M Carmen Fariñas

Publications (26)107 Total impact

• Article: Reduced incidence of pneumonia in influenza-vaccinated solid organ transplant recipients with influenza disease.

  P Perez-Romero, T A Aydillo, A Perez-Ordoñez, P Muñoz, A Moreno, F López-Medrano, M Bodro, M Montejo, J Gavaldà, M Carmen Fariñas, J Pachon, E Cordero
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  ABSTRACT: Clin Microbiol Infect ABSTRACT: Whether influenza vaccination influences the severity of illness in cases of clinical failure in solid organ transplant (SOT) recipients receiving influenza vaccine has not been extensively studied. Our goal was to evaluate the frequency of influenza vaccination among SOT recipients with influenza disease and its impact on the illness severity during the 2010-2011 season. Adult SOT recipients with confirmed influenza infection were included from December 2010 to April 2011. Follow-up data were recorded and antibody titres were determined using a microneutralization assay. Sixty-four SOT recipients were included in the study, ten (15.6%) with severe disease, requiring admission to intensive care units, of whom four (6.3%) died. In all, 34 (53.1%) received the 2010-2011 seasonal influenza vaccine and 32 (50.0%) received the 2009-H1N1 pandemic vaccine, and none had detectable antibodies against influenza at the time of diagnosis of influenza infection. Twenty-three (67.6%) of the patients that received the vaccine required hospital admission and presented less dyspnoea (10, 29.4% versus 14 (50.0%), p 0.09) and pneumonia (8, 23.8% versus 15, 50.0%, p 0.03, relative risk 0.3, 95% CI 0.1-0.9) than unvaccinated patients, with relative risk reductions of 60% and 70%, respectively. Although influenza vaccination confers protection on SOT recipients against developing influenza pneumonia, the rate of clinical failure is still high. New strategies to improve influenza immunization are needed for this group of patients.
  Clinical Microbiology and Infection 09/2012; · 4.54 Impact Factor
• Article: [Daptomycin in complicated skin and soft tissue infections].

  José Barberán, M Carmen Fariñas
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  ABSTRACT: In recent years, Staphylococcus aureus, the most commonly identified infectious agent causing skin and soft tissue infections (SSTIs), has shown an increase in methicillin resistance and decreased susceptibility to vancomycin. Because of its spectrum, microbiological activity, pharmacokinetics, and safety, as well as clinical experience in its use, daptomycin seems to be a highly appropriate antibiotic in the treatment of SSTIs, especially those produced by methicillin-resistant S. aureus.
  Enfermedades Infecciosas y Microbiología Clínica 02/2012; 30 Suppl 1:33-7. · 1.49 Impact Factor
• Article: Prognosis of 2009 A(H1N1) influenza in hospitalized pregnant women in a context of early diagnosis and antiviral therapy.

  José Ramón Paño-Pardo, Jesús Rodríguez-Baño, Nuria Martínez-Sánchez, Diego Viasus, M Carmen Fariñas, María Leyes, Francisco López-Medrano, Jerónimo Pachón, Julián Torre-Cisneros, José Antonio Oteo, Tomás Pumarola, Mercedes García-Gasalla, Lucía Ortega, Ferrán Segura, Jordi Carratalá
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  ABSTRACT: Initial reports suggested that novel A(H1N1) influenza virus (2009 A[H1N1]v) infection was significantly more severe in pregnant than in non-pregnant women. In Spain, antiviral therapy was recommended for pregnant women from the beginning of the 2009 pandemic. The prospective cohort study included consecutive pregnant and non-pregnant women of reproductive age with a proven diagnosis of 2009 A(H1N1)v admitted to any of the 13 participating Spanish hospitals between 12 June and 10 November 2009. In total, 98 pregnant and 112 non-pregnant women with proven 2009 A(H1N1)v hospitalized during the study period were included. Influenza was more severe among non-pregnant patients than pregnant patients with respect to outcomes of both intensive care unit admission (18% versus 2%; P<0.001) and death (5 versus 0; P=0.06). Pregnant women had fewer associated comorbid conditions other than pregnancy (18% versus 44%; P<0.001); they were also admitted earlier than non-pregnant women (median days since onset of symptoms: 2 versus 3; P<0.001) and a higher percentage received early antiviral therapy (41% versus 28%; P=0.03). Neither a multivariate nor a matched cohort analysis found pregnancy to be associated with greater severity than that associated with hospitalized, seriously ill non-pregnant women. 2009 A(H1N1)v influenza was not associated with worse outcomes in hospitalized pregnant women compared with non-pregnant ones of reproductive age in a context of early diagnosis and antiviral therapy.
  Antiviral therapy 12/2011; 17(4):719-28. · 3.16 Impact Factor
• Article: [Lights and shadows of cytomegalovirus infection in solid organ transplantation].

