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ABSTRACT: PURPOSE: Peroneal nerve palsy in traumatic knee dislocations associated with multiple ligament injuries is common. Several surgical approaches are described for this lesion with less-than-optimal outcomes. The present case represents the application of plasma rich in growth factors (PRGF) technology for the treatment of peroneal nerve palsy with drop foot. This technology has already been proven its therapeutic potential for various musculoskeletal disorders. Based on these results, we hypothesized that PRGF could stimulate the healing process of traumatic peroneal nerve palsy with drop foot. METHODS: The patient was a healthy 28-year-old man. He suffered peroneal nerve palsy with drop foot after multiple ligament injuries of the knee. PRGF was prepared according to the manufactured instruction. Eleven months after the trauma with severe axonotmesis, serial intraneural infiltrations of PRGF were started using ultrasound guidance. The therapeutic effect was assessed by electromyography (EMG), echogenicity of the peroneal nerve under ultrasound (US) and manual muscle testing. RESULTS: Twenty-one months after the first injection, not complete but partial useful recovery is obtained. He is satisfied with walking and running without orthosis. Sensitivity demonstrates almost full recovery in the peroneal nerve distribution area. EMG controls show complete reinnervation for the peroneus longus and a better reinnervation for the tibialis anterior muscle, compared with previous examinations. CONCLUSION: Plasma rich in growth factors (PRGF) infiltrations could enhance healing process of peroneal nerve palsy with drop foot. This case report demonstrates the therapeutic potential of this technology for traumatic peripheral nerve palsy and the usefulness of US-guided PRGF. LEVEL OF EVIDENCE: V.
Knee Surgery Sports Traumatology Arthroscopy 03/2013; · 2.21 Impact Factor
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ABSTRACT: To determine the epidemiology of bacteraemia due to biliary tract infection (BTI) and to identify independent predictors of mortality.
This study was part of a bloodstream infection surveillance study that prospectively collected data on consecutive patients with bacteraemia in our institution from 1991 to 2010. BTI was the confirmed source of 1373 patients with bacteraemia, and the independent prognostic factors of 30 day mortality were determined.
The mean age of patients with biliary sepsis was 71 years (± 14 years). The most frequent comorbidities were biliary lithiasis and solid-organ cancer [484 cases (35%) and 362 cases (26%), respectively]. The BTI was healthcare-associated in 33% of patients. Shock and mortality accounted for 209 and 126 cases, respectively (15% and 9%). The most frequent microorganisms isolated were Escherichia coli (749, 55%), Klebsiella spp. (240, 17%), Enterococcus spp. (171, 12%), Pseudomonas aeruginosa (86, 6%) and Enterobacter spp. (63, 5%). There were 47 (3%) cefotaxime-resistant (CTX-R) E. coli or Klebsiella spp. Inappropriate empirical antibiotic treatment was an independent factor associated with mortality (OR 1.4, 95% CI 1.1-1.7). Inappropriate empirical treatment was more frequent in P. aeruginosa and CTX-R Enterobacteriaceae bacteraemia. These microorganisms were significantly more common in patients with previous antibiotic therapy, solid-organ cancer or transplantation and in healthcare-associated bacteraemia.
In patients with bacteraemic BTI, inappropriate empirical therapy was more frequent in P. aeruginosa and CTX-R Enterobacteriaceae infection and was associated with a higher mortality rate. In patients with bacteraemia due to BTI and solid-organ cancer or transplantation, healthcare-associated infection or previous antibiotic treatment, initial therapy with piperacillin/tazobactam or a carbapenem would be advisable.
