Revistas
Autores:
Albasanz-Puig, A.; Dura-Miralles, X.; Laporte-Amargos, J.; et al.
Revista:
MICROORGANISMS
ISSN 2076-2607
Vol. 10
N° 4
Año 2022
Págs.733
To assess the effect of combination antibiotic empirical therapy on 30-day case-fatality rate in neutropenic cancer patients with Pseudomonas aeruginosa (PA) bacteremic pneumonia. This was a multinational, retrospective cohort study of neutropenic onco-hematological patients with PA bloodstream infection (BSI) (2006-2018). The effect of appropriate empirical combination therapy, appropriate monotherapy and inappropriate empirical antibiotic therapy [IEAT] on 30-day case-fatality was assessed only in patients with PA bacteremic pneumonia. Among 1017 PA BSI episodes, pneumonia was the source of BSI in 294 (28.9%). Among those, 52 (17.7%) were caused by a multidrug-resistant (MDR) strain and 68 (23.1%) received IEAT, mainly when the infection was caused by an MDR strain [38/52 (73.1%) vs. 30/242 (12.4%); p < 0.001]. The 30-day case-fatality rate was higher in patients with PA bacteremic pneumonia than in those with PA BSI from other sources (55.1% vs. 31.4%; p < 0.001). IEAT was associated with increased 30-day case-fatality (aHR 1.44 [95%CI 1.01-2.03]; p = 0.042), whereas the use of appropriate combination empirical treatment was independently associated with improved survival (aHR 0.46 [95%CI 0.27-0.78]; p = 0.004). Appropriate empirical monotherapy was not associated with improved overall survival (aHR 1.25 [95%CI 0.76-2.05]; p = 0.39). Combination antibiotic empirical therapy should be administered promptly in febrile neutropenic patients with suspected pneumonia as the source of infection.
Revista:
ANTIBIOTICS
ISSN 2079-6382
Vol. 11
N° 3
Año 2022
Págs.330
Antimicrobial stewardship programs (ASP) promote appropriate antimicrobial use. We present a 4-year retrospective study that evaluated the clinical impact of the acceptance of the recommendations made by a meropenem-focused ASP. A total of 318 meropenem audits were performed. The ASP team (comprising infectious disease physicians, pharmacists and microbiologists) considered meropenem use in 96 audits (30.2%) to be inappropriate. The reasons to consider these uses inappropriate were the possibility of de-escalating to a narrower-spectrum antibiotic, in 66 (68.7%) audits, and unnecessary meropenem use, in 30 (31.3%) audits. The ASP team recommended de-escalation in 66 audits (68.7%) and discontinuation of meropenem in 30 audits (31.3%). ASP interventions were stratified according to whether or not recommendations were followed. The group in which recommendations were accepted and followed (i.e., accepted audit, AA) included 66 audits (68.7%) and the group in which recommendations were not followed (i.e., rejected audit, RA) included 30 (31.3%) audits. The comorbidity of the AA group (Charlson score) was higher than in the RA group (7.0 (5.0-9.0) vs. 6.0 (4.0-7.0), p = 0.02). Discontinuation of meropenem was recommended in 83.3% of audits in the AA group vs. 62.2% in the RA group (OR 3.05 (1.03-8.99), p = 0.04). Ertapenem de-escalation resulted in a 100% greater rate of follow-up compared with the non-carbapenem option (100% vs. 51.9%, OR 1.50 (1.21-1.860), p = 0.001). Significant differences were observed in the AA group when cultures were taken before antibiotic prescription-98.5% vs. 83.3% (p = 0.01, OR 13.0 (1.45-116.86))-or when screening cultures were taken-45.5% vs. 19.2% (p = 0.03, OR 3.5 (1.06-11.52)). There were no differences between the groups in terms of overall mortality and 30-day mortality, length of stay, Clostridiodes difficile infection, 30-day readmission or hospitalization costs. In conclusion, meropenem ASP recommendations contributed to a decrease in meropenem prescription without worsening clinical and economic outcomes.
Revista:
REVISTA IBEROAMERICANA DE MICOLOGIA
ISSN 1130-1406
Vol. 38
N° 2
Año 2021
Págs.84 - 90
The treatment of invasive fungal infections remains a challenge, both for the diagnosis and for the need of providing the appropriate antifungal therapy. Candida auris is a pathogenic yeast that is responsible for hospital outbreaks, especially in intensive care units; it is characterized by a high resistance to the antifungal agents and can become multidrug-resistant. At present, the recommended antifungal agents for the invasive infections with this pathogen are echinocandins, always after carrying out an antifungal susceptibility testing. In case of no clinical response or persistent candidemia, the addition of liposomal amphotericin B or isavuconazole may be considered. Both fungal infection of the central nervous system and that associated with biomedical devices remain rare entities affecting mainly immunocompromised patients. However, an increase in their incidence in recent years, along with high morbidity and mortality, has been shown. The treatment of these infections is conditioned by the limited knowledge of the pharmacokinetic properties of antifungals. A better understanding of the pharmacokinetic and pharmacodynamic parameters of the different antifungals is essential to determine the efficacy of the antifungal agents in the treatment of these infections. (C) 2021 Asociacion Espanola de Micologla. Published by Elsevier Espana, S.L.U. All rights reserved.
Autores:
Serrano-Lobo, J.; Gómez, A.; Sánchez-Yebra, W.; et al.
Revista:
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
ISSN 0066-4804
Vol. 65
N° 1
Año 2021
Págs.e01693-20
The EUCAST EDef 9.3.2 procedure recommends visual readings of azole and amphotericin B MICs against Aspergillus spp. Visual determination of MICs may be challenging. In this work, we aim to obtain and compare visual and spectrophotometric MIC readings of azoles and amphotericin B against Aspergillus fumigatus sensu lato isolates. A total of 847 A. fumigatus sensu lato isolates (A. fumigatus sensu stricto [n = 828] and cryptic species [n = 19]) were tested against amphotericin B, itraconazole, voriconazole, posaconazole, and isavuconazole using the EUCAST EDef 9.3.2 procedure. Isolates were classified as susceptible or resistant/non-wild type according to the 2020 updated breakpoints. The area of technical uncertainty for the azoles was defined in the updated breakpoints. Visual and spectrophotometric (fungal growth reduction of >95% compared to the control, read at 540 nm) MICs were compared. Essential (+/- 1 2-fold dilution) and categorical agreements were calculated. Overall, high essential (97.1%) and categorical (99.6%) agreements were found. We obtained 100% categorical agreements for amphotericin B, itraconazole, and posaconazole, and consequently, no errors were found. Categorical agreements were 98.7 and 99.3% for voriconazole and isavuconazole, respectively. Most of the misclassifications for voriconazole and isavuconazole were found to be associated with MIC results falling either in the area of technical uncertainty or within one 2-fold dilution above the breakpoint. The resistance rate was slightly lower when the MICs were obtained by spectrophotometric readings. However, all relevant cyp51A mutants were correctly classified as resistant. Spectrophotometric determination of azole and amphotericin B MICs against A. fumigatus sensu lato isolates may be a convenient alternative to visual endpoint readings.
Autores:
del Toro López, M. D. (Autor de correspondencia); Arias Diaz, J.; Balibrea, J. M.; et al.
Revista:
CIRUGIA ESPAÑOLA
ISSN 0009-739X
Vol. 99
N° 1
Año 2021
Págs.11 - 26
Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and antimicrobial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. The Sociedad Espanola de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociacion Espanola de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis in surgery to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery.
Autores:
del Toro-López, M. D. (Autor de correspondencia); Arias-Díaz, J.; Balibrea, J. M.; et al.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN 0213-005X
Vol. 39
N° 1
Año 2021
Págs.29 - 40
Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and bacterial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. La Sociedad Espanola de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociacion Espanola de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery.
Revista:
REVISTA ESPAÑOLA DE QUIMIOTERAPIA
ISSN 0214-3429
Vol. 34
N° 6
Año 2021
Págs.668 - 671
Objetive. The aim of this study was to analyze the activity of the imipenem-relebactam combination (IMI/REL) against a collection of multidrug-resist Enterobacterales, Pseudomonas aeruginosa and Acinetobacter baumannii clinical isolates. Material and methods. The study was conducted in two tertiary hospitals in Spain and included 192 clinical isolates of these 3 genera (139 resistant and 53 susceptible to IMI). The MICs for IMI with and without REL (at a fixed concentration of 4 mg/L) were determined by a standard broth microdilution method according to international recommendations. Results. All IMI-susceptible E. coli strains were also susceptible to IMI/REL. Enterobacterales resistant to IMI due to the production of carbapenemases, the MIC50 and MIC90 decreased from 64/256 with IMI to 8/64 mg/L with IMI/REL. This high activity was principally detected among isolates with KPC enzymes. Enterobacterales with class B carbapenemases, P. aeruginosa carrying VIM carbapenemase and A. baumannii strains showed no changes on IMI MIC50 or MIC90 after adding REL. Among P. aeruginosa strains without carbapenemase the MIC for IMI/REL was reduced between 1 to 5 dilutions. Conclusions. IMI/REL showed high activity against the strains that carry Klebsiella pneumoniae carbapenemase (KPC) and against carbapenem-resistant P. aeruginosa unrelated to the VIM enzyme, mainly AmpC beta lactamase associated with impermeability. Against strains carrying oxacillinase 48 (OXA-48) associated with extended-spectrum beta-lactamase (ESBL), IMI/REL presented activity only slightly better than IMI and had no beneficial effect superior to IMI against A. baumannii.
Revista:
EXPERT REVIEW OF ANTI-INFECTIVE THERAPY
ISSN 1478-7210
Vol. 19
N° 11
Año 2021
Págs.1443 - 1456
Introduction: As a result of progress in medical care, a huge number of medical devices are used in the treatment of human diseases. In turn, biofilm-related infection has become a growing threat due to the tolerance of biofilms to antimicrobials, a problem magnified by the development of antimicrobial resistance worldwide. As a result, successful treatment of biofilm-disease using only antimicrobials is problematic. Areas covered: We summarize some alternative approaches to classic antimicrobials for the treatment of biofilm disease. This review is not intended to be exhaustive but to give a clinical picture of alternatives to antimicrobial agents to manage biofilm disease. We highlight those strategies that may be closer to application in clinical practice. Expert opinion: There are a number of outstanding challenges in the development of novel antibiofilm therapies. Screening for effective antibiofilm compounds requires models relevant to all clinical scenarios. Although in vitro research of anti-biofilm strategies has progressed significantly over the past decade, there is a lack of in vivo research. In addition, the complexity of biofilm biology makes it difficult to develop a compound that is likely to provide the single 'magic bullet'. The multifaceted nature of biofilms imposes the need for multi-targeted or combinatorial therapies.
Revista:
REVISTA ESPAÑOLA DE QUIMIOTERAPIA
ISSN 0214-3429
Vol. 34
N° Supl. 1
Año 2021
Págs.69 - 71
There are few publications on the impact of coinfection and superinfection in patients with COVID-19. Patients with higher severity are much more prone to secondary bacterial, fungal or viral infections. The overuse of antimicrobials in many viral infections (including SARS-CoV-2 infections) undoubtedly contributes to the current antimicrobial resistance crisis. In the context of COVID-19, we are witnessing an increase in multidrug-resistant bacterial infections in our hospitals. The heterogeneity of published studies makes it critical to perform more large-scale studies to better understand the pathogenesis of coinfections or superinfections in the COVID-19 patient.
