184 results on '"Puerta-Alcalde, P."'
Search Results
2. Corrigendum to 'Safety and effectiveness of isavuconazole in real-life non-neu tropenic patients' [International Journal of Infectious Diseases 144 (2024) 107070]
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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
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Infectious and parasitic diseases ,RC109-216 - Published
- 2024
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3. Safety and effectiveness of isavuconazole in real-life non-neutropenic patients
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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
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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.
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- 2024
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4. Current microbiological testing approaches and documented infections at febrile neutropenia onset in patients with hematologic malignancies
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Chumbita Mariana, Peyrony Olivier, Teijón-Lumbreras Christian, Monzó-Gallo Patricia, Aiello Tommaso Francesco, Gallardo-Pizarro Antonio, Gras Emmanuelle, Puerta-Alcalde Pedro, Mateu Espasa, Martínez Carmen, Rivero Andrea, Casals-Pascual Climent, Soriano Alex, and Garcia-Vidal Carolina
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Febrile neutropenia ,Epidemiology ,Bacteremia ,Hematologic patients ,Infectious and parasitic diseases ,RC109-216 - Abstract
Objectives: This study aims to identify infection etiology in febrile neutropenia (FN) is vital. This study explores different microbiological approaches and their impact on diagnosing infections in patients with hematologic malignancies and FN. Methods: This is a retrospective analysis conducted at the Hospital Clinic of Barcelona details microbiological testing strategies used to diagnose infections at FN onset between January 2020 and July 2022. Results: A total of 4520 microbiological tests were ordered in 462 FN episodes, achieving a 10% test positivity rate, with 200 (43.3%) episodes showing microbiological documentation of infection. Blood cultures (40.4%), non-culture blood tests (21.2%), and respiratory tract samples (16.2%) were the most requested. Blood cultures exhibited the highest (16.9%) test positivity rates, whereas non-culture blood tests showed the lowest (3.3%). Bacterial infections were present in 149 of 462 (32.3%) FN episodes. Viral infections (66 of 462, 14.3%)—notably, respiratory viruses—were also frequent. Mortality rate at 60 days was 9.1%; documented infections were associated with a higher risk (15%). Conclusions: In the current landscape of antimicrobial diagnostics, our findings revealed the highest reported rate of microbiologically documented infections at FN onset. Bacterial infections are common; however, our data reiterate the significance of viral infections in causing fever. Optimizing FN management during respiratory viral infections remains a challenge for antimicrobial de-escalation. The low positivity rates observed in certain diagnostic tests emphasize the need for cost-effective diagnostic stewardship.
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- 2024
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5. An Assessment of a New Rapid Multiplex PCR Assay for the Diagnosis of Meningoencephalitis
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Genoveva Cuesta, Pedro Puerta-Alcalde, Andrea Vergara, Enric Roses, Jordi Bosch, Climent Casals-Pascual, Alex Soriano, Mª Ángeles Marcos, Sergi Sanz, and Jordi Vila
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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.
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- 2024
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6. Epidemiology and risk factors for recurrence in biliary source bloodstream infection episodes in oncological patients
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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
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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.
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- 2023
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7. Impact of SARS-CoV-2 viral load and duration of symptoms before hospital admission on the mortality of hospitalized COVID-19 patients
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Rico-Caballero, Verónica, Fernández, Mariana, Hurtado, Juan C., Marcos, M. Angeles, Cardozo, Celia, Albiach, Laia, Agüero, Daiana, Ambrosioni, Juan, Bodro, Marta, Chumbita, Mariana, De la Mora, Lorena, Garcia-Pouton, Nicole, Gonzalez-Cordón, Ana, Dueñas, Gerard, Hernandez-Meneses, Marta, Inciarte, Alexy, Laguno, Montse, Leal, Lorna, Macaya, Irene, Martínez, Miguel J., Cuesta, Genoveva, Meira, Fernanda, Morata, Laura, Puerta-Alcalde, Pedro, Rojas, John, Torres, Berta, Castro, Pedro, Muñoz, Jose, Mensa, Josep, Martínez, José Antonio, Sanjuan, Gemma, Vila, Jordi, García, Felipe, Garcia-Vidal, Carolina, and Soriano, Alex
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- 2022
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8. High Rate of Inappropriate Antibiotics in Patients with Hematologic Malignancies and Pseudomonas aeruginosa Bacteremia following International Guideline Recommendations
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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
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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.
