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Alonso-Menchén D, Sánchez-Carrillo C, Alcalá L, Soriano-Martín A, Cercenado E, Burillo A, Serrano-Lobo J, Pérez-Latorre L, Muñoz P, Bouza E. Bloodstream infections: trends and evolution of incidence and etiology in a 12-year period (2010-2021). Infect Dis (Lond) 2024; 56:441-450. [PMID: 38407125 DOI: 10.1080/23744235.2024.2320333] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/13/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION The epidemiological evolution of bloodstream infections (BSIs) in the last decade is not clearly defined. Our aim was to analyze the changes in the workload in our institution and to describe the evolution of the incidence and etiology of BSIs in a 12-year period, including the COVID-19 pandemic. METHODS All blood cultures received in the laboratory of a tertiary general hospital between 2010 and 2021 were analyzed. Bloodstream infection episodes refer to each episode of bacteremia or fungemia in each patient. Incidence rates per 1000 admissions and per 100,000 population were calculated. RESULTS No significant changes in the incidence of BSI episodes/1000 admissions were observed (mean, 31.1), while estimated population-based incidences showed declining trends (mean, 182.8/100,000 inhabitants). There was a slight increase in BSI episodes per 1000 admissions caused by Gram-negatives (mean, 16.6/1000 admissions) and E. coli was the most frequent pathogen (mean, 8.5/1000 admissions). There was no significant rise in episodes caused by ESBL- and carbapenemase-producing E. coli or K. pneumoniae, with a decline in those caused by methicillin-resistant S. aureus. A spike in BSI episodes, fungal BSIs and catheter-related infections was detected in 2020, during the COVID-19 outbreak. CONCLUSIONS No clear increase in the incidence of BSI episodes was detected in our center over this period. Gram-negatives are the most frequent etiology, with no clear rise in antimicrobial resistance phenotypes. The COVID-19 pandemic accounted for a small increase in BSI episodes in 2020, probably related to the increase of catheter-related infections.
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Affiliation(s)
- David Alonso-Menchén
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Carlos Sánchez-Carrillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CIBERES CB06/06/0058), Madrid, Spain
| | - Luis Alcalá
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CIBERES CB06/06/0058), Madrid, Spain
| | - Ana Soriano-Martín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Emilia Cercenado
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CIBERES CB06/06/0058), Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Almudena Burillo
- Department of 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
| | - Julia Serrano-Lobo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Leire Pérez-Latorre
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Infecciosas-CIBERINFEC, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CIBERES CB06/06/0058), Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CIBERES CB06/06/0058), Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Herrera-Hidalgo L, Muñoz P, Álvarez-Uría A, Alonso-Menchén D, Luque-Marquez R, Gutiérrez-Carretero E, Fariñas MDC, Miró JM, Goenaga MA, López-Cortés LE, Angulo-Lara B, Boix-Palop L, de Alarcón A. Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort. Int J Infect Dis 2023; 137:134-143. [PMID: 37926195 DOI: 10.1016/j.ijid.2023.10.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/26/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). METHODS Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. RESULTS We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. CONCLUSION Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective.
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Affiliation(s)
- Laura Herrera-Hidalgo
- Department of Pharmacy, University Hospital Virgen del Rocío, Seville, Spain; Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute, Gregorio Marañón General University Hospital, Madrid, Spain; Complutense University of Madrid, Madrid, Spain; Biomedical Research Centre Network for Respiratory Diseases-CIBERES, Madrid, Spain
| | - Ana Álvarez-Uría
- Department of Clinical Microbiology and Infectious Diseases, Hospital Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute, Gregorio Marañón General University Hospital, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
| | - David Alonso-Menchén
- Department of Clinical Microbiology and Infectious Diseases, Hospital Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute, Gregorio Marañón General University Hospital, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
| | - Rafael Luque-Marquez
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain
| | - Encarnación Gutiérrez-Carretero
- Department of Cardiac Surgery, Institute of Biomedicine of Seville (IBiS) University of Seville/CSIC/University Hospital Virgen del Rocío Seville, Spain; Biomedical Research Centre Network for Cardiovascular Diseases-CIBERCV, Madrid, Spain
| | - María Del Carmen Fariñas
