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1. Risk Factors and Prognosis of Nosocomial Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Escherichia coli▿

Author

Antonio Oliver, Manuel Almela, Fabio Grill, Álvaro Pascual, José Miguel Cisneros, Carmen Peña, Javier Colomina, Benito Almirante, Ana Coloma, Paloma Gijón, Jesús Rodríguez-Baño, Carlos Fernández-Mazarrasa, Encarnación Picón, Gemma Navarro, Lorena López-Cerero, J. R. Hernández, Sonia Molinos, Universidad de Sevilla. Departamento de Medicina, and Universidad de Sevilla. Departamento de Microbiología

Subjects
Microbiology (medical), Male, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Antibiotics, Bacteremia, beta-Lactamases, Pharmacotherapy, Risk Factors, Internal medicine, medicine, Escherichia coli, Humans, Risk factor, Intensive care medicine, Escherichia coli Infections, Aged, Aged, 80 and over, Cross Infection, business.industry, Case-control study, Bacteriology, Odds ratio, medicine.disease, Prognosis, Drug Utilization, Hospitals, Anti-Bacterial Agents, Transplantation, Spain, Case-Control Studies, Beta-lactamase, Female, business
Abstract

Extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is an increasing cause of community and nosocomial infections worldwide. However, there is scarce clinical information about nosocomial bloodstream infections (BSIs) caused by these pathogens. We performed a study to investigate the risk factors for and prognosis of nosocomial BSIs due to ESBLEC in 13 Spanish hospitals. Risk factors were assessed by using a case-control-control study; 96 cases (2 to 16% of all nosocomial BSIs due to E. coli in the participating centers) were included; the most frequent ESBL was CTX-M-14 (48% of the isolates). We found CTX-M-15 in 10% of the isolates, which means that this enzyme is emerging as a cause of invasive infections in Spain. By repetitive extragenic palindromic sequence-PCR, most isolates were found to be clonally unrelated. By multivariate analysis, the risk factors for nosocomial BSIs due to ESBLEC were found to be organ transplant (odds ratio [OR] = 4.8; 95% confidence interval [CI] = 1.4 to 15.7), the previous use of oxyimino-β-lactams (OR = 6.0; 95% CI = 3.0 to 11.8), and unknown BSI source (protective; OR = 0.4; 95% CI = 0.2 to 0.9), and duration of hospital stay (OR = 1.02; 95% CI = 1.00 to 1.03). The variables independently associated with mortality were a Pitt score of >1 (OR = 3.9; 95% CI = 1.2 to 12.9), a high-risk source (OR = 5.5; 95% CI = 1.4 to 21.9), and resistance to more than three antibiotics, apart from penicillins and cephalosporins (OR = 6.5; 95% CI = 1.4 to 30.0). Inappropriate empirical therapy was not associated with mortality. We conclude that ESBLEC is an important cause of nosocomial BSIs. The previous use of oxyimino-β-lactams was the only modifiable risk factor found. Resistance to drugs other than penicillins and cephalosporins was associated with increased mortality.

Published
2010

2. In Vitro Activity of Fosfomycin against Extended-Spectrum-β-Lactamase- Producing Escherichia coli and Klebsiella pneumoniae: Comparison of Susceptibility Testing Procedures

Author

J. R. Hernández, Álvaro Pascual, L. López, M. de Cueto, Concepción Morillo, [Cueto,M.de, López,L, Hernández,JR, Morillo, C, Pascual,A] Departamento de Microbiología, Hospital Universitario Virgen Macarena, Facultad de Medicina, Universidad de Sevilla, Seville, Spain., This study was partially supported by a grant from Pharmazan and was developed under the auspices of the Spanish Network for Research on Infectious Diseases (REIPI CO3/14, and Instituto de Salud Carlos III, Madrid, Spain).

