96 results on '"Pedro Puerta-Alcalde"'
Search Results
2. Safety and effectiveness of isavuconazole in real-life non-neutropenic patients
- Author
-
Patricia Monzó-Gallo, Carlos Lopera, Ana M Badía-Tejero, Marina Machado, Julio García-Rodríguez, Pablo Vidal-Cortés, Esperanza Merino, Jorge Calderón, Jesús Fortún, Zaira R. Palacios-Baena, Javier Pemán, Joan Roig Sanchis, Manuela Aguilar-Guisado, Carlota Gudiol, Juan C Ramos, Isabel Sánchez-Romero, Pilar Martin-Davila, Luis E. López-Cortés, Miguel Salavert, Isabel Ruiz-Camps, Mariana Chumbita, Tommaso Francesco Aiello, Olivier Peyrony, Pedro Puerta-Alcalde, Alex Soriano, Francesc Marco, and Carolina Garcia-Vidal
- Subjects
Isavuconazole ,Non-neutropenic ,Invasive fungal infection ,Effectiveness ,Safety ,Infectious and parasitic diseases ,RC109-216 - Abstract
ABSTRACT: Objectives: Information is scarce on clinical experiences with non-neutropenic patients with invasive fungal infection (IFI) receiving isavuconazole. We aimed to report the safety and effectiveness of this drug as a first-line treatment or rescue in real life. Methods: A retrospective, observational multicentric study of non-neutropenic patients who received isavuconazole as an IFI treatment at 12 different university hospitals (January 2018-2022). All patients met criteria for proven, probable or possible IFI according to EORTC-MSG. Results: A total of 238 IFIs were treated with isavuconazole during the study period. Combination therapy was administered in 27.7% of cases. The primary IFI was aspergillosis (217, 91.2%). Other IFIs treated with isavuconazole were candidemia (n = 10), mucormycosis (n = 8), histoplasmosis (n = 2), cryptococcosis (n = 2), and others (n = 4). Median time of isavuconazole treatment was 29 days. Only 5.9% (n = 14) of cases developed toxicity, mainly hepatic-related (10 patients, 4.2%). Nine patients (3.8%) had treatment withdrawn. Successful clinical response at 12 weeks was documented in 50.5% of patients. Conclusion: Isavuconazole is an adequate treatment for non-neutropenic patients with IFIs. Toxicity rates were low and its effectiveness was comparable to other antifungal therapies previously reported.
- Published
- 2024
- Full Text
- View/download PDF
3. Reply to Paranhos-Baccalà et al. Comment on 'Cuesta et al. An Assessment of a New Rapid Multiplex PCR Assay for the Diagnosis of Meningoencephalitis. Diagnostics 2024, 14, 802'
- Author
-
Genoveva Cuesta, Pedro Puerta-Alcalde, Andrea Vergara, Enric Roses, Jordi Bosch, Climent Casals-Pascual, Alex Soriano, Maria Ángeles Marcos, Sergi Sanz, and Jordi Vila
- Subjects
n/a ,Medicine (General) ,R5-920 - Abstract
We appreciate the interest and reflections of Paranhos-Baccalà and colleagues in our recent article published in Diagnostics [...]
- Published
- 2024
- Full Text
- View/download PDF
4. An Assessment of a New Rapid Multiplex PCR Assay for the Diagnosis of Meningoencephalitis
- Author
-
Genoveva Cuesta, Pedro Puerta-Alcalde, Andrea Vergara, Enric Roses, Jordi Bosch, Climent Casals-Pascual, Alex Soriano, Mª Ángeles Marcos, Sergi Sanz, and Jordi Vila
- Subjects
meningitis ,encephalitis ,FilmArray ME ,QIAstat-Dx ME ,multiplex PCR ,Medicine (General) ,R5-920 - Abstract
The rapid and broad microbiological diagnosis of meningoencephalitis (ME) has been possible thanks to the development of multiplex PCR tests applied to cerebrospinal fluid (CSF). We aimed to assess a new multiplex PCR panel (the QIAstat-Dx ME panel), which we compared to conventional diagnostic tools and the Biofire FilmArray ME Panel. The pathogens analyzed using both methods were Escherichia coli K1, Haemophilus influenzae, Listeria monocytogenes, Neisseria meningitidis, Streptococcus agalactiae, Streptococcus pneumoniae, Enterovirus, herpes simplex virus 1–2, human herpesvirus 6, human parechovirus, varicella zoster virus, and Cryptococcus neoformans/gattii. We used sensitivity, specificity, PPV, NPV, and kappa correlation index parameters to achieve our objective. Fifty CSF samples from patients with suspected ME were included. When conventional methods were used, 28 CSF samples (56%) were positive. The sensitivity and specificity for QIAstat-Dx/ME were 96.43% (CI95%, 79.8–99.8) and 95.24% (75.2–99.7), respectively, whereas the PPV and NPV were 96.43% (79.8–99.8) and 95.24% (75.1–99.7), respectively. The kappa value was 91.67%. Conclusions: A high correlation of the QIAstat-Dx ME panel with reference methods was shown. QIAstat-Dx ME is a rapid-PCR technique to be applied in patients with suspected ME with a high accuracy.
- Published
- 2024
- Full Text
- View/download PDF
5. Epidemiology and risk factors for recurrence in biliary source bloodstream infection episodes in oncological patients
- Author
-
Ignacio Grafia, Mariana Chumbita, Elia Seguí, Celia Cardozo, Juan Carlos Laguna, Marta García de Herreros, Nicole Garcia-Pouton, Ana Villaescusa, Cristina Pitart, Verónica Rico-Caballero, Javier Marco-Hernández, Carles Zamora, Margarita Viladot, Joan Padrosa, Albert Tuca, Eric Mayor-Vázquez, Francesc Marco, Jose A. Martínez, Josep Mensa, Carolina Garcia-Vidal, Alex Soriano, and Pedro Puerta-Alcalde
- Subjects
cholangitis ,biliary source bloodstream infection ,mortality ,empirical treatment ,recurrence ,Microbiology ,QR1-502 - Abstract
ABSTRACT We aimed to describe the characteristics and outcomes of biliary source bloodstream infections (BSIs) in oncological patients. Secondarily, we analyzed risk factors for recurrent BSI episodes. All episodes of biliary source BSIs in oncological patients were prospectively collected (2008–2019) and retrospectively analyzed. Logistic regression analyses were performed. A rule to stratify patients into risk groups for recurrent biliary source BSI was conducted. Four hundred biliary source BSIs were documented in 291 oncological patients. The most frequent causative agents were Escherichia coli (42%) and Klebsiella spp. (27%), and 86 (21.5%) episodes were caused by multidrug-resistant Gram-negative bacilli (MDR-GNB). The rates of MDR-GNB increased over time. Overall, 73 patients developed 118 recurrent BSI episodes. Independent risk factors for recurrent BSI episodes were prior antibiotic therapy (OR 3.781, 95% CI 1.906–7.503), biliary prosthesis (OR 2.232, 95% CI 1.157–4.305), prior admission due to suspected biliary source infection (OR 4.409, 95% CI 2.338–8.311), and BSI episode caused by an MDR-GNB (OR 2.857, 95% CI 1.389–5.874). With these variables, a score was generated that predicted recurrent biliary source BSI with an area under the receiver operating characteristic (ROC) curve of 0.819. Inappropriate empirical antibiotic treatment (IEAT) was administered in 23.8% of patients, and 30-d mortality was 19.5%. As a conclusion, biliary source BSI in oncological patients is mainly caused by GNB, with high and increasing MDR rates, frequent IEAT, and high mortality. Recurrent BSI episodes are frequent. A simple score to identify recurrent episodes was developed to potentially establish prophylactic strategies. IMPORTANCE This study shows that biliary source bloodstream infections (BSIs) in oncological patients are mainly caused by Gram-negative bacilli (GNB), with high and increasing rates of multidrug resistance. Importantly, recurrent biliary source BSI episodes were very frequent and associated with delays in chemotherapy, high rates of inappropriate empirical antibiotic therapy, and high 30-d mortality (19.5%). Using the variable independently associated with recurrent BSI episodes, a score was generated that predicted recurrent biliary source BSI with high accuracy. This score could be used to establish prophylactic strategies and lower the risk of relapsing episodes and the associated morbidity and mortality.
- Published
- 2023
- Full Text
- View/download PDF
6. High Rate of Inappropriate Antibiotics in Patients with Hematologic Malignancies and Pseudomonas aeruginosa Bacteremia following International Guideline Recommendations
- Author
-
Mariana Chumbita, Pedro Puerta-Alcalde, Lucrecia Yáñez, Maria Angeles Cuesta, Anabelle Chinea, Ignacio Español-Morales, Pascual Fernandez-Abellán, Carlota Gudiol, Pedro González-Sierra, Rafael Rojas, José María Sánchez-Pina, Irene Sánchez Vadillo, Miguel Sánchez, Rosario Varela, Lourdes Vázquez, Manuel Guerreiro, Patricia Monzo, Carlos Lopera, Tommaso Francesco Aiello, Oliver Peyrony, Alex Soriano, and Carolina Garcia-Vidal
- Subjects
neutropenia ,bacteremia ,P. aeruginosa ,mortality ,empirical antibiotic treatment ,Microbiology ,QR1-502 - Abstract
ABSTRACT Optimal coverage of Pseudomonas aeruginosa is challenging in febrile neutropenic patients due to a progressive increase in antibiotic resistance worldwide. We aimed to detail current rates of resistance to antibiotics recommended by international guidelines for P. aeruginosa isolated from bloodstream infections (BSI) in patients with hematologic malignancies. Secondarily, we aimed to describe how many patients received inappropriate empirical antibiotic treatment (IEAT) and its impact on mortality. We conducted a retrospective, multicenter cohort study of the last 20 BSI episodes caused by P. aeruginosa in patients with hematologic malignancies from across 14 university hospitals in Spain. Of the 280 patients with hematologic malignancies and BSI caused by P. aeruginosa, 101 (36%) had strains resistant to at least one of the β-lactam antibiotics recommended in international guidelines, namely, cefepime, piperacillin-tazobactam, and meropenem. Additionally, 21.1% and 11.4% of the strains met criteria for MDR and XDR P. aeruginosa, respectively. Even if international guidelines were followed in most cases, 47 (16.8%) patients received IEAT and 66 (23.6%) received inappropriate β-lactam empirical antibiotic treatment. Thirty-day mortality was 27.1%. In the multivariate analysis, pulmonary source (OR 2.22, 95% CI 1.14 to 4.34) and IEAT (OR 2.67, 95% CI 1.37 to 5.23) were factors independently associated with increased mortality. We concluded that P. aeruginosa-causing BSI in patients with hematologic malignancies is commonly resistant to antibiotics recommended in international guidelines, which is associated with frequent IEAT and higher mortality. New therapeutic strategies are needed. IMPORTANCE Bloodstream infection (BSI) caused by P. aeruginosa is related with an elevated morbidity and mortality in neutropenic patients. For this reason, optimal antipseudomonal coverage has been the basis of all historical recommendations in the empirical treatment of febrile neutropenia. However, in recent years the emergence of multiple types of antibiotic resistances has posed a challenge in treating infections caused by this microorganism. In our study we postulated that P. aeruginosa-causing BSI in patients with hematologic malignancies is commonly resistant to antibiotics recommended in international guidelines. This observation is associated with frequent IEAT and increased mortality. Consequently, there is a need for a new therapeutic strategy.
- Published
- 2023
- Full Text
- View/download PDF
7. The Etiology, Antibiotic Therapy and Outcomes of Bacteremic Skin and Soft-Tissue Infections in Onco-Hematological Patients
- Author
-
Valeria Castelli, Enric Sastre-Escolà, Pedro Puerta-Alcalde, Leyre Huete-Álava, Júlia Laporte-Amargós, Alba Bergas, Mariana Chumbita, Mar Marín, Eva Domingo-Domenech, Ana María Badia-Tejero, Paula Pons-Oltra, Carolina García-Vidal, Jordi Carratalà, and Carlota Gudiol
- Subjects
bacteremia ,skin and soft-tissue infections ,cancer ,Pseudomonas aeruginosa ,antibiotic resistance ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Objectives: to assess the current epidemiology, antibiotic therapy and outcomes of onco- hematological patients with bacteremic skin and soft-tissue infections (SSTIs), and to identify the risk factors for Gram-negative bacilli (GNB) infection and for early and overall mortality. Methods: episodes of bacteremic SSTIs occurring in cancer patients at two hospitals were prospectively recorded and retrospectively analyzed. Results: Of 164 episodes of bacteremic SSTIs, 53% occurred in patients with solid tumors and 47% with hematological malignancies. GNB represented 45.5% of all episodes, led by Pseudomonas aeruginosa (37.8%). Multidrug resistance rate was 16%. Inadequate empirical antibiotic therapy (IEAT) occurred in 17.7% of episodes, rising to 34.6% in those due to resistant bacteria. Independent risk factors for GNB infection were corticosteroid therapy and skin necrosis. Early and overall case-fatality rates were 12% and 21%, respectively. Risk factors for early mortality were older age, septic shock, and IEAT, and for overall mortality were older age, septic shock and resistant bacteria. Conclusions: GNB bacteremic SSTI was common, particularly if corticosteroid therapy or skin necrosis. IEAT was frequent in resistant bacteria infections. Mortality occurred mainly in older patients with septic shock, resistant bacteria and IEAT. These results might guide empirical antibiotic therapy in this high-risk population.
