Revistas
Revista:
TRANSPLANT INFECTIOUS DISEASE
ISSN:
1398-2273
Año:
2024
Vol.:
26
N°:
1
Págs.:
e14174
Revista:
AESTHETIC PLASTIC SURGERY
ISSN:
0364-216X
Año:
2023
Vol.:
47
N°:
5
Págs.:
2093 - 2105
Background Breast implant capsule development and behavior are mainly determined by implant surface combined with other external factors such as intraoperative contamination, radiation or concomitant pharmacologic treatment. Thus, there are several diseases: capsular contracture, breast implant illness or Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), that have been correlated with the specific type of implant placed. This is the first study to compare all major implant and texture models available in the market on the development and behave of the capsules. Through a histopathological analysis, we compared the behavior of different implant surfaces and how different cellular and histological properties give rise to different susceptibilities to develop capsular contracture among these devices.Methods A total of 48 Wistar female rats were used to implant 6 different types of breast implants. Mentor (R), McGhan (R), Polytech polyurethane (R), Xtralane (R), Motiva (R) and Natrelle Smooth (R) implants were employed; 20 rats received Motiva (R), Xtralane (R) and Polytech polyurethane (R), and 28 rats received Mentor (R), McGhan (R) and Natrelle Smooth (R) implants. The capsules were removed five weeks after the implants placement. Further histological analysis compared capsule composition, collagen density and cellularity.Results High texturization implants showed the highest levels of collagen and cellularity along the capsule. However, polyurethane implants capsules behaved differently regarding capsule composition, with the thickest capsules but fewer collagen and myofibroblasts than expected, despite being generally considered as a macrotexturized implant. Nanotextured implants and microtextured implants histological findings showed similar characteristics and less susceptibility to develop a capsular contracture compared with smooth implants.Conclusions This study shows the relevance of the breast implant surface on the definitive capsules' development, since this is one of the most differentiated factors that determine the incidence of capsular contracture and probably other diseases like BIA-ALCL. A correlation of these findings with clinical cases will help to unify implant classification criteria based on their shell and their estimated incidence of capsule-associated pathologies. Up to this point, the establishment of additional groups is recommended as nanotexturized implants seem to behave differently to pure smooth surfaces and polyurethane implants present diverse features from macro- or microtextured implants.No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGÍA CLÍNICA
ISSN:
2529-993X
Año:
2023
Vol.:
41
N°:
7
Págs.:
438 - 440
Revista:
GASTROENTEROLOGIA Y HEPATOLOGIA
ISSN:
0210-5705
Año:
2023
Vol.:
46
N°:
6
Págs.:
489 - 490
Revista:
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
ISSN:
0066-4804
Año:
2023
Vol.:
67
N°:
1
Págs.:
e0126422
Tunneled central venous catheter (TCVC) related infection remains a challenge in the care of hemodialysis patients. We aimed to determine the best antimicrobial lock therapy (ALT) to eradicate coagulase-negative staphylococci (CoNS) biofilms. Tunneled central venous catheter (TCVC) related infection remains a challenge in the care of hemodialysis patients. We aimed to determine the best antimicrobial lock therapy (ALT) to eradicate coagulase-negative staphylococci (CoNS) biofilms. We studied the colonization status of the catheter every 30 days by quantitative blood cultures (QBC) drawn through all catheter lumens. Those patients with a significant culture (i.e.,100 to 1,000 CFU/mL) of a CoNS were classified as patients with a high risk of developing catheter-related bloodstream infections (CRBSI). They were assigned to receive daptomycin, vancomycin, teicoplanin lock solution, or the standard of care (SoC) (i.e., heparin lock). The primary endpoint was to compare eradication ability (i.e., negative QBC for 30 days after ending ALT) rates between different locks and the SoC. A second objective was to analyze the correlation between ALT exposure and isolation of CoNS with antimicrobial resistance. Daptomycin lock was associated with a significant higher eradication success than with the SoC: 85% versus 30% (relative risk [RR] = 14, 95% confidence interval [CI] = 2.4 - 82.7); followed by teicoplanin locks with a 83.3% success (RR = 11.7; 95% CI = 2 - 70.2). We observed CoNs isolates with a higher teicoplanin MIC in patients with repeated teicoplanin locks exposure (coefficient = 0.3; 95% CI = 0.11 - 0.47). However, teicoplanin MICs decreased in patients treated with vancomycin locks (coefficient = -0.56; 95% CI = -0.85 - -0.02). Methicillin-resistance decreased with accumulative ALT (RR = 0.82; 95% CI = 0.69 - 0.98). In this study, daptomycin locks achieve the highest eradication rate of CoNS from hemodialysis catheters in vivo.
Revista:
FRONTIERS IN MICROBIOLOGY
ISSN:
1664-302X
Año:
2023
Vol.:
14
Págs.:
1094929
IntroductionSuspected infectious diseases located in difficult-to-access sites can be challenging due to the need for invasive procedures to isolate the etiological agent. Positron emission tomography (PET) is a non-invasive imaging technology that can help locate the infection site. The most widely used radiotracer for PET imaging (2-deoxy-2[F-18] fluoro-D-glucose: [F-18]FDG) shows uptake in both infected and sterile inflammation. Therefore, there is a need to develop new radiotracers able to specifically detect microorganisms. MethodsWe tested two specific radiotracers: 2-deoxy-2-[F-18]-fluoro-D-sorbitol ([F-18]FDS) and 2-[F-18]F-rho-aminobenzoic acid ([F-18]FPABA), and also developed a simplified alternative of the latter for automated synthesis. Clinical and reference isolates of bacterial and yeast species (19 different strains in all) were tested in vitro and in an experimental mouse model of myositis infection. Results and discussionNon-lactose fermenters (Pseudomonas aeruginosa and Stenotrophomonas maltophilia) were unable to take up [F-18]FDG in vitro. [F-18]FDS PET was able to visualize Enterobacterales myositis infection (i.e., Escherichia coli) and to differentiate between yeasts with differential assimilation of sorbitol (i.e., Candida albicans vs. Candida glabrata). All bacteria and yeasts tested were detected in vitro by [F-18]FPABA. Furthermore, [F-18]FPABA was able to distinguish between inflammation and infection in the myositis mouse model (E. coli and Staphylococcus aureus) and could be used as a probe for a wide variety of bacterial and fungal species.
