1
|
Roca I, Espinoza K, Irigoin-Lovera C, Piquet M, Palomino-Kobayashi LA, Castillo AK, Gonzales-DelCarpio DD, Viñes J, Muñoz L, Ymaña B, Oporto R, Zavalaga C, Pons MJ, Ruiz J. Clonal dissemination of Acinetobacter radioresistens among Humboldt penguins (Spheniscus humboldti) inhabiting a barren northern Peruvian island. Eur J Microbiol Immunol (Bp) 2024; 14:210-218. [PMID: 38483509 DOI: 10.1556/1886.2023.00066] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/27/2024] [Indexed: 05/16/2024] Open
Abstract
Acinetobacter spp. are often isolated from natural sources, but knowledge about their presence in wild animals is fragmented and uncomplete. The present study aimed to characterize a series of Acinetobacter radioresistens isolated from Humboldt penguins (Spheniscus humboldti). Fifteen Humboldt penguins from an inhabited northern Peruvian island were sampled. Microorganisms were identified by MALDI-TOF MS. Antibiotic susceptibility to 12 antimicrobial agents was established, and clonal relationships were determined. A representative isolate was selected for whole genome sequencing (WGS). A. radioresistens were isolated from the feces of 12 (80%) Humboldt penguins, being susceptible to all the antimicrobial agents tested, except eight cefotaxime-intermediate isolates. All A. radioresistens were clonally related. WGS showed that the isolate belonged to ST1972, the presence of two chromosomal encoded carbapenemases (blaOXA-23 and a putative subclass B3 metallo-β-lactamase), and a series of point mutations in antibiotic-resistance related chromosomal genes, which were considered as polymorphisms. In addition, a few virulence factors, including a capsule-encoding operon, superoxide dismutases, catalases, phospholipases and a siderophore receptor were identified. The present results suggest that A. radioresistens may be a common member of the gut microbiota of Humboldt penguins, but further studies in other geographical areas are needed to establish this finding.
Collapse
Affiliation(s)
- Ignasi Roca
- 1Department of Microbiology, Biomedical Diagnostic Center (CDB) and ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- 2CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Kathya Espinoza
- 3Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - "One Health", Universidad Científica del Sur, Lima, Peru
- 4Grupo de Investigación en Enfermedades Emergentes y Reemergentes, Universidad Científica del Sur, Lima, Peru
| | - Cinthia Irigoin-Lovera
- 5Unidad de Investigación de Ecosistemas Marinos-Grupo Aves Marinas, Universidad Científica del Sur, Lima, Peru
| | - Maria Piquet
- 1Department of Microbiology, Biomedical Diagnostic Center (CDB) and ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Luciano A Palomino-Kobayashi
- 3Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - "One Health", Universidad Científica del Sur, Lima, Peru
- 4Grupo de Investigación en Enfermedades Emergentes y Reemergentes, Universidad Científica del Sur, Lima, Peru
| | - Angie K Castillo
- 3Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - "One Health", Universidad Científica del Sur, Lima, Peru
- 4Grupo de Investigación en Enfermedades Emergentes y Reemergentes, Universidad Científica del Sur, Lima, Peru
| | - Diego D Gonzales-DelCarpio
- 5Unidad de Investigación de Ecosistemas Marinos-Grupo Aves Marinas, Universidad Científica del Sur, Lima, Peru
| | - Joaquim Viñes
- 1Department of Microbiology, Biomedical Diagnostic Center (CDB) and ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- 6Servei Veterinari de Genètica Molecular (SVGM), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Muñoz
- 1Department of Microbiology, Biomedical Diagnostic Center (CDB) and ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- 2CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Barbara Ymaña
- 3Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - "One Health", Universidad Científica del Sur, Lima, Peru
- 4Grupo de Investigación en Enfermedades Emergentes y Reemergentes, Universidad Científica del Sur, Lima, Peru
| | - Rosario Oporto
- 3Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - "One Health", Universidad Científica del Sur, Lima, Peru
- 4Grupo de Investigación en Enfermedades Emergentes y Reemergentes, Universidad Científica del Sur, Lima, Peru
| | - Carlos Zavalaga
- 5Unidad de Investigación de Ecosistemas Marinos-Grupo Aves Marinas, Universidad Científica del Sur, Lima, Peru
| | - Maria J Pons
- 3Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - "One Health", Universidad Científica del Sur, Lima, Peru
- 4Grupo de Investigación en Enfermedades Emergentes y Reemergentes, Universidad Científica del Sur, Lima, Peru
| | - Joaquim Ruiz
- 3Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - "One Health", Universidad Científica del Sur, Lima, Peru
- 4Grupo de Investigación en Enfermedades Emergentes y Reemergentes, Universidad Científica del Sur, Lima, Peru
| |
Collapse
|
2
|
De La Mora L, Pitart C, Morata L, Ugarte A, Martinez-Rebollar M, De Lazzari E, Vergara A, Bosch J, Roca I, Piquet M, Rodriguez A, Laguno M, Ambrosioni J, Torres B, González-Cordón A, Inciarte A, Foncillas A, Riera J, Fuertes I, Chivite I, Martinez E, Blanco JL, Soriano A, Mallolas J. Increasing of New CA-MRSA Infections Detected in people living with HIV Who Engage in Chemsex in Barcelona: An Ambispective Study. Infect Dis Ther 2023; 12:2179-2189. [PMID: 37491688 PMCID: PMC10505111 DOI: 10.1007/s40121-023-00846-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION There are no data on community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in the context of the chemsex phenomenon. This study aimed to characterize CA-MRSA-related infections in a cohort of people living with HIV (PLWH) who engage in chemsex. METHODS At the Hospital Clinic of Barcelona, from February 2018 to January 2022, we analyzed CA-MRSA infections diagnosed in a cohort of PLWH who engage in chemsex. Epidemiological, behavioral and clinical variables were assessed. Mass spectrometry identification and antimicrobial susceptibility testing were performed on MRSA isolates. Pulse field electrophoresis was used to assess the clonality of the MRSA strains. The presence of Panton-Valentine leukocidin was also investigated. RESULTS Among the cohort of 299 participants who engage in chemsex, 25 (8%) with CA-MRSA infections were identified, 9 at baseline and 16 with incident cases; the cumulative incidence was 5.5% (95% CI: 3.2%, 8.8%). The most common drugs were methamphetamine (96%) and GHB/GBL (92%). Poly-consumption and slamming were reported by 32% and 46%, respectively. CA-MRSA was isolated from the infection sites of 20 participants, and CA-MRSA colonization was confirmed in the remaining 5 persons. Seventy-one percent had used antibiotics in the previous year. All participants presented with skin and soft tissue infections, 28% required hospitalization, and 48% had recurrence. Of the 23 MRSA isolates further studied, 19 (82,6%) belonged to the same clone. Panton-Valentine leukocidin was detected in all isolates. CONCLUSION PLWH who engage in chemsex may present with CA-MRSA infections. Clinical suspicion and microbiological diagnosis are required to provide adequate therapy, and CA-MRSA prevention interventions should be designed.
Collapse
Affiliation(s)
- Lorena De La Mora
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, AIDS and HIV Research Group, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Cristina Pitart
- Department of Clinical Microbiology, ISGlobal, Hospital Clínic-University of Barcelona, CIBERINF, Barcelona, Spain
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clinic, IDIBAPS, CIBERINF, University of Barcelona, Barcelona, Spain
| | - Ainoa Ugarte
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, AIDS and HIV Research Group, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - María Martinez-Rebollar
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, AIDS and HIV Research Group, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Elisa De Lazzari
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, AIDS and HIV Research Group, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Andrea Vergara
- Department of Clinical Microbiology, ISGlobal, Hospital Clínic-University of Barcelona, CIBERINF, Barcelona, Spain
| | - Jordi Bosch
- Department of Clinical Microbiology, ISGlobal, Hospital Clínic-University of Barcelona, CIBERINF, Barcelona, Spain
| | - Ignasi Roca
- Department of Clinical Microbiology, ISGlobal, Hospital Clínic-University of Barcelona, CIBERINF, Barcelona, Spain
| | - Maria Piquet
- Department of Clinical Microbiology, ISGlobal, Hospital Clínic-University of Barcelona, CIBERINF, Barcelona, Spain
| | - Ana Rodriguez
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, AIDS and HIV Research Group, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Montserrat Laguno
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, AIDS and HIV Research Group, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Juan Ambrosioni
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, AIDS and HIV Research Group, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Berta Torres
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, AIDS and HIV Research Group, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Ana González-Cordón
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, AIDS and HIV Research Group, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Alexy Inciarte
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, AIDS and HIV Research Group, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Alberto Foncillas
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, AIDS and HIV Research Group, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Josep Riera
- Dermatology Service, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Irene Fuertes
- Dermatology Service, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Iván Chivite
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, AIDS and HIV Research Group, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Esteban Martinez
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, AIDS and HIV Research Group, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - José L Blanco
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, AIDS and HIV Research Group, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic, IDIBAPS, CIBERINF, University of Barcelona, Barcelona, Spain
| | - Josep Mallolas
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, AIDS and HIV Research Group, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| |
Collapse
|
3
|
Steven D, Fiedler L, Roca I, Lorgat F, Lacotte J, Haqqani H, Jesser E, Williams C, Roithinger F. High-density mapping in catheter ablation for persistent atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott Laboratories
Background
Pulmonary vein isolation (PVI) is an established treatment option for persistent atrial fibrillation (PersAF). Corresponding long-term success rates remain modest however, advancements in high-density (HD) mapping may better identify substrates. The HD grid-style mapping catheter (HD Grid) allows for simultaneous analysis of adjacent orthogonal bipolar signals that may assist in ablation strategy decisions to achieve favorable outcomes in treating PersAF.
Objective
This was a prospective, multi-center, observational study to quantify and characterize the use of a market-released HD mapping catheter in PersAF subjects.
Methods
HD Grid was used in PersAF subjects undergoing radiofrequency (RF) ablation across 25 sites to gather data regarding safety, mapping efficiency and quality, ablation strategies, and procedural outcomes.
Results
334 PersAF subjects (average age: 64.2 years; 76% male) were enrolled in this study. Types of maps generated included peak-to-peak voltage (78%; 322/413), local activation time (LAT) (11.4%; 47/413), and complex fractionated electrogram (CFE) mean (7.7%; 32/413). Median total mapping points collected and used were 8428.0 (IQR 4845.0-13366.0) and 2099.0 (IQR 1219.0-2947.0), respectively, in a median of 11.0 (IQR 7.3-16.0) minutes per map. Low voltage, scar/fibrosis, and CFE were searched for in 90.4% (302/334), 53.6% (179/334), and 15.9% (53/334) of subjects, respectively. A PVI approach was used in 93.1% of all ablation procedures and 34.1% (114/334) of subjects received PVI plus additional lesions. HD Grid identified signals of interest not identified by the ablation catheter in 80.4% (205/255) of subjects. The total procedure time was 134.3 ± 51.3 minutes with a fluoroscopy time of 14.5 ± 11.3 minutes and RF ablation time of 32.4 ± 29.6 minutes. Of the subjects in atrial fibrillation (AF) (59.6%; 199/334), AF was terminated in 80.4% (160/199). 87.4% (173/198) of subjects were free from recurrent atrial arrhythmias as detected by 48-hour Holter monitoring at 12 months. 13.8% (46/334) of subjects experienced any adverse event through 12 months including 1 death unrelated to the procedure and 1 event deemed related to HD Grid by the investigator.
Conclusion
This study demonstrated the use of the HD Grid mapping catheter to create detailed maps and to guide ablation strategies to treat PersAF while maintaining an adequate safety profile.
Collapse
Affiliation(s)
- D Steven
- Heart Center at the University of Cologne, Electrophysiology, Cologne, Germany
| | - L Fiedler
- LK Wiener Neustadt Abteilung fuer Kardiologie und Nephrologie, Wiener Neustadt, Austria
| | - I Roca
- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - F Lorgat
- Christiaan Barnard Memorial Hospital, Cape Town, South Africa
| | - J Lacotte
- JACQUES CARTIER PRIVATE HOSPITAL, Massy, France
| | - H Haqqani
- The Prince Charles Hospital, Brisbane, Australia
| | - E Jesser
- Abbott, Abbott Park, United States of America
| | - C Williams
- Abbott, Abbott Park, United States of America
| | - F Roithinger
- LK Wiener Neustadt Abteilung fuer Kardiologie und Nephrologie, Wiener Neustadt, Austria
| |
Collapse
|
4
|
Marí-Almirall M, Ferrando N, Fernández MJ, Cosgaya C, Viñes J, Rubio E, Cuscó A, Muñoz L, Pellice M, Vergara A, Campo I, Rodríguez-Serna L, Santana G, Del Río A, Francino O, Ciruela P, Ballester F, Marco F, Martínez JA, Soriano Á, Pitart C, Vila J, Roca I. Clonal Spread and Intra- and Inter-Species Plasmid Dissemination Associated With Klebsiella pneumoniae Carbapenemase-Producing Enterobacterales During a Hospital Outbreak in Barcelona, Spain. Front Microbiol 2021; 12:781127. [PMID: 34867923 PMCID: PMC8637019 DOI: 10.3389/fmicb.2021.781127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/25/2021] [Indexed: 02/03/2023] Open
Abstract
Objectives: The study aimed to characterize the clonal spread of resistant bacteria and dissemination of resistance plasmids among carbapenem-resistant Enterobacterales at a tertiary hospital in Catalonia, Spain. Methods: Isolates were recovered from surveillance rectal swabs and diagnostic samples. Species identification was by matrix-assisted laser desorption ionization-time time of flight mass spectrometry (MALDI-TOF MS). Molecular typing was performed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Antimicrobial susceptibility was assessed by gradient-diffusion and carriage of bla genes was detected by PCR. Plasmid typing, conjugation assays, S1-PFGE studies and long-read sequencing were used to characterize resistance plasmids. Results: From July 2018 to February 2019, 125 Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales were recovered from 101 inpatients from surveillance (74.4%) or clinical samples (25.6%), in a tertiary hospital in Barcelona. Clonality studies identified a major clone of Klebsiella pneumoniae belonging to sequence type ST15 and additional isolates of K. pneumoniae, Escherichia coli and Enterobacter sp. from different STs. All isolates but one carried the bla KPC-2 allelic variant. The bla KPC-2 gene was located in an IncFIIk plasmid of circa 106 Kb in a non-classical Tn4401 element designated NTEKPC-pMC-2-1. Whole-genome sequencing revealed different rearrangements of the 106 Kb plasmid while the NTEKPC-pMC-2-1 module was highly conserved. Conclusion: We report a hospital outbreak caused by the clonal dissemination of KPC-producing ST15 K. pneumoniae but also the intra- and inter-species transmission of the bla KPC-2 gene associated with plasmid conjugation and/or transposon dissemination. To our knowledge, this is the first report of an outbreak caused by KPC-producing Enterobacterales isolated from human patients in Catalonia and highlights the relevance of surveillance studies in the early detection and control of antibiotic resistant high-risk clones.
Collapse
Affiliation(s)
- Marta Marí-Almirall
- Laboratory of Antimicrobial Resistance, ISGlobal, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
| | - Núria Ferrando
- Laboratory of Antimicrobial Resistance, ISGlobal, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
| | - Mariana José Fernández
- Department of Clinical Microbiology, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
| | - Clara Cosgaya
- Laboratory of Antimicrobial Resistance, ISGlobal, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
| | - Joaquim Viñes
- Molecular Genetics Veterinary Service, Universitat Autònoma de Barcelona, Barcelona, Spain
- Vetgenomics, PRUAB, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisa Rubio
- Department of Clinical Microbiology, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
| | - Anna Cuscó
- Vetgenomics, PRUAB, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Muñoz
- Laboratory of Antimicrobial Resistance, ISGlobal, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
| | - Martina Pellice
- Department of Infectious Diseases, Hospital Clínic–Institut d’Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Andrea Vergara
- Department of Clinical Microbiology, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
| | - Irene Campo
- Department of Clinical Microbiology, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
| | - Laura Rodríguez-Serna
- Department of Preventive Medicine and Epidemiology, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
| | - Gemina Santana
- Department of Preventive Medicine and Epidemiology, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
| | - Ana Del Río
- Department of Infectious Diseases, Hospital Clínic–Institut d’Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Olga Francino
- Molecular Genetics Veterinary Service, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Ciruela
- Public Health Agency of Catalonia (ASPCAT), Generalitat de Catalunya, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Frederic Ballester
- Hospital Universitari Sant Joan de Reus-Laboratori de Referència del Camp de Tarragona i de les Terres de l’Ebre, Reus, Spain
| | - Francesc Marco
- Laboratory of Antimicrobial Resistance, ISGlobal, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
- Department of Clinical Microbiology, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
| | - José Antonio Martínez
- Department of Infectious Diseases, Hospital Clínic–Institut d’Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Álex Soriano
- Department of Infectious Diseases, Hospital Clínic–Institut d’Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Pitart
- Laboratory of Antimicrobial Resistance, ISGlobal, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
- Department of Clinical Microbiology, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
| | - Jordi Vila
- Laboratory of Antimicrobial Resistance, ISGlobal, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
- Department of Clinical Microbiology, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
| | - Ignasi Roca
- Laboratory of Antimicrobial Resistance, ISGlobal, Hospital Clínic–Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
5
|
Marí-Almirall M, Cosgaya C, Pitart C, Viñes J, Muñoz L, Campo I, Cuscó A, Rodríguez-Serna L, Santana G, Del Río A, Francino O, Ciruela P, Pujol I, Ballester F, Marco F, Martínez JA, Soriano Á, Vila J, Roca I. Dissemination of NDM-producing Klebsiella pneumoniae and Escherichia coli high-risk clones in Catalan healthcare institutions. J Antimicrob Chemother 2021; 76:345-354. [PMID: 33200193 DOI: 10.1093/jac/dkaa459] [Citation(s) in RCA: 9] [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: 06/13/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To characterize the clonal spread of carbapenem-resistant Klebsiella pneumoniae and Escherichia coli isolates between different healthcare institutions in Catalonia, Spain. METHODS Antimicrobial susceptibility was tested by disc diffusion. MICs were determined by gradient diffusion or broth microdilution. Carbapenemase production was confirmed by lateral flow. PCR and Sanger sequencing were used to identify the allelic variants of resistance genes. Clonality studies were performed by PFGE and MLST. Plasmid typing, conjugation assays, S1-PFGE plus Southern blotting and MinION Oxford Nanopore sequencing were used to characterize resistance plasmids. RESULTS Twenty-nine carbapenem-resistant isolates recovered from three healthcare institutions between January and November 2016 were included: 14 K. pneumoniae isolates from a tertiary hospital in the south of Catalonia (hospital A); 2 K. pneumoniae isolates from a nearby healthcare centre; and 12 K. pneumoniae isolates and 1 E. coli isolate from a tertiary hospital in Barcelona (hospital B). The majority of isolates were resistant to all antimicrobial agents, except colistin, and all were NDM producers. PFGE identified a major K. pneumoniae clone (n = 27) belonging to ST147 and co-producing NDM-1 and CTX-M-15, with a few isolates also harbouring blaOXA-48. Two sporadic isolates of K. pneumoniae ST307 and E. coli ST167 producing NDM-7 were also identified. blaNDM-1 was carried in two related IncR plasmid populations and blaNDM-7 in a conjugative 50 kb IncX3 plasmid. CONCLUSIONS We report the inter-hospital dissemination of XDR high-risk clones of K. pneumoniae and E. coli associated with the carriage of small, transferable plasmids harbouring blaNDM genes.
