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2. Implementation of a PCR-based strategy to control an outbreak by Serratia marcescens in a Neonatal Intensive Care Unit

Author

Ángel Rodríguez-Villodres, José Manuel Ortiz de la Rosa, Raquel Valencia-Martin, Francisco Jiménez Parrilla, Guillermo Martín-Gutiérrez, Natividad Márquez Patiño, Estela Perea Cruz, María Teresa Sánchez Jiménez, Antonio Pavón Delgado, José Miguel Cisneros, and José Antonio Lepe

Subjects
Serratia marcescens, PCR, Outbreak, Neonatal Intensive Care Unit, Epidemiology, Therapeutics. Pharmacology, RM1-950, Infectious and parasitic diseases, RC109-216, Microbiology, QR1-502
Abstract

Abstract Objectives To evaluate the clinical and epidemiological impact of a new molecular surveillance strategy based on qPCR to control an outbreak by Serratia marcescens in a Neonatal Intensive Care Unit (NICU). Methods We design a specific qPCR for the detection of S. marcescens in rectal swabs of patients admitted to a NICU. We divided the surveillance study into two periods: (a) the pre-PCR, from the outbreak declaration to the qPCR introduction, and (b) the PCR period, from the introduction of the qPCR until the outbreak was solved. In all cases, S. marcescens isolates were recovered and their clonal relationship was analysed by PFGE. Control measures were implemented during the outbreak. Finally, the number of bloodstream infections (BSI) was investigated in order to evaluate the clinical impact of this molecular strategy. Results Nineteen patients colonized/infected by S. marcescens were detected in the pre-PCR period (October 2020–April 2021). On the contrary, after the PCR implementation, 16 new patients were detected. The PFGE revealed 24 different pulsotypes belonging to 7 different clonal groups, that were not overlapping at the same time. Regarding the clinical impact, 18 months after the qPCR implementation, no more outbreaks by S. marcescens have been declared in the NICU of our hospital, and only 1 episode of BSI has occurred, compared with 11 BSI episodes declared previously to the outbreak control. Conclusions The implementation of this qPCR strategy has proved to be a useful tool to control the nosocomial spread of S. marcescens in the NICU.

Published
2023
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3. Enterobacterales carrying chromosomal AmpC β-lactamases in Europe (EuESCPM): Epidemiology and antimicrobial resistance burden from a cohort of 27 hospitals, 2020–2022

Author

Boattini, Matteo, Bianco, Gabriele, Llorente, Laura Iglesias, Acero, Laura Alonso, Nunes, Daniel, Seruca, Miguel, Mendes, Vasco Santos, Almeida, André, Bastos, Paulo, Rodríguez-Villodres, Ángel, Gascón, Adelina Gimeno, Halperin, Ana Verónica, Cantón, Rafael, Escartín, Maria Nieves Larrosa, González-López, Juan José, Floch, Pauline, Massip, Clémence, Chainier, Delphine, Barraud, Olivier, Dortet, Laurent, Cuzon, Gaëlle, Zancanaro, Clément, Mizrahi, Assaf, Schade, Rogier, Rasmussen, Asger Nellemann, Schønning, Kristian, Hamprecht, Axel, Schaffarczyk, Lukas, Glöckner, Stefan, Rödel, Jürgen, Kristóf, Katalin, Balonyi, Ágnes, Mancini, Stefano, Quiblier, Chantal, Fasciana, Teresa, Giammanco, Anna, Paglietti, Bianca, Rubino, Salvatore, Budimir, Ana, Bedenić, Branka, Rubic, Zana, Marinović, Jelena, Gartzonika, Konstantina, Christaki, Eirini, Mavromanolaki, Viktoria Eirini, Maraki, Sofia, Yalçın, Tuğba Yanık, Azap, Özlem Kurt, Licker, Monica, Musuroi, Corina, Talapan, Daniela, Vrancianu, Corneliu Ovidiu, Comini, Sara, Zalas-Więcek, Patrycja, Michalska, Anna, Cavallo, Rossana, Melo Cristino, José, and Costa, Cristina

Published
2024
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5. Pseudomonas aeruginosa antibiotic susceptibility profiles, genomic epidemiology and resistance mechanisms: a nation-wide five-year time lapse analysis

Author

Galán-Sánchez, Fátima, Gracia-Ahufinger, Irene, Martínez-Martínez, Luis, Liébana-Martos, Carmen, Roldán, Carolina, Sánchez-Calvo, Juan Manuel, Clavijo, Encarnación, Mora-Navas, Laura, Aznar, Javier, Lepe, José Antonio, Rodríguez-Villodres, Ángel, Recacha, Esther, Casas-Círia, Francisco Javier, Martínez-Rubio, Carmen, Sempere-Alcocer, Marco Antonio, Martín-Hita, Lina, Seral, Cristina, López-Calleja, Ana Isabel, Aspiroz, Carmen, Monforte, Marisa, Iglesia-Martínez, Pedro de la, Jimenez-Guerra, Gemma, Riera-Pérez, Elena, Collado, Carmen, Gallegos, Carmen, Mulet, Xavier, Fernández-Muñoz, Almudena, Sastre-Femenía, Miquel Àngel, Gomis-Font, María Antonia, Zamorano, Laura, Oliver, Antonio, Siller-Ruiz, María, Calvo, Jorge, Quesada, Dolores, Wang, Jun Hao, Pitart, Cristina, Marco, Francesc, Prim, Nuria, Horcajada, Juan Pablo, Padilla, Eduardo, Del Barrio-Tofiño, Ester, Viñado-Pérez, Belen, Larrosa, Nieves, Tubau, Fe, Capilla, Silvia, Casabella, Antonio, Pérez-Moreno, Mar Olga, Padilla, Emma, Ballestero, Mónica, Rivera, Alba, Navarro, Ferrán, Gómez-Bertomeu, Fréderic, Pardo-Granell, Sergio, Picó-Plana, Ester, Guerrero, Dolores, Sarvisé-Buil, Carolina, Belles-Belles, Alba, Fernández-Esgueva, Marta, Ortega-Lafont, María del Pilar, García, Inmaculada, Arenal-Andrés, Noelia, Hernando-Real, Susana, Ibáñez, Rosario, Martínez, Jesús, Becerra, Federico, Aldea-Mansilla, Carmen, Alaoui-Sosse, Asmaa, González, José Carlos, Guzman-Puche, Julia, Blázquez-Andrada, Miguel Ángel, Martínez-Ramírez, Nora Mariela, Beteta, Alicia, Gomila-Sard, Bárbara, Almaraz, Salvador Giner, Garduño, Eugenio, Juiz-González, Pedro Miguel, Arca-Suárez, Jorge, Alba, Javier, Alonso, Pilar, Rodríguez, Ana Isabel, Paz-Vidal, María Isabel, García-Campello, Marta, Camacho, Pablo, Pallarés, María de los Ángeles, Pérez del Molino, María Luisa, Coira, Amparo, Barbeito, Gema, Rincón, Anniris, Vasallo-Vidal, Francisco José, Alonso-Acero, Laura, Iglesias-Llorente, Laura, Bordes-Benites, Ana, Florén-Zabala, Laura, Azcona, José Manuel, Alonso, Carla Andrea, Sáenz, Yolanda, Lamata-Subero, Marta, Molina, David, González-Torralba, Ana, Villa, Jennifer, Viedma, Esther, Cercenado, Emilia, Alarcón, Teresa, Vargas, Paula, Díez, María, Cantón, Rafael, Ruiz, Patricia, Sánchez-Romero, María Isabel, Pérez-García, Felipe, Yagüe-Guirao, Genoveva, Oteiza, Amaia Concepción, Leiva, José, Portillo, María Eugenia, Canut-Blasco, Andrés, Vidal, Matxalen, Alonso, Iker, Zuriarrain, Maider, Barrios-Andrés, José Luis, Sastre-Femenia, Miquel Àngel, Taltavull, Biel, López-Causapé, Carla, and Oteo-Iglesias, Jesús

Published
2023
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6. Pseudomonas aeruginosa antibiotic susceptibility profiles, genomic epidemiology and resistance mechanisms: a nation-wide five-year time lapse analysisResearch in context

