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Fernández-Ruiz M, Gioia F, Bodro M, Gutiérrez Martín I, Sabé N, Rodriguez-Álvarez R, Corbella L, López-Viñau T, Valerio M, Illaro A, Salto-Alejandre S, Cordero E, Arnaiz de Las Revillas F, Fariñas MC, Muñoz P, Vidal E, Carratalà J, Goikoetxea J, Ramos-Martínez A, Moreno A, Martín-Dávila P, Fortún J, Aguado JM. Isavuconazole Versus Voriconazole as the First-line Therapy for Solid Organ Transplant Recipients With Invasive Aspergillosis: Comparative Analysis of 2 Multicenter Cohort Studies. Transplantation 2024:00007890-990000000-00775. [PMID: 38773846 DOI: 10.1097/tp.0000000000005082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
BACKGROUND Isavuconazole (ISA) and voriconazole (VORI) are recommended as the first-line treatment for invasive aspergillosis (IA). Despite theoretical advantages of ISA, both triazole agents have not been compared in solid organ transplant recipients. METHODS We performed a post hoc analysis of 2 retrospective multicenter cohorts of solid organ transplant recipients with invasive fungal disease (the SOTIS [Solid Organ Transplantation and ISavuconazole] and DiasperSOT [DIagnosis of ASPERgillosis in Solid Organ Transplantation] studies). We selected adult patients with proven/probable IA that were treated for ≥48 h with ISA (n = 57) or VORI (n = 77) as first-line therapy, either in monotherapy or combination regimen. The primary outcome was the rate of clinical response at 12 wk from the initiation of therapy. Secondary outcomes comprised 12-wk all-cause and IA-attributable mortality and the rates of treatment-emergent adverse events and premature treatment discontinuation. RESULTS Both groups were comparable in their demographics and major clinical and treatment-related variables. There were no differences in the rate of 12-wk clinical response between the ISA and VORI groups (59.6% versus 59.7%, respectively; odds ratio [OR], 0.99; 95% confidence interval [CI], 0.49-2.00). This result was confirmed after propensity score adjustment (OR, 0.81; 95% CI, 0.32-2.05) and matching (OR, 0.79; 95% CI, 0.31-2.04). All-cause and IA-attributable mortality were also similar. Patients in the ISA group were less likely to experience treatment-emergent adverse events (17.5% versus 37.7%; P = 0.011) and premature treatment discontinuation (8.8% versus 23.4%; P = 0.027). CONCLUSIONS Front-line treatment with ISA for posttransplant IA led to similar clinical outcomes than VORI, with better tolerability and higher treatment completion.
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Affiliation(s)
- Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre," Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Francesca Gioia
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Marta Bodro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Clinic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Isabel Gutiérrez Martín
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahona, Spain
| | - Núria Sabé
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Laura Corbella
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre," Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Teresa López-Viñau
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Unit of Pharmacy, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Maricela Valerio
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Aitziber Illaro
- Department of Pharmacy, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Sonsoles Salto-Alejandre
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen del Rocío, Institute of Biomedicine of Seville, Virgen del Rocío and Virgen Macarena University Hospitals/CSIC/University of Seville, Seville, Spain
| | - Elisa Cordero
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen del Rocío, Institute of Biomedicine of Seville, Virgen del Rocío and Virgen Macarena University Hospitals/CSIC/University of Seville, Seville, Spain
| | - Francisco Arnaiz de Las Revillas
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - María Carmen Fariñas
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
- Department of Medicine, School of Medicine, Universidad de Cantabria, Santander, Spain
| | - Patricia Muñoz
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisa Vidal
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Department of Medicine, School of Medicine, University of Córdoba, Córdoba, Spain
| | - Jordi Carratalà
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Josune Goikoetxea
- Unit of Infectious Diseases, Hospital Universitario de Cruces, Baracaldo, Spain
| | - Antonio Ramos-Martínez
- Unit of Infectious Diseases, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHSA), Majadahonda, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Asunción Moreno
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Clinic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Pilar Martín-Dávila
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Jesús Fortún
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad de Alcalá, Alcalá de Henares, Spain
| | - José María Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre," Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Fayos M, Arnaiz de Las Revillas F, González Quintanilla V, González-Rico C, Fariñas-Álvarez C, Parra JA, Fariñas MC. Progression of subclinical cardiovascular disease in patients with HIV. Rev Esp Quimioter 2024:fayos29apr2024. [PMID: 38682819 DOI: 10.37201/req/033.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Human immunodeficiency virus (HIV) infected patients are at increased risk of cardiovascular disease (CVD). Multidetector computed tomography (MDCT) stratifies cardiovascular risk in asymptomatic patients with subclinical atherosclerosis. The aim of this study was to determine the ability of MCTD and clinical and laboratory parameters to assess subclinical CVD progression in HIV patients. METHODS Prospective longitudinal cohort study of patients with at least 10 years of HIV infection and 5 years of antiretroviral therapy history, low cardiovascular risk and monitored for 6 years (2015-2021). All patients underwent clinical assessment, blood analysis, carotid ultrasound, and gated MDCT in 2015 and 2021. RESULTS Sixty-three patients (63.5% male) with a mean age of 49.9 years (standard deviation [SD], 10.5) were included in 2015; 63 of them were followed until 2021. Comparing the results from 2015 with those from 2021, Systematic Coronary Risk Estimation-2 (SCORE2) was 2.9% (SD, 2.1) vs. 4.4% (SD,3.1); Multi-Ethnic Study of Atherosclerosis score (MESA risk) was 3.4 (SD 5.8) vs. 6.0 (SD 8.6); coronary artery calcification CAC) score >100 was 11.1% vs. 25.4% (P < 0.05); and 11% vs. 27% had carotid plaques (P = 0.03). CONCLUSIONS After six years of follow-up, an increase in SCORE2, carotid plaques, CAC scoring and MESA risk was observed. MDCT findings, along with other clinical and laboratory parameters, could play an important role as a marker of CVD progression in the evaluation of patients with HIV and low cardiovascular risk.
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Affiliation(s)
| | | | | | | | | | | | - M C Fariñas
- María Carmen Fariñas. Infectious Diseases Service. Hospital Universitario Marqués de Valdecilla-IDIVAL. University of Cantabria. Santander. CIBERINFEC. Av. de Valdecilla s/n, 39008. Santander, Cantabria. Spain.
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Escrihuela-Vidal F, Berbel D, Fernández-Hidalgo N, Escolà-Vergé L, Muñoz P, Olmedo M, Goenaga MÁ, Goikoetxea J, Fariñas MC, De Alarcón A, Miró JM, Ojeda G, Plata A, Cuervo G, Carratalà J. Impact of Intermediate Susceptibility to Penicillin on Antimicrobial Treatment and Outcomes of Endocarditis Caused by Viridans and Gallolyticus Group Streptococci. Clin Infect Dis 2023; 77:1273-1281. [PMID: 37345869 DOI: 10.1093/cid/ciad375] [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: 03/22/2023] [Revised: 06/04/2023] [Accepted: 06/19/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Evidence supporting combination treatment with a beta-lactam plus an aminoglycoside (C-BA) for endocarditis caused by viridans and gallolyticus group streptococci (VGS-GGS) with intermediate susceptibility to penicillin (PENI-I) is lacking. We assessed the clinical characteristics and outcomes of PEN-I VGS-GGS endocarditis and compared the effectiveness and safety of C-BA with third-generation cephalosporin monotherapy. METHODS Retrospective analysis of prospectively collected data of a cohort of definite endocarditis caused by penicillin-susceptible and PENI-I VGS-GGS (penicillin minimum inhibitory concentration ranging from 0.25 to 2 mg/L) between 2008 and 2018 in 40 Spanish hospitals. We compared cases treated with monotherapy or with C-BA and performed multivariable analyses of risk factors for in-hospital and 1-year mortality. RESULTS A total of 914 consecutive cases of definite endocarditis caused by VGS-GGS with complete or intermediate susceptibility to penicillin were included. A total of 688 (75.3%) were susceptible to penicillin and 226 (24.7%) were PENI-I. Monotherapy was used in 415 (45.4%) cases (cephalosporin in 331 cases) and 499 (54.6%) cases received C-BA. In-hospital mortality was 11.9%, and 190 (20.9%) patients developed acute kidney injury. Heart failure (odds ratio [OR]: 6.06; 95% confidence interval [CI]: 1.37-26.87; P = .018), central nervous system emboli (OR: 9.83; 95% CI: 2.17-44.49; P = .003) and intracardiac abscess (OR: 13.47; 95% CI: 2.24-81.08; P = .004) were independently associated with in-hospital mortality among PEN-I VGS-GGS cases, while monotherapy was not (OR: 1.01; 95% CI: .26-3.96; P = .982). CONCLUSIONS Our findings support the use of cephalosporin monotherapy in PEN-I VGS-GGS endocarditis in order to avoid nephrotoxicity without adversely affecting patient outcomes.
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Affiliation(s)
- Francesc Escrihuela-Vidal
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d´Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain
| | - Damaris Berbel
- Department of Microbiology, Hospital Universitari de Bellvitge, IDIBELL (Institut d´Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Núria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Campus Hospitalari, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Escolà-Vergé
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, 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
| | - María Olmedo
- Clinical Microbiology and Infectious Diseases Department, 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
| | - Miguel Ángel Goenaga
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián, Spain
| | - Josune Goikoetxea
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Spain
| | - María Carmen Fariñas
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - Arístides De Alarcón
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología (UCEIMP), Grupo de Resistencias Bacterianas y Antimicrobianos CIBERINFEC, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - José M Miró
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Guillermo Ojeda
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Antonio Plata
- Servicio de Enfermedades Infecciosas, UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Guillermo Cuervo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d´Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Fernández-Manteca MG, Ocampo-Sosa AA, Ruiz de Alegría-Puig C, Pía Roiz M, Rodríguez-Grande J, Madrazo F, Calvo J, Rodríguez-Cobo L, López-Higuera JM, Fariñas MC, Cobo A. Automatic classification of Candida species using Raman spectroscopy and machine learning. Spectrochim Acta A Mol Biomol Spectrosc 2023; 290:122270. [PMID: 36580749 DOI: 10.1016/j.saa.2022.122270] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
One of the problems that most affect hospitals is infections by pathogenic microorganisms. Rapid identification and adequate, timely treatment can avoid fatal consequences and the development of antibiotic resistance, so it is crucial to use fast, reliable, and not too laborious techniques to obtain quick results. Raman spectroscopy has proven to be a powerful tool for molecular analysis, meeting these requirements better than traditional techniques. In this work, we have used Raman spectroscopy combined with machine learning algorithms to explore the automatic identification of eleven species of the genus Candida, the most common cause of fungal infections worldwide. The Raman spectra were obtained from more than 220 different measurements of dried drops from pure cultures of each Candida species using a Raman Confocal Microscope with a 532 nm laser excitation source. After developing a spectral preprocessing methodology, a study of the quality and variability of the measured spectra at the isolate and species level, and the spectral features contributing to inter-class variations, showed the potential to discriminate between those pathogenic yeasts. Several machine learning and deep learning algorithms were trained using hyperparameter optimization techniques to find the best possible classifier for this spectral data, in terms of accuracy and lowest possible overfitting. We found that a one-dimensional Convolutional Neural Network (1-D CNN) could achieve above 80 % overall accuracy for the eleven classes spectral dataset, with good generalization capabilities.
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Affiliation(s)
| | - Alain A Ocampo-Sosa
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain; Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Carlos Ruiz de Alegría-Puig
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain; Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - María Pía Roiz
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain; Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Jorge Rodríguez-Grande
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain; Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Fidel Madrazo
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Jorge Calvo
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain; Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Rodríguez-Cobo
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain; Photonics Engineering Group, Universidad de Cantabria, Santander, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | - José Miguel López-Higuera
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain; Photonics Engineering Group, Universidad de Cantabria, Santander, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | - María Carmen Fariñas
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Spain
| | - Adolfo Cobo
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain; Photonics Engineering Group, Universidad de Cantabria, Santander, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain.
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5
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Pérez-Nadales E, Fernández-Ruiz M, Natera AM, Gutiérrez-Gutiérrez B, Mularoni A, Russelli G, Pierrotti LC, Freire MP, Falcone M, Tiseo G, Tumbarello M, Raffaelli F, Abdala E, Bodro M, Gervasi E, Fariñas MC, Seminari EM, Castón JJ, Marín-Sanz JA, Gálvez-Soto V, Rana MM, Loeches B, Martín-Dávila P, Pascual Á, Rodríguez-Baño J, Aguado JM, Martínez-Martínez L, Torre-Cisneros J. Efficacy of ceftazidime-avibactam in solid organ transplant recipients with bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae. Am J Transplant 2023:S1600-6135(23)00354-4. [PMID: 37028515 DOI: 10.1016/j.ajt.2023.03.011] [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: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 04/08/2023]
Abstract
We aimed to compare the efficacy of ceftazidime-avibactam (CAZ-AVI) versus the best available therapy (BAT) in solid organ transplant (SOT) recipients with bloodstream infection caused by carbapenemase-producing Klebsiella pneumoniae (CPKP-BSI). A retrospective (2016-2021) observational cohort study was performed in 14 INCREMENT-SOT centers (ClinicalTrials.gov identifier: NCT02852902). Outcomes were 14-day and 30-day clinical success (complete resolution of attributable manifestations, adequate source control and negative follow-up blood cultures) and 30-day all-cause mortality. Multivariable logistic and Cox regression analyses adjusted for the propensity score to receive CAZ-AVI were constructed. Among 210 SOT recipients with CPKP-BSI, 149 received active primary therapy with CAZ-AVI (66/149) or BAT (83/149). Patients treated with CAZ-AVI had higher 14-day (80.7% versus 60.6%, P=0.011) and 30-day (83.1% versus 60.6%, P=0.004) clinical success and lower 30-day mortality (13.25% versus 27.3%, P=0.053) than those receiving BAT. In the adjusted analysis, CAZ-AVI increased the probability of 14-day (adjusted odds ratio [aOR]: 2.65; 95% confidence interval [95%CI]: 1.03-6.84, P=0.044) and 30-day clinical success (aOR: 3.14; 95%CI: 1.17-8.40; P=0.023). In contrast, CAZ-AVI therapy was not independently associated with 30-day mortality. In the CAZ-AVI group, combination therapy was not associated with better outcomes. In conclusion, CAZ-AVI may be considered a first-line treatment in SOT recipients with CPKP-BSI. SUMMARY SENTENCE: We retrospectively analyzed a cohort of 210 SOT recipients with bloodstream infection due to carbapenemase-producing Klebsiella pneumoniae. Among 149 patients receiving active therapy, 83 were treated with CAZ-AVI and 66 with other regimens. CAZ-AVI was an independent predictor of 14-day and 30-day clinical success.
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Affiliation(s)
- Elena Pérez-Nadales
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, Cordoba, Spain; Department of Agricultural Chemistry, Soil Science and Microbiology, University of Cordoba, Cordoba, Spain.
| | - Mario Fernández-Ruiz
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, "12 de Octubre" University Hospital, Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain
| | - Alejandra M Natera
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Belén Gutiérrez-Gutiérrez
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Clinical Unit of Infectious Diseases and Microbiology, University Hospital Virgen Macarena and Departments of Medicine and Microbiology, University of Seville, Institute of Biomedicine of Seville (University Hospital Virgen Macarena/CSIC/University of Seville), Seville, Spain
| | - Alessandra Mularoni
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Giovanna Russelli
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Ligia Camera Pierrotti
- Department of Infectious Diseases, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Maristela Pinheiro Freire
- Working Committee for Hospital Epidemiology and Infection Control, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Giusy Tiseo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Mario Tumbarello
- Dipartimento Biotecnologie Mediche, Università di Siena, Siena, Italy
| | - Francesca Raffaelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Edson Abdala
- Faculdade de Medicina da Universidade de Sao Paulo, Instituto do Cancer do Estado de Sao Paulo, Brazil
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Elena Gervasi
- Infectious Diseases Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - María Carmen Fariñas
- Department of Infectious Diseases, Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain
| | | | - Juan José Castón
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, Cordoba, Spain; Clinical Unit of Infectious Diseases, Reina Sofía University Hospital, Cordoba, Spain
| | - Juan Antonio Marín-Sanz
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Víctor Gálvez-Soto
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | | | - Belén Loeches
- Clinical Unit of Infectious Diseases, La Paz University Hospital, Madrid, Spain
| | - Pilar Martín-Dávila
- Infectious Diseases Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Álvaro Pascual
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Clinical Unit of Infectious Diseases and Microbiology, University Hospital Virgen Macarena and Departments of Medicine and Microbiology, University of Seville, Institute of Biomedicine of Seville (University Hospital Virgen Macarena/CSIC/University of Seville), Seville, Spain
| | - Jesús Rodríguez-Baño
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Clinical Unit of Infectious Diseases and Microbiology, University Hospital Virgen Macarena and Departments of Medicine and Microbiology, University of Seville, Institute of Biomedicine of Seville (University Hospital Virgen Macarena/CSIC/University of Seville), Seville, Spain
| | - José María Aguado
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, "12 de Octubre" University Hospital, Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain
| | - Luis Martínez-Martínez
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, Cordoba, Spain; Department of Agricultural Chemistry, Soil Science and Microbiology, University of Cordoba, Cordoba, Spain; Clinical Unit of Microbiology, Reina Sofía University Hospital, Cordoba, Spain
| | - Julián Torre-Cisneros
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, Cordoba, Spain; Department of Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain; Clinical Unit of Infectious Diseases, Reina Sofía University Hospital, Cordoba, Spain
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6
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García-Fernández S, Calvo J, Cercenado E, Suárez-Barrenechea AI, Fernández-Billón M, Castillo FJ, Gálvez-Benítez L, Tubau F, Figueroa Cerón RE, Hernández-Cabezas A, González Romo F, Fariñas MC, Gómez M, Díaz-Regañón J, Cantón R. Activity of imipenem/relebactam against Enterobacterales and Pseudomonas aeruginosa in Spain. SMART 2016-2020. Rev Esp Quimioter 2023; 36:302-309. [PMID: 36951688 DOI: 10.37201/req/007.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To determine susceptibility to the novel β-lactam/β-lactamase inhibitor combination imipenem/relebactam in clinical isolates recovered from intra-abdominal (IAI), urinary (UTI), respiratory (RTI) and bloodstream (BSI) infections in the SMART (Study for Monitoring Antimicrobial Resistance Trends) study in SPAIN during 2016 - 2020. METHODS Broth microdilution MICs for imipenem/relebactam and comparators were determined by a central laboratory against isolates of Enterobacterales and Pseudomonas aeruginosa. MICs were interpreted using EUCAST-2021 breakpoints. RESULTS In total, 5,210 Enterobacterales and 1,418 P. aeruginosa clinical isolates were analyzed. Imipenem/relebactam inhibited 98.8% of Enterobacterales. Distinguishing by source of infection susceptibility was 99.1% in BSI, 99.2% in IAI, 97.9% in RTI, and 99.2% in UTI. Of intensive care unit isolates (ICU) 97.4% were susceptible and of non-ICU isolates 99.2% were susceptible. In Enterobacterales, activity against Class A, Class B and Class D carbapenemases was 96.2%, 15.4% and 73.2%, respectively. In P. aeruginosa, imipenem/relebactam was active in 92.2% of isolates. By source of infection it was 94.8% in BSI, 92.9% in IAI, 91.7% in RTI, and 93.1% in UTI. An 88.7% of ICU isolates and 93.6% of non-ICU isolates were susceptible to imipenem/relebactam. Imipenem/relebactam remained active against P. aeruginosa ceftazidime-resistant (76.3%), cefepime-resistant (73.6%), imipenem-resistant (71.5%) and piperacillin-resistant (78.7%) isolates. Of all multidrug-resistant or difficult-to-treat resistance P. aeruginosa isolates, 75.1% and 46.2%, respectively, were susceptible to imipenem/relebactam. CONCLUSIONS Imipenem/relebactam showed high rates of susceptibility in Enterobacterales and P. aeruginosa isolates from different sources of infection as well as depending on patients' location (ICU or non-ICU scenarios).
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Affiliation(s)
- S García-Fernández
- Sergio García-Fernández, Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
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7
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Pablo-Marcos D, Siller M, Agüero J, Álvarez-Justel A, García-Fernández S, de la Fuente SV, Goicoechea P, Rodríguez-Lozano J, Ocampo-Sosa A, Lucas-Fernández J, Fariñas MC, Fernández J, Fraile-Ribot PA, Aracil B, Oteo-Iglesias J, Calvo-Montes J. Are GES carbapenemases underdiagnosed? An allelic discrimination assay for their accurate detection and differentiation. J Microbiol Methods 2023; 207:106694. [PMID: 36871870 DOI: 10.1016/j.mimet.2023.106694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
GES (Guiana Extended Spectrum) carbapenemases belong to "minor class A carbapenemases" and its prevalence could be underestimated due to the lack of specific tests. The aim of this study was to develop an easy PCR method to differentiate between GES β-lactamases with or without carbapenemase activity, based on an allelic discrimination system of SNPs that encode E104K and G170S mutations, without need of sequencing. Two pair of primers and Affinity Plus probes, labeled with different fluorophores; FAM/IBFQ and YAK/IBFQ, were designed for each one of the SNPs. This allelic discrimination assay allows to detect in real time the presence of all type of GES- β-lactamases, being able to differentiate between carbapenemases and extended-spectrum β-lactamase (ESBL), through a quick PCR test that avoid costly sequencing approaches and could help to decrease the current underdiagnosis of minor carbapenemases that scape of phenotypic screenings.
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Affiliation(s)
- D Pablo-Marcos
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
| | - M Siller
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - J Agüero
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - A Álvarez-Justel
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - S García-Fernández
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - S Velasco de la Fuente
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - P Goicoechea
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - J Rodríguez-Lozano
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - A Ocampo-Sosa
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - J Lucas-Fernández
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - M C Fariñas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - J Fernández
- Servicio de Microbiología, Hospital Universitario Central de Asturias. Grupo de Microbiología Traslacional, ISPA, s, Asturias, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - P A Fraile-Ribot
- Servicio de Microbiología, Hospital Universitario Son Espases e Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - B Aracil
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - J Oteo-Iglesias
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - J Calvo-Montes
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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8
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Tattevin P, Muñoz P, Moreno A, Hékimian G, Delahaye F, Duval X, Castel MÁ, Hasse B, Jaramillo N, Vincelj J, Wray D, Limonta S, Fariñas MC, Mestres CA, Miro JM. Heart transplantation as salvage treatment of intractable infective endocarditis. Infect Dis (Lond) 2023; 55:370-374. [PMID: 36866973 DOI: 10.1080/23744235.2023.2184490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND For infective endocarditis (IE) with extensive perivalvular lesions or end-stage cardiac failure, heart transplantation (HT) may be the last resort. METHODS We retrospectively collected all cases of HT for IE within the International Collaboration on Endocarditis (ICE) network. RESULTS Between 1991 and 2021, 20 patients (5 women, 15 men), median age 50 years [interquartile range, 29-61], underwent HT for IE in Spain (n = 9), France (n = 6), Switzerland (n = 2), Colombia, Croatia, and USA (n = 1). IE affected prosthetic (n = 10), and native valves (n = 10), primarily aortic (n = 11) and mitral (n = 6). The main pathogens were oral streptococci (n = 8), Staphylococcus aureus (n = 5), and Enterococcus faecalis (n = 2). The major complications included heart failure (n = 18), peri-annular abscess (n = 10), and prosthetic valve dehiscence (n = 4). Eighteen patients had previous cardiac surgery for this episode of IE, and four were on circulatory support before HT (left ventricular assist-device and extra-corporeal membrane oxygenation, 2 patients each). The median time interval between first symptoms of IE and HT was 44.5 days [22-91.5]. The main post-HT complication was acute rejection (n = 6). Seven patients died (35%), four during the first month post-HT. Thirteen (81%) of the 16 patients discharged from the hospital survived with a median follow-up of 35.5 months [4-96.5] after HT, and no relapse of IE. CONCLUSIONS IE is not an absolute contraindication for HT: Our case series and the literature review support that HT may be considered as a salvage treatment in highly-selected patients with intractable IE.
