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1. Crimean-Congo Hemorrhagic Fever, Spain, 2013–2021

Author

Helena Miriam Lorenzo Juanes, Cristina Carbonell, Begoña Febrer Sendra, Amparo López-Bernus, Alberto Bahamonde, Alberto Orfao, Carmen Vieira Lista, María Sánchez Ledesma, Ana Isabel Negredo, Beatriz Rodríguez-Alonso, Beatriz Rey Bua, María Paz Sánchez-Seco, Juan Luis Muñoz Bellido, Antonio Muro, and Moncef Belhassen-García

Subjects
Crimean-Congo hemorrhagic fever virus, hemorrhagic fever, viruses, tick-borne infections, zoonoses, Spain, Medicine, Infectious and parasitic diseases, RC109-216
Abstract

Crimean-Congo hemorrhagic fever (CCHF) is a viral infectious disease for which distribution of the main vector, Hyalomma spp. ticks, is expanding. We analyzed all 10 cases of CCHF diagnosed in Spain during 2013–2021; case-patient median age was 56.5 years, and 7 were men. We identified CCHF virus genotypes III and V. Six case-patients acquired the infection in urban areas. Sixty percent of patients were infected in summer and 40% in spring. Two patients met criteria for hemophagocytic syndrome. Seven patients survived. The epidemiologic pattern of CCHF in Spain is based on occasional cases with an elevated mortality rate. Genotype III and, to a less extent also genotype V, CCHF circulates in humans in a common geographic area in Spain. Those data suggest that the expansion pathways are complex and may change over time. Physicians should remain alert to the possibility of new CCHF cases.

Published
2023
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2. Establishment and Persistence of Glycopeptide-Resistant Enterococcus faecium ST80 and ST117 Clones Within a Health Care Facility Located in a Low-Prevalence Geographical Region

Author

Carlos Rodríguez-Lucas, Javier Fernández, Alberto Bahamonde, Carmen Raya, Rosario Muñoz, M. R. Rodicio, and Antonio Quiroga

Subjects
Microbiology (medical), Pharmacology, Glycopeptide resistant enterococcus, biology, Immunology, Nosocomial pathogens, Dose dependence, biochemical phenomena, metabolism, and nutrition, biology.organism_classification, Microbiology, Persistence (computer science), chemistry.chemical_compound, chemistry, Vancomycin resistant, Linezolid, medicine, Daptomycin, Enterococcus faecium, medicine.drug
Abstract

Vancomycin-resistant Enterococcus faecium (VREfm) is one of the most important nosocomial pathogens with limited therapeutic alternatives. In this study, we followed the trends of VREfm and E. faecium causing bloodstream infections (BSIs) in a Spanish hospital, from 2011 to 2020. During this period, 832 E. faecium strains were isolated and 121 (14.5%) were vancomycin resistant. Nineteen of 101 BSIs (18.8%) caused by E. faecium were due to VREfm. The number of BSI-producing E. faecium isolates increased significantly over the past 5 years, with the percentage of invasive VREfm isolates being substantially higher than the average values in Europe and especially in Spain (

Published
2022
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3. Modelo Predictivo de la No Unión de Tibia

Author

Matías Alejandro Vaccia, Luis Felipe Ramirez, Andrés Sebastián Oyarzún, Gabriel Ignacio Durán, Carlos Felipe Albarrán, Luis Alberto Bahamonde, Alvaro Zamorano, and Pierluca Zecchetto

Subjects
030222 orthopedics, 03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, Orthopedics and Sports Medicine, Surgery, 030212 general & internal medicine, business, Humanities, Non union
Abstract

Resumen Objetivos Estimar un modelo predictivo para la no-unión en pacientes que presentan fractura de tibia. Materiales y Métodos Estudio de cohorte retrospectivo, en pacientes con fractura de tibia operadas entre 2012 y 2018, con un mínimo de 12 meses de seguimiento, excluyendo amputaciones traumáticas. Realizamos un modelo de regresión logística con 13 variables descritas en la literatura. Se descartaron las variables estadísticamente no significativas y las que no causaban efecto de confusión. Se evaluó la bondad de ajuste mediante el test de Hosmer-Lemeshow y la discriminación del modelo con la curva ROC. Resultados Se incluyeron 411 fracturas de tibia, las variables estadísticamente significativas fueron: exposición ósea OR = 2,57(IC:1,15–5,75, p = 0,022), diabetes OR = 3,29(IC:1,37–7,91, p = 0,008) y uso de tutor externo OR = 1,77(IC:0,81–3,85), el que tuvo efecto de confusión. La bondad de ajuste demostró que los datos se ajustan adecuadamente al modelo (p = 0,35). La curva ROC demuestra un 70,91% de poder discriminatorio. Al evaluar aisladamente las fracturas expuestas, no hubo asociación estadísticamente significativa con ninguna variable. Discusión Al evaluar el modelo, obtuvimos una asociación estadísticamente significativa entre: no unión, exposición ósea, diabetes y uso de tutor externo, información concordante con la literatura. Al estudiar el subgrupo de fracturas expuestas, las demás variables son estadísticamente no significativas. Eso refleja que la exposición ósea es la variable que confiere mayor riesgo. El seguimiento adecuado de esos pacientes es fundamental dado este alto riesgo de evolucionar con no-unión. Conclusión En nuestra serie, la exposición ósea es el factor de riesgo más importante para presentar no unión de tibia.