Author

Miquel Àngel Sastre-Femenia, Almudena Fernández-Muñoz, María Antonia Gomis-Font, Biel Taltavull, Carla López-Causapé, Jorge Arca-Suárez, Luis Martínez-Martínez, Rafael Cantón, Nieves Larrosa, Jesús Oteo-Iglesias, Laura Zamorano, Antonio Oliver, Fátima Galán-Sánchez, Irene Gracia-Ahufinger, Carmen Liébana-Martos, Carolina Roldán, Juan Manuel Sánchez-Calvo, Encarnación Clavijo, Laura Mora-Navas, Javier Aznar, José Antonio Lepe, Ángel Rodríguez-Villodres, Esther Recacha, Francisco Javier Casas-Círia, Carmen Martínez-Rubio, Marco Antonio Sempere-Alcocer, Lina Martín-Hita, Cristina Seral, Ana Isabel López-Calleja, Carmen Aspiroz, Marisa Monforte, Pedro de la Iglesia-Martínez, Gemma Jimenez-Guerra, Elena Riera-Pérez, Carmen Collado, Carmen Gallegos, Xavier Mulet, Miquel Àngel Sastre-Femenía, María Siller-Ruiz, Jorge Calvo, Dolores Quesada, Jun Hao Wang, Cristina Pitart, Francesc Marco, Nuria Prim, Juan Pablo Horcajada, Eduardo Padilla, Ester Del Barrio-Tofiño, Belen Viñado-Pérez, Fe Tubau, Silvia Capilla, Antonio Casabella, Mar Olga Pérez-Moreno, Emma Padilla, Mónica Ballestero, Alba Rivera, Ferrán Navarro, Fréderic Gómez-Bertomeu, Sergio Pardo-Granell, Ester Picó-Plana, Dolores Guerrero, Carolina Sarvisé-Buil, Alba Belles-Belles, Marta Fernández-Esgueva, María del Pilar Ortega-Lafont, Inmaculada García, Noelia Arenal-Andrés, Susana Hernando-Real, Rosario Ibáñez, Jesús Martínez, Federico Becerra, Carmen Aldea-Mansilla, Asmaa Alaoui-Sosse, José Carlos González, Julia Guzman-Puche, Miguel Ángel Blázquez-Andrada, Nora Mariela Martínez-Ramírez, Alicia Beteta, Bárbara Gomila-Sard, Salvador Giner Almaraz, Eugenio Garduño, Pedro Miguel Juiz-González, Javier Alba, Pilar Alonso, Ana Isabel Rodríguez, María Isabel Paz-Vidal, Marta García-Campello, Pablo Camacho, María de los Ángeles Pallarés, María Luisa Pérez del Molino, Amparo Coira, Gema Barbeito, Anniris Rincón, Francisco José Vasallo-Vidal, Laura Alonso-Acero, Laura Iglesias-Llorente, Ana Bordes-Benites, Laura Florén-Zabala, José Manuel Azcona, Carla Andrea Alonso, Yolanda Sáenz, Marta Lamata-Subero, David Molina, Ana González-Torralba, Jennifer Villa, Esther Viedma, Emilia Cercenado, Teresa Alarcón, Paula Vargas, María Díez, Patricia Ruiz, María Isabel Sánchez-Romero, Felipe Pérez-García, Genoveva Yagüe-Guirao, Amaia Concepción Oteiza, José Leiva, María Eugenia Portillo, Andrés Canut-Blasco, Matxalen Vidal, Iker Alonso, Maider Zuriarrain, and José Luis Barrios-Andrés

Subjects
Post-acute sequelae of SARS-CoV-2, PASC, COVID-19, SARS-CoV-2, Electronic health records, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: Pseudomonas aeruginosa healthcare-associated infections are one of the top antimicrobial resistance threats world-wide. In order to analyze the current trends, we performed a Spanish nation-wide high-resolution analysis of the susceptibility profiles, the genomic epidemiology and the resistome of P. aeruginosa over a five-year time lapse. Methods: A total of 3.180 nonduplicated P. aeruginosa clinical isolates from two Spanish nation-wide surveys performed in October 2017 and 2022 were analyzed. MICs of 13 antipseudomonals were determined by ISO-EUCAST. Multidrug resistance (MDR)/extensively drug resistance (XDR)/difficult to treat resistance (DTR)/pandrug resistance (PDR) profiles were defined following established criteria. All XDR/DTR isolates were subjected to whole genome sequencing (WGS). Findings: A decrease in resistance to all tested antibiotics, including older and newer antimicrobials, was observed in 2022 vs 2017. Likewise, a major reduction of XDR (15.2% vs 5.9%) and DTR (4.2 vs 2.1%) profiles was evidenced, and even more patent among ICU isolates [XDR (26.0% vs 6.0%) and DTR (8.9% vs 2.6%)] (p

Published
2023
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8. Ultrasensitive and rapid identification of ESRI developer- and piperacillin/tazobactam-resistant Escherichia coli by the MALDIpiptaz test

Author

Angel Rodríguez Villodres, Lydia Gálvez Benítez, Manuel J. Arroyo, Gema Méndez, Luis Mancera, Andrea Vila Domínguez, José Antonio Lepe Jímenez, and Younes Smani

Subjects
Piperacillin, tazobactam, Escherichia coli, resistance, beta-lactamase, beta-lactamase inhibitor, Infectious and parasitic diseases, RC109-216, Microbiology, QR1-502
Abstract

Background The excessive use of piperacillin/tazobactam (P/T) has promoted the emergence of P/T-resistant Enterobacterales. We reported that in Escherichia coli, P/T contributes to the development of extended-spectrum resistance to β-lactam/β-lactamase inhibitor (BL/BLI) (ESRI) in isolates that are P/T susceptible but have low-level resistance to BL/BLI. Currently, the detection of P/T resistance relying on conventional methods is time-consuming. To overcome this issue, we developed a cost-effective test based on MALDI-MS technology, called MALDIpiptaz, which aims to detect P/T resistance and ESRI developers in E. coli.Methods We used automated Clover MS Data Analysis software to analyse the protein profile spectra obtained by MALDI-MS from a collection of 248 E. coli isolates (91 P/T-resistant, 81 ESRI developers and 76 P/T-susceptible). This software allowed to preprocess all the spectra to build different peak matrices that were analysed by machine learning algorithms.Results We demonstrated that MALDIpiptaz can efficiently and rapidly (15 min) discriminate between P/T-resistant, ESRI developer and P/T-susceptible isolates and allowed the correct classification between ESRI developers from their isogenic resistance to P/T.Conclusion The combination of excellent performance and cost-effectiveness are all desirable attributes, allowing the MALDIpiptaz test to be a useful tool for the rapid determination of P/T resistance in clinically relevant E. coli isolates.

Published
2022
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9. BIChromET: A Chromogenic Culture Medium for Detection of Piperacillin/Tazobactam and Cefepime Resistance in Pseudomonas aeruginosa

Author

José Manuel Ortiz de la Rosa, Ángel Rodríguez-Villodres, Guillermo Martín-Gutiérrez, Carmen Cintora Mairal, José Luis García Escobar, Lydia Gálvez-Benítez, José Miguel Cisneros, and José Antonio Lepe

Subjects
n/a, Therapeutics. Pharmacology, RM1-950
Abstract

Objectives: The BIChromET selective medium for detecting piperacillin-tazobactam (TZP) and cefepime (FEP) resistant Pseudomonas aeruginosa was developed. Methods: The performance of this medium was first evaluated using a collection of 100 P. aeruginosa clinical strains (70 TZP-susceptible, 30 TZP-resistant, 58 FEP-susceptible, and 42 FEP-resistant). Then, we performed clinical validation by testing 173 respiratory clinical samples. Results: The BIChromET medium showed excellent sensitivity (TZP (avg. 96.7%); FEP (avg. 92.7%)) and specificity (TZP (avg. 98.9%); FEP (avg. 98%)) in distinguishing the detection limit ranging from 104 to 108 CFU/mL. Then, testing the bronchoalveolar lavage (BAL) and tracheobronchial aspirate (TBA) clinical specimens (N = 173) revealed the excellent performance of the medium with P. aeruginosa, showing 100% and 92.6% of categorical agreements with the results obtained via the broth microdilution methods (BMD) for TZP and FEP, respectively. Conclusion: This medium allows for easy and accurate detection of TZP/FEP-resistant isolates regardless of their resistance mechanisms.

Published
2023
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10. Activity of cefepime, carbapenems and new β-lactam/β-lactamase inhibitor combinations on Enterobacter cloacae complex and Klebsiella aerogenes in Spain (SMART 2016–2022)

Author

Rodríguez-Villodres, Ángel, primary, Lepe-Balsalobre, Esperanza, additional, Ortiz De La Rosa, José Manuel, additional, Giner Almaraz, Salvador, additional, González De Herrero, Elisa, additional, Cercenado, Emilia, additional, García-Fernández, Sergio, additional, Benito, Rafael, additional, Ponz Mir, Ricardo, additional, Cantón, Rafael, additional, and Lepe, José Antonio, additional

Published
2024
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12. Identification and validation of clinical phenotypes with prognostic implications in patients admitted to hospital with COVID-19: a multicentre cohort study

Author

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

Published
2021
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13. Impact of the COVID-19 Pandemic on Survival in the Patients With the Intra-Abdominal Infections

Author

Lydia Gálvez-Benítez, Ángel Rodríguez-Villodres, Rocío Álvarez-Marín, Rosa Jiménez-Rodríguez, José Antonio Lepe-Jiménez, Jerónimo Pachón, and Younes Smani

Subjects
COVID-19, intra-abdominal infection, Escherichia coli, surgery, mortality, Medicine (General), R5-920
Abstract

Objective: To analyze the availability and access to the hospital for the patients with intra-abdominal infections (IAIs) by Escherichia coli (E. coli) as a result of the coronavirus disease 2019 (COVID-19) pandemic and the impact of these changes in the diagnosis and their effects on the death of these patients.Methods: Two prospective observational cohorts of the patients with IAI by E. coli were conducted in 2016 (the pre-COVID-19, n = 108) and in 2020 (during the COVID-19, n = 96) at the University Hospital of Seville, Spain. The demographic and clinical variables of the patients were collected and analyzed. The patients were followed-up for 120 days, until the hospital discharge or death. The bivariate and multivariate analyses were performed.Results: Both the cohorts were homogeneous according to age, sex, emergency surgery cause, immunosuppression, neutropenia, acquisition type, and previous intervention. The patients attended during the COVID-19 had significantly higher Charlson comorbidity index and the more McCabe score, required more emergency surgery, had more severe infections with the higher rates of septic shock and sepsis, and the presence of additional care support such as a nasogastric tube. They were diagnosed later; the time intervals between the symptoms onset (SO) to the first medical contact or surgical intervention (SI) and between the first medical contact to the admission or SI were significantly higher. The death rates during the COVID-19 and the pre-COVID-19 were 16.7 and 6.5%, respectively (p = 0.02). Finally, the multivariate analysis in both the cohorts together identified the patients diagnosed during the COVID-19, the longer period from SO to SI, septic shock, and the Charlson comorbidity index as the independent factors associated with death.Conclusion: This study showed the impact of the COVID-19 pandemic on the clinical outcome and death due to IAI with an extension of the time between SO and SI.

