36 results on '"Dolors Rodríguez-Pardo"'
Search Results
2. Role of asymptomatic bacteriuria on early periprosthetic joint infection after hip hemiarthroplasty. BARIFER randomized clinical trial
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P. Corona, Dolors Rodríguez-Pardo, Jose Antonio Iribarren, Miguel Ángel García-Viejo, Magdalena Femenias, María Del Carmen Pulido-Garcia, Laura Guío-Carrión, María Dolores González-Ripoll Navarro, María Dolores del Toro, Benito Almirante, Laura Soldevila-Boixader, Carles Pigrau, María Velasco-Arribas, Mayli Lung, Marta Fernández-Sampedro, and Rosa Escudero-Sánchez
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musculoskeletal diseases ,Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Prosthesis-Related Infections ,Bacteriuria ,Arthroplasty, Replacement, Hip ,030106 microbiology ,Periprosthetic ,Fosfomycin-trometamol ,urologic and male genital diseases ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Primary outcome ,Fosfomycin ,Randomized controlled trial ,law ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Tromethamine ,Asymptomatic Infections ,Asymptomatic bacteriuria ,Aged ,Aged, 80 and over ,business.industry ,Incidence (epidemiology) ,Hip hemiarthroplasty ,Mean age ,General Medicine ,Anti-Bacterial Agents ,Infectious Diseases ,Early-periprosthetic joint infection ,Cohort ,Female ,Joint Diseases ,business - Abstract
[Purpose] To evaluate preoperative asymptomatic bacteriuria (ASB) treatment to reduce early-periprosthetic joint infections (early-PJIs) after hip hemiarthroplasty (HHA) for fracture., [Methods] Open-label, multicenter RCT comparing fosfomycin-trometamol versus no intervention with a parallel follow-up cohort without ASB. Primary outcome: early-PJI after HHA., [Results] Five hundred ninety-four patients enrolled (mean age 84.3); 152(25%) with ASB (77 treated with fosfomycin-trometamol/75 controls) and 442(75%) without. Despite the study closed without the intended sample size, ASB was not predictive of early-PJI (OR: 1.06 [95%CI: 0.33–3.38]), and its treatment did not modify early-PJI incidence (OR: 1.03 [95%CI: 0.15–7.10]). [Conclusions] Neither preoperative ASB nor its treatment appears to be risk factors of early-PJI after HHA. ClinicalTrials.gov Identifier: Eudra CT 2016-001108-47., This work was supported by the Spanish Clinical Research Network (SCReN), co-finaced by the ISCIII-Subdirección General de Evaluación y Fomento de la Investigación, through the project PI15/02161 and by the Plan Nacional de I+D+i 2013-016 and ISCIIII, Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Economia, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003)-co-financed by European Development Regional Fund “A way to achieve Europe,” Operative program Intelligent Growth 2014-2020.
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- 2021
3. Empirical use of β-lactam/β-lactamase inhibitor combinations does not increase mortality compared with cloxacillin and cefazolin in methicillin-susceptible Staphylococcus aureus bacteraemia: a propensity-weighted cohort study
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Rein Willekens, Mireia Puig-Asensio, Paula Suanzes, Nuria Fernández-Hidalgo, Maria N Larrosa, Juan J González-López, Dolors Rodríguez-Pardo, Carles Pigrau, and Benito Almirante
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Pharmacology ,Microbiology (medical) ,Adult ,Staphylococcus aureus ,Lactams ,Bacteremia ,Staphylococcal Infections ,beta-Lactams ,Anti-Bacterial Agents ,Cohort Studies ,Methicillin ,Infectious Diseases ,Cefazolin ,Humans ,Pharmacology (medical) ,beta-Lactamase Inhibitors ,Cloxacillin ,Retrospective Studies - Abstract
Objectives To evaluate the effectiveness of empirical therapy with β-lactam/β-lactamase inhibitor combinations (BL/BLICs) for MSSA bacteraemia. Methods We conducted a post hoc analysis of all adult patients with MSSA bacteraemia who were hospitalized at a Spanish university hospital between 2013 and 2018. We compared 30 day mortality among patients receiving initial therapy with BL/BLICs (de-escalated to cloxacillin or cefazolin within 96 h) versus cloxacillin or cefazolin, using propensity score analysis with the inverse probability of treatment weighting (IPTW) method. Results We evaluated 373 patients with MSSA bacteraemia. Among them, 198 patients met the eligibility criteria, including 127 patients in the BL/BLICs group and 71 patients in the cloxacillin/cefazolin group. Patients in the BL/BLICs group had a higher Charlson comorbidity index (median, 2 [IQR, 1–4.5] versus 2 [IQR, 0–4]); an increased proportion of high-risk sources (i.e. endocarditis, respiratory sources and bacteraemia of unknown origin [34.6% versus 18.3%]); and an earlier start of antibiotic treatment (median, 0 days [IQR, 0–0] versus 1 day [IQR, 1–2]). Thirty day mortality did not significantly differ between the BL/BLICs and the cloxacillin/cefazolin groups (27 patients [21.3%] versus 13 patients [18.3%]; IPTW-adjusted OR = 0.53 [95% CI, 0.18–1.51]). For secondary outcomes, 7 day mortality and 90 day relapse were not statistically different between study groups (8.7% versus 5.6% [P = 0.62] and 6.2% versus 3.8% [P = 0.81], respectively). Conclusions BL/BLICs might be an effective empirical treatment for MSSA bacteraemia when de-escalated to cloxacillin or cefazolin within 96 h from the index blood culture.
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- 2022
4. Fidaxomicin monotherapy versus standard therapy combined with bezlotoxumab for treating patients with Clostridioides difficile infection at high risk of recurrence: a matched cohort study
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Rosa Escudero-Sanchez, Alfonso Muriel García, Sergio García Fernández, Angela Valencia Alijo, Mariona Tasias Pitarch, Esperanza Merino De Lucas, Angela Gutierrez Rojas, Antonio Ramos Martínez, Miguel Salavert Lletí, Livia Giner, María Ruíz Ruigomez, Lorena García Basas, Jorge Fernández Fradejas, María Olmedo Sampedrio, Angela Cano Yuste, Beatriz Díaz Pollán, María Jesús Rodríguez Hernández, Oriol Martín Segarra, Carmen Sáez Bejar, Carlos Armiñanzas Castillo, Belén Gutiérrez, Dolors Rodríguez-Pardo, Julián De La Torre Cisneros, Francisco López Medrano, and Javier Cobo Reinoso
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Pharmacology ,Microbiology (medical) ,DISEASES SOCIETY ,OUTCOMES ,IMPACT ,Antibodies, Monoclonal ,VANCOMYCIN ,GUIDELINES ,Anti-Bacterial Agents ,Cohort Studies ,HEALTH-CARE EPIDEMIOLOGY ,AMERICA IDSA ,Infectious Diseases ,Treatment Outcome ,CLINICAL-PRACTICE ,Recurrence ,Vancomycin ,MANAGEMENT ,Clostridium Infections ,UPDATE ,Humans ,Pharmacology (medical) ,Broadly Neutralizing Antibodies ,Fidaxomicin ,Retrospective Studies - Abstract
Background Both fidaxomicin and bezlotoxumab (used in combination with an antibiotic against Clostridioides difficile) achieve reductions in recurrence rates of C. difficile infection (CDI). However, the two strategies have never been compared. Methods Data from two retrospective cohorts of ‘real-life’ use of fidaxomicin and bezlotoxumab in combination with a standard anti-C. difficile antibiotic were used to compare the rates of recurrence of both strategies. Since the two cohorts were not identical, we used a propensity score analysis. Results Three hundred and two patients were included: 244 in the fidaxomicin cohort and 78 in the bezlotoxumab cohort. A history of renal failure or immunosuppression was more frequent in patients receiving bezlotoxumab (39.7% and 66.7% versus 26.6% and 38.9%; P = 0.03 and P Conclusions We observed that fidaxomicin and bezlotoxumab are prescribed in similar clinical scenarios, although those treated with bezlotoxumab have greater comorbidity. The proportion of recurrences was numerically lower in those treated with bezlotoxumab, although the propensity analysis did not find significant differences between the two drugs.
