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Blanco-Martín T, Guzmán-Puche J, Riazzo C, Gasca-Santiyán M, Hernández-García M, Cantón R, Torre-Cisneros J, Herrera C, Martínez-Martínez L. Phenotypic and Molecular Characterization of an Enterobacter ludwigii Clinical Isolate Carrying a Plasmid-Mediated blaIMI-6 Gene. Microbiol Spectr 2023; 11:e0462022. [PMID: 37074170 PMCID: PMC10269617 DOI: 10.1128/spectrum.04620-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 04/20/2023] Open
Abstract
We report a plasmid-encoded IMI-6 carbapenemase in a clinical isolate of Enterobacter ludwigii from Spain. The isolate belongs to ST641 and was susceptible to expanded-spectrum cephalosporins and resistant to carbapenems. The modified carbapenem inactivation method (mCIM) test was positive, but β-Carba was negative. Whole-genome sequencing identified the blaIMI-6 gene located in a conjugative IncFIIY plasmid and associated with the LysR-like regulator imiR. Both genes were bracketed by an ISEclI-like insertion sequence and a putatively defective ISEc36 insertion sequence. IMPORTANCE IMI carbapenemases confer an unusual resistance pattern of susceptibility to broad-spectrum cephalosporins and piperacillin-tazobactam but decreased susceptibility to carbapenems, which may make them difficult to detect in routine practice. Commercially available molecular methods for the detection of carbapenemases in clinical laboratories do not usually include blaIMI genes, which could contribute to the hidden dissemination of bacteria producing these enzymes. Techniques should be implemented to detect minor carbapenemases that are not very frequent in our environment and control their dissemination.
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Affiliation(s)
- T. Blanco-Martín
- Microbiology Unit, Reina Sofía University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - J. Guzmán-Puche
- Microbiology Unit, Reina Sofía University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - C. Riazzo
- Microbiology Unit, Reina Sofía University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - M. Gasca-Santiyán
- Microbiology Unit, Reina Sofía University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - M. Hernández-García
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Unit, Ramón y Cajal University Hospital and Ramón y Cajal Institute for Health Reasearch (IRICYS), Madrid, Spain
| | - R. Cantón
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Unit, Ramón y Cajal University Hospital and Ramón y Cajal Institute for Health Reasearch (IRICYS), Madrid, Spain
| | - J. Torre-Cisneros
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Unit, Reina Sofía University Hospital, Cordoba, Spain
- Medical and Surgical Sciences Department, University of Cordoba, Cordoba, Spain
| | - C. Herrera
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- Haematology Department, Reina Sofía University Hospital, Cordoba, Spain
| | - L. Martínez-Martínez
- Microbiology Unit, Reina Sofía University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Agricultural Chemistry, Soil Science and Microbiology Department, University of Cordoba, Cordoba, Spain
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2
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Machuca I, Guzmán-Puche J, Pérez-Nadales E, Gracia-Ahufinger I, Mendez A, Cano A, Castón JJ, Domínguez A, Torre-Cisneros J, Martínez-Martínez L. Community-acquired bacteremia by Klebsiella pneumoniae producing KPC-3 and resistant to ceftazidime/avibactam. J Glob Antimicrob Resist 2022; 30:399-402. [PMID: 35878781 DOI: 10.1016/j.jgar.2022.07.017] [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: 05/08/2022] [Revised: 07/04/2022] [Accepted: 07/16/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES To describe the clinical and microbiological features of a case of community-acquired infection by KPC-producing K. pneumoniae (KPCKP) resistant to ceftazidime/avibactam (CAZ-AVI). METHODS Identification of microorganisms was performed with MALDI Biotyper CA System (BrukerDaltonics, Madrid, Spain). Antimicrobial susceptibility testing was performed using Sensitre EURGNCOL panels (Thermo Fisher Scientific, Madrid, Spain) and gradient strips (Etest, bioMérieux, Madrid, Spain) in the case of CAZ-AVI, using EUCAST breakpoints for interpretation. Whole Genome Sequencing of blood culture and rectal swab isolates was performed using the Illumina NovaSeq 6000 sequencing system, with 2 × 150-bp paired-end reads (Illumina Inc). RESULTS Blood culture and rectal swab KPCKP isolates were resistant to carbapenems and to CAZ-AVI. The blood culture isolate showed susceptibility to trimethoprim-sulfamethoxazole (TMP-SMX) but the rectal swab culture isolate was resistant to this antibiotic. Both isolates belonged to clonal lineage ST512, harboured a single copy of blaKPC-3 gene, and showed 16 Single Nucleotide Polymorphism (SNP) between them and 38 SNPs with regards to the first KPC-3 producing K. pneumoniae isolated in our hospital in an initial outbreak in 2012. Genome-wide resistome analysis revealed the presence of a IncFIB(K) plasmid harbouring sul1 and dfrA12 genes only in the rectal swab culture isolate, which may explain its resistance to TMP-SMX. CONCLUSIONS Resistance to ceftazidime-avibactam is an emerging nosocomial problem. This case shows that CAZ-AVI-resistant KPCKP strains may disseminate into the community and cause serious infections.
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Affiliation(s)
- I Machuca
- Unit of Infectious Diseases, Reina Sofía University Hospital, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, University of Cordoba (IMIBIC/HURS/UCO), Cordoba, Spain
| | - J Guzmán-Puche
- Unit of Microbiology, Reina Sofía University Hospital, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, University of Cordoba (IMIBIC/HURS/UCO), Cordoba, Spain
| | - E Pérez-Nadales
- Maimonides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, University of Cordoba (IMIBIC/HURS/UCO), Cordoba, Spain
| | - I Gracia-Ahufinger
- Unit of Microbiology, Reina Sofía University Hospital, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, University of Cordoba (IMIBIC/HURS/UCO), Cordoba, Spain
| | - A Mendez
- Maimonides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, University of Cordoba (IMIBIC/HURS/UCO), Cordoba, Spain
| | - A Cano
- Unit of Infectious Diseases, Reina Sofía University Hospital, Cordoba, Spain
| | - J J Castón
- Unit of Infectious Diseases, Reina Sofía University Hospital, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, University of Cordoba (IMIBIC/HURS/UCO), Cordoba, Spain
| | - A Domínguez
- Department of Anesthesiology, Resuscitation and Therapeutics of pain, Reina Sofía University Hospital, Cordoba, Spain
| | - J Torre-Cisneros
- Unit of Infectious Diseases, Reina Sofía University Hospital, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, University of Cordoba (IMIBIC/HURS/UCO), Cordoba, Spain; Department of Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain.
| | - L Martínez-Martínez
- Unit of Microbiology, Reina Sofía University Hospital, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, University of Cordoba (IMIBIC/HURS/UCO), Cordoba, Spain; Department of Agricultural Chemistry, Soil Science and Microbiology, University of Cordoba, Cordoba, Spain
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3
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Guzmán-Puche J, Pérez-Nadales E, Pérez-Vázquez M, Causse M, Gracia-Ahufinger I, Mendez-Natera A, Allalou-Ruiz Y, Elías C, Oteo-Iglesias J, Torre-Cisneros J, Martínez-Martínez L. In vivo selection of KPC-94 and KPC-95 in Klebsiella pneumoniae isolates from patients treated with ceftazidime-avibactam. Int J Antimicrob Agents 2022; 59:106524. [PMID: 35038557 DOI: 10.1016/j.ijantimicag.2022.106524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/09/2021] [Accepted: 01/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ceftazidime-avibactam (CZA) is used to treat infections caused by KPC-producing Klebsiella pneumoniae (KPC-Kp). Resistance to CZA is commonly related to point mutations in the blaKPC gene. OBJECTIVES We describe the in vivo emergence of CZA resistance in clinical isolates of KPC-Kp from four patients treated with this combination therapy. METHODS Four pre-therapy and five post-therapy isolates were examined. Antibiogram (microdilution; gradient strips) and whole genome sequencing were performed. The role of KPC mutations was validated by cloning blaKPC genes into competent E. coli. RESULTS All isolates recovered before treatment with CZA were susceptible to CZA and produced KPC-3. Five KPC-Kp isolates recovered after treatment were resistant to this combination. Three post-therapy isolates from two patients produced KPC-31 (D179Y mutation). Additionally, we identified the novel substitution LN169-170H (KPC-94) in one isolate and the combination in another isolate of two independently described mutations, D179Y and A172T (KPC-95). All KPC-producing K. pneumoniae isolates belonged to ST512. All CZA-resistant isolates with blaKPC variants had restoration of carbapenem susceptibility. CONCLUSIONS Resistance to CZA was related to blaKPC mutations, including the new KPC-94 and KPC-95 alleles, which did not cause carbapenem resistance.
