15 results on '"Puerta-Alcalde, P."'
Search Results
2. Safety and effectiveness of isavuconazole in real-life non-neutropenic patients
- Author
-
Patricia Monzó-Gallo, Carlos Lopera, Ana M Badía-Tejero, Marina Machado, Julio García-Rodríguez, Pablo Vidal-Cortés, Esperanza Merino, Jorge Calderón, Jesús Fortún, Zaira R. Palacios-Baena, Javier Pemán, Joan Roig Sanchis, Manuela Aguilar-Guisado, Carlota Gudiol, Juan C Ramos, Isabel Sánchez-Romero, Pilar Martin-Davila, Luis E. López-Cortés, Miguel Salavert, Isabel Ruiz-Camps, Mariana Chumbita, Tommaso Francesco Aiello, Olivier Peyrony, Pedro Puerta-Alcalde, Alex Soriano, Francesc Marco, and Carolina Garcia-Vidal
- Subjects
Isavuconazole ,Non-neutropenic ,Invasive fungal infection ,Effectiveness ,Safety ,Infectious and parasitic diseases ,RC109-216 - Abstract
ABSTRACT: Objectives: Information is scarce on clinical experiences with non-neutropenic patients with invasive fungal infection (IFI) receiving isavuconazole. We aimed to report the safety and effectiveness of this drug as a first-line treatment or rescue in real life. Methods: A retrospective, observational multicentric study of non-neutropenic patients who received isavuconazole as an IFI treatment at 12 different university hospitals (January 2018-2022). All patients met criteria for proven, probable or possible IFI according to EORTC-MSG. Results: A total of 238 IFIs were treated with isavuconazole during the study period. Combination therapy was administered in 27.7% of cases. The primary IFI was aspergillosis (217, 91.2%). Other IFIs treated with isavuconazole were candidemia (n = 10), mucormycosis (n = 8), histoplasmosis (n = 2), cryptococcosis (n = 2), and others (n = 4). Median time of isavuconazole treatment was 29 days. Only 5.9% (n = 14) of cases developed toxicity, mainly hepatic-related (10 patients, 4.2%). Nine patients (3.8%) had treatment withdrawn. Successful clinical response at 12 weeks was documented in 50.5% of patients. Conclusion: Isavuconazole is an adequate treatment for non-neutropenic patients with IFIs. Toxicity rates were low and its effectiveness was comparable to other antifungal therapies previously reported.
- Published
- 2024
- Full Text
- View/download PDF
3. Current microbiological testing approaches and documented infections at febrile neutropenia onset in patients with hematologic malignancies
- Author
-
Chumbita Mariana, Peyrony Olivier, Teijón-Lumbreras Christian, Monzó-Gallo Patricia, Aiello Tommaso Francesco, Gallardo-Pizarro Antonio, Gras Emmanuelle, Puerta-Alcalde Pedro, Mateu Espasa, Martínez Carmen, Rivero Andrea, Casals-Pascual Climent, Soriano Alex, and Garcia-Vidal Carolina
- Subjects
Febrile neutropenia ,Epidemiology ,Bacteremia ,Hematologic patients ,Infectious and parasitic diseases ,RC109-216 - Abstract
Objectives: This study aims to identify infection etiology in febrile neutropenia (FN) is vital. This study explores different microbiological approaches and their impact on diagnosing infections in patients with hematologic malignancies and FN. Methods: This is a retrospective analysis conducted at the Hospital Clinic of Barcelona details microbiological testing strategies used to diagnose infections at FN onset between January 2020 and July 2022. Results: A total of 4520 microbiological tests were ordered in 462 FN episodes, achieving a 10% test positivity rate, with 200 (43.3%) episodes showing microbiological documentation of infection. Blood cultures (40.4%), non-culture blood tests (21.2%), and respiratory tract samples (16.2%) were the most requested. Blood cultures exhibited the highest (16.9%) test positivity rates, whereas non-culture blood tests showed the lowest (3.3%). Bacterial infections were present in 149 of 462 (32.3%) FN episodes. Viral infections (66 of 462, 14.3%)—notably, respiratory viruses—were also frequent. Mortality rate at 60 days was 9.1%; documented infections were associated with a higher risk (15%). Conclusions: In the current landscape of antimicrobial diagnostics, our findings revealed the highest reported rate of microbiologically documented infections at FN onset. Bacterial infections are common; however, our data reiterate the significance of viral infections in causing fever. Optimizing FN management during respiratory viral infections remains a challenge for antimicrobial de-escalation. The low positivity rates observed in certain diagnostic tests emphasize the need for cost-effective diagnostic stewardship.
