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Revilla-Pacheco F, Rivera-May L, Manrique-Guzmán S, Herrada-Pineda T, Hoyo I, Franco-Granillo J, Perez-Vazquez AK, Wilches-Dávalos MJ. [Utility of topical vancomycin application in the prevention of surgical site infection of the lumbosacral spine]. Acta Ortop Mex 2024; 38:73-81. [PMID: 38782471] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
INTRODUCTION surgical site infections (SSI) remain a significant cause of morbidity and mortality and one of the most representative causes of nosocomial infections. The use of intrawound vancomycin in lumbar spine surgery is a potential prophylactic measure against SSI; however, evidence regarding its efficacy is contradictory. Our study was designed to research if intrawound vancomycin significantly prevents SSI in lumbar spine surgery. MATERIAL AND METHODS this is a randomized, double-blinded, controlled clinical trial; 233 patients who underwent lumbar spine surgery, were randomly assigned to a group in which intrawound vancomycin was instilled in the incision before closure (109), or to a control group (114). The main outcome is the presence of SSI; we determined its prevalence and searched for difference between groups for association between SSI and independent variables. RESULTS global SSI prevalence was 1.8%, in the experimental group was 0.9%, in the control group was 2.6%. There was no significant difference between these values, p = 0.622. The relative risk of SSI in the experimental group was 0.35 (95% CI 0.037-3.30), that of the control group was 2.87 (95% CI 0.30-27.16). The number needed to treat is 58.3. We did not find a significant association between the independent variables studied and the appearance of SSI. CONCLUSIONS we did not find a significant difference in the prevalence of SSI between groups nor a significant association between SSI and independent variables.
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Affiliation(s)
- F Revilla-Pacheco
- Centro Médico ABC. Ciudad de México
- Universidad Anáhuac México, Facultad de Ciencias de la Salud
- Hospital Ángeles Lomas, Huixquilucan, Estado de México
| | - L Rivera-May
- Universidad Anáhuac México, Facultad de Ciencias de la Salud
| | - S Manrique-Guzmán
- Centro Médico ABC. Ciudad de México
- Universidad Anáhuac México, Facultad de Ciencias de la Salud
- Hospital Ángeles Lomas, Huixquilucan, Estado de México
| | - T Herrada-Pineda
- Centro Médico ABC. Ciudad de México
- Hospital Ángeles Lomas, Huixquilucan, Estado de México
| | - I Hoyo
- Centro Médico ABC. Ciudad de México
- Hospital Ángeles Lomas, Huixquilucan, Estado de México
| | | | - A K Perez-Vazquez
- Universidad Anáhuac México, Facultad de Ciencias de la Salud
- Hospital Ángeles Lomas, Huixquilucan, Estado de México
| | - M J Wilches-Dávalos
- Centro Médico ABC. Ciudad de México
- Universidad Anáhuac México, Facultad de Ciencias de la Salud
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Pérez-González B, Thomas-Lora FC, Hoyo I, Flores-García NC, Rodríguez-Aguilar EF, Páez-Zayas VM, Márquez-Guillén E, Visag-Castillo V, García-Juárez I, Contreras AG. Hepatic transplant during SARS-CoV-2 (COVID-19) pandemic. A literature review. CIR CIR 2021; 89:269-274. [PMID: 33784290 DOI: 10.24875/ciru.20000994] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ANTECEDENTES En diciembre de 2019 se identificó en la ciudad de Wuhan, China, un nuevo beta coronavirus, el SARS-CoV-2, como agente causal de neumonía grave, conocida como COVID-19, lo cual ha provocado medidas estrictas de aislamiento, cierre de programas de trasplante hepático y la necesidad de modificar los protocolos de tratamiento. OBJETIVO Documentar la información publicada sobre el impacto de la COVID-19 en la población con antecedente de trasplante hepático y establecer un protocolo de tratamiento. MÉTODO Se buscaron en PubMed los términos MeSH "SARS-CoV-2", "COVID-19", "trasplante hepático" y "tratamiento". RESULTADOS Hasta el momento se ha demostrado en la población con trasplante hepático una mayor facilidad para adquirir el virus, sin una