  M Carmen Fariñas, Julián Torre-Cisneros, Albert Pahissa
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  ABSTRACT: Cytomegalovirus (CMV) develops in 30-80% of patients undergoing solid organ transplantation (SOT). The incidence and presence of symptomatic disease varies depending on the type of transplant, the presence of associated risk factors, the intensity of immunosuppression, and the prevention strategies used. The impact of CMV on SOT is due not only to the effects of CMV disease per se, but also to its multiple indirect effects resulting from its immunomodulatory role and immunoactivation caused by viral latency. The two prophylactic strategies used (universal prophylaxis and preemptive therapy) are equally useful. Both strategies have advantages and disadvantages, and uncertainties remain on the populations that should receive prophylaxis and for how long. Viral monitoring to detect CMV infection is important for diagnosis, prognosis and evaluation of treatment response. The new real-time polymerase chain reaction techniques have provided numerous advantages but standardization remains an issue and common reference values are required. Specific anti-CMV drugs are available but issues such as the role of valganciclovir versus ganciclovir, the development of resistances and optimal treatment length are still being debated. Complementary therapy with mTOR inhibitors and vaccine strategies against CMV are alternatives for which conclusive data are lacking.
  Enfermedades Infecciosas y Microbiología Clínica 12/2011; 29 Suppl 6:1-3. · 1.49 Impact Factor
• Article: Risk factors, clinical features, and outcomes of toxoplasmosis in solid-organ transplant recipients: a matched case-control study.

  Núria Fernàndez-Sabé, Carlos Cervera, M Carmen Fariñas, Marta Bodro, Patricia Muñoz, Mercè Gurguí, Julián Torre-Cisneros, Pilar Martín-Dávila, Ana Noblejas, Oscar Len, Ana García-Reyne, José Luis Del Pozo, Jordi Carratalà
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  ABSTRACT: Solid-organ transplant (SOT) recipients are considered to be at increased risk for toxoplasmosis. However, risk factors for this infection have not been assessed. The aim of this study was to determine the risk factors, clinical features, and outcomes of toxoplasmosis in SOT recipients. A multicenter, matched case-control study (1:2 ratio) was conducted between 2000 and 2009. Control subjects were matched for center, transplant type, and timing. Cases were identified from the hospitals' microbiology and transplantation program databases. Logistic regression was performed to identify independent risk factors. Twenty-two cases (0.14%) of toxoplasmosis were identified among 15 800 SOTs performed in 11 Spanish hospitals, including 12 heart, 6 kidney, and 4 liver recipients. Diagnosis was made by seroconversion (n = 17), histopathologic examination (n = 5), polymerase chain reaction (n = 2), and autopsy (n = 2). In a comparison of case patients with 44 matched control subjects, a negative serostatus prior to transplantation was the only independent risk factor for toxoplasmosis (odds ratio, 15.12 [95% confidence interval, 2.37-96.31]; P = .004). The median time to diagnosis following transplantation was 92 days. Primary infection occurred in 18 (81.8%) cases. Manifestations included pneumonitis (n = 7), myocarditis (n = 5), brain abscesses (n = 5), chorioretinitis (n = 3), lymph node enlargement (n = 2), hepatosplenomegaly (n = 2), and meningitis (n =1). Five patients (22.7%) had disseminated disease. Crude mortality rate was 13.6% (3 of 22 patients). Although uncommon, toxoplasmosis in SOT patients causes substantial morbidity and mortality. Seronegative recipients are at high risk for developing toxoplasmosis and should be given prophylaxis and receive careful follow-up.
  Clinical Infectious Diseases 11/2011; 54(3):355-61. · 9.15 Impact Factor
• Article: Pneumonia Complicating Pandemic (H1N1) 2009: Risk Factors, Clinical Features, and Outcomes

