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89 results on '"Perez-Flores, I."'

20. Efficacy and Safety of Oral Fosfomycin for Asymptomatic Bacteriuria in Kidney Transplant Recipients: Results from a Spanish Multicenter Cohort

Author

Ruiz-Ruigomez M, Fernandez-Ruiz M, Silva J, Vidal E, Origuen J, Calvo-Cano A, Luna-Huerta E, Merino E, Hernandez D, Jironda-Gallegos C, Escudero-Sanchez R, Gioia F, Moreno A, Roca C, Cordero E, Janeiro D, Sanchez-Sobrino B, Montero M, Redondo D, Candel F, Perez-Flores I, Arminanzas C, Gonzalez-Rico C, Farinas M, Rodrigo E, Loeches B, Lopez-Oliva M, Montejo M, Lauzurica R, Horcajada J, Pascual J, Andres A, Aguado J, Lopez-Medrano F, and REIPI Redinren GESITRA-IC SEIMC

Subjects
kidney transplant, asymptomatic bacteriuria, fosfomycin
Abstract

Current guidelines recommend against systematic screening for or treating asymptomatic bacteriuria (AB) among kidney transplant (KT) recipients, although the evidence regarding episodes occurring early after transplantation or in the presence of anatomical abnormalities is inconclusive. Oral fosfomycin may constitute a good option for the treatment of posttransplant AB, particularly due to the emergence of multidrug-resistant (MDR) uropathogens. Available clinical evidence supporting its use in this specific setting, however, remains scarce. We performed a retrospective study in 14 Spanish institutions from January 2005 to December 2017. Overall, 137 episodes of AB diagnosed in 133 KT recipients treated with oral fosfomycin (calcium and trometamol salts) with a test-of-cure urine culture within the first 30 days were included. Median time from transplantation to diagnosis was 3.1 months (interquartile range [IQR], 1.1 to 10.5). Most episodes (96.4% [132/137]) were caused by Gram-negative bacteria (GNB), and 56.9% (78/137) were categorized as MDR (extended-spectrum beta-lactamase-producing Enterobacterales [20.4%] and carbapenem-resistant GNB [2.9%]). Rate of microbiological failure at month 1 was 40.1% (95% confidence interval [CI], 31.9% to 48.9%) for the whole cohort and 42.3% (95% CI, 31.2% to 54.0%) for episodes due to MDR pathogens. Previous urinary tract infection (odds ratio [OR], 2.42; 95% CI, 1.11 to 5.29; P value = 0.027) and use of fosfomycin as salvage therapy (OR, 8.31; 95% CI, 1.67 to 41.35; P value = 0.010) were predictors of microbiological failure. No severe treatment-related adverse events were detected. Oral fosfomycin appears to be a suitable and safe alternative for the treatment (if indicated) of AB after KT, including those episodes due to MDR uropathogens.

Published
2021

25. Use of tocilizumab in kidney transplant recipients with COVID-19

Author

Perez-Saez M, Blasco M, Redondo-Pachon D, Ventura-Aguiar P, Bada-Bosch T, Perez-Flores I, Melilli E, Sanchez-Camara L, Lopez-Oliva M, Canal C, Shabaka A, Garra-Moncau N, Martin-Moreno P, Lopez V, Hernandez-Gallego R, Siverio O, Galeano C, Espi-Reig J, Cabezas C, Rodrigo M, Llinas-Mallol L, Fernandez-Reyes M, Cruzado-Vega L, Perez-Tamajon L, Santana-Estupinan R, Ruiz-Fuentes M, Tabernero G, Zarraga S, Ruiz J, Gutierrez-Dalmau A, Mazuecos A, Sanchez-Alvarez E, Crespo M, Pascual J, and Spanish Soc Nephrology COVID-19 Gr

