M Carmen Fariñas

Universidad de Cantabria, Santander, Cantabria, Spain

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Publications (74)197.2 Total impact

  • [Show abstract] [Hide abstract]
    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. · 1.48 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; · 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.
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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. · 1.48 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.
  • 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. · 1.88 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 05/2013; · 1.48 Impact Factor
  • Revista Iberoamericana de Micología 01/2013; · 0.97 Impact Factor
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    ABSTRACT: OBJECTIVE: to analyze the factors that are associated with the adequacy of empirical antibiotic therapy and its impact in mortality in a large cohort of patients with extended-spectrum beta-lactamase (ESBL) - producing Escherichia coli and Klebsiella spp. bacteraemia, METHODS: cases of ESBL producing Enterobacteriaceae (ESBL-E) bacteraemia collected from 2003 through 2008 in 19 hospitals in Spain. Statistical analysis was performed using multivariate logistic regression. RESULTS: we analyzed 387 cases ESBL-E bloodstream infections. The main sources of bacteremia were urinary tract (55.3%), biliary tract (12.7%), intra-abdominal (8.8%) and unknown origin (9.6%). Among all the 387 episodes, E. coli was isolated from blood cultures in 343 and in 45.7% the ESBL-E was multidrug resistant. Empirical antibiotic treatment was adequate in 48.8% of the cases and the in hospital mortality was 20.9%. In a multivariate analysis adequacy was a risk factor for death [adjusted OR (95% CI): 0.39 (0.31-0.97); P=0.04], but not in patients without severe sepsis or shock. The class of antibiotic used empirically was not associated with prognosis in adequately treated patients. CONCLUSION: ESBL-E bacteremia has a relatively high mortality that is partly related with a low adequacy of empirical antibiotic treatment. In selected subgroups the relevance of the adequacy of empirical therapy is limited.
    BMC Infectious Diseases 10/2012; 12(1):245. · 2.56 Impact Factor
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    ABSTRACT: The influenza pandemic that was declared by the World Health Organization in June 2009 created a new scenario for the use of influenza antivirals and vaccination. The new strain, influenza A(H1N1)pdm09, was resistant to amantadine and rimantadine, and the most frequently used antiviral was oseltamivir. Randomized studies were not performed comparing neuraminidase inhibitors with placebo. Nevertheless, experience from prospective and retrospective cohorts indicated that these drugs were useful for improving the prognosis of patients admitted to hospitals, especially for those with more severe disease. Treatment with oseltamivir was associated with a reduction in days of fever, length of hospital stay, use of mechanical ventilation and mortality. Treatment was more effective if it was begun within the first 48 h after the onset of symptoms, but it was also useful if begun later. A safe and effective vaccine to prevent disease from this new influenza strain was available in developed countries soon after the pandemic began; thus, the rate of adverse effects was comparable to that of seasonal influenza vaccines. The main barrier to its use was the concern of target populations about its necessity and safety. Therefore, the challenges for future pandemics will be to increase the population coverage of the vaccine in developed countries and to make it affordable for developing countries.
    Enfermedades Infecciosas y Microbiología Clínica 10/2012; 30 Suppl 4:49-53. · 1.48 Impact Factor
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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; · 4.58 Impact Factor
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    ABSTRACT: An increase in infections by filamentous fungi other than Aspergillus has been observed in the last few years. Clear fungi or hyalohyphomycetes, dematiaceous or dark fungi, agents of mucormycosis, and Pneumocystis jirovecii are generally emerging opportunistic fungi that produce disseminated infection in patients with severe immunosuppression. The clinical manifestations in this group of patients are often non-specific as their expression is modified by the disease itself or by the concomitant treatments, which difficult early diagnosis. This, together with the relatively limited therapeutic resources available, has led to invasive fungal infections by these filamentous fungi being associated with significant mortality (30-100%). Nowadays with the emergence of the new triazole drugs or lipid formulations of amphotericin B, often combined with other antifungal drugs, attempts are being made to change the dire prognosis of patients with these infections.
    Enfermedades Infecciosas y Microbiología Clínica 08/2012; 30(7):414–419. · 1.88 Impact Factor
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    ABSTRACT: Background The incidence and clinical significance of pulmonary residual thrombosis 6 months after an acute pulmonary embolism (PE) are still not well-known. Purpose To evaluate the association between residual vascular obstruction and the risk of venous thromboembolism (VTE) recurrence or death. Material and Methods Computed tomography pulmonary angiography (CTPA) was repeated in 97 consecutive patients 6 months after an acute episode of hemodynamically stable pulmonary embolism. We assessed the long-term consequences of residual thrombosis on vital status and incidence of recurrent VTE. Results Six patients were lost for follow-up. The remaining 91 patients were classified according to the presence (Group 1: 18 cases) or absence (Group 2: 73 cases) of residual pulmonary vascular obstruction. After a mean ± SD of 2.91 ± 0.99 years, there were eight (8.8%) deaths and 11 (12.1%) VTE recurrences. Groups 1 and 2 did not differ in the incidence of death or VTE recurrence. Conclusion Persistent pulmonary vascular obstruction on 6-month CTPA did not predict long-term adverse outcome events.
