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Fayos M, Arnaiz de Las Revillas F, González Quintanilla V, González-Rico C, Fariñas-Álvarez C, Parra JA, Fariñas MC. Progression of subclinical cardiovascular disease in patients with HIV. Rev Esp Quimioter 2024:fayos29apr2024. [PMID: 38682819 DOI: 10.37201/req/033.2024] [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] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Human immunodeficiency virus (HIV) infected patients are at increased risk of cardiovascular disease (CVD). Multidetector computed tomography (MDCT) stratifies cardiovascular risk in asymptomatic patients with subclinical atherosclerosis. The aim of this study was to determine the ability of MCTD and clinical and laboratory parameters to assess subclinical CVD progression in HIV patients. METHODS Prospective longitudinal cohort study of patients with at least 10 years of HIV infection and 5 years of antiretroviral therapy history, low cardiovascular risk and monitored for 6 years (2015-2021). All patients underwent clinical assessment, blood analysis, carotid ultrasound, and gated MDCT in 2015 and 2021. RESULTS Sixty-three patients (63.5% male) with a mean age of 49.9 years (standard deviation [SD], 10.5) were included in 2015; 63 of them were followed until 2021. Comparing the results from 2015 with those from 2021, Systematic Coronary Risk Estimation-2 (SCORE2) was 2.9% (SD, 2.1) vs. 4.4% (SD,3.1); Multi-Ethnic Study of Atherosclerosis score (MESA risk) was 3.4 (SD 5.8) vs. 6.0 (SD 8.6); coronary artery calcification CAC) score >100 was 11.1% vs. 25.4% (P < 0.05); and 11% vs. 27% had carotid plaques (P = 0.03). CONCLUSIONS After six years of follow-up, an increase in SCORE2, carotid plaques, CAC scoring and MESA risk was observed. MDCT findings, along with other clinical and laboratory parameters, could play an important role as a marker of CVD progression in the evaluation of patients with HIV and low cardiovascular risk.
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Affiliation(s)
| | | | | | | | | | | | - M C Fariñas
- María Carmen Fariñas. Infectious Diseases Service. Hospital Universitario Marqués de Valdecilla-IDIVAL. University of Cantabria. Santander. CIBERINFEC. Av. de Valdecilla s/n, 39008. Santander, Cantabria. Spain.
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García-Fernández S, Calvo J, Cercenado E, Suárez-Barrenechea AI, Fernández-Billón M, Castillo FJ, Gálvez-Benítez L, Tubau F, Figueroa Cerón RE, Hernández-Cabezas A, González Romo F, Fariñas MC, Gómez M, Díaz-Regañón J, Cantón R. Activity of imipenem/relebactam against Enterobacterales and Pseudomonas aeruginosa in Spain. SMART 2016-2020. Rev Esp Quimioter 2023; 36:302-309. [PMID: 36951688 DOI: 10.37201/req/007.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To determine susceptibility to the novel β-lactam/β-lactamase inhibitor combination imipenem/relebactam in clinical isolates recovered from intra-abdominal (IAI), urinary (UTI), respiratory (RTI) and bloodstream (BSI) infections in the SMART (Study for Monitoring Antimicrobial Resistance Trends) study in SPAIN during 2016 - 2020. METHODS Broth microdilution MICs for imipenem/relebactam and comparators were determined by a central laboratory against isolates of Enterobacterales and Pseudomonas aeruginosa. MICs were interpreted using EUCAST-2021 breakpoints. RESULTS In total, 5,210 Enterobacterales and 1,418 P. aeruginosa clinical isolates were analyzed. Imipenem/relebactam inhibited 98.8% of Enterobacterales. Distinguishing by source of infection susceptibility was 99.1% in BSI, 99.2% in IAI, 97.9% in RTI, and 99.2% in UTI. Of intensive care unit isolates (ICU) 97.4% were susceptible and of non-ICU isolates 99.2% were susceptible. In Enterobacterales, activity against Class A, Class B and Class D carbapenemases was 96.2%, 15.4% and 73.2%, respectively. In P. aeruginosa, imipenem/relebactam was active in 92.2% of isolates. By source of infection it was 94.8% in BSI, 92.9% in IAI, 91.7% in RTI, and 93.1% in UTI. An 88.7% of ICU isolates and 93.6% of non-ICU isolates were susceptible to imipenem/relebactam. Imipenem/relebactam remained active against P. aeruginosa ceftazidime-resistant (76.3%), cefepime-resistant (73.6%), imipenem-resistant (71.5%) and piperacillin-resistant (78.7%) isolates. Of all multidrug-resistant or difficult-to-treat resistance P. aeruginosa isolates, 75.1% and 46.2%, respectively, were susceptible to imipenem/relebactam. CONCLUSIONS Imipenem/relebactam showed high rates of susceptibility in Enterobacterales and P. aeruginosa isolates from different sources of infection as well as depending on patients' location (ICU or non-ICU scenarios).
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Affiliation(s)
- S García-Fernández
- Sergio García-Fernández, Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
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Pablo-Marcos D, Siller M, Agüero J, Álvarez-Justel A, García-Fernández S, de la Fuente SV, Goicoechea P, Rodríguez-Lozano J, Ocampo-Sosa A, Lucas-Fernández J, Fariñas MC, Fernández J, Fraile-Ribot PA, Aracil B, Oteo-Iglesias J, Calvo-Montes J. Are GES carbapenemases underdiagnosed? An allelic discrimination assay for their accurate detection and differentiation. J Microbiol Methods 2023; 207:106694. [PMID: 36871870 DOI: 10.1016/j.mimet.2023.106694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
GES (Guiana Extended Spectrum) carbapenemases belong to "minor class A carbapenemases" and its prevalence could be underestimated due to the lack of specific tests. The aim of this study was to develop an easy PCR method to differentiate between GES β-lactamases with or without carbapenemase activity, based on an allelic discrimination system of SNPs that encode E104K and G170S mutations, without need of sequencing. Two pair of primers and Affinity Plus probes, labeled with different fluorophores; FAM/IBFQ and YAK/IBFQ, were designed for each one of the SNPs. This allelic discrimination assay allows to detect in real time the presence of all type of GES- β-lactamases, being able to differentiate between carbapenemases and extended-spectrum β-lactamase (ESBL), through a quick PCR test that avoid costly sequencing approaches and could help to decrease the current underdiagnosis of minor carbapenemases that scape of phenotypic screenings.
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Affiliation(s)
- D Pablo-Marcos
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
| | - M Siller
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - J Agüero
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - A Álvarez-Justel
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - S García-Fernández
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - S Velasco de la Fuente
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - P Goicoechea
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - J Rodríguez-Lozano
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - A Ocampo-Sosa
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - J Lucas-Fernández
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - M C Fariñas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - J Fernández
- Servicio de Microbiología, Hospital Universitario Central de Asturias. Grupo de Microbiología Traslacional, ISPA, s, Asturias, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - P A Fraile-Ribot
- Servicio de Microbiología, Hospital Universitario Son Espases e Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - B 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; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - J 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; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - J Calvo-Montes
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Fernandez-Sampedro M, Sanlés-González I, García-Ibarbia C, Fañanás-Rodríquez N, Fakkas-Fernández M, Fariñas MC. The poor accuracy of D-dimer for the diagnosis of prosthetic joint infection but its potential usefulness in early postoperative infections following revision arthroplasty for aseptic loosening. BMC Infect Dis 2022; 22:91. [PMID: 35086474 PMCID: PMC8793264 DOI: 10.1186/s12879-022-07060-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/13/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND D-dimer was introduced in 2018 as an alternative biomarker for C-reactive protein (CRP) in the diagnostic of prosthetic joint infection (PJI) criteria of the Musculoskeletal Infection Society. We assessed the accuracy of plasma D-dimer for the diagnosis of early, delayed, and late PJI according to Infectious Diseases Society of America (IDSA) criteria, and whether persistently high levels of D-dimer in cases of aseptic loosening (AL) may be predictive of subsequent implant-related infection. METHODS A prospective study of a consecutive series of 187 revision arthroplasties was performed at a single institution. Septic (n = 39) and aseptic revisions (n = 141) were classified based on IDSA criteria. Preoperative assessment of CRP, erythrocyte sedimentation rate (ESR) and D-dimer was performed. Receiver operating curves were used to determine maximum sensitivity and specificity of the biomarkers. The natural progress of D-dimer for AL cases was followed up either until the date of implant-related infection at any time during the first year or 1 year after revision in patients without failure. Clinical outcomes for those AL cases included infection-related failure that required a new surgery or need for antibiotic suppression. RESULTS Preoperative D-dimer level was significantly higher in PJI cases than in AL cases (p = 0.000). The optimal threshold of D-dimer for the diagnosis of PJI was 1167 ng/mL. For overall diagnosis of PJI, C-reactive protein (CRP) achieved the highest sensitivity (84.6%), followed by erythrocyte sedimentation rate (ESR) and D-dimer (82% and 71.8%, respectively). Plasma D-dimer sensitivity was lower for all PJI types. When combinations of 2 tests were studied, the combined use of ESR and CRP achieved the best accuracy for all types of PJI (76.9%). 4.25% of AL cases had implant failure due to implant-related infection during the first year after the index revision arthroplasty, only the cases with early failure maintained high D-dimer levels. CONCLUSIONS Plasma D-dimer did not offer an improvement over the individual or combined diagnosis for any type of PJI according to IDSA criteria. Persistently raised levels of D-dimer after revision arthroplasty in AL cases might be used to effectively diagnose early postoperative infection.