  Diego Viasus, José Ramón Paño-Pardo, Jerónimo Pachón, Melchor Riera, Francisco López-Medrano, Antoni Payeras, M. Carmen Fariñas, Asunción Moreno, Jesús Rodríguez-Baño, José Antonio Oteo, Joaquín Martínez-Montauti, Julián Torre-Cisneros, Ferrán Segura, Francesc Gudiol, Jordi Carratalà
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  ABSTRACT: We performed an observational analysis of a prospective cohort of adults hospitalized for pandemic (H1N1) 2009 at 13 Spanish hospitals, from June to November 2009, to determine the risk factors, clinical features, and outcomes of pneumonia. Of 585 patients requiring hospitalization, chest radiography was obtained in 542. A total of 234 (43.1%) patients had pneumonia, of whom 210 underwent bacterial microbiologic studies. Of these patients, 174 (82.8%) had primary viral pneumonia and 36 (17.2%) had concomitant/secondary bacterial pneumonia. Bilateral pneumonia occurred in 48.3% of patients. Streptococcus pneumoniae was the most frequent pathogen among patients with bacterial pneumonia (26 of 36 patients). None of them had received pneumococcal vaccine. Compared with patients without pneumonia, those with pneumonia more frequently had shock during hospitalization (9.8% vs. 1%; p < 0.001), required intensive care unit admission (22.6% vs. 5.8%; p < 0.001), underwent mechanical ventilation (17.9% vs. 3.2%; p < 0.001), and had longer length of hospital stay (median, 7 d vs. 5 d; p < 0.001). In-hospital mortality was higher in patients with pneumonia than in the others (5.2% vs. 0%; p < 0.001). Absence of comorbid conditions (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.32-3.24) was found to be an independent risk factor for pneumonia, whereas early (≤48 h) oseltamivir therapy (OR, 0.29; 95% CI, 0.19-0.46) was a protective factor. In conclusion, pneumonia is a frequent complication among adults hospitalized for pandemic (H1N1) 2009 and causes significant morbidity. Mortality in pandemic (H1N1) 2009 is low, but occurs mainly in patients with pneumonia. Early oseltamivir therapy is a protective factor for this complication. Abbreviations: BMI = body mass index, CAP = community-acquired pneumonia, CI = confidence interval, CURB-65 = confusion, urea, respiratory rate, blood pressure, and age ≥65 years, ICU = intensive care unit, OR = odds ratio, PSI = pneumonia severity index, ROC = receiver operating characteristic, RT-PCR = reverse-transcription polymerase chain reaction.
  Medicine 08/2011; 90(5):328-336. · 4.35 Impact Factor
• Article: New trends in infective endocarditis.

  M Carmen Fariñas, Pedro Llinares, Benito Almirante, José Barberán, Juan de Dios Colmenero, Javier Garau, Francisco Gudiol, José Hernández Quero, José Mensa, Miguel Montejo, Jerónimo Pachón, Jesús Rodríguez-Baño, Miguel Sánchez-García
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  ABSTRACT: The present article is an update of the literature on endocarditis. A multidisciplinary group of Spanish physicians with an interest in cardiac infections selected the most important papers produced lately in the field. Two of the members of the group discussed the content of each of the selected papers, with a critical review by others members of the panel. After a review of the state of the art papers from the fields of epidemiology, new causative microorganisms (bacterial and fungal), clinical findings including those in special patients, laboratory diagnosis, prognostic factors, nosocomial endocarditis, prophylaxis, new drugs and guidelines for antibiotic treatment were discussed by the group.
  Enfermedades Infecciosas y Microbiología Clínica 03/2011; 29 Suppl 4:22-35. · 1.49 Impact Factor
• Article: Timing of oseltamivir administration and outcomes in hospitalized adults with pandemic 2009 influenza A(H1N1) virus infection.

