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Soriano-Martín A, Muñoz P, García-Rodríguez J, Cantón R, Vena A, Bassetti M, Bouza E. Unresolved issues in the diagnosis of catheter related candidemia: A position paper. Rev Esp Quimioter 2024; 37:1-16. [PMID: 37953593 PMCID: PMC10874659 DOI: 10.37201/req/112.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023]
Abstract
The incidence and recent trends of candidemia and the contribution of the COVID-19 pandemic to its evolution are not well documented. The catheter is a major focus of Candida spp. infections, but the methods used to confirm the origin of candidemia are still based on the data generated for bacterial infection. The presence of Candida spp. on the tip of a removed catheter is the gold standard for confirmation but it is not always possible to remove it. Conservative methods, without catheter removal, have not been specifically studied for microorganisms whose times of growth are different from those of bacteria and therefore these results are not applicable to candidemia. The different Candida species do not have a particular tropism for catheter colonization and fungal biomarkers have not yet been able to contribute to the determination of the origin of candidemia. Techniques such Candida T2 Magnetic Resonance (T2MR) has not yet been applied for this purpose. Finally, there is not yet a consensus of how to proceed when Candida spp. is isolated from an extracted catheter and blood cultures obtained from simultaneous peripheral veins are negative. In this lack of firm data, a group of experts has formulated a series of questions trying to answer them based on the literature, indicating the current deficiencies and offering their own opinion. All authors agree with the conclusions of the manuscript and offer it as a position and discussion paper.
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Affiliation(s)
- A Soriano-Martín
- Ana Soriano Martín, Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón. Calle Doctor Esquerdo 46, 28007 Madrid, Spain.
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Yuguero O, Bernal M, Farré J, Martinez-Alonso M, Vena A, Purroy F. Clinical complications after a traumatic brain injury and its relation with brain biomarkers. Sci Rep 2023; 13:20057. [PMID: 37973882 PMCID: PMC10654919 DOI: 10.1038/s41598-023-47267-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/11/2023] [Indexed: 11/19/2023] Open
Abstract
We aimed to find out which are the most frequent complications for patients who suffer a traumatic brain injury (TBI) and its relation with brain biomarker levels. We conducted a hospital cohort study with patients who attended the Hospital Emergency Department between 1 June 2018 and 31 December 2020. Different variables were collected such as biomarkers levels after 6 h and 12 h of TBI (S100, NSE, UCHL1 and GFAP), clinical and sociodemographic variables, complementary tests, and complications 48 h and 7 days after TBI. Qualitative variables were analysed with Pearson's chi-square test, and quantitative variables with the Mann-Whitney U test. A multivariate logistic regression model for the existence of complications one week after discharge was performed to assess the discriminatory capacity of the clinical variables. A total of 51 controls and 540 patients were included in this study. In the TBI group, the mean age was 83 years, and 53.9% of the patients were male. Complications at seven days were associated with the severity of TBI (p < 0.05) and the number of platelets (p = 0.016). All biomarkers except GFAP showed significant differences in their distribution of values according to gender, with significantly higher values of the three biomarkers for women with respect to men. Patients with complications presented significantly higher S100 values (p < 0.05). The patient's baseline status, the severity of the TBI and the S100 levels can be very important elements in determining whether a patient may develop complications in the few hours after TBI.
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Affiliation(s)
- Oriol Yuguero
- ERLab, Emergency Medicine Research Group, Institute for Biomedical Research Dr. Pifarré Foundation, IRBLLEIDA, Avda. Rovira Roure 80, 25198, Lleida, Spain.
- Faculty of Medicine, University of Lleida, Avda. Rovira Roure 80, 25198, Lleida, Spain.
| | - Maria Bernal
- Clinical Laboratory, University Hospital Arnau de Vilanova, Avda. Rovira Roure 80, 25198, Lleida, Spain
| | - Joan Farré
- Clinical Laboratory, University Hospital Arnau de Vilanova, Avda. Rovira Roure 80, 25198, Lleida, Spain
| | - Montserrat Martinez-Alonso
- Faculty of Medicine, University of Lleida, Avda. Rovira Roure 80, 25198, Lleida, Spain
- Systems Biology and Statistical Methods for Biomedical Research Group, Institute for Biomedical Research Dr. Pifarré Foundation, IRBLLEIDA, Avda. Rovira Roure 80, 25198, Lleida, Spain
| | - Ana Vena
- ERLab, Emergency Medicine Research Group, Institute for Biomedical Research Dr. Pifarré Foundation, IRBLLEIDA, Avda. Rovira Roure 80, 25198, Lleida, Spain
- Faculty of Medicine, University of Lleida, Avda. Rovira Roure 80, 25198, Lleida, Spain
| | - Francisco Purroy
- Faculty of Medicine, University of Lleida, Avda. Rovira Roure 80, 25198, Lleida, Spain
- Clinical neurosciences group, Institute for Biomedical Research Dr. Pifarré Foundation, IRBLLEIDA, Avda. Rovira Roure 80, 25198, Lleida, Spain
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Yuguero O, Vena A, Bernal M, Martínez-Alonso M, Farre J, Purroy F. Platelet levels and age are determinants of survival after mild-moderate TBI: A prospective study in Spain. Front Public Health 2023; 11:1109426. [PMID: 37020814 PMCID: PMC10067594 DOI: 10.3389/fpubh.2023.1109426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/14/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction Traumatic brain injury (TBI) is a very important reason for consultation in emergency departments. Methods A hospital cohort study with patients who attended a hospital emergency department between June 1, 2018 and December 31, 2020 due to TBI was studied. Clinical and sociodemographic variables were recorded. The levels of biomarkers and management variables were used. Qualitative variables were analyzed using Pearson's chi-square test, and quantitative variables using the Mann-Whitney U-test. Survival analyses were performed by fitting a multivariable Cox regression model for patient survival during the follow-up of the study in relation to the patient's characteristics upon admission to the emergency department. Results A total of 540 patients were included. The mean age was 83 years, and 53.9% of the patients were men. Overall, 112 patients (20.7%) died during the study follow-up. The mortality rate per 100 person-years was 14.33 (11.8-17.24), the most frequent mechanism being falls in the home, with none caused on public roads. The multivariable Cox proportional hazards model showed that survival after TBI was significantly associated with age, S100 levels, Charlson index, patient's institutionalized status, the place where the TBI occurred, and hemoglobin and platelet levels. Discussion The most common profile for a patient with a TBI was male and aged between 80 and 90 years. The combination of the variables age, Charlson index, place of TBI occurrence, and hemoglobin and platelet levels could offer early prediction of survival in our population independently of TBI severity. With the data obtained, a therapeutic algorithm could be established for patients suffering from mild TBI, allowing the patient to be supervised at home, avoiding futile referrals to emergency services.
