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1. Antimicrobial management of Tropheryma whipplei endocarditis: the Spanish Collaboration on Endocarditis (GAMES) experience

Author

Garcia-Alvarez L, Sanz M, Marin M, Farinas M, Montejo M, Goikoetxea J, Garcia R, de Alarcon A, Almela M, Fernandez-Hidalgo N, Socas M, Goenaga M, Navas E, Vicioso L, Oteo J, Adan I, Sanchez F, Noureddine M, Rosas G, Lima J, Aramendi J, Bereciartua E, Boado M, Lazaro M, Goiti J, Hernandez J, Iruretagoyena J, Zuazabal J, Lopez-Soria L, Perez P, Rodriguez R, Voces R, Lopez M, Georgieva R, Solero M, Bailon I, Morales J, Cuende A, Echeverria T, Fuerte A, Gaminde E, Idigoras P, Iribarren J, Yarza A, Urkola X, Reviejo C, Carrasco R, Climent V, Llamas P, Merino E, Plazas J, Reus S, Alvarez N, Bravo-Ferrer J, Castelo L, Cuenca J, Llinares P, Rey E, Mayo M, Sanchez E, Regueiro D, Martinez F, Alonso M, Castro B, Marrero D, Duran M, Gomez M, La Calzada J, Nassar I, Ciezar A, Iglesias J, Alvarez V, Costas C, de la Hera J, Suarez J, Fraile L, Arguero V, Menendez J, Bajo P, Morales C, Torrico A, Palomo C, Martinez B, Esteban A, Asensio M, Ambrosioni J, Armero Y, Azqueta M, Brunet M, Cartana R, Falces C, Fita G, Fuster D, de la Maria C, Gatell J, Perez J, Manzardo C, Marco F, Miro J, Moreno A, Ninot S, Quintana E, Pare C, Pereda D, Pericas J, Pomar J, Ramirez J, Rovira I, Sitges M, Soy D, Tellez A, Vidal B, Vila J, Bermejo J, Bouza E, Cuerpo G, de Egea V, Eworo A, Cruz A, Leoni M, del Vecchio M, Ramallo V, Hernandez M, Martinez-Selles M, Menarguez M, Munoz P, Rincon C, Rodriguez-Abella H, Rodriguez-Creixems M, Pinilla B, Pinto A, Valerio M, Moreno E, Antorrena I, Loeches B, Moreno M, Ramirez U, Baston V, Romero M, Saldana A, Castillo C, Arnaiz A, Berrazueta J, Bellisco S, Belaustegui M, Duran R, Farinas-Alvarez C, Mazarrasa C, Izquierdo R, Rico C, Diez J, Pajaron M, Parra J, Teira R, Zarauza J, Pavia P, Gonzalez J, Orden B, Ramos A, Gonzalez E, Centella T, Hermida J, Moya J, Martin-Davila P, Oliva E, del Rio A, Ruiz S, Tenorio C, de Castro A, de Cueto M, Gallego P, Acebal J, Bano J, Garcia E, Haro J, Lepe J, Lopez F, Luque R, Alonso L, Azcarate P, Gutierrez J, Blanco J, de Benito N, Gurgui M, Pacho C, Pericas R, Pons G, Alvarez M, Fernandez A, Martinez A, Prieto A, Regueiro B, Tijeira E, Vega M, Blasco A, Mollar J, Arana J, Uriarte O, Lopez A, de Zarate Z, Matos J, Nacle M, Sanchez-Porto A, Vallejo L, Leal J, Vazquez E, Torres A, Blazquez A, Valenzuela G, Alonso A, Aramburu J, Calvo F, Rodriguez A, Tarabini-Castellani P, Galvez E, Bellido C, Pau J, Sepulveda M, Sierra P, Iqbal-Mirza S, Alcolea E, Serrano P, Roca J, Escobar E, Monje A, Cabrera V, Garcia D, Luna C, Morcillo J, Seco M, and Spanish Collaboration Endocarditis

