M C Fariñas

Instituto de Salud Carlos III, Madrid, Madrid, Spain

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Publications (139)428.1 Total impact

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    ABSTRACT: The most common cause of implant failure is aseptic loosening (AL), followed by prosthetic joint infection (PJI). This study evaluates the incidence of PJI among patients operated with suspected AL and whether the diagnosis of PJI was predictive of subsequent implant failure including re-infection, at 2 years of follow up. Patients undergoing revision hip or knee arthroplasty due to presumed AL from February 2009 to September 2011 were prospectively evaluated. A sonication fluid of prosthesis and tissue samples for microbiology and histopathology at the time of the surgery were collected. Implant failure include recurrent or persistent infection, reoperation for any reason or need for chronic antibiotic suppression. Of 198 patients with pre-and intraoperative diagnosis of AL, 24 (12.1 %) had postoperative diagnosis of PJI. After a follow up of 31 months (IQR: 21 to 38 months), 9 (37.5 %) of 24 patients in the PJI group had implant failure compared to only 1 (1.1 %) in the 198 of AL group (p < 0.0001). Sensitivity of sonicate fluid culture (>20 CFU) and peri-prosthetic tissue culture were 87.5 % vs 66.7 %, respectively. Specificities were 100 % for both techniques (95 % CI, 97.9-100 %). A greater number of patients with PJI (79.1 %) had previous partial arthroplasty revisions than those patients in the AL group (56.9 %) (p = 0.04). In addition, 5 (55.5 %) patients with PJI and implant failure had more revision arthroplasties during the first year after the last implant placement than those patients with PJI without implant failure (1 patient; 6.7 %) (RR 3.8; 95 % CI 1.4-10.1; p = 0.015). On the other hand, 6 (25 %) patients finally diagnosed of PJI were initially diagnosed of AL in the first year after primary arthroplasty, whereas it was only 16 (9.2 %) patients in the group of true AL (RR 2.7; 95 % CI 1.2-6.1; p = 0.03). More than one tenth of patients with suspected AL are misdiagnosed PJI. Positive histology and positive peri-implant tissue and sonicate fluid cultures are highly predictive of implant failure in patients with PJI. Patients with greater number of partial hip revisions for a presumed AL had more risk of PJI. Early loosening is more often caused by hidden PJI than late loosening.
    BMC Infectious Diseases 12/2015; 15(1):232. DOI:10.1186/s12879-015-0976-y · 2.56 Impact Factor
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    ABSTRACT: To analyze the epidemiological and clinical characteristics and mortality of patients with cystic echinococcosis (CE) in northern Spain. A retrospective study of the medical records of patients diagnosed with CE and hospitalized from 1997 to 2011 in a University Hospital. A total of 76 patients (44 men) were diagnosed with CE. The mean age was 57.8 years (SD: 19.1 years; range: 14.9-92.7). The yearly average incidence was 1.08 cases/100,000 inhabitants. The highest incidence was registered in patients aged 70-79 years (22.7% of all cases). Liver was the main organ involved (92.1%), followed by lung (6.6%) and peritoneum (1.3%). Fifty-five patients (72%) received treatment: 2 (3.6%) medical treatment with albendazole, 27 (49%) surgical treatment, 3 (5.4%) medical treatment combined with cyst drainage, and 23 (42%) combined medical and surgical treatment. Eight patients had a recurrence. Twenty-four (31.2%) patients died. No patient's death was attributed directly to hydatidosis, though mortality was significantly higher in the untreated vs. the treated patient group (57% vs. 22%, p=0.003). Hydatidosis treatment and diagnostic approaches remain heterogeneous. The liver continues being the main organ affected. Mortality was higher in patients who did not receive treatment. However, this result might have been influenced by other factors, mainly age. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.