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Affiliation(s)
- J Guzmán-Puche
- Microbiology Unit, Reina Sofía University Hospital Reina Sofía, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain; Spanish Network for Research in Infectious Diseases, Carlos III Research Institute, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Carlos III Research Institute, Majadahonda, Madrid, Spain.
| | - E Pérez-Nadales
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain; Spanish Network for Research in Infectious Diseases, Carlos III Research Institute, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Carlos III Research Institute, Majadahonda, Madrid, Spain
| | - M Pérez-Vázquez
- Spanish Network for Research in Infectious Diseases, Carlos III Research Institute, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Carlos III Research Institute, Majadahonda, Madrid, Spain; Reference Laboratory and Research on Resistance to Antibiotics and Infections Related to Healthcare, National Centre for Microbiology, Carlos III Health Institute, Majadahonda, Madrid, Spain
| | - M Causse
- Microbiology Unit, Reina Sofía University Hospital Reina Sofía, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain; Spanish Network for Research in Infectious Diseases, Carlos III Research Institute, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Carlos III Research Institute, Majadahonda, Madrid, Spain
| | - I Gracia-Ahufinger
- Microbiology Unit, Reina Sofía University Hospital Reina Sofía, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain; Spanish Network for Research in Infectious Diseases, Carlos III Research Institute, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Carlos III Research Institute, Majadahonda, Madrid, Spain
| | - A Mendez-Natera
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain; Reference Laboratory and Research on Resistance to Antibiotics and Infections Related to Healthcare, National Centre for Microbiology, Carlos III Health Institute, Majadahonda, Madrid, Spain
| | - Y Allalou-Ruiz
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain
| | - C Elías
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain; Spanish Network for Research in Infectious Diseases, Carlos III Research Institute, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Carlos III Research Institute, Majadahonda, Madrid, Spain
| | - J Oteo-Iglesias
- Spanish Network for Research in Infectious Diseases, Carlos III Research Institute, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Carlos III Research Institute, Majadahonda, Madrid, Spain; Reference Laboratory and Research on Resistance to Antibiotics and Infections Related to Healthcare, National Centre for Microbiology, Carlos III Health Institute, Majadahonda, Madrid, Spain
| | - J Torre-Cisneros
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain; Spanish Network for Research in Infectious Diseases, Carlos III Research Institute, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Carlos III Research Institute, Majadahonda, Madrid, Spain; Department of Medical and Surgical Sciences. University Hospital, Córdoba, Spain; Infectious Diseases Unit, Reina Sofía University Hospital, Cordoba, Spain
| | - L Martínez-Martínez
- Microbiology Unit, Reina Sofía University Hospital Reina Sofía, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain; Spanish Network for Research in Infectious Diseases, Carlos III Research Institute, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Carlos III Research Institute, Majadahonda, Madrid, Spain; Department of Agricultural Chemistry, Soil Science and Microbiology, University of Cordoba, Cordoba, Spain
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Tacconelli E, Mazzaferri F, de Smet AM, Bragantini D, Eggimann P, Huttner BD, Kuijper EJ, Lucet JC, Mutters NT, Sanguinetti M, Schwaber MJ, Souli M, Torre-Cisneros J, Price JR, Rodríguez-Baño J. ESCMID-EUCIC clinical guidelines on decolonization of multidrug-resistant Gram-negative bacteria carriers. Clin Microbiol Infect 2019; 25:807-817. [PMID: 30708122 DOI: 10.1016/j.cmi.2019.01.005] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [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: 10/30/2018] [Revised: 01/08/2019] [Accepted: 01/12/2019] [Indexed: 12/16/2022]
Abstract
SCOPE The aim of these guidelines is to provide recommendations for decolonizing regimens targeting multidrug-resistant Gram-negative bacteria (MDR-GNB) carriers in all settings. METHODS These evidence-based guidelines were produced after a systematic review of published studies on decolonization interventions targeting the following MDR-GNB: third-generation cephalosporin-resistant Enterobacteriaceae (3GCephRE), carbapenem-resistant Enterobacteriaceae (CRE), aminoglycoside-resistant Enterobacteriaceae (AGRE), fluoroquinolone-resistant Enterobacteriaceae (FQRE), extremely drug-resistant Pseudomonas aeruginosa (XDRPA), carbapenem-resistant Acinetobacter baumannii (CRAB), cotrimoxazole-resistant Stenotrophomonas maltophilia (CRSM), colistin-resistant Gram-negative organisms (CoRGNB), and pan-drug-resistant Gram-negative organisms (PDRGNB). The recommendations are grouped by MDR-GNB species. Faecal microbiota transplantation has been discussed separately. Four types of outcomes were evaluated for each target MDR-GNB:(a) microbiological outcomes (carriage and eradication rates) at treatment end and at specific post-treatment time-points; (b) clinical outcomes (attributable and all-cause mortality and infection incidence) at the same time-points and length of hospital stay; (c) epidemiological outcomes (acquisition incidence, transmission and outbreaks); and (d) adverse events of decolonization (including resistance development). The level of evidence for and strength of each recommendation were defined according to the GRADE approach. Consensus of a multidisciplinary expert panel was reached through a nominal-group technique for the final list of recommendations. RECOMMENDATIONS The panel does not recommend routine decolonization of 3GCephRE and CRE carriers. Evidence is currently insufficient to provide recommendations for or against any intervention in patients colonized with AGRE, CoRGNB, CRAB, CRSM, FQRE, PDRGNB and XDRPA. On the basis of the limited evidence of increased risk of CRE infections in immunocompromised carriers, the panel suggests designing high-quality prospective clinical studies to assess the risk of CRE infections in immunocompromised patients. These trials should include monitoring of development of resistance to decolonizing agents during treatment using stool cultures and antimicrobial susceptibility results according to the EUCAST clinical breakpoints.
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Affiliation(s)
- E Tacconelli
- Division of Infectious Diseases, Department of Internal Medicine I, Tübingen University Hospital, Germany; Infectious Diseases Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy.
| | - F Mazzaferri
- Infectious Diseases Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - A M de Smet
- University of Groningen, University Medical Centre Groningen, Department of Critical Care, Groningen, the Netherlands
| | - D Bragantini
- Infectious Diseases Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - P Eggimann
- Adult Critical Care Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - B D Huttner
- Division of Infectious Diseases and Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - E J Kuijper
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J-C Lucet
- Infection Control Unit, Bichat-Claude Bernard Hospital, AP-HP, Paris, France; IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - N T Mutters
- European Committee on Infection Control (EUCIC), Basel, Switzerland; Institute for Infection Prevention and Hospital Epidemiology, Medical Centre, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - M Sanguinetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Microbiologia, Rome, Italy
| | - M J Schwaber
- National Centre for Infection Control, Israel Ministry of Health, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - M Souli
- Duke Clinical Research Institute, Duke University, Durham, NC, USA; Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - J Torre-Cisneros
- Infectious Diseases Service, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research (IMIBIC), Department of Medicine, University of Córdoba, Córdoba, Spain
| | - J R Price
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - J Rodríguez-Baño
- Division of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena / Department of Medicine, University of Seville / Biomedicine Institute of Seville (IBiS), Seville, Spain
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Palacios-Baena ZR, Delgado-Valverde M, Valiente Méndez A, Almirante B, Gómez-Zorrilla S, Borrell N, Corzo JE, Gurguí M, De la Calle C, García-Álvarez L, Ramos L, Gozalo M, Morosini MI, Molina J, Causse M, Pascual Á, Rodríguez-Baño J, de Cueto M, Planes Reig AM, Tubau Quintano F, Peña C, Galán Otalora ME, Ruíz de Alegría C, Cantón R, Lepe JA, Cisneros JM, Torre-Cisneros J, Lara R. Impact of De-escalation on Prognosis of Patients With Bacteremia due to Enterobacteriaceae: A Post Hoc Analysis From a Multicenter Prospective Cohort. Clin Infect Dis 2018; 69:956-962. [DOI: 10.1093/cid/ciy1032] [Citation(s) in RCA: 10] [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: 09/22/2018] [Accepted: 12/04/2018] [Indexed: 12/31/2022] Open
Abstract
Abstract
Background
More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. The aims of this study were to investigate predictors of de-escalation and its impact on the outcome of patients with bloodstream infection due to Enterobacteriaceae (BSI-E).
Methods
A post hoc analysis was performed on a prospective, multicenter cohort of patients with BSI-E initially treated with ertapenem or antipseudomonal β-lactams. Logistic regression was used to analyze factors associated with early de-escalation (EDE) and Cox regression for the impact of EDE and late de-escalation (LDE) on 30-day all-cause mortality. A propensity score (PS) for EDE vs no de-escalation (NDE) was calculated. Failure at end of treatment and length of hospital stay were also analyzed.
Results
Overall, 516 patients were included. EDE was performed in 241 patients (46%), LDE in 95 (18%), and NDE in 180 (35%). Variables independently associated with a lower probability of EDE were multidrug-resistant isolates (odds ratio [OR], 0.50 [95% confidence interval {CI}, .30–.83]) and nosocomial infection empirically treated with imipenem or meropenem (OR, 0.35 [95% CI, .14–.87]). After controlling for confounders, EDE was not associated with increased risk of mortality; hazard ratios (HR) (95% CIs) were as follows: general model, 0.58 (.25–1.31); model with PS, 0.69 (.29–1.65); and PS-based matched pairs, 0.98 (.76–1.26). LDE was not associated with mortality. De-escalation was not associated with clinical failure or length of hospital stay.
Conclusions
De-escalation in patients with monomicrobial bacteremia due to Enterobacteriaceae was not associated with a detrimental impact on clinical outcome.
