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1. Epidemiology and risk factors of mycotic aneurysm in patients with infective endocarditis and the impact of its rupture in outcomes. Analysis of a national prospective cohort

Author: Universidad de Sevilla. Departamento de Cirugía, Universidad de Sevilla. Departamento de Microbiología, Universidad de Sevilla. Departamento de Medicina, Calderón-Parra, Jorge, Domínguez, Fernando, González-Rico, Claudia, Arnaiz de las Revillas, Francisco, Goenaga, Miguel Ángel, Álvarez, I., Muñoz, Patricia, Alonso, David, Rodríguez-García, Raquel, Miró, José María, Spanish Collaboration on Endocarditis (GAMES), Araji Tiliani, Omar, Cueto López, Marina de, Gutiérrez Carretero, Encarnación, Lepe Jiménez, José Antonio, López-Cortes, Luis Eduardo, Universidad de Sevilla. Departamento de Cirugía, Universidad de Sevilla. Departamento de Microbiología, Universidad de Sevilla. Departamento de Medicina, Calderón-Parra, Jorge, Domínguez, Fernando, González-Rico, Claudia, Arnaiz de las Revillas, Francisco, Goenaga, Miguel Ángel, Álvarez, I., Muñoz, Patricia, Alonso, David, Rodríguez-García, Raquel, Miró, José María, Spanish Collaboration on Endocarditis (GAMES), Araji Tiliani, Omar, Cueto López, Marina de, Gutiérrez Carretero, Encarnación, Lepe Jiménez, José Antonio, and López-Cortes, Luis Eduardo
Abstract: Background. Several aspects of the occurrence and management of mycotic aneurysm (MA) in patients with infective endocarditis (IE) have not been studied. Objectives. To determine the incidence and factors associated with MA presence and rupture and to assess the evolution of those initially unruptured MA. Methods. Prospective multicenter cohort including all patients with definite IE between January 2008 and December 2020. Results. Of 4548 IE cases, 85 (1.9%) developed MA. Forty-six (54.1%) had intracranial MA and 39 (45.9%) extracranial MA. Rupture of MA occurred in 39 patients (45.9%). Patients with ruptured MA had higher 1-year mortality (hazard ratio, 2.33; 95% confidence interval, 1.49–3.67). Of the 55 patients with initially unruptured MA, 9 (16.4%) presented rupture after a median of 3 days (interquartile range, 1–7) after diagnosis, being more frequent in intracranial MA (32% vs 3.3%, P = .004). Of patients with initially unruptured MA, there was a trend toward better outcomes among those who received early specific intervention, including lower follow-up rupture (7.1% vs 25.0%, P = .170), higher rate of aneurysm resolution in control imaging (66.7% vs 31.3%, P = .087), lower MA-related mortality (7.1% vs 16.7%, P = .232), and lower MA-related sequalae (0% vs 27.8%, P = .045). Conclusions. MA occurred in 2% of the patients with IE. Half of the Mas occurred in an intracranial location. Their rupture is frequent and associated with poor prognosis. A significant proportion of initially unruptured aneurysms result from rupture during the first several days, being more common in intracranial aneurysms. Early specific treatment could potentially lead to better outcomes
Published: 2024

2. Multivalvular Endocarditis: A Rare Condition with Poor Prognosis

Author: Quintana, Eduard [0000-0002-5386-7463], Villa, Sofía de la [0000-0002-1371-6417], Rodríguez Esteban, Ángeles [0000-0001-7393-2501], Miró, José María [0000-0001-8057-7755], Goenaga Sánchez, Miguel Ángel [0000-0003-3532-4681], Goikoetxea-Aguirre, Josune [0000-0003-1983-3742], Martínez-Sellés, Manuel [0000-0003-0289-6229], Álvarez-Zaballos, Sara, González Ramallo, Víctor, Quintana, Eduard, Muñoz, Patricia, Villa, Sofía de la, Fariñas, María del Carmen, Arnaiz-De Las Revillas, Francisco, Alarcón González, Arístides de, Rodríguez Esteban, Ángeles, Miró, José María, Goenaga Sánchez, Miguel Ángel, Goikoetxea-Aguirre, Josune, García Vázquez, Elisa, Boix-Palop, Lucía, Martínez-Sellés, Manuel, GAMEs investigators, Quintana, Eduard [0000-0002-5386-7463], Villa, Sofía de la [0000-0002-1371-6417], Rodríguez Esteban, Ángeles [0000-0001-7393-2501], Miró, José María [0000-0001-8057-7755], Goenaga Sánchez, Miguel Ángel [0000-0003-3532-4681], Goikoetxea-Aguirre, Josune [0000-0003-1983-3742], Martínez-Sellés, Manuel [0000-0003-0289-6229], Álvarez-Zaballos, Sara, González Ramallo, Víctor, Quintana, Eduard, Muñoz, Patricia, Villa, Sofía de la, Fariñas, María del Carmen, Arnaiz-De Las Revillas, Francisco, Alarcón González, Arístides de, Rodríguez Esteban, Ángeles, Miró, José María, Goenaga Sánchez, Miguel Ángel, Goikoetxea-Aguirre, Josune, García Vázquez, Elisa, Boix-Palop, Lucía, Martínez-Sellés, Manuel, and GAMEs investigators
Abstract: [Background] Infective endocarditis (IE) is a severe condition. Our aim was to describe the profile and prognosis of patients with multivalvular infective endocarditis (MIE) and compare them to single-valve IE (SIE). Methods. We used a retrospective analysis of the Spanish IE Registry (2008−2020)., [Results] From 4064 definite cases of valvular IE, 577 (14.2%) had MIE. In patients with MIE, the most common locations were mitral (552, 95.7%) and aortic (550, 95.3%), with mitral-aortic involvement present in 507 patients (87.9%). The most common etiologies were S. viridans (192, 33.3%) and S. aureus (113, 19.6%). MIE involved only native valves in 450 patients (78.0%). Compared with patients with SIE, patients with MIE had a similar age (69 vs. 67 years, respectively, p = 0.27) and similar baseline characteristics, but were more frequently men (67.1% vs. 72.9%, p = 0.005) and had a higher incidence of intracardiac complications (36.2% vs. 50.4%, p < 0.001), heart failure (42.7% vs. 52.9%, p < 0.001), surgical indication (67.7 vs. 85.1%, p < 0.001), surgery (46.3% vs. 56.3%), and in-hospital mortality (26.9% vs. 34.3%, p < 0.001). MIE was an independent predictor of in-hospital mortality (odds ratio (OR) 1.3, 95% confidence interval (CI) 1.1−1.7, p = 0.004) but did not have an independent association with 1-year mortality (OR 1.1, 95% CI 0.9−1.4, p = 0.43)., [Conclusions] About one-seventh of the valvular IE patients had MIE, mainly due to mitral-aortic involvement. MIE is associated with a poor in-hospital prognosis. An early diagnosis and treatment of IE might avoid its spread to a second valve.
Published: 2022

3. Non-nosocomial Healthcare-Associated Infective Endocarditis: A Distinct Entity? Data From the GAMES Series (2008–2021)

Author: Instituto de Salud Carlos III, European Commission, Alonso-Menchén, David, Bouza Santiago, Emilio, Valerio, Maricela, Alarcón González, Arístides de, Gutiérrez-Carretero, Encarnación, Miró, José María, Goenaga Sánchez, Miguel Ángel, Plata-Ciezar, Antonio, González-Rico, Claudia, López-Cortés, Luis Eduardo, Rodríguez-Esteban, María Ángeles, Martínez-Marcos, Francisco Javier, Muñoz, Patricia, Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES) Investigators, Instituto de Salud Carlos III, European Commission, Alonso-Menchén, David, Bouza Santiago, Emilio, Valerio, Maricela, Alarcón González, Arístides de, Gutiérrez-Carretero, Encarnación, Miró, José María, Goenaga Sánchez, Miguel Ángel, Plata-Ciezar, Antonio, González-Rico, Claudia, López-Cortés, Luis Eduardo, Rodríguez-Esteban, María Ángeles, Martínez-Marcos, Francisco Javier, Muñoz, Patricia, and Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES) Investigators
Abstract: [Background] Patients who acquire infective endocarditis (IE) following contact with the healthcare system, but outside the hospital, are classified as having non-nosocomial healthcare-associated IE (HCIE). Our aim was to characterize HCIE and establish whether its etiology, diagnosis, and therapeutic approach suggest it should be considered a distinct entity., [Methods] This study retrospectively analyzes data from a nationwide, multicenter, prospective cohort including consecutive cases of IE at 45 hospitals across Spain from 2008 to 2021. HCIE was defined as IE detected in patients in close contact with the healthcare system (eg, patients receiving intravenous treatment, hemodialysis, or institutionalized). The prevalence and main characteristics of HCIE were examined and compared with those of community-acquired IE (CIE) and nosocomial IE (NIE) and with literature data., [Results] IE was diagnosed in 4520 cases, of which 2854 (63%) were classified as CIE, 1209 (27%) as NIE, and 457 (10%) as HCIE. Patients with HCIE showed a high burden of comorbidities, a high presence of intravascular catheters, and a predominant staphylococcal etiology, Staphylococcus aureus being identified as the most frequent causative agent (35%). They also experienced more persistent bacteremia, underwent fewer surgeries, and showed a higher mortality rate than those with CIE (32.4% vs 22.6%). However, mortality in this group was similar to that recorded for NIE (32.4% vs 34.9%, respectively, P = .40)., [Conclusions] Our data do not support considering HCIE as a distinct entity. HCIE affects a substantial number of patients, is associated with a high mortality, and shares many characteristics with NIE.
Published: 2023

4. Impact of Intermediate Susceptibility to Penicillin on Antimicrobial Treatment and Outcomes of Endocarditis Caused by Viridans and Gallolyticus Group Streptococci

Author: Escrihuela-Vidal, Francesc, Berbel, Damaris, Fernández-Hidalgo, Núria, Escolà‐Vergé, Laura, Muñoz, Patricia, Olmedo, María, Goenaga Sánchez, Miguel Ángel, Goikoetxea, Josune, Fariñas, María del Carmen, Alarcón González, Arístides de, Miró, José María, Ojeda Burgos, Guillermo, Plata-Ciezar, Antonio, Cuervo, Guillermo, Carratalà, Jordi, GAMES Investigators, Escrihuela-Vidal, Francesc, Berbel, Damaris, Fernández-Hidalgo, Núria, Escolà‐Vergé, Laura, Muñoz, Patricia, Olmedo, María, Goenaga Sánchez, Miguel Ángel, Goikoetxea, Josune, Fariñas, María del Carmen, Alarcón González, Arístides de, Miró, José María, Ojeda Burgos, Guillermo, Plata-Ciezar, Antonio, Cuervo, Guillermo, Carratalà, Jordi, and GAMES Investigators
Abstract: [Background] Evidence supporting combination treatment with a beta-lactam plus an aminoglycoside (C-BA) for endocarditis caused by viridans and gallolyticus group streptococci (VGS-GGS) with intermediate susceptibility to penicillin (PENI-I) is lacking. We assessed the clinical characteristics and outcomes of PEN-I VGS-GGS endocarditis and compared the effectiveness and safety of C-BA with third-generation cephalosporin monotherapy., [Methods] Retrospective analysis of prospectively collected data of a cohort of definite endocarditis caused by penicillin-susceptible and PENI-I VGS-GGS (penicillin minimum inhibitory concentration ranging from 0.25 to 2 mg/L) between 2008 and 2018 in 40 Spanish hospitals. We compared cases treated with monotherapy or with C-BA and performed multivariable analyses of risk factors for in-hospital and 1-year mortality., [Results] A total of 914 consecutive cases of definite endocarditis caused by VGS-GGS with complete or intermediate susceptibility to penicillin were included. A total of 688 (75.3%) were susceptible to penicillin and 226 (24.7%) were PENI-I. Monotherapy was used in 415 (45.4%) cases (cephalosporin in 331 cases) and 499 (54.6%) cases received C-BA. In-hospital mortality was 11.9%, and 190 (20.9%) patients developed acute kidney injury. Heart failure (odds ratio [OR]: 6.06; 95% confidence interval [CI]: 1.37–26.87; P = .018), central nervous system emboli (OR: 9.83; 95% CI: 2.17–44.49; P = .003) and intracardiac abscess (OR: 13.47; 95% CI: 2.24–81.08; P = .004) were independently associated with in-hospital mortality among PEN-I VGS-GGS cases, while monotherapy was not (OR: 1.01; 95% CI: .26–3.96; P = .982)., [Conclusions] Our findings support the use of cephalosporin monotherapy in PEN-I VGS-GGS endocarditis in order to avoid nephrotoxicity without adversely affecting patient outcomes.
Published: 2023

5. EN-DALBACEN 2.0 Cohort: real-life study of dalbavancin as sequential/consolidation therapy in patients with infective endocarditis due to Gram-positive cocci

Author: Hidalgo-Tenorio, Carmen, Sadyrbaeva-Dolgova, Svetlana, Enríquez-Gómez, Andrés, Muñoz, Patricia, Plata-Ciezar, Antonio, Miró, José María, Alarcón González, Arístides de, Martínez-Marcos, Francisco Javier, Loeches, Belén, Escrihuela-Vidal, Francesc, Vinuesa, David, Herrero, Carmen, Boix-Palop, Lucía, Arenas, María del Mar, García-Vázquez, Elisa, Arnaiz-De Las Revillas, Francisco, Pasquau, J., on behalf of the EN-DALBACEN study group, Hidalgo-Tenorio, Carmen, Sadyrbaeva-Dolgova, Svetlana, Enríquez-Gómez, Andrés, Muñoz, Patricia, Plata-Ciezar, Antonio, Miró, José María, Alarcón González, Arístides de, Martínez-Marcos, Francisco Javier, Loeches, Belén, Escrihuela-Vidal, Francesc, Vinuesa, David, Herrero, Carmen, Boix-Palop, Lucía, Arenas, María del Mar, García-Vázquez, Elisa, Arnaiz-De Las Revillas, Francisco, Pasquau, J., and on behalf of the EN-DALBACEN study group
Abstract: [Objectives] Infective endocarditis (IE) has high mortality and morbidity and requires long hospital stays to deliver the antibiotic treatment recommended in clinical practice guidelines. We aimed to analyse the health outcomes of the use of dalbavancin (DBV) in the consolidation treatment of IEs caused by Gram-positive cocci and to perform a pharmacoeconomic study., [Materials and methods] This observational, retrospective, Spanish multicentre study in patients with IE who received DBV as part of antibiotic treatment in consolidation phase were followed for at least 12 months. The study was approved by the Provincial Committee of the coordinating centre., [Results] The study included 124 subjects, 70.2% male, with a mean age of 67.4 years and median Charlson index of 4 (interquartile range: 2.5–6). Criteria for definite IE were met by 91.1%. Coagulase-negative staphylococci (38.8%), Staphylococcus aureus (22.6%), Enterococcus faecalis (19.4%), and Streptococcus Spp. (9.7%) were isolated more frequently, all susceptible to vancomycin. Before DVB administration, 91.2% had undergone surgery; 60.5% had received a second regimen for 24.5 d (16.6–56); and 20.2% had received a third regimen for 14.5 d (12–19.5). DBV was administered to facilitate discharge in 95.2% of cases. At 12 months, the effectiveness was of 95.9%, and there was 0.8% loss to follow-up, 0.8% IE-related death, and 3.2% relapse. Adverse events were recorded in 3.2%. The hospital stay was reduced by 14 d, and there was a mean savings of 5548.57 €/patient vs. conventional treatments., [Conclusion] DBV is highly effective, safe, and cost-effective as consolidation therapy in patients with IE by Gram-positive cocci, with few adverse events.
Published: 2023

6. Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Author: Instituto de Salud Carlos III, European Commission, Herrera-Hidalgo, Laura, Muñoz, Patricia, Álvarez-Uría, Ana, Alonso-Menchén, David, Luque-Márquez, Rafael, Gutiérrez-Carretero, Encarnación, Fariñas, María del Carmen, Miró, José María, Goenaga Sánchez, Miguel Ángel, López-Cortés, Luis Eduardo, Angulo-Lara, Basilio, Boix-Palop, Lucía, Alarcón González, Arístides de, Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES) Cohort Investigator, Instituto de Salud Carlos III, European Commission, Herrera-Hidalgo, Laura, Muñoz, Patricia, Álvarez-Uría, Ana, Alonso-Menchén, David, Luque-Márquez, Rafael, Gutiérrez-Carretero, Encarnación, Fariñas, María del Carmen, Miró, José María, Goenaga Sánchez, Miguel Ángel, López-Cortés, Luis Eduardo, Angulo-Lara, Basilio, Boix-Palop, Lucía, Alarcón González, Arístides de, and Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES) Cohort Investigator
Abstract: [Objectives] This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP)., [Methods] Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately., [Results] We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors., [Conclusion] Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective.
Published: 2023

7. Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry

Author: Ramos-Martínez, Antonio, Domínguez, Fernando, Muñoz, Patricia, Marín, Mercedes, Pedraz, Álvaro, Fariñas, María del Carmen, Tascón, Valentín, Alarcón González, Arístides de, Rodríguez-García, Raquel, Miró, José María, Goikoetxea, Josune, Ojeda Burgos, Guillermo, Escrihuela-Vidal, Francesc, Calderón-Parra, Jorge, On behalf of the GAMES investigators, Ramos-Martínez, Antonio, Domínguez, Fernando, Muñoz, Patricia, Marín, Mercedes, Pedraz, Álvaro, Fariñas, María del Carmen, Tascón, Valentín, Alarcón González, Arístides de, Rodríguez-García, Raquel, Miró, José María, Goikoetxea, Josune, Ojeda Burgos, Guillermo, Escrihuela-Vidal, Francesc, Calderón-Parra, Jorge, and On behalf of the GAMES investigators
Abstract: [Background] Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment., [Methods] Study on clinical characteristics and prognosis of a large contemporary prospective cohort of prosthetic valve endocarditis (PVE) that included patients diagnosed between January 2008 and December 2020. Univariate and multivariate analysis of factors associated with in-hospital mortality was performed., [Results] The study included 1354 cases of PVE. The median age was 71 years with an interquartile range of 62–77 years and 66.9% of the cases were male. Patients diagnosed during the first year after valve implantation (early onset) were characterized by a higher proportion of cases due to coagulase-negative staphylococci and Candida and more perivalvular complications than patients detected after the first year (late onset). In-hospital mortality of PVE in this series was 32.6%; specifically, it was 35.4% in the period 2008–2013 and 29.9% in 2014–2020 (p = 0.031). Variables associated with in-hospital mortality were: Age-adjusted Charlson comorbidity index (OR: 1.15, 95% CI: 1.08–1.23), intracardiac abscess (OR:1.78, 95% CI:1.30–2.44), acute heart failure related to PVE (OR: 3. 11, 95% CI: 2.31–4.19), acute renal failure (OR: 3.11, 95% CI:1.14–2.09), septic shock (OR: 5.56, 95% CI:3.55–8.71), persistent bacteremia (OR: 1.85, 95% CI: 1.21–2.83) and surgery indicated but not performed (OR: 2.08, 95% CI: 1.49–2.89). In-hospital mortality in patients with surgical indication according to guidelines was 31.3% in operated patients and 51.3% in non-operated patients (p<0.001). In the latter group, there were more cases of advanced age, comorbidity, hospital acquired PVE, PVE due to Staphylococcus aureus, septic shock, and stroke., [Conclusions] Not performing cardiac surgery in patients with PVE and surgical indication, according to guidelines, has a significant negative effect on in-hospital mortality. Strategies to better discriminate patients who can benefit most from surgery would be desirable.
Published: 2023

8. Infective endocarditis in children and adolescents: a different profile with clinical implications

Author: Vicent, Lourdes, Goenaga Sánchez, Miguel Ángel, Muñoz, Patricia, Marín-Arriaza, Mercedes, Valerio, Maricela, Fariñas, María del Carmen, Cobo Belaustegui, Manuel, Alarcón González, Arístides de, Rodríguez Esteban, Ángeles, Miró, José María, Goikoetxea-Aguirre, Josune, Castro Campos, Daniel de, García Vázquez, Elisa, Martínez-Sellés, Manuel, GAMEs investigators, Vicent, Lourdes, Goenaga Sánchez, Miguel Ángel, Muñoz, Patricia, Marín-Arriaza, Mercedes, Valerio, Maricela, Fariñas, María del Carmen, Cobo Belaustegui, Manuel, Alarcón González, Arístides de, Rodríguez Esteban, Ángeles, Miró, José María, Goikoetxea-Aguirre, Josune, Castro Campos, Daniel de, García Vázquez, Elisa, Martínez-Sellés, Manuel, and GAMEs investigators
Abstract: [Background] Our aim was to compare pediatric infective endocarditis (IE) with the clinical profile and outcomes of IE in adults., [Methods] Prospective multicenter registry in 31 Spanish hospitals including all patients with a diagnosis of IE from 2008 to 2020., [Results] A total of 5590 patients were included, 49 were <18 years (0.1%). Congenital heart disease (CHD) was present in 31 children and adolescents (63.2%). Right-sided location was more common in children/adolescents than in adults (46.9% vs. 6.3%, P < 0.001). Pediatric pulmonary IE was more frequent in patients with CHD (48.4%) than in those without (5.6%), P = 0.004. Staphylococcus aureus etiology tended to be more common in pediatric patients (32.7%) than in adults (22.3%), P = 0.082. Heart failure was less common in pediatric patients than in adults, due to the lower rate of heart failure in children/adolescents with CHD (9.6%) with respect to those without CHD (44.4%), P = 0.005. Inhospital mortality was high in both children, and adolescents and adults (16.3% vs. 25.9%; P = 0.126)., [Conclusions] Most IE cases in children and adolescents are seen in patients with CHD that have a more common right-sided location and a lower prevalence of heart failure than patients without CHD. IE in children and adolescents without CHD has a more similar profile to IE in adults.
Published: 2022

9. Clinical features and outcomes of Streptococcus anginosus group infective Endocarditis: a multicenter matched cohort study

Author: Inmunología, microbiología y parasitología, Medicina, Immunologia, mikrobiologia eta parasitologia, Medikuntza, Escrihuela-Vidal, Francesc, López Cortés, Luis Eduardo, Escolà Vergé, Laura, De Alarcón, Arístides, Cuervo, Guillermo, Sánchez Porto, Antonio, Fernández-Hidalgo, Núria, Luque, Rafael, Montejo Baranda, José Miguel, Miró, José María, Goenaga, Miguel Ángel, Muñoz, Patricia, Valerio, Maricela C., Ripa, Marco, Sousa Regueiro, Dolores, Gurguí, Mercé, Fariñas, Carmen, Mateu, Lourdes, García Vázquez, Elisa, Gálvez Acebal, Juan, Carratalà, Jordi, Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES), Barcelona Endocarditis Study Team (BEST), Inmunología, microbiología y parasitología, Medicina, Immunologia, mikrobiologia eta parasitologia, Medikuntza, Escrihuela-Vidal, Francesc, López Cortés, Luis Eduardo, Escolà Vergé, Laura, De Alarcón, Arístides, Cuervo, Guillermo, Sánchez Porto, Antonio, Fernández-Hidalgo, Núria, Luque, Rafael, Montejo Baranda, José Miguel, Miró, José María, Goenaga, Miguel Ángel, Muñoz, Patricia, Valerio, Maricela C., Ripa, Marco, Sousa Regueiro, Dolores, Gurguí, Mercé, Fariñas, Carmen, Mateu, Lourdes, García Vázquez, Elisa, Gálvez Acebal, Juan, Carratalà, Jordi, Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES), and Barcelona Endocarditis Study Team (BEST)
Abstract: [EN] Background. Although Streptococcus anginosus group (SAG) endocarditis is considered a severe disease associated with abscess formation and embolic events, there is limited evidence to support this assumption. Methods. We performed a retrospective analysis of prospectively collected data from consecutive patients with definite SAG endocarditis in 28 centers in Spain and Italy. A comparison between cases due to SAG endocarditis and viridans group streptococci (VGS) or Streptococcus gallolyticus group (SGG) was performed in a 1:2 matched analysis. Results. Of 5336 consecutive cases of definite endocarditis, 72 (1.4%) were due to SAG and matched with 144 cases due to VGS/ SGG. SAG endocarditis was community acquired in 64 (88.9%) cases and affected aortic native valve in 29 (40.3%). When comparing SAG and VGS/SGG endocarditis, no significant differences were found in septic shock (8.3% vs 3.5%, P = .116); valve disorder, including perforation (22.2% vs 18.1%, P = .584), pseudoaneurysm (16.7% vs 8.3%, P = .108), or prosthesis dehiscence (1.4% vs 6.3%, P = .170); paravalvular complications, including abscess (25% vs 18.8%, P = .264) and intracardiac fistula (5.6% vs 3.5%, P = .485); heart failure (34.7% vs 38.9%, P = .655); or embolic events (41.7% vs 32.6%, P = .248). Indications for surgery (70.8% vs 70.8%; P = 1) and mortality (13.9% vs 16.7%; P = .741) were similar between groups. Conclusions. SAG endocarditis is an infrequent but serious condition that presents a prognosis similar to that of VGS/SGG.
Published: 2021

10. Clinical features and outcomes of Streptococcus anginosus group infective Endocarditis: a multicenter matched cohort study

Author: Inmunología, microbiología y parasitología, Medicina, Immunologia, mikrobiologia eta parasitologia, Medikuntza, Escrihuela-Vidal, Francesc, López Cortés, Luis Eduardo, Escolà Vergé, Laura, De Alarcón, Arístides, Cuervo, Guillermo, Sánchez Porto, Antonio, Fernández-Hidalgo, Núria, Luque, Rafael, Montejo Baranda, José Miguel, Miró, José María, Goenaga, Miguel Ángel, Muñoz, Patricia, Valerio, Maricela C., Ripa, Marco, Sousa Regueiro, Dolores, Gurguí, Mercé, Fariñas, Carmen, Mateu, Lourdes, García Vázquez, Elisa, Gálvez Acebal, Juan, Carratalà, Jordi, Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES), Barcelona Endocarditis Study Team (BEST), Inmunología, microbiología y parasitología, Medicina, Immunologia, mikrobiologia eta parasitologia, Medikuntza, Escrihuela-Vidal, Francesc, López Cortés, Luis Eduardo, Escolà Vergé, Laura, De Alarcón, Arístides, Cuervo, Guillermo, Sánchez Porto, Antonio, Fernández-Hidalgo, Núria, Luque, Rafael, Montejo Baranda, José Miguel, Miró, José María, Goenaga, Miguel Ángel, Muñoz, Patricia, Valerio, Maricela C., Ripa, Marco, Sousa Regueiro, Dolores, Gurguí, Mercé, Fariñas, Carmen, Mateu, Lourdes, García Vázquez, Elisa, Gálvez Acebal, Juan, Carratalà, Jordi, Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES), and Barcelona Endocarditis Study Team (BEST)
Abstract: [EN] Background. Although Streptococcus anginosus group (SAG) endocarditis is considered a severe disease associated with abscess formation and embolic events, there is limited evidence to support this assumption. Methods. We performed a retrospective analysis of prospectively collected data from consecutive patients with definite SAG endocarditis in 28 centers in Spain and Italy. A comparison between cases due to SAG endocarditis and viridans group streptococci (VGS) or Streptococcus gallolyticus group (SGG) was performed in a 1:2 matched analysis. Results. Of 5336 consecutive cases of definite endocarditis, 72 (1.4%) were due to SAG and matched with 144 cases due to VGS/ SGG. SAG endocarditis was community acquired in 64 (88.9%) cases and affected aortic native valve in 29 (40.3%). When comparing SAG and VGS/SGG endocarditis, no significant differences were found in septic shock (8.3% vs 3.5%, P = .116); valve disorder, including perforation (22.2% vs 18.1%, P = .584), pseudoaneurysm (16.7% vs 8.3%, P = .108), or prosthesis dehiscence (1.4% vs 6.3%, P = .170); paravalvular complications, including abscess (25% vs 18.8%, P = .264) and intracardiac fistula (5.6% vs 3.5%, P = .485); heart failure (34.7% vs 38.9%, P = .655); or embolic events (41.7% vs 32.6%, P = .248). Indications for surgery (70.8% vs 70.8%; P = 1) and mortality (13.9% vs 16.7%; P = .741) were similar between groups. Conclusions. SAG endocarditis is an infrequent but serious condition that presents a prognosis similar to that of VGS/SGG.
Published: 2021

11. Clinical features and outcomes of Streptococcus anginosus group infective Endocarditis: a multicenter matched cohort study