- Published
- 2023
- Full Text
- View/download PDF
8. Bacterial co-infection at hospital admission in patients with COVID-19
- Author
-
Estela Moreno-García, Pedro Puerta-Alcalde, Laura Letona, Fernanda Meira, Gerard Dueñas, Mariana Chumbita, Nicole Garcia-Pouton, Patricia Monzó, Carlos Lopera, Laia Serra, Celia Cardozo, Marta Hernandez-Meneses, Verónica Rico, Marta Bodro, Laura Morata, Mariana Fernandez-Pittol, Ignacio Grafia, Pedro Castro, Josep Mensa, José Antonio Martínez, Gemma Sanjuan, Mª Angeles Marcos, Alex Soriano, and Carolina Garcia-Vidal
- Subjects
COVID-19 ,bacterial infection ,co-infection ,antibiotics ,SARS-CoV-2 ,Infectious and parasitic diseases ,RC109-216 - Abstract
ABSTRACT: Objectives: We described the current incidence and risk factors of bacterial co-infection in hospitalized patients with COVID-19. Methods: Observational cohort study was performed at the Hospital Clinic of Barcelona (February 2020–February 2021). All patients with COVID-19 who were admitted for >48 hours with microbiological sample collection and procalcitonin (PCT) determination within the first 48 hours were included. Results: A total of 1125 consecutive adults met inclusion criteria. Co-infections were microbiologically documented in 102 (9.1%) patients. Most frequent microorganisms were Streptococcus pneumoniae (79%), Staphylococcus aureus (6.8%), and Haemophilus influenzae (6.8%). Test positivity was 1% (8/803) for blood cultures, 10.1% (79/780) for pneumococcal urinary antigen test, and 11.4% (15/132) for sputum culture. Patients with PCT higher than 0.2, 0.5, 1, and 2 ng/mL had significantly more co-infections than those with lower levels (p=0.017, p=0.031, p94%.
- Published
- 2022
- Full Text
- View/download PDF
9. C-reactive protein cut-off for early tocilizumab and dexamethasone prescription in hospitalized patients with COVID-19
- Author
-
Ana M. Camon, Rodrigo Alonso, Francisco J. Muñoz, Celia Cardozo, Javier Bernal-Maurandi, Laia Albiach, Daiana Agüero, M. Angeles Marcos, Juan Ambrosioni, Marta Bodro, Mariana Chumbita, Lorena De la Mora, Nicole Garcia-Pouton, Gerard Dueñas, Marta Hernandez-Meneses, Alexy Inciarte, Genoveva Cuesta, Fernanda Meira, Laura Morata, Pedro Puerta-Alcalde, Verónica Rico, Sabina Herrera, Montse Tuset, Pedro Castro, Sergio Prieto-González, Alex Almuedo, José Muñoz, Josep Mensa, Gemma Sanjuan, J. M. Nicolas, Ana Del Rio, Jordi Vila, Felipe García, José Antonio Martínez, Carolina Garcia-Vidal, Alex Soriano, and Hospital Clinic of Barcelona COVID-19 Research Group
- Subjects
Medicine ,Science - Abstract
Abstract Dexamethasone and tocilizumab have been associated with reduction in mortality, however, the beneficial effect is not for all patients and the impact on viral replication is not well defined. We hypostatized that C-reactive protein (CRP) could help in the identification of patients requiring anti-inflammatory therapy. Patients admitted for > 48 h in our hospital for a confirmed or suspected infection by SARS-CoV-2 from February 2020 to February 2021 were retrospectively evaluated. The primary outcome was mortality at 30 days. Demographics and the most relevant variables related with the outcome were included. CRP was stratified by percentiles. Univariate and multivariate analysis were performed. A total of 3218 patients were included with a median (IQR) age of 66 (74–78) years and 58.9% were males. The rate of intensive care unit admission was 24.4% and the 30-day mortality rate was 11.8%. Within the first 5 days from admission, 1018 (31.7%) patients received dexamethasone and 549 tocilizumab (17.1%). The crude analysis showed a mortality reduction in patients receiving dexamethasone when CRP was > 13.75 mg/dL and > 3.5 mg/dL for those receiving tocilizumab. Multivariate analysis identified the interaction of CRP > 13.75 mg/dL with dexamethasone (OR 0.57; CI 95% 0.37–0.89, P = 0014) and CRP > 3.5 mg/dL with tocilizumab (0.65; CI95%:0.44–0.95, P = 0.029) as independent predictors of mortality. Our results suggest that dexamethasone and tocilizumab are associated with a reduction in mortality when prescribed to patients with a certain inflammatory activity assessed by C-reactive protein.
- Published
- 2022
- Full Text
- View/download PDF
10. Non-Aspergillus mould lung infections
- Author
-
Pedro Puerta-Alcalde and Carolina Garcia-Vidal
- Subjects
Diseases of the respiratory system ,RC705-779 - Abstract
Non-Aspergillus filamentous fungi causing invasive mould infections have increased over the last years due to the widespread use of anti-Aspergillus prophylaxis and increased complexity and survival of immunosuppressed patients. In the few studies that have reported on invasive mould infection epidemiology, Mucorales are the most frequently isolated group, followed by either Fusarium spp. or Scedosporium spp. The overall incidence is low, but related mortality is exceedingly high. Patients with haematological malignancies and haematopoietic stem cell transplant recipients comprise the classical groups at risk of infection for non-Aspergillus moulds due to profound immunosuppression and the vast use of anti-Aspergillus prophylaxis. Solid organ transplant recipients also face a high risk, especially those receiving lung transplants, due to direct exposure of the graft to mould spores with altered mechanical and immunological elimination, and intense, associated immunosuppression. Diagnosing non-Aspergillus moulds is challenging due to unspecific symptoms and radiological findings, lack of specific biomarkers, and low sensitivity of cultures. However, the advent of molecular techniques may prove helpful. Mucormycosis, fusariosis and scedosporiosis hold some differences regarding clinical paradigmatic presentations and preferred antifungal therapy. Surgery might be an option, especially in mucormycosis. Finally, various promising strategies to restore or enhance the host immune response are under current evaluation.
- Published
- 2022
- Full Text
- View/download PDF
11. Real-Life Use of Ceftolozane/Tazobactam for the Treatment of Bloodstream Infection Due to Pseudomonas aeruginosa in Neutropenic Hematologic Patients: a Matched Control Study (ZENITH Study)
- Author
-
Alba Bergas, Adaia Albasanz-Puig, Ana Fernández-Cruz, Marina Machado, Andrés Novo, David van Duin, Carolina Garcia-Vidal, Morgan Hakki, Isabel Ruiz-Camps, José Luis del Pozo, Chiara Oltolini, Catherine DeVoe, Lubos Drgona, Oriol Gasch, Malgorzata Mikulska, Pilar Martín-Dávila, Maddalena Peghin, Lourdes Vázquez, Júlia Laporte-Amargós, Xavier Durà-Miralles, Natàlia Pallarès, Eva González-Barca, Ana Álvarez-Uría, Pedro Puerta-Alcalde, Juan Aguilar-Company, Francisco Carmona-Torre, Teresa Daniela Clerici, Sarah B. Doernberg, Lucía Petrikova, Silvia Capilla, Laura Magnasco, Jesús Fortún, Nadia Castaldo, Jordi Carratalà, and Carlota Gudiol
- Subjects
multidrug-resistant ,Pseudomonas aeruginosa ,bacteremia ,bloodstream infection ,neutropenia ,hematologic malignancy ,Microbiology ,QR1-502 - Abstract
ABSTRACT We sought to assess the characteristics and outcomes of neutropenic hematologic patients with Pseudomonas aeruginosa (PA) bloodstream infection (BSI) treated with ceftolozane-tazobactam (C/T). We conducted a multicenter, international, matched-cohort study of PA BSI episodes in neutropenic hematologic patients who received C/T. Controls were patients with PA BSI treated with other antibiotics. Risk factors for overall 7-day and 30-day case fatality rates were analyzed. We compared 44 cases with 88 controls. Overall, 91% of episodes were caused by multidrug-resistant (MDR) strains. An endogenous source was the most frequent BSI origin (35.6%), followed by pneumonia (25.8%). There were no significant differences in patient characteristics between groups. C/T was given empirically in 11 patients and as definitive therapy in 41 patients. Treatment with C/T was associated with less need for mechanical ventilation (13.6% versus 33.3%; P = 0.021) and reduced 7-day (6.8% versus 34.1%; P = 0.001) and 30-day (22.7% versus 48.9%; P = 0.005) mortality. In the multivariate analysis, pneumonia, profound neutropenia, and persistent BSI were independent risk factors for 30-day mortality, whereas lower mortality was found among patients treated with C/T (adjusted OR [aOR] of 0.19; confidence interval [CI] 95% of 0.07 to 0.55; P = 0.002). Therapy with C/T was associated with less need for mechanical ventilation and reduced 7-day and 30-day case fatality rates compared to alternative agents in neutropenic hematologic patients with PA BSI. IMPORTANCE Ceftolozane-tazobactam (C/T) has been shown to be a safe and effective alternative for the treatment of difficult to treat infections due to Pseudomonas aeruginosa (PA) in the general nonimmunocompromised population. However, the experience of this agent in immunosuppressed neutropenic patients is very limited. Our study is unique because it is focused on extremely immunosuppressed hematological patients with neutropenia and bloodstream infection (BSI) due to PA (mainly multidrug resistant [MDR]), a scenario which is often associated with very high mortality rates. In our study, we found that the use of C/T for the treatment of MDR PA BSI in hematological neutropenic patients was significantly associated with improved outcomes, and, in addition, it was found to be an independent risk factor associated with increased survival. To date, this is the largest series involving neutropenic hematologic patients with PA BSI treated with C/T.
- Published
- 2022
- Full Text
- View/download PDF
12. Impact of low serum calcium at hospital admission on SARS-CoV-2 infection outcome
- Author
-
Berta Torres, Pau Alcubilla, Ana González-Cordón, Alexy Inciarte, Mariana Chumbita, Celia Cardozo, Fernanda Meira, Marga Giménez, Ana de Hollanda, Alex Soriano, Laia Albiach, Daiana Agüero, Juan Ambrosioni, Marta Bodro, Jose Luis Blanco, Lorena De la Mora, Felipe García-Alcaide, Nicole García-Pouton, Carolina Garcia-Vidal, Marta Hernández-Meneses, Montserrat Laguno, Lorna Leal, Laura Linares, Irene Macaya, Josep Mallolas, Esteban Martínez, María Martínez-Rebollar, José María Miró, José Mensa, Asunción Moreno, Antonio Moreno, Estela Moreno-García, Laura Morata, José Antonio Martínez, Pedro Puerta-Alcalde, Verónica Rico, John Rojas, Montserrat Solá, and Manuel Torres
- Subjects
SARS-CoV-2 infection ,COVID-19 ,Hypocalcemia ,Outcome ,Infectious and parasitic diseases ,RC109-216 - Abstract
Background: Calcium is an essential ion for pathogen survival and virulence and is involved in the regulation of the inflammatory response. Hypocalcemia is a common laboratory finding in critically ill patients. Data regarding levels of calcium in SARS-CoV-2 infection is scarce. Patients with SARS-CoV-2 infection who present with hypocalcemia could have a worse outcome. Methods: We performed a retrospective analysis of hospitalized patients with SARS-CoV-2 infection and included all patients who had any serum calcium measurement in the first 72 h since hospital admission. The main objective was to investigate the relation of low serum calcium with adverse outcome, measured by the requirement of high oxygen support – defined as high flow nasal cannula oxygen, non-invasive mechanical ventilation and/or invasive ventilation – intensive care unit admission or death. Results: A total of 316 patients were included in the study. Median age was 65 years (IQR 55–74); 65% were men. Hypocalcemia within 72 h since hospital admission was present in 63% of patients. A higher number of patients in the hypocalcemia group required high oxygen support during hospitalization (49% vs 32%; p = 0,01) and were admitted to the ICU (42% vs 26%; p = 0,005). No differences in mortality were observed between groups. Conclusions: Hypocalcemia is frequent in hospitalized patients with SARS-CoV-2 infection and can identify patients who will have a worse outcome. More studies are needed to understand the role of calcium metabolism in SARS-CoV-2 infection and to address the clinical implications and therapeutic interventions it might have.
