M Rodríguez-Créixems

Complutense University of Madrid, Madrid, Madrid, Spain

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Publications (135)658.38 Total impact

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    ABSTRACT: MALDI-TOF MS for the identification of NTM isolates was evaluated in this study. Overall, 125 NTM isolates were analyzed by MALDI-TOF and GenoType CM/AS. Identification by 16S rRNA/hsp65 sequencing was considered as the gold standard. Agreements between MALDI-TOF and GenoType CM/AS with the reference method were, respectively, 94.4% and 84.0%. In 17 cases (13.6%) results provided by GenoType and MALDI-TOF were discordant, however the reference method agreed with MALDI-TOF in 16/17 cases (94.1%; p=0.002). Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Journal of clinical microbiology 06/2015; 53(8). DOI:10.1128/JCM.01380-15 · 3.99 Impact Factor
  • A Fernández-Cruz · M Cruz Menárguez · P Muñoz · M Pedromingo · T Peláez · J Solís · M Rodríguez-Créixems · E Bouza ·
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    ABSTRACT: Most current guidelines do not recommend systematic screening with echocardiography in patients with candidemia, as Candida infective endocarditis (CIE) is considered an uncommon disease. During the study period, we recommended echocardiography systematically to all candidemic patients that did not have contraindications and accepted to participate in the study. We intended to assess the incidence of unrecognized CIE in adult patients with candidemia. Our institution is a tertiary teaching hospital in which we follow all patients with candidemia. From January 2007 to October 2012, echocardiography was systematically recommended to suitable candidates. We recorded 263 cases of candidemia in adult patients. Echocardiography was not performed in 76 of these patients for the following reasons: patients had died when blood cultures became positive (17), patients were critically or terminally ill (38), or the patient or physician refused the procedure (21). The remaining 187 patients constitute the basis of this report. CIE was diagnosed in 11 cases (4.2 % of the whole candidemic population and 5.9 % of the population with echocardiographic study). The results of transthoracic echocardiography (TTE) suggested infective endocarditis (IE) in 5/172 patients (2.9 %), and the result of transesophageal echocardiography (TEE) was positive in 10/87 (11.5 %). Among 11 confirmed cases of CIE, the disease was clinically unsuspected in three patients. At least 4.2 % of all candidemic patients have CIE. CIE is frequently clinically unsuspected and echocardiography is required to demonstrate a high proportion of cases.
    European Journal of Clinical Microbiology 05/2015; 34(8). DOI:10.1007/s10096-015-2384-z · 2.67 Impact Factor
  • E Bouza · M Rodríguez-Créixems · L Alcalá · M Marín · V De Egea · F Braojos · P Muñoz · E Reigadas ·
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    ABSTRACT: Despite the high concentration of patients with known risk factors for Clostridium difficile infection (CDI) in intensive care units (ICUs), data on ICU patients are scarce. The aim of this study was describe the incidence, clinical characteristics, and evolution of CDI in critically ill patients. From 2003 to 2012, adult patients admitted to an ICU (A-ICU) and positive for CDI were included and classified as follows: pre-ICU, if the positive sample was obtained within ±3 days of ICU admission; in-ICU, if obtained after 3 days of ICU admission and up to 3 days after ICU discharge. We recorded 4095 CDI episodes, of which 328 were A-ICU (8%). Episodes of A-ICU decreased from 19.4 to 8.7 per 10000 ICU days of stay (P < .0001). Most A-ICU CDIs (66.3%) were mild to moderate. Pre-ICU episodes accounted for 16.2% and were more severe complicated than in-ICU episodes (11% vs 0%; P = .020). Overall mortality was 28.6%, and CDI-attributable mortality was only 3%. The incidence of A-ICU CDI has decreased steadily over the last 10 years. A significant proportion of A-ICU CDI episodes are pre-ICU and are more severe than in-ICU CDI episodes. Most episodes of A-ICU CDI were nonsevere, with low associated mortality. Copyright © 2015. Published by Elsevier Inc.
    Journal of critical care 02/2015; 30(3). DOI:10.1016/j.jcrc.2015.02.011 · 2.00 Impact Factor
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    ABSTRACT: Background. The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis–Prospective Cohort Study. Methods. Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use. Results. EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non–S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39–1.15]; P = .15). Conclusions. In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.
