E Bouza

Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Madrid, Spain

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Publications (646)2428.7 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Biofilm production in Candida spp. can be studied by measuring the biomass produced after application of crystal violet stain or by measuring metabolic activity with XTT. Our study is the first in which crystal violet and XTT are compared to analyze the ability of clinically relevant Candida and non-Candida species to produce biofilm. We studied 577 isolates causing fungemia in 512 patients admitted from January 2007 to July 2013. Based on the biomass production measured by crystal violet and the metabolic activity measured by XTT, strains were divided into terciles to establish tentative cut-offs to classify isolates as being low, moderate, or high biofilm-forming and as having low, moderate, or high metabolic activity. Considerable variability in biofilm production and metabolic activity was found both between species and within species. C. tropicalis showed the highest biomass production, whereas C. glabrata showed the highest metabolic activity, and non-Candida species isolates showed the lowest metabolic activity (P < 0.0023). The isolates were classified as low metabolic activity, moderate metabolic activity, and high metabolic activity according to their cut-offs by XTT (<0.097, 0.097–0.2, and >0.2) and as low biofilm-forming, moderate biofilm-forming, and high biofilm-forming according to their cut-offs by crystal violet (<0.44, 0.44–1.17, and >1.17). The overall categorical agreement between the procedures was 43.7%, which increased to >50% for C. albicans and C. parapsilosis. XTT and crystal violet are complementary procedures for the study of biofilm production.
    International Journal of Medical Microbiology 09/2014; · 4.54 Impact Factor
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    ABSTRACT: Listeria monocytogenes (LM) is a gram-positive intracellular bacillus that in immunodeficient patients, children, geriatric patients, pregnant women, and even in healthy individuals can cause central nervous system infection, bacteremia, and other clinical manifestations, becoming a relevant pathogen.
    European journal of gastroenterology & hepatology. 08/2014;
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    ABSTRACT: Survey of intravascular catheter management is an essential step in the control and prevention of catheter-related infection. In recent years, most surveillance studies only included catheters from intensive care units (ICUs). Data regarding the level of care and adherence to international guidelines in a whole general institution are scarce. Our objective was to evaluate the care situation of intravascular catheters in our adult units of a General Hospital.
    The journal of vascular access. 07/2014;
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    ABSTRACT: In Spain, despite the high rates of healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA), the incidence of community-associated (CA) MRSA seems to be low on the basis of a small number of studies. We analysed the evolution of CA-MRSA in Spain from 2004 to 2012, and identified the clonal lineages and population structure.
    Journal of Antimicrobial Chemotherapy 07/2014; · 5.34 Impact Factor
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    ABSTRACT: We assessed the in vitro activity of micafungin against preformed Candida biofilms by measuring the concentration of drug causing the most fungal damage and inhibition of regrowth. We studied 37 biofilm-producing Candida spp. strains from blood cultures. We showed that micafungin was active against planktonic and sessile forms of C. albicans strains and moderately active against C. parapsilosis sessile cells. Concentrations of micafungin above 2 μg/mL were sufficiently high to inactivate regrowth of Candida sessile cells.
    Antimicrobial Agents and Chemotherapy 06/2014; · 4.57 Impact Factor
  • Jesús Guinea, Emilio Bouza
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    ABSTRACT: The diagnosis of invasive aspergillosis is challenging because no sufficiently sensitive or specific tests have been developed to date. Infection can only be confirmed using histology, although this approach is unavailable in many patients. Therefore, diagnosis of invasive aspergillosis is based on a combination of the presence of host factors, radiological and clinical findings, and mycological criteria. In clinical practice, lack of optimal diagnostics often leads to empirical therapy and great cost and toxicity. Mycological criteria include the isolation of Aspergillus from clinical samples or the detection of biomarkers in fluids. Culture is cheap and easy and enables the identification of fungi and performance of antifungal susceptibility testing; however, it has low sensitivity and specificity. Non-culture-based diagnosis is based on the detection of fungal biomarkers such as galactomannan or (1 → 3)-β-D-glucan in normally sterile body fluids. These procedures enable faster and more sensitive and specific detection of Aspergillus; however, diagnostic accuracy is affected by the patient's underlying condition. Finally, while detection of Aspergillus DNA is promising, the lack of standardization limits its inclusion as a mycological criterion for the definition of probable invasive aspergillosis. New diagnostic procedures based on lateral flow technology are also promising but need further evaluation. In the present review, we discuss current culture-based and non-culture-based procedures for the microbiological diagnosis of invasive aspergillosis.