diferencia en la mortalidad al compararla con la población general. La inmunosupresión debe continuar, sin suspender los inhibidores de la calcineurina. Del tratamiento específico, los esteroides son los que han demostrado el mayor beneficio clínico y una disminución de la mortalidad. CONCLUSIÓN El trasplante hepático no se asocia de manera independiente a una mayor mortalidad. Otros factores, además del trasplante, deben tomarse en cuenta al momento de establecer la gravedad. BACKGROUND In December 2019, a new beta coronavirus, SARS-CoV-2, was identified in the city of Wuhan, China, as a causative agent of severe pneumonia, known as COVID-19, which has led to strict isolation measures, closure of liver transplantation programs and the need to modify treatment protocols. OBJECTIVE Document the information published so far on the impact of COVID-19 in the population with a history of liver transplantation and establish a treatment protocol. METHOD MeSH terms were searched for “SARS-CoV-2”, “COVID-19”, “liver transplantation” and “treatment”. RESULTS Up to now, a greater ease in acquiring the virus has been shown in the liver transplant population, without a difference in mortality when compared to the general population. Immunosuppression should continue at the minimum tolerated levels, without suspending calcineurin inhibitors. Of the specific treatment, steroids are those that have shown the greatest clinical benefit and decreased mortality. CONCLUSION Liver transplantation is not independently associated with higher mortality. Factors other than transplantation must be taken into account when considering the risk of severity.
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Affiliation(s)
- Bernardo Pérez-González
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Freyris C Thomas-Lora
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Irma Hoyo
- Servicio de Medicina Interna y Práctica Médica Grupal de Infectología, Centro Médico ABC, Ciudad de México, México
| | - Nayelli C Flores-García
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | | | - Víctor M Páez-Zayas
- Departamento de Trasplante de Órganos, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - Ernesto Márquez-Guillén
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Víctor Visag-Castillo
- Departamento de Trasplante de Órganos, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - Ignacio García-Juárez
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Alan G Contreras
- Departamento de Trasplante de Órganos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
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Salmanton-García J, Sprute R, Stemler J, Bartoletti M, Dupont D, Valerio M, Garcia-Vidal C, Falces-Romero I, Machado M, de la Villa S, Schroeder M, Hoyo I, Hanses F, Ferreira-Paim K, Giacobbe DR, Meis JF, Gangneux JP, Rodríguez-Guardado A, Antinori S, Sal E, Malaj X, Seidel D, Cornely OA, Koehler P. COVID-19-Associated Pulmonary Aspergillosis, March-August 2020. Emerg Infect Dis 2021; 27:1077-1086. [PMID: 33539721 PMCID: PMC8007287 DOI: 10.3201/eid2704.204895] [Citation(s) in RCA: 163] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019. Because of the severe immunomodulation and lymphocyte depletion caused by this virus and the subsequent administration of drugs directed at the immune system, we anticipated that patients might experience fungal superinfection. We collected data from 186 patients who had coronavirus disease-associated pulmonary aspergillosis (CAPA) worldwide during March-August 2020. Overall, 182 patients were admitted to the intensive care unit (ICU), including 180 with acute respiratory distress syndrome and 175 who received mechanical ventilation. CAPA was diagnosed a median of 10 days after coronavirus disease diagnosis. Aspergillus fumigatus was identified in 80.3% of patient cultures, 4 of which were azole-resistant. Most (52.7%) patients received voriconazole. In total, 52.2% of patients died; of the deaths, 33.0% were attributed to CAPA. We found that the cumulative incidence of CAPA in the ICU ranged from 1.0% to 39.1%.