Collapse
Affiliation(s)
- Marta Marí-Almirall
- Laboratory of Antimicrobial Resistance, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Clara Cosgaya
- Laboratory of Antimicrobial Resistance, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Cristina Pitart
- Department of Clinical Microbiology, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Joaquim Viñes
- SVGM, Molecular Genetics Veterinary Service, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.,Vetgenomics, PRUAB, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Laura Muñoz
- Laboratory of Antimicrobial Resistance, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Irene Campo
- Department of Clinical Microbiology, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Anna Cuscó
- Vetgenomics, PRUAB, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Laura Rodríguez-Serna
- Department of Epidemiology and Preventive Medicine, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Gemina Santana
- Department of Epidemiology and Preventive Medicine, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ana Del Río
- Department of Infectious Diseases, Hospital Clínic - Institut d'investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Olga Francino
- SVGM, Molecular Genetics Veterinary Service, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Pilar Ciruela
- Public Health Agency of Catalonia (ASPCAT), Generalitat de Catalunya, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Pujol
- Laboratori de Microbiologia, Hospital Universitari Sant Joan de Reus, Reus, Spain.,Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - Frederic Ballester
- Hospital Universitari Sant Joan de Reus-Laboratori de Referència del Camp de Tarragona i de les Terres de l'Ebre, Reus, Spain
| | - Francesc Marco
- Laboratory of Antimicrobial Resistance, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Clinical Microbiology, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - José Antonio Martínez
- Department of Infectious Diseases, Hospital Clínic - Institut d'investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Álex Soriano
- Department of Infectious Diseases, Hospital Clínic - Institut d'investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Jordi Vila
- Laboratory of Antimicrobial Resistance, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Clinical Microbiology, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ignasi Roca
- Laboratory of Antimicrobial Resistance, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | |
Collapse
|
6
|
Vergara A, Moreno-Morales J, Roca I, Pitart C, Kostyanev T, Rodriguez-Baño J, Goossens H, Marco F, Vila J. A comparative study between real-time PCR and loop-mediated isothermal amplification to detect carbapenemase and/or ESBL genes in Enterobacteriaceae directly from bronchoalveolar lavage fluid samples. J Antimicrob Chemother 2021; 75:1453-1457. [PMID: 32073602 DOI: 10.1093/jac/dkaa031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To evaluate and compare the efficacy of real-time PCR (Xpert Carba-R) and loop-mediated isothermal amplification (Eazyplex® SuperBug CRE) for detecting carbapenemase carriage in Enterobacteriaceae directly from bronchoalveolar lavage (BAL). METHODS Negative BAL samples were spiked with 21 well-characterized carbapenemase-producing Enterobacteriaceae strains to a final concentration of 102-104 cfu/mL. Xpert Carba-R (Cepheid, Sunnyvale, CA, USA), which detects five targets (blaKPC, blaNDM, blaVIM, blaOXA-48 and blaIMP-1), and the Eazyplex® SuperBug CRE system (Amplex-Diagnostics GmbH, Germany), which detects seven genes (blaKPC, blaNDM, blaVIM, blaOXA-48, blaOXA-181, blaCTXM-1 and blaCTXM-9), were evaluated for the detection of these genes directly from BAL samples. RESULTS Xpert Carba-R showed 100% agreement with carbapenemase characterization by PCR and sequencing for all final bacteria concentrations. Eazyplex® SuperBug CRE showed 100%, 80% and 27% agreement with PCR and sequencing when testing 104, 103 and 102 cfu/mL, respectively. False negative results for Eazyplex® SuperBug CRE matched the highest cycle threshold values for Xpert Carba-R. Hands-on time for both assays was about 15 min, but Eazyplex® SuperBug CRE results were available within 30 min, whereas Xpert Carba-R took around 50 min. CONCLUSIONS We here describe the successful use of two commercial diagnostic tests, Xpert Carba-R and Eazyplex® SuperBug CRE, to detect bacterial carbapenem resistance genes directly in lower respiratory tract samples. Our results could be used as proof-of-concept data for validation of these tests for this indication.
Collapse
Affiliation(s)
- A Vergara
- Department of Clinical Microbiology - CDB, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - J Moreno-Morales
- Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - I Roca
- Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - C Pitart
- Department of Clinical Microbiology - CDB, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - T Kostyanev
- Department of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - J Rodriguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - H Goossens
- Department of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.,Laboratory of Medical Microbiology, University Hospital Antwerp, Antwerp, Belgium
| | - F Marco
- Department of Clinical Microbiology - CDB, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - J Vila
- Department of Clinical Microbiology - CDB, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
7
|
Fiedler L, Roithinger F, Roca I, Lorgat F, Roux A, Lacotte J, Miller A, Steven D. Simultaneous orthogonal bipole mapping compared to conventional electrode configurations and impact on ablation strategies: results from a real world observational study. Europace 2021. [DOI: 10.1093/europace/euab116.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott
Background
3D mapping systems are pivotal to identify low voltage areas and to define ablation strategies. In this context, high-density multipolar mapping catheters with varying electrode configurations are used for accurate myocardial substrate definition. High density mapping using a grid shaped catheter allows for use of simultaneous analysis of adjacent orthogonal bipolar signals that may assist in more accurate substrate characterization and ablation strategy decisions.
Purpose
This was a prospective, multicenter observational study to characterize the utility of electroanatomical mapping with a high density grid-style mapping catheter (HD Grid) in subjects undergoing catheter ablation for persistent atrial fibrillation (PersAF) or ventricular tachycardia (VT) in real-world clinical settings.
Methods
Mapping was performed with the HD Grid catheter to generate high-density maps of cardiac chambers in order to assess the potential influence of the simultaneous orthogonal bipole configuration on PersAF and VT ablation strategies. Differences in substrate identification between simultaneous orthogonal bipole configuration and standard along-the-spline electrode configuration, and potential effects on ablation strategies were investigated.
Results
During the study period (January 2019 through April 2020), 367 subjects underwent catheter ablation for PersAF (N = 333, average age 64.1yr, 75% male) or VT (N = 34, average age = 64.3yr, 85.3% male).
In total, 494 maps were generated to treat patients undergoing PersAF ablation and 57 to treat patients undergoing VT ablation. Compared to standard along-the-spline configuration, mapping with the simultaneous orthogonal bipole configuration showed differences in 57.8% (178/308) of maps generated, with the greatest difference noticed in surface area of low voltage (62.9%) and location of low voltage (55.6%).
In comparisons performed live during the procedure (n = 50), simultaneous orthogonal bipole configuration assisted in identification of ablation targets in 70.0% of cases, changing the ablation strategy compared to that identified with along-the-spline configuration in 34.3%.
In comparisons performed retrospectively after the procedure (n = 258), the ablation strategy identified with simultaneous orthogonal bipole configuration differed from along-the-spline configuration in 21.7% of maps. Even compared to a higher-density electrode configuration using all-bipoles rather than along-the-spline bipoles, simultaneous orthogonal bipole configuration identified differences in 57.1% of maps.
Conclusion
The HD grid catheter combined with simultaneous orthogonal bipole configuration can define myocardial substrate more accurately compared to standard along-the-spline configuration. The difference in substrate identification has potential impact on ablation strategy. Further clinical trials are needed to elucidate the role of orthogonal bipole configuration mapping and improved ablation success rates.
Collapse
Affiliation(s)
- L Fiedler
- LK Wiener Neustadt Abteilung fuer Kardiologie und Nephrologie, Wiener Neustadt, Austria
| | - F Roithinger
- LK Wiener Neustadt Abteilung fuer Kardiologie und Nephrologie, Wiener Neustadt, Austria
| | - I Roca
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - F Lorgat
- Christiaan Barnard Memorial Hospital, Cape Town, South Africa
| | - A Roux
- SANTE REPUBLIQUE CENTRE, Clermont-Ferrand, France
| | - J Lacotte
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - A Miller
- Abbott, Minneapolis, United States of America
| | - D Steven
- University hospital Köln, Cologne, Germany
| |
Collapse
|
8
|
Francisco Pascual J, Rivas Gandara N, Santos Ortega A, Perez Rodon J, Benito B, Roca I, Cantalapiedra Romero J, Maldonado J, Jordan Marchite P, Herrador Galindo L, Ferreira Gonzalez I. First Vs Recurrent Syncope In Patients With Structural Heart Disease Or Bundle Branch Block. Europace 2021. [DOI: 10.1093/europace/euab116.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitari Vall d"Hebron - Vall d"Hebron Institut de Recerca. CIBERCV
BACKGROUND
Patients with structural heart disease (SHD) or bundle branch block (BBB) are at high risk of having an arrhythmic syncope (AS). In patients with recurrent syncope episodes (RSE) complete work-up including electrophysiological study (EPS) and/or implantation of a loop recorder (ILR) is recommended, however patients with their first episode may also be at risk of an AS.
AIM
To determinate if the patients with SHD or BBB with a single syncope episode (SSE) are at high risk of having an AS and compare it with patients with recurrent episodes (RSE).
METHODS Cohort study carried out in a tertiary hospital that is a reference centre for syncope. From January 2008 to August 2020 patients with SHD or BBB with syncope of unknown origin after the initial evaluation and without direct indication of an ICD were included. They were managed according the current ESC guidelines.
RESULTS
417patients were included (74 ±11 y. o; 39% female). Mean follow up was 2.5 ±1 y. 223 patients were diagnosed from an AS [113 (53%) in SSE group and 110 (54%) in RSE group, p = 0.9], 210 were due to bradyarrhythmia (AV block or sinus arrest). No differences in baseline characteristics where found comparing both groups, except that BBB was slightly more prevalent in patients with RSE (81% vs 90%, p = 0.01) (FIGURE- PANEL A). Risk of AS was 53% in patients with SE and 54% (p = 0.9). RSE were not associated with an increased risk of AS in univariate analyses (OR 1.01 IC95% 0.7-1.5) neither in the multivariate (FIGURE- PANEL B). EPS and ILR diagnostic yield was 45% / 32% respectively in SSE group and 44% / 33% in RSE group (p = 0.8) (FIGURE - PANEL C). After appropriate treatment, recurrence syncope rate was 10% in SSE group and 9% in RSE group (p = 0.8). No significant differences in mortality rate were found.
CONCLUSIONS
Patients with SHD or BBB and single syncope episode are at a high risk of having AS, and similar to those with RSE. EPS and ILR offer a similar diagnostic yield in both groups. Complete syncope work-up must be recommended in these patients despite having had only a single episode. Abstract Figure
Collapse
Affiliation(s)
- J Francisco Pascual
- University Hospital Vall d"Hebron & Vall d"Hebron Institut de Recerca, Servei de Cardiologia. - Universitat autònoma de Barcelona. CIBER-CV, Barcelona, Spain, Barcelona, Spain
| | - N Rivas Gandara
- University Hospital Vall d"Hebron & Vall d"Hebron Institut de Recerca, Servei de Cardiologia. - Universitat autònoma de Barcelona. CIBER-CV, Barcelona, Spain, Barcelona, Spain
| | - A Santos Ortega
- University Hospital Vall d"Hebron & Vall d"Hebron Institut de Recerca, Servei de Cardiologia. - Universitat autònoma de Barcelona. CIBER-CV, Barcelona, Spain, Barcelona, Spain
| | - J Perez Rodon
- University Hospital Vall d"Hebron & Vall d"Hebron Institut de Recerca, Servei de Cardiologia. - Universitat autònoma de Barcelona. CIBER-CV, Barcelona, Spain, Barcelona, Spain
| | - B Benito
- University Hospital Vall d"Hebron & Vall d"Hebron Institut de Recerca, Servei de Cardiologia. - Universitat autònoma de Barcelona. CIBER-CV, Barcelona, Spain, Barcelona, Spain
| | - I Roca
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - J Cantalapiedra Romero
- University Hospital Vall d"Hebron & Vall d"Hebron Institut de Recerca, Servei de Cardiologia. - Universitat autònoma de Barcelona. CIBER-CV, Barcelona, Spain, Barcelona, Spain
| | - J Maldonado
- University Hospital Vall d"Hebron & Vall d"Hebron Institut de Recerca, Servei de Cardiologia. - Universitat autònoma de Barcelona. CIBER-CV, Barcelona, Spain, Barcelona, Spain
| | - P Jordan Marchite
- University Hospital Vall d"Hebron & Vall d"Hebron Institut de Recerca, Servei de Cardiologia. - Universitat autònoma de Barcelona. CIBER-CV, Barcelona, Spain, Barcelona, Spain
| | - L Herrador Galindo
- University Hospital Vall d"Hebron & Vall d"Hebron Institut de Recerca, Servei de Cardiologia. - Universitat autònoma de Barcelona. CIBER-CV, Barcelona, Spain, Barcelona, Spain
| | - I Ferreira Gonzalez
- University Hospital Vall d"Hebron, Servei de Cardiologia. - VHIR- Universitat autònoma de Barcelona. CIVERESP, Barcelona, Spain
| |
Collapse
|
9
|
Roca I, Lorgat F, Haqqani H, Lacotte J, Roithinger F, Fiedler L, Miller A, Steven D. Impact of high density mapping using a grid shaped catheter with orthogonal signal analysis on ventricular tachycardia ablation strategy. Europace 2021. [DOI: 10.1093/europace/euab116.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott
Background
Ventricular tachycardia (VT) in patients with structural heart disease (SHD) is related to scar and slow conduction areas. Substrate-based ablation has become the gold standard treatment in patients with SHD-related refractory VT. A new high-density grid shaped catheter that allows simultaneous analysis of adjacent orthogonal bipolar signals can allow better understanding of these slow conduction areas with the potential to improve ablation results.
Purpose
This was a prospective, multicenter observational study to characterize the utility of electroanatomical mapping with a high density grid-style mapping catheter (HD Grid) in subjects undergoing catheter ablation for ventricular tachycardia (VT) in real-world clinical settings.
Methods
During the study period, patients who underwent VT ablation using the HD Grid catheter as the primary mapping catheter were included. Comparisons both during the procedure and retrospectively were performed between conventional electrode configuration maps and simultaneous orthogonal bipole electrode configuration maps. The influence of these different configurations on ablation strategy was analyzed.
Results
During study period (January 2019 – April 2020) 57 maps were performed in 34 VT subjects (average age: 64.3yr, male: 85.3%, ischemic cardiomyopathy: 70.6%). The left ventricle was mapped in 94.1% of subjects, including left ventricular outflow tract and papillary muscles in 20.6% and 8.8% respectively, reporting minimal or no ectopic beats in 97.1% of the subjects. The total number of mapping points collected was 14172.0 ± 15174.8 in 24.3 ± 17.9 min per map.
Simultaneous orthogonal bipole mapping identified differences in 67.6% of maps compared to linear along-the-spline electrode configurations. The differences consisted mainly in the surface area (92%) and location of low voltage (40%). When compared during the procedure, simultaneous orthogonal bipole mapping was used to identify ablation strategy in 100% of cases. When compared to a standard along-the-spline configuration retrospectively, the ablation strategy identified with simultaneous orthogonal bipoles was different in 30.1% of cases. The ablation strategy used in these subjects was mainly substrate ablation (late potentials and low voltage areas in scar regions) with an acute success rate of 97.1%.
Conclusions
The use of the HD Grid catheter with the ability to analyze orthogonal signals is feasible and has the potential to change the ablation strategy in one third of VT patients with a high acute success rate.
Collapse
Affiliation(s)
- I Roca
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - F Lorgat
- Christiaan Barnard Memorial Hospital, Cape Town, South Africa
| | - H Haqqani
- The Prince Charles Hospital, Brisbane, Australia
| | - J Lacotte
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - F Roithinger
- LK Wiener Neustadt Abteilung fuer Kardiologie und Nephrologie, Wiener Neustadt, Austria
| | - L Fiedler
- LK Wiener Neustadt Abteilung fuer Kardiologie und Nephrologie, Wiener Neustadt, Austria
| | - A Miller
- Abbott, Minneapolis, United States of America
| | - D Steven
- University hospital Köln, Cologne, Germany
| |
Collapse
|
10
|
Sanchez Somonte P, Quinto L, Zarakett F, Garre P, Alarcon F, Tolosana J, Guasch E, Arbelo E, Pujol M, Caixal G, Ortiz J, Jauregui B, Berruezo A, Mont L, Roca I. Usefulness of late gadolinium enhancement cardiac magnetic resonance to predict appropriate therapies in implantable cardioverter defibrillator patients in primary prevention. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The scar and the amount of border zone measured by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) has been proposed as an independent predictor of ventricular arrhythmias in patients with ischemic and non-ischemic cardiomyopathy. However, at the present time, the guidelines are based only on the ejection fraction to recommend an implantable cardioverter defibrillator (ICD) in primary prevention, and only a minority of these patients receive appropriate therapies. So, prevention needs to be improved.
Purpose
To identify predictors of appropriate therapies in patients with a primary prevention ICD using cardiac magnetic resonance imaging and a dedicated software (ADAS-3D) to characterize the scar.
Methods
Patients who underwent a LGE-MR prior to ICD implantation in primary prevention were retrospectively included. Clinical and cardiac imaging characteristics were collected. The myocardium was segmented with ADAS-3D software in 10 layers (from endocardium to epicardium). The scar, border zone, core and conducting channels were automatically measured in grams by the software.
Results
Since 2008 to 2017, 206 patients were included. Mean age was 67±28 years, 80% men, mean ejection fraction 26%±9, 52% with ischemic cardiomyopathy and 48% non-ischemic. The primary endpoint was appropriate therapies and/or sudden cardiac death (SCD). Median follow-up was 46.33 months. 46 patients (22%) reached the primary endpoint. Greater scar mass (36.05 grams vs 21.5 grams; HR 1.04; 95% CI (1.03–1-05), p<0.001), core mass (9.8 grams vs 5.6 grams; HR 1.06; 95% CI (1.04–1-09), p<0.001), border zone mass (26.2 grams vs 15.9 grams; HR 1.05; 95% CI (1.04–1-09), p<0.001) and channel mass (3.0 grams vs 1.6 grams; HR 1.15 95% CI (1.06–1.25), p<0.001) were associated with appropriate therapies and SCD. A border zone mass >5.3 grams was independently associated with the primary endpoint (HR: 4.77; 95% CI (1.15–19.73), p=0.03).
Conclusions
The amount of border zone, core and channel mass measured by LGE-MR and ADAS software are independent predictors of appropriate therapies and SCD in patients with ICD in primary prevention.
