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Grijota-Camino MD, Pérez-Recio S, Trapero C, Luque MJ, Casellas M, Sabé-Fernández N, Santin M. Identifying gaps in the cascade of care for latent TB infection in a low-incidence setting. Int J Tuberc Lung Dis 2023; 27:315-321. [PMID: 37035981 DOI: 10.5588/ijtld.22.0611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND: The End TB Strategy calls for the global scale-up of treatment for latent TB infection (LTBI). We aimed to evaluate a nurse-led care programme for LTBI by identifying gaps in the care cascade in a low-incidence TB setting.METHODS: We included people at risk of TB over a 15-year period. We define three main outcomes in the LTBI care cascade: 1) attendance at the first appointment, 2) completion of the evaluation process, and 3) completion of treatment.RESULTS: We identified 6,126 individuals (2,369 TB contacts, 1,749 biological therapy candidates, and 2,008 transplant candidates). Overall, 5,938 (96.9%) attended, 5,872/5,938 (98.9%) completed the evaluation and 1,624/1,847 (87.9%) completed treatment. Pre-biological (aOR 2.32, 95% CI 1.54-3.49) and pre-transplant (aOR 1.82, 95% CI 1.20-2.76) candidates were more likely to attend the first appointment, while age was associated with completing the evaluation process (aOR 1.02, 95% CI 1.003-1.04). Female sex (aOR 1.47, 95% CI 1.08-1.99) was associated with completing the treatment.CONCLUSION: Successful assessment and treatment of LTBI is achievable when delivered as a part of a comprehensive, nurse-led, patient-centred programme in specialist TB clinics.
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Affiliation(s)
- M D Grijota-Camino
- Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute for Biomedical Research (IDIBELL), L´Hospitalet de Llobregat, Barcelona, Spain, Department of Fundamental and Medical-Surgical Nursing, University of Barcelona, L´Hospitalet de Llobregat, Barcelona, Spain
| | - S Pérez-Recio
- Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute for Biomedical Research (IDIBELL), L´Hospitalet de Llobregat, Barcelona, Spain
| | - C Trapero
- Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute for Biomedical Research (IDIBELL), L´Hospitalet de Llobregat, Barcelona, Spain
| | - M J Luque
- Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute for Biomedical Research (IDIBELL), L´Hospitalet de Llobregat, Barcelona, Spain
| | - M Casellas
- Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute for Biomedical Research (IDIBELL), L´Hospitalet de Llobregat, Barcelona, Spain
| | - N Sabé-Fernández
- Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute for Biomedical Research (IDIBELL), L´Hospitalet de Llobregat, Barcelona, Spain, Department of Clinical Sciences, University of Barcelona, L´Hospitalet de Llobregat, Barcelona, Spain
| | - M Santin
- Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute for Biomedical Research (IDIBELL), L´Hospitalet de Llobregat, Barcelona, Spain, Department of Clinical Sciences, University of Barcelona, L´Hospitalet de Llobregat, Barcelona, Spain
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Aznar ML, Espinosa-Pereiro J, Saborit N, Jové N, Sánchez Martinez F, Pérez-Recio S, Vitoria A, Sanjoaquin I, Gallardo E, Llenas-García J, Pomar V, García IO, Cacho J, Goncalves De Freitas L, San Martin JV, García Rodriguez JF, Jiménez-Fuentes MÁ, De Souza-Galvao ML, Tórtola T, Zules R, Molina I, Sánchez-Montalvá A. Impact of the COVID-19 pandemic on tuberculosis management in Spain. Int J Infect Dis 2021; 108:300-305. [PMID: 33930543 PMCID: PMC8078060 DOI: 10.1016/j.ijid.2021.04.075] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 12/22/2022] Open
Abstract
Background The impact of COVID-19 on the diagnosis and management of tuberculosis (TB) patients is unknown. Methods Participating centres completed a structured web-based survey regarding changes to TB patient management during the COVID-19 pandemic. The study also included data from participating centres on patients aged ≥18 diagnosed with TB in 2 periods: March 15 to June 30, 2020 and March 15 to June 30, 2019. Clinical variables and information about patient household contacts were retrospectively collected. Results A total of 7 (70%) TB units reported changes in their usual TB team operations. Across both periods of study, 169 patients were diagnosed with active TB (90 in 2019, 79 in 2020). Patients diagnosed in 2020 showed more frequent bilateral lesions in chest X-ray than patients diagnosed in 2019 (P = 0.004). There was a higher percentage of latent TB infection and active TB among children in households of patients diagnosed in 2020, compared with 2019 (P = 0.001). Conclusions The COVID-19 pandemic has caused substantial changes in TB care. TB patients diagnosed during the COVID-19 pandemic showed more extended pulmonary forms. The increase in latent TB infection and active TB in children of patient households could reflect increased household transmission due to anti-COVID-19 measures.