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department Servicio de of Infectious Diseases, Health Research Institute Valdecilla (IDIVAL), University Hospital Universitario Marqués de Valdecilla/ University of Cantabria, Santander
| | - Jose Maria Miró
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases. Hospital Clínic/ Biomedical Research Institute August Pi i Sunyer (IDIBAPS)/ University of Barcelona, Barcelona, Spain
| | - Miguel Angel Goenaga
- Department of Infectious Diseases, Donosti Hospital, Donostia-San Sebastian, Spain
| | - Luis Eduardo López-Cortés
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases and Microbiology Clinical, University Hospital Virgen Macarena, Sevilla, Spain; Department of Medicine, School of Medicine, University of Sevilla, Sevilla, Spain; Biomedicine Institute of Sevilla (IBiS)/CSIC, Seville, Spain
| | - Basilio Angulo-Lara
- Department of Cardiology, University Hospital Puerta del Hierro, Madrid, Spain
| | - Lucia Boix-Palop
- Department of Infectious Diseases, University Hospital Mútua Terrassa, Barcelona, Spain
| | - Arístides de Alarcón
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Alonso-Menchén D, Bouza E, Valerio M, de Alarcón A, Gutiérrez-Carretero E, Miró JM, Goenaga-Sánchez MÁ, Plata-Ciézar A, González-Rico C, López-Cortés LE, Rodríguez Esteban MÁ, Martínez-Marcos FJ, Muñoz P. Non-nosocomial Healthcare-Associated Infective Endocarditis: A Distinct Entity? Data From the GAMES Series (2008-2021). Open Forum Infect Dis 2023; 10:ofad393. [PMID: 37564744 PMCID: PMC10411035 DOI: 10.1093/ofid/ofad393] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Indexed: 08/12/2023] Open
Abstract
Background Patients who acquire infective endocarditis (IE) following contact with the healthcare system, but outside the hospital, are classified as having non-nosocomial healthcare-associated IE (HCIE). Our aim was to characterize HCIE and establish whether its etiology, diagnosis, and therapeutic approach suggest it should be considered a distinct entity. Methods This study retrospectively analyzes data from a nationwide, multicenter, prospective cohort including consecutive cases of IE at 45 hospitals across Spain from 2008 to 2021. HCIE was defined as IE detected in patients in close contact with the healthcare system (eg, patients receiving intravenous treatment, hemodialysis, or institutionalized). The prevalence and main characteristics of HCIE were examined and compared with those of community-acquired IE (CIE) and nosocomial IE (NIE) and with literature data. Results IE was diagnosed in 4520 cases, of which 2854 (63%) were classified as CIE, 1209 (27%) as NIE, and 457 (10%) as HCIE. Patients with HCIE showed a high burden of comorbidities, a high presence of intravascular catheters, and a predominant staphylococcal etiology, Staphylococcus aureus being identified as the most frequent causative agent (35%). They also experienced more persistent bacteremia, underwent fewer surgeries, and showed a higher mortality rate than those with CIE (32.4% vs 22.6%). However, mortality in this group was similar to that recorded for NIE (32.4% vs 34.9%, respectively, P = .40). Conclusions Our data do not support considering HCIE as a distinct entity. HCIE affects a substantial number of patients, is associated with a high mortality, and shares many characteristics with NIE.
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Affiliation(s)
- David Alonso-Menchén
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Medicine Department, Universidad Complutense de Madrid, Madrid, Spain
- CIBER (Centro de Investigación Biomédica en Red) de Enfermedades Respiratorias (CB06/06/0058), Instituto de Salud Carlos III, Madrid, Spain
| | - Maricela Valerio
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Medicine Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Arístides de Alarcón
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, University Hospital Virgen del Rocío, Institute of Biomedicine of Seville, University of Seville/CSIC (Consejo Superior de Investigaciones Científicas), Seville, Spain
- CIBER (Centro de Investigación Biomédica en Red) de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Encarnación Gutiérrez-Carretero
- Cardiac Surgery Service, University Hospital Virgen del Rocío, Institute of Biomedicine of Seville, University of Seville/CSIC(Consejo Superior de Investigaciones Científicas), Seville, Spain
- CIBER (Centro de Investigación Biomédica en Red) de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - José M Miró
- CIBER (Centro de Investigación Biomédica en Red) de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Service, Hospital Clínic–IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), University of Barcelona, Barcelona, Spain
| | | | - Antonio Plata-Ciézar
- Servicio de Enfermedades Infecciosas Hospital Regional Universitario de Málaga, IBIMA (Instituto de Investigación Biomédica de Málaga), Málaga, Spain
| | - Claudia González-Rico
- CIBER (Centro de Investigación Biomédica en Red) de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla–IDIVAL (Instituto de Investigación Marqués de Valdecilla), Santander, Spain
| | - Luis Eduardo López-Cortés
