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

Author

Laura Herrera-Hidalgo, Patricia Muñoz, Ana Álvarez-Uría, David Alonso-Menchén, Rafael Luque-Marquez, Encarnación Gutiérrez-Carretero, María Del Carmen Fariñas, Jose Maria Miró, Miguel Angel Goenaga, Luis Eduardo López-Cortés, Basilio Angulo-Lara, Lucia Boix-Palop, Arístides de Alarcón, Fernando Fernández Sánchez, José Mª García de Lomas, Gabriel Rosas, Javier de la Torre Lima, Elena Bereciartua, María José Blanco Vidal, Roberto Blanco, María Victoria Boado, Marta Campaña Lázaro, Alejandro Crespo, Laura Guio Carrión, Mikel Del Álamo Martínez de Lagos, Gorane Euba Ugarte, Ane Josune Goikoetxea, Marta Ibarrola Hierro, José Ramón Iruretagoyena, Josu Irurzun Zuazabal, Leire López-Soria, Miguel Montejo, Javier Nieto, David Rodrigo, Regino Rodríguez, Yolanda Vitoria, Roberto Voces, Mª Victoria García López, Radka Ivanova Georgieva, Guillermo Ojeda, Isabel Rodríguez Bailón, Josefa Ruiz Morales, Ignacio Álvarez Rodríguez, Harkaitz Azkune Galparsoro, Elisa Berritu Boronat, Mª Jesús Bustinduy Odriozola, Cristina del Bosque Martín, Tomás Echeverría, Alberto Eizaguirre Yarza, Ana Fuentes, Miguel Ángel Goenaga, Muskilda Goyeneche del Río, Ángela Granda Bauza, José Antonio Iribarren, Xabier Kortajarena Urkola, José Ignacio Pérez-Moreiras López, Ainhoa Rengel Jiménez, Karlos Reviejo, Alberto Sáez Berbejillo, Elou Sánchez Haza, Rosa Sebastián Alda, Itziar Solla Ruiz, Irati Unamuno Ugartemendia, Diego Vicente Anza, Iñaki Villanueva Benito, Mar Zabalo Arrieta, Rafael Carrasco, Vicente Climent, Patricio Llamas, Esperanza Merino, Joaquín Plazas, Sergio Reus, Alberto Bouzas, Brais Castelo, José Cuenca, Laura Gutiérrez, Lucía Ramos, María Rodríguez Mayo, Joaquín Manuel Serrano, Dolores Sousa Regueiro, Francisco Javier Martínez, Mª del Mar Alonso, Beatriz Castro, Teresa Delgado Melian, Javier Fernández Sarabia, Dácil García Rosado, Julia González González, Juan Lacalzada, Lissete Lorenzo de la Peña, Alina Pérez Ramírez, Pablo Prada Arrondo, Fermín Rodríguez Moreno, Antonio Plata Ciezar, José Mª Reguera Iglesias, Víctor Asensi Álvarez, Carlos Costas, Jesús de la Hera, Jonnathan Fernández Suárez, Lisardo Iglesias Fraile, Víctor León Arguero, José López Menéndez, Pilar Mencia Bajo, Carlos Morales, Alfonso Moreno Torrico, Carmen Palomo, Begoña Paya Martínez, Ángeles Rodríguez Esteban, Raquel Rodríguez García, Mauricio Telenti Asensio, Manuel Almela, Juan Ambrosioni, Manuel Azqueta, Mercè Brunet, Marta Bodro, Ramón Cartañá, Guillermo Cuervo, Carlos Falces, Mariana J Fernández-Pittol, Guillermina Fita, David Fuster, Cristina García de la Mària, Delia García-Pares, Marta Hernández-Meneses, Jaume Llopis Pérez, Francesc Marco, José M. Miró, Asunción Moreno, David Nicolás, Salvador Ninot, Eduardo Quintana, Carlos Paré, Daniel Pereda, Juan M. Pericás, José L. Pomar, José Ramírez, Mercè Roque, Irene Rovira, Elena Sandoval, Marta Sitges, Dolors Soy, Adrián Téllez, José M. Tolosana, Bárbara Vidal, Jordi Vila, Iván Adán, David Alonso, Juan Carlos Alonso, Javier Bermejo, Emilio Bouza, Gregorio Cuerpo Caballero, Antonia Delgado Montero, Agustín Estévez, Ramón Fortuny Ribas, Esther Gargallo, Mª Eugenia García Leoni, Ana González Mansilla, Francisco Javier González Moraga, Víctor González Ramallo, Martha Kestler Hernández, Amaia Mari Hualde, Marina Machado, Mercedes Marín, Manuel Martínez-Sellés, Rosa Melero, Diego Monzón, María Olmedo, Álvaro Pedraz, Blanca Pinilla, Ángel Pinto, Cristina Rincón, Hugo Rodríguez-Abella, Marta Rodríguez-Créixems, Eduardo Sánchez-Pérez, Antonio Segado, Neera Toledo, Maricela Valerio, Pilar Vázquez, Eduardo Verde Moreno, Sofía de la Villa, Isabel Antorrena, Belén Loeches, Mar Moreno, Ulises Ramírez, Verónica Rial Bastón, María Romero, Sandra Rosillo, Jesús Agüero Balbín, Cristina Amado Fernández, Carlos Armiñanzas Castillo, Francisco Arnaiz de las Revillas, Manuel Cobo Belaustegui, María Carmen Fariñas, Concepción Fariñas-Álvarez, Marta Fernández Sampedro, Iván García, Claudia González Rico, Laura Gutiérrez-Fernández, Manuel Gutiérrez-Cuadra, José Gutiérrez Díez, Marcos Pajarón, José Antonio Parra, Ramón Teira, Jesús Zarauza, Jorge Calderón Parra, Marta Cobo, Fernando Domínguez, Pablo García Pavía, Ana Fernández Cruz, Antonio Ramos-Martínez, Isabel Sánchez Romero, Tomasa Centella, José Manuel Hermida, José Luis Moya, Pilar Martín-Dávila, Enrique Navas, Enrique Oliva, Alejandro del Río, Jorge Rodríguez-Roda Stuart, Soledad Ruiz, Carmen Hidalgo Tenorio, Sergio Sequera, Manuel Almendro Delia, Omar Araji, José Miguel Barquero, Román Calvo Jambrina, Marina de Cueto, Juan Gálvez Acebal, Irene Méndez, Isabel Morales, José Antonio Lepe, José López-Haldón, Rafael Luque-Márquez, Guillermo Marín, Antonio Ortiz-Carrellán, Eladio Sánchez-Domínguez, Luis Javier Alonso, Pedro Azcárate, José Manuel Azcona Gutiérrez, José Ramón Blanco, Estíbaliz Corral Armas, Lara García-Álvarez, José Antonio Oteo, Antonio Barros Membrilla, Antonino Ginel Iglesias, Sara Grillo, Rubén Leta Petracca, Joaquín López-Contreras, María Alba Rivera Martínez, M. Álvarez, A.L. Fernández, Amparo Martínez, A. Prieto, Benito Regueiro, E. Tijeira, Marino Vega, Amaia Aguirre Quiñonero, Ángela Alonso Miñambres, Juan Carlos Gainzarain Arana, Sara González de Alaiza Ortega, Miguel Ángel Morán Rodríguez, Anai Moreno Rodríguez, Zuriñe Ortiz de Zárate, José Joaquín Portu Zapirain, Ester Sáez de Adana Arroniz, Daisy Carolina Sorto Sánchez, Sánchez-Porto Antonio, Úbeda Iglesias Alejandro, José Mª Arribas Leal, Elisa García Vázquez, Alicia Hernández Torres, Ana Blázquez, Gonzalo de la Morena Valenzuela, Ángel Alonso, Javier Aramburu, Felicitas Elena Calvo, Paola Tarabini-Castellani, Eva Heredero Gálvez, Carolina Maicas Bellido, José Largo Pau, Mª Antonia Sepúlveda, Pilar Toledano Sierra, Sadaf Zafar Iqbal-Mirza, Eva Cascales Alcolea, Ivan Keituqwa Yañez, Julián Navarro Martínez, Ana Peláez Ballesta, Eduardo Moreno Escobar, Alejandro Peña Monje, Valme Sánchez Cabrera, David Vinuesa García, María Arrizabalaga Asenjo, Carmen Cifuentes Luna, Juana Núñez Morcillo, Mª Cruz Pérez Seco, Aroa Villoslada Gelabert, Carmen Aured Guallar, Nuria Fernández Abad, Pilar García Mangas, Marta Matamala Adell, Mª Pilar Palacián Ruiz, Juan Carlos Porres, Begoña Alcaraz Vidal, María Jesús Del Amor Espín, Francisco Buendía, Roberto Jiménez Sánchez, Rosario Mármol, Francisco Martínez, Antonio Meseguer, Beatriz Pérez, Leticia Risco, Zoser Saura, Vanina Silva, Mª Belén Villmarín, Mª Ángels Ribas Blanco, Enrique Ruiz de Gopegui Bordes, Laura Vidal Bonet, Miquel Vives Borràs, Mª Carmen Bellón Munera, Elena Escribano Garaizabal, Antonia Tercero Martínez, Juan Carlos Segura Luque, Cristina Badía, Lucía Boix Palop, Mariona Xercavins, Sónia Ibars, Xerach Bosch, Eloy Gómez Nebreda, Ibalia Horcajada Herrera, Irene Menduiña Gallego, Imanol Pulido, Héctor Marrero Santiago, Isabel de Miguel Martínez, Elena Pisos Álamo, Daniel San Román Sánchez, Jorge Boan Pérez, Eva Mª Aguilar Blanco, Mercedes Catalán González, María Angélica Corres Peiretti, Andrea Eixerés Esteve, Laura Domínguez Pérez, Santiago de Cossío Tejido, Francisco Galván Román, José Antonio García Robles, Francisco López Medrano, Mª Jesús López Gude, Mª Ángeles Orellana Miguel, Patrick Pilkington, Yolanda Revilla Ostalaza, Juan Ruiz Morales, Sebastián Ruiz Solís, Ana Sabín Collado, Marcos Sánchez Fernández, Javier Solera Rallo, Jorge Solís Martín, Francesc Escrihuela-Vidal, Jordi Carratalà, Inmaculada Grau, Carmen Ardanuy, Dámaris Berbel, José Carlos Sánchez Salado, Oriol Alegre, Alejandro Ruiz Majoral, Fabrizio Sbraga, Arnau Blasco, Laura Gracia Sánchez, Iván Sánchez-Rodríguez, Gonzalo Aldamiz, Beatriz Álvarez, Marina Bernal Palacios, Alfonso Cabello Úbeda, Ricardo Fernández Roblas, Rafael Hernández, Victoria Andrea Hortigüela Martín, Andrea Kallmeyer, Cristina Landaeta Kancev, Marta Martín, Miguel Morante Ruiz, Miguel Ángel Navas Lobato, Ana María Pello, Laura Prieto, Marta Tomás Mallebrera, Laura Varela, Mireia de la Peña Triguero, Ruth Esther Figueroa Cerón, Lara Ruiz Gómez, Mireia Ble, Juan Pablo Horcajada Gallego, Antonio José Ginel, Inmaculada López, Alexandra Mas, Antoni Mestres, Lluís Molina, Ramón Serrat, Núria Ribas, Francisca Sánchez, Ana Silverio, Marina Suárez, Luisa Sorlí, Lluís Recasens, Manuel Taurón, María Fernández Regueras, María Ángeles Mantecón Vallejo, José Ángel Pérez Rivera, Nuria Sánchez Mata, Antonia Calvo Cano, Miguel Fajardo Olivares, María Victoria Millán Núñez, and Agustín Muñoz Sanz

Subjects
Infective endocarditis, Methicillin-susceptible Staphylococcus aureus, Cefazolin, Antistaphylococcal penicillin, Infectious and parasitic diseases, RC109-216
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

Published
2023
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2. Stability of meropenem in portable elastomeric infusion devices: which protocol should be implemented in clinical practice?

Author

Beatriz Esteban-Cartelle, Dolores R. Serrano, Covadonga Pérez Menéndez-Conde, Noelia Vicente-Oliveros, Ana Álvarez-Díaz, Jesús Fortún Abete, and Pilar Martín-Dávila

Subjects
meropenem, OPAT, outpatient parenteral antimicrobial therapy, elastomeric infusion devices, elastomers, Microbiology, QR1-502
Abstract

ABSTRACT Meropenem has an excellent activity against gram-positive and gram-negative bacteria, including multi-resistant microorganisms. Even though meropenem is a great candidate for outpatient parenteral antimicrobial therapy (OPAT), its physicochemical stability is a major challenge. This work aimed to demonstrate the suitability of including meropenem in OPAT by elucidating its physicochemical stability in a range of commonly prescribed concentrations within portable elastomeric infusion devices. Physical and chemical stability were evaluated at two concentrations commonly used in clinical practice (2 mg/mL and 25 mg/mL), and three temperatures (2–8°C, 25°C, and 32°C) using Accufuser portable elastomeric infusion devices. Drug adsorption onto portable elastomeric infusion devices was also determined at the end of the experiment. Meropenem stability significantly decreased at higher temperatures and when higher drug solution concentrations were used. Meropenem solutions at 2 mg/mL kept the drug content above 95% over 24 h at 2–8°C, but just for 8 h at 25°C. Nevertheless, solutions containing 25 mg/mL of meropenem showed a dramatic decrease in chemical stability after 8 h 2–8°C and just after 4 h at 25°C or 32°C. However, physical stability was kept favorable during this period. The drug adsorption on the material of the elastomeric infusion device was below 1%, indicating the suitability of the chosen device. We propose several administration protocols for meropenem in portable elastomeric infusion devices in clinical practice, according to the results obtained in our study. The results obtained in this study open up a possibility of administering meropenem in an OPAT setting despite its short stability. IMPORTANCE Although outpatient parenteral antibiotic therapy can be a good approach to treating infections, a lack of data regarding antibiotic stability in portable elastomeric infusion devices restricts its safe and effective use. Actually, meropenem is used for prolonged periods above 24 h, and it is not physicochemically stable, which can compromise efficacy and toxicity. This work is of high importance to show the clinicians the real shelf life of meropenem when administered in portable elastomeric infusion devices. We propose several administration protocols for meropenem in portable elastomeric infusion devices in clinical practice, according to the stability drug results obtained in our study.

Published
2024
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3. A Phase I/IIa Prospective, Randomized, Open-Label Study on the Safety and Efficacy of Nebulized Liposomal Amphotericin for Invasive Pulmonary Aspergillosis

Author

Jesús Fortún, Elia Gómez-García de la Pedrosa, Alberto Martínez-Lorca, Patricia Paredes, Pilar Martín-Dávila, Alicia Gómez-López, María José Buitrago, Javier López-Jiménez, Francesca Gioia, Rosa Escudero, Maria Elena Alvarez-Alvarez, Cruz Soriano, Javier Moreno-García, Diana San Miguel, Noelia Vicente, and Santiago Moreno

Subjects
invasive pulmonary aspergillosis, nebulized liposomal amphotericin B, 18F-fluorodeoxyglucose positron emission tomography, Biology (General), QH301-705.5
Abstract

Although nebulized liposomal amphotericin B (NLAB) is being used in invasive pulmonary aspergillosis (IPA) prophylaxis, no clinical trial has shown its efficacy as a therapeutic strategy. NAIFI is the inaugural randomized, controlled clinical trial designed to examine the safety and effectiveness of NLAB (dosage: 25 mg in 6 mL, three times per week for 6 weeks) against a placebo, in the auxiliary treatment of IPA. Throughout the three-year clinical trial, thirteen patients (six NLAB, seven placebo) were included, with 61% being onco-hematological with less than 100 neutrophils/μL. There were no significant differences noted in their pre- and post-nebulization results of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and oxygen saturation between the groups. Neither bronchospasm nor serum amphotericin B levels were reported in any patients given NLAB. 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET-TC) was carried out at the baseline and after 6 weeks. A notable decrease in median SUV (standardized uptake value) was observed in NLAB patients after 6 weeks (−3.6 vs. −0.95, p: 0.039, one tail). Furthermore, a reduction in serum substance galactomannan and beta-D-Glucan was identified within NLAB recipients. NLAB is well tolerated and safe for patients with IPA. Encouraging indirect efficacy data have been derived from image monitoring or biomarkers. However, further studies involving more patients are necessary.

Published
2024
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4. Pseudomonas aeruginosa Bloodstream Infections Presenting with Septic Shock in Neutropenic Cancer Patients: Impact of Empirical Antibiotic Therapy

Author

Cristina Royo-Cebrecos, Júlia Laporte-Amargós, Marta Peña, Isabel Ruiz-Camps, Carolina Garcia-Vidal, Edson Abdala, Chiara Oltolini, Murat Akova, Miguel Montejo, Malgorzata Mikulska, Pilar Martín-Dávila, Fabián Herrera, Oriol Gasch, Lubos Drgona, Hugo Manuel Paz Morales, Anne-Sophie Brunel, Estefanía García, Burcu Isler, Winfried V. Kern, Zaira R. Palacios-Baena, Guillermo Maestr de la Calle, Maria Milagro Montero, Souha S. Kanj, Oguz R. Sipahi, Sebnem Calik, Ignacio Márquez-Gómez, Jorge I. Marin, Marisa Z. R. Gomes, Philipp Hemmatii, Rafael Araos, Maddalena Peghin, Jose L. Del Pozo, Lucrecia Yáñez, Robert Tilley, Adriana Manzur, Andrés Novo, Jordi Carratalà, and Carlota Gudiol

Subjects
Pseudomonas aeruginosa, bacteremia, septic shock, bloodstream infection, neutropenia, cancer, Biology (General), QH301-705.5
Abstract

This large, multicenter, retrospective cohort study including onco-hematological neutropenic patients with Pseudomonas aeruginosa bloodstream infection (PABSI) found that among 1213 episodes, 411 (33%) presented with septic shock. The presence of solid tumors (33.3% vs. 20.2%, p < 0.001), a high-risk Multinational Association for Supportive Care in Cancer (MASCC) index score (92.6% vs. 57.4%; p < 0.001), pneumonia (38% vs. 19.2% p < 0.001), and infection due to multidrug-resistant P. aeruginosa (MDRPA) (33.8% vs. 21.1%, p < 0.001) were statistically significantly higher in patients with septic shock compared to those without. Patients with septic shock were more likely to receive inadequate empirical antibiotic therapy (IEAT) (21.7% vs. 16.2%, p = 0.020) and to present poorer outcomes, including a need for ICU admission (74% vs. 10.5%; p < 0.001), mechanical ventilation (49.1% vs. 5.6%; p < 0.001), and higher 7-day and 30-day case fatality rates (58.2% vs. 12%, p < 0.001, and 74% vs. 23.1%, p < 0.001, respectively). Risk factors for 30-day case fatality rate in patients with septic shock were orotracheal intubation, IEAT, infection due to MDRPA, and persistent PABSI. Therapy with granulocyte colony-stimulating factor and BSI from the urinary tract were associated with improved survival. Carbapenems were the most frequent IEAT in patients with septic shock, and the use of empirical combination therapy showed a tendency towards improved survival. Our findings emphasize the need for tailored management strategies in this high-risk population.

Published
2024
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5. Real-Life Use of Ceftolozane/Tazobactam for the Treatment of Bloodstream Infection Due to Pseudomonas aeruginosa in Neutropenic Hematologic Patients: a Matched Control Study (ZENITH Study)

Author

Alba Bergas, Adaia Albasanz-Puig, Ana Fernández-Cruz, Marina Machado, Andrés Novo, David van Duin, Carolina Garcia-Vidal, Morgan Hakki, Isabel Ruiz-Camps, José Luis del Pozo, Chiara Oltolini, Catherine DeVoe, Lubos Drgona, Oriol Gasch, Malgorzata Mikulska, Pilar Martín-Dávila, Maddalena Peghin, Lourdes Vázquez, Júlia Laporte-Amargós, Xavier Durà-Miralles, Natàlia Pallarès, Eva González-Barca, Ana Álvarez-Uría, Pedro Puerta-Alcalde, Juan Aguilar-Company, Francisco Carmona-Torre, Teresa Daniela Clerici, Sarah B. Doernberg, Lucía Petrikova, Silvia Capilla, Laura Magnasco, Jesús Fortún, Nadia Castaldo, Jordi Carratalà, and Carlota Gudiol

Subjects
multidrug-resistant, Pseudomonas aeruginosa, bacteremia, bloodstream infection, neutropenia, hematologic malignancy, Microbiology, QR1-502
Abstract

ABSTRACT We sought to assess the characteristics and outcomes of neutropenic hematologic patients with Pseudomonas aeruginosa (PA) bloodstream infection (BSI) treated with ceftolozane-tazobactam (C/T). We conducted a multicenter, international, matched-cohort study of PA BSI episodes in neutropenic hematologic patients who received C/T. Controls were patients with PA BSI treated with other antibiotics. Risk factors for overall 7-day and 30-day case fatality rates were analyzed. We compared 44 cases with 88 controls. Overall, 91% of episodes were caused by multidrug-resistant (MDR) strains. An endogenous source was the most frequent BSI origin (35.6%), followed by pneumonia (25.8%). There were no significant differences in patient characteristics between groups. C/T was given empirically in 11 patients and as definitive therapy in 41 patients. Treatment with C/T was associated with less need for mechanical ventilation (13.6% versus 33.3%; P = 0.021) and reduced 7-day (6.8% versus 34.1%; P = 0.001) and 30-day (22.7% versus 48.9%; P = 0.005) mortality. In the multivariate analysis, pneumonia, profound neutropenia, and persistent BSI were independent risk factors for 30-day mortality, whereas lower mortality was found among patients treated with C/T (adjusted OR [aOR] of 0.19; confidence interval [CI] 95% of 0.07 to 0.55; P = 0.002). Therapy with C/T was associated with less need for mechanical ventilation and reduced 7-day and 30-day case fatality rates compared to alternative agents in neutropenic hematologic patients with PA BSI. IMPORTANCE Ceftolozane-tazobactam (C/T) has been shown to be a safe and effective alternative for the treatment of difficult to treat infections due to Pseudomonas aeruginosa (PA) in the general nonimmunocompromised population. However, the experience of this agent in immunosuppressed neutropenic patients is very limited. Our study is unique because it is focused on extremely immunosuppressed hematological patients with neutropenia and bloodstream infection (BSI) due to PA (mainly multidrug resistant [MDR]), a scenario which is often associated with very high mortality rates. In our study, we found that the use of C/T for the treatment of MDR PA BSI in hematological neutropenic patients was significantly associated with improved outcomes, and, in addition, it was found to be an independent risk factor associated with increased survival. To date, this is the largest series involving neutropenic hematologic patients with PA BSI treated with C/T.

Published
2022
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6. Pseudomonas aeruginosa Bloodstream Infections in Patients with Cancer: Differences between Patients with Hematological Malignancies and Solid Tumors

Author

Cristina Royo-Cebrecos, Julia Laporte-Amargós, Marta Peña, Isabel Ruiz-Camps, Pedro Puerta-Alcalde, Edson Abdala, Chiara Oltolini, Murat Akova, Miguel Montejo, Malgorzata Mikulska, Pilar Martín-Dávila, Fabian Herrera, Oriol Gasch, Lubos Drgona, Hugo Manuel Paz Morales, Anne-Sophie Brunel, Estefanía García, Burcu Isler, Winfried V. Kern, Zaira R. Palacios-Baena, Guillermo Maestro de la Calle, Maria Milagro Montero, Souha S. Kanj, Oguz R. Sipahi, Sebnem Calik, Ignacio Márquez-Gómez, Jorge I. Marin, Marisa Z. R. Gomes, Philipp Hemmatti, Rafael Araos, Maddalena Peghin, José Luis del Pozo, Lucrecia Yáñez, Robert Tilley, Adriana Manzur, Andrés Novo, Jordi Carratalà, and Carlota Gudiol

Subjects
Pseudomonas aeruginosa, bacteremia, bloodstream infection, cancer, solid tumor, hematologic malignancy, Medicine
Abstract

Objectives: To assess the clinical features and outcomes of Pseudomonas aeruginosa bloodstream infection (PA BSI) in neutropenic patients with hematological malignancies (HM) and with solid tumors (ST), and identify the risk factors for 30-day mortality. Methods: We performed a large multicenter, retrospective cohort study including onco-hematological neutropenic patients with PA BSI conducted across 34 centers in 12 countries (January 2006–May 2018). Episodes occurring in hematologic patients were compared to those developing in patients with ST. Risk factors associated with 30-day mortality were investigated in both groups. Results: Of 1217 episodes of PA BSI, 917 occurred in patients with HM and 300 in patients with ST. Hematological patients had more commonly profound neutropenia (0.1 × 109 cells/mm) (67% vs. 44.6%; p < 0.001), and a high risk Multinational Association for Supportive Care in Cancer (MASCC) index score (32.2% vs. 26.7%; p = 0.05). Catheter-infection (10.7% vs. 4.7%; p = 0.001), mucositis (2.4% vs. 0.7%; p = 0.042), and perianal infection (3.6% vs. 0.3%; p = 0.001) predominated as BSI sources in the hematological patients, whereas pneumonia (22.9% vs. 33.7%; p < 0.001) and other abdominal sites (2.8% vs. 6.3%; p = 0.006) were more common in patients with ST. Hematological patients had more frequent BSI due to multidrug-resistant P. aeruginosa (MDRPA) (23.2% vs. 7.7%; p < 0.001), and were more likely to receive inadequate initial antibiotic therapy (IEAT) (20.1% vs. 12%; p < 0.001). Patients with ST presented more frequently with septic shock (45.8% vs. 30%; p < 0.001), and presented worse outcomes, with increased 7-day (38% vs. 24.2%; p < 0.001) and 30-day (49% vs. 37.3%; p < 0.001) case-fatality rates. Risk factors for 30-day mortality in hematologic patients were high risk MASCC index score, IEAT, pneumonia, infection due to MDRPA, and septic shock. Risk factors for 30-day mortality in patients with ST were high risk MASCC index score, IEAT, persistent BSI, and septic shock. Therapy with granulocyte colony-stimulating factor was associated with survival in both groups. Conclusions: The clinical features and outcomes of PA BSI in neutropenic cancer patients showed some differences depending on the underlying malignancy. Considering these differences and the risk factors for mortality may be useful to optimize their therapeutic management. Among the risk factors associated with overall mortality, IEAT and the administration of granulocyte colony-stimulating factor were the only modifiable variables.