Published
2020
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4. Does my patient really need this at admission? Seven opportunities for improving value in patient care during their hospitalization

Author

Luis Corral-Gudino, Ana González-Fernández, Martín Ortega-Gil, Alberto Bahamonde-Carrasco, Miriam Rodríguez-María, Ana Tierra-Rodríguez, Paula Runza-Buznego, Ester Hernández-Martín, Alicia Rivas-Lamazares, and Carmen Aguilera-Sanz

Subjects
Adult, Quality Control, medicine.medical_specialty, medicine.medical_treatment, Urinary system, Psychological intervention, Unnecessary Procedures, 030204 cardiovascular system & hematology, Health Services Misuse, Bed rest, Tertiary Care Centers, 03 medical and health sciences, 0302 clinical medicine, Patients' Rooms, Internal Medicine, medicine, Humans, In patient, 030212 general & internal medicine, Evidence-Based Medicine, business.industry, Stress ulcer, Atrial fibrillation, Evidence-based medicine, medicine.disease, Hospitalization, Venous thrombosis, Medicalization, Practice Guidelines as Topic, Emergency medicine, Patient Care, business
Abstract

Introduction Besides the main treatment for their disease, hospital patients receive multiple care measures which include venous lines (VL), urinary catheters (UC), dietary restrictions (DR), mandatory bed rest (BR), deep venous thrombosis prophylaxis (VTP), stress ulcer prophylaxis (SUP) and anticoagulation bridge therapy for atrial fibrillation (BAF). In many cases these practices are of low value. Methods We analysed patients admitted to Internal Medicine wards throughout 2018 (2714 inpatients). We used different methodologies to identify low-value clinical practices. Results BR or DR at admission were recommended in 37% (32–44) and 24% (19–30) of the patients respectively. In 81% (71–87) and 33% (21–45) of the cases this restriction was deemed unnecessary. Ninety-six percent (92–98) had VL and 25% (19–32) UC. VL were not used in 10% (6–12), UC had no indications for insertion in 21% (11–35) and for maintenance in 31% (12–46) patients. Fifty-seven percent (49–64) of the patients were administered VTP and 69% (62–76) were prescribed SUP. Twenty-two percent (15–31) of patients with VTP and 52% (43–60) with SUP had no indication. Chronic anticoagulation for AF was interrupted in 65% (53–75) with BAF was prescribed in 38% (25–52) of them. An intervention to reduce low-value care supporting clinical practices addressed only to the Internal Medicine Wards showed very poor results. Conclusion These results demonstrate that there is ample room for reduction of low-value care. Interventions to implement clinical guidelines at admissions should be addressed to cover the entire admission process, from the emergency room to the ward. Partial approaches are discouraged.

Published
2019
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5. Infections after spine instrumentation: effectiveness of short antibiotic treatment in a large multicentre cohort

Author

Luisa Sorlí, Dolors Rodríguez-Pardo, David Rodriguez-Montserrat, Oscar Murillo, Beatriz Sobrino-Diaz, Luis F Caballero-Martinez, Andrés Nodar, María Dolores Del Toro López, Joan Duran, Elena Muñez, Carlos Pigrau, Marta Ulldemolins, Maria Jose Garcia-Pais, Reipi, Javier Ariza, Helem H Vilchez, Eva Benavent, Rosa Escudero-Sánchez, Javier Cobo, Susana Núñez-Pereira, María Jesús Bustinduy, Alberto Bahamonde, María Teresa Pérez-Rodríguez, Ferran Pellisé, Instituto de Salud Carlos III, and Ministerio de Ciencia e Innovación (España)

Subjects
musculoskeletal diseases, Microbiology (medical), medicine.medical_specialty, Prosthesis-Related Infections, medicine.drug_class, Antibiotics, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Humans, Medicine, Pharmacology (medical), 030212 general & internal medicine, Retrospective Studies, Pharmacology, business.industry, Proportional hazards model, Retrospective cohort study, medicine.disease, Comorbidity, Anti-Bacterial Agents, Treatment Outcome, Infectious Diseases, Debridement, Propensity score matching, Cohort, Coinfection, Female, Implant, business, 030217 neurology & neurosurgery
Abstract

REIPI (Spanish Network for Research in Infectious Disease)/GEIO–SEIMC (Group for the Study of Osteoarticular Infections – Spanish Society of Infectious Diseases and Clinical Microbiology)., [Background and objectives] Available information about infection after spine instrumentation (IASI) and its management are scarce. We aimed to analyse DAIR (debridement, antibiotics and implant retention) prognosis and evaluate effectiveness of short antibiotic courses on early forms., [Methods] Multicentre retrospective study of patients with IASI managed surgically (January 2010–December 2016). Risk factors for failure were analysed by multivariate Cox regression and differences between short and long antibiotic treatment were evaluated with a propensity score-matched analysis., [Results] Of the 411 IASI cases, 300 (73%) presented in the first month after surgery, 48 in the second month, 22 in the third and 41 thereafter. Infections within the first 2 months (early cases) occurred mainly to older patients, with local inflammatory signs and predominance of Enterobacteriaceae, unlike those in the later periods. When managed with DAIR, prognosis of early cases was better than later ones (failure rate 10.4% versus 26.1%, respectively; P = 0.02). Risk factors for DAIR failure in early cases were female sex, Charlson Score, large fusions (>6 levels) and polymicrobial infections (adjusted HRs of 2.4, 1.3, 2.6 and 2.26, respectively). Propensity score matching proved shorter courses of antibiotics (4–6 weeks) as effective as longer courses (failure rates 11.4% and 10.5%, respectively; P = 0.870)., [Conclusions] IASIs within the first 2 months could be managed effectively with DAIR and shorter antibiotic courses. Clinicians should be cautious when faced with patients with comorbidities, large fusions and/or polymicrobial infections., E.B. was supported with a grant of the Instituto de Salud Carlos III – Ministry of Science and Innovation (FI 16/00397). This research was carried out as part of our routine work.