Autores:
Ferrer, R.; Soriano, A.; Cantón, R.; et al.
Revista:
REVISTA ESPAÑOLA DE QUIMIOTERAPIA
ISSN 0214-3429
Vol. 34
N° 4
Año 2021
Págs.298 - 307
Objetivo. El objetivo del estudio es identificar los factores de riesgo asociados a infecciones por Pseudomonas aeruginosa resistente a antibióticos carbapenémicos (PARC) y Acinetobacter baumannii resistente a antibióticos carbapenémicos (ABRC) en pacientes adultos a través de una revisión sistemática de la literatura, clasificarlos según su nivel de importancia y exponer las recomendaciones en el entorno español de un panel de expertos.
Material y métodos. Se llevó a cabo una revisión sistemática de la literatura para identificar los factores de riesgo asociados a PARC o ABRC y posteriormente evaluar cada factor de riesgo por un panel de expertos basándose en la evidencia disponible y su experiencia en la práctica clínica.
Resultados. Se identificaron 593 artículos incluyéndose 29 para PARC y 23 para ABRC. Se identificaron 38 factores de riesgo asociados a PARC y 36 factores de riesgo asociados a ABRC. Tras su evaluación, para PARC, se clasificaron en: 11 importantes, 10 moderadamente importantes y 15 poco importantes; y para ABRC, 9 importantes, 5 moderadamente importantes y 19 poco importantes. Para ambos patógenos, los factores de riesgo importantes estuvieron relacionados con el uso previo de antibióticos y la hospitalización.
Conclusión. Se han identificado los principales factores de riesgo asociados a PARC y ABRC mediante una revisión de la evidencia disponible. Sin embargo, son necesarios estudios adicionales prospectivos que permitan identificar los pacientes con infecciones por dichos patógenos.
Revista:
ECLINICALMEDICINE
ISSN 2589-5370
Vol. 32
Año 2021
Págs.100720
Background: Ivermectin inhibits the replication of SARS-CoV-2 in vitro at concentrations not readily achievable with currently approved doses. There is limited evidence to support its clinical use in COVID-19 patients. We conducted a Pilot, randomized, double-blind, placebo-controlled trial to evaluate the efficacy of a single dose of ivermectin reduce the transmission of SARS-CoV-2 when administered early after disease onset.
Methods: Consecutive patients with non-severe COVID-19 and no risk factors for complicated disease attending the emergency room of the Clínica Universidad de Navarra between July 31, 2020 and September 11, 2020 were enrolled. All enrollments occurred within 72 h of onset of fever or cough. Patients were randomized 1:1 to receive ivermectin, 400 mcg/kg, single dose (n = 12) or placebo (n = 12). The primary outcome measure was the proportion of patients with detectable SARS-CoV-2 RNA by PCR from nasopharyngeal swab at day 7 post-treatment. The primary outcome was supported by determination of the viral load and infectivity of each sample. The differences between ivermectin and placebo were calculated using Fisher's exact test and presented as a relative risk ratio. This study is registered at ClinicalTrials.gov: NCT04390022.
Findings: All patients recruited completed the trial (median age, 26 [IQR 19-36 in the ivermectin and 21-44 in the controls] years; 12 [50%] women; 100% had symptoms at recruitment, 70% reported headache, 62% reported fever, 50% reported general malaise and 25% reported cough). At day 7, there was no difference in the proportion of PCR positive patients (RR 0·92, 95% CI: 0·77-1·09, p = 1·0). The ivermectin group had non-statistically significant lower viral loads at day 4 (p = 0·24 for gene E; p = 0·18 for gene N) and day 7 (p = 0·16 for gene E; p = 0·18 for gene N) post treatment as well as lower IgG titers at day 21 post treatment (p = 0·24). Patients in the ivermectin group recovered earlier from hyposmia/anosmia (76 vs 158 patient-days; p < 0.001).
Interpretation: Among patients with non-severe COVID-19 and no risk factors for severe disease receiving a single 400 mcg/kg dose of ivermectin within 72 h of fever or cough onset there was no difference in the proportion of PCR positives. There was however a marked reduction of self-reported anosmia/hyposmia, a reduction of cough and a tendency to lower viral loads and lower IgG titers which warrants assessment in larger trials.
Funding: ISGlobal, Barcelona Institute for Global Health and Clínica Universidad de Navarra.
Autores:
López, M. G.; Chiner-Oms, A.; García de Viedma, D.; et al.
Revista:
NATURE GENETICS
ISSN 1061-4036
Vol. 53
N° 10
Año 2021
Págs.1405 - 1414
The coronavirus disease 2019 (COVID-19) pandemic has affected the world radically since 2020. Spain was one of the European countries with the highest incidence during the first wave. As a part of a consortium to monitor and study the evolution of the epidemic, we sequenced 2,170 samples, diagnosed mostly before lockdown measures. Here, we identified at least 500 introductions from multiple international sources and documented the early rise of two dominant Spanish epidemic clades (SECs), probably amplified by superspreading events. Both SECs were related closely to the initial Asian variants of SARS-CoV-2 and spread widely across Spain. We inferred a substantial reduction in the effective reproductive number of both SECs due to public-health interventions (R-e < 1), also reflected in the replacement of SECs by a new variant over the summer of 2020. In summary, we reveal a notable difference in the initial genetic makeup of SARS-CoV-2 in Spain compared with other European countries and show evidence to support the effectiveness of lockdown measures in controlling virus spread, even for the most successful genetic variants. Analysis of 2,170 SARS-CoV-2 sequences from the first wave of the COVID-19 epidemic in Spain provides insights into transmission patterns and the effects of lockdown on the emergence of new variants.
Autores:
Sanchez-Guijo, F.; Garcia-Arranz, M.; Lopez-Parra, M.; et al.
Revista:
ECLINICALMEDICINE
ISSN 2589-5370
Vol. 25
Año 2020
Págs.100454
Background: Identification of effective treatments in severe cases of COVID-19 requiring mechanical ventilation represents an unmet medical need. Our aim was to determine whether the administration of adipose-tissue derived mesenchymal stromal cells (AT-MSC) is safe and potentially useful in these patients.
Methods: Thirteen COVID-19 adult patients under invasive mechanical ventilation who had received previous antiviral and/or anti-inflammatory treatments (including steroids, lopinavir/ritonavir, hydroxychloroquine and/or tocilizumab, among others) were treated with allogeneic AT-MSC. Ten patients received two doses, with the second dose administered a median of 3 days (interquartile range-IQR- 1 day) after the first one. Two patients received a single dose and another patient received 3 doses. Median number of cells per dose was 0.98 × 106 (IQR 0.50 × 106) AT-MSC/kg of recipient's body weight. Potential adverse effects related to cell infusion and clinical outcome were assessed. Additional parameters analyzed included changes in imaging, analytical and inflammatory parameters.
Findings: First dose of AT-MSC was administered at a median of 7 days (IQR 12 days) after mechanical ventilation. No adverse events were related to cell therapy. With a median follow-up of 16 days (IQR 9 days) after the first dose, clinical improvement was observed in nine patients (70%). Seven patients were extubated and discharged from ICU while four patients remained intubated (two with an improvement in their ventilatory and radiological parameters and two in stable condition). Two patients died (one due to massive gastrointestinal bleeding unrelated to MSC therapy). Treatment with AT-MSC was followed by a decrease in inflammatory parameters (reduction in C-reactive protein, IL-6, ferritin, LDH and d-dimer) as well as an increase in lymphocytes, particularly in those patients with clinical improvement.
Interpretation: Treatment with intravenous administration of AT-MSC in 13 severe COVID-19 pneumonia under mechanical ventilation in a small case series did not induce significant adverse events and was followed by clinical and biological improvement in most subjects.
Autores:
Gudiol, C. (Autor de correspondencia); Albasanz-Puig, A. ; Laporte-Amargos, J.; et al.
Revista:
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
ISSN 0066-4804
Vol. 64
N° 4
Año 2020
Págs.e02494-19
We aimed to assess the rate and predictive factors of bloodstream infection (BSI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa in neutropenic cancer patients. We performed a multicenter, retrospective cohort study including oncohematological neutropenic patients with BSI due to P. aeruginosa conducted across 34 centers in 12 countries from January 2006 to May 2018. A mixed logistic regression model was used to estimate a model to predict the multidrug resistance of the causative pathogens. Of a total of 1,217 episodes of BSI due to P. aeruginosa, 309 episodes (25.4%) were caused by MDR strains. The rate of multidrug resistance increased significantly over the study period (P = 0.033). Predictors of MDR P. aeruginosa BSI were prior therapy with piperacillin-tazobactam (odds ratio [OR), 3.48; 95% confidence interval [CI], 2.29 to 5.30), prior antipseudomonal carbapenem use (OR, 2.53; 95% CI, 1.65 to 3.87), fluoroquinolone prophylaxis (OR, 2.99; 95% CI, 1.92 to 4.64), underlying hematological disease (OR, 2.09; 95% CI, 1.26 to 3.44), and the presence of a urinary catheter (OR, 2.54; 95% CI, 1.65 to 3.91), whereas older age (OR, 0.98; 95% CI, 0.97 to 0.99) was found to be protective. Our prediction model achieves good discrimination and calibration, thereby identifying neutropenic patients at higher risk of BSI due to MDR P. aeruginosa. The application of this model using a web-based calculator may be a simple strategy to identify high-risk patients who may benefit from the early administration of broad-spectrum antibiotic coverage against MDR strains according to the local susceptibility patterns, thus avoiding the use of broad-spectrum antibiotics in patients at a low risk of resistance development.
Revista:
EDUCACION MEDICA
ISSN 1575-1813
Vol. 21
N° 3
Año 2020
Págs.207-211
Autores:
Laporte-Amargós, J.; Gudiol, C. (Autor de correspondencia); Arnán, M.; et al.