    Clinical Infectious Diseases 11/2014; 60(5). DOI:10.1093/cid/ciu871 · 8.89 Impact Factor
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    ABSTRACT: Background: Frequency of enterococcal bloodstream infection (E-BSI) is increasing, and the number of episodes complicated by infective endocarditis (IE) varies. Performing transesophageal echocardiography (TEE) in all patients with E-BSI is costly and time-consuming. Our objectives were to identify patients with E-BSI who are at very low risk of enterococcal IE (and therefore do not require TEE) and to compare the outcome of E-BSI in patients with/without IE. Methods: Between September 2003 and October 2012, we performed a prospective cohort study (all patients with E-BSI) and a case-control study (patients with/without enterococcal IE) in our center. Results: We detected 1515 patients with E-BSI and 65 with enterococcal IE (4.29% of all episodes of E-BSI, 16.7% of patients with E-BSI who underwent transthoracic echocardiography, and 35.5% of all patients with E-BSI who underwent TEE). We developed a bedside predictive score for enterococcal IE-Number of positive blood cultures, Origin of the bacteremia, previous Valve disease, Auscultation of heart murmur (NOVA) score-based on the following variables: Number of positive blood cultures (3/3 blood cultures or the majority if more than 3), 5 points; unknown Origin of bacteremia, 4 points; prior heart Valve disease, 2 points; Auscultation of a heart murmur, 1 point (receiver operating characteristic = 0.83). The best cutoff corresponded to a score ≥4 (sensitivity, 100%; specificity, 29%). A score <4 points suggested a very low risk for enterococcal IE and that TEE could be obviated. Conclusions: Enterococcal IE may be more frequent than generally thought. Depending on local prevalence of endocarditis, application of the NOVA score may safely obviate echocardiography in 14%-27% of patients with E-BSI.
    Clinical Infectious Diseases 11/2014; 60(4). DOI:10.1093/cid/ciu872 · 8.89 Impact Factor
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    ABSTRACT: Background Patients with septic episodes whose blood cultures turn positive after being sent home from emergency departments (EDs) are recognized as having occult bloodstream infections (BSI). The incidence, etiology, clinical circumstances, and outcome of occult BSI in children are well known but, to our knowledge, data in adult patients are scarce. We analyzed the episodes of occult BSI in adult patients at our institution. Methods Retrospective cohort study (September 2010-September 2012), in adult patients discharged from the ED in whom blood cultures turned positive. Patients were evaluated according to a pre-established protocol. Results We recorded 4,025 cases of significant BSI in the ED and 113 patients with adult occult BSI. In other words, the incidence of occult BSI in the ED was 2.8 per 100 episodes. The predominant microorganisms were gram-negative bacteria (57%); E. coli was the most common (41%), followed by gram-positive bacteria (29%), anaerobes (6.9%), polymicrobial (6.1%), and yeasts (0.8%). The most frequent suspected origin was UTI (53%) and the majority of infections were community acquired (63.7%). Of the 105 patients that we were able to trace, 54 (42.5%) were asymptomatic and were receiving adequate antibiotic treatment at the time of the call and 65 (51.2%) had persistent fever or were not receiving adequate antibiotic treatment. Conclusions Occult BSI is relatively common in patients in the adult ED. Despite the need for re-admission of a fairly high proportion of patients, occult BSI behaves as a relatively benign entity.