Published
2021

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

Author

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

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

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

Published
2021

7. Methylprednisolone in adults hospitalized with COVID-19 pneumonia : An open-label randomized trial (GLUCOCOVID)

Author

Ana Cerezo-Hernández, Fernando Hernández-Blanco, Jesica Abadía-Otero, Julia Gómez-Barquero, José A. Riancho, Luis Nieto, Luis Corral-Gudino, Víctor Mora, Alberto Bahamonde, María Carmen Fariñas, Francisco Arnaiz-Revillas, José M. Cifrián, Miguel F Carrascosa, José L. Hernández, José M. Olmos, Graciela Lopez-Muniz, and Carmen García-Ibarbia

Subjects
Adult, medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, Lower risk, Methylprednisolone, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Clinical endpoint, Humans, 030212 general & internal medicine, Mortality, Glucocorticoids, Aged, Mechanical ventilation, business.industry, SARS-CoV-2, COVID-19, General Medicine, Intensive care unit, Respiration, Artificial, Confidence interval, Treatment Outcome, Relative risk, Original Article, business, Coronavirus Infections, medicine.drug
Abstract

Summary Purpose To determine whether a 6-day course of methylprednisolone (MP) improves outcome in patients with severe SARS-CoV‑2 (Corona Virus Disease 2019 [COVID-19]). Methods The study was a multicentric open-label trial of COVID-19 patients who were aged ≥ 18 years, receiving oxygen without mechanical ventilation, and with evidence of systemic inflammatory response who were assigned to standard of care (SOC) or SOC plus intravenous MP (40 mg bid for 3 days followed by 20 mg bid for 3 days). The primary outcome was a composite of death, admission to the intensive care unit, or requirement for noninvasive ventilation. Both intention-to-treat (ITT) and per protocol (PP) analyses were performed. Results A total of 91 patients were screened, and 64 were randomized (mean age70 ± 12 years). In the ITT analysis, 14 of 29 patients (48%) in the SOC group and 14 of 35 (40%) in the MP group suffered the composite endpoint (40% versus 20% in patients under 72 years and 67% versus 48% in those over 72 years; p = 0.25). In the PP analysis, patients on MP had a significantly lower risk of experiencing the composite endpoint (age-adjusted risk ratio 0.42; 95% confidence interval, CI 0.20–0.89; p = 0.043). Conclusion The planned sample size was not achieved, and our results should therefore be interpreted with caution. The use of MP had no significant effect on the primary endpoint in ITT analysis; however, the PP analysis showed a beneficial effect due to MP, which consistent with other published trials support the use of glucocorticoids in severe cases of COVID-19. Supplementary Information The online version of this article (10.1007/s00508-020-01805-8) contains supplementary material, which is available to authorized users.

Published
2020

8. The Not-So-Good Prognosis of Streptococcal Periprosthetic Joint Infection Managed by Implant Retention

Author

María Dolores del Toro, Matteo Ferrari, Rafael San Juan, Cédric Arvieux, Benjamin M. Clark, Joshua S. Davis, Tristan Ferry, Trisha Peel, Jaime Lora-Tamayo, Eric Senneville, Louis Bernard, Efthymia Giannitsioti, Dace Vigante, Antonio Ramos, José Antonio Iribarren, Dolors Rodríguez-Pardo, Melchor Riera, L Guio, N. Benito, Daniëlle Neut, Rihard Trebše, Karina O'Connell, Craig A Aboltins, Michel Dupon, Alfredo Jover-Sáenz, H K Li, Peter F. M. Choong, Alberto Bahamonde, Josu Baraia-Etxaburu, Thomas Gottlieb, Jaime Esteban, M Jose G. Pais, Mauro José Costa Salles, Kaisa Huotari, Severine Ansart, Alex Soriano, Martin Clauss, Parham Sendi, Nathalie Asseray, Alba Ribera, Nina Gorisek Miksic, Mar Sánchez-Somolinos, Gábor Skaliczki, Lucía Gómez, Javier Ariza, Valérie Zeller, Juan Pablo Horcajada, Julián Palomino, Javier Cobo, Marta Fernandez-Sampedro, Alicia Rico, Ulrike Dapunt, Gwenael Le Moal, Ilker Uçkay, José Maria Barbero, and Werner Zimmerli

Subjects
0301 basic medicine, Male, Internationality, Periprosthetic, Arthritis, Salvage therapy, SUSCEPTIBILITY, GUIDELINES, biofilm, 0302 clinical medicine, bone and joint infection, Clinical endpoint, 030212 general & internal medicine, Treatment Failure, Prosthesis-Related Infection, 610 Medicine & health, PREDICTORS, RISK, Hazard ratio, Prognosis, 3. Good health, Anti-Bacterial Agents, ETIOLOGY, Infectious Diseases, Female, Rifampin, ANTIBIOTICS, rifampin, Microbiology (medical), medicine.medical_specialty, Prosthesis-Related Infections, 030106 microbiology, beta-Lactams, Streptococcus agalactiae, 03 medical and health sciences, PROSTHESIS, Streptococcal Infections, TREATMENT FAILURE, medicine, Humans, DAIR, Aged, Retrospective Studies, STAPHYLOCOCCUS-AUREUS, Salvage Therapy, Arthritis, Infectious, business.industry, Retrospective cohort study, DEBRIDEMENT, medicine.disease, Surgery, Debridement, Bacteremia, Biofilms, 570 Life sciences, biology, business
Abstract

Background.: Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success.Methods.: A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy.Results.: Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34).Conclusions.: This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin.