    Revista Clínica Española 06/2015; DOI:10.1016/j.rce.2015.05.003 · 1.31 Impact Factor
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    ABSTRACT: Hydatidosis or cystic echinococcosis (CE) is a parasitic zoonosis caused by Echinococcus granulosus. Its life cycle involves dogs, sheep and sometimes other animals. CE has a worldwide distribution, with greater prevalence in temperate zones. In Spain, Castile and León, La Rioja, Navarre, Aragón, and the Mediterranean coast are the areas where it is most commonly diagnosed, although there have also been published cases in other regions, such as Cantabria. Clinical signs and symptoms of EC may be related to the mass effect of the cyst, its superinfection or anaphylactic reactions secondary to its rupture. Because of its slow growth, diagnosis is usually made in adulthood by combining clinical symptoms with imaging and serological tests. There is no universal consensus on the management of CE. Treatment is based mainly on three pillars: medical treatment (mainly albendazole), surgery, and percutaneous drainage. The choice of the most appropriate approach is based on the patient's symptoms and the characteristics of the cysts.
    Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 06/2015; 28(3):116-124. · 0.91 Impact Factor
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    ABSTRACT: Urinary tract infections (UTIs) are one of the most common infections in solid organ transplant (SOT) recipients. Experienced SOT researchers and clinicians have developed and implemented this consensus document in support of the optimal management of these patients. A systematic review was conducted, and evidence levels based on the available literature are given for each recommendation. This article was written in accordance with international recommendations on consensus statements and the recommendations of the Appraisal of Guidelines for Research and Evaluation II (AGREE II). Recommendations are provided on the management of asymptomatic bacteriuria, and prophylaxis and treatment of UTI in SOT recipients. The diagnostic-therapeutic management of recurrent UTI and the role of infection in kidney graft rejection or dysfunction are reviewed. Finally, recommendations on antimicrobials and immunosuppressant interactions are also included. The latest scientific information on UTI in SOT is incorporated in this consensus document. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.
    Enfermedades Infecciosas y Microbiología Clínica 05/2015; DOI:10.1016/j.eimc.2015.03.024 · 1.88 Impact Factor
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    ABSTRACT: Urinary tract infections (UTI) are one of the most common infections in solid organ transplant (SOT) recipients. A systematic review was performed to assess the management of UTI in SOT recipients. Recommendations are provided on the management of asymptomatic bacteriuria, and prophylaxis and treatment of UTI in SOT recipients. The diagnostic-therapeutic management of recurrent UTI and the role of infection in kidney graft rejection or dysfunction are reviewed. Finally, recommendations on antimicrobials and immunosuppressant interactions are also included. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.
    Enfermedades Infecciosas y Microbiología Clínica 05/2015; DOI:10.1016/j.eimc.2015.03.020 · 1.88 Impact Factor
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    ABSTRACT: Background and objectives: Among patients with bacteraemia due to S. aureus, persistence of positive blood cultures after 2-3 days of active therapy (persistent bacteraemia or PB) is considered a marker for complicated SAB. PB may be related bacterial determinants, hosts' features, or clinical management. The aim of this analysis is to investigate the hosts' and management variables associated to PB despite an adequate targeted therapy and early source control. Methods: Prospective cohort of SAB from 12 tertiary Spanish hospitals between 2008 and 2011. Two analyses were performed; (a) including only patients in whom follow-up blood cultures (FUBC) were performed 48-72 hours after start of active therapy; and (b) including all patients with SAB (those without FUBC were considered not to have PB). Those cases who died before 72 hours and those receiving palliative care for terminal conditions were excluded. Univariate analyses were performed by Chi-square test, and multivariate analyses by logistic regression. Results: 292 of the 496 (58.9%) included patients had FUBC; of them, 91 (31.2%) had PB. In the univariate analysis, PB was associated with high 14-day (RR 1.74; 95% CI 0.93-3.25, p= 0.08) and 30-day crude mortality (RR 1.77; 95% CI 1.03-3.01, p= 0.04). The variables associated with PB in multivariate analysis were a Pitt score >2 (OR 2.69; 95% CI: 1.13-6.37, p=0.03), skin and soft tissue infection as a source (OR 2.75; 95% CI: 0.87-8.65, p=0.08), and presence of septic metastasis (OR 3.45; 95% CI: 1.00-11.83, p=0.05). MRSA, early active therapy, and early source control were not associated. Among the whole series of patients with SAB (n=496), the variables associated with PB in multivariate analysis were a Pitt score >2 (OR 3.43; 95% CI: 1.62-7.27, p=0.001), skin and soft tissue infection as a source (OR 3.76; 95% CI: 1.35-10.46, p=0.01), presence of septic metastasis (OR 2.42; 95% CI: 0.90-6.46, p=0.08), and endocarditis diagnosis during the course of the SAB (OR 2.60; 95% CI: 0.99-6.84, p=0.05). Conclusion: The frequency of PB was high. The clinical variables associated with PB at the diagnosis were the severity of illness assessed by Pitt score and the skin and soft tissue source. The presence or development of septic metastasis during the bacteraemia and infectious endocarditis were also associated. It is crucial to performance FUBC because the presence of PB has clinical management and prognosis implications.