Published
2021
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14. Semirapid Detection of Piperacillin/Tazobactam Resistance and Extended-Spectrum Resistance to β-Lactams/β-Lactamase Inhibitors in Clinical Isolates of Escherichia coli

Author

Ángel Rodríguez-Villodres, Alicia Gutiérrez Linares, Lydia Gálvez-Benitez, Jerónimo Pachón, José Antonio Lepe, and Younes Smani

Subjects
ESRI, Escherichia coli, beta-lactamase, beta-lactamase inhibitor, piperacillin, resistance, Microbiology, QR1-502
Abstract

ABSTRACT Piperacillin/tazobactam (TZP) is a β-lactam/β-lactamase inhibitor (BL/BLI) recommended for the empirical treatment of severe infections. The excessive and indiscriminate use of TZP has promoted the emergence of TZP-resistant Escherichia coli isolates. Recently, we demonstrated that TZP may contribute to the development of extended-spectrum resistance to BL/BLI (ESRI) in E. coli isolates that are TZP susceptible but have low-level resistance to BL/BLI (resistance to amoxicillin/clavulanic acid [AMC] and/or ampicillin/sulbactam [SAM]). This raises the need for the development of rapid detection systems. Therefore, the objective of this study was to design and validate a method able to detect TZP resistance and ESRI in E. coli. A colorimetric assay based on β-lactam ring hydrolysis by β-lactamases was designed (ESRI test). A total of 114 E. coli isolates from bloodstream and intra-abdominal sources, characterized according to their susceptibility profiles to BL/BLI, were used. Detection of the three most frequent β-lactamases involved in BL/BLI resistance (blaTEM, blaOXA-1, and blaSHV) was performed by PCR. The ESRI test was able to detect all the TZP-intermediate/-resistant isolates, as well as all the TZP-susceptible isolates with a capacity for ESRI development. Their median times to results were 5 and 30 min, respectively. All the isolates without resistance to BL/BLI displayed a negative result in the ESRI test. blaTEM was the most frequent β-lactamase gene detected, follow by blaSHV and blaOXA-1. These results demonstrate the efficacy of the ESRI test, showing great clinical potential which could lead to reductions in health costs, ineffective treatments, and inappropriate use of BL/BLI. IMPORTANCE TZP is a BL/BLI recommended for the empirical treatment of severe infections. The excessive use of TZP has promoted the emergence of TZP-resistant Escherichia coli isolates. We recently reported that TZP may contribute to the development of ESRI in E. coli isolates that are TZP susceptible but have low-level resistance to BL/BLI. This raises the need for the development of rapid detection systems. Here, we demonstrated that the ESRI test was able to detect the TZP-intermediate or -resistant isolates and the TZP-susceptible isolates with the capacity for ESRI development. All the isolates without BL/BLI resistance were negative for the ESRI test and did not harbor β-lactamase genes. For ESRI developers and TZP-intermediate or -resistant isolates, blaTEM was the most frequent β-lactamase gene detected, follow by blaSHV and blaOXA-1. The sensitivity, specificity, and positive and negative predictive values were all 100%. These data demonstrate the efficacy of the ESRI test and show that it has great clinical potential.

Published
2021
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15. Pseudomonas aeruginosa antibiotic susceptibility profiles, genomic epidemiology and resistance mechanisms: a nation-wide five-year time lapse analysis

Author

Sastre-Femenia, Miquel Àngel, primary, Fernández-Muñoz, Almudena, additional, Gomis-Font, María Antonia, additional, Taltavull, Biel, additional, López-Causapé, Carla, additional, Arca-Suárez, Jorge, additional, Martínez-Martínez, Luis, additional, Cantón, Rafael, additional, Larrosa, Nieves, additional, Oteo-Iglesias, Jesús, additional, Zamorano, Laura, additional, Oliver, Antonio, additional, Galán-Sánchez, Fátima, additional, Gracia-Ahufinger, Irene, additional, Liébana-Martos, Carmen, additional, Roldán, Carolina, additional, Sánchez-Calvo, Juan Manuel, additional, Clavijo, Encarnación, additional, Mora-Navas, Laura, additional, Aznar, Javier, additional, Lepe, José Antonio, additional, Rodríguez-Villodres, Ángel, additional, Recacha, Esther, additional, Casas-Círia, Francisco Javier, additional, Martínez-Rubio, Carmen, additional, Sempere-Alcocer, Marco Antonio, additional, Martín-Hita, Lina, additional, Seral, Cristina, additional, López-Calleja, Ana Isabel, additional, Aspiroz, Carmen, additional, Monforte, Marisa, additional, Iglesia-Martínez, Pedro de la, additional, Jimenez-Guerra, Gemma, additional, Riera-Pérez, Elena, additional, Collado, Carmen, additional, Gallegos, Carmen, additional, Mulet, Xavier, additional, Sastre-Femenía, Miquel Àngel, additional, Siller-Ruiz, María, additional, Calvo, Jorge, additional, Quesada, Dolores, additional, Wang, Jun Hao, additional, Pitart, Cristina, additional, Marco, Francesc, additional, Prim, Nuria, additional, Horcajada, Juan Pablo, additional, Padilla, Eduardo, additional, Del Barrio-Tofiño, Ester, additional, Viñado-Pérez, Belen, additional, Tubau, Fe, additional, Capilla, Silvia, additional, Casabella, Antonio, additional, Pérez-Moreno, Mar Olga, additional, Padilla, Emma, additional, Ballestero, Mónica, additional, Rivera, Alba, additional, Navarro, Ferrán, additional, Gómez-Bertomeu, Fréderic, additional, Pardo-Granell, Sergio, additional, Picó-Plana, Ester, additional, Guerrero, Dolores, additional, Sarvisé-Buil, Carolina, additional, Belles-Belles, Alba, additional, Fernández-Esgueva, Marta, additional, Ortega-Lafont, María del Pilar, additional, García, Inmaculada, additional, Arenal-Andrés, Noelia, additional, Hernando-Real, Susana, additional, Ibáñez, Rosario, additional, Martínez, Jesús, additional, Becerra, Federico, additional, Aldea-Mansilla, Carmen, additional, Alaoui-Sosse, Asmaa, additional, González, José Carlos, additional, Guzman-Puche, Julia, additional, Blázquez-Andrada, Miguel Ángel, additional, Martínez-Ramírez, Nora Mariela, additional, Beteta, Alicia, additional, Gomila-Sard, Bárbara, additional, Almaraz, Salvador Giner, additional, Garduño, Eugenio, additional, Juiz-González, Pedro Miguel, additional, Alba, Javier, additional, Alonso, Pilar, additional, Rodríguez, Ana Isabel, additional, Paz-Vidal, María Isabel, additional, García-Campello, Marta, additional, Camacho, Pablo, additional, Pallarés, María de los Ángeles, additional, Pérez del Molino, María Luisa, additional, Coira, Amparo, additional, Barbeito, Gema, additional, Rincón, Anniris, additional, Vasallo-Vidal, Francisco José, additional, Alonso-Acero, Laura, additional, Iglesias-Llorente, Laura, additional, Bordes-Benites, Ana, additional, Florén-Zabala, Laura, additional, Azcona, José Manuel, additional, Alonso, Carla Andrea, additional, Sáenz, Yolanda, additional, Lamata-Subero, Marta, additional, Molina, David, additional, González-Torralba, Ana, additional, Villa, Jennifer, additional, Viedma, Esther, additional, Cercenado, Emilia, additional, Alarcón, Teresa, additional, Vargas, Paula, additional, Díez, María, additional, Ruiz, Patricia, additional, Sánchez-Romero, María Isabel, additional, Pérez-García, Felipe, additional, Yagüe-Guirao, Genoveva, additional, Oteiza, Amaia Concepción, additional, Leiva, José, additional, Portillo, María Eugenia, additional, Canut-Blasco, Andrés, additional, Vidal, Matxalen, additional, Alonso, Iker, additional, Zuriarrain, Maider, additional, and Barrios-Andrés, José Luis, additional

Published
2023
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19. BIChromET: A Chromogenic Culture Medium for Detection of Piperacillin/Tazobactam and Cefepime Resistance in Pseudomonas aeruginosa

Author

Universidad de Sevilla. Departamento de Medicina, Universidad de Sevilla. Departamento de Microbiología, Universidad de Sevilla. CTS 203: Estudio de las Enfermedades Infecciosas, Ortiz de la Rosa, José Manuel, Rodríguez Villodres, Ángel, Martín Gutiérrez, Guillermo, Cintora Mairal, Carmen, García Escobar, José Luis, Gálvez Benítez, Lydia, Cisneros, José Miguel, Lepe Jiménez, José Antonio, Universidad de Sevilla. Departamento de Medicina, Universidad de Sevilla. Departamento de Microbiología, Universidad de Sevilla. CTS 203: Estudio de las Enfermedades Infecciosas, Ortiz de la Rosa, José Manuel, Rodríguez Villodres, Ángel, Martín Gutiérrez, Guillermo, Cintora Mairal, Carmen, García Escobar, José Luis, Gálvez Benítez, Lydia, Cisneros, José Miguel, and Lepe Jiménez, José Antonio

Abstract

Objectives: The BIChromET selective medium for detecting piperacillin-tazobactam (TZP) and cefepime (FEP) resistant Pseudomonas aeruginosa was developed. Methods: The performance of this medium was first evaluated using a collection of 100 P. aeruginosa clinical strains (70 TZP-susceptible, 30 TZP-resistant, 58 FEP-susceptible, and 42 FEP-resistant). Then, we performed clinical validation by testing 173 respiratory clinical samples. Results: The BIChromET medium showed excellent sensitivity (TZP (avg. 96.7%); FEP (avg. 92.7%)) and specificity (TZP (avg. 98.9%); FEP (avg. 98%)) in distinguishing the detection limit ranging from 104 to 108 CFU/mL. Then, testing the bronchoalveolar lavage (BAL) and tracheobronchial aspirate (TBA) clinical specimens (N = 173) revealed the excellent performance of the medium with P. aeruginosa, showing 100% and 92.6% of categorical agreements with the results obtained via the broth microdilution methods (BMD) for TZP and FEP, respectively. Conclusion: This medium allows for easy and accurate detection of TZP/FEP-resistant isolates regardless of their resistance mechanisms.

