27 results on '"G. Maestro-de la Calle"'
Search Results
2. Incidence of intravenous colistin nephrotoxicity in hospitalized patients
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C Rosas Espinoza, M Arrieta Loitegui, G. Maestro de la Calle, JM Ferrari Piquero, and JM Caro Teller
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Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,toxicidad farmacológica ,Original ,030106 microbiology ,Renal function ,Nephrotoxicity ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,factores de riesgo ,030212 general & internal medicine ,Colistina ,Aged ,Retrospective Studies ,Pharmacology ,Creatinine ,Colistin ,business.industry ,Cumulative dose ,Incidence ,Incidence (epidemiology) ,General Medicine ,Middle Aged ,medicine.disease ,drug toxicity ,Anti-Bacterial Agents ,chemistry ,Concomitant ,Female ,business ,medicine.drug ,Kidney disease - Abstract
RESUMEN Objetivos El incremento de infecciones por bacterias multirresistentes ha obligado a retomar el uso de colistina, antibiótico con nefrotoxicidad conocida. El objetivo del estudio es determinar la incidencia de nefrotoxicidad por colistina en la actualidad. Material y métodos Estudio retrospectivo, observacional y unicéntrico que recoge los pacientes hospitalizados en tratamiento con colistina intravenosa durante los años 2018-2019. Se excluyeron los pacientes ingresados en unidades de cuidados críticos. Se definió la nefrotoxicidad según la escala RIFLE. Las variables para determinarla fueron creatinina sérica (Crs) y filtrado glomerular (FG). Las variables analizadas fueron: edad, sexo, duración de tratamiento, dosis de carga y acumulada, tratamiento empírico/dirigido, enfermedad renal crónica, uso de contrastes intravenosos y fármacos nefrotóxicos concomitantes. Resultados Se incluyeron 90 pacientes (60% hombres), con una media de edad de 58,2±18,1 años. La media de duración de tratamiento fue de 9±8,3 días, con una media de dosis acumulada de 69,8±71MU. No hubo diferencias entre Crs y FG al inicio y final del tratamiento. La incidencia de nefrotoxicidad fue de 1,73 casos/100 días de tratamiento (prevalencia del 15,56%). Conclusión La nefrotoxicidad por colistina presenta una incidencia importante, sin desarrollar cuadros graves.
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- 2020
3. S1638 INTERRUPTING QUINOLONE PROPHYLAXIS IN HEMATOLOGIC PATIENTS WITH PROLONGED NEUTROPENIA: AN OBSERVATIONAL STUDY
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J. Martínez López, M. Lizosaín Hernández, L. Lorza Gil, G. Maestro De la Calle, C. García Sánchez, and A. Bienert García
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medicine.medical_specialty ,medicine.drug_class ,business.industry ,Internal medicine ,medicine ,Observational study ,Hematology ,Neutropenia ,medicine.disease ,Quinolone ,business - Published
- 2019
4. Síndrome de platipnea-ortodeoxia
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S. Mateo Álvarez, M. Sierra Bracamonte, A. Mérida García, G. Maestro de la Calle, and C. Merino Argumánez
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business.industry ,Medicine ,General Medicine ,business ,Humanities - Abstract
El sindrome de platipnea-ortodeoxia (SPO) es un sindrome infrecuente que se caracteriza por disnea y desaturacion de oxigeno arterial en posicion ortostatica que mejora con el decubito. Desde su descripcion por Burchell et al. hace unos 50 anos se vienen publicando casos aislados del mismo. Para su formacion precisa 2 condiciones, una anatomica y otra funcional, que se manifiesta en posicion erecta. La condicion anatomica subyacente mas frecuente es el foramen oval permeable (prevalencia de uno por cada 25.000 nacidos vivos [http://www.orpha.net/consor/cgibin/OC Exp.php?Expert=1478&lng=ES]), y que normalmente no desarrolla sintomatologia1. En el SPO, puede ocurrir que la presion en la auricula derecha supere la de la izquierda con el consecuente desarrollo de un cortocircuito derechaizquierda. Tambien cabe la posibilidad de que el shunt se produzca en ausencia de un gradiente significativo de presion entre las camara auriculares y con presiones pulmonares normales o bajas, siendo la responsable del shunt la posicion erecta mas que la presion en cavidades derechas y en la arteria pulmonar.
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- 2014
5. Clinical efficacy of β-lactam/β-lactamase inhibitor combinations for the treatment of bloodstream infection due to extended-spectrum β-lactamase-producing Enterobacteriaceae in haematological patients with neutropaenia: a study protocol for a retrospective observational study (BICAR)
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Adriana Manzur, Carlota Gudiol, Pilar Martín-Dávila, F. Herrera, Edson Abdala, L. Gómez, Cristina Royo-Cebrecos, Georg Maschmeyer, Thomas Gottlieb, Murat Akova, Jesús Rodríguez-Baño, Jordi Carratalà, T. C. Sukiennik, Wanessa Trindade Clemente, Alison G. Freifeld, Maddalena Peghin, Y. Meije, Miguel Montejo, R. Álvarez, M. Gurguí, Cristian Tebé, Isabel Ruiz-Camps, A. Cano, G. Maestro-de la Calle, and Carlos Cervera
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0301 basic medicine ,medicine.medical_specialty ,education.field_of_study ,business.industry ,030106 microbiology ,Population ,Retrospective cohort study ,General Medicine ,Neutropenia ,bacterial infections and mycoses ,medicine.disease ,medicine.disease_cause ,Intensive care unit ,law.invention ,Sepsis ,03 medical and health sciences ,law ,Superinfection ,medicine ,Observational study ,Adverse effect ,Intensive care medicine ,education ,business - Abstract
Introduction Bloodstream infection (BSI) due to extended-spectrum β-lactamase-producing Gram-negative bacilli (ESBL-GNB) is increasing at an alarming pace worldwide. Although β-lactam/β-lactamase inhibitor (BLBLI) combinations have been suggested as an alternative to carbapenems for the treatment of BSI due to these resistant organisms in the general population, their usefulness for the treatment of BSI due to ESBL-GNB in haematological patients with neutropaenia is yet to be elucidated. The aim of the BICAR study is to compare the efficacy of BLBLI combinations with that of carbapenems for the treatment of BSI due to an ESBL-GNB in this population. Methods and analysis A multinational, multicentre, observational retrospective study. Episodes of BSI due to ESBL-GNB occurring in haematological patients and haematopoietic stem cell transplant recipients with neutropaenia from 1 January 2006 to 31 March 2015 will be analysed. The primary end point will be case-fatality rate within 30 days of onset of BSI. The secondary end points will be 7-day and 14-day case-fatality rates, microbiological failure, colonisation/infection by resistant bacteria, superinfection, intensive care unit admission and development of adverse events. Sample size The number of expected episodes of BSI due to ESBL-GNB in the participant centres will be 260 with a ratio of control to experimental participants of 2. Ethics and dissemination The protocol of the study was approved at the first site by the Research Ethics Committee (REC) of Hospital Universitari de Bellvitge. Approval will be also sought from all relevant RECs. Any formal presentation or publication of data from this study will be considered as a joint publication by the participating investigators and will follow the recommendations of the International Committee of Medical Journal Editors (ICMJE). The study has been endorsed by the European Study Group for Bloodstream Infection and Sepsis (ESGBIS) and the European Study Group for Infections in Compromised Hosts (ESGICH).
