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Pintado V, Ruiz-Garbajosa P, Aguilera-Alonso D, Baquero-Artigao F, Bou G, Cantón R, Grau S, Gutiérrez-Gutiérrez B, Larrosa N, Machuca I, Martínez Martínez L, Montero MM, Morte-Romea E, Oliver A, Paño-Pardo JR, Sorlí L. Executive summary of the consensus document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) on the diagnosis and antimicrobial treatment of infections due to carbapenem-resistant Gram-negative bacteria. Enferm Infecc Microbiol Clin (Engl Ed) 2023; 41:360-370. [PMID: 36522272 DOI: 10.1016/j.eimce.2022.06.014] [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] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 06/05/2023]
Abstract
Infections caused by multidrug resistant Gram-negative bacteria are becoming a worldwide problem due to their increasing incidence and associated high mortality. Carbapenem-resistant bacteria such as Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii are the most important in clinical practice. The objective of these guidelines is to update the recommendations for the diagnosis and treatment of infections caused by these multidrug resistant bacteria. Although 'old' antibiotics such as aminoglycosides, colistin, or tigecycline are frequently used for therapy of these bacteria, the 'new' beta-lactams such as ceftazidime-avibactam, ceftolozane-tazobactam, meropenem-vaborbactam, imipenem-cilastatin-relebactam or cefiderocol are progressively becoming the first-line therapy for most of these microorganisms. The Spanish Society of Infectious Diseases and Clinical Microbiology (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica) designated a panel of experts in the field to provide evidence-based recommendations in response to common clinical questions. This document is primarily focused on microbiological diagnosis, clinical management, and targeted antimicrobial therapy of these infections, with special attention to defining the role of the new antimicrobials in the treatment of these bacteria.
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Affiliation(s)
- Vicente Pintado
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; CIBER en Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid (CIBERINFEC), Madrid, Spain.
| | - Patricia Ruiz-Garbajosa
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal e IRYCIS, CIBERINFEC, Madrid, Spain
| | - David Aguilera-Alonso
- Unidad de Enfermedades Infecciosas Pediátricas, Servicio de Pediatría, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain; Sociedad Española de Infectología Pediátrica (SEIP), Red de Investigación Traslacional en Infectología Pediátrica (RITIP), CIBERINFEC, Spain
| | - Fernando Baquero-Artigao
- Unidad de Enfermedades Infecciosas Pediátricas, Servicio de Pediatría, Hospital La Paz, SEIP, RITIP y CIBERINFEC, Madrid, Spain
| | - Germán Bou
- Servicio de Microbiología, Complejo Hospitalario Universitario A Coruña, CIBERINFEC, A Coruña, Spain
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal e IRYCIS, CIBERINFEC, Madrid, Spain
| | - Santiago Grau
- Departamento de Farmacia, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Belén Gutiérrez-Gutiérrez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS), CIBERINFEC, Sevilla, Spain
| | - Nieves Larrosa
- Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), CIBERINFEC, Barcelona, Spain
| | - Isabel Machuca
- Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), CIBERINFEC, Córdoba, Spain
| | - Luis Martínez Martínez
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Reina Sofía, Departamento de Química Agrícola, Edafología y Microbiología, Universidad de Córdoba, IMIBIC, CIBERINFEC, Córdoba, Spain
| | - María Milagro Montero
- Universitat Pompeu Fabra, Barcelona, Spain; Servicio de Enfermedades Infecciosas, Hospital del Mar, Parc de Salut Mar, CIBERINFEC, Barcelona, Spain
| | - Elena Morte-Romea
- Servicio de Enfermedades Infecciosas, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón, CIBERINFEC, Zaragoza, Spain
| | - Antonio Oliver
- Servicio de Microbiología y Unidad de Investigación, Hospital Son Espases, CIBERINFEC, Palma de Mallorca, Spain
| | - José Ramón Paño-Pardo
- Servicio de Enfermedades Infecciosas, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón, CIBERINFEC, Zaragoza, Spain
| | - Luisa Sorlí
- Universitat Pompeu Fabra, Barcelona, Spain; Servicio de Enfermedades Infecciosas, Hospital del Mar, Parc de Salut Mar, CIBERINFEC, Barcelona, Spain
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2
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Paño-Pardo JR, Rodilla EM, Sacristan SC, Saldaña JLC, Párraga LP, León JLDP, Genti PR, Oviedo AR, Jaén MJT, Vidal-Cortes P, Sanz CC. Management of patients with suspected or confirmed antibiotic allergy. Executive summary of guidance from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Allergy and Clinical Immunology (SEAIC), the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Intensive Medicine and Coronary Care Units (SEMICYUC). Enferm Infecc Microbiol Clin (Engl Ed) 2023; 41:181-186. [PMID: 36707291 DOI: 10.1016/j.eimce.2022.08.010] [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] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 01/26/2023]
Abstract
Suspected or confirmed antibiotic allergy is a frequently encountered clinical circumstance that influences antimicrobial prescribing and often leads to the avoidable use of less efficacious and/or more toxic or costly drugs than first-line antimicrobials. Optimizing antimicrobial therapy in patients with antibiotic allergy labels has become one of the priorities of antimicrobial stewardship programs (ASP) in several countries. This guidance document aims to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. A panel of eleven members of involved Scientific Societies with expertise in the management of patients with suspected or confirmed antibiotic allergy formulated questions about the management of patients with suspected or confirmed antibiotic allergy. A systematic literature review was performed by a medical librarian. The questions were distributed among panel members who selected the most relevant references, summarized the evidence and formulated graded recommendations when possible. The answers to all questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy is recommended to improve antibiotic selection and, consequently clinical outcomes. A clinically oriented, 3-category risk-stratification strategy was recommended for patients with suspected antibiotic allergy. Complementary assessments should consider both clinical risk category and preferred antibiotic agent. Empirical therapy recommendations for the most relevant clinical syndromes in patients with suspected or confirmed β-lactam allergy were formulated. Recommendations on the implementation and monitoring of the impact of the guidelines were formulated. ASP and allergists should design and implement activities that facilitate the most adequate antibiotic use in these patients.
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Affiliation(s)
- José Ramón Paño-Pardo
- Division of Infectious Diseases, Hospital Clínico Universitario, Instituto de Investigación Sanitaria Aragón, CIBER en Enfermedades Infecciosas (CIBERINFEC), Zaragoza, Spain.
| | - Esther Moreno Rodilla
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain; IBSAL (Institute for Biomedical Research of Salamanca), Salamanca, Spain; Department of Biomedical and Diagnostic Sciences, Salamanca Medical School, University of Salamanca, Salamanca, Spain; RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL), Madrid, Spain
| | - Sara Cobo Sacristan
- Department of Pharmacy, Hospital Universitari de Bellvitge-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Cubero Saldaña
- Department of Allergy, Hospital Clínico Universitario, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Leonor Periañez Párraga
- Farmacia Hospitalaria, Hospital Universitari Son Espases, CIBER en Enfermedades Infecciosas (CIBERINFEC), Spain
| | - José Luis Del Pozo León
- Division of Infectious Diseases, Department of Microbiology, Clínica Universidad de Navarra, Spain
| | - Pilar Retamar Genti
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Instituto de Biomedicina de Sevilla/Departamento de Medicina, Universidad de Sevilla/CSIC, Sevilla, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Alejandro Rodríguez Oviedo
- Servicio de Medicina Intensiva, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain; IISPV, CIBERES, Spain
| | - María José Torres Jaén
- Allergy Unit, Hospital Regional Universitario de Málaga-HRUM, Medicine Department, Universidad de Málaga-UMA, IBIMA-ARADyAL, Málaga, Spain
| | - Pablo Vidal-Cortes
- Servicio de Medicina Intensiva, Hospital Universitario de Ourense, Orense, Spain
| | - Carlos Colás Sanz
- Department of Allergy, Hospital Clínico Universitario, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
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Paño-Pardo JR, Moreno Rodilla E, Cobo Sacristan S, Cubero Saldaña JL, Periañez Párraga L, del Pozo León JL, Retamar Genti P, Rodríguez Oviedo A, Torres Jaén MJ, Vidal-Cortes P, Colás Sanz C. Management of patients with suspected or confirmed antibiotic allergy. Executive summary of guidance from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Allergy and Clinical Immunology (SEAIC), the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Intensive Medicine and Coronary Care Units (SEMICYUC). Enferm Infecc Microbiol Clin 2023. [DOI: 10.1016/j.eimc.2022.08.003] [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: 03/06/2023]
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Molina J, Rosso-Fernández CM, Montero-Mateos E, Paño-Pardo JR, Solla M, Guisado-Gil AB, Álvarez-Marín R, Pachón-Ibáñez ME, Gimeno A, Martín-Gutiérrez G, Lepe JA, Cisneros JM. Study protocol for a randomized clinical trial to assess 7 versus 14-days of treatment for Pseudomonas aeruginosa bloodstream infections (SHORTEN-2 trial). PLoS One 2022; 17:e0277333. [PMID: 36548225 PMCID: PMC9778939 DOI: 10.1371/journal.pone.0277333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Research priorities in Antimicrobial Stewardship (AMS) have rapidly evolved in the last decade. The need for a more efficient use of antimicrobials have fueled plenty of studies to define the optimal duration for antibiotic treatments, and yet, there still are large areas of uncertainty in common clinical scenarios. Pseudomonas aeruginosa has been pointed as a priority for clinical research, but it has been unattended by most randomized trials tackling the effectiveness of short treatments. The study protocol of the SHORTEN-2 trial is presented as a practical example of new ways to approach common obstacles for clinical research in AMS. OBJECTIVE To determine whether a 7-day course of antibiotics is superior to 14-day schemes for treating bloodstream infections by P. aeruginosa (BSI-PA). METHODS A superiority, open-label, randomized controlled trial will be performed across 30 Spanish hospitals. Adult patients with uncomplicated BSI-PA will be randomized to receive a 7 versus 14-day course of any active antibiotic. The primary endpoint will be the probability for the 7-day group of achieving better outcomes than the control group, assessing altogether clinical effectiveness, severe adverse events, and antibiotic exposure through a DOOR/RADAR analysis. Main secondary endpoints include treatment failure, BSI-PA relapses, and mortality. A superiority design was set for the primary endpoint and non-inferiority for treatment failure, resulting in a sample size of 304 patients. CONCLUSIONS SHORTEN-2 trial aligns with some of the priorities for clinical research in AMS. The implementation of several methodological innovations allowed overcoming common obstacles, like feasible sample sizes or measuring the clinical impact and unintended effects. TRIAL REGISTRATION EudraCt: 2021-003847-10; ClinicalTrials.gov: NCT05210439.
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Affiliation(s)
- José Molina
- Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Enrique Montero-Mateos
- Department of Pathology and Institute of Biomedical Research of Salamanca (IBSAL), University Hospital of Salamanca, Salamanca, Spain
| | - José Ramón Paño-Pardo
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - María Solla
- Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain
- Unidad de Investigación Clínica y Ensayos Clínicos (CTU), Hospital Virgen del Rocío, Sevilla, Spain
| | - Ana Belén Guisado-Gil
- Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Pharmacy, Virgen del Rocío University Hospital, Seville, Spain
| | - Rocío Álvarez-Marín
- Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - María Eugenia Pachón-Ibáñez
- Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Adelina Gimeno
- Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Guillermo Martín-Gutiérrez
- Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - José Antonio Lepe
- Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - José Miguel Cisneros
- Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- * E-mail:
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5
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Paño-Pardo JR, Moreno Rodilla E, Cobo Sacristan S, Cubero Saldaña JL, Periañez Párraga L, Del Pozo León JL, Retamar Genti P, Rodríguez Oviedo A, Torres Jaén MJ, Vidal-Cortes P, Colás Sanz C. Management of Patients with Suspected or Confirmed Antibiotic Allergy. Executive Summary of Guidance from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Allergy and Clinical Immunology (SEAIC), the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Intensive Medicine and Coronary Care Units (SEMICYUC). J Investig Allergol Clin Immunol 2022; 33:95-101. [PMID: 36069440 DOI: 10.18176/jiaci.0859] [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] [Indexed: 11/20/2022] Open
Abstract
Suspected or confirmed antibiotic allergy is a frequently encountered clinical circumstance that influences antimicrobial prescribing and often leads to the avoidable use of less efficacious and / or more toxic or costly drugs than first-line antimicrobials. Optimizing antimicrobial therapy in patients with antibiotic allergy labels has become one of the priorities of antimicrobial stewardship programs (ASP) in several countries. This guidance document aims to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. A panel of eleven members of involved Scientific Societies with expertise in the management of patients with suspected or confirmed antibiotic allergy formulated questions about the management of patients with suspected or confirmed antibiotic allergy. A systematic literature review was performed by a medical librarian. The questions were distributed among panel members who selected the most relevant references, summarized the evidence and formulated graded recommendations when possible. The answers to all questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy is recommended to improve antibiotic selection and, consequently clinical outcomes. A clinically-oriented, 3-category risk-stratification strategy was recommended for patients with suspected antibiotic allergy. Complementary assessments should consider both clinical risk category and preferred antibiotic agent. Empirical therapy recommendations for the most relevant clinical syndromes in patients with suspected or confirmed -lactam allergy were formulated. Recommendations on the implementation and monitoring of the impact of the guidelines were formulated. ASP and allergists should design and implement activities that facilitate the most adequate antibiotic use in these patients.