Scar characterization
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
| | - L Quinto
- Hospital Clinic of Barcelona, Barcelona, Spain
| | - F Zarakett
- Hospital Clinic of Barcelona, Barcelona, Spain
| | - P Garre
- Hospital Clinic of Barcelona, Barcelona, Spain
| | - F Alarcon
- Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - E Guasch
- Hospital Clinic of Barcelona, Barcelona, Spain
| | - E Arbelo
- Hospital Clinic of Barcelona, Barcelona, Spain
| | - M Pujol
- Hospital Clinic of Barcelona, Barcelona, Spain
| | - G Caixal
- Hospital Clinic of Barcelona, Barcelona, Spain
| | - J.M Ortiz
- Hospital Clinic of Barcelona, Barcelona, Spain
| | | | | | - L Mont
- Hospital Clinic of Barcelona, Barcelona, Spain
| | - I Roca
- Hospital Clinic of Barcelona, Barcelona, Spain
| |
Collapse
|
11
|
Pons MJ, Marí-Almirall M, Ymaña B, Moya-Salazar J, Muñoz L, Sauñe S, Salazar-Hernández R, Vila J, Roca I. Spread of ST348 Klebsiella pneumoniae Producing NDM-1 in a Peruvian Hospital. Microorganisms 2020; 8:microorganisms8091392. [PMID: 32932763 PMCID: PMC7563475 DOI: 10.3390/microorganisms8091392] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 08/01/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 12/28/2022] Open
Abstract
The aim of this study was to characterize carbapenem-resistant Klebsiella pneumoniae (CR-Kp) isolates recovered from adults and children with severe bacteremia in a Peruvian Hospital in June 2018. Antimicrobial susceptibility was determined by disc/gradient diffusion and broth microdilution when necessary. Antibiotic resistance mechanisms were evaluated by PCR and DNA sequencing. Clonal relatedness was assessed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Plasmid typing was performed with a PCR-based method. Thirty CR-Kp isolates were recovered in June 2018. All isolates were non-susceptible to all β-lactams, ciprofloxacin, gentamicin and trimethoprim-sulfamethoxazole, while mostly remaining susceptible to colistin, tigecycline, levofloxacin and amikacin. All isolates carried the blaNDM-1 gene and were extended spectrum β-lactamase (ESBL) producers. PFGE showed four different pulsotypes although all isolates but two belonged to the ST348 sequence type, previously reported in Portugal. blaNDM-1 was located in an IncFIB-M conjugative plasmid. To our knowledge, this is the first report of an New Delhi metallo-β-lactamase (NDM)-producing K. pneumoniae recovered from both children and adults in Lima, Peru, as well as the first time that the outbreak strain ST348 is reported in Peru and is associated with NDM. Studies providing epidemiological and molecular data on CR-Kp in Peru are essential to monitor their dissemination and prevent further spread.
Collapse
Affiliation(s)
- Maria J. Pons
- Facultad de Medicina, Universidad Científica del Sur, Carr. Antigua Panamericana Sur 19, Villa El Salvador, Lima 15067, Peru;
- Correspondence: (M.J.P.); (I.R.)
| | - Marta Marí-Almirall
- Department of Clinical Microbiology, ISGlobal, Hospital Clínic, Universitat de Barcelona, Rosselló 149-153, 08036 Barcelona, Spain; (M.M.-A.); (L.M.); (J.V.)
| | - Barbara Ymaña
- Facultad de Medicina, Universidad Científica del Sur, Carr. Antigua Panamericana Sur 19, Villa El Salvador, Lima 15067, Peru;
| | - Jeel Moya-Salazar
- Hospital Nacional Docente Madre Niño San Bartolomé, Avenida Alfonso Ugarte 825, Lima 150101, Peru;
- Escuela de Posgrado, Facultad de Ciencias de la Salud, Universidad Privada San Juan Bautista, Ex Hacienda Villa, Av José Antonio Lavalle s/n, Lima 15067, Peru;
| | - Laura Muñoz
- Department of Clinical Microbiology, ISGlobal, Hospital Clínic, Universitat de Barcelona, Rosselló 149-153, 08036 Barcelona, Spain; (M.M.-A.); (L.M.); (J.V.)
| | - Sharon Sauñe
- Escuela de Posgrado, Facultad de Ciencias de la Salud, Universidad Privada San Juan Bautista, Ex Hacienda Villa, Av José Antonio Lavalle s/n, Lima 15067, Peru;
- Servicio de Citología y Citogenética, Departamento de Anatomía Patológica, Hospital Nacional Guillermo Almenara Irigoyen, Jirón García Naranjo 840, La Victoria 13, Lima 150115, Peru;
| | - Richard Salazar-Hernández
- Servicio de Citología y Citogenética, Departamento de Anatomía Patológica, Hospital Nacional Guillermo Almenara Irigoyen, Jirón García Naranjo 840, La Victoria 13, Lima 150115, Peru;
| | - Jordi Vila
- Department of Clinical Microbiology, ISGlobal, Hospital Clínic, Universitat de Barcelona, Rosselló 149-153, 08036 Barcelona, Spain; (M.M.-A.); (L.M.); (J.V.)
| | - Ignasi Roca
- Department of Clinical Microbiology, ISGlobal, Hospital Clínic, Universitat de Barcelona, Rosselló 149-153, 08036 Barcelona, Spain; (M.M.-A.); (L.M.); (J.V.)
- Correspondence: (M.J.P.); (I.R.)
| |
Collapse
|
12
|
Al-Hassan L, Roemer-Mahler A, Price J, Islam J, El-Mahallawy H, Higgins PG, Hussein AFA, Roca I, Newport M. The TACTIC experience: establishing an international, interdisciplinary network to tackle antimicrobial resistance. J Med Microbiol 2020; 69:1213-1220. [PMID: 32902373 DOI: 10.1099/jmm.0.001249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Antimicrobial resistance (AMR) is a major global health threat that requires an interdisciplinary international approach to address. In response to calls from policymakers and funders alike, a growing number of research networks on AMR have been created with this approach in mind. However, there are many challenges facing researchers in establishing such networks and research projects. In this article, we share our experience of establishing the network 'TACTIC: Tackling AMR Challenges through Translational Interdisciplinary Collaborations'. Although presented with many challenges both scientific and logistical, the network has underpinned productive interaction between biomedical and social scientists from several countries and fostered true collaboration in an educative, stimulating and sustainable way that forms a platform for important research on AMR.
Collapse
Affiliation(s)
- Leena Al-Hassan
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - Anne Roemer-Mahler
- Department of International Relations, University of Sussex, Brighton, BN1 9SN, UK
| | - James Price
- Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Jasmin Islam
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | | | - Paul G Higgins
- German Centre for Infection Research (DZIF), partner site, Bonn-Cologne, Germany.,Institute of Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne 50935, Germany
| | - Amira F A Hussein
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ignasi Roca
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain
| | - Melanie Newport
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| |
Collapse
|
13
|
Yero D, Huedo P, Conchillo-Solé O, Martínez-Servat S, Mamat U, Coves X, Llanas F, Roca I, Vila J, Schaible UE, Daura X, Gibert I. Genetic Variants of the DSF Quorum Sensing System in Stenotrophomonas maltophilia Influence Virulence and Resistance Phenotypes Among Genotypically Diverse Clinical Isolates. Front Microbiol 2020; 11:1160. [PMID: 32582100 PMCID: PMC7283896 DOI: 10.3389/fmicb.2020.01160] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 02/03/2020] [Accepted: 05/06/2020] [Indexed: 12/16/2022] Open
Abstract
The pathogenicity of Stenotrophomonas maltophilia is regulated in part by its quorum sensing (QS) system. The main QS signaling molecule in S. maltophilia is known as diffusible signal factor (DSF), and the rpf gene cluster is responsible for its synthesis and perception. Two cluster variants have been previously described, rpf-1 and rpf-2, which differ basically in the conditions under which DSF is produced. Here, correlations between the rpf variant and antibiotic susceptibility, LPS electrophoretic profiles and virulence-related phenotypes were evaluated for a collection of 78 geographically and genetically diverse clinical strains of S. maltophilia. In general there were associations between previously established genogroups and the genetic variant of the rpf cluster. However, only few genotype-phenotype correlations could be observed. Resistance to the β-lactam antibiotics ceftazidime and ticarcillin was associated with strains carrying the rpf-1 variant, whereas strains of variant rpf-2, particularly those of genogroup C, showed higher resistance levels to colistin. Strains of variant rpf-2 were also significantly more virulent to Galleria mellonella larvae than those of rpf-1, most likely due to an increased ability of rpf-2 strains to form biofilms. A comparative genomic analysis revealed the presence of proteins unique to individual genogroups. In particular, the strains of genogroup C share an operon that encodes for a new virulence determinant in S. maltophilia related to the synthesis of an alternative Flp/Tad pilus. Overall, this study establishes a link between the DSF-based QS system and the virulence and resistance phenotypes in this species, and identifies potential high-risk clones circulating in European hospitals.
Collapse
Affiliation(s)
- Daniel Yero
- Institut de Biotecnologia i de Biomedicina (IBB), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Departament de Genètica i de Microbiologia, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Pol Huedo
- Institut de Biotecnologia i de Biomedicina (IBB), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Departament de Genètica i de Microbiologia, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Oscar Conchillo-Solé
- Institut de Biotecnologia i de Biomedicina (IBB), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Departament de Genètica i de Microbiologia, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Sònia Martínez-Servat
- Institut de Biotecnologia i de Biomedicina (IBB), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Departament de Genètica i de Microbiologia, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Uwe Mamat
- Cellular Microbiology, Priority Research Area Infections, Research Center Borstel - Leibniz Lung Center, Borstel, Germany
| | - Xavier Coves
- Institut de Biotecnologia i de Biomedicina (IBB), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Departament de Genètica i de Microbiologia, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ferran Llanas
- Institut de Biotecnologia i de Biomedicina (IBB), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ignasi Roca
- Department of Clinical Microbiology-ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jordi Vila
- Department of Clinical Microbiology-ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ulrich E Schaible
- Cellular Microbiology, Priority Research Area Infections, Research Center Borstel - Leibniz Lung Center, Borstel, Germany
| | - Xavier Daura
- Institut de Biotecnologia i de Biomedicina (IBB), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Isidre Gibert
- Institut de Biotecnologia i de Biomedicina (IBB), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Departament de Genètica i de Microbiologia, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| |
Collapse
|
14
|
Gunturiz Beltran C, Borras-Amoraga R, Alarcon F, Garre P, Figueras R, Caixal G, Tolosana JM, Arbelo E, Roca I, Prat S, Perea MJ, Brugada J, Guasch E, Mont L. P1016Correlation between cardiac magnetic resonance-late gadolinium enhancement and electro-anatomical map for right atrium. Europace 2020. [DOI: 10.1093/europace/euaa162.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
none
Background
Electroanatomical map (EAM) detects areas of low voltage as a surrogated marker of fibrosis areas, being the reference technique for its detection. Cardiac magnetic resonance with Late Gadolinium enhancement (CMR-LGE) allows non-invasive detection of atrial fibrotic areas. CMR-LGE studies have focused on the left atrium since now.
Purpose
We need to validate this test to extend its use to the right atrium (RA), since it is involved in the arrhythmogenic substrate of several arrhythmias, and probably also in atrial fibrillation (AF).
Methods
Prospective observational study. Fifteen patients undergoing a first AF ablation procedure were included. All patients had a pre-procedural LGE-CMR performed. The blood pool-normalized intensity signal (image intensity ratio-IIR) was calculated for the right atrial wall, and values projected in a shell. IIR values validated for the left atrium were used to identify dense and intermediate fibrosis, and healthy tissue (>1.32, 1.2-1.32, <1.2, respectively). During the procedure but before ablation, a point-by-point high density EA bipolar voltage map of RA was obtained with a multipolar catheter. Standard voltage thresholds of 0,1 mV and 0,5 mV were used to characterize fibrotic and healthy tissue in EAM. For each RA, the EAM was projected into the IIR shell, and the correlation between bipolar voltage and normalized IIR values for each shell point was quantified. Then, we also obtained its concordance (categorical variables) according to the label automatically assigned by EAM/CMR with the pre-set thresholds: healthy tissue/ intermediate fibrosis/dense fibrosis.
Results
A total of 8,830 points were obtained, mean per patient 588 (± 509) points. A global weak negative correlation was found between the EA bipolar voltage map (EAM) and IIR (CMR) (r= -0.16, p < 0.0001)(figure). LGE-CMR identified more healthy tissue than EAM (81.0% vs 60.6% respectively), then CMR underestimated the fibrotic tissue in RA. Finally, we analyzed the concordance and we obtained that the degree of accuracy between both measurements was 55.7%.
Conclusion
There was an inverse correlation between the bipolar voltage EAM and IIR (CMR) of low grade but with statistical significance. CMR underestimated fibrotic tissue in RA with respect to its identification by EAM.
Abstract Figure. Correlation between bipolar voltage-IIR
Collapse
Affiliation(s)
| | | | - F Alarcon
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - P Garre
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - R Figueras
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - G Caixal
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - E Arbelo
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - I Roca
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - S Prat
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - M J Perea
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - J Brugada
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Guasch
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - L Mont
- Hospital Clinic de Barcelona, Barcelona, Spain
| |
Collapse
|
15
|
Caixal G, Alarcon F, Nunez M, Garre P, Soto D, Borras R, Gunturitz C, Perea R, Roca I, Guasch E, Mont L. P1010Association between left atrial fibrosis detected by cardiac magnetic resonance and endocardial electroanatomic mapping in the evaluation of the electrophysiological substrate in atrial fibrillation. Europace 2020. [DOI: 10.1093/europace/euaa162.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is related to left atrial fibrosis, but its identification by late magnetic resonance imaging (LGE) with gadolinium (LGE) persists in controversy due to heterogeneous results in its correlation with the electroatomic map (EAM) and the difficulty of perform histological studies in humans.
Purpose
We try to examine the point-by-point association between high density EAM and LGE-MRI using an automatic and reproducible method.
Methods
A LGE-MRI was performed in 16 patients prior to ablation. Three different areas were established depending on the intensity of normalized enhancement for each patient according to their blood group with the image intensity ratio (IIR) (healthy <1.20, border area (BZ) ≥1.20 <1.32 and scar ≥1.32). The high density electroanatomic maps of the left atrium (LA) were projected onto the MRI, obtaining an automatic correlation point by point.
Results
The study obtained significant differences (p < 0.001) between voltage (mV) and CV (mm/ms) among healthy, BZ and scar areas, as well a significant inverse correlation (p < 0.001) between voltage and IIR (R=-0.39). It obtained too a significant correlation between CV and IIR (R=-0.24), but this showed a greater correlation in those patients who have the least dilated LA (p = 0.02).
Conclusions
LGE-MRI and EAM showed good correlation in delineating potential pathologic substrate in AF, but left atrium dilation could reduce the performance of the CMR in this task. Conduction velocity could be more sensitive than voltage and LGE-MRI to detect incipient substrate in AF.
Voltage and conduction velocity values Area /IIR Velocity (mm/ms) Voltage (mV) I / <.20 1.036(0.913-1.158) 1.593(1.489-1.696) 2 / ≥1.20 and <1.32 0.722(0.590-0.850) 0.792 (0.649-0,935) 3 / ≥1.32 0.623(0.473-0,733) 0.444(0.245-0.642) Voltage and conduction velocity values in the three areas of the LGE-RMN.
Abstract Figure. Correlation among voltage, VC and LA
Collapse
Affiliation(s)
- G Caixal
- Barcelona Clinic Hospital, Barcelona, Spain
| | - F Alarcon
- Barcelona Clinic Hospital, Barcelona, Spain
| | - M Nunez
- Barcelona Clinic Hospital, Barcelona, Spain
| | - P Garre
- Barcelona Clinic Hospital, Barcelona, Spain
| | - D Soto
- Barcelona Clinic Hospital, Barcelona, Spain
| | - R Borras
- Barcelona Clinic Hospital, Barcelona, Spain
| | | | - R Perea
- Barcelona Clinic Hospital, Barcelona, Spain
| | - I Roca
- Barcelona Clinic Hospital, Barcelona, Spain
| | - E Guasch
- Barcelona Clinic Hospital, Barcelona, Spain
| | - L Mont
- Barcelona Clinic Hospital, Barcelona, Spain
| |
Collapse
|
16
|
Gunturiz Beltran C, Borras-Amoraga R, Alarcon F, Garre P, Figueras R, Caixal G, Cozzari J, Trotta O, Tolosana JM, Arbelo E, Roca I, Brugada J, Guasch E, Mont L. P402Analysis of right atrium remodeling by cardiac magnetic resonance in patients with atrial fibrillation and its association with left atrium. Europace 2020. [DOI: 10.1093/europace/euaa162.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
none
Background
Atrial fibrillation (AF) causes changes in atrial anatomy and this remodeling leads to the arrhythmogenic substrate. Most studies with cardiac magnetic resonance-late gadolinium enhancement (CMR-LGE) have focused on the left atrium (LA); The role of the right atrium (RA) in AF is unknown.
Purpose
To evaluate RA remodeling parameters and its comparison with LA in patients with AF.
Methods
Observational study. We included 109 patients: 9 healthy volunteers, 55 paroxysmal AF, 45 persistent AF. All of them had a CMR-RTG 3.0 T. Image post-processed with segmentation of both atria. Comparison of mean parameters of RA and LA (T test), correlation between them (R Pearson). Multivariate analysis (Cox regression) to study predictive factors.
Results
AF patients had a mean age of 58.5 ± 10.5 years, 70(70%) were men, without structural heart disease 80(80%), and associated atrial flutter 11(11%). The RA parameters were compared by subgroups. We found differences in (healthy/paroxAF/persistAF): area(cm2) 94.0 ± 15.9 /125.3 ± 20.8/ 152.8 ± 24.4 (p <0.0001); volume (ml) 76.7 ± 19.6/ 107.0 ± 25.6/ 150.9 ± 37.6 (p <0.0001); and total fibrosis (%) 3.7 ± 4.3/ 16.5 ± 14.1/ 19.4 ± 15.9 (p 0.014).
RA was higher than LA in all subgroups. There was more fibrosis in RA in paroxysmal/persistent AF. Both types of AF had at least a moderate correlation for area, volume and fibrosis (table).
Finally, RA sphericity was the only predictor factor of AF recurrence after ablation among RA remodeling parameters (HR 1.1 95%CI [1.0 -1.3], p = 0.049).
Conclusions
Area, volume and fibrosis progressively increased from healthy to paroxysmal AF, and then to persistent AF. RA was higher than LA and it also had more fibrosis in patients with AF. The size and fibrosis between both atria had at least moderate correlation. The RA sphericity was a predictor of post-ablation AF recurrences.
COMPARISON/CORRELATION RA LA p R PEARSON(RA/LA) p HEALTHY VOLUNTEERS Volume (ml) 76.7 ± 19.6 37.0 ± 9.4 <0.0001 0.457 0.254 Total Fibrosis (%) 3.7 ± 4.3 5.0 ± 6.1 0.278 0.837 0.005 PAROXYSMAL AF Volume (ml) 107.0 ± 25.6 69.5 ± 26.5 <0.0001 0.422 0.001 Total Fibrosis (%) 16.5 ± 14.1 8.0 ± 8.6 <0.0001 0.485 <0.0001 PERSISTENT AF Volume (ml) 150.9 ± 37.6 103.2 ± 28.5 <0.0001 0.582 <0.0001 Total Fibrosis (%) 19.4 ± 15.9 10.5 ± 11.7 <0.0001 0.571 <0.0001
Abstract Figure. Correlation of area and fibrosis RA/LA
Collapse
Affiliation(s)
| | | | - F Alarcon
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - P Garre
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - R Figueras
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - G Caixal
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - J Cozzari
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - O Trotta
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - E Arbelo
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - I Roca
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - J Brugada
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Guasch
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - L Mont
- Hospital Clinic de Barcelona, Barcelona, Spain
| |
Collapse
|
17
|
Ruiz de Alegría-Puig C, De-Malet-Pintos-Fonseca A, Angulo-López I, Agüero-Balbín J, Marco F, Cayô R, Roca I, Vila J, Martínez-Martínez L. Evaluation of Vitek-MS™ and Microflex LT™ commercial systems for identification of Acinetobacter calcoaceticus-baumannii complex. Enferm Infecc Microbiol Clin 2020; 39:9-13. [PMID: 32307128 DOI: 10.1016/j.eimc.2020.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/21/2020] [Accepted: 02/27/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Acinetobacter is a genus that comprises a group of opportunistic pathogens responsible for a variety of nosocomial infections. The Acinetobacter calcoaceticus-Acinetobacter baumannii (Acb) complex includes some species of clinical importance, mainly A. baumannii, A. pittii and A. nosocomialis, which share phenotypic similarities that make it very difficult to distinguish between them using a phenotypic approach. The aim of this study was to evaluate two commercial matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) systems for the identification of different Acinetobacter species, with a special focus among those belonging to the Acb complex. METHODS One hundred and fifty-six Acinetobacter spp. clinical strains, identified by amplified ribosomal DNA restriction analysis (ARDRA) and rpoB gene sequencing, were analysed by two different MALDI-TOF systems. RESULTS Considering only the 144 strains of the Acb complex evaluated in this study, the Vitek-MS™ and Microflex LT™ systems correctly identified 129 (89.6%) and 143 (99.3%) strains, respectively. CONCLUSION After analysing 156 strains belonging to Acinetobacter spp., both Vitek-MS™ and Microflex LT™ proved to be rapid and accurate systems for the identification of Acb complex species showing a good correlation. However, both manufacturers should improve their databases to include new species in them.