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- 2017
6. Platypnea-orthodeoxia syndrome
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C, Merino Argumánez, A, Mérida García, M, Sierra Bracamonte, G, Maestro de la Calle, and S, Mateo Álvarez
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- 2014
7. Assessment of risk-adjusted mortality ratio (RAMR) in bloodstream infections using all-patient refined diagnosis-related groups (APR-DRGs).
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Maestro De La Calle G, Vélez J, Mateo Flores J, García Barrio N, Orellana MÁ, Quirós-González V, Lumbreras Bermejo C, and Bernal JL
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- Humans, Retrospective Studies, Male, Female, Aged, Middle Aged, Aged, 80 and over, Hospitalization statistics & numerical data, Escherichia coli isolation & purification, Adult, Bacteremia mortality, Bacteremia microbiology, Bacteremia diagnosis, Hospital Mortality
- Abstract
Objectives: To calculate a risk-adjusted mortality ratio (RAMR) for bloodstream infections (BSIs) using all-patient refined diagnosis-related groups (APR-DRGs) and compare it with the crude mortality rate (CMR)., Methods: Retrospective observational study of prevalent BSI at our institution from January 2019 to December 2022. In-hospital mortality was adjusted with a binary logistic regression model adjusting for sex, age, admission type and mortality risk for the hospitalization episode according to the four severity levels of APR DRGs. The RAMR was calculated as the ratio of observed to expected in-hospital mortality, and the CMR was calculated as the proportion of deaths among all bacteraemia episodes., Results: Of 2939 BSIs, 2541 were included: Escherichia coli (n = 1310), Klebsiella pneumoniae (n = 428), Pseudomonas aeruginosa (n = 209), Staphylococcus aureus (n = 498) and candidaemia (n = 96). A total of 436 (17.2%) patients died during hospitalization and 279 died within the first 14 days after the onset of BSI. Throughout the period, all BSI cases had a mortality rate above the expected adjusted mortality (RAMR value greater than 1), except for Escherichia coli (1.03; 95% CI 0.86-1.21). The highest overall RAMR values were observed for P. aeruginosa, Candida and S. aureus with 2.06 (95% CI 1.57-2.62), 1.99 (95% CI 1.3-2.81) and 1.8 (95% CI 1.47-2.16), respectively. The temporal evolution of CMR may differ from RAMR, especially in E. coli, where it was reversed., Conclusions: RAMR showed higher than expected mortality for all BSIs studied except E. coli and provides complementary to and more clinically comprehensive information than CMR, the currently recommended antibiotic stewardship programme mortality indicator., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
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- 2024
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8. Characteristics of clinical trials of influenza and respiratory syncytial virus registered in ClinicalTrials.gov between 2014 and 2021.
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Lora D, García-Reyne A, Lalueza A, Maestro de la Calle G, Ruíz-Ruigómez M, Calderón EJ, and Menéndez-Orenga M
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- Child, Preschool, Female, Humans, Infant, Pregnancy, Cross-Sectional Studies, Randomized Controlled Trials as Topic, Respiratory Syncytial Viruses, Influenza Vaccines, Influenza, Human prevention & control, Orthomyxoviridae, Respiratory Syncytial Virus Infections prevention & control
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The randomized clinical trial (RCT) is the ideal and mandatory type of study to verify the effect and safety of a drug. Our aim is to examine the fundamental characteristics of interventional clinical trials on influenza and respiratory syncytial virus (RSV). This is a cross-sectional study of RCTs on influenza and RSV in humans between 2014 and 2021 registered in ClinicalTrials.gov. A total of 516 studies were identified: 94 for RSV, 423 for influenza, and 1 for both viruses. There were 51 RCTs of RSV vaccines (54.3%) and 344 (81.3%) for influenza virus vaccines ( p < 0.001). Twelve (12.8%) RCTs for RSV were conducted only with women, and 6 were conducted only with pregnant women; for RCTs for influenza, 4 (0.9%) and 3, respectively. For RSV, 29 (31%) of the RCTs were exclusive to people under 5 years of age, and 21 (5%) for influenza virus ( p < 0.001). For RSV, there are no RCTs exclusively for people older than or equal to 65 years and no phase 4 trials. RCTs on influenza virus and RSV has focused on vaccines. For the influenza virus, research has been consolidated, and for RSV, research is still in the development phase and directed at children and pregnant women., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lora, García-Reyne, Lalueza, Maestro de la Calle, Ruíz-Ruigómez, Calderón and Menéndez-Orenga.)
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- 2023
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9. [Impact of days elapsed from the onset of symptoms to hospitalization in COVID-19 in-hospital mortality: Time matters].
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Maestro de la Calle G, García Reyne A, Lora-Tamayo J, Muiño Miguez A, Arnalich-Fernandez F, Beato Pérez JL, Vargas Núñez JA, Caudevilla Martínez MA, Alcalá Rivera N, Orviz Garcia E, Sánchez Moreno B, Freire Castro SJ, Rhyman N, Pesqueira Fontan PM, Piles L, López Caleya JF, Fraile Villarejo ME, Jiménez-García N, Boixeda R, González Noya A, Gracia Gutiérrez A, Martín Oterino JÁ, Gómez Huelgas R, Antón Santos JM, and Lumbreras Bermejo C
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Background: COVID-19 shows different clinical and pathophysiological stages over time. Theeffect of days elapsed from the onset of symptoms (DEOS) to hospitalization on COVID-19prognostic factors remains uncertain. We analyzed the impact on mortality of DEOS to hospital-ization and how other independent prognostic factors perform when taking this time elapsedinto account., Methods: This retrospective, nationwide cohort study, included patients with confirmed COVID-19 from February 20th and May 6th, 2020. The data was collected in a standardized online datacapture registry. Univariate and multivariate COX-regression were performed in the generalcohort and the final multivariate model was subjected to a sensitivity analysis in an earlypresenting (EP; < 5 DEOS) and late presenting (LP; ≥5 DEOS) group., Results: 7915 COVID-19 patients were included in the analysis, 2324 in the EP and 5591 in theLP group. DEOS to hospitalization was an independent prognostic factor of in-hospital mortalityin the multivariate Cox regression model along with other 9 variables. Each DEOS incrementaccounted for a 4.3% mortality risk reduction (HR 0.957; 95% CI 0.93---0.98). Regarding variationsin other mortality predictors in the sensitivity analysis, the Charlson Comorbidity Index onlyremained significant in the EP group while D-dimer only remained significant in the LP group., Conclusion: When caring for COVID-19 patients, DEOS to hospitalization should be consideredas their need for early hospitalization confers a higher risk of mortality. Different prognosticfactors vary over time and should be studied within a fixed timeframe of the disease., (© 2023 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)
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- 2023
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10. Rapid diagnosis of pulmonary tuberculosis using Xpert MTB/RIF assay in gastric aspirate samples from adult patients with sputum-absent disease: A first-step alternative to bronchoscopy?