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Affiliation(s)
- Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | | | - Asuncion Moreno
- Infectious Diseases Service. Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Guillaume Hékimian
- Institut de Cardiométabolisme et Nutrition (ICAN), Service de Médecine Intensive Réanimation, Hôpital La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | | | - Xavier Duval
- Université Paris-Cité APHP; Inserm CIC, Paris, France
| | - María Ángeles Castel
- Unit for Heart Failure and Heart Transplantation, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Josip Vincelj
- Department of Cardiology, Medikol Polyclinic, Zagreb, Croatia
| | - Dannah Wray
- Medical University of South Carolina, Charleston, SC, USA
| | - Silvia Limonta
- Infectious Diseases, Ospedale San Gerardo, ASST Monza, Italy
| | - María Carmen Fariñas
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Carlos A Mestres
- Department of Cardiovascular Surgery, University Hospital, Zurich, Switzerland
| | - Jose M Miro
- Infectious Diseases Service. Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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9
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Mejia-Chew C, Carver PL, Rutjanawech S, Camargo LFA, Fernandes R, Belga S, Daniels SA, Müller NJ, Burkhard S, Theodoropoulos NM, Postma DF, van Duijn PJ, Fariñas MC, González-Rico C, Hand J, Lowe A, Bodro M, Vanino E, Cruz AF, Ramos A, Makek MJ, Mjahed RB, Manuel O, Kamar N, Calvo-Cano A, Carrasco LR, Muñoz P, Rodríguez S, Pérez-Recio S, Sabé N, Álvarez RR, Silva JT, Mularoni A, Vidal E, Alonso-Titos J, Del Rosal T, Classen AY, Goss CW, Agarwal M, López-Medrano F. Risk Factors for Nontuberculous Mycobacteria Infections in Solid Organ Transplant Recipients: A Multinational Case-Control Study. Clin Infect Dis 2023; 76:e995-e1003. [PMID: 35879465 DOI: 10.1093/cid/ciac608] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 03/28/2022] [Revised: 07/10/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Risk factors for nontuberculous mycobacteria (NTM) infections after solid organ transplant (SOT) are not well characterized. Here we aimed to describe these factors. METHODS Retrospective, multinational, 1:2 matched case-control study that included SOT recipients ≥12 years old diagnosed with NTM infection from 1 January 2008 to 31 December 2018. Controls were matched on transplanted organ, NTM treatment center, and post-transplant survival greater than or equal to the time to NTM diagnosis. Logistic regression on matched pairs was used to assess associations between risk factors and NTM infections. RESULTS Analyses included 85 cases and 169 controls (59% male, 88% White, median age at time of SOT of 54 years [interquartile range {IQR} 40-62]). NTM infection occurred in kidney (42%), lung (35%), heart and liver (11% each), and pancreas transplant recipients (1%). Median time from transplant to infection was 21.6 months (IQR 5.3-55.2). Most underlying comorbidities were evenly distributed between groups; however, cases were older at the time of NTM diagnosis, more frequently on systemic corticosteroids and had a lower lymphocyte count (all P < .05). In the multivariable model, older age at transplant (adjusted odds ratio [aOR] 1.04; 95 confidence interval [CI], 1.01-1.07), hospital admission within 90 days (aOR, 3.14; 95% CI, 1.41-6.98), receipt of antifungals (aOR, 5.35; 95% CI, 1.7-16.91), and lymphocyte-specific antibodies (aOR, 7.73; 95% CI, 1.07-56.14), were associated with NTM infection. CONCLUSIONS Risk of NTM infection in SOT recipients was associated with older age at SOT, prior hospital admission, receipt of antifungals or lymphocyte-specific antibodies. NTM infection should be considered in SOT patients with these risk factors.
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Affiliation(s)
- Carlos Mejia-Chew
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peggy L Carver
- College of Pharmacy, The University of Michigan, Ann Arbor, Michigan, USA
| | - Sasinuch Rutjanawech
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - Sara Belga
- Division of Infectious Diseases, Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Shay-Anne Daniels
- Division of Infectious Diseases, Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Nicolas J Müller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Sara Burkhard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Nicole M Theodoropoulos
- Department of Medicine, Division of Infectious Diseases & Immunology, UMass Chan Medical School, Worchester, Massachusetts, USA
| | - Douwe F Postma
- Department of Internal Medicine and Infectious Diseases, University Medical Center Groningen, The Netherlands
| | - Pleun J van Duijn
- Department of Clinical Microbiology, University Medical Center Groningen, The Netherlands
| | - María Carmen Fariñas
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Spain.,CIBERINFEC (CB21/13/00068), ISCIII, Madrid, Spain
| | - Claudia González-Rico
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Spain.,CIBERINFEC (CB21/13/00068), ISCIII, Madrid, Spain
| | - Jonathan Hand
- Department of Infectious Diseases, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Adam Lowe
- Department of Infectious Diseases, Ochsner Medical Center, New Orleans, Louisiana, USA
| | | | - Elisa Vanino
- Infectious Diseases Unit, IRCCS Policlinico Sant'Orsola, University of Bologna, Italy.,Infectious Diseases Unit, Ravenna Hospital, AUSL Romagna, Italy
| | - Ana Fernández Cruz
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Antonio Ramos
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Ribal Bou Mjahed
- Lausanne University Hospital (CHUV), University of Lausanne, Switzerland
| | - Oriol Manuel
- Lausanne University Hospital (CHUV), University of Lausanne, Switzerland
| | - Nassim Kamar
- Department of Nephrology and Organs Transplantation, Toulouse Rangueil University, INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Disease (Infinity), Paul Sabatier University, Toulouse, France
| | - Antonia Calvo-Cano
- Infectious Disease Department, University Hospital Badajoz, Badajoz, Spain
| | | | | | | | - Sandra Pérez-Recio
- Tuberculosis Unit, Department of Infectious Diseases, Bellvitge University Hospital Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Sabé
- Tuberculosis Unit, Department of Infectious Diseases, Bellvitge University Hospital Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - José Tiago Silva
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación del Hospital 12 de Octubre (imas12), School of Medicine, Universidad Complutense, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Alessandra Mularoni
- IRCC-ISMETT, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Elisa Vidal
- Infectious Diseases Service, Reina Sofia University Hospital, Madrid, Spain
| | - Juana Alonso-Titos
- Nephrology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Teresa Del Rosal
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain
| | - Annika Y Classen
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Charles W Goss
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mansi Agarwal
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Francisco López-Medrano
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación del Hospital 12 de Octubre (imas12), School of Medicine, Universidad Complutense, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
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10
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Bodro M, Cervera C, Linares L, Suárez B, Llopis J, Sanclemente G, Casadó-Llombart S, Fernández-Ruiz M, Fariñas MC, Cantisan S, Montejo M, Cordero E, Oriol I, Marcos MA, Lozano F, Moreno A. Polygenic Innate Immunity Score to Predict the Risk of Cytomegalovirus Infection in CMV D+/R- Transplant Recipients. A Prospective Multicenter Cohort Study. Front Immunol 2022; 13:897912. [PMID: 36016941 PMCID: PMC9397545 DOI: 10.3389/fimmu.2022.897912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Several genetic polymorphisms of the innate immune system have been described to increase the risk of cytomegalovirus (CMV) infection in transplant patients. The aim of this study was to assess the impact of a polygenic score to predict CMV infection and disease in high risk CMV transplant recipients (heart, liver, kidney or pancreas). On hundred and sixteen CMV-seronegative recipients of grafts from CMV-seropositive donors undergoing heart, liver, and kidney or pancreas transplantation from 7 centres were prospectively included for this purpose during a 2-year period. All recipients received 100-day prophylaxis with valganciclovir. CMV infection occurred in 61 patients (53%) at 163 median days from transplant, 33 asymptomatic replication (28%) and 28 CMV disease (24%). Eleven patients (9%) had recurrent CMV infection. Clinically and/or functionally relevant single nucleotide polymorphisms (SNPs) from TLR2, TLR3, TLR4, TLR7, TLR9, AIM2, MBL2, IL28, IFI16, MYD88, IRAK2 and IRAK4 were assessed by real time polymerase chain reaction (RT-PCR) or sequence-based typing (PCR-SBT). A polygenic score including the TLR4 (rs4986790/rs4986791), TLR9 (rs3775291), TLR3 (rs3775296), AIM2 (rs855873), TLR7 (rs179008), MBL (OO/OA/XAO), IFNL3/IL28B (rs12979860) and IFI16 (rs6940) SNPs was built based on the risk of CMV infection and disease. The CMV score predicted the risk of CMV disease with an AUC of the model of 0.68, with sensitivity and specificity of 64.3 and 71.6%, respectively. Even though further studies are needed to validate this score, its use would represent an effective model to develop more robust scores predicting the risk of CMV disease in donor/recipient mismatch (D+/R-) transplant recipients.
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Affiliation(s)
- Marta Bodro
- Infectious Diseases Department, Hospital Clinic de Barcelona - Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- *Correspondence: Marta Bodro,
| | - Carlos Cervera
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Laura Linares
- Infectious Diseases Department, Hospital Clinic de Barcelona - Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Belén Suárez
- Immunology Department, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jaume Llopis
- Infectious Diseases Department, Hospital Clinic de Barcelona - Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Gemma Sanclemente
- Infectious Diseases Department, Hospital Clinic de Barcelona - Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sergi Casadó-Llombart
- Immunoreceptors of the Innate and Adaptive Sistems, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mario Fernández-Ruiz
- Hospital Universitario “12 de Octubre”, Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - María Carmen Fariñas
- University Hospital “Marqués de Valdecilla”, Instituto de Investigación “Marqués de Valdecilla” (IDIVAL), University of Cantabria, Santander, Spain
| | - Sara Cantisan
- Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain
| | - Miguel Montejo
- Hospital Universitario Cruces, Barakaldo, Universidad del País Vasco, Bilbao, Spain
| | - Elisa Cordero
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena University Hospitals/CSIC/University of Seville, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
| | - Isabel Oriol
- University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - María Angeles Marcos
- Infectious Diseases Department, Hospital Clinic de Barcelona - Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Francisco Lozano
- Immunology Department, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
- Immunoreceptors of the Innate and Adaptive Sistems, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Biomedicine Department, University of Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Infectious Diseases Department, Hospital Clinic de Barcelona - Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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11
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Cruz R, Almeida SDD, Heredia ML, Quintela I, Ceballos FC, Pita G, Lorenzo-Salazar JM, González-Montelongo R, Gago-Domínguez M, Porras MS, Castaño JAT, Nevado J, Aguado JM, Aguilar C, Aguilera-Albesa S, Almadana V, Almoguera B, Alvarez N, Andreu-Bernabeu Á, Arana-Arri E, Arango C, Arranz MJ, Artiga MJ, Baptista-Rosas RC, Barreda-Sánchez M, Belhassen-Garcia M, Bezerra JF, Bezerra MAC, Boix-Palop L, Brion M, Brugada R, Bustos M, Calderón EJ, Carbonell C, Castano L, Castelao JE, Conde-Vicente R, Cordero-Lorenzana ML, Cortes-Sanchez JL, Corton M, Darnaude MT, De Martino-Rodríguez A, Campo-Pérez V, Bustamante AD, Domínguez-Garrido E, Luchessi AD, Eirós R, Sanabria GME, Fariñas MC, Fernández-Robelo U, Fernández-Rodríguez A, Fernández-Villa T, Gil-Fournier B, Gómez-Arrue J, Álvarez BG, Quirós FGB, González-Peñas J, Gutiérrez-Bautista JF, Herrero MJ, Herrero-Gonzalez A, Jimenez-Sousa MA, Lattig MC, Borja AL, Lopez-Rodriguez R, Mancebo E, Martín-López C, Martín V, Martinez-Nieto O, Martinez-Lopez I, Martinez-Resendez MF, Martinez-Perez Á, Mazzeu JA, Macías EM, Minguez P, Cuerda VM, Silbiger VN, Oliveira SF, Ortega-Paino E, Parellada M, Paz-Artal E, Santos NPC, Pérez-Matute P, Perez P, Pérez-Tomás ME, Perucho T, Pinsach-Abuin ML, Pompa-Mera EN, Porras-Hurtado GL, Pujol A, León SR, Resino S, Fernandes MR, Rodríguez-Ruiz E, Rodriguez-Artalejo F, Rodriguez-Garcia JA, Ruiz-Cabello F, Ruiz-Hornillos J, Ryan P, Soria JM, Souto JC, Tamayo E, Tamayo-Velasco A, Taracido-Fernandez JC, Teper A, Torres-Tobar L, Urioste M, Valencia-Ramos J, Yáñez Z, Zarate R, Nakanishi T, Pigazzini S, Degenhardt F, Butler-Laporte G, Maya-Miles D, Bujanda L, Bouysran Y, Palom A, Ellinghaus D, Martínez-Bueno M, Rolker S, Amitrano S, Roade L, Fava F, Spinner CD, Prati D, Bernardo D, Garcia F, Darcis G, Fernández-Cadenas I, Holter JC, Banales JM, Frithiof R, Duga S, Asselta R, Pereira AC, Romero-Gómez M, Nafría-Jiménez B, Hov JR, Migeotte I, Renieri A, Planas AM, Ludwig KU, Buti M, Rahmouni S, Alarcón-Riquelme ME, Schulte EC, Franke A, Karlsen TH, Valenti L, Zeberg H, Richards B, Ganna A, Boada M, Rojas I, Ruiz A, Sánchez P, Real LM, Guillen-Navarro E, Ayuso C, González-Neira A, Riancho JA, Rojas-Martinez A, Flores C, Lapunzina P, Carracedo Á. Novel genes and sex differences in COVID-19 severity. Hum Mol Genet 2022; 31:3789-3806. [PMID: 35708486 DOI: 10.1093/hmg/ddac132] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 01/08/2023] Open
Abstract
Here we describe the results of a genome-wide study conducted in 11 939 COVID-19 positive cases with an extensive clinical information that were recruited from 34 hospitals across Spain (SCOURGE consortium). In sex-disaggregated genome-wide association studies for COVID-19 hospitalization, genome-wide significance (p < 5x10-8) was crossed for variants in 3p21.31 and 21q22.11 loci only among males (p = 1.3x10-22 and p = 8.1x10-12, respectively), and for variants in 9q21.32 near TLE1 only among females (p = 4.4x10-8). In a second phase, results were combined with an independent Spanish cohort (1598 COVID-19 cases and 1068 population controls), revealing in the overall analysis two novel risk loci in 9p13.3 and 19q13.12, with fine-mapping prioritized variants functionally associated with AQP3 (p = 2.7x10-8) and ARHGAP33 (p = 1.3x10-8), respectively. The meta-analysis of both phases with four European studies stratified by sex from the Host Genetics Initiative confirmed the association of the 3p21.31 and 21q22.11 loci predominantly in males and replicated a recently reported variant in 11p13 (ELF5, p = 4.1x10-8). Six of the COVID-19 HGI discovered loci were replicated and an HGI-based genetic risk score predicted the severity strata in SCOURGE. We also found more SNP-heritability and larger heritability differences by age (<60 or ≥ 60 years) among males than among females. Parallel genome-wide screening of inbreeding depression in SCOURGE also showed an effect of homozygosity in COVID-19 hospitalization and severity and this effect was stronger among older males. In summary, new candidate genes for COVID-19 severity and evidence supporting genetic disparities among sexes are provided.
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Affiliation(s)
- Raquel Cruz
- Centro Nacional de Genotipado (CEGEN), Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.,Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas (CIMUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Silvia Diz-de Almeida
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas (CIMUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Miguel López Heredia
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Inés Quintela
- Centro Nacional de Genotipado (CEGEN), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco C Ceballos
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología (CNM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Guillermo Pita
- Human Genotyping-CEGEN Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - José M Lorenzo-Salazar
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
| | | | - Manuela Gago-Domínguez
- Fundación Pública Galega de Medicina Xenómica, Sistema Galego de Saúde (SERGAS), Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Marta Sevilla Porras
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz-IDIPAZ, Madrid, Spain
| | - Jair Antonio Tenorio Castaño
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz-IDIPAZ, Madrid, Spain.,ERN-ITHACA-European Reference Network
| | - Julian Nevado
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz-IDIPAZ, Madrid, Spain.,ERN-ITHACA-European Reference Network
| | - Jose María Aguado
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0002), Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain.,Centre for Biomedical Network Research on Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Sergio Aguilera-Albesa
- Pediatric Neurology Unit, Department of Pediatrics, Navarra Health Service Hospital, Pamplona, Spain.,Navarra Health Service, Navarra BioMed Research Group, Pamplona, Spain
| | | | - Berta Almoguera
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Department of Genetics & Genomics, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz University Hospital - Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain
| | - Nuria Alvarez
- Human Genotyping-CEGEN Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - Álvaro Andreu-Bernabeu
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0002), Instituto de Salud Carlos III, Madrid, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón (IiSGM), Madrid, Spain
| | - Eunate Arana-Arri
- Biocruces Bizkai HRI, Bizkaia, Spain.,Cruces University Hospital, Osakidetza, Bizkaia, Spain
| | - Celso Arango
- School of Medicine, Universidad Complutense, Madrid, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón (IiSGM), Madrid, Spain.,Centre for Biomedical Network Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - María J Arranz
- Fundació Docència I Recerca Mutua Terrassa, Barcelona, Spain
| | | | - Raúl C Baptista-Rosas
- Hospital General de Occidente, Zapopan Jalisco, Mexico.,Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá Jalisco, Mexico.,Centro de Investigación Multidisciplinario en Salud, Universidad de Guadalajara, Tonalá Jalisco, Mexico
| | - María Barreda-Sánchez
- Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain
| | - Moncef Belhassen-Garcia
- Servicio de Medicina Interna-Unidad de Enfermedades Infecciosas, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.,Universidad de Salamanca, Salamanca, Spain
| | - Joao F Bezerra
- Escola Tecnica de Saúde, Laboratorio de Vigilancia Molecular Aplicada, Brazil
| | - Marcos A C Bezerra
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, PE, Brazil
| | | | - María Brion
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.,Centre for Biomedical Network Research on Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Ramón Brugada
- Centre for Biomedical Network Research on Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Cardiovascular Genetics Center, Institut d'Investigació Biomèdica Girona (IDIBGI), Girona, Spain.,Medical Science Department, School of Medicine, University of Girona, Girona, Spain.,Cardiology Service, Hospital Josep Trueta, Girona, Spain
| | - Matilde Bustos
- Institute of Biomedicine of Seville (IBiS), Consejo Superior de Investigaciones Científicas (CSIC)- University of Seville- Virgen del Rocio University Hospital, Seville, Spain
| | - Enrique J Calderón
- Departemento de Medicina, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain.,Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Cristina Carbonell
- Universidad de Salamanca, Salamanca, Spain.,Servicio de Medicina Interna, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Luis Castano
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Biocruces Bizkai HRI, Bizkaia, Spain.,Osakidetza, Cruces University Hospital, Bizkaia, Spain.,Centre for Biomedical Network Research on Diabetes and Metabolic Associated Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.,University of Pais Vasco, UPV/EHU, Bizkaia, Spain
| | - Jose E Castelao
- Oncology and Genetics Unit, Instituto de Investigacion Sanitaria Galicia Sur, Xerencia de Xestion Integrada de Vigo-Servizo Galego de Saúde, Vigo, Spain
| | | | - M Lourdes Cordero-Lorenzana
- Servicio de Medicina intensiva, Complejo Hospitalario Universitario de A Coruña (CHUAC), Sistema Galego de Saúde (SERGAS), A Coruña, Spain
| | - Jose L Cortes-Sanchez
- Tecnológico de Monterrey, Monterrey, Mexico.,Departament of Microgravity and Translational Regenerative Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Marta Corton
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Department of Genetics & Genomics, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz University Hospital - Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain
| | | | - Alba De Martino-Rodríguez
- Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain.,Instituto Investigación Sanitaria Aragón (IIS-Aragon), Zaragoza, Spain
| | - Victor Campo-Pérez
- Preventive Medicine Department, Instituto de Investigacion Sanitaria Galicia Sur, Xerencia de Xestion Integrada de Vigo-Servizo Galego de Saúde, Vigo, Spain
| | | | | | - Andre D Luchessi
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Rocío Eirós
- Servicio de Cardiología, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | | | - María Carmen Fariñas
- IDIVAL, Cantabria, Spain.,Universidad de Cantabria, Cantabria, Spain.,Hospital U M Valdecilla, Cantabria, Spain
| | - Uxía Fernández-Robelo
- Urgencias Hospitalarias, Complejo Hospitalario Universitario de A Coruña (CHUAC), Sistema Galego de Saúde (SERGAS), A Coruña, Spain
| | - Amanda Fernández-Rodríguez
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología (CNM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Tania Fernández-Villa
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS) - Instituto de Biomedicina (IBIOMED), Universidad de León, León, Spain
| | | | - Javier Gómez-Arrue
- Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain.,Instituto Investigación Sanitaria Aragón (IIS-Aragon), Zaragoza, Spain
| | - Beatriz González Álvarez
- Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain.,Instituto Investigación Sanitaria Aragón (IIS-Aragon), Zaragoza, Spain
| | | | - Javier González-Peñas
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón (IiSGM), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain.,Centre for Biomedical Network Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan F Gutiérrez-Bautista
- Servicio de Análisis Clínicos e Inmunología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - María José Herrero
- Plataforma de Farmacogenética, IIS La Fe, Valencia, Spain.,Departamento de Farmacología, Universidad de Valencia, Valencia, Spain
| | - Antonio Herrero-Gonzalez
- Data Analysis Department, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz University Hospital - Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain
| | - María A Jimenez-Sousa
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología (CNM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - María Claudia Lattig
- Facultad de Ciencias, Universidad de los Andes, Bogotá, Colombia.,SIGEN Alianza Universidad de los Andes - Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Rosario Lopez-Rodriguez
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Department of Genetics & Genomics, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz University Hospital - Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain
| | - Esther Mancebo
- Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Transplant Immunology and Immunodeficiencies Group, Madrid, Spain
| | | | - Vicente Martín
- Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Biomedicina (IBIOMED), Universidad de León, León, Spain
| | - Oscar Martinez-Nieto
- SIGEN Alianza Universidad de los Andes - Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Departamento Patologia y Laboratorios, Fundación Santa Fe de Bogota, Bogotá, Colombia
| | - Iciar Martinez-Lopez
- Unidad de Genética y Genómica Islas Baleares, Islas Baleares, Spain.,Unidad de Diagnóstico Molecular y Genética Clínica, Hospital Universitario Son Espases, Islas Baleares, Spain
| | | | - Ángel Martinez-Perez
- Genomics of Complex Diseases Unit, Research Institute of Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
| | - Juliana A Mazzeu
- Faculdade de Medicina, Universidade de Brasília, Brazil.,Programa de Pós-Graduação em Ciências Médicas (UnB), Brazil.,Programa de Pós-Graduação em Ciencias da Saude (UnB), Brazil
| | | | - Pablo Minguez
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Department of Genetics & Genomics, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz University Hospital - Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain
| | - Victor Moreno Cuerda
- Medicina Interna, Hospital Universitario Mostoles, Madrid, Spain.,Universidad Francisco de Vitoria, Madrid, Spain
| | - Vivian N Silbiger
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Silviene F Oliveira
- Programa de Pós-Graduação em Ciencias da Saude (UnB), Brazil.,Departamento de Genética e Morfologia, Instituto de Ciências Biológicas, Universidade de Brasília, Brazil.,Programa de Pós-Graduação em Biologia Animal (UnB), Brazil.,Programa de Pós-Graduação Profissional em Ensino de Biologia (UnB), Brazil
| | - Eva Ortega-Paino
- Spanish National Cancer Research Center, CNIO Biobank, Madrid, Spain
| | - Mara Parellada
- School of Medicine, Universidad Complutense, Madrid, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón (IiSGM), Madrid, Spain.,Centre for Biomedical Network Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Estela Paz-Artal
- Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Transplant Immunology and Immunodeficiencies Group, Madrid, Spain.,Department of Immunology, Ophthalmology and ENT, Universidad Complutense de Madrid, Madrid, Spain
| | - Ney P C Santos
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Patricia Pérez-Matute
- Infectious Diseases, Microbiota and Metabolism Unit, Center for Biomedical Research of La Rioja (CIBIR), Logroño, Spain
| | | | - M Elena Pérez-Tomás
- Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | | | - Mel Lina Pinsach-Abuin
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica Girona (IDIBGI), Girona, Spain.,Centre for Biomedical Network Research on Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Ericka N Pompa-Mera
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Instituto Mexicano del Seguro Social (IMSS), Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | | | - Aurora Pujol
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Neurometabolic Diseases Laboratory, L'Hospitalet de Llobregat, Spain.,Catalan Institution of Research and Advanced Studies (ICREA), Barcelona, Spain
| | | | - Salvador Resino
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología (CNM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Marianne R Fernandes
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, Pará, Brazil.,Departamento de Ensino e Pesquisa, Hospital Ophir Loyola, Belém, Pará, Brazil
| | - Emilio Rodríguez-Ruiz
- Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.,Unidad de Cuidados Intensivos, Hospital Clínico Universitario de Santiago (CHUS), Sistema Galego de Saúde (SERGAS), Santiago de Compostela, Spain
| | - Fernando Rodriguez-Artalejo
- Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.,IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | | | - Francisco Ruiz-Cabello
- Servicio de Análisis Clínicos e Inmunología, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs GRANADA), Granada, Spain.,Departamento Bioquímica, Biología Molecular e Inmunología III, Universidad de Granada, Granada, Spain
| | - Javier Ruiz-Hornillos
- Allergy Unit, Valdemoro, Hospital Infanta Elena, Madrid, Spain.,Instituto de Investigación Sanitaria-Fundación Jiménez Díaz University Hospital - Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain.,Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Pablo Ryan
- Hospital Universitario Infanta Leonor, Madrid, Spain.,Complutense University of Madrid, Madrid, Spain.,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - José Manuel Soria
- Genomics of Complex Diseases Unit, Research Institute of Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
| | - Juan Carlos Souto
- Haemostasis and Thrombosis Unit, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
| | - Eduardo Tamayo
- Servicio de Anestesiologia y Reanimación, Hospital Clinico Universitario de Valladolid, Valladolid, Spain.,Departamento de Cirugía, Universidad de Valladolid, Valladolid, Spain
| | - Alvaro Tamayo-Velasco
- Servicio de Hematologia y Hemoterapia, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Juan Carlos Taracido-Fernandez
- Data Analysis Department, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz University Hospital - Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain
| | - Alejandro Teper
- Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina
| | | | - Miguel Urioste
- Familial Cancer Clinical Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | | | - Zuleima Yáñez
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Ruth Zarate
- Centro para el Desarrollo de la Investigación Científica, Paraguay
| | - Tomoko Nakanishi
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Finland.,Department of Human Genetics, McGill University, Montréal, Québec, Canada.,Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada.,Kyoto-McGill International Collaborative School in Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Research Fellow, Japan Society for the Promotion of Science, Japan
| | - Sara Pigazzini
- University of Milano-Bicocca, Milano, Italy.,Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Frauke Degenhardt
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany.,University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Guillaume Butler-Laporte
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Douglas Maya-Miles
- Digestive Diseases Unit, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain.,Centre for Biomedical Network Research on Hepatic and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Bujanda
- Centre for Biomedical Network Research on Hepatic and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain.,Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute - Donostia University Hospital, University of the Basque Country (UPV/EHU), San Sebastian, Spain
| | - Youssef Bouysran
- Centre de Génétique Humaine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Adriana Palom
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellatera, Barcelona, Spain.,Liver Diseases, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - David Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany.,Novo Nordisk Foundation Center for Protein Research, Disease Systems Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Manuel Martínez-Bueno
- GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, Granada, Spain
| | - Selina Rolker
- Institute of Human Genetics, University Hospital Bonn, Medical Faculty University of Bonn, Bonn, Germany
| | - Sara Amitrano
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Italy
| | - Luisa Roade
- Centre for Biomedical Network Research on Hepatic and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain.,Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Universitat Autònoma de Barcelona, Departament de Medicina, Bellatera, Barcelona, Spain
| | - Francesca Fava
- Medical Genetics, University of Siena, Italy.,Azienda Ospedaliero-Universitaria Senese, Genetica Medica, Italy.,Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Italy
| | - Christoph D Spinner
- Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Daniele Prati
- Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - David Bernardo
- Centre for Biomedical Network Research on Hepatic and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain.,Mucosal Immunology Lab, Unidad de Excelencia del Instituto de Biomedicina y Genética Molecular (IBGM, Universidad de Valladolid-CSIC), Valladolid, Spain
| | - Federico Garcia
- Hospital Universitario Clinico San Cecilio, Granada, Spain.,Instituto de Investigación Ibs.Granada, Granada, Spain
| | - Gilles Darcis
- University of Liege. GIGA-Insitute, Liege, Belgium.,Liege University Hospital (CHU of Liege), Liege, Belgium
| | - Israel Fernández-Cadenas
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Stroke Pharmacogenomics and Genetics Group, Barcelona, Spain
| | - Jan Cato Holter
- Department of Microbiology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jesus M Banales
- Centre for Biomedical Network Research on Hepatic and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain.,Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute - Donostia University Hospital, University of the Basque Country (UPV/EHU), Ikerbasque, San Sebastian, Spain
| | - Robert Frithiof
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Stefano Duga
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Manuel Romero-Gómez
- Digestive Diseases Unit, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain.,Centre for Biomedical Network Research on Hepatic and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Nafría-Jiménez
- Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Clinical Biochemistry Department, San Sebastian, Spain
| | - Johannes R Hov
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian PSC Research Center and Section of Gastroenterology, Dept Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Isabelle Migeotte
- Centre de Génétique Humaine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.,Fonds de la Recherche Scientifique (FNRS)
| | - Alessandra Renieri
- Medical Genetics, University of Siena, Italy.,Azienda Ospedaliero-Universitaria Senese, Genetica Medica, Italy.,Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Italy
| | - Anna M Planas
- Institute for Biomedical Researhc of Barcelona (IIBB), National Spanish Research Council (CSIC), Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Kerstin U Ludwig
- Institute of Human Genetics, University Hospital Bonn, Medical Faculty University of Bonn, Bonn, Germany
| | - Maria Buti
- Centre for Biomedical Network Research on Hepatic and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain.,Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Universitat Autònoma de Barcelona, Departament de Medicina, Bellatera, Barcelona, Spain
| | | | - Marta E Alarcón-Riquelme
- GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, Granada, Spain.,Institute for Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Eva C Schulte
- Institute of Virology, Technical University Munich/Helmholtz Zentrum München, Munich, Germany.,Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich University, Munich, Germany.,Department of Psychiatry, University Hospital, LMU Munich University, Munich, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany.,University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Tom H Karlsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian PSC Research Center and Section of Gastroenterology, Dept Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Luca Valenti
- Department of Pathopgysiology and Transplantation, Università degli Studi di Milano, Milano, Italy.,Department of Transfusion Medicine and Hematology, Precision Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Hugo Zeberg
- Department of Neuroscience, Karolinska Institutet, Sweden.,Max-Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Brent Richards
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada.,Department of Human Genetics, Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,King's College London, Department of Twin Research, London, United Kingdom
| | - Andrea Ganna
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.,Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Mercè Boada
- Research Center and Memory clinic, ACE Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Spain.,Centre for Biomedical Network Research on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Itziar Rojas
- Research Center and Memory clinic, ACE Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Spain.,Centre for Biomedical Network Research on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Agustín Ruiz
- Research Center and Memory clinic, ACE Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Spain.,Centre for Biomedical Network Research on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Pascual Sánchez
- CIEN Foundation/Queen Sofia Foundation Alzheimer Center, Madrid, Spain
| | - Luis Miguel Real
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | | | | | | | - Encarna Guillen-Navarro
- Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Sección Genética Médica - Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, Servicio Murciano de Salud, Murcia, Spain.,Departamento Cirugía, Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Murcia (UMU), Murcia, Spain.,Grupo Clínico Vinculado, Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Ayuso
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Department of Genetics & Genomics, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz University Hospital - Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain
| | - Anna González-Neira
- Human Genotyping-CEGEN Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - José A Riancho
- IDIVAL, Cantabria, Spain.,Universidad de Cantabria, Cantabria, Spain.,Hospital U M Valdecilla, Cantabria, Spain
| | | | - Carlos Flores
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain.,Research Unit, Hospital Universitario N.S. de Candelaria, Santa Cruz de Tenerife, Spain.,Centre for Biomedical Network Research on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Pablo Lapunzina
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz-IDIPAZ, Madrid, Spain.,ERN-ITHACA-European Reference Network
| | - Ángel Carracedo
- Centro Nacional de Genotipado (CEGEN), Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Fundación Pública Galega de Medicina Xenómica, Sistema Galego de Saúde (SERGAS), Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.,Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas (CIMUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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12
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Fernandez-Sampedro M, Sanlés-González I, García-Ibarbia C, Fañanás-Rodríquez N, Fakkas-Fernández M, Fariñas MC. The poor accuracy of D-dimer for the diagnosis of prosthetic joint infection but its potential usefulness in early postoperative infections following revision arthroplasty for aseptic loosening. BMC Infect Dis 2022; 22:91. [PMID: 35086474 PMCID: PMC8793264 DOI: 10.1186/s12879-022-07060-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/13/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND D-dimer was introduced in 2018 as an alternative biomarker for C-reactive protein (CRP) in the diagnostic of prosthetic joint infection (PJI) criteria of the Musculoskeletal Infection Society. We assessed the accuracy of plasma D-dimer for the diagnosis of early, delayed, and late PJI according to Infectious Diseases Society of America (IDSA) criteria, and whether persistently high levels of D-dimer in cases of aseptic loosening (AL) may be predictive of subsequent implant-related infection. METHODS A prospective study of a consecutive series of 187 revision arthroplasties was performed at a single institution. Septic (n = 39) and aseptic revisions (n = 141) were classified based on IDSA criteria. Preoperative assessment of CRP, erythrocyte sedimentation rate (ESR) and D-dimer was performed. Receiver operating curves were used to determine maximum sensitivity and specificity of the biomarkers. The natural progress of D-dimer for AL cases was followed up either until the date of implant-related infection at any time during the first year or 1 year after revision in patients without failure. Clinical outcomes for those AL cases included infection-related failure that required a new surgery or need for antibiotic suppression. RESULTS Preoperative D-dimer level was significantly higher in PJI cases than in AL cases (p = 0.000). The optimal threshold of D-dimer for the diagnosis of PJI was 1167 ng/mL. For overall diagnosis of PJI, C-reactive protein (CRP) achieved the highest sensitivity (84.6%), followed by erythrocyte sedimentation rate (ESR) and D-dimer (82% and 71.8%, respectively). Plasma D-dimer sensitivity was lower for all PJI types. When combinations of 2 tests were studied, the combined use of ESR and CRP achieved the best accuracy for all types of PJI (76.9%). 4.25% of AL cases had implant failure due to implant-related infection during the first year after the index revision arthroplasty, only the cases with early failure maintained high D-dimer levels. CONCLUSIONS Plasma D-dimer did not offer an improvement over the individual or combined diagnosis for any type of PJI according to IDSA criteria. Persistently raised levels of D-dimer after revision arthroplasty in AL cases might be used to effectively diagnose early postoperative infection.
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Affiliation(s)
- M Fernandez-Sampedro
- Infectious Diseases Department, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Av. Valdecilla s/n 39008, Santander, Spain.
| | - I Sanlés-González
- Infectious Diseases Department, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Av. Valdecilla s/n 39008, Santander, Spain
| | - C García-Ibarbia
- Internal Medicine Department, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - N Fañanás-Rodríquez
- Clinical Analysis Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M Fakkas-Fernández
- Orthopaedic Surgery Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M C Fariñas
- Infectious Diseases Department, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Av. Valdecilla s/n 39008, Santander, Spain
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13
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Fariñas MC. Clinical experience of cefiderocol. Rev Esp Quimioter 2022; 35 Suppl 2:35-38. [PMID: 36193983 PMCID: PMC9632058 DOI: 10.37201/req/s02.05.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Infections by antibiotic-resistant microorganisms could be considered a "stealth pandemic" that we fight daily in most hospitals. Some estimates suggest that today 700,000 deaths per year can be attributed to antimicrobial resistance. By the year 2050, it is estimated that this will increase to ten million deaths per year as a result of infections by multidrug-resistant microorganisms. In this context, the availability of antimicrobial therapy that is effective against these pathogens is essential to be able to "save the lives" of our patients. Cefiderocol, a new cephalosporin with a different mechanism of action, will be an essential treatment in many infections caused by resistant aerobic gram-negative bacteria. Cefiderocol has been used to treat patients with complicated urinary tract infections (cUTI); hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), healthcare-associated pneumonia (HAP); in patients with sepsis and bacteremia, some without an identified primary focus of infection.
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Affiliation(s)
- María Carmen Fariñas
- Correspondence: María Carmen Fariñas Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla. Universidad de Cantabria. Santander. Cantabria, Spain. E-mail:
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14
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Bouza E, de Alarcón A, Fariñas MC, Gálvez J, Goenaga MÁ, Gutiérrez-Díez F, Hortal J, Lasso J, Mestres CA, Miró JM, Navas E, Nieto M, Parra A, Pérez de la Sota E, Rodríguez-Abella H, Rodríguez-Créixems M, Rodríguez-Roda J, Sánchez Espín G, Sousa D, Velasco García de Sierra C, Muñoz P, Kestler M. Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections ( SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery ( SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases ( CIBERES). J Clin Med 2021; 10:5566. [PMID: 34884268 PMCID: PMC8658224 DOI: 10.3390/jcm10235566] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 01/04/2023] Open
Abstract
This is a consensus document of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES). These three entities have brought together a multidisciplinary group of experts that includes anaesthesiologists, cardiac and cardiothoracic surgeons, clinical microbiologists, infectious diseases and intensive care specialists, internal medicine doctors and radiologists. Despite the clinical and economic consequences of sternal wound infections, to date, there are no specific guidelines for the prevention, diagnosis and management of mediastinitis based on a multidisciplinary consensus. The purpose of the present document is to provide evidence-based guidance on the most effective diagnosis and management of patients who have experienced or are at risk of developing a post-surgical mediastinitis infection in order to optimise patient outcomes and the process of care. The intended users of the document are health care providers who help patients make decisions regarding their treatment, aiming to optimise the benefits and minimise any harm as well as the workload.
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Affiliation(s)
- Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | | | | | - Juan Gálvez
- Virgen Macarena University Hospital, 41009 Seville, Spain;
| | | | - Francisco Gutiérrez-Díez
- Cardiovascular Surgery Department, Marques de Valdecilla University Hospital, 39008 Santander, Cantabria, Spain;
| | - Javier Hortal
- Anesthesia and Intensive Care Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - José Lasso
- Plastic Surgery Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - Carlos A. Mestres
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - José M. Miró
- Infectious Diseases Services, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain;
| | - Enrique Navas
- Infectious Diseases Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain;
| | - Mercedes Nieto
- Cardiovascular Unit, Intensive Care Department, San Carlos Clinical Hospital, 28040 Madrid, Spain;
| | - Antonio Parra
- Department of Radiology, Marquez de Valdecilla University Hospital, 39008 Santander, Cantabria, Spain;
| | | | - Hugo Rodríguez-Abella
- Cardiac Surgery Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - Marta Rodríguez-Créixems
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | | | - Gemma Sánchez Espín
- Heart Clinical Management Unit, Virgen de la Victoria University Hospital, 29006 Malaga, Spain;
| | - Dolores Sousa
- Infectious Diseases Department, A Coruña Hospital Complex, 15006 A Coruña, Spain;
| | | | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | - Martha Kestler
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
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15
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Ferrer R, Fariñas MC, Maseda E, Salavert M, Bou G, Díaz-Regañón J, López D, Lozano V, Gómez-Ulloa D, Fenoll R, Lara N, McCann E. Clinical management of cUTI, cIAI, and HABP/VABP attributable to carbapenem-resistant Gram-negative infections in Spain. Rev Esp Quimioter 2021; 34:639-650. [PMID: 34806858 PMCID: PMC8638756 DOI: 10.37201/req/096.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction. Carbapenem-resistant Gram-negative (CRGN) infections are a major public health problem in Spain, often implicated in complicated, healthcare-associated infections that require the use of potentially toxic antibacterial agents of last resort. The objective of this study was to assess the clinical management of complicated infections caused by CRGN bacteria in Spanish hospitals. Methods. The study included: 1) a survey assessing the GN infection and antibacterial susceptibility profile in five participating Spanish hospitals and 2) a non-interventional, retrospective single cohort chart review of 100 patients with complicated urinary tract infection (cUTI), complicated intra-abdominal infection (cIAI), or hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia (HABP/VABP) attributable to CRGN pathogens. Results. In the participating hospitals CRGN prevalence was 9.3% amongst complicated infections. In the retrospective cohort, 92% of infections were healthcare-associated, and Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common pathogens. OXA was the most frequently detected carbapenemase type (71.4%). We found that carbapenems were frequently used to treat cUTI, cIAI, HABP/VABP caused by CRGN pathogens. Carbapenem use, particularly in combination with other agents, persisted after confirmation of carbapenem resistance. Clinical cure was 66.0%, mortality during hospitalization 35.0%, mortality at the time of chart review 62.0%, and 6-months-post-discharge readmission 47.7%. Conclusion. Our results reflect the high burden and unmet needs associated with the management of complicated infections attributable to CRGN pathogens in Spain and highlight the urgent need for enhanced clinical management of these difficult-to-treat infections.
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Affiliation(s)
- R Ferrer
- Ricard Ferrer. Hospital Universitario Vall d'Hebron, Barcelona, Spain.
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16
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Gutiérrez-Gutiérrez B, Pérez-Nadales E, Pérez-Galera S, Fernández-Ruiz M, Carratalà J, Oriol I, Cordero E, Lepe JA, Tan BH, Corbella L, Paul M, Natera AM, David MD, Montejo M, Iyer RN, Pierrotti LC, Merino E, Steinke SM, Rana MM, Muñoz P, Mularoni A, van Delden C, Grossi PA, Seminari EM, Gunseren F, Lease ED, Roilides E, Fortún J, Arslan H, Coussement J, Tufan ZK, Pilmis B, Rizzi M, Loeches B, Eriksson BM, Abdala E, Soldani F, Lowman W, Clemente WT, Bodro M, Fariñas MC, Kazak E, Martínez-Martínez L, Aguado JM, Torre-Cisneros J, Pascual Á, Rodríguez-Baño J. Propensity Score and Desirability of Outcome Ranking Analysis of Ertapenem for Treatment of Nonsevere Bacteremic Urinary Tract Infections Due to Extended-Spectrum-Beta-Lactamase-Producing Enterobacterales in Kidney Transplant Recipients. Antimicrob Agents Chemother 2021; 65:e0110221. [PMID: 34370578 PMCID: PMC8522723 DOI: 10.1128/aac.01102-21] [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: 06/04/2021] [Accepted: 08/05/2021] [Indexed: 11/20/2022] Open
Abstract
There are scarce data on the efficacy of ertapenem in the treatment of bacteremia due to extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales (ESBL-E) in kidney transplant (KT) recipients. We evaluated the association between treatment with ertapenem or meropenem and clinical cure in KT recipients with nonsevere bacteremic urinary tract infections (B-UTI) caused by ESBL-E. We performed a registered, retrospective, international (29 centers in 14 countries) cohort study (INCREMENT-SOT, NCT02852902). The association between targeted therapy with ertapenem versus meropenem and clinical cure at day 14 (the principal outcome) was studied by logistic regression. Propensity score matching and desirability of outcome ranking (DOOR) analyses were also performed. A total of 201 patients were included; only 1 patient (treated with meropenem) in the cohort died. Clinical cure at day 14 was reached in 45/100 (45%) and 51/101 (50.5%) of patients treated with ertapenem and meropenem, respectively (adjusted OR 1.29; 95% CI 0.51 to 3.22; P = 0.76); the propensity score-matched cohort included 55 pairs (adjusted OR for clinical cure at day 14, 1.18; 95% CI 0.43 to 3.29; P = 0.74). In this cohort, the proportion of cases treated with ertapenem with better DOOR than with meropenem was 49.7% (95% CI, 40.4 to 59.1%) when hospital stay was considered. It ranged from 59 to 67% in different scenarios of a modified (weights-based) DOOR sensitivity analysis when potential ecological advantage or cost was considered in addition to outcome. In conclusion, targeted therapy with ertapenem appears as effective as meropenem to treat nonsevere B-UTI due to ESBL-E in KT recipients and may have some advantages.
