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2. Pseudomonas aeruginosa bloodstream infections in children and adolescents: risk factors associated with carbapenem resistance and mortality

Author

Grasa, C., Sánchez Castellano, M., Rodríguez-Molino, P., Castro Martínez, M., de Llano, B.B.Q., San Juan, I., Rodríguez, N.E.G., Aguilera-Alonso, D., Escosa, L., Gómez-Gil, M.R., Manzanares, Á., Ascaso, M.G., Bermejo-Gómez, A., Abad, M.J.G., Ramos, A.M., Núñez, A.S., Orellana, M.Á., Cercenado, E., Lozano, J.S., Calvo, C., and Baquero-Artigao, F.

Published
2024
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6. Pseudomonas aeruginosa bloodstream infections in children and adolescents: risk factors associated with carbapenem resistance and mortality.

Author

Rodríguez, N.E.G., Aguilera-Alonso, D., Escosa, L., Gómez-Gil, M.R., Manzanares, Á., Ascaso, M.G., Bermejo-Gómez, A., Abad, M.J.G., Ramos, A.M., Núñez, A.S., Orellana, M.Á., Cercenado, E., Lozano, J.S., Calvo, C., and Baquero-Artigao, F.

Abstract

Pseudomonas aeruginosa bloodstream infections (PA-BSIs) are a serious disease and a therapeutic challenge due to increasing resistance to carbapenems. Our objectives were to describe the prevalence and risk factors associated with carbapenem resistance (CR) and mortality in children with PA-BSI. A retrospective, multi-centre study was carried out, including patients aged <20 years with PA-BSI in four tertiary hospitals in Madrid (Spain) during 2010–2020. Risk factors for CR PA-BSIs and 30-day mortality were evaluated in a multi-variable logistic regression model. In total, 151 patients with PA-BSI were included, with a median age of 29 months (interquartile range: 3.5–87.1). Forty-five (29.8%) cases were CR, 9.9% multi-drug resistant and 6.6% extensively drug resistant. The prevalence of CR remained stable throughout the study period, with 26.7% (12/45) of CR mediated by VIM-type carbapenemase. Patients with BSIs produced by CR-PA were more likely to receive inappropriate empiric treatment (53.3% vs 5.7%, P <0.001) and to have been previously colonized by CR-PA (8.9% vs 0%, P =0.002) than BSIs caused by carbapenem-susceptible P. aeruginosa. CR was associated with carbapenem treatment in the previous month (adjusted odds ratio (aOR) 11.15) and solid organ transplantation (aOR 7.64). The 30-day mortality was 23.2%, which was associated with mechanical ventilation (aOR 4.24), sepsis (aOR 5.72), inappropriate empiric antibiotic therapy (aOR 5.86), and source control as a protective factor (aOR 0.16). This study shows a concerning prevalence of CR in children with PA-BSIs, leading to high mortality. Inappropriate empiric treatment and sepsis were associated with mortality. The high prevalence of CR with an increased risk of inappropriate empiric treatment should be closely monitored. [ABSTRACT FROM AUTHOR]

Published
2024
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10. chapter 6: THE EXCEPTIONAL IBERIAN HEATWAVE OF SUMMER 2018

Author

Barriopedro, D., Sousa, P.M., Trigo, R.M., Garcia-Herrera, R., and Ramos, A.M.

Subjects
Summer -- Environmental aspects, Hot weather -- Environmental aspects, Business, Earth sciences
Abstract

August 2018 saw the warmest Iberian heatwave since that of 2003. Recent climate change has exacerbated this event making it at least [much greater than] 1[degrees]C warmer than similar events [...]

Published
2020
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37. Early detection of diabetic kidney disease by urinary proteomics and subsequent intervention with spironolactone to delay progression (PRIORITY): a prospective observational study and embedded randomised placebo-controlled trial