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Affiliation(s)
- M Fernandez-Sampedro
- Infectious Diseases Department, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Av. Valdecilla s/n 39008, Santander, Spain.
| | - I Sanlés-González
- Infectious Diseases Department, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Av. Valdecilla s/n 39008, Santander, Spain
| | - C García-Ibarbia
- Internal Medicine Department, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - N Fañanás-Rodríquez
- Clinical Analysis Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M Fakkas-Fernández
- Orthopaedic Surgery Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M C Fariñas
- Infectious Diseases Department, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Av. Valdecilla s/n 39008, Santander, Spain
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Ferrer R, Fariñas MC, Maseda E, Salavert M, Bou G, Díaz-Regañón J, López D, Lozano V, Gómez-Ulloa D, Fenoll R, Lara N, McCann E. Clinical management of cUTI, cIAI, and HABP/VABP attributable to carbapenem-resistant Gram-negative infections in Spain. Rev Esp Quimioter 2021; 34:639-650. [PMID: 34806858 PMCID: PMC8638756 DOI: 10.37201/req/096.2021] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction. Carbapenem-resistant Gram-negative (CRGN) infections are a major public health problem in Spain, often implicated in complicated, healthcare-associated infections that require the use of potentially toxic antibacterial agents of last resort. The objective of this study was to assess the clinical management of complicated infections caused by CRGN bacteria in Spanish hospitals. Methods. The study included: 1) a survey assessing the GN infection and antibacterial susceptibility profile in five participating Spanish hospitals and 2) a non-interventional, retrospective single cohort chart review of 100 patients with complicated urinary tract infection (cUTI), complicated intra-abdominal infection (cIAI), or hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia (HABP/VABP) attributable to CRGN pathogens. Results. In the participating hospitals CRGN prevalence was 9.3% amongst complicated infections. In the retrospective cohort, 92% of infections were healthcare-associated, and Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common pathogens. OXA was the most frequently detected carbapenemase type (71.4%). We found that carbapenems were frequently used to treat cUTI, cIAI, HABP/VABP caused by CRGN pathogens. Carbapenem use, particularly in combination with other agents, persisted after confirmation of carbapenem resistance. Clinical cure was 66.0%, mortality during hospitalization 35.0%, mortality at the time of chart review 62.0%, and 6-months-post-discharge readmission 47.7%. Conclusion. Our results reflect the high burden and unmet needs associated with the management of complicated infections attributable to CRGN pathogens in Spain and highlight the urgent need for enhanced clinical management of these difficult-to-treat infections.
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Affiliation(s)
- R Ferrer
- Ricard Ferrer. Hospital Universitario Vall d'Hebron, Barcelona, Spain.
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Arnaiz de Las Revillas F, Gonzalez-Quintanilla V, Parra JA, Palacios E, Gonzalez-Rico C, Armiñanzas C, Gutiérrez-Cuadra M, Oterino A, Fariñas-Alvarez C, Fariñas MC. Evaluation of endothelial function and subclinical atherosclerosis in patients with HIV infection. Sci Rep 2021; 11:18431. [PMID: 34531450 PMCID: PMC8446055 DOI: 10.1038/s41598-021-97795-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/29/2021] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to analyse the association between human immunodeficiency virus (HIV) related clinical and analytical parameters and the presence of subclinical atherosclerosis as well as endothelial dysfunction. This was a prospective cohort study of HIV-positive patients who underwent intima media thickness (IMT) determination and coronary artery calcium scoring to determine subclinical atherosclerosis. To detect endothelial dysfunction, the breath holding index, flow-mediated dilation and the concentration of endothelial progenitor cells (EPCs) were measured. Patients with an IMT ≥ 0.9 mm had an average of 559.3 ± 283.34 CD4/μl, and those with an IMT < 0.9 mm had an average of 715.4 ± 389.92 CD4/μl (p = 0.04). Patients with a low calcium score had a significantly higher average CD4 cell value and lower zenith viral load (VL) than those with a higher score (707.7 ± 377.5 CD4/μl vs 477.23 ± 235.7 CD4/μl (p = 0.01) and 7 × 104 ± 5 × 104 copies/ml vs 23.4 × 104 ± 19 × 104 copies/ml (p = 0.02)). The number of early EPCs in patients with a CD4 nadir < 350/µl was lower than that in those with a CD4 nadir ≥ 350 (p = 0.03). In HIV-positive patients, low CD4 cell levels and high VL were associated with risk of developing subclinical atherosclerosis. HIV patients with CD4 cell nadir < 350/µl may have fewer early EPCs.
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Affiliation(s)
- F Arnaiz de Las Revillas
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | | | - J A Parra
- Radiology Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - E Palacios
- Neurology Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - C Gonzalez-Rico
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | - C Armiñanzas
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | - M Gutiérrez-Cuadra
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | - A Oterino
- Neurology Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - C Fariñas-Alvarez
- Quality Unit. Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - M C Fariñas
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain.
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Varela Barca L, Vidal-Bonnet L, Fariñas MC, Muñoz P, Valerio Minero M, de Alarcón A, Gutiérrez Carretero E, Gutiérrez Cuadra M, Moreno Camacho A, Kortajarena Urkola X, Goikoetxea Agirre J, Ojeda Burgos G, López-Cortés LE, Porres Azpiroz JC, Lopez-Menendez J. Analysis of sex differences in the clinical presentation, management and prognosis of infective endocarditis in Spain. Heart 2021; 107:1717-1724. [PMID: 34290038 DOI: 10.1136/heartjnl-2021-319254] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/28/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Sex-dependent differences of infective endocarditis (IE) have been reported. Women suffer from IE less frequently than men and tend to present more severe manifestations. Our objective was to analyse the sex-based differences of IE in the clinical presentation, treatment, and prognosis. MATERIAL AND METHODS We analysed the sex differences in the clinical presentation, modality of treatment and prognosis of IE in a national-level multicentric cohort between 2008 and 2018. All data were prospectively recorded by the GAMES cohort (Spanish Collaboration on Endocarditis). RESULTS A total of 3451 patients were included, of whom 1105 were women (32.0%). Women were older than men (mean age, 68.4 vs 64.5). The most frequently affected valves were the aortic valve in men (50.6%) and mitral valve in women (48.7%). Staphylococcus aureus aetiology was more frequent in women (30.1% vs 23.1%; p<0.001).Surgery was performed in 38.3% of women and 50% of men. After propensity score (PS) matching for age and estimated surgical risk (European System for Cardiac Operative Risk Evaluation II (EuroSCORE II)), the analysis of the matched cohorts revealed that women were less likely to undergo surgery (OR 0.74; 95% CI 0.59 to 0.91; p=0.05).The observed overall in-hospital mortality was 32.8% in women and 25.7% in men (OR for the mortality of female sex 1.41; 95% CI 1.21 to 1.65; p<0.001). This statistical difference was not modified after adjusting for all possible confounders. CONCLUSIONS Female sex was an independent factor related to mortality after adjusting for confounders. In addition, women were less frequently referred for surgical treatment.
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Affiliation(s)
- Laura Varela Barca
- Cardiac Surgery, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Laura Vidal-Bonnet
- Servicio de Cirugía Cardiaca, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
| | - M C Fariñas
- Servicio de Enfermedades Infecciosas, Marques de Valdecilla Foundation, Santander, Cantabria, Spain
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Gregorio Maranon General University Hospital Cardiology Service, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Maricela Valerio Minero
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Gregorio Maranon General University Hospital Cardiology Service, Madrid, Spain
| | - Arístides de Alarcón
- Servicio de Enfermedades Infecciosas, Virgen del Rocio University Hospital, Sevilla, Spain
| | | | - Manuel Gutiérrez Cuadra
- Servicio de Enfermedades Infecciosas, Marques de Valdecilla Foundation, Santander, Cantabria, Spain
| | - Asuncion Moreno Camacho
- Servicio de Enfermedades Infecciosas, Clinic Barcelona Hospital University, Barcelona, Spain
| | | | | | - Guillermo Ojeda Burgos
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, University Hospital Virgen de la Victoria, Malaga, Spain
| | - Luis Eduardo López-Cortés
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Complejo Hospitalario Virgen de la Macarena, Sevilla, Spain
| | - J C Porres Azpiroz
- Servicio de Cardiología, Miguel Servet University Hospital, Zaragoza, Spain
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Arnaíz de Las Revillas F, Sousa D, Ardunay C, García-Vidal C, Montejo M, Rodríguez-Álvarez R, Pasquau J, Bouza E, Oteo JA, Balseiro C, Méndez C, Lwoff N, Llinares P, Fariñas MC. Healthcare-associated pneumonia: a prospective study in Spain. Rev Esp Quimioter 2020; 33:358-368. [PMID: 32693555 PMCID: PMC7528418 DOI: 10.37201/req/067.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The aim of the study was to describe the epidemiological characteristics and factors related to outcome in Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated pneumonia (HCAP). Patients and method A 3-year prospective observational epidemiological case study of HCAP was conducted in seven Spanish hospitals. Microbiological and patient characteristics and outcomes were collected and classified by causative pathogen into 4 categories: “S. pneumoniae”, “MRSA”, “Others” and “Unknown”. Patients were followed up 30 days after discharge. Results A total of 258 (84.6%) patients were enrolled (170 were men [65.9%]). Mean age was 72.4 years ± 15 years (95% CI [70.54-74.25]). The etiology of pneumonia was identified in 73 cases (28.3%):S. pneumoniae in 35 patients (13.6%), MRSA in 8 (3.1%), and other microorganisms in 30 patients (11.6%). Significant differences in rates of chronic obstructive pulmonary disease (p < 0.05), previous antibiotic treatment (p < 0.05), other chronic respiratory diseases, inhaled corticosteroids (p < 0.01), and lymphoma (p < 0.05) were observed among the four groups. Patients with MRSA pneumonia had received more previous antibiotic treatment (87.5%). Thirty-three (12.8%) patients died during hospitalisation; death in 27 (81.2%) was related to pneumonia. Conclusions The etiology of HCAP was identified in only one quarter of patients, with S. pneumoniae being the most prevalent microorganism. Patients with chronic respiratory diseases more frequently presented HCAP due to MRSA than to S. pneumoniae. Death at hospital discharge was related in most cases to pneumonia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - M C Fariñas
- María Carmen Fariñas. Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, 39008 Santander, Cantabria, Spain.
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Puente M, Fariñas-Alvarez C, Moreto A, Sánchez-Velasco P, Ocejo-Vinyals JG, Fariñas MC. Low pre-transplant levels of mannose-binding lectin are associated with viral infections and mortality after haematopoietic allogeneic stem cell transplantation. BMC Immunol 2019; 20:40. [PMID: 31706269 PMCID: PMC6842494 DOI: 10.1186/s12865-019-0318-8] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mannose-binding lectin (MBL) is a key component of innate immunity. Low serum MBL levels, related to promoter polymorphism and structural variants, have been associated with an increased risk of infection. The aim of this work was to analyse the incidence and severity of infections and mortality in relation to the MBL2 genotype and MBL levels in patients underwent allogeneic haematopoietic stem cell transplantation (Allo-HSCT). RESULTS This was a prospective cohort study of 72 consecutive patients underwent Allo-HSCT between January 2007 and June 2009 in a tertiary referral centre. Three periods were considered in the patients' follow-up: the early period (0-30 days after Allo-HSCT), the intermediate period (30-100 days after Allo-HSCT) and the late period (> 100 days after Allo-HSCT). A commercial line probe assay for MBL2 genotyping and an ELISA Kit were used to measure MBL levels. A total of 220 episodes of infection were collected in the 72 patients. No association between donor or recipient MBL2 genotype and infection was found. The first episode of infection presented earlier in patients with pre-transplant MBL levels of < 1000 ng/ml (median 6d vs 8d, p = 0.036). MBL levels < 1000 ng/ml in the pre-transplant period (risk ratio (RR) 2.48, 95% CI 1.00-6.13), neutropenic period (0-30 days, RR 3.28, 95% CI 1.53-7.06) and intermediate period (30-100 days, RR 2.37, 95% CI 1.15-4.90) were associated with increased risk of virus infection. No association with bacterial or fungal disease was found. Mortality was associated with pre-transplant MBL levels < 1000 ng/ml (hazard ratio 5.55, 95% CI 1.17-26.30, p = 0.03) but not with MBL2 genotype. CONCLUSIONS Patients who underwent Allo-HSCT with low pre-transplant MBL levels presented the first episode of infection earlier and had an increased risk of viral infections and mortality in the first 6 months post-transplant. Thus, pre-transplant MBL levels would be important in predicting susceptibility to viral infections and mortality and might be considered a biomarker to be included in the pre-transplantation risk assessment.
