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1
High-dose daptomycin together with rifampin as salvage therapy for prosthetic joint infections
Dergi Makalesi

Dergi Makalesi
Kaynak :
Science Direct
Dergi:
Medicina Clínica (English Edition)
Yayıncı:
Elsevier
Yazar(lar) :
Sabina Herrera , Luisa Sorlí , Juan Pablo Horcajada
Yıl :
2017
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
DOI : 10.1016/j.medcle.2017.04.036
ISSN: 2387-0206
Sayı: 5
Cilt: 149
Sayfa: 223-224
Sınıflandırma :
2
Off-label prescription of tigecycline: clinical and microbiological characteristics and outcomes
Dergi Makalesi

Dergi Makalesi
Kaynak :
Science Direct
Dergi:
International Journal of Antimicrobial Agents
Yayıncı:
Elsevier
Yazar(lar) :
David Conde-Estévez , Santiago Grau , Juan Pablo Horcajada , Sonia Luque
Yıl :
2010
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
DOI : 10.1016/j.ijantimicag.2010.07.006
ISSN: 0924-8579
Sayı: 5
Cilt: 36
Sayfa: 471-472
Sınıflandırma :
3
Eosinophil Count and Neutrophil-Lymphocyte Count Ratio as Prognostic Markers in Patients with Bacteremia: A Retrospective Cohort Study
Araştırma Makalesi

Araştırma Makalesi
Open Access
Kaynak 1:
PLOS - Public Library of Science
Kaynak 2:
Directory of Open Access Journals (DOAJ)
Dergi:
Public Library of Science
Yazar(lar) :
Hernando Knobel , Juan Pablo Horcajada , Xavier Castells , Pere Saballs , Marta Riu , Jordi Blanch , Santiago Grau , Roser Terradas
Yıl :
2012
Juan Pablo Horcajada
Tam Metin
Kaydet Alıntıla
Introduction There is scarce evidence on the use of eosinophil count as a marker of outcome in patients with infection. The aim of this study was to evaluate whether changes in eosinophil count, as well as the neutrophil-lymphocyte count ratio (NLCR), could be used as clinical markers of outcome in patients with bacteremia. Methods We performed a retrospective study of patients with a first episode of community-acquired or healthcare-related bacteremia during hospital admission between 2004 and 2009. A total of 2,311 patients were included. Cox regression was used to analyze the behaviour of eosinophil count and the NLCR in survivors and non-survivors. Results In the adjusted analysis, the main independent risk factor for mortality was persistence of an eosinophil count below 0.0454·103/uL (HR = 4.20; 95% CI 2.66–6.62). An NLCR value >7 was also an independent risk factor but was of lesser importance. The mean eosinophil count in survivors showed a tendency to increase rapidly and to achieve normal values between the second and third day. In these patients, the NLCR was <7 between the second and third day. Conclusion Both sustained eosinopenia and persistence of an NLCR >7 were independent markers of mortality in patients with bacteremia.
DOI : 10.1371/journal.pone.0042860
Anahtar Kelimeler : Eosinophils, Bacteremia, Death rates, Blood, Blood counts, Bacterial diseases, White blood cells, Pseudomonas aeruginosa
4
Systemic AA amyloidosis induced by oral contraceptive-associated hepatocellular adenoma: a 13-year follow up
Dergi Makalesi

Dergi Makalesi
Kaynak :
Wiley Online Library
Yazar(lar) :
Angel Cosme , Juan Pablo Horcajada , Fernando Vidaur , Evelia Ojeda , Julio Torrado , Juan Ignacio Arenas
Konu :
Hepatology
Yıl :
2008
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
DOI : 10.1111/j.1600-0676.1995.tb00665.x
ISSN: 0106-9543
Sayı: 3
Cilt: 15
Sayfa: 164-167
5
Differences in pharmacokinetics and pharmacodynamics of colistimethate sodium (CMS) and colistin between three different CMS dosage regimens in a critically ill patient infected by a multidrug-resistant Acinetobacter baumannii
Dergi Makalesi

Dergi Makalesi
Kaynak :
Science Direct
Dergi:
International Journal of Antimicrobial Agents
Yayıncı:
Elsevier
Yazar(lar) :
Sònia Luque , Santiago Grau , Marta Valle , Luisa Sorlí , Juan Pablo Horcajada , Concha Segura , Francisco Álvarez-Lerma
Yıl :
2013
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
Use of colistin has re-emerged for the treatment of infections caused by multidrug-resistant (MDR) Gram-negative bacteria, but information on its pharmacokinetics and pharmacodynamics is limited, especially in critically ill patients. Recent data from pharmacokinetic/pharmacodynamic (PK/PD) population studies have suggested that this population could benefit from administration of higher than standard doses of colistimethate sodium (CMS), but the relationship between administration of incremental doses of CMS and corresponding PK/PD parameters as well as its efficacy and toxicity have not yet been investigated in a clinical setting. The objective was to study the PK/PD differences of CMS and colistin between three different CMS dosage regimens in the same critically ill patient. A critically ill patient with nosocomial pneumonia caused by a MDR Acinetobacter baumannii received incremental doses of CMS. During administration of the different CMS dosage regimens, CMS and colistin plasma concentrations were determined and PK/PD indexes were calculated. With administration of the highest CMS dose once daily (720 mg every 24 h), the peak plasma concentration of CMS and colistin increased to 40.51 mg/L and 1.81 mg/L, respectively, and the AUC0–24/MIC of colistin was 184.41. This dosage regimen was efficacious, and no nephrotoxicity or neurotoxicity was observed. In conclusion, a higher and extended-interval CMS dosage made it possible to increase the exposure of CMS and colistin in a critically ill patient infected by a MDR A. baumannii and allowed a clinical and microbiological optimal response to be achieved without evidence of toxicity.
DOI : 10.1016/j.ijantimicag.2013.04.018
Anahtar Kelimeler : Polymyxins, Colistin, Critical care, Pharmacokinetics, Pharmacodynamics, Dosage regimens
ISSN: 0924-8579
Sayı: 2
Cilt: 42
Sayfa: 178-181
Sınıflandırma :
6
Management of the SARS-CoV-2 (COVID-19) coronavirus epidemic in hemodialysis units
Dergi Makalesi

Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Nefrología (English Edition)
Yazar(lar) :
María Dolores Arenas , Judit Villar , Cristina González , Higinio Cao , Silvia Collado , Marta Crespo , Juan Pablo Horcajada , Julio Pascual
Yıl :
2020
Juan Pablo Horcajada
Yayıncı Web Sitesi
Kaydet Alıntıla
The current outbreak of SARS-CoV-2 represents a special risk for renal patients due to their comorbidities and advanced age. The usual performance of hemodialysis treatment s in collective rooms increases the risk. The specific information at this time in this regard is very limited. This manuscript includes a proposal for action to prevent infection in the Nephrology Services, and in particular in hemodialysis units, with the objective of early identification of patients who meet the definition of a suspected case of infection by SARS-CoV-2 and propose circuits and mechanisms to carry out hemodialysis treatments. They are recommendations in continuous review and can be modified if the epidemiological situation, the diagnostic and therapeutic options so require. Resumen: La epidemia de SARS-CoV-2 representa un riesgo especial para los pacientes renales por su condición de personas con comorbilidades y edad avanzada, y por la realización del tratamiento de hemodiálisis en salas colectivas. La información específica en el momento actual al respecto es muy limitada. El presente manuscrito recoge una propuesta de actuación para prevenir la infección en los Servicios de Nefrología, y en particular en las Unidades de Hemodiálisis, con el objetivo de identificar precozmente aquellos pacientes que cumplan con la definición de caso sospechoso de infección por el SARS-CoV-2 y proponer circuitos y mecanismos para administrarles el tratamiento con hemodiálisis. Son recomendaciones en continua revisión y podrán ser modificadas si la situación epidemiológica y las opciones diagnóstico-terapéuticas así lo requieren.
Anahtar Kelimeler : Hemodiálisis, SARS-CoV-2, COVID-19, Coronavirus
ISSN: 2013-2514
Cilt: 40
Sayı: 3
Sayfa: 258 - 264
7
Manejo de la epidemia por coronavirus SARS-CoV-2 (COVID-19) en unidades de hemodiálisis
Dergi Makalesi

Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Nefrología
Yazar(lar) :
María Dolores Arenas , Judit Villar , Cristina González , Higinio Cao , Silvia Collado , Marta Crespo , Juan Pablo Horcajada , Julio Pascual
Yıl :
2020
Juan Pablo Horcajada
Yayıncı Web Sitesi
Kaydet Alıntıla
Resumen: La epidemia de SARS-CoV-2 representa un riesgo especial para los pacientes renales por su condición de personas con comorbilidades y edad avanzada, y por la realización del tratamiento de hemodiálisis en salas colectivas. La información específica en el momento actual al respecto es muy limitada. El presente manuscrito recoge una propuesta de actuación para prevenir la infección en los Servicios de Nefrología, y en particular en las unidades de hemodiálisis, con el objetivo de identificar precozmente a los pacientes que cumplan con la definición de caso sospechoso de infección por el SARS-CoV-2 y proponer circuitos y mecanismos para administrarles el tratamiento con hemodiálisis. Son recomendaciones en continua revisión y podrán ser modificadas si la situación epidemiológica y las opciones diagnóstico-terapéuticas así lo requieren. Abstract: The current outbreak of SARS-CoV-2 represents a special risk for renal patients due to their comorbidities and advanced age. The usual performance of hemodialysis treatments in collective rooms increases the risk. The specific information at this time in this regard is very limited. This manuscript includes a proposal for action to prevent infection in the Nephrology Services, and in particular in Hemodialysis Units, with the objective of early identification of patients who meet the definition of a suspected case of infection by SARS-CoV-2 and propose circuits and mechanisms to carry out hemodialysis treatments. They are recommendations in continuous review and can be modified if the epidemiological situation, the diagnostic and therapeutic options so require.
Anahtar Kelimeler : Hemodialysis, SARS-CoV-2, COVID-19, Coronavirus
ISSN: 0211-6995
Cilt: 40
Sayı: 3
Sayfa: 258 - 264
8
Relationship Between Biofilm Formation and Antimicrobial Resistance in Gram-Negative Bacteria.
Dergi Makalesi

Dergi Makalesi
Open Access
Kaynak :
PubMed
Dergi:
Microb. Drug Resist.
Yazar(lar) :
Virginio Cepas , Yuly López , Estela Muñoz , Dora Rolo , Carmen Ardanuy , Sara Martí , Mariona Xercavins , Juan Pablo Horcajada , Jordi Bosch , Sara M Soto
Yıl :
2018
Juan Pablo Horcajada
Yayıncı Web Sitesi
 Piri Tam Metin Bulucu
Kaydet Alıntıla
Gram-negative microorganisms are a significant cause of infection in both community and nosocomial settings. The increase, emergence, and spread of antimicrobial resistance among bacteria are the most important health problems worldwide. One of the mechanisms of resistance used by bacteria is biofilm formation, which is also a mechanism of virulence. This study analyzed the possible relationship between antimicrobial resistance and biofilm formation among isolates of three Gram-negative bacteria species. Several relationships were found between the ability to form biofilm and antimicrobial resistance, being different for each species. Indeed, gentamicin and ceftazidime resistance was related to biofilm formation in Escherichia coli, piperacillin/tazobactam, and colistin in Klebsiella pneumoniae, and ciprofloxacin in Pseudomonas aeruginosa. However, no relationship was observed between global resistance or multidrug-resistance and biofilm formation. In addition, compared with other reported data, the isolates in the present study showed higher rates of antimicrobial resistance. In conclusion, the acquisition of specific antimicrobial resistance can compromise or enhance biofilm formation in several species of Gram-negative bacteria. However, multidrug-resistant isolates do not show a trend to being greater biofilm producers than non-multiresistant isolates.
DOI : 10.1089/mdr.2018.0027
Anahtar Kelimeler : antimicrobial resistance, biofilm, gram-negative, infections
Sınıflandırma :
9
Protección de los profesionales sanitarios en nefrología ante la pandemia por COVID-19
Dergi Makalesi

Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
Nefrología
Yazar(lar) :
María Dolores Arenas , Judit Villar , Cristina González , Higinio Cao , Silvia Collado , Francesc Barbosa , Marta Crespo , Juan Pablo Horcajada , Julio Pascual
Yıl :
2020
Juan Pablo Horcajada
Yayıncı Web Sitesi
Kaydet Alıntıla
Resumen: La epidemia de COVID-19 representa un riesgo especial para los pacientes renales por sus comorbilidades y edad avanzada, y por la realización del tratamiento de hemodiálisis en salas colectivas, pero también supone un riesgo para los profesionales responsables de su atención. El presente manuscrito recoge una propuesta de actuación para prevenir la infección entre los profesionales en los Servicios de Nefrología. Abstract: The COVID-19 epidemic represents a special risk for kidney patients due to their comorbidities and advanced age, and the need for hemodialysis treatment in group rooms. It also represents a risk for professionals responsible for their attention. This manuscript contains a proposal for action to prevent infection of professionals in the Nephrology Services, one of the most valuable assets at the present time.
Anahtar Kelimeler : Nephrology, SARS-CoV-2, COVID-19, Coronavirus, Health-care workers
ISSN: 0211-6995
Cilt: 40
Sayı: 4
Sayfa: 395 - 402
10
Infection due to Actinobaculum spp: Report of 12 patients in Spain
Dergi Makalesi

Dergi Makalesi
Kaynak :
Science Direct
Dergi:
Journal of Infection
Yayıncı:
Elsevier
Yazar(lar) :
Margarita Salvadó , Virginia Plasencia , Concha Segura , Julià Gómez , Ma José Medina , Juan Antonio Sáez-Nieto , Sandra Castellanos , Juan Pablo Horcajada
Yıl :
2013
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
DOI : 10.1016/j.jinf.2012.06.013
ISSN: 0163-4453
Sayı: 1
Cilt: 66
Sayfa: 107-109
Sınıflandırma :
11
Colistin for the treatment of urinary tract infections caused by extremely drug-resistant Pseudomonas aeruginosa: Dose is critical
Dergi Makalesi

Dergi Makalesi
Kaynak :
Science Direct
Dergi:
Journal of Infection
Yayıncı:
Elsevier
Yazar(lar) :
Luisa Sorlí , Sonia Luque , Jian Li , Núria Campillo , Marc Danés , Milagro Montero , Concha Segura , Santiago Grau , Juan Pablo Horcajada
Yıl :
2019
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
Summary Optimal dosage regimens of colistin for the treatment of urinary tract infections (UTI) are unknown. Colistimethate sodium (CMS), the inactive prodrug of colistin, is mainly excreted in urine and converts to colistin after filtration by glomeruli, suggesting that concentrations of colistin in urine could be much higher than in plasma. Therefore, there is a need to optimize dosage regimens of intravenous CMS for UTI. The aim of this study was to examine the relationship between AUC/MIC of formed colistin and clinical outcomes in patients with UTI caused by extremely drug resistant (XDR) Pseudomonas aeruginosa. Methods This prospective, observational cohort study involved patients with UTI caused by XDR P. aeruginosa. Clinical cure, bacteriological clearance and acute kidney injury (AKI) were analyzed. Steady-state colistin plasma concentrations (Css) were measured using HPLC. Based on the PK/PD of colistin in neutropenic mouse thigh infection models with P. aeruginosa, the optimal AUC/MIC should be ≥60 mg·h/L. According to the pharmacokinetics (PK) in critically-ill patients, the Css target of formed colistin in plasma was 2.5 mg/L. Results Thirty-three patients were included (24 lower UTI and 9 pyelonephritis). The MIC50 and MIC90 values for colistin were 0.5 and 2 mg/L respectively. Nineteen patients (57.6%) received colistin monotherapy (84.2% lower UTI and 15.8% pyelonephritis). Of these, clinical cure was achieved in 89.5% of cases. Among patients with clinical cure and monotherapy, only 5 (29.4%) attained an optimal plasma AUC/MIC and only 1 (5.9%) the therapeutic level of formed colistin (2.5 mg/L). However, 10 (58.8%) patients showed colistin plasma concentrations above the MIC of the isolated P. aeruginosa. Microbiological eradication was achieved in 76.9% of patients. AKI at the end of treatment was present in 29.4% of patients. Conclusions The currently recommended dosage regimens of CMS showed high efficacy for the treatment of lower complicated UTI caused by XDR P. aeruginosa in non-critically ill patients and in the case of low MIC values, but also a considerable nephrotoxicity rate. Our data suggest that the use of lower CMS doses for lower UTI should be investigated in future studies to minimize the unnecessary nephrotoxicity.
DOI : 10.1016/j.jinf.2019.06.011
Anahtar Kelimeler : Colistin-associated nephrotoxicity, Colistin plasma concentrations, Urinary tract infections
ISSN: 0163-4453
Sayı: 3
Cilt: 79
Sayfa: 253-261
Sınıflandırma :
12
Multiplex PCR of sonication fluid accurately differentiates between prosthetic joint infection and aseptic failure
Dergi Makalesi

Dergi Makalesi
Kaynak :
Science Direct
Dergi:
Journal of Infection
Yayıncı:
Elsevier
Yazar(lar) :
María Eugenia Portillo , Margarita Salvadó , Lluisa Sorli , Albert Alier , Santos Martínez , Andrej Trampuz , Julià Gómez , Lluis Puig , Juan Pablo Horcajada
Yıl :
2012
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
Summary Objective Cultures have limited sensitivity in the diagnosis of prosthetic joint infection (PJI), especially in low-grade infections. We assessed the value of multiplex PCR in differentiating PJI from aseptic failure (AF). Methods Included were patients in whom the joint prosthesis was removed and submitted for sonication. The resulting sonication fluid was cultured and investigated by multiplex PCR, and compared with periprosthetic tissue culture. Results Among 86 explanted prostheses (56 knee, 25 hip, 3 elbow and 2 shoulder prostheses), AF was diagnosed in 62 cases (72%) and PJI in 24 cases (28%). PJI was more common detected by multiplex PCR (n = 23, 96%) than by periprosthetic tissue (n = 17, 71%, p = 0.031) or sonication fluid culture (n = 16, 67%, p = 0.016). Among 12 patients with PJI who previously received antibiotics, periprosthetic tissue cultures were positive in 8 cases (67%), sonication fluid cultures in 6 cases (50%) and multiplex PCR in 11 cases (92%). In AF cases, periprosthetic tissue grew organisms in 11% and sonication fluid in 10%, whereas multiplex PCR detected no organisms. Conclusions Multiplex PCR of sonication fluid demonstrated high sensitivity (96%) and specificity (100%) for diagnosing PJI, providing good discriminative power towards AF, especially in patients previously receiving antibiotics.
DOI : 10.1016/j.jinf.2012.08.018
Anahtar Kelimeler : Sonication, Implant-associated infection, Polymerase chain reaction
ISSN: 0163-4453
Sayı: 6
Cilt: 65
Sayfa: 541-548
Sınıflandırma :
13
Cephalosporin-induced Nonconvulsive Status Epilepticus: Clinical and Electroencephalographic Features
Dergi Makalesi