Journal of Antimicrobial Chemotherapy 03/2012; 67(6):1508-13. · 5.07 Impact Factor
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Catia Cillóniz,
Santiago Ewig,
Eva Polverino,
Maria Angeles Marcos,
Elena Prina,
Jacobo Sellares,
Miquel Ferrer, Mar Ortega,
Albert Gabarrús,
Josep Mensa,
Antoni Torres
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ABSTRACT: The purpose of this study was to establish the microbial aetiology and outcomes of patients with community-acquired pneumonia (CAP) treated as outpatients after presenting to a hospital emergency care unit. A prospective observational study was carried out in the Hospital Clinic of Barcelona (Barcelona, Spain). All consecutive cases of CAP treated as outpatients were included. 568 adult outpatients with CAP were studied (mean±sd age 47.2±17.6 yrs; 110 (19.4%) were aged ≥65 yrs). Aetiological diagnoses were established in 188 (33.1%) cases. Streptococcus pneumoniae was the most frequent pathogen followed by Mycoplasma pneumoniae and respiratory viruses. Legionella was detected in 13 (2.3%) cases. More than one causative agent was found in 17 (9.0%) patients. Mortality was low (three (0.5%) patients died) and other adverse events were rare (30 (5.2%) patients had complications, 13 (2.3%) were re-admitted and treatment failed in 13 (2.3%)). Complications were mostly related to pleural effusion and empyema, and re-admissions and treatment failures to comorbidities. Outpatients with CAP have a characteristic microbial pattern. Regular antipneumococcal coverage remains mandatory. Treatment failures and re-admissions are rare and may be reduced by increased attention to patients requiring short-term observation in the emergency care unit and in the presence of pleural effusion and comorbidities.
European Respiratory Journal 01/2012; 40(4):931-8. · 5.89 Impact Factor
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ABSTRACT: We attempt to describe the epidemiology and outcome associated with cefotaxime-resistant (CTX-R) Klebsiella spp bacteraemia. Klebsiella spp bloodstream infection episodes prospectively collected through a blood culture surveillance programme from January 1991 to December 2008 in a single institution were analysed. A total of 910 monomicrobial episodes of Klebsiella spp bacteraemia were identified during the study period. The most important sources were from urinary tract infection, unknown sources, billiary focus and catheter related infection. There were 112 (12%) CTX-R isolates. Out of 112 isolates, 98 were CTX-R by Extended-Spectrum β-Lactamase production. Shock on presentation and mortality were significantly more frequent in CTX-R than in CTX susceptible isolates. Inappropriate empirical therapy was received in 50 (45%) cases in the CTX-R Klebsiella spp group (13 cases of death, 26%). Predictive factors associated with CTX-R Klebsiella spp isolate were: previous β-lactam therapy (OR = 4.16), nosocomial acquired bacteraemia (OR = 1.93), solid organ trasplantation (OR = 2.09) and shock (OR = 1.90). Independent risk factors associated with mortality in Klebsiella spp bacteraemia were: age (OR = 1.03), liver cirrhosis (OR = 2.63), ultimately or rapidly fatal prognosis of underlying disease (OR = 2.44), shock (OR = 8.60), pneumonia (OR = 4.96) or intraabdominal (OR = 3.85) source of bacteraemia and CTX-R isolate (OR = 4.63). Klebsiella spp is an important cause of bloodstream infection. CTX-R isolates have been increasing since 2000. CTX-R is an independent factor associated with mortality in Klebsiella spp bacteraemia.
European Journal of Clinical Microbiology 04/2011; 30(12):1599-605. · 2.86 Impact Factor
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ABSTRACT: Candidaemia remains a major cause of morbidity and mortality in the healthcare setting. Candida spp. bloodstream infection episodes prospectively recorded through a blood culture surveillance programme in a single institution from 1991 to 2008 were included in the study. Data regarding candidaemia episodes were analysed, including specific fungal species and patient survival at 30 days after diagnosis. There were 529 candidaemia episodes during the study period (495 were nosocomial infections). The incidence of candidaemia caused by non-Candida albicans Candida spp. (52%) was higher than the incidence of candidaemia caused by C. albicans (48%). The overall crude 30 day mortality rate was 32%. Patients with Candida parapsilosis candidaemia had the lowest mortality rate (23%). Candida krusei candidaemia was most commonly associated with haematological malignancy (61%; P < 0.001), stem cell transplantation (22%; P = 0.004), neutropenia (57%; P = 0.001) and prior use of antifungal azole agents (26%; P < 0.001). Patients with C. krusei candidaemia had the highest crude 30 day mortality in this series (39%). Epidemiological studies are important to define clinical and microbiological candidaemia characteristics and to guide empirical treatment in every setting.