    25th European Congress of Clinical Microbriology and Infectious Diseases, Copenhagen, Denmark; 04/2015
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    ABSTRACT: This cross-sectional study analyzes factors associated with the development of CMV-specific CD8+ response, measured by IFNg production after cytomegalovirus (CMV) peptide stimulation, in CMV-seropositive solid organ transplantation candidates. A total of 114 candidates were enrolled, of whom 22.8% (26/114) were nonreactive (IFNγ < 0.2 IU/mL). Multivariate logistic regression analysis showed that age, HLA alleles and organ to be transplanted were associated with developing CMV-specific CD8+ immunity (reactive; IFNγ ≥ 0.2 IU/mL). The probability of being reactive was higher in candidates over 50 than in those under 50 (OR 6.33, 95%CI 1.93–20.74). Candidates with HLA-A1 and/or HLA-A2 alleles had a higher probability of being reactive than those with non-HLA-A1/non-HLA-A2 alleles (OR 10.97, 95%CI 3.36–35.83). Renal candidates had a higher probability of being reactive than lung (adjusted OR 8.85, 95%CI 2.24–34.92) and liver candidates (OR 4.87, 95%CI 1.12–21.19). The AUC of this model was 0.84 (p < 0.001). Positive and negative predictive values were 84.8% and 76.9%, respectively. In renal candidates longer dialysis was associated with an increased frequency of reactive individuals (p = 0.040). Therefore, although the assessment of CMV-specific CD8+ response is recommended in all R+ candidates, it is essential in those with a lower probability of being reactive, such as non-renal candidates, candidates under 50 or those with non-HLA-A1/non-HLA-A2 alleles.
    American Journal of Transplantation 02/2015; 15(3). DOI:10.1111/ajt.13012 · 6.19 Impact Factor
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    ABSTRACT: The safety and efficacy of treatment of infectious endocarditis (IE) was evaluated within a program of hospital-in-home (HIH) based on self-administered outpatient parenteral antimicrobial therapy (S-OPAT). IE episodes (n = 48 in 45 patients; 71% middle-aged males) were recruited into the HIH program between 1998 and 2012. Following treatment stabilization at the hospital they returned home for HIH in which a physician and/or a nurse supervised the S-OPAT. Safety and efficacy were evaluated as mortality, re-occurrence, and unexpected re-admission to hospital. Of the episodes of IE, 83.3% had comorbidities with a mean score of 2.3 on the Charlson index and 1.5 on the Profund index; 60.4% had pre-existing valve disease (58.6% having had surgical intervention); 8.3% of patients had suffered a previous IE episode; 62.5% of all episodes affected a native valve; 45.8% being mitral; 70.8% of infection derived from the community. In 75% of the episodes there was micro-organism growth, of which 83.3% were Gram positive. Overall duration of antibiotic treatment was 4.8 weeks; 60.4% of this time corresponding to HIH. Re-admission occurred in 12.5% of episodes of which 33.3% returned to HIH to complete the S-OPAT. No deaths occurred during HIH. One year after discharge, 2 patients had recurrence and 5 patients died, in 2 of whom previous IE as cause-of-death could not be excluded. In conclusion, the S-OPAT schedule of hospital-in-home is safe and efficacious in selected patients with IE.