Dergi Makalesi
Kaynak :
Wiley Online Library
Dergi:
Epilepsia
Yazar(lar) :
Jose Luis Fernandez-Torre , Marian Martinez-Martinez , Jesus Gonzalez-Rato , Iratxe Maestro , Itziar Alonso , Emilio Rodrigo , Juan Pablo Horcajada
Konu :
Neurology, Clinical Neurology
Yıl :
2005
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
DOI : 10.1111/j.1528-1167.2005.16305.x
ISSN: 0013-9580
Sayı: 9
Cilt: 46
Sayfa: 1550-1552
14
Effective removal of colistin methanesulphonate and formed colistin during intermittent haemodialysis in a patient infected by polymyxin-only-susceptiblePseudomonas aeruginosa
Dergi Makalesi

Dergi Makalesi
Kaynak :
Taylor and Francis
Dergi:
Journal of Chemotherapy
Yayıncı:
Informa UK Limited
Yazar(lar) :
Sonia Luque , Luisa Sorli , Jian Li , Silvia Collado , Francesc Barbosa , Nuria Berenguer , Juan Pablo Horcajada , Santiago Grau
Yıl :
2013
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
Colistin use has reemerged for the treatment of infections caused by multidrug-resistant Gram-negative bacteria. However, the information on its pharmacokinetics is limited, especially in patients with end-stage renal disease, in which dosage adjustments are contradictory, and evidences the need to investigate the removal of colistin through renal replacement therapies like haemodialysis. This case study showed efficient removal of colistin methanesulphonate and formed colistin during intermittent haemodialysis in a patient infected by polymyxin-only-susceptible Pseudomonas aeruginosa. These results suggest the importance to monitor colistin plasma concentrations in these patients to minimize treatment failure due to suboptimal exposure to antibacterial colistin.
DOI : 10.1179/1973947813y.0000000104
Anahtar Kelimeler : Colistin, Haemodialysis, Renal insufficiency, Pharmacokinetics, Pseudomonas aeruginosa
ISSN: 1120-009X
Sayı: 2
Cilt: 26
Sayfa: 122-124
15
Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?
Dergi Makalesi

Dergi Makalesi
Open Access
Kaynak 1:
Directory of Open Access Journals (DOAJ)
Kaynak 2:
MDPI
Dergi:
Journal of Clinical Medicine
Yazar(lar) :
María Milagro Montero , Inmaculada López Montesinos , Hernando Knobel , Ema Molas , Luisa Sorlí , Ana Siverio-Parés , Nuria Prim , Concepción Segura , Xavier Duran-Jordà , Santiago Grau , Juan Pablo Horcajada
Yıl :
2020
Juan Pablo Horcajada
Piri Tam Metin Bulucu
Kaydet Alıntıla
This study aimed to assess the impact of extensively drug-resistant (XDR) phenotype on mortality in Pseudomonas aeruginosa bacteremia. A retrospective cohort study was performed in a tertiary hospital from January 2000 to December 2018. All consecutive prospectively recorded P. aeruginosa bacteremia in adult patients were assessed. In this study, 382 patients were included, of which 122 (31.9%) due to XDR P. aeruginosa. Independent factors associated with 14-day mortality were as follows: high-risk source of bacteremia (hazard ratio (HR) 3.07, 95% confidence interval (CI), 1.73−5.46), septic shock (HR 1.75, 95% CI, 1.12−2.75), and higher Pitt scores (one-point increments; HR 1.25, 95% CI, 1.12−1.38). Otherwise, the appropriateness of definitive antibiotic therapy was a protective factor (HR 0.39, 95% CI, 0.24−0.62). The same variables were also associated with 30-day mortality. XDR phenotype was not associated with 14- or 30-day mortality. In a subanalysis considering only high-risk source cases, combined antimicrobial therapy was independently associated with 14-day favorable outcome (HR 0.56, 95% CI, 0.33−0.93). In conclusion, XDR phenotype was not associated with poor prognosis in patients with P. aeruginosa bacteremia in our cohort. However, source of infection, clinical severity, and inappropriate definitive antibiotic therapy were risk factors for mortality. Combined antimicrobial therapy should be considered for high-risk sources.
DOI : 10.3390/jcm9020514
Anahtar Kelimeler : extensively drug-resistant pseudomonas aeruginosa, multidrug resistance, high-risk clones, combined antimicrobial therapy, bacteremia, outcome
ISSN: 2077-0383
Cilt: 9
Sayı: 2
Sayfa: 514
Sınıflandırma :
16
Virulence genes and subclone status as markers of experimental virulence in a murine sepsis model among Escherichia coli sequence type 131 clinical isolates from Spain.
Dergi Makalesi