The Journal of hospital infection 02/2011; 77(2):157-61. · 3.01 Impact Factor
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ABSTRACT: Evidence supporting the combination of aminoglycosides with beta-lactams for gram-negative bacteremia is inconclusive. We have explored the influence on survival of empirical therapy with a beta-lactam alone versus that with a beta-lactam-aminoglycoside combination by retrospectively analyzing a series of bacteremic episodes due to aerobic or facultative gram-negative microorganisms treated with single or combination therapy. The outcome variable was a 30-day mortality. Prognostic factors were selected by regression logistic analysis. A total of 4,863 episodes were assessed, of which 678 (14%) received combination therapy and 467 (10%) were fatal. Factors independently associated with mortality included age greater than 65 (odds ratio [OR], 2; 95% confidence interval [CI], 1.6 to 2.6), hospital acquisition (OR, 1.5; 95% CI, 1.2 to 1.9), a rapidly or ultimately fatal underlying disease (OR, 2.5; 95% CI, 2 to 3.2), cirrhosis (OR, 1.9; 95% CI, 1.4 to 2.6), prior corticosteroids (OR, 1.5; 95% CI, 1.1 to 2), shock on presentation (OR, 8.8; 95% CI, 7 to 11), pneumonia (OR, 2.8; 95% CI, 1.9 to 4), and inappropriate empirical therapy (OR, 1.8; 95% CI, 1.3 to 2.5). Subgroup analysis revealed that combination therapy was an independent protective factor in episodes presenting shock (OR, 0.6; 95% CI, 0.4 to 0.9) or neutropenia (OR, 0.5; 95% CI, 0.3 to 0.9). Combination therapy improved the appropriateness of empirical therapy in episodes due to extended-spectrum beta-lactamase (ESBL)- or AmpC-producing Enterobacteriaceae and Pseudomonas aeruginosa. In patients with gram-negative bacteremia, we could not find an overall association between empirical beta-lactam-aminoglycoside combination therapy and prognosis. However, a survival advantage cannot be discarded for episodes presenting shock or neutropenia, hence in these situations the use of combination therapy may still be justified. Combination therapy also should be considered for patients at risk of being infected with resistant organisms, if only to increase the appropriateness of empirical therapy.
Antimicrobial Agents and Chemotherapy 09/2010; 54(9):3590-6. · 4.84 Impact Factor
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ABSTRACT: the aim of our study was to review the epidemiology and clinical manifestations of infections due to Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus (PVL-MRSA).
Medical history of patients infected by MRSA-PVL admitted to our hospital from January 2007 to July 2009 was reviewed. PVL and the type of cromosomic cassette were determined in all strains by PCR.
A total of 37 cases were included. Seventy percent were males and the median age was 39 years. Sixtytwo percent were Spanish, 14 (37.8%) were HIV-positive and 11 (29.7%) were homosexual. The source of the infection was the skin and soft tissue in 36 cases and pneumonia in 1. Sixteen patients were hospitalized, 5 had bacteremia and 5 developed septic metastasis. The relapse rate was 24% (9 cases). The prevalence during the study period was 11.2% of all MRSA isolated (37 out of 329). All the strains had a cromosomic cassette type IV and were susceptible to cotrimoxazole, rifampin, vancomyin, daptomycin and linezolid. The MIC of vancomycin, measured by E-test, was ≥ 1.5 mg/L in 28 out of 34 cases (82.3%).
Eleven percent of the MRSA strains isolated in our hospital are PVL positive. In general, skin and soft tissue infections are the most common and bacteremia or septic metastasis are frequent. In contrast to previous Spanish studies, more cases are observed in patients born in Spain and the infections are more severe.
Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 06/2010; 23(2):93-9. · 0.81 Impact Factor
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ABSTRACT: To assess the influence of new antifungal treatments on candidaemia outcome.
Candidaemia episodes prospectively collected through a blood culture surveillance programme in a single institution. The study was divided into two periods of time, 1994-2003 (A) and 2004-2008 (B), according to the introduction of echinocandin treatment. Non-conditional logistic regression methods with mortality as the dependent variable were used.
Four hundred and thirty-three (3%) candidaemias out of 15 628 bloodstream infection episodes were analysed. Candida albicans was the most frequent species (211; 49%). Mortality was noted in 132 cases (30%). A total of 262 and 171 candidaemias were reported in period A and B, respectively. There were 94 deaths in period A (36%) and 38 in period B (22%, P = 0.03). Treatment in period A was amphotericin B in 89 patients (41 dead, 46%) and fluconazole in 151 (41 dead, 27%, P = 0.003). In period B, 113 patients received a triazole (26 dead, 23%), 30 an echinocandin (3 dead, 10%, P = 0.08) and 9 (0 dead) were treated with combined therapy (echinocandin and triazole). Mortality was higher in period A (94 dead, 36%) than in period B (38 dead, 27%), P = 0.03. Independent risk factors associated with mortality in period B were: age, chronic renal failure, ultimately or rapidly fatal prognosis of underlying disease and shock. Echinocandin alone or in combination therapy was associated with better outcome (odds ratio = 0.22, 95% confidence interval = 0.06-0.81, P = 0.02).
