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Rodríguez-Gascón A, Lloréns-Villar Y, Solinís MÁ, Barrasa H, Canut-Blasco A. Does selective digestive decontamination (SDD) increase antibiotic resistance? Long-term comparison of two intensive care units (with and without SDD) of the same tertiary hospital. Eur J Clin Microbiol Infect Dis 2024; 43:885-893. [PMID: 38460030 DOI: 10.1007/s10096-024-04792-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/26/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE The aim of this study was to to compare the antimicrobial resistance rate and its relationship with the antibiotic consumption in two separate Intensive Care Units (ICUs) of the same hospital, one with and other without selective decontamination of the digestive tract (SDD). METHODS We performed a retrospective study in the two ICUs of the Araba University Hospital. Trauma and neurosurgical patients are admitted to the SDD-ICU, and general digestive surgery patients go to the no SDD-ICU. From 2014 to 2018 we analyzed the number of isolates, and the bacterial resistance trends of 47 antimicrobial-microorganism combinations. Additionally, antimicrobial consumption was estimated in both ICUs. Resistance rates were also compared with those reported in ENVIN-HELICS Spanish national registry. RESULTS In the ICU with SDD protocol, there was a significant decrease in the resistance of E. coli to amoxicillin/clavulanic acid and in the resistance of E. faecalis to high concentration of gentamycin and high concentration of streptomycin. A significant increase of resistance of Staphylococcus coagulasa negative (CoNS) to linezolid in the no SDD-ICU was also detected. Overall, the level of resistance in the SDD-ICU was lower or of the same order than in the ICU without SDD and that reported in the Spanish national registry. CONCLUSIONS SDD had neither a clinically relevant impact on emergence and spread of resistance, nor in the overall systemic antimicrobial use. The patient type rather than the SDD protocol showed to condition the ecology and therefore, the resistance rate in the ICUs.
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Affiliation(s)
- Alicia Rodríguez-Gascón
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (Pharma Nano Gene), Faculty of Pharmacy, Centro de Investigación Lascaray Ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, 01006, Spain.
- Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, 01009, Spain.
| | - Yanire Lloréns-Villar
- Hospital Pharmacy Service, Araba University Hospital, Osakidetza Basque Health Service, Vitoria-Gasteiz, 01009, Spain
| | - María Ángeles Solinís
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (Pharma Nano Gene), Faculty of Pharmacy, Centro de Investigación Lascaray Ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, 01006, Spain
- Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, 01009, Spain
| | - Helena Barrasa
- Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, 01009, Spain
- Intensive Care Unit, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, 01009, Spain
| | - Andrés Canut-Blasco
- Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, 01009, Spain
- Microbiology Service, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, 01009, Spain
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Canut-Blasco A, Gómez-González C, Barbero-Herranz R, Barbero-Martínez I, Abasolo-Osinaga E. The importance of prevalence and pre-test probability on the microbiological diagnosis of SARS-CoV-2: the case of Spain in 2020. Rev Esp Quimioter 2023; 36:498-506. [PMID: 37476842 PMCID: PMC10586731 DOI: 10.37201/req/033.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/19/2023] [Accepted: 06/01/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE The aim of this work was to estimate the conditioned probability for the diagnosis of SARS-CoV-2 infection with reverse transcription polymerase chain reaction (RT-PCR), viral antigen rapid diagnostic tests (Ag-RDT), and antibody detection tests depending on the prevalence in the specific healthcare settings in Spain in 2020, and on the pre-test probability (PTP) according to the clinical situation, age and unknown or close contacts of the patient. METHODS Performance parameters of tests were obtained from literature. Prevalence data and PTP were obtained from Spanish sources and a survey, respectively. The post-test probability is the positive predictive value (PPV) when test is positive. For negative result, we also calculated the probability of having the infection (false negatives). RESULTS For both RT-PCR and viral Ag-RDT, the lowest PPV values were for the population screenings. This strategy proved to be useful in ruling out infection but generates a high number of false positives. At individual level, both tools provided high PPV (≥ 97%) when the PTP values are over 35%. In seroprevalence studies, though the specificity of IgG alone tests is high, under low seroprevalence, false positives cannot be avoided. Total antibodies tests are useful for diagnosis of COVID-19 in those doubtful cases with RT-PCR or Ag-RDT tests being repeatedly negative. CONCLUSIONS The interpretating of results depends not only on the accuracy of the test, but also on the prevalence of the infection in different settings, and the PTP associated to the patient before performing the test.
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Affiliation(s)
- Andrés Canut-Blasco
- Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Araba University Hospital, Microbiology Service, Vitoria-Gasteiz, Spain
| | - Carmen Gómez-González
- Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Araba University Hospital, Microbiology Service, Vitoria-Gasteiz, Spain
| | - Raquel Barbero-Herranz
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Ismael Barbero-Martínez
- Department of Medicine Preventive, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Vitoria-Gasteiz, Spain
| | - Eider Abasolo-Osinaga
- Department of Medicine Preventive, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Vitoria-Gasteiz, Spain
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Alarcia-Lacalle A, Barrasa H, Maynar J, Canut-Blasco A, Solinís MÁ, Isla A, Rodríguez-Gascón A. Ceftaroline and Avibactam Removal by Continuous Renal Replacement Therapies: An in vitro Study. Blood Purif 2023:1-10. [PMID: 36858039 DOI: 10.1159/000529264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/08/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Continuous renal replacement therapies (CRRTs) are frequently used in critically ill patients; however, there are scarce in vitro and in vivo studies showing the extracorporeal elimination of ceftaroline and avibactam. The aim of this study was to assess, through an in vitro model, the extracorporeal elimination of ceftaroline and avibactam by continuous veno-venous hemofiltration (CVVH), continuous veno-venous hemodiafiltration (CVVHDF), and continuous veno-venous hemodialysis (CVVHD), using a polysulfone hemofilter. METHODS Simulated in vitro experiments were performed using a multiFiltrate machine with a 1.4 m2 Ultraflux® AV600S polysulfone hemofilter. Isofundin® without or with bovine serum albumin was circulated as vehicle for ceftaroline or avibactam. Pre-filter, post-filter, and effluent samples were taken over a period of 60 min, and they were immediately stored at 4°C until processed in the same day. The quantification of ceftaroline and avibactam in the samples was performed by high-performance liquid chromatography with ultraviolet detection. Protein binding, extraction coefficient (EC), and extracorporeal clearance (CLCRRT) were calculated. RESULTS The elimination of both ceftaroline and avibactam during the three extracorporeal modalities followed first-order pharmacokinetics. Regardless of the CRRT technique, EC values for both molecules were around 1, similar to the unbound fraction of avibactam (0.96) and higher than the unbound fraction of ceftaroline (0.79). CLCRRT of ceftaroline ranged from 15.63 to 17.66 mL/min when CVVH and CVVHD were used with a flow rate of 1,000 mL/h, and from 29.25 to 32.95 mL/min for the CVVHDF modality with a flow rate of 2,000 mL/h. For avibactam, CLCRRT ranged from 15.07 to 18.82 mL/min for CVVH and CVVHD, and from 33.74 to 34.13 mL/min for CVVHDF. DISCUSSION Avibactam and ceftaroline are extensively removed through the polysulfone membrane, and a dose adjustment may be recommended for patients under CRRT to ensure pharmacodynamic target achievement.