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- 2021
5. Mortality in Staphylococcus aureus bacteraemia remains high despite adherence to quality indicators: secondary analysis of a prospective cohort study
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Nuria Fernández-Hidalgo, María Nieves Larrosa, Mireia Puig-Asensio, Carles Pigrau, Rein Willekens, Paula Suanzes, Benito Almirante, Juan José González-López, and Dolors Rodríguez-Pardo
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Microbiology (medical) ,Adult ,medicine.medical_specialty ,Staphylococcus aureus ,Cefazolin ,Staphylococcus aureus bacteraemia ,Bacteremia ,Cloxacillin ,Internal medicine ,Post-hoc analysis ,medicine ,Humans ,Blood culture ,Prospective Studies ,Prospective cohort study ,Quality Indicators, Health Care ,medicine.diagnostic_test ,business.industry ,Staphylococcal Infections ,medicine.disease ,Anti-Bacterial Agents ,Infectious Diseases ,Infective endocarditis ,Vancomycin ,business ,medicine.drug - Abstract
Objectives To evaluate the association between compliance with previously published quality indicators (QIs) for the management of Staphylococcus aureus bacteraemia (SAB) and 30-day mortality. Methods We conducted a post hoc analysis of all adult patients with SAB who were hospitalized at a Spanish university hospital between 2013 and 2018. We evaluated the compliance with 7 QIs of SAB management (i.e., Infectious Diseases consultation, follow-up blood cultures, early source control, echocardiography, early cloxacillin or cefazolin, vancomycin monitoring, and appropriate treatment duration). The QIs compliance rate was considered good if ≥75% of the QIs recommended in each patient were performed. We studied the impact of different risk factors (including QIs compliance) on 30-day all-cause mortality adjusting by multivariable modeling and propensity-matched analysis. Results We included 441 patients with SAB. The QIs compliance rate was ≥75% in 361 patients (81.9%). A total of 95 patients (21.5%) died within 30 days after the index blood culture. In the multivariable model, the variables associated with 30-day mortality were: age (OR, 1.1; 95% CI, 1.0–1.1), Charlson comorbidity index (OR, 1.2; 95% CI, 1.1–1.4), persistent bacteraemia >72 h (OR, 6.0; 95% CI, 3.2–11.5), infective endocarditis (OR, 2.8; 95% CI, 1.2–6.7), and SAB of unknown source (OR, 3.3; 95% CI, 1.5–7.1). We did not find an association between a global QIs compliance rate of ≥75% or any individual QI with 30-day mortality. Conclusions SAB 30-day mortality remains high despite good adherence to previously published QIs for the management of SAB. Future research should focus on additional factors to further improve SAB-related mortality.
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- 2021
6. Prognosis of unexpected positive intraoperative cultures in arthroplasty revision: A large multicenter cohort
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Mikel Mancheño-Losa, Jaime Lora-Tamayo, Marta Fernández-Sampedro, Dolors Rodríguez-Pardo, Ernesto Muñoz-Mahamud, Laura Soldevila, Mariona Palou, José María Barbero, María Dolores del Toro, José Antonio Iribarren, Natividad Benito, Beatriz Sobrino, Alicia Rico-Nieto, Laura Guío-Carrión, Lucía Gómez, Rosa Escudero-Sánchez, María José García-País, Alfredo Jover-Sáenz, Julia Praena, Josu Miren Baraia-Etxaburu, Álvaro Auñón, Elena Múñez-Rubio, Oscar Murillo, Javier Cobo Reinoso, Mª Ángeles Meléndez-Carmona, Esther Viedma, Maria Carmen Fariñas, Carlos Salas-Venero, Pablo S. Corona, Mayli Lung, Laura Morata, Alex Soriano, Eva Benavent, Oriol Gasch, Lluís Falgueras, Jose Bravo-Ferrer Acosta, X. Kortajarena, M.A. Goenaga, Libe Asua Mentxaca, Iraia Arteagoitia Colino, Eva Cuchí Burgos, Lluís Font-Vizcarra, Patricia Ruiz Garbajosa, Eva María Romay Lema, Alejandro López-Pardo Pardo, Ferran Pérez-Villar, Alba Bellés-Bellés, Jaime Esteban, and Joaquín García-Cañete
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Microbiology (medical) ,Male ,Reoperation ,medicine.medical_specialty ,Prosthesis-Related Infections ,medicine.drug_class ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Antibiotics ,Arthritis ,Prosthesis ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,business.industry ,Prosthetic joint infection ,medicine.disease ,Prognosis ,Arthroplasty ,Infectious Diseases ,Cohort ,Etiology ,Female ,Aseptic processing ,business - Abstract
Background The positive-intraoperative-cultures-type prosthetic joint infection (PIOC-PJI) is considered when surgical cultures yield microorganisms in presumed aseptic arthroplasty revisions. Herein we assess the risk factors for failure in the largest cohort of PIOC-PJI patients reported to date. Methods A retrospective, observational, multicenter study was performed during 2007–2017. Surgeries leading to diagnose PIOC-PJI included only one-stage procedures with either complete or partial prosthesis revision. Failure was defined as recurrence caused by the same microorganism. Results 203 cases were included (age 72 years, 52% females). Coagulase-negative staphylococci (n = 125, 62%) was the main etiology, but some episodes were caused by virulent bacteria (n = 51, 25%). Prosthesis complete and partial revision was performed in 93 (46%) and 110 (54%) cases, respectively. After a median of 3.4 years, failure occurred in 17 episodes (8.4%, 95%CI 5.3–13.1). Partial revision was an independent predictor of failure (HR 3.63; 95%CI 1.03–12.8), adjusted for gram-negative bacilli (GNB) infection (HR 2.68; 95%CI 0.91–7.89) and chronic renal impairment (HR 2.40; 95%CI 0.90–6.44). Treatment with biofilm-active antibiotics (rifampin/fluoroquinolones) had a favorable impact on infections caused by staphylococci and GNB. Conclusion Overall prognosis of PIOC-PJI is good, but close follow-up is required in cases of partial revision and in infections caused by GNB.
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- 2021
7. Periprosthetic Joint Infection Prophylaxis in the Elderly after Hip Hemiarthroplasty in Proximal Femur Fractures: Insights and Challenges
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Carles Pigrau, P. Corona, Benito Almirante, Júlia Sellarès-Nadal, Laura Escolà-Vergé, Dolors Rodríguez-Pardo, Institut Català de la Salut, [Rodríguez-Pardo D] Servei de Malalties Infeccioses, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain. Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain. Medicina Interna, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Escolà-Vergé L, Pigrau C] Servei de Malalties Infeccioses, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain. Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain. [Sellarès-Nadal J] Servei de Malalties Infeccioses, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain. Medicina Interna, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Corona PS] Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain. Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain. Medicina Interna, Universitat Autònoma de Barcelona, Bellaterra, Spain. Unitat de Cirurgia Sèptica i Reconstructiva (UCSO), Servei de Cirurgia Ortopèdica, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Almirante B] Servei de Malalties Infeccioses, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain. Medicina Interna, Universitat Autònoma de Barcelona, Bellaterra, Spain, and Vall d'Hebron Barcelona Hospital Campus
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0301 basic medicine ,Infeccions quirúrgiques ,Antibiotics ,Cefazolin ,Periprosthetic ,Other subheadings::Other subheadings::/drug therapy [Other subheadings] ,Otros calificadores::Otros calificadores::/efectos adversos [Otros calificadores] ,Biochemistry ,0302 clinical medicine ,Decolonization ,Periprosthetic joint infection ,Pharmacology (medical) ,030212 general & internal medicine ,General Pharmacology, Toxicology and Pharmaceutics ,Antibiotic prophylaxis ,periprosthetic joint infection ,antibiotic prophylaxis ,intervenciones quirúrgicas::procedimientos ortopédicos::artroplastia::artroplastia de sustitución::hemiartroplastia [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Articulacions artificials ,Antimicrobial ,Glycopeptide ,Infectious Diseases ,Perspective ,medicine.drug ,Microbiology (medical) ,medicine.medical_specialty ,medicine.drug_class ,030106 microbiology ,Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores] ,Proximal femur fracture ,Microbiology ,03 medical and health sciences ,Internal medicine ,medicine ,Malalties bacterianes - Tractament ,Bacterial Infections and Mycoses::Infection::Prosthesis-Related Infections [DISEASES] ,Other subheadings::Other subheadings::/adverse effects [Other subheadings] ,business.industry ,proximal femur fracture ,Hip hemiarthroplasty ,lcsh:RM1-950 ,infecciones bacterianas y micosis::infección::infecciones relacionadas con prótesis [ENFERMEDADES] ,Clindamycin ,Surgical Procedures, Operative::Orthopedic Procedures::Arthroplasty::Arthroplasty, Replacement::Hemiarthroplasty [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,lcsh:Therapeutics. Pharmacology ,hip hemiarthroplasty ,decolonization ,business - Abstract
Profilaxi antibiòtica; Hemiartroplàstia de maluc; Infecció periprotèsica de l'articulació Profilaxis antibiótica; Hemiartroplastia de cadera; Infección de la articulación periprotésica Antibiotic prophylaxis; Hip hemiarthroplasty; Periprosthetic joint infection We review antibiotic and other prophylactic measures to prevent periprosthetic joint infection (PJI) after hip hemiarthroplasty (HHA) surgery in proximal femoral fractures (PFFs). In the absence of specific guidelines, those applied to these individuals are general prophylaxis guidelines. Cefazolin is the most widely used agent and is replaced by clindamycin or a glycopeptide in beta-lactam allergies. A personalized antibiotic scheme may be considered when colonization by a multidrug-resistant microorganism (MDRO) is suspected. Particularly in methicillin-resistant Staphylococcus aureus (MRSA) colonization or a high prevalence of MRSA-caused PJIs a glycopeptide with cefazolin is recommended. Strategies such as cutaneous decolonization of MDROs, mainly MRSA, or preoperative asymptomatic bacteriuria treatment have also been addressed with debatable results. Some areas of research are early detection protocols in MDRO colonizations by polymerase-chain-reaction (PCR), the use of alternative antimicrobial prophylaxis, and antibiotic-impregnated bone cement in HHA. Given that published evidence addressing PJI prophylactic strategies in PFFs requiring HHA is scarce, PJIs can be reduced by combining different prevention strategies after identifying individuals who will benefit from personalized prophylaxis. This work was supported by the ISCIII-Subdirección General de Evaluación y Fomento de la Investigación, through the project PI15/02161 and by the Plan Nacional de I+D+i 2013-016 and ISCIIII, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economia, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003)-co-financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014–2020.