In patients with candidaemia, echinocandin therapy results in a better outcome.
Journal of Antimicrobial Chemotherapy 03/2010; 65(3):562-8. · 5.07 Impact Factor
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Revista Clínica Española 01/2009; 208(11):591-2; author reply 592. · 2.01 Impact Factor
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ABSTRACT: To describe the predictive factors for the isolation of fluoroquinolone-resistant or extended- spectrum beta-lactamase (ESBL)-producing Escherichia coli and their impact on bacteraemia outcome.
Analysis of E. coli bacteraemia episodes prospectively collected through a blood culture surveillance programme from January 1991 to December 2007.
Out of 18 080 episodes, 4758 (26%) E. coli bacteraemias were reported in the period of study. Mortality was noted in 440 cases (9%). Fluoroquinolone-resistant strains were reported in 1300 (27%) cases and ESBL-producing strains in 211 cases (4%). One hundred and seventy-eight strains out of 211 (84%) ESBL-producing E. coli were isolated since 2001. The two main independent risk factors for mortality were shock (OR: 10.28, P < 0.001) and inappropriate empirical therapy (OR: 4.83, P < 0.001). Inappropriate empirical therapy was significantly more frequent for infections caused by fluoroquinolone-resistant strains (n = 203, 16%, P < 0.001) and ESBL-producing strains (n = 110, 52%, P < 0.001). Independent factors associated with the isolation of a fluoroquinolone-resistant strain were: nosocomial origin (OR: 1.61, P < 0.001); urinary catheterization (OR: 2.44, P < 0.001); and previous therapy with a fluoroquinolone (OR: 7.41, P < 0.001). The independent risk factors associated with the isolation of an ESBL-producing strain were: nosocomial origin (OR: 1.68, P = 0.03); urinary catheterization (OR: 1.88, P = 0.001); and previous beta-lactam antibiotic therapy (OR: 2.81, P < 0.001).
Inappropriate empirical therapy was the strongest independent factor that we could modify to improve mortality in E. coli bacteraemia and was more frequent in cases caused by fluoroquinolone-resistant or ESBL-producing strains. Nosocomial acquisition, urinary catheterization and previous therapy with a fluoroquinolone or beta-lactam were predictive factors for infection with an antibiotic-resistant strain.
Journal of Antimicrobial Chemotherapy 01/2009; 63(3):568-74. · 5.07 Impact Factor
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ABSTRACT: A greater rate of treatment failures with vancomycin in methicillin-resistant Staphylococcus aureus (MRSA) bacteremia has been reported recently when the minimum inhibitory concentration (MIC) is > or =2 mg/l. This study has aimed to evaluate if there are clinical and/or epidemiological factors that predict isolation of a MRSA strain with MIC of vancomycin of > or =2 mg/L in the bacteremia episodes collected during a 15 year period (January 1991 to December 2005) in a tertiary urban hospital. During the study period, a total of 478 episodes of MRSA bacteremia were studied prospectively. The following clinical variables were recorded for each one: age, gender, comorbidity, previous administration of vancomycin or another antibiotic, prognosis of baseline diseases, bacteremia focus, shock, empiric antibiotic received and mortality. The MIC of vancomycin of 419 strains (88%) was determined with the E-test. In 216 (52%) of the isolations the MIC of vancomycin was 1.50 mg/L, in 110 (26%) of the cases it was < or =1 mg/l and in 93 (22%) 2 mg/l. Uni-and multivariate analyses were made, comparing the clinical variables of the patients infected by strains with MIC of vancomycin > or =2 mg/l regarding the MIC strains < or =1 mg/l. In the last 3 years of the study (2003-2005) the proportion of the strains with MIC of vancomycin > or =2 mg/l was significantly greater than those isolated with MIC < or = 1 mg/L (44 % vs 3 %; p<0.001). In the multivariate analysis, the only clinical characteristic associated independently to the isolation of a strain with MIC > or =2 mg/l was the nosocomial-acquired infection OR (95 % CI): 1.94 (1.04-3.63); p=0.04. Although the isolation of a MRSA strain with MIC of vancomycin > or =2 mg/l is more frequent in the nosocomial-acquired bacteremia episodes, in the clinical practice, it is not a useful predictive parameter because the frequency of isolation of these strains in the community is also high.
Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 07/2008; 21(2):93-8. · 0.81 Impact Factor
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ABSTRACT: This study was undertaken to describe the epidemiology and sensitivity pattern of pathogens causing community-acquired (CA) and nosocomial (N) bloodstream infection (BSI) in adult HIV-infected patients and to establish risk factors for mortality. The type of study was a retrospective analysis of BSI episodes prospectively collected through a blood culture surveillance program from January 1991 to December 2006. We used non-conditional logistic regression methods with death as a dependent variable. One thousand and seventy-seven episodes of BSI (6%) occurred in HIV-infected patients out of 16,946 episodes during the period of study. CA and N BSI were 634 (59%) and 443 (41%) respectively. S. pneumoniae and S. aureus were the most frequent pathogens (n = 279, 44%) in CA BSI. Coagulase-negative staphylococci and S. aureus were the most frequent micro-organisms isolated in N cases (n = 169, 38%). Cotrimoxazole resistance was common in CA and N BSI and was caused by gram-negative bacilli (50% and 61% respectively). However, resistance rates to ceftriaxone were low (3%). Crude mortality accounted for 140 cases (13%). The independent risk factors associated with mortality were: liver cirrhosis (OR: 2.90, p = 0.001), corticosteroids treatment (OR: 3.51, p < 0.001), neutropenia (OR: 2.21, p = 0.02), inappropriate empirical therapy (OR: 2.44, p = 0.006), and isolate of C. albicans (OR: 7.58, p = 0.010). BSI in adult HIV-infected patients was often caused by gram-positive pathogens in both CA and N settings. Inappropriate empirical therapy and the presence of other immunosuppressive factors were independent risk factors for mortality. Ceftriaxone could be used as the initial empiric therapy for HIV-infected patients with suspected CA BSI.
European Journal of Clinical Microbiology 05/2008; 27(10):969-76. · 2.86 Impact Factor
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Emergency Medicine Journal 02/2008; 25(1):60. · 1.44 Impact Factor
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ABSTRACT: The purpose of this study was to investigate if vancomycin concentration is maintained along the lumen of dialysis catheters after 48 h of lock therapy. Each lumen of nine catheters (three subclavian and six femoral) was locked with 2,500 mg/l of vancomycin for 48 h. After that period, the content of the lumen was aspirated with three different syringes of 0.4 ml each to measure the proximal, medial and distal vancomycin concentration. Vancomycin concentration was measured using a homogeneous particle-enhanced turbidimetric inhibition immunoassay. A non-parametric ANOVA, by means of a rank transformation on the antibiotic concentration, was used to assess the influence of the catheter segment (proximal, medial and distal) and the catheter type (femoral or subclavian). A significant decrease in vancomycin concentration from proximal to distal segments was observed (p < 0.001). In addition, the vancomycin concentration in subclavian catheters was significantly higher than in femoral catheters (p < 0.001). In our study there was a decreasing gradient in vancomycin concentration from proximal to distal segments of the catheter. This may explain the failure of antibiotic lock-therapy.