    American Journal of Emergency Medicine 09/2014; 32(9). DOI:10.1016/j.ajem.2014.05.007 · 1.27 Impact Factor
  • E Reigadas · M Rodríguez-Créixems · C Sánchez-Carrillo · P Martín-Rabadán · E Bouza ·
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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; 143(04):1-4. DOI:10.1017/S0950268814001435 · 2.54 Impact Factor
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    ABSTRACT: Introducción La espectrometría de masas MALDI-TOF ha demostrado ser rápida y eficaz en la identificación de microorganismos que colonizan determinadas muestras clínicas. Nuestro objetivo fue analizar los valores de validez de la espectrometría de masas MALDI-TOF para predecir colonización y bacteriemia relacionada con el catéter (BRC) en todos los catéteres que llegaran al laboratorio de Microbiología. Métodos Durante 3 meses, la espectrometría de masas MALDI-TOF se realizó sobre las puntas de catéter recibidas (previo rodamiento para cultivo). Las reglas de oro de colonización y BRC fueron, respectivamente, la presencia de ≥ 15 ufc/placa en el cultivo de la punta de catéter y el aislamiento del (de los) mismo(s) microorganismo(s) tanto en los hemocultivos como en el catéter colonizado (7 días antes o después de la retirada del catéter). Resultados Se incluyeron un total de 182 catéteres intravasculares. La tasa global de colonización detectada por la técnica del rodamiento y la espectrometría de masas MALDI-TOF fue del 31,9 y del 32,4%, respectivamente. Hubo un total de 33 (18,1%) episodios de BRC. Los valores de validez de la espectrometría de masas MALDI-TOF para predecir colonización y BRC fueron, respectivamente: sensibilidad (69,0/66,7%), especificidad (84,7/75,2%), valor predictivo positivo (65,6/36,1%) y valor predictivo negativo (86,8/92,6%). Conclusión La espectrometría de masas MALDI-TOF puede ser una herramienta de diagnóstico alternativa para descartar BRC. Sin embargo, a pesar de haber demostrado ser más rápida que el cultivo convencional, son necesarios futuros estudios que mejoren el proceso pre-analítico.
    Enfermedades Infecciosas y Microbiología Clínica 06/2014; 32(6). DOI:10.1016/j.eimc.2014.01.011 · 2.17 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; 55(7). DOI:10.2967/jnumed.113.134981 · 6.16 Impact Factor
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    ABSTRACT: This study evaluates MALDI-TOF MS capability for the identification of difficult-to-identify microorganisms. A total of 150 bacterial isolates inconclusively identified with conventional phenotypic tests were further assessed by 16S rRNA sequencing and by MALDI-TOF MS following two methods: a) a simplified formic acid-based, on-plate extraction and b) performing a tube-based extraction step. Using the simplified method, 29 isolates could not be identified. For the remaining 121 isolates (80.7%) we obtained a reliable identification by MALDI-TOF: in 103 isolates the identification by 16S rRNA sequencing and MALDI TOF coincided at the species level (68.7% from the total 150 analyzed isolates and 85.1% from the samples with MALDI-TOF result) and in 18 isolates the identification by both methods coincided at the genus level (12% from the total and 14.9% from the samples with MALDI-TOF results). No discordant results were observed. The performance of the tube-based extraction step allowed the identification at the species level of 6 of the 29 unidentified isolates by the simplified method. In summary, MALDI-TOF can be used for the rapid identification of many bacterial isolates inconclusively identified by conventional methods
    Diagnostic microbiology and infectious disease 05/2014; 79(1). DOI:10.1016/j.diagmicrobio.2014.01.021 · 2.46 Impact Factor

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    ABSTRACT: Microbiological confirmation of a urinary tract infection (UTI) takes 24-48 h. In the meantime, patients are usually given empirical antibiotics, sometimes inappropriately. We assessed the feasibility of sequentially performing a Gram stain and MALDI-TOF MS mass spectrometry (MS) on urine samples to anticipate clinically useful information. In May-June 2012, we randomly selected 1000 urine samples from patients with suspected UTI. All were Gram stained and those yielding bacteria of a single morphotype were processed for MALDI-TOF MS. Our sequential algorithm was correlated with the standard semiquantitative urine culture result as follows: Match, the information provided was anticipative of culture result; Minor error, the information provided was partially anticipative of culture result; Major error, the information provided was incorrect, potentially leading to inappropriate changes in antimicrobial therapy. A positive culture was obtained in 242/1000 samples. The Gram stain revealed a single morphotype in 207 samples, which were subjected to MALDI-TOF MS. The diagnostic performance of the Gram stain was: sensitivity (Se) 81.3%, specificity (Sp) 93.2%, positive predictive value (PPV) 81.3%, negative predictive value (NPV) 93.2%, positive likelihood ratio (+LR) 11.91, negative likelihood ratio (-LR) 0.20 and accuracy 90.0% while that of MALDI-TOF MS was: Se 79.2%, Sp 73.5, +LR 2.99, -LR 0.28 and accuracy 78.3%. The use of both techniques provided information anticipative of the culture result in 82.7% of cases, information with minor errors in 13.4% and information with major errors in 3.9%. Results were available within 1 h. Our serial algorithm provided information that was consistent or showed minor errors for 96.1% of urine samples from patients with suspected UTI. The clinical impacts of this rapid UTI diagnosis strategy need to be assessed through indicators of adequacy of treatment such as a reduced time to appropriate empirical treatment or earlier withdrawal of unnecessary antibiotics.