Abstract

Objectives: Tropheryma whipplei has been detected in 3.5% of the blood culture-negative cases of endocarditis in Spain. Experience in the management of T. whipplei endocarditis is limited. Here we report the long-term outcome of the treatment of previously reported patients who were diagnosed with infective endocarditis (IE) caused by T. whipplei from the Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en Espana (GAMES) and discuss potential options for antimicrobial therapy for IE caused by T. whipplei. Patients and methods: Seventeen patients with T. whipplei endocarditis were recruited between 2008 and 2014 in 25 Spanish hospitals. Patients were classified according to the therapeutic regimen: ceftriaxone and trimethoprim/sulfamethoxazole, doxycycline + hydroxychloroquine and other treatment options. Results: Follow-up data were obtained from 14 patients. The median follow-up was 46.5months. All patients completed the antibiotic treatment prescribed, with a median duration of 13months. Six patients were treated with ceftriaxone and trimethoprim/sulfamethoxazole (median duration 13months), four with doxycycline + hydroxychloroquine (median duration 13.8months) and four with other treatment options (median duration 22.3months). The follow-up after the end of the treatments was between 5 and 84months (median 24months). Conclusions: All treatment lines were effective and well tolerated. Therapeutic failures were not detected during the treatment. None of the patients died or experienced a relapse during the follow-up. Only six patients received antibiotic treatment in accordance with guidelines. These data suggest that shorter antimicrobial treatments could be effective.

Published
2019

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

Author

Cuerpo G, Valerio M, Pedraz A, Rodriguez-Abella H, Mestres C, Obrador E, Gonzalez-Calle A, Alvarez R, Garcia P, Bouza E, Sanchez F, Noureddine M, Rosas G, Lima J, Aramendi J, Bereciartua E, Blanco M, Blanco R, Boado M, Lazaro M, Crespo A, Goikoetxea J, Iruretagoyena J, Zuazabal J, Lopez-Soria L, Montejo M, Nieto J, Rodrigo D, Rodriguez D, Rodriguez R, Vitoria Y, Voces R, Lopez M, Georgieva R, Ojeda G, Bailon I, Morales J, Cuende A, Echeverria T, Fuerte A, Gaminde E, Goenaga M, Idigoras P, Iribarren J, Yarza A, Urkola X, Reviejo C, Carrasco R, Climent V, Llamas P, Merino E, Plazas J, Reus S, Alvarez N, Bravo-Ferrer J, Castelo L, Cuenca J, Llinares P, Rey E, Mayo M, Sanchez E, Regueiro D, Martinez F, Alonso M, Castro B, Rosado D, Duran M, Gomez M, Lacalzada J, Nassar I, Ciezar A, Iglesias J, Alvarez V, Costas C, de la Hera J, Suarez J, Fraile L, Arguero V, Menendez J, Bajo P, Morales C, Torrico A, Palomo C, Martinez B, Esteban A, Garcia R, Asensio M, Almela M, Ambrosioni J, Azqueta M, Brunet M, Bodro M, Cartana R, Falces C, Fita G, Fuster D, de la Maria C, Hernandez-Meneses M, Perez J, Marco F, Miro J, Moreno A, Nicolas D, Ninot S, Quintana E, Pare C, Pereda D, Pericas J, Pomar J, Ramirez J, Rovira I, Sandoval E, Sitges M, Soy D, Tellez A, Tolosana J, Vidal B, Vila J, Adan I, Bermejo J, Celemin D, Caballero G, Pinto A, Montero A, Cruz A, Mansilla A, Leoni M, Ramallo V, Hernandez M, Hualde A, Marin M, Martinez-Selles M, Menarguez M, Munoz P, Rincon C, Rodriguez-Creixems M, Pinilla B, Vazquez P, Moreno E, Antorrena I, Loeches B, Quiros A, Moreno M, Ramirez U, Baston V, Romero M, Saldana A, Balbin J, Castillo C, Arnaiz A, Revillas F, Belaustegui M, Farinas M, Farinas-Alvarez C, Izquierdo R, Garcia I, Rico C, Gutierrez-Cuadra M, Diez J, Pajaron M, Parra J, Teira R, Zarauza J, Dominguez F, Pavia P, Gonzalez J, Orden B, Ramos A, Centella T, Hermida J, Moya J, Martin-Davila P, Navas E, Oliva E, del Rio A, Ruiz S, Tenorio C, Delia M, Araji O, Barquero J, Jambrina R, de Cueto M, Acebal J, Mendez I, Morales I, Lopez-Cortes L, de Alarcon A, Garcia E, Haro J, Lepe J, Lopez F, Luque R, Alonso L, Azcarate P, Gutierrez J, Blanco J, Villegas A, Garcia-Alvarez L, Oteo J, Sanz M, de Benito N, Gurgui M, Pacho C, Pericas R, Pons G, Alvarez M, Fernandez A, Martinez A, Prieto A, Regueiro B, Tijeira E, Vega M, Blasco A, Mollar J, Arana J, Uriarte O, Lopez A, de Zarate Z, Matos J, Dominguez G, Sanchez-Porto A, Leal J, Vazquez E, Torres A, Blazquez A, Valenzuela G, Alonso A, Aramburu J, Calvo F, Rodriguez A, Tarabini-Castellani P, Galvez E, Bellido C, Pau J, Sepulveda M, Sierra P, Iqbal-Mirza S, Alcolea E, Yanez I, Ballesta A, Escobar E, Monje A, Cabrera V, Garcia D, Asenjo M, Luna C, Morcillo J, Seco M, Gelabert A, Guallar C, Abad N, Mangas P, Adell M, Ruiz M, Porres J, Trigueros N, Espin M, Caro J, Sanchez R, Almazan A, Freire A, Gonzalez M, Ramis P, Bordes E, Bonet L, Munera M, Garaizabal E, Luque J, and GAMEs Study Grp