    European Journal of Internal Medicine 01/2015; 26(2). DOI:10.1016/j.ejim.2015.01.001 · 2.30 Impact Factor
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    ABSTRACT: The emergence and spread of carbapenemase-producing Enterobacteriaceae is an important and very concerning problem. There is an urgent need of new antibimicrobials for treating these infections. Currently there are some options in the pipeline. Several new beta-lactamase and carbapenemase inhibitors as avibactam and MK-7655, combined with old or new betalactams are a very interesting option. Some combinations as ceftazidime-avibactam are in the late stages of clinical development and could reach the market in the next years. New aminoglycosides as plazomicin, tetracycline derivates as eravacycline, and several other new molecules as monosulfactams are currently in different stages of development. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
    Enfermedades Infecciosas y Microbiología Clínica 12/2014; 32S4:56-60. DOI:10.1016/S0213-005X(14)70175-2 · 1.88 Impact Factor
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    ABSTRACT: To evaluate the results of the treatment with pegylated interferon and ribavirin for recurrence of hepatitis C after liver transplantation in HCV/HIV-coinfected patients.
    Journal of Hepatology 08/2014; DOI:10.1016/j.jhep.2014.07.034 · 10.40 Impact Factor
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    ABSTRACT: Aims Surgery for infective endocarditis (IE) is associated with high mortality. Our objectives were to describe the experience with surgical treatment for IE in Spain, and to identify predictors of in-hospital mortality. Methods Prospective cohort of 1000 consecutive patients with IE. Data were collected in 26 Spanish hospitals. Results Surgery was performed in 437 patients (43.7%). Patients treated with surgery were younger and predominantly male. They presented fewer comorbid conditions and more often had negative blood cultures and heart failure. In-hospital mortality after surgery was lower than in the medical therapy group (24.3 vs 30.7%, p = 0.02). In patients treated with surgery, endocarditis involved a native valve in 267 patients (61.1%), a prosthetic valve in 122 (27.9%), and a pacemaker lead with no clear further valve involvement in 48 (11.0%). The most common aetiologies were Staphylococcus (186, 42.6%), Streptococcus (97, 22.2%), and Enterococcus (49, 11.2%). The main indications for surgery were heart failure and severe valve regurgitation. A risk score for in-hospital mortality was developed using 7 prognostic variables with a similar predictive value (OR between 1.7 and 2.3): PALSUSE: prosthetic valve, age ≥ 70, large intracardiac destruction, Staphylococcus spp, urgent surgery, sex [female], EuroSCORE ≥ 10. In-hospital mortality ranged from 0% in patients with a PALSUSE score of 0 to 45.4% in patients with PALSUSE score >3. Conclusions The prognosis of IE surgery is highly variable. The PALSUSE score could help to identify patients with higher in-hospital mortality.
    International Journal of Cardiology 07/2014; DOI:10.1016/j.ijcard.2014.04.266 · 6.18 Impact Factor
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    ABSTRACT: Corynebacteria are mostly harmless, however, there is more and more evidence of its pathogenicity, especially as a cause of nosocomial infection in immunocompromised patients. Is the most important genus, Corynebacterium diptheriae is the most important species. Humans are the only known reservoir of diphtheria and respiratory tract the main source of transmission. The tonsillar and pharyngeal involvement is the most common clinical form. The clinical efficacy of the vaccine is 97 %. Fermentative not lipophilic corynebacteria (C. striatum, C. amycolatum) and lipophilic (C. jeikeium, C. urealyticum) are mainly related to nosocomial infections. Infections with Bacillus spp. traditionally have been limited to Bacillus anthracis anthrax responsible, a zoonosis caused by the entry of spores through skin abrasions, inhalation or ingestion of the same, which depend on its clinical forms and Bacillus cereus producing both disease as localized gastrointestinal infection. Listeria monocytogenes is an intracellular pathogen with a predilection for patients with impaired cellular immunity (pregnant and immunocompromised). The digestive tract is the most common portal of entry. The definitive diagnosis is made by culture. The clinical picture varies from meningitis, sepsis, perinatal and local infections. The treatment of choice is ampicillin to that associated gentamicin.