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- 2023
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9. The Etiology, Antibiotic Therapy and Outcomes of Bacteremic Skin and Soft-Tissue Infections in Onco-Hematological Patients
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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
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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.
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- 2023
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10. Clinical Presentation and Outcome of COVID-19 in a Latin American Versus Spanish Population: Matched Case-Control Study
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Alonso, Rodrigo, Camon, Ana M., Cardozo, Celia, Albiach, Laia, Agüero, Daiana, Marcos, M. Angeles, Ambrosioni, Juan, Bodro, Marta, Chumbita, Mariana, de la Mora, Lorena, Garcia-Pouton, Nicole, Dueñas, Gerard, Hernandez-Meneses, Marta, Inciarte, Alexy, Cuesta, Genoveva, Meira, Fernanda, Morata, Laura, Puerta-Alcalde, Pedro, Herrera, Sabina, Tuset, Montse, Castro, Pedro, Prieto-Gonzalez, Sergio, Mensa, Josep, Martínez, José Antonio, Sanjuan, Gemma, Nicolas, J. M., del Rio, A., Vila, Jordi, Garcia, Felipe, Garcia-Vidal, Carolina, and Soriano, Alex
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- 2022
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11. Bacterial co-infection at hospital admission in patients with COVID-19
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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
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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%.
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- 2022
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12. C-reactive protein cut-off for early tocilizumab and dexamethasone prescription in hospitalized patients with COVID-19
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Camon, Ana M., Alonso, Rodrigo, Muñoz, Francisco J., Cardozo, Celia, Bernal-Maurandi, Javier, Albiach, Laia, Agüero, Daiana, Marcos, M. Angeles, Ambrosioni, Juan, Bodro, Marta, Chumbita, Mariana, De la Mora, Lorena, Garcia-Pouton, Nicole, Dueñas, Gerard, Hernandez-Meneses, Marta, Inciarte, Alexy, Cuesta, Genoveva, Meira, Fernanda, Morata, Laura, Puerta-Alcalde, Pedro, Rico, Verónica, Herrera, Sabina, Tuset, Montse, Castro, Pedro, Prieto-González, Sergio, Almuedo, Alex, Muñoz, José, Mensa, Josep, Sanjuan, Gemma, Nicolas, J. M., Del Rio, Ana, Vila, Jordi, García, Felipe, Martínez, José Antonio, Garcia-Vidal, Carolina, and Soriano, Alex
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- 2022
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13. C-reactive protein cut-off for early tocilizumab and dexamethasone prescription in hospitalized patients with COVID-19
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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
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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.
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- 2022
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14. Non-Aspergillus mould lung infections
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Pedro Puerta-Alcalde and Carolina Garcia-Vidal
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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.
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- 2022
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15. Impact of Inflammatory Response Modifiers on the Incidence of Hospital-Acquired Infections in Patients with COVID-19
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Meira, Fernanda, Moreno-García, Estela, Linares, Laura, Macaya, Irene, Tomé, Adria, Hernández-Meneses, Marta, Albiach, Laia, Morata, Laura, Letona, Laura, Bodro, Marta, Cózar-Llistó, Alberto, Cardozo, Celia, Chumbita, Mariana, Pitart, Cristina, Ambrosioni, Juan, Rico, Verónica, Agüero, Daiana, Puerta-Alcalde, Pedro, Garcia-Pouton, Nicole, Marco, Francesc, Garcia-Vidal, Carolina, Soriano, Alex, and Martínez, José Antonio
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- 2021
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16. Antibiotic-resistant microorganisms in patients with bloodstream infection of intraabdominal origin: risk factors and impact on mortality
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Rodríguez-Núñez, Olga, Agüero, Daiana L., Morata, Laura, Puerta-Alcalde, Pedro, Cardozo, Celia, Rico, Verónica, Pitart, Cristina, Marco, Francesc, Balibrea, José M., Garcia-Vidal, Carolina, del Río, Ana, Soriano, Alex, and Martínez-Martínez, José A.
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- 2021
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17. Clinical Characteristics and Outcome of Bloodstream Infections in HIV-Infected Patients with Cancer and Febrile Neutropenia: A Case–Control Study
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Puerta-Alcalde, Pedro, Ambrosioni, Juan, Chumbita, Mariana, Hernández-Meneses, Marta, Garcia-Pouton, Nicole, Cardozo, Celia, Moreno-García, Estela, Marco, Francesc, Mensa, Josep, Rovira, Montserrat, Esteve, Jordi, Martínez, Jose A., García, Felipe, Mallolas, Josep, Soriano, Alex, Miró, José M., and Garcia-Vidal, Carolina
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- 2021
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18. 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)
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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
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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.
