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Ponirakis G, Odriozola A, Ortega L, Martinez L, Odriozola S, Torrens A, Coroleu D, Martínez S, Sanz X, Ponce M, Meije Y, Clemente M, Duarte A, Odriozola MB, Malik RA. Quantitative sensory testing defines the trajectory of sensory neuropathy after severe COVID-19. Diabetes Res Clin Pract 2024; 207:111029. [PMID: 38007044 DOI: 10.1016/j.diabres.2023.111029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/01/2023] [Accepted: 11/22/2023] [Indexed: 11/27/2023]
Abstract
AIMS To assess sensory neuropathy development after severe COVID-19. METHODS Patients with severe COVID-19 underwent assessment of neuropathic symptoms, tendon reflexes, and quantitative sensory testing to evaluate vibration (VPT), cold (CPT), warm (WPT) and heat perception thresholds (HPT) within 1-3 weeks of admission and after 1-year. RESULTS 32 participants with severe COVID-19 aged 68.6 ± 12.4 (18.8 % diabetes) were assessed. At baseline, numbness and neuropathic pain were present in 56.3 % and 43.8 % of participants, respectively. On the feet, VPT, WPT, and HPT were abnormal in 81.3 %, CPT was abnormal in 50.0 % and HPT on the face was abnormal in 12.5 % of patients. At 1-year follow-up, the prevalence of abnormal VPT (81.3 % vs 50.0 %, P < 0.01), WPT (81.3 % vs 43.8 %, P < 0.01), and HPT (81.3 % vs 50.0 %, P < 0.01) decreased, with no change in CPT (P = 0.21) on the feet or HPT on the face (P = 1.0). Only participants without diabetes recovered from an abnormal VPT, CPT, and WPT. Patients with long-COVID (37.5 %) had comparable baseline VPT, WPT and CPT with those without long-COVID (P = 0.07-0.69). CONCLUSIONS Severe COVID-19 is associated with abnormal vibration and thermal thresholds which are sustained for up to 1 year in patients with diabetes. Abnormal sensory thresholds have no association with long-COVID development.
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Affiliation(s)
- Georgios Ponirakis
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | | | | | | | | | | | | | | | - Xavier Sanz
- Hospital of Barcelona SCIAS, Barcelona, Spain
| | | | | | | | | | | | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
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2
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Badia-Cebada L, Carmezim J, Pérez-Rodríguez MT, Bereciartua E, López LE, Montenegro MR, Pomar V, Andrés M, Petkova E, Sopena N, Lora-Tamayo J, Monsálvez V, Ramirez-Hidalgo MF, Gómez-Zorrilla S, Boix L, Meije Y, Jiménez E, Gasch O. Randomized Clinical Trial of the Need for Antibiotic Treatment for Low-Risk Catheter-Related Bloodstream Infection Caused by Coagulase-Negative Staphylococci. Antibiotics (Basel) 2023; 12:antibiotics12050839. [PMID: 37237744 DOI: 10.3390/antibiotics12050839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
According to clinical guidelines, the management of catheter-related bloodstream infections (CRBSI) due to coagulase-negative staphylococci (CoNS) includes catheter removal and antibiotic treatment for 5 to 7 days. However, in low-risk episodes, it remains uncertain whether antibiotic therapy is necessary. This randomized clinical trial aims to determine whether the non-administration of antibiotic therapy is as safe and effective as the recommended strategy in low-risk episodes of CRBSI caused by CoNS. With this purpose, a randomized, open-label, multicenter, non-inferiority clinical trial was conducted in 14 Spanish hospitals from 1 July 2019 to 31 January 2022. Patients with low-risk CRBSI caused by CoNS were randomized 1:1 after catheter withdrawal to receive/not receive parenteral antibiotics with activity against the isolated strain. The primary endpoint was the presence of any complication related to bacteremia or to antibiotic therapy within 90 days of follow-up. The secondary endpoints were persistent bacteremia, septic embolism, time until microbiological cure, and time until the disappearance of a fever. EudraCT: 2017-003612-39 INF-BACT-2017. A total of 741 patients were assessed for eligibility. Of these, 27 were included in the study; 15 (55.6%) were randomized to the intervention arm (non-antibiotic administration) and 12 (44.4%) to the control arm (antibiotic therapy as per standard practice). The primary endpoint occurred in one of the 15 patients in the intervention group (septic thrombophlebitis) and in no patients in the control group. The median time until microbiological cure was 3 days (IQR 1-3) in the intervention arm and 1.25 days (IQR 0.5-2.62) in the control arm, while the median time until fever resolution was zero days in both arms. The study was stopped due to the insufficient number of recruited patients. These results seem to indicate that low-risk CRBSI caused by CoNS can be managed without antibiotic therapy after catheter removal; efficacy and safety are not affected.
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Affiliation(s)
- Laia Badia-Cebada
- Internal Medicine Department, Hospital Universitari Parc Taulí, Institut d'investigació i innovació Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - João Carmezim
- Unit of Statistics, Hospital Universitari de Bellvitge/Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, 08908 L'Hospitalet de Llobregat, Spain
| | - María-Teresa Pérez-Rodríguez
- Infectious Diseases Unit, Department of Internal Medicine. Hospital Álvaro Cunqueiro, Galicia Sur Health Research Institute, 36312 Vigo, Spain
| | - Elena Bereciartua
- Infectious Diseases Unit, Hospital Universitario de Cruces, 48903 Barakaldo, Spain
| | - Luis-Eduardo López
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena, 41009 Seville, Spain
- Departament of Medicine, School of Medicine, University of Sevilla, 41009 Seville, Spain
- Biomedicine Institute of Sevilla (IBiS)/CSIC, 41009 Seville, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marta Represa Montenegro
- Infectious Diseases Unit, Department of Internal Medicine. Hospital Álvaro Cunqueiro, Galicia Sur Health Research Institute, 36312 Vigo, Spain
| | - Virginia Pomar
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu I Sant Pau, 08025 Barcelona, Spain
| | - Marta Andrés
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Consorci de Terrassa, 08227 Terrassa, Spain
| | - Elizabet Petkova
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Nieves Sopena
- Infectious Diseases Department Hospital Germans Trias i Pujol, 08916 Badalona, Spain
| | - Jaime Lora-Tamayo
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación "imas12" Hospital 12 de Octubre, 28041 Madrid, Spain
| | - Víctor Monsálvez
- Internal Medicine Department, Hospital Universitari Parc Taulí, Institut d'investigació i innovació Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
- Infectious Diseases Department, Hospital Universitari Parc Taulí. Institut d'investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, 08193 Sabadell, Spain
| | | | - Silvia Gómez-Zorrilla
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Infectious Diseases Department. Hospital del Mar, Fundació Institut Mar d'Investigacions Mèdiques, Universitat Pompeu Fabra, 08003 Barcelona, Spain
| | - Lucía Boix
- Infectious Diseases Department, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
- Faculty of Medicine, Infectious Diseases, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
| | - Yolanda Meije
- Infectious Diseases Unit, Department of Internal Medicine. Hospital de Barcelona, 08034 Barcelona, Spain
| | - Emili Jiménez
- Infectious Diseases Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, 08907 L'Hospitalet de Llobregat, Spain
| | - Oriol Gasch
- Infectious Diseases Department, Hospital Universitari Parc Taulí. Institut d'investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, 08193 Sabadell, Spain
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Viasus D, Simonetti AF, Nonell L, Vidal O, Meije Y, Ortega L, Arnal M, Bódalo-Torruella M, Sierra M, Rombauts A, Abelenda-Alonso G, Blanchart G, Gudiol C, Carratalà J. Whole-Blood Gene Expression Profiles Associated with Mortality in Community-Acquired Pneumonia. Biomedicines 2023; 11:biomedicines11020429. [PMID: 36830965 PMCID: PMC9953679 DOI: 10.3390/biomedicines11020429] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
(1) Background: Information regarding gene expression profiles and the prognosis of community-acquired pneumonia (CAP) is scarce. We aimed to examine the differences in the gene expression profiles in peripheral blood at hospital admission between patients with CAP who died during hospitalization and those who survived. (2) Methods: This is a multicenter study of nonimmunosuppressed adult patients who required hospitalization for CAP. Whole blood samples were obtained within 24 h of admission for genome-expression-profile analysis. Gene expression profiling identified both differentially expressed genes and enriched gene sets. (3) Results: A total of 198 samples from adult patients who required hospitalization for CAP were processed, of which 13 were from patients who died. Comparison of gene expression between patients who died and those who survived yielded 49 differentially expressed genes, 36 of which were upregulated and 13 downregulated. Gene set enrichment analysis (GSEA) identified four positively enriched gene sets in survivors, mainly associated with the interferon-alpha response, apoptosis, and sex hormone pathways. Similarly, GSEA identified seven positively enriched gene sets, associated with the oxidative stress, endoplasmic reticulum stress, oxidative phosphorylation, and angiogenesis pathways, in the patients who died. Protein-protein-interaction-network analysis identified FOS, CDC42, SLC26A10, EIF4G2, CCND3, ASXL1, UBE2S, and AURKA as the main gene hubs. (4) Conclusions: We found differences in gene expression profiles at hospital admission between CAP patients who died and those who survived. Our findings may help to identify novel candidate pathways and targets for potential intervention and biomarkers for risk stratification.
