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1. Quality check: concordance between two monitoring systems for postoperative organ/space-surgical site infections in rectal cancer surgery. Linkage of data from the Catalan Cancer Plan and the VINCat infection surveillance programme

Author

Carlota Matallana, Miguel Pera, Eloy Espin-Basany, Sebastiano Biondo, Josep M Badia, Enric Limon, Miquel Pujol, Borja de Lacy, Luisa Aliste, Josep M Borràs, and Paula Manchon-Walsh

Subjects
Surgical Site infection, Surgical Wound Infection/prevention & control*, Cohort studies, Rectal Surgery* / adverse effects, Rectal cancer, Surgical Wound infection / prevention & control, Surgery, RD1-811, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background The Catalan Cancer Plan (CCP) undertakes periodic audits of cancer treatment outcomes, including organ/space surgical site infections (O/S-SSI) rates, while the Catalan Healthcare-associated Infections Surveillance Programme (VINCat) carries out standardized prospective surveillance of surgical site infections (SSI) in colorectal surgery. This cohort study aimed to assess the concordance between these two monitoring systems for O/S-SSI following primary rectal cancer surgery. Methods The study compared O/S-SSI incidence data from CCP clinical audits versus the VINCat Programme in patients undergoing surgery for primary rectal cancer, in 2011-12 and 2015-16, in publicly funded centres in Spain. The main outcome variable was the incidence of O/S-SSI in the first 30 days after surgery. Concordance between the two registers was analysed using Cohen’s kappa. Discordant cases were reviewed by an expert, and the main reasons for discrepancies evaluated. Results Pooling data from both databases generated a sample of 2867 patients. Of these, O/S-SSI was detected in 414 patients—235 were common to both registry systems, with satisfactory concordance (κ = 0.69, 95% confidence interval 0.65–0.73). The rate of discordance from the CCP (positive cases in VINCat and negative in CCP) was 2.7%, and from VINCat (positive in CCP and negative in VINCat) was 3.6%. External review confirmed O/S-SSI in 66.2% of the cases in the CCP registry and 52.9% in VINCat. Conclusions This type of synergy shows the potential of pooling data from two different information sources with a satisfactory level of agreement as a means to improving O/S-SSI detection. ClinicalTrials.gov Identifier: NCT06104579. Registered 30 November 2023.

Published
2024
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2. Antimicrobial stewardship programs in acute-care hospitals: A multicenter assessment of structure, process, and outcome indicators in Italy and Spain

Author

Giuseppina Lo Moro, Noemi Marengo, Alessandro Mara, José Ramón Paño Pardo, Sergi Hernandez, Ester Fusté, Miquel Pujol, Carla Maria Zotti, Enric Limón, and Costanza Vicentini

Subjects
Antimicrobial stewardship, Quality indicators, Italy, Spain, Antimicrobial resistance, Pandemic, Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270
Abstract

Background: Antimicrobial stewardship (AMS) programs have been differently implemented across Europe. This study primarily aimed to compare AMS in two European regions. Secondarily, the study explored the COVID-19 pandemic impact on surrogate outcome indicators of AMS. Methods: A retrospective observational study was conducted in Piedmont (Italy) and Catalonia (Spain). AMS programs were compared through structure and process indicators in 2021. Changes in surrogate outcome indicators (antimicrobial usage; alcohol-based sanitizer consumption; antimicrobial resistance, AMR) from 2017 to 2021 described the pandemic impact. Results: Seventy-eight facilities provided structure and process indicators. Catalonia showed better structure scores (p

Published
2024
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3. Effects of the COVID-19 Pandemic on Incidence and Epidemiology of Catheter-Related Bacteremia, Spain

Author

Oriol Gasch, Laia Badia-Cebada, Joao Carmezim, Montserrat Vaqué, Virginia Pomar, Encarna Moreno, Anna Marrón, Emili Jiménez-Martínez, Maria José García-Quesada, Xavier Garcia-Alarcón, Dolors Domènech, Jordi Càmara, Marta Andrés, Judith Peñafiel, Rosario Porrón, Enric Limón, Esther Calbo, and Miquel Pujol

Subjects
COVID-19, respiratory infections, severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, SARS, coronavirus disease, Medicine, Infectious and parasitic diseases, RC109-216
Abstract

We compared hospital-acquired catheter-related bacteremia (CRB) episodes diagnosed at acute care hospitals in Catalonia, Spain, during the COVID-19 pandemic in 2020 with those detected during 2007–2019. We compared the annual observed and predicted CRB rates by using the negative binomial regression model and calculated stratified annual root mean squared errors. A total of 10,030 episodes were diagnosed during 2007–2020. During 2020, the observed CRB incidence rate was 0.29/103 patient-days, whereas the predicted CRB rate was 0.14/103 patient-days. The root mean squared error was 0.153. Thus, a substantial increase in hospital-acquired CRB cases was observed during the COVID-19 pandemic in 2020 compared with the rate predicted from 2007–2019. The incidence rate was expected to increase by 1.07 (95% CI 1–1.15) for every 1,000 COVID-19–related hospital admissions. We recommend maintaining all CRB prevention efforts regardless of the coexistence of other challenges, such as the COVID-19 pandemic.

Published
2022
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4. Best practice in the use of peripheral venous catheters: A scoping review and expert consensus

Author

Walter Zingg, Andrew Barton, James Bitmead, Philippe Eggimann, Miquel Pujol, Arne Simon, and Johannes Tatzel

Subjects
Peripheral venous catheter, Complications, Bloodstream infections, Exit-site infections, Prevention, Best practice, Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: Peripheral intravenous catheters (PIVCs) are the most commonly used invasive medical device in health care with an overall failure rate of 35–50%. Most complications are non-infectious, but local site and bloodstream infections can also occur. Even if PIVC-related infections are rare, the total number of affected patients and the preponderance of Staphylococcus aureus as related pathogen due to the frequent use of these devices are relevant arguments to implement preventive strategies. The aim of this document is to raise awareness that infections caused by PIVCs are a relevant problem that can be reduced by practice change. Methods: A panel of experts discussed this topic based on evidence and proposed practice points by consensus. Discussion: Despite published evidence-based guidelines, current practice concerning aseptic techniques during insertion and care of PIVCs often are substandard. These devices have become commonplace and tend to be perceived as safe. An overall lack of awareness about the true risks associated with the use of PIVCs results in limited surveillance and prevention efforts. Conclusion: Successful insertion and maintenance bundles in central venous lines are a blueprint to the implementation of adapted bundle strategies in the prevention of PIVC-associated infections. There is a need for studies to specifically investigate infection prevention in PIVCs and to agree on effective and implementable bundles.

Published
2023
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5. Economic impact of a care bundle to prevent surgical site infection after craniotomy: a cost-analysis study

Author

Emilio Jiménez-Martínez, Guillermo Cuervo, Jordi Carratalà, Ana Hornero, Pilar Ciercoles, Andreu Gabarrós, Carmen Cabellos, Ivan Pelegrin, Maria Angeles Domínguez-Luzón, Jordi Càmara, Ramon Moreno-Fuentes, Jordi Adamuz, and Miquel Pujol

Subjects
Surgical site infection, Craniotomy, Bundle, Prevention, Economic impact, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background Surgical site infections after craniotomy (SSI-CRAN) significantly impact patient outcomes and healthcare costs by increasing length of stay and readmission and reoperation rates. However, to our knowledge, no study has yet analysed the economic impact of a surgical care bundle for preventing SSI-CRAN. The aim is to analyse the hospital cost saving after implementation of a care bundle for the prevention of SSI-CRAN. Methods A retrospective cost-analysis was performed, considering two periods: pre-care bundle (2013–2015) and care bundle (2016–2017). A bottom-up approach was used to calculate the costs associated with infection in patients who developed a SSI-CRAN in comparison to those who did not, in both periods and on a patient-by-patient basis. The derived cost of SSI-CRAN was calculated considering: (1) cost of the antibiotic treatment, (2) cost of length of stay in the neurosurgery ward within the 1-year follow up period, (3) cost of the re-intervention, and (4) cost of the implant for cranial reconstruction, when necessary. Results A total of 595 patients were included in the pre-care bundle period and 422 in the care bundle period. Mean cost of a craniotomy procedure was approximately €8000, rising to €24,000 in the case of SSI-CRAN. Mean yearly hospital costs fell by €502,857 in the care bundle period (€714,886 vs. €212,029). Extra costs between periods were mainly due to increased length of hospital stay (€573,555.3 vs. €183,958.9; difference: €389,596.4), followed by the cost of implant for cranial reconstruction (€69,803.4 vs. €9,936; difference: €59,867.4). Overall, implementation of the care bundle saved the hospital €500,844.3/year. Conclusion The implementation of a care bundle for SSI-CRAN had a significant economic impact. Hospitals should consider the deployment of this multimodal preventive strategy to reduce their SSI-CRAN rates, and also their costs.

Published
2021
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6. Clinical characteristics and outcome of bacteraemia caused by Enterobacter cloacae and Klebsiella aerogenes: more similarities than differences

Author

Rocío Álvarez-Marín, José Antonio Lepe, Oriol Gasch-Blasi, José Manuel Rodríguez-Martínez, Jorge Calvo-Montes, Rosario Lara-Contreras, Cecilia Martín-Gandul, Fe Tubau-Quintano, María Eliecer Cano-García, Fernando Rodríguez-López, Jesús Rodríguez-Baño, Miquel Pujol-Rojo, Julián Torre-Cisneros, Luis Martínez-Martínez, Álvaro Pascual-Hernández, and Manuel E. Jiménez-Mejías

Subjects
Enterobacter cloacae, Klebsiella aerogenes, Enterobacter aerogenes, Bacteraemia, Case–control study, Quinolone resistance mechanism, Microbiology, QR1-502
Abstract

ABSTRACT: Objectives: The genus Enterobacter is a common cause of nosocomial infections. Historically, the most frequent Enterobacter species were those of Enterobacter cloacae complex and Enterobacter aerogenes. In 2019, E. aerogenes was re-classified as Klebsiella aerogenes owing to its higher genotypic similarity with the genus Klebsiella. Our objective was to characterise and compare the clinical profiles of bacteraemia caused by E. cloacae and K. aerogenes. Methods: This 3-year multicentre, prospective cohort study enrolled consecutive patients with bacteraemia by E. cloacae or K. aerogenes. Baseline characteristics, bacteraemia features (source, severity, treatment), antibiotic susceptibility, resistance mechanisms and mortality were analysed. Results: The study included 285 patients with bacteraemia [196 (68.8%) E. cloacae and 89 (31.2%) K. aerogenes]. The groups showed no differences in age, sex, previous use of invasive devices, place of acquisition, sources or severity at onset. The Charlson score was higher among patients with E. cloacae bacteraemia [2 (1–4) vs. 1 (0.5–3); P = 0.018], and previous antibiotic therapy was more common in patients with K. aerogenes bacteraemia (57.3% vs. 41.3%; P = 0.01). Mortality was 19.4% for E. cloacae and 20.2% for K. aerogenes (P = 0.869). Antibiotic susceptibility was similar for both species, and the incidence of multidrug resistance or ESBL production was low (6% and 5.3%, respectively), with no differences between species. Conclusion: Bacteraemias caused by E. cloacae and K. aerogenes share similar patient profiles, presentation and prognosis. Patients with E. cloacae bacteraemia had more co-morbidities and those with K. aerogenes bacteraemia had received more antibiotics.

Published
2021
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7. Risk factors for hospital readmission following complicated urinary tract infection

Author

Tanya Babich, Noa Eliakim-Raz, Adi Turjeman, Miquel Pujol, Jordi Carratalà, Evelyn Shaw, Aina Gomila Grange, Cuong Vuong, Ibironke Addy, Irith Wiegand, Sally Grier, Alasdair MacGowan, Christiane Vank, Leo van den Heuvel, and Leonard Leibovici

Subjects
Medicine, Science
Abstract

Abstract Hospital readmissions following severe infections are a major economic burden on the health care system and have a negative influence on patients' quality of life. Understanding the risk factors for readmission, particularly the extent to which they could be prevented, is of a great importance. In this study we evaluated potentially preventable risk factors for 60-day readmission in patients surviving hospitalization for complicated urinary tract infection (cUTI). This was a multinational, multicentre retrospective cohort study conducted in Europe and the Middle East. Our cohort included survivors of hospitalization due to cUTI during the years 2013–2014. The primary outcome was 60-day readmission following index hospitalization. Patient characteristics that could have influenced readmission: demographics, infection presentation and management, microbiological and clinical data; were collected via computerized medical records from infection onset up to 60 days after hospital discharge. Overall, 742 patients were included. The cohort median age was 68 years (interquartile range, (IQR) 55–80) and 43.3% (321/742) of patients were males. The all-cause 60-day readmission rate was 20.1% (149/742) and more than half were readmitted for infection [57.1%, (80/140)]. Recurrent cUTI was the most frequent cause for readmission [46.4% (65/140)]. Statistically significant risk factors associated with 60-day readmission in multivariable analysis were: older age (odds ratio (OR) 1.02 for an one-year increment, confidence interval (CI) 1.005–1.03), diabetes mellitus (OR 1.63, 95% CI 1.04–2.55), cancer (OR 1.7, 95% CI 1.05–2.77), previous urinary tract infection (UTI) in the last year (OR 1.8, 95% CI: 1.14–2.83), insertion of an indwelling bladder catheter (OR 1.62, 95% CI 1.07–2.45) and insertion of percutaneous nephrostomy (OR 3.68, 95% CI 1.67–8.13). In conclusion, patients surviving hospitalization for cUTI are frequently re-hospitalized, mostly for recurrent urinary infections associated with a medical condition that necessitated urinary interventions. Interventions to avoid re-admissions should target these patients.

Published
2021
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8. Secondary Characters Coloring the Complex Cultural Atmosphere in Unorthodox

Author

Miquel Pujol-Tubau and Laura Santamaria Guinot

Subjects
L3, audiovisual translation, multilingualism, visual channel, identity, Translating and interpreting, P306-310
Abstract

The objective of this article is to analyze how different languages in the series Unorthodox convey information on characters’ identities, and whether, at the same time, the choice of language produces different effects on the film narrative itself. Since we are dealing with audiovisual products, in any full account of the story, the image must be considered as an essential factor affecting the audiences’ interpretation of the show. The article analyzes how multilingualism is rendered in its Spanish version and shows that different translation solutions may change how each character’s identity is perceived. We found that the main four languages of the series (English, Yiddish, German, and Hebrew) are used to convey different personal and social identities to each character. Besides, linguistic choices between Yiddish and English show the evolution of the main character towards freedom. Although multilingualism is hardly present in the visual channel, cultural references conveyed through images help the viewer to follow key shifts in the story.

Published
2022
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9. La narración de historias en la enseñanza virtual: percepciones, herramientas digitales y experiencias en la escuela primaria durante el confinamiento

Author

Mireia Canals-Botines, Núria Medina-Casanovas, Ángel Raluy-Alonso, and Miquel Pujol-Tubau

Subjects
Storytelling, Language learning, Distance education, Teachers’ beliefs, Education (General), L7-991, Social sciences (General), H1-99
Abstract

La narración de historias es una poderosa arma educativa para alumnos de infantil y primaria. Existe abundante literatura en donde se enfatiza la importancia de la narrativa como instrumento significativo tanto en el aprendizaje de lenguas (Cameron, 2001; Kim, 2010) como en su uso (Magid, 2013). La pandemia COVID ha acelerado la implementación de métodos de aprendizaje a distancia en la escuela y ha supuesto asimismo una prueba para comprobar su efectividad en entornos virtuales. El objetivo de este estudio es explorar la relación existente entre las creencias del profesorado y la aplicación de instrumentos digitales en la enseñanza de inglés como lengua extranjera dentro del contexto del cierre de las escuelas. Como instrumento de investigación se ha utilizado un cuestionario online que ha sido contestado parcialmente por 54 educadores y totalmente por 32. Los resultados parecen indicar que, a pesar de la falta de formación y las dificultades pedagógicas y técnicas inherentes a la enseñanza virtual, se ha generalizado el uso de herramientas online para seguir leyendo historias en la clase de inglés como lengua extranjera.