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Affiliation(s)
- Oriol Yuguero
- ERLab Emergency Research Group, Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Universitat de Lleida, Lleida, Spain
- Faculty of Medicine, University of Lleida, Lleida, Spain
- *Correspondence: Oriol Yuguero
| | - Ana Vena
- ERLab Emergency Research Group, Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Universitat de Lleida, Lleida, Spain
- Faculty of Medicine, University of Lleida, Lleida, Spain
| | - Maria Bernal
- Clinical Laboratory, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Montserrat Martínez-Alonso
- Systems Biology and Statistical Methods for Biomedical Research Group, Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Joan Farre
- Clinical Laboratory, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Francisco Purroy
- Faculty of Medicine, University of Lleida, Lleida, Spain
- Neurosciences Group, Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Universitat de Lleida, Lleida, Spain
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Yuguero Torres O, Fernandez J, Justribo E, González E, Vena A. Impact of the SARS-COV-2 Pandemic Lockdown on Sexually Transmitted Urethritis in a Spanish Health Region. Cureus 2021; 13:e18921. [PMID: 34812305 PMCID: PMC8603631 DOI: 10.7759/cureus.18921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/05/2022] Open
Abstract
Background The incidence of sexually transmitted diseases (STD) has increased in recent years, especially in the young population. Urethritis is one of the most common clinical presentations of STD in emergency departments. During the SARS-COV-2 pandemic, in Spain lockdown lasted almost three months, and mobility was greatly restricted. This is the first study of these characteristics conducted in Spain. Methods A cross-sectional study of all patients treated for clinical symptoms of urethritis between March and June 2019 and between March and June 2020 was conducted. We evaluated patients' sociodemographic and clinical variables. Results Seventy-nine patients were included in the study: 37 in 2019 and 38 in 2020 of whom 94.9% were men. The main symptoms were urethral discharge (59.5%) followed by dysuria (26.6%). Risky sexual relations were reported by 63.2% of patients in 2019, and this percentage decreased to 43.9% in 2020. Conclusions The number of patients attending an emergency department in our health region for urethritis did not undergo any variations between 2019 and 2020. No significant reduction in the number of cases of urethritis was observed, probably because people continued with unsafe sexual relations despite the social restrictions and difficulties posed by the lockdown.
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Affiliation(s)
| | - Josep Fernandez
- Dermatology, Institut de Recerca Biomèdica de Lleida (IRBLLEIDA), Lleida, ESP
| | - Elena Justribo
- Primary Health, Institut Català de la Salut, Lleida, ESP
| | - Eva González
- Infectious Diseases, Institut de Recerca Biomèdica de Lleida (IRBLLEIDA), Lleida, ESP
| | - Ana Vena
- Geriatrics, Institut de Recerca Biomèdica de Lleida (IRBLLEIDA), Lleida, ESP
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Purroy F, Arque G, Mauri G, García-Vázquez C, Vicente-Pascual M, Pereira C, Vazquez-Justes D, Torres-Querol C, Vena A, Abilleira S, Cardona P, Forné C, Jiménez-Fàbrega X, Pagola J, Portero-Otin M, Rodríguez-Campello A, Rovira À, Martí-Fàbregas J. REMOTE Ischemic Perconditioning Among Acute Ischemic Stroke Patients in Catalonia: REMOTE-CAT PROJECT. Front Neurol 2020; 11:569696. [PMID: 33101178 PMCID: PMC7546310 DOI: 10.3389/fneur.2020.569696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/27/2020] [Indexed: 01/24/2023] Open
Abstract
Rationale: Remote ischemic perconditioning during cerebral ischemia (RIPerC) refers to the application of brief episodes of transient limb ischemia commonly to a limb, it represents a new safe, simple and low-cost paradigm in neuroprotection. Aim and/or Hypothesis: To evaluate the effects of RIPerC on acute ischemic stroke (AIS) patients, applied in the ambulance, to improve functional outcomes compared with standard of care. Sample Size Estimates: A sample size of 286 patients in each arm achieves 80% power to detect treatment differences of 14% in the outcome, using a two-sided binomial test at significance level of 0.05, assuming that 40% of the control patients will experience good outcome and an initial misdiagnosis rate of 29%. Methods and Design: We aim to conduct a multicentre study of pre-hospital RIPerC application in AIS patients. A total of 572 adult patients diagnosed of suspected clinical stroke within 8 h of symptom onset and clinical deficit >0 according to prehospital rapid arterial occlusion evaluation (RACE) scale score will be randomized, in blocks of size 4, to RIPerC or sham. Patients will be stratified by RACE score scale. RIPerC will be started in the ambulance before hospital admission and continued in the hospital if necessary. It will consist of five cycles of electronic tourniquet inflation and deflation (5 min each). The cuff pressure for RIPerC will be 200 mmHg during inflation. Sham will only simulate vibration of the device. Study Outcome(s): The primary outcome will be the difference in the proportion of patients with good outcomes as defined by a mRS score of 2 or less at 90 days. Secondary outcomes to be monitored will include early neurological improvement rate, treatment related serious adverse event rates, size of the infarct volume, symptomatic intracranial hemorrhage, metabolomic and lipidomic response to RIPerC and Neuropsychological evaluation at 90 days. Discussion: Neuroprotective therapies could not only increase the benefits of available reperfusion therapies among AIS patients but also provide an option for patients who are not candidates for these treatments. REMOTE-CAT will investigate the clinical benefit of RIC as a new neuroprotective strategy in AIS. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03375762.
