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Fernández-Cruz A, Muñoz P, Sandoval C, Fariñas C, Gutiérrez-Cuadra M, Pericás Pulido JM, Miró JM, Goenaga-Sánchez MÁ, de Alarcón A, Bonache-Bernal F, Rodríguez M, Noureddine M, Bouza Santiago E. Infective endocarditis in patients with cancer: a consequence of invasive procedures or a harbinger of neoplasm?: A prospective, multicenter cohort. Medicine (Baltimore) 2017; 96:e7913. [PMID: 28930826 PMCID: PMC5617693 DOI: 10.1097/md.0000000000007913] [Citation(s) in RCA: 19] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of the study was to draw a comparison between the characteristics of infective endocarditis (IE) in patients with cancer and those of IE in noncancer patients.Patients with IE, according to the modified Duke criteria, were prospectively included in the GAMES registry between January 2008 and February 2014 in 30 hospitals. Patients with active cancer were compared with noncancer patients.During the study period, 161 episodes of IE fulfilled the inclusion criteria. We studied 2 populations: patients whose cancer was diagnosed before IE (73.9%) and those whose cancer and IE were diagnosed simultaneously (26.1%). The latter more frequently had community-acquired IE (67.5% vs 26.4%, P < .01), severe sepsis (28.6% vs 11.1%, P = .013), and IE caused by gastrointestinal streptococci (42.9% vs 16.8%, P < .01). However, catheter source (7.1% vs 29.4%, P = .003), invasive procedures (26.2% vs 44.5%, P = .044), and immunosuppressants (9.5% vs 35.6%, P = .002) were less frequent.When compared with noncancer patients, patients with cancer were more often male (75.2% vs 67.7%, P = .049), with a higher comorbidity index (7 vs 4). In addition, IE was more often nosocomial (48.7% vs 29%) and originated in catheters (23.6% vs 6.2%) (all P < .01). Prosthetic endocarditis (21.7% vs 30.3%, P = .022) and surgery when indicated (24.2% vs 46.5%, P < .01) were less common. In-hospital mortality (34.8% vs 25.8%, P = .012) and 1-year mortality (47.8% vs 30.9%, P < .01) were higher in cancer patients, although 30-day mortality was not (24.8% vs 19.3%, P = .087).A significant proportion of cases of IE (5.6%) were recorded in cancer patients, mainly as a consequence of medical interventions. IE may be a harbinger of occult cancer, particularly that of gastrointestinal or urinary origin.
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Affiliation(s)
- Ana Fernández-Cruz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid
- Instituto de Investigación Sanitaria Gregorio Marañón
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid
- Instituto de Investigación Sanitaria Gregorio Marañón
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058)
- Facultad de Medicina, Departamento de Medicina, Universidad Complutense de Madrid
| | - Carmen Sandoval
- Instituto de Investigación Sanitaria Gregorio Marañón
- Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid
| | - Carmen Fariñas
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander
| | - Manuel Gutiérrez-Cuadra
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander
| | - Juan M. Pericás Pulido
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, Universitat de Barcelona, Barcelona
| | - José M. Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, Universitat de Barcelona, Barcelona
| | | | - Arístides de Alarcón
- Department of Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla
| | | | - MªÁngeles Rodríguez
- Department of Infectious Diseases, Hospital Universitario Central de Asturias, Oviedo
| | - Mariam Noureddine
- Department of Infectious Diseases, Hospital Costa del Sol, Marbella, Spain
| | - Emilio Bouza Santiago
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid
- Instituto de Investigación Sanitaria Gregorio Marañón
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058)
- Facultad de Medicina, Departamento de Medicina, Universidad Complutense de Madrid
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San-Juan R, Fernández-Ruiz M, Gasch O, Camoez M, López-Medrano F, Domínguez MÁ, Almirante B, Padilla B, Pujol M, Aguado JM. High vancomycin MICs predict the development of infective endocarditis in patients with catheter-related bacteraemia due to methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother 2017; 72:2102-2109. [PMID: 28379553 DOI: 10.1093/jac/dkx096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 11/21/2016] [Accepted: 02/28/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It has been suggested that there is an increased risk of treatment failure in episodes of MRSA bloodstream infection (BSI) caused by strains with high vancomycin MICs. However, it is unknown if this phenomenon may also act as a risk factor for the development of infective endocarditis (IE). METHODS We analysed 207 episodes of catheter-related (CR)-BSI recruited from June 2008 to December 2009 within a prospective study on MRSA BSI in 21 Spanish hospitals. Vancomycin susceptibility was centrally tested. The impact of high vancomycin MIC values (≥1.5 mg/L by Etest) on the subsequent development of IE was investigated by Cox regression. RESULTS High vancomycin MIC values were observed in 46.9% of the isolates. Initial therapy consisted of vancomycin [99 episodes (44.7%)], daptomycin [25 (12.1%)], linezolid [18 (8.7%)] and other antistaphylococcal agents [16 (7.7%)]. Haematogenous complications occurred in 41 patients (19.8%), including 10 episodes complicated by IE. Early (48 h) and late (30 day) all-cause mortality were 3.4% and 25.1%, respectively. High vancomycin MIC isolates were more common among patients that developed IE compared with those free from this complication [90.9% (9/10) versus 44.7% (88/197); P = 0.007]. This association remained significant after adjusting for multiple confounders (including initial antibiotic therapy and catheter removal) in different models (minimum hazard ratio: 9.18; 95% CI: 1.16-72.78; P = 0.036). There were no differences in mortality according to vancomycin MIC values. CONCLUSIONS Decreased susceptibility to vancomycin acted as a predictor of the development of IE complicating MRSA CR-BSI.
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Affiliation(s)
- Rafael San-Juan
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (i?+?12), Universidad Complutense, Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (i?+?12), Universidad Complutense, Madrid, Spain
| | - Oriol Gasch
- Department of Infectious Diseases, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Mariana Camoez
- Department of Microbiology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco López-Medrano
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (i?+?12), Universidad Complutense, Madrid, Spain
| | - María Ángeles Domínguez
- Department of Microbiology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Benito Almirante
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Belén Padilla
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario 'Gregorio Marañón', Universidad Complutense, Madrid, Spain
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José María Aguado
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (i?+?12), Universidad Complutense, Madrid, Spain
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Lora-Tamayo J, Senneville É, Ribera A, Bernard L, Dupon M, Zeller V, Li HK, Arvieux C, Clauss M, Uçkay I, Vigante D, Ferry T, Iribarren JA, Peel TN, Sendi P, Miksic NG, Rodríguez-Pardo D, Del Toro MD, Fernández-Sampedro M, Dapunt U, Huotari K, Davis JS, Palomino J, Neut D, Clark BM, Gottlieb T, Trebše R, Soriano A, Bahamonde A, Guío L, Rico A, Salles MJC, Pais MJG, Benito N, Riera M, Gómez L, Aboltins CA, Esteban J, Horcajada JP, O'Connell K, Ferrari M, Skaliczki G, Juan RS, Cobo J, Sánchez-Somolinos M, Ramos A, Giannitsioti E, Jover-Sáenz A, Baraia-Etxaburu JM, Barbero JM, Choong PFM, Asseray N, Ansart S, Moal GL, Zimmerli W, Ariza J. The Not-So-Good Prognosis of Streptococcal Periprosthetic Joint Infection Managed by Implant Retention: The Results of a Large Multicenter Study. Clin Infect Dis 2017; 64:1742-1752. [PMID: 28369296 DOI: 10.1093/cid/cix227] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/14/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND. Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success. METHODS. A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy. RESULTS. Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34). CONCLUSIONS. This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin.
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Affiliation(s)
- Jaime Lora-Tamayo
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI)
| | - Éric Senneville
- Department of Infectious Diseases, Gustave Dron Hospital of Tourcoing, France
| | - Alba Ribera
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Infectious Diseases, Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - Louis Bernard
- Department of Infectious Diseases, Hôpital Universitaire Bretonneau, Tours, France
- Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO)
| | - Michel Dupon
- Centre correspondant de prise en charge des Infections Ostéo-articulaires Complexes du Grand Sud-Ouest, CHU Bordeaux
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, and
| | - Ho Kwong Li
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - Cédric Arvieux
- Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO)
- Department of Infectious Diseases, Rennes University Hospital, Rennes, France
| | - Martin Clauss
- Interdisciplinary Septic Surgical Unit, Kantonsspital Baselland, Liestal
| | - Ilker Uçkay
- Department of Infectious Diseases, Hôpitaux Universitaires Genève, Switzerland
| | - Dace Vigante
- Hospital of Traumatology and Orthopedics, Riga, Latvia
| | - Tristan Ferry
- Department of Infectious and Tropical Diseases, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, France
| | - José Antonio Iribarren
- Department of Infectious Diseases, Hospital Universitario Donostia, San Sebastián, Spain
| | - Trisha N Peel
- Department of Infectious Diseases, Saint Vincent's Public Hospital, Melbourne, Victoria, Australia
| | - Parham Sendi
- Department of Infectious Diseases, University Hospital of Bern, Switzerland
| | - Nina Gorišek Miksic
- Infectious Diseases Department, University Clinical Center, Maribor, Slovenia
| | - Dolors Rodríguez-Pardo
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona
| | - María Dolores Del Toro
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (Ibis), University of Seville, University Hospitals Virgen Macarena y Virgen del Rocío, and
| | - Marta Fernández-Sampedro
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ulrike Dapunt
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Germany
| | | | - Joshua S Davis
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Julián Palomino
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (Ibis), University of Seville, University Hospitals Virgen Macarena y Virgen del Rocío, and
| | - Danielle Neut
- Departments of Orthopedic Surgery and Biomedical Engineering, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Benjamin M Clark
- Department of Infectious Diseases, Fiona Stanley Hospital, Western Australia
| | - Thomas Gottlieb
- Department of Microbiology and Infectious Diseases, Concord Hospital, New South Wales, Australia
| | - Rihard Trebše
- Service for Bone Infections, Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
| | - Alex Soriano
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain
- ESCMID Study Group for Implant-Associated Infections (ESGIAI)
| | | | - Laura Guío
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Unit of Infectious Diseases, Hospital de Cruces, Barakaldo, and
| | - Alicia Rico
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - Mauro J C Salles
- Unit of Infectious Diseases, Department of Internal Medicine, Santa Casa de Misericórdia de São Paulo, Brazil
| | - M José G Pais
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Natividad Benito
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Unit of Infectious Diseases, Hospital Universitari de la Santa Creu I Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona
| | - Melchor Riera
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Internal Medicine, Hospital Son Espases, Palma de Mallorca, and
| | - Lucía Gómez
- Unit of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Spain
| | - Craig A Aboltins
- Department of Infectious Diseases, Northern Health, Victoria and University of Melbourne, Northern Clinical School, Australia
| | - Jaime Esteban
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, Madrid
| | | | - Karina O'Connell
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Matteo Ferrari
- Department of Orthopedics and Rehabilitation, Humanitas Research Hospital, Milano, Italy
| | - Gábor Skaliczki
- Department of Orthopedics, OrhopediClinic, Semmelweis University, Budapest, Hungary
| | - Rafael San Juan
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI)
| | - Javier Cobo
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS
| | - Mar Sánchez-Somolinos
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, and
| | - Antonio Ramos
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Efthymia Giannitsioti
- Department of Infectious Diseases, 4th Department of Internal Medicine, NKUA, ATTIKON University General Hospital, Athens, Greece
| | - Alfredo Jover-Sáenz
- Department of Infectious Diseases, Hospital Universitari Arnau de Vilanova, Lleida
| | | | - José María Barbero
- Department of Internal Medicine, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Peter F M Choong
- University of Melbourne, Departments of Surgery and Orthopaedic, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Nathalie Asseray
- Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO)
- Department of Infectious Diseases, Hôpital Universitaire Hôtel Dieu, Nantes
| | - Séverine Ansart
- Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO)
- Department of Infectious Diseases, Hôpital Universitaire La Cavale Blanche, Brest, and
| | - Gwenäel Le Moal
- Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO)
- Department of Infectious Diseases, Hôpital Universitaire La Miletrie, Poitiers, France
| | - Werner Zimmerli
- Interdisciplinary Septic Surgical Unit, Kantonsspital Baselland, Liestal
| | - Javier Ariza
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Infectious Diseases, Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain
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Pomar V, Benito N, López-Contreras J, Coll P, Gurguí M, Domingo P. Characteristics and outcome of spontaneous bacterial meningitis in patients with cancer compared to patients without cancer. Medicine (Baltimore) 2017; 96:e6899. [PMID: 28489800 PMCID: PMC5428634 DOI: 10.1097/md.0000000000006899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In cancer patients, who are frequently immunocompromised, bacterial meningitis (BM) can be a severe complication, with a different presentation, etiology, and course, compared to patients without cancer. Our objective is to compare the characteristics and outcomes of BM in patients with and without cancer. A single-center, prospective observational cohort study, conducted between 1982 and 2012, in a tertiary university hospital in Barcelona (Spain). The main outcome measure is in-hospital mortality. We evaluated 659 episodes of BM; 97 (15%) had active cancer. Patients with malignancies were older (median 63 (interquartile range [IQR] 24) vs 52 [IQR 42] years, P < .001) and more often had a Charlson comorbidity score of ≥3 (51% vs 11%, P < .001). The classic meningitis triad (35% vs 50%, P = .05), fever (91% vs 96%, P = .03), neck stiffness (58% vs 78%, P < .001), headache (63% vs 77%) P = .003), and rash (7% vs 30%, P < .001) were less frequent. There was a longer interval between admission and antibiotic therapy (median 5 [IQR 14] vs 3 [IQR 6] hours, P < .001). Listeria meningitis was the commonest cause of BM (29%) and was more frequent in cancer than noncancer (8%, P < .001) patients, whereas meningococcal meningitis was much less frequent (4% vs 36%, P < .001). Overall mortality was higher in patients with cancer (31% vs 16%, P < .001), although cancer was not associated with an unfavorable outcome in the multivariate analysis (odds ratio 1.825, P = .07). Patients with meningitis and cancer are older and have more subtle clinical manifestations than patients without cancer. Listeria monocytogenes is the predominant pathogen and mortality is higher in cancer patients.