    Mycopathologia. 06/2014;
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    ABSTRACT: The ability to form biofilm enables Candida spp. to cause catheter-related candidaemia. The use of agents with in vitro activity against Candida albicans biofilms, such as micafungin, could obviate catheter removal. The metabolic activity of C. albicans biofilms is strain-dependent, and cell wall formation is thought to be more prominent in biofilms showing high metabolic activity.
    Journal of Antimicrobial Chemotherapy 06/2014; · 5.34 Impact Factor
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    ABSTRACT: SUMMARY The clinical and microbiological characteristics of catheter-related bloodstream infection (CR-BSI) due to uncommon microorganisms was assessed in a retrospective case-control study over a 9-year period in a tertiary teaching hospital. Uncommon microorganisms were defined as those representing <0·5% of all CR-BSI. Diagnosis of CR-BSI required that the same microorganism was grown from at least one peripheral venous blood culture and a catheter tip culture. Thirty-one episodes of CR-BSI were identified due to 13 different genera and these accounted for 2·3% of all CR-BSI in the hospital. Although these infections were not associated with increased mortality, they occurred in patients with more severe underlying conditions who were receiving prolonged antibiotic therapy.
    Epidemiology and infection. 06/2014;
  • Journal of clinical microbiology. 06/2014; 52(6):2285.
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    ABSTRACT: Accurate knowledge of the fungemia epidemiology requires identification of strains to molecular level. Various studies have shown that the rate of resistance to fluconazole ranges from 2.5% to 9% in Candida spp. isolated from blood samples. However, trends in antifungal resistance have received little attention and have only been studied using CLSI M27-A3 methodology. We assessed the fungemia epidemiology in a large tertiary institution in Madrid, Spain by identifying isolates to molecular level and performing antifungal susceptibility testing according to the updated breakpoints of EUCAST EDEF 7.2. We studied 613 isolates causing 598 episodes of fungemia in 544 patients admitted to our hospital (January 2007 to December 2013). Strains were identified after amplification and sequencing of the ITS1-5.8S-ITS2 region and further tested for in vitro susceptibility to amphotericin B, fluconazole, posaconazole, voriconazole, micafungin, and anidulafungin. Resistance was defined using EUCAST species-specific breakpoints, and ECOFFs were applied as tentative breakpoints. Most episodes were caused by C. albicans (46%), C. parapsilosis (28.7%), C. glabrata (9.8%), and C. tropicalis (8%). Molecular identification enabled us to better detect cryptic species of C. guilliermondii and C. parapsilosis complexes and episodes of polyfungal fungemia. The overall percentage of fluconazole-resistant isolates was 5%, although this was higher in C. glabrata (8.6%), and non-Candida yeast isolates (47.4%). The rate of resistance to echinocandins was 4.4% and was mainly due to the presence of intrinsically resistant non-Candida species. Resistance mainly affected non-Candida yeasts. The rate of resistance to fluconazole and echinocandins did not change considerably during the study period.