Dergi Makalesi
Open Access
Kaynak :
Directory of Open Access Journals (DOAJ)
Dergi:
PLoS ONE
Yazar(lar) :
Irene Merino , Stephen B Porter , Brian D Johnston , Connie Clabots , Evelyn Shaw , Juan Pablo Horcajada , Rafael Cantón , Patricia Ruiz-Garbajosa , James R Johnson , ITUBRAS-GEIH group
Yıl :
2017
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
To assess experimental virulence among sequence type 131 (ST131) Escherichia coli bloodstream isolates in relation to virulence genotype and subclone.We analysed 48 Spanish ST131 bloodstream isolates (2010) by PCR for ST131 subclone status (H30Rx, H30 non-Rx, or non-H30), virulence genes (VGs), and O-type. Then we compared these traits with virulence in a murine sepsis model, as measured by illness severity score (ISS) and rapid lethality (mean ISS ≥ 4).Of the 48 study isolates, 65% were H30Rx, 21% H30 non-Rx, and 15% non-H30; 44% produced ESBLs, 98% were O25b, and 83% qualified as extraintestinal pathogenic E. coli (ExPEC). Of 49 VGs, ibeA and iss were associated significantly with non-H30 isolates, and sat, iha and malX with H30 isolates. Median VG scores differed by subclone, i.e., 12 (H30Rx), 10 (H30 non-Rx), and 11 (non-H30) (p < 0.01). Nearly 80% of isolates represented a described virotype. In mice, H30Rx and non-H30 isolates were more virulent than H30 non-Rx isolates (according to ISS [p = 0.03] and rapid lethality [p = 0.03]), as were ExPEC isolates compared with non-ExPEC isolates (median ISS, 4.3 vs. 2.7: p = 0.03). In contrast, most individual VGs, VG scores, VG profiles, and virotypes were not associated with mouse virulence.ST131 subclone and ExPEC status, but not individual VGs, VG scores or profiles, or virotypes, predicted mouse virulence. Given the lower virulence of non-Rx H30 isolates, hypervirulence probably cannot explain the ST131-H30 clade's epidemic emergence.
DOI : 10.1371/journal.pone.0188838
ISSN: 1932-6203
Cilt: 12
Sayı: 11
Sayfa: e0188838
17
Proceedings of International Consensus Meeting on Orthopedic Infections: General Assembly, Treatment, Antimicrobials: International Consensus Meeting on Prosthetic Joint Infection.
Dergi Makalesi

Dergi Makalesi
Open Access
Kaynak :
PubMed
Dergi:
J Arthroplasty
Yazar(lar) :
Keely Boyle , Feng-Chih Kuo , Juan Pablo Horcajada , Harriet Hughes , Luca Cavagnaro , Camelia Marculescu , Alex McLaren , Scott R Nodzo , Giovanni Riccio , Parham Sendi , Randi Silibovsky , John Stammers , Timothy L Tan , Matthias Wimmer
Yıl :
2018
Juan Pablo Horcajada
Yayıncı Web Sitesi
 Piri Tam Metin Bulucu
Kaydet Alıntıla
DOI : 10.1016/j.arth.2018.09.074
Anahtar Kelimeler : Clostridium difficile, Cutibacterium acnes, Enterococcus, Mycobacterium tuberculosis, amphotericin B, antibiotic alternatives, antibiotic duration, fungal PJI, gram-negative PJI, methicillin-resistant Staphylococcus epidermidis, minimum biofilm bactericidal concentration, minimum biofilm inhibitory concentration, minimum inhibitory concentration, polymicrobial periprosthetic joint infection, resistant microorganisms, rifampicin resistance, treatment
Sınıflandırma :
18
Is Mannose-Binding Lectin Deficiency Associated with Infection Due to Gram-Positive Bacteria?
Dergi Makalesi

Dergi Makalesi
Kaynak :
JSTOR
Dergi:
Clinical Infectious Diseases
Yayıncı:
Oxford University Press
Yazar(lar) :
Alex Smithson , Rafael Perelló , Juan Pablo Horcajada , Josep-Maria Nicolas , Francisco Lozano
Konu :
Medicine & Allied Health, Health Sciences
Yıl :
2008
Juan Pablo Horcajada
Yayıncı Web Sitesi
Kaydet Alıntıla
Cilt: 47
Sayı: 11
Sayfa: pp. 1492-1493
Yayın Tarihi: 2008-12-01
ISSN: 1058-4838
19
Validation Protocol of Vitamin D Supplementation in Patients with HIV-Infection
Dergi Makalesi

Dergi Makalesi
Open Access
Kaynak 1:
Directory of Open Access Journals (DOAJ)
Kaynak 2:
Hindawi Limited
Dergi:
AIDS Research and Treatment
Yazar(lar) :
Elisabet Lerma-Chippirraz , Roberto Güerri-Fernández , Judit Villar García , Alicia González Mena , Ana Guelar Grinberg , María Milagro Montero , Luisa Sorli , Sonia Calzado , Juan Pablo Horcajada , Adolfo Díez-Pérez , Hernando Knobel Freud
Yıl :
2016
Juan Pablo Horcajada
Piri Tam Metin Bulucu
Kaydet Alıntıla
Hypovitaminosis D and secondary hyperparathyroidism are frequent among HIV-infected patients. As there are no data about the best supplementation therapy both in treatment and in maintenance, we conducted an observational study of 300 HIV-infected patients for whom vitamin D and parathormone (PTH) had been measured in order to validate a protocol of vitamin D supplementation in patients with HIV-infection. Patients with vitamin D deficiency (defined as 25(OH)D < 10 ng/mL), insufficiency (defined as 25(OH)D < 20 ng/mL), or hyperparathyroidism (PTH > 65 pg/mL) were supplemented with cholecalciferol 16.000IU (0.266 mg) weekly (if deficiency) or fortnightly (if insufficiency or high PTH levels). Rates of normalization of 25(OH)D (levels above 20 ng/mL) and PTH levels (<65 pg/mL) were analyzed. Multivariate analysis of factors related to normalization was carried out. With a median follow-up of 2 years, 82.1% of patients with deficiency and 83.9% of cases with insufficiency reached levels above 20 ng/mL. However, only 67.2% of individuals with hyperparathyroidism at baseline reached target levels (<65 pg/mL). Independent factors for not achieving PTH objective were tenofovir (TDF) and protease inhibitors use. In HIV-infected patients with hypovitaminosis, the protocol of cholecalciferol supplementation normalized vitamin D levels regardless of antiretroviral regimen in a high proportion of patients but it was less effective to correct hyperparathyroidism.
DOI : 10.1155/2016/5120831
Cilt: 2016
20
Azithromycin in the treatment of COVID-19: a review
Dergi Makalesi