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Affiliation(s)
- Ana Alarcia-Lacalle
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de Investigación Lascaray Ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain.,Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain
| | - Helena Barrasa
- Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain.,Osakidetza Basque Health Service, Araba University Hospital, Intensive Care Unit, Vitoria-Gasteiz, Spain
| | - Javier Maynar
- Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain.,Osakidetza Basque Health Service, Araba University Hospital, Intensive Care Unit, Vitoria-Gasteiz, Spain
| | - Andrés Canut-Blasco
- Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain.,Osakidetza Basque Health Service, Araba University Hospital, Microbiology Service, Vitoria-Gasteiz, Spain
| | - María Ángeles Solinís
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de Investigación Lascaray Ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain.,Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain
| | - Arantxa Isla
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de Investigación Lascaray Ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain.,Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain
| | - Alicia Rodríguez-Gascón
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de Investigación Lascaray Ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain.,Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain
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Larrosa MN, Canut-Blasco A, Benito N, Cantón R, Cercenado E, Docobo-Pérez F, Fernández-Cuenca F, Fernández-Domínguez J, Guinea J, López-Navas A, Moreno MÁ, Morosini MI, Navarro F, Martínez-Martínez L, Oliver A. Spanish Antibiogram Committee (COESANT) recommendations for cumulative antibiogram reports. Enferm Infecc Microbiol Clin (Engl Ed) 2022:S2529-993X(22)00177-0. [PMID: 36175285 DOI: 10.1016/j.eimce.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/31/2021] [Accepted: 01/13/2022] [Indexed: 06/16/2023]
Abstract
The Spanish Antibiogram Committee (Comité Español del Antibiograma, COESANT) presents in this document a series of recommendations intending to unify how cumulative antibiogram reports must be made in Clinical Microbiology Spanish laboratories. This article is based on the information included in the Clinical Microbiology Procedure No. 51, «Preparation of cumulative reports on antimicrobial susceptibility» of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), published in 2014. The recommendations also include the modifications in the definition of clinical interpretive categories recently published by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in 2019. Its final objective is to establish a homogeneous way of preparing these summaries to compare results from different centers or aggregate the information from these in order to carry out an adequate local or even national surveillance regarding the evolution of antimicrobial susceptibility.
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Affiliation(s)
- María Nieves Larrosa
- Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain.
| | | | - Natividad Benito
- Unidad de Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Rafael Cantón
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Emilia Cercenado
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Docobo-Pérez
- Departamento de Microbiología, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Felipe Fernández-Cuenca
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; UGC Enfermedades Infecciosas y Microbiología Clínica, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Javier Fernández-Domínguez
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Jesús Guinea
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio López-Navas
- Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Miguel Ángel Moreno
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense, Madrid, Spain
| | - Mª Isabel Morosini
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Ferran Navarro
- Servicio de Microbiología, Hospital de la Santa Creu i Sant Pau, Departamento de Genética y de Microbiología de la Universitat Autònoma de Barcelona, Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Luis Martínez-Martínez
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Unidad de Gestión Clínica de Microbiología, Hospital Reina Sofía, Departamento de Química Agrícola, Edafología y Microbiología, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Antonio Oliver
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, Spain
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Aguirre-Quiñonero A, Alonso R, Marroyo-Salazar M, Canut-Blasco A. Gonococcal bacteremia: Report of two clinical cases linked with pharyngeal asymptomatic infection. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Aguirre-Quiñonero A, Alonso R, Marroyo-Salazar M, Canut-Blasco A. Gonococcal bacteremia: Report of two clinical cases linked with pharyngeal asymptomatic infection. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:282-283. [PMID: 35577449 DOI: 10.1016/j.eimce.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/16/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Amaia Aguirre-Quiñonero
- Bioaraba, Clinical Microbiology, Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Araba University Hospital, Microbiology Service, Vitoria-Gasteiz, Spain; Immunology, Microbiology and Parasitology Department, Faculty of Pharmacy, Bioaraba Health Research Institute, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain.
| | - Rodrigo Alonso
- Immunology, Microbiology and Parasitology Department, Faculty of Pharmacy, Bioaraba Health Research Institute, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
| | - Maitane Marroyo-Salazar
- Bioaraba, Internal Medicine, Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Andrés Canut-Blasco
- Bioaraba, Clinical Microbiology, Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Araba University Hospital, Microbiology Service, Vitoria-Gasteiz, Spain
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Burillo A, Candel FJ, Canut-Blasco A. Value of syndromic panels in the management of severe community-acquired pneumonia. Rev Esp Quimioter 2022; 35 Suppl 1:15-20. [PMID: 35488818 PMCID: PMC9106196 DOI: 10.37201/req/s01.03.2022] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Community-acquired pneumonia requiring hospital admission is a prevalent and potentially serious infection, especially in high-risk patients (e.g., those requiring ICU admission or immunocompromised). International guidelines recommend early aetiological diagnosis to improve prognosis and reduce mortality. Syndromic panels that detect causative pathogens by molecular methods are here to stay. They are highly sensitive and specific for detecting the targets included in the test. A growing number of studies measuring their clinical impact have observed increased treatment appropriateness and decreased turnaround time to aetiological diagnosis, need for admission, length of hospital stay, days of isolation, adverse effects of medication and hospital costs. Its use is recommended a) per a pre-established protocol on making the diagnosis and managing the patient, b) together with an antimicrobial stewardship programme involving both the Microbiology Service and the clinicians responsible for the patient, and c) the final evaluation of the whole process. However, we recall that microbiological diagnosis with traditional methods remains mandatory due to the possibility that the aetiological agent is not included among the molecular targets and to determine the antimicrobial susceptibility of the pathogens detected.