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Maestro-de la Calle G, Fernández-Ruiz M, López-Roa P, and Aguado JM
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- Adult, Bronchoscopy, Humans, Sputum, Mycobacterium tuberculosis genetics, Tuberculosis, Pulmonary diagnosis
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- 2022
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11. The importance of association of comorbidities on COVID-19 outcomes: a machine learning approach.
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Arévalo-Lorido JC, Carretero-Gómez J, Casas-Rojo JM, Antón-Santos JM, Melero-Bermejo JA, López-Carmona MD, Palacios LC, Sanz-Cánovas J, Pesqueira-Fontán PM, de la Peña-Fernández AA, de la Sierra Alcántara NM, García-García GM, Torres Peña JD, Magallanes-Gamboa JO, Fernández-Madera-Martinez R, Fernández-Fernández J, Rubio-Rivas M, Maestro-de la Calle G, Cervilla-Muñoz E, Ramos-Martínez A, Méndez-Bailón M, Ramos-Rincón JM, and Gómez-Huelgas R
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- Comorbidity, Female, Hospitalization, Humans, Machine Learning, Male, Retrospective Studies, Risk Factors, SARS-CoV-2, COVID-19 epidemiology
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Background: The individual influence of a variety of comorbidities on COVID-19 patient outcomes has already been analyzed in previous works in an isolated way. We aim to determine if different associations of diseases influence the outcomes of inpatients with COVID-19., Methods: Retrospective cohort multicenter study based on clinical practice. Data were taken from the SEMI-COVID-19 Registry, which includes most consecutive patients with confirmed COVID-19 hospitalized and discharged in Spain. Two machine learning algorithms were applied in order to classify comorbidities and patients (Random Forest -RF algorithm, and Gaussian mixed model by clustering -GMM-). The primary endpoint was a composite of either, all-cause death or intensive care unit admission during the period of hospitalization. The sample was randomly divided into training and test sets to determine the most important comorbidities related to the primary endpoint, grow several clusters with these comorbidities based on discriminant analysis and GMM, and compare these clusters., Results: A total of 16,455 inpatients (57.4% women and 42.6% men) were analyzed. According to the RF algorithm, the most important comorbidities were heart failure/atrial fibrillation (HF/AF), vascular diseases, and neurodegenerative diseases. There were six clusters: three included patients who met the primary endpoint (clusters 4, 5, and 6) and three included patients who did not (clusters 1, 2, and 3). Patients with HF/AF, vascular diseases, and neurodegenerative diseases were distributed among clusters 3, 4 and 5. Patients in cluster 5 also had kidney, liver, and acid peptic diseases as well as a chronic obstructive pulmonary disease; it was the cluster with the worst prognosis., Conclusion: The interplay of several comorbidities may affect the outcome and complications of inpatients with COVID-19.
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- 2022
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12. Analysis of the factors predicting clinical response to tocilizumab therapy in patients with severe COVID-19.
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San-Juan R, Fernández-Ruiz M, López-Medrano F, Carretero O, Lalueza A, Maestro de la Calle G, Pérez-Jacoiste Asín MA, Bueno H, Caro-Teller JM, Catalán M, de la Calle C, García-García R, Gómez C, Laguna-Goya R, Lizasoáin M, Martínez-López J, Origüen J, Sevillano Á, Gutiérrez E, de Miguel B, Aguilar F, Parra P, Ripoll M, Ruiz-Merlo T, Trujillo H, Pablos JL, Paz-Artal E, Lumbreras C, and Aguado JM
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- Antibodies, Monoclonal, Humanized, Humans, Retrospective Studies, SARS-CoV-2, COVID-19 Drug Treatment
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Background: Controversy remains about the efficacy of tocilizumab (TCZ) for the treatment of severe COVID-19. We aimed to analyze the profile of TCZ-respondent patients., Methods: We retrospectively analyzed a cohort of patients with severe COVID-19 who received off-label TCZ after recommendation by a local committee and were admitted to the University Hospital "12 de Octubre" until May 2020. The primary end point was a significant clinical improvement (SCI) on day 14 after administration of TCZ. Factors independently related to SCI were analyzed by multivariate logistic regression models., Results: Of 428 (63.3%) patients treated with TCZ, 271 (63.3%) experienced SCI. After adjustment for factors related to unfavorable outcomes, TCZ administration within the first 48 hours from admission (odds ratio [OR]: 1.98, 95% confidence Interval [95% CI]: 1.1-3.55; P = 0.02) and ALT levels >100 UI/L at day 0 (OR: 3.28; 95% CI: 1.3-8.1; P = 0.01) were independently related to SCI. The rate of SCI significantly decreased according to the time of TCZ administration: 70.2% in the first 48 hours from admission, 58.5% on days 3-7, and 45.1% after day 7 (P = 0.03 and P = 0.001, respectively)., Conclusion: TCZ improves the prognosis of patients with COVID-19 the most if treatment starts within the first 48 hours after admission., Competing Interests: Conflicts of interest All the authors declare no potential conflict of interest regarding this study., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2022
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13. A predictive score at admission for respiratory failure among hospitalized patients with confirmed 2019 Coronavirus Disease: a simple tool for a complex problem.
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Lalueza A, Lora-Tamayo J, Maestro-de la Calle G, Folgueira D, Arrieta E, de Miguel-Campo B, Díaz-Simón R, Lora D, de la Calle C, Mancheño-Losa M, Marchán-López Á, García-Reyne A, Fernández-Ruiz M, Sayas-Catalán J, Serrano A, Cueto-Felgueroso C, San Juan R, García-García R, Catalán M, Villena V, Aguado JM, and Lumbreras C
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- Adult, Aged, Aged, 80 and over, Humans, Middle Aged, Pandemics, Prospective Studies, SARS-CoV-2, COVID-19 complications, Respiratory Insufficiency epidemiology
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Coronavirus Disease 2019 (COVID-19) pandemic has implacably stricken on the wellness of many countries and their health-care systems. The aim of the present study is to analyze the clinical characteristics of the initial wave of patients with COVID-19 attended in our center, and to identify the key variables predicting the development of respiratory failure. Prospective design study with concurrent data retrieval from automated medical records of all hospitalized adult patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rRT-PCR assay performed on respiratory samples from March 2nd to 18th, 2020. Patients were followed up to May 1st, 2020 or death. Respiratory failure was defined as a PaO
2 /FiO2 ratio ≤ 200 mm Hg or the need for mechanical ventilation (either non-invasive positive pressure ventilation or invasive mechanical ventilation). We included 521 patients of whom 416 (81%) had abnormal Chest X-ray on admission. Median age was 64.6 ± 18.2 years. One hundred eighty-one (34.7%) developed respiratory failure after a median time from onset of symptoms of 9 days (IQR 6-11). In-hospital mortality was 23.8% (124/521). The modeling process concluded into a logistic regression multivariable analysis and a predictive score at admission. Age, peripheral pulse oximetry, lymphocyte count, lactate dehydrogenase and C-reactive protein were the selected variables. The model has a good discriminative capacity with an area under the ROC curve of 0.85 (0.82-0.88). The application of a simple and reliable score at admission seems to be a useful tool to predict respiratory failure in hospitalized COVID-19 patients., (© 2021. Società Italiana di Medicina Interna (SIMI).)- Published
- 2022
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14. Longitudinal dynamics of SARS-CoV-2-specific cellular and humoral immunity after natural infection or BNT162b2 vaccination.