Author: Inmunología, microbiología y parasitología, Medicina, Immunologia, mikrobiologia eta parasitologia, Medikuntza, Escrihuela-Vidal, Francesc, López Cortés, Luis Eduardo, Escolà Vergé, Laura, De Alarcón, Arístides, Cuervo, Guillermo, Sánchez Porto, Antonio, Fernández-Hidalgo, Núria, Luque, Rafael, Montejo Baranda, José Miguel, Miró, José María, Goenaga, Miguel Ángel, Muñoz, Patricia, Valerio, Maricela C., Ripa, Marco, Sousa Regueiro, Dolores, Gurguí, Mercé, Fariñas, Carmen, Mateu, Lourdes, García Vázquez, Elisa, Gálvez Acebal, Juan, Carratalà, Jordi, Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES), Barcelona Endocarditis Study Team (BEST), Inmunología, microbiología y parasitología, Medicina, Immunologia, mikrobiologia eta parasitologia, Medikuntza, Escrihuela-Vidal, Francesc, López Cortés, Luis Eduardo, Escolà Vergé, Laura, De Alarcón, Arístides, Cuervo, Guillermo, Sánchez Porto, Antonio, Fernández-Hidalgo, Núria, Luque, Rafael, Montejo Baranda, José Miguel, Miró, José María, Goenaga, Miguel Ángel, Muñoz, Patricia, Valerio, Maricela C., Ripa, Marco, Sousa Regueiro, Dolores, Gurguí, Mercé, Fariñas, Carmen, Mateu, Lourdes, García Vázquez, Elisa, Gálvez Acebal, Juan, Carratalà, Jordi, Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES), and Barcelona Endocarditis Study Team (BEST)
Abstract: [EN] Background. Although Streptococcus anginosus group (SAG) endocarditis is considered a severe disease associated with abscess formation and embolic events, there is limited evidence to support this assumption. Methods. We performed a retrospective analysis of prospectively collected data from consecutive patients with definite SAG endocarditis in 28 centers in Spain and Italy. A comparison between cases due to SAG endocarditis and viridans group streptococci (VGS) or Streptococcus gallolyticus group (SGG) was performed in a 1:2 matched analysis. Results. Of 5336 consecutive cases of definite endocarditis, 72 (1.4%) were due to SAG and matched with 144 cases due to VGS/ SGG. SAG endocarditis was community acquired in 64 (88.9%) cases and affected aortic native valve in 29 (40.3%). When comparing SAG and VGS/SGG endocarditis, no significant differences were found in septic shock (8.3% vs 3.5%, P = .116); valve disorder, including perforation (22.2% vs 18.1%, P = .584), pseudoaneurysm (16.7% vs 8.3%, P = .108), or prosthesis dehiscence (1.4% vs 6.3%, P = .170); paravalvular complications, including abscess (25% vs 18.8%, P = .264) and intracardiac fistula (5.6% vs 3.5%, P = .485); heart failure (34.7% vs 38.9%, P = .655); or embolic events (41.7% vs 32.6%, P = .248). Indications for surgery (70.8% vs 70.8%; P = 1) and mortality (13.9% vs 16.7%; P = .741) were similar between groups. Conclusions. SAG endocarditis is an infrequent but serious condition that presents a prognosis similar to that of VGS/SGG.
Published: 2021

12. Characteristics and Outcome of Acute Heart Failure in Infective Endocarditis: Focus on Cardiogenic Shock

Author: Ministerio de Sanidad y Consumo (España), Instituto de Salud Carlos III, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Ministerio de Economía y Competitividad (España), Pericás Pulico, Juan Manuel, Hernández-Meneses, Marta, Muñoz, Patricia, Martínez-Sellés, Manuel, Álvarez-Uria, Ana, Alarcón González, Arístides de, Gutiérrez-Carretero, Encarnación, Goenaga Sánchez, Miguel Ángel, Zarauza, Manuel J., Falces, Carlos, Rodríguez Esteban, Ángeles, Hidalgo-Tenorio, Carmen, Hernández-Cabrera, Michele, Miró, José María, Ministerio de Sanidad y Consumo (España), Instituto de Salud Carlos III, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Ministerio de Economía y Competitividad (España), Pericás Pulico, Juan Manuel, Hernández-Meneses, Marta, Muñoz, Patricia, Martínez-Sellés, Manuel, Álvarez-Uria, Ana, Alarcón González, Arístides de, Gutiérrez-Carretero, Encarnación, Goenaga Sánchez, Miguel Ángel, Zarauza, Manuel J., Falces, Carlos, Rodríguez Esteban, Ángeles, Hidalgo-Tenorio, Carmen, Hernández-Cabrera, Michele, and Miró, José María
Abstract: [Background] Studies investigating the impact of cardiogenic shock (CS) on endocarditis are lacking., [Methods] Prospectively collected cohort from 35 Spanish centers (2008-2018). Logistic regression analyses were performed to identify risk factors for developing CS and predictors of mortality., [Results] Among 4856 endocarditis patients, 1652 (34%) had acute heart failure (AHF) and 244 (5%) CS. Compared with patients without AHF and AHF but no CS, patients with CS presented higher rates of surgery (40.5%, 52.5%, and 68%; P < .001) and in-hospital mortality (16.3%, 39.1%, and 52.5%). Compared with patients with septic shock, CS patients presented higher rates of surgery (42.5% vs 68%; P < .001) and lower rates of in-hospital and 1-year mortality (62.3% vs 52.5%, P = .008, and 65.3% vs 57.4%, P = .030). Severe aortic and mitral regurgitation (OR [95% CI], 2.47 [1.82-3.35] and 3.03 [2.26-4.07]; both P < .001), left-ventricle ejection fraction <60% (1.72; 1.22-2.40; P = .002), heart block (2.22; 1.41-3.47; P = .001), tachyarrhythmias (5.07; 3.13-8.19; P < .001), and acute kidney failure (2.29; 1.73-3.03; P < .001) were associated with higher likelihood of developing CS. Prosthetic endocarditis (2.03; 1.06 -3.88; P = .032), Staphylococcus aureus (3.10; 1.16 -8.30; P = .024), tachyarrhythmias (3.09; 1.50-10.13; P = .005), and not performing cardiac surgery (11.40; 4.83-26.90; P < .001) were associated with a higher risk of mortality., [Conclusions] AHF is common among patients with endocarditis. CS is associated with high mortality and should be promptly identified and assessed for cardiac surgery.
Published: 2021

13. Daptomycin Plus Fosfomycin Versus Daptomycin Alone for Methicillin-resistant Staphylococcus aureus Bacteremia and Endocarditis: A Randomized Clinical Trial

Author: Ministerio de Ciencia, Innovación y Universidades (España), Red Española de Investigación en Patología Infecciosa, Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad (España), European Commission, Spanish Clinical Research Network, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Pujol, Miquel, Miró, José María, Shaw, Evelyn, Aguado, José María, San Juan, Rafael, Puig-Asensio, M., Pigrau, Carlos, Calbo, Esther, Montejo, Miguel, Rodríguez-Álvarez, Regino José, García-País, María José, Pintado, Vicente, Escudero-Sánchez, Rosa, López-Contreras, Joaquín, Morata, Laura, Montero, Milagros, Andrés, Marta, Pasquau-Liaño, Juan, Arenas-Miras, Maria del Mar, Padilla, Belén, Murillas, Javier, Jover-Sáenz, Alfredo, López-Cortés, Luis Eduardo, García-Prado, Graciano, Gasch, Oriol, Videla, Sebastián, Hereu, Pilar, Tebé, Cristian, Pallarès, Natalia, Sanllorente, Mireia, Domínguez, María Ángeles, Càmara, Jordi, Ferrer, Anna, Padullés, Ariadna, Cuervo, Guillermo, Carratalà, Jordi, Ministerio de Ciencia, Innovación y Universidades (España), Red Española de Investigación en Patología Infecciosa, Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad (España), European Commission, Spanish Clinical Research Network, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Pujol, Miquel, Miró, José María, Shaw, Evelyn, Aguado, José María, San Juan, Rafael, Puig-Asensio, M., Pigrau, Carlos, Calbo, Esther, Montejo, Miguel, Rodríguez-Álvarez, Regino José, García-País, María José, Pintado, Vicente, Escudero-Sánchez, Rosa, López-Contreras, Joaquín, Morata, Laura, Montero, Milagros, Andrés, Marta, Pasquau-Liaño, Juan, Arenas-Miras, Maria del Mar, Padilla, Belén, Murillas, Javier, Jover-Sáenz, Alfredo, López-Cortés, Luis Eduardo, García-Prado, Graciano, Gasch, Oriol, Videla, Sebastián, Hereu, Pilar, Tebé, Cristian, Pallarès, Natalia, Sanllorente, Mireia, Domínguez, María Ángeles, Càmara, Jordi, Ferrer, Anna, Padullés, Ariadna, Cuervo, Guillermo, and Carratalà, Jordi
Abstract: [Background] We aimed to determine whether daptomycin plus fosfomycin provides higher treatment success than daptomycin alone for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and endocarditis., [Methods] A randomized (1:1) phase 3 superiority, open-label, and parallel group clinical trial of adult inpatients with MRSA bacteremia was conducted at 18 Spanish hospitals. Patients were randomly assigned to receive either 10 mg/kg of daptomycin intravenously daily plus 2 g of fosfomycin intravenously every 6 hours, or 10 mg/kg of daptomycin intravenously daily. Primary endpoint was treatment success 6 weeks after the end of therapy., [Results] Of 167 patients randomized, 155 completed the trial and were assessed for the primary endpoint. Treatment success at 6 weeks after the end of therapy was achieved in 40 of 74 patients who received daptomycin plus fosfomycin and in 34 of 81 patients who were given daptomycin alone (54.1% vs 42.0%; relative risk, 1.29 [95% confidence interval, .93–1.8]; P = .135). At 6 weeks, daptomycin plus fosfomycin was associated with lower microbiologic failure (0 vs 9 patients; P = .003) and lower complicated bacteremia (16.2% vs 32.1%; P = .022). Adverse events leading to treatment discontinuation occurred in 13 of 74 patients (17.6%) receiving daptomycin plus fosfomycin, and in 4 of 81 patients (4.9%) receiving daptomycin alone (P = .018)., [Conclusions] Daptomycin plus fosfomycin provided 12% higher rate of treatment success than daptomycin alone, but this difference did not reach statistical significance. This antibiotic combination prevented microbiological failure and complicated bacteremia, but it was more often associated with adverse events., [Clinical Trials Registration] NCT01898338.
Published: 2021

14. Multicentre, randomised, open-label, phase IV–III study to evaluate the efficacy of cloxacillin plus fosfomycin versus cloxacillin alone in adult patients with methicillin-susceptible Staphylococcus aureus bacteraemia: study protocol for the SAFO trial

Author: Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad (España), Red Española de Investigación en Patología Infecciosa, Grillo, Sara, Cuervo, Guillermo, Carratalà, Jordi, San Juan, Rafael, Aguado, José María, Morata, Laura, Gómez-Zorrilla, Silvia, López-Contreras, Joaquín, Gasch, Oriol, Gomila-Grange, Aina, Iftimie, Simona, García-Prado, Graciano, Calbo, Esther, Boix-Palop, Lucía, Oriol, Isabel, Jover-Sáenz, Alfredo, López-Cortés, Luis Eduardo, Euba, Gorane, Aguirregabiria, Malen, García-País, María José, Gioia, Francesca, Paño, José Ramón, Pedro-Botet, María Luisa, Benítez, Rosa María, Pérez-Rodríguez, María Teresa, Meije, Yolanda, Loeches, Belén, Horna, Gestrudis, Berbel, Dàmaris, Domínguez, María Ángeles, Padullés, Ariadna, Cobo, Sara, Hereu, Pilar, Videla, Sebastián, Tebé, Cristian, Pallarès, Natalia, Miró, José María, Pujol, Miquel, Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad (España), Red Española de Investigación en Patología Infecciosa, Grillo, Sara, Cuervo, Guillermo, Carratalà, Jordi, San Juan, Rafael, Aguado, José María, Morata, Laura, Gómez-Zorrilla, Silvia, López-Contreras, Joaquín, Gasch, Oriol, Gomila-Grange, Aina, Iftimie, Simona, García-Prado, Graciano, Calbo, Esther, Boix-Palop, Lucía, Oriol, Isabel, Jover-Sáenz, Alfredo, López-Cortés, Luis Eduardo, Euba, Gorane, Aguirregabiria, Malen, García-País, María José, Gioia, Francesca, Paño, José Ramón, Pedro-Botet, María Luisa, Benítez, Rosa María, Pérez-Rodríguez, María Teresa, Meije, Yolanda, Loeches, Belén, Horna, Gestrudis, Berbel, Dàmaris, Domínguez, María Ángeles, Padullés, Ariadna, Cobo, Sara, Hereu, Pilar, Videla, Sebastián, Tebé, Cristian, Pallarès, Natalia, Miró, José María, and Pujol, Miquel
Abstract: [Introduction] Methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia is a frequent condition, with high mortality rates. There is a growing interest in identifying new therapeutic regimens able to reduce therapeutic failure and mortality observed with the standard of care of beta-lactam monotherapy. In vitro and small-scale studies have found synergy between cloxacillin and fosfomycin against S. aureus. Our aim is to test the hypothesis that cloxacillin plus fosfomycin achieves higher treatment success than cloxacillin alone in patients with MSSA bacteraemia., [Methods] We will perform a superiority, randomised, open-label, phase IV–III, two-armed parallel group (1:1) clinical trial at 20 Spanish tertiary hospitals. Adults (≥18 years) with isolation of MSSA from at least one blood culture ≤72 hours before inclusion with evidence of infection, will be randomly allocated to receive either cloxacillin 2 g/4-hour intravenous plus fosfomycin 3 g/6-hour intravenous or cloxacillin 2 g/4-hour intravenous alone for 7 days. After the first week, sequential treatment and total duration of antibiotic therapy will be determined according to clinical criteria by the attending physician. Primary endpoints: (1) Treatment success at day 7, a composite endpoint comprising all the following criteria: patient alive, stable or with improved quick-Sequential Organ Failure Assessment score, afebrile and with negative blood cultures for MSSA at day 7. (2) Treatment success at test of cure (TOC) visit: patient alive and no isolation of MSSA in blood culture or at another sterile site from day 8 until TOC (12 weeks after randomisation). We assume a rate of treatment success of 74% in the cloxacillin group. Accepting alpha risk of 0.05 and beta risk of 0.2 in a two-sided test, 183 subjects will be required in each of the control and experimental groups to obtain statistically significant difference of 12% (considered clinically significant)., [Ethics and dissemination] Ethical approval has been obtained from the Ethics Committee of Bellvitge University Hospital (AC069/18) and from the Spanish Medicines and Healthcare Product Regulatory Agency (AEMPS, AC069/18), and is valid for all participating centres under existing Spanish legislation. The results will be presented at international meetings and will be made available to patients and funders., [Trial registration number] The protocol has been approved by AEMPS with the Trial Registration Number EudraCT 2018-001207-37. ClinicalTrials.gov Identifier: NCT03959345; Pre-results.
Published: 2021