Collapse
Affiliation(s)
| | | | - Itziar Angulo-López
- Microbiology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Jesús Agüero-Balbín
- Microbiology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Department of Molecular Biology, School of Medicine, University of Cantabria, Santander, Spain
| | - Francesc Marco
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain; Department of Clinical Microbiology. Hospital Clinic-Universitat de Barcelona, Spain
| | - Rodrigo Cayô
- Universidade Federal de São Paulo (UNIFESP), Laboratório de Inmunologia e Bacteriologia (LIB), Setor de Biologia Molecular, Microbiologia e Inmunologia - Departamento de Ciências Biológicas (DCB), Instituto de Ciências Ambientais, Químicas e Farmacêuticas (ICAQF), Diadema, SP, Brazil; Universidade Federal de São Paulo - UNIFESP, Laboratório Alerta, Disciplina de Infectología, Departamento de Medicina, Escola Paulista de Medicina - EPM, São Paulo, SP, Brazil
| | - Ignasi Roca
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Jordi Vila
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain; Department of Clinical Microbiology. Hospital Clinic-Universitat de Barcelona, Spain
| | - Luis Martínez-Martínez
- Unit of Microbiology, University Hospital Reina Sofia, Cordoba, Spain; Department of Microbiology, University of Cordoba, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Spain
| |
Collapse
|
18
|
Gerson S, Lucaßen K, Wille J, Nodari CS, Stefanik D, Nowak J, Wille T, Betts JW, Roca I, Vila J, Cisneros JM, Seifert H, Higgins PG. Diversity of amino acid substitutions in PmrCAB associated with colistin resistance in clinical isolates of Acinetobacter baumannii. Int J Antimicrob Agents 2019; 55:105862. [PMID: 31837449 DOI: 10.1016/j.ijantimicag.2019.105862] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/02/2019] [Accepted: 12/08/2019] [Indexed: 11/18/2022]
Abstract
This study aimed to investigate the mechanisms of colistin resistance in 64 Acinetobacter baumannii isolates obtained from patients with ventilator-associated pneumonia hospitalised in Greece, Italy and Spain. In total, 31 A. baumannii isolates were colistin-resistant. Several novel amino acid substitutions in PmrCAB were found in 27 colistin-resistant A. baumannii. Most substitutions were detected in PmrB, indicating the importance of the histidine kinase for colistin resistance. In two colistin-resistant isolates, 93 amino acid changes were observed in PmrCAB compared with A. baumannii ACICU, and homologous recombination across different clonal lineages was suggested. Analysis of gene expression revealed increased pmrC expression in isolates harbouring pmrCAB mutations. Complementation of A. baumannii ATCC 19606 and ATCC 17978 with a pmrAB variant revealed increased pmrC expression but unchanged colistin MICs, indicating additional unknown factors associated with colistin resistance. Moreover, a combination of PmrB and PmrC alterations was associated with very high colistin MICs, suggesting accumulation of mutations as the mechanism for high-level resistance. The pmrC homologue eptA was detected in 29 colistin-susceptible and 26 colistin-resistant isolates. ISAba1 was found upstream of eptA in eight colistin-susceptible and one colistin-resistant isolate and eptA was disrupted by ISAba125 in two colistin-resistant isolates. Whilst in most isolates an association of eptA with colistin resistance was excluded, in one isolate an amino acid substitution in EptA (R127L) combined with a point mutation in ISAba1 upstream of eptA contributed to elevated colistin MICs. This study helps to gain an insight into the diversity and complexity of colistin resistance in A. baumannii.
Collapse
Affiliation(s)
- Stefanie Gerson
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - Kai Lucaßen
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - Julia Wille
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - Carolina S Nodari
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany; Universidade Federal de São Paulo (UNIFESP), Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, Brazil
| | - Danuta Stefanik
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - Jennifer Nowak
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - Thorsten Wille
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - Jonathan W Betts
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Ignasi Roca
- Department of Clinical Microbiology and ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Jordi Vila
- Department of Clinical Microbiology and ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Jose M Cisneros
- Department of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - Paul G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany.
| |
Collapse
|
19
|
Cosgaya C, Ratia C, Marí-Almirall M, Rubio L, Higgins PG, Seifert H, Roca I, Vila J. In vitro and in vivo Virulence Potential of the Emergent Species of the Acinetobacter baumannii (Ab) Group. Front Microbiol 2019; 10:2429. [PMID: 31708900 PMCID: PMC6821683 DOI: 10.3389/fmicb.2019.02429] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/08/2019] [Indexed: 01/30/2023] Open
Abstract
The increased use of molecular identification methods and mass spectrometry has revealed that Acinetobacter spp. of the A. baumannii (Ab) group other than A. baumannii are increasingly being recovered from human samples and may pose a health challenge if neglected. In this study 76 isolates of 5 species within the Ab group (A. baumannii n = 16, A. lactucae n = 12, A. nosocomialis n = 16, A. pittii n = 20, and A. seifertii n = 12), were compared in terms of antimicrobial susceptibility, carriage of intrinsic resistance genes, biofilm formation, and the ability to kill Caenorhabditis elegans in an infection assay. In agreement with previous studies, antimicrobial resistance was common among A. baumannii while all other species were generally more susceptible. Carriage of genes encoding different efflux pumps was frequent in all species and the presence of intrinsic class D β-lactamases was reported in A. baumannii, A. lactucae (heterotypic synonym of A. dijkshoorniae) and A. pittii but not in A. nosocomialis and A. seifertii. A. baumannii and A. nosocomialis presented weaker pathogenicity in our in vitro and in vivo models than A. seifertii, A. pittii and, especially, A. lactucae. Isolates from the former species showed decreased biofilm formation and required a longer time to kill C. elegans nematodes. These results suggest relevant differences in terms of antibiotic susceptibility patterns among the members of the Ab group as well as highlight a higher pathogenicity potential for the emerging species of the group in this particular model. Nevertheless, the impact of such potential in the human host still remains to be determined.
Collapse
Affiliation(s)
- Clara Cosgaya
- ISGlobal, Hospital Clínic - University of Barcelona, Barcelona, Spain
| | - Carlos Ratia
- ISGlobal, Hospital Clínic - University of Barcelona, Barcelona, Spain
| | | | - Laia Rubio
- ISGlobal, Hospital Clínic - University of Barcelona, Barcelona, Spain
| | - Paul G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn, Germany
| | - Ignasi Roca
- ISGlobal, Hospital Clínic - University of Barcelona, Barcelona, Spain
| | - Jordi Vila
- ISGlobal, Hospital Clínic - University of Barcelona, Barcelona, Spain
| |
Collapse
|
20
|
Marí-Almirall M, Cosgaya C, Pons MJ, Nemec A, Ochoa TJ, Ruiz J, Roca I, Vila J. Pathogenic Acinetobacter species including the novel Acinetobacter dijkshoorniae recovered from market meat in Peru. Int J Food Microbiol 2019; 305:108248. [PMID: 31226568 DOI: 10.1016/j.ijfoodmicro.2019.108248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/17/2019] [Accepted: 06/10/2019] [Indexed: 11/19/2022]
Abstract
Species of the Acinetobacter calcoaceticus-Acinetobacter baumannii complex are important human pathogens which can be recovered from animals and food, potential sources for their dissemination. The aim of the present study was to characterise the Acinetobacter isolates recovered from market meat samples in Peru. From July through August 2012, 138 meat samples from six traditional markets in Lima were cultured in Lysogeny and Selenite broths followed by screening of Gram-negative bacteria in selective media. Bacterial isolates were identified by MALDI-TOF MS and DNA-based methods and assessed for their clonal relatedness and antimicrobial susceptibility. Twelve Acinetobacter isolates were recovered from calf samples. All but one strain were identified as members of the clinically-relevant Acinetobacter calcoaceticus-Acinetobacter baumannii complex: 9 strains as Acinetobacter pittii, 1 strain as A. baumannii, and 1 strain as the recently described novel species A. dijkshoorniae. The remaining strain could not be identified at the species level unambiguously but all studies suggested close relatedness to A. bereziniae. All isolates were well susceptible to antibiotics. Based on macrorestriction analysis, six isolates were further selected and some of them were associated with novel MLST profiles. The presence of pathogenic Acinetobacter species in human consumption meat might pose a risk to public health as potential reservoirs for their further spread into the human population. Nevertheless, the Acinetobacter isolates from meat found in this study were not multidrug resistant and their prevalence was low. To our knowledge, this is also the first time that the A. dijkshoorniae species is reported in Peru.
Collapse
Affiliation(s)
- Marta Marí-Almirall
- Department of Clinical Microbiology, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Clara Cosgaya
- Department of Clinical Microbiology, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Maria J Pons
- Department of Clinical Microbiology, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Universidad Científica del Sur, Lima, Peru
| | - Alexandr Nemec
- Laboratory of Bacterial Genetics, National Institute of Public Health, Prague, Czech Republic; Department of Laboratory Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Theresa J Ochoa
- Tropical Medicine Institute "Alexander von Humboldt", Universidad Peruana Cayetano Hereida, Lima, Peru
| | - Joaquim Ruiz
- Department of Clinical Microbiology, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ignasi Roca
- Department of Clinical Microbiology, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
| | - Jordi Vila
- Department of Clinical Microbiology, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
21
|
Levy-Blitchtein S, Roca I, Plasencia-Rebata S, Vicente-Taboada W, Velasquez-Pomar J, Pons M, Del Valle-Mendoza J, Vila J. Successfully emerging Acinetobacter baumannii clones from two hospitals in Lima, Perú. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3705] [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: 10/28/2022] Open
|
22
|
Levy-Blitchtein S, Roca I, Plasencia-Rebata S, Vicente-Taboada W, Velásquez-Pomar J, Muñoz L, Moreno-Morales J, Pons MJ, Del Valle-Mendoza J, Vila J. Emergence and spread of carbapenem-resistant Acinetobacter baumannii international clones II and III in Lima, Peru. Emerg Microbes Infect 2018; 7:119. [PMID: 29970918 PMCID: PMC6030224 DOI: 10.1038/s41426-018-0127-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/19/2018] [Accepted: 06/04/2018] [Indexed: 01/17/2023]
Abstract
Carbapenem-resistant Acinetobacter baumannii is the top-ranked pathogen in the World Health Organization priority list of antibiotic-resistant bacteria. It emerged as a global pathogen due to the successful expansion of a few epidemic lineages, or international clones (ICs), producing acquired class D carbapenemases (OXA-type). During the past decade, however, reports regarding IC-I isolates in Latin America are scarce and are non-existent for IC-II and IC-III isolates. This study evaluates the molecular mechanisms of carbapenem resistance and the epidemiology of 80 non-duplicate clinical samples of A. baumannii collected from February 2014 through April 2016 at two tertiary care hospitals in Lima. Almost all isolates were carbapenem-resistant (97.5%), and susceptibility only remained high for colistin (95%). Pulsed-field gel electrophoresis showed two main clusters spread between both hospitals: cluster D containing 51 isolates (63.8%) associated with sequence type 2 (ST2) and carrying OXA-72, and cluster F containing 13 isolates (16.3%) associated with ST79 and also carrying OXA-72. ST2 and ST79 were endemic in at least one of the hospitals. ST1 and ST3 OXA-23-producing isolates were also identified. They accounted for sporadic hospital isolates. Interestingly, two isolates carried the novel OXA-253 variant of OXA-143 together with an upstream novel insertion sequence (ISAba47). While the predominant A. baumannii lineages in Latin America are linked to ST79, ST25, ST15, and ST1 producing OXA-23 enzymes, we report the emergence of highly resistant ST2 (IC-II) isolates in Peru producing OXA-72 and the first identification of ST3 isolates (IC-III) in Latin America, both considered a serious threat to public health worldwide.
Collapse
Affiliation(s)
- Saúl Levy-Blitchtein
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, 15067, Lima, Peru
| | - Ignasi Roca
- ISGlobal, Hospital Clínic - Universitat de Barcelona, 08036, Barcelona, Spain.
| | - Stefany Plasencia-Rebata
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, 15067, Lima, Peru
| | | | | | - Laura Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, 08036, Barcelona, Spain
| | | | - Maria J Pons
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, 15067, Lima, Peru.,Laboratorio de Microbiología Molecular y Genética Bacteriana, Universidad Científica del Sur, Lima, Peru
| | - Juana Del Valle-Mendoza
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, 15067, Lima, Peru.,Instituto de Investigación Nutricional, 15024, Lima, Peru
| | - Jordi Vila
- ISGlobal, Hospital Clínic - Universitat de Barcelona, 08036, Barcelona, Spain
| |
Collapse
|
23
|
Nowak J, Zander E, Stefanik D, Higgins PG, Roca I, Vila J, McConnell MJ, Cisneros JM, Seifert H. High incidence of pandrug-resistant Acinetobacter baumannii isolates collected from patients with ventilator-associated pneumonia in Greece, Italy and Spain as part of the MagicBullet clinical trial. J Antimicrob Chemother 2017; 72:3277-3282. [PMID: 28961773 PMCID: PMC5890771 DOI: 10.1093/jac/dkx322] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To investigate the molecular epidemiology, antimicrobial susceptibility and carbapenem resistance determinants of Acinetobacter baumannii isolates from respiratory tract samples of patients diagnosed with ventilator-associated pneumonia (VAP) who were enrolled in the MagicBullet clinical trial. METHODS A. baumannii isolates were prospectively cultured from respiratory tract samples from 65 patients from 15 hospitals in Greece, Italy and Spain. Susceptibility testing was performed by broth microdilution. Carbapenem resistance determinants were identified by PCR and sequencing. Molecular epidemiology was investigated using rep-PCR (DiversiLab) and international clones (IC) were identified using our in-house database. RESULTS Of 65 isolates, all but two isolates (97%) were resistant to imipenem and these were always associated with an acquired carbapenemase, OXA-23 (80%), OXA-40 (4.6%), OXA-58 (1.5%) or OXA-23/58 (1.5%). Resistance to colistin was 47.7%. Twenty-two isolates were XDR, and 20 isolates were pandrug-resistant (PDR). The majority of isolates clustered with IC2 (n = 54) with one major subtype comprising isolates from 12 hospitals in the three countries, which included 19 XDR and 16 PDR isolates. CONCLUSIONS Carbapenem resistance rates were very high in A. baumannii recovered from patients with VAP. Almost half of the isolates were colistin resistant, and 42 (64.6%) isolates were XDR or PDR. Rep-PCR confirmed IC2 is the predominant clonal lineage in Europe and suggests the presence of an epidemic XDR/PDR A. baumannii clone that has spread in Greece, Italy and Spain. These data highlight the difficulty in empirical treatment of patients with A. baumannii VAP in centres with a high prevalence of carbapenem-resistant A. baumannii.
Collapse
Affiliation(s)
- J Nowak
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - E Zander
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - D Stefanik
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - P G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - I Roca
- Department of Clinical Microbiology and ISGlobal, Barcelona Ctr. Int. Health Res. CRESIB, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - J Vila
- Department of Clinical Microbiology and ISGlobal, Barcelona Ctr. Int. Health Res. CRESIB, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - M J McConnell
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - J M Cisneros
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - H Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | | |
Collapse
|
24
|
Uwingabiye J, Lemnouer A, Roca I, Alouane T, Frikh M, Belefquih B, Bssaibis F, Maleb A, Benlahlou Y, Kassouati J, Doghmi N, Bait A, Haimeur C, Louzi L, Ibrahimi A, Vila J, Elouennass M. Clonal diversity and detection of carbapenem resistance encoding genes among multidrug-resistant Acinetobacter baumannii isolates recovered from patients and environment in two intensive care units in a Moroccan hospital. Antimicrob Resist Infect Control 2017; 6:99. [PMID: 28959441 PMCID: PMC5615474 DOI: 10.1186/s13756-017-0262-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/25/2017] [Indexed: 11/22/2022] Open
Abstract
Background Carbapenem-resistant Acinetobacter baumannii has recently been defined by the World Health Organization as a critical pathogen. The aim of this study was to compare clonal diversity and carbapenemase-encoding genes of A. baumannii isolates collected from colonized or infected patients and hospital environment in two intensive care units (ICUs) in Morocco. Methods The patient and environmental sampling was carried out in the medical and surgical ICUs of Mohammed V Military teaching hospital from March to August 2015. All A. baumannii isolates recovered from clinical and environmental samples, were identified using routine microbiological techniques and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry. Antimicrobial susceptibility testing was performed using disc diffusion method. The carbapenemase-encoding genes were screened for by PCR. Clonal relatedness was analyzed by digestion of the DNA with low frequency restriction enzymes and pulsed field gel electrophoresis (PFGE) and the multi locus sequence typing (MLST) was performed on two selected isolates from two major pulsotypes. Results A total of 83 multidrug-resistant A. baumannii isolates were collected: 47 clinical isolates and 36 environmental isolates. All isolates were positive for the blaOXA51-like and blaOXA23-like genes. The coexistence of blaNDM-1/blaOXA-23-like and blaOXA 24-like/blaOXA-23-like were detected in 27 (32.5%) and 2 (2.4%) of A. baumannii isolates, respectively. The environmental samples and the fecally-colonized patients were significantly identified (p < 0.05) as the most common sites of isolation of NDM-1-harboring isolates. PFGE grouped all isolates into 9 distinct clusters with two major groups (0007 and 0008) containing up to 59% of the isolates. The pulsotype 0008 corresponds to sequence type (ST) 195 while pulsotype 0007 corresponds to ST 1089.The genetic similarity between the clinical and environmental isolates was observed in 80/83 = 96.4% of all isolates, belonging to 7 pulsotypes. Conclusion This study shows that the clonal spread of environmental A. baumannii isolates is related to that of clinical isolates recovered from colonized or infected patients, being both associated with a high prevalence of the blaOXA23-like and blaNDM-1genes. These findings emphasize the need for prioritizing the bio-cleaning of the hospital environment to control and prevent the dissemination of A. baumannii clonal lineages. Electronic supplementary material The online version of this article (10.1186/s13756-017-0262-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jean Uwingabiye
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Abdelhay Lemnouer
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Ignasi Roca
- Department of Clinical Microbiology and ISGlobal- Barcelona Ctr. Int. Health Res. CRESIB, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Tarek Alouane
- Medical Biotechnology Laboratory (Medbiotech), Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mohammed Frikh
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Bouchra Belefquih
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Fatna Bssaibis
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Adil Maleb
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Yassine Benlahlou
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Jalal Kassouati
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Nawfal Doghmi
- Department of Intensive Care Units , Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Abdelouahed Bait
- Department of Intensive Care Units , Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Charki Haimeur
- Department of Intensive Care Units , Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Lhoussain Louzi
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Azeddine Ibrahimi
- Medical Biotechnology Laboratory (Medbiotech), Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Jordi Vila
- Department of Clinical Microbiology and ISGlobal- Barcelona Ctr. Int. Health Res. CRESIB, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Mostafa Elouennass
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| |
Collapse
|
25
|
Beisani M, Roca I, Cardenas R, Blanco L, Abu-Suboh M, Dot J, Armengol J, Olsina J, Balsells J, Charco R, Castell J. Initial experience in sentinel lymph node detection in pancreatic cancer. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2015.10.016] [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: 11/29/2022]
|
26
|
Cosgaya C, Marí-Almirall M, Van Assche A, Fernández-Orth D, Mosqueda N, Telli M, Huys G, Higgins PG, Seifert H, Lievens B, Roca I, Vila J. Acinetobacter dijkshoorniae sp. nov., a member of the Acinetobacter calcoaceticus-Acinetobacter baumannii complex mainly recovered from clinical samples in different countries. Int J Syst Evol Microbiol 2016; 66:4105-4111. [PMID: 27432448 DOI: 10.1099/ijsem.0.001318] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The recent advances in bacterial species identification methods have led to the rapid taxonomic diversification of the genus Acinetobacter. In the present study, phenotypic and molecular methods have been used to determine the taxonomic position of a group of 12 genotypically distinct strains belonging to the Acinetobacter calcoaceticus-Acinetobacter baumannii (ACB) complex, initially described by Gerner-Smidt and Tjernberg in 1993, that are closely related to Acinetobacter pittii. Strains characterized in this study originated mostly from human samples obtained in different countries over a period of 15 years. rpoB gene sequences and multilocus sequence typing were used for comparisons against 94 strains representing all species included in the ACB complex. Cluster analysis based on such sequences showed that all 12 strains grouped together in a distinct clade closest to Acinetobacter pittiithat was supported by bootstrap values of 99 %. Values of average nucleotide identity based on blast between the genome sequence of strain JVAP01T (NCBI accession no. LJPG00000000) and those of other species from the ACB complex were always <91.2 %, supporting the species status of the group. In addition, the metabolic characteristics of the group matched those of the ACB complex and the analysis of their protein signatures by matrix-assisted laser desorption ionization time-of-flight MS identified some specific peaks. Our results support the designation of these strains as representing a novel species, for which the name Acinetobacter dijkshoorniae sp. nov. is proposed. The type strain is JVAP01T (=CECT 9134T=LMG 29605T).