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Affiliation(s)
- Diego Viasus
- Department of Medicine, Division of Health Sciences, Universidad del Norte and Hospital Universidad del Norte, Barranquilla 081001, Colombia
- Correspondence:
| | - Antonella F. Simonetti
- Department of Internal Medicine, Consorci Sanitari Alt Penedès-Garraf, 08720 Sant Pere de Ribes, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Institulo de Salud Carlos III, 28029 Madrid, Spain
| | - Lara Nonell
- MARGenomics, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Oscar Vidal
- Department of Medicine, Division of Health Sciences, Universidad del Norte and Hospital Universidad del Norte, Barranquilla 081001, Colombia
| | - Yolanda Meije
- Unit of Infectious Disease, Department of Internal Medicine, Hospital de Barcelona—Societat Cooperativa d’Instal·lacions Assistencials Sanitàries (SCIAS), 08029 Barcelona, Spain
| | - Lucía Ortega
- Unit of Infectious Disease, Department of Internal Medicine, Hospital de Barcelona—Societat Cooperativa d’Instal·lacions Assistencials Sanitàries (SCIAS), 08029 Barcelona, Spain
| | - Magdalena Arnal
- MARGenomics, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | | | - Montserrat Sierra
- Microbiology Unit, Department of Clinical Laboratory, Hospital de Barcelona—Societat Cooperativa d’Instal·lacions Assistencials Sanitàries (SCIAS), 08029 Barcelona, Spain
| | - Alexander Rombauts
- Department of Infectious Diseases, Bellvitge University Hospital—Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain
| | - Gabriela Abelenda-Alonso
- Department of Infectious Diseases, Bellvitge University Hospital—Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain
| | - Gemma Blanchart
- Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Carlota Gudiol
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Institulo de Salud Carlos III, 28029 Madrid, Spain
- Department of Infectious Diseases, Bellvitge University Hospital—Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, 08907 Barcelona, Spain
| | - Jordi Carratalà
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Institulo de Salud Carlos III, 28029 Madrid, Spain
- Department of Infectious Diseases, Bellvitge University Hospital—Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, 08907 Barcelona, Spain
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4
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Grillo S, Cuervo G, Carratala J, San-Juan R, Aguado JM, Morata L, Gomez-Zorrilla S, López-Contreras J, Gasch O, Gomila-Grange A, Iftimie S, Garcia-Pardo G, Calbo E, Boix-Palop L, Oriol I, Jover-Sáenz A, López-Cortés LE, Euba G, Aguirregabiria M, Garcia-Pais MJ, Gioia F, Paño JR, Pedro-Botet ML, Benítez RM, Pérez-Rodríguez MT, Meije Y, Loeches-Yagüe MB, Horna G, Berbel D, Domínguez MÁ, Padullés A, Cobo S, Hereu P, Videla S, Tebe C, Pallarés N, Miro JM, Pujol M. Multicentre, randomised, open-label, phase IV-III study to evaluate the efficacy of cloxacillin plus fosfomycin versus cloxacillin alone in adult patients with methicillin-susceptible Staphylococcus aureus bacteraemia: study protocol for the SAFO trial. BMJ Open 2021; 11:e051208. [PMID: 34353808 PMCID: PMC8344278 DOI: 10.1136/bmjopen-2021-051208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia is a frequent condition, with high mortality rates. There is a growing interest in identifying new therapeutic regimens able to reduce therapeutic failure and mortality observed with the standard of care of beta-lactam monotherapy. In vitro and small-scale studies have found synergy between cloxacillin and fosfomycin against S. aureus. Our aim is to test the hypothesis that cloxacillin plus fosfomycin achieves higher treatment success than cloxacillin alone in patients with MSSA bacteraemia. METHODS We will perform a superiority, randomised, open-label, phase IV-III, two-armed parallel group (1:1) clinical trial at 20 Spanish tertiary hospitals. Adults (≥18 years) with isolation of MSSA from at least one blood culture ≤72 hours before inclusion with evidence of infection, will be randomly allocated to receive either cloxacillin 2 g/4-hour intravenous plus fosfomycin 3 g/6-hour intravenous or cloxacillin 2 g/4-hour intravenous alone for 7 days. After the first week, sequential treatment and total duration of antibiotic therapy will be determined according to clinical criteria by the attending physician.Primary endpoints: (1) Treatment success at day 7, a composite endpoint comprising all the following criteria: patient alive, stable or with improved quick-Sequential Organ Failure Assessment score, afebrile and with negative blood cultures for MSSA at day 7. (2) Treatment success at test of cure (TOC) visit: patient alive and no isolation of MSSA in blood culture or at another sterile site from day 8 until TOC (12 weeks after randomisation).We assume a rate of treatment success of 74% in the cloxacillin group. Accepting alpha risk of 0.05 and beta risk of 0.2 in a two-sided test, 183 subjects will be required in each of the control and experimental groups to obtain statistically significant difference of 12% (considered clinically significant). ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Committee of Bellvitge University Hospital (AC069/18) and from the Spanish Medicines and Healthcare Product Regulatory Agency (AEMPS, AC069/18), and is valid for all participating centres under existing Spanish legislation. The results will be presented at international meetings and will be made available to patients and funders. TRIAL REGISTRATION NUMBER The protocol has been approved by AEMPS with the Trial Registration Number EudraCT 2018-001207-37. ClinicalTrials.gov Identifier: NCT03959345; Pre-results.
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Affiliation(s)
- Sara Grillo
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
| | - Guillermo Cuervo
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
| | - Jordi Carratala
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- University of Barcelona, Barcelona, Spain
| | - Rafael San-Juan
- Department of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - Jose M Aguado
- Department of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| | - Silvia Gomez-Zorrilla
- Department of Infectious Diseases, Consorci Parc de Salut MAR de Barcelona, Barcelona, Spain
- Institut de Recerca Hospital del Mar, IMIM, Barcelona, Spain
| | - Joaquín López-Contreras
- Department of Infectious diseases, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Spain
| | - Oriol Gasch
- Infectious Diseases Department, Consorcio Corporacion Sanitaria Parc Tauli, Sabadell, Spain
- Institut d'Investigació i Innovació Parc Taulí, I3PT, Sabadell, Spain
| | - Aina Gomila-Grange
- Institut d'Investigació i Innovació Parc Taulí, I3PT, Sabadell, Spain
- Consorcio Corporación Sanitaria Parc Taulí, Sabadell, Spain
| | - Simona Iftimie
- Department of Infection and Immunity, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Graciano Garcia-Pardo
- Departament of Preventive Medicine, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Esther Calbo
- Infectious Diseases Unit, Hospital Universitari MutuaTerrassa, Terrassa, Spain
- Fundació per la Docència i Recerca MútuaTerrassa, Terrassa, Spain
| | - Lucía Boix-Palop
- Infectious Diseases Unit, Hospital Universitari MutuaTerrassa, Terrassa, Spain
- Fundació per la Docència i Recerca MútuaTerrassa, Terrassa, Spain
| | - Isabel Oriol
- Department of Internal Medicine, Hospital de Sant Joan Despi Moises Broggi, Sant Joan Despi, Spain
| | - Alfredo Jover-Sáenz
- Territorial Unit of Nosocomial Infection, Hospital Universitari Arnau de Vilanova, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, IRBLLEIDA, Lleida, Spain
| | - Luis Eduardo López-Cortés
- Department of Infectious diseases, Hospital Universitario Virgen Macarena, Seville, Spain
- Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Gorane Euba
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Malen Aguirregabiria
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Microbiology Department, Hospital Universitario Cruces, Barakaldo, Spain
| | - Maria Jose Garcia-Pais
- Internal Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francesca Gioia
- Department of Infectious diseases, Hospital Universitario Ramon y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Jose Ramón Paño
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Maria Luisa Pedro-Botet
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Rosa Maria Benítez
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | | | - Yolanda Meije
- Hospital de Barcelona, Barcelona, Spain
- Societat Cooperativa d'Instal·lacions Assistencials Sanitàries, Barcelona, Spain
| | | | - Gertrudis Horna
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
| | - Damaris Berbel
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Department of Microbiology and Parassitology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Maria Ángeles Domínguez
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Department of Microbiology and Parassitology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Ariadna Padullés
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Pharmacy Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Sara Cobo
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Pharmacy Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Pilar Hereu
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Department of Clinical Pharmacology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Sebastian Videla
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Department of Clinical Pharmacology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Cristian Tebe
- University of Barcelona, Barcelona, Spain
- Biostatistics Unit, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Natàlia Pallarés
- University of Barcelona, Barcelona, Spain
- Biostatistics Unit, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Josep M Miro
- Department of Infectious Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
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5
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Meije Y, Duarte-Borges A, Sanz X, Clemente M, Ribera A, Ortega L, González-Pérez R, Cid R, Pareja J, Cantero I, Ariño M, Sagués T, LLaberia J, Ayestarán A, Fernández-Hidalgo N, Candás-Estébanez B. Long-term outcomes of patients following hospitalization for coronavirus disease 2019: a prospective observational study. Clin Microbiol Infect 2021; 27:1151-1157. [PMID: 33901667 PMCID: PMC8062910 DOI: 10.1016/j.cmi.2021.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Few data are available regarding follow up of patients with coronavirus disease 2019 (COVID-19) after their discharge. We aim to describe the long-term outcomes of survivors of hospitalization for COVID-19 followed up first at an outpatient facility and subsequently by telephone. METHODS Observational prospective study conducted at a tertiary general hospital. Clinical and radiological progression was assessed and data were recorded on a standardized reporting form. Patients were divided into three groups according to Pao2/Fio2 at hospitalization: Pao2/Fio2 >300, Pao2/Fio2 300-200 and Pao2/Fio2 <200. A logistic multivariate regression model was performed to identify factors associated with persistence of symptoms. RESULTS For facility follow up, 302 individuals were enrolled. Median follow up was 45 days after discharge; 78% (228/294) of patients had COVID-19-related symptoms (53% asthenia, 56% respiratory symptoms) and 40% (122/302) had residual pulmonary radiographic lesions. Pao2/Fio2 <200 was an independent predictor of persistent dyspnoea (OR 1.87, 95% CI 1.38-2.52, p < 0.0001). Pao2/Fio2 >300 was associated with resolution of chest radiographic lesions (OR 0.56, 95% CI 0.42-0.74, p < 0.0001). Fifty per cent of patients required specific medical follow up after the first consultation and were transferred to another physician. A total of 294 patients were contacted for telephone follow up after a median follow-up time of 7 months. Fifty per cent of patients (147/294) still presented symptoms and 49% (145/294) had psychological disorders. Asthenia was identified in 27% (78/294) and dyspnoea in 10% (28/294) of patients independently of Pao2/Fio2. CONCLUSIONS Patients with COVID-19 require long-term follow up because of the persistence of symptoms; patients with low Pao2/Fio2 during the acute illness require special attention.