15. A Contemporary Picture of Enterococcal Endocarditis

Author: Pericás Pulico, Juan Manuel, Llopis, Jaume, Muñoz, Patricia, Gálvez-Acebal, Juan, Kestler Hernández, Martha, Valerio, Maricela, Hernández-Meneses, Marta, Goenaga Sánchez, Miguel Ángel, Cobo Belaustegui, Manuel, Montejo, Miguel, Ojeda Burgos, Guillermo, Sousa Regueiro, Dolores, Alarcón González, Arístides de, Ramos-Martínez, Antonio, Miró, José María, Pericás Pulico, Juan Manuel, Llopis, Jaume, Muñoz, Patricia, Gálvez-Acebal, Juan, Kestler Hernández, Martha, Valerio, Maricela, Hernández-Meneses, Marta, Goenaga Sánchez, Miguel Ángel, Cobo Belaustegui, Manuel, Montejo, Miguel, Ojeda Burgos, Guillermo, Sousa Regueiro, Dolores, Alarcón González, Arístides de, Ramos-Martínez, Antonio, and Miró, José María
Abstract: [Background] Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking., [Objectives] The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort., [Methods] This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses., [Results] Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p = 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%; p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse., [Conclusions] Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE.
Published: 2020

16. Role of age and comorbidities in mortality of patients with infective endocarditis

Author: Armiñanzas Castillo, Carlos, Fariñas-Álvarez, Concepción, Zarauza, Jesús, Muñoz, Patricia, González Ramallo, Víctor, Martínez-Sellés, Manuel, Miró, José María, Pericás Pulico, Juan Manuel, Goenaga Sánchez, Miguel Ángel, Ojeda Burgos, Guillermo, Rodríguez-Álvarez, Regino José, Moreno, Asunción, Morales, Carlos, Montejo, Miguel, Largo Pau, José, Cascales Alcolea, Eva, Ruiz de Gopegui Bordes, Enrique, Vinuesa García, David, Viqueira González, Monserrat, Goikoetxea-Aguirre, Josune, Azqueta, Manuel, Rosas, Gabriel, Fuster, David, Paya Martínez, Begoña, Marín-Arriaza, Mercedes, Arrizabalaga Asenjo, María, Loeches, Belén, Sarralde, Aurelio, Pajarón, Marcos, Alonso, Mª. del Mar, Gutiérrez-Cuadra, Manuel, Sepúlveda, M. A., Alcaraz Vidal, Begoña, Azcárate, Pedro, Fariñas, María del Carmen, López-Cortés, Luis Eduardo, Sitges, Marta, Cifuentes Luna, Carmen, Barquero, José M., Rodrigo, David, Gutiérrez Díez, José, Almendro Delia, Manuel, Río, A. del, Pericas, Roser, Pacho, Cristina, Núñez Morcillo, Juana, Agüero, Jesús, Aured Guallar, Carmen, Celemín, Daniel, Paré, Carlos, Llamas, Patricio, García Rosado, Dácil, Palomo, Carmen, Araji, Omar, García, Iván, Oteo, José Antonio, Giner Caro, José Antonio, Benito, Natividad, Canut, Andrés, Vidal Bonet, Laura, Ramos, Antonio, Rodríguez, David, Menárguez, Mª. Cruz, Castelo Corral, Laura, Echeverría, Tomás, García-López, María Victoria, Plazas, Joaquín, Pereda, Daniel, Fuerte, Ana, Rincón, Cristina, Aramendi, José, Prieto, A., Alonso, Ángel, Menéndez, José López, Blázquez, Ana, Rodríguez, Regino, Blanco, José Ramón, López, Francisco, Gaminde, Eduardo, Noureddine, Mariam, Jiménez Sánchez, Roberto, Miguel Gómez, Mª. Antonia, Durán, Mª. del Carmen, Rodríguez-García, Raquel, Reus, Sergio, Álvarez, Nemesio, Hermida, José Manuel, Porres, Juan Carlos, Sanz, Mercedes, Sánchez-Porto, Antonio, Soriano, Víctor, Hernández Torres, Alicia, Brunet, Mercè, Keituqwa Yañez, Iván, Idígoras, Pedro, Pons, Guillem, Bravo-Ferrer, José, Luque-Márquez, Rafael, Cueto, Marina de, Teira Cobo, Ramón, Castelo, Laura, Crespo, Alejandro, Lacalzada, Juan, Rodríguez Mayo, María, Iqbal-Mirza, Sadaf Zafar, Almela, Manel, Ramírez, José, Nassar, Ibrahim, Moya, José Luis, Ruiz, Soledad, Torre, Javier de la, Regueiro, Benito, Toledano Sierra, Pilar, Arribas, José Ramón, Egea Serrano, Pilar, Téllez, Adrián, Rial Bastón, Verónica, Cobos-Trigueros, Nazaret, Cuenca, José, Irurzun Zuazabal, Josu, Marco, Francesc, Plata-Ciezar, Antonio, Alonso, Luis Javier, Reguera-Iglesias, J. M., Matamala Adell, Marta, García Pavía, Pablo, Abad, Nuria Fernández, Hera, Jesús de la, Pérez Seco, Mª. Cruz, López-Soria, Leire, Asensi, Víctor, Aramburu, Javier, Bereciartúa, Elena, Gurguí, Mercè, Bodro, Marta, Rodríguez-Abella, Hugo, García Mansilla, Ana, García Mangas, Pilar, Gálvez-Acebal, Juan, Bellón Munera, Mª. Carmen, Ruiz Morales, Josefa, Tercero Martínez, Antonia, Rodríguez Bailón, Isabel, Cartañá, Ramón, Peña Monje, Alejandro, García-de-la-Mària, Cristina, Vega, Marino, Vidal, Bárbara, Saldaña, Araceli, Rodríguez-Créixems, Marta, Alarcón González, Arístides de, Martínez-Marcos, Francisco Javier, Cordo Mollar, José, Ninot, Salvador, Vitoria, Yolanda, Parra, José Antonio, Carrasco, Rafael, Vila, Jordi, Ortín Freire, Alejandro, García Leoni, Mª. Eugenia, Izaguirre Yarza, Alberto, Orden, Beatriz, Amado, Cristina, Pinilla, Blanca, Pinto, A., Mencia Bajo, Pilar, Escribano Garaizabal, Elena, Iribarren, José A., Castro, Beatriz, Calvo Jambrina, Román, Martín-Dávila, Pilar, Martínez, Francisco Javier, Kestler Hernández, Martha, Nieto, Javier, Valerio, Maricela, Iruretagoyena, José Ramón, Hernández Roca, José Joaquín, Vázquez, Pilar, Pomar, José L., Martín Quirós, Alejandro, Miguez Rey, Enrique, Centella, Tomasa, Lepe, José A., Arnaiz, A., Villoslada Gelabert, Aroa, Nicolás, David, Voces, Roberto, Llinares, Pedro, Rodríguez Esteban, Ángeles, Sánchez, Efrén, Azcona-Gutiérrez, José Manuel, Morena Valenzuela, Gonzalo de la, Moreno Torrico, Alfonso, Verde Moreno, Eduardo, Cuende, Ana María, Cobo Belaustegui, Manuel, Pericás Ramis, Pere, Gómez Izquierdo, Rubén, León Arguero, Víctor, Peláez Ballesta, Ana, Fernández Suárez, Jonathan, González-Rico, Claudia, Morales, Isabel, Soy, Dolors, Merino, Esperanza, Quintana, Eduardo, Segura Luque, Juan Carlos, Navas, Enrique, Gainzarain Arana, Juan Carlos, Álvarez, M., Iglesias Fraile, Lisardo, Hernández-Meneses, Marta, Falces, Carlos, Delgado Montero, Antonia, Cuerpo Caballero, Gregorio, Oliva, Enrique, Kortajarena Urkola, Xabier, Hidalgo-Tenorio, Carmen, Ivanova-Georgieva, Radka, Blanco, María José, Campaña Lázaro, Marta, García Uriarte, Óscar, Amor Espín, María Jesús Del, Llopis, Jaume, Costas, Carlos, Adán, Iván, García, Emilio, Bouza Santiago, Emilio, Muñoz García, Patricia, García-Álvarez, Lara, Telenti Asensio, Mauricio, Fernández, A.L., Reviejo, Carlos, Blanco, Roberto, Moreno Escobar, Eduardo, Tijeira, E., Calvo, Felicitas Elena, Martín López, Alejandro, Boado, María Victoria, Climent, Vicente, Fita, Guillermina, Mari Hualde, Amaia, Romero, María, Palacián Ruiz, Mª. Pilar, Ramírez, Ulises, Martínez, Amparo, Tolosana, José M., Ortiz de Zárate, Zuriñe, Rovira, Irene, Sousa Regueiro, Dolores, Urturi Matos, José Antonio, Haro, Juan Luis, Moreno-Rodríguez, Anai, García Vázquez, Elisa, Sánchez Cabrera, Valme, Jimeno Almazán, Amaya, Tarabini-Castellani, Paola, Ambrosioni, Juan, Méndez, Irene, Bermejo, Javier, Antorrena Miranda, Isabel, González, Jesús, Moreno, Mar, Ribas Blanco, Mª. Ángels, Domínguez, Fernando, García Domínguez, Gloria, Fernández Cruz, Ana, Heredero Gálvez, Eva, Sandoval, Elena, Maicas Bellido, Carolina, Armiñanzas Castillo, Carlos, Fariñas-Álvarez, Concepción, Zarauza, Jesús, Muñoz, Patricia, González Ramallo, Víctor, Martínez-Sellés, Manuel, Miró, José María, Pericás Pulico, Juan Manuel, Goenaga Sánchez, Miguel Ángel, Ojeda Burgos, Guillermo, Rodríguez-Álvarez, Regino José, Moreno, Asunción, Morales, Carlos, Montejo, Miguel, Largo Pau, José, Cascales Alcolea, Eva, Ruiz de Gopegui Bordes, Enrique, Vinuesa García, David, Viqueira González, Monserrat, Goikoetxea-Aguirre, Josune, Azqueta, Manuel, Rosas, Gabriel, Fuster, David, Paya Martínez, Begoña, Marín-Arriaza, Mercedes, Arrizabalaga Asenjo, María, Loeches, Belén, Sarralde, Aurelio, Pajarón, Marcos, Alonso, Mª. del Mar, Gutiérrez-Cuadra, Manuel, Sepúlveda, M. A., Alcaraz Vidal, Begoña, Azcárate, Pedro, Fariñas, María del Carmen, López-Cortés, Luis Eduardo, Sitges, Marta, Cifuentes Luna, Carmen, Barquero, José M., Rodrigo, David, Gutiérrez Díez, José, Almendro Delia, Manuel, Río, A. del, Pericas, Roser, Pacho, Cristina, Núñez Morcillo, Juana, Agüero, Jesús, Aured Guallar, Carmen, Celemín, Daniel, Paré, Carlos, Llamas, Patricio, García Rosado, Dácil, Palomo, Carmen, Araji, Omar, García, Iván, Oteo, José Antonio, Giner Caro, José Antonio, Benito, Natividad, Canut, Andrés, Vidal Bonet, Laura, Ramos, Antonio, Rodríguez, David, Menárguez, Mª. Cruz, Castelo Corral, Laura, Echeverría, Tomás, García-López, María Victoria, Plazas, Joaquín, Pereda, Daniel, Fuerte, Ana, Rincón, Cristina, Aramendi, José, Prieto, A., Alonso, Ángel, Menéndez, José López, Blázquez, Ana, Rodríguez, Regino, Blanco, José Ramón, López, Francisco, Gaminde, Eduardo, Noureddine, Mariam, Jiménez Sánchez, Roberto, Miguel Gómez, Mª. Antonia, Durán, Mª. del Carmen, Rodríguez-García, Raquel, Reus, Sergio, Álvarez, Nemesio, Hermida, José Manuel, Porres, Juan Carlos, Sanz, Mercedes, Sánchez-Porto, Antonio, Soriano, Víctor, Hernández Torres, Alicia, Brunet, Mercè, Keituqwa Yañez, Iván, Idígoras, Pedro, Pons, Guillem, Bravo-Ferrer, José, Luque-Márquez, Rafael, Cueto, Marina de, Teira Cobo, Ramón, Castelo, Laura, Crespo, Alejandro, Lacalzada, Juan, Rodríguez Mayo, María, Iqbal-Mirza, Sadaf Zafar, Almela, Manel, Ramírez, José, Nassar, Ibrahim, Moya, José Luis, Ruiz, Soledad, Torre, Javier de la, Regueiro, Benito, Toledano Sierra, Pilar, Arribas, José Ramón, Egea Serrano, Pilar, Téllez, Adrián, Rial Bastón, Verónica, Cobos-Trigueros, Nazaret, Cuenca, José, Irurzun Zuazabal, Josu, Marco, Francesc, Plata-Ciezar, Antonio, Alonso, Luis Javier, Reguera-Iglesias, J. M., Matamala Adell, Marta, García Pavía, Pablo, Abad, Nuria Fernández, Hera, Jesús de la, Pérez Seco, Mª. Cruz, López-Soria, Leire, Asensi, Víctor, Aramburu, Javier, Bereciartúa, Elena, Gurguí, Mercè, Bodro, Marta, Rodríguez-Abella, Hugo, García Mansilla, Ana, García Mangas, Pilar, Gálvez-Acebal, Juan, Bellón Munera, Mª. Carmen, Ruiz Morales, Josefa, Tercero Martínez, Antonia, Rodríguez Bailón, Isabel, Cartañá, Ramón, Peña Monje, Alejandro, García-de-la-Mària, Cristina, Vega, Marino, Vidal, Bárbara, Saldaña, Araceli, Rodríguez-Créixems, Marta, Alarcón González, Arístides de, Martínez-Marcos, Francisco Javier, Cordo Mollar, José, Ninot, Salvador, Vitoria, Yolanda, Parra, José Antonio, Carrasco, Rafael, Vila, Jordi, Ortín Freire, Alejandro, García Leoni, Mª. Eugenia, Izaguirre Yarza, Alberto, Orden, Beatriz, Amado, Cristina, Pinilla, Blanca, Pinto, A., Mencia Bajo, Pilar, Escribano Garaizabal, Elena, Iribarren, José A., Castro, Beatriz, Calvo Jambrina, Román, Martín-Dávila, Pilar, Martínez, Francisco Javier, Kestler Hernández, Martha, Nieto, Javier, Valerio, Maricela, Iruretagoyena, José Ramón, Hernández Roca, José Joaquín, Vázquez, Pilar, Pomar, José L., Martín Quirós, Alejandro, Miguez Rey, Enrique, Centella, Tomasa, Lepe, José A., Arnaiz, A., Villoslada Gelabert, Aroa, Nicolás, David, Voces, Roberto, Llinares, Pedro, Rodríguez Esteban, Ángeles, Sánchez, Efrén, Azcona-Gutiérrez, José Manuel, Morena Valenzuela, Gonzalo de la, Moreno Torrico, Alfonso, Verde Moreno, Eduardo, Cuende, Ana María, Cobo Belaustegui, Manuel, Pericás Ramis, Pere, Gómez Izquierdo, Rubén, León Arguero, Víctor, Peláez Ballesta, Ana, Fernández Suárez, Jonathan, González-Rico, Claudia, Morales, Isabel, Soy, Dolors, Merino, Esperanza, Quintana, Eduardo, Segura Luque, Juan Carlos, Navas, Enrique, Gainzarain Arana, Juan Carlos, Álvarez, M., Iglesias Fraile, Lisardo, Hernández-Meneses, Marta, Falces, Carlos, Delgado Montero, Antonia, Cuerpo Caballero, Gregorio, Oliva, Enrique, Kortajarena Urkola, Xabier, Hidalgo-Tenorio, Carmen, Ivanova-Georgieva, Radka, Blanco, María José, Campaña Lázaro, Marta, García Uriarte, Óscar, Amor Espín, María Jesús Del, Llopis, Jaume, Costas, Carlos, Adán, Iván, García, Emilio, Bouza Santiago, Emilio, Muñoz García, Patricia, García-Álvarez, Lara, Telenti Asensio, Mauricio, Fernández, A.L., Reviejo, Carlos, Blanco, Roberto, Moreno Escobar, Eduardo, Tijeira, E., Calvo, Felicitas Elena, Martín López, Alejandro, Boado, María Victoria, Climent, Vicente, Fita, Guillermina, Mari Hualde, Amaia, Romero, María, Palacián Ruiz, Mª. Pilar, Ramírez, Ulises, Martínez, Amparo, Tolosana, José M., Ortiz de Zárate, Zuriñe, Rovira, Irene, Sousa Regueiro, Dolores, Urturi Matos, José Antonio, Haro, Juan Luis, Moreno-Rodríguez, Anai, García Vázquez, Elisa, Sánchez Cabrera, Valme, Jimeno Almazán, Amaya, Tarabini-Castellani, Paola, Ambrosioni, Juan, Méndez, Irene, Bermejo, Javier, Antorrena Miranda, Isabel, González, Jesús, Moreno, Mar, Ribas Blanco, Mª. Ángels, Domínguez, Fernando, García Domínguez, Gloria, Fernández Cruz, Ana, Heredero Gálvez, Eva, Sandoval, Elena, and Maicas Bellido, Carolina
Abstract: [Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group.
Published: 2019