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Affiliation(s)
- Francisco Purroy
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Gloria Arque
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Gerard Mauri
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Cristina García-Vázquez
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Mikel Vicente-Pascual
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Cristina Pereira
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Daniel Vazquez-Justes
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Coral Torres-Querol
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Ana Vena
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Sònia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Pere Cardona
- Stroke Unit, Hospital de Bellvitge, Hospitalet de Llobregat, Spain
| | - Carles Forné
- Department of Basic Medical Sciences, Universitat de Lleida, Lleida, Spain
| | | | - Jorge Pagola
- Stroke Unit, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Manuel Portero-Otin
- Department of Experimental Medicine, NUTREN-Nutrigenomics, Biomedical Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Ana Rodríguez-Campello
- Neurovascular Research Group, Neurology Department, Institut Hospital del Mar d'Investigacions Mèdiques-Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology and MRI Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Purroy F, García C, Mauri G, Pereira C, Torres C, Vazquez-Justes D, Vicente-Pascual M, Vena A, Arque G. Induced neuroprotection by remote ischemic perconditioning as a new paradigm in ischemic stroke at the acute phase, a systematic review. BMC Neurol 2020; 20:266. [PMID: 32615939 PMCID: PMC7330956 DOI: 10.1186/s12883-020-01836-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/22/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Remote ischemic conditioning during cerebral ischemia (remote ischemic perconditioning, RIPerC) refers to the application of several cycles of brief ischemia and reperfusion (I/R) commonly to a limb, and it represents a new paradigm in neuroprotection with multiple mechanisms of action in ischemic stroke (IS) patients during acute phase. Some clinical trials just finished, and a few others are still ongoing; gather the current knowledge and pull it down to influence the present and future studies was the goal of this paper. METHODS A systematic review of published research papers and/or registered clinical trials since 2000 was performed. RESULTS Nineteen studies were identified and only four studies were completed. All of them have demonstrated that RIPerC is safe, feasible and well tolerated in IS patients. However, a high heterogeneity of clinical trial characteristics was observed: five (26.3%) randomized clinical trials (RCTs) included only thrombolytic-treated patients, three (15.8%) RCTs only thrombectomy-treated patients, and five (26.3%) RCTs required radiological confirmation of IS. Temporal inclusion criteria vary from 4 h to 48 h. Most of the clinical trials used 4 cycles of RIPerC in the upper non-affected limb. Interestingly, only three (16.7%) RCTs applied RIPerC during the transportation in the ambulance. Neuroimaging outputs were the main endpoints when endovascular therapy was applied; functional outcome is also the main endpoint in large-medium size studies. CONCLUSIONS This review summarizes the completed and ongoing clinical trials on RIPerC in IS patients, where RIPerC has been used alone or in combination with recanalization therapies. Ongoing clinical trials will provide new information on the best RIPerC intervention strategy and potentially improve the functional outcome of IS patients; definition of new RIPerC strategies would ideally aim at enhancing tissue preservation, promoting neurological recovery, and stratify patients to improve treatment feasibility.
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Affiliation(s)
- Francisco Purroy
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova, Avda Rovira Roure 80, 25198, Lleida, Spain. .,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida). UdL, Lleida, Spain.
| | - Cristina García
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida). UdL, Lleida, Spain
| | - Gerard Mauri
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova, Avda Rovira Roure 80, 25198, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida). UdL, Lleida, Spain
| | - Cristina Pereira
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida). UdL, Lleida, Spain
| | - Coral Torres
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida). UdL, Lleida, Spain
| | - Daniel Vazquez-Justes
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova, Avda Rovira Roure 80, 25198, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida). UdL, Lleida, Spain
| | - Mikel Vicente-Pascual
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova, Avda Rovira Roure 80, 25198, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida). UdL, Lleida, Spain
| | - Ana Vena
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova, Avda Rovira Roure 80, 25198, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida). UdL, Lleida, Spain
| | - Gloria Arque
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida). UdL, Lleida, Spain.
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Bassetti M, Giacobbe DR, Aliberti S, Barisione E, Centanni S, De Rosa FG, Di Marco F, Gori A, Granata G, Mikulska M, Petrosillo N, Richeldi L, Santus P, Tascini C, Vena A, Viale P, Blasi F. Balancing evidence and frontline experience in the early phases of the COVID-19 pandemic: current position of the Italian Society of Anti-infective Therapy (SITA) and the Italian Society of Pulmonology (SIP). Clin Microbiol Infect 2020; 26:880-894. [PMID: 32360444 PMCID: PMC7195088 DOI: 10.1016/j.cmi.2020.04.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19), which has rapidly become epidemic in Italy and other European countries. The disease spectrum ranges from asymptomatic/mildly symptomatic presentations to acute respiratory failure. At the present time the absolute number of severe cases requiring ventilator support is reaching or even surpassing the intensive care unit bed capacity in the most affected regions and countries. OBJECTIVES To narratively summarize the available literature on the management of COVID-19 in order to combine current evidence and frontline opinions and to provide balanced answers to pressing clinical questions. SOURCES Inductive PubMed search for publications relevant to the topic. CONTENT The available literature and the authors' frontline-based opinion are summarized in brief narrative answers to selected clinical questions, with a conclusive statement provided for each answer. IMPLICATIONS Many off-label antiviral and anti-inflammatory drugs are currently being administered to patients with COVID-19. Physicians must be aware that, as they are not supported by high-level evidence, these treatments may often be ethically justifiable only in those worsening patients unlikely to improve only with supportive care, and who cannot be enrolled onto randomized clinical trials. Access to well-designed randomized controlled trials should be expanded as much as possible because it is the most secure way to change for the better our approach to COVID-19 patients.
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Affiliation(s)
- M Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | - D R Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - S Aliberti
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
| | - E Barisione
- Interventional Pulmonology, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - S Centanni
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - F G De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - F Di Marco
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A Gori
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - G Granata
- Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - M Mikulska
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - N Petrosillo
- Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - L Richeldi
- Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, UOC Pneumologia, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Santus
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Respiratory Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - C Tascini
- Infectious Diseases Clinic, Santa Maria Misericordia Hospital, Udine, Italy
| | - A Vena
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - P Viale
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - F Blasi
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
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Bassetti M, Vena A, Bouza E, Peghin M, Muñoz P, Righi E, Pea F, Lackner M, Lass-Flörl C. Antifungal susceptibility testing in Candida, Aspergillus and Cryptococcus infections: are the MICs useful for clinicians? Clin Microbiol Infect 2020; 26:1024-1033. [PMID: 32120042 DOI: 10.1016/j.cmi.2020.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 02/08/2020] [Accepted: 02/14/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Invasive fungal infections (IFIs) represent a global issue and affect various patient populations. In recent years, resistant fungal isolates showing increased azole or echinocandin MICs have been reported, and their potential clinical impact has been investigated. AIMS To provide an update on the epidemiology of resistance among fungi (e.g., Candida spp., Aspergillus spp., and Cryptococcus spp.) and to offer a critical appraisal of the relevant literature regarding the impact of MICs on clinical outcome in patients with IFI. SOURCES PubMed search with relevant keywords along with a personal collection of relevant publications. CONTENT Although antifungal resistance has been associated with a poorer response to antifungal therapy in various studies, other factors such as comorbidities, septic shock and source of infection appear to be key determinants affecting the clinical outcome of patients with IFI. IMPLICATIONS Future international collaborative studies are required to tease out the relative contribution of in vitro antifungal resistance on patient outcomes, thus enabling the optimization of IFI management.
