Teresa Peláez

Complutense University of Madrid, Madrid, Madrid, Spain

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Publications (117)477.12 Total impact

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    ABSTRACT: We monitored trough voriconazole serum concentrations from 107 patients (n = 258 samples) at 6 hospitals in Madrid. Most of the patients were male (67%) and had the following underlying conditions: hematological cancer (42%), solid organ transplantation (15%), chronic obstructive pulmonary disease (14%), human immunodeficiency virus infection (8.4%), solid cancer (5.6%), and other (29%). The indication for voriconazole administration was aspergillosis treatment (74.6%) and prophylaxis (14%). The main reasons for voriconazole trough drug monitoring were initiation of treatment/prophylaxis (33%), patient monitoring (47%), and suspected toxicity (3.5%). Levels (μg/ml) were subtherapeutic (<1; 18.2%), on-target (1–5.5; 71.3%), and high (>5.5; 10.5%). The samples percentage with on-target levels was significantly lower for the first sample than for subsequent samples (62.6% vs. 77.5%). “Subsequent samples,” “admission in nonpediatric wards,” “voriconazole used for treatment of invasive aspergillosis,” and “use of proton pump inhibitors” were predictors of voriconazole therapeutic levels (≥1 μg/ml).
    No preview · Article · Jan 2016 · Medical mycology: official publication of the International Society for Human and Animal Mycology
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    ABSTRACT: CLSI epidemiological cutoff values (ECVs) of antifungal agents are available for various Candida spp., Aspergillus spp. and the Mucorales. However, those categorical endpoints have not been established for Fusarium spp., mostly due to the difficulties associated with collecting sufficient CLSI MICs for clinical isolates identified according to the currently recommended molecular DNA-PCR based identification methodologies. CLSI MIC distributions were established for 53 Fusarium dimerum species complex (SC), 10 F. fujikuroi, 82 F. proliferatum, 20 F. incarnatum-equiseti SC, 226 F. oxysporum SC, 608 F. solani SC, and 151 F. verticillioides isolates originating in 17 laboratories (Argentina, Australia, Brazil, Canada, Europe, Mexico and the United States). According to the CLSI guidelines for ECV definition, ECVs encompassing ≥97.5% of pooled statistically modeled MIC populations were as follows: amphotericin B ECVs of 4 μg/ml (F. verticillioides) and 8 μg/ml (F. oxysporum SC and F. solani SC); posaconazole ECVs of 2 μg/ml (F. verticillioides), 8 μg/ml (F. oxysporum SC), and 32 μg/ml (F. solani SC); voriconazole ECVs of 4 μg/ml (F. verticillioides), 16 μg/ml (F. oxysporum SC) and 32 μg/ml (F. solani SC); and itraconazole ECVs of 32 μg/ml (F. oxysporum SC and F. solani SC). Insufficient data precluded ECV definition for the other species. Although these ECVs could aid in detecting non-WT isolates with reduced susceptibility to the agents evaluated, the relationship between molecular mechanisms of resistance (gene mutations) and MICs needs to be investigated for Fusarium spp.
    Full-text · Article · Dec 2015 · Antimicrobial Agents and Chemotherapy
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    Full-text · Dataset · Sep 2015
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    ABSTRACT: A total of 216 colonies of Malassezia pachydermatis from 28 cases of fungal otitis or dermatitis in pets were genotyped by M13 fingerprinting and tested for antifungal susceptibility. A huge genetic diversity was found (157 M13 types in total), with all animals having a polyclonal pattern of infection (5.4 ± 1.5 genotypes/sample). Furthermore, analysis of molecular variance (AMOVA) revealed that most genetic diversity (44%) was found at the within sample level. In contrast, variability in antifungal susceptibility among isolates from the same sample was less important, with different M13 types displaying in most cases identical or very similar MIC results. Most isolates displayed high in vitro susceptibility to amphotericin B, terbinafine and all azoles tested except fluconazole, for which MIC values were always ≥4 μg/ml and a 26.9% of isolates displayed values ≥32 μg/ml. We conclude that although characterization of multiple yeast isolates results in a considerable increase in laboratory workload and expenses, it may help to get a better understanding of the epidemiology of M. pachydermatis in a given patient population.