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Talavera JO, Roy-García I, Palacios-Cruz L, Rivas-Ruiz R, Hoyo I, Pérez-Rodríguez M. Back to the clinic. Methods I. Research designs. Higher quality of information, more certainty to the answer. GAC MED MEX 2020. [DOI: 10.24875/gmm.m19000304] [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: 11/17/2022] Open
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Talavera JO, Roy-García I, Palacios-Cruz L, Rivas-Ruiz R, Hoyo I, Pérez-Rodríguez M. De vuelta a la clínica. Métodos I. Diseños de investigación. Mayor calidad de información, mayor certeza a la respuesta. GAC MED MEX 2019; 155:399-405. [PMID: 31486784 PMCID: PMC7446753 DOI: 10.24875/gmm.19005226] [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: 04/15/2019] [Accepted: 05/17/2019] [Indexed: 11/17/2022] Open
Abstract
Research designs refer to the way information is obtained and are limited by ethical, economic and temporal viability. Research designs are standardized strategies to reduce biases, which in the architectural model of research are identified in the baseline state, the maneuver and the outcome; hence, there are no specific designs for each question. The design with the lowest probability of bias is the clinical trial, followed by cohort and case-control studies and, finally, by cross-sectional surveys. Among the main characteristics that give merit to research designs are the following: population inquiry, which refers to the situation of the population in relation to the clinical course/natural history of the disease; the maneuver, or action that is expected to modify the baseline state, which can be observational or experimental; follow-up, or documented monitoring that is given to each subject, which can be longitudinal or cross-sectional; and directionality, which can prolective or retrolective and refers to the timing of data collection for research purposes. It will always be better having a valuable question, even when answered with a design with higher risk of bias, than a question that is irrelevant or has no applicability.
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Affiliation(s)
| | - Ivonne Roy-García
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Centro de Adiestramiento en Investigación Clínica
| | - Lino Palacios-Cruz
- Instituto Nacional de Psiquiatría “Dr. Ramón de la Fuente”, Subdirección de Investigaciones Clínicas, Departamento Epidemiología Clínica
| | - Rodolfo Rivas-Ruiz
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Centro de Adiestramiento en Investigación Clínica
| | - Irma Hoyo
- Servicio de Medicina Interna, Centro Médico ABC. Ciudad de México
| | - Marcela Pérez-Rodríguez
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Centro de Adiestramiento en Investigación Clínica
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Hoyo I, Sanclemente G, de la Bellacasa JP, Cofán F, Ricart M, Cardona M, Colmenero J, Fernández J, Escorsell A, Navasa M, Moreno A, Cervera C. Epidemiology, clinical characteristics, and outcome of invasive aspergillosis in renal transplant patients. Transpl Infect Dis 2014; 16:951-957. [DOI: 10.1111/tid.12301] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- I. Hoyo
- Department of Infectious Diseases; Hospital Clinic of Barcelona - Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona; Barcelona Spain
| | - G. Sanclemente
- Department of Infectious Diseases; Hospital Clinic of Barcelona - Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona; Barcelona Spain
| | - J. Puig de la Bellacasa
- Microbiology, “Centre Diagnòstic Biomèdic” (CDB); Centre for International Health Research (CRESIB); Hospital Clinic of Barcelona - IDIBAPS - University of Barcelona; Barcelona Spain
| | - F. Cofán
- Renal Transplant Unit; Hospital Clinic of Barcelona - IDIBAPS - University of Barcelona; Barcelona Spain
| | - M.J. Ricart
- Renal Transplant Unit; Hospital Clinic of Barcelona - IDIBAPS - University of Barcelona; Barcelona Spain