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Affiliation(s)
- A Burillo
- Almudena Burillo, Clinical Microbiology and Infectious Diseases Department, Doctor Esquerdo 46, 28007 Madrid, Spain.
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Alarcia-Lacalle A, Barrasa H, Maynar J, Canut-Blasco A, Gómez-González C, Solinís MÁ, Isla A, Rodríguez-Gascón A. Quantification of Ceftaroline in Human Plasma Using High-Performance Liquid Chromatography with Ultraviolet Detection: Application to Pharmacokinetic Studies. Pharmaceutics 2021; 13:959. [PMID: 34202113 PMCID: PMC8309110 DOI: 10.3390/pharmaceutics13070959] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022] Open
Abstract
This study was conducted to develop a rapid, simple and reproducible method for the quantification of ceftaroline in plasma samples by high-performance liquid chromatography with ultraviolet detection (HPLC-UV). Sample processing consisted of methanol precipitation and then, after centrifugation, the supernatant was injected into the HPLC system, working in isocratic mode. Ceftaroline was detected at 238 nm at a short acquisition time (less than 5 min). The calibration curve was linear over the concentration range from 0.25 to 40 µg/mL, and the method appeared to be selective, precise and accurate. Ceftaroline in plasma samples was stable at -80 °C for at least 3 months. The method was successfully applied to characterize the pharmacokinetic profile of ceftaroline in two critically ill patients and to evaluate whether the pharmacokinetic/pharmacodynamic (PK/PD) target was reached or not with the dose regimen administered.
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Affiliation(s)
- Ana Alarcia-Lacalle
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (Pharma Nano Gene), Centro de Investigación Lascaray Ikergunea, Faculty of Pharmacy, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain; (A.A.-L.); (M.Á.S.); (A.I.)
- Instituto de Investigación Sanitaria Bioaraba, 01009 Vitoria-Gasteiz, Spain; (H.B.); (J.M.); (A.C.-B.); (C.G.-G.)
| | - Helena Barrasa
- Instituto de Investigación Sanitaria Bioaraba, 01009 Vitoria-Gasteiz, Spain; (H.B.); (J.M.); (A.C.-B.); (C.G.-G.)
- Intensive Care Unit, Araba University Hospital, Osakidetza Basque Health Service, 01009 Vitoria-Gasteiz, Spain
| | - Javier Maynar
- Instituto de Investigación Sanitaria Bioaraba, 01009 Vitoria-Gasteiz, Spain; (H.B.); (J.M.); (A.C.-B.); (C.G.-G.)
- Intensive Care Unit, Araba University Hospital, Osakidetza Basque Health Service, 01009 Vitoria-Gasteiz, Spain
| | - Andrés Canut-Blasco
- Instituto de Investigación Sanitaria Bioaraba, 01009 Vitoria-Gasteiz, Spain; (H.B.); (J.M.); (A.C.-B.); (C.G.-G.)
- Microbiology Service, Araba University Hospital, Osakidetza Basque Health Service, 01009 Vitoria-Gasteiz, Spain
| | - Carmen Gómez-González
- Instituto de Investigación Sanitaria Bioaraba, 01009 Vitoria-Gasteiz, Spain; (H.B.); (J.M.); (A.C.-B.); (C.G.-G.)
- Microbiology Service, Araba University Hospital, Osakidetza Basque Health Service, 01009 Vitoria-Gasteiz, Spain
| | - María Ángeles Solinís
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (Pharma Nano Gene), Centro de Investigación Lascaray Ikergunea, Faculty of Pharmacy, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain; (A.A.-L.); (M.Á.S.); (A.I.)
- Instituto de Investigación Sanitaria Bioaraba, 01009 Vitoria-Gasteiz, Spain; (H.B.); (J.M.); (A.C.-B.); (C.G.-G.)
| | - Arantxazu Isla
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (Pharma Nano Gene), Centro de Investigación Lascaray Ikergunea, Faculty of Pharmacy, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain; (A.A.-L.); (M.Á.S.); (A.I.)
- Instituto de Investigación Sanitaria Bioaraba, 01009 Vitoria-Gasteiz, Spain; (H.B.); (J.M.); (A.C.-B.); (C.G.-G.)
| | - Alicia Rodríguez-Gascón
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (Pharma Nano Gene), Centro de Investigación Lascaray Ikergunea, Faculty of Pharmacy, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain; (A.A.-L.); (M.Á.S.); (A.I.)
- Instituto de Investigación Sanitaria Bioaraba, 01009 Vitoria-Gasteiz, Spain; (H.B.); (J.M.); (A.C.-B.); (C.G.-G.)
