listeria was more frequent (18% vs. 10%, p = 0.033), whereas meningococcal meningitis was less frequent (10% vs 32%, p < 0.001). Overall mortality was higher in patients with diabetes (26% vs 16%, p = 0.025) concerning non-diabetics. CONCLUSIONS Patients with bacterial meningitis and diabetes mellitus are older, have more comorbidities, and higher mortality. S. pneumoniae and L. monocytogenes are the predominant pathogens, Listeria being more common, whereas Neisseria meningitidis is significantly less frequent than in non-diabetics.
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Affiliation(s)
- Virginia Pomar
- Infectious Diseases Unit (Department of Internal Medicine), Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Natividad de Benito
- Infectious Diseases Unit (Department of Internal Medicine), Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Mauri
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pere Coll
- Department of Clinical Microbiology, Hospital de la Santa Creu i Sant Pau. - Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mercè Gurguí
- Infectious Diseases Unit (Department of Internal Medicine), Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Domingo
- Infectious Diseases Unit (Department of Internal Medicine), Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
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Cantón R, Oliver A, Alós JI, de Benito N, Bou G, Campos J, Calvo J, Canut A, Castillo J, Cercenado E, Domínguez MÁ, Fernández-Cuenca F, Guinea J, Larrosa N, Liñares J, López-Cerero L, López-Navas A, Marco F, Mirelis B, Moreno-Romo MÁ, Morosini MI, Navarro F, Oteo J, Pascual Á, Pérez-Trallero E, Pérez-Vázquez M, Soriano A, Torres C, Vila J, Martínez-Martínez L. Recommendations of the Spanish Antibiogram Committee (COESANT) for selecting antimicrobial agents and concentrations for in vitro susceptibility studies using automated systems. Enferm Infecc Microbiol Clin 2020; 38:182-187. [PMID: 30878313 DOI: 10.1016/j.eimc.2019.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/06/2019] [Indexed: 02/05/2023]
Abstract
Automated antimicrobial susceptibility testing devices are widely implemented in clinical microbiology laboratories in Spain, mainly using EUCAST (European Committee on Antimicrobial Susceptibility Testing) breakpoints. In 2007, a group of experts published recommendations for including antimicrobial agents and selecting concentrations in these systems. Under the patronage of the Spanish Antibiogram Committee (Comité Español del Antibiograma, COESANT) and the Study Group on Mechanisms of Action and Resistance to Antimicrobial Agents (GEMARA) from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and aligned with the Spanish National Plan against Antimicrobial Resistance (PRAN), a group of experts have updated this document. The main modifications from the previous version comprise the inclusion of new antimicrobial agents, adaptation of the ranges of concentrations to cover the EUCAST breakpoints and epidemiological cut-off values (ECOFFs), and the inference of new resistance mechanisms. This proposal should be considered by different manufacturers and users when designing new panels or cards. In addition, recommendations for selective reporting are also included. With this approach, the implementation of EUCAST breakpoints will be easier, increasing the quality of antimicrobial susceptibility testing data and their microbiological interpretation. It will also benefit epidemiological surveillance studies as well as the clinical use of antimicrobials aligned with antimicrobial stewardship programs.
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Affiliation(s)
- Rafael Cantón
- Servicio de Microbiología, Hospital Universtario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
| | - Antonio Oliver
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Juan Ignacio Alós
- Servicio de Microbiología, Hospital Universitario de Getafe, Madrid, Spain
| | - Natividad de Benito
- Unidad de Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma, Barcelona, Spain
| | - Germán Bou
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología-INIBIC, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - José Campos
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Jorge Calvo
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Andrés Canut
- Servicio de Microbiología, Hospital Universitario de Álava, Vitoria, Spain
| | - Javier Castillo
- Servicio de Microbiología, Hospital Clínico Universitario, Zaragoza, Spain
| | - Emilia Cercenado
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maria Ángeles Domínguez
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Felipe Fernández-Cuenca
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Virgen Macarena, Sevilla, Spain
| | - Jesús Guinea
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nieves Larrosa
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Josefina Liñares
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Universtario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Lorena López-Cerero
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Virgen Macarena, Sevilla, Spain
| | - Antonio López-Navas
- Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Francesc Marco
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Microbiología, Centro de Diagnóstico Biomédico (CDB), Hospital Clínic, Universidad de Barcelona, and ISGlobal, Barcelona, Spain
| | - Beatriz Mirelis
- Servicio de Microbiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - María Isabel Morosini
- Servicio de Microbiología, Hospital Universtario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Ferran Navarro
- Servicio de Microbiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jesús Oteo
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Álvaro Pascual
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Virgen Macarena, Sevilla, Spain
| | - Emilio Pérez-Trallero
- Servicio de Microbiología, Hospital Universitario Donostia-IIS Biodonostia, San Sebastián, Spain
| | - María Pérez-Vázquez
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Alex Soriano
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - Carmen Torres
- Facultad de Ciencias y Tecnología, Área de Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | - Jordi Vila
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Microbiología, Centro de Diagnóstico Biomédico (CDB), Hospital Clínic, Universidad de Barcelona, and ISGlobal, Barcelona, Spain
| | - Luis Martínez-Martínez
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Unidad de Gestión Clínica de Microbiología, Hospital Reina Sofía, Departamento de Microbiología, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
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25
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Escudero-Sanchez R, Senneville E, Digumber M, Soriano A, Del Toro MD, Bahamonde A, Del Pozo JL, Guio L, Murillo O, Rico A, García-País MJ, Rodríguez-Pardo D, Iribarren JA, Fernández M, Benito N, Fresco G, Muriel A, Ariza J, Cobo J. Suppressive antibiotic therapy in prosthetic joint infections: a multicentre cohort study. Clin Microbiol Infect 2020; 26:499-505. [PMID: 31539638 DOI: 10.1016/j.cmi.2019.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/01/2019] [Accepted: 09/07/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim was to describe the effectiveness of suppressive antibiotic treatment (SAT) in routine clinical practice when used in situations in which removal of a prosthetic implant is considered essential for the eradication of an infection, and it cannot be performed. METHODS This was a descriptive retrospective and multicentre cohort study of prosthetic joint infection (PJI) cases managed with SAT. SAT was considered to have failed if a fistula appeared or persisted, if debridement was necessary, if the prosthesis was removed due to persistence of the infection or if uncontrolled symptoms were present. RESULTS In total, 302 patients were analysed. Two hundred and three of these patients (67.2%) received monotherapy. The most commonly used drugs were tetracyclines (39.7% of patients) (120/302) and cotrimoxazole (35.4% of patients) (107/302). SAT was considered successful in 58.6% (177/302) of the patients (median time administered, 36.5 months; IQR 20.75-59.25). Infection was controlled in 50% of patients at 5 years according to Kaplan-Meier analysis. Resistance development was documented in 15 of 65 (23.1%) of the microbiologically documented cases. SAT failure was associated with age <70 years (sub-hazard ratio (SHR) 1.61, 95% CI 1.1-2.33), aetiology other than Gram-positive cocci (SHR 1.56, 95% CI 1.09-2.27) and location of the prosthesis in the upper limb (SHR 2.4, 95% CI 1.5-3.84). SAT suspension was necessary due to adverse effects in 17 of 302 patients (5.6%). CONCLUSIONS SAT offers acceptable results for patients with PJI when surgical treatment is not performed or when it fails to eradicate the infection.
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Affiliation(s)
| | - E Senneville
- Centre Hospitalier Gustave Dron, Tourcoing, France
| | - M Digumber
- Centre Hospitalier Gustave Dron, Tourcoing, France
| | | | | | | | | | - L Guio
- Hospital Cruces, Vizcaya, Spain
| | - O Murillo
- Hospital Bellvitge, Barcelona, Spain
| | - A Rico
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | - N Benito
- Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | - G Fresco
- Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - A Muriel
- Hospital Ramón y Cajal, IRYCIS, CIBER, Madrid, Spain
| | - J Ariza
- Hospital Bellvitge, Barcelona, Spain
| | - J Cobo
- Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
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26
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Pericàs JM, Llopis J, Muñoz P, Gálvez-Acebal J, Kestler M, Valerio M, Hernández-Meneses M, Goenaga MÁ, Cobo-Belaustegui M, Montejo M, Ojeda-Burgos G, Sousa-Regueiro MD, de Alarcón A, Ramos-Martínez A, Miró JM. A Contemporary Picture of Enterococcal Endocarditis. J Am Coll Cardiol 2020; 75:482-494. [PMID: 32029130 DOI: 10.1016/j.jacc.2019.11.047] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/03/2019] [Accepted: 11/19/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking. OBJECTIVES The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort. METHODS This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses. RESULTS Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p = 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%; p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse. CONCLUSIONS Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE.
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Affiliation(s)
- Juan M Pericàs
- Hospital Clínic de Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain; Clinical Direction of Infectious Diseases and Microbiology, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Jaume Llopis
- Hospital Clínic de Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain; Department of Genetics, Microbiology and Statistics, Universitat de Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan Gálvez-Acebal
- Hospital Universitario Virgen de la Macarena/CSIC/Instituto de Biomedicina de Sevilla (IBiS), Departamento de Medicina, Universidad de Sevilla, Seville, Spain
| | - Martha Kestler
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Maricela Valerio
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | | | - Guillermo Ojeda-Burgos
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | | | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | | | - José M Miró
- Hospital Clínic de Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
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Larrosa MN, Benito N, Cantón R, Canut A, Cercenado E, Fernández-Cuenca F, Guinea J, López-Navas A, Moreno MÁ, Oliver A, Martínez-Martínez L. From CLSI to EUCAST, a necessary step in Spanish laboratories. Enferm Infecc Microbiol Clin 2020; 38:79-83. [PMID: 30409509 DOI: 10.1016/j.eimc.2018.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 02/08/2023]
Abstract
The Spanish Antibiogram Committee (Comité Español del Antibiograma, COESANT) presents in this document a simple "roadmap" or decalogue of recommendations, with a view to facilitating the transition from the Clinical and Laboratory Standards Institute (CLSI) to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) antimicrobial susceptibility testing regulations to the Clinical Microbiology Spanish laboratories that still use the CLSI guidelines. The objectives are to adapt the closer European regulations to the Spanish clinical and epidemiological reality and to fully implement the EUCAST recommendations in all microbiology laboratories in Spain.