    No preview · Article · Sep 2015 · Medical mycology: official publication of the International Society for Human and Animal Mycology
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    ABSTRACT: Neither breakpoints (BPs) nor epidemiological cutoff values (ECVs) have been established for Candida spp. with anidulafungin, caspofungin and micafungin when using the Sensititre YeastOne ®: (SYO) broth dilution colorimetric method. In addition, reference caspofungin MICs have so far proven to be unreliable. Candida species wild-type (WT) MIC distributions (microorganisms in a species-drug combination with no detectable phenotypic resistance) were established for 6,007 Candida albicans, 186 C. dubliniensis, 3,188 C. glabrata complex, 119 C. guilliermondii, 493 C. krusei, 205 C. lusitaniae, 3,136 C. parapsilosis complex, and 1,016 C. tropicalis isolates. SYO MIC data gathered from 38 laboratories in Australia, Canada, Europe, Mexico, New Zealand, South Africa, and the United States were pooled to statistically define SYO-ECVs. ECVs of anidulafungin, caspofungin and micafungin encompassing ≥97.5% of the statistically-modeled population were, respectively, 0.12, 0.25, 0.06 μg/ml for C. albicans, 0.12, 0.25, 0.03 μg/mL for C. glabrata complex, 4, 2, 4 μg/ml for C. parapsilosis complex, 0.5, 0.25, 0.06 μg/ml for C. tropicalis, 0.25, 1, 0.25 μg/ml for C. krusei, 0.25, 1, 0.12 μg/ml for C. lusitaniae, 4, 2, 2 μg/ml for C. guilliermondii, and 0.25, 0.25, 0.12 μg/ml for C. dubliniensis. Species-specific SYO-ECVs of anidulafungin, caspofungin and micafungin correctly classified 72 (88.9%), 74 (91.4%), 76 (93.8%), respectively, of 81 Candida isolates with identified fks mutations. SYO-ECVs may aid in detecting non-WT isolates with reduced susceptibility to anidulafungin, micafungin and especially to caspofungin, since testing the susceptibilities of Candida spp. to caspofungin by reference methodologies is not recommended. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Full-text · Article · Aug 2015 · Antimicrobial Agents and Chemotherapy
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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.
    No preview · Article · May 2015 · European Journal of Clinical Microbiology
  • E Reigadas · L Alcalá · M Marín · T Pelaéz · A Martin · C Iglesias · E Bouza
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    ABSTRACT: Clostridium difficile infection (CDI) is the leading cause of hospital-acquired diarrhoea in developed countries. Metronidazole and vancomycin are the mainstay of treatment, although they are associated with treatment failure and recurrence. Novel agents have emerged to address these shortcomings. We investigated the in vitro activity of a novel agent, surotomycin (formerly CB-183,315), and seven other antimicrobial agents against clinical C. difficile isolates. Antimicrobial susceptibility to surotomycin, fidaxomicin, metronidazole, vancomycin, clindamycin, rifaximin, moxifloxacin and tigecycline was determined for 100 contemporary clinical isolates of C. difficile collected in 2013. MICs were determined by agar dilution according to CLSI procedures. In addition, 10 strains with reduced susceptibility to metronidazole (n = 6) and vancomycin (n = 4) were also tested. Strains were PCR ribotyped. The MICs of surotomycin for the 100 isolates ranged from ≤0.06 to 2 mg/L, with a geometric mean (GM) of 0.31 mg/L and an MIC50/90 of 0.25/0.5 mg/L. The MIC range of surotomycin was 0.25-1 mg/L (GM = 0.45 mg/L) for isolates with reduced metronidazole susceptibility and 0.125-0.5 mg/L (GM = 0.25 mg/L) for isolates with reduced vancomycin susceptibility. The three most common ribotypes were 001 (31.0%), 014/020 (17.0%) and 078/126 (17.0%). Ribotype 014/020 exhibited the lowest MICs of surotomycin (GM = 0.22 mg/L); the highest MICs were for ribotype 078/126 (GM = 0.72 mg/L). Surotomycin exhibited potent in vitro activity against all the isolates tested, including those with elevated metronidazole and vancomycin MICs. The potential role of this agent in the treatment of CDI requires further clinical evaluation. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
