Francesc Marco

Instituto de Salud Carlos III, Madrid, Madrid, Spain

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Publications (227)1029.75 Total impact

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    PLoS ONE 05/2015; 10(5):e0125818. DOI:10.1371/journal.pone.0125818 · 3.53 Impact Factor
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    ABSTRACT: There are different methodological recommendations for in vitro testing of the co-amoxiclav combination. Performance of co-amoxiclav MIC testing for Escherichia coli by the standard ISO microdilution method (ISO 20776-1) was compared using EUCAST (fixed 2 mg/L clavulanate concentration) and CLSI (2 : 1 ratio) interpretive criteria. MICs were determined by broth microdilution using a 2 : 1 ratio and fixed clavulanate concentrations (2 and 4 mg/L) for 160 clinical E. coli isolates with characterized resistance mechanisms. Essential agreements, categorical agreements and relative errors were determined. For all isolates, essential agreement between microdilution using 2 mg/L clavulanate and a 2 : 1 ratio was 25.6%. For ESBL-producing isolates, considering EUCAST breakpoints, 55% of isolates tested with 2 mg/L clavulanate were classified as resistant; conversely, 95% of isolates tested with 4 mg/L clavulanate were susceptible. When using CLSI breakpoints and a 2 : 1 ratio, 90% of isolates were susceptible and 10% were intermediate. Variation in the clavulanate concentration gave different susceptibility testing results, particularly among ESBL-producing E. coli isolates. The in vitro concentration of clavulanate that better correlates with clinical outcome is still under debate and should be established. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
    Journal of Antimicrobial Chemotherapy 04/2015; DOI:10.1093/jac/dkv088 · 5.44 Impact Factor
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    ABSTRACT: There are conflicting reports describing the effect of macrolide resistance on the presentation and outcomes of patients with Streptococcus pneumoniae pneumonia. METHODS: We conducted a retrospective, observational study in the Hospital Clinic of Barcelona of all adult patients hospitalized with pneumonia who had positive cultures for S. pneumoniae from January 1, 2000 to December 31, 2013. Outcomes examined included bacteremia, pulmonary complications, acute renal failure, shock, intensive care unit admission, need for mechanical ventilation, length of hospital stay and 30-day mortality. RESULTS: Of 643 patients hospitalized for S. pneumoniae pneumonia, 139 (22%) were macrolide-resistant. Patients with macrolide-resistant organisms were less likely to have bacteremia, pulmonary complications and shock, and were less likely to require non-invasive mechanical ventilation. We found no increase in the incidence of acute renal failure, the frequency of ICU admission, the need for invasive ventilatory support, the length hospital stay or the 30-day mortality in patients with (invasive or non-invasive) macrolide-resistant S. pneumoniae pneumonia, and no effect on outcomes as a function of whether treatment regimens did or did not comply with current guidelines. CONCLUSIONS: We found no evidence suggesting that patients hospitalized for macrolide-resistant S. pneumoniae pneumonia had worse clinical outcomes.
    American Journal of Respiratory and Critical Care Medicine 03/2015; · 11.99 Impact Factor
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    ABSTRACT: There are conflicting reports describing the effect of macrolide resistance on the presentation and outcomes of patients with Streptococcus pneumoniae pneumonia. We conducted a retrospective, observational study in the Hospital Clinic of Barcelona of all adult patients hospitalized with pneumonia who had positive cultures for S. pneumoniae from January 1, 2000 to December 31, 2013. Outcomes examined included bacteremia, pulmonary complications, acute renal failure, shock, intensive care unit admission, need for mechanical ventilation, length of hospital stay and 30-day mortality. Of 643 patients hospitalized for S. pneumoniae pneumonia, 139 (22%) were macrolide-resistant. Patients with macrolide-resistant organisms were less likely to have bacteremia, pulmonary complications and shock, and were less likely to require non-invasive mechanical ventilation. We found no increase in the incidence of acute renal failure, the frequency of ICU admission, the need for invasive ventilatory support, the length hospital stay or the 30-day mortality in patients with (invasive or non-invasive) macrolide-resistant S. pneumoniae pneumonia, and no effect on outcomes as a function of whether treatment regimens did or did not comply with current guidelines. We found no evidence suggesting that patients hospitalized for macrolide-resistant S. pneumoniae pneumonia had worse clinical outcomes.