Autores:
Paño-Pardo, J. R. (Autor de correspondencia); Moreno Rodilla, E.; Cobo Sacristan, S.; et al.
Revista:
JOURNAL OF INVESTIGATIONAL ALLERGOLOGY AND CLINICAL IMMUNOLOGY
ISSN:
1018-9068
Año:
2023
Vol.:
33
N°:
2
Págs.:
95 - 101
Suspected or confirmed antibiotic allergy is a frequent clinical circumstance that influences antimicrobial prescription and often leads to the avoidable use of less efficacious and/or more toxic or costly drugs than first-line antimicrobials. Optimizing antimicrobial therapy in patients with antibiotic allergy labels has become one of the priorities of antimicrobial stewardship programs in several countries. These guidelines aim to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. An expert panel (11 members of various scientific societies) formulated questions about the management of patients with suspected or confirmed antibiotic allergy. A systematic literature review was performed by a medical librarian. The questions were distributed among panel members who selected the most relevant references, summarized the evidence, and formulated graded recommendations when possible. The answers to all the questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy was recommended to improve antibiotic selection and, consequently, clinical outcomes. A clinically oriented, 3-category risk-stratification strategy was recommended for patients with suspected antibiotic allergy. Complementary assessments should consider both clinical risk category and preferred antibiotic agent. Empirical therapy recommendations for the most relevant clinical syndromes in patients with suspected or confirmed ss-lactam allergy were formulated, as were recommendations on the implementation and monitoring of the impact of the guidelines. Antimicrobial stewardship programs and allergists should design and implement activities that facilitate the most appropriate use of antibiotics in these patients.
Autores:
Sanchez-Olivieri, I.; Rudd, M.; Gabaldon-Figueira, J. C.; et al.
Revista:
BMJ OPEN RESPIRATORY RESEARCH
ISSN:
2052-4439
Año:
2023
Vol.:
10
N°:
1
Págs.:
e001942
IntroductionDespite its high prevalence and significance, there is still no widely available method to quantify cough. In order to demonstrate agreement with the current gold standard of human annotation, emerging automated techniques require a robust, reproducible approach to annotation. We describe the extent to which a human annotator of cough sounds (a) agrees with herself (intralabeller or intrarater agreement) and (b) agrees with other independent labellers (interlabeller or inter-rater agreement); we go on to describe significant sex differences in cough sound length and epochs size.Materials and methods24 participants wore an audiorecording smartwatch to capture 6-24 hours of continuous audio. A randomly selected sample of the whole audio was labelled twice by an expert annotator and a third time by six trained annotators. We collected 400 hours of audio and analysed 40 hours. The cough counts as well as cough seconds (any 1 s of time containing at least one cough) from different annotators were compared and summary statistics from linear and Bland-Altman analyses were used to quantify intraobserver and interobserver agreement.ResultsThere was excellent intralabeller (less than two disagreements per hour monitored, Pearson's correlation 0.98) and interlabeller agreement (Pearson's correlation 0.96), using cough seconds as the unit of analysis decreased annotator discrepancies by 50% in comparison to coughs. Within this data set, it was observed that the length of cough sounds and epoch size (number of coughs per bout or attach) differed between women and men.ConclusionGiven the decreased interobserver variability in annotation when using cough seconds (vs just coughs) we propose their use for manually annotating cough when assessing of the performance of automatic cough monitoring systems. The differences in cough sound length and epochs size may have important implications for equality in the development of cough monitoring tools.Trial registration numberNCT05042063.
Revista:
FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY
ISSN:
2235-2988
Año:
2023
Vol.:
13
Págs.:
1110467
Background: The main objective was to evaluate the efficacy of intranasal photodynamic therapy (PDT) in SARS-CoV-2 mildly symptomatic carriers on decreasing the infectivity period. SARS-CoV-2-specific immune-stimulating effects and safety were also analysed.
Methods: We performed a randomized, placebo-controlled, clinical trial in a tertiary hospital (NCT05184205). Patients with a positive SARS-CoV-2 PCR in the last 48 hours were recruited and aleatorily assigned to PDT or placebo. Patients with pneumonia were excluded. Participants and investigators were masked to group assignment. The primary outcome was the reduction in in vitro infectivity of nasopharyngeal samples at days 3 and 7. Additional outcomes included safety assessment and quantification of humoral and T-cell immune-responses.
Findings: Patients were recruited between December 2021 and February 2022. Most were previously healthy adults vaccinated against COVID-19 and most carried Omicron variant. 38 patients were assigned to placebo and 37 to PDT. Intranasal PDT reduced infectivity at day 3 post-treatment when compared to placebo with a ß-coefficient of -812.2 (CI95%= -478660 ¿ -1.3, p<0.05) infectivity arbitrary units. The probability of becoming PCR negative (ct>34) at day 7 was higher on the PDT-group, with an OR of 0.15 (CI95%=0.04-0.58). There was a decay in anti-Spike titre and specific SARS-CoV-2 T cell immunity in the placebo group 10 and 20 weeks after infection, but not in the PDT-group. No serious adverse events were reported.
Interpretation: Intranasal-PDT is safe in pauci-symptomatic COVID-19 patients, it reduces SARS-CoV-2 infectivity and decelerates the decline SARS-CoV-2 specific immune-responses.