Subjects
Infectious endocarditis, Mitral valve reparation, Cardiac surgery, Mitral valve replacement
Abstract

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

Published
2019

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

Author

Llopis J, Gonzalez-Ramallo V, Goenaga M, Garcia-Leoni M, Farinas M, Oteo J, Carrizo E, Reguera-Iglesias J, Hidalgo-Tenorio C, Sanchez F, Noureddine M, Rosas G, Lima J, Blanco R, Boado M, Lazaro M, Crespo A, Goikoetxea J, Iruretagoyena J, Zuazabal J, Lopez-Soria L, Montejo M, Nieto J, Rodrigo D, Rodriguez R, Vitoria Y, Voces R, Lopez M, Georgieva R, Ojeda G, Bailon I, Morales J, Cuende A, Echeverria T, Fuerte A, Gaminde E, Idigoras P, Iribarren J, Yarza A, Urkola X, Reviejo C, Carrasco R, Climent V, Llamas P, Merino E, Plazas J, Reus S, Alvarez N, Bravo-Ferrer J, Castelo L, Cuenca J, Llinares P, Rey E, Mayo M, Sanchez E, Regueiro D, Martinez F, Alonso M, Castro B, Rosado D, Duran M, Gomez M, Lacalzada J, Nassar I, Ciezar A, Iglesias J, Alvarez V, Costas C, de la Hera J, Suarez J, Fraile L, Arguero V, Menendez J, Bajo P, Morales C, Torrico A, Palomo C, Martinez B, Esteban A, Garcia R, Asensio M, Almela M, Ambrosioni J, Azqueta M, Brunet M, Bodro M, Cartana R, Falces C, Fita G, Fuster D, de la Maria C, Garcia-Valls L, Hernandez-Meneses M, Perez J, Marco F, Miro J, Moreno A, Nicolas D, Ninot S, Quintana E, Pare C, Pereda D, Pericas J, Pomar J, Ramirez J, Rovira I, Sandoval E, Sala M, Sitges M, Soy D, Tellez A, Tolosana J, Vidal B, Vila J, Adan I, Bermejo J, Bouza E, Celemin D, Caballero G, Montero A, Cruz A, Mansilla A, Leoni M, Ramallo V, Hernandez M, Hualde A, Marin M, Martinez-Selles M, Menarguez M, Munoz P, Rincon C, Rodriguez-Abella H, Rodriguez-Creixems M, Pinilla B, Pinto A, Valerio M, Vazquez P, Moreno E, Antorrena I, Loeches B, Quiros A, Moreno M, Ramirez U, Baston V, Romero M, Saldana A, Balbin J, Castillo C, Arnaiz A, Revillas F, Belaustegui M, Farinas-Alvarez C, Izquierdo R, Garcia I, Rico C, Gutierrez-Cuadra M, Diez J, Pajaron M, Parra J, Teira R, Zarauza J, Dominguez F, Pavia P, Gonzalez J, Orden B, Ramos A, Centella T, Hermida J, Moya J, Martin-Davila P, Navas E, Oliva E, del Rio A, Stuart J, Rodriguez S, Tenorio C, Delia M, Araji O, Barquero J, Jambrina R, de Cueto M, Acebal J, Mendez I, Morales I, Lopez-Cortes L, de Alarcon A, Garcia E, Haro J, Lepe J, Lopez F, Luque R, Alonso L, Azcarate P, Gutierrez J, Blanco J, Garcia-Alvarez L, Sanz M, de Benito N, Gurgui M, Pacho C, Pericas R, Pons G, Alvarez M, Fernandez A, Martinez A, Prieto A, Regueiro B, Tijeira E, Vega M, Blasco A, Mollar J, Arana J, Uriarte O, Lopez A, de Zarate Z, Matos J, Dominguez G, Sanchez-Porto A, Leal J, Vazquez E, Torres A, Blazquez A, Valenzuela G, Alonso A, Aramburu J, Calvo F, Rodriguez A, Tarabini-Castellani P, Galvez E, Bellido C, Pau J, Sepulveda M, Sierra P, Iqbal-Mirza S, Alcolea E, Serrano P, Roca J, Yanez I, Ballesta A, Soriano V, Escobar E, Monje A, Cabrera V, Garcia D, Asenjo M, Luna C, Morcillo J, Seco M, Gelabert A, Guallar C, Abad N, Mangas P, Adell M, Ruiz M, Porres J, Trigueros N, Espin M, Caro J, Sanchez R, Almazan A, Freire A, Gonzalez M, Ramis P, Blanco M, Bordes E, Bonet L, Munera M, Garaizabal E, Luque J, and Spanish Collaboration Endocarditis