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Almendro-Vázquez P, Laguna-Goya R, Ruiz-Ruigomez M, Utrero-Rico A, Lalueza A, Maestro de la Calle G, Delgado P, Perez-Ordoño L, Muro E, Vila J, Zamarron I, Moreno-Batanero M, Chivite-Lacaba M, Gil-Etayo FJ, Martín-Higuera C, Meléndez-Carmona MÁ, Lumbreras C, Arellano I, Alarcon B, Allende LM, Aguado JM, and Paz-Artal E
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- Adult, Aged, Antibodies, Neutralizing blood, Female, Humans, Immunoglobulin G blood, Longitudinal Studies, Male, Middle Aged, Spike Glycoprotein, Coronavirus immunology, Antibodies, Viral blood, BNT162 Vaccine immunology, COVID-19 immunology, SARS-CoV-2 immunology, T-Lymphocytes immunology, Vaccination
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The timing of the development of specific adaptive immunity after natural SARS-CoV-2 infection, and its relevance in clinical outcome, has not been characterized in depth. Description of the long-term maintenance of both cellular and humoral responses elicited by real-world anti-SARS-CoV-2 vaccination is still scarce. Here we aimed to understand the development of optimal protective responses after SARS-CoV-2 infection and vaccination. We performed an early, longitudinal study of S1-, M- and N-specific IFN-γ and IL-2 T cell immunity and anti-S total and neutralizing antibodies in 88 mild, moderate or severe acute COVID-19 patients. Moreover, SARS-CoV-2-specific adaptive immunity was also analysed in 234 COVID-19 recovered subjects, 28 uninfected BNT162b2-vaccinees and 30 uninfected healthy controls. Upon natural infection, cellular and humoral responses were early and coordinated in mild patients, while weak and inconsistent in severe patients. The S1-specific cellular response measured at hospital arrival was an independent predictive factor against severity. In COVID-19 recovered patients, four to seven months post-infection, cellular immunity was maintained but antibodies and neutralization capacity declined. Finally, a robust Th1-driven immune response was developed in uninfected BNT162b2-vaccinees. Three months post-vaccination, the cellular response was comparable, while the humoral response was consistently stronger, to that measured in COVID-19 recovered patients. Thus, measurement of both humoral and cellular responses provides information on prognosis and protection from infection, which may add value for individual and public health recommendations., Competing Interests: The authors have declared that no competing interests exist.
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- 2021
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15. Impact of viral load at admission on the development of respiratory failure in hospitalized patients with SARS-CoV-2 infection.
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de la Calle C, Lalueza A, Mancheño-Losa M, Maestro-de la Calle G, Lora-Tamayo J, Arrieta E, García-Reyne A, Losada I, de Miguel B, Díaz-Simón R, López-Medrano F, Fernández-Ruiz M, Carretero O, San Juan R, Aguado JM, and Lumbreras C
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- Adult, Aged, Aged, 80 and over, COVID-19 diagnosis, COVID-19 Nucleic Acid Testing, Female, Hospitalization, Humans, Male, Middle Aged, Nasopharynx virology, Real-Time Polymerase Chain Reaction, COVID-19 complications, Respiratory Insufficiency virology, Viral Load
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The aim of our study was to elucidate if SARS-CoV-2 viral load on admission, measured by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) cycle threshold (Ct) value on nasopharyngeal samples, was a marker of disease severity. All hospitalized adult patients with a diagnosis of SARS-CoV-2 infection by rRT-PCR performed on a nasopharingeal sample from March 1 to March 18 in our institution were included. The study population was divided according to the Ct value obtained upon admission in patients with high viral load (Ct < 25), intermediate viral load (Ct: 25-30) and low viral load (Ct > 30). Demographic, clinical and laboratory variables of the different groups were analyzed to assess the influence of viral load on the development of respiratory failure during admission. Overall, 455 sequential patients were included. The median Ct value was 28 (IQR: 24-32). One hundred and thirty patients (28.6%) had a high viral load, 175 (38.5%) an intermediate viral load and 150 (33%) a low viral load. Advanced age, male sex, presence of cardiovascular disease and laboratory markers such as lactate dehydrogenase, lymphocyte count and C-reactive protein, as well as a high viral load on admission, were predictive of respiratory failure. A Ct value < 25 was associated with a higher risk of respiratory failure during admission (OR: 2.99, 95%IC: 1.57-5.69). SARS-CoV-2 viral load, measured through the Ct value on admission, is a valuable tool to predict the development of respiratory failure in COVID-19 inpatients.
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- 2021
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16. Effectiveness of anakinra for tocilizumab-refractory severe COVID-19: A single-centre retrospective comparative study.
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de la Calle C, López-Medrano F, Pablos JL, Lora-Tamayo J, Maestro-de la Calle G, Sánchez-Fernández M, Fernández-Ruiz M, Pérez-Jacoiste Asín MA, Caro-Teller JM, García-García R, Catalán M, Martínez-López J, Sevillano Á, Origüen J, Ripoll M, San Juan R, Lalueza A, de Miguel B, Carretero O, Aguilar F, Gómez C, Paz-Artal E, Bueno H, Lumbreras C, and Aguado JM
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- Aged, COVID-19 complications, Case-Control Studies, Cohort Studies, Cytokine Release Syndrome etiology, Female, Hospital Mortality, Humans, Immunomodulation drug effects, Male, Middle Aged, Retrospective Studies, Salvage Therapy, Spain epidemiology, Treatment Failure, Treatment Outcome, Antibodies, Monoclonal, Humanized therapeutic use, Cytokine Release Syndrome drug therapy, Interleukin 1 Receptor Antagonist Protein therapeutic use, SARS-CoV-2, COVID-19 Drug Treatment
- Abstract
Objectives: A subgroup of patients with SARS-CoV-2 infection was thought to have developed cytokine release syndrome and were treated with tocilizumab; however, a significant percentage of patients evolved. This study aimed to determine the usefulness of anakinra as a rescue treatment for patients with tocilizumab-refractory COVID-19 disease., Methods: A prospective cohort of patients with COVID-19 pneumonia who received anakinra as salvage therapy after failure of tocilizumab were compared (1:1) with selected controls in a historical cohort of patients treated with tocilizumab. Cases and controls were matched by age, comorbidities, pulse oximetry oxygen saturation to fraction of inspired oxygen (SpO2/FiO2) ratio at baseline, and time elapsed since the initiation of treatment with tocilizumab. The primary outcome was the improvement in clinical status measured by a 6-point ordinal scale, from baseline to day 21., Results: The study included 20 cases and 20 controls (mean age 65.3 ± 12.8 years, 65% males). No differences were found in the clinical improvement rates at 7, 14 and 21 days of follow-up. The in-hospital mortality rate for patients receiving anakinra was 55% vs. 45% in the control group (P = 0.527)., Conclusions: Treatment with anakinra was not useful in improving the prognosis of patients with tocilizumab-refractory severe COVID-19., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2021
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17. Combination therapy with tocilizumab and corticosteroids for aged patients with severe COVID-19 pneumonia: A single-center retrospective study.