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Affiliation(s)
- Yolanda Meije
- Infectious Disease Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Multidisciplinary COVID-Team, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Joint Commission for Infectious Disease Management, Control & Prevention, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain.
| | - Alejandra Duarte-Borges
- Infectious Disease Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Multidisciplinary COVID-Team, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Joint Commission for Infectious Disease Management, Control & Prevention, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Xavier Sanz
- Infectious Disease Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Multidisciplinary COVID-Team, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Mercedes Clemente
- Infectious Disease Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Multidisciplinary COVID-Team, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Alba Ribera
- Infectious Disease Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Multidisciplinary COVID-Team, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Joint Commission for Infectious Disease Management, Control & Prevention, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Lucía Ortega
- Infectious Disease Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Multidisciplinary COVID-Team, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Ruth González-Pérez
- Infectious Disease Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Multidisciplinary COVID-Team, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Roser Cid
- Multidisciplinary COVID-Team, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Júlia Pareja
- Infectious Disease Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Multidisciplinary COVID-Team, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Irene Cantero
- Infectious Disease Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Multidisciplinary COVID-Team, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Miquel Ariño
- Infectious Disease Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Multidisciplinary COVID-Team, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Teresa Sagués
- Infectious Disease Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Multidisciplinary COVID-Team, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Jaume LLaberia
- Multidisciplinary COVID-Team, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Joint Commission for Infectious Disease Management, Control & Prevention, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Microbiology Unit, Clinical Laboratory Department. Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Ana Ayestarán
- Multidisciplinary COVID-Team, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Joint Commission for Infectious Disease Management, Control & Prevention, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Pharmacy Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Nuria Fernández-Hidalgo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Candás-Estébanez
- Multidisciplinary COVID-Team, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain; Biochemistry Unit, Clinical Laboratory Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
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Odriozola A, Ortega L, Martinez L, Odriozola S, Torrens A, Corroleu D, Martínez S, Ponce M, Meije Y, Presas M, Duarte A, Belén Odriozola M, Malik RA. Widespread sensory neuropathy in diabetic patients hospitalized with severe COVID-19 infection. Diabetes Res Clin Pract 2021; 172:108631. [PMID: 33346072 PMCID: PMC7746125 DOI: 10.1016/j.diabres.2020.108631] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/23/2020] [Accepted: 12/12/2020] [Indexed: 12/11/2022]
Abstract
AIMS To characterize the distribution and severity of sensory neuropathy using a portable quantitative sensory testing (QST) device in diabetic patients (DM) hospitalized with severe COVID-19 infection. METHODS Four patients with diabetes and severe SARS-CoV-2 requiring non-invasive ventilation for a protracted duration underwent clinical, laboratory and radiologic assessment and detailed evaluation of neuropathic symptoms, neurological assessment, QST on the dorsum of the foot and face using NerveCheck Master with assessment of taste and smell. RESULTS All four subjects developed neuropathic symptoms characterized by numbness in the feet with preserved reflexes. QST confirmed symmetrical abnormality of vibration and thermal thresholds in both lower limbs in all patients and an abnormal heat pain threshold on the face of two patients and altered taste and smell. CONCLUSIONS Severe COVID-19 infection with hypoxemia is associated with neuropathic symptoms and widespread sensory dysfunction in patients with DM.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
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7
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Carrasco G, Morillas J, Calizaya M, Baeza I, Molina R, Meije Y. ICU decision making based on Living Systematic Review strategy during SARS-CoV-2 pandemic. Results of a prospective case serie. Medicina Intensiva (English Edition) 2020. [PMCID: PMC7519393 DOI: 10.1016/j.medine.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Carrasco G, Morillas J, Calizaya M, Baeza I, Molina R, Meije Y. [ICU decision making based on Living Systematic Review strategy during SARS-CoV-2 pandemic. Results of a prospective case serie]. Med Intensiva 2020; 44:516-519. [PMID: 32653236 PMCID: PMC7287417 DOI: 10.1016/j.medin.2020.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022]
Affiliation(s)
- G Carrasco
- Servicio de Medicina Intensiva, SCIAS Hospital de Barcelona, Barcelona, España.
| | - J Morillas
- Servicio de Medicina Intensiva, SCIAS Hospital de Barcelona, Barcelona, España
| | - M Calizaya
- Servicio de Medicina Intensiva, SCIAS Hospital de Barcelona, Barcelona, España
| | - I Baeza
- Servicio de Medicina Intensiva, SCIAS Hospital de Barcelona, Barcelona, España
| | - R Molina
- Servicio de Medicina Intensiva, SCIAS Hospital de Barcelona, Barcelona, España
| | - Y Meije
- Grupo UCI-Covidem, SCIAS Hospital de Barcelona, Barcelona, España
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9
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Escolà-Vergé L, Peghin M, Givone F, Pérez-Rodríguez MT, Suárez-Varela M, Meije Y, Abelenda G, Almirante B, Fernández-Hidalgo N. Prevalencia de enfermedad colorrectal en la endocarditis infecciosa por Enterococcus faecalis: resultados de un estudio multicéntrico observacional. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abelenda-Alonso G, Rombauts A, Gudiol C, Meije Y, Clemente M, Ortega L, Ardanuy C, Niubó J, Padullés A, Videla S, Tebe C, Carratalà J. Impact of comprehensive molecular testing to reduce antibiotic use in community-acquired pneumonia (RADICAP): a randomised, controlled, phase IV clinical trial protocol. BMJ Open 2020; 10:e038957. [PMID: 32819999 PMCID: PMC7443276 DOI: 10.1136/bmjopen-2020-038957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) continues to be a major health problem worldwide and is one of the main reasons for prescribing antibiotics. However, the causative agent is often not identified, resulting in antibiotic overtreatment, which is a key driver of antimicrobial resistance and adverse events. We aim to test the hypothesis that comprehensive molecular testing, compared with routine microbiological testing, would be effective in reducing antibiotic use in patients with CAP. METHODS AND ANALYSIS We will perform a randomised, controlled, open-label clinical trial with two parallel groups (1:1) at two tertiary hospitals between 2020 and 2022. Non-severely immunosuppressed adults hospitalised for CAP will be considered eligible. Patients will be randomly assigned to receive either the experimental diagnosis (comprehensive molecular testing plus routine microbiological testing) or standard diagnosis (only microbiological routine testing). The primary endpoint will be antibiotic consumption measured as days of antibiotic therapy per 1000 patient-days. Secondary endpoints will be de-escalation to narrower antibiotic treatment, time to switch from intravenous to oral antibiotics, days to reaching an aetiological diagnosis, antibiotic-related side effects, length of stay, days to clinical stability, intensive care unit admission, days of mechanical ventilation, hospital readmission up to 30 days after randomisation and death from any cause by 48 hours and 30 days after randomisation. We will need to include 440 subjects to be able to reject the null hypothesis that both groups have equal days of antibiotic therapy per 1000 patient-days with a probability >0.8. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Committee of Bellvitge Hospital (AC028/19) and from the Spanish Medicines and Medical Devices Agency, and it is valid for all participating centres under existing Spanish legislation. Results will be presented at international meetings and will be made available to patients, their caregivers and funders. TRIAL REGISTRATION NUMBER ClinicalTrials: NCT04158492. EudraCT: 2018-004880-29.