- Published
- 2024
- Full Text
- View/download PDF
4. Bacterial co-infection at hospital admission in patients with COVID-19
- Author
-
Estela Moreno-García, Pedro Puerta-Alcalde, Laura Letona, Fernanda Meira, Gerard Dueñas, Mariana Chumbita, Nicole Garcia-Pouton, Patricia Monzó, Carlos Lopera, Laia Serra, Celia Cardozo, Marta Hernandez-Meneses, Verónica Rico, Marta Bodro, Laura Morata, Mariana Fernandez-Pittol, Ignacio Grafia, Pedro Castro, Josep Mensa, José Antonio Martínez, Gemma Sanjuan, Mª Angeles Marcos, Alex Soriano, and Carolina Garcia-Vidal
- Subjects
COVID-19 ,bacterial infection ,co-infection ,antibiotics ,SARS-CoV-2 ,Infectious and parasitic diseases ,RC109-216 - Abstract
ABSTRACT: Objectives: We described the current incidence and risk factors of bacterial co-infection in hospitalized patients with COVID-19. Methods: Observational cohort study was performed at the Hospital Clinic of Barcelona (February 2020–February 2021). All patients with COVID-19 who were admitted for >48 hours with microbiological sample collection and procalcitonin (PCT) determination within the first 48 hours were included. Results: A total of 1125 consecutive adults met inclusion criteria. Co-infections were microbiologically documented in 102 (9.1%) patients. Most frequent microorganisms were Streptococcus pneumoniae (79%), Staphylococcus aureus (6.8%), and Haemophilus influenzae (6.8%). Test positivity was 1% (8/803) for blood cultures, 10.1% (79/780) for pneumococcal urinary antigen test, and 11.4% (15/132) for sputum culture. Patients with PCT higher than 0.2, 0.5, 1, and 2 ng/mL had significantly more co-infections than those with lower levels (p=0.017, p=0.031, p94%.
- Published
- 2022
- Full Text
- View/download PDF
5. Impact of low serum calcium at hospital admission on SARS-CoV-2 infection outcome
- Author
-
Berta Torres, Pau Alcubilla, Ana González-Cordón, Alexy Inciarte, Mariana Chumbita, Celia Cardozo, Fernanda Meira, Marga Giménez, Ana de Hollanda, Alex Soriano, Laia Albiach, Daiana Agüero, Juan Ambrosioni, Marta Bodro, Jose Luis Blanco, Lorena De la Mora, Felipe García-Alcaide, Nicole García-Pouton, Carolina Garcia-Vidal, Marta Hernández-Meneses, Montserrat Laguno, Lorna Leal, Laura Linares, Irene Macaya, Josep Mallolas, Esteban Martínez, María Martínez-Rebollar, José María Miró, José Mensa, Asunción Moreno, Antonio Moreno, Estela Moreno-García, Laura Morata, José Antonio Martínez, Pedro Puerta-Alcalde, Verónica Rico, John Rojas, Montserrat Solá, and Manuel Torres
- Subjects
SARS-CoV-2 infection ,COVID-19 ,Hypocalcemia ,Outcome ,Infectious and parasitic diseases ,RC109-216 - Abstract
Background: Calcium is an essential ion for pathogen survival and virulence and is involved in the regulation of the inflammatory response. Hypocalcemia is a common laboratory finding in critically ill patients. Data regarding levels of calcium in SARS-CoV-2 infection is scarce. Patients with SARS-CoV-2 infection who present with hypocalcemia could have a worse outcome. Methods: We performed a retrospective analysis of hospitalized patients with SARS-CoV-2 infection and included all patients who had any serum calcium measurement in the first 72 h since hospital admission. The main objective was to investigate the relation of low serum calcium with adverse outcome, measured by the requirement of high oxygen support – defined as high flow nasal cannula oxygen, non-invasive mechanical ventilation and/or invasive ventilation – intensive care unit admission or death. Results: A total of 316 patients were included in the study. Median age was 65 years (IQR 55–74); 65% were men. Hypocalcemia within 72 h since hospital admission was present in 63% of patients. A higher number of patients in the hypocalcemia group required high oxygen support during hospitalization (49% vs 32%; p = 0,01) and were admitted to the ICU (42% vs 26%; p = 0,005). No differences in mortality were observed between groups. Conclusions: Hypocalcemia is frequent in hospitalized patients with SARS-CoV-2 infection and can identify patients who will have a worse outcome. More studies are needed to understand the role of calcium metabolism in SARS-CoV-2 infection and to address the clinical implications and therapeutic interventions it might have.