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López-Medrano F, Pérez-Jacoiste Asín MA, Fernández-Ruiz M, Carretero O, Lalueza A, Maestro de la Calle G, Caro JM, de la Calle C, Catalán M, García-García R, Martínez-López J, Origüen J, Ripoll M, San Juan R, Trujillo H, Sevillano Á, Gutiérrez E, de Miguel B, Aguilar F, Gómez C, Silva JT, García-Ruiz de Morales D, Saro-Buendía M, Marrero-Sánchez Á, Chiara-Graciani G, Bueno H, Paz-Artal E, Lumbreras C, Pablos JL, and Aguado JM
- Subjects
- Aged, Aged, 80 and over, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Retrospective Studies, Antibodies, Monoclonal, Humanized administration & dosage, Methylprednisolone administration & dosage, SARS-CoV-2, COVID-19 Drug Treatment
- Abstract
Background: The role of combination immunomodulatory therapy with systemic corticosteroids and tocilizumab (TCZ) for aged patients with COVID-19-associated cytokine release syndrome remains unclear., Methods: A retrospective single-center study was conducted on consecutive patients aged ≥65 years who developed severe COVID-19 between 03 March and 01 May 2020 and were treated with corticosteroids at various doses (methylprednisolone 0.5mg/kg/12h to 250mg/24h), either alone (CS group) or associated with intravenous tocilizumab (400-600mg, one to three doses) (CS-TCZ group). The primary outcome was all-cause mortality by day +14, whereas secondary outcomes included mortality by day +28 and clinical improvement (discharge and/or a ≥2 point decrease on a 6-point ordinal scale) by day +14. Propensity score (PS)-based adjustment and inverse probability of treatment weights (IPTW) were applied., Results: Totals of 181 and 80 patients were included in the CS and CS-TCZ groups, respectively. All-cause 14-day mortality was lower in the CS-TCZ group, both in the PS-adjusted (hazard ratio [HR]: 0.34; 95% confidence interval [CI]: 0.17-0.68; P=0.002) and IPTW-weighted models (odds ratio [OR]: 0.38; 95% CI: 0.21-0.68; P=0.001). This protective effect was also observed for 28-day mortality (PS-adjusted HR: 0.38; 95% CI: 0.21-0.72; P=0.003). Clinical improvement by day +14 was higher in the CS-TCZ group with IPTW analysis only (OR: 2.26; 95% CI: 1.49-3.41; P<0.001). The occurrence of secondary infection was similar between both groups., Conclusions: The combination of corticosteroids and TCZ was associated with better outcomes among patients aged ≥65 years with severe COVID-19., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2021
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18. [Incidence of intravenous colistin nephrotoxicity in hospitalized patients].
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Rosas Espinoza C, Caro Teller JM, Maestro de la Calle G, Arrieta Loitegui M, and Ferrari Piquero JM
- Subjects
- Adult, Aged, Female, Humans, Incidence, Male, Middle Aged, Retrospective Studies, Risk Factors, Anti-Bacterial Agents adverse effects, Colistin adverse effects
- Abstract
Objective: The increase in infections with multidrug resistant bacteria has forced to return to the use of colistin, antibiotic with known nephrotoxicity. The aim of the study is to determine the incidence of colistin nephrotoxicity nowadays., Methods: Retrospective-observational-unicentric study was collected hospitalized patients in intravenous colistin treatment during the years 2018-2019. Nephrotoxicity was defined according to the RIFLE scale. The variables to determine it were serum creatinine (sCr) and glomerular filtration (GF). The variables analyzed were age, sex, treatment duration, loading and cumulative dose, empirical/targeted treatment, chronic kidney disease, concomitant use of intravenous contrast and nephrotoxic drugs., Results: A total of 90 patients (60% men) were included, with an average age of 58.2±18.1 years. The mean duration of treatment was 9±8.3 days, with an average cumulative dose of 69.8±71MU. There were no differences between sCr and GF at the beginning and end of treatment. The incidence of nephrotoxicity was 1.73 cases/100 days of treatment (prevalence of 15.56%)., Conclusions: Colistin nephrotoxicity has an important incidence, without developing severe illness., (©The Author 2020. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)
- Published
- 2021
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19. Tocilizumab for the treatment of adult patients with severe COVID-19 pneumonia: A single-center cohort study.
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Fernández-Ruiz M, López-Medrano F, Pérez-Jacoiste Asín MA, Maestro de la Calle G, Bueno H, Caro-Teller JM, Catalán M, de la Calle C, García-García R, Gómez C, Laguna-Goya R, Lizasoáin M, Martínez-López J, Origüen J, Pablos JL, Ripoll M, San Juan R, Trujillo H, Lumbreras C, and Aguado JM
- Subjects
- Administration, Intravenous, Adult, Body Temperature drug effects, C-Reactive Protein metabolism, COVID-19 immunology, COVID-19 mortality, COVID-19 virology, Cytokine Release Syndrome immunology, Cytokine Release Syndrome mortality, Cytokine Release Syndrome virology, Female, Heart Rate drug effects, Humans, Interferon-beta adverse effects, L-Lactate Dehydrogenase blood, Male, Middle Aged, Receptors, Interleukin-6 antagonists & inhibitors, Receptors, Interleukin-6 genetics, Receptors, Interleukin-6 immunology, Respiratory Rate drug effects, Retrospective Studies, SARS-CoV-2 immunology, Severity of Illness Index, Survival Analysis, Antibodies, Monoclonal, Humanized therapeutic use, Antiviral Agents therapeutic use, Cytokine Release Syndrome prevention & control, Immunologic Factors therapeutic use, SARS-CoV-2 pathogenicity, COVID-19 Drug Treatment
- Abstract
Coronavirus disease 2019 (COVID-19) can lead to a massive cytokine release. The use of the anti-interleukin-6 receptor monoclonal antibody tocilizumab (TCZ) has been proposed in this hyperinflammatory phase, although supporting evidence is limited. We retrospectively analyzed 88 consecutive patients with COVID-19 pneumonia that received at least one dose of intravenous TCZ in our institution between 16 and 27 March 2020. Clinical status from day 0 (first TCZ dose) through day 14 was assessed by a 6-point ordinal scale. The primary outcome was clinical improvement (hospital discharge and/or a decrease of ≥2 points on the 6-point scale) by day 7. Secondary outcomes included clinical improvement by day 14 and dynamics of vital signs and laboratory values. Rates of clinical improvement by days 7 and 14 were 44.3% (39/88) and 73.9% (65/88). Previous or concomitant receipt of subcutaneous interferon-β (adjusted odds ratio [aOR]: 0.23; 95% confidence interval [CI]: 0.06-0.94; P = .041) and serum lactate dehydrogenase more than 450 U/L at day 0 (aOR: 0.25; 95% CI: 0.06-0.99; P = .048) were negatively associated with clinical improvement by day 7. All-cause mortality was 6.8% (6/88). Body temperature and respiratory and cardiac rates significantly decreased by day 1 compared to day 0. Lymphocyte count and pulse oximetry oxygen saturation/FiO
2 ratio increased by days 3 and 5, whereas C-reactive protein levels dropped by day 2. There were no TCZ-attributable adverse events. In this observational single-center study, TCZ appeared to be useful and safe as immunomodulatory therapy for severe COVID-19 pneumonia., (© 2020 Wiley Periodicals LLC.)- Published
- 2021
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20. Clinical Characteristics and Prognosis of COPD Patients Hospitalized with SARS-CoV-2.
