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Álvarez Zaballos S, Vazquez Alen P, Muñoz P, de Alarcón A, Gutiérrez-Carretero E, Álvarez-Uría A, Fariñas MC, Rodríguez-García R, Goenaga MÁ, Cuervo G, Plata-Ciezar A, Hidalgo-Tenorio C, Aldamiz-Echevarría G, Martínez-Sellés M. Prevalence and Prognostic Impact of Stroke in a National Cohort of Infective Endocarditis. Int J Stroke 2024:17474930241255560. [PMID: 38708722 DOI: 10.1177/17474930241255560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Stroke is a common complication of infective endocarditis (IE). Our aim was to describe the prevalence and prognostic impact of stroke in a national prospective cohort of IE. METHODS Consecutive inclusion at 46 Spanish hospitals between 2008 and 2021. RESULTS Out of 5667 IE cases, 1125 had acute stroke (19.8%): 811 ischemic strokes (618 cardioembolic strokes, 193 cardioembolic strokes with hemorrhagic transformation, 4 transient ischemic attacks, 3 lacunar infarctions), 125 intracranial hemorrhages, and 29 other neurological complications (cerebral abscesses, encephalitis, meningitis, seizures). Compared to patients without stroke, those with stroke had a similar mean age (69 years) but were more frequently female (68.2% vs. 63.7%, p=0.04) and had a higher incidence of intracardiac complications (35% vs 30%, p=0.01), surgical indication (69.9% vs 65.9%, p=0.001), in-hospital mortality (40.9% vs. 22.0%, p<0.001), and one-year mortality (46.2% vs 27.9%, p<0.001). The following variables were independently associated with stroke: mitral location (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.34-1.8, p<0.001), vascular phenomenon (OR 2.9, 95% CI 2.4-3.6, p=0.0001), acute renal failure (OR 1.2, 95% CI 1.0-1.4, p=0.021), septic shock (OR 1.3, CI 1.1-1.6, p=0.007), sepsis (OR 1.3, CI 1.1-1.6, p=0.005), surgery indicated but not performed (OR 1.4, 95% CI 1.2-1.7, p<0.001), community-acquired IE (OR 1.2, 95% CI 1-1.4, p=0.017), and peripheral embolization (OR 1.6, CI 1.4-1.9, p <0.001). Stroke was an independent predictor of in-hospital (OR 2.1, 95% CI: 1.78-2.51, p<0.001) and one-year mortality (hazard ratio 1.9, 95% CI 1.6-2.5). CONCLUSIONS One fifth of patients with IE have concomitant stroke. Stroke is associated with mortality.
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Affiliation(s)
- Sara Álvarez Zaballos
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV. Madrid, Spain
| | - Pilar Vazquez Alen
- Neurology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz
- Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid
- Instituto de Investigación Sanitaria Gregorio Marañón. Madrid. Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058). Madrid. Spain
- Facultad de Medicina, Universidad Complutense de Madrid. Spain
| | - Arístides de Alarcón
- Infective Diseases, Microbiology and Parasitology Department, (UCEIMP), Hospital Virgen del Rocío Seville, Spain
- Grupo de Resistencias bacterianas y antimicrobianos CIBERINFEC. Madrid. Spain
- Institute of Biomedicine of Seville (IBiS). Seville, Spain
- University of Seville/CSIC/University
| | - Encarnación Gutiérrez-Carretero
- Institute of Biomedicine of Seville (IBiS). Seville, Spain
- University of Seville/CSIC/University
- Cardiac Surgery Service CIBERCV. Hospital Virgen del Rocío Seville, Spain
| | - Ana Álvarez-Uría
- Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid
- Instituto de Investigación Sanitaria Gregorio Marañón. Madrid. Spain
| | - Mª Carmen Fariñas
- Infectious Diseases Department, Hospital Universitario Marqués de Valdecilla IDIVAL. Spain
- CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00068), Instituto de Salud Carlos III, Madrid, Spain
- University of Cantabria, Spain
| | - Raquel Rodríguez-García
- Intensive Medicine Department, Hospital Universitario Central de Asturias, Oviedo. Spain
- University of Oviedo, Spain
| | - Miguel Ángel Goenaga
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Guillermo Cuervo
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antonio Plata-Ciezar
- Infectious Diseases Department, UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Regional Universitario de Málaga, IBIMA, Spain
| | - Carmen Hidalgo-Tenorio
- Internal Medicine Department, Hospital Universitario Virgen de las Nieves. Granada. Spain
| | - Gonzalo Aldamiz-Echevarría
- Cardiac Surgery Department, Hospital Universitario Fundación Jiménez Díaz, Madrid. Universidad Autónoma de Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV. Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón. Madrid. Spain
- Facultad de Medicina, Universidad Complutense de Madrid. Spain
- Universidad Europea. Madrid, Spain
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Hidalgo-Tenorio C, Sequera S, Vivancos MJ, Vinuesa D, Collado A, Santos IDL, Sorni P, Cabello-Clotet N, Montero M, Font CR, Terron A, Galindo MJ, Martinez O, Ryan P, Omar-Mohamed M, Iglesias HA, Javier R, Ruz MÁL, Romero A, Garcia-Vallecillos C. Bictegravir/emtricitabine/tenofovir alafenamide as first-line treatment in naïve HIV patients in a rapid-initiation model of care: BIC-NOW clinical trial. Int J Antimicrob Agents 2024; 63:107164. [PMID: 38574873 DOI: 10.1016/j.ijantimicag.2024.107164] [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: 01/22/2024] [Revised: 02/29/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Multiple strategies have been utilised to reduce the incidence of HIV, including PrEP and rapid antiretroviral therapy initiation. The study objectives were to evaluate the efficacy, safety, satisfaction, treatment adherence, and system retention obtained with rapid initiation of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in naïve patients. METHODS This phase IV, multicenter, open-label, single-arm, 48-week clinical trial enrolled patients between January 2020 and June 2022. Adherence to treatment was evaluated with the SMAQ questionnaire and patient satisfaction with the EQ-5D. RESULTS Two hundred eight participants were enrolled with mean age of 35.6 years; 87.6% were males; mean CD4 count was 393.5 cells/uL (<200 cells/uL in 22.1%); viral load log was 5.6 (VL>100 000 cop/mL in 43.3%); 22.6% had AIDS, and 4.3% were coinfected with HBV. BIC/FTC/TAF was initiated on the day of their first visit to the HIV specialist in 98.6% of participants, and 9.6% were lost to follow-up. The efficacy at week 48 was 84.1 % by intention-to- treat (ITT), 94.6% by modified ITT, and 98.3% by per protocol analysis. The regimen was discontinued in two subjects (0.9%) during week 1 for grade 3 adverse events. Treatment adherence (weeks 4 [90%, IQR: 80-99%] vs. 48 [90%, IQR: 80-95%; P = 0.49]) and patient satisfaction (weeks 4 [90%, IQR: 80-99%] vs. 48 [90%, IQR: 80-95 P = 0.49]) rates were very high over the 48- week study period. CONCLUSIONS BIC/FTC/TAF is an appropriate option for rapid ART initiation in naïve HIV patients, offering high efficacy, safety, durability, treatment adherence, retention in the healthcare system, and patient satisfaction. Number Clinical Trial registration: NCT06177574.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - Sergio Sequera
- Unit of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - David Vinuesa
- Unit of Infectious Diseases, Hospital Universitario San Cecilio, Granada, Spain
| | - Antonio Collado
- Unit of Infectious Diseases, Hospital Universitario Torrecardenas, Almería, Spain
| | | | - Patricia Sorni
- Unit of Infectious Diseases, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - Noemi Cabello-Clotet
- Infectious Diseases Unit, Hospital Clínico San Carlos, Complutense University, Madrid, Spain
| | - Marta Montero
- Infectious Diseases Service, Hospital Universitario La Fe, Valencia, Spain
| | - Carlos Ramos Font
- Nuclear Medicine Service, Hospital Universitario Virgen de las Nieves Granada, Granada, Spain
| | - Alberto Terron
- Unit of Infectious Diseases, Hospital Universitario de Jerez, Cádiz, Spain
| | - Maria José Galindo
- Infectious Diseases Service, Hospital Universitario Clínico de Valencia, Spain
| | - Onofre Martinez
- Unit of Infectious Diseases, Hospital Universitario Santa Lucía, Cartagena, Spain
| | - Pablo Ryan
- Internal Medicine Service, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Helena Albendín Iglesias
- Department of Internal Medicine, HIV and STI Unit, Hospital Universitario Virgen de la Arrixaca, IMIB, Murcia, Spain
| | - Rosario Javier
- Unit of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Alberto Romero
- Unit of Infectious Diseases, Facultad de Medicina, Hospital Universitario Puerto Real, INIBICA, Universidad de Cadiz, Cádiz, Spain
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Membrillo de Novales FJ, Bravo de Pablo O, Estella García Á, Morata Ruiz L, Oltra Sempere MR, Salavert Lleti M, Estébanez Muñoz M, Hidalgo-Tenorio C. The positioning of ceftobiprole in Staphylococcus aureus bacteremia. Clin Infect Dis 2024:ciae123. [PMID: 38466267 DOI: 10.1093/cid/ciae123] [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: 11/24/2023] [Revised: 01/10/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024] Open
Affiliation(s)
- Francisco Javier Membrillo de Novales
- CBRN and Infectious Diseases Department. Hospital Central de la Defensa "Gómez Ulla". Madrid, Spain
- Internal Medicine Department. Hospital La Moraleja. Madrid, Spain
| | | | - Ángel Estella García
- Intensive Care Department. University of Cádiz, INIBiCA.Hospital Universitario de Jerez. Jerez, Spain
| | | | | | | | - Miriam Estébanez Muñoz
- CBRN and Infectious Diseases Department. Hospital Central de la Defensa "Gómez Ulla". Madrid, Spain
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Gasca-Capote C, Lian X, Gao C, Roseto IC, Jiménez-León MR, Gladkov G, Camacho-Sojo MI, Pérez-Gómez A, Gallego I, Lopez-Cortes LE, Bachiller S, Vitalle J, Rafii-El-Idrissi Benhnia M, Ostos FJ, Collado-Romacho AR, Santos J, Palacios R, Gomez-Ayerbe C, Muñoz-Medina L, Ruiz-Sancho A, Frias M, Rivero-Juarez A, Roca-Oporto C, Hidalgo-Tenorio C, Rull A, Olalla J, Lopez-Ruz MA, Vidal F, Viladés C, Mastrangelo A, Cavassini M, Espinosa N, Perreau M, Peraire J, Rivero A, López-Cortes LF, Lichterfeld M, Yu XG, Ruiz-Mateos E. The HIV-1 reservoir landscape in persistent elite controllers and transient elite controllers. J Clin Invest 2024; 134:e174215. [PMID: 38376918 PMCID: PMC11014653 DOI: 10.1172/jci174215] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/13/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUNDPersistent controllers (PCs) maintain antiretroviral-free HIV-1 control indefinitely over time, while transient controllers (TCs) eventually lose virological control. It is essential to characterize the quality of the HIV reservoir in terms of these phenotypes in order to identify the factors that lead to HIV progression and to open new avenues toward an HIV cure.METHODSThe characterization of HIV-1 reservoir from peripheral blood mononuclear cells was performed using next-generation sequencing techniques, such as full-length individual and matched integration site proviral sequencing (FLIP-Seq; MIP-Seq).RESULTSPCs and TCs, before losing virological control, presented significantly lower total, intact, and defective proviruses compared with those of participants on antiretroviral therapy (ART). No differences were found in total and defective proviruses between PCs and TCs. However, intact provirus levels were lower in PCs compared with TCs; indeed the intact/defective HIV-DNA ratio was significantly higher in TCs. Clonally expanded intact proviruses were found only in PCs and located in centromeric satellite DNA or zinc-finger genes, both associated with heterochromatin features. In contrast, sampled intact proviruses were located in permissive genic euchromatic positions in TCs.CONCLUSIONSThese results suggest the need for, and can give guidance to, the design of future research to identify a distinct proviral landscape that may be associated with the persistent control of HIV-1 without ART.FUNDINGInstituto de Salud Carlos III (FI17/00186, FI19/00083, MV20/00057, PI18/01532, PI19/01127 and PI22/01796), Gilead Fellowships (GLD22/00147). NIH grants AI155171, AI116228, AI078799, HL134539, DA047034, MH134823, amfAR ARCHE and the Bill and Melinda Gates Foundation.
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Affiliation(s)
- Carmen Gasca-Capote
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Xiaodong Lian
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ce Gao
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Isabelle C. Roseto
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - María Reyes Jiménez-León
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Gregory Gladkov
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - María Inés Camacho-Sojo
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Alberto Pérez-Gómez
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Isabel Gallego
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Luis E. Lopez-Cortes
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Seville, Spain
- Department of Medicine and Microbiology, School of Medicine and
- IBiS, Virgen Macarena University Hospital, CSIC, University of Seville, Seville, Spain
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Sara Bachiller
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
- Department of Medical Biochemistry, Molecular Biology, and Immunology, School of Medicine, University of Seville, Seville, Spain
| | - Joana Vitalle
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Mohamed Rafii-El-Idrissi Benhnia
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
- Department of Medical Biochemistry, Molecular Biology, and Immunology, School of Medicine, University of Seville, Seville, Spain
| | - Francisco J. Ostos
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
- Department of Medical Biochemistry, Molecular Biology, and Immunology, School of Medicine, University of Seville, Seville, Spain
| | | | - Jesús Santos
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Rosario Palacios
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Cristina Gomez-Ayerbe
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Leopoldo Muñoz-Medina
- Unit of Infectious Diseases, San Cecilio University Hospital, Biohealth Research Institute, IBS-Granada, Granada, Spain
| | - Andrés Ruiz-Sancho
- Unit of Infectious Diseases, San Cecilio University Hospital, Biohealth Research Institute, IBS-Granada, Granada, Spain
| | - Mario Frias
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Service of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba University, Cordoba, Spain
| | - Antonio Rivero-Juarez
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Service of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba University, Cordoba, Spain
| | - Cristina Roca-Oporto
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, Biohealth Research Institute, IBS-Granada, Granada, Spain
| | - Anna Rull
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Joan XXIII University Hospital of Tarragona, IISPV, University of Rovira i Virgili, Tarragona, Spain
| | - Julian Olalla
- Internal Medicine Department, Costa Del Sol Hospital, Marbella, Spain
| | - Miguel A. Lopez-Ruz
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, Biohealth Research Institute, IBS-Granada, Granada, Spain
| | - Francesc Vidal
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Joan XXIII University Hospital of Tarragona, IISPV, University of Rovira i Virgili, Tarragona, Spain
| | - Consuelo Viladés
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Joan XXIII University Hospital of Tarragona, IISPV, University of Rovira i Virgili, Tarragona, Spain
| | | | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Nuria Espinosa
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Matthieu Perreau
- Service of Immunology and Allergy, Lausanne University Hospital and
| | - Joaquin Peraire
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Joan XXIII University Hospital of Tarragona, IISPV, University of Rovira i Virgili, Tarragona, Spain
| | - Antonio Rivero
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Service of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba University, Cordoba, Spain
| | - Luis F. López-Cortes
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Mathias Lichterfeld
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Xu G. Yu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ezequiel Ruiz-Mateos
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
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Sequera-Arquelladas S, Hidalgo-Tenorio C, López-Cortés L, Gutiérrez A, Santos J, Téllez F, Omar M, Ferra-Murcia S, Fernández E, Javier R, García-Vallecillos C, Pasquau J. DOLAMA 200: Effectiveness and Safety of a Dual Therapy with Dolutegravir Plus Lamivudine in Treatment-Experienced HIV-1 Infected Real World Participants in Spain. Viruses 2024; 16:259. [PMID: 38400035 PMCID: PMC10893067 DOI: 10.3390/v16020259] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
The continuous pharmacological advances in antiretroviral treatment (ART) and the increasing understanding of HIV drug resistance has led to a change in the paradigm of ART optimization in the setting of the viral suppression of treatment-experienced patients with the emerging evidence of the effectiveness and safety of dual therapies. The aim of this study is to determine the antiviral efficacy and safety of switching to Dolutegravir + Lamivudine in people living with HIV, and to analyze the rate of patients with virologic failure (VF). A total of 200 patients were included with a median age of 51 years, 189 cells/µL of nadir CD4+, 13 years on ART and four previous ART regimens. Among the 168 patients who completed a follow-up at 48 weeks, a total of five VFs occurred, resulting in a 2.98% (5/168) VF rate. The results of the intention-to-treat analysis were a VF rate of 2.54% (5/197), and the rate of patients/year with viral suppression was 98.3% (298/303) in the observed data analysis. We observed a significant improvement in mean CD4 lymphocytes, the CD4/CD8 ratio and lipid profiles. The optimization of ART to DTG plus 3TC is a cost-effective switch option for treatment-experienced HIV patients, and also improves their lipid profiles.