Published
2017
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9. Far Proximal and Far Distal Tibial Fractures: Management with Intramedullary Nails

Author

Alvaro Zamorano, Pierluca Zecchetto, and Luis Alberto Bahamonde

Subjects
Intramedullary rod, medicine.medical_specialty, business.industry, law, InformationSystems_INFORMATIONSTORAGEANDRETRIEVAL, Medicine, business, GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries), law.invention, Surgery
Published
2020

10. Suppressive antibiotic therapy in prosthetic joint infections: a multicentre cohort study

Author

N. Benito, M. Digumber, Jesús Cobo, G. Fresco, Dolors Rodríguez-Pardo, Alicia Rico, Marta S. Fernández, Javier Ariza, Eric Senneville, Maria Jose Garcia-Pais, Jose Antonio Iribarren, M.D. del Toro, J.L. del Pozo, A. Soriano, Alfonso Muriel, Oscar Murillo, L Guio, Alberto Bahamonde, Rosa Escudero-Sánchez, and Universidad de Cantabria

Subjects
0301 basic medicine, Microbiology (medical), Male, medicine.medical_specialty, Prosthetic joint infection, Prosthesis-Related Infections, Prosthetic Joint Infection, Suppressive Antibiotic Treatment, medicine.drug_class, Fistula, medicine.medical_treatment, 030106 microbiology, Antibiotics, Prosthesis, Suppressive antibiotic treatment, 03 medical and health sciences, Postoperative complications, Postoperative Complications, 0302 clinical medicine, Internal medicine, medicine, Humans, 030212 general & internal medicine, Prosthesis-Related Infection, Aged, Retrospective Studies, Aged, 80 and over, Arthritis, Infectious, Debridement, Bacteria, business.industry, General Medicine, Middle Aged, medicine.disease, Anti-Bacterial Agents, Infectious Diseases, Treatment Outcome, Female, Implant, business, Cohort study
Abstract

Objectives: The aim was to describe the effectiveness of suppressive antibiotic treatment (SAT) in routine clinical practice when used in situations in which removal of a prosthetic implant is considered essential for the eradication of an infection, and it cannot be performed. Methods: This was a descriptive retrospective and multicentre cohort study of prosthetic joint infection (PJI) cases managed with SAT. SAT was considered to have failed if a fistula appeared or persisted, if debridement was necessary, if the prosthesis was removed due to persistence of the infection or if uncontrolled symptoms were present. Results: In total, 302 patients were analysed. Two hundred and three of these patients (67.2%) received monotherapy. The most commonly used drugs were tetracyclines (39.7% of patients) (120/302) and cotrimoxazole (35.4% of patients) (107/302). SAT was considered successful in 58.6% (177/302) of the patients (median time administered, 36.5 months; IQR 20.75-59.25). Infection was controlled in 50% of patients at 5 years according to Kaplan-Meier analysis. Resistance development was documented in 15 of 65 (23.1%) of the microbiologically documented cases. SAT failure was associated with age

Published
2019

11. Revisiting the epidemiology of bloodstream infections and healthcare-associated episodes: results from a multicentre prospective cohort in Spain (PRO-BAC Study)

Author

Carmen Herrero Rodríguez, Clara Natera Kindelán, Teresa Marrodan Ciordia, Marcos Guzmán García, Juan Sevilla Blanco, Lucía Boix-Palop, Carlos Armiñanzas Castillo, Adrian Sousa Domínguez, Luis Eduardo López-Cortés, Alfredo Jover Saenz, Alberto Bahamonde-Carrasco, María Ángeles Mantecon Vallejo, Isabel María Reche Molina, María Luisa Cantón-Bulnes, José María Reguera-Iglesias, Eva León Jiménez, Berta Becerril Carral, Inmaculada López-Hernández, Jesús Rodríguez-Baño, Alfonso Del Arco Jiménez, José Bravo-Ferrer, Joaquín Felipe Lanz-García, Esperanza Merino de Lucas, Antonio Sánchez-Porto, Josune Goikoetxea Aguirre, David Garcia, Inés Pérez Camacho, Fátima Galán-Sánchez, Jonathan Fernández Suárez, Pedro María Martínez Pérez-Crespo, Alejandro Smithson Amat, Jordi Cuquet Pedragosa, Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), Red Española de Investigación en Patología Infecciosa, and European Commission