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Affiliation(s)
- M Puente
- Service of Hematology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.,Present address: Service of Hematology, Hospital de Cruces, Bilbao, Spain
| | - C Fariñas-Alvarez
- Division of Health Care Quality, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - A Moreto
- Service of Hematology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.,Present address: Service of Hematology, Hospital de Cruces, Bilbao, Spain
| | - P Sánchez-Velasco
- Division of Health Care Quality, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - J G Ocejo-Vinyals
- Division of Health Care Quality, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M C Fariñas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain.
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10
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Oriol I, Sabe N, Càmara J, Berbel D, Ballesteros MA, Escudero R, Lopez-Medrano F, Linares L, Len O, Silva JT, Oliver E, Soldevila L, Pérez-Recio S, Guillem LL, Camprubí D, LLadó L, Manonelles A, González-Costello J, Domínguez MA, Fariñas MC, Lavid N, González-Rico C, Garcia-Cuello L, Arnaiz de Las Revillas F, Fortun J, Aguado JM, Jimenez-Romero C, Bodro M, Almela M, Paredes D, Moreno A, Pérez-Cameo C, Muñoz-Sanz A, Blanco-Fernández G, Cabo-González JA, García-López JL, Nuño E, Carratalà J. The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation: A Prospective Multicenter Cohort Study. Open Forum Infect Dis 2019; 6:ofz180. [PMID: 31198815 PMCID: PMC6546202 DOI: 10.1093/ofid/ofz180] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/17/2019] [Indexed: 01/29/2023] Open
Abstract
Background We analyzed the prevalence, etiology, and risk factors of culture-positive preservation fluid and their impact on the management of solid organ transplant recipients. Methods From July 2015 to March 2017, 622 episodes of adult solid organ transplants at 7 university hospitals in Spain were prospectively included in the study. Results The prevalence of culture-positive preservation fluid was 62.5% (389/622). Nevertheless, in only 25.2% (98/389) of the cases were the isolates considered "high risk" for pathogenicity. After applying a multivariate regression analysis, advanced donor age was the main associated factor for having culture-positive preservation fluid for high-risk microorganisms. Preemptive antibiotic therapy was given to 19.8% (77/389) of the cases. The incidence rate of preservation fluid-related infection was 1.3% (5 recipients); none of these patients had received preemptive therapy. Solid organ transplant (SOT) recipients with high-risk culture-positive preservation fluid receiving preemptive antibiotic therapy presented both a lower cumulative incidence of infection and a lower rate of acute rejection and graft loss compared with those who did not have high-risk culture-positive preservation fluid. After adjusting for age, sex, type of transplant, and prior graft rejection, preemptive antibiotic therapy remained a significant protective factor for 90-day infection. Conclusions The routine culture of preservation fluid may be considered a tool that provides information about the contamination of the transplanted organ. Preemptive therapy for SOT recipients with high-risk culture-positive preservation fluid may be useful to avoid preservation fluid-related infections and improve the outcomes of infection, graft loss, and graft rejection in transplant patients.
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Affiliation(s)
- I Oriol
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI).,Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona
| | - N Sabe
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI).,Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona
| | - J Càmara
- Microbiology Department, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Spain.,CIBER de Enfermedades Respiratorias (CIBERes), Madrid, Spain
| | - D Berbel
- Microbiology Department, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Spain.,CIBER de Enfermedades Respiratorias (CIBERes), Madrid, Spain
| | - M A Ballesteros
- Intensive Care Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - R Escudero
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. IRYCIS
| | - F Lopez-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain
| | - L Linares
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona.,Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - O Len
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J T Silva
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain.,Department of Infectious Diseases, Hospital Universitario de Badajoz, Spain
| | - E Oliver
- Donor Coordination Unit, Bellvitge University Hospital, Barcelona, Spain
| | - L Soldevila
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Pérez-Recio
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain
| | - L L Guillem
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Camprubí
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain
| | - L LLadó
- Liver Transplant Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - A Manonelles
- Department of Nephrology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - J González-Costello
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - M A Domínguez
- Spanish Network for Research in Infectious Diseases (REIPI).,Microbiology Department, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Spain.,Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona
| | - M C Fariñas
- Infectious Diseases Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - N Lavid
- Donor Coordination Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - C González-Rico
- Infectious Diseases Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - L Garcia-Cuello
- Infectious Diseases Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - F Arnaiz de Las Revillas
- Infectious Diseases Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - J Fortun
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. IRYCIS
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain
| | - C Jimenez-Romero
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain
| | - M Bodro
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona.,Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - M Almela
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona.,Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - D Paredes
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona.,Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - A Moreno
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona.,Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - C Pérez-Cameo
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Muñoz-Sanz
- Department of Infectious Diseases, Hospital Universitario de Badajoz, Spain
| | | | | | - J L García-López
- Donor Coordination Unit, Hospital universitario de Badajoz, Spain
| | - E Nuño
- Donor Coordination Unit, Hospital universitario de Badajoz, Spain
| | - J Carratalà
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI).,Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona
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11
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Fernández-Hidalgo N, Ribera A, Larrosa MN, Viedma E, Origüen J, de Alarcón A, Fariñas MC, Sáez C, Peña C, Múñez E, García López MV, Gavaldà J, Pérez-Montarelo D, Chaves F, Almirante B. Impact of Staphylococcus aureus phenotype and genotype on the clinical characteristics and outcome of infective endocarditis. A multicentre, longitudinal, prospective, observational study. Clin Microbiol Infect 2017; 24:985-991. [PMID: 29269091 DOI: 10.1016/j.cmi.2017.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We aimed to evaluate the impact of Staphylococcus aureus phenotype (vancomycin MIC) and genotype (agr group, clonal complex CC) on the prognosis and clinical characteristics of infective endocarditis (IE). METHODS We performed a multicentre, longitudinal, prospective, observational study (June 2013 to March 2016) in 15 Spanish hospitals. Two hundred and thirteen consecutive adults (≥18 years) with a definite diagnosis of S. aureus IE were included. Primary outcome was death during hospital stay. Main secondary end points were persistent bacteraemia, sepsis/septic shock, peripheral embolism and osteoarticular involvement. RESULTS Overall in-hospital mortality was 37% (n = 72). Independent risk factors for death were age-adjusted Charlson co-morbidity index (OR 1.20; 95% CI 1.08-1.34), congestive heart failure (OR 3.60; 95% CI 1.72-7.50), symptomatic central nervous system complication (OR 3.17; 95% CI 1.41-7.11) and severe sepsis/septic shock (OR 4.41; 95% CI 2.18-8.96). In the subgroup of methicillin-susceptible S. aureus IE (n = 173), independent risk factors for death were the age-adjusted Charlson co-morbidity index (OR 1.17; 95% CI 1.03-1.31), congestive heart failure (OR 3.39; 95% CI 1.51-7.64), new conduction abnormality (OR 4.42; 95% CI 1.27-15.34), severe sepsis/septic shock (OR 5.76; 95% CI 2.57-12.89) and agr group III (OR 0.27; 0.10-0.75). Vancomycin MIC ≥1.5 mg/L was not independently associated with death during hospital nor was it related to secondary end points. No other genotype variables were independently associated with in-hospital death. CONCLUSIONS This is the first prospective study to assess the impact of S. aureus phenotype and genotype. Phenotype and genotype provided no additional predictive value beyond conventional clinical characteristics. No evidence was found to justify therapeutic decisions based on vancomycin MIC for either methicillin-resistant or methicillin-susceptible S. aureus.
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Affiliation(s)
- N Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
| | - A Ribera
- Cardiovascular Epidemiology Unit, Cardiology Department, Vall d'Hebron University Hospital, CIBERESP, Barcelona, Spain
| | - M N Larrosa
- Universitat Autonoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Servei de Microbiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Viedma
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Origüen
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigacion Hospital 12 de Octubre (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - A de Alarcón
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville, University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - M C Fariñas
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Unit, Hospital Universitario Marques de Valdecilla, University of Cantabria, Santander, Spain
| | - C Sáez
- Unidad de Infecciosas, Hospital de la Princesa, Instituto de Investigacion, Madrid, Spain
| | - C Peña
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Servei de Malalties Infeccioses, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Servei de Medicina Interna, Hospital Mare de Deu dels Lliris, Alcoi, Spain
| | - E Múñez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - M V García López
- Servicio de Microbiologia, Hospital Universitario Virgen de la Victoria, Instituto de Investigacion Biomedica, Malaga, Spain
| | - J Gavaldà
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - D Pérez-Montarelo
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Chaves
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - B Almirante
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
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12
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Fernández-Sampedro M, Fariñas-Alvarez C, Garces-Zarzalejo C, Alonso-Aguirre MA, Salas-Venero C, Martínez-Martínez L, Fariñas MC. Accuracy of different diagnostic tests for early, delayed and late prosthetic joint infection. BMC Infect Dis 2017; 17:592. [PMID: 28841913 PMCID: PMC6389211 DOI: 10.1186/s12879-017-2693-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 08/17/2017] [Indexed: 01/16/2023] Open
Abstract
Background A combination of laboratory, histopathological and microbiological tests for diagnosis of prosthetic joint infection (PJI) have been strongly recommended. This study aims to characterize the accuracy of individual or group tests, such as culture of sonicate fluid, synovial fluid and peri-implant tissue, C-reactive protein (CRP) and histopathology for detection of early, delayed and late PJI. Methods A prospective study of patients undergoing hip or knee arthroplasty from February 2009 to February 2014 was performed in a Spanish tertiary health care hospital. The diagnostic accuracy of the different methods was evaluated constructing receiver-operating-characteristic (ROC) curve areas. Results One hundred thirty consecutive patients were included: 18 (13.8%) early PJI, 35 (27%) delayed PJI and 77 (59.2%) late PJI. For individual parameters, the area under the ROC curve for peri-implant tissue culture was larger for early (0.917) than for delayed (0.829) and late PJI (0.778), p = 0.033. There was a significantly larger difference for ROC area in the synovial fluid culture for delayed (0.803) than for early (0.781) and late infections (0.679), p = 0.039. The comparison of the areas under the ROC curves for the two microbiological tests showed that sonicate fluid was significantly different from peri-implant tissue in delayed (0.951 vs 0.829, p = 0.005) and late PJI (0.901 vs 0.778, p = 0.000). The conjunction of preoperative parameters, synovial fluid culture and CRP, improved the accuracy for late PJI (p = 0.01). The conjunction of histopathology and sonicate fluid culture increased the area under ROC curve of sonication in early (0.917 vs 1.000); p = 0.06 and late cases (0.901 vs 0.999); p < 0.001. Conclusion For early PJI, sonicate fluid and peri-implant tissue cultures achieve the same best sensitivity. For delayed and late PJI, sonicate fluid culture is the most sensitive individual diagnostic method. By combining histopathology and peri-implant tissue, all early, 97% of delayed and 94.8% of late cases are diagnosed. The conjunction of histopathology and sonicate fluid culture yields a sensitivity of 100% for all types of infection.