Dergi Makalesi
Kaynak :
Taylor and Francis
Dergi:
Expert Review of Anti-infective Therapy
Yayıncı:
Informa UK Limited
Yazar(lar) :
Daniel Echeverría-Esnal , Clara Martin-Ontiyuelo , María Eugenia Navarrete-Rouco , Marta De-Antonio Cuscó , Olivia Ferrández , Juan Pablo Horcajada , Santiago Grau
Konu :
Microbiology (medical), Microbiology, Virology, Infectious Diseases
Yıl :
2020
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
Introduction SARS-CoV-2 is a novel virus that causes coronavirus disease-19 (COVID-19). Antiviral and immunomodulatory agents have been proposed as potential treatments. Azithromycin exhibits both properties and therefore may play a role. Areas covered This article reviews the pharmacology, pharmacokinetics, clinical efficacy, and safety of azithromycin in viral infections, with emphasis on COVID-19. A literature search of PUBMED was conducted on May 30th and updated on July 28th. Expert opinion Azithromycin presents in vitro activity against SARS-CoV-2 and could act in different points of the viral cycle. Its immunomodulatory properties include the ability to downregulate cytokine production, maintain epithelial cell integrity or prevent lung fibrosis. Azithromycin use was associated with a reduction in mortality and ventilation days in other viral infections. These properties could be beneficial throughout the COVID-19. However, the evidence of its use is scarce and of low quality. Azithromycin has been assessed in retrospective observational studies mainly in combination with hydroxychloroquine, which has shown to provide no benefit. This macrolide presents a well-known safety profile. Upcoming clinical trials will determine the role of azithromycin in the COVID-19 (including the stage of the disease where it offers the greatest benefits and the effect of its combination with other drugs).
DOI : 10.1080/14787210.2020.1813024
Anahtar Kelimeler : Azithromycin, antivirals, immunomodulation, COVID-19, cytokine release syndrome, pneumonia, SARS-CoV-2
ISSN: 1478-7210
Sayı: 2
Cilt: 19
Sayfa: 147-163
21
Characterization and rapid control of a vancomycin-resistant Enterococcus faecium (VREF) outbreak in a renal transplant unit in Spain: The environment matters
Dergi Makalesi

Dergi Makalesi
Kaynak :
Science Direct
Dergi:
Enfermedades infecciosas y microbiologia clinica (English ed.)
Yayıncı:
Elsevier
Yazar(lar) :
Sabina Herrera , Luisa Sorlí , Maria Jose Pérez-Sáez , Patricia Ruiz-Garbajosa , Clara Barrios , Virginia Plasencia , Milagro Montero , Roser Terradas , Marta Crespo , Xavier Castells , Rafael Cantón , Julio Pascual , Juan Pablo Horcajada
Yıl :
2017
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
Objective To describe a clonal outbreak due to vancomycin-resistant Enterococcus faecium (VREF) in the nephrology and renal transplant unit of a tertiary teaching hospital in Barcelona, Spain, and to highlight how active patient and environment surveillance cultures, as well as prompt and directed intervention strategies, mainly environmental, helped to successfully bring it under control. Patients and methods A study was conducted on patients admitted to the nephrology ward with any culture positive for VREF over a 6-month period (August 2012–January 2013). Based on the identification of a clonal link between the isolates, weekly rectal screening using swabs was implemented for all patients, as well as environmental cultures and cleaning of medical equipment and the ward. VREF isolates were identified by MicroScan and confirmed by Etest. Bacterial identification was confirmed by MALDI-TOF MS. The presence of van genes, and esp and hyl virulence genes was determined using PCR. The clonal relationship between the isolates was studied first with DiversiLab (bioMérieux), and then by PFGE-Smal and MLST. A two-tier sequence of infection control measures was implemented. Results During the study period, VREF was isolated from 13 patients. All cases were colonized with no criteria for infection. VREF isolates were also extensively recovered from the environment and medical equipment. Isolates carried the vanA gene, and were multidrug-resistant, including high-level resistance (MIC >16 mg/L) to vancomycin and teicoplanin. Molecular analysis showed that all VREF isolates belonged to sequence type 17 (ST17) carrying hyl virulence genes. After implementing infection control measures in a two-tier sequence, and reinforcing particularly environmental and medical equipment cleaning, no further cases were detected in the follow-up year. Conclusion A clonal outbreak of VREF-ST17 involving only colonization is reported. The prompt implementation of aggressive infection control measures in patients and the environment was effective in controlling the outbreak and avoided the potential emergence of infection among patients. Resumen Objetivo Describir un brote clonal de Enterococcus faecium resistente a vancomicina (VREF) en la unidad de trasplante renal de un hospital universitario en Barcelona (España) y destacar que los controles ambientales, así como las estrategias de intervención dirigidas y tempranas, principalmente ambientales, fueron suficientes para controlar el brote. Pacientes y métodos Se estudiaron todos los pacientes ingresados en la unidad de nefrología con un cultivo positivo para VREF en un periodo de 6 meses (Agosto de 2012 a Enero de 2013). Basados en la identificación de una relación clonal entre las cepas, se implementaron frotis rectales de cribado para todos los pacientes, así como frotis ambientales y limpieza de todo el material médico y de la unidad. Se identificaron las cepas de VREF por MicroScan y se confirmaron con Etest. La identificación bacteriana se confirmó con MALDI-TOF MS. La presencia de genes van, y de genes de virulencia esp y hyl, se investigó por PCR. La relación clonal entre las cepas se estudió con DiversiLab (bioMérieux), y después con PFGE-Smal y MLST. Resultados Durante el periodo estudiado, se aislaron cepas de VREF de 13 pacientes. Todos fueron casos de colonización sin casos de infección. Se aislaron numerosas cepas del ambiente y del equipo médico. Las cepas presentaban el gen VanA y eran multirresistentes. El análisis molecular mostró que todas las cepas pertenecían a la secuencia tipo 17 (ST17), portando genes de virulencia hyl. Tras la implementación de medidas de control de infección de 2 niveles, e incrementando sobretodo la limpieza del ambiente y del equipo médico, no se detectaron nuevos casos en el año posterior. Conclusión Se informa de un brote clonal de VREF-ST17. La pronta implementación de medidas agresivas de control de infección en pacientes y en el ambiente fue efectiva para el control del brote.
DOI : 10.1016/j.eimce.2017.01.003
Anahtar Kelimeler : Enterococcus faecium, VREF, Renal transplantation, Outbreak, Infection control, Nosocomial, Enterococcus faecium, VREF, Trasplante renal, Brote, Control de infección, Nosocomial
ISSN: 2529-993X
Sayı: 1
Cilt: 35
Sayfa: 5-11
Sınıflandırma :
22
General Assembly, Treatment, Antimicrobials: Proceedings of International Consensus on Orthopedic Infections
Dergi Makalesi

