Javier Garau

• University of Barcelona

Escherichia coli recovered from three hospitals in Barcelona (Spain) were studied to determine the prevalence of isolates with acquired AmpC (ac-AmpC) and/or overproduced chromosomal AmpC (c-AmpC). Mechanisms involved in blac-AmpC overexpression, blaac-AmpC and the plasmids associated with their distribution as well as the prevalence of plasmid-med...

Pneumococcal conjugate vaccine (PCV13) has been recently added to the vaccine recommendations for immunossuppressed adults (ISP). We conducted a multicenter observational prospective study aimed to assess the evolving epidemiology of invasive pneumococcal disease (IPD) in adults, with especial focus on ISP. All IPD cases admitted from 1999-2014 wer...

ABSTRACT Klebsiella pneumoniae is responsible for a large number of hospital outbreaks. In the 1990s, there were clonal epidemics, affecting mostly intensive care patients, which carried SHV and TEM enzyme types. With the advent of CTX-M-15 enzymes in the 2000, plasmids encoding multiple extended-spectrum β-lactamase (ESBL) types were described and...

Healthcare worker's (HCW) hands are the commonest vehicle for the transmission of microorganisms from patient to patient and within the healthcare environment. The aims of this study were to evaluate the impact of a multimodal campaign over the type and amount of resident and transient flora and the presence of potential risk factors for hand conta...

This study aimed to determine the aetiology of community-acquired pneumonia (CAP) by adding polymerase chain reaction (PCR) to conventional methods and to describe the clinical and laboratory features between patients with bacterial pneumonia (BP) and viral pneumonia (VP). Adults with CAP admitted from November 2009 to October 2010 were included. D...

Meticillin-resistant Staphylococcus aureus (MRSA) remains one of the principal multiply resistant bacterial pathogens causing serious healthcare-associated and community-onset infections. This paper reviews recent studies that have elucidated the virulence strategies employed by MRSA, key clinical trials of agents used to treat serious MRSA infecti...

Clin Microbiol Infect 2012; 18: 1212–1218 Improvement in hand hygiene (HH) compliance has been associated with a decrease in the incidence of hospital-acquired infection (HAI) and hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) infection/colonization. We aimed to evaluate the impact of a multimodal intervention in medical wa...

Streptococcus pneumoniae continues to be responsible for significant mortality and morbidity worldwide. A better understanding of the inflammatory response generated by the interaction of this microorganism with the host and antimicrobial therapy will improve the management of patients with pneumococcal infection. On the side of the microorganism,...

Severe (life-threatening) meticillin-resistant Staphylococcus aureus (MRSA) infection continues to be treated with vancomycin despite accumulating evidence of poor outcome, increasing resistance and unachievable pharmacokinetic/pharmacodynamic (PK/PD) targets. The minimum inhibitory concentration (MIC) susceptibility breakpoint for vancomycin was r...

We describe a foodborne nosocomial outbreak due to extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae. An outbreak of ESBL K. pneumoniae was detected in March 2008. Initial control measures included contact isolation and a protocol for routine detection and reinforcement in hand hygiene practices. ESBL producers were screened for...

The present article is an update of the literature on endocarditis. A multidisciplinary group of Spanish physicians with an interest in cardiac infections selected the most important papers produced lately in the field. Two of the members of the group discussed the content of each of the selected papers, with a critical review by others members of...

Infectious diseases such as smallpox, pneumonia, rotavirus, malaria and measles have inflicted untold pain, suffering and death on the human population. The fingerprints of these deadly diseases can be found across the pages of history. The harrowing effects of pneumonia on the human body were described by Hippocrates as early as 460 B.C.;1 smallpo...

This symposium on nosocomial infections, antimicrobial resistance and the benefits of doripenem in this setting was held in Madrid, Spain, on 7 October 2009, and was supported by Janssen-Cilag. The topic was presented under an interdisciplinary approach by different international experts in the field.