    Antimicrobial Agents and Chemotherapy 05/2014; · 4.57 Impact Factor
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    ABSTRACT: It was our purpose to evaluate the clinical impact of systematic PET/CT for the diagnosis of infectious embolisms in patients with infectious endocarditis (IE) in comparison with a historic cohort of IE patients managed without this technique. Detection of extracardiac lesions is an essential component of the management and outcome of IE. Studies using PET/CT for the evaluation of patients with IE are scarce, lack a control group, evaluate a small number of patients, or consist of case reports. We performed a prospective cohort study (47 patients with definite IE undergoing PET/CT) with matched controls (94 patients with definite IE not undergoing PET/CT) from January 2012 to July 2013 in a tertiary hospital. The results were compared with those of conventional diagnostic techniques and clinical follow-up. PET/CT revealed at least 1 lesion in 35 patients (74.5%): 18 showed an embolic complication, 8 showed pathologic uptake on the valves or cardiac devices, 1 showed both, 5 had incidental noninfectious findings, and the findings for 3 were considered false-positive. The validity values for the efficacy of PET/CT in the diagnosis of septic lesions were as follows: sensitivity, 100%; specificity, 80%; positive predictive value, 90%; and negative predictive value, 100%. PET/CT was the only initially positive imaging technique in 15 true-positive cases (55.5%). The systematic use of PET/CT was associated with a 2-fold reduction in the number of relapses (9.6% vs. 4.2%, P = 0.25) and enabled significantly more infectious complications to be diagnosed (18% vs. 57.4%, P = 0.0001). PET/CT enables the extent of IE to be assessed using a single test. It is fast (<2 h) and comfortable for the patient, gathers whole-body data, and detects significantly more infectious complications.
    Journal of Nuclear Medicine 05/2014; · 5.77 Impact Factor
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    ABSTRACT: Catheter-related candidemia (CRC) is typically a biofilm related disease, but it is mostly unknown if the production of biofilm is a feature exclusively shown by Candida spp. isolates causing CRC. We performed an in vitro biofilm assay using Candida isolates obtained from the blood of patients with candidemia. We demonstrated that biofilm production was not a good predictor of catheter-related candidemia. Also, we demonstrated that there was no difference in the mortality of candidemia patients infected by biofilm-forming isolates and those in which the infection is caused by nonbiofilm-forming species.
    Medical mycology: official publication of the International Society for Human and Animal Mycology 04/2014; · 2.13 Impact Factor
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    ABSTRACT: Complicated skin and soft tissue infections (cSSTIs) are a diverse group of infections, with a range of presentations and microbiological causes. Hospitalization is common for patients with a cSSTI, which is treated by drainage of the affected area and with antibiotics. Host factors such as co-morbidities, and microbial factors, in particular drug resistance, complicate the management of these infections. Methicillin-resistant Staphylococcus aureus (MRSA) is an important cSSTI pathogen in Europe, and its involvement can be associated with poor patient outcomes. European guidelines recommend vancomycin, teicoplanin, linezolid, daptomycin, tigecycline or ceftaroline for treatment of MRSA cSSTIs. Of primary importance when treating cSSTIs is the agent's clinical efficacy against the causative pathogens, as well as its bioavailability in the skin and associated structures. Linezolid is well-suited for the treatment of MRSA cSSTIs; it achieves high penetration into skin and soft tissues with 100% oral bioavailability, and therefore enables an intravenous to oral switch and outpatient treatment. When eligible patients are offered oral therapy the associated length of hospital stay and overall costs can be reduced. Linezolid has demonstrated clinical efficacy and favourable outcomes in patients for the treatment of MRSA cSSTIs including the treatment of lower extremity infections. Furthermore, efficacy has been documented in key defined populations, such as individuals with renal impairment and the obese. The safety profile of linezolid is well-documented, making this antibacterial a viable choice for the treatment of MRSA cSSTIs.