| | - M. Cardona
- Heart Transplant Unit; Hospital Clinic of Barcelona - IDIBAPS - University of Barcelona; Barcelona Spain
| | - J. Colmenero
- Liver Transplant Unit; Hospital Clinic of Barcelona - IDIBAPS - University of Barcelona; Barcelona Spain
| | - J. Fernández
- Liver Transplant Unit; Hospital Clinic of Barcelona - IDIBAPS - University of Barcelona; Barcelona Spain
| | - A. Escorsell
- Liver Transplant Unit; Hospital Clinic of Barcelona - IDIBAPS - University of Barcelona; Barcelona Spain
| | - M. Navasa
- Liver Transplant Unit; Hospital Clinic of Barcelona - IDIBAPS - University of Barcelona; Barcelona Spain
| | - A. Moreno
- Department of Infectious Diseases; Hospital Clinic of Barcelona - Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona; Barcelona Spain
| | - C. Cervera
- Department of Infectious Diseases; Hospital Clinic of Barcelona - Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona; Barcelona Spain
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Sanclemente G, Marco F, Cervera C, Hoyo I, Colmenero J, Pitart C, Almela M, Navasa M, Moreno A. Candida norvegensis fungemia in a liver transplant recipient. Rev Iberoam Micol 2014; 32:115-7. [PMID: 24794213 DOI: 10.1016/j.riam.2013.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 08/01/2013] [Accepted: 11/12/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The incidence of candidemia due to non-Candida albicans Candida species has been progressively increasing in recent years. The use of fluconazole as antifungal prophylaxis has been described as a risk factor for the development of infections by fluconazole resistant Candida strains. We report a case of Candida norvegensis bloodstream infection in a liver transplant recipient. CASE REPORT A 61-year-old man, who received a third liver allograft and became worse with the onset of ischemic cholangiopathy and recurrent episodes of cholangitis, was admitted to our hospital due to the development of intra-abdominal abscesses. He received multiple antibiotic schemes, and after 3 months he was discharged, maintaining parenteral antibiotic at home. While he was on fluconazole prophylaxis, a breakthrough candidemia due to C. norvegensis occurred. In vitro susceptibilities of the isolate to several antifungal agents were as follows: amphotericin B MIC 0.5 mg/l, flucytosine 64 mg/l, fluconazole 64 mg/l, itraconazole 4 mg/l, voriconazole 0.75 mg/l, and caspofungin 0.047 mg/l. He was treated with anidulafungin with resolution of candidemia. CONCLUSIONS The use of fluconazole for antifungal prophylaxis may lead to the emergence of fluconazole-resistant Candida infections, with C. norvegensis being a possible emerging pathogen in organ transplant recipients.
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Affiliation(s)
- Gemma Sanclemente
- Department of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Spain
| | - Francesc Marco
- Department of Microbiology, "Centre Diagnòstic Biomèdic" (CDB), Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, University of Barcelona, Spain
| | - Carlos Cervera
- Department of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Spain
| | - Irma Hoyo
- Department of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Spain
| | - Jordi Colmenero
- Department of Hepatology, Hospital Clínic de Barcelona, University of Barcelona, Spain
| | - Cristina Pitart
- Department of Microbiology, "Centre Diagnòstic Biomèdic" (CDB), Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, University of Barcelona, Spain
| | - Manuel Almela
- Department of Microbiology, "Centre Diagnòstic Biomèdic" (CDB), Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, University of Barcelona, Spain
| | - Miquel Navasa
- Department of Hepatology, Hospital Clínic de Barcelona, University of Barcelona, Spain
| | - Asunción Moreno
- Department of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Spain.