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Affiliation(s)
- M L Aznar
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain; Mycobacteria Infection Study Group (GEIM, Spanish acronym) from Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC, Spanish acronym), Spain.
| | - J Espinosa-Pereiro
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - N Saborit
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - N Jové
- Unitat Clínica de Tuberculosis, Hospital del Mar, Barcelona, Spain
| | | | - S Pérez-Recio
- Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - A Vitoria
- Microbiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - I Sanjoaquin
- Infectious Diseases Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - E Gallardo
- Internal Medicine Department, Hospital Vega Baja-FISABIO Orihuela (Alicante, Spain), Clinical Medicine Department, Miguel Hernández University, Elche, Alicante, Spain
| | - J Llenas-García
- Internal Medicine Department, Hospital Vega Baja-FISABIO Orihuela (Alicante, Spain), Clinical Medicine Department, Miguel Hernández University, Elche, Alicante, Spain
| | - V Pomar
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret, 167, 08025 Barcelona, Spain
| | - I O García
- Microbiology and Infection's Control Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - J Cacho
- Microbiology Department, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, Spain
| | | | - J V San Martin
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - J F García Rodriguez
- Infectious Diseases Unit, Complexo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | | | | | - T Tórtola
- Microbiology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - R Zules
- Preventive Medicine and Epidemiology Department, University Hospital Vall d'Hebron, Barcelona, Spain
| | - I Molina
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain; Mycobacteria Infection Study Group (GEIM, Spanish acronym) from Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC, Spanish acronym), Spain
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Gomila-Grange A, Pérez-Recio S, Camprubí-Ferrer D, Lladó L, Fava A, García-Romero E, Grijota-Camino MD, Sabé N, Santin M. Rifabutin for treating tuberculosis in solid organ transplant recipients: A retrospective observational study and literature review. Transpl Infect Dis 2020; 23:e13471. [PMID: 32959494 DOI: 10.1111/tid.13471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/17/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The treatment of tuberculosis (TB) in solid organ transplant (SOT) recipients is challenging owing to interactions between rifampin and immunosuppressive drugs. Rifabutin, a rifamycin with excellent activity against Mycobacterium tuberculosis and that induces cytochrome p450 less, may facilitate treatment. We report our experience with rifabutin for treating TB in SOT recipients and review the available literature. METHODS A retrospective observational study of all SOT recipients with TB between January 2000 and December 2019. The clinical characteristics and outcomes of patients treated with and without rifabutin-containing regimens were compared and a literature review was conducted. RESULTS We included 31 SOT recipients with TB, among whom 22 (71%) were men and the median age was 62 years (interquartile range 50-20). There were no significant differences between patients treated with rifabutin (n = 12), rifampin (n = 14), and non-rifamycins (n = 5) in clinical cure rates (83.3%, 64.3%, and 100%, respectively; P = .21), side effects (25%, 37.5%, and 20%, respectively; P = .74), or mortality (16.7%, 35.7%, and 0%, respectively; P = .21). Only one patient, treated with rifampin, suffered graft rejection. The literature review identified 59 SOT recipients with TB treated with rifabutin-containing regimens from 8 publications. Overall, the clinical cure, graft rejection, and mortality rates were 93.2%, 5.1%, and 6.8%, respectively. CONCLUSIONS Rifabutin-containing regimens offer a reliable alternative to rifampin when treating TB in SOT recipients.
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Affiliation(s)
- A Gomila-Grange
- Department of Infectious Diseases and Tuberculosis Unit, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain
| | - S Pérez-Recio
- Department of Infectious Diseases and Tuberculosis Unit, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain
| | - D Camprubí-Ferrer
- Department of Infectious Diseases and Tuberculosis Unit, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain
| | - L Lladó
- Liver Transplantation Unit, Bellvitge University Hospital, Barcelona, Spain
| | - A Fava
- Kidney Transplantation Unit, Bellvitge University Hospital, Barcelona, Spain
| | - E García-Romero
- Cardiac Transplantation Unit, Bellvitge University Hospital, Barcelona, Spain
| | - M D Grijota-Camino
- Department of Infectious Diseases and Tuberculosis Unit, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain
| | - N Sabé
- Department of Infectious Diseases and Tuberculosis Unit, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - M Santin
- Department of Infectious Diseases and Tuberculosis Unit, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
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4
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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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