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Affiliation(s)
- J R Paño-Pardo
- Division of Infectious Diseases. Hospital Clínico Universitario. Instituto de Investigación Sanitaria Aragón. Zaragoza, Spain. CIBER en Enfermedades Infecciosas (CIBERINFEC)
| | - E Moreno Rodilla
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain. IBSAL (Institute for Biomedical Research of Salamanca), Salamanca, Spain. Department of Biomedical and Diagnostic Sciences, Salamanca Medical School, University of Salamanca, Salamanca
| | - S Cobo Sacristan
- Department of Pharmacy, Hospital Universitari de Bellvitge-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - J L Cubero Saldaña
- Department of Allergy. Hospital Clínico Universitario. Instituto de Investigación Sanitaria Aragón. Zaragoza, Spain
| | - L Periañez Párraga
- Farmacia hospitalaria. Hospital Universitari Son Espases. CIBER en Enfermedades Infecciosas (CIBERINFEC)
| | - J L Del Pozo León
- Division of Infectious Diseases. Department of Microbiology. Clínica Universidad de Navarra
| | - P Retamar Genti
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain. Instituto de Biomedicina de Sevilla / Departamento de Medicina, Universidad de Sevilla / CSIC, Sevilla, Spain. Centro de Investigación Biom
| | - A Rodríguez Oviedo
- Servicio de Medicina Intensiva. Hospital Universitari de Tarragona Joan XXIII. Tarragona, Spain. IISPV. CIBERES
| | - M J Torres Jaén
- Allergy Unit. Hospital Regional Universitario de Málaga-HRUM. Medicine Department, Universidad de Málaga-UMA, IBIMA-ARADyAL, Málaga, Spain
| | - P Vidal-Cortes
- Servicio de Medicina Intensiva. Hospital Universitario de Ourense. Orense, Spain
| | - C Colás Sanz
- Department of Allergy. Hospital Clínico Universitario. Instituto de Investigación Sanitaria Aragón. Zaragoza, Spain
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6
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Bartoletti M, Azap O, Barac A, Bussini L, Ergonul O, Krause R, Paño-Pardo JR, Power NR, Sibani M, Szabo BG, Tsiodras S, Verweij PE, Zollner-Schwetz I, Rodríguez-Baño J. ESCMID COVID-19 living guidelines: drug treatment and clinical management. Clin Microbiol Infect 2022; 28:222-238. [PMID: 34823008 PMCID: PMC8606314 DOI: 10.1016/j.cmi.2021.11.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 02/08/2023]
Abstract
SCOPE In January 2021, the ESCMID Executive Committee decided to launch a new initiative to develop ESCMID guidelines on several COVID-19-related issues, including treatment of COVID-19. METHODS An ESCMID COVID-19 guidelines task force was established by the ESCMID Executive Committee. A small group was established, half appointed by the chair, and the remaining selected with an open call. Each panel met virtually once a week. For all decisions, a simple majority vote was used. A long list of clinical questions using the PICO (population, intervention, comparison, outcome) format was developed at the beginning of the process. For each PICO, two panel members performed a literature search with a third panellist involved in case of inconsistent results. Voting was based on the GRADE approach. QUESTIONS ADDRESSED BY THE GUIDELINE AND RECOMMENDATIONS A synthesis of the available evidence and recommendations is provided for each of the 15 PICOs, which cover use of hydroxychloroquine, bamlanivimab alone or in combination with etesevimab, casirivimab combined with imdevimab, ivermectin, azithromycin and empirical antibiotics, colchicine, corticosteroids, convalescent plasma, favipiravir, remdesivir, tocilizumab and interferon β-1a, as well as the utility of antifungal prophylaxis and enoxaparin. In general, the panel recommended against the use of hydroxychloroquine, ivermectin, azithromycin, colchicine and interferon β-1a. Conditional recommendations were given for the use of monoclonal antibodies in high-risk outpatients with mild-moderate COVID-19, and remdesivir. There was insufficient evidence to make a recommendation for use of favipiravir and antifungal prophylaxis, and it was recommended that antibiotics should not be routinely prescribed in patients with COVID-19 unless bacterial coinfection or secondary infection is suspected or confirmed. Tocilizumab and corticosteroids were recommended for treatment of severe COVID-19 but not in outpatients with non-severe COVID-19. SCOPE The aim of the present guidance is to provide evidence-based recommendations for management of adults with coronavirus disease 2019 (COVID-19). More specifically, the goal is to aid clinicians managing patients with COVID-19 at various levels of severity including outpatients, hospitalized patients, and those admitted to intensive care unit. Considering the composition of the panel, mostly clinical microbiologists or infectious disease specialists with no pulmonology or intensive care background, we focus only on pharmacological treatment and do not give recommendations on oxygen supplement/support. Similarly, as no paediatricians were included in the panel; the recommendations are only for adult patients with COVID-19. Considering the current literature, no guidance was given for special populations such as the immunocompromised.
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Affiliation(s)
- Michele Bartoletti
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Ozlem Azap
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Linda Bussini
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Onder Ergonul
- Koc University Research Centre for Infectious Diseases, Istanbul, Turkey
| | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - José Ramón Paño-Pardo
- Fundación Instituto de Investigación Sanitaria Aragón (IIS Aragón), Biomedical Research Centre of Aragón (CIBA), Zaragoza, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Nicholas R Power
- Royal College of Physicians of Ireland, Setanta House, Setanta Pl, Dublin, Ireland
| | - Marcella Sibani
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Balint Gergely Szabo
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Budapest, Hungary; School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Paul E Verweij
- Department of Medical Microbiology and Radboudumc-CWZ Centre of Expertise for Mycology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Ines Zollner-Schwetz
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jesús Rodríguez-Baño
- Clinical Unit of Infectious Diseases and Microbiology Virgen Macarena University Hospital and Department of Medicine, University of Seville, Institute of Biomedicine of Seville, Seville, Spain
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7
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Villanueva-Saz S, Giner J, Fernández A, Lacasta D, Ortín A, Ramos JJ, Ferrer LM, Ruiz de Arcaute M, Tobajas AP, Pérez MD, Verde M, Marteles D, Hurtado-Guerrero R, Pardo J, Santiago L, González-Ramírez AM, Macías-León J, García-García A, Taleb V, Lira-Navarrete E, Paño-Pardo JR, Ruíz H. Absence of SARS-CoV-2 Antibodies in Natural Environment Exposure in Sheep in Close Contact with Humans. Animals (Basel) 2021; 11:1984. [PMID: 34359111 PMCID: PMC8300300 DOI: 10.3390/ani11071984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 12/26/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the zoonotic causative agent of coronavirus disease 2019 (COVID-19) that has caused a pandemic situation with millions of infected humans worldwide. Among domestic animals, there have been limited studies regarding the transmissibility and exposure to the infection in natural conditions. Some animals are exposed and/or susceptible to SARS-CoV-2 infection, such as cats, ferrets and dogs. By contrast, there is no information about the susceptibility of ruminants to SARS-CoV-2. This study tested the antibody response in 90 ovine pre-pandemic serum samples and 336 sheep serum samples from the pandemic period (June 2020 to March 2021). In both cases, the animals were in close contact with a veterinary student community composed of more than 700 members. None of the serum samples analyzed was seroreactive based on an enzyme-linked immunosorbent assay (ELISA) using the receptor-binding domain (RBD) of the spike antigen. In this sense, no statistical difference was observed compared to the pre-pandemic sheep. Our results suggest that it seems unlikely that sheep could play a relevant role in the epidemiology of SARS-CoV-2 infection. This is the first study to report the absence of evidence of sheep exposure to SARS-CoV-2 in natural conditions.
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Affiliation(s)
- Sergio Villanueva-Saz
- Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain; (J.G.); (A.F.); (D.L.); (A.O.); (J.J.R.); (L.M.F.); (M.R.d.A.); (M.V.); (D.M.)
- Clinical Immunology Laboratory, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain
- Instituto Agroalimentario de Aragón-IA2, Universidad de Zaragoza-CITA, 50013 Zaragoza, Spain; (A.P.T.); (M.D.P.)
| | - Jacobo Giner
- Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain; (J.G.); (A.F.); (D.L.); (A.O.); (J.J.R.); (L.M.F.); (M.R.d.A.); (M.V.); (D.M.)
- Clinical Immunology Laboratory, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain
| | - Antonio Fernández
- Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain; (J.G.); (A.F.); (D.L.); (A.O.); (J.J.R.); (L.M.F.); (M.R.d.A.); (M.V.); (D.M.)
- Clinical Immunology Laboratory, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain
- Instituto Agroalimentario de Aragón-IA2, Universidad de Zaragoza-CITA, 50013 Zaragoza, Spain; (A.P.T.); (M.D.P.)
| | - Delia Lacasta
- Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain; (J.G.); (A.F.); (D.L.); (A.O.); (J.J.R.); (L.M.F.); (M.R.d.A.); (M.V.); (D.M.)
- Instituto Agroalimentario de Aragón-IA2, Universidad de Zaragoza-CITA, 50013 Zaragoza, Spain; (A.P.T.); (M.D.P.)
| | - Aurora Ortín
- Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain; (J.G.); (A.F.); (D.L.); (A.O.); (J.J.R.); (L.M.F.); (M.R.d.A.); (M.V.); (D.M.)
- Instituto Agroalimentario de Aragón-IA2, Universidad de Zaragoza-CITA, 50013 Zaragoza, Spain; (A.P.T.); (M.D.P.)
| | - Juan José Ramos
- Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain; (J.G.); (A.F.); (D.L.); (A.O.); (J.J.R.); (L.M.F.); (M.R.d.A.); (M.V.); (D.M.)
- Instituto Agroalimentario de Aragón-IA2, Universidad de Zaragoza-CITA, 50013 Zaragoza, Spain; (A.P.T.); (M.D.P.)
| | - Luis Miguel Ferrer
- Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain; (J.G.); (A.F.); (D.L.); (A.O.); (J.J.R.); (L.M.F.); (M.R.d.A.); (M.V.); (D.M.)
- Instituto Agroalimentario de Aragón-IA2, Universidad de Zaragoza-CITA, 50013 Zaragoza, Spain; (A.P.T.); (M.D.P.)
| | - Marta Ruiz de Arcaute
- Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain; (J.G.); (A.F.); (D.L.); (A.O.); (J.J.R.); (L.M.F.); (M.R.d.A.); (M.V.); (D.M.)
- Instituto Agroalimentario de Aragón-IA2, Universidad de Zaragoza-CITA, 50013 Zaragoza, Spain; (A.P.T.); (M.D.P.)
| | - Ana Pilar Tobajas
- Instituto Agroalimentario de Aragón-IA2, Universidad de Zaragoza-CITA, 50013 Zaragoza, Spain; (A.P.T.); (M.D.P.)
- Department of Animal Production and Sciences of the Food, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain
| | - María Dolores Pérez
- Instituto Agroalimentario de Aragón-IA2, Universidad de Zaragoza-CITA, 50013 Zaragoza, Spain; (A.P.T.); (M.D.P.)
- Department of Animal Production and Sciences of the Food, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain
| | - Maite Verde
- Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain; (J.G.); (A.F.); (D.L.); (A.O.); (J.J.R.); (L.M.F.); (M.R.d.A.); (M.V.); (D.M.)