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López MG, Chiner-Oms Á, García de Viedma D, Ruiz-Rodriguez P, Bracho MA, Cancino-Muñoz I, D’Auria G, de Marco G, García-González N, Goig GA, Gómez-Navarro I, Jiménez-Serrano S, Martinez-Priego L, Ruiz-Hueso P, Ruiz-Roldán L, Torres-Puente M, Alberola J, Albert E, Aranzamendi Zaldumbide M, Bea-Escudero MP, Boga JA, Bordoy AE, Canut-Blasco A, Carvajal A, Cilla Eguiluz G, Cordón Rodríguez ML, Costa-Alcalde JJ, de Toro M, de Toro Peinado I, del Pozo JL, Duchêne S, Fernández-Pinero J, Fuster Escrivá B, Gimeno Cardona C, González Galán V, Gonzalo Jiménez N, Hernáez Crespo S, Herranz M, Lepe JA, López-Causapé C, López-Hontangas JL, Martín V, Martró E, Milagro Beamonte A, Montes Ros M, Moreno-Muñoz R, Navarro D, Navarro-Marí JM, Not A, Oliver A, Palop-Borrás B, Parra Grande M, Pedrosa-Corral I, Pérez González MC, Pérez-Lago L, Pérez-Ruiz M, Piñeiro Vázquez L, Rabella N, Rezusta A, Robles Fonseca L, Rodríguez-Villodres Á, Sanbonmatsu-Gámez S, Sicilia J, Soriano A, Tirado Balaguer MD, Torres I, Tristancho A, Marimón JM, Coscolla M, González-Candelas F, Comas I. The first wave of the COVID-19 epidemic in Spain was associated with early introductions and fast spread of a dominating genetic variant. Nat Genet 2021; 53:1405-1414. [PMID: 34594042 PMCID: PMC8481935 DOI: 10.1038/s41588-021-00936-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 08/11/2021] [Indexed: 02/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has affected the world radically since 2020. Spain was one of the European countries with the highest incidence during the first wave. As a part of a consortium to monitor and study the evolution of the epidemic, we sequenced 2,170 samples, diagnosed mostly before lockdown measures. Here, we identified at least 500 introductions from multiple international sources and documented the early rise of two dominant Spanish epidemic clades (SECs), probably amplified by superspreading events. Both SECs were related closely to the initial Asian variants of SARS-CoV-2 and spread widely across Spain. We inferred a substantial reduction in the effective reproductive number of both SECs due to public-health interventions (Re < 1), also reflected in the replacement of SECs by a new variant over the summer of 2020. In summary, we reveal a notable difference in the initial genetic makeup of SARS-CoV-2 in Spain compared with other European countries and show evidence to support the effectiveness of lockdown measures in controlling virus spread, even for the most successful genetic variants.
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Affiliation(s)
- Mariana G. López
- grid.466828.60000 0004 1793 8484Instituto de Biomedicina de Valencia (IBV-CSIC), Valencia, Spain
| | - Álvaro Chiner-Oms
- grid.466828.60000 0004 1793 8484Instituto de Biomedicina de Valencia (IBV-CSIC), Valencia, Spain
| | - Darío García de Viedma
- grid.410526.40000 0001 0277 7938Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain ,grid.410526.40000 0001 0277 7938Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain ,grid.413448.e0000 0000 9314 1427CIBER Enfermedades Respiratorias (CIBERES), Bunyola, Spain
| | - Paula Ruiz-Rodriguez
- grid.5338.d0000 0001 2173 938XInstituto de Biología Integrativa de Sistemas, I2SysBio (CSIC-Universitat de València), Valencia, Spain
| | - Maria Alma Bracho
- grid.5338.d0000 0001 2173 938XJoint Research Unit Infection and Public Health FISABIO-University of Valencia I2SysBio, Valencia, Spain ,grid.413448.e0000 0000 9314 1427Ciber en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Irving Cancino-Muñoz
- grid.466828.60000 0004 1793 8484Instituto de Biomedicina de Valencia (IBV-CSIC), Valencia, Spain
| | - Giuseppe D’Auria
- grid.413448.e0000 0000 9314 1427Ciber en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain ,grid.428862.2FISABIO, Servicio de Secuenciación, València, Spain
| | | | - Neris García-González
- grid.5338.d0000 0001 2173 938XJoint Research Unit Infection and Public Health FISABIO-University of Valencia I2SysBio, Valencia, Spain
| | - Galo Adrian Goig
- grid.416786.a0000 0004 0587 0574Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Inmaculada Gómez-Navarro
- grid.466828.60000 0004 1793 8484Instituto de Biomedicina de Valencia (IBV-CSIC), Valencia, Spain
| | - Santiago Jiménez-Serrano
- grid.466828.60000 0004 1793 8484Instituto de Biomedicina de Valencia (IBV-CSIC), Valencia, Spain
| | | | - Paula Ruiz-Hueso
- grid.428862.2FISABIO, Servicio de Secuenciación, València, Spain
| | - Lidia Ruiz-Roldán
- grid.5338.d0000 0001 2173 938XJoint Research Unit Infection and Public Health FISABIO-University of Valencia I2SysBio, Valencia, Spain
| | - Manuela Torres-Puente
- grid.466828.60000 0004 1793 8484Instituto de Biomedicina de Valencia (IBV-CSIC), Valencia, Spain
| | - Juan Alberola
- grid.411289.70000 0004 1770 9825Servicio de Microbiología. Hospital Dr Peset, Valencia, Spain ,grid.424970.c0000 0001 2353 2112Conselleria de Sanitat i Consum, Generalitat Valenciana, Valencia, Spain ,grid.5338.d0000 0001 2173 938XDepartamento Microbiología, Facultad de Medicina, Universitat de València, Valencia, Spain
| | - Eliseo Albert
- grid.411308.fMicrobiology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Maitane Aranzamendi Zaldumbide
- grid.411232.70000 0004 1767 5135Servicio de Microbiología, Hospital Universitario Cruces, Bilbao, Spain ,Grupo de Microbiología y Control de Infección, Instituto de Investigación Sanitaria Biocruces Bizkaia, Barakaldo, Spain
| | - María Pilar Bea-Escudero
- grid.460738.ePlataforma de Genómica y Bioinformática, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Jose Antonio Boga
- grid.411052.30000 0001 2176 9028Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, Spain ,grid.511562.4Grupo de Microbiología Traslacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Antoni E. Bordoy
- grid.411438.b0000 0004 1767 6330Servicio de Microbiología, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain
| | - Andrés Canut-Blasco
- grid.426049.d0000 0004 1793 9479Servicio de Microbiología, Hospital Universitario de Álava, Osakidetza-Servicio Vasco de Salud, Vitoria-Gasteiz (Álava), Spain
| | - Ana Carvajal
- grid.4807.b0000 0001 2187 3167Animal Health Department, Universidad de León, León, Spain