Revista:
TRIALS
ISSN 1745-6215
Vol. 21
N° 1
Año 2020
Págs.412
Background Febrile neutropaenia (FN) is a very common complication in patients with haematological malignancies and is associated with considerable morbidity and mortality. Broad-spectrum antipseudomonal beta-lactam antibiotics (BLA) are routinely used for the treatment of cancer patients with FN. However, the clinical efficacy of BLA may be diminished in these patients because they present with pathophysiological variations that compromise the pharmacokinetic (PK) parameters of these antibiotics. Optimised administration of BLA in prolonged infusions has demonstrated better clinical outcomes in critically ill patients. However, there is a paucity of data on the usefulness of this strategy in patients with FN. The aim of this study is to test the hypothesis that the administration of BLA would be clinically more effective by extended infusion (EI) than by intermittent infusion (II) in haematological patients with FN. Methods A randomised, multicentre, open-label, superiority clinical trial will be performed. Patients with haematological malignancies undergoing chemotherapy or haematopoietic stem-cell transplant and who have FN and receive empirical antibiotic therapy with cefepime, piperacillin-tazobactam or meropenem will be randomised (1:1) to receive the antibiotic by EI (during half the time of the dosing interval) in the study group, or by II (30 min) in the control group. The primary endpoint will be clinical efficacy, defined as defervescence without modifying the antibiotic treatment administered within the first 5 days of therapy. The primary endpoint will be analysed in the intention-to-treat population. The secondary endpoints will be pharmacokinetic/pharmacodynamic (PK/PD) target achievement, bacteraemia clearance, decrease in C-reactive protein, overall (30-day) case-fatality rate, adverse events and development of a population PK model of the BLA studied. Discussion Data on the usefulness of BLA administration in patients with FN are scant. Only three clinical studies addressing this issue have been published thus far, with contradictory results. Moreover, these studies had some methodological flaws that limit the interpretation of their findings. If this randomised, multicentre, phase IV, open-label, superiority clinical trial validates the hypothesis that the administration of BLA is clinically more effective by EI than by II in haematological patients with FN, then the daily routine management of these high-risk patients could be changed to improve their outcomes.
Revista:
THORAX
ISSN 0040-6376
Vol. 75
N° 12
Año 2020
Págs.1116 - 1118
In December 2019, an outbreak of severe acute respiratory syndrome associated to SARS-CoV2 was reported in Wuhan, China. To date, little is known on histopathological findings in patients infected with the new SARS-CoV2. Lung histopathology shows features of acute and organising diffuse alveolar damage. Subtle cellular inflammatory infiltrate has been found in line with the cytokine storm theory. Medium-size vessel thrombi were frequent, but capillary thrombi were not present. Despite the elevation of biochemical markers of cardiac injury, little histopathological damage could be confirmed. Viral RNA from paraffin sections was detected at least in one organ in 90% patients.
Autores:
Escudero-Sanchez, R. (Autor de correspondencia); Senneville, E. ; Digumber, M. ; et al.
Revista:
CLINICAL MICROBIOLOGY AND INFECTION
ISSN 1198-743X
Vol. 26
N° 4
Año 2020
Págs.499 - 505
Objectives: The aim was to describe the effectiveness of suppressive antibiotic treatment (SAT) in routine clinical practice when used in situations in which removal of a prosthetic implant is considered essential for the eradication of an infection, and it cannot be performed.
Methods: This was a descriptive retrospective and multicentre cohort study of prosthetic joint infection (PJI) cases managed with SAT. SAT was considered to have failed if a fistula appeared or persisted, if debridement was necessary, if the prosthesis was removed due to persistence of the infection or if uncontrolled symptoms were present.
Results: In total, 302 patients were analysed. Two hundred and three of these patients (67.2%) received monotherapy. The most commonly used drugs were tetracyclines (39.7% of patients) (120/302) and cotrimoxazole (35.4% of patients) (107/302). SAT was considered successful in 58.6% (177/302) of the patients (median time administered, 36.5 months; IQR 20.75-59.25). Infection was controlled in 50% of patients at 5 years according to Kaplan-Meier analysis. Resistance development was documented in 15 of 65 (23.1%) of the microbiologically documented cases. SAT failure was associated with age <70 years (sub-hazard ratio (SHR) 1.61, 95% CI 1.1-2.33), aetiology other than Gram-positive cocci (SHR 1.56, 95% CI 1.09-2.27) and location of the prosthesis in the upper limb (SHR 2.4, 95% CI 1.5-3.84). SAT suspension was necessary due to adverse effects in 17 of 302 patients (5.6%).
Conclusions: SAT offers acceptable results for patients with PJI when surgical treatment is not performed or when it fails to eradicate the infection.
Revista:
EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
ISSN 1619-7070
Vol. 46
N° SUPPL 1
Año 2019
Págs.S316 - S316
Revista:
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
ISSN 0305-7453
Vol. 74
N° 9
Año 2019
Págs.2817 - 2819
Autores:
Perez-Vazquez, M. (Autor de correspondencia); Campoy, P. J. S. ; Ortega, A.; et al.
Revista:
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
ISSN 0305-7453
Vol. 74
N° 12
Año 2019
Págs.3489 - 3496
Objectives: NDM carbapenemases have spread worldwide. However, little information exists about the impact of NDM-producing Enterobacteriaceae in Spain. By WGS, we sought to elucidate the population structure of NDM-like-producing Klebsiella pneumoniae and Escherichia coli in Spain and to determine the plasmids harbouring bla(NDM)-like genes. Methods: High-resolution SNP typing, core-genome MLST and plasmid reconstruction (PlasmidID) were performed on 59 NDM-like-producing K. pneumoniae and 8 NDM-like-producing E. coli isolated over an 8year period in Spain. Results: Five major epidemic clones of NDM-producing K. pneumoniae caused five important nationwide outbreaks: ST437/NDM-7, ST437/NDM-1, ST147/NDM-1, ST11/NDM-1 and ST101/NDM-1; in contrast, the spread of NDM-producing E. coli was polyclonal. Three bla(NDM) types were identified: bla(NDM-1), 61.2%; bla(NDM-7), 32.8%; and bla(NDM-5), 6%. Five K. pneumoniae isolates co-produced other carbapenemases (three bla(OXA-48) and two bla(VIM-1)). The average number of acquired resistance genes was higher in K. pneumoniae than in E. coli. The plasmids encoding bla(NDM)-like genes belonged to IncFII, IncFIB, IncX3, IncR, IncN and IncC types, of which IncF, IncR and IncC were associated with MDR. The genetic surroundings of bla(NDM)-like genes showed a highly variable region upstream of ISAba125. Conclusions: In recent years NDM-producing K. pneumoniae and E. coli have emerged in Spain; the spread of a few high-risk K. pneumoniae clones such as ST437/NDM-7, ST437/NDM-1, ST147/NDM-1, ST11/NDM-1 and ST101/NDM-1 have caused several interregional outbreaks. In contrast, the spread of NDM-producing E. coli has been polyclonal. Plasmid types IncFII, IncFIB, IncX3, IncR, IncN and IncC carried bla(NDM), and the same IncX3 plasmid was detected in K. pneumoniae and E. coli.
Autores:
Ibeas, J. (Autor de correspondencia); Roca-Tey, R.; Vallespin, J. ; et al.
Revista:
NEFROLOGIA
ISSN 0211-6995
Vol. 39
N° 6
Año 2019
Págs.680 - 682
Autores:
Anemüller, R.; Belden, K.; Brause, B.; et al.
Revista:
JOURNAL OF ARTHROPLASTY
ISSN 0883-5403
Vol. 34
N° Supl. 2
Año 2019
Págs.S463 - S475
Autores:
Albasanz-Puig, A.; Gudiol, C. (Autor de correspondencia); Parody, R.; et al.
Revista:
BMJ OPEN
ISSN 2044-6055
Vol. 9
N° 5
Año 2019
Págs.e025744
Introduction Pseudomonas aeruginosa (PA) has historically been one of the major causes of severe sepsis and death among neutropenic cancer patients. There has been a recent increase of multidrug-resistant PA (MDRPA) isolates that may determine a worse prognosis, particularly in immunosuppressed patients. The aim of this study is to establish the impact of antibiotic resistance on the outcome of neutropenic onco-haematological patients with PA bacteraemia, and to identify the risk factors for MDRPA bacteraemia and mortality.
Methods and analysis This is a retrospective, observational, multicentre, international study. All episodes of PA bacteraemia occurring in neutropenic onco-haematological patients followed up at the participating centres from 1 January 2006 to 31 May 2018 will be retrospectively reviewed. The primary end point will be overall case-fatality rate within 30 days of onset of PA bacteraemia. The secondary end points will be to describe the following: the incidence and risk factors for multidrug-resistant and extremely drug-resistant PA bacteraemia (by comparing the episodes due to susceptible PA with those produced by MDRPA), the efficacy of ceftolozane/tazobactam, the rates of persistent bacteraemia and bacteraemia relapse and the risk factors for very early (48 hours), early (7 days) and overall (30 days) case-fatality rates.
Ethics and dissemination The Clinical Research Ethics Committee of Bellvitge University Hospital approved the protocol of the study at the primary site. To protect personal privacy, identifying information of each patient in the electronic database will be encrypted. The processing of the patients' personal data collected in the study will comply with the Spanish Data Protection Act of 1998 and with the European Directive on the privacy of data. All data collected, stored and processed will be anonymised. Results will be reported at conferences and in peer-reviewed publications.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN 0213-005X
Vol. 37
N° 1
Año 2019
Págs.25 - 30
NTRODUCTION:
One of the main tools to optimize antibiotics use is education of prescribers. The aim of this article is to study undergraduate education in the field of infectious diseases, antimicrobial resistance and antibiotic stewardship from the perspective of Spanish medical students.
MATERIAL AND METHODS:
An anonymous online questionnaire was distributed among sixth grade students using different channels in Europe, within the ESGAP Student-Prepare survey. The questionnaire included 45 questions about knowledge, attitudes and perceptions about diagnosis, bacterial resistance, use of antibiotics and undergraduate training in infectious diseases. We present here the Spanish results.
RESULTS:
A total of 441 surveys were received from 21 medical schools. A total of 374 responses (84.8%) were obtained from the 8 most represented faculties, with a response rate of 28.9%. Most students felt adequately prepared to identify clinical signs of infection (418; 94.8%) and to accurately interpret laboratory tests (382; 86.6%). A total of 178 (40.4%) acknowledged being able to choose an antibiotic with confidence without consulting books or guidelines. Only 107 (24.3%) students considered that they had received sufficient training in judicious use of antibiotics. Regarding learning methods, the discussion of clinical cases, infectious diseases units rotatories and small group workshops were considered the most useful, being evaluated favorably in 76.9%, 76% and 68.8% of the cases.
CONCLUSION:
Medical students feel more confident in the diagnosis of infectious diseases than in antibiotic treatment. They also feel the need to receive more training in antibiotics and judicious antibiotic use.
Revista:
PATHOGENS AND DISEASE
ISSN 2049-632X
Vol. 77
N° 5
Año 2019
Págs.ftz051
Non-pigmented rapidly growing mycobacteria (NPRGM) are widely distributed in water, soil and animals. It has been
observed an increasing importance of NPRGM related-infections, particularly due to the high antimicrobial resistance.
NPRGM have rough and smooth colony phenotypes, and several studies have showed that rough colony variants are more
virulent than smooth ones. However, other studies have failed to validate this observation. In this study, we have performed
two models, in vitro and in vivo, in order to assess the different pathogenicity of these two phenotypes. We used collection
and clinical strains of Mycobacterium abscessus, Mycobacterium fortuitum and Mycobacterium chelonae. On the in vitro model
(macrophages), phagocytosis was higher for M. abscessus and M. fortuitum rough colony variant strains when compared to
smooth colony variants. However, we did not find differences with colonial variants of M. chelonae. Survival of Galleria
mellonella larvae in the experimental model was lower for M. abscessus and M. fortuitum rough colony variants when
compared with larvae infected with smooth colony variants. We did not find differences in larvae infected with M. chelonae.