Published
2023

20. Rapid Detection of Piperacillin-Tazobactam Resistance in Klebsiella pneumoniae and Escherichia coli

Author

Universidad de Sevilla. Departamento de Medicina, Universidad de Sevilla. Departamento de Microbiología, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, JR19/00039, Ortiz de la Rosa, José Manuel, Rodríguez-Villodres, Ángel, Gimeno Gascón, María Adelina, Martín-Gutiérrez, Guillermo, Cisneros, José Miguel, Lepe Jiménez, José Antonio, Universidad de Sevilla. Departamento de Medicina, Universidad de Sevilla. Departamento de Microbiología, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, JR19/00039, Ortiz de la Rosa, José Manuel, Rodríguez-Villodres, Ángel, Gimeno Gascón, María Adelina, Martín-Gutiérrez, Guillermo, Cisneros, José Miguel, and Lepe Jiménez, José Antonio

Abstract

Rapid determination of susceptibility to piperacillin-tazobactam (TZP) is very important since the development of antibiotic resistance and inadequate treatment could increase the risk of clinical failure in infected patients, especially if such resistance is unknown to the clinician. Therefore, based on color change from orange to yellow of phenol red due to glucose metabolism (bacterial growth) in the presence of an adequate concentration of TZP (10 mg/L piperacillin and 5 mg/L tazobactam), the RapidTZP test has been developed to detect TZP resistance in Escherichia coli and Klebsiella pneumoniae isolates in a maximum of 3 h. A total of 140 isolates, 43 of E. coli and 97 of K. pneumoniae, were used to evaluate the performance of the test, 60 being resistant to TZP. The sensitivity and specificity of the test were 98.24% and 100%, respectively. Additionally, the RapidTZP test was validated by a pellet obtained directly from blood culture bottles. A total of 37 positive blood cultures for E. coli and 43 for K. pneumoniae were used for validation, 8 of them resistant to TZP. The sensitivity and specificity shown in the evaluation were 100% for both parameters. This new test is easy, fast, and accurate, providing results in 3 h.

Published
2023

21. Clinical and Ecological Impact of an Educational Program to Optimize Antibiotic Treatments in Nursing Homes (PROA-SENIOR): A Cluster, Randomized, Controlled Trial and Interrupted Time-Series Analysis

Author

Peñalva-Moreno, Germán, Crespo-Rivas, Juan Carlos, Guisado-Gil, Ana Belén, Rodríguez-Villodres, Ángel, Pachón-Ibáñez, M. E., Cachero-Alba, Bárbara, Rivas-Romero, Blas, Gil-Moreno, Josefa, Galvá-Borras, María Isabel, García-Moreno, Mercedes, Salamanca-Bautista, María Dolores, Martínez-Rascón, Manuel Bautista, Cantudo-Cuenca, María Rosa, Ninahuaman-Poma, Ruth Concepción, Enrique-Mirón, María de Los Ángeles, Pérez-Barroso, Aurora, Marín-Ariza, Inmaculada, González-Florido, Miguel, Mora-Santiago, María Del Rosario, Belda-Rustarazo, Susana, Expósito-Tirado, José Antonio, Rosso-Fernández, Clara, Gil-Navarro, María Victoria, Lepe, José A., Cisneros, José Miguel, Peñalva-Moreno, Germán, Crespo-Rivas, Juan Carlos, Guisado-Gil, Ana Belén, Rodríguez-Villodres, Ángel, Pachón-Ibáñez, M. E., Cachero-Alba, Bárbara, Rivas-Romero, Blas, Gil-Moreno, Josefa, Galvá-Borras, María Isabel, García-Moreno, Mercedes, Salamanca-Bautista, María Dolores, Martínez-Rascón, Manuel Bautista, Cantudo-Cuenca, María Rosa, Ninahuaman-Poma, Ruth Concepción, Enrique-Mirón, María de Los Ángeles, Pérez-Barroso, Aurora, Marín-Ariza, Inmaculada, González-Florido, Miguel, Mora-Santiago, María Del Rosario, Belda-Rustarazo, Susana, Expósito-Tirado, José Antonio, Rosso-Fernández, Clara, Gil-Navarro, María Victoria, Lepe, José A., and Cisneros, José Miguel

Abstract

[Background] Antimicrobial stewardship programs (ASPs) are recommended in nursing homes (NHs), although data are limited. We aimed to determine the clinical and ecological impact of an ASP for NHs., [Methods] We performed a cluster, randomized, controlled trial and a before–after study with interrupted time-series analyses in 14 NHs for 30 consecutive months from July 2018 to December 2020 in Andalusia, Spain. Seven facilities implemented an ASP with a bundle of 5 educational measures (general ASP) and 7 added 1-to-1 educational interviews (experimental ASP). The primary outcome was the overall use of antimicrobials, calculated monthly as defined daily doses (DDD) per 1000 resident days (DRD)., [Results] The total mean antimicrobial consumption decreased by 31.2% (−16.72 DRD; P = .045) with respect to the preintervention period; the overall use of quinolones and amoxicillin–clavulanic acid dropped by 52.2% (P = .001) and 42.5% (P = .006), respectively; and the overall prevalence of multidrug-resistant organisms (MDROs) decreased from 24.7% to 17.4% (P = .012). During the intervention period, 12.5 educational interviews per doctor were performed in the experimental ASP group; no differences were found in the total mean antimicrobial use between groups (−14.62 DRD; P = .25). Two unexpected coronavirus disease 2019 waves affected the centers increasing the overall mean use of antimicrobials by 40% (51.56 DRD; P < .0001)., [Conclusions] This study suggests that an ASP for NHs appears to be associated with a decrease in total consumption of antimicrobials and prevalence of MDROs. This trial did not find benefits associated with educational interviews, probably due to the coronavirus disease 2019 pandemic., [Clinical Trials Registration] NCT03543605.

Published
2023

22. Bases genéticas de la adquisición de la resistencia in vivo a piperacilina-tazobactam en Escherichia coli

Author

Gálvez-Benítez, Lydia, Ortiz de la Rosa, José Manuel, Rodríguez-Villodres, Ángel, Molino Panadero, I, Álvarez-Marín, Rocío, Bonnin, R., Naas, T., Pachón, Jerónimo, Cisneros, José Miguel, Smani, Younes, Lepe, José A., Gálvez-Benítez, Lydia, Ortiz de la Rosa, José Manuel, Rodríguez-Villodres, Ángel, Molino Panadero, I, Álvarez-Marín, Rocío, Bonnin, R., Naas, T., Pachón, Jerónimo, Cisneros, José Miguel, Smani, Younes, and Lepe, José A.

Published
2023

23. Rapid Detection of Piperacillin-Tazobactam Resistance in Klebsiella pneumoniae and Escherichia coli

Author

Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), Ortiz de la Rosa, José Manuel, Rodríguez-Villodres, Ángel, Gimeno-Gascón, María Adelina, Martín-Gutiérrez, Guillermo, Cisneros, José Miguel, Lepe, José A., Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), Ortiz de la Rosa, José Manuel, Rodríguez-Villodres, Ángel, Gimeno-Gascón, María Adelina, Martín-Gutiérrez, Guillermo, Cisneros, José Miguel, and Lepe, José A.

Abstract

Rapid determination of susceptibility to piperacillin-tazobactam (TZP) is very important since the development of antibiotic resistance and inadequate treatment could increase the risk of clinical failure in infected patients, especially if such resistance is unknown to the clinician. Therefore, based on color change from orange to yellow of phenol red due to glucose metabolism (bacterial growth) in the presence of an adequate concentration of TZP (10 mg/L piperacillin and 5 mg/L tazobactam), the RapidTZP test has been developed to detect TZP resistance in Escherichia coli and Klebsiella pneumoniae isolates in a maximum of 3 h. A total of 140 isolates, 43 of E. coli and 97 of K. pneumoniae, were used to evaluate the performance of the test, 60 being resistant to TZP. The sensitivity and specificity of the test were 98.24% and 100%, respectively. Additionally, the RapidTZP test was validated by a pellet obtained directly from blood culture bottles. A total of 37 positive blood cultures for E. coli and 43 for K. pneumoniae were used for validation, 8 of them resistant to TZP. The sensitivity and specificity shown in the evaluation were 100% for both parameters. This new test is easy, fast, and accurate, providing results in 3 h.