Subjects
infective endocarditis, readmission, outpatient parenteral antibiotic treatment, outcomes, hospitalization
Abstract

Background. Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT). Methods. Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008-2012) was performed. Results. A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56-76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32-54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P < .001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04-1.42; P = .01) and cardiac surgery (OR, 0.24; 95% CI, .09-.63; P = .04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI, .22-.98; P = .007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission. Conclusions. OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded.

Published
2019

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

Author

Ramos-Martinez A, Calderon-Parra J, Miro J, Farinas M, Goenaga M, Marcos F, Vinuesa D, Sanchez F, Noureddine M, Rosas G, Lima J, Aramendi J, Blanco M, Blanco R, Boado M, Lazaro M, Crespo A, Goikoetxea J, Iruretagoyena J, Zuazabal J, Lopez-Soria L, Montejo M, Nieto J, Rodrigo D, Rodriguez D, Rodriguez R, Vitoria Y, Voces R, Lopez M, Georgieva R, Ojeda G, Bailon I, Morales J, Cuende A, Echeverria T, Fuerte A, Gaminde E, Idigoras P, Iribarren J, Yarza A, Urkola X, Reviejo C, Carrasco R, Climent V, Llamas P, Merino E, Plazas J, Reus S, Alvarez N, Bravo-Ferrer J, Castelo L, Cuenca J, Llinares P, Rey E, Mayo M, Sanchez E, Regueiro D, Martinez F, Alonso M, Castro B, Rosado D, Duran M, Gomez M, Lacalzada J, Nassar I, Ciezar A, Iglesias J, Alvarez V, Costas C, de la Hera J, Suarez J, Fraile L, Arguero V, Menendez J, Bajo P, Morales C, Torrico A, Palomo C, Martinez B, Esteban A, Garcia R, Asensio M, Almela M, Ambrosioni J, Azqueta M, Brunet M, Bodro M, Cartana R, Falces C, Fita G, Fuster D, de la Maria C, Hernandez-Meneses M, Perez J, Marco F, Moreno A, Nicolas D, Ninot S, Quintana E, Pare C, Pereda D, Pericas J, Pomar J, Ramirez J, Rovira I, Sandoval E, Sitges M, Soy D, Tellez A, Tolosana J, Vidal B, Vila J, Adan I, Bermejo J, Bouza E, Celemin D, Caballero G, Montero A, Cruz A, Mansilla A, Leoni M, Ramallo V, Hernandez M, Hualde A, Marin M, Martinez-Selles M, Menarguez M, Munoz P, Rincon C, Rodriguez-Abella H, Rodriguez-Creixems M, Pinilla B, Pinto A, Valerio M, Vazquez P, Moreno E, Antorrena I, Loeches B, Quiros A, Moreno M, Ramirez U, Baston V, Romero M, Saldana A, Balbin J, Castillo C, Arnaiz A, de las Revillas F, Belaustegui M, Farinas-Alvarez C, Izquierdo R, Garcia I, Rico C, Gutierrez-Cuadra M, Diez J, Pajaron M, Parra J, Teira R, Zarauza J, Dominguez F, Pavia P, Gonzalez J, Orden B, Ramos A, Centella T, Hermida J, Moya J, Martin-Davila P, Navas E, Oliva E, del Rio A, Ruiz S, Tenorio C, Delia M, Araji O, Barquero