    Acta Radiologica 07/2012; 53(7):728-31. · 1.35 Impact Factor
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    ABSTRACT: An increase in infections by filamentous fungi other than Aspergillus has been observed in the last few years. Clear fungi or hyalohyphomycetes, dematiaceous or dark fungi, agents of mucormycosis, and Pneumocystis jirovecii are generally emerging opportunistic fungi that produce disseminated infection in patients with severe immunosuppression. The clinical manifestations in this group of patients are often non-specific as their expression is modified by the disease itself or by the concomitant treatments, which difficult early diagnosis. This, together with the relatively limited therapeutic resources available, has led to invasive fungal infections by these filamentous fungi being associated with significant mortality (30-100%). Nowadays with the emergence of the new triazole drugs or lipid formulations of amphotericin B, often combined with other antifungal drugs, attempts are being made to change the dire prognosis of patients with these infections.
    Enfermedades Infecciosas y Microbiología Clínica 03/2012; 30(7):414-9. · 1.48 Impact Factor
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    ABSTRACT: The outcome of patients with influenza A 2009 (H1N1)v virus infection taking into account hospital type has not been elucidated. To compare risk factors, clinical features and outcome of patients admitted to 3 public hospitals with different levels of health-care. Prospective study of all non-pregnant adult patients admitted to 3 hospitals with pandemic H1N1 infection, from June 1 to December 31 and followed up until 1 month after discharge. During the study period, 111 patients with a mean age of 49 years (15-89) were hospitalized: 52 in hospital 1 (900-bed tertiary-teaching-hospital), 33 in hospital 2 (315-beds secondary-hospital) and 26 in hospital 3 (150-beds primary-care-hospital).Overall 80% of patients had at least 1 comorbid condition with no differences between hospitals. Symptoms or signs on admission were similar except for cough (P=0.01) more frequent in patients in hospital 1 and dyspnea (P=0.05), myalgia, arthralgia (P=0.04) and hypoxemia (P=0.009) present in more patients in hospital 2. In-hospital mortality rates were not statistically different between hospitals. In the stepwise analysis, independent predictors of mortality were pneumonia on admission (adjusted OR=8.68, 95%CI 1.0-82.43) and cardiac complications during hospitalization (adjusted OR=13.2, 95%CI 1.67-103.98). Mortality of patients with pandemic H1N1 infection was influenced by patients underlying conditions, severity of disease (pneumonia) on admission and complications during hospitalization. Hospital-characteristics do not appear to have influenced severe outcome.
    Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 03/2012; 25(1):56-64. · 0.91 Impact Factor
  • Patricia Muñoz, Nuria Sabé Fernández, María Carmen Fariñas
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    ABSTRACT: Infection remains a significant complication after solid organ transplantation (SOT). The incidence of various pathogens varies widely depending on the presence of specific factors, according to which patients can be classified into different risk categories that may merit tailored prophylaxis strategies. Both the endogenous origin of microorganisms (previous colonization or latent infection) and new acquisition (primary infection from donor or environment) should be considered. Bacterial infections predominate in patients with complex hospital stays or anatomical alterations. Viral infections, caused both by opportunistic (CMV, EBV, BKV, etc.) and common viruses (influenza, respiratory virus, VVZ, etc.), are of great importance, and may contribute to chronic rejection. Fungal infections are uncommon nowadays, but cause high mortality and deserve prophylaxis for a subset of patients. Parasitic infections are a clear threat, mainly in transplanted patients or those travelling to endemic areas. Physicians attending SOT recipients should be aware of these risk factors, which include specific host characteristics, type of transplantation, microorganism and immunosuppressive policy.
    Enfermedades Infecciosas y Microbiología Clínica 03/2012; 30 Suppl 2:10-8. · 1.48 Impact Factor
  • 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. · 1.48 Impact Factor
  • 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; 30:33–37. · 1.88 Impact Factor
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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. · 3.14 Impact Factor
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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. · 1.48 Impact Factor

Publication Stats

448 Citations
197.20 Total Impact Points

Institutions

  • 1997–2014
    • Universidad de Cantabria
      Santander, Cantabria, Spain
  • 2013
    • Instituto de Biomedicina de Sevilla (IBIS)
      Hispalis, Andalusia, Spain
  • 2012
    • Hospital Central de la Defensa Gómez Ulla
      Madrid, Madrid, Spain
    • Complutense University of Madrid
      Madrid, Madrid, Spain
  • 2001–2012
    • Hospital Universitario Marques de Valdecilla
      • Servicio de Microbiología
      Santander, Cantabria, Spain
  • 2011
    • University Hospital Lucus Augusti
      Lugo, Galicia, Spain
    • IDIBELL Bellvitge Biomedical Research Institute
      Barcino, Catalonia, Spain
    • University of Barcelona
      Barcino, Catalonia, Spain
  • 2010–2011
    • Conselleria de Sanidade
      La Corogne, Galicia, Spain
  • 2009–2011
    • Hospital Universitari de Bellvitge
      • Department of Infectious Diseases
      l'Hospitalet de Llobregat, Catalonia, Spain