- Published
- 2021
- Full Text
- View/download PDF
13. Prolonged viral replication in patients with hematologic malignancies hospitalized with COVID-19
- Author
-
Carolina Garcia-Vidal, Pedro Puerta-Alcalde, Aina Mateu, Genoveva Cuesta-Chasco, Fernanda Meira, Carlos Lopera, Patricia Monzo, Marta Santos-Bravo, Gerard Duenas, Mariana Chumbita, Nicole Garcia-Pouton, Anna Gaya, Marta Bodro, Sabina Herrera, Mar Mosquera, Francesc Fernandez-Aviles, Jose Antonio Martinez, Josep Mensa, Eva Gine, Maria Angeles Marcos, and Alex Soriano
- Subjects
Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2022
- Full Text
- View/download PDF
14. Emergence of Progressive Mutations in SARS-CoV-2 From a Hematologic Patient With Prolonged Viral Replication
- Author
-
Carolina Garcia-Vidal, María Iglesias-Caballero, Pedro Puerta-Alcalde, Vicente Mas, Genoveva Cuesta-Chasco, Nicole Garcia-Pouton, Sarai Varona, Francisco Pozo, Sonia Vázquez-Morón, Maria Angeles Marcos, Alex Soriano, Inmaculada Casas, and HEMATOCOVID19-Researchers Group
- Subjects
COVID-19 ,antivirals ,persistence ,mutations ,remdesivir ,immunosuppression ,Microbiology ,QR1-502 - Abstract
We documented a hematologic patient with prolonged SARS-CoV-2 viral replication in whom emergence of viral mutations was documented after the consecutive use of antivirals and convalescent plasma. The virus detected in the last of 12 clinical samples (day 237) had accumulated 22 changes in amino acids and 29 in nucleotides. Some of these changes, such as the E484Q, were mutations of concern as defined by WHO. This finding represents an enormous epidemiological threat and poses a major clinical challenge. Combined antiviral strategies, as well as specific strategies related to the diagnostic approach of prolonged infections for this specific population, may be needed.
- Published
- 2022
- Full Text
- View/download PDF
15. Factors associated with the development of septic shock in patients with candidemia: a post hoc analysis from two prospective cohorts
- Author
-
Matteo Bassetti, Antonio Vena, Marco Meroi, Celia Cardozo, Guillermo Cuervo, Daniele Roberto Giacobbe, Miguel Salavert, Paloma Merino, Francesca Gioia, Mario Fernández-Ruiz, Luis Eduardo López-Cortés, Benito Almirante, Laura Escolà-Vergé, Miguel Montejo, Manuela Aguilar-Guisado, Pedro Puerta-Alcalde, Mariona Tasias, Alba Ruiz-Gaitán, Fernando González, Mireia Puig-Asensio, Francesc Marco, Javier Pemán, Jesus Fortún, Jose Maria Aguado, Alejandro Soriano, Jordi Carratalá, Carolina Garcia-Vidal, Maricela Valerio, Assunta Sartor, Emilio Bouza, and Patricia Muñoz
- Subjects
Candidemia ,Septic shock ,Intra-abdominal candidiasis ,Risk factors ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Almost one third of the patients with candidemia develop septic shock. The understanding why some patients do and others do not develop septic shock is very limited. The objective of this study was to identify variables associated with septic shock development in a large population of patients with candidemia. Methods A post hoc analysis was performed on two prospective, multicenter cohort of patients with candidemia from 12 hospitals in Spain and Italy. All episodes occurring from September 2016 to February 2018 were analyzed to assess variables associated with septic shock development defined according to The Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3). Results Of 317 candidemic patients, 99 (31.2%) presented septic shock attributable to candidemia. Multivariate logistic regression analysis identifies the following factors associated with septic shock development: age > 50 years (OR 2.57, 95% CI 1.03–6.41, p = 0.04), abdominal source of the infection (OR 2.18, 95% CI 1.04–4.55, p = 0.04), and admission to a general ward at the time of candidemia onset (OR 0.21, 95% CI, 0.12–0.44, p = 0.001). Septic shock development was independently associated with a greater risk of 30-day mortality (OR 2.14, 95% CI 1.08–4.24, p = 0.02). Conclusions Age and abdominal source of the infection are the most important factors significantly associated with the development of septic shock in patients with candidemia. Our findings suggest that host factors and source of the infection may be more important for development of septic shock than intrinsic virulence factors of organisms.
- Published
- 2020
- Full Text
- View/download PDF
16. Gustatory and olfactory dysfunctions in hospitalised patients with COVID-19 pneumonia: a prospective study
- Author
-
Felipe García, Ana González Cordón, Pedro Puerta-Alcalde, Celia Cardozo, Carolina Garcia-Vidal, Marta Bodro, Isam Alobid, Juan Ambrosioni, Jhon Rojas, Alexy Inciarte, Berta Torres, Alex Soriano, José Antonio Martínez, Josep Mensa, Marta Hernández-Meneses, Laura Morata, Mariana Chumbita, Pau Alcubilla, Veronica Rico, Daiana Aguero, Nicole García-Pouton, Laia Albiach, Fernanda Meira, Lorena De la Mora, laura Linares, Irene Macaya, Montse Laguno, Angela Ramos, Estela Moreno-García, Antonio Moreno, Montse Sola, Lorna Leal, and Manuel Torres
- Subjects
Medicine - Abstract
Importance Identifying undetected clinical signs is imperative in the prevention of SARS-CoV-2.Objective To establish the prevalence of clinical gustatory and olfactory dysfunctions in patients with COVID-19 pneumonia. Clinical outcomes and recovery rates associated with gustatory and olfactory dysfunctions were also assessed.Design A prospective study was performed in 80 patients admitted to Hospital Clínic of Barcelona (Spain) for COVID-19 pneumonia. Patients were re-evaluated in the ward daily until discharge. Gustatory and olfactory dysfunction symptoms were retrospectively collected from emergency room (ER) charts after first assessments. Follow-up was performed in telemedicine consultation.Setting The single-centre study was performed in a hospitalisation ward at a university hospital.Participants Consecutive patients meeting hospitalisation criteria for COVID-19 pneumonia were eligible. Study exclusion criteria were patients who could not speak, had previous gustatory and olfactory dysfunctions or whose PCR tests for SARS-CoV-19 were negative.Interventions Systematic assessment of gustatory and olfactory symptoms with standardised questions.Outcome(s) Prevalence of gustatory and olfactory dysfunctions in patients with COVID-19 pneumonia.Results Of the 80 study subjects, 62.5% were male and the median age was 57 years. Half of the cohort (n=40) presented with comorbidities. The prevalence of chemosensitive disorder was 73.8% (n=59) (95% CI: 63.8 to 83.8), although self-reported symptoms were recorded in only 26.3% (n=21) of patients in the ER. Gustatory and olfactory dysfunctions were observed in 58.8% (n=47) and 55% (n=44) of cases, respectively. They were also the first symptoms in 25% (n=20) of patients. Anosmia was associated with ageusia, OR: 7, 95% CI: 2.3 to 21.8, p=0.001). No differences in clinical outcomes were observed when patients with and without gustatory and olfactory dysfunctions were compared. Recovery rates were 20% (n=10) and 85% (n=42) at days 7 and 45, respectively.Conclusion The prevalence of gustatory and olfactory dysfunctions in COVID-19 pneumonia was much higher than in self-report. Presence of gustatory and olfactory dysfunctions was not a predictor of clinical outcomes.
- Published
- 2021
- Full Text
- View/download PDF
17. Pseudomonas aeruginosa Bloodstream Infections in Patients with Cancer: Differences between Patients with Hematological Malignancies and Solid Tumors
- Author
-
Cristina Royo-Cebrecos, Julia Laporte-Amargós, Marta Peña, Isabel Ruiz-Camps, Pedro Puerta-Alcalde, Edson Abdala, Chiara Oltolini, Murat Akova, Miguel Montejo, Malgorzata Mikulska, Pilar Martín-Dávila, Fabian Herrera, Oriol Gasch, Lubos Drgona, Hugo Manuel Paz Morales, Anne-Sophie Brunel, Estefanía García, Burcu Isler, Winfried V. Kern, Zaira R. Palacios-Baena, Guillermo Maestro de la Calle, Maria Milagro Montero, Souha S. Kanj, Oguz R. Sipahi, Sebnem Calik, Ignacio Márquez-Gómez, Jorge I. Marin, Marisa Z. R. Gomes, Philipp Hemmatti, Rafael Araos, Maddalena Peghin, José Luis del Pozo, Lucrecia Yáñez, Robert Tilley, Adriana Manzur, Andrés Novo, Jordi Carratalà, and Carlota Gudiol
- Subjects
Pseudomonas aeruginosa ,bacteremia ,bloodstream infection ,cancer ,solid tumor ,hematologic malignancy ,Medicine - Abstract
Objectives: To assess the clinical features and outcomes of Pseudomonas aeruginosa bloodstream infection (PA BSI) in neutropenic patients with hematological malignancies (HM) and with solid tumors (ST), and identify the risk factors for 30-day mortality. Methods: We performed a large multicenter, retrospective cohort study including onco-hematological neutropenic patients with PA BSI conducted across 34 centers in 12 countries (January 2006–May 2018). Episodes occurring in hematologic patients were compared to those developing in patients with ST. Risk factors associated with 30-day mortality were investigated in both groups. Results: Of 1217 episodes of PA BSI, 917 occurred in patients with HM and 300 in patients with ST. Hematological patients had more commonly profound neutropenia (0.1 × 109 cells/mm) (67% vs. 44.6%; p < 0.001), and a high risk Multinational Association for Supportive Care in Cancer (MASCC) index score (32.2% vs. 26.7%; p = 0.05). Catheter-infection (10.7% vs. 4.7%; p = 0.001), mucositis (2.4% vs. 0.7%; p = 0.042), and perianal infection (3.6% vs. 0.3%; p = 0.001) predominated as BSI sources in the hematological patients, whereas pneumonia (22.9% vs. 33.7%; p < 0.001) and other abdominal sites (2.8% vs. 6.3%; p = 0.006) were more common in patients with ST. Hematological patients had more frequent BSI due to multidrug-resistant P. aeruginosa (MDRPA) (23.2% vs. 7.7%; p < 0.001), and were more likely to receive inadequate initial antibiotic therapy (IEAT) (20.1% vs. 12%; p < 0.001). Patients with ST presented more frequently with septic shock (45.8% vs. 30%; p < 0.001), and presented worse outcomes, with increased 7-day (38% vs. 24.2%; p < 0.001) and 30-day (49% vs. 37.3%; p < 0.001) case-fatality rates. Risk factors for 30-day mortality in hematologic patients were high risk MASCC index score, IEAT, pneumonia, infection due to MDRPA, and septic shock. Risk factors for 30-day mortality in patients with ST were high risk MASCC index score, IEAT, persistent BSI, and septic shock. Therapy with granulocyte colony-stimulating factor was associated with survival in both groups. Conclusions: The clinical features and outcomes of PA BSI in neutropenic cancer patients showed some differences depending on the underlying malignancy. Considering these differences and the risk factors for mortality may be useful to optimize their therapeutic management. Among the risk factors associated with overall mortality, IEAT and the administration of granulocyte colony-stimulating factor were the only modifiable variables.
- Published
- 2022
- Full Text
- View/download PDF
18. Trends in mortality of hospitalised COVID-19 patients: A single centre observational cohort study from Spain
- Author
-
Carolina Garcia-Vidal, Alberto Cózar-Llistó, Fernanda Meira, Gerard Dueñas, Pedro Puerta-Alcalde, Catia Cilloniz, Nicole Garcia-Pouton, Mariana Chumbita, Celia Cardozo, Marta Hernández, Verónica Rico, Marta Bodro, Laura Morata, Pedro Castro, Alex Almuedo-Riera, Felipe García, Josep Mensa, José Antonio Martínez, Gemma Sanjuan, Antoni Torres, JM Nicolás, and Alex Soriano
- Subjects
COVID-19 ,ICU admission ,Outcomes ,Mortality ,Public aspects of medicine ,RA1-1270 - Abstract
Background: We aimed to describe changes in characteristics and treatment strategies of hospitalised patients with COVID-19 and detail the mortality trend over time. Methods: Observational cohort study of all consecutive patients admitted ≥ 48 h to Hospital Clinic of Barcelona for COVID-19 (1 March–30 September 2020). Findings: A total of 1645 consecutive patients with COVID-19 were assessed over a 7-month period. Overall mortality (≤30 days) was 9.7% (159 patients), 7.7% in patients hospitalised in regular wards and 16.7 % in patients requiring ICU admission. Overall mortality decreased from 11.6% in the first month to 1.4% in the last month, reflecting a progressive, significant downward trend (p for trend 700 ng/mL (OR 2.3, CI 1.3–4.1), ferritin>489 ng/mL (OR 1.9; CI 1.5–3.2), C-RP>7 mg/dL (OR 2.6; CI 1.5–4.6), and shorter duration from symptom onset to hospital admission (OR 1.11; CI 1.04–1.17) were factors associated with 30-day mortality at hospital admission. Conversely, hospital admission in the last months (OR 0.80; CI 0.65–0.98) was significantly associated with lower mortality. Interpretation: In-hospital mortality has decreased in patients with COVID-19 over the last, few months, even though main patient characteristics remain similar. Several changes made when managing patients may explain this decreasing trend. Our study provides current data on mortality of patients hospitalised with COVID-19 that might be useful in establishing quality of standard of care. Funding: EIT Health, European Union´s Horizon 2020 Research and Innovation Programme), EDRD. PPA [CM18/00132], NGP [FI19/00133], and CGV [FIS PI18/01061], have received grants from Ministerio de Sanidad y Consumo, ISCIII. Resumen: Contexto: Nuestro objetivo es describir los cambios en las características y las estrategias de tratamiento de los pacientes hospitalizados por COVID-19, y detallar la tendencia de la mortalidad en el tiempo. Métodos: Estudio observacional de cohortes de todos los pacientes consecutivos, ingresados por COVID-19 durante más de 48 horas, en el Hospital Clínic de Barcelona (del 1 de marzo al 30 de septiembre de 2020). Resultados: Un total de 1645 pacientes consecutivos fueron evaluados durante un período de 7 meses. La mortalidad global (≤30 días) fue del 9.7% (159 pacientes): 7.7% en pacientes hospitalizados en salas convencionales, y 16.7% en pacientes que requirieron ingreso en UCI. La mortalidad global disminuyó del 11.6% en el primer mes al 1.4% en el último mes evaluado, reflejando una progresiva y significativa tendencia a la baja (p para la tendencia 700 ng/mL (OR 2.3; CI 1.3–4.1), ferritina>489 ng/mL (OR 1.9; CI 1.5–3.2), PCR>7 mg/dL (OR 2.6; CI 1.5–4.6), y una menor duración desde el inicio de síntomas a la hospitalización (OR 1.11; CI 1.04–1.17) fueron factores asociados a la mortalidad intrahospitalaria a 30 días. Por el contrario, el ingreso hospitalario previo en los últimos meses (OR 0.80; CI 0.65–0.98) se asoció significativamente a una menor mortalidad. Discusión: La mortalidad intrahospitalaria ha disminuido en los pacientes con COVID-19 durante los últimos meses, incluso siendo similares las características de los pacientes. Algunos cambios realizados en el manejo de estos pacientes podrían explicar esta tendencia decreciente. Nuestro estudio aporta datos actualizados en la mortalidad de los pacientes hospitalizados con COVID-19, que podrían ser útiles de cara a establecer unos cuidados estándar de calidad. Financiación: EIT Health, European Union´s Horizon 2020 Research and Innovation Programme, EDRD. PPA [CM18/00132], NGP [FI19/00133] y CGV [FIS PI18/01061], han recibido becas del Ministerio de Sanidad y Consumo, ISCIII.