Revista:
EUROPEAN RADIOLOGY
ISSN:
0938-7994
Año:
2023
Vol.:
33
N°:
10
Págs.:
7178 - 7185
Purpose: To study the association between ultrasound cortical thickness in reactive post-vaccination lymph nodes and the elicited humoral response and to evaluate the performance of cortical thickness as a predictor of vaccine effectiveness in patients with and without a previous history of COVID-19 infection.
Methods: A total of 156 healthy volunteers were recruited and followed prospectively after receiving two COVID-19 vaccination doses using different protocols. Within a week after receiving the second dose, an axillary ultrasound of the ipsilateral vaccinated arm was performed, and serial post-vaccination serologic tests (PVST) were collected. Maximum cortical thickness was chosen as a nodal feature to analyze association with humoral immunity. Total antibodies quantified during consecutive PVST in previously-infected patients and in coronavirus-naïve volunteers were compared (Mann-Whitney U test). The association between hyperplastic-reactive lymph nodes and effective humoral response was studied (odds ratio). The performance of cortical thickness in detecting vaccination effectiveness was evaluated (area under the ROC curve).
Results: Significantly higher values for total antibodies were observed in volunteers with a previous history of COVID-19 infection (p < 0.001). The odds ratio associating immunized coronavirus-naïve volunteers after 90 and 180 days of the second dose with a cortical thickness ¿ 3 mm was statistically significant (95% CI 1.52-6.97 and 95% CI 1.47-7.29, respectively). The best AUC result was obtained comparing antibody secretion of coronavirus-naïve volunteers at 180 days (0.738).
Conclusions: Ultrasound cortical thickness of reactive lymph nodes in coronavirus-naïve patients may reflect antibody production and a long-term effective humoral response elicited by vaccination.
Clinical relevance statement: In coronavirus-naïve patients, ultrasound cortical thickness of post-vaccination reactive lymphadenopathy shows a positive association with protective antibody titers against SARS-CoV-2, especially in the long term, providing new insights into previous publications.
Key points: ¿ Hyperplastic lymphadenopathy was frequently observed after COVID-19 vaccination. ¿ Ultrasound cortical thickness of reactive post-vaccine lymph nodes may reflect a long-term effective humoral response in coronavirus-naïve patients.
Revista:
REVISTA ESPAÑOLA DE QUIMIOTERAPIA
ISSN:
0214-3429
Año:
2023
Vol.:
36
Págs.:
54 - 58
Pseudomonas aeruginosa is a pathogen that has a high propensity to develop antibiotic resistance, and the emergence of multidrug-resistant strains is a major concern for global health. The mortality rate associated with infections caused by this microorganism is significant, especially those caused by multidrug-resistant strains. The antibiotics used to treat these infections include quinolones, aminoglycosides, colistin, and beta-lactams. However, novel combinations of beta-lactams-beta-lactamase inhibitors and cefiderocol offer advantages over other members of their family due to their better activity against certain resistance mechanisms. Selecting the appropriate empiric antibiotic treatment requires consideration of the patient's clinical entity, comorbidities, and risk factors for multidrug-resistant pathogen infections, and local epidemiological data. Optimizing antibiotic pharmacokinetics, controlling the source of infection, and appropriate collection of samples are crucial for successful treatment. In the future, the development of alternative treatments and strategies, such as antimicrobial peptides, new antibiotics, phage therapy, vaccines, and colonization control, holds great promise for the management of P. aeruginosa infections.
Revista:
MEDICINA CLINICA
ISSN:
0025-7753
Año:
2023
Vol.:
160
N°:
9
Págs.:
416 - 417
Revista:
MEDICINA CLINICA
ISSN:
0025-7753
Año:
2023
Vol.:
160
N°:
12
Págs.:
564 - 565
Autores:
Becerra-Aparicio, F.; Gomez-Zorrilla, S.; Hernandez-Garcia, M.; et al.
Revista:
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
ISSN:
0305-7453
Año:
2023
Vol.:
78
N°:
9
Págs.:
2291 - 2296
Objectives To assess the microbiological characteristics of Escherichia coli causing healthcare-associated bacteraemia of urinary origin (HCA-BUO) in Spain (ITUBRAS-2 project), with particular focus on ESBL producers and isolates belonging to ST131 high-risk clone (HiRC). Clinical characteristics and outcomes associated with ST131 infection were investigated. Methods A total of 222 E. coli blood isolates were prospectively collected from patients with HCA-BUO from 12 tertiary-care hospitals in Spain (2017-19). Antimicrobial susceptibility and ESBL/carbapenemase production were determined. ST131 subtyping was performed. A subset of 115 isolates were selected for WGS to determine population structure, resistome and virulome. Clinical charts were reviewed. Results ESBL-producing E. coli prevalence was 30.6% (68/222). ST131 represented 29.7% (66/222) of E. coli isolates and accounted for the majority of ESBL producers (46/68, 67.6%). The C2/H30-Rx subclone accounted for most ST131 isolates (44/66) and was associated with CTX-M-15 (37/44) and OXA-1 enzymes (27/44). Cluster C1-M27 was identified in 4/10 isolates belonging to subclade C1/H30-R1 and associated with CTX-M-27. Additionally, ST131 isolates showed a high content of other acquired resistance genes, and clade C/ST131 isolates carried characteristic QRDR mutations. They were categorized as uropathogenic E. coli and had higher aggregate virulence scores. ST131 infection was associated with more complex patients, prior use of cephalosporins and inadequate empirical treatment but was not associated with worse clinical outcomes. Conclusions ST131 HiRC is the main driver of ESBL-producing E. coli causing HCA-BUO in Spain, mainly associated with the expansion of subclade CTX-M-15-C2/H30-Rx and the emergence of CTX-M-27-C1/H30-R1 (Cluster C1-M27).