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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
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid
| | - 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
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid
| | - Joaquin López-Contreras
- 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
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid
| | - Pere Coll
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid
- Department of Clinical Microbiology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mercedes 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
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid
| | - 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
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Ariza J, Cobo J, Baraia-Etxaburu J, Benito N, Bori G, Cabo J, Corona P, Esteban J, Horcajada JP, Lora-Tamayo J, Murillo O, Palomino J, Parra J, Pigrau C, Del Pozo JL, Riera M, Rodríguez D, Sánchez-Somolinos M, Soriano A, Del Toro MD, de la Torre B. Executive summary of management of prosthetic joint infections. Clinical practice guidelines by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). Enferm Infecc Microbiol Clin 2017; 35:189-195. [PMID: 28215487 DOI: 10.1016/j.eimc.2016.08.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 07/25/2016] [Accepted: 08/04/2016] [Indexed: 02/08/2023]
Abstract
The incidence of prosthetic joint infection (PJI) is expected to increase in the coming years. PJI has serious consequences for patients, and high costs for the health system. The complexity of these infections makes it necessary to organize the vast quantity of information published in the last several years. The indications for the choice of a given surgical strategy and the corresponding antimicrobial therapy are specifically reviewed. The authors selected clinically relevant questions and then reviewed the available literature in order to give recommendations according to a pre-determined level of scientific evidence. The more controversial aspects were debated, and the final composition was agreed at an ad hoc meeting. Before its final publication, the manuscript was made available online in order that all SEIMC members were able to read it and make comments and suggestions.
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Affiliation(s)
- Javier Ariza
- Servicio de Enfermedade Infecciosas, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Javier Cobo
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
| | - Josu Baraia-Etxaburu
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Basurto, Bilbao, 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
| | - Guillermo Bori
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clinic, Barcelona, Spain
| | - Javier Cabo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Pablo Corona
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaime Esteban
- Departamento de Microbiología Clínica, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Jaime Lora-Tamayo
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Oscar Murillo
- Servicio de Enfermedades Infecciosas, Servicio de Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Julián Palomino
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Jorge Parra
- Servicio de Enfermedades Infecciosas, Hospital Clínico San Cecilio de Granada, Spain
| | - Carlos Pigrau
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - José Luis Del Pozo
- Área de Enfermedades Infecciosas y Microbiología Clínica, Clínica Universitaria de Navarra, Spain
| | - Melchor Riera
- Servicio de Medicina Interna-Infecciosas, H. Son Espases, Palma de Mallorca, Spain
| | - Dolores Rodríguez
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mar Sánchez-Somolinos
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Spain
| | - Alex Soriano
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - M Dolores Del Toro
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Basilio de la Torre
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Temkin E, Torre-Cisneros J, Beovic B, Benito N, Giannella M, Gilarranz R, Jeremiah C, Loeches B, Machuca I, Jiménez-Martín MJ, Martínez JA, Mora-Rillo M, Navas E, Osthoff M, Pozo JC, Ramos Ramos JC, Rodriguez M, Sánchez-García M, Viale P, Wolff M, Carmeli Y. Ceftazidime-Avibactam as Salvage Therapy for Infections Caused by Carbapenem-Resistant Organisms. Antimicrob Agents Chemother 2017; 61:AAC.01964-16. [PMID: 27895014 PMCID: PMC5278727 DOI: 10.1128/aac.01964-16] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [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: 09/13/2016] [Accepted: 11/08/2016] [Indexed: 02/08/2023] Open
Abstract
Ceftazidime-avibactam (CAZ-AVI) is a recently approved β-lactam-β-lactamase inhibitor combination with the potential to treat serious infections caused by carbapenem-resistant organisms. Few patients with such infections were included in the CAZ-AVI clinical trials, and clinical experience is lacking. We present a case series of patients with infections caused by carbapenem-resistant Enterobacteriaceae (CRE) or Pseudomonas aeruginosa (CRPa) who were treated with CAZ-AVI salvage therapy on a compassionate-use basis. Physicians who had prescribed CAZ-AVI completed a case report form. We used descriptive statistics to summarize patient characteristics and treatment outcomes. We used the Wilcoxon rank sum test and Fisher's exact test to compare patients by treatment outcome. The sample included 36 patients infected with CRE and two with CRPa. The most common infections were intra-abdominal. Physicians categorized 60.5% of patients as having life-threatening infections. All but two patients received other antibiotics before CAZ-AVI, for a median of 13 days. The median duration of CAZ-AVI treatment was 16 days. Twenty-five patients (65.8%) concurrently received other antibiotics to which their pathogen was nonresistant in vitro Twenty-eight patients (73.7%, 95% confidence interval [CI], 56.9 to 86.6%) experienced clinical and/or microbiological cure. Five patients (20.8%) with documented microbiological cure died, whereas 10 patients (71.4%) with no documented microbiological cure died (P = 0.01). In three-quarters of cases, CAZ-AVI (alone or combined with other antibiotics) cured infections caused by carbapenem-resistant organisms, 95% of which had failed previous therapy. Microbiological cure was associated with improved survival. CAZ-AVI shows promising clinical results for infections for which treatment options are limited.
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Affiliation(s)
- Elizabeth Temkin
- Department of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Julian Torre-Cisneros
- Department of Infectious Diseases, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica, Universidad de Córdoba, Córdoba, Spain
| | - Bojana Beovic
- Department of Infectious Disease, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Natividad Benito
- Infectious Diseases Unit, Department of Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maddalena Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Raúl Gilarranz
- Department of Clinical Microbiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Cameron Jeremiah
- Department of Infectious Diseases, St Vincent's Hospital, Melbourne, Australia
| | - Belén Loeches
- Infectious Diseases Unit, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - Isabel Machuca
- Department of Infectious Diseases, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica, Universidad de Córdoba, Córdoba, Spain
| | | | - José Antonio Martínez
- Department of Infectious Diseases, Hospital Clínic, IDIBAPS, Barcelona University, Barcelona, Spain
| | - Marta Mora-Rillo
- Infectious Diseases Unit, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - Enrique Navas
- Infectious Diseases Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Michael Osthoff
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Juan Carlos Pozo
- Department of Critical Care Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Marina Rodriguez
- Department of Critical Care Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Pierluigi Viale
- Department of Medical Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Michel Wolff
- Centre Hospitalier Universitaire Bichat-Claude Bernard, AP-HP, Paris, France
- Université Paris Diderot, Paris, France
| | - Yehuda Carmeli
- Department of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sorlí L, Luque S, Segura C, Campillo N, Montero M, Esteve E, Herrera S, Benito N, Alvarez-Lerma F, Grau S, Horcajada JP. Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa. BMC Infect Dis 2017; 17:11. [PMID: 28056821 PMCID: PMC5217330 DOI: 10.1186/s12879-016-2117-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 12/14/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Colistin has a narrow therapeutic window with nephrotoxicity being the major dose-limiting adverse effect. Currently, the optimal doses and therapeutic plasma levels are unknown. METHODS Prospective observational cohort study, including patients infected by colistin-susceptible P. aeruginosa treated with intravenous colistimethate sodium (CMS). Clinical data and colistin plasma levels at steady-state (Css) were recorded. The primary and secondary end points were clinical cure and 30-day all-cause mortality. RESULTS Ninety-one patients were included. Clinical cure was observed in 72 (79%) patients. The mean (SD) Css was 1.49 (1.4) mg/L and 2.42 (1.5) mg/L (p = 0.01) in patients who achieved clinical cure and those who not, respectively. Independent risk factors for clinical failure were male sex (OR 5.88; 95% CI 1.09-31.63), APACHE II score (OR 1.15; 95% CI 1.03-1.27) and nephrotoxicity at the EOT (OR 9.13; 95% CI 95% 2.06-40.5). The 30-day mortality rate was 30.8%. Risk factors for 30-day mortality included the APACHE II score (OR 1.98; 95% CI 1-1.20), the McCabe score (OR 2.49; 95% CI 1.14-5.43) and the presence of nephrotoxicity at the end of treatment (EOT) (OR 3.8; 95% CI 1.26-11.47). CONCLUSION In this series of patients with infections caused by XDR P. aeruginosa infections, Css is not observed to be related to clinical outcome.
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Affiliation(s)
- Luisa Sorlí
- Infectious Disease Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Sonia Luque
- Pharmacy Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Concepción Segura
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- Laboratori de Referència de Catalunya, Prat de Llobregat, Spain
| | - Nuria Campillo
- Pharmacy Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Milagro Montero
- Infectious Disease Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERES, Madrid, Spain
| | - Erika Esteve
- Infectious Disease Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Sabina Herrera
- Infectious Disease Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Natividad Benito
- InfectiousDiseaseUnit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain
- CIBERES, Madrid, Spain
| | - Francisco Alvarez-Lerma
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
- CIBERES, Madrid, Spain
| | - Santiago Grau
- Pharmacy Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERES, Madrid, Spain
| | - Juan Pablo Horcajada
- Infectious Disease Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- Intensive Care Unit, Hospital del Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- CEXS-Universitat Pompeu Fabra, Barcelona, Spain
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58
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Horcajada JP, Sorlí L, Luque S, Benito N, Segura C, Campillo N, Montero M, Esteve E, Mirelis B, Pomar V, Cuquet J, Martí C, Garro P, Grau S. Validation of a colistin plasma concentration breakpoint as a predictor of nephrotoxicity in patients treated with colistin methanesulfonate. Int J Antimicrob Agents 2016; 48:725-727. [PMID: 28128096 DOI: 10.1016/j.ijantimicag.2016.08.020] [Citation(s) in RCA: 40] [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: 05/09/2016] [Revised: 07/12/2016] [Accepted: 08/20/2016] [Indexed: 02/05/2023]
Abstract
Nephrotoxicity limits the effective use of colistin for the treatment of multidrug-resistant Gram-negative bacteria (MDR-GNB) infections. We previously defined a steady-state colistin plasma concentration (Css) of 2.42 mg/L that predicted nephrotoxicity at end of treatment (EOT). The objective of this study was to validate this breakpoint in a prospective cohort. This was a multicentre, prospective, observational study conducted at three hospitals with a cohort of patients treated for MDR-GNB infection with colistin methanesulfonate from September 2011 until January 2015. Nephrotoxicity was evaluated at Day 7 and at EOT using the RIFLE criteria. Css values were measured and analysed using HPLC. Taking the previously defined breakpoint for colistin concentration as a criterion, patients were divided into two groups (Css, ≤2.42 mg/L vs. >2.42 mg/L). Sixty-four patients were included. Seven patients (10.9%) had a Css > 2.42 mg/L and were compared with the remaining patients. Bivariate analysis showed that patients with a Css > 2.42 mg/L were older and had a significantly higher incidence of nephrotoxicity at Day 7 and EOT. Although not statistically significant, nephrotoxicity occurred earlier in these patients (6.2 days vs. 9.2 days in patients with lower Css; P = 0.091). Multivariate analysis of nephrotoxicity showed that Css > 2.42 mg/L was the only predictive factor. Nephrotoxicity was more frequent and occurred earlier in patients with colistin plasma concentrations higher than the previously defined breakpoint (2.42 mg/L). Colistin therapeutic drug monitoring should be routinely considered to avoid reaching this toxicity threshold and potential clinical consequences.
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Affiliation(s)
- Juan P Horcajada
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdicues (IMIM), CEXS-Universitat Pompeu Fabra, Barcelona, Spain.
| | - Luisa Sorlí
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdicues (IMIM), CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Sonia Luque
- Pharmacy Service, Hospital del Mar, Barcelona, Spain
| | - Natividad Benito
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Sant Pau, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - Concepción Segura
- Laboratori de Referència de Catalunya, Prat de Llobregat, Barcelona, Spain
| | | | - Milagro Montero
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdicues (IMIM), CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Erika Esteve
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdicues (IMIM), CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Beatriz Mirelis
- Service of Microbiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Virginia Pomar
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Sant Pau, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Pau Garro
- Hospital del Granollers, Barcelona, Spain
| | - Santiago Grau
- Pharmacy Service, Hospital del Mar, Barcelona, Spain
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59
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Lora-Tamayo J, Euba G, Cobo J, Horcajada JP, Soriano A, Sandoval E, Pigrau C, Benito N, Falgueras L, Palomino J, Del Toro MD, Jover-Sáenz A, Iribarren JA, Sánchez-Somolinos M, Ramos A, Fernández-Sampedro M, Riera M, Baraia-Etxaburu JM, Ariza J. Short- versus long-duration levofloxacin plus rifampicin for acute staphylococcal prosthetic joint infection managed with implant retention: a randomised clinical trial. Int J Antimicrob Agents 2016; 48:310-6. [PMID: 27524103 DOI: 10.1016/j.ijantimicag.2016.05.021] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [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: 03/14/2016] [Revised: 05/04/2016] [Accepted: 05/28/2016] [Indexed: 02/08/2023]
Abstract
Levofloxacin plus rifampicin (L+R) is the treatment of choice for acute staphylococcal prosthetic joint infection (PJI) managed with debridement and implant retention (DAIR). Long courses have been empirically recommended, but some studies have suggested that shorter treatments could be as effective. Our aim was to prove that a short treatment schedule was non-inferior to the standard long schedule. An open-label, multicentre, randomised clinical trial (RCT) was performed. Patients with an early post-surgical or haematogenous staphylococcal PJI, managed with DAIR and initiated on L+R were randomised to receive 8 weeks of treatment (short schedule) versus a long schedule (3 months or 6 months for hip or knee prostheses, respectively). The primary endpoint was cure rate. From 175 eligible patients, 63 were included (52% women; median age, 72 years): 33 patients (52%) received the long schedule and 30 (48%) received the short schedule. There were no differences between the two groups except for a higher rate of polymicrobial infection in the long-schedule group (27% vs. 7%; P = 0.031). Median follow-up was 540 days. In the intention-to-treat analysis, cure rates were 58% and 73% in patients receiving the long and short schedules, respectively (difference -15.7%, 95% CI -39.2% to 7.8%). Forty-four patients (70%) were evaluable per-protocol: cure rates were 95.0% and 91.7% for the long and short schedules, respectively (difference 3.3%, 95% CI -11.7% to 18.3%). This is the first RCT suggesting that 8 weeks of L+R could be non-inferior to longer standard treatments for acute staphylococcal PJI managed with DAIR.