- Published
- 2021
- Full Text
- View/download PDF
19. Factors Associated With Short-Term Eradication of Rectal Colonization by KPC-2 Producing Klebsiella pneumoniae in an Outbreak Setting
- Author
-
Martina Pellicé, Olga Rodríguez-Núñez, Verónica Rico, Daiana Agüero, Laura Morata, Celia Cardozo, Pedro Puerta-Alcalde, Carolina Garcia-Vidal, Elisa Rubio, Mariana J. Fernandez-Pittol, Andrea Vergara, Cristina Pitart, Francesc Marco, Gemina Santana, Laura Rodríguez-Serna, Ana Vilella, Ester López, Alex Soriano, Jose Antonio Martínez, and Ana Del Rio
- Subjects
decolonization ,probiotic ,non-absorbable antibiotic regimen ,KPC-2 producing Klebsiella pneumoniae ,outbreak ,Microbiology ,QR1-502 - Abstract
Background: KPC-producing Klebsiella pneumoniae (KPCKP) is a threat for patients admitted to healthcare institutions.Objectives: To assess the efficacy of several decolonization strategies for KPCKP rectal carriage.Methods: Observational study performed in a 750-bed university center from July to October 2018 on the efficacy of a 10-day non-absorbable oral antibiotic (NAA) regimen (colistin 10 mg/ml, amikacin 8 mg/ml, and nystatin 30 mg/ml, 10 ml/6 h) vs. the same regimen followed by a probiotic (Vivomixx®) for 20 days in adult patients with KPCKP rectal colonization acquired during an outbreak.Results: Seventy-three patients colonized by KPCKP were included, of which 21 (29%) did not receive any treatment and 52 (71.2%) received NAA either alone (n = 26, 35.6%) or followed by a probiotic (n = 26, 35.6%). Eradication was observed in 56 (76.7%) patients and the only variable significantly associated with it was not receiving systemic antibiotics after diagnosis of rectal carriage [22/24 (91.6%) vs. 34/49 (69.3%), p = 0.04]. Eradication in patients receiving NAA plus probiotic was numerically but not significantly higher than that of controls [23/26 (88.4%) vs. 15/21 (71.4%), p = 0.14] and of those receiving only NAA (OR = 3.4, 95% CI = 0.78–14.7, p = 0.09).Conclusion: In an outbreak setting, rectal carriage of KPCKP persisted after a mean of 36 days in about one quarter of patients. The only factor associated with eradication was not receiving systemic antibiotic after diagnosis. A 10-day course of NAA had no impact on eradication. Probiotics after NAA may increase the decolonization rate, hence deserving further study.
- Published
- 2021
- Full Text
- View/download PDF
20. Changing epidemiology of catheter-related bloodstream infections in neutropenic oncohematological patients.
- Author
-
Dajana Lendak, Pedro Puerta-Alcalde, Estela Moreno-García, Mariana Chumbita, Nicole García-Pouton, Celia Cardozo, Laura Morata, Maria Suárez-Lledó, Marta Hernández-Meneses, Lucio Ghiglione, Francesc Marco, Jose Antonio Martinez, Josep Mensa, Ivana Urošević, Alex Soriano, and Carolina Garcia-Vidal
- Subjects
Medicine ,Science - Abstract
BackgroundWe aimed to describe the epidemiology of catheter-related bloodstream infections (CRBSIs) in onco-hematological neutropenic patients during a 25-year study period, to evaluate the risk factors for Gram-negative bacilli (GNB) CRBSI, as well as rates of inappropriate empirical antibiotic treatments (IEAT) and mortality.Materials/methodsAll consecutive episodes of CRBSIs were prospectively collected (1994-2018). Changing epidemiology was evaluated comparing five-year time spans. A multivariate regression model was built to evaluate risk factors for GNB CRBSIs.Results482 monomicrobial CRBSIs were documented. The proportion of CRBSIs among all BSIs decreased over time from 41.2% to 15.8% (pConclusionA significant shift towards GNB-CRBSIs was observed. Secondarily, and coinciding with an increasing number of GNB-MDR infections, mortality increased over time.
- Published
- 2021
- Full Text
- View/download PDF
21. Effect of Combination Antibiotic Empirical Therapy on Mortality in Neutropenic Cancer Patients with Pseudomonas aeruginosa Pneumonia
- Author
-
Adaia Albasanz-Puig, Xavier Durà-Miralles, Júlia Laporte-Amargós, Alberto Mussetti, Isabel Ruiz-Camps, Pedro Puerta-Alcalde, Edson Abdala, Chiara Oltolini, Murat Akova, José Miguel Montejo, Malgorzata Mikulska, Pilar Martín-Dávila, Fabián Herrera, Oriol Gasch, Lubos Drgona, Hugo Manuel Paz Morales, Anne-Sophie Brunel, Estefanía García, Burcu Isler, Winfried V. Kern, Pilar Retamar-Gentil, José María Aguado, Milagros Montero, Souha S. Kanj, Oguz R. Sipahi, Sebnem Calik, Ignacio Márquez-Gómez, Jorge I. Marin, Marisa Z. R. Gomes, Philipp Hemmati, Rafael Araos, Maddalena Peghin, José Luis del Pozo, Lucrecia Yáñez, Robert Tilley, Adriana Manzur, Andres Novo, Natàlia Pallarès, Alba Bergas, Jordi Carratalà, Carlota Gudiol, and on behalf of the IRONIC Study Group
- Subjects
Pseudomonas aeruginosa ,bloodstream infection ,pneumonia ,septic shock ,neutropenia ,Biology (General) ,QH301-705.5 - Abstract
To assess the effect of combination antibiotic empirical therapy on 30-day case-fatality rate in neutropenic cancer patients with Pseudomonas aeruginosa (PA) bacteremic pneumonia. This was a multinational, retrospective cohort study of neutropenic onco-hematological patients with PA bloodstream infection (BSI) (2006–2018). The effect of appropriate empirical combination therapy, appropriate monotherapy and inappropriate empirical antibiotic therapy [IEAT] on 30-day case-fatality was assessed only in patients with PA bacteremic pneumonia. Among 1017 PA BSI episodes, pneumonia was the source of BSI in 294 (28.9%). Among those, 52 (17.7%) were caused by a multidrug-resistant (MDR) strain and 68 (23.1%) received IEAT, mainly when the infection was caused by an MDR strain [38/52 (73.1%) vs. 30/242 (12.4%); p < 0.001]. The 30-day case-fatality rate was higher in patients with PA bacteremic pneumonia than in those with PA BSI from other sources (55.1% vs. 31.4%; p < 0.001). IEAT was associated with increased 30-day case-fatality (aHR 1.44 [95%CI 1.01–2.03]; p = 0.042), whereas the use of appropriate combination empirical treatment was independently associated with improved survival (aHR 0.46 [95%CI 0.27–0.78]; p = 0.004). Appropriate empirical monotherapy was not associated with improved overall survival (aHR 1.25 [95%CI 0.76–2.05]; p = 0.39). Combination antibiotic empirical therapy should be administered promptly in febrile neutropenic patients with suspected pneumonia as the source of infection.
- Published
- 2022
- Full Text
- View/download PDF
22. Changing Epidemiology of Invasive Fungal Disease in Allogeneic Hematopoietic Stem Cell Transplantation
- Author
-
Pedro Puerta-Alcalde and Carolina Garcia-Vidal
- Subjects
antifungal ,fungal infection ,immunosuppression ,invasive fungal disease ,molds ,mortality ,Biology (General) ,QH301-705.5 - Abstract
Invasive fungal disease (IFD) is a common cause of morbidity and mortality in patients with hematologic malignancies, especially among those undergoing allogeneic hematopoietic stem cell transplantation (HSCT). The epidemiology of IFD in HSCT patients has been evolving over the last decades, mainly in relation to changes in HSCT therapies such as antifungal prophylaxis. A progressive decrease in Candida albicans infection has been documented, alongside a progressive increase in infections caused by non-albicans Candida species, filamentous fungi, and/or multidrug-resistant fungi. Currently, the most frequent IFD is invasive aspergillosis. In some parts of the world, especially in north Central Europe, a high percentage of Aspergillus fumigatus isolates are azole-resistant. New diagnostic techniques have documented the existence of cryptic Aspergillus species with specific characteristics. An increase in mucormycosis and fusariosis diagnoses, as well as diagnoses of other rare fungi, have also been described. IFD epidemiology is likely to continue changing further due to both an increased use of mold-active antifungals and a lengthened survival of patients with HSCT that may result in hosts with weaker immune systems. Improvements in microbiology laboratories and the widespread use of molecular diagnostic tools will facilitate more precise descriptions of current IFD epidemiology. Additionally, rising resistance to antifungal drugs poses a major threat. In this scenario, knowledge of current epidemiology and accurate IFD diagnoses are mandatory in order to establish correct prophylaxis guidelines and appropriate early treatments.
- Published
- 2021
- Full Text
- View/download PDF
23. Can Artificial Intelligence Improve the Management of Pneumonia
- Author
-
Mariana Chumbita, Catia Cillóniz, Pedro Puerta-Alcalde, Estela Moreno-García, Gemma Sanjuan, Nicole Garcia-Pouton, Alex Soriano, Antoni Torres, and Carolina Garcia-Vidal
- Subjects
artificial intelligence ,pneumonia ,Medicine - Abstract
The use of artificial intelligence (AI) to support clinical medical decisions is a rather promising concept. There are two important factors that have driven these advances: the availability of data from electronic health records (EHR) and progress made in computational performance. These two concepts are interrelated with respect to complex mathematical functions such as machine learning (ML) or neural networks (NN). Indeed, some published articles have already demonstrated the potential of these approaches in medicine. When considering the diagnosis and management of pneumonia, the use of AI and chest X-ray (CXR) images primarily have been indicative of early diagnosis, prompt antimicrobial therapy, and ultimately, better prognosis. Coupled with this is the growing research involving empirical therapy and mortality prediction, too. Maximizing the power of NN, the majority of studies have reported high accuracy rates in their predictions. As AI can handle large amounts of data and execute mathematical functions such as machine learning and neural networks, AI can be revolutionary in supporting the clinical decision-making processes. In this review, we describe and discuss the most relevant studies of AI in pneumonia.