The major advances produced in infectious diseases, partly favored by technological development in the last few years, together with current changes in healthcare, have led to a new scenario in which, far from the control of infectious diseases, clinical microbiology has acquired an undoubted leading role. This new panorama implies collaboration am...

The major advances produced in infectious diseases, partly favored by technological development in the last few years, together with current changes in healthcare, have led to a new scenario in which, far from the control of infectious diseases, clinical microbiology has acquired an undoubted leading role. This new panorama implies collaboration am...

The aim of this study was to compare outcomes for patients with community-acquired pneumonia (CAP) caused by Legionella spp. following treatment with moxifloxacin or a range of comparator antimicrobial agents. Data were pooled from four sequential I.V./P.O. trials of moxifloxacin in the treatment of CAP. Comparators were ceftriaxone +/- erythromyci...

Although the rapid spread of carbapenemase-producing Gram-negatives (CPGNs) is providing the scientific community with a great deal of information about the molecular epidemiology of these enzymes and their genetic background, data on how to treat multidrug-resistant or extended drug-resistant carbapenemase-producing Enterobacteriaceae and how to c...

Patients with fever and granulocytopenia are at risk of developing severe infection. We performed a prospective, randomized trial to evaluate the efficacy of low-dose cefepime plus amikacin (C-A) compared to low-dose piperacillin/tazobactam plus amikacin (PT-A). Patients received cefepime (2 g/12 h) plus amikacin (15 mg/kg/day) or piperacillin/tazo...

To describe the clinical characteristics and outcomes of tuberculosis (TB) in elderly people. Observational analysis of a prospective cohort of adults with TB (1995-2004). A case-control study to determine attributable mortality to TB in very old people was done. Of 319 patients with TB, 109 (34.2%) were aged 65 and older. The older group was more...

Pneumococcal pneumonia is characterised by an intense inflammatory response induced mainly by cell wall components of the bacterium. Recognition of cell wall components by Toll-like receptors (TLRs) induces intracellular signalling pathways that culminate in the activation of pro-inflammatory genes through nuclear factor kappaB (NF-kappaB). Tumour...

Infections caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are increasing in frequency and are associated with high mortality rates. Circulation of CTX-M-type ESBLs in the community is of particular concern, because it may confound standard infection-control measures. We analyzed the results of epidemiologic studies o...

Background The BODE index can accurately predict mortality in ambulatory patients with COPD, although its utility in hospitalized patients is unknown.Material and methodsWe prospectively evaluated all patients hospitalized during one year for acute exacerbation of COPD with one or more admissions in the previous year. On discharge, previous functio...

The BODE index can accurately predict mortality in ambulatory patients with COPD, although its utility in hospitalized patients is unknown. We prospectively evaluated all patients hospitalized during one year for acute exacerbation of COPD with one or more admissions in the previous year. On discharge, previous functional dependence, comorbidity, d...

The aim of our study was to analyse the impact of time from onset of symptoms on the systemic cytokine concentrations in patients with pneumococcal pneumonia. Adults with severe pneumococcal pneumonia were prospectively included. At admission, vital signs, time from onset of pneumonia symptoms and circulating levels of C-reactive protein (CRP), ser...

The purpose of the study was to compare the clinical characteristics and outcomes of bacteraemic pneumococcal pneumonia (BPP) in chronic obstructive pulmonary disease (COPD) and non-COPD patients. A case-control study was conducted. Cases were any adult with BPP and forced expiratory volume in 1 second (FEV(1)) <80% and FEV(1)/forced expiratory vit...

Risk factors for Pseudomonas aeruginosa (PA) isolation in patients hospitalised for chronic obstructive pulmonary disease (COPD) exacerbation remain controversial. The aim of our study was to determine the incidence and risk factors for PA isolation in sputum at hospital admission in a prospective cohort of patients with acute exacerbation of COPD....

La piomiositis representa una importante infección del músculo esquelético causada principalmente por Staphylococcus aureus. En este artículo se presenta el caso clínico de un futbolista de élite con antecedentes de foliculitis de repetición y portador crónico de S. aureus que presenta en un período de 6 meses dos episodios de piomiositis muscular...