Published
2022
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7. Risk factors for unfavorable outcome and impact of early post-transplant infection in solid organ recipients with COVID-19: A prospective multicenter cohort study.

Author

Sonsoles Salto-Alejandre, Silvia Jiménez-Jorge, Nuria Sabé, Antonio Ramos-Martínez, Laura Linares, Maricela Valerio, Pilar Martín-Dávila, Mario Fernández-Ruiz, María Carmen Fariñas, Marino Blanes-Juliá, Elisa Vidal, Zaira R Palacios-Baena, Román Hernández-Gallego, Jordi Carratalá, Jorge Calderón-Parra, María Ángeles Marcos, Patricia Muñoz, Jesús Fortún-Abete, José María Aguado, Francisco Arnaiz-Revillas, Rosa Blanes-Hernández, Julián de la Torre-Cisneros, Luis E López-Cortés, Elena García de Vinuesa-Calvo, Clara M Rosso, Jerónimo Pachón, Javier Sánchez-Céspedes, Elisa Cordero, and COVIDSOT Working Team

Subjects
Medicine, Science
Abstract

The aim was to analyze the characteristics and predictors of unfavorable outcomes in solid organ transplant recipients (SOTRs) with COVID-19. We conducted a prospective observational cohort study of 210 consecutive SOTRs hospitalized with COVID-19 in 12 Spanish centers from 21 February to 6 May 2020. Data pertaining to demographics, chronic underlying diseases, transplantation features, clinical, therapeutics, and complications were collected. The primary endpoint was a composite of intensive care unit (ICU) admission and/or death. Logistic regression analyses were performed to identify the factors associated with these unfavorable outcomes. Males accounted for 148 (70.5%) patients, the median age was 63 years, and 189 (90.0%) patients had pneumonia. Common symptoms were fever, cough, gastrointestinal disturbances, and dyspnea. The most used antiviral or host-targeted therapies included hydroxychloroquine 193/200 (96.5%), lopinavir/ritonavir 91/200 (45.5%), and tocilizumab 49/200 (24.5%). Thirty-seven (17.6%) patients required ICU admission, 12 (5.7%) suffered graft dysfunction, and 45 (21.4%) died. A shorter interval between transplantation and COVID-19 diagnosis had a negative impact on clinical prognosis. Four baseline features were identified as independent predictors of intensive care need or death: advanced age, high respiratory rate, lymphopenia, and elevated level of lactate dehydrogenase. In summary, this study presents comprehensive information on characteristics and complications of COVID-19 in hospitalized SOTRs and provides indicators available upon hospital admission for the identification of SOTRs at risk of critical disease or death, underlining the need for stringent preventative measures in the early post-transplant period.

Published
2021
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8. Effect of Combination Antibiotic Empirical Therapy on Mortality in Neutropenic Cancer Patients with Pseudomonas aeruginosa Pneumonia

Author

Adaia Albasanz-Puig, Xavier Durà-Miralles, Júlia Laporte-Amargós, Alberto Mussetti, Isabel Ruiz-Camps, Pedro Puerta-Alcalde, Edson Abdala, Chiara Oltolini, Murat Akova, José Miguel Montejo, Malgorzata Mikulska, Pilar Martín-Dávila, Fabián Herrera, Oriol Gasch, Lubos Drgona, Hugo Manuel Paz Morales, Anne-Sophie Brunel, Estefanía García, Burcu Isler, Winfried V. Kern, Pilar Retamar-Gentil, José María Aguado, Milagros Montero, Souha S. Kanj, Oguz R. Sipahi, Sebnem Calik, Ignacio Márquez-Gómez, Jorge I. Marin, Marisa Z. R. Gomes, Philipp Hemmati, Rafael Araos, Maddalena Peghin, José Luis del Pozo, Lucrecia Yáñez, Robert Tilley, Adriana Manzur, Andres Novo, Natàlia Pallarès, Alba Bergas, Jordi Carratalà, Carlota Gudiol, and on behalf of the IRONIC Study Group

Subjects
Pseudomonas aeruginosa, bloodstream infection, pneumonia, septic shock, neutropenia, Biology (General), QH301-705.5
Abstract

To assess the effect of combination antibiotic empirical therapy on 30-day case-fatality rate in neutropenic cancer patients with Pseudomonas aeruginosa (PA) bacteremic pneumonia. This was a multinational, retrospective cohort study of neutropenic onco-hematological patients with PA bloodstream infection (BSI) (2006–2018). The effect of appropriate empirical combination therapy, appropriate monotherapy and inappropriate empirical antibiotic therapy [IEAT] on 30-day case-fatality was assessed only in patients with PA bacteremic pneumonia. Among 1017 PA BSI episodes, pneumonia was the source of BSI in 294 (28.9%). Among those, 52 (17.7%) were caused by a multidrug-resistant (MDR) strain and 68 (23.1%) received IEAT, mainly when the infection was caused by an MDR strain [38/52 (73.1%) vs. 30/242 (12.4%); p < 0.001]. The 30-day case-fatality rate was higher in patients with PA bacteremic pneumonia than in those with PA BSI from other sources (55.1% vs. 31.4%; p < 0.001). IEAT was associated with increased 30-day case-fatality (aHR 1.44 [95%CI 1.01–2.03]; p = 0.042), whereas the use of appropriate combination empirical treatment was independently associated with improved survival (aHR 0.46 [95%CI 0.27–0.78]; p = 0.004). Appropriate empirical monotherapy was not associated with improved overall survival (aHR 1.25 [95%CI 0.76–2.05]; p = 0.39). Combination antibiotic empirical therapy should be administered promptly in febrile neutropenic patients with suspected pneumonia as the source of infection.

Published
2022
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9. Clinical efficacy of ceftazidime/avibactam versus other active agents for the treatment of bacteremia due to carbapenemase-producing Enterobacteriaceae in hematologic patients

Author

Juan J. Castón, Isabel Lacort-Peralta, Pilar Martín-Dávila, Belén Loeches, Salvador Tabares, Liz Temkin, Julián Torre-Cisneros, and José R. Paño-Pardo

Subjects
Carbapenemase-producing Enterobacteriaceae, Bloodstream infections, Ceftazidime-avibactam, Infectious and parasitic diseases, RC109-216
Abstract

Objectives: The primary objective was to describe clinical features, treatment and outcomes in patients with carbapenemase-producing Enterobacteriaceae (CPE) bacteremia. Additionally, patients treated with ceftazidime/avibactam (study group) were compared to the rest of the patients (comparator group) to determine the influence of the treatment in both crude mortality and clinical cure. Methods: Multicenter and retrospective study that included patients with hematologic malignancies who had CPE bacteremia. A bivariate analysis was performed to compare the clinical variables between the study group and the control group. Results: 31 patients were included. Bacteremia was considered primary in 14 (45%) patients. Overall crude mortality at 30 days was 45.2% (n = 14). Mortality was more frequent when septic shock (78.6% vs 11.8%; p > 0.001) and higher Pitt score (6 + 14 vs 1.5 + 4; p

Published
2017
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10. Antibiotic stability in portable elastomeric infusion devices: A systematic review

Author

Beatriz Esteban-Cartelle, Noelia Vicente-Oliveros, Covadonga Pérez Menéndez-Conde, Dolores R Serrano, Pilar Martín-Dávila, Jesús Fortún-Abete, Lourdes A León-Gil, and Ana Álvarez-Díaz

Subjects
Pharmacology, Elastomers, Health Policy, Outpatients, Humans, Infusions, Parenteral, Infusion Pumps, Anti-Bacterial Agents
Abstract

Purpose Although outpatient parenteral antibiotic therapy (OPAT) can be a good approach to treatment of infections, a lack of data regarding antibiotic stability in portable elastomeric infusion devices restricts its safe, appropriate, and effective use. The objective of this work was to complete a systematic peer-reviewed analysis of published articles about antibiotic stability in elastomeric infusion devices that provide evidence supporting their use in OPAT. Summary A systematic review following PRISMA guidelines was conducted in January 2021 to identify published articles about antibiotic stability in portable elastomeric infusion devices. The databases used were PubMed, Embase, Web of Science, and a Cochrane database. A total of 1,615 original studies and conference communications were found. After title, abstract, and full-text review, 33 articles met the inclusion criteria. The data obtained included information about the stability of 30 different antibiotics. To our knowledge, this is the first review to summarize the available published data on the stability of antibiotics in portable elastomeric infusion devices. The results highlight the poor stability of some antibiotics in solution and the variability of the laboratory conditions in the included studies. Conclusion This systematic review can serve as a useful resource for healthcare professionals involved in providing OPAT using portable elastomeric infusion devices. However, further stability studies should be performed, especially high-quality studies simulating real-life time and temperature conditions.

Published
2022
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11. Efficacy of ceftazidime-avibactam in solid organ transplant recipients with bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae

Author

Elena Pérez-Nadales, Mario Fernández-Ruiz, Alejandra M. Natera, Belén Gutiérrez-Gutiérrez, Alessandra Mularoni, Giovanna Russelli, Ligia Camera Pierrotti, Maristela Pinheiro Freire, Marco Falcone, Giusy Tiseo, Mario Tumbarello, Francesca Raffaelli, Edson Abdala, Marta Bodro, Elena Gervasi, María Carmen Fariñas, Elena M. Seminari, Juan José Castón, Juan Antonio Marín-Sanz, Víctor Gálvez-Soto, Meenakshi M. Rana, Belén Loeches, Pilar Martín-Dávila, Álvaro Pascual, Jesús Rodríguez-Baño, José María Aguado, Luis Martínez-Martínez, Julián Torre-Cisneros, Mical Paul, Jordi Carratala, Isabel Oriol, Regino José Rodríguez-Álvarez, Elisa Cordero, José Antonio Lepe, Esperanza Merino de Lucas, Patricia Muñoz, Jesús Fortún, Julien Coussement, Laurent Dewispelaere, Britt Marie Eriksson, Christian van Delden, Oriol Manuel, Wanessa T. Clemente, Tania Mara Varejão Strabelli, Benoit Pilmis, Emmanuel Roilides, Iyer Ranganathan N, Paolo A. Grossi, Fabio Soldani, Marco Rizzi, Ban Hock Tan, Warren Lowman, Filiz Gunseren, Hande Arslan, Zeliha Koçak Tufan, Esra Kazak, Miruna D. David, Seema Mehta Steinke, Darin Ostrander, Robin Avery, and Erika D. Lease

Subjects
Transplantation, Immunology and Allergy, Pharmacology (medical)
Published
2023
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13. Clinical Significance of Human Herpesvirus 6 and 7 Infection in a Tertiary Hospital: a Case-Control Study

Author

Pablo Borque, Juan Carlos Galán, Beatriz Romero, Francesca Gioia, Rosa Escudero, Pilar Martín-Dávila, Santiago Moreno, and Jesús Fortún

Abstract

BackgroundHuman herpesviruses (HHV)-6 and HHV-7 are ubiquitous viruses with a global seroprevalence of around 90%, but their pathogenic significance remains unclear. MethodsFor 2 years, at our center, the presence of HHV6 and 7 DNA was investigated by PCR assay in blood, CSF, or other fluids. Epidemiological and clinical variables were collected from these patients and compared with those obtained in a negative-control cohort. Molecular detection of herpesvirus was performed using The Clart Entherpex kit (Genomica, Coslada, Spain), allowing simultaneous detection and identification of the eight human herpesviruses (HSV-1 to HHV-8) and Enterovirus (echovirus, poliovirus, and coxsackievirus).ResultsAll patients, cases, and controls were immunocompromised and had similar baseline clinical conditions. For all of them, molecular amplification of HHV-6 or 7 was requested as a diagnostic complement from different clinical pictures, mainly neurological symptomatology (80%). Corticosteroid treatment and viral or bacterial co-infection were independently associated with HHV-6 or 7 infections. When the impact of both viruses was analyzed independently, it was confirmed that HHV-6 was independently associated with higher 1-year mortality. ConclusionHHV-6 replication in CSF or blood may be a surrogate marker of mortality in the medium term in immunocompromised patients.

Published
2022
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14. Pharmacokinetics of echinocandins in suspected candida peritonitis: A potential risk for resistance

Author

Jesús Fortún, Pilar Martín-Dávila, Manuel Cuenca-Estrella, Maria Alvarez, Elia Gomez-García de la Pedrosa, Francesca Gioia, Alicia Gomez-Lopez, Santiago Moreno, Instituto de Salud Carlos III, Redes Tematicas de Investigacion Cooperativa en Salud (España), Ministerio de Ciencia, Innovación y Universidades (España), Red Española de Investigación en Patología Infecciosa, European Regional Development Fund, Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III - ISCIII, and European Regional Development Fund (ERDF/FEDER)

Subjects
Male, 0301 basic medicine, Antifungal Agents, Resistance, Candida glabrata, Anidulafungin, Gastroenterology, Echinocandins, chemistry.chemical_compound, 0302 clinical medicine, Caspofungin, Prospective Studies, 030212 general & internal medicine, Candida, biology, Candidiasis, General Medicine, Infectious Diseases, Female, medicine.drug, Adult, Microbiology (medical), medicine.medical_specialty, Echinocandin, Critical Illness, 030106 microbiology, Peritonitis, Microbial Sensitivity Tests, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, Internal medicine, medicine, Humans, lcsh:RC109-216, Pharmacokinetics, business.industry, Peritoneal fluid, Micafungin, bacterial infections and mycoses, medicine.disease, biology.organism_classification, chemistry, business
Abstract

Introduction: A possible increase in Candida resistance, especially in Candida glabrata, has been speculated according to poor diffusion of echinocandins to peritoneal fluid. Materials/methods: Peritoneal and serum concentrations of caspofungin, micafungin and anidulafungin were analysed in surgical patients with suspected candida peritonitis. After 4 days of starting therapy, serum and peritoneal samples (through peritoneal drainage) were obtained at baseline, 1, 6, 12 and 24 h of drug administration. Micafungin and anidulafungin concentrations were determined using highperformance liquid chromatography (HPLC/F), whereas caspofungin concentrations were established by bioassay. Results: Twenty-three critically ill patients with suspected abdominal fungal infection who were receiving an echinocandin were prospectively recruited. No specific criteria were applied to prescribe one specific echinocandin. No special clinical differences were observed among the three groups of patients. All were receiving antibiotic therapy, 80% required inotropic drugs, and fungal peritonitis was confirmed in 74% of them. The AUC0_24h (mg h/L) obtained in serum and peritoneal fluid were: 126.84 and 34.38, 98.52 and 18.83, and 66.9 and 8.78 for anidulafungin, micafungin and caspofungin, respectively. The median concentration in peritoneal fluid ranged from 0.66 to 1.82mg/mL for anidulafungin, 0.68–0.88mg/mL for micafungin and 0.21–0.46 mg/mL for caspofungin. Conclusion: The results showed moderate penetration of echinocandins into the peritoneal fluid of these patients. These levels are below the threshold of resistance mutant selection published by other authors. This could justify a potential risk of resistance in patients with prolonged treatment with echinocandins and suboptimal control of abdominal infection. The study received funding from the “Fondo de Investigaciones Sanitarias” of the Spanish Ministry of Health (FIS PI 15/1536). The work was supported by Plan Nacional de I + D+i 2013-2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16), and co-financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014-2020. Sí

Published
2020
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15. Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort

Author

Pilar Vizcarra, María J Pérez-Elías, Carmen Quereda, Ana Moreno, María J Vivancos, Fernando Dronda, José L Casado, Santiago Moreno, Maria Jesús Pérez-Elías, Jesús Fortún, Enrique Navas, Santos Del Campo, Rogelio López-Vélez, Javier Cobo Reinoso, José Luis Casado, Franceca Norman, Pilar Martín-Dávila, José Manuel Hermida, José Antonio Pérez Molina, Begoña Monge, Vicente Pintado, Sergio Serrano-Villar, Matilde Sánchez-Conde, Sandra Chamorro, Rosa Escudero, Francesca Gioia, Belén Comeche, Clara Crespillo, Sabina Herrera, Raquel Ron, Javier Martínez-Sanz, Mario Pons-Guillén, and María Jesús Vivancos

Subjects
0301 basic medicine, medicine.medical_specialty, education.field_of_study, Epidemiology, business.industry, Incidence (epidemiology), Immunology, Population, Lower risk, medicine.disease, 030112 virology, Comorbidity, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, Virology, Internal medicine, Cohort, Medicine, 030212 general & internal medicine, Young adult, business, Prospective cohort study, education, Body mass index
Abstract

Summary Background Information about incidence, clinical characteristics, and outcomes of HIV-infected individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is scarce. We characterised individuals with COVID-19 among a cohort of HIV-infected adults in Madrid. Methods In this observational prospective study, we included all consecutive HIV-infected individuals (aged ≥18 years) who had suspected or confirmed COVID-19 as of April 30, 2020, at the Hospital Universitario Ramon y Cajal (Madrid, Spain). We compared the characteristics of HIV-infected individuals with COVID-19 with a sample of HIV-infected individuals assessed before the COVID-19 pandemic, and described the outcomes of individuals with COVID-19. Findings 51 HIV-infected individuals were diagnosed with COVID-19 (incidence 1·8%, 95% CI 1·3–2·3). Mean age of patients was 53·3 years (SD 9·5); eight (16%) were women, and 43 (84%) men. 35 (69%) cases of co-infection had laboratory confirmed COVID-19, and 28 (55%) required hospital admission. Age and CD4 cell counts in 51 patients diagnosed with COVID-19 were similar to those in 1288 HIV-infected individuals without; however, 32 (63%) with COVID-19 had at least one comorbidity (mostly hypertension and diabetes) compared with 495 (38%) without COVID-19 (p=0·00059). 37 (73%) patients had received tenofovir before COVID-19 diagnosis compared with 487 (38%) of those without COVID-19 (p=0·0036); 11 (22%) in the COVID-19 group had previous protease inhibitor use (mostly darunavir) compared with 175 (14%; p=0·578). Clinical, analytical, and radiological presentation of COVID-19 in HIV-infected individuals was similar to that described in the general population. Six (12%) individuals were critically ill, two of whom had CD4 counts of less than 200 cells per μL, and two (4%) died. SARS-CoV-2 RT-PCR remained positive after a median of 40 days from symptoms onset in six (32%) individuals, four of whom had severe disease or low nadir CD4 cell counts. Interpretation HIV-infected individuals should not be considered to be protected from SARS-CoV-2 infection or to have lower risk of severe disease. Generally, they should receive the same treatment approach applied to the general population. Funding None.

Published
2020
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17. Aspergillus endocarditis in the recent years, report of cases of a multicentric national cohort and literature review

Author

Víctor José González Ramallo, Marta Hernández-Meneses, Claudia González-Rico, Maria Olmedo Samperio, Marta Camici, Mariona Xercavins, Carmen Hidalgo Tenorio, Eduard Quintana, Maricela Valerio, Guillermo Cuervo, Marina Machado, Jesus Vicente Guinea Ortega, Pilar Martín-Dávila, Ana Fernández-Cruz, Sofia De la Villa, David Nicolás, Dolores Sousa, Guillermo Ojeda Burgos, Natividad Benito, Fernando Dominguez, Jose A. Lepe, Jordi Carratala, Jose Lopez-Haldon, and Alicia Galar

Subjects
Male, infectious endocarditis, Antifungal Agents, Endocarditis, Aspergillus fumigatus, Dermatology, General Medicine, Middle Aged, Aspergillus, antifungal agents, Aspergillosis, immunodeficiency, Humans, Infectious Diseases
Abstract

(1) To describe the incidence, clinical characteristics, treatment and outcome of Aspergillus Endocarditis (AE) in a nationwide multicentric cohort (GAMES). (2) To compare the AE cases of the GAMES cohort, with the AE cases reported in the literature since 2010. (3) To identify variables related to mortality.We recruited 10 AE cases included in the GAMES cohort (January 2008-December 2018) and 51 cases from the literature published from January 2010 to July 2019.4528 patients with infectious endocarditis (IE) were included in the GAMES cohort, of them 10 (0.2%) were AE. After comparing our 10 cases with the 51 of the literature, no differences were found. Analysing the 61 AE cases together, 55.7% were male, median age 45 years. Their main underlying conditions were as follows: prosthetic valve surgery (34.4%) and solid organ transplant (SOT) (19.7%). Mainly affecting mitral (36.1%) and aortic valve (29.5%). Main isolated species were as follows: Aspergillus fumigatus (47.5%) and Aspergillus flavus (24.6%). Embolisms occurred in 54%. Patients were treated with antifungals (90.2%), heart surgery (85.2%) or both (78.7%). Overall, 52.5% died. A greater mortality was observed in immunosuppressed patients (59.4% vs. 24.1%, OR = 4.09, 95%CI = 1.26-13.19, p = .02), and lower mortality was associated with undergoing cardiac surgery plus azole therapy (28.1% vs. 65.5%, OR = 0.22, 95%CI = 0.07-0.72, p = .01).AE accounts for 0.2% of all IE episodes of a national multicentric cohort, mainly affecting patients with previous valvular surgery or SOT recipients. Mortality remains high especially in immunosuppressed hosts and azole-based treatment combined with surgical resection are related to a better outcome.

Published
2022

18. Co-infections and superinfections complicating COVID-19 in cancer patients: A multicentre, international study

Author

Belén Gutiérrez-Gutiérrez, F. Herrera, X. Durà-Miralles, C. Maluquer, Pilar Martín-Dávila, C.M. Ayaz, Lourdes Vázquez, G. Haidar, Luisa Sorlí, A. Silva-Pinto, Maddalena Peghin, M. Machado, P. Hernández-Jiménez, B. Kayaaslan, Ignacio Márquez-Gómez, F. Gabilán, Edson Abdala, J. Goikoetxea, J. Aguilar-Company, T.M. Andermann, Carlota Gudiol, Hugo Manuel Paz Morales, C. González-Rico, Natalia Pallares, Jordi Carratalà, S. Cuellar, Mercedes Marín, F. Fernandez-Avilés, Cristina Royo-Cebrecos, C. Salgueira, N. De Castro, M. Martínez-Cutillas, Manuela Aguilar-Guisado, Institut Català de la Salut, [Gudiol C] Department of Infectious Diseases, Biostatistics Unit, Bellvitge University Hospital, Bellvitge Institute for Biomedical Research (IDIBELL), University of Barcelona, Barcelona, Spain. Institut Català d’Oncologia, IDIBELL, University of Barcelona, Barcelona, Spain. Spainsh Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain. [Durà-Miralles X] Department of Infectious Diseases, Biostatistics Unit, Bellvitge University Hospital, Bellvitge Institute for Biomedical Research (IDIBELL), University of Barcelona, Barcelona, Spain. Spainsh Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain. [Aguilar-Company J] Servei d’Oncologia Mèdica, Servei de Malalties Infeccioses, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain. [Hernández-Jiménez P] Infectious Diseases Unit, 12 de Octubre University Hospital, Madrid, Spain. [Martínez-Cutillas M] Medical Oncology Department, Puerta de Hierro University Hospital, Madrid, Spain. [Fernandez-Avilés F] Bone Marrow Transplantation Unit, Department of Haematology, Hospital Clinic of Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
Microbiology (medical), medicine.medical_specialty, Neutropenia, medicine.disease_cause, COVID-19 (Malaltia), Càncer - Complicacions, Article, law.invention, neoplasias [ENFERMEDADES], Cohort Studies, Otros calificadores::Otros calificadores::/complicaciones [Otros calificadores], law, Internal medicine, Neoplasms, Streptococcus pneumoniae, Epidemiology, virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES], medicine, Humans, Opportunistic infections, Virus Diseases::Coinfection [DISEASES], Respiratory tract infections, business.industry, Coinfection, SARS-CoV-2, virosis::coinfección [ENFERMEDADES], Cancer, COVID-19, Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES], Cancer patients, medicine.disease, Intensive care unit, Neoplasms [DISEASES], Malalts de càncer, Intensive Care Units, Infectious Diseases, Superinfection, business, Infeccions oportunistes, Other subheadings::Other subheadings::/complications [Other subheadings], Cohort study
Abstract

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Complicacions infeccioses; Càncer Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Complicaciones infecciosas; Cáncer Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Infectious complications; Cancer Background We aimed to describe the epidemiology, risk factors, and clinical outcomes of co-infections and superinfections in onco-hematological patients with COVID-19. Methods International, multicentre cohort study of cancer patients with COVID-19. All patients were included in the analysis of co-infections at diagnosis, while only patients admitted at least 48 h were included in the analysis of superinfections. Results 684 patients were included (384 with solid tumors and 300 with hematological malignancies). Co-infections and superinfections were documented in 7.8% (54/684) and 19.1% (113/590) of patients, respectively. Lower respiratory tract infections were the most frequent infectious complications, most often caused by Streptococcus pneumoniae and Pseudomonas aeruginosa . Only seven patients developed opportunistic infections. Compared to patients without infectious complications, those with infections had worse outcomes, with high rates of acute respiratory distress syndrome, intensive care unit (ICU) admission, and case-fatality rates. Neutropenia, ICU admission and high levels of C-reactive protein (CRP) were independent risk factors for infections. Conclusions Infectious complications in cancer patients with COVID-19 were lower than expected, affecting mainly neutropenic patients with high levels of CRP and/or ICU admission. The rate of opportunistic infections was unexpectedly low. The use of empiric antimicrobials in cancer patients with COVID-19 needs to be optimized. This study was supported by the Spanish Plan Nacional de IDi 2013-2016, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, and the Spanish Network for Research in Infectious Diseases (REIPI grant: RD16/0016/0001). It was also co-financed by the European Development Regional Fund ‘A Way to Make Europe’, Operational Programme Smart Growth 2014-2020.