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Affiliation(s)
- M Fernández-Sampedro
- Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain.
| | - C Fariñas-Alvarez
- Division of Health Care Quality Hospital, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - C Garces-Zarzalejo
- Department of Orthopaedic Surgery, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - M A Alonso-Aguirre
- Department of Orthopaedic Surgery, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - C Salas-Venero
- Service of Microbiology, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - L Martínez-Martínez
- Service of Microbiology, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - M C Fariñas
- Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain.
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13
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Calderon-Gonzalez R, Terán-Navarro H, García I, Marradi M, Salcines-Cuevas D, Yañez-Diaz S, Solis-Angulo A, Frande-Cabanes E, Fariñas MC, Garcia-Castaño A, Gomez-Roman J, Penades S, Rivera F, Freire J, Álvarez-Domínguez C. Gold glyconanoparticles coupled to listeriolysin O 91-99 peptide serve as adjuvant therapy against melanoma. Nanoscale 2017; 9:10721-10732. [PMID: 28714508 DOI: 10.1039/c7nr02494k] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Dendritic cell-based (DC-based) vaccines are promising immunotherapies for cancer. However, several factors, such as the lack of efficient targeted delivery and the sources and types of DCs, have limited the efficacy of DCs and their clinical potential. We propose an alternative nanotechnology-based vaccine platform with antibacterial prophylactic abilities that uses gold glyconanoparticles coupled to listeriolysin O 91-99 peptide (GNP-LLO91-99), which acts as a novel adjuvant for cancer therapy. GNP-LLO91-99, when used to vaccinate mice, exhibited dual antitumour activities, namely, the inhibition of tumour migration and growth and adjuvant activity for recruiting and activating DCs, including those from melanoma patients. GNP-LLO91-99 nanoparticles caused tumour apoptosis and induced antigen- and melanoma-specific cytotoxic Th1 responses (P ≤ 0.5). We propose this adjuvant nanotherapy for preventing the progression of the first stages of melanoma.
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Affiliation(s)
- R Calderon-Gonzalez
- Grupo de Nanovacunas y vacunas celulares basadas en Listeria y sus aplicaciones en biomedicina, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Avda. Cardenal Herrera Oria s/n, 39011 Santander, Cantabria, Spain.
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14
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Calderon-Gonzalez R, Teran-Navarro H, Marimon JM, González-Rico C, Calvo-Montes J, Frande-Cabanes E, Alkorta-Gurrutxaga M, Fariñas MC, Martínez-Martínez L, Perez-Trallero E, Alvarez-Dominguez C. Biomarker Tools to Design Clinical Vaccines Determined from a Study of Annual Listeriosis Incidence in Northern Spain. Front Immunol 2016; 7:541. [PMID: 27965668 PMCID: PMC5126465 DOI: 10.3389/fimmu.2016.00541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/16/2016] [Indexed: 12/23/2022] Open
Abstract
Two regions of northern Spain, Gipuzkoa, and Cantabria present high annual incidence of listeriosis (1.86 and 1.71 cases per 100,000 inhabitants, respectively). We report that the high annual incidences are a consequence of infection with highly virulent Listeria monocytogenes isolates linked to fatal outcomes in elderly patients with cancer. In addition, listeriosis patients with cancer present low IL-17A/IL-6 ratios and significantly reduced levels of anti-GAPDH1–22 antibodies, identified as two novel biomarkers of poor prognosis. Analysis of these biomarkers may aid in reducing the incidence of listeriosis. Moreover, GAPDH1–22-activated monocyte-derived dendritic cells of listeriosis patients with cancer seem useful tools to prepare clinical vaccines as they produce mainly Th1 cytokines.
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Affiliation(s)
- Ricardo Calderon-Gonzalez
- Grupo de Nanovacunas y vacunas celulares basadas en Listeria y sus aplicaciones en biomedicine, Instituto de Investigación Marqués de Valdecilla (IDIVAL) , Santander , Spain
| | - Hector Teran-Navarro
- Grupo de Nanovacunas y vacunas celulares basadas en Listeria y sus aplicaciones en biomedicine, Instituto de Investigación Marqués de Valdecilla (IDIVAL) , Santander , Spain
| | - José María Marimon
- Servicio de Microbiología, Instituto de Investigación Sanitaria Biodonostia, Hospital Universitario Donostia, San Sebastián, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Claudia González-Rico
- Sección de Enfermedades Infecciosas, Hospital Universitario Marques de Valdecilla , Santander , Spain
| | - Jorge Calvo-Montes
- Servicio de Microbiología, Hospital Universitario Marques de Valdecilla , Santander , Spain
| | - Elisabet Frande-Cabanes
- Grupo de Nanovacunas y vacunas celulares basadas en Listeria y sus aplicaciones en biomedicine, Instituto de Investigación Marqués de Valdecilla (IDIVAL) , Santander , Spain
| | - Miriam Alkorta-Gurrutxaga
- Servicio de Microbiología, Instituto de Investigación Sanitaria Biodonostia, Hospital Universitario Donostia, San Sebastián, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - M C Fariñas
- Sección de Enfermedades Infecciosas, Hospital Universitario Marques de Valdecilla, Santander, Spain; Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Spain
| | - Luis Martínez-Martínez
- Servicio de Microbiología, Hospital Universitario Marques de Valdecilla, Santander, Spain; Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain
| | - Emilio Perez-Trallero
- Servicio de Microbiología, Instituto de Investigación Sanitaria Biodonostia, Hospital Universitario Donostia, San Sebastián, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Carmen Alvarez-Dominguez
- Grupo de Nanovacunas y vacunas celulares basadas en Listeria y sus aplicaciones en biomedicine, Instituto de Investigación Marqués de Valdecilla (IDIVAL) , Santander , Spain
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15
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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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16
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Capdevila JA, Guembe M, Barberán J, de Alarcón A, Bouza E, Fariñas MC, Gálvez J, Goenaga MA, Gutiérrez F, Kestler M, Llinares P, Miró JM, Montejo M, Muñoz P, Rodríguez-Creixems M, Sousa D, Cuenca J, Mestres CA. 2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adult. Rev Esp Quimioter 2016; 29:230-238. [PMID: 27580009] [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: 06/06/2023]
Abstract
The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. Short peripheral catheters have been found to be associated with the risk of nosocomial bacteremia resulting in morbidity and mortality. Staphyloccus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been elaborated by a panel of experts of the Spanish Society of Cardiovascular Infections in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy and Spanish Society of Thoracic-Cardiovascular Surgery and aims at define and establish the norm for management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance and registry, diagnosis and treatment of infection, indications for removal and stresses on continuous education as a driver for quality. Implementation of this norm will allow uniformity in usage thus minimizing the risk of infection and its complications.
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Affiliation(s)
- J A Capdevila
- Josep A. Capdevila, Internal Medicine, Consorcio Hospitalario de Mataró, Barcelona (Spain).
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17
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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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18
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Armiñanzas C, Herrera LA, Fariñas MC. [Bacteriobilia: a non-resolved problem]. Rev Esp Quimioter 2016; 29:113-118. [PMID: 27062980] [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: 06/05/2023]
Abstract
Bile duct is usually sterile, and the isolating of microorganisms (bacteriobilia) has been related to some factors, such as age, biliary drainage before pancreatic surgery or bile duct stones. Gramnegative strains remain the most frequent pathogens, especially Escherichia coli. Among grampositives Enterococcus spp should be mentioned. Currently, there is controversy about whether the presence of bacteriobilia has an impact on unfavorable outcome of biliary disease or surgical procedures or mortality rates, with complications such as surgical site infections or bacteremia. In high-risk patients, such as immunosuppressed or those underwent pancreaticoduodenectomy, bile duct cultures performed routinely, even if there are not clinical data of infection, could be necessary in order to start antibiotic treatment or to reduce its spectrum.
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Affiliation(s)
| | | | - M C Fariñas
- M. Carmen Fariñas, Sección de Enfermedades Infecciosas. Hospital Universitario Marqués de Valdecilla Universidad de Cantabria. Av. Valdecilla s/n 39008, Santander, Spain.
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19
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Armiñanzas C, Tigera T, Ferrer D, Calvo J, Herrera LA, Pajarón M, Gómez-Fleitas M, Fariñas MC. [Role of bacteriobilia in postoperative complications]. Rev Esp Quimioter 2016; 29:123-129. [PMID: 27062981] [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: 06/05/2023]
Abstract
OBJECTIVE At present there is a controversy regarding the impact of positive bile cultures on morbidity and mortality rates, and on the incidence of readmissions in patients with biliar disease. The aim of this study was to evaluate the role of bacteriobilia in postoperatory infections, mortality or readmissions in these patients. METHODS The information was obtained from all patients with bile cultures admitted to Hospital Universitario Marqués de Valdecilla (Santander, Spain) from January to December 2011. Clinical, epidemiological and microbiological data and laboratory findings were analyzed. The patients were followed for two years. RESULTS One hundred and fifty-two patients (65% men) were included. Mean age was 67 years (SD= 15 years). The most frequent diagnoses were acute cholecystitis (79%) and cholangitis (8%). Laparoscopic cholecystectomy was performed in 42% of patients, open cholecystectomy in 45% and percutaneous cholecystostomy in 8%. Bacteriobilia was present in 83 patients (55%). The most frecuent microorganisms isolated were Escherichia coli (31%), Enterococcus faecium (13%) and Klebsiella pneumoniae (13%). The initial antimicrobial agent was a carbapenem in 62 patients (44%) and piperacillin-tazobactam in 28 (18%). There were 39 postoperative infections (26%), 21 readmissions (14%) and 17 patients died during admission (11%). The presence of microorganisms in bile cultures was not a statistically significant predictor of neither complications nor readmissions. CONCLUSIONS Intra-operative bile cultures would allow guide early appropriate antibiotic treatment use in case of infection, or empiric antimicrobial therapy, however there was no correlation between bacteriobilia and postoperative infections, length of stay, mortality or readmissions.