Published
2023

24. Implementation of a PCR-based strategy to control an outbreak by Serratia marcescens in a Neonatal Intensive Care Unit

Author

Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), Rodríguez-Villodres, Ángel, Ortiz de la Rosa, José Manuel, Valencia-Martin, Raquel, Jiménez-Parrilla, Francisco, Martín-Gutiérrez, Guillermo, Márquez-Patiño, Natividad, Perea-Cruz, Estela, Sánchez-Jiménez, María Teresa, Pavón-Delgado, Antonio, Cisneros, José Miguel, Lepe, José A., Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), Rodríguez-Villodres, Ángel, Ortiz de la Rosa, José Manuel, Valencia-Martin, Raquel, Jiménez-Parrilla, Francisco, Martín-Gutiérrez, Guillermo, Márquez-Patiño, Natividad, Perea-Cruz, Estela, Sánchez-Jiménez, María Teresa, Pavón-Delgado, Antonio, Cisneros, José Miguel, and Lepe, José A.

Abstract

[Objectives] To evaluate the clinical and epidemiological impact of a new molecular surveillance strategy based on qPCR to control an outbreak by Serratia marcescens in a Neonatal Intensive Care Unit (NICU)., [Methods] We design a specific qPCR for the detection of S. marcescens in rectal swabs of patients admitted to a NICU. We divided the surveillance study into two periods: (a) the pre-PCR, from the outbreak declaration to the qPCR introduction, and (b) the PCR period, from the introduction of the qPCR until the outbreak was solved. In all cases, S. marcescens isolates were recovered and their clonal relationship was analysed by PFGE. Control measures were implemented during the outbreak. Finally, the number of bloodstream infections (BSI) was investigated in order to evaluate the clinical impact of this molecular strategy., [Results] Nineteen patients colonized/infected by S. marcescens were detected in the pre-PCR period (October 2020–April 2021). On the contrary, after the PCR implementation, 16 new patients were detected. The PFGE revealed 24 different pulsotypes belonging to 7 different clonal groups, that were not overlapping at the same time. Regarding the clinical impact, 18 months after the qPCR implementation, no more outbreaks by S. marcescens have been declared in the NICU of our hospital, and only 1 episode of BSI has occurred, compared with 11 BSI episodes declared previously to the outbreak control., [Conclusions] The implementation of this qPCR strategy has proved to be a useful tool to control the nosocomial spread of S. marcescens in the NICU.

Published
2023

25. High-level delafloxacin resistance through the combination of two different mechanisms in Staphylococcus aureus

Author

Grupo Menarini, Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), Ortiz de la Rosa, José Manuel, Aznar Fernández, María, Rodríguez-Villodres, Ángel, Casimiro-Soriguer, Carlos S., Cisneros, José Miguel, Lepe, José A., Grupo Menarini, Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), Ortiz de la Rosa, José Manuel, Aznar Fernández, María, Rodríguez-Villodres, Ángel, Casimiro-Soriguer, Carlos S., Cisneros, José Miguel, and Lepe, José A.

Abstract

Delafloxacin is a new fluoroquinolone indicated for the treatment of complicated bacterial skin infections caused by Staphylococcus aureus. Despite its recent approval by the US Food and Drug Administration, the emergence of S. aureus-resistant strains has been reported. As such, this study aimed to investigate the activity of delafloxacin against a collection of S. aureus, and to determine the mechanisms of resistance. The activity of delafloxacin was measured in 59 S. aureus clinical isolates [40 methicillin-resistant S. aureus (MRSA) and 19 methicillin-susceptible S. aureus (MSSA)]. Whole-genome sequencing (WGS) was performed in the isolates resistant to delafloxacin. The minimum inhibitory concentrations required to inactivate 50% and 90% of the isolates (MIC50 and MIC90, respectively) were higher in MRSA (0.19 mg/L and 0.75 mg/L, respectively) than in MSSA (0.008 mg/L and 0.25 mg/L, respectively). Furthermore, 10 S. aureus clinical isolates (16.9%) were categorized as resistant to delafloxacin. Regarding the WGS data, several mutations were found in the quinolone resistance-determining region. Nevertheless, a mutation in the same position (E84K and E84V) of topoisomerase IV (ParC) was found exclusively in the four high-level delafloxacin-resistant isolates. Interestingly, a plasmid-encoded qacC gene (efflux pump) was found to be harboured by the isolate with the highest delafloxacin MIC value (32 mg/L). The use of a wide-spectrum efflux pump inhibitor revealed an important contribution of this system to the acquisition of delafloxacin resistance. In conclusion, delafloxacin has activity against S. aureus, including MRSA. However, this study showed that mutations in position 84 of ParC and the acquisition of a QacC efflux pump are key factors for the development of delafloxacin resistance in S. aureus.

Published
2023

26. Evaluation of the MDR Direct Flow Chip Kit for the Detection of Multiple Antimicrobial Resistance Determinants

Author

Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), Rodríguez-Villodres, Ángel, Galiana-Cabrera, Antonio, Torres Fink, Ignacio, Duran Jiménez, Rosario, Cisneros, José Miguel, Lepe, José A., Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), Rodríguez-Villodres, Ángel, Galiana-Cabrera, Antonio, Torres Fink, Ignacio, Duran Jiménez, Rosario, Cisneros, José Miguel, and Lepe, José A.

Abstract

The objective of this study was to evaluate the accuracy of the MDR Direct Flow Chip Kit for the detection of antimicrobial resistance (AMR) determinants from bacterial colonies. Ninety-two clinical isolates with known AMR determinants genotypically characterized were used. The MDR Direct Flow Chip Kit is a microarray-based assay that included 55 AMR determinants for beta-lactams (23), quinolones (13), aminoglycosides (5), macrolides (5), sulfonamides (3), colistin (2), vancomycin (2), chloramphenicol (1), and linezolid (1). The MDR Direct Flow Chip Kit correctly detects 52 of 53 AMR determinants tested. The cfr gene (linezolid resistance) was not detected. The global sensibility, specificity, positive predictive value, and the negative predictive value calculated were 98%, 100%, 100%, and 97%. The Cohen's Kappa coefficient calculated was 0.97 [95% Confidence Interval (0.90–1.03)]. In conclusion, the MDR Direct Flow Chip is an accurate assay for the detection of multiple AMR determinants in one simple reaction.

Published
2023

27. BIChromET: A Chromogenic Culture Medium for Detection of Piperacillin/Tazobactam and Cefepime Resistance in Pseudomonas aeruginosa

Author

Instituto de Salud Carlos III, European Commission, Ortiz de la Rosa, José Manuel, Rodríguez-Villodres, Ángel, Martín-Gutiérrez, Guillermo, Cintora Mairal, Carmen, García-Escobar, José Luis, Gálvez-Benítez, Lydia, Cisneros, José Miguel, Lepe, José A., Instituto de Salud Carlos III, European Commission, Ortiz de la Rosa, José Manuel, Rodríguez-Villodres, Ángel, Martín-Gutiérrez, Guillermo, Cintora Mairal, Carmen, García-Escobar, José Luis, Gálvez-Benítez, Lydia, Cisneros, José Miguel, and Lepe, José A.

Abstract

Objectives: The BIChromET selective medium for detecting piperacillin-tazobactam (TZP) and cefepime (FEP) resistant Pseudomonas aeruginosa was developed. Methods: The performance of this medium was first evaluated using a collection of 100 P. aeruginosa clinical strains (70 TZP-susceptible, 30 TZP-resistant, 58 FEP-susceptible, and 42 FEP-resistant). Then, we performed clinical validation by testing 173 respiratory clinical samples. Results: The BIChromET medium showed excellent sensitivity (TZP (avg. 96.7%); FEP (avg. 92.7%)) and specificity (TZP (avg. 98.9%); FEP (avg. 98%)) in distinguishing the detection limit ranging from 104 to 108 CFU/mL. Then, testing the bronchoalveolar lavage (BAL) and tracheobronchial aspirate (TBA) clinical specimens (N = 173) revealed the excellent performance of the medium with P. aeruginosa, showing 100% and 92.6% of categorical agreements with the results obtained via the broth microdilution methods (BMD) for TZP and FEP, respectively. Conclusion: This medium allows for easy and accurate detection of TZP/FEP-resistant isolates regardless of their resistance mechanisms.

Published
2023

28. Genetic basis for in vivo piperacillin/tazobactam resistance in Escherichia coli

Author

Gálvez-Benítez, Lydia, Rodríguez Villodres, A., Molina Panadero, Irene, Álvarez-Marín, Rocío, Bonnin, R., Naas, Thierry, Pachón, Jerónimo, Cisneros, José Miguel, Lepe, José A., Smani, Younes, Gálvez-Benítez, Lydia, Rodríguez Villodres, A., Molina Panadero, Irene, Álvarez-Marín, Rocío, Bonnin, R., Naas, Thierry, Pachón, Jerónimo, Cisneros, José Miguel, Lepe, José A., and Smani, Younes

Published
2023

29. Rapid Detection of Piperacillin-Tazobactam Resistance in Klebsiella pneumoniae and Escherichia coli

Author

José Manuel Ortiz de la Rosa, Ángel Rodríguez-Villodres, María Adelina Gimeno Gascón, Guillermo Martín-Gutiérrez, José Miguel Cisneros, and José Antonio Lepe

Subjects
Microbiology (medical), Infectious Diseases, General Immunology and Microbiology, Ecology, Physiology, Genetics, Cell Biology
Abstract

TZP is an antibiotic widely used for the empirical treatment of severe infections such as bloodstream infections. However, resistance to TZP in K. pneumoniae and E. coli has been increasing in the last few years.