Published
2021
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10. Molecular Epidemiology, Antimicrobial Susceptibility, and Clinical Features of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections over 30 Years in Barcelona, Spain (1990–2019)

Author

Daniel Antonio Vázquez-Sánchez, Sara Grillo, Anna Carrera-Salinas, Aida González-Díaz, Guillermo Cuervo, Inmaculada Grau, Mariana Camoez, Sara Martí, Dàmaris Berbel, Fe Tubau, Carmen Ardanuy, Miquel Pujol, Jordi Càmara, and Mª Ángeles Domínguez

Subjects
MRSA, Staphylococcus aureus, bacteraemia, antimicrobial resistance, whole-genome sequencing, bloodstream infection, Biology (General), QH301-705.5
Abstract

Methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA-BSI) are a significant cause of mortality. We analysed the evolution of the molecular and clinical epidemiology of MRSA-BSI (n = 784) in adult patients (Barcelona, 1990–2019). Isolates were tested for antimicrobial susceptibility and genotyped (PFGE), and a selection was sequenced (WGS) to characterise the pangenome and mechanisms underlying antimicrobial resistance. Increases in patient age (60 to 71 years), comorbidities (Charlson’s index > 2, 10% to 94%), community-onset healthcare-associated acquisition (9% to 60%), and 30-day mortality (28% to 36%) were observed during the 1990–1995 and 2014–2019 periods. The proportion of catheter-related BSIs fell from 57% to 20%. Current MRSA-BSIs are caused by CC5-IV and an upward trend of CC8-IV and CC22-IV clones. CC5 and CC8 had the lowest core genome proportions. Antimicrobial resistance rates fell, and only ciprofloxacin, tobramycin, and erythromycin remained high (>50%) due to GyrA/GrlA changes, the presence of aminoglycoside-modifying enzymes (AAC(6′)-Ie-APH(2″)-Ia and ANT(4′)-Ia), and mph(C)/msr(A) or erm (C) genes. Two CC22-IV strains showed daptomycin resistance (MprF substitutions). MRSA-BSI has become healthcare-associated, affecting elderly patients with comorbidities and causing high mortality rates. Clonal replacement with CC5-IV and CC8-IV clones resulted in lower antimicrobial resistance rates. The increased frequency of the successful CC22-IV, associated with daptomycin resistance, should be monitored.

Published
2022
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11. Multicentre, randomised, open-label, phase IV–III study to evaluate the efficacy of cloxacillin plus fosfomycin versus cloxacillin alone in adult patients with methicillin-susceptible Staphylococcus aureus bacteraemia: study protocol for the SAFO trial

Author

Joaquin López-contreras, Josep M Miró, Cristian Tebe, Jordi Carratalà, Guillermo Cuervo, Oriol Gasch, Miquel Pujol, Esther Calbo, Yolanda Meije, Ariadna Padullés, Sebastian Videla, José M Aguado, Francesca Gioia, Luis Eduardo López-Cortés, Sara Grillo, Rafael San-Juan, Silvia Gomez-Zorrilla, Aina Gomila-Grange, Simona Iftimie, Graciano Garcia-Pardo, Lucía Boix-Palop, Isabel Oriol, Alfredo Jover-Sáenz, Gorane Euba, Malen Aguirregabiria, Maria Jose Garcia-Pais, Jose Ramón Paño, Maria Luisa Pedro-Botet, Rosa Maria Benítez, Maria Teresa Pérez-Rodríguez, Maria Belén Loeches-Yagüe, Gertrudis Horna, Damaris Berbel, Maria Ángeles Domínguez, Sara Cobo, Pilar Hereu, and Natàlia Pallarés

Subjects
Medicine
Abstract

Introduction Methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia is a frequent condition, with high mortality rates. There is a growing interest in identifying new therapeutic regimens able to reduce therapeutic failure and mortality observed with the standard of care of beta-lactam monotherapy. In vitro and small-scale studies have found synergy between cloxacillin and fosfomycin against S. aureus. Our aim is to test the hypothesis that cloxacillin plus fosfomycin achieves higher treatment success than cloxacillin alone in patients with MSSA bacteraemia.Methods We will perform a superiority, randomised, open-label, phase IV–III, two-armed parallel group (1:1) clinical trial at 20 Spanish tertiary hospitals. Adults (≥18 years) with isolation of MSSA from at least one blood culture ≤72 hours before inclusion with evidence of infection, will be randomly allocated to receive either cloxacillin 2 g/4-hour intravenous plus fosfomycin 3 g/6-hour intravenous or cloxacillin 2 g/4-hour intravenous alone for 7 days. After the first week, sequential treatment and total duration of antibiotic therapy will be determined according to clinical criteria by the attending physician.Primary endpoints: (1) Treatment success at day 7, a composite endpoint comprising all the following criteria: patient alive, stable or with improved quick-Sequential Organ Failure Assessment score, afebrile and with negative blood cultures for MSSA at day 7. (2) Treatment success at test of cure (TOC) visit: patient alive and no isolation of MSSA in blood culture or at another sterile site from day 8 until TOC (12 weeks after randomisation).We assume a rate of treatment success of 74% in the cloxacillin group. Accepting alpha risk of 0.05 and beta risk of 0.2 in a two-sided test, 183 subjects will be required in each of the control and experimental groups to obtain statistically significant difference of 12% (considered clinically significant).Ethics and dissemination Ethical approval has been obtained from the Ethics Committee of Bellvitge University Hospital (AC069/18) and from the Spanish Medicines and Healthcare Product Regulatory Agency (AEMPS, AC069/18), and is valid for all participating centres under existing Spanish legislation. The results will be presented at international meetings and will be made available to patients and funders.Trial registration number The protocol has been approved by AEMPS with the Trial Registration Number EudraCT 2018-001207-37. ClinicalTrials.gov Identifier: NCT03959345; Pre-results.

Published
2021
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12. Clinical outcomes of hospitalised patients with catheter-associated urinary tract infection in countries with a high rate of multidrug-resistance: the COMBACTE-MAGNET RESCUING study

Author

Aina Gomila, Jordi Carratalà, Noa Eliakim-Raz, Evelyn Shaw, Cristian Tebé, Martin Wolkewitz, Irith Wiegand, Sally Grier, Christiane Vank, Nienke Cuperus, Leonard Van den Heuvel, Cuong Vuong, Alasdair MacGowan, Leonard Leibovici, Ibironke Addy, Miquel Pujol, and on behalf of RESCUING Study Group and Study Sites

Subjects
Catheter-associated urinary tract infection, Antimicrobial resistance, Gram-negative infections, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background Although catheter-associated urinary tract infection (CA-UTI) is a major healthcare-related problem worldwide, there is a scarcity of current data from countries with high antimicrobial resistance rates. We aimed to determine the clinical outcomes of patients with CA-UTI compared to those of patients with other sources of complicated urinary tract infection (cUTI), and to assess the impact of antimicrobial resistance. We also aimed to identify the factors influencing 30-day mortality among patients with CA-UTI. Methods This was a multicentre, multinational retrospective cohort study including hospitalised adults with cUTI between January 2013 and December 2014 in twenty hospitals from eight countries from southern Europe, Turkey and Israel. The primary endpoint was 30-day mortality. The secondary endpoints were length of hospital stay, symptom improvement after 7 days’ treatment, symptom recurrence at 30 days and readmission 60 days after hospital discharge. Results Of the 807 cUTI episodes, 341 (42.2%) were CA-UTIs. The time from catheter insertion to cUTI diagnosis was less than 2 weeks in 44.6% of cases. Overall, 74.5% of cases had hospital or healthcare-acquired CA-UTI. Compared to patients with other cUTI aetiologies, those with CA-UTI had the following characteristics: they were more frequently males, older, admitted for a reason other than cUTI and admitted from a long-term care facility; had higher Charlson’s comorbidity index; and more frequently had polymicrobial infections and multidrug-resistant Gram-negative bacteria (MDR-GNB). Patients with CA-UTI also had significantly higher 30-day mortality rates (15.2% vs 6%) and longer hospital stay (median 14 [interquartile range -IQR- 7-27] days vs 8 [IQR 5–14] days) than patients with cUTI of other sources. After adjusting for confounders, CA-UTI was not independently associated with an increased risk of mortality (odds ratio, 1.40; 95% confidence interval, 0.77–2.54), and neither was the presence of MDR-GNB. Conclusions CA-UTI was the most frequent source of cUTI, affecting mainly frail patients. The mortality of patients with CA-UTI was high, though this was not directly related to the infection.

Published
2019
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13. Risk factors for surgical site infection after craniotomy: a prospective cohort study

Author

Emilio Jiménez-Martínez, Guillermo Cuervo, Ana Hornero, Pilar Ciercoles, Andres Gabarrós, Carmen Cabellos, Ivan Pelegrin, Dolores García-Somoza, Jordi Adamuz, Jordi Carratalà, and Miquel Pujol

Subjects
Risk factors, Surgical site infection, Craniotomy, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background Although surgical site infection after craniotomy (SSI-CRAN) is a serious complication, risk factors for its development have not been well defined. We aim to identify the risk factors for developing SSI-CRAN in a large prospective cohort of adult patients undergoing craniotomy. Methods A series of consecutive patients who underwent craniotomy at a university hospital from January 2013 to December 2015 were prospectively assessed. Demographic, epidemiological, surgical, clinical and microbiological data were collected. Patients were followed up in an active post-discharge surveillance programm e for up to one year after surgery. Multivariate analysis was carried out to identify independent risk factors for SSI-CRAN. Results Among the 595 patients who underwent craniotomy, 91 (15.3%) episodes of SSI-CRAN were recorded, 67 (73.6%) of which were organ/space. Baseline demographic characteristics were similar among patients who developed SSI-CRAN and those who did not. The most frequent causative Gram-positive organisms were Cutibacterium acnes (23.1%) and Staphylococcus epidermidis (23.1%), whereas Enterobacter cloacae (12.1%) was the most commonly isolated Gram-negative agent. In the univariate analysis the factors associated with SSI-CRAN were ASA score > 2 (48.4% vs. 35.5% in SSI-CRAN and no SSI-CRAN respectively, p = 0.025), extrinsic tumour (28.6% vs. 19.2%, p = 0.05), and re-intervention (4.4% vs. 1.4%, p = 2 (AOR: 2.26, 95% CI: 1.32–3.87; p = .003) and re-intervention (OR: 8.93, 95% CI: 5.33–14.96; p

Published
2019
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14. The Effectiveness of Combination Therapy for Treating Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Systematic Literature Review and a Meta-Analysis

Author

Sara Grillo, Mireia Puig-Asensio, Marin L. Schweizer, Guillermo Cuervo, Isabel Oriol, Miquel Pujol, and Jordi Carratalà

Subjects
Staphylococcus aureus, methicillin-susceptible, bacteremia, combination therapy, meta-analysis, Biology (General), QH301-705.5
Abstract

Background: This meta-analysis aims to evaluate the effectiveness of combination therapy for treating MSSA bacteremia. Methods: We searched Ovid MEDLINE, EMBASE, Cochrane CENTRAL, and clinicaltrials.gov for studies including adults with MSSA bacteremia. The monotherapy group used a first-line antibiotic active against MSSA and the combination group used a first-line antibiotic plus additional antibiotic/s. The primary outcome was all-cause mortality. Secondary outcomes included persistent bacteremia, duration of bacteremia, relapse, and adverse events. Random-effects models with inverse variance weighting were used to estimate pooled risk ratios (pRR). Heterogeneity was assessed using the I2 value and the Cochrane’s Q statistic. Results: A total of 12 studies (6 randomized controlled trials [RCTs]) were included. Combination therapy did not significantly reduce 30-day mortality (pRR 0.92, 95% CI, 0.70–1.20), 90-day mortality (pRR 0.89, 95% CI, 0.74–1.06), or any-time mortality (pRR 0.91, 95% CI, 0.76–1.08). Among patients with deep-seated infections, adjunctive rifampicin may reduce 90-day mortality (3 studies with moderate-high risk of bias; pRR 0.62, 95% CI, 0.42–0.92). For secondary outcomes, combination therapy decreased the risk of relapse (pRR 0.38, 95% CI, 0.22–0.66), but this benefit was not maintained when pooling RCTs (pRR 0.54, 95% CI, 0.12–2.51). Combination therapy was associated with an increased risk of adverse events (pRR 1.74, 95% CI, 1.31–2.31). Conclusions: Combination therapy not only did not decrease mortality in patients with MSSA bacteremia, but also increased the risk of adverse events. Combination therapy may reduce the risk of relapse, but additional high-quality studies are needed.

Published
2022
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15. Predictive factors for multidrug-resistant gram-negative bacteria among hospitalised patients with complicated urinary tract infections

Author

Aina Gomila, Evelyn Shaw, Jordi Carratalà, Leonard Leibovici, Cristian Tebé, Irith Wiegand, Laura Vallejo-Torres, Joan M. Vigo, Stephen Morris, Margaret Stoddart, Sally Grier, Christiane Vank, Nienke Cuperus, Leonard Van den Heuvel, Noa Eliakim-Raz, Cuong Vuong, Alasdair MacGowan, Ibironke Addy, Miquel Pujol, and on behalf of COMBACTE-MAGNET WP5- RESCUING Study

Subjects
Multidrug-resistance, Complicated urinary tract infection, Gram-negative bacteria, Predictive model of multidrug-resistance gram-negative bacteria, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background Patients with complicated urinary tract infections (cUTIs) frequently receive broad-spectrum antibiotics. We aimed to determine the prevalence and predictive factors of multidrug-resistant gram-negative bacteria in patients with cUTI. Methods This is a multicenter, retrospective cohort study in south and eastern Europe, Turkey and Israel including consecutive patients with cUTIs hospitalised between January 2013 and December 2014. Multidrug-resistance was defined as non-susceptibility to at least one agent in three or more antimicrobial categories. A mixed-effects logistic regression model was used to determine predictive factors of multidrug-resistant gram-negative bacteria cUTI. Results From 948 patients and 1074 microbiological isolates, Escherichia coli was the most frequent microorganism (559/1074), showing a 14.5% multidrug-resistance rate. Klebsiella pneumoniae was second (168/1074) and exhibited the highest multidrug-resistance rate (54.2%), followed by Pseudomonas aeruginosa (97/1074) with a 38.1% multidrug-resistance rate. Predictors of multidrug-resistant gram-negative bacteria were male gender (odds ratio [OR], 1.66; 95% confidence interval [CI], 1.20–2.29), acquisition of cUTI in a medical care facility (OR, 2.59; 95%CI, 1.80–3.71), presence of indwelling urinary catheter (OR, 1.44; 95%CI, 0.99–2.10), having had urinary tract infection within the previous year (OR, 1.89; 95%CI, 1.28–2.79) and antibiotic treatment within the previous 30 days (OR, 1.68; 95%CI, 1.13–2.50). Conclusions The current high rate of multidrug-resistant gram-negative bacteria infections among hospitalised patients with cUTIs in the studied area is alarming. Our predictive model could be useful to avoid inappropriate antibiotic treatment and implement antibiotic stewardship policies that enhance the use of carbapenem-sparing regimens in patients at low risk of multidrug-resistance.