- Clinical Immunology Laboratory, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain
- Instituto Agroalimentario de Aragón-IA2, Universidad de Zaragoza-CITA, 50013 Zaragoza, Spain; (A.P.T.); (M.D.P.)
| | - Diana Marteles
- Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain; (J.G.); (A.F.); (D.L.); (A.O.); (J.J.R.); (L.M.F.); (M.R.d.A.); (M.V.); (D.M.)
| | - Ramón Hurtado-Guerrero
- Institute for Biocomputation and Physics of Complex Systems (BIFI), Mariano Esquillor s/n, Campus Rio Ebro, Edificio I+D, University of Zaragoza, 50013 Zaragoza, Spain; (R.H.-G.); (A.M.G.-R.); (J.M.-L.); (A.G.-G.); (V.T.); (E.L.-N.)
- Aragon I+D Foundation (ARAID), 50018 Zaragoza, Spain;
- Laboratorio de Microscopías Avanzada (LMA), Mariano Esquillor s/n, Campus Rio Ebro, Edificio I+D, Copenhagen Center for Glycomics, 50018 Zaragoza, Spain
- Copenhagen Center for Glycomics, Department of Cellular and Molecular Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Julián Pardo
- Aragon I+D Foundation (ARAID), 50018 Zaragoza, Spain;
- Aragon Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain;
- Department of Microbiology, Pediatrics, Radiology and Public Health, Zaragoza University of Zaragoza, 50013 Zaragoza, Spain
| | - Llipsy Santiago
- Aragon Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain;
| | - Andrés Manuel González-Ramírez
- Institute for Biocomputation and Physics of Complex Systems (BIFI), Mariano Esquillor s/n, Campus Rio Ebro, Edificio I+D, University of Zaragoza, 50013 Zaragoza, Spain; (R.H.-G.); (A.M.G.-R.); (J.M.-L.); (A.G.-G.); (V.T.); (E.L.-N.)
| | - Javier Macías-León
- Institute for Biocomputation and Physics of Complex Systems (BIFI), Mariano Esquillor s/n, Campus Rio Ebro, Edificio I+D, University of Zaragoza, 50013 Zaragoza, Spain; (R.H.-G.); (A.M.G.-R.); (J.M.-L.); (A.G.-G.); (V.T.); (E.L.-N.)
| | - Ana García-García
- Institute for Biocomputation and Physics of Complex Systems (BIFI), Mariano Esquillor s/n, Campus Rio Ebro, Edificio I+D, University of Zaragoza, 50013 Zaragoza, Spain; (R.H.-G.); (A.M.G.-R.); (J.M.-L.); (A.G.-G.); (V.T.); (E.L.-N.)
| | - Víctor Taleb
- Institute for Biocomputation and Physics of Complex Systems (BIFI), Mariano Esquillor s/n, Campus Rio Ebro, Edificio I+D, University of Zaragoza, 50013 Zaragoza, Spain; (R.H.-G.); (A.M.G.-R.); (J.M.-L.); (A.G.-G.); (V.T.); (E.L.-N.)
| | - Erandi Lira-Navarrete
- Institute for Biocomputation and Physics of Complex Systems (BIFI), Mariano Esquillor s/n, Campus Rio Ebro, Edificio I+D, University of Zaragoza, 50013 Zaragoza, Spain; (R.H.-G.); (A.M.G.-R.); (J.M.-L.); (A.G.-G.); (V.T.); (E.L.-N.)
| | - José Ramón Paño-Pardo
- Infectious Disease Department, University Hospital Lozano Blesa, 50009 Zaragoza, Spain;
| | - Héctor Ruíz
- Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, 50013 Zaragoza, Spain; (J.G.); (A.F.); (D.L.); (A.O.); (J.J.R.); (L.M.F.); (M.R.d.A.); (M.V.); (D.M.)
- Instituto Agroalimentario de Aragón-IA2, Universidad de Zaragoza-CITA, 50013 Zaragoza, Spain; (A.P.T.); (M.D.P.)
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8
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Santiago L, Uranga-Murillo I, Arias M, González-Ramírez AM, Macías-León J, Moreo E, Redrado S, García-García A, Taleb V, Lira-Navarrete E, Hurtado-Guerrero R, Aguilo N, del Mar Encabo-Berzosa M, Hidalgo S, Galvez EM, Ramirez-Labrada A, de Miguel D, Benito R, Miranda P, Fernández A, Domingo JM, Serrano L, Yuste C, Villanueva-Saz S, Paño-Pardo JR, Pardo J. Determination of the Concentration of IgG against the Spike Receptor-Binding Domain That Predicts the Viral Neutralizing Activity of Convalescent Plasma and Serum against SARS-CoV-2. Biology (Basel) 2021; 10:208. [PMID: 33801808 PMCID: PMC8001978 DOI: 10.3390/biology10030208] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/01/2021] [Accepted: 03/06/2021] [Indexed: 12/22/2022]
Abstract
Several hundred millions of people have been diagnosed of coronavirus disease 2019 (COVID-19), causing millions of deaths and a high socioeconomic burden. SARS-CoV-2, the causative agent of COVID-19, induces both specific T- and B-cell responses, being antibodies against the virus detected a few days after infection. Passive immunization with hyperimmune plasma from convalescent patients has been proposed as a potentially useful treatment for COVID-19. Using an in-house quantitative ELISA test, we found that plasma from 177 convalescent donors contained IgG antibodies specific to the spike receptor-binding domain (RBD) of SARS-CoV-2, although at very different concentrations which correlated with previous disease severity and gender. Anti-RBD IgG plasma concentrations significantly correlated with the plasma viral neutralizing activity (VN) against SARS-CoV-2 in vitro. Similar results were found using an independent cohort of serum from 168 convalescent health workers. These results validate an in-house RBD IgG ELISA test in a large cohort of COVID-19 convalescent patients and indicate that plasma from all convalescent donors does not contain a high enough amount of anti-SARS-CoV-2-RBD neutralizing IgG to prevent SARS-CoV-2 infection in vitro. The use of quantitative anti-RBD IgG detection systems might help to predict the efficacy of the passive immunization using plasma from patients recovered from SARS-CoV-2.
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Affiliation(s)
- Llipsy Santiago
- Biomedical Research Centre of Aragón (CIBA), Fundación Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (L.S.); (I.U.-M.); (S.H.); (D.d.M.); (R.B.)
| | - Iratxe Uranga-Murillo
- Biomedical Research Centre of Aragón (CIBA), Fundación Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (L.S.); (I.U.-M.); (S.H.); (D.d.M.); (R.B.)
| | - Maykel Arias
- Instituto de Carboquímica (ICB), Consejo Superior de Investigaciones Científicas (CSIC), 50018 Zaragoza, Spain; (M.A.); (S.R.); (E.M.G.)
| | - Andrés Manuel González-Ramírez
- Institute for Biocomputation and Physics of Complex Systems (BIFI), Mariano Esquillor s/n, Campus Rio Ebro, Edificio I+D, 50018 Zaragoza, Spain; (A.M.G.-R.); (J.M.-L.); (A.G.-G.); (V.T.); (E.L.-N.); (R.H.-G.)
| | - Javier Macías-León
- Institute for Biocomputation and Physics of Complex Systems (BIFI), Mariano Esquillor s/n, Campus Rio Ebro, Edificio I+D, 50018 Zaragoza, Spain; (A.M.G.-R.); (J.M.-L.); (A.G.-G.); (V.T.); (E.L.-N.); (R.H.-G.)
| | - Eduardo Moreo
- Department Microbiology, Preventive Medicine and Public Health, University of Zaragoza, 50009 Zaragoza, Spain; (E.M.); (N.A.)
| | - Sergio Redrado
- Instituto de Carboquímica (ICB), Consejo Superior de Investigaciones Científicas (CSIC), 50018 Zaragoza, Spain; (M.A.); (S.R.); (E.M.G.)
| | - Ana García-García
- Institute for Biocomputation and Physics of Complex Systems (BIFI), Mariano Esquillor s/n, Campus Rio Ebro, Edificio I+D, 50018 Zaragoza, Spain; (A.M.G.-R.); (J.M.-L.); (A.G.-G.); (V.T.); (E.L.-N.); (R.H.-G.)
| | - Víctor Taleb
- Institute for Biocomputation and Physics of Complex Systems (BIFI), Mariano Esquillor s/n, Campus Rio Ebro, Edificio I+D, 50018 Zaragoza, Spain; (A.M.G.-R.); (J.M.-L.); (A.G.-G.); (V.T.); (E.L.-N.); (R.H.-G.)
| | - Erandi Lira-Navarrete
- Institute for Biocomputation and Physics of Complex Systems (BIFI), Mariano Esquillor s/n, Campus Rio Ebro, Edificio I+D, 50018 Zaragoza, Spain; (A.M.G.-R.); (J.M.-L.); (A.G.-G.); (V.T.); (E.L.-N.); (R.H.-G.)
| | - Ramón Hurtado-Guerrero
- Institute for Biocomputation and Physics of Complex Systems (BIFI), Mariano Esquillor s/n, Campus Rio Ebro, Edificio I+D, 50018 Zaragoza, Spain; (A.M.G.-R.); (J.M.-L.); (A.G.-G.); (V.T.); (E.L.-N.); (R.H.-G.)
- Aragon I+D Foundation (ARAID), 50018 Zaragoza, Spain
- Laboratorio de Microscopías Avanzada (LMA), Mariano Esquillor s/n, Campus Rio Ebro, Edificio I+D, 50018 Zaragoza, Spain
- Copenhagen Center for Glycomics, Department of Cellular and Molecular Medicine, School of Dentistry, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Nacho Aguilo
- Department Microbiology, Preventive Medicine and Public Health, University of Zaragoza, 50009 Zaragoza, Spain; (E.M.); (N.A.)
| | | | - Sandra Hidalgo
- Biomedical Research Centre of Aragón (CIBA), Fundación Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (L.S.); (I.U.-M.); (S.H.); (D.d.M.); (R.B.)
| | - Eva M. Galvez
- Instituto de Carboquímica (ICB), Consejo Superior de Investigaciones Científicas (CSIC), 50018 Zaragoza, Spain; (M.A.); (S.R.); (E.M.G.)
| | - Ariel Ramirez-Labrada
- Unidad de Nanotoxicología e Inmunotoxicología (UNATI), Biomedical Research Centre of Aragón (CIBA), Fundación Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain;
| | - Diego de Miguel
- Biomedical Research Centre of Aragón (CIBA), Fundación Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (L.S.); (I.U.-M.); (S.H.); (D.d.M.); (R.B.)
| | - Rafael Benito
- Biomedical Research Centre of Aragón (CIBA), Fundación Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (L.S.); (I.U.-M.); (S.H.); (D.d.M.); (R.B.)
- Department Microbiology, Preventive Medicine and Public Health, University of Zaragoza, 50009 Zaragoza, Spain; (E.M.); (N.A.)
- Servicio de Microbiología, Hospital Clinico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Patricia Miranda
- Banco de Sangre y Tejidos de Aragón, 50009 Zaragoza, Spain; (P.M.); (J.M.D.)
| | - Antonio Fernández
- Department Animal Pathology, University of Zaragoza, 50013 Zaragoza, Spain;
| | - José María Domingo
- Banco de Sangre y Tejidos de Aragón, 50009 Zaragoza, Spain; (P.M.); (J.M.D.)
| | - Laura Serrano
- Servicio de Prevención de Riesgos Laborales, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (L.S.); (C.Y.)
| | - Cristina Yuste
- Servicio de Prevención de Riesgos Laborales, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (L.S.); (C.Y.)
| | - Sergio Villanueva-Saz
- Department Pharmacology and Physiology, University of Zaragoza, 50013 Zaragoza, Spain;
| | - José Ramón Paño-Pardo
- Biomedical Research Centre of Aragón (CIBA), Fundación Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (L.S.); (I.U.-M.); (S.H.); (D.d.M.); (R.B.)
- Servicio de Enfermedades Infecciosas, Hospital Clinico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Julián Pardo
- Biomedical Research Centre of Aragón (CIBA), Fundación Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain; (L.S.); (I.U.-M.); (S.H.); (D.d.M.); (R.B.)
- Department Microbiology, Preventive Medicine and Public Health, University of Zaragoza, 50009 Zaragoza, Spain; (E.M.); (N.A.)