Published
2023
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30. Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: A Review

Author

Ángel Rodríguez-Villodres, Cecilia Martín-Gandul, Germán Peñalva, Ana Belén Guisado-Gil, Juan Carlos Crespo-Rivas, María Eugenia Pachón-Ibáñez, José Antonio Lepe, and José Miguel Cisneros

Subjects
multidrug-resistant organism, long term care facilities, nursing homes, prevalence, risk factors, antimicrobial stewardship, Therapeutics. Pharmacology, RM1-950
Abstract

Elderly people confined to chronic care facilities face an increased risk of acquiring infections by multidrug-resistant organisms (MDROs). This review presents the current knowledge of the prevalence and risk factors for colonization by MDROs in long-term care facilities (LTCF), thereby providing a useful reference to establish objectives for implementing successful antimicrobial stewardship programs (ASPs). We searched in PubMed and Scopus for studies examining the prevalence of MDROs and/or risk factors for the acquisition of MDROs in LTCF. One hundred and thirty-four studies published from 1987 to 2020 were included. The prevalence of MDROs in LTCF varies between the different continents, where Asia reported the highest prevalence of extended-spectrum ß-lactamase (ESBL) Enterobacterales (71.6%), carbapenem resistant (CR) Enterobacterales (6.9%) and methicillin-resistant Staphylococcus aureus (MRSA) (25.6%) and North America the highest prevalence to MDR Pseudomonas aeruginosa (5.4%), MDR Acinetobacter baumannii (15.0%), vancomycin-resistant Enterococcus spp. (VRE) (4.0%), and Clostridioides difficile (26.1%). Furthermore, MDRO prevalence has experienced changes over time, with increases in MDR P. aeruginosa and extended spectrum ß-lactamase producing Enterobacterales observed starting in 2015 and decreases of CR Enterobacterales, MDR A. baumannii, VRE, MRSA and C. difficile. Several risk factors have been found, such as male sex, chronic wounds, the use of medical devices, and previous antibiotic use. The last of these aspects represents one of the most important modifiable factors for reducing colonization with MDROs through implementing ASPs in LTCF.

Published
2021
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31. Genetic basis for in vivo piperacillin-tazobactam resistance

Author

Benítez, Lydia Gálvez, primary, Rosa, José Manuel Ortiz De La, additional, Rodríguez-Villodres, Ángel, additional, Casimiro-Soriguer, Carlos, additional, Molina-Panadero, Irene, additional, Álvarez-Marín, Rocío, additional, Bonnin, Rémy, additional, Naas, Thierry, additional, Pachón, Jerónimo, additional, Cisneros, José Miguel, additional, Lepe, José, additional, and Smani, Younes, additional

Published
2023
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33. Genetic basis for in vivo piperacillin-tazobactam resistance

Author

Lydia Gálvez Benítez, José Manuel Ortiz De La Rosa, Ángel Rodríguez-Villodres, Carlos Casimiro-Soriguer, Irene Molina-Panadero, Rocío Álvarez-Marín, Rémy Bonnin, Thierry Naas, Jerónimo Pachón, José Miguel Cisneros, José Lepe, and Younes Smani

Abstract

Piperacillin-tazobactam resistance (P/T-R) is increasingly reported among Escherichia coli isolates. Although in vitro experiments have suggested that blaTEM gene plays a key role in the P/T-R acquisition, no clinical in vivo study has yet confirmed the role of blaTEM or other genes. Therefore, we aimed to identify the mechanisms underlying P/T-R by following up patients with E. coli intraabdominal infections (IAI) who experienced P/T treatment failure. We found a higher copy number of blaTEM gene in P/T-R isolates, generated by three different genetic events: (1)IS26-mediated duplication of the blaTEM gene, (2) generation of a small multicopy plasmid (ColE-like) carrying blaTEM, and (3) adaptive evolution via reduction of plasmid size, leading to a higher plasmid copy number. Moreover, two P/T-R strains showed reduced expression of OmpC. Thus, P/T treatment may lead to the development of resistance in patients with IAI by E. coli, through three blaTEM-dependent mechanisms and downregulation of OmpC.

Published
2023
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35. Evolution of faecal microbiome diversity in long-term care residents during an antimicrobial stewardship programme and its association with multidrug-resistant bacterial colonisation

Author

Alba-Rubio, Claudio, Peñalva-Moreno, Germán, Cebrero-Cangueiro, Tania, Labrador-Herrera, Gema, Crespo-Rivas, Juan Carlos, Guisado-Gil, Ana Belén, Rodríguez-Villodres, Ángel, Cerillo-Matilla, Julio, Cachero-Alba, Bárbara, Gil-Moreno, Josefa, Galvá-Borras, María Isabel, García-Moreno, Mercedes, Lepe, José Antonio, Pachón-Ibáñez, María Eugenia, and Cisneros, José Miguel

Published
2023
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36. Antibacterial Activity of Colloidal Silver against Gram-Negative and Gram-Positive Bacteria

Author

Andrea Vila Domínguez, Rafael Ayerbe Algaba, Andrea Miró Canturri, Ángel Rodríguez Villodres, and Younes Smani

Subjects
multidrug-resistant bacteria, colloidal silver, gram-negative bacteria, gram-positive bacteria, Therapeutics. Pharmacology, RM1-950
Abstract

Due to the emergence of antimicrobial resistance, new alternative therapies are needed. Silver was used to treat bacterial infections since antiquity due to its known antimicrobial properties. Here, we aimed to evaluate the in vitro activity of colloidal silver (CS) against multidrug-resistant (MDR) Gram-negative and Gram-positive bacteria. A total of 270 strains (Acinetobacter baumannii (n = 45), Pseudomonas aeruginosa (n = 25), Escherichia coli (n = 79), Klebsiella pneumoniae (n = 58)], Staphylococcus aureus (n = 34), Staphylococcus epidermidis (n = 14), and Enterococcus species (n = 15)) were used. The minimal inhibitory concentration (MIC) of CS was determined for all strains by using microdilution assay, and time−kill curve assays of representative reference and MDR strains of these bacteria were performed. Membrane permeation and bacterial reactive oxygen species (ROS) production were determined in presence of CS. CS MIC90 was 4−8 mg/L for all strains. CS was bactericidal, during 24 h, at 1× and 2× MIC against Gram-negative bacteria, and at 2× MIC against Gram-positive bacteria, and it did not affect their membrane permeabilization. Furthermore, we found that CS significantly increased the ROS production in Gram-negative with respect to Gram-positive bacteria at 24 h of incubation. Altogether, these results suggest that CS could be an effective treatment for infections caused by MDR Gram-negative and Gram-positive bacteria.

Published
2020
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37. Evaluation of the MDR Direct Flow Chip Kit for the Detection of Multiple Antimicrobial Resistance Determinants.

Author

Rodríguez-Villodres, Ángel, Galiana-Cabrera, Antonio, Torres Fink, Ignacio, Duran Jiménez, Rosario, Cisneros, José Miguel, and Lepe, José Antonio

Subjects
*DRUG resistance in microorganisms, *BACTERIAL colonies, *LINEZOLID, *CHLORAMPHENICOL, *QUINOLONE antibacterial agents, *MACROLIDE antibiotics
Abstract

The objective of this study was to evaluate the accuracy of the MDR Direct Flow Chip Kit for the detection of antimicrobial resistance (AMR) determinants from bacterial colonies. Ninety-two clinical isolates with known AMR determinants genotypically characterized were used. The MDR Direct Flow Chip Kit is a microarray-based assay that included 55 AMR determinants for beta-lactams (23), quinolones (13), aminoglycosides (5), macrolides (5), sulfonamides (3), colistin (2), vancomycin (2), chloramphenicol (1), and linezolid (1). The MDR Direct Flow Chip Kit correctly detects 52 of 53 AMR determinants tested. The cfr gene (linezolid resistance) was not detected. The global sensibility, specificity, positive predictive value, and the negative predictive value calculated were 98%, 100%, 100%, and 97%. The Cohen's Kappa coefficient calculated was 0.97 [95% Confidence Interval (0.90–1.03)]. In conclusion, the MDR Direct Flow Chip is an accurate assay for the detection of multiple AMR determinants in one simple reaction. [ABSTRACT FROM AUTHOR]

Published
2023
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38. MDR Shigella sonnei in Spain: an ever-evolving emerging threat?

Author

José Manuel Ortiz de la Rosa, Ángel Rodríguez-Villodres, Carlos S Casimiro-Soriguer, Maite Ruiz-Pérez De Pipaón, Eduardo Briones, María Aznar Fernández, and José Antonio Lepe

Subjects
General Medicine
Abstract

Background Seven CTX-M-27-producing Shigella sonnei strains were isolated at the University Hospital Virgen del Rocío (Seville, Spain) microbiology service from October to November 2021. Objectives To offer extensive information on the microbiological and molecular epidemiology results of the seven S. sonnei isolates and compare them with other previously documented CTX-M-27-producing S. sonnei associated with MSM transmission. Methods S. sonnei isolated from stool samples of patients with acute diarrhoea were identified through biochemical and serological typing. Whole characterization of the seven isolates was performed by sequencing with MinION Mk1C followed by genomic and molecular analysis. Results All the isolates were resistant to penicillins, cephalosporins, fluoroquinolones, cotrimoxazole and azithromycin. Sequencing showed the presence of several resistance determinants, outstanding blaCTX-M-27, azithromycin resistance genes [ermB and mph(A)], qnrB19 and mutations in the QRDRs. All isolates belonged to the same hierarchical clustering of cgMLST (HierCC) with five allele distance (HC5) scheme v1 from EnteroBase. However, they presented differences in plasmid composition, with all seven isolates harbouring IncFII, IncB/O/K/Z and ColE1-like while SH2, SH6 and SH7 had IncFIB only. Our isolates were closely related to others from Spain (HC5; 98748), Australia (HC5; 98748) and the UK (HC5; 98748), which were also associated with MSM transmission. Nevertheless, the structure of the non-chromosomal genetic elements and the genetic context of blaCTX-M-27 presented a certain variability compared with isolates from other countries and among them. Conclusions This study confirms the emergence of CTX-M-27-producing S. sonnei (ST152) associated with MSM transmission in Spain, adding it to the Europe outbreak list and reinforcing the necessity of active surveillance and control of this high-risk clone.