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Affiliation(s)
- Gabriela Abelenda-Alonso
- Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Institute for Biomedical Research, Barcelona, Spain
| | - Alexander Rombauts
- Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Statistics Advisory Service, Institut d\'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Carlota Gudiol
- Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Catalunya, Spain
| | - Yolanda Meije
- Infectious Diseases Unit-Department of Internal Medicine, Hospital de Barcelona, Barcelona, Catalunya, Spain
| | - Mercedes Clemente
- Infectious Diseases Unit-Department of Internal Medicine, Hospital de Barcelona, Barcelona, Catalunya, Spain
| | - Lucía Ortega
- Infectious Diseases Unit-Department of Internal Medicine, Hospital de Barcelona, Barcelona, Catalunya, Spain
| | - Carmen Ardanuy
- Department of Clinical Microbiology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Niubó
- Department of Clinical Microbiology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ariadna Padullés
- Department of Farmacology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sebastian Videla
- Department of Clinical Farmacology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristian Tebe
- Statistics Advisory Service, Institut d\'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Jordi Carratalà
- Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Catalunya, Spain
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Rombauts A, Abelenda-Alonso G, Simonetti AF, Verdejo G, Meije Y, Ortega L, Clemente M, Niubó J, Ruiz Y, Gudiol C, Tebé C, Videla S, Carratalà J. Effect of albumin administration on outcomes in hypoalbuminemic patients hospitalized with community-acquired pneumonia (ALBUCAP): a prospective, randomized, phase III clinical controlled trial-a trial protocol. Trials 2020; 21:727. [PMID: 32819439 PMCID: PMC7438978 DOI: 10.1186/s13063-020-04627-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 07/26/2020] [Indexed: 01/02/2023] Open
Abstract
Background Community-acquired pneumonia (CAP) remains a leading cause of death worldwide, and hypoalbuminemia is associated with worse outcomes. However, it remains uncertain whether albumin administration could have any beneficial effects. We aim to assess whether the administration of albumin in hypoalbuminemic patients with CAP increases the proportion of clinically stable patients at day 5 compared with the standard of care alone. Methods This is a trial protocol for a superiority, non-blinded, multicenter, randomized, phase 3, interventional controlled clinical trial. The primary endpoint will be the proportion of clinical stable patients at day 5 (intention to treat), defined as those with stable vital signs for at least 24 h. The secondary endpoints will be time to clinical stability, duration of intravenous and total antibiotic treatment, length of hospital stay, intensive care unit admission, duration of mechanical ventilation and vasopressor treatment, adverse events, readmission within 30 days, and all-cause mortality. The trial has been approved by the Spanish Medicines and Healthcare Products Regulatory Agency. The investigators commit to publish the data in peer-reviewed journals within a year of the study completion date. Subjects will be recruited from three Spanish hospitals over a planned enrolment period of 2 years. A follow-up visit will be performed 1 month after discharge. We have estimated the need for a sample size of 360 patients at a two-sided 5% alpha-level with a power of 80% based on intention to treat. Eligible participants must be hospitalized, hypoalbuminemic (≤ 30 g/L), non-immunosuppressed, adults, and diagnosed with CAP. They will be randomly assigned (1:1) to receive standard care plus albumin (20 g in 100 mL) every 12 h for 4 days or standard care alone. Discussion If this randomized trial confirms the hypothesis, it should lead to a change in current clinical practice for the management of hypoalbuminemic patients with CAP. Trial registration European Clinical Trials Database (EudraCT) 2018-003117-18. Registered on 12 April 2019. ClinicalTrials.gov NCT04071041. Registered on 27 August 2019
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Affiliation(s)
- Alexander Rombauts
- Department of Infectious Disease, Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - Gabriela Abelenda-Alonso
- Department of Infectious Disease, Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Antonella Francesca Simonetti
- Department of Internal Medicine, Hospital Residència Sant Camil-Consorci Sanitari del Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Guillermo Verdejo
- Department of Internal Medicine, Hospital Residència Sant Camil-Consorci Sanitari del Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Yolanda Meije
- Infectious Diseases Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Lucia Ortega
- Infectious Diseases Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Mercedes Clemente
- Infectious Diseases Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Jordi Niubó
- Department of Microbiology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Yolanda Ruiz
- Department of Pneumology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Carlota Gudiol
- Department of Infectious Disease, Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Sebastian Videla
- Department of Clinical Pharmacology, Hospital Universitari de Bellvitge, Hospital de Llobregat, Barcelona, Spain
| | - Jordi Carratalà
- Department of Infectious Disease, Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
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12
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Abelenda-Alonso G, Rombauts A, Gudiol C, Meije Y, Ortega L, Clemente M, Ardanuy C, Niubó J, Carratalà J. Influenza and Bacterial Coinfection in Adults With Community-Acquired Pneumonia Admitted to Conventional Wards: Risk Factors, Clinical Features, and Outcomes. Open Forum Infect Dis 2020; 7:ofaa066. [PMID: 32206675 PMCID: PMC7081386 DOI: 10.1093/ofid/ofaa066] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/25/2020] [Indexed: 12/18/2022] Open
Abstract
Background Relevance of viral and bacterial coinfection (VBC) in non-intensive care unit (ICU) hospitalized adults with community-acquired pneumonia (CAP) is poorly characterized. We aim to determine risk factors, features, and outcomes of VBC-CAP in this setting. Methods This is a prospective cohort of adults admitted to conventional wards with CAP. Patients were divided into VBC-CAP, viral CAP (V-CAP), and bacterial CAP (B-CAP) groups. Independent risk and prognostic factors for VBC-CAP were identified. Results We documented 1123 episodes: 57 (5.1%) VBC-CAP, 98 (8.7%) V-CAP, and 968 (86.1%) B-CAP. Patients with VBC-CAP were younger than those with B-CAP (54 vs 71 years; P < .001). Chronic respiratory disease was more frequent in patients with VBC-CAP than in those with V-CAP (26.3% vs 14.3%%; P = .001). Among those with influenza (n = 153), the VBC-CAP group received empirical oseltamivir less often (56.1% vs 73.5%; P < .001). Patients with VBC-CAP also had more respiratory distress (21.1% VBC-CAP; 19.4% V-CAP, and 9.8% B-CAP; P < .001) and required ICU admission more often (31.6% VBC-CAP, 31.6% V-CAP, and 12.8% B-CAP; P < .001). The 30-day case-fatality rate was 3.5% in the VBC-CAP group, 3.1% in the V-CAP group, and 6.3% in the B-CAP group (P = .232). Furthermore, VBC-CAP was associated with severity criteria (odds ratio [OR], 5.219; P < .001) and lack of empirical oseltamivir therapy in influenza cases (OR, 0.401; P < .043). Conclusions Viral and bacterial coinfection-CAP involved younger patients with comorbidities and with poor influenza vaccination rate. Patients with VBC-CAP presented more respiratory complications and more often required ICU admission. Nevertheless, 30-day mortality rate was low and related either to severity criteria or to delayed initiation of oseltamivir therapy.
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Affiliation(s)
- Gabriela Abelenda-Alonso
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Alexander Rombauts
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Carlota Gudiol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Yolanda Meije
- Department Internal Medicine, Infectious Diseases Unit, Hospital de Barcelona, Societat, Cooperativa d'Installacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Lucía Ortega
- Department Internal Medicine, Infectious Diseases Unit, Hospital de Barcelona, Societat, Cooperativa d'Installacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Mercedes Clemente
- Department Internal Medicine, Infectious Diseases Unit, Hospital de Barcelona, Societat, Cooperativa d'Installacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Carmen Ardanuy
- Department Clinical Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jordi Niubó
- Department Clinical Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
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Escolà-Vergé L, Peghin M, Givone F, Pérez-Rodríguez MT, Suárez-Varela M, Meije Y, Abelenda G, Almirante B, Fernández-Hidalgo N. Prevalence of colorectal disease in Enterococcus faecalis infective endocarditis: results of an observational multicenter study. ACTA ACUST UNITED AC 2019; 73:711-717. [PMID: 31444092 DOI: 10.1016/j.rec.2019.07.007] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to determine the prevalence of colorectal disease in Enterococcus faecalis infective endocarditis (EFIE) patients. METHODS An observational, retrospective, multicenter study was performed at 4 referral centers. From the moment that a colonoscopy was systematically performed in EFIE in each participating hospital until October 2018, we included all consecutive episodes of definite EFIE in adult patients. The outcome was an endoscopic finding of colorectal disease potentially causing bacteremia. RESULTS A total of 103 patients with EFIE were included; 83 (81%) were male, the median age was 76 [interquartile range 67-82] years, and the median age-adjusted Charlson comorbidity index was 5 [interquartile range 4-7]. The presumed sources of infection were unknown in 63 (61%), urinary in 20 (19%), gastrointestinal in 13 (13%), catheter-related bacteremia in 5 (5%), and others in 2 (2%). Seventy-eight patients (76%) underwent a colonoscopy, and 47 (60%) had endoscopic findings indicating a potential source of bacteremia. Thirty-nine patients (83%) had a colorectal neoplastic disease, and 8 (17%) a nonneoplastic disease. Of the 45 with an unknown portal of entry who underwent a colonoscopy, gastrointestinal origin was identified in 64%. In the subgroup of 25 patients with a known source of infection and a colonoscopy, excluding those with previously diagnosed colorectal disease, 44% had colorectal disease. CONCLUSIONS Performing a colonoscopy in all EFIE patients, irrespective of the presumed source of infection, could be helpful to diagnose colorectal disease in these patients and to avoid a new bacteremia episode (and eventually infective endocarditis) by the same or a different microorganism.
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Affiliation(s)
- Laura Escolà-Vergé
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Maddalena Peghin
- Clinica di Malattie Infettive, Dipartimento de Medicina, Università di Udine e Ospedale Santa Maria della Misericordia, Udine, Italy
| | - Filippo Givone
- Clinica di Malattie Infettive, Dipartimento de Medicina, Università di Udine e Ospedale Santa Maria della Misericordia, Udine, Italy
| | - María Teresa Pérez-Rodríguez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica Galicia-Sur, Vigo, Pontevedra, Spain
| | - Milagros Suárez-Varela
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica Galicia-Sur, Vigo, Pontevedra, Spain
| | - Yolanda Meije
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Gabriela Abelenda
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Benito Almirante
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Fernández-Hidalgo
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Meije Y, Martínez-Montauti J, Caylà JA, Loureiro J, Ortega L, Clemente M, Sanz X, Ricart M, Santomà MJ, Coll P, Sierra M, Calsina M, Vaqué M, Ruiz-Camps I, López-Sánchez C, Montes M, Ayestarán A, Carratalà J, Orcau À. Healthcare-Associated Mycobacterium bovis-Bacille Calmette-Guérin (BCG) Infection in Cancer Patients Without Prior BCG Instillation. Clin Infect Dis 2019; 65:1136-1143. [PMID: 28575173 DOI: 10.1093/cid/cix496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 05/23/2017] [Indexed: 11/14/2022] Open
Abstract
Background Bacille Calmette-Guérin (BCG), an attenuated strain of Mycobacterium bovis, is widely used as adjunctive therapy for superficial bladder cancer. Intravesical administration of BCG has been associated with systemic infection. Disseminated infection due to M. bovis is otherwise uncommon. Methods After identification of 3 patients with healthcare-associated BCG infection who had never received intravesical BCG administration, an epidemiologic study was performed. All patients with healthcare-associated BCG infection in the Barcelona tuberculosis (TB) program were reviewed from 1 January 2005 to 31 December 2015, searching for infections caused by M. bovis-BCG. Patients with healthcare-associated BCG infection who had not received intravesical BCG instillation were selected and the source of infection was investigated. Results Nine oncology patients with infection caused by M. bovis-BCG were studied. All had permanent central venous catheters. Catheter maintenance was performed at 4 different outpatient clinics in the same room in which other patients underwent BCG instillations for bladder cancer without required biological precautions. All patients developed pulmonary TB, either alone or with extrapulmonary disease. Catheter-related infection was considered the mechanism of acquisition based on the epidemiologic association and positive catheter cultures for BCG in patients in whom mycobacterial cultures were performed. Conclusions Physicians should be alerted to the possibility of TB due to nosocomially acquired, catheter-related infections with M. bovis-BCG in patients with indwelling catheters. This problem may be more common than expected in centers providing BCG therapy for bladder cancer without adequate precautions.