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Affiliation(s)
- Belén Gutiérrez-Gutiérrez
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Elena Pérez-Nadales
- Spanish Network for Research in Infectious Diseases (REIPI)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Salvador Pérez-Galera
- Clinical Unit of Internal Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Mario Fernández-Ruiz
- Spanish Network for Research in Infectious Diseases (REIPI)
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Universidad Complutense, Madrid, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedicine Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Isabel Oriol
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedicine Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Elisa Cordero
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - José Antonio Lepe
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Laura Corbella
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Universidad Complutense, Madrid, Spain
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Alejandra M. Natera
- Spanish Network for Research in Infectious Diseases (REIPI)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Miruna D. David
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Miguel Montejo
- Infectious Diseases Unit, Cruces University Hospital, Bilbao, Spain
| | - Ranganathan N. Iyer
- Clinical Microbiology Identification and Infection Control, Global Hospitals, Hyderabad, India
| | - Ligia Camera Pierrotti
- Infectious Diseases Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Esperanza Merino
- Unit of Infectious Diseases, General University Hospital of Alicante, ISABIAL, Alicante, Spain
| | | | | | - Patricia 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
| | | | - Christian van Delden
- Unit for Transplant Infectious Diseases, University Hospitals of Geneva and the Swiss Transplant Cohort Study (STCS), Geneva, Switzerland
| | - Paolo Antonio Grossi
- Infectious Diseases Section, Department of Medicine and Surgery, University of Insubria, Varese. National Center for Transplantation, Rome, Italy
| | - Elena María Seminari
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy
| | - Filiz Gunseren
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Erika D. Lease
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Emmanuel Roilides
- Infectious Diseases Unit and 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Jesús Fortún
- Ramón y Cajal University Hospital, Madrid, Spain
| | - Hande Arslan
- Bakent University School of Medicine, Ankara, Turkey
| | - Julien Coussement
- Division of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Zeliha Koçak Tufan
- Infectious Diseases and Clinical Microbiology Department, Medical School of Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Benoit Pilmis
- Paris Descartes University, Necker-Enfants Malades University Hospital, Department of Infectious Diseases and Tropical Medicine, Centre d’Infectiologie Necker-Pasteur, Institut Imagine, AP-HP, Paris, France
| | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Belén Loeches
- Infectious Diseases Unit, Hospital La Paz, Madrid, Spain
| | - Britt Marie Eriksson
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - Edson Abdala
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fabio Soldani
- Department of Medicine, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Warren Lowman
- Wits Donald Gordon Medical Centre, Pathcare/Vermaak, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wanessa Trindade Clemente
- Faculdade de Medicina, UFMG, Grupo de Transplante de Fígado, Instituto Alfa de Gastroenterologia, Hospital da Clínicas, Universidad de Federal Minas Gerais (HC-UFMG), Minas Gerais, Brazil
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
| | - María Carmen Fariñas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | | | - Luis Martínez-Martínez
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Microbiology, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Department of Microbiology, University of Cordoba, Córdoba, Spain
| | - José María Aguado
- Spanish Network for Research in Infectious Diseases (REIPI)
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Universidad Complutense, Madrid, Spain
| | - Julián Torre-Cisneros
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Córdoba, Spain
| | - Álvaro Pascual
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Jesús Rodríguez-Baño
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Investigators from the REIPI/ESGICH/ESGBIS/INCREMENT-SOT Group
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
- Clinical Unit of Internal Medicine, Virgen Macarena University Hospital, Seville, Spain
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Universidad Complutense, Madrid, Spain
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedicine Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
- Department of Infectious Diseases, Singapore General Hospital, Singapore
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Universidad Complutense, Madrid, Spain
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Infectious Diseases Unit, Cruces University Hospital, Bilbao, Spain
- Clinical Microbiology Identification and Infection Control, Global Hospitals, Hyderabad, India
- Infectious Diseases Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
- Unit of Infectious Diseases, General University Hospital of Alicante, ISABIAL, Alicante, Spain
- Johns Hopkins University, School of Medicine, Baltimore, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- 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
- IRCCS ISMETT, Palermo, Italy
- Unit for Transplant Infectious Diseases, University Hospitals of Geneva and the Swiss Transplant Cohort Study (STCS), Geneva, Switzerland
- Infectious Diseases Section, Department of Medicine and Surgery, University of Insubria, Varese. National Center for Transplantation, Rome, Italy
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
- Infectious Diseases Unit and 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
- Ramón y Cajal University Hospital, Madrid, Spain
- Bakent University School of Medicine, Ankara, Turkey
- Division of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Infectious Diseases and Clinical Microbiology Department, Medical School of Ankara Yildirim Beyazit University, Ankara, Turkey
- Paris Descartes University, Necker-Enfants Malades University Hospital, Department of Infectious Diseases and Tropical Medicine, Centre d’Infectiologie Necker-Pasteur, Institut Imagine, AP-HP, Paris, France
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- Infectious Diseases Unit, Hospital La Paz, Madrid, Spain
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Department of Medicine, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
- Wits Donald Gordon Medical Centre, Pathcare/Vermaak, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Faculdade de Medicina, UFMG, Grupo de Transplante de Fígado, Instituto Alfa de Gastroenterologia, Hospital da Clínicas, Universidad de Federal Minas Gerais (HC-UFMG), Minas Gerais, Brazil
- Infectious Diseases Department, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
- Uludag University, Bursa, Turkey
- Clinical Unit of Microbiology, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Department of Microbiology, University of Cordoba, Córdoba, Spain
- Clinical Unit of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Córdoba, Spain
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Arnaiz de Las Revillas F, Gonzalez-Quintanilla V, Parra JA, Palacios E, Gonzalez-Rico C, Armiñanzas C, Gutiérrez-Cuadra M, Oterino A, Fariñas-Alvarez C, Fariñas MC. Evaluation of endothelial function and subclinical atherosclerosis in patients with HIV infection. Sci Rep 2021; 11:18431. [PMID: 34531450 PMCID: PMC8446055 DOI: 10.1038/s41598-021-97795-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/29/2021] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to analyse the association between human immunodeficiency virus (HIV) related clinical and analytical parameters and the presence of subclinical atherosclerosis as well as endothelial dysfunction. This was a prospective cohort study of HIV-positive patients who underwent intima media thickness (IMT) determination and coronary artery calcium scoring to determine subclinical atherosclerosis. To detect endothelial dysfunction, the breath holding index, flow-mediated dilation and the concentration of endothelial progenitor cells (EPCs) were measured. Patients with an IMT ≥ 0.9 mm had an average of 559.3 ± 283.34 CD4/μl, and those with an IMT < 0.9 mm had an average of 715.4 ± 389.92 CD4/μl (p = 0.04). Patients with a low calcium score had a significantly higher average CD4 cell value and lower zenith viral load (VL) than those with a higher score (707.7 ± 377.5 CD4/μl vs 477.23 ± 235.7 CD4/μl (p = 0.01) and 7 × 104 ± 5 × 104 copies/ml vs 23.4 × 104 ± 19 × 104 copies/ml (p = 0.02)). The number of early EPCs in patients with a CD4 nadir < 350/µl was lower than that in those with a CD4 nadir ≥ 350 (p = 0.03). In HIV-positive patients, low CD4 cell levels and high VL were associated with risk of developing subclinical atherosclerosis. HIV patients with CD4 cell nadir < 350/µl may have fewer early EPCs.
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Affiliation(s)
- F Arnaiz de Las Revillas
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | | | - J A Parra
- Radiology Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - E Palacios
- Neurology Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - C Gonzalez-Rico
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | - C Armiñanzas
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | - M Gutiérrez-Cuadra
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | - A Oterino
- Neurology Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - C Fariñas-Alvarez
- Quality Unit. Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - M C Fariñas
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain.
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San Segundo D, Arnáiz de las Revillas F, Lamadrid-Perojo P, Comins-Boo A, González-Rico C, Alonso-Peña M, Irure-Ventura J, Olmos JM, Fariñas MC, López-Hoyos M. Innate and Adaptive Immune Assessment at Admission to Predict Clinical Outcome in COVID-19 Patients. Biomedicines 2021; 9:biomedicines9080917. [PMID: 34440121 PMCID: PMC8389676 DOI: 10.3390/biomedicines9080917] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023] Open
Abstract
During the COVID-19 pandemic, many studies have been carried out to evaluate different immune system components to search for prognostic biomarkers of the disease. A broad multiparametric antibody panel of cellular and humoral components of the innate and the adaptative immune response in patients with active SARS-CoV-2 infection has been evaluated in this study. A total of 155 patients were studied at admission into our center and were categorized according to the requirement of oxygen therapy as mild or severe (the latter being those with the requirement). The patients with severe disease were older and had high ferritin, D-dimer, C-reactive protein, troponin, interleukin-6 (IL-6) levels, and neutrophilia with lymphopenia at admission. Moreover, the patients with mild symptoms had significantly increased circulating non-classical monocytes, innate lymphoid cells, and regulatory NK cells. In contrast, severe patients had a low frequency of Th1 and regulatory T cells with increased activated and exhausted CD8 phenotype (CD8+CD38+HLADR+ and CD8+CD27-CD28-, respectively). The predictive model included age, ferritin, D-dimer, lymph counts, C4, CD8+CD27-CD28-, and non-classical monocytes in the logistic regression analysis. The model predicted severity with an area under the curve of 78%. Both innate and adaptive immune parameters could be considered potential predictive biomarkers of the prognosis of COVID-19 disease.
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Affiliation(s)
- David San Segundo
- Immunology Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; (D.S.S.); (A.C.-B.); (J.I.-V.)
- Transplantation and Autoimmunity Laboratory, Research Institute “Marqués de Valdecilla” (IDIVAL), 39011 Santander, Spain; (P.L.-P.); (M.A.-P.)
| | - Francisco Arnáiz de las Revillas
- Infectious Diseases Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; (F.A.d.l.R.); (C.G.-R.); (M.C.F.)
| | - Patricia Lamadrid-Perojo
- Transplantation and Autoimmunity Laboratory, Research Institute “Marqués de Valdecilla” (IDIVAL), 39011 Santander, Spain; (P.L.-P.); (M.A.-P.)
| | - Alejandra Comins-Boo
- Immunology Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; (D.S.S.); (A.C.-B.); (J.I.-V.)
- Transplantation and Autoimmunity Laboratory, Research Institute “Marqués de Valdecilla” (IDIVAL), 39011 Santander, Spain; (P.L.-P.); (M.A.-P.)
| | - Claudia González-Rico
- Infectious Diseases Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; (F.A.d.l.R.); (C.G.-R.); (M.C.F.)
| | - Marta Alonso-Peña
- Transplantation and Autoimmunity Laboratory, Research Institute “Marqués de Valdecilla” (IDIVAL), 39011 Santander, Spain; (P.L.-P.); (M.A.-P.)
| | - Juan Irure-Ventura
- Immunology Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; (D.S.S.); (A.C.-B.); (J.I.-V.)
- Transplantation and Autoimmunity Laboratory, Research Institute “Marqués de Valdecilla” (IDIVAL), 39011 Santander, Spain; (P.L.-P.); (M.A.-P.)
| | - José Manuel Olmos
- Internal Medicine Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain;
- Faculty of Medicine, University of Cantabria, 39011 Santander, Spain
| | - María Carmen Fariñas
- Infectious Diseases Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; (F.A.d.l.R.); (C.G.-R.); (M.C.F.)
- Faculty of Medicine, University of Cantabria, 39011 Santander, Spain
| | - Marcos López-Hoyos
- Immunology Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; (D.S.S.); (A.C.-B.); (J.I.-V.)
- Transplantation and Autoimmunity Laboratory, Research Institute “Marqués de Valdecilla” (IDIVAL), 39011 Santander, Spain; (P.L.-P.); (M.A.-P.)
- Faculty of Medicine, University of Cantabria, 39011 Santander, Spain
- Correspondence:
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Varela Barca L, Vidal-Bonnet L, Fariñas MC, Muñoz P, Valerio Minero M, de Alarcón A, Gutiérrez Carretero E, Gutiérrez Cuadra M, Moreno Camacho A, Kortajarena Urkola X, Goikoetxea Agirre J, Ojeda Burgos G, López-Cortés LE, Porres Azpiroz JC, Lopez-Menendez J. Analysis of sex differences in the clinical presentation, management and prognosis of infective endocarditis in Spain. Heart 2021; 107:1717-1724. [PMID: 34290038 DOI: 10.1136/heartjnl-2021-319254] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/28/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Sex-dependent differences of infective endocarditis (IE) have been reported. Women suffer from IE less frequently than men and tend to present more severe manifestations. Our objective was to analyse the sex-based differences of IE in the clinical presentation, treatment, and prognosis. MATERIAL AND METHODS We analysed the sex differences in the clinical presentation, modality of treatment and prognosis of IE in a national-level multicentric cohort between 2008 and 2018. All data were prospectively recorded by the GAMES cohort (Spanish Collaboration on Endocarditis). RESULTS A total of 3451 patients were included, of whom 1105 were women (32.0%). Women were older than men (mean age, 68.4 vs 64.5). The most frequently affected valves were the aortic valve in men (50.6%) and mitral valve in women (48.7%). Staphylococcus aureus aetiology was more frequent in women (30.1% vs 23.1%; p<0.001).Surgery was performed in 38.3% of women and 50% of men. After propensity score (PS) matching for age and estimated surgical risk (European System for Cardiac Operative Risk Evaluation II (EuroSCORE II)), the analysis of the matched cohorts revealed that women were less likely to undergo surgery (OR 0.74; 95% CI 0.59 to 0.91; p=0.05).The observed overall in-hospital mortality was 32.8% in women and 25.7% in men (OR for the mortality of female sex 1.41; 95% CI 1.21 to 1.65; p<0.001). This statistical difference was not modified after adjusting for all possible confounders. CONCLUSIONS Female sex was an independent factor related to mortality after adjusting for confounders. In addition, women were less frequently referred for surgical treatment.
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Affiliation(s)
- Laura Varela Barca
- Cardiac Surgery, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Laura Vidal-Bonnet
- Servicio de Cirugía Cardiaca, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
| | - M C Fariñas
- Servicio de Enfermedades Infecciosas, Marques de Valdecilla Foundation, Santander, Cantabria, Spain
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Gregorio Maranon General University Hospital Cardiology Service, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Maricela Valerio Minero
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Gregorio Maranon General University Hospital Cardiology Service, Madrid, Spain
| | - Arístides de Alarcón
- Servicio de Enfermedades Infecciosas, Virgen del Rocio University Hospital, Sevilla, Spain
| | | | - Manuel Gutiérrez Cuadra
- Servicio de Enfermedades Infecciosas, Marques de Valdecilla Foundation, Santander, Cantabria, Spain
| | - Asuncion Moreno Camacho
- Servicio de Enfermedades Infecciosas, Clinic Barcelona Hospital University, Barcelona, Spain
| | | | | | - Guillermo Ojeda Burgos
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, University Hospital Virgen de la Victoria, Malaga, Spain
| | - Luis Eduardo López-Cortés
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Complejo Hospitalario Virgen de la Macarena, Sevilla, Spain
| | - J C Porres Azpiroz
- Servicio de Cardiología, Miguel Servet University Hospital, Zaragoza, Spain
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Armiñanzas C, Arnaiz de Las Revillas F, Gutiérrez Cuadra M, Arnaiz A, Fernández Sampedro M, González-Rico C, Ferrer D, Mora V, Suberviola B, Latorre M, Calvo J, Olmos JM, Cifrián JM, Fariñas MC. Usefulness of the COVID-GRAM and CURB-65 scores for predicting severity in patients with COVID-19. Int J Infect Dis 2021; 108:282-288. [PMID: 34044145 PMCID: PMC8142713 DOI: 10.1016/j.ijid.2021.05.048] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/23/2022] Open
Abstract
AIM The aim of this study was to determine the usefulness of COVID-GRAM and CURB-65 scores as predictors of the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Caucasian patients. METHODS This was a retrospective observational study including all adults with SARS-CoV-2 infection admitted to Hospital Universitario Marqués de Valdecilla from February to May 2020. Patients were stratified according to COVID-GRAM and CURB-65 scores as being at low-medium or high risk of critical illness. Univariate analysis, multivariate logistic regression models, receiver operating characteristic curve, and area under the curve (AUC) were calculated. RESULTS A total of 523 patients were included (51.8% male, 48.2% female; mean age 65.63 years (standard deviation 17.89 years)), of whom 110 (21%) presented a critical illness (intensive care unit admission 10.3%, 30-day mortality 13.8%). According to the COVID-GRAM score, 122 (23.33%) patients were classified as high risk; 197 (37.7%) presented a CURB-65 score ≥2. A significantly greater proportion of patients with critical illness had a high COVID-GRAM score (64.5% vs 30.5%; P < 0.001). The COVID-GRAM score emerged as an independent predictor of critical illness (odds ratio 9.40, 95% confidence interval 5.51-16.04; P < 0.001), with an AUC of 0.779. A high COVID-GRAM score showed an AUC of 0.88 for the prediction of 30-day mortality, while a CURB-65 ≥2 showed an AUC of 0.83. CONCLUSIONS The COVID-GRAM score may be a useful tool for evaluating the risk of critical illness in Caucasian patients with SARS-CoV-2 infection. The CURB-65 score could be considered as an alternative.
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Affiliation(s)
- Carlos Armiñanzas
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - Francisco Arnaiz de Las Revillas
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - Manuel Gutiérrez Cuadra
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - Ana Arnaiz
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - Marta Fernández Sampedro
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - Claudia González-Rico
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - Diego Ferrer
- Service of Respiratory Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Víctor Mora
- Service of Respiratory Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Borja Suberviola
- Service of Intensive Care, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Maite Latorre
- Service of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Jorge Calvo
- Service of Microbiology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - José Manuel Olmos
- Service of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - José Manuel Cifrián
- Service of Respiratory Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - María Carmen Fariñas
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
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21
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Martínez-Sellés M, Valerio-Minero M, Fariñas MC, Rodríguez-Abella H, Rodríguez ML, de Alarcón A, Gutiérrez-Carretero E, Cobo-Belaustegui M, Goenaga MÁ, Moreno-Camacho A, Domínguez F, García-Pérez L, Domínguez-Pérez L, Muñoz P. Infective endocarditis in patients with solid organ transplantation. A nationwide descriptive study. Eur J Intern Med 2021; 87:59-65. [PMID: 33685806 DOI: 10.1016/j.ejim.2021.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/01/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Solid organ transplantation (SOT) implies immunosuppression and frequent health care contact. Our aim was to compare the characteristics of patients with infective endocarditis (IE) and SOT against those without SOT. METHODS We used data from the Spanish Collaboration on Endocarditis during the period 2008-2018. RESULTS We identified 4794 cases of IE, 85 (1.8%) in SOT (56 kidney, 18 liver, 8 heart, 3 lung). Thirteen patients with other transplantation types (bone marrow, hematopoietic precursors, and cornea) were excluded from the analysis. Compared with patients without SOT, patients with SOT had lower median age (61 vs. 69 years, p<0.001), more comorbidities (mean age-adjusted Charlson index 5.7±2.9 vs. 4.9±2.9, p=0.004), a lower prevalence of native valvular heart disease (29.4 vs. 45.4%, p=0.003), more in-hospital and healthcare-related IE (70.5% vs. 36.3%, p<0.001) and staphylococcal etiology (57.7% vs. 39.7%, p=0.001). Patients with SOT had more frequent kidney function worsening (47.1% vs. 34.6%, p=0.02), septic shock (25.9% vs. 12.1 %, p<0.001), sepsis (27.1% vs. 17.2%, p=0.02), and less surgery indication (54.1% vs 66.3%, p=0.02) and surgery (32.9% vs. 46.3%, p=0.01) than patients without SOT. There were no significant differences in mortality: inhospital (30.6% SOT vs. 25.6% without SOT, p=0.31), 1-year (38.8% SOT vs. 31.9% without SOT, p=0.18). CONCLUSIONS Most IE in SOT recipients are nosocomial and over 70% are health care-related. Half have previously normal heart valves and almost 60% are due to Staphylococcus spp. infections. Mortality seems to be similar to non-SOT counterparts.
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Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV. Universidad Europea. Universidad Complutense. Madrid, Spain.
| | - Maricela Valerio-Minero
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid. Instituto de Investigación Sanitaria Gregorio Marañón. Madrid, Spain
| | - María Carmen Fariñas
- Infectious Diseases Unit. Hospital Universitario Marqués de Valdecilla. University of Cantabria, Santander, Spain
| | - Hugo Rodríguez-Abella
- Servicio de Cirugía Cardiaca, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Rodríguez
- Servicio de Nefrología. Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Aristides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group Institute of Biomedicine of Seville (IBiS) University of 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 Ángel Goenaga
- Servicio de Enfermedades Infecciosas. Hospital Universitario Donosti. San Sebastián. Spain
| | - Asunción Moreno-Camacho
- Infectious Diseases Service. Hospital Clinic - IDIBAPS. University of Barcelona. Barcelona. Spain
| | - Fernando Domínguez
- Servicio de Cardiología. Hospital Universitario Puerta de Hierro. Majadahonda. Madrid, Spain
| | - Laura García-Pérez
- Servicio de Cardiología AGC del Corazón. Hospital Central de Asturias. Oviedo, Spain
| | - Laura Domínguez-Pérez
- Unidad clínica y unidad de cuidados críticos cardiológicos. Hospital Universitario Doce de Octubre. Madrid, 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
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22
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Salto-Alejandre S, Jiménez-Jorge S, Sabé N, Ramos-Martínez A, Linares L, Valerio M, Martín-Dávila P, Fernández-Ruiz M, Fariñas MC, Blanes-Juliá M, Vidal E, Palacios-Baena ZR, Hernández-Gallego R, Carratalá J, Calderón-Parra J, Ángeles Marcos M, Muñoz P, Fortún-Abete J, Aguado JM, Arnaiz-Revillas F, Blanes-Hernández R, de la Torre-Cisneros J, López-Cortés LE, García de Vinuesa-Calvo E, Rosso CM, Pachón J, Sánchez-Céspedes J, Cordero E. Risk factors for unfavorable outcome and impact of early post-transplant infection in solid organ recipients with COVID-19: A prospective multicenter cohort study. PLoS One 2021; 16:e0250796. [PMID: 33914803 PMCID: PMC8084252 DOI: 10.1371/journal.pone.0250796] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
The aim was to analyze the characteristics and predictors of unfavorable outcomes in solid organ transplant recipients (SOTRs) with COVID-19. We conducted a prospective observational cohort study of 210 consecutive SOTRs hospitalized with COVID-19 in 12 Spanish centers from 21 February to 6 May 2020. Data pertaining to demographics, chronic underlying diseases, transplantation features, clinical, therapeutics, and complications were collected. The primary endpoint was a composite of intensive care unit (ICU) admission and/or death. Logistic regression analyses were performed to identify the factors associated with these unfavorable outcomes. Males accounted for 148 (70.5%) patients, the median age was 63 years, and 189 (90.0%) patients had pneumonia. Common symptoms were fever, cough, gastrointestinal disturbances, and dyspnea. The most used antiviral or host-targeted therapies included hydroxychloroquine 193/200 (96.5%), lopinavir/ritonavir 91/200 (45.5%), and tocilizumab 49/200 (24.5%). Thirty-seven (17.6%) patients required ICU admission, 12 (5.7%) suffered graft dysfunction, and 45 (21.4%) died. A shorter interval between transplantation and COVID-19 diagnosis had a negative impact on clinical prognosis. Four baseline features were identified as independent predictors of intensive care need or death: advanced age, high respiratory rate, lymphopenia, and elevated level of lactate dehydrogenase. In summary, this study presents comprehensive information on characteristics and complications of COVID-19 in hospitalized SOTRs and provides indicators available upon hospital admission for the identification of SOTRs at risk of critical disease or death, underlining the need for stringent preventative measures in the early post-transplant period.