Results of our in vivo study correlated well with the experimental model. This fact could have implications on the
interpretation of the clinical significance of the NPRGM isolate colonial variants.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN 0213-005X
Vol. 37
N° 1
Año 2019
Págs.25 - 30
INTRODUCTION:
One of the main tools to optimize antibiotics use is education of prescribers. The aim of this article is to study undergraduate education in the field of infectious diseases, antimicrobial resistance and antibiotic stewardship from the perspective of Spanish medical students.
MATERIAL AND METHODS:
An anonymous online questionnaire was distributed among sixth grade students using different channels in Europe, within the ESGAP Student-Prepare survey. The questionnaire included 45 questions about knowledge, attitudes and perceptions about diagnosis, bacterial resistance, use of antibiotics and undergraduate training in infectious diseases. We present here the Spanish results.
RESULTS:
A total of 441 surveys were received from 21 medical schools. A total of 374 responses (84.8%) were obtained from the 8 most represented faculties, with a response rate of 28.9%. Most students felt adequately prepared to identify clinical signs of infection (418; 94.8%) and to accurately interpret laboratory tests (382; 86.6%). A total of 178 (40.4%) acknowledged being able to choose an antibiotic with confidence without consulting books or guidelines. Only 107 (24.3%) students considered that they had received sufficient training in judicious use of antibiotics. Regarding learning methods, the discussion of clinical cases, infectious diseases units rotatories and small group workshops were considered the most useful, being evaluated favorably in 76.9%, 76% and 68.8% of the cases.
CONCLUSION:
Medical students feel more confident in the diagnosis of infectious diseases than in antibiotic treatment. They also feel the need to receive more training in antibiotics and judicious antibiotic use.
Autores:
Garrigues, G.E. (Autor de correspondencia); Zmistowski, B.; Cooper, A.M.; et al.
Revista:
JOURNAL OF SHOULDER AND ELBOW SURGERY
ISSN 1058-2746
Vol. 28
N° 6S
Año 2019
Págs.S67 - S99
Revista:
REVISTA ESPAÑOLA DE QUIMIOTERAPIA
ISSN 0214-3429
Vol. 32
N° Supl. 2
Año 2019
Págs.42 - 46
Sepsis is the major cause of mortality from any infectious disease worldwide. The goals of antimicrobial stewardship are to achieve optimum clinical outcomes and to ensure cost effectiveness and minimum unintended consequences, including toxic effects, selection of pathogenic organisms, and resistance. The combination of inadequate diagnostic criteria for sepsis with the extraordinary time pressure to provide broad-spectrum antimicrobial therapy is troubling from a stewardship perspective. Use of empirical therapy according to guidelines, de-escalation of therapy, switch from intravenous to oral therapy, therapeutic drug monitoring, use of a list of restricted antibiotics, and bedside consultation can lead to significant benefits for clinical outcomes, adverse events, and costs.
Revista:
MEDICINE - UK EDITION
ISSN 1357-3039
Vol. 12
N° 50
Año 2018
Págs.2990.e1 - 2990.e4
Revista:
MEDICINE - UK EDITION
ISSN 1357-3039
Vol. 12
N° 51
Año 2018
Págs.3057.e1 - 3057.e3
Revista:
JOURNAL OF ATTENTION DISORDERS
ISSN 1087-0547
Vol. 22
N° 9
Año 2018
Págs.864 - 871
Revista:
EXPERT REVIEW OF ANTI-INFECTIVE THERAPY
ISSN 1478-7210
Vol. 16
N° 1
Año 2018
Págs.51 - 65
Biofilm formation represents a protected mode of growth that renders bacterial cells less susceptible to antimicrobials and to killing by host immune effector mechanisms and so enables the pathogens to survive in hostile environments and also to disperse and colonize new niches. Biofilm disease includes device-related infections, chronic infections in the absence of a foreign body, and even malfunction of medical devices. Areas covered: This review puts forward a new medical entity that represents a major public health issue, which we have named 'biofilm-related disease'. We highlight the characteristics of biofilm disease including its pathogenesis, microbiological features, clinical presentation, and treatment challenges. Expert commentary: The diversity of biofilm-associated infections is increasing over time and its impact may be underestimated. This peculiar form of development endows associated bacteria with a high tolerance to conventional antimicrobial agents. A small percentage of persister cells developing within the biofilm is known to be highly tolerant to antibiotics and has typically been involved in causing relapse of infections. Knowledge of the pivotal role played by biofilm-growing microorganisms in related infections will provide new treatment dynamics for this biofilm-related disease.
Revista:
MEDICINE - UK EDITION
ISSN 1357-3039
Vol. 12
N° 50
Año 2018
Págs.2952 - 2962
Introduction: In recent years, an increase in the average annual incidence of Vibrio infections has been reported, probably related to global climate change. This includes cholera, a secretory diarrhoea caused by toxigenic strains of Vibrio cholerae serogroups O1 and O139. Pathogenic: Infections caused by the genus Vibrio produce diverse clinical manifestations, from gastrointestinal syndromes (of greater or lesser severity) to cutaneous infections and lethal septicaemia. Diagnosis: The epidemiological context as well as the use of appropriate culture media are keys, in conjunction with biochemical and agglutination tests. Treatment: It will vary depending on the clinical presentation, ranging from oral or intravenous fluid replacement, with administration of antibiotics in the most severe cases, until debridement of the necrotic tissues in cases of severe cutaneous involvement.
Revista:
INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS
ISSN 0924-8579
Vol. 52
N° 1
Año 2018
Págs.123 - 124
Autores:
Candel, F. J.; Borges, Sá. M.; Belda, S.; et al.
Revista:
REVISTA ESPAÑOLA DE QUIMIOTERAPIA
ISSN 0214-3429
Vol. 31
N° 4
Año 2018
Págs.298 - 315
The incidence and prevalence of sepsis depend on the definitions and records that we use and we may be underestimating their impact. Up to 60% of the cases come from the community and in 30-60% we obtain microbiological information. Sometimes its presentation is ambiguous and there may be a delay in its detection, especially in the fragile population. Procalcitonin is the most validated biomarker for bacterial sepsis and the one that best discriminates the non-infectious cause. Presepsin and pro-adrenomedullin are useful for early diagnosis, risk stratification and prognosis in septic patients. The combination of biomarkers is even more useful to clarify an infectious cause than any isolated biomarker. Resuscitation with artificial colloids has worse results than crystalloids, especially in patients with renal insufficiency. The combination of saline solution and balanced crystalloids is associated with a better prognosis. Albumin is only recommended in patients who require a large volume of fluids. The modern molecular methods on the direct sample or the identification by MALDI-TOF on positive blood culture have helped to shorten the response times in diagnosis, to optimize the antibiotic treatment and to facilitate stewardship programs. The hemodynamic response in neonates and children is different from that in adults. In neonatal sepsis, persistent pulmonary hypertension leads to an increase in right ventricular afterload and heart failure with hepatomegaly. Hypotension, poor cardiac output with elevated systemic vascular resistance (cold shock) is often a terminal sign in septic shock. Developing ultra-fast Point-of-Care tests (less than 30 minutes), implementing technologies based on omics, big data or massive sequencing or restoring "healthy" microbiomes in critical patients after treatment are the main focuses of research in sepsis. The main benefits of establishing a sepsis code are to decrease the time to achieve diagnosis and treatment, improve organization, unify criteria, promote teamwork to achieve common goals, increase participation, motivation and satisfaction among team members, and reduce costs.
Revista:
MEDICINA INTENSIVA
ISSN 0210-5691
Vol. 42
N° 1
Año 2018
Págs.5 - 36
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (the Spanish Society of Infectious Diseases and Clinical Microbiology and [SEIMC] and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units [SEMICYUC]). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Gram-negative bacilli, and Candida spp.), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications. (C) 2017 Elsevier Espana, S.L.U. y SEMICYUC. All rights reserved.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN 0213-005X
Vol. 36
N° 2
Año 2018
Págs.112 - 119
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica and the Sociedad Espanola de Medicina Intensiva, Crftica y Unidades Coronarias). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Sthaphylococcus aureus, Enterococcus spp, Gram-negative bacilli, and Candida spp), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications. (C) 2017 Elsevier Espana, S.L.U. and Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.
Revista:
NEFROLOGIA
ISSN 0211-6995
Vol. 39
N° 1
Año 2018
Págs.1 - 2
En el artículo «Guía Clínica Española del Acceso Vascular para Hemodiálisis» (Nefrologia. 2017;37[Supl 1]:1-192) se ha detectado un error en la filiación de la Dra. Isabel Crehuet, siendo la correcta:
Hospital Universitario Río Hortega, Valladolid
Revista:
REVISTA ESPAÑOLA DE QUIMIOTERAPIA
ISSN 0214-3429
Vol. 31
N° Supl. 1
Año 2018
Págs.35 - 38
Biofilms cause recurrent invasive infections that are difficult to eradicate because of their high resistance to antimicrobials and host defence mechanisms. Fungal biofilm-related infections are associated with high mortality rates. Although current guidelines recommend catheter removal for catheter-related bloodstream infections due to Candida species, several studies have shown that the efficacy of the antifungal lock technique. The use of combinations of antifungal agents may improve the management of biofilm-related fungal infections and prevent the emergence of resistance associated with monotherapy. Since the presence of mixed bacterial-fungal biofilm infections is very prevalent, a combination of antibacterial and antifungal agents should be considered.
Autores:
Basas, J.; Palau, M.; Ratia, C.; et al.
Revista:
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
ISSN 0066-4804
Vol. 62
N° 2
Año 2018
Long- term catheter- related bloodstream infections (CRBSIs) involving coagulase-negative staphylococci are associated with poor patient outcomes, increased hospitalization, and high treatment costs. The use of vancomycin lock therapy has been an important step forward in treatment of these biofilms, although failures occur in 20% of patients. In this study, we report that a high dose of daptomycin lock therapy may offer a therapeutic advantage for these CRBSIs in just 24 h of treatment.
Revista:
MEDICINE - UK EDITION
ISSN 1357-3039
Vol. 12
N° 51
Año 2018
Págs.3010 - 3019
Revista:
MEDICINE (ELSEVIER)
ISSN 0304-5412
Vol. 12
N° 50
Año 2018
Págs.2963 - 2971
ntroduction: The HACEK group (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella) includes slow-growing gram-negative bacteria that form part of the microbiota of the upper respiratory and genitourinary tracts of humans and animals. Clinical manifestations: These are the slow-growing, gram-negative bacilli that most frequently cause infections in human beings, and can give rise to infections in any location, but fundamentally the skin and soft tissues, and cause bacteraemia and endocarditis. Diagnosis: They are nutritionally demanding bacteria and for visible colonies to develop require blood agar or chocolate agar, an aerobic atmosphere, generally CO2 rich and incubation of at least 42 hours. They are difficult to identify phenotypically as a species and it is not always possible to do so, even using automated systems. However molecular and proteomic techniques have resulted in increased identification and an awareness of their role in human infectious pathology. Treatment: There is limited data on their sensitivity to antimicrobial agents, although from the existing data it is known that amoxicillin-clavulanic acid, second and third generation cephalosporins and fluoroquinolones generally act against them.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN 0213-005X
Vol. 36
N° 6
Año 2018
Págs.375 - 381
Biofilm-related infections represent a serious health problem, accounting for 65-80% of all infections. The infections are generally chronic and characterized by the persistence of the microorganism, due to the increased resistance of biofilms to both the immune system and antimicrobials. Biofilms can be located to almost every human body tissue and on exogenous devices such as catheters, pacemakers, prosthetic material, implants, urinary catheters, etc. Traditional antimicrobial susceptibility studies in clinical microbiology laboratories have lied on the study of planktonic form of microorganisms. However, this approach might lead to miss the biofilm characteristics and to a treatment failure. Microbiological diagnosis and antimicrobial susceptibility studies of biofilm-related infections are complex and, nowadays, represent a challenge that clinicians and microbiologists have to address as a team in the absence of consensus or standardized protocols. (C) 2017 Elsevier Espana, S.L.U. and Sociedad Espanola de Enfermedades lnfecciosas y Microbiologia Clinica. All rights reserved.
