In this retrospective cohort study, we aimed to assess whether introducing benznidazole at escalating doses reduces the probability of adverse events or treatment discontinuation compared with a ...full-dose scheme. We collected data from patients who had chronic
infection and underwent treatment from July 2008 to January 2017 in a referral center in Madrid. Dose was adjusted to body weight (5 mg/kg/day), with treatment introduction with full dose or escalating dose according to local consensus and protocols. Among the 62 patients treated, benznidazole was introduced at full dose in 28 patients and on escalating dose in the remaining 34. We found no statistical differences in the number of adverse events, treatment discontinuations, days of treatment, or sociodemographic profiles. There is insufficient evidence to support escalating dose as a strategy for reducing the adverse effects of benznidazole. Further research is needed to evaluate this approach.
Epidemiology and risk factors associated to bacterial resistance in solid organ cancer (SOC) patients has been barely described. This retrospective monocentric study analyzed clinical variables in ...SOC patients who developed bacteremia between 1 January 2019 and 31 December 2022. We described rates of bacterial resistance in Gram negative bacteria (80.6%):
, Carbapenem-Resistant
and Meropenem-Resistant
as well as antibiotic consumption, and compared these rates between the medical and oncology wards. In total, we included 314 bacteremias from 253 patients. SOC patients are frequently prescribed antibiotics (40.8%), mainly fluoroquinolones. Nosocomial bacteremia accounted for 18.2% of the cases and only 14.3% of patients were neutropenic. Hepatobiliary tract was the most frequent tumor (31.5%) and source of bacteremia (38.5%). Resistant bacteria showed a decreased rate of resistance during the years studied in the oncology ward. Both K-ESBL and K-CBP resistance rates decreased (from 45.8% to 20.0%, and from 29.2% to 20.0%, respectively), as well as MRPA, which varied from a resistance rate of 28% to 16.7%. The presence of a urinary catheter (
< 0.001) and previous antibiotic prescription (
= 0.002) were risk factors for bacterial resistance. Identifying either of these risk factors could help in guiding antibiotic prescription for SOC patients.
•Laboratory diagnosis of Strongyloides stercoralis is based in combining low-sensitive parasitological techniques and serological tests.•The most sensitive parasitological test is agar-plate culture, ...to date, the required time of incubation have not been properly studied.•An incubation time of at least 7 days is required for diagnosis of strongyloidiasis.•Incubating the plates below 2 and 5 days, could miss an important percentage of patients.
Agar-plate culture (APC) remains the most sensitive parasitological technique for S. stercoralis diagnosis. Although it was first described three decades ago, the time of incubation of the plates is neither a commonly described feature nor usually standardized. The aim of the study was to analyze the required time to detect S. stercoralis larvae in APC.
A prospective laboratory-based study including all patients with at least one positive APC was performed. The plates were incubated at room temperature for 7 days. Clinical, analytical and parasitological features including results of the direct visualization of the stool (DV) after formalin-ether concentration and time-to-detection (TTD) of the larvae in APC were recorded.
A total of 141 samples from 75 patients had a positive APC. In 49 of them (65.3%) three or more stool samples were processed for direct visualization (DV) and APC. Of these 49 patients, 8 (16.3%) were also diagnosed with DV and 41 (83.7%) were diagnosed only with APC. In 38 samples from 23 (30.7%) patients, the TTD was below 2 days, while in 27 samples from 13 (17.3%) patients, the larvae were detected on the 6th and 7th day.
Direct visualization failed to detect S. stercoralis in most of the patients that were diagnosed with APC. Incubation periods below 2 and 5 days would miss an important percentage of infections. At least 7 days of incubation of the APC are required to detect presumably low-burden chronic infections in non-endemic countries.
To describe the determinants of outcome of infections due to oxacillinase-48 (OXA-48) carbapenemase-producing Klebsiella pneumoniae (OXA-48-Kp).
A retrospective cohort study of 117 episodes of ...OXA-48-Kp infection were conducted. Multivariate Cox models identified factors predicting 14-day clinical response and 30-day all-cause mortality.