Published
2022
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39. Clinical and ecological impact of an educational program to optimize antibiotic treatments in nursing homes (PROA-SENIOR): a cluster randomized controlled trial and interrupted time-series analysis

Author

Germán, Peñalva, Juan Carlos, Crespo-Rivas, Ana Belén, Guisado-Gil, Ángel, Rodríguez-Villodres, María Eugenia, Pachón-Ibáñez, Bárbara, Cachero-Alba, Blas, Rivas-Romero, Josefa, Gil-Moreno, María Isabel, Galvá-Borras, Mercedes, García-Moreno, María Dolores, Salamanca-Bautista, Manuel Bautista, Martínez-Rascón, María Rosa, Cantudo-Cuenca, Ruth Concepción, Ninahuaman-Poma, María, de Los Ángeles Enrique-Mirón, Aurora, Pérez-Barroso, Inmaculada, Marín-Ariza, Miguel, González-Florido, María, Del Rosario Mora-Santiago, Susana, Belda-Rustarazo, José Antonio, Expósito-Tirado, Clara María, Rosso-Fernández, María Victoria, Gil-Navarro, José Antonio, Lepe-Jiménez, and José Miguel, Cisneros

Subjects
Microbiology (medical), Infectious Diseases
Abstract

BackgroundAntimicrobial stewardship programs (ASPs) are recommended in nursing homes (NHs), although data are limited. We aimed to determine the clinical and ecological impact of an ASP for NHs.MethodsWe performed a cluster, randomized, controlled trial and a before–after study with interrupted time-series analyses in 14 NHs for 30 consecutive months from July 2018 to December 2020 in Andalusia, Spain. Seven facilities implemented an ASP with a bundle of 5 educational measures (general ASP) and 7 added 1-to-1 educational interviews (experimental ASP). The primary outcome was the overall use of antimicrobials, calculated monthly as defined daily doses (DDD) per 1000 resident days (DRD).ResultsThe total mean antimicrobial consumption decreased by 31.2% (−16.72 DRD; P = .045) with respect to the preintervention period; the overall use of quinolones and amoxicillin–clavulanic acid dropped by 52.2% (P = .001) and 42.5% (P = .006), respectively; and the overall prevalence of multidrug-resistant organisms (MDROs) decreased from 24.7% to 17.4% (P = .012). During the intervention period, 12.5 educational interviews per doctor were performed in the experimental ASP group; no differences were found in the total mean antimicrobial use between groups (−14.62 DRD; P = .25). Two unexpected coronavirus disease 2019 waves affected the centers increasing the overall mean use of antimicrobials by 40% (51.56 DRD; P < .0001).ConclusionsThis study suggests that an ASP for NHs appears to be associated with a decrease in total consumption of antimicrobials and prevalence of MDROs. This trial did not find benefits associated with educational interviews, probably due to the coronavirus disease 2019 pandemic.Clinical Trials Registration. NCT03543605.

Published
2022

43. MDR

Author

José Manuel, Ortiz de la Rosa, Ángel, Rodríguez-Villodres, Carlos S, Casimiro-Soriguer, Maite, Ruiz-Pérez De Pipaón, Eduardo, Briones, María, Aznar Fernández, and José Antonio, Lepe

Abstract

Seven CTX-M-27-producingTo offer extensive information on the microbiological and molecular epidemiology results of the sevenAll the isolates were resistant to penicillins, cephalosporins, fluoroquinolones, cotrimoxazole and azithromycin. Sequencing showed the presence of several resistance determinants, outstandingThis study confirms the emergence of CTX-M-27-producing

Published
2022

44. MDR Shigella sonnei in Spain: an ever-evolving emerging threat?

Author

Universidad de Sevilla. Departamento de Microbiología, Instituto de Salud Carlos III, Ortiz de la Rosa, José Manuel, Rodríguez Villodres, Ángel, Casimiro-Soriguer, Carlos S., Ruiz Pérez de Pipaón, Maite, Briones, Eduardo, Aznar Fernández, María, Lepe Jiménez, José Antonio, Universidad de Sevilla. Departamento de Microbiología, Instituto de Salud Carlos III, Ortiz de la Rosa, José Manuel, Rodríguez Villodres, Ángel, Casimiro-Soriguer, Carlos S., Ruiz Pérez de Pipaón, Maite, Briones, Eduardo, Aznar Fernández, María, and Lepe Jiménez, José Antonio

Abstract

Background Seven CTX-M-27-producing Shigella sonnei strains were isolated at the University Hospital Virgen del Rocío (Seville, Spain) microbiology service from October to November 2021. Objectives To offer extensive information on the microbiological and molecular epidemiology results of the seven S. sonnei isolates and compare them with other previously documented CTX-M-27-producing S. sonnei associated with MSM transmission. Methods S. sonnei isolated from stool samples of patients with acute diarrhoea were identified through biochemical and serological typing. Whole characterization of the seven isolates was performed by sequencing with MinION Mk1C followed by genomic and molecular analysis. Results All the isolates were resistant to penicillins, cephalosporins, fluoroquinolones, cotrimoxazole and azithromycin. Sequencing showed the presence of several resistance determinants, outstanding blaCTX-M-27, azithromycin resistance genes [ermB and mph(A)], qnrB19 and mutations in the QRDRs. All isolates belonged to the same hierarchical clustering of cgMLST (HierCC) with five allele distance (HC5) scheme v1 from EnteroBase. However, they presented differences in plasmid composition, with all seven isolates harbouring IncFII, IncB/O/K/Z and ColE1-like while SH2, SH6 and SH7 had IncFIB only. Our isolates were closely related to others from Spain (HC5; 98748), Australia (HC5; 98748) and the UK (HC5; 98748), which were also associated with MSM transmission. Nevertheless, the structure of the non-chromosomal genetic elements and the genetic context of blaCTX-M-27 presented a certain variability compared with isolates from other countries and among them. Conclusions This study confirms the emergence of CTX-M-27-producing S. sonnei (ST152) associated with MSM transmission in Spain, adding it to the Europe outbreak list and reinforcing the necessity of active surveillance and control of this high-risk clone.

Published
2022

45. Effect of subinhibitory concentrations of ampicillin on Listeria monocytogenes

Author

Ángel Rodríguez-Villodres, Jesús Blázquez, Javier Aznar, and José Antonio Lepe

Subjects
0301 basic medicine, Microbiology (medical), Aggregates, Heterorresistencia, Cns infections, Ampicilina, 030106 microbiology, Agregados, Microbial Sensitivity Tests, medicine.disease_cause, Microbiology, 03 medical and health sciences, Minimum inhibitory concentration, 0302 clinical medicine, Listeria monocytogenes, Ampicillin, medicine, 030212 general & internal medicine, Subinhibitory concentrations, Concentraciones subinhibitorias, Chemistry, Meningoencephalitis, medicine.disease, Staining, Anti-Bacterial Agents, Penicillin, Heteroresistance, Gentamicin, medicine.drug
Abstract

[EN] Listeria monocytogenes is an important cause of meningoencephalitis associated with high mortality. The treatment of choice for listeriosis is ampicillin alone or in combination with gentamicin or penicillin G. However, only low ampicillin concentrations are recorded in the central nervous system (CNS). In this study, we analysed the effect of subinhibitory concentrations of ampicillin on the morphology, growth and survival of L. monocytogenes. The non-inhibitory concentration (NIC), the minimum inhibitory concentration (MIC) and the MIC/NIC ratio were determined. Gram and Live/Dead staining showed aggregates of L. monocytogenes cells when grown at subinhibitory concentrations of ampicillin, with >90% of viable cells. The L. monocytogenes strains tested showed an intermediate heteroresistance to ampicillin, characterised by a MIC/NIC ratio of 4. Our results seem to indicate that both intermediate heteroresistance and the formation of aggregates could play a role in the clinical failure of ampicillin in the treatment of CNS infections caused by L. monocytogenes. However, more studies are necessary to elucidate this question., [ES] Listeria monocytogenes es una importante causa de meningoencefalitis asociada con una elevada mortalidad. El tratamiento de elección para la listeriosis es ampicilina asociada o no a gentamicina o penicilina G. Sin embargo, en el sistema nervioso central (SNC) solo se alcanzan concentraciones bajas de ampicilina. En este estudio, analizamos el efecto de las concentraciones subinhibitorias de ampicilina sobre la morfología, el crecimiento y la supervivencia de L. monocytogenes. Para ello determinamos la concentración no inhibitoria (CNI), la concentración mínima inhibitoria (CMI) y el cociente CMI/CNI. Además, la tinción de Gram y la de vivos y muertos mostraron agregados de L. monocytogenes cuando crece a concentraciones subinhibitorias de ampicilina, con > 90% de las células viables. Las cepas de L. monocytogenes testadas mostraron heterorresistencia intermedia a la ampicilina, caracterizada por un cociente CMI/CNI de 4. Nuestros resultados parecen indicar que tanto la formación de agregados como la heterorresistencia intermedia podrían jugar un papel en el fracaso terapéutico observado en las infecciones del SNC causadas por L. monocytogenes. Sin embargo, se necesitan más estudios para aclarar esta cuestión.