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Affiliation(s)
- María Nieves Larrosa
- Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España.
| | - Natividad Benito
- Unidad de Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau), Barcelona, España
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
| | - Andrés Canut
- Servicio de Microbiología, Hospital Universitario de Álava, Instituto de Investigación de Álava (BIOARABA), Vitoria-Gasteiz, España
| | - Emilia Cercenado
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Felipe Fernández-Cuenca
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, España
| | - Jesús Guinea
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Antonio López-Navas
- Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Miguel Ángel Moreno
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense, Madrid, España
| | - Antonio Oliver
- Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, España
| | - Luis Martínez-Martínez
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Reina Sofía, Departamento de Microbiología, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
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28
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Babich T, Naucler P, Valik JK, Giske CG, Benito N, Cardona R, Rivera A, Pulcini C, Fattah MA, Haquin J, MacGowan A, Grier S, Chazan B, Yanovskay A, Ami RB, Landes M, Nesher L, Zaidman-Shimshovitz A, McCarthy K, Paterson DL, Tacconelli E, Buhl M, Maurer S, Rodriguez-Bano J, Morales I, Oliver A, de Gopegui ER, Cano A, Machuca I, Gozalo-Marguello M, Martinez-Martinez L, Gonzalez-Barbera EM, Alfaro IG, Salavert M, Beovic B, Saje A, Mueller-Premru M, Pagani L, Vitrat V, Kofteridis D, Zacharioudaki M, Maraki S, Weissman Y, Paul M, Dickstein Y, Leibovici L, Yahav D. Risk factors for mortality among patients with Pseudomonas aeruginosa bacteraemia: a retrospective multicentre study. Int J Antimicrob Agents 2020; 55:105847. [PMID: 31770625 DOI: 10.1016/j.ijantimicag.2019.11.004] [Citation(s) in RCA: 31] [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: 09/14/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 02/08/2023]
Abstract
This study aimed to evaluate risk factors for 30-day mortality among hospitalised patients with Pseudomonas aeruginosa bacteraemia, a highly fatal condition. A retrospective study was conducted between 1 January 2009 and 31 October 2015 in 25 centres (9 countries) including 2396 patients. Univariable and multivariable analyses of risk factors were conducted for the entire cohort and for patients surviving ≥48 h. A propensity score for predictors of appropriate empirical therapy was introduced into the analysis. Of the 2396 patients, 636 (26.5%) died within 30 days. Significant predictors (odds ratio and 95% confidence interval) of mortality in the multivariable analysis included patient-related factors: age (1.02, 1.01-1.03); female sex (1.34, 1.03-1.77); bedridden functional capacity (1.99, 1.24-3.21); recent hospitalisation (1.43, 1.07-1.92); concomitant corticosteroids (1.33, 1.02-1.73); and Charlson comorbidity index (1.05, 1.01-1.93). Infection-related factors were multidrug-resistant Pseudomonas (1.52, 1.15-2.1), non-urinary source (2.44, 1.54-3.85) and Sequential Organ Failure Assessment (SOFA) score (1.27, 1.18-1.36). Inappropriate empirical therapy was not associated with increased mortality (0.81, 0.49-1.33). Among 2135 patients surviving ≥48 h, hospital-acquired infection (1.59, 1.21-2.09), baseline endotracheal tube (1.63, 1.13-2.36) and ICU admission (1.53, 1.02-2.28) were additional risk factors. Risk factors for mortality among patients with P. aeruginosa were mostly irreversible. Early appropriate empirical therapy was not associated with reduced mortality. Further research should be conducted to explore subgroups that may not benefit from broad-spectrum antipseudomonal empirical therapy. Efforts should focus on prevention of infection, mainly hospital-acquired infection and multidrug-resistant pseudomonal infection.
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Affiliation(s)
- Tanya Babich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pontus Naucler
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - John Karlsson Valik
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Christian G Giske
- Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Natividad Benito
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ruben Cardona
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alba Rivera
- Department of Microbiology, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Celine Pulcini
- Université de Lorraine, APEMAC, F-54000 Nancy, France; Université de Lorraine, CHRU de Nancy, Infectious Diseases Department, F-54000 Nancy, France
| | - Manal Abdel Fattah
- Université de Lorraine, CHRU de Nancy, Infectious Diseases Department, F-54000 Nancy, France
| | - Justine Haquin
- Université de Lorraine, CHRU de Nancy, Infectious Diseases Department, F-54000 Nancy, France
| | - Alasdair MacGowan
- Department of Infection Sciences, Pathology Sciences Building, Southmead Hospital, Bristol, UK
| | - Sally Grier
- Department of Infection Sciences, Pathology Sciences Building, Southmead Hospital, Bristol, UK
| | - Bibiana Chazan
- Infectious Diseases Unit, Emek Medical Center, Afula, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Anna Yanovskay
- Infectious Diseases Unit, Emek Medical Center, Afula, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ronen Ben Ami
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Sourasky Medical Center, Tel Aviv, Israel
| | - Michal Landes
- Infectious Diseases Unit, Sourasky Medical Center, Tel Aviv, Israel
| | - Lior Nesher
- Infectious Disease Institute, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Adi Zaidman-Shimshovitz
- Infectious Disease Institute, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Kate McCarthy
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - David L Paterson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Evelina Tacconelli
- Division of Infectious Diseases, Tübingen University Hospital, Tübingen, Germany
| | - Michael Buhl
- Division of Infectious Diseases, Tübingen University Hospital, Tübingen, Germany
| | - Susanna Maurer
- Division of Infectious Diseases, Tübingen University Hospital, Tübingen, Germany
| | - Jesus Rodriguez-Bano
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Isabel Morales
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Antonio Oliver
- Servicio de Microbiología & Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Enrique Ruiz de Gopegui
- Servicio de Microbiología & Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Angela Cano
- Infectious Diseases Unit, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - Isabel Machuca
- Infectious Diseases Unit, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | | | - Luis Martinez-Martinez
- Microbiology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | | | - Miguel Salavert
- Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Bojana Beovic
- Department of Infectious Diseases, University Medical Centre, Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andreja Saje
- Department of Infectious Diseases, University Medical Centre, Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Manica Mueller-Premru
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Leonardo Pagani
- Infectious Diseases Unit, Annecy Genevois Hospital Center (CHANGE), Annecy, France
| | - Virginie Vitrat
- Infectious Diseases Unit, Annecy Genevois Hospital Center (CHANGE), Annecy, France
| | - Diamantis Kofteridis
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Maria Zacharioudaki
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Sofia Maraki
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Yulia Weissman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mical Paul
- Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Yaakov Dickstein
- Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Leonard Leibovici
- Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, Petah Tikva 49100, Israel.
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Benito N, Filella D, Mateo J, Fortuna AM, Gutierrez-Alliende JE, Hernandez N, Gimenez AM, Pomar V, Castellvi I, Corominas H, Casademont J, Domingo P. Pulmonary Thrombosis or Embolism in a Large Cohort of Hospitalized Patients With Covid-19. Front Med (Lausanne) 2020; 7:557. [PMID: 32984388 PMCID: PMC7477312 DOI: 10.3389/fmed.2020.00557] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/05/2020] [Indexed: 02/05/2023] Open
Abstract
Objective: We set out to analyze the incidence and predictive factors of pulmonary embolism (PE) in hospitalized patients with Covid-19. Methods: We prospectively collected data from all consecutive patients with laboratory-confirmed Covid-19 admitted to the Hospital de la Santa Creu i Sant Pau, a university hospital in Barcelona, between March 9 and April 15, 2020. Patients with suspected PE, according to standardized guidelines, underwent CT pulmonary angiography (CTPA). Results: A total of 1,275 patients with Covid-19 were admitted to hospital. CTPA was performed on 76 inpatients, and a diagnosis of PE was made in 32 (2.6% [95%CI 1.7-3.5%]). Patients with PE were older, and they exhibited lower PaO2:FiO2 ratios and higher levels of D-dimer and C-reactive protein (CRP). They more often required admission to ICU and mechanical ventilation, and they often had longer hospital stays, although in-hospital mortality was no greater than in patients without PE. High CRP and D-dimer levels at admission (≥150 mg/L and ≥1,000 ng/ml, respectively) and a peak D-dimer ≥6,000 ng/ml during hospital stay were independent factors associated with PE. Prophylactic low molecular weight heparin did not appear to prevent PE. Increased CRP levels correlated with increased D-dimer levels and both correlated with a lower PaO2:FiO2. Conclusions: The 2.6% incidence of PE in Covid-19 hospitalized patients is clearly high. Higher doses of thromboprophylaxis may be required to prevent PE, particularly in patients at increased risk, such as those with high levels of CRP and D-dimer at admission. These findings should be validated in future studies.
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Affiliation(s)
- Natividad Benito
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
- *Correspondence: Natividad Benito
| | - David Filella
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Jose Mateo
- Thrombosis and Hemostasis Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Ana M. Fortuna
- Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Juan E. Gutierrez-Alliende
- Department of Radiology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Nerea Hernandez
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Ana M. Gimenez
- Department of Radiology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Virginia Pomar
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Ivan Castellvi
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Hector Corominas
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Jordi Casademont
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Pere Domingo
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
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Pericà S JM, Llopis J, González-Ramallo V, Goenaga MÁ, Muñoz P, García-Leoni ME, Fariñas MC, Pajarón M, Ambrosioni J, Luque R, Goikoetxea J, Oteo JA, Carrizo E, Bodro M, Reguera-Iglesias JM, Navas E, Hidalgo-Tenorio C, Miró JM. Outpatient Parenteral Antibiotic Treatment for Infective Endocarditis: A Prospective Cohort Study From the GAMES Cohort. Clin Infect Dis 2019; 69:1690-1700. [PMID: 30649282 DOI: 10.1093/cid/ciz030] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT). METHODS Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008-2012) was performed. RESULTS A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56-76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32-54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P < .001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04-1.42; P = .01) and cardiac surgery (OR, 0.24; 95% CI, .09-.63; P = .04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI, .22-.98; P = .007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission. CONCLUSIONS OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded.