Dergi Makalesi
Kaynak :
Science Direct
Dergi:
The Journal of Arthroplasty
Yayıncı:
Elsevier
Yazar(lar) :
K. Keely Boyle , Feng-Chih Kuo , Juan Pablo Horcajada , Harriet Hughes , Luca Cavagnaro , Camelia Marculescu , Alex McLaren , Scott R. Nodzo , Giovanni Riccio , Parham Sendi , Randi Silibovsky , John Stammers , Timothy L. Tan , Matthias Wimmer
Yıl :
2019
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
DOI : 10.1016/j.arth.2018.09.074
Anahtar Kelimeler : treatment, antibiotic duration, polymicrobial periprosthetic joint infection, antibiotic alternatives, resistant microorganisms, minimum inhibitory concentration, minimum biofilm inhibitory concentration, minimum biofilm bactericidal concentration, methicillin-resistant Staphylococcus epidermidis, Clostridium difficile, Enterococcus, rifampicin resistance, gram-negative PJI, fungal PJI, Cutibacterium acnes, Mycobacterium tuberculosis, amphotericin B
ISSN: 0883-5403
Sayı: 2
Cilt: 34
Sayfa: S225-S237
Sınıflandırma :
23
Scientific evidence of the duration of antibiotic treatment in intra-abdominal infections with surgical focus control
Dergi Makalesi

Dergi Makalesi
Kaynak :
Science Direct
Dergi:
Cirugía Española (English Edition)
Yayıncı:
Elsevier BV
Yazar(lar) :
Estela Membrilla-Fernández , Silvia Gómez-Zorrilla , Ana María González-Castillo , Amalia Pelegrina-Manzano , Juan Guzmán-Ahumada , Nuria Prim , Daniel Echeverria-Esnal , Santiago Grau-Cerrato , Juan Pablo Horcajada-Gallego , Josep María Badía , Juan José Sancho-Insenser
Yıl :
2022
Juan Pablo Horcajada-Gallego
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
A non-systematic review of the published scientific evidence has been carried out on the duration of empirical antibiotic treatment in surgical intra-abdominal infections (IIA) with effective focus control. Given the progressive increase in antibiotic resistance, it is urgent to have strategies to reduce the pressure on the microbiota. The American guidelines made by Mazuski et al. of 20171, as the central axis in the recommendations of the duration of empirical antibiotic treatment in intra-abdominal infections with control of the focus and a bibliographic search of all the articles that contained the keywords in Pubmed and Google Scholar is added. 21 articles referring to the duration of empirical antibiotic treatment in intra-abdominal infection with control of the focus are collected. With the American guidelines and these articles, a proposal is prepared for the duration of empirical antibiotic treatment in patients without risk factors between 24 and 72 h. And in those who present risk factors, it should be individualized with active monitoring every 24 h of fever, paralytic ileus and leukocytosis (FIL), before an early detection of complications or the need for changes in antibiotic treatment. Short treatments are just as effective as those of longer durations and are associated with fewer adverse effects, therefore, daily adjusting and reassessing the duration of empirical antibiotic treatment is essential for better practice. Resumen El aumento progresivo de las resistencias antibióticas apremia el tener estrategias para disminuir la presión sobre la microbiota. La duración del tratamiento antibiótico empírico es variable, a pesar de las recomendaciones de las guías. Se ha realizado una revisión bibliográfica de la evidencia científica publicada sobre la duración del tratamiento antibiótico empírico en las infecciones intraabdominales (IIA) quirúrgicas con control de foco efectivo. Se analizan las guías americanas realizadas por Mazuski et al. de 20171, como eje central en las recomendaciones de la duración de tratamiento antibiótico empírico en infecciones intraabdominales con control del foco y se añade una búsqueda bibliográfica de todos los artículos que contuviesen las palabras claves en Pubmed y Google Scholar. Se recopilan 21 artículos referentes en la duración del tratamiento antibiótico empírico en la infección intraabdominal con control del foco. Con las guías americanas y estos artículos se ha elaborado una propuesta de duración del tratamiento antibiótico empírico en pacientes sin factores de riesgo entre 24 y 72 horas. Y en los que presentan factores de riesgo se habría de individualizar el mismo con monitorización activa cada 24 horas de fiebre, íleo paralítico y leucocitosis (FIL), ante una detección precoz de complicaciones o de necesidad de cambios en el espectro antibiótico. Los tratamientos cortos son igual de eficaces que los de duraciones más prolongadas y se asocian a menos tasa de efectos adversos, por tanto, ajustar y reevaluar diariamente la duración del tratamiento antibiótico empírico es fundamental para una mejor praxis.
DOI : 10.1016/j.cireng.2022.06.042
Anahtar Kelimeler : Antibiotic therapy, Antibiotic treatment, Intra-abdominal sepsis, Intra-abdominal infection, Antimicrobial treatmentu2019s length, Prophylactic antibiotics, Brief antibiotic prophylaxis and abdominal surgery, Antimicrobial stewardship, Terapia antibiótica, Tratamiento antibiótico, Sepsis intraabdominal, Infección intraabdominal, Duración del tratamiento antimicrobiano, Antibióticos profilácticos, Profilaxis antibiótica breve y cirugía abdominal, Programas de optimización uso de antibióticos
ISSN: 2173-5077
24
Pharmacological management of antifungal agents in pulmonary aspergillosis: an updated review
Dergi Makalesi