    Clinical Microbiology and Infection 04/2014; 20 Suppl 4:3-18. · 4.58 Impact Factor
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    ABSTRACT: Ventilator-associated pneumonia (VAP) is the most frequent infection in patients admitted to intensive care units.The efficacy of individual measures for the prevention of VAP is well-documented, and data on the impact of implementing bundle measures have usually been reported from studies where several measures are implemented simultaneously in the general intensive care unit (ICU).The objective of our work was to evaluate the impact of four sequentially implemented measures for preventing VAP in a major heart surgery ICU. The measures were a specific training program, aspiration of subglottic secretions (ASS), introduction of an inclinometer to improve the semirecumbent position, and reinforcement of oral care with chlorhexidine. We compared rates of VAP, days on mechanical ventilation (MV), and cost of antimicrobial agents before and during implementation. We collected data from 401 patients before the intervention and from 1534 patients during the intervention. Both groups were comparable. No significant differences in EuroSCORE were observed between the patients of both periods (6.4 vs 6.3 P = 0.7). The rates of VAP (episodes/1,000 days of ventilation) were, respectively, 23.9 vs 13.5 (P = 0.005). Mean number of days of MV/1,000 days of stay was 507 vs 375 (P = 0.001), and the cost of antimicrobial therapy (Euros/1,000 days of stay) was [euro sign]70,612 vs [euro sign]52,775 (P = 0.10). The main effect of sequential application of preventive measures in time achieved a relative rate reduction of VAP of 41% (IRR, 0.41; 95% CI, 0.28 to 0.62). The mortality rate before and during the intervention was 13.0% and 10.2% respectively.VAP rate was most significantly reduced by training and the use of the inclinometer. A sequentially applied bundle of four preventive measures reduces VAP rates, days of MV, and the cost of antimicrobial therapy in patients admitted to the major heart surgery ICU.Trial registration: Clinical Trials.gov:NCT02060045.
    Critical care (London, England) 03/2014; 18(2):R53. · 4.72 Impact Factor
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    ABSTRACT: Patients with candidemia may have transient or catheter-related infections without involvement of deep tissues or deep-seated candidiasis. Clinical differentiation of these entities may not be evident with conventional microbiological and imaging methods. Our aim was to determine if the detection of Candida albicans germ tube-specific antibody (CAGTA) in patients with candidemia was related to the extent of the disease. This study was conducted from 2003 to 2012 with 50 patients diagnosed as having candidemia, that is, 29 with deep-seated candidiasis and 21 with non-deep-seated candidiasis. The most common species recovered from samples obtained from these patients were C. albicans, 40%; C. tropicalis, 20%; C. parapsilosis, 18%; and C. glabrata, 12%. Serum samples were processed according to the manufacturer's recommendations (Vircell Microbiologist S.L., Granada, Spain). The CAGTA tests were positive in 1/21 non-deep-seated candidemias (DSCs; 4.76%) and 20/29 DSCs (68.96%; P < 0.01). Accordingly, the values for specificity and positive predictive values of CAGTA for identifying DSC were 95%. We concluded that the presence of a positive CAGTA test in a sample from a patient with candidemia suggests deep-seated candidiasis. Extension screening studies should be considered and origins other than catheters should be searched. Prospective studies are needed to determine the clinical implications of this finding and its potential use in defining the optimal duration of therapy.
    Medical mycology: official publication of the International Society for Human and Animal Mycology 03/2014; · 2.13 Impact Factor
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    ABSTRACT: To assess the quality of antifungal use, to propose a point score for this evaluation and to estimate the potential economic savings of an antifungal stewardship programme. From December 2010 to January 2011, we identified 100 adult inpatients receiving systemic antifungals. Antifungal use was evaluated by means of a predefined score that considered indication, drug selection, dosage, adjustments after microbiology results, switching to an oral agent and length of treatment. Total antifungal prescriptions [in defined daily doses (DDDs) and days of therapy (DOTs)] and potential cost savings were calculated. Overall, 43% of prescriptions came from medical departments, 25% from haematology/oncology and 17% from intensive care units. The main reasons for starting antifungals were empirical (42%), pre-emptive (20%) and targeted treatment (20%). Antifungals were unnecessary in 16% of cases. Inadequacies in other aspects of antifungal prescription were: drug selection, 31%; dosing, 16%; no switch from intravenous to oral administration, 20%; no adjustment after microbiological results, 35%; and length of therapy, 27%. The number of antifungal DDDs per 1000 patient-days was 65.1. The total number of DOTs was 1556, which added a direct cost of €219 364. Only 51.3% of DOTs were considered optimal. The potential estimated savings would be €50 536. Major efforts should be made to improve the selection and duration of antifungal therapy. Our study demonstrated the potential cost savings that could be achieved by optimizing antifungal therapy. A stewardship programme should include an instrument to objectively evaluate the adequacy of antifungal use.