This review addresses selected aspects of the management of severe healthcare-associated infections due to methicillin-resistant Staphylococcus aureus (MRSA), including the limitations of current therapy, potential alternative agents, new therapeutic options, clinical approaches to MRSA bacteraemia/endocarditis and ventilator-associated pneumonia,...

La piomiositis representa una important infecció del múscul esquelètic causada principalment per Staphylococcus aureus. En aquest article es presenta el cas clínic d’un futbolista d’elit amb antecedents de fol·liculitis de repetició i portador crònic de S. aureus que presenta en un període de 6 mesos dos episodis de piomiositis muscular no traumàti...

Infectious Diseases is a recognised clinical specialty in almost all European countries, in the United States of America, Canada and most countries in Central and South America. Even though the training programs are heterogeneous in the different European countries, the Infectious Diseases section of the UEMS (European Union of Medical Specialties)...

Infectious Diseases is a recognised clinical specialty in almost all European countries, in the United States of America, Canada and most countries in Central and South America. Even though the training programs are heterogeneous in the different European countries, the Infectious Diseases section of the UEMS (European Union of Medical Specialties)...

Infectious Diseases is a recognised clinical specialty in almost all European countries, in the United States of America, Canada and most countries in Central and South America. Even though the training programs are heterogeneous in the different European countries, the Infectious Diseases section of the UEMS (European Union of Medical Specialties)...

Antimicrobial resistance to antibiotics is a significant problem in the treatment of serious nosocomial infections. Antibiotic therapy is often empiric, until a specific pathogen and its antibiotic susceptibility are known, after which time adjustments in initial therapy may be made as necessary. The increasing prevalence of Gram-positive bacteria...

Background: The aim of our study was to compare the clinical presentation and outcome of BPP between patients < or > 80 years old. Methods: From 1993-2007 all adults with BPP were included. Data on demographics, Charlson score, serotypes, antimicrobial susceptibility and in hospital mortality were collected. Population was classified in two age gro...

We sought to determine factors associated with opportunistic infections (OI) in infliximab-treated patients. A retrospective study cohort (1999-2004) was examined. Nine OI were diagnosed in 94 infliximab-treated patients: tuberculosis (four), visceral leishmaniasis (one), pyogenic muscular abscess (one Salmonella spp. and one Streptococcus pneumoni...

Received 20 May 2007/Returned for modification 2 August 2007/Accepted 15 April 2008 Bacterial alveolar invasion is followed by an inflammatory response. A systemic extension of the compart- mentalized immune response has been described in patients with severe pneumonia. The data suggest that some antimicrobials may induce a differential release of...

Bacterial alveolar invasion is followed by an inflammatory response. A systemic extension of the compartmentalized immune response has been described in patients with severe pneumonia. The data suggest that some antimicrobials may induce a differential release of cytokines. We conducted a prospective, randomized study in adult patients with severe...

The aim of this study was to show that sequential intravenous and oral moxifloxacin monotherapy (400 mg once per day) is as efficacious and safe as a combination regimen (intravenous ceftriaxone, 2 g once per day, plus sequential intravenous and oral levofloxacin, 500 mg twice per day) in patients hospitalized with community-acquired pneumonia. We...

A 1-year retrospective multicentre study was performed to identify factors influencing hospital length of stay (LOS) and mortality of patients (n = 3233) admitted to hospital because of community-acquired pneumonia (CAP). Pneumonia severity index (PSI) high-risk classes (IV and V), positive blood culture, admission to an intensive care unit (ICU),...

El presente artículo recoge una actualización bibliográfica de patógenos bacterianos. Dado el interés científico y la importancia que tienen para la salud pública las infecciones producidas por patógenos bacterianos con nuevos mecanismos de virulencia y/o nuevos mecanismos de resistencia a los antimicrobianos, un grupo multidisciplinario de microbi...