- Published
- 2021
- Full Text
- View/download PDF
6. Trends in mortality of hospitalised COVID-19 patients: A single centre observational cohort study from Spain
- Author
-
Carolina Garcia-Vidal, Alberto Cózar-Llistó, Fernanda Meira, Gerard Dueñas, Pedro Puerta-Alcalde, Catia Cilloniz, Nicole Garcia-Pouton, Mariana Chumbita, Celia Cardozo, Marta Hernández, Verónica Rico, Marta Bodro, Laura Morata, Pedro Castro, Alex Almuedo-Riera, Felipe García, Josep Mensa, José Antonio Martínez, Gemma Sanjuan, Antoni Torres, JM Nicolás, and Alex Soriano
- Subjects
COVID-19 ,ICU admission ,Outcomes ,Mortality ,Public aspects of medicine ,RA1-1270 - Abstract
Background: We aimed to describe changes in characteristics and treatment strategies of hospitalised patients with COVID-19 and detail the mortality trend over time. Methods: Observational cohort study of all consecutive patients admitted ≥ 48 h to Hospital Clinic of Barcelona for COVID-19 (1 March–30 September 2020). Findings: A total of 1645 consecutive patients with COVID-19 were assessed over a 7-month period. Overall mortality (≤30 days) was 9.7% (159 patients), 7.7% in patients hospitalised in regular wards and 16.7 % in patients requiring ICU admission. Overall mortality decreased from 11.6% in the first month to 1.4% in the last month, reflecting a progressive, significant downward trend (p for trend 700 ng/mL (OR 2.3, CI 1.3–4.1), ferritin>489 ng/mL (OR 1.9; CI 1.5–3.2), C-RP>7 mg/dL (OR 2.6; CI 1.5–4.6), and shorter duration from symptom onset to hospital admission (OR 1.11; CI 1.04–1.17) were factors associated with 30-day mortality at hospital admission. Conversely, hospital admission in the last months (OR 0.80; CI 0.65–0.98) was significantly associated with lower mortality. Interpretation: In-hospital mortality has decreased in patients with COVID-19 over the last, few months, even though main patient characteristics remain similar. Several changes made when managing patients may explain this decreasing trend. Our study provides current data on mortality of patients hospitalised with COVID-19 that might be useful in establishing quality of standard of care. Funding: EIT Health, European Union´s Horizon 2020 Research and Innovation Programme), EDRD. PPA [CM18/00132], NGP [FI19/00133], and CGV [FIS PI18/01061], have received grants from Ministerio de Sanidad y Consumo, ISCIII. Resumen: Contexto: Nuestro objetivo es describir los cambios en las características y las estrategias de tratamiento de los pacientes hospitalizados por COVID-19, y detallar la tendencia de la mortalidad en el tiempo. Métodos: Estudio observacional de cohortes de todos los pacientes consecutivos, ingresados por COVID-19 durante más de 48 horas, en el Hospital Clínic de Barcelona (del 1 de marzo al 30 de septiembre de 2020). Resultados: Un total de 1645 pacientes consecutivos fueron evaluados durante un período de 7 meses. La mortalidad global (≤30 días) fue del 9.7% (159 pacientes): 7.7% en pacientes hospitalizados en salas convencionales, y 16.7% en pacientes que requirieron ingreso en UCI. La mortalidad global disminuyó del 11.6% en el primer mes al 1.4% en el último mes evaluado, reflejando una progresiva y significativa tendencia a la baja (p para la tendencia 700 ng/mL (OR 2.3; CI 1.3–4.1), ferritina>489 ng/mL (OR 1.9; CI 1.5–3.2), PCR>7 mg/dL (OR 2.6; CI 1.5–4.6), y una menor duración desde el inicio de síntomas a la hospitalización (OR 1.11; CI 1.04–1.17) fueron factores asociados a la mortalidad intrahospitalaria a 30 días. Por el contrario, el ingreso hospitalario previo en los últimos meses (OR 0.80; CI 0.65–0.98) se asoció significativamente a una menor mortalidad. Discusión: La mortalidad intrahospitalaria ha disminuido en los pacientes con COVID-19 durante los últimos meses, incluso siendo similares las características de los pacientes. Algunos cambios realizados en el manejo de estos pacientes podrían explicar esta tendencia decreciente. Nuestro estudio aporta datos actualizados en la mortalidad de los pacientes hospitalizados con COVID-19, que podrían ser útiles de cara a establecer unos cuidados estándar de calidad. Financiación: EIT Health, European Union´s Horizon 2020 Research and Innovation Programme, EDRD. PPA [CM18/00132], NGP [FI19/00133] y CGV [FIS PI18/01061], han recibido becas del Ministerio de Sanidad y Consumo, ISCIII.