    American Journal of Respiratory and Critical Care Medicine 03/2015; 191(11). DOI:10.1164/rccm.201502-0212OC · 11.99 Impact Factor
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    ABSTRACT: Ceftazidime-avibactam and comparator antibiotics were tested by the broth microdilution method against 200 Enterobacteriaceae and 25 Pseudomonas aeruginosa strains resistant to fluoroquinolones (including extended-spectrum β -lactamases (ESBL)-phenotype and ceftazidime-resistant strains) collected from our institution. MICs and mechanisms of resistance to fluoroquinolone were also studied. Ninety-nine percent of fluoroquinolone-resistant Enterobacteriaceae strains were inhibited at a ceftazidime-avibactam MIC of ≤4 mg/L (using the susceptible CLSI breakpoint for ceftazidime alone as a reference). Ceftazidime-avibactam was very active against ESBL-Escherichia coli (MIC90 of 0.25 mg/L), ESBL-Klebsiella pneumoniae (MIC90 of 0.5 mg/L), ceftazidime-resistant AmpC-producing species (MIC90 of 1 mg/L), non-ESBL E. coli (MIC90 of ≤0.125 mg/L), non-ESBL K. pneumoniae (MIC90 of 0.25 mg/L) and ceftazidime-non-resistant AmpC-producing species (MIC90 of ≤0.5 mg/L). Ninety-six percent of fluoroquinolone-resistant P. aeruginosa were inhibited at a ceftazidime-avibactam MIC of ≤8 mg/L (using the susceptible CLSI breakpoint for ceftazidime alone as a reference) with an MIC90 of 8 mg/L. Additionally, fluoroquinolone-resistant mutants from each species tested were obtained in vitro from two strains, one susceptible to ceftazidime and the other a β-lactamase producer with a high MIC against ceftazidime but susceptible to ceftazidime-avibactam. Thereby the impact of fluoroquinolone-resistance on the activity of ceftazidime-avibactam could be assessed. The MIC90 values of ceftazidime-avibactam for the fluoroquinolone-resistant mutant strains of Enterobacteriaceae and P. aeruginosa were ≤4 mg/L and ≤8 mg/L, respectively. We conclude that the presence of fluoroquinolone resistance does not affect Enterobacteriaceae and P. aeruginosa susceptibility to ceftazidime-avibactam, that is, there is no cross-resistance. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Antimicrobial Agents and Chemotherapy 03/2015; 59(6). DOI:10.1128/AAC.05136-14 · 4.45 Impact Factor
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    ABSTRACT: Serratia spp. are opportunistic human pathogens responsible for an increasing number of nosocomial infections. However, little is known about the virulence factors and regulatory circuits that may enhance the establishment and long-term survival of S. liquefaciens in the hospital environment. In this study, two reporter strains, Chromobacterium violaceum CV026 and VIR24, and high resolution triple quadrupole liquid chromatography mass spectrometry (LC-MS) were used to detect and to quantify N-acyl-homoserine lactones (AHLs) quorum sensing signals in 20 S. liquefaciens strains isolated from clinical samples. Only 4 of the strains produced sufficient amount of AHLs to activate the sensors. The presence of AHLs was studied in two of the positive strains by HPLC-MS, confirming the presence of significant amounts of short AHLs (C4 and C6-HSL) in both strains, which presented a complex and strain-specific signal profile, that included minor amounts of short (C8, OC6-HSL) and long (C10, C12 and C14) AHLs. No correlation between biofilm formation and the production of high amounts of AHLs could be established. Fimbrial-like structures were observed by transmission electron microscopy and the presence of the Type 1 fimbrial adhesin fimH gene was confirmed in all strains by polymerase chain reaction. The ability of S. liquefaciens to adhere to abiotic surfaces and to form biofilms likely contributes to its persistence in the hospital environment, increasing the probability of causing nosocomial infections, and therefore, a better understanding of the adherence properties in thispecies will provide greater insights into the diseases caused by this bacterium. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Applied and Environmental Microbiology 03/2015; 81(10). DOI:10.1128/AEM.00088-15 · 3.95 Impact Factor
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    ABSTRACT: We sought to determine the frequency, risk factors, and clinical impact of recurrent urinary tract infections (UTI) in kidney transplant recipients. Of 867 patients who received a kidney transplant between 2003 and 2010, 174 (20%) presented at least one episode of UTI. Fifty-five patients presented a recurrent UTI (32%) and 78% of them could be also considered relapsing episodes. Recurrent UTI was caused by extended-spectrum betalactamase (ESBL)-producing Klebsiella pneumoniae (31%), followed by non-ESBL producing Escherichia coli (15%), multidrug-resistant (MDR) Pseudomonas aeruginosa (14%), and ESBL-producing E. coli (13%). The variables associated with a higher risk of recurrent UTI were a first or second episode of infection by MDR bacteria (OR 12; 95%CI 528), age >60 years (OR 2.2; 95%CI 1.15.1), and reoperation (OR 3; 95%CI 1.37.1). In addition, more relapses were recorded in patients with UTI caused by MDR organisms than in those with susceptible microorganisms. There were no differences in acute rejection, graft function, graft loss or 1 year mortality between groups. In conclusion, recurrent UTI is frequent among kidney recipients and associated with MDR organism. Classic risk factors for UTI (female gender and diabetes) are absent in kidney recipients, thus highlighting the relevance of uropathogens in this population. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.
