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1. El ictus en pacientes muy ancianos: mitos y realidades

Author

Manuel Fuentes-Ferrer, Vicente Estrada, Jesús Porta-Etessam, Cristina Valencia, Ana Bravo, Sergio Serrano-Villar, Pedro Ruiz-Artacho, and Gema Fresco

Subjects
Gynecology, medicine.medical_specialty, Disease susceptibility, business.industry, Ischemic stroke, medicine, General Medicine, Hospital mortality, business
Abstract

Resumen Fundamento y objetivo La incidencia de ictus en individuos muy ancianos se halla en ascenso. Sin embargo, existen muy pocos datos sobre las diferencias en el tratamiento y la evolucion de estos pacientes en nuestro medio. Material y metodo Se analizaron las caracteristicas clinicas, los recursos diagnostico-terapeuticos empleados, las complicaciones medicas y la mortalidad intrahospitalaria en 463 sujetos ingresados por ictus isquemico entre 2009-2010. Se compararon las diferencias entre los pacientes con ≥ 85 anos («muy ancianos») y los de menor edad. Resultados Los pacientes muy ancianos presentaron al ingreso mayor frecuencia de fibrilacion auricular (34 frente a 19%, p National Institutes of Health Stroke Scale (IC 95% 1,8-38,1). Conclusiones Los sujetos muy ancianos ingresados por ictus isquemico reciben menores recursos diagnosticos y terapeuticos. Sin embargo, en nuestro estudio la edad no fue un factor independiente para la mortalidad, que vino determinada esencialmente por la situacion funcional previa y la gravedad del ictus.

Published
2013

2. Short- versus long-duration levofloxacin plus rifampicin for acute staphylococcal prosthetic joint infection managed with implant retention: a randomised clinical trial

Author

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

3. Executive summary of the diagnosis and antimicrobial treatment of invasive infections due to multidrug-resistant Enterobacteriaceae. Guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC)

Author

Carmen Peña, Gema Fresco, Carlota Gudiol, Nazaret Cobos-Trigueros, Germán Bou, Vicente Pintado, Lorena López-Cerero, Carolina Navarro-San Francisco, Álvaro Pascual, José Garnacho-Montero, Juan Pablo Horcajada, Pilar Retamar, Milagro Montero, José Miguel Cisneros, José Ramón Paño-Pardo, Jesús Rodríguez-Baño, José Molina, José Antonio Martínez, Marcio Borges-Sa, and María Tomás

Subjects
Microbiology (medical), medicine.medical_specialty, Executive summary, biology, business.industry, Public health, Enterobacteriaceae Infections, Microbiological Techniques, Antimicrobial, biology.organism_classification, Enterobacteriaceae, Microbiology, Multiple drug resistance, Clinical microbiology, Anti-Infective Agents, Drug Resistance, Multiple, Bacterial, medicine, Humans, Observational study, Intensive care medicine, business
Abstract

The spread of multidrug-resistant Enterobacteriaceae related to the production of extended-spectrum β-lactamases (ESBL) and carbapenemases is a serious public health problem worldwide. Microbiological diagnosis and therapy of these infections are challenging and controversial. After the selection of clinically relevant questions, this document provides evidence-based recommendations for the use of microbiological techniques for the detection of ESBL- and carbapenemase-producing Enterobacteriaceae, and for antibiotic therapy for invasive infections caused by these organisms. The absence of randomized-controlled trials is noteworthy, thus recommendations are mainly based on observational studies, that have important methodological limitations, pharmacokinetic and pharmacodynamics models, and data from animal studies. Additionally, areas for future research were identified.

Published
2014

4. [Stroke in the very old: myths and realities]

Author

Sergio, Serrano-Villar, Gema, Fresco, Pedro, Ruiz-Artacho, Ana, Bravo, Cristina, Valencia, Manuel, Fuentes-Ferrer, Vicente, Estrada, and Jesús, Porta-Etessam

Subjects
Male, Diagnostic Techniques, Cardiovascular, Comorbidity, Severity of Illness Index, Brain Ischemia, Recurrence, Risk Factors, Atrial Fibrillation, Diabetes Mellitus, Humans, Hospital Mortality, Aged, Dyslipidemias, Aged, 80 and over, Incidence, Anticoagulants, Length of Stay, Prognosis, Drug Utilization, Intracranial Embolism, Spain, Hypertension, Female, Disease Susceptibility, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Platelet Aggregation Inhibitors
Abstract