Revista:
PARASITES AND VECTORS
ISSN 1756-3305
Vol. 11
Año 2018
Págs.287
Background: Mosquitoes that feed on animals can survive and mediate residual transmission of malaria even after most humans have been protected with insecticidal bednets or indoor residual sprays. Ivermectin is a widely-used drug for treating parasites of humans and animals that is also insecticidal, killing mosquitoes that feed on treated subjects. Mass administration of ivermectin to livestock could be particularly useful for tackling residual malaria transmission by zoophagic vectors that evade human-centred approaches. Ivermectin comes from a different chemical class to active ingredients currently used to treat bednets or spray houses, so it also has potential for mitigating against emergence of insecticide resistance. However, the duration of insecticidal activity obtained with ivermectin is critical to its effectiveness and affordability.
Results: A slow-release formulation for ivermectin was implanted into cattle, causing 40 weeks of increased mortality among Anopheles arabiensis that fed on them. For this zoophagic vector of residual malaria transmission across much of Africa, the proportion surviving three days after feeding (typical mean duration of a gonotrophic cycle in field populations) was approximately halved for 25 weeks.
Conclusions: This implantable ivermectin formulation delivers stable and sustained insecticidal activity for approximately 6 months. Residual malaria transmission by zoophagic vectors could be suppressed by targeting livestock with this long-lasting formulation, which would be impractical or unacceptable for mass treatment of human populations.
Revista:
INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS
ISSN 0391-3988
Vol. 41
N° 1
Año 2018
Págs.23 - 27
PURPOSE:
To determine the fungicidal activity by time-killing assays of amphotericin B (AMB) combined with anidulafungin (ANF) against biofilms of 2 clinical isolates of Candida tropicalis and the reference strain ATCC® 750, developed on polytetrafluoroethylene (PTFE) and titanium, using the CDC Biofilm Reactor (CBR) as an in vitro model.
METHODS:
Biofilms were developed for 24 hours on the disk surfaces and then exposed to AMB (40 mg/L), ANF (8 mg/L), alone and combined. At predetermined time points after drug exposure, biofilms were removed from the disk surface by vortexing-sonication to quantify viable biofilm cells.
RESULTS:
Drug activity was dependent on strain and time. After exposure to AMB, the mean decrease in viable cells attached to PTFE was 2.23 ± 0.89 Log10 cfu/cm2 (range 0.6-3.56 Log10), and on titanium 2.91 ± 1.04 (range 1.49-4.51 Log10). The reduction with ANF was 0.78 ± 0.5 (0.03-1.58 Log10) on PTFE and 0.8 ± 2.26 (0.42-1.16 Log10) on titanium. The reduction obtained with the combination of AMB + ANF was 1.8 ± 1.07 (0.22-3.54 Log10) on PTFE and 1.97 ± 0.49 (1.36-2.84 Log10) on titanium. The interaction was classified as indifferent with a tendency to antagonism.
CONCLUSIONS:
The activity of antifungal agents depends on the biomaterial surfaces the biofilm forming capacity of the isolate. AMB + ANF is less effective than AMB alone on both surfaces. Thus, the combination of these antifungals does not seem to add additional benefits to the treatment of C. tropicalis biofilm-related infections.
Revista:
REVISTA IBEROAMERICANA DE MICOLOGIA
ISSN 1130-1406
Vol. 34
N° 3
Año 2017
Págs.175 - 179
BACKGROUND:
Current therapeutic strategies have a limited efficacy against Candida biofilms that form on the surfaces of biomedical devices. Few studies have evaluated the activity of antifungal agents against Candida tropicalis biofilms.
OBJECTIVES:
To evaluate the activity of amphotericin B (AMB) and anidulafungin (AND), alone and in combination, against C. tropicalis biofilms developed on polytetrafluoroethylene (teflon -PTFE) and titanium surfaces using time-kill assays.
METHODS:
Assays were performed using the CDC Biofilm Reactor equipped with PTFE and titanium disks with C. tropicalis biofilms after 24h of maturation. The concentrations assayed were 40mg/l for AMB and 8mg/l for AND, both alone and combined. After 24, 48 and 72h of exposure to the antifungals, the cfu/cm2 was determined by a vortexing-sonication procedure.
RESULTS:
AMB reduced biofilm viable cells attached to PTFE and titanium by ¿99% and AND by 89.3% on PTFE and 96.8% on titanium. The AMB+AND combination was less active than AMB alone, both on PTFE (decrease of cfu/cm2 3.09 Log10vs. 1.08 when combined) and titanium (4.51 vs. 1.53 when combined), being the interaction irrelevant on both surfaces.
CONCLUSIONS:
AMB is more active than AND against C. tropicalis biofilms. Yeast killing rates are higher on titanium than on PTFE surfaces. The combination of AMB plus AND is less effective than AMB alone on both surfaces.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN 0213-005X
Vol. 35
N° Supl. 3
Año 2017
Págs.29 - 43
Revista:
LANCET INFECTIOUS DISEASES
ISSN 1473-3099
Vol. 17
N° 2
Año 2017
Págs.139 - 140
Revista:
SCIENTIFIC REPORTS
ISSN 2045-2322
Vol. 7
N° 1
Año 2017
Págs.8535
Mass administration of endectocides, drugs that kill blood-feeding arthropods, has been proposed as a complementary strategy to reduce malaria transmission. Ivermectin is one of the leading candidates given its excellent safety profile. Here we provide proof that the effect of ivermectin can be boosted at two different levels by drugs inhibiting the cytochrome or ABC transporter in the mammal host and the target mosquitoes. Using a mini-pig model, we show that drug-mediated cytochrome P450/ABC transporter inhibition results in a 3-fold increase in the time ivermectin remains above mosquito-killing concentrations. In contrast, P450/ABC transporter induction with rifampicin markedly impaired ivermectin absorption. The same ketoconazole-mediated cytochrome/ABC transporter inhibition also occurs outside the mammal host and enhances the mortality of Anopheles gambiae. This was proven by using the samples from the mini-pig experiments to conduct an ex-vivo synergistic bioassay by membrane-feeding Anopheles mosquitoes. Inhibiting the same cytochrome/xenobiotic pump complex in two different organisms to simultaneously boost the pharmacokinetic and pharmacodynamic activity of a drug is a novel concept that could be applied to other systems. Although the lack of a dose-response effect in the synergistic bioassay warrants further exploration, our study may have broad implications for the control of parasitic and vector-borne diseases.
Autores:
Ariza, J.; Cobo, J.; Baraia Etxaburu, J.; et al.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN 0213-005X
Vol. 35
N° 3
Año 2017
Págs.189 - 195
The incidence of prosthetic joint infection (PJI) is expected to increase in the coming years. PJI has serious consequences for patients, and high costs for the health system. The complexity of these infections makes it necessary to organize the vast quantity of information published in the last several years. The indications for the choice of a given surgical strategy and the corresponding antimicrobial therapy are specifically reviewed. The authors selected clinically relevant questions and then reviewed the available literature in order to give recommendations according to a pre-determined level of scientific evidence. The more controversial aspects were debated, and the final composition was agreed at an ad hoc meeting. Before its final publication, the manuscript was made available online in order that all SEIMC members were able to read it and make comments and suggestions. (C)2016 Elsevier Espana, S.L.U. and Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.
Revista:
AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE
ISSN 0002-9637
Vol. 95
N° 5
Año 2017
Págs.96 - 96
Revista:
REVISTA ESPAÑOLA DE QUIMIOTERAPIA
ISSN 0214-3429
Vol. 30
N° Supl 1
Año 2017
Págs.42-47
Revista:
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
ISSN 0066-4804
Vol. 61
N° 11
Año 2017
Págs.e01330-17
Treatment of an infected postpneumonectomy cavity is very difficult. We present a patient with an infection of a postpneumonectomy cavity by Staphylococcus epidermidis treated with local daptomycin for different dwell times, maintaining high antibiotic levels above the MIC. Clinical and microbiological cure were achieved successfully.
Revista:
REVISTA ESPAÑOLA DE QUIMIOTERAPIA
ISSN 0214-3429
Vol. 30
N° Supl. 1
Año 2017
Págs.42 - 47
In the last few years there has been an increase of implantable cardiac electronic device and vascular graft related infections. This is due in part to a higher complexity of some of these procedures and an increase in patient's comorbidities. Despite wide diagnosis methods availability, early stage diagnosis usually constitutes a challenge as often patients only denote insidious symptoms. In most confirmed cases, removal of the infected device is required to resolve the infection. This is mostly explainable because of bacterial ability to grow as biofilms on biomaterial surfaces, conferring them antimicrobial resistance. If removal is not possible, chronic suppressive antimicrobial therapy could be an option.
Revista:
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
ISSN 0066-4804
Vol. 61
N° 3
Año 2017
Págs. e02104-16
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN 0213-005X
Vol. 35
N° 6
Año 2017
Págs.398 - 398
Revista:
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
ISSN 0305-7453
Vol. 72
N° 2
Año 2017
Págs.625 - 628
Revista:
LANCET INFECTIOUS DISEASES
ISSN 1473-3099
Vol. 17
N° 5
Año 2017
Págs.477 - 478
Revista:
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
ISSN 0305-7453
Vol. 7
N° 1
Año 2016
Págs.278-9
Revista:
REVISTA ESPAÑOLA DE QUIMIOTERAPIA
ISSN 0214-3429
N° Supl.1
Año 2016
Págs.15-20
Infections caused by Staphylococcus aureus have had classically an important impact in morbidity and mortality in the nosocomial and community scene. The description of methicillin resistance among nosocomial isolates of S. aureus and his widespread diffusion has become methicillin-resistant S. aureus (MRSA) in one of the most common causes of bacterial nosocomial infections. In the last years MRSA strains have also emergence in the community. This together with a progressive increase in resistance to antibiotics used classically has become vancomycin in the treatment of choice in most cases according to clinical guidelines. As a result, a progressive rise in the minimum inhibitory concentration (MIC) to vancomycin has been reported. In this context strains with intermediate susceptibility to vancomycin (MIC 8-4 mg/L) and heteroresistance have been noted. These strains are associated with a higher risk of treatment failure when using vancomycin. Among isolates of S. aureus susceptible to vancomycin there has been described stains with elevated MICs (¿1.5 mg/L). It is controversial if the presence of these strains has an impact on clinical outcome if treatment with vancomycin or ß-lactams is prescribed. The development of new antibiotics with activity against MRSA and exploring synergies offer a promising alternative to treatment with vancomycin.