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Affiliation(s)
- Sergio Sequera-Arquelladas
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Luis López-Cortés
- Department of Infectious Diseases, Virgen del Rocio University Hospitals, 41013 Seville, Spain; (L.L.-C.); (A.G.)
| | - Alicia Gutiérrez
- Department of Infectious Diseases, Virgen del Rocio University Hospitals, 41013 Seville, Spain; (L.L.-C.); (A.G.)
| | - Jesús Santos
- IBIMA Plataforma BIONAND, Unit of Infectious Diseases, Virgen de la Victoria University Hospital, 29010 Málaga, Spain;
| | - Francisco Téllez
- Unit of Infectious Diseases, Puerto Real Universitary Hospital, 11510 Cádiz, Spain;
| | - Mohamed Omar
- Unit of Infectious Diseases, Hospital Complex of Jaen, 23007 Jaén, Spain;
| | - Sergio Ferra-Murcia
- Unit of Infectious Diseases, Hospital Torrecárdenas Hospital, 04009 Almería, Spain;
| | - Elisa Fernández
- Internal medicine Service, Hospital Poniente, 04700 Almería, Spain;
| | - Rosario Javier
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Coral García-Vallecillos
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Juan Pasquau
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
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Arnés García D, Pitto-Robles I, Calderón Parra J, Calvo Salvador M, Herrero Rodríguez C, Gisbert L, Hidalgo-Tenorio C. Ceft-to-Ceft Study: Real-Life Experience with Ceftaroline and Ceftobiprole in Treatment of the Principal Infectious Syndromes in a Spanish Multicenter Hospital Cohort. Antibiotics (Basel) 2023; 12:1692. [PMID: 38136726 PMCID: PMC10740782 DOI: 10.3390/antibiotics12121692] [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: 10/19/2023] [Revised: 11/17/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND To compare the real-life effectiveness and safety of ceftaroline fosamil (ceftaroline-F) and ceftobiprole medocaril (ceftobiprole-M) for infections in hospitalized patients. METHODS This comparative, observational, retrospective, and multicenter Spanish study included patients receiving outpatient parenteral antimicrobial therapy (OPAT) and hospitalized patients treated for at least 48 h with ceftaroline-F or ceftobiprole-M between their first incorporation in the clinical protocol of each hospital and 31 July 2022. RESULTS Ceftaroline-F was administered to 227 patients and ceftobiprole-M to 212. In comparison to the latter, ceftaroline-F-treated participants were younger (63.02 vs. 66.40 years, OR 1.1; 95%CI: 1.001-1.05) and had higher rates of septic shock (OR 0.27; 95%CI: 0.09-0.81) and higher frequencies of targeted (57.7 vs. 29.7%; OR: 0.35; 95%CI: 0.18-0.69) and combined (89.0 vs. 45.8%, OR: 0.13; 95%CI: 0.06-0.28) therapies that were second line or more (82.4% vs. 64.6%%; OR 0.35; 95%CI: 0.18-0.69), and higher rates of infections due to Gram-positive cocci (92.7 vs. 64.7%, p = 0.001), bacteremia (51.9 vs. 21.7%, p = 0.001), infective endocarditis (24.2 vs. 2.4%, p = 0.0001), and mechanical ventilation-associated pneumonia (8.8 vs. 2.4%, p = 0.0001). Ceftobiprole-M was more frequently administered against polymicrobial infections (38.1 vs. 14.0%, p = 0.001), those produced by Gram-negative bacilli (19.7 vs. 6.0%, p = 0.0001), nosocomial pneumonia (33 vs. 10.6%, p = 0.0001), and skin and soft-tissue infections (25.4 vs. 10.1%, p = 0.0001). Patients treated with ceftaroline-F had a longer hospital stay (36 (IQR: 19-60) vs. 19.50 (IQR: 12-30.75, p = 0.0001) days), with no difference in infection-related mortality at 14 (13.2 vs. 8.0%, p = 0.078) or 28 (4.8 vs. 3.3%, p = 0.415) days or in dropout rate for adverse effects (2.2 vs. 0.9%; p = 1). CONCLUSIONS The fifth-generation cephalosporins, ceftaroline-F and ceftobiprole-M, are safe and effective in real life, with no difference between them in health outcomes.
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Affiliation(s)
- Daniel Arnés García
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain; (D.A.G.); (I.P.-R.)
| | - Inés Pitto-Robles
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain; (D.A.G.); (I.P.-R.)
| | - Jorge Calderón Parra
- Unidad Enfermedades Infecciosas, Hospital Puerta de Hierro de Majadahonda, 28222 Madrid, Spain;
| | - Marina Calvo Salvador
- Servicio de Farmacia, Hospital Puerta de Hierro de Majadahonda, 28222 Madrid, Spain;
| | - Carmen Herrero Rodríguez
- Unidad de Enfermedades Infecciosas y Microbiología, Complejo Hospitalario de Jaén, 23007 Jaén, Spain;
| | - Laura Gisbert
- Unidad de Enfermedades Infecciosas, Hospital Universitario Mútua de Terrassa, 08221 Barcelona, Spain;
| | - Carmen Hidalgo-Tenorio
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18014 Granada, Spain
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Podzamczer D, Imaz A, Lopez-Lirola A, Knobel H, Masiá M, Fanciulli C, Hernández C, Lagarde M, Gutierrez A, Curran A, Morano L, Montero-Alonso M, Troya J, Rigo R, Casadellà M, Navarro-Alcaraz A, Ardila F, Parera M, Bernal E, Echeverria P, Estrada V, Hidalgo-Tenorio C, Macias J, Prieto P, Portilla J, Valencia E, Vivancos MJ, Rivero A. Switching to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) plus darunavir/cobicistat in heavily antiretroviral-experienced, virologically suppressed HIV-infected adults receiving complex regimens. J Antimicrob Chemother 2023; 78:2696-2701. [PMID: 37725999 DOI: 10.1093/jac/dkad285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/25/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVES To evaluate the efficacy and safety of the two-pill regimen bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) plus darunavir/cobicistat as a switching strategy in heavily treatment-experienced people living with HIV (PLWH). METHODS Multicentre, prospective, single-arm pilot clinical trial. Participants were virologically suppressed adults receiving a stable antiretroviral regimen of at least three pills from at least three drug families due to previous virological failures and/or toxicities with no documented resistance to integrase strand transfer inhibitors or darunavir (≥15 points, Stanford). Clinical and laboratory assessments were performed at 0, 4, 12, 24, 36 and 48 weeks. HIV-1 proviral DNA was amplified and sequenced by Illumina at baseline. Plasma bictegravir concentrations were determined in 22 patients using UHPLC-MS/MS. The primary study endpoint was viral load (VL)< 50 copies/mL at Week 48 (ITT). RESULTS We enrolled 63 participants (92% men) with median baseline CD4 count of 515 cells/mm3 (IQR: 334.5-734.5), 24 years on ART (IQR: 15.9-27.8). The median number of pills was 4 (range: 3-10). At baseline, proviral DNA was amplified in 39 participants: 33/39 had resistance mutations. Three participants discontinued owing to toxicity. At 48 weeks, 95% had VL < 50 copies/mL by ITT and 100% by PP analysis. A modest increase was observed in the bictegravir plasma concentration, and a significant decrease in estimated glomerular filtration rate was observed only at Week 4, probably related to interaction with renal transporters. CONCLUSIONS Our data suggest that BIC/FTC/TAF + darunavir/cobicistat is an effective, well-tolerated regimen that may improve convenience and, potentially, long-term success in stable heavily pre-treated PLWH.
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Affiliation(s)
| | - Arkaitz Imaz
- Infectious Diseases Department, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospitalet del Llobregat, Hospital Universitario de Bellvitge, Spain
| | - Ana Lopez-Lirola
- Infectious Diseases Department, Hospital universitario de Canarias, San Cristóbal de la Laguna, Spain
| | - Hernando Knobel
- Infectious Diseases Department, Hospital del Mar, Barcelona, Spain
| | - Mar Masiá
- Infectious Diseases Department, Hospital Universitario general de Elche, Elche, Spain
| | - Chiara Fanciulli
- Infectious Diseases Department, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Hernández
- Infectious Diseases Department, Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | - María Lagarde
- Infectious Diseases Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Angela Gutierrez
- Infectious Diseases Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Adrià Curran
- Infectious Diseases Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Luis Morano
- Infectious Diseases Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Marta Montero-Alonso
- Infectious Diseases Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Jesús Troya
- Infectious Diseases Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Raúl Rigo
- Infectious Diseases Department, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospitalet del Llobregat, Hospital Universitario de Bellvitge, Spain
| | - María Casadellà
- Microbial Genomics Group, IrsiCaixa-Institut de Recerca de la SIDA, Badalona, Spain
| | | | - Fernando Ardila
- Infectious Diseases Department, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospitalet del Llobregat, Hospital Universitario de Bellvitge, Spain
| | - Mariona Parera
- Microbial Genomics Group, IrsiCaixa-Institut de Recerca de la SIDA, Badalona, Spain
| | - Enrique Bernal
- Infectious Diseases Department, Hospital Universitario Reina Sofía, Murcia, Spain
| | - Patricia Echeverria
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Vicente Estrada
- Infectious Diseases Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Carmen Hidalgo-Tenorio
- Infectious Diseases Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Juan Macias
- Instituto de Biomedicina de Sevilla, Departamento de Medicina, CIBERINFEC, Unidad de Enfermedades Infecciosas y Microbiología, IBiS/Hospital Universitario Virgen de Valme/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Paula Prieto
- Infectious Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Joaquín Portilla
- Infectious Diseases Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Eulalia Valencia
- Infectious Diseases Department, Hospital Universitario La Paz, Madrid, Spain
| | - María Jesús Vivancos
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Antonio Rivero
- Department of Infectious Diseases, Hospital Universitario Reina Sofia, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas Instituto de Salud Carlos III, Madrid, Spain
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Senneville E, Cuervo G, Gregoire M, Hidalgo-Tenorio C, Jehl F, Miro JM, Seaton A, Söderquist B, Soriano A, Thalhammer F, Pea F. Expert Opinion on Dose Regimen and Therapeutic Drug Monitoring for Long-Term Use of Dalbavancin: Expert Review Panel. Int J Antimicrob Agents 2023; 62:106960. [PMID: 37633424 DOI: 10.1016/j.ijantimicag.2023.106960] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 05/23/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Dalbavancin is a lipoglycopeptide with a long elimination half-life and is currently licensed for the treatment of acute bacterial skin and skin structure infections in adults. Dalbavancin's potential in treating off-label complex Gram-positive infections is promising and real-world experience in treating such infections is growing. However, clear guidance on extended dosing regimens is lacking. OBJECTIVES This study aimed to provide clear expert opinion based on recent pharmacokinetic literature and expert and real-world experience in infection areas that require > 2 weeks of treatment. METHODS A single face-to-face meeting was held in September 2022 to collate expert opinion and present safety data of dalbavancin use in these clinical indications. A survey was completed by all authors on their individual experience with dalbavancin, which highlighted the heterogeneity in the regimens that were used. RESULTS After review of the survey data and recent literature, this study presents expert panel proposals that accommodate different healthcare settings and resource availability, and centre around the length of treatment duration including up to or exceeding 6 weeks. To achieve adequate dalbavancin concentrations for up to 6 weeks, 3000 mg of dalbavancin should be given over 4 weeks for the agreed complex infections requiring > 2 weeks of treatment. Therapeutic drug monitoring (TDM) is advised for longer treatment durations and in cases of renal failure. Specific dosing recommendations for other special populations require further investigation. CONCLUSIONS These proposals based on expert opinion have been defined to encourage best practice with dalbavancin, to optimise its administration beyond the current approved licenced dose across different healthcare settings.
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Affiliation(s)
- Eric Senneville
- Infectious Diseases department, Gustave Dron Hospital, University of Lille, Tourcoing, France.
| | - Guillermo Cuervo
- Department of Infectious Diseases, Hospital Clinic of Barcelona - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Matthieu Gregoire
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique, Nantes, France; Nantes Université, CHU Nantes, Cibles et médicaments des infections et de l'immunité, IICiMed, Nantes, France
| | - Carmen Hidalgo-Tenorio
- Infectious Diseases Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitario de Granada (IBS-Granada), Granada, Spain
| | - François Jehl
- Laboratory of Clinical Microbiology, University Hospital of Strasbourg, Strasbourg, France
| | - Jose M Miro
- Department of Infectious Diseases, Hospital Clinic of Barcelona - IDIBAPS, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Andrew Seaton
- Infectious Diseases, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Bo Söderquist
- School of Medical Sciences, Faculty of Medicine, and Health, Örebro University, Örebro, Sweden; Department of Infectious Diseases and Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Alex Soriano
- Department of Infectious Diseases, Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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9
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Ruiz Del Pino M, Rosales-Castillo A, Hidalgo-Tenorio C, Expósito-Ruiz M, Navarro-Marí JM, Gutiérrez-Fernández J. [Isolation of Haemophilus no ducreyi in samples from the genital tract of men: Its clinical relationship]. Rev Int Androl 2023; 21:100374. [PMID: 37413940 DOI: 10.1016/j.androl.2023.100374] [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: 10/25/2022] [Revised: 03/01/2023] [Accepted: 03/27/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION With the advancement of microbiological methods, the isolation of less typical pathogens in cases of urethral and rectal infection is more frequent, apart from the classic etiological agents. One of them is formed by species of Haemophilus no ducreyi (HND). The objective of this work is to describe frequency, susceptibility to antibiotics, and clinical features of HDN urethritis and proctitis in adult males. PATIENTS AND METHODS This is an observational retrospective descriptive study of the results obtained by the Microbiology laboratory of the Virgen de las Nieves University Hospital on the isolates of HND in genital and rectal samples from males between 2016 and 2019. RESULTS HND was isolated in 135 (7%) of the genital infection episodes diagnosed in men. H. parainfluenzae was the most commonly isolated (34/45; 75.6%). The most frequent symptoms in men with proctitis were rectal tenesmus (31.6%) and lymphadenopathy (10.5%); in those with urethritis, dysuria (71.6%), urethral suppuration (46.7%) and gland lesions (27%), so differentiating it from infections caused by other genitopathogens is difficult. 43% of patients were HIV positive. Antibiotic resistance rates for H. parainfluenzae were high to quinolons, ampicillin, tetracycline and macrolides. CONCLUSION HND species should be considered as possible etiologic agents in episodes of urethral and rectal infection in men, especially in cases with negative screening tests for agents that cause sexually transmitted infections (STIs). Its microbiological identification is essential for the establishment of an effective targeted treatment.
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Affiliation(s)
- Marta Ruiz Del Pino
- Departamento de Microbiología, Hospital Universitario Virgen de las Nieves-IBS, Granada, España
| | - Antonio Rosales-Castillo
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves-IBS, Granada, España; Departamento de Microbiología, Facultad de Medicina, Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada-IBS, Granada, España.
| | - Carmen Hidalgo-Tenorio
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves-IBS, Granada, España
| | - Manuela Expósito-Ruiz
- Departamento de Bioestadística de FIBAO, Hospital Universitario Virgen de las Nieves-IBS, Granada, España
| | - José María Navarro-Marí
- Departamento de Microbiología, Facultad de Medicina, Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada-IBS, Granada, España
| | - José Gutiérrez-Fernández
- Departamento de Microbiología, Hospital Universitario Virgen de las Nieves-IBS, Granada, España; Departamento de Microbiología, Facultad de Medicina, Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada-IBS, Granada, España
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10
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Hidalgo-Tenorio C, Sadyrbaeva-Dolgova S, Enríquez-Gómez A, Muñoz P, Plata-Ciezar A, Miró JM, Alarcón A, Martínez-Marcos FJ, Loeches B, Escrihuela-Vidal F, Vinuesa D, Herrero C, Boix-Palop L, Del Mar Arenas M, Vázquez EG, de Las Revillas FA, Pasquau J. EN-DALBACEN 2.0 Cohort: real-life study of dalbavancin as sequential/consolidation therapy in patients with infective endocarditis due to Gram-positive cocci. Int J Antimicrob Agents 2023; 62:106918. [PMID: 37442488 DOI: 10.1016/j.ijantimicag.2023.106918] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 11/13/2022] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES Infective endocarditis (IE) has high mortality and morbidity and requires long hospital stays to deliver the antibiotic treatment recommended in clinical practice guidelines. We aimed to analyse the health outcomes of the use of dalbavancin (DBV) in the consolidation treatment of IEs caused by Gram-positive cocci and to perform a pharmacoeconomic study. MATERIALS AND METHODS This observational, retrospective, Spanish multicentre study in patients with IE who received DBV as part of antibiotic treatment in consolidation phase were followed for at least 12 months. The study was approved by the Provincial Committee of the coordinating centre. RESULTS The study included 124 subjects, 70.2% male, with a mean age of 67.4 years and median Charlson index of 4 (interquartile range: 2.5-6). Criteria for definite IE were met by 91.1%. Coagulase-negative staphylococci (38.8%), Staphylococcus aureus (22.6%), Enterococcus faecalis (19.4%), and Streptococcus Spp. (9.7%) were isolated more frequently, all susceptible to vancomycin. Before DVB administration, 91.2% had undergone surgery; 60.5% had received a second regimen for 24.5 d (16.6-56); and 20.2% had received a third regimen for 14.5 d (12-19.5). DBV was administered to facilitate discharge in 95.2% of cases. At 12 months, the effectiveness was of 95.9%, and there was 0.8% loss to follow-up, 0.8% IE-related death, and 3.2% relapse. Adverse events were recorded in 3.2%. The hospital stay was reduced by 14 d, and there was a mean savings of 5548.57 €/patient vs. conventional treatments. CONCLUSION DBV is highly effective, safe, and cost-effective as consolidation therapy in patients with IE by Gram-positive cocci, with few adverse events.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada, Granada, Spain.