- Published
- 2020
- Full Text
- View/download PDF
24. Risk factors for mortality in patients with acute leukemia and bloodstream infections in the era of multiresistance.
- Author
-
Carolina Garcia-Vidal, Celia Cardozo-Espinola, Pedro Puerta-Alcalde, Francesc Marco, Adrian Tellez, Daiana Agüero, Francisco Romero-Santana, Marina Díaz-Beyá, Eva Giné, Laura Morata, Olga Rodríguez-Núñez, Jose Antonio Martinez, Josep Mensa, Jordi Esteve, and Alex Soriano
- Subjects
Medicine ,Science - Abstract
OBJECTIVES:We assess the epidemiology and risk factors for mortality of bloodstream infection (BSI) in patients with acute leukemia (AL). METHODS:Prospectively collected data of a cohort study from July 2004 to February 2016. Multivariate analyses were performed. RESULTS:589 episodes of BSI were documented in 357 AL patients, 55% caused by gram-positive bacteria (coagulase-negative staphylococci 35.7%, Enterococcus spp 10.8%) and 43.5% by gram-negative bacteria (E. coli 21%, PA 12%). We identified 110 (18.7%) multidrug-resistant (MDR) microorganisms, especially MDR-Pseudomonas aeruginosa (7%) and extended-spectrum beta-lactamase producing Enterobacteriaceae (7%). The 30-day mortality was 14.8%. Age (OR 3.1; 95% CI 1.7-5.7); chronic lung disease (4.8; 1.1-21.8); fatal prognosis according to McCabe index (13.9; 6.4-30.3); shock (3.8; 1.9-7.7); pulmonary infection (3.6; 1.3-9.9); and MDR-PA infections with inappropriate treatment (12.8; 4.1-40.5) were related to mortality. MDR-PA BSI was associated to prior antipseudomonal cephalosporin use (9.31; 4.38-19.79); current use of betalactams (2.01; 1.01-4.3); shock (2.63; 1.03-6.7) and pulmonary source of infection (9.6; 3.4-27.21). CONCLUSIONS:MDR organisms were commonly isolated in BSI in AL. Inappropriate empiric antibiotic treatment for MDR-PA is the primary factor related to mortality that can be changed. New treatment strategies to improve the coverage of MDR-PA BSI should be considered in those patients with risk factors for this infection.
- Published
- 2018
- Full Text
- View/download PDF
25. High prevalence of S. Stercoralis infection among patients with Chagas disease: A retrospective case-control study.
- Author
-
Pedro Puerta-Alcalde, Joan Gomez-Junyent, Ana Requena-Mendez, Maria Jesús Pinazo, Miriam José Álvarez-Martínez, Natalia Rodríguez, Joaquim Gascon, and Jose Muñoz
- Subjects
Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
We evaluate the association between Trypanosoma cruzi infection and strongyloidiasis in a cohort of Latin American (LA) migrants screened for both infections in a non-endemic setting.Case-control study including LA individuals who were systematically screened for T. cruzi infection and strongyloidiasis between January 2013 and April 2015. Individuals were included as cases if they had a positive serological result for Strongyloides stercoralis. Controls were randomly selected from the cohort of individuals screened for T. cruzi infection that tested negative for S. stercoralis serology. The association between T. cruzi infection and strongyloidiasis was evaluated by logistic regression models.During the study period, 361 individuals were screened for both infections. 52 (14.4%) individuals had a positive serological result for strongyloidiasis (cases) and 104 participants with negative results were randomly selected as controls. 76 (48.7%) indiviuals had a positive serological result for T. cruzi. Factors associated with a positive T. cruzi serology were Bolivian origin (94.7% vs 78.7%; p = 0.003), coming from a rural area (90.8% vs 68.7%; p = 0.001), having lived in an adobe house (88.2% vs 70%; p = 0.006) and a referred contact with triatomine bugs (86.7% vs 63.3%; p = 0.001). There were more patients with a positive S. stercoralis serology among those who were infected with T. cruzi (42.1% vs 25%; p = 0.023). Epidemiological variables were not associated with a positive strongyloidiasis serology. T. cruzi infection was more frequent among those with strongyloidiasis (61.5% vs 42.3%; p = 0.023). In multivariate analysis, T. cruzi infection was associated with a two-fold increase in the odds of strongyloidiasis (OR 2.23; 95% CI 1.07-4.64; p = 0.030).T. cruzi infection was associated with strongyloidiasis in LA migrants attending a tropical diseases unit even after adjusting for epidemiological variables. These findings should encourage physicians in non-endemic settings to implement a systematic screening for both infections in LA individuals.
- Published
- 2018
- Full Text
- View/download PDF
26. Current microbiological testing approaches and documented infections at febrile neutropenia onset in patients with hematologic malignancies
- Author
-
Mariana, Chumbita, Olivier, Peyrony, Christian, Teijón-Lumbreras, Patricia, Monzó-Gallo, Francesco, Aiello Tommaso, Antonio, Gallardo-Pizarro, Emmanuelle, Gras, Pedro, Puerta-Alcalde, Espasa, Mateu, Carmen, Martínez, Andrea, Rivero, Climent, Casals-Pascual, Alex, Soriano, and Carolina, Garcia-Vidal
- Published
- 2024
- Full Text
- View/download PDF
27. Current outcomes of SARS-CoV-2 Omicron variant infection in high-risk haematological patients treated early with antivirals
- Author
-
Tommaso-Francesco Aiello, Pedro Puerta-Alcalde, Mariana Chumbita, Carlos Lopera, Patricia Monzó, Albert Cortes, Francesc Fernández-Avilés, María Suárez-Lledó, Juan Correa, Valentín Ortiz-Maldonado, Genoveva Cuesta, Nuria Martinez-Cibrian, Jordi Esteve, Maria Ángeles Marcos, Josep Mensa, Alex Soriano, and Carolina Garcia-Vidal
- Subjects
Pharmacology ,Microbiology (medical) ,Infectious Diseases ,Pharmacology (medical) - Abstract
Objectives We aimed to describe the clinical outcomes and duration of viral shedding in high-risk patients with haematological malignancies hospitalized with COVID-19 during Omicron variant predominance who received early treatment with antivirals. Methods We conducted a prospective observational study on high-risk haematological patients admitted in our hospital between December 2021 and March 2022. We performed detection techniques on viral subgenomic mRNAs until negative results were obtained to document active, prolonged viral replication. Results This analysis included 60 consecutive adults with high-risk haematological malignancies and COVID-19. All of these patients underwent early treatment with remdesivir. Thirty-two (53%) patients received combined antiviral strategies, with sotrovimab or hyperimmune plasma being added to remdesivir. The median length of viral replication—as measured by real-time RT-PCR and/or subgenomic RNA detection—was 20 (IQR 14–28) days. Prolonged viral replication (6 weeks after diagnosis) was documented in six (10%) patients. Only two patients had prolonged infection for more than 2 months. Overall mortality was 5%, whereas COVID-19-related mortality was 0%. Conclusions Current outcomes of high-risk patients with haematological malignancies hospitalized with COVID-19 during Omicron variant predminance are good with the use of early antiviral strategies. Persistent viral shedding is uncommon.
- Published
- 2023
28. Breakthrough invasive fungal infection among patients with haematologic malignancies: A national, prospective, and multicentre study
- Author
-
Pedro Puerta-Alcalde, Patricia Monzó-Gallo, Manuela Aguilar-Guisado, Juan Carlos Ramos, Júlia Laporte-Amargós, Marina Machado, Pilar Martin-Davila, Mireia Franch-Sarto, Isabel Sánchez-Romero, Jon Badiola, Lucia Gómez, Isabel Ruiz-Camps, Lucrecia Yáñez, Lourdes Vázquez, Mariana Chumbita, Francesc Marco, Alex Soriano, Pedro González, Ana Fernández-Cruz, Montserrat Batlle, Jesús Fortún, Jesús Guinea, Carlota Gudiol, Julio García, Maite Ruiz Pérez de Pipaón, Ana Alastruey-Izquierdo, Carolina Garcia-Vidal, Gilead Sciences (Spain), Instituto de Salud Carlos III, and Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF)
- Subjects
Microbiology (medical) ,Antifungal Agents ,Fungi ,Candidemia ,Antifungal ,Breakthrough ,Infectious Diseases ,Fungal disease ,Invasive fungal infection ,Aspergillus ,Hematologic Neoplasms ,Humans ,Prospective Studies ,Mortality ,Invasive Fungal Infections - Abstract
Objectives: We describe the current epidemiology, causes, and outcomes of breakthrough invasive fungal infections (BtIFI) in patients with haematologic malignancies. Methods: BtIFI in patients with ≥ 7 days of prior antifungals were prospectively diagnosed (36 months across 13 Spanish hospitals) according to revised EORTC/MSG definitions. Results: 121 episodes of BtIFI were documented, of which 41 (33.9%) were proven; 53 (43.8%), probable; and 27 (22.3%), possible. The most frequent prior antifungals included posaconazole (32.2%), echinocandins (28.9%) and fluconazole (24.8%)-mainly for primary prophylaxis (81%). The most common haematologic malignancy was acute leukaemia (64.5%), and 59 (48.8%) patients had undergone a hematopoietic stem-cell transplantation. Invasive aspergillosis, principally caused by non-fumigatus Aspergillus, was the most frequent BtIFI with 55 (45.5%) episodes recorded, followed by candidemia (23, 19%), mucormycosis (7, 5.8%), other moulds (6, 5%) and other yeasts (5, 4.1%). Azole resistance/non-susceptibility was commonly found. Prior antifungal therapy widely determined BtIFI epidemiology. The most common cause of BtIFI in proven and probable cases was the lack of activity of the prior antifungal (63, 67.0%). At diagnosis, antifungal therapy was mostly changed (90.9%), mainly to liposomal amphotericin-B (48.8%). Overall, 100-day mortality was 47.1%; BtIFI was either the cause or an essential contributing factor to death in 61.4% of cases. Conclusions: BtIFI are mainly caused by non-fumigatus Aspergillus, non-albicans Candida, Mucorales and other rare species of mould and yeast. Prior antifungals determine the epidemiology of BtIFI. The exceedingly high mortality due to BtIFI warrants an aggressive diagnostic approach and early initiation of broad-spectrum antifungals different than those previously used. This work was funded by a grant from Gilead Sciences. P.P.-A. (JR20/00012, PI21/00498, and ICI21/00103) and C.G.-V. (FIS PI21/01640 and ICI21/00103) have received research grants funded by Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union. The funders had neither a specific role in study design or collection of data, nor in writing of the paper or decision to submit. Sí
- Published
- 2023
29. Treatment of infections caused by carbapenemase-producing Enterobacterales
- Author
-
Mariana Chumbita, Patricia Monzo-Gallo, Carlos Lopera-Mármol, Tommaso Francesco Aiello, Pedro Puerta-Alcalde, and Carolina Garcia-Vidal
- Subjects
Microbiology (medical) ,Pharmacology ,Bacterial Proteins ,Carbapenems ,Humans ,Microbial Sensitivity Tests ,General Medicine ,beta-Lactamases ,Anti-Bacterial Agents - Abstract
Antibiotic resistance is one of the main menaces to public and individual health worldwide. In the last two decades, an increase in the detection of carbapenem-resistant Enterobacterales has been reported. The treatment of infections caused by these strains is a therapeutic challenge. The use of carbapenems may be beneficial depending on MIC value and source of infection. New drugs, with different activity against the different classes of carbapenemases, are developed showing significant benefits.
- Published
- 2022
30. Qualitative Subgenomic RNA to Monitor the Response to Remdesivir in Hospitalized Patients With Coronavirus Disease 2019: Impact on the Length of Hospital Stay and Mortality
- Author
-
Rodrigo Alonso-Navarro, Genoveva Cuesta, Marta Santos, Celia Cardozo, Verónica Rico, Nicole Garcia-Pouton, Montse Tuset, Marta Bodro, Laura Morata, Pedro Puerta-Alcalde, Sabina Herrera, Dafne Soria, Marta Aldea, Josep Mensa, José Antonio Martínez, Ana del Rio, Jordi Vila, Felipe Garcia, Carolina Garcia-Vidal, M Angeles Marcos, and Alex Soriano
- Subjects
Microbiology (medical) ,Infectious Diseases - Abstract
Background There is no reliable microbiological marker to guide the indication and the response to antiviral treatment in patients with coronavirus disease 2019 (COVID-19). We aimed to evaluate the dynamics of subgenomic RNA (sgRNA) in patients with COVID-19 before and after receiving treatment with remdesivir. Methods We included consecutive patients admitted for COVID-19 who received remdesivir according to our institutional protocol and accepted to participate in the study. A nasopharyngeal swab for quantitative reverse transcriptase–polymerase chain reaction (qRT-PCR) was collected at baseline and after 3 and 5 days of treatment with remdesivir. Genomic and sgRNA were analyzed in those samples and main comorbidities and evolution were collected for the analyses. The main outcomes were early discharge (≤10 days) and 30-day mortality. Results A total of 117 patients were included in the study, of whom 24 had a negative sgRNA at baseline, with 62.5% (15/24) receiving early discharge (≤10 days) and no deaths in this group. From the 93 remaining patients, 62 had a negative sgRNA at day 5 with 37/62 (59.6%) with early discharge and a mortality rate of 4.8% (3/62). In the subgroup of 31 patients with positive sgRNA after 5 days of remdesivir, the early discharge rate was 29% (9/31) and the mortality rate was 16.1% (5/31). In multivariable analyses, the variables associated with early discharge were negative sgRNA at day 3 and not needing treatment with corticosteroids or intensive care unit admission. Conclusions Qualitative sgRNA could help in monitoring the virological response in patients who receive remdesivir. Further studies are needed to confirm these findings.