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- 2021
8. Candida Periprosthetic Joint Infection: Is It Curable?
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Dolors Rodríguez-Pardo, P. Corona, Carles Pigrau, Laura Escolà-Vergé, Institut Català de la Salut, [Escolà-Vergé L, Rodríguez-Pardo D, Pigrau C] Servei de Malalties Infeccioses, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain. Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain. [Corona PS] Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain. Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain. Unitat de Cirurgia Sèptica i Reconstructiva, Servei de Cirurgia Ortopèdica, Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
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0301 basic medicine ,Microbiology (medical) ,Antifungal ,medicine.medical_specialty ,medicine.drug_class ,Candida spp ,030106 microbiology ,Cement spacer ,Periprosthetic ,Candidiasi - Tractament ,Two-stage exchange surgery ,RM1-950 ,antifungal-loaded cement spacer ,Biochemistry ,Microbiology ,biofilm ,03 medical and health sciences ,0302 clinical medicine ,Antifungal-loaded cement spacer ,two-stage exchange surgery ,Antibiotic therapy ,Bacterial Infections and Mycoses::Mycoses::Candidiasis [DISEASES] ,Pròtesis - Complicacions ,Periprosthetic joint infection ,Bacterial Infections and Mycoses::Infection::Prosthesis-Related Infections [DISEASES] ,Medicine ,Pharmacology (medical) ,General Pharmacology, Toxicology and Pharmaceutics ,Intensive care medicine ,Otros calificadores::/terapia [Otros calificadores] ,Fungus ,030222 orthopedics ,Surgical approach ,periprosthetic joint infection ,business.industry ,Biofilm ,fungus ,infecciones bacterianas y micosis::infección::infecciones relacionadas con prótesis [ENFERMEDADES] ,infecciones bacterianas y micosis::micosis::candidiasis [ENFERMEDADES] ,Other subheadings::/therapy [Other subheadings] ,Chronic infection ,Infectious Diseases ,Perspective ,Therapeutics. Pharmacology ,business - Abstract
Fong; Infecció articular periprotèsica; Cirurgia d'intercanvi en dues etapes Hongo; Infección de la articulación periprotésica; Cirugía de recambio en dos etapas Fungus; Periprosthetic joint infection; Two-stage exchange surgery Candida periprosthetic joint infection (CPJI) is a rare and very difficult to treat infection, and high-quality evidence regarding the best management is scarce. Candida spp. adhere to medical devices and grow forming biofilms, which contribute to the persistence and relapse of this infection. Typically, CPJI presents as a chronic infection in a patient with multiple previous surgeries and long courses of antibiotic therapy. In a retrospective series of cases, the surgical approach with higher rates of success consists of a two-stage exchange surgery, but the best antifungal treatment and duration of antifungal treatment are still unclear, and the efficacy of using an antifungal agent-loaded cement spacer is still controversial. Until more evidence is available, focusing on prevention and identifying patients at risk of CPJI seems more than reasonable. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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- 2021
9. Antibiotic prophylaxis in orthopaedic surgery: Clinical practice guidelines or individualized prophylaxis?
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Dolors Rodríguez-Pardo
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Microbiology (medical) ,medicine.medical_specialty ,business.industry ,MEDLINE ,Antibiotic Prophylaxis ,Clinical Practice ,Orthopedic surgery ,Humans ,Surgical Wound Infection ,Medicine ,Orthopedic Procedures ,Antibiotic prophylaxis ,business ,Intensive care medicine - Published
- 2019
10. Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: Role of surgery and impact of colistin administration
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Panayiotis D. Megaloikonomos, Dolors Rodríguez-Pardo, Panayiotis J. Papagelopoulos, Alba Ribera, Aikaterini Kyprianou, Eric Senneville, Eric Bonnet, Sabine Petersdorf, Carlos Pigrau, S. Nguyen, Antonios Papadopoulos, Nikos Pantazis, María Dolores del Toro, Javier Ariza, Gábor Skaliczki, Efthymia Giannitsioti, A. Soriano, Nuala H. O'Connell, Zeliha Kocak Tufan, Pierre Tattevin, Maria Bruna Pasticci, Mauro José Costa Salles, Antonio Blanco-García, Natividad Benito, Monica Chan, and Andreas F. Mavrogenis
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Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Prosthesis-Related Infections ,medicine.drug_class ,030106 microbiology ,Antibiotics ,Drug resistance ,medicine.disease_cause ,03 medical and health sciences ,0302 clinical medicine ,Antibiotic resistance ,Drug Resistance, Multiple, Bacterial ,Gram-Negative Bacteria ,medicine ,Humans ,Pharmacology (medical) ,Prospective Studies ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Antiinfective agent ,biology ,Colistin ,business.industry ,Pseudomonas aeruginosa ,General Medicine ,Middle Aged ,biology.organism_classification ,Survival Analysis ,Anti-Bacterial Agents ,Surgery ,Multiple drug resistance ,Treatment Outcome ,Infectious Diseases ,Female ,Gram-Negative Bacterial Infections ,business ,Enterobacter cloacae ,medicine.drug - Abstract
Factors influencing treatment outcome of patients with Gram-negative bacterial (GNB) multidrug-resistant (MDR) and extensively drug-resistant (XDR) prosthetic joint infection (PJIs) were analysed. Data were collected (2000-2015) by 18 centres. Treatment success was analysed by surgery type for PJI, resistance (MDR/XDR) and antimicrobials (colistin/non-colistin) using logistic regression and survival analyses. A total of 131 patients (mean age 73.0 years, 35.9% male, 58.8% with co-morbidities) with MDR (n = 108) or XDR (n = 23) GNB PJI were assessed. The most common pathogens were Escherichia coli (33.6%), Pseudomonas aeruginosa (25.2%), Klebsiella pneumoniae (21.4%) and Enterobacter cloacae (17.6%). Pseudomonas aeruginosa predominated in XDR cases. Isolates were carbapenem-resistant (n = 12), fluoroquinolone-resistant (n = 63) and ESBL-producers (n = 94). Treatment outcome was worse in XDR versus MDR cases (P = 0.018). Success rates did not differ for colistin versus non-colistin in XDR cases (P = 0.657), but colistin was less successful in MDR cases (P = 0.018). Debridement, antibiotics and implant retention (DAIR) (n = 67) was associated with higher failure rates versus non-DAIR (n = 64) (OR = 3.57, 95% CI 1.68-7.58; P < 0.001). Superiority of non-DAIR was confirmed by Kaplan-Meir analysis (HR = 0.36, 95% CI 0.20-0.67) and remained unchangeable by time of infection (early/late), antimicrobial resistance (MDR/XDR) and antimicrobials (colistin/non-colistin) (Breslow-Day, P = 0.737). DAIR is associated with higher failure rates even in early MDR/XDR GNB PJIs versus implant removal. Colistin should be preserved for XDR cases as it is detrimental in MDR infections.
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- 2019
11. Infections after spine instrumentation: effectiveness of short antibiotic treatment in a large multicentre cohort
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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)
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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.