Subjects
Adult, Male, 0301 basic medicine, Microbiology (medical), Staphylococcus aureus, medicine.medical_specialty, Multivariate analysis, Adolescent, Epidemiology, 030106 microbiology, Bacteremia, Bloodstream infection, Healthcare-associated, Logistic regression, Severity of Illness Index, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Interquartile range, Klebsiella, Internal medicine, Escherichia coli, medicine, Humans, Pharmacology (medical), Prospective Studies, 030212 general & internal medicine, Aetiology, Prospective cohort study, Aged, Aged, 80 and over, Cross Infection, business.industry, Mortality rate, General Medicine, Middle Aged, Confidence interval, Community-Acquired Infections, Infectious Diseases, Spain, Etiology, Bacteraemia, Female, business
Abstract

PROBAC REIPI/GEIH-SEIMC/SAEI Group., The epidemiology of bloodstream infections (BSIs) is dynamic as it depends on microbiological, host and healthcare system factors. The aim of this study was to update the information regarding the epidemiology of BSIs in Spain considering the type of acquisition. An observational, prospective cohort study in 26 Spanish hospitals from October 2016 through March 2017 including all episodes of BSI in adults was performed. Bivariate analyses stratified by type of acquisition were performed. Multivariate analyses were performed by logistic regression. Overall, 6345 BSI episodes were included; 2510 (39.8%) were community-acquired (CA), 1661 (26.3%) were healthcare-associated (HCA) and 2056 (32.6%) hospital-acquired (HA). The 30-day mortality rates were 11.6%, 19.5% and 22.0%, respectively. The median age of patients was 71 years (interquartile range 60–81 years) and 3656 (58.3%; 95% confidence interval 57.1–59.6%) occurred in males. The proportions according to patient sex varied according to age strata. Escherichia coli (43.8%), Klebsiella spp. (8.9%), Staphylococcus aureus (8.9%) and coagulase-negative staphylococci (7.4%) were the most frequent pathogens. Multivariate analyses confirmed important differences between CA and HCA episodes, but also between HCA and HA episodes, in demographics, underlying conditions and aetiology. In conclusion, we have updated the epidemiological information regarding patients’ profiles, underlying conditions, frequency of acquisition types and aetiological agents of BSI in Spain. HCA is confirmed as a distinct type of acquisition., This work was financed by grants from Plan Nacional de I+D+i 2013–2016, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades [PI16/01432] and the Spanish Network for Research in Infectious Diseases (REIPI) [RD16/0016/0001; RD16/0016/0008], co‐financed by the European Development Regional Fund ‘A way to achieve Europe’, Operative program Intelligent Growth 2014–2020.

Published
2021
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12. Characteristics of prosthetic joint infections due to Enterococcus sp. and predictors of failure: a multi-national study

Author

M.D. del Toro, N. Benito, Josu Baraia-Etxaburu, Dolors Rodríguez-Pardo, Julián Palomino, Javier Ariza, Alberto Bahamonde, B. Lakatos, Melchor Riera, Alfredo Jover-Sáenz, Alex Soriano, Eduard Tornero, Eric Senneville, Luisa Sorlí, Matteo Ferrari, Rihard Trebše, Sabine Petersdorf, M. Pilares, Antonio Ramos, and G. Euba

Subjects
Microbiology (medical), medicine.medical_specialty, Poor prognosis, Prosthetic joint, medicine.medical_treatment, Enterococcus faecium, Enterococcus faecalis, Internal medicine, medicine, one-stage exchange, prosthetic joint infection, biology, business.industry, General Medicine, Enterococcus sp, biology.organism_classification, medicine.disease, Comorbidity, Arthroplasty, Surgery, Multi national, Infectious Diseases, Debridement, outcome, business, two-stage exchange
Abstract

The objective of this study was to review the characteristics and outcome of prosthetic joint infections (PJI) due to Enterococcus sp. collected in 18 hospitals from six European countries. Patients with a PJI due to Enterococcus sp. diagnosed between January 1999 and July 2012 were retrospectively reviewed. Relevant information about demographics, comorbidity, clinical characteristics, microbiological data, surgical treatment and outcome was registered. Univariable and multivariable analyses were performed. A total of 203 patients met the inclusion criteria. The mean (SD) was 70.4 (13.6) years. In 59 patients the infection was diagnosed within the first 30 days (29.1%) from arthroplasty, in 44 (21.7%) between 31 and 90 days, in 54 (26.6%) between 91 days and 2 years and in 43 (21%) after 2 years. Enterococcus faecalis was isolated in 176 cases (89%). In 107 (54%) patients the infection was polymicrobial. Any comorbidity (OR 2.53, 95% CI 1.18–5.40, p 0.01), and fever (OR 2.65, 95% CI 1.23–5.69, p 0.01) were independently associated with failure. The only factor associated with remission was infections diagnosed later than 2 years (OR 0.25, 95% CI 0.09–0.71, p 0.009). In conclusion, prosthetic joint infections due to Enterococcus sp. were diagnosed within the first 2 years from arthroplasty in >70% of the patients, almost 50% had at least one comorbidity and infections were frequently polymicrobial (54%). The global failure rate was 44% and patients with comorbidities, fever, and diagnosed within the first 2 years from arthroplasty had a poor prognosis.