    American Journal of Transplantation 02/2015; 15(4). DOI:10.1111/ajt.13075 · 6.19 Impact Factor
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    ABSTRACT: The sensitivity of blood cultures in the diagnosis of bacteraemia for community-acquired pneumonia is low. Recommendations, by guidelines, to perform blood cultures are discordant. We aimed to determine the incidence, microbial aetiology, risk factors and outcomes of bacteraemic patients with community-acquired pneumonia, including cases with antibiotic-resistant pathogens (ARP). A prospective, observational study was undertaken on consecutive adult patients admitted to the Hospital Clinic of Barcelona (Barcelona, Spain) with community-acquired pneumonia and blood cultures were obtained. Of the 2892 patients included, bacteraemia was present in 297 (10%) patients; 30 (10%) of whom had ARP (multidrug-resistant Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and an extended spectrum of beta-lactamase producing Enterobacteriaceae). In multivariate analyses, pleuritic pain, C-reactive protein ⩾21.6 mg·dL(-1) and intensive care unit admissions were independently associated with bacteraemia, while prior antibiotic treatment and pneumococcal vaccine were protective factors. The risk factors for ARP bacteraemia were previous antibiotics and C-reactive protein <22.2 mg·dL(-1), while pleuritic pain was the only protective factor in the multivariate analysis. Bacteraemia (excluding ARP), appropriate empiric treatment, neurological disease, arterial oxygen tension/inspiratory oxygen fraction <250, pneumonia severity index risk classes IV and V, and intensive care unit admission were independently associated with a 30-day hospital mortality in the multivariate analysis. Inappropriate therapy was more frequent in ARP bacteraemia, compared with other bacteraemias (27% versus 3%, respectively, p<0.001). Antibiotic therapy protected against bacteraemia, but increased specifically the risk of bacteraemia from ARP due to the inappropriate coverage of these pathogens. Identifying patients at risk of ARP bacteraemia would help in deciding appropriate empiric antimicrobial therapy. The results from this study provide evidence concerning community-acquired pneumonia patients in whom blood cultures should not be performed. Copyright ©ERS 2015.
    European Respiratory Journal 01/2015; 45(5). DOI:10.1183/09031936.00152514 · 7.13 Impact Factor
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    ABSTRACT: This study reports one case and review the literature on TAVI-associated endocarditis (TAVIE), to describe its clinical picture and to perform an analysis on prognostic factors. A MEDLINE search from January 2002 to July 2013 revealed 31 cases of TAVIE, including 1 from our hospital. Median age was 81 years (IQR, 78-85), 53% of patients were males and the median age-adjusted Charlson score was 7 (IQR, 5-8). Heart failure was recorded in 42%, embolic events in 19%, and periannular complications in 45%. The most common causative agents was Enterococcus spp (36%). Ten patients (32%) underwent surgery and nine patients died (29%). The prognostic factors for 6-month mortality were heart failure (HR, 9.97 [3.7-24.5]; p=0.001), periannular complications (HR, 11.82 [3.3-41.3]; p=0.004), and nonenterococcal/streptococcal etiology (HR, 4.76 [2.1-11.1]; p=0.03). In patients with heart failure who did not undergo surgery, mortality was 89% (8 out of 9); in those who did undergo surgery, mortality was 0% (p<0.001). TAVIE is an emerging entity with high mortality. Patients with heart failure who did not undergo surgery had a higher probability of dying. Surgical treatment provided better outcomes even in patients in whom surgery had previously been ruled out. Copyright © 2014. Published by Elsevier Ltd.