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Affiliation(s)
- Yolanda Meije
- Infectious Disease Unit, Internal Medicine Department, and
- Joint Commission for the Infectious Disease Management, Control and Prevention, Hospital de Barcelona, Societat Cooperativa d'Installacions Assistencials Sanitàries (SCIAS)
| | - Joaquín Martínez-Montauti
- Infectious Disease Unit, Internal Medicine Department, and
- Joint Commission for the Infectious Disease Management, Control and Prevention, Hospital de Barcelona, Societat Cooperativa d'Installacions Assistencials Sanitàries (SCIAS)
| | - Joan A Caylà
- Epidemiology Service. Public Health Agency of Barcelona and CIBER de Epidemiologia y Salud Pública
| | - Jose Loureiro
- Infectious Disease Unit, Internal Medicine Department, and
| | - Lucía Ortega
- Infectious Disease Unit, Internal Medicine Department, and
| | - Mercedes Clemente
- Infectious Disease Unit, Internal Medicine Department, and
- Joint Commission for the Infectious Disease Management, Control and Prevention, Hospital de Barcelona, Societat Cooperativa d'Installacions Assistencials Sanitàries (SCIAS)
| | - Xavier Sanz
- Infectious Disease Unit, Internal Medicine Department, and
| | - Montserrat Ricart
- Epidemiology Service. Public Health Agency of Barcelona and CIBER de Epidemiologia y Salud Pública
| | - María J Santomà
- Epidemiology Service. Public Health Agency of Barcelona and CIBER de Epidemiologia y Salud Pública
| | - Pere Coll
- Microbiology Department, Fundació de Gestió Sanitaria del Hospital de la Santa Creu i Sant Pau
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, and
- Institut d'Investigació Biomèdica Sant Pau, Barcelona
- Spanish Network for the Research in Infectious Diseases, Madrid
| | - Montserrat Sierra
- Joint Commission for the Infectious Disease Management, Control and Prevention, Hospital de Barcelona, Societat Cooperativa d'Installacions Assistencials Sanitàries (SCIAS)
- Microbiology Department, Hospital de Barcelona, SCIAS
| | - Marta Calsina
- Joint Commission for the Infectious Disease Management, Control and Prevention, Hospital de Barcelona, Societat Cooperativa d'Installacions Assistencials Sanitàries (SCIAS)
| | - Montserrat Vaqué
- Joint Commission for the Infectious Disease Management, Control and Prevention, Hospital de Barcelona, Societat Cooperativa d'Installacions Assistencials Sanitàries (SCIAS)
| | | | | | - Mar Montes
- Pharmacy Department, Hospital de Barcelona, SCIAS
| | - Ana Ayestarán
- Joint Commission for the Infectious Disease Management, Control and Prevention, Hospital de Barcelona, Societat Cooperativa d'Installacions Assistencials Sanitàries (SCIAS)
- Pharmacy Department, Hospital de Barcelona, SCIAS
| | - Jordi Carratalà
- Spanish Network for the Research in Infectious Diseases, Madrid
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, and
- Department of Clinical Sciences, University of Barcelona, Spain
| | - Àngels Orcau
- Epidemiology Service. Public Health Agency of Barcelona and CIBER de Epidemiologia y Salud Pública
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Gasch O, Meije Y, Espasa M, Font B, Jiménez S, Fernández-Hidalgo N. Infección por Mycobacterium chimaera diseminada tras sustitución de válvula aórtica. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.04.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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16
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Meije Y, Pigrau C, Fernández-Hidalgo N, Clemente M, Ortega L, Sanz X, Loureiro-Amigo J, Sierra M, Ayestarán A, Morales-Cartagena A, Ribera A, Duarte A, Abelenda G, Rodríguez-Baño J, Martínez-Montauti J. Non-intravenous carbapenem-sparing antibiotics for definitive treatment of bacteraemia due to Enterobacteriaceae producing extended-spectrum β-lactamase (ESBL) or AmpC β-lactamase: A propensity score study. Int J Antimicrob Agents 2019; 54:189-196. [PMID: 31075401 DOI: 10.1016/j.ijantimicag.2019.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/09/2019] [Accepted: 05/01/2019] [Indexed: 01/09/2023]
Abstract
Carbapenems are considered the treatment of choice for extended-spectrum β-lactamase (ESBL)- or AmpC β-lactamase-producing Enterobacteriaceae bacteraemia. Data on the effectiveness of non-intravenous carbapenem-sparing antibiotic options are limited. This study compared the 30-day mortality and clinical failure associated with the use of carbapenems versus alternative non-intravenous antibiotics for the definitive treatment of ESBL/AmpC-positive Enterobacteriaceae bacteraemia. This 12-year retrospective study (2004-2015) included all patients with bacteraemia due to ESBL/AmpC-producing Enterobacteriaceae at a Spanish hospital. Given the lack of randomisation of initial therapies, a propensity score for receiving carbapenems was calculated. There were 1115 patients with a first episode of bacteraemia due to Escherichia coli or Klebsiella pneumoniae, of which 123 (11.0%) were ESBL/AmpC-positive. There were 101 eligible patients: 59 in the carbapenem group and 42 in the alternative treatment group (trimethoprim/sulfamethoxazole 59.5%, quinolones 21.4%). The most frequent sources of infection were urinary (63%) and biliary (15%). Compared with the carbapenem group, patients treated with an alternative regimen had a shorter hospital stay [median (IQR) 7 (5-10) days vs. 12 (9-18) days; P < 0.001]. Use of an alternative non-intravenous therapy did not increase mortality (OR = 0.27, 95% CI 0.05-1.61; P = 0.15). After controlling for confounding factors with the propensity score, the adjusted OR of carbapenem treatment was 4.95 (95% CI 0.94-26.01; P = 0.059). Alternative non-intravenous carbapenem-sparing antibiotics could have a role in the definitive treatment of ESBL/AmpC-positive Enterobacteriaceae bacteraemia, allowing a reduction in carbapenem use. Use of trimethoprim/sulfamethoxazole in this series showed favourable results.
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Affiliation(s)
- Yolanda Meije
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain.
| | - Carles Pigrau
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - Núria Fernández-Hidalgo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercedes Clemente
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Lucía Ortega
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Xavier Sanz
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Jose Loureiro-Amigo
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Montserrat Sierra
- Microbiology Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Ana Ayestarán
- Pharmacy Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Alejandra Morales-Cartagena
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Alba Ribera
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Alejandra Duarte
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Gabriela Abelenda
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Jesús Rodríguez-Baño
- 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, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Joaquim Martínez-Montauti
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
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Gasch O, Meije Y, Espasa M, Font B, Jiménez S, Fernández-Hidalgo N. Disseminated Infection Due to Mycobacterium chimaera After Aortic Valve Replacement. ACTA ACUST UNITED AC 2018; 72:502-503. [PMID: 30029979 DOI: 10.1016/j.rec.2018.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/03/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Oriol Gasch
- Servei de Malalties Infeccioses, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Yolanda Meije
- Servei de Medicina Interna, Unitat de Malalties Infeccioses, Societat Cooperativa d'Instal(·)lacions Assistencials Sanitàries (SCIAS), Hospital de Barcelona, Barcelona, Spain
| | - Mateu Espasa
- Servei de Microbiologia, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Bernat Font
- Servei de Malalties Infeccioses, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Soledad Jiménez
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Nuria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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18
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Fernández-Ruiz M, Meije Y, Manuel O, Akan H, Carratalà J, Aguado J, Delaloye J. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Introduction). Clin Microbiol Infect 2018; 24 Suppl 2:S2-S9. [DOI: 10.1016/j.cmi.2018.01.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/21/2018] [Accepted: 01/27/2018] [Indexed: 12/13/2022]
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19
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Cuervo G, Garcia-Vidal C, Puig-Asensio M, Vena A, Meije Y, Fernández-Ruiz M, González-Barberá E, Blanco-Vidal MJ, Manzur A, Cardozo C, Gudiol C, Montejo JM, Pemán J, Ayats J, Aguado JM, Muñoz P, Marco F, Almirante B, Carratalà J. Echinocandins Compared to Fluconazole for Candidemia of a Urinary Tract Source: A Propensity Score Analysis. Clin Infect Dis 2018; 64:1374-1379. [PMID: 28329281 DOI: 10.1093/cid/cix033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/15/2017] [Indexed: 01/05/2023] Open
Abstract
Background Whether echinocandins could be used to treat candidemia of a urinary tract source (CUTS) is unknown. We aimed to provide current epidemiological information of CUTS and to compare echinocandin to fluconazole treatment on CUTS outcomes. Methods A multicenter study of adult patients with candidemia was conducted in 9 hospitals. CUTS was defined as a candidemia with concomitant candiduria by the same organism associated with significant urological comorbidity. The primary outcome assessed was clinical failure (defined by 7-day mortality or persistent candidemia) in patients treated with either an echinocandin or fluconazole. A propensity score was calculated and then entered into a regression model. Results Of 2176 episodes of candidemia, 128 were CUTS (5.88%). Most CUTS cases were caused by Candida albicans (52.7%), followed by Candida glabrata (25.6%) and Candida tropicalis (16.3%). Clinical failure occurred in 7 patients (20%) treated with an echinocandin and in 15 (17.1%) treated with fluconazole (P = .730). Acute renal failure (adjusted odds ratio [AOR], 3.01; 95% confidence interval [CI], 1.01-8.91; P = .047) was the only independent factor associated with clinical failure, whereas early urinary tract drainage procedures (surgical, percutaneous, or endoscopic) were identified as protective (AOR, 0.08; 95% CI, .02-.31; P < .001). Neither univariate nor multivariate analysis showed that echinocandin therapy altered the risk of clinical failure. Conclusions Initial echinocandin therapy was not associated with clinical failure in patients with CUTS. Notably, acute renal failure predicted worse outcomes and performing an early urologic procedure was a protective measure.