| | - Gustavo Cilla Eguiluz
- grid.414651.3Servicio de MicrobiologíaBiodonostia, Osakidetza, Hospital Universitario Donostia, San Sebastián, Spain
| | - Maria Luz Cordón Rodríguez
- grid.426049.d0000 0004 1793 9479Servicio de Microbiología, Hospital Universitario de Álava, Osakidetza-Servicio Vasco de Salud, Vitoria-Gasteiz (Álava), Spain
| | - José J. Costa-Alcalde
- grid.411048.80000 0000 8816 6945Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - María de Toro
- grid.460738.ePlataforma de Genómica y Bioinformática, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | | | - Jose Luis del Pozo
- grid.411730.00000 0001 2191 685XServicio de Enfermedades Infecciosas y Microbiología clínica, Clínica Universidad de Navarra, Pamplona, Spain
| | - Sebastián Duchêne
- grid.1008.90000 0001 2179 088XDepartment of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria Australia
| | - Jovita Fernández-Pinero
- grid.419190.40000 0001 2300 669XInstituto Nacional de Investigación y Tecnología Agraria y Alimentaria, O.A., M.P. – INIA, Madrid, Spain
| | - Begoña Fuster Escrivá
- grid.5338.d0000 0001 2173 938XDepartamento Microbiología, Facultad de Medicina, Universitat de València, Valencia, Spain ,grid.106023.60000 0004 1770 977XServicio de Microbiología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Concepción Gimeno Cardona
- grid.106023.60000 0004 1770 977XServicio de Microbiología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Verónica González Galán
- grid.411109.c0000 0000 9542 1158Servicio de Microbiología UCEIMP, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Nieves Gonzalo Jiménez
- grid.411093.e0000 0004 0399 7977Servicio Microbiología, Departamento de Salud de Elche-Hospital General, Elche, Alicante, Spain
| | - Silvia Hernáez Crespo
- grid.426049.d0000 0004 1793 9479Servicio de Microbiología, Hospital Universitario de Álava, Osakidetza-Servicio Vasco de Salud, Vitoria-Gasteiz (Álava), Spain
| | - Marta Herranz
- grid.410526.40000 0001 0277 7938Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain ,grid.410526.40000 0001 0277 7938Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain ,grid.413448.e0000 0000 9314 1427CIBER Enfermedades Respiratorias (CIBERES), Bunyola, Spain
| | - José Antonio Lepe
- grid.411109.c0000 0000 9542 1158Servicio de Microbiología UCEIMP, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Carla López-Causapé
- grid.411164.70000 0004 1796 5984Servicio de Microbiología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - José Luis López-Hontangas
- grid.84393.350000 0001 0360 9602Hospital Universitario y Politécnico La Fe, Servicio de Microbiología, Valencia, Spain
| | - Vicente Martín
- grid.413448.e0000 0000 9314 1427Ciber en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain ,grid.4807.b0000 0001 2187 3167Research Group on Gene-Environment Interactions and Health. Institute of Biomedicine (IBIOMED), Universidad de León, León, Spain
| | - Elisa Martró
- grid.413448.e0000 0000 9314 1427Ciber en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain ,grid.411438.b0000 0004 1767 6330Servicio de Microbiología, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain
| | - Ana Milagro Beamonte
- grid.411106.30000 0000 9854 2756Servicio de Microbiología Clínica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Milagrosa Montes Ros
- grid.414651.3Servicio de MicrobiologíaBiodonostia, Osakidetza, Hospital Universitario Donostia, San Sebastián, Spain
| | | | - David Navarro
- grid.5338.d0000 0001 2173 938XDepartamento Microbiología, Facultad de Medicina, Universitat de València, Valencia, Spain ,grid.411308.fMicrobiology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - José María Navarro-Marí
- grid.411380.f0000 0000 8771 3783Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Granada, Spain ,grid.411380.f0000 0000 8771 3783Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs, Granada, Spain
| | - Anna Not
- grid.411438.b0000 0004 1767 6330Servicio de Microbiología, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain
| | - Antonio Oliver
- grid.411164.70000 0004 1796 5984Servicio de Microbiología, Hospital Universitario Son Espases, Palma de Mallorca, Spain ,Instituto de Investigación Sanitaria de las Islas Baleares, Palma, Spain
| | - Begoña Palop-Borrás
- grid.411457.2Servicio de Microbiologia, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Mónica Parra Grande
- grid.507938.0Laboratorio de Microbiología, Hospital Marina Baixa, Villajoyosa, Spain
| | - Irene Pedrosa-Corral
- grid.411380.f0000 0000 8771 3783Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Granada, Spain ,grid.411380.f0000 0000 8771 3783Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs, Granada, Spain
| | - Maria Carmen Pérez González
- grid.411250.30000 0004 0399 7109Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Laura Pérez-Lago
- grid.410526.40000 0001 0277 7938Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain ,grid.410526.40000 0001 0277 7938Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Mercedes Pérez-Ruiz
- grid.411457.2Servicio de Microbiologia, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Luis Piñeiro Vázquez
- grid.414651.3Servicio de MicrobiologíaBiodonostia, Osakidetza, Hospital Universitario Donostia, San Sebastián, Spain
| | - Nuria Rabella
- grid.413396.a0000 0004 1768 8905Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain ,CREPIMC, Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain ,grid.7080.fDepartament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Cerdanyola, Spain
| | - Antonio Rezusta
- grid.411106.30000 0000 9854 2756Servicio de Microbiología Clínica, Hospital Universitario Miguel Servet, Zaragoza, Spain ,grid.488737.70000000463436020Instituto de Investigación Sanitaria de Aragón, Centro de Investigación Biomédica de Aragón (CIBA), Zaragoza, Spain ,grid.11205.370000 0001 2152 8769Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
| | - Lorena Robles Fonseca
- grid.411094.90000 0004 0506 8127Hospital General Universitario de Albacete, Albacete, Spain
| | - Ángel Rodríguez-Villodres
- grid.411109.c0000 0000 9542 1158Servicio de Microbiología UCEIMP, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Sara Sanbonmatsu-Gámez