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- 2021
12. Prognosis of Clostridium difficile infection in adult oncohaematological patients: experience from a large prospective observational study
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Isabel Ruiz-Camps, Dolors Rodríguez-Pardo, Gloria Roig, Pere Barba, Thais Larrainzar-Coghen, V. Rodríguez, Carmen Ferrer, Benito Almirante, and Juan Aguilar-Company
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0301 basic medicine ,Microbiology (medical) ,Chemotherapy ,medicine.medical_specialty ,Univariate analysis ,business.industry ,medicine.medical_treatment ,030106 microbiology ,Cancer ,General Medicine ,Clostridium difficile ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Medical microbiology ,Internal medicine ,Epidemiology ,medicine ,Absolute neutrophil count ,030212 general & internal medicine ,business ,Prospective cohort study - Abstract
The aim of the study is to evaluate demographics, epidemiology, clinical characteristics, treatment and outcomes of Clostridium difficile infection (CDI) in patients with and without concurrent cancer. This is a prospective cohort study of consecutive primary CDI episodes in adults (January 2006–December 2016). CDI was diagnosed on the presence of diarrhoea and positive stool testing for toxigenic C. difficile. Univariate analysis assessed differences between cancer and non-cancer patients. Risk factors of all-cause 30-day mortality were determinate using the logistic multivariable procedure. In total, 787 CDI episodes were recorded, 191 in cancer patients (median age 64, IQR 50–73). Of these, 120 (63%) had solid and 71 (37%) haematological malignancies (24 received a stem cell transplant). At the CDI diagnosis, 158 (82.7%) cancer patients had prior antibiotics and 150 (78.5%) were receiving proton pump inhibitors. Fifty-seven (80.3%) patients with haematological and 52 (43.3%) with solid malignancies were under chemotherapy at diagnosis; 25 (35.2%) with haematological and 11 (9.2%) with solid malignancies had an absolute neutrophil count
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- 2018
13. Native vertebral osteomyelitis in aged patients: distinctive features. An observational cohort study
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Nuria Fernández-Hidalgo, Mayli Lung, Benito Almirante, Ferran Pellisé, Carles Pigrau, Dolors Rodríguez-Pardo, Vicenç Falcó, and Juan Aguilar-Company
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Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,Staphylococcus aureus ,medicine.medical_specialty ,030106 microbiology ,Population ,Heart Valve Diseases ,Comorbidity ,Cohort Studies ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Spinal cord compression ,Internal medicine ,medicine ,Humans ,Vertebral osteomyelitis ,Hospital Mortality ,030212 general & internal medicine ,education ,Aged ,Retrospective Studies ,Aged, 80 and over ,Cross Infection ,Univariate analysis ,education.field_of_study ,business.industry ,Osteomyelitis ,Age Factors ,Retrospective cohort study ,Endocarditis, Bacterial ,General Medicine ,Middle Aged ,Staphylococcal Infections ,Prognosis ,medicine.disease ,Infectious Diseases ,Spain ,Infective endocarditis ,Female ,Spinal Diseases ,business ,Cohort study - Abstract
To describe the demographic, clinical, and microbiological profile of native vertebral osteomyelitis (NVO) in aged patients as compared to that of younger patients, to identify differences that could motivate changes in clinical management. Retrospective, observational cohort study (1990–2015) including all adult patients with microbiologically confirmed NVO divided into 2 groups: aged (≥ 65 years) vs younger (18–64 years). 247 patients included, 138 aged and 109 younger. Relative to younger patients, the aged had higher rates of healthcare-related infection (40.6 vs 25.7%, p = 0.014), previous known heart valve disease (29.7 vs 9.2%, p
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- 2018
14. The Not-So-Good Prognosis of Streptococcal Periprosthetic Joint Infection Managed by Implant Retention
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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
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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.
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- 2017
15. Executive summary of the diagnosis and treatment of urinary tract infection: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC)
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Dolors Rodríguez-Pardo, Luis Aliaga, Marina de Cueto, Ibai Los-Arcos, José Antonio Martínez, José Mensa, Juan-Ignacio Alós, Jose Yuste, Andrés Canut, Carles Pigrau, and Vicente Pintado
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0301 basic medicine ,Male ,Antibiotics ,Prevalence ,Drug resistance ,urologic and male genital diseases ,Recurrent urinary tract infections ,0302 clinical medicine ,Pregnancy ,Medicine ,Acute Cystitis ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Asymptomatic bacteriuria ,Societies, Medical ,Urinary tract infection ,Infectious Disease Medicine ,Infecciones recurrentes del tracto urinario ,Drug Resistance, Microbial ,Antimicrobial ,female genital diseases and pregnancy complications ,Anti-Bacterial Agents ,Clinical microbiology ,Urinary Tract Infections ,Female ,Urinary Catheterization ,Microbiology (medical) ,medicine.medical_specialty ,Bacteriuria ,medicine.drug_class ,Urinary system ,Pielonefritis aguda ,030106 microbiology ,Catheter-associated urinary tract infection ,Microbiology ,03 medical and health sciences ,Bacteriuria asintomática ,Infecciones urinarias asociadas al sondaje vesical ,Humans ,Intensive care medicine ,Acute pyelonephritis ,business.industry ,Cistitis aguda ,Antibiotic Prophylaxis ,bacterial infections and mycoses ,Infecciones del tracto urinario ,Bacterial Load ,Acute cystitis ,Catheter-Related Infections ,business - Abstract
[EN] Most urinary tract infections (UTI) are uncomplicated infections occurring in young women. An extensive evaluation is not required in the majority of cases, and they can be safely managed as outpatients with oral antibiotics. Escherichia coli is by far the most common uropathogen, accounting for >80% of all cases. Other major clinical problems associated with UTI include asymptomatic bacteriuria, and patients with complicated UTI. Complicated UTIs are a heterogeneous group associated with conditions that increase the risk of acquiring infection or treatment failure. Distinguishing between complicated and uncomplicated UTI is important, as it influences the initial evaluation, choice, and duration of antimicrobial therapy. Diagnosis is especially challenging in the elderly and in patients with in-dwelling catheters. The increasing prevalence of resistant uropathogens, including extended-spectrum β-lactamases and carbapenemase-producing Enterobacteriaceae, and other multidrug-resistant Gram-negative organisms further compromises treatment of both complicated and uncomplicated UTIs. The aim of these Clinical Guidelines is to provide a set of recommendations for improving the diagnosis and treatment of UTI. [ES] La mayoría de infecciones del tracto urinario (ITU) son infecciones no complicadas que se presentan en mujeres jóvenes. En la mayoría de los casos no se requieren pruebas diagnósticas complementarias y se pueden tratar ambulatoriamente de forma segura con antibióticos por vía oral. Escherichia coli es el uropatógeno más frecuente causando más del 80% de estas infecciones. La bacteriuria asintomática (BA) y las ITUs complicadas son otras formas de presentación de la ITU. Las ITU complicadas son un grupo heterogéneo de condiciones que incrementan el riesgo de adquisición de la infección o de fracaso del tratamiento. La distinción entre ITU complicada y no complicada es fundamental para decidir la evaluación inicial del paciente, la elección del antimicrobiano y la duración del mismo. El diagnóstico es especialmente difícil en ancianos y en pacientes con sondaje permanente. El incremento de cepas resistentes a los antibióticos, especialmente Enterobacterías productoras de beta-lactamasas de espectro extendido y de carbapenemasas y de otros Gram negativos multirresistentes, dificultan la elección del tratamiento de las ITU complicadas y no complicadas. El objetivo de esta guía clínica es proporcionar recomendaciones basadas en la evidencia para mejorar el diagnóstico y tratamiento de las ITU.
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- 2017
16. Evaluación de la evidencia clínica con dalbavancina
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Dolors Rodríguez-Pardo
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0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Lipoglycopeptide ,medicine.drug_class ,business.industry ,Teicoplanin ,030106 microbiology ,Antibiotics ,Dalbavancin ,medicine.disease ,medicine.disease_cause ,Sepsis ,03 medical and health sciences ,chemistry.chemical_compound ,Tolerability ,chemistry ,Staphylococcus aureus ,Internal medicine ,medicine ,Vancomycin ,business ,medicine.drug - Abstract
Gram-positive infections are currently a therapeutic challenge because of the emergence of strains resistant to first-line antibiotics. Consequently, in the last few years, new antibiotics have been developed with activity against multiresistant Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus and strains with intermediate sensitivity to vancomycin. Among the new antibiotics approved for the treatment of these microorganisms, dalbavancin is a semisynthetic lipoglycopeptide derived from teicoplanin, but has a superior efficacy profile to the latter. Studies published to date have confirmed the efficacy, safety and tolerability of dalbavancin in the treatment of skin and soft tissue infections caused by Gram-positive microorganisms sensitive to this drug and position it as a therapeutic option in Gram-positive catheter-related sepsis. Dalbavancin has an excellent safety profile and pharmacokinetics that allow its intravenous administration in a single weekly dose, making it a therapeutic option for outpatient use. Dalbavancin could also be an attractive alternative for patients requiring prolonged antibiotic therapy, with the aim of avoiding the need for a permanent intravenous line and its associated risks, such as infection and/or septic thrombophlebitis.
