M Rodríguez-Créixems

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

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Publications (128)561.66 Total impact

  • [show abstract] [hide abstract]
    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. · 3.73 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 01/2014; · 1.48 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 01/2014; · 2.45 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; · 4.58 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; · 3.02 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; · 3.01 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; · 3.01 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; · 2.13 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 (January 2007 to December 2011). Each isolate represented 1 candidemia episode. Multiple episodes were defined as 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 a marked genetic diversity in 174 different genotypes: 155 were unique, and 19 were endemic and formed 19 clusters (2-6 patients per cluster). Up to 25% of patients were infected by endemic genotypes that infected 2 or more different patients. Some of these endemic genotypes were found in the same unit, mainly neonatology, whereas others infected patients in different wards.
    Journal of clinical microbiology 04/2013; · 4.16 Impact Factor
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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; · 5.34 Impact Factor
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    Mycoses 02/2013; · 1.28 Impact Factor
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    ABSTRACT: Management of complicated bloodstream infections requires more aggressive treatment than uncomplicated bloodstream infections. We assessed the value of follow-up bloodculture in bloodstream infections caused by S. aureus, Enterococcus sp, Streptococcus sp, and Candida sp, and studied the value of persistence of DNA in blood (Septifast®) for predicting complicated bloodstream infections. Patients with bloodstream infections caused by these microorganisms were enrolled prospectively. After the first positive bloodculture, samples were obtained every 3rd day to perform bloodculture and Septifast® simultaneously. Patients were followed to detect complicated bloodstream infection. The study sample comprised 119 patients. One-third developed complicated bloodstream infection. The values of persistently positive tests to predict complicated bloodstream infection were: Septifast® + (sensitivity, 56%; specificity, 79.5%; positive predictive value, 54%; negative predictive value, 80.5%; accuracy, 72.3%) and positive bloodcultures (sensitivity, 30.5%; specificity, 92.8%; positive predictive value, 64%; negative predictive value, 75.5%; accuracy, 73.9%). Multivariate analysis showed that patients with a positive Septifast® between days 3-7 had an almost 8-fold higher risk of developing complicated bloodstream infection. In S. aureus, the combination of both techniques to exclude endovascular complications was significantly better than bloodculture alone. We obtained a score with variables selected by the multivariate model. With a cut-off of 7, the negative predictive value for complicated bloodstream infection was 96.6%.Patients with a positive Septifast® result between days 3 and 7 after a positive bloodculture have an almost 8-fold higher risk of developing complicated bloodstream infections . A score combining clinical data with Septifast® may improve exclusion of complicated bloodstream infections.
    Journal of clinical microbiology 01/2013; · 4.16 Impact Factor
  • E Bouza, L Alcalá, P Muñoz, P Martín-Rabadán, M Guembe, M Rodríguez-Créixems
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    ABSTRACT: We compared the efficacy of three techniques-minimal time to positivity (MTTP) of blood cultures (BCs), differential time to positivity (DTTP) of BCs obtained from the catheter and peripheral veins and the number of positive BCs-in predicting catheter involvement in patients with well-demonstrated catheter-related candidaemia (C-RC) and non-catheter-related candidaemia (NC-RC).C-RC was defined as isolation of the same Candida species from blood and catheter tip culture (≥15 cfu/plate). A ROC curve was created for each quantitative variable to determine the best cut-off for predicting C-RC.A total of 108 episodes of candidaemia were included (84 adults and 24 children; 67 C-RC and 41 NC-RC). These were caused mainly by C. albicans (49.1%) and C. parapsilosis (30.6%). The MTTP was significantly shorter in adult patients with C-RC than in those with NC-RC (29.8 vs. 36.8 hours; p 0.035), although no cut-off value provided acceptable accuracy. DTTP had high sensitivity but low specificity for predicting CRC. However, C-RC episodes had a significantly greater number of positive BCs than NC-RC episodes. The optimal cut-off for predicting C-RC was at least two positive BCs out of three, with the following validity values: sensitivity, 100%; specificity, 62.5%; positive predictive value, 83.3%; negative predictive value, 100%; accuracy, 87.0%.None of the tests evaluated allow a clear-cut prediction of C-RC and the criteria accepted for bacteraemia should not be automatically extrapolated to candidaemia. We found that a low number of positive BCs with Candida had a high negative predictive value for a catheter origin.
    Clinical Microbiology and Infection 11/2012; · 4.58 Impact Factor