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Affiliation(s)
| | | | | | | | | | | | | | - M C Fariñas
- M. Carmen Fariñas, Sección de Enfermedades Infecciosas. Hospital Universitario Marqués de Valdecilla Universidad de Cantabria. Av. Valdecilla s/n 39008, Santander, Spain.
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20
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Ruiz-Morales J, Ivanova-Georgieva R, Fernández-Hidalgo N, García-Cabrera E, Miró JM, Muñoz P, Almirante B, Plata-Ciézar A, González-Ramallo V, Gálvez-Acebal J, Fariñas MC, Bravo-Ferrer JM, Goenaga-Sánchez MA, Hidalgo-Tenorio C, Goikoetxea-Agirre J, de Alarcón-González A. Left-sided infective endocarditis in patients with liver cirrhosis. J Infect 2015; 71:627-41. [PMID: 26408206 DOI: 10.1016/j.jinf.2015.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 05/14/2015] [Revised: 09/05/2015] [Accepted: 09/07/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery. METHODS Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals. RESULTS A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p < 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23-1.85; p < 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery. CONCLUSIONS Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.
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Affiliation(s)
- J Ruiz-Morales
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
| | - R Ivanova-Georgieva
- Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
| | - N Fernández-Hidalgo
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - E García-Cabrera
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Jose M Miró
- Hospital Clinic - IDIBAPS, Servicio de Enfermedades Infecciosas y Microbiología, Universidad de Barcelona, Barcelona, Spain.
| | - P Muñoz
- Servicio de Microbiología y Enfermedades infecciosas, H. Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
| | - B Almirante
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - A Plata-Ciézar
- UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital General Universitario, Málaga, Spain.
| | - V González-Ramallo
- Unidad de Hospitalización a Domicilio, H. Universitario Gregorio Marañón, Madrid, Spain.
| | - J Gálvez-Acebal
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - M C Fariñas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
| | - J M Bravo-Ferrer
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario Juan Canalejo, A Coruña, Spain.
| | - M A Goenaga-Sánchez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián, Spain.
| | - C Hidalgo-Tenorio
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - J Goikoetxea-Agirre
- Servicio de Enfermedades Infecciosas, Hospital Universitario Cruces, Bilbao, Spain.
| | - A de Alarcón-González
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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21
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Amado-Diago CA, Gutiérrez-Cuadra M, Armiñanzas C, Arnaíz de Las Revillas F, Gómez-Fleitas M, Fariñas MC. Echinococcosis: A 15-year epidemiological, clinical and outcome overview. Rev Clin Esp 2015; 215:380-4. [PMID: 26119089 DOI: 10.1016/j.rce.2015.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze the epidemiological and clinical characteristics and mortality of patients with cystic echinococcosis (CE) in northern Spain. PATIENTS AND METHODS A retrospective study of the medical records of patients diagnosed with CE and hospitalized from 1997 to 2011 in a University Hospital. RESULTS A total of 76 patients (44 men) were diagnosed with CE. The mean age was 57.8 years (SD: 19.1 years; range: 14.9-92.7). The yearly average incidence was 1.08 cases/100,000 inhabitants. The highest incidence was registered in patients aged 70-79 years (22.7% of all cases). Liver was the main organ involved (92.1%), followed by lung (6.6%) and peritoneum (1.3%). Fifty-five patients (72%) received treatment: 2 (3.6%) medical treatment with albendazole, 27 (49%) surgical treatment, 3 (5.4%) medical treatment combined with cyst drainage, and 23 (42%) combined medical and surgical treatment. Eight patients had a recurrence. Twenty-four (31.2%) patients died. No patient's death was attributed directly to hydatidosis, though mortality was significantly higher in the untreated vs. the treated patient group (57% vs. 22%, p=0.003). CONCLUSIONS Hydatidosis treatment and diagnostic approaches remain heterogeneous. The liver continues being the main organ affected. Mortality was higher in patients who did not receive treatment. However, this result might have been influenced by other factors, mainly age.
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Affiliation(s)
- C A Amado-Diago
- Service of Pneumology, Hospital Universitario Marqués de Valdecilla, , Santander, Spain
| | - M Gutiérrez-Cuadra
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - C Armiñanzas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - F Arnaíz de Las Revillas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - M Gómez-Fleitas
- General Surgery Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - M C Fariñas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
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22
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Cantisán S, Rodelo-Haad C, Páez-Vega A, Nieto A, Vaquero JM, Poyato A, Montejo M, Fariñas MC, Rivero A, Solana R, Martín-Malo A, Torre-Cisneros J. Factors related to the development of CMV-specific CD8+ T cell response in CMV-seropositive solid organ transplant candidates. Am J Transplant 2015; 15:715-22. [PMID: 25648131 DOI: 10.1111/ajt.13012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 09/10/2014] [Accepted: 09/11/2014] [Indexed: 01/25/2023]
Abstract
This cross-sectional study analyzes factors associated with the development of CMV-specific CD8+ response, measured by IFNg production after cytomegalovirus (CMV) peptide stimulation, in CMV-seropositive solid organ transplantation candidates. A total of 114 candidates were enrolled, of whom 22.8% (26/114) were nonreactive (IFNγ < 0.2 IU/mL). Multivariate logistic regression analysis showed that age, HLA alleles and organ to be transplanted were associated with developing CMV-specific CD8+ immunity (reactive; IFNγ ≥ 0.2 IU/mL). The probability of being reactive was higher in candidates over 50 than in those under 50 (OR 6.33, 95%CI 1.93-20.74). Candidates with HLA-A1 and/or HLA-A2 alleles had a higher probability of being reactive than those with non-HLA-A1/non-HLA-A2 alleles (OR 10.97, 95%CI 3.36-35.83). Renal candidates had a higher probability of being reactive than lung (adjusted OR 8.85, 95%CI 2.24-34.92) and liver candidates (OR 4.87, 95%CI 1.12-21.19). The AUC of this model was 0.84 (p < 0.001). Positive and negative predictive values were 84.8% and 76.9%, respectively. In renal candidates longer dialysis was associated with an increased frequency of reactive individuals (p = 0.040). Therefore, although the assessment of CMV-specific CD8+ response is recommended in all R+ candidates, it is essential in those with a lower probability of being reactive, such as non-renal candidates, candidates under 50 or those with non-HLA-A1/non-HLA-A2 alleles.
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Affiliation(s)
- S Cantisán
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
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23
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Len O, Montejo M, Cervera C, Fariñas MC, Sabé N, Ramos A, Cordero E, Torre-Cisneros J, Martín-Dávila P, Azanza JR, Pahissa A, Gavaldà J. Daptomycin is safe and effective for the treatment of gram-positive cocci infections in solid organ transplantation. Transpl Infect Dis 2014; 16:532-8. [PMID: 24834833 DOI: 10.1111/tid.12232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/04/2013] [Accepted: 01/27/2014] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Infections caused by resistant gram-positive cocci (GPC), especially to glycopeptides, are difficult to treat in solid organ transplant (SOT) recipients as a result of lower effectiveness and high rates of renal impairment. The aim of this study was to evaluate the use of daptomycin in this population. METHODS Over a 2-year period (March 2008-2010) in 9 Spanish centers, we enrolled all consecutive recipients who received daptomycin to treat GPC infection. The study included 43 patients, mainly liver and kidney transplant recipients. RESULTS The most frequent infections were catheter-related bacteremia caused by coagulase-negative staphylococci (23.2%), skin infection caused by Staphylococcus aureus (11.5%), and intra-abdominal abscess caused by Enterococcus faecium (20.9%). The daily daptomycin dose was 6 mg/kg in 32 patients (74.4%). On day 7 of daptomycin treatment, median estimated area under the curve was 1251 μg/mL/h. At the end of follow-up, analytical parameters were similar to the values at the start of therapy. No changes were observed in tacrolimus levels. No patient required discontinuation of daptomycin because of adverse effects. Clinical success at treatment completion was achieved in 37 (86%) patients. Three patients died while on treatment with daptomycin. CONCLUSION In summary, daptomycin was a safe and useful treatment for GPC infection in SOT recipients.
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Affiliation(s)
- O Len
- Department of Infectious Diseases, Hospital Vall d'Hebron, Barcelona, Spain
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24
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Ocejo-Vinyals JG, Puente de Mateo E, Ausín F, Agüero R, Arroyo JL, Gutiérrez-Cuadra M, Fariñas MC. Human toll-like receptor 1 T1805G polymorphism and susceptibility to pulmonary tuberculosis in northern Spain. Int J Tuberc Lung Dis 2013; 17:652-4. [PMID: 23575331 DOI: 10.5588/ijtld.12.0767] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Toll-like receptors (TLRs) are key sensors of mycobacterial infections and play a crucial role in the initiation and coordination of the antimycobacterial innate immune response. T1805G, a functional TLR1 single nucleotide polymorphism (SNP), has been associated with susceptibility to pulmonary tuberculosis (PTB), but contradictory results among different populations have been reported. Our objective was to study this SNP in a genetically homogeneous population to evaluate its role in conferring susceptibility or resistance to PTB. In our population, the 1805G allele and the GG genotype (OR 2.04, 95%CI 1.26-3.31) influence susceptibility to PTB, in contrast with data observed in other populations.