| | - Svetlana Sadyrbaeva-Dolgova
- Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada, Granada, Spain
| | - Andrés Enríquez-Gómez
- Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla / Departamento de Medicina, Universidad de Sevilla / CSIC, Centro de Investigación Biomédica en Red en Enfermedades Infecciosas, Sevilla, Spain
| | - Patricia Muñoz
- Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Jose Maria Miró
- Hospital Universitario Clinic-IDIBAPS, Departamento de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Arístides Alarcón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla / Departamento de Medicina, Universidad de Sevilla / CSIC, Sevilla Investigación Biomédica en Red en Enfermedades Infecciosas, Sevilla, Spain
| | | | | | | | - David Vinuesa
- Hospital Universitario San Cecilio, Instituto de Investigación Biosanitario de Granada, Granada, Spain
| | | | | | | | | | | | - J Pasquau
- Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada, Granada, Spain
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Hidalgo-Tenorio C, Pitto-Robles I, Arnés García D, de Novales FJM, Morata L, Mendez R, de Pablo OB, López de Medrano VA, Lleti MS, Vizcarra P, Lora-Tamayo J, Arnáiz García A, Núñez LM, Masiá M, Seco MPR, Sadyrbaeva-Dolgova S. Cefto Real-Life Study: Real-World Data on the Use of Ceftobiprole in a Multicenter Spanish Cohort. Antibiotics (Basel) 2023; 12:1218. [PMID: 37508314 PMCID: PMC10376387 DOI: 10.3390/antibiotics12071218] [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: 06/19/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Ceftobiprole is a fifth-generation cephalosporin that has been approved in Europe solely for the treatment of community-acquired and nosocomial pneumonia. The objective was to analyze the use of ceftobiprole medocaril (Cefto-M) in Spanish clinical practice in patients with infections in hospital or outpatient parenteral antimicrobial therapy (OPAT). METHODS This retrospective, observational, multicenter study included patients treated from 1 September 2021 to 31 December 2022. RESULTS A total of 249 individuals were enrolled, aged 66.6 ± 15.4 years, of whom 59.4% were male with a Charlson index of four (IQR 2-6), 13.7% had COVID-19, and 4.8% were in an intensive care unit (ICU). The most frequent type of infection was respiratory (55.8%), followed by skin and soft tissue infection (21.7%). Cefto-M was administered to 67.9% of the patients as an empirical treatment, in which was administered as monotherapy for 7 days (5-10) in 53.8% of cases. The infection-related mortality was 11.2%. The highest mortality rates were identified for ventilator-associated pneumonia (40%) and infections due to methicillin-resistant Staphylococus aureus (20.8%) and Pseudomonas aeruginosa (16.1%). The mortality-related factors were age (OR: 1.1, 95%CI (1.04-1.16)), ICU admission (OR: 42.02, 95%CI (4.49-393.4)), and sepsis/septic shock (OR: 2.94, 95%CI (1.01-8.54)). CONCLUSIONS In real life, Cefto-M is a safe antibiotic, comprising only half of prescriptions for respiratory infections, that is mainly administered as rescue therapy in pluripathological patients with severe infectious diseases.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18012 Granada, Spain
| | - Inés Pitto-Robles
- Unit of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18012 Granada, Spain
| | - Daniel Arnés García
- Unit of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18012 Granada, Spain
| | | | - Laura Morata
- Infectious Diseases Service, Hospital Clinic, 08036 Barcelona, Spain
| | - Raul Mendez
- Pneumology Deparment, Hospital Universitario La Fe, Valencia (CIBERES), 46026 Valencia, Spain
| | | | | | - Miguel Salavert Lleti
- Infectious Diseases Service, Hospital Universitario La Fe, Valencia (CIBERES), 46026 Valencia, Spain
| | - Pilar Vizcarra
- Infectious Diseases Service, Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Jaime Lora-Tamayo
- Internal Medicine Service, Hospital Universitario 12 Octubre (CIBERINFEC), 28041 Madrid, Spain
| | - Ana Arnáiz García
- Department of Infectious Diseases, Hospital Sierrallana, 39300 Torrelavega, Spain
| | - Leonor Moreno Núñez
- Internal Medicine Service, Hospital Fundación de Alcorcón, 28922 Alcorcón, Spain
| | - Mar Masiá
- Infectious Diseases Service, Hospital Universitario General of Elche, 03203 Elche, Spain
| | | | - Svetlana Sadyrbaeva-Dolgova
- Pharmacy Service, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18012 Granada, Spain
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12
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Hidalgo-Tenorio C, Calle-Gómez I, Moya-Megías R, Rodríguez-Granges J, Omar M, López Hidalgo J, García-Martínez C. HPV Infection of the Oropharyngeal, Genital and Anal Mucosa and Associated Dysplasia in People Living with HIV. Viruses 2023; 15:v15051170. [PMID: 37243256 DOI: 10.3390/v15051170] [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: 03/30/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The main objectives were to describe the prevalence of HPV, its genotypes and HPV-associated dysplastic lesions in the oropharyngeal mucosa of PLHIV and related factors. MATERIAL AND METHODS This cross-sectional prospective study consecutively enrolled PLHIV attending our specialist outpatient units. At visit, HIV-related clinical and analytical variables were gathered, and oropharyngeal mucosa exudates were taken to detect HPV and other STIs by polymerase chain reaction. Samples were also taken from the anal canal of all participants and from the genital mucosa of the women for HPV detection/genotyping and cytological study. RESULTS The 300 participants had a mean age of 45.1 years; 78.7% were MSM and 21.3% women; 25.3% had a history of AIDS; 99.7% were taking ART; and 27.3% had received an HPV vaccine. HPV infection prevalence in the oropharynx was 13%, with genotype 16 being the most frequent (2.3%), and none had dysplasia. Simultaneous infection with Treponema pallidum (HR: 4.02 (95% CI: 1.06-15.24)) and a history of anal HSIL or SCCA (HR: 21.52 (95% CI: 1.59-291.6)) were risk factors for oropharyngeal HPV infection, whereas ART duration (8.8 vs. 7.4 years) was a protective factor (HR: 0.989 (95% CI: 0.98-0.99)). CONCLUSIONS The prevalence of HPV infection and dysplasia was low in the oropharyngeal mucosae. A higher exposure to ART was protective against oral HPV infection.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18014 Granada, Spain
| | - Inmaculada Calle-Gómez
- Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18014 Granada, Spain
| | - Raquel Moya-Megías
- Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18014 Granada, Spain
| | - Javier Rodríguez-Granges
- Microbiology Service, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18014 Granada, Spain
| | - Mohamed Omar
- Unit of Infectious Diseases, Complejo Hospitalario de Jaen, 23007 Jaen, Spain
| | - Javier López Hidalgo
- Pathology Service, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18014 Granada, Spain
| | - Carmen García-Martínez
- Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18014 Granada, Spain
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13
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Sadyrbaeva-Dolgova S, Sánchez-Suárez MDM, Reguera Márquez JA, Hidalgo-Tenorio C. The Challenge of Bacteremia Treatment due to Non-Fermenting Gram-Negative Bacteria. Microorganisms 2023; 11:microorganisms11040899. [PMID: 37110322 PMCID: PMC10146667 DOI: 10.3390/microorganisms11040899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Nosocomial infections caused by non-fermenting Gram-negative bacteria are a real challenge for clinicians, especially concerning the accuracy of empirical treatment. This study aimed to describe the clinical characteristic, empirical antibiotic therapy, accuracy of these prescriptions for appropriate coverage and risk factor for clinical failure of bloodstream infections due to non-fermenting Gram-negative bacilli. This retrospective, observational cohort study was conducted between January 2016 and June 2022. Data were collected from the hospital’s electronic record. The statistic tests corresponding to each objective were applied. A multivariate logistic regression was performed. Among the total 120 patients included in the study, the median age was 63.7 years, and 79.2% were men. Considering the appropriate empirical treatment rate by species, inappropriate treatment for S. maltophilia was 72.4% (p = 0.088), for A. baumanii 67.6% and 45.6% for P. aeruginosa. Clinical success was achieved in 53.3%, and overall, 28-day mortality was 45.8%. ICU admission, sepsis or shock septic, age, previous antibiotic treatment and contact with healthcare facilities were independently associated with clinical failure. In conclusion, bloodstream infection produced by multidrug-resistant non-fermenting Gram-negative bacteria is a significant therapeutic management challenge for clinicians. The accuracy of empirical treatment is low due to the fact that it is not recommended to cover these microorganisms empirically, especially S. maltophilia and A. baumanii.
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Affiliation(s)
- Svetlana Sadyrbaeva-Dolgova
- Pharmacy Service, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18014 Granada, Spain
- Correspondence: (S.S.-D.); (C.H.-T.)
| | | | | | - Carmen Hidalgo-Tenorio
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18014 Granada, Spain
- Infectious Disease Service, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
- Correspondence: (S.S.-D.); (C.H.-T.)
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14
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Wei F, Goodman MT, Xia N, Zhang J, Giuliano AR, D’Souza G, Hessol NA, Schim van der Loeff MF, Dai J, Neukam K, de Pokomandy A, Poynten IM, Geskus RB, Burgos J, Etienney I, Moscicki AB, Donà MG, Gillison ML, Nyitray AG, Nowak RG, Yunihastuti E, Zou H, Hidalgo-Tenorio C, Phanuphak N, Molina JM, Schofield AM, Kerr S, Fan S, Lu Y, Ong JJ, Chikandiwa AT, Teeraananchai S, Squillace N, Wiley DJ, Palefsky JM, Georges D, Alberts CJ, Clifford GM. Incidence and Clearance of Anal Human Papillomavirus Infection in 16 164 Individuals, According to Human Immunodeficiency Virus Status, Sex, and Male Sexuality: An International Pooled Analysis of 34 Longitudinal Studies. Clin Infect Dis 2023; 76:e692-e701. [PMID: 35869839 PMCID: PMC10226739 DOI: 10.1093/cid/ciac581] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/24/2022] [Accepted: 07/13/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Understanding the natural history of anal high-risk human papillomavirus (hrHPV) infection is key for designing anal cancer prevention programs but has not been systematically characterized. METHODS We reanalyzed data from 34 studies including 16 164 individuals in 6 risk groups defined by human immunodeficiency virus (HIV) status, sex, and male sexuality: men who have sex with men (MSM) and people with HIV (MSMWH), HIV-negative MSM, women with HIV (WWH), HIV-negative women, men who have sex with women (MSW) with HIV (MSWWH), and HIV-negative MSW. We used Markov models to estimate incidence and clearance of 13 hrHPV types and their determinants. RESULTS Human papillomavirus (HPV) 16 had the highest incidence-clearance ratio of the hrHPV types. MSMWH had the highest hrHPV incidence (eg, 15.5% newly HPV-16 infected within 2 years), followed by HIV-negative MSM (7.5%), WWH (6.6%), HIV-negative women (2.9%), MSWWH (1.7%), and HIV-negative MSW (0.7%). Determinants of HPV-16 incidence included HIV status and number of sexual partners for MSM, women, and MSW, and anal sex behavior for MSM only. HPV-16 clearance was lower for people with HIV (PWH) and lower for prevalent than incident infection. Among MSM, increasing age was associated with lower clearance of prevalent, but not incident, HPV-16 infection. CONCLUSIONS This robust and unifying analysis of anal hrHPV natural history is essential to designing and predicting the impact of HPV vaccination and HPV-based screening programs on anal cancer prevention, particularly in MSM and PWH. Importantly, it demonstrates the higher carcinogenic potential of longstanding anal prevalent hrHPV infection than more recent incident infection.
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Affiliation(s)
- Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Marc T Goodman
- Cancer Prevention and Control Program, Cedars Cancer, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer (CIIRC), Moffitt Cancer Center, Tampa, Florida, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nancy A Hessol
- Department of Clinical Pharmacy, University of CaliforniaSan Francisco, California, USA
| | | | - Jianghong Dai
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Karin Neukam
- Unidad Clínica de Enfermedades Infecciosas y Medicina Preventiva, UCEIMP, Instituto de Biomedicina de Sevilla, CSIC, Universidad de Sevilla, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre and Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - I Mary Poynten
- The Kirby Institute, University of New South Wales, Kensington, Sydney, New South Wales, Australia
| | - Ronald B Geskus
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Joaquin Burgos
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Vall d’Hebron Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | | | - Maria Gabriella Donà
- Sexually Transmitted Infections (STI)/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Maura L Gillison
- Thoracic Head and Neck Medical Oncology Department, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alan G Nyitray
- Center for AIDS Intervention Research and Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Evy Yunihastuti
- Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Carmen Hidalgo-Tenorio
- Early Clinical Trial Unit. Biosanitary Institute (IBS.Granada). Infectious Diseases Unit. University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Jean-Michel Molina
- Department of Infectious diseases, University of Paris Cité, St-Louis Hospital, Paris, France
| | - Alice M Schofield
- Institute of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Stephen Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, and Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Song Fan
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Yong Lu
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia
| | - Admire T Chikandiwa
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sirinya Teeraananchai
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | - Nicola Squillace
- Infectious Diseases Unit ASST-Monza, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Dorothy J Wiley
- School of Nursing, University of California, Los Angeles, California, USA
| | - Joel M Palefsky
- Department of Medicine, University of California, San Francisco, California, USA
| | - Damien Georges
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Catharina J Alberts
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Gary M Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
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15
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Hidalgo-Tenorio C, Sadyrbaeva S, Enríquez-Gómez A, Muñoz P, Plata Ciezar A, Miró Meda J, Alarcón A, Martínez Marcos F, Loheches B, Eschiruela-Vidal F, Vinuesa D, Herrero C, Badia Martí C, Arenas M, García Vázquez E, Fariñas M, Pasquau J. COHORTE EN-DALBACEN 2.0: DALBAVANCINA COMO TRATAMIENTO ANTIBIÓTICO DE CONSOLIDACIÓN DE EI POR COCOS GRAM POSITIVOS. Cirugía Cardiovascular 2023. [DOI: 10.1016/j.circv.2022.12.020] [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: 02/15/2023] Open
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16
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Díaz-Alberola I, Gutiérrez-Bautista JF, Espuch-Oliver A, García-Aznar JM, Anderson P, Jiménez P, Hidalgo-Tenorio C, López-Nevot MÁ. Incidence, Management Experience and Characteristics of Patients with Giardiasis and Common Variable Immunodeficiency. J Clin Med 2022; 11:jcm11237007. [PMID: 36498582 PMCID: PMC9740678 DOI: 10.3390/jcm11237007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/18/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Common variable immunodeficiency (CVID) is an antibody immunodeficiency with a wide variety of clinical and immunological manifestations, and whose genetic cause is found in about 25% of diagnosed cases. Giardia lamblia is one of the main causes of gastrointestinal infections in CVID. 5-Nitroimidazoles are the most used first-line treatment, but nitroimidazole-refractory giardiasis is increasing. Nevertheless, only a few cases of refractory giardiasis in CVID have been reported. This study aimed to determine the incidence of Giardia infection in our CVID cohort, shows our management experience and describes patients' phenotypic features. Clinical data collection, immunological, immunogenetics and microbiology assays were performed, and previous cases of giardiasis in CVID were reviewed. The incidence of symptomatic giardiasis was 12.9%. The main immunological features were undetectable or decreased IgA levels and reduced switched memory B cells. A probable PTEN pathogenic variant was detected in one. Three patients responded to metronidazole but suffered reinfections, and one was a refractory giardiasis eradicated with innovative quinacrine plus paromomycin combination. This work could contribute to the decision-making and therapeutic management of future patients with CVID and giardiasis, highlighting the importance of the early detection and treatment of infections in patients with CVID to ensure a good quality of life.
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Affiliation(s)
- Irene Díaz-Alberola
- Servicio de Análisis Clínicos e Inmunología, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
- Programa de Doctorado en Biomedicina, University of Granada, 10816 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Correspondence:
| | | | - Andrea Espuch-Oliver
- Servicio de Reproducción Asistida, Hospital Universitario de Torrecárdenas, 04009 Almería, Spain
| | | | - Per Anderson
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Departamento Bioquímica, Biología Molecular e Inmunología III, University of Granada, 18071 Granada, Spain
| | - Pilar Jiménez
- Servicio de Análisis Clínicos e Inmunología, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
| | - Carmen Hidalgo-Tenorio
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | - Miguel Ángel López-Nevot
- Servicio de Análisis Clínicos e Inmunología, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Departamento Bioquímica, Biología Molecular e Inmunología III, University of Granada, 18071 Granada, Spain
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17
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Sadyrbaeva-Dolgova S, García-Fumero R, Exposito-Ruiz M, Pasquau-Liaño J, Jiménez-Morales A, Hidalgo-Tenorio C. Incidence of nephrotoxicity associated with intravenous colistimethate sodium administration for the treatment of multidrug-resistant gram-negative bacterial infections. Sci Rep 2022; 12:15261. [PMID: 36088407 PMCID: PMC9464192 DOI: 10.1038/s41598-022-19626-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 08/31/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractColistimethate sodium (CMS) is the inactive prodrug of colistin, CMS has a narrow antibacterial spectrum with concentration-dependent bactericidal activity against multidrug-resistant gram-negative bacteria, including Pseudomonas aeruginosa and Acinetobacter baumannii. This study aimed to analyze potential correlations between clinical features and the development of CMS-induced nephrotoxicity. This retrospective cohort study was conducted in a tertiary-care university hospital between 1 January 2015 and 31 December 2019. A total of 163 patients received CMS therapy. 75 patients (46%) developed nephrotoxicity attributable to colistin treatment, although only 14 patients (8.6%) discontinued treatment for this reason. 95.7% of CMS were prescribed as target therapy. Acinetobacter baumannii spp. was the most commonly identified pathogen (72.4%) followed by P. aeruginosa (19.6%). Several risk factors associated with nephrotoxicity were identified, among these were age (HR 1.033, 95%CI 1.016–1.052, p < 0.001), Charlson Index (HR 1.158, 95%CI 1.0462–1.283; p = 0.005) and baseline creatinine level (HR 1.273, 95%CI 1.071–1.514, p = 0.006). In terms of in-hospital mortality, risk factors were age (HR 2.43, 95%CI 1.021–1.065, p < 0.001); Charlson Index (HR 1.274, 95%CI 1.116–1.454, p = 0.043), higher baseline creatinine levels (HR 1.391, 95%CI 1.084–1.785, p = 0.010) and nephrotoxicity due to CMS treatment (HR 5.383, 95%CI 3.126–9.276, p < 0.001). In-hospital mortality rate were higher in patients with nephrotoxicity (log rank test p < 0.001). In conclusion, the nephrotoxicity was reported in almost half of the patients. Its complex management, continuous renal dose adjustment and monitoring creatinine levels at least every 48 h leads to a high percentage of inappropriate use and treatment failure.
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18
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Gómez-Ayerbe C, Palacios R, Mayorga M, Navarrete MN, Ferra S, Ruiz I, Garcia C, Castaño M, Merino D, Collado A, Hidalgo-Tenorio C, Delgado M, Rivero A, Santos J. Weight changes after first-line antiretroviral initiation in a cohort of HIV-positive patients in Southern Spain (CAPOTA study). Int J STD AIDS 2022; 33:1119-1123. [PMID: 36071543 DOI: 10.1177/09564624221125356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Obesity among persons living with HIV (PLWH) has increased and weight gain after antiretroviral therapy (ART) can lead to metabolic disorders and impact survival. Our objective was to analyze weight and metabolic changes in HIV näive patients after 48 weeks of ART. METHODS Observational, retrospective, multicentered cohort study comprising naïve-patients who started tenofovir alafenamide/emtricitabine/elvitegravir/cobicistat (TAF/FTC/EVG/c) or abacavir/lamivudine/dolutegravir (ABC/3TC/DTG), with no change in treatment for 48 weeks. Clinical and metabolic parameters were collected at baseline and week-48. Statistical program used was SPSS 21.0.0. RESULTS The study included 329 participants from 6 hospitals. Participants were 89% male and 10% had AIDS diagnosis. Median age was 35 (IQR 27-43) years. Median baseline CD4 count was 417 (IQR 250-569) cell/mm3 and HIV viral load 4.65 (IQR 4.21-5.18) log10 copies/ml. Baseline median weight was 70 (IQR 62-79) kg, body mass index 23.4 (IQR 21.2-26.0) kg/m2; 22.7% overweight and 6.4% obese. ART regimens: ABC/3TC/DTG (196), TAF/FTC/EVG/c (133). Baseline characteristics were similar in both ART groups. Average weight gain at week-48 was 2.9 (SD 5.5) kg (p < 0.0001) with no differences between both groups. There was an increase in obesity (6.4%-8%; p < 0.003) and overweight (22.7%-28.9%; p < 0.0001). Weight increase was associated with AIDS: OR 3.05 (95%; CI 1.009-9.22), p = 0.048; and lower baseline weight: OR 1.032 (95% CI 1.009-1.05), p = 0.006. CONCLUSIONS After ART initiation patients gain weight regardless of the regimen they take. Weight gain is associated with AIDS and the use of TAF/FTC/EVG/c.