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Affiliation(s)
- Sonsoles Salto-Alejandre
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Silvia Jiménez-Jorge
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Nuria Sabé
- Service of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Ramos-Martínez
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Puerta de Hierro University Hospital, Madrid, Spain
| | - Laura Linares
- Service of Infectious Diseases, Clinic University Hospital, Barcelona, Spain
| | - Maricela Valerio
- Service of Clinical Microbiology and Infectious Diseases, Sanitary Research Institute, Gregorio Marañón University Hospital, Madrid, Spain
| | - Pilar Martín-Dávila
- Service of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, 12 de Octubre University Hospital, 12 de Octubre Hospital Research Institute (i+12), Madrid, Spain
| | - María Carmen Fariñas
- Service of Infectious Diseases, Marqués de Valdecilla University Hospital, Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | | | - Elisa Vidal
- Service of Infectious Diseases, Reina Sofía University Hospital, Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
| | - Zaira R. Palacios-Baena
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Román Hernández-Gallego
- Unit of Kidney Transplant, Service of Nefrology, Badajoz University Hospital, Extremadura, Spain
| | - Jordi Carratalá
- Service of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Jorge Calderón-Parra
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Puerta de Hierro University Hospital, Madrid, Spain
| | | | - Patricia Muñoz
- Service of Clinical Microbiology and Infectious Diseases, Sanitary Research Institute, Gregorio Marañón University Hospital, Madrid, Spain
- CIBERES (CB06/06/0058), Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Jesús Fortún-Abete
- Service of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, 12 de Octubre University Hospital, 12 de Octubre Hospital Research Institute (i+12), Madrid, Spain
| | - Francisco Arnaiz-Revillas
- Service of Infectious Diseases, Marqués de Valdecilla University Hospital, Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | | | - Julián de la Torre-Cisneros
- Service of Infectious Diseases, Reina Sofía University Hospital, Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
| | - Luis E. López-Cortés
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen Macarena University Hospital, Seville, Spain
| | | | - Clara M. Rosso
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- Unit of Clinical Investigation and Clinical Trials, Virgen del Rocío University Hospital, Seville, Spain
| | - Jerónimo Pachón
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
| | - Javier Sánchez-Céspedes
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Elisa Cordero
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
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23
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Berastegui-Cabrera J, Salto-Alejandre S, Valerio M, Pérez-Palacios P, Revillas FADL, Abelenda-Alonso G, Oteo-Revuelta JA, Carretero-Ledesma M, Muñoz P, Pascual Á, Gozalo M, Rombauts A, Alba J, García-Díaz E, Rodríguez-Ferrero ML, Valiente A, Fariñas MC, Carratalà J, Santibáñez S, Camacho-Martínez P, Pachón J, Cisneros JM, Cordero E, Sánchez-Céspedes J. SARS-CoV-2 RNAemia is associated with severe chronic underlying diseases but not with nasopharyngeal viral load. J Infect 2021; 82:e38-e41. [PMID: 33248220 PMCID: PMC7688428 DOI: 10.1016/j.jinf.2020.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/22/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Judith Berastegui-Cabrera
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain
| | - Sonsoles Salto-Alejandre
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain
| | - Maricela Valerio
- Service of Clinical Microbiology and Infectious Diseases, Sanitary Research Institute, Gregorio Marañón University Hospital, Madrid, Spain
| | - Patricia Pérez-Palacios
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine. Virgen Macarena University Hospital, Seville, Spain
| | - Francisco Arnaiz-De Las Revillas
- Service of Infectious Diseases, Marqués de Valdecilla University Hospital, Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Gabriela Abelenda-Alonso
- Service of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Marta Carretero-Ledesma
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain
| | - Patricia Muñoz
- Service of Clinical Microbiology and Infectious Diseases, Sanitary Research Institute, Gregorio Marañón University Hospital, Madrid, Spain; CIBERES (CB06/06/0058), Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Álvaro Pascual
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain; Unit of Infectious Diseases, Microbiology, and Preventive Medicine. Virgen Macarena University Hospital, Seville, Spain
| | - Mónica Gozalo
- Service of Microbiology, Marqués de Valdecilla University Hospital, Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Alexander Rombauts
- Service of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Jorge Alba
- Department of Infectious Diseases, San Pedro-CIBIR University Hospital, Logroño, La Rioja, Spain
| | - Emilio García-Díaz
- Unit of Emergencies, Virgen del Rocío University Hospital, Seville, Spain
| | - María Luisa Rodríguez-Ferrero
- Service of Clinical Microbiology and Infectious Diseases, Sanitary Research Institute, Gregorio Marañón University Hospital, Madrid, Spain
| | - Adoración Valiente
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine. Virgen Macarena University Hospital, Seville, Spain
| | - María Carmen Fariñas
- Service of Infectious Diseases, Marqués de Valdecilla University Hospital, Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Jordi Carratalà
- Service of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Sonia Santibáñez
- Department of Infectious Diseases, San Pedro-CIBIR University Hospital, Logroño, La Rioja, Spain
| | - Pedro Camacho-Martínez
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - Jerónimo Pachón
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain; Department of Medicine, University of Seville, Sevilla, Spain
| | - José Miguel Cisneros
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain
| | - Elisa Cordero
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain; Department of Medicine, University of Seville, Sevilla, Spain.
| | - Javier Sánchez-Céspedes
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain.
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24
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Corral-Gudino L, Bahamonde A, Arnaiz-Revillas F, Gómez-Barquero J, Abadía-Otero J, García-Ibarbia C, Mora V, Cerezo-Hernández A, Hernández JL, López-Muñíz G, Hernández-Blanco F, Cifrián JM, Olmos JM, Carrascosa M, Nieto L, Fariñas MC, Riancho JA. Methylprednisolone in adults hospitalized with COVID-19 pneumonia : An open-label randomized trial (GLUCOCOVID). Wien Klin Wochenschr 2021; 133:303-311. [PMID: 33534047 PMCID: PMC7854876 DOI: 10.1007/s00508-020-01805-8] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [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: 10/09/2020] [Accepted: 12/30/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE To determine whether a 6-day course of methylprednisolone (MP) improves outcome in patients with severe SARS-CoV‑2 (Corona Virus Disease 2019 [COVID-19]). METHODS The study was a multicentric open-label trial of COVID-19 patients who were aged ≥ 18 years, receiving oxygen without mechanical ventilation, and with evidence of systemic inflammatory response who were assigned to standard of care (SOC) or SOC plus intravenous MP (40 mg bid for 3 days followed by 20 mg bid for 3 days). The primary outcome was a composite of death, admission to the intensive care unit, or requirement for noninvasive ventilation. Both intention-to-treat (ITT) and per protocol (PP) analyses were performed. RESULTS A total of 91 patients were screened, and 64 were randomized (mean age70 ± 12 years). In the ITT analysis, 14 of 29 patients (48%) in the SOC group and 14 of 35 (40%) in the MP group suffered the composite endpoint (40% versus 20% in patients under 72 years and 67% versus 48% in those over 72 years; p = 0.25). In the PP analysis, patients on MP had a significantly lower risk of experiencing the composite endpoint (age-adjusted risk ratio 0.42; 95% confidence interval, CI 0.20-0.89; p = 0.043). CONCLUSION The planned sample size was not achieved, and our results should therefore be interpreted with caution. The use of MP had no significant effect on the primary endpoint in ITT analysis; however, the PP analysis showed a beneficial effect due to MP, which consistent with other published trials support the use of glucocorticoids in severe cases of COVID-19.
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Affiliation(s)
- Luis Corral-Gudino
- Hospital Rio Hortega, Servicio de Medicina Interna, Universidad de Valladolid, Valladolid, Spain
| | | | - Francisco Arnaiz-Revillas
- IDIVAL, Hospital U M Valdecilla, Servicio de Enfermedades Infecciosas, Universidad de Cantabria, Santander, Spain
| | - Julia Gómez-Barquero
- Hospital Rio Hortega, Servicio de Medicina Interna, Consulta de Enfermedades Infecciosas, Universidad de Valladolid, Valladolid, Spain
| | - Jesica Abadía-Otero
- Hospital Rio Hortega, Servicio de Medicina Interna, Consulta de Enfermedades Infecciosas, Universidad de Valladolid, Valladolid, Spain
| | - Carmen García-Ibarbia
- IDIVAL, Hospital U M Valdecilla, Servicio de Medicina Interna, Universidad de Cantabria, Santander, Spain
| | - Víctor Mora
- IDIVAL, Hospital U M Valdecilla, Servicio de Neumología, Universidad de Cantabria, Santander, Spain
| | | | - José L. Hernández
- IDIVAL, Hospital U M Valdecilla, Servicio de Medicina Interna, Universidad de Cantabria, Santander, Spain
| | | | | | - Jose M. Cifrián
- IDIVAL, Hospital U M Valdecilla, Servicio de Neumología, Universidad de Cantabria, Santander, Spain
| | - Jose M. Olmos
- IDIVAL, Hospital U M Valdecilla, Servicio de Medicina Interna, Universidad de Cantabria, Santander, Spain
| | | | - Luis Nieto
- Servicio de Medicina Interna, Hospital Sierrallana, Torrelavega, Spain
| | - María Carmen Fariñas
- IDIVAL, Hospital U M Valdecilla, Servicio de Enfermedades Infecciosas, Universidad de Cantabria, Santander, Spain
| | - José A. Riancho
- IDIVAL, Hospital U M Valdecilla, Servicio de Medicina Interna, Universidad de Cantabria, Santander, Spain
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25
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Gómez-Fernández C, López-Sundh AE, González-Vela C, Ocejo-Vinyals JG, Mayor-Ibarguren A, Salas-Venero CA, Gutiérrez-Larrañaga M, Tejerina-Puente A, Fariñas MC, Cabero-Pérez MJ, López-Hoyos M, González-López MA. High prevalence of cryofibrinogenemia in patients with chilblains during the COVID-19 outbreak. Int J Dermatol 2020; 59:1475-1484. [PMID: 33070314 DOI: 10.1111/ijd.15234] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/06/2020] [Accepted: 09/14/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Many cutaneous manifestations have been described in possible association with the COVID-19 pandemic, including acral lesions resembling chilblains. The underlying pathomechanisms of COVID-19 chilblains are not fully understood. The aim of this study was to describe the clinical, pathological, and laboratory findings of a series of patients who developed chilblains during the COVID-19 outbreak and to investigate the possible factors that could be involved in the pathogenesis of these lesions. METHODS We conducted a prospective cohort study that included 54 patients who presented with chilblains during the highest peak in the incidence of COVID-19 in Cantabria (northern Spain). Skin biopsies were performed on 10 of these patients who presented with recent lesions. Laboratory investigations, including immunological analysis, serological studies, and the assessment of cryoproteins, were also performed. RESULTS Most patients presented erythematous plaques located on the toes and/or purpuric macules located on the feet. Histopathological findings were compatible with those of idiopathic chilblains. Immunohistochemical evaluation showed C3d and C4d deposits in the vessel walls in seven cases. The autoimmunity panel was negative in most of our series. Cryoprotein testing showed positive cryofibrinogen in two-thirds (66.7%) of the patients assessed. On follow-up, most patients presented almost complete resolution, although six patients required prednisone and antiaggregant drug treatment. CONCLUSIONS This study shows, for the first time to our knowledge, a high prevalence of cryofibrinogenemia in patients with chilblains during the COVID-19 pandemic. Cryofibrinogenemia could be implicated in the pathogenesis of chilblains related to COVID-19.
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Affiliation(s)
- Cristina Gómez-Fernández
- Division of Dermatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain
| | - Ana E López-Sundh
- Division of Dermatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain
| | - Carmen González-Vela
- Division of Pathology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain
| | - Javier Gonzalo Ocejo-Vinyals
- Division of Immunology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain
| | | | - Carlos A Salas-Venero
- Division of Microbiology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain
| | - María Gutiérrez-Larrañaga
- Division of Immunology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain
| | - Ana Tejerina-Puente
- Unit of Pediatrics, Health Center La Marina (Santander), Cantabrian Health Service, Santander, Spain
| | - María Carmen Fariñas
- Unit of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain
| | - María Jesús Cabero-Pérez
- Division of Pediatrics, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain
| | - Marcos López-Hoyos
- Division of Immunology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain
| | - Marcos A González-López
- Division of Dermatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain
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Cordero E, Bulnes-Ramos A, Aguilar-Guisado M, González Escribano F, Olivas I, Torre-Cisneros J, Gavaldá J, Aydillo T, Moreno A, Montejo M, Fariñas MC, Carratalá J, Muñoz P, Blanes M, Fortún J, Suárez-Benjumea A, López-Medrano F, Roca C, Lara R, Pérez-Romero P. Effect of Influenza Vaccination Inducing Antibody Mediated Rejection in Solid Organ Transplant Recipients. Front Immunol 2020; 11:1917. [PMID: 33123119 PMCID: PMC7574595 DOI: 10.3389/fimmu.2020.01917] [Citation(s) in RCA: 15] [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] [Received: 03/04/2020] [Accepted: 07/16/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Our goal was to study whether influenza vaccination induced antibody mediated rejection in a large cohort of solid organ transplant recipients (SOTR). Methods Serum anti-Human Leukocyte Antigen (HLA) antibodies were determined using class I and class II antibody-coated latex beads (FlowPRATM Screening Test) by flow cytometry. Anti-HLA antibody specificity was determined using the single-antigen bead flow cytometry (SAFC) assay and assignation of donor specific antibodies (DSA) was performed by virtual-crossmatch. Results We studied a cohort of 490 SOTR that received an influenza vaccination from 2009 to 2013: 110 (22.4%) received the pandemic adjuvanted vaccine, 59 (12%) within the first 6 months post-transplantation, 185 (37.7%) more than 6 months after transplantation and 136 (27.7%) received two vaccination doses. Overall, no differences of anti-HLA antibodies were found after immunization in patients that received the adjuvanted vaccine, within the first 6 months post-transplantation, or based on the type of organ transplanted. However, the second immunization dose increased the percentage of patients positive for anti-HLA class I significantly compared with patients with one dose (14.6% vs. 3.8%; P = 0.003). Patients with pre-existing antibodies before vaccination (15.7% for anti-HLA class I and 15.9% for class II) did not increase reactivity after immunization. A group of 75 (14.4%) patients developed de novo anti-HLA antibodies, however, only 5 (1.02%) of them were DSA, and none experienced allograft rejection. Only two (0.4%) patients were diagnosed with graft rejection with favorable outcomes and neither of them developed DSA. Conclusion Our results suggest that influenza vaccination is not associated with graft rejection in this cohort of SOTR.
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Affiliation(s)
- Elisa Cordero
- Instituto de Biomedicina de Sevilla (IBIS), University Hospital Virgen del Rocío, CSIC, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
| | - Angel Bulnes-Ramos
- Instituto de Biomedicina de Sevilla (IBIS), University Hospital Virgen del Rocío, CSIC, University of Seville, Seville, Spain
| | - Manuela Aguilar-Guisado
- Instituto de Biomedicina de Sevilla (IBIS), University Hospital Virgen del Rocío, CSIC, University of Seville, Seville, Spain
| | - Francisca González Escribano
- Servicio de Inmunología, Instituto de Biomedicina de Sevilla (IBIS), University Hospital Virgen del Rocío, CSIC, University of Seville, Seville, Spain
| | - Israel Olivas
- Servicio de Inmunología, Instituto de Biomedicina de Sevilla (IBIS), University Hospital Virgen del Rocío, CSIC, University of Seville, Seville, Spain
| | - Julián Torre-Cisneros
- Reina Sofia University Hospital, Maimonides Institute for Biomedical Research (IMIBIC), University of Córdoba (UCO), Córdoba, Spain
| | - Joan Gavaldá
- Vall d'Hebron University Hospital, VHIR, Barcelona, Spain
| | - Teresa Aydillo
- Instituto de Biomedicina de Sevilla (IBIS), University Hospital Virgen del Rocío, CSIC, University of Seville, Seville, Spain
| | | | | | | | - Jordi Carratalá
- Belltvitge University Hospital, IDIBELL, University of Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigaciónn Biomédica Gregorio Marañón, Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,CIBERES (CB06/06/0058), Madrid, Spain
| | | | - Jesús Fortún
- University Hospital Ramón y Cajal, Madrid, Spain
| | | | - Francisco López-Medrano
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación Biomédica imas12, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Roca
- Instituto de Biomedicina de Sevilla (IBIS), University Hospital Virgen del Rocío, CSIC, University of Seville, Seville, Spain
| | - Rosario Lara
- Reina Sofia University Hospital, Maimonides Institute for Biomedical Research (IMIBIC), University of Córdoba (UCO), Córdoba, Spain
| | - Pilar Pérez-Romero
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
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Ramos-Vivas J, Chapartegui-González I, Fernández-Martínez M, González-Rico C, Barrett J, Fortún J, Escudero R, Marco F, Linares L, Nieto J, Aranzamendi M, Muñoz P, Valerio M, Aguado JM, Chaves F, Gracia-Ahufinger I, Paez-Vega A, Martínez-Martínez L, Fariñas MC. Adherence to Human Colon Cells by Multidrug Resistant Enterobacterales Strains Isolated From Solid Organ Transplant Recipients With a Focus on Citrobacter freundii. Front Cell Infect Microbiol 2020; 10:447. [PMID: 33042855 PMCID: PMC7525035 DOI: 10.3389/fcimb.2020.00447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022] Open
Abstract
Enterobacteria species are common causes of hospital-acquired infections, which are associated with high morbidity and mortality rates. Immunocompromised patients such as solid organ transplant (SOT) recipients are especially at risk because they are frequently exposed to antibiotics in the course of their treatments. In this work, we used a collection of 106 Escherichia coli, 78 Klebsiella pneumoniae, 25 Enterobacter spp., and 24 Citrobacter spp. multidrug resistant strains isolated from transplant patients (hepatic, renal or renal/pancreatic) in order to examine their ability to adhere in vitro to HT-29 human colon cells, and to determine if some adhesive characteristics are associated with prevalence and persistence of these strains. A total of 33 E. coli (31%), 21 K. pneumoniae (27%), 7 Enterobacter spp. (28%), and 5 Citrobacter spp. (21%), adhered to the colon epithelial cells. Two main adherence patterns were observed in the four species analyzed, diffuse adherence, and aggregative adherence. Under transmission electronic microscopy (TEM), most bacteria lacked visible fimbria on their surface, despite their strong adherence to epithelial cells. None of the strains studied was able to induce any cytotoxic effect on HT-29 cells although some of them strongly colonizing both cells and glass coverslips at high density. Some of the strains failed to adhere to the epithelial cells but adhered strongly to the cover-slide, which shows that microscopy studies are mandatory to elucidate the adherence of bacteria to epithelial cells in vitro, and that quantitative assays using colony forming unit (CFUs) counting need to be supplemented with pictures to determine definitively if a bacterial strain adheres or not to animal cells in vitro. We report here, for the first time, the aggregative adherence pattern of two multidrug resistant (MDR) Citrobacter freundii strains isolated from human patients; importantly, biofilm formation in Citrobacter is totally dependent on the temperature; strong biofilms were formed at room temperature (RT) but not at 37°C, which can play an important role in the colonization of hospital surfaces. In conclusion, our results show that there is a great variety of adhesion phenotypes in multidrug-resistant strains that colonize transplanted patients.
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Affiliation(s)
| | | | - Marta Fernández-Martínez
- Instituto de Investigación Valdecilla-IDIVAL, Santander, Spain.,Service of Microbiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Claudia González-Rico
- Instituto de Investigación Valdecilla-IDIVAL, Santander, Spain.,Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - John Barrett
- Instituto de Investigación Valdecilla-IDIVAL, Santander, Spain.,New York University School of Medicine, New York, NY, United States
| | - Jesús Fortún
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rosa Escudero
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Francesc Marco
- Service of Microbiology, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Laura Linares
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Javier Nieto
- Infectious Diseases Unit, Hospital Universitario de Cruces, Barakaldo, Spain
| | | | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maricela Valerio
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jose María Aguado
- Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando Chaves
- Service of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Irene Gracia-Ahufinger
- Microbiology Unit, Hospital Universitario Reina Sofía, Córdoba, Spain.,Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain.,Department of Microbiology, Universidad de Córdoba, Córdoba, Spain
| | - Aurora Paez-Vega
- Infectious Diseases Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Luis Martínez-Martínez
- Microbiology Unit, Hospital Universitario Reina Sofía, Córdoba, Spain.,Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain.,Department of Microbiology, Universidad de Córdoba, Córdoba, Spain
| | - María Carmen Fariñas
- Instituto de Investigación Valdecilla-IDIVAL, Santander, Spain.,Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Arnaíz de Las Revillas F, Sousa D, Ardunay C, García-Vidal C, Montejo M, Rodríguez-Álvarez R, Pasquau J, Bouza E, Oteo JA, Balseiro C, Méndez C, Lwoff N, Llinares P, Fariñas MC. Healthcare-associated pneumonia: a prospective study in Spain. Rev Esp Quimioter 2020; 33:358-368. [PMID: 32693555 PMCID: PMC7528418 DOI: 10.37201/req/067.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The aim of the study was to describe the epidemiological characteristics and factors related to outcome in Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated pneumonia (HCAP). Patients and method A 3-year prospective observational epidemiological case study of HCAP was conducted in seven Spanish hospitals. Microbiological and patient characteristics and outcomes were collected and classified by causative pathogen into 4 categories: “S. pneumoniae”, “MRSA”, “Others” and “Unknown”. Patients were followed up 30 days after discharge. Results A total of 258 (84.6%) patients were enrolled (170 were men [65.9%]). Mean age was 72.4 years ± 15 years (95% CI [70.54-74.25]). The etiology of pneumonia was identified in 73 cases (28.3%):S. pneumoniae in 35 patients (13.6%), MRSA in 8 (3.1%), and other microorganisms in 30 patients (11.6%). Significant differences in rates of chronic obstructive pulmonary disease (p < 0.05), previous antibiotic treatment (p < 0.05), other chronic respiratory diseases, inhaled corticosteroids (p < 0.01), and lymphoma (p < 0.05) were observed among the four groups. Patients with MRSA pneumonia had received more previous antibiotic treatment (87.5%). Thirty-three (12.8%) patients died during hospitalisation; death in 27 (81.2%) was related to pneumonia. Conclusions The etiology of HCAP was identified in only one quarter of patients, with S. pneumoniae being the most prevalent microorganism. Patients with chronic respiratory diseases more frequently presented HCAP due to MRSA than to S. pneumoniae. Death at hospital discharge was related in most cases to pneumonia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - M C Fariñas
- María Carmen Fariñas. Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, 39008 Santander, Cantabria, Spain.
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Cuadrado-Lavín A, Olmos JM, Cifrian JM, Gimenez T, Gandarillas MA, García-Saiz M, Rebollo MH, Martínez-Taboada V, López-Hoyos M, Fariñas MC, Crespo J. Controlled, double-blind, randomized trial to assess the efficacy and safety of hydroxychloroquine chemoprophylaxis in SARS CoV2 infection in healthcare personnel in the hospital setting: A structured summary of a study protocol for a randomised controlled trial. Trials 2020; 21:472. [PMID: 32493494 PMCID: PMC7268173 DOI: 10.1186/s13063-020-04400-4] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 11/24/2022] Open
Abstract
Background SARS-CoV-2 infection presents a high transmission in the group of health professionals in Spain (12-15% infected). Currently there is no accepted chemoprophylaxis but hydroxychloroquine (HDQ) is known to inhibit the coronavirus in vitro. Our hypothesis is that oral administration of hydroxychloroquine to healthcare professionals can reduce the incidence and prevalence of infection as well as its severity in this group. Methods Design: Prospective, single center, double blind, randomised, controlled trial (RCT). Participants: Adult health-care professionals (18-65 years) working in areas of high exposure and high risk of transmission of SARS-COV-2 (COVID areas, Intensive Care Unit –ICUs-, Emergency, Anesthesia and all those performing aerosol-generating procedures) will be included. Exclusion criteria include previous infection with SARS CoV2 (positive SARS-CoV-2 PCR or IgG serology), pregnancy or lactation, any contraindication to hydroxychloroquine or evidence of unstable or clinically significant systemic disease. Interventions Patients will be randomized (1:1) to receive once-daily oral Hydroxychloroquine 200mg for two months (HC group) or placebo (P group) in addition to the protective measures appropriate to the level of exposure established by the hospital. A serological evaluation will be carried out every 15 days with PCR in case of seroconversion, symptoms or risk exposure. Primary outcome is the percentage of subjects presenting infection (seroconversion and/or PCR +ve) by the SARS-Cov-2 virus during the observation period. Additionally, both the percentage of subjects in each group presenting Pneumonia with severity criteria (Curb 65 ≥2) and that of subjects requiring admission to ICU will be determined. Discussion While awaiting a vaccine, hygiene measures, social distancing and personal protective equipment are the only primary prophylaxis measures against SARS-CoV-2, but they have not been sufficient to protect our healthcare professionals. Some evidence of the in vitro efficacy of hydroxychloroquine against this virus is known, along with some clinical data that would support the study of this drug in the chemoprophylaxis of infection. However, there are still no data from controlled clinical trials in this regard. If our hypothesis is confirmed, hydroxychloroquine can help professionals fight this infection with more guarantees. Participants This is a single-center study that will be carried out at the Marqués de Valdecilla University Hospital. 450 health professionals working at the Hospital Universitario Marqués de Valdecilla in areas of high exposure and high risk of transmission of SARS COV2 (COVID hospital areas, Intensive Care Unit, Emergency, Anesthesia and all those performing aerosol-generating procedures) will be included. Inclusion criteria: 1) Health professionals aged between 18 and 65 years (inclusive) at the time of the first screening visit; 2) They must provide signed written informed consent and agree to comply with the study protocol; 3) Active work in high exposure areas during the last two weeks and during the following weeks. Exclusion criteria: 1) Previous infection with SARS CoV2 (positive coronavirus PCR or positive serology with SARS Cov2 negative PCR and absence of symptoms); 2) Current treatment with hydroxychloroquine or chloroquine; 3) Hypersensitivity, allergy or any contraindication for taking hydroxychloroquine, in the technical sheet; 4) Previous or current treatment with tamoxifen or raloxifene; 5) Previous eye disease, especially maculopathy; 6) Known heart failure (Grade III to IV of the New York Heart Association classification) or prolonged QTc; 7) Any type of cancer (except basal cell) in the last 5 years; 6) Refusal to give informed consent; 8) Evidence of any other unstable or clinically significant untreated immune, endocrine, hematological, gastrointestinal, neurological, neoplastic or psychiatric illness; 9) Antibodies positive for the human immunodeficiency virus; 10) Significant kidney or liver disease; 11) Pregnancy or lactation. Intervention and comparator Two groups will be analyzed with a 1: 1 randomization rate.