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    ABSTRACT: Clin Microbiol Infect ABSTRACT: The incidence of central-line-associated bloodstream infection (CLA-BSI) is reported per 1000 days of catheter exposure, mainly in the intensive care unit (ICU), because recording exposure throughout an institution is not always feasible. Confirmation of catheter-related bloodstream infection (CR-BSI) requires specific laboratory testing that identifies the catheter as the source of infection. This information is available in microbiology laboratories and can be assessed using a denominator of 1000 admissions. We evaluated recent trends in the incidence and aetiology of CR-BSI and compared adult ICUs with the remaining areas of the hospital in a retrospective cohort analysis of all confirmed CR-BSIs. During the 8-year study period, we recorded 1208 episodes (8.2% of BSIs) of CR-BSI. After adjusting for the blood cultures drawn, a significant reduction in incidence was observed in adult ICUs (47%), where care bundles had been applied. The reduction was similar irrespective of whether CLA-BSI or CR-BSI was assessed. We recorded a significant reduction in the incidence of Staphylococcus aureus CR-BSI, and a significant increase in the incidence of CR-BSI caused by Enterococcus sp., Gram-negative microorganisms and fungi. The microbiology department may complement CLA-BSI/1000 catheter-days by providing CR-BSI when days of exposure are not available, because both figures are parallel. We demonstrated a significant reduction in the incidence of CR-BSI in recent years in the population admitted to adult ICUs but not in the remaining areas of the hospital. A shift in the aetiological spectrum of CR-BSI may be occurring.
    Clinical Microbiology and Infection 10/2012; · 4.58 Impact Factor
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    ABSTRACT: Recent studies have reported a greater probability of vancomycin treatment failure in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections caused by strains with a vancomycin MIC ≥ 1.5 mg/L. However, previous reports included patients treated without adjustments based on vancomycin serum levels and with different methods to evaluate MICs, which may render different results. Over a 5 year period (2005-09), vancomycin MICs were determined for 361 MRSA isolates recovered from 309 patients with bloodstream infection using microdilution and the Etest simultaneously. The relationship between the vancomycin MICs determined by each method was assessed. To assess the outcome of patients treated with vancomycin, 104 patients for whom serum vancomycin levels had been determined were selected. The percentage of MRSA strains with MIC values ≥ 1.5 mg/L according to the Etest was 66.5% compared with only 3.6% according to microdilution. No correlation between mortality and any MIC value obtained with either method was observed, independently of the vancomycin serum levels measured. There is a poor correlation between vancomycin MIC values obtained by microdilution and by Etest. No association between mortality rate and any MIC value was observed, not even in patients with suboptimal vancomycin trough serum levels. These data do not support replacing or complementing the standard microdilution test with the Etest for determination of MICs of vancomycin in microbiology laboratories.
    Journal of Antimicrobial Chemotherapy 05/2012; 67(7):1760-8. · 5.34 Impact Factor
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    ABSTRACT: Clin Microbiol Infect ABSTRACT: The role of Enterococcus spp. as a cause of catheter-related bloodstream infections (CR-BSI) is almost unexplored. We assessed the incidence and clinical characteristics of enterococcal CR-BSI (ECR-BSI) over an 8-year period in our hospital. We performed a retrospective study (January 2003 to December 2010) in a large teaching institution. We recorded the incidence, and the microbiological and clinical data from patients with ECR-BSI. The incidence per 10 000 admissions for enterococcal BSI and ECR-BSI was 25 and 1.7, respectively. ECR-BSI was the fourth leading cause of CR-BSI in our institution (6%). A total of 75 episodes of ECR-BSI were detected in 73 patients (6% of all enterococcal BSI). The incidence of ECR-BSI increased by 17% annually (95% CI 19.0-21.0%) during the study period. Nineteen percent of ECR-BSI episodes were polymicrobial. Overall mortality was 33%. ECR-BSI is an emerging and increasingly common entity with a high mortality. This finding should be taken into account when selecting empirical treatment for presumptive CR-BSI.
    Clinical Microbiology and Infection 04/2012; · 4.58 Impact Factor
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    ABSTRACT: To analyze the incidence trend of listeriosis, its present epidemiology and the potential benefit of aminoglycosides during the last two decades. We reviewed all cases of invasive listeriosis detected during a 22-year period in a large tertiary hospital. Two equal periods of 11 years were compared. We detected 111 cases of listeriosis (32 during the first 11-year period and 79 during the second). Incidence of listeriosis increased significantly (from 4.66/10(6) inhabitants to 10.39/10(6) inhabitants; P = .001). In the second period, there were more patients >65 years (21.9%-45.6%; P = .02) and with no significant underlying diseases (0 vs. 16.5%; P = .02). Comparing clinical presentations between the two periods, primary bacteremia increased (40.6% vs. 55.7%), while central nervous system infections decreased (34.4% vs. 27.8%). Cotrimoxazole (SXT) use increased significantly in the second period (from 6.3% to 40.5%, P = .001) while the administration of aminoglycosides decreased (from 40.6% to 21.5%, P = .04). The use of combination therapy did not have any impact on mortality, however it did increase toxicity. Listeriosis should be considered an emerging health problem, especially among the elderly, including those with no underlying medical conditions. The use of aminoglycosides does not seem to be justified according to our data.