  Diego Viasus, José Ramón Paño-Pardo, Jerónimo Pachón, Melchor Riera, Francisco López-Medrano, Antoni Payeras, M Carmen Fariñas, Asunción Moreno, Jesús Rodríguez-Baño, José Antonio Oteo, Lucia Ortega, Julián Torre-Cisneros, Ferrán Segura, Jordi Carratalà
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  ABSTRACT: Data on the clinical effectiveness of oseltamivir in patients with pandemic 2009 influenza A(H1N1) (A[H1N1]) virus infection are scarce. We aimed to determine the effect of timing of oseltamivir administration on outcomes in hospitalized adults with A(H1N1). Observational analysis of a prospective cohort of adults hospitalized with laboratory-confirmed A(H1N1) was performed at 13 Spanish hospitals. Time from onset of symptoms to oseltamivir administration was the independent variable. Outcomes were duration of fever, hospital length of stay (LOS), need for mechanical ventilation, and mortality during hospitalization. Multivariate logistic regression was used to describe the association between the independent variable and the outcomes. Five hundred thirty-eight hospitalized patients with A(H1N1) were studied. The median time from onset of symptoms to oseltamivir administration was 3 days (interquartile range [IQR], 2-5 days). With regard to outcomes, the median duration of fever was 2 days (IQR, 1-3 days), the median LOS was 5 days (IQR, 3-8 days), 49 patients (9.1%) underwent mechanical ventilation, and 11 patients (2%) died during hospitalization. In univariate analysis, prolonged duration of fever (above the median), prolonged LOS (above the median), need for mechanical ventilation, and mortality all increased with time to oseltamivir administration (χ(2) test for trend P = .001, P ≤ .001, P = .008, and P = .001, respectively). After adjustment for confounding factors, time from onset of symptoms to oseltamivir administration (+ 1-day increase) was associated with a prolonged duration of fever (OR, 1.10; 95% CI, 1.02-1.19), prolonged LOS (OR, 1.07; 95% CI, 1.00-1.15), and higher mortality (OR, 1.20; 95% CI, 1.06-1.35). Timely oseltamivir administration has a beneficial effect on outcomes in hospitalized adults with A(H1N1), even in those who are admitted beyond 48 h after onset of symptoms.
  Chest 03/2011; 140(4):1025-32. · 5.25 Impact Factor
• Article: [Identification of clinically relevant fungi using molecular techniques].

  Fabián Unda, Jesús Agüero, M Carmen Fariñas, Luis Martínez-Martínez
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  ABSTRACT: To apply a sequencing-based molecular method to identify clinically relevant fungi to species level. Thirty-six fungi not identifiable at a species level by a conventional approach and 39 invasive clinical samples were prospectively evaluated. The results were compared with those obtained by conventional methods. Molecular methods allowed rapid and reliable identification of fungi at species level, including both from organisms grown in culture and those in clinical samples. Molecular methods show clear advantages for fungal identification, including rapid identification at species level and high negative predictive value.
  Enfermedades Infecciosas y Microbiología Clínica 02/2011; 29(4):282-5. · 1.49 Impact Factor
• Article: Risk factors, clinical features, and outcomes of listeriosis in solid-organ transplant recipients: a matched case-control study.

  Núria Fernàndez-Sabé, Carlos Cervera, Francisco López-Medrano, Miguel Llano, Elena Sáez, Oscar Len, Jesús Fortún, Marino Blanes, Rosa Laporta, Julián Torre-Cisneros, Joan Gavaldà, Patricia Muñoz, M Carmen Fariñas, José María Aguado, Asunción Moreno, Jordi Carratalà
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  ABSTRACT: Solid-organ transplant (SOT) recipients are classically considered to be at increased risk for listeriosis. However, risk factors for this infection have not been assessed. We carried out a multicenter, matched case-control study (1:2 ratio) from January 1995 through December 2007. Control subjects were matched for center, transplant type, and timing. Conditional logistic regression was performed to identify independent risk factors. Clinical features and outcomes for all case patients were reviewed. Thirty patients (0.12%) with cases of listeriosis were identified among 25,997 SOT recipients at 15 Spanish transplant centers. In a comparison of case patients with 60 matched control subjects, the following independent risk factors for listeriosis were identified: diabetes mellitus (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.6-19.6; ), P = .007 history of cytomegalovirus infection or disease within the preceding 6 months (OR, 35.9; 95% CI, 2.1-620; P = .014), receipt of high-dose prednisone within the preceding 6 months (OR, 6.2; 95% CI, 1.8-21.1; P = .003), and trimethoprim-sulfamethoxazole (TMP-SMZ) prophylaxis (OR, 0.07; 95% CI, 0.006-0.76; P = .029). Twenty-six patients (86.7%) had bacteremia, and 7 had shock at presentation. Other manifestations included meningoencephalitis (10 cases), spontaneous peritonitis (2), pleural empyema (1), brain abscesses (1), and liver abscesses (1). The 30-day mortality rate was 26.7% (8 of 30 patients died). Listeriosis in SOT recipients is uncommon but causes high mortality. Diabetes mellitus, cytomegalovirus infection or disease, and receipt of high-dose steroids are independent risk factors for this infection, whereas TMP-SMZ prophylaxis is a protective factor.
  Clinical Infectious Diseases 10/2009; 49(8):1153-9. · 9.15 Impact Factor
• Article: Clinical course and predictors of death in prosthetic valve endocarditis over a 20-year period.