- Published
- 2021
- Full Text
- View/download PDF
7. Corrigendum to "Safety and effectiveness of isavuconazole in real-life non-neu tropenic patients" [International Journal of Infectious Diseases 144 (2024) 107070].
- Author
-
Monzó-Gallo P, Lopera C, Badía-Tejero AM, Machado M, García-Rodríguez J, Vidal-Cortés P, Merino E, Calderón J, Fortún J, Palacios-Baena ZR, Pemán J, Sanchis JR, Aguilar-Guisado M, Gudiol C, Ramos JC, Sánchez-Romero I, Martin-Davila P, López-Cortés LE, Salavert M, Ruiz-Camps I, Chumbita M, Aiello TF, Peyrony O, Puerta-Alcalde P, Soriano A, Marco F, and Garcia-Vidal C
- Published
- 2024
- Full Text
- View/download PDF
8. Safety and effectiveness of isavuconazole in real-life non-neutropenic patients.
- Author
-
Monzó-Gallo P, Lopera C, Badía-Tejero AM, Machado M, García-Rodríguez J, Vidal-Cortés P, Merino E, Calderón J, Fortún J, Palacios-Baena ZR, Pemán J, Sanchis JR, Aguilar-Guisado M, Gudiol C, Ramos JC, Sánchez-Romero I, Martin-Davila P, López-Cortés LE, Salavert M, Ruiz-Camps I, Chumbita M, Aiello TF, Peyrony O, Puerta-Alcalde P, Soriano A, Marco F, and Garcia-Vidal C
- Subjects
- Humans, Retrospective Studies, Female, Male, Middle Aged, Aged, Adult, Treatment Outcome, Aged, 80 and over, Aspergillosis drug therapy, Young Adult, Nitriles therapeutic use, Nitriles adverse effects, Pyridines therapeutic use, Pyridines adverse effects, Antifungal Agents therapeutic use, Antifungal Agents adverse effects, Triazoles therapeutic use, Triazoles adverse effects, Invasive Fungal Infections drug therapy
- Abstract
Objectives: Information is scarce on clinical experiences with non-neutropenic patients with invasive fungal infection (IFI) receiving isavuconazole. We aimed to report the safety and effectiveness of this drug as a first-line treatment or rescue in real life., Methods: A retrospective, observational multicentric study of non-neutropenic patients who received isavuconazole as an IFI treatment at 12 different university hospitals (January 2018-2022). All patients met criteria for proven, probable or possible IFI according to EORTC-MSG., Results: A total of 238 IFIs were treated with isavuconazole during the study period. Combination therapy was administered in 27.7% of cases. The primary IFI was aspergillosis (217, 91.2%). Other IFIs treated with isavuconazole were candidemia (n = 10), mucormycosis (n = 8), histoplasmosis (n = 2), cryptococcosis (n = 2), and others (n = 4). Median time of isavuconazole treatment was 29 days. Only 5.9% (n = 14) of cases developed toxicity, mainly hepatic-related (10 patients, 4.2%). Nine patients (3.8%) had treatment withdrawn. Successful clinical response at 12 weeks was documented in 50.5% of patients., Conclusion: Isavuconazole is an adequate treatment for non-neutropenic patients with IFIs. Toxicity rates were low and its effectiveness was comparable to other antifungal therapies previously reported., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
9. Clinical evaluation of antifungal de-escalation in Candida infections: A systematic review and meta-analysis.
- Author
-
Albanell-Fernández M, Salazar González F, Montero Pérez O, Aniyar V, Carrera Hueso FJ, Soriano A, García-Vidal C, Puerta-Alcalde P, Martínez JA, and Vázquez Ferreiro P
- Subjects
- Humans, Fluconazole therapeutic use, Candida drug effects, Voriconazole therapeutic use, Echinocandins therapeutic use, Treatment Outcome, Azoles therapeutic use, Azoles pharmacology, Antifungal Agents therapeutic use, Candidiasis drug therapy, Candidiasis mortality, Candidiasis microbiology
- Abstract
Objectives: De-escalation (DES) from echinocandins to azoles is recommended by several medical societies in Candida infections. We summarise the evidence of DES on clinical and microbiological cure and 30-day survival and compare it with continuing the treatment with echinocandins (non-DES)., Methods: We searched MEDLINE, Embase, Web of Science and Scopus. Studies describing DES in inpatients and reporting any of the outcomes evaluated were included. Pooled estimates of the tree outcomes were calculated with a fixed or random-effects model. Heterogeneity was explored stratifying by subgroups and via meta-regression. This systematic review is registered with PROSPERO (CRD42023475486)., Results: Of 1853 records identified, 9 studies were included, totalling 1575 patients. Five studies stepped-down to fluconazole; one to voriconazole and three to any of azoles. The mean day of DES was 5.2 (4.6-6.5) days. The clinical cure OR was 1.29 (95% CI: 0.88-1.88); the microbiological cure 1.62 (95% CI: 0.71-3.71); and 30-day survival 2.17 (95% CI: 1.09-4.32). The 30-day survival data into subgroups showed higher effect on critically ill patients and serious-risk bias studies. Meta-regression did not identify significant effect modifiers., Conclusions: DES is a safe strategy; it showed no higher 30-day mortality and a trend towards greater clinical and microbiological cure., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