Published
2018
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16. Risk factors and outcomes of organ-space surgical site infections after elective colon and rectal surgery

Author

Aina Gomila, Jordi Carratalà, Daniel Camprubí, Evelyn Shaw, Josep Mª Badia, Antoni Cruz, Francesc Aguilar, Carmen Nicolás, Anna Marrón, Laura Mora, Rafel Perez, Lydia Martin, Rosa Vázquez, Ana Felisa Lopez, Enric Limón, Francesc Gudiol, Miquel Pujol, and on behalf of VINCat colon surgery group

Subjects
Surgical site infections, Organ-space surgical site infections, Colorectal surgery, Surveillance, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background Organ-space surgical site infections (SSI) are the most serious and costly infections after colorectal surgery. Most previous studies of risk factors for SSI have analysed colon and rectal procedures together. The aim of the study was to determine whether colon and rectal procedures have different risk factors and outcomes for organ-space SSI. Methods A multicentre observational prospective cohort study of adults undergoing elective colon and rectal procedures at 10 Spanish hospitals from 2011 to 2014. Patients were followed up until 30 days post-surgery. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Oral antibiotic prophylaxis (OAP) was considered as the administration of oral antibiotics the day before surgery combined with systemic intravenous antibiotic prophylaxis. Results Of 3,701 patients, 2,518 (68%) underwent colon surgery and 1,183 (32%) rectal surgery. In colon surgery, the overall SSI rate was 16.4% and the organ-space SSI rate was 7.9%, while in rectal surgery the rates were 21.6% and 11.5% respectively (p

Published
2017
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17. High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus

Author

Rafael San-Juan, Esther Viedma, Fernando Chaves, Antonio Lalueza, Jesús Fortún, Elena Loza, Miquel Pujol, Carmen Ardanuy, Isabel Morales, Marina de Cueto, Elena Resino-Foz, Alejandra Morales-Cartagena, Alicia Rico, María P. Romero, María Ángeles Orellana, Francisco López-Medrano, Mario Fernández-Ruiz, and José María Aguado

Subjects
methicillin-sensitive Staphylococcus aureus, MSSA, bacteria, complicated bacteremia, vancomycin, daptomycin, Medicine, Infectious and parasitic diseases, RC109-216
Abstract

We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011–June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 μg/mL and 0.5 μg/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2–5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1–5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications.

Published
2016
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18. Low prevalence of Cfr-mediated linezolid resistance among methicillin-resistant Staphylococcus aureus in a Spanish hospital: case report on linezolid resistance acquired during linezolid therapy.

Author

Josep M Sierra, Mariana Camoez, Fe Tubau, Oriol Gasch, Miquel Pujol, Rogelio Martin, and M Angeles Domínguez

Subjects
Medicine, Science
Abstract

Linezolid is an effective antimicrobial agent to treat methicillin-resistant Staphylococcus aureus (MRSA). Resistance to linezolid due to the cfr gene is described worldwide. The present study aimed to analyze the prevalence of the cfr-mediated linezolid resistance among MRSA clinical isolates in our area. A very low prevalence of cfr mediated linezolid resistance was found: only one bacteremic isolate out of 2 215 screened isolates. The only linezolid resistant isolate arose in a patient, previously colonized by MRSA, following linezolid therapy. Despite the low rate of resistance in our area, ongoing surveillance is advisable to avoid the spread of linezolid resistance.

Published
2013
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19. Prevalence and molecular characterization of methicillin-resistant Staphylococcus aureus ST398 resistant to tetracycline at a Spanish hospital over 12 years.

Author

Mariana Camoez, Josep M Sierra, Miquel Pujol, Ana Hornero, Rogélio Martin, and M Angeles Domínguez

Subjects
Medicine, Science
Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) ST398, associated with livestock animals, was described in 2003 as a new lineage infecting or colonizing humans. We evaluated the prevalence and molecular characteristics of MRSA ST398 isolated in the Hospital Universitari de Bellvitge from January 2000 to June 2011. Tetracycline resistant (Tet-R) MRSA isolates from single patients (pts) were screened by SmaI-pulsed field gel electrophoresis (PFGE). Nontypable MRSA strains by SmaI (NT Sma I)-MRSA were further analysed by ApaI-PFGE, spa, SCCmec, agr, MLST typing, and by DNA microarray hybridization. Among 164 pts harboring Tet-R MRSA, NT Sma I-MRSA ST398-agrI was found in 33 pts (20%). Although the first pt was detected in 2003, 22/33 pts (67%) were registered in the 2010-2011 period. Ten pts (30%) were infected and cancer was the most frequent underlying disease. In one case, death was due to MRSA-ST398-related infection. Five pulsotypes (A-E) were detected using ApaI-PFGE, with type A accounting for 76% of the strains. The majority of the studied isolates presented spa type t011 (70%) and SCCmec type V (88%). One strain was spa negative both by PCR and microarray analysis. Forty-nine percent of the studied isolates showed resistance to 3 or more antibiotic classes, in addition to beta-lactams. Ciprofloxacin resistance was 67%. Tet-R was mediated by tet(M) and tet(K) in 26 isolates. All isolates lacked Panton-Valentine Leukocidin production, as well as other significant toxins. This study displays the molecular features of MRSA-ST398 clone and shows the increase in tetracycline resistance together with arise in MRSA-ST398 isolates infecting or colonizing patients in our clinical setting.

Published
2013
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20. Clostridioides difficile infection recurrence in the VINCat hospitals: a prospective observational cohort study

Author

Miquel Pujol, Enric Limón, Nieves Sopena, Joaquín Lopez-Contreras, Laia Castellá, Jordi Cuquet, Maria López-Sánchez, Rafel Pérez, Carlota Gudiol, Ana Coloma, Mariló Marimón, Joan Espinach, Marta Andres, Purificación Martos, Sergi Hernández, Alexander Almendral, Patrick Saliba, Gonçalo Carvalho Rodrigues, Esther Calbo, and VINCat Program Group

Subjects
Microbiology (medical), Microbiology
Abstract

Background: The 2016 cumulative incidence of Clostridioides difficile infection (CDI) in Spain was reported by the European Center for Disease Control to be above the mean of other European countries. The aim of this multicenter prospective observational cohort study was to examine the risk factors that determine 90-day CDI recurrence in Catalonia, Spain. Methods: The study included 558 consecutive adults admitted to hospital who had a symptomatic, first positive CDI diagnosis. Sociodemographic, clinical and epidemiological variables were recorded. The primary outcome was 90-day CDI recurrence. Results: In this Catalan population, having received more than one course of antibiotics in the 30 days prior to CDI diagnosis (odds ratio: 2.459; 95% CI: 1.195–5.060; p = 0.015) and active chemotherapy (odds ratio: 4.859; 95% CI: 1.495–15.792; p = 0.009) are significant predictors of 90-day CDI recurrence. Conclusion: The identification of independent risk factors of 90-day CDI recurrence will enable the optimization of preventive measures in at-risk populations.

Published
2022
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22. Health and Vaccination Status of Unaccompanied Minors After Arrival in a European Border Country: A Cross-sectional Study (2017-2020)

Author

Clara Carreras-Abad, Inés Oliveira-Souto, Diana Pou-Ciruelo, Joan Miquel Pujol-Morro, Pere Soler-Palacín, Antoni Soriano-Arandes, Elena Sulleiro, Begoña Treviño-Maruri, Claudia Broto-Cortés, Juliana Esperalba, Guadalupe García-Salgado, Francesc Zarzuela, Núria Serre-Delcor, and María Espiau

Subjects
Microbiology (medical), Male, Refugees, Adolescent, Vaccination, COVID-19, Europe, Minors, Infectious Diseases, Cross-Sectional Studies, Pediatrics, Perinatology and Child Health, Humans, Female, Child, Pandemics, Retrospective Studies
Abstract

Unaccompanied and separated children (UASC) are a high-risk group for infectious diseases and information on their vaccination status is scarce. Different approaches are used to screen newly arrived minors in Europe. The aim of this study was to describe the health status and serological protection against different vaccine-preventable diseases among UASC to inform public health decision-making.Retrospective study of all UASC seen at an international health reference center in Barcelona (Spain) between January 2017 and February 2020. Screening results were analyzed using binary logistic regression with adjustment for symptoms, geographic origin, and time since arrival.We studied 289 UASC (88.9% males; median age, 17 years). At least one infection was diagnosed in 136 minors (47.1%). There was a high prevalence of intestinal parasites (22.8%), latent tuberculosis infection (22.5%), and hepatitis B (5.2%), even in asymptomatic individuals, and especially among UASC from sub-Saharan Africa (odds ratio, 2.5; 95% confidence interval, 1.5-4.0, Plt; 0.001). We did not observe a significant association between clinical symptoms and the presence of infection or differences in the prevalence of different infections according to number of months since arrival. Protection against hepatitis B virus (36%), measles (80%), and varicella (83%) was suboptimal.Our results highlight the importance of screening and vaccination programs for UASC arriving in Europe, especially border countries. Protocols should be adjusted according to geographic origin. Absence of symptoms does not necessarily rule out infection, highlighting the importance of screening in asymptomatic minors. These programs are a public health priority and should not be neglected during the current COVID-19 pandemic.

Published
2022

23. Risk factors for enterococcal urinary tract infections: a multinational, retrospective cohort study

Author

Christiane Vank, Aina Gomila-Grange, Study Sites, Irith Wiegand, Tanya Babich, Leonard Leibovici, Leo van den Heuvel, Miquel Pujol, Jordi Carratalà, Noa Eliakim-Raz, Sally Grier, Evelyn Shaw, Adi Turjeman, Ibironke Addy, Alasdair P. MacGowan, Nienke Cuperus, and Cuong Vuong

Subjects
0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Multivariate analysis, biology, Urinary retention, Hospitalized patients, business.industry, Urinary system, 030106 microbiology, Retrospective cohort study, General Medicine, biology.organism_classification, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, Medical microbiology, Enterococcus, Internal medicine, medicine, 030212 general & internal medicine, medicine.symptom, business, Male gender
Abstract

Complicated urinary tract infection (cUTI) is a frequent cause of morbidity. In this multinational retrospective cohort study, we aimed to demonstrate risk factors for enterococcal UTI. Univariate and multivariate analyses of risk factors for enterococcal infection were performed. Among 791 hospitalized patients with cUTI, enterococci accounted for approximately 10% of cases (78/791). Risk factors for enterococcal UTI in multivariable analysis were male gender, age range of 55-75 years, catheter-associated UTI, and urinary retention. This information may assist treating physicians in their decision-making on prescribing empiric anti-enterococcus treatment to hospitalized patients presenting with cUTI and thus improve clinical outcomes.

Published
2021
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24. Secondary characters colouring the complex cultural atmosphere in 'Unorthodox'. Multilingualism and its translation in watering screen landscapes

Author

Miquel Pujol and Laura Santamaria Guinot

Subjects
Cultural Studies, Linguistics and Language, Literature and Literary Theory, Visual channel, Identity, L3, Multilingualism, Audiovisual translation, Language and Linguistics
Abstract

The objective of this article is to analyze how different languages in the series Unorthodox convey information on characters’ identities, and whether, at the same time, the choice of language produces different effects on the film narrative itself. Since we are dealing with audiovisual products, in any full account of the story, the image must be considered as an essential factor affecting the audiences’ interpretation of the show. The article analyzes how multilingualism is rendered in its Spanish version and shows that different translation solutions may change how each character’s identity is perceived. We found that the main four languages of the series (English, Yiddish, German, and Hebrew) are used to convey different personal and social identities to each character. Besides, linguistic choices between Yiddish and English show the evolution of the main character towards freedom. Although multilingualism is hardly present in the visual channel, cultural references conveyed through images help the viewer to follow key shifts in the story.

Published
2022

25. The Challenge of Distant Teaching for Primary School Teachers of English during the Covid-19: the Cases of Spain, Italy and Romania

Author

Mireia Canals-Botines, Marius-Mircea Crișan, Raffaella Leproni, Núria Medina-Casanovas, Miquel Pujol Tubau, Angel Raluy Alonso, Canals-Botines, Mireia, Crișan, Marius-Mircea, Leproni, Raffaella, Medina-Casanovas, Núria, Pujol Tubau, Miquel, and Raluy Alonso, Angel

Subjects
Teachers’ Beliefs, COVID Pandemic, Distant Teaching, EFL, Teachers’ Belief, Language and Literature, EFL, Distant Teaching, COVID Pandemic
Abstract

This paper illustrates some teachers��� perspectives, beliefs and experiences as to distance learning before and during the COVID-19 pandemic. The comparative analysis of the responses to a specifically designed online survey administered to a hundred primary-school EFL teachers in some regions of Italy, Romania, and Spain in May/July 2020, aimed to examine the brunt of the pandemic on teachers in those severely affected areas. Results suggest that educators were somehow prepared to face distance learning in terms of resources and materials. During the lockdown they used synchronic video-conferencing tools and online games more extensively; though they struggled to monitor children���s progress and to uphold their motivation throughout the school closures, they seem ready to embed those instruments and strategies in future blended teaching. However, educators admit to lack training in how to implement FL online teaching and are concerned about its efficacy with young learners., LEA - Lingue e Letterature d'Oriente e d'Occidente, Vol. 10 (2021)

Published
2021
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26. La narración de historias en la enseñanza virtual: percepciones, herramientas digitales y experiencias en la escuela primaria durante el confinamiento

Author

Miquel Pujol-Tubau, Ángel Raluy-Alonso, Mireia Canals-Botines, and Núria Medina-Casanovas

Abstract

La narración de historias es una poderosa arma educativa para alumnos de infantil y primaria. Existe abundante literatura en donde se enfatiza la importancia de la narrativa como instrumento significativo tanto en el aprendizaje de lenguas (Cameron, 2001; Kim, 2010) como en su uso (Magid, 2013). La pandemia COVID ha acelerado la implementación de métodos de aprendizaje a distancia en la escuela y ha supuesto asimismo una prueba para comprobar su efectividad en entornos virtuales. El objetivo de este estudio es explorar la relación existente entre las creencias del profesorado y la aplicación de instrumentos digitales en la enseñanza de inglés como lengua extranjera dentro del contexto del cierre de las escuelas. Como instrumento de investigación se ha utilizado un cuestionario online que ha sido contestado parcialmente por 54 educadores y totalmente por 32. Los resultados parecen indicar que, a pesar de la falta de formación y las dificultades pedagógicas y técnicas inherentes a la enseñanza virtual, se ha generalizado el uso de herramientas online para seguir leyendo historias en la clase de inglés como lengua extranjera.