    Medicine - Programa de Formación Médica Continuada Acreditado 06/2014; 11(59):3493–3504. DOI:10.1016/S0304-5412(14)70805-4
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    ABSTRACT: IntroductionInfections caused by resistant gram-positive cocci (GPC), especially to glycopeptides, are difficult to treat in solid organ transplant (SOT) recipients as a result of lower effectiveness and high rates of renal impairment. The aim of this study was to evaluate the use of daptomycin in this population.Methods Over a 2-year period (March 2008–2010) in 9 Spanish centers, we enrolled all consecutive recipients who received daptomycin to treat GPC infection. The study included 43 patients, mainly liver and kidney transplant recipients.ResultsThe most frequent infections were catheter-related bacteremia caused by coagulase-negative staphylococci (23.2%), skin infection caused by Staphylococcus aureus (11.5%), and intra-abdominal abscess caused by Enterococcus faecium (20.9%). The daily daptomycin dose was 6 mg/kg in 32 patients (74.4%). On day 7 of daptomycin treatment, median estimated area under the curve was 1251 μg/mL/h. At the end of follow-up, analytical parameters were similar to the values at the start of therapy. No changes were observed in tacrolimus levels. No patient required discontinuation of daptomycin because of adverse effects. Clinical success at treatment completion was achieved in 37 (86%) patients. Three patients died while on treatment with daptomycin.Conclusion In summary, daptomycin was a safe and useful treatment for GPC infection in SOT recipients.
    Transplant Infectious Disease 05/2014; 16(4). DOI:10.1111/tid.12232 · 1.98 Impact Factor
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    ABSTRACT: Background. Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality. Several aspects of clinical management have been shown to have significant impact on prognosis. The objective of the study was to identify evidence-based quality-of-care indicators (QCIs) for the management of SAB, and to evaluate the impact of a QCI-based bundle on the management and prognosis of SAB. Methods. A systematic review of the literature to identify QCIs in the management of SAB was performed. Then, the impact of a bundle including selected QCIs was evaluated in a quasi-experimental study in 12 tertiary Spanish hospitals. The main and secondary outcome variables were adherence to QCIs and mortality. Specific structured individualized written recommendations on 6 selected evidence-based QCIs for the management of SAB were provided. Results. A total of 287 and 221 patients were included in the preintervention and intervention periods, respectively. After controlling for potential confounders, the intervention was independently associated with improved adherence to follow-up blood cultures (odds ratio [OR], 2.83; 95% confidence interval [CI], 1.78-4.49), early source control (OR, 4.56; 95% CI, 2.12-9.79), early intravenous cloxacillin for methicillin-susceptible isolates (OR, 1.79; 95% CI, 1.15-2.78), and appropriate duration of therapy (OR, 2.13; 95% CI, 1.24-3.64). The intervention was independently associated with a decrease in 14-day and 30-day mortality (OR, 0.47; 95% CI, .26-.85 and OR, 0.56; 95% CI, .34-.93, respectively). Conclusions. A bundle orientated to improving adherence to evidence-based QCIs improved the management of patients with SAB and was associated with reduced mortality.
    Clinical Infectious Diseases 10/2013; 57(9):1225-1233. DOI:10.. 1093/cid/cit499 · 9.42 Impact Factor
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    ABSTRACT: The purpose of this study was to determine vaccination rates against influenza and pneumococcus in a large cohort of adults hospitalized with confirmed influenza A(H1N1)pdm09 infection, and to identify differences in clinical features, frequency of bacterial coinfection, and outcomes between vaccinated and non-vaccinated patients. A prospective cohort study conducted at 14 teaching hospitals in Spain. Adult patients (n=699) hospitalized with confirmed influenza A(H1N1)pdm09 infection during the pandemic and the first post pandemic influenza periods were included. Vaccination status against influenza and pneumococcus was established in 547 and 587individuals, respectively. The vaccination rates were low: 14% for seasonal influenza and 5.4% for pneumococcus. Despite conducting whole population and subgroup multivariate analyses, we observed no beneficial effects on outcomes (intensive care unit admission and mortality) for both vaccines. However, patients who had been vaccinated, whether against influenza or pneumococcus, did tend todevelop fewer bacterial coinfections, particularly that due to S. pneumoniae.