  Hector Alonso-Valle, Concepcion Fariñas-Alvarez, Jose Daniel García-Palomo, Jose Manuel Bernal, Rafael Martín-Durán, Jose Francisco Gutiérrez Díez, Jose Manuel Revuelta, M Carmen Fariñas
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  ABSTRACT: To compare early and late outcome of patients with prosthetic valve endocarditis treated medically versus surgically and to determine predictors of in-hospital death. We retrospectively reviewed patient's clinical records, including laboratory findings, surgery, and pathologic files, in an acute-care, 1200-bed teaching hospital. One hundred thirty-three episodes of definite prosthetic valve endocarditis as defined by the Duke University diagnostic criteria occurred in 122 patients from January 1986 to December 2005. Logistic regression model was used to identify prognostic factors of in-hospital mortality. Long-term follow-up was made to assess late prognosis. Bioprostheses were involved in 52% of cases and mechanical valves in 48%. The aortic valve was affected in 45% of patients. Staphylococcus epidermidis was isolated in 23% of cases, Streptococcus spp in 21%, S aureus in 13%, and Enterococcus in 8%. Cultures were negative in 18% of cases. Twenty-six patients were treated medically and 107 with combined antibiotics and valve replacement. The operative mortality was 6.5% and the in-hospital mortality, 29%. Presence of an abscess at echocardiography, urgent surgical treatment, heart failure, thrombocytopenia, and renal failure were significant predictors of in-hospital death. Kaplan-Meier survival at 12 months was 42% in patients treated medically and 71% in those treated surgically (P = .0007). Freedom from endocarditis was 91% at the end of follow-up. Prosthetic valve endocarditis is a serious condition with high mortality. Patients with perivalvular abscess had a worse prognosis, and combined surgical and medical treatment could be the preferred approach to improve outcome.
  The Journal of thoracic and cardiovascular surgery 08/2009; 139(4):887-93. · 3.41 Impact Factor
• Article: Use of mitral homograft to support a mechanical valve prosthesis: a feasible solution for recurrent mitral valve dysfunction.

  José M Bernal, Francisco Gutiérrez, M Carmen Fariñas, Elena Arnaiz, Carmen Diago, Alejandro Pontón, Blanca Ruiz, J Fernando Val-Bernal, José M Revuelta
  The Journal of thoracic and cardiovascular surgery 04/2009; 137(3):762-3. · 3.41 Impact Factor
• Article: Post-operative mediastinitis, pleuritis and pericarditis due to Mycoplasma hominis and Ureaplasma urealyticum with a fatal outcome.

  Celia García-de-la-Fuente, Eduardo Miñambres, Estibaliz Ugalde, Ana Sáez, Luis Martinez-Martinez, M Carmen Fariñas
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  ABSTRACT: Post-sternotomy mediastinitis, although infrequent, is a potentially life-threatening complication of cardiac surgery. We report an unusual case of Mycoplasma hominis and Ureaplasma urealyticum post-surgical mediastinitis with persistent pleural and pericardial effusion. Clinical manifestations and response to therapy are described, and the difficulties of establishing the diagnosis are discussed.
  Journal of Medical Microbiology 06/2008; 57(Pt 5):656-7. · 2.50 Impact Factor
• Source

  Available from: PubMed Central

  Article: Invasive Cryptococcosis and adalimumab treatment.

  Juan P Horcajada, Jose L Peña, Víctor M Martínez-Taboada, Trinitario Pina, Isabel Belaustegui, María Eliecer Cano, Daniel García-Palomo, M Carmen Fariñas
  Emerging infectious diseases 07/2007; 13(6):953-5. · 6.17 Impact Factor
• Article: Periannular complications in infective endocarditis involving native aortic valves.