Intervention: (n = 225): One 200 mg hydroxychloroquine sulfate coated tablet once daily for two months. Comparator (control group) (n = 225): One hydroxychloroquine placebo tablet (identical to that of the drug) once daily for two months
Main outcomes The primary outcome of this study will be to evaluate:
number and percentage of healthcare personnel presenting symptomatic and asymptomatic infection (see “Diagnosis of SARS CoV2 infection” below) by the SARS-Cov2 virus during the study observation period (8 weeks) in both treatment arms; number and percentage of healthcare personnel in each group presenting with Pneumonia with severity criteria (Curb 65 ≥2) and number and percentage of healthcare personnel requiring admission to the Intensive Care Unit (ICU) in both treatment arms.
Diagnosis of SARS CoV2 infection Determination of IgA, IgM and IgG type antibodies against SARS-CoV-2 using the Anti-SARS-CoV-2 ELISA kit (EUROIMMUN Medizinische Labordiagnostika AG, Germany) every two weeks. In cases of seroconversion, a SARS-CoV-2 PCR will be performed to rule out / confirm an active infection (RT-PCR in One Step: RT performed with mastermix (Takara) and IDT probes, following protocol published and validated by the CDC Evaluation of COVID-19 in case of SARS-CoV-2 infection Randomisation Participants will be allocated to intervention and comparator groups according to a balanced randomization scheme (1: 1). The assignment will be made through a computer-generated numeric sequence for all participants Blinding (masking) Both participants and investigators responsible for recruiting and monitoring participants will be blind to the assigned arm. Numbers to be randomised (sample size) Taking into account the current high prevalence of infection in healthcare personnel in Spain (up to 15%), to detect a difference equal to or greater than 8% in the percentage estimates through a two-tailed 95% CI, with a statistical power of 80% and a dropout rate of 5%, a total of 450 participants will need to be included (250 in each arm). Trial Status The protocol approved by the health authorities in Spain (Spanish Agency for Medicines and Health Products “AEMPS”) and the Ethics and Research Committee of Cantabria (CEIm Cantabria) corresponds to version 1.1 of April 2, 2020. Currently, recruitment has not yet started, with the start scheduled for the second week of May 2020. Trial registration Eudra CT number: 2020-001704-42 (Registered on 29 March 2020) Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).
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Affiliation(s)
- Antonio Cuadrado-Lavín
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, 39011, Santander, Cantabria, Spain
| | - José Manuel Olmos
- Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, 39011, Santander, Cantabria, Spain.,Internal Medicine Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
| | - José Manuel Cifrian
- Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, 39011, Santander, Cantabria, Spain.,Service of Pneumology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
| | - Teresa Gimenez
- Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, 39011, Santander, Cantabria, Spain.,Pharmacy Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
| | - Marco Antonio Gandarillas
- Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, 39011, Santander, Cantabria, Spain.,Department of Prevention and Risks, Work Medicine, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
| | - Mar García-Saiz
- Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, 39011, Santander, Cantabria, Spain.,Department of Clinical Pharmacology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
| | - Maria Henar Rebollo
- Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, 39011, Santander, Cantabria, Spain.,Department of Preventive Medicine, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
| | - Victor Martínez-Taboada
- Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, 39011, Santander, Cantabria, Spain.,Department of Rheumatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
| | - Marcos López-Hoyos
- Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, 39011, Santander, Cantabria, Spain.,Department of Immunology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
| | - María Carmen Fariñas
- Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, 39011, Santander, Cantabria, Spain.,Infectious diseases Service, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
| | - Javier Crespo
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain. .,Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, 39011, Santander, Cantabria, Spain.
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30
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López-Medrano F, Silva JT, Fernández-Ruiz M, Vidal E, Origüen J, Calvo-Cano A, Luna-Huerta E, Merino E, Hernández D, Jironda-Gallegos C, Escudero R, Gioia F, Moreno A, Roca C, Cordero E, Janeiro D, Sánchez-Sobrino B, Montero MM, Redondo D, Candel FJ, Pérez-Flores I, Armiñanzas C, González-Rico C, Fariñas MC, Rodrigo E, Loeches B, López-Oliva MO, Montejo M, Lauzurica R, Horcajada JP, Pascual J, Andrés A, Aguado JM. Oral fosfomycin for the treatment of lower urinary tract infections among kidney transplant recipients-Results of a Spanish multicenter cohort. Am J Transplant 2020; 20:451-462. [PMID: 31550408 DOI: 10.1111/ajt.15614] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/03/2019] [Revised: 09/08/2019] [Accepted: 09/12/2019] [Indexed: 01/25/2023]
Abstract
Oral fosfomycin may constitute an alternative for the treatment of lower urinary tract infections (UTIs) in kidney transplant recipients (KTRs), particularly in view of recent safety concerns with fluroquinolones. Specific data on the efficacy and safety of fosfomycin in KTR are scarce. We performed a retrospective study in 14 Spanish hospitals including KTRs treated with oral fosfomycin (calcium and trometamol salts) for posttransplant cystitis between January 2005 and December 2017. A total of 133 KTRs developed 143 episodes of cystitis. Most episodes (131 [91.6%]) were produced by gram-negative bacilli (GNB), and 78 (54.5%) were categorized as multidrug resistant (including extended-spectrum β-lactamase-producing Enterobacteriaceae [14%] or carbapenem-resistant GNB [3.5%]). A median daily dose of 1.5 g of fosfomycin (interquartile range [IQR]: 1.5-2) was administered for a median of 7 days (IQR: 3-10). Clinical cure (remission of UTI-attributable symptoms at the end of therapy) was achieved in 83.9% (120/143) episodes. Among those episodes with follow-up urine culture, microbiological cure at month 1 was achieved in 70.2% (59/84) episodes. Percutaneous nephrostomy was associated with a lower probability of clinical cure (adjusted odds ratio: 10.50; 95% confidence interval: 0.98-112.29; P = 0.052). In conclusion, fosfomycin is an effective orally available alternative for treating cystitis among KTRs.
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Affiliation(s)
- Francisco López-Medrano
- Unit of Infectious Diseases, University Hospital, "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - José Tiago Silva
- Unit of Infectious Diseases, University Hospital, "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, University Hospital, "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Elisa Vidal
- Unit of Infectious Diseases, University Hospital "Reina Sofía", Instituto Maimónides de Investigación en Biomedicina de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | - Julia Origüen
- Unit of Infectious Diseases, University Hospital, "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Antonia Calvo-Cano
- Department of Infectious Diseases, University Hospital of Badajoz, Badajoz, Spain
| | | | - Esperanza Merino
- Unit of Infectious Diseases, General University Hospital of Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Domingo Hernández
- Department of Nephrology, Regional University Hospital "Carlos Haya", Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Cristina Jironda-Gallegos
- Department of Nephrology, Regional University Hospital "Carlos Haya", Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Rosa Escudero
- Department of Infectious Diseases, University Hospital "Ramón y Cajal", Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Francesca Gioia
- Department of Infectious Diseases, University Hospital "Ramón y Cajal", Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Antonio Moreno
- Department of Infectious Diseases, University Hospitals "Virgen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Cristina Roca
- Department of Infectious Diseases, University Hospitals "Virgen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Elisa Cordero
- Department of Infectious Diseases, University Hospitals "Virgen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Darío Janeiro
- Department of Nephrology, University Hospital Puerta de Hierro-Majadahonda, Investigación Sanitaria Puerta de Hierro "Segovia de Arana", Majadahonda, Spain
| | - Beatriz Sánchez-Sobrino
- Department of Nephrology, University Hospital Puerta de Hierro-Majadahonda, Investigación Sanitaria Puerta de Hierro "Segovia de Arana", Majadahonda, Spain
| | - María Milagro Montero
- Department of Infectious Diseases, Hospital del Mar, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Dolores Redondo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Francisco Javier Candel
- Department of Clinical Microbiology and Infectious Diseases, Hospital Clínico Universitario "San Carlos", Instituto de Investigación Sanitaria "San Carlos" (IdISSC), Transplant Coordination Unit, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Isabel Pérez-Flores
- Department of Nephrology, Hospital Clínico Universitario "San Carlos", Instituto de Investigación Sanitaria "San Carlos" (IdISSC), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Carlos Armiñanzas
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Instituto de Investigación "Marqués de Valdecilla" (IDIVAL), University of Cantabria, Santander, Spain
| | - Claudia González-Rico
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Instituto de Investigación "Marqués de Valdecilla" (IDIVAL), University of Cantabria, Santander, Spain
| | - María Carmen Fariñas
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Instituto de Investigación "Marqués de Valdecilla" (IDIVAL), University of Cantabria, Santander, Spain
| | - Emilio Rodrigo
- Department of Nephrology, University Hospital "Marqués de Valdecilla", Instituto de Investigación "Marqués de Valdecilla" (IDIVAL), University of Cantabria, Santander, Spain
| | - Belén Loeches
- Department of Microbiology, University Hospital La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - María O López-Oliva
- Department of Nephrology, University Hospital La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Miguel Montejo
- Unit of Infectious Diseases, Hospital Universitario Cruces, Universidad del País Vasco, Barakaldo, Spain
| | - Ricardo Lauzurica
- Department of Nephrology, University Hospital "Germans Trias i Pujol", Badalona, Barcelona, Spain
| | - Juan Pablo Horcajada
- Department of Infectious Diseases, Hospital del Mar, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Amado Andrés
- Department of Nephrology, University Hospital "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, University Hospital, "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
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Len O, Los-Arcos I, Aguado JM, Blanes M, Bodro M, Carratalà J, Cordero E, Fariñas MC, Fernández-Ruiz M, Fortún J, Gavaldà J, López-Medrano F, López-Vélez R, Lumbreras C, Mahillo B, Marcos MÁ, Martin-Dávila P, Montejo JM, Moreno A, Muñoz P, Norman F, Pérez-Sáenz JL, Pumarola T, Sabé N, San-Juan R, Vidal E, Domínguez-Gil B. Selection criteria of solid organ donors in relation to infectious diseases: A Spanish consensus. Transplant Rev (Orlando) 2020; 34:100528. [PMID: 32001103 DOI: 10.1016/j.trre.2020.100528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/30/2022]
Abstract
The immunosuppressive treatment that recipients receive from a solid organ transplantation hinders the defensive response to infection. Its transmission from the donor can cause dysfunction or loss of the graft and even death of the recipient if proper preventive measures are not established. This potential risk should be thoroughly evaluated to minimise the risk of infection transmission from donor to recipient, especially with organ transplantation from donors with infections, without increasing graft dysfunction and morbidity and mortality in the recipient. This document aims to review current knowledge about infection screening in potential donors and offer clinical and microbiological recommendations about the use of organs from donors with infection based on available scientific evidence.
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Affiliation(s)
- Oscar Len
- Hospital Universitari Vall d'Hebrón, Barcelona, Spain.
| | | | | | - Marino Blanes
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Jordi Carratalà
- Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | | | | | | | - Jesús Fortún
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Joan Gavaldà
- Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | | | | | | | | | | | | | | | | | - Patricia Muñoz
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - Núria Sabé
- Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | | | - Elisa Vidal
- Hospital Universitario Reina Sofía, Córdoba, Spain
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Pérez-Nadales E, Gutiérrez-Gutiérrez B, Natera AM, Abdala E, Reina Magalhães M, Mularoni A, Monaco F, Camera Pierrotti L, Pinheiro Freire M, Iyer RN, Mehta Steinke S, Grazia Calvi E, Tumbarello M, Falcone M, Fernández-Ruiz M, María Costa-Mateo J, Rana MM, Mara Varejão Strabelli T, Paul M, Carmen Fariñas M, Clemente WT, Roilides E, Muñoz P, Dewispelaere L, Loeches B, Lowman W, Tan BH, Escudero-Sánchez R, Bodro M, Antonio Grossi P, Soldani F, Gunseren F, Nestorova N, Pascual Á, Martínez-Martínez L, Aguado JM, Rodríguez-Baño J, Torre-Cisneros J. Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia. Am J Transplant 2019; 20:S1600-6135(22)22362-4. [PMID: 31891235 DOI: 10.1111/ajt.15769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/30/2019] [Accepted: 12/22/2019] [Indexed: 01/25/2023]
Abstract
Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score ≥8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score ≥8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance.
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Affiliation(s)
- Elena Pérez-Nadales
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
| | - Belén Gutiérrez-Gutiérrez
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Alejandra M Natera
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
| | - Edson Abdala
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Mario Tumbarello
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Falcone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain
| | - José María Costa-Mateo
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | | | | | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus and Faculty of Medicine, Technion - Israel Faculty of Technology, Haifa, Israel
| | - María Carmen Fariñas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - Wanessa Trindade Clemente
- Faculty of Medicine, Liver Transplantation Program, Hospital das Clínicas -Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Emmanuel Roilides
- Infectious Diseases Unit and 3rd, Department of Pediatrics, Aristotle University School of Health Sciences, Hippokration Hospital, Thessaloniki, Greece
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Laurent Dewispelaere
- Department of Microbiology, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Belén Loeches
- Infectious Diseases Unit, Hospital La Paz, Madrid, Spain
| | - Warren Lowman
- Wits Donald Gordon Medical Centre, Vermaak & Partners/Pathcare, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Rosa Escudero-Sánchez
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Ramón y Cajal University Hospital, Madrid, Spain
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Fabio Soldani
- Department of Medicine, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Filiz Gunseren
- Department of Infectious Diseases, Akdeniz University Hospital, Antalya, Turkey
| | | | - Álvaro Pascual
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Luis Martínez-Martínez
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Reina Sofía, IMIBIC, Universidad de Cordoba, Cordoba, Spain
| | - José María Aguado
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain
| | - Jesús Rodríguez-Baño
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Julián Torre-Cisneros
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
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Len O, Los-Arcos I, Aguado JM, Blanes M, Bodro M, Carratalà J, Cordero E, Fariñas MC, Fernández-Ruiz M, Fortún J, Gavaldà J, López-Medrano F, López-Vélez R, Lumbreras C, Mahillo B, Marcos MÁ, Martin-Dávila P, Montejo JM, Moreno A, Muñoz P, Norman F, Pérez-Sáenz JL, Pumarola T, Sabé N, San-Juan R, Vidal E, Domínguez-Gil B. Executive summary of the Consensus Statement of the Transplant Infection Study Group (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the National Transplant Organization (ONT) on the Selection Criteria of Donors of Solid Organs in relation to Infectious Diseases. Enferm Infecc Microbiol Clin 2019; 38:379-389. [PMID: 31870646 DOI: 10.1016/j.eimc.2019.10.016] [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: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
The immunosuppressive treatment that recipients receive from a solid organ transplantation hinders the defensive response to infection. Its transmission from the donor can cause dysfunction or loss of the graft and even death of the recipient if proper preventive measures are not established. This potential risk should be thoroughly evaluated to minimise the risk of infection transmission from donor to recipient, especially with organ transplantation from donors with infections, without increasing graft dysfunction and morbidity and mortality in the recipient. This document aims to review current knowledge about infection screening in potential donors and offer clinical and microbiological recommendations about the use of organs from donors with infection based on available scientific evidence.
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Affiliation(s)
- Oscar Len
- Hospital Universitari Vall d'Hebrón, Barcelona, Spain.
| | | | | | - Marino Blanes
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Jordi Carratalà
- Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | | | | | | | - Jesús Fortún
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Joan Gavaldà
- Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | | | | | | | | | | | | | | | | | - Patricia Muñoz
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - Núria Sabé
- Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | | | - Elisa Vidal
- Hospital Universitario Reina Sofía, Córdoba, Spain
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Puente M, Fariñas-Alvarez C, Moreto A, Sánchez-Velasco P, Ocejo-Vinyals JG, Fariñas MC. Low pre-transplant levels of mannose-binding lectin are associated with viral infections and mortality after haematopoietic allogeneic stem cell transplantation. BMC Immunol 2019; 20:40. [PMID: 31706269 PMCID: PMC6842494 DOI: 10.1186/s12865-019-0318-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mannose-binding lectin (MBL) is a key component of innate immunity. Low serum MBL levels, related to promoter polymorphism and structural variants, have been associated with an increased risk of infection. The aim of this work was to analyse the incidence and severity of infections and mortality in relation to the MBL2 genotype and MBL levels in patients underwent allogeneic haematopoietic stem cell transplantation (Allo-HSCT). RESULTS This was a prospective cohort study of 72 consecutive patients underwent Allo-HSCT between January 2007 and June 2009 in a tertiary referral centre. Three periods were considered in the patients' follow-up: the early period (0-30 days after Allo-HSCT), the intermediate period (30-100 days after Allo-HSCT) and the late period (> 100 days after Allo-HSCT). A commercial line probe assay for MBL2 genotyping and an ELISA Kit were used to measure MBL levels. A total of 220 episodes of infection were collected in the 72 patients. No association between donor or recipient MBL2 genotype and infection was found. The first episode of infection presented earlier in patients with pre-transplant MBL levels of < 1000 ng/ml (median 6d vs 8d, p = 0.036). MBL levels < 1000 ng/ml in the pre-transplant period (risk ratio (RR) 2.48, 95% CI 1.00-6.13), neutropenic period (0-30 days, RR 3.28, 95% CI 1.53-7.06) and intermediate period (30-100 days, RR 2.37, 95% CI 1.15-4.90) were associated with increased risk of virus infection. No association with bacterial or fungal disease was found. Mortality was associated with pre-transplant MBL levels < 1000 ng/ml (hazard ratio 5.55, 95% CI 1.17-26.30, p = 0.03) but not with MBL2 genotype. CONCLUSIONS Patients who underwent Allo-HSCT with low pre-transplant MBL levels presented the first episode of infection earlier and had an increased risk of viral infections and mortality in the first 6 months post-transplant. Thus, pre-transplant MBL levels would be important in predicting susceptibility to viral infections and mortality and might be considered a biomarker to be included in the pre-transplantation risk assessment.
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Affiliation(s)
- M Puente
- Service of Hematology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.,Present address: Service of Hematology, Hospital de Cruces, Bilbao, Spain
| | - C Fariñas-Alvarez
- Division of Health Care Quality, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - A Moreto
- Service of Hematology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.,Present address: Service of Hematology, Hospital de Cruces, Bilbao, Spain
| | - P Sánchez-Velasco
- Division of Health Care Quality, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - J G Ocejo-Vinyals
- Division of Health Care Quality, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M C Fariñas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain.
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Ramos-Vivas J, Chapartegui-González I, Fernández-Martínez M, González-Rico C, Fortún J, Escudero R, Marco F, Linares L, Montejo M, Aranzamendi M, Muñoz P, Valerio M, Aguado JM, Resino E, Ahufinger IG, Vega AP, Martínez-Martínez L, Fariñas MC. Biofilm formation by multidrug resistant Enterobacteriaceae strains isolated from solid organ transplant recipients. Sci Rep 2019; 9:8928. [PMID: 31222089 PMCID: PMC6586660 DOI: 10.1038/s41598-019-45060-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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: 01/22/2019] [Accepted: 05/29/2019] [Indexed: 11/09/2022] Open
Abstract
Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant bacteria (MDR). In this study, the biofilm-forming capability of 209 MDR strains (Escherichia coli n = 106, Klebsiella pneumoniae n = 78, and Enterobacter spp. n = 25) isolated from rectal swabs in the first 48 hours before or after kidney (93 patients), liver (60 patients) or kidney/pancreas transplants (5 patients) were evaluated by using a microplate assay. Thirty-nine strains were isolated before transplant and 170 strains were isolated post-transplant. Overall, 16% of E. coli strains, 73% of K. pneumoniae strains and 4% Enterobacter strains showed moderate or strong biofilm production. Nine strains isolated from infection sites after transplantation were responsible of infections in the first month. Of these, 4 K. pneumoniae, 1 E. coli and 1 Enterobacter spp. strains isolated pre-transplant or post-transplant as colonizers caused infections in the post-transplant period. Our results suggest that in vitro biofilm formation could be an important factor for adhesion to intestine and colonization in MDR K. pneumoniae strains in SOT recipients, but this factor appears to be less important for MDR E. coli and Enterobacter spp.
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Affiliation(s)
- José Ramos-Vivas
- Instituto de Investigación Valdecilla-IDIVAL, Avd. Cardenal Herrera Oria, 39011, Santander, Spain
| | | | - Marta Fernández-Martínez
- Service of Microbiology, Hospital Universitario Marqués de Valdecilla, Avd. Valdecilla, 39008, Santander, Spain
| | - Claudia González-Rico
- Infectious Diseases Unit. Hospital Universitario Marqués de Valdecilla, Santander, Spain. Avd. Valdecilla, 39008, Santander, Spain
| | - Jesús Fortún
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Ctra. Colmenar Viejo, km. 9, 100, 28034, Madrid, Spain
| | - Rosa Escudero
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Ctra. Colmenar Viejo, km. 9, 100, 28034, Madrid, Spain
| | - Francesc Marco
- Service of Microbiology, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Laura Linares
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Miguel Montejo
- Infectious Diseases Unit, Hospital Universitario Cruces, Plaza de Cruces, S/N, 48903, Baracaldo, Vizcaya, Spain
| | - Maitane Aranzamendi
- Service of Microbiology, Hospital Universitario Cruces, Plaza de Cruces, S/N, 48903, Baracaldo, Vizcaya, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Maricela Valerio
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Jose María Aguado
- Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Av. Córdoba, s/n, 28004, Madrid, Spain
| | - Elena Resino
- Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Av. Córdoba, s/n, 28004, Madrid, Spain
| | - Irene Gracia Ahufinger
- Service of Microbiology, Hospital Universitario Reina Sofía, Av. Menéndez Pidal, s/n, 14004, Córdoba, Spain
| | - Aurora Paz Vega
- Infectious Diseases Unit, Hospital Universitario Reina Sofía, Av. Menéndez Pidal, s/n, 14004, Córdoba, Spain
| | - Luis Martínez-Martínez
- Service of Microbiology, Hospital Universitario Marqués de Valdecilla, Avd. Valdecilla, 39008, Santander, Spain.,Service of Microbiology, Hospital Universitario Reina Sofía, Av. Menéndez Pidal, s/n, 14004, Córdoba, Spain
| | - María Carmen Fariñas
- Instituto de Investigación Valdecilla-IDIVAL, Avd. Cardenal Herrera Oria, 39011, Santander, Spain. .,Infectious Diseases Unit. Hospital Universitario Marqués de Valdecilla, Santander, Spain. Avd. Valdecilla, 39008, Santander, Spain.