J, Jambrina R, de Cueto M, Acebal J, Mendez I, Morales I, Lopez-Cortes L, de Alarcon A, Garcia E, Haro J, Lepe J, Lopez F, Luque R, Alonso L, Azcarate P, Gutierrez J, Blanco J, Villegas A, Garcia-Alvarez L, Oteo J, Sanz M, de Benito N, Gurgui M, Pacho C, Pericas R, Pons G, Alvarez M, Fernandez A, Martinez A, Prieto A, Regueiro B, Tijeira E, Vega M, Blasco A, Mollar J, Arana J, Uriarte O, Lopez A, de Zarate Z, Matos J, Gloria G, Antonio S, Leal J, Vazquez E, Torres A, Blazquez A, Valenzuela G, Alonso A, Aramburu J, Calvo F, Rodriguez A, Tarabini-Castellani P, Galvez E, Bellido C, Pau J, Sepulveda M, Sierra P, Iqbal-Mirza S, Alcolea E, Yanez I, Ballesta A, Escobar E, Monje A, Cabrera V, Garcia D, Asenjo M, Luna C, Morcillo J, Seco M, Villoslada A, Guallar A, Abad N, Mangas P, Adell M, Ruiz M, Porres J, Trigueros N, Espin M, Caro J, Sanchez R, Almazan A, Freire A, Gonzalez M, Ramis P, Bordes E, Bonet L, Munera M, Garaizabal E, Luque J, and Spanish Collaboration Endocarditis

Subjects
Endocarditis, Embolism, Heart failure, Bacteremia, Mortality
Abstract

Aim: To evaluate the effect of the type of surgical indication on mortality in infective endocarditis (IE) patients who are rejected for surgery. Methods and results: From January 2008 to December 2016, 2714 patients with definite left-sided IE were attended in the participating hospitals. One thousand six hundred and fifty-three patients (60.9%) presented surgical indications. Five hundred and thirty-eight patients (32.5%) presented surgical indications but received medical treatment alone. The indications for surgery in these patients were uncontrolled infection (366 patients, 68%), heart failure (168 patients, 31.3%) and prevention of embolism (148 patients, 27.6%). One hundred and thirty patients (24.2%) presented more than one indication. The mortality during hospital admission was 60% (323 patients). The in-hospital mortality of patients whose indication for surgery was heart failure, uncontrolled infection or risk of embolism was 75.6%, 61.4% and 54.7%, respectively (p < 0.001). Surgical indications due to heart failure (OR: 3.24; CI 95%: 1.99-5.9) or uncontrolled infection (OR: 1.83; CI 95%: 1.04-3.18) were independently associated with a fatal outcome during hospital admission. Mortality during the first year was 75.4%. The mortality during the first year in patients whose indication for surgery was heart failure, uncontrolled infection or risk of embolism was 85.9%, 76.7% and 72.7%, respectively (p = 0.016). Surgical indication due to heart failure (OR: 3.03; CI 95%: 1.53-5.98) were independently associated with fatal outcome during the first year. Conclusions: The type of surgical indication is associated with mortality in IE patients who are rejected for surgical intervention. (c) 2019 Elsevier B.V. All rights reserved.