  Ignasi Anguera, Jose M Miro, Artur Evangelista, Christopher H Cabell, Jose Alberto San Roman, Isidre Vilacosta, Benito Almirante, Tomas Ripoll, M Carmen Fariñas, Manuel Anguita, [......], Cristina Sarria, Gabriel Rufi, Francisco Miralles, Carles Pare, Vance G Fowler, Carlos A Mestres, Elisa de Lazzari, Joan R Guma, Asunción Moreno, G Ralph Corey
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  ABSTRACT: The extension of infection in native valve infective endocarditis (IE) from valvular structures to the periannular tissue is incompletely understood. It is unknown, for example, whether the prognosis of patients with aortocavitary fistulae is worse than that of those with nonruptured abscesses. The aims of this study were to determine the distinct clinical characteristics of patients with aortocavitary fistulae and nonruptured abscesses in native valve IE and to evaluate the impact of fistulization on the outcomes of patients with native aortic valve IE complicated with periannular lesions. In a retrospective multicenter study of 2,055 native valve IE episodes, 201 patients (9.8%) with periannular complications in aortic valve IE were identified (46 with aortocavitary fistulization and 155 with nonruptured abscesses). Rates of heart failure (p = 0.07), ventricular septal defect (p <0.001), and third-degree atrioventricular block (p = 0.07) were higher in patients with fistulization. Surgical treatment was undertaken in 172 patients (86%), and in-hospital mortality in the overall population was 29%. Multivariate analysis identified age >60 years (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.3 to 5.2), renal failure (OR 3.0, 95% CI 1.5 to 6.0), and moderate or severe heart failure (OR 2.5, 95% CI 1.2 to 5.2) as independent risk factors for death. There was a trend toward increased in-hospital mortality in patients with aortocavitary fistulae (OR 1.5, 95% CI 0.7 to 3.0). The actuarial 5-year survival rate in surgical survivors was 80% in patients with fistulae and 92% in patients with nonruptured abscesses (log-rank p = 0.6). In conclusion, aortocavitary fistulous tract formation in the setting of native valve IE is associated with higher rates of heart failure, ventricular septal defect, and atrioventricular block than nonruptured abscess. Despite these higher rates of complications, fistulous tract formation in the current era of IE is not an independent risk factor for mortality.
  The American Journal of Cardiology 12/2006; 98(9):1254-60. · 3.37 Impact Factor
• Article: Periannular complications in infective endocarditis involving prosthetic aortic valves.

  Ignasi Anguera, Jose M Miro, Jose Alberto San Roman, Aristides de Alarcon, Manuel Anguita, Benito Almirante, Artur Evangelista, Christopher H Cabell, Isidre Vilacosta, Tomas Ripoll, [......], M Carmen Fariñas, Gabriel Rufi, Francisco Miralles, Carles Pare, Vance G Fowler, Carlos A Mestres, Elisa de Lazzari, Joan R Guma, Ana del Río, G Ralph Corey
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  ABSTRACT: The periannular extension of infection in prosthetic valve endocarditis (PVE) is a serious complication of infective endocarditis associated with high mortality. Periannular lesions in PVE occasionally rupture into adjacent cardiac chambers, leading to aortocavitary fistulae and intracardiac shunting. It is unknown whether the prognosis of patients with aortocavitary fistulae is worse than that of those with nonruptured abscesses. The aims of this study were to determine the distinctive clinical characteristics of patients with PVE and either aortocavitary fistulization or nonruptured abscesses. In a retrospective multicenter study of >872 PVE episodes, 150 patients (17%) with periannular complications in PVE in the aortic position were identified (29 with aortocavitary fistulization and 121 with nonruptured abscesses). Early-onset PVE was present in 73 patients (49%). Rates of heart failure (p = 0.09), ventricular septal defect (p <0.01), and third-degree atrioventricular block (p = 0.07) were higher in patients with fistulization. Surgical treatment was undertaken in 128 patients (83%). In-hospital mortality in the overall population was 39%. Multivariate analysis identified heart failure (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.6 to 6.8), renal failure (OR 2.5, 95% CI 1.2 to 5.2), and co-morbidity (OR 2.4, 95% CI 1.1 to 5.1) as independent risk factors for death. Fistulous tract formation was not associated with increased in-hospital mortality (OR 1.6, 95% CI 0.7 to 3.7). The actuarial 5-year survival rate in surgical survivors was 100% in patients with fistulae and 78% in patients with nonruptured abscesses (log-rank p = 0.14). In conclusion, aortocavitary fistulous tract formation in PVE complicated with periannular complications is associated with higher rates of heart failure, ventricular septal defect, and atrioventricular block than nonruptured abscesses. Despite the frequent complications, fistulous tract formation in the current era of infective endocarditis is not an independent risk factor for mortality.
  The American Journal of Cardiology 12/2006; 98(9):1261-8. · 3.37 Impact Factor
• Article: Risk factors of prosthetic valve endocarditis: a case-control study.