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- 2022
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19. Impact of low serum calcium at hospital admission on SARS-CoV-2 infection outcome
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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
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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.
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- 2021
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20. Prolonged viral replication in patients with hematologic malignancies hospitalized with COVID-19
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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
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Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2022
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21. Emergence of Progressive Mutations in SARS-CoV-2 From a Hematologic Patient With Prolonged Viral Replication
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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
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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.
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- 2022
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22. Predictors of multidrug-resistant Pseudomonas aeruginosa in neutropenic patients with bloodstream infection
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Viasus, D., Puerta-Alcalde, P., Cardozo, C., Suárez-Lledó, M., Rodríguez-Núñez, O., Morata, L., Fehér, C., Marco, F., Chumbita, M., Moreno-García, E., Fernández-Avilés, F., Gutiérrez-Garcia, G., Martínez, J.A., Mensa, J., Rovira, M., Esteve, J., Soriano, A., and Garcia-Vidal, C.
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- 2020
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23. Efficacy of extended infusion of β-lactam antibiotics for the treatment of febrile neutropenia in haematologic patients: protocol for a randomised, multicentre, open-label, superiority clinical trial (BEATLE)
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J. Laporte-Amargos, C. Gudiol, M. Arnan, P. Puerta-Alcalde, F. Carmona-Torre, M. Huguet, A. Albasanz-Puig, R. Parody, C. Garcia-Vidal, J. L. del Pozo, M. Batlle, C. Tebé, R. Rigo-Bonnin, C. Muñoz, A. Padullés, F. Tubau, S. Videla, A. Sureda, and J. Carratalà
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Febrile neutropaenia ,β-lactam antibiotics ,Cefepime ,Piperacillin-tazobactam ,Meropenem ,Extended infusion ,Medicine (General) ,R5-920 - Abstract
Abstract Background Febrile neutropaenia (FN) is a very common complication in patients with haematological malignancies and is associated with considerable morbidity and mortality. Broad-spectrum antipseudomonal β-lactam antibiotics (BLA) are routinely used for the treatment of cancer patients with FN. However, the clinical efficacy of BLA may be diminished in these patients because they present with pathophysiological variations that compromise the pharmacokinetic (PK) parameters of these antibiotics. Optimised administration of BLA in prolonged infusions has demonstrated better clinical outcomes in critically ill patients. However, there is a paucity of data on the usefulness of this strategy in patients with FN. The aim of this study is to test the hypothesis that the administration of BLA would be clinically more effective by extended infusion (EI) than by intermittent infusion (II) in haematological patients with FN. Methods A randomised, multicentre, open-label, superiority clinical trial will be performed. Patients with haematological malignancies undergoing chemotherapy or haematopoietic stem-cell transplant and who have FN and receive empirical antibiotic therapy with cefepime, piperacillin-tazobactam or meropenem will be randomised (1:1) to receive the antibiotic by EI (during half the time of the dosing interval) in the study group, or by II (30 min) in the control group. The primary endpoint will be clinical efficacy, defined as defervescence without modifying the antibiotic treatment administered within the first 5 days of therapy. The primary endpoint will be analysed in the intention-to-treat population. The secondary endpoints will be pharmacokinetic/pharmacodynamic (PK/PD) target achievement, bacteraemia clearance, decrease in C-reactive protein, overall (30-day) case-fatality rate, adverse events and development of a population PK model of the BLA studied. Discussion Data on the usefulness of BLA administration in patients with FN are scant. Only three clinical studies addressing this issue have been published thus far, with contradictory results. Moreover, these studies had some methodological flaws that limit the interpretation of their findings. If this randomised, multicentre, phase IV, open-label, superiority clinical trial validates the hypothesis that the administration of BLA is clinically more effective by EI than by II in haematological patients with FN, then the daily routine management of these high-risk patients could be changed to improve their outcomes. Trial registration European Clinical Trials Database: EudraCT 2018–001476-37 . ClinicalTrials.gov , ID: NCT04233996 .
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- 2020
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24. Factors associated with the development of septic shock in patients with candidemia: a post hoc analysis from two prospective cohorts
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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
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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.