10. Bacterial co-infection at hospital admission in patients with COVID-19.
- Author
-
Moreno-García E, Puerta-Alcalde P, Letona L, Meira F, Dueñas G, Chumbita M, Garcia-Pouton N, Monzó P, Lopera C, Serra L, Cardozo C, Hernandez-Meneses M, Rico V, Bodro M, Morata L, Fernandez-Pittol M, Grafia I, Castro P, Mensa J, Martínez JA, Sanjuan G, Marcos MA, Soriano A, and Garcia-Vidal C
- Subjects
- Adult, Ferritins, Hospitals, Humans, Procalcitonin, Retrospective Studies, SARS-CoV-2, Bacterial Infections microbiology, COVID-19 epidemiology, Coinfection epidemiology
- Abstract
Objectives: We described the current incidence and risk factors of bacterial co-infection in hospitalized patients with COVID-19., Methods: Observational cohort study was performed at the Hospital Clinic of Barcelona (February 2020-February 2021). All patients with COVID-19 who were admitted for >48 hours with microbiological sample collection and procalcitonin (PCT) determination within the first 48 hours were included., Results: A total of 1125 consecutive adults met inclusion criteria. Co-infections were microbiologically documented in 102 (9.1%) patients. Most frequent microorganisms were Streptococcus pneumoniae (79%), Staphylococcus aureus (6.8%), and Haemophilus influenzae (6.8%). Test positivity was 1% (8/803) for blood cultures, 10.1% (79/780) for pneumococcal urinary antigen test, and 11.4% (15/132) for sputum culture. Patients with PCT higher than 0.2, 0.5, 1, and 2 ng/mL had significantly more co-infections than those with lower levels (p=0.017, p=0.031, p<0.001, and p<0.001, respectively). In multivariate analysis, oxygen saturation ≤94% (OR 2.47, CI 1.57-3.86), ferritin levels <338 ng/mL (OR 2.63, CI 1.69-4.07), and PCT higher than 0.2 ng/mL (OR 1.74, CI 1.11-2.72) were independent risk factors for co-infection at hospital admission owing to COVID-19., Conclusions: Bacterial co-infection in patients hospitalized for COVID-19 is relatively common. However, clinicians could spare antibiotics in patients with PCT values <0.2, especially with high ferritin values and oxygen saturation >94%., Competing Interests: Declaration of Competing Interest CG-V has received honoraria for talks on behalf of Gilead Science, MSD, Novartis, Pfizer, Janssen, Lilly, as well as a grant from Gilead Science and MSD. AS has received honoraria for talks on behalf of Merck Sharp and Dohme, Pfizer, Novartis, Angellini, as well as grant support from Pfizer. PC has received honoraria for talks on behalf of Merck Sharp and Dohme, Pfizer, Gilead, and Alexion. JM has received honoraria for talks on behalf of Merck Sharp and Dohme, Pfizer, Novartis, and Angellini. PP-A has received honoraria for talks on behalf of Merck Sharp and Dohme, Lilly, ViiV Healthcare, and Gilead Science., (Copyright © 2022. Published by Elsevier Ltd.)
- Published
- 2022
- Full Text
- View/download PDF
11. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study.