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Affiliation(s)
- Juan M Pericà S
- Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander
| | - Jaume Llopis
- Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander
| | - Víctor González-Ramallo
- Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria, Gregorio Marañón. Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES, CB06/06/0058), Department of Medicine, Universidad Complutense de Madrid, Santander
| | | | - Patricia Muñoz
- Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria, Gregorio Marañón. Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES, CB06/06/0058), Department of Medicine, Universidad Complutense de Madrid, Santander
| | - M Eugenia García-Leoni
- Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria, Gregorio Marañón. Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES, CB06/06/0058), Department of Medicine, Universidad Complutense de Madrid, Santander
| | - M Carmen Fariñas
- Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander
| | - Marcos Pajarón
- Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander
| | - Juan Ambrosioni
- Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander
| | - Rafael Luque
- Hospital Universitario Virgen del Rocío, Sevilla
| | | | | | - Enara Carrizo
- Hospital Universitario de Araba-Txagorritxu, Gasteiz
| | - Marta Bodro
- Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander
| | | | | | | | - José M Miró
- Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander
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Horcajada JP, Montero M, Oliver A, Sorlí L, Luque S, Gómez-Zorrilla S, Benito N, Grau S. Epidemiology and Treatment of Multidrug-Resistant and Extensively Drug-Resistant Pseudomonas aeruginosa Infections. Clin Microbiol Rev 2019; 32:32/4/e00031-19. [PMID: 31462403 PMCID: PMC6730496 DOI: 10.1128/cmr.00031-19] [Citation(s) in RCA: 397] [Impact Index Per Article: 79.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
In recent years, the worldwide spread of the so-called high-risk clones of multidrug-resistant or extensively drug-resistant (MDR/XDR) Pseudomonas aeruginosa has become a public health threat. This article reviews their mechanisms of resistance, epidemiology, and clinical impact and current and upcoming therapeutic options. In vitro and in vivo treatment studies and pharmacokinetic and pharmacodynamic (PK/PD) models are discussed. Polymyxins are reviewed as an important therapeutic option, outlining dosage, pharmacokinetics and pharmacodynamics, and their clinical efficacy against MDR/XDR P. aeruginosa infections. Their narrow therapeutic window and potential for combination therapy are also discussed. Other "old" antimicrobials, such as certain β-lactams, aminoglycosides, and fosfomycin, are reviewed here. New antipseudomonals, as well as those in the pipeline, are also reviewed. Ceftolozane-tazobactam has clinical activity against a significant percentage of MDR/XDR P. aeruginosa strains, and its microbiological and clinical data, as well as recommendations for improving its use against these bacteria, are described, as are those for ceftazidime-avibactam, which has better activity against MDR/XDR P. aeruginosa, especially strains with certain specific mechanisms of resistance. A section is devoted to reviewing upcoming active drugs such as imipenem-relebactam, cefepime-zidebactam, cefiderocol, and murepavadin. Finally, other therapeutic strategies, such as use of vaccines, antibodies, bacteriocins, anti-quorum sensing, and bacteriophages, are described as future options.
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Affiliation(s)
- Juan P Horcajada
- Service of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
- Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain
| | - Milagro Montero
- Service of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
- Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain
| | - Antonio Oliver
- Service of Microbiology, Hospital Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Luisa Sorlí
- Service of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
- Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain
| | - Sònia Luque
- Service of Pharmacy, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Silvia Gómez-Zorrilla
- Service of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
- Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Santiago Grau
- Service of Pharmacy, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
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Wouthuyzen-Bakker M, Sebillotte M, Lomas J, Kendrick B, Palomares EB, Murillo O, Parvizi J, Shohat N, Reinoso JC, Sánchez RE, Fernandez-Sampedro M, Senneville E, Huotari K, Allende JMB, García AB, Lora-Tamayo J, Ferrari MC, Vaznaisiene D, Yusuf E, Aboltins C, Trebse R, Salles MJ, Benito N, Vila A, Toro MDD, Kramer TS, Petersdorf S, Diaz-Brito V, Tufan ZK, Sanchez M, Arvieux C, Soriano A. Timing of implant-removal in late acute periprosthetic joint infection: A multicenter observational study. J Infect 2019; 79:199-205. [PMID: 31319141 DOI: 10.1016/j.jinf.2019.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/21/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We evaluated the treatment outcome in late acute (LA) periprosthetic joint infections (PJI) treated with debridement and implant retention (DAIR) versus implant removal. METHODS In a large multicenter study, LA PJIs of the hip and knee were retrospectively evaluated. Failure was defined as: PJI related death, prosthesis removal or the need for suppressive antibiotic therapy. LA PJI was defined as acute symptoms <3 weeks in patients more than 3 months after the index surgery and with a history of normal joint function. RESULTS 445 patients were included, comprising 340 cases treated with DAIR and 105 cases treated with implant removal (19% one-stage revision (n = 20), 74.3% two-stage revision (n = 78) and 6.7% definitive implant removal (n = 7). Overall failure in patients treated with DAIR was 45.0% (153/340) compared to 24.8% (26/105) for implant removal (p < 0.001). Difference in failure rate remained after 1:1 propensity-score matching. A preoperative CRIME80-score ≥3 (OR 2.9), PJI caused by S. aureus (OR 1.8) and implant retention (OR 3.1) were independent predictors for failure in the multivariate analysis. CONCLUSION DAIR is a viable surgical treatment for most patients with LA PJI, but implant removal should be considered in a subset of patients, especially in those with a CRIME80-score ≥3.
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Affiliation(s)
- Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
| | - Marine Sebillotte
- Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France
| | - Jose Lomas
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Benjamin Kendrick
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | | | - Oscar Murillo
- Infectious Disease Service, IDIBELL-Hospital Universitari Bellvitge, Barcelona, Spain
| | - Javad Parvizi
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, United States
| | - Noam Shohat
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, United States; Department of Orthopaedic Surgery, Tel Aviv University, Tel Aviv, Israel
| | - Javier Cobo Reinoso
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Rosa Escudero Sánchez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Marta Fernandez-Sampedro
- Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marques de Valdecilla-IDIVAL, Cantabria, Spain
| | - Eric Senneville
- Department of Infectious Diseases, University Hospital Gustave Dron Hospital, Tourcoing, France
| | - Kaisa Huotari
- Inflammation Center, Infectious Diseases, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Finland
| | | | - Antonio Blanco García
- Department of Internal Medicine-Emergency, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - Jaime Lora-Tamayo
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Madrid, Spain
| | - Matteo Carlo Ferrari
- Department of Prosthetic Joint Replacement and Rehabilitation Center, Humanitas Research Hospital and Humanitas University, Milan, Italy
| | - Danguole Vaznaisiene
- Department of Infectious Diseases, Medical Academy, Lithuanian University of Health Sciences, Kaunas Clinical Hospital, Kaunas, Lithuania
| | - Erlangga Yusuf
- Department of Microbiology, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium
| | - Craig Aboltins
- The Department of Infectious Diseases, Northern Health, Melbourne, Australia; Northern Clinical School, The University of Melbourne, Melbourne, Australia
| | - Rihard Trebse
- Service for Bone Infections, Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
| | - Mauro José Salles
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brasil
| | - Natividad Benito
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Vila
- Servicio de Infectología, Hospital Italiano de Mendoza, Mendoza, Argentina
| | - Maria Dolores Del Toro
- Unidad Clínica de Enfermedades Infecciosa y Microbiología, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| | - Tobias Siegfried Kramer
- Nationales Referenzzentrum für Surveillance von nosokomialen Infektionen am Institut für Hygiene und Umweltmedizin Charité-Universitätsmedizin, Berlin, Germany; LADR, GmbH MVZ, Neuruppin, Germany
| | - Sabine Petersdorf
- Institute of Medical Microbiology, Hospital Hygiene University Hospital, Heinrich-Heine-University. Düsseldorf, Germany
| | - Vicens Diaz-Brito
- Infectious Diseases Unit, Parc Sanitari Sant Joan de Deu, IDIBAPS, Sant Boi, Barcelona, Spain
| | - Zeliha Kocak Tufan
- Infectious Diseases and Clinical Microbiology Department, Ankara Yildirim Beyazit University, Ataturk Training & Research Hospital, Ankara, Turkey
| | - Marisa Sanchez
- Infectious Diseases Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Argentina
| | - Cédric Arvieux
- Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France; Great West Reference centers for Complex Bone and Joint Infections (CRIOGO), France
| | - Alex Soriano
- Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Cuerpo GP, Valerio M, Pedraz A, Rodríguez-Abella H, Mestres CA, Obrador EQ, González-Calle A, Rodríguez Álvarez R, García PM, Bouza E. Mitral valve repair in infective endocarditis is not inferior to valve replacement: results from a Spanish nationwide prospective registry. Gen Thorac Cardiovasc Surg 2019; 67:585-593. [PMID: 30666586 DOI: 10.1007/s11748-019-01063-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/18/2018] [Accepted: 01/07/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Infective endocarditis (IE) still carries high morbidity and mortality and frequently requires surgery. The benefit of mitral valve repair (MVr) in the setting of IE is yet to be proven. The goal of this study was to assess the results of MVr in patients with IE after a minimum follow-up of 1 year. METHODS This study is based on a Spanish nationwide prospective registry that included patients operated on for native mitral valve IE. The collaborating Institutions pooled their pre-, peri-, and postoperative data into the database of the GAMES group [Grupo de Apoyo al Manejo de la EndocarditiS (Group for support and management of infective endocarditis)]. RESULTS Data from 27 hospitals were recorded and 3524 cases of active IE identified between 2008 and 2016. There were 1513 cases of mitral IE, of which 898 involved native valves. Of these, 437 patients underwent surgical treatment, and 369 completed the 1-year follow-up. The valve was repaired in 68 cases (18.4%). Preoperative groups were comparable (EuroSCORE MVr 7.7 vs MVR 8.0; p = ns). Mortality in the repair group was inferior to that in the replacement group (16.2% vs 27.2%, p = 0.058). At 1 year, mortality remained higher in the replacement group: 3.7% vs 2.9%. Relapse of the infection was slightly more frequent in the repair group (7.1% vs 3.7%; p = ns), although this did not lead to higher rates of reintervention (MVr/MVR: 2.9% vs 4.9%). CONCLUSION MVr is an attractive option for specific patients with IE and does not seem to negatively impact on relapses.