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- 2020
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25. Changing epidemiology of bloodstream infection in a 25-years hematopoietic stem cell transplant program: current challenges and pitfalls on empiric antibiotic treatment impacting outcomes
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Puerta-Alcalde, Pedro, Cardozo, Celia, Marco, Francesc, Suárez-Lledó, Maria, Moreno, Estela, Morata, Laura, Fernández-Avilés, Francesc, Gutiérrez-Garcia, Gonzalo, Chumbita, Mariana, Rosiñol, Laura, Martínez, Jose Antonio, Martínez, Carmen, Mensa, Josep, Urbano, Álvaro, Rovira, Montserrat, Soriano, Alex, and Garcia-Vidal, Carolina
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- 2020
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26. Up-to-Date Infection Control Practices for Febrile Neutropenic Patients
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Morales, Hugo Manuel Paz, Puerta-Alcalde, Pedro, Sanjuan-Gomez, Gemma, Moreno-Garcia, Estela, Chumbita, Mariana, Garcia-Pouton, Nicole, Soriano, Alex, and Garcia-Vidal, Carolina
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- 2020
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27. Gustatory and olfactory dysfunctions in hospitalised patients with COVID-19 pneumonia: a prospective study
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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
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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.
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- 2021
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28. Pseudomonas aeruginosa Bloodstream Infections in Patients with Cancer: Differences between Patients with Hematological Malignancies and Solid Tumors
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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
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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.
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- 2022
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29. Current time-to-positivity of blood cultures in febrile neutropenia: a tool to be used in stewardship de-escalation strategies
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Puerta-Alcalde, P., Cardozo, C., Suárez-Lledó, M., Rodríguez-Núñez, O., Morata, L., Fehér, C., Marco, F., Del Río, A., Martínez, J.A., Mensa, J., Rovira, M., Esteve, J., Soriano, A., and Garcia-Vidal, C.
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- 2019
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30. Trends in mortality of hospitalised COVID-19 patients: A single centre observational cohort study from Spain
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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
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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.
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- 2021
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31. Factors Associated With Short-Term Eradication of Rectal Colonization by KPC-2 Producing Klebsiella pneumoniae in an Outbreak Setting
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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
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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.
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- 2021
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32. Changing epidemiology of catheter-related bloodstream infections in neutropenic oncohematological patients.
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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
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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.
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- 2021
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33. Effect of Combination Antibiotic Empirical Therapy on Mortality in Neutropenic Cancer Patients with Pseudomonas aeruginosa Pneumonia
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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
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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.
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- 2022
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34. Changing Epidemiology of Invasive Fungal Disease in Allogeneic Hematopoietic Stem Cell Transplantation
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Pedro Puerta-Alcalde and Carolina Garcia-Vidal
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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.
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- 2021
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35. Efficacy of extended infusion of β-lactam antibiotics for the treatment of febrile neutropenia in haematologic patients: protocol for a randomised, multicentre, open-label, superiority clinical trial (BEATLE)
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Laporte-Amargos, J., Gudiol, C., Arnan, M., Puerta-Alcalde, P., Carmona-Torre, F., Huguet, M., Albasanz-Puig, A., Parody, R., Garcia-Vidal, C., del Pozo, J. L., Batlle, M., Tebé, C., Rigo-Bonnin, R., Muñoz, C., Padullés, A., Tubau, F., Videla, S., Sureda, A., and Carratalà, J.
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- 2020
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36. Factors associated with the development of septic shock in patients with candidemia: a post hoc analysis from two prospective cohorts
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Bassetti, Matteo, Vena, Antonio, Meroi, Marco, Cardozo, Celia, Cuervo, Guillermo, Giacobbe, Daniele Roberto, Salavert, Miguel, Merino, Paloma, Gioia, Francesca, Fernández-Ruiz, Mario, López-Cortés, Luis Eduardo, Almirante, Benito, Escolà-Vergé, Laura, Montejo, Miguel, Aguilar-Guisado, Manuela, Puerta-Alcalde, Pedro, Tasias, Mariona, Ruiz-Gaitán, Alba, González, Fernando, Puig-Asensio, Mireia, Marco, Francesc, Pemán, Javier, Fortún, Jesus, Aguado, Jose Maria, Soriano, Alejandro, Carratalá, Jordi, Garcia-Vidal, Carolina, Valerio, Maricela, Sartor, Assunta, Bouza, Emilio, and Muñoz, Patricia
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- 2020
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37. Performance of differential time to positivity as a routine diagnostic test for catheter-related bloodstream infections: a single-centre experience
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Orihuela-Martín, J., Rodríguez-Núñez, O., Morata, L., Cardozo, C., Puerta-Alcalde, P., Hernández-Meneses, M., Ambrosioni, J., Linares, L., Bodro, M., de los Angeles Guerrero-León, M., del Río, A., Garcia-Vidal, C., Almela, M., Pitart, C., Marco, F., Soriano, A., and Martínez, J.A.