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Affiliation(s)
- Guillermo Cuervo
- Department of Infectious Diseases.,Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge, Department of Microbiology, Universitat de Barcelona
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases.,Hospital Clínic, Department of Microbiology, Centre Diagnòstic Biomèdic and ISGlobal, Barcelona Centre for International Health Research, Universitat de Barcelona
| | - Mireia Puig-Asensio
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona
| | - Antonio Vena
- Department of Infectious Diseases, Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid
| | - Yolanda Meije
- Department of Infectious Diseases, Hospital de Barcelona
| | - Mario Fernández-Ruiz
- Department of Infectious Diseases, Hospital Universitario "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre", Universidad Complutense de Madrid
| | - Eva González-Barberá
- Department of Microbiology Hospital Universitari I Politecnic "La Fe,"Valencia, and
| | | | - Adriana Manzur
- Department of Infectious Diseases, Hospital "Dr Guillermo Rawson,"San Juan, Argentina
| | - Celia Cardozo
- Department of Infectious Diseases.,Hospital Clínic, Department of Microbiology, Centre Diagnòstic Biomèdic and ISGlobal, Barcelona Centre for International Health Research, Universitat de Barcelona
| | - Carlota Gudiol
- Department of Infectious Diseases.,Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge, Department of Microbiology, Universitat de Barcelona
| | - José Miguel Montejo
- Department of Infectious Diseases, Hospital Universitario "Cruces,"Bilbao, Spain; and
| | - Javier Pemán
- Department of Microbiology Hospital Universitari I Politecnic "La Fe,"Valencia, and
| | - Josefina Ayats
- Department of Infectious Diseases.,Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge, Department of Microbiology, Universitat de Barcelona
| | - Jose María Aguado
- Department of Infectious Diseases, Hospital Universitario "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre", Universidad Complutense de Madrid
| | - Patricia Muñoz
- Department of Infectious Diseases, Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid
| | - Francesc Marco
- Department of Infectious Diseases.,Hospital Clínic, Department of Microbiology, Centre Diagnòstic Biomèdic and ISGlobal, Barcelona Centre for International Health Research, Universitat de Barcelona
| | - Benito Almirante
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona
| | - Jordi Carratalà
- Department of Infectious Diseases.,Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge, Department of Microbiology, Universitat de Barcelona
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Gudiol C, Royo-Cebrecos C, Tebe C, Abdala E, Akova M, Álvarez R, Maestro-de la Calle G, Cano A, Cervera C, Clemente WT, Martín-Dávila P, Freifeld A, Gómez L, Gottlieb T, Gurguí M, Herrera F, Manzur A, Maschmeyer G, Meije Y, Montejo M, Peghin M, Rodríguez-Baño J, Ruiz-Camps I, Sukiennik TC, Carratalà J. Clinical efficacy of β-lactam/β-lactamase inhibitor combinations for the treatment of bloodstream infection due to extended-spectrum β-lactamase-producing Enterobacteriaceae in haematological patients with neutropaenia: a study protocol for a retrospective observational study (BICAR). BMJ Open 2017; 7:e013268. [PMID: 28115333 PMCID: PMC5278288 DOI: 10.1136/bmjopen-2016-013268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Bloodstream infection (BSI) due to extended-spectrum β-lactamase-producing Gram-negative bacilli (ESBL-GNB) is increasing at an alarming pace worldwide. Although β-lactam/β-lactamase inhibitor (BLBLI) combinations have been suggested as an alternative to carbapenems for the treatment of BSI due to these resistant organisms in the general population, their usefulness for the treatment of BSI due to ESBL-GNB in haematological patients with neutropaenia is yet to be elucidated. The aim of the BICAR study is to compare the efficacy of BLBLI combinations with that of carbapenems for the treatment of BSI due to an ESBL-GNB in this population. METHODS AND ANALYSIS A multinational, multicentre, observational retrospective study. Episodes of BSI due to ESBL-GNB occurring in haematological patients and haematopoietic stem cell transplant recipients with neutropaenia from 1 January 2006 to 31 March 2015 will be analysed. The primary end point will be case-fatality rate within 30 days of onset of BSI. The secondary end points will be 7-day and 14-day case-fatality rates, microbiological failure, colonisation/infection by resistant bacteria, superinfection, intensive care unit admission and development of adverse events. SAMPLE SIZE The number of expected episodes of BSI due to ESBL-GNB in the participant centres will be 260 with a ratio of control to experimental participants of 2. ETHICS AND DISSEMINATION The protocol of the study was approved at the first site by the Research Ethics Committee (REC) of Hospital Universitari de Bellvitge. Approval will be also sought from all relevant RECs. Any formal presentation or publication of data from this study will be considered as a joint publication by the participating investigators and will follow the recommendations of the International Committee of Medical Journal Editors (ICMJE). The study has been endorsed by the European Study Group for Bloodstream Infection and Sepsis (ESGBIS) and the European Study Group for Infections in Compromised Hosts (ESGICH).
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Affiliation(s)
- C Gudiol
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- Duran i Reynals Hospital, ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - C Royo-Cebrecos
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - C Tebe
- Statistics Advisory Service, Institute of Biomedical Research of Bellvitge, Rovira i Virgili University, L'Hospitalet de Llobregat, Barcelona, Spain
| | - E Abdala
- Faculty of Medicine, Instituto do Câncer do Estado de São Paulo, University of São Paulo, Sao Paulo, Brazil
| | - M Akova
- Hacettepe University School of Medicine, Ankara, Turkey
| | - R Álvarez
- Infectious Diseases Research Group, Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospitals Virgen del Rocio and Virgen Macarena, Seville, Spain
| | - G Maestro-de la Calle
- Infectious Diseases Unit, Instituto de Investigación Hospital “12 de Octubre” (i+12), “12 de Octubre” University Hospital; School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Cano
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
- Reina Sofía University Hospital-IMIBIC-UCO, Córdoba, Spain
| | - C Cervera
- University Hospital of Alberta, Edmonton, Alberta, Canada
| | - W T Clemente
- Infectious Disease Consultant, Digestive Transplant Service, Hospital das Clínicas, Universidade FederalMinas Gerais, Brazil
| | - P Martín-Dávila
- Infectious Diseases Department, Ramon y Cajal Hospital, Madrid, Spain
| | - A Freifeld
- Infectious Diseases Section, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - L Gómez
- Department of Internal Medicine, University Hospital Mútua de Terrassa, Barcelona, Spain
| | - T Gottlieb
- Department of Microbiology & Infectious Diseases, Concord Hospital, Concord, New South Wales, Australia
| | - M Gurguí
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau and Instituto de Investigación Biomédica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Herrera
- Infectious Diseases Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - A Manzur
- Infectious Diseases, Hospital Rawson, San Juan, Argentina
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Academic Teaching Hospital of Charité University Medical School, Berlin, Germany
| | - Y Meije
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Disease Unit, Internal Medicine Department, Barcelona Hospital, SCIAS,Barcelona, Spain
| | - M Montejo
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Unit, Cruces University Hospital, Bilbao, Spain
| | - M Peghin
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - J Rodríguez-Baño
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospitals Virgen Macarena and Virgen del Rocío—IBiS; Department of Medicine, University of Seville, Seville, Spain
| | - I Ruiz-Camps
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - T C Sukiennik
- Hospital Santa Casa de Misericórdia de Porto Alegre, Brazil
| | - J Carratalà
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
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Loureiro-Amigo J, Pons S, Sierra M, Meije Y. Prosthetic valve with infective endocarditis caused by Propionibacterium avidum. A case report. Enferm Infecc Microbiol Clin 2016; 35:196-197. [PMID: 27743680 DOI: 10.1016/j.eimc.2016.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/02/2016] [Accepted: 08/08/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Jose Loureiro-Amigo
- Infectious Disease Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Silvia Pons
- Cardiology Unit, Hospital de Barcelona, SCIAS, Barcelona, Spain
| | - Montserrat Sierra
- Microbiology Department, Hospital de Barcelona, SCIAS, Barcelona, Spain
| | - Yolanda Meije
- Infectious Disease Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain.