    The Journal of infection 01/2012; 64(1):19-33. · 4.13 Impact Factor
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    ABSTRACT: The ideal number of blood samples to be obtained from peripheral veins (PVs) when differential time to positivity (DTTP) is being performed is an unresolved issue and most institutions obtain a single set. Our objective was to assess the number of proven central line-associated bloodstream infection (CLABSI) episodes that would have been recovered if blood had been cultured from one or two PVs. We performed a retrospective study in patients with proven CLABSI in which catheter lumens and two or more PV blood cultures were taken simultaneously. We calculated the number of episodes that would have been recovered if the culture of one or more PV blood cultures had been artificially eliminated. During a period of 4 years, we collected 60 episodes of proven CLABSI. Overall, if one PV culture had been eliminated in patients with two or three PV blood cultures, we would have documented 91.8% (p=0.362) and 96.9% (p>0.999) of episodes, respectively. If we had eliminated two PV blood cultures in patients with three PV blood cultures, 90.8% (p>0.999) of episodes would have been documented. When performing the DTTP technique to confirm CLABSI, a single paired PV blood culture was not associated with a significant number of missed CLABSI episodes.
    European Journal of Clinical Microbiology 10/2011; 31(7):1367-72. · 3.02 Impact Factor
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    ABSTRACT: The risk factors and clinical features of patients with Candida tropicalis fungaemia have not been fully defined. We performed a case-control study comparing 59 cases of C. tropicalis fungaemia with 177 episodes of fungaemia caused by other species of Candida in our hospital over a 24-year period (January 1985 to December 2008). Patients with C. tropicalis fungaemia were more likely to be older (median age, 67 vs. 56 years; p 0.01), to have cancer (45.5% vs. 31.6%, p 0.04), and to have the abdomen as the portal of entry (32.2% vs. 11.9%, p 0.001), and had a higher in-hospital mortality rate (61% vs. 44%, p 0.03). Multivariate analysis showed that the independent risk factors for C. tropicalis fungaemia were cancer (OR 4.5; 95% CI 1.05-3.83; p 0.03) and the abdomen as the portal of entry (OR 13.6; 95% CI 1.9-8.2; p <0.001). When survivors were compared with non-survivors, the risk factors associated with a poor outcome were neutropenia (19.4% vs. 0; p 0.03), corticosteroid treatment (36% vs. 13%; p 0.07), and septic shock (50% vs. 17.4%; p 0.01). The independent risk factors for mortality in the multivariate analysis were corticosteroid treatment (OR 8.2; 95% CI 0.9-27.7; p 0.04) and septic shock (OR 14.6; 95% CI 2.4-90.2; p 0.004), whereas urinary tract infection (OR 0.07; 95% CI 0.01-0.8; p 0.03) and catheter removal (OR 0.06; 95% CI 0.01-0.4; p 0.002) were protective factors. C. tropicalis is the fourth most common cause of fungaemia in our hospital. It is associated with underlying malignancy, the abdomen as the portal of entry, and poor outcome.
    Clinical Microbiology and Infection 10/2011; 17(10):1538-45. · 4.58 Impact Factor
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    ABSTRACT: Whether patients whose catheter tip grows Staphylococcus aureus but who have no concomitant bacteraemia should receive antimicrobials remains an unresolved issue. However, a proportion of patients with catheter tips colonized by S. aureus have no blood cultures taken because of low suspicion of sepsis and the meaning of this microbiological finding is unknown. We have analysed all catheter tips growing S. aureus during a 6-year period and have selected patients without blood cultures taken 7 days before or after central vascular catheter removal. Patient's evolution was classified into good and poor outcome. Poor outcome was defined as S. aureus infection within 3 months after catheter withdrawal or death in the same period with no obvious cause. Patients with good and poor outcomes were compared to assess whether antimicrobial therapy influenced evolution. Sixty-seven patients fulfilled our inclusion criteria and five (7.4%) had a poor outcome. The administration of early anti-staphylococcal therapy had no impact on the outcome of this population (p 0.99). The only factor independently associated with a poor outcome was the presence of clinical signs of sepsis when the catheter was removed (OR 20.8; 95% CI 2.0-206.1; p 0.009). Our data suggest that patients with central vascular catheter tips colonized with S. aureus should be closely monitored for signs and symptoms of ongoing infection, but if these are not present then antimicrobial therapy does not seem justified.
    Clinical Microbiology and Infection 09/2011; 18(9):877-82. · 4.58 Impact Factor

Publication Stats

2k Citations
561.66 Total Impact Points

Institutions

  • 2013–2014
    • Instituto de Investigación Sanitaria Gregorio Marañón
      Madrid, Madrid, Spain
  • 1988–2014
    • Hospital General Universitario Gregorio Marañón
      • • Clinical Microbiology and Infectious Diseases
      • • Servicio de Microbiología
      • • Department of Clinical Microbiology
      Madrid, Madrid, Spain
  • 1997–2013
    • Complutense University of Madrid
      Madrid, Madrid, Spain
  • 1999
    • Hospital Universitari Mutua de Terrassa
      Terrassa, Catalonia, Spain
  • 1996
    • The University of Western Ontario
      • Department of Microbiology and Immunology
      London, Ontario, Canada
  • 1985–1987
    • Centro Especial Ramón y Cajal
      Madrid, Madrid, Spain