    No preview · Article · Apr 2015 · Journal of Antimicrobial Chemotherapy
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    ABSTRACT: We report the first isolation of a voriconazole-resistant Aspergillus fumigatus strain harbouring the azole resistance mechanism TR46/Y121F/T289A, recovered from an azole-naive patient in Spain with chronic obstructive pulmonary disease. This new finding in Spain suggests the spread of this resistance mechanism and reinforces the need for antifungal susceptibility surveillance.
    Full-text · Article · Apr 2015
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    ABSTRACT: The use of molecular identification techniques has revealed an increasing number of new species within Aspergillus section Terrei. We phenotyped a set of 26 clinical isolates that showed genetic differences with A. terreus sensu stricto by analyzing sequences from PCR amplified β-tubulin and calmodulin genes and the ITS region. Since the isolates were phylogenetically and morphologically different from all the Aspergillus section Terrei members, they are described here as a new species, Aspergillus citrinoterreus, so named because it produces a diffusible yellowish pigment in agar. A. citrinoterreus isolates were significantly more susceptible to itraconazole, voriconazole, and posaconazole than A. terreus sensu stricto isolates; in contrast, amphotericin B showed high MICs for both species. A. citrinoterreus was found in clinical samples from patients with proven or probable invasive aspergillosis and colonized patients, none of whom had hematological malignancies as predisposing conditions. However, they did have other underlying conditions such as chronic obstructive pulmonary disease, cirrhosis, and cancer, or had received a solid organ transplant, and presented not only with invasive pulmonary aspergillosis but also with mediastinitis. A. citrinoterreus isolates were detected for the first time in 2002. In all cases of invasive aspergillosis, A. citrinoterreus was found to be a copathogen, mostly with A. fumigatus. Copyright © 2014, American Society for Microbiology. All Rights Reserved.
    Full-text · Article · Feb 2015 · Journal of Clinical Microbiology
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    ABSTRACT: In the absence of histopathology studies of lung biopsies, the bronchoalveolar lavage (BAL) sample is preferred for the diagnosis of invasive pulmonary aspergillosis. Isolation of Aspergillus fumigatus from sputum and bronchial secretion samples are commonly interpreted as colonization or laboratory contamination, particularly in nonneutropenic patients. We studied if sputum/bronchial secretions and BAL samples are equally useful for the diagnosis of invasive pulmonary aspergillosis. We retrospectively selected 14 patients with proven (n = 1) or probable (n = 13) invasive pulmonary aspergillosis from whose samples A. fumigatus had been simultaneously isolated in BAL and sputum/bronchial secretions between 2006 and 2012. The isolates were identified by sequencing the β-tubulin gene and genotyped using the STRAf assay. Matches between BAL and sputum/bronchial secretions were observed in patients with identical genotypes in BAL and sputum/bronchial secretions. All patients had clinically suspected pneumonia, before the diagnosis of invasive pulmonary aspergillosis. The sample from which A. fumigatus was initially isolated was collected as a result of the presence of fever (50%), abnormal radiological findings (100%), and/or pneumonia that did not respond to antibiotics (36%). The underlying conditions varied, although the most common predisposing factors were hematological malignancies (21.5%) and COPD (43%). In 13 of the 14 patients (93%), we found matching genotypes in the BAL and the sputum/bronchial secretion samples. Genotyping showed that samples of sputum or bronchial secretions were equally useful as samples of BAL for the diagnosis of invasive pulmonary aspergillosis. © The Author 2015. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