  M Carmen Fariñas, Alberto Pérez-Vázquez, Concepción Fariñas-Alvarez, J Daniel García-Palomo, José M Bernal, José M Revuelta, Jesús González-Macías
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  ABSTRACT: Prosthetic valve endocarditis is an important cause of the morbidity and mortality associated with heart valve replacement surgery. The objective of this study was to assess risk factors of prosthetic valve endocarditis related to patients, perioperative events, and postoperative complications. This was a retrospective case-control study conducted in a tertiary care hospital in Santander, Spain, from January 1986 to January 1998. Cases were patients with "definite" and "possible" infective endocarditis defined according to the Durack criteria. Controls were patients undergoing prosthetic valve replacement who at the time of the study had not developed infective endocarditis. Information was abstracted from medical records. Cases and controls (1:2) were matched by sex, age at operation (+/- 5 years), surgery of one or more valves in the same anatomic position, and date of operation (+/- 6 months). There were 81 cases and 162 controls. In the multivariate analysis, risk factors significantly associated with prosthetic valve endocarditis were functional class III or IV (New York Heart Association), alcohol consumption, prior history of endocarditis, fever in the intensive care unit, and gastrointestinal bleeding. Functional class III or IV and complications of the surgical wound were independent predictors of early infective endocarditis, whereas fever in the intensive care unit and gastrointestinal bleeding were predictors of prosthetic valve endocarditis late after operation. Patients with prosthetic valve endocarditis differ from people without infective endocarditis with regard to intrinsic and postoperative risk factors but not regarding perioperative-related variables.
  The Annals of thoracic surgery 05/2006; 81(4):1284-90. · 3.74 Impact Factor
• Article: [Treatment of uncomplicated lower urinary tract infections].

  Juan Pablo Horcajada, Daniel García-Palomo, M Carmen Fariñas
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  ABSTRACT: Empirical antibiotic treatment of lower urinary tract infections should be based on the patient's clinical data and on local sensitivity data. Because of the increase in resistance among uropathogens, recommendations on the empirical treatment of urinary tract infections have been modified. Currently, the empirical use of co-trimoxazole, ampicillin, and first-generation cephalosporins and quinolones is not recommended. Fluoroquinolones have been demonstrated to be highly effective in comparative studies but, because of the increase in resistance, the type of patient who can benefit from these antimicrobial agents must be selected. Second- and third-generation cephalosporins still have high sensitivity rates, although the higher recurrence rates associated with their use and the emergence of extended-spectrum beta-lactamase-producing enterobacterial in the community should be taken into account. Amoxicillin-clavulanate is less effective in eradicating infections than quinolones. Fosfomycin-trometamol has resistance rates of below 2% and single-dose therapy has been demonstrated to be safe and effective. Nitrofurantoin is also currently active, although it must be administered for 7 days and can produce toxicity. Both agents are currently recommended as alternative therapeutic options to fluoroquinolones in uncomplicated infections of the lower urinary tract.
  Enfermedades Infecciosas y Microbiología Clínica 01/2006; 23 Suppl 4:22-7. · 1.49 Impact Factor
• Article: Nosocomial infection after lung surgery: incidence and risk factors.