- Published
- 2022
31. Impact of Ptcy-Based Prophylaxis on Early Infectious Complications in Adults Undergoing Peripheral Blood Allo-HCT
- Author
-
María Queralt Salas, Paola Charry, Pedro Puerta-Alcalde, Nuria Martínez-Cibrian, Mariana Chumbita, Tommaso Francesco Aiello, Marc Brusosa, María Teresa Solano, Anna Serrahima, Joan Cid, Miquel Lozano, Jordi Arcarons, Noemí Llobet, Laura Rosinol Dachs, Jordi Esteve, Álvaro Urbano-Ispizua, Enric Carreras, Carolina García-Vidal, Maria Carmen Martinez Munoz, Francesc Fernández-Avilés, María Suárez-Lledó, and Montserrat Rovira
- Subjects
Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
32. Aspergillosis by cryptic Aspergillus species: A case series and review of the literature
- Author
-
Mariana Fernandez-Pittol, Izaskun Alejo-Cancho, Elisa Rubio-García, Celia Cardozo, Pedro Puerta-Alcalde, Estela Moreno-García, Nicole Garcia-Pouton, Miriam Garrido, Miriam Villanueva, Ana Alastruey-Izquierdo, Cristina Pitart, Carolina Garcia-Vidal, and Francesc Marco
- Subjects
Antifungal Agents ,Aspergillus ,Infectious Diseases ,Amphotericin B ,Aspergillosis ,Humans ,Microbial Sensitivity Tests ,Microbiology ,Retrospective Studies - Abstract
The cryptic Aspegillus species are rare, these microorganisms are usually more resistant to common antifungal therapies. Therefore, a correct identification is important when evaluating the impact of such species in aspergillosis.We aimed to describe the frequency, clinical and microbiological characteristics, and the outcomes of those cases of aspergillosis caused by cryptic species in a tertiary hospital.We retrospectively identified all microbiologically documented cases of aspergillosis between January 2013 and December 2018. Definitive species identification of clinically significant isolates was achieved via sequencing methods. The polymerase chain reaction (PCR) products were sequenced, and the results obtained were compared to sequences deposited in GenBank. Antifungal susceptibility testing was performed using the Sensititre® YeastOne® panel.A total of 679 Aspergillus isolates were recovered from 489 patients, of which 109 were clinically relevant. Ten (9.2%) isolates were identified as cryptic species: Aspergillus arcoverdensis (2), Aspergillus lentulus (2), Aspergillus ellipticus (2), Aspergillus alliaceus (1), Aspergillus nomius (1), Aspergillus tubingensis (1) and Aspergillus montevidensis (1). Most patients already suffered some type of immunosuppression. Half of these patients had required intensive care before the infection showed up, and most of them had a pulmonary infection. Mortality at the 100-day follow-up was 40%. Antifungal susceptibility testing was performed on three of the isolates (A. arcoverdensis, A. tubingensis and A. nomius), which showed high minimum inhibitory concentrations (MIC) for azoles and amphotericin B.The frequency of cryptic species in our centre was 9.2%. Most patients had some degree of immunosuppression, and the mortality rate was 40%.
- Published
- 2022
33. Real-life epidemiology and current outcomes of hospitalized adults with invasive fungal infections
- Author
-
Patricia Monzó-Gallo, Mariana Chumbita, Carlos Lopera, Tommaso Francesco Aiello, Oliver Peyrony, Marta Bodro, Sabina Herrera, Abiu Sempere, Mariana Fernández-Pittol, Genoveva Cuesta, Silvia Simó, Mariana Benegas, Claudia Fortuny, Josep Mensa, Alex Soriano, Pedro Puerta-Alcalde, Francesc Marco, and Carolina Garcia-Vidal
- Subjects
Infectious Diseases ,General Medicine - Abstract
We aimed to describe the current epidemiology of both hosts with invasive fungal infections (IFIs) and causative fungi. And, detail outcomes of these infections at 12 weeks in a real-life cohort of hospitalized patients. The study was retrospective and observational to describe IFI diagnosed in a tertiary hospital (February 2017–December 2021). We included all consecutive patients meeting criteria for proven or probable IFI according to EORTC-MSG and other criteria. A total of 367 IFIs were diagnosed. 11.7% were breakthrough infections, and 56.4% were diagnosed in the intensive care unit. Corticosteroid use (41.4%) and prior viral infection (31.3%) were the most common risk factors for IFI. Lymphoma and pneumocystis pneumonia were the most common baseline and fungal diseases. Only 12% of IFI occurred in patients with neutropenia. Fungal cultures were the most important diagnostic tests (85.8%). The most frequent IFIs were candidemia (42.2%) and invasive aspergillosis (26.7%). Azole-resistant Candida strains and non-fumigatus Aspergillus infections represented 36.1% and 44.5% of the cases, respectively. Pneumocystosis (16.9%), cryptococcosis (4.6%), and mucormycosis (2.7%) were also frequent, as well as mixed infections (3.4%). Rare fungi accounted for 9.5% of infections. Overall, IFI mortality at 12 weeks was 32.2%; higher rates were observed for Mucorales (55.6%), Fusarium (50%), and mixed infections (60%). We documented emerging changes in both hosts and real-life IFI epidemiology. Physicians should be aware of these changes to suspect infections and be aggressive in diagnoses and treatments. Currently, outcomes for such clinical scenarios remain extremely poor.
- Published
- 2023
34. Invasive candidiasis: current clinical challenges and unmet needs in adult populations
- Author
-
Alex Soriano, Patrick M Honore, Pedro Puerta-Alcalde, Carolina Garcia-Vidal, Anna Pagotto, Daniela C Gonçalves-Bradley, Paul E Verweij, UCL - SSS/IREC/MONT - Pôle Mont Godinne, and UCL - (MGD) Services des soins intensifs
- Subjects
Pharmacology ,Microbiology (medical) ,Infectious Diseases ,All institutes and research themes of the Radboud University Medical Center ,lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4] ,Pharmacology (medical) - Abstract
Invasive candidiasis (IC) is a serious infection caused by several Candida species, and the most common fungal disease in hospitals in high-income countries. Despite overall improvements in health systems and ICU care in the last few decades, as well as the development of different antifungals and microbiological techniques, mortality rates in IC have not substantially improved. The aim of this review is to summarize the main issues underlying the management of adults affected by IC, focusing on specific forms of the infection: IC developed by ICU patients, IC observed in haematological patients, breakthrough candidaemia, sanctuary site candidiasis, intra-abdominal infections and other challenging infections. Several key challenges need to be tackled to improve the clinical management and outcomes of IC patients. These include the lack of global epidemiological data for IC, the limitations of the diagnostic tests and risk scoring tools currently available, the absence of standardized effectiveness outcomes and long-term data for IC, the timing for the initiation of antifungal therapy and the limited recommendations on the optimal step-down therapy from echinocandins to azoles or the total duration of therapy. The availability of new compounds may overcome some of the challenges identified and increase the existing options for management of chronic Candida infections and ambulant patient treatments. However, early identification of patients that require antifungal therapy and treatment of sanctuary site infections remain a challenge and will require further innovations.
- Published
- 2023
35. Efficacy of early transfusion of convalescent plasma with high‐titer <scp>SARS‐CoV</scp> ‐2 neutralizing antibodies in hospitalized patients with <scp>COVID</scp> ‐19
- Author
-
Cristina Sanz, Meritxell Nomdedeu, Arturo Pereira, Silvia Sauleda, Rodrigo Alonso, Marta Bes, Helena Brillembourg, Carolina García‐Vidal, Anna Millan, Nuria Martínez‐Llonch, María Pirón, Pedro Puerta‐Alcalde, Lluis Puig, Veronica Rico, and Alex Soriano
- Subjects
Male ,SARS-CoV-2 ,Immunology ,Immunization, Passive ,COVID-19 ,Hematology ,Antibodies, Viral ,Antibodies, Neutralizing ,COVID-19 Testing ,Case-Control Studies ,Humans ,Immunology and Allergy ,Female ,COVID-19 Serotherapy ,Aged - Abstract
Despite most controlled trials have shown no measurable benefit of COVID-19 convalescent plasma (CCP) in patients with COVID-19, some studies suggest that early administration of CCP with high-titer anti-SARS-CoV-2 can be beneficial in selected patients. We investigated the efficacy of early administration of high-titer CCP to patients with COVID-19 who required hospitalization, STUDY DESIGN AND METHODS: Observational, propensity score (PS) matched case-control study of COVID-19 patients treated with CCP within 72 h of hospital admission and untreated controls from August 2020 to February 2021. All CCP donations had a Euroimmun anti-SARS-CoV-2 sample-to-cutoff ratio ≥3. PS matching was based on prognostic factors and presented features with high-standardized differences between the treated and control groups. The primary endpoint was mortality within 30 days of diagnosis.A total of 1604 patients were analyzed, 261 of whom received CCP, most (82%) within 24 h after admission. Median age was 67 years (interquartile range: 56-79), and 953 (60%) were men. Presenting factors independently associated with higher 30-day mortality were increased age, cardiac disease, hypoxemic respiratory failure, renal failure, and plasma d-dimer700 ng/ml. After PS matching, transfusion of CCP was associated with a significant reduction in the 30-day mortality rate (odds ratio [OR]; 0.94, 95% confidence interval [CI]: 0.91-0.98; p = .001) that extended to the 60th day after COVID-19 diagnosis (OR: 0.95; 95% CI: 0.92-0.99; p = .01).Our results suggest that CCP can still be helpful in selected patients with COVID-19 and call for further studies before withdrawing CCP from the COVID-19 therapeutic armamentarium.
- Published
- 2022
36. COVID-19 in patients aged 80 years and over during the peaks of the first three pandemic waves at a Spanish tertiary hospital
- Author
-
Gerad Dueñas, Antoni Torres, Pedro Puerta-Alcalde, Carolina Garcia-Vidal, Verónica Rico, Alex Soriano, Catia Cilloniz, Mariana Chumbita, Julia Gimeno-Miron, Nicole Garcia-Pouton, Albert Gabarrus, and Fernanda Meira
- Subjects
Pulmonary and Respiratory Medicine ,Pediatrics ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Pandemic ,medicine ,In patient ,business - Published
- 2021
37. Impact of remdesivir according to the pre-admission symptom duration in patients with COVID-19
- Author
-
Carolina, Garcia-Vidal, Rodrigo, Alonso, Ana M, Camon, Celia, Cardozo, Laia, Albiach, Daiana, Agüero, M Angeles, Marcos, Juan, Ambrosioni, Marta, Bodro, Mariana, Chumbita, Lorena, de la Mora, Nicole, Garcia-Pouton, Gerard, Dueñas, Marta, Hernandez-Meneses, Alexy, Inciarte, Genoveva, Cuesta, Fernanda, Meira, Laura, Morata, Pedro, Puerta-Alcalde, Sabina, Herrera, Montse, Tuset, Pedro, Castro, Sergio, Prieto-Gonzalez, Alex, Almuedo-Riera, Josep, Mensa, José Antonio, Martínez, Gemma, Sanjuan, J M, Nicolas, A, Del Rio, José, Muñoz, Jordi, Vila, Felipe, Garcia, Alex, Soriano, and Y, Zboromyrska
- Subjects
Male ,Microbiology (medical) ,medicine.medical_specialty ,Multivariate analysis ,Coronavirus disease 2019 (COVID-19) ,medicine.medical_treatment ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Antiviral Agents ,law.invention ,law ,Internal medicine ,Symptom duration ,medicine ,Humans ,AcademicSubjects/MED00740 ,Pharmacology (medical) ,In patient ,Aged ,Retrospective Studies ,Original Research ,Pharmacology ,Mechanical ventilation ,Alanine ,SARS-CoV-2 ,business.industry ,Mortality rate ,Respiration, Artificial ,Intensive care unit ,Adenosine Monophosphate ,COVID-19 Drug Treatment ,AcademicSubjects/MED00290 ,Infectious Diseases ,AcademicSubjects/MED00230 ,business - Abstract
Background The use of remdesivir has demonstrated a significant reduction in the time to recovery in patients with COVID-19. However, the impact on mortality is still controversial. Therefore, it is necessary to evaluate whether there is a specific subgroup of patients in whom an active antiviral therapy also reduces the mortality. Methods Patients admitted for >48 h in our hospital for a SARS-CoV-2 confirmed or suspected infection from February 2020 to February 2021 were retrospectively analysed. The primary outcome of the study was mortality at 30 days. Univariate and multivariate analyses were performed to identify predictors of mortality. Results In total, 2607 patients (438 receiving remdesivir and 2169 not) were included with a median (IQR) age of 65 (54–77) years and 58% were male. Four hundred and seventy-six were admitted to the ICU (18.3%) and 264 required invasive mechanical ventilation (10.1%). The global 30 day mortality rate was 10.7%. Pre-admission symptom duration of 4–6 days and ≤3 days was associated with a 1.5- and 2.5-fold increase in the mortality rate, respectively, in comparison with >6 days and treatment with remdesivir was independently associated with a lower mortality rate (OR = 0.382, 95% CI = 0.218–0.671). The analysis showed that the major difference was among patients with shorter pre-admission symptom duration ( Conclusions Patients with ≤3 days and 4–6 days from symptom onset to admission are associated with a 2.5- and 1.5-fold higher risk of death, respectively. Remdesivir was associated with 62% reduced odds of death versus standard-of-care and its survival benefit increased with shorter duration of symptoms.