Published
2014
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13. A Large Multicenter Study of Methicillin–Susceptible and Methicillin–Resistant Staphylococcus aureus Prosthetic Joint Infections Managed With Implant Retention

Author

Teresa Álvarez, Julián Palomino, Jaime Lora-Tamayo, Miguel A. Muniain, Mercedes Marín, Enrique Moreno, Javier Cobo, Roger Sordé, Antonio Ramírez, Laura Iogna Prat, Salvador Pedrero, Marcos Jordán, Luis García-Paíno, Rodrigo García, Xavier Cabo, Lluís Puig, Carlos Pigrau, Dolors Rodríguez-Pardo, N. Benito, Melchor Riera, J.C. Martínez-Pastor, Oscar Murillo, Isabel Nieto, Alfredo Jover-Sáenz, Maitane Elola, Ana-Isabel Suárez, M. Gomez, Pedro Cano, Javier Ariza, Alberto Bahamonde, Juan Miguel Santamaría, Juan Pablo Horcajada, Alicia Rico, Miguel Ángel Goenaga, José Antonio Iribarren, Vicente Pintado, Iñigo López, Alex Soriano, Sebastián García-Ramiro, Juan Amador-Mellado, Paula González-Miguez, Manuel Villanueva, Antonio Ramos, G. Euba, Luisa Sorlí, Eduardo Garagorri, Juan M. García-Lechuz, Ferran Pérez, María Dolores del Toro, María Franco, Andres Puente, Elena Múñez, A. Granados, Pere Coll, Josu Miren Baraia-Etxaburu, Carlos Fuster-Foz, Carmen Marinescu, Fernando Barcenilla, Xavier Flores, Mar Sánchez-Somolinos, Ramón Cisterna, María Antonia Maseguer, and Eduard Tornero

Subjects
Adult, Male, Methicillin-Resistant Staphylococcus aureus, Microbiology (medical), Staphylococcus aureus, medicine.medical_specialty, Prosthesis-Related Infections, medicine.drug_class, medicine.medical_treatment, Antibiotics, Salvage therapy, medicine.disease_cause, Prosthesis, Humans, Medicine, Treatment Failure, Aged, Retrospective Studies, Aged, 80 and over, Arthritis, Infectious, business.industry, Proportional hazards model, Incidence (epidemiology), Retrospective cohort study, Middle Aged, Staphylococcal Infections, biochemical phenomena, metabolism, and nutrition, Prognosis, bacterial infections and mycoses, Methicillin-resistant Staphylococcus aureus, Anti-Bacterial Agents, Surgery, Treatment Outcome, Infectious Diseases, Female, Rifampin, business, Methicillin Susceptible Staphylococcus Aureus
Abstract

Background. Several series predicting the prognosis of staphylococcal prosthetic joint infection (PJI) managed with debridement, antibiotics, and implant retention (DAIR) have been published, but some of their conclusions are controversial. At present, little is known regarding the efficacy of the different antibiotics that are used or their ability to eliminate methicillin-resistant S. aureus (MRSA) infection. Methods. This was a retrospective, multicenter, observational study of cases of PJI by S. aureus that were managed with DAIR (2003–2010). Cases were classified as failures when infection persistence/relapse, death, need for salvage therapy, or prosthesis removal occurred. The parameters that predicted failure were analyzed with logistic and Cox regression. Results. Out of 345 episodes (41% men, 73 years), 81 episodes were caused by MRSA. Fifty-two were hematogenous, with poorer prognoses, and 88% were caused by methicillin-susceptible S. aureus (MSSA). Antibiotics were used for a median of 93 days, with similar use of rifampin-based combinations in MSSA- and MRSA-PJI. Failure occurred in 45% of episodes, often early after debridement. The median survival time was 1257 days. There were no overall prognostic differences between MSSA- and MRSA-PJI, but there was a higher incidence of MRSA-PJI treatment failure during the period of treatment (HR 2.34), while there was a higher incidence of MSSA-PJI treatment failure after therapy. Rifampin-based combinations exhibited an independent protective effect. Other independent predictors of outcome were polymicrobial, inflammatory, and bacteremic infections requiring more than 1 debridement, immunosuppressive therapy, and the exchange of removable components of the prosthesis. Conclusions. This is the largest series of PJI by S. aureus managed with DAIR reported to date. The success rate was 55%. The use of rifampin may have contributed to homogenizing MSSA and MRSA prognoses, although the specific rifampin combinations may have had different efficacies.

Published
2012
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14. Bone Tumors Around the Knee: Risks and Benefits of Arthroscopic Procedures

Author

Jaime Catalán and Luis Alberto Bahamonde

Subjects
musculoskeletal diseases, medicine.medical_specialty, Knee Joint, medicine.diagnostic_test, business.industry, Biopsy, Arthroscopy, Soft tissue, Bone Neoplasms, Soft Tissue Neoplasms, Magnetic resonance imaging, Surgery, Endoscopy, Therapeutic approach, Primary bone, Humans, Medicine, Orthopedics and Sports Medicine, Radiology, business
Abstract

Although most primary bone tumors and soft tissue tumors arise around the knee joint, many patients with tumoral conditions attribute their symptoms to traumatic events. This may lead to misdiagnosis and mistakes in selection of therapeutic approach. Arthroscopy is the preferred method for diagnosis and treatment of knee joint disease, but even a minimally invasive procedure may have adverse consequences in the presence of an unsuspected neoplasm. Thus, evaluation of all patients who may benefit from knee arthroscopy requires a careful and systematic workup that consists of appropriate noninvasive imaging studies and thoughtful consideration regarding the need for magnetic resonance imaging. Arthroscopic biopsy and treatment are recommended for selected intra-articular tumors. In addition, arthroscopy is a useful adjunct during surgical treatment of patients with certain juxta-articular benign bone tumors. In this Current Concepts review, we consider the risks and benefits of arthroscopy in the presence of tumors about the knee joint.