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Affiliation(s)
- M Bassetti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy.
| | - A Vena
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - E Bouza
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - M Peghin
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - P Muñoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - E Righi
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy; Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - F Pea
- Institute of Clinical Pharmacology, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - M Lackner
- Medical University of Innsbruck, Division of Hygiene and Medical Microbiology, Schöpfstrasse 41, A-6020 Innsbruck, Austria
| | - C Lass-Flörl
- Medical University of Innsbruck, Division of Hygiene and Medical Microbiology, Schöpfstrasse 41, A-6020 Innsbruck, Austria
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9
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Purroy F, Vena A, Forné C, de Arce AM, Dávalos A, Fuentes B, Arenillas JF, Krupinski J, Gómez-Choco M, Palomeras E, Martí-Fábregas J, Castillo J, Ustrell X, Tejada J, Masjuan J, Garcés M, Benabdelhak I, Serena J. Age- and Sex-Specific Risk Profiles and In-Hospital Mortality in 13,932 Spanish Stroke Patients. Cerebrovasc Dis 2019; 47:151-164. [PMID: 31055571 DOI: 10.1159/000500205] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 04/08/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In-hospital stroke death rate is an important sanitary issue. Despite advances in the acute phase management of stroke patients, mortality and disability rates remain high. In aging populations and with different mortality between the sexes in general, the study of sex- and age-related differences becomes increasingly relevant for optimization of post-acute clinical care of stroke patients. METHODS We designed a cohort follow-up study with 13,932 consecutive ischemic stroke (IS) patients from 19 Spanish hospitals. Data was obtained from the Spanish Stroke Registry; transient ischemic attacks and ages <18 years were excluded. Patients were organised by age group and sex. We compared female and male patient cohorts within and across age groups univariately and used multivariable logistic regression to adjust for confounders in differential in-hospital mortality. RESULTS The median (percentiles 2.5 and 97.5%) age was 78 (41-92) years old for women and 71 (41-92) for men. IS women were more likely to be older, to exhibit cardio-embolic aetiology, and less likely to have been admitted to a stroke unit or to have had a stroke code activated. Both pre-stroke modified Rankin Scale and National Institute of Health Stroke Scale (NIHSS) scores at admission increased significantly with age and were higher in women than those in men. Differences in distributions of common risk factors for IS and of in-hospital outcomes between women and men actually changed with patient's age. It is to be noted here that although there were no statistically significant differences (p > 0.05) between the sexes within any age group, in-hospital mortality appeared significantly higher in women than that in men when analysed overall, due to confounding. Death was more closely related to stroke in women than in men and occurred earlier. Although there were some age-specific sex differences between the predictors for in-hospital mortality, stroke severity measured by NIHSS was the main predictor of in-hospital mortality for both sexes. Topographic classifications - partial anterior circulatory infarct and total anterior circulatory infarct - were significant prognostic factors for men aged <60 years and for those in the 60-69 years range respectively. CONCLUSION Although most of our findings were consistent with previous studies, it is important to take into account and highlight differences in in-hospital mortality between the sex and age group. Not to account for age-related differences between the sexes can give false results that may mislead management decisions. As most deaths in women were related to stroke, it is important to improve their early management, stroke code activation, access to stroke units and/or revascularisation therapies, especially in the older age groups.
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Affiliation(s)
- Francisco Purroy
- Stroke Unit, Hospital Universitari Arnau de Vilanova, Grup Neurociències Clíniques Biomedical Research Institute of Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain,
| | - Ana Vena
- Stroke Unit, Hospital Universitari Arnau de Vilanova, Grup Neurociències Clíniques Biomedical Research Institute of Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Carles Forné
- Biostatistics Unit, Biomedical Research Institute of Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | | | - Antonio Dávalos
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | | | | | | | - José Castillo
- Department of Neurology, Hospital Clínico Universitario de Santiago, Universidade de Santiago de Compostela, Health Research Institute of Santiago, Santiago de Compostela, Spain
| | | | | | | | | | - Ikram Benabdelhak
- Stroke Unit, Hospital Universitari Arnau de Vilanova, Grup Neurociències Clíniques Biomedical Research Institute of Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
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10
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Yuguero O, Vena A, Forné C, Lacasta JD, Llobet C, Abadías MJ. Quality of care indicators for a resuscitation unit: A descriptive study and proposal. Medicine (Baltimore) 2018; 97:e13467. [PMID: 30508973 PMCID: PMC6283204 DOI: 10.1097/md.0000000000013467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There are lack of indicators of quality of care in resuscitation units of emergency departments. With the aim of proposing a series of indicators to evaluate the quality of care delivered in hospital resuscitation areas, we conducted a descriptive study of 7579 admissions to the resuscitation unit of an emergency department at a Spanish hospital between 2012 and 2016. The proposed indicators were the percentage of patients attending to the emergency department admitted to the resuscitation area by level of triage, the length of stay, the percentage of patients moved to intensive care and surgery at disposition, the mortality in the area or in the emergency department within 24 hours of disposition, and the data completeness. A majority of the patients (62.6%) were men and the median age was 68 years. Over 99% of the required data were recorded. Median length of stay in the resuscitation unit was 0.87 hours (interquartile range, 0.5-1.5). Approximately 80% of patients categorized as an emergency on admission to the emergency department were admitted to the resuscitation unit, although the proportion of urgency patients was higher. The main disposition destination was a trauma cubicle (82.3% of cases). Mortality was 0.41%.Specific indicators are needed to assess the quality of care delivery in resuscitation units. We believe that our findings will provide new insights into the work done to date in this field.