The incidence of stroke in the very old is increasing. However, there are very few data regarding the differences in the management and outcomes in Spain.We analyzed the clinical characteristics, diagnostic and therapeutic procedures, medical complications and intrahospitalary mortality in 463 subjects admitted because of ischemic stroke between 2009 and 2010. Very-old patients (≥ 85 year-old) were compared with younger patients.Very old patients showed on admission higher frequency of atrial fibrillation (34 vs 19%, P.001) and lower use of antiplatelet agents and oral anticoagulants (P.001). Disability and stroke severity were higher among the very old (P.001) and the use of diagnostic and therapeutic procedures was significantly lower (P.001). The length of stay was longer in the very old (12 [6-24] days vs 8 [5-15], P.001), as wells as the intrahospitalary mortality (27 vs 6%, P.001). After a multivariate analysis, independent predictive factors of mortality were previous disability, measured by the modified Rankin scale (95% confidence interval [95%CI] 1.6-10.7), impaired level of consciousness (IC95% 2.1-13.9) and stroke severity measured by the National Institutes of Health Stroke Scale (95%CI 1.8-38.1).Very old patients admitted with ischemic stroke undergo less diagnostic and therapeutic procedures. However, in our study, very old age was not an independent predictor of mortality, which was essentially determined by previous functional status and stroke severity.

Published
2012

5. [Aspergillosis. Clinical forms and treatment]

Author

Jesús, Fortún, Yolanda, Meije, Gema, Fresco, and Santiago, Moreno

Subjects
Neuroaspergillosis, Salvage Therapy, Cross Infection, Endophthalmitis, Antifungal Agents, Endocarditis, Galactose, Vulnerable Populations, Mannans, Radiography, Immunocompromised Host, Aspergillus, Postoperative Complications, Species Specificity, Risk Factors, Drug Resistance, Multiple, Fungal, Aspergillosis, Humans, Pulmonary Aspergillosis, Fungemia
Abstract

Invasive aspergillosis, chronic pulmonary aspergillosis and allergic bronchopulmonary aspergillosis are the clinical forms of aspergillosis. Although there is a great number of Aspergillus species, Aspergillus fumigatus-complex is the more frequent aetiological agent, regardless of clinical form or baseline condition. The increase in immunosuppressive agents and the higher use of corticosteroids in chronic obstructive pulmonary disease have led to aspergillosis becoming more prominent in recent years. Galactomannan detection and radiological diagnostic images complement the limitations of microbiology cultures in these patients. Voriconazole and liposomal amphotericin B are the gold standard in patients requiring therapy, and posaconazole, itraconazole, caspofungin and other echinocandins are effective alternatives. The prognosis depends of clinical forms and characteristics of the host, but it is particularly poor in the disseminated invasive forms.

Published
2011

6. Diagnosis and antimicrobial treatment of invasive infections due to multidrug-resistant Enterobacteriaceae. Guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology

Author

Carmen Peña, Marcio Borges-Sa, Pilar Retamar, Álvaro Pascual, Gema Fresco, José Molina, Nazaret Cobos-Trigueros, José Antonio Martínez, José Ramón Paño-Pardo, Juan Pablo Horcajada, María Tomás, Germán Bou, Carolina Navarro-San Francisco, Milagro Montero, Jesús Rodríguez-Baño, José Garnacho-Montero, Vicente Pintado, José Miguel Cisneros, Lorena López-Cerero, and Carlota Gudiol

Subjects
Microbiology (medical), Final version, medicine.medical_specialty, biology, business.industry, Public health, Enterobacteriaceae Infections, Microbiological Techniques, Antimicrobial, biology.organism_classification, Enterobacteriaceae, Microbiology, Multiple drug resistance, Clinical microbiology, Drug Resistance, Multiple, Bacterial, medicine, Humans, Observational study, Intensive care medicine, business
Abstract