Revista:
REVISTA IBEROAMERICANA DE MICOLOGIA
ISSN 1130-1406
Vol. 33
N° 3
Año 2016
Págs.176 - 183
The number of biomedical devices (intravascular catheters, heart valves, joint replacements, etc.) that are implanted in our hospitals has increased exponentially in recent years. Candida species are pathogens which are becoming more significant in these kinds of infections. Candida has two forms of development: planktonic and in biofilms. A biofilm is a community of microorganisms which adhere to a surface and are enclosed by an extracellular matrix. This form of development confers a high resistance to the antimicrobial agents. This is the reason why antibiotic treatments usually fail and biomedical devices may have to be removed in most cases. Unspecific adhesion mechanisms, the adhesion-receptor systems, and an intercellular communication system called quorum sensing play an essential role in the development of Candida biofilms. In general, the azoles have poor activity against Candida biofilms, while echinocandins and polyenes show a greater activity. New therapeutic strategies need to be developed due to the high morbidity and mortality and high economic costs associated with these infections. Most studies to date have focused on bacterial biofilms. The knowledge of the formation of Candida biofilms and their composition is essential to develop new preventive and therapeutic strategies.
Revista:
REVISTA IBEROAMERICANA DE MICOLOGIA
ISSN 1130-1406
Vol. 33
N° 3
Año 2016
Págs.176 - 183
The number of biomedical devices (intravascular catheters, heart valves, joint replacements, etc.) that are implanted in our hospitals has increased exponentially in recent years. Candida species are pathogens which are becoming more significant in these kinds of infections. Candida has two forms of development: planktonic and in biofilms. A biofilm is a community of microorganisms which adhere to a surface and are enclosed by an extracellular matrix. This form of development confers a high resistance to the antimicrobial agents. This is the reason why antibiotic treatments usually fail and biomedical devices may have to be removed in most cases. Unspecific adhesion mechanisms, the adhesion-receptor systems, and an intercellular communication system called quorum sensing play an essential role in the development of Candida biofilms. In general, the azoles have poor activity against Candida biofilms, while echinocandins and polyenes show a greater activity. New therapeutic strategies need to be developed due to the high morbidity and mortality and high economic costs associated with these infections. Most studies to date have focused on bacterial biofilms. The knowledge of the formation of Candida biofilms and their composition is essential to develop new preventive and therapeutic strategies.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN 0213-005X
Vol. 34
N° 10
Año 2016
Págs.655 - 660
The use of surgically implanted medical devices has increased greatly over the last few years. Despite surgical advances and improvements in the materials and design of devices, infection continues to be a major complication of their use. Device-associated infections are produced mainly during their implantation and, are caused by microorganisms that are part of the skin flora. Biofilm development on device surfaces is the most important factor to explain the pathophysiological aspects of infection. Microbiological diagnosis is difficult and can often only be achieved after removal of the device. Sonication of the removed device may be a useful tool, since this procedure dislodges and disaggregates biofilm bacteria from the device. Molecular techniques, especially PCR, applied to the tissues and material obtained after sonication have shown to have a high sensitivity and specificity for the diagnosis of cardiovascular device infections. (C) 2015 Elsevier Espana, S.L.U. and Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.
Autores:
Basas, J.; Morer, A.; Ratia, C.; et al.
Revista:
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
ISSN 0305-7453
Vol. 71
N° 10
Año 2016
Págs.2895 - 2901
OBJECTIVES:
The effectiveness of anidulafungin versus liposomal amphotericin B (LAmB) for treating experimental Candida parapsilosis catheter-related infection by an antifungal-lock technique was assessed.
METHODS:
Two clinical strains of C. parapsilosis (CP12 and CP54) were studied. In vitro studies were used to determine the biofilm MICs (MBIC50 and MBIC90) by XTT reduction assay and LIVE/DEAD biofilm viability for anidulafungin and LAmB on 96-well microtitre polystyrene plates and silicone discs. An intravenous catheter was implanted in New Zealand white rabbits. Infection was induced by locking the catheter for 48 h with the inoculum. The 48 h antifungal-lock treatment groups included control, 3.3 mg/mL anidulafungin and 5.5 mg/mL LAmB.
RESULTS:
Anidulafungin showed better in vitro activity than LAmB against C. parapsilosis growing in biofilm on silicone discs. MBIC90 of LAmB: CP12, >1024 mg/L; CP54, >1024 mg/L. MBIC90 of anidulafungin: CP12, 1 mg/L; CP54, 1 mg/L (P¿¿¿0.05). Moreover, only anidulafungin (1 mg/L) showed >90% non-viable cells in the LIVE/DEAD biofilm viability assay on silicone discs. No differences were observed between the in vitro susceptibility of anidulafungin or LAmB when 96-well plates were used. Anidulafungin achieved significant reductions relative to LAmB in log10 cfu recovered from the catheter tips for both strains (P¿¿¿0.05). Only anidulafungin achieved negative catheter tip cultures (CP12 63%, CP54 73%, P¿¿¿0.05).
CONCLUSIONS:
Silicone discs may be a more reliable substrate for the study of in vitro biofilm susceptibility of C. parapsilosis. Anidulafungin-lock therapy showed the highest activity for experimental catheter-related infection with C. parapsilosis.
Revista:
INTERNATIONAL JOURNAL OF CLINICAL PRACTICE
ISSN 1368-5031
Vol. 70
N° 2
Año 2016
Págs.147-155
The predictive rule was able to predict risk of death as a result of enterococcal bloodstream infection as well as to identify patients, who being below the threshold value, will have a low risk of death with a negative predictive value of 96%
Revista:
PEDIATRIC ALLERGY AND IMMUNOLOGY
ISSN 0905-6157
Vol. 27
N° 3
Año 2016
Págs.320 - 321
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN 1137-6627
Vol. 38
N° 1
Año 2015
Págs.71-77
Analizar los predictores de mortalidad y mal pronóstico en el paciente oncológico diagnosticado de bacteriemia por E. faecium. Métodos. Se analizaron datos demográficos, clínicos y microbiológicos (Enero 1998-Junio 2011). Resultados. El análisis multivariable demostró que la presencia de una sonda urinaria se asoció a mal pronóstico a los 7 días y alta mortalidad del paciente al final del estudio. Un índice de Charlson elevado se asoció a un aumento en la mortalidad a los 7 días. Conclusión. En nuestro estudio, la presencia de sonda urinaria se asoció con mal pronóstico del paciente a los 7 días y aumento de la mortalida
Revista:
JOURNAL OF CLINICAL PHARMACY AND THERAPEUTICS
ISSN 0269-4727
Vol. 40
N° 5
Año 2015
Págs.601 - 603
What is known and objectiveInvasive fungal infections are a major cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). This provides a clear rationale for antifungal prophylaxis in this population. A concern is the potential for drug interactions, given that most of antifungals are metabolized through the P450 cytochrome system.
Case summaryWe present a case of a 33-year-old woman, with a past history of high-risk epilepsy, who underwent allogeneic HSCT for a myelodysplastic syndrome. Anidulafungin was successfully used as antifungal prophylaxis to minimize drug interactions with her antiepileptic treatment.
What is new and conclusionThis is the first reported case of antifungal prophylaxis with this echinocandin in HSCT. Anidulafungin may be an option in transplant recipients with multiple risk factors for drug interactions.
Revista:
EXPERT REVIEW OF ANTICANCER THERAPY
ISSN 1473-7140
Vol. 15
N° 3
Año 2015
Págs.317 - 330
Microbial communities that colonize in humans are collectively described as microbiome. According to conservative estimates, about 15% of all types of neoplasms are related to different infective agents. However, current knowledge is not sufficient to explain how the microbiome contributes to the growth and development of cancers. Large and thorough studies involving colonized, diverse and complex microbiome entities are required to identify microbiome as a potential cancer marker and to understand how the immune system is involved in response to pathogens. This article reviews the existing evidence supporting the enigmatic association of transformed microbiome with the development of cancer through the immunological modification. Ascertaining the connection between microbiome and immunological responses with risk of cancer may direct to explaining significant advances in the etiology of cancer, potentially disclosing a novel paradigm of research for the management and prevention of cancer.
Revista:
EXPERT REVIEW OF ANTI-INFECTIVE THERAPY
ISSN 1478-7210
Vol. 13
N° 4
Año 2015
Págs.505 - 509
Malaria is a curable disease, provided timely access to efficacious drugs is sought. Poor quality and, in particular, falsified antimalarial drugs harm the population of malaria endemic areas; they put lives in peril, cause economic losses to patients, families, industry, and generally undermine the trust in health systems. The extent of the problem is not easily assessed, and although a prevalence of up to 35% of poor-quality antimalarials has been reported, this number should be interpreted with caution given the heterogeneity of methods used to measure it. The trade in falsified antimalarials can be curtailed by putting in place drug quality surveillance, better legislation and improving the access and affordability of these essential drugs.
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN 1137-6627
Vol. 38
N° 1
Año 2015
Págs.71-7
After multivariate analysis, presence of a urinary catheter was associated with a worse 7-day prognosis, and higher mortality at discharge. A high Charlson index was also associated with higher 7-day mortality.
CONCLUSION:
Presence of a urinary catheter was associated with poor 7-day prognosis and higher mortality at discharge in the present series.
Revista:
ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY
ISSN 0065-2598
Vol. 831
Año 2015
Págs.53 - 67
Revista:
MALARIA JOURNAL
ISSN 1475-2875
Vol. 14
Año 2015
Págs.102
Background: The prospect of eliminating malaria is challenged by emerging insecticide resistance and vectors with outdoor and/or crepuscular activity. Ivermectin can simultaneously tackle these issues by killing mosquitoes feeding on treated animals and humans. A single oral dose, however, confers only short-lived mosquitocidal plasma levels.
Methods: Three different slow-release formulations of ivermectin were screened for their capacity to sustain mosquito-killing levels of ivermectin for months. Thirty rabbits received a dose of one, two or three silicone implants containing different proportions of ivermectin, deoxycholate and sucrose. Animals were checked for toxicity and ivermectin was quantified periodically in blood. Potential impact of corresponding long-lasting formulation was mathematically modelled.
Results: All combinations of formulation and dose released ivermectin for more than 12 weeks; four combinations sustained plasma levels capable of killing 50% of Anopheles gambiae feeding on a treated subject for up to 24 weeks. No major adverse effects attributable to the drug were found. Modelling predicts a 98% reduction in infectious vector density by using an ivermectin formulation with a 12-week duration.
Conclusions: These results indicate that relatively stable mosquitocidal plasma levels of ivermectin can be safely sustained in rabbits for up to six months using a silicone-based subcutaneous formulation. Modifying the formulation of ivermectin promises to be a suitable strategy for malaria vector control.
Revista:
INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
ISSN 1201-9712
Vol. 27
Año 2014
Págs.65 - 66
Enterococci are implicated in less than 2.3% of prosthetic joint infections. These infections can be difficult to treat and therapeutic failures are not uncommon. In these situations, daptomycin is a safe and effective alternative. We present a clinical case with a successful response to the prolonged use of high-dose daptomycin.