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Affiliation(s)
- Gregorio P Cuerpo
- Servicio de Cirugía Cardíaca, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- Department of Cardiac Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - M Valerio
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Pedraz
- Servicio de Cirugía Cardíaca, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - H Rodríguez-Abella
- Servicio de Cirugía Cardíaca, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos A Mestres
- Department of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Antonio González-Calle
- Servicio de Cirugía Cardiaca, Unidad del Corazón, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Regino Rodríguez Álvarez
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Spain
| | - Patricia Muñoz García
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Emilio Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Armiñanzas C, Fariñas-Alvarez C, Zarauza J, Muñoz P, González Ramallo V, Martínez Sellés M, Miró Meda JM, Pericás JM, Goenaga MÁ, Ojeda Burgos G, Rodríguez Álvarez R, Castelo Corral L, Gálvez-Acebal J, Martínez Marcos FJ, Fariñas MC, Fernández Sánchez F, Noureddine M, Rosas G, de la Torre Lima J, Aramendi J, Bereciartua E, Blanco MJ, Blanco R, Boado MV, Campaña Lázaro M, Crespo A, Goikoetxea J, Iruretagoyena JR, Irurzun Zuazabal J, López-Soria L, Montejo M, Nieto J, Rodrigo D, Rodríguez D, Rodríguez R, Vitoria Y, Voces R, García López MV, Georgieva RI, Ojeda G, Rodríguez Bailón I, Ruiz Morales J, Cuende AM, Echeverría T, Fuerte A, Gaminde E, Goenaga MÁ, Idígoras P, Iribarren JA, Izaguirre Yarza A, Kortajarena Urkola X, Reviejo C, Carrasco R, Climent V, Llamas P, Merino E, Plazas J, Reus S, Álvarez N, Bravo-Ferrer JM, Castelo L, Cuenca J, Llinares P, Miguez Rey E, Rodríguez Mayo M, Sánchez E, Sousa Regueiro D, Martínez FJ, Alonso MDM, Castro B, García Rosado D, Durán MDC, Miguel Gómez MA, Lacalzada J, Nassar I, Plata Ciezar A, Reguera Iglesias JM, Asensi Álvarez V, Costas C, de la Hera J, Fernández Suárez J, Iglesias Fraile L, León Arguero V, López Menéndez J, Mencia Bajo P, Morales C, Moreno Torrico A, Palomo C, Paya Martínez B, Rodríguez Esteban Á, Rodríguez García R, Telenti Asensio M, Almela M, Ambrosioni J, Azqueta M, Brunet M, Bodro M, Cartañá R, Falces C, Fita G, Fuster D, García de la Mària C, Hernández-Meneses M, Llopis Pérez J, Marco F, Miró JM, Moreno A, Nicolás D, Ninot S, Quintana E, Paré C, Pereda D, Pericás JM, Pomar JL, Ramírez J, Rovira I, Sandoval E, Sitges M, Soy D, Téllez A, Tolosana JM, Vidal B, Vila J, Adán I, Bermejo J, Bouza E, Celemín D, Cuerpo Caballero G, Delgado Montero A, Fernández Cruz A, García Mansilla A, García Leoni ME, González Ramallo V, Kestler Hernández M, Hualde AM, Marín M, Martínez-Sellés M, Menárguez MC, Muñoz P, Rincón C, Rodríguez-Abella H, Rodríguez-Créixems M, Pinilla B, Pinto Á, Valerio M, Vázquez P, Verde Moreno E, Antorrena I, Loeches B, Martín Quirós A, Moreno M, Ramírez U, Rial Bastón V, Romero M, Saldaña A, Agüero Balbín J, Amado C, Armiñanzas Castillo C, Arnaiz García A, Cobo Belaustegui M, Fariñas MC, Fariñas-Álvarez C, Gómez Izquierdo R, García I, González-Rico C, Gutiérrez-Cuadra M, Gutiérrez Díez J, Pajarón M, Parra JA, Sarralde A, Teira R, Zarauza J, Domínguez F, García Pavía P, González J, Orden B, Ramos A, Centella T, Hermida JM, Moya JL, Martín-Dávila P, Navas E, Oliva E, Del Río A, Ruiz S, Hidalgo Tenorio C, Almendro Delia M, Araji O, Barquero JM, Calvo Jambrina R, de Cueto M, Gálvez Acebal J, Méndez I, Morales I, López-Cortés LE, de Alarcón A, García E, Haro JL, Lepe JA, López F, Luque R, Alonso LJ, Azcárate P, Azcona Gutiérrez JM, Blanco JR, García-Álvarez L, Oteo JA, Sanz M, de Benito N, Gurguí M, Pacho C, Pericas R, Pons G, Álvarez M, Fernández AL, Martínez A, Prieto A, Regueiro B, Tijeira E, Vega M, Canut Blasco A, Cordo Mollar J, Gainzarain Arana JC, García Uriarte O, Martín López A, Ortiz de Zárate Z, Urturi Matos JA, García Domínguez G, Sánchez-Porto A, Arribas Leal JM, García Vázquez E, Hernández Torres A, Blázquez A, de la Morena Valenzuela G, Alonso Á, Aramburu J, Calvo FE, Moreno Rodríguez A, Tarabini-Castellani P, Heredero Gálvez E, Maicas Bellido C, Largo Pau J, Sepúlveda MA, Toledano Sierra P, Iqbal-Mirza SZ, Cascales Alcolea E, Egea Serrano P, Hernández Roca JJ, Keituqwa Yañez I, Peláez Ballesta A, Soriano V, Moreno Escobar E, Peña Monje A, Sánchez Cabrera V, Vinuesa García D, Arrizabalaga Asenjo M, Cifuentes Luna C, Núñez Morcillo J, Pérez Seco MC, Villoslada Gelabert A, Aured Guallar C, Fernández Abad N, García Mangas P, Matamala Adell M, Palacián Ruiz MP, Porres JC, Alcaraz Vidal B, Cobos Trigueros N, Del Amor Espín MJ, Giner Caro JA, Jiménez Sánchez R, Jimeno Almazán A, Ortín Freire A, Viqueira González M, Pericás Ramis P, Ribas Blanco MÁ, Ruiz de Gopegui Bordes E, Vidal Bonet L, Bellón Munera MC, Escribano Garaizabal E, Tercero Martínez A, Segura Luque JC. Role of age and comorbidities in mortality of patients with infective endocarditis. Eur J Intern Med 2019; 64:63-71. [PMID: 30904433 DOI: 10.1016/j.ejim.2019.03.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/22/2019] [Accepted: 03/05/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. METHODS Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. RESULTS A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32-3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39-1.88),and non-performed surgery (HR:1.64;95% CI:11.16-1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. CONCLUSION There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group.
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Affiliation(s)
- Carlos Armiñanzas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - Concepción Fariñas-Alvarez
- Division of Health Care Quality, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
| | - Jesús Zarauza
- Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Spain.
| | - Víctor González Ramallo
- Servicio de Medicina Interna, Hospitalización a Domicilio, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Manuel Martínez Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Universidad Europea, Universidad Complutense, Madrid, Spain.
| | - José Mª Miró Meda
- Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
| | - Juan Manuel Pericás
- Servicio de Enfermedades Infecciosas, Hospital Clinic de Barcelona-IDIBAPS. Barcelona, Spain.
| | - Miguel Ángel Goenaga
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián, Spain
| | - Guillermo Ojeda Burgos
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Regino Rodríguez Álvarez
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Universidad del País Vasco, País Vasco, Spain.
| | - Laura Castelo Corral
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario A Coruña, A Coruña, Spain
| | - Juan Gálvez-Acebal
- JUnidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena Instituto de Biomedicina de Sevilla, IBIS, Universidad de Sevilla, Sevilla, Spain.
| | | | - Maria Carmen Fariñas
- Maria Carmen Fariñas, Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana María Cuende
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | - Tomás Echeverría
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | - Ana Fuerte
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | - Eduardo Gaminde
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | | | - Pedro Idígoras
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | | | | | | | - Carlos Reviejo
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | | | | | | | | | - Joaquín Plazas
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Sergio Reus
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Nemesio Álvarez
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Laura Castelo
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - José Cuenca
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Pedro Llinares
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | | | - Efrén Sánchez
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Carlos Costas
- Hospital Universitario Central Asturias, Oviedo, Spain
| | | | | | | | | | | | | | | | | | - Carmen Palomo
- Hospital Universitario Central Asturias, Oviedo, Spain
| | | | | | | | | | - Manuel Almela
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Manuel Azqueta
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Mercè Brunet
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Marta Bodro
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Ramón Cartañá
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Carlos Falces
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Guillermina Fita
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - David Fuster
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | | | | | | | - Francesc Marco
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - José M Miró
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - David Nicolás
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Salvador Ninot
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Eduardo Quintana
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Carlos Paré
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Daniel Pereda
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Juan M Pericás
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - José L Pomar
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - José Ramírez
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Irene Rovira
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Elena Sandoval
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Marta Sitges
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Dolors Soy
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Adrián Téllez
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - José M Tolosana
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Bárbara Vidal
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Jordi Vila
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Iván Adán
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Bermejo
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Emilio Bouza
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Daniel Celemín
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Mercedes Marín
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Patricia Muñoz
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Rincón
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Blanca Pinilla
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Pinto
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Pilar Vázquez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | - Mar Moreno
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Iván García
- Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | | | | | - Ramón Teira
- Universitario Marqués de Valdecilla, Santander, Spain
| | - Jesús Zarauza
- Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Soledad Ruiz
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Omar Araji
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | | | | | - Irene Méndez
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | | | - Emilio García
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | - Rafael Luque
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | | | | | | | | | | | - Mercé Gurguí
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Roser Pericas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Guillem Pons
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Álvarez
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - A L Fernández
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - Amparo Martínez
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - A Prieto
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - Benito Regueiro
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - E Tijeira
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - Marino Vega
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Blázquez
- Hospital Clínico Universitario Virgen de la Arrixaca Murcia, Spain
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García-Álvarez L, Sanz MM, Marín M, Fariñas MC, Montejo M, Goikoetxea J, Rodríguez García R, de Alarcón A, Almela M, Fernández-Hidalgo N, Alonso Socas MM, Goenaga MA, Navas E, Vicioso L, Oteo JA. Antimicrobial management of Tropheryma whipplei endocarditis: the Spanish Collaboration on Endocarditis (GAMES) experience. J Antimicrob Chemother 2019; 74:1713-1717. [PMID: 30789210 DOI: 10.1093/jac/dkz059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/16/2019] [Accepted: 01/18/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Tropheryma whipplei has been detected in 3.5% of the blood culture-negative cases of endocarditis in Spain. Experience in the management of T. whipplei endocarditis is limited. Here we report the long-term outcome of the treatment of previously reported patients who were diagnosed with infective endocarditis (IE) caused by T. whipplei from the Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES) and discuss potential options for antimicrobial therapy for IE caused by T. whipplei. PATIENTS AND METHODS Seventeen patients with T. whipplei endocarditis were recruited between 2008 and 2014 in 25 Spanish hospitals. Patients were classified according to the therapeutic regimen: ceftriaxone and trimethoprim/sulfamethoxazole, doxycycline + hydroxychloroquine and other treatment options. RESULTS Follow-up data were obtained from 14 patients. The median follow-up was 46.5 months. All patients completed the antibiotic treatment prescribed, with a median duration of 13 months. Six patients were treated with ceftriaxone and trimethoprim/sulfamethoxazole (median duration 13 months), four with doxycycline + hydroxychloroquine (median duration 13.8 months) and four with other treatment options (median duration 22.3 months). The follow-up after the end of the treatments was between 5 and 84 months (median 24 months). CONCLUSIONS All treatment lines were effective and well tolerated. Therapeutic failures were not detected during the treatment. None of the patients died or experienced a relapse during the follow-up. Only six patients received antibiotic treatment in accordance with guidelines. These data suggest that shorter antimicrobial treatments could be effective.