Published
2019

5. Bacterial DNA in the diagnosis of spontaneous bacterial peritonitis

Author

Soriano, G, Esparcia, O, Montemayor, M, Guarner-Argente, C, Pericas, R, Torras, X, Calvo, N, Roman, E, Navarro, F, Guarner, C, and Coll, P

Abstract

P>Background Despite inoculation into blood culture bottles, ascitic fluid culture is negative in 50% of cases of spontaneous bacterial peritonitis (SBP). Aim To determine whether 16S rDNA gene detection by real-time polymerase chain reaction (PCR) and sequencing increases the efficacy of culture in microbiological diagnosis of spontaneous bacterial peritonitis. Methods We prospectively included 55 consecutive spontaneous bacterial peritonitis episodes in cirrhotic patients, 20 cirrhotic patients with sterile ascites and 27 patients with neoplasic ascites. Ascitic fluid was inoculated into blood culture bottles at the bedside and tested for bacterial DNA by real-time PCR and sequencing of 16S rDNA gene. Results Bacterial DNA was detected in 23/25 (92%) culture-positive SBP, 16/30 (53%) culture-negative SBP (P = 0.002 with respect to culture-positive SBP), 12/20 (60%) sterile ascites (P = 0.01 with respect to culture-positive SBP) and 0/27 neoplasic ascites (P < 0.001 with respect to other groups). Sequencing identified to genus or species level 12 culture-positive SBP, six culture-negative SBP and six sterile ascites. In the remaining cases with positive PCR, sequencing did not yield a definitive bacterial identification. Conclusions Bacterial DNA was not detected in almost half the culture-negative spontaneous bacterial peritonitis episodes. Methodology used in the present study did not always allow identification of amplified bacterial DNA.

Published
2011

6. Main Results of Phase IV BEMUSE Project. Simulation of LBLOCA in a NPP

Author

Pérez, M, Reventós, F, AND PERICAS R, BATET L., Toth, I, AND DE CRÉCY A, BAZIN P., Borisov, S, AND SKOREK T, GLAESER H., AND PROBST P, JOUCLA J., Ui, A, Chung, B, OH D, Y., AND PERNICA R, KYNCL M., Manera, A, D'Auria, FRANCESCO SAVERIO, Petruzzi, A, and DEL NEVO, A.

Published
2008

7. Simulation of a LBLOCA in ZION Nuclear Power Plant - BEMUSE Phase IV Report

Author

Reventos, F., Perez, M., Batet, L., (Coordinators), Pericas R., Toth, I., Bazin, P., De Crecy, A., Borisov, S., Glaeser, H., Skorek, T., Joucla, J., Probst, P., Ui, A., Chung, B., Oh, D., Kyncl, M., Pernica, R., Manera, A., D’Auria, F., Petruzzi, A., and Del Nevo, A.

Subjects
Zion NPP, BEMUSE project (OECD/NEA/CSNI), Zion NPP, Uncertainty method application, uncertainty analysis, BEMUSE project (OECD/NEA/CSNI), Uncertainty method application, uncertainty analysis
Published
2008

9. [Comparison of the automatized BacT/ALERT blood culture incubation and reading system and a conventional system]

Author

Alonso C, Jordi Rello, Mirelis B, Pericas R, Navarro F, and Prats G

Subjects
Adult, Bacteriological Techniques, Electronic Data Processing, Blood, Time Factors, Humans, False Positive Reactions, Sensitivity and Specificity
Abstract

The aim of the present study was to compare the BacT/ALERT blood culture automatic management and reading system (Organon Teknika) with a conventional, nonautomatic technique (DUO, Bio-Mérieux).1,405 blood cultures were parallel compared. 263 of them were positive; out of these, 148 were considered as indicative of septicaemia, 38 of doubtful clinical significance and 77 as accidental contaminations.No differences were detected between both systems neither in the number of isolates obtained nor in the kind of microorganisms recovered or in the number of false-positive or false-negative readings. The conventional system detected 28% of significant isolates during the first 24 hours, reaching 77% after 48 hours; whereas the BacT/ALERT system had detected 57% of significant isolates after 12 hours, reaching 82% after 24 hours (p0.001).The results obtained and the automatization of the BacT/ALERT system appoint it as a firm candidate to be included into the Clinical Microbiology laboratory routine.