Published
2021

19. Carbapenemase-producing

Author

Vicente, Pintado, Patricia, Ruiz-Garbajosa, Rosa, Escudero-Sanchez, Francesca, Gioia, Sabina, Herrera, Pilar, Vizcarra, Jesús, Fortún, Javier, Cobo, Pilar, Martín-Dávila, María Isabel, Morosini, Rafael, Cantón, and Santiago, Moreno

Subjects
Coinfection, SARS-CoV-2, carbapenemase-producing Enterobacterales, multidrug-resistant, Enterobacteriaceae Infections, COVID-19, beta-Lactamases, Klebsiella Infections, Klebsiella pneumoniae, Bacterial Proteins, Case-Control Studies, outcome, Humans, Original Article, Serratia marcescens, Retrospective Studies, Research Article
Abstract

Background Carbapenemase-producing Enterobacterales (CPE) infections have been occasionally described in patients with coronavirus disease-19 (COVID-19). We assess the clinical features and outcome of these infections. Methods In this retrospective single-centre, case-control study, we included 54 patients with CPE infection: 30 case-patients (COVID-19) and 24 controls (non-COVID-19), collected between March and May 2020. We compared the epidemiological, clinical features, and outcome between cases and controls. Results CPE infection was more frequent in COVID-19 patients than in controls (1.1 vs. 0.5%, p = .005). COVID-19 patients were younger, had a lower frequency of underlying diseases (p = .01), and a lower median Charlson score (p = .002). Predisposing factors such as antimicrobial use, mechanical ventilation, or ICU admission, were more frequent in COVID-19 patients (p

Published
2021

22. Posaconazole salvage therapy: The Posifi study

Author

Juan José Castón, Carlota Gudiol, Rocío Parody, Jesús Fortún, Carolina Garcia-Vidal, Marina Machado, Antonio Ramos, Patricia Muñoz, Javier López, Matías Enzenhofer, Francesca Gioia, Celia Cardozo, Pilar Martín-Dávila, Elena Diago, Pedro Puerta-Alcalde, and Azahara Frutos

Subjects
Adult, Male, 0301 basic medicine, Posaconazole, medicine.medical_specialty, Antifungal Agents, Drug-Related Side Effects and Adverse Reactions, 030106 microbiology, Administration, Oral, Salvage therapy, Dermatology, Aspergillosis, Gastroenterology, Tertiary Care Centers, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Refractory, Internal medicine, medicine, Humans, Aged, Retrospective Studies, Aged, 80 and over, Salvage Therapy, medicine.diagnostic_test, business.industry, General Medicine, Middle Aged, Triazoles, medicine.disease, Treatment Outcome, Infectious Diseases, Mycoses, Withholding Treatment, Spain, Toxicity, Female, Liver function, Zygomycosis, Liver function tests, business, Blood Chemical Analysis, medicine.drug
Abstract

BACKGROUND Posaconazole (PCZ) is used mainly for the prevention of invasive fungal infection (IFI). METHODS A multicentre retrospective, investigational study using a non-randomized, single-arm design carried out in six tertiary hospitals in Spain to evaluate the use of PCZ in different forms of administration in the (non-prophylactic) treatment of IFI. RESULTS Over an eight-year-period, 67 patients were included in this study. PCZ was administered as salvage therapy (intolerant or refractory to a previous antifungal agent) in 65/67 (97%); of these, it was used against Aspergillosis (68.6%), Zygomycosis (13.4%), other moulds (8.9%) and yeast (10.5%). The median duration of PCZ therapy was 75 days. The oral solution was associated with low serum levels (

Published
2019
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23. Aerosolized Lipid Amphotericin B for Complementary Therapy and/or Secondary Prophylaxis in Patients with Invasive Pulmonary Aspergillosis: A Single-Center Experience

Author

Pilar Martín-Dávila, Luis Máiz, E. Gómez-García de la Pedrosa, E Filigheddu, Santiago Moreno, E. Venanzi, J López, R Escudero, Francesca Gioia, and J. Fortún

Subjects
Adult, Complementary Therapies, Male, 0301 basic medicine, medicine.medical_specialty, Antifungal Agents, Drug-Related Side Effects and Adverse Reactions, Aerosolized amphotericin B, Antifungal therapy, Invasive aspergillosis, Veterinary (miscellaneous), 030106 microbiology, Single Center, Chemoprevention, Applied Microbiology and Biotechnology, Microbiology, Group A, Group B, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Amphotericin B, Internal medicine, Secondary Prevention, medicine, Humans, Respiratory system, Aged, Retrospective Studies, Aerosols, Invasive Pulmonary Aspergillosis, Univariate analysis, Proportional hazards model, business.industry, Retrospective cohort study, Middle Aged, Survival Analysis, Treatment Outcome, Female, business, Agronomy and Crop Science, medicine.drug
Abstract

Experience with aerosolized lipid amphotericin B (aeLAB) as therapy or secondary prophylaxis in patients with invasive pulmonary aspergillosis (IPA) is anecdotal. We performed a single-center retrospective cohort study to evaluate the efficacy of systemic antifungal therapy with and without aeLAB in patients with proven or probable IPA. Complete or partial response at 3 months was the primary end-point. Clinical response and mortality at 12 months, occurrence of adverse drug reactions and respiratory fungal colonization were secondary end-point. Eleven patients (39%) received aeLAB in addition to systemic antifungal therapy (group A), and 22 (61%) received systemic antifungal therapy only (group B). The use of aeLAB was not standardized. Amphotericin B lipid complex was used in all patients but one, who received liposomal amphotericin B. Five patients received aeLAB as antifungal complementary therapy and 6 received it as secondary prophylaxis. Except for the requirement of inhaled corticosteroids and home oxygen therapy, more frequent in group A, both groups were similar in baseline conditions. A better (nonsignificant) clinical outcome was observed at 3 months in patients receiving aeLAB. Only uncontrolled baseline condition was associated with one-year mortality in univariate analysis (p = 0.002). A multivariate Cox regression analysis suggests that aeLAB, corrected for uncontrolled underlying disease, reduces mortality at 12 months (HR 0.258; 95% CI 0.072–0.922; p = 0.037). Although no significant difference was observed in the main variable (3-month clinical response) and in spite of methodological limitations of the study, the possible survival benefit of aeLAB, adjusted for the control of the underlying disease, could justify the performance of well-controlled studies with a greater number of patients.

Published
2019
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24. Impact of the Inclusion of an Aminoglycoside to the Initial Empirical Antibiotic Therapy for Gram-Negative Bloodstream Infections in Hematological Neutropenic Patients: a Propensity-Matched Cohort Study (AMINOLACTAM Study)

Author

Mercadal S, P. Puerta-Alcalde, Marina Machado, Jordi Carratalà, Carol Garcia-Vidal, Murat Akova, Celia Cardozo, Jesús Fortún, Bergas A, Natalia Pallares, C.M. Ayaz, Pilar Martín-Dávila, X Durà-Miralles, Carlota Gudiol, F. Herrera, Júlia Laporte-Amargós, H Pomares, Patricia Muñoz, Adaia Albasanz-Puig, A Álvarez-Uría, Torres D, and E García-Lerma

Subjects
0301 basic medicine, medicine.medical_specialty, Combination therapy, Cefepime, 030106 microbiology, Bacteremia, Clinical Therapeutics, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Sepsis, Case fatality rate, medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, Retrospective Studies, Pharmacology, business.industry, Aminoglycoside, Odds ratio, medicine.disease, Anti-Bacterial Agents, Regimen, Infectious Diseases, Aminoglycosides, Amikacin, Drug Therapy, Combination, business, Gram-Negative Bacterial Infections, Febrile neutropenia, medicine.drug
Abstract

To test the hypothesis that the addition of an aminoglycoside to a β-lactam antibiotic could provide better outcomes than β-lactam monotherapy for the initial empirical treatment of hematological neutropenic patients with subsequently documented Gram-negative bacillus (GNB) bloodstream infection (BSI), a multinational, retrospective, cohort study of GNB BSI episodes in hematological neutropenic patients in six centers (2010 to 2017) was conducted. Combination therapy (β-lactam plus aminoglycoside) was compared to β-lactam monotherapy. The primary endpoint was the case fatality rate, assessed at 7 and 30 days from BSI onset. Secondary endpoints were nephrotoxicity and persistent BSI. Propensity score (PS) matching was performed. Among 542 GNB BSI episodes, 304 (56%) were initially treated with combination therapy, with cefepime plus amikacin being most common (158/304 [52%]). Overall, Escherichia coli (273/304 [50.4%]) was the main etiological agent, followed by Pseudomonas aeruginosa, which predominated in the combination group (76/304 [25%] versus 28/238 [11.8%]; P

Published
2021

25. Invasive aspergillosis in solid organ transplantation: Diagnostic challenges and differences in outcome in a Spanish national cohort (Diaspersot study)

Author

Eta Filigheddu, Pilar Martín-Dávila, Ana Perez-Ayala, Mario Fernández-Ruiz, Laura Linares, Patricia Muñoz, Julián Torre-Cisneros, Marta Bodro, Francisco López-Medrano, Elisa Vidal, José Miguel Montejo, Claudia González-Rico, Laura Corbella, Regino Rodríguez-Álvarez, Marina Machado, Santiago Moreno, Maria Mar Ras, N. Sabé, Francisco Arnaiz, Maricela Valerio, Jesús Fortún, Jorge Calvo, Rafael Cantón, María Carmen Fariñas, Jose Maria Cifrian, José María Aguado, Sandra Pérez, Ana Fernández-Cruz, Leyre López-Soria, Asunción Moreno, and Francesca Gioia

Subjects
Adult, Male, medicine.medical_specialty, Antifungal Agents, Combination therapy, Population, Dermatology, Aspergillosis, Sensitivity and Specificity, Cohort Studies, Young Adult, Internal medicine, Epidemiology, Medicine, Humans, education, Retrospective Studies, Invasive Pulmonary Aspergillosis, education.field_of_study, business.industry, Incidence (epidemiology), Breakthrough infection, General Medicine, Organ Transplantation, medicine.disease, Transplantation, Causality, Infectious Diseases, Spain, Cohort, Female, Voriconazole, business
Abstract

BACKGROUND The diagnosis of invasive aspergillosis (IA) can be problematic in solid organ transplantation (SOT). The prognosis greatly varies according to the type of transplant, and the impact of prophylaxis is not well defined. PATIENTS AND METHODS The Diaspersot cohort analyses the impact of IA in SOT in Spain during the last 10 years. Proven and probable/putative IA was included. RESULTS We analysed 126 cases of IA. The incidences of IA were as follows: 6.5%, 2.9%, 1.8% and 0.6% for lung, heart, liver and kidney transplantation, respectively. EORTC/MSG criteria confirmed only 49.7% of episodes. Tree-in-bud sign or ground-glass infiltrates were present in 56.3% of patients, while serum galactomannan (optical density index >0.5) was positive in 50.6%. A total of 41.3% received combined antifungal therapy. Overall mortality at 3 months was significantly lower (p

Published
2021

26. COVID-19 and geographical area of origin

Author

Francesca F. Norman, Clara Crespillo-Andújar, José Antonio Pérez-Molina, Belén Comeche, Sandra Chamorro, Begoña Monge-Maillo, Santiago Moreno-Guillén, Rogelio López-Vélez, Pilar Vizcarra, Francesca Norman, Clara Crespillo, José Pérez-Molina, Begoña Monge, Santiago Moreno, Maria Jesús Pérez-Elías, Jesús Fortún, Enrique Navas, Carmen Quereda, Fernando Dronda, Santos Del Campo, Javier Cobo Reinoso, José Luis Casado, Ana Moreno, Pilar Martín-Dávila, José Manuel Hermida, Vicente Pintado, Sergio Serrano-Villar, Matilde Sánchez-Conde, Rosa Escudero, Francesca Gioia, Sabina Herrera, Raquel Ron, Javier Martínez-Sanz, Mario Pons-Guillén, and María Jesús Vivancos

Subjects
Adult, Male, 0301 basic medicine, Microbiology (medical), Asia, Adolescent, Coronavirus disease 2019 (COVID-19), Hospitalized patients, 030106 microbiology, Comorbidity, law.invention, Young Adult, 03 medical and health sciences, 0302 clinical medicine, law, Humans, Medicine, Hospital Mortality, 030212 general & internal medicine, Young adult, Child, Aged, Retrospective Studies, Aged, 80 and over, SARS-CoV-2, business.industry, Age Factors, COVID-19, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Intensive care unit, Icu admission, Europe, Hospitalization, Intensive Care Units, Latin America, Infectious Diseases, Spain, Africa, Referral centre, Female, Original Article, business, Immigrant, Demography
Abstract

OBJECTIVES: To describe and compare the main clinical characteristics and outcome measures in hospitalized patients with confirmed coronavirus disease 2019 (COVID-19) according to geographical area of origin. METHODS: A retrospective analysis of patients hospitalized with confirmed COVID-19 at a referral centre in Madrid, Spain, during March-May 2020 was performed. Recorded variables (age, gender, intensive care unit (ICU) admission, outcome), and geographical area of origin were compared for Europeans and non-Europeans (Latin Americans, Asians and Africans). RESULTS: In total, 2345 patients with confirmed COVID-19 hospitalized during the study period were included in the study. Of these, 1956 (83.4%) were European and 389 (16.6%) were non-European (of whom over 90%, 354/389, were Latin American). Non-Europeans were significantly younger than Europeans (mean 54 (SD 13.5) versus 70.4 (SD 15.1) years, p

Published
2021
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27. Analysis of sex differences in the clinical presentation, management and prognosis of infective endocarditis in Spain

Author

Víctor José González Ramallo, Claudia González-Rico, Luis Eduardo López-Cortés, José David Rodrigo Carbonero, Mariona Xercavins, Pere Pericas, Pilar Martín-Dávila, Ana Fernández-Cruz, José A. Oteo, David Nicolás, Guillermo Ojeda Burgos, Elena Muñez Rubio, Natividad Benito, Isabel M Morales Barroso, Fernando Dominguez, and Jose A. Lepe

Subjects
Aortic valve, Male, medicine.medical_specialty, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Sex Factors, Internal medicine, Mitral valve, medicine, Endocarditis, Humans, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, Sex Distribution, Propensity Score, Aged, business.industry, Confounding, Disease Management, medicine.disease, Prognosis, Survival Rate, medicine.anatomical_structure, Spain, Infective endocarditis, Cohort, Propensity score matching, Etiology, Female, Morbidity, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

IntroductionSex-dependent differences of infective endocarditis (IE) have been reported. Women suffer from IE less frequently than men and tend to present more severe manifestations. Our objective was to analyse the sex-based differences of IE in the clinical presentation, treatment, and prognosis.Material and methodsWe analysed the sex differences in the clinical presentation, modality of treatment and prognosis of IE in a national-level multicentric cohort between 2008 and 2018. All data were prospectively recorded by the GAMES cohort (Spanish Collaboration on Endocarditis).ResultsA total of 3451 patients were included, of whom 1105 were women (32.0%). Women were older than men (mean age, 68.4 vs 64.5). The most frequently affected valves were the aortic valve in men (50.6%) and mitral valve in women (48.7%). Staphylococcus aureus aetiology was more frequent in women (30.1% vs 23.1%; pSurgery was performed in 38.3% of women and 50% of men. After propensity score (PS) matching for age and estimated surgical risk (European System for Cardiac Operative Risk Evaluation II (EuroSCORE II)), the analysis of the matched cohorts revealed that women were less likely to undergo surgery (OR 0.74; 95% CI 0.59 to 0.91; p=0.05).The observed overall in-hospital mortality was 32.8% in women and 25.7% in men (OR for the mortality of female sex 1.41; 95% CI 1.21 to 1.65; pConclusionsFemale sex was an independent factor related to mortality after adjusting for confounders. In addition, women were less frequently referred for surgical treatment.

Published
2021

28. Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Author

Jesús Rodríguez-Baño, Jerónimo Pachón, Jordi Carratalà, Pablo Ryan, Inmaculada Jarrín, María Yllescas, José Ramón Arribas, Juan Berenguer, Esther Aznar Muñoz, Pedro Gil Divasson, Patricia González Muñiz, Clara Muñoz Aguirre, Marta Díaz Menéndez, Fernando de la Calle Prieto, Marta Arsuaga Vicente, Elena Trigo Esteban, Ignacio Pérez Valero, Rosa de Miguel Buckley, Julen Cadiñaños Loidi, Beatriz Diaz Pollan, Luz Martín Carbonero, Juan Carlos Ramos Ramos, Belén Loeches Yagüe, Rocío Montejano Sánchez, Juan González García, Julio García Rodríguez, Margarita Ramírez, Isabel Gutiérrez, Francisco Tejerina, Teresa Aldámiz-Echevarría, Cristina Díez, Chiara Fanciulli, Leire Pérez-Latorre, Blanca Pinilla, Juan Carlos López, Ana Such Diaz, Elena Álvaro Alonso, Juan Torres Macho, Guillermo Cuevas Tascon, Eva Jiménez González de Buitrago, Fátima Brañas Baztán, Jorge Valencia de la Rosa, Mario Pérez Butragueño, Inés Fernández Jiménez, Gemma Muñiz Nicolás, Antonia Sepúlveda Berrocal, Alberto Gato Díez, María Pilar Toledano Sierra, María Paz García Butenegro, Ana Isabel Peláez Ballesta, Elena Morcillo Rodríguez, Isidoro Fernández Romero, Cristina Peláez Ballesta, María Isabel Guirado Torrecillas, Josune Goikoetxea Agirre, Elena Bereciartua Bastarrica, Laura Guio Carrión, Regino Rodríguez Álvarez, Marta Ibarrola Hierro, Isabel A. Pérez Hernández, Inés Pérez Zapata, Sergio Román Soto, Mohamed Kallouchi, Juan Ramón Domínguez Vicent, Rafae Silvariño Fernández, Jon Ugalde Espiñeira, Ainhoa Sanjuan López, Silvia García Martínez, Mikel Temprano Gogenola, Víctor Asensi, Silvia Suárez, Lucia Suárez, Carmen Yllera, María Rivas-Carmenado, Alberto Romero-Palacios, Jesús Ruiz Aragón, Patricia Jiménez Aguilar, Ma Luisa Fernández Ávila, Rosario Castilla Ortiz, Vanesa Alende Castro, Cristina Pérez García, Marta Fernández Morales, María Lorena María Valle Feijoo Begoña Rodríguez Ferreira, Joan Gómez-Junyent, Judit Villar-García, Inmaculada López-Montesinos, Itziar Arrieta-Aldea, Abora Rial-Villavecchia, Elisa García Vázquez, Aychel Elena Roura Piloto, Encarnación Moral Escudero, Alicia Hernández Torres, Helena Albendín Iglesias, David Vinuesa García, Clara Martínez Montes, Francisco Javier De la Hera Fernández, Francisco Anguita Santos, Andrés Ruiz Sancho, Vicens Díaz de Brito Fernández, Montserrat Sanmarti Vilamala, Sergio España Cueto, Daniel Molina Morant, Araceli González-Cuevas, Joel Elías Chara Cervantes, Guillem Policarpo Torres, Meritxell Ortega Montoliu, Mònica Angerri Nadal, Ariadna De Genover Gil, Eleni Patera, Rita Godoy Lorenzo, Evangelia Anna María Zioga, Virginia Isern Fernández, Carlos Enrique Sabbagh Fajardo, Ana Ferrer Ribera, Carlos Bea Serrano, Rosa Oltra Sempere, Sara Vela Bernal, Paloma Albiol Viñals, Miguel Pedromingo Kus, María Ángeles Garcinuño, Silvana Fiorante, Sergio Pérez Pinto, Alexandra de la Vega, María Carmen Fariñas Álvarez, Claudia González Rico, Francisco Arnaiz de las Revillas, Teresa Giménez, Jorge Calvo, Yolanda Meije Castillo, Alejandra Duarte Borges, Júlia Pareja Coca, Mercedes Clemente Presas, Xavier Sanz Salvador, Ma Teresa Pérez Rodríguez, Adrián Sousa, Alexandre Pérez González, Rebeca Longueira, Alejandro Araujo, Blanca Alonso Martínez, Laura García Escudero, Sara Lidia Kamel Rey, David Roa Alonso, Juan Pablo Avilés Parra, Iván Pelegrín Senent, Rosana Rouco Esteves Marques, Laia Raich Montiu, Jessica Souto Higueras, Manuel Alejandro Gálvez Bobadilla, Jorge Parra Ruiz, Violeta Ramos Sesma, Sara Velasco Fuentes, Laura García Pereña, Alfonso Lluna Carrascosa, Sergio Gilaberte Reyzábal, Mónica Liébana Gómez, Juan Salillas Hernando, Alberto Serrano Martínez, Miguel Torralba González de Suso, Patricia Martínez Martín, Isabel Rábago Lorite, Patricia González-Ruano Pérez, Beatriz Pérez-Monte Mínguez, Ángeles García Flores, Pere Comas Casanova, Andrea Martín Plata, Sergio Manuel Santana Báez, Oscar Sanz Peláez, Karim Mohamed Ramírez, José María Robaina Bordón, Helem Haydeé Vílchez Rueda, Melchor Riera Jaume, Gemma Mut Ramon, Meritxell Gavalda Manso, Lluis Planas Bibiloni, Laura Castelo Corral, Lucía Ramos Merino, Efrén Sánchez Vidal, María Rodríguez Mayo, Enrique Míguez Rey, José M. García de Lomas Guerrero, Javier De la Torre Lima, Ana Correa Ruiz, Fernando Fernández Sánchez, Nicolás Jiménez-García, José Luis Sierra-Monzón, Borja Gracia-Tello, María Hernández-Bonaga, Galadriel Pellejero, Marta Asín-Corrochano, Lucia Boix Palop, Esther Calbo, Cristina Badía, Beatriz Dietl, Gómez Lucía, Ángel Domínguez-Castellano, María José Ríos-Villegas, María D. del Toro, Zaira R. Palacios Baena, Elena Salamanca-Rivera, Elena Marín, Virginia Almadana, Salvador Pérez-Galera, Luisa González-Iglesias, Gabriela Abelenda-Alonso, Claudia Álvarez-Pouso, Francesc Escrihuela, Carlota Gudiol, Laia Lorenzo-Esteller, Jordi Niubó, Daniel Podzamczer, Miquel Pujol, Alexander Rombauts, Miguel Salvert Lletí, Ricardo Gil Sánchez, Marta Jiménez Escrig, Laura Parra Gómez, Mariona Tasias Pitarch, Marta Navarro Vilasaró, María Luisa Machado Sicilia, Aina Gomila Grange, Sonia Calzado Isbert, Nerea Carrasco Antón, Elizabet Petkova-Saiz, Alfonso Cabello Úbeda, Miguel Górgolas Hernández-Mora, Olga Sánchez-Pernaute, Carlos Dueñas Gutiérrez, Javier Martin Guerra, José Javier Castrodeza Sanz, Virginia Fernández Espinilla, Laura Rodríguez Fernández, Juan González-Moreno, Aroa Villoslada Gelabert, María Antonia Ribot Sanso, María Victoria Fernández-Baca, Almudena Hernández Milian, Miguel Ángel Morán Rodríguez, Zuriñe Ortiz de Zárate Ibarra, José Joaquin Portu Zapirain, Ester Saez de Adana Arroniz, Juan Carlos Gainzarain Arana, Olga Meca Birlanga, Ma Jesús del Amor Espín, Montserrat Viqueira González, Josefina García García, Onofre Martínez Madrid, Enrique Bernal Morell, Antonia Alcaraz, Ángeles Muñoz, Ignacio Pina, Vicente de la Rosa, Tamara Caínzos Romero, Sabela Sánchez Trigo, Ana Isabel Mariño Callejo, Hortensia Álvarez Díaz, Nieves Valcarce Pardeiro, Adriana Sánchez Serrano, Diana Piñar Cabezos, Eva Pilar García Villalba, Carmen Aguayo Jiménez, María Ruíz Campuzano, Virginia Naranjo Velasco, Marta Santos Peña, Juan Mora Delgado, Israel Sevilla Moreno, Cristina Lojo Cruz, Xabier Kortajarena Urkola, José Antonio Iribarren Loyarte, María Jesús Bustinduy Odriozola, Maialen Ibarguren Pinilla, Ignacio Álvarez Rodríguez, Francisco Javier Martínez Marcos, Francisco Javier Rodríguez Gómez, Isabel Asschert Agüero, Francisco Muñoz Beamud, Antonio José Ruiz Reina, Jara Llenas-García, Inmaculada González-Cuello, Elena Hellín-Valiente, Esther Martínez Birlanga, José Manuel Tafalla Torres, Jorge Calderón Parra, Gabriela Escudero López, Isabel Gutiérrez Martín, Ane Andrés Eisenhofer, Sonia García Prieto, Raquel Álvarez Franco, Daniel Roger Zapata, Blanca Martínez Cifre, Elena Aranda Rife, Irene Martín Rubio, André Barbosa Ventura, Javier Garrido, Concepción Gonzalo, Iván Piñero, Nieves de la Cruz Felipe, Eva Talavera García, Marta Lamata Subero, Paula Mendoza Roy, María Soledad García de Carlos, Justo Lajusticia Aisa, Lorea Arteche Eguizabal, Ainhoa Urrutia Losada, Saioa Domingo Echaburu, Pedro Ángel Cuadros Tito, Gurutz Orbe Narváez, Ma del Carmen Liébana Martos, Carolina Roldán Fontana, Carmen Herrero Rodríguez, Gaspar Duro Ruiz, Santiago Pérez Parra, Arantzazu Mera Fidalgo, Miquel Hortos Alsina, Ana Alberich Conesa, Lourdes Bladé Vidal, Nicolás Merchante Gutiérrez, Eva León Jiménez, Reinaldo Espíndola Gómez, María Erostarbe Gallardo, Pedro Martínez Pérez-Crespo, José Miguel Cisneros, Manuela Aguilar-Guisado, Teresa Aldabó, Claudio Bueno, Elisa Cordero-Matía, Ana Escoresca, Carmen Infante, Martín Guillermo, Sonsoles Salto, Francesca Gioia, Pilar Vizcarra, Jesús Fortún Abete, Pilar Martín Dávila, Santiago Moreno Guillén, José A. Oteo Revuelta, Concepción García-García, Paula Santibañez Sáenz, Cristina Cervera Acedo, José M. Azcona Gutiérrez, José María Reguera Iglesias, Antonio Plata Ciezar, Lucia Valiente de Santis, Beatriz Sobrino Diaz, Juan Diego Ruiz Mesa, Ministerio de Ciencia e Innovación, Fundación SEIMC/GeSIDA, Instituto de Salud Carlos III - ISCIII, European Regional Development Fund (ERDF/FEDER), Red Española de Investigación en SIDA, Red Española de Investigación en Patología Infecciosa, UAM. Departamento de Medicina, UAM. Departamento de Medicina Preventiva y Salud Pública y Microbiología, Universidad de Cantabria, SAM-COVID Study Group, [Rodríguez-Baño,J] Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain. [Rodríguez-Baño,J, Pachón,J] Departamento de Medicina, Universidad de Sevilla, Spain. [Rodríguez-Baño,J, Pachón,J] Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain. [Pachón,J] Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain. [Carratalà,J] Servei de Malalties Infeccioses, Hospital Universitari de Bellvitge, Barcelona, Spain. [Carratalà,J] Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, Spain. [Carratalà,J] Universitat de Barcelona, Barcelona, Spain. [Ryan,P] Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, Spain. [Jarrín,I] Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain. [Yllescas,M] Fundación SEIMC/GeSIDA, Madrid, Spain. [Arribas,JR] Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain. [Arribas,JR] Instituto de Investigación Hospital Universitario La Paz, Madrid, Spain. [Berenguer,J] Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain. [Berenguer,J] Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain., Ministerio de Ciencia e Innovación (España), Instituto de Salud Carlos III, Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), Red de Investigación Cooperativa en Investigación en Sida (España), Red de Investigación Cooperativa en Investigación en Patología Infecciosa (España), Gilead Sciences, ViiV Healthcare, AbbVie Pharmaceuticals, Merck & Co, Janssen Biotech, Teva Pharmaceutical Industries, Ministerio de Ciencia, Innovación y Universidades (España), European Commission, Universidad de Sevilla. Departamento de Medicina, Instituto Carlos III (España), and Unión Europea