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Affiliation(s)
- Lara García-Álvarez
- Departamento de Enfermedades Infecciosas, Hospital Universitario San Pedro-Centro de investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - M Mercedes Sanz
- Departamento de Enfermedades Infecciosas, Hospital Universitario San Pedro-Centro de investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Mercedes Marín
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Carmen Fariñas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - Miguel Montejo
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Universidad del País Vasco, Bilbao, Spain
| | - Josune Goikoetxea
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Universidad del País Vasco, Bilbao, Spain
| | - Raquel Rodríguez García
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Universidad de Oviedo, Oviedo, Spain
| | - Arístides de Alarcón
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Manuel Almela
- Servicio de Microbiología y Parasitología, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Nuria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Mar Alonso Socas
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Canarias, Tenerife, Spain
| | - Miguel A Goenaga
- Servicio de Enfermedades Infecciosas, Hospital Donostia, OSI Donostialdea, San Sebastián, Gipuzkoa, Spain
| | - Enrique Navas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Luis Vicioso
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - José A Oteo
- Departamento de Enfermedades Infecciosas, Hospital Universitario San Pedro-Centro de investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
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Garrigues GE, Zmistowski B, Cooper AM, Green A. Proceedings from the 2018 International Consensus Meeting on Orthopedic Infections: management of periprosthetic shoulder infection. J Shoulder Elbow Surg 2019; 28:S67-S99. [PMID: 31196516 DOI: 10.1016/j.jse.2019.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 04/20/2019] [Indexed: 02/05/2023]
Abstract
The Second International Consensus Meeting on Orthopedic Infections was held in Philadelphia, Pennsylvania, in July 2018. A multidisciplinary team of international experts from all 9 subspecialties of orthopedic surgery and allied fields of infectious disease, microbiology, and epidemiology was assembled to form the International Consensus Group. The following consensus proceedings from the International Consensus Meeting involve 30 questions pertaining to the management of periprosthetic shoulder infection.
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Affiliation(s)
- Grant E Garrigues
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
| | - Benjamin Zmistowski
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexus M Cooper
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew Green
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Benito N, Mur I, Ribera A, Soriano A, Rodríguez-Pardo D, Sorlí L, Cobo J, Fernández-Sampedro M, Del Toro MD, Guío L, Praena J, Bahamonde A, Riera M, Esteban J, Baraia-Etxaburu JM, Martínez-Alvarez J, Jover-Sáenz A, Dueñas C, Ramos A, Sobrino B, Euba G, Morata L, Pigrau C, Horcajada JP, Coll P, Crusi X, Ariza J. The Different Microbial Etiology of Prosthetic Joint Infections according to Route of Acquisition and Time after Prosthesis Implantation, Including the Role of Multidrug-Resistant Organisms. J Clin Med 2019; 8:jcm8050673. [PMID: 31086080 PMCID: PMC6572185 DOI: 10.3390/jcm8050673] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 02/05/2023] Open
Abstract
The aim of our study was to characterize the etiology of prosthetic joint infections (PJIs)-including multidrug-resistant organisms (MDRO)-by category of infection. A multicenter study of 2544 patients with PJIs was performed. We analyzed the causative microorganisms according to the Tsukayama's scheme (early postoperative, late chronic, and acute hematogenous infections (EPI, LCI, AHI) and "positive intraoperative cultures" (PIC)). Non-hematogenous PJIs were also evaluated according to time since surgery: <1 month, 2-3 months, 4-12 months, >12 months. AHIs were mostly caused by Staphylococcus aureus (39.2%) and streptococci (30.2%). EPIs were characterized by a preponderance of virulent microorganisms (S. aureus, Gram-negative bacilli (GNB), enterococci), MDROs (24%) and polymicrobial infections (27.4%). Conversely, coagulase-negative staphylococci (CoNS) and Cutibacterium species were predominant in LCIs (54.5% and 6.1%, respectively) and PICs (57.1% and 15.1%). The percentage of MDROs isolated in EPIs was more than three times the percentage isolated in LCIs (7.8%) and more than twice the proportion found in AHI (10.9%). There was a significant decreasing linear trend over the four time intervals post-surgery for virulent microorganisms, MDROs, and polymicrobial infections, and a rising trend for CoNS, streptococci and Cutibacterium spp. The observed differences have important implications for the empirical antimicrobial treatment of PJIs.
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Affiliation(s)
- Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain.
| | - Isabel Mur
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain.
| | - Alba Ribera
- Department of Infectious Diseases, Hospital Universitari Bellvitge, 08097 Barcelona, Spain.
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic Universitari, 08036 Barcelona, Spain.
| | - Dolors Rodríguez-Pardo
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain.
| | - Luisa Sorlí
- Department of Infectious Diseases, Parc de Salut Mar, 08003 Barcelona, Spain.
| | - Javier Cobo
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal ⁻ IRYCIS, 28034 Madrid, Spain.
| | | | - María Dolores Del Toro
- Department of Infectious Diseases, Clinical Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain.
| | - Laura Guío
- Department of Infectious Diseases, Hospital Universitario Cruces, 48903 Bilbao, Spain.
| | - Julia Praena
- Department of Infectious Diseases, Clinical Microbiology and Preventive Medicine, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain.
| | - Alberto Bahamonde
- Department of Internal Medicine-Infectious Diseases, Hospital Universitario del Bierzo, 24404 León, Spain.
| | - Melchor Riera
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain.
| | - Jaime Esteban
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain.
| | | | - Jesús Martínez-Alvarez
- Department of Orthopedic and Traumatology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain.
| | - Alfredo Jover-Sáenz
- Unit of Nosocomial Infection, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain.
| | - Carlos Dueñas
- Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain.
| | - Antonio Ramos
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Madrid, Spain.
| | - Beatriz Sobrino
- Department of Infectious Diseases, Hospital Regional Universitario Málaga, 29010 Málaga, Spain.
| | - Gorane Euba
- Department of Infectious Diseases, Hospital Universitari Bellvitge, 08097 Barcelona, Spain.
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clínic Universitari, 08036 Barcelona, Spain.
| | - Carles Pigrau
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain.
| | - Juan P Horcajada
- Department of Infectious Diseases, Parc de Salut Mar, 08003 Barcelona, Spain.
| | - Pere Coll
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain.
- Department of Clinical Microbiology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain.
| | - Xavier Crusi
- Department of Orthopedic and Traumatology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain.
| | - Javier Ariza
- Department of Infectious Diseases, Hospital Universitari Bellvitge, 08097 Barcelona, Spain.
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- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain.
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Papadopoulos A, Ribera A, Mavrogenis AF, Rodriguez-Pardo D, Bonnet E, JoséSalles M, Dolores Del Toro M, Nguyen S, Blanco-García A, Skaliczki G, Soriano A, Benito N, Petersdorf S, Pasticci MB, Tattevin P, Tufan ZK, Chan M, O'Connell N, Pantazis N, Kyprianou A, Pigrau C, Megaloikonomos PD, Senneville E, Ariza J, Papagelopoulos PJ, Giannitsioti E. Corrigendum to "Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: Role of surgery and impact of colistin administration" [International Journal of Antimicrobial Agents 53(3) (2019) 294-301]. Int J Antimicrob Agents 2019; 53:538-539. [PMID: 30910479 DOI: 10.1016/j.ijantimicag.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Antonios Papadopoulos
- Fourth Department of Internal Medicine, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alba Ribera
- Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dolors Rodriguez-Pardo
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Eric Bonnet
- Department of Infectious Diseases, Hôpital Joseph Ducuing, Toulouse, France
| | - Mauro JoséSalles
- Division of Infectious Diseases, Department of Internal Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - María Dolores Del Toro
- Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Sophie Nguyen
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
| | - Antonio Blanco-García
- Bone and Joint Infection Unit, Department of Emergency Medicine, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Gábor Skaliczki
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Alejandro Soriano
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Natividad Benito
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'InvestigacióBiomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sabine Petersdorf
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Zeliha Kocak Tufan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Yildirim Beyazit University, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Monica Chan
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Nuala O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Kyprianou
- Fourth Department of Internal Medicine, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Carlos Pigrau
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Panayiotis D Megaloikonomos
- First Department of Orthopaedics, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eric Senneville
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
| | - Javier Ariza
- Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedics, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthymia Giannitsioti
- Fourth Department of Internal Medicine, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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Mitsuwan W, Jiménez-Munguía I, Visutthi M, Sianglum W, Rodríguez-Ortega MJ, Voravuthikunchai SP. Rhodomyrtone decreases Staphylococcus aureus SigB activity during exponentially growing phase and inhibits haemolytic activity within membrane vesicles. Microb Pathog 2019; 128:112-118. [PMID: 30583020 DOI: 10.1016/j.micpath.2018.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/08/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 02/05/2023]
Abstract
Sigma factor B (SigB) controls the expression of Staphylococcus aureus genes including virulence factors and plays a role in the bacterial secretion system through membrane vesicle production. Inhibition of SigB could attenuate SigB dependent virulence and secretion system. The objective of this study was to determine the effects of rhodomyrtone on SigB and virulence factors related to SigB. Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) values of rhodomyrtone against 67 clinical methicillin-resistant S. aureus isolates were 0.25-8 μg/ml, which were similar to those of vancomycin. Using luciferase gene fused to SigB dependent promoters of asp23, five time reduction in SigB activity was observed when the bacteria were treated with rhodomyrtone for 3 h. Rhodomyrtone significantly reduced SigB activity in a concentration dependent manner in exponentially growing cells (P < 0.05). In addition, sigB mutant was more sensitive towards increasing concentrations of rhodomyrtone than the wild type and yabJ-spoVG mutant. Rhodomyrtone at 0.625 μg/ml reduced the growth of sigB mutant by approximately 99%, compared with the yabJ-spoVG mutant and the wild type. Membrane vesicles were significantly reduced in the bacterial cells when treated with 0.5 × MIC rhodomyrtone (P < 0.05). Decreased haemolytic activity was detected within rhodomyrtone-treated membrane vesicles. The results indicated that rhodomyrtone inhibited S. aureus SigB activity during exponentially growing phase and inhibited haemolytic activity within membrane vesicles.
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Affiliation(s)
- Watcharapong Mitsuwan
- Department of Microbiology and Excellent Research Laboratory on Natural Products and Natural Product Research Center of Excellence, Faculty of Science, Prince of Songkla University, Songkhla, Thailand
| | - Irene Jiménez-Munguía
- Departamento de Bioquímica y Biología Molecular, Universidad de Córdoba, Campus de Excelencia Internacional CeiA3, Córdoba, Spain; Department of Engineering of Technological Equipment, National University of Science and Technology "MISiS", Moscow, Russia
| | - Monton Visutthi
- Department of Microbiology and Excellent Research Laboratory on Natural Products and Natural Product Research Center of Excellence, Faculty of Science, Prince of Songkla University, Songkhla, Thailand
| | - Wipawadee Sianglum
- Department of Microbiology and Excellent Research Laboratory on Natural Products and Natural Product Research Center of Excellence, Faculty of Science, Prince of Songkla University, Songkhla, Thailand
| | | | - Manuel J Rodríguez-Ortega
- Departamento de Bioquímica y Biología Molecular, Universidad de Córdoba, Campus de Excelencia Internacional CeiA3, Córdoba, Spain
| | - Supayang P Voravuthikunchai
- Department of Microbiology and Excellent Research Laboratory on Natural Products and Natural Product Research Center of Excellence, Faculty of Science, Prince of Songkla University, Songkhla, Thailand.