- Aragon I+D Foundation (ARAID), 50018 Zaragoza, Spain
- Centro de Investigación Biomédicaen Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 50018 Madrid, Spain
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9
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Oteo-Iglesias J, Pérez-Vázquez M, Sola Campoy P, Moure Z, Sánchez Romero I, Sánchez Benito R, Aznar E, Seral C, Paño-Pardo JR, Ávila A, Lara N, Bautista V, Aracil B, Campos J. Emergence of blood infections caused by carbapenemase-producing Klebsiella pneumoniae ST307 in Spain. J Antimicrob Chemother 2020; 75:3402-3405. [PMID: 32772085 DOI: 10.1093/jac/dkaa301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jesús Oteo-Iglesias
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - María Pérez-Vázquez
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro Sola Campoy
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Zaira Moure
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Isabel Sánchez Romero
- Servicio de Microbiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Esteban Aznar
- Laboratorio Central de Microbiología BR-Salud, Madrid, Spain
| | - Cristina Seral
- Servicio Microbiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - José Ramón Paño-Pardo
- Servicio de Enfermedades Infecciosas, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Alicia Ávila
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Noelia Lara
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - Verónica Bautista
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - Belén Aracil
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - José Campos
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
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10
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Ramos-Ramos JC, Lázaro-Perona F, Arribas JR, García-Rodríguez J, Mingorance J, Ruiz-Carrascoso G, Borobia AM, Paño-Pardo JR, Herruzo R, Arnalich F. Proof-of-concept trial of the combination of lactitol with Bifidobacterium bifidum and Lactobacillus acidophilus for the eradication of intestinal OXA-48-producing Enterobacteriaceae. Gut Pathog 2020; 12:15. [PMID: 32280375 PMCID: PMC7137496 DOI: 10.1186/s13099-020-00354-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/31/2020] [Indexed: 11/29/2023] Open
Abstract
Background The major reservoir of carbapenemase-producing Enterobacteriaceae (CPE) is the gastrointestinal tract of colonized patients. Colonization is silent and may last for months, but the risk of infection by CPE in colonized patients is significant. Methods Eight long-term intestinal carriers of OXA-48-producing Enterobacteriaceae (OXA-PE) were treated during 3 weeks with daily oral lactitol (Emportal®), Bifidobacterium bifidum and Lactobacillus acidophilus (Infloran®). Weekly stool samples were collected during the treatment period and 6 weeks later. The presence of OXA-PE was investigated by microbiological cultures and qPCR. Results At the end of treatment (EoT, secondary endpoint 1), four of the subjects had negative OXA-PE cultures. Three weeks later (secondary endpoint 2), six subjects were negative. Six weeks after the EoT (primary endpoint), three subjects had negative OXA-PE cultures. The relative intestinal load of OXA-PE decreased in all the patients during treatment. Conclusions The combination of prebiotics and probiotics was well tolerated. A rapid reduction on the OXA-PE intestinal loads was observed. At the EoT, decolonization was achieved in three patients. Clinical Trials Registration: NCT02307383. EudraCT Number: 2014-000449-65.
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Affiliation(s)
- Juan Carlos Ramos-Ramos
- 1Unidad de Microbiología Clínica y Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Fernando Lázaro-Perona
- 2Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - José Ramón Arribas
- 1Unidad de Microbiología Clínica y Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Julio García-Rodríguez
- 2Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Jesús Mingorance
- 2Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Guillermo Ruiz-Carrascoso
- 2Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Alberto M Borobia
- 3Departamento de Farmacología Clínica, Hospital Universitario La Paz, Paseo de La Catellana 261, 28046 Madrid, Spain
| | - José Ramón Paño-Pardo
- 1Unidad de Microbiología Clínica y Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046 Madrid, Spain.,6Present Address: Division of Infectious Diseases, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain.,Present Address: Instituto de Investigaciones Sanitarias (IIS) de Aragón, Zaragoza, Spain
| | - Rafael Herruzo
- 4Servicio de Medicina Preventiva, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Francisco Arnalich
- 5Servicio de Medicina Interna, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046 Madrid, Spain
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Gutiérrez-Urbón JM, Gil-Navarro MV, Moreno-Ramos F, Núñez-Núñez M, Paño-Pardo JR, Periáñez-Párraga L. Indicators of the hospital use of antimicrobial agents based on consumption. Farm Hosp 2019; 43:94-100. [PMID: 31072287 DOI: 10.7399/fh.11163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify indicators of hospital use of antimicrobials from the benchmark analysis of consumption data between hospitals at the same level through the collective judgement of a group of experts. METHOD A committee formed by members of the Spanish Societies of Hospital Pharmacy and Infectious Diseases and Clinical Microbiology prepared a proposal of indicators which was submitted to consensus by a panel of 21 experts on infectious diseases, microbiology and antimicrobial therapy, through a modified Delphi method. The panel underwent two rounds of scores by e-mail. Participants assigned a score from 1 (completely disagree) to 9 (completely agree) to the relevance of each indicator in four dimensions: scientific evidence, efficacy and safety, ecological impact and cost. Scores were processed according to the RAND- UCLA method. An indicator was considered to be relevant if at least one dimension other than cost obtained a median score equal to or higher than 7 without disagreement among the panel. RESULTS The committee submitted an initial proposal of 14 indicators. After the first round of panel scores, one indicator was ruled out and two were modified for moving on to the second round. Finally, 13 indicators were considered relevant. CONCLUSIONS Determining indicators of the hospital use of antimicrobial agents based on consumption can allow the antimicrobial stewardship programs to detect any potential problems with the use of antimicrobial agents, and to help guide their efforts in order to implement actions of improvement, as well as to assess the impact of the measures implemented.
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López-Camacho E, Paño-Pardo JR, Sotillo A, Elías-López C, Martínez-Martínez L, Gómez-Gil R, Mingorance J. Meropenem heteroresistance in clinical isolates of OXA-48–producing Klebsiella pneumoniae. Diagn Microbiol Infect Dis 2019; 93:162-166. [DOI: 10.1016/j.diagmicrobio.2018.09.008] [Citation(s) in RCA: 3] [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] [Received: 04/19/2018] [Revised: 08/02/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
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Horcajada JP, Grau S, Paño-Pardo JR, López A, Oliver A, Cisneros JM, Rodriguez-Baño J. Antimicrobial stewardship in Spain: Programs for Optimizing the use of Antibiotics (PROA) in Spanish hospitals. Germs 2018; 8:109-112. [PMID: 30250829 DOI: 10.18683/germs.2018.1137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Juan P Horcajada
- MD, PhD, Service of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autónoma de Barcelona, Passeig Marítim 25, Barcelona, 08003, Spain
| | - Santiago Grau
- PharmD, PhD, Service of Pharmacy, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autónoma de Barcelona, Passeig Marítim 25, Barcelona, 08003, Spain
| | - José Ramón Paño-Pardo
- MD, PhD, Infectious Diseases Service, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Avda. San Juan Bosco, 15, Zaragoza, 50009, Spain
| | - Antonio López
- PharmD, MSc, Spanish Agency of Medicines and Health Products (AEMPS), Calle Campezo 1, Madrid, 28022, Spain
| | - Antonio Oliver
- PhD, Service of Microbiology, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdiSBa), Ctra Valldemossa 79, Palma de Mallorca, 07120, Spain
| | - José M Cisneros
- MD, PhD, Department of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Avda. Manuel Siurot s/n, Sevilla, 41013, Spain
| | - Jesús Rodriguez-Baño
- MD, PhD, Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Avda. Dr. Fedriani nº 3, Sevilla, 41009, Spain
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14
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Lázaro-Perona F, Ramos JC, Sotillo A, Mingorance J, García-Rodríguez J, Ruiz-Carrascoso G, Paño-Pardo JR, Arribas JR, Herruzo R, Arnalich F. Intestinal persistence of a plasmid harbouring the OXA-48 carbapenemase gene after hospital discharge. J Hosp Infect 2018; 101:175-178. [PMID: 30017896 DOI: 10.1016/j.jhin.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/05/2018] [Indexed: 11/17/2022]
Abstract
To study intestinal colonization by OXA-48-producing Klebsiella pneumoniae (KpO48) after hospital discharge, stool samples from 22 previously colonized subjects were collected. Time from discharge was 33-611 days, without readmissions. Eight subjects (36%) were identified as blaOXA-48 gene carriers. In all of them the hospital-acquired strain of KpO48 had been lost, and the gene was harboured by other strains of K. pneumoniae, Klebsiella oxytoca and/or Escherichia coli. Our findings show intestinal persistence for several months of a plasmid harbouring the OXA-48 carbapenemase gene in a significant proportion of individuals in the absence of antibiotic treatment.
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Affiliation(s)
- F Lázaro-Perona
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - J C Ramos
- Unidad de Microbiología Clínica y Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
| | - A Sotillo
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - J Mingorance
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain.
| | - J García-Rodríguez
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - G Ruiz-Carrascoso
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - J R Paño-Pardo
- Unidad de Microbiología Clínica y Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
| | - J R Arribas
- Unidad de Microbiología Clínica y Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
| | - R Herruzo
- Servicio de Medicina Preventiva, Hospital Universitario La Paz, Madrid, Spain
| | - F Arnalich
- Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
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López-Camacho E, Paño-Pardo JR, Ruiz-Carrascoso G, Wesselink JJ, Lusa-Bernal S, Ramos-Ruiz R, Ovalle S, Gómez-Gil R, Pérez-Blanco V, Pérez-Vázquez M, Gómez-Puertas P, Mingorance J. Population structure of OXA-48-producing Klebsiella pneumoniae ST405 isolates during a hospital outbreak characterised by genomic typing. J Glob Antimicrob Resist 2018; 15:48-54. [PMID: 29940334 DOI: 10.1016/j.jgar.2018.06.008] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/01/2018] [Accepted: 06/13/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the structure of a broad and sustained hospital outbreak of OXA-48-producing Klebsiella pneumoniae (KpO48) belonging to sequence type 405 (ST405). METHODS Whole-genome sequencing and comparison of ten ST405 KpO48 isolates obtained from clinical samples in our hospital was performed. Using stringent criteria, 36 single nucleotide polymorphisms (SNPs) were detected (range 0-21 in pairwise comparisons), and allele-specific PCR was used to call the SNPs among a larger set of isolates. RESULTS Several haplotypes were identified within the population. The haplotypes did not show a spatial structure, but a temporal evolution of sequential haplotype replacements was observed. CONCLUSIONS The dispersed spatial distribution suggests a reservoir formed by a large pool of colonised patients, and the temporal replacement pattern suggests that the sustained outbreak was composed of several small outbreaks that appeared and rapidly dispersed to several units.
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Affiliation(s)
- Elena López-Camacho
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - José Ramón Paño-Pardo
- Unidad de Microbiología Clínica y Enfermedades Infecciosas, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Spain
| | - Guillermo Ruiz-Carrascoso
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Jan-Jaap Wesselink
- Biomol-Informatics, S.L., Campus Universidad Autónoma de Madrid, C/Faraday 7, 28049 Madrid, Spain
| | - Silvia Lusa-Bernal
- Biomol-Informatics, S.L., Campus Universidad Autónoma de Madrid, C/Faraday 7, 28049 Madrid, Spain
| | - Ricardo Ramos-Ruiz
- Madrid Science Park, Campus Universidad Autónoma de Madrid, C/Faraday 7, 28049 Madrid, Spain
| | - Susana Ovalle
- Madrid Science Park, Campus Universidad Autónoma de Madrid, C/Faraday 7, 28049 Madrid, Spain
| | - Rosa Gómez-Gil
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Verónica Pérez-Blanco
- Servicio de Medicina Preventiva, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - María Pérez-Vázquez
- Red Española de Investigación en Patología Infecciosa (REIPI), Spain; Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain
| | - Paulino Gómez-Puertas
- Centro de Biología Molecular 'Severo Ochoa' (CSIC-UAM), Campus Universidad Autónoma de Madrid C/Nicolás Cabrera 1, 28049 Madrid, Spain
| | - Jesús Mingorance
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Spain.