Published
2021
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27. Economic impact of a care bundle to prevent surgical site infection after craniotomy: a cost-analysis study

Author

Iván Pelegrín, Miquel Pujol, Jordi Carratalà, Pilar Ciercoles, Emilio Jiménez-Martínez, Andreu Gabarrós, Ramon Moreno-Fuentes, Guillermo Cuervo, A. Hornero, Jordi Càmara, Jordi Adamuz, Carmen Cabellos, and Maria Angeles Domínguez-Luzón

Subjects
Male, Microbiology (medical), medicine.medical_specialty, medicine.medical_treatment, Infectious and parasitic diseases, RC109-216, Hospitals, University, Nosocomial infections, Health care, medicine, Humans, Surgical Wound Infection, Pharmacology (medical), Care bundle, Economic impact analysis, health care economics and organizations, Craniotomy, Retrospective Studies, business.industry, Research, Prevention, Public Health, Environmental and Occupational Health, Health Care Costs, Length of Stay, Middle Aged, Infeccions nosocomials, Combined Modality Therapy, Anti-Bacterial Agents, Bundle, Economic impact, Treatment Outcome, Infectious Diseases, Spain, Emergency medicine, Costs and Cost Analysis, Cost analysis, Female, Neurosurgery, business, Surgical site infection, Anàlisi d'impacte econòmic
Abstract

Background Surgical site infections after craniotomy (SSI-CRAN) significantly impact patient outcomes and healthcare costs by increasing length of stay and readmission and reoperation rates. However, to our knowledge, no study has yet analysed the economic impact of a surgical care bundle for preventing SSI-CRAN. The aim is to analyse the hospital cost saving after implementation of a care bundle for the prevention of SSI-CRAN. Methods A retrospective cost-analysis was performed, considering two periods: pre-care bundle (2013–2015) and care bundle (2016–2017). A bottom-up approach was used to calculate the costs associated with infection in patients who developed a SSI-CRAN in comparison to those who did not, in both periods and on a patient-by-patient basis. The derived cost of SSI-CRAN was calculated considering: (1) cost of the antibiotic treatment, (2) cost of length of stay in the neurosurgery ward within the 1-year follow up period, (3) cost of the re-intervention, and (4) cost of the implant for cranial reconstruction, when necessary. Results A total of 595 patients were included in the pre-care bundle period and 422 in the care bundle period. Mean cost of a craniotomy procedure was approximately €8000, rising to €24,000 in the case of SSI-CRAN. Mean yearly hospital costs fell by €502,857 in the care bundle period (€714,886 vs. €212,029). Extra costs between periods were mainly due to increased length of hospital stay (€573,555.3 vs. €183,958.9; difference: €389,596.4), followed by the cost of implant for cranial reconstruction (€69,803.4 vs. €9,936; difference: €59,867.4). Overall, implementation of the care bundle saved the hospital €500,844.3/year. Conclusion The implementation of a care bundle for SSI-CRAN had a significant economic impact. Hospitals should consider the deployment of this multimodal preventive strategy to reduce their SSI-CRAN rates, and also their costs.

Published
2021
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28. Bloodstream Infection and Endocarditis Caused by Staphylococcus aureus in Patients with Cancer: A Multicenter Cohort Study

Author

Guillermo Cuervo, Miquel Pujol, Jordi Carratalà, Júlia Laporte-Amargós, Manel Tuells, Immaculada Grau, Carlota Gudiol, Dàmaris Berbel, and Sara Grillo

Subjects
Microbiology (medical), medicine.medical_specialty, business.industry, Incidence (epidemiology), Cancer, medicine.disease, medicine.disease_cause, Infectious Diseases, Staphylococcus aureus, Internal medicine, Infective endocarditis, Bloodstream infection, Bacteremia, Medicine, Endocarditis, business, Cohort study
Abstract

INTRODUCTION In a large cohort of patients with Staphylococcus aureus bloodstream infection (SABSI), we aimed to analyze the incidence and risk factors for infective endocarditis (IE) among patients with active cancer (PAC) in comparison with those without cancer (PWC). METHODS Multicenter cohort study of patients with SABSI admitted to two tertiary care hospitals, from 2011 to 2019. PAC were defined as those with an active solid organ cancer or hematological malignancies. SABSI and S. aureus IE were compared between PAC and PWC. RESULTS Among 978 episodes of SABSI, 217 (22.2%) occurred in PAC. PAC were younger, had fewer comorbidities, carried cardiac devices less often, and had less community-acquired SABSI than PWC. Compared to PWC, PAC more frequently had catheter-related SABSI, less IE (2.8% vs 10.9%, p

Published
2021

29. Long-term consequences of COVID-19: research needs

Author

Giovanni Guaraldi, Laurent Kaiser, Cristina Mussini, Andre C. Kalil, Carlota Gudiol, Alessandra Bandera, Pauline Vetter, Mical Paul, Eytan Wirtheim, Leonard Leibovici, Dana Yelin, Luigia Scudeller, Michael Runold, Miquel Pujol, and Judith Bruchfeld

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, biology, Coronavirus disease 2019 (COVID-19), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Comment, Research needs, biology.organism_classification, medicine.disease, Term (time), Pneumonia, Infectious Diseases, Pandemic, medicine, Intensive care medicine, business, Betacoronavirus
Published
2020

30. Risk factors for hospital readmission following complicated urinary tract infection

Author

Christiane Vank, Noa Eliakim-Raz, Leo van den Heuvel, Aina Gomila Grange, Cuong Vuong, Tanya Babich, Ibironke Addy, Adi Turjeman, Miquel Pujol, Jordi Carratalà, Sally Grier, Evelyn Shaw, Alasdair P. MacGowan, Irith Wiegand, and Leonard Leibovici

Subjects
Male, medicine.medical_specialty, Risk factors in diseases, Urinary system, Science, Diseases, 030204 cardiovascular system & hematology, Patient Readmission, Article, 03 medical and health sciences, 0302 clinical medicine, Medical research, Infeccions del tracte urinari, Quality of life, Interquartile range, Internal medicine, medicine, Humans, 030212 general & internal medicine, Israel, Aged, Retrospective Studies, Aged, 80 and over, Multidisciplinary, business.industry, Factors de risc en les malalties, Medical record, Retrospective cohort study, Odds ratio, Middle Aged, Urinary tract infections, Confidence interval, Europe, Risk factors, Cohort, Urinary Tract Infections, Medicine, Female, business
Abstract

Hospital readmissions following severe infections are a major economic burden on the health care system and have a negative influence on patients' quality of life. Understanding the risk factors for readmission, particularly the extent to which they could be prevented, is of a great importance. In this study we evaluated potentially preventable risk factors for 60-day readmission in patients surviving hospitalization for complicated urinary tract infection (cUTI). This was a multinational, multicentre retrospective cohort study conducted in Europe and the Middle East. Our cohort included survivors of hospitalization due to cUTI during the years 2013–2014. The primary outcome was 60-day readmission following index hospitalization. Patient characteristics that could have influenced readmission: demographics, infection presentation and management, microbiological and clinical data; were collected via computerized medical records from infection onset up to 60 days after hospital discharge. Overall, 742 patients were included. The cohort median age was 68 years (interquartile range, (IQR) 55–80) and 43.3% (321/742) of patients were males. The all-cause 60-day readmission rate was 20.1% (149/742) and more than half were readmitted for infection [57.1%, (80/140)]. Recurrent cUTI was the most frequent cause for readmission [46.4% (65/140)]. Statistically significant risk factors associated with 60-day readmission in multivariable analysis were: older age (odds ratio (OR) 1.02 for an one-year increment, confidence interval (CI) 1.005–1.03), diabetes mellitus (OR 1.63, 95% CI 1.04–2.55), cancer (OR 1.7, 95% CI 1.05–2.77), previous urinary tract infection (UTI) in the last year (OR 1.8, 95% CI: 1.14–2.83), insertion of an indwelling bladder catheter (OR 1.62, 95% CI 1.07–2.45) and insertion of percutaneous nephrostomy (OR 3.68, 95% CI 1.67–8.13). In conclusion, patients surviving hospitalization for cUTI are frequently re-hospitalized, mostly for recurrent urinary infections associated with a medical condition that necessitated urinary interventions. Interventions to avoid re-admissions should target these patients.

Published
2021

31. Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Author

Jesús Rodríguez-Baño, Jerónimo Pachón, Jordi Carratalà, Pablo Ryan, Inmaculada Jarrín, María Yllescas, José Ramón Arribas, Juan Berenguer, Esther Aznar Muñoz, Pedro Gil Divasson, Patricia González Muñiz, Clara Muñoz Aguirre, Marta Díaz Menéndez, Fernando de la Calle Prieto, Marta Arsuaga Vicente, Elena Trigo Esteban, Ignacio Pérez Valero, Rosa de Miguel Buckley, Julen Cadiñaños Loidi, Beatriz Diaz Pollan, Luz Martín Carbonero, Juan Carlos Ramos Ramos, Belén Loeches Yagüe, Rocío Montejano Sánchez, Juan González García, Julio García Rodríguez, Margarita Ramírez, Isabel Gutiérrez, Francisco Tejerina, Teresa Aldámiz-Echevarría, Cristina Díez, Chiara Fanciulli, Leire Pérez-Latorre, Blanca Pinilla, Juan Carlos López, Ana Such Diaz, Elena Álvaro Alonso, Juan Torres Macho, Guillermo Cuevas Tascon, Eva Jiménez González de Buitrago, Fátima Brañas Baztán, Jorge Valencia de la Rosa, Mario Pérez Butragueño, Inés Fernández Jiménez, Gemma Muñiz Nicolás, Antonia Sepúlveda Berrocal, Alberto Gato Díez, María Pilar Toledano Sierra, María Paz García Butenegro, Ana Isabel Peláez Ballesta, Elena Morcillo Rodríguez, Isidoro Fernández Romero, Cristina Peláez Ballesta, María Isabel Guirado Torrecillas, Josune Goikoetxea Agirre, Elena Bereciartua Bastarrica, Laura Guio Carrión, Regino Rodríguez Álvarez, Marta Ibarrola Hierro, Isabel A. Pérez Hernández, Inés Pérez Zapata, Sergio Román Soto, Mohamed Kallouchi, Juan Ramón Domínguez Vicent, Rafae Silvariño Fernández, Jon Ugalde Espiñeira, Ainhoa Sanjuan López, Silvia García Martínez, Mikel Temprano Gogenola, Víctor Asensi, Silvia Suárez, Lucia Suárez, Carmen Yllera, María Rivas-Carmenado, Alberto Romero-Palacios, Jesús Ruiz Aragón, Patricia Jiménez Aguilar, Ma Luisa Fernández Ávila, Rosario Castilla Ortiz, Vanesa Alende Castro, Cristina Pérez García, Marta Fernández Morales, María Lorena María Valle Feijoo Begoña Rodríguez Ferreira, Joan Gómez-Junyent, Judit Villar-García, Inmaculada López-Montesinos, Itziar Arrieta-Aldea, Abora Rial-Villavecchia, Elisa García Vázquez, Aychel Elena Roura Piloto, Encarnación Moral Escudero, Alicia Hernández Torres, Helena Albendín Iglesias, David Vinuesa García, Clara Martínez Montes, Francisco Javier De la Hera Fernández, Francisco Anguita Santos, Andrés Ruiz Sancho, Vicens Díaz de Brito Fernández, Montserrat Sanmarti Vilamala, Sergio España Cueto, Daniel Molina Morant, Araceli González-Cuevas, Joel Elías Chara Cervantes, Guillem Policarpo Torres, Meritxell Ortega Montoliu, Mònica Angerri Nadal, Ariadna De Genover Gil, Eleni Patera, Rita Godoy Lorenzo, Evangelia Anna María Zioga, Virginia Isern Fernández, Carlos Enrique Sabbagh Fajardo, Ana Ferrer Ribera, Carlos Bea Serrano, Rosa Oltra Sempere, Sara Vela Bernal, Paloma Albiol Viñals, Miguel Pedromingo Kus, María Ángeles Garcinuño, Silvana Fiorante, Sergio Pérez Pinto, Alexandra de la Vega, María Carmen Fariñas Álvarez, Claudia González Rico, Francisco Arnaiz de las Revillas, Teresa Giménez, Jorge Calvo, Yolanda Meije Castillo, Alejandra Duarte Borges, Júlia Pareja Coca, Mercedes Clemente Presas, Xavier Sanz Salvador, Ma Teresa Pérez Rodríguez, Adrián Sousa, Alexandre Pérez González, Rebeca Longueira, Alejandro Araujo, Blanca Alonso Martínez, Laura García Escudero, Sara Lidia Kamel Rey, David Roa Alonso, Juan Pablo Avilés Parra, Iván Pelegrín Senent, Rosana Rouco Esteves Marques, Laia Raich Montiu, Jessica Souto Higueras, Manuel Alejandro Gálvez Bobadilla, Jorge Parra Ruiz, Violeta Ramos Sesma, Sara Velasco Fuentes, Laura García Pereña, Alfonso Lluna Carrascosa, Sergio Gilaberte Reyzábal, Mónica Liébana Gómez, Juan Salillas Hernando, Alberto Serrano Martínez, Miguel Torralba González de Suso, Patricia Martínez Martín, Isabel Rábago Lorite, Patricia González-Ruano Pérez, Beatriz Pérez-Monte Mínguez, Ángeles García Flores, Pere Comas Casanova, Andrea Martín Plata, Sergio Manuel Santana Báez, Oscar Sanz Peláez, Karim Mohamed Ramírez, José María Robaina Bordón, Helem Haydeé Vílchez Rueda, Melchor Riera Jaume, Gemma Mut Ramon, Meritxell Gavalda Manso, Lluis Planas Bibiloni, Laura Castelo Corral, Lucía Ramos Merino, Efrén Sánchez Vidal, María Rodríguez Mayo, Enrique Míguez Rey, José M. García de Lomas Guerrero, Javier De la Torre Lima, Ana Correa Ruiz, Fernando Fernández Sánchez, Nicolás Jiménez-García, José Luis Sierra-Monzón, Borja Gracia-Tello, María Hernández-Bonaga, Galadriel Pellejero, Marta Asín-Corrochano, Lucia Boix Palop, Esther Calbo, Cristina Badía, Beatriz Dietl, Gómez Lucía, Ángel Domínguez-Castellano, María José Ríos-Villegas, María D. del Toro, Zaira R. Palacios Baena, Elena Salamanca-Rivera, Elena Marín, Virginia Almadana, Salvador Pérez-Galera, Luisa González-Iglesias, Gabriela Abelenda-Alonso, Claudia Álvarez-Pouso, Francesc Escrihuela, Carlota Gudiol, Laia Lorenzo-Esteller, Jordi Niubó, Daniel Podzamczer, Miquel Pujol, Alexander Rombauts, Miguel Salvert Lletí, Ricardo Gil Sánchez, Marta Jiménez Escrig, Laura Parra Gómez, Mariona Tasias Pitarch, Marta Navarro Vilasaró, María Luisa Machado Sicilia, Aina Gomila Grange, Sonia Calzado Isbert, Nerea Carrasco Antón, Elizabet Petkova-Saiz, Alfonso Cabello Úbeda, Miguel Górgolas Hernández-Mora, Olga Sánchez-Pernaute, Carlos Dueñas Gutiérrez, Javier Martin Guerra, José Javier Castrodeza Sanz, Virginia Fernández Espinilla, Laura Rodríguez Fernández, Juan González-Moreno, Aroa Villoslada Gelabert, María Antonia Ribot Sanso, María Victoria Fernández-Baca, Almudena Hernández Milian, Miguel Ángel Morán Rodríguez, Zuriñe Ortiz de Zárate Ibarra, José Joaquin Portu Zapirain, Ester Saez de Adana Arroniz, Juan Carlos Gainzarain Arana, Olga Meca Birlanga, Ma Jesús del Amor Espín, Montserrat Viqueira González, Josefina García García, Onofre Martínez Madrid, Enrique Bernal Morell, Antonia Alcaraz, Ángeles Muñoz, Ignacio Pina, Vicente de la Rosa, Tamara Caínzos Romero, Sabela Sánchez Trigo, Ana Isabel Mariño Callejo, Hortensia Álvarez Díaz, Nieves Valcarce Pardeiro, Adriana Sánchez Serrano, Diana Piñar Cabezos, Eva Pilar García Villalba, Carmen Aguayo Jiménez, María Ruíz Campuzano, Virginia Naranjo Velasco, Marta Santos Peña, Juan Mora Delgado, Israel Sevilla Moreno, Cristina Lojo Cruz, Xabier Kortajarena Urkola, José Antonio Iribarren Loyarte, María Jesús Bustinduy Odriozola, Maialen Ibarguren Pinilla, Ignacio Álvarez Rodríguez, Francisco Javier Martínez Marcos, Francisco Javier Rodríguez Gómez, Isabel Asschert Agüero, Francisco Muñoz Beamud, Antonio José Ruiz Reina, Jara Llenas-García, Inmaculada González-Cuello, Elena Hellín-Valiente, Esther Martínez Birlanga, José Manuel Tafalla Torres, Jorge Calderón Parra, Gabriela Escudero López, Isabel Gutiérrez Martín, Ane Andrés Eisenhofer, Sonia García Prieto, Raquel Álvarez Franco, Daniel Roger Zapata, Blanca Martínez Cifre, Elena Aranda Rife, Irene Martín Rubio, André Barbosa Ventura, Javier Garrido, Concepción Gonzalo, Iván Piñero, Nieves de la Cruz Felipe, Eva Talavera García, Marta Lamata Subero, Paula Mendoza Roy, María Soledad García de Carlos, Justo Lajusticia Aisa, Lorea Arteche Eguizabal, Ainhoa Urrutia Losada, Saioa Domingo Echaburu, Pedro Ángel Cuadros Tito, Gurutz Orbe Narváez, Ma del Carmen Liébana Martos, Carolina Roldán Fontana, Carmen Herrero Rodríguez, Gaspar Duro Ruiz, Santiago Pérez Parra, Arantzazu Mera Fidalgo, Miquel Hortos Alsina, Ana Alberich Conesa, Lourdes Bladé Vidal, Nicolás Merchante Gutiérrez, Eva León Jiménez, Reinaldo Espíndola Gómez, María Erostarbe Gallardo, Pedro Martínez Pérez-Crespo, José Miguel Cisneros, Manuela Aguilar-Guisado, Teresa Aldabó, Claudio Bueno, Elisa Cordero-Matía, Ana Escoresca, Carmen Infante, Martín Guillermo, Sonsoles Salto, Francesca Gioia, Pilar Vizcarra, Jesús Fortún Abete, Pilar Martín Dávila, Santiago Moreno Guillén, José A. Oteo Revuelta, Concepción García-García, Paula Santibañez Sáenz, Cristina Cervera Acedo, José M. Azcona Gutiérrez, José María Reguera Iglesias, Antonio Plata Ciezar, Lucia Valiente de Santis, Beatriz Sobrino Diaz, Juan Diego Ruiz Mesa, Ministerio de Ciencia e Innovación, Fundación SEIMC/GeSIDA, Instituto de Salud Carlos III - ISCIII, European Regional Development Fund (ERDF/FEDER), Red Española de Investigación en SIDA, Red Española de Investigación en Patología Infecciosa, UAM. Departamento de Medicina, UAM. Departamento de Medicina Preventiva y Salud Pública y Microbiología, Universidad de Cantabria, SAM-COVID Study Group, [Rodríguez-Baño,J] Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain. [Rodríguez-Baño,J, Pachón,J] Departamento de Medicina, Universidad de Sevilla, Spain. [Rodríguez-Baño,J, Pachón,J] Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain. [Pachón,J] Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain. [Carratalà,J] Servei de Malalties Infeccioses, Hospital Universitari de Bellvitge, Barcelona, Spain. [Carratalà,J] Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, Spain. [Carratalà,J] Universitat de Barcelona, Barcelona, Spain. [Ryan,P] Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, Spain. [Jarrín,I] Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain. [Yllescas,M] Fundación SEIMC/GeSIDA, Madrid, Spain. [Arribas,JR] Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain. [Arribas,JR] Instituto de Investigación Hospital Universitario La Paz, Madrid, Spain. [Berenguer,J] Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain. [Berenguer,J] Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain., Ministerio de Ciencia e Innovación (España), Instituto de Salud Carlos III, Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), Red de Investigación Cooperativa en Investigación en Sida (España), Red de Investigación Cooperativa en Investigación en Patología Infecciosa (España), Gilead Sciences, ViiV Healthcare, AbbVie Pharmaceuticals, Merck & Co, Janssen Biotech, Teva Pharmaceutical Industries, Ministerio de Ciencia, Innovación y Universidades (España), European Commission, Universidad de Sevilla. Departamento de Medicina, Instituto Carlos III (España), and Unión Europea