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Papadopoulos A, Ribera A, Mavrogenis AF, Rodriguez-Pardo D, Bonnet E, Salles MJ, Dolores Del Toro M, Nguyen S, Blanco-García A, Skaliczki G, Soriano A, Benito N, Petersdorf S, Pasticci MB, Tattevin P, Tufan ZK, Chan M, O'Connell N, Pantazis N, Kyprianou A, Pigrau C, Megaloikonomos PD, Senneville E, Ariza J, Papagelopoulos PJ, Giannitsioti E. Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: Role of surgery and impact of colistin administration. Int J Antimicrob Agents 2019; 53:294-301. [PMID: 30395988 DOI: 10.1016/j.ijantimicag.2018.10.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 08/20/2018] [Revised: 10/21/2018] [Accepted: 10/27/2018] [Indexed: 02/08/2023]
Abstract
Factors influencing treatment outcome of patients with Gram-negative bacterial (GNB) multidrug-resistant (MDR) and extensively drug-resistant (XDR) prosthetic joint infection (PJIs) were analysed. Data were collected (2000-2015) by 18 centres. Treatment success was analysed by surgery type for PJI, resistance (MDR/XDR) and antimicrobials (colistin/non-colistin) using logistic regression and survival analyses. A total of 131 patients (mean age 73.0 years, 35.9% male, 58.8% with co-morbidities) with MDR (n = 108) or XDR (n = 23) GNB PJI were assessed. The most common pathogens were Escherichia coli (33.6%), Pseudomonas aeruginosa (25.2%), Klebsiella pneumoniae (21.4%) and Enterobacter cloacae (17.6%). Pseudomonas aeruginosa predominated in XDR cases. Isolates were carbapenem-resistant (n = 12), fluoroquinolone-resistant (n = 63) and ESBL-producers (n = 94). Treatment outcome was worse in XDR versus MDR cases (P = 0.018). Success rates did not differ for colistin versus non-colistin in XDR cases (P = 0.657), but colistin was less successful in MDR cases (P = 0.018). Debridement, antibiotics and implant retention (DAIR) (n = 67) was associated with higher failure rates versus non-DAIR (n = 64) (OR = 3.57, 95% CI 1.68-7.58; P < 0.001). Superiority of non-DAIR was confirmed by Kaplan-Meir analysis (HR = 0.36, 95% CI 0.20-0.67) and remained unchangeable by time of infection (early/late), antimicrobial resistance (MDR/XDR) and antimicrobials (colistin/non-colistin) (Breslow-Day, P = 0.737). DAIR is associated with higher failure rates even in early MDR/XDR GNB PJIs versus implant removal. Colistin should be preserved for XDR cases as it is detrimental in MDR infections.
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Affiliation(s)
- Antonios Papadopoulos
- Fourth Department of Internal Medicine, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alba Ribera
- Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dolors Rodriguez-Pardo
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Eric Bonnet
- Department of Infectious Diseases, Hôpital Joseph Ducuing, Toulouse, France
| | - Mauro José Salles
- Division of Infectious Diseases, Department of Internal Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - María Dolores Del Toro
- Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Sophie Nguyen
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
| | - Antonio Blanco-García
- Bone and Joint Infection Unit, Department of Emergency Medicine, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Gábor Skaliczki
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Alejandro Soriano
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Natividad Benito
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sabine Petersdorf
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Zeliha Kocak Tufan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Yildirim Beyazit University, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Monica Chan
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Nuala O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Kyprianou
- Fourth Department of Internal Medicine, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Carlos Pigrau
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Panayiotis D Megaloikonomos
- First Department of Orthopaedics, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eric Senneville
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
| | - Javier Ariza
- Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedics, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthymia Giannitsioti
- Fourth Department of Internal Medicine, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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Ascione T, Barrack R, Benito N, Blevins K, Brause B, Cornu O, Frommelt L, Gant V, Goswami K, Hu R, Klement MR, Komnos G, Malhotra R, Mirza Y, Munhoz Lima AL, Nelson C, Noor SS, O'Malley M, Oussedik S, Portillo ME, Prieto H, Saxena A, Sessa G. General Assembly, Diagnosis, Pathogen Isolation - Culture Matters: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S197-S206. [PMID: 30360977 DOI: 10.1016/j.arth.2018.09.071] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Wouthuyzen-Bakker M, Sebillotte M, Lomas J, Taylor A, Palomares EB, Murillo O, Parvizi J, Shohat N, Reinoso JC, Sánchez RE, Fernandez-Sampedro M, Senneville E, Huotari K, Barbero JM, Garcia-Cañete J, Lora-Tamayo J, Ferrari MC, Vaznaisiene D, Yusuf E, Aboltins C, Trebse R, Salles MJ, Benito N, Vila A, Toro MDD, Kramer TS, Petersdorf S, Diaz-Brito V, Tufan ZK, Sanchez M, Arvieux C, Soriano A. Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention. J Infect 2019; 78:40-47. [PMID: 30092305 DOI: 10.1016/j.jinf.2018.07.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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: 12/21/2017] [Revised: 07/05/2018] [Accepted: 07/19/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Debridement, antibiotics and implant retention (DAIR) is the recommended treatment for all acute prosthetic joint infections (PJI), but its efficacy in patients with late acute (LA) PJI is not well described. METHODS Patients diagnosed with LA PJI between 2005 and 2015 were retrospectively evaluated. LA PJI was defined as the development of acute symptoms (≤ 3 weeks) occurring ≥ 3 months after arthroplasty. Failure was defined as: (i) the need for implant removal, (ii) infection related death, (iii) the need for suppressive antibiotic therapy and/or (iv) relapse or reinfection during follow-up. RESULTS 340 patients from 27 centers were included. The overall failure rate was 45.0% (153/340). Failure was dominated by Staphylococcus aureus PJI (54.7%, 76/139). Significant independent preoperative risk factors for failure according to the multivariate analysis were: fracture as indication for the prosthesis (odds ratio (OR) 5.4), rheumatoid arthritis (OR 5.1), age above 80 years (OR 2.6), male gender (OR 2.0) and C-reactive protein > 150 mg/L (OR 2.0). Exchanging the mobile components during DAIR was the strongest predictor for treatment success (OR 0.35). CONCLUSION LA PJIs have a high failure rate. Treatment strategies should be individualized according to patients' age, comorbidity, clinical presentation and microorganism causing the infection.
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Affiliation(s)
- Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Marine Sebillotte
- Department of Infectious Diseases and IntensiveCare Medicine, Rennes University Hospital, Rennes, France
| | - Jose Lomas
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Adrian Taylor
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | | | - Oscar Murillo
- Infectious Disease Service, IDIBELL-Hospital Universitari Bellvitge, Barcelona, Spain
| | - Javad Parvizi
- Rothman Institute at Thomas Jefferson University Hospital, Philidelphia, United States
| | - Noam Shohat
- Rothman Institute at Thomas Jefferson University Hospital, Philidelphia, United States; Department of Orthopaedic Surgery, Tel Aviv University, Tel Aviv, Israel
| | - Javier Cobo Reinoso
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Rosa Escudero Sánchez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Marta Fernandez-Sampedro
- Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marques de Valdecilla-IDIVAL, Cantabria, Spain
| | - Eric Senneville
- Department of Infectious Diseases, University Hospital Gustave Dron Hospital, Tourcoing, France
| | - Kaisa Huotari
- Inflammation center, Infectious Diseases, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Finland
| | - José Maria Barbero
- Department of Internal Medicine, Hospital Universitario Principe de Asturias, Madrid, Spain
| | - Joaquín Garcia-Cañete
- Department of Internal Medicine-Emergency, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - Jaime Lora-Tamayo
- Department of Internal Medicine. Hospital Universitario 12 de Octubre. Instituto de Investigación i+12, Madrid, Spain
| | - Matteo Carlo Ferrari
- Department of Prosthetic Joint Replacement and Rehabilitation Center, Humanitas Research Hospital and Humanitas University, Milan, Italy
| | - Danguole Vaznaisiene
- Department of Infectious Diseases, Medical Academy, Lithuanian University of Health Sciences, Kaunas Clinical Hospital, Kaunas, Lithuania
| | - Erlangga Yusuf
- Department of Microbiology, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium
| | - Craig Aboltins
- The Department of Infectious Diseases, Northern Health, Melbourne, Australia; The University of Melbourne, Northern Clinical School, Melbourne, Australia
| | - Rihard Trebse
- Service for Bone Infections, Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
| | - Mauro José Salles
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brasil
| | - Natividad Benito
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Vila
- Servicio de Infectología, Hospital Italiano de Mendoza, Mendoza, Argentina
| | - Maria Dolores Del Toro
- Unidad Clínica de Enfermedades Infecciosa y Microbiología, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| | - Tobias Siegfried Kramer
- Nationales Referenzzentrum für Surveillance von nosokomialen Infektionen am Institut für Hygiene und Umweltmedizin Charité-Universitätsmedizin, Berlin, Germany; LADR, GmbH MVZ, Neuruppin, Germany
| | - Sabine Petersdorf
- Institute of Medical Microbiology and Hospital Hygiene University Hospital, Heinrich-Heine-University. Düsseldorf, Germany
| | - Vicens Diaz-Brito
- Infectious Diseases Unit, Parc Sanitari Sant Joan de Deu, Sant Boi, Barcelona, Spain
| | - Zeliha Kocak Tufan
- Infectious Diseases and Clinical Microbiology Department, Ankara Yildirim Beyazit University, Ataturk Training & Research Hospital, Ankara, Turkey
| | - Marisa Sanchez
- Infectious Diseases Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Argentina
| | - Cédric Arvieux
- Department of Infectious Diseases and IntensiveCare Medicine, Rennes University Hospital, Rennes, France; Great West Reference centers for Complex Bone and Joint Infections (CRIOGO), France
| | - Alex Soriano
- Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Escolà-Vergé L, Rodríguez-Pardo D, Lora-Tamayo J, Morata L, Murillo O, Vilchez H, Sorli L, Carrión LG, Barbero JM, Palomino-Nicás J, Bahamonde A, Jover-Sáenz A, Benito N, Escudero R, Sampedro MF, Vidal RP, Gómez L, Corona PS, Almirante B, Ariza J, Pigrau C. Candida periprosthetic joint infection: A rare and difficult-to-treat infection. J Infect 2018; 77:151-157. [PMID: 29746950 DOI: 10.1016/j.jinf.2018.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 01/25/2018] [Revised: 03/01/2018] [Accepted: 03/04/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Candida periprosthetic joint infection (CPJI) is a rare, difficult-to-treat disease. The purpose of this study was to evaluate the clinical characteristics and outcomes of CPJI treated with various surgical and antifungal strategies. METHODS We conducted a multicenter retrospective study of all CPJI diagnosed between 2003 and 2015 in 16 Spanish hospitals. RESULTS Forty-three patients included: median age, 75 years, and median Charlson Comorbidity Index score, 4. Thirty-four (79.1%) patients had ≥1 risk factor for Candida infection. Most common causative species were C. albicans and C. parapsilosis. Thirty-five patients were evaluable for outcome: overall, treatment succeeded in 17 (48.6%) and failed in 18 (51.4%). Success was 13/20 (67%) in patients with prosthesis removal and 4/15 (27%) with debridement and prosthesis retention (p = 0.041). All 3 patients who received an amphotericin B-impregnated cement spacer cured. In the prosthesis removal group, success was 5/6 (83%) with an antibiofilm regimen and 8/13 (62%) with azoles (p = 0.605). In the debridement and prosthesis retention group, success was 3/10 (30%) with azoles and 1/5 (20%) with antibiofilm agents. Therapeutic failure was due to relapse in 9 patients, need for suppressive treatment in 5, persistent infection in 2, and CPJI-related death in 2; overall attributable mortality was 6%. CONCLUSIONS CPJI is usually a chronic disease in patients with comorbidities and risk factors for Candida infection. Treatment success is low, and prosthesis removal improves outcome. Although there is insufficient evidence that use of antifungals with antibiofilm activity has additional benefits, our experience indicates it may be recommendable.