To study the characteristics of major bleeding episodes into a closed space (BCS) of patients under chronic anticoagulation with either unfractionated heparin (HS) or coumadin (CM), and to determine the relationship, if any, of anticoagulation parameters (INR, PT and PTT) values at the time of bleeding with the episode. Finally, to determine risk f...

The progressive increase of extended-spectrum beta-lactamase (ESBL) -producing enteric bacteria in recent years has called for a re-evaluation of current antibiotic therapy for these infections. The activity and potential use of two old antimicrobials, nitrofurantoin and fosfomycin, and the new compound tigecycline for treatment of infections due t...

The objective of this study was to evaluate the characteristics of bloodstream infections occurring among outpatients having recent contact with the health care system compared to hospital and community-acquired infections. Prospective observational cohort study of adult patients with bloodstream infections at three teaching hospitals. Bloodstream...

Objetive: To study the characteristics of major bleeding episodes into a closed space (BCS) of patients under chronic anticoagulation with either unfractionated heparin (HS) or coumadin (CM), and to determine the relationship, if any, of anticoagulation parameters (INR, PT and PTT) values at the time of bleeding with the episode. Finally, to determ...

Acute respiratory tract infections, such as bacterial pneumonia and acute exacerbations of chronic bronchitis, have been identified by the World Health Organisation as the leading global infectious cause of death. An increasing prevalence of antibiotic resistance has been identified worldwide in the three major bacterial respiratory pathogens -Stre...

The benefit of systemic steroids as adjunctive treatment in patients with severe community-acquired pneumonia (CAP) remains unclear. The present study aimed to evaluate the impact of corticosteroid treatment on mortality in patients with severe CAP. A retrospective, observational study of a cohort of patients hospitalised with severe CAP, classes I...

Among young children, pneumococcal nasopharyngeal colonization (NPC) rates of >90% have been described. The aim of our study was to assess the effect of amoxicillin exposure on the NPC. From Dec 2001 to Feb 2004, less than 5 years old children with respiratory symptoms and fever who were prescribed amoxicillin were eligible. Three nasopharyngeal sw...

To assess the cost-effectiveness of empirical outpatient treatment options for community-acquired pneumonia (CAP) in France, the USA and Germany, representing high, moderate and low antimicrobial resistance prevalence, respectively. A decision analytic model was developed for mild-to-moderate CAP outpatient treatment. Treatment algorithms incorpora...

The most common complications after surgical extraction of the third mandibular molar are trismus, oedema or swelling, local pain, dysphagia and infection. The aim of this comparative, double-blind, randomized clinical trial was to evaluate the efficacy of two sustained release amoxicillin/clavulanate regimens in the reduction of infection after th...

Un grupo multidisciplinario de clínicos con experiencia en las infecciones que sufren los pacientes con neutropenia y hematooncológicos se ha reunido para discutir la situación actual y las publicaciones más relevantes que se han realizado durante los 2 últimos años en el campo de las infecciones bacterianas en los pacientes con neutropenia. Los pa...

Skin and soft tissue infections (SSTIs) and complicated SSTIs (cSSTIs), particularly those caused by Gram-positive pathogens, are among the most common human bacterial infections. The emergence of resistance to antibiotics such as methicillin and vancomycin has compromised treatment options for these infections and stimulated the search for new ant...

We evaluated the effectiveness and safety of rifampicin addition to clarithromycin in the treatment of Legionnaires' disease. An observational cohort study was conducted on patients assigned to a Legionnaires' disease outbreak. Of 32 patients with confirmed Legionella pneumonia, 11 received clarithromycin monotherapy and 21 received combination the...

This study evaluated the impact of heptavalent pneumococcal conjugate vaccine (HPCV) on invasive pneumococcal disease (IPD) in children aged < or = 5 years in Barcelona, Spain. The incidence of IPD, vaccine uptake and prevalence of nasopharyngeal colonisation were analysed in two different periods: 1999-2001 (pre-licence period), and 2002-2004 (pos...