Subjects
0301 basic medicine, Male, law.invention, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], chemistry.chemical_compound, 0302 clinical medicine, Organisms::Viruses::RNA Viruses::Nidovirales::Coronaviridae [Medical Subject Headings], Randomized controlled trial, law, Adrenal Cortex Hormones, Clinical endpoint, Medicine, 030212 general & internal medicine, Hospital Mortality, Health Care::Environment and Public Health::Public Health::Epidemiologic Measurements::Demography::Vital Statistics::Mortality [Medical Subject Headings], Adrenocortical hormones, Hazard ratio, General Medicine, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Intubation::Intubation, Intratracheal [Medical Subject Headings], Middle Aged, Tocilizumab, Hospitalization, Infectious Diseases, Treatment Outcome, Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections [Medical Subject Headings], Drug Therapy, Combination, Female, Cohort study, Microbiology (medical), medicine.medical_specialty, Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections::Severe Acute Respiratory Syndrome [Medical Subject Headings], Combination therapy, Medicina, Hyperinflammatory state, 030106 microbiology, Estudios de cohortes, Antibodies, Monoclonal, Humanized, Article, 03 medical and health sciences, Internal medicine, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Follow-Up Studies [Medical Subject Headings], Intubation, Intratracheal, Mortalitat, Humans, Corticosteroids, Mortality, Corticoesteroides, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings], Aged, Proportional Hazards Models, Retrospective Studies, Geographical Locations::Geographic Locations::Europe::Spain [Medical Subject Headings], Inflammation, business.industry, SARS-CoV-2, COVID-19, Odds ratio, Chemicals and Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Adrenal Cortex Hormones [Medical Subject Headings], Corticosteroides, COVID-19 Drug Treatment, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Propensity Score [Medical Subject Headings], chemistry, Spain, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies [Medical Subject Headings], Propensity score matching, Mortalidad, Monoclonal antibodies, business, Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Inflammation [Medical Subject Headings], Anticossos monoclonals
Abstract

© 2020 The Author(s)., [Objectives]: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters., [Methods]: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs)., [Results]: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22–0.47; p < 0.001) for tocilizumab, 0.82 (0.71–1.30; p 0.82) for IHDC, 0.61 (0.43–0.86; p 0.006) for PDC, and 1.17 (0.86–1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02–0.17; p < 0.001)., [Conclusions]: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situation., IJ has received honoraria for participating in an advisory board from Gilead Sciences, and for educational activities from ViiV. JB has received research grants from AbbVie, Gilead Sciences, Merck, and ViiV, and honoraria for being a speaker or advisory board participation from AbbVie, Gilead Sciences, Janssen, Merck, and ViiV. JRA received fees for participating in an advisory board, being a speaker, and research grant support from Viiv, Janssen, Gilead, MSD, Teva, Alexa and Serono. PR is involved as speaker or advisory board participant for Gilead Sciences, AbbVie and ViiV. JR-B, JP, JC and MY have no conflicts of interest to declare. SAM-COVID was funded by Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (COV20/01031) co-funded by European Union (ERDF/ESF, “Investing in your future”) and Fundación SEIMC/GeSIDA. In addition, Juan Berenguer, Jesús Rodríguez-Baño, Inmaculada Jarrín, Jordi Carratalá, Jerónimo Pachón, and José R Arribas received funding for research from Plan Nacional de I+D+i 2013-2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades – co- financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014–2020 through the networks: Spanish AIDS Research Network (RIS) [RD16/0025/0017 (JB), RD16/0025/0018 (JRA), RD16/0025/00XX (IJ)] and Spanish Network for Research in Infectious Diseases (REIPI)[RD16/0016/0001 (JRB), RD16/0016/0005 (JC), and RD16/0016/0009 (JP).

Published
2021

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

Author

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

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

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

Published
2021

33. Daptomycin plus fosfomycin versus daptomycin alone for methicillin-resistant staphylococcus aureus bacteremia and endocarditis: a randomized clinical trial

Author

María-Ángeles Domínguez, Marta Andrés, Laura Morata, Mireia Sanllorente, María-Jose Garcia-Pais, María-Del-Mar Arenas, Rosa Escudero-Sánchez, Miró Jm, Vicente Pintado, Miguel Montejo, Anna Ferrer, Guillermo Cuervo, Mrsa Bacteremia (Bacsarm) Trial Investigators, Joaquín López-Contreras, Javier Murillas, Cristian Tebé, Pilar Hereu, Mireia Puig-Asensio, Belén Padilla, Natalia Pallares, Oriol Gasch, G. García-Pardo, Rafael San-Juan, Alfredo Jover-Sáenz, Ariadna Padullés, Juan Pasquau, Miquel Pujol, Jordi Carratalà, Luis-Eduardo López-Cortes, Esther Calbo, Milagros Montero, Regino Rodriguez-Alvarez, Sebastián Videla, Jordi Càmara, Evelyn Shaw, Carles Pigrau, José María Aguado, Ministerio de Ciencia, Innovación y Universidades (España), Red Española de Investigación en Patología Infecciosa, Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad (España), European Commission, Spanish Clinical Research Network, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Institut Català de la Salut, [Pujol M, Shaw E] Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain. [Miró JM] Department of Infectious Diseases, Hospital Clinic, Institut d’Investigacions Biomèdiques Agust Pi i Sunyer, University of Barcelona, Barcelona, Spain. [Aguado JM, San-Juan R] Department of Infectious Diseases, Hospital Universitario 12 Octubre, Instituto de Investigación Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain. [Puig-Asensio M, Pigrau C] Servei de Malalties Infeccioses, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
0301 basic medicine, Bacteremia, MRSA, medicine.disease_cause, Other subheadings::Other subheadings::/drug therapy [Other subheadings], terapéutica::tratamiento combinado [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Infeccions per estafilococs - Tractament, law.invention, Bacterièmia, 0302 clinical medicine, Randomized controlled trial, law, Clinical endpoint, polycyclic compounds, Medicaments antibacterians - Ús terapèutic, 030212 general & internal medicine, Endocarditis, Bacterèmia, Fosfomicina, Staphylococcal Infections, infecciones bacterianas y micosis::infecciones bacterianas::infecciones por bacterias grampositivas::infecciones estafilocócicas [ENFERMEDADES], Anti-Bacterial Agents, Clinical trial, Infectious Diseases, Treatment Outcome, Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents [CHEMICALS AND DRUGS], lipids (amino acids, peptides, and proteins), Estafilococ aureus resistent a la meticil·lina, medicine.drug, Microbiology (medical), Adult, medicine.medical_specialty, 030106 microbiology, Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores], Fosfomycin, acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos::antibacterianos [COMPUESTOS QUÍMICOS Y DROGAS], Estafilococo aureus resistente a la meticilina, 03 medical and health sciences, Daptomycin, Internal medicine, medicine, Humans, Adverse effect, business.industry, biochemical phenomena, metabolism, and nutrition, medicine.disease, bacterial infections and mycoses, Methicillin-resistant Staphylococcus aureus, Therapeutics::Combined Modality Therapy [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], carbohydrates (lipids), Daptomicina, Bacteriemia, Methicillin-resistant staphylococcus aureus, Bacterial Infections and Mycoses::Bacterial Infections::Gram-Positive Bacterial Infections::Staphylococcal Infections [DISEASES], business
Abstract

[Background] We aimed to determine whether daptomycin plus fosfomycin provides higher treatment success than daptomycin alone for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and endocarditis., [Methods] A randomized (1:1) phase 3 superiority, open-label, and parallel group clinical trial of adult inpatients with MRSA bacteremia was conducted at 18 Spanish hospitals. Patients were randomly assigned to receive either 10 mg/kg of daptomycin intravenously daily plus 2 g of fosfomycin intravenously every 6 hours, or 10 mg/kg of daptomycin intravenously daily. Primary endpoint was treatment success 6 weeks after the end of therapy., [Results] Of 167 patients randomized, 155 completed the trial and were assessed for the primary endpoint. Treatment success at 6 weeks after the end of therapy was achieved in 40 of 74 patients who received daptomycin plus fosfomycin and in 34 of 81 patients who were given daptomycin alone (54.1% vs 42.0%; relative risk, 1.29 [95% confidence interval, .93–1.8]; P = .135). At 6 weeks, daptomycin plus fosfomycin was associated with lower microbiologic failure (0 vs 9 patients; P = .003) and lower complicated bacteremia (16.2% vs 32.1%; P = .022). Adverse events leading to treatment discontinuation occurred in 13 of 74 patients (17.6%) receiving daptomycin plus fosfomycin, and in 4 of 81 patients (4.9%) receiving daptomycin alone (P = .018)., [Conclusions] Daptomycin plus fosfomycin provided 12% higher rate of treatment success than daptomycin alone, but this difference did not reach statistical significance. This antibiotic combination prevented microbiological failure and complicated bacteremia, but it was more often associated with adverse events., [Clinical Trials Registration] NCT01898338., This work was supported by the Spanish Ministry of Science, Innovation and Universities (PI12/01907); Spanish Network for Research in Infectious Diseases (RD16/0016/0005); Instituto de Salud Carlos III (ISCIII); and Spanish Ministry of Economy, Industry and Competitiveness. This work was also supported by the European Development Regional Fund “A way to achieve Europe,” Operational Programme Intelligent Growth 2014–2020; Spanish Clinical Research Network (SCReN), co-financed by the Plan Nacional de I+D and ISCIII, Subdirección General de Evaluación y Fomento de la Investigación (PT13/0002/0007); and the Grupo de Estudio de la Infección Relacionada con la Asistencia Sanitaria. J. M.-M. received a personal 80:20 research grant from the Institut d’Investigacions Biomèdiques Agust Pi i Sunyer, Barcelona, Spain, during 2017–2021.

Published
2021

34. Monotherapy versus combination therapy for sepsis due to multidrug-resistant Acinetobacter baumannii: analysis of a multicentre prospective cohort

Author

López-Cortés, L. E., Cisneros, J. M., Fernández-Cuenca, F., Bou, G., Tomás, M., Garnacho-Montero, J., Pascual, A., Martínez-Martínez, L., Vila, J., Pachón, J., Rodríguez Baño, J., Porto, Antonio Sánchez, Vallejo, Luis, Pérez, Begoña Fernández, Villar Chao, José Carlos, Ortega, Belén Padilla, Mansilla, Emilia Cercenado, García Irure, José Javier, del Arco Jiménez, Alfonso, de la Torre Lima, Javier, Cardona, Concepción Gimeno, Abril, Vicente, Pujals, Joseph Vilaró, Aguirre, Marian Navarro, Jiménez Alfaro, José Antonio, Jaca, Carlos Reviejo, Casanova, Pilar Marín, Guerreo, Francisca, Mayoral, Teresa Nebreda, Fernández Calavia, María José, de Lucas, Esperanza Merino, Zorraquino, Alfredo, Eseverri, Eugenio Garduño, Sánchez, Luis López, Gutiérrez, Ana Fleites, Guardado, Azucena Rodríguez, García-Arenzana Anguera, José María, Palmero, Serafín López, Maresca, Manuel Rodríguez, Garrote, Fernando García, Otero, José Varela, Verdú, Elisa Vidal, López, Fernando Rodríguez, Sánchez, Fernanda Pardo, Vizoso, E. Ferrer, Gurgui, Mercé, Pericas, Roser, Olaechea Astigarraga, Pedro María, Igartua, Rafael Ayarza, Maciá Romero, María Dolores, de Gopegui Bordes, Enrique Ruiz, Sánchez Romero, María Isabel, Mata, Jesús García, Goyanes, María José, Quero, José Hernández, Lara, Trinidad Escobar, Bastardie, Frederic Ballester, Iftimie, Simona, Galán Navarro, María Isabel, Cádiz Gurrea, María Luz, Antequera, Carmen Amores, Gómez, Montserrat, Salas, Carmina Martí, Peragosa, Jordi Cuquet, Real, Susana Hernando, Carrero González, Pablo A., Pallarés González, María Angeles, Fernández, Sergio Rodríguez, Rojo, Miquel Pujol, Tubau, Fe, Alvarez, Enrique Nuño, Torres, María Ortega, Almaraz, Salvador Giner, Hortelano, Elena, Sánchez, Fernando Chaves, Reyne, Ana García, Horcajada Gallego, Juan Pablo, Segura, Concha, Dorado, Gema Sierra, Escudero, Raquel Yano, Dorta Hung, María Elena, and del Rosario Q, Cristóbal