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- 2017
17. Suppressive antibiotic therapy in prosthetic joint infections: a multicentre cohort study
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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
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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
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- 2019
18. Acute spinal implant infection treated with debridement: does extended antibiotic treatment improve the prognosis?
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Dolors Rodríguez-Pardo, Mayli Lung, Ferran Pellisé, Benito Almirante, Sleiman Haddad, Pau Bosch-Nicolau, and Carles Pigrau
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0301 basic medicine ,Microbiology (medical) ,Adult ,Male ,medicine.medical_specialty ,Total Disc Replacement ,Prosthesis-Related Infections ,Time Factors ,medicine.drug_class ,medicine.medical_treatment ,030106 microbiology ,Antibiotics ,Prosthesis Retention ,medicine.disease_cause ,Enterococcus faecalis ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Debridement ,biology ,Bacteria ,Pseudomonas aeruginosa ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,biology.organism_classification ,Bone Diseases, Infectious ,Prognosis ,Combined Modality Therapy ,Anti-Bacterial Agents ,Infectious Diseases ,Treatment Outcome ,chemistry ,Staphylococcus aureus ,Linezolid ,Acute Disease ,Female ,Implant ,business - Abstract
The study aims to determine whether 8 weeks of antibiotics is non-inferior to 12 weeks in patients with acute deep spinal implant infection (SII). In the retrospective study of all SII cases (2009–2016), patients aged ≥ 15 years with microbiologically confirmed SII treated with debridement and implant retention were included. Whenever possible, tailored antibiotic treatment was used: rifampin/linezolid in gram-positive and quinolones in gram-negative infection. Patients were divided into short treatment course (8 weeks, ST group) and extended treatment (12 weeks, ET group). Primary outcome measure was percentage of cures at 1-year follow-up. One-hundred-twenty-four patients considered, 48 excluded based on the above criteria, leaving 76 patients, 28 ST and 48 ET. There were no differences in patient age, comorbidities, underlying pathologies, infection location, or surgery characteristics between groups. Surgery-to-debridement time was similar (18.5-day ST vs. 19-day ET; P = 0.96). Sixteen SII cases (21.1%) occurred with bloodstream infection. Pathogens found were Enterobacteriaceae (35, 46.1%), Staphylococcus aureus (29, 38.2%), coagulase-negative staphylococci (12, 15.8%), Pseudomonas aeruginosa (12, 15.8%), and Enterococcus faecalis (7, 9.2%). Twenty seven (35.5%) had polymicrobial infection. E. faecalis was more frequent in the ST group (7, 25% vs. 0; P
- Published
- 2019
19. Early Oral Switch to Linezolid for Low-risk Patients With Staphylococcus aureus Bloodstream Infections: A Propensity-matched Cohort Study
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Rein Willekens, Dolors Rodríguez-Pardo, María Nieves Larrosa, Benito Almirante, Isabel Ruiz-Camps, Carles Pigrau, Juan José González-López, Mireia Puig-Asensio, and Nuria Fernández-Hidalgo
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0301 basic medicine ,Microbiology (medical) ,Male ,medicine.medical_specialty ,Staphylococcus aureus ,030106 microbiology ,Administration, Oral ,Bacteremia ,medicine.disease_cause ,Hospitals, University ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Matched cohort ,Risk Factors ,Internal medicine ,Medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Propensity Score ,Aged ,business.industry ,Drug Substitution ,Linezolid ,Length of Stay ,Middle Aged ,Staphylococcal Infections ,medicine.disease ,Discontinuation ,Anti-Bacterial Agents ,Catheter ,Infectious Diseases ,chemistry ,Spain ,Propensity score matching ,Female ,business - Abstract
Background Oral switch to linezolid is a promising alternative to standard parenteral therapy (SPT) in Staphylococcus aureus bacteremia (SAB). Methods We conducted a prospective cohort study of all adult cases of SAB between 2013 and 2017 in a Spanish university hospital. We compared the efficacy, safety, and length of hospital stay of patients receiving SPT and those where SPT was switched to oral linezolid between days 3 and 9 of treatment until completion. We excluded complicated SAB and osteoarticular infections. A k-nearest neighbor algorithm was used for propensity score matching with a 2:1 ratio. Results After propensity score matching, we included 45 patients from the linezolid group and 90 patients from the SPT group. Leading SAB sources were catheter related (49.6%), unknown origin (20.0%), and skin and soft tissue (17.0%). We observed no difference in 90-day relapse between the linezolid group and the SPT group (2.2% vs 4.4% respectively; P = .87). No statistically significant difference was observed in 30-day all-cause mortality between the linezolid group and the SPT group (2.2% vs 13.3%; P = .08). The median length of hospital stay after onset was 8 days in the linezolid group and 19 days in the SPT group (P < .01). No drug-related events leading to discontinuation were noted in the linezolid group. Conclusions Treatment of SAB in selected low-risk patients with an oral switch to linezolid between days 3 and 9 of treatment until completion yielded similar clinical outcomes as SPT, allowing earlier discharge from the hospital.
- Published
- 2018
20. Teicoplanin for treating enterococcal infective endocarditis: A retrospective observational study from a referral centre in Spain
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Laura Escolà-Vergé, Carlos Pigrau, Benito Almirante, Dolors Rodríguez-Pardo, Rosa Bartolomé, Juan José González-López, and Nuria Fernández-Hidalgo
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0301 basic medicine ,Microbiology (medical) ,Male ,medicine.medical_specialty ,030106 microbiology ,Enterococcus faecium ,Salvage therapy ,Microbial Sensitivity Tests ,Enterococcus faecalis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Adverse effect ,Prospective cohort study ,Gram-Positive Bacterial Infections ,Aged ,Retrospective Studies ,Aged, 80 and over ,biology ,Teicoplanin ,business.industry ,Retrospective cohort study ,General Medicine ,Endocarditis, Bacterial ,biochemical phenomena, metabolism, and nutrition ,Middle Aged ,medicine.disease ,biology.organism_classification ,Anti-Bacterial Agents ,Infectious Diseases ,Spain ,Infective endocarditis ,Female ,business ,medicine.drug - Abstract
This study aimed to evaluate the effectiveness and safety of teicoplanin for treating enterococcal infective endocarditis (EIE). A retrospective analysis of a prospective cohort of definite EIE patients treated with teicoplanin in a Spanish referral centre (2000-2017) was performed. The primary outcome was mortality during treatment. Secondary outcomes were mortality during 3-month follow-up, adverse effects and relapse. A total of 22 patients received teicoplanin, 9 (40.9%) as first-line (8 Enterococcus faecium and 1 Enterococcus faecalis) and 13 (59.1%) as salvage therapy (13 E. faecalis). Median (IQR) age was 71.5 (58.3-78) years and Charlson comorbidity index was 4.5 (3-7). Five (22.7%) affected prosthetic valves. Median duration of treatment in survivors was 53 (42.5-61) days for antibiotics and 27 (17-41.5) days for teicoplanin [median dose 10 (10-10.8) mg/kg/day]. Reasons for teicoplanin use were resistance to β-lactams (40.9%), adverse events with previous regimens (31.8%) and outpatient parenteral antimicrobial therapy (OPAT) (27.3%). Teicoplanin was withdrawn due to adverse events in 2 patients (9.1%). Five patients (22.7%) died during treatment: four in the first-line (three with surgery indicated but not performed) and one in the salvage therapy group (surgery indicated but not performed). Two deaths (11.8%) occurred over the 3-month follow-up. There were no relapses during a median of 43.2 (22.1-69.1) months. Teicoplanin can be used as an alternative treatment for susceptible E. faecium IE and as a salvage therapy in selected patients with E. faecalis IE when adverse events develop with standard regimens or to allow OPAT.
- Published
- 2018
21. Corrigendum to 'Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: Role of surgery and impact of colistin administration' [International Journal of Antimicrobial Agents 53(3) (2019) 294–301]
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Pierre Tattevin, Nikos Pantazis, Alba Ribera, Panayiotis J. Papagelopoulos, Efthymia Giannitsioti, Maria Bruna Pasticci, Dolors Rodríguez-Pardo, Carlos Pigrau, Monica Chan, Andreas F. Mavrogenis, Eric Senneville, Gábor Skaliczki, Eric Bonnet, Aikaterini Kyprianou, S. Nguyen, Zeliha Kocak Tufan, A. Soriano, Dolores Del Toro M, N. Benito, JoséSalles M, Nuala H. O'Connell, Sabine Petersdorf, Panayiotis D. Megaloikonomos, Javier Ariza, Blanco-García A, and Antonios Papadopoulos
- Subjects
Microbiology (medical) ,Prosthetic joint ,business.industry ,General Medicine ,Drug resistance ,Pharmacology ,Antimicrobial ,Multiple drug resistance ,Infectious Diseases ,Colistin ,Medicine ,Pharmacology (medical) ,business ,medicine.drug - Published
- 2019
22. Characteristics of prosthetic joint infections due to Enterococcus sp. and predictors of failure: a multi-national study
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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
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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.