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Perez-Ordoño L, Hoyo I, Sanclemente G, Ricart M, Cofan F, Perez-Villa F, de la Bellacasa JP, Moreno A, Cervera C. Late-onsetPneumocystis jiroveciipneumonia in solid organ transplant recipients. Transpl Infect Dis 2014; 16:324-8. [DOI: 10.1111/tid.12184] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/13/2013] [Accepted: 07/15/2013] [Indexed: 11/30/2022]
Affiliation(s)
- L. Perez-Ordoño
- Department of Infectious Diseases; Hospital Clinic de Barcelona-University of Barcelona; Barcelona Spain
| | - I. Hoyo
- Department of Infectious Diseases; Hospital Clinic de Barcelona-University of Barcelona; Barcelona Spain
| | - G. Sanclemente
- Department of Infectious Diseases; Hospital Clinic de Barcelona-University of Barcelona; Barcelona Spain
| | - M.J. Ricart
- Renal Transplant Unit; Hospital Clinic de Barcelona-University of Barcelona; Barcelona Spain
| | - F. Cofan
- Renal Transplant Unit; Hospital Clinic de Barcelona-University of Barcelona; Barcelona Spain
| | - F. Perez-Villa
- Heart Transplant Unit; Hospital Clinic de Barcelona-University of Barcelona; Barcelona Spain
| | - J. Puig de la Bellacasa
- Department of Microbiology; “Centre Diagnòstic Biomèdic” (CDB); Centre for International Health Research (CRESIB); Hospital Clinic de Barcelona-University of Barcelona; Barcelona Spain
| | - A. Moreno
- Department of Infectious Diseases; Hospital Clinic de Barcelona-University of Barcelona; Barcelona Spain
| | - C. Cervera
- Department of Infectious Diseases; Hospital Clinic de Barcelona-University of Barcelona; Barcelona Spain
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Hoyo I, Sanclemente G, Cervera C, Cofán F, Ricart MJ, Perez-Villa F, Navasa M, Marcos MA, Puig de la Bellacasa J, Moreno A. Opportunistic pulmonary infections in solid organ transplant recipients. Transplant Proc 2013; 44:2673-5. [PMID: 23146490 DOI: 10.1016/j.transproceed.2012.09.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Opportunistic pulmonary infections (OPI) represent common life-threatening complications after solid organ transplantation. Our objective was to describe pulmonary infections caused by opportunistic pathogens in solid-organ transplant patients. METHODS We analyzed all adult solid organ recipients (liver, heart, kidney, and pancreas) between July 2003 and June 2010, reporting all episodes of pulmonary opportunistic infection. RESULTS During the study period, 1656 solid organ transplants were performed and 188 opportunistic infections were diagnosed in 163 patients (incidence 10%). In 40 cases, the site of infection was the lung (21%) with 57.5% occurring between the first and sixth month posttransplantation. The most frequently isolated microorganism was Aspergillus spp (n = 25, 63%), followed by Pneumocystis jirovecii (n = 6 cs, 15%). Twenty-five patients with an opportunistic pulmonary infections died during the follow-up including, 16 related to the infection (40%). The causative organism responsible for the highest mortality was Aspergillus spp (n = 12; 48%). Twenty-one patients with an opportunistic nonrespiratory infection died, five of them related to it (4%). Opportunistic pulmonary infection was associated with an increased mortality rate (P < .001). There was a trend toward a higher mortality among patients who developed OPI during the first 6 months after transplantation. CONCLUSIONS Opportunistic pulmonary infections after solid organ transplantation are not infrequent. The period of risk for developing this infectious complications goes beyond the first 6 months posttransplantation. Mortality due to these infections was high in comparison to that of opportunistic nonrespiratory infections. It is important to keep a high index of suspicion for infectious complications during all posttransplant periods, as this is the first step toward a rapid diagnosis and adequate treatment.