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Affiliation(s)
- Zaira R Palacios-Baena
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Departamentos de Medicina y Microbiología, Universidad de Sevilla and Instituto de Biomedicina de Sevilla
| | - Mercedes Delgado-Valverde
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Departamentos de Medicina y Microbiología, Universidad de Sevilla and Instituto de Biomedicina de Sevilla
| | - Adoración Valiente Méndez
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Departamentos de Medicina y Microbiología, Universidad de Sevilla and Instituto de Biomedicina de Sevilla
| | - Benito Almirante
- Servei de Malalties Infeccioses, Hospital Universitari Vall d’Hebron, Barcelona
| | | | - Núria Borrell
- Servicio de Microbiología, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares
| | - Juan E Corzo
- Unidad Clínica Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla
| | - Mercedes Gurguí
- Unitat de Malaties Infeccioses, Hospital de la Santa Creu i Sant Pau
| | | | - Lara García-Álvarez
- Departamento de Enfermedades Infecciosas, Hospital San Pedro-Centro de Investigación Biomédica de La Rioja, Logroño
| | - Lucía Ramos
- Servicio de Microbiología, Hospital Universitario A Coruña, Santander
| | - Mónica Gozalo
- Servicio de Microbiología, Hospital Marqués de Valdecilla-Instituto de Investigación Sanitaria Valdecilla, Santander
| | | | - José Molina
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Universidad de Sevilla and Instituto de Biomedicina de Sevilla
| | - Manuel Causse
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Clínica, Universidad de Córdoba, Spain
| | - Álvaro Pascual
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Departamentos de Medicina y Microbiología, Universidad de Sevilla and Instituto de Biomedicina de Sevilla
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Departamentos de Medicina y Microbiología, Universidad de Sevilla and Instituto de Biomedicina de Sevilla
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Rivero-Juarez A, Aguado R, Lopez-Lopez P, Sanchez-Frias M, Frias M, Briceño J, de la Mata M, Torre-Cisneros J, Rivero A. Prevalence of hepatitis E virus infection in liver donors in Spain. Clin Microbiol Infect 2018; 24:1218-1219. [DOI: 10.1016/j.cmi.2018.06.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 01/11/2023]
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Guirao-Arrabal E, Torre-Cisneros J. Tuberculin skin test, Interferon gamma release assays or just chest x-ray to study latent tuberculosis before solid organ transplantation? Transpl Infect Dis 2018; 20:e12920. [DOI: 10.1111/tid.12920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/23/2018] [Accepted: 05/17/2018] [Indexed: 11/30/2022]
Affiliation(s)
- E. Guirao-Arrabal
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC); Hospital Universitario Reina Sofía-Universidad de Córdoba (UCO); Córdoba Spain
| | - J. Torre-Cisneros
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC); Hospital Universitario Reina Sofía-Universidad de Córdoba (UCO); Córdoba Spain
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Amat T, Gutiérrez-Pizarraya A, Machuca I, Gracia-Ahufinger I, Pérez-Nadales E, Torre-Giménez Á, Garnacho-Montero J, Cisneros J, Torre-Cisneros J. The combined use of tigecycline with high-dose colistin might not be associated with higher survival in critically ill patients with bacteraemia due to carbapenem-resistant Acinetobacter baumannii. Clin Microbiol Infect 2018; 24:630-634. [DOI: 10.1016/j.cmi.2017.09.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
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9
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Fernández-Ruiz M, Giménez E, Vinuesa V, Ruiz-Merlo T, Parra P, Amat P, Montejo M, Paez-Vega A, Cantisán S, Torre-Cisneros J, Fortún J, Andrés A, San Juan R, López-Medrano F, Navarro D, Aguado JM. Regular monitoring of cytomegalovirus-specific cell-mediated immunity in intermediate-risk kidney transplant recipients: predictive value of the immediate post-transplant assessment. Clin Microbiol Infect 2018; 25:381.e1-381.e10. [PMID: 29803844 DOI: 10.1016/j.cmi.2018.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/13/2018] [Accepted: 05/17/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Previous studies on monitoring of post-transplant cytomegalovirus (CMV)-specific cell-mediated immunity (CMI) are limited by single-centre designs and disparate risk categories. We aimed to assess the clinical value of a regular monitoring strategy in a large multicentre cohort of intermediate-risk kidney transplant (KT) recipients. METHODS We recruited 124 CMV-seropositive KT recipients with no T-cell-depleting induction pre-emptively managed at four Spanish institutions. CMV-specific interferon-γ-producing CD4+ and CD8+ T cells were counted through the first post-transplant year by intracellular cytokine staining after stimulation with pp65 and immediate early-1 peptides (mean of six measurements per patient). The primary outcome was the occurrence of any CMV event (asymptomatic infection and/or disease). Optimal cut-off values for CMV-specific T cells were calculated at baseline and day 15. RESULTS Twelve-month cumulative incidence of CMV infection and/or disease was 47.6%. Patients with pre-transplant CMV-specific CD8+ T-cell count <1.0 cells/μL had greater risk of CMV events (adjusted hazard ratio (aHR) 2.84; p 0.054). When the CMI assessment was performed in the immediate post-transplant period (day 15), the presence of <2.0 CD8+ T cells/μL (aHR 2.18; p 0.034) or <1.0 CD4+ T cells/μL (aHR 2.43; p 0.016) also predicted the subsequent development of a CMV event. In addition, lower counts of CMV-specific CD4+ (but not CD8+) T cells at days 60 and 180 were associated with a higher incidence of late-onset events. CONCLUSIONS Monitoring for CMV-specific CMI in intermediate-risk KT recipients must be regular to reflect dynamic changes in overall immunosuppression and individual susceptibility. The early assessment at post-transplant day 15 remains particularly informative.
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Affiliation(s)
- M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain.
| | - E Giménez
- Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - V Vinuesa
- Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - T Ruiz-Merlo
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - P Parra
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - P Amat
- Department of Haematology and Medical Oncology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - M Montejo
- Unit of Infectious Diseases, Hospital Universitario de Cruces, Bilbao, Spain
| | - A Paez-Vega
- Clinical Unit of Infectious Diseases, Maimonides Biomedical Research Institute of Cordoba, University Hospital "Reina Sofia", University of Cordoba, Spain
| | - S Cantisán
- Clinical Unit of Infectious Diseases, Maimonides Biomedical Research Institute of Cordoba, University Hospital "Reina Sofia", University of Cordoba, Spain
| | - J Torre-Cisneros
- Clinical Unit of Infectious Diseases, Maimonides Biomedical Research Institute of Cordoba, University Hospital "Reina Sofia", University of Cordoba, Spain
| | - J Fortún
- Department of Infectious Diseases, University Hospital "Ramón y Cajal", Instituto "Ramón y Cajal" de Investigación Sanitaria, Madrid, Spain
| | - A Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - R San Juan
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - D Navarro
- Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
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10
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Serrano-Alonso M, Guillen-Grima F, Martin-Moreno P, Rabago G, Manrique J, Garcia-del-Barrio M, Reina G, Torre-Cisneros J, Fernandez-Alonso M, Herrero J. Reduction in mortality associated with secondary cytomegalovirus prophylaxis after solid organ transplantation. Transpl Infect Dis 2018; 20:e12873. [DOI: 10.1111/tid.12873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/02/2018] [Accepted: 01/14/2018] [Indexed: 01/06/2023]
Affiliation(s)
| | - F. Guillen-Grima
- Preventive Medicine Department; Clínica Universidad de Navarra; Pamplona Spain
- Department of Health Sciences; Public University of Navarra; Pamplona Spain
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
| | - P. Martin-Moreno
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
- Nephrology Department; Clínica Universidad de Navarra; Pamplona Spain
| | - G. Rabago
- Cardiac Surgery Department; Clínica Universidad de Navarra; Pamplona Spain
| | - J. Manrique
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
- Nephrology Department; Complejo Hospitalario de Navarra; Pamplona Spain
| | | | - G. Reina
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
- Microbiology Department; Clínica Universidad de Navarra; Pamplona Spain
| | - J. Torre-Cisneros
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC); Reina Sofía University Hospital; University of Cordoba; Cordoba Spain
| | - M. Fernandez-Alonso
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
- Microbiology Department; Clínica Universidad de Navarra; Pamplona Spain
| | - J.I. Herrero
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
- Liver Unit; Clínica Universidad de Navarra; Pamplona Spain
- Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd); Madrid Spain
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11
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Torre-Cisneros J, Natera C, Mesa F, Trikic M, Rodríguez-Baño J. Clinical predictors of methicillin-resistant Staphylococcus aureus in nosocomial and healthcare-associated pneumonia: a multicenter, matched case-control study. Eur J Clin Microbiol Infect Dis 2017; 37:51-56. [PMID: 28887643 DOI: 10.1007/s10096-017-3100-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/29/2017] [Indexed: 01/31/2023]
Abstract
The situations in which coverage for methicillin-resistant Staphylococcus aureus (MRSA) in the empirical treatment of nosocomial pneumonia (NP) or severe healthcare-associated pneumonia (HCAP) is needed are poorly defined, particularly outside intensive care units (ICUs). Our aim was to characterize if the risk of MRSA NP/HCAP can be defined by clinical variables. We designed an observational, retrospective, multicenter, case-control study to analyze the association between defined clinical variables and risk of MRSA NP/HCAP in non-ICU patients using conditional multivariable logistic regression. Cases and controls (1:2) with microbiological diagnosis were included. Controls were matched for hospital, type of pneumonia (NP or HCAP), and date of isolation. A total of 140 cases (77 NP and 63 HCAP) and 280 controls were studied. The variables associated with the risk of MRSA pneumonia were: (i) respiratory infection/colonization caused by MRSA in the previous year [odds ratio (OR) 14.81, 95% confidence interval (CI) 4.13-53.13, p < 0.001]; (ii) hospitalization in the previous 90 days (OR 2.41, 95% CI 1.21-4.81, p = 0.012); and (iii) age (OR 1.02, 95% CI 1.001-1.05, p = 0.040). The area under the receiver operating characteristic (ROC) curve for the multivariable model was 0.72 (95% CI 0.66-0.78). The multivariate model had a sensitivity of 74.5% (95% CI 65.3-83.6), a specificity of 63.3% (95% CI 56.0-70.6), a positive predictive value of 52.5% (95% CI 43.9-61.2), and a negative predictive value of 82.0% (95% CI 75.3-88.8) for the observed data. Clinical predictors of MRSA NP/HCAP can be used to define a low-risk population in whom coverage against MRSA may not be needed.