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Affiliation(s)
- J G Ocejo-Vinyals
- Immunology Service, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
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25
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Riancho J, Delgado-Alvarado M, Valero C, Echevarría S, Fariñas MC. Clinical spectrum of peripheral facial paralysis in HIV-infected patients according to HIV status. Int J STD AIDS 2013; 24:39-41. [DOI: 10.1177/0956462412472308] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although peripheral facial palsy is the most common cranial neuropathy in HIV-infected patients, no series have been reported recently in the literature. In this study we reviewed the clinical records of HIV-infected patients with a diagnosis of peripheral facial palsy between 2000 and 2011 attending the Hospital Marqués de Valdecilla (Infectious Diseases Unit), a 900-bed university hospital in northern Spain. We identified eight patients (4 men, 4 women): median CD4 count and viral load were 232 cells per μL and 130,000 RNA copies per mL, respectively. Most of them presented co-morbidities, including hepatitis C virus in 75%, hepatitis B virus in 15% and tuberculosis in 15%. Aetiologies of palsy were varied: idiopathic Bell's palsy predominated at early stages of the disease, whereas secondary causes, such as lymphoma and infections were frequently the cause of paralysis in advanced HIV/AIDS. At early stages of HIV infection, facial palsy is similar, both in aetiology and prognosis, to cases in the general population. However, in advanced stages the palsy is frequently secondary to underlying complications. Clinicians should be aware of these differences to tailor the diagnostic work-up.
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Affiliation(s)
| | | | - C Valero
- Infectious Diseases Unit, Internal Medicine, Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - S Echevarría
- Infectious Diseases Unit, Internal Medicine, Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - M C Fariñas
- Infectious Diseases Unit, Internal Medicine, Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain
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26
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Horcajada JP, Gutiérrez-Cuadra M, Martínez-Rodríguez I, Salas C, Parra JA, Benito N, Quirce R, Carril JM, Fariñas MC. High prevalence of upper urinary tract involvement detected by 111indium-oxine leukocyte scintigraphy in patients with candiduria. Eur J Clin Microbiol Infect Dis 2012; 31:237-42. [PMID: 21633831 DOI: 10.1007/s10096-011-1299-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Accepted: 05/15/2011] [Indexed: 02/05/2023]
Abstract
The purpose of this investigation was to assess the prevalence of upper urinary tract involvement in patients with candiduria by means of (111)indium-oxine-labeled leukocyte scintigraphy. An observational cohort study of patients with confirmed candiduria was conducted in an acute-care teaching hospital in Spain from March 2006 through February 2009. An (111)In-labeled leukocyte scan was performed in order to assess the upper urinary tract involvement. A series of non-matched patients without candiduria nor bacteriuria undergoing scintigraphy to exclude infections in other sites than the urinary tract was also studied. Demographics, baseline illness, and clinical data were recorded. Candiduria was detected in 428 patients, and scintigraphy was performed in 35 of these patients. Twenty-nine patients without candiduria nor bacteriuria were also studied. Positive renal scintigraphy was documented in 24 (68%) patients with confirmed candiduria and in 3 (10%) patients without candiduria (p < 0.005). Renal uptake was not associated with a higher mortality nor with re-admissions. Subclinical pyelonephritis could be more frequent in patients with candiduria than it has been previously considered.
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Affiliation(s)
- J P Horcajada
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
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27
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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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28
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Cordero E, Pérez-Romero P, Moreno A, Len O, Montejo M, Vidal E, Martín-Dávila P, Fariñas MC, Fernández-Sabé N, Giannella M, Pachón J. Pandemic influenza A(H1N1) virus infection in solid organ transplant recipients: impact of viral and non-viral co-infection. Clin Microbiol Infect 2012; 18:67-73. [PMID: 21790857 PMCID: PMC7129435 DOI: 10.1111/j.1469-0691.2011.03537.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [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] [Indexed: 11/26/2022]
Abstract
Solid organ transplant recipients (SOTR) are at risk of serious influenza-related complications. The impact of respiratory co-infection in SOTR with 2009 pandemic influenza A(H1N1) is unknown. A multicentre prospective study of consecutive cases of pandemic influenza A(H1N1) in SOTR was carried out to assess the clinical characteristics and outcome and the risk factors for co-infection. Overall, 51 patients were included. Median time from transplant was 3.7 years, 5.9% of the cases occurred perioperatively and 7.8% were hospital-acquired. Pneumonia was diagnosed in 15 (29.4%) patients. Ten cases were severe (19.6%): 13.7% were admitted to intensive care units, 5.9% suffered septic shock, 5.9% developed acute graft rejection and 7.8% died. Co-infection was detected in 15 patients (29.4%): eight viral, six bacterial and one fungal. Viral co-infection did not affect the outcome. Patients with non-viral co-infection had a worse outcome: longer hospital stay (26.2 ± 20.7 vs. 5.5 ± 10.2) and higher rate of severe diseases (85.7% vs. 2.3%) and mortality (42.8% vs. 2.3%). Independent risk factors for non-viral co-infection were: diabetes mellitus and septic shock. Other factors associated with severe influenza were: delayed antiviral therapy, diabetes mellitus, time since transplantation <90 days and pneumonia. In conclusion, pandemic influenza A can cause significant direct and indirect effects in SOTR, especially in the early post-transplant period, and should be treated early. Clinicians should be aware of the possibility of non-viral co-infection, mainly in diabetic patients and severe cases. An effort should be made to prevent influenza with immunization of the patient and the environment.
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Affiliation(s)
- E Cordero
- Infectious Diseases Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina Sevilla, Sevilla, Spain.
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29
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Golpe R, Pérez-de-Llano LA, Castro-Añón O, Vázquez-Caruncho M, González-Juanatey C, Fariñas MC. [Troponin-I in hemodynamically-stable pulmonary embolism: correlation with echocardiography and computed tomography angiography]. Rev Clin Esp 2011; 211:69-75. [PMID: 21316656 DOI: 10.1016/j.rce.2010.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 06/18/2010] [Accepted: 06/27/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Troponin-I (TnI) is a marker of severe pulmonary thromboembolism (PTE) in unselected patients. There are few articles that assess its usefulness in hemodynamically-stable patients. OBJECTIVES To assess the correlation between TnI levels and both echocardiographic/radiologic signs of right ventricle (RV) dysfunction or pulmonary hypertension (PH), and the severity of the pulmonary vascular obstruction. METHODS We selected patients from a prospective cohort of 103 consecutive patients with PTE and systolic arterial pressure ≥ 90 mmHg. Computed tomography pulmonary angiography (CTPA) and echocardiography were performed in all patients. We performed a post hoc study, analyzing the 68 cases in which TnI was measured, at the discretion of the emergency room physician. RESULTS Patients included had a median age of 74 years and 50% were male. The patients with elevated TnI had a differentiated clinical profile, suggestive of more severe PTE. There was a significant correlation between TnI levels and systolic pulmonary artery pressure (r=0.46, P<.001), the CTPA-measured pulmonary artery diameter (r=0.48, P<.001), the CTPA-measured RV diameter (r=0.47, P=.001) and the pulmonary vascular obstruction index (r=0.39, P=.001). CONCLUSION The higher levels of TnI in patients with hemodynamically stable PTE predicts the existence of more severe PE in hemodynamically-stable patients. This biomarker could be used in the clinical practice to select those patients who might require more intensive monitoring or additional complementary studies.
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Affiliation(s)
- R Golpe
- Servicio de Neumología, Complexo Hospitalario Xeral-Calde, Lugo, España.
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30
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Gutiérrez-Cuadra M, Ballesteros MA, Vallejo A, Miñambres E, Fariñas-Alvarez C, García-Palomo JD, Vázquez Barquero A, Fariñas MC. [Brain abscess in a third-level hospital: epidemiology and prognostic factors related to mortality]. Rev Esp Quimioter 2009; 22:201-206. [PMID: 20082040] [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: 05/28/2023]
Abstract
OBJECTIVE To document the epidemiology, causes, treatment and prognostic factors associated with mortality of patients with brain abscess in a tertiary medical center. METHODS Observational retrospective cohort study of patients with cerebral abscess admitted at a tertiary hospital during 13 years. RESULTS The case records of 71 patients admitted to a tertiary hospital between January 1992 and December 2005 and diagnosed of brain abscess were review. Brain abscess occurred at all ages, more frequently in men than in women. Fever, headache and altered mental status were common presenting symptoms. The most common site of infection was the frontal lobe (28 patients). Seventeen patients had multiple abscesses. Staphylococcal infection was seen most commonly. Computed tomography provided sufficient diagnostic information in all cases. Twenty six patients had early surgical drainage. Thirty four patients were admitted to the intensive care Unit (ICU). The overall mortality was 21% (15 patients), all of that related to the infection. Six patients died in ICU. More than 65 years of age (OR, 1.0; CI 95%, 1.0-1.1), medical treatment without surgery (OR, 8.9; CI 95%, 1.1-73.8), presence of multiple abscesses, (OR, 6.0; CI 95%, 1.0-34.9), immunosuppression (OR, 21.5; CI 95%, 2.9-157.2) and delay in starting antibiotherapy (OR, 1.5 per day of delay; CI 95%, 1.0-2.1) were independent predictors of in-hospital death. CONCLUSIONS In spite of improvement in diagnosis and treatment of patients with cerebral abscess, mortality is still high. Factors related to patient underlying diseases and the delay in the start an antibiotic treatment were associated with increased mortality (50% increase of mortality risk per day in the delay of starting antibiotherapy).
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Affiliation(s)
- M Gutiérrez-Cuadra
- Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Avda Valdecilla, s/n, 39008 Santander, Cantabria, Spain
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31
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Peña-Sagredo JL, Fariñas MC, Perez-Zafrilla B, Cruz-Valenciano A, Crespo M, Joven-Ibañez B, Riera E, Manero-Ruiz FJ, Chalmeta I, Hernández MV, Rodríguez-Gómez M, Maíz O, López R, Cobo T, Pita J, Carmona L, Gonzalez-Gay MA. Non-typhi Salmonella infection in patients with rheumatic diseases on TNF-alpha antagonist therapy. Clin Exp Rheumatol 2009; 27:920-925. [PMID: 20149306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES The morbidity and mortality of patients with rheumatic diseases has improved considerably following the use of biologic therapies. However, an increase in the frequency of bacterial infections has been observed in patients receiving these drugs. In the present study we aimed to establish the incidence and clinical manifestations of non-typhi Salmonella infection in a large cohort of patients with rheumatic diseases undergoing TNF-alpha antagonist therapy due to severe rheumatic diseases refractory to conventional therapies. METHODS The rate of non-typhi Salmonella infection found in the Spanish Registry of Adverse Events of Biological Therapies in Rheumatic Diseases (BIOBADASER) was compared with that observed in a cohort of rheumatoid arthritis (RA) patients from the EMECAR (Morbidity and Clinical Expression of Rheumatoid Arthritis) Study, who were not treated with TNF-alpha antagonists. The rate found in the BIOBADASER registry was also compared with that available in a non-RA historic control cohort reported in a population from Huesca (Northern Spain). RESULTS Seventeen cases of non-typhi Salmonella infection were observed in the series of patients exposed to anti-TNF-alpha therapies. The incidence rate of non-typhi Salmonella in BIOBADASER was 0.73 per 1000 patient-years (95% confidence interval [CI]: 0.45-1.17). The incidence rate in the EMECAR cohort was 0.44 per 1000 patient-years. The relative risk for non-typhi salmonellosis in RA patients exposed to TNF-alpha inhibitors compared to those not treated with biological therapies was 2.07 (95% CI: 0.27-15.73) (p=0.480) whereas the relative risk of non-typhi Salmonella infections in patients with rheumatic diseases undergoing TNF-alpha antagonist therapy compared with the non-RA Spanish control cohort was 0.63 (95% CI: 0.38-1.04) (p=0.07). Nine of the 17 patients with non-typhi salmonellosis presented a severe systemic infection. CONCLUSION Incidence of non-typhi Salmonella infection is not increased significantly in rheumatic patients undergoing anti-TNF-alpha therapy when compared with RA patients undergoing conventional DMARD therapy or with the general population. Nevertheless, at least 50% of patients on TNF-alpha have severe complications once they develop non-typhi Salmonella infection. This fact suggests that anti-TNF-alpha therapies may predispose to salmonella dissemination rather than to infection.