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- 2020
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38. Breakthrough invasive fungal infection among patients with haematologic malignancies: A national, prospective, and multicentre study.
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Puerta-Alcalde, Pedro, Monzó-Gallo, Patricia, Aguilar-Guisado, Manuela, Ramos, Juan Carlos, Laporte-Amargós, Júlia, Machado, Marina, Martin-Davila, Pilar, Franch-Sarto, Mireia, Sánchez-Romero, Isabel, Badiola, Jon, Gómez, Lucia, Ruiz-Camps, Isabel, Yáñez, Lucrecia, Vázquez, Lourdes, Chumbita, Mariana, Marco, Francesc, Soriano, Alex, González, Pedro, Fernández-Cruz, Ana, and Batlle, Montserrat
- Abstract
We describe the current epidemiology, causes, and outcomes of breakthrough invasive fungal infections (BtIFI) in patients with haematologic malignancies. BtIFI in patients with ≥ 7 days of prior antifungals were prospectively diagnosed (36 months across 13 Spanish hospitals) according to revised EORTC/MSG definitions. 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. 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. [Display omitted] • BtIFI are caused by non- fumigatus Aspergillus , non- albicans Candida , Mucorales and other rare species of mould and yeast. • Prior antifungals determine the epidemiology of BtIFI. • BtIFI is associated with an exceedingly high mortality. • Aggressive diagnostic approach and early change of antifungal class is warranted. [ABSTRACT FROM AUTHOR]
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- 2023
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39. Can Artificial Intelligence Improve the Management of Pneumonia
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Mariana Chumbita, Catia Cillóniz, Pedro Puerta-Alcalde, Estela Moreno-García, Gemma Sanjuan, Nicole Garcia-Pouton, Alex Soriano, Antoni Torres, and Carolina Garcia-Vidal
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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.
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- 2020
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40. Risk factors for mortality in patients with acute leukemia and bloodstream infections in the era of multiresistance.
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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
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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.
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- 2018
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41. High prevalence of S. Stercoralis infection among patients with Chagas disease: A retrospective case-control study.
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Pedro Puerta-Alcalde, Joan Gomez-Junyent, Ana Requena-Mendez, Maria Jesús Pinazo, Miriam José Álvarez-Martínez, Natalia Rodríguez, Joaquim Gascon, and Jose Muñoz
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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.
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- 2018
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42. Correction to: Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies
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Moreno-García, E, Puerta-Alcalde, P, Gariup, G, Fernández-Ruiz, M, López Cortés, L E, Cuervo, G, Salavert, M, Merino, P, Machado, M, Guinea, J, García-Rodríguez, J, Garnacho-Montero, J, Cardozo, C, Peman, J, Montejo, M, Fortún, J, Almirante, B, Castro, C, Rodríguez-Baño, J, Aguado, J M, Martínez, J A, Carratalà, J, Soriano, A, and Garcia-Vidal, C
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Infectious Diseases ,Oncology - Abstract
[This corrects the article DOI: 10.1093/ofid/ofab250.].
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- 2022
43. 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)
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Bergas, A. (Alba), Albasanz-Puig, A. (Adaia), Fernández-Cruz, A. (Ana), Machado, M. (Marina), Novo, A. (Andrés), Van-Duin, D. (David), Garcia-Vidal, C. (C.), Hakki, M. (Morgan), Ruiz-Camps, I. (Isabel), Pozo, J.L. (José Luis) del, Oltolini, C. (Chiara), DeVoe, C. (Catherine), Drgona, L. (Lubos), Gasch, O. (Oriol), Mikulska, M. (Malgorzata), Martín-Dávila, P. (Pilar), Peghin, M. (Maddalena), Laporte-Amargos, J. (J.), Durà-Miralles, X. (Xavier), Pallarès, N. (Natàlia), González-Barca, E. (Eva), Álvarez-Uría, A. (Ana), Puerta-Alcalde, P. (Pedro), Aguilar-Company, J. (Juan), Carmona-Torre, F. (Francisco de A.), Clerici, T.D. (Teresa Daniela), Doernberg, S.B. (Sarah B.), Petrikova, L. (Lucía), Capilla, S. (Silvia), Magnasco, L. (Laura), Fortún, J. (Jesús), Castaldo, N. (Nadia), Carratalà, J. (Jordi), and Gudiol, C. (Carlota)
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Hematologic malignancy ,Tazobactam ,Neutropenia ,Epidemiology ,Pseudomonas aeruginosa ,Multidrug-resistant ,Bacteremia ,Gram-negative infections ,Ceftolozane/Tazobactam ,Therapy ,Bloodstream infection ,Malignancies - 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. 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.