Revista:
JOURNAL OF INFECTION
ISSN 0163-4453
Vol. 68
N° 6
Año 2014
Págs.548-52
Daptomycin showed greater in vitro activity than vancomycin against biofilm bacteria (MBECs of vancomycin and daptomycin for MSSA, >2000 mg/L and 7 mg/L; MRSA, >2000 mg/L and 15 mg/L). Daptomycin 5 mg/mL achieved significant reductions relative to vancomycin 10 mg/mL in log10 cfu recovered from catheter tips for both strains (P < 0.05). Only daptomycin 50 mg/mL achieved negative catheter tip cultures (up to 75% in MSSA and 85% in MRSA, P < 0.05), showing the greatest median log10 cfu reduction compared to controls (6.07 in MSSA and 6.59 in MRSA, P < 0.05).
CONCLUSIONS: Daptomycin 50 mg/mL showed the highest activity against both strains biofilms.
Revista:
LANCET INFECTIOUS DISEASES
ISSN 1473-3099
Vol. 14
N° 8
Año 2014
Págs.676
Autores:
Oteo, J.; Calbo, E.; Rodríguez-Baño, J.; et al.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN 0213-005X
Vol. 32
N° 10
Año 2014
Págs.666 - 670
La emergencia y diseminación de enterobacterias productoras de carbapenemasas, como paradigma actual de la resistencia extensa y de la panresistencia a antibióticos, en nuestro ámbito sanitario es una grave amenaza para la salud de los pacientes y para la salud pública. El máximo impacto de esta problemática se debe a la dispersión de cepas de Klebsiella pneumoniae productoras de OXA-48 y VIM-1. Estas evidencias llevan a los miembros de un panel representativo de los Grupos de Estudio de la Infección Hospitalaria y de los Mecanismos de Acción y de la Resistencia a Antimicrobianos de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIH/GEMARA-SEIMC) a posicionarse exponiendo la necesidad de una respuesta rotunda, coordinada y protocolizada por parte de todos los profesionales sanitarios y autoridades implicadas, así como una adaptación de los sistemas de salud que permita su control precoz y minimice su impacto.
Revista:
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
ISSN 0066-4804
Vol. 58
N° 7
Año 2014
Págs.4227 - 4229
Mitochondrial toxicity has been recently suggested to be the underlying mechanism of long-term linezolid-associated toxicity in patients with 16S rRNA genetic polymorphisms. Here, we report for the first time two cases of lactic acidosis due to long-term linezolid exposure in liver transplant recipients who presented an A2706G mitochondrial DNA polymorphism.
Revista:
INFECTION AND DRUG RESISTANCE
ISSN 1178-6973
Vol. 18
N° 7
Año 2014
Págs.25 - 35
Since the first description in 1982, totally implanted venous access ports have progressively improved patients' quality of life and medical assistance when a medical condition requires the use of long-term venous access. Currently, they are part of the standard medical care for oncohematologic patients. However, apart from mechanical and thrombotic complications, there are also complications associated with biofilm development inside the catheters. These biofilms increase the cost of medical assistance and extend hospitalization. The most frequently involved micro-organisms in these infections are gram-positive cocci. Many efforts have been made to understand biofilm formation within the lumen catheters, and to resolve catheter-related infection once it has been established. Apart from systemic antibiotic treatment, the use of local catheter treatment (ie, antibiotic lock technique) is widely employed. Many different antimicrobial options have been tested, with different outcomes, in clinical and in in vitro assays. The stability of antibiotic concentration in the lock solution once instilled inside the catheter lumen remains unresolved. To prevent infection, it is mandatory to perform hand hygiene before catheter insertion and manipulation, and to disinfect catheter hubs, connectors, and injection ports before accessing the catheter. At present, there are still unresolved questions regarding the best antimicrobial agent for catheter-related bloodstream infection treatment and the duration of concentration stability of the antibiotic solution within the lumen of the port
Revista:
JOURNAL OF APPLIED BIOMATERIALS & FUNCTIONAL MATERIALS
ISSN 2280-8000
Vol. 12
N° 2
Año 2014
Págs.81 - 83
A technique for the prevention of staphylococcal adhesion by electrical current exposure was investigated. Teflon coupons were exposed to a continuous flow of 10(3) cfu/ml Staphylococcus epidermidis with or without 2000 microA DC electrical current delivered by electrodes on opposite sides of a coupon, touching neither each other nor the coupon. A mean 3.46 (SD, 0.20) and 5.70 (SD, 1.03) log(10) cfu/cm(2) were adhered to the non-electrical current exposed coupons after 4 h and 24 h, respectively. A mean 2.46 (SD, 0.31) and 1.47 (SD, 0.73) log(10) cfu/cm(2) were adhered after 4 h and 24 h with exposure to 2000 microA electrical current delivered by graphite electrodes. A mean 2.21 (SD, 0.14) and 0.55 (SD, 0.00) log(10) cfu/cm(2) were adhered after 4 h and 24 h with exposure to 2000 microA electrical current delivered by stainless steel electrodes. Electrical current may be useful in the prevention of staphylococcal adhesion to biomaterials.
Revista:
BIOMEDICAL MICRODEVICES
ISSN 1387-2176
Vol. 16
N° 3
Año 2014
Págs.365 - 374
Central venous catheters (CVC) are commonly used in clinical practice to improve a patient's quality of life. Unfortunately, there is an intrinsic risk of acquiring an infection related to microbial biofilm formation inside the catheter lumen. It has been estimated that 80 % of all human bacterial infections are biofilm-associated. Additionally, 50 % of all nosocomial infections are associated with indwelling devices. Bloodstream infections account for 30-40 % of all cases of severe sepsis and septic shock, and are major causes of morbidity and mortality. Diagnosis of bloodstream infections must be performed promptly so that adequate antimicrobial therapy can be started and patient outcome improved. An ideal diagnostic technology would identify the infecting organism(s) in a timely manner, so that appropriate pathogen-driven therapy could begin promptly. Unfortunately, despite the essential information it provides, blood culture, the gold standard, largely fails in this purpose because time is lost waiting for bacterial or fungal growth. This work presents a new design of a venous access port that allows the monitoring of the inner reservoir surface by means of an impedimetric biosensor. An ad-hoc electronic system was designed to manage the sensor and to allow communication with the external receiver. Historic data recorded and stored in the device was used as the reference value for the detection of bacterial biofilm. The RF communication system sends an alarm signal to the external receiver when a microbial colonization of the port occurs. The successful in vitro analysis of the biosensor, the electronics and the antenna of the new indwelling device prototype are shown. The experimental conditions were selected in each case as the closest to the clinical working conditions for the smart central venous catheter (SCVC) testing. The results of this work allow a new generation of this kind of device that could potentially provide more efficient treatments for catheter-related infections.
Autores:
Oteo, J.; Calbo, E.; Rodríguez-Baño, J.; et al.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN 0213-005X
Vol. 32
N° 10
Año 2014
Págs.666 - 670
The emergence and spread of carbapenemase-producing Enterobacteriaceae (CPE), as the current paradigm of extensive drug-resistance and multi-drug resistance to antibiotics, is a serious threat to patient health and public health. The increase in OXA-48- and VIM-1-producing Klebsiella pneumoniae isolates represents the greatest impact of CPE in Spain. This evidence has lead the members of a representative panel of the Spanish Study Groups of Nosocomial Infections and Mechanisms of Action and Resistance. to Antimicrobials of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIH/GEMARA-SEIMC) to make a position statement expressing the need for: (i) definitive and coordinated action by all health professionals and authorities involved, and (ii) an adaptation of health systems to facilitate their early control and minimize their impact.
Revista:
JOURNAL OF TRAVEL MEDICINE
ISSN 1195-1982
Vol. 20
N° 5
Año 2013
Págs.326 - 328
We describe a Schistosoma haematobium infection with asymptomatic eosinophilia, persistently negative urine microscopy, and late seroconversion (7.5months) in a traveler returning from Mali. After initial negative parasitological tests, travel history led to diagnostic cystoscopy, allowing final diagnosis with urine microscopy after the bladder biopsy. The patient was successfully treated with praziquantel. Difficulties in making the diagnosis of schistosomiasis in asymptomatic returning travelers are discussed; we propose a trial treatment in these cases.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN 0213-005X
Vol. 31
N° 6
Año 2013
Págs.412 - 413
Revista:
SENSORS AND ACTUATORS B-CHEMICAL
ISSN 0925-4005
Vol. 178
Año 2013
Págs.663 - 670
Bacterial biofilms are a common cause of persistent and chronic infections, mostly related to implantable devices. In this context, Staphylococcus species are the most relevant microorganisms involved in causing high costs for the healthcare system. New diagnostic and/or therapeutic tools should be developed by providing in vivo analysis of the specific physiological parameters directly related to the status of the indwelling device. Monitoring the biofilm's biological evolution will allow an earlier diagnostic. Impedance microbiology is suggested as a proper technique for directly measuring the development of bacterial biofilms generated inside intravascular catheters. In this study we propose interdigitated microelectrode biosensors be integrated within those implantable devices. In vitro assays have been carried out in order to characterize this methodology as a detection and monitoring tool for bacterial biofilm development. Impedance spectroscopy (IS) was implemented in 96-well microtiter plates, leading to positive results in detecting and monitoring bacterial biofilm development. Two Staphylococcus aureus and two Staphylococcus epidermidis strains were successfully monitored during a 20-h culture, and results show that the low range of the frequency is the most suitable setting for measuring the maximum relative changes. (c) 2013 Elsevier B.V. All rights reserved.
Revista:
NEW ENGLAND JOURNAL OF MEDICINE
ISSN 0028-4793
Vol. 368
N° 21
Año 2013
Págs.2037
Revista:
ANNALS OF VASCULAR SURGERY
ISSN 0890-5096
Vol. 27
N° 7
Año 2013
Págs.974.e1 - 974.e6
In the last 20 years, endovascular procedures have radically altered the treatment of diseases of the aorta. The objective of endovascular treatment of dissections is to close the entry point to redirect blood flow toward the true lumen, thereby achieving thrombosis of the false lumen. In extensive chronic dissections that have evolved with the formation of a large aneurysm, the dissection is maintained from the end of the endoprosthesis due to multiple orifices, or reentries, that communicate with the lumens. In addition, one of the primary limitations of this technique is when the visceral arteries have disease involvement. In this report we present a case where, despite having treated the entire length of the descending thoracic aorta, the dissection was maintained distally, leading to progression of the diameter of the aneurysm. After reviewing the literature, and to the best of our knowledge, we describe the first case in which renal autotransplant was performed to allow for subsequent exclusion of the aorta at the thoracoabdominal level using a fenestrated endoprosthesis for the celiac trunk and the superior mesenteric artery.