Published
2014
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35. Characterization of plasmids carrying the blaOXA-24/40 carbapenemase gene and the genes encoding the AbkA/AbkB proteins of a toxin/antitoxin system

Author

Mosqueda, Noraida, Gato, Eva, Roca, Ignasi, López, María, de Alegría, Carlos Ruíz, Fernández Cuenca, Felipe, Martínez-Martínez, Luis, Pachón, Jerónimo, Cisneros, José Miguel, Rodríguez-Baño, Jesús, Pascual, Álvaro, Vila, Jordi, Bou, Germán, Tomás, María, Garnacho, José, Pizarraya, Antonio Gutierrez, Márquez Vácaro, Juan Antonio, Cano, María Eliecer, Fariñas, M. Carmen, Porto, Antonio Sánchez, Meruendano, Gloria Esteban, Vales, Luis Barbeyto, Ciria, Javier Casas, Vallejo, Luis, Pérez, Begona Fernández, Chao, José Carlos Villar, Ortega, Belén Padilla, Mansilla, Emilia Cercenado, Irure, José Javier García, del Arco Jiménez, Alfonso, Cardona, Concepción Gimeno, Valía, Juan Carlos, Palop, Núria Tormo, Abril, Vicente, Rifa, Josefina, Jesus, Maria, Garcia, Martinez, Pujals, Joseph Vilaró, Aguirre, Marian Navarro, Vilamala, Ana, Alfaro, José Antonio Jiménez, Jaca, Carlos Reviejo, Casanova, Pilar Marín, Guerreo, Francisca, Shaw, Evelyn, Plasencia, Virginia, Mayoral, Teresa Nebreda, Calavia, María José Fernández, de Cruz, Susana García, Mansilla, Carmen Aldea, de Lucas, Esperanza Merino, Zorraquino, Alfredo, Bañuls, Sergio Reus, Eseverri, Eugenio Garduno, Sánchez, Luis López, Gutiérrez, Ana Fleites, Guardado, Azucena Rodríguez, Moreno, Alfonso, Anguera, José María García-Arenzana, Palmero, Serafín López, Maresca, Manuel Rodríguez, Garrote, Fernando García, Otero, José Varela, del Pilar Alonso, María, Verdú, Elisa Vidal, López, Fernando Rodríguez, Sánchez, Fernanda Pardo, Vizoso, E. Ferrer, Garcia, B. Regueiro, Gurgui, Mercé, Pericas, Roser, Pomar, Virginia, Astigarraga, Pedro María Olaechea, Igartua, Rafael Ayarza, Romero, María Dolores Maciá, de Gopegui Bordes, Enrique Ruiz, Romero, María Isabel Sánchez, Mata, Jesús García, Goyanes, María José, Mateos, Cristina Morales, Quero, José Hernández, Lara, Trinidad Escobar, Bastardie, Frederic Ballester, Iftimie, Simona, Bajador, Isabel Pujol, Navarro, María Isabel Galán, Gurrea, María Luz Cádiz, Antequera, Carmen Amores, Gómez, Montserrat, Cantudo, Purificación, Salas, Carmina Martí, Peragosa, Jordi Cuquet, Flores, Antonio Moreno, García, Luis Anibarro, Real, Susana Hernando, González, Pablo A. Carrero, González, María Angeles Pallarés, Fernández, Sergio Rodríguez, Rojo, Miquel Pujol, Tubau, Fe, Alvarez, Enrique Nuno, Torres, María Ortega, Almaraz, Salvador Giner, Castelló, María Rosa Roca, Castillo, Manuela, Hortelano, Elena, Sánchez, Fernando Chaves, Reyne, Ana García, Gallego, Juan Pablo Horcajada, Segura, Concha, Dorado, Gema Sierra, Escudero, Raquel Yano, Hung, María Elena Dorta, and del Rosario Q, Cristóbal

Published
2014
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36. Clinical characteristics and outcome of bacteraemia caused by Enterobacter cloacae and Klebsiella aerogenes: more similarities than differences

Author

Jorge Calvo-Montes, Rosario Lara-Contreras, Julián Torre-Cisneros, María Eliecer Cano-García, Miquel Pujol-Rojo, José Antonio Lepe, Fernando Rodríguez-López, Luis Martínez-Martínez, Fe Tubau-Quintano, Rocío Álvarez-Marín, Manuel E. Jiménez-Mejías, Jesús Rodríguez-Baño, Álvaro Pascual-Hernández, Cecilia Martín-Gandul, José-Manuel Rodríguez-Martínez, Oriol Gasch-Blasi, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación (España), Ministerio de Ciencia, Innovación y Universidades (España), Red Española de Investigación en Patología Infecciosa, European Commission, Spanish Network for Research in Infectious Diseases/Enterobacter spp. Bacteriemia Project Group, [Álvarez-Marín,R, Lepe,JA, Martín-Gandul,C, Jiménez-Mejías,ME] Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/Virgen del Rocío University Hospital, Seville, Spain. [Gasch-Blasi,O] Infectious Diseases Service, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (l3PT), Sabadell, Spain, Spanish Network for Research in Infectious Diseases. [Rodríguez-Martínez,JM, Pascual-Hernández,Á] Department of Microbiology, Virgen Macarena University Hospital, Seville, Spain, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC, Seville, Spain. [Calvo-Montes,J, Cano-García,ME, Martínez-Martínez,L] Department of Microbiology, Marqués de Valdecilla University Hospital – IDIVAL, Santander, Spain. [Lara-Contreras,R, Torre-Cisneros,J] Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Clinical Unit of Infectious Diseases, Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain. [Tubau-Quintano,F] Department of Microbiology, University Hospital of Bellvitge, Barcelona, Spain, CIBER of Respiratory Diseases (CIBERes), Instituto de Salud Carlos III, Madrid, Spain. [Rodríguez-López,F] Department of Microbiology, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC)/University of Cordoba, Córdoba, Spain. [Rodríguez-Baño,J] Department of Medicine, Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen Macarena University Hospital, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC, Seville, Spain. [Pujol-Rojo,M] Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS-HUB), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain, Institut d'Investigació Biomédica de Bellvitge (IDIBELL), Barcelona, Spain. [Martínez-Martínez,L] Department of Molecular Biology, University of Cantabria, Santander, Spain. [Martínez-Martínez,L] Department of Microbiology, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC)/University of Cordoba, Córdoba, Spain., This work was supported by the Instituto Carlos III [grant PS09/00916], Ministerio de Ciencia e Innovación, the Plan Nacional I+D+i 2013–2016 and Instituto Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases [REIPI, RD16/0016/0001, RD16/0016/0005, RD16/0016/0007, RD16/0016/0008, and RD16/0016/0009], co-financed by the European Regional Development Fund ‘A way to achieve Europe’, Operative program Intelligent Growth 2014–2020.

Subjects
Quinolone resistance mechanism, 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies [Medical Subject Headings], Case–control study, medicine.drug_class, 030106 microbiology, Immunology, Antibiotics, Bacteremia, Enterobacter aerogenes, Microbiology, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Klebsiella aerogenes, Genotype, Enterobacter cloacae, medicine, Immunology and Allergy, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Organisms::Bacteria::Gram-Negative Bacteria::Gram-Negative Facultatively Anaerobic Rods::Enterobacteriaceae::Enterobacter::Enterobacter aerogenes [Medical Subject Headings], Estudios de casos y controles, biology, business.industry, Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Bacteremia [Medical Subject Headings], Incidence (epidemiology), Case-control study, Enterobacteriaceae Infections, bacterial infections and mycoses, biology.organism_classification, QR1-502, Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Negative Bacterial Infections::Enterobacteriaceae Infections [Medical Subject Headings], Multiple drug resistance, Organisms::Bacteria::Gram-Negative Bacteria::Gram-Negative Facultatively Anaerobic Rods::Enterobacteriaceae::Enterobacter::Enterobacter cloacae [Medical Subject Headings], Bacteriemia, Bacteraemia, business
Abstract

Spanish Network for Research in Infectious Diseases/Enterobacter spp. Bacteriemia Project Group., [Objectives] The genus Enterobacter is a common cause of nosocomial infections. Historically, the most frequent Enterobacter species were those of Enterobacter cloacae complex and Enterobacter aerogenes. In 2019, E. aerogenes was re-classified as Klebsiella aerogenes owing to its higher genotypic similarity with the genus Klebsiella. Our objective was to characterise and compare the clinical profiles of bacteraemia caused by E. cloacae and K. aerogenes., [Methods] This 3-year multicentre, prospective cohort study enrolled consecutive patients with bacteraemia by E. cloacae or K. aerogenes. Baseline characteristics, bacteraemia features (source, severity, treatment), antibiotic susceptibility, resistance mechanisms and mortality were analysed. bacteraemia had received more antibiotics., [Results] The study included 285 patients with bacteraemia [196 (68.8%) E. cloacae and 89 (31.2%) K. aerogenes]. The groups showed no differences in age, sex, previous use of invasive devices, place of acquisition, sources or severity at onset. The Charlson score was higher among patients with E. cloacae bacteraemia [2 (1–4) vs. 1 (0.5–3); P = 0.018], and previous antibiotic therapy was more common in patients with K. aerogenes bacteraemia (57.3% vs. 41.3%; P = 0.01). Mortality was 19.4% for E. cloacae and 20.2% for K. aerogenes (P = 0.869). Antibiotic susceptibility was similar for both species, and the incidence of multidrug resistance or ESBL production was low (6% and 5.3%, respectively), with no differences between species., [Conclusion] Bacteraemias caused by E. cloacae and K. aerogenes share similar patient profiles, presentation and prognosis. Patients with E. cloacae bacteraemia had more co-morbidities and those with K. aerogenes bacteraemia had received more antibiotics., This work was supported by the Instituto Carlos III [grant PS09/00916], Ministerio de Ciencia e Innovación, the Plan Nacional I+D+i 2013–2016 and Instituto Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases [REIPI, RD16/0016/0001; RD16/0016/0005; RD16/0016/0007; RD16/0016/0008; RD16/0016/0009], co-financed by the European Regional Development Fund ‘A way to achieve Europe’, Operative program Intelligent Growth 2014–2020.

Published
2020

37. Information technology aspects of large-scale implementation of automated surveillance of healthcare-associated infections

Author

Michael Behnke, John Karlsson Valik, Sophie Gubbels, Daniel Teixeira, Brian Kristensen, Mohamed Abbas, Stephanie M. van Rooden, Petra Gastmeier, Maaike S.M. van Mourik, Olov Aspevall, Pascal Astagneau, Marc J.M. Bonten, Elena Carrara, Aina Gomila-Grange, Sabine C. de Greeff, Wendy Harrison, Hilary Humphreys, Anders Johansson, Mayke B.G. Koek, Alain Lepape, Jean-Christophe Lucet, Siddharth Mookerjee, Pontus Naucler, Zaira R. Palacios-Baena, Elisabeth Presterl, Miquel Pujol, Jacqui Reilly, Christopher Roberts, Evelina Tacconelli, Thomas Tängdén, ZonMw, European Commission, European Federation of Pharmaceutical Industries and Associations, and VINNOVA (Sweden)

Subjects
Microbiology (medical), Automated, Process management, Standardization, Computer science, Process (engineering), As is, Electronic health record, Interoperability, Bloodstream infection, Automation, Health care, Humans, Healthcare-associated infection, Digital infection control, Data, Cross Infection, Infection Control, Surveillance, business.industry, Information technology, General Medicine, Quality, Europe, Infectious Diseases, Scale (social sciences), Information technology management, business, Information Technology, Surgical site infection, Electronic HAI surveillance
Abstract

PRAISE network: Maaike S. M. van Mourik, Stephanie M.van Rooden, Mohamed Abbas, Olov Aspevall, Pascal Astagneau, Marc J. M. Bonten, Elena Carrara, Aina Gomila-Grange, Sabine C. de Greeff , Sophie Gubbels, Wendy Harrison, Hilary Humphreys, Anders Johansson, Mayke B. G. Koek, Brian Kristensen, Alain Lepape, Jean-Christophe Lucet, Siddharth Mookerjee, Pontus Naucler, Zaira R. Palacios-Baena, Elisabeth Presterl, Miquel Pujol, Jacqui Reilly, Christopher Roberts, Evelina Tacconelli, Daniel Teixeira, Thomas Tängdén, John Karlsson Valik, Michael Behnke, PetraGastmeier., [Introduction] Healthcare-associated infections (HAI) are a major public health concern. Monitoring of HAI rates, with feedback, is a core component of infection prevention and control programmes. Digitalization of healthcare data has created novel opportunities for automating the HAI surveillance process to varying degrees. However, methods are not standardized and vary widely between different healthcare facilities. Most current automated surveillance (AS) systems have been confined to local settings, and practical guidance on how to implement large-scale AS is needed., [Methods] This document was written by a task force formed in March 2019 within the PRAISE network (Providing a Roadmap for Automated Infection Surveillance in Europe), gathering experts in HAI surveillance from ten European countries., [Results] The document provides an overview of the key e-health aspects of implementing an AS system of HAI in a clinical environment to support both the infection prevention and control team and information technology (IT) departments. The focus is on understanding the basic principles of storage and structure of healthcare data, as well as the general organization of IT infrastructure in surveillance networks and participating healthcare facilities. The fundamentals of data standardization, interoperability and algorithms in relation to HAI surveillance are covered. Finally, technical aspects and practical examples of accessing, storing and sharing healthcare data within a HAI surveillance network, as well as maintenance and quality control of such a system, are discussed., [Conclusions] With the guidance given in this document, along with the PRAISE roadmap and governance documents, readers will find comprehensive support to implement large-scale AS in a surveillance network., This network has been supported under the 7th transnational call within the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR), Network Call on Surveillance (2018) and was thereby funded by ZonMw (grant 549007001). This project also received support from the COMBACTE MAGNET EPI-Net project funded by the Innovative Medicines Initiative Joint Undertaking under grant agreement 115523 | 115620 | 115737 | 777362, resources of which are composed of financial contribution from the European Union Seventh Framework Programme (FP7/2007-2013) and EFPIA companies in kind contribution. J.K.V. was supported by grants from Region Stockholm and Vinnova.

Published
2020

38. Reply to Pacios-Martínez and García-Monzón

Author

José M. Miró, Natalia Pallares, Cristian Tebé, Miquel Pujol, and Jordi Carratalà

Subjects
Microbiology (medical), Infectious Diseases, biology, business.industry, Garcia, Medicine, biology.organism_classification, business, Humanities
Published
2020

39. Risk factors for enterococcal urinary tract infections: a multinational, retrospective cohort study

Author

Adi, Turjeman, Tanya, Babich, Miquel, Pujol, Jordi, Carratalà, Evelyn, Shaw, Aina, Gomila-Grange, Cuong, Vuong, Ibironke, Addy, Irith, Wiegand, Sally, Grier, Alasdair, MacGowan, Christiane, Vank, Nienke, Cuperus, Leo, van den Heuvel, Leonard, Leibovici, and Noa, Eliakim-Raz

Subjects
Male, Internationality, Middle Aged, Anti-Bacterial Agents, Europe, Hospitalization, Middle East, Risk Factors, Urinary Tract Infections, Humans, Female, Enterococcus, Aged, Retrospective Studies
Abstract

Complicated urinary tract infection (cUTI) is a frequent cause of morbidity. In this multinational retrospective cohort study, we aimed to demonstrate risk factors for enterococcal UTI. Univariate and multivariate analyses of risk factors for enterococcal infection were performed. Among 791 hospitalized patients with cUTI, enterococci accounted for approximately 10% of cases (78/791). Risk factors for enterococcal UTI in multivariable analysis were male gender, age range of 55-75 years, catheter-associated UTI, and urinary retention. This information may assist treating physicians in their decision-making on prescribing empiric anti-enterococcus treatment to hospitalized patients presenting with cUTI and thus improve clinical outcomes.