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Gómez Antúnez M, Muiño Míguez A, Bendala Estrada AD, Maestro de la Calle G, Monge Monge D, Boixeda R, Ena J, Mella Pérez C, Anton Santos JM, and Lumbreras Bermejo C
- Subjects
- Aged, COVID-19 mortality, Female, Humans, Male, Pandemics, Pneumonia, Viral complications, Pneumonia, Viral mortality, Pneumonia, Viral therapy, Pneumonia, Viral virology, Prognosis, Pulmonary Disease, Chronic Obstructive mortality, Registries, Retrospective Studies, Risk Factors, SARS-CoV-2, Spain epidemiology, Survival Rate, COVID-19 complications, COVID-19 therapy, Pulmonary Disease, Chronic Obstructive complications, Pulmonary Disease, Chronic Obstructive therapy
- Abstract
Objective: To describe the characteristics and prognosis of patients with COPD admitted to the hospital due to SARS-CoV-2 infection., Methods: The SEMI-COVID registry is an ongoing retrospective cohort comprising consecutive COVID-19 patients hospitalized in Spain since the beginning of the pandemic in March 2020. Data on demographics, clinical characteristics, comorbidities, laboratory tests, radiology, treatment, and progress are collected. Patients with COPD were selected and compared to patients without COPD. Factors associated with a poor prognosis were analyzed., Results: Of the 10,420 patients included in the SEMI-COVID registry as of May 21, 2020, 746 (7.16%) had a diagnosis of COPD. Patients with COPD are older than those without COPD (77 years vs 68 years) and more frequently male. They have more comorbidities (hypertension, hyperlipidemia, diabetes mellitus, atrial fibrillation, heart failure, ischemic heart disease, peripheral vascular disease, kidney failure) and a higher Charlson Comorbidity Index (2 vs 1, p<0.001). The mortality rate in COPD patients was 38.3% compared to 19.2% in patients without COPD (p<0.001). Male sex, a history of hypertension, heart failure, moderate-severe chronic kidney disease, presence of cerebrovascular disease with sequelae, degenerative neurological disease, dementia, functional dependence, and a higher Charlson Comorbidity Index have been associated with increased mortality due to COVID-19 in COPD patients. Survival was higher among patients with COPD who were treated with hydroxychloroquine (87.1% vs 74.9%, p<0.001) and with macrolides (57.9% vs 50%, p<0.037). Neither prone positioning nor non-invasive mechanical ventilation, high-flow nasal cannula, or invasive mechanical ventilation were associated with a better prognosis., Conclusion: COPD patients admitted to the hospital with SARS-CoV-2 infection have more severe disease and a worse prognosis than non-COPD patients., Competing Interests: The authors declare that they have no conflicts of interest for this work., (© 2020 Gómez Antúnez et al.)
- Published
- 2021
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21. Clinical Predictive Model of Multidrug Resistance in Neutropenic Cancer Patients with Bloodstream Infection Due to Pseudomonas aeruginosa.
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Gudiol C, Albasanz-Puig A, Laporte-Amargós J, Pallarès N, Mussetti A, Ruiz-Camps I, Puerta-Alcalde P, Abdala E, Oltolini C, Akova M, Montejo M, Mikulska M, Martín-Dávila P, Herrera F, Gasch O, Drgona L, Paz Morales H, Brunel AS, García E, Isler B, Kern WV, Morales I, Maestro-de la Calle G, Montero M, Kanj SS, Sipahi OR, Calik S, Márquez-Gómez I, Marin JI, Gomes MZR, Hemmatti P, Araos R, Peghin M, Del Pozo JL, Yáñez L, Tilley R, Manzur A, Novo A, and Carratalà J
- Subjects
- Anti-Bacterial Agents therapeutic use, Bacteremia drug therapy, Female, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Models, Biological, Neoplasms complications, Neutropenia complications, Pseudomonas Infections drug therapy, Pseudomonas aeruginosa drug effects, ROC Curve, Retrospective Studies, Risk Factors, Treatment Outcome, Bacteremia microbiology, Drug Resistance, Multiple, Bacterial, Neoplasms microbiology, Neutropenia microbiology, Pseudomonas Infections microbiology
- Abstract
We aimed to assess the rate and predictive factors of bloodstream infection (BSI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa in neutropenic cancer patients. We performed a multicenter, retrospective cohort study including oncohematological neutropenic patients with BSI due to P. aeruginosa conducted across 34 centers in 12 countries from January 2006 to May 2018. A mixed logistic regression model was used to estimate a model to predict the multidrug resistance of the causative pathogens. Of a total of 1,217 episodes of BSI due to P. aeruginosa , 309 episodes (25.4%) were caused by MDR strains. The rate of multidrug resistance increased significantly over the study period ( P = 0.033). Predictors of MDR P. aeruginosa BSI were prior therapy with piperacillin-tazobactam (odds ratio [OR], 3.48; 95% confidence interval [CI], 2.29 to 5.30), prior antipseudomonal carbapenem use (OR, 2.53; 95% CI, 1.65 to 3.87), fluoroquinolone prophylaxis (OR, 2.99; 95% CI, 1.92 to 4.64), underlying hematological disease (OR, 2.09; 95% CI, 1.26 to 3.44), and the presence of a urinary catheter (OR, 2.54; 95% CI, 1.65 to 3.91), whereas older age (OR, 0.98; 95% CI, 0.97 to 0.99) was found to be protective. Our prediction model achieves good discrimination and calibration, thereby identifying neutropenic patients at higher risk of BSI due to MDR P. aeruginosa The application of this model using a web-based calculator may be a simple strategy to identify high-risk patients who may benefit from the early administration of broad-spectrum antibiotic coverage against MDR strains according to the local susceptibility patterns, thus avoiding the use of broad-spectrum antibiotics in patients at a low risk of resistance development., (Copyright © 2020 American Society for Microbiology.)
- Published
- 2020
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22. Impact of antibiotic resistance on outcomes of neutropenic cancer patients with Pseudomonas aeruginosa bacteraemia (IRONIC study): study protocol of a retrospective multicentre international study.