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Muñoz-Muñoz L, Paño-Pardo JR, Torrubia-Pérez C, Algarate-Cajo S, Morte-Romea E, Salvo-Gonzalo S. [Mycotic aneurysm of the abdominal aorta due to Listeria monocytogenes]. Rev Esp Quimioter 2018; 31:293-294. [PMID: 29806764 PMCID: PMC6166251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lara Muñoz-Muñoz
- Servicio de Microbiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza
| | - José Ramón Paño-Pardo
- Servicio de Enfermedades Infecciosas, Hospital Clínico Universitario Lozano Blesa, Zaragoza,Instituto de Investigación Sanitaria Aragón
| | | | - Sonia Algarate-Cajo
- Servicio de Microbiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza,Instituto de Investigación Sanitaria Aragón,Facultad de Medicina, Universidad de Zaragoza
| | - Elena Morte-Romea
- Servicio de Enfermedades Infecciosas, Hospital Clínico Universitario Lozano Blesa, Zaragoza
| | - Soledad Salvo-Gonzalo
- Servicio de Microbiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza,Instituto de Investigación Sanitaria Aragón,Facultad de Medicina, Universidad de Zaragoza
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Sánchez-Fabra D, Dyar OJ, Del Pozo JL, Amiguet JA, Colmenero JDD, Fariñas MDC, López-Medrano F, Portilla J, Praena J, Torre-Cisneros J, Rodríguez-Baño J, Pulcini C, Paño-Pardo JR. Perspective of Spanish medical students regarding undergraduate education in infectious diseases, bacterial resistance and antibiotic use. Enferm Infecc Microbiol Clin 2018; 37:25-30. [PMID: 29429753 DOI: 10.1016/j.eimc.2017.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 12/10/2017] [Accepted: 12/14/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION One of the main tools to optimize antibiotics use is education of prescribers. The aim of this article is to study undergraduate education in the field of infectious diseases, antimicrobial resistance and antibiotic stewardship from the perspective of Spanish medical students. MATERIAL AND METHODS An anonymous online questionnaire was distributed among sixth grade students using different channels in Europe, within the ESGAP Student-Prepare survey. The questionnaire included 45 questions about knowledge, attitudes and perceptions about diagnosis, bacterial resistance, use of antibiotics and undergraduate training in infectious diseases. We present here the Spanish results. RESULTS A total of 441 surveys were received from 21 medical schools. A total of 374 responses (84.8%) were obtained from the 8 most represented faculties, with a response rate of 28.9%. Most students felt adequately prepared to identify clinical signs of infection (418; 94.8%) and to accurately interpret laboratory tests (382; 86.6%). A total of 178 (40.4%) acknowledged being able to choose an antibiotic with confidence without consulting books or guidelines. Only 107 (24.3%) students considered that they had received sufficient training in judicious use of antibiotics. Regarding learning methods, the discussion of clinical cases, infectious diseases units rotatories and small group workshops were considered the most useful, being evaluated favorably in 76.9%, 76% and 68.8% of the cases. CONCLUSION Medical students feel more confident in the diagnosis of infectious diseases than in antibiotic treatment. They also feel the need to receive more training in antibiotics and judicious antibiotic use.
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Affiliation(s)
- David Sánchez-Fabra
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón, Zaragoza, España
| | - Oliver J Dyar
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Estocolmo, Suecia
| | - José Luis Del Pozo
- Unidad de Enfermedades Infecciosas, Servicio de Microbiología Clínica, Clínica Universitaria de Navarra. Departamento de Microbiología, Universidad de Navarra, Pamplona, España
| | - Juan Antonio Amiguet
- Servicio de Enfermedades Infecciosas, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón. Departamento de Medicina. Universidad de Zaragoza, Zaragoza, España
| | - Juan de Dios Colmenero
- Servicio de Enfermedades Infecciosas, Hospital Universitario Regional de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, España
| | - María Del Carmen Fariñas
- Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla. Departamento de Medicina, Universidad de Cantabria, Santander, España
| | - Francisco López-Medrano
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica i+12. Departamento de Medicina. Universidad Complutense de Madrid, Madrid, España
| | - Joaquín Portilla
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Universitario de Alicante, Instituto de Investigación Miguel Hernández. Departamento de Medicina, Universidad Miguel Hernández, Elche, España
| | - Julia Praena
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Julián Torre-Cisneros
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC). Departamento de Medicina, Universidad de Córdoba, Córdoba, España
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla-IBiS, Hospital Universitario Virgen Macarena. Universidad de Sevilla, Sevilla, España
| | - Céline Pulcini
- Service des maladies infectieuses et tropicales, Centre hospitalier régional universitaire (CHRU) de Nancy. Université de Lorraine, Nancy, Francia
| | - José Ramón Paño-Pardo
- Servicio de Enfermedades Infecciosas, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón. Departamento de Medicina. Universidad de Zaragoza, Zaragoza, España.
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Goycochea-Valdivia WA, Moreno-Ramos F, Paño-Pardo JR, Aracil-Santos FJ, Baquero-Artigao F, del Rosal-Rabes T, Mellado-Peña MJ, Escosa-García L. Identifying priorities to improve paediatric in-hospital antimicrobial use by cross-sectional evaluation of prevalence and appropriateness of prescription. Enferm Infecc Microbiol Clin 2017; 35:556-562. [DOI: 10.1016/j.eimc.2017.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 11/27/2022]
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Palacios-Baena ZR, Gutiérrez-Gutiérrez B, Calbo E, Almirante B, Viale P, Oliver A, Pintado V, Gasch O, Martínez-Martínez L, Pitout J, Akova M, Peña C, Molina Gil-Bermejo J, Hernández A, Venditti M, Prim N, Bou G, Tacconelli E, Tumbarello M, Hamprecht A, Giamarellou H, Almela M, Pérez F, Schwaber MJ, Bermejo J, Lowman W, Hsueh PR, Paño-Pardo JR, Torre-Cisneros J, Souli M, Bonomo RA, Carmeli Y, Paterson DL, Pascual Á, Rodríguez-Baño J. Empiric Therapy With Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results From the INCREMENT Cohort. Clin Infect Dis 2017; 65:1615-1623. [PMID: 29020250 PMCID: PMC5849995 DOI: 10.1093/cid/cix606] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/13/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is little information about the efficacy of active alternative drugs to carbapenems except β-lactam/β-lactamase inhibitors for the treatment of bloodstream infections (BSIs) due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E). The objective of this study was to assess the outcomes of patients with BSI due to ESBL-E who received empiric therapy with such drugs (other active drugs [OADs]) or carbapenems. METHODS A multinational retrospective cohort study of patients with BSI due to ESBL-E who received empiric treatment with OADs or carbapenems was performed. Cox regression including a propensity score for receiving OADs was performed to analyze 30-day all-cause mortality as main outcome. Clinical failure and length of stay were also analyzed. RESULTS Overall, 335 patients were included; 249 received empiric carbapenems and 86 OADs. The most frequent OADs were aminoglycosides (43 patients) and fluoroquinolones (20 patients). Empiric therapy with OADs was not associated with mortality (hazard ratio [HR], 0.75; 95% confidence interval [CI], .38-1.48) in the Cox regression analysis. Propensity score-matched pairs, subgroups, and sensitivity analyses did not show different trends; specifically, the adjusted HR for aminoglycosides was 1.05 (95% CI, .51-2.16). OADs were neither associated with 14-day clinical failure (adjusted odds ratio, 0.62; 95% CI, .29-1.36) nor length of hospital stay. CONCLUSIONS We were unable to show that empiric treatment with OAD was associated with a worse outcome compared with carbapenems. This information allows more options to be considered for empiric therapy, at least for some patients, depending on local susceptibility patterns of ESBL-E.
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Affiliation(s)
- Zaira Raquel Palacios-Baena
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología/Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen Macarena/Universidad de Sevilla
| | - Belén Gutiérrez-Gutiérrez
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología/Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen Macarena/Universidad de Sevilla
| | - Esther Calbo
- Hospital Universitari Mútua de Terrassa, Universitat Internacional de Catalunya
| | | | - Pierluigi Viale
- Teaching Hospital Policlinico S. Orsola Malpighi, Bologna, Italy
| | | | | | | | | | | | - Murat Akova
- Hacettepe University School of Medicine, Ankara, Turkey
| | | | - José Molina Gil-Bermejo
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología/Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen Macarena/Universidad de Sevilla
| | | | | | - Nuria Prim
- Hospital de la Santa Creu i Sant Pau, Barcelona
| | - German Bou
- Complejo Hospitalario Universitario A Coruña, Spain
| | | | | | - Axel Hamprecht
- Institut für Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Köln, Cologne, Germany
| | | | | | - Federico Pérez
- Louis Stokes Cleveland Veteran Affairs Medical Center, Case Western Reserve University, Ohio
| | - Mitchell J Schwaber
- Tel Aviv Sourasky Medical Center, National Center for Infection Control, Israel Ministry of Health, and Sackler Faculty of Medicine, Tel Aviv University
| | | | - Warren Lowman
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Po-Ren Hsueh
- National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei
| | | | - Julián Torre-Cisneros
- Maimonides Biomedical Research Institute of Córdoba, Unidades de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Reina Sofia University Hospital and University of Córdoba, Spain
| | - Maria Souli
- National and Kapodistrian University of Athens, School of Medicine, University General Hospital Attikon, Greece
| | - Robert A Bonomo
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center and Departments of Medicine, Pharmacology, Biochemistry, and Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Ohio
| | - Yehuda Carmeli
- Tel Aviv Sourasky Medical Center, National Center for Infection Control, Israel Ministry of Health, and Sackler Faculty of Medicine, Tel Aviv University
| | - David L Paterson
- University of Queensland Centre for Clinical Research, Herston, Brisbane, Australia
| | - Álvaro Pascual
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología/Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen Macarena/Universidad de Sevilla
| | - Jesús Rodríguez-Baño
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología/Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen Macarena/Universidad de Sevilla
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Vena A, Bouza E, Valerio M, Padilla B, Paño-Pardo JR, Fernández-Ruiz M, Díaz Martín A, Salavert M, Mularoni A, Puig-Asensio M, Muñoz P. Candidemia in non-ICU surgical wards: Comparison with medical wards. PLoS One 2017; 12:e0185339. [PMID: 29045423 PMCID: PMC5646772 DOI: 10.1371/journal.pone.0185339] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 09/11/2017] [Indexed: 11/23/2022] Open
Abstract
Candidemia acquired outside critical care or hematological areas has received much attention in recent years; however, data on candidemia in surgical departments are very scarce. Our objectives were to describe episodes of candidemia diagnosed in surgical wards and to compare them with episodes occurring in medical wards. We performed a post hoc analysis of a prospective, multicenter study implemented in Spain during 2010–2011 (CANDIPOP project). Of the 752 episodes of candidemia, 369 (49.1%) occurred in patients admitted to surgical wards (165, 21.9%) or medical wards (204, 27.2%). Clinical characteristics associated with surgical patients were solid tumor as underlying disease, recent surgery, indwelling CVC, and parenteral nutrition. Candidemia was more commonly related to a CVC in the surgical than in the medical wards. The CVC was removed more frequently and early management was more appropriate within 48 hours of blood sampling in the surgical patients. Overall, 30-day mortality in the surgical departments was significantly lower than in medical wards (37.7% vs. 15.8%, p<0.001). Multivariate analysis revealed admission to a surgical ward and appropriate early management of candidemia as factors independently associated with a better outcome. We found that approximately 50% of episodes of candidemia occurred in non-hematological patients outside the ICU and that clinical outcome was better in patients admitted to surgical wards than in those hospitalized in medical wards. These findings can be explained by the lower severity of underlying disease, prompt administration of antifungal therapy, and central venous catheter removal.
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Affiliation(s)
- Antonio Vena
- Clinical Microbiology and Infectious Disease Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Clinica Malattie Infettive AOU Santa Maria della Misericordia Piazzale Santa Maria della Misericordia, Udine, Italy
- * E-mail: (PM); (AV)
| | - Emilio Bouza
- Clinical Microbiology and Infectious Disease Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Maricela Valerio
- Clinical Microbiology and Infectious Disease Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Belén Padilla
- Clinical Microbiology and Infectious Disease Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Mario Fernández-Ruiz
- Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Ana Díaz Martín
- Servicio Andaluz de Salud, UGC-SCCU, Sevilla, Andalucía, Spain
| | | | - Alessandra Mularoni
- Istituto mediterraneo per i trapianti e terapie ad alta specializzazione ISMETT-UPMC, Palermo, Italy
| | | | - Patricia Muñoz
- Clinical Microbiology and Infectious Disease Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- * E-mail: (PM); (AV)
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Moreno-García E, García Rodríguez J, Paño-Pardo JR. Optimizing antimicrobial prescribing: a practical decalogue. Rev Esp Quimioter 2017; 30 Suppl 1:56-60. [PMID: 28882018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Increasing antibiotic resistance is one of the leading problems in the Public Agenda worldwide. In the last 20 years, the pace of antimicrobial drug development has markedly slowed leading to a dramatic world situation. Infections with antibiotic-resistant microorganisms have been associated with increased length of stay, mortality and costs. Improving antimicrobial prescribing is one of the tools in our hands to optimize the outcomes of patients with moderate to severe infections and control the emerging of resistance. Several clues to improve antimicrobial prescribing are provided as a key-messages decalogue.