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- 2022
44. Efficacy of early transfusion of convalescent plasma with high-titer SARS-CoV-2 neutralizing antibodies in hospitalized patients with COVID-19
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Sanz, C, Nomdedeu, M, Pereira, A, Sauleda, S, Alonso, R, Bes, M, Brillembourg, H, Garcia-Vidal, C, Millan, A, Martinez-Llonch, N, Piron, M, Puerta-Alcalde, P, Puig, L, Rico, V, and Soriano, A
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FFP transfusion ,blood center operations ,transfusion practices (adult) - Abstract
Background 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. Results 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-dimer >700 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). Conclusion 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.
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- 2022
45. Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies (vol 8, ofab250, 2021)
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Moreno-Garcia, E., Puerta-Alcalde, P., Gariup, G., Fernandez-Ruiz, M., Lopez Cortes, L. E., Cuervo, G., Salavert, M., Merino, P., Machado, M., Guinea, J., Garcia-Rodriguez, J., Garnacho-Montero, J., Cardozo, C., Peman, J., Montejo, M., Fortun, J., Almirante, B., Castro, C., Rodriguez-Bano, J., Aguado, J. M., Martinez, J. A., Carratala, J., Soriano, A., and Garcia-Vidal, C.
- Abstract
[This corrects the article DOI: 10.1093/ofid/ofab250.].
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- 2022
46. Resistance to empirical ß-lactams recommended in febrile neutropenia guidelines in Gram-negative bacilli bloodstream infections in Spain: a multicentre study
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Chumbita M, Puerta-Alcalde P, Yáñez L, Cuesta MA, Chinea A, Español Morales I, Fernández Abellán P, Gudiol C, Guerreiro M, González-Sierra P, Rojas R, María Sánchez Pina J, Sánchez Vadillo I, Varela R, Vázquez L, Lopera C, Monzó P, and Garcia-Vidal C
- Abstract
OBJECTIVES: To describe current resistance to the ß-lactams empirically recommended in the guidelines in bloodstream infection (BSI) episodes caused by Gram-negative bacilli (GNB). METHODS: Retrospective, multicentre cohort study of the last 50 BSI episodes in haematological patients across 14 university hospitals in Spain. Rates of inappropriate empirical antibiotic therapy (IEAT) and impact on mortality were evaluated. RESULTS: Of the 700 BSI episodes, 308 (44%) were caused by GNB, mainly Escherichia coli (141; 20.1%), Klebsiella spp. (56; 8%) and Pseudomonas aeruginosa (48; 6.9%). Among GNB BSI episodes, 80 (26%) were caused by MDR isolates. In those caused by Enterobacterales, 25.8% were ESBL producers and 3.5% were carbapenemase producers. Among P. aeruginosa BSI episodes, 18.8% were caused by MDR isolates. Overall, 34.7% of the isolated GNB were resistant to at least one of the three ß-lactams recommended in febrile neutropenia guidelines (cefepime, piperacillin/tazobactam and meropenem). Despite extensive compliance with guideline recommendations (91.6%), 16.6% of BSI episodes caused by GNB received IEAT, which was more frequent among MDR GNB isolates (46.3% versus 6.1%; P < 0.001). Thirty day mortality was 14.6%, reaching 21.6% in patients receiving IEAT. CONCLUSIONS: Current resistance to empirical ß-lactams recommended in febrile neutropenia guidelines is exceedingly high and IEAT rates are greater than desired. There is an urgent need to adapt guidelines to current epidemiology and better identify patients with a high risk of developing MDR GNB infection.