a b s t r a c t The spread of multidrug-resistant Enterobacteriaceae related to the production of extended-spectrum - lactamases and carbapenemases is a serious public health problem worldwide. Microbiological diagnosis and therapy of these infections are challenging and controversial. Clinically relevant questions were selected and the literature was reviewed for each of them. The information from the selected articles was extracted and recommendations were provided and graded according to the strength of the recommendations and quality of the evidence. The document was opened to comments from the members from the Spanish Society of Infectious Diseases and Clinical Microbiology, which were considered for inclusion in the final version. Evidence-based recommendations are provided for the use of microbiological techniques for the detec- tion of extended-spectrum -lactamases and carbapenemases in Enterobacteriaceae, and for antibiotic therapy for invasive/severe infections caused by these organisms. The absence of randomised controlled trials is noteworthy; thus, recommendations are mainly based on observational studies (that have impor- tant methodological limitations), pharmacokinetic and pharmacodynamics models, and data from animal studies. Additionally, areas for future research were identified.

Published
2015

7. Pneumonia treated in the internal medicine department: focus on healthcare-associated pneumonia

Author

GIANNELLA, MADDALENA, Pinilla, B., Capdevila, J. A., Martínez Alarcón, J., Muñoz, P., López Álvarez, J., Bouza, E., de Henares, Alcalá, Álvarez, Joaquín López, Ruiz, Eduardo Montero, de Lis Muñoz, José María, Narrillos, Carmen Cano, Sánchez, Pascual Sesma, Díaz, Hortensia Álvarez, Martínez, María Paloma Geijo, Ruiz Capilla, Juan José Jusdado, López, Daniel Ferreiro, Lechuz, Juan Manuel García, Martínez, Valentín Cuervas Mons, del Campo, Pedro Durán, Montaud, Alberto Roldán, Vivanco Martínez, Francisco Javier, Pinedo, Amaya Egoluz, Leizaola, Katixa, Vidal, Rafael Pérez, El Boutrouki, Omar, San Román Terán, Carlos Made, Sepúlveda, Sonsoles Fernández, Piñero, Emilio Santín, Santos, Javier Solera, de Tomas Labat, Maelena, Olavarrieta, Juan Custardoy, Zaragoza, José Manuel Murcia, Liaño, Francisco Pasquau, Prous, Concepción Amador, Pou, Jordi Casademont, Marcuello, Jordi Martín, Salva, Joaquín Oristrell, Martínez, Susana Herranz, Palao, José Soriano, Marco, Francisco de Asis Sarabia, Suárez, Pedro Cancelo, Álvarez, Pedro Luis Álvarez, Gaviria, Antonio Zapatero, Mena Bernal, Juan Hinojosa, Fuster, Peter Reth, Camacho, Sandra Milena Bacca, Fernández, Carmen Suárez, Ramos, Laura Prosper, Bejar, Carmen Sáez, Calabuig, Eva, Garau, Javier, Calbo, Esther, Pascual, Vanesa, Audibert, Luis, Bunsow, Eleonora, Castaño, Jesús García, Esteban, Elena Trigo, Antúnez, María Gómez, Polo, Naiara Aldezábal, Rubio, José Santiago Filgueira, Berastegui, Olga López, Rodríguez, Miguel Ángel Artacho, González Cobos, Cristina López, Acebes, Eduardo Oliveros, Martín, María Jesús Granda, Hernández, Belén Mora, Huerta, Faustino Herrero, Marina, Gandia Herrero, Fernández, Francisco Santolaria, Rodríguez, José Juan Viña, Salomó, Antoni Castro, Iftimie, Simona, de Casadola, Gonzalo García, Quero, José Luis Pérez, Casanova, Pere Comas, Molina, Juan Valencia, Miranda, José López, Fernández, Rafael Martínez, Perea, Carmelo Perea, Hernández, Carmen González, Calvet, Paloma Lucena, Pujol, Ramón, Losa, Carlos Ferre, O. Callaghan, Francisco Cabades, Babiloni, Manuel Arnal, Company, José Bisbe, Igual, Jesús Javier González, Otin, Elena Castellar, Porras, Miguel Carrascosa, Saiz Quevedo García, José Antonio, Del Villar Sordo, Valentín, Sánchez, Mario Del Valle, Rodríguez, José Perales, Fariña, Sergio Diz, Ugarte, Carlos Pereda, Alabau, Filomena Ceres, Santos, Pedro González, Linares, Juan Luis Carrillo, Farre, José Barbera, Salinas, Miguel Torres, Méndez, Luis Miguel Sarmiento, Torres, María Sánchez, Planas, Joaquín Vila, Amorós, Jordi Grau, Paires, Joan Colomer, Ferrer, Cristina Soler, Moreno, Agustín Zamarrón, Carrillo, Laura Hurtado, López, MaDolores Díaz, Rodríguez, Ricardo Fernánder, Manuel, Elpidio Calvo, Camacho, Cesar Augusto Henríquez, Cruz, Arturo Fernández, Biezma, Cristina Gómez Sánchez, González, Baltasar Orejas, Navacerrada, Gema Fresco, Peláez, Vanesa López, Bellver, Salvador, Estebanez, Carlos Tornero, Carruez, Antonio Jimeno, Muñoz, Luis Ángel Sánchez, Montoro, Domingo Bofill, Ribera, Mercé Cardona, Martínez, Andrés Tutor, Berrocal, María Antonia Sepúlveda, Moraleja, Julio