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Affiliation(s)
- Oriol Yuguero
- Emergency Deparment. University Hospital Arnau de Vilanova de Lleida
- Urgency and Emergency Multi-discipliarany Research Group. IRBLleida
| | - Ana Vena
- Geriatrics Department, University Hospital of Saint's Mary
- Neurosciences Research Group
| | - Carles Forné
- Biostatistics Unit, IRBLleida
- Department of Basic Medical Sciences, University of Lleida, Lleida, Spain
| | - Jose Daniel Lacasta
- Emergency Deparment. University Hospital Arnau de Vilanova de Lleida
- Urgency and Emergency Multi-discipliarany Research Group. IRBLleida
| | - Cecilia Llobet
- Emergency Deparment. University Hospital Arnau de Vilanova de Lleida
- Urgency and Emergency Multi-discipliarany Research Group. IRBLleida
| | - Maria José Abadías
- Emergency Deparment. University Hospital Arnau de Vilanova de Lleida
- Urgency and Emergency Multi-discipliarany Research Group. IRBLleida
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11
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Muñoz P, Agnelli C, Guinea J, Vena A, Álvarez-Uría A, Marcos-Zambrano LJ, Escribano P, Valerio M, Bouza E. Is biofilm production a prognostic marker in adults with candidaemia? Clin Microbiol Infect 2018; 24:1010-1015. [PMID: 29408611 DOI: 10.1016/j.cmi.2018.01.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/21/2018] [Accepted: 01/24/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The role of biofilm production in the outcome of candidaemia remains under discussion. Current evidence relies on variable biofilm detection methods while evaluating distinct clinical end points. We aimed to determine the impact of biofilm production measured by metabolic activity (MA) and biomass (BM) on the prognosis of adults with candidaemia. METHODS Retrospective cohort including 280 adults with candidaemia admitted from 2010 to 2016. BM was assessed using crystal violet binding stain and the XTT reduction assay was used to detect MA. Strains were classified as high and moderate-low biofilm producers according to published cut-offs. The primary outcome was overall mortality within 7 and 30 days. The secondary outcome was unfavourable prognosis defined as metastatic infection, admission to an intensive care unit due to the severity of candidaemia, or death within 30 days. RESULTS High BM and high MA were detected in 90 (32.1%) and 114 (40.7%) of the 280 isolates, respectively. Comparison of high and moderate-low biofilm forming isolates revealed no correlation between biofilm production and 7-day mortality (BM high 15/90 (16.7%) versus moderate-low 24/190 (12.6%); MA high 12/114 (10.5%) versus moderate-low 27/166 (16.3%)), 30-day mortality (BM high 34/90 (37.8%) versus moderate-low 61/190 (32.1%); MA high 33/114 (28.9%) versus moderate-low 62/166 (37.3%)), or unfavourable prognosis (BM high 45/90 (50.0%) versus moderate-low 73/190 (38.4%); MA high 41/114 (36.0%) versus moderate-low 77/166 (46.4%)). CONCLUSIONS Biofilm production was not a predictor of mortality or of unfavourable prognosis in adults with candidaemia.
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Affiliation(s)
- P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Sanitary Research Institute, Madrid, Spain; Respiratory Diseases Networking Biomedical Research Centre, Madrid, Spain; Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - C Agnelli
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Sanitary Research Institute, Madrid, Spain.
| | - J Guinea
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Sanitary Research Institute, Madrid, Spain; Respiratory Diseases Networking Biomedical Research Centre, Madrid, Spain; Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - A Vena
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Sanitary Research Institute, Madrid, Spain
| | - A Álvarez-Uría
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Sanitary Research Institute, Madrid, Spain
| | - L J Marcos-Zambrano
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Sanitary Research Institute, Madrid, Spain
| | - P Escribano
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Sanitary Research Institute, Madrid, Spain
| | - M Valerio
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Sanitary Research Institute, Madrid, Spain
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Sanitary Research Institute, Madrid, Spain; Respiratory Diseases Networking Biomedical Research Centre, Madrid, Spain; Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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12
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Álvarez-Uría A, Muñoz P, Vena A, Guinea J, Marcos-Zambrano LJ, Escribano P, Sánchez-Carrillo C, Bouza E. Fungaemia caused by rare yeasts: incidence, clinical characteristics and outcome over 10 years. J Antimicrob Chemother 2018; 73:823-825. [PMID: 29216359 DOI: 10.1093/jac/dkx436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Álvarez-Uría
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P Muñoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - A Vena
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - J Guinea
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - L J Marcos-Zambrano
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - P Escribano
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - C Sánchez-Carrillo
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - E Bouza
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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13
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Gudmundsson M, Perchiazzi G, Pellegrini M, Vena A, Hedenstierna G, Rylander C. Atelectasis is inversely proportional to transpulmonary pressure during weaning from ventilator support in a large animal model. Acta Anaesthesiol Scand 2018; 62:94-104. [PMID: 29058315 DOI: 10.1111/aas.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/22/2017] [Accepted: 09/30/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND In mechanically ventilated, lung injured, patients without spontaneous breathing effort, atelectasis with shunt and desaturation may appear suddenly when ventilator pressures are decreased. It is not known how such a formation of atelectasis is related to transpulmonary pressure (PL ) during weaning from mechanical ventilation when the spontaneous breathing effort is increased. If the relation between PL and atelectasis were known, monitoring of PL might help to avoid formation of atelectasis and cyclic collapse during weaning. The main purpose of this study was to determine the relation between PL and atelectasis in an experimental model representing weaning from mechanical ventilation. METHODS Dynamic transverse computed tomography scans were acquired in ten anaesthetized, surfactant-depleted pigs with preserved spontaneous breathing, as ventilator support was lowered by sequentially reducing inspiratory pressure and positive end expiratory pressure in steps. The volumes of gas and atelectasis in the lungs were correlated with PL obtained using oesophageal pressure recordings. Work of breathing (WOB) was assessed from Campbell diagrams. RESULTS Gradual decrease in PL in both end-expiration and end-inspiration caused a proportional increase in atelectasis and decrease in the gas content (linear mixed model with an autoregressive correlation matrix; P < 0.001) as the WOB increased. However, cyclic alveolar collapse during tidal ventilation did not increase significantly. CONCLUSION We found a proportional correlation between atelectasis and PL during the 'weaning process' in experimental mild lung injury. If confirmed in the clinical setting, a gradual tapering of ventilator support can be recommended for weaning without risk of sudden formation of atelectasis.