    PLoS ONE 01/2014; 9(1):e86915. DOI:10.1371/journal.pone.0086915 · 3.23 Impact Factor
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    ABSTRACT: In the last years, matrix-assisted laser desorption-ionization time of flight (MALDI-TOF) mass spectrometry has proved a rapid and reliable method for the identification of bacteria and yeast already isolated. The objective of this study was to evaluate this technology, as a routine method for the identification of microorganisms directly from grown blood culture bottles (BCB), before isolation, in a large collection of samples. For this purpose, 1,000 positive BCBs containing 1,085 microorganisms have been analyzed by conventional phenotypic methods and by MALDI-TOF MS. Discrepancies have been resolved using molecular methods: the amplification and sequencing of 16S rRNA gene or the Superoxide Dismutase gene (sodA) for streptococcal isolates. MALDI-TOF anticipated a species- or genus-level identification of 81.4% of the analyzed microorganisms. The analysis by episode yielded a complete identification of 814 out of 1.000 analyzed episodes (81.4%). MALDI-TOF identification is available for clinicians within hours of a working shift, versus 18 hours later when conventional identification methods are performed. Moreover, although further improvement of the sample preparation for polymicrobial BCBs is required, the identification of more than one pathogen in the same BCB provides a valuable indication of unexpected pathogens when their presence may remain undetected in the Gram staining. Implementation of MALDI-TOF identification directly from the BCB provides a rapid and reliable identification of the causing pathogen within hours. This article is protected by copyright. All rights reserved.
    Clinical Microbiology and Infection 11/2013; 20(7). DOI:10.1111/1469-0691.12455 · 5.77 Impact Factor
  • M Guembe · M Rodríguez-Créixems · P Martín-Rabadán · L Alcalá · P Muñoz · E Bouza ·
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    ABSTRACT: Most episodes of catheter-related bloodstream infection (C-RBSI) are documented before or at the time of catheter withdrawal. The risk of C-RBSI in the period after removing a colonized catheter in patients without bacteremia (late C-RBSI) is unknown. We assessed the risk of developing a late C-RBSI episode in an unselected population with positive catheter tip cultures and analyzed associated risk factors. We analyzed retrospectively all colonized catheter tips between 2003 and 2010 and matched them with blood cultures. C-RBSI episodes were classified as early C-RBSI (positive blood cultures were obtained ≤24 h after catheter withdrawal) or late C-RBSI (positive blood cultures were obtained ≥24 h after catheter withdrawal). We analyzed the risk factors associated with late C-RBSI episodes by comparison with a selected group of early C-RBSI episodes. We collected a total of 17,981 catheter tips: 4,533 (25.2 %) were colonized. Of them, 1,063 (23.5 %) were associated to early C-RBSI episodes and from the remaining 3,470, only 143 (4.1 %) were associated to late C-RBSI episodes. Then, they corresponded to 11.9 % of the total 1,206 C-RBSI episodes. After comparing early and late C-RBSI episodes, we found that late C-RBSI was significantly associated with the presence of methicillin-resistant Staphylococcus aureus (MRSA, p = 0.028) and with higher mortality (p = 0.030). According to our data, patients with colonized catheter tips had a 4.1 % risk of developing late C-RBSI, which was associated with higher crude mortality.