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Affiliation(s)
- J Torre-Cisneros
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain.,Red Española de Investigación en Patología Infecciosa (REIPI), Sevilla, Spain
| | - C Natera
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain.,Red Española de Investigación en Patología Infecciosa (REIPI), Sevilla, Spain
| | - F Mesa
- Medical Department, Pfizer PEH, Avenida de Europa, 20 B, 28108, Alcobendas, Madrid, Spain.
| | - M Trikic
- Medical Department, Pfizer PEH, Avenida de Europa, 20 B, 28108, Alcobendas, Madrid, Spain
| | - J Rodríguez-Baño
- Red Española de Investigación en Patología Infecciosa (REIPI), Sevilla, Spain.,Unidad Cínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain.,Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
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12
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Rivero-Juarez A, Cuenca-Lopez F, Martinez-Peinado A, Camacho A, Real LM, Frias M, Gordon A, Cantisán S, Torre-Cisneros J, Pineda JA, Rivero A. Rural habitat as risk factor for hepatitis E virus seroconversion in HIV-infected patients: A prospective longitudinal study. Zoonoses Public Health 2017; 64:e60-e64. [PMID: 28236361 DOI: 10.1111/zph.12347] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Indexed: 12/15/2022]
Abstract
Our objective was to determine the incidence and clinical manifestations of acute hepatitis E virus (HEV) in HIV-infected patients. A prospective longitudinal study including HIV-infected HEV-seronegative patients was conducted; HEV seroconversion (to IgG and/or IgM) was the main outcome variable. All patients were tested for HEV antibodies every 3-6 months. For patients who developed HEV seroconversion, a data collection protocol was followed to identify associated clinical manifestations and analytical alterations. A total of 627 patients (89.9%) were followed during a median of 11.96 months (IQR: 8.52-14.52 months) and formed the study population. Forty-one patients developed detectable anti-HEV antibodies (7.2 cases per 100 patients/year). Our study found a high incidence of HEV in HIV-infected patients in southern Spain strongly associated with a rural habitat.
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Affiliation(s)
- A Rivero-Juarez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - F Cuenca-Lopez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - A Martinez-Peinado
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - A Camacho
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - L M Real
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - M Frias
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - A Gordon
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - S Cantisán
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - J Torre-Cisneros
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - J A Pineda
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - A Rivero
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
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13
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Frías M, Rodríguez-Cano D, Cuenca-López F, Macías J, Gordon A, Manzanares-Martín B, Pineda JA, Camacho Á, Torre-Cisneros J, Peña J, Rivero-Juárez A, Rivero A. HLA-B18 as risk factor of liver fibrosis progression in HIV/HCV treatment-experienced patients. Pharmacogenomics J 2016; 17:479-480. [DOI: 10.1038/tpj.2016.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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14
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Guirao-Arrabal E, Santos F, Redel-Montero J, Vaquero JM, Cantisán S, Vidal E, Torre-Giménez Á, Rivero A, Torre-Cisneros J. Risk of tuberculosis after lung transplantation: the value of pretransplant chest computed tomography and the impact of mTOR inhibitors and azathioprine use. Transpl Infect Dis 2016; 18:512-9. [PMID: 27224905 DOI: 10.1111/tid.12555] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/16/2016] [Accepted: 02/29/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND It is necessary to determine the incidence and risk factors for tuberculosis (TB), as well as strategies to assess and treat latent tuberculosis infection (LTBI) in lung transplant recipients. METHODS A retrospective cohort study of 398 lung transplant recipients was performed. Episodes of TB were studied and the incidence rate was calculated. Logistic regression analysis was used to analyze specific variables as potential risk factors for TB. RESULTS Median follow-up was 558 days (range 1-6636). Six cases (1.5%) of TB were documented in 398 transplant patients. The incidence density of TB was 406.3 cases/10(5) patient-years (95% confidence interval [CI] 164.7-845), which is higher than in the general population (13.10 cases/10(5) person-years). All cases occurred in the period 1993-2006, when the tuberculin skin test (TST) and treatment of LTBI in positive TST patients were not part of the protocol. Pretransplant computed tomography (CT) showed residual lesions in 50% of patients who developed TB, although the TST was negative and the chest radiograph was inconclusive. Multivariate analysis identified the presence of residual lesions in the pretransplant chest CT (odds ratio [OR] 11.5, 95% CI 1.9-69.1, P = 0.008), use of azathioprine (OR 10.6, 95% CI 1.1-99.1, P = 0.038), and use of everolimus (OR 6.7, 95% CI 1.1-39.8, P = 0.036) as independent risk factors for TB. CONCLUSIONS Residual lesions in the pretransplant chest CTs and the use of azathioprine and mTOR inhibitors are associated with the risk of TB.
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Affiliation(s)
- E Guirao-Arrabal
- Infectious Diseases Unit, Hospital Universitario Reina Sofía, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba, Spain
| | - F Santos
- Thoracic Surgery and Lung Transplantation Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - J Redel-Montero
- Thoracic Surgery and Lung Transplantation Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - J M Vaquero
- Thoracic Surgery and Lung Transplantation Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - S Cantisán
- Infectious Diseases Unit, Hospital Universitario Reina Sofía, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba, Spain
| | - E Vidal
- Infectious Diseases Unit, Hospital Universitario Reina Sofía, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba, Spain
| | - Á Torre-Giménez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba, Spain
| | - A Rivero
- Infectious Diseases Unit, Hospital Universitario Reina Sofía, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba, Spain
| | - J Torre-Cisneros
- Infectious Diseases Unit, Hospital Universitario Reina Sofía, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba, Spain
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15
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Torre-Cisneros J, Aguado J, Caston J, Almenar L, Alonso A, Cantisán S, Carratalá J, Cervera C, Cordero E, Fariñas M, Fernández-Ruiz M, Fortún J, Frauca E, Gavaldá J, Hernández D, Herrero I, Len O, Lopez-Medrano F, Manito N, Marcos M, Martín-Dávila P, Monforte V, Montejo M, Moreno A, Muñoz P, Navarro D, Pérez-Romero P, Rodriguez-Bernot A, Rumbao J, San Juan R, Vaquero J, Vidal E. Management of cytomegalovirus infection in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations. Transplant Rev (Orlando) 2016; 30:119-43. [DOI: 10.1016/j.trre.2016.04.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 04/02/2016] [Accepted: 04/04/2016] [Indexed: 02/06/2023]
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16
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Pérez-Romero P, Bulnes-Ramos A, Torre-Cisneros J, Gavaldá J, Aydillo T, Moreno A, Montejo M, Fariñas M, Carratalá J, Muñoz P, Blanes M, Fortún J, Suárez-Benjumea A, López-Medrano F, Barranco J, Peghin M, Roca C, Lara R, Cordero E, Alamo J, Gasch A, Gentil-Govantes M, Molina-Ortega F, Lage E, Martínez-Atienza J, Sánchez M, Rosso C, Arizón J, Aguera M, Cantisán S, Montero J, Páez A, Rodríguez A, Santos S, Vidal E, Berasategui C, Campins M, López-Meseguer M, Saez B, Marcos M, Sanclemente G, Diez N, Goikoetxea J, Casafont F, Cobo-Beláustegy M, Durán R, Fábrega-García E, Fernández-Rozas S, González-Rico C, Zurbano-Goñi F, Bodro M, Niubó J, Oriol S, Sabé N, Anaya F, Bouza E, Catalán P, Diez P, Eworo A, Kestler M, Lopez-Roa P, Rincón D, Rodríguez M, Salcedo M, Sousa Y, Valerio M, Morales-Barroso I, Aguado J, Origuen J. Influenza vaccination during the first 6 months after solid organ transplantation is efficacious and safe. Clin Microbiol Infect 2015; 21:1040.e11-8. [DOI: 10.1016/j.cmi.2015.07.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/01/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
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17
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Meije Y, Piersimoni C, Torre-Cisneros J, Dilektasli AG, Aguado JM. Mycobacterial infections in solid organ transplant recipients. Clin Microbiol Infect 2015; 20 Suppl 7:89-101. [PMID: 24707957 DOI: 10.1111/1469-0691.12641] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [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: 11/06/2013] [Revised: 03/21/2014] [Accepted: 03/29/2014] [Indexed: 12/29/2022]
Abstract
Mycobacterial infections represent a growing challenge for solid organ transplant recipients (SOT). The adverse effects of tuberculosis (TB) therapy present a major difficulty, due to the interactions with immunosuppressive drugs and direct drug toxicity. While TB may be donor-transmitted or community-acquired, it usually develops at a latent infection site in the recipient. Pre-transplant prevention efforts will improve transplant outcomes and avoid the complications associated with post-transplant diagnosis and treatment. The present review and consensus manuscript is based on the updated published information and expert recommendations. The current data about epidemiology, diagnosis, new regimens for the treatment of latent TB infection (LTBI), the experience with rifamycins for the treatment of active TB in the post-transplant period and the experience with isoniazid for LTBI in the liver transplant population, are also reviewed. We attempt to provide useful recommendations for each transplant period and problem concerning mycobacterial infections in SOT recipients.