- CIBER (Centro de Investigación Biomédica en Red) de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena, Institute of Biomedicine of Seville, University of Seville/CSIC (Consejo Superior de Investigaciones Científicas), Seville, Spain
| | | | | | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Medicine Department, Universidad Complutense de Madrid, Madrid, Spain
- CIBER (Centro de Investigación Biomédica en Red) de Enfermedades Respiratorias (CB06/06/0058), Instituto de Salud Carlos III, Madrid, Spain
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Gasulla Ó, Ledesma-Carbayo MJ, Borrell LN, Fortuny-Profitós J, Mazaira-Font FA, Barbero Allende JM, Alonso-Menchén D, García-Bennett J, Del Río-Carrrero B, Jofré-Grimaldo H, Seguí A, Monserrat J, Teixidó-Román M, Torrent A, Ortega MÁ, Álvarez-Mon M, Asúnsolo A. Enhancing physicians' radiology diagnostics of COVID-19's effects on lung health by leveraging artificial intelligence. Front Bioeng Biotechnol 2023; 11:1010679. [PMID: 37152658 PMCID: PMC10157246 DOI: 10.3389/fbioe.2023.1010679] [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: 08/03/2022] [Accepted: 03/14/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction: This study aimed to develop an individualized artificial intelligence model to help radiologists assess the severity of COVID-19's effects on patients' lung health. Methods: Data was collected from medical records of 1103 patients diagnosed with COVID-19 using RT- qPCR between March and June 2020, in Hospital Madrid-Group (HM-Group, Spain). By using Convolutional Neural Networks, we determine the effects of COVID-19 in terms of lung area, opacities, and pulmonary air density. We then combine these variables with age and sex in a regression model to assess the severity of these conditions with respect to fatality risk (death or ICU). Results: Our model can predict high effect with an AUC of 0.736. Finally, we compare the performance of the model with respect to six physicians' diagnosis, and test for improvements on physicians' performance when using the prediction algorithm. Discussion: We find that the algorithm outperforms physicians (39.5% less error), and thus, physicians can significantly benefit from the information provided by the algorithm by reducing error by almost 30%.
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Affiliation(s)
- Óscar Gasulla
- Hospital Universitari de Bellvitge-Universitat de Barcelona, L´Hospitalet de Llobregat, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
| | - Maria J. Ledesma-Carbayo
- Biomedical Image Technologies, Universidad Politécnica de Madrid & CIBER BBN, ISCIII, Madrid, Spain
| | - Luisa N. Borrell
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, University of New York, New York, NY, United States
| | | | - Ferran A. Mazaira-Font
- Departament d'Econometria, Estadística i Economia Aplicada-Universitat de Barcelona, Barcelona, Spain
| | - Jose María Barbero Allende
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - David Alonso-Menchén
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Josep García-Bennett
- Hospital Universitari de Bellvitge-Universitat de Barcelona, L´Hospitalet de Llobregat, Spain
| | - Belen Del Río-Carrrero
- Hospital Universitari de Bellvitge-Universitat de Barcelona, L´Hospitalet de Llobregat, Spain
| | - Hector Jofré-Grimaldo
- Hospital Universitari de Bellvitge-Universitat de Barcelona, L´Hospitalet de Llobregat, Spain
| | - Aleix Seguí
- Campus Nord, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Miguel Teixidó-Román
- Departament d'Econometria, Estadística i Economia Aplicada-Universitat de Barcelona, Barcelona, Spain
| | - Adrià Torrent
- Departament d'Econometria, Estadística i Economia Aplicada-Universitat de Barcelona, Barcelona, Spain
| | - Miguel Ángel Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- *Correspondence: Angel Asúnsolo, ; Melchor Álvarez-Mon, ; Miguel Ángel Ortega,
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Service of Internal Medicine and Immune System Diseases-Rheumatology, University Hospital Príncipe de Asturias, (CIBEREHD), Alcalá de Henares, Spain
- *Correspondence: Angel Asúnsolo, ; Melchor Álvarez-Mon, ; Miguel Ángel Ortega,
| | - Angel Asúnsolo
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, University of New York, New York, NY, United States
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- *Correspondence: Angel Asúnsolo, ; Melchor Álvarez-Mon, ; Miguel Ángel Ortega,
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Franco-Moreno A, Acedo-Gutiérrez MS, Martín NLS, Hernández-Blanco C, Rodríguez-Olleros C, Ibáñez-Estéllez F, Suárez-Simón A, Balado-Rico M, Romero-Paternina AR, Alonso-Menchén D, Escolano-Fernández B, Piniella-Ruiz E, Alonso-Monge E, Notario-Leo H, Bibiano-Guillén C, Peña-Lillo G, Antiqueira-Pérez A, Romero-Pareja R, Cabello-Clotet N, Estrada-Pérez V, Troya-García J, de Carranza-López M, Escobar-Rodríguez I, Vallejo-Maroto N, Torres-Macho J. Effect of EARLY administration of DEXamethasone in patients with COVID-19 pneumonia without acute hypoxemic respiratory failure and risk of development of acute respiratory distress syndrome (EARLY-DEX COVID-19): study protocol for a randomized controlled trial. Trials 2022; 23:784. [PMID: 36109825 PMCID: PMC9479245 DOI: 10.1186/s13063-022-06722-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 09/08/2022] [Indexed: 12/15/2022] Open