A total of 77 (65.8%) isolates were susceptible to imipenem/meropenem. The 14-day clinical response and 30-day mortality rates were 41.9% and 28.2%. Catheter-related bloodstream infection (adjusted hazard ratio aHR: 8.33; 95% confidence interval 95%CI: 3.19-21.72; P-value <0.001), urinary tract infection (aHR: 3.04; 95%CI: 1.39-6.66; P-value = 0.006) and early appropriate treatment (aHR: 1.77; 95%CI: 0.97-3.22; P-value = 0.064) predicted clinical response, whereas severe sepsis had a deleterious impact (aHR: 0.22; 95%CI: 0.10-0.50; P-value <0.001). Lower respiratory tract infection (aHR: 6.58; 95%CI: 2.83-15.29; P-value <0.001) and bloodstream infection (aHR: 2.33; 95%CI: 1.05-5.15; P-value = 0.037) were associated with 30-day mortality, whereas definitive therapy including ≥1 active agent (aHR: 0.26; 95%CI: 0.11-0.63; P-value = 0.003) and source control (aHR: 0.35; 95%CI: 0.14-0.91; P-value = 0.030) were protective. Combination therapy did not seem to be associated with better outcomes.
Appropriate antimicrobial treatment was protective for 30-day mortality in OXA-48-Kp infections. Carbapenems are usually active, whereas combination therapy appeared not to confer additional benefit.
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Serological diagnosis of Strongyloides stercoralis is often limited by its low specificity due to cross-reactivity with other parasitic nematodes. Novel serological tests assumed to be more specific ...have been recently developed. The aim of our study was to compare two commercial tests based on different antigens for S. stercoralis diagnosis in humans from a non-endemic area.
A retrospective laboratory-based study was conducted in the Hospital Universitario 12 de Octubre, Madrid, Spain. Samples from patients with a requested S. stercoralis serology from January 2013 to October 2016 were tested with two commercial enzyme-linked immunosorbent assay (ELISA) tests (crude larval suspension ELISA CrAg-ELISA and recombinant antigen ELISA NIE-ELISA). Sensitivity, specificity and predictive values were calculated using primary and composite gold standards. The κ index was calculated.
A total of 249 samples from 233 patients were tested (κ=0.735). The CrAg-ELISA yielded sensitivities from 89.2% (95% confidence interval CI 80.7 to 94.2) to 94.7% (95% CI 75.4 to 99.0) and the NIE-ELISA from 72.3% (95% CI 58.2 to 83.1) to 78.9% (95% CI 56.7 to 91.5). Specificity ranged from 72.3% (95% CI 58.2 to 83.1) to 89.3% (95% CI 83.1 to 93.4) for the CrAg-ELISA and from 85.1% (95% CI 72.3 to 92.6) to 93.6% (95% CI 88.2 to 96.6) for the NIE-ELISA.
The NIE-ELISA is more specific than the CrAg-ELISA, but its low sensitivity limits its use in S. stercoralis screening. New diagnostic tests are needed for the diagnosis of S. stercoralis.
Background: Pseudomonas aeruginosa (PSA) infection often occurs in immunocompromised patients, which also face an increased risk of multidrug-resistant (MDR) bacteria. A deeper knowledge of the risk ...factors for MDR-PSA infection in this patient population may help to choose appropriate empirical antibiotic therapy. Methods: a single-center case-control (1:2) retrospective study that included 48 patients with underlying immunosuppression developing MDR-PSA infection (cases) and 96 patients also immunocompromised that were infected with non-MDR-PSA (controls) was conducted. Both groups were matched by site of infection, clinical features and type of immunosuppression. Risk factors for MDR-PSA were assessed by logistic regression. Clinical outcomes were also compared between both groups. Results: immunosuppression was due to solid cancer in 63 (43.8%) patients, solid organ transplantation in 39 (27.1%), hematological disease in 35 (24.3%) and other causes in 7 (4.9%). Independent risk factors for MDR-PSA infection were diabetes mellitus (odds ratio OR: 4.74; 95% confidence interval CI: 1.63−13.79; p = 0.004), antibiotic therapy in the previous 3 months (OR: 5.32; 95% CI: 1.93−14.73; p = 0.001), previous MDR-PSA colonization (OR: 42.1; 95% CI: 4.49−394.8; p = 0.001) and septic shock (OR: 3.73; 95% CI: 1.36−10.21; p = 0.010). MDR-PSA cases were less likely to receive adequate empirical therapy (14 29.2% vs. 69 71.9%; p < 0.001). 30-day clinical improvement was less common in MDR-PSA cases (25 52.1% vs. 76 79.2%; p = 0.001). Conclusions: diabetes mellitus, previous MDR-PSA colonization, prior receipt of antibiotics and septic shock acted as risk factors for developing MDR-PSA infections in immunocompromised patients, who have a poorer outcome than those infected with non-MDR-PSA strains.