González, Terradellas, Joan Brugues, Sosa, Esteban Reynaga, Mora, Arturo Artero, Gimeno, Francesc Puchades, Cerezo, Jorge Francisco Gómez, Cantero, Rafael del Castillo, Aragoneses, Lourdes Mancebo, Cortés, Eduardo Aguilar, Mariscal, María Ruiz, Serrano, Carmen Piqueras, Calderón, Juan L. Rodríguez, Ruiz, Pablo Robles, Legarre, Ángel Samperiz, Gómez, Raquel Carrillo, Asensio, Arturo Noguerado, Sánchez, Fernando Marcos, Cuerda, Elena Nuñez, Arberas, Victoria Egurbide, López, Ramiro de la Prieta, Sánchez, Pilar Román, Serra, Josep Masferrer, Martín, José Felipe Morales, Pérez, José Luis Beato, Puig, Rita Massa, Rosell, Nuria Costa, Moya, Miguel de Paco, Llinares, Juan Ramón Sánchez, Bohórquez, Francisco José Castro, Giannella, M, Pinilla, B., Capdevila, J.A., Martínez Alarcón, J., Muñoz, P., López Álvarez, J., Bouza, E., de Henares, Alcalá, Álvarez, Joaquín López, Ruiz, Eduardo Montero, de Lis Muñoz, José María, Narrillos, Carmen Cano, Sánchez, Pascual Sesma, Díaz, Hortensia Álvarez, Martínez, María Paloma Geijo, Ruiz-Capilla, Juan José Jusdado, López, Daniel Ferreiro, Lechuz, Juan Manuel García, Martínez, Valentín Cuervas-Mon, del Campo, Pedro Durán, Montaud, Alberto Roldán, Vivanco Martínez, Francisco Javier, Pinedo, Amaya Egoluz, Leizaola, Katixa, Vidal, Rafael Pérez, El Boutrouki, Omar, San Román Terán, Carlos Made, Sepúlveda, Sonsoles Fernández, Piñero, Emilio Santín, Santos, Javier Solera, de Tomas Labat, Maelena, Olavarrieta, Juan Custardoy, Zaragoza, José Manuel Murcia, Liaño, Francisco Pasquau, Prous, Concepción Amador, Pou, Jordi Casademont, Marcuello, Jordi Martín, Salva, Joaquín Oristrell, Martínez, Susana Herranz, Palao, José Soriano, Marco, Francisco de Asis Sarabia, Suárez, Pedro Cancelo, Álvarez, Pedro Luis Álvarez, Gaviria, Antonio Zapatero, Mena-Bernal, Juan Hinojosa, Fuster, Peter Reth, Camacho, Sandra Milena Bacca, Fernández, Carmen Suárez, Ramos, Laura Prosper, Bejar, Carmen Sáez, Calabuig, Eva, Garau, Javier, Calbo, Esther, Pascual, Vanesa, Audibert, Lui, Bunsow, Eleonora, Castaño, Jesús García, Esteban, Elena Trigo, Antúnez, María Gómez, Polo, Naiara Aldezábal, Rubio, José Santiago Filgueira, Berastegui, Olga López, Rodríguez, Miguel Ángel Artacho, González-Cobos, Cristina López, Acebes, Eduardo Olivero, Martín, María Jesús Granda, Hernández, Belén Mora, Huerta, Faustino Herrero, Marina, Gandia Herrero, Fernández, Francisco Santolaria, Rodríguez, José Juan Viña, Salomó, Antoni Castro, Iftimie, Simona, de Casadola, Gonzalo García, Quero, José Luis Pérez, Casanova, Pere Coma, Molina, Juan Valencia, Miranda, José López, Fernández, Rafael Martínez, Perea, Carmelo Perea, Hernández, Carmen González, Calvet, Paloma Lucena, Pujol, Ramón, Losa, Carlos Ferre, O-Callaghan, Francisco Cabade, Babiloni, Manuel Arnal, Company, José Bisbe, Igual, Jesús Javier González, Otin, Elena Castellar, Porras, Miguel Carrascosa, Saiz-Quevedo García, José Antonio, Del Villar Sordo, Valentín, Sánchez, Mario Del Valle, Rodríguez, José Perale, Fariña, Sergio Diz, Ugarte, Carlos Pereda, Alabau, Filomena Cere, Santos, Pedro González, Linares, Juan Luis Carrillo, Farre, José Barbera, Salinas, Miguel Torre, Méndez, Luis Miguel Sarmiento, Torres, María Sánchez, Planas, Joaquín Vila, Amorós, Jordi Grau, Paires, Joan Colomer, Ferrer, Cristina Soler, Moreno, Agustín Zamarrón, Carrillo, Laura Hurtado, López, MaDolores Díaz, Rodríguez, Ricardo Fernánder, Manuel, Elpidio Calvo, Camacho, Cesar Augusto Henríquez, Cruz, Arturo Fernández, Biezma, Cristina Gómez Sánchez, González, Baltasar Oreja, Navacerrada, Gema Fresco, Peláez, Vanesa López, Bellver, Salvador, Estebanez, Carlos Tornero, Carruez, Antonio Jimeno, Muñoz, Luis Ángel Sánchez, Montoro, Domingo Bofill, Ribera, Mercé Cardona, Martínez, Andrés Tutor, Berrocal, María Antonia Sepúlveda, Moraleja, Julio González, Terradellas, Joan Brugue, Sosa, Esteban Reynaga, Mora, Arturo Artero, Gimeno, Francesc Puchade, Cerezo, Jorge Francisco Gómez, Cantero, Rafael del Castillo, Aragoneses, Lourdes Mancebo, Cortés, Eduardo Aguilar, Mariscal, María Ruiz, Serrano, Carmen Piquera, Calderón, Juan L. Rodríguez, Ruiz, Pablo Roble, Legarre, Ángel Samperiz, Gómez, Raquel Carrillo, Asensio, Arturo Noguerado, Sánchez, Fernando Marco, Cuerda, Elena Nuñez, Arberas, Victoria Egurbide, López, Ramiro de la Prieta, Sánchez, Pilar Román, Serra, Josep Masferrer, Martín, José Felipe Morale, Pérez, José Luis Beato, Puig, Rita Massa, Rosell, Nuria Costa, Moya, Miguel de Paco, Llinares, Juan Ramón Sánchez, and Bohórquez, Francisco José Castro