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Affiliation(s)
- Y Meije
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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18
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Cantisán S, Solana R, Torre-Cisneros J. Response to "Influence of Age and HLA Alleles on the CMV-Specific Cell-Mediated Immunity Among CMV-Seropositive Kidney Transplant Candidates". Am J Transplant 2015; 15:2527-8. [PMID: 26139328 DOI: 10.1111/ajt.13371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/29/2015] [Indexed: 01/25/2023]
Affiliation(s)
- S Cantisán
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain
| | - R Solana
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain
| | - J Torre-Cisneros
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain
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19
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Gracia-Ahufinger I, Ferrando-Martínez S, Montejo M, Muñoz-Villanueva M, Cantisán S, Rivero A, Solana R, Leal M, Torre-Cisneros J. Pre-transplant thymic function is associated with the risk of cytomegalovirus disease after solid organ transplantation. Clin Microbiol Infect 2015; 21:511.e1-7. [DOI: 10.1016/j.cmi.2014.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/20/2014] [Accepted: 12/24/2014] [Indexed: 11/28/2022]
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Cantisán S, Rodelo-Haad C, Páez-Vega A, Nieto A, Vaquero JM, Poyato A, Montejo M, Fariñas MC, Rivero A, Solana R, Martín-Malo A, Torre-Cisneros J. Factors related to the development of CMV-specific CD8+ T cell response in CMV-seropositive solid organ transplant candidates. Am J Transplant 2015; 15:715-22. [PMID: 25648131 DOI: 10.1111/ajt.13012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 06/11/2014] [Revised: 09/10/2014] [Accepted: 09/11/2014] [Indexed: 01/25/2023]
Abstract
This cross-sectional study analyzes factors associated with the development of CMV-specific CD8+ response, measured by IFNg production after cytomegalovirus (CMV) peptide stimulation, in CMV-seropositive solid organ transplantation candidates. A total of 114 candidates were enrolled, of whom 22.8% (26/114) were nonreactive (IFNγ < 0.2 IU/mL). Multivariate logistic regression analysis showed that age, HLA alleles and organ to be transplanted were associated with developing CMV-specific CD8+ immunity (reactive; IFNγ ≥ 0.2 IU/mL). The probability of being reactive was higher in candidates over 50 than in those under 50 (OR 6.33, 95%CI 1.93-20.74). Candidates with HLA-A1 and/or HLA-A2 alleles had a higher probability of being reactive than those with non-HLA-A1/non-HLA-A2 alleles (OR 10.97, 95%CI 3.36-35.83). Renal candidates had a higher probability of being reactive than lung (adjusted OR 8.85, 95%CI 2.24-34.92) and liver candidates (OR 4.87, 95%CI 1.12-21.19). The AUC of this model was 0.84 (p < 0.001). Positive and negative predictive values were 84.8% and 76.9%, respectively. In renal candidates longer dialysis was associated with an increased frequency of reactive individuals (p = 0.040). Therefore, although the assessment of CMV-specific CD8+ response is recommended in all R+ candidates, it is essential in those with a lower probability of being reactive, such as non-renal candidates, candidates under 50 or those with non-HLA-A1/non-HLA-A2 alleles.
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Affiliation(s)
- S Cantisán
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
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Gonzalez-Padilla M, Torre-Cisneros J, Rivera-Espinar F, Pontes-Moreno A, Lopez-Cerero L, Pascual A, Natera C, Rodriguez M, Salcedo I, Rodriguez-Lopez F, Rivero A, Rodriguez-Bano J. Gentamicin therapy for sepsis due to carbapenem-resistant and colistin-resistant Klebsiella pneumoniae. J Antimicrob Chemother 2014; 70:905-13. [DOI: 10.1093/jac/dku432] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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22
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Len O, Montejo M, Cervera C, Fariñas MC, Sabé N, Ramos A, Cordero E, Torre-Cisneros J, Martín-Dávila P, Azanza JR, Pahissa A, Gavaldà J. Daptomycin is safe and effective for the treatment of gram-positive cocci infections in solid organ transplantation. Transpl Infect Dis 2014; 16:532-8. [PMID: 24834833 DOI: 10.1111/tid.12232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 09/06/2013] [Revised: 11/04/2013] [Accepted: 01/27/2014] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Infections caused by resistant gram-positive cocci (GPC), especially to glycopeptides, are difficult to treat in solid organ transplant (SOT) recipients as a result of lower effectiveness and high rates of renal impairment. The aim of this study was to evaluate the use of daptomycin in this population. METHODS Over a 2-year period (March 2008-2010) in 9 Spanish centers, we enrolled all consecutive recipients who received daptomycin to treat GPC infection. The study included 43 patients, mainly liver and kidney transplant recipients. RESULTS The most frequent infections were catheter-related bacteremia caused by coagulase-negative staphylococci (23.2%), skin infection caused by Staphylococcus aureus (11.5%), and intra-abdominal abscess caused by Enterococcus faecium (20.9%). The daily daptomycin dose was 6 mg/kg in 32 patients (74.4%). On day 7 of daptomycin treatment, median estimated area under the curve was 1251 μg/mL/h. At the end of follow-up, analytical parameters were similar to the values at the start of therapy. No changes were observed in tacrolimus levels. No patient required discontinuation of daptomycin because of adverse effects. Clinical success at treatment completion was achieved in 37 (86%) patients. Three patients died while on treatment with daptomycin. CONCLUSION In summary, daptomycin was a safe and useful treatment for GPC infection in SOT recipients.
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Affiliation(s)
- O Len
- Department of Infectious Diseases, Hospital Vall d'Hebron, Barcelona, Spain
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Meije Y, Fortún J, Len Ó, Aguado JM, Moreno A, Cisneros JM, Gurguí M, Carratalà J, Muñoz P, Montejo M, Blanes M, Bou G, Pérez JL, Torre-Cisneros J, Ramos A, Pahissa A, Gavaldà J. Prevention strategies for cytomegalovirus disease and long-term outcomes in the high-risk transplant patient (D+/R-): experience from the RESITRA-REIPI cohort. Transpl Infect Dis 2014; 16:387-96. [PMID: 24807640 DOI: 10.1111/tid.12226] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/27/2013] [Accepted: 01/20/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV)-negative recipients of a graft from a CMV-positive donor (D+/R-) are at high risk of CMV disease. Current preventive strategies include universal prophylaxis (UP) and preemptive therapy (PT). However, the best strategy to prevent CMV disease and achieve better long-term outcomes remains a matter of debate. METHODS We analyzed the incidence of CMV disease and long-term outcomes including graft dysfunction and patient mortality at 5 years after transplantation with both preventive strategies. High-risk (D+/R-) kidney and liver transplant recipients from the RESITRA cohort were included. RESULTS Of 2410 kidney or liver transplant patients, 195 (8.3%) were D+/R-. The final cohort included 58 liver and 102 kidney recipients. UP was given in 92 patients and 68 received PT; 10.9% and 36.8% developed CMV disease, respectively (P < 0.01). The independent risk factors for CMV disease were PT strategy (hazard ratio [HR], 3.30; 95% confidence interval [CI], 1.6-6.9), kidney transplantation (HR, 3.8; 95% CI, 1.4-9.9), and cyclosporine immunosuppression (HR, 2.4; 95% CI, 1.2-4.7). PT strategy was also a risk factor for CMV disease in both liver transplantation (HR, 11.0; 95% CI, 1.2-98.7) and kidney transplantation (HR, 2.7; 95% CI, 1.3-6.0), independently. The development of CMV replication during the first 2 years after transplantation was a risk factor for graft dysfunction at 5 years after transplantation (odds ratio, 3.4; 95% CI, 1.3-9.0). Nevertheless, no significant differences were seen in either graft dysfunction or mortality between the 2 strategies. CONCLUSIONS The study supports the benefit of the UP strategy to prevent CMV disease in D+/R- liver or kidney transplant patients. The development of CMV replication during the first 2 years after transplantation was associated with graft dysfunction at 5 years after transplantation.