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Affiliation(s)
- J L Peña-Sagredo
- Division of Rheumatology, Hospital Universitario Marques de Valdecilla, University of Cantabria, Santander, Spain
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32
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Peña-Sagredo JL, Hernández MV, Fernandez-Llanio N, Giménez-Ubeda E, Muñoz-Fernandez S, Ortiz A, Gonzalez-Gay MA, Fariñas MC. Listeria monocytogenes infection in patients with rheumatic diseases on TNF-alpha antagonist therapy: the Spanish Study Group experience. Clin Exp Rheumatol 2008; 26:854-859. [PMID: 19032819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The prognosis of patients with rheumatic diseases has improved considerably following the use of biological therapies. However, an increase in the frequency of bacterial infections has been observed in patients receiving these therapies. In the present study we aimed to assess the frequency of Listeria monocytogenes infection in a large series of patients with rheumatic diseases on treatment with tumor necrosis factor (TNF)-alpha blockers because of active disease refractory to conventional therapy, included in the Spanish Registry of Adverse Events of Biological Therapies in Rheumatic Diseases (BIOBADASER) of the Spanish Society for Rheumatology. METHODS Assessment of the incidence of infection due to Listeria monocytogenes in the Spanish Registry Study (BIOBADASER) per 1000 patient-years and 95% confidence intervals (95% CIs) was performed. Rate from this registry was compared with that from the general population in Europe and with the rate found in patients with rheumatoid arthritis (RA) from the Spanish Rheumatoid Arthritis Registry Cohort Study (EMECAR) that assessed morbidity and clinical expression of RA and included patients treated in most cases with conventional therapies. RESULTS Six patients on treatment with TNF-alpha antagonists were diagnosed as having Listeria monocytogenes infection. The incidence of this infection per 1000 patient-year (95% CI) was 0.256 (95% CI: 0.115-0.570). This was greater than the incidence observed in the general population from Europe and in the EMECAR study. CONCLUSION Despite the benefits associated to the use of TNF-alpha antagonists, a high level of surveillance is required to reduce the potential risk of infections related to the use of these drugs.
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Affiliation(s)
- J L Peña-Sagredo
- Divisions of Rheumatology and Infectious Diseases, Hospital Universitario Marques de Valdecilla, University of Cantabria, Spain
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Fernández-Ayala M, Nan DN, Fariñas-Alvarez C, Nistal JF, Revuelta JM, González-Macías J, Fariñas MC. Surgical site infections in cardiac surgery after a hospital catastrophe. J Hosp Infect 2008; 70:48-52. [PMID: 18621436 DOI: 10.1016/j.jhin.2008.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 05/22/2008] [Indexed: 11/18/2022]
Abstract
On 2 November 1999, one of the main hospital façades adjoining cardiovascular surgery collapsed in a 900-bed teaching hospital in Santander, Spain. The purpose of this study was to determine whether the accident affected the safety of patients by increasing the risk for nosocomial and surgical site infections (SSI). Measures for the prevention of nosocomial infections were immediately reinforced. A total of 217 consecutive patients were operated on before 2 November 1999, with another 296 after this date. Patients in both study periods showed similar severity of illness, complexity of surgical procedure and length of hospital stay. The overall rate of nosocomial infection before and after the accident was 28.1% and 24.7%, respectively (P=0.381). The rates of respiratory infection, urinary infection and bacteraemia were also similar. A statistically significant reduction in the SSI rate in the second period was observed (14.8% vs 4.4%, P=0.008). The collapse of the façade was not associated with any increase in nosocomial infection rates, but there was a significant reduction of SSI rates in relation to intensive infection control measures implemented after the collapse.
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Affiliation(s)
- M Fernández-Ayala
- Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria Santander, Spain
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Parra JA, Revuelta S, Gallego T, Bueno J, Berrio JI, Fariñas MC. Prosthetic mesh used for inguinal and ventral hernia repair: normal appearance and complications in ultrasound and CT. Br J Radiol 2004; 77:261-5. [PMID: 15020373 DOI: 10.1259/bjr/63333975] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The use of prosthetic mesh has now become accepted practice in the treatment of patients with both inguinal and ventral hernias. This pictorial review illustrates the various radiological appearances of these meshes and also demonstrates the post-operative complications associated with their implantation.
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Affiliation(s)
- J A Parra
- Department of Radiology, Hospital Sierrallana, Torrelavega, Cantabria, Spain
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Alonso-Valle H, Acha O, García-Palomo JD, Fariñas-Alvarez C, Fernández-Mazarrasa C, Fariñas MC. Candidemia in a tertiary care hospital: epidemiology and factors influencing mortality. Eur J Clin Microbiol Infect Dis 2003; 22:254-7. [PMID: 12709840 DOI: 10.1007/s10096-003-0890-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The present study was conducted in order to assess the epidemiology and clinical course of candidemia and to identify the risk factors associated with mortality. A total of 143 episodes of nosocomial candidemia were identified during a 5-year period, and these were included in the study. The majority of candidemic episodes were due to Candida albicans (63, 44%), followed by Candida parapsilosis(32, 22%). The overall mortality was 45%. The following independent prognostic factors for mortality were identified: bacterial sepsis, rapidly fatal illness, chronic obstructive lung disease, presence of a central venous catheter, candidemia due to Candida albicans, and lack of antifungal therapy.
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Affiliation(s)
- H Alonso-Valle
- Division of Preventive Medicine, University of Cantabria, School of Medicine, Santander, Spain
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36
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Hernández JL, Calvo J, Antolínez X, Gutiérrez-Rubio F, Fariñas MC. [Septic arthritis due to Staphylococcus lugdunensis]. Enferm Infecc Microbiol Clin 2001; 19:414. [PMID: 11602151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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37
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Hernández JL, Calvo J, Sota R, Agüero J, García-Palomo JD, Fariñas MC. Clinical and microbiological characteristics of 28 patients with Staphylococcus schleiferi infection. Eur J Clin Microbiol Infect Dis 2001; 20:153-8. [PMID: 11347663 DOI: 10.1007/pl00011251] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this study was to analyse the clinical and microbiological characteristics of a series of patients with infection by Staphylococcus schleiferi. Seventy-one isolates were recovered from 36 patients between January 1993 and June 1999 at a tertiary care centre in northern Spain. There were 28 patients with well-documented clinical data. Infection was more frequent in men (89.3%), and more than half of the patients had some degree of immunosuppression, mainly malignant neoplasms. Infection was nosocomial in 22 cases and community-acquired in the remaining cases. Staphylococcus schleiferi was frequently associated with wound infections, mainly surgical-site infections, although unusual types of infections were detected. Infection-related mortality was low. This study highlights the importance of careful identification of Staphylococcus schleiferi in the clinical microbiology laboratory. Due to the documented association of Staphylococcus schleiferi with clinical infections in humans, any isolates of this organism should be assumed to be pathogenic, unless proven otherwise.
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Affiliation(s)
- J L Hernández
- Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain.
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Albalate M, Fariñas MC, Octavio JG, Perez JH, Goicoechea M, Caramelo C. Development of porphyria cutanea tarda in a hemodialysis patient after reactivation of hepatitis C virus infection. Nephron Clin Pract 2001; 88:170-3. [PMID: 11399922 DOI: 10.1159/000045980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Cases of porphyria cutanea tarda (PCT) are occasionally reported in hemodialysis patients. Recently, hepatitis C virus has been recognized as a precipitating factor of PCT. The activity of the liver disease may be critical for the appearance of PCT. In this regard, liver disease reactivation after treatment with interferon alpha (IFN-alpha) is a well-known phenomenon. We report the case of a hemodialysis patient who developed PCT coincidentally with reactivation of liver disease, immediately after treatment with IFN-alpha. Therefore, in the present case, reactivation of hepatitis after IFN-alpha withdrawal could be the triggering factor. The occurrence of a bout of PCT should be considered as a possible complication at the end of IFN-alpha therapy, if reactivation of the disease exists.
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Affiliation(s)
- M Albalate
- Centro de Diálisis Santa Engracia, Fundación Renal Iñigo Alvárez de Toledo, Madrid, España
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Calvo J, Zarrabeitia R, García-Palomo D, Fariñas MC, Agüero J. [Evaluation of three methods of diagnosis of Clostridium difficile infection]. Enferm Infecc Microbiol Clin 2001; 19:184-6. [PMID: 11333611 DOI: 10.1016/s0213-005x(01)72605-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nan DN, Fernández-Ayala M, Terán E, Parra JA, Fariñas MC. Severe hypercalcemia and solitary hepatic mass as initial manifestation of primary hepatic lymphoma. Liver 2001; 21:159-60. [PMID: 11318986 DOI: 10.1034/j.1600-0676.2001.021002159.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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42
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Nan DN, Fernández-Ayala M, García-Palomo D, Arce F, Fariñas MC. Atypical skin lesions associated with mixed cryoglobulinaemia and hepatitis C virus infection in a cocaine-consuming patient. Br J Dermatol 2000; 143:1330-1. [PMID: 11122051 DOI: 10.1046/j.1365-2133.2000.03918.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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43
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Fernández-Ayala M, Fariñas MC, Nan D, González-Macías J. [Kidney failure caused by sulphadiazine in patients with toxoplasma encephalitis]. An Med Interna 2000; 17:616-7. [PMID: 11322040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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44
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Ayuso-Mateos JL, Pereda M, Gómez Del Barrio A, Echevarria S, Fariñas MC, García-Palomo D. Slowed reaction time in HIV-1-seropositive intravenous drug users without AIDS. Eur Neurol 2000; 44:72-8. [PMID: 10965157 DOI: 10.1159/000008200] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
One hundred and fourteen subjects with a history of intravenous drug abuse (65 subjects infected with the human immunodeficiency virus, HIV, and 49 seronegative controls) were evaluated with a reaction time (RT) test which included one measure of simple RT and three measures of complex RT. All seropositive patients were in HIV stages A or B. The multivariate analysis of covariance controlled for age, educational level and Montgomery-Asberg Depression Rating Scale score, showed differences between seropositive subjects and controls: the seropositive group scored slower than the control group on two RT tasks, simple RT and a more complex RT measure. Our results suggest that computerized RT measures may be more sensitive than conventional neuropsychological tests in detecting subtle cognitive and motor retardation in the early stages of HIV infection, thus extending the findings of other studies to the intravenous drug-user population.