The food supply is suspected to be a source of fluoroquinolone-resistant Escherichia coli that cause disease in humans, but supporting molecular data are lacking. We performed a molecular-epidemiological comparison, in Barcelona, Spain (1996-1998), of 117 contemporaneous, geographically matched E. coli isolates from humans (35 blood isolates and 33...

Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli have been increasingly recognized in the community. The aim of this study was to determine the prevalence, types of ESBLs and risk factors for community-onset ESBL-producing E. coli in urinary tract infections (UTIs). Adults with community-onset UTIs due to ESBL-producing E. coli (c...

B rucellosis, a zoonosis, is an important cause of human disease in many parts of the world. Brucellae are small, gram-negative nonsporulating rods or coccobacilli that are transmitted from infected animals, mainly cattle and other domesticated ruminants (e.g., camels). Brucellae are shed in the feces, milk, and urine of infected animals and are tr...

Hospital readmissions for acute exacerbation of chronic obstructive pulmonary disease (COPD) are one of the leading causes of health care expenditures worldwide. To identify risk factors for hospital readmission in COPD patients. We prospectively evaluated 129 consecutive patients hospitalized for acute exacerbation of COPD. Clinical, spirometric a...

Nosocomial pneumonia (NP) is the second most frequent cause of hospital-acquired infection and is associated with elevated morbidity and mortality rates, particularly in intensive care units (ICU). The objectives of this study were to determine the incidence, risk factors and prognostic factors of NP acquired outside the ICU. A prospective case-con...

To achieve bacteriologic and clinical success, sufficient concentrations of antimicrobial at the site of infection must be maintained for an adequate period of time. These dynamics are determined by combining drug pharmacokinetic and pharmacodynamic (PK/PD) data with minimum inhibitory concentrations. Bacteriologically confirmed failures have been...

Background: To assess the cost-effectiveness of moxifloxacin as a first-line treatment in CAP out-patients in the presence of antimicrobial resistance in three countries with differing levels of resistance; with France representing high, the US moderate and Germany low resistance levels. Methods: A decision analytic model was developed for CAP pati...

Six of 284 patients treated with infliximab developed active tuberculosis. Four (67%) of these patients had a paradoxical response to antituberculous therapy. Physicians should be aware of the increased risk of a paradoxical response in this population and should consider the use of corticosteroids when a paradoxical reaction is suspected.

Community-acquired pneumonia (CAP) is a common respiratory illness, frequently caused by Streptococcus pneumoniae. The prevalence of S. pneumoniae resistance to common antimicrobials has increased over recent years. A new pharmacokinetically enhanced formulation of amoxicillin/clavulanate (2000/125 mg) has been developed, designed to combat infecti...

Community acquired pneumonia is still an important health problem. In Spain the year incidence is 162 cases per 100,000 inhabitants with 53,000 hospital admission costing 115 millions of euros per year. In the last years there have been significant advances in the knowledge of: aetiology, diagnostic tools, treatment alternatives and antibiotic resi...

Empiric antimicrobial prescribing for community-acquired pneumonia remains a challenge, despite the availability of treatment guidelines. A number of key differences exist between North American and European guidelines, mainly in the outpatient setting. The North American approach is to use initial antimicrobial therapy, which provides coverage for...

The objective of this study was to evaluate the management of community acquired pneumonia (CAP) according to conventional clinical criteria applied in the emergency room as compared to a pneumonia prognosis index (PPI) (Fine et al. NEJM 1997). We also analyzed which factors were associated with the need for inpatient treatment in PPI risk category...

Antimicrobial resistance in respiratory pathogens has become a common clinical problem that has serious public health implications. Inappropriate use of antibiotics for the treatment of viral upper respiratory tract infections (URTIs) has contributed to the development of resistant microorganisms. Health care providers can help control the spread o...

Recent articles of clinical interest on Pseudomonas aeruginosa respiratory tract infections including CAP, nosocomially-acquired pneumonia, particularly in the ventilated patient, and chronic infections in cystic fibrosis patients are reviewed. The growing importance of P. aeruginosa as an etiologic agent of CAP, the occurrence of CAP in previously...