    Journal of Infection 01/2015; 70(6). DOI:10.1016/j.jinf.2014.12.013 · 4.02 Impact Factor
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    ABSTRACT: To evaluate the performance of the eazyplex(®) SuperBug CRE system, a loop-mediated isothermal amplification (LAMP)-based system, for confirming the presence of carbapenemases in addition to CTX-M-type ESBLs in previously genotypically and/or phenotypically characterized clinical Enterobacteriaceae isolates recovered in two centres in Spain. A collection of 94 carbapenemase-producing strains previously characterized by conventional PCR and sequencing and a total of 45 prospectively collected isolates with phenotypes compatible with the presence of a carbapenemase were tested with the eazyplex(®) SuperBug CRE system. In both cases, the presence of an ESBL was also assessed. Results were evaluated to establish the accuracy of this rapid LAMP-based system as well as to determine the concordance between all approaches. The eazyplex(®) SuperBug CRE system correctly detected bla carbapenemase genes with or without blaCTX-M genes in 100% of the molecularly characterized strains. Absolute concordance (100%) was also observed in the case of isolates with phenotypes compatible with the presence of a carbapenemase with or without an ESBL inferred by susceptibility patterns and phenotypic inhibitory profiles. Determinations performed with the eazyplex(®) SuperBug CRE system took 15 min. The eazyplex(®) SuperBug CRE system proved to be a powerful tool for the detection of different carbapenemases as well as CTX-M-type ESBLs in Enterobacteriaceae with a rapid resolution time. The test has the high-performance parameters attributable to the sensitivity and specificity already demonstrated by LAMP-based assays. These results assure the usefulness of this test for routine rapid confirmation of carbapenemase-producing Enterobacteriaceae. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
    Journal of Antimicrobial Chemotherapy 11/2014; DOI:10.1093/jac/dku476 · 5.44 Impact Factor
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    ABSTRACT: We describe the occurrence of blaVIM-2 in 10 carbapenem-resistant Pseudomonas monteilii strains isolated from different clinical samples in our hospital in Northern Spain. All the blaVIM-2-harbouring P. monteilii isolates possessed a class 1 integron, with the cassette array [intI1_blaVIM-2_aac(6' )-Ib_qacEΔ1_sul1]. Our results show the emergence of VIM-2-producing multidrug-resistant species other than P. aeruginosa or P. putida in a Spanish hospital. P. monteilii, though sporadically isolated, should also be considered as an important MBLs reservoir. Copyright © 2014, American Society for Microbiology. All Rights Reserved.
    Antimicrobial Agents and Chemotherapy 11/2014; 59(2). DOI:10.1128/AAC.04639-14 · 4.45 Impact Factor
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    ABSTRACT: Infective endocarditis (IE) continues to be a serious disease with a poor prognosis and high mortality. Neither incidence rates nor mortality have decreased in recent decades. Because of this, it is important to prevent IE in patients at risk. In the past, prevention of IE has focused on antimicrobial prophylaxis, mainly for dental procedures. However, recent major changes in epidemiology, the most significant being the growing frequency and high mortality rate of health care-associated valve endocarditis (HAIE), mean that preventive strategies against IE must also change. Since intravascular catheters are the most common source of bacteremia among patients with HAIE, significant efforts must be made to minimize the risk of catheter-related bloodstream infections. Measures for preventing the infection of prosthetic valves and cardiac implantable devices at the time of implantation also need to be implemented.
    Current Infectious Disease Reports 11/2014; 16(11):439. DOI:10.1007/s11908-014-0439-4
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    ABSTRACT: A carbapenem-resistant Escherichia coli (ST448) was recovered from a urine culture of a female patient with no recent travelling record. PCR screening identified the presence of blaNDM-5, blaTEM-1,blaOXA-1, blaCMY-42 and rmtB. blaNDM-5 was carried in a conjugative IncFII-type plasmid (90 Kb) together with blaTEM-1 and rmtB. The genetic surrounding of blaNDM-5 showed structural similarities to those of pMC-NDM and pGUE-NDM, identified in Poland and France in E. coli of African and Indian origin, respectively.