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Affiliation(s)
- Laura Escolà-Vergé
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Dolors Rodríguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaime Lora-Tamayo
- Internal Medicine Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre "i+12", Madrid, Spain
| | - Laura Morata
- Infectious Diseases Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Oscar Murillo
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Helem Vilchez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Palma, Spain
| | - Luisa Sorli
- Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR) Institut Hospital del Mar d'Investigacioms Mèdiques (IMIM) CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | | | - José Mª Barbero
- Internal Medicine Department, Hospital Príncipe de Asturias, Universidad de Alcalá de Henares, Madrid
| | - Julián Palomino-Nicás
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | | | - Alfredo Jover-Sáenz
- Infectious Diseases Department, Unidad Territorial para el control de la Infección Nosocomial (UTIN), Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Natividad Benito
- Infectious Diseases Unit, Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rosa Escudero
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. IRYCIS
| | - Marta Fernandez Sampedro
- Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marqués de Valdecilla-IDIVAL, Cantabria, Spain
| | - Rafael Pérez Vidal
- Infectious Diseases Unit, Internal Medicine Department, Althaia, Hospital de Sant Joan de Déu, Manresa, Spain
| | - Lucía Gómez
- Internal Medicine, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Pablo S Corona
- Reconstructive and Septic Surgery Division, Department of Orthopedic Surgery, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Benito Almirante
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Ariza
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Carles Pigrau
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
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Ramos-Martínez A, Muñoz Serrano A, de Alarcón González A, Muñoz P, Fernández-Cruz A, Valerio M, Fariñas MC, Gutiérrez-Cuadra M, Miró JM, Ruiz-Morales J, Sousa-Regueiro D, Montejo JM, Gálvez-Acebal J, HidalgoTenorio C, Domínguez F. Gentamicin may have no effect on mortality of staphylococcal prosthetic valve endocarditis. J Infect Chemother 2018; 24:555-562. [PMID: 29628387 DOI: 10.1016/j.jiac.2018.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/23/2018] [Accepted: 03/06/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE). METHODS From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-four patients (28.1%) received treatment based on β-lactam or vancomycin plus rifampicin and were included in the study. Variables were analyzed which related to patient survival during admission, including having received treatment with gentamicin. RESULTS Seventy-seven (81.9%) were treated with cloxacillin (or vancomycin) plus rifampicin plus gentamicin, and 17 patients (18.1%) received the same regimen without gentamicin. The causative microorganism was Staphylococcus aureus in 40 cases (42.6%) and coagulase-negative staphylococci in 54 cases (57.4%). Overall, 40 patients (42.6%) died during hospital admission, 33 patients (42.9%) in the group receiving gentamicin and 7 patients in the group that did not (41.2%, P = 0.899). Worsening renal function was observed in 42 patients (54.5%) who received gentamicin and in 9 patients (52.9%) who did not (p = 0.904). Heart failure as a complication of endocarditis (OR: 4.58; CI 95%: 1.84-11.42) and not performing surgery when indicated (OR: 2.68; CI 95%: 1.03-6.94) increased mortality. Gentamicin administration remained unrelated to mortality (OR: 1.001; CI 95%: 0.29-3.38) in the multivariable analysis. CONCLUSIONS The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome.
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Affiliation(s)
- Antonio Ramos-Martínez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Universitario Puerta de Hierro, Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Alejandro Muñoz Serrano
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Arístides de Alarcón González
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Grupo de Investigación sobre Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla / CSIC / Universidad Virgen del Rocío y Virgen Macarena, Sevilla, Spain.
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Spain.
| | - Ana Fernández-Cruz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Maricela Valerio
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - María Carmen Fariñas
- Unidad de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
| | - Manuel Gutiérrez-Cuadra
- Unidad de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - José Ma Miró
- Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS. Universidad de Barcelona, Barcelona, Spain.
| | - Josefa Ruiz-Morales
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Victoria, IBIMA, Málaga, Spain.
| | | | - José Miguel Montejo
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Universidad del País Vasco, País Vasco, Spain.
| | - Juan Gálvez-Acebal
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena Instituto de Biomedicina de Sevilla, IBIS. Universidad de Sevilla, Sevilla, Spain.
| | - Carmen HidalgoTenorio
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Complejo Hospitalario de Granada, Granada, Spain.
| | - Fernando Domínguez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
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45
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Zegri-Reiriz I, de Alarcón A, Muñoz P, Martínez Sellés M, González-Ramallo V, Miro JM, Falces C, Gonzalez Rico C, Kortajarena Urkola X, Lepe JA, Rodriguez Alvarez R, Reguera Iglesias JM, Navas E, Dominguez F, Garcia-Pavia P. Infective Endocarditis in Patients With Bicuspid Aortic Valve or Mitral Valve Prolapse. J Am Coll Cardiol 2018; 71:2731-2740. [PMID: 29903346 DOI: 10.1016/j.jacc.2018.03.534] [Citation(s) in RCA: 47] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/16/2018] [Accepted: 03/17/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions. OBJECTIVES This study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions. METHODS This analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group; n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group; n = 1,839), and IE with BAV (n = 54) or MVP (n = 89). RESULTS BAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0%; all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients. CONCLUSIONS IE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered.
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Affiliation(s)
- Isabel Zegri-Reiriz
- Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infecious Diseases Research Group, Institute of Biomedicine of Seville, University of Seville/CSIC/University Hospitals Virgen del Rocío and Virgen Macarena, Seville, Spain
| | - Patricia Muñoz
- Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERES, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martínez Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Victor González-Ramallo
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jose M Miro
- Department of Infectious Diseases, Hospital Clínic- Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Carles Falces
- Department of Cardiology, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Claudia Gonzalez Rico
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - José Antonio Lepe
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infecious Diseases Research Group, Institute of Biomedicine of Seville, University of Seville/CSIC/University Hospitals Virgen del Rocío and Virgen Macarena, Seville, Spain
| | | | | | - Enrique Navas
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Fernando Dominguez
- Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain; Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
| | - Pablo Garcia-Pavia
- Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain; University Francisco de Vitoria, Pozuelo de Alarcon, Madrid, Spain.
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46
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Pericàs JM, Moreno A, Almela M, García-de-la-Mària C, Marco F, Muñoz P, Peña C, de Alarcón A, Del Río A, Eworo A, Cruceta A, Paré JC, Mestres CA, Miró JM. Efficacy and safety of fosfomycin plus imipenem versus vancomycin for complicated bacteraemia and endocarditis due to methicillin-resistant Staphylococcus aureus: a randomized clinical trial. Clin Microbiol Infect 2018; 24:673-676. [PMID: 29408610 DOI: 10.1016/j.cmi.2018.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 02/05/2023]
Affiliation(s)
- J M Pericàs
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A Moreno
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
| | - M Almela
- Microbiology Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - C García-de-la-Mària
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - F Marco
- Microbiology Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - C Peña
- Infectious Diseases Service, Hospital de Bellvitge, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - A de Alarcón
- Infectious Diseases Service, UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva Grupo de Investigacion en Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla (IBiS)/CSIC/HU Virgen del Rocío, Sevilla, Spain
| | - A Del Río
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A Eworo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - A Cruceta
- Clinical Trials Unit, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J C Paré
- Cardiology Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C A Mestres
- Department of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J M Miró
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
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Rivoisy C, Vena A, Schaeffer L, Charlier C, Fontanet A, Delahaye F, Bouza E, Lortholary O, Munoz P, Lefort A. Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis-The ESCAPE Study. Clin Infect Dis 2018; 66:825-832. [PMID: 29077791 DOI: 10.1093/cid/cix913] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/24/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment. METHODS We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome. RESULTS Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects. CONCLUSION L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients.