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Affiliation(s)
- Y Meije
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Cantisán S, Lara R, Montejo M, Redel J, Rodríguez-Benot A, Gutiérrez-Aroca J, González-Padilla M, Bueno L, Rivero A, Solana R, Torre-Cisneros J. Pretransplant interferon-γ secretion by CMV-specific CD8+ T cells informs the risk of CMV replication after transplantation. Am J Transplant 2013; 13:738-45. [PMID: 23311355 DOI: 10.1111/ajt.12049] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/30/2012] [Accepted: 11/02/2012] [Indexed: 01/25/2023]
Abstract
In this prospective study we analyzed pretransplant interferon-γ secretion by cytomegalovirus (CMV)-specific CD8+ T cells to assess its possible utility in determining the risk of CMV replication after solid organ transplantation. A total of 113 lung and kidney transplant patients were enrolled in the study but only 55 were evaluable. All CMV-seronegative recipients were pretransplant "nonreactive" (IFNγ <0.2 IU/mL) (11/11), whereas 30/44 (68.2%) CMV-seropositive (R+) recipients were "reactive" (IFNγ ≥0.2 IU/mL) and 14/44 (31.8%) were "nonreactive". In the R(+) "nonreactive" group, 7/14 (50%) developed posttransplant CMV replication, whereas the virus replicated only in 4/30 (13.3%) of the R(+) "reactive" patients (p = 0.021). According to the best multivariate model, pretransplant "nonreactive" recipients receiving an organ from a CMV-seropositive donor had a 10-fold increased risk of CMV replication compared to pretransplant "reactive" recipients (adjusted OR 10.49, 95% CI 1.88-58.46). This model displayed good discrimination ability (AUC 0.80) and calibration (Hosmer-Lemeshow test, p = 0.92). Negative and positive predictive values were 83.7% and 75%, respectively. The accuracy of the model was 82%. Therefore, assessment of interferon-γ secretion by cytomegalovirus (CMV)-specific CD8+ T cells prior to transplantation is useful in informing the risk of posttransplant CMV replication in solid organ transplant patients.
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Affiliation(s)
- S Cantisán
- Instituto Maimónides de Investigación Biomédica de Córdoba-Reina Sofia University Hospital-University of Cordoba, Cordoba, Spain.
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25
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Gasch O, Camoez M, Dominguez MA, Padilla B, Pintado V, Almirante B, Lepe JA, Lagarde M, Ruiz de Gopegui E, Martinez JA, Montejo M, Torre-Cisneros J, Arnaiz A, Goenaga MA, Benito N, Rodriguez-Bano J, Pujol M. Predictive factors for early mortality among patients with methicillin-resistant Staphylococcus aureus bacteraemia. J Antimicrob Chemother 2013; 68:1423-30. [DOI: 10.1093/jac/dkt016] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Rivero-Juarez A, Mira JA, Camacho A, Neukam K, Perez-Camacho I, Caruz A, Macias J, Torre-Cisneros J, Pineda JA, Rivero A. Baseline risk factors for relapse in HIV/HCV co-infected patients treated with PEG-IFN/RBV. Infection 2012; 41:21-6. [DOI: 10.1007/s15010-012-0352-4] [Citation(s) in RCA: 6] [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: 01/09/2012] [Accepted: 10/03/2012] [Indexed: 12/25/2022]
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Miro JM, Montejo M, Castells L, Rafecas A, Moreno S, Agüero F, Abradelo M, Miralles P, Torre-Cisneros J, Pedreira JD, Cordero E, de la Rosa G, Moyano B, Moreno A, Perez I, Rimola A. Outcome of HCV/HIV-coinfected liver transplant recipients: a prospective and multicenter cohort study. Am J Transplant 2012; 12:1866-76. [PMID: 22471341 DOI: 10.1111/j.1600-6143.2012.04028.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Eighty-four HCV/HIV-coinfected and 252-matched HCV-monoinfected liver transplant recipients were included in a prospective multicenter study. Thirty-six (43%) HCV/HIV-coinfected and 75 (30%) HCV-monoinfected patients died, with a survival rate at 5 years of 54% (95% CI, 42-64) and 71% (95% CI, 66 to 77; p = 0.008), respectively. When both groups were considered together, HIV infection was an independent predictor of mortality (HR, 2.202; 95% CI, 1.420-3.413 [p < 0.001]). Multivariate analysis of only the HCV/HIV-coinfected recipients, revealed HCV genotype 1 (HR, 2.98; 95% CI, 1.32-6.76), donor risk index (HR, 9.48; 95% CI, 2.75-32.73) and negative plasma HCV RNA (HR, 0.14; 95% CI, 0.03-0.62) to be associated with mortality. When this analysis was restricted to pretransplant variables, we identified three independent factors (HCV genotype 1, pretransplant MELD score and centers with <1 liver transplantation/year in HIV-infected patients) that allowed us to identify a subset of 60 (71%) patients with a similar 5-year prognosis (69%[95% CI, 54-80]) to that of HCV-monoinfected recipients. In conclusion, 5-year survival in HCV/HIV-coinfected liver recipients was lower than in HCV-monoinfected recipients, although an important subset with a favorable prognosis was identified in the former.
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Affiliation(s)
- J M Miro
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
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Vidal E, Torre-Cisneros J, Blanes M, Montejo M, Cervera C, Aguado JM, Len O, Carratalá J, Cordero E, Bou G, Muñoz P, Ramos A, Gurguí M, Borrell N, Fortún J. Bacterial urinary tract infection after solid organ transplantation in the RESITRA cohort. Transpl Infect Dis 2012; 14:595-603. [PMID: 22650416 DOI: 10.1111/j.1399-3062.2012.00744.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 01/18/2012] [Accepted: 03/27/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Urinary tract infection (UTI) is the most common infection in renal transplant patients, but it is necessary to determine the risk factors for bacterial UTI in recipients of other solid organ transplants (SOTs), as well as changes in etiology, clinical presentation, and prognosis. METHODS In total, 4388 SOT recipients were monitored in 16 transplant centers belonging to the Spanish Network for Research on Infection in Transplantation (RESITRA). The frequency and characteristics of bacterial UTI in transplant patients were obtained prospectively from the cohort (September 2003 to February 2005). RESULTS A total of 192 patients (4.4%) presented 249 episodes of bacterial UTI (0.23 episodes per 1000 transplantation days); 156 patients were kidney or kidney-pancreas transplant recipients, and 36 patients were liver, heart, and lung transplant recipients. The highest frequency was observed in renal transplants (7.3%). High frequency of cystitis versus pyelonephritis without related mortality was observed in both groups. The most frequent etiology was Escherichia coli (57.8%), with 25.7% producing extended-spectrum β-lactamase (ESBL). In all transplants but renal, most cases occurred in the first month after transplantation. Cases were uniformly distributed during the first 6 months after transplantation in renal recipients. Age (odds ratio [OR] per decade 1.1, 95% confidence interval [CI] 1.02-1.17), female gender (OR 1.74, 95% CI 1.42-2.13), and the need for immediate post-transplant dialysis (OR 1.63, 95% CI 1.29-2.05) were independent variables associated with bacterial UTI in renal and kidney-pancreas recipients. The independent risk factors identified in non-renal transplants were age (OR per decade 1.79, 95% CI 1.09-3.48), female gender (OR 1.7, 95% CI 1.43-2.49), and diabetes (OR 1.02, 95% CI 1.001-1.040). CONCLUSIONS UTI was frequent in renal transplants, but also not unusual in non-renal transplants. Because E. coli continues to be the most frequent etiology, the emergence of ESBL-producing strains has been identified as a new problem. In both populations, most cases were cystitis without related mortality. Although the first month after transplantation was a risk period in all transplants, cases were uniformly distributed during the first 6 months in renal transplants. Age and female gender were identified as risk factors for UTI in both populations. Other particular risk factors were the need for immediate post-transplant dialysis in renal transplants and diabetes in non-renal transplants.
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Affiliation(s)
- E Vidal
- Unit of Infectious Diseases, Reina Sofía University Hospital-IMIBIC, Córdoba, Spain.
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Cordero E, Perez-Ordoñez A, Aydillo TA, Torre-Cisneros J, Gavalda J, Lara R, Segura C, Len O, Cabral E, Gasch A, Pachon J, Perez-Romero P. Therapy with m-TOR inhibitors decreases the response to the pandemic influenza A H1N1 vaccine in solid organ transplant recipients. Am J Transplant 2011; 11:2205-13. [PMID: 21831151 DOI: 10.1111/j.1600-6143.2011.03692.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Concern has been raised regarding the response to vaccination in solid organ transplant recipients (SOTR) undergoing immunosuppressant regimens and the possibility of rejection related to the immune response associated with pandemic influenza H1N1-2009 vaccination. The goal of this study was to assess the immunogenicity, efficacy and safety of the pandemic vaccine in SOTR. We performed a multicenter prospective study in SOTR receiving the pandemic vaccine. Immunological response was determined in serum 5 weeks after vaccination by microneutralization assays, and immunoglobulins were measured by ELISA. Three hundred and forty-six SOTR were included. Preexisting seroprotection was detected in 13.6% of cases and rates of seroconversion and seroprotection after vaccination were 73.1% and 82.9%, respectively. Patients with baseline antibody titers had better geometric mean titers (GMT)-post after pandemic vaccination (339.4 vs. 121.4, p < 0.001). Younger age, liver disease and m-TOR inhibitor therapy were independently associated with lower seroprotection and GMT-post. There were no major adverse effects or rejection episodes. Pandemic vaccine was safe in SOTR and elicited an adequate response, although lower than in healthy individuals. This is the first study describing a decreased response after vaccination in patients receiving mTOR inhibitors who presented lower seroprotection rates and lower GMT-post.