10. Acute rhabdomyolysis and myonecrosis complicating aeromonas bacteremia in neutropenic patients with hematologic malignancies: report of two cases

Author

RODRIGO MARTINO, Santamaría, A., Pericas, R., Sureda, A., and Brunet, S.

Subjects
Adult, Male, Leukemia, Myeloid, Acute, Necrosis, Neutropenia, Acute Disease, Humans, Bacteremia, Female, Aeromonas, Middle Aged, Gram-Negative Bacterial Infections, Rhabdomyolysis
Abstract

Infections by Aeromonas spp. are a rare cause of systemic infection in normal and immunocompromised hosts. We report the cases of two patients with acute non-lymphoblastic leukemia who developed septic shock by Aeromonas species with unusual soft-tissue complications. One patient who was undergoing consolidation chemotherapy developed septic shock by Aeromonas hydrophila with rhabdomyolysis and subsequent soft-tissue destruction consistent with myonecrosis. She recovered with combination antibiotic therapy and supportive care. The second patient developed neutropenia due to ganciclovir treatment for post-allogeneic transplant cytomegalovirus antigenemia. He developed a rapidly progressive septic shock due to Aeromonas sobria with rhabdomyolysis, multi-organ failure and bilateral lower limb myonecrosis, and died within 48 hours. The portal of entry was not identified in either case. These cases confirm the potentially aggressive nature of these bacteria in neutropenic cancer patients with an unusual tendency to produce muscular and soft-tissue destruction.

12. [Etiology of enteritis in a university general hospital in Barcelona (1992-1995)]

Author

Prats G, Llovet T, Muñoz C, Solé R, Mirelis B, Izquierdo C, Rodríguez P, Me, Sabanés, Núria Rabella, Pericas R, Sánchez F, Margall N, Navarro F, and Coll P

Subjects
Adult, Male, Feces, Age Distribution, Adolescent, Risk Factors, Child, Preschool, Infant, Newborn, Humans, Infant, Female, Child, Enteritis
Abstract

The aim of the study was to describe the etiology of enteropathogenic agents over a four-year period (1992-1995) in a University Hospital in Barcelona.We studied 12,793 stool samples, 4519 were obtained from patients under 15 years and 8274 were obtained from patients over 14 years. The specimens were examined for bacteriological, parasitological and virological enteropathogens.In 3380 specimens of 12,793 stool samples studied were identified an enteropathogen (26.4%). Polymicrobial associations were observed in the 6.8% of the cases. Pathogens were identified in 45% of children samples and 16.3% of adults samples. The etiological enteritis agents more frequently detected in the paediatric patients were Campylobacter (13.5%), rotavirus (11.3%) and Salmonella (10.2%); and Salmonella (4.9%), Campylobacter (3.1%) and Giardia intestinalis (2.1%) in adults. Cryptosporidium (13.5%) was the most frequent cause of gastrointestinal tract infections in HIV-infected subjects. In the children with stools positives, the presence of red and white blood cells were more frequent than the adults with stools positives (73% versus 26.6%).The enteropathogenic agents such as Campylobacter, Salmonella, and Giardia were the most frequent cause of gastroenteritis in our environment. In the children, rotavirus infections predominated during the cold months. The most frequent cause of gastroenteritis in HIV-infected patients was Cryptosporidium followed by Campylobacter.

13. Achromobacter xylosoxidans bacteremia in patients with hematologic malignancies

Author

Hernandez, J. -A, RODRIGO MARTINO, Pericas, R., Sureda, A., Brunet, S., and Domingo-Albos, A.

Subjects
Adult, Male, Hematologic Neoplasms, Humans, Female, Alcaligenes, Middle Aged, Gram-Negative Bacterial Infections, Aged, Catheterization
Abstract

We report nine cases of Achromobacter xylosoxidans bacteremia diagnosed in patients with hematologic malignancies. There was not an obvious epidemiologic link between cases and the organism was not isolated from any source. Outcome was cure in all nine cases. In our experience, catheter removal is generally required for eradication of A. xylosoxidans.

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