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Affiliation(s)
| | | | - J R Paño-Pardo
- José Ramón Paño-Pardo, Servicio de Enfermedades Infecciosas. Hospital Clínico Universitario "Lozano Blesa" Avenida San Juan Bosco 15. 50009 Zaragoza, Spain.
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22
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Paño-Pardo JR. Early outbreak identification and multifaceted, bundled interventions for outbreak control: Paths of victory. Enferm Infecc Microbiol Clin 2017; 35:3-4. [DOI: 10.1016/j.eimc.2016.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/10/2016] [Indexed: 10/20/2022]
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23
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López-Medrano F, Fernández-Ruiz M, Silva JT, Carver PL, van Delden C, Merino E, Pérez-Saez MJ, Montero M, Coussement J, de Abreu Mazzolin M, Cervera C, Santos L, Sabé N, Scemla A, Cordero E, Cruzado-Vega L, Martín-Moreno PL, Len Ó, Rudas E, de León AP, Arriola M, Lauzurica R, David M, González-Rico C, Henríquez-Palop F, Fortún J, Nucci M, Manuel O, Paño-Pardo JR, Montejo M, Muñoz P, Sánchez-Sobrino B, Mazuecos A, Pascual J, Horcajada JP, Lecompte T, Moreno A, Carratalà J, Blanes M, Hernández D, Fariñas MC, Andrés A, Aguado JM. Clinical Presentation and Determinants of Mortality of Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: A Multinational Cohort Study. Am J Transplant 2016; 16:3220-3234. [PMID: 27105907 DOI: 10.1111/ajt.13837] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/24/2016] [Accepted: 04/17/2016] [Indexed: 01/25/2023]
Abstract
The prognostic factors and optimal therapy for invasive pulmonary aspergillosis (IPA) after kidney transplantation (KT) remain poorly studied. We included in this multinational retrospective study 112 recipients diagnosed with probable (75.0% of cases) or proven (25.0%) IPA between 2000 and 2013. The median interval from transplantation to diagnosis was 230 days. Cough, fever, and expectoration were the most common symptoms at presentation. Bilateral pulmonary involvement was observed in 63.6% of cases. Positivity rates for the galactomannan assay in serum and bronchoalveolar lavage samples were 61.3% and 57.1%, respectively. Aspergillus fumigatus was the most commonly identified species. Six- and 12-week survival rates were 68.8% and 60.7%, respectively, and 22.1% of survivors experienced graft loss. Occurrence of IPA within the first 6 months (hazard ratio [HR]: 2.29; p-value = 0.027) and bilateral involvement at diagnosis (HR: 3.00; p-value = 0.017) were independent predictors for 6-week all-cause mortality, whereas the initial use of a voriconazole-based regimen showed a protective effect (HR: 0.34; p-value = 0.007). The administration of antifungal combination therapy had no apparent impact on outcome. In conclusion, IPA entails a dismal prognosis among KT recipients. Maintaining a low clinical suspicion threshold is key to achieve a prompt diagnosis and to initiate voriconazole therapy.
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Affiliation(s)
- F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J T Silva
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - P L Carver
- University of Michigan Health System, Ann Harbor, MI
| | - C van Delden
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - E Merino
- Unit of Infectious Diseases, Hospital Universitario General, Alicante, Spain
| | - M J Pérez-Saez
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - M Montero
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J Coussement
- Department of Nephrology, Dialysis and Kidney Transplantation, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M de Abreu Mazzolin
- Division of Nephology, Department of Medicine, Universidade Federal de São Paulo-UNIFESP and Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - C Cervera
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - L Santos
- Unit of Renal Transplantation, Department of Urology and Kidney Transplantation, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - N Sabé
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - A Scemla
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Paris, France
| | - E Cordero
- Unit of Infectious Diseases, Hospitales Universitarios "Vigen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - L Cruzado-Vega
- Department of Nephrology, Hospital Universitario "La Fe", Valencia, Spain
| | - P L Martín-Moreno
- Department of Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Ó Len
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - E Rudas
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - A P de León
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México
| | - M Arriola
- Clínica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina
| | - R Lauzurica
- Department of Nephrology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M David
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C González-Rico
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - F Henríquez-Palop
- Department of Nephrology, University Hospital "Doctor Negrín", Las Palmas de Gran Canaria, Spain
| | - J Fortún
- Department of Infectious Diseases, University Hospital "Ramón y Cajal", Madrid, Spain
| | - M Nucci
- Department of Internal Medicine, Hematology Service and Mycology Laboratory, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - O Manuel
- Department of Infectious Diseases and Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - J R Paño-Pardo
- Department of Internal Medicine, Hospital Universitario "La Paz", School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Montejo
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Bilbao, Spain
| | - P Muñoz
- Department of Microbiology and Infectious Diseases, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - B Sánchez-Sobrino
- Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Mazuecos
- Department of Nephrology, Hospital Universitario "Puerta del Mar", Cádiz, Spain
| | - J Pascual
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J P Horcajada
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - T Lecompte
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - A Moreno
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - M Blanes
- Unit of Infectious Diseases, Hospital Universitario "La Fe", Valencia, Spain
| | - D Hernández
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - M C Fariñas
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - A Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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Sotillo A, Paño-Pardo JR, López-Quintana B, Gómez-Gil R. Development of daptomycin resistance during therapy in a patient with methicillin-resistant Staphylococcus aureus endocarditis: A case report. Enferm Infecc Microbiol Clin 2016; 34:534-5. [DOI: 10.1016/j.eimc.2015.11.006] [Citation(s) in RCA: 4] [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: 06/25/2015] [Revised: 11/16/2015] [Accepted: 11/16/2015] [Indexed: 11/30/2022]
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25
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Gutiérrez-Gutiérrez B, Salamanca E, de Cueto M, Hsueh PR, Viale P, Paño-Pardo JR, Venditti M, Tumbarello M, Daikos G, Pintado V, Doi Y, Tuon FF, Karaiskos I, Machuca I, Schwaber MJ, Azap ÖK, Souli M, Roilides E, Pournaras S, Akova M, Pérez F, Bermejo J, Oliver A, Almela M, Lowman W, Almirante B, Bonomo RA, Carmeli Y, Paterson DL, Pascual A, Rodríguez-Baño J. A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae. Mayo Clin Proc 2016; 91:1362-1371. [PMID: 27712635 DOI: 10.1016/j.mayocp.2016.06.024] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [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] [Received: 03/02/2016] [Revised: 05/29/2016] [Accepted: 06/01/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To develop a score to predict mortality in patients with bloodstream infections (BSIs) due to carbapenemase-producing Enterobacteriaceae (CPE). PATIENTS AND METHODS A multinational retrospective cohort study (INCREMENT project) was performed from January 1, 2004, through December 31, 2013. Patients with clinically relevant monomicrobial BSIs due to CPE were included and randomly assigned to either a derivation cohort (DC) or a validation cohort (VC). The variables were assessed on the day the susceptibility results were available, and the predictive score was developed using hierarchical logistic regression. The main outcome variable was 14-day all-cause mortality. The predictive ability of the model and scores were measured by calculating the area under the receiver operating characteristic curve. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different cutoffs of the score. RESULTS The DC and VC included 314 and 154 patients, respectively. The final logistic regression model of the DC included the following variables: severe sepsis or shock at presentation (5 points); Pitt score of 6 or more (4 points); Charlson comorbidity index of 2 or more (3 points); source of BSI other than urinary or biliary tract (3 points); inappropriate empirical therapy and inappropriate early targeted therapy (2 points). The score exhibited an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.74-0.85) in the DC and 0.80 (95% CI, 0.73-0.88) in the VC. The results for 30-day all-cause mortality were similar. CONCLUSION A validated score predictive of early mortality in patients with BSIs due to CPE was developed. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01 764490.
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Affiliation(s)
- Belén Gutiérrez-Gutiérrez
- Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBIS, Seville, Spain
| | - Elena Salamanca
- Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBIS, Seville, Spain
| | - Marina de Cueto
- Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBIS, Seville, Spain
| | - Po-Ren Hsueh
- National Taiwan University Hospital, Taipei, Taiwan
| | - Pierluigi Viale
- Teaching Hospital Policlinico S. Orsola Malpighi, Bologna, Italy
| | - José Ramón Paño-Pardo
- Hospital Universitario La Paz-IDIPAZ, Madrid, Spain; Hospital Clínico Universitario "Lozano Blesa"-IIS Aragón, Zaragoza, Spain
| | - Mario Venditti
- Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | | | - George Daikos
- National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Yohei Doi
- University of Pittsburgh, Pittsburgh, PA
| | | | | | - Isabel Machuca
- Hospital Universitario Reina Sofía-IMIBIC, Córdoba, Spain
| | | | | | - Maria Souli
- University General Hospital Attikon, Chaidiri, Greece
| | | | | | - Murat Akova
- Hacettepe University School of Medicine, Ankara, Turkey
| | - Federico Pérez
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
| | | | - Antonio Oliver
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Warren Lowman
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | | | - Robert A Bonomo
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH; Departments of Medicine, Pharmacology, Biochemistry, Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Yehuda Carmeli
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
| | - David L Paterson
- University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, Australia
| | - Alvaro Pascual
- Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBIS, Seville, Spain; Departamento de Microbiología, Universidad de Sevilla, Seville, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBIS, Seville, Spain; Departamento de Medicina, Universidad de Sevilla, Seville, Spain.
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Paño-Pardo JR, López Quintana B, Lázaro Perona F, Ruiz Carrascoso G, Romero-Gómez MP, Loeches Yagüe B, Díaz-Pollán B, Martínez-Virto A, Mingorance J, García Rodríguez J, Arribas JR, Gómez-Gil R. Community-Onset Bloodstream and Other Infections, Caused by Carbapenemase-Producing Enterobacteriaceae: Epidemiological, Microbiological, and Clinical Features. Open Forum Infect Dis 2016; 3:ofw136. [PMID: 27703997 PMCID: PMC5047395 DOI: 10.1093/ofid/ofw136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/20/2016] [Indexed: 02/06/2023] Open
Abstract
Background. Because most infections caused by carbapenemase-producing Enterobacteriaceae (CPE) begin during hospitalization, there are limited data about community-onset (CO) infections caused by CPE. Our aim is to describe the frequency of CO infections caused by CPE as well as the clinical features of CO bloodstream infections (CO-BSIs). Methods. This study includes retrospective case series of CO infections caused by CPE in a tertiary hospital from January 2010 to July 2014. Any clinical sample with a positive culture for CPE that had been ordered by primary care doctors or by doctors at the emergency room (ER) were classified as CO. Epidemiological and microbiological features of CO cases were assessed as were clinical features of CO-BSIs. Results. Of 780 clinical samples with CPE, 180 were requested at the ER or by primary care doctors (22.9%), 150 of which were produced by Klebsiella pneumoniae (83.3%). The blaOXA−48 gene was detected in 149 isolates (82.8%) followed by the blaVIM gene, 29 (16.1%). Sixty-one patients (33.9%) had a prior history of CPE infection/colonization. Thirty-four of the 119 (28.6%) patients without prior history of CPE infection/colonization did not fulfill Friedman criteria for healthcare-associated infections (HAIs). Considering previous hospitalization of up to 12 months as a criterion for defining HAI, only 16 (13.4%) cases were identified as community-acquired infections. The most frequent positive sample was urine (133 of 180; 73.9%). Twenty-one (11.7%) patients had a BSI, 9 of them secondary to urinary tract infections (42.9%). Thirty-day crude mortality among patients with BSI was 23.8% (5 of 21). Conclusions. Community-onset infections caused by CPE are an important subgroup of all CPE infections. The urinary tract is the main source. Bloodstream infections accounted for more than 10% of the cases.