Subjects
0301 basic medicine, Male, law.invention, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], chemistry.chemical_compound, 0302 clinical medicine, Organisms::Viruses::RNA Viruses::Nidovirales::Coronaviridae [Medical Subject Headings], Randomized controlled trial, law, Adrenal Cortex Hormones, Clinical endpoint, Medicine, 030212 general & internal medicine, Hospital Mortality, Health Care::Environment and Public Health::Public Health::Epidemiologic Measurements::Demography::Vital Statistics::Mortality [Medical Subject Headings], Adrenocortical hormones, Hazard ratio, General Medicine, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Intubation::Intubation, Intratracheal [Medical Subject Headings], Middle Aged, Tocilizumab, Hospitalization, Infectious Diseases, Treatment Outcome, Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections [Medical Subject Headings], Drug Therapy, Combination, Female, Cohort study, Microbiology (medical), medicine.medical_specialty, Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections::Severe Acute Respiratory Syndrome [Medical Subject Headings], Combination therapy, Medicina, Hyperinflammatory state, 030106 microbiology, Estudios de cohortes, Antibodies, Monoclonal, Humanized, Article, 03 medical and health sciences, Internal medicine, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Follow-Up Studies [Medical Subject Headings], Intubation, Intratracheal, Mortalitat, Humans, Corticosteroids, Mortality, Corticoesteroides, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings], Aged, Proportional Hazards Models, Retrospective Studies, Geographical Locations::Geographic Locations::Europe::Spain [Medical Subject Headings], Inflammation, business.industry, SARS-CoV-2, COVID-19, Odds ratio, Chemicals and Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Adrenal Cortex Hormones [Medical Subject Headings], Corticosteroides, COVID-19 Drug Treatment, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Propensity Score [Medical Subject Headings], chemistry, Spain, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies [Medical Subject Headings], Propensity score matching, Mortalidad, Monoclonal antibodies, business, Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Inflammation [Medical Subject Headings], Anticossos monoclonals
Abstract

© 2020 The Author(s)., [Objectives]: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters., [Methods]: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs)., [Results]: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22–0.47; p < 0.001) for tocilizumab, 0.82 (0.71–1.30; p 0.82) for IHDC, 0.61 (0.43–0.86; p 0.006) for PDC, and 1.17 (0.86–1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02–0.17; p < 0.001)., [Conclusions]: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situation., IJ has received honoraria for participating in an advisory board from Gilead Sciences, and for educational activities from ViiV. JB has received research grants from AbbVie, Gilead Sciences, Merck, and ViiV, and honoraria for being a speaker or advisory board participation from AbbVie, Gilead Sciences, Janssen, Merck, and ViiV. JRA received fees for participating in an advisory board, being a speaker, and research grant support from Viiv, Janssen, Gilead, MSD, Teva, Alexa and Serono. PR is involved as speaker or advisory board participant for Gilead Sciences, AbbVie and ViiV. JR-B, JP, JC and MY have no conflicts of interest to declare. SAM-COVID was funded by Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (COV20/01031) co-funded by European Union (ERDF/ESF, “Investing in your future”) and Fundación SEIMC/GeSIDA. In addition, Juan Berenguer, Jesús Rodríguez-Baño, Inmaculada Jarrín, Jordi Carratalá, Jerónimo Pachón, and José R Arribas received funding for research from Plan Nacional de I+D+i 2013-2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades – co- financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014–2020 through the networks: Spanish AIDS Research Network (RIS) [RD16/0025/0017 (JB), RD16/0025/0018 (JRA), RD16/0025/00XX (IJ)] and Spanish Network for Research in Infectious Diseases (REIPI)[RD16/0016/0001 (JRB), RD16/0016/0005 (JC), and RD16/0016/0009 (JP).

Published
2021

29. Identification and validation of clinical phenotypes with prognostic implications in patients admitted to hospital with COVID-19: a multicentre cohort study

Author

Jaime Fernández-Bujarrabal Villoslada, Beatriz Dietl Gómez-Luengo, Daniel Ortiz-Sánchez, José Ramón Blanco Ramos, Bartolomé Gómez-Arroyo, Martín Sebastián Ruiz Grinspan, Ester Sáez de Adana Arróniz, Daniel Daniel López, Judit Villar-García, Begoña De Dios García, Josefina García García, Nuria Rabella García, Ana Rodríguez-Revillas, Lydia Martín González, Mercedes San Franco, Elena Martinez Robles, Teresa González Alegre, Elena Morcillo Rodríguez, Oriol Gasch Blasi, Laura Prieto Pérez, Isabel Jiménez Martínez, Elena Isaba Ares, Ricardo Deza-Palacios, Helena Mendez del Sol, Melchor Riera Jaume, Mercedes Rodriguez-Gutiérrez, Daniel Podzamczer, Mikel Urroz, Luis Ramos Ruperto, María Paniagua, Sergio Alcolea-Batres, Mar Masiá Canuto, Rubén Soriano-Arroyo, Paloma Merino Amador, Berta Antón-Huguet, Gabriela Alcaraz, Pablo Ryan, Carlos Franco, Leyre Díez-Porres, Juan Carlos Figueiras, Sara Lidia Kamal, Mónica Hernández, Lorena Barrera-López, Germán Ramírez-Olivencia, Kapil Laxman Nanwani Nanwani, Alberto Oreja, Montserrat Laguno, José Javier Castrodeza Sanz, Belén Loeches Yagüe, Maria Vargas, Luis Eduardo López-Cortés, Isabel Gutiérrez, Sara Vela Berna, P. Martín, Miguel Pedromingo Kus, Jesús Sanz Sanz, Mº Antonia Sepúlveda Berrocal, Carmen Yera Bergua, Juan Cuadros González, Julen Cadiñanos Loidi, Josefa Serralta Buades, María Concepción Prados Sánchez, Francesca Gioia, Iris Pedrola Gorrea, Francisco Arnaiz de las Revillas, Xabier Kortajarena Urkola, Laia Lorenzo-Esteller, Ruth Bravo-Lizcano, Angel Iniesta, Sofía González-García, Belén Martínez López, Agustín Rojas-Vieyra, Concepción García García, Raquel Cavallé-Pulla, Lucía Gómez García, Alicia Herrero, Carlos Jesús Dueñas Gutiérrez, Loreto Vidaur Tello, Carmen Fernández-Capitán, Victoria Lo-Iacono García, Cecilia Gómez-Domínguez, Adalgisa Falcone, María José Ruiz Rodríguez, Arancha Castellano, Miquel Hortos Alsina, María Concepción Nuñez, María Luisa Fernández Vidal, Jésica Abadia Otero, Natalia Moya-González, Albert Sabater Gil, Pedro de la Oliva, Ylenia María Conde-Alonso, Laura Castelo Corral, José Mº García de Lomas Guerrero, Verónica Pérez-Blanco, Isabel San Juan, Martina Archinà, Júlia Sellarés, Juan Carlos Ramos, Cintia María Martínez Mateu, Belén Fernández-Puntero, Andrea Torrecillas-Mainez, Luis Falgueras López, Carlos Carpio-Segura, María Gandullo-Moro, Francisco Abellán Martínez, Cristina Díez, Pilar Martín Dávila, Silvia Gómez-Zorrilla, María Pilar García García, Renzo Tejada-Sorados, María Dolores del Toro, E. Álvarez-Rojas, Gema Muñiz, Lucía Cajuela, María Novella Mena, Estel Pons Viñas, Andrea Pérez Rodríguez, Benito Almirante, Mónica Gozalo, Patricia Girón De Velasco-Sada, Camilo Sanz Zamudio, Ángeles García Flores, Joaquín López-Contreras González, Blanca Fabre-Estremera, Pelayo Fernández Cidón, María Martínez-Redondo, Paula Alejandra Hernández-Liebo, Juan Herrero, Marta Duque-Alcorta, María Teresa García Morales, Concepción Amador Prous, Alex Soriano, Raquel Hernando Nieto, Raquel Álvarez Franco, Alfonso Cabello Úbeda, Luis Force Sanmartín, Laura Mao Martín, Daniel Prieto-Arribas, Mario Pérez-Butragueño, Pere Domingo Pedrol, Henar Serrano-Martín, Mónica Zubimendi, M. Rodríguez-Rubio, David Pujol-Pocull, Manuel García-Gutiérrez, Carlos Manrique de Lara, Lucy Abella Vázquez, Marta Navarro Vilasaró, Carlota Cascajares-Sanz, Berta Torres, Daniel Ceniza-Pena, Isidro Moreno Gómez-Limón, María Rodríguez Mahía, Alí Martakoush, Antonio Buño-Soto, Patricia Serrano de la Fuente, Claudia González Rico, Teresa Pedraz, Conchita Pérez-Jorge Peremarch, Elena Trigo Esteban, Rosana Rouco Esteves Marques, Juan Mora Delgado, Inés Pérez Zapata, Sandra Pérez-Recio, María Ángeles Domínguez, Manuel Cervantes García, Francisco Reinoso-Lozano, M. Martí De Gracia, Carmina Oltra, Beatriz Pérez-Monte Mínguez, Guillermina Bejarano-Redondo, Sara Heili Frades, María Paz García Butenegro, Miguel Torralba González de Suso, Elena Álvaro-Alonso, Víctor J Moreno Cuerda, Gonzalo Garzón, Marcelo Daltro-Lage, Alberto Serrano Martínez, José María Aguado, Mar Mosquera, Ruth Figueroa Cerón, Juan Carlos Martin Gutiérrez, Javier Oliver Ortega, Esteban Martínez, Cristina Gómez-Ayerbe, Nerea Carrasco Antón, María Carmen Fariñas Álvarez, José Antonio Ruiz, Justo Menéndez, Lucía Díaz, José L. Casado, Pilar Vizcarra, Javier Veganzones, Miguel Ángel Moran Rodríguez, Mercedes López-Martinez, Emilio Letang, Paloma Romero Gallego-Acho, Julia Vasquez-Manau, Alexander Rombauts, Marta Robledo del Prado, Luis Puente, Beatriz Alvarez, Juan Emilio Losa García, José Tomas Algado Rabasa, Rafael Torres Perea, Angélica Rivera-Núñez, Esther Expósito Palomo, Antonio J. Carcas, Lucía Platero-Dueñas, Irene Martín Rubio, Miguel Salavert Lletí, Claudia García-Vaz, Antonio Martínez-Verdasco, Jorge Díaz-Garzón, Javier Nieto Arana, Fernando Cadenas-Gota, Richard Rojas, Abelardo García de Lorenzo, Juan Carlos López, Pedro Luis Martinez Hernández, Manuela de Pablos-Gómez, Pablo Alonso, Enrique Seco, María García-López, Lorena López-Corcuer, Celia Blasco-Andres, Delia Romera-Cano, José M. Azcona Gutiérrez, Almudena Gutiérrez-Arroyo, Paula Mendoza Roy, Ignacio De los Santos Gil, Miguel Angel Sánchez-Castellano, Sara Medrano Pardo, Mikel del Álamo Martínez de Lagos, Rocío Martínez Avilés, Elisabet Martínez-Cerón, José Manuel Vázquez Comendador, Marta Virgós-Varela, Alejandra Álvarez Brandt, Carmen Herrero Rodríguez, Jorge Martínez Jordán, Antonio Rezusta López, Marta Vizcaíno Callejón, Manuela Simon-Velasco, Jorge Ignacio Alonso-Eiras, Elisa García Vázquez, Mercè Gurguí Ferrer, Mónica González Bardanca, Nataly Cancelliere-Fernández, José Luis Díaz de Tuesta del Arco, María Larrosa, Alejandro García García, Carmen Román-Hernández, Elena Calvin-García, José Sanz Moreno, Miguel Silvestre-Niño, Nieves Valcarce Pardeiro, Maria Teresa Corcuera-Pindado, Enrique Monteoliva, Aina Gabarrell Pascuet, Elena María Aranda Rife, Aina Gomila Grange, Alba Alastrué Violeta, Daniel Roger Zapata, Jaime Montserrat, Eduardo Malmierca Corral, Marco Palma, Blanca Martínez Cifre, Gema Domínguez de Pablos, Emilio Cuesta, Eva Perales, Silvia Hernáez Crespo, Juan Torres-Macho, Adrián Sánchez Montalvá, Rocío Montejano Sánchez, Eva Van den Eynde Otero, Silvia Castañeda Espinosa, Virginia Pérez Doñate, Adriana Hernández Belmonte, Laura Iglesias Llorente, María Sanz de Pedro, Juan Espinosa Pereiro, Lubna Dani Ben-Abdellah, Raquel Barrós González, Iván Piñero, Araceli López-Tofiño, Ana Such-Diaz, Karim Mohamed Ramírez, Pilar Toledano Sierra, Rebeca Izquierdo, Guillermo Cuevas, Andrés Felipe Cardona Arias, Ileana Gabriela-Tomoiu, David Vinuesa García, Ander González Sarria, Stephan Stuart, José María Fernández, Javier Torres-Cortés, Elisabet Delgado Sánchez, María Varela-Cerdeira, Gemma Bassani, Berta Román Bernal, Isabel García, Paula Betancort de la Torre, Yolanda Martínez-Abad, Beatriz Arizcun, Juan José Cabanillas-Martín, Guillermo Estrada Fernández, Oscar del Río Pérez, Inmaculada Martín Pérez, Andony García, Luis Gómez-Carrera, Alexander Agrifoglio, Alberto M. Borobia, Jordi Niubó, Vanessa Alende Castro, Lara Montes Andújar, Alexandra De la Vega, Efrén Sánchez Vidal, Isabel A. Pérez Hernández, Laura Frade-Pardo, Ana Josefa Tebar-Martinez, Silvia Álvarez Kaelis, Sara De la Fuente Moral, Luz Martin Carbonero, Juan Cantón De Seoane, María Dolores Montero-Vega, Juan Carlos Gainzarain Arana, Sergio España Cueto, Rocío Nuñez-Cabetas, María Sánchez-Martín, Constanza Muñoz Hornero, Ana Gómez-Zamora, Javier Díaz Luperena, Patricia González-Donapetry, José Miguel Cisneros, Lucía Hernández-Rivas, Patricia González Ruano, Andrea Espigares Correa, Rocío González-León, Nicolás García-Arenzana, Omar Cervera, Andrés Canut Blasco, Ana Isabel Cañabate, Mercedes Villarreal García-Lomas, Melania Íñigo Pestaña, Maria Álvarez de Castro, Ana Correa Ruiz, Belén Civantos, Lydia Pascual-García, Paula Villares Fernández, Mikel Rico-Briñas, María José Alcaide-Martín, Adoración Valiente, Victoria Arnalich-Montiel, Pilar Retamar, Jesús Mingorance, Eva María Romay Lema, Pablo Galindo-Ballesteros, M. Teresa Pérez-Rodríguez, Rosario Maria Torres Santos-Olmo, Inmaculada Pinilla, Elie Dahdouh, Beatriz Tejero-Soriano, Cristina Pizarro-Sanchez, Félix Gutiérrez Rodero, Luis Jara-Palomares, María Hernández-Gancedo, Cristina Chico Chumillas, Sergio Gilaberte Reyzábal, Manuel González-Viñolis, Ana Martínez Sapiña, Francisco Parras, Teresa Rubio Obanos, Iker Falces-Romero, Adriana Sánchez Serrano, Teresa Álvarez de Espejo Montiel, Jorge Valencia, Miquel Pujol, José Luis Velasco Garrido, Belén Calderón-Llopis, Álvaro Varela Plaza, Abel Caro, Juan José González-Garcia, Miguel Sampedro Núñez, María Fernández-Velilla, Emilio Cendejas-Bueno, María Cecilia Cánepa, José Luis Santiago Blanco, Alicia Rico-Nieto, Mónica Liébana Gómez, Sarah Caro Bragado, Susana Sánchez-Rico, José María Marimón Ortiz de Zárate, Paloma Dorao, Cristina Plaza-Moreno, Isabel Valbuena, Natividad Benito Hernández, Ginger Giorgiana Cabrera Tejada, Jordi Carratalà, Sara Fernández Rodríguez, Vicente Ferrer Díaz De Brito Fernández, Pilar Catalán, Pablo Mariscal-Aguilar, Germán Daroca-Bengoa, Rafael Fernandez, Raquel Casitas-Mateo, Ester Zamarrón de Lucas, Úrsula Quesada, Julio Yagüe, María Isabel Quijano Contreras, Trinidad Baselga-Puente, Lourdes Herrera Pacheco, Carlota Gudiol, Alazne Lartategi Iraurgi, Estefanía Martinez-Chavez, Silvia Valero Rovira, Alba Bergas, Zaida Ruiz de Azua, Teresa Prim, Cristina García-Quero, Pilar Hernández Machín, Rubén Gomez-Rioja, María Pavón-Masa, María de las Mercedes Valentín-Pastrana Aguilar, Ilduara Pintos Pascual, Lucía Brieba-Plata, María Jesús Domínguez Santalla, Francisco Javier Membrillo de Novales, Raúl Galera-Martínez, Ana Lérida Urteaga, Miguel Cervero, Alberto Mangas-Moro, José Hernández Quero, Teresa Sancho Bueso, María Angustias Quesada Simón, Luz Parra-Gordo, Sofía Díaz-Carrasco, Juan Carlos Abad Almendro, Andrés Javier Ruiz Fernández, Estíbaliz Molina Iturritza, Aurea Díez-Tascón, Yale Tung-Chen, Marta Rava, Carlos Villasante, Gabriel Gaspar Alonso-Vega, Clara Cabré-Verdiell Surribas, Esther Fraile Villarejo, Aida Gutiérrez García, Ana Robustillo-Rodela, Rafael Padrós Selma, Jesús Rodríguez-Baño, Frank Perdomo-García, Lydia de la Fuente Regaño, María del Mar Arenas-Miras, Cristina Rodríguez Roca, Blanca Montero-San Martín, Gema Crespo-Sánchez, Miguel Ramírez-Verdyguer, Alberto Diaz de Santiago, Marta Díaz Menéndez, María de la Luz Padilla Salazar, Silvia Arribas-Terradillos, Sadaf Zafar Iqubal-Mirza, Isabel Rábago Lorite, Belén Estébanez, Maite Ganchegui Aguirre, André Barbosa Ventura, Estefanía Fernandez-Cerezo, Maria Eulalia Valencia, Zaira R. Palacios-Baena, Beatriz Diaz Pollan, Lidia Martín, Sara Fabra-Cadenas, José Miguel Cantero-Escribano, Carmen Busca Arenzana, Emilia Guasch-Arévalo, Virginia Fernández Espinilla, Ainhoa Urrutia Losada, Oscar Noya González, Raquel Aranega, Alejandro Rodríguez Saenz de Urturi, María Jesús Jaras Hernandez, Charbel Maroun Eid, Marta Mora Rillo, Antonio Ramos Martínez, Meritxell Ortega Montoliu, Jose María Mostaza, Sonia García Calvo, Cristina Verdú, Celia Salamanca, Cristina Cervera Acedo, Mónica Martínez, Miren Urrestarazu Larrañag, Carmen Barroso Castro, Ivo Vives-Beltrán, Lorea Arteche Eguizabal, Ana Montero, Javier Balsa Vázquez, Amparo Perez-Garcia Morillón, Alejandra Pérez García, Isabel Pérez-Tamayo, Rafael Cantón Moreno, Antonio Marín-García, Inmaculada Jarrín, Núria Trullen, Ines Fernandez-Jimenez, Guillermo Ruiz-Carrascosa, Almudena Villa Martí, Jamil Cedeño, Marcos Díez Martínez, Carlos Lahoz, Lorena De la Mora, Javier Sánchez-Lora, Ana María Martínez-Virto, Irene Sanjosé Muñiz, Adrian Peña-Hidalgo, Cristina López Mestanza, Carola Gutiérrez, Ana Laila Qasem-Moreno, Irene Salvo García, Lucía Fernández de Orueta, Jorge Parra Ruiz, Sergio Pérez Pinto, Carlos García-Mochales Fortún, Esteban García de las Heras, Patricia González Muñiz, Mario Fernández-Ruiz, Anna Ferrer Santolaria, Olga Sánchez Pernaute, Julieta Latorre, Jesús Manzanares, Miguel Angel Martinez Gallego, Helena Notario, Ángel Rodríguez-Villodres, Eva Fernández-Bretón, Encarnación Moral Escudero, Mónica Sánchez-Santiuste, Carmen Martínez Cilleros, Ricardo Fernández Roblas, María Yllescas, Eva Soria-Alcaide, Marta Arsuaga Vicente, Marta Gómez-López, Regina Cabrera-Gamero, Natalia Carrasco Fons, Diana Piñar Cabezos, Begoña Sánchez-Sánchez, Francisca Garcia-Iglesias, Raquel Marín-Baselga, Alberto Arranz Caso, Virginia Guedez-López, Lucia Boix Palop, Íñigo Gredilla Zubiría, María Hidalgo-Sánchez, Laura López-Tappero Irazábal, José Ignacio Bernardino de la Serna, Javier Queiruga, Natalia Guadalupe Barrera-López, María López-Jodar, Jorge Calderón Parra, Diego Rodríguez-Álvarez, José Molina, María Luisa Montes, Beatriz Rodríguez-Alonso, Daniel Useros Brañas, Maria Gracia Liras-Hernández, Lucía Romero-Imaz, Nieves Jaén Sánchez, Marta Segovia-Amaro, Marta Vara, Maribel Zamora Cintas, Montaña Jiménez Álvaro, Alberto Moreno Fernandez, Asunción Díaz, Jordi Mancebo Cortés, Francisco Javier De Castro Vega, Álvaro Navarro Batet, Francisco Javier Sagra, Alexandre Pérez González, Luis Castro, Isabel Barrio López, Marta Ruiz-Alguero, Silvia Ossaba-Vélez, Alberto Martín-Vega, Maria Jesus Bustinduy Odriozola, Sivia Pastor-Yvorra, Nuria Espinosa, Elena Múñez Rubio, María E García-Leoni, Sandra Rosillo, Cristina Carbonell, Iván Navas Clemente, Paula Arriola Martínez, Marta Peña, Lucía Martínez de Soto, Roberto Mora-Corcovado, Alberto Iglesias-Sigüenza, Rocío Ruíz-Hueso, Elena Alvar, Pedro Camacho, Jesús Sojo-Dorado, Remedios Alemán Valls, Ines Ponz, Esmeralda Palmier Peláez, María Arcos Rueda, Guillermo Maestro de la Calle, Ramón Pérez Tanoira, Ana Martínez Vidal, Cristina Amodeo, Marina Pacheco Martínez-Atienza, Clara Muñoz Aguirre, Felipe Villar Álvarez, Giorgina Salgueiro, Xavier Sanz Salvador, César Pérez-Romero, Beatriz Álvarez Zapatero, Nelsa González-Aguado, Robert Torres Sánchez del Arco, Enrique Míguez Rey, Merce Sirisi, Xavier Bonfill Cosp, Marta Yagüe-Barrado, Elena Pérez-Costa, Sandra Casares, Eva Estirado, Jorge Alvarez Troncoso, Cristina Martín-Carrasco, Diana Sande Llovo, Melchor Álvarez de Mon Soto, Arantzazu Mera Fidalgo, Francisco Marqués-González, Agustín Valido-Morales, Luis Alberto Nieto Fernández del Campo, Helem Haydee Vilchez, María Rivas-Carmenado, Francisco Moreno, Ignacio Fernández-Fernández, Henar Calvo Sánchez, Ana González-Cordón, Isabel Fernández-Navarro, María Simón Sacristán, Eva Jiménez-González de Buitrago, M. Muñoz, María Laplaza-González, Rosa de Miguel Buckley, Marta Redondo-Gutierrez, Paula Santibáñez Sáenz, Raquel Martínez Goñi, Marta Rico Rodríguez, Carlos Toro-Rueda, Francisco Arnalich, Ana Santiago-Recuerda, Clara Soto Abanedes, María Dolores Herrero Mendoza, Aquilino Sanchez Purificación, Diego Franch Llasat, María Velasco Arribas, Alejandro Martín-Quirós, Jorge Alba Fernández, Elena Ramírez, Amparo López-Bernus, Marta Alvarado, María Rexach Fumaña, Martín Pilares-Barco, Carmen Liébana Martos, Yolanda Martínez Martínez, Nicolas Merchante Gutiérrez, Maria José Asensio, Ianire Virto Peña, Lucía Mejuto-Illade, María Angeles Martinez-López, Pilar López-Pirez, Alejandro Suárez, Cristóbal Manuel Rodríguez Leal, Sara Garcia-Bellido Ruiz, Jorge Guisández Martín, Lucia Cachafeiro, Pedro Gil Divasson, Almudena Quintás-Viqueira, Laura Currás-Sánchez, Alverio Seiz-Martinez, Mario Ruiz-Bastián, Juan José Menéndez, Jorge Orihuela Martín, María Dolores Nieto Martín, Cristina Arévalo, Rebeca Marinas, Susana Casas Rodríguez, Zuriñe Ortiz de Zárate Ibarra, Yolanda Posada Franco, Joan Gómez-Junyent, Ana María Garijo Saiz, Marina Alguacil-Guillén, Ana Alguacil, Esther Aznar Muñoz, Sara Bañón Escandell, Juan Salillas Hernando, Chiara Fanciulli, Rosa Gómez-Gil, Francisco García-Río, Moncef Belhassen-García, Belén Gutierrez Sancerni, Sonia Vega Molpeceres, Inés Suárez-García, Leire Pérez-Latorre, Elena Chamarro Martí, Carmen Rosario Herrero Gil, Belén Gutiérrez-Gutiérrez, Tatiana Mata Forte, Francesca Sánchez Martínez, Lucía Ramos Merino, Santiago Yus, Mº Ángeles Marcos, Susana Martínez-Álvarez, Alexy Inciarte, Manuel Quintana-Díaz, Lucía Serrá, Belén Alejos, Guillem Policarpo Torres, José Román Muñoz del Rey, Irene Blanco-Bartolomé, Alberto Bahamonde Carrasco, Victoria Hernando, Jhon Rojas, David Roa, María Ángeles Garcinuño, Aránzazu Villasante de la Puente, Patricia Pérez-Palacios, Jesús Ruiz Aragón, Valvanera Ibarra Cucalón, Lucía Ortega Enciso, Ismail Zakariya-Yousef Breval, Jorge Navarro López, Gema Barbeito Castiñeiras, Clara Sala Jofre, Nora Molina Torres, Manuel Poyato, Inmaculada Poquet Catala, Virginia Pomar Solchaga, María Pilar Romero-Gómez, Clara Hernández, Helena Mozas Moriñigo, Mercedes Guillamón Sánchez, Zineb Karroud, Arianna Catino, Violeta Ramos Sesma, Santos del Campo, Pilar Fernández-Calle, Ana Fernández Cruz, Fernando Salvador, Rosa Mayayo-Alvira, Pilar Barco Núñez, Ana Isabel Peláez Ballesta, Silvia Suárez Diaz, Beatriz María Sanjuan, Nora Izko Gartzia, Teresa Aldámiz-Echevarría, Cecilia Tortajada Alamilla, Pau Bosch-Nicolau, María del Mar Alonso Socas, Sonia Calzado Isbert, Jose R. Arribas, Juan Fernández-Lahera, Elizabet Petkova Saiz, Eva Jiménez, Gabriela Abelenda-Alonso, Alba Ribera Puig, Pascual Sanabria-Carretero, Sara Rodrigo González, Irene Díaz de la Torre, Tamara Manso Gómez, Carmen Sáez Barberá, Roi Suárez Gil, Paloma García-Clemente, Héctor Meijide Míguez, Elsa Izquierdo-García, Josune Goikoetxea Agirre, Olalla Martínez Macia, Jesús Santos González, Guillermo Jiménez Álvarez, Cristina Marcelo-Calvo, Javier Coy Coy, Isabel Arenas-Berenguer, Julio García Rodríguez, Natalia Yustas-Benitez, Sarai Quirós-Fernández, Marina Noguerol-Gutiérrez, María Adalid Moll, Iván Bloise-Sánchez, Mario José Rodriguez Dominguez, Elena Salamanca, Francisco Mora Gómez, Lucio García-Fraile, Pablo Millán, C Gutiérrez, Montserrat Rodríguez, José Antonio Oteo Revuelta, Joseba Portu Zapirain, Cristina Moreno, Irene Carrillo Acosta, Jorge Calvo, Ana Mariño Callejo, David Romero-Ribate, Blanca Alonso, Elena Muñoz del Val, Elena Resino Foz, Olaia Rodriguez-Fraga, Miguel Villamarín, Irene Amores-Hernández, Laura Muñoz López, Esther García Almodóvar, Ismael Casares Guerrero, Angélica Villanueva-Freije, Nuria Parra Arribas, Montserrat Sanmarti Vilamala, Macarena Lerín-Baratas, Mercedes Castro-Martínez, Melissa Carreres Candela, Lucia Suárez Pérez, Jose Manuel Iturzaeta-Sánchez, Thamires Silva-Freire, José Antonio Peregrina, María Luisa Machado Sicilia, Sergio Zurita, Daniel Molina Morant, Olga González-Peña, Fernando Lázaro-Perona, Paloma Oliver-Saez, Beatriz Mestre-Gómez, Luis Díaz Díez Picazo, Silvia García-Bujalance, Francisco Rodríguez Gómez, Pere Comas Casanova, Carlos Ruiz Martínez, Alberto Delgado-Iribarren, Berta Alonso-González, Isabel Moreno-Parra, Teresa Gómez-Ballesteros, Araceli Menéndez, Jose Manuel Añón, Ruth Jorge García, Jonathan Cámara Fernández, Miguel Górgolas Hernández-Mora, Itziar Diego Yagüe, Miriam Latorre-Millán, Covadonga Morcate Fernández, M. Río-García, Elisabet Lerma-Chippirraz, Carmen Yllera Gutiérrez, Francesc Albertí, Eva Flores, Carmen R. Uña Orejón, Patricio González-Pizarro, Neila Rodriguez-Roca, Miguel Fernández-Huerta, Inés Ferrer Ortiz, María José Blanco Vidal, Juan Pablo Avilés, Alicia Lorenzo Hernández, Mireia Puig Campmany, José Bravo-Ferrer, Gonzalo Martínez-Alés, Pablo Marguenda Contreras, M. Sánchez, Antonio García Pardo, Yolanda Meije, Francisco Tejerina, Carolina Hernández Carballo, Victoria Moreno, Daniel Laorden-Escudero, Ana Barrios Blandino, Alexia Costanza Espiño Álvarez, Ana Milagro Beamonte, Jerónimo Pachón, S San José-Villar, Marta Morando, María del Carmen Navarro Sáez, Rodolfo Álvarez-Sala Walther, Jon Ugalde Espiñeira, Fernando De la Calle Prieto, Nuria Fernández, Iván Pelegrín Senent, Alba Rueda López, Cristina Schüffelmann, Marcelino Hayek Peraza, Laura Labajo-Montero, Angel Robles Marhuenda, Pilar Durán, Ana Esteban-Romero, María Rosa Oltra Sempere, Ana Cosmen Sánchez, Alex Smithson Amat, Margarita Ramírez-Schacke, Marco Antonio Sempere Alcocer, Paloma Carrera-Vázquez, M Miarons, Teresa García Delange, Amelia Rodriguez-Mariblanca, Eva Talavera García, Roberto Vates Gómez, Óscar Sanz Peláez, José María Muñoz-Ramón, José Luis García Fogeda, Isabel Arroyo-Rico, Verónica Cano Llorente, Fernando González-Romo, Alberto Alonso-Babarro, Fátima Brañas, Fabricio Iannuccelli, Pilar Álvarez Padín, Luis Metola Sacristán, Vicente Boix, Víctor Hontañón, Juan Berenguer, José Luís Del Pozo León, Patricia Sorní Moreno, Maria Isabel Torres, Rafael Mican Rivera, Amparo Blasco Claramunt, Carmen Ardanuy, Aychel Elena Roura Piloto, María Ángeles Molina, Isabel Asschert Agüero, Julía Alvárez del Vayo, Consuelo García-Sánchez, Begoña Reche-Martínez, Guillermo Cuervo, Carlos Iniesta, María Antonia Gómez-Mendieta, Ana María Noblejas Mozo, Andres Bartrina-Tarrio, Carmen De la Higuera Arranz, Yeray Untoria Tabares, Andrés Enrique Suárez-Plaza, Jesús Frías, Paloma López-Arévalo, Irene María Llorente-Cortijo, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación (España), and Fundación SEIMC-GESIDA

