Publications by authors named "Carolina Garcia-Vidal"

118 Publications

A propensity score-matched analysis of mortality in solid organ transplant patients with COVID-19 compared to non-solid organ transplant patients.

PLoS One 2021 3;16(3):e0247251. Epub 2021 Mar 3.

Department of Infectious Diseases, Hospital Clinic - IDIBAPS, ISGlobal (Institute for Global Health), University of Barcelona, Barcelona, Spain.

In the context of COVID-19 pandemic, we aimed to analyze the epidemiology, clinical characteristics, risk factors for mortality and impact of COVID-19 on outcomes of solid organ transplant (SOT) recipients compared to a cohort of non transplant patients, evaluating if transplantation could be considered a risk factor for mortality. From March to May 2020, 261 hospitalized patients with COVID-19 pneumonia were evaluated, including 41 SOT recipients. Of these, thirty-two were kidney recipients, 4 liver, 3 heart and 2 combined kidney-liver transplants. Median time from transplantation to COVID-19 diagnosis was 6 years. Thirteen SOT recipients (32%) required Intensive Care Unit (ICU) admission and 5 patients died (12%). Using a propensity score match analysis, we found no significant differences between SOT recipients and non-transplant patients. Older age (OR 1.142; 95% [CI 1.08-1.197]) higher levels of C-reactive protein (OR 3.068; 95% [CI 1.22-7.71]) and levels of serum creatinine on admission (OR 3.048 95% [CI 1.22-7.57]) were associated with higher mortality. The clinical outcomes of SARS-CoV-2 infection in our cohort of SOT recipients appear to be similar to that observed in the non-transplant population. Older age, higher levels of C-reactive protein and serum creatinine were associated with higher mortality, whereas SOT was not associated with worse outcomes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247251PLOS
March 2021

Factors Associated With Short-Term Eradication of Rectal Colonization by KPC-2 Producing in an Outbreak Setting.

Front Microbiol 2021 1;12:630826. Epub 2021 Feb 1.

Service of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona, Spain.

KPC-producing (KPCKP) is a threat for patients admitted to healthcare institutions. To assess the efficacy of several decolonization strategies for KPCKP rectal carriage. Observational study performed in a 750-bed university center from July to October 2018 on the efficacy of a 10-day non-absorbable oral antibiotic (NAA) regimen (colistin 10 mg/ml, amikacin 8 mg/ml, and nystatin 30 mg/ml, 10 ml/6 h) vs. the same regimen followed by a probiotic (Vivomixx®) for 20 days in adult patients with KPCKP rectal colonization acquired during an outbreak. Seventy-three patients colonized by KPCKP were included, of which 21 (29%) did not receive any treatment and 52 (71.2%) received NAA either alone ( = 26, 35.6%) or followed by a probiotic ( = 26, 35.6%). Eradication was observed in 56 (76.7%) patients and the only variable significantly associated with it was not receiving systemic antibiotics after diagnosis of rectal carriage [22/24 (91.6%) vs. 34/49 (69.3%), = 0.04]. Eradication in patients receiving NAA plus probiotic was numerically but not significantly higher than that of controls [23/26 (88.4%) vs. 15/21 (71.4%), = 0.14] and of those receiving only NAA (OR = 3.4, 95% CI = 0.78-14.7, = 0.09). In an outbreak setting, rectal carriage of KPCKP persisted after a mean of 36 days in about one quarter of patients. The only factor associated with eradication was not receiving systemic antibiotic after diagnosis. A 10-day course of NAA had no impact on eradication. Probiotics after NAA may increase the decolonization rate, hence deserving further study.
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http://dx.doi.org/10.3389/fmicb.2021.630826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882481PMC
February 2021

COVID-19-Associated Pulmonary Aspergillosis, March-August 2020.

Emerg Infect Dis 2021 02 4;27(4). Epub 2021 Feb 4.

Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019. Because of the severe immunomodulation and lymphocyte depletion caused by this virus and the subsequent administration of drugs directed at the immune system, we anticipated that patients might experience fungal superinfection. We collected data from 186 patients who had coronavirus disease-associated pulmonary aspergillosis (CAPA) worldwide during March-August 2020. Overall, 182 patients were admitted to the intensive care unit (ICU), including 180 with acute respiratory distress syndrome and 175 who received mechanical ventilation. CAPA was diagnosed a median of 10 days after coronavirus disease diagnosis. Aspergillus fumigatus was identified in 80.3% of patient cultures, 4 of which were azole-resistant. Most (52.7%) patients received voriconazole. In total, 52.2% of patients died; of the deaths, 33.0% were attributed to CAPA. We found that the cumulative incidence of CAPA in the ICU ranged from 1.0% to 39.1%.
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http://dx.doi.org/10.3201/eid2704.204895DOI Listing
February 2021

Primary immunodeficiency and chronic mucocutaneous candidiasis: pathophysiological, diagnostic, and therapeutic approaches.

Allergol Immunopathol (Madr) 2021 2;49(1):118-127. Epub 2021 Jan 2.

Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.

Chronic mucocutaneous candidiasis (CMC) is characterized by a chronic or recurrent non-invasive infection, mainly due to , in skin, nails, and mucous membranes, associated in some cases with autoimmune manifestations. The key immune defect is a disruption of the action of cytokine IL-17, whose most common genetic etiology is gene gain-of-function (GOF) mutations. The initial appropriate treatment for fungal infections is with azoles. However, the frequent occurrence of drug resistance is the main limitation. Therefore, identification of the underlying inborn error if immunity in CMC may allow to widen therapeutic options aimed at restoring immunological function. Type I and II -inhibitors have been shown to control CMC in cases associated with GOF. In this review, we delve into the pathogenesis of CMC and the underlying immune mechanisms. We describe the reported genetic defects in which CMC is the main manifestation. Diagnostic and therapeutic approaches for these patients are also offered.
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http://dx.doi.org/10.15586/aei.v49i1.20DOI Listing
January 2021

Invasive Fusariosis in Nonneutropenic Patients, Spain, 2000-2015.

Emerg Infect Dis 2021 Jan;27(1)

Invasive fusariosis (IF) is associated with severe neutropenia