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- 2022
47. Impact of the Inclusion of an Aminoglycoside to the Initial Empirical Antibiotic Therapy for Gram-Negative Bloodstream Infections in Hematological Neutropenic Patients: a Propensity-Matched Cohort Study (AMINOLACTAM Study)
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Albasanz-Puig, A., primary, Gudiol, C., additional, Puerta-Alcalde, P., additional, Ayaz, C. M., additional, Machado, M., additional, Herrera, F., additional, Martín-Dávila, P., additional, Laporte-Amargós, J., additional, Cardozo, C., additional, Akova, M., additional, Álvarez-Uría, A., additional, Torres, D., additional, Fortún, J., additional, García-Vidal, C., additional, Muñoz, P., additional, Bergas, A., additional, Pomares, H., additional, Mercadal, S., additional, Durà-Miralles, X., additional, García-Lerma, E., additional, Pallarès, N., additional, and Carratalà, J., additional
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- 2021
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48. Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies
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Moreno-García, E, primary, Puerta-Alcalde, P, additional, Gariup, G, additional, Fernández-Ruiz, M, additional, López Cortés, L E, additional, Cuervo, G, additional, Salavert, M, additional, Merino, P, additional, Machado, M, additional, Guinea, J, additional, García-Rodríguez, J, additional, Garnacho-Montero, J, additional, Cardozo, C, additional, Peman, J, additional, Montejo, M, additional, Fortún, J, additional, Almirante, B, additional, Castro, C, additional, Rodríguez-Baño, J, additional, Aguado, J M, additional, Martínez, J A, additional, Carratalà, J, additional, Soriano, A, additional, and Garcia-Vidal, C, additional
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- 2021
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49. Bacterial Bloodstream Infections in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation With Post-Transplantation Cyclophosphamide
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Salas, María Queralt, Charry, Paola, Puerta-Alcalde, Pedro, Martínez-Cibrian, Nuria, Solano, María Teresa, Serrahima, Ana, Nomdedeu, Meritxell, Cid, Joan, Lozano, Miquel, Chumbinta, Mariana, Aiello, Tommaso Francesco, Arcarons, Jordi, LLobet, Noemi de, Pedraza, Alexandra, Rosiñol, Laura, Esteve, Jordi, Urbano-Ispizua, Álvaro, Carreras, Enric, Martínez, Carmen, Fernández-Avilés, Francesc, García-Vidal, Carolina, Suárez-Lledó, Maria, and Rovira, Monserrat
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[Display omitted]
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- 2022
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50. Clinical predictive model of multidrug resistance in neutropenic cancer patients with bloodstream infection due to Pseudomonas aeruginosa
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Herrera, F., Cuervo, Guillermo, Carratalà, J., Novo, A., Manzur, A., Tilley, R., Yáñez, L., Del Pozo, J.L., Peghin, M., Araos, R., Hemmatti, P., Gomes, M.Z.R., Marin, J.I., Márquez-Gómez, I., Calik, S., Sipahi, O.R., Kanj, S.S., Montero, M., Maestro-De La Calle, G., Morales, I., Kern, W.V., Isler, B., García, E., Brunel, A.-S., Paz Morales, H., Drgona, L., Gasch, O., Tubau, Fe, Escrihuela-Vidal, Francesc, Martín-Dávila, P., Aguado, José María, Horcajada, Juan Pablo, Mikulska, M., Tebé, Cristian, Arias, Marisol Rodríguez, Aguilar-Company, Juan, Larrosa, Nieves, Cardozo, Celia, Garcia-Vidal, Carolina, Karim-Yaqub, Ibrahim, Greco, Raffaella, Montejo, M., AKOVA, MURAT, Oltolini, C., Abdala, E., Puerta-Alcalde, P., Ruiz-Camps, I., Mussetti, A., Pallarès, N., Laporte-Amargós, J., Albasanz-Puig, A., Gudiol, C., Cichero, Paola, Ayaz, Caglayan Merve, Céspedes, Roberto, López-Soria, Leire, Magnasco, Laura, Fortún, Jesús, Torres, Diego, Boté, Anna, Espasa, Mateu, Montaguti, Mia Hold, Bochud, Pierre-Yves, Manuel, Oriol, Carrasco, Salvador Tabares, López, Josefina Serrano, Bertz, Hartmut, Rieg, Siegbert, De Cueto, Marina, Rodríguez-Baño, Jesús, Lizasoain, Manuel, Sangro Del Alcázar, Paloma, Castaldo, Nadia, Bassetti, Matteo, Munita, Jose, Maschmeyer, Georg, Tonhá, João Pedro Silva, Aparecida Da Silva Machado, Amanda, Correa, Lina Clemencia, Palop, Begoña, Nazli-Zeka, Arzu, Uyan-Onal, Ayse, Jabbour, Jean-Francois, El Zein, Saeed, Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad (España), Red Española de Investigación en Patología Infecciosa, European Commission, Promex Stiftung Fur Die Forschung, Gilead Sciences, MSD, Astellas Pharma, Novartis, Pfizer, and Ege Üniversitesi