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGÍA CLÍNICA
ISSN:
2529-993X
Año:
2023
Vol.:
41
N°:
6
Págs.:
373 - 374
Revista:
MICROORGANISMS
ISSN:
2076-2607
Año:
2022
Vol.:
10
N°:
10
Págs.:
2004
Capsular contracture is the most frequently associated complication following breast implant placement. Biofilm formation on the surface of such implants could significantly influence the pathogenesis of this complication. The objective of this study was to design an experimental model of breast implant infection that allowed us to compare the in vivo S. epidermidis ability to form and perpetuate biofilms on commonly used types of breast implants (i.e., macrotexturized, microtexturized, and smooth). A biofilm forming S. epidermidis strain (ATCC 35984) was used for all experiments. Three different implant surface types were tested: McGhan BIOCELL (R) (i.e., macrotexturized); Mentor Siltex (R) (i.e., microtexturized); and Allergan Natrelle Smooth (R) (i.e., smooth). Two different infection scenarios were simulated. The ability to form biofilm on capsules and implants over time was evaluated by quantitative post-sonication culture of implants and capsules biopsies. This experimental model allows the generation of a subclinical staphylococcal infection associated with a breast implant placed in the subcutaneous tissue of Wistar rats. The probability of generating an infection was different according to the type of implant studied and to the time from implantation to implant removal. Infection was achieved in 88.9% of macrotextured implants (i.e., McGhan), 37.0% of microtexturized implants (i.e., Mentor), and 18.5% of smooth implants (i.e., Allergan Smooth) in the short-term (p < 0.001). Infection was achieved in 47.2% of macrotextured implants, 2.8% of microtexturized implants, and 2.8% of smooth implants (i.e., Allergan Smooth) in the longterm (p < 0.001). There was a clear positive correlation between biofilm formation on any type of implant and capsule colonization/infection. Uniformly, the capsules formed around the macro- or microtexturized implants were consistently macroscopically thicker than those formed around the smooth implants regardless of the time at which they were removed (i.e., 1-2 weeks or 3-5 weeks). We have shown that there is a difference in the ability of S epidermidis to develop in vivo biofilms on macrotextured, microtextured, and smooth implants. Smooth implants clearly thwart bacterial adherence and, consequently, biofilm formation and persistence are hindered.
Revista:
ADVANCES IN LABORATORY MEDICINE / AVANCES EN MEDICINA DE LABORATORIO
ISSN:
2628-491X
Año:
2022
Vol.:
3
N°:
2
Págs.:
97 - 99
Autores:
Albasanz-Puig, A.; Dura-Miralles, X.; Laporte-Amargos, J.; et al.
Revista:
MICROORGANISMS
ISSN:
2076-2607
Año:
2022
Vol.:
10
N°:
4
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:
EUROPEAN JOURNAL OF INTERNAL MEDICINE
ISSN:
0953-6205
Año:
2022
Vol.:
104
Págs.:
103 - 104
Revista:
SCIENTIFIC REPORTS
ISSN:
2045-2322
Año:
2022
Vol.:
12
N°:
1
Págs.:
15606
Scarce data have been reported about cellular immunity and longevity for different COVID-19 vaccination schedules. We carried out a prospective study enrolling 709 healthcare workers receiving two doses of mRNA-1273, BNT162b2, ChAdOx1, ChAdOx1/BNT162b2 or ChAdOx1 single dose to compare humoral and cellular immunogenicity across 9 months. Higher SARS-CoV-2 spike antibody levels were observed among individuals with hybrid immunity with one dose of any vaccine in comparison to uninfected individuals receiving two doses (mRNA-1273: 20,145 vs 4295 U/mL; BNT162b2: 15,659 vs 1959 U/mL; ChAdOx1: 5344 vs 2230 U/mL), except for ChAdOx1/BNT162b2 heterologous schedule (12,380 U/mL). Naturally infected individuals did not increase substantially the titers after the second dose and showed higher levels throughout the 9 months follow-up. The mean elimination half-life of antibodies among COVID-19 naive participants was 98, 111, 60 and 36 days, for mRNA-1273, BNT162b2, ChAdOx1/ChAdOx1 and ChAdOx1/BNT162b2, respectively. Cellular immunity was preserved in 96%, 98%, 88% and 92% of uninfected individuals who received mRNA-1273, BNT162b2, ChAdOx1/ChAdOx1 and ChAdOx1/BNT162b2 after 6/9 months. Individuals with specific T cells showed robust long lasting protection, especially when m-RNA based vaccines are inoculated. These data may influence the validity of the vaccination passport and the need for booster vaccinations.
Revista:
ANTIBIOTICS
ISSN:
2079-6382
Año:
2022
Vol.:
11
N°:
3
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:
CHEST
ISSN:
0012-3692
Año:
2022
Vol.:
162
N°:
5
Págs.:
1006 - 1016
BACKGROUND: Excessive inflammation is pathogenic in the pneumonitis associated with severe COVID-19. Neutrophils are among the most abundantly present leukocytes in the inflammatory infiltrates and may form neutrophil extracellular traps (NETs) under the local influence of cytokines. NETs constitute a defense mechanism against bacteria, but have also been shown to mediate tissue damage in a number of diseases. RESEARCH QUESTION: Could NETs and their tissue-damaging properties inherent to neutrophil- associated functions play a role in the respiratory failure seen in patients with severe COVID-19, and how does this relate to the SARS-CoV-2 viral loads, IL-8 (CXCL8) chemokine expression, and cytotoxic T-lymphocyte infiltrates? STUDY DESIGN AND METHODS: Sixteen lung biopsy samples obtained immediately after death were analyzed methodically as exploratory and validation cohorts. NETs were analyzed quantitatively by multiplexed immunofluorescence and were correlated with local levels of IL-8 messenger RNA (mRNA) and the density of CD8+ T-cell infiltration. SARS-CoV-2 presence in tissue was quantified by reverse-transcriptase polymerase chain reaction and immunohistochemistry analysis. RESULTS: NETs were found in the lung interstitium and surrounding the bronchiolar epithelium with interindividual and spatial heterogeneity. NET density did not correlate with SARS-CoV-2 tissue viral load. NETs were associated with local IL-8 mRNA levels. NETs were also detected in pulmonary thrombi and in only one of eight liver tissues. NET focal presence correlated negatively with CD8+ T-cell infiltration in the lungs. INTERPRETATION: Abundant neutrophils undergoing NETosis are found in the lungs of patients with fatal COVID-19, but no correlation was found with viral loads. The strong association between NETs and IL-8 points to this chemokine as a potentially causative factor. The function of cytotoxic T-lymphocytes in the immune responses against SARS-CoV-2 may be interfered with by the presence of NETs.