Author

Tofte, N. Lindhardt, M. Adamova, K. Bakker, S.J.L. Beige, J. Beulens, J.W.J. Birkenfeld, A.L. Currie, G. Delles, C. Dimos, I. Francová, L. Frimodt-Møller, M. Girman, P. Göke, R. Havrdova, T. Heerspink, H.J.L. Kooy, A. Laverman, G.D. Mischak, H. Navis, G. Nijpels, G. Noutsou, M. Ortiz, A. Parvanova, A. Persson, F. Petrie, J.R. Ruggenenti, P.L. Rutters, F. Rychlík, I. Siwy, J. Spasovski, G. Speeckaert, M. Trillini, M. Zürbig, P. von der Leyen, H. Rossing, P. Zimmermann, S. Rädisch, B. Hävemeier, A. Busmann, A. Wittkop, U. Neuhaus, B. Ax-Smolarski, R. Zieglschmid, V. Bollweber, E. Wölk, H. Curovic, V.R. Tougaard, N.H. Eickhoff, M.K. Pilemann-Lyberg, S. Winther, S.A. Rosenlund, S.V. Hansen, T.W. von Scholten, B.J. Hansen, C.S. Zobel, E.H. Laursen, J.C. Theilade, S. Jelstrup, L. Juhl, T.R. Riis, D. Hermann, J.A. Lundgaard, A.G. Halkjær, M.L.D. Aabo, L. Frost Lerche, T. Lajer, M. Stefansen, R.J. Campbell, M.A. Durban, A. Raad, J. Prigge, M. Schiemann, M. Wilson, R. Kean, S. Douglas, E. Surtees, P. Gant, C. Yeung, S.M.H. Hagedoorn, I. Flynn, J. Galloway, J. Brooksbank, K. Aparicio, C. Iliev, I.P. Nones, F. Lo Bue, F. Melacini, D. Cugini, D. Prandini, S. Lecchi, V. Yakymchuk, S. Gherardi, G. Villa, A. Villa, D. Gaspari, F. Cannata, A.N. Ferrari, S. Stucchi, N. Albrechtová, Š. Eldeik, E. Amanaki, R. Fernandez-Fernandez, B. Sanchez-Rodriguez, J. Vázquez, C. Sanz, A.B. Sanchez-Niño, M.D. Ramos, A.M. Gonzalo, M.Á. Schmidt, U. Selim, G. Gjorgovski, T. Stratrova, S.S. Stojceva-Taneva, O. Schutten-Westerneng, P. Wierbos, B. Huvers, F. De Bruin, A.K. Lapauw, B. de Man, E. Rokegem, K. Inion, S. Kreutzmann, K. Dewettinck, I. Boukens-de Graaf, C. Clerc-de Jong, F. Entius, J. Nannings, M. van Steenderen, S. Petry, F.W. Kilic, C. PRIORITY investigators

Abstract

Background: Microalbuminuria is an early sign of kidney disease in people with diabetes and indicates increased risk of cardiovascular disease. We tested whether a urinary proteomic risk classifier (CKD273) score was associated with development of microalbuminuria and whether progression to microalbuminuria could be prevented with the mineralocorticoid receptor antagonist spironolactone. Methods: In this multicentre, prospective, observational study with embedded randomised controlled trial (PRIORITY), we recruited people with type 2 diabetes, normal urinary albumin excretion, and preserved renal function from 15 specialist centres in ten European countries. All participants (observational cohort) were tested with the CKD273 classifier and classified as high risk (CKD273 classifier score >0·154) or low risk (≤0·154). Participants who were classified as high risk were entered into a randomised controlled trial and randomly assigned (1:1), by use of an interactive web-response system, to receive spironolactone 25 mg once daily or matched placebo (trial cohort). The primary endpoint was development of confirmed microalbuminuria in all individuals with available data (observational cohort). Secondary endpoints included reduction in incidence of microalbuminuria with spironolactone (trial cohort, intention-to-treat population) and association between CKD273 risk score and measures of impaired renal function based on estimated glomerular filtration rate (eGFR; observational cohort). Adverse events (particularly gynaecomastia and hyperkalaemia) and serious adverse events were recorded for the intention-to-treat population (trial cohort). This study is registered with the EU Clinical Trials Register (EudraCT 20120-004523-4) and ClinicalTrials.gov (NCT02040441) and is completed. Findings: Between March 25, 2014, and Sept 30, 2018, we enrolled and followed-up 1775 participants (observational cohort), 1559 (88%) of 1775 participants had a low-risk urinary proteomic pattern and 216 (12%) had a high-risk pattern, of whom 209 were included in the trial cohort and assigned to spironolactone (n=102) or placebo (n=107). The overall median follow-up time was 2·51 years (IQR 2·0–3·0). Progression to microalbuminuria was seen in 61 (28%) of 216 high-risk participants and 139 (9%) of 1559 low-risk participants (hazard ratio [HR] 2·48, 95% CI 1·80–3·42; p

Published
2020

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