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Affiliation(s)
- I Hoyo
- Service of Infectious Disease, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
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10
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Bartoletti M, Cervera C, Hoyo I, Linares L, Sanclemente G, Bosch J, Marco F, Cofán F, Ricart MJ, Navasa M, Moreno A. Incidence and outcome of earlyCandidaperitonitis after liver and pancreas transplantation. Mycoses 2012; 56:162-7. [DOI: 10.1111/j.1439-0507.2012.02227.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hoyo I, Martínez-Pastor J, Garcia-Ramiro S, Climent C, Brunet M, Cuesta M, Mensa J, Soriano A. Decreased serum linezolid concentrations in two patients receiving linezolid and rifampicin due to bone infections. ACTA ACUST UNITED AC 2012; 44:548-50. [PMID: 22385321 DOI: 10.3109/00365548.2012.663931] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Methicillin-resistant Staphylococcus is a common cause of orthopaedic implant infections. In such cases, rifampicin is the antibiotic of choice, but it should not be administered alone to avoid the selection of resistant mutants. Linezolid has activity against resistant staphylococci and a high oral bioavailability; therefore, it could be a good option for combining with rifampicin. We describe 2 patients admitted to our hospital due to orthopaedic implant infections, who received combination therapy with linezolid and rifampicin. In both cases, the trough serum concentration of linezolid during rifampicin treatment was below the minimum inhibitory concentration required to inhibit the growth of 90% of organisms (MIC(90)) for staphylococci, but increased after rifampicin withdrawal. This finding suggests an interaction between rifampicin and linezolid, and a possible explanation is discussed.
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Affiliation(s)
- Irma Hoyo
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
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12
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Linares L, Sanclemente G, Cervera C, Hoyo I, Cofán F, Ricart MJ, Pérez-Villa F, Navasa M, Marcos MA, Antón A, Pumarola T, Moreno A. Influence of cytomegalovirus disease in outcome of solid organ transplant patients. Transplant Proc 2012; 43:2145-8. [PMID: 21839217 DOI: 10.1016/j.transproceed.2011.05.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Despite recent advances in prevention and treatment, cytomegalovirus (CMV) is still a major complication in transplant patients. This study sought to analyze the incidence of CMV disease and its impact on patient and graft survival. METHODS Between June 2003 and December 2009, we included all kidney, liver, heart, and double transplant patients who underwent solid organ transplantation. They had 1-year posttransplant follow-up. RESULTS Among the 1427 patients who received kidney (n = 661), liver (n = 494), heart (n = 89), or double (n = 183) transplants, 103 (7.2%) displayed CMV disease. The incidence by type of transplant was: heart (n = 17, 19%), liver (n = 35, 7%), kidney (n = 41, 6.2%), or double transplant (n = 10, 5.5%; P < .001). In 59% of cases, the infection developed during the first 3 months after transplantation. CMV infections ranged from viral syndrome (n = 47, 45%) to tissue-invasive disease (n = 56, 55%), including 38% with gastrointestinal involvement. Relapsing episodes occurred in 12 patients (11%). Discordant donor/recipient CMV serology was present in 151 patients (donor positive/receptor negative), including 34 (22.5%) who developed primary CMV disease (P < .001). Coinfections mostly bacterial, were diagnosed in 38% of patients. An acute rejection episode was present in 31% of patients with CMV disease compared to 20% without this complication (P = .017). Crude mortality was significantly higher among patients with CMV disease (n = 18 patients [18%] vs 92 patients [7%]; P < .001). CONCLUSION Our data confirmed that CMV disease was associated with worse transplant outcomes, with higher incidences of acute rejection episodes and mortality.