    No preview · Article · Jan 2015 · Medical Mycology
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    ABSTRACT: Clinical breakpoints (CBPs) have not been established for the Mucorales and any antifungal agent. In lieu of CBPs, epidemiologic cutoff values (ECVs) are proposed for amphotericin B, posaconazole and itraconazole and four Mucorales species. Wild type (WT) MIC distributions (organisms in a species/drug combination with no detectable acquired resistance mechanisms) were defined with available pooled CLSI MICs from 14 laboratories (Argentina, Australia, Canada, Europe, India, Mexico, and the United States) as follows: 10 Apophysomyces variabilis, 32 Cunninghamella bertholletiae, 136 Lichtheimia corymbifera, 10 Mucor indicus, 123 M. circinelloides, 19 M. ramosissimus, 349 Rhizopus arrhizus, 146 R. microsporus, 33 Rhizomucor pusillus, and 36 Syncephalastrum racemosum. CLSI broth microdilution MICs were aggregated for the analyses. ECVs comprising ≥95% and ≥97.5% of the modeled populations were as follows: amphotericin B ECVs for L. corymbifera were 1 and 2 μg/ml, for M. circinelloides 1 and 2 μg/ml, for R. arrhizus 2 and 4 μg/ml, and for R. microsporus 2 and 2 μg/ml, respectively; posaconazole ECVs for L. corymbifera were 1 and 2, for M. circinelloides 4 and 4, for R. arrhizus 1 and 2, and for R. microsporus 1 and 2, respectively; both itraconazole ECVs for R. arrhizus were 2 μg/ml. ECVs may aid in detecting emerging resistance or those isolates with reduced susceptibility (non-WT-MICs) to the agents evaluated. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Full-text · Article · Jan 2015 · Antimicrobial Agents and Chemotherapy
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    ABSTRACT: To longitudinally assess the shedding of antimicrobial resistant Clostridium difficile strains by clinically healthy dogs raised at breeding facilities. 18 puppies from three different litters (#1, 2 and 3) were sampled weekly from parturition to day 20-55 postpartum. Faecal samples from the mothers of litters #2 and 3 were also available for analysis. Bacterial isolates were ribotyped, tested for in vitro antimicrobial susceptibility and further characterised. C. difficile was recovered from all sampled animals of litters #1 and 2, and a third of puppies from litter #3, but marked differences in C. difficile recovery were detected in different age groups (0-100%). Recovered PCR ribotypes included 056 (22 isolates), 010 (6 isolates), 078 and 213 (2 isolates each), and 009 and 020 (1 isolate each). Different ribotypes were shed by four individual animals. Regardless of their origin and ribotype, all isolates demonstrated full resistance to levofloxacin. Additionally, all but one isolate (belonging to ribotype 078) were resistant to ertapenem, and all ribotype 010 isolates displayed high-level resistance to clindamycin, clarithromycin and erythromycin. A single ribotype 078 isolate showed metronidazole heteroresistance. Healthy dogs can shed antimicrobial-resistant C. difficile strains. © 2014 British Small Animal Veterinary Association.
    No preview · Article · Dec 2014 · Journal of Small Animal Practice
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    Pilar Escribano · Teresa Peláez · Emilio Bouza · Jesús Guinea
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    ABSTRACT: We studied whether STRAf can differentiate between A. fumigatus invasive and colonizing genotypes. Of the 395 genotypes detected (n=1,373 isolates), 50 were clusters, and 24 (6% of all genotypes) involved both patients with invasive aspergillosis and colonized patients, indicating that genotyping cannot discriminate between invasive and colonizing isolates. Copyright © 2014, American Society for Microbiology. All Rights Reserved.
    Preview · Article · Nov 2014 · Journal of Clinical Microbiology