Subjects
Male, Microbiology (medical), medicine.medical_specialty, Community-acquired pneumonia, Population, Aspiration pneumonia, medicine.disease_cause, Hospital-acquired pneumonia, Risk Factors, Internal medicine, Streptococcus pneumoniae, medicine, Pneumonia, Bacterial, hospital-acquired pneumonia, Humans, Community-Acquired Infection, education, Aged, Aged, 80 and over, education.field_of_study, Cross Infection, Pseudomonas aeruginosa, business.industry, Risk Factor, healthcare-associated pneumonia, General Medicine, medicine.disease, Community-Acquired Infections, Pneumonia, hospitalized pneumonia patient, internal medicine, Infectious Diseases, Etiology, Female, Guideline Adherence, Health Services Research, business, Human
Abstract

Patients with pneumonia treated in the internal medicine department (IMD) are often at risk of healthcare-associated pneumonia (HCAP). The importance of HCAP is controversial. We invited physicians from 72 IMDs to report on all patients with pneumonia hospitalized in their department during 2weeks (one each in January and June 2010) to compare HCAP with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). We analysed 1002 episodes of pneumonia: 58.9% were CAP, 30.6% were HCAP and 10.4% were HAP. A comparison between CAP, HCAP and HAP showed that HCAP patients were older (77, 83 and 80.5years; p

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