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Affiliation(s)
- E Cordero
- Unit of Infectious Disease, Microbiology and Preventive Medicine, Institute of Biomedicine of Sevilla (IBiS), University Hospital Virgen del Roc´ıo/CSIC/University of Sevilla, Sevilla, Spain
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Castón JJ, Linares MJ, Rivero A, Casal M, Torre-Cisneros J. Clinical differences between invasive pulmonary infection by Scedosporium apiospermum and invasive pulmonary aspergillosis. Mycoses 2011; 54:e468-73. [DOI: 10.1111/j.1439-0507.2010.01952.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rivero-Juarez A, Mira JA, Perez-Camacho I, Macias J, Camacho A, Neukam K, Torre-Cisneros J, Merchante N, Pineda JA, Rivero A. Twelve week post-treatment follow-up predicts sustained virological response to pegylated interferon and ribavirin therapy in HIV/hepatitis C virus co-infected patients. J Antimicrob Chemother 2011; 66:1351-3. [DOI: 10.1093/jac/dkr091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Fortun J, Martin-Davila P, Pascual J, Cervera C, Moreno A, Gavalda J, Aguado J, Pereira P, Gurguí M, Carratala J, Fogueda M, Montejo M, Blasco F, Bou G, Torre-Cisneros J. Immunosuppressive therapy and infection after kidney transplantation. Transpl Infect Dis 2010; 12:397-405. [DOI: 10.1111/j.1399-3062.2010.00526.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Blanco-Molina A, Lopez Segura F, Vara E, Lopez Miranda J, Torre-Cisneros J, Perez-Jimenez F. Different secretory response of pancreatic isolated lobules and dissociated acini from hypothyroid rats to exogen TRH. Exp Clin Endocrinol 2009; 98:15-22. [PMID: 1718766 DOI: 10.1055/s-0029-1211095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This paper analyses the effect of hypothyroidism on pancreatic TRH and somatostatin concentrations, as well as the action of exogen TRH on pancreatic amylase secretion from isolated lobules and dissociated acini of both healthy and hypothyroid rats. In the hypothyroid group, pancreatic TRH and somatostatin increased. In the pancreatic lobules of untreated animals, bethanechol produced stimulatory action that was inhibited by TRH. On the other hand, lobules from hypothyroid rats did not respond to bethanechol stimulation. Acini amylase secretion after bethanechol stimulation was similar in both groups, although hypothyroid animals were more sensitive to the inhibitory effect of TRH. These findings suggest the existence of a factor blocking the amylase secretion in pancreatic lobules. This agent, probably TRH, could be eliminated in the experimental model of dissociated acini.
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Affiliation(s)
- A Blanco-Molina
- Department of Internal Medicine, Reina Sofia Hospital, S.A.S., Madrid, Spain
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Abstract
Invasive fungal infection is a growing cause of morbidity and mortality in immunosuppressed patients. Furthermore, the use of azole prophylaxis against Candida species has coincided with an increase in the incidence of invasive aspergillosis and infections by other filamentous fungi such as Mucorales. New risk factors and different timescales for onset have been identified. Knowledge of changes in the epidemiology of, and risk factors for, invasive fungal infection is particularly important when developing therapeutic strategies and effective prophylaxis to improve the prognosis of immunosuppressed patients.
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Affiliation(s)
- J J Castón-Osorio
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain.
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Ramos A, Asensio A, Muñez E, Torre-Cisneros J, Blanes M, Carratalá J, Segovia J, Munoz P, Cisneros J, Bou G, Aguado J, Cervera C, Gurgui M. Incisional surgical infection in heart transplantation. Transpl Infect Dis 2008; 10:298-302. [DOI: 10.1111/j.1399-3062.2008.00316.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rivero A, García-Lázaro M, Pérez-Camacho I, Natera C, del Carmen Almodovar M, Camacho A, Torre-Cisneros J. Successful Long-Term Treatment with Linezolid for Disseminated Infection with Multiresistant Nocardia farcinica. Infection 2008; 36:389-91. [DOI: 10.1007/s15010-008-7236-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 03/13/2008] [Indexed: 11/24/2022]
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San Juan R, Aguado JM, Lumbreras C, Díaz-Pedroche C, López-Medrano F, Lizasoain M, Gavalda J, Montejo M, Moreno A, Gurguí M, Torre-Cisneros J. Incidence, clinical characteristics and risk factors of late infection in solid organ transplant recipients: data from the RESITRA study group. Am J Transplant 2007; 7:964-71. [PMID: 17391136 DOI: 10.1111/j.1600-6143.2006.01694.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [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: 01/25/2023]
Abstract
Information describing the incidence and clinical characteristics of late infection (LI) in solid organ transplantation (SOT) is scarce. The aim of this study was to define the incidence, clinical characteristics and risk factors for LI (>6 months) as compared with infection in the early period (<6 months) after SOT. By the online database of the Spanish Network of Infection in Transplantation (RESITRA) we prospectively analyzed 2702 SOT recipients from September 2003 to February 2005. Univariate and multivariate analysis using logistic regression were performed to calculate the risk factors associated with the development of LI. A total of 131 patients developed 176 LI episodes (8%). Global incidence of LI was 0.4 per 1000 transplant-days, ranging from 0.3/1000 in kidney transplants to 1.4 in lung transplants. Independent risk factors for LI in were: acute rejection in the early period (OR 1.5; CI 95%: 1.1-2.3), chronic graft malfunction (OR 2; CI 95%: 1.4-3), re-operation (OR 1.9; CI 95%: 1.3-2.8) relapsing viral infection apart from CMV (OR 1.9; CI 95%: 1.1-3.5), previous bacterial infection (OR 1.8; CI 95%: 1.2-2.6) and lung transplantation (OR 4.5; CI 95%: 2.6-7.8). Severe LI occurs in a subgroup of high-risk SOT recipients who deserve a more careful follow-up and could benefit from prolonged prophylactic measures similar to that performed in the early period after transplantation.
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Affiliation(s)
- R San Juan
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain.
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Torre-Cisneros J, Del Castillo M, Castón JJ, Castro MC, Pérez V, Collantes E. Infliximab does not activate replication of lymphotropic herpesviruses in patients with refractory rheumatoid arthritis. Rheumatology (Oxford) 2005; 44:1132-5. [PMID: 15927999 DOI: 10.1093/rheumatology/keh696] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [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: 12/18/2022] Open
Abstract
OBJECTIVE The reactivation of human lymphotropic herpesviruses can be related to the intensity of immunosuppression. We analysed the risk of reactivation of lymphotropic herpesviruses in patients with refractory rheumatoid arthritis treated with an anti-tumour necrosis factor-alpha (TNF-alpha) agent (infliximab). METHODS Fifteen patients were treated with infliximab (3 mg/kg) at weeks 0, 2 and 6. Samples of both plasma and peripheral blood mononuclear cells (PBMC) were obtained before treatment (week 0) and before each infusion at weeks 2 and 6. Samples were analysed using a multiplex qualitative polymerase chain reaction (PCR) for lymphotropic herpesviruses. Quantification of cytomegalovirus (CMV) viral load (copies/ml) was performed using quantitative PCR. Reactivation was defined as the presence of viral DNA in plasma. Latent infection was defined as the presence of viral DNA in PBMC samples but not in plasma. RESULTS On baseline, latent CMV infection was detected in eight patients (53.3%), human herpesviruses-6 (HHV-6) in two (13.3%), Epstein-Barr virus (EBV) in seven (46.6%), CMV + HHV-6 in one (6.6%), CMV + EBV in two (13.3%) and HHV-6 + EBV in one (6.6%). Viral reactivation related to infliximab treatment was not observed. There was only one patient who had HHV-6 reactivation, but this was already detected in the baseline sample. CONCLUSIONS Infliximab treatment does not induce replication of human lymphotropic herpesviruses in patients with rheumatoid arthritis. Thus, herpesviruses prophylaxis would not be indicated in these patients.
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Affiliation(s)
- J Torre-Cisneros
- Section of Infectious Diseases, Reina Sofía University Hospital, Córdoba, Spain.
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40
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Gavalda J, Len O, San Juan R, Aguado JM, Fortun J, Lumbreras C, Moreno A, Munoz P, Blanes M, Ramos A, Rufi G, Gurgui M, Torre-Cisneros J, Montejo M, Cuenca-Estrella M, Rodriguez-Tudela JL, Pahissa A. Risk factors for invasive aspergillosis in solid-organ transplant recipients: a case-control study. Clin Infect Dis 2005; 41:52-9. [PMID: 15937763 DOI: 10.1086/430602] [Citation(s) in RCA: 219] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2004] [Accepted: 02/19/2005] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND To facilitate the design of strategies for prevention of invasive aspergillosis in solid-organ transplant recipients, this study investigates whether the development of early-onset and late-onset aspergillosis are related to different risk factors, thereby distinguishing 2 risk populations for this serious complication. METHODS A retrospective case-control study was performed, including 156 cases of proven or probable invasive aspergillosis in patients recruited from 11 Spanish centers since the start of the centers' transplantation programs. RESULTS Among all patients, 57% had early-onset IA (i.e., occurred during the first 3 months after transplantation). Risk factor analysis in this group identified as significantly associated risk factors a more complicated postoperative period, repeated bacterial infections or cytomegalovirus disease, and renal failure or the need for dialysis. Among patients with late-onset infections (i.e., occurred > 3 months after transplantation), who comprised 43% of cases, the patients at risk were older, were in an overimmunosuppressed state because of chronic transplant rejection or allograft dysfunction, and had posttransplantation renal failure. CONCLUSIONS Risk factors in patients with early-onset cases and patients with late-onset cases of posttransplantation invasive aspergillosis are not the same, a fact that could have implications for the preventive approaches used for this infection.