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Affiliation(s)
| | | | | | | | | | | | - Coral Garcia
- 16504Hospital Virgen de Las Nieves, Granada, Spain
| | | | | | | | | | | | | | - Jesús Santos
- 16867Hospital Virgen de La Victoria e IBIMA, Málaga, Spain
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19
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Bustos-Merlo A, Rosales-Castillo A, Cobo F, Hidalgo-Tenorio C. Blood Culture-Negative Infective Endocarditis by Mycoplasma hominis: Case Report and Literature Review. J Clin Med 2022; 11:jcm11133841. [PMID: 35807126 PMCID: PMC9267468 DOI: 10.3390/jcm11133841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023] Open
Abstract
Mycoplasma hominis is a habitual colonizing microorganism of the lower genital tract but can exceptionally be the causal agent of blood culture-negative infective endocarditis (IE). Only 11 cases of this entity have been published to date. The study objectives were to describe the first case diagnosed in our center of IE by M. hominis on pacemaker lead and to carry out a narrative review. Among published cases of IE by this microorganism, 72.7% were male, with a mean age of 45 years and a history of valve surgery; the diagnosis was by culture (54.5%) or molecular technique (45.5%), and the prognosis was favorable in 72.7% of cases. The most frequently prescribed antibiotics were doxycycline, quinolones, and clindamycin.
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Affiliation(s)
- Antonio Bustos-Merlo
- Department of Internal Medicine, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (A.B.-M.); (A.R.-C.)
| | - Antonio Rosales-Castillo
- Department of Internal Medicine, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (A.B.-M.); (A.R.-C.)
| | - Fernando Cobo
- Department of Microbiology, Virgen de las Nieves University Hospital, 18012 Granada, Spain;
| | - Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, 18014 Granada, Spain
- Correspondence: ; Tel.: +34-627-010-441
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Hidalgo-Tenorio C, Pasquau J, Vinuesa D, Ferra S, Terrón A, SanJoaquín I, Payeras A, Martínez OJ, López-Ruz MÁ, Omar M, de la Torre-Lima J, López-Lirola A, Palomares J, Blanco JR, Montero M, García-Vallecillos C. DOLAVI Real-Life Study of Dolutegravir Plus Lamivudine in Naive HIV-1 Patients (48 Weeks). Viruses 2022; 14:v14030524. [PMID: 35336931 PMCID: PMC8951045 DOI: 10.3390/v14030524] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 12/28/2022] Open
Abstract
Brief: Real-world data in naïve HIV-1 patients demonstrate that dolutegravir plus lamivudine in a multiple tablet regimen is effective, safe, and satisfactory; it causes moderately increasing weight and abdominal circumference and is administrable on a test-and-treat strategy. Background: Our objectives were to determine the real-life effectiveness and safety of DT with dolutegravir (50 mg/QD) plus lamivudine (300 mg/QD) in a multiple-tablet regimen (MTR) in naïve PLHIV followed up for 48 weeks and to evaluate the compliance and satisfaction of patients. Material and methods: An open, single-arm, multicenter, non-randomized clinical trial from May 2019 through September 2020 with a 48-week follow-up. Results: The study included 88 PLHIV patients (87.5% male) with a mean age of 35.9 years; 76.1% were MSM patients. The mean baseline CD4 was 516.4 cells/uL, with a viral load (VL) of 4.49 log10, and 11.4% were in the AIDS stage. DT started within 7 days of first specialist consultation in all patients and the same day in 84.1%; 3.4% had baseline resistance mutations (K103N, V106I + E138A, and V108I); 12.5% were lost to follow-up. At week 48, 86.3% had VL < 50 cop/uL by intention-to-treat analysis and 98.7% by per-protocol (PP) analysis. Virological failure (VF) was recorded in 1.1%, with no resistance mutation. One blip was detected in 5.2% without VF. Three reported anxiety, dizziness, and cephalgia, respectively, at week 4 and one reported insomnia at week 24; none reported adverse events at week 48. The mean weight was 4 kg higher at 48 weeks (p = 0.0001) and abdominal circumference 3 cm larger at 24 weeks (p = 0.022). No forgetfulness occurred in 98.7% of patients. Patient satisfaction was 90/100 at 4, 24, and 48 weeks. Conclusion: Real-world data demonstrate that dolutegravir plus lamivudine in MTR is effective, safe, and satisfactory, moderately increasing weight and abdominal circumference and administrable on a test-and-treat strategy.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.P.); (M.Á.L.-R.); (C.G.-V.)
- Correspondence:
| | - Juan Pasquau
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.P.); (M.Á.L.-R.); (C.G.-V.)
| | - David Vinuesa
- Unit of Infectious Diseases, University Hospital San Cecilio, 18016 Granada, Spain;
| | - Sergio Ferra
- Unit of Infectious Diseases, Torrecárdenas University Hospital, 04009 Almería, Spain;
| | - Alberto Terrón
- Unit of Infectious Diseases, Hospital de Jerez, 11407 Jerez de la Frontera, Spain;
| | - Isabel SanJoaquín
- Unit of Infectious Diseases, Hospital Lozano Blesa, 50009 Zaragoza, Spain;
| | - Antoni Payeras
- Internal Medicine Service, Hospital Son Llatzer, 07198 Palma, Spain;
| | | | - Miguel Ángel López-Ruz
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.P.); (M.Á.L.-R.); (C.G.-V.)
| | - Mohamed Omar
- Unit of Infectious Diseases, Hospital Complex of Jaén, 23007 Jaén, Spain;
| | | | - Ana López-Lirola
- Unit of Infectious Diseases, University Hospital Canarias, 38320 San Cristóbal de La Laguna, Spain;
| | - Jesús Palomares
- Internal Medicine Service, Hospital Santa Ana, 18600 Motril, Spain;
| | - José Ramón Blanco
- Unit of Infectious Diseases, Hospital San Pedro, 26006 Logroño, Spain;
| | - Marta Montero
- Service of Infectious Diseases, Hospital de La Fe, 46026 València, Spain;
| | - Coral García-Vallecillos
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.P.); (M.Á.L.-R.); (C.G.-V.)
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21
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Pasquau-Liaño J, Sadyrbaeva-Dolgova S, Sequera-Arquellada S, García-Vallecillos C, Hidalgo-Tenorio C. Timing in antibiotic therapy: when and how to start, de-escalate and stop antibiotic therapy. Proposals from a stablished antimicrobial stewardship program. Rev Esp Quimioter 2022; 35 Suppl 3:102-107. [PMID: 36285869 PMCID: PMC9717451 DOI: 10.37201/req/s03.22.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The current morbimortality of serious infections is unacceptable and there is a need to promote the increase in the efficacy of empirical and targeted antibiotherapy. This could be achieved by initiatives coming from ASP teams aimed at promoting increased efficacy of antibiotic therapy .In the optimization of the antibiotic therapy there are several critical points in which an adequate timing could achieve benefits in the survival of patients with severe infections: prompt initiation of empirical treatment; de-escalation performance, appropriate targeted treatment; and finally, curtail antibiotic duration.
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Affiliation(s)
- Juan Pasquau-Liaño
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de la Nieves, Granada, Spain,Correspondence: Juan Pasquau Servicio de Enfermedades Infecciosas. Hospital Universitario Virgen de la Nieves, Granada, Spain E-mail:
| | | | | | | | - Carmen Hidalgo-Tenorio
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de la Nieves, Granada, Spain
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22
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Muñoz P, De la Villa S, Martínez-Sellés M, Goenaga MA, Reviejo-Jaka K, Revillas FADL, García-Cuello L, Hidalgo-Tenorio C, Rodríguez-Esteban MA, Antorrena I, Castelo-Corral L, García-Vázquez E, De la Torre J, Bouza E. Linezolid for infective endocarditis: A structured approach based on a national database experience. Medicine (Baltimore) 2021; 100:e27597. [PMID: 34941026 PMCID: PMC8701757 DOI: 10.1097/md.0000000000027597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 10/20/2020] [Accepted: 10/06/2021] [Indexed: 01/05/2023] Open
Abstract
Current data on the frequency and efficacy of linezolid (LNZ) in infective endocarditis (IE) are based on small retrospective series. We used a national database to evaluate the effectiveness of LNZ in IE.This is a retrospective study of IE patients in the Spanish GAMES database who received LNZ. We defined 3 levels of therapeutic impact: LNZ < 7 days, LNZ high-impact (≥ 7 days, > 50% of the total treatment, and > 50% of the LNZ doses prescribed in the first weeks of treatment), and LNZ ≥ 7 days not fulfilling the high-impact criteria (LNZ-NHI). Effectiveness of LNZ was assessed using propensity score matching and multivariate analysis of high-impact cases in comparison to patients not treated with LNZ from the GAMES database matched for age-adjusted comorbidity Charlson index, heart failure, renal failure, prosthetic and intracardiac IE device, left-sided IE, and Staphylococcus aureus. Primary outcomes were in-hospital mortality and one-year mortality. Secondary outcomes included IE complications and relapses.From 3467 patients included in the GAMES database, 295 (8.5%) received LNZ. After excluding 3 patients, 292 were grouped as follows for the analyses: 99 (33.9%) patients in LNZ < 7 days, 11 (3.7%) in LNZ high-impact, and 178 (61%) in LNZ-NHI. In-hospital mortality was 51.5%, 54.4%, and 19.1% respectively. In the propensity analysis, LNZ high-impact group presented with respect to matched controls not treated with LNZ higher in-hospital mortality (54.5% vs 18.2%, P = .04). The multivariate analysis showed an independent relationship of LNZ use with in-hospital mortality (odds ratio 9.06, 95% confidence interval 1.15--71.08, P = .03).Treatment with LNZ is relatively frequent, but most cases do not fulfill our high-impact criteria. Our data suggest that the use of LNZ as definitive treatment in IE may be associated with higher in-hospital mortality.
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Affiliation(s)
- P Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - S De la Villa
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - M A Goenaga
- Servicio de Enfermedades Infecciosas. Hospital Universitario Donosti, San Sebastián
| | - K Reviejo-Jaka
- Servicio de Medicina Intensiva. Policlínica-Grupo Quirón Gipuzkoa, San Sebastián, Spain
| | - F Arnáiz de Las Revillas
- Servicio de Enfermedades Infecciosas. Hospital Universitario Marqués de Valdecilla. Universidad de Cantabria, Santander, Spain
| | - L García-Cuello
- Servicio de Enfermedades Infecciosas. Hospital Universitario Marqués de Valdecilla. Universidad de Cantabria, Santander, Spain
| | - C Hidalgo-Tenorio
- Unidad de Gestión Clínica de Enfermedades Infecciosas. Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M A Rodríguez-Esteban
- Unidad de Cuidados Intensivos Cardiológicos. Hospital Universitario Central de Asturias, Oviedo, Spain
| | - I Antorrena
- Servicio de Cardiología. Hospital Universitario La Paz, Madrid, Spain
| | - L Castelo-Corral
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - E García-Vázquez
- Servicio de Medicina Interna-Infecciosas. IMIB. Hospital Clínico Universitario Virgen de la Arrixaca. Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - J De la Torre
- Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna. Hospital Costa del Sol, Málaga, Spain
| | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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23
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Herrera-Hidalgo L, Lomas-Cabezas JM, López-Cortés LE, Luque-Márquez R, López-Cortés LF, Martínez-Marcos FJ, de la Torre-Lima J, Plata-Ciézar A, Hidalgo-Tenorio C, García-López MV, Vinuesa D, Gutiérrez-Valencia A, Gil-Navarro MV, De Alarcón A. Ampicillin Plus Ceftriaxone Combined Therapy for Enterococcus faecalis Infective Endocarditis in OPAT. J Clin Med 2021; 11:7. [PMID: 35011748 PMCID: PMC8745305 DOI: 10.3390/jcm11010007] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 01/21/2023] Open
Abstract
Ampicillin plus ceftriaxone (AC) is a well-recognized inpatient regimen for Enterococcus faecalis infective endocarditis (IE). In this regimen, ceftriaxone is usually administered 2 g every 2 h (AC12). The administration of AC in outpatient parenteral antibiotic treatment (OPAT) programs is challenging because multiple daily doses are required. AC regimens useful for OPAT programs include once-daily high-dose administration of ceftriaxone (AC24) or AC co-diluted and jointly administered in bolus every 4 h (ACjoined). In this retrospective analysis of prospectively collected cases, we aimed to assess the clinical effectivity and safety of three AC regimens for the treatment of E. faecalis IE. Fifty-nine patients were treated with AC combinations (AC12 n = 32, AC24 n = 17, and ACjoined n = 10). Six relapses occurred in the whole cohort: five (29.4%) treated with AC24 regimen and one (10.0%) with ACjoined. Patients were cured in 30 (93.3%), 16 (94.1%), and eight (80.0%) cases in the AC12, AC24 and ACjoined groups, respectively. Unplanned readmission occurred in eight (25.0%), six (35.3%), and two (20.0%) patients in the AC12, AC24 and ACjoined groups, respectively. The outcome of patients with E. faecalis IE treated with AC in OPAT programs relies on an optimization of the delivery of the combination. AC24 exhibit an unexpected rate of failures, however, ACjoined might be an effective alternative which clinical results should corroborate in further studies.
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Affiliation(s)
- Laura Herrera-Hidalgo
- Unidad de Farmacia, Hospital Universitario Virgen del Rocío/CSIC/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain;
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío/CSIC/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain; (J.M.L.-C.); (R.L.-M.); (L.F.L.-C.); (A.G.-V.); (A.D.A.)
| | - Jose Manuel Lomas-Cabezas
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío/CSIC/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain; (J.M.L.-C.); (R.L.-M.); (L.F.L.-C.); (A.G.-V.); (A.D.A.)
| | - Luis Eduardo López-Cortés
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/CSIC/Instituto de Biomedicina de Sevilla (IBiS), 41009 Seville, Spain;
| | - Rafael Luque-Márquez
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío/CSIC/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain; (J.M.L.-C.); (R.L.-M.); (L.F.L.-C.); (A.G.-V.); (A.D.A.)
| | - Luis Fernando López-Cortés
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío/CSIC/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain; (J.M.L.-C.); (R.L.-M.); (L.F.L.-C.); (A.G.-V.); (A.D.A.)
| | | | - Javier de la Torre-Lima
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Costa del Sol, 29603 Marbella, Spain;
| | - Antonio Plata-Ciézar
- Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Malaga, 29010 Málaga, Spain;
| | - Carmen Hidalgo-Tenorio
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
| | | | - David Vinuesa
- Servicio de Enfermedades Infecciosas, Hospital Universitario San Cecilio, 18016 Granada, Spain;
| | - Alicia Gutiérrez-Valencia
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío/CSIC/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain; (J.M.L.-C.); (R.L.-M.); (L.F.L.-C.); (A.G.-V.); (A.D.A.)
| | - Maria Victoria Gil-Navarro
- Unidad de Farmacia, Hospital Universitario Virgen del Rocío/CSIC/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain;
| | - Arístides De Alarcón
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío/CSIC/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain; (J.M.L.-C.); (R.L.-M.); (L.F.L.-C.); (A.G.-V.); (A.D.A.)
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24
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Valerio M, Camici M, Machado M, Galar A, Olmedo M, Sousa D, Antorrena I, Fariñas Alvarez MC, Hidalgo-Tenorio C, Montejo M, Vena A, Guinea J, Bouza E, Muñoz P. Aspergillus Endocarditis in the recent years, report of cases of a multicentric national cohort and literature review. Mycoses 2021; 65:362-373. [PMID: 34931375 DOI: 10.1111/myc.13415] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES 1) To describe the incidence, clinical characteristics, treatment and outcome of Aspergillus Endocarditis (AE) in a nationwide multicentric cohort (GAMES). 2) To compare the AE cases of the GAMES cohort, with the AE cases reported in the literature since 2010. 3) To identify variables related to mortality. METHODS We recruited 10 AE cases included in the GAMES cohort (January 2008-December 2018) and 51 cases from the literature published from January 2010-July 2019. RESULTS 4.528 patients with Infectious Endocarditis (IE) were included in the GAMES cohort, of them 10 (0.2%) were AE. After comparing our 10 cases with the 51 of the literature, no differences were found. Analyzing the 61 AE cases together, 55.7% were male, median age 45 years. Their main underlying conditions were: prosthetic valve surgery (34.4%) and solid organ transplant (SOT) (19.7%). Mainly affecting mitral (36.1%) and aortic valve (29.5%). Main isolated species were: A.fumigatus (47.5%) and A.flavus (24.6%). Embolisms occurred in 54%. Patients were treated with antifungals (90.2%), heart surgery (85.2%) or both (78.7%). Overall, 52.5% died. A greater mortality was observed in immunosuppressed patients (59.4% vs 24.1%, OR=4.09, 95%CI=1.26-13.19, p=0.02) and lower mortality was associated with undergoing cardiac surgery plus azole therapy (28.1% vs 65.5%, OR=0.22, 95%CI=0.07-0.72, p=0.01). CONCLUSIONS AE accounts for 0.2% of all IE episodes of a national multicentric cohort, mainly affecting patients with previous valvular surgery or SOT recipients. Mortality remains high especially in immunosuppressed hosts and azole-based treatment combined with surgical resection are related to a better outcome.