Revista:
ANTIBIOTICS
ISSN:
2079-6382
Año:
2022
Vol.:
11
N°:
12
Págs.:
1692
This study aimed to prove that pre-emptive antimicrobial locks in patients at risk of bacteremia decrease infection. We performed a non-randomized prospective pilot study of hemodialysis patients with tunneled central venous catheters. We drew quantitative blood cultures monthly to detect colonization. Patients with a critical catheter colonization by coagulase-negative staphylococci (defined as counts of 100-999 CFU/mL) were at high risk of developing a catheter-related bloodstream infection. We recommended antimicrobial lock for this set of patients. The nephrologist in charge of the patient decided whether to follow the recommendation or not (i.e., standard of care). We compared bloodstream infection rates between patients treated with antimicrobial lock therapy versus patients treated with the standard of care (i.e., heparin). We enrolled 149 patients and diagnosed 86 episodes of critical catheter colonization by coagulase-negative staphylococci. Patients treated with antimicrobial lock had a relative risk of bloodstream infection of 0.19 when compared with heparin lock (CI 95%, 0.11-0.33, p < 0.001) within three months of treatment. We avoided one catheter-related bloodstream infection for every ten catheter-critical colonizations treated with antimicrobial lock [number needed to treat 10, 95% CI, 5.26-100, p = 0.046]. In conclusion, pre-emptive antimicrobial locks decrease bloodstream infection rates in hemodialysis patients with critical catheter colonization.
Autores:
Royo-Cebrecos, C.; Laporte-Amargos, J.; Pena, M.; et al.
Revista:
PATHOGENS
ISSN:
2076-0817
Año:
2022
Vol.:
11
N°:
10
Págs.:
1132
Objectives: To assess the clinical features and outcomes of Pseudomonas aeruginosa bloodstream infection (PA BSI) in neutropenic patients with hematological malignancies (HM) and with solid tumors (ST), and identify the risk factors for 30-day mortality. Methods: We performed a large multicenter, retrospective cohort study including onco-hematological neutropenic patients with PA BSI conducted across 34 centers in 12 countries (January 2006-May 2018). Episodes occurring in hematologic patients were compared to those developing in patients with ST. Risk factors associated with 30-day mortality were investigated in both groups. Results: Of 1217 episodes of PA BSI, 917 occurred in patients with HM and 300 in patients with ST. Hematological patients had more commonly profound neutropenia (0.1 x 10(9) cells/mm) (67% vs. 44.6%; p < 0.001), and a high risk Multinational Association for Supportive Care in Cancer (MASCC) index score (32.2% vs. 26.7%; p = 0.05). Catheter-infection (10.7% vs. 4.7%; p = 0.001), mucositis (2.4% vs. 0.7%; p = 0.042), and perianal infection (3.6% vs. 0.3%; p = 0.001) predominated as BSI sources in the hematological patients, whereas pneumonia (22.9% vs. 33.7%; p < 0.001) and other abdominal sites (2.8% vs. 6.3%; p = 0.006) were more common in patients with ST. Hematological patients had more frequent BSI due to multidrug-resistant P. aeruginosa (MDRPA) (23.2% vs. 7.7%; p < 0.001), and were more likely to receive inadequate initial antibiotic therapy (IEAT) (20.1% vs. 12%; p < 0.001). Patients with ST presented more frequently with septic shock (45.8% vs. 30%; p < 0.001), and presented worse outcomes, with increased 7-day (38% vs. 24.2%; p < 0.001) and 30-day (49% vs. 37.3%; p < 0.001) case-fatality rates. Risk factors for 30-day mortality in hematologic patients were high risk MASCC index score, IEAT, pneumonia, infection due to MDRPA, and septic shock. Risk factors for 30-day mortality in patients with ST were high risk MASCC index score, IEAT, persistent BSI, and septic shock. Therapy with granulocyte colony-stimulating factor was associated with survival in both groups. Conclusions: The clinical features and outcomes of PA BSI in neutropenic cancer patients showed some differences depending on the underlying malignancy. Considering these differences and the risk factors for mortality may be useful to optimize their therapeutic management. Among the risk factors associated with overall mortality, IEAT and the administration of granulocyte colony-stimulating factor were the only modifiable variables.
Autores:
Bergas, A.; Albasanz-Puig, A.; Fernández-Cruz, A.; et al.