  • No preview · Article · Oct 2014 · Enfermedades Infecciosas y Microbiología Clínica

  • No preview · Article · Jul 2014 · Enfermedades Infecciosas y Microbiología Clínica
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    ABSTRACT: Objectives: To assess the quality of antifungal use, to propose a point score for this evaluation and to estimate the potential economic savings of an antifungal stewardship programme. Methods: From December 2010 to January 2011, we identified 100 adult inpatients receiving systemic antifungals. Antifungal use was evaluated by means of a predefined score that considered indication, drug selection, dosage, adjustments after microbiology results, switching to an oral agent and length of treatment. Total antifungal prescriptions [in defined daily doses (DDDs) and days of therapy (DOTs)] and potential cost savings were calculated. Results: Overall, 43% of prescriptions came from medical departments, 25% from haematology/oncology and 17% from intensive care units. The main reasons for starting antifungals were empirical (42%), pre-emptive (20%) and targeted treatment (20%). Antifungals were unnecessary in 16% of cases. Inadequacies in other aspects of antifungal prescription were: drug selection, 31%; dosing, 16%; no switch from intravenous to oral administration, 20%; no adjustment after microbiological results, 35%; and length of therapy, 27%. The number of antifungal DDDs per 1000 patient-days was 65.1. The total number of DOTs was 1556, which added a direct cost of €219364. Only 51.3% of DOTs were considered optimal. The potential estimated savings would be €50536. Conclusions: Major efforts should be made to improve the selection and duration of antifungal therapy. Our study demonstrated the potential cost savings that could be achieved by optimizing antifungal therapy. A stewardship programme should include an instrument to objectively evaluate the adequacy of antifungal use. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
    Full-text · Article · Jul 2014 · Journal of Antimicrobial Chemotherapy
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    ABSTRACT: We assessed the in vitro activity of micafungin against preformed Candida biofilms by measuring the concentration of drug causing the most fungal damage and inhibition of regrowth. We studied 37 biofilm-producing Candida spp. strains from blood cultures. We showed that micafungin was active against planktonic and sessile forms of Candida albicans strains and moderately active against Candida parapsilosis sessile cells. Concentrations of micafungin above 2 μg/ml were sufficiently high to inactivate regrowth of Candida sessile cells.
    No preview · Article · Jun 2014 · Antimicrobial Agents and Chemotherapy
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    ABSTRACT: Many bloodstream infections (BSI) in patients with central venous catheters (CVC) are not catheter-related (CR). Assessment of catheter involvement without catheter withdrawal has not been studied in candidemia. We assessed the value of conservative techniques to evaluate catheters as the origin of candidemia in patients with CVC in a prospective cohort study (superficial Gram stain and culture, Kite technique (Gram stain and culture of the first 1 cm blood drawn from the CVC), proportion of positive blood cultures (PPBCs), differential time to positivity (DTP), and minimal time to positivity (MTP)). All catheters were cultured at withdrawal. From June 2008 to January 2012, 22 cases fulfilled the inclusion criteria. CR-candidemia (CRC) was confirmed in 10. Validity values for predicting CRC were: superficial Gram stain (S, 30%; Sp, 81.83%; PPV, 60%; NPV, 56.3%; Ac, 57.1%), superficial cultures (S, 40%; Sp, 75%; PPV, 57.1%; NPV, 60%; Ac, 59.1%), Kite Gram stain (S, 33.3%; Sp, 66.7%; PPV, 50%; NPV, 50%; Ac, 50%), Kite culture (S, 80%; Sp, 66.7%; PPV, 66.7%; NPV, 80%; Ac, 72.7%), PPBC (S, 50%; Sp, 41.7%; PPV, 41.7%; NPV, 50.0%; Ac, 45.5%), DTP (S, 100%; Sp, 33.3%; PPV, 55.6%; NPV, 100%; Ac, 63.6%), and MTTP (S, 70%; Sp, 58.3%; PPV, 58.3%; NPV, 70%; Ac, 63.6%). While combinations of two tests improved sensitivity and NPV, more than two tests did not improve validity values. Classic tests to assess CR-BSI caused by bacteria cannot be reliably used to diagnose CRC. Combinations of tests could be useful, but more and larger studies are required.
    Full-text · Article · Jun 2014 · Medical Mycology
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    ABSTRACT: Catheter-related candidemia (CRC) is typically a biofilm related disease, but it is mostly unknown if the production of biofilm is a feature exclusively shown by Candida spp. isolates causing CRC. We performed an in vitro biofilm assay using Candida isolates obtained from the blood of patients with candidemia. We demonstrated that biofilm production was not a good predictor of catheter-related candidemia. Also, we demonstrated that there was no difference in the mortality of candidemia patients infected by biofilm-forming isolates and those in which the infection is caused by nonbiofilm-forming species.
    Full-text · Article · Apr 2014 · Medical mycology: official publication of the International Society for Human and Animal Mycology
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    ABSTRACT: We determined the in vitro amphotericin B susceptibility of 60 Malassezia pachydermatis isolates by the CLSI broth microdilution method and the Etest using lipid-enriched media. All isolates were susceptible at MICs of ≤1 μg/ml, confirming the high activity of amphotericin B against this yeast species. Overall, the essential agreement between the tested methods was high (80% and 96.7% after 48 h and 72 h, respectively), and all discrepancies were regarded as nonsubstantial.
    Preview · Article · Apr 2014 · Antimicrobial Agents and Chemotherapy

Publication Stats

3k Citations
477.12 Total Impact Points

Institutions

  • 1997-2015
    • Complutense University of Madrid
      • Department of Medicine
      Madrid, Madrid, Spain
  • 1991-2014
    • Hospital General Universitario Gregorio Marañón
      • • Servicio de Aparato Digestivo
      • • Clinical Microbiology and Infectious Diseases
      Madrid, Madrid, Spain
  • 2011
    • University of Adelaide
      Tarndarnya, South Australia, Australia