    European Journal of Clinical Microbiology 10/2013; 33(5). DOI:10.1007/s10096-013-2004-8 · 2.67 Impact Factor
  • E Bouza · A Eworo · A Fernández Cruz · E Reigadas · M Rodríguez-Créixems · P Muñoz ·
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    ABSTRACT: From 2008 to 2010, patients with microbiologically confirmed Gram-negative catheter-related bloodstream infection (GN-CRBSI) were each compared with two randomly selected controls. We included 81 cases (17% of all CRBSI) and 162 controls with CRBSI caused by other pathogens. Incidence of GN-CRBSI was 0.53 episodes per 1000 admissions. Cases were more likely to have underlying neurological disease or gastrointestinal conditions, previous antimicrobial therapy and a shorter time to blood culture positivity. Surgery in the present admission (odds ratio: 3.5), P. aeruginosa (3.6) and a complicated bacteraemia (4.1) were related to a higher mortality rate. GN-CRBSI accounts for 17% of all CRBSI and should be taken into consideration in the empirical therapy of patients with the characteristics mentioned above.
    The Journal of hospital infection 09/2013; 85(4). DOI:10.1016/j.jhin.2013.08.008 · 2.54 Impact Factor
  • L Rojas · P Muñoz · M Kestler · D Arroyo · M Guembe · M Rodríguez-Créixems · E Verde · E Bouza ·
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    ABSTRACT: Information regarding bloodstream infections (BSIs) in patients with kidney diseases is scarce and mainly derived from selected groups of patients. To assess the characteristics of BSI in an unselected population of patients with kidney disease, including renal transplant recipients and patients with chronic kidney failure who were receiving or not receiving dialysis. A retrospective cohort study of all patients who presented with BSI in the nephrology department of a large teaching hospital. Clinical records were reviewed according to a pre-established protocol. Standard definitions were used. In all, 155 episodes of BSI were recorded in 108 patients. The incidence of BSI was 77.3 episodes per 1000 admissions, and 4.5 episodes per 100 patient-years. Haemodialysis patients had the highest incidence of BSI. The distribution of micro-organisms was as follows: Gram-negative, 52.3%; Gram-positive, 46.5%; fungi, 1.2%. Escherichia coli was the most frequently isolated micro-organism (27%). The BSI was classed as bacteraemia of unknown source (29.7%), urinary tract infection (23.2%), vascular access infection (17.4%), and other (29.7%). Eighteen patients (11.6%) developed septic shock or multi-organ failure, and the same proportion had persistent bacteraemia. The crude mortality rate was 14.6%. The risk factors for mortality were high Charlson index, persistent bacteraemia, and absence of fever. Nephrology patients have a high incidence of BSI, particularly patients undergoing haemodialysis. The predominant micro-organisms causing BSI episodes were Gram-negative bacilli. Patients with kidney disease have high BSI-related morbidity and mortality. Risk factors for mortality were high Charlson comorbidity index and persistent BSI. The presence of fever during the BSI episodes was found to be a protective factor.
    The Journal of hospital infection 08/2013; 85(3). DOI:10.1016/j.jhin.2013.07.009 · 2.54 Impact Factor
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    ABSTRACT: We retrospectively studied 22 patients with catheter-related candidemia caused by Candida albicans. Strains isolated simultaneously from blood and catheter tips were genotyped using six microsatellite markers. Matches between genotypes of isolates recovered from both sample sources were found in 20/22 (91%) patients. Consequently, identification of the same species from both the catheter tip and blood could be used to confirm catheter-related candidemia.
    Medical mycology: official publication of the International Society for Human and Animal Mycology 07/2013; 51(7). DOI:10.3109/13693786.2013.803165 · 2.34 Impact Factor
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    ABSTRACT: Genotyping of Candida albicans strains causing candidemia can uncover the presence of endemic genotypes in the hospital. Using a highly reproducible and discriminatory microsatellite marker panel, we studied the genetic diversity of 217 C. albicans isolates from the blood cultures of 202 patients with candidemia (from January 2007 to December 2011). Each isolate represented 1 candidemia episode. Multiple episodes were defined as the isolation of C. albicans in further blood cultures taken ≥7 days after the last isolation in blood culture. Of the 202 patients, 188 had 1 episode, 13 had 2 episodes, and 1 had 3 episodes. Identical genotypes showed the same alleles for all 6 markers. The genotypes causing both episodes were identical in most patients with 2 episodes (11/13; 84.6%). In contrast, 2 different genotypes were found in the patient with 3 episodes, one causing the first and second episodes and the other causing the third episode (isolated 6 months later). We found marked genetic diversity in 174 different genotypes: 155 were unique, and 19 were endemic and formed 19 clusters (2 to 6 patients per cluster). Up to 25% of the patients were infected by endemic genotypes that infected 2 or more different patients. Some of these endemic genotypes were found in the same unit of the hospital, mainly neonatology, whereas others infected patients in different wards.