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Affiliation(s)
- M. Gudmundsson
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - G. Perchiazzi
- Hedenstierna Laboratory; Institute of Medical Sciences; Uppsala University; Uppsala Sweden
| | - M. Pellegrini
- Hedenstierna Laboratory; Institute of Medical Sciences; Uppsala University; Uppsala Sweden
| | - A. Vena
- Department of Emergency and Organ Transplant; Bari University; Bari Italy
| | - G. Hedenstierna
- Hedenstierna Laboratory; Institute of Medical Sciences; Uppsala University; Uppsala Sweden
| | - C. Rylander
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Hedenstierna Laboratory; Institute of Medical Sciences; Uppsala University; Uppsala Sweden
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14
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Purroy F, Vena A, Cánovas D, Cardona P, Cocho D, Cuadrado-Godia E, Chamorro A, Dávalos A, Garcés M, Gomis M, Krupinski J, Palomeras E, Ribó M, Roquer J, Rubiera M, Sanahuja J, Saura J, Serena J, Ustrell X, Vargas M, Benabdelhak I, Abilleira S, Gallofré M. Influence of Hospital Type on Outcomes of Individuals Aged 80 and Older with Stroke Treated Using Intravenous Thrombolysis. J Am Geriatr Soc 2017; 65:E117-E122. [DOI: 10.1111/jgs.14935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Ana Vena
- Hospital Universitari Arnau de Vilanova de Lleida; Lleida Spain
| | | | - Pere Cardona
- Hospital de Bellvitge; Hospitalet del Llobregat Spain
| | | | | | | | | | | | | | | | | | - Marc Ribó
- Vall d'Hebrón Hospital; Barcelona Spain
| | | | | | - Jordi Sanahuja
- Hospital Universitari Arnau de Vilanova de Lleida; Lleida Spain
| | | | | | | | | | | | - Sonia Abilleira
- Agency for Health Quality and Assessment of Catalonia; Barcelona Spain
| | - Miquel Gallofré
- Agency for Health Quality and Assessment of Catalonia; Barcelona Spain
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15
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Muñoz P, Vena A, Padilla B, Valerio M, Sanchez M, Puig-Asensio M, Fortún J, Fernández-Ruiz M, Merino P, Losa J, Loza A, Rivas R, Bouza E. No evidence of increased ocular involvement in candidemic patients initially treated with echinocandins. Diagn Microbiol Infect Dis 2017; 88:141-144. [DOI: 10.1016/j.diagmicrobio.2017.02.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/07/2017] [Accepted: 02/21/2017] [Indexed: 01/05/2023]
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16
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Vena A, Bouza E, Álvarez-Uría A, Gayoso J, Martín-Rabadán P, Cajuste F, Guinea J, Gómez Castellá J, Alonso R, Munoz P. The misleading effect of serum galactomannan testing in high-risk haematology patients receiving prophylaxis with micafungin. Clin Microbiol Infect 2017; 23:1000.e1-1000.e4. [PMID: 28506782 DOI: 10.1016/j.cmi.2017.05.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/28/2017] [Accepted: 05/07/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate the performance of the routine serum galactomannan (sGM) assay in the diagnosis of invasive aspergillosis (IA) in high-risk haematology patients receiving prophylaxis with micafungin. METHODS Retrospective study including all haematological patients who received prophylaxis with micafungin during high-risk IA episodes (neutropenic patients after chemotherapy for acute myeloid leukaemia/myelodysplastic syndrome; allogeneic haematopoietic stem-cell transplantation during early neutropenic phase or graft-versus-host disease requiring high prednisone doses) and for whom at least one sGM result was available. Episodes were classified as follows: true-positive (positive GM in the context of IA), false-positive (positive GM result in patients who had no evidence of IA), true-negative (negative GM test results and no IA), or false-negative (negative GM test in the context of IA). Non-evaluable patients were excluded. RESULTS Among 146 evaluable episodes, four were true-positive in the context of probable breakthrough IA (incidence of breakthrough IA, 2.7%); 111/146 high-risk episodes (76%) were considered true-negative and 31/146 (21.2%) were considered false-positive. No false-negative episodes were detected. All but one of the false-positive episodes were detected in surveillance GM tests, leading to high-resolution CT scans in eight cases (8/31; 25.8%), all of which were negative. The positive predictive and negative predictive values of sGM for surveillance and diagnostic approaches were 3.2% (1/31) and 100% (110/110) and 75% (3/4) and 100% (1/1), respectively. CONCLUSIONS Surveillance of asymptomatic patients receiving prophylaxis with micafungin using sGM is unnecessary, because the results are either negative or false-positive. However, sGM remains useful in the diagnosis of breakthrough IA in symptomatic patients during prophylaxis.
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Affiliation(s)
- A Vena
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain.