Revista:
MICROBIOLOGY SPECTRUM
ISSN:
2165-0497
Año:
2022
Vol.:
10
N°:
3
Págs.:
e0229221
We sought to assess the characteristics and outcomes of neutropenic hematologic patients with Pseudomonas aeruginosa (PA) bloodstream infection (BSI) treated with ceftolozane-tazobactam (C/T). We conducted a multicenter, international, matched-cohort study of PA BSI episodes in neutropenic hematologic patients who received C/T. Controls were patients with PA BSI treated with other antibiotics. Risk factors for overall 7-day and 30-day case fatality rates were analyzed. We compared 44 cases with 88 controls. Overall, 91% of episodes were caused by multidrug-resistant (MDR) strains. An endogenous source was the most frequent BSI origin (35.6%), followed by pneumonia (25.8%). There were no significant differences in patient characteristics between groups. C/T was given empirically in 11 patients and as definitive therapy in 41 patients. Treatment with C/T was associated with less need for mechanical ventilation (13.6% versus 33.3%; P = 0.021) and reduced 7-day (6.8% versus 34.1%; P = 0.001) and 30-day (22.7% versus 48.9%; P = 0.005) mortality. In the multivariate analysis, pneumonia, profound neutropenia, and persistent BSI were independent risk factors for 30-day mortality, whereas lower mortality was found among patients treated with C/T (adjusted OR [aOR] of 0.19; confidence interval [CI] 95% of 0.07 to 0.55; P = 0.002). Therapy with C/T was associated with less need for mechanical ventilation and reduced 7-day and 30-day case fatality rates compared to alternative agents in neutropenic hematologic patients with PA BSI. IMPORTANCE Ceftolozane-tazobactam (C/T) has been shown to be a safe and effective alternative for the treatment of difficult to treat infections due to Pseudomonas aeruginosa (PA) in the general nonimmunocompromised population. However, the experience of this agent in immunosuppressed neutropenic patients is very limited. Our study is unique because it is focused on extremely immunosuppressed hematological patients with neutropenia and bloodstream infection (BSI) due to PA (mainly multidrug resistant [MDR]), a scenario which is often associated with very high mortality rates. In our study, we found that the use of C/T for the treatment of MDR PA BSI in hematological neutropenic patients was significantly associated with improved outcomes, and, in addition, it was found to be an independent risk factor associated with increased survival. To date, this is the largest series involving neutropenic hematologic patients with PA BSI treated with C/T. Ceftolozane-tazobactam (C/T) has been shown to be a safe and effective alternative for the treatment of difficult to treat infections due to Pseudomonas aeruginosa (PA) in the general nonimmunocompromised population. However, the experience of this agent in immunosuppressed neutropenic patients is very limited.
Revista:
REVISTA ESPAÑOLA DE QUIMIOTERAPIA
ISSN:
0214-3429
Año:
2022
Vol.:
35
N°:
Suppl. 1
Págs.:
64 - 66
In the last two years, the capacity of our hospitals has clearly been overwhelmed due to the COVID-19 pandemic The patient who comes to the hospital with a respiratory coinfection does not have the same characteristics as the patient who suffers a superinfection while hospitalized. The number of secondary infections increase proportionally to the severity of the patient¿s disease. Besides, pathogens that cause a coinfection are clearly differentiated from the pathogens that cause a superinfection. However, in patients subjected to airway manipulation, superinfections by distinct pathogens can occur. Seventy five percent of patients admitted worldwide with COVID-19 (especially during the first two waves of the pandemic) received some form of antibiotic treatment during admission. In this context, it is essential to develop and implement algorithms that allow us to define the predictors in each individual case for the development of a superinfection
Autores:
Bernaus, M.; Aunon-Rubio, A.; Monfort-Mira, M.; et al.
Revista:
SURGICAL INFECTIONS
ISSN:
1096-2964
Año:
2022
Vol.:
23
N°:
3
Págs.:
280 - 287
Background: Debridement, antibiotic agents, and implant retention (DAIR) is a currently accepted approach for the treatment of early prosthetic joint infections (PJI). The success of a DAIR procedure has shown variable results throughout the published literature. Scoring systems such as the Kidney, Liver, Index surgery, Cemented prosthesis, and C-reactive protein value (KLIC) score for the selection of patients that are likely to benefit from DAIR have proved to be helpful in decision making. Our study aims to further validate the KLIC score using a large external multicentric cohort and to evaluate other risk factors for failure.Patients and Methods: A retrospective analysis of patients with an early acute PJI who were treated with DAIR and recorded in a database of eight Spanish university hospitals was performed. According to pre-operative variables of the KLIC study, patients were categorized into five groups: group A, <= 2 points; group B, 2.5-3.5 points; group C, 4-5 points; group D, 5.5-6.5 points; and group E, >= 7 points. Failure rates were compared between groups at 60 days and after 60 days of DAIR. Further variables for risk of failure were also analyzed.Results: A total of 455 patients with early acute PJI were included in the analyses. At 60 days, patients presenting with pre-operative elevated C-reactive protein serum levels, Staphylococcus aureus, and polymicrobial infections were associated with failure. Failure rates recorded were 12% for group A (n = 210), 18% for group B (n = 83), 26% for group C (n = 89), 24% for group D (n = 66), and 0% for group E (n = 7). Univariable analysis between consecutive groups of the KLIC score showed no differences for failure before 60 days of the DAIR procedure. Scheduled surgery and having the procedure performed by a specialized unit were also identified as important factors for DAIR success.Conclusions: Our results suggest the KLIC score was not useful for predicting failure in our cohort. Furthermore, our results indicate a specialized unit should conduct DAIR procedures.
Revista:
REVISTA IBEROAMERICANA DE MICOLOGIA
ISSN:
1130-1406
Año:
2021
Vol.:
38
N°:
2
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
Año:
2021
Vol.:
65
N°:
1
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
Año:
2021
Vol.:
99
N°:
1
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
Año:
2021
Vol.:
39
N°:
1
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.
Autores:
Peñuelas, M.; García-Salguero, C.; Iñigo, M; et al.
Revista:
REVISTA ESPAÑOLA DE QUIMIOTERAPIA
ISSN:
0214-3429
Año:
2021
Vol.:
34
N°:
6
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:
REVISTA ESPAÑOLA DE QUIMIOTERAPIA
ISSN:
0214-3429
Año:
2021
Vol.:
34
N°:
Supl. 1
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.
Revista:
ECLINICALMEDICINE
ISSN:
2589-5370
Año:
2021
Vol.:
32
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
Año:
2021
Vol.:
53
N°:
10
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
Año:
2020
Vol.:
25
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
Año:
2020
Vol.:
64
N°:
4
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
Año:
2020
Vol.:
21
N°:
3
Págs.:
207-211
Autores:
Laporte-Amargós, J.; Gudiol, C. (Autor de correspondencia); Arnán, M.; et al.