- Author
-
Garcia-Vidal C, Sanjuan G, Moreno-García E, Puerta-Alcalde P, Garcia-Pouton N, Chumbita M, Fernandez-Pittol M, Pitart C, Inciarte A, Bodro M, Morata L, Ambrosioni J, Grafia I, Meira F, Macaya I, Cardozo C, Casals C, Tellez A, Castro P, Marco F, García F, Mensa J, Martínez JA, and Soriano A
- Subjects
- Aged, Anti-Bacterial Agents therapeutic use, Bacterial Infections microbiology, Bacterial Infections mortality, Bacterial Infections therapy, Bacterial Typing Techniques, Blood Culture methods, COVID-19 mortality, COVID-19 therapy, COVID-19 virology, Coinfection, Community-Acquired Infections, Cross Infection microbiology, Cross Infection mortality, Cross Infection therapy, Female, Hospitalization, Hospitals, Humans, Incidence, Male, Middle Aged, Mycoses microbiology, Mycoses mortality, Mycoses therapy, Retrospective Studies, Spain epidemiology, Sputum microbiology, Superinfection mortality, Superinfection therapy, Superinfection virology, Survival Analysis, Virus Diseases mortality, Virus Diseases therapy, Virus Diseases virology, Bacterial Infections epidemiology, COVID-19 epidemiology, Cross Infection epidemiology, Mycoses epidemiology, SARS-CoV-2 pathogenicity, Superinfection epidemiology, Virus Diseases epidemiology
- Abstract
Objectives: To describe the burden, epidemiology and outcomes of co-infections and superinfections occurring in hospitalized patients with coronavirus disease 2019 (COVID-19)., Methods: We performed an observational cohort study of all consecutive patients admitted for ≥48 hours to the Hospital Clinic of Barcelona for COVID-19 (28 February to 22 April 2020) who were discharged or dead. We describe demographic, epidemiologic, laboratory and microbiologic results, as well as outcome data retrieved from electronic health records., Results: Of a total of 989 consecutive patients with COVID-19, 72 (7.2%) had 88 other microbiologically confirmed infections: 74 were bacterial, seven fungal and seven viral. Community-acquired co-infection at COVID-19 diagnosis was uncommon (31/989, 3.1%) and mainly caused by Streptococcus pneumoniae and Staphylococcus aureus. A total of 51 hospital-acquired bacterial superinfections, mostly caused by Pseudomonas aeruginosa and Escherichia coli, were diagnosed in 43 patients (4.7%), with a mean (SD) time from hospital admission to superinfection diagnosis of 10.6 (6.6) days. Overall mortality was 9.8% (97/989). Patients with community-acquired co-infections and hospital-acquired superinfections had worse outcomes., Conclusions: Co-infection at COVID-19 diagnosis is uncommon. Few patients developed superinfections during hospitalization. These findings are different compared to those of other viral pandemics. As it relates to hospitalized patients with COVID-19, such findings could prove essential in defining the role of empiric antimicrobial therapy or stewardship strategies., (Copyright © 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
12. How I perform hematopoietic stem cell transplantation on patients with a history of invasive fungal disease.
- Author
-
Puerta-Alcalde P, Champlin RE, and Kontoyiannis DP
- Subjects
- Aged, Allografts, Humans, Male, Antifungal Agents therapeutic use, Hematologic Neoplasms immunology, Hematologic Neoplasms therapy, Hematopoietic Stem Cell Transplantation, Invasive Fungal Infections drug therapy, Invasive Fungal Infections immunology
- Abstract
Hematopoietic transplantation is the preferred treatment for many patients with hematologic malignancies. Some patients may develop invasive fungal diseases (IFDs) during initial chemotherapy, which need to be considered when assessing patients for transplantation and treatment posttransplantation. Given the associated high risk of relapse and mortality in the post-hematopoietic stem cell transplantation (HSCT) period, IFDs, especially invasive mold diseases, were historically considered a contraindication for HSCT. Over the last 3 decades, advances in antifungal drugs and early diagnosis have improved IFD outcomes, and HSCT in patients with a recent IFD has become increasingly common. However, an organized approach for performing transplantation in patients with a prior IFD is scarce, and decisions are highly individualized. Patient-, malignancy-, transplantation procedure-, antifungal treatment-, and fungus-specific issues affect the risk of IFD relapse. Effective surveillance to detect IFD relapse post-HSCT and careful drug selection for antifungal prophylaxis are of paramount importance. Antifungal drugs have their own toxicities and interact with immunosuppressive drugs such as calcineurin inhibitors. Immune adjunct cytokine or cellular therapy and surgery can be considered in selected cases. In this review, we critically evaluate these factors and provide guidance for the complex decision making involved in the peri-HSCT management of these patients., (© 2020 by The American Society of Hematology.)