Revista:
ANNALS OF VASCULAR SURGERY
ISSN 0890-5096
Vol. 27
N° 7
Año 2013
Págs.974.e1-6
In the last 20 years, endovascular procedures have radically altered the treatment of diseases of the aorta. The objective of endovascular treatment of dissections is to close the entry point to redirect blood flow toward the true lumen, thereby achieving thrombosis of the false lumen. In extensive chronic dissections that have evolved with the formation of a large aneurysm, the dissection is maintained from the end of the endoprosthesis due to multiple orifices, or reentries, that communicate with the lumens. In addition, one of the primary limitations of this technique is when the visceral arteries have disease involvement. In this report we present a case where, despite having treated the entire length of the descending thoracic aorta, the dissection was maintained distally, leading to progression of the diameter of the aneurysm. After reviewing the literature, and to the best of our knowledge, we describe the first case in which renal autotransplant was performed to allow for subsequent exclusion of the aorta at the thoracoabdominal level using a fenestrated endoprosthesis for the celiac trunk and the superior mesenteric artery.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN 0213-005X
Vol. 31
N° 10
Año 2013
Págs.641-2
Revista:
INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS
ISSN 0391-3988
Vol. 35
N° 10
Año 2012
Págs.780-91
Candida species have two distinct lifestyles: planktonic, and surface-attached communities called biofilms. Mature C. albicans biofilms show a complex three-dimensional architecture with extensive spatial heterogeneity, and consist of a dense network of yeast, hyphae, and pseudohyphae encased within a matrix of exopolymeric material. Several key processes are likely to play vital roles at the different stages of biofilm development, such as cell-substrate and cell-cell adherence, hyphal development, and quorum sensing. Biofilm formation is a survival strategy, since biofilm yeasts are more resistant to antifungals and environmental stress. Antifungal resistance is a multifactorial process that includes multidrug efflux pumps, target proteins of the ergosterol biosynthetic pathway. Most studies agree in presenting azoles as agents with poor activity against Candida spp. biofilms. However, recent studies have demonstrated that echinocandins and amphotericin B exhibit remarkable activity against C. albicans and Candida non-albicans biofilms. The association of Candida species with biofilm formation increases the therapeutic complexity of foreign body-related yeast infections. The traditional approach to the management of these infections has been to explant the affected device. There is a strong medical but also economical motivation for the development of novel anti-fungal biofilm strategies due to the constantly increasing resistance of Candida biofilms to conventional antifungals, and the high mortality caused by related infections. A better description of the extent and role of yeast in biofilms may be critical for developing novel therapeutic strategies in the clinical setting.
Revista:
NEW ENGLAND JOURNAL OF MEDICINE
ISSN 0028-4793
Vol. 367
N° 17
Año 2012
Págs.1670 - 1671
Revista:
INTERNATIONAL JOURNAL OF CLINICAL PRACTICE
ISSN 1368-5031
Vol. 66
N° 3
Año 2012
Págs.305 -308
DPT lock therapy demonstrated good in vivo efficacy in LT-CRBI caused by coagulase negative staphylococci and Enterococcus species.
Revista:
INFECTION
ISSN 0300-8126
Vol. 40
N° 4
Año 2012
Págs.445 - 449
Candida osteomyelitis is a well recognized but infrequent entity. We describe an interesting case of iliac bone C. albicans osteomyelitis as a result of a surgical trauma of an iliac bone for the auto-grafting of a fracture in the lumbar spine. The peri-operative acquisition of Candida was by the inoculation of a yeast colonizing the skin. Remarkably, several risk factors described for Candida infection and candidemia were absent. The patient also presented with a local fistula. The iliac crest was the only bone affected and local pain was the only symptom present in our case. Diagnosis was made by multiple-specimen biopsy obtained by surgery. Treatment with fluconazole was successful.
Revista:
INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
ISSN 1201-9712
Vol. 17
N° 2
Año 2012
Págs.e132-3
Listeriosis can be a cause of arthritis. Here, we present a case of Listeria monocytogenes septic arthritis of the right hip in a 66-year-old male treated with mycophenolate mofetil for polyarteritis nodosa. So far, septic arthritis due to this microorganism has not been reported in patients treated with mycophenolate mofetil. We review the literature of L. monocytogenes septic arthritis and discuss the role of mycophenolate mofetil treatment in precipitating listeriosis.
Revista:
BIOSENSORS AND BIOELECTRONICS
ISSN 0956-5663
Vol. 38
N° 1
Año 2012
Págs.226 - 232
Detection of device-associated infectious processes is still an important clinical challenge. Bacteria grow adhered to the device surfaces creating biofilms that are resistant to antimicrobial agents, increasing mortality and morbidity. Thus there is need of a surgical procedure to remove the indwelling infected device. The elevated cost of these procedures, besides patients discomfort and increased risks, highlights the need to develop more efficient, accurate and rapid detection methods. Biosensors integrated with implantable devices will provide an effective diagnostic tool. In vivo, rapid and sensitive detection of bacteria attached to the device surfaces will allow efficient treatments. Impedance spectroscopy technique would be an adequate tool to detect the adherence and the growth of the microorganism by monitoring the impedance characteristics. In this work a label-free interdigitated microelectrode (IDAM) biosensor has been developed to be integrated with implantable devices. Impedance characterization of Staphylococcus epidermidis biofilms has been performed achieving electrical monitoring of the bacterial growths in a few hours from the onset of the infection. This pathogen represents the most common microorganism related to intravascular catheters associated infections. The experimental setup presented in this work, a modified CDC biofilm reactor, simulates the natural environment conditions for bacterial biofilm development. The results prove that the low range of frequency is the most suitable setting for monitoring biofilm development. Our findings prove the effectiveness of this technique which shows variations of 59% in the equivalent serial capacitance component of the impedance. (C) 2012 Elsevier B.V. All rights reserved.
Autores:
Fernández-Sabe, N.; Cervera, C.; Fariñas, M.C.; et al.
Revista:
CLINICAL INFECTIOUS DISEASES
ISSN 1058-4838
Vol. 54
N° 3
Año 2012
Págs.355-361
Although uncommon, toxoplasmosis in SOT patients causes substantial morbidity and mortality. Seronegative recipients are at high risk for developing toxoplasmosis and should be given prophylaxis and receive careful follow-up.
Autores:
Chaccour , C.J.; Kaur, H.; Mabey, D.; et al.
Revista:
LANCET
ISSN 0140-6736
Vol. 380
N° 9847
Año 2012
Págs.1120
Revista:
INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS
ISSN 0391-3988
Vol. 34
N° 9
Año 2011
Págs.766 - 770
Effectiveness of amphotericin B alone or in combination with rifampicin or clarithromycin on the killing of Candida species biofilms was investigated in vitro. Amphotericin B was assayed at 0.005 to 10 mg/ml. Rifampin and clarithromycin were assayed at 10 mg/ml. We studied 7 Candida albicans, 3 Candida parapsilosis, 3 Candida glabrata, 3 Candida krusei and 2 Candida tropicalis strains. Biofilms were developed in 96-well, flat-bottomed microtiter plates for 48 hours. A synergistic effect between amphotericin B and clarithromycin was demonstrated against 66.6% of C. parapsilosis, 66.6% of C. glabrata, and 42.8% of C. albicans biofilms. A synergistic effect between amphotericin B and rifampin was demonstrated against 66.6% of C. parapsilosis, 42.8% of C. albicans, and 33.3% of C. glabrata biofilms. No synergistic effect was observed against C. krusei or C. tropicalis biofilms with any of the combinations. Rifampin or clarithromycin alone did not exert any effect on Candida species biofilms. Rifampin or clarithromycin combinations with amphotericin B might be of interest in the treatment of Candida biofilm-related infections.
Revista:
International Journal of Antimicrobial Agents
ISSN 0924-8579
Vol. 37
N° 6
Año 2011
Págs.585 - 587
Revista:
DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE
ISSN 0732-8893
Vol. 70
N° 4
Año 2011
Págs.522 - 524
Here, we report a case of multidrug-resistant tuberculosis (TB) presenting as a solitary splenic mass in a 60-year-old immunocompetent patient. Splenic TB is unusual and, when present, is usually associated with disseminated disease in immunocompromised patients. A high level of suspicion is required for diagnosis, and, as occurred in our case, it may be an unexpected finding following surgery. Diagnosis was made by polymerase chain reaction, which showed the presence of Mycobacterium tuberculosis DNA. Interestingly, rifampicin- and isoniazid-resistant genes were detected in our analysis. Splenic TB diagnosis and treatment are reviewed.
Revista:
Revista española de cirugía ortopédica y traumatología (Ed. impresa)
ISSN 1888-4415
Vol. 55 Esp. Congreso
N° CC-921
Año 2011
Págs.431 - 432
Revista:
EXPERT REVIEW OF ANTI-INFECTIVE THERAPY
ISSN 1478-7210
Vol. 9
N° 9
Año 2011
Págs.787 - 802
Prosthetic joint implantations improve patients' quality of life but are associated with complications, including aseptic failure and prosthetic joint infection (PJI). Biofilms are the essential factor in the persistence of infection. Early postoperative and acute hematogenous infections are usually easily diagnosed; however, late chronic infections are challenging to predict. Joint aspiration with differential cell counts appears to be a very useful test. New microbiological techniques (i.e., implant sonication and molecular studies) are promising tools. Main objectives of treatment are to alleviate pain, to restore the function and to eradicate the infection. In deciding the best approach for an individual patient, several factors should be considered: the type of the infection, presence of loosening, functional prognosis, etiology and the patient's preferences. Antimicrobial therapy should be coherent with the chosen surgical strategy. Level of evidence in the field of PJI is low, and recommendations are based on short literature series, experimental data and expert experience.
Revista:
INFECTION AND DRUG RESISTANCE
ISSN 1178-6973
Vol. 3
Año 2010
Págs.5-14
Antimicrobial resistance is a global concern. Over the past few years, considerable efforts and resources have been expended to detect, monitor, and understand at the basic level the many different facets of emerging and increasing resistance. Development of new antimicrobial agents has been matched by the development of new mechanisms of resistance by bacteria. Current antibiotics act at a variety of sites within the target bacteria, including the cross-linking enzymes in the cell wall, various ribosomal enzymes, nucleic acid polymerases, and folate synthesis. Ceftobiprole is a novel parenteral cephalosporin with high affinity for most penicillin-binding proteins, including the mecA product penicillin-binding protein 2a, rendering it active against methicillin-resistant staphylococci. Its in vitro activity against staphylococci and multiresistant pneumococci, combined with its Gram-negative spectrum comparable to that of other extended-spectrum cephalosporins, its stability against a wide range of beta-lactamases, and its pharmacokinetic and safety profiles make ceftobiprole an attractive and well tolerated new antimicrobial agent. The US Food and Drug Administration granted ceftobiprole medocaril fast-track status in 2003 for the treatment of complicated skin infections and skin structure infections due to methicillin-resistant staphylococci, and subsequently extended this to treatment of hospital-acquired pneumonia, including ventilator-associated pneumonia due to suspected or proven methicillin-resistant Staphylococcus aureus.
Revista:
CLINICAL INFECTIOUS DISEASES
ISSN 1058-4838
Vol. 50
N° 1
Año 2010
Págs.121 - 122
Revista:
PANCREATOLOGY
ISSN 1424-3903
Vol. 10
N° 2-3
Año 2010
Págs.114 - 118