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Meije Y, Piersimoni C, Torre-Cisneros J, Dilektasli AG, Aguado JM. Mycobacterial infections in solid organ transplant recipients. Clin Microbiol Infect 2015; 20 Suppl 7:89-101. [PMID: 24707957 DOI: 10.1111/1469-0691.12641] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 03/21/2014] [Accepted: 03/29/2014] [Indexed: 12/29/2022]
Abstract
Mycobacterial infections represent a growing challenge for solid organ transplant recipients (SOT). The adverse effects of tuberculosis (TB) therapy present a major difficulty, due to the interactions with immunosuppressive drugs and direct drug toxicity. While TB may be donor-transmitted or community-acquired, it usually develops at a latent infection site in the recipient. Pre-transplant prevention efforts will improve transplant outcomes and avoid the complications associated with post-transplant diagnosis and treatment. The present review and consensus manuscript is based on the updated published information and expert recommendations. The current data about epidemiology, diagnosis, new regimens for the treatment of latent TB infection (LTBI), the experience with rifamycins for the treatment of active TB in the post-transplant period and the experience with isoniazid for LTBI in the liver transplant population, are also reviewed. We attempt to provide useful recommendations for each transplant period and problem concerning mycobacterial infections in SOT recipients.
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Affiliation(s)
- Y Meije
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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San-Juan R, Navarro D, García-Reyne A, Montejo M, Muñoz P, Carratala J, Len O, Fortun J, Muñoz-Cobo B, Gimenez E, Eworo A, Sabe N, Meije Y, Martín-Davila P, Andres A, Delgado J, Jimenez C, Amat P, Fernández-Ruiz M, López-Medrano F, Lumbreras C, Aguado JM. Effect of long-term prophylaxis in the development of cytomegalovirus-specific T-cell immunity in D+/R- solid organ transplant recipients. Transpl Infect Dis 2015; 17:637-46. [PMID: 26134282 DOI: 10.1111/tid.12417] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 01/22/2015] [Revised: 04/04/2015] [Accepted: 06/17/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aimed to characterize the dynamics of acquisition of cytomegalovirus (CMV)-specific cell-mediated immunity (CMI) in CMV donor positive/recipient negative solid organ transplant (SOT) patients receiving long-term antiviral prophylaxis, and to determine whether development of CMI confers protection against CMV disease. METHODS A prospective multicenter study was conducted in Spain from September 2009 to September 2012. Whole blood specimens were prospectively collected at 30, 90, 120, 200, and 365 days after SOT, and CMI was determined by enumeration of CMV pp65 and IE-1-specific CD69(+) /interferon-γ-producing CD8(+) and CD4(+) T cells by flow cytometry for intracellular cytokine staining. As part of a simultaneous clinical trial, patients received either early prophylaxis (in the first 3 days after transplantation) in the first period of the study or delayed prophylaxis (initiated at day 14) during the second period of the study. The impact of the dynamics of acquisition of CMV-specific CMI on the incidence of CMV disease was evaluated by Kaplan-Meier survival analysis. RESULTS A total of 95 SOT recipients were recruited. CMV infection and disease occurred in 38 (40%) and 26 (27.4%) patients, respectively. The proportion of patients achieving any detectable CMV-specific CMI response at each of the different monitoring points was higher in liver transplant recipients, as compared to kidney or heart transplant recipients. The presence of any detectable response at day 120 or 200 was protective against the development of CMV disease (positive predictive values 92% and 93%, respectively). CONCLUSIONS The rate of acquisition of CMV-specific CMI in SOT recipients undergoing antiviral prophylaxis differed significantly between different SOT populations. Patients developing any detectable CMI response were protected against the occurrence of CMV disease.
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Affiliation(s)
- R San-Juan
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
| | - D Navarro
- Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Valencia, Spain
| | - A García-Reyne
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
| | - M Montejo
- Unit of Infectious Diseases, Hospital Universitario de Cruces, Bilbao, Spain
| | - P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - J Carratala
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - O Len
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Fortun
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - B Muñoz-Cobo
- Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Valencia, Spain
| | - E Gimenez
- Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Valencia, Spain
| | - A Eworo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - N Sabe
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Y Meije
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Martín-Davila
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A Andres
- Department of Nephrology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
| | - J Delgado
- Unit of Heart Transplantation, Department of Cardiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
| | - C Jimenez
- Department of Abdominal Organ Transplantation and General and Digestive Surgery, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
| | - P Amat
- Department of Hematology and Medical Oncology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Valencia, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
| | - F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
| | - C Lumbreras
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), 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), Universidad Complutense, Madrid, Spain
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San-Juan R, Navarro D, García-Reyne A, Montejo M, Muñoz P, Carratala J, Len O, Fortun J, Muñoz-Cobo B, Gimenez E, Eworo A, Sabe N, Meije Y, Martin-Davila P, Andres A, Delgado J, Jimenez C, Amat P, Fernández-Ruiz M, López-Medrano F, Lumbreras C, Aguado JM. Effect of delaying prophylaxis against CMV in D+/R- solid organ transplant recipients in the development of CMV-specific cellular immunity and occurrence of late CMV disease. J Infect 2015; 71:561-70. [PMID: 26183297 DOI: 10.1016/j.jinf.2015.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 04/12/2015] [Accepted: 06/11/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Evaluate the protective effect against late CMV disease of delaying antiviral prophylaxis initiation in D+/R- patients receiving solid organ transplant (SOT). METHODS Prospective multicenter study in D+/R- SOT recipients in Spain (Sept/09-Sept/12). Whole blood specimens were prospectively collected after Tx for CMV-specific cell-mediated immunity (CMI) determination. Two prophylaxis strategies were compared: early prophylaxis (EP; starting within the first 3 days after Tx) and delayed prophylaxis (DP; starting 14 days after Tx). Risk factors for the occurrence of CMV disease were determined by survival analysis and proportional risk Cox regression models. RESULTS We included 95 patients (50 EP V 45 DP). Twenty six patients (27.4%) developed CMV disease: 32.7% EP vs. 20% DP; (p = 0.2). No cases of CMV disease were reported previously to beginning delayed prophylaxis. The percentage of individuals with detectable CMI response was higher in patients with DP although differences did not reach statistic significance (42% vs 29.6% at day 200 after Tx; p = 0.4). There was a clear trend towards less end-organ CMV disease in patients receiving DP (18.2% EP vs 5% DP; p = 0.09) and DP was the only protective factor in the multivariate analysis (HR: 0.26; CI: 0.05-1.2; p = 0.09). CONCLUSIONS A 14-day delay in CMV prophylaxis in D+/R- SOT recipients is safe and may reduce the incidence of late CMV end-organ disease although correlation of this effect with CMI responses was not complete.
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Affiliation(s)
- R San-Juan
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.
| | - D Navarro
- Microbiology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - A García-Reyne
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - M Montejo
- Unit of Infectious Diseases, University Hospital de Cruces, Bilbao, Spain
| | - P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, University Hospital Gregorio Marañon, Madrid, Spain
| | - J Carratala
- Department of Infectious Diseases, Department of Infectious Diseases, University Hospital Bellvitge-IDIBELL, Universidad de Barcelona, Barcelona, Spain
| | - O Len
- Department of Infectious Diseases, University Hospital Vall d'Hebron, Barcelona, Spain
| | - J Fortun
- Infectious Diseases Unit, University Hospital Ramon y Cajal, Madrid, Spain
| | - B Muñoz-Cobo
- Microbiology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - E Gimenez
- Microbiology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - A Eworo
- Department of Clinical Microbiology and Infectious Diseases, University Hospital Gregorio Marañon, Madrid, Spain
| | - N Sabe
- Department of Infectious Diseases, Department of Infectious Diseases, University Hospital Bellvitge-IDIBELL, Universidad de Barcelona, Barcelona, Spain
| | - Y Meije
- Department of Infectious Diseases, University Hospital Vall d'Hebron, Barcelona, Spain
| | - P Martin-Davila
- Infectious Diseases Unit, University Hospital Ramon y Cajal, Madrid, Spain
| | - A Andres
- Nephrology Service, Kidney Transplant Unit, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - J Delgado
- Cardiology Service, Heart Transplant Unit, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - C Jimenez
- General Abdominal Surgery Service, Intra-abdominal Transplant Unit, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - P Amat
- Haematology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - F López-Medrano
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - C Lumbreras
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
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Gavaldà J, Meije Y, Fortún J, Roilides E, Saliba F, Lortholary O, Muñoz P, Grossi P, Cuenca-Estrella M. Invasive fungal infections in solid organ transplant recipients. Clin Microbiol Infect 2014; 20 Suppl 7:27-48. [DOI: 10.1111/1469-0691.12660] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Len O, Garzoni C, Lumbreras C, Molina I, Meije Y, Pahissa A, Grossi P. Recommendations for screening of donor and recipient prior to solid organ transplantation and to minimize transmission of donor–derived infections. Clin Microbiol Infect 2014; 20 Suppl 7:10-8. [DOI: 10.1111/1469-0691.12557] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/16/2014] [Accepted: 01/17/2014] [Indexed: 12/11/2022]
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Fortun J, Meije Y, Buitrago MJ, Gago S, Bernal-Martinez L, Peman J, Perez M, Gomez-G Pedrosa E, Madrid N, Pintado V, Martin-Davila P, Cobo J, Fresco G, Moreno S, Cuenca-Estrella M. Clinical validation of a multiplex real-time PCR assay for detection of invasive candidiasis in intensive care unit patients. J Antimicrob Chemother 2014; 69:3134-41. [DOI: 10.1093/jac/dku225] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Meije Y, Almirante B, Del Pozo JL, Martín MT, Fernández-Hidalgo N, Shan A, Basas J, Pahissa A, Gavaldà J. Daptomycin is effective as antibiotic-lock therapy in a model of Staphylococcus aureus catheter-related infection. J Infect 2014; 68:548-52. [DOI: 10.1016/j.jinf.2014.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/15/2013] [Accepted: 01/01/2014] [Indexed: 01/07/2023]
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Meije Y, Fortún J, Len Ó, Aguado JM, Moreno A, Cisneros JM, Gurguí M, Carratalà J, Muñoz P, Montejo M, Blanes M, Bou G, Pérez JL, Torre-Cisneros J, Ramos A, Pahissa A, Gavaldà J. Prevention strategies for cytomegalovirus disease and long-term outcomes in the high-risk transplant patient (D+/R-): experience from the RESITRA-REIPI cohort. Transpl Infect Dis 2014; 16:387-96. [PMID: 24807640 DOI: 10.1111/tid.12226] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/27/2013] [Accepted: 01/20/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV)-negative recipients of a graft from a CMV-positive donor (D+/R-) are at high risk of CMV disease. Current preventive strategies include universal prophylaxis (UP) and preemptive therapy (PT). However, the best strategy to prevent CMV disease and achieve better long-term outcomes remains a matter of debate. METHODS We analyzed the incidence of CMV disease and long-term outcomes including graft dysfunction and patient mortality at 5 years after transplantation with both preventive strategies. High-risk (D+/R-) kidney and liver transplant recipients from the RESITRA cohort were included. RESULTS Of 2410 kidney or liver transplant patients, 195 (8.3%) were D+/R-. The final cohort included 58 liver and 102 kidney recipients. UP was given in 92 patients and 68 received PT; 10.9% and 36.8% developed CMV disease, respectively (P < 0.01). The independent risk factors for CMV disease were PT strategy (hazard ratio [HR], 3.30; 95% confidence interval [CI], 1.6-6.9), kidney transplantation (HR, 3.8; 95% CI, 1.4-9.9), and cyclosporine immunosuppression (HR, 2.4; 95% CI, 1.2-4.7). PT strategy was also a risk factor for CMV disease in both liver transplantation (HR, 11.0; 95% CI, 1.2-98.7) and kidney transplantation (HR, 2.7; 95% CI, 1.3-6.0), independently. The development of CMV replication during the first 2 years after transplantation was a risk factor for graft dysfunction at 5 years after transplantation (odds ratio, 3.4; 95% CI, 1.3-9.0). Nevertheless, no significant differences were seen in either graft dysfunction or mortality between the 2 strategies. CONCLUSIONS The study supports the benefit of the UP strategy to prevent CMV disease in D+/R- liver or kidney transplant patients. The development of CMV replication during the first 2 years after transplantation was associated with graft dysfunction at 5 years after transplantation.