Abstract
Background Corticosteroids are one of the few drugs that have shown a reduction in mortality in coronavirus disease 2019 (COVID-19). In the RECOVERY trial, the use of dexamethasone reduced 28-day mortality compared to standard care in hospitalized patients with suspected or confirmed COVID-19 requiring supplemental oxygen or invasive mechanical ventilation. Evidence has shown that 30% of COVID-19 patients with mild symptoms at presentation will progress to acute respiratory distress syndrome (ARDS), particularly patients in whom laboratory inflammatory biomarkers associated with COVID-19 disease progression are detected. We postulated that dexamethasone treatment in hospitalized patients with COVID-19 pneumonia without additional oxygen requirements and at risk of progressing to severe disease might lead to a decrease in the development of ARDS and thereby reduce death. Methods/design This is a multicenter, randomized, controlled, parallel, open-label trial testing dexamethasone in 252 adult patients with COVID-19 pneumonia who do not require supplementary oxygen on admission but are at risk factors for the development of ARDS. Risk for the development of ARDS is defined as levels of lactate dehydrogenase > 245 U/L, C-reactive protein > 100 mg/L, and lymphocyte count of < 0.80 × 109/L. Eligible patients will be randomly assigned to receive either dexamethasone or standard of care. Patients in the dexamethasone group will receive a dose of 6 mg once daily during 7 days. The primary outcome is a composite of the development of moderate or more severe ARDS and all-cause mortality during the 30-day period following enrolment. Discussion If our hypothesis is correct, the results of this study will provide additional insights into the management and progression of this specific subpopulation of patients with COVID-19 pneumonia without additional oxygen requirements and at risk of progressing to severe disease. Trial registration ClinicalTrials.gov NCT04836780. Registered on 8 April 2021 as EARLY-DEX COVID-19.
Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06722-x.
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Alonso-Menchén D, Muñoz P, Sánchez-Carrillo C, Pérez-Latorre L, Bouza E. Unresolved issues in the epidemiology and diagnosis of bacteremia: an opinion paper. Rev Esp Quimioter 2022; 35:519-537. [PMID: 35892171 PMCID: PMC9728596 DOI: 10.37201/req/066.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Bacteremia is an important cause of morbidity and mortality worldwide and, despite the diagnostic and therapeutic advances of the last decades, the evidence supporting many diagnostic aspects of bacteremia is scarce. Information on the epidemiological evolution of this entity is limited and many methodological aspects of blood culture collection and analysis are under discussion. Furthermore, the recommendations of the main scientific societies on many of these aspects are variable and, in many cases, have not been updated recently. In this scenario, we have arranged a series of questions on different aspects of bacteremia and reviewed the literature trying to find proper answers for them. We offer our opinion on the topics where the evidence was weak. The topics covered include epidemiological aspects of bacteremia, indications for blood culture extraction, methods for obtaining and incubating samples, or ways of transmitting results from the microbiology laboratory. We do not intend to summarize the current clinical practice guidelines, nor will we deal with the therapeutic management of this entity. The aim of this paper is to review the current perspective on the diagnosis of bacteremia with a critical approach, to point out the gaps in the literature, to offer the opinion of a team dedicated to infectious diseases and clinical microbiology, and to identify some areas of knowledge on which future studies should focus.
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Affiliation(s)
- David Alonso-Menchén
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón,,Gregorio Marañón Health Research Institute,Correspondence: David Alonso Menchén, MD. Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón. Calle Doctor Esquerdo 46, 28007 Madrid, Spain. E-mail:
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón,,Gregorio Marañón Health Research Institute,Medicine Department, School of Medicine, Universidad Complutense de Madrid,,CIBER Enfermedades Respiratorias-CIBERES (CIBERES CB06/06/0058), Madrid, Spain
| | - Carlos Sánchez-Carrillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón,,Gregorio Marañón Health Research Institute
| | - Leire Pérez-Latorre
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón,,Gregorio Marañón Health Research Institute,CIBER Enfermedades Infecciosas-CIBERINFEC, Madrid, Spain
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón,,Gregorio Marañón Health Research Institute,Medicine Department, School of Medicine, Universidad Complutense de Madrid,,CIBER Enfermedades Respiratorias-CIBERES (CIBERES CB06/06/0058), Madrid, Spain
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