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Affiliation(s)
- Jaime Lora-Tamayo
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre "i+12", Madrid, Spain.
| | - Gorane Euba
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Javier Cobo
- Servicio de Enfermedades Infecciosas, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Pablo Horcajada
- Servicio de Enfermedades Infecciosas, Hospital del Mar, IMIM, CEXS-UPF, Barcelona, Spain
| | - Alex Soriano
- Servicio de Enfermedades Infecciosas, Hospital Clínic i Provincial, IDIBAPS, Barcelona, Spain
| | - Enrique Sandoval
- Servicio de Traumatología, Fundación Jiménez Díaz, Madrid, Spain
| | - Carles Pigrau
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Natividad Benito
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Falgueras
- Servicio de Enfermedades Infecciosas, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Julián Palomino
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - María Dolores Del Toro
- Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Seville, Spain
| | - Alfredo Jover-Sáenz
- Unidad Funcional de Infección Nosocomial y Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, Spain
| | - Mar Sánchez-Somolinos
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Antonio Ramos
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Marta Fernández-Sampedro
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Melchor Riera
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Javier Ariza
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, Barcelona, Spain
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60
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Merino I, Shaw E, Horcajada JP, Cercenado E, Mirelis B, Pallarés MA, Gómez J, Xercavins M, Martínez-Martínez L, De Cueto M, Cantón R, Ruiz-Garbajosa P. CTX-M-15-H30Rx-ST131 subclone is one of the main causes of healthcare-associated ESBL-producing Escherichia coli bacteraemia of urinary origin in Spain. J Antimicrob Chemother 2016; 71:2125-30. [PMID: 27494832 DOI: 10.1093/jac/dkw133] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 11/19/2015] [Accepted: 03/20/2016] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The objective of this study was to assess the prevalence and molecular epidemiology of ESBL-producing Escherichia coli causing healthcare-associated (HCA) and community-associated (CA) bacteraemia of urinary origin (BUO) in Spain. METHODS An observational cohort study was conducted at eight hospitals from different Spanish geographical areas (2010-11). BUO episodes (n = 425) were classified as HCA (n = 215) and CA (n = 210), and one blood isolate per episode was collected. Susceptibility testing was performed, ESBLs were screened by double-disc diffusion test and ESBL and OXA-1 genes were characterized (PCR and sequencing). Population structure (phylogenetic groups, XbaI-PFGE and MLST) and ST131 subtyping (PCR) were determined. Virulence genes were detected by PCR and virulence score, profiles and extraintestinal pathogenic E. coli (ExPEC) status calculated. RESULTS ESBL-producing E. coli prevalence was 9.2% (39/425). ESBL-producing E. coli episodes were significantly associated with HCA-BUO episodes [14% (30/215) versus 4.3% (9/210); P = 0.001]. The highest non-susceptibility proportions corresponded to ciprofloxacin (97.4%), amoxicillin/clavulanate (74.4%), co-trimoxazole (69.2%) and tobramycin (61.5%). Of the 39 ESBL-producing E. coli isolates, 34 produced CTX-M enzymes (21 CTX-M-15, 11 CTX-M-14 and 2 CTX-M-1). Fifteen STs were identified, the B2-ST131 clone being the most prevalent (54%; 21/39). All ST131 isolates were ExPEC and had the highest virulence scores, but they showed less diversity in virulence profiles than other STs. The H30Rx subclone accounted for most ST131 isolates (20/21), co-produced CTX-M-15 (20/20) and OXA-1 (19/20) enzymes and was associated with HCA episodes (16/20). CONCLUSIONS The CTX-M-15-ST131-H30Rx subclone is a relevant MDR pathogen causing BUO, mainly HCA episodes. The dominance of this subclone with comparatively less diversity of virulence profiles reflects the spread of a successful and MDR ESBL ST131 lineage in Spain.
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Affiliation(s)
- Irene Merino
- Servicio de Microbiología, Hospital Universitario 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
| | - Evelyn Shaw
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - Juan Pablo Horcajada
- Departamento de Enfermedades Infecciosas, Hospital del Mar and Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Emilia Cercenado
- Servicio de Microbiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Beatriz Mirelis
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain Servicio de Microbiología, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - M Angeles Pallarés
- Servicio de Microbiología, Complexo Hospitalario de Pontevedra, Pontevedra, Spain
| | - Juliá Gómez
- Laboratori de Referència de Catalunya, Barcelona, Spain
| | - M Xercavins
- Servicio de Microbiología, Catlab, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Luis Martínez-Martínez
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain Servicio de Microbiología, Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain
| | - Marina De Cueto
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario 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
| | - Patricia Ruiz-Garbajosa
- Servicio de Microbiología, Hospital Universitario 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
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61
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Benito N, Franco M, Ribera A, Soriano A, Rodriguez-Pardo D, Sorlí L, Fresco G, Fernández-Sampedro M, Dolores Del Toro M, Guío L, Sánchez-Rivas E, 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, Coll P, Mur I, Ariza J. Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study. Clin Microbiol Infect 2016; 22:732.e1-8. [PMID: 27181408 DOI: 10.1016/j.cmi.2016.05.004] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [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: 02/26/2016] [Revised: 04/24/2016] [Accepted: 05/03/2016] [Indexed: 02/05/2023]
Abstract
It is important to know the spectrum of the microbial aetiology of prosthetic joint infections (PJIs) to guide empiric treatment and establish antimicrobial prophylaxis in joint replacements. There are no available data based on large contemporary patient cohorts. We sought to characterize the causative pathogens of PJIs and to evaluate trends in the microbial aetiology. We hypothesized that the frequency of antimicrobial-resistant organisms in PJIs has increased in the recent years. We performed a cohort study in 19 hospitals in Spain, from 2003 to 2012. For each 2-year period (2003-2004 to 2011-2012), the incidence of microorganisms causing PJIs and multidrug-resistant bacteria was assessed. Temporal trends over the study period were evaluated. We included 2524 consecutive adult patients with a diagnosis of PJI. A microbiological diagnosis was obtained for 2288 cases (90.6%). Staphylococci were the most common cause of infection (1492, 65.2%). However, a statistically significant rising linear trend was observed for the proportion of infections caused by Gram-negative bacilli, mainly due to the increase in the last 2-year period (25% in 2003-2004, 33.3% in 2011-2012; p 0.024 for trend). No particular species contributed disproportionally to this overall increase. The percentage of multidrug-resistant bacteria PJIs increased from 9.3% in 2003-2004 to 15.8% in 2011-2012 (p 0.008), mainly because of the significant rise in multidrug-resistant Gram-negative bacilli (from 5.3% in 2003-2004 to 8.2% in 2011-2012; p 0.032). The observed trends have important implications for the management of PJIs and prophylaxis in joint replacements.
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Affiliation(s)
- N 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; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
| | - M Franco
- 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
| | - A Ribera
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain
| | - A Soriano
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Clínic Universitari, Barcelona, Spain
| | - D Rodriguez-Pardo
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - L Sorlí
- Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain
| | - G Fresco
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Fernández-Sampedro
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Valdecilla, Santander, Spain
| | - M Dolores Del Toro
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - L Guío
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Cruces, Bilbao, Spain
| | - E Sánchez-Rivas
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Bahamonde
- Department of Internal Medicine-Infectious Diseases, Hospital el Bierzo, León, Spain
| | - M Riera
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Unit, Department of Infectious Diseases, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - J Esteban
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - J Martínez-Alvarez
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - A Jover-Sáenz
- Unit of Nosocomial Infection, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - C Dueñas
- Department of Internal Medicine, Hospital Universitario de Burgos, Burgos, Spain
| | - A Ramos
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - B Sobrino
- Department of Infectious Diseases, Hospital Regional Universitario Málaga, Málaga, Spain
| | - G Euba
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain
| | - L Morata
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Clínic Universitari, Barcelona, Spain
| | - C Pigrau
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - P Coll
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Clinical Microbiology, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - I Mur
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - J Ariza
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain
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García-Jiménez A, Prim N, Crusi X, Benito N. Septic arthritis due to Clostridium ramosum. Semin Arthritis Rheum 2016; 45:617-20. [PMID: 26546506 DOI: 10.1016/j.semarthrit.2015.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 07/06/2015] [Revised: 09/07/2015] [Accepted: 09/28/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Clostridium species are anaerobic bacilli that are rarely reported as etiologic agents of infectious arthritis. Previous cases of arthritis caused by Clostridium ramosum have not been reported. We describe the first 2 cases of C. ramosum arthritis. METHODS We reviewed the etiology of arthritis in our hospital during the previous 15 years. RESULTS Both patients had underlying immunocompromising conditions and their infections involved a joint with preexisting disease: patient 1 had rheumatic arthritis and a prosthetic joint; patient 2, chronic renal failure on dialysis and hip osteoarthritis. The infection was hematogenously acquired and the course was indolent but destructive in both the cases. Management included open arthrotomy and resection arthroplasty. The infection had a persisting and relapsing course, and prolonged antibiotic treatment was required. In the literature review, we found 55 previous cases of arthritis caused by Clostridium species between 1966 and 2014; Clostridium perfringens was the most common infecting species; the infection was traumatically acquired in most of the cases. A total of 15 patients have been described with infections caused by C. ramosum; none had septic arthritis. The majority were elderly or immunocompromised adults. Proper collection, transportation and processing of clinical specimens is essential for diagnosing clostridial infections. More information about the best management of clostridial arthritis are needed. CONCLUSIONS We describe the first 2 cases of septic arthritis caused by C. ramosum. They shared several pathogenic and clinical features. The possibility of anaerobic arthritis should always be considered when collecting diagnostic specimens. An increasing number of clostridial arthritis cases are likely to be diagnosed in future years.
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Affiliation(s)
- Antonio García-Jiménez
- Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau, Institut d׳Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Núria Prim
- Department of Microbiology, Hospital de la Santa Creu i Sant Pau, Institut d׳Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Xavier Crusi
- Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau, Institut d׳Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Natividad Benito
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut d׳Investigació Biomèdica Sant Pau, Sant Antoni Maria Claret, 167, Barcelona 08025, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
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63
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Cuervo G, Gasch O, Shaw E, Camoez M, Domínguez MÁ, Padilla B, Pintado V, Almirante B, Lepe JA, López-Medrano F, Ruiz de Gopegui E, Martínez JA, Montejo JM, Perez-Nadales E, Arnáiz A, Goenaga MÁ, Benito N, Horcajada JP, Rodríguez-Baño J, Pujol M. Clinical characteristics, treatment and outcomes of MRSA bacteraemia in the elderly. J Infect 2016; 72:309-16. [PMID: 26723914 DOI: 10.1016/j.jinf.2015.12.009] [Citation(s) in RCA: 8] [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: 09/15/2015] [Revised: 12/13/2015] [Accepted: 12/16/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare clinical and microbiological characteristics, treatment and outcomes of MRSA bacteraemia among elderly and younger patients. MATERIAL AND METHODS Prospective study conducted at 21 Spanish hospitals including patients with MRSA bacteraemia diagnosed between June/2008 and December/2009. Episodes diagnosed in patients aged 75 or more years old (≥75) were compared with the rest of them (<75). RESULTS Out of 579 episodes of MRSA bacteraemia, 231 (39.9%) occurred in patients ≥75. Comorbidity was significantly higher in older patients (Charlson score ≥4: 52.8 vs. 44%; p = .037) as was the severity of the underlying disease (McCabe ≥1: 61.9 vs. 43.4%; p < .001). In this group the acquisition was more frequently health-care related (43.3 vs. 33.9%, p = .023), mostly from long-term care centers (12.1 vs. 3.7%, p < .001). An unknown focus was more frequent among ≥75 (19.9 vs. 13.8%; p = .050) while severity at presentation was similar between groups (Pitt score ≥3: 31.2 vs. 27.6%; p = .352). The prevalence of vancomycin resistant isolates was similar between groups, as was the appropriateness of empirical antibiotic therapy. Early (EM) and overall mortality (OM) were significantly more frequent in the ≥75 group (EM: 12.1 vs. 6%; p = .010 OM: 42.9 vs. 23%; p < .001). In multivariate analysis age ≥75 was an independent risk factor for overall mortality (aOR: 2.47, CI: 1.63-3.74; p < .001). CONCLUSION MRSA bacteraemia was frequent in patients aged ≥75 of our cohort. This group had higher comorbidity rates and the source of infection was more likely to be unknown. Although no differences were seen in severity or adequacy of empiric therapy, elderly patients showed a higher overall mortality.
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Affiliation(s)
- Guillermo Cuervo
- Department of Infectious Diseases, H. Bellvitge, Barcelona, Spain.
| | - Oriol Gasch
- Department of Infectious Diseases, H. Parc Taulí, Sabadell, Spain.
| | - Evelyn Shaw
- Department of Infectious Diseases, H. Bellvitge, Barcelona, Spain.
| | - Mariana Camoez
- Department of Microbiology, H. Bellvitge, Barcelona, Spain.
| | | | - Belén Padilla
- Department of Infectious Diseases, H. Gregorio Marañón, Madrid, Spain.
| | - Vicente Pintado
- Department of Infectious Diseases, H. Ramón y Cajal, Madrid, Spain.
| | - Benito Almirante
- Department of Infectious Diseases, H. Vall d'Hebrón, Barcelona, Spain.
| | - José A Lepe
- Department of Infectious Diseases, H. Virgen del Rocío, Sevilla, Spain.
| | | | | | - José A Martínez
- Department of Infectious Diseases, H. Clìnic, Barcelona, Spain.
| | | | - Elena Perez-Nadales
- Department of Infectious Diseases, H. Reina Sofía/IMIBIC/UCO, Córdoba, Spain.
| | - Ana Arnáiz
- Department of Microbiology, H. Marqués de Valdecilla, Santander, Spain.
| | | | - Natividad Benito
- Department of Infectious Diseases, H. de la Santa Creu i Sant Pau, Barcelona, Spain.
| | | | | | - Miquel Pujol
- Department of Infectious Diseases, H. Bellvitge, Barcelona, Spain.
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64
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Ruiz-Morales J, Ivanova-Georgieva R, Fernández-Hidalgo N, García-Cabrera E, Miró JM, Muñoz P, Almirante B, Plata-Ciézar A, González-Ramallo V, Gálvez-Acebal J, Fariñas MC, Bravo-Ferrer JM, Goenaga-Sánchez MA, Hidalgo-Tenorio C, Goikoetxea-Agirre J, de Alarcón-González A. Left-sided infective endocarditis in patients with liver cirrhosis. J Infect 2015; 71:627-41. [PMID: 26408206 DOI: 10.1016/j.jinf.2015.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/05/2015] [Accepted: 09/07/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery. METHODS Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals. RESULTS A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p < 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23-1.85; p < 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery. CONCLUSIONS Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.