- grid.411380.f0000 0000 8771 3783Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Granada, Spain ,grid.411380.f0000 0000 8771 3783Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs, Granada, Spain
| | - Jon Sicilia
- grid.410526.40000 0001 0277 7938Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain ,grid.410526.40000 0001 0277 7938Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Alex Soriano
- grid.410458.c0000 0000 9635 9413Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Ignacio Torres
- grid.411308.fMicrobiology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Alexander Tristancho
- grid.411106.30000 0000 9854 2756Servicio de Microbiología Clínica, Hospital Universitario Miguel Servet, Zaragoza, Spain ,grid.488737.70000000463436020Instituto de Investigación Sanitaria de Aragón, Centro de Investigación Biomédica de Aragón (CIBA), Zaragoza, Spain
| | - José María Marimón
- grid.414651.3Servicio de MicrobiologíaBiodonostia, Osakidetza, Hospital Universitario Donostia, San Sebastián, Spain
| | | | - Mireia Coscolla
- grid.5338.d0000 0001 2173 938XInstituto de Biología Integrativa de Sistemas, I2SysBio (CSIC-Universitat de València), Valencia, Spain
| | - Fernando González-Candelas
- grid.5338.d0000 0001 2173 938XJoint Research Unit Infection and Public Health FISABIO-University of Valencia I2SysBio, Valencia, Spain ,grid.413448.e0000 0000 9314 1427Ciber en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Iñaki Comas
- grid.466828.60000 0004 1793 8484Instituto de Biomedicina de Valencia (IBV-CSIC), Valencia, Spain ,grid.413448.e0000 0000 9314 1427Ciber en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Barrasa H, Martín A, Maynar J, Rello J, Fernández-Torres M, Aguirre-Quiñonero A, Canut-Blasco A. High rate of infections during ICU admission of patients with severe SARS-CoV-2 pneumonia: A matter of time? J Infect 2020; 82:186-230. [PMID: 33285217 PMCID: PMC7837178 DOI: 10.1016/j.jinf.2020.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Helena Barrasa
- Bioaraba, Intensive Care Unit, Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Araba University Hospital, Intensive Care Unit, Vitoria-Gasteiz, Spain.
| | - Alejandro Martín
- Bioaraba, Intensive Care Unit, Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Araba University Hospital, Intensive Care Unit, Vitoria-Gasteiz, Spain
| | - Javier Maynar
- Bioaraba, Intensive Care Unit, Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Araba University Hospital, Intensive Care Unit, Vitoria-Gasteiz, Spain
| | - Jordi Rello
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto Salud Carlos III, Madrid, Spain; Clinical Research in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Marina Fernández-Torres
- Bioaraba, Clinical Microbiology, Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Araba University Hospital, Service of Microbiology, Vitoria-Gasteiz, Spain
| | - Amaia Aguirre-Quiñonero
- Bioaraba, Clinical Microbiology, Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Araba University Hospital, Service of Microbiology, Vitoria-Gasteiz, Spain
| | - Andrés Canut-Blasco
- Bioaraba, Clinical Microbiology, Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Araba University Hospital, Service of Microbiology, Vitoria-Gasteiz, Spain
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Ibar-Bariain M, Rodríguez-Gascón A, Isla A, Solinís MÁ, Canut-Blasco A. Evaluation of the adequacy of the antimicrobial therapy of invasive Haemophilus influenzae infections: A pharmacokinetic/pharmacodynamic perspective. Enferm Infecc Microbiol Clin 2020; 39:65-71. [PMID: 32636039 DOI: 10.1016/j.eimc.2020.05.025] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION In Europe, non-typeable H. influenzae (NTHi) is the leading cause of invasive H. influenzae disease in adults and is associated with high mortality. The goal of this study was to determine whether current antimicrobial treatments for H. influenzae infection in Spain are suitable based on their probability of achieving pharmacokinetic/pharmacodynamic (PK/PD) targets. METHODS Pharmacokinetic parameters for the antibiotics studied (amoxicillin, amoxicillin/clavulanic acid, ampicillin, cefotaxime, ceftriaxone, imipenem and ciprofloxacin) and susceptibility data for H. influenzae were obtained from literature. A Monte Carlo simulation was used to estimate the probability of target attainment (PTA), defined as the probability that at least a specific value of a PK/PD index is achieved at a certain MIC, and the cumulative fraction of response (CFR), defined as the expected population PTA for a specific drug dose and a specific microorganism population. RESULTS Regardless of dosing regimen, all antibiotics yielded CFR values of 100% or nearly 100% for all strains, including BL+, BL- and BLNAR, except amoxicillin and ampicillin for BL+. Thus, if an infection is caused by BL+ strains, treatment with amoxicillin and ampicillin has a high probability of failure (CFR≤8%). For standard doses of amoxicillin, amoxicillin/clavulanic acid and imipenem, PK/PD breakpoints were consistent with EUCAST clinical breakpoints. For the other antimicrobials, PK/PD breakpoints were higher than EUCAST clinical breakpoints. CONCLUSIONS Our study confirms by PK/PD analysis that, with the antimicrobials used as empirical treatment of invasive H. influenzae disease, a high probability of therapeutic success can be expected.
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Affiliation(s)
- Maitane Ibar-Bariain
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de Investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, Spain
| | - Alicia Rodríguez-Gascón
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de Investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, Spain
| | - Arantxa Isla
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de Investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, Spain
| | - María Ángeles Solinís
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de Investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, Spain
| | - Andrés Canut-Blasco
- Microbiology Service, Hospital Universitario de Álava (HUA), Instituto de Investigación Sanitaria de Álava (BIOARABA), Servicio Vasco de Salud-Osakidetza, C/Francisco Leandro de Viana s/n, Vitoria-Gasteiz, Spain.