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Affiliation(s)
- J Gavalda
- Hospital Vall d'Hebron, Barcelona, Spain.
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41
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Soriano V, Miró JM, García-Samaniego J, Torre-Cisneros J, Núñez M, del Romero J, Martín-Carbonero L, Castilla J, Iribarren JA, Quereda C, Santín M, González J, Arribas JR, Santos I, Hernández-Quero J, Ortega E, Asensi V, del Pozo MA, Berenguer J, Tural C, Clotet B, Leal M, Mallolas J, Sánchez-Tapias JM, Moreno S, Gatell JM, Téllez MJ, Rubio R, Ledesma E, Domingo P, Barreiro P, Pedreira J, Romero M, González-Lahoz J, Lissen E. Consensus conference on chronic viral hepatitis and HIV infection: updated Spanish recommendations. J Viral Hepat 2004; 11:2-17. [PMID: 14738553 DOI: 10.1046/j.1365-2893.2003.00491.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Chronic hepatitis B and C represent a leading cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected patients worldwide. New treatment options against both hepatitis B (HBV) and C (HCV) viruses have prompted us to update previous recommendations for the management of coinfected individuals. Fifteen topics (nine related to HCV, five to HBV and one to both viruses) were selected for this purpose. A panel of Spanish experts in the field was invited to review these areas and propose specific recommendations, which were scored according to the Infectious Disease Society of America (IDSA) grading system. These guidelines represent a comprehensive and updated overview on the management of hepatitis B and C in HIV-infected patients.
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Affiliation(s)
- V Soriano
- Service of Infectious Diseases, Hospital Carlos III, Madrid, Spain.
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42
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Vidal Verdú E, Torre-Cisneros J. [Treatment of viral chronic hepatitis in HIV infected patients]. Rev Clin Esp 2003; 203:193-5. [PMID: 12681203 DOI: 10.1157/13045540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- E Vidal Verdú
- Sección de Enfermedades Infecciosas. Hospital Universitario Reina Sofía. Córdoba. Spain.
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43
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Torre-Cisneros J, Madueño JA, Herrero C, de la Mata M, Gonzalez R, Rivero A, Miño G, Sánchez-Guijo P. Pre-emptive oral ganciclovir can reduce the risk of cytomegalovirus disease in liver transplant recipients. Clin Microbiol Infect 2002; 8:773-80. [PMID: 12519350 DOI: 10.1046/j.1469-0691.2002.00510.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [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: 11/20/2022]
Abstract
A cohort of 65 liver transplant recipients was prospectively monitored with qualitative polymerase chain reaction (PCR) in plasma. The first 25 patients did not receive prophylaxis. From a consecutive group of 40 recipients, 11 high-risk patients donor CMV-seropositive/receptor CMV-seronegative (D+/R-), persistent CMV replication) received pre-emptive oral ganciclovir (1000 mg three times daily), when a marker of risk was identified, until day 90. The overall incidence of cytomegalovirus (CMV) disease at six months was 20% (five of 25 patients) in the non-prophylaxis group and 2.5% (one of 40 patients) in the group treated with pre-emptive oral ganciclovir (relative risk, 0.11; 95% confidence interval; 0.01-0.96; P = 0.04). The PCR sensitivity for detecting CMV disease was 80%, the specificity was 90%, and the positive and negative predictive values were 66% and 95%, respectively. Adverse events, graft rejection and survival were similar between groups. We conclude that pre-emptive oral ganciclovir in high-risk patients can reduce the risk of CMV disease.
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Affiliation(s)
- J Torre-Cisneros
- Section of Infectious Diseases, Liver Transplantation Unit and Service of Immunology, Hospital Universitario Reina Sofia, Cordoba, Spain.
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44
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Torre-Cisneros J, Herrero C, Cañas E, Reguera JM, De La Mata M, Gómez-Bravo MA. High mortality related with Staphylococcus aureus bacteremia after liver transplantation. Eur J Clin Microbiol Infect Dis 2002; 21:385-8. [PMID: 12072924 DOI: 10.1007/s10096-002-0725-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of the present study was to analyze the characteristics of bacteremia occurring in liver-transplant patients in Andalusia, Spain, during the 1990s. At the three participating hospitals, 405 liver transplantations were performed during the study period, and 119 bacteremic episodes were observed following 91 of them (22.4%, 29.4 episodes/100 liver transplants). Gram-positive organisms were the predominant bacteria isolated in cases of early-onset bacteremia (70.7%, P=0.04). The most common sources of bacteremia were the abdomen (33.6%) and intravascular catheters (22.7%), but frequently the source of bacteremia was unknown (31.9%). Mortality at 30 days was 21%. Isolation of Staphylococcus aureus was the only independent risk factor for mortality (relative risk, 3.13; 95% confidence interval, 1.3-7.5; P=0.01). These results indicate that control measures are required in order to reduce the incidence of gram-positive bacteremia and catheter-related infection in this patient population. The observed etiology must be considered when empirical antimicrobial therapy is indicated while awaiting blood-culture results.
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Affiliation(s)
- J Torre-Cisneros
- Sección de Enfermedades Infecciosas, HRU Reina Sofía, Avenida Menéndez Pidal sn, 14004 Córdoba, Spain.
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Lozano F, Torre-Cisneros J, Santos J, León E, Domínguez A, Montesdeoca M, Selma D, Terrón A. Impact of highly active antiretroviral therapy on fever of unknown origin in HIV-infected patients. Eur J Clin Microbiol Infect Dis 2002; 21:137-9. [PMID: 11939396 DOI: 10.1007/s10096-001-0676-y] [Citation(s) in RCA: 12] [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: 10/27/2022]
Abstract
In order to assess the impact of highly active antiretroviral therapy (HAART) on the frequency and etiology of fever of unknown origin in HIV-infected patients, a retrospective study was performed on cases of fever of unknown origin observed from January 1997 to December 1999 in seven hospitals in five cities in Andalusia, Spain. During the period specified, a total of 4,858 HIV-infected patients receiving HAART and 2,787 HIV-infected individuals not receiving HAART were studied. The frequency of fever of unknown origin was 0.6% in patients receiving HAART and 3% in non-HAART patients (P=0.001). Human immunodeficiency virus infection was the only cause of fever found more frequently in the non-HAART patient group (P=0.07). The study findings suggest that the use of HAART has reduced the frequency of fever of unknown origin in HIV-infected patients, but the etiology of the condition remains mostly unchanged.
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Affiliation(s)
- F Lozano
- Infectious Diseases Section, Hospital Universitario de Valme, Seville, Spain.
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46
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Gavilán F, Torre-Cisneros J, Vizcaíno MA, Arizón JM, Lama R, López-Rubio F, Sánchez-Guijo P. Clinical microbiological case: poor radiologic evolution of pulmonary tuberculosis in a heart transplant patient. Clin Microbiol Infect 2001; 7:367-8, 399-401. [PMID: 11531982 DOI: 10.1046/j.1198-743x.2001.00265.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- F Gavilán
- Reina Sofía University Hospital, Córdoba, Spain
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47
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Gavilán F, Torre-Cisneros J, Vizcaíno M, Arizón J, Lama R, López-Rubio F, Sánchez-Guijo P. Clinical microbiological case: poor radiologic evolution of pulmonary tuberculosis in a heart transplant patient. Clin Microbiol Infect 2001. [DOI: 10.1046/j.1198-743x.2001.00271.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: 11/20/2022]
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Torre-Cisneros J, Rivero A. [Management of chronic hepatitis C infection in patients infected with the human immunodeficiency virus: from what we know to what we ignore]. Med Clin (Barc) 2001; 116:775-8. [PMID: 11440683 DOI: 10.1016/s0025-7753(01)71984-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mañez R, Breinig MK, Linden P, Kusne S, Torre-Cisneros J, Wilson J, Starzl TE, Ho M. Factors associated with the development of post-transplant lymphoproliferative disease (PTLD) in Epstein-Barr virus (EBV)-seronegative adult liver transplant recipients. Transpl Int 2001; 7 Suppl 1:S235-7. [PMID: 11271213 DOI: 10.1111/j.1432-2277.1994.tb01356.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [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: 11/26/2022]
Abstract
Epstein-Barr virus (EBV) infection is recognized as the principal aetiological factor in the pathogenesis of post-transplant lymphoproliferative disease (PTLD), particularly when primary EBV infection occurs after transplantation. We analysed, using a time-dependent proportional hazards model, the factors associated with development of PTLD in 40 adult liver transplant recipients who were seronegative for EBV prior to transplantation. Of 40 patients, 13 (33%) had a tissue diagnosis of PTLD at a median time of 126 days after transplantation. The multivariate analysis showed that prior CMV disease, the number of steroid boluses given and the number of units of RBC and FFP transfused were significant risk factors for development of PTLD.
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Affiliation(s)
- R Mañez
- Department of Surgery and Infectious Diseases and Microbiology, School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
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50
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Linares MJ, Javier MR, Villanueva JL, Solís F, Torre-Cisneros J, Rodríguez F, Kindelán JM, Casal M. Detection of antibodies to Candida albicans germ tubes in heroin addicts with systemic candidiasis. Clin Microbiol Infect 2001; 7:218-26. [PMID: 11422247 DOI: 10.1046/j.1198-743x.2001.00229.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- M J Linares
- Department of Microbiology and Infectious Diseases Unit, Reina Sofia University Hospital, Córdoba, Spain.
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