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Affiliation(s)
- J Ruiz-Morales
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
| | - R Ivanova-Georgieva
- Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
| | - N Fernández-Hidalgo
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - E García-Cabrera
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Jose M Miró
- Hospital Clinic - IDIBAPS, Servicio de Enfermedades Infecciosas y Microbiología, Universidad de Barcelona, Barcelona, Spain.
| | - P Muñoz
- Servicio de Microbiología y Enfermedades infecciosas, H. Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
| | - B Almirante
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - A Plata-Ciézar
- UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital General Universitario, Málaga, Spain.
| | - V González-Ramallo
- Unidad de Hospitalización a Domicilio, H. Universitario Gregorio Marañón, Madrid, Spain.
| | - J Gálvez-Acebal
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - M C Fariñas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
| | - J M Bravo-Ferrer
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario Juan Canalejo, A Coruña, Spain.
| | - M A Goenaga-Sánchez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián, Spain.
| | - C Hidalgo-Tenorio
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - J Goikoetxea-Agirre
- Servicio de Enfermedades Infecciosas, Hospital Universitario Cruces, Bilbao, Spain.
| | - A de Alarcón-González
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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Cuervo G, Camoez M, Shaw E, Dominguez MÁ, Gasch O, Padilla B, Pintado V, Almirante B, Molina J, López-Medrano F, Ruiz de Gopegui E, Martinez JA, Bereciartua E, Rodriguez-Lopez F, Fernandez-Mazarrasa C, Goenaga MÁ, Benito N, Rodriguez-Baño J, Espejo E, Pujol M. Methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia in haemodialysis patients. BMC Infect Dis 2015; 15:484. [PMID: 26518487 PMCID: PMC4628295 DOI: 10.1186/s12879-015-1227-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 01/08/2015] [Accepted: 10/19/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The aim of the study was to determine clinical and microbiological differences between patients with methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia (CRB) undergoing or not undergoing haemodialysis, and to compare outcomes. METHODS Prospective multicentre study conducted at 21 Spanish hospitals of patients with MRSA bacteraemia diagnosed between June 2008 and December 2009. Patients with MRSA-CRB were selected. Data of patients on haemodialysis (HD-CRB) and those not on haemodialysis (non-HD-CRB) were compared. RESULTS Among 579 episodes of MRSA bacteraemia, 218 (37.7%) were CRB. Thirty-four (15.6%) were HD-CRB and 184 (84.4%) non-HD-CRB. All HD-CRB patients acquired the infection at dialysis centres, while in 85.3% of the non-HD-CRB group the infection was nosocomial (p < .001). There were no differences in age, gender or severity of bacteraemia (Pitt score); comorbidities (Charlson score ≥ 4) were higher in the HD-CRB group than in the non-HD-CRB group (73.5% vs. 46.2%, p = .003). Although there were no differences in VAN-MIC ≥ 1.5 mg/L according to microdilution, using the E-test a higher rate of VAN-MIC ≥ 1.5 mg/L was observed in HD-CRB than in non-HD-CRB patients (63.3% vs. 44.1%, p = .051). Vancomycin was more frequently administered in the HD-CRB group than in the non-HD-CRB group (82.3% vs. 42.4%, p = <.001) and therefore the appropriate empirical therapy was significantly higher in HD-CRB group (91.2% vs. 73.9%, p = .029). There were no differences with regard to catheter removal (79.4% vs. 84.2%, p = .555, respectively). No significant differences in mortality rate were observed between both groups (Overall mortality: 11.8% vs. 27.2%, p = .081, respectively), but there was a trend towards a higher recurrence rate in HD-CRB group (8.8% vs. 2.2%, p = .076). CONCLUSIONS In our multicentre study, ambulatory patients in chronic haemodialysis represented a significant proportion of cases of MRSA catheter-related bacteraemia. Although haemodialysis patients with MRSA catheter-related bacteraemia had significantly more comorbidities and higher proportion of strains with reduced vancomycin susceptibility than non-haemodialysis patients, overall mortality between both groups was similar.
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Affiliation(s)
- Guillermo Cuervo
- Department of Infectious Diseases, Hospital Universitari de Bellvitge; Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Mariana Camoez
- Department of Microbiology, H. Bellvitge, Barcelona, Spain.
| | - Evelyn Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge; Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | | | - Oriol Gasch
- Department of Infectious Diseases, H. Parc Taulí, Sabadell, Spain.
| | - Belén Padilla
- Department of Infectious Diseases, H. Gregorio Marañón, Madrid, Spain.
| | - Vicente Pintado
- Department of Infectious Diseases, H. Ramón y Cajal, Madrid, Spain.
| | - Benito Almirante
- Department of Infectious Diseases, H. Vall d'Hebrón, Barcelona, Spain.
| | - José Molina
- Department of Infectious Diseases, H. Virgen del Rocío, Sevilla, Spain.
| | | | | | - José A Martinez
- Department of Infectious Diseases, H. Clìnic, Barcelona, Spain.
| | | | | | | | | | - Natividad Benito
- Department of Infectious Diseases, H. de la Santa Creu i Sant Pau, Barcelona, Spain.
| | | | - Elena Espejo
- Department of Infectious Diseases, H. Terrassa, Terrassa, Spain.
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge; Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
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Muñoz P, Kestler M, De Alarcon A, Miro JM, Bermejo J, Rodríguez-Abella H, Fariñas MC, Cobo Belaustegui M, Mestres C, Llinares P, Goenaga M, Navas E, Oteo JA, Tarabini P, Bouza E. Current Epidemiology and Outcome of Infective Endocarditis: A Multicenter, Prospective, Cohort Study. Medicine (Baltimore) 2015; 94:e1816. [PMID: 26512582 PMCID: PMC4985396 DOI: 10.1097/md.0000000000001816] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of the study was to describe the epidemiologic and clinical characteristics and identify the risk factors of short-term and 1-year mortality in a recent cohort of patients with infective endocarditis (IE).From January 2008, multidisciplinary teams have prospectively collected all consecutive cases of IE, diagnosed according to the Duke criteria, in 25 Spanish hospitals.Overall, 1804 patients were diagnosed. The median age was 69 years (interquartile range, 55-77), 68.0% were men, and 37.1% of the cases were nosocomial or health care-related IE. Gram-positive microorganisms accounted for 79.3% of the episodes, followed by Gram-negative (5.2%), fungi (2.4%), anaerobes (0.9%), polymicrobial infections (1.9%), and unknown etiology (9.1%). Heart surgery was performed in 44.2%, and in-hospital mortality was 28.8%. Risk factors for in-hospital mortality were age, previous heart surgery, cerebrovascular disease, atrial fibrillation, Staphylococcus or Candida etiology, intracardiac complications, heart failure, and septic shock. The 1-year independent risk factors for mortality were age (odds ratio [OR], 1.02), neoplasia (OR, 2.46), renal insufficiency (OR, 1.59), and heart failure (OR, 4.42). Surgery was an independent protective factor for 1-year mortality (OR, 0.44).IE remains a severe disease with a high rate of in-hospital (28.9%) and 1-year mortality (11.2%). Surgery was the only intervention that significantly reduced 1-year mortality.
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Affiliation(s)
- Patricia Muñoz
- From the Hospital General Universitario Gregorio Marañon (PM, MK, JB, HR-A, EB), Madrid; Medicine Department (PM, MK, JB, HR-A, EB), School of Medicine, Universidad Complutense de Madrid; H Valdecilla (MCF, MCB), Santander; Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva. Hospital, Universitario Virven del Rocío, Sevilla (ADA), Sevilla; H Clinic-IDIBAPS (JMM, CM), University of Barcelona, Barcelona; Complejo Hospitalario Universitario A Coruña (PL), A Coruña; H Donosti Policlinica Gipuzkoa (MG), San Sebastián; H Ramón y Cajal (EN), Madrid; H San Pedro (JAO), La Rioja; Hospital Universitario de Álava, sede Txagorritxu (PT), Vitoria; and CIBER de Enfermedades Respiratorias-CIBERES (CB06/06/0058) (EB, PM), Madrid, Spain
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Benito N, García-Vázquez E, Horcajada JP, González J, Oppenheimer F, Cofán F, Ricart MJ, Rimola A, Navasa M, Rovira M, Roig E, Pérez-Villa F, Cervera C, Moreno A. Clinical features and outcomes of tuberculosis in transplant recipients as compared with the general population: a retrospective matched cohort study. Clin Microbiol Infect 2015; 21:651-8. [PMID: 25882369 DOI: 10.1016/j.cmi.2015.03.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 11/26/2014] [Revised: 02/28/2015] [Accepted: 03/21/2015] [Indexed: 02/08/2023]
Abstract
There are no previous studies comparing tuberculosis in transplant recipients (TRs) with other hosts. We compared the characteristics and outcomes of tuberculosis in TRs and patients from the general population. Twenty-two TRs who developed tuberculosis from 1996 through 2010 at a tertiary hospital were included. Each TR was matched by age, gender and year of diagnosis with four controls selected from among non-TR non-human immunodeficiency virus patients with tuberculosis. TRs (21 patients, 96%) had more factors predisposing to tuberculosis than non-TRs (33, 38%) (p <0.001). Pulmonary tuberculosis was more common in non-TRs (77 (88%) vs. 12 TRs (55%); p 0.001); disseminated tuberculosis was more frequent in TRs (five (23%) vs. four non-TRs (5%); p 0.005). Time from clinical suspicion of tuberculosis to definitive diagnosis was longer in TRs (median of 14 days) than in non-TRs (median of 0 days) (p <0.001), and invasive procedures were more often required (12 (55%) TRs and 15 (17%) non-TRs, respectively; p 0.001). Tuberculosis was diagnosed post-mortem in three TRs (14%) and in no non-TRs (p <0.001). Rates of toxicity associated with antituberculous therapy were 38% in TRs (six patients) and 10% (seven patients) in non-TRs (p 0.014). Tuberculosis-related mortality rates in TRs and non-TRs were 18% and 6%, respectively (p 0.057). The adjusted Cox regression analysis showed that the only predictor of tuberculosis-related mortality was a higher number of organs with tuberculosis involvement (adjusted hazard ratio 8.6; 95% CI 1.2-63). In conclusion, manifestations of tuberculosis in TRs differ from those in normal hosts. Post-transplant tuberculosis resists timely diagnosis, and is associated with a higher risk of death before a diagnosis can be made.
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Affiliation(s)
- N Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
| | - E García-Vázquez
- Infectious Diseases Service, Hospital Clínico Universitario Virgen de la Arrixaca. University of Murcia, Murcia, Spain
| | - J P Horcajada
- Infectious Diseases Service, Parc de Salut Mar. Universitat Pompeu Fabra, Barcelona, Spain
| | - J González
- Microbiology Service, Hospital Clínic Universitari - Institut d'Investigacions Biomèdicas Agust Pí y Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
| | - F Oppenheimer
- Renal Transplant Unit, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
| | - F Cofán
- Renal Transplant Unit, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
| | - M J Ricart
- Renal Transplant Unit, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
| | - A Rimola
- Liver Unit, Hospital Clínic Universitari - IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - M Navasa
- Liver Unit, Hospital Clínic Universitari - IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - M Rovira
- Haematology Service, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
| | - E Roig
- Cardiology Service, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Pérez-Villa
- Cardiology Service, Hospital Clínic Universitari - IDIBAPS, University of Barcelona Institut d'Investigacions Biomèdicas Agust Pí y Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C Cervera
- Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
| | - A Moreno
- Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
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68
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Shaw E, Benito N, Rodríguez-Baño J, Padilla B, Pintado V, Calbo E, Pallarés MA, Gozalo M, Ruiz-Garbajosa P, Horcajada JP. Risk factors for severe sepsis in community-onset bacteraemic urinary tract infection: impact of antimicrobial resistance in a large hospitalised cohort. J Infect 2015; 70:247-54. [PMID: 25305497 DOI: 10.1016/j.jinf.2014.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/12/2014] [Accepted: 09/15/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine risks factors associated with severe sepsis or septic shock (SS) at admission in patients with community-onset bacteraemic urinary tract infection (CO-BUTI) including the impact of multidrug-resistant (MDR) bacteria. METHODS We analysed a prospective cohort of all consecutive episodes of CO-BUTI requiring hospitalisation in 8 tertiary hospitals of Spain between October 2010 and June 2011. RESULTS Of an overall of 525 CO-BUTI episodes, 175 (33%) presented with SS at admission. MDR bacteria were isolated in 29% (51/175) of episodes with SS and in 33% (117/350) of those without SS (p = 0.32). The main MDR microorganism was Escherichia coli in both groups (25% and 28% respectively). Independent risk factors associated with SS at admission were: having fatal underlying conditions, McCabe score II/III (OR 1.90; 95%CI 1.23-2.92; p = 0.004), presence of an indwelling urethral catheter (OR 3.01; 95%CI 1.50-6.03; p = 0.002) and a history of urinary tract obstruction (OR 1.56; 95%CI 1.03-2.34; p = 0.03). After considering interactions, indwelling urethral catheters were a risk factor only for patients without fatal underlying conditions. CONCLUSIONS SS at hospital admission occurred in a third of CO-BUTI. Mainly host factors, and not the causative microorganisms or antimicrobial resistance patterns had an impact on the presence of SS.
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Affiliation(s)
- Evelyn Shaw
- Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain.
| | - Natividad Benito
- Servicio de Enfermedades Infecciosas, Hospital de Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - Belén Padilla
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital Gregorio Marañón, Madrid, Spain
| | - Vicente Pintado
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain
| | - Esther Calbo
- Servicio de Medicina Interna, Hospital Mútua de Terrassa, Barcelona, Spain
| | | | - Mónica Gozalo
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Juan Pablo Horcajada
- Servicio de Enfermedades Infecciosas, Hospital Universitari del Mar and Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
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Rodríguez-Pardo D, Pigrau C, Lora-Tamayo J, Soriano A, del Toro MD, Cobo J, Palomino J, Euba G, Riera M, Sánchez-Somolinos M, Benito N, Fernández-Sampedro M, Sorli L, Guio L, Iribarren JA, Baraia-Etxaburu JM, Ramos A, Bahamonde A, Flores-Sánchez X, Corona PS, Ariza J. Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study. Clin Microbiol Infect 2014; 20:O911-9. [PMID: 24766536 DOI: 10.1111/1469-0691.12649] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/07/2014] [Accepted: 04/18/2014] [Indexed: 02/05/2023]
Abstract
We aim to evaluate the epidemiology and outcome of gram-negative prosthetic joint infection (GN-PJI) treated with debridement, antibiotics and implant retention (DAIR), identify factors predictive of failure, and determine the impact of ciprofloxacin use on prognosis. We performed a retrospective, multicentre, observational study of GN-PJI diagnosed from 2003 through to 2010 in 16 Spanish hospitals. We define failure as persistence or reappearance of the inflammatory joint signs during follow-up, leading to unplanned surgery or repeat debridement>30 days from the index surgery related death, or suppressive antimicrobial therapy. Parameters predicting failure were analysed with a Cox regression model. A total of 242 patients (33% men; median age 76 years, interquartile range (IQR) 68-81) with 242 episodes of GN-PJI were studied. The implants included 150 (62%) hip, 85 (35%) knee, five (2%) shoulder and two (1%) elbow prostheses. There were 189 (78%) acute infections. Causative microorganisms were Enterobacteriaceae in 78%, Pseudomonas spp. in 20%, and other gram-negative bacilli in 2%. Overall, 19% of isolates were ciprofloxacin resistant. DAIR was used in 174 (72%) cases, with an overall success rate of 68%, which increased to 79% after a median of 25 months' follow-up in ciprofloxacin-susceptible GN-PJIs treated with ciprofloxacin. Ciprofloxacin treatment exhibited an independent protective effect (adjusted hazard ratio (aHR) 0.23; 95% CI, 0.13-0.40; p<0.001), whereas chronic renal impairment predicted failure (aHR, 2.56; 95% CI, 1.14-5.77; p 0.0232). Our results confirm a 79% success rate in ciprofloxacin-susceptible GN-PJI treated with debridement, ciprofloxacin and implant retention. New therapeutic strategies are needed for ciprofloxacin-resistant PJI.