- Subjects
Male ,Carbapenem ,Bacteremia ,predictive model ,0302 clinical medicine ,Risk Factors ,Drug Resistance, Multiple, Bacterial ,Neoplasms ,Pharmacology (medical) ,030212 general & internal medicine ,Antibiotic prophylaxis ,Cancer ,0303 health sciences ,Middle Aged ,Antibiotic coverage ,Anti-Bacterial Agents ,Infectious Diseases ,Treatment Outcome ,Pseudomonas aeruginosa ,Female ,medicine.drug ,medicine.medical_specialty ,Neutropenia ,Antibiotic sensitivity ,bloodstream infection ,Microbial Sensitivity Tests ,Tazobactam ,Models, Biological ,Epidemiology and Surveillance ,03 medical and health sciences ,Internal medicine ,medicine ,cancer ,Humans ,Pseudomonas Infections ,multidrug resistant, Pseudomonas aeruginosa, bacteremia, bloodstream infection, neutropenia, cancer, risk factors, predictive model ,Retrospective Studies ,Pharmacology ,030306 microbiology ,business.industry ,multidrug resistant ,Retrospective cohort study ,Odds ratio ,Multidrug resistant ,Risk factors ,ROC Curve ,Predictive model ,Bloodstream infections ,business ,Bloodstream infection ,Piperacillin - Abstract
We aimed to assess the rate and predictive factors of bloodstream infection (BSI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa in neutropenic cancer patients. We performed a multicenter, retrospective cohort study including oncohematological neutropenic patients with BSI due to P. aeruginosa conducted across 34 centers in 12 countries from January 2006 to May 2018. A mixed logistic regression model was used to estimate a model to predict the multidrug resistance of the causative pathogens. of a total of 1,217 episodes of BSI due to P. aeruginosa, 309 episodes (25.4%) were caused by MDR strains. the rate of multidrug resistance increased significantly over the study period (P = 0.033). Predictors of MDR P. aeruginosa BSI were prior therapy with piperacillin-tazobactam (odds ratio [OR), 3.48; 95% confidence interval [CI], 2.29 to 5.30), prior antipseudomonal carbapenem use (OR, 2.53; 95% CI, 1.65 to 3.87), fluoroquinolone prophylaxis (OR, 2.99; 95% CI, 1.92 to 4.64), underlying hematological disease (OR, 2.09; 95% CI, 1.26 to 3.44), and the presence of a urinary catheter (OR, 2.54; 95% CI, 1.65 to 3.91), whereas older age (OR, 0.98; 95% CI, 0.97 to 0.99) was found to be protective. Our prediction model achieves good discrimination and calibration, thereby identifying neutropenic patients at higher risk of BSI due to MDR P. aeruginosa. the application of this model using a web-based calculator may be a simple strategy to identify high-risk patients who may benefit from the early administration of broad-spectrum antibiotic coverage against MDR strains according to the local susceptibility patterns, thus avoiding the use of broad-spectrum antibiotics in patients at a low risk of resistance development., ESGBIES study group; ESGICH study group; Spanish Plan Nacional de I+D+i 2013-2016; Instituto de Salud Carlos III, Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Economia, Industria y Competitividad, Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0001]; European Development Regional Fund A Way To Achieve Europe, Operative Program Intelligent Growth 2014-2020; Promex Stiftung fur die Forschung (Carigest SA); GileadGilead Sciences; PfizerPfizer, We thank the ESGBIES and the ESGICH study groups for supporting the study.; This study was supported by the Spanish Plan Nacional de I+D+i 2013-2016 and the Instituto de Salud Carlos III, Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Economia, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (grant REIPI RD16/0016/0001), cofinanced by the European Development Regional Fund A Way To Achieve Europe, Operative Program Intelligent Growth 2014-2020.; A.-S.B. received a grant from Promex Stiftung fur die Forschung (via Carigest SA) and funding from Gilead to attend the ECCMID Congress (2018). O.R.S. received speaker honoraria from MSD, Astellas, Novartis, and Pfizer. S.S.K. received speaker honoraria from Pfizer, MSD, Astellas. F.H. received speaker honoraria from MSD, and Pfizer and a research and educational grant from Pfizer. the rest of the authors declare no conflicts of interest.
- Published
- 2020
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