- Published
- 2020
- Full Text
- View/download PDF
13. Predictors of multidrug-resistant Pseudomonas aeruginosa in neutropenic patients with bloodstream infection.
- Author
-
Viasus D, Puerta-Alcalde P, Cardozo C, Suárez-Lledó M, Rodríguez-Núñez O, Morata L, Fehér C, Marco F, Chumbita M, Moreno-García E, Fernández-Avilés F, Gutiérrez-Garcia G, Martínez JA, Mensa J, Rovira M, Esteve J, Soriano A, and Garcia-Vidal C
- Subjects
- Adult, Aged, Area Under Curve, Biomarkers, Female, Humans, Leukocyte Count, Male, Middle Aged, Neutropenia diagnosis, Neutropenia epidemiology, Odds Ratio, Pseudomonas Infections drug therapy, Pseudomonas Infections epidemiology, Risk Factors, Sensitivity and Specificity, Spain epidemiology, Drug Resistance, Multiple, Bacterial, Neutropenia complications, Pseudomonas Infections diagnosis, Pseudomonas Infections etiology, Pseudomonas aeruginosa drug effects
- Abstract
Objectives: To assess risk factors for multidrug-resistant Pseudomonas aeruginosa (MDR-PA) infection in neutropenic patients., Methods: Single-centre retrospective analysis of consecutive bloodstream infection (BSI) episodes (2004-2017, Barcelona). Two multivariate regression models were used at BSI diagnosis and P. aeruginosa detection. Significant predictors were used to establish rules for stratifying patients according to MDR-PA BSI risk., Results: Of 661 Gram-negative BSI episodes, 190 (28.7%) were caused by P. aeruginosa (70 MDR-PA). Independent factors associated with MDR-PA among Gram-negative organisms were haematological malignancy (OR 3.30; 95% CI 1.15-9.50), pulmonary source of infection (OR 7.85; 95% CI 3.32-18.56), nosocomial-acquired BSI (OR 3.52; 95% CI 1.74-7.09), previous antipseudomonal cephalosporin (OR 13.66; 95% CI 6.64-28.10) and piperacillin/tazobactam (OR 2.42; 95% CI 1.04-5.63), and BSI occurring during ceftriaxone (OR 4.27; 95% CI 1.15-15.83). Once P. aeruginosa was identified as the BSI aetiological pathogen, nosocomial acquisition (OR 7.13; 95% CI 2.87-17.67), haematological malignancy (OR 3.44; 95% CI 1.07-10.98), previous antipseudomonal cephalosporin (OR 3.82; 95% CI 1.42-10.22) and quinolones (OR 3.97; 95% CI 1.37-11.48), corticosteroids (OR 2.92; 95% CI 1.15-7.40), and BSI occurring during quinolone (OR 4.88; 95% CI 1.58-15.05) and β-lactam other than ertapenem (OR 4.51; 95% CI 1.45-14.04) were independently associated with MDR-PA. Per regression coefficients, 1 point was assigned to each parameter, except for nosocomial-acquired BSI (3 points). In the second analysis, a score >3 points identified 60 (86.3%) out of 70 individuals with MDR-PA BSI and discarded 100 (84.2%) out of 120 with non-MDR-PA BSI., Conclusions: A simple score based on demographic and clinical factors allows stratification of individuals with bacteraemia according to their risk of MDR-PA BSI, and may help facilitate the use of rapid MDR-detection tools and improve early antibiotic appropriateness., (Copyright © 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
14. Performance of differential time to positivity as a routine diagnostic test for catheter-related bloodstream infections: a single-centre experience.
- Author
-
Orihuela-Martín J, Rodríguez-Núñez O, Morata L, Cardozo C, Puerta-Alcalde P, Hernández-Meneses M, Ambrosioni J, Linares L, Bodro M, de Los Angeles Guerrero-León M, Del Río A, Garcia-Vidal C, Almela M, Pitart C, Marco F, Soriano A, and Martínez JA
- Subjects
- Aged, Aged, 80 and over, Biomarkers, Catheter-Related Infections epidemiology, Catheter-Related Infections etiology, Catheter-Related Infections history, Catheterization, Central Venous adverse effects, Disease Management, Female, History, 21st Century, Humans, Male, Middle Aged, ROC Curve, Reproducibility of Results, Sepsis epidemiology, Sepsis etiology, Sepsis history, Spain epidemiology, Symptom Assessment, Time Factors, Catheter-Related Infections diagnosis, Diagnostic Tests, Routine methods, Diagnostic Tests, Routine standards, Sepsis diagnosis
- Abstract