| | - E Bouza
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - A Álvarez-Uría
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Gayoso
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain; Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P Martín-Rabadán
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - F Cajuste
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Guinea
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Gómez Castellá
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R Alonso
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - P Munoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
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17
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Vena A, Muñoz P, Valerio M, Rodríguez-Creixéms M, Marín M, Martínez Jiménez M, Martínez Sellés M, Rodríguez Abella H, Bouza E. 11. Endocarditis fúngica: aún muchas controversias pendientes. Cirugía Cardiovascular 2017. [DOI: 10.1016/j.circv.2016.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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18
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Lagunes L, Rey-Pérez A, Martín-Gómez MT, Vena A, de Egea V, Muñoz P, Bouza E, Díaz-Martín A, Palacios-García I, Garnacho-Montero J, Campins M, Bassetti M, Rello J. Association between source control and mortality in 258 patients with intra-abdominal candidiasis: a retrospective multi-centric analysis comparing intensive care versus surgical wards in Spain. Eur J Clin Microbiol Infect Dis 2016; 36:95-104. [PMID: 27649699 DOI: 10.1007/s10096-016-2775-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Abstract
Early empiric therapy and adequate resuscitation have been identified as main predictors of outcome in patients with candidemia or bacteremia. Moreover, source control is a major determinant in infectious sites when feasible, as a main technique to reduce microbiological burden. A retrospective, multicenter, cohort study was performed at surgical wards and intensive care units (ICU) of three University Hospitals in Spain between 2010 and 2014, with the aim of improving understanding of the interaction between source control, early antifungal therapy, and use of vasoactives in patients with intra-abdominal candidiasis (IAC). Source control was defined as all physical actions taken to control a focus of infection and reduce the favorable conditions that promote microorganism growth or that maintain the impairment of host defenses. Two hundred and fifty-eight patients with IAC were identified. Sixty-one patients were at ICU for diagnosis. Mortality was higher in the ICU group compared to what was documented for the non-ICU group (35 % vs 19.5 %, p = 0011). Adequate source control within 48 h of diagnosis was achieved in 60 % of the cohort. In multivariate analysis, inadequate source control was identified as the only common risk factor for 30-day mortality in both groups (ICU group OR: 13.78 (95% CI: 2.60-72.9, p = 0.002) and non-ICU group OR: 6.53 (95% CI: 2.56-16.61, p = <0.001). The population receiving both adequate source control and adequate antifungal treatment was the one associated with a higher survival rate, in both the ICU and surgical groups. Source control remains a key element in IAC, inside and outside the intensive care unit. Early antifungal treatment among ICU patients was associated with lower mortality.
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Affiliation(s)
- L Lagunes
- Critical Care Department, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119-129, 08035, Barcelona, Spain. .,Medicine Department, Universitat Autónoma de Barcelona, (UAB), Barcelona, Spain.
| | - A Rey-Pérez
- Neurocritical and Burns Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - M T Martín-Gómez
- Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - A Vena
- Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - V de Egea
- Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P Muñoz
- Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Department of Medicine, Universidad Complutense (UCM), Madrid, Spain.,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III (CIBERES), Madrid, Spain
| | - E Bouza
- Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Díaz-Martín
- Critical Care Department, Virgen Rocío University Hospital, Sevilla, Spain
| | - I Palacios-García
- Critical Care Department, Virgen Rocío University Hospital, Sevilla, Spain
| | - J Garnacho-Montero
- Critical Care Department, Virgen Rocío University Hospital, Sevilla, Spain
| | - M Campins
- Preventive Medicine and Epidemiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - M Bassetti
- IAC Study Coordinator, Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - J Rello
- Medicine Department, Universitat Autónoma de Barcelona, (UAB), Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III (CIBERES), Madrid, Spain
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19
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Muñoz P, Vena A, Valerio M, Álvarez-Uría A, Guinea J, Escribano P, Bouza E. Risk factors for late recurrent candidaemia. A retrospective matched case-control study. Clin Microbiol Infect 2015; 22:277.e11-20. [PMID: 26548507 DOI: 10.1016/j.cmi.2015.10.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 07/28/2015] [Revised: 10/08/2015] [Accepted: 10/21/2015] [Indexed: 11/18/2022]
Abstract
Incidence, risk factors and clinical significance of late recurrent (LR) candidaemia (>1 month between episodes) remains unclear. The 1219 episodes of candidaemia detected from January 1985 to December 2014 were reviewed. We selected all cases with more than one episode separated by at least 30 days after clinical resolution in the interim (cases) and compared each of them with two controls (patients with single episodes of candidaemia). Clinical strains were genotyped to differentiate relapses from re-infection. Eighteen patients (1.48%) had 36 episodes of LR candidaemia (median 4 months). Independent risk factors for recurrence in the multivariate analysis were: underlying gastrointestinal disease (OR 67.16; 95% CI 5.23-861.71; p 0.001) and fungaemia due to Candida parapsilosis (OR 9.10; 95% 1.33-62.00; p 0.02). All episodes of LR candidaemia diagnosed during the first 3 months were due to an intravascular source of infection, whereas in those occurring after 3 months the main source of the disease was the abdomen, followed by endocarditis, and urinary tract. Molecular typing showed that 42.9% of LR candidaemias were relapses and 57.1% were re-infections. Neither time of recurrence nor clinical origin could predict type of recurrence. LR candidaemia is a relatively rare event that is more frequent in patients who have an initial episode of candidaemia due to C. parapsilosis or an underlying gastrointestinal disease. Episodes of LR candidaemia that occur within the first 3 months should prompt an attempt to exclude an intravascular source of infection, whereas those occurring later point to an intra-abdominal origin.
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Affiliation(s)
- P Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón General Universitario, Madrid, Spain; CIBER Enfermedades Respiratorias- CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - A Vena
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón General Universitario, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - M Valerio
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain
| | - A Álvarez-Uría
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain
| | - J Guinea
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain
| | - P Escribano
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain
| | - E Bouza
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón General Universitario, Madrid, Spain; CIBER Enfermedades Respiratorias- CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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20
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Falcone M, Vena A, Mezzatesta ML, Gona F, Caio C, Goldoni P, Trancassini AM, Conti C, Orsi GB, Carfagna P, Stefani S, Venditti M. Role of empirical and targeted therapy in hospitalized patients with bloodstream infections caused by ESBL-producing Enterobacteriaceae. Ann Ig 2014; 26:293-304. [PMID: 25001119 DOI: 10.7416/ai.2014.1989] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Bloodstream infection (BSI) due to extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae are a major cause of in-hospital mortality. The effect on survival of empirical and targeted antibiotic therapy in these patients remains controversial. METHODS A prospective cohort study was conducted analyzing data from 94 patients (age 59 ± 21 years) with BSI due to ESBL producing strains (Sixty-one E. coli, 26 K. pneumoniae, 4 Proteus spp and 3 Enterobacter spp). RESULTS Risk factors associated with 21-day mortality at univariate analysis were: recent administration of antibiotic therapy (p=0.049), higher SOFA score (p=0.05), ICU stay (p <0.01), hypotension at presentation (p =0.001) or septic shock (p <0.001) and bacteremia from source other than urinary tract (p=0.03). Regardless of antibiotic class used, no differences in survival were noted between patients receiving or not adequate initial antimicrobial treatment (37.1% vs 23.7% p=0.23); on the other hand, compared with the administration of other in vitro active antibiotics, the use of carbapenem as definitive therapy was associated with a significantly lower 21-day mortality (54.3% vs 28.5% p=0.02). CONCLUSIONS These findings suggest that the administration of an adequate initial therapy is not associated with mortality in hospitalized patients with BSI due to Enterobacteriaceae. The severity of clinical conditions at presentation and the administration of carbapenems as definitive therapy seems to be really important in affecting the outcome of patients with BSI due to ESBL producing strains.