    Journal of clinical microbiology 04/2013; 51(7). DOI:10.1128/JCM.00516-13 · 3.99 Impact Factor
  • Emilio Bouza · Almudena Burillo · Patricia Muñoz · Jesús Guinea · Mercedes Marín · Marta Rodríguez-Créixems ·
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    ABSTRACT: Objectives: Polymicrobial bloodstream infection (BSI) is an imprecisely defined entity purportedly associated with a worse outcome than monomicrobial BSI. This study examines trends in BSI episodes caused by bacteria and Candida spp. (mixed-BSI) in a large teaching hospital. Methods: All episodes of BSI from January 2000 to December 2010 were reviewed. Three groups (n = 54 each) of patients were compared: all adults with mixed-BSI from January 2006 to December 2010 (cases) and randomly selected patients with polybacterial BSI (polyB-BSI) (Control 1) or Candida spp. BSI (Candida-BSI) (Control 2) in this same period. Results: A total of 139 episodes of mixed-BSI were recorded (0.7% of all BSI, 6.9% of all poly-BSI and 18.0% of all Candida-BSI episodes). The incidence of mixed-BSI was 0.21 cases/1000 admissions, increasing from 0.08 (2000) to 0.34 (2010) cases/1000 admissions (P = 0.007). Mixed-BSI represented 11.8% and 22.9% of all episodes of candidaemia in 2000 and 2010, respectively (P = 0.011). Compared with polyB-BSI, mixed-BSI patients showed fewer malignancies, more frequent nosocomial or intravenous catheter BSI source and less frequent intra-abdominal origin, were more frequently admitted to an intensive care unit (ICU), received more antimicrobials and showed a longer hospital stay and higher mortality. Compared with Candida-BSI, mixed-BSI patients showed more severe underlying diseases, were more frequently admitted to an ICU or oncology-haematology unit, showed a higher APACHE II score, more often progressed to septic shock or multiorgan failure and received more antimicrobials. Mortality was similar. Conclusions: Mixed-BSI is a rare, distinct infection with a worse prognosis than polyB-BSI. We were unable to detect differences in the prognosis of mixed-BSI when compared with Candida-BSI.
    Journal of Antimicrobial Chemotherapy 03/2013; 68(8). DOI:10.1093/jac/dkt099 · 5.31 Impact Factor
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    Maddalena Giannella · Patricia Muñoz · Jesús Guinea · Pilar Escribano · Marta Rodríguez-Créixems · Emilio Bouza ·

    Mycoses 02/2013; 56(4). DOI:10.1111/myc.12045 · 2.24 Impact Factor

Publication Stats

3k Citations
658.38 Total Impact Points


  • 1997-2015
    • Complutense University of Madrid
      • • Facultad de Medicina
      • • Department of Medicine
      Madrid, Madrid, Spain
  • 1989-2015
    • Hospital General Universitario Gregorio Marañón
      • • Clinical Microbiology and Infectious Diseases
      • • Department of Clinical Microbiology
      • • Servicio de Microbiología
      Madrid, Madrid, Spain
  • 2014
    • Instituto de Investigación Sanitaria Gregorio Marañón
      Madrid, Madrid, Spain
  • 1996
    • The University of Western Ontario
      • Department of Microbiology and Immunology
      London, Ontario, Canada
  • 1988
    • Hospital Universitario Ramón y Cajal
      • Departamento de Microbiologia y Parasitología
      Madrid, Madrid, Spain
  • 1985-1987
    • Centro Especial Ramón y Cajal
      Madrid, Madrid, Spain