17. Analysis of the costs and cost-effectiveness of the guidelines recommended by the 2018 GESIDA/Spanish National AIDS Plan for initial antiretroviral therapy in HIV-infected adults

Author: Pérez-Molina, José A., Martínez, Esteban, Blasco, Antonio Javier, Arribas, José Ramón, Domingo, Pere, Iribarren, José A., Knobel, Hernando, Lázaro, Pablo, López-Aldeguer, José, Lozano, Fernando, Mariño, Ana, Miró, José María, Moreno, Santiago, Negredo, Eugenia, Pulido, Federico, Rubio, Rafael, Santos, Jesús, Torre, Javier de la, Tuset, Montserrat, von Wichman, Miguel A., Gatell, José María, Pérez-Molina, José A., Martínez, Esteban, Blasco, Antonio Javier, Arribas, José Ramón, Domingo, Pere, Iribarren, José A., Knobel, Hernando, Lázaro, Pablo, López-Aldeguer, José, Lozano, Fernando, Mariño, Ana, Miró, José María, Moreno, Santiago, Negredo, Eugenia, Pulido, Federico, Rubio, Rafael, Santos, Jesús, Torre, Javier de la, Tuset, Montserrat, von Wichman, Miguel A., and Gatell, José María
Abstract: [Background]: The GESIDA/National AIDS Plan expert panel recommended preferred regimens (PR), alternative regimens (AR) and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2018. The objective of this study was to evaluate the costs and the efficiency of initiating treatment with PR and AR. [Methods]: Economic assessment of costs and efficiency (cost-effectiveness) based on decision tree analyses. Effectiveness was defined as the probability of reporting a viral load <50 copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug-resistance studies) over the first 48 weeks. The payer perspective (National Health System) was applied considering only differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting was Spain and the costs correspond to those of 2018. A deterministic sensitivity analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. [Results]: In the base-case scenario, the cost of initiating treatment ranges from 6788 euros for TAF/FTC/RPV (AR) to 10,649 euros for TAF/FTC + RAL (PR). The effectiveness varies from 0.82 for TAF/FTC + DRV/r (AR) to 0.91 for TAF/FTC + DTG (PR). The efficiency, in terms of cost-effectiveness, ranges from 7814 to 12,412 euros per responder at 48 weeks, for ABC/3TC/DTG (PR) and TAF/FTC + RAL (PR), respectively. [Conclusion]: Considering ART official prices, the most efficient regimen was ABC/3TC/DTG (PR), followed by TAF/FTC/RPV (AR) and TAF/FTC/EVG/COBI (AR)., [Introducción]: El panel de expertos de GESIDA/Plan Nacional del Sida ha recomendado pautas preferentes (PP), pautas alternativas (PA) y otras pautas (OP) para el tratamiento antirretroviral (TAR) como terapia de inicio en pacientes infectados por VIH para 2018. El objetivo de este estudio es evaluar los costes y la eficiencia de iniciar tratamiento con PP y PA. [Métodos]: Evaluación económica de costes y eficiencia (coste/eficacia) mediante construcción de árboles de decisión. Se definió eficacia como la probabilidad de tener carga viral <50 copias/ml en la semana 48 en análisis por intención de tratar. Se definió coste de iniciar tratamiento con una pauta como los costes del TAR y de todas sus consecuencias (efectos adversos, cambios de pauta y estudio de resistencias) que se producen en las siguientes 48 semanas. Se utilizó la perspectiva del Sistema Nacional de Salud, considerando solo costes directos diferenciales: TAR (a precio oficial), manejo de efectos adversos, estudios de resistencias y determinación de HLA-B*5701. El ámbito es España, con costes de 2018. Se realizó un análisis de sensibilidad determinista construyendo 3 escenarios para cada pauta: basal, más favorable y más desfavorable. [Resultados]: En el escenario basal, los costes de iniciar tratamiento oscilaron entre 6.788 para TAF/FTC/RPV (PA) y 10.649 para TAF/FTC + RAL (PP). La eficacia osciló entre 0,82 para TAF/FTC + DRV/r (PA) y 0,91 para TAF/FTC + DTG (PP). La eficiencia, en términos de coste/eficacia, osciló entre 7.814 y 12.412 por respondedor a las 48 semanas, para ABC/3TC/DTG (PP) y TAF/FTC + RAL (PP), respectivamente. [Conclusión]: Considerando el precio oficial del TAR, la pauta más eficiente fue ABC/3TC/DTG (PP), seguida de TAF/FTC/RPV (PA) y TAF/FTC/EVG/COBI (PA).
Published: 2019

18. Outpatient parenteral antibiotic treatment for infective endocarditis: a prospective cohort study from the GAMES cohort

Author: Instituto de Salud Carlos III, European Commission, Ministerio de Economía y Competitividad (España), European Society of Clinical Microbiology and Infectious Diseases, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Pericás Pulico, Juan Manuel, Llopis, Jaume, González Ramallo, Víctor, Goenaga Sánchez, Miguel Ángel, Muñoz García, Patricia, García-Leoni, M. Eugenia, Fariñas, María del Carmen, Pajarón, Marcos, Ambrosioni, Juan, Luque-Márquez, Rafael, Goikoetxea-Aguirre, Josune, Oteo, José Antonio, Carrizo, Enara, Bodro, Marta, Reguera-Iglesias, J. M., Navas, Enrique, Hidalgo-Tenorio, Carmen, Miró, José María, Instituto de Salud Carlos III, European Commission, Ministerio de Economía y Competitividad (España), European Society of Clinical Microbiology and Infectious Diseases, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Pericás Pulico, Juan Manuel, Llopis, Jaume, González Ramallo, Víctor, Goenaga Sánchez, Miguel Ángel, Muñoz García, Patricia, García-Leoni, M. Eugenia, Fariñas, María del Carmen, Pajarón, Marcos, Ambrosioni, Juan, Luque-Márquez, Rafael, Goikoetxea-Aguirre, Josune, Oteo, José Antonio, Carrizo, Enara, Bodro, Marta, Reguera-Iglesias, J. M., Navas, Enrique, Hidalgo-Tenorio, Carmen, and Miró, José María
Abstract: [Background] Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT). [Methods] Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008–2012) was performed. [Results] A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56–76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32–54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P < .001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04–1.42; P = .01) and cardiac surgery (OR, 0.24; 95% CI, .09–.63; P = .04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI, .22–.98; P = .007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission. [Conclusions] OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded.
Published: 2019

19. DALBACEN cohort: dalbavancin as consolidation therapy in patients with endocarditis and/or bloodstream infection produced by gram-positive cocci

Author: Hidalgo-Tenorio, Carmen, Vinuesa García, David, Plata-Ciezar, Antonio, Martín-Dávila, Pilar, Iftimie, Simona, Sequera, Sergio, Loeches, Belén, López-Cortés, Luis Eduardo, Fariñas, María del Carmen, Fernández-Roldán, Concepción, Javier-Martinez, Rosario, Muñoz García, Patricia, Arenas-Miras, Maria del Mar, Martínez-Marcos, Francisco Javier, Miró, José María, Herrero-Rodríguez, Carmen, Bereciartúa, Elena, De Jesus, Samantha E., Pasquau-Liaño, Juan, Hidalgo-Tenorio, Carmen, Vinuesa García, David, Plata-Ciezar, Antonio, Martín-Dávila, Pilar, Iftimie, Simona, Sequera, Sergio, Loeches, Belén, López-Cortés, Luis Eduardo, Fariñas, María del Carmen, Fernández-Roldán, Concepción, Javier-Martinez, Rosario, Muñoz García, Patricia, Arenas-Miras, Maria del Mar, Martínez-Marcos, Francisco Javier, Miró, José María, Herrero-Rodríguez, Carmen, Bereciartúa, Elena, De Jesus, Samantha E., and Pasquau-Liaño, Juan
Abstract: [Objectives] To analyse the effectiveness of dalbavancin (DBV) in clinical practice as consolidation therapy in patients with bloodstream infection (BSI) and/or infective endocarditis (IE) produced by gram-positive cocci (GPC), as well as its safety and pharmacoeconomic impact. [Methods] A multicentre, observational and retrospective study was conducted of hospitalised patients with IE and/or BSI produced by GPC who received at least one dose of DBV. Clinical response was assessed during hospitalization, at 3 months and at 1 year. [Results] Eighty-three patients with median age of 73 years were enrolled; 73.5% were male; 59.04% had BSI and 49.04% IE (44.04% prosthetic valve IE, 32.4% native IE, 23.5% pacemaker lead). The most frequently isolated microorganism was Staphylococcus aureus in BSI (49%) and coagulase-negative staphylococci in IE (44.1%). All patients with IE were clinically cured in hospital; at 12 months, there was 2.9% loss to follow-up, 8.8% mortality unrelated to IE, and 2.9% therapeutic failure rate. The percentage effectiveness of DBV to treat IE was 96.7%. The clinical cure rate for BSI was 100% during hospital stay and at 3 months; there were no recurrences or deaths during the follow-up. No patient discontinued treatment for adverse events. The saving in hospital stay was 636 days for BSI (315,424.20€) and 557 days for IE (283,187.45€). [Conclusions] DBV is an effective consolidation antibiotic therapy in clinically stabilized patients with IE and/or BSI. It proved to be a cost-effective treatment, reducing the hospital stay, thanks to the pharmacokinetic/pharmacodynamic profile of this drug.
Published: 2019

20. Effect of the type of surgical indication on mortality in patients with infective endocarditis who are rejected for surgical intervention

Author: Ramos-Martínez, Antonio, Calderón-Parra, Jorge, Miró, José María, Muñoz García, Patricia, Rodríguez-Abella, Hugo, Varelio, Maricela, Alarcón González, Arístides de, Luque-Márquez, Rafael, Ambrosioni, Juan, Fariñas, María del Carmen, Goenaga Sánchez, Miguel Ángel, Oteo, José Antonio, Martínez-Marcos, Francisco Javier, Vinuesa García, David, Domínhuez, Fernando, Ramos-Martínez, Antonio, Calderón-Parra, Jorge, Miró, José María, Muñoz García, Patricia, Rodríguez-Abella, Hugo, Varelio, Maricela, Alarcón González, Arístides de, Luque-Márquez, Rafael, Ambrosioni, Juan, Fariñas, María del Carmen, Goenaga Sánchez, Miguel Ángel, Oteo, José Antonio, Martínez-Marcos, Francisco Javier, Vinuesa García, David, and Domínhuez, Fernando
Abstract: [Aim] To evaluate the effect of the type of surgical indication on mortality in infective endocarditis (IE) patients who are rejected for surgery., [Methods and results] From January 2008 to December 2016, 2714 patients with definite left-sided IE were attended in the participating hospitals. One thousand six hundred and fifty-three patients (60.9%) presented surgical indications. Five hundred and thirty-eight patients (32.5%) presented surgical indications but received medical treatment alone. The indications for surgery in these patients were uncontrolled infection (366 patients, 68%), heart failure (168 patients, 31.3%) and prevention of embolism (148 patients, 27.6%). One hundred and thirty patients (24.2%) presented more than one indication. The mortality during hospital admission was 60% (323 patients). The in-hospital mortality of patients whose indication for surgery was heart failure, uncontrolled infection or risk of embolism was 75.6%, 61.4% and 54.7%, respectively (p < 0.001). Surgical indications due to heart failure (OR: 3.24; CI 95%: 1.99–5.9) or uncontrolled infection (OR: 1.83; CI 95%: 1.04–3.18) were independently associated with a fatal outcome during hospital admission. Mortality during the first year was 75.4%. The mortality during the first year in patients whose indication for surgery was heart failure, uncontrolled infection or risk of embolism was 85.9%, 76.7% and 72.7%, respectively (p = 0.016). Surgical indication due to heart failure (OR: 3.03; CI 95%: 1.53–5.98) were independently associated with fatal outcome during the first year., [Conclusions] The type of surgical indication is associated with mortality in IE patients who are rejected for surgical intervention.
Published: 2019