Published
2006
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15. Mediterranean spotted fever with lymphangitis occurring from a tick bite lesion. A case in Spain

Author

Juan Manuel Barja López, Alberto Bahamonde Carrasco, Antonio Alija Senra, Jose Antonio Manjón Haces, and Francisco Soto del Moral

Subjects
Mediterranean climate, medicine.medical_specialty, biology, business.industry, Dermatology, Tick, biology.organism_classification, medicine.disease, Spotted fever, Lesion, Lymphangitis, medicine, medicine.symptom, business
Published
2015
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16. Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study

Author

Regino Rodriguez Alvarez, S. Ibarra, Isabel Mur, Lluís Puig, Carlos Pigrau, Virginia Plasencia, Elena Sandoval, Pablo S. Corona, C. Garcés-Zarzalejo, María Carmen Fariñas, M.Á. Muniain-Ezcurra, C.I. Marinescu, Eduard Tornero, J.C. Martínez-Pastor, Beatriz Sobrino, Xavier Crusi, Ferran Pérez-Villar, M. Dolores del Toro, Juan Miguel Santamaría, M. López-Pliego, Antonio Ramos, C. Rodríguez-Alonso, Jaime Lora-Tamayo, Alberto Bahamonde, R. Muedra-Font, Ramón Cisterna, A I Suárez, Joaquín García-Cañete, P. Ruiz-Carbajosa, G. Euba, Javier Cobo, Albert Alier, R. Cabo-Magadan, C. Raya-Fernández, N. Benito, Itziar Angulo López, Julián Palomino, Melchor Riera, Oscar Murillo, M. Fernández-Sampedro, L Guio, Marcos Jordán, Andres Puente, Lluisa Sorli, Carlos Salas-Venero, C. Fariñas-Álvarez, Dolors Rodríguez-Pardo, J. Merino-Pérez, S. Pedrero, Antonio Ramírez, S. García, M. Franco, David Vinuesa García, Luis Martínez-Martínez, E. Sánchez-Rivas, Alfredo Jover-Sáenz, Asunción Moreno, Carlos Dueñas, C. Peñas-Espinar, F. Montaner, José Cordero, S. Álvarez-Parrondo, M. Lung, J.M. Montejo, Andreu Combalia, Antonio Blanco, Javier Ariza, Juan Pablo Horcajada, M. Fakkas-Fernández, F. Barcenilla, Alba Ribera, J. Martínez-Alvarez, Laura Prats-Gispert, Pere Coll, J. Cabo, Jaime Esteban, Álvaro Auñón, G. Fresco, L. Morata, Josu Baraia-Etxaburu, M.A. Blanco-Martínez-de-Morentin, Alex Soriano, [Benito, N.] Inst Invest Biomed St Pau, Hosp Santa Creu & St Pau, Infect Dis Unit, St Antoni Maria Claret 167, Barcelona 08025, Spain, [Franco, M.] Inst Invest Biomed St Pau, Hosp Santa Creu & St Pau, Infect Dis Unit, St Antoni Maria Claret 167, Barcelona 08025, Spain, [Mur, I.] Inst Invest Biomed St Pau, Hosp Santa Creu & St Pau, Infect Dis Unit, St Antoni Maria Claret 167, Barcelona 08025, Spain, [Benito, N.] Univ Autonoma Barcelona, Dept Med, Barcelona, Spain, [Franco, M.] Univ Autonoma Barcelona, Dept Med, Barcelona, Spain, [Benito, N.] Inst Salud Carlos III, Spanish Network Res Infect Dis REIPI RD12 0015, Madrid, Spain, [Ribera, A.] Inst Salud Carlos III, Spanish Network Res Infect Dis REIPI RD12 0015, Madrid, Spain, [Soriano, A.] Inst Salud Carlos III, Spanish Network Res Infect Dis REIPI RD12 0015, Madrid, Spain, [Rodriguez-Pardo, D.] Inst Salud Carlos III, Spanish Network Res Infect Dis REIPI RD12 0015, Madrid, Spain, [Fresco, G.] Inst Salud Carlos III, Spanish Network Res Infect Dis REIPI RD12 0015, Madrid, Spain, [Fernandez-Sampedro, M.] Inst Salud Carlos III, Spanish Network Res Infect Dis REIPI RD12 0015, Madrid, Spain, [Dolores del Toro, M.] Inst Salud Carlos III, Spanish Network Res Infect Dis REIPI RD12 0015, Madrid, Spain, [Guio, L.] Inst Salud Carlos III, Spanish Network Res Infect Dis REIPI RD12 0015, Madrid, Spain, [Sanchez-Rivas, E.] Inst Salud Carlos III, Spanish Network Res Infect Dis REIPI RD12 0015, Madrid, Spain, [Riera, M.] Inst Salud Carlos III, Spanish Network Res Infect Dis REIPI RD12 0015, Madrid, Spain, [Euba, G.] Inst Salud Carlos III, Spanish Network Res Infect Dis REIPI RD12 0015, Madrid, Spain, [Morata, L.] Inst Salud Carlos III, Spanish Network Res Infect Dis REIPI RD12 0015, Madrid, Spain, [Pigrau, C.] Inst Salud Carlos III, Spanish Network Res Infect Dis REIPI RD12 0015, Madrid, Spain, [Coll, P.] Inst Salud Carlos III, Spanish Network Res Infect Dis REIPI RD12 0015, Madrid, Spain, [Ariza, J.] Inst Salud Carlos III, Spanish Network Res Infect Dis REIPI RD12 0015, Madrid, Spain, [Ribera, A.] Hosp Univ Bellvitge, Dept Infect Dis, Barcelona, Spain, [Euba, G.] Hosp Univ Bellvitge, Dept Infect Dis, Barcelona, Spain, [Ariza, J.] Hosp Univ Bellvitge, Dept Infect Dis, Barcelona, Spain, [Soriano, A.] Hosp Clin Univ, Dept Infect Dis, Barcelona, Spain, [Morata, L.] Hosp Clin Univ, Dept Infect Dis, Barcelona, Spain, [Rodriguez-Pardo, D.] Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain, [Pigrau, C.] Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain, [Sorli, L.] Hosp del Mar, Dept Infect Dis, Barcelona, Spain, [Fresco, G.] Hosp Univ Ramon & Cajal, Dept Infect Dis, Madrid, Spain, [Dolores del Toro, M.] Hosp Univ Virgen Macarena, Dept Infect Dis, Seville, Spain, [Guio, L.] Hosp Univ Cruces, Dept Infect Dis, Bilbao, Spain, [Sanchez-Rivas, E.] Hosp Univ Virgen del Rocio, Dept Infect Dis, Seville, Spain, [Bahamonde, A.] Hosp el Bierzo, Dept Internal Med Infect Dis, Leon, Spain, [Riera, M.] Hosp Univ Son Espases, Dept Infect Dis, Infect Dis Unit, Palma de Mallorca, Spain, [Esteban, J.] IIS Fundacion Jimenez Diaz, Dept Clin Microbiol, Madrid, Spain, [Baraia-Etxaburu, J. M.] Hosp Basurto, Dept Infect Dis, Bilbao, Spain, [Martinez-Alvarez, J.] Hosp Univ Cent Asturias, Dept Internal Med, Oviedo, Spain, [Jover-Saenz, A.] Hosp Arnau Vilanova, Unit Nosocomial Infect, Lleida, Spain, [Duenas, C.] Hosp Univ Burgos, Dept Internal Med, Burgos, Spain, [Ramos, A.] Hosp Univ Puerta Hierro, Dept Internal Med, Infect Dis Unit, Madrid, Spain, [Sobrino, B.] Univ Malaga, Hosp Reg, Dept Infect Dis, Malaga, Spain, [Coll, P.] Inst Invest Biomed St Pau, Hosp Santa Creu & St Pau, Dept Clin Microbiol, Barcelona, Spain, [Fernandez-Sampedro, M.] Hosp Univ Valdecilla, Dept Infect Dis, Santander, Spain, Plan Nacional de I+D+i, and Instituto de Salud Carlos III