Objective: To assess the performance of differential time to positivity (DTP) for the diagnosis of catheter-related bloodstream infections (CRBSI)., Methods: From all episodes of bloodstream infections (BSI) diagnosed during a 15-year period (2003-17) those in which a paired set of blood cultures drawn from a catheter and a peripheral vein were positive for the same microorganism and had a clinically and/or microbiologically defined source were selected. To assess diagnostic discrimination ability and accuracy of DTP for CRBSI, area under the receiver operating characteristic curves (AUC) and performance characteristics of a DTP ≥2 h were computed., Results: A total of 512 BSI were included, of which 302 (59%) were CRBSI. Discrimination ability of DTP was low for Staphylococcus aureus (AUC 0.656 ± 0.06), coagulase-negative staphylococci (AUC 0.618 ± 0.081), enterococci (AUC 0.554 ± 0.117) and non-AmpC-producing Enterobacteriaceae (AUC 0.653 ± 0.053); moderate for Pseudomonas aeruginosa (AUC 0.841 ± 0.073), and high for AmpC-producing Enterobacteriaceae (AUC 0.944 ± 0.039). For the entire sample, DTP had a low-to-moderate discrimination ability (AUC 0.698 ± 0.024). A DTP ≥2 h has a low sensitivity for coagulase-negative staphylococci (60%) and very low for S. aureus (34%), enterococci (40%) and non-AmpC-producing Enterobacteriaceae (42%). A DTP cut-off of 1 h improved sensitivity (90%) for AmpC-producing Enterobacteriaceae., Conclusions: Differential time to positivity performs well for diagnosing CRBSI only when AmpC-producing Enterobacteriaceae and P. aeruginosa are involved. Performance is low for common Gram-positive organisms and non-AmpC-producing enteric bacilli; a negative test should not be used to rule out CRBSI due to these microorganisms. A DTP ≥1 h may improve accuracy for AmpC-producing Enterobacteriaceae, particularly Enterobacter spp., (Copyright © 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
15. Current time-to-positivity of blood cultures in febrile neutropenia: a tool to be used in stewardship de-escalation strategies.
- Author
-
Puerta-Alcalde P, Cardozo C, Suárez-Lledó M, Rodríguez-Núñez O, Morata L, Fehér C, Marco F, Del Río A, Martínez JA, Mensa J, Rovira M, Esteve J, Soriano A, and Garcia-Vidal C
- Subjects
- Aged, Bacteremia blood, Bacteremia diagnosis, Bacteremia microbiology, Blood Culture, Febrile Neutropenia blood, Febrile Neutropenia microbiology, Female, Gram-Negative Bacterial Infections blood, Gram-Negative Bacterial Infections microbiology, Gram-Positive Bacterial Infections blood, Gram-Positive Bacterial Infections microbiology, Humans, Male, Middle Aged, Prospective Studies, Anti-Bacterial Agents therapeutic use, Antimicrobial Stewardship methods, Bacteremia drug therapy, Drug Resistance, Multiple, Bacterial physiology, Febrile Neutropenia drug therapy, Gram-Negative Bacterial Infections drug therapy, Gram-Positive Bacterial Infections drug therapy, Neoplasms complications
- Abstract
Objectives: We aimed to describe the current time-to-positivity (TTP) of blood cultures in individuals with onco-haematological diseases with febrile neutropenia. We assessed the probability of having a multidrug-resistant Gram-negative bacilli (MDR-GNB) bloodstream infection (BSI) 24 h after cultures were taken, to use this information for antibiotic de-escalation strategies., Methods: BSI episodes were prospectively collected (2003-2017). When a patient experienced more than one BSI, only one episode was randomly chosen. Time elapsed from the beginning of incubation to a positive reading was observed; TTP was recorded when the first bottle had a positive result., Results: Of the 850 patient-unique episodes, 323 (38%) occurred in acute leukaemia, 185 (21.8%) in non-Hodgkin's lymphoma and 144 (16.9%) in solid neoplasms. Coagulase-negative staphylococci (225; 26.5%), Escherichia coli (207; 26.1%), Pseudomonas aeruginosa (136; 16%), Enterococcus spp. (81; 9.5%) and Klebsiella pneumoniae (67; 7.9%), were the most frequent microorganisms isolated. MDR-GNB were documented in 126 (14.8%) episodes. Median TTP was 12 h (interquartile range 9-16.5 h). Within the first 24 h, 92.1% of blood cultures were positive (783/850). No MDR-GNB was positive over 24 h. Of the 67 (7.9%) episodes with a TTP ≥24 h, 25 (37.3%) occurred in patients who were already receiving active antibiotics against the isolated pathogen. Most common isolations with TTP ≥24 h were coagulase-negative staphylococci, candidaemia and a group of anaerobic GNB., Conclusions: Currently, the vast majority of BSI in individuals with onco-haematological diseases with febrile neutropenia have a TTP <24 h, including all episodes caused by MDR-GNB. Our results support reassessing empiric antibiotic treatment in neutropenic patients at 24 h, to apply antibiotic stewardship de-escalation strategies., (Copyright © 2018. Published by Elsevier Ltd.)
- Published
- 2019
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.