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Armiñanzas C, Fariñas-Alvarez C, Zarauza J, Muñoz P, González Ramallo V, Martínez Sellés M, Miró Meda JM, Pericás JM, Goenaga MÁ, Ojeda Burgos G, Rodríguez Álvarez R, Castelo Corral L, Gálvez-Acebal J, Martínez Marcos FJ, Fariñas MC, Fernández Sánchez F, Noureddine M, Rosas G, de la Torre Lima J, Aramendi J, Bereciartua E, Blanco MJ, Blanco R, Boado MV, Campaña Lázaro M, Crespo A, Goikoetxea J, Iruretagoyena JR, Irurzun Zuazabal J, López-Soria L, Montejo M, Nieto J, Rodrigo D, Rodríguez D, Rodríguez R, Vitoria Y, Voces R, García López MV, Georgieva RI, Ojeda G, Rodríguez Bailón I, Ruiz Morales J, Cuende AM, Echeverría T, Fuerte A, Gaminde E, Goenaga MÁ, Idígoras P, Iribarren JA, Izaguirre Yarza A, Kortajarena Urkola X, Reviejo C, Carrasco R, Climent V, Llamas P, Merino E, Plazas J, Reus S, Álvarez N, Bravo-Ferrer JM, Castelo L, Cuenca J, Llinares P, Miguez Rey E, Rodríguez Mayo M, Sánchez E, Sousa Regueiro D, Martínez FJ, Alonso MDM, Castro B, García Rosado D, Durán MDC, Miguel Gómez MA, Lacalzada J, Nassar I, Plata Ciezar A, Reguera Iglesias JM, Asensi Álvarez V, Costas C, de la Hera J, Fernández Suárez J, Iglesias Fraile L, León Arguero V, López Menéndez J, Mencia Bajo P, Morales C, Moreno Torrico A, Palomo C, Paya Martínez B, Rodríguez Esteban Á, Rodríguez García R, Telenti Asensio M, Almela M, Ambrosioni J, Azqueta M, Brunet M, Bodro M, Cartañá R, Falces C, Fita G, Fuster D, García de la Mària C, Hernández-Meneses M, Llopis Pérez J, Marco F, Miró JM, Moreno A, Nicolás D, Ninot S, Quintana E, Paré C, Pereda D, Pericás JM, Pomar JL, Ramírez J, Rovira I, Sandoval E, Sitges M, Soy D, Téllez A, Tolosana JM, Vidal B, Vila J, Adán I, Bermejo J, Bouza E, Celemín D, Cuerpo Caballero G, Delgado Montero A, Fernández Cruz A, García Mansilla A, García Leoni ME, González Ramallo V, Kestler Hernández M, Hualde AM, Marín M, Martínez-Sellés M, Menárguez MC, Muñoz P, Rincón C, Rodríguez-Abella H, Rodríguez-Créixems M, Pinilla B, Pinto Á, Valerio M, Vázquez P, Verde Moreno E, Antorrena I, Loeches B, Martín Quirós A, Moreno M, Ramírez U, Rial Bastón V, Romero M, Saldaña A, Agüero Balbín J, Amado C, Armiñanzas Castillo C, Arnaiz García A, Cobo Belaustegui M, Fariñas MC, Fariñas-Álvarez C, Gómez Izquierdo R, García I, González-Rico C, Gutiérrez-Cuadra M, Gutiérrez Díez J, Pajarón M, Parra JA, Sarralde A, Teira R, Zarauza J, Domínguez F, García Pavía P, González J, Orden B, Ramos A, Centella T, Hermida JM, Moya JL, Martín-Dávila P, Navas E, Oliva E, Del Río A, Ruiz S, Hidalgo Tenorio C, Almendro Delia M, Araji O, Barquero JM, Calvo Jambrina R, de Cueto M, Gálvez Acebal J, Méndez I, Morales I, López-Cortés LE, de Alarcón A, García E, Haro JL, Lepe JA, López F, Luque R, Alonso LJ, Azcárate P, Azcona Gutiérrez JM, Blanco JR, García-Álvarez L, Oteo JA, Sanz M, de Benito N, Gurguí M, Pacho C, Pericas R, Pons G, Álvarez M, Fernández AL, Martínez A, Prieto A, Regueiro B, Tijeira E, Vega M, Canut Blasco A, Cordo Mollar J, Gainzarain Arana JC, García Uriarte O, Martín López A, Ortiz de Zárate Z, Urturi Matos JA, García Domínguez G, Sánchez-Porto A, Arribas Leal JM, García Vázquez E, Hernández Torres A, Blázquez A, de la Morena Valenzuela G, Alonso Á, Aramburu J, Calvo FE, Moreno Rodríguez A, Tarabini-Castellani P, Heredero Gálvez E, Maicas Bellido C, Largo Pau J, Sepúlveda MA, Toledano Sierra P, Iqbal-Mirza SZ, Cascales Alcolea E, Egea Serrano P, Hernández Roca JJ, Keituqwa Yañez I, Peláez Ballesta A, Soriano V, Moreno Escobar E, Peña Monje A, Sánchez Cabrera V, Vinuesa García D, Arrizabalaga Asenjo M, Cifuentes Luna C, Núñez Morcillo J, Pérez Seco MC, Villoslada Gelabert A, Aured Guallar C, Fernández Abad N, García Mangas P, Matamala Adell M, Palacián Ruiz MP, Porres JC, Alcaraz Vidal B, Cobos Trigueros N, Del Amor Espín MJ, Giner Caro JA, Jiménez Sánchez R, Jimeno Almazán A, Ortín Freire A, Viqueira González M, Pericás Ramis P, Ribas Blanco MÁ, Ruiz de Gopegui Bordes E, Vidal Bonet L, Bellón Munera MC, Escribano Garaizabal E, Tercero Martínez A, Segura Luque JC. Role of age and comorbidities in mortality of patients with infective endocarditis. Eur J Intern Med 2019; 64:63-71. [PMID: 30904433 DOI: 10.1016/j.ejim.2019.03.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 12/29/2018] [Revised: 02/22/2019] [Accepted: 03/05/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. METHODS Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. RESULTS A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32-3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39-1.88),and non-performed surgery (HR:1.64;95% CI:11.16-1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. CONCLUSION There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group.
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Affiliation(s)
- Carlos Armiñanzas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - Concepción Fariñas-Alvarez
- Division of Health Care Quality, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
| | - Jesús Zarauza
- Hospital Universitario Marqués de Valdecilla, Santander, 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, Spain.
| | - Víctor González Ramallo
- Servicio de Medicina Interna, Hospitalización a Domicilio, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Manuel Martínez Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Universidad Europea, Universidad Complutense, Madrid, Spain.
| | - José Mª Miró Meda
- Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
| | - Juan Manuel Pericás
- Servicio de Enfermedades Infecciosas, Hospital Clinic de Barcelona-IDIBAPS. Barcelona, Spain.
| | - Miguel Ángel Goenaga
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián, Spain
| | - Guillermo Ojeda Burgos
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Regino Rodríguez Álvarez
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Universidad del País Vasco, País Vasco, Spain.
| | - Laura Castelo Corral
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario A Coruña, A Coruña, Spain
| | - Juan Gálvez-Acebal
- JUnidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena Instituto de Biomedicina de Sevilla, IBIS, Universidad de Sevilla, Sevilla, Spain.
| | | | - Maria Carmen Fariñas
- Maria Carmen Fariñas, Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana María Cuende
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | - Tomás Echeverría
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | - Ana Fuerte
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | - Eduardo Gaminde
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | | | - Pedro Idígoras
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | | | | | | | - Carlos Reviejo
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | | | | | | | | | - Joaquín Plazas
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Sergio Reus
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Nemesio Álvarez
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Laura Castelo
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - José Cuenca
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Pedro Llinares
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | | | - Efrén Sánchez
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Carlos Costas
- Hospital Universitario Central Asturias, Oviedo, Spain
| | | | | | | | | | | | | | | | | | - Carmen Palomo
- Hospital Universitario Central Asturias, Oviedo, Spain
| | | | | | | | | | - Manuel Almela
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Manuel Azqueta
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Mercè Brunet
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Marta Bodro
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Ramón Cartañá
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Carlos Falces
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Guillermina Fita
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - David Fuster
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | | | | | | | - Francesc Marco
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - José M Miró
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - David Nicolás
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Salvador Ninot
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Eduardo Quintana
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Carlos Paré
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Daniel Pereda
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Juan M Pericás
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - José L Pomar
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - José Ramírez
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Irene Rovira
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Elena Sandoval
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Marta Sitges
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Dolors Soy
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Adrián Téllez
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - José M Tolosana
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Bárbara Vidal
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Jordi Vila
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Iván Adán
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Bermejo
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Emilio Bouza
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Daniel Celemín
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Mercedes Marín
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Patricia Muñoz
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Rincón
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Blanca Pinilla
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Pinto
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Pilar Vázquez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | - Mar Moreno
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Iván García
- Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | | | | | - Ramón Teira
- Universitario Marqués de Valdecilla, Santander, Spain
| | - Jesús Zarauza
- Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Soledad Ruiz
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Omar Araji
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | | | | | - Irene Méndez
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | | | - Emilio García
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | - Rafael Luque
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | | | | | | | | | | | - Mercé Gurguí
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Roser Pericas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Guillem Pons
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Álvarez
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - A L Fernández
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - Amparo Martínez
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - A Prieto
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - Benito Regueiro
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - E Tijeira
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - Marino Vega
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Blázquez
- Hospital Clínico Universitario Virgen de la Arrixaca Murcia, Spain
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Oriol I, Sabe N, Càmara J, Berbel D, Ballesteros MA, Escudero R, Lopez-Medrano F, Linares L, Len O, Silva JT, Oliver E, Soldevila L, Pérez-Recio S, Guillem LL, Camprubí D, LLadó L, Manonelles A, González-Costello J, Domínguez MA, Fariñas MC, Lavid N, González-Rico C, Garcia-Cuello L, Arnaiz de Las Revillas F, Fortun J, Aguado JM, Jimenez-Romero C, Bodro M, Almela M, Paredes D, Moreno A, Pérez-Cameo C, Muñoz-Sanz A, Blanco-Fernández G, Cabo-González JA, García-López JL, Nuño E, Carratalà J. The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation: A Prospective Multicenter Cohort Study. Open Forum Infect Dis 2019; 6:ofz180. [PMID: 31198815 PMCID: PMC6546202 DOI: 10.1093/ofid/ofz180] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/17/2019] [Indexed: 01/29/2023] Open
Abstract
Background We analyzed the prevalence, etiology, and risk factors of culture-positive preservation fluid and their impact on the management of solid organ transplant recipients. Methods From July 2015 to March 2017, 622 episodes of adult solid organ transplants at 7 university hospitals in Spain were prospectively included in the study. Results The prevalence of culture-positive preservation fluid was 62.5% (389/622). Nevertheless, in only 25.2% (98/389) of the cases were the isolates considered "high risk" for pathogenicity. After applying a multivariate regression analysis, advanced donor age was the main associated factor for having culture-positive preservation fluid for high-risk microorganisms. Preemptive antibiotic therapy was given to 19.8% (77/389) of the cases. The incidence rate of preservation fluid-related infection was 1.3% (5 recipients); none of these patients had received preemptive therapy. Solid organ transplant (SOT) recipients with high-risk culture-positive preservation fluid receiving preemptive antibiotic therapy presented both a lower cumulative incidence of infection and a lower rate of acute rejection and graft loss compared with those who did not have high-risk culture-positive preservation fluid. After adjusting for age, sex, type of transplant, and prior graft rejection, preemptive antibiotic therapy remained a significant protective factor for 90-day infection. Conclusions The routine culture of preservation fluid may be considered a tool that provides information about the contamination of the transplanted organ. Preemptive therapy for SOT recipients with high-risk culture-positive preservation fluid may be useful to avoid preservation fluid-related infections and improve the outcomes of infection, graft loss, and graft rejection in transplant patients.
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Affiliation(s)
- I Oriol
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI).,Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona
| | - N Sabe
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI).,Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona
| | - J Càmara
- Microbiology Department, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Spain.,CIBER de Enfermedades Respiratorias (CIBERes), Madrid, Spain
| | - D Berbel
- Microbiology Department, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Spain.,CIBER de Enfermedades Respiratorias (CIBERes), Madrid, Spain
| | - M A Ballesteros
- Intensive Care Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - R Escudero
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. IRYCIS
| | - F Lopez-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain
| | - L Linares
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona.,Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - O Len
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J T Silva
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain.,Department of Infectious Diseases, Hospital Universitario de Badajoz, Spain
| | - E Oliver
- Donor Coordination Unit, Bellvitge University Hospital, Barcelona, Spain
| | - L Soldevila
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Pérez-Recio
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain
| | - L L Guillem
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Camprubí
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain
| | - L LLadó
- Liver Transplant Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - A Manonelles
- Department of Nephrology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - J González-Costello
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - M A Domínguez
- Spanish Network for Research in Infectious Diseases (REIPI).,Microbiology Department, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Spain.,Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona
| | - M C Fariñas
- Infectious Diseases Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - N Lavid
- Donor Coordination Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - C González-Rico
- Infectious Diseases Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - L Garcia-Cuello
- Infectious Diseases Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - F Arnaiz de Las Revillas
- Infectious Diseases Unit, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Spain
| | - J Fortun
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. IRYCIS
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain
| | - C Jimenez-Romero
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain
| | - M Bodro
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona.,Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - M Almela
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona.,Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - D Paredes
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona.,Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - A Moreno
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona.,Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - C Pérez-Cameo
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Muñoz-Sanz
- Department of Infectious Diseases, Hospital Universitario de Badajoz, Spain
| | | | | | - J L García-López
- Donor Coordination Unit, Hospital universitario de Badajoz, Spain
| | - E Nuño
- Donor Coordination Unit, Hospital universitario de Badajoz, Spain
| | - J Carratalà
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI).,Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona
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Ercibengoa M, Goenaga MA, Ardanuy C, Grau I, García-de-la-Maria C, Almela M, Miro JM, Navas E, Fariñas MC, de Alegría CR, de la Torre J, Fernández F, Marín M, Muñoz P, Orden B, Oteo JA, García-Álvarez L, de Alarcón A, Jiménez JAL, Marimón JM. Epidemiological and clinical characteristics of Streptococcus tigurinus endocarditis. BMC Infect Dis 2019; 19:291. [PMID: 30922322 PMCID: PMC6440093 DOI: 10.1186/s12879-019-3914-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 03/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background Streptococcus tigurinus was recently described as a new streptococcal species within the viridans group streptococci (VGS). The objectives of the present work were to analyse the clinical and microbiological characteristics of S. tigurinus isolated from patients with bacteraemias, to determine the prevalence of S. tigurinus among VGS endocarditis in Spain, and to compare the clinical characteristics and outcomes of endocarditis caused by S. tigurinus and other VGS. Methods Retrospective nationwide study, performed between 2008 and 2016 in 9 Spanish hospitals from 7 different provinces comprising 237 cases of infective endocarditis. Streptococcal isolates were identified by sequencing fragments of their 16S rRNA, sodA and groEL genes. Clinical data of patients with streptococcal endocarditis were prospectively collected according to a pre-established protocol. Results Patients with endocarditis represented 7/9 (77.8%) and 26/86 (30.2%) of the bacteraemias caused by S. tigurinus and other VGS, respectively (p < 0.001), in two of the hospital participants. Among patients with streptococcal endocarditis, 12 different Streptococcus species were recognized being S. oralis, S. tigurinus and S. mitis the three more common. No relevant statistical differences were observed in the clinical characteristics and outcomes of endocarditis caused by the different VGS species. Conclusions In this multicenter study performed in Spain, S. tigurinus showed a higher predilection for the endocardial endothelium as compared to other VGS. However, clinical characteristics and outcomes of endocarditis caused by S. tigurinus did not significantly differ from endocarditis caused by other oral streptococci.
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Affiliation(s)
| | | | - Carmen Ardanuy
- CIBER Enfermedades Respiratorias-CIBERES, Madrid, Spain.,Servicio de Microbiologia, Hospital Universitari de Bellvitge. Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Immaculada Grau
- CIBER Enfermedades Respiratorias-CIBERES, Madrid, Spain.,Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge. Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Cristina García-de-la-Maria
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Manuel Almela
- Servicio de Microbiología, Hospital Clínic de Barcelona, Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jose María Miro
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Enrique Navas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - María Carmen Fariñas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - Carlos Ruiz de Alegría
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - Javier de la Torre
- Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Fernando Fernández
- Servicio de Microbiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Mercedes Marín
- CIBER Enfermedades Respiratorias-CIBERES, Madrid, Spain.,Departamento de Medicina, Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio, Marañón, Madrid, Spain
| | - Patricia Muñoz
- CIBER Enfermedades Respiratorias-CIBERES, Madrid, Spain.,Departamento de Medicina, Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio, Marañón, Madrid, Spain
| | - Beatriz Orden
- Departamento de Microbiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - José Antonio Oteo
- Departamento de Enfermedades Infecciosas, Hospital Universitario San Pedro, Logroño, La Rioja, Spain
| | - Lara García-Álvarez
- Departamento de Enfermedades Infecciosas, Hospital Universitario San Pedro, Logroño, La Rioja, Spain
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine. Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Virgen del Rocío and Virgen Macarena, Sevilla, Spain
| | - José Antonio Lepe Jiménez
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine. Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Virgen del Rocío and Virgen Macarena, Sevilla, Spain
| | - Jose María Marimón
- CIBER Enfermedades Respiratorias-CIBERES, Madrid, Spain. .,Servicio de Microbiología, Hospital Universitario Donostia-IIS Biodonostia, Paseo Dr Beguiristain s/n, 20014, San Sebastián, Spain.
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Parra JA, Hernández L, Muñoz P, Blanco G, Rodríguez-Álvarez R, Vilar DR, de Alarcón A, Goenaga MA, Moreno M, Fariñas MC. Detection of spleen, kidney and liver infarcts by abdominal computed tomography does not affect the outcome in patients with left-side infective endocarditis. Medicine (Baltimore) 2018; 97:e11952. [PMID: 30113500 PMCID: PMC6112969 DOI: 10.1097/md.0000000000011952] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Extra-cardiac abdominal complications are common in left-side infective endocarditis (LS-IE). The aim of this work was to study whether patients with LS-IE presenting splenic, renal, or liver (SRL) involvement seen in abdominal computed tomography (CT) had different clinical features, therapeutic plans, and outcome than those without these findings on CT.From January 2008 to April 2010, multidisciplinary teams have prospectively collected all consecutive cases of IE, diagnosed according to the Duke criteria, in which abdominal CT was performed.A total of 147 patients with LS-IE had abdominal CT. Fifty (34%) had SRL lesions: 46 splenic, 15 renal, 1 liver infarct, and 2 liver abscesses. Patients with SRL lesions were mainly men (P = .01), had liver disease (P = .001) with natural valve (P = .050) and mitro-aortic valve involvement (P = .042), splenomegaly (P = .001), nonabdominal emboli (P = .001), and a greater number and larger vegetation (>15 mm, P = .049) in the mitro-aortic valves (P = .051) than patients with normal abdominal CT. The site of acquisition, clinical characteristics, microbiology, surgical treatment, days of hospitalization, hospital death, and 1-year mortality were similar in patients with and without SRL emboli on CT. In the stepwise logistic regression analysis, male gender (odds ratio [OR] = 3.6, 95% confidence interval [CI] = 1.4-9.1), liver disease (OR = 8.3, 95% CI = 2.1-31.8), and nonabdominal emboli (OR = 5.2, 95% CI = 2.3-11.7) were independently associated with SRL lesions.Male patients with native LS-IE who had liver disease and nonabdominal emboli had more frequent abdominal lesions seen on CT. The presence of SRL infarcts on abdominal CT scan performed on patients with LS-IE seems to have poor practical implications, and as a consequence, its realization should only be considered when there are symptoms or signs that suggest them.
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Affiliation(s)
- José A. Parra
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Cantabria
| | - Luis Hernández
- Department of Radiology, Hospital General Universitario Gregorio Marañón, Madrid
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid
| | - Gerardo Blanco
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria
| | | | | | - Arístides de Alarcón
- Infectious Diseases Service, UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva Grupo de Investigacion en Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla (IBiS)/CSIC/, Hospital Universitario Virgen del Rocío, Sevilla
| | | | - Mar Moreno
- Department of Cardiology, Hospital Universitario La Paz, Madrid
| | - María Carmen Fariñas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Cantabria, Spain
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40
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Ramos-Martínez A, Muñoz Serrano A, de Alarcón González A, Muñoz P, Fernández-Cruz A, Valerio M, Fariñas MC, Gutiérrez-Cuadra M, Miró JM, Ruiz-Morales J, Sousa-Regueiro D, Montejo JM, Gálvez-Acebal J, HidalgoTenorio C, Domínguez F. Gentamicin may have no effect on mortality of staphylococcal prosthetic valve endocarditis. J Infect Chemother 2018; 24:555-562. [PMID: 29628387 DOI: 10.1016/j.jiac.2018.03.003] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/23/2018] [Accepted: 03/06/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE). METHODS From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-four patients (28.1%) received treatment based on β-lactam or vancomycin plus rifampicin and were included in the study. Variables were analyzed which related to patient survival during admission, including having received treatment with gentamicin. RESULTS Seventy-seven (81.9%) were treated with cloxacillin (or vancomycin) plus rifampicin plus gentamicin, and 17 patients (18.1%) received the same regimen without gentamicin. The causative microorganism was Staphylococcus aureus in 40 cases (42.6%) and coagulase-negative staphylococci in 54 cases (57.4%). Overall, 40 patients (42.6%) died during hospital admission, 33 patients (42.9%) in the group receiving gentamicin and 7 patients in the group that did not (41.2%, P = 0.899). Worsening renal function was observed in 42 patients (54.5%) who received gentamicin and in 9 patients (52.9%) who did not (p = 0.904). Heart failure as a complication of endocarditis (OR: 4.58; CI 95%: 1.84-11.42) and not performing surgery when indicated (OR: 2.68; CI 95%: 1.03-6.94) increased mortality. Gentamicin administration remained unrelated to mortality (OR: 1.001; CI 95%: 0.29-3.38) in the multivariable analysis. CONCLUSIONS The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome.
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Affiliation(s)
- Antonio Ramos-Martínez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Universitario Puerta de Hierro, Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Alejandro Muñoz Serrano
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Arístides de Alarcón González
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Grupo de Investigación sobre Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla / CSIC / Universidad Virgen del Rocío y Virgen Macarena, Sevilla, 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, Spain.
| | - Ana Fernández-Cruz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Maricela Valerio
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - María Carmen Fariñas
- Unidad de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
| | - Manuel Gutiérrez-Cuadra
- Unidad de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - José Ma Miró
- Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS. Universidad de Barcelona, Barcelona, Spain.
| | - Josefa Ruiz-Morales
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Victoria, IBIMA, Málaga, Spain.
| | | | - José Miguel Montejo
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Universidad del País Vasco, País Vasco, Spain.
| | - Juan Gálvez-Acebal
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena Instituto de Biomedicina de Sevilla, IBIS. Universidad de Sevilla, Sevilla, Spain.
| | - Carmen HidalgoTenorio
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Complejo Hospitalario de Granada, Granada, Spain.
| | - Fernando Domínguez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, 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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Arnaiz de Las Revillas F, Fernandez-Sampedro M, Arnaiz-García AM, Gutierrez-Cuadra M, Armiñanzas C, Pulitani I, Ponton A, Tascon V, García I, Fariñas MC. Daptomycin treatment in Gram-positive vascular graft infections. Int J Infect Dis 2018; 68:69-73. [PMID: 29373845 DOI: 10.1016/j.ijid.2018.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 08/23/2017] [Revised: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Daptomycin is a bactericidal antibiotic approved for the treatment of skin and soft tissue infections and right-side endocarditis. However, there is a lack of published data outlining its usefulness in vascular graft infections (VGI). The aim of this study was to describe the clinical experience of daptomycin use in the treatment of VGI caused by Gram-positive bacteria. METHODS This was a retrospective cohort study of patients diagnosed with VGI receiving daptomycin at a tertiary care hospital during the period January 2010 to December 2012. RESULTS Of a total 1066 consecutive patients who had undergone vascular grafts (VG), 25 were diagnosed with VGI. Fifteen of these patients (11 prosthetic VG, three autologous VG, one both types) received daptomycin (median dose 6.7mg/kg/day, range 4.1-7.1mg/kg/day; median age 69 years, range 45-83 years; 80% male). The infected bypass was removed in 13 cases. The most common reason for selecting daptomycin was kidney failure (53%). The Gram-positive organisms isolated were coagulase-negative Staphylococcus (n=10), Staphylococcus aureus (n=3) (two methicillin-resistant S. aureus), Enterococcus faecium (n=2), and Enterococcus faecalis (n=1). The mean follow-up was 69 months (interquartile range 48-72 months). Ten patients (66.7%) achieved complete healing of the VGI. A recurrence of the infection was observed in 100% of patients in whom the bypass was not removed. Among patients who did not achieve complete healing, one needed a supracondylar amputation and one died as a consequence of infection. Five patients received treatment with rifampicin in addition to daptomycin and they were all cured. CONCLUSIONS The use of daptomycin and surgery for Gram-positive VGI was effective and well tolerated, and this may be a good alternative for the treatment of VGI in patients with peripheral arterial disease in whom renal insufficiency is common.