Subjects
Male, 0301 basic medicine, Prosthetic joint infection, Multidrug-resistant organisms, Epidemiology, Resistance, Comorbidity, Cohort Studies, Diagnosis, Aged, 80 and over, Incidence (epidemiology), General Medicine, Middle Aged, Antimicrobial, Anti-Bacterial Agents, Management, Risk-factors, Infectious Diseases, Female, Surgical site infections, Surgical site infection, Empiric treatment, Cohort study, Microbiology (medical), medicine.medical_specialty, Prosthesis-Related Infections, Prosthetic joint, 030106 microbiology, Guidelines, Biology, History, 21st Century, Microbiology, Arthroplasty, 03 medical and health sciences, Internal medicine, Drug Resistance, Bacterial, Microbial aetiology, medicine, Humans, Aged, Arthritis, Infectious, Bacteria, Adult patients, Time trends, Fungi, Knee arthroplasty, Surgery, Treatment failure, Debridement, Spain, Etiology
Abstract

It is important to know the spectrum of the microbial aetiology of prosthetic joint infections (PJIs) to guide empiric treatment and establish antimicrobial prophylaxis in joint replacements. There are no available data based on large contemporary patient cohorts. We sought to characterize the causative pathogens of PJIs and to evaluate trends in the microbial aetiology. We hypothesized that the frequency of antimicrobial-resistant organisms in PJIs has increased in the recent years. We performed a cohort study in 19 hospitals in Spain, from 2003 to 2012. For each 2-year period (2003-2004 to 2011-2012), the incidence of microorganisms causing PJIs and multidrug-resistant bacteria was assessed. Temporal trends over the study period were evaluated. We included 2524 consecutive adult patients with a diagnosis of PJI. A microbiological diagnosis was obtained for 2288 cases (90.6%). Staphylococci were the most common cause of infection (1492, 65.2%). However, a statistically significant rising linear trend was observed for the proportion of infections caused by Gram-negative bacilli, mainly due to the increase in the last 2-year period (25% in 2003-2004, 33.3% in 2011-2012; p 0.024 for trend). No particular species contributed disproportionally to this overall increase. The percentage of multidrug-resistant bacteria PJIs increased from 9.3% in 2003-2004 to 15.8% in 2011-2012 (p 0.008), mainly because of the significant rise in multidrug-resistant Gram-negative bacilli (from 5.3% in 2003-2004 to 8.2% in 2011-2012; p 0.032). The observed trends have important implications for the management of PJIs and prophylaxis in joint replacements. N. Benito, (C) 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Published
2016
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