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Affiliation(s)
- D Rodríguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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70
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Tornero E, Senneville E, Euba G, Petersdorf S, Rodriguez-Pardo D, Lakatos B, Ferrari MC, Pilares M, Bahamonde A, Trebse R, Benito N, Sorli L, del Toro MD, Baraiaetxaburu JM, Ramos A, Riera M, Jover-Sáenz A, Palomino J, Ariza J, Soriano A. Characteristics of prosthetic joint infections due to Enterococcus sp. and predictors of failure: a multi-national study. Clin Microbiol Infect 2014; 20:1219-24. [PMID: 24943469 DOI: 10.1111/1469-0691.12721] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [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: 12/15/2013] [Revised: 06/03/2014] [Accepted: 06/12/2014] [Indexed: 02/05/2023]
Abstract
The objective of this study was to review the characteristics and outcome of prosthetic joint infections (PJI) due to Enterococcus sp. collected in 18 hospitals from six European countries. Patients with a PJI due to Enterococcus sp. diagnosed between January 1999 and July 2012 were retrospectively reviewed. Relevant information about demographics, comorbidity, clinical characteristics, microbiological data, surgical treatment and outcome was registered. Univariable and multivariable analyses were performed. A total of 203 patients met the inclusion criteria. The mean (SD) was 70.4 (13.6) years. In 59 patients the infection was diagnosed within the first 30 days (29.1%) from arthroplasty, in 44 (21.7%) between 31 and 90 days, in 54 (26.6%) between 91 days and 2 years and in 43 (21%) after 2 years. Enterococcus faecalis was isolated in 176 cases (89%). In 107 (54%) patients the infection was polymicrobial. Any comorbidity (OR 2.53, 95% CI 1.18-5.40, p 0.01), and fever (OR 2.65, 95% CI 1.23-5.69, p 0.01) were independently associated with failure. The only factor associated with remission was infections diagnosed later than 2 years (OR 0.25, 95% CI 0.09-0.71, p 0.009). In conclusion, prosthetic joint infections due to Enterococcus sp. were diagnosed within the first 2 years from arthroplasty in >70% of the patients, almost 50% had at least one comorbidity and infections were frequently polymicrobial (54%). The global failure rate was 44% and patients with comorbidities, fever, and diagnosed within the first 2 years from arthroplasty had a poor prognosis.
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Affiliation(s)
- E Tornero
- Bone and Joint Infection Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain
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71
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Benito N, Pericas JM, Gurguí M, Mestres CA, Marco F, Moreno A, Horcajada JP, Miró JM. Health Care-Associated Infective Endocarditis: a Growing Entity that Can Be Prevented. Curr Infect Dis Rep 2014; 16:439. [PMID: 25230606 DOI: 10.1007/s11908-014-0439-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Infective endocarditis (IE) continues to be a serious disease with a poor prognosis and high mortality. Neither incidence rates nor mortality have decreased in recent decades. Because of this, it is important to prevent IE in patients at risk. In the past, prevention of IE has focused on antimicrobial prophylaxis, mainly for dental procedures. However, recent major changes in epidemiology, the most significant being the growing frequency and high mortality rate of health care-associated valve endocarditis (HAIE), mean that preventive strategies against IE must also change. Since intravascular catheters are the most common source of bacteremia among patients with HAIE, significant efforts must be made to minimize the risk of catheter-related bloodstream infections. Measures for preventing the infection of prosthetic valves and cardiac implantable devices at the time of implantation also need to be implemented.
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Affiliation(s)
- 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, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain,
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72
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de Quintana-Schmidt C, Pascual-Sedano B, Alvarez-Holzapfel MJ, Gironell A, Leidinger A, Benito N, Rodríguez-Rodríguez R, Molet-Teixidó J. [Complications related with implanted devices in patients with Parkinson's disease treated with deep brain stimulation. A study of a series of 124 patients over a period of 16 years]. Rev Neurol 2014. [PMID: 25005315 DOI: 10.33588/rn.5902.2014001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Establishing protocols of the best candidates for deep brain stimulation in patients with Parkinson's disease and a greater knowledge of the technique have increased its safety profile. Yet, the complications related with implanted devices still occur with a far-from-negligible frequency and have both an economic and clinical impact. AIM From a broad series of patients undergoing deep brain stimulation included consecutively for the treatment of their Parkinson's disease, data concerning the complications related with implanted devices were gathered and compared with those in the literature. PATIENTS AND METHODS Altogether 124 patients with a total of 242 implanted electrodes and 252 generator replacements were included in the study. Mean follow-up time was 8.4 years (range: 3-16 years). Data on all the complications related with implanted devices were collected retrospectively. RESULTS Findings showed that 23 implanted device-related complications occurred (17.7% of the patients): 12 (9.6%) had culture-positive ulcers, five (4%) had culture-negative ulcers, four (3.2%) were left with infections following generator replacement, one (0.8%) had a generator malfunction, and electrode migration took place in one (0.8%). Significant differences were observed as regards the effectiveness of the treatment involving surgical revision of the ulcers, which suggests that the culture-negative ulcers responded to the surgical revision better than the culture-positive ulcers (80% healing versus 16.6%; p = 0.028). CONCLUSIONS The results observed in the series were comparable to those in the existing literature. The presence of culture-positivity in the ulcers is a factor forecasting surgical revision.
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73
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Benito N, Franco M, Coll P, Gálvez ML, Jordán M, López-Contreras J, Pomar V, Monllau JC, Mirelis B, Gurguí M. Etiology of surgical site infections after primary total joint arthroplasties. J Orthop Res 2014; 32:633-7. [PMID: 24436163 DOI: 10.1002/jor.22581] [Citation(s) in RCA: 27] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 12/17/2013] [Indexed: 02/05/2023]
Abstract
We sought to characterize the causative pathogens of surgical site infections (SSIs) following primary total joint arthroplasties and to evaluate trends in the microbial etiology. We analyzed the etiology of SSIs following 2,632 total hip arthroplasty and knee arthroplasty procedures performed at our institution from 2004 through 2010. We calculated the annual proportion of SSIs accounted for each of the most common organisms and evaluated trends using the χ(2) test for trend. SSIs were identified in 111 procedures (4.2%). The annual incidence of SSIs did not change significantly during the study period. Staphylococci were the most common cause of infection (59.6%) and most of infections were monomicrobial (82.8%). From 2004 to 2010, the annual proportion of infections due to gram-negative bacilli (GNB) increased from 21.4% to 66.7% (p = 0.085 for trend). This increase was accompanied by a decline in the proportion of SSIs from coagulase-negative staphylococci (p = 0.003). Additionally, we found an increase in the percentage of polymicrobial infections (from 7.1% in 2004 to 41.7% in 2010, p = 0.014). Multivariate analysis corroborated these trends. Our study reports an emergence of GNB as a cause of SSIs after primary total joint arthroplaties and an increase of polymicrobial infections.
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Affiliation(s)
- Natividad Benito
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Sant Antoni Maria Claret 167, 08025, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid
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74
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Gasch O, Camoez M, Dominguez MA, Padilla B, Pintado V, Almirante B, Martín-Gandul C, López-Medrano F, de Gopegui ER, Ramón Blanco J, García-Pardo G, Calbo E, Horcajada JP, Granados A, Jover-Sáenz A, Dueñas C, Pujol M. Lack of association between genotypes and haematogenous seeding infections in a large cohort of patients with methicillin-resistant Staphylococcus aureus bacteraemia from 21 Spanish hospitals. Clin Microbiol Infect 2014; 20:361-7. [PMID: 23991832 DOI: 10.1111/1469-0691.12330] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/02/2013] [Accepted: 07/04/2013] [Indexed: 02/05/2023]
Abstract
There is increasing concern regarding the association between certain methicillin-resistant Staphylococcus aureus (MRSA) genotypes and poor clinical outcome. To assess this issue, a large cohort of 579 subjects with MRSA bacteraemia was prospectively followed from June 2008 to December 2009, in 21 hospitals in Spain. Epidemiology, clinical data, therapy, and outcome were recorded. All MRSA strains were analysed in a central laboratory. Presence of a haematogenous seeding infection was the dependent variable in an adjusted logistic regression model. Of the 579 patients included in the study, 84 (15%) had haematogenous seeding infections. Microdilution vancomycin median MIC (IQR) was 0.73 (0.38-3) mg/L. Most MRSA isolates (n = 371; 67%) belonged to Clonal Complex 5 (CC5) and carried an SCCmec element type IV and agr type 2. Isolates belonging to ST8-agr1-SCCmecIV, ST22-agr1-SCCmecIV and ST228-agr2-SCCmecI--a single locus variant of ST5--accounted for 8%, 9% and 9% of the isolates, respectively. After adjusting by clinical variables, any of the clones was associated with increased risk of haematogenous seeding infections. Higher vancomycin MIC was not identified as an independent risk factor, either. In contrast, persistent bacteraemia (OR 4.2; 2.3-7.8) and non-nosocomial acquisition (3.0; 1.7-5.6) were associated with increased risk.
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Affiliation(s)
- O Gasch
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
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Benito N, Arguis P, Muñoz J. [A 24-year old man with fever and pulmonary infiltrates]. Med Clin (Barc) 2014; 142:259-64. [PMID: 24210977 DOI: 10.1016/j.medcli.2013.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 08/14/2013] [Indexed: 02/08/2023]
Affiliation(s)
- Natividad Benito
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Red Española de Investigación en Patología Infecciosa (REIPI), Barcelona, España.
| | - Pedro Arguis
- Servicio de Radiodiagnóstico, Centro de Diagnóstico por la Imagen, Hospital Clínic, Barcelona, España
| | - José Muñoz
- Servicio de Medicina Tropical y Salud Internacional, Hospital Clínic, Barcelona, España
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76
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Gasch O, Camoez M, Domínguez MA, Padilla B, Pintado V, Almirante B, Martín C, López-Medrano F, de Gopegui ER, Blanco JR, García-Pardo G, Calbo E, Montero M, Granados A, Jover A, Dueñas C, Pujol M. Emergence of resistance to daptomycin in a cohort of patients with methicillin-resistant Staphylococcus aureus persistent bacteraemia treated with daptomycin. J Antimicrob Chemother 2014; 69:568-71. [PMID: 24107389 DOI: 10.1093/jac/dkt396] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- O Gasch
- Hospital Universitari de Bellvitge, Barcelona, Spain
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77
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Gasch O, Camoez M, Dominguez MA, Padilla B, Pintado V, Almirante B, Molina J, Lopez-Medrano F, Ruiz E, Martinez JA, Bereciartua E, Rodriguez-Lopez F, Fernandez-Mazarrasa C, Goenaga MA, Benito N, Rodriguez-Baño J, Espejo E, Pujol M. Predictive factors for mortality in patients with methicillin-resistant Staphylococcus aureus bloodstream infection: impact on outcome of host, microorganism and therapy. Clin Microbiol Infect 2013; 19:1049-57. [PMID: 23331461 DOI: 10.1111/1469-0691.12108] [Citation(s) in RCA: 52] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 11/03/2012] [Accepted: 11/18/2012] [Indexed: 02/05/2023]
Abstract
Mortality related to methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) remains high, despite changes in the epidemiology. To analyze the current predictive factors for mortality we conducted a prospective study in a large cohort of patients with MRSA-BSI from 21 Spanish hospitals. Epidemiology, clinical data, therapy and outcome were recorded. All MRSA strains were analysed, including susceptibility to antibiotics and molecular characterization. Vancomycin MICs (V-MIC) were tested by the E-test and microdilution methods. Time until death was the dependent variable in a Cox regression analysis. Overall, 579 episodes were included. Acquisition was nosocomial in 59% and vascular catheter was the most frequent source (38%). A dominant PFGE genotype was found in 368 (67%) isolates, which belonged to Clonal Complex (CC)5 and carried SCCmecIV and agr2. Microdilution V-MIC50 and V-MIC90 were 0.7 and 1.0 mg/L, respectively. Initial therapy was appropriate in 66% of episodes. Overall mortality was observed in 179 (32%) episodes. The Cox-regression analysis identified age >70 years (HR 1.88), previous fatal disease (HR 2.16), Pitt score >1 (HR 3.45), high-risk source (HR 1.85) and inappropriate initial treatment (HR 1.39) as independent predictive factors for mortality. CC5 and CC22 (HR 0.52 and 0.45) were associated with significantly lower mortality rates than CC8. V-MIC ≥1.5 did not have a significant impact on mortality, regardless of the method used to assess it.
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Affiliation(s)
- O Gasch
- Department of Infectious Diseases and Microbiology, H. Bellvitge, Universitat de Barcelona, Barcelona, Spain
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Horcajada JP, Shaw E, Padilla B, Pintado V, Calbo E, Benito N, Gamallo R, Gozalo M, Rodríguez-Baño J. Healthcare-associated, community-acquired and hospital-acquired bacteraemic urinary tract infections in hospitalized patients: a prospective multicentre cohort study in the era of antimicrobial resistance. Clin Microbiol Infect 2013; 19:962-8. [PMID: 23279375 DOI: 10.1111/1469-0691.12089] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/25/2012] [Accepted: 10/25/2012] [Indexed: 02/05/2023]
Abstract
The clinical and microbiological characteristics of community-onset healthcare-associated (HCA) bacteraemia of urinary source are not well defined. We conducted a prospective cohort study at eight tertiary-care hospitals in Spain, from October 2010 to June 2011. All consecutive adult patients hospitalized with bacteraemic urinary tract infection (BUTI) were included. HCA-BUTI episodes were compared with community-acquired (CA) and hospital-acquired (HA) BUTI. A logistic regression analysis was performed to identify 30-day mortality risk factors. We included 667 episodes of BUTI (246 HCA, 279 CA and 142 HA). Differences between HCA-BUTI and CA-BUTI were female gender (40% vs 69%, p <0.001), McCabe score II-III (48% vs 14%, p <0.001), Pitt score ≥2 (40% vs 31%, p 0.03), isolation of extended spectrum β-lactamase-producing Enterobacteriaciae (13% vs 5%, p <0.001), median hospital stay (9 vs 7 days, p 0.03), inappropriate empirical antimicrobial therapy (21% vs 13%, p 0.02) and mortality (11.4% vs 3.9%, p 0.001). Pseudomonas aeruginosa was more frequently isolated in HA-BUTI (16%) than in HCA-BUTI (4%, p <0.001). Independent factors for mortality were age (OR 1.04; 95% CI 1.01-1.07), McCabe score II-III (OR 3.2; 95% CI 1.8-5.5), Pitt score ≥2 (OR 3.2 (1.8-5.5) and HA-BUTI OR 3.4 (1.2-9.0)). Patients with HCA-BUTI are a specific group with significant clinical and microbiological differences from patients with CA-BUTI, and some similarities with patients with HA-BUTI. Mortality was associated with patient condition, the severity of infection and hospital acquisition.