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Affiliation(s)
- L Linares
- Services of Infectious Diseases, Hospital Clínic, Barcelona-IDIBAPS-University of Barcelona, Barcelona, Spain
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Cervera C, Fernández-Ruiz M, Valledor A, Linares L, Antón A, Ángeles Marcos M, Sanclemente G, Hoyo I, Cofán F, Ricart MJ, Pérez-Villa F, Navasa M, Pumarola T, Moreno A. Epidemiology and risk factors for late infection in solid organ transplant recipients. Transpl Infect Dis 2011; 13:598-607. [PMID: 21535336 DOI: 10.1111/j.1399-3062.2011.00646.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Information concerning the risk factors and outcome of late infection (LI) after solid organ transplantation (SOT) still remains scarce. METHODS We prospectively analyzed all patients undergoing SOT from July 2003 to March 2008, who survived the first 6 months after surgery and with a minimum 1-year follow-up. Risk factors associated with the development of bacterial and cytomegalovirus (CMV) LI and survival were identified. RESULTS Overall, 942 SOT recipients (491 kidney, 280 liver, 65 heart, and 106 double transplants) were included. During the study period 147 patients (15.6%) developed 276 episodes of LI (incidence rate, 0.43 per 1000 transplantation-days). Bacteria were the most prevalent etiology (88.0%). Primary sources of infection included urinary tract (36.9%), intra-abdominal (16.7%), and sepsis without source (13.4%). Independent risk factors for late bacterial infection were: age (hazard ratio [HR] [per year] 1.0; 95% confidence interval [CI]: 1.0-1,0), female gender (HR 1.7; 95%CI: 1.1-2.6), anti-hepatitis C virus (HCV) positive serostatus (HR 1.8; 95%CI: 1.1-3.0), chronic allograft dysfunction (HR 3.2; 95%CI: 1.7-6.1), early CMV disease (HR 2.2; 95%CI 1.2-4.1), and early bacterial infection (HR 2.5; 95%CI 1.6-3.8). The occurrence of chronic allograft dysfunction was an independent risk factor for late CMV disease (HR 6.5; 95%CI: 1.7-24.6), whereas immunosuppression based on mammalian target of rapamycin inhibitors protected against the development of late CMV disease (HR 0.3; 95%CI: 0.1-1.0). Cox model selected anti-HCV positive serostatus (adjusted HR [aHR] 2.67; 95%CI: 1.27-5.59), age (aHR [per year] 1.06; 95%CI: 1.02-1.10), and the occurrence of LI (aHR 9.12; 95%CI: 3.90-21.33) as independent factors for mortality. CONCLUSIONS LI did not constitute an uncommon complication in our cohort, and patients at risk may benefit from close clinical monitoring.
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Affiliation(s)
- C Cervera
- Department of Infectious Diseases-CIBERHED, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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Linares L, Cervera C, Hoyo I, Sanclemente G, Marco F, Cofán F, Ricart MJ, Navasa M, Moreno A. Klebsiella pneumoniae infection in solid organ transplant recipients: epidemiology and antibiotic resistance. Transplant Proc 2011; 42:2941-3. [PMID: 20970577 DOI: 10.1016/j.transproceed.2010.07.080] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Klebsiella pneumoniae is a well recognized source of nosocomial infection in solid-organ transplant (SOT) recipients. It is also the most common species capable of producing extended-spectrum β-lactamases (ESBL). Its treatment can therefore be a challenge owing to antibiotic resistance. METHODS Prospective study of all transplant recipients from July 2003 to December 2007 at our center. Klebsiellla pneumoniae infectious events were recorded. RESULTS A total of 1,057 patients were enrolled, 509 (48%) renal, 360 (34%) liver, 78 (7%) heart, and 110 (10%) double transplants. We diagnosed 116 episodes of K. pneumoniae infection in 92 patients during the study period, of which 62 were ESBL-producing strains (53%). Thirty-four episodes had bacteremia (29%), 15 of which were caused by ESBL-producing strains. There were no strains of K. pneumoniae producing carbapanemase (KPC). Forty-seven percent of the episodes occurred during the first month after transplantation. The incidence of infection by type of transplant was: renal 11%, liver 7%, cardiac 5%, and double transplant 6% (P=.075). The major sites of infection were urinary tract 72%, surgical wound 5%, intraabdominal 6%, catheter 5%, lung 1%, bloodstream 1%, and others 2%. ESBL-producing K. pneumoniae strains were more common in renal transplant patients (P=.035) and in those who required posttransplant dialysis (P=.022). There were 4 deaths in the first 30 days after the isolation of K. pneumoniae, and 3 of these cases were infections caused by ESBL-producing strains. CONCLUSIONS There was a high incidence of ESBL-producing K. pneumoniae infections in SOT recipients and renal transplant recipients, and those who required dialysis were more likely to develop infection by this strain. No KPC-producing organisms were found in our series. The existence of such a high level of resistance is a well recognized hospital threat, and appropriate policies and interventions should be addressed in high-risk patients.