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Albasanz-Puig A, Gudiol C, Parody R, Tebe C, Akova M, Araos R, Bote A, Brunel AS, Calik S, Drgona L, García E, Hemmati P, Herrera F, Ibrahim KY, Isler B, Kanj S, Kern W, Maestro de la Calle G, Manzur A, Marin JI, Márquez-Gómez I, Martín-Dávila P, Mikulska M, Montejo JM, Montero M, Morales HMP, Morales I, Novo A, Oltolini C, Peghin M, Del Pozo JL, Puerta-Alcalde P, Ruiz-Camps I, Sipahi OR, Tilley R, Yáñez L, Gomes MZR, and Carratalà J
- Subjects
- Anti-Bacterial Agents therapeutic use, Bacteremia mortality, Cephalosporins therapeutic use, Humans, International Cooperation, Logistic Models, Multicenter Studies as Topic, Observational Studies as Topic, Pseudomonas aeruginosa isolation & purification, Research Design, Retrospective Studies, Tazobactam therapeutic use, Time Factors, Bacteremia drug therapy, Drug Resistance, Multiple, Bacterial, Neoplasms complications, Neutropenia complications, Pseudomonas Infections drug therapy
- Abstract
Introduction: Pseudomonas aeruginosa (PA) has historically been one of the major causes of severe sepsis and death among neutropenic cancer patients. There has been a recent increase of multidrug-resistant PA (MDRPA) isolates that may determine a worse prognosis, particularly in immunosuppressed patients. The aim of this study is to establish the impact of antibiotic resistance on the outcome of neutropenic onco-haematological patients with PA bacteraemia, and to identify the risk factors for MDRPA bacteraemia and mortality., Methods and Analysis: This is a retrospective, observational, multicentre, international study. All episodes of PA bacteraemia occurring in neutropenic onco-haematological patients followed up at the participating centres from 1 January 2006 to 31 May 2018 will be retrospectively reviewed. The primary end point will be overall case-fatality rate within 30 days of onset of PA bacteraemia. The secondary end points will be to describe the following: the incidence and risk factors for multidrug-resistant and extremely drug-resistant PA bacteraemia (by comparing the episodes due to susceptible PA with those produced by MDRPA), the efficacy of ceftolozane/tazobactam, the rates of persistent bacteraemia and bacteraemia relapse and the risk factors for very early (48 hours), early (7 days) and overall (30 days) case-fatality rates., Ethics and Dissemination: The Clinical Research Ethics Committee of Bellvitge University Hospital approved the protocol of the study at the primary site. To protect personal privacy, identifying information of each patient in the electronic database will be encrypted. The processing of the patients' personal data collected in the study will comply with the Spanish Data Protection Act of 1998 and with the European Directive on the privacy of data. All data collected, stored and processed will be anonymised. Results will be reported at conferences and in peer-reviewed publications., Competing Interests: Competing interests: A-SB received grant from Promex Stiftung fur die Forschung (by Carigest SA), and funding by Gilead to assist to the ECCMID Congress (2018). ORS received speaker’s honorarium from MSD, Astellas, Novartis and Pfizer., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
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23. Toxin B PCR Amplification Cycle Threshold Adds Little to Clinical Variables for Predicting Outcomes in Clostridium difficile Infection: a Retrospective Cohort Study.
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Origüen J, Orellana MÁ, Fernández-Ruiz M, Corbella L, San Juan R, Ruiz-Ruigómez M, López-Medrano F, Lizasoain M, Ruiz-Merlo T, Maestro-de la Calle G, Parra P, Villa J, Delgado R, and Aguado JM
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Immunoenzyme Techniques methods, Male, Middle Aged, Prognosis, ROC Curve, Recurrence, Retrospective Studies, Sensitivity and Specificity, Treatment Outcome, Young Adult, Bacterial Proteins genetics, Bacterial Toxins genetics, Clinical Decision Rules, Clostridium Infections diagnosis, Clostridium Infections pathology, Polymerase Chain Reaction methods
- Abstract
The objective of the present study was to evaluate the value of the PCR cycle threshold ( C
T ) for predicting the recurrence/severity of infection compared to that of toxin detection plus clinical variables. First episodes of Clostridium difficile infection (CDI) diagnosed during 2015 at our institution were included. Samples were tested for glutamate dehydrogenase (GDH) and toxin A/B by use of a single enzyme immunoassay (EIA). The Xpert C. difficile PCR assay was performed on GDH-positive samples. Medical data were reviewed by investigators blinded to diagnostic results for comparison of patients with and without recurrence or a poor outcome (severe/severe-complicated CDI episodes and all-cause death). We generated two sets of predictive models by incorporating the presence of a positive toxin EIA ("EIA-including model") or the optimal PCR CT cutoff value ("PCR-including model") into the clinical variables. Among 227 episodes of CDI included in the study, the rates of recurrence and poor outcome were 15.8% and 30.8%, respectively. The mean PCR CT was lower for episodes with recurrence (24.00 ± 3.28 versus 26.02 ± 4.54; P = 0.002) or a poor outcome (24.9 ± 4.24 versus 26.05 ± 4.47; P = 0.07). The optimal cutoff value for recurrence was 25.65 (sensitivity, 77.8% [95% confidence interval {CI}, 60.9 to 89.9]; and specificity, 46.6% [95% CI, 39.4 to 53.9]). The area under the receiver operator characteristics curve (auROC) for the "PCR-including model" was similar to that for the "EIA-including model" (0.785 versus 0.775, respectively). The optimal PCR CT value for poor outcome was 27.55 (sensitivity, 78.6% [95% CI, 67.1 to 87.5]; and specificity, 35.7% [95% CI, 28.2 to 43.7]). The auROC of the "PCR-including model" was again similar to that of the "EIA-including model" (0.804 versus 0.801). Despite the inverse correlation between PCR CT and the risk of CDI recurrence/severity, this determination does not meaningfully increase the predictive value of clinical variables plus toxin EIA., (Copyright © 2019 American Society for Microbiology.)- Published
- 2019
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24. Post-transplant hypocomplementemia: A novel marker of cardiovascular risk in kidney transplant recipients?