Revista:
TRIALS
ISSN:
1745-6215
Año:
2020
Vol.:
21
N°:
1
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
Año:
2020
Vol.:
75
N°:
12
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
Año:
2020
Vol.:
26
N°:
4
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:
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
ISSN:
0305-7453
Año:
2019
Vol.:
74
N°:
9
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
Año:
2019
Vol.:
74
N°:
12
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
Año:
2019
Vol.:
39
N°:
6
Págs.:
680 - 682
Autores:
Anemüller, R.; Belden, K.; Brause, B.; et al.
Revista:
JOURNAL OF ARTHROPLASTY
ISSN:
0883-5403
Año:
2019
Vol.:
34
N°:
Supl. 2
Págs.:
S463 - S475
Autores:
Albasanz-Puig, A.; Gudiol, C. (Autor de correspondencia); Parody, R.; et al.
Revista:
BMJ OPEN
ISSN:
2044-6055
Año:
2019
Vol.:
9
N°:
5
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
Año:
2019
Vol.:
37
N°:
1
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
Año:
2019
Vol.:
77
N°:
5
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
Año:
2019
Vol.:
37
N°:
1
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
Año:
2019
Vol.:
28
N°:
6S
Págs.:
S67 - S99
Revista:
MEDICINE - UK EDITION
ISSN:
1357-3039
Año:
2018
Vol.:
12
N°:
50
Págs.:
2990.e1 - 2990.e4
Revista:
MEDICINE - UK EDITION
ISSN:
1357-3039
Año:
2018
Vol.:
12
N°:
51
Págs.:
3057.e1 - 3057.e3
Revista:
JOURNAL OF ATTENTION DISORDERS
ISSN:
1087-0547
Año:
2018
Vol.:
22
N°:
9
Págs.:
864 - 871
Revista:
MEDICINE - UK EDITION
ISSN:
1357-3039
Año:
2018
Vol.:
12
N°:
50
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
Año:
2018
Vol.:
52
N°:
1
Págs.:
123 - 124
Autores:
Chaves, F.; Garnacho-Montero, J. (Autor de correspondencia); del Pozo, Jose L; et al.
Revista:
MEDICINA INTENSIVA
ISSN:
0210-5691
Año:
2018
Vol.:
42
N°:
1
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
Año:
2018
Vol.:
36
N°:
2
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.
Autores:
Ibeas, J.; Roca-Tey, R.; Vallespín, J.; et al.
Revista:
NEFROLOGIA
ISSN:
0211-6995
Año:
2018
Vol.:
39
N°:
1
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
Autores:
Basas, J.; Palau, M.; Ratia, C.; et al.
Revista:
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
ISSN:
0066-4804
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
Año:
2018
Vol.:
12
N°:
51
Págs.:
3010 - 3019
Revista:
MEDICINE (ELSEVIER)
ISSN:
0304-5412
Año:
2018
Vol.:
12
N°:
50
Págs.:
2931 - 2940
Introducción
Los bacilos Gram negativos no fermentadores constituyen un complejo conjunto de microorganismos aerobios estrictos, de distribución universal, con gran resistencia a factores ambientales severos, lo que les permite propagarse rápidamente y desarrollar resistencia a todos los antimicrobianos convencionales.
Factores de riesgo
Dentro de estos, Pseudomonas aeruginosa, Acinetobacter baumanii y Stenotrophomonas maltophilia son los que tienen mayor implicación clínica. Se consideran microorganismos oportunistas, ya que afectan principalmente a pacientes hospitalizados en unidades de críticos, inmunodeprimidos, portadores de material protésico, ampliamente instrumentados y tratados previamente con antibióticos. También se caracterizan por causar brotes en los hospitales.
Manifestaciones clínicas
Destacan como patógenos del tracto respiratorio inferior, siendo la principal causa de neumonía asociada a ventilación mecánica e infección respiratoria en pacientes con fibrosis quística.
Tratamiento
El tratamiento de las infecciones causadas por estos microorganismos es complicado, ya que no sólo presentan resistencia natural a diferentes familias de antibióticos sino que además tienen una gran capacidad para adquirir nuevos mecanismos de resistencia durante el tratamiento, por lo que a menudo presentan patrones de multirresistencia.
Revista:
MEDICINE (ELSEVIER)
ISSN:
0304-5412
Año:
2018
Vol.:
12
N°:
50
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:
MEDICINE (ELSEVIER)
ISSN:
0304-5412
Año:
2018
Vol.:
12
N°:
50
Págs.:
2982 - 2985
La gastroenteritis aguda es una de las principales causas de morbilidad a nivel mundial y mortalidad en países en vías de desarrollo. La presentación del cuadro clínico, según sea una gastroenteritis inflamatoria o no inflamatoria, marcará la actitud diagnóstica y terapéutica.
Tratamiento
La mayoría de las diarreas infecciosas del adulto inmunocompetente son episodios autolimitados que no requieren estudio de laboratorio específico y evolucionan favorablemente con solo un tratamiento sintomático. De modo general, no se recomienda el uso empírico de antibióticos y estos quedan reservados para los casos de diarrea inflamatoria aguda, pacientes menores de 2 años o mayores de 70 años, pacientes inmunodeprimidos y pacientes con patología vascular. En el caso de instaurar tratamiento empírico, este se seleccionará en función del cuadro clínico y la información obtenida en la anamnesis del paciente.
Revista:
MEDICINE (ELSEVIER)
ISSN:
0304-5412
Año:
2018
Vol.:
12
N°:
50
Págs.:
2986 - 2989
Introducción
La mayoría de las infecciones de la cavidad bucal son odontogénicas, aunque también pueden afectar a las estructuras extradentales (infecciones no odontogénicas). La faringitis es la inflamación y/o la infección de la faringe y/o área periamigdalar.