- Published
- 2021
38. COVID-19 and fungal infections: Etiopathogenesis and therapeutic implications
- Author
-
Carolina Garcia-Vidal, Pedro Puerta-Alcalde, Nicole Garcia-Pouton, and Mariana Chumbita
- Subjects
Microbiology (medical) ,Pharmacology ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Aspergillus ,Coronavirus disease 2019 (COVID-19) ,biology ,business.industry ,SARS-CoV-2 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,COVID-19 ,CAPA ,General Medicine ,biology.organism_classification ,Viral infection ,Update on the management of SARS-CoV-2 infection ,Intensive Care Units ,co-infection ,Mycoses ,Medicine ,Humans ,aspergillosis ,business ,Intensive care medicine - Abstract
Invasive fungal infection often complicates patients with severe viral infection, especially those admitted to critical care units. Severe SARS-CoV-2 infection has been no exception and a significant association with Aspergillus spp. has been documented, resulting in high patient mortality. In this summary we describe the clinical presentation, the underlying diseases most commonly linked with this association, radiological manifestations and therapeutic management of CAPA.
- Published
- 2021
39. Bacterial Bloodstream Infections in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation With Post-Transplantation Cyclophosphamide
- Author
-
María Queralt Salas, Paola Charry, Pedro Puerta-Alcalde, Nuria Martínez-Cibrian, María Teresa Solano, Ana Serrahima, Meritxell Nomdedeu, Joan Cid, Miquel Lozano, Mariana Chumbinta, Tommaso Francesco Aiello, Jordi Arcarons, Noemi de LLobet, Alexandra Pedraza, Laura Rosiñol, Jordi Esteve, Álvaro Urbano-Ispizua, Enric Carreras, Carmen Martínez, Francesc Fernández-Avilés, Carolina García-Vidal, Maria Suárez-Lledó, and Monserrat Rovira
- Subjects
Adult ,Transplantation ,Hematopoietic Stem Cell Transplantation ,Graft vs Host Disease ,Cell Biology ,Hematology ,Bacterial Infections ,United States ,Sepsis ,Molecular Medicine ,Immunology and Allergy ,Humans ,Transplantation, Homologous ,Cyclophosphamide - Abstract
This study investigates the incidence and predictors for bacterial bloodstream infection (BSI) in 330 adults undergoing allo-HCT, and explores the effect of post-transplantation cyclophosphamide (PTCY) on the probability of presenting this complication. All patients received levofloxacin during the aplastic phase. Only the first episode of BSI was counted as an event. Patients were classified into 2 groups: PTCY-based (n = 200) versus other prophylaxis (n = 130). One hundred twenty-four patients were diagnosed with a first episode of BSI, most of them during the first 30 days (70.2%). Proportions of BSIs caused by Gram-positive bacteria were comparable to those caused by Gram-negative bacteria (48.3% versus 45.9%). The cumulative incidence of BSI was higher in patients receiving PTCY than in those receiving other prophylaxis (days 30 and 100: 35.0% and 37.0% versus 13.1% and 18.5%, P.001). At day 30, the likelihood of BSI was 2.41 (P = .012) times higher in the PTCY group than in the non-PTCY group. The 30-day mortality rate in all patients with BSI was 8.0%, lower (P = .002) in the PTCY group (2.3%) than in the non-PTCY group (21.6%). Finally, the overall survival of patients receiving PTCY and diagnosed with BSI was similar to that of patients without presenting this complication. © 2023 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
- Published
- 2022
40. Infection with the Omicron variant of SARS-CoV-2 is associated with less severe disease in hospitalized patients with COVID-19
- Author
-
Tommaso Francesco Aiello, Pedro Puerta-Alcalde, Mariana Chumbita, Patricia Monzó, Carlos Lopera, Juan Carlos Hurtado, Fernanda Meira, Mar Mosquera, Marta Santos, Mariana Fernandez-Pittol, Josep Mensa, José Antonio Martínez, Alex Soriano, Ma Angeles Marcos, and Carolina Garcia-Vidal
- Subjects
Microbiology (medical) ,Infectious Diseases ,SARS-CoV-2 ,COVID-19 ,Humans ,Cell Line - Published
- 2022
41. Experience with the use of siltuximab in patients with SARS-CoV-2 infection
- Author
-
G Dueñas, M. A. Torres, M Laguno, A. Soriano, Asunción Moreno, Juan Ambrosioni, Lorna Leal, M De la Mora, L Albiach, M Solá, Laura Linares, C Carbonell, Ana González-Cordón, E Moreno-García, L Letona, Celia Cardozo, F Meira, J A Martín-Oterino, M Chumbita, N García-Pouton, Rico, Alexy Inciarte, A Cózar-Llistó, Berta Torres, Laura Morata, Federico García, Carol Garcia-Vidal, Marta Hernández-Meneses, M Martín-Ordiales, Joel Rojas, I Macaya, Marta Bodro, Pedro Puerta-Alcalde, D Agüero, and J A Martínez
- Subjects
Male ,Microbiology (medical) ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Original ,First line ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Discharged alive ,Antibodies, Monoclonal, Humanized ,Linea ,Siltuximab ,chemistry.chemical_compound ,Humans ,Medicine ,In patient ,Aged ,Retrospective Studies ,siltuximab ,Salvage Therapy ,Pharmacology ,Gynecology ,IL-6 ,Retrospective review ,COVID-19 mortality ,Interleukin-6 ,business.industry ,Antibodies, Monoclonal ,COVID-19 ,General Medicine ,Middle Aged ,COVID-19 Drug Treatment ,C-Reactive Protein ,Treatment Outcome ,chemistry ,Hypertension ,Disease Progression ,mortalidad ,Female ,Cytokine Release Syndrome ,business - Abstract
espanolObjetivo. Nuestro estudio tiene como objetivo describir las caracteristicas clinicas y evolucion de los pacientes infectados por SARS-CoV-2 tratados con siltuximab, de acuerdo con el protocolo local, con objetivo de bloquear precozmente la actividad de la Interleukina-6 evitando la progresion de la cascada inflamatoria. Pacientes y metodos. Estudio retrospectivo de los primeros 31 pacientes con COVID-19 tratados con siltuximab en el Hospital Clinic de Barcelona y en el Hospital Universitario de Salamanca, en el periodo de marzo a abril, que tenian una PCR en frotis nasal positiva para SARS-CoV-2. Resultados. Fueron incluidos 31 pacientes tratados con siltuximab, con una mediana (RIC) de edad de 62 anos (56-71) y una prevalencia de varones del 71%. La comorbilidad mas frecuente fue la hipertension arterial (48%). La mediana de dosis administrada de siltuximab fue 800 mg con un rango de 785 mg a 900 mg. Siete pacientes recibieron siltuximab como terapia de rescate despues de una dosis de tocilizumab. Al final del estudio, un total de 26 (83.9) pacientes recibieron alta hospitalaria vivos. La tasa de mortalidad fue de 16.1%, sin embargo, solo 1 de los 24 pacientes que recibieron siltuximab como primera linea de tratamiento fallecio (4%). Conclusiones. Siltuximab es una alternativa bien tolerada al uso de tocilizumab como primera linea de tratamiento para pacientes con neumonia por COVID-19 dentro de los primeros 10 dias de sintomas y con proteina C-reactiva elevada. EnglishObjectives. The study aims to describe characteristics and clinical outcome of patients with SARS-CoV-2 infection that received siltuximab according to a protocol that aimed to early block the activity of IL-6 to avoid the progression of the inflammatory flare. Patients and methods. Retrospective review of the first 31 patients with SARS-CoV-2 treated with siltuximab, in Hospital Clinic of Barcelona or Hospital Universitario Salamanca, from March to April 2020 with positive polymerase-chain reaction (PCR) from a nasopharyngeal swab. Results. The cohort included 31 cases that received siltuximab with a median (IQR) age of 62 (56-71) and 71% were males. The most frequent comorbidity was hypertension (48%). The median dose of siltuximab was 800 mg ranging between 785 and 900 mg. 7 patients received siltuximab as a salvage therapy after one dose of tocilizumab. At the end of the study, a total of 26 (83.9) patients had been discharged alive and the mortality rate was 16.1% but only 1 out of 24 that received siltuximab as a first line option (4%). Conclusions. Siltuximab is a well-tolerated alternative to tocilizumab when administered as a first line option in patients with COVID-19 pneumonia within the first 10 days from symptoms onset and high C-reactive protein.
- Published
- 2021
42. Machine Learning to Assess the Risk of Multidrug-Resistant Gram-Negative Bacilli Infections in Febrile Neutropenic Hematological Patients
- Author
-
Jordi Esteve, Miquel A. Orellana, Montserrat Rovira, Celia Cardozo, Carolina Garcia-Vidal, Jaime Lagunas, Gaston Besanson, Alex Soriano, Nicole Garcia-Pouton, Mariana Chumbita, Pedro Puerta-Alcalde, Ana del Río, Francesc Marco, Josep Mensa, and José Antonio Martínez
- Subjects
0301 basic medicine ,Microbiology (medical) ,Multivariate analysis ,Isolation (health care) ,business.industry ,medicine.drug_class ,030106 microbiology ,Antibiotics ,Retrospective cohort study ,Neutropenia ,Logistic regression ,medicine.disease ,Machine learning ,computer.software_genre ,Multiple drug resistance ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,medicine ,030212 general & internal medicine ,Artificial intelligence ,business ,computer ,Febrile neutropenia - Abstract
We aimed to assess risk factors for multidrug-resistant Gram-negative bacilli (MDR-GNB) from a large amount of data retrieved from electronic health records (EHRs) and determine whether machine learning (ML) may be useful in assessing the risk of MDR-GNB infection at febrile neutropenia (FN) onset. Retrospective study of almost 7 million pieces of structured data from all consecutive episodes of FN in hematological patients in a tertiary hospital in Barcelona (January 2008–December 2017). Conventional multivariate analysis and ML algorithms (random forest, gradient boosting machine, XGBoost, and GLM) were done. A total of 3235 episodes of FN in 349 patients were documented; MDR-GNB caused 180 (5.6%) infections in 132 patients. The most frequent MDR-GNBs were MDR-Pseudomonas aeruginosa (53%) and extended-spectrum beta-lactamase-producing Enterobacterales (46%). According to conventional logistic regression analysis, independent factors associated with MDR-GNB infection were age older than 45 years (OR 2.07; 95% CI 1.31–3.24), prior antibiotics (2.62; 1.39–4.92), first-ever FN in this hospitalization (2.94; 1.33–6.52), prior hospitalizations for FN (1.72; 1.02–2.89); at least 15 prior hospital visits (2.65; 1.31–5.33), high-risk hematological diseases (3.62; 1.12–11.67), and hospitalization in a room formerly occupied by patients with MDR-GNB isolation (1.69; 1.20–2.38). ML algorithms achieved the following AUC and F1 score for MDR-GNB prediction: random forest, 0.79–0.9711; GMB, 0.79–0.9705; XGBoost, 0.79–0.9670; and GLM, 0.78–0.9716. Data generated in EHRs proved useful in assessing risk factors for MDR-GNB infections in patients with FN. The great number of analyzed variables allowed us to identify new factors related to MDR infection, as well as to train ML algorithms for infection predictions. This information may be used by clinicians to make better clinical decisions.
- Published
- 2021
43. Clinical Characteristics and Outcome of Bloodstream Infections in HIV-Infected Patients with Cancer and Febrile Neutropenia: A Case–Control Study
- Author
-
Juan Ambrosioni, Josep Mensa, Montserrat Rovira, Josep Mallolas, José Antonio Martínez, Francesc Marco, Celia Cardozo, Jordi Esteve, Estela Moreno-García, Marta Hernández-Meneses, Alex Soriano, Mariana Chumbita, Felipe García, Carolina Garcia-Vidal, Nicole Garcia-Pouton, Pedro Puerta-Alcalde, and José M. Miró
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,business.industry ,Cancer ,Neutropenia ,medicine.disease ,Chronic liver disease ,Regimen ,Infectious Diseases ,Internal medicine ,Bacteremia ,Epidemiology ,medicine ,business ,Viral load ,Febrile neutropenia - Abstract
We aimed to compare the clinical characteristics and outcomes of bloodstream infections (BSI) in cancer patients presenting febrile neutropenia with and without HIV infection, and analyze the prognostic factors for mortality. BSI episodes in febrile neutropenic patients following chemotherapy were prospectively collected (1997–2018). A case (HIV-infected)–control (non-HIV-infected) sub-analysis was performed (1:2 ratio), matching patients by age, gender, baseline disease, and etiological microorganism. From 1755 BSI episodes in neutropenic cancer patients, 60 (3.4%) occurred in those with HIV. HIV characteristics: 51.7% were men who have sex with men; 58.3% had
- Published
- 2021
44. Tocilizumab reduces the risk of ICU admission and mortality in patients with SARS-CoV-2 infection
- Author
-
Joel Rojas, M Chumbita, Marta Bodro, D Soy, A Almuedo-Riera, Asunción Moreno, A. Soriano, Juan Ambrosioni, Lorna Leal, J.M. Nicolás, M De la Mora, M Fernandez-Pittol, E Rico, L Albiach, Jazmín Muñoz, I Macay, A Tomé, F Meira, Pedro Puerta-Alcalde, M Laguno, Pedro Castro, E Moreno-García, Marta Hernández-Meneses, Ana González-Cordón, J A Martínez, Josep Mensa, N García-Pouton, M.A. Marcos, Celia Cardozo, M. A. Torres, Berta Torres, S Fernández, Montse Tuset, Laura Morata, Laura Linares, M Solá, Federico García, Carol Garcia-Vidal, Alexy Inciarte, and D Agüero
- Subjects
Microbiology (medical) ,Male ,medicine.medical_specialty ,unidad de cuidados intensivos ,Original ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine.medical_treatment ,02 engineering and technology ,Antibodies, Monoclonal, Humanized ,01 natural sciences ,intensive care unit ,law.invention ,chemistry.chemical_compound ,tocilizumab ,Tocilizumab ,law ,0103 physical sciences ,medicine ,Humans ,skin and connective tissue diseases ,010303 astronomy & astrophysics ,Bed Occupancy ,Retrospective Studies ,Pharmacology ,Mechanical ventilation ,business.industry ,SARS-CoV-2 ,Mortality rate ,COVID-19 ,Retrospective cohort study ,General Medicine ,Middle Aged ,021001 nanoscience & nanotechnology ,Intensive care unit ,Respiration, Artificial ,Hospitalization ,Intensive Care Units ,chemistry ,Radiological weapon ,Emergency medicine ,Breathing ,Female ,0210 nano-technology ,business - Abstract
Objectives. In some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management around the world; therefore, clinical strategies to avoid ICU admission are needed. We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients. Material and methods. A retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first. Results. A total of 77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P=0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In the multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0.1, P=0.0001) of ICU admission or death. Conclusions. Tocilizumab in early stages of the inflammatory flare could reduce an important number of ICU admissions and mechanical ventilation. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports. This is a non-randomized study and the results should be interpreted with caution.