Collapse
Affiliation(s)
- Clara Cosgaya
- Department of Clinical Microbiology and ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Marta Marí-Almirall
- Department of Clinical Microbiology and ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Ado Van Assche
- Laboratory for Process Microbial Ecology and Bioinspirational Management (PME&BIM), Department of Microbial and Molecular Systems (M2S), KU Leuven, Sint-Katelijne-Waver, Belgium
| | - Dietmar Fernández-Orth
- Department of Clinical Microbiology and ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Noraida Mosqueda
- Department of Clinical Microbiology and ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Murat Telli
- Department of Clinical Microbiology, School of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Geert Huys
- Laboratory of Microbiology, Faculty of Sciences, Ghent University, Ghent, Belgium
| | - Paul G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner site Bonn-Cologne, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner site Bonn-Cologne, Germany
| | - Bart Lievens
- Laboratory for Process Microbial Ecology and Bioinspirational Management (PME&BIM), Department of Microbial and Molecular Systems (M2S), KU Leuven, Sint-Katelijne-Waver, Belgium
| | - Ignasi Roca
- Department of Clinical Microbiology and ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Jordi Vila
- Department of Clinical Microbiology and ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
27
|
Beisani M, Roca I, Cardenas R, Blanco L, Abu-Suboh M, Dot J, Armengol JR, Olsina JJ, Balsells J, Charco R, Castell J. Initial experience in sentinel lymph node detection in pancreatic cancer. Rev Esp Med Nucl Imagen Mol 2015; 35:287-91. [PMID: 26670326 DOI: 10.1016/j.remn.2015.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 10/06/2015] [Accepted: 10/08/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The local recurrence of pancreatic cancer is around 30% when complete resection can be achieved. Extended lymphatic resections may improve survival, but increases severe morbidity. As accurate patient selection should be mandatory, a new method is presented for pancreatic sentinel lymph node (SLN) detection with lymphoscintigraphy and gamma probe. MATERIALS AND METHODS Seven patients with cT2N0M0 pancreatic head cancer were enrolled between 2009 and 2012 in this prospective study. One day prior to surgery, preoperative lymphoscintigraphy with echoendoscopic intratumoural administration of Tc(99m)-labelled nanocolloid was performed, with planar and SPECT-CT images obtained 2h later. Gamma probe detection of SLN was also carried out during surgery. RESULTS Radiotracer administration was feasible in all patients. Scintigraphy images showed inter-aortocaval lymph nodes in 2 patients, hepatoduodenal ligament lymph nodes in 1, intravascular injection in 3, intestinal transit in 5, and main pancreatic duct visualisation in 1. Surgical resection could only be achieved in 4 patients owing to locally advanced disease. Intraoperative SLN detection was accomplished in 2 patients, both with negative results. Only in one patient could SLN be confirmed as truly negative by final histopathological analysis. CONCLUSIONS This new method of pancreatic SLN detection is technically feasible, but challenging. Our preliminary results with 7 patients are not sufficient for clinical validation.
Collapse
Affiliation(s)
- M Beisani
- Department of HPB Surgery, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
| | - I Roca
- Department of Nuclear Medicine, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
| | - R Cardenas
- Department of Nuclear Medicine, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - L Blanco
- Department of HPB Surgery, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - M Abu-Suboh
- Department of Digestive Endoscopy, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - J Dot
- Department of Digestive Endoscopy, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - J R Armengol
- Department of Digestive Endoscopy, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - J J Olsina
- Department of Surgery, Hospital Arnau de Vilanova, University of Lleida, Lleida, Spain
| | - J Balsells
- Department of HPB Surgery, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - R Charco
- Department of HPB Surgery, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - J Castell
- Department of Nuclear Medicine, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| |
Collapse
|
28
|
Camoez M, Sierra JM, Dominguez MA, Ferrer-Navarro M, Vila J, Roca I. Automated categorization of methicillin-resistant Staphylococcus aureus clinical isolates into different clonal complexes by MALDI-TOF mass spectrometry. Clin Microbiol Infect 2015; 22:161.e1-161.e7. [PMID: 26482268 DOI: 10.1016/j.cmi.2015.10.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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: 08/06/2015] [Revised: 09/28/2015] [Accepted: 10/05/2015] [Indexed: 11/28/2022]
Abstract
Early identification of methicillin-resistant Staphylococcus aureus (MRSA) dominant clones involved in infection and initiation of adequate infection control measures are essential to limit MRSA spread and understand MRSA population dynamics. In this study we evaluated the use of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF/MS) for the automated discrimination of the major MRSA lineages (clonal complexes, CC) identified in our hospital during a 20-year period (1990-2009). A collection of 82 well-characterized MRSA isolates belonging to the four main CCs (CC5, CC8, CC22 and CC398) was split into a reference set (n = 36) and a validation set (n = 46) to generate pattern recognition models using the ClinProTools software for the identification of MALDI-TOF/MS biomarker peaks. The supervised neural network (SNN) model showed the best performance compared with two other models, with sensitivity and specificity values of 100% and 99.11%, respectively. Eleven peaks (m/z range: 3278-6592) with the highest separation power were identified and used to differentiate all four CCs. Validation of the SNN model using ClinProTools resulted in a positive predictive value (PPV) of 99.6%. The specific contribution of each peak to the model was used to generate subtyping reference signatures for automated subtyping using the BioTyper software, which successfully classified MRSA isolates into their corresponding CCs with a PPV of 98.9%. In conclusion, we find this novel automated MALDI-TOF/MS approach to be a promising, powerful and reliable tool for S. aureus typing.
Collapse
Affiliation(s)
- M Camoez
- Department of Microbiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Universidad de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, Spain
| | - J M Sierra
- Department of Microbiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Universidad de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, Spain
| | - M A Dominguez
- Department of Microbiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, Universidad de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, Spain.
| | - M Ferrer-Navarro
- Department of Clinical Microbiology, ISGlobal, Barcelona CRESIB, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - J Vila
- Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, Spain; Department of Clinical Microbiology, ISGlobal, Barcelona CRESIB, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - I Roca
- Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, Spain; Department of Clinical Microbiology, ISGlobal, Barcelona CRESIB, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
29
|
Roca I, Akova M, Baquero F, Carlet J, Cavaleri M, Coenen S, Cohen J, Findlay D, Gyssens I, Heuer OE, Kahlmeter G, Kruse H, Laxminarayan R, Liébana E, López-Cerero L, MacGowan A, Martins M, Rodríguez-Baño J, Rolain JM, Segovia C, Sigauque B, Tacconelli E, Wellington E, Vila J. The global threat of antimicrobial resistance: science for intervention. New Microbes New Infect 2015; 6:22-9. [PMID: 26029375 PMCID: PMC4446399 DOI: 10.1016/j.nmni.2015.02.007] [Citation(s) in RCA: 620] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/09/2015] [Accepted: 02/25/2015] [Indexed: 12/11/2022] Open
Abstract
In the last decade we have witnessed a dramatic increase in the proportion and absolute number of bacterial pathogens resistant to multiple antibacterial agents. Multidrug-resistant bacteria are currently considered as an emergent global disease and a major public health problem. The B-Debate meeting brought together renowned experts representing the main stakeholders (i.e. policy makers, public health authorities, regulatory agencies, pharmaceutical companies and the scientific community at large) to review the global threat of antibiotic resistance and come up with a coordinated set of strategies to fight antimicrobial resistance in a multifaceted approach. We summarize the views of the B-Debate participants regarding the current situation of antimicrobial resistance in animals and the food chain, within the community and the healthcare setting as well as the role of the environment and the development of novel diagnostic and therapeutic strategies, providing expert recommendations to tackle the global threat of antimicrobial resistance.
Collapse
Affiliation(s)
- I Roca
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - M Akova
- Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey ; ESCMID Executive Committee, Basel, Switzerland
| | - F Baquero
- Department of Microbiology at the Ramón y Cajal University Hospital, Ramón y Cajal Institute for Health Research (IRYCIS), Division for Research in Microbial Biology and Evolution, CIBERESP, Madrid, Spain
| | - J Carlet
- Fondation Hôpital St, Joseph, Paris, France and World Alliance Against Antibiotic Resistance (WAAAR), Creteil, France
| | - M Cavaleri
- European Medicines Agency (EMA), London, UK
| | - S Coenen
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - J Cohen
- Brighton and Sussex Medical School, Brighton, UK
| | - D Findlay
- Global Commercial Lead, GlaxoSmithKline (GSK), London, UK
| | - I Gyssens
- Department of Medicine, Radboud University Medical Center and Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - O E Heuer
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - G Kahlmeter
- Clinical Microbiology, Central Hospital, Växjö, Sweden ; ESCMID Executive Committee, Basel, Switzerland ; EUCAST Steering Committee, Växjö, Sweden
| | - H Kruse
- WHO Regional Office for Europe, UN City, Marmorvej, Copenhagen, Denmark
| | - R Laxminarayan
- Center for Disease Dynamics, Economics and Policy, Washington, DC, USA ; Princeton University, Princeton, NJ, USA
| | - E Liébana
- Scientific Unit on Biological Hazards, European Food Safety Authority (EFSA), Parma, Italy
| | - L López-Cerero
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain
| | - A MacGowan
- Department of Medical Microbiology, Southmead Hospital, Bristol, UK ; EUCAST Steering Committee, Växjö, Sweden
| | - M Martins
- School of Public Health, Physiotherapy and Population Science, UCD Centre for Food and Safety, Molecular Innovation and Drug Discovery, University College Dublin, Dublin, Ireland
| | - J Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, and Departamento de Medicina, Universidad de Sevilla, Seville, Spain ; ESCMID Executive Committee, Basel, Switzerland
| | - J-M Rolain
- Aix-Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Inserm, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, and APHM, CHU Timone, Pôle Infectieux, Marseille, France
| | - C Segovia
- Instituto de Salud Carlos III, ISCIII, Madrid, Spain
| | - B Sigauque
- Centro de Investigação em Saúde da Manhiça and Instituto Nacional de Saúde/Ministério de Saúde, Maputo, Mozambique
| | - E Tacconelli
- Division of Infectious Diseases, Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany ; ESCMID Executive Committee, Basel, Switzerland
| | - E Wellington
- School of Life Sciences, University of Warwick, Coventry, UK
| | - J Vila
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain ; ESCMID Executive Committee, Basel, Switzerland
| |
Collapse
|
30
|
Li Bassi G, Fernandez-Barat L, Saucedo L, Giunta V, Marti JD, Tavares Ranzani O, Aguilera Xiol E, Rigol M, Roca I, Muñoz L, Luque N, Esperatti M, Saco MA, Ramirez J, Vila J, Ferrer M, Torres A. Endotracheal tube biofilm translocation in the lateral Trendelenburg position. Crit Care 2015; 19:59. [PMID: 25887536 PMCID: PMC4355496 DOI: 10.1186/s13054-015-0785-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/03/2015] [Indexed: 12/11/2022]
Abstract
Introduction Laboratory studies demonstrated that the lateral Trendelenburg position (LTP) is superior to the semirecumbent position (SRP) in the prevention of ventilator-associated pulmonary infections. We assessed whether the LTP could also prevent pulmonary colonization and infections caused by an endotracheal tube (ETT) biofilm. Methods Eighteen pigs were intubated with ETTs colonized by Pseudomonas aeruginosa biofilm. Pigs were positioned in LTP and randomized to be on mechanical ventilatin (MV) up to 24 hour, 48 hour, 48 hour with acute lung injury (ALI) by oleic acid and 72 hour. Bacteriologic and microscopy studies confirmed presence of biofilm within the ETT. Upon autopsy, samples from the proximal and distal airways were excised for P.aeruginosa quantification. Ventilator-associated tracheobronchitis (VAT) was confirmed by bronchial tissue culture ≥3 log colony forming units per gram (cfu/g). In pulmonary lobes with gross findings of pneumonia, ventilator-associated pneumonia (VAP) was confirmed by lung tissue culture ≥3 log cfu/g. Results P.aeruginosa colonized the internal lumen of 16 out of 18 ETTs (88.89%), and a mature biofilm was consistently present. P.aeruginosa colonization did not differ among groups, and was found in 23.6% of samples from the proximal airways, and in 7.1% from the distal bronchi (P = 0.001). Animals of the 24 hour group never developed respiratory infections, whereas 20%, 60% and 25% of the animals in group 48 hour, 48 hour-ALI and 72 hour developed P.aeruginosa VAT, respectively (P = 0.327). Nevertheless, VAP never developed. Conclusions Our findings imply that during the course of invasive MV up to 72 hour, an ETT P.aeruginosa biofilm hastily colonizes the respiratory tract. Yet, the LTP compartmentalizes colonization and infection within the proximal airways and VAP never develops.
Collapse
Affiliation(s)
- Gianluigi Li Bassi
- Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. .,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. .,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain.
| | - Laia Fernandez-Barat
- Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. .,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain.
| | - Lina Saucedo
- Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. .,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain.
| | | | - Joan Daniel Marti
- Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. .,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain.
| | - Otavio Tavares Ranzani
- Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. .,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. .,Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Pulmonary Intensive Care Unit, São Paulo, Brazil.
| | - Eli Aguilera Xiol
- Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. .,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain.
| | - Montserrat Rigol
- Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. .,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. .,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain.
| | - Ignasi Roca
- Department of Clinical Microbiology, School of Medicine, and Barcelona Centre for International Health Research, (CRESIB) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
| | - Laura Muñoz
- Department of Clinical Microbiology, School of Medicine, and Barcelona Centre for International Health Research, (CRESIB) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
| | - Nestor Luque
- Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain.
| | - Mariano Esperatti
- Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain.
| | | | - Jose Ramirez
- Pathology Department, Hospital Clinic, Barcelona, Spain.
| | - Jordi Vila
- Department of Clinical Microbiology, School of Medicine, and Barcelona Centre for International Health Research, (CRESIB) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. .,University of Barcelona, Barcelona, Spain.
| | - Miguel Ferrer
- Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. .,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. .,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain.
| | - Antoni Torres
- Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. .,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. .,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. .,University of Barcelona, Barcelona, Spain.
| |
Collapse
|
31
|
Roca I, Mosqueda N, Altun B, Espinal P, Akova M, Vila J. Molecular characterization of NDM-1-producing Acinetobacter pittii isolated from Turkey in 2006. J Antimicrob Chemother 2014; 69:3437-8. [DOI: 10.1093/jac/dku306] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
32
|
Merino M, Poza M, Roca I, Barba MJ, Sousa MD, Vila J, Bou G. Nosocomial Outbreak of a MultiresistantAcinetobacter baumanniiExpressing OXA-23 Carbapenemase in Spain. Microb Drug Resist 2014; 20:259-63. [DOI: 10.1089/mdr.2013.0127] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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)
- María Merino
- Microbiology Department, Biomedical Research Institute-INIBIC, University Hospital A Coruña, A Coruña, Spain
| | - Margarita Poza
- Microbiology Department, Biomedical Research Institute-INIBIC, University Hospital A Coruña, A Coruña, Spain
| | - Ignasi Roca
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - María José Barba
- Microbiology Department, Biomedical Research Institute-INIBIC, University Hospital A Coruña, A Coruña, Spain
| | | | - Jordi Vila
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Germán Bou
- Microbiology Department, Biomedical Research Institute-INIBIC, University Hospital A Coruña, A Coruña, Spain
| |
Collapse
|
33
|
Mosqueda N, Gato E, Roca I, López M, de Alegría CR, Fernández Cuenca F, Martínez-Martínez L, Pachón J, Cisneros JM, Rodríguez-Baño J, Pascual A, Vila J, Bou G, Tomás M. Characterization of plasmids carrying the blaOXA-24/40 carbapenemase gene and the genes encoding the AbkA/AbkB proteins of a toxin/antitoxin system. J Antimicrob Chemother 2014; 69:2629-33. [PMID: 24879663 DOI: 10.1093/jac/dku179] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CRAb) is a major source of nosocomial infections in Spain associated with the production of OXA-58-like or OXA-24/40-like β-lactamase enzymes. We analysed the plasmids carrying the bla(OXA-24/40)-like gene in CRAb isolates obtained a decade apart. METHODS The presence of β-lactamases was screened for by PCR (metallo-β-lactamases, carbapenem-hydrolysing class D β-lactamases, GES and KPC) in 101 CRAb isolates obtained in two multicentre studies (GEIH/REIPI-Ab-2000 and GEIH/REIPI-Ab-2010; n = 493 Acinetobacter spp). We analysed the distribution and characterization of the plasmids carrying the bla(OXA-24/40)-like gene and sequenced two plasmids, AbATCC223p (2000) and AbATCC329p (2010) from A. baumannii ATCC 17978 transformants. RESULTS Acquisition of the bla(OXA-24/40)-like gene was the main mechanism underlying resistance to carbapenems (48.7% in 2000 compared with 51.6% in 2010). This gene was mainly isolated in ST2 A. baumannii strains in both studies, although some novel STs (ST79 and ST80) appeared in 2010. The gene was located in plasmids (8-12 kbp) associated with the repAci2 or repAci2/repGR12 types. The sequences of AbATCC223p (8840 bp) and AbATCC329p (8842 bp) plasmids were similar, particularly regarding the presence of the genes encoding the AbkA/AbkB proteins associated with the toxin/antitoxin system. Moreover, the abkA/abkB gene sequences (>96% identity) were also located in plasmids harbouring the bla(OXA-58)-like gene. CONCLUSIONS The action of OXA-24/40 and OXA-58 β-lactamase-like enzymes represents the main mechanism underlying resistance to carbapenems in Spain in the last decade. AbkA/AbkB proteins in the toxin/antitoxin system may be involved in the successful dissemination of plasmids carrying the bla(OXA-24/40)-like gene, and probably also the bla(OXA-58)-like gene, thus contributing to the plasmid stability.