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- 2014
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23. Teicoplanin – An old new treatment for enterococcal prosthetic joint infections
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Benito Almirante, Pablo S. Corona, Mayli Lung, Carles Amat, Dolors Rodríguez-Pardo, Cristina López-Sánchez, Lluís Carrera, and Carles Pigrau
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0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Prosthesis-Related Infections ,biology ,Teicoplanin ,Prosthetic joint ,business.industry ,030106 microbiology ,Staphylococcal Infections ,Staphylococcal infections ,medicine.disease ,biology.organism_classification ,Anti-Bacterial Agents ,Surgery ,03 medical and health sciences ,Infectious Diseases ,Enterococcus ,medicine ,Humans ,Joint Diseases ,business ,medicine.drug - Published
- 2016
24. Postoperative urinary tract infection and surgical site infection in instrumented spinal surgery: is there a link?
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Enric Cáceres, Dolors Rodríguez-Pardo, Susana Núñez-Pereira, Carlos Pigrau, C. Villanueva, Ferran Pellisé, and Juan Bagó
- Subjects
Adult ,Male ,Microbiology (medical) ,medicine.medical_specialty ,Multivariate analysis ,Urinary system ,medicine.medical_treatment ,Quinolone resistance ,Interquartile range ,Statistical significance ,medicine ,Humans ,Surgical Wound Infection ,Prospective Studies ,Aged ,Retrospective Studies ,business.industry ,Incidence ,Incidence (epidemiology) ,General Medicine ,Middle Aged ,surgical site infection ,Surgery ,Ciprofloxacin ,Spinal Fusion ,Infectious Diseases ,Catheter-Related Infections ,Spinal fusion ,Urinary Tract Infections ,Female ,urinary tract infection ,business ,Surgical site infection ,medicine.drug - Abstract
A potential relationship between postoperative urinary tract infection (UTI) and surgical site infection (SSI) following posterior spinal fusion and instrumentation (PSFI) was investigated. A retrospective review was performed of prospectively collected demographic, clinical and microbiological data of 466 consecutive patients (median age, 53.7 years (interquartile range (IQR) 33.8–65.6); 58.6% women) undergoing PSFI to identify those with UTI in the first 4 weeks and SSI in the first 12 weeks after PSFI. Overall, 40.8% had an American Society of Anesthesiologists score of >2, and 49.8% had undergone fusion of more than three segments. Eighty-nine patients had UTI, 54 had SSI, and 22 had both conditions. In nine of the 22 (38%) cases, the two infections were caused by the same microorganism. The urinary tract was the probable source of SSI by Gram-negative bacteria in 38% (8/21) of cases. On multivariate analysis, UTI (OR 3.1, 95% CI 1.6–6.1; P 0.001) and instrumentation of more than three segments (OR 2.7, 95% CI 1.1–6.3; P 0.024) were statistically associated with SSI. Patients receiving ciprofloxacin for UTI had higher microbial resistance rates to fluoroquinolones at SSIs (46.13%) than those without ciprofloxacin (21.9%), although the difference did not reach statistical significance (p 0.1). In our series, UTI was significantly associated with SSI after PSFI. On the basis of our results, we conclude that further efforts to reduce the incidence of postoperative UTI and provide adequate empirical antibiotic therapy that avoids quinolones whenever possible may help to reduce SSI rates and potential microbial resistance.
- Published
- 2014
25. Linezolid in late-chronic prosthetic joint infection caused by gram-positive bacteria
- Author
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Javier, Cobo, Jaime, Lora-Tamayo, Gorane, Euba, Alfredo, Jover-Sáenz, Julián, Palomino, Ma Dolores, del Toro, Dolors, Rodríguez-Pardo, Melchor, Riera, Javier, Ariza, and A, Ramírez
- Subjects
Male ,Microbiology (medical) ,medicine.medical_specialty ,Prosthesis-Related Infections ,Gram-positive bacteria ,Gram-Positive Bacteria ,chemistry.chemical_compound ,Internal medicine ,Acetamides ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Adverse effect ,Oxazolidinones ,Aged ,Aged, 80 and over ,biology ,business.industry ,Arthritis ,Linezolid ,Prosthetic joint infection ,General Medicine ,Middle Aged ,Antimicrobial ,biology.organism_classification ,Anti-Bacterial Agents ,Surgery ,Clinical trial ,Treatment Outcome ,Infectious Diseases ,chemistry ,Toxicity ,Female ,business - Abstract
Linezolid may be an interesting alternative for prosthetic joint infection (PJI) due to its bioavailability and its antimicrobial spectrum. However, experience in this setting is scarce. The aim of the study was to assess linezolid's clinical and microbiological efficacy, and also its tolerance. This was a prospective, multicenter, open-label, non-comparative study of 25 patients with late-chronic PJI caused by Gram-positive bacteria managed with a two-step exchange procedure plus 6 weeks of linezolid. Twenty-two (88%) patients tolerated linezolid without major adverse effects, although a global decrease in the platelet count was observed. Three patients were withdrawn because of major toxicity, which reversed after linezolid stoppage. Among patients who completed treatment, 19 (86%) demonstrated clinical and microbiological cure. Two patients presented with clinical and microbiological failure, and one showed clinical cure and microbiological failure. In conclusion, linezolid showed good results in chronic PJI managed with a two-step exchange procedure. Tolerance seems acceptable, though close surveillance is required.
- Published
- 2013
26. Infecciones producidas por Clostridium difficile
- Author
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Dolors Rodríguez-Pardo, Ferran Navarro, and Beatriz Mirelis
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Microbiology (medical) ,Enterocolitis ,Pediatrics ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Clostridium difficile ,Pathogenicity ,Clostridium difficile infections ,Ribotyping ,Epidemiology ,medicine ,Infection control ,medicine.symptom ,business - Abstract
The epidemiology of Clostridium difficile infections (CDIs) has dramatically changed over the last decade in both North America and Europe, and it has become more frequent, more severe, more refractory to standard therapy, and more likely to relapse. These changes have been associated with the emergence of a "hypervirulent" strain known as BI/NAP1/027 which has become endemic in some areas, although, other hypervirulent genotypes (e.g. PCR ribotype 078) have also been described. To reduce the incidence of CDIs, the diagnostic guidelines on diagnosis and treatment methods have been recently updated. The aim of this review is to highlight the recent epidemiological data on CDIs and to provide an overview of the pathogenicity of the infection, diagnostic approaches, old and new treatment options, and current knowledge of infection control measures.