Subjects
Male, Prognostic variable, medicine.medical_specialty, Databases, Factual, Coronavirus disease 2019 (COVID-19), 030204 cardiovascular system & hematology, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Humans, Medicine, 030212 general & internal medicine, Aged, Retrospective Studies, Models, Statistical, SARS-CoV-2, business.industry, Mortality rate, COVID-19, Retrospective cohort study, Articles, Middle Aged, Prognosis, medicine.disease, Phenotype, Hospitals, Hospitalization, Logistic Models, Infectious Diseases, Spain, Cohort, Female, Lymphocytopenia, business, Cohort study
Abstract

REIPI-SEIMC COVID-19 group and COVID@HULP group., [Background] The clinical presentation of COVID-19 in patients admitted to hospital is heterogeneous. We aimed to determine whether clinical phenotypes of patients with COVID-19 can be derived from clinical data, to assess the reproducibility of these phenotypes and correlation with prognosis, and to derive and validate a simplified probabilistic model for phenotype assignment. Phenotype identification was not primarily intended as a predictive tool for mortality., [Methods] In this study, we used data from two cohorts: the COVID-19@Spain cohort, a retrospective cohort including 4035 consecutive adult patients admitted to 127 hospitals in Spain with COVID-19 between Feb 2 and March 17, 2020, and the COVID-19@HULP cohort, including 2226 consecutive adult patients admitted to a teaching hospital in Madrid between Feb 25 and April 19, 2020. The COVID-19@Spain cohort was divided into a derivation cohort, comprising 2667 randomly selected patients, and an internal validation cohort, comprising the remaining 1368 patients. The COVID-19@HULP cohort was used as an external validation cohort. A probabilistic model for phenotype assignment was derived in the derivation cohort using multinomial logistic regression and validated in the internal validation cohort. The model was also applied to the external validation cohort. 30-day mortality and other prognostic variables were assessed in the derived phenotypes and in the phenotypes assigned by the probabilistic model., [Findings] Three distinct phenotypes were derived in the derivation cohort (n=2667)—phenotype A (516 [19%] patients), phenotype B (1955 [73%]) and phenotype C (196 [7%])—and reproduced in the internal validation cohort (n=1368)—phenotype A (233 [17%] patients), phenotype B (1019 [74%]), and phenotype C (116 [8%]). Patients with phenotype A were younger, were less frequently male, had mild viral symptoms, and had normal inflammatory parameters. Patients with phenotype B included more patients with obesity, lymphocytopenia, and moderately elevated inflammatory parameters. Patients with phenotype C included older patients with more comorbidities and even higher inflammatory parameters than phenotype B. We developed a simplified probabilistic model (validated in the internal validation cohort) for phenotype assignment, including 16 variables. In the derivation cohort, 30-day mortality rates were 2·5% (95% CI 1·4–4·3) for patients with phenotype A, 30·5% (28·5–32·6) for patients with phenotype B, and 60·7% (53·7–67·2) for patients with phenotype C (log-rank test p, [Interpretation] Patients admitted to hospital with COVID-19 can be classified into three phenotypes that correlate with mortality. We developed and validated a simplified tool for the probabilistic assignment of patients into phenotypes. These results might help to better classify patients for clinical management, but the pathophysiological mechanisms of the phenotypes must be investigated., [Funding] Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Fundación SEIMC/GeSIDA., Funding: Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Fundación SEIMC/GeSIDA.

Published
2021

30. Carbapenemase-producing Enterobacterales infections in COVID-19 patients

Author

Santiago Moreno, Pilar Vizcarra, Javier Cobo, Jesús Fortún, Rosa Escudero-Sánchez, Rafael Cantón, Sabina Herrera, María Isabel Morosini, Patricia Ruiz-Garbajosa, Francesca Gioia, Pilar Martín-Dávila, and Vicente Pintado

Subjects
Microbiology (medical), Mechanical ventilation, medicine.medical_specialty, General Immunology and Microbiology, biology, business.industry, Klebsiella pneumoniae, Urinary system, Mortality rate, medicine.medical_treatment, General Medicine, medicine.disease, biology.organism_classification, Pneumonia, Infectious Diseases, Internal medicine, Epidemiology, medicine, SOFA score, business, Enterobacter cloacae
Abstract

BACKGROUND: Carbapenemase-producing Enterobacterales (CPE) infections have been occasionally described in patients with coronavirus disease-19 (COVID-19). We assess the clinical features and outcome of these infections. METHODS: In this retrospective single-centre, case-control study, we included 54 patients with CPE infection: 30 case-patients (COVID-19) and 24 controls (non-COVID-19), collected between March and May 2020. We compared the epidemiological, clinical features, and outcome between cases and controls. RESULTS: CPE infection was more frequent in COVID-19 patients than in controls (1.1 vs. 0.5%, p = .005). COVID-19 patients were younger, had a lower frequency of underlying diseases (p = .01), and a lower median Charlson score (p = .002). Predisposing factors such as antimicrobial use, mechanical ventilation, or ICU admission, were more frequent in COVID-19 patients (p < .05). There were 73 episodes of infection (42 cases and 31 controls) that were more frequently hospital-acquired and diagnosed at the ICU in COVID-19 patients (p < .001). Urinary tract was the most common source of infection (47.9%), followed by pneumonia (23.3%). The frequency of severe sepsis or shock (p = .01) as well as the median SOFA score (p = .04) was higher in cases than in controls. Klebsiella pneumoniae (80.8%), Serratia marcescens (11%) and Enterobacter cloacae (4.1%) were the most common bacteria in both groups (KPC 56.2%, OXA-48 26% and VIM 17.8%). Overall 30-d mortality rate of COVID-19 patients and controls was 30 and 16.7%, respectively (p = .25). CONCLUSIONS: COVID-19 patients have an increased risk of CPE infections, which usually present as severe, nosocomial infections, appearing in critically-ill patients and associated with a high mortality.

Published
2021
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31. Mitral valve repair in infective endocarditis is not inferior to valve replacement: results from a Spanish nationwide prospective registry

Author

Javier Bermejo, Víctor José González Ramallo, Marta Hernández-Meneses, Adrián Téllez, Víctor Asensi Álvarez, Claudia González-Rico, Vicente Climent, Luis Eduardo López-Cortés, José David Rodrigo Carbonero, Castelo-Corral Laura, Francesc Marco, Eduard Quintana, Leyre López-Soria, Pere Pericas, Pilar Martín-Dávila, Ana Fernández-Cruz, Alejandro Martin-Quiros, José Ignacio Aramendi, José A. Oteo, Roberto Blanco Mata, David Nicolás, Marina Cueto-López, Guillermo Ojeda Burgos, Marta Bodro, Esperanza Merino de Lucas, Natividad Benito, Fernando Dominguez, Jose A. Lepe, Patricia Carmen Muñoz García, Juan M Pericas, Daniel Pereda, Javier De La Torre-Lima, Omar A Araji-Tiliani, Antonia Delgado-Montero, and Asunción Moreno Camacho

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, Heart Valve Diseases, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, Recurrence, Mitral valve, medicine, Humans, Endocarditis, Prospective Studies, Registries, Aged, Heart Valve Prosthesis Implantation, Mitral valve repair, business.industry, Mitral valve replacement, EuroSCORE, General Medicine, Middle Aged, medicine.disease, Surgery, Survival Rate, medicine.anatomical_structure, 030228 respiratory system, Spain, Cardiothoracic surgery, Infective endocarditis, Mitral Valve, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Introduction Infective endocarditis (IE) still carries high morbidity and mortality and frequently requires surgery. The benefit of mitral valve repair (MVr) in the setting of IE is yet to be proven. The goal of this study was to assess the results of MVr in patients with IE after a minimum follow-up of 1 year. Methods This study is based on a Spanish nationwide prospective registry that included patients operated on for native mitral valve IE. The collaborating Institutions pooled their pre-, peri-, and postoperative data into the database of the GAMES group [Grupo de Apoyo al Manejo de la EndocarditiS (Group for support and management of infective endocarditis)]. Results Data from 27 hospitals were recorded and 3524 cases of active IE identified between 2008 and 2016. There were 1513 cases of mitral IE, of which 898 involved native valves. Of these, 437 patients underwent surgical treatment, and 369 completed the 1-year follow-up. The valve was repaired in 68 cases (18.4%). Preoperative groups were comparable (EuroSCORE MVr 7.7 vs MVR 8.0; p = ns). Mortality in the repair group was inferior to that in the replacement group (16.2% vs 27.2%, p = 0.058). At 1 year, mortality remained higher in the replacement group: 3.7% vs 2.9%. Relapse of the infection was slightly more frequent in the repair group (7.1% vs 3.7%; p = ns), although this did not lead to higher rates of reintervention (MVr/MVR: 2.9% vs 4.9%). Conclusion MVr is an attractive option for specific patients with IE and does not seem to negatively impact on relapses.

Published
2019
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32. Outpatient Parenteral Antibiotic Treatment for Infective Endocarditis: A Prospective Cohort Study From the GAMES Cohort

Author

Víctor José González Ramallo, Marta Hernández-Meneses, Víctor Asensi Álvarez, Claudia González-Rico, Vicente Climent, José David Rodrigo Carbonero, Francesc Marco, Eduard Quintana, Leyre López-Soria, Pere Pericas, Pilar Martín-Dávila, Ana Fernández-Cruz, Alejandro Martin-Quiros, Lara García-Álvarez, José A. Oteo, Marina Cueto-López, Guillermo Ojeda Burgos, Marta Bodro, Esperanza Merino de Lucas, EDUARDO MORENO ESCOBAR, Natividad Benito, Fernando Dominguez, Jose A. Lepe, Patricia Carmen Muñoz García, Juan M Pericas, Daniel Pereda, Javier De La Torre-Lima, Jonathan Fernández-Suárez, Omar A Araji-Tiliani, Antonia Delgado-Montero, Fernando Fernández Sánchez, Asunción Moreno Camacho, Jose Lopez-Menendez, Instituto de Salud Carlos III, European Commission, Ministerio de Economía y Competitividad (España), European Society of Clinical Microbiology and Infectious Diseases, and Institut d'Investigacions Biomèdiques August Pi i Sunyer

Subjects
Male, 0301 basic medicine, Microbiology (medical), 030106 microbiology, Outcomes, 03 medical and health sciences, 0302 clinical medicine, Bacterial endocarditis, Outpatients, Humans, Medicine, Infusions, Parenteral, Prospective Studies, 030212 general & internal medicine, Aged, Retrospective Studies, business.industry, Parenteral antibiotic, Endocarditis, Bacterial, Middle Aged, Hospitals, Anti-Bacterial Agents, Hospitalization, Treatment Outcome, Outpatient parenteral antibiotic treatment, Infectious Diseases, Cardiac Surgery procedures, Spain, Female, Infective endocarditis, business, Humanities, Readmission
Abstract

For the Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES) investigators: Hospital Costa del Sol, Marbella: Fernando Fernández Sánchez, Mariam Noureddine, Gabriel Rosas, Javier de la Torre Lima. Hospital Universitario de Cruces, (Bilbao): Roberto Blanco, María Victoria Boado, Marta Campaña Lázaro, Alejandro Crespo, Josune Goikoetxea, José Ramón Iruretagoyena, Josu Irurzun Zuazabal, Leire López-Soria, Miguel Montejo, Javier Nieto, David Rodrigo, Regino Rodríguez, Yolanda Vitoria, Roberto Voces. Hospital Universitario Virgen de la Victoria, Málaga: María (Mª) Victoria García López, Radka Ivanova Georgieva, Guillermo Ojeda, Isabel Rodríguez Bailón, Josefa Ruiz Morales. Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián: Ana María Cuende, Tomás Echeverría, Ana Fuerte, Eduardo Gaminde, Miguel Ángel Goenaga, Pedro Idígoras, José Antonio Iribarren, Alberto Izaguirre Yarza, Xabier Kortajarena Urkola, Carlos Reviejo. Hospital General Universitario de Alicante, Alicante: Rafael Carrasco, Vicente Climent, Patricio Llamas, Esperanza Merino, Joaquín Plazas, Sergio Reus. Complejo Hospitalario Universitario A Coruña, A Coruña: Nemesio Álvarez, José María Bravo-Ferrer, Laura Castelo, José Cuenca, Pedro Llinares, Enrique Miguez Rey, María Rodríguez Mayo, Efrén Sánchez, Dolores Sousa Regueiro. Complejo Hospitalario Universitario de Huelva, Huelva: Francisco Javier Martínez. Hospital Universitario de Canarias, Canarias: Mª del Mar Alonso, Beatriz Castro, Dácil García Rosado, Mª del Carmen Durán, Mª Antonia Miguel Gómez, Juan Lacalzada, Ibrahim Nassar. Hospital Regional Universitario de Málaga, Málaga: Antonio Plata Ciezar, José Mª Reguera Iglesias. Hospital Universitario Central Asturias, Oviedo: Víctor Asensi Álvarez, Carlos Costas, Jesús de la Hera, Jonnathan Fernández Suárez, Lisardo Iglesias Fraile, Víctor León Arguero, José López Menéndez, Pilar Mencia Bajo, Carlos Morales, Alfonso Moreno Torrico, Carmen Palomo, Begoña Paya Martínez, Ángeles Rodríguez Esteban, Raquel Rodríguez García, Mauricio Telenti Asensio. Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona: Manuel Almela, Juan Ambrosioni, Manuel Azqueta, Mercè Brunet, Marta Bodro, Ramón Cartañá, Carlos Falces, Guillermina Fita, David Fuster, Cristina García de la Mària, Laura García-Valls, Marta Hernández-Meneses, Jaume Llopis Pérez, Francesc Marco, José M. Miró, Asunción Moreno, David Nicolás, Salvador Ninot, Eduardo Quintana, Carlos Paré, Daniel Pereda, Juan M. Pericás, José L. Pomar, José Ramírez, Irene Rovira, Elena Sandoval, Marta Sala, Marta Sitges, Dolors Soy, Adrián Téllez, José M. Tolosana, Bárbara Vidal, Jordi Vila. Hospital General Universitario Gregorio Marañón, Madrid: Iván Adán, Javier Bermejo, Emilio Bouza, Daniel Celemín, Gregorio Cuerpo Caballero, Antonia Delgado Montero, Ana Fernández Cruz, Ana García Mansilla, Mª Eugenia García Leoni, Víctor González Ramallo, Martha Kestler Hernández, Amaia Mari Hualde, Mercedes Marín, Manuel Martínez-Sellés, Mª Cruz Menárguez, Patricia Muñoz, Cristina Rincón, Hugo Rodríguez-Abella, Marta Rodríguez-Créixems, Blanca Pinilla, Ángel Pinto, Maricela Valerio, Pilar Vázquez, Eduardo Verde Moreno. Hospital Universitario La Paz, Madrid: Isabel Antorrena, Belén Loeches, Alejandro Martín Quirós, Mar Moreno, Ulises Ramírez, Verónica Rial Bastón, María Romero, Araceli Saldaña. Hospital Universitario Marqués de Valdecilla, Santander: Jesús Agüero Balbín, Carlos Armiñanzas Castillo, Ana Arnaiz, Francisco Arnaiz de las Revillas, Manuel Cobo Belaustegui, María Carmen Fariñas, Concepción Fariñas-Álvarez, Rubén Gómez Izquierdo, Iván García, Claudia González Rico, Manuel Gutiérrez-Cuadra, José Gutiérrez Díez, Marcos Pajarón, José Antonio Parra, Ramón Teira, Jesús Zarauza. Hospital Universitario Puerta de Hierro, Madrid: Fernando Domínguez, Pablo García Pavía, Jesús González, Beatriz Orden, Antonio Ramos. Hospital Universitario Ramón y Cajal, (Madrid): Tomasa Centella, José Manuel Hermida, José Luis Moya, Pilar Martín-Dávila, Enrique Navas, Enrique Oliva, Alejandro del Río, Jorge Rodríguez-Roda Stuart, Soledad Ruiz Rodríguez. Hospital Universitario Virgen de las Nieves, Granada: Carmen Hidalgo Tenorio. Hospital Universitario Virgen Macarena, Sevilla: Manuel Almendro Delia, Omar Araji, José Miguel Barquero, Román Calvo Jambrina, Marina de Cueto, Juan Gálvez Acebal, Irene Méndez, Isabel Morales, Luis Eduardo López-Cortés. Hospital Universitario Virgen del Rocío, Sevilla: Arístides de Alarcón, Emilio García, Juan Luis Haro, José Antonio Lepe, Francisco López, Rafael Luque. Hospital San Pedro, Logroño: Luis Javier Alonso, Pedro Azcárate, José Manuel Azcona Gutiérrez, José Ramón Blanco, Lara García-Álvarez, José Antonio Oteo, Mercedes Sanz. Hospital de la Santa Creu i Sant Pau, Barcelona: Natividad de Benito, Mercé Gurguí, Cristina Pacho, Roser Pericas, Guillem Pons. Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña: M. Álvarez, A. L. Fernández, Amparo Martínez, A. Prieto, Benito Regueiro, E. Tijeira, Marino Vega. Hospital Santiago Apóstol, Vitoria: Andrés Canut Blasco, José Cordo Mollar, Juan Carlos Gainzarain Arana, Oscar García Uriarte, Alejandro Martín López, Zuriñe Ortiz de Zárate, José Antonio Urturi Matos. Hospital SAS Línea de la Concepción, Cádiz: Gloria García Domínguez, Antonio Sánchez-Porto. Hospital Clínico Universitario Virgen de la Arrixaca, Murcia: José Mª Arribas Leal, Elisa García Vázquez, Alicia Hernández Torres, Ana Blázquez, Gonzalo de la Morena Valenzuela. Hospital de Txagorritxu, Vitoria: Ángel Alonso, Javier Aramburu, Felicitas Elena Calvo, Anai Moreno Rodríguez, Paola Tarabini-Castellani. Hospital Virgen de la Salud, Toledo: Eva Heredero Gálvez, Carolina Maicas Bellido, José Largo Pau, Mª Antonia Sepúlveda, Pilar Toledano Sierra, Sadaf Zafar Iqbal-Mirza. Hospital Rafael Méndez, Lorca-Murcia: Eva Cascales Alcolea, Pilar Egea Serrano, José Joaquín Hernández Roca, Ivan Keituqwa Yañez, Ana Peláez Ballesta, Víctor Soriano. Hospital Universitario San Cecilio, Granada: Eduardo Moreno Escobar, Alejandro Peña Monje, Valme Sánchez Cabrera, David Vinuesa García. Hospital Son Llátzer, Palma de Mallorca: María Arrizabalaga Asenjo, Carmen Cifuentes Luna, Juana Núñez Morcillo, Mª Cruz Pérez Seco, Aroa Villoslada Gelabert. Hospital Universitario Miguel Servet, Zaragoza: Carmen Aured Guallar, Nuria Fernández Abad, Pilar García Mangas, Marta Matamala Adell, Mª Pilar Palacián Ruiz, Juan Carlos Porres. Hospital General Universitario Santa Lucía, Cartagena: Begoña Alcaraz Vidal, Nazaret Cobos Trigueros, María Jesús Del Amor Espín, José Antonio Giner Caro, Roberto Jiménez Sánchez, Amaya Jimeno Almazán, Alejandro Ortín Freire, Monserrat Viqueira González. Hospital Universitario Son Espases, Palma de Mallorca: Pere Pericás Ramis, Mª Ángels Ribas Blanco, Enrique Ruiz de Gopegui Bordes, Laura Vidal Bonet. Complejo Hospitalario Universitario de Albacete, Albacete: Mª Carmen Bellón Munera, Elena Escribano Garaizabal, Antonia Tercero Martínez, Juan Carlos Segura Luque., [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., This work was supported by the Ministerio de Economia and Competitividad (Madrid, Spain) (FIS NCT00871104, Instituto de Salud Carlos III). J. M. P. received a “Rio Hortega” research grant from Instituto de Salud Carlos III and the Ministerio de Economia and Competitividad (Madrid, Spain) and the European Society for Clinical Microbiology and Infectious Diseases and Federation of European Microbiological Societies Research Fellowship 2016. Instituto de Salud Carlos III, Ministerio de Economía y Competitividad (Madrid, Spain) provided J. M. M. with a personal intensification research grant (INT15/00168) during 2016 and a personal 80:20 research grant from the Institut d’Investigacions Biomèdiques Pi i Sunyer for the period 2017–2019.