    Journal of Antimicrobial Chemotherapy 03/2014; · 5.34 Impact Factor
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    ABSTRACT: Summary Background Neuraminidase inhibitors were widely used during the 2009–10 influenza A H1N1 pandemic, but evidence for their effectiveness in reducing mortality is uncertain. We did a meta-analysis of individual participant data to investigate the association between use of neuraminidase inhibitors and mortality in patients admitted to hospital with pandemic influenza A H1N1pdm09 virus infection. Methods We assembled data for patients (all ages) admitted to hospital worldwide with laboratory confirmed or clinically diagnosed pandemic influenza A H1N1pdm09 virus infection. We identified potential data contributors from an earlier systematic review of reported studies addressing the same research question. In our systematic review, eligible studies were done between March 1, 2009 (Mexico), or April 1, 2009 (rest of the world), until the WHO declaration of the end of the pandemic (Aug 10, 2010); however, we continued to receive data up to March 14, 2011, from ongoing studies. We did a meta-analysis of individual participant data to assess the association between neuraminidase inhibitor treatment and mortality (primary outcome), adjusting for both treatment propensity and potential confounders, using generalised linear mixed modelling. We assessed the association with time to treatment using time-dependent Cox regression shared frailty modelling. Findings We included data for 29 234 patients from 78 studies of patients admitted to hospital between Jan 2, 2009, and March 14, 2011. Compared with no treatment, neuraminidase inhibitor treatment (irrespective of timing) was associated with a reduction in mortality risk (adjusted odds ratio [OR] 0·81; 95% CI 0·70–0·93; p=0·0024). Compared with later treatment, early treatment (within 2 days of symptom onset) was associated with a reduction in mortality risk (adjusted OR 0·48; 95% CI 0·41–0·56; p<0·0001). Early treatment versus no treatment was also associated with a reduction in mortality (adjusted OR 0·50; 95% CI 0·37–0·67; p<0·0001). These associations with reduced mortality risk were less pronounced and not significant in children. There was an increase in the mortality hazard rate with each day’s delay in initiation of treatment up to day 5 as compared with treatment initiated within 2 days of symptom onset (adjusted hazard ratio [HR 1·23] [95% CI 1·18–1·28]; p<0·0001 for the increasing HR with each day’s delay). Interpretation We advocate early instigation of neuraminidase inhibitor treatment in adults admitted to hospital with suspected or proven influenza infection.