    10/2013; 1(3):22-31. DOI:10.14312/2053-1273.2013-4
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    ABSTRACT: Education is a cornerstone of antimicrobial stewardships programs, because 50% of inappropriate antimicrobial prescriptions are a consequence of an imbalance between the high levels of knowledge required for the appropriate use of antibiotics and the scarce training offered to medical specialists. For this reason, programs optimizing antimicrobial (PROA) are essentially based on support and educational activities for prescribers. The educational activities are difficult to evaluate. In our country, the application of educational activities in antimicrobial training programs is very heterogeneous, although it has improved in recent years. We recommend the following educational measures, which are prioritized in order of effectiveness. Interactive educational interventions are the most effective. These are non-compulsory interventions based on real prescriptions in clinical practice and include educational outreach visits, audits and counseling interviews with feedback and multifaceted interventions. Passive educational strategies, with posters, newsletters, and dissemination of guidelines, are only marginally effective in changing antimicrobial prescribing practices and have not shown a sustained effect. These measures need extensive professional involvement and should be combined with more active approaches. Currently, interventions can be enhanced with some teaching tools in electronic format. Both interactive and passive educational measures should be integrated into the PROA and should have institutional support. Finally, we recommend including antimicrobials in the training plans of all clinical specialties.
    Enfermedades Infecciosas y Microbiología Clínica 09/2013; 31S4:31-37. DOI:10.1016/S0213-005X(13)70130-7 · 1.88 Impact Factor
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    ABSTRACT: BACKGROUND: Interleukin 17 (IL-17) is induced during the early stages of tuberculosis infection, playing an important role in the defense against mycobacterial infection. To date, only one study performed in Chinese Han population has found an association between IL-17F sequence variants and susceptibility to tuberculosis, but no relationship has been found with another single nucleotide polymorphism (SNP) in IL-17A gene (rs2275913). METHODS: To assess if rs2275913 (G-152A) SNP, could be associated with susceptibility to pulmonary tuberculosis (PTB) in a genetically homogeneous Caucasian population, we analyzed if its allele and genotype frequencies were statistically significant in a case-control study. One hundred and ninety-two patients with active PTB and 266 blood healthy donors were enrolled in this study. RESULTS: The frequency of the GG versus GA+AA genotype was significantly more frequent in patients with PTB than in control subjects assuming a dominant model (50.52% versus 39.10% respectively, OR=1.59, 95%CI=1.09-2.31, p=0.015). Despite patients with PTB had higher serum IL-17 levels, we did not find an association of this SNP with IL-17 ex vivo production after stimulation with Mycobacterium tuberculosis (Mtb) antigens or phytohemagglutinin (PHA). CONCLUSION: Our results would suggest an association between IL-17A rs2275913 - 152G allele and GG genotype with susceptibility to PTB for the first time.
    Cytokine 06/2013; 64(1). DOI:10.1016/j.cyto.2013.05.022 · 2.87 Impact Factor
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    ABSTRACT: OBJECTIVES: To determine the aetiology, clinical features and prognosis of CAP during the first post-pandemic influenza season. We also assessed the factors associated with severe disease and tested the ability of a scoring system for identifying influenza A (H1N1)pdm09-related pneumonia. METHODS: Prospective cohort study carried out at 10 tertiary hospitals of Spain. All adults hospitalised with CAP from December 01, 2010 to March 31, 2011 were analysed. RESULTS: A total of 747 adults with CAP required hospitalisation. The aetiology was determined in 315 (42.2%) patients, in whom 154 (21.9%) were due to bacteria, 125 (16.7%) were due to viruses and 36 (4.8%) were mixed (due to viruses and bacteria). The most frequently isolated bacteria were Streptococccus pneumoniae. Among patients with viral pneumonia, the most common organism identified were influenza A (H1N1)pdm09. Independent factors associated with severe disease were impaired consciousness, septic shock, tachypnea, hyponatremia, hypoxemia, influenza B, and influenza A (H1N1)pdm09. The scoring system evaluated did not differentiate reliably between patients with influenza A (H1N1)pdm09-related pneumonia and those with other aetiologies. CONCLUSIONS: The frequency of bacterial and viral pneumonia during the first post-pandemic influenza season was similar. The main identified virus was influenza A (H1N1)pdm09, which was associated with severe disease. Although certain presenting clinical features may allow recognition of influenza A (H1N1)pdm09-related pneumonia, it is difficult to express them in a reliable scoring system.