Published
2019
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33. A Contemporary Picture of Enterococcal Endocarditis

Author

Juan M. Pericàs, Jaume Llopis, Patricia Muñoz, Juan Gálvez-Acebal, Martha Kestler, Maricela Valerio, Marta Hernández-Meneses, Miguel Á. Goenaga, Manuel Cobo-Belaustegui, Miguel Montejo, Guillermo Ojeda-Burgos, M. Dolores Sousa-Regueiro, Arístides de Alarcón, Antonio Ramos-Martínez, José M. Miró, Fernando Fernández Sánchez, Mariam Noureddine, Gabriel Rosas, Javier de la Torre Lima, Roberto Blanco, María Victoria Boado, Marta Campaña Lázaro, Alejandro Crespo, Josune Goikoetxea, José Ramón Iruretagoyena, Josu Irurzun Zuazabal, Leire López-Soria, Javier Nieto, David Rodrigo, Regino Rodríguez, Yolanda Vitoria, Roberto Voces, Ma Victoria García López, Radka Ivanova Georgieva, Guillermo Ojeda, Isabel Rodríguez Bailón, Josefa Ruiz Morales, Ana María Cuende, Tomás Echeverría, Ana Fuerte, Eduardo Gaminde, Miguel Ángel Goenaga, Pedro Idígoras, José Antonio Iribarren, Alberto Izaguirre Yarza, Xabier Kortajarena Urkola, Carlos Reviejo, Rafael Carrasco, Vicente Climent, Patricio Llamas, Esperanza Merino, Joaquín Plazas, Sergio Reus, Nemesio Álvarez, José María Bravo-Ferrer, Laura Castelo, José Cuenca, Pedro Llinares, Enrique Miguez Rey, María Rodríguez Mayo, Efrén Sánchez, Dolores Sousa Regueiro, Francisco Javier Martínez, Ma del Mar Alonso, Beatriz Castro, Dácil García Rosado, Ma del Carmen Durán, Ma Antonia Miguel Gómez, Juan Lacalzada, Ibrahim Nassar, Antonio Plata Ciezar, José Ma Reguera Iglesias, Víctor Asensi Álvarez, Carlos Costas, Jesús de la Hera, Jonnathan Fernández Suárez, Lisardo Iglesias Fraile, Víctor León Arguero, José López Menéndez, Pilar Mencia Bajo, Carlos Morales, Alfonso Moreno Torrico, Carmen Palomo, Begoña Paya Martínez, Ángeles Rodríguez Esteban, Raquel Rodríguez García, Mauricio Telenti Asensio, Manuel Almela, Juan Ambrosioni, Manuel Azqueta, Mercè Brunet, Marta Bodro, Ramón Cartañá, Carlos Falces, Guillermina Fita, David Fuster, Cristina García de la Mària, Delia García-Pares, Jaume Llopis Pérez, Francesc Marco, Asunción Moreno, David Nicolás, Salvador Ninot, Eduardo Quintana, Carlos Paré, Daniel Pereda, Juan M. Pericás, José L. Pomar, José Ramírez, Irene Rovira, Elena Sandoval, Marta Sitges, Dolors Soy, Adrián Téllez, José M. Tolosana, Bárbara Vidal, Jordi Vila, Iván Adán, Javier Bermejo, Emilio Bouza, Daniel Celemín, Gregorio Cuerpo Caballero, Antonia Delgado Montero, Ana García Mansilla, Ma Eugenia García Leoni, Víctor González Ramallo, Martha Kestler Hernández, Amaia Mari Hualde, Mercedes Marín, Manuel Martínez-Sellés, Cristina Rincón, Hugo Rodríguez-Abella, Marta Rodríguez-Créixems, Blanca Pinilla, Ángel Pinto, Pilar Vázquez, Eduardo Verde Moreno, Isabel Antorrena, Belén Loeches, Alejandro Martín Quirós, Mar Moreno, Ulises Ramírez, Verónica Rial Bastón, María Romero, Araceli Saldaña, Jesús Agüero Balbín, Carlos Armiñanzas Castillo, Ana Arnaiz, Francisco Arnaiz de las Revillas, Manuel Cobo Belaustegui, María Carmen Fariñas, Concepción Fariñas-Álvarez, Rubén Gómez Izquierdo, Iván García, Claudia González Rico, Manuel Gutiérrez-Cuadra, José Gutiérrez Díez, Marcos Pajarón, José Antonio Parra, Ramón Teira, Jesús Zarauza, Jorge Calderón Parra, Marta Cobo, Fernando Domínguez, Alberto Fortaleza, Pablo García Pavía, Jesús González, Ana Fernández Cruz, Elena Múñez, Antonio Ramos, Isabel Sánchez Romero, Tomasa Centella, José Manuel Hermida, José Luis Moya, Pilar Martín-Dávila, Enrique Navas, Enrique Oliva, Alejandro del Río, Jorge Rodríguez-Roda Stuart, Soledad Ruiz, Carmen Hidalgo Tenorio, Manuel Almendro Delia, Omar Araji, José Miguel Barquero, Román Calvo Jambrina, Marina de Cueto, Juan Gálvez Acebal, Irene Méndez, Isabel Morales, Luis Eduardo López-Cortés, Emilio García, Juan Luis Haro, José Antonio Lepe, Francisco López, Rafael Luque, Luis Javier Alonso, Pedro Azcárate, José Manuel Azcona Gutiérrez, José Ramón Blanco, Antonio Cabrera Villegas, Lara García-Álvarez, José Antonio Oteo, Mercedes Sanz, Natividad de Benito, Mercé Gurguí, Cristina Pacho, Roser Pericas, Guillem Pons, M. Álvarez, A.L. Fernández, Amparo Martínez, A. Prieto, Benito Regueiro, E. Tijeira, Marino Vega, Andrés Canut Blasco, José Cordo Mollar, Juan Carlos Gainzarain Arana, Oscar García Uriarte, Alejandro Martín López, Zuriñe Ortiz de Zárate, José Antonio Urturi Matos, García-Domínguez Gloria, Sánchez-Porto Antonio, José Ma Arribas Leal, Elisa García Vázquez, Alicia Hernández Torres, Ana Blázquez, Gonzalo de la Morena Valenzuela, Ángel Alonso, Javier Aramburu, Felicitas Elena Calvo, Anai Moreno Rodríguez, Paola Tarabini-Castellani, Eva Heredero Gálvez, Carolina Maicas Bellido, José Largo Pau, Ma Antonia Sepúlveda, Pilar Toledano Sierra, Sadaf Zafar Iqbal-Mirza, Eva Cascales Alcolea, Ivan Keituqwa Yañez, Julián Navarro Martínez, Ana Peláez Ballesta, Eduardo Moreno Escobar, Alejandro Peña Monje, Valme Sánchez Cabrera, David Vinuesa García, María Arrizabalaga Asenjo, Carmen Cifuentes Luna, Juana Núñez Morcillo, Ma Cruz Pérez Seco, Aroa Villoslada Gelabert, Carmen Aured Guallar, Nuria Fernández Abad, Pilar García Mangas, Marta Matamala Adell, Ma Pilar Palacián Ruiz, Juan Carlos Porres, Begoña Alcaraz Vidal, Nazaret Cobos Trigueros, María Jesús Del Amor Espín, José Antonio Giner Caro, Roberto Jiménez Sánchez, Amaya Jimeno Almazán, Alejandro Ortín Freire, Monserrat Viqueira González, Pere Pericás Ramis, Ma Ángels Ribas Blanco, Enrique Ruiz de Gopegui Bordes, Laura Vidal Bonet, Ma Carmen Bellón Munera, Elena Escribano Garaizabal, Antonia Tercero Martínez, Juan Carlos Segura Luque, Cristina Badía, Lucía Boix Palop, Mariona Xercavins, Sónia Ibars, Eloy Gómez Nebreda, Ibalia Horcajada Herrera, Irene Menduiña Gallego, Héctor Marrero Santiago, Isabel de Miguel Martínez, Elena Pisos Álamo, Carmen Díaz Pedroche, Fernando Chaves, Santiago de Cossío, Francisco López Medrano, Ma Jesús López, Javier Solera, Jorge Solís, Carmen Ardanuy, Guillermo Cuervo Requena, Sara Grillo, and Alejandro Ruiz Majoral

Subjects
Aortic valve, Male, medicine.medical_specialty, relapses, Enterococci, Epidemiology, medicine.medical_treatment, heart failure, Heart failure, 030204 cardiovascular system & hematology, Logistic regression, Prosthesis, prosthetic valves, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, enterococci, Internal medicine, Post-hoc analysis, medicine, Enterococcus faecalis, Endocarditis, Humans, 030212 general & internal medicine, Gram-Positive Bacterial Infections, Aged, Bacteria, business.industry, infective endocarditis, ComputingMilieux_PERSONALCOMPUTING, Endocarditis, Bacterial, Middle Aged, Prosthetic valves, medicine.disease, medicine.anatomical_structure, Spain, Infective endocarditis, Cohort, epidemiology, Female, Cardiology and Cardiovascular Medicine, business, Relapses
Abstract

GAMES Investigators., [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

34. Direct-acting antivirals are effective and safe in HCV/HIV-coinfected liver transplant recipients who experience recurrence of hepatitis C: A prospective nationwide cohort study

Author

Federico Pulido, Ferran Torres, ALBERTO VENTOSO, Valentín Cuervas-Mons, Pedro Lopez Cillero, Víctor Asensi Álvarez, Carolina Almohalla, Rosa JORBA, Ramon Charco, José Antonio Pons-Miñano, Carme Baliellas, Pilar Barrera Baena, Rafael Bañares, Isabel Campos Varela, Gonzalo Crespo, Montse Tuset, M. Trinidad Serrano Aulló, Manuel Rodriguez, Josep Mallolas Masferrer, Antonio Rivero Román, Santos Del Campo, Constantino Fondevila, Pilar Martín-Dávila, Juan González-García, Carlos Cervera, Victor Manuel Vargas Blasco, Oscar Len, María Pilar Alonso García, Jesus Fortun, MARIA VICTORIA AGUILERA SANCHO-TELLO, Gloria Sanchez Antolin, Montserrat Laguno Centeno, José Miguel Cisneros, Jorge Calvo, Jordi Carratala, Xavier Forns, Rafael Rubio García, Antonio Rivero, Asunción Moreno Camacho, Elisa Cordero, Xavier Xiol, and Emilio Fábrega

Subjects
Male, Human immunodeficiency virus (HIV), HIV Infections, Hepacivirus, 030230 surgery, medicine.disease_cause, DIRECT ACTING ANTIVIRALS, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) [infection and infectious agents-viral], Gastroenterology, chemistry.chemical_compound, 0302 clinical medicine, Recurrence, Genotype, Immunology and Allergy, Medicine, Pharmacology (medical), Prospective Studies, liver transplantation, Coinfection, virus diseases, Hepatitis C, Middle Aged, Prognosis, practice, human immunodeficiency virus (HIV) [infection and infectious agentsviral], hepatitis C [infection and infectious agentsviral], Tolerability, Drug Therapy, Combination, Female, 030211 gastroenterology & hepatology, Cohort study, medicine.medical_specialty, Hepatitis C virus, clinical research/practice, Antiviral Agents, 03 medical and health sciences, Internal medicine, Humans, acquired immunodeficiency syndrome (AIDS), Transplantation, business.industry, Ribavirin, HIV, medicine.disease, Transplant Recipients, digestive system diseases, Liver Transplantation, clinical research, chemistry, hepatology, hepatitis C [infection and infectious agents-viral], business, liver transplantation/hepatology, Follow-Up Studies
Abstract

Direct-acting antivirals have proved to be highly efficacious and safe in monoinfected liver transplant (LT) recipients who experience recurrence of hepatitis C virus (HCV) infection. However, there is a lack of data on effectiveness and tolerability of these regimens in HCV/HIV-coinfected patients who experience recurrence of HCV infection after LT. In this prospective, multicenter cohort study, the outcomes of 47 HCV/HIV-coinfected LT patients who received DAA therapy (with or without ribavirin [RBV]) were compared with those of a matched cohort of 148 HCV-monoinfected LT recipients who received similar treatment. Baseline characteristics were similar in both groups. HCV/HIV-coinfected patients had a median (IQR) CD4 T-cell count of 366 (256-467) cells/mu L. HIV-RNA was

Published
2018
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35. Gentamicin may have no effect on mortality of staphylococcal prosthetic valve endocarditis

Author

Antonio Ramos-Martínez, Alejandro Muñoz Serrano, Arístides de Alarcón González, Patricia Muñoz, Ana Fernández-Cruz, Maricela Valerio, María Carmen Fariñas, Manuel Gutiérrez-Cuadra, José Ma Miró, Josefa Ruiz-Morales, Dolores Sousa-Regueiro, José Miguel Montejo, Juan Gálvez-Acebal, Carmen HidalgoTenorio, Fernando Domínguez, Fernando Fernández Sánchez, Mariam Noureddine, Gabriel Rosas, Javier de la Torre Lima, José Aramendi, Elena Bereciartua, Roberto Blanco, María Victoria Boado, Itxasne Cabezón Estébanez, Marta Campaña Lázaro, Josune Goikoetxea, Juan José Goiti, José Ramón Iruretagoyena, Josu Irurzun Zuazabal, Leire López-Soria, Miguel Montejo, Javier Nieto, David Rodríguez, Regino Rodríguez, Roberto Voces, Ma Victoria García López, Radka Ivanova Georgieva, Guillermo Ojeda, Isabel Rodríguez Bailón, Josefa Ruiz Morales, Ana María Cuende, Tomás Echeverría, Ana Fuerte, Eduardo Gaminde, Miguel Ángel Goenaga, Pedro Idígoras, José Antonio Iribarren, Alberto Izaguirre Yarza, Xabier Kortajarena Urkola, Carlos Reviejo, Rafael Carrasco, Vicente Climent, Patricio Llamas, Esperanza Merino, Joaquín Plazas, Sergio Reus, Nemesio Álvarez, José María Bravo-Ferrer, Laura Castelo, José Cuenca, Pedro Llinares, Enrique Miguez Rey, María Rodríguez Mayo, Efrén Sánchez, Dolores Sousa Regueiro, Francisco Javier Martínez, Ma del Mar Alonso, Beatriz Castro, Dácil García Rosado, Ma del Carmen Durán, Ma Antonia Miguel Gómez, Juan Lacalzada, Ibrahim Nassar, Antonio Plata Ciezar, José Ma Reguera Iglesias, Víctor Asensi Álvarez, Carlos Costas, Jesús de la Hera, Jonnathan Fernández Suárez, Lisardo Iglesias Fraile, Víctor León Arguero, José López Menéndez, Pilar Mencia Bajo, Carlos Morales, Alfonso Moreno Torrico, Carmen Palomo, Begoña Paya Martínez, Ángeles Rodríguez Esteban, Raquel Rodríguez García, Mauricio Telenti Asensio, Manuel Almela, Juan Ambrosioni, Manuel Azqueta, Mercè Brunet, Marta Bodro, Ramón Cartañá, Carlos Falces, Guillermina Fita, David Fuster, Cristina García de la Mària, Marta Hernández-Meneses, Jaume Llopis Pérez, Francesc Marco, José M. Miró, Asunción Moreno, David Nicolás, Salvador Ninot, Eduardo Quintana, Carlos Paré, Daniel Pereda, Juan M. Pericás, José L. Pomar, José Ramírez, Irene Rovira, Elena Sandoval, Marta Sitges, Dolors Soy, Adrián Téllez, José M. Tolosana, Bárbara Vidal, Jordi Vila, Iván Adán, Javier Bermejo, Emilio Bouza, Gregorio Cuerpo Caballero, Ana Fernández Cruz, Ma Eugenia García Leoni, Víctor González Ramallo, Martha Kestler Hernández, Mercedes Marín, Manuel Martínez-Sellés, Ma Cruz Menárguez, Cristina Rincón, Hugo Rodríguez-Abella, Marta Rodríguez-Créixems, Blanca Pinilla, Ángel Pinto, Pilar Vázquez, Eduardo Verde Moreno, Isabel Antorrena, Belén Loeches, Alejandro Martín Quirós, Mar Moreno, Ulises Ramírez, Verónica Rial Bastón, María Romero, Araceli Saldaña, Jesús Agüero Balbín, Carlos Armiñanzas Castillo, Ana Arnaiz, Francisco Arnaiz de las Revillas, Manuel Cobo Belaustegui, Concepción Fariñas-Álvarez, Rubén Gómez Izquierdo, Iván García, Claudia González Rico, José Gutiérrez Díez, Marcos Pajarón, José Antonio Parra, Ramón Teira, Jesús Zarauza, Pablo García Pavíaz, Jesús Gonzálezz, Beatriz Ordenz, Antonio Ramosz, Tomasa Centella, José Manuel Hermida, José Luis Moya, Pilar Martín-Dávila, Enrique Navas, Enrique Oliva, Alejandro del Río, Soledad Ruiz, Carmen Hidalgo Tenorio, Manuel Almendro Delia, Omar Araji, José Miguel Barquero, Román Calvo Jambrina, Marina de Cueto, Juan Gálvez Acebal, Irene Méndez, Isabel Morales, Luis Eduardo López-Cortés, Arístides de Alarcón, Emilio García, Juan Luis Haro, José Antonio Lepe, Francisco López, Rafael Luque, Luis Javier Alonso, Pedro Azcárate, José Manuel Azcona Gutiérrez, José Ramón Blanco, Lara García-Álvarez, José Antonio Oteo, Mercedes Sanz, Natividad de Benito, Mercé Gurguí, Cristina Pacho, Roser Pericas, Guillem Pons, M. Álvarez, A.L. Fernández, Amparo Martínez, A. Prieto, Benito Regueiro, E. Tijeira, Marino Vega, Andrés Canut Blasco, José Cordo Mollar, Juan Carlos Gainzarain Arana, Oscar García Uriarte, Alejandro Martín López, Zuriñe Ortiz de Zárate, José Antonio Urturi Matos, Gloria García Domínguez, Antonio Sánchez-Porto, José Ma Arribas Leal, Elisa García Vázquez, Alicia Hernández Torres, Ana Blázquez, Gonzalo de la Morena Valenzuela, Ángel Alonso, Javier Aramburu, Felicitas Elena Calvo, Anai Moreno Rodríguez, Paola Tarabini-Castellani, Eva Heredero Gálvez, Carolina Maicas Bellido, José Largo Pau, Ma Antonia Sepúlveda, Pilar Toledano Sierra, Sadaf Zafar Iqbal-Mirza, Eva Cascales Alcolea, Pilar Egea Serrano, José Joaquín Hernández Roca, Ivan Keituqwa Yañez, Ana Peláez Ballesta, Víctor Soriano, Eduardo Moreno Escobar, Alejandro Peña Monje, Valme Sánchez Cabrera, David Vinuesa García, María Arrizabalaga Asenjo, Carmen Cifuentes Luna, Juana Núñez Morcillo, Ma Cruz Pérez Seco, Aroa Villoslada Gelabert, Carmen Aured Guallar, Nuria Fernández Abad, Pilar García Mangas, Marta Matamala Adell, Ma Pilar Palacián Ruiz, and Juan Carlos Porres

Subjects
Male, 0301 basic medicine, Microbiology (medical), Staphylococcus aureus, medicine.medical_specialty, Prosthesis-Related Infections, 030106 microbiology, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Cloxacillin, Vancomycin, Internal medicine, medicine, Humans, Endocarditis, Pharmacology (medical), Prospective Studies, Renal Insufficiency, 030212 general & internal medicine, Aged, Heart Failure, business.industry, Endocarditis, Bacterial, Middle Aged, Staphylococcal Infections, medicine.disease, Anti-Bacterial Agents, Regimen, Infectious Diseases, Heart Valve Prosthesis, Multivariate Analysis, Female, Gentamicin, Gentamicins, Rifampin, business, Complication, Rifampicin, medicine.drug
Abstract

Purpose: To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE). Methods: From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-four patients (28.1%) received treatment based on β-lactam or vancomycin plus rifampicin and were included in the study. Variables were analyzed which related to patient survival during admission, including having received treatment with gentamicin. Results: Seventy-seven (81.9%) were treated with cloxacillin (or vancomycin) plus rifampicin plus gentamicin, and 17 patients (18.1%) received the same regimen without gentamicin. The causative microorganism was Staphylococcus aureus in 40 cases (42.6%) and coagulase-negative staphylococci in 54 cases (57.4%). Overall, 40 patients (42.6%) died during hospital admission, 33 patients (42.9%) in the group receiving gentamicin and 7 patients in the group that did not (41.2%, P = 0.899). Worsening renal function was observed in 42 patients (54.5%) who received gentamicin and in 9 patients (52.9%) who did not (p = 0.904). Heart failure as a complication of endocarditis (OR: 4.58; CI 95%: 1.84–11.42) and not performing surgery when indicated (OR: 2.68; CI 95%: 1.03–6.94) increased mortality. Gentamicin administration remained unrelated to mortality (OR: 1.001; CI 95%: 0.29–3.38) in the multivariable analysis. Conclusions: The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome.

Published
2018
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37. Prevalence of Colorectal Neoplasms Among Patients With Enterococcus faecalis Endocarditis in the GAMES Cohort (2008-2017)

Author

Juan M. Pericàs, Juan Ambrosioni, Patricia Muñoz, Arístides de Alarcón, Martha Kestler, Amaia Mari-Hualde, Asunción Moreno, Miguel Á. Goenaga, M. Carmen Fariñas, Regino Rodríguez-Álvarez, Guillermo Ojeda-Burgos, Juan Gálvez-Acebal, Carmen Hidalgo-Tenorio, Mariam Noureddine, José M. Miró, Fernando Fernández Sánchez, Gabriel Rosas, Javier de la Torre Lima, Roberto Blanco, María Victoria Boado, Marta Campaña Lázaro, Alejandro Crespo, Josune Goikoetxea, José Ramón Iruretagoyena, Josu Irurzun Zuazabal, Leire López-Soria, Miguel Montejo, Javier Nieto, David Rodrigo, Regino Rodríguez, Yolanda Vitoria, Roberto Voces, Ma Victoria García López, Radka Ivanova Georgieva, Guillermo Ojeda, Isabel Rodríguez Bailón, Josefa Ruiz Morales, Ana María Cuende, Tomás Echeverría, Ana Fuerte, Eduardo Gaminde, Miguel Ángel Goenaga, Pedro Idígoras, José Antonio Iribarren, Alberto Izaguirre Yarza, Xabier Kortajarena Urkola, Carlos Reviejo, Rafael Carrasco, Vicente Climent, Patricio Llamas, Esperanza Merino, Joaquín Plazas, Sergio Reus, Nemesio Álvarez, José María Bravo-Ferrer, Laura Castelo, José Cuenca, Pedro Llinares, Enrique Miguez Rey, María Rodríguez Mayo, Efrén Sánchez, Dolores Sousa Regueiro, Francisco Javier Martínez, Ma del Mar Alonso, Beatriz Castro, Dácil García Rosado, Ma del Carmen Durán, Ma Antonia Miguel Gómez, Juan Lacalzada, Ibrahim Nassar, Antonio Plata Ciezar, José Ma Reguera Iglesias, Víctor Asensi Álvarez, Carlos Costas, Jesús de la Hera, Jonnathan Fernández Suárez, Lisardo Iglesias Fraile, Víctor León Arguero, José López Menéndez, Pilar Mencia Bajo, Carlos Morales, Alfonso Moreno Torrico, Carmen Palomo, Begoña Paya Martínez, Ángeles Rodríguez Esteban, Raquel Rodríguez García, Mauricio Telenti Asensio, Manuel Almela, Manuel Azqueta, Mercè Brunet, Marta Bodro, Ramón Cartañá, Carlos Falces, Guillermina Fita, David Fuster, Cristina García de la Mària, Delia García-Pares, Marta Hernández-Meneses, Jaume Llopis Pérez, Francesc Marco, David Nicolás, Salvador Ninot, Eduardo Quintana, Carlos Paré, Daniel Pereda, Juan M. Pericás, José L. Pomar, José Ramírez, Irene Rovira, Elena Sandoval, Marta Sitges, Dolors Soy, Adrián Téllez, José M. Tolosana, Bárbara Vidal, Jordi Vila, Iván Adán, Javier Bermejo, Emilio Bouza, Daniel Celemín, Gregorio Cuerpo Caballero, Antonia Delgado Montero, Ana García Mansilla, Ma Eugenia García Leoni, Víctor González Ramallo, Martha Kestler Hernández, Amaia Mari Hualde, Mercedes Marín, Manuel Martínez-Sellés, Cristina Rincón, Hugo Rodríguez-Abella, Marta Rodríguez-Créixems, Blanca Pinilla, Ángel Pinto, Maricela Valerio, Pilar Vázquez, Eduardo Verde Moreno, Isabel Antorrena, Belén Loeches, Alejandro Martín Quirós, Mar Moreno, Ulises Ramírez, Verónica Rial Bastón, María Romero, Araceli Saldaña, Jesús Agüero Balbín, Carlos Armiñanzas Castillo, Ana Arnaiz, Francisco Arnaiz de las Revillas, Manuel Cobo Belaustegui, María Carmen Fariñas, Concepción Fariñas-Álvarez, Rubén Gómez Izquierdo, Iván García, Claudia González Rico, Manuel Gutiérrez-Cuadra, José Gutiérrez Díez, Marcos Pajarón, José Antonio Parra, Ramón Teira, Jesús Zarauza, Jorge Calderón Parra, Marta Cobo, Fernando Domínguez, Alberto Fortaleza, Pablo García Pavía, Jesús González, Ana Fernández Cruz, Elena Múñez, Antonio Ramos, Isabel Sánchez Romero, Tomasa Centella, José Manuel Hermida, José Luis Moya, Pilar Martín-Dávila, Enrique Navas, Enrique Oliva, Alejandro del Río, Jorge Rodríguez-Roda Stuart, Soledad Ruiz, Carmen Hidalgo Tenorio, Manuel Almendro Delia, Omar Araji, José Miguel Barquero, Román Calvo Jambrina, Marina de Cueto, Juan Gálvez Acebal, Irene Méndez, Isabel Morales, Luis Eduardo López-Cortés, Emilio García, Juan Luis Haro, José Antonio Lepe, Francisco López, Rafael Luque, Luis Javier Alonso, Pedro Azcárate, José Manuel Azcona Gutiérrez, José Ramón Blanco, Antonio Cabrera Villegas, Lara García-Álvarez, José Antonio Oteo, Mercedes Sanz, Natividad de Benito, Mercé Gurguí, Cristina Pacho, Roser Pericas, Guillem Pons, M. Álvarez, A.L. Fernández, Amparo Martínez, A. Prieto, Benito Regueiro, E. Tijeira, Marino Vega, Andrés Canut Blasco, José Cordo Mollar, Juan Carlos Gainzarain Arana, Oscar García Uriarte, Alejandro Martín López, Zuriñe Ortiz de Zárate, José Antonio Urturi Matos, García-Domínguez Gloria, Sánchez-Porto Antonio, José Ma Arribas Leal, Elisa García Vázquez, Alicia Hernández Torres, Ana Blázquez, Gonzalo de la Morena Valenzuela, Ángel Alonso, Javier Aramburu, Felicitas Elena Calvo, Anai Moreno Rodríguez, Paola Tarabini-Castellani, Eva Heredero Gálvez, Carolina Maicas Bellido, José Largo Pau, Ma Antonia Sepúlveda, Pilar Toledano Sierra, Sadaf Zafar Iqbal-Mirza, Eva Cascales Alcolea, Ivan Keituqwa Yañez, Julián Navarro Martínez, Ana Peláez Ballesta, Eduardo Moreno Escobar, Alejandro Peña Monje, Valme Sánchez Cabrera, David Vinuesa García, María Arrizabalaga Asenjo, Carmen Cifuentes Luna, Juana Núñez Morcillo, Ma Cruz Pérez Seco, Aroa Villoslada Gelabert, Carmen Aured Guallar, Nuria Fernández Abad, Pilar García Mangas, Marta Matamala Adell, Ma Pilar Palacián Ruiz, Juan Carlos Porres, Begoña Alcaraz Vidal, Nazaret Cobos Trigueros, María Jesús Del Amor Espín, José Antonio Giner Caro, Roberto Jiménez Sánchez, Amaya Jimeno Almazán, Alejandro Ortín Freire, Monserrat Viqueira González, Pere Pericás Ramis, Ma Ángels Ribas Blanco, Enrique Ruiz de Gopegui Bordes, Laura Vidal Bonet, Ma Carmen Bellón Munera, Elena Escribano Garaizabal, Antonia Tercero Martínez, Juan Carlos Segura Luque, Cristina Badía, Lucía Boix Palop, Mariona Xercavins, Sónia Ibars. Eloy Gómez Nebreda, Ibalia Horcajada Herrera, Irene Menduiña Gallego Héctor Marrero Santiago, Isabel de Miguel Martínez, and Elena Pisos Álamo