Published
2020
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46. Clinical and Ecological Impact of an Educational Program to Optimize Antibiotic Treatments in Nursing Homes (PROA-SENIOR): A Cluster, Randomized, Controlled Trial and Interrupted Time-Series Analysis.

Author

Peñalva, Germán, Crespo-Rivas, Juan Carlos, Guisado-Gil, Ana Belén, Rodríguez-Villodres, Ángel, Pachón-Ibáñez, María Eugenia, Cachero-Alba, Bárbara, Rivas-Romero, Blas, Gil-Moreno, Josefa, Galvá-Borras, María Isabel, García-Moreno, Mercedes, Salamanca-Bautista, María Dolores, Martínez-Rascón, Manuel Bautista, Cantudo-Cuenca, María Rosa, Ninahuaman-Poma, Ruth Concepción, Enrique-Mirón, María de los Ángeles, Pérez-Barroso, Aurora, Marín-Ariza, Inmaculada, González-Florido, Miguel, Mora-Santiago, María del Rosario, and Belda-Rustarazo, Susana

Subjects
ANTIBIOTICS, ANTIMICROBIAL stewardship, INTERVIEWING, NURSING care facilities, RANDOMIZED controlled trials, INAPPROPRIATE prescribing (Medicine), TIME series analysis, DESCRIPTIVE statistics, DRUG prescribing, RESEARCH funding, DRUG resistance in microorganisms, PHYSICIAN practice patterns, EDUCATIONAL outcomes
Abstract

Background Antimicrobial stewardship programs (ASPs) are recommended in nursing homes (NHs), although data are limited. We aimed to determine the clinical and ecological impact of an ASP for NHs. Methods We performed a cluster, randomized, controlled trial and a before–after study with interrupted time-series analyses in 14 NHs for 30 consecutive months from July 2018 to December 2020 in Andalusia, Spain. Seven facilities implemented an ASP with a bundle of 5 educational measures (general ASP) and 7 added 1-to-1 educational interviews (experimental ASP). The primary outcome was the overall use of antimicrobials, calculated monthly as defined daily doses (DDD) per 1000 resident days (DRD). Results The total mean antimicrobial consumption decreased by 31.2% (−16.72 DRD; P =.045) with respect to the preintervention period; the overall use of quinolones and amoxicillin–clavulanic acid dropped by 52.2% (P =.001) and 42.5% (P =.006), respectively; and the overall prevalence of multidrug-resistant organisms (MDROs) decreased from 24.7% to 17.4% (P =.012). During the intervention period, 12.5 educational interviews per doctor were performed in the experimental ASP group; no differences were found in the total mean antimicrobial use between groups (−14.62 DRD; P =.25). Two unexpected coronavirus disease 2019 waves affected the centers increasing the overall mean use of antimicrobials by 40% (51.56 DRD; P <.0001). Conclusions This study suggests that an ASP for NHs appears to be associated with a decrease in total consumption of antimicrobials and prevalence of MDROs. This trial did not find benefits associated with educational interviews, probably due to the coronavirus disease 2019 pandemic. Clinical Trials Registration. NCT03543605. [ABSTRACT FROM AUTHOR]

Published
2023
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50. Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: A Review

Author

Rodríguez-Villodres, Ángel, Martín-Gandul, Cecilia, Peñalva, Germán, Guisado-Gil, Ana Belén, Crespo-Rivas, Juan Carlos, Pachón-Ibáñez, María Eugenia, Lepe, José Antonio, Cisneros, José Miguel, [Rodríguez-Villodres,A, Martín-Gandul,C, Peñalva,G, Guisado-Gil,AB, Crespo-Rivas,JC, Pachón-Ibáñez,ME, Lepe,JA, Cisneros,JM] Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain. [Guisado-Gil,AB] Department of Pharmacy, University Hospital Virgen del Rocío, Seville, Spain., and The study was funded by the Instituto de Salud Carlos III, the Spanish Ministry of Economy, Industry, and Competitiveness (grant number: PI17-02195) and was partially funded by the European Development Regional Fund 'A way to achieve Europe'. A.R.V. and A.B.G.G. are supported by the Subprograma Río Hortega, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spain. A.R.V. grant number: CM18/00122. A.B.G.G. grant number: CM19/00029. C.M.G. and J.C.C.R. are supported by the Instituto de Salud Carlos III (grant number: PI17-02195) and co-financed by European Development Regional Fund ‘A way to achieve Europe’ ERDF, Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016/0009).G.P. is supported by the Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001)- co-financed by European Development Regional Fund 'A way to achieve Europe', Operative program Intelligent Growth 2014–2020. M.E.P.I. is a postdoctoral researcher belonging to the program 'Nicolás Monardes' (C1-0038-2019), Servicio Andaluz de Salud, Junta de Andalucía, Spain. J.M.C. received funding for research from Plan Nacional de I+D+i 2013–2016 and Instituto de Salud Carlos III, Subdireccion General de Redes y Centros de InvestigacionCooperativa, Ministry of Economy, Industry and Competitiveness, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001, RD16/0016/0009), co-financed by the European Development Regional Fund 'A way to achieve Europe'.

Subjects
Acinetobacter baumannii, Geographical Locations::Geographic Locations::Americas::North America [Medical Subject Headings], Cuidados a largo plazo, Staphylococcus aureus resistente a meticilina, Nursing homes, Check Tags::Male [Medical Subject Headings], Antimicrobial stewardship, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors [Medical Subject Headings], Organisms::Bacteria::Gram-Negative Bacteria::Gram-Negative Aerobic Bacteria::Gram-Negative Aerobic Rods and Cocci::Moraxellaceae::Acinetobacter::Acinetobacter baumannii [Medical Subject Headings], Prevalence, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Patient Care::Long-Term Care [Medical Subject Headings], Geographical Locations::Geographic Locations::Asia [Medical Subject Headings], Casas de salud, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Morbidity::Prevalence [Medical Subject Headings], Programas de optimización del uso de los antimicrobianos, Organisms::Bacteria::Endospore-Forming Bacteria::Gram-Positive Endospore-Forming Bacteria::Gram-Positive Endospore-Forming Rods::Staphylococcaceae::Staphylococcus::Staphylococcus aureus::Methicillin-Resistant Staphylococcus aureus [Medical Subject Headings], Persons::Persons::Age Groups::Adult::Aged [Medical Subject Headings], Multidrug-resistant organism, Organisms::Bacteria::Gram-Negative Bacteria::Gram-Negative Aerobic Bacteria::Gram-Negative Aerobic Rods and Cocci::Pseudomonadaceae::Pseudomonas::Pseudomonas aeruginosa [Medical Subject Headings], Long term care facilities, Phenomena and Processes::Microbiological Phenomena::Bacterial Physiological Phenomena::Drug Resistance, Bacterial::Drug Resistance, Multiple, Bacterial [Medical Subject Headings], Risk factors, Chemicals and Drugs::Carbohydrates::Glycoconjugates::Glycopeptides::Vancomycin [Medical Subject Headings], Pseudomonas aeruginosa, Information Science::Information Science::Information Storage and Retrieval::Databases as Topic::Databases, Bibliographic::PubMed [Medical Subject Headings], Information Science::Information Science::Communications Media::Publications::Bibliography as Topic::Bibliometrics [Medical Subject Headings], Methicillin-resistant staphylococcus aureus, Organisms::Bacteria::Gram-Positive Bacteria::Lactobacillales::Enterococcaceae::Enterococcus [Medical Subject Headings], Prevalencia, Chemicals and Drugs::Organic Chemicals::Amides::Lactams::beta-Lactams::Carbapenems [Medical Subject Headings], Enterococcus, Factores de riesgo, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents [Medical Subject Headings]
Abstract

Elderly people confined to chronic care facilities face an increased risk of acquiring infections by multidrug-resistant organisms (MDROs). This review presents the current knowledge of the prevalence and risk factors for colonization by MDROs in long-term care facilities (LTCF), thereby providing a useful reference to establish objectives for implementing successful antimicrobial stewardship programs (ASPs). We searched in PubMed and Scopus for studies examining the prevalence of MDROs and/or risk factors for the acquisition of MDROs in LTCF. One hundred and thirty-four studies published from 1987 to 2020 were included. The prevalence of MDROs in LTCF varies between the different continents, where Asia reported the highest prevalence of extended-spectrum ß-lactamase (ESBL) Enterobacterales (71.6%), carbapenem resistant (CR) Enterobacterales (6.9%) and methicillin-resistant Staphylococcus aureus (MRSA) (25.6%) and North America the highest prevalence to MDR Pseudomonas aeruginosa (5.4%), MDR Acinetobacter baumannii (15.0%), vancomycin-resistant Enterococcus spp. (VRE) (4.0%), and Clostridioides difficile (26.1%). Furthermore, MDRO prevalence has experienced changes over time, with increases in MDR P. aeruginosa and extended spectrum ß-lactamase producing Enterobacterales observed starting in 2015 and decreases of CR Enterobacterales, MDR A. baumannii, VRE, MRSA and C. difficile. Several risk factors have been found, such as male sex, chronic wounds, the use of medical devices, and previous antibiotic use. The last of these aspects represents one of the most important modifiable factors for reducing colonization with MDROs through implementing ASPs in LTCF. Yes

Published
2021

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