    The Journal of infection 06/2013; 67(3). DOI:10.1016/j.jinf.2013.05.006 · 4.02 Impact Factor
  • María Carmen Fariñas, Luis Martínez-Martínez
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    ABSTRACT: Multiresistant Gram-negative bacteria represent a major health problem worldwide. This is related to the severity of the infections they cause, the difficulties for empiric (even directed) treatment, the ease of multiresistance spread, and the absence of new antimicrobial agents active against this group of pathogens. Accordingly, antimicrobial therapy should be based on the results of susceptibility testing, and may require using antimicrobial combinations. The production of extended-spectrum beta-lactamases represents the most important current problem of resistance among enterobacteria; these organisms cause nosocomial infections, but can also be cultured from non-hospitalised patients. In our country, enterobacteria producing plasmid-mediated AmpC enzymes or most carbapenemases are still uncommon, at the moment. Enterobacteria expressing these types of beta-lactamases present high rates of resistance to aminoglycosides and quinolones, because plasmids coding for beta-lactamases also contain other genes involved in additional resistances and/or the selection of additional chromosomal mutations. Among multiresistant Gram-negative non-fermenting bacteria, the most clinically relevant organism is Pseudomonas aeruginosa, an organism with intrinsic resistance to multiple agents and with ability to capture acquired resistance mechanisms. Other organisms in the latter group include Acinetobacter baumannii, with increasing rates of resistance to antimicrobial agents, and to a lesser extent Stenotrophomonas maltophilia.
    Enfermedades Infecciosas y Microbiología Clínica 06/2013; 31(6):402–409. DOI:10.1016/j.eimc.2013.03.016 · 1.88 Impact Factor
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    ABSTRACT: Serratia marcescens has been recognized as an important cause of nosocomial and community-acquired infections. To our knowledge, we describe the first case of S. marcescens rhabdomyolysis, most probably related to acute cholecystitis and secondary bacteremia. The condition was successfully managed with levofloxacin. Keeping in mind the relevant morbidity and mortality associated with bacterial rhabdomyolysis, physicians should consider this possibility in patients with suspected or proven bacterial disease. We suggest S. marcescens should be regarded as a new causative agent of infectious rhabdomyolysis.
    Advances in Infectious Diseases 06/2013; 3(2):63-4. DOI:10.4236/aid.2013.32009

Publication Stats

1k Citations
428.10 Total Impact Points

Institutions

  • 2015
    • Instituto de Salud Carlos III
      Madrid, Madrid, Spain
  • 1997–2015
    • Universidad de Cantabria
      • Department of Molecular Biology
      Santander, Cantabria, Spain
  • 1993–2015
    • Hospital Universitario Marques de Valdecilla
      • • Servicio de Cardiología
      • • Servicio de Microbiología
      Santander, Cantabria, Spain
  • 2012
    • Hospital Central de la Defensa Gómez Ulla
      Madrid, Madrid, Spain
  • 2011
    • Conselleria de Sanidade
      La Corogne, Galicia, Spain
  • 2010
    • Hospital Son Dureta
      Palma, Balearic Islands, Spain
  • 2006
    • Facultad de Medicina
      Madrid, Madrid, Spain
  • 2000–2004
    • Hospital Sierrallana
      Torrelavega, Cantabria, Spain