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Affiliation(s)
- J P Horcajada
- Hospital Universitari del Mar, Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
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79
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Pomar V, Benito N, López-Contreras J, Coll P, Gurguí M, Domingo P. Spontaneous gram-negative bacillary meningitis in adult patients: characteristics and outcome. BMC Infect Dis 2013; 13:451. [PMID: 24079517 PMCID: PMC3849584 DOI: 10.1186/1471-2334-13-451] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 09/24/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Spontaneous meningitis caused by gram-negative bacilli in adult patients is uncommon and poorly characterized. Our objective is to describe and compare the characteristics and the outcome of adult patients with spontaneous gram-negative bacilli meningitis (GNBM) and spontaneous meningitis due to other pathogens. METHODS Prospective single hospital-based observational cohort study conducted between 1982 and 2006 in a university tertiary hospital in Barcelona (Spain). The Main Outcome Measure: In-hospital mortality. RESULTS Gram-negative bacilli meningitis was diagnosed in 40 (7%) of 544 episodes of spontaneous acute bacterial meningitis. The most common pathogens were Escherichia coli and Pseudomonas species. On admission, characteristics associated with spontaneous gram-negative bacilli meningitis by multivariate modeling were advanced age, history of cancer, nosocomial acquisition of infection, urinary tract infection as distant focus of infection, absence of rash, hypotension, and a high cerebrospinal fluid white-cell count. Nine (23%) episodes were acquired in the hospital and they were most commonly caused by Pseudomonas. The in-hospital mortality rate was 53%. The mortality rate was higher among patients with Gram-negative bacillary meningitis than among those with other bacterial meningitis and their risk of death was twenty times higher than among patients infected with Neisseria meningitidis (odds ratio 20.47; 95% confidence interval 4.03-103.93; p<0.001). CONCLUSIONS Gram-negative bacilli cause 9% of spontaneous bacterial meningitis of known etiology in adults. Characteristics associated with GNBM include advanced age, history of cancer, nosocomial acquisition, and urinary tract infection as distant focus of infection. The mortality rate is higher among patients with gram-negative bacillary meningitis than among those with other bacterial meningitides.
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Affiliation(s)
- Virginia Pomar
- Department of Internal Medicine, Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spanish Network for Research in Infectious Diseases (REIPI), C/ Mas Casanovas 90, Barcelona 08025, Catalonia, Spain
| | - Natividad Benito
- Department of Internal Medicine, Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spanish Network for Research in Infectious Diseases (REIPI), C/ Mas Casanovas 90, Barcelona 08025, Catalonia, Spain
| | - Joaquin López-Contreras
- Department of Internal Medicine, Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spanish Network for Research in Infectious Diseases (REIPI), C/ Mas Casanovas 90, Barcelona 08025, Catalonia, 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. Spanish Network for Research in Infectious Diseases (REIPI)., Barcelona, Spain
| | - Mercedes Gurguí
- Department of Internal Medicine, Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spanish Network for Research in Infectious Diseases (REIPI), C/ Mas Casanovas 90, Barcelona 08025, Catalonia, Spain
| | - Pere Domingo
- Department of Internal Medicine, Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spanish Network for Research in Infectious Diseases (REIPI), C/ Mas Casanovas 90, Barcelona 08025, Catalonia, Spain
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80
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Sorlí L, Luque S, Grau S, Berenguer N, Segura C, Montero MM, Álvarez-Lerma F, Knobel H, Benito N, Horcajada JP. Trough colistin plasma level is an independent risk factor for nephrotoxicity: a prospective observational cohort study. BMC Infect Dis 2013; 13:380. [PMID: 23957376 PMCID: PMC3765824 DOI: 10.1186/1471-2334-13-380] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [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] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 08/12/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Data regarding the most efficacious and least toxic schedules for the use of colistin are scarce. The aim of this study was to determine the incidence and the potential risk factors of colistin-associated nephrotoxicity including colistin plasma levels. METHODS A prospective observational cohort study was conducted for over one year in patients receiving intravenous colistin methanesulfonate sodium (CMS). Blood samples for colistin plasma levels were collected immediately before (Cmin) and 30 minutes after CMS infusion (Cmax). Renal function was assessed at baseline, on day 7 and at the end of treatment (EOT). Severity of acute kidney injury (AKI) was defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease) criteria. RESULTS One hundred and two patients met the inclusion criteria. AKI related to CMS treatment on day 7 and at the end of treatment (EOT) was observed in 26 (25.5%) and 50 (49.0%) patients, respectively. At day 7, Cmin (OR, 4.63 [2.33-9.20]; P < 0.001) was the only independent predictor of AKI. At EOT, the Charlson score (OR 1.26 [1.01-1.57]; P = 0.036), Cmin (OR 2.14 [1.33-3.42]; P = 0.002), and concomitant treatment with ≥ 2 nephrotoxic drugs (OR 2.61 [1.0-6.8]; P = 0.049) were independent risk factors for AKI. When Cmin was evaluated as a categorical variable, the breakpoints that better predicted AKI were 3.33 mg/L (P < 0.001) on day 7 and 2.42 mg/L (P < 0.001) at EOT. CONCLUSIONS When using the RIFLE criteria, colistin-related nephrotoxicity is observed in a high percentage of patients. Cmin levels are predictive of AKI. Patients who receive intravenous colistin should be closely monitored and Cmin might be a new useful tool to predict AKI.
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Affiliation(s)
- Luisa Sorlí
- Infectious Diseases Service, Parc de Salut Mar, Passeig Marítim 25-29, E-08003 Barcelona, Spain
| | - Sonia Luque
- Pharmacy Service, Parc de Salut Mar, Passeig Marítim 25-29, E-08003 Barcelona, Spain
| | - Santiago Grau
- Pharmacy Service, Parc de Salut Mar, Passeig Marítim 25-29, E-08003 Barcelona, Spain
| | - Núria Berenguer
- Pharmacy Service, Parc de Salut Mar, Passeig Marítim 25-29, E-08003 Barcelona, Spain
| | - Concepción Segura
- Laboratori de Referència de Catalunya, C/ de la Selva 10, E-08820 Barcelona, Spain
| | - María Milagro Montero
- Infectious Diseases Service, Parc de Salut Mar, Passeig Marítim 25-29, E-08003 Barcelona, Spain
| | - Francisco Álvarez-Lerma
- Intensive Care Medicine Service, Parc de Salut Mar, Passeig Marítim 25-29, E-08003 Barcelona, Spain
| | - Hernando Knobel
- Infectious Diseases Service, Parc de Salut Mar, Passeig Marítim 25-29, E-08003 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, Sant Quintí 89, 08025 Barcelona, Spain
- Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain
| | - Juan P Horcajada
- Infectious Diseases Service, Parc de Salut Mar, Passeig Marítim 25-29, E-08003 Barcelona, Spain
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Prim N, Benito N, Montes G, Pomar V, Molet J, Rabella N. Human herpesvirus 1 meningoencephalitis after trigeminal neuralgia surgery. J Infect 2013; 67:79-81. [PMID: 23068448 DOI: 10.1016/j.jinf.2012.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 07/25/2012] [Revised: 08/29/2012] [Accepted: 10/07/2012] [Indexed: 02/05/2023]
Abstract
We report a case of human herpesvirus 1 (HHV-1) meningoencephalitis in a patient who underwent trigeminal neuralgia surgery. Although this surgery has been reported to increase the risk of mucocutaneous HHV-1 recurrence, to our knowledge, an association between trigeminal surgery and HHV-1 encephalitis has not been previously described.
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Affiliation(s)
- Núria Prim
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, Barcelona, Spain
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82
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Abstract
BACKGROUND We conducted a prospective, observational study in Barcelona to determine the epidemiology, clinical features, and outcome of elderly patients with acute bacterial meningitis (ABM) compared with younger adults. METHODS During 1982-2010, all patients with ABM were prospectively evaluated. There were two groups: I (15-64 years) and II (≥ 65 years). All patients underwent clinical examination on admission and at discharge following a predefined protocol. RESULTS We evaluated 635 episodes of ABM. The incidence was 4.03/100,000 (Group I) and 7.40 /100,000 inhabitants/year (Group II) (RR = 1.84; 95%CI: 1.56-2.17, P < 0.0001). Elderly patients had co-morbid conditions more frequently (P < 0.0001) and more frequently lacked fever (P = 0.0625), neck stiffness (P < 0.0001) and skin rash (P < 0.0001), but had an altered level of consciousness more often (P < 0.0001). The interval admission-start of antibiotic therapy was longer for elderly patients (P < 0.0001). Meningococcal meningitis was less frequent in elderly patients (P < 0.0001), whereas listerial (P = 0.0196), gram-negative bacillary (P = 0.0065), and meningitis of unknown origin (P = 0.0076) were more frequent. Elderly patients had a higher number of neurologic (P = 0.0009) and extra-neurologic complications (P < 0.0001). The overall mortality ratio was higher in elderly patients (P < 0.0001). CONCLUSIONS Elderly people are at higher risk of having ABM than younger adults. ABM in the elderly presents with co-morbid conditions, is clinically subtler, has a longer interval admission-antibiotic therapy, and has non-meningococcal etiology. It is associated with an earlier and higher mortality rate than in younger patients.
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Affiliation(s)
- Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Av. Sant Antoni Mª Claret, 167, Barcelona 08025, Spain
| | - Virginia Pomar
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Av. Sant Antoni Mª Claret, 167, Barcelona 08025, Spain
| | - Natividad de Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Av. Sant Antoni Mª Claret, 167, Barcelona 08025, Spain
| | - Pere Coll
- Department of Microbiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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83
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Domingo P, Pomar V, Benito N, Coll P. The changing pattern of bacterial meningitis in adult patients at a large tertiary university hospital in Barcelona, Spain (1982-2010). J Infect 2013; 66:147-54. [PMID: 23168216 DOI: 10.1016/j.jinf.2012.10.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 03/23/2012] [Revised: 10/26/2012] [Accepted: 10/31/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND We conducted a prospective, observational study in Barcelona (Spain) to determine changes in the spectrum of adult patients with bacterial meningitis (BM) over a 29-year period. METHODS The observation was divided into two periods: 1982-1995 (I) and 1996-2010 (II). All patients underwent clinical examination on admission and at discharge following a predefined protocol. RESULTS We evaluated 635 episodes of BM. The most frequent etiologic agents were Neisseria meningitidis and Streptococcus pneumoniae in periods I and II, respectively. Patients in period II were older (Median: 47.5 [95%CI: 23.0-64.5] vs. 58.0 [39.0-73.0] years, P<0.0001), had a longer interval from admission to therapy (Median: 2.3 [95%CI: 1.0-5.0] vs. 4.0 [2.0-12.0] hours, P<0.0001), and more frequently had co-morbid conditions (39.1% vs. 62%, P<0.0001). Meningococcal meningitis decreased by 66% (P<0.0001), whereas meningitis by Listeria monocytogenes increased by 110% (P=0.0007) in period II. There were no differences in the overall case-fatality and post-meningitic sequelae rates between both periods. CONCLUSIONS BM in adult patients has substantially changed over 29 years in terms of population affected, aetiology, and management, but not in terms of its overall mortality rate and appearance of post-meningitic sequelae.
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Affiliation(s)
- Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Av. Sant Antoni M(a) Claret 167, 08025 Barcelona, Spain.
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84
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Lora-Tamayo J, Murillo O, Iribarren JA, Soriano A, Sánchez-Somolinos M, Baraia-Etxaburu JM, Rico A, Palomino J, Rodríguez-Pardo D, Horcajada JP, Benito N, Bahamonde A, Granados A, del Toro MD, Cobo J, Riera M, Ramos A, Jover-Sáenz A, Ariza J. A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention. Clin Infect Dis 2013; 56:182-94. [PMID: 22942204 DOI: 10.1093/cid/cis746] [Citation(s) in RCA: 242] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Several series predicting the prognosis of staphylococcal prosthetic joint infection (PJI) managed with debridement, antibiotics, and implant retention (DAIR) have been published, but some of their conclusions are controversial. At present, little is known regarding the efficacy of the different antibiotics that are used or their ability to eliminate methicillin-resistant S. aureus (MRSA) infection. METHODS This was a retrospective, multicenter, observational study of cases of PJI by S. aureus that were managed with DAIR (2003-2010). Cases were classified as failures when infection persistence/relapse, death, need for salvage therapy, or prosthesis removal occurred. The parameters that predicted failure were analyzed with logistic and Cox regression. RESULTS Out of 345 episodes (41% men, 73 years), 81 episodes were caused by MRSA. Fifty-two were hematogenous, with poorer prognoses, and 88% were caused by methicillin-susceptible S. aureus (MSSA). Antibiotics were used for a median of 93 days, with similar use of rifampin-based combinations in MSSA- and MRSA-PJI. Failure occurred in 45% of episodes, often early after debridement. The median survival time was 1257 days. There were no overall prognostic differences between MSSA- and MRSA-PJI, but there was a higher incidence of MRSA-PJI treatment failure during the period of treatment (HR 2.34), while there was a higher incidence of MSSA-PJI treatment failure after therapy. Rifampin-based combinations exhibited an independent protective effect. Other independent predictors of outcome were polymicrobial, inflammatory, and bacteremic infections requiring more than 1 debridement, immunosuppressive therapy, and the exchange of removable components of the prosthesis. CONCLUSIONS This is the largest series of PJI by S. aureus managed with DAIR reported to date. The success rate was 55%. The use of rifampin may have contributed to homogenizing MSSA and MRSA prognoses, although the specific rifampin combinations may have had different efficacies.
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Affiliation(s)
- Jaime Lora-Tamayo
- Infectious Diseases, Hospital Universitario Bellvitge, IDIBELL, Universidad de Barcelona, Barcelona, Spain.