- Published
- 2013
27. Short- versus long-duration levofloxacin plus rifampicin for acute staphylococcal prosthetic joint infection managed with implant retention: a randomised clinical trial
- Author
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Alex Soriano, Joaquín García-Cañete, Mireia Puig-Asensio, Rocío Álvarez, María Carmen Fariñas, Oscar Murillo, Dolors Rodríguez-Pardo, Francisco Muntaner, Michel Fakkas, Sofía Ibarra, Jaime Lora-Tamayo, Gaspar de la Herrán, Cristina Campo, Pere Coll, Guillem Bori, Antonio Ramos, G. Euba, Javier Ariza, Alfredo Jover-Sáenz, Luisa Sorlí, Enrique Sandoval, Juan Pablo Horcajada, N. Benito, Maialen Ibarguren, Luis Falgueras, Isabel Mur, Mercè García-González, Laura Morata, Jaime Esteban, Patricia Ruiz-Garbajosa, Ramón Cisterna, Carles Pigrau, Ferran Pérez-Villar, A. Granados, Elena Múñez-Rubio, Josu Baraia-Etxaburu, José Antonio Iribarren, Andres Puente, Cecilia Peñas-Espinar, Roger Sordé-Masip, Gabriel Domecq, Xavier Cabo, Mar Sánchez-Somolinos, Melchor Riera, Miguel Ángel Muniain-Ezcurra, Alba Ribera, Joan Leal, Ana Isabel Suárez, Antonio Ramírez, Marcos Jordán, Laura Prats-Gispert, Gema Fresco, Íñigo López-Azkarreta, María Dolores del Toro, J.C. Martínez-Pastor, Luis Puig, Isabel Sánchez-Romero, Javier Jiménez-Cristóbal, Marta Fernandez-Sampedro, Antonio Blanco, Javier Cobo, and Julián Palomino
- Subjects
0301 basic medicine ,Microbiology (medical) ,Male ,medicine.medical_specialty ,Prosthesis-Related Infections ,Time Factors ,030106 microbiology ,Prosthesis Retention ,Levofloxacin ,law.invention ,03 medical and health sciences ,Randomized controlled trial ,law ,Osteoarthritis ,medicine ,Clinical endpoint ,Humans ,Pharmacology (medical) ,Short duration ,Aged ,Aged, 80 and over ,business.industry ,Prosthetic joint infection ,General Medicine ,Middle Aged ,Surgery ,Anti-Bacterial Agents ,Clinical trial ,Infectious Diseases ,Treatment Outcome ,Debridement ,Female ,Implant ,Rifampin ,business ,Rifampicin ,medicine.drug - Abstract
Levofloxacin plus rifampicin (L+R) is the treatment of choice for acute staphylococcal prosthetic joint infection (PJI) managed with debridement and implant retention (DAIR). Long courses have been empirically recommended, but some studies have suggested that shorter treatments could be as effective. Our aim was to prove that a short treatment schedule was non-inferior to the standard long schedule. An open-label, multicentre, randomised clinical trial (RCT) was performed. Patients with an early post-surgical or haematogenous staphylococcal PJI, managed with DAIR and initiated on L+R were randomised to receive 8 weeks of treatment (short schedule) versus a long schedule (3 months or 6 months for hip or knee prostheses, respectively). The primary endpoint was cure rate. From 175 eligible patients, 63 were included (52% women; median age, 72 years): 33 patients (52%) received the long schedule and 30 (48%) received the short schedule. There were no differences between the two groups except for a higher rate of polymicrobial infection in the long-schedule group (27% vs. 7%; P = 0.031). Median follow-up was 540 days. In the intention-to-treat analysis, cure rates were 58% and 73% in patients receiving the long and short schedules, respectively (difference −15.7%, 95% CI −39.2% to 7.8%). Forty-four patients (70%) were evaluable per-protocol: cure rates were 95.0% and 91.7% for the long and short schedules, respectively (difference 3.3%, 95% CI −11.7% to 18.3%). This is the first RCT suggesting that 8 weeks of L+R could be non-inferior to longer standard treatments for acute staphylococcal PJI managed with DAIR.
- Published
- 2016
28. A Large Multicenter Study of Methicillin–Susceptible and Methicillin–Resistant Staphylococcus aureus Prosthetic Joint Infections Managed With Implant Retention
- Author
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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
29. An update on surgical and antimicrobial therapy for acute periprosthetic joint infection: new challenges for the present and the future
- Author
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Benito Almirante, Dolors Rodríguez-Pardo, Pablo S. Corona, and Carles Pigrau
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,Prosthesis-Related Infections ,Combination therapy ,medicine.drug_class ,medicine.medical_treatment ,Antibiotics ,Periprosthetic ,Microbiology ,Pharmacotherapy ,Virology ,medicine ,Humans ,Device Removal ,Antiinfective agent ,Debridement ,business.industry ,Evidence-based medicine ,Arthroplasty ,Surgery ,Anti-Bacterial Agents ,Infectious Diseases ,Biofilms ,Acute Disease ,Joints ,Rifampin ,business ,Fluoroquinolones - Abstract
Periprosthetic joint infection (PJI) is a devastating complication that can occur following any arthroplasty procedure. Approximately half of these infections develop within the first year after arthroplasty, mainly in the first 1 to 3 months. These infections are known as early PJI. It is widely accepted that many early PJIs can be successfully managed by debridement, irrigation, and prosthetic retention, followed by a course of biofilm-effective antibiotics (debridement, antibiotics, implant retention procedure), but candidate patients should meet the requirements set down in Zimmerli's algorithm. The best antibiotic regimen for acute PJI treated without implant removal remains uncertain. Rifampin-containing regimens, when feasible, are recommended in gram-positive infections, and fluoroquinolones in gram-negative cases. The duration, dosage, and administration route of antibiotics and the use of combined therapy are matters that requires further clarification, as the current level of evidence is low and most recommendations are based on experimental data, studies in small series, and expert experience.
- Published
- 2015
30. High doses of daptomycin (10 mg/kg/d) plus rifampin for the treatment of staphylococcal prosthetic joint infection managed with implant retention: a comparative study
- Author
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José Mensa, Eduardo Tornero, Jorge Parra-Ruiz, Jaime Lora-Tamayo, Alba Ribera, Alex Soriano, Javier Ariza, Carles Pigrau, José Barberán, and Dolors Rodríguez-Pardo
- Subjects
Microbiology (medical) ,Male ,medicine.medical_specialty ,Prosthesis-Related Infections ,medicine.drug_class ,Staphylococcus ,Antibiotics ,Microbial Sensitivity Tests ,Daptomycin ,Drug Resistance, Bacterial ,medicine ,High doses ,Initial treatment ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Prosthetic joint infection ,General Medicine ,Middle Aged ,Staphylococcal Infections ,Discontinuation ,Surgery ,Anti-Bacterial Agents ,Infectious Diseases ,Treatment Outcome ,Toxicity ,Female ,Implant ,Rifampin ,business ,medicine.drug - Abstract
We aimed to analyze the efficacy and safety of high doses of daptomycin (10 mg/kg/d) plus rifampin (D10 + R) for prosthetic joint infection (PJI). This was an observational retrospective multicenter study (2010-2012) including all patients with acute PJI by fluoroquinolone-resistant staphylococci managed with implant retention and D10 + R. Twenty cases were included: 2 (10%) were withdrawn due to toxicity, leaving 18 cases for efficacy evaluation: 13 (72%) women, age 79 years (range 58-90). Clinical failure was observed in 9 (50%) patients: in 5 cases, staphylococci were recovered (28% of microbiological failures); no modification of daptomycin-MIC was observed. These 18 cases were compared with 44 matched historical cases: failure rate was similar, but whereas in the historical series, failure occurred fundamentally during therapy, in the present series, it was recorded after discontinuation of antibiotics. In summary, D10 + R may be the initial treatment of choice for PJI by fluoroquinolone-resistant staphylococci managed with implant retention.
- Published
- 2014
31. Epidemiology of Clostridium difficile infection and risk factors for unfavorable clinical outcomes: results of a hospital-based study in Barcelona, Spain
- Author
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Dolors, Rodríguez-Pardo, Benito, Almirante, Rosa M, Bartolomé, Virginia, Pomar, Beatriz, Mirelis, Ferran, Navarro, Alex, Soriano, Luisa, Sorlí, Joaquín, Martínez-Montauti, Maria Teresa, Molins, Maily, Lung, Jordi, Vila, Albert, Pahissa, and M, Fuster
- Subjects
Microbiology (medical) ,Diarrhea ,Male ,medicine.medical_specialty ,Epidemiology ,medicine.medical_treatment ,Bacterial Toxins ,Microbial Sensitivity Tests ,Logistic regression ,Enterotoxins ,Feces ,Bacterial Proteins ,Internal medicine ,Drug Resistance, Multiple, Bacterial ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Colectomy ,Aged ,Aged, 80 and over ,Cross Infection ,business.industry ,Clostridioides difficile ,Incidence (epidemiology) ,Proton Pump Inhibitors ,Odds ratio ,Clostridium difficile ,Middle Aged ,bacterial infections and mycoses ,Confidence interval ,Hospitals ,Surgery ,Anti-Bacterial Agents ,Treatment Outcome ,Spain ,Clostridium Infections ,Female ,business - Abstract
Prospective hospital-based surveillance for Clostridium difficile -associated disease (CDAD) was conducted in Barcelona (Spain) to describe the epidemiology of this condition and investigate the risk factors for an unfavorable outcome. All patients diagnosed with CDAD during 2009 were included. Using logistic regression modeling, we analyzed the potential risk factors associated with recurrent and complicated CDAD, defined as a need for colectomy or death within 30 days. There were 365 episodes of CDAD, yielding an incidence of 22.5 cases/10 5 person-years, 1.22 cases/10 3 hospital discharges, and 1.93 cases/10 4 patient-days. The main PCR ribotypes identified were 241 (26%), 126 (18%), 078 (7%), and 020 (5%). PCR ribotype 027 was not detected. Among the 348 cases analyzed, 232 (67%) patients were cured, 63 (18%) had a recurrence of CDAD, and 53 (15%) developed complicated CDAD. Predictors of complicated CDAD were continued use of antibiotics following CDAD diagnosis (odds ratio [OR], 2.009; 95% confidence interval [CI], 1.012 to 3.988; P = 0.046), Charlson comorbidity index score (OR, 1.265; 95% CI, 1.105 to 1.449; P = 0.001), and age (OR, 1.028; 95% CI, 1.005 to 1.053; P = 0.019). A leukocyte count of >15 × 10 3 cells/ml (OR, 2.277; 95% CI, 1.189 to 4.362; P = 0.013), continuation of proton pump inhibitor (PPI) use after CDAD diagnosis (OR, 2.168; 95% CI, 1.081 to 4.347; P = 0.029), and age (OR, 1.021; 95% CI, 1.001 to 1.041; P = 0.036) were independently associated with higher odds of recurrence. The incidence of CDAD in Barcelona during 2009 was on the lower end of the previously described range for all of Europe. Our analysis suggests that the continuation of non- C. difficile antibiotics and use of PPIs in patients diagnosed with CDAD are associated with unfavorable clinical outcomes.