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Affiliation(s)
- Maricela Valerio
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain
| | - Marta Camici
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Alicia Galar
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Maria Olmedo
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Dolores Sousa
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario La Coruña, La Coruña
| | | | | | - Carmen Hidalgo-Tenorio
- Servicio de Enfermedades Infecciosas. Hospital Universitario Virgen de las Nieves. Complejo Hospitalario de Granada, Granada
| | - Miguel Montejo
- Servicio de Enfermedades Infecciosas. Hospital de Cruces, Bilbao
| | - Antonio Vena
- Infectious Diseases Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, 16132, Genoa, Italy
| | - Jesús Guinea
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain.,CIBERES (CB06/06/0058), Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain.,CIBERES (CB06/06/0058), Madrid, Spain
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25
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Bukkems VE, Hidalgo-Tenorio C, Garcia C, van Hulzen AGW, Richel O, Burger DM, Colbers AP. First pharmacokinetic data of bictegravir in pregnant women living with HIV. AIDS 2021; 35:2405-2406. [PMID: 34723856 DOI: 10.1097/qad.0000000000003032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Vera E Bukkems
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Coral Garcia
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Olivier Richel
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Angela P Colbers
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, the Netherlands
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26
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Hidalgo-Tenorio C, García-Vallecillos C, Sequera-Arquelladas S. Real-world outcomes of COVID-19 treatment with remdesivir in a Spanish hospital. Medicine (Baltimore) 2021; 100:e27228. [PMID: 34664862 PMCID: PMC8448042 DOI: 10.1097/md.0000000000027228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/23/2021] [Indexed: 12/25/2022] Open
Abstract
Remdesivir is the only antiviral approved for lower respiratory tract infection produced by SARS-CoV-2. The main objective of this study was to determine the mortality rate, readmissions, mean hospital stay, need for higher levels of oxygen support, and adverse effect-induced abandonment rate in hospitalized patients diagnosed with COVID-19 and treated with remdesivir (RDSV). The secondary objective was to determine mortality-related risk factors in these patients.The study included a prospective cohort of patients admitted to a third level Spanish hospital between July 5, 2020 and February 3, 2021 for COVID-19 diagnosed by SARS-CoV-2 polymerase chain reaction and/or antigen test and treated with RDSV.Remdesivir was received by 185 patients (69.7% males) with a mean age of 62.5 years, median Charlson index of 3 (interquartile range [IQR]: 1-4), and median ambient air oxygen saturation of 91% (IQR: 90-93); 61.6% of patients had hyper-inflammatory syndrome at admission. Median time with symptoms before RDSV treatment was 5 days (IQR: 3-6) and the median hospital stay was 10 days (IQR: 7-15); 19 patients (10.3%) died after a median stay of 13.5 days (IQR: 9.7-24 days), 58 patients (12.9%) were admitted to ICU, 58 (31.4%) needed higher levels of oxygen support, 0.5% abandoned the treatment due to adverse effects, and there were no readmissions. The only mortality-related factor was the need for higher levels of oxygen support (odds ratio 12.02; 95% confidence interval 2.25-64.2).All studied patients were admitted to hospital with a diagnosis of COVID-19 and in respiratory failure, needing initial low-flow oxygen support, and all received RDSV within 1 week of symptom onset. The percent mortality was lower in these patients than was observed in all patients with severe COVID-19 admitted to our center (10.3% vs 20.3%, respectively). Despite receiving RDSV, 1 in 3 patients needed higher levels of oxygen support, the sole mortality-related factor.
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27
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Wei F, Gaisa MM, D'Souza G, Xia N, Giuliano AR, Hawes SE, Gao L, Cheng SH, Donà MG, Goldstone SE, Schim van der Loeff MF, Neukam K, Meites E, Poynten IM, Dai J, Combes JD, Wieland U, Burgos J, Wilkin TJ, Hernandez AL, Iribarren Díaz M, Hidalgo-Tenorio C, Valencia Arredondo M, Nyitray AG, Wentzensen N, Chow EP, Smelov V, Nowak RG, Phanuphak N, Woo YL, Choi Y, Hu Y, Schofield AM, Woestenberg PJ, Chikandiwa AT, Hickey AC, de Pokomandy A, Murenzi G, Péré H, Del Pino M, Ortiz AP, Charnot-Katsikas A, Liu X, Chariyalertsak S, Strong C, Ong JJ, Yunihastuti E, Etienney I, Ferré VM, Zou H, Segondy M, Chinyowa S, Alberts CJ, Clifford GM. Epidemiology of anal human papillomavirus infection and high-grade squamous intraepithelial lesions in 29 900 men according to HIV status, sexuality, and age: a collaborative pooled analysis of 64 studies. Lancet HIV 2021; 8:e531-e543. [PMID: 34339628 PMCID: PMC8408042 DOI: 10.1016/s2352-3018(21)00108-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/29/2021] [Accepted: 05/18/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Robust age-specific estimates of anal human papillomavirus (HPV) and high-grade squamous intraepithelial lesions (HSIL) in men can inform anal cancer prevention efforts. We aimed to evaluate the age-specific prevalence of anal HPV, HSIL, and their combination, in men, stratified by HIV status and sexuality. METHODS We did a systematic review for studies on anal HPV infection in men and a pooled analysis of individual-level data from eligible studies across four groups: HIV-positive men who have sex with men (MSM), HIV-negative MSM, HIV-positive men who have sex with women (MSW), and HIV-negative MSW. Studies were required to inform on type-specific HPV infection (at least HPV16), detected by use of a PCR-based test from anal swabs, HIV status, sexuality (MSM, including those who have sex with men only or also with women, or MSW), and age. Authors of eligible studies with a sample size of 200 participants or more were invited to share deidentified individual-level data on the above four variables. Authors of studies including 40 or more HIV-positive MSW or 40 or more men from Africa (irrespective of HIV status and sexuality) were also invited to share these data. Pooled estimates of anal high-risk HPV (HR-HPV, including HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68), and HSIL or worse (HSIL+), were compared by use of adjusted prevalence ratios (aPRs) from generalised linear models. FINDINGS The systematic review identified 93 eligible studies, of which 64 contributed data on 29 900 men to the pooled analysis. Among HIV-negative MSW anal HPV16 prevalence was 1·8% (91 of 5190) and HR-HPV prevalence was 6·9% (345 of 5003); among HIV-positive MSW the prevalences were 8·7% (59 of 682) and 26·9% (179 of 666); among HIV-negative MSM they were 13·7% (1455 of 10 617) and 41·2% (3798 of 9215), and among HIV-positive MSM 28·5% (3819 of 13 411) and 74·3% (8765 of 11 803). In HIV-positive MSM, HPV16 prevalence was 5·6% (two of 36) among those age 15-18 years and 28·8% (141 of 490) among those age 23-24 years (ptrend=0·0091); prevalence was 31·7% (1057 of 3337) among those age 25-34 years and 22·8% (451 of 1979) among those age 55 and older (ptrend<0·0001). HPV16 prevalence in HIV-negative MSM was 6·7% (15 of 223) among those age 15-18 and 13·9% (166 of 1192) among those age 23-24 years (ptrend=0·0076); the prevalence plateaued thereafter (ptrend=0·72). Similar age-specific patterns were observed for HR-HPV. No significant differences for HPV16 or HR-HPV were found by age for either HIV-positive or HIV-negative MSW. HSIL+ detection ranged from 7·5% (12 of 160) to 54·5% (61 of 112) in HIV-positive MSM; after adjustment for heterogeneity, HIV was a significant predictor of HSIL+ (aPR 1·54, 95% CI 1·36-1·73), HPV16-positive HSIL+ (1·66, 1·36-2·03), and HSIL+ in HPV16-positive MSM (1·19, 1·04-1·37). Among HPV16-positive MSM, HSIL+ prevalence increased with age. INTERPRETATION High anal HPV prevalence among young HIV-positive and HIV-negative MSM highlights the benefits of gender-neutral HPV vaccination before sexual activity over catch-up vaccination. HIV-positive MSM are a priority for anal cancer screening research and initiatives targeting HPV16-positive HSIL+. FUNDING International Agency for Research on Cancer.
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Affiliation(s)
- Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Michael M Gaisa
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Stephen E Hawes
- Department of Epidemiology, Department of Health Services, and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Lei Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Maria Gabriella Donà
- Sexually Transmitted Infections/HIV Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Stephen E Goldstone
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands; Department of Internal Medicine, Amsterdam institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Karin Neukam
- Unidad Clínica de Enfermedades Infecciosas y Medicina Preventiva, UCEIMP, Instituto de Biomedicina de Sevilla, CSIC, Universidad de Sevilla, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Elissa Meites
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - I Mary Poynten
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jianghong Dai
- School of Public Health, Xinjiang Medical University, Xinjiang, Urumqi, China
| | - Jean-Damien Combes
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Ulrike Wieland
- Institute of Virology, University of Cologne, National Reference Center for Papilloma and Polyomaviruses, Cologne, Germany
| | - Joaquin Burgos
- Department of infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Timothy J Wilkin
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Alexandra L Hernandez
- Department of Medicine, University of California, San Francisco, CA, USA; Public Health Program, College of Education and Health Sciences, Touro University, Vallejo, CA, USA
| | - Mauricio Iribarren Díaz
- Department of Surgery, Complexo Hospitalario Universitario de Vigo-Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Carmen Hidalgo-Tenorio
- Infectious Disease Unit, Biosanitary Research Institute Granada, University Hospital Virgen de las Nieves, Granada, Spain
| | - Marleny Valencia Arredondo
- Universidad de Antioquia, Escuela de Microbiología, Grupo de investigación Salud Sexual y Cáncer, Medellín, Antioquia, Colombia
| | - Alan G Nyitray
- Clinical Cancer Center and Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Eric Pf Chow
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Vitaly Smelov
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France; Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand; Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
| | - Yin Ling Woo
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yoojin Choi
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Yifei Hu
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China
| | - Alice M Schofield
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - Petra J Woestenberg
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Admire T Chikandiwa
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew C Hickey
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre and Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Gad Murenzi
- Rwanda Military Hospital and Research for Development Rwanda, Kigali, Rwanda
| | - Hélène Péré
- Assistance Publique Hôpitaux de Paris-Centre, Service de Microbiologie (Unité de virologie), Hôpital Européen Georges Pompidou, Paris, France; Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, Functional Genomics of Solid Tumors Laboratory, Equipe Labellisée Ligue Nationale contre le Cancer, Labex OncoImmunology, Paris, France
| | - Marta Del Pino
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Gynecology Oncology Unit, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Medicine Faculty, Barcelona University, Barcelona, Spain
| | - Ana P Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA; Graduate School of Public Health, University of Puerto Rico, San Juan, PR, USA
| | - Angella Charnot-Katsikas
- Department of Pathology, The University of Chicago, Chicago, IL, USA; MolDx Program, Palmetto GBA, Columbia, SC, USA
| | - Xing Liu
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Suwat Chariyalertsak
- Faculty of Public Health, Chiang Mai University and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Carol Strong
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Evy Yunihastuti
- Department of Internal Medicine, University of Indonesia, Jakarta, Indonesia
| | | | - Valentine M Ferré
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Service de Virologie, Hôpital Bichat, Paris, France; Decision Science in Infectious Disease Prevention, Control and Care, INSERM, Université de Paris, Paris, France
| | - Huachun Zou
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia; School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China; School of Public Health, Shanghai Jiao Tong University, Shanghai, China; Melbourne Sexual Health Centre, Sydney, NSW, Australia
| | - Michel Segondy
- Pathogenesis and Control of Chronic Infections, INSERM, CHU, University of Montpellier, Montpellier, France
| | - Simbarashe Chinyowa
- Department of Surgery, College of Health Sciences University of Zimbabwe, Harare, Zimbabwe
| | - Catharina J Alberts
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Gary M Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
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Pericàs JM, Hernández-Meneses M, Muñoz P, Álvarez-Uría A, Pinilla-Llorente B, de Alarcón A, Reviejo K, Fariñas MC, Falces C, Goikoetxea-Agirre J, Gálvez-Acebal J, Hidalgo-Tenorio C, Gómez-Nebreda E, Miro JM. Outcomes and Risk Factors of Septic Shock in Patients With Infective Endocarditis: A Prospective Cohort Study. Open Forum Infect Dis 2021; 8:ofab119. [PMID: 34189153 PMCID: PMC8232381 DOI: 10.1093/ofid/ofab119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/23/2021] [Indexed: 12/29/2022] Open
Abstract
Background Little is known about the characteristics and impact of septic shock (SS) on the outcomes of infective endocarditis (IE). We aimed to investigate the characteristics and outcomes of patients with IE presenting with SS and to compare them to those of IE patients with sepsis (Se) and those with neither Se nor SS (no-Se-SS). Methods This is a prospective cohort study of 4864 IE patients from 35 Spanish centers (2008 to 2018). Logistic regression analyses were performed to identify risk factors for SS and mortality. Results Septic shock and Se presented in 597 (12.3%) and 559 (11.5%) patients, respectively. Patients with SS were younger and presented significantly higher rates of diabetes, chronic renal and liver disease, transplantation, nosocomial acquisition, Staphylococcus aureus, IE complications, and in-hospital mortality (62.5%, 37.7% for Se and 18.2% for no-Se-SS, P < .001). Staphylococcus aureus (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.34–2.81; P < .001), Gram negative (OR, 2.21; 95% CI, 1.25–3.91; P = .006), nosocomial acquisition (OR, 1.44; 95% CI, 1.07–1.94; P = .015), persistent bacteremia (OR, 1.82; 95% CI, 1.24–2.68; P = .002), acute renal failure (OR, 3.02; 95% CI, 2.28–4.01; P < .001), central nervous system emboli (OR, 1.48; 95% CI, 1.08–2.01; P = .013), and larger vegetation size (OR, 1.01; 95% CI, 1.00–1.02; P. = 020) were associated with a higher risk of developing SS. Charlson score, heart failure, persistent bacteremia, acute renal failure, mechanical ventilation, worsening of liver disease, S aureus, and receiving aminoglycosides within the first 24 hours were associated with higher in-hospital mortality, whereas male sex, native valve IE, and cardiac surgery were associated with lower mortality. Conclusions Septic shock is frequent and entails dismal prognosis. Early identification of patients at risk of developing SS and early assessment for cardiac surgery appear as key factors to improve outcomes.
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Affiliation(s)
- Juan M Pericàs
- Infectious Diseases Department, Hospital Clinic, Barcelona, Spain.,Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Marta Hernández-Meneses
- Infectious Diseases Department, Hospital Clinic, Barcelona, Spain.,Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Instituto de Salud Carlos III, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Álvarez-Uría
- Clinical Microbiology and Infectious Diseases Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Instituto de Salud Carlos III, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Blanca Pinilla-Llorente
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infectious Diseases Research Group, Virgen del Rocío and Virgen Macarena University Hospitals, Seville, Spain.,Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC, Seville, Spain
| | - Karlos Reviejo
- Policlínica Gipuzkoa, Grupo Quirón, San Sebastián, Spain
| | - M Carmen Fariñas
- Infectious Diseases Unit. Hospital Universitario Marqués de Valdecilla, Santander, Spain.,University of Cantabria, Santander, Spain
| | - Carlos Falces
- Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Cardiology Department, Hospital Clinic, Barcelona, Spain
| | | | - Juan Gálvez-Acebal
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infectious Diseases Research Group, Virgen del Rocío and Virgen Macarena University Hospitals, Seville, Spain.,Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC, Seville, Spain
| | - Carmen Hidalgo-Tenorio
- Infectious Diseases Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Eloy Gómez-Nebreda
- Infectious Diseases Unit, Internal Medicine Department, Hospital General de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - Jose M Miro
- Infectious Diseases Department, Hospital Clinic, Barcelona, Spain
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29
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Pericàs JM, Hernández-Meneses M, Muñoz P, Martínez-Sellés M, Lvarez-Uria AÁ, de Alarcón A, Gutiérrez-Carretero E, Goenaga MA, Zarauza MJ, Falces C, Rodríguez-Esteban MÁ, Hidalgo-Tenorio C, Hernández-Cabrera M, Miró JM. Characteristics and outcome of acute heart failure in infective endocarditis: focus on cardiogenic shock. Clin Infect Dis 2021; 73:765-774. [PMID: 33560404 DOI: 10.1093/cid/ciab098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies investigating the impact of cardiogenic shock (CS) on endocarditis are lacking. We aimed to investigate the characteristics and outcomes of endocarditis patients presenting with acute heart failure (AHF), particularly of those developing CS. METHODS Prospectively collected cohort from 35 Spanish centers (2008-2018). Logistic regression analyses were performed to identify risk factors for developing CS and predictors of mortality. RESULTS Amongst 4,856 endocarditis patients, 1,652 (34%) had AHF and 244 (5%) CS. Compared to patients without AHF and AHF but no CS, patients with CS presented higher rates of surgery (40.5%, 52.5% and 68%,p<.001) and in-hospital mortality (16.3%,39.1%, and 52.5%). Compared to patients with septic shock, CS patients presented higher rates of surgery (42.5% vs. 68%, p<.001), and lower rates of in-hospital and 1-year mortality (62.3% vs. 52.5%,p.008;and 65.3% vs. 57.4%,p.030). Severe aortic and mitral regurgitation (OR 2.47, 95%CI 1.82-3.35 and OR 3.03, 95%CI 2.26-4.07, both p<.001), left-ventricle ejection fraction<60% (OR 1.72, 95%CI 1.22-2.40, p.002), heart block (OR 2.22, 95%CI 1.41-3.47, p.001), tachyarrhythmias (OR 5.07,95%CI 3.13-8.19, p<.001) and acute kidney failure (OR 2.29, 95%CI 1.73-3.03,p<.001) were associated to a higher likelihood of developing CS. Prosthetic endocarditis (OR 2.03, 95%CI 1.06-3.88, p.032), S. aureus (OR 3.10, 95%CI 1.16-8.30, p.024), tachyarrhythmias (OR 3.09,95%CI 1.50-10.13, p.005), and not performing cardiac surgery (OR 11.40, 95%CI 4.83-26.90, p<.001) were associated to a higher risk of mortality. CONCLUSIONS Acute heart failure is common among patients with endocarditis. Cardiogenic shock is associated to very high mortality and should be promptly identified and assessed for cardiac surgery.