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85
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Benito N, Mirelis B, Luz Gálvez M, Vila M, López-Contreras J, Cotura A, Pomar V, March F, Navarro F, Coll P, Gurguí M. Outbreak of Pseudomonas fluorescens bloodstream infection in a coronary care unit. J Hosp Infect 2012; 82:286-9. [PMID: 23103246 DOI: 10.1016/j.jhin.2012.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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: 07/04/2012] [Accepted: 09/06/2012] [Indexed: 02/05/2023]
Abstract
An outbreak of Pseudomonas fluorescens infection in six patients in a coronary care unit was associated with a source not previously reported, namely the ice bath used for cardiac output determinations. Outbreaks of pseudobacteraemia caused by P. fluorescens and occasional blood transfusion-associated bloodstream infection (BSI) have been described. However, during the last two decades, two outbreaks of P. fluorescens BSI have been described and this article reports a third. Isolation of P. fluorescens in blood cultures must alert clinicians to the possibility of contamination of infusate, lock solutions or catheter flush.
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Affiliation(s)
- N Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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86
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Fariñas MC, Saravia G, Calvo-Montes J, Benito N, Martínez-Garde JJ, Fariñas-Alvarez C, Aguilar L, Agüero R, Amado JA, Martínez-Martínez L, Gómez-Fleitas M. Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patients. BMC Infect Dis 2012; 12:292. [PMID: 23140210 PMCID: PMC3514236 DOI: 10.1186/1471-2334-12-292] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [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: 02/24/2012] [Accepted: 11/07/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Consultation to infectious diseases specialists (ID), although not always performed by treating physicians, is part of hospital's daily practice. This study analyses adherence by treating physicians to written ID recommendations (inserted in clinical records) and its effect on outcome in hospitalized antibiotic-treated patients in a tertiary hospital in Spain. METHODS A prospective, randomized, one-year study was performed. Patients receiving intravenous antimicrobial therapy prescribed by treating physicians for 3 days were identified and randomised to intervention (insertion of written ID recommendations in clinical records) or non-intervention. Appropriateness of empirical treatments (by treating physicians) was classified as adequate, inadequate or unnecessary. In the intervention group, adherence to recommendations was classified as complete, partial or non-adherence. RESULTS A total of 1173 patients were included, 602 in the non-intervention and 571 in the intervention group [199 (34.9%) showing complete adherence, 141 (24.7%) partial adherence and 231 (40.5%) non-adherence to recommendations]. In the multivariate analysis for adherence (R2 Cox=0.065, p=0.009), non-adherence was associated with prolonged antibiotic prophylaxis (p=0.004; OR=0.37, 95%CI=0.19-0.72). In the multivariate analysis for clinical failure (R2 Cox=0.126, p<0.001), Charlson index (p<0.001; OR=1.19, 95%CI=1.10-1.28), malnutrition (p=0.006; OR=2.00, 95%CI=1.22-3.26), nosocomial infection (p<0.001; OR=4.12, 95%CI=2.27-7.48) and length of hospitalization (p<0.001; OR=1.01, 95%CI=1.01-1.02) were positively associated with failure, while complete adherence (p=0.001; OR=0.35, 95%CI=0.19-0.64) and adequate initial treatment (p=0.010; OR=0.39, 95%CI=0.19-0.80) were negatively associated. CONCLUSIONS Adherence to ID recommendations by treating physicians was associated with favorable outcome, in turn associated with shortened length of hospitalization. This may have important health-economic benefits and stimulates further investigation. TRIAL REGISTRATION Current Controlled Trials ISRCTN83234896. http://www.controlled-trials.com/isrctn/sample_documentation.asp.
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Affiliation(s)
- María-Carmen Fariñas
- Infectious Diseases Unit, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008 Santander, Spain
| | - Gabriela Saravia
- Infectious Diseases Unit, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008 Santander, Spain
| | - Jorge Calvo-Montes
- Microbiology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | - Natividad Benito
- Infectious Diseases Unit, Hospital Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Juan-José Martínez-Garde
- Pharmacy Department, Hospital Universitario Marques de Valdecilla, Av. Valdecilla s/n, 39008, Santander, Spain
| | - Concepción Fariñas-Alvarez
- Preventive Medicine Department, Hospital Sierrallana, Bª Ganzo s/n, 39300, Torrelavega, Cantabria, Spain
| | - Lorenzo Aguilar
- Microbiology Department, School of Medicine Universidad Complutense, Avda. Complutense s/n, 28040, Madrid, Spain
| | - Ramón Agüero
- Pneumology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | - José-Antonio Amado
- Endocrinology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | - Luis Martínez-Martínez
- Microbiology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
- Department of Molecular Biology, University of Cantabria, Avda. Cardenal Herrera Oria s/n, 39011, Santander, Spain
| | - Manuel Gómez-Fleitas
- General Surgery Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
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Horcajada JP, Gutiérrez-Cuadra M, Martínez-Rodríguez I, Salas C, Parra JA, Benito N, Quirce R, Carril JM, Fariñas MC. High prevalence of upper urinary tract involvement detected by 111indium-oxine leukocyte scintigraphy in patients with candiduria. Eur J Clin Microbiol Infect Dis 2012; 31:237-42. [PMID: 21633831 DOI: 10.1007/s10096-011-1299-6] [Citation(s) in RCA: 5] [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: 11/27/2010] [Accepted: 05/15/2011] [Indexed: 02/05/2023]
Abstract
The purpose of this investigation was to assess the prevalence of upper urinary tract involvement in patients with candiduria by means of (111)indium-oxine-labeled leukocyte scintigraphy. An observational cohort study of patients with confirmed candiduria was conducted in an acute-care teaching hospital in Spain from March 2006 through February 2009. An (111)In-labeled leukocyte scan was performed in order to assess the upper urinary tract involvement. A series of non-matched patients without candiduria nor bacteriuria undergoing scintigraphy to exclude infections in other sites than the urinary tract was also studied. Demographics, baseline illness, and clinical data were recorded. Candiduria was detected in 428 patients, and scintigraphy was performed in 35 of these patients. Twenty-nine patients without candiduria nor bacteriuria were also studied. Positive renal scintigraphy was documented in 24 (68%) patients with confirmed candiduria and in 3 (10%) patients without candiduria (p < 0.005). Renal uptake was not associated with a higher mortality nor with re-admissions. Subclinical pyelonephritis could be more frequent in patients with candiduria than it has been previously considered.
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Affiliation(s)
- J P Horcajada
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
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Abstract
Tuberculosis is an opportunistic infection with high morbidity and mortality in solid organ transplant patients. The reasons for this high morbidity and mortality lie mostly in diagnostic difficulties, which cause delays in starting treatment, and associated pharmaceutical toxicity. There are still major issues and difficulties in managing tuberculosis in solid organ transplant patients. These include problems due to interactions between antituberculosis and immunosuppressant drugs, the high risk of toxicity of antituberculosis drugs (particularly in liver transplant patients) and the absence of clear indications for the treatment of latent tuberculous infection. This article updates current understanding of tuberculosis in solid organ transplant patients.
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Affiliation(s)
- Antonio Doblas
- Department of Internal Medicine, Hospital de Alta Resolución Valle del Guadiato, Peñarroya-Pueblonuevo, Córdoba, Spain.
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89
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Abstract
From the first descriptions of HIV/AIDS, the lung has been the site most frequently affected by the disease. Most patients develop a pulmonary complication during the history of HIV infection, mainly of infectious aetiology. Important changes in the epidemiology of HIV-related pulmonary infections have occurred. Overall, prescription of Pneumocystis jirovecii prophylaxis and the introduction of highly active antiretroviral therapy (HAART) are the main causes. Currently, the most frequent diagnosis in developed countries is bacterial pneumonia, especially pneumococcal pneumonia, the second most frequent cause is Pneumocystis pneumonia and the third is tuberculosis. However, in Africa, tuberculosis could be the most common pulmonary complication of HIV. Pulmonary infections remain one of the most important causes of morbidity and mortality in these patients, and the first cause of hospital admission in the HAART era. Achieving an aetiological diagnosis of pulmonary infection in these patients is important due to its prognostic consequences.
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Affiliation(s)
- N Benito
- Infectious Diseases Unit, Internal Medicine Service, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain.
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90
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Cobo J, Miguel LGS, Euba G, Rodríguez D, García-Lechuz JM, Riera M, Falgueras L, Palomino J, Benito N, del Toro MD, Pigrau C, Ariza J. Early prosthetic joint infection: outcomes with debridement and implant retention followed by antibiotic therapy. Clin Microbiol Infect 2011; 17:1632-7. [PMID: 20678178 DOI: 10.1111/j.1469-0691.2010.03333.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recent expert reviews recommend a conservative surgical strategy - debridement and irrigation, antibiotics and implant retention (DAIR) - for most early post-surgical prosthetic joint infections (PJI). However, differences exist in published series regarding success rates with DAIR, and the size of most series is small. In this prospective multicenter cohort study of early PJI managed by DAIR, factors associated with failure of the DAIR were analyzed. Out of 139 early PJI, 117 cases managed with DAIR were studied For 67 patients (57.3%), infection was cured and the implant was salvaged with definite antimicrobial therapy. In 35 (29.9%) DAIR failed and removal of the prosthesis was necessary during follow-up. Finally, 15 patients (12.8%) needed chronic suppressive antimicrobial therapy due to suspected or confirmed persistent infection. Infections due to methicillin-resistant S. aureus (72.7% failed; p 0.05) and those treated at one of the hospitals (80.0% failed; p <0.05) had worse outcomes, but only this last variable was associated with treatment failure following multivariate analysis. Seventy-four per cent of patients who were successfully treated by DAIR and only 32.7% of the failures were able to walk without help or with one stick at the last follow-up visit (p <0.05). In conclusion, a substantial proportion of patients with an early PJI may be successfully treated with DAIR and definite antimicrobial therapy. In more than half of these, the infection can be cured. Since identification of factors associated with failure of DAIR is not simple, we recommend offering DAIR to most patients with early PJI.
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Affiliation(s)
- J Cobo
- Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.
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91
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Alvarez-Martínez MJ, Miró JM, Valls ME, Mas J, de la Bellacasa JP, Sued O, Solé M, Rivas PV, de Lazzari E, Benito N, García F, Agustí C, Wilson PE, Gatell JM, Jiménez de Anta MT, Meshnick SR, Moreno A. Prevalence of dihydropteroate synthase genotypes before and after the introduction of combined antiretroviral therapy and their influence on the outcome of Pneumocystis pneumonia in HIV-1-infected patients. Diagn Microbiol Infect Dis 2010; 68:60-5. [PMID: 20727472 DOI: 10.1016/j.diagmicrobio.2010.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 04/08/2010] [Accepted: 04/09/2010] [Indexed: 02/08/2023]
Abstract
The objective of this study was to determine whether the prevalence of Pneumocystis jirovecii dihydropteroate synthase (DHPS) gene mutations has changed since the introduction of combined antiretroviral therapy (cART) and whether the mutations are associated with poor outcome in Spanish HIV-1-infected patients with Pneumocystis pneumonia (PcP). We studied 167 PcP episodes in HIV-1-infected patients diagnosed during the pre-cART (1989-1995) and cART (2001-2004) periods. Molecular genotyping of DHPS was successfully performed in 98 patients (43 pre-cART and 55 cART). Seventeen patients (17/98, 17%; 95% confidence interval [CI], 10-25%) had mutations in the DHPS gene: 14 patients (14/43, 33%; 95% CI, 19-49%) from the pre-cART period and 3 patients (3/55, 5.5%; 95% CI, 1.3-16%) from the cART period (P < 0.01). In the multivariate analysis, the pre-cART period, previous PcP prophylaxis with sulfa drugs, and homosexuality as an HIV risk factor were found to be associated with a higher risk of presenting DHPS mutations. Overall, 95% of patients were treated with trimethoprim and sulfamethoxazole (TMP-SMX). In-hospital mortality was similar in patients with (out) mutations (6% versus 11%, P = 0.84). DHPS gene mutations were more common during the pre-cART period and were associated with previous sulfa exposure and homosexuality. However, their presence did not worsen prognosis of PcP. The response to TMP-SMX with therapeutic doses was successful in most cases.
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Affiliation(s)
- Míriam J Alvarez-Martínez
- Hospital Clínic-IDIBAPS (Institut d'Investigació August Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain
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92
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Aguado JM, Torre-Cisneros J, Fortún J, Benito N, Meije Y, Doblas A, Muñoz P. [Consensus document for the management of tuberculosis in solid organ transplant recipients]. Enferm Infecc Microbiol Clin 2009; 27:465-73. [PMID: 19477046 DOI: 10.1016/j.eimc.2008.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 10/10/2008] [Indexed: 02/08/2023]
Abstract
The relevance of tuberculosis in solid organ transplant recipients stems from the difficulties in the diagnosis, which delay the start of treatment, and the associated toxicity of pharmacological therapy. These facts are responsible for the large number of clinical complications and the high mortality in this population. This Consensus Document from GESITRA (Spanish Transplantation Infection Study Group) defines the indications for prophylaxis of latent tuberculosis infection in patients undergoing solid organ transplantation, in particular those with a high risk of pharmacological toxicity, as is the case of liver transplant recipients. This Consensus Document also establishes recommendations for the choice of drugs to use and duration of treatment for tuberculosis in solid organ transplant recipients, with special mention of vigilance for the development of pharmacological interactions between rifampin and immunosuppressive drugs (cyclosporine, tacrolimus, rapamycin, and steroids).
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Affiliation(s)
- José María Aguado
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, España.
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93
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García-Goez JF, Linares L, Benito N, Cervera C, Cofán F, Ricart MJ, Navasa M, Pérez-Villa F, González J, Moreno A. Tuberculosis in solid organ transplant recipients at a tertiary hospital in the last 20 years in Barcelona, Spain. Transplant Proc 2009; 41:2268-70. [PMID: 19715894 DOI: 10.1016/j.transproceed.2009.06.080] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Mycobacterium tuberculosis (TB) is a serious opportunistic infection in solid organ transplant recipients. The TB incidence is 20 to 74 times greater than that among the general population. Our aim was to determine the incidence as well as the clinical, radiological, and microbiological features and outcomes of TB in these patients. MATERIALS AND METHODS We reviewed the clinical records of subjects with posttransplant TB from January 1988 to December 2007. A definite TB case was defined by a positive culture; probable TB by a positive smear or histological finding; and disseminated TB when 2 organs were involved. We noted an early diagnosis as ones in the first year posttransplantation. Outcomes were classified following the WHO recommendation and mortality related defined by death during treatment. RESULTS Among 4634 recipients (2757 kidney, 1334 liver, 361 double kidney-pancreas, and 182 heart), 21 (0.45%) developed posttransplant TB: namely, 0.47%, 0.22%, 1.1%, and 0.54%, respectively. In 2 cases M. tuberculosis did not grow upon culture; the diagnosis was established by positive acid-fast bacilli on a sputum smear or by histological findings on biopsy. The mean posttransplantation time to TB diagnosis was 21 months (48% early TB). Two patients had a previous history of TB. Fever was the most common symptom (71%). Pulmonary tuberculosis represented 47.6% of cases; extrapulmonary, 28.6%; and disseminated, 23.8%. Among the cases of pulmonary TB, 60% had unilateral infiltrates and 10% cavitations on X ray. Eighteen patients completed treatment. Five patients displayed adverse events, 3 of which were liver toxicity. Four patients died, with 3 deaths related to TB. CONCLUSIONS The incidence of TB in this cohort was higher than that among the general population (450 cases/100,000 recipients). TB was associated with adverse effects of treatment and significant mortality.