Dergi Makalesi
Kaynak :
Taylor and Francis
Dergi:
Expert Review of Anti-infective Therapy
Yayıncı:
Informa UK Limited
Yazar(lar) :
Daniel Echeverria-Esnal , Clara Martín-Ontiyuelo , Maria Eugenia Navarrete-Rouco , Jaime Barcelo-Vidal , David Conde-Estévez , Nuria Carballo , Marta De-Antonio Cuscó , Olivia Ferrández , Juan Pablo Horcajada , Santiago Grau
Yıl :
2021
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
Introduction Aspergillus may cause different types of lung infections: invasive, chronic pulmonary or allergic bronchopulmonary aspergillosis. Pharmacological management with antifungals poses as a challenge. Patients diagnosed with pulmonary aspergillosis are complex, as well as the problems associated with antifungal agents. Areas covered This article reviews the pharmacology of antifungal agents in development and currently used to treat pulmonary aspergillosis, including the mechanisms of action, pharmacokinetics, pharmacodynamics, dosing, therapeutic drug monitoring and safety. Recommendations to manage situations that arise in daily clinical practice are provided. A literature search of PubMed was conducted on November 15th, 2020 and updated on March 30th, 2021. Expert opinion Recent and relevant developments in the treatment of pulmonary aspergillosis have taken place. Novel antifungals with new mechanisms of action that extend antifungal spectrum and improve pharmacokinetic-related aspects, drug-drug interactions and safety are under current study. For those antifungals already marketed, new data related to pharmacokinetics, pharmacodynamics, dose adjustments in special situations, therapeutic drug monitoring and safety are available. To maximize efficacy and reduce the risk of associated toxicities, it is essential to choose the most appropriate antifungal; optimize its dose, interval, route of administration and length of treatment; and prevent side effects.
DOI : 10.1080/14787210.2021.1962292
Anahtar Kelimeler : Allergic bronchopulmonary aspergillosis, antifungals, Aspergillus, chronic pulmonary aspergillosis, invasive aspergillosis, isavuconazole, liposomal amphotericin B, pharmacology, posaconazole, voriconazole
ISSN: 1478-7210
Sayfa: 1-19
25
Comorbidities and Mortality in Patients With COVID-19 Aged 60 Years and Older in a University Hospital in Spain
Dergi Makalesi

Dergi Makalesi
Kaynak :
Science Direct
Dergi:
Archivos de Bronconeumología (English Edition)
Yayıncı:
Elsevier BV
Yazar(lar) :
Margarita Posso , Mercè Comas , Marta Román , Laia Domingo , Javier Louro , Cristina González , María Sala , Albert Anglès , Isabel Cirera , Francesc Cots , Víctor-Manuel Frías , Joaquim Gea , Robert Güerri-Fernández , Joan Ramon Masclans , Xavier Noguès , Olga Vázquez , Judith Villar-García , Juan Pablo Horcajada , Julio Pascual , Xavier Castells
Yıl :
2020
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
DOI : 10.1016/j.arbr.2020.06.010
ISSN: 1579-2129
Sayı: 11
Cilt: 56
Sayfa: 756-758
26
Extended Virulence Genotypes and Phylogenetic Background of Escherichia coli Isolates from Patients with Cystitis, Pyelonephritis, or Prostatitis
Dergi Makalesi

Dergi Makalesi
Kaynak :
JSTOR
Dergi:
The Journal of Infectious Diseases
Yayıncı:
Oxford University Press
Yazar(lar) :
James R. Johnson , Michael A. Kuskowski , Abby Gajewski , Sara Soto , Juan Pablo Horcajada , M. Teresa Jimenez de Anta , Jordi Vila
Konu :
Medicine & Allied Health, Health Sciences
Yıl :
2005
Juan Pablo Horcajada
Yayıncı Web Sitesi
Kaydet Alıntıla
Molecular analysis of 63 Escherichia coli urine isolates showed that pyelonephritis (n = 23) and prostatitis (n = 17) isolates exhibited more virulence factors (VFs) among the 35 sought than did cystitis isolates (n = 23). Several nontraditional VFs-including bmaE (M fimbriae), gafD (G fimbriae), fyuA (yersiniabactin receptor), ireA and iroN (novel siderophore receptors), cvaC (colicin [microcin] V), traT (serum-resistance associated), ibeA (invasion of brain endothelium), ompT (outer membrane protease T), and malX (pathogenicity island marker)—either differentiated significantly between syndromes (despite small numbers of isolates and possible multiple-comparison artifacts) or were broadly prevalent. Thus, interventions that target conserved uro-VFs may be possible, despite the likely existence of syndrome-specific pathogenetic mechanisms and/or host defense systems.
Cilt: 191
Sayı: 1
Sayfa: pp. 46-50
Yayın Tarihi: 2005-01-01
ISSN: 0022-1899
27
Risk factors for severe sepsis in community-onset bacteraemic urinary tract infection: Impact of antimicrobial resistance in a large hospitalised cohort
Dergi Makalesi

Dergi Makalesi
Kaynak :
Science Direct
Dergi:
Journal of Infection
Yayıncı:
Elsevier
Yazar(lar) :
Evelyn Shaw , Natividad Benito , Jesús Rodríguez-Baño , Belén Padilla , Vicente Pintado , Esther Calbo , MªAngeles Pallarés , Mónica Gozalo , Patricia Ruiz-Garbajosa , Juan Pablo Horcajada , J. Gómez , E. Cercenado , E. Bunshow , C. Sánchez-Carrillo , M. Xercavins , M. Riera , B. Mirelis , R. Gamallo , L. Martínez , M.C. Fariñas , M. de Cueto , A. Pascual
Yıl :
2015
Juan Pablo Horcajada
Yayıncı Web Sitesi
Tam Metin
Kaydet Alıntıla
Summary Objective To determine risks factors associated with severe sepsis or septic shock (SS) at admission in patients with community-onset bacteraemic urinary tract infection (CO-BUTI) including the impact of multidrug-resistant (MDR) bacteria. Methods We analysed a prospective cohort of all consecutive episodes of CO-BUTI requiring hospitalisation in 8 tertiary hospitals of Spain between October 2010 and June 2011. Results Of an overall of 525 CO-BUTI episodes, 175 (33%) presented with SS at admission. MDR bacteria were isolated in 29% (51/175) of episodes with SS and in 33% (117/350) of those without SS (p = 0.32). The main MDR microorganism was Escherichia coli in both groups (25% and 28% respectively). Independent risk factors associated with SS at admission were: having fatal underlying conditions, McCabe score II/III (OR 1.90; 95%CI 1.23–2.92; p = 0.004), presence of an indwelling urethral catheter (OR 3.01; 95%CI 1.50–6.03; p = 0.002) and a history of urinary tract obstruction (OR 1.56; 95%CI 1.03–2.34; p = 0.03). After considering interactions, indwelling urethral catheters were a risk factor only for patients without fatal underlying conditions. Conclusions SS at hospital admission occurred in a third of CO-BUTI. Mainly host factors, and not the causative microorganisms or antimicrobial resistance patterns had an impact on the presence of SS.
DOI : 10.1016/j.jinf.2014.09.011
Anahtar Kelimeler : Bacteraemia, Urinary tract infection, Severe sepsis or septic shock, Multidrug resistance, Risk factors
ISSN: 0163-4453
Sayı: 3
Cilt: 70
Sayfa: 247-254
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