- Published
- 2013
32. Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study
- Author
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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
33. Long-term follow-up of jaw osteomyelitis associated with bisphosphonate use in a tertiary-care center
- Author
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Albert Pahissa-Berga, Carlos Pigrau-Serrallach, Nuria Fernández-Hidalgo, Dolors Rodríguez-Pardo, Roger Sordé-Masip, Socorro Bescos-Atín, Evelyn Cabral-Galeano, Nieves Larrosa-Escartín, and Benito Almirante-Gragera
- Subjects
Microbiology (medical) ,Male ,medicine.medical_specialty ,Time Factors ,Long term follow up ,medicine.medical_treatment ,Tertiary care ,Tertiary Care Centers ,medicine ,Humans ,Aged ,Retrospective Studies ,Jaw osteomyelitis ,Bone Density Conservation Agents ,Diphosphonates ,business.industry ,Incidence (epidemiology) ,Osteomyelitis ,Bisphosphonate ,Middle Aged ,medicine.disease ,Surgery ,Jaw ,Sequestrectomy ,Etiology ,Female ,Osteonecrosis of the jaw ,business ,Follow-Up Studies - Abstract
a b s t r a c t Objectives: This study reviews our experience in bisphosphonate-associated jaw osteomyelitis (BJOM), focusing on the incidence, etiology, treatment, and long-term outcome. Methods: Retrospective review of the clinical histories adult patients diagnosed with BJOM (1995-2008) in a tertiary hospital. Results: BJOM was found in 30 of 132 (22.7%) consecutive patients with jaw osteomyelitis. The percent- age of BJOM cases increased from 8.7% (4/46) in 1995-2005 to 30.2% (26/86) in 2005-2008. Symptoms appeared in a median of 2.5 years after intravenous use, and 4.5 years after oral exposure. Viridans group streptococci were isolated in 83.3% of cases. Actinomyces spp. was found in 16 (39.0%) of 41 bone histolo- gies. All included patients received a median of 6 months of appropiate antibiotic therapy and a surgical procedure (debridament and/or sequestrectomy). Thirteen of 27 cases (48.1%) with long-term follow-up (median 22 months, IQR 25-75 17-28) failed. Clinical failure defined as, persistent infection or relapse, was more frequent in patients receiving intravenous than oral bisphosphonates (11/16 (68.8%) vs. 2/11 (18.2%); P < .05) and in cases with Actinomyces spp. (7/10 (70.0%) vs6/17 (35.3%); P = .08). Conclusions: Bisphosphonate therapy is now a frequent cause of JO. BJOM is difficult to cure and relapses are common, particularly in patients exposed to intravenous bisphosphonates.
- Published
- 2012
34. Réplica a «Infecciones producidas por Clostridium difficile. Observaciones»
- Author
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Beatriz Mirelis, Dolors Rodríguez-Pardo, and Ferran Navarro
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Microbiology (medical) ,business.industry ,Medicine ,business - Published
- 2013
35. Impact of prompt catheter withdrawal and adequate antimicrobial therapy on the prognosis of hospital-acquired parenteral nutrition catheter-related bacteraemia
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Benito Almirante, R. Alcaraz, Carlos Pigrau, Dolors Rodríguez-Pardo, R. Burgos, Carmen Ferrer, Nuria Fernández-Hidalgo, Albert Pahissa, and A.M. Planes
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Microbiology (medical) ,Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Time Factors ,medicine.drug_class ,Antibiotics ,Bacteremia ,parenteral nutrition ,Logistic regression ,Cohort Studies ,prevention ,Epidemiology ,medicine ,Humans ,Prospective Studies ,Risk factor ,Cause of death ,Aged ,Cross Infection ,business.industry ,Incidence (epidemiology) ,General Medicine ,Middle Aged ,Prognosis ,Survival Analysis ,Hospitals ,Anti-Bacterial Agents ,Catheter ,Infectious Diseases ,Parenteral nutrition ,Withholding Treatment ,Catheter-related bacteraemia ,Catheter-Related Infections ,outcome ,Female ,epidemiology ,business - Abstract
Catheter-related bacteraemia (CRB) is a cause of death in hospitalized patients, and parenteral nutrition (PN) is a risk factor. We aim to describe the prognosis of PN-CRB and the impact of catheter extraction within 48 h from bacteraemia. All consecutive hospitalized adult patients with CRB (2007–2012) were prospectively enrolled. Factors associated with 30-day mortality were determined by logistic regression analysis. Among 847 episodes of CRB identified, 291 (34%) episodes were associated with short-term catheter use for PN. Cure was achieved in 236 (81%) episodes, 42 (14.5%) patients died within the first 30 days, 7 (2.5%) relapsed, and 6 (2%) had re-infection. On multivariate analysis, previous immunosuppressive therapy (OR 5.62; 95% CI 1.69–18.68; p 0.0048) and patient age (OR 1.05; 95% CI 1.02–1.07; p 0.0009) were predictors of 30-day mortality, whereas catheter removal within 48 h of bacteraemia onset (OR 0.26; 95% CI 0.12–0.58; p 0.0010) and adequate empirical antibiotic treatment (OR 0.36; 95% CI 0.17–0.77; p 0.0081) were protective factors. Incidence of PN-CRB decreased from 5.36 episodes/1000 days of PN in 2007 to 2.9 in 2012, yielding a 46.1% rate reduction (95% CI 15.7–65.5%), which may be attributable to implementation of a multifaceted prevention strategy. In conclusion, short-term PN-CRB accounted for one-third of all episodes of CRB in our setting, and 14.5% of patients died within 30 days following bacteraemia. Our findings suggest that prompt catheter removal and adequate empirical antibiotic treatment could be protective factors for 30-day mortality. Concomitantly with implementation of a multifaceted prevention strategy, PN-CRB incidence was reduced by half.
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36. First recurrence of Clostridium difficile infection: clinical relevance, risk factors, and prognosis
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Nuria Fernández-Hidalgo, Tomás Pumarola, Carlos Pigrau, Thais Larrainzar-Coghen, Dolors Rodríguez-Pardo, Carmen Ferrer, Benito Almirante, Mireia Puig-Asensio, V. Rodríguez, and Rosa Bartolomé
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Adult ,Diarrhea ,Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,030106 microbiology ,Comorbidity ,Cohort Studies ,03 medical and health sciences ,Recurrence ,Risk Factors ,Internal medicine ,Odds Ratio ,Prevalence ,Humans ,Medicine ,Prospective cohort study ,Enterocolitis, Pseudomembranous ,Aged ,Colectomy ,Aged, 80 and over ,First episode ,Framingham Risk Score ,Clostridioides difficile ,business.industry ,General Medicine ,Odds ratio ,Middle Aged ,Prognosis ,bacterial infections and mycoses ,medicine.disease ,Surgery ,Patient Outcome Assessment ,Infectious Diseases ,Cohort ,Female ,business ,Cohort study - Abstract
Therapy for recurrent Clostridium difficile-associated diarrhea (CDAD) is challenging. We evaluated the frequency, associated risk factors, and prognosis of first CDAD recurrences. Prospective cohort study of all consecutive cases of primary CDAD diagnosed in a university hospital from January 2006 to June 2013. Recurrent infection was defined as reappearance of symptoms within 8 weeks of the primary diagnosis, provided that CDAD symptoms had previously resolved and a new toxin test was positive. Predictors of a first episode of recurrent CDAD were determined by logistic regression analysis. In total, 502 patients (51.6 % men) with a mean age of 62.3 years (SD 18.5) had CDAD; 379 (76 %) were cured, 61 (12 %) had a first recurrence, 52 (10 %) died within 30 days of the CDAD diagnosis, nine (2 %) required colectomy, and one was lost to follow-up. Among the 61 patients with a first recurrence, 36 (59.3 %) were cured, 15 (23.7 %) had a second recurrence, nine (15.3 %) died, and one (1.7 %) required colectomy. On multivariate analysis, age older than 65 years (OR 2.04; 95 % CI, 1.14-3.68; P
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