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Rodríguez-Gascón A, Aguirre-Quiñonero A, Canut-Blasco A. Are oral cefuroxime axetil, cefixime and cefditoren pivoxil adequate to treat uncomplicated acute pyelonephritis after switching from intravenous therapy? A pharmacokinetic/pharmacodynamic perspective. Enferm Infecc Microbiol Clin 2020; 38:306-311. [PMID: 32085928 DOI: 10.1016/j.eimc.2019.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The goal of this study is to assess, by means of pharmacokinetic/pharmacodynamic (PK/PD) analysis using the Monte Carlo simulation, the adequacy of oral cephalosporins cefuroxime axetil, cefixime and cefditoren at different dosing regimens as switch therapy after intravenous cephalosporin treatment in uncomplicated acute pyelonephritis. METHODS The methodology included: (i) dosing regimen selection and acquisition of pharmacokinetic data; (ii) microbiological data acquisition; and (iii) Monte Carlo simulation to estimate the PTA (probability of PK/PD target attainment) and CFR (cumulative fraction of response), as indicators of treatment success. RESULTS At the current susceptibility breakpoints defined by EUCAST and CLSI for either cefuroxime axetil or cefixime, the probability of bactericidal target attainment is zero for the dosage regimens simulated. Considering the bactericidal target %fT>MIC>70%, the likelihood of the cefuroxime 500-mg q8h regimen or the cefixime 200-mg q12h regimen producing this exposure or achieving this target is only above 90% for organisms yielding MICs≤0.5mg/l and MICs≤0.25mg/l, respectively. Cefditoren pivoxil 400mg q12h provided probabilities of bactericidal target attainment of 80% or higher for MICs≤0.03mg/l, and ≤0.25mg/l if considering total instead of free drug concentrations. CONCLUSIONS The results of the PK/PD target attainment analysis reveal that the likelihood of treatment success based upon the current breakpoints proposed by either EUCAST or CLSI is low. Of the three cephalosporins, cefixime 400mg q12h prove to be the best option in oral APN treatment, although this regimen is currently off label.
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Affiliation(s)
- Alicia Rodríguez-Gascón
- Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Centro de Investigación Lascaray Ikergunea, Universidad del País Vasco UPV/EHU, Vitoria, Spain
| | - Amaia Aguirre-Quiñonero
- Servicio de Microbiología, Hospital Universitario de Álava, Instituto de Investigación Biosanitaria, BioAraba, Vitoria-Gasteiz, Spain.
| | - Andrés Canut-Blasco
- Servicio de Microbiología, Hospital Universitario de Álava, Instituto de Investigación Biosanitaria, BioAraba, Vitoria-Gasteiz, Spain
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Rodríguez-Gascón A, Canut-Blasco A. Deciphering pharmacokinetics and pharmacodynamics of fosfomycin. Rev Esp Quimioter 2019; 32 Suppl 1:19-24. [PMID: 31131588 PMCID: PMC6555163] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Fosfomycin, a low molecular weight and hydrophilic drug with negligible protein binding, is eliminated almost exclusively by glomerular filtration, whose clearance is subject to patient renal function. The volume of distribution approximates to the extracellular body water (about 0.3 L/Kg) in healthy volunteers, but it is increased in critically ill patients with bacterial infections. Fosfomycin presents a high ability to distribute into many tissues, including inflamed tissues and abscess fluids. Based on PK/PD analysis and Monte Carlo simulations, we have evaluated different fosfomycin dosing regimen to optimize the treatment of septic patients due to Enterobacterales and Pseudomonas aeruginosa. As PK/PD targets, we selected %T>MIC > 70% for all pathogens, and AUC24/MIC > 24 and AUC24/MIC > 15 for net stasis of Enterobacterales and P. aeruginosa, respectively. Pharmacokinetic parameters in critically ill patients were obtained from the literature. Several dosing regimens were studied in patients with normal renal function: fosfomycin 2-8 g given every 6-12 hours, infused over 30 minutes- 24 hours. At the susceptibility EUCAST breakpoint for Enterobacterales and Staphylococcus spp. (MIC ≤ 32 mg/L), fosfomycin 4 g/8h or higher infused over 30 minutes achieved a probability of target attainment (PTA) > 90%, based in both %T>MIC and AUC24/MIC. For MIC of 64 mg/L, fosfomycin 6 g/6h in 30-minute infusion and 8 g/ 8h in 30-minute and 6 hours infusions also achieved PTA values higher than 90%. No fosfomycin monotherapy regimen was able to achieve PK/PD targets related to antimicrobial efficacy for P. aeruginosa with MICs of 256-512 mg/L.
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Affiliation(s)
- Alicia Rodríguez-Gascón
- Pharmacokinetics, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, España,Centro de Investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, España
| | - Andrés Canut-Blasco
- Microbiology Service, Hospital Universitario de Álava, Servicio Vasco de Salud Osakidetza, Vitoria-Gasteiz, España,Instituto de Investigación Biosanitaria (BIOARABA), Servicio Vasco de Salud Osakidetza, Vitoria-Gasteiz, España
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Ibar-Bariain M, Rodríguez-Gascón A, Isla A, Solinís MÁ, Canut-Blasco A. Application of pharmacokinetic/pharmacodynamic analysis to evaluate the adequacy of antimicrobial therapy for pediatric acute otitis media in Spain before and after the introduction of the PCV7 vaccine. Rev Esp Quimioter 2019; 32:121-129. [PMID: 30727714 PMCID: PMC6441979] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate, by applying pharmacokinetic/pharmacodynamic (PK/PD) analysis, if the change in antibiotic susceptibility after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in Spain had any influence on the usefulness of the antimicrobials more frequently used as empirical treatment of pediatric acute otitis media (AOM). METHODS PK parameters and susceptibility of Streptococcus pneumoniae and Haemophilus influenzae were obtained from bibliography. Monte Carlo simulation was used to estimate the cumulative fraction of response (CFR), understood as the expected probability of therapy success. For amoxicillin and amoxicillin/clavulanate, the target was free antibiotic concentration remaining above the minimum inhibitory concentration (MIC) for ≥50% of the dosing interval (fT>MIC≥50%), whereas for cefuroxime axetil and cefotaxime, the target was fT>MIC≥60%. CFR values ≥90% were considered successful. RESULTS When all serotypes of S. pneumoniae are considered, amoxicillin and cefotaxime turned out to reach a high probability of success, and difference before and after vaccination was scarce. For H. influenzae, CFR values were higher with amoxicillin/clavulanate than with amoxicillin. For both microorganisms, cefuroxime axetil resulted in low probability of success in the two periods of study. CONCLUSIONS We have shown that the introduction of the PCV7 vaccination did not lead to changes in the probability of success of the current empiric treatments of the AOM. Integrated PK/PD analysis has demonstrated to be a useful tool to identify changes in antimicrobial activity after the implantation of a vaccination program, providing complementary information to the simple assessment of MIC values.