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Affiliation(s)
- J F García-Goez
- Service of Infectious Diseases, Hospital Clinic, Barcelona-IDIBAPS-University of Barcelona, Barcelona, Spain
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94
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Benito N, Miró JM, de Lazzari E, Cabell CH, del Río A, Altclas J, Commerford P, Delahaye F, Dragulescu S, Giamarellou H, Habib G, Kamarulzaman A, Kumar AS, Nacinovich FM, Suter F, Tribouilloy C, Venugopal K, Moreno A, Fowler VG. Health care-associated native valve endocarditis: importance of non-nosocomial acquisition. Ann Intern Med 2009; 150:586-94. [PMID: 19414837 PMCID: PMC3625649 DOI: 10.7326/0003-4819-150-9-200905050-00004] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The clinical profile and outcome of nosocomial and non-nosocomial health care-associated native valve endocarditis are not well defined. OBJECTIVE To compare the characteristics and outcomes of community-associated and nosocomial and non-nosocomial health care-associated native valve endocarditis. DESIGN Prospective cohort study. SETTING 61 hospitals in 28 countries. PATIENTS Patients with definite native valve endocarditis and no history of injection drug use who were enrolled in the ICE-PCS (International Collaboration on Endocarditis Prospective Cohort Study) from June 2000 to August 2005. MEASUREMENTS Clinical and echocardiographic findings, microbiology, complications, and mortality. RESULTS Health care-associated native valve endocarditis was present in 557 (34%) of 1622 patients (303 with nosocomial infection [54%] and 254 with non-nosocomial infection [46%]). Staphylococcus aureus was the most common cause of health care-associated infection (nosocomial, 47%; non-nosocomial, 42%; P = 0.30); a high proportion of patients had methicillin-resistant S. aureus (nosocomial, 57%; non-nosocomial, 41%; P = 0.014). Fewer patients with health care-associated native valve endocarditis had cardiac surgery (41% vs. 51% of community-associated cases; P < 0.001), but more of the former patients died (25% vs. 13%; P < 0.001). Multivariable analysis confirmed greater mortality associated with health care-associated native valve endocarditis (incidence risk ratio, 1.28 [95% CI, 1.02 to 1.59]). LIMITATIONS Patients were treated at hospitals with cardiac surgery programs. The results may not be generalizable to patients receiving care in other types of facilities or to those with prosthetic valves or past injection drug use. CONCLUSION More than one third of cases of native valve endocarditis in non-injection drug users involve contact with health care, and non-nosocomial infection is common, especially in the United States. Clinicians should recognize that outpatients with extensive out-of-hospital health care contacts who develop endocarditis have clinical characteristics and outcomes similar to those of patients with nosocomial infection. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Natividad Benito
- Hospital de la Santa Creu i Sant Pau, University Autónoma of Barcelona, Barcelona (Spain)
| | - José M. Miró
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, (Spain)
- Address for correspondence and reprints: José M. Miró. Hospital Clinic Universitari. Helios-Villarroel Building - Desk no. 26. Villarroel, 170. 08036-Barcelona (Spain). Phone# 34-93-2275586/5400 (Ext. No. 2765). Fax# 34-93-4514438/5424.
| | - Elisa de Lazzari
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, (Spain)
| | | | - Ana del Río
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, (Spain)
| | | | | | | | - Stefan Dragulescu
- Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | | | | | | | | | | | | | | | | | - Asuncion Moreno
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, (Spain)
| | - Vance G. Fowler
- Duke University Medical Center, Durham, North Carolina (USA)
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95
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Aguado JM, Torre-Cisneros J, Fortún J, Benito N, Meije Y, Doblas A, Muñoz P. Tuberculosis in solid-organ transplant recipients: consensus statement of the group for the study of infection in transplant recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology. Clin Infect Dis 2009; 48:1276-84. [PMID: 19320593 DOI: 10.1086/597590] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Tuberculosis is a particularly important condition in solid-organ transplant recipients because of the delay in treatment caused by the difficulties involved in its diagnosis and because of the pharmacological toxicity associated with this treatment. Both treatment delay and toxicity are responsible for the many clinical complications of and high mortality associated with tuberculosis in this population. The Consensus Statement from the Spanish Group for the Study of Infectious Diseases in Transplant Recipients defines the indications for treatment of latent tuberculosis infection in solid-organ transplant recipients, especially in patients with a high risk of pharmacological toxicity, as is the case with liver recipients. We established a series of recommendations regarding the types of drugs and the duration of treatment of tuberculosis in solid-organ recipients, giving special attention to pharmacological interactions between rifampin and immunosuppressive drugs (cyclosporine, tacrolimus, rapamycin, and corticosteroids).
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Affiliation(s)
- José María Aguado
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, Spain
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96
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Alvarez-Martínez MJ, Moreno A, Miró JM, Valls ME, Rivas PV, de Lazzari E, Sued O, Benito N, Domingo P, Ribera E, Santín M, Sirera G, Segura F, Vidal F, Rodríguez F, Riera M, Cordero ME, Arribas JR, Jiménez de Anta MT, Gatell JM, Wilson PE, Meshnick SR. Pneumocystis jirovecii pneumonia in Spanish HIV-infected patients in the combined antiretroviral therapy era: prevalence of dihydropteroate synthase mutations and prognostic factors of mortality. Diagn Microbiol Infect Dis 2008; 62:34-43. [PMID: 18554841 DOI: 10.1016/j.diagmicrobio.2008.04.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [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: 11/08/2007] [Revised: 03/14/2008] [Accepted: 04/16/2008] [Indexed: 02/08/2023]
Abstract
The incidence of Pneumocystis jirovecii pneumonia (PCP) in HIV-infected patients has decreased thanks to sulfa prophylaxis and combined antiretroviral therapy. The influence of P. jirovecii dihydropteroate synthase (DHPS) gene mutations on survival is controversial and has not been reported in Spain. This prospective multicenter study enrolled 207 HIV-infected patients with PCP from 2000 to 2004. Molecular genotyping was performed on stored specimens. Risk factors for intensive care unit (ICU) admission and mortality were identified using a logistic regression model. Seven patients (3.7%; 95% confidence interval [CI], 1.5-7.5%) had DHPS mutations. Overall mortality was 15% (95% CI, 10-21%), rising to 80% (95% CI, 61-92%) in patients requiring mechanical ventilation. None of the patients with DHPS mutants died, nor did they need ICU admission or mechanical ventilation. PaO(2) <60 mm Hg at admission was a predictor of ICU admission (P = 0.01), and previous antiretroviral therapy predicted non-ICU admission (P = 0.009). PaO(2) <60 mm Hg at admission and ICU admission during the 1st week were predictors of mortality (P = 0.03 and P < 0.001, respectively). The prevalence of DHPS mutants in Spain is low and is not associated with a worse outcome. Severe respiratory failure at admission is the strongest predictor of PCP outcome.
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97
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García-de-la-Fuente C, Campo-Esquisabel AB, Unda F, Ruiz de Alegría C, Benito N, Martínez-Martínez L. Comparison of different culture media and growth conditions for recognition of Arcanobacterium haemolyticum. Diagn Microbiol Infect Dis 2008; 61:232-4. [PMID: 18325709 DOI: 10.1016/j.diagmicrobio.2008.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 09/13/2007] [Revised: 01/06/2008] [Accepted: 01/20/2008] [Indexed: 02/05/2023]
Abstract
Detection of Arcanobacterium haemolyticum is based upon typical beta-hemolysis and colony morphology, but it may go undetected if only conventional sheep blood agar media for detection of beta-hemolytic streptococci are used. The influence of different culture media, atmospheres, and times of incubation for the recognition of colonies of 47 isolates of A. haemolyticum was studied. After 48 h of incubation, trypticase soy agar with 5% horse blood in 5% CO(2) was the best medium.
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98
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Prieto-Solís JA, Benito N, Martín-Durán R. [Electrocardiographic diagnosis of left main coronary artery obstruction using ST-segment and QRS-complex vector analysis]. Rev Esp Cardiol 2008. [PMID: 18364182 DOI: 10.1157/13116201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES It is vital that obstruction of the left main coronary artery (LMCA) is diagnosed early. We investigated the value of ST-segment and QRS-complex vector analysis in identifying LMCA obstruction in acute coronary syndrome. METHODS The study involved 57 consecutive patients with electrocardiographic features suggestive of LMCA obstruction. Both ST-segment and QRS-complex parameter vectors were analyzed. RESULTS Coronary angiography showed that the obstructed vessel was the LMCA in 20 patients, the left circumflex artery in 19, the right coronary artery in 10, and the left anterior descending artery in three. Five patients had three-vessel disease. An ST vector that was directed between -90 degrees and 180 degrees in the frontal plane was observed in 100% of patients with an LMCA obstruction (P< .001). The specificity of this observation was 78%. An ST vector directed anteriorly or parallel to the horizontal plane was present in 95% of patients (19/20) with an LMCA obstruction (P< .001; specificity 92%). A QRS vector with a left shift é-30 degrees was observed in 75% (15/20) with LMCA disease (P< .001; specificity 95%). An ST vector directed between -90 degrees and 180 degrees and anteriorly had a sensitivity of 95% and specificity of 100% for LMCA obstruction. An ST vector directed between -90 degrees and 180 degrees combined with a left QRS vector shift > or =-30 degrees had a sensitivity of 75% and a specificity of 100% for LMCA obstruction. A simple algorithm combining these observation was able to predict LMCA obstruction in 100% of patients. CONCLUSIONS In acute coronary syndrome, ST-segment and QRS-complex vector analysis can predict the presence of LMCA obstruction.
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Affiliation(s)
- José A Prieto-Solís
- Servicio de Cardiología, Unidad Coronaria, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
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99
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Antón A, Cervera C, Pumarola T, Moreno A, Benito N, Linares L, Esteva C, Cofán F, Jiménez de Anta MT, Marcos MA. Human herpesvirus 7 primary infection in kidney transplant recipients. Transplantation 2008; 85:298-302. [PMID: 18212637 DOI: 10.1097/tp.0b013e3181601413] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aims of the study were to evaluate the incidence and the clinical implications of human herpesvirus (HHV)-7 primary infection in patients undergoing kidney transplantation and the probable interactions between the three beta-herpesviruses (cytomegalovirus [CMV], HHV-6, and HHV-7). Sixty kidney transplant recipients had sequential plasma and whole blood samples collected prior to transplantation and at 7, 14, 21, 28, 45, 60, 75, 90, and 180 days posttransplantation. We used indirect immunofluorescence assays to detect HHV-7 immunoglobulin (Ig) G antibodies in plasma and quantitative real-time polymerase chain reaction to assess CMV, HHV-6 and HHV-7 viral loads. Sixteen out of 60 patients (27%) did not show HHV-7 IgG antibodies prior to transplantation and they were selected for this study. Whereas 3 (18.75%) out of the 16 HHV-7 seronegative patients seroconverted after transplantation, only one patient (6%) had a high HHV-7 viral load from the seventh day posttransplantation in consecutive blood samples during follow-up without clinical manifestations. In our study, the incidence of posttransplant HHV-7 primary infection was low and asymptomatic.
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Affiliation(s)
- Andrés Antón
- Department of Microbiology, Hospital Clínic (Barcelona), IDIBAPS, University of Barcelona, Barcelona, Spain
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100
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Morpeth S, Murdoch D, Cabell CH, Karchmer AW, Pappas P, Levine D, Nacinovich F, Tattevin P, Fernández-Hidalgo N, Dickerman S, Bouza E, del Río A, Lejko-Zupanc T, de Oliveira Ramos A, Iarussi D, Klein J, Chirouze C, Bedimo R, Corey GR, Fowler VG. Non-HACEK gram-negative bacillus endocarditis. Ann Intern Med 2007; 147:829-35. [PMID: 18087053 DOI: 10.7326/0003-4819-147-12-200712180-00002] [Citation(s) in RCA: 177] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Infective endocarditis caused by non-HACEK (species other than Haemophilus species, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, or Kingella species) gram-negative bacilli is rare, is poorly characterized, and is commonly considered to be primarily a disease of injection drug users. OBJECTIVE To describe the clinical characteristics and outcomes of patients with non-HACEK gram-negative bacillus endocarditis in a large, international, contemporary cohort of patients. DESIGN Observations from the International Collaboration on Infective Endocarditis Prospective Cohort Study (ICE-PCS) database. SETTING 61 hospitals in 28 countries. PATIENTS Hospitalized patients with definite endocarditis. MEASUREMENTS Characteristics of non-HACEK gram-negative bacillus endocarditis cases were described and compared with those due to other pathogens. RESULTS Among the 2761 case-patients with definite endocarditis enrolled in ICE-PCS, 49 (1.8%) had endocarditis (20 native valve, 29 prosthetic valve or device) due to non-HACEK, gram-negative bacilli. Escherichia coli (14 patients [29%]) and Pseudomonas aeruginosa (11 patients [22%]) were the most common pathogens. Most patients (57%) with non-HACEK gram-negative bacillus endocarditis had health care-associated infection, whereas injection drug use was rare (4%). Implanted endovascular devices were frequently associated with non-HACEK gram-negative bacillus endocarditis compared with other causes of endocarditis (29% vs. 11%; P < 0.001). The in-hospital mortality rate of patients with endocarditis due to non-HACEK gram-negative bacilli was high (24%) despite high rates of cardiac surgery (51%). LIMITATIONS Because of the small number of patients with non-HACEK gram-negative bacillus endocarditis in each treatment group and the lack of long-term follow-up, strong treatment recommendations are difficult to make. CONCLUSION In this large, prospective, multinational cohort, more than one half of all cases of non-HACEK gram-negative bacillus endocarditis were associated with health care contact. Non-HACEK gram-negative bacillus endocarditis is not primarily a disease of injection drug users.
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Affiliation(s)
- Susan Morpeth
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina 27710, USA
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