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Affiliation(s)
- Juan M Pericàs
- Infectious Diseases Service. Hospital Clinic-IDIBAPS. University of Barcelona, Barcelona, Spain
| | - Marta Hernández-Meneses
- Infectious Diseases Service. Hospital Clinic-IDIBAPS. University of Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid. Instituto de Investigación Sanitaria Gregorio Marañón. CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058). Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department. Hospital Universitario Gregorio Marañón. CIBERCV. Universidad Europea. Universidad Complutense. Madrid, Spain
| | - Ana Á Lvarez-Uria
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid. Instituto de Investigación Sanitaria Gregorio Marañón. CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058). Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine. Infectious Diseases Research Group.Institute of Biomedicine of Seville (IBiS). University Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - Encarnación Gutiérrez-Carretero
- Cardiac Surgery Service. CIBERCV. Institute of Biomedicine of Seville (IBiS). University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - Miguel A Goenaga
- Servicio de Enfermedades Infecciosas. Hospital Universitario Donosti. ISS Biodonostia, San Sebastián, Spain
| | - Manuel J Zarauza
- Servicio de Cardiología. Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Carlos Falces
- Cardiology Service. Hospital Clinic-IDIBAPS. University of Barcelona, Barcelona, Spain
| | | | - Carmen Hidalgo-Tenorio
- Unidad de Enfermedades Infecciosas. Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Michele Hernández-Cabrera
- Unidad de Enfermedades Infecciosas y Medicina Tropical Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Jose M Miró
- Infectious Diseases Service. Hospital Clinic-IDIBAPS. University of Barcelona, Barcelona, Spain
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Pericàs JM, Ambrosioni J, Muñoz P, de Alarcón A, Kestler M, Mari-Hualde A, Moreno A, Goenaga MÁ, Fariñas MC, Rodríguez-Álvarez R, Ojeda-Burgos G, Gálvez-Acebal J, Hidalgo-Tenorio C, Noureddine M, Miró JM. Prevalence of Colorectal Neoplasms Among Patients With Enterococcus faecalis Endocarditis in the GAMES Cohort (2008-2017). Mayo Clin Proc 2021; 96:132-146. [PMID: 33413809 DOI: 10.1016/j.mayocp.2020.06.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/08/2020] [Accepted: 06/01/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To investigate the rate of colorectal neoplasms (CRNs) in patients who have Enterococcus faecalis infective endocarditis (EFIE) with available colonoscopies and to assess whether this is associated with the identification of a focus the infection. PATIENTS AND METHODS Retrospective analysis of data from a prospective multicenter study involving 35 centers who are members of the Grupo de Apoyo para el Manejo de la Endocarditis en España [Support Group for the Management of Infective Endocarditis in Spain] cohort. A specific set of queries regarding information on colonoscopy and histopathology of colorectal diseases was sent to each participating center. Four-hundred sixty-seven patients with EFIE were included from January 1, 2008, to December 31, 2017, from whom data on colonoscopy performance and results were available in 411 patients. RESULTS One hundred forty-two (34.5%) patients had a colonoscopy close to the EFIE episode. The overall rate of colorectal diseases was 70.4% (100 of 142), whereas the prevalence of CRN (advanced adenomas and colorectal carcinoma) was 14.8% (21 of 142), with no significant differences between the group of EFIE of unknown focus and that with an identified focus. CONCLUSION Our study adds to prior evidence suggesting a much higher rate of CRN among patients with EFIE than in the general population of the same age and sex. In addition, our findings suggest that this phenomenon might take place both in EFIE with an unknown and an identified source of infection.
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Affiliation(s)
- Juan M Pericàs
- Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Vall d'Hebron Institute for Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Juan Ambrosioni
- Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Martha Kestler
- Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Amaia Mari-Hualde
- Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Asunción Moreno
- Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Miguel Á Goenaga
- Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital Universitario Donostia, Donostia, Spain
| | | | | | | | | | | | - Mariam Noureddine
- Hospital Universitario Virgen de la Macarena, Universidad de Sevilla, Seville, Spain
| | - José M Miró
- Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
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31
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Hidalgo-Tenorio C, Gálvez J, Martínez-Marcos FJ, Plata-Ciezar A, De La Torre-Lima J, López-Cortés LE, Noureddine M, Reguera JM, Vinuesa D, García MV, Ojeda G, Luque R, Lomas JM, Lepe JA, de Alarcón A. Clinical and prognostic differences between methicillin-resistant and methicillin-susceptible Staphylococcus aureus infective endocarditis. BMC Infect Dis 2020; 20:160. [PMID: 32085732 PMCID: PMC7035751 DOI: 10.1186/s12879-020-4895-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 09/12/2019] [Accepted: 02/17/2020] [Indexed: 12/14/2022] Open
Abstract
Background S. aureus (SA) infective endocarditis (IE) has a very high mortality, attributed to the age and comorbidities of patients, inadequate or delayed antibiotic treatment, and methicillin resistance, among other causes. The main study objective was to analyze epidemiological and clinical differences between IE by methicillin-resistant versus methicillin-susceptible SA (MRSA vs. MSSA) and to examine prognostic factors for SA endocarditis, including methicillin resistance and vancomycin minimum inhibitory concentration (MIC) values > 1 μg/mL to MRSA. Methods Patients with SA endocarditis were consecutively and prospectively recruited from the Andalusia endocarditis cohort between 1984 and January 2017. Results We studied 437 patients with SA endocarditis, which was MRSA in 13.5% of cases. A greater likelihood of history of COPD (OR 3.19; 95% CI 1.41–7.23), invasive procedures, or recognized infection focus in the 3 months before IE onset (OR 2.9; 95% CI 1.14–7.65) and of diagnostic delay (OR 3.94; 95% CI 1.64–9.5) was observed in patients with MRSA versus MSSA endocarditis. The one-year mortality rate due to SA endocarditis was 44.3% and associated with decade of endocarditis onset (1985–1999) (OR 8.391; 95% CI (2.82–24.9); 2000–2009 (OR 6.4; 95% CI 2.92–14.06); active neoplasm (OR 6.63; 95% CI 1.7–25.5) and sepsis (OR 2.28; 95% CI 1.053–4.9). Methicillin resistance was not associated with higher IE-related mortality (49.7 vs. 43.1%; p = 0.32). Conclusion MRSA IE is associated with COPD, previous invasive procedure or recognized infection focus, and nosocomial or healthcare-related origin. Methicillin resistance does not appear to be a decisive prognostic factor for SA IE.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas n° 2, 18014, Granada, Spain.
| | - Juan Gálvez
- Infectious Disease Service, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | | | - Antonio Plata-Ciezar
- Infectious Disease Service, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | | | | | | | - José M Reguera
- Infectious Disease Service, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - David Vinuesa
- Infectious Disease Unit, Hospital Universitario San Cecilio, Granada, Spain
| | - Maria Victoria García
- Infectious Disease Service, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Guillermo Ojeda
- Infectious Disease Service, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Rafael Luque
- Infectious Disease Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - José Manuel Lomas
- Infectious Disease Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jose Antonio Lepe
- Infectious Disease Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Arístides de Alarcón
- Infectious Disease Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Sadyrbaeva-Dolgova S, Aznarte-Padial P, Jimenez-Morales A, Expósito-Ruiz M, Calleja-Hernández MÁ, Hidalgo-Tenorio C. Pharmacist recommendations for carbapenem de-escalation in urinary tract infection within an antimicrobial stewardship program. J Infect Public Health 2019; 13:558-563. [PMID: 31685404 DOI: 10.1016/j.jiph.2019.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/31/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Carbapenem antibiotics are considered the treatment of choice for serious extended-spectrum beta-lactamase-producing Gram-negative bacteria infections. Our objectives were to analyze the results of carbapenem de-escalation therapy in complicated urinary tract infections (UTIs) attended in a third-level Spanish hospital and to evaluate the impact of pharmacist recommendation in this practice, the outcomes obtained, and associated factors. METHODS This prospective observational study of carbapenem prescriptions and de-escalation performance was conducted in a third-level hospital between August 1 2013 and July 31, 2014. Data were gathered on carbapenem treatment duration, de-escalation, length of hospital stay, mortality rate, and associated re-admissions. RESULTS De-escalation, which was only ordered for patients with positive cultures, was conducted in 49.7% of the 163 patients with complicated UTI. More than half (69.1%) of pharmacist interventions were accepted. De-escalation reduced the median hospital stay by five days (p=0.030). Crude hospital mortality was lower in the de-escalation group (7.4% vs. 29.3%, p<0.001), although their exposure to carbapenems was lower (4 vs 6 days, p<0.001). Factors associated with de-escalation were ICU stay for at least 48h, pharmacist recommendation and ESBL or AmpC producing Enterobacteriaceae. Factors associated with in-hospital mortality were age, previous admission and duration of hospital stay, but not pharmacist recommendation. Otherwise, carbapenem de-escalation was associated as a protective factor against in-hospital mortality. CONCLUSIONS Carbapenem de-escalation in accordance with pharmacist recommendation proved to be a safe approach in complicated UTI, reducing the hospital stay of patients without affecting the re-admission rate.
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Affiliation(s)
| | - Pilar Aznarte-Padial
- Department of Pharmacy, University Hospital Virgen de las Nieves, Granada, Spain
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Pericà S JM, Llopis J, González-Ramallo V, Goenaga MÁ, Muñoz P, García-Leoni ME, Fariñas MC, Pajarón M, Ambrosioni J, Luque R, Goikoetxea J, Oteo JA, Carrizo E, Bodro M, Reguera-Iglesias JM, Navas E, Hidalgo-Tenorio C, Miró JM. Outpatient Parenteral Antibiotic Treatment for Infective Endocarditis: A Prospective Cohort Study From the GAMES Cohort. Clin Infect Dis 2019; 69:1690-1700. [PMID: 30649282 DOI: 10.1093/cid/ciz030] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 07/05/2018] [Accepted: 01/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT). METHODS Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008-2012) was performed. RESULTS A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56-76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32-54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P < .001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04-1.42; P = .01) and cardiac surgery (OR, 0.24; 95% CI, .09-.63; P = .04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI, .22-.98; P = .007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission. CONCLUSIONS OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded.
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Affiliation(s)
- Juan M Pericà S
- Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander
| | - Jaume Llopis
- Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander
| | - Víctor González-Ramallo
- Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria, Gregorio Marañón. Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES, CB06/06/0058), Department of Medicine, Universidad Complutense de Madrid, Santander
| | | | - Patricia Muñoz
- Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria, Gregorio Marañón. Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES, CB06/06/0058), Department of Medicine, Universidad Complutense de Madrid, Santander
| | - M Eugenia García-Leoni
- Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria, Gregorio Marañón. Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES, CB06/06/0058), Department of Medicine, Universidad Complutense de Madrid, Santander
| | - M Carmen Fariñas
- Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander
| | - Marcos Pajarón
- Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander
| | - Juan Ambrosioni
- Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander
| | - Rafael Luque
- Hospital Universitario Virgen del Rocío, Sevilla
| | | | | | - Enara Carrizo
- Hospital Universitario de Araba-Txagorritxu, Gasteiz
| | - Marta Bodro
- Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander
| | | | | | | | - José M Miró
- Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander
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Hidalgo-Tenorio C, Gil-Anguita C, López Ruz MA, Omar M, López-Hidalgo J, Pasquau J. ART is key to clearing oncogenic HPV genotypes (HR-HPV) in anal mucosa of HIV-positive MSM. PLoS One 2019; 14:e0224183. [PMID: 31648254 PMCID: PMC6813028 DOI: 10.1371/journal.pone.0224183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/06/2019] [Indexed: 12/23/2022] Open
Abstract
Background Anal squamous cell carcinoma (ASCC) is one of the most frequent non-AIDS-defining neoplasias in HIV patients, mainly in MSM, and it has been associated with chronic infection with high-risk human papilloma virus (HR-HPV). Our main objective was to determine HR-HPV clearance and acquisition rates and related factors and their relationship with the incidence of HSILs and ASCC in anal mucosa of HIV+ MSM. Patients and methods The study included consecutive HIV-infected MSM between May 2010 and December 2018. Data were gathered at baseline and annually on their sexual behavior, CD4 and CD8 levels, plasma HIV viral load, and results of anal cytology, HPV PCR, and high-resolution anoscopy. Results Out of the 405 patients studied, 34.9% of patients cleared oncogenic genotypes (IQR: 37–69) within 49 months, and 42.9% acquired new genotypes within 36 months (IQR:12–60). In multivariate analysis, clearance was only significantly influenced by the duration of antiretroviral therapy (ART) (OR: 1.016, 95% CI 1.003–1.030). The incidence of HSILs was 30.86/1,000 patient-years and that of ASCC was 81.22/100,000 patient-years; these incidences were not influenced by the acquisition (acquired: 14.9% vs. non-acquired: 10.4%; p = 0.238) or clearance (cleared 11.4% vs. non-cleared: 13.2%; p = 0.662) rates of these viruses. Conclusions The duration of ART appears to positively affect oncogenic genotype clearance in the anal mucosa of HIV+ MSM, although this clearance does not affect the incidence of HSILs or ASCC. The reduction in HSIL+ rate observed in our patients may be attributable to the bundle of measures adopted at our center.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Department of Infectious Diseases; “Virgen de las Nieves” University Hospital, Granada, Spain
- * E-mail:
| | - Concepción Gil-Anguita
- Department of Infectious Diseases; “Virgen de las Nieves” University Hospital, Granada, Spain
| | - Miguel Angel López Ruz
- Department of Infectious Diseases; “Virgen de las Nieves” University Hospital, Granada, Spain
| | - Mohamed Omar
- Unit of Infectious Diseases, Jaen “Hospital Complex”, Spain
| | - Javier López-Hidalgo
- Pathology Department; “Virgen de las Nieves” University Hospital, Granada, Spain
| | - Juan Pasquau
- Department of Infectious Diseases; “Virgen de las Nieves” University Hospital, Granada, Spain
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Hidalgo-Tenorio C, Vinuesa D, Plata A, Martin Dávila P, Iftimie S, Sequera S, Loeches B, Lopez-Cortés LE, Fariñas MC, Fernández-Roldan C, Javier-Martinez R, Muñoz P, Arenas-Miras MDM, Martínez-Marcos FJ, Miró JM, Herrero C, Bereciartua E, De Jesus SE, Pasquau J. DALBACEN cohort: dalbavancin as consolidation therapy in patients with endocarditis and/or bloodstream infection produced by gram-positive cocci. Ann Clin Microbiol Antimicrob 2019; 18:30. [PMID: 31629409 PMCID: PMC6800500 DOI: 10.1186/s12941-019-0329-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [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: 02/15/2019] [Accepted: 10/09/2019] [Indexed: 12/27/2022] Open
Abstract
Objectives To analyse the effectiveness of dalbavancin (DBV) in clinical practice as consolidation therapy in patients with bloodstream infection (BSI) and/or infective endocarditis (IE) produced by gram-positive cocci (GPC), as well as its safety and pharmacoeconomic impact. Methods A multicentre, observational and retrospective study was conducted of hospitalised patients with IE and/or BSI produced by GPC who received at least one dose of DBV. Clinical response was assessed during hospitalization, at 3 months and at 1 year. Results Eighty-three patients with median age of 73 years were enrolled; 73.5% were male; 59.04% had BSI and 49.04% IE (44.04% prosthetic valve IE, 32.4% native IE, 23.5% pacemaker lead). The most frequently isolated microorganism was Staphylococcus aureus in BSI (49%) and coagulase-negative staphylococci in IE (44.1%). All patients with IE were clinically cured in hospital; at 12 months, there was 2.9% loss to follow-up, 8.8% mortality unrelated to IE, and 2.9% therapeutic failure rate. The percentage effectiveness of DBV to treat IE was 96.7%. The clinical cure rate for BSI was 100% during hospital stay and at 3 months; there were no recurrences or deaths during the follow-up. No patient discontinued treatment for adverse events. The saving in hospital stay was 636 days for BSI (315,424.20€) and 557 days for IE (283,187.45€). Conclusions DBV is an effective consolidation antibiotic therapy in clinically stabilized patients with IE and/or BSI. It proved to be a cost-effective treatment, reducing the hospital stay, thanks to the pharmacokinetic/pharmacodynamic profile of this drug.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas no 2, 18014, Granada, Spain.
| | | | | | | | | | - Sergio Sequera
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas no 2, 18014, Granada, Spain
| | | | | | | | - Concepción Fernández-Roldan
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas no 2, 18014, Granada, Spain
| | - Rosario Javier-Martinez
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas no 2, 18014, Granada, Spain
| | | | | | | | | | | | | | - Samantha E De Jesus
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas no 2, 18014, Granada, Spain
| | - Juan Pasquau
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas no 2, 18014, Granada, Spain
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Palacios R, Mayorga M, González-Domenech CM, Hidalgo-Tenorio C, Gálvez C, Muñoz-Medina L, de la Torre J, Lozano A, Castaño M, Omar M, Santos J. Safety and Efficacy of Dolutegravir Plus Rilpivirine in Treatment-Experienced HIV-Infected Patients: The DORIVIR Study. J Int Assoc Provid AIDS Care 2019. [PMID: 29529910 PMCID: PMC6748491 DOI: 10.1177/2325958218760847] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Indexed: 11/16/2022] Open
Abstract
Objectives: To analyze the efficacy and safety of dolutegravir/rilpivirine (DTG/RPV) in HIV-infected patients who switched from any other antiretroviral therapy (ART). Methods: Open-label, multicenter study including patients who switched to DTG/RPV between February 2015 and February 2016. Efficacy (HIV RNA <50 copies/mL), adverse events, and metabolic changes at 24 weeks were analyzed. Results: A total of 104 participants were included, who switched for the following reasons: toxicity/intolerance (42.3%), convenience (27.8%), and drug interactions (17.3%). Prior regimens are protease inhibitor (56.7%), integrase strand transfer inhibitor (26.9%), and non-nucleoside reverse transcriptase inhibitor (16.3%). Efficacy at 24 weeks was 88.4% (intention to treat) and 96.8% (per protocol). Triglyceride levels were reduced, on average, by 12.7% and a mean decrease of 9.0% in the glomerular filtration rate was observed as well (P values of .003 and .002, respectively), whereas total cholesterol, HDL cholesterol, LDL cholesterol, creatinine, and glutamic-pyruvic transaminase remained unchanged. No patient discontinued due to adverse events. Conclusions: Dolutegravir/RPV is effective and safe in long-term HIV-infected patients under any prior ART. Toxicity, convenience, and interactions were the main reasons for changing. At 24 weeks, the lipid profile improved with a decrease in triglycerides.