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Affiliation(s)
- Claire Rivoisy
- Université Paris Descartes, Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker Pasteur, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France
| | - Antonio Vena
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Spain
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Universidad Complutense de Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Universidad Complutense de Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain
| | - Laura Schaeffer
- Unit of Epidemiology of Emerging Diseases, Institut Pasteur, Paris, France
| | - Caroline Charlier
- Université Paris Descartes, Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker Pasteur, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France
| | - Arnaud Fontanet
- Unit of Epidemiology of Emerging Diseases, Institut Pasteur, Paris, France
- PACRI Unit, Conservatoire National des Arts et Métiers, Paris, France
| | | | - Emilio Bouza
- CIBER de Enfermedades Respiratorias (CIBERES), Universidad Complutense de Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain
- Hospital General Universitario Gregorio Marañón, Madrid Spain
| | - Olivier Lortholary
- Université Paris Descartes, Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker Pasteur, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, Clichy, France
| | - Patricia Munoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Spain
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Universidad Complutense de Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Universidad Complutense de Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain
| | - Agnès Lefort
- IAME, UMR1137, Université Paris-Diderot, Sorbonne Paris Cité, Clichy, France
- Service de Médecine Interne, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val-de-Seine, Assistance Publique-Hôpitaux de Paris, Clichy, France
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Del Barrio-Tofiño E, López-Causapé C, Cabot G, Rivera A, Benito N, Segura C, Montero MM, Sorlí L, Tubau F, Gómez-Zorrilla S, Tormo N, Durá-Navarro R, Viedma E, Resino-Foz E, Fernández-Martínez M, González-Rico C, Alejo-Cancho I, Martínez JA, Labayru-Echverria C, Dueñas C, Ayestarán I, Zamorano L, Martinez-Martinez L, Horcajada JP, Oliver A. Erratum for del Barrio-Tofiño et al., "Genomics and Susceptibility Profiles of Extensively Drug-Resistant Pseudomonas aeruginosa Isolates from Spain". Antimicrob Agents Chemother 2018; 62:62/1/e02352-17. [PMID: 29269435 PMCID: PMC5740333 DOI: 10.1128/aac.02352-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Ester Del Barrio-Tofiño
- Department of Microbiology, Intensive Care Unit and Unidad de Investigación, Hospital Universitari Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Carla López-Causapé
- Department of Microbiology, Intensive Care Unit and Unidad de Investigación, Hospital Universitari Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Gabriel Cabot
- Department of Microbiology, Intensive Care Unit and Unidad de Investigación, Hospital Universitari Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Alba Rivera
- Department of Microbiology and Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Natividad Benito
- Department of Microbiology and Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Concepción Segura
- Laboratory de Referència de Catalunya and Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR)-Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - María Milagro Montero
- Laboratory de Referència de Catalunya and Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR)-Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Luisa Sorlí
- Laboratory de Referència de Catalunya and Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR)-Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Fe Tubau
- Department of Microbiology and Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Silvia Gómez-Zorrilla
- Department of Microbiology and Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Nuria Tormo
- Department of Microbiology and Infectious Diseases, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Raquel Durá-Navarro
- Department of Microbiology and Infectious Diseases, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Esther Viedma
- Department of Microbiology and Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elena Resino-Foz
- Department of Microbiology and Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marta Fernández-Martínez
- Department of Microbiology and Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigacion Valdecilla (IDIVAL), Santander, Spain
| | - Claudia González-Rico
- Department of Microbiology and Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigacion Valdecilla (IDIVAL), Santander, Spain
| | - Izaskun Alejo-Cancho
- Department of Microbiology and Infectious Diseases, Hospital Universitari Clínic, Barcelona, Spain
| | - Jose Antonio Martínez
- Department of Microbiology and Infectious Diseases, Hospital Universitari Clínic, Barcelona, Spain
| | | | - Carlos Dueñas
- Department of Microbiology and Infectious Diseases, Hospital Universitario de Burgos, Burgos, Spain
| | - Ignacio Ayestarán
- Department of Microbiology, Intensive Care Unit and Unidad de Investigación, Hospital Universitari Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Laura Zamorano
- Department of Microbiology, Intensive Care Unit and Unidad de Investigación, Hospital Universitari Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Luis Martinez-Martinez
- Unit of Microbiology, Hospital Universitario Reina Sofía, Departament of Microbiology, University of Córdoba, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Juan Pablo Horcajada
- Laboratory de Referència de Catalunya and Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR)-Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Antonio Oliver
- Department of Microbiology, Intensive Care Unit and Unidad de Investigación, Hospital Universitari Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
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Del Barrio-Tofiño E, López-Causapé C, Cabot G, Rivera A, Benito N, Segura C, Montero MM, Sorlí L, Tubau F, Gómez-Zorrilla S, Tormo N, Durá-Navarro R, Viedma E, Resino-Foz E, Fernández-Martínez M, González-Rico C, Alejo-Cancho I, Martínez JA, Labayru-Echverria C, Dueñas C, Ayestarán I, Zamorano L, Martinez-Martinez L, Horcajada JP, Oliver A. Genomics and Susceptibility Profiles of Extensively Drug-Resistant Pseudomonas aeruginosa Isolates from Spain. Antimicrob Agents Chemother 2017; 61:AAC.01589-17. [PMID: 28874376 PMCID: PMC5655108 DOI: 10.1128/aac.01589-17] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [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: 08/02/2017] [Accepted: 08/27/2017] [Indexed: 02/08/2023] Open
Abstract
This study assessed the molecular epidemiology, resistance mechanisms, and susceptibility profiles of a collection of 150 extensively drug-resistant (XDR) Pseudomonas aeruginosa clinical isolates obtained from a 2015 Spanish multicenter study, with a particular focus on resistome analysis in relation to ceftolozane-tazobactam susceptibility. Broth microdilution MICs revealed that nearly all (>95%) of the isolates were nonsusceptible to piperacillin-tazobactam, ceftazidime, cefepime, aztreonam, imipenem, meropenem, and ciprofloxacin. Most of them were also resistant to tobramycin (77%), whereas nonsusceptibility rates were lower for ceftolozane-tazobactam (31%), amikacin (7%), and colistin (2%). Pulsed-field gel electrophoresis-multilocus sequence typing (PFGE-MLST) analysis revealed that nearly all of the isolates belonged to previously described high-risk clones. Sequence type 175 (ST175) was detected in all 9 participating hospitals and accounted for 68% (n = 101) of the XDR isolates, distantly followed by ST244 (n = 16), ST253 (n = 12), ST235 (n = 8), and ST111 (n = 2), which were detected only in 1 to 2 hospitals. Through phenotypic and molecular methods, the presence of horizontally acquired carbapenemases was detected in 21% of the isolates, mostly VIM (17%) and GES enzymes (4%). At least two representative isolates from each clone and hospital (n = 44) were fully sequenced on an Illumina MiSeq. Classical mutational mechanisms, such as those leading to the overexpression of the β-lactamase AmpC or efflux pumps, OprD inactivation, and/or quinolone resistance-determining regions (QRDR) mutations, were confirmed in most isolates and correlated well with the resistance phenotypes in the absence of horizontally acquired determinants. Ceftolozane-tazobactam resistance was not detected in carbapenemase-negative isolates, in agreement with sequencing data showing the absence of ampC mutations. The unique set of mutations responsible for the XDR phenotype of ST175 clone documented 7 years earlier were found to be conserved, denoting the long-term persistence of this specific XDR lineage in Spanish hospitals. Finally, other potentially relevant mutations were evidenced, including those in penicillin-binding protein 3 (PBP3), which is involved in β-lactam (including ceftolozane-tazobactam) resistance, and FusA1, which is linked to aminoglycoside resistance.
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Affiliation(s)
- Ester Del Barrio-Tofiño
- Department of Microbiology, Intensive Care Unit and Unidad de Investigación, Hospital Universitari Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Carla López-Causapé
- Department of Microbiology, Intensive Care Unit and Unidad de Investigación, Hospital Universitari Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Gabriel Cabot
- Department of Microbiology, Intensive Care Unit and Unidad de Investigación, Hospital Universitari Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Alba Rivera
- Department of Microbiology and Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Natividad Benito
- Department of Microbiology and Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Concepción Segura
- Laboratory de Referència de Catalunya and Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR)-Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - María Milagro Montero
- Laboratory de Referència de Catalunya and Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR)-Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Luisa Sorlí
- Laboratory de Referència de Catalunya and Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR)-Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Fe Tubau
- Department of Microbiology and Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Silvia Gómez-Zorrilla
- Department of Microbiology and Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Nuria Tormo
- Department of Microbiology and Infectious Diseases, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Raquel Durá-Navarro
- Department of Microbiology and Infectious Diseases, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Esther Viedma
- Department of Microbiology and Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elena Resino-Foz
- Department of Microbiology and Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marta Fernández-Martínez
- Department of Microbiology and Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigacion Valdecilla (IDIVAL), Santander, Spain
| | - Claudia González-Rico
- Department of Microbiology and Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigacion Valdecilla (IDIVAL), Santander, Spain
| | - Izaskun Alejo-Cancho
- Department of Microbiology and Infectious Diseases, Hospital Universitari Clínic, Barcelona, Spain
| | - Jose Antonio Martínez
- Department of Microbiology and Infectious Diseases, Hospital Universitari Clínic, Barcelona, Spain
| | | | - Carlos Dueñas
- Department of Microbiology and Infectious Diseases, Hospital Universitario de Burgos, Burgos, Spain
| | - Ignacio Ayestarán
- Department of Microbiology, Intensive Care Unit and Unidad de Investigación, Hospital Universitari Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Laura Zamorano
- Department of Microbiology, Intensive Care Unit and Unidad de Investigación, Hospital Universitari Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Luis Martinez-Martinez
- Unit of Microbiology, Hospital Universitario Reina Sofía, Departament of Microbiology, University of Córdoba, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Juan Pablo Horcajada
- Laboratory de Referència de Catalunya and Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR)-Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Antonio Oliver
- Department of Microbiology, Intensive Care Unit and Unidad de Investigación, Hospital Universitari Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
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Wouthuyzen-Bakker M, Benito N, Soriano A. The Effect of Preoperative Antimicrobial Prophylaxis on Intraoperative Culture Results in Patients with a Suspected or Confirmed Prosthetic Joint Infection: a Systematic Review. J Clin Microbiol 2017; 55:2765-2774. [PMID: 28659322 PMCID: PMC5648712 DOI: 10.1128/jcm.00640-17] [Citation(s) in RCA: 37] [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: 04/17/2017] [Accepted: 06/23/2017] [Indexed: 02/08/2023] Open
Abstract
Obtaining reliable cultures during revision arthroplasty is important to adequately diagnose and treat a prosthetic joint infection (PJI). The influence of antimicrobial prophylaxis on culture results remains unclear. Since withholding prophylaxis increases the risk for surgical site infections, clarification on this topic is critical. A systematic review was performed with the following research question: in patients who undergo revision surgery of a prosthetic joint, does preoperative antimicrobial prophylaxis affect the culture yield of intraoperative samples in comparison with nonpreoperative antimicrobial prophylaxis? Seven articles were included in the final analysis. In most studies, standard diagnostic culture techniques were used. In patients with a PJI, pooled analysis showed a culture yield of 88% (145/165) in the prophylaxis group versus 95% (344/362) in the nonprophylaxis group (P = 0.004). Subanalysis of patients with chronic PJIs showed positive cultures in 88% (78/89) versus 91% (52/57), respectively (P = 0.59). In patients with a suspected chronic infection, a maximum difference of 4% in culture yield between the prophylaxis and nonprophylaxis groups was observed. With the use of standard culture techniques, antimicrobial prophylaxis seems to affect cultures in a minority of patients. Along with the known risk of surgical site infections due to inadequate timing of antimicrobial prophylaxis, we discourage the postponement of prophylaxis until tissue samples are obtained in revision surgery. Future studies are necessary to conclude whether the small percentage of false-negative cultures after prophylaxis can be further reduced with the use of more-sensitive culture techniques, like sonication.
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Affiliation(s)
- Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Natividad Benito
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Soriano
- Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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