European Journal of Clinical Microbiology 10/2007; 26(9):659-61. · 2.86 Impact Factor
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ABSTRACT: We conducted this study to determine the associated factors and outcomes of community-acquired primary bacteremia (PB), to describe the most frequently isolated microorganisms, the antibiotic resistance pattern, and to guide the most appropriate antibiotic treatment. A total of 1,640 community-acquired bacteremia cases in nonneutropenic adults were consecutively enrolled from January 2003 to May 2006 and prospectively followed up. Nonconditional logistic regression methods were used with PB and death as dependent variables. Secondary bacteremia (SB) was present in 1,440 patients, and 200 (12%) cases were PB. The independent factors associated with PB were male sex (OR 1.69, 95%CI 1.27-2.25, P = 0.001) and an ultimately or rapidly fatal prognosis for an underlying disease (OR 2.48, 95%CI 1.84-3.34, P = 0.001). The most frequently isolated microorganisms in PB were E. coli and other enterobacteria (26 and 22%, respectively) and S. aureus (15%). There were 28 and 37% ciprofloxacin-resistant E. coli strains in SB and PB, respectively (P = 0.2). Mortality was significantly higher in PB cases (13 vs 8%, P = 0.04). The independent factors associated with mortality in PB were ultimately or rapidly fatal prognosis of underlying disease (OR 2.1, 95%CI 1.41-3.13, P = 0.001), lack of fever at the moment of bacteremia (OR 2.38, 95%CI 1.18-4.76, P = 0.02) and incorrect empirical antibiotic therapy (OR 2.01, 95%CI 1.22-3.33, P = 0.006). The initial empiric antibiotic treatment was more frequently incorrect in PB than in SB, and this was a predictive factor for mortality in PB. The resistance pattern of E. coli, other enterobacteria and S. aureus in every setting should guide the most appropriate empirical treatment for PB.
European Journal of Clinical Microbiology 08/2007; 26(7):453-7. · 2.86 Impact Factor
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ABSTRACT: The aim of this study was to analyze whether procalcitonin (PCT) is a diagnostic marker of infectious diseases during the non-neutropenic period in patients who have received an allogeneic hematopoietic stem cell transplant (HSCT). We included 65 patients in whom an allogeneic HSCT was performed in a 2-year period (April 2002-July 2004). PCT levels were monitored in every febrile episode by an immunoluminometric assay. Febrile episodes were classified according to the final diagnosis in: fever of unknown origin, microbiologically or clinically documented infection and non-infectious fever. Fifty-two febrile episodes in the non-neutropenic period were included in the study. Out of these 52, 26 had an infectious etiology: 11 fulfilled criteria for probable or proven invasive aspergillosis (IA), three were classified as possible invasive fungal infection (IFI) and 12 episodes were caused by other infections. Mean values of PCT on the first day of admission were: 8.0 (+/- 4.9) in probable-proven IA (P = 0.013, Kruskall-Wallis), 4.5 (+/- 3.4) in possible IFI and 1.5 (+/- 0.9) in infections other than IFI. Therefore, we could conclude that during the non-neutropenic phases of allogeneic HSCT, a high PCT value is associated significantly with IA.
Bone Marrow Transplantation 04/2006; 37(5):499-502. · 3.75 Impact Factor
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ABSTRACT: Information about the in vitro effect of combinations of anti-staphylococcal agents on staphylococci is scarce. The aim of the study was to evaluate the in vitro activity of linezolid, moxifloxacin, levofloxacin, clindamycin and rifampin, alone or in combination, against Staphylococcus spp. Two Staphylococcus aureus and two Staphylococcus epidermidis strains isolated from blood cultures were studied using the killing curve method. The combinations analyzed were linezolid+moxifloxacin, linezolid+levofloxacin, linezolid+clindamycin, linezolid+rifampin, moxifloxacin+rifampin, moxifloxacin+clindamycin, levofloxacin+rifampin and levofloxacin+clindamycin. The following concentrations (mg/l) were used: 8 and 16 for linezolid, 2 for moxifloxacin, 3 for levofloxacin, 2 for clindamycin and 2 and 5 for rifampin. The activity was considered synergistic when a reduction in growth of at least 2 log(10) was produced with the combination in comparison to the most active antibiotic alone; antagonistic when a growth of at least 2 log(10) was produced with the combination in comparison to the most active antibiotic alone; and indifferent if the variation was less than 1 log(10). Linezolid and clindamycin were bacteriostatic, while moxifloxacin and levofloxacin were bactericidal. Rifampin was bacteriostatic against S. aureus and bactericidal against S. epidermidis. Linezolid and clindamycin reduced the bactericidal activity of levofloxacin and moxifloxacin, however an antagonistic effect was only observed against S. aureus. Other combinations of linezolid, rifampin, clindamycin, levofloxacin or moxifloxacin were indifferent. Linezolid and clindamycin antagonize the bactericidal activity of fluorquinolones against staphylococci. There was no difference between any other combinations against either S. aureus or S. epidermidis.
Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 07/2005; 18(2):168-72. · 0.81 Impact Factor
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ABSTRACT: A cohort of 1,391 patients with community-acquired pneumonia of unknown etiology, atypical pneumonia, Legionella pneumophila pneumonia, viral pneumonia, or pneumococcal pneumonia was studied according to a standard protocol to analyse whether the addition of a macrolide to beta-lactam empirical treatment decreases mortality rates. Patients admitted to the intensive care unit were excluded. Severity was assessed using the PORT score. An etiological diagnosis was achieved in 498 (35.8%) patients (292 infections due to Streptococcus pneumoniae). Treatment was chosen by the attending physician according to his/her own criteria: beta-lactam agent in 270 and beta-lactam agent plus a macrolide in 918 cases. The mortality rate was 13.3% in the group treated with a beta-lactam agent alone and 6.9% in the group treated with a beta-lactam agent plus a macrolide (p=0.001). The percentage of PORT-group V patients was 32.6% in the group treated with a beta-lactam agent alone compared to 25.7% in the group who received a beta-lactam agent plus a macrolide (p=0.02). After controlling for PORT score, the odds of fatal outcome was two times higher in patients treated with a beta-lactam agent alone than in those treated with a beta-lactam agent plus a macrolide (adjusted OR = 2, 95%CI 1.24-3.23). The results suggest that the addition of a macrolide to an initial beta-lactam-based antibiotic regimen is associated with lower mortality in patients with community-acquired pneumonia, independent of severity of infection, thus supporting the recommendation of a beta-lactam-agent plus a macrolide as empirical therapy.
European Journal of Clinical Microbiology 04/2005; 24(3):190-5. · 2.86 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the usefulness of C-reactive protein (CRP) monitoring in the differential diagnosis and prognosis of febrile neutropenic episodes in hematopoietic cell transplantation (HCT). In all, 100 patients were enrolled in the study. The CRP was determined in serum every 48 h from admission until resolution of the febrile episode. All patients presented with fever during the post-HCT neutropenic period. The febrile episodes were classified as microbiologically documented infection in 32 cases, clinically documented infection in 27 patients and fever of unknown origin in 41 patients. The mean CRP values on the first day of fever in these three groups were similar (NS). On the fifth day of antibiotic treatment, 50 patients remained pyrexial. Of these, 41 improved with modifications of antibiotherapy (mean CRP: 9.5 mg/dl; standard deviation (s.d.): 6.2) and nine died, five due to an infectious etiology (CRP: 21 mg/dl; s.d.: 4.4; P<0.003) and four from other causes (CRP: 11 mg/dl; s.d.: 3.4). On multivariate analysis, the CRP on the fifth day of treatment was an independent prognostic factor for fatal outcome. We conclude that persistent elevation of the CRP is an independent factor predicting a fatal outcome in patients who remain febrile on the fifth day of antibiotherapy during neutropenic febrile episodes post-HCT.
Bone Marrow Transplantation 05/2004; 33(7):741-4. · 3.75 Impact Factor
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J J Mateos,
M Velasco,
F Lomena,
J P Horcajada,
F J Setoain,
F Martin, M Ortega,
D Fuster,
C Piera,
F Pons,
J Mensa
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ABSTRACT: Although prostatitis is a common problem the diagnosis is still controversial despite the availability of a wide variety of diagnostic tools. In fact, there is still no accurate method of localizing the infected tissue. The aims of the present study were to assess whether 111In labelled leukocytes (ILLs) accumulated in the infected tissue of acute prostatitis and if such uptake responded to treatment. We prospectively studied 10 adult male patients who had community acquired prostatitis and compared them with six male patients who had urinary tract infections but without prostatitis. An initial urinary culture and two blood cultures were carried out for each patient. All patients were followed up for 8 weeks after therapy was completed. Pre- and post-treatment scintigraphies were performed. Before treatment, all patients with prostatitis showed uptake of ILLs in the prostate area. After the patients had completed treatment with antibiotics, the scintigraphy results showed no uptake in the prostate area in 9/10 patients. The remaining patient showed a marked decrease in the uptake of ILLs. None of the six patients with urinary tract infection showed ILL uptake in the prostate region. It is suggested that ILLs could be useful for detecting acute prostatitis, especially in clinically ambiguous patients with urological infections. Furthermore, scintigraphy with 111In labelled leukocytes could help to determine the most appropriate course of therapy.
Nuclear Medicine Communications 12/2002; 23(11):1137-42. · 1.40 Impact Factor