Collapse
Affiliation(s)
- Noraida Mosqueda
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Eva Gato
- Servicio de Microbiología, Complejo Hospitalario Universitario A Coruña-INIBIC, La Coruña, Spain
| | - Ignasi Roca
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - María López
- Servicio de Microbiología, Complejo Hospitalario Universitario A Coruña-INIBIC, La Coruña, Spain
| | - Carlos Ruíz de Alegría
- Microbiology Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Felipe Fernández Cuenca
- Clinical Unit for Infectious Diseases and Microbiology, Hospital Universitario Virgen Macarena, and University of Seville, Seville, Spain
| | - Luis Martínez-Martínez
- Microbiology Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain Department of Molecular Biology, University of Cantabria, Santander, Spain
| | - Jerónimo Pachón
- Clinical Unit for Infectious Diseases, Microbiology and Preventive Medicine-IBiS, University Hospital Virgen del Rocío, Seville, Spain
| | - José Miguel Cisneros
- Clinical Unit for Infectious Diseases, Microbiology and Preventive Medicine-IBiS, University Hospital Virgen del Rocío, Seville, Spain
| | - Jesús Rodríguez-Baño
- Clinical Unit for Infectious Diseases and Microbiology, Hospital Universitario Virgen Macarena, and University of Seville, Seville, Spain
| | - Alvaro Pascual
- Clinical Unit for Infectious Diseases and Microbiology, Hospital Universitario Virgen Macarena, and University of Seville, Seville, Spain
| | - Jordi Vila
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain Department of Clinical Microbiology, Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Germán Bou
- Servicio de Microbiología, Complejo Hospitalario Universitario A Coruña-INIBIC, La Coruña, Spain
| | - María Tomás
- Servicio de Microbiología, Complejo Hospitalario Universitario A Coruña-INIBIC, La Coruña, Spain
| |
Collapse
|
34
|
Lorente L, Brouard M, Roca I, Jiménez A, Pastor E, Lafuente N, Mora M. Lesser incidence of accidental catheter removal with femoral versus radial arterial access. Med Intensiva 2013; 37:316-9. [DOI: 10.1016/j.medin.2012.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 05/15/2012] [Accepted: 05/29/2012] [Indexed: 10/27/2022]
|
35
|
Migliavacca R, Espinal P, Principe L, Drago M, Fugazza G, Roca I, Nucleo E, Bracco S, Vila J, Pagani L, Luzzaro F. Characterization of resistance mechanisms and genetic relatedness of carbapenem-resistant Acinetobacter baumannii isolated from blood, Italy. Diagn Microbiol Infect Dis 2012; 75:180-6. [PMID: 23265293 DOI: 10.1016/j.diagmicrobio.2012.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 10/11/2012] [Accepted: 11/05/2012] [Indexed: 10/27/2022]
Abstract
The aim of this study was to characterize the resistance mechanisms and genetic relatedness of 21 carbapenem-resistant Acinetobacter baumannii blood isolates collected in Italy during a 1-year multicenter prospective surveillance study. Genes coding for carbapenemase production were identified by polymerase chain reaction (PCR) and sequencing. Pulsed-field gel electrophoresis (PFGE), multiplex PCRs for group identification, and multilocus sequence typing (MLST) were used to determine genetic relationships. Carbapenem resistance was consistently related to the production of oxacillinases, mostly the plasmid-mediated OXA-58 enzyme. Strains producing the OXA-23 enzyme (chromosomally mediated) were also detected. Seven PFGE clones were identified, some of which being related to international (ICL- I and ICL-II) or national clonal lineages. Multiplex PCRs identified 4 different groups (group 2 being dominant), further distinguishable in 6 sequence types by MLST. The heterogeneity of profiles highlights the diffusion of international and national clonal lineages in Italy. Continuous surveillance is needed for monitoring the spread of these worrisome strains equipped with multiple drug resistance mechanisms.
Collapse
Affiliation(s)
- Roberta Migliavacca
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, Section of Microbiology, University of Pavia, Pavia, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Espinal P, Seifert H, Dijkshoorn L, Vila J, Roca I. Rapid and accurate identification of genomic species from the Acinetobacter baumannii (Ab) group by MALDI-TOF MS. Clin Microbiol Infect 2012; 18:1097-103. [DOI: 10.1111/j.1469-0691.2011.03696.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
37
|
Roca I, Espinal P, Vila-Farrés X, Vila J. The Acinetobacter baumannii Oxymoron: Commensal Hospital Dweller Turned Pan-Drug-Resistant Menace. Front Microbiol 2012; 3:148. [PMID: 22536199 PMCID: PMC3333477 DOI: 10.3389/fmicb.2012.00148] [Citation(s) in RCA: 243] [Impact Index Per Article: 20.3] [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: 11/11/2011] [Accepted: 03/28/2012] [Indexed: 12/28/2022] Open
Abstract
During the past few decades Acinetobacter baumannii has evolved from being a commensal dweller of health-care facilities to constitute one of the most annoying pathogens responsible for hospitalary outbreaks and it is currently considered one of the most important nosocomial pathogens. In a prevalence study of infections in intensive care units conducted among 75 countries of the five continents, this microorganism was found to be the fifth most common pathogen. Two main features contribute to the success of A. baumannii: (i) A. baumannii exhibits an outstanding ability to accumulate a great variety of resistance mechanisms acquired by different mechanisms, either mutations or acquisition of genetic elements such as plasmids, integrons, transposons, or resistant islands, making this microorganism multi- or pan-drug-resistant and (ii) The ability to survive in the environment during prolonged periods of time which, combined with its innate resistance to desiccation and disinfectants, makes A. baumannii almost impossible to eradicate from the clinical setting. In addition, its ability to produce biofilm greatly contributes to both persistence and resistance. In this review, the pathogenesis of the infections caused by this microorganism as well as the molecular bases of antibacterial resistance and clinical aspects such as treatment and potential future therapeutic strategies are discussed in depth.
Collapse
Affiliation(s)
- Ignasi Roca
- Department of Clinical Microbiology, School of Medicine, IDIBAPS and Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona Barcelona, Spain
| | | | | | | |
Collapse
|
38
|
Cordoba O, Perez-Ceresuela F, Peg V, Roca I, Cortadellas T, Mendoza C, Espinosa-Caro M, Rodriguez J, Rubio I, Xercavins J. 573 Sentinel Lymph Node Dissection in Breast Cancer Relapse After Previous Axillary Surgery. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70638-x] [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: 11/26/2022]
|
39
|
Cordoba O, Perez-Ceresuela F, Roca I, Mendoza C, Cortadellas T, Espinosa-Bravo M, Rodriguez J, Peg V, Rubio IT, Xercavins J. P3-07-45: Role of SPECT-CT in Detecting Sentinel Lymph Nodes in Patients with Ipsilateral Breast Cancer Recurrence and Previous Axillary Lymph Node Dissection. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-07-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Use of sentinel lymph node dissection in patients with ipsilateral breast cancer recurrence and a previous axillary lymph node dissection (ALND) is still controversial. Although previous reports have showed extra-axillary drainage in 40–60% of patients, the clinical significance of this drainage is unknown. SPECT-CT may help to localize aberrant sentinel nodes.
Material and Methods: Between 2008 and 2011, SLN were performed in 25 patients with ipsilateral breast cancer recurrence and previous ALND. The day before surgery 99Tc nanocolloid was injected retroareolar in the affected breast and injected intratumorally when the recurrence was after a mastectomy. Linfoscintigraphy was obtained in all patients and a SPECT-CT was performed in all cases even when planar images showed no drainage. During surgery, the sentinel node was identified using a gamma probe. During the procedure the surgeon decided to remove the sentinel node if it was considered technically feasible. The project was IRB approved and all patients signed an informed consent.
Results: Records from the previous ALND showed 9 patients with positive axillary nodes with a mean of 19 (range 10–35) lymph nodes excised. Twenty four patients had undergone a lumpectomy and 1 patient a mastectomy. After the injection, the SPECT-CT showed at least one hot spot in 20 patients, with a mean of 1.8 hot spots (range 0–5). Hot spots on SPECT-CT were located as follows: in 10 patients axillary, 1 subclavicular, 7 internal mammary, 1 intramammary, 1 mediastinic and 7 patients had a contralateral axillary hot spot. In 4 patients we don't found any hot spot on SPECT-CT. After excising 2 axillary nodes and 1 intrammary node in 3 patients, the pathologist didn't identify any lymph node in the hot spot removed. This are considered as false positives (15%). In 4 patients although hot spots were identified, sentinel node dissection wasn't performed because it was arguable the benefit for the patients taking into account the location and number of hot spots.
All this 4 patients are free of disease and any of them have developed recurrences. In 14 (56%) patients all the sentinel nodes were identified and removed. Three (3/14 = 21%) patients had positive sentinel nodes (1 in the ipsilateral axilla, 1 internal mammary and 1 in the contralateral axillary). One patient had 2 positive contralateral axillary sentinel nodes so an ALND was performed with no additional positive nodes. No surgical complications were observed.
Conclusions: In patients who had a previous ALND who develop a breast cancer recurrence, the SPTC-CT might show the exact location of aberrant hot spots but, some of the identified as hot spots may not be lymph nodes. We must consider the exact location of the hot spot and the likelihood of false positives to avoid additional morbidity on the procedure.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-45.
Collapse
Affiliation(s)
- O Cordoba
- 1Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Perez-Ceresuela
- 1Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Roca
- 1Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Mendoza
- 1Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - T Cortadellas
- 1Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Espinosa-Bravo
- 1Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Rodriguez
- 1Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V Peg
- 1Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - IT Rubio
- 1Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Xercavins
- 1Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
40
|
Espinal P, Roca I, Vila J. Clinical impact and molecular basis of antimicrobial resistance in non-baumannii Acinetobacter. Future Microbiol 2011; 6:495-511. [PMID: 21585259 DOI: 10.2217/fmb.11.30] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Species of Acinetobacter other than Acinetobacter baumannii are involved in nosocomial infections. Acinetobacter lwoffii, Acinetobacter genomospecies 3 and Acinetobacter genomospecies 13TU are found in community- and nosocomial-acquired infections as well as in neonatal intensive care units. The non-baumannii Acinetobacter are normally highly susceptible to ciprofloxacin, ampicillin/sulbactam, gentamicin and tigecycline. Carbepenems show good activity although resistant isolates have been reported. Resistance to β-lactams other than carbapenems is associated with overexpression of chromosomal cephalosporinases and extended-spectrum β-lactamase acquisition, whereas resistance to carbapenems involves acquisition of carbapenemases. Quinolone resistance is related to gyrA and/or parC mutations but overexpresion of efflux proteins also plays an important role. With the development of novel and more accurate typing methodologies, an increase in infections caused by non-baumannii Acinetobacter might be observed in the future.
Collapse
Affiliation(s)
- Paula Espinal
- Department of Microbiology, Hospital Clinic, School of Medicine, University of Barcelona, CRESIB, IDIBAPS, Spain
| | | | | |
Collapse
|
41
|
Andersson T, Magnusson A, Bryngelsson IL, Frobert O, Henriksson KM, Edvardsson N, Poci D, Polovina M, Potpara T, Licina M, Mujovic N, Kocijancic A, Simic D, Ostojic MC, Providencia RA, Botelho A, Trigo J, Nascimento J, Quintal N, Mota P, Leitao-Marques AM, Bosch RF, Kirch W, Rosin L, Willich SN, Pittrow D, Bonnemeier H, Valenza MC, Martin L, Munoz Casaubon T, Valenza G, Botella M, Serrano M, Valenza B, Cabrera I, Anderson K, Benzaquen BS, Koziolova N, Nikonova J, Shilova Y, Scherr D, Narayan S, Wright M, Krummen D, Jadidi A, Jais P, Haissaguerre M, Hocini M, Hunter R, Liu Y, Lu Y, Wang W, Schilling RJ, Bernstein S, Wong B, Rooke R, Vasquez C, Shah R, Rosenberg S, Chinitz L, Morley G, Bashir Choudhary M, Holmqvist F, Carlson J, Nilsson HJ, Platonov PG, Jadidi AS, Cochet H, Miyazaki S, Shah AJ, Scherr D, Marrouche N, Haissaguerre M, Jais P, Calvo N, Nadal M, Andreu D, Tamborero D, Diaz FE, Berruezo A, Brugada J, Mont L, Fichtner S, Hessling G, Estner HL, Jilek C, Reents T, Ammar S, Wu J, Deisenhofer I, Nakanishi H, Kashiwase K, Hirata A, Wada M, Ueda Y, Skoda J, Neuzil P, Popelova J, Petru J, Sediva L, Lavergne T, Le Heuzey JY, Mousseaux E, Hersi A, Alhabib K, Alfaleh H, Sulaiman K, Almahmeed W, Alsuwidi J, Amin H, Reddy VY, Almotarreb A, Pang HWK, Redfearn DP, Simpson CS, Michael K, Pereira EJ, Munt PW, Fitzpatrick MF, Baranchuk A, Revishvili AS, Uldry L, Simonyan G, Dzhordzhikiya T, Sopov O, Kalinin V, Locati ET, Vecchi AM, Cattafi G, Sachero A, Lunati M, Sayah S, Forclaz A, Alizadeh A, Nazari N, Hekmat M, Moradi M, Zeighami M, Ghanji H, Suzuki K, Takagi M, Maeda K, Tatsumi H, Virag N, Gomes C, Meireles A, Anjo D, Roque C, Vieira P, Lagarto V, Reis H, Torres S, Toth A, Vago H, Hocini M, Takacs P, Edes E, Marki A, Balazs GY, Huttl K, Merkely B, Lainis F, Buckley MM, Johns EJ, Seifer CM, Vesin JM, Daba L, Liebrecht K, Pietrucha AZ, Borowiec A, Mroczek-Czernecka D, Bzukala I, Wnuk M, Piwowarska W, Nessler J, Toquero Ramos J, Jais P, Perez Pereira E, Mitroi C, Castro Urda V, Fernandez Villanueva JM, Corona Figueroa A, Hernandez Reina L, Fernandez Lozano I, Bartoletti A, Bocconcelli P, Giuli S, Kappenberger L, Massa R, Svetlich C, Tarsi G, Tronconi F, Vitale E, Pietrucha AZ, Bzukala I, Wnuk M, Stryjewski P, Konduracka E, Haissaguerre M, Wegrzynowska M, Kruszelnicka O, Nessler J, Lousinha A, Labandeiro J, Antunes E, Silva S, Alves S, Timoteo A, Oliveira M, Sehra R, Cruz Ferreira R, Pietrucha AZ, Wnuk M, Jedrzejczyk-Spaho J, Bzukala I, Kruszelnicka O, Wegrzynowska M, Piwowarska W, Nessler J, Krummen D, Briggs C, Rappel WJ, Narayan S, Sediva L, Neuzil P, Petru J, Skoda J, Janotka M, Chovanec M, Yamashiro K, Takami K, Sakamoto Y, Satoh K, Suzuki T, Nakagawa H, Romanov A, Pokushalov E, Artemenko S, Shabanov V, Stenin I, Elesin D, Turov A, Yakubov A, Hioki M, Matsuo S, Ito K, Narui R, Yamashita S, Sugimoto K, Yoshimura M, Yamane T, Pokushalov E, Romanov A, Artemenko S, Shabanov V, Elesin D, Stenin I, Turov A, Yakubov A, Miyazaki S, Shah AJ, Hocini M, Jais P, Haissaguerre M, Di Biase L, Gallinghouse JD, Rajappan K, Kautzner J, Dello Russo A, Tondo C, Lorgat F, Natale A, Balta O, Buenz K, Paessler M, Anders H, Horlitz M, Deneke T, Lickfett L, Liberman I, Linhart M, Andrie R, Mittmann-Braun E, Stockigt F, Nickenig G, Schrickel J, Tilz R, Rillig A, Feige B, Metzner A, Fuernkranz A, Burchard A, Wissner E, Ouyang F, Betts TR, Jones MA, Wong KCK, Qureshi N, Bashir Y, Rajappan K, Romanov A, Pokushalov E, Corbucci G, Artemenko S, Shabanov V, Turov A, Losik D, Selina V, Crandall MA, Daniels C, Daoud E, Kalbfleisch S, Yamaji H, Murakami T, Kawamura H, Murakami M, Hina K, Kusachi S, Dakos G, Vassilikos V, Paraskevaidis S, Mantziari A, Theophylogiannakos S, Chouvarda I, Chatzizisis I, Styliadis I, Kimura T, Fukumoto K, Nishiyama N, Aizawa Y, Fukuda Y, Sato T, Miyoshi S, Takatsuki S, Navarrete Casas AJ, Ali I, Conte FC, Moran M, Graham BG, Kalejs O, Lacis R, Stradins P, Koris A, Putnins I, Vikmane M, Lejnieks A, Erglis A, Estrada A, Perez Silva A, Castrejon S, Doiny D, Merino JL, Baranchuk A, Greiss I, Simpson CS, Abdollah H, Redfearn