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Maestro de la Calle G, Fernández-Ruiz M, López-Medrano F, Polanco N, González E, San Juan R, Ruiz-Merlo T, Origüen J, Paz-Artal E, Andrés A, and Aguado JM
- Subjects
- Adult, Aged, Biomarkers blood, Cardiovascular Diseases blood, Cardiovascular Diseases diagnosis, Cardiovascular Diseases epidemiology, Female, Humans, Incidence, Male, Middle Aged, Monitoring, Immunologic, Progression-Free Survival, Prospective Studies, Retrospective Studies, Risk Assessment, Risk Factors, Spain epidemiology, Time Factors, Cardiovascular Diseases immunology, Complement C3 deficiency, Complement C4 deficiency, Kidney Transplantation adverse effects
- Abstract
Background and Aims: Cardiovascular disease (CVD) is a leading cause of mortality after kidney transplantation (KT). The potential role of the complement system in the pathogenesis of post-transplant CVD remains unexplored., Methods: Serum complement (C3 and C4) levels were measured at baseline and post-transplant months 1 and 6 in 447 kT recipients. The study outcome was post-transplant atherothrombotic event (PAE), a composite of acute coronary syndrome, critical peripheral arterial disease, stroke and/or transient ischemic attack., Results: After a median follow-up of 4.2 years, 48 PAEs occurred in 43 patients (cumulative incidence: 9.6%; incidence rate: 2.6 events per 100 transplant-years). No differences were found in C3 and C4 levels at baseline or month 1 between patients with or without PAE. However, C3 levels at month 6 were significantly lower in patients developing PAE beyond that point (i.e., late PAE) (96.9 ± 22.3 vs. 109.6 ± 24.0 mg/dL; p = 0.013). The presence of C3 hypocomplementemia at month 6 was associated with a lower PAE-free survival (p = 0.002). After adjusting for conventional CVD risk factors and acute graft rejection, C3 hypocomplementemia at month 6 remained as an independent risk factor for late PAE in all the exploratory models (minimum hazard ratio: 3.24; p = 0.011). With respect to a model exclusively based on clinical variables, the inclusion of C3 levels at month 6 improved predictive capacity (areas under ROC curves: 0.788 and 0.812, respectively)., Conclusions: Post-transplant monitoring of serum C3 levels might be useful to identify KT recipients at increased risk of CVD., (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Published
- 2018
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25. Efficacy of β-Lactam/β-Lactamase Inhibitor Combinations for the Treatment of Bloodstream Infection Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae in Hematological Patients with Neutropenia.
- Author
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Gudiol C, Royo-Cebrecos C, Abdala E, Akova M, Álvarez R, Maestro-de la Calle G, Cano A, Cervera C, Clemente WT, Martín-Dávila P, Freifeld A, Gómez L, Gottlieb T, Gurguí M, Herrera F, Manzur A, Maschmeyer G, Meije Y, Montejo M, Peghin M, Rodríguez-Baño J, Ruiz-Camps I, Sukiennik TC, Tebe C, and Carratalà J
- Subjects
- Adult, Bacteremia complications, Bacteremia microbiology, Bacteremia mortality, Carbapenems therapeutic use, Cohort Studies, Enterobacteriaceae enzymology, Enterobacteriaceae Infections complications, Enterobacteriaceae Infections microbiology, Enterobacteriaceae Infections mortality, Female, Humans, Male, Middle Aged, beta-Lactamases metabolism, beta-Lactams therapeutic use, Anti-Bacterial Agents therapeutic use, Bacteremia drug therapy, Enterobacteriaceae drug effects, Enterobacteriaceae Infections drug therapy, Neutropenia complications, beta-Lactamase Inhibitors therapeutic use
- Abstract
β-Lactam/β-lactamase inhibitors (BLBLIs) were compared to carbapenems in two cohorts of hematological neutropenic patients with extended-spectrum-β-lactamase (ESBL) bloodstream infection (BSI): the empirical therapy cohort (174 patients) and the definitive therapy cohort (251 patients). The 30-day case fatality rates and other secondary outcomes were similar in the two therapy groups of the two cohorts and also in the propensity-matched cohorts. BLBLIs might be carbapenem-sparing alternatives for the treatment of BSI due to ESBLs in these patients., (Copyright © 2017 American Society for Microbiology.)
- Published
- 2017
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26. Clinical efficacy of β-lactam/β-lactamase inhibitor combinations for the treatment of bloodstream infection due to extended-spectrum β-lactamase-producing Enterobacteriaceae in haematological patients with neutropaenia: a study protocol for a retrospective observational study (BICAR).
- Author
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Gudiol C, Royo-Cebrecos C, Tebe C, Abdala E, Akova M, Álvarez R, Maestro-de la Calle G, Cano A, Cervera C, Clemente WT, Martín-Dávila P, Freifeld A, Gómez L, Gottlieb T, Gurguí M, Herrera F, Manzur A, Maschmeyer G, Meije Y, Montejo M, Peghin M, Rodríguez-Baño J, Ruiz-Camps I, Sukiennik TC, and Carratalà J
- Subjects
- Adolescent, Adult, Aged, Bacteremia drug therapy, Drug Therapy, Combination, Female, Hematologic Neoplasms therapy, Hematopoietic Stem Cell Transplantation, Humans, Male, Middle Aged, Retrospective Studies, Superinfection prevention & control, Anti-Bacterial Agents therapeutic use, Enterobacteriaceae Infections drug therapy, Neutropenia complications, beta-Lactamase Inhibitors therapeutic use, beta-Lactams therapeutic use
- Abstract
Introduction: Bloodstream infection (BSI) due to extended-spectrum β-lactamase-producing Gram-negative bacilli (ESBL-GNB) is increasing at an alarming pace worldwide. Although β-lactam/β-lactamase inhibitor (BLBLI) combinations have been suggested as an alternative to carbapenems for the treatment of BSI due to these resistant organisms in the general population, their usefulness for the treatment of BSI due to ESBL-GNB in haematological patients with neutropaenia is yet to be elucidated. The aim of the BICAR study is to compare the efficacy of BLBLI combinations with that of carbapenems for the treatment of BSI due to an ESBL-GNB in this population., Methods and Analysis: A multinational, multicentre, observational retrospective study. Episodes of BSI due to ESBL-GNB occurring in haematological patients and haematopoietic stem cell transplant recipients with neutropaenia from 1 January 2006 to 31 March 2015 will be analysed. The primary end point will be case-fatality rate within 30 days of onset of BSI. The secondary end points will be 7-day and 14-day case-fatality rates, microbiological failure, colonisation/infection by resistant bacteria, superinfection, intensive care unit admission and development of adverse events., Sample Size: The number of expected episodes of BSI due to ESBL-GNB in the participant centres will be 260 with a ratio of control to experimental participants of 2., Ethics and Dissemination: The protocol of the study was approved at the first site by the Research Ethics Committee (REC) of Hospital Universitari de Bellvitge. Approval will be also sought from all relevant RECs. Any formal presentation or publication of data from this study will be considered as a joint publication by the participating investigators and will follow the recommendations of the International Committee of Medical Journal Editors (ICMJE). The study has been endorsed by the European Study Group for Bloodstream Infection and Sepsis (ESGBIS) and the European Study Group for Infections in Compromised Hosts (ESGICH)., Competing Interests: JR-B has been a scientific consultant for Merck, AstraZeneca, Achaogen and InfectoPharm, a speaker in accredited educational activities for Merck and AstraZeneca, a recipient of research grants from COMBACTE-NET, COMBACTE-CARE and COMBACTE-MAGNET, funded by the Innovative Medicines Initiative (European Union and EFPIA in kind). AF has received research fees from Merck, and from Astellas for data and safety monitoring. JC has received lecture fees from Novartis, Astellas, Pfizer, MSD, Janssen and Astra-Zeneca., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
- Published
- 2017
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27. Platypnea-orthodeoxia syndrome.
- Author
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Merino Argumánez C, Mérida García A, Sierra Bracamonte M, Maestro de la Calle G, and Mateo Álvarez S
- Published
- 2014
- Full Text
- View/download PDF
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