Subjects
Graft Rejection, Male, kidney transplantation/nephrology, Comorbidity, Gastroenterology, law.invention, chemistry.chemical_compound, infection and infectious agents ‐ viral, Randomized controlled trial, law, Immunology and Allergy, Pharmacology (medical), education.field_of_study, Mortality rate, Incidence, Hazard ratio, Middle Aged, practice, clinical research/practice, infection and infectious agents - viral, kidney transplantation/nephrology, patient survival, Treatment Outcome, Female, Cohort study, Adult, medicine.medical_specialty, infection and infectious agents - viral, Population, nephrology, kidney transplantation, Brief Communication, clinical research/practice, Antibodies, Monoclonal, Humanized, Young Adult, Tocilizumab, patient survival, Internal medicine, medicine, Humans, education, Pandemics, Retrospective Studies, Transplantation, business.industry, SARS-CoV-2, COVID-19, medicine.disease, Kidney Transplantation, Confidence interval, chemistry, clinical research, Spain, business, Cytokine storm, Follow-Up Studies
Abstract

Acute respiratory distress syndrome associated with coronavirus infection is related to a cytokine storm with large interleukin-6 (IL-6) release. The IL-6-receptor blocker tocilizumab may control the aberrant host immune response in patients with coronavirus disease 2019 (COVID-19) . In this pandemic, kidney transplant (KT) recipients are a high-risk population for severe infection and showed poor outcomes. We present a multicenter cohort study of 80 KT patients with severe COVID-19 treated with tocilizumab during hospital admission. High mortality rate was identified (32.5%), related with older age (hazard ratio [HR] 3.12 for those older than 60 years, P = .039). IL-6 and other inflammatory markers, including lactic acid dehydrogenase, ferritin, and D-dimer increased early after tocilizumab administration and their values were higher in nonsurvivors. Instead, C-reactive protein (CRP) levels decreased after tocilizumab, and this decrease positively correlated with survival (mean 12.3 mg/L in survivors vs. 33 mg/L in nonsurvivors). Each mg/L of CRP soon after tocilizumab increased the risk of death by 1% (HR 1.01 [confidence interval 1.004-1.024], P = .003). Although patients who died presented with worse respiratory situation at admission, this was not significantly different at tocilizumab administration and did not have an impact on outcome in the multivariate analysis. Tocilizumab may be effective in controlling cytokine storm in COVID-19 but randomized trials are needed.

Published
2020

33. Serum Level of Fibroblast Growth Factor 23 and its Relationship with Bone Mineral Metabolism in Maintenance Renal Transplant Patients

Author

Sánchez Fructuoso, A., primary, Maestro, M. L., additional, Perez Flores, I., additional, Valero, R., additional, Rafael, S., additional, Veganzones, S., additional, Calvo, N., additional, De La Orden, V., additional, De la Flor, J. C., additional, Valga, F., additional, Vidaurreta, M., additional, Fernandez Perez, C., additional, and Barrientos, A., additional

Published
2012
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34. Serum Lactic Dehydrogenase Levels as a Prognosis Marker for Clinical Outcomes in Donors after Cardiac Death Kidney Transplant Recipients

Author

Perez Flores, I., primary, Rodriguez Cubillo, B., additional, Delgado Conde, P., additional, Martin Rodriguez, L., additional, Valga Amado, E. F., additional, Calvo Romero, N., additional, De la Flor, J. C., additional, Florit, E., additional, Barrientos Guzman, A., additional, and Sanchez Fructuoso, A. I., additional

Published
2012
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37. Serum level of fibroblast growth factor 23 in maintenance renal transplant patients

Author

Sanchez Fructuoso, A. I., primary, Maestro, M. L., additional, Perez-Flores, I., additional, Valero, R., additional, Rafael, S., additional, Veganzones, S., additional, Calvo, N., additional, De la Orden, V., additional, De la Flor, J. C., additional, Valga, F., additional, Vidaurreta, M., additional, Fernandez-Perez, C., additional, and Barrientos, A., additional

Published
2012
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