DP, Buys-Topart M, Nitzsche R, Thibault B, Deisenhofer I, Reents T, Ammar S, Fichtner S, Kathan S, Kolb C, Hessling G, Reif S, Schade S, Taggeselle J, Frey A, Birkenhagen A, Kohler S, Schmidt M, Cano Perez O, Buendia F, Igual B, Osca JM, Sanchez JM, Sancho-Tello MJ, Olague JM, Salvador A, Calvo N, Tolosana JM, Fernandez-Armenta J, Matas M, Barbarin MC, Berruezo A, Brugada J, Mont L, Habibovic M, Van Den Broek KC, Theuns DAMJ, Jordaens L, Alings M, Van Der Voort PH, Pedersen SS, Pupita G, Molini S, Brambatti M, Capucci A, Molodykh S, Idov EM, Belyaev OV, Segreti L, Soldati E, Zucchelli G, Di Cori A, Viani S, Paperini L, De Lucia R, Bongiorni MG, Binner L, Taborsky M, Bello D, Heuer H, Ramza B, Jenniskens I, Johnson WB, Silvetti MS, Rava' L, Russo MS, Di Mambro C, Ammirati A, Gimigliano G, Prosperi M, Drago F, Santos AR, Picarra B, Semedo P, Dionisio P, Matos R, Leitao M, Jacinto A, Trinca M, Mazzone P, Ciconte G, Marzi A, Paglino G, Vergara P, Sora N, Gulletta S, Della Bella P, Koppitz P, Fach A, Hobbiesiefken S, Fiehn E, Hambrecht R, Sperzel J, Jung M, Schmitt J, Pajitnev D, Burger H, Burger H, Goebel G, Ehrlich W, Walther T, Ziegelhoeffer T, Vancura V, Wichterle D, Melenovsky V, Kautzner J, Glikson M, Goldenberg G, Segev A, Dvir D, Kuzniec J, Finkelstein A, Hay I, Guetta V, Choo WK, Gupta S, Kirkfeldt R, Johansen J, Nohr E, Moller M, Arnsbo P, Nielsen J, Santos AR, Picarra B, Semedo P, Dionisio P, Matos R, Leitao M, Banha M, Trinca M, Stojanov P, Raspopovic S, Vasic D, Savic D, Nikcevic G, Jovanovic V, Defaye P, Mondesert B, Mbaye A, Cassagneau R, Gagniere V, Jacon J, Sanfins V, Reis HR, Nobre JN, Martins VM, Duarte LD, Morais CM, Conceicao JC, Hero M, Rey JL, Thibault B, Ducharme A, Simpson C, Stuglin C, Blier L, Senaratne M, Khaykin Y, Pinter A, Mlynarska A, Mlynarski R, Sosnowski M, Wilczek J, Iorgulescu C, Bogdan S, Constantinescu D, Caldararu C, Dorobantu M, Radu A, Vatasescu RG, Yusu S, Ikeda T, Mera H, Miwa Y, Abe A, Miyakoshi M, Tsukada T, Yoshino H, Nayar V, Cantelon P, Rawling A, Belham MRD, Pugh PJ, Osca Asensi J, Sanchez JM, Cano O, Tejada D, Munoz B, Rodriguez M, Sancho-Tello MJ, Olague J, Wecke L, Van Hunnik A, Thompson T, Di Carlo L, Zdeblick M, Auricchio A, Prinzen F, Doltra Magarolas A, Bijnens B, Silva E, Penela D, Mont L, Tolosana JM, Brugada J, Sitges M, Ofman P, Navaravong L, Leng J, Peralta A, Hoffmeister P, Levine R, Cook J, Stoenescu M, Tettamanti ME, Revilla Orodea A, Lopez Diaz J, De La Fuente Galan L, Arnold R, Garcia Moran E, San Roman Calvar JA, Gomez Salvador I, Nakamura K, Takami M, Keida T, Mesato A, Higa S, Shimabukuro M, Masuzaki H, Proietti R, Sagone A, Domenichini G, Burri H, Valzania C, Biffi M, Sunthorn H, Gavaruzzi G, Foulkes H, Boriani G, Koh S, Hou W, Rosenberg S, Snell J, Poore J, Dalal N, Bornzin G, Kloppe A, Mijic D, Bogossian H, Ninios I, Zarse M, Lemke B, Guedon-Moreau L, Kouakam C, Klug D, Marquie C, Ziglio F, Kacet S, Mohamed Fereig Hamed H, Hamdy AMAL, Abd El Aziz AHMED, Nabih MRVAT, Hamdy REHAB, Yaminisaharif A, Davoudi GH, Kasemisaeid A, Sadeghian S, Vasheghani Farahani A, Yazdanifard P, Shafiee A, Alonso C, Grimard C, Jauvert G, Lazarus A, Fernandez-Armenta J, Berruezo A, Mont LL, Sitges M, Andreu D, Ortiz-Perez J, Caralt T, Brugada J, Escudero J, Perez F, Griffith KM, Ferreyra R, Urena P, Demas M, Muratore C, Mazzetti H, Guardado J, Sanfins V, Fernandes M, Pereira VH, Canario-Almeida F, Ferreira F, Rodrigues B, Almeida J, Sokal A, Jedrzejczyk E, Lenarczyk R, Pluta S, Kowalski O, Pruszkowska P, Swiatkowski A, Kalarus Z, Heinke M, Ismer B, Kuehnert H, Heinke T, Surber R, Osypka N, Prochnau D, Figulla HR, Iacopino S, Landolina M, Proclemer A, Padeletti L, Calvi V, Pierantozzi A, Di Stefano P, Boriani G, Bauer A, Bode F, Le Gal F, Deharo JC, Delay M, Nitzsche R, Clementy J, Kawamura M, Munetsugu Y, Tanno K, Kobayashi Y, Cannom D, Hosoda J, Ishikawa T, Andoh K, Nobuyoshi M, Fujii S, Shizuta S, Kimura T, Isshiki T, Castel MA, Tolosana JM, Perez-Villa F, Mont L, Sitges M, Vidal B, Brugada J, Pluta S, Lenarczyk R, Kowalski O, Pruszkowska-Skrzep P, Sokal A, Szulik M, Kukulski T, Kalarus Z, Gianfranchi L, Bettiol K, Pacchioni F, Alboni P, Abu Sham'a R, Buber J, Nof E, Kuperstein R, Feinberg M, Luria D, Eldar M, Glikson M, Parks K, Stone JR, Singh JP, Hatzinikolaou-Kotsakou E, Kotsakou M, Beleveslis TH, Moschos G, Reppas E, Latsios P, Tsakiridis K, Kazemisaeid A, Davoodi G, Yamini Sharif A, Sadeghian S, Sheikhvatan M, Toniolo M, Zanotto G, Rossi A, Tomasi L, Vassanelli C, Versteeg H, Van Den Broek KC, Theuns DAMJ, Mommersteeg PMC, Alings M, Van Der Voort PH, Jordaens L, Pedersen SS, Vergara G, Blauer J, Ranjan R, Vijayakumar S, Kholmovski E, Volland N, Macleod R, Marrouche N, Aguinaga Arrascue LE, Bravo A, Garcia Freire P, Gallardo P, Hasbani E, Dantur J, Quintana R, Adragao PP, Cavaco D, Parreira L, Reis Santos K, Carmo P, Miranda R, Marcelino S, Cabrita D, Sommer P, Gaspar T, Rolf S, Arya A, Piorkowski C, Hindricks G, Valles Gras E, Bazan V, Portillo L, Suarez F, Bruguera J, Marti J, Huo Y, Arya A, Richter S, Schoenbauer R, Sommer P, Hindricks G, Piorkowski C, Rivas N, Casaldaliga J, Roca I, Dos L, Perez-Rodon J, Pijuan A, Garcia-Dorado D, Moya A, Carter HB, Garg A, Hegrenes J, Sih HJ, Teplitsky LR, Kuroki K, Tada H, Seo Y, Ishizu T, Igawa M, Sekiguchi Y, Kuga K, Aonuma K, Rodriguez A C, Mejias J, Hidalgo P, Hidalgo L JA, Orczykowski M, Derejko P, Walczak F, Szufladowicz E, Urbanek P, Bodalski R, Bieganowska K, Szumowski L, Peichl P, Wichterle D, Cihak R, Skalsky I, Kautzner J, Kubus P, Vit P, Zaoral L, Peichl P, Gebauer RA, Fiala M, Janousek J, Hiroshima K, Goya M, Ohe M, Hayashi K, Makihara Y, Nagashima M, An Y, Nobuyoshi M, Schloesser M, Lawrenz T, Meyer Zu Vilsendorf D, Strunk-Mueller C, Stellbrink C, Papagiannis J, Avramidis D, Kokkinakis C, Kirvassilis G, Eidelman G, Arenal A, Datino T, Atienza F, Gonzalez Torrecilla E, Miracle A, Hernandez J, Fernandez Aviles F, Ene E, Caldararu C, Iorgulescu C, Dorobantu M, Vatasescu RG, Insulander P, Bastani H, Braunschweig F, Drca N, Kenneback G, Schwieler J, Tapanainen J, Jensen-Urstad M, Andrea B, Andrea EMA, Maciel WM, Siqueira LS, Cosenza RC, Mittidieri FM, Farah SF, Atie JA, Kanoupakis E, Kallergis E, Mavrakis H, Goudis C, Saloustros I, Malliaraki N, Chlouverakis G, Vardas P, Bonnes JL, Jaspers Focks J, Westra SW, Brouwer MA, Smeets JLRM, Inama G, Pedrinazzi C, Landolina M, Oliva F, Senni M, Proclemer A, Zoni Berisso M, Mostov S, Haim M, Nevzorov R, Hasadi D, Starsberg B, Porter A, Kuschyk J, Schoene A, Streitner F, Veltmann CG, Schimpf R, Borggrefe M, Luesebrink U, Gardiwal A, Oswald H, Koenig T, Duncker D, Klein G, Bastiaenen R, Batchvarov V, Atty O, Cheng JH, Behr ER, Gallagher MM, Starrenburg AH, Kraaier K, Pedersen SS, Scholten MF, Van Der Palen J, Adhya S, Smith LA, Zhao T, Bannister C, Kamdar RH, Martinelli M, Siqueira S, Greco R, Nishioka SAD, Pedrosa AAA, Alkmim-Teixeira R, Peixoto GL, Costa R, Pedersen SS, Versteeg H, Nielsen JC, Mortensen PT, Johansen JB, Kwasniewski W, Filipecki A, Urbanczyk-Swic D, Orszulak W, Trusz - Gluza M, Jimenez-Candil J, Hernandez J, Morinigo J, Ledesma C, Martin-Luengo C, Vogtmann T, Gomer M, Stiller S, Kuehlkamp V, Zach G, Loescher S, Kespohl S, Baumann G, Snell JD, Korsun N, Rooke R, Snell JR, Morley B, Bharmi R, Nabutovsky Y, Mollerus M, Naslund L, Meyer A, Lipinski M, Libey B, Dornfeld K, Jimenez-Candil J, Hernandez J, Martin A, Gallego M, Morinigo J, Ledesma C, Martin-Luengo C, De Bie MK, Van Rees JB, Borleffs CJ, Thijssen J, Jukema JW, Schalij MJ, Van Erven L, Van Der Velde ET, Witteman TA, Foeken H, Van Erven L, Schalij MJ, Szili-Torok T, Akca F, Caliskan K, Ten Cate F, Jordaens L, Michels M, Cozma DC, Petrescu L, Mornos C, Dragulescu SI, Groeneweg JA, Velthuis BK, Cox MGPJ, Loh P, Dooijes D, Cramer MJ, De Bakker JMT, Hauer RNW, Park SD, Shin SH, Woo SI, Kwan J, Park KS, Kim DH, Kwan J, Iorio A, Vitali Serdoz L, Brun F, Daleffe E, Zecchin M, Dal Ferro M, Santangelo S, Sinagra GF, Ouali S, Hammemi R, Hammas S, Kacem S, Gribaa R, Neffeti E, Remedi F, Boughzela E, Korantzopoulos P, Letsas K, Christogiannis Z, Kalantzi K, Ntorkos A, Goudevenos J, Foley PWX, Yung L, Barnes E, Munetsugu Y, Tanno K, Kikuchi M, Ito H, Miyoshi F, Kawamura M, Kobayashi Y, Pecini R, Marott JM, Jensen GB, Theilade J, Mine T, Kodani T, Masuyama T, Mozos IM, Serban C, Costea C, Susan L, Barthel P, Mueller A, Malik M, Schmidt G, Schmidt G, Barthel P, Mueller A, Malik M, Karakurt O, Kilic H, Munevver Sari DR, Mroczek-Czernecka D, Pietrucha AZ, Borowiec A, Wnuk M, Bzukala I, Kruszelnicka O, Konduracka E, Nessler J, Kikuchi Y, Meireles A, Gomes C, Anjo D, Roque C, Pinheiro Vieira A, Lagarto V, Hipolito Reis A, Torres S, Nof E, Miller L, Kuperstein R, Eldar M, Glikson M, Luria D, Vedrenne G, Bruguiere E, Redheuil A. Poster Session 2. Europace 2011. [DOI: 10.1093/europace/eur222] [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: 11/15/2022] Open
|
42
|
Tada H, Yamasaki H, Sekiguchi Y, Igarashi M, Kuroki K, Machino T, Yoshida K, Aonuma K, Heinzel FR, Forstner H, Lercher P, Bisping E, Rotman B, Fruhwald FM, Pieske BM, Dabrowski R, Kowalik I, Borowiec A, Smolis-Bak E, Trybuch A, Sosnowski C, Szwed H, Baturova MA, Lindgren A, Shubik YV, Olsson B, Platonov PG, Van Den Broek KC, Denollet J, Widdershoven J, Kupper N, Allam R, Allam RAGAB, Galal WAGDY, El-Damnhoury HAYAM, Mortada AYMAN, Jimenez-Candil J, Martin A, Hernandez J, Martin F, Gallego M, Martin-Luengo C, Quintanilla JG, Moreno Planas J, Molina-Morua R, Archondo T, Garcia-Torrent MJ, Perez-Castellano N, Macaya C, Perez-Villacastin J, Saiz J, Tobon C, Rodriguez JF, Hornero F, Ferrero JM, Ito K, Date T, Kawai M, Hioki M, Narui R, Matsuo S, Yoshimura M, Yamane T, Tabatabaei N, Lin G, Powell BD, Smairat R, Glockner JF, Brady PA, Fichtner S, Czudnochowsky U, Estner H, Reents T, Jilek C, Ammar S, Hessling G, Deisenhofer I, Shah DC, Kautzner J, Saoudi N, Herrera C, Jais P, Hindricks G, Neuzil P, Kuck KH, Wong KCK, Jones M, Qureshi N, Muthumala A, Betts TR, Bashir Y, Rajappan K, Vogtmann T, Wagner M, Schurig J, Hein P, Hamm B, Baumann G, Lembcke A, Saad B, Piwowarska W, Nessler J, Edvardsson N, Rieger G, Garutti C, Linker N, Jorge C, Silva Marques J, Veiga A, Cruz J, Slater C, Correia MJ, Sousa J, Miltenberger-Miltenyi G, Nunes Diogo A, Matic D, Mrdovic I, Stankovic G, Asanin M, Antonijevic N, Matic M, Oliveira LA, Kocev N, Vasiljevic Z, Ramirez-Marrero MA, Perez-Villardon B, Delgado-Prieto JL, Jimenez-Navarro M, De Teresa-Galvan E, De Mora-Martin M, Pietrucha AZ, Bzukala I, Elias R, Sztefko K, Wnuk M, Malek A, Piwowarska W, Nessler J, Szili-Torok T, Bauernfeind T, De Groot N, Shalganov T, Schalij M, Camiletti A, Jordaens L, Rivas N, Casaldaliga J, Roca I, Pijuan A, Perez-Rodon J, Dos L, Garcia-Dorado D, Moya A, Baruteau AE, Moura D, Behaghel A, Chatel S, Mabo P, Schott JJ, Daubert JC, Le Marec H, Probst V, Zorio Grima E, Navarro-Manchon J, Molina P, Maldonado P, Igual B, Cano O, Bermejo M, Giner J, Salvador A, Bourgonje VJA, Vos MA, Ozdemir S, Doisne N, Van Der Heyden MAG, Camanho LE, Van Veen AAB, Sipido K, Antoons G, Altieri PI, Escobales N, Crespo M, Banchs HL, Sciarra L, Bloise R, Allocca G, Bulava A, Marras E, Lioy E, Delise P, Priori S, Calo' L, Hanis J, Sitek D, Novotny A, Chik WB, Lim TW, Choon HK, See VA, Mccall R, Thomas L, Ross DL, Thomas SP, Chen J, De Bortoli A, Rossvoll O, Hoff PI, Solheim E, Sun LZ, Schuster P, Ohm OJ, Ardashev AV, Zhelyakov E, Rybachenko MS, Konev AV, Belenkov YUN, Gunawardene M, Chun KRJ, Schulte-Hahn B, Windhorst V, Kulikoglu M, Nowak B, Schmidt B, Albina GA, Rivera RS, Scazzuso F, Laino RL, Giniger GA, Arbelo E, Calvo N, Tamborero D, Andreu D, Borras R, Berruezo A, Brugada J, Mont L, Stefan L, Eisenberger M, Celentano E, Peytchev P, Bodea O, Geelen P, De Potter T, Oliveira MM, Silva N, Cunha PS, Feliciano J, Lousinha A, Toste A, Santos S, Ferreira RC, Matsuda H, Harada T, Soejima K, Ishikawa Y, Mizukoshi K, Sasaki T, Mizuno K, Miyake F, Adragao PP, Cavaco D, Miranda R, Santos M, Morgado F, Reis Santos K, Candeias R, Marcelino S, Zoppo F, Grandolino G, Zerbo F, Bertaglia E, Schlueter SM, Grebe O, Vester EG, Miracle Blanco AL, Arenal Maiz A, Atienza Fernandez F, Datino Romaniega T, Gonzalez Torrecilla E, Eidelman G, Hernandez Hernandez J, Fernandez Aviles F, Fukumoto K, Takatsuki S, Kimura T, Nishiyama N, Aizawa Y, Sato T, Miyoshi S, Fukuda K, Richter B, Gwechenberger M, Socas A, Zorn G, Albinni S, Marx M, Wojta J, Goessinger H, Deneke T, Balta O, Paesler M, Buenz K, Anders H, Horlitz M, Muegge A, Shin DI, Natsuyama K, Yamaguchi KM, Nishida YN, De Bortoli A, Ohm OJ, Hoff PI, Solheim E, Schuster P, Sun LZ, Chen J, Kosiuk J, Bode K, Arya A, Piorkowski C, Gaspar T, Sommer P, Hindricks G, Bollmann A, Wichterle D, Peichl P, Simek J, Havranek S, Bulkova V, Cihak R, Kautzner J, Jurado Roman A, Salguero Bodes R, Lopez Gil M, Fontenla Cerezuela A, De Riva Silva M, Arribas Ynsaurriaga F, Fernandez Herranz AI, De Dios Perez S, Revishvili AS, Dishekov M, Tembotova Z, Barsamyan S, Vaccari D, Alvarenga C, Jesus I, Layher J, Takahashi A, Singh N, Siot P, Elkaim JP, Savelieva I, Mcclelland L, Lovegrove A, Jones S, Camm J, Folino AF, Breda R, Calzavara P, Comisso J, Borghetti F, Iliceto S, Buja G, Mlynarski R, Mlynarska A, Sosnowski M, Wilczek J, Mabo P, Carrault G, Bordachar P, Makdissi A, Duchemin L, Alonso C, Neri G, Masaro G, Vittadello S, Vaccari D, Gardin A, Barbetta A, Di Gregorio F, Sciaraffia E, Ginks MR, Gustafsson JS, Hollmark MC, Rinaldi CA, Blomstrom Lundqvist C, Brusich S, Tomasic D, Ferek-Petric B, Mavric Z, Kutarski A, Malecka B, Kolodzinska A, Grabowski M, Dovellini EV, Giurlani L, Cerisano G, Carrabba N, Valenti R, Antoniucci D, Kolodzinska A, Kutarski A, Grabowski M, Malecka B, Opolski G, Tomassoni G, Baker J, Corbisiero R, Martin D, Niazi I, Sheppard R, Sperzel J, Gutleben K, Petru J, Sediva L, Skoda J, Neuzil P, Mazzone P, Ciconte G, Vergara P, Marzi A, Paglino G, Sora N, Gulletta S, Della Bella P, Kutarski A, Pietura R, Czajkowski M, Cabanelas N, Martins VP, Alves M, Valente FX, Marta L, Francisco A, Silva R, Ferreira Da Silva G, Huo Y, Holmqvist F, Carlson J, Arya A, Wetzel U, Hindricks G, Bollmann A, Platonov P, Nof E, Abu Shama R, Kuperstein R, Feinberg MS, Eldar M, Glikson M, Luria D, Kubus P, Materna O, Gebauer RA, Matejka T, Gebauer R, Tlaskal T, Janousek J, Muessigbrodt A, Arya A, Wetzel U, Hindricks G, Richter S, Stockburger M, Boveda S, Defaye P, Stancak Branislav P, Kaliska G, Rolando M, Moreno J, Ohlow MAG, Lauer B, Buchter B, Schreiber M, Geller JC, Val-Mejias JE, Ouali S, Azzez S, Kacem S, Ben Salem H, Hammas S, Neffeti E, Remedi F, Boughzela E, Miyazaki H, Miyanaga S, Shibayama K, Tokuda M, Narui R, Kudo T, Yamane T, Yoshimura M, Coppola B, Shehada REN, Costandi P, Healey J, Hohnloser SH, Gold MR, Capucci A, Van Gelder IC, Carlson M, Lau CP, Connolly SJ, Bogaard MD, Leenders GE, Maskara B, Tuinenburg AE, Loh P, Hauer RN, Doevendans PA, Meine M, Thibault B, Dubuc M, Karst E, Ryu K, Paiement P, Farazi T, Puetz V, Berndt C, Buchholz J, Dorszewski A, Mornos C, Cozma D, Ionac A, Petrescu L, Mornos A, Pescariu S, Puetz V, Berndt C, Buchholz J, Dorszewski A, Benser M, Roscoe G, De Jong S, Roberts G, Boileau P, Rec A, Ryu K, Folman C, Morttada A, Abd El Kader M, Samir R, Roushdy R, Khaled S, Abo El Maaty M, Van Gelder B, Houthuizen P, Bracke FA, Osca Asensi J, Tejada D, Sanchez JM, Munoz B, Cano O, Rodriguez M, Sancho-Tello MJ, Olague J, Hou W, Rosenberg S, Koh S, Poore J, Snell J, Yang M, Nirav D, Bornzin G, Deering T, Dan D, Wickliffe AC, Cazeau S, Karimzadeh K, Mukerji S, Loghin C, Kantharia B, Bogaard MD, Leenders GE, Maskara B, Tuinenburg AE, Loh P, Hauer RN, Doevendans PA, Meine M, Betts TR, Jones MA, Wong KCK, Qureshi N, Rajappan K, Bashir Y, Lamba J, Simpson CS, Redfearn DP, Michael KA, Fitzpatrick M, Baranchuk A, Heinke M, Ismer B, Kuehnert H, Surber R, Haltenberger AM, Prochnau D, Figulla HR, Delarche N, Bizeau O, Couderc P, Chapelet A, Amara W, Lazarus A, Kubus P, Krupickova S, Gebauer RA, Janousek J, Van Deursen CJM, Strik M, Vernooy K, Van Hunnik A, Kuiper M, Crijns HJGM, Prinzen FW, Islam N, Gras D, Abraham W, Calo L, Birgersdotter-Green U, Clyne C, Herre J, Sheppard R, Abraham W, Gras D, Birgersdotter-Green U, Calo L, Clyne C, Klein N, Herre J, Sheppard R, Kowalski O, Lenarczyk R, Pruszkowska P, Sokal A, Kukulski T, Zielinska T, Pluta S, Kalarus Z, Schwab JO, Gasparini