    Antimicrobial Agents and Chemotherapy 10/2014; 59(1). DOI:10.1128/AAC.04040-14 · 4.45 Impact Factor
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    ABSTRACT: Carbapenem-resistant Acinetobacter baumannii is a major source of nosocomial infections worldwide and is mainly associated with the acquisition of OXA-type carbapenemases and, to a lesser extent, metallo-β-lactamases (MBLs). In this study, 82 non-epidemiologically related Acinetobacter strains carrying different types of OXA- or MBL-enzymes were tested using the Eazyplex® system, a LAMP-based method to rapidly detect carbapenemase carriage. The presence/absence of carbapenem-hydrolyzing enzymes was correctly determined for all isolates in less than 30 minutes.
    Antimicrobial Agents and Chemotherapy 09/2014; 58(12). DOI:10.1128/AAC.03870-14 · 4.45 Impact Factor
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    ABSTRACT: Objectives: The aim of the study was to assess the in vivo efficacy of DAP, DAP+AMP, or AMP + ceftriaxone (CRO) against 2 different HLAR E. faecalis strains: EFAE-188, which developed DAP resistance after 24 h of in vitro exposure to subinhibitory DAP concentrations (MIC increased from 2 to 8 mg/L), and EFAE-324, which did not. Methods: The MIC/MBCs of DAP, AMP, and CRO were tested using a microdilution method. An inoculum of 7×107 cfu/mL of EFAE-188 or EFAE-324 was injected intravenously 24 h after formation of catheter-induced aortic valve vegetations. 24 h after infection, the animals were treated for 72 h with iv DAP, DAP+AMP, or AMP+CRO, which were administered with a computer-controlled infusion pump system to simulate human serum antibiotic levels corresponding to human doses of DAP 10 mg/kg/d, AMP 2 g/4 h and CRO 2 g/12 h. Rabbits were sacrificed after 6 drug half-lives. Vegetations were obtained and cultured. In all isolates recovered from vegetations, DAP MICs were tested by E-test. A population analysis profile (PAP) was generated to detect increases in resistant subpopulations. Results: The DAP, AMP, and CRO MIC/MBCs were 2/8, 1/4, and >256/- mg/L respectively for EFAE-188 and 1/8, 2/4 and >512/- mg/L for EFAE-324. The peak and trough levels achieved were as follows: DAP, 130/17 mg/L (10 mg/kg/d); AMP, 100/6 mg/L (2 g/4 h); CRO, 256/45 mg/L (2 g/12 h). All the isolates recovered from vegetations presented the same MICs as the original strains and did not present differences in the PAP. Conclusions: After 3 days of treatment, DAP monotherapy at 10 mg/kg had no activity against either of the HLAR E. faecalis strains in the EE model. However, the combination of DAP+AMP was synergistic against both strains and showed the same activity as AMP+CRO against EFAE-324.
    ICAAC 2014, Washington, D.C; 09/2014
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    ABSTRACT: Objectives To evaluate characteristics and prognostic factors of community-onset bloodstream infection (Co-BSI) in elderly patients (≥65 years). Methods Analysis of a prospective series of Co-BSI at a tertiary hospital (2005-2011). Predictors of 30-day mortality were established by logistic regression analysis. Results A total of 2605 episodes of Co-BSI were identified and empirical antibiotic treatment was inappropriate in 404 (15.5%). Thirty-day mortality was 11.4% and was independently associated with age (75-84 years OR 1.9, 1.37-2.65; ≥85 OR 2.84, 1.92-4.19), previous hospitalization (OR 1.45, 1.05-1.99), a fatal underlying disease (OR 2.80, 2.09-3.76), neutropenia (OR 2.61, 1.54-4.42), absence of fever (OR 1.99, 1.26-3.12), shock (OR 7.96, 5.82-10.88), inappropriate empirical treatment (OR 1.48, 1.02-2.12), isolation of Staphylococcus aureus (methicillin-resistant OR 2.83, 1.38-5.78; methicillin-susceptible OR 3.24, 1.98-5.32), enterococci (OR 2.03, 1.15-3.60) or Enterobacteriaceae resistant to third-generation cephalosporin (3GCR-E) (OR 1.97, 1.16-3.33) and having endovascular non-catheter (OR 4.65, 2.52-8.61), abdominal (OR 3.65, 2.12-6.28), skin/soft tissue (OR 3.45, 1.88-6.32), respiratory (OR 2.81, 1.75-4.50) or unknown (OR 1.84, 1.18-2.88) source. Conclusions Age is a prognostic factor and appropriateness of empirical treatment is the only modifiable variable. S. aureus, enterococci and 3GCR-E may be the microorganisms with major prognostic significance; hence efforts should be made to improve their management.