Subjects
Male, medicine.medical_specialty, Colorectal cancer, Population, Colonoscopy, Enterococcus faecalis, Risk Factors, Internal medicine, medicine, Prevalence, Endocarditis, Humans, education, Gram-Positive Bacterial Infections, Aged, Retrospective Studies, Aged, 80 and over, education.field_of_study, medicine.diagnostic_test, biology, business.industry, Retrospective cohort study, General Medicine, Endocarditis, Bacterial, Middle Aged, medicine.disease, biology.organism_classification, Infective endocarditis, Cohort, Female, business, Colorectal Neoplasms
Abstract

Objective: To investigate the rate of colorectal neoplasms (CRNs) in patients who have Enterococcus faecalis infective endocarditis (EFIE) with available colonoscopies and to assess whether this is associated with the identification of a focus the infection. Patients and Methods: Retrospective analysis of data from a prospective multicenter study involving 35 centers who are members of the Grupo de Apoyo para el Manejo de la Endocarditis en Espana [Support Group for the Management of Infective Endocarditis in Spain] cohort. A specific set of queries regarding information on colonoscopy and histopathology of colorectal diseases was sent to each participating center. Four-hundred sixty-seven patients with EFIE were included from January 1, 2008, to December 31, 2017, from whom data on colonoscopy performance and results were available in 411 patients. Results: One hundred forty-two (34.5%) patients had a colonoscopy close to the EFIE episode. The overall rate of colorectal diseases was 70.4% (100 of 142), whereas the prevalence of CRN (advanced adenomas and colorectal carcinoma) was 14.8% (21 of 142), with no significant differences between the group of EFIE of unknown focus and that with an identified focus. Conclusion: Our study adds to prior evidence suggesting a much higher rate of CRN among patients with EFIE than in the general population of the same age and sex. In addition, our findings suggest that this phenomenon might take place both in EFIE with an unknown and an identified source of infection.

Published
2019

38. Resumen ejecutivo de la Declaración de consenso del Grupo de Estudio de la Infección en el Trasplante (GESITRA) de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) y la Organización Nacional de Trasplantes (ONT) sobre los criterios de selección de donantes de órganos sólidos en relación con las enfermedades infecciosas

Author

Francesca F. Norman, Patricia Muñoz, Carlos Lumbreras, Oscar Len, Jesús Fortún, Beatriz Mahillo, Joan Gavaldà, Marino Blanes, María Carmen Fariñas, Rogelio López-Vélez, Marta Bodro, José Luis Pérez-Sáenz, Mario Fernández-Ruiz, Tomás Pumarola, N. Sabé, Jordi Carratalà, Pilar Martín-Dávila, Asunción Moreno, Ibai Los-Arcos, Francisco López-Medrano, Beatriz Domínguez-Gil, Elisa Vidal, José Miguel Montejo, José María Aguado, Elisa Cordero, Rafael San-Juan, Maria Angeles Marcos, and Universidad de Cantabria

Subjects
Microbiology (medical), medicine.medical_specialty, Infection screening, Graft dysfunction, Consensus, Communicable Diseases, Organ transplantation, Solid Organ Transplantation, Medicine, Infección, Transmission, Humans, Intensive care medicine, Societies, Medical, Executive summary, Transmisión, business.industry, Transmission (medicine), Risk of infection, Trasplante de Órgano Sólido, Patient Selection, Donación, Organ Transplantation, Donation, Tissue Donors, Clinical microbiology, Spain, Solid organ transplantation, business, Infection, Donación, Donation, Infección, Infection, Solid organ transplantation, Transmisión, Transmission, Trasplante de órgano sólido
Abstract

The immunosuppressive treatment that recipients receive from a solid organ transplantation hinders the defensive response to infection. Its transmission from the donor can cause dysfunction or loss of the graft and even death of the recipient if proper preventive measures are not established. This potential risk should be thoroughly evaluated to minimise the risk of infection transmission from donor to recipient, especially with organ transplantation from donors with infections, without increasing graft dysfunction and morbidity and mortality in the recipient. This document aims to review current knowledge about infection screening in potential donors and offer clinical and microbiological recommendations about the use of organs from donors with infection based on available scientific evidence. This work was supported by GESITRA/SEIMC, ONT and‘Plan Nacional de I+D+I’ and Instituto de Salud Carlos III(Fondo de Investigaciones Sanitarias 12/02269 and ProyectoIntegrado de Excelencia 13/00045), Subdirección General de Redesy Centros de Investigacion Cooperativa, Spanish Ministry of Econ-omy and Competitiveness, Spanish Network for Research inInfectious Diseases (REIPI RD16/0016), co-financed by the Euro-pean Development Regional Fund A way to achieve Europe.

Published
2019

39. Impact of antibiotic resistance on outcomes of neutropenic cancer patients with

Author

Adaia, Albasanz-Puig, Carlota, Gudiol, Rocío, Parody, Cristian, Tebe, Murat, Akova, Rafael, Araos, Anna, Bote, Anne-Sophie, Brunel, Sebnem, Calik, Lubos, Drgona, Estefanía, García, Philipp, Hemmati, Fabián, Herrera, Karim Yaqub, Ibrahim, Burcu, Isler, Souha, Kanj, Winfried, Kern, Guillermo, Maestro de la Calle, Adriana, Manzur, Jorge Iván, Marin, Ignacio, Márquez-Gómez, Pilar, Martín-Dávila, Malgorzata, Mikulska, José Miguel, Montejo, Milagros, Montero, Hugo Manuel Paz, Morales, Isabel, Morales, Andrés, Novo, Chiara, Oltolini, Maddalena, Peghin, Jose Luis, Del Pozo, Pedro, Puerta-Alcalde, Isabel, Ruiz-Camps, Oguz Resat, Sipahi, Robert, Tilley, Lucrecia, Yáñez, Marisa Zenaide Ribeiro, Gomes, Jordi, Carratalà, and Amanda Aparecida, da Silva Machado

Subjects
Tazobactam, bacteraemia, Neutropenia, Time Factors, International Cooperation, multidrug-resistant, onco-haematological patients, Bacteremia, bloodstream infection, pseudomonas aeruginosa, Anti-Bacterial Agents, Cephalosporins, Observational Studies as Topic, Logistic Models, Infectious Diseases, Research Design, Drug Resistance, Multiple, Bacterial, Neoplasms, Protocol, Humans, Multicenter Studies as Topic, Pseudomonas Infections, Retrospective Studies
Abstract

Introduction Pseudomonas aeruginosa (PA) has historically been one of the major causes of severe sepsis and death among neutropenic cancer patients. There has been a recent increase of multidrug-resistant PA (MDRPA) isolates that may determine a worse prognosis, particularly in immunosuppressed patients. The aim of this study is to establish the impact of antibiotic resistance on the outcome of neutropenic onco-haematological patients with PA bacteraemia, and to identify the risk factors for MDRPA bacteraemia and mortality. Methods and analysis This is a retrospective, observational, multicentre, international study. All episodes of PA bacteraemia occurring in neutropenic onco-haematological patients followed up at the participating centres from 1 January 2006 to 31 May 2018 will be retrospectively reviewed. The primary end point will be overall case-fatality rate within 30 days of onset of PA bacteraemia. The secondary end points will be to describe the following: the incidence and risk factors for multidrug-resistant and extremely drug-resistant PA bacteraemia (by comparing the episodes due to susceptible PA with those produced by MDRPA), the efficacy of ceftolozane/tazobactam, the rates of persistent bacteraemia and bacteraemia relapse and the risk factors for very early (48 hours), early (7 days) and overall (30 days) case-fatality rates. Ethics and dissemination The Clinical Research Ethics Committee of Bellvitge University Hospital approved the protocol of the study at the primary site. To protect personal privacy, identifying information of each patient in the electronic database will be encrypted. The processing of the patients’ personal data collected in the study will comply with the Spanish Data Protection Act of 1998 and with the European Directive on the privacy of data. All data collected, stored and processed will be anonymised. Results will be reported at conferences and in peer-reviewed publications.

Published
2019

40. Propensity Score Analysis of the Role of Initial Antifungal Therapy in the Outcome of Candida glabrata Bloodstream Infections

Author

Mario Fernández-Ruiz, Pilar Merino, Jesús Guinea, Mireia Puig-Asensio, D. Lora-Pablos, Pilar Martín-Dávila, Benito Almirante, Manuel Cuenca-Estrella, and José María Aguado

Subjects
Male, 0301 basic medicine, medicine.medical_specialty, Antifungal Agents, Echinocandin, 030106 microbiology, Population, Candida glabrata, Microbial Sensitivity Tests, Clinical Therapeutics, Echinocandins, 03 medical and health sciences, 0302 clinical medicine, Amphotericin B, Internal medicine, medicine, Humans, Pharmacology (medical), Prospective Studies, 030212 general & internal medicine, education, Fluconazole, Aged, Pharmacology, education.field_of_study, biology, business.industry, Candidemia, Odds ratio, Middle Aged, bacterial infections and mycoses, biology.organism_classification, Surgery, Regimen, Infectious Diseases, Propensity score matching, Female, business, medicine.drug
Abstract

Candida glabrata isolates have reduced in vitro susceptibility to azoles, which raises concerns about the clinical effectiveness of fluconazole for treating bloodstream infection (BSI) by this Candida species. We aimed to evaluate whether the choice of initial antifungal treatment (fluconazole versus echinocandins or liposomal amphotericin B [L-AmB]-based regimens) has an impact on the outcome of C. glabrata BSI. We analyzed data from a prospective, multicenter, population-based surveillance program on candidemia conducted in 5 metropolitan areas of Spain (May 2010 to April 2011). Adult patients with an episode of C. glabrata BSI were included. The main outcomes were 14-day mortality and treatment failure (14-day mortality and/or persistent C. glabrata BSI for ≥48 h despite antifungal initiation). The impact of using fluconazole as initial antifungal treatment on the patients' prognosis was assessed by logistic regression analysis with the addition of a propensity score approach. A total of 94 patients with C. glabrata BSI were identified. Of these, 34 had received fluconazole and 35 had received an echinocandin/L-AmB-based regimen. Patients in the echinocandin/L-AmB group had poorer baseline clinical status than did those in the fluconazole group. Patients in the fluconazole group were more frequently (55.9% versus 28.6%) and much earlier (median time, 3 versus 7 days) switched to another antifungal regimen. Overall, 14-day mortality was 13% (9/69) and treatment failure 34.8% (24/69), with no significant differences between the groups. On multivariate analysis, after adjusting for baseline characteristics by propensity score, fluconazole use was not associated with an unfavorable evolution (adjusted odds ratio [OR] for 14-day mortality, 1.16, with 95% confidence interval [CI] of 0.22 to 6.17; adjusted OR for treatment failure, 0.83, with 95% CI of 0.27 to 2.61). In conclusion, initial fluconazole treatment was not associated with a poorer outcome than that obtained with echinocandins/L-AmB regimens in patients with C. glabrata BSI. (This study has been registered at ClinicalTrials.gov under registration no. NCT01236261.)

Published
2016
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41. Galactomannan in bronchoalveolar lavage fluid for diagnosis of invasive aspergillosis in non-hematological patients

Author

E. Venanzi, J.J. Cabanillas, Julio García-Rodríguez, Pilar Martín-Dávila, José Tiago Silva, R. García-Luján, Mario Fernández-Ruiz, D. Benito, F. Lazaro, E. Gomez Garcia de la Pedrosa, Jesús Fortún, José María Aguado, F. Castaño, I. Quiles, and Santiago Moreno

Subjects
Adult, Male, 0301 basic medicine, Microbiology (medical), Pathology, medicine.medical_specialty, Neutropenia, 030106 microbiology, Aspergillosis, Sensitivity and Specificity, Gastroenterology, Article, Mannans, Immunocompromised Host, Pulmonary Disease, Chronic Obstructive, Young Adult, 03 medical and health sciences, Galactomannan, chemistry.chemical_compound, Internal medicine, Humans, Medicine, In patient, Retrospective Studies, Invasive Pulmonary Aspergillosis, COPD, medicine.diagnostic_test, business.industry, Galactose, Retrospective cohort study, Middle Aged, respiratory system, University hospital, medicine.disease, respiratory tract diseases, Infectious Diseases, Bronchoalveolar lavage, chemistry, Spain, Population study, Female, business, Bronchoalveolar Lavage Fluid
Abstract

Summary Background The role of galactomannan (GM) in serum or bronchoalveolar lavage fluid (BALF) for the diagnosis of invasive pulmonary aspergillosis (IPA) has been extensively evaluated in hematological patients, however its performance in non-hematological patients is not well established. Methods We performed a multicenter retrospective study in 3 university hospitals in Madrid, Spain between 2010 and 2014. The study population comprised patients with chronic obstructive pulmonary disease (COPD) and patients with immunosuppressive conditions in whom IPA was suspected and for whom BALF GM was available. Patients with hematological disorders were excluded. Results A total of 188 patients (35 with COPD and 153 with immunosuppressive conditions) were analyzed, and 31 cases of IPA (proven or probable) were identified. The global sensitivity of BALF GM (optical density index [ODI] ≥ 1.0) was 77.4%; sensitivity was higher in patients with immunosuppressive conditions than in patients with COPD (81.8% vs 66.7%; p: 0.38). In COPD patients, the best performance was obtained for BALF GM (ODI ≥ 0.5), although sensitivity (88.9%) was similar to that of BALF fungal culture (88.9%). The sensitivity of GM in serum was very poor in both populations (36.4% and 11.6%, respectively). Conclusions In the present series, the diagnostic performance of BALF GM was good for IPA in non-hematological patients, especially in patients with immunosuppressive conditions.

Published
2016
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42. Selection criteria of solid organ donors in relation to infectious diseases: A Spanish consensus

Author

Jesús Fortún, Jordi Carratalà, María Carmen Fariñas, Rogelio López-Vélez, Elisa Vidal, José Miguel Montejo, Beatriz Domínguez-Gil, Carlos Lumbreras, José Luis Pérez-Sáenz, Ibai Los-Arcos, Beatriz Mahillo, Tomás Pumarola, Francesca F. Norman, Marta Bodro, Maria Angeles Marcos, Elisa Cordero, Rafael San-Juan, Oscar Len, Asunción Moreno, N. Sabé, Joan Gavaldà, Patricia Muñoz, Marino Blanes, Grupo de Estudio de la Infección en el Trasplante, José María Aguado, Pilar Martín-Dávila, Francisco López-Medrano, and Mario Fernández-Ruiz

Subjects
Graft dysfunction, medicine.medical_specialty, Consensus, 030230 surgery, Infections, Organ transplantation, Donor Selection, Immunocompromised Host, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, medicine, Humans, Mass Screening, Intensive care medicine, Mass screening, Transplantation, Donor selection, Transmission (medicine), business.industry, Risk of infection, Organ Transplantation, Allografts, Spain, 030211 gastroenterology & hepatology, Solid organ, Solid organ transplantation, business
Abstract

The immunosuppressive treatment that recipients receive from a solid organ transplantation hinders the defensive response to infection. Its transmission from the donor can cause dysfunction or loss of the graft and even death of the recipient if proper preventive measures are not established. This potential risk should be thoroughly evaluated to minimise the risk of infection transmission from donor to recipient, especially with organ transplantation from donors with infections, without increasing graft dysfunction and morbidity and mortality in the recipient. This document aims to review current knowledge about infection screening in potential donors and offer clinical and microbiological recommendations about the use of organs from donors with infection based on available scientific evidence.

Published
2020
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43. Infective Endocarditis in Patients With Bicuspid Aortic Valve or Mitral Valve Prolapse

Author

Isabel Zegri-Reiriz, Arístides de Alarcón, Patricia Muñoz, Manuel Martínez Sellés, Victor González-Ramallo, Jose M. Miro, Carles Falces, Claudia Gonzalez Rico, Xabier Kortajarena Urkola, José Antonio Lepe, Regino Rodriguez Alvarez, Jose Maria Reguera Iglesias, Enrique Navas, Fernando Dominguez, Pablo Garcia-Pavia, Fernando Fernández Sánchez, Mariam Noureddine, Gabriel Rosas, Javier de la Torre Lima, José Aramendi, Elena Bereciartua, María José Blanco, Roberto Blanco, María Victoria Boado, Marta Campaña Lázaro, Alejandro Crespo, Josune Goikoetxea, José Ramón Iruretagoyena, Josu Irurzun Zuazabal, Leire López-Soria, Miguel Montejo, Javier Nieto, David Rodrigo, David Rodríguez, Regino Rodríguez, Yolanda Vitoria, Roberto Voces, María Victoria García López, Radka Ivanova Georgieva, Guillermo Ojeda, Isabel Rodríguez Bailón, Josefa Ruiz Morales, Ana María Cuende, Tomás Echeverría, Ana Fuerte, Eduardo Gaminde, Miguel Ángel Goenaga, Pedro Idígoras, José Antonio Iribarren, Alberto Izaguirre Yarza, Carlos Reviejo, Rafael Carrasco, Vicente Climent, Patricio Llamas, Esperanza Merino, Joaquín Plazas, Sergio Reus, Nemesio Álvarez, José María Bravo-Ferrer, Laura Castelo, José Cuenca, Pedro Llinares, Enrique Miguez Rey, María Rodríguez Mayo, Efrén Sánchez, Dolores Sousa Regueiro, Francisco Javier Martínez, María del Mar Alonso, Beatriz Castro, Dácil García Rosado, Mª del Carmen Durán, Mª Antonia Miguel Gómez, Juan Lacalzada, Ibrahim Nassar, Antonio Plata Ciezar, José Mª Reguera Iglesias, Víctor Asensi Álvarez, Carlos Costas, Jesús de la Hera, Jonnathan Fernández Suárez, Lisardo Iglesias Fraile, Víctor León Arguero, José López Menéndez, Pilar Mencia Bajo, Carlos Morales, Alfonso Moreno Torrico, Carmen Palomo, Begoña Paya Martínez, Ángeles Rodríguez Esteban, Raquel Rodríguez García, Mauricio Telenti Asensio, Manuel Almela, Juan Ambrosioni, Manuel Azqueta, Mercè Brunet, Marta Bodro, Ramón Cartañá, Carlos Falces, Guillermina Fita, David Fuster, Cristina García de la Mària, Marta Hernández-Meneses, Jaume Llopis Pérez, Francesc Marco, José María Miró, Asunción Moreno, David Nicolás, Salvador Ninot, Eduardo Quintana, Carlos Paré, Daniel Pereda, Juan Manuel Pericás, José Luis Pomar, José Ramírez, Irene Rovira, Elena Sandoval, Marta Sitges, Dolors Soy, Adrián Téllez, José M. Tolosana, Bárbara Vidal, Jordi Vila, Iván Adán, Javier Bermejo, Emilio Bouza, Daniel Celemín, Gregorio Cuerpo Caballero, Antonia Delgado Montero, Ana Fernández Cruz, Ana García Mansilla, María Eugenia García Leoni, Víctor González Ramallo, Martha Kestler Hernández, Amaia Mari Hualde, Mercedes Marín, Manuel Martínez-Sellés, María Cruz Menárguez, Cristina Rincón, Hugo Rodríguez-Abella, Marta Rodríguez-Créixems, Blanca Pinilla, Ángel Pinto, Maricela Valerio, Pilar Vázquez, Eduardo Verde Moreno, Isabel Antorrena, Belén Loeches, Alejandro Martín Quirós, Mar Moreno, Ulises Ramírez, Verónica Rial Bastón, María Romero, Araceli Saldaña, Jesús Agüero Balbín, Carlos Armiñanzas Castillo, Ana Arnaiz, Francisco Arnaiz de las Revillas, Manuel Cobo Belaustegui, María Carmen Fariñas, Concepción Fariñas-Álvarez, Rubén Gómez Izquierdo, Iván García, Claudia González Rico, Manuel Gutiérrez-Cuadra, José Gutiérrez Díez, Marcos Pajarón, José Antonio Parra, Ramón Teira, Jesús Zarauza, Fernando Domínguez, Pablo García-Pavía, Jesús González Mirelis, Beatriz Orden, Antonio Ramos, Marta Cobo-Marcos, Tomasa Centella, José Manuel Hermida, José Luis Moya, Pilar Martín-Dávila, Enrique Oliva, Alejandro del Río, Soledad Ruiz, Carmen Hidalgo Tenorio, Manuel Almendro Delia, Omar Araji, José Miguel Barquero, Román Calvo Jambrina, Marina de Cueto, Juan Gálvez Acebal, Irene Méndez, Isabel Morales, Luis Eduardo López-Cortés, Emilio García, Juan Luis Haro, Francisco López, Rafael Luque, Luis Javier Alonso, Pedro Azcárate, José Manuel Azcona Gutiérrez, José Ramón Blanco, Lara García-Álvarez, José Antonio Oteo, Mercedes Sanz, Natividad de Benito, Mercé Gurguí, Cristina Pacho, Roser Pericas, Guillem Pons, Ángel Luis Fernández, Amparo Martínez, Arturo Prieto, Benito Regueiro, Marino Vega, Andrés Canut Blasco, José Cordo Mollar, Juan Carlos Gainzarain Arana, Oscar García Uriarte, Alejandro Martín López, Zuriñe Ortiz de Zárate, José Antonio Urturi Matos, Gloria García Domínguez, Antonio Sánchez-Porto, José Mª Arribas Leal, Elisa García Vázquez, Alicia Hernández Torres, Ana Blázquez, Gonzalo de la Morena Valenzuela, Ángel Alonso, Javier Aramburu, Felicitas Elena Calvo, Anai Moreno Rodríguez, Paola Tarabini-Castellani, Eva Heredero Gálvez, Carolina Maicas Bellido, José Largo Pau, María Antonia Sepúlveda, Pilar Toledano Sierra, Sadaf Zafar Iqbal-Mirza, Eva Cascales Alcolea, Pilar Egea Serrano, José Joaquín Hernández Roca, Ivan Keituqwa Yañez, Ana Peláez Ballesta, Víctor Soriano, Eduardo Moreno Escobar, Alejandro Peña Monje, Valme Sánchez Cabrera, David Vinuesa García, María Arrizabalaga Asenjo, Carmen Cifuentes Luna, Juana Núñez Morcillo, Mª Cruz Pérez Seco, Aroa Villoslada Gelabert, Carmen Aured Guallar, Nuria Fernández Abad, Pilar García Mangas, Marta Matamala Adell, Mª Pilar Palacián Ruiz, Juan Carlos Porres, Begoña Alcaraz Vidal, Nazaret Cobos Trigueros, María Jesús Del Amor Espín, José Antonio Giner Caro, Roberto Jiménez Sánchez, Amaya Jimeno Almazán, Alejandro Ortín Freire, Monserrat Viqueira González, Pere Pericás Ramis, Mª Ángels Ribas Blanco, Enrique Ruiz de Gopegui Bordes, Laura Vidal Bonet, Mª Carmen Bellón Munera, Elena Escribano Garaizabal, Antonia Tercero Martínez, and Juan Carlos Segura Luque

Subjects
Adult, Male, medicine.medical_specialty, bicuspid aortic valve, Enfermedad cardiovascular, Heart Valve Diseases, 030204 cardiovascular system & hematology, Intracardiac injection, 03 medical and health sciences, Tratamiento médico, 0302 clinical medicine, Bicuspid aortic valve, Bicuspid Aortic Valve Disease, medicine, Mitral valve prolapse, Endocarditis, Humans, In patient, 030212 general & internal medicine, Registries, Antibiotic prophylaxis, Antibióticos, Aged, Endocarditis infecciosa, Mitral Valve Prolapse, antibiotic prophylaxis, business.industry, Incidence (epidemiology), Antibiotic Prophylaxis, Middle Aged, medicine.disease, Surgery, Infective endocarditis, Aortic Valve, Válvulas cardíacas, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Background: There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions. Objectives: This study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions. Methods: This analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group; n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group; n = 1,839), and IE with BAV (n = 54) or MVP (n = 89). Results: BAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0%; all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients. Conclusions: IE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered. Sin financiación 18.639 JCR (2018) Q1, 3/136 Cardiac & Cardiovascular Systems 9.280 SJR (2018) Q1, 1/365 Cardiology and Cardiovascular Medicine No data IDR 2018 UEM

Published
2018

44. T2 magnetic resonance for the diagnosis of deep-seated invasive candidiasis in a liver recipient without candidemia

Author

Jesús Fortún, Pilar Martín-Dávila, Ana Saiz, Santiago Moreno, Elia Gomez-García de la Pedrosa, Francesca Gioia, Javier Graus, Patricia Muñoz, and Antonio Vena

Subjects
0301 basic medicine, Pathology, medicine.medical_specialty, Magnetic Resonance Spectroscopy, Isolation (health care), Invasive, 030106 microbiology, Invasive candidiasis, Liver transplant, T2 magnetic resonance, Candidemia, Candidiasis, Invasive, Female, Humans, Middle Aged, Postoperative Complications, Liver Transplantation, Microbiology, 03 medical and health sciences, medicine, In patient, Arteritis, medicine.diagnostic_test, business.industry, Candidiasis, Magnetic resonance imaging, equipment and supplies, medicine.disease, Thrombosis, Infectious Diseases, business
Abstract

Background T2 magnetic resonance imaging (T2MR) is a new method for the diagnosis of invasive candidiasis, although most studies have analyzed its role in patients with candidemia or not infection. Case report We present the case of a patient with arteritis and thrombosis of the hepatic graft resulted from an undocumented fungal infection in the explanted liver.T2MR in serum was a suitable diagnostic tool for the diagnosis of the deep-seated invasive candidiasis in the absence of candidemia or the isolation of the yeast in culture. Conclusions T2MR allowed the diagnosis of deep-seated invasive candidiasis in an immunodepressed patient without candidemia, even before the onset of symptoms.