Tratamiento
Ambas infecciones tienen una prevalencia muy alta en la población, siendo uno de los motivos más frecuentes de consulta y prescripción de antibióticos en las consultas de Atención Primaria. El tratamiento de ambas infecciones suele ser empírico, basado en el diagnóstico clínico y la prevalencia y sensibilidad antibiótica de los microorganismos implicados con más frecuencia.
Revista:
PARASITES AND VECTORS
ISSN:
1756-3305
Año:
2018
Vol.:
11
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
Año:
2018
Vol.:
41
N°:
1
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
Año:
2017
Vol.:
34
N°:
3
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
Año:
2017
Vol.:
35
N°:
Supl. 3
Págs.:
29 - 43
Revista:
LANCET INFECTIOUS DISEASES
ISSN:
1473-3099
Año:
2017
Vol.:
17
N°:
2
Págs.:
139 - 140
Revista:
SCIENTIFIC REPORTS
ISSN:
2045-2322
Año:
2017
Vol.:
7
N°:
1
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
Año:
2017
Vol.:
35
N°:
3
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:
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
ISSN:
0066-4804
Año:
2017
Vol.:
61
N°:
11
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
Año:
2017
Vol.:
30
N°:
Supl. 1
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
Año:
2017
Vol.:
61
N°:
3
Págs.:
e02104-16
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN:
0213-005X
Año:
2017
Vol.:
35
N°:
6
Págs.:
398 - 398
Revista:
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
ISSN:
0305-7453
Año:
2017
Vol.:
72
N°:
2
Págs.:
625 - 628
Revista:
LANCET INFECTIOUS DISEASES
ISSN:
1473-3099
Año:
2017
Vol.:
17
N°:
5
Págs.:
477 - 478
Revista:
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
ISSN:
0305-7453
Año:
2016
Vol.:
7
N°:
1
Págs.:
278-9
Revista:
REVISTA ESPAÑOLA DE QUIMIOTERAPIA
ISSN:
0214-3429
Año:
2016
N°:
Supl.1
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.
Autores:
Basas, J.; Morer, A.; Ratia, C.; et al.
Revista:
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
ISSN:
0305-7453
Año:
2016
Vol.:
71
N°:
10
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
Año:
2016
Vol.:
70
N°:
2
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
Año:
2016
Vol.:
27
N°:
3
Págs.:
320 - 321
Revista:
JOURNAL OF CLINICAL PHARMACY AND THERAPEUTICS
ISSN:
0269-4727
Año:
2015
Vol.:
40
N°:
5
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
Año:
2015
Vol.:
15
N°:
3
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
Año:
2015
Vol.:
13
N°:
4
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
Año:
2015
Vol.:
38
N°:
1
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:
MALARIA JOURNAL
ISSN:
1475-2875
Año:
2015
Vol.:
14
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
Año:
2014
Vol.:
27
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
Año:
2014
Vol.:
68
N°:
6
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
Año:
2014
Vol.:
14
N°:
8
Págs.:
676
Autores:
Oteo, J.; Calbo, E.; Rodríguez-Baño, J.; et al.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN:
0213-005X
Año:
2014
Vol.:
32
N°:
10
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
Año:
2014
Vol.:
58
N°:
7
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:
JOURNAL OF APPLIED BIOMATERIALS & FUNCTIONAL MATERIALS
ISSN:
2280-8000
Año:
2014
Vol.:
12
N°:
2
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
Año:
2014
Vol.:
16
N°:
3
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
Año:
2014
Vol.:
32
N°:
10
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
Año:
2013
Vol.:
20
N°:
5
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
Año:
2013
Vol.:
31
N°:
6
Págs.:
412 - 413
Revista:
SENSORS AND ACTUATORS B-CHEMICAL
ISSN:
0925-4005
Año:
2013
Vol.:
178
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
Año:
2013
Vol.:
368
N°:
21
Págs.:
2037
Revista:
ANNALS OF VASCULAR SURGERY
ISSN:
0890-5096
Año:
2013
Vol.:
27
N°:
7
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:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN:
0213-005X
Año:
2013
Vol.:
31
N°:
10
Págs.:
641-2
Revista:
INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS
ISSN:
0391-3988
Año:
2012
Vol.:
35
N°:
10
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
Año:
2012
Vol.:
367
N°:
17
Págs.:
1670 - 1671
Revista:
INTERNATIONAL JOURNAL OF CLINICAL PRACTICE
ISSN:
1368-5031
Año:
2012
Vol.:
66
N°:
3
Págs.:
305 -308
DPT lock therapy demonstrated good in vivo efficacy in LT-CRBI caused by coagulase negative staphylococci and Enterococcus species.
Revista:
INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
ISSN:
1201-9712
Año:
2012
Vol.:
17
N°:
2
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
Año:
2012
Vol.:
38
N°:
1
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
Año:
2012
Vol.:
54
N°:
3
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
Año:
2012
Vol.:
380
N°:
9847
Págs.:
1120
Revista:
INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS
ISSN:
0391-3988
Año:
2011
Vol.:
34
N°:
9
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
Año:
2011
Vol.:
37
N°:
6
Págs.:
585 - 587
Revista:
DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE
ISSN:
0732-8893
Año:
2011
Vol.:
70
N°:
4
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
Año:
2011
Vol.:
55 Esp. Congreso
N°:
CC-921
Págs.:
431 - 432
Revista:
CLINICAL INFECTIOUS DISEASES
ISSN:
1058-4838
Año:
2010
Vol.:
50
N°:
1
Págs.:
121 - 122
Revista:
PANCREATOLOGY
ISSN:
1424-3903
Año:
2010
Vol.:
10
N°:
2-3
Págs.:
114 - 118