Published
2020

40. Antibiotic prescription during the COVID-19 pandemic: A biphasic pattern

Author

Alexander Rombauts, Gabriela Abelenda-Alonso, Ramon Jodar, Miquel Pujol, Jordi Carratalà, Carlota Gudiol, Claudia Alvarez-Pouso, and Ariadna Padullés

Subjects
Microbiology (medical), 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), business.industry, Epidemiology, medicine.disease, Virology, Antibiotic prescription, Pneumonia, Biphasic Pattern, Infectious Diseases, Pandemic, medicine, Antimicrobial stewardship, business, Coronavirus Infections
Published
2020
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41. Characteristics and Outcomes of Staphylococcus aureus Bloodstream Infection Originating From the Urinary Tract: A Multicenter Cohort Study

Author

Ana Sanchez-Batanero, Cristian Tebé, José María Aguado, Rafael San-Juan, Luis Eduardo López-Cortés, Miquel Pujol, Jordi Carratalà, Sara Grillo, Antonio Lalueza, Guillermo Cuervo, Carmen Ardanuy, Dolors García-Somoza, Mariona Llaberia, Immaculada Grau, Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad (España), Red Española de Investigación en Patología Infecciosa, European Commission, [Grillo,S, Cuervo,G, Carratalà,J, Grau,I, Llaberia,M, Pujol,M] Department of Infectious Diseases, Bellvitge University Hospital, Barcelona, Spain. [Grillo,S, Ardanuy,C, García-Somoza,D, Pujol,M] Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain. [Aguado,JM, Lalueza,A, Sanjuan,R] Unit of Infectious Diseases, 12 de Octubre University Hospital, Madrid, Spain. [Aguado,JM, Sanjuan,R] Research Institute Hospital 12 de Octubre (I+12), Madrid, Spain. [Lopez-Cortés,LE] Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/CSIC/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain. [Sanchez-Batanero,A] Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/CSIC/Departamento de Medicina, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain. [Ardanuy,C, García-Somoza,D] Department of Microbiology, Bellvitge University Hospital, Barcelona, Spain. [Grau,I, García-Somoza,D] CIBER of Respiratory Diseases, ISCIII, Madrid, Spain. [Grillo,S, Aguado,JM, Lopez-Cortés,LE, Sanjuan,R, and Ardanuy,C] Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain. [Ardanuy,C] Departmentos de Fundamentos Clínicos and Patología y Terapeútica Experimental, School of Medicine, of University of Barcelona (UB), Barcelona, Spain. [Aguado,JM] Complutense University of Madrid, Madrid, Spain. [Tebé,C] Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain. [Tebé,C] Basic Clinical Practice Department, Rovira Virgili University, Reus, Spain. [Carratalà,J] University of Barcelona (UB), Barcelona, Spain.

Subjects
0301 basic medicine, medicine.medical_specialty, Staphylococcus aureus, medicine.medical_treatment, Urinary system, 030106 microbiology, Check Tags::Male [Medical Subject Headings], Bacteremia, medicine.disease_cause, Urinary catheterization, Diseases::Bacterial Infections and Mycoses::Infection::Urinary Tract Infections [Medical Subject Headings], Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], 03 medical and health sciences, 0302 clinical medicine, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Retrospective Studies [Medical Subject Headings], Aparell urinari, Internal medicine, Case fatality rate, Infecciones estafilocócicas, Medicine, Staphylococcal infections, 030212 general & internal medicine, Infecciones urinarias, Organisms::Bacteria::Endospore-Forming Bacteria::Gram-Positive Endospore-Forming Bacteria::Gram-Positive Endospore-Forming Rods::Staphylococcaceae::Staphylococcus::Staphylococcus aureus::Methicillin-Resistant Staphylococcus aureus [Medical Subject Headings], Anatomy::Urogenital System::Urinary Tract [Medical Subject Headings], Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Positive Bacterial Infections::Staphylococcal Infections [Medical Subject Headings], Geographical Locations::Geographic Locations::Europe::Spain [Medical Subject Headings], Urinary tract infection, business.industry, Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Bacteremia [Medical Subject Headings], Infeccions per estafilococs, Urinary devices, medicine.disease, Comorbidity, Methicillin-resistant Staphylococcus aureus, Urinary organs, Infectious Diseases, Oncology, Organisms::Bacteria::Gram-Positive Bacteria::Bacillales::Staphylococcaceae::Staphylococcus::Staphylococcus aureus [Medical Subject Headings], Bacteriemia, business, Cohort study
Abstract

[Background] Staphylococcus aureus bloodstream infection (SABSI) arising from a urinary tract source (UTS) is poorly understood., [Methods] We conducted a retrospective analysis in 3 major teaching hospitals in Spain of prospectively collected data of hospitalized patients with SABSI. SABSI-UTS was diagnosed in patients with urinary tract symptoms and/or signs, no evidence of an extra-urinary source of infection, and a urinary S. aureus count of ≥105 cfu/mL. Susceptibility of S. aureus strains and patient mortality were compared between SABSI from UTS (SABSI-UTS) and other sources (SABSI-other)., [Results] Of 4181 episodes of SABSI, we identified 132 (3.16%) cases of SABSI-UTS that occurred predominantly in patients who were male, had high Charlson comorbidity scores, were dependent for daily life activities, and who had undergone urinary catheterization and/or urinary manipulation before the infection. SABSI-UTS was more often caused by MRSA strains compared with SABSI-other (40.9% vs 17.5%; P < .001). Patients with SABSI-UTS caused by MRSA more often received inadequate empirical treatment compared with those caused by susceptible strains (59.7% vs 23.1%; P < .001). The 30-day case fatality rate was lower in patients with SABSI-UTS than in those with SABSI-other (14.4% vs 23.8%; P = .02). Factors independently associated with mortality were dependence for daily activities (aOR, 3.877; 95% CI, 1.08–13.8; P = .037) and persistent bacteremia (aOR, 7.88; 95% CI, 1.57–39.46; P = .012)., [Conclusions] SABSI-UTS occurs predominantly in patients with severe underlying conditions and in those who have undergone urinary tract manipulation. Moreover, it is frequently due to MRSA strains and causes significant mortality., This work was supported by Plan Nacional de I+D+i 2017–2021 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0005, RD16/0016/0002, RD16/0016/0001) and was co-financed by the European Development Regional Fund “A way to achieve Europe,” Operative program Intelligent Growth 2014–2020.

Published
2020

42. Characteristics and Outcomes of

Author

Sara, Grillo, Guillermo, Cuervo, Jordi, Carratalà, Immaculada, Grau, Mariona, Llaberia, José María, Aguado, Luis Eduardo, Lopez-Cortés, Antonio, Lalueza, Rafael, Sanjuan, Ana, Sanchez-Batanero, Carmen, Ardanuy, Dolors, García-Somoza, Cristian, Tebé, and Miquel, Pujol

Subjects
Staphylococcus aureus, AcademicSubjects/MED00290, Major Article, bacteremia, urinary devices, urinary tract infection
Abstract

Background Staphylococcus aureus bloodstream infection (SABSI) arising from a urinary tract source (UTS) is poorly understood. Methods We conducted a retrospective analysis in 3 major teaching hospitals in Spain of prospectively collected data of hospitalized patients with SABSI. SABSI-UTS was diagnosed in patients with urinary tract symptoms and/or signs, no evidence of an extra-urinary source of infection, and a urinary S. aureus count of ≥105 cfu/mL. Susceptibility of S. aureus strains and patient mortality were compared between SABSI from UTS (SABSI-UTS) and other sources (SABSI-other). Results Of 4181 episodes of SABSI, we identified 132 (3.16%) cases of SABSI-UTS that occurred predominantly in patients who were male, had high Charlson comorbidity scores, were dependent for daily life activities, and who had undergone urinary catheterization and/or urinary manipulation before the infection. SABSI-UTS was more often caused by MRSA strains compared with SABSI-other (40.9% vs 17.5%; P < .001). Patients with SABSI-UTS caused by MRSA more often received inadequate empirical treatment compared with those caused by susceptible strains (59.7% vs 23.1%; P < .001). The 30-day case fatality rate was lower in patients with SABSI-UTS than in those with SABSI-other (14.4% vs 23.8%; P = .02). Factors independently associated with mortality were dependence for daily activities (aOR, 3.877; 95% CI, 1.08–13.8; P = .037) and persistent bacteremia (aOR, 7.88; 95% CI, 1.57–39.46; P = .012). Conclusions SABSI-UTS occurs predominantly in patients with severe underlying conditions and in those who have undergone urinary tract manipulation. Moreover, it is frequently due to MRSA strains and causes significant mortality.

Published
2020

43. Recommendations for the diagnosis and treatment of Clostridioides difficile infection: An official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)

Author

Elena Reigadas, José Barberán, Miguel Salavert, P Alonso-Fernández, N Merchante, Emilio Maseda, Juan Pablo Horcajada, Marcio Borges, J L Pérez Sáenz, Benito Almirante, Emilio Bouza, Luis Alcalá, J Guardiola, José Mensa, Miquel Pujol, José María Aguado, Javier Cobo, and Patricia Muñoz

Subjects
0301 basic medicine, Male, diarrea asociada a C. difficile, Cost-Benefit Analysis, Antibiotics, Bezlotoxumab, Clostridiodes difficile, Feces, 0302 clinical medicine, Secondary Prevention, Medicine, Fidaxomicin, 030212 general & internal medicine, Societies, Medical, Vaccines, Monoclonal antibodie, fidaxomicina, probióticos, General Medicine, Clostridium difficile, Continuity of Patient Care, Anti-Bacterial Agents, Diarrhea, Vancomycin, Female, medicine.symptom, medicine.drug, Microbiology (medical), medicine.medical_specialty, medicine.drug_class, 030106 microbiology, Microbial Sensitivity Tests, Diarrhoea associated to C. difficile, Specimen Handling, 03 medical and health sciences, Internal medicine, Metronidazole, Humans, vacunas, anticuerpos monoclonales, Consensus Document, Pharmacology, vancomicina, business.industry, Clostridioides difficile, Fecal Material Transplantation (FMT), Probiotics, Guideline, Trasplante de materia fecal, metronidazol, Spain, Clostridium Infections, Monoclonal antibodies, business
Abstract

This document gathers the opinion of a multidisciplinary forum of experts on different aspects of the diagnosis and treatment of Clostridioides difficile infection (CDI) in Spain. It has been structured around a series of questions that the attendees considered relevant and in which a consensus opinion was reached. The main messages were as follows: CDI should be suspected in patients older than 2 years of age in the presence of diarrhea, paralytic ileus and unexplained leukocytosis, even in the absence of classical risk factors. With a few exceptions, a single stool sample is sufficient for diagnosis, which can be sent to the laboratory with or without transportation media for enteropathogenic bacteria. In the absence of diarrhoea, rectal swabs may be valid. The microbiology laboratory should include C. difficile among the pathogens routinely searched in patients with diarrhoea. Laboratory tests in different order and sequence schemes include GDH detection, presence of toxins, molecular tests and toxigenic culture. Immediate determination of sensitivity to drugs such as vancomycin, metronidazole or fidaxomycin is not required. The evolution of toxin persistence is not a suitable test for follow up. Laboratory diagnosis of CDI should be rapid and results reported and interpreted to clinicians immediately. In addition to the basic support of all diarrheic episodes, CDI treatment requires the suppression of antiperistaltic agents, proton pump inhibitors and antibiotics, where possible. Oral vancomycin and fidaxomycin are the antibacterials of choice in treatment, intravenous metronidazole being restricted for patients in whom the presence of the above drugs in the intestinal lumen cannot be assured. Fecal material transplantation is the treatment of choice for patients with multiple recurrences but uncertainties persist regarding its standardization and safety. Bezlotoxumab is a monoclonal antibody to C. difficile toxin B that should be administered to patients at high risk of recurrence. Surgery is becoming less and less necessary and prevention with vaccines is under research. Probiotics have so far not been shown to be therapeutically or preventively effective. The therapeutic strategy should be based, rather than on the number of episodes, on the severity of the episodes and on their potential to recur. Some data point to the efficacy of oral vancomycin prophylaxis in patients who reccur CDI when systemic antibiotics are required again.

Published
2020

44. Executive summary of the Consensus Document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and of the Spanish Association of Surgeons (AEC) in antibiotic prophylaxis in surgery

Author

Josep M. Badia, Natividad Benito, Juan Diego Ruiz Mesa, Jaime Ruiz-Tovar Polo, Mª Dolores Del Toro López, Melchor Riera, Erika Esteve, Juan Pablo Horcajada, Andrés Canut Blasco, Inés Rubio Pérez, José María Balibrea, Cristóbal Muñoz Casares, José Luis del Pozo, Javier Arias Díaz, A. Serrablo, Miquel Pujol, Alba Manuel Vázquez, Alex Soriano, and Jaime Jimeno

Subjects
0301 basic medicine, Microbiology (medical), Pediatrics, medicine.medical_specialty, medicine.drug_class, First line, 030106 microbiology, Antibiotics, 030230 surgery, Dengue fever, law.invention, Febrile syndrome, 03 medical and health sciences, 0302 clinical medicine, Antibiotic resistance, law, Epidemiology, medicine, 030212 general & internal medicine, Antibiotic prophylaxis, Elective surgery, Executive summary, business.industry, Risk of infection, General Engineering, Tropics, medicine.disease, Antimicrobial, Intensive care unit, Surgery, Etiology, business, Malaria, Pediatric population
Abstract

Introduction International travelers have grown significantly over last years, as well as imported diseases from tropical areas. Information in pediatric population is scarce. We describe demographic and clinical characteristics of febrile children coming from the tropics. Methods Retrospective review of patients under 18 years old, presenting at a tertiary hospital and surrounding primary health care centers between July 2002 and July 2018 with a stay in a tropical region during the previous year. Patients were selected from microbiological charts of thick smears for malaria or dengue serologies. Results 188 patients were studied: 52.7% were born in Spain with a median age of 3.0 years old (IQR 1.5–8.0). Main regions of stay were Sub-Saharan Africa (54.8%) and Latin America (29.8%), mostly for visiting their friends and relatives (56.3%), followed by recent arrival migrants (32.4%). Only 34% of travelers attended pre-travel consultation. More than 80% of these febrile children attended directly the Emergency Room. The most frequent diagnoses were febrile syndrome without source (56.4%), respiratory condition (15.4%) and acute diarrhea (11.7%). Around a half (52.1%) were managed as outpatients, but 46.2% were hospitalized and 7.4% were admitted to Intensive Care Unit. No specific diagnosis was achieved in 24% of cases. However, 29.7% were diagnosed with malaria. Conclusion Children with fever coming from tropical areas were at risk of severe infectious diseases. Malaria was diagnosed in one out of four and 7% required admission in PICU. This information emphasizes the need of reinforcing training about tropical diseases among first line physicians.