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Affiliation(s)
| | - Marta Fernandez-Sampedro
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Ana María Arnaiz-García
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Manuel Gutierrez-Cuadra
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Carlos Armiñanzas
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Ivana Pulitani
- Cardiovascular Surgery Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Alejandro Ponton
- Cardiovascular Surgery Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Valentin Tascon
- Cardiovascular Surgery Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Ivan García
- Cardiovascular Surgery Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - María Carmen Fariñas
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
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43
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Fernández-Hidalgo N, Ribera A, Larrosa MN, Viedma E, Origüen J, de Alarcón A, Fariñas MC, Sáez C, Peña C, Múñez E, García López MV, Gavaldà J, Pérez-Montarelo D, Chaves F, Almirante B. Impact of Staphylococcus aureus phenotype and genotype on the clinical characteristics and outcome of infective endocarditis. A multicentre, longitudinal, prospective, observational study. Clin Microbiol Infect 2017; 24:985-991. [PMID: 29269091 DOI: 10.1016/j.cmi.2017.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We aimed to evaluate the impact of Staphylococcus aureus phenotype (vancomycin MIC) and genotype (agr group, clonal complex CC) on the prognosis and clinical characteristics of infective endocarditis (IE). METHODS We performed a multicentre, longitudinal, prospective, observational study (June 2013 to March 2016) in 15 Spanish hospitals. Two hundred and thirteen consecutive adults (≥18 years) with a definite diagnosis of S. aureus IE were included. Primary outcome was death during hospital stay. Main secondary end points were persistent bacteraemia, sepsis/septic shock, peripheral embolism and osteoarticular involvement. RESULTS Overall in-hospital mortality was 37% (n = 72). Independent risk factors for death were age-adjusted Charlson co-morbidity index (OR 1.20; 95% CI 1.08-1.34), congestive heart failure (OR 3.60; 95% CI 1.72-7.50), symptomatic central nervous system complication (OR 3.17; 95% CI 1.41-7.11) and severe sepsis/septic shock (OR 4.41; 95% CI 2.18-8.96). In the subgroup of methicillin-susceptible S. aureus IE (n = 173), independent risk factors for death were the age-adjusted Charlson co-morbidity index (OR 1.17; 95% CI 1.03-1.31), congestive heart failure (OR 3.39; 95% CI 1.51-7.64), new conduction abnormality (OR 4.42; 95% CI 1.27-15.34), severe sepsis/septic shock (OR 5.76; 95% CI 2.57-12.89) and agr group III (OR 0.27; 0.10-0.75). Vancomycin MIC ≥1.5 mg/L was not independently associated with death during hospital nor was it related to secondary end points. No other genotype variables were independently associated with in-hospital death. CONCLUSIONS This is the first prospective study to assess the impact of S. aureus phenotype and genotype. Phenotype and genotype provided no additional predictive value beyond conventional clinical characteristics. No evidence was found to justify therapeutic decisions based on vancomycin MIC for either methicillin-resistant or methicillin-susceptible S. aureus.
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Affiliation(s)
- N Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
| | - A Ribera
- Cardiovascular Epidemiology Unit, Cardiology Department, Vall d'Hebron University Hospital, CIBERESP, Barcelona, Spain
| | - M N Larrosa
- Universitat Autonoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Servei de Microbiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Viedma
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Origüen
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigacion Hospital 12 de Octubre (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - A de Alarcón
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville, University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - M C Fariñas
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Unit, Hospital Universitario Marques de Valdecilla, University of Cantabria, Santander, Spain
| | - C Sáez
- Unidad de Infecciosas, Hospital de la Princesa, Instituto de Investigacion, Madrid, Spain
| | - C Peña
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Servei de Malalties Infeccioses, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Servei de Medicina Interna, Hospital Mare de Deu dels Lliris, Alcoi, Spain
| | - E Múñez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - M V García López
- Servicio de Microbiologia, Hospital Universitario Virgen de la Victoria, Instituto de Investigacion Biomedica, Malaga, Spain
| | - J Gavaldà
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - D Pérez-Montarelo
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Chaves
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - B Almirante
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
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Fariñas MC, Campo A, Duran R, Sarralde JA, Nistal JF, Gutiérrez-Díez JF, Fariñas-Álvarez C. Risk factors and outcomes for nosocomial infection after prosthetic vascular grafts. J Vasc Surg 2017; 66:1417-1426. [DOI: 10.1016/j.jvs.2017.06.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 06/07/2017] [Indexed: 01/22/2023]
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Fernández-Sampedro M, Fariñas-Alvarez C, Garces-Zarzalejo C, Alonso-Aguirre MA, Salas-Venero C, Martínez-Martínez L, Fariñas MC. Accuracy of different diagnostic tests for early, delayed and late prosthetic joint infection. BMC Infect Dis 2017; 17:592. [PMID: 28841913 PMCID: PMC6389211 DOI: 10.1186/s12879-017-2693-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 08/17/2017] [Indexed: 01/16/2023] Open
Abstract
Background A combination of laboratory, histopathological and microbiological tests for diagnosis of prosthetic joint infection (PJI) have been strongly recommended. This study aims to characterize the accuracy of individual or group tests, such as culture of sonicate fluid, synovial fluid and peri-implant tissue, C-reactive protein (CRP) and histopathology for detection of early, delayed and late PJI. Methods A prospective study of patients undergoing hip or knee arthroplasty from February 2009 to February 2014 was performed in a Spanish tertiary health care hospital. The diagnostic accuracy of the different methods was evaluated constructing receiver-operating-characteristic (ROC) curve areas. Results One hundred thirty consecutive patients were included: 18 (13.8%) early PJI, 35 (27%) delayed PJI and 77 (59.2%) late PJI. For individual parameters, the area under the ROC curve for peri-implant tissue culture was larger for early (0.917) than for delayed (0.829) and late PJI (0.778), p = 0.033. There was a significantly larger difference for ROC area in the synovial fluid culture for delayed (0.803) than for early (0.781) and late infections (0.679), p = 0.039. The comparison of the areas under the ROC curves for the two microbiological tests showed that sonicate fluid was significantly different from peri-implant tissue in delayed (0.951 vs 0.829, p = 0.005) and late PJI (0.901 vs 0.778, p = 0.000). The conjunction of preoperative parameters, synovial fluid culture and CRP, improved the accuracy for late PJI (p = 0.01). The conjunction of histopathology and sonicate fluid culture increased the area under ROC curve of sonication in early (0.917 vs 1.000); p = 0.06 and late cases (0.901 vs 0.999); p < 0.001. Conclusion For early PJI, sonicate fluid and peri-implant tissue cultures achieve the same best sensitivity. For delayed and late PJI, sonicate fluid culture is the most sensitive individual diagnostic method. By combining histopathology and peri-implant tissue, all early, 97% of delayed and 94.8% of late cases are diagnosed. The conjunction of histopathology and sonicate fluid culture yields a sensitivity of 100% for all types of infection.
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Affiliation(s)
- M Fernández-Sampedro
- Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain.
| | - C Fariñas-Alvarez
- Division of Health Care Quality Hospital, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - C Garces-Zarzalejo
- Department of Orthopaedic Surgery, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - M A Alonso-Aguirre
- Department of Orthopaedic Surgery, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - C Salas-Venero
- Service of Microbiology, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - L Martínez-Martínez
- Service of Microbiology, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - M C Fariñas
- Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain.
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Calderon-Gonzalez R, Terán-Navarro H, García I, Marradi M, Salcines-Cuevas D, Yañez-Diaz S, Solis-Angulo A, Frande-Cabanes E, Fariñas MC, Garcia-Castaño A, Gomez-Roman J, Penades S, Rivera F, Freire J, Álvarez-Domínguez C. Gold glyconanoparticles coupled to listeriolysin O 91-99 peptide serve as adjuvant therapy against melanoma. Nanoscale 2017; 9:10721-10732. [PMID: 28714508 DOI: 10.1039/c7nr02494k] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Dendritic cell-based (DC-based) vaccines are promising immunotherapies for cancer. However, several factors, such as the lack of efficient targeted delivery and the sources and types of DCs, have limited the efficacy of DCs and their clinical potential. We propose an alternative nanotechnology-based vaccine platform with antibacterial prophylactic abilities that uses gold glyconanoparticles coupled to listeriolysin O 91-99 peptide (GNP-LLO91-99), which acts as a novel adjuvant for cancer therapy. GNP-LLO91-99, when used to vaccinate mice, exhibited dual antitumour activities, namely, the inhibition of tumour migration and growth and adjuvant activity for recruiting and activating DCs, including those from melanoma patients. GNP-LLO91-99 nanoparticles caused tumour apoptosis and induced antigen- and melanoma-specific cytotoxic Th1 responses (P ≤ 0.5). We propose this adjuvant nanotherapy for preventing the progression of the first stages of melanoma.
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Affiliation(s)
- R Calderon-Gonzalez
- Grupo de Nanovacunas y vacunas celulares basadas en Listeria y sus aplicaciones en biomedicina, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Avda. Cardenal Herrera Oria s/n, 39011 Santander, Cantabria, Spain.
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Calderon-Gonzalez R, Teran-Navarro H, Marimon JM, González-Rico C, Calvo-Montes J, Frande-Cabanes E, Alkorta-Gurrutxaga M, Fariñas MC, Martínez-Martínez L, Perez-Trallero E, Alvarez-Dominguez C. Biomarker Tools to Design Clinical Vaccines Determined from a Study of Annual Listeriosis Incidence in Northern Spain. Front Immunol 2016; 7:541. [PMID: 27965668 PMCID: PMC5126465 DOI: 10.3389/fimmu.2016.00541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/16/2016] [Indexed: 12/23/2022] Open
Abstract
Two regions of northern Spain, Gipuzkoa, and Cantabria present high annual incidence of listeriosis (1.86 and 1.71 cases per 100,000 inhabitants, respectively). We report that the high annual incidences are a consequence of infection with highly virulent Listeria monocytogenes isolates linked to fatal outcomes in elderly patients with cancer. In addition, listeriosis patients with cancer present low IL-17A/IL-6 ratios and significantly reduced levels of anti-GAPDH1–22 antibodies, identified as two novel biomarkers of poor prognosis. Analysis of these biomarkers may aid in reducing the incidence of listeriosis. Moreover, GAPDH1–22-activated monocyte-derived dendritic cells of listeriosis patients with cancer seem useful tools to prepare clinical vaccines as they produce mainly Th1 cytokines.
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Affiliation(s)
- Ricardo Calderon-Gonzalez
- Grupo de Nanovacunas y vacunas celulares basadas en Listeria y sus aplicaciones en biomedicine, Instituto de Investigación Marqués de Valdecilla (IDIVAL) , Santander , Spain
| | - Hector Teran-Navarro
- Grupo de Nanovacunas y vacunas celulares basadas en Listeria y sus aplicaciones en biomedicine, Instituto de Investigación Marqués de Valdecilla (IDIVAL) , Santander , Spain
| | - José María Marimon
- Servicio de Microbiología, Instituto de Investigación Sanitaria Biodonostia, Hospital Universitario Donostia, San Sebastián, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Claudia González-Rico
- Sección de Enfermedades Infecciosas, Hospital Universitario Marques de Valdecilla , Santander , Spain
| | - Jorge Calvo-Montes
- Servicio de Microbiología, Hospital Universitario Marques de Valdecilla , Santander , Spain
| | - Elisabet Frande-Cabanes
- Grupo de Nanovacunas y vacunas celulares basadas en Listeria y sus aplicaciones en biomedicine, Instituto de Investigación Marqués de Valdecilla (IDIVAL) , Santander , Spain
| | - Miriam Alkorta-Gurrutxaga
- Servicio de Microbiología, Instituto de Investigación Sanitaria Biodonostia, Hospital Universitario Donostia, San Sebastián, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - M C Fariñas
- Sección de Enfermedades Infecciosas, Hospital Universitario Marques de Valdecilla, Santander, Spain; Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Spain
| | - Luis Martínez-Martínez
- Servicio de Microbiología, Hospital Universitario Marques de Valdecilla, Santander, Spain; Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain
| | - Emilio Perez-Trallero
- Servicio de Microbiología, Instituto de Investigación Sanitaria Biodonostia, Hospital Universitario Donostia, San Sebastián, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Carmen Alvarez-Dominguez
- Grupo de Nanovacunas y vacunas celulares basadas en Listeria y sus aplicaciones en biomedicine, Instituto de Investigación Marqués de Valdecilla (IDIVAL) , Santander , Spain
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López-Medrano F, Fernández-Ruiz M, Silva JT, Carver PL, van Delden C, Merino E, Pérez-Saez MJ, Montero M, Coussement J, de Abreu Mazzolin M, Cervera C, Santos L, Sabé N, Scemla A, Cordero E, Cruzado-Vega L, Martín-Moreno PL, Len Ó, Rudas E, de León AP, Arriola M, Lauzurica R, David M, González-Rico C, Henríquez-Palop F, Fortún J, Nucci M, Manuel O, Paño-Pardo JR, Montejo M, Muñoz P, Sánchez-Sobrino B, Mazuecos A, Pascual J, Horcajada JP, Lecompte T, Moreno A, Carratalà J, Blanes M, Hernández D, Fariñas MC, Andrés A, Aguado JM. Clinical Presentation and Determinants of Mortality of Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: A Multinational Cohort Study. Am J Transplant 2016; 16:3220-3234. [PMID: 27105907 DOI: 10.1111/ajt.13837] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/24/2016] [Accepted: 04/17/2016] [Indexed: 01/25/2023]
Abstract
The prognostic factors and optimal therapy for invasive pulmonary aspergillosis (IPA) after kidney transplantation (KT) remain poorly studied. We included in this multinational retrospective study 112 recipients diagnosed with probable (75.0% of cases) or proven (25.0%) IPA between 2000 and 2013. The median interval from transplantation to diagnosis was 230 days. Cough, fever, and expectoration were the most common symptoms at presentation. Bilateral pulmonary involvement was observed in 63.6% of cases. Positivity rates for the galactomannan assay in serum and bronchoalveolar lavage samples were 61.3% and 57.1%, respectively. Aspergillus fumigatus was the most commonly identified species. Six- and 12-week survival rates were 68.8% and 60.7%, respectively, and 22.1% of survivors experienced graft loss. Occurrence of IPA within the first 6 months (hazard ratio [HR]: 2.29; p-value = 0.027) and bilateral involvement at diagnosis (HR: 3.00; p-value = 0.017) were independent predictors for 6-week all-cause mortality, whereas the initial use of a voriconazole-based regimen showed a protective effect (HR: 0.34; p-value = 0.007). The administration of antifungal combination therapy had no apparent impact on outcome. In conclusion, IPA entails a dismal prognosis among KT recipients. Maintaining a low clinical suspicion threshold is key to achieve a prompt diagnosis and to initiate voriconazole therapy.
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Affiliation(s)
- F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J T Silva
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - P L Carver
- University of Michigan Health System, Ann Harbor, MI
| | - C van Delden
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - E Merino
- Unit of Infectious Diseases, Hospital Universitario General, Alicante, Spain
| | - M J Pérez-Saez
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - M Montero
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J Coussement
- Department of Nephrology, Dialysis and Kidney Transplantation, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M de Abreu Mazzolin
- Division of Nephology, Department of Medicine, Universidade Federal de São Paulo-UNIFESP and Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - C Cervera
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - L Santos
- Unit of Renal Transplantation, Department of Urology and Kidney Transplantation, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - N Sabé
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - A Scemla
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Paris, France
| | - E Cordero
- Unit of Infectious Diseases, Hospitales Universitarios "Vigen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - L Cruzado-Vega
- Department of Nephrology, Hospital Universitario "La Fe", Valencia, Spain
| | - P L Martín-Moreno
- Department of Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Ó Len
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - E Rudas
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - A P de León
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México
| | - M Arriola
- Clínica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina
| | - R Lauzurica
- Department of Nephrology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M David
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C González-Rico
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - F Henríquez-Palop
- Department of Nephrology, University Hospital "Doctor Negrín", Las Palmas de Gran Canaria, Spain
| | - J Fortún
- Department of Infectious Diseases, University Hospital "Ramón y Cajal", Madrid, Spain
| | - M Nucci
- Department of Internal Medicine, Hematology Service and Mycology Laboratory, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - O Manuel
- Department of Infectious Diseases and Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - J R Paño-Pardo
- Department of Internal Medicine, Hospital Universitario "La Paz", School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Montejo
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Bilbao, Spain
| | - P Muñoz
- Department of Microbiology and Infectious Diseases, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - B Sánchez-Sobrino
- Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Mazuecos
- Department of Nephrology, Hospital Universitario "Puerta del Mar", Cádiz, Spain
| | - J Pascual
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J P Horcajada
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - T Lecompte
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - A Moreno
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - M Blanes
- Unit of Infectious Diseases, Hospital Universitario "La Fe", Valencia, Spain
| | - D Hernández
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - M C Fariñas
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - A Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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Capdevila JA, Guembe M, Barberán J, de Alarcón A, Bouza E, Fariñas MC, Gálvez J, Goenaga MA, Gutiérrez F, Kestler M, Llinares P, Miró JM, Montejo M, Muñoz P, Rodríguez-Creixems M, Sousa D, Cuenca J, Mestres CA. 2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adult. Rev Esp Quimioter 2016; 29:230-238. [PMID: 27580009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. Short peripheral catheters have been found to be associated with the risk of nosocomial bacteremia resulting in morbidity and mortality. Staphyloccus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been elaborated by a panel of experts of the Spanish Society of Cardiovascular Infections in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy and Spanish Society of Thoracic-Cardiovascular Surgery and aims at define and establish the norm for management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance and registry, diagnosis and treatment of infection, indications for removal and stresses on continuous education as a driver for quality. Implementation of this norm will allow uniformity in usage thus minimizing the risk of infection and its complications.
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Affiliation(s)
- J A Capdevila
- Josep A. Capdevila, Internal Medicine, Consorcio Hospitalario de Mataró, Barcelona (Spain).
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López-Medrano F, Silva JT, Fernández-Ruiz M, Carver PL, van Delden C, Merino E, Pérez-Saez MJ, Montero M, Coussement J, de Abreu Mazzolin M, Cervera C, Santos L, Sabé N, Scemla A, Cordero E, Cruzado-Vega L, Martín-Moreno PL, Len Ó, Rudas E, de León AP, Arriola M, Lauzurica R, David M, González-Rico C, Henríquez-Palop F, Fortún J, Nucci M, Manuel O, Paño-Pardo JR, Montejo M, Muñoz P, Sánchez-Sobrino B, Mazuecos A, Pascual J, Horcajada JP, Lecompte T, Lumbreras C, Moreno A, Carratalà J, Blanes M, Hernández D, Hernández-Méndez EA, Fariñas MC, Perelló-Carrascosa M, Morales JM, Andrés A, Aguado JM. Risk Factors Associated With Early Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: Results From a Multinational Matched Case-Control Study. Am J Transplant 2016; 16:2148-57. [PMID: 26813515 DOI: 10.1111/ajt.13735] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/13/2016] [Indexed: 01/25/2023]
Abstract
Risk factors for invasive pulmonary aspergillosis (IPA) after kidney transplantation have been poorly explored. We performed a multinational case-control study that included 51 kidney transplant (KT) recipients diagnosed with early (first 180 posttransplant days) IPA at 19 institutions between 2000 and 2013. Control recipients were matched (1:1 ratio) by center and date of transplantation. Overall mortality among cases was 60.8%, and 25.0% of living recipients experienced graft loss. Pretransplant diagnosis of chronic pulmonary obstructive disease (COPD; odds ratio [OR]: 9.96; 95% confidence interval [CI]: 1.09-90.58; p = 0.041) and delayed graft function (OR: 3.40; 95% CI: 1.08-10.73; p = 0.037) were identified as independent risk factors for IPA among those variables already available in the immediate peritransplant period. The development of bloodstream infection (OR: 18.76; 95% CI: 1.04-339.37; p = 0.047) and acute graft rejection (OR: 40.73, 95% CI: 3.63-456.98; p = 0.003) within the 3 mo prior to the diagnosis of IPA acted as risk factors during the subsequent period. In conclusion, pretransplant COPD, impaired graft function and the occurrence of serious posttransplant infections may be useful to identify KT recipients at the highest risk of early IPA. Future studies should explore the potential benefit of antimold prophylaxis in this group.
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Affiliation(s)
- F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J T Silva
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - P L Carver
- University of Michigan Health System, Ann Arbor, MI
| | - C van Delden
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - E Merino
- Unit of Infectious Diseases, Hospital Universitario General, Alicante, Spain
| | - M J Pérez-Saez
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - M Montero
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J Coussement
- Department of Nephrology, Dialysis and Kidney Transplantation, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M de Abreu Mazzolin
- Division of Nephology, Department of Medicine, Universidade Federal de São Paulo-UNIFESP and Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - C Cervera
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - L Santos
- Unit of Renal Transplantation, Department of Urology and Kidney Transplantation, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - N Sabé
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - A Scemla
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Paris, France
| | - E Cordero
- Unit of Infectious Diseases, Hospitales Universitarios "Vigen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - L Cruzado-Vega
- Department of Nephrology, Hospital Universitario "La Fe", Valencia, Spain
| | - P L Martín-Moreno
- Department of Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Ó Len
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - E Rudas
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - A Ponce de León
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México
| | - M Arriola
- Clínica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina
| | - R Lauzurica
- Department of Nephrology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M David
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C González-Rico
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - F Henríquez-Palop
- Department of Nephrology, University Hospital "Doctor Negrín", Las Palmas de Gran Canaria, Spain
| | - J Fortún
- Department of Infectious Diseases, University Hospital "Ramón y Cajal", Madrid, Spain
| | - M Nucci
- Department of Internal Medicine, Hematology Service and Mycology Laboratory, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - O Manuel
- Department of Infectious Diseases and Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - J R Paño-Pardo
- Department of Internal Medicine, Hospital Universitario "La Paz", School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Montejo
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Bilbao, Spain
| | - P Muñoz
- Department of Microbiology and Infectious Diseases, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - B Sánchez-Sobrino
- Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Mazuecos
- Department of Nephrology, Hospital Universitario "Puerta del Mar", Cádiz, Spain
| | - J Pascual
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J P Horcajada
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - T Lecompte
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - C Lumbreras
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Moreno
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - M Blanes
- Unit of Infectious Diseases, Hospital Universitario "La Fe", Valencia, Spain
| | - D Hernández
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - E A Hernández-Méndez
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México
| | - M C Fariñas
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - M Perelló-Carrascosa
- Department of Nephrology, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - J M Morales
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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