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Affiliation(s)
- Y Meije
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Gavaldà J, Meije Y, Len Ó, Pahissa A. Infección fúngica invasora en el trasplante de órgano sólido. Enferm Infecc Microbiol Clin 2012; 30:645-53. [DOI: 10.1016/j.eimc.2012.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 09/05/2012] [Accepted: 09/06/2012] [Indexed: 11/27/2022]
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Lalueza A, López-Medrano F, del Palacio A, Alhambra A, Alvarez E, Ramos A, Pérez A, Lizasoain M, Meije Y, García-Reyne A, Aguado JM. Cladosporium macrocarpum brain abscess after endoscopic ultrasound-guided celiac plexus block. Endoscopy 2011; 43 Suppl 2 UCTN:E9-10. [PMID: 21271535 DOI: 10.1055/s-0030-1255804] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A Lalueza
- Infectious Diseases Unit, University Hospital 12 de Octubre, Madrid, Spain.
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Meije Y, Aguado JM, Cuenca-Estrella M. Silent and prolonged Aspergillus DNAemia in oncohematological patients receiving antifungal prophylaxis: a new phenomenon with clinical implications. Bone Marrow Transplant 2010; 46:1016-7. [DOI: 10.1038/bmt.2010.219] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Garcia-Reyne A, López-Medrano F, Morales JM, García Esteban C, Martín I, Eraña I, Meije Y, Lalueza A, Alastruey-Izquierdo A, Rodríguez-Tudela JL, Aguado JM. Cutaneous infection by Phomopsis longicolla in a renal transplant recipient from Guinea: first report of human infection by this fungus. Transpl Infect Dis 2010; 13:204-7. [PMID: 21457423 DOI: 10.1111/j.1399-3062.2010.00570.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report the case of a 72-year-old female renal transplant recipient with a nodular lesion in the distal phalange of the third left finger produced by a dematiaceous fungus that was identified as Phomopsis longicolla. She was treated with itraconazole and terbinafine and later with voriconazole, without response. The patient underwent a surgical resection with lesion-free edge and continued on voriconazole. One year later she was asymptomatic and had not developed new lesions.
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Affiliation(s)
- A Garcia-Reyne
- Infectious Disease Unit, University Hospital 12 Octubre, Madrid, Spain.
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Meije Y, Lizasoain M, García-Reyne A, Martínez P, Rodríguez V, López-Medrano F, Juan RS, Lalueza A, Aguado JM. Emergence of cytomegalovirus disease in patients receiving temozolomide: report of two cases and literature review. Clin Infect Dis 2010; 50:e73-6. [PMID: 20455691 DOI: 10.1086/653011] [Citation(s) in RCA: 18] [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: 11/03/2022] Open
Abstract
Temozolomide chemotherapy has become part of the therapy used to treat glioblastoma multiforme and refractory anaplastic astrocytoma. Temozolomide frequently produces profound lymphopenia. We report 2 cases of cytomegalovirus disease that occurred in patients receiving temozolomide therapy and review 4 additional cases reported in the literature. Narrow monitoring with cytomegalovirus antigenemia assay should be considered for recommendation.
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Affiliation(s)
- Yolanda Meije
- Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Abstract
The clinical application of xenotransplantation poses immunologic, ethical, and microbiologic challenges. Significant progress has been made in the investigation of each of these areas. Among concerns regarding infectious risks for human xenograft recipients is the identification in swine of infectious agents including porcine endogenous retroviruses (PERV) that are capable of replication in some human cell lines. PERV replication has, however, been difficult to demonstrate in primate-derived cell lines and in preclinical studies of non-human primates receiving porcine xenografts. Endogenous 'retroviral restriction factors' are intracellular proteins and components of the innate immune system that act at various steps in retroviral replication. Recent studies suggest that some of these factors may have applications in the management of endogenous retroviruses in xenotransplantation. The risks of PERV infection and the potential role of retroviral restriction factors in xenotransplantation are reviewed in detail.
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Affiliation(s)
- Yolanda Meije
- Infectious Disease Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Jay A. Fishman
- Infectious Disease Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA,Correspondence to: Jay A. Fishman, M.D, Director, Transplant Infectious Disease and Compromised Host Program, Massachusetts General Hospital, 55 Fruit St; GRJ 504, Boston, MA 02114, Tel.: 617-726-5777; Fax: 617-726-5411
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Aguado JM, Torre-Cisneros J, Fortún J, Benito N, Meije Y, Doblas A, Muñoz P. [Consensus document for the management of tuberculosis in solid organ transplant recipients]. Enferm Infecc Microbiol Clin 2009; 27:465-73. [PMID: 19477046 DOI: 10.1016/j.eimc.2008.10.008] [Citation(s) in RCA: 8] [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] [Received: 09/29/2008] [Accepted: 10/10/2008] [Indexed: 02/08/2023]
Abstract
The relevance of tuberculosis in solid organ transplant recipients stems from the difficulties in the diagnosis, which delay the start of treatment, and the associated toxicity of pharmacological therapy. These facts are responsible for the large number of clinical complications and the high mortality in this population. This Consensus Document from GESITRA (Spanish Transplantation Infection Study Group) defines the indications for prophylaxis of latent tuberculosis infection in patients undergoing solid organ transplantation, in particular those with a high risk of pharmacological toxicity, as is the case of liver transplant recipients. This Consensus Document also establishes recommendations for the choice of drugs to use and duration of treatment for tuberculosis in solid organ transplant recipients, with special mention of vigilance for the development of pharmacological interactions between rifampin and immunosuppressive drugs (cyclosporine, tacrolimus, rapamycin, and steroids).
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Affiliation(s)
- José María Aguado
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, España.
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Aguado JM, Torre-Cisneros J, Fortún J, Benito N, Meije Y, Doblas A, Muñoz P. Tuberculosis in solid-organ transplant recipients: consensus statement of the group for the study of infection in transplant recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology. Clin Infect Dis 2009; 48:1276-84. [PMID: 19320593 DOI: 10.1086/597590] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [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: 02/05/2023] Open
Abstract
Tuberculosis is a particularly important condition in solid-organ transplant recipients because of the delay in treatment caused by the difficulties involved in its diagnosis and because of the pharmacological toxicity associated with this treatment. Both treatment delay and toxicity are responsible for the many clinical complications of and high mortality associated with tuberculosis in this population. The Consensus Statement from the Spanish Group for the Study of Infectious Diseases in Transplant Recipients defines the indications for treatment of latent tuberculosis infection in solid-organ transplant recipients, especially in patients with a high risk of pharmacological toxicity, as is the case with liver recipients. We established a series of recommendations regarding the types of drugs and the duration of treatment of tuberculosis in solid-organ recipients, giving special attention to pharmacological interactions between rifampin and immunosuppressive drugs (cyclosporine, tacrolimus, rapamycin, and corticosteroids).
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Affiliation(s)
- José María Aguado
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, Spain
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Abstract
Despite the worldwide distribution of Coxiella burnetii, Q fever is not a frequent infection in travelers. This disease should be considered in recent travelers from the tropics with unknown fever, headache, raised liver enzymes, and low platelets. Five cases in western travelers to the tropics returning with fever are presented.
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Affiliation(s)
- Thuy-Huong Ta
- Department of Clinical Microbiology, Ramón y Cajal Hospital, Madrid, Spain
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