21. Executive summary of the GeSIDA/National AIDS Plan consensus document on antiretroviral therapy in adults infected by the human immunodeficiency virus (updated January 2018)

Author: Pérez-Molina, José A., Polo, Rosa, López-Aldeguer, José, Lozano, Fernando, Aguirrebengoa, Koldo, Arribas, José Ramón, Boix, Vicente, Berenguer, Juan, Blanco, José Ramón, Domingo, Pere, Estrada Pérez, Vicente, Galindo, María José, García, Federico, Gatell, José María, González-García, Juan, Gutiérrez, Félix, Iribarren, José A., Knobel, Hernando, Llibre, Josep María, López Bernaldo de Quirós, Juan Carlos, López-Cortés, Luis F., Losa, Juan Emilio, Mariño, Ana, Miró, José María, Montes, María Luisa, Moreno, Santiago, Negredo, Eugenia, Pérez-Elías, María Jesús, Podzamczer, Daniel, Portilla, Joaquín, Poveda, Eva, Pulido, Federico, Ribera, Esteban, Rivero, Antonio, Rubio, Rafael, Santos, Jesús, Sanz-Moreno, José, Sanz-Sanz, Jesús, Serrano, Sergio, Torre, Javier de la, Tuset, Montserrat, von Wichman, Miguel A., Martínez, Esteban, Pérez-Molina, José A., Polo, Rosa, López-Aldeguer, José, Lozano, Fernando, Aguirrebengoa, Koldo, Arribas, José Ramón, Boix, Vicente, Berenguer, Juan, Blanco, José Ramón, Domingo, Pere, Estrada Pérez, Vicente, Galindo, María José, García, Federico, Gatell, José María, González-García, Juan, Gutiérrez, Félix, Iribarren, José A., Knobel, Hernando, Llibre, Josep María, López Bernaldo de Quirós, Juan Carlos, López-Cortés, Luis F., Losa, Juan Emilio, Mariño, Ana, Miró, José María, Montes, María Luisa, Moreno, Santiago, Negredo, Eugenia, Pérez-Elías, María Jesús, Podzamczer, Daniel, Portilla, Joaquín, Poveda, Eva, Pulido, Federico, Ribera, Esteban, Rivero, Antonio, Rubio, Rafael, Santos, Jesús, Sanz-Moreno, José, Sanz-Sanz, Jesús, Serrano, Sergio, Torre, Javier de la, Tuset, Montserrat, von Wichman, Miguel A., and Martínez, Esteban
Abstract: [EN] This update to the document on antiretroviral therapy (ART) in adults, which has been prepared jointly by GeSIDA and the Spanish National AIDS Plan for the last two decades, supersedes the document published in 2017.1 The update provides physicians treating HIV-1-infected adults with evidence-based recommendations to guide their therapeutic decisions. The main difference with respect to the previous document concerns recommended initial ART regimens, only three of which are maintained as preferential. All three include dolutegravir or raltegravir, together with emtricitabine/tenofovir alafenamide or abacavir/lamivudine. Other differences concern the section on switching ART in patients with suppressed viral replication, which now includes new two- and three-drug regimens, and the antiretroviral drugs recommended for pregnant women and patients with tuberculosis. A recommendation has also been added for patients who present with acute HIV infection after pre-exposure prophylaxis., [ES] Esta actualización del documento sobre el tratamiento antirretroviral (TAR) en adultos que GeSIDA y el PNS elaboran desde hace 2 décadas, reemplaza a la de 20171. Su objetivo es proporcionar a los clínicos que tratan a adultos con infección por el VIH-1 recomendaciones basadas en evidencias científicas para guiar sus decisiones terapéuticas. El principal cambio respecto al documento previo incumbe a los regímenes recomendados para el TAR de inicio, solo 3 de los cuales se mantienen como preferentes, incluyendo todos ellos dolutegravir o raltegravir junto con emtricitabina/tenofovir alafenamida o abacavir/lamivudina. Otros cambios conciernen al apartado de cambio del TAR en pacientes con replicación viral suprimida, en el que se han incluido nuevos regímenes de 2 y 3 fármacos, y a los antirretrovirales recomendados en embarazadas o en pacientes con tuberculosis. Se ha añadido también una recomendación para personas que habiendo realizado profilaxis pre-exposición al VIH presentan una infección aguda por dicho virus.
Published: 2019

22. Epidemiological and clinical characteristics of Streptococcus tigurinus endocarditis

Author: Institut d'Investigacions Biomèdiques August Pi i Sunyer, Ercibengoa, María, Goenaga Sánchez, Miguel Ángel, Ardanuy, Carmen, Grau, Inmaculada, García-de-la-Mària, Cristina, Almela, Manel, Miró, José María, Navas, Enrique, Fariñas, María del Carmen, Ruiz de Alegría, Carlos, Torre, Javier de la, Fernández, Fernando, Marín-Arriaza, Mercedes, Muñoz García, Patricia, Orden, Beatriz, Oteo, José Antonio, García-Álvarez, Lara, Alarcón González, Arístides de, Lepe, José A., Marimón, José María, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Ercibengoa, María, Goenaga Sánchez, Miguel Ángel, Ardanuy, Carmen, Grau, Inmaculada, García-de-la-Mària, Cristina, Almela, Manel, Miró, José María, Navas, Enrique, Fariñas, María del Carmen, Ruiz de Alegría, Carlos, Torre, Javier de la, Fernández, Fernando, Marín-Arriaza, Mercedes, Muñoz García, Patricia, Orden, Beatriz, Oteo, José Antonio, García-Álvarez, Lara, Alarcón González, Arístides de, Lepe, José A., and Marimón, José María
Abstract: [Background] Streptococcus tigurinus was recently described as a new streptococcal species within the viridans group streptococci (VGS). The objectives of the present work were to analyse the clinical and microbiological characteristics of S. tigurinus isolated from patients with bacteraemias, to determine the prevalence of S. tigurinus among VGS endocarditis in Spain, and to compare the clinical characteristics and outcomes of endocarditis caused by S. tigurinus and other VGS., [Methods] Retrospective nationwide study, performed between 2008 and 2016 in 9 Spanish hospitals from 7 different provinces comprising 237 cases of infective endocarditis. Streptococcal isolates were identified by sequencing fragments of their 16S rRNA, sodA and groEL genes. Clinical data of patients with streptococcal endocarditis were prospectively collected according to a pre-established protocol., [Results] Patients with endocarditis represented 7/9 (77.8%) and 26/86 (30.2%) of the bacteraemias caused by S. tigurinus and other VGS, respectively (p < 0.001), in two of the hospital participants. Among patients with streptococcal endocarditis, 12 different Streptococcus species were recognized being S. oralis, S. tigurinus and S. mitis the three more common. No relevant statistical differences were observed in the clinical characteristics and outcomes of endocarditis caused by the different VGS species., [Conclusions] In this multicenter study performed in Spain, S. tigurinus showed a higher predilection for the endocardial endothelium as compared to other VGS. However, clinical characteristics and outcomes of endocarditis caused by S. tigurinus did not significantly differ from endocarditis caused by other oral streptococci.
Published: 2019

23. Efficacy and safety of fosfomycin plus imipenem versus vancomycin for complicated bacteraemia and endocarditis due to methicillin-resistant Staphylococcus aureus: a randomized clinical trial

Author: Ministerio de Sanidad y Consumo (España), Instituto de Salud Carlos III, Ministerio de Economía y Competitividad (España), Institut d'Investigacions Biomèdiques August Pi i Sunyer, European Society of Clinical Microbiology and Infectious Diseases, Federation of European Microbiological Societies, Pericás Pulico, Juan Manuel, Moreno, Asunción, Almela, Manel, García-de-la-Mària, Cristina, Marco, Francesc, Muñoz García, Patricia, Peña, Carmen, Alarcón González, Arístides de, Río, A. del, Eworo, A., Cruceta, A., Paré, J. C., Mestres, C. A., Miró, José María, Ministerio de Sanidad y Consumo (España), Instituto de Salud Carlos III, Ministerio de Economía y Competitividad (España), Institut d'Investigacions Biomèdiques August Pi i Sunyer, European Society of Clinical Microbiology and Infectious Diseases, Federation of European Microbiological Societies, Pericás Pulico, Juan Manuel, Moreno, Asunción, Almela, Manel, García-de-la-Mària, Cristina, Marco, Francesc, Muñoz García, Patricia, Peña, Carmen, Alarcón González, Arístides de, Río, A. del, Eworo, A., Cruceta, A., Paré, J. C., Mestres, C. A., and Miró, José María
Published: 2018

24. Cohort profile: Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord

Author: Chêne, Geneviève, Miró, José María, Barger, Diana, Termote, Monique, Schwimmer, Christine, Brandt, Rikke Salbøl, Friis-Møller, Nina, Raben, Dorthe, Haerry, David, Egger, Matthias, Weller, Ian, Phillips, Andrew N., De Wit, Stéphane, Costagliola, Dominique, Sterne, Jonathan, Furrer, Hansjakob, del Amo, Julia, Mocroft, Amanda, d'Arminio Monforte, Antonella, Dabis, François, Chêne, Geneviève, Miró, José María, Barger, Diana, Termote, Monique, Schwimmer, Christine, Brandt, Rikke Salbøl, Friis-Møller, Nina, Raben, Dorthe, Haerry, David, Egger, Matthias, Weller, Ian, Phillips, Andrew N., De Wit, Stéphane, Costagliola, Dominique, Sterne, Jonathan, Furrer, Hansjakob, del Amo, Julia, Mocroft, Amanda, d'Arminio Monforte, Antonella, and Dabis, François
Abstract: SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2017

25. Nonnucleoside Reverse-transcriptase Inhibitor- vs Ritonavir-boosted Protease Inhibitor-based Regimens for Initial Treatment of HIV Infection: A Systematic Review and Metaanalysis of Randomized Trials

Author: Borges, Alvaro Humberto, Huedo-Medina, Tania Bibiana, Hughes, Michael J.M.B., Huppler Hullsiek, Katherine, Khabo, Paul, Komati, Stephanus, Kumar, Princy Suresh, Lockman, Shahin, MacArthur, Rodger R.D., Maggiolo, Franco, Matteelli, Alberto, Lundh, Andreas, Miró, José María, Oka, Shinichi, Petoumenos, Kathy, Puls, Rebekah R.L., Riddler, Sharon S.A., Sax, Paul Edward Dward P.E., Sierra-Madero, Juan, Torti, Carlo, Lundgren, Jens D, Tendal, Britta, Bartlett, John J.A., Clumeck, Nathan, Costagliola, Dominique, Daar, Eric E.S., Echeverría, Patrícia, Gisslén, Magnus, Borges, Alvaro Humberto, Huedo-Medina, Tania Bibiana, Hughes, Michael J.M.B., Huppler Hullsiek, Katherine, Khabo, Paul, Komati, Stephanus, Kumar, Princy Suresh, Lockman, Shahin, MacArthur, Rodger R.D., Maggiolo, Franco, Matteelli, Alberto, Lundh, Andreas, Miró, José María, Oka, Shinichi, Petoumenos, Kathy, Puls, Rebekah R.L., Riddler, Sharon S.A., Sax, Paul Edward Dward P.E., Sierra-Madero, Juan, Torti, Carlo, Lundgren, Jens D, Tendal, Britta, Bartlett, John J.A., Clumeck, Nathan, Costagliola, Dominique, Daar, Eric E.S., Echeverría, Patrícia, and Gisslén, Magnus
Abstract: BACKGROUND: Previous studies suggest that nonnucleoside reverse-transcriptase inhibitors (NNRTIs) cause faster virologic suppression, while ritonavir-boosted protease inhibitors (PI/r) recover more CD4 cells. However, individual trials have not been powered to compare clinical outcomes., SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2016

26. The incidence of AIDS-defining illnesses at a current CD4 count ≥200 cells/μL in the post-combination antiretroviral therapy era

Author: Mocroft, Amanda, Furrer, Hansjakob, Miró, José María, Reiss, Peter, Mussini, Cristina, Kirk, Ole, Kjaer, Jesper, Grarup, Jesper, Lundgren, Jens D, Obel, Niels, Abgrall, Sophie, Ayayi, S., Bartmeyer, Barbara, Braun, Dominique Laurent D., Castagna, Antonella, d'Arminio Monforte, Antonella, Gazzard, Brian George, Gutiérrez, Félix, Hurtado, Isabel Cristina I., Jansen, Klaus, Meyer, Laurence, Muñoz, Patricia, Soler, P., Papadopoulos, Antonios, Raffi, François, Ramos, Jose Tomas, Rockstroh, Jürgen, Salmon, Dominique, Torti, Carlo, Warszawski, Josiane, De Wit, Stéphane, Zangerle, Robert, Fabre-Colin, Céline, Chêne, Geneviève, Mocroft, Amanda, Furrer, Hansjakob, Miró, José María, Reiss, Peter, Mussini, Cristina, Kirk, Ole, Kjaer, Jesper, Grarup, Jesper, Lundgren, Jens D, Obel, Niels, Abgrall, Sophie, Ayayi, S., Bartmeyer, Barbara, Braun, Dominique Laurent D., Castagna, Antonella, d'Arminio Monforte, Antonella, Gazzard, Brian George, Gutiérrez, Félix, Hurtado, Isabel Cristina I., Jansen, Klaus, Meyer, Laurence, Muñoz, Patricia, Soler, P., Papadopoulos, Antonios, Raffi, François, Ramos, Jose Tomas, Rockstroh, Jürgen, Salmon, Dominique, Torti, Carlo, Warszawski, Josiane, De Wit, Stéphane, Zangerle, Robert, Fabre-Colin, Céline, and Chêne, Geneviève
Abstract: Background. Few studies consider the incidence of individual AIDS-defining illnesses (ADIs) at higher CD4 counts, relevant on a population level for monitoring and resource allocation. Methods. Individuals from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) aged ≥14 years with ≥1 CD4 count of ≥200 μL between 1998 and 2010 were included. Incidence rates (per 1000 personyears of follow-up [PYFU]) were calculated for each ADI within different CD4 strata; Poisson regression, using generalized estimating equations and robust standard errors, was used to model rates of ADIs with current CD4 ≥500/μL. Results. A total of 12 135 ADIs occurred at a CD4 count of ≥200 cells/μL among 207 539 persons with 1 154 803 PYFU. Incidence rates declined from 20.5 per 1000 PYFU (95% confidence interval [CI], 20.0-21.1 per 1000 PYFU) with current CD4 200-349 cells/μL to 4.1 per 1000 PYFU (95% CI, 3.6-4.6 per 1000 PYFU) with current CD4 ≥ 1000 cells/μL. Persons with a current CD4 of 500-749 cells/μL had a significantly higher rate of ADIs (adjusted incidence rate ratio [aIRR], 1.20; 95% CI, 1.10-1.32), whereas those with a current CD4 of ≥1000 cells/μL had a similar rate (aIRR, 0.92; 95% CI, 79-1.07), compared to a current CD4 of 750-999 cells/μL. Results were consistent in persons with high or low viral load. Findings were stronger for malignant ADIs (aIRR, 1.52; 95% CI, 1.25-1.86) than for nonmalignant ADIs (aIRR, 1.12; 95% CI, 1.01-1.25), comparing persons with a current CD4 of 500-749 cells/μL to 750-999 cells/μL. Discussion. The incidence of ADIs was higher in individuals with a current CD4 count of 500-749 cells/μL compared to those with a CD4 count of 750-999 cells/μL, but did not decrease further at higher CD4 counts. Results were similar in patients virologically suppressed on combination antiretroviral therapy, suggesting that immune reconstitution is not complete until the CD4 increases to >750 cells/μL. © The Author 2013. Published by Oxford Univ, SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2013

27. CD4 cell count and the risk of AIDS or death in HIV-Infected adults on combination antiretroviral therapy with a suppressed viral load: a longitudinal cohort study from COHERE.