Subjects
Klebsiella pneumoniae, medicine.medical_treatment, Microbial Sensitivity Tests, Fosfomycin, medicine.disease_cause, Microbiology, Agar dilution, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], medicine, Escherichia coli, Humans, Pharmacology (medical), Infecciones por Klebsiella, Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Negative Bacterial Infections::Enterobacteriaceae Infections::Klebsiella Infections [Medical Subject Headings], Escherichia coli Infections, Antibacterial agent, Pharmacology, biology, Broth microdilution, Fosfomicina, Chemicals and Drugs::Organic Chemicals::Organophosphorus Compounds::Organophosphonates::Fosfomycin [Medical Subject Headings], biochemical phenomena, metabolism, and nutrition, biology.organism_classification, Enterobacteriaceae, Humanos, Organisms::Bacteria::Gram-Negative Bacteria::Gram-Negative Facultatively Anaerobic Rods::Enterobacteriaceae::Escherichia::Escherichia coli [Medical Subject Headings], Anti-Bacterial Agents, Klebsiella Infections, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Clinical Laboratory Techniques::Microbiological Techniques::Microbial Sensitivity Tests [Medical Subject Headings], Infectious Diseases, Antibacterianos, Susceptibility, Beta-lactamase, Organisms::Bacteria::Gram-Negative Bacteria::Gram-Negative Facultatively Anaerobic Rods::Enterobacteriaceae::Klebsiella::Klebsiella pneumoniae [Medical Subject Headings], Pruebas de Sensibilidad Microbiana, medicine.drug, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents [Medical Subject Headings]
Abstract

The agar dilution, broth microdilution, and disk diffusion methods were compared to determine the in vitro susceptibility of 428 extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae to fosfomycin. Fosfomycin showed very high activity against all ESBL-producing strains. Excellent agreement between the three susceptibility methods was found for E. coli , whereas marked discrepancies were observed for K. pneumoniae .

Published
2006

4. Production, partial characterization and mass spectrometric studies of the extracellular laccase activity from Fusarium proliferatum.

Author

Fernaud, J. R. Hernández, Marina, A., González, K., Vázquez, J., and Falcón, M. A.

Subjects
*LACCASE, *FUSARIUM, *GEL permeation chromatography, *GEL electrophoresis, *ISOENZYMES
Abstract

Benzyl alcohol and starch-free commercial wheat bran were effective inducers of the laccase activity in cultures of Fusarium proliferatum (MUCL 31970). Initial pH value in the cultures was also an overriding factor for increasing its production. By gel permeation high-performance liquid chromatography, the enzyme eluted as an apparently homogeneous peak with a molecular mass of 54 kDa, but by isoelectrofocusing, two proteins with pI values of 5.17 and 5.07 were revealed. Two different phenoloxidase activities were also detected after nondenaturing polyacrylamide gel electrophoresis. By matrix-assisted laser desorption/ionization–time of flight–mass spectrometry (MALDI-TOF-MS), both proteins showed unique fingerprints, so they were classifiable as isozymes, and were named laccase 1 (Lac1, pI 5.17) and laccase 2 (Lac2, pI 5.07). No clear matches were found when compared with other proteins. The tandem mass spectrometry of some peptides from both isozymes reanalyzed by nanoelectron ionization–ion trap–mass spectrometry (nESI-IT-MS) confirmed their unique character. The following interesting properties, particularly its stability at alkaline pH, make this laccase a promising industrial enzyme for biotechnological applications: maximum activity at 60°C, thermal stability for 2 h at 40°C, optimum pH 3.5 (km=62 μM) measured on 2,2′-azino-bis(3-ethylbenz-thiazoline-6-sulfonate), and pH stability 4–8 (75% stability at pH levels 2.2 and 9) for 2 h at 25°C. [ABSTRACT FROM AUTHOR]

Published
2006
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6. Outcome for tracheostomized patients who requiring prolonged stay in intensive care unit.

Author

Santana-Cabrera, L., Mendoza, C. Díaz, Sánchez-Palacios, M., Martin-Santana, J. D., and Hernández, J. R. Hernández

Subjects
TRACHEOTOMY patients, INTENSIVE care units, CATASTROPHIC illness
Abstract

A letter to the editor is presented about the effect of tracheostomy on intensive care unit (ICU) and in-hospital mortality for patients who require prolonged stay in ICU.

Published
2013
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