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Affiliation(s)
- M Falcone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - A Vena
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - M L Mezzatesta
- Department of Bio-Medical Sciences-Section of Microbiology, University of Catania, Italy
| | - F Gona
- Department of Bio-Medical Sciences-Section of Microbiology, University of Catania, Italy
| | - C Caio
- Department of Bio-Medical Sciences-Section of Microbiology, University of Catania, Italy
| | - P Goldoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - A M Trancassini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - C Conti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - G B Orsi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | | | - S Stefani
- Department of Bio-Medical Sciences-Section of Microbiology, University of Catania, Italy
| | - M Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
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21
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Orsi GB, Bencardino A, Vena A, Carattoli A, Venditti C, Falcone M, Giordano A, Venditti M. Patient risk factors for outer membrane permeability and KPC-producing carbapenem-resistant Klebsiella pneumoniae isolation: results of a double case-control study. Infection 2012; 41:61-7. [PMID: 23070604 DOI: 10.1007/s15010-012-0354-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 10/03/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the 1,200-bed university hospital "Umberto I" in Rome, Italy, we observed a dramatic substitution of a precedingly well-documented Klebsiella pneumoniae clone (ST37) with ertapenem resistance by outer membrane permeability modification (Porin-ER-Kp) with a new K. pneumoniae strain expressing carbapenem resistance due to K. pneumoniae carbapenemase production (KPC-CR-Kp). A case-case-control study was carried out to evaluate risk factors for Porin-ER-Kp and KPC-CR-Kp isolation. METHODS All patients with hospital-acquired K. pneumoniae isolation between July 2008 and June 2011 were included. Two case groups including patients harbouring KPC-CR-Kp and Porin-ER-Kp were analysed, with a third control group from whom carbapenem-susceptible K. pneumoniae (CS-Kp) were isolated. RESULTS Forty-four KPC-CR-Kp cases, 39 Porin-ER-Kp cases and 60 CS-Kp controls were analysed. During the 3-year study, a specific Porin-ER-Kp endemic clone (ST37) was substituted by a new KPC-CR-Kp clone (ST512). Breakthrough bacteraemias occurred in 21 out of 26 KPC-CR-Kp group bloodstream infections (BSIs); nine of these developed during carbapenem therapy and seven with colistin and/or tigecycline therapy. In 13 Porin-ER-Kp BSIs, breakthrough bacteraemias developed in eight patients and four during carbapenem therapy. In the multivariable analysis, KPC-CR-Kp isolates were associated with carbapenems [odds ratio (OR) 7.74; 95 % confidence interval (CI) 1.70-35.2; p < 0.01) and endoscopy (OR 6.71; 95 % CI 1.25-36.0; p < 0.03). Porin-ER-Kp independent risk factors included second-generation cephalosporins (OR 25.7; 95 % CI 3.20-206.8; p < 0.01), carbapenems (OR 19.1; 95 % CI 4.34-83.9; p < 0.001), acute renal failure (OR 7.17; 95 % CI 1.33-38.6; p < 0.03), endoscopy (OR 6.12; 95 % CI 1.46-25.6; p < 0.02) and third-generation cephalosporins (OR 5.3; 95 % CI 1.34-20.9; p < 0.02). CONCLUSIONS Porin-ER-Kp strains needed major antimicrobial pressure compared to KPC-CR-Kp to express resistance. KPC-CR-Kp substituted Porin-ER-Kp strains, causing more infections. KPC-CR-Kp breakthrough bacteraemia occurred even under therapy with tigecycline or colistin, underlining that an antibiotic stewardship programme is needed urgently.
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Affiliation(s)
- G B Orsi
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
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22
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Russo A, Falcone M, Vena A, Venditti C, Mancini C, Morelli A, Venditti M. Invasive pulmonary aspergillosis in non-neutropenic patients: analysis of a 14-month prospective clinical experience. J Chemother 2012; 23:290-4. [PMID: 22005062 DOI: 10.1179/joc.2011.23.5.290] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Invasive pulmonary aspergillosis (IPA) is one of the major causes of morbidity and mortality in severely immunocompromised patients, but recently several authors have reported the occurrence of IPA in liver cirrhosis, chronic obstructive pulmonary disease (COPD) patients, most of whom, but not all, were receiving steroid treatment, with a very high mortality rate. The detection of galactomannan performed in respiratory specimens is a new valuable test for the diagnosis of probable IPA, even in non-neutropenic high risk patients. Since the frequency and clinical impact of IPA in non-hematologic patients is not well known, it seemed rational to us to attempt a prospective study evaluating all patients hospitalized in a university hospital for whom an infectious Diseases consultation was required. This 14-month survey in our hospital, using recently recommended diagnostic criteria, seems to suggest an emerging role of IPA in these patients who may have a higher mortality rate than their neutropenic peers, and provides preliminary evidence that early diagnosis and prompt initiation of antifungal therapy may improve the ultimate outcome of their IPA.
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Affiliation(s)
- A Russo
- Internal Medicine Unit, Department of Public Health and Infectious Diseases, Policlinico Umberto I, University Sapienza, Rome, Italy
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Falcone M, Accarpio F, Venditti M, Vena A, Sibio S, Sammartino P, Di Giorgio A. Septic bilateral pulmonary candidiasis successfully treated with anidulafungin therapy in two patients with peritoneal carcinomatosis. J Antimicrob Chemother 2010; 65:2266-7. [DOI: 10.1093/jac/dkq297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Higes F, Abad JC, Vena A, Vázquez-Miralles JM, Yusta A. [Parkinson's syndrome as presentation form of left fronto-parietal meningioma. Letter]. Rev Neurol 1996; 24:1304. [PMID: 8983736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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25
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Vena A. [The role of the vitreous body in the pathogenesis of retinal tears]. Ann Ocul (Paris) 1972; 205:295-8. [PMID: 5053183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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26
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Vena A. [Biomicroscopy of the anterior chamber. Technic of determination of the width of the camerular sinus]. Ann Ocul (Paris) 1970; 203:825-6. [PMID: 5478878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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