  Daniel N Nan, Marta Fernández-Ayala, Concepción Fariñas-Alvarez, Roberto Mons, Francisco J Ortega, Jesús González-Macías, M Carmen Fariñas
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  ABSTRACT: To assess the incidence and risk factors for nosocomial infection after lung surgery. Prospective cohort study. Service of thoracic surgery of an acute-care teaching hospital in Santander, Spain. Between June 1, 1999, and January 31, 2001, all consecutive patients undergoing lung surgery were prospectively followed up for 1 month after discharge from the hospital to assess the development of nosocomial infection, the primary outcome of the study. During the hospitalization period, patients were visited on a daily basis. Postdischarge surveillance was based on visits to the surgeon. We studied 295 patients (84% men; mean age, 60.9 years), 89% of whom underwent resection operations. Ninety episodes of nosocomial infection were diagnosed in 76 patients, including pneumonia (n = 10), lower respiratory tract infection (n = 47), wound infection (n = 16; one third were detected after hospital discharge), urinary tract infection (n = 9), and bacteremia (n = 8; three fourths were catheter-related bacteremia). Twenty patients had severe infections (pneumonia or empyema), with a mortality rate of 60%. COPD (adjusted odds ratio [OR], 2.70; 95% confidence interval [CI], 1.52 to 4.84), duration of surgery with an increased risk for each additional minute (Mantel-Haenzel chi(2) test for trend, p = 0.037), and ICU admission (OR, 3.69; 95% CI, 1.94 to 7.06) were independent risk factors for nosocomial infection. The use of an epidural catheter was a protective factor (OR, 0.45; 95% CI, 0.22 to 0.95). There were no differences according to the use of amoxicillin/clavulanate or cefotaxime for surgical prophylaxis. Nosocomial infections are common after lung surgery. One third of wound infections were detected after hospital discharge. The profile of a high-risk patient includes COPD as underlying disease, prolonged operative time, and postoperative ICU admission.
  Chest 11/2005; 128(4):2647-52. · 5.25 Impact Factor
• Article: Aorto-cavitary fistulous tract formation in infective endocarditis: clinical and echocardiographic features of 76 cases and risk factors for mortality.

  Ignasi Anguera, Jose M Miro, Isidre Vilacosta, Benito Almirante, Manuel Anguita, Patricia Muñoz, Jose Alberto San Roman, Aristides de Alarcon, Tomas Ripoll, Enrique Navas, [......], M Carmen Fariñas, Ruben Leta, Gabriel Rufi, Francisco Miralles, Carles Pare, Artur Evangelista, Vance G Fowler, Carlos A Mestres, Elisa de Lazzari, Joan R Guma
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  ABSTRACT: To investigate the clinical features, echocardiographic characteristics, management, and prognostic factors of mortality of aorto-cavitary fistulization (ACF) in infective endocarditis (IE). Extension of infection in aortic valve IE beyond valvular structures may result in peri-annular complications with resulting necrosis and rupture, and subsequent development of ACF. Aorto-cavitary communications create intra-cardiac shunts, which may result in further clinical deterioration and haemodynamic instability. In a retrospective multi-centre study over 4681 episodes of IE, a total of 76 patients with ACF [1.6%, confidence interval (CI) 95%: 1.2-2.0%] diagnosed by echocardiography or during surgery were identified. Fistulae were found in 1.8% of cases of native valve IE and in 3.5% of cases of prosthetic valve IE from the general population and in 0.4% of drug abusers. PVE was present in 31 (41%) cases of ACF. Transthoracic and transoesophageal echocardiography detected the fistulous tracts in 53 and 97% of cases, respectively. Peri-annular abscesses were detected in 78% of cases, fistulae originated in similar rates from the three sinuses of Valsalva, and the four cardiac chambers were equally involved in the fistulous tracts. Heart failure (HF) developed in 62% of cases and surgery was performed in 66 (87% CI 95% 77-93%) patients with a mortality of 41% (95% CI 30-53%) in the overall population. Multivariate analysis identified HF (OR 3.4, CI 95% 1.0-11.5), prosthetic IE (OR 4.6, CI 95% 1.4-15.4) and urgent or emergency surgical treatment (OR 4.3, CI 95% 1.3-16.6) as variables significantly associated with an increased risk of death. Major complications during follow-up (death, re-operation, or re-admission for HF) among the five operative survivors with residual fistulae occurred in 20 and 100% of patients at 1 and 2 years, respectively. Aorto-cavitary fistulous tract formation is an uncommon but extremely serious complication of IE. In-hospital mortality was exceptionally high despite aggressive management with surgical intervention in the majority of patients. Prosthetic IE, urgent surgery, and the development of HF identify the subgroup of patients with IE and ACF that have significantly increased risk of in-hospital death.
  European Heart Journal 03/2005; 26(3):288-97. · 10.48 Impact Factor