M, Anselme F, Clementy J, Santini M, Martinez Ferrer J, Burrone V, Santi E, Nevzorov R, Porter A, Kusniec J, Golovchiner G, Ben-Gal T, Strasberg B, Haim M, Rordorf R, Savastano S, Sanzo A, Vicentini A, Petracci B, De Amici M, Striuli L, Landolina M, Tolosana JM, Martin AM, Hernandez-Madrid A, Macias A, Fernandez-Lozano I, Osca J, Quesada A, Mont L, Igarashi M, Tada H, Yamasaki H, Sekiguchi Y, Kuroki K, Yoshida K, Noguchi Y, Aonuma K, Shahrzad S, Karim Soleiman N, Tavoosi A, Taban S, Emkanjoo Z, Fukunaga M, Goya M, Hiroshima K, Ohe M, Hayashi K, Iwabuchi M, Nosaka H, Nobuyoshi M, Doiny D, Perez-Silva A, Castrejon Castrejon S, Estrada A, Ortega M, Lopez-Sendon JL, Merino JL, Garcia Fernandez FJ, Gallardo R, Pachon M, Almendral J, Gonzalez Torrecilla E, Martin J, Yahya D, Al-Mogheer B, Gouda S, Eweis E, El Ramly M, Abdelwahab A, Kassenberg W, Wittkampf FHM, Hof IE, Heijden JH, Neven KGEJ, Meine M, Hauer RNW, Loh P, Baratto F, Bignami E, Pappalardo F, Maccabelli G, Nicolotti D, Zangrillo A, Della Bella P, Hayashi K, Goya M, Hiroshima K, Nagashima M, An Y, Fukunaga M, Okreglicki A, Russouw C, Tilz R, Yoshiga Y, Mathew S, Fuernkranz A, Rillig A, Wissner E, Kuck KH, Ouyang F, De Sisti A, Tonet J, Gueffaf F, Amara W, Touil F, Aouate P, Hidden-Lucet F, Doiny D, Castrejon Castrejon S, Estrada A, Ortega M, Perez-Silva A, Lopez-Sendon JL, Merino JL, Makimoto H, Satomi K, Yamada Y, Okamura H, Noda T, Shimizu W, Aihara N, Kamakura S, Estrada A, Perez Silva A, Doiny D, Castrejon S, Gonzalez Vasserot M, Merino JL, Tilz R, Senges J, Brachmann J, Andresen D, Hoffmann E, Schumacher B, Willems S, Kuck KH, Reents T, Deisenhofer I, Ammar S, Springer B, Fichtner S, Jilek C, Kolb C, Hessling G, Akca F, Bauernfeind T, De Groot NMS, Schwagten B, Witsenburg M, Jordaens L, Szili-Torok T, Hata Y, Nakagami R, Watanabe T, Sato A, Watanabe H, Kabutoya T, Mituhashi T, Theuns DAMJ, Smith T, Pedersen SS, Dabiri-Abkenari L, Jordaens L, Prull MW, Unverricht S, Bittlinsky A, Wirdemann H, Sasko B, Wirdeier S, Trappe HJ, Zorio Grima E, Rueda J, Medina P, Jaijo T, Sevilla T, Osca J, Arnau MA, Salvador A, Starrenburg AH, Kraaier K, Pedersen SS, Scholten MF, Van Der Palen J, De Haan S, Commandeur J, De Boer K, Beek AM, Van Rossum AC, Allaart CP, Berne P, Porres JM, Fernandez-Lozano I, Arnaiz JA, Mont L, Berruezo A, Brugada R, Brugada J, Man S, Maan AC, Thijssen J, Van Der Wall EE, Schalij MJ, Burattini L, Burattini R, Swenne CA, Bonny A, Hidden-Lucet F, Ditah I, Larrazet F, Frank R, Fontaine G, Van Den Broek KC, Pedersen SS, Theuns DAMJ, Jordaens L, Van Der Voort PH, Alings M, Denollet J, Shimane A, Okajima K, Kanda G, Yokoi K, Yamada S, Taniguchi Y, Hayashi T, Kajiya T, Santos MC, Wright J, Betts J, Denman R, Dominguez-Perez L, Arias Palomares MA, Toquero J, Jimenez-Candil J, Olague J, Diaz-Infante E, Tercedor L, Valverde I, Miracle Blanco AL, Datino Romaniega T, Arenal Maiz A, Atienza Fernandez F, Gonzalez Torrecilla E, Eidelman G, Hernandez Hernandez J, Fernandez Aviles F, Napp A, Joosten S, Stunder D, Zink M, Marx N, Schauerte P, Silny J, Trucco ME, Arce M, Palazzolo J, Femenia F, Glad JM, Szymkiewicz SJ, Glad JM, Szymkiewicz SJ, Fernandez-Armenta J, Camara O, Mont LL, Andreu D, Diaz E, Silva E, Frangi A, Berruezo A, Brembilla-Perrot B, Laporte F, Jimenez-Candil J, Martin A, Gallego M, Morinigo J, Ledesma C, Martin-Luengo C, Hadid C, Almendral J, Ortiz M, Quesada A, Wolpert C, Cobo E, Navarro X, Arribas F, Miki Y, Naitoh S, Kumagai K, Goto K, Kaseno K, Oshima S, Taniguchi K, Rivera S, Scazzuso F, Albina G, Klein A, Laino R, Sammartino V, Giniger A, Fukumoto K, Takatsuki S, Kimura T, Nishiyama N, Aizawa Y, Sato T, Miyoshi S, Fukuda K, Muggenthaler M, Raju H, Papadakis M, Chandra N, Bastiaenen R, Behr ER, Sharma S, Samniah N, Radezishvsky Y, Omari H, Rosenschein U, Perez Riera AR, Ferreira M, Hopman WM, Mcintyre WF, Baranchuk AR, Wongcharoen W, Keanprasit K, Phrommintikul A, Chaiwarith R, Yagishita A, Hachiya H, Nakamura T, Tanaka Y, Higuchi K, Kawabata M, Hirao K, Isobe M, Havranek S, Simek J, Wichterle D, Stoickov V, Ilic S, Deljanin Ilic M, Aagaard P, Sahlen A, Bergfeldt L, Braunschweig F, Sousa A, Lebreiro A, Sousa C, Oliveira S, Correia AS, Rangel I, Freitas J, Maciel MJ, Asensio Lafuente E, Aguilera AAC, Corral MACC, Mendoza KLMC, Nava PEND, Rendon ALRC, Villegas LVC, Castillo LCM, Schaerf R, Develle R, Brembilla-Perrot B, Oliver C, Zinzius PY, Providencia RA, Botelho A, Trigo J, Nascimento J, Quintal N, Mota P, Leitao-Marques AM, Borbola J, Abraham P, Foldesi CS, Kardos A, Miranda R, Almeida S, Santos MB, Cavaco D, Quaresma R, Morgado FB, Adragao P, Fatemi M, Didier R, Le Gal G, Etienne Y, Jobic Y, Gilard M, Boschat J, Mansourati J, Zubaid M, Rashed W, Alsheikh-Ali A, Almahmeed W, Shehab A, Sulaiman K, Asaad N, Amin H, Boersma LVA, Swaans M, Post M, Rensing B, Jarverud K, Broome M, Noren K, Svensson T, Hjelm S, Hollmark M, Bjorling A, Providencia RA, Botelho A, Trigo J, Nascimento J, Quintal N, Mota P, Leitao-Marques AM, Maeda K, Takagi M, Suzuki K, Tatsumi H, Yoshiyama M, Simeonidou E, Michalakeas C, Kastellanos S, Varounis C, Nikolopoulou A, Koniari C, Anastasiou-Nana M, Furukawa T, Maggi R, Bertolone C, Fontana D, Brignole M, Pietrucha AZ, Wnuk M, Bzukala I, Mroczek-Czernecka D, Konduracka E, Kruszelnicka O. Poster Session 4. Europace 2011. [DOI: 10.1093/europace/eur231] [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: 11/14/2022] Open
|
43
|
Sabaté M, Roca I, Córdoba O, Kysiel N, Rubio I, Castell J. [Contralateral axillary drainage in breast tumor recurrence]. ACTA ACUST UNITED AC 2011; 30:327-8. [PMID: 21514976 DOI: 10.1016/j.remn.2011.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 03/01/2011] [Indexed: 10/18/2022]
Affiliation(s)
- M Sabaté
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Barcelona, España.
| | | | | | | | | | | |
Collapse
|
44
|
Lorente L, Jiménez A, Roca I, Martín MM, Mora ML. Influence of tracheostomy on the incidence of catheter-related bloodstream infection in the catheterization of jugular vein by posterior access. Eur J Clin Microbiol Infect Dis 2011; 30:1049-51. [PMID: 21301912 DOI: 10.1007/s10096-011-1190-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 01/21/2011] [Indexed: 12/29/2022]
Abstract
There are no data about the influence of tracheostomy in the incidence of catheter-related bloodstream infection (CRBSI) on the catheterization of the jugular vein by posterior access and there are no recommendations relating to this circumstance in the guidelines of the Centers for Disease Control and Prevention (CDC) and of Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA) for the prevention of CRBSI. The novel finding of this observational study was that there was a higher incidence of CRBSI in the catheterization of jugular vein by posterior access in patients with tracheostomy than without it (13.24 vs 0 episodes of CRBSI per 1,000 catheter-day; odds ratio = 23.92; 95% CI = 1.86-infinite; p = 0.008). Thus, the presence of tracheostomy is a risk factor of CRBSI on the catheterization of jugular vein by posterior access.
Collapse
Affiliation(s)
- L Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n La Cuesta, La Laguna, 38320 Santa Cruz de Tenerife, Spain.
| | | | | | | | | |
Collapse
|
45
|
Lorente L, Palmero S, Jiménez JJ, Roca I, Naranjo C, Castedo J, Huidobro S, Lorenzo L, Iribarren JL, Mora ML. Higher incidence of catheter-related bloodstream infection in femoral venous access than in subclavian venous access in the presence of tracheostomy. Crit Care 2011. [PMCID: PMC3066902 DOI: 10.1186/cc9648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
46
|
Panosa A, Roca I, Gibert I. Ribonucleotide reductases of Salmonella typhimurium: transcriptional regulation and differential role in pathogenesis. PLoS One 2010; 5:e11328. [PMID: 20593029 PMCID: PMC2892513 DOI: 10.1371/journal.pone.0011328] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 05/22/2010] [Indexed: 11/18/2022] Open
Abstract
Ribonucleotide reductases (RNRs) are essential enzymes that carry out the de novo synthesis of deoxyribonucleotides by reducing ribonucleotides. There are three different classes of RNRs (I, II and III), all having different oxygen dependency and biochemical characteristics. Salmonella enterica serovar Typhimurium (S. Typhimurium) harbors class Ia, class Ib and class III RNRs in its genome. We have studied the transcriptional regulation of these three RNR classes in S. Typhimurium as well as their differential function during infection of macrophage and epithelial cells. Deletion of both NrdR and Fur, two main transcriptional regulators, indicates that Fur specifically represses the class Ib enzyme and that NrdR acts as a global repressor of all three classes. A Fur recognition sequence within the nrdHIEF promoter has also been described and confirmed by electrophoretic mobility shift assays (EMSA). In order to elucidate the role of each RNR class during infection, S. Typhimurium single and double RNR mutants (as well as Fur and NrdR mutants) were used in infection assays with macrophage and epithelial cell lines. Our results indicate class Ia to be mainly responsible for deoxyribonucleotide production during invasion and proliferation inside macrophages and epithelial cells. Neither class Ib nor class III seem to be essential for growth under these conditions. However, class Ib is able to maintain certain growth in an nrdAB mutant during the first hours of macrophage infection. Our results suggest that, during the early stages of macrophage infection, class Ib may contribute to deoxyribonucleotide synthesis by means of both an NrdR and a Fur-dependent derepression of nrdHIEF due to hydrogen peroxide production and DNA damage associated with the oxidative burst, thus helping to overcome the host defenses.
Collapse
Affiliation(s)
- Anaïs Panosa
- Institut de Biotecnologia i de Biomedicina and Departament de Genètica i de Microbiologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Ignasi Roca
- Institut de Biotecnologia i de Biomedicina and Departament de Genètica i de Microbiologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
- * E-mail: (IR); (IG)
| | - Isidre Gibert
- Institut de Biotecnologia i de Biomedicina and Departament de Genètica i de Microbiologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
- * E-mail: (IR); (IG)
| |
Collapse
|
47
|
Rubio I, Cebrecos I, Mendoza C, Cordoba O, Cortadellas T, Roca I, Peg V, Xercavins J. 313 Micrometastasis and isolated tumour cells in the sentinel lymph node after neoadjuvant treatment in breast cancer patients may reflect residual disease in non sentinel nodes. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70339-6] [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: 10/19/2022] Open
|
48
|
Roca I, Ballana E, Panosa A, Torrents E, Gibert I. Fumarate and nitrate reduction (FNR) dependent activation of the Escherichia coli anaerobic ribonucleotide reductase nrdDG promoter. Int Microbiol 2008; 11:49-56. [PMID: 18683632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The nrdDG promoter regulates transcriptional expression of the anaerobic ribonucleotide reductase of Escherichia coli, an essential enzyme required to supply the building blocks for DNA synthesis. In this work, binding of the pleiotropic FNR (fumarate and nitrate reduction) transcriptional regulator to the nrdDG promoter region and the effects of binding on transcription were investigated. Gel retardation analysis with purified FNR* demonstrated FNR interaction at two FNR sites, termed FNR-2 and FNR-1, while studies with altered FNR boxes indicated that the upstream FNR-2 site was essential for anaerobic activation of the nrdDG promoter. Although the FNR-1 site was not absolutely required, it allowed maximal expression of this promoter. These results suggest that the two sites have an additive effect in coordinating nrdDG expression in response to shifting oxygen concentrations.
Collapse
Affiliation(s)
- Ignasi Roca
- Institute of Biotechnology and Biomedicine, Department of Genetics and Microbiology, Autonomous University of Barcelona, Bellaterra, Spain
| | | | | | | | | |
Collapse
|
49
|
Martinez-Palones JM, Perez-Benavente A, Diaz-Feijoo B, Gil-Moreno A, Roca I, García-Jimenez A, Aguilar-Martinez I, Xercavins J. Sentinel lymph node identification in a primary ductal carcinoma arising in the vulva. Int J Gynecol Cancer 2007; 17:471-7. [PMID: 17362321 DOI: 10.1111/j.1525-1438.2007.00817.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Primary or metastasic breast-like carcinoma of the vulva is a rare event. Because of the similarity with breast ductal carcinoma, we think that the same principles used for treatment of orthotopic breast cancer can be applied, as well as the use of sentinel lymph node technique, which is widely accepted in the management of early-stage breast cancer. We report a 49-old-year postmenopausal woman who was referred to our institution after small biopsy of a 3.5- × 3-cm right vulvar tumor. Histopathologically, infiltration of the vulvar dermis by a ductal carcinoma of mammary gland type was reported. At operation, the sentinel node technique revealed two sentinel nodes in the right inguinal area. Although these nodes proved negative for malignancy, the patient underwent wide local excision of tumor and complete ipsilateral inguinofemoral lymphadenectomy. The remaining excised nodes were negative. Surgical specimen proved estrogen- and progesterone-positive receptors, the reason for which the patient received tamoxifen adjuvant therapy. This report represents the first case in the world literature of primary breast carcinoma arising in the vulva in which sentinel lymph node identification has been possible. Because of the rarity of this condition, the pathologic similarity of this tumor along with currently accepted guidelines for the management of breast cancer supports the possibility of local excision and sentinel lymph node identification as a possible alternative to inguinofemoral lymphadenectomy
Collapse
Affiliation(s)
- J M Martinez-Palones
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Roca I, Caresia AP, Gil-Moreno A, Pifarre P, Aguade-Bruix S, Castell-Conesa J, Martínez-Palones JM, Xercavins J. Usefulness of sentinel lymph node detection in early stages of cervical cancer. Eur J Nucl Med Mol Imaging 2005; 32:1210-6. [PMID: 15909192 DOI: 10.1007/s00259-005-1834-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Accepted: 04/06/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE Sentinel lymph node (SLN) mapping in combination with surgical biopsy is an emerging technique for use in the early stages of cervical cancer. The purpose of this study was to evaluate the technique in a series of 40 consecutive women with early stage cervical cancer. METHODS Forty patients with early stage cervical cancer [FIGO stage IA2 (2), IB1 (34), IB2 (1) or IIA (3)] were referred for radical hysterectomy with pelvic lymphadenectomy. Patients were submitted to preoperative lymphoscintigraphy (four 99mTc-nanocolloid injections around the tumour) and intraoperative SLN detection. Hand-held or laparoscopic gamma probes were used to locate SLNs during surgery. RESULTS The mean number of SLNs was 2.5 per patient (interiliac 49%, external iliac 19%). Of the total of 99 SLNs, six, in four women, showed metastases (all 68 non-SLNs removed were negative). In the other 36 patients, all the removed lymph nodes (sentinel and non-sentinel) were negative (0% false negative rate). During the follow-up (median 25 months), only two patients presented distant metastases: one died 6 months after surgery (two of three SLNs positive, both hot and blue), while the second patient is alive 4 years after surgery (lung metastasis, no isotope drainage, negative blue SLN). The survival rate was 95% and disease-free survival, 97%. CONCLUSION SLN surgical biopsy based on lymphoscintigraphy and blue dye is a feasible and useful technique to avoid lymph node dissection in the early stages of cervical cancer. It has a high negative predictive value, can be incorporated into clinical routine (laparoscopy or open surgery) and is close to achieving validation in this setting.
Collapse
Affiliation(s)
- I Roca
- Servei de Medicina Nuclear, Hospital Universitari Vall d'Hebron, 08035, Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|