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Affiliation(s)
- José Ramón Paño-Pardo
- Infectious Diseasesand Clinical Microbiology Unit, Department of Internal Medicine; Division of Infectious Diseases, Hospital Clínico Universitario "Lozano Blesa",; Instituto de Investigaciones Sanitarias (IIS) de Aragón, Zaragoza, Spain
| | | | | | | | | | - Belén Loeches Yagüe
- Infectious Diseases and Clinical Microbiology Unit, Department of Microbiology
| | - Beatriz Díaz-Pollán
- Infectious Diseases and Clinical Microbiology Unit, Department of Internal Medicine
| | - Ana Martínez-Virto
- Department of Emergency Medicine , Hospital Universitario La Paz-IdiPAZ , Madrid
| | | | | | - José Ramón Arribas
- Infectious Diseases and Clinical Microbiology Unit, Department of Internal Medicine
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27
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López-Medrano F, Silva JT, Fernández-Ruiz M, Carver PL, van Delden C, Merino E, Pérez-Saez MJ, Montero M, Coussement J, de Abreu Mazzolin M, Cervera C, Santos L, Sabé N, Scemla A, Cordero E, Cruzado-Vega L, Martín-Moreno PL, Len Ó, Rudas E, de León AP, Arriola M, Lauzurica R, David M, González-Rico C, Henríquez-Palop F, Fortún J, Nucci M, Manuel O, Paño-Pardo JR, Montejo M, Muñoz P, Sánchez-Sobrino B, Mazuecos A, Pascual J, Horcajada JP, Lecompte T, Lumbreras C, Moreno A, Carratalà J, Blanes M, Hernández D, Hernández-Méndez EA, Fariñas MC, Perelló-Carrascosa M, Morales JM, Andrés A, Aguado JM. Risk Factors Associated With Early Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: Results From a Multinational Matched Case-Control Study. Am J Transplant 2016; 16:2148-57. [PMID: 26813515 DOI: 10.1111/ajt.13735] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/13/2016] [Indexed: 01/25/2023]
Abstract
Risk factors for invasive pulmonary aspergillosis (IPA) after kidney transplantation have been poorly explored. We performed a multinational case-control study that included 51 kidney transplant (KT) recipients diagnosed with early (first 180 posttransplant days) IPA at 19 institutions between 2000 and 2013. Control recipients were matched (1:1 ratio) by center and date of transplantation. Overall mortality among cases was 60.8%, and 25.0% of living recipients experienced graft loss. Pretransplant diagnosis of chronic pulmonary obstructive disease (COPD; odds ratio [OR]: 9.96; 95% confidence interval [CI]: 1.09-90.58; p = 0.041) and delayed graft function (OR: 3.40; 95% CI: 1.08-10.73; p = 0.037) were identified as independent risk factors for IPA among those variables already available in the immediate peritransplant period. The development of bloodstream infection (OR: 18.76; 95% CI: 1.04-339.37; p = 0.047) and acute graft rejection (OR: 40.73, 95% CI: 3.63-456.98; p = 0.003) within the 3 mo prior to the diagnosis of IPA acted as risk factors during the subsequent period. In conclusion, pretransplant COPD, impaired graft function and the occurrence of serious posttransplant infections may be useful to identify KT recipients at the highest risk of early IPA. Future studies should explore the potential benefit of antimold prophylaxis in this group.
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Affiliation(s)
- F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J T Silva
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - P L Carver
- University of Michigan Health System, Ann Arbor, MI
| | - C van Delden
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - E Merino
- Unit of Infectious Diseases, Hospital Universitario General, Alicante, Spain
| | - M J Pérez-Saez
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - M Montero
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J Coussement
- Department of Nephrology, Dialysis and Kidney Transplantation, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M de Abreu Mazzolin
- Division of Nephology, Department of Medicine, Universidade Federal de São Paulo-UNIFESP and Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - C Cervera
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - L Santos
- Unit of Renal Transplantation, Department of Urology and Kidney Transplantation, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - N Sabé
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - A Scemla
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Paris, France
| | - E Cordero
- Unit of Infectious Diseases, Hospitales Universitarios "Vigen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - L Cruzado-Vega
- Department of Nephrology, Hospital Universitario "La Fe", Valencia, Spain
| | - P L Martín-Moreno
- Department of Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Ó Len
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - E Rudas
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - A Ponce de León
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México
| | - M Arriola
- Clínica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina
| | - R Lauzurica
- Department of Nephrology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M David
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C González-Rico
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - F Henríquez-Palop
- Department of Nephrology, University Hospital "Doctor Negrín", Las Palmas de Gran Canaria, Spain
| | - J Fortún
- Department of Infectious Diseases, University Hospital "Ramón y Cajal", Madrid, Spain
| | - M Nucci
- Department of Internal Medicine, Hematology Service and Mycology Laboratory, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - O Manuel
- Department of Infectious Diseases and Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - J R Paño-Pardo
- Department of Internal Medicine, Hospital Universitario "La Paz", School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Montejo
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Bilbao, Spain
| | - P Muñoz
- Department of Microbiology and Infectious Diseases, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - B Sánchez-Sobrino
- Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Mazuecos
- Department of Nephrology, Hospital Universitario "Puerta del Mar", Cádiz, Spain
| | - J Pascual
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J P Horcajada
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - T Lecompte
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - C Lumbreras
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Moreno
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - M Blanes
- Unit of Infectious Diseases, Hospital Universitario "La Fe", Valencia, Spain
| | - D Hernández
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - E A Hernández-Méndez
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México
| | - M C Fariñas
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - M Perelló-Carrascosa
- Department of Nephrology, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - J M Morales
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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Paño-Pardo JR, Schüffelmann-Gutiérrez C, Escosa-García L, Laplaza-González M, Moreno-Ramos F, Gómez-Gil R, López JD, Jordán I, Téllez C, de la Oliva P. Opportunities to improve antimicrobial use in paediatric intensive care units: a nationwide survey in Spain. Clin Microbiol Infect 2015; 22:171-177. [PMID: 26498852 DOI: 10.1016/j.cmi.2015.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/04/2015] [Accepted: 10/11/2015] [Indexed: 02/06/2023]
Abstract
Improving antimicrobial use is a complex process that requires an accurate assessment of ongoing problems and barriers. Paediatric intensive care units (PICU) have seldom been assessed from this perspective. Two Internet-based, self-administered surveys were conducted nationwide in Spain between January and February 2014. The first survey aimed to assess those characteristics of Spanish PICUs that could influence antimicrobial prescribing or antimicrobial stewardship. The second survey targeted Spanish PICU physicians and pursued to assess their attitudes and perceptions regarding antimicrobial resistance and antimicrobial use. Information about 29/39 contacted PICUs was obtained. A total of 114/206 (55.3%) paediatric intensivists responded. PICUs were heterogeneous regarding years since foundation, number of beds, type of patients admitted and staffing. Only 11 (37.9%) PICUs had available e-prescribing systems. Procalcitonin was available in 24 (89.1%) PICUs, but there were no procalcitonin-based protocols in 14 (60.9%) of them. Half of surveyed PICUs had implemented antimicrobial stewardship activities. Ninety-eight of the 114 PICU physicians (86%) who participated considered that antimicrobial resistance was a significantly relevant problem for their daily and that improving antimicrobial use in their PICU should be a priority (103; 90.4%). The main perceived problems regarding antimicrobial use were the excessive use of antimicrobials in patients with nonconfirmed infections and excessive use of broad-spectrum antimicrobials. The most valued antimicrobial stewardship interventions were the implementation of protocols to guide antimicrobial therapy. Spanish PICU doctors are aware of the relevance of the problem of antimicrobial resistance and the need to improve antimicrobial use. Targeted interventions should take into account their difficulties and preferences when feasible.
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Affiliation(s)
- J R Paño-Pardo
- Division of Infectious Diseases, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain; Instituto de Investigación Sanitaria (IIS) de Aragón, Aragón, Spain
| | | | - L Escosa-García
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, Hospital Universitario La Paz, Madrid, Spain
| | - M Laplaza-González
- Paediatric Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain
| | - F Moreno-Ramos
- Pharmacy Department, Hospital Universitario La Paz, Madrid, Spain
| | - R Gómez-Gil
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | - J D López
- Paediatric Intensive Care Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - I Jordán
- Paediatric Intensive Care Unit, Hospital Sant Joan de Deu, Barcelona, Spain
| | - C Téllez
- Paediatric Intensive Care Unit, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - P de la Oliva
- Paediatric Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain; Department of Paediatrics, Medical School, Universidad Autónoma, Madrid, Spain
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Béraud G, Pulcini C, Paño-Pardo JR, Hoen B, Beovic B, Nathwani D. How do physicians cope with controversial topics in existing guidelines for the management of infective endocarditis? Results of an international survey. Clin Microbiol Infect 2015; 22:163-170. [PMID: 26493845 DOI: 10.1016/j.cmi.2015.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/03/2015] [Accepted: 10/09/2015] [Indexed: 12/20/2022]
Abstract
International guidelines are available to help physicians prescribe appropriate antibiotic regimens to patients with infective endocarditis (IE). However some topics of these guidelines are controversial. We conducted an international survey to assess physicians' adherence to these guidelines, focusing on these controversial items. An invitation to participate to a 15-question online survey was sent in 2012-2013 to European Society of Clinical Microbiology and Infectious Diseases (ESCMID) members, scientific societies and corresponding authors of publications on IE mentioned in PubMed from 1990 to 2012, inclusive. Eight hundred thirty-seven physicians participated in the survey, and 625 (74.7%) completed it over the first question. The results showed great heterogeneity of practices. Claiming to follow guidelines was marginally associated with more guideline-based strategies. Gentamicin use depended on causative pathogens (p <0.001) and physician specialty (p 0.02). Eighty-six per cent of the physicians favoured vancomycin alone or in combination with gentamicin or rifampicin as a first-line treatment for left-sided native valve methicillin-resistant Staphylococcus aureus IE, 31% considered switching to oral therapy as a therapeutic option and 33% used the ampicillin and ceftriaxone combination for enterococcal IE as a first-line therapy. Physician specialty significantly affected the choice of a therapeutic strategy, while practicing in a university hospital or the number of years of practice had virtually no impact. Our survey, the largest on IE treatment, underscores important heterogeneity in practices for treatment of IE. Nonetheless, physicians who do not follow guidelines can have rational strategies that are based on the literature. These results could inform the revision of future guidelines and identify unmet needs for future studies.
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Affiliation(s)
- G Béraud
- Médecine Interne et Maladies Infectieuses, Centre Hospitalier de Poitiers, Poitiers, France; EA2694, Université Droit et Santé Lille 2, Lille, France; Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium.