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Affiliation(s)
- L Linares
- Service of Infectious Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Hoyo I, Linares L, Cervera C, Almela M, Marcos MA, Sanclemente G, Cofán F, Ricart MJ, Moreno A. Epidemiology of pneumonia in kidney transplantation. Transplant Proc 2011; 42:2938-40. [PMID: 20970576 DOI: 10.1016/j.transproceed.2010.07.082] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pneumonia remains an important cause of morbidity among solid organ transplant recipients. METHODS We prospectively evaluated all renal transplant patients at our center from July 2003 to December 2008 who had pneumonia that required hospitalization. We gathered data regarding underlying diseases as well as pretransplant, transplant, and posttransplant characteristics. Pneumonia defined according to the Centers for Disease Control and Prevention criteria was classified depending on its origin as community acquired or nosocomial. In all patients, microbiologic samples of respiratory secretions and blood were collected at the physician's discretion. The indication to perform a fiberoptic bronchoscopy was the presence of multiple, bilateral, or diffuse pulmonary infiltrates or the absence of a clinical or radiologic response after 3 days of antimicrobial therapy. RESULTS Among 610 kidney transplant recipients, we diagnosed 60 episodes of pneumonia in 54 patients (8.8%), of which 23 had a nosocomial origin (38%) and 37 community acquired (62%). Bacterial infection was the most frequent etiology (44%), followed by fungal in 4 (7%) and viral in 2 (3.5%). The most commonly isolated microorganism in nosocomial pneumonia was Pseudomonas aeruginosa (26%, among which 50% was multidrug resistant). In 34% there was no microbiologic isolation. The most common pathogen among community-acquired pneumonias was Strepococcus pneumoniae (11%). In 54% of cases there was no microbiologic confirmation of disease. The overall accuracy of bronchoalveolar lavage was 72%. A total of 21 patients with pneumonia (35%) were admitted to the intensive care unit; of these, 14 had a nosocomial origin (60%) and 9 (15%) died due to the infection (8 [88%] of whom had nosocomial pneumonia; P=.001). CONCLUSIONS Our data confirmed that nosocomial pulmonary infections are associated with considerable morbidity and mortality in renal transplant recipients. The performance of invasive procedures is useful for the diagnosis of pneumonia.
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Affiliation(s)
- I Hoyo
- Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Martina MN, Cervera C, Esforzado N, Linares L, Torregrosa V, Sanclemente G, Hoyo I, Cofan F, Oppenheimer F, Miro JM, Campistol JM, Moreno A. Toxoplasma gondii primary infection in renal transplant recipients. Two case reports and literature review. Transpl Int 2010; 24:e6-12. [PMID: 20955469 DOI: 10.1111/j.1432-2277.2010.01173.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Toxoplasmosis after solid organ transplantation is a complication associated with high morbidity and mortality. Universal prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) is effective to prevent post-transplant toxoplasmosis. We report two cases of renal transplant recipients with negative antibodies against Toxoplasma gondii pretransplant who developed toxoplasmosis after TMP-SMX discontinuation. We have also performed a review of published cases of primary toxoplasmosis after renal transplantation. Of 20 cases reviewed, 11 were male and the mean age was 37.8 years (SD = 13.8). Donor serology for T. gondii was determined in 15 donors, two of them (13%) with negative immunoglobulin (Ig)G and four (27%) with positive IgG and IgM antibodies. Fever was present in 85% of primary toxoplasmosis and hematologic abnormalities were observed in 69% of the cases. Ten patients died (50%). All patients with fatal outcomes had clinical evidence of toxoplasmosis during the early post-transplant period (first 90 days), while no patient with late toxoplasmosis died (P = 0.003). Primary toxoplasmosis is associated with high mortality rates and TMP-SMX prophylaxis can delay the onset of symptoms resulting in an improvement of prognosis.
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Affiliation(s)
- María-Noel Martina
- Renal Transplant Unit, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
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