Published
2017

45. Infective endocarditis in patients with cancer: a consequence of invasive procedures or a harbinger of neoplasm?: A prospective, multicenter cohort

Author

Antonio Sánchez-Porto, Javier Bermejo, Víctor José González Ramallo, Marta Hernández-Meneses, Adrián Téllez, Víctor Asensi Álvarez, Claudia González-Rico, Vicente Climent, Luis Eduardo López-Cortés, Angel L. Fernández, Eduard Quintana, Jordi Vila, Pilar Martín-Dávila, Ana Fernández-Cruz, José A. Oteo, Jose Maria Arribas Leal, Marina Cueto-López, Natividad Benito, Fernando Dominguez, Jose A. Lepe, Patricia Carmen Muñoz García, Javier De La Torre-Lima, Omar A Araji-Tiliani, Universidad de Cantabria, and Universitat de Barcelona

Subjects
Male, medicine.medical_specialty, 030204 cardiovascular system & hematology, Duke criteria, 03 medical and health sciences, 0302 clinical medicine, Sex Factors, Risk Factors, Internal medicine, Neoplasms, medicine, Endocarditis, Neoplasm, Humans, In patient, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, Prospective cohort study, Càncer, Aged, Cancer, Cross Infection, business.industry, General Medicine, Middle Aged, medicine.disease, Surgery, Estudi de casos, Infective endocarditis, Cohort, Female, Case studies, business
Abstract

The aim of the study was to draw a comparison between the characteristics of infective endocarditis (IE) in patients with cancer and those of IE in noncancer patients.Patients with IE, according to the modified Duke criteria, were prospectively included in the GAMES registry between January 2008 and February 2014 in 30 hospitals. Patients with active cancer were compared with noncancer patients.During the study period, 161 episodes of IE fulfilled the inclusion criteria. We studied 2 populations: patients whose cancer was diagnosed before IE (73.9%) and those whose cancer and IE were diagnosed simultaneously (26.1%). The latter more frequently had community-acquired IE (67.5% vs 26.4%, P

Published
2017

46. Efficacy of β-Lactam/β-Lactamase Inhibitor Combinations for the Treatment of Bloodstream Infection Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae in Hematological Patients with Neutropenia

Author

F. Herrera, Jordi Carratalà, Guillermo Maestro de la Calle, Cristina Royo-Cebrecos, Carlos Cervera, Murat Akova, Maddalena Peghin, Georg Maschmeyer, Pilar Martín-Dávila, Mercè Gurguí, Jesús Rodríguez-Baño, Isabel Ruiz-Camps, Angela Cano, Yolanda Meije, Adriana Manzur, Teresa C. Sukiennik, Edson Abdala, Wanessa Trindade Clemente, Alison G. Freifeld, Cristian Tebe, Miguel Montejo, Thomas Gottlieb, Lucía Gómez, Carlota Gudiol, R. Alvarez, European Society of Clinical Microbiology and Infectious Diseases, Ministerio de Economía y Competitividad (España), Instituto de Salud Carlos III, European Commission, Red Española de Investigación en Patología Infecciosa, [Gudiol, Carlota] Univ Barcelona, Bellvitge Univ Hosp, IDIBELL, Infect Dis Dept, Barcelona, Spain, [Royo-Cebrecos, Cristina] Univ Barcelona, Bellvitge Univ Hosp, IDIBELL, Infect Dis Dept, Barcelona, Spain, [Carratala, Jordi] Univ Barcelona, Bellvitge Univ Hosp, IDIBELL, Infect Dis Dept, Barcelona, Spain, [Gudiol, Carlota] Duran & Reynals Hosp, ICO, Barcelona, Spain, [Abdala, Edson] Univ Sao Paulo, Fac Med, Inst Canc Estado Sao Paulo, Sao Paulo, Brazil, [Akova, Murat] Hacettepe Univ, Sch Med, Ankara, Turkey, [Alvarez, Rocio] Univ Seville, CSIC, Univ Hosp Virgen Rocio & Virgen Macarena, Inst Biomed Seville IBiS,Infect Dis Res Grp,Clin, Seville, Spain, [Maestro-de la Calle, Guillermo] Univ Complutense, Sch Med, Octubre Univ Hosp 12, Inst Invest Hosp Octubre 12 i 12,Infect Dis Unit, Madrid, Spain, [Cano, Angela] UCO, Reina Sofia Univ Hosp, IMIBIC, Cordoba, Spain, [Cervera, Carlos] Univ Alberta Hosp, Edmonton, AB, Canada, [Clemente, Wanessa T.] Univ Fed Minas Gerais, Hosp Clin, Digest Transplant Serv, Belo Horizonte, MG, Brazil, [Martin-Davila, Pilar] Hosp Ramon & Cajal, Infect Dis Dept, Madrid, Spain, [Freifeld, Alison] Univ Nebraska, Med Ctr, Internal Med Infect Dis Sect, Omaha, NE 68182 USA, [Gomez, Lucia] Univ Hosp Mutua Terrassa, Internal Med, Barcelona, Spain, [Gottlieb, Thomas] Concord Hosp, Dept Microbiol & Infect Dis, Concord, NSW, Australia, [Gurgui, Merce] Univ Autonoma Barcelona, Hosp Santa Creu & Sant Pau, Infect Dis Unit, Barcelona, Spain, [Gurgui, Merce] Univ Autonoma Barcelona, Inst Invest Biomed Sant Pau, Barcelona, Spain, [Herrera, Fabian] CEMIC, Dept Med, Infect Dis Sect, Buenos Aires, DF, Argentina, [Manzur, Adriana] Hosp Rawson, Infect Dis, San Juan, Argentina, [Maschmeyer, Georg] Charite, Med Sch, Acad Teaching Hosp, Dept Hematol Oncol & Palliat Care,Klinikum Ernst, Berlin, Germany, [Meije, Yolanda] Barcelona Hosp, SCIAS, Internal Med Dept, Infect Dis Unit, Barcelona, Spain, [Montejo, Miguel] Cruces Univ Hosp, Infect Dis Unit, Bilbao, Spain, [Peghin, Maddalena] Santa Maria Misericordia Univ Hosp, Infect Dis Div, Udine, Italy, [Rodriguez-Bano, Jesus] Univ Seville, Univ Hosp Virgen Macarena & Virgen Rocio IBiS, Dept Med, Clin Unit Infect Dis Microbiol & Prevent Med, Seville, Spain, [Ruiz-Camps, Isabel] Vall Hebron Univ Hosp, Infect Dis Dept, Barcelona, Spain, [Sukiennik, Teresa C.] Hosp Santa Casa Misericordia Porto Alegre, Porto Alegre, RS, Brazil, [Tebe, Cristian] Rovira & Virgili Univ, Inst Biomed Res Bellvitge, Stat Advisory Serv, Tarragona, Spain, [Gudiol, Carlota] Inst Salud Carlos III, REIPI Spanish Network Res Infect Dis, Madrid, Spain, [Royo-Cebrecos, Cristina] Inst Salud Carlos III, REIPI Spanish Network Res Infect Dis, Madrid, Spain, [Meije, Yolanda] Inst Salud Carlos III, REIPI Spanish Network Res Infect Dis, Madrid, Spain, [Montejo, Miguel] Inst Salud Carlos III, REIPI Spanish Network Res Infect Dis, Madrid, Spain, [Rodriguez-Bano, Jesus] Inst Salud Carlos III, REIPI Spanish Network Res Infect Dis, Madrid, Spain, [Ruiz-Camps, Isabel] Inst Salud Carlos III, REIPI Spanish Network Res Infect Dis, Madrid, Spain, [Carratala, Jordi] Inst Salud Carlos III, REIPI Spanish Network Res Infect Dis, Madrid, Spain, ESGBIS, ESGICH, Ministerio de Economia y Competitividad, Instituto de Salud Carlos III - European Development Regional Fund 'A way to achieve Europe' EDRF, Spanish Network for the Research in Infectious Diseases, COMBACTE-NET, COMBACTE-CARE, COMBACTE-MAGNET, Innovative Medicines Initiative (European Union), Innovative Medicines Initiative (EFPIA), Merck, Astellas, Novartis, Pfizer, MSD, Janssen, Astra-Zeneca, and İç Hastalıkları

Subjects
0301 basic medicine, Male, Definitive Therapy, Bacteremia, Escherichia-coli, Cohort Studies, chemistry.chemical_compound, Bloodstream infection, Case fatality rate, polycyclic compounds, beta-lactam/beta-lactamase inhibitors, Pharmacology (medical), Pharmacology & Pharmacy, Cancer, biology, Klebsiella-pneumoniae, Enterobacteriaceae Infections, Middle Aged, Enterobacteriaceae, Anti-Bacterial Agents, Risk-factors, Infectious Diseases, Beta-lactam/beta-lactamase inhibitors, Cohort, Lactam, Female, beta-Lactamase Inhibitors, Adult, medicine.medical_specialty, Neutropenia, 030106 microbiology, bloodstream infection, Outcomes, Clinical Therapeutics, beta-Lactams, Microbiology, beta-Lactamases, 03 medical and health sciences, β lactamase inhibitor, Piperacillin-tazobactam, Internal medicine, medicine, Humans, Mortality, Intensive care medicine, Pharmacology, business.industry, biochemical phenomena, metabolism, and nutrition, medicine.disease, biology.organism_classification, bacterial infections and mycoses, mortality, chemistry, ESBLs, Carbapenems, bacteria, Therapy, Bloodstream infections, business
Abstract

β-Lactam/β-lactamase inhibitors (BLBLIs) were compared to carbapenems in two cohorts of hematological neutropenic patients with extended-spectrum-β-lactamase (ESBL) bloodstream infection (BSI): the empirical therapy cohort (174 patients) and the definitive therapy cohort (251 patients). The 30-day case fatality rates and other secondary outcomes were similar in the two therapy groups of the two cohorts and also in the propensity-matched cohorts. BLBLIs might be carbapenem-sparing alternatives for the treatment of BSI due to ESBLs in these patients., We thank the ESGBIS and the ESGICH study groups for supporting the study. This study was supported by Ministerio de Economía y Competitividad, Instituto de Salud Carlos III—cofinanced by European Development Regional Fund “A way to achieve Europe” EDRF, Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015).

Published
2017

47. Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations

Author

Álvaro Pascual, Domingo Hernández, Francisco López-Medrano, Pilar Martín-Dávila, Rafael Cantón, M.J. Goyanes, Belén Gutiérrez-Gutiérrez, Elisa Vidal, A. Solé-Jover, J. Fortún, Patricia Muñoz, Julián Torre-Cisneros, Rafael López-Andújar, Oscar Len, A. Román-Broto, Antonio Oliver, Valentín Cuervas-Mons, Miguel Montejo, Mario Fernández-Ruiz, Joan Gavaldà, Emilia Cercenado, Carlota Gudiol, A. Moreno, Elena Pérez-Nadales, Juan José Castón, Elisa Cordero, Rafael San-Juan, Daniel Serón, Carlos Cervera, J.T. Silva, María G. Crespo-Leiro, Luis Martínez-Martínez, Benito Almirante, José María Aguado, Luis Almenar, M.C. Fariñas, Maricela Valerio, J. Elizalde-Fernández, José Miguel Cisneros, Jordi Carratalà, Universidad de Cantabria, Universitat de Barcelona, [Aguado, J. M.] Univ Complutense, Univ Hosp 12 Octubre, Infect Dis Unit, Inst Invest Hosp 12 Octubre i +72, Madrid, Spain, [Fernandez-Ruiz, M.] Univ Complutense, Univ Hosp 12 Octubre, Infect Dis Unit, Inst Invest Hosp 12 Octubre i +72, Madrid, Spain, [Lopez-Medrano, F.] Univ Complutense, Univ Hosp 12 Octubre, Infect Dis Unit, Inst Invest Hosp 12 Octubre i +72, Madrid, Spain, [San-Juan, R.] Univ Complutense, Univ Hosp 12 Octubre, Infect Dis Unit, Inst Invest Hosp 12 Octubre i +72, Madrid, Spain, [Silva, J. T.] Univ Extremadura, Fdn Formac & Invest Profes Salud Extremadura Fund, Univ Hosp Badajoz, Dept Infect Dis, Badajoz, Spain, [Cordero, E.] Univ Seville, Clin Unit Infect Dis Microbiol & Prevent Med, Inst Biomed Seville, IBiS,Univ Hosp Virgen Rocio,CSIC, Seville, Spain, [Cisneros, J. M.] Univ Seville, Clin Unit Infect Dis Microbiol & Prevent Med, Inst Biomed Seville, IBiS,Univ Hosp Virgen Rocio,CSIC, Seville, Spain, [Fortun, J.] Univ Hosp Ramon & Cajal, Dept Infect Dis, Madrid, Spain, [Martin-Davila, P.] Univ Hosp Ramon & Cajal, Dept Infect Dis, Madrid, Spain, [Gudiol, C.] Univ Barcelona, Dept Infect Dis, Hosp Univ Bellvitge, Inst Invest Biomed Bellvitge IDIBELL, Barcelona, Spain, [Carratala, J.] Univ Barcelona, Dept Infect Dis, Hosp Univ Bellvitge, Inst Invest Biomed Bellvitge IDIBELL, Barcelona, Spain, [Martinez-Martinez, L.] Univ Cordoba, Reina Sofia Univ Hosp, Clin Unit Microbiol, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Andalusia, Spain, [Vidal, E.] Univ Cordoba, Reina Sofia Univ Hosp, Clin Unit Infect Dis, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Andalusia, Spain, [Caston, J. J.] Univ Cordoba, Reina Sofia Univ Hosp, Clin Unit Infect Dis, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Andalusia, Spain, [Perez-Nadales, E.] Univ Cordoba, Reina Sofia Univ Hosp, Clin Unit Infect Dis, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Andalusia, Spain, [Torre-Cisneros, J.] Univ Cordoba, Reina Sofia Univ Hosp, Clin Unit Infect Dis, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Andalusia, Spain, [Almenar, L.] Hosp Univ La Fe, Cardiol Dept, Heart Failure & Heart Transplant Unit, Valencia, Spain, [Almirante, B.] Univ Autonoma Barcelona, Dept Infect Dis, Hosp Univ Vail Hebron, Barcelona, Spain, [Gavalda, J.] Univ Autonoma Barcelona, Dept Infect Dis, Hosp Univ Vail Hebron, Barcelona, Spain, [Len, O.] Univ Autonoma Barcelona, Dept Infect Dis, Hosp Univ Vail Hebron, Barcelona, Spain, [Canton, R.] Univ Hosp Ramon & Cajal, Microbiol Dept, IRYCIS, Madrid, Spain, [Cercenado, E.] Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Hosp Gregorio Maranon, Clin Microbiol & Infect Dis, Madrid, Spain, [Goyanes, M. J.] Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Hosp Gregorio Maranon, Clin Microbiol & Infect Dis, Madrid, Spain, [Valerio, M.] Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Hosp Gregorio Maranon, Clin Microbiol & Infect Dis, Madrid, Spain, [Munoz, P.] Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Hosp Gregorio Maranon, Clin Microbiol & Infect Dis, Madrid, Spain, [Cercenado, E.] CIBERES C606 06 0058, Enfermedades Resp, Madrid, Spain, [Goyanes, M. J.] CIBERES C606 06 0058, Enfermedades Resp, Madrid, Spain, [Valerio, M.] CIBERES C606 06 0058, Enfermedades Resp, Madrid, Spain, [Munoz, P.] CIBERES C606 06 0058, Enfermedades Resp, Madrid, Spain, [Cercenado, E.] Univ Complutense Madrid, Sch Med, Med Dept, Madrid, Spain, [Goyanes, M. J.] Univ Complutense Madrid, Sch Med, Med Dept, Madrid, Spain, [Valerio, M.] Univ Complutense Madrid, Sch Med, Med Dept, Madrid, Spain, [Munoz, P.] Univ Complutense Madrid, Sch Med, Med Dept, Madrid, Spain, [Cervera, C.] Univ Alberta, Div Infect Dis, Dept Med, Edmonton, AB, Canada, [Crespo-Leiro, M. G.] Complexo Hosp Univ A Coruna, Cardiol Dept, La Coruna, Spain, [Cuervas-Mons, V.] Hosp Clin Puerto Hierro, Liver Transplantat Internal Med, Madrid, Spain, [Elizalde-Fernandez, J.] Hosp Navarra, Intens Care Unit, Pamplona, Spain, [Farinas, M. C.] Univ Cantabria, Univ Hosp Marques Valdecilla, Unit Infect Dis, Santander, Spain, [Gutierrez-Gutierrez, B.] Univ Seville, Clin Unit Infect Dis & Microbiol, Unidad Gest Clin Enfermedades Infecciosas & Micro, Inst Biomed Sevilla,Hosp Univ Virgen Macarena,IBi, Seville, Spain, [Pascual, A.] Univ Seville, Clin Unit Infect Dis & Microbiol, Unidad Gest Clin Enfermedades Infecciosas & Micro, Inst Biomed Sevilla,Hosp Univ Virgen Macarena,IBi, Seville, Spain, [Hernandez, D.] Univ Malaga, Dept Nephrol, Carlos Haya Reg Univ Hosp, Inst Biomed Res Malaga IBIMA, Malaga, Spain, [Lopez-Andujar, R.] Hosp Univ & Politecn La Fe, Gen Surg Serv, Hepatobiliopancreat Surg & Transplantat Unit, Valencia, Spain, [Montejo, M.] Univ Hosp Cruces, Unit Infect Dis, Bilbao, Spain, [Moreno, A.] Univ Barcelona, Hosp Clin, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Barcelona, Spain, [Oliver, A.] Hosp Son Espases, Inst Invest Sanitaria Palma IdISPa, Dept Microbiol, Palma de Mallorca, Spain, [Oliver, A.] Hosp Son Espases, Inst Invest Sanitaria Palma IdISPa, Res Unit, Palma de Mallorca, Spain, [Roman-Broto, A.] Univ Autonoma Barcelona, Hosp Univ Vall Hebron, Lung Transplant Unit, Barcelona, Spain, [Seron, D.] Hosp Univ Vall Hebron, Nephrol Dept, Barcelona, Spain, [Sole-Jover, A.] Hosp Univ La Fe, Dept Pneumol, Lung Transplant Unit, Valencia, Spain, Spanish Ministry of Economy and Competitiveness, Institute de Salud Carlos III, and Fundacion pars la Formacion e Investigacion de los Profesionales de la Salud de Extremadura (FundeSalud), Institute de Salud Carlos III

Subjects
0301 basic medicine, medicine.medical_treatment, Antibiotics, Carbapenem-resistant enterobacteriaceae, Communicable diseases, Organ transplantation, Lactamase-producing enterobacteriaceae, Postoperative Complications, Solid organ transplantation, Medicine, Blood-stream infections, Kidney transplantation, Transplantation of organs, Carbapenem-resistant Gram-negative bacilli, High-risk patients, Multidrug resistant Gram-negative bacilli, Disease Management, Drug Resistance, Multiple, Tissue Donors, Anti-Bacterial Agents, Pseudomonas-aeruginosa bacteremia, medicine.medical_specialty, medicine.drug_class, 030106 microbiology, Urinary-tract-infections, 03 medical and health sciences, Surgical prophylaxis, Acinetobacter-baumannii infections, Pseudomonas, Ventilator-associated pneumonia, Lung transplantation, Humans, Extended-spectrum β-lactamases, Intensive care medicine, Contraindication, Transplantation, business.industry, Bacils, Extensively-drug-resistant, Organ Transplantation, Malalties infeccioses, medicine.disease, Transplant Recipients, Trasplantament d'òrgans, Bacillus (Bacteria), Spectrum beta-lactamases, Intensive-care-unit, business, Gram-Negative Bacterial Infections
Abstract

Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate´s phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection. J.T.S. holds a research contract from the Fundación para la Formación e Investigación de los Profesionales de la Salud de Extremadura (FundeSalud), Instituto de Salud Carlos III. M.F.R. holds a clinical research contract “Juan Rodés” (JR14/00036) from the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III.

Published
2017

48. Incidental finding of a primary thyroid tuberculosis

Author

Elisa Santacruz, Héctor Pian-Arias, Laura Montánez-Fernández, Pilar Martín-Dávila, A.E. Ortiz-Flores, José I. Botella-Carretero, and Francesca Gioia

Subjects
medicine.medical_specialty, Tuberculosis, medicine.diagnostic_test, business.industry, Thyroid, 030209 endocrinology & metabolism, Nodule (medicine), Case Report, Disease, medicine.disease, Microbiology, Preoperative care, Dermatology, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, medicine.anatomical_structure, Granuloma, Biopsy, medicine, Parasitology, 030212 general & internal medicine, Differential diagnosis, medicine.symptom, business
Abstract

Thyroid tuberculosis (TT) is a very rare condition, even in countries where tuberculosis is endemic. However, the prevalence of tuberculosis has increased worldwide and thyroid involvement can be a primary manifestation of the disease. We present the case of a 43-year-old patient with this diagnosis and perform a review of the related literature. After searching for similar case reports in Western Europe since 2010 we identified six cases in four countries. TT should be considered in the differential diagnosis of a thyroid nodule. Fine-needle aspiration cytology and polymerase chain reaction are useful tools as preoperative diagnosis. Typical caseous necrotic granulomas are the hallmark in biopsy.

Published
2017

49. Clinical efficacy of ceftazidime/avibactam versus other active agents for the treatment of bacteremia due to carbapenemase-producing Enterobacteriaceae in hematologic patients

Author

Isabel Lacort-Peralta, Julián Torre-Cisneros, Juan José Castón, Salvador Tabares, José Ramón Paño-Pardo, Belén Loeches, Liz Temkin, and Pilar Martín-Dávila

Subjects
0301 basic medicine, Microbiology (medical), Male, Carbapenemase-Producing Enterobacteriaceae, medicine.medical_specialty, Avibactam, 030106 microbiology, Ceftazidime, Bacteremia, Microbial Sensitivity Tests, beta-Lactamases, lcsh:Infectious and parasitic diseases, Cohort Studies, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Bacterial Proteins, Enterobacteriaceae, Internal medicine, Medicine, Humans, lcsh:RC109-216, 030212 general & internal medicine, Carbapenemase-producing Enterobacteriaceae, Retrospective Studies, business.industry, Septic shock, Ceftazidime-avibactam, Enterobacteriaceae Infections, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Ceftazidime/avibactam, Surgery, Anti-Bacterial Agents, Infectious Diseases, Treatment Outcome, chemistry, Hematologic Neoplasms, Drug Therapy, Combination, Female, Bloodstream infections, business, Azabicyclo Compounds, medicine.drug, Cohort study
Abstract

Objectives: The primary objective was to describe clinical features, treatment and outcomes in patients with carbapenemase-producing Enterobacteriaceae (CPE) bacteremia. Additionally, patients treated with ceftazidime/avibactam (study group) were compared to the rest of the patients (comparator group) to determine the influence of the treatment in both crude mortality and clinical cure. Methods: Multicenter and retrospective study that included patients with hematologic malignancies who had CPE bacteremia. A bivariate analysis was performed to compare the clinical variables between the study group and the control group. Results: 31 patients were included. Bacteremia was considered primary in 14 (45%) patients. Overall crude mortality at 30 days was 45.2% (n = 14). Mortality was more frequent when septic shock (78.6% vs 11.8%; p > 0.001) and higher Pitt score (6 + 14 vs 1.5 + 4; p

Published
2017

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