•Multi-resistance is an emerging health problem that requires new approach strategies.•Pseudomonas aeruginosa infections have a high mortality rate and require a quick and effective approach.•The ...development of risk scores is a useful tool for the management of infectious pathology.•Antibiotic management in infectious diseases is a challenge for therapeutic success and for caring for the local ecology.
Multidrug-resistant Pseudomonas aeruginosa (MDR-PSA) constitutes an emerging health problem. A predictive score of MDR-PSA infection would allow an early adaptation of empirical antibiotic therapy.
We performed a single-centre case-control (1:2) retrospective study including 100 patients with MDR-PSA and 200 with a non–MDR-PSA infection. Cases and controls were matched by site of infection, clinical characteristics and immunosuppression. A point risk score for prediction of MDR-PSA infection was derived from a logistic regression model. Secondary outcomes (clinical improvement, complications and discharge) were also compared.
Cases with MDR-PSA infection were younger than controls (67.5 vs. 73.0 y; P = 0.031) and have more frequent cirrhosis (9% vs. 2%; P = 0.005). Independent risk factors for MDR-PSA infection were prior antibiotic treatment (80% vs. 50.5%; P < 0.001), prior colonisation with MDR bacteria (41% vs. 13.5%; P < 0.001), hospital-acquired infection (63% vs. 47%; P = 0.009) and septic shock at diagnosis (33% vs. 14%; P < 0.001). Adequate therapy was less frequent in MDR-PSA infections (31% vs. 66.5% for empirical therapy; P < 0.001). The risk score included: previous MDR-PSA isolation (11 points), prior antibiotic use (3 points), hospital-acquired infection (2 points) and septic shock at diagnosis (2 points). It showed an area under the curve of 0.755 (95% CI: 0.70–0.81) and allowed to classify individual risk into various categories: 0–2 points (<20%), 3–5 points (25%–45%), 7–11 points (55%–60%), 13–16 points (75%–87%) and a maximum of 18 points (93%).
Infections due to MDR-PSA have a poorer prognosis than those produced by non-MDR-PSA. Our score could guide empirical therapy for MDR-PSA when P. aeruginosa is isolated.
•COVID-19 has worse outcomes in haematologic than in non-haematologic patients.•Worse outcome of COVID-19 in haematologic patients is independent of age.•The development of ARDS and thrombotic ...complications drive the higher in-hospital mortality.
The characteristics of COVID-19 in haematologic patients compared to non-haematologic patients have seldom been analyzed. Our aim was to analyze whether there are differences in clinical characteristics and outcome of haematologic patients with COVID-19 as compared to non-haematologic.
Retrospective cohort study in 2 University hospitals of patients admitted with laboratory-confirmed COVID-19 included in the SEMICOVID19 database. The cohort with underlying haematologic disease was compared to a cohort of age and date-of-COVID-19-matched controls without haematologic disease (1:2).
71 cases and 142 controls were included from March-May 2020.
Twenty (28.1%) had received recent chemotherapy. Twelve (16.9%) were stem cell transplant recipients (SCT). Eleven (15.5%) were neutropenic concurrently with COVID-19 diagnosis.
Haematologic patients presented ARDS (58.5 vs 20.7%, p = 0.0001), thrombotic complications (15.7 vs 2.1%, p = 0.002), DIC (5.7 vs 0.0%, p = 0.011), heart failure (14.3 vs 4.9%, p = 0.029) and required ICU admission (15.5 vs 2.8%, p = 0.001), MV (14.1% vs 2.1%, p 0.001), steroid (64.8 vs 33.1%, p = 0.0001), tocilizumab (33.8 vs 8.5%, p = 0.0001) or anakinra treatment (9.9% vs 0%, p = 0.0001) more often. In-hospital mortality was significantly higher (38.0% vs 18.3%, p = 0.002).
Our results suggest COVID-19 has worse outcomes in haematologic patients than in non-haematologic, independently of age, and that the development of ARDS and thrombotic complications drive the higher in-hospital mortality.
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