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Affiliation(s)
- Rosario Palacios
- 1 UGC Enfermedades Infecciosas y Microbiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - M Mayorga
- 2 UGC Enfermedades Infecciosas y Microbiología, Hospital Carlos Haya, Málaga, Spain
| | - C M González-Domenech
- 1 UGC Enfermedades Infecciosas y Microbiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - C Hidalgo-Tenorio
- 3 Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario Granada, Granada, Spain
| | - C Gálvez
- 4 UGC Enfermedades Infecciosas, Hospital Torrecárdenas, Málaga, Spain
| | - L Muñoz-Medina
- 3 Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario Granada, Granada, Spain
| | - J de la Torre
- 5 UGC Enfermedades Infecciosas, Hospital Costa del Sol, Málaga, Spain
| | - A Lozano
- 6 UGC Enfermedades Infecciosas, Hospital de Poniente, Almería, Spain
| | - M Castaño
- 2 UGC Enfermedades Infecciosas y Microbiología, Hospital Carlos Haya, Málaga, Spain
| | - M Omar
- 7 UGC Enfermedades Infecciosas, Complejo hospitalario de Jaén, Jaén, Spain
| | - Jesús Santos
- 1 UGC Enfermedades Infecciosas y Microbiología, Hospital Virgen de la Victoria, Málaga, Spain
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Pérez AB, Chueca N, Macías J, Pineda JA, Salmerón J, Rivero-Juárez A, Hidalgo-Tenorio C, Espinosa MD, Téllez F, Von-Wichmann MÁ, Omar M, Santos J, Hernández-Quero J, Antón JJ, Collado A, Lozano AB, García-Deltoro M, Casado M, Pascasio JM, Selfa A, Rosales JM, De la Iglesia A, Arenas JI, García-Bujalance S, Ríos MJ, Bernal E, Martínez O, García-Herola A, Vélez M, Rincón P, García F. Prevalence of resistance associated substitutions and efficacy of baseline resistance-guided chronic hepatitis C treatment in Spain from the GEHEP-004 cohort. PLoS One 2019; 14:e0221231. [PMID: 31469856 PMCID: PMC6716636 DOI: 10.1371/journal.pone.0221231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 08/01/2019] [Indexed: 12/11/2022] Open
Abstract
Treatment guidelines differ in their recommendation to determine baseline resistance associated substitutions (RAS) before starting a first-line treatment with direct-acting antivirals (DAAs). Here we analyze the efficacy of DAA treatment with baseline RAS information. We conducted a prospective study involving 23 centers collaborating in the GEHEP-004 DAA resistance cohort. Baseline NS5A and NS3 RASs were studied by Sanger sequencing. After issuing a comprehensive resistance report, the treating physician decided the therapy, duration and ribavirin use. Sustained virological response (SVR12) data are available in 275 patients. Baseline NS5A RAS prevalence was between 4.3% and 26.8% according to genotype, and NS3 RASs prevalence (GT1a) was 6.3%. Overall, SVR12 was 97.8%. Amongst HCV-GT1a patients, 75.0% had >800,000 IU/ml and most of those that started grazoprevir/elbasvir were treated for 12 weeks. In genotype 3, NS5A Y93H was detected in 9 patients. 42.8% of the HCV-GT3 patients that started sofosbuvir/velpatasvir included ribavirin, although only 14.7% carried Y93H. The efficacy of baseline resistance-guided treatment in our cohort has been high across the most prevalent HCV genotypes in Spain. The duration of the grazoprevir/elbasvir treatment adhered mostly to AASLD/IDSA recommendations. In cirrhotic patients infected with GT-3 there has been a high use of ribavirin.
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Affiliation(s)
- Ana Belén Pérez
- Clinical Microbiology Unit, University Hospital Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Natalia Chueca
- Clinical Microbiology Unit, University Hospital San Cecilio, Instituto de Investigacion Ibs. Granada, Granada, Spain
| | - Juan Macías
- Infectious Diseases Unit, University Hospital Nuestra Señora de Valme, Sevilla, Spain
| | - Juan Antonio Pineda
- Infectious Diseases Unit, University Hospital Nuestra Señora de Valme, Sevilla, Spain
| | - Javier Salmerón
- Hepatology Unit, University Hospital San Cecilio Granada, Instituto de Investigación Ibs. CIBERehd, Granada, Spain
| | - Antonio Rivero-Juárez
- Infectious Diseases Unit, University Hospital Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | | | | | - Francisco Téllez
- Infectious Diseases Unit, Hospital Puerto Real, Puerto Real, Cádiz, Spain
| | | | - Mohamed Omar
- Infectious Diseases Unit, Complejo Hospitalario de Jaén, Jáen, Spain
| | - Jesús Santos
- Infectious Diseases Unit, University Hospital Virgen de la Victoria, Málaga, Spain
| | | | | | - Antonio Collado
- Infectious Diseases Unit, Complejo Hospitalario Torrecárdenas, Almería, Spain
| | - Ana Belén Lozano
- Infectious Diseases Unit, Hospital de Poniente, El Ejido, Almería, Spain
| | | | - Marta Casado
- Hepatology Unit, Complejo Hospitalario Torrecárdenas, Almería, Spain
| | | | - Aida Selfa
- Hepatology Unit, Hospital Comarcal Santa Ana, Motril Granada, Spain
| | | | | | | | | | - María José Ríos
- Infectious Diseases Unit, University Hospital Virgen Macarena, Seville, Spain
| | - Enrique Bernal
- Infectious Diseases Unit, Hospital General Reina Sofía, Murcia, Spain
| | - Onofre Martínez
- Infectious Diseases Unit, University Hospital Santa Lucía, Cartagena, Spain
| | | | - Mónica Vélez
- Infectious Diseases Unit, Hospital General de La Palma, La Palma, Spain
| | - Pilar Rincón
- Infectious Diseases Unit, University Hospital Nuestra Señora de Valme, Sevilla, Spain
| | - Federico García
- Clinical Microbiology Unit, University Hospital San Cecilio, Instituto de Investigacion Ibs. Granada, Granada, Spain
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Lin C, Slama J, Gonzalez P, Goodman MT, Xia N, Kreimer AR, Wu T, Hessol NA, Shvetsov Y, Ortiz AP, Grinsztejn B, Moscicki AB, Heard I, Del Refugio González Losa M, Kojic EM, Schim van der Loeff MF, Wei F, Longatto-Filho A, Mbulawa ZA, Palefsky JM, Sohn AH, Hernandez BY, Robison K, Simpson S, Conley LJ, de Pokomandy A, van der Sande MAB, Dube Mandishora RS, Volpini LPB, Pierangeli A, Romero B, Wilkin T, Franceschi S, Hidalgo-Tenorio C, Ramautarsing RA, Park IU, Tso FK, Godbole S, D'Hauwers KWM, Sehnal B, Menezes LJ, Heráclio SA, Clifford GM. Cervical determinants of anal HPV infection and high-grade anal lesions in women: a collaborative pooled analysis. Lancet Infect Dis 2019; 19:880-891. [PMID: 31204304 PMCID: PMC6656696 DOI: 10.1016/s1473-3099(19)30164-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/27/2019] [Accepted: 03/15/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cervical cancer screening might contribute to the prevention of anal cancer in women. We aimed to investigate if routine cervical cancer screening results-namely high-risk human papillomavirus (HPV) infection and cytohistopathology-predict anal HPV16 infection, anal high-grade squamous intraepithelial lesions (HSIL) and, hence, anal cancer. METHODS We did a systematic review of MEDLINE, Embase, and the Cochrane library for studies of cervical determinants of anal HPV and HSIL published up to Aug 31, 2018. We centrally reanalysed individual-level data from 13 427 women with paired cervical and anal samples from 36 studies. We compared anal high-risk HPV prevalence by HIV status, cervical high-risk HPV, cervical cytohistopathology, age, and their combinations, using prevalence ratios (PR) and 95% CIs. Among 3255 women with anal cytohistopathology results, PRs were similarly calculated for all anal HSIL and HPV16-positive anal HSIL. FINDINGS Cervical and anal HPV infections were highly correlated. In HIV-negative women, anal HPV16 prevalence was 41% (447/1097) in cervical HPV16-positive versus 2% (214/8663) in cervical HPV16-negative women (PR 16·5, 95% CI 14·2-19·2, p<0·0001); these values were 46% (125/273) versus 11% (272/2588) in HIV-positive women (4·4, 3·7-5·3, p<0·0001). Anal HPV16 was also associated with cervical cytohistopathology, with a prevalence of 44% [101/228] for cervical cancer in HIV-negative women (PR vs normal cytology 14·1, 11·1-17·9, p<0·0001). Anal HSIL was associated with cervical high-risk HPV, both in HIV-negative women (from 2% [11/527] in cervical high-risk HPV-negative women up to 24% [33/138] in cervical HPV16-positive women; PR 12·9, 95% CI 6·7-24·8, p<0·0001) and HIV-positive women (from 8% [84/1094] to 17% [31/186]; 2·3, 1·6-3·4, p<0·0001). Anal HSIL was also associated with cervical cytohistopathology, both in HIV-negative women (from 1% [5/498] in normal cytology up to 22% [59/273] in cervical HSIL; PR 23·1, 9·4-57·0, p<0·0001) and HIV-positive women (from 7% [105/1421] to 25% [25/101]; 3·6, 2·5-5·3, p<0·0001). Prevalence of HPV16-positive anal HSIL was 23-25% in cervical HPV16-positive women older than 45 years (5/20 in HIV-negative women, 12/52 in HIV-positive women). INTERPRETATION HPV-based cervical cancer screening programmes might help to stratify anal cancer risk, irrespective of HIV status. For targeted secondary anal cancer prevention in high-risk groups, HIV-negative women with cervical HPV16, especially those older than 45 years, have a similar anal cancer risk profile to that of HIV-positive women. FUNDING International Agency for Research on Cancer.
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Affiliation(s)
- Chunqing Lin
- International Agency for Research on Cancer, Lyon, France; National Cancer Center, National Clinical Research Center for Cancer, and Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiri Slama
- Department of Gynecology and Obstetrics, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Paula Gonzalez
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | - Marc T Goodman
- Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Aimée R Kreimer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ting Wu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | | | - Yurii Shvetsov
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Ana P Ortiz
- University of Puerto Rico Comprehensive Cancer Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, UPR, San Juan, Puerto Rico
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil
| | | | - Isabelle Heard
- Department of Endocrinology and Reproductive Medicine, IE3M, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique, Hôpitaux de Paris, Paris, France
| | | | - Erna M Kojic
- Mount Sinai West and St Luke's Hospitals, New York, NY, USA
| | | | - Feixue Wei
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Adhemar Longatto-Filho
- Research Institute of Life and Health Sciences, School of Medicine, University of Minho, Braga, Portugal; 3B's (Biomaterials, Biodegradables and Biomimetics) Research Group, Portugal Government Associate Laboratory, Braga, Portugal; Laboratory of Medical Investigation 14, Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; Teaching and Research Institute, Molecular Oncology Research Center, Barretos Cancer Hospital-Pio XII Foundation, Barretos, Brazil
| | - Zizipho A Mbulawa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa; Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; South African Medical Research Council Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | | | - Annette H Sohn
- TREAT Asia/amfAR-Foundation for AIDS Research, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | - Katina Robison
- Obstetrics & Gynecology and Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Lois J Conley
- Division of HIV/AIDS Prevention, Epidemiology Research Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre and Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Marianne A B van der Sande
- Public Health Epidemiology, Head Department Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Racheal S Dube Mandishora
- Department of Medical Microbiology, University of Zimbabwe College of Health Sciences, Parirenyatwa Hospital premises, Harare, Zimbabwe
| | - Lays P B Volpini
- Health Sciences Center, Federal University of Espírito Santo, Vitória, Brazil
| | | | - Byron Romero
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | | | | | | | | | - Ina U Park
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Fernanda K Tso
- Department of Gynecology of the Federal University of São Paulo, São Paulo, Brazil
| | - Sheela Godbole
- Division of Epidemiology and Biostatistics, ICMR-National AIDS Research Institute, Indian Council of Medical Research, Pune, India
| | - Kathleen W M D'Hauwers
- Radboud University Nijmegen, Medical Centre, Department of Urology, Nijmegen, Netherlands
| | - Borek Sehnal
- Department of Gynecology and Obstetrics, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lynette J Menezes
- Division of Infectious Disease, University of South Florida, Tampa, FL, USA
| | - Sandra A Heráclio
- Women's Healthcare Center, Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil; Cytopathology Division, Public Health Laboratory of the State of Pernambuco, Recife, PE, Brazil
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Hidalgo-Tenorio C, Cortés LL, Gutiérrez A, Santos J, Omar M, Gálvez C, Sequera S, Jesús SED, Téllez F, Fernández E, García C, Pasquau J. DOLAMA study: Effectiveness, safety and pharmacoeconomic analysis of dual therapy with dolutegravir and lamivudine in virologically suppressed HIV-1 patients. Medicine (Baltimore) 2019; 98:e16813. [PMID: 31393412 PMCID: PMC6708975 DOI: 10.1097/md.0000000000016813] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Dolutegravir (DTG) has shown effectiveness in combination with rilpivirine in with experience of antiretroviral therapy (ART) and with 3TC in naïve patients (GEMINI trial). The main objectives of this real-life study were to analyze the effectiveness and safety of 3TC plus DTG in virologically suppressed HIV-1 patients and to conduct a pharmacoeconomic analysis.We conducted an observational, retrospective and multicenter study of HIV+ patients pretreated for at least 6 months with ART that was then simplified to 3TC + DTG for any reason. We gathered data on viral loads (VLs) during exposure to the DT, calculating the rate with VL < 50 copies/mL at week 48, and on associated adverse effects.The 177 HIV+ patients were collected, 77.4% male, with average age of 48.5 years and mean count of 252.2cell/μL CD4+ nadir lymphocytes; 96.6% had VL < 50 copies/mL and 674 cells/μL CD4+ lymphocytes. Median time since HIV diagnosis was 15 years, and median ART duration was 13 years, and 34.5% of patients were on mono- or dual-therapy before the switch. At week 48, 82.4% of patients had VL < 50 cop/μL using an intention-to-treat (ITT) analysis, 89.6% according to mITT, and 96.7% according to Per-Protocol analysis. 3.3% patients had virological failure (VF). These effectiveness data and costs were compared with those for 2 reference triple therapies (DTG/ABC/3TC and EVG/cobi/FTC/TAF) in a cost minimization analysis, showing cost savings with administration of DTG+3TC (2741 &OV0556;/year vs DTG/ABC/3TC and 4164 &OV0556;/year vs EVG/cobi/FTC/TAF) and in a cost-effectiveness analysis, finding the DT to be the most cost-effective approach (ICER = -548 vs DTG/ABC/3TC and ICER = -4,627&OV0556; vs EVG/cobi/FTC/TAF)The combination of 3TC with DTG appears to be a safe and effective option for the simplification of ART in pretreated and virologically stable HIV-positive patients, being cost-effective and offering the same effectiveness as the triple therapy it replaces.
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Affiliation(s)
| | - Luis López Cortés
- Department of Infectious Diseases, Virgen del Rocio University Hospitals, Seville
| | - Alicia Gutiérrez
- Department of Infectious Diseases, Virgen del Rocio University Hospitals, Seville
| | - Jesús Santos
- Unit of Infectious Diseases, Virgen de las Victoria University Hospital, Málaga
| | - Mohamed Omar
- Unit of Infectious Diseases, Hospital Complex of Jaen
| | - Carmen Gálvez
- Unit of Infectious Diseases, Hospital Torrecárdenas Hospital, Almería
| | - Sergio Sequera
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, Granada
| | | | - Franciso Téllez
- Unit of Infectious Diseases, University Hospital Puerto Real, Cádiz
| | - Elisa Fernández
- Internal medicine Service, Hospital Poniente, Almería, Spain
| | - Coral García
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, Granada
| | - Juan Pasquau
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, Granada
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Sadyrbaeva-Dolgova S, Aznarte-Padial P, Pasquau-Liaño J, Expósito-Ruiz M, Calleja Hernández MÁ, Hidalgo-Tenorio C. Clinical outcomes of carbapenem de-escalation regardless of microbiological results: A propensity score analysis. Int J Infect Dis 2019; 85:80-87. [PMID: 31075508 DOI: 10.1016/j.ijid.2019.04.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/15/2019] [Revised: 04/27/2019] [Accepted: 04/30/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the safety and efficacy of de-escalation in patients under treatment with carbapenems and its impact on clinical outcomes. METHODS A prospective observational study was conducted for 1year. Patients administered active carbapenems for at least 24h were included. Primary outcomes were in-hospital mortality, mortality at 30 days after carbapenem prescription, and infection-related readmission within 30 days. De-escalation was defined as the substitution of carbapenem with narrower spectrum antimicrobial agents or its discontinuation during the first 96h of treatment. RESULTS The study included 1161 patients, and de-escalation was performed in 667 (57.5%) of these. In the de-escalation group, 54.9% of cultures were positive. After propensity score matching, 30-day mortality was lower (17.4% vs. 25.7%, p=0.036), carbapenem treatment was 4 days shorter (4 vs. 8 days, p<0.001), total antibiotic therapy duration was 2 days longer (12 vs. 10 days, p=0.003), and length of hospital stay was 5 days shorter (8 vs. 13 days, p=0.008) in the de-escalated versus non-de-escalated patients. In-hospital mortality and 30-day readmission rates did not differ significantly between these groups. CONCLUSION Carbapenem de-escalation is a safe strategy that does not compromise the clinical status of patients.
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Affiliation(s)
- Svetlana Sadyrbaeva-Dolgova
- Department of Pharmacy, University Hospital Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria de Granada, Granada, Spain.
| | - Pilar Aznarte-Padial
- Department of Pharmacy, University Hospital Virgen de las Nieves, Granada, Spain
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Pasquau J, de Jesus SE, Arazo P, Crusells MJ, Ríos MJ, Lozano F, de la Torre J, Galindo MJ, Carmena J, Santos J, Tornero C, Verdejo G, Samperiz G, Palacios Z, Hidalgo-Tenorio C. Effectiveness and safety of dual therapy with rilpivirine and boosted darunavir in treatment-experienced patients with advanced HIV infection: a preliminary 24 week analysis (RIDAR study). BMC Infect Dis 2019; 19:207. [PMID: 30819101 PMCID: PMC6396540 DOI: 10.1186/s12879-019-3817-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/18/2018] [Accepted: 02/13/2019] [Indexed: 01/01/2023] Open
Abstract
Background The objective was to analyze the effectiveness and safety of dual therapy with rilpivirine plus boosted-darunavir (RPV + bDRV) in real-life patients. Methods Observational, retrospective, multi-center study in HIV+ patients who had received RPV + bDRV for 24 weeks to optimize/simplify their previous antiretroviral treatment. We determined the percentage of patients without virologic failure (2 consecutive viral loads > 50 copies/mL) at 24 weeks of treatment. Results The study included 161 patients from 15 hospitals with median age of 49 years; 29.3% had previous AIDS stage and median CD4+ lymphocyte nadir of 170 cells/uL. They had been diagnosed with HIV for a median of 17 years and had received 14 years of ART, with five previous treatment combinations, and 36.6% had a history of virological failure. The reasons for the switch were simplification/optimization (49.7%), toxicity/intolerance (17.4%), or inadequate effectiveness of previous ART (10.6%). Baseline VL of 50–1000 copies/mL was recorded in 25.5% of the patients. In the“intention-to-treat” analysis at 24 weeks, 87.6% of 161 patients continued the study treatment without virologic failure criteria. In the “on treatment” analysis (excluding patients who discontinued treatment with dual therapy for any reason other than virologic failure) the efficacy was 94.6% (141/149 patients). Conclusions Dual therapy with RPV + DRVb proved to be effective and safe in patients with advanced HIV infection, long exposure to ART, low CD4 nadir, previous virologic failure, and/or history of ineffective ART.