Published
2020

45. A framework to develop semiautomated surveillance of surgical site infections : An international multicenter study

Author

Gonny Moen, Jannie Romme, Evelina Tacconelli, Miquel Pujol, Stephanie M. van Rooden, Elodie Couvé-Deacon, Joaquín Lanz, Jesús Rodríguez Baño, Maaike S. M. van Mourik, Camille Bataille, Aina Gomila, and Jan Kluytmans

Subjects
Microbiology (medical), medicine.medical_specialty, Infeccions quirúrgiques, Internationality, Standardization, Epidemiology, MEDLINE, 030501 epidemiology, 03 medical and health sciences, Automation, 0302 clinical medicine, Colon surgery, Nosocomial infections, Medicine, Electronic Health Records, Humans, Surgical Wound Infection, Orthopedic Procedures, 030212 general & internal medicine, Cardiac Surgical Procedures, Digestive System Surgical Procedures, Retrospective Studies, business.industry, Workload, Retrospective cohort study, Infeccions nosocomials, Hospitals, Europe, Infectious Diseases, Emergency medicine, Orthopedic surgery, 0305 other medical science, business, Sentinel Surveillance, Algorithms
Abstract

Objective:Automated surveillance of healthcare-associated infections reduces workload and improves standardization, but it has not yet been adopted widely. In this study, we assessed the performance and feasibility of an easy implementable framework to develop algorithms for semiautomated surveillance of deep incisional and organ-space surgical site infections (SSIs) after orthopedic, cardiac, and colon surgeries.Design:Retrospective cohort study in multiple countries.Methods:European hospitals were recruited and selected based on the availability of manual SSI surveillance data from 2012 onward (reference standard) and on the ability to extract relevant data from electronic health records. A questionnaire on local manual surveillance and clinical practices was administered to participating hospitals, and the information collected was used to pre-emptively design semiautomated surveillance algorithms standardized for multiple hospitals and for center-specific application. Algorithm sensitivity, positive predictive value, and reduction of manual charts requiring review were calculated. Reasons for misclassification were explored using discrepancy analyses.Results:The study included 3 hospitals, in the Netherlands, France, and Spain. Classification algorithms were developed to indicate procedures with a high probability of SSI. Components concerned microbiology, prolonged length of stay or readmission, and reinterventions. Antibiotics and radiology ordering were optional. In total, 4,770 orthopedic procedures, 5,047 cardiac procedures, and 3,906 colon procedures were analyzed. Across hospitals, standardized algorithm sensitivity ranged between 82% and 100% for orthopedic surgery, between 67% and 100% for cardiac surgery, and between 84% and 100% for colon surgery, with 72%–98% workload reduction. Center-specific algorithms had lower sensitivity.Conclusions:Using this framework, algorithms for semiautomated surveillance of SSI can be successfully developed. The high performance of standardized algorithms holds promise for large-scale standardization.

Published
2020

46. A Care Bundle Intervention to Prevent Surgical Site Infections After a Craniotomy

Author

Guillermo Cuervo, Dolores García-Somoza, Miquel Pujol, Jordi Carratalà, Cristian Tebé, Carmen Cabellos, Maria Angeles Dominguez Luzón, A. Hornero, Iván Pelegrín, Jordi Càmara, Jordi Adamuz, Emilio Jiménez-Martínez, Pilar Ciercoles, and Andres Gabarrós

Subjects
Microbiology (medical), medicine.medical_specialty, medicine.medical_treatment, 03 medical and health sciences, 0302 clinical medicine, Vancomycin, Intervention (counseling), Medicine, Humans, Surgical Wound Infection, 030212 general & internal medicine, Craniotomy, business.industry, Proportional hazards model, Incidence (epidemiology), Chlorhexidine, Surgical wound, Antibiotic Prophylaxis, Bandages, Surgery, Infectious Diseases, Propensity score matching, business, 030217 neurology & neurosurgery, Patient Care Bundles, medicine.drug
Abstract

Background Although surgical site infections after a craniotomy (SSI-CRANs) are a serious problem that involves significant morbidity and costs, information on their prevention is scarce. We aimed to determine whether the implementation of a care bundle was effective in preventing SSI-CRANs. Methods A historical control study was used to evaluate the care bundle, which included a preoperative shower with 4% chlorhexidine soap, appropriate hair removal, adequate preoperative systemic antibiotic prophylaxis, the administration of 1 g of vancomycin powder into the subgaleal space before closing, and a postoperative dressing of the incisional surgical wound with a sterile absorbent cover. Patients were divided into 2 groups: preintervention (January 2013 to December 2015) and intervention (January 2016 to December 2017). The primary study end point was the incidence of SSI-CRANs within 1 year postsurgery. Propensity score matching was performed, and differences between the 2 study periods were assessed using Cox regression models. Results A total of 595 and 422 patients were included in the preintervention and intervention periods, respectively. The incidence of SSI-CRANs was lower in the intervention period (15.3% vs 3.5%; P < .001). Using a propensity score model, 421 pairs of patients were matched. The care bundle intervention was independently associated with a reduced incidence of SSI-CRANs (adjusted odds ratio, 0.23; 95% confidence interval, .13–.40; P < .001). Conclusions The care bundle intervention was effective in reducing SSI-CRAN rates. The implementation of this multimodal preventive strategy should be considered in centers with high SSI-CRAN incidences.

Published
2020

47. A prospective, multicenter case control study of risk factors for acquisition and mortality in Enterobacter species bacteremia

Author

Fe Tubau-Quintano, Dolores Navarro-Amuedo, Luis Martínez-Martínez, Fernando Rodríguez-López, Álvaro Pascual-Hernández, Julián Torre-Cisneros, Jorge Calvo-Montes, Jesús Rodríguez-Baño, Oriol Gasch-Blasi, Manuel E. Jiménez-Mejías, Rocío Álvarez-Marín, Rosario Lara-Contreras, José Antonio Lepe-Jiménez, María Eliecer Cano-García, Miquel Pujol-Rojo, José-Manuel Rodríguez-Martínez, Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), Red Española de Investigación en Patología Infecciosa, and European Commission

Subjects
0301 basic medicine, Microbiology (medical), medicine.medical_specialty, medicine.medical_treatment, 030106 microbiology, Enterobacter, Bacteremia, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Risk factor, Prospective cohort study, biology, Septic shock, business.industry, Case-control study, Enterobacteriaceae Infections, biology.organism_classification, medicine.disease, Anti-Bacterial Agents, Infectious Diseases, Spain, Case-Control Studies, Etiology, Hemodialysis, business
Abstract

Spanish Network for Research in Infectious Diseases/Enterobacter spp. Bacteriemia Project group., [Background] Enterobacter is among the main etiologies of hospital-acquired infections. This study aims to identify the risk factors of acquisition and attributable mortality of Enterobacter bacteremia., [Results] The study included 285 cases and 570 controls. E. cloacae was isolated in 198(68.8%) cases and E. aerogenes in 89(31.2%). Invasive procedures (hemodialysis, nasogastric tube, mechanical ventilation, surgical drainage tube) and previous antibiotics or corticosteroids were independently associated with Enterobacter bacteremia. Its attributable mortality was 7.8%(CI95%2.7–13.4%), being dissimilar according to a McCabe index: non-fatal=3.2%, ultimately fatal=12.9% and rapidly fatal=0.12%. Enterobacter bacteremia remained an independent risk factor for mortality among cases with severe sepsis or septic shock (OR 5.75 [CI95%2.57–12.87], p, [Conclusions] Invasive procedures, previous antibiotics and corticosteroids predispose to acquire Enterobacter bacteremia. This entity increases mortality among fragile patients and those with severe infections. Antibiotic resistances did not affect the outcome., This study was supported by the Instituto Carlos III, grant PS09/00916, Ministerio de Ciencia e Innovación, and the Plan Nacional I+D+i 2013-2016 and Instituto Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI, RD 16/0016/0001; RD 16/0016/0005; RD 16/0016/0007; RD 16/0016/0008; RD 16/0016/0009) – co – financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014-2020.

Published
2020

48. Interventions to decrease short-term peripheral venous catheter-related bloodstream infections: impact on incidence and mortality

Author

Emilio Jimenez, A. Hornero, Imma Grau, Cristian Tebe, Dàmaris Berbel, Jose M. Martínez-Sánchez, Laura Gavaldà, Guillermo Cuervo, Patrick Saliba, Miquel Pujol, Jordi Carratalà, Evelyn Shaw, P. Martos, and J.M. Verge

Subjects
Male, Microbiology (medical), medicine.medical_specialty, Attitude of Health Personnel, Psychological intervention, 030501 epidemiology, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Behavior Therapy, Interquartile range, Sepsis, Catheterization, Peripheral, medicine, Humans, Longitudinal Studies, Prospective Studies, 030212 general & internal medicine, Poisson regression, Aged, Cause of death, Aged, 80 and over, Infection Control, Catheter insertion, business.industry, Incidence, Incidence (epidemiology), General Medicine, Middle Aged, Staphylococcal Infections, University hospital, Infectious Diseases, Catheter-Related Infections, Emergency medicine, symbols, Peripheral venous catheter, Female, Guideline Adherence, 0305 other medical science, business
Abstract

Summary Background Short-term peripheral venous catheters are a significant source of healthcare-acquired bloodstream infections and a preventable cause of death. Aim To assess the effectiveness of interventions applied to reduce the incidence and mortality associated with short-term peripheral venous catheter-related bloodstream infections (PVCR-BSIs). Methods The intervention included continuous PVCR-BSI surveillance, implementation of preventive measures related to catheter insertion and maintenance in accordance with evidence-based recommendations and the hospital's own data, front-line staff educational campaigns, and assessment of adherence to hospital guidelines by ward rounds. A Poisson regression model was used to estimate the trend of rate per year. Findings From January 2003 to December 2016, 227 episodes of PVCR-BSI were identified among hospitalized patients at a university hospital. The mean age of patients was 67 years (standard deviation 14 years), 69% were male and the median Charlson score was 3 (interquartile range 2–5). Staphylococcus aureus caused 115 (50.7%) episodes. Thirty-day mortality was 13.2%. After implementation of the intervention, the incidence of PVCR-BSIs decreased significantly from 30 episodes in 2003 (1.17 episodes/10,000 patient-days) to eight episodes in 2016 (0.36/10,000 patient-days). The number of episodes caused by S. aureus decreased from 18 episodes in 2003 (0.70/10,000 patient-days) to three episodes in 2016 (0.14/10,000 patient-day), and mortality decreased from seven cases in 2003 (0.27/10,000 patient-days) to zero cases in 2016 (0.00/10,000 patient-days). Conclusions Surveillance, implementation of a multi-modal strategy and periodical assessment of healthcare workers' adherence to hospital guidelines led to a sustained reduction in PVCR-BSIs. This reduction had a major impact on S. aureus BSI rates and associated mortality.

Published
2018
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49. Efficacy and safety of fosfomycin plus imipenem versus vancomycin for complicated bacteraemia and endocarditis due to methicillin-resistant Staphylococcus aureus: a randomized clinical trial

Author

J.M. Pericàs, A. Moreno, M. Almela, C. García-de-la-Mària, F. Marco, P. Muñoz, C. Peña, A. de Alarcón, A. del Río, A. Eworo, A. Cruceta, J.C. Paré, C.A. Mestres, J.M. Miró, José M. Miró, Asunción Moreno, Juan M. Pericàs, Juan Ambrosioni, Adrián Tellez, Marta Hernandez-Meneses, Ana del Río, Carlos Cervera, Francesc Marco, Cristina Garcia de la Mària, Yolanda Armero, Manel Almela, Carlos A. Mestres, Juan C. Paré, David Fuster, Ramón Cartañá, Salvador Ninot, Manel Azqueta, Marta Sitges, Jose Ramírez, Merce Brunet, Dolors Soy, Jaume Llopis, Carmen Peña, Oriol Gasch, Cristina Suarez, Miquel Pujol, Javier Ariza, Jordi Carratalà, Francisco Gudiol, Patricia Muñoz, Alia Eworo, Emilio Bouza, Arístides de Alarcón, Mercè Gurgui, Natividad Benito, Juan-Emilio Losa-Garcia, Enrique Navas, Jose R. Paño-Pardo, Belén Loeches, Jose R. Arribas, Miguel Montejo, Juan Galvez, University of Zurich, Moreno, A, Ministerio de Sanidad y Consumo (España), Instituto de Salud Carlos III, Ministerio de Economía y Competitividad (España), Institut d'Investigacions Biomèdiques August Pi i Sunyer, European Society of Clinical Microbiology and Infectious Diseases, and Federation of European Microbiological Societies

Subjects
Male, Methicillin-Resistant Staphylococcus aureus, 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Imipenem, 030106 microbiology, Treatment outcome, 610 Medicine & health, Bacteremia, Microbial Sensitivity Tests, Fosfomycin, medicine.disease_cause, 2726 Microbiology (medical), law.invention, 03 medical and health sciences, Randomized controlled trial, Vancomycin, law, Internal medicine, medicine, Humans, Endocarditis, Aged, Aged, 80 and over, business.industry, 2725 Infectious Diseases, General Medicine, Middle Aged, medicine.disease, Methicillin-resistant Staphylococcus aureus, 10020 Clinic for Cardiac Surgery, Anti-Bacterial Agents, Treatment Outcome, Infectious Diseases, Multicenter study, Female, business, medicine.drug
Abstract

FOSIMI Investigators., This work was supported by the Ministerio de Sanidad y Consumo of Spain (Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III, Madrid, Spain, Grant #EC0800190). JMP received a “Rio Hortega” Research Grant (CM14/00135; 2015-16) from Instituto de Salud Carlos III and the Ministerio de Economia and Competitividad, Madrid (Spain) and the ESCMID/FEMS Research Fellowship 2016. JMM received a personal 80:20 research grant from the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, during 2017–19.

Published
2018
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50. Predictive factors for early- and late-onset surgical site infections in patients undergoing elective colorectal surgery. A multicentre, prospective, cohort study

Author

L. Pagespetit, D Fraccalvieri, Francisco Gudiol, R. Pérez, S Biondo, L Mora, N. Arroyo, Aina Gomila, Vicens Diaz-Brito, E Limón, C. Sanz, Miquel Pujol, Jordi Carratalà, Josep M. Badia, M Brugués, N Freixas, Simona Iftimie, and Evelyn Shaw

Subjects
Male, Microbiology (medical), medicine.medical_specialty, Colorectal cancer, medicine.medical_treatment, Decision Support Techniques, Stoma, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Colon surgery, Internal medicine, Acute care, medicine, Humans, Surgical Wound Infection, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Aged, Aged, 80 and over, Chemotherapy, business.industry, General Medicine, Odds ratio, medicine.disease, Colorectal surgery, Europe, Infectious Diseases, 030220 oncology & carcinogenesis, Female, business, Colorectal Surgery
Abstract

Surgical site infections (SSIs) are the leading cause of healthcare-associated infections in acute care hospitals in Europe. However, the risk factors for the development of early-onset (EO) and late-onset (LO) SSI have not been elucidated.This study investigated the predictive factors for EO-SSI and LO-SSI in a large cohort of patients undergoing colorectal surgery.We prospectively followed-up adult patients undergoing elective colorectal surgery in 10 hospitals (2011-2014). Patients were divided into three groups: EO-SSI, LO-SSI, or no infection (no-SSI). The cut-off defining EO-SSI and LO-SSI was seven days (median time to SSI development). Different predictive factors for EO-SSI and LO-SSI were analysed, comparing each group with the no-SSI patients.Of 3701 patients, 320 (8.6%) and 349 (9.4%) developed EO-SSI and LO-SSI, respectively. The rest had no-SSI. Patients with EO-SSI were mostly males, had colon surgery and developed organ-space SSI whereas LO-SSI patients frequently received chemotherapy or radiotherapy and had incisional SSI. Male sex (odds ratio (OR): 1.92; P 0.001), American Society of Anesthesiologists' physical status2 (OR: 1.51; P = 0.01), administration of mechanical bowel preparation (OR: 0.7; P = 0.03) and stoma creation (OR: 1.95; P 0.001) predicted EO-SSI whereas rectal surgery (OR: 1.43; P = 0.03), prolonged surgery (OR: 1.4; P = 0.03) and previous chemotherapy (OR: 1.8; P = 0.03) predicted LO-SSI.We found distinctive predictive factors for the development of SSI before and after seven days following elective colorectal surgery. These factors could help establish specific preventive measures in each group.

Published
2018
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