- Published
- 2021
45. Non
- Author
-
Pedro, Puerta-Alcalde and Carolina, Garcia-Vidal
- Subjects
Antifungal Agents ,Fungi ,Humans ,Mucormycosis ,Lung ,Biomarkers - Abstract
Non
- Published
- 2022
46. Real-life use of remdesivir in hospitalized patients with COVID-19
- Author
-
Carolina Garcia-Vidal, Marta Bodro, Laura Morata, Ferran Segui, Josep Mensa, Nacho Grafia, Marta Hernández-Meneses, Juan Ambrosioni, Alex Soriano, Mariana Chumbita, Gemma Sanjuan, Carlos Lopera, Felipe García, José Antonio Martínez, Daiana Agüero, Verónica Rico, Pedro Puerta-Alcalde, Carlota Jordan, Fernanda Meira, Alberto Cózar-Llistó, Rodrigo Alonso-Navarro, Nicole Garcia-Pouton, Pedro Castro, Gerard Dueñas, and Celia Cardozo
- Subjects
Male ,Microbiology (medical) ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Original ,Hospitalized patients ,medicine.medical_treatment ,resultados ,Anti-Inflammatory Agents ,remdesivir ,Antibodies, Monoclonal, Humanized ,Antiviral Agents ,Dexamethasone ,law.invention ,Cohort Studies ,law ,Humans ,Medicine ,Hospital Mortality ,Adverse effect ,Aged ,Pharmacology ,Mechanical ventilation ,Inpatients ,Alanine ,business.industry ,Mortality rate ,COVID-19 ,General Medicine ,Middle Aged ,Antivirals ,Respiration, Artificial ,Intensive care unit ,Adenosine Monophosphate ,COVID-19 Drug Treatment ,Discontinuation ,Intensive Care Units ,Treatment Outcome ,Spain ,Emergency medicine ,outcome ,Antivirales ,Female ,business ,Cohort study - Abstract
Objective. Controversial results on remdesivir efficacy have been reported. We aimed to report our real-life experience with the use of remdesivir from its availability in Spain. Methods. We performed a descriptive study of all patients admitted for ≥48 hours with confirmed COVID-19 who received remdesivir between the 1st of July and the 30th of September 2020. Results. A total of 123 patients out of 242 admitted with COVID-19 at our hospital (50.8%) received remdesivir. Median age was 58 years, 61% were males and 56.9 % received at least one anti-inflammatory treatment. No adverse events requiring remdesivir discontinuation were reported. The need of intensive care unit admission, mechanical ventilation and 30-days mortality were 19.5%, 7.3% and 4.1%, respectively. Conclusion. In our real-life experience, the use of remdesivir in hospitalized patients with COVID-19 was associated with a low mortality rate and good safety profile.
- Published
- 2021
47. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study
- Author
-
Carolina Garcia-Vidal, Gemma Sanjuan, Estela Moreno-García, Pedro Puerta-Alcalde, Nicole Garcia-Pouton, Mariana Chumbita, Mariana Fernandez-Pittol, Cristina Pitart, Alexy Inciarte, Marta Bodro, Laura Morata, Juan Ambrosioni, Ignacio Grafia, Fernanda Meira, Irene Macaya, Celia Cardozo, Climent Casals, Adrian Tellez, Pedro Castro, Francesc Marco, Felipe García, Josep Mensa, José Antonio Martínez, Alex Soriano, Verónica Rico, Marta Hernández-Meneses, Daiana Agüero, Berta Torres, Ana González, Lorena de la Mora, Jhon Rojas, Laura Linares, Berta Fidalgo, Natalia Rodriguez, David Nicolas, Laia Albiach, José Muñoz, Alex Almuedo, Daniel Camprubí, Ma Angeles Marcos, Catia Cilloniz, Sara Fernández, Jose M. Nicolas, and Antoni Torres
- Subjects
Male ,0301 basic medicine ,medicine.disease_cause ,0302 clinical medicine ,Pandemic ,Epidemiology ,030212 general & internal medicine ,Cross Infection ,Coinfection ,Incidence ,Incidence (epidemiology) ,Bacterial Infections ,General Medicine ,Middle Aged ,Hospitals ,Infeccions ,Anti-Bacterial Agents ,Bacterial Typing Techniques ,Community-Acquired Infections ,Hospitalization ,Infectious Diseases ,Virus Diseases ,Superinfection ,Female ,Original Article ,Superinfections ,Cohort study ,Microbiology (medical) ,medicine.medical_specialty ,030106 microbiology ,Infections ,03 medical and health sciences ,Internal medicine ,Streptococcus pneumoniae ,medicine ,Humans ,Mortality ,Aged ,Retrospective Studies ,Co-infections ,SARS-CoV-2 ,Pseudomonas aeruginosa ,business.industry ,Sputum ,COVID-19 ,Retrospective cohort study ,Survival Analysis ,Mycoses ,Blood Culture ,Spain ,business - Abstract
Objectives To describe the burden, epidemiology and outcomes of co-infections and superinfections occurring in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods We performed an observational cohort study of all consecutive patients admitted for ≥48 hours to the Hospital Clinic of Barcelona for COVID-19 (28 February to 22 April 2020) who were discharged or dead. We describe demographic, epidemiologic, laboratory and microbiologic results, as well as outcome data retrieved from electronic health records. Results Of a total of 989 consecutive patients with COVID-19, 72 (7.2%) had 88 other microbiologically confirmed infections: 74 were bacterial, seven fungal and seven viral. Community-acquired co-infection at COVID-19 diagnosis was uncommon (31/989, 3.1%) and mainly caused by Streptococcus pneumoniae and Staphylococcus aureus. A total of 51 hospital-acquired bacterial superinfections, mostly caused by Pseudomonas aeruginosa and Escherichia coli, were diagnosed in 43 patients (4.7%), with a mean (SD) time from hospital admission to superinfection diagnosis of 10.6 (6.6) days. Overall mortality was 9.8% (97/989). Patients with community-acquired co-infections and hospital-acquired superinfections had worse outcomes. Conclusions Co-infection at COVID-19 diagnosis is uncommon. Few patients developed superinfections during hospitalization. These findings are different compared to those of other viral pandemics. As it relates to hospitalized patients with COVID-19, such findings could prove essential in defining the role of empiric antimicrobial therapy or stewardship strategies.
- Published
- 2021
48. Impact of Empirical Antibiotic Regimens on Mortality in Neutropenic Patients with Bloodstream Infection Presenting with Septic Shock
- Author
-
Alex Soriano, Júlia Laporte-Amargós, Mariana Chumbita, Jordi Carratalà, Maria Condom, Carolina Garcia-Vidal, Andrea Ladino, María Suárez-Lledó, Carlota Gudiol, Francesc Marco, Enric Sastre, Ignacio Grafia, Josep Mensa, Alba Bergas, Cristina Helguera, José Antonio Martínez, Adaia Albasanz-Puig, Pedro Castro, Nicole Garcia-Pouton, Xavier Durà, Carlota Jordan, and Pedro Puerta-Alcalde
- Subjects
medicine.medical_specialty ,Multivariate analysis ,Combination therapy ,medicine.drug_class ,Antibiotics ,Bacteremia ,Clinical Therapeutics ,Internal medicine ,Bloodstream infection ,Sepsis ,medicine ,Humans ,Pharmacology (medical) ,Prospective Studies ,Aged ,Retrospective Studies ,Pharmacology ,business.industry ,Septic shock ,Acute kidney injury ,Retrospective cohort study ,bacterial infections and mycoses ,medicine.disease ,Shock, Septic ,Anti-Bacterial Agents ,Infectious Diseases ,Amikacin ,business ,medicine.drug - Abstract
We analyzed risk factors for mortality in febrile neutropenic patients with bloodstream infections (BSI) presenting with septic shock and assessed the impact of empirical antibiotic regimens. A multicenter retrospective study (2010 to 2019) of two prospective cohorts compared BSI episodes in patients with or without septic shock. Multivariate analysis was performed to identify independent risk factors for mortality in episodes with septic shock. Of 1,563 patients with BSI, 257 (16%) presented with septic shock. Those patients with septic shock had higher mortality than those without septic shock (55% versus 15%, P 70 years (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.2 to 4.7), IEAT for Candida spp. or Gram-negative bacilli (OR, 3.8; 95% CI, 1.3 to 11.1), acute kidney injury (OR, 2.6; 95% CI, 1.4 to 4.9), and amikacin as the only active antibiotic (OR, 15.2; 95% CI, 1.7 to 134.5) were independent risk factors for mortality, while the combination of β-lactam and amikacin was protective (OR, 0.32; 95% CI, 0.18 to 0.57). Septic shock in febrile neutropenic patients with BSI is associated with extremely high mortality, especially when IEAT is administered. Combination therapy including an active β-lactam and amikacin results in the best outcomes.
- Published
- 2022
49. Main Acquired Risk Factors of Different Fungal Diseases
- Author
-
Pedro Puerta-Alcalde and Carolina Garcia-Vidal
- Published
- 2022
50. Cytokine response as a biomarker for early diagnosis and outcome prediction of stem cell transplant recipients and acute leukemia patients with invasive aspergillosis
- Author
-
Pedro Puerta-Alcalde, Isabel Ruiz-Camps, Carlota Gudiol, Miquel Salavert, Pere Barba, Francisco Morandeira, Isidro Jarque, Guillermo Cuervo, Josefina Ayats, Jordi Carratalà, and Carolina Garcia-Vidal
- Subjects
Leukemia ,Interleukin-6 ,General Medicine ,immunological biomarkers ,outcomes ,cytokines ,Interleukin-10 ,Infectious Diseases ,Early Diagnosis ,Animals ,Aspergillosis ,Cytokines ,Invasive aspergillosis ,Biomarkers ,Invasive Fungal Infections ,Stem Cell Transplantation - Abstract
We aimed to determine the role of serum cytokine expression in invasive aspergillosis (IA) diagnosis and outcome prediction in hematologic patients. In this multicenter study, serum cytokines (IL6, IL10, INF-gamma, IL12, IL4, TNF-alpha, IL17, and IL23) were prospectively recruited from all consecutive patients with hematologic malignances at IA diagnosis and compared to control patients matched by center, age, baseline disease, and therapeutic regimen. We included 36 patients with IA and 36 controls. Serum levels of IL6 and IL10 cytokines on day 0 were significantly increased in patients with IA when compared to controls (P = 0.001 and P = 0.025, respectively), even in those who were neutropenic. No differences were observed for the other cytokines. IL6 and IL10 predicted IA with an area under the ROC curve of 0.74 (95% CI 0.62–0.86) and 0.64 (95% CI 0.51–0.77), respectively. The best cutoff point in predicting IA was 20.85 pg/ml for IL6 (sensitivity 72.2%; specificity 77.8%; PPV 76.5% and NPV 73.7%), and 0.045 pg/ml for IL10 (sensitivity 62.9%; specificity 63.9%; PPV 62.9% and NPV 63.9%). IL6 levels were associated with increased mortality, with the best cutoff value being 65.59 pg/ml in mortality prediction. In conclusion, in addition to current tests in place, IL6 and IL10 levels—as measured in plasma—may help clinicians diagnose IA. High levels of IL6 at IA diagnosis are related with worse outcomes. Lay summary We evaluated the role of serum cytokine expression in invasive aspergillosis (IA) diagnosis and outcome. Serum levels of IL6 and IL10 are increased in patients with IA compared to controls, and IL6 levels are associated with mortality.
- Published
- 2022
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.