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Affiliation(s)
- Juan Pasquau
- Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | | | | | | | | | | | | | | | - Jorge Carmena
- Hospital Universitario Doctor Peset, Valencia, Spain
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Vicent L, Saldivar HG, Bouza E, Muñoz P, Cuerpo G, de Alarcón A, Vidal B, Cobo M, Goenaga MÁ, Carrasco-Chinchilla F, Montejo M, Gálvez-Acebal J, Hidalgo-Tenorio C, Vinuesa-García D, Martínez-Sellés M. Prognostic implications of a negative echocardiography in patients with infective endocarditis. Eur J Intern Med 2018; 52:40-48. [PMID: 29409744 DOI: 10.1016/j.ejim.2018.01.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/14/2017] [Accepted: 01/31/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Echocardiography plays an important role in infective endocarditis (IE) diagnosis according with the modified Duke criteria. We evaluated the implications of a positive echocardiography in the prognosis of a cohort of patients with IE. METHODS Prospective multicentre study in 31 Spanish centres. From January 2008 to September 2016, 3467 patients were included (2765 definite IE, 702 possible IE). The main outcome was in-hospital mortality. Echocardiography diagnosis was based on modified Duke criteria for the diagnosis of IE. RESULTS Median age was 69 years (interquartile range: 57-77 years). Comorbidity was high (mean Charlson index 4.7 ± 2.8). Transoesophageal echocardiography was performed in 2680 (77.3%). The overall inhospital mortality rate was 26.7%. Univariate analysis showed that, in patients with definite IE, inhospital mortality was similar in patients with positive and negative echocardiography (27.7% vs. 24.6%, respectively, p = 0.121). In possible IE these figures were 27.5% vs. 16.7%, respectively, p < 0.001. Complications (cardiac and extracardiac [embolic, immunological, and septic shock]) were more frequent with positive than with negative echocardiography, regardless of clinical suspicion (definite IE 35.5% vs. 16.8%, respectively, p < 0.001; possible IE 20.8% vs. 7.6%, respectively, p < 0.001). Positive echocardiography was a predictor of inhospital death by logistic regression modelling, after adjusting for confounders, definite IE (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.02-1.76, p = 0.036), possible IE (OR 1.59, 95% CI 1.02-2.45, p = 0.036). CONCLUSIONS A positive echocardiography in patients with IE is associated with increased inhospital mortality, in addition to other clinical factors and comorbidities.
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Affiliation(s)
- Lourdes Vicent
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Hugo González Saldivar
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Emilio Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Gregorio Cuerpo
- Servicio de Cirugía Cardiaca, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Aristides de Alarcón
- Servicio de Microbiología Clínica, Enfermedades Infecciosas y Medicina preventiva, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla/CSIC/Hospital Virgen del Rocío and Virgen Macarena, Sevilla, Spain
| | - Bárbara Vidal
- Servicio de Cardiología, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Spain
| | - Manuel Cobo
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Miguel Ángel Goenaga
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián, Spain
| | | | - Miguel Montejo
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Universidad del País Vasco, Bilbao, Spain
| | - Juan Gálvez-Acebal
- Instituto de Biomedicina de Sevilla, IBIS, Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, CSIC, Universidad de Sevilla, Spain
| | - Carmen Hidalgo-Tenorio
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Complejo Hospitalario de Granada, Spain
| | - David Vinuesa-García
- Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital Clínico San Cecilio, Granada, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain; Universidad Complutense and Universidad Europea, Madrid, Spain.
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Pasquau J, Hidalgo-Tenorio C, Montes ML, Romero-Palacios A, Vergas J, Sanjoaquín I, Hernández-Quero J, Aguirrebengoa K, Orihuela F, Imaz A, Ríos-Villegas MJ, Flores J, Fariñas MC, Vázquez P, Galindo MJ, García-Mercé I, Lozano F, de los Santos I, de Jesus SE, García-Vallecillos C. High quality of life, treatment tolerability, safety and efficacy in HIV patients switching from triple therapy to lopinavir/ritonavir monotherapy: A randomized clinical trial. PLoS One 2018; 13:e0195068. [PMID: 29649309 PMCID: PMC5896909 DOI: 10.1371/journal.pone.0195068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/15/2018] [Indexed: 01/03/2023] Open
Abstract
Trial design The QoLKAMON study evaluated quality of life, efficacy and treatment safety in HIV patients receiving lopinavir/ritonavir in monotherapy (MT) versus continuing combined antiretroviral triple treatment with a boosted protease inhibitor (TT). Methods This was a 24-week, open-label, multicentre study in virologically-suppressed HIV-infected participants (N = 225) with a 2:1 randomization: 146 patients who switched to MT were compared with 79 patients who remained on a TT regimen. The primary endpoint was change in patient-reported outcomes in quality of life as measured by the MOS-HIV and EQ-5D questionnaires. Secondary endpoints included treatment adherence, patient satisfaction, incidence of adverse events and differences in plasma HIV-1 RNA viral load (VL) and CD4 cell counts. Results Baseline quality of life, measured with the MOS-HIV score, was very good (overall score of 83 ± 10.5 in the MT arm and 82.3 ± 11.3 in the TT arm) and suffered no change during the study in any of the arms (at week 24, 83.5 ± 12.2 in MT arm and 81.9 ± 12.7 in TT arm), without statistically significant differences when compared. In regards to adherence to therapy and patient satisfaction, some aspects (number of doses forgotten in the last week and satisfaction of treatment measured with the CESTA score, dimension 1) improved significantly with MT. There were also no differences in the incidence and severity of adverse events, even though 22.8% of those in the MT arm switched their treatment when they were included in the study. Moreover, there was also no significant difference between the immunological and virological evolution of MT and TT. In the MT arm, the VL was always undetectable in 83% of patients (vs 90.7% in the TT arm) and there were only 6.7% of virological failures with VL > 50 copies/mL (vs 2.3% in the TT arm), without resistance mutations and with resuppression of VL after switching back to TT. Conclusions In a new clinical trial, monotherapy as a treatment simplification strategy in HIV-1 infected patients with sustained viral suppression has demonstrated quality of life, safety and efficacy profiles comparable to those of conventional triple therapy regimens.
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Affiliation(s)
- Juan Pasquau
- Hospital Universitario Virgen de las Nieves, Infectious Diseases, Granada, Spain
- * E-mail:
| | | | - María Luisa Montes
- Hospital Universitario de La Paz, Internal Medicine HIV Unit, Madrid, Spain
| | | | - Jorge Vergas
- Hospital Clínico San Carlos, Infectious Diseases, Granada, Spain
| | - Isabel Sanjoaquín
- Hospital Clínico Universitario Lozano Blesa, Infectious Diseases, Zaragoza, Spain
| | | | | | - Francisco Orihuela
- Hospital Regional Universitario de Málaga, Infectious Diseases, Málaga, Spain
| | - Arkaitz Imaz
- Hospital Universitario de Bellvitge, Infectious Diseases, Barcelona, Spain
| | - María José Ríos-Villegas
- Hospital Universitario Virgen Macarena, Infectious Diseases and Clinical Microbiology, Seville, Spain
| | - Juan Flores
- Hospital Arnau de Vilanova, Infectious Diseases, Valencia, Spain
| | - María Carmen Fariñas
- Hospital Universitario Marqués de Valdecilla, Infectious Diseases, Santander, Spain
| | - Pilar Vázquez
- Hospital Universitario Juan Canalejo, Infectious Diseases, La Coruña, Spain
| | - María José Galindo
- Hospital Clínico Universitario de Valencia, Infectious Diseases, Valencia, Spain
| | | | - Fernando Lozano
- Hospital Universitario Nuestra Señora de Valme, Infectious Diseases, Seville, Spain
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Fernández-Hidalgo N, Ferreria-González I, Marsal JR, Ribera A, Aznar ML, de Alarcón A, García-Cabrera E, Gálvez-Acebal J, Sánchez-Espín G, Reguera-Iglesias JM, De La Torre-Lima J, Lomas JM, Hidalgo-Tenorio C, Vallejo N, Miranda B, Santos-Ortega A, Castro MA, Tornos P, García-Dorado D, Almirante B. A pragmatic approach for mortality prediction after surgery in infective endocarditis: optimizing and refining EuroSCORE. Clin Microbiol Infect 2018; 24:1102.e7-1102.e15. [PMID: 29408350 DOI: 10.1016/j.cmi.2018.01.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 11/06/2017] [Revised: 01/13/2018] [Accepted: 01/20/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To simplify and optimize the ability of EuroSCORE I and II to predict early mortality after surgery for infective endocarditis (IE). METHODS Multicentre retrospective study (n = 775). Simplified scores, eliminating irrelevant variables, and new specific scores, adding specific IE variables, were created. The performance of the original, recalibrated and specific EuroSCOREs was assessed by Brier score, C-statistic and calibration plot in bootstrap samples. The Net Reclassification Index was quantified. RESULTS Recalibrated scores including age, previous cardiac surgery, critical preoperative state, New York Heart Association >I, and emergent surgery (EuroSCORE I and II); renal failure and pulmonary hypertension (EuroSCORE I); and urgent surgery (EuroSCORE II) performed better than the original EuroSCOREs (Brier original and recalibrated: EuroSCORE I: 0.1770 and 0.1667; EuroSCORE II: 0.2307 and 0.1680). Performance improved with the addition of fistula, staphylococci and mitral location (EuroSCORE I and II) (Brier specific: EuroSCORE I 0.1587, EuroSCORE II 0.1592). Discrimination improved in specific models (C-statistic original, recalibrated and specific: EuroSCORE I: 0.7340, 0.7471 and 0.7728; EuroSCORE II: 0.7442, 0.7423 and 0.7700). Calibration improved in both EuroSCORE I models (intercept 0.295, slope 0.829 (original); intercept -0.094, slope 0.888 (recalibrated); intercept -0.059, slope 0.925 (specific)) but only in specific EuroSCORE II model (intercept 2.554, slope 1.114 (original); intercept -0.260, slope 0.703 (recalibrated); intercept -0.053, slope 0.930 (specific)). Net Reclassification Index was 5.1% and 20.3% for the specific EuroSCORE I and II. CONCLUSIONS The use of simplified EuroSCORE I and EuroSCORE II models in IE with the addition of specific variables may lead to simpler and more accurate models.
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Affiliation(s)
- N Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - I Ferreria-González
- Unitat d'Epidemiologia, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
| | - J R Marsal
- Unitat d'Epidemiologia, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Unitat de Suport a la Recerca Lleida-Pirineus, IDIAP Jordi Gol, Lleida, Spain
| | - A Ribera
- Unitat d'Epidemiologia, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - M L Aznar
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A de Alarcón
- Universitat Autònoma de Barcelona, Barcelona, Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain; Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain
| | - E García-Cabrera
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain
| | - J Gálvez-Acebal
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - G Sánchez-Espín
- Unidad de Gestión Clínica del Corazón, Instituto de Investigación Biomédica de Málaga (BIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - J M Reguera-Iglesias
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - J De La Torre-Lima
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - J M Lomas
- Unitat de Suport a la Recerca Lleida-Pirineus, IDIAP Jordi Gol, Lleida, Spain; Unidad de Enfermedades Infecciosas, Hospitales Juan Ramón Jiménez-Infanta Elena, Huelva, Spain
| | - C Hidalgo-Tenorio
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - N Vallejo
- Servicio de Cardiología, Grupo de Trabajo de Endocarditis Infecciosa, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - B Miranda
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Santos-Ortega
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M A Castro
- Servei de Cirurgia Cardíaca, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - P Tornos
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - D García-Dorado
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - B Almirante
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
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Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R. Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. Emerg Infect Dis 2018; 23:542-543. [PMID: 28221124 PMCID: PMC5382739 DOI: 10.3201/eid2303.161039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We report 2 cases from Spain of infectious proctitis caused by Neisseria meningitidis in HIV-positive men who have sex with men. Genetic characterization of the isolates showed that they are unusual strains not found in other more frequent meningococcal locations. This finding suggests an association between specific strains and anogenital tract colonization.
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Hidalgo-Tenorio C, Elisabeth de Jesus S, Fernández-Roldán C, Javier R, Pasquau J. Dalbavancina como tratamiento antibiótico de pacientes con endocarditis y/o bacteriemia por cocos grampositivos, en la práctica clínica habitual. Cirugía Cardiovascular 2018. [DOI: 10.1016/j.circv.2017.12.034] [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: 11/29/2022] Open
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Muñoz P, de la Villa P, Ramallo V, Mestres C, Goenaga M, Kortajarena X, Hidalgo-Tenorio C, de Jesús S, Fariñas M, Antorrena I, Rodríguez-Esteban M, Castelo L, García-Vázquez E, Ramos A, Bouza E. Análisis de una cohorte de pacientes con endocarditis infecciosa tratados con linezolid. Cirugía Cardiovascular 2018. [DOI: 10.1016/j.circv.2017.12.018] [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: 11/29/2022] Open
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Hidalgo-Tenorio C, Gil-Anguita C, Ramírez-Taboada J, Esquivias J, López-Ruz MA, Balgahata OM, Javier-Martinez R, Pasquau J. Risk factors for infection by oncogenic human papillomaviruses in HIV-positive MSM patients in the ART era (2010-2016). Medicine (Baltimore) 2017; 96:e8109. [PMID: 28953633 PMCID: PMC5626276 DOI: 10.1097/md.0000000000008109] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Squamous cell carcinoma of anus (SCCA) is one of the most frequent non-AIDS-defining diseases in HIV patients, mainly in men who have sex with men (MSM), and it is associated with human papillomavirus (HPV) infection.To determine the prevalence of high-risk HPV (HR-HPV) genotypes, premalignant lesions (HSIL) and SCCA in a cohort of HIV-positive MSM; to study the distribution of HPV genotypes according to anal histology results; and to analyze risk factors for this infection.This prospective single-center study was conducted between May 2010 and September 2016. At the study visit, cotton swabs were used to collect anal samples for cytology study in ThinPrep Pap Test liquid medium (Thin Prep Processor 2000, Hologic Corp, USA), and for HPV PCR (Linear Array HPV Genotyping Test). After, high-resolution anoscopy (HRA) (Zeiss 150 fc) was carried out. Logistic regression analysis was performed to identify risk factors for HR-HPV infection.The study included 319 patients, with mean age of 36.7 years; HR-HPV was detected in 81.3%. The prevalence of HSIL was 13.5% and SCCA was 0.3%. With regard to the distribution of HPV genotypes according to histology results, HPV 16 was the most frequent genotype in normal anal mucosa (26.7%), in LSILs (36.9%), and in HSILs (38%). In multivariate analysis, CD4 nadir < 200 cells/μL was the factor associated with infection by HR-HPV (OR 3.66, 95% CI 1.05%-12.75%).HIV-positive MSM showed a high prevalence of HSIL+ lesions and of infection by oncogenic HPV, which appears to be favored by a deficient immune system. HPV 16 was the most frequently isolated genotype in anal mucosa, regardless of lesion type.
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Affiliation(s)
| | | | | | - Javier Esquivias
- Department of Pathology, Virgen de las Nieves University Hospital, Granada
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Hidalgo-Tenorio C, Ramírez-Taboada J, Gil-Anguita C, Esquivias J, Omar-Mohamed-Balgahata M, SamPedro A, Lopez-Ruz M, Pasquau J. Safety and immunogenicity of the quadrivalent human papillomavirus (qHPV) vaccine in HIV-positive Spanish men who have sex with men (MSM). AIDS Res Ther 2017; 14:34. [PMID: 28720147 PMCID: PMC5516305 DOI: 10.1186/s12981-017-0160-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/11/2017] [Indexed: 01/05/2023] Open
Abstract
Background Safety and immunogenicity of the quadrivalent human papillomavirus (qHPV) vaccine were evaluated in HIV-positive Spanish MSM. The prevalence of High Squamous Intraepithelial Lesions (HSIL) and genotypes of high-risk human papillomavirus (HR-HPV) were also determined, as well as risk factors associated with the presence of HR-HPV in anal mucosa. Methods This is a randomised, double blind, placebo-controlled trial of the quadrivalent HPV (qHPV) vaccine. The study enrolled from May 2012 to May 2014. Vaccine and placebo were administered at 0, 2 and 6 months (V1, V2, V3 clinical visits). Vaccine antibody titres were evaluated at 7 months. Cytology (Thin Prep® Pap Test), HPV PCR genotyping (Linear Array HPV Genotyping Test), and high-resolution anoscopy (Zeiss 150 fc© colposcope) were performed at V1. Results Patients (n = 162; mean age 37.9 years) were screened for inclusion; 14.2% had HSIL, 73.1% HR-HPV and 4.5% simultaneous infection with HPV16 and 18. Study participants (n = 129) were randomized to qHPV vaccine or placebo. The most common adverse event was injection-site pain predominating in the placebo group [the first dose (83.6% vs. 56.1%; p = 0.0001]; the second dose (87.8% vs. 98.4%; p = 0.0001); the third dose (67.7% vs. 91.9%; p = 0.0001). The vaccine did not influence either the viral load of HIV or the levels of CD4. Of those vaccinated, 76% had antibodies to HPV vs. 30.2% of those receiving placebo (p = 0.0001). In the multivariate analysis, Older age was associated with lower HR-HPV infection (RR 0.97; 95% CI 0.96–0.99), and risk factor were viral load of HIV >200 copies/µL (RR 1.42 95% CI 1.17–1.73) and early commencement of sexual activity (RR 1.35; 95% CI 1.001–1.811). Conclusions This trial showed significantly higher anti-HR-HPV antibody titres in vaccinated individuals than in unvaccinated controls. There were no serious adverse events attributable to the vaccine. In our cohort, 1 of every 7 patients had HSIL and the prevalence of combined infection by genotypes 16 and 18 was low. This suggests that patients could benefit from receiving qHPV vaccine. Older age was the main protective factor against HR-HPV infection, and non-suppressed HIV viremia was a risk factor. Clinical trial registration: ISRCTN14732216 (http://www.isrctn.com/ISRCTN14732216).
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Plata A, Reguera J, Cabrera E, Ruiz J, Vinuesa D, Martínez-Marcos F, Lomas J, Hidalgo-Tenorio C, de la Torre J, de Alarcon A. 15. Diferencias en la presentación clínica entre la endocarditis protésica precoz y la tardía, ¿realmente existen? Cirugía Cardiovascular 2017. [DOI: 10.1016/j.circv.2016.11.039] [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: 11/26/2022] Open
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