| | - C Pulcini
- Service de Maladies Infectieuses, CHU Nancy, France; EA 4360 Apemac, Université de Lorraine, Université Paris Descartes, Nancy, France
| | - J R Paño-Pardo
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Departamento de Medicina Interna, Hospital Universitario La Paz, IDIPAZ, Madrid, Spain
| | - B Hoen
- Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, France; Centre Hospitalier Universitaire de Pointe-à-Pitre, Inserm CIC1424, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Pointe-à-Pitre, France
| | - B Beovic
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - D Nathwani
- Ninewells Hospital and Medical School, Dundee, Scotland, UK
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Paño-Pardo JR, Campos J, Natera Kindelán C, Ramos A. Initiatives and resources to promote antimicrobial stewardship. Enferm Infecc Microbiol Clin 2013; 31 Suppl 4:51-5. [DOI: 10.1016/s0213-005x(13)70133-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Rodríguez-Baño J, Paño-Pardo JR, Múñez Rubio E, Segura Porta F. Pregnancy, obesity and other risk factors for complications in influenza A(H1N1) pdm09 infection. Enferm Infecc Microbiol Clin 2012; 30 Suppl 4:32-7. [DOI: 10.1016/s0213-005x(12)70102-7] [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: 02/07/2023]
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Casado-Verrier B, Gómez-Fernández C, Paño-Pardo JR, Gómez-Gil R, Mingorance-Cruz J, Moreno-Alonso de Celada R, Herranz-Pinto P. Prevalencia de infecciones de piel y tejidos blandos producidas por Staphylococcus aureus resistente a Meticilina Comunitario en Madrid. Enferm Infecc Microbiol Clin 2012; 30:300-6. [DOI: 10.1016/j.eimc.2011.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 11/21/2011] [Accepted: 11/21/2011] [Indexed: 11/29/2022]
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Paño-Pardo JR, Viasus D, Pachón J, Campins A, López-Medrano F, Villoslada A, Gutiérrez-Cuadra M, Pumarola T, del Toro MD, Oteo JA, Martínez-Montauti J, Gutiérrez-Aroca J, Segura F, Carratalà J. Pandemic 2009 A(H1N1) Infection Requiring Hospitalization of Elderly Spanish Adults. J Am Geriatr Soc 2012; 60:740-4. [DOI: 10.1111/j.1532-5415.2012.03903.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Diego Viasus
- Department of Infectious Diseases; Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona; Barcelona
| | - Jerónimo Pachón
- Department of Infectious Diseases; Hospital Universitario Virgen del Rocío; Sevilla
| | - Antoni Campins
- Department of Infectious Diseases; Hospital Universitario Son Dureta-Son Espases; Palma de Mallorca
| | | | - Aroa Villoslada
- Department of Infectious Diseases; Hospital Son Llàtzer; Palma de Mallorca
| | | | - Tomás Pumarola
- Department of Microbiology; Hospital Universitario Clinic; Barcelona
| | | | - José A. Oteo
- Department of Microbiology; Hospital San Pedro-CIBIR; Logroño
| | | | - Juan Gutiérrez-Aroca
- Department of Infectious Diseases; Hospital Universitario Reina Sofía-IMIBIC, University of Córdoba; Córdoba
| | - Ferrán Segura
- Department of Infectious Diseases; Hospital Parc Tauli; Sabadell; Spain
| | - Jordi Carratalà
- Department of Infectious Diseases; Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona; Barcelona
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Viasus D, Cordero E, Rodríguez-Baño J, Oteo JA, Fernández-Navarro A, Ortega L, Gracia-Ahufinger I, Fariñas MC, García-Almodovar E, Payeras A, Paño-Pardo JR, Muñez-Rubio E, Carratalà J. Changes in epidemiology, clinical features and severity of influenza A (H1N1) 2009 pneumonia in the first post-pandemic influenza season. Clin Microbiol Infect 2012; 18:E55-62. [PMID: 22264321 DOI: 10.1111/j.1469-0691.2011.03753.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
MESH Headings
- Adolescent
- Adult
- Age Distribution
- Aged
- Aged, 80 and over
- Antiviral Agents/administration & dosage
- Cohort Studies
- Critical Care/statistics & numerical data
- Female
- Hospitals, Teaching
- Humans
- Influenza A Virus, H1N1 Subtype/isolation & purification
- Influenza A Virus, H1N1 Subtype/pathogenicity
- Influenza, Human/complications
- Influenza, Human/epidemiology
- Influenza, Human/pathology
- Influenza, Human/virology
- Length of Stay
- Male
- Middle Aged
- Pandemics
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/pathology
- Pregnancy
- Prospective Studies
- Respiration, Artificial/statistics & numerical data
- Spain/epidemiology
- Treatment Outcome
- Young Adult
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Affiliation(s)
- D Viasus
- Hospital Universitari de Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain
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Rodríguez-Baño J, Paño-Pardo JR, Alvarez-Rocha L, Asensio Á, Calbo E, Cercenado E, Cisneros JM, Cobo J, Delgado O, Garnacho-Montero J, Grau S, Horcajada JP, Hornero A, Murillas-Angoiti J, Oliver A, Padilla B, Pasquau J, Pujol M, Ruiz-Garbajosa P, San Juan R, Sierra R. Programas de optimización de uso de antimicrobianos (PROA) en hospitales españoles: documento de consenso GEIH-SEIMC, SEFH y SEMPSPH. Enferm Infecc Microbiol Clin 2012; 30:22.e1-22.e23. [DOI: 10.1016/j.eimc.2011.09.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 09/22/2011] [Accepted: 09/27/2011] [Indexed: 01/12/2023]
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Rodríguez-Baño J, Paño-Pardo JR, Alvarez-Rocha L, Asensio Á, Calbo E, Cercenado E, Cisneros JM, Cobo J, Delgado O, Garnacho-Montero J, Grau S, Horcajada JP, Hornero A, Murillas-Angoiti J, Oliver A, Padilla B, Pasquau J, Pujol M, Ruiz-Garbajosa P, San Juan R, Sierra R. [Programs for optimizing the use of antibiotics (PROA) in Spanish hospitals: GEIH-SEIMC, SEFH and SEMPSPH consensus document]. Farm Hosp 2011; 36:33.e1-30. [PMID: 22137161 DOI: 10.1016/j.farma.2011.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 10/18/2011] [Indexed: 11/28/2022] Open
Abstract
The antimicrobial agents are unique drugs for several reasons. First, their efficacy is higher than other drugs in terms of reduction of morbidity and mortality. Also, antibiotics are the only group of drugs associated with ecological effects, because their administration may contribute to the emergence and spread of microbial resistance. Finally, they are used by almost all medical specialties. Appropriate use of antimicrobials is very complex because of the important advances in the management of infectious diseases and the spread of antibiotic resistance. Thus, the implementation of programs for optimizing the use of antibiotics in hospitals (called PROA in this document) is necessary. This consensus document defines the objectives of the PROA (namely, to improve the clinical results of patients with infections, to minimise the adverse events associated to the use of antimicrobials including the emergence and spread of antibiotic resistance, and to ensure the use of the most cost-efficacious treatments), and provides recommendations for the implementation of these programs in Spanish hospitals. The key aspects of the recommendations are as follows. Multidisciplinary antibiotic teams should be formed, under the auspices of the Infection Committees. The PROA need to be considered as part of institutional programs and the strategic objectives of the hospital. The PROA should include specific objectives based on measurable indicators, and activities aimed at improving the use of antimicrobials, mainly through educational activities and interventions based more on training activities directed to prescribers than just on restrictive measures.
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Affiliation(s)
- J Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Sevilla, España.
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Viasus D, Paño-Pardo JR, Pachón J, Riera M, López-Medrano F, Payeras A, Fariñas MC, Moreno A, Rodríguez-Baño J, Oteo JA, Martínez-Montauti J, Torre-Cisneros J, Segura F, Gudiol F, Carratalà J. Pneumonia complicating pandemic (H1N1) 2009: risk factors, clinical features, and outcomes. Medicine (Baltimore) 2011; 90:328-336. [PMID: 21862936 DOI: 10.1097/md.0b013e31822e67a7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We performed an observational analysis of a prospective cohort of adults hospitalized for pandemic (H1N1) 2009 at 13 Spanish hospitals, from June to November 2009, to determine the risk factors, clinical features, and outcomes of pneumonia. Of 585 patients requiring hospitalization, chest radiography was obtained in 542. A total of 234 (43.1%) patients had pneumonia, of whom 210 underwent bacterial microbiologic studies. Of these patients, 174 (82.8%) had primary viral pneumonia and 36 (17.2%) had concomitant/secondary bacterial pneumonia. Bilateral pneumonia occurred in 48.3% of patients. Streptococcus pneumoniae was the most frequent pathogen among patients with bacterial pneumonia (26 of 36 patients). None of them had received pneumococcal vaccine. Compared with patients without pneumonia, those with pneumonia more frequently had shock during hospitalization (9.8% vs. 1%; p < 0.001), required intensive care unit admission (22.6% vs. 5.8%; p < 0.001), underwent mechanical ventilation (17.9% vs. 3.2%; p < 0.001), and had longer length of hospital stay (median, 7 d vs. 5 d; p < 0.001). In-hospital mortality was higher in patients with pneumonia than in the others (5.2% vs. 0%; p < 0.001). Absence of comorbid conditions (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.32-3.24) was found to be an independent risk factor for pneumonia, whereas early (≤ 48 h) oseltamivir therapy (OR, 0.29; 95% CI, 0.19-0.46) was a protective factor. In conclusion, pneumonia is a frequent complication among adults hospitalized for pandemic (H1N1) 2009 and causes significant morbidity. Mortality in pandemic (H1N1) 2009 is low, but occurs mainly in patients with pneumonia. Early oseltamivir therapy is a protective factor for this complication.
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Affiliation(s)
- Diego Viasus
- From Departments of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL (DV, FG, JC), University of Barcelona (FG, JC), Hospital Universitario Clinic (AM), SCIAS-Hospital de Barcelona (JM-M), Barcelona; Hospital Universitario La Paz-IDIPAZ (JRP-P), Hospital Universitario 12 de Octubre (FL-M), Madrid; Hospital Universitario Virgen del Rocío (JP), Hospital Universitario Virgen Macarena (JR-B), Sevilla; Hospital Universitario Son Dureta (MR), Hospital Son Llàtzer (AP), Palma de Mallorca; Hospital Universitario Marqués de Valdecilla (MCF), Santander; Hospital San Pedro-CIBIR (JAO), Logroño; Hospital Universitario Reina Sofía-IMIBIC, University of Córdoba (JT-C), Córdoba; Hospital Parc Tauli (FS), Sabadell; Spain
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Viasus D, Paño-Pardo JR, Pachón J, Riera M, López-Medrano F, Payeras A, Fariñas MC, Moreno A, Rodríguez-Baño J, Oteo JA, Ortega L, Torre-Cisneros J, Segura F, Carratalà J. Timing of oseltamivir administration and outcomes in hospitalized adults with pandemic 2009 influenza A(H1N1) virus infection. Chest 2011; 140:1025-1032. [PMID: 21415133 DOI: 10.1378/chest.10-2792] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Data on the clinical effectiveness of oseltamivir in patients with pandemic 2009 influenza A(H1N1) (A[H1N1]) virus infection are scarce. We aimed to determine the effect of timing of oseltamivir administration on outcomes in hospitalized adults with A(H1N1). METHODS Observational analysis of a prospective cohort of adults hospitalized with laboratory-confirmed A(H1N1) was performed at 13 Spanish hospitals. Time from onset of symptoms to oseltamivir administration was the independent variable. Outcomes were duration of fever, hospital length of stay (LOS), need for mechanical ventilation, and mortality during hospitalization. Multivariate logistic regression was used to describe the association between the independent variable and the outcomes. RESULTS Five hundred thirty-eight hospitalized patients with A(H1N1) were studied. The median time from onset of symptoms to oseltamivir administration was 3 days (interquartile range [IQR], 2-5 days). With regard to outcomes, the median duration of fever was 2 days (IQR, 1-3 days), the median LOS was 5 days (IQR, 3-8 days), 49 patients (9.1%) underwent mechanical ventilation, and 11 patients (2%) died during hospitalization. In univariate analysis, prolonged duration of fever (above the median), prolonged LOS (above the median), need for mechanical ventilation, and mortality all increased with time to oseltamivir administration (χ(2) test for trend P = .001, P ≤ .001, P = .008, and P = .001, respectively). After adjustment for confounding factors, time from onset of symptoms to oseltamivir administration (+ 1-day increase) was associated with a prolonged duration of fever (OR, 1.10; 95% CI, 1.02-1.19), prolonged LOS (OR, 1.07; 95% CI, 1.00-1.15), and higher mortality (OR, 1.20; 95% CI, 1.06-1.35). CONCLUSIONS Timely oseltamivir administration has a beneficial effect on outcomes in hospitalized adults with A(H1N1), even in those who are admitted beyond 48 h after onset of symptoms.
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Affiliation(s)
- Diego Viasus
- Departments of Infectious Diseases from the Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | | | | | - Melchor Riera
- Hospital Universitario Son Dureta, Palma de Mallorca, Spain
| | | | | | | | | | | | | | | | | | | | - Jordi Carratalà
- Departments of Infectious Diseases from the Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain.
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Paño-Pardo JR, Rodríguez-Baño J, Martínez-Sánchez N, Viasus D, Fariñas MC, Leyes M, López-Medrano F, Pachón J, Torre-Cisneros J, Oteo JA, Pumarola T, García-Gasalla M, Ortega L, Segura F, Carratalá J. Prognosis of 2009 A(H1N1) influenza in hospitalized pregnant women in a context of early diagnosis and antiviral therapy. Antivir Ther 2011; 17:719-28. [DOI: 10.3851/imp2019] [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] [Accepted: 09/10/2011] [Indexed: 10/14/2022]
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Paño-Pardo JR, Alcaide ML, Abbo L, Dickinson G. Primary HIV infection with multisystemic presentation. Int J Infect Dis 2009; 13:e177-80. [PMID: 19028126 DOI: 10.1016/j.ijid.2008.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 09/20/2008] [Indexed: 10/21/2022] Open
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Rico A, Paño-Pardo JR, Luisa Montes M, Mingorance J. [An HIV-positive homosexual man with fever and a skin lesion]. Enferm Infecc Microbiol Clin 2009; 27:419-21. [PMID: 19406517 DOI: 10.1016/j.eimc.2008.11.012] [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: 07/01/2008] [Revised: 11/09/2008] [Accepted: 11/20/2008] [Indexed: 10/20/2022]
Affiliation(s)
- Alicia Rico
- Hospital Universitario La Paz, Madrid, España.
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