    Lancet Respir Med 2014. 03/2014;
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    ABSTRACT: This manuscript along with the commentary can be found on The Lancet Respiratory Medicine's website: doi:10.1016/S2213-2600(14)70041-4 2 SUMMARY BACKGROUND
    The Lancet Respiratory Medicine. 03/2014;
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    ABSTRACT: Summary Background Neuraminidase inhibitors were widely used during the 2009–10 influenza A H1N1 pandemic, but evidence for their effectiveness in reducing mortality is uncertain. We did a meta-analysis of individual participant data to investigate the association between use of neuraminidase inhibitors and mortality in patients admitted to hospital with pandemic influenza A H1N1pdm09 virus infection. Methods We assembled data for patients (all ages) admitted to hospital worldwide with laboratory confirmed or clinically diagnosed pandemic influenza A H1N1pdm09 virus infection. We identified potential data contributors from an earlier systematic review of reported studies addressing the same research question. In our systematic review, eligible studies were done between March 1, 2009 (Mexico), or April 1, 2009 (rest of the world), until the WHO declaration of the end of the pandemic (Aug 10, 2010); however, we continued to receive data up to March 14, 2011, from ongoing studies. We did a meta-analysis of individual participant data to assess the association between neuraminidase inhibitor treatment and mortality (primary outcome), adjusting for both treatment propensity and potential confounders, using generalised linear mixed modelling. We assessed the association with time to treatment using time-dependent Cox regression shared frailty modelling. Findings We included data for 29 234 patients from 78 studies of patients admitted to hospital between Jan 2, 2009, and March 14, 2011. Compared with no treatment, neuraminidase inhibitor treatment (irrespective of timing) was associated with a reduction in mortality risk (adjusted odds ratio [OR] 0·81; 95% CI 0·70–0·93; p=0·0024). Compared with later treatment, early treatment (within 2 days of symptom onset) was associated with a reduction in mortality risk (adjusted OR 0·48; 95% CI 0·41–0·56; p<0·0001). Early treatment versus no treatment was also associated with a reduction in mortality (adjusted OR 0·50; 95% CI 0·37–0·67; p<0·0001). These associations with reduced mortality risk were less pronounced and not significant in children. There was an increase in the mortality hazard rate with each day’s delay in initiation of treatment up to day 5 as compared with treatment initiated within 2 days of symptom onset (adjusted hazard ratio [HR 1·23] [95% CI 1·18–1·28]; p<0·0001 for the increasing HR with each day’s delay). Interpretation We advocate early instigation of neuraminidase inhibitor treatment in adults admitted to hospital with suspected or proven influenza infection.
    Lancet Respir Med. 03/2014;

Publication Stats

10k Citations
2,428.70 Total Impact Points

Institutions

  • 2012–2014
    • Instituto de Investigación Sanitaria Gregorio Marañón
      Madrid, Madrid, Spain
  • 1988–2014
    • Complutense University of Madrid
      • Department of Medicine
      Madrid, Madrid, Spain
    • Fundación Jiménez Díaz
      Madrid, Madrid, Spain
  • 1987–2014
    • Hospital General Universitario Gregorio Marañón
      • • Clinical Microbiology and Infectious Diseases
      • • Servicio de Microbiología
      • • Department of Immunology
      • • Department of Clinical Microbiology
      Madrid, Madrid, Spain
    • Hospital Universitario Ramón y Cajal
      Madrid, Madrid, Spain
  • 2011
    • Complejo Hospitalario de Toledo
      Toledo, Castille-La Mancha, Spain
  • 2010
    • Hospital Universitario de Móstoles
      Madrid, Madrid, Spain
  • 2009
    • Hospital Universitari de Bellvitge
      • Department of Infectious Diseases
      l'Hospitalet de Llobregat, Catalonia, Spain
  • 2007–2009
    • Instituto de Salud Carlos III
      Madrid, Madrid, Spain
    • Hospital de la Santa Creu i Sant Pau
      Barcino, Catalonia, Spain
    • Hospital Universitario Puerta de Hierro-Majadahonda
      • Servicio de Microbiología
      Majadahonda, Madrid, Spain
  • 2003
    • Università degli Studi di Genova
      Genova, Liguria, Italy
  • 2001
    • University Hospital Donostia
      San Sebastián, Basque Country, Spain
  • 1999
    • Hospital Universitari Mutua de Terrassa
      Terrassa, Catalonia, Spain
  • 1996
    • University of Barcelona
      • Department of Medicine
      Barcino, Catalonia, Spain
    • The University of Western Ontario
      • Department of Microbiology and Immunology
      London, Ontario, Canada
  • 1984–1987
    • Centro Especial Ramón y Cajal
      Madrid, Madrid, Spain
  • 1977
    • Universidad Autónoma de Madrid
      Madrid, Madrid, Spain