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Affiliation(s)
- Maitane Ibar-Bariain
- Hospital Pharmacy. Hospital Universitario de Álava (HUA). Servicio Vasco de Salud Osakidetza. Vitoria-Gasteiz, Spain
| | - Alicia Rodríguez-Gascón
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Arantxa Isla
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - María Ángeles Solinís
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Andrés Canut-Blasco
- Microbiology Department. Hospital Universitario de Álava (HUA). Servicio Vasco de Salud Osakidetza. Vitoria-Gasteiz, Spain
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Canut-Blasco A, Calvo J, Rodríguez-Díaz JC, Martínez-Martínez L. [Antimicrobial susceptibility cumulative reports]. Enferm Infecc Microbiol Clin 2015; 34:524-30. [PMID: 25962661 DOI: 10.1016/j.eimc.2015.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 03/27/2015] [Indexed: 11/26/2022]
Abstract
Cumulative reports on antimicrobial susceptibility tests data are important for selecting empirical treatments, as an educational tool in programs on antimicrobial use, and for establishing breakpoints defining clinical categories. These reports should be based on data validated by clinical microbiologists using diagnostic samples (not surveillance samples). In order to avoid a bias derived from including several isolates obtained from the same patient, it is recommended that, for a defined period, only the first isolate is counted. A minimal number of isolates per species should be presented: a figure of >=30 isolates is statistically acceptable. The report is usually presented in a table format where, for each cell, information on clinically relevant microorganisms-antimicrobial agents is presented. Depending on particular needs, multiple tables showing data related to patients, samples, services or special pathogens can be prepared.
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Affiliation(s)
| | - Jorge Calvo
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, España
| | - Juan Carlos Rodríguez-Díaz
- Servicio de Microbiología, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, España
| | - Luis Martínez-Martínez
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, España; Departamento de Biología Molecular, Universidad de Cantabria, Santander, España.
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Rodríguez-Hernández J, Canut-Blasco A, Martín-Sánchez AM. Seasonal prevalences of Cryptosporidium and Giardia infections in children attending day care centres in Salamanca (Spain) studied for a period of 15 months. Eur J Epidemiol 1996; 12:291-5. [PMID: 8884197 DOI: 10.1007/bf00145419] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Five studies were carried out in children younger than 4 years old attending regularly day care centres in order to determine the intestinal parasitization by Cryptosporidium and Giardia. The percent of children parasitized by Cryptosporidium was 10% (17 children out of 170 studied). Cryptosporidiosis was more frequent in winter than in other seasons (difference statistically significant). Giardia intestinalis, which was the most frequent parasite, was identified in 25.3% (43 children out of 170 studied). Giardiasis was more frequent in autumn and in the low SEL (difference statistically significant in both cases). The frequency of giardiasis increased from 8% in children studied during 1-2 seasons, to 34% in children studied for 3-5 seasons (difference statistically significant), whereas the frequency of cryptosporidiosis did not show variation with increased number of specimens studied per child. The 35% of children parasitized by Cryptosporidium sp. showed gastrointestinal symptoms but only 14% of children with Giardia intestinalis.
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Carbajo-Ferreira AJ, Ochoa-Sangrador C, Canut-Blasco A, Castaño-García MT. Neonatal brucellosis. Pediatr Infect Dis J 1995; 14:406-7. [PMID: 7638028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Rodríguez-Hernandez J, Canut-Blasco A, Ledesma-Garcia M, Martín-Sánchez AM. Cryptosporidium oocysts in water for human consumption. Comparison of staining methods. Eur J Epidemiol 1994; 10:215-8. [PMID: 7813701 DOI: 10.1007/bf01730373] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A study was carried out on the presence of oocysts of Cryptosporidium spp. in water for human consumption in the Province of Salamanca, Spain, using four different staining techniques: Ziehl-Neelsen, auramine, indirect immunofluorescence with monoclonal antibodies (Meridian, USA) and direct immunofluorescence with monoclonal antibodies (Pasteur, France). The presence of oocysts was detected in the water used for the washing of sand filters in the four water purifying plants and in the drinking water of two of the six geographical areas studied. The Ziehl-Neelsen and auramine staining techniques were found to have excellent diagnostic correlation. Immunofluorescence stainings with monoclonal antibodies proved to be less sensitive.
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Martín-Sánchez AM, Canut-Blasco A, Rodríguez-Hernández J, Montes-Martínez I, García-Rodríguez JA. Epidemiology and clinical significance of Blastocystis hominis in different population groups in Salamanca (Spain). Eur J Epidemiol 1992; 8:553-9. [PMID: 1397225 DOI: 10.1007/bf00146376] [Citation(s) in RCA: 18] [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] [Indexed: 12/26/2022]
Abstract
A prospective study was carried out to investigate the epidemiology and clinical significance of Blastocystis hominis in the following groups of the population of the city of Salamanca (Spain): in children attending 11 day care centres and 7 primary schools, two fecal samples were obtained from each child, and in 1231 patients attending the Clinical Hospital. A B. hominis incidence of 5.3-10.3% was found in the day care centres and an incidence rate of 13.4-19.4% was found in the primary schools. All the cases were observed in asymptomatic children. The incidence of B. hominis was greater in children older than 3 years in the day care centres and in the 10-14 year-old group in the primary schools. A heavier parasitization was observed in the boys than in the girls and in the students of schools in areas of low socio-economic level. B. hominis was identified in 40 patients attending the Clinical Hospital (3.25% of all those studied). The maximum peak of incidence was found in subjects with ages between 10 and 14 years. A follow up study was performed on 18 patients parasitized exclusively by B. hominis; 7 of these were considered to have acute gastroenteritis and one chronic gastroenteritis associated with the protozoan. No statistically significant association was observed between the number of B. hominis cells and the presence of diarrhoea. Our results show that despite the high number of asymptomatic carriers of B. hominis in the juvenile population, this protozoan may be, on other occasions, responsible for gastrointestinal symptoms.
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