    Journal of Infection 09/2014; 70(2). DOI:10.1016/j.jinf.2014.09.002 · 4.02 Impact Factor
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    ABSTRACT: The aim of this study was to assess changes in antibiotic resistance, epidemiology, and outcome among patients with Enterococcus faecalis infective endocarditis (EFIE) and to compare the efficacy and safety of the combination of ampicillin and gentamicin (A+G) with that of ampicillin plus ceftriaxone (A+C). The study was a retrospective analysis of a prospective cohort of EFIE patients treated in our center from 1997 to 2011. Thirty patients were initially treated with A+G (ampicillin 2 g/4 h and gentamicin 3 mg/kg/d) and 39 with A+C (ampicillin 2 g/4 h and ceftriaxone 2 g/12 h) for 4-6 weeks. Increased rates of high-level aminoglycoside resistance (HLAR: gentamicin MIC ≥512 mg/L, streptomycin MIC ≥1024 mg/L or both) were observed in recent years (24% in 1997-2006 and 49% in 2007-2011; P=0.03). The use of A+C increased over time: 1997-2001, 4/18 (22%); 2002-2006, 5/16 (31%); and 2007-2011, 30/35 (86%) (P<0.001). Renal failure developed in 65% of the A+G group and in 34% of the A+C group (P=0.014). Thirteen patients (43%) in the A+G group had to discontinue treatment, whereas only 1 patient (3%) treated with A+C had to discontinue treatment (P<0.001). Only development of heart failure and previous chronic renal failure were independently associated with one-year mortality, while the individual antibiotic regimen (A+C vs. A+G) did not affect outcome (OR 0.7, 95%CI 0.2-2.2, P=0.549). Our study shows that the prevalence of HLAR EFIE has increased significantly in recent years and that alternative treatment with A+C is safer than A+G, with similar clinical outcomes, although the sample size is too small to draw firm conclusions. Randomized controlled studies are needed to confirm these results.This article is protected by copyright. All rights reserved.
    Clinical Microbiology and Infection 07/2014; 20(12). DOI:10.1111/1469-0691.12756 · 5.20 Impact Factor
  • International journal of antimicrobial agents 07/2014; 44(1). DOI:10.1016/j.ijantimicag.2014.04.005 · 4.26 Impact Factor

Publication Stats

5k Citations
1,029.75 Total Impact Points

Institutions

  • 2015
    • Instituto de Salud Carlos III
      • National Center of Microbiology (CNM)
      Madrid, Madrid, Spain
  • 2014–2015
    • CRESIB Barcelona Centre for International Health Research
      Barcino, Catalonia, Spain
  • 1993–2015
    • University of Barcelona
      • • Department of Medicine
      • • Department of Microbiology
      • • Facultad de Medicina
      Barcino, Catalonia, Spain
  • 1990–2015
    • Hospital Clínic de Barcelona
      • • Servicio de Microbiología
      • • Servicio de Enfermedades Infecciosas
      • • Servicio de Neumología
      Barcino, Catalonia, Spain
  • 1999–2014
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
  • 2007–2012
    • Universidad de Las Palmas de Gran Canaria
      Las Palmas, Canary Islands, Spain
    • Hospital Universitario Ramón y Cajal
      • Departamento de Microbiologia y Parasitología
      Madrid, Madrid, Spain
  • 2009
    • Wayne State University
      • Department of Internal Medicine
      Detroit, Michigan, United States
  • 2008
    • Hospital Universitario Marques de Valdecilla
      Santander, Cantabria, Spain
    • Hospital Universitari i Politècnic la Fe
      • Servicio de Microbiología
      Valenza, Valencia, Spain
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 2005
    • Hospital Universitari Mutua de Terrassa
      Terrassa, Catalonia, Spain
  • 1995
    • Hospital Universitari Germans Trias i Pujol
      Badalona, Catalonia, Spain