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Affiliation(s)
- J L Ayuso-Mateos
- Department of Medicine and Psychiatry, University of Cantabria Medical School, Santander, Spain.
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45
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Fariñas-Alvarez C, Fariñas MC, Prieto D, Delgado-Rodríguez M. Applicability of two surgical-site infection risk indices to risk of sepsis in surgical patients. Infect Control Hosp Epidemiol 2000; 21:633-8. [PMID: 11083178 DOI: 10.1086/501705] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the ability of the Study of the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infection Surveillance (NNIS) indices to predict the development of nosocomial sepsis in subjects undergoing surgery. DESIGN 1-year prospective case-control study. SETTING A tertiary-care center in Spain. PATIENTS Cases were surgical patients with nosocomial sepsis defined using the criteria of the Consensus Conference on Sepsis, identified by daily prospective surveillance. METHODS Controls were randomly selected from the daily list of surgical inpatients. Data were prospectively collected. To determine whether either index added explanatory information to the other, two methods were used. The first method involved computing a set of residuals for both variables. Residuals and primary variables were introduced in logistic regression models. The second method evaluated both indices with the Goodman-Kruskal (G) nonparametric coefficient. RESULTS 99 cases and 97 controls were included. After controlling for confounders, both the SENIC index (P<.001) and the NNIS index (P=.04) showed a significant trend. Residuals of the SENIC index added discriminating ability to the NNIS index, whereas residuals of the NNIS index did not improve the prediction ability of the SENIC index. Similar results were yielded by the G statistic: the SENIC index showed higher predictive power than the NNIS index (G=0.56 vs G=0.41). CONCLUSIONS Both indices performed about equally well for discriminating risk of nosocomial sepsis. The SENIC index had a somewhat better ability than the NNIS index only when the number of discharge diagnoses (not truly a predictive factor) were involved in the calculation of the SENIC index.
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Affiliation(s)
- C Fariñas-Alvarez
- Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Santander, Spain
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Fariñas-Alvarez C, Fariñas MC, Fernández-Mazarrasa C, Llorca J, Delgado-Rodríguez M. Epidemiological differences between sepsis syndrome with bacteremia and culture-negative sepsis. Infect Control Hosp Epidemiol 2000; 21:639-44. [PMID: 11083179 DOI: 10.1086/501706] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the association of putative disease markers and potential risk factors with the nosocomial sepsis syndrome. DESIGN Prospective case-control study matched for gender, age, and length of preinfection hospital stay. SETTING 1,200-bed tertiary-care center in Spain. PATIENTS Cases were selected using the sepsis syndrome criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference and were divided into three groups: sepsis with bacteremia (109 cases), sepsis with positive culture other than blood (122 cases), and sepsis with negative culture (115 cases without documented infection but with sepsis syndrome, clinically suspected infection, and empirical antibiotic treatment). Controls were randomly selected from the daily list of inpatients. Data were collected prospectively. Crude and multiple-risk-factor-adjusted odds ratios and their 95% confidence intervals were computed using conditional logistic regression analysis. RESULTS Presence of coma in the 48 hours before sepsis, intensive care unit (ICU) stay, and decreased serum albumin levels at admission were common epidemiological markers identified for the three groups of cases. Having a central venous catheter was the main healthcare-related risk factor for bacteremia. ICU stay and nasogastric tube were the main risk factors for sepsis with positive culture other than blood. Coma within 48 hours before sepsis and the need of intensive care were the only two markers identified for culture-negative sepsis. CONCLUSION Culture-negative sepsis does not behave like culture-positive sepsis, and this may imply that implementation of preventive measures to decrease the risk of bacteremia may not decrease the risk of sepsis syndrome.
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Affiliation(s)
- C Fariñas-Alvarez
- Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Satander, Spain
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47
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Calvo J, Hernández JL, Fariñas MC, García-Palomo D, Agüero J. Osteomyelitis caused by Staphylococcus schleiferi and evidence of misidentification of this Staphylococcus species by an automated bacterial identification system. J Clin Microbiol 2000; 38:3887-9. [PMID: 11015429 PMCID: PMC87502 DOI: 10.1128/jcm.38.10.3887-3889.2000] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of sternal osteomyelitis due to Staphylococcus schleiferi in a patient who underwent thoracic surgery. This constitutes the first documented case of osteomyelitis caused by this Staphylococcus species. We also relate our experience in the utilization of commercially available MicroScan panels for the identification of this microorganism.
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Affiliation(s)
- J Calvo
- Servicio de Microbiologia, Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
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Fariñas-Alvarez C, Fariñas MC, García-Palomo JD, González-Ruiz M, Fernández-Mazarrasa C, Parra JA, González-Macías J. Prognostic factors for pneumococcal bacteremia in a university hospital. Eur J Clin Microbiol Infect Dis 2000; 19:733-41. [PMID: 11117636 DOI: 10.1007/s100960000361] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The records of adult patients with pneumococcal bacteremia who were seen over an 8-year-period at an 1,100-bed university teaching hospital were reviewed in order to revise the clinical and laboratory findings and to identify the risk factors associated with mortality. A total of 156 patients were studied, 101 men and 55 women. The mean age of the patients was 65 years. Eighty-seven percent of the patients had community-acquired bacteremia and 13% had nosocomial pneumococcal bacteremia. The overall mortality was 33.9% and the related mortality was 20.5%. The following factors were associated with an increased risk of adverse outcome in the univariate analysis: mechanical ventilation (risk ratio [RR]=3.40; 95% confidence interval [95% CI]=1.44-8.05), administration of parenteral nutrition (RR=3.40; 95% CI =1.44-8.05), and the presence of an intravenous catheter (RR=2.33; 95% CI=1.27-4.24). In the multivariate analysis, the independent prognostic factors for mortality were as follows: development of clinical complications during the episode of bacteremia, rapidly fatal illness, advanced age and administration of parenteral nutrition. The results suggest that the overall mortality due to pneumococcal bacteremia continues to be high. Four independent risk factors associated with increased mortality were identified. Prevention and immunization with polyvalent pneumococcal polysaccharide vaccine should be practiced more widely.
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Affiliation(s)
- C Fariñas-Alvarez
- Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Santander, Spain
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Fariñas-Alvarez C, Fariñas MC, Fernández-Mazarrasa C, Llorca J, Casanova D, Delgado-Rodríguez M. Analysis of risk factors for nosocomial sepsis in surgical patients. Br J Surg 2000; 87:1076-81. [PMID: 10931054 DOI: 10.1046/j.1365-2168.2000.01466.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study aimed to identify patients at high risk for developing sepsis following surgery according to criteria determined by the American College of Chest Physicians and the Society of Critical Care Medicine Consensus Conference on sepsis. METHODS A prospective case-control study was performed in surgical patients in a tertiary care centre over 1 year. Patients were identified by a daily prospective surveillance. Controls were selected randomly from the daily list of surgical inpatients. Data were collected prospectively. Crude and adjusted odds ratios (ORs) and their 95 per cent confidence intervals were computed using logistic regression analysis. RESULTS During follow-up, 99 cases and 99 controls were identified. The main risk factors for sepsis found in the multivariate analysis were coma within 48 h before sepsis (OR 13.5, 95 per cent confidence interval 3.6-50.8), low serum albumin level at admission (OR 15.8, 5.4-46.4), two or more intrinsic co-morbidities (OR 11.8, 2.8-49.4) and parenteral nutrition (OR 5.1, 1.5-17.1). Emergency surgery (OR 3.0, 1.4-6.4), abdominal surgery (OR 2.6, 1.0-6.8) and number of surgical interventions (OR 2.5, 1. 1-6.1) were the variables related to surgery that significantly increased the risk of sepsis. Both the study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance indices showed a statistically significant trend with sepsis. CONCLUSION Patient-related factors appear to represent the greatest risk for developing postoperative nosocomial sepsis, rather than factors associated with the surgery.
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Affiliation(s)
- C Fariñas-Alvarez
- Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine and Infectious Diseases Unit, Service of Microbiology and Department of Surgery, University Hospital 'Marqués de Valdecilla', Santander, Spain
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Nan DN, Fernández-Ayala M, Iglesias L, García-Palomo D, Parra JA, Fariñas MC. Talc granulomatosis. A differential diagnosis of interstitial lung disease in HIV patients. Chest 2000; 118:258-60. [PMID: 10893392 DOI: 10.1378/chest.118.1.258] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Consumers of adulterated drugs may present with talc-induced interstitial lung disease. A transbronchial biopsy specimen showing granulomas with intracellular talc crystals is necessary to confirm this diagnosis. In patients infected with HIV, such a condition can be indistinguishable at first glance from opportunistic infections or other pulmonary diseases. A case is presented of a seropositive patient whose chest radiographs showed a diffuse interstitial pattern.
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MESH Headings
- Adult
- Diagnosis, Differential
- Fatal Outcome
- Granuloma, Foreign-Body/diagnostic imaging
- Granuloma, Foreign-Body/etiology
- Granuloma, Foreign-Body/pathology
- Granuloma, Respiratory Tract/diagnostic imaging
- Granuloma, Respiratory Tract/etiology
- Granuloma, Respiratory Tract/pathology
- HIV Infections/complications
- Humans
- Lung Diseases, Interstitial/diagnostic imaging
- Lung Diseases, Interstitial/etiology
- Lung Diseases, Interstitial/pathology
- Male
- Radiography
- Talc/adverse effects
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Affiliation(s)
- D N Nan
- Infectious Diseases Unit, Department of Internal Medicine, Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
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