Author: Opportunistic Infections Project Team of the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord, Young, Jim, Psichogiou, Mina, Meyer, Laurence, Ayayi, Sylvie, Grabar, Sophie, Raffi, François, Reiss, Peter, Gazzard, Brian, Sharland, Mike, Gutiérrez, Félix, Obel, Niels, Kirk, Ole, Miró, José María, Furrer, Hansjakob, Castagna, Antonella, De Wit, Stéphane, Muñoz, Josefa, Kjaer, Jesper, Grarup, Jesper, Chêne, Geneviève, Bucher, Heiner H.C., Opportunistic Infections Project Team of the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord, Young, Jim, Psichogiou, Mina, Meyer, Laurence, Ayayi, Sylvie, Grabar, Sophie, Raffi, François, Reiss, Peter, Gazzard, Brian, Sharland, Mike, Gutiérrez, Félix, Obel, Niels, Kirk, Ole, Miró, José María, Furrer, Hansjakob, Castagna, Antonella, De Wit, Stéphane, Muñoz, Josefa, Kjaer, Jesper, Grarup, Jesper, Chêne, Geneviève, and Bucher, Heiner H.C.
Abstract: Most adults infected with HIV achieve viral suppression within a year of starting combination antiretroviral therapy (cART). It is important to understand the risk of AIDS events or death for patients with a suppressed viral load., info:eu-repo/semantics/published
Published: 2012

28. Restoration of T cell responses to Toxoplasma gondii after successful combined antiretroviral therapy in patients with AIDS with previous toxoplasmic encephalitis

Author: Lejeune, Marylène, Plana, Montserrat, Gallart, Teresa, Miró, José María, Lazzari, Elisa De, García, Felipe, Claramonte, Xavier, Martinez, Esteban, Mallolas, Josep, Gatell, Jose, Ribera, Esteban, Arrizabalaga, Julio, Arribas, Jose, Domingo, Pere, Ferrer, Elena, Podzamczer, Daniel, Valls, María Eugenia, Pumarola, Tomás, Jacquet, Alain, Lejeune, Marylène, Plana, Montserrat, Gallart, Teresa, Miró, José María, Lazzari, Elisa De, García, Felipe, Claramonte, Xavier, Martinez, Esteban, Mallolas, Josep, Gatell, Jose, Ribera, Esteban, Arrizabalaga, Julio, Arribas, Jose, Domingo, Pere, Ferrer, Elena, Podzamczer, Daniel, Valls, María Eugenia, Pumarola, Tomás, and Jacquet, Alain
Abstract: Background: It is unknown whether a Toxoplasma gondii-specific T cell response is restored after successful combined antiretroviral therapy (cART) in patients with AIDS and current or previous toxoplasmic encephalitis (TE). Methods: We performed a multicenter cross-sectional study with 17 healthy T. gondii-positive human immunodeficiency virus (HIV)-1-uninfected individuals and 90 patients coinfected with HIV-1 and T. gondii distributed in 5 groups according to their CD4+ T cell counts and T. gondii infection (with or without current or previous TE). We investigated the lymphocyte proliferative response (LPR) and interferon (IFN)-γ production in response to T. gondii soluble antigen extract (SATg) and as CD4+ and CD8+ T cell subsets. Results: SATg-specific LPR and IFN-γ production were not observed in many of the most immunosuppressed patients (CD4+ T cell count, <200 cells/μL, with or without current or previous TE). By contrast, these responses occurred in a considerable percentage (LPR, 43%; IFN-γ production, 80%) of patients receiving successful cART (CD4 + T cell count, >200 cells/μL) who presented with TE and had already stopped secondary TE prophylaxis. Similar results were found in immunocompetent asymptomatic patients who did not receive TE prophylaxis. The predictors of SATgspecific T cell responses and IFN-γ production were a cART-mediated increase in CD4+ T cell count and LPR to phytohemagglutinin and viral suppression and a decrease in the activated (CD38+) CD8+ T cell count, respectively. Conclusions: cART restores T. gondii-specific CD4 T cell responses in most patients with AIDS who had previous TE. Our data support the safety of withdrawing TE prophylaxis when the CD4+ T cell count returns to levels >200 cells/μL. © The Author 2011., SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2011

29. Is it safe to discontinue primary Pneumocystis jiroveci pneumonia prophylaxis in patients with virologically suppressed HIV infection and a CD4 cell count <200 cells/microL?

Author: Opportunistic Infections Project Team of the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE), Mocroft, Amanda, Reiss, Peter, Kirk, Ole, Mussini, Cristina, Girardi, Enrico, Morlat, Philippe, Stephan, Christoph, De Wit, Stéphane, Doerholt, Katja, Ghosn, Jade, Bucher, Heiner H.C., Lundgren, Jens D, Chêne, Geneviève, Miró, José María, Furrer, Hansjakob, Opportunistic Infections Project Team of the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE), Mocroft, Amanda, Reiss, Peter, Kirk, Ole, Mussini, Cristina, Girardi, Enrico, Morlat, Philippe, Stephan, Christoph, De Wit, Stéphane, Doerholt, Katja, Ghosn, Jade, Bucher, Heiner H.C., Lundgren, Jens D, Chêne, Geneviève, Miró, José María, and Furrer, Hansjakob
Abstract: Current guidelines suggest that primary prophylaxis for Pneumocystis jiroveci pneumonia (PcP) can be safely stopped in human immunodeficiency virus (HIV)-infected patients who are receiving combined antiretroviral therapy (cART) and who have a CD4 cell count >200 cells/microL. There are few data regarding the incidence of PcP or safety of stopping prophylaxis in virologically suppressed patients with CD4 cell counts of 101-200 cells/microL., SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2010

30. Trastuzumab resistance: Bringing tailored therapy to the clinic

Author: Bannister, Wendy, Ruiz, Lidia, Cozzi-Lepri, Alessandro, Mocroft, Amanda, Kirk, Ole, Staszewski, Schlomo, Loveday, Clive, Karlsson, Anders, d'Arminio Monforte, Antonella, Clotet, Bonaventura, Lundgren, Jens D, Losso, Marcello, Durand, Arnaud, Vetter, Norbert, Karpov, Igor, Vassilenko, A., Clumeck, Nathan, Dewit, Suzanne, Poll, Bénédicte, Colebunders, Robert Leon, Kostov, Kostadin, Begovac, Josip, Ristola, Matti, Machala, Ladislav, Rozsypal, Hanuš, Sedlacek, Dalibor, Nielsen, Jorgen E, Benfield, Thomas, Gerstoft, Jan, Katzenstein, Terese Lea, Hansen, Annette Brit Eg, Skinhøj, Peter, Pedersen, Court, Oestergaard, Lone Lange, Zilmer, Kai, Smidt, Jelena, Katlama, Christine, Viard, Jean-Paul, Girard, Pierre Marie, Livrozet, Jean-Michel, Vanhems, Philippe, Pradier, Christian, Dabis, François, Rockstroh, Jürgen, Schmidt, Rüdiger, Van Lunzen, Jan, Degen, Olaf, Stellbrink, Hans-Jurgen, Bogner, Johannes, Fätkenheuer, Gerd, Kosmidis, John, Gargalianos, Panagiotis, Xylomenos, George, Perdios, J., Panos, George, Filandras, A., Karabatsaki, E., Sambattakou, H., Banhegyi, Dénes, Mulcahy, Fiona, Yust, Israel, Turner, Dan, Burke, Michael, Pollack, Simeon, Hassoun, Gamal, Maayan, Shlomo, Chiesi, Antonio, Esposito, Roberto, Mazeu, I., Mussini, Cirillo, Arici, Claudio, Pristera, Raffaele, Mazzotta, Francesco, Gabbuti, Andrea, Vullo, Vincenzo, Lichtner, Miriam, Chirianni, Antonio, Montesarchio, Enzo, Gargiulo, Miriam, Antonucci, Giorgio, Iacomi, Fabio, Narciso, Pasquale, Vlassi, Chrysoula, Zaccarelli, Mauro, Lazzarin, Adriano, Finazzi, Renato, Galli, Mara, Ridolfo, Anna Lisa, Rozentale, Baiba, Aldins, Pauls, Chaplinskas, Saulius, Hemmer, Robert, Staub, Thérèse, Reiss, Peter, Bruun, Johan, Maeland, Arild, Ormaasen, Vidar, Knysz, Brygida, Gasiorowski, Jacek, Horban, Andrzej, Prokopowicz, Danuta, Wiercinska-Drapalo, A., Boron-Kaczmarska, Anna, Pynka, Magdalena, Beniowski, Marek, Mularska, Elzbieta, Trocha, Hanna, Antunes, Francisco, Valadas, Emília, Mansinho, Kamal, Maltez, Fernando, Duiculescu, Dan, Rakhmanova, Aza, Vinogradova, E., Buzunova, S., Jevtovic, Djordje, Mokráš, Miloš, Staneková, Danica, Gonzalez-Lahoz, Juan, Soriano, V., Martin-Carbonero, L., Labarga, P., Jou, A., Conejero, J., Tural, C., Gatell, J.M., Miró, José María, Domingo, Perre, Gutierrez, Maria, Mateo, V, Sambeat, María Antònia, Karlsson, Annika, Persson, P.O., Flamholc, Leo, Ledergerber, Bruno, Weber, R., Francioli, Patrick, Cavassini, Matthias, Hirschel, Bernard, Boffi, Emmanuelle, Furrer, Hansjakob, Battegay, Manuel, Elzi, Luigia, Kravchenko, É V., Chentsova, Nelly, Barton, Simon E.Simon, Johnson, Antoinette, Mercey, Danielle, Phillips, Adam, Johnson, Margaret, Murphy, M., Weber, J., Scullard, George, Fisher, Martin, Brettle, R., Antunes, F., Gatell, Jose, Gazzard, Brian George, Ledergerber, B., Reiss, P., Friis-Møller, Nina, Cozzi-Lepri, A., Bannister, W., Ellefson, M., Borch, A., Podlevkareva, D., Holkmann Olsen, C., Kjar, J., Petersen, Lars, Reekie, J., Bannister, Wendy, Ruiz, Lidia, Cozzi-Lepri, Alessandro, Mocroft, Amanda, Kirk, Ole, Staszewski, Schlomo, Loveday, Clive, Karlsson, Anders, d'Arminio Monforte, Antonella, Clotet, Bonaventura, Lundgren, Jens D, Losso, Marcello, Durand, Arnaud, Vetter, Norbert, Karpov, Igor, Vassilenko, A., Clumeck, Nathan, Dewit, Suzanne, Poll, Bénédicte, Colebunders, Robert Leon, Kostov, Kostadin, Begovac, Josip, Ristola, Matti, Machala, Ladislav, Rozsypal, Hanuš, Sedlacek, Dalibor, Nielsen, Jorgen E, Benfield, Thomas, Gerstoft, Jan, Katzenstein, Terese Lea, Hansen, Annette Brit Eg, Skinhøj, Peter, Pedersen, Court, Oestergaard, Lone Lange, Zilmer, Kai, Smidt, Jelena, Katlama, Christine, Viard, Jean-Paul, Girard, Pierre Marie, Livrozet, Jean-Michel, Vanhems, Philippe, Pradier, Christian, Dabis, François, Rockstroh, Jürgen, Schmidt, Rüdiger, Van Lunzen, Jan, Degen, Olaf, Stellbrink, Hans-Jurgen, Bogner, Johannes, Fätkenheuer, Gerd, Kosmidis, John, Gargalianos, Panagiotis, Xylomenos, George, Perdios, J., Panos, George, Filandras, A., Karabatsaki, E., Sambattakou, H., Banhegyi, Dénes, Mulcahy, Fiona, Yust, Israel, Turner, Dan, Burke, Michael, Pollack, Simeon, Hassoun, Gamal, Maayan, Shlomo, Chiesi, Antonio, Esposito, Roberto, Mazeu, I., Mussini, Cirillo, Arici, Claudio, Pristera, Raffaele, Mazzotta, Francesco, Gabbuti, Andrea, Vullo, Vincenzo, Lichtner, Miriam, Chirianni, Antonio, Montesarchio, Enzo, Gargiulo, Miriam, Antonucci, Giorgio, Iacomi, Fabio, Narciso, Pasquale, Vlassi, Chrysoula, Zaccarelli, Mauro, Lazzarin, Adriano, Finazzi, Renato, Galli, Mara, Ridolfo, Anna Lisa, Rozentale, Baiba, Aldins, Pauls, Chaplinskas, Saulius, Hemmer, Robert, Staub, Thérèse, Reiss, Peter, Bruun, Johan, Maeland, Arild, Ormaasen, Vidar, Knysz, Brygida, Gasiorowski, Jacek, Horban, Andrzej, Prokopowicz, Danuta, Wiercinska-Drapalo, A., Boron-Kaczmarska, Anna, Pynka, Magdalena, Beniowski, Marek, Mularska, Elzbieta, Trocha, Hanna, Antunes, Francisco, Valadas, Emília, Mansinho, Kamal, Maltez, Fernando, Duiculescu, Dan, Rakhmanova, Aza, Vinogradova, E., Buzunova, S., Jevtovic, Djordje, Mokráš, Miloš, Staneková, Danica, Gonzalez-Lahoz, Juan, Soriano, V., Martin-Carbonero, L., Labarga, P., Jou, A., Conejero, J., Tural, C., Gatell, J.M., Miró, José María, Domingo, Perre, Gutierrez, Maria, Mateo, V, Sambeat, María Antònia, Karlsson, Annika, Persson, P.O., Flamholc, Leo, Ledergerber, Bruno, Weber, R., Francioli, Patrick, Cavassini, Matthias, Hirschel, Bernard, Boffi, Emmanuelle, Furrer, Hansjakob, Battegay, Manuel, Elzi, Luigia, Kravchenko, É V., Chentsova, Nelly, Barton, Simon E.Simon, Johnson, Antoinette, Mercey, Danielle, Phillips, Adam, Johnson, Margaret, Murphy, M., Weber, J., Scullard, George, Fisher, Martin, Brettle, R., Antunes, F., Gatell, Jose, Gazzard, Brian George, Ledergerber, B., Reiss, P., Friis-Møller, Nina, Cozzi-Lepri, A., Bannister, W., Ellefson, M., Borch, A., Podlevkareva, D., Holkmann Olsen, C., Kjar, J., Petersen, Lars, and Reekie, J.
Abstract: SCOPUS: re.j, info:eu-repo/semantics/published
Published: 2008

31. Trastuzumab resistance: Bringing tailored therapy to the clinic

Author: Bannister, Wendy, Ruiz, Lidia, Cozzi-Lepri, Alessandro, Mocroft, Amanda, Kirk, Ole, Staszewski, Schlomo, Loveday, Clive, Karlsson, Anders, d'Arminio Monforte, Antonella, Clotet, Bonaventura, Lundgren, Jens D, Losso, Marcello, Durand, Arnaud, Vetter, Norbert, Karpov, Igor, Vassilenko, A., Clumeck, Nathan, Dewit, Suzanne, Poll, Bénédicte, Colebunders, Robert Leon, Kostov, Kostadin, Begovac, Josip, Ristola, Matti, Machala, Ladislav, Rozsypal, Hanuš, Sedlacek, Dalibor, Nielsen, Jorgen E, Benfield, Thomas, Gerstoft, Jan, Katzenstein, Terese Lea, Hansen, Annette Brit Eg, Skinhøj, Peter, Pedersen, Court, Oestergaard, Lone Lange, Zilmer, Kai, Smidt, Jelena, Katlama, Christine, Viard, Jean-Paul, Girard, Pierre Marie, Livrozet, Jean-Michel, Vanhems, Philippe, Pradier, Christian, Dabis, François, Rockstroh, Jürgen, Schmidt, Rüdiger, Van Lunzen, Jan, Degen, Olaf, Stellbrink, Hans-Jurgen, Bogner, Johannes, Fätkenheuer, Gerd, Kosmidis, John, Gargalianos, Panagiotis, Xylomenos, George, Perdios, J., Panos, George, Filandras, A., Karabatsaki, E., Sambattakou, H., Banhegyi, Dénes, Mulcahy, Fiona, Yust, Israel, Turner, Dan, Burke, Michael, Pollack, Simeon, Hassoun, Gamal, Maayan, Shlomo, Chiesi, Antonio, Esposito, Roberto, Mazeu, I., Mussini, Cirillo, Arici, Claudio, Pristera, Raffaele, Mazzotta, Francesco, Gabbuti, Andrea, Vullo, Vincenzo, Lichtner, Miriam, Chirianni, Antonio, Montesarchio, Enzo, Gargiulo, Miriam, Antonucci, Giorgio, Iacomi, Fabio, Narciso, Pasquale, Vlassi, Chrysoula, Zaccarelli, Mauro, Lazzarin, Adriano, Finazzi, Renato, Galli, Mara, Ridolfo, Anna Lisa, Rozentale, Baiba, Aldins, Pauls, Chaplinskas, Saulius, Hemmer, Robert, Staub, Thérèse, Reiss, Peter, Bruun, Johan, Maeland, Arild, Ormaasen, Vidar, Knysz, Brygida, Gasiorowski, Jacek, Horban, Andrzej, Prokopowicz, Danuta, Wiercinska-Drapalo, A., Boron-Kaczmarska, Anna, Pynka, Magdalena, Beniowski, Marek, Mularska, Elzbieta, Trocha, Hanna, Antunes, Francisco, Valadas, Emília, Mansinho, Kamal, Maltez, Fernando, Duiculescu, Dan, Rakhmanova, Aza, Vinogradova, E., Buzunova, S., Jevtovic, Djordje, Mokráš, Miloš, Staneková, Danica, Gonzalez-Lahoz, Juan, Soriano, V., Martin-Carbonero, L., Labarga, P., Jou, A., Conejero, J., Tural, C., Gatell, J.M., Miró, José María, Domingo, Perre, Gutierrez, Maria, Mateo, V, Sambeat, María Antònia, Karlsson, Annika, Persson, P.O., Flamholc, Leo, Ledergerber, Bruno, Weber, R., Francioli, Patrick, Cavassini, Matthias, Hirschel, Bernard, Boffi, Emmanuelle, Furrer, Hansjakob, Battegay, Manuel, Elzi, Luigia, Kravchenko, É V., Chentsova, Nelly, Barton, Simon E.Simon, Johnson, Antoinette, Mercey, Danielle, Phillips, Adam, Johnson, Margaret, Murphy, M., Weber, J., Scullard, George, Fisher, Martin, Brettle, R., Antunes, F., Gatell, Jose, Gazzard, Brian George, Ledergerber, B., Reiss, P., Friis-Møller, Nina, Cozzi-Lepri, A., Bannister, W., Ellefson, M., Borch, A., Podlevkareva, D., Holkmann Olsen, C., Kjar, J., Petersen, Lars, Reekie, J., Bannister, Wendy, Ruiz, Lidia, Cozzi-Lepri, Alessandro, Mocroft, Amanda, Kirk, Ole, Staszewski, Schlomo, Loveday, Clive, Karlsson, Anders, d'Arminio Monforte, Antonella, Clotet, Bonaventura, Lundgren, Jens D, Losso, Marcello, Durand, Arnaud, Vetter, Norbert, Karpov, Igor, Vassilenko, A., Clumeck, Nathan, Dewit, Suzanne, Poll, Bénédicte, Colebunders, Robert Leon, Kostov, Kostadin, Begovac, Josip, Ristola, Matti, Machala, Ladislav, Rozsypal, Hanuš, Sedlacek, Dalibor, Nielsen, Jorgen E, Benfield, Thomas, Gerstoft, Jan, Katzenstein, Terese Lea, Hansen, Annette Brit Eg, Skinhøj, Peter, Pedersen, Court, Oestergaard, Lone Lange, Zilmer, Kai, Smidt, Jelena, Katlama, Christine, Viard, Jean-Paul, Girard, Pierre Marie, Livrozet, Jean-Michel, Vanhems, Philippe, Pradier, Christian, Dabis, François, Rockstroh, Jürgen, Schmidt, Rüdiger, Van Lunzen, Jan, Degen, Olaf, Stellbrink, Hans-Jurgen, Bogner, Johannes, Fätkenheuer, Gerd, Kosmidis, John, Gargalianos, Panagiotis, Xylomenos, George, Perdios, J., Panos, George, Filandras, A., Karabatsaki, E., Sambattakou, H., Banhegyi, Dénes, Mulcahy, Fiona, Yust, Israel, Turner, Dan, Burke, Michael, Pollack, Simeon, Hassoun, Gamal, Maayan, Shlomo, Chiesi, Antonio, Esposito, Roberto, Mazeu, I., Mussini, Cirillo, Arici, Claudio, Pristera, Raffaele, Mazzotta, Francesco, Gabbuti, Andrea, Vullo, Vincenzo, Lichtner, Miriam, Chirianni, Antonio, Montesarchio, Enzo, Gargiulo, Miriam, Antonucci, Giorgio, Iacomi, Fabio, Narciso, Pasquale, Vlassi, Chrysoula, Zaccarelli, Mauro, Lazzarin, Adriano, Finazzi, Renato, Galli, Mara, Ridolfo, Anna Lisa, Rozentale, Baiba, Aldins, Pauls, Chaplinskas, Saulius, Hemmer, Robert, Staub, Thérèse, Reiss, Peter, Bruun, Johan, Maeland, Arild, Ormaasen, Vidar, Knysz, Brygida, Gasiorowski, Jacek, Horban, Andrzej, Prokopowicz, Danuta, Wiercinska-Drapalo, A., Boron-Kaczmarska, Anna, Pynka, Magdalena, Beniowski, Marek, Mularska, Elzbieta, Trocha, Hanna, Antunes, Francisco, Valadas, Emília, Mansinho, Kamal, Maltez, Fernando, Duiculescu, Dan, Rakhmanova, Aza, Vinogradova, E., Buzunova, S., Jevtovic, Djordje, Mokráš, Miloš, Staneková, Danica, Gonzalez-Lahoz, Juan, Soriano, V., Martin-Carbonero, L., Labarga, P., Jou, A., Conejero, J., Tural, C., Gatell, J.M., Miró, José María, Domingo, Perre, Gutierrez, Maria, Mateo, V, Sambeat, María Antònia, Karlsson, Annika, Persson, P.O., Flamholc, Leo, Ledergerber, Bruno, Weber, R., Francioli, Patrick, Cavassini, Matthias, Hirschel, Bernard, Boffi, Emmanuelle, Furrer, Hansjakob, Battegay, Manuel, Elzi, Luigia, Kravchenko, É V., Chentsova, Nelly, Barton, Simon E.Simon, Johnson, Antoinette, Mercey, Danielle, Phillips, Adam, Johnson, Margaret, Murphy, M., Weber, J., Scullard, George, Fisher, Martin, Brettle, R., Antunes, F., Gatell, Jose, Gazzard, Brian George, Ledergerber, B., Reiss, P., Friis-Møller, Nina, Cozzi-Lepri, A., Bannister, W., Ellefson, M., Borch, A., Podlevkareva, D., Holkmann Olsen, C., Kjar, J., Petersen, Lars, and Reekie, J.
Abstract: SCOPUS: re.j, info:eu-repo/semantics/published
Published: 2008

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31 results on '"Miró, José María"'

1. Epidemiology and risk factors of mycotic aneurysm in patients with infective endocarditis and the impact of its rupture in outcomes. Analysis of a national prospective cohort

2. Multivalvular Endocarditis: A Rare Condition with Poor Prognosis

3. Non-nosocomial Healthcare-Associated Infective Endocarditis: A Distinct Entity? Data From the GAMES Series (2008–2021)

4. Impact of Intermediate Susceptibility to Penicillin on Antimicrobial Treatment and Outcomes of Endocarditis Caused by Viridans and Gallolyticus Group Streptococci

5. EN-DALBACEN 2.0 Cohort: real-life study of dalbavancin as sequential/consolidation therapy in patients with infective endocarditis due to Gram-positive cocci

6. Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

7. Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry

8. Infective endocarditis in children and adolescents: a different profile with clinical implications

9. Clinical features and outcomes of Streptococcus anginosus group infective Endocarditis: a multicenter matched cohort study

10. Clinical features and outcomes of Streptococcus anginosus group infective Endocarditis: a multicenter matched cohort study

11. Clinical features and outcomes of Streptococcus anginosus group infective Endocarditis: a multicenter matched cohort study

12. Characteristics and Outcome of Acute Heart Failure in Infective Endocarditis: Focus on Cardiogenic Shock

13. Daptomycin Plus Fosfomycin Versus Daptomycin Alone for Methicillin-resistant Staphylococcus aureus Bacteremia and Endocarditis: A Randomized Clinical Trial

14. Multicentre, randomised, open-label, phase IV–III study to evaluate the efficacy of cloxacillin plus fosfomycin versus cloxacillin alone in adult patients with methicillin-susceptible Staphylococcus aureus bacteraemia: study protocol for the SAFO trial

15. A Contemporary Picture of Enterococcal Endocarditis

16. Role of age and comorbidities in mortality of patients with infective endocarditis

17. Analysis of the costs and cost-effectiveness of the guidelines recommended by the 2018 GESIDA/Spanish National AIDS Plan for initial antiretroviral therapy in HIV-infected adults

18. Outpatient parenteral antibiotic treatment for infective endocarditis: a prospective cohort study from the GAMES cohort

19. DALBACEN cohort: dalbavancin as consolidation therapy in patients with endocarditis and/or bloodstream infection produced by gram-positive cocci

20. Effect of the type of surgical indication on mortality in patients with infective endocarditis who are rejected for surgical intervention

21. Executive summary of the GeSIDA/National AIDS Plan consensus document on antiretroviral therapy in adults infected by the human immunodeficiency virus (updated January 2018)

22. Epidemiological and clinical characteristics of Streptococcus tigurinus endocarditis

23. Efficacy and safety of fosfomycin plus imipenem versus vancomycin for complicated bacteraemia and endocarditis due to methicillin-resistant Staphylococcus aureus: a randomized clinical trial

24. Cohort profile: Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord

25. Nonnucleoside Reverse-transcriptase Inhibitor- vs Ritonavir-boosted Protease Inhibitor-based Regimens for Initial Treatment of HIV Infection: A Systematic Review and Metaanalysis of Randomized Trials

26. The incidence of AIDS-defining illnesses at a current CD4 count ≥200 cells/μL in the post-combination antiretroviral therapy era

27. CD4 cell count and the risk of AIDS or death in HIV-Infected adults on combination antiretroviral therapy with a suppressed viral load: a longitudinal cohort study from COHERE.

28. Restoration of T cell responses to Toxoplasma gondii after successful combined antiretroviral therapy in patients with AIDS with previous toxoplasmic encephalitis

29. Is it safe to discontinue primary Pneumocystis jiroveci pneumonia prophylaxis in patients with virologically suppressed HIV infection and a CD4 cell count <200 cells/microL?

30. Trastuzumab resistance: Bringing tailored therapy to the clinic

31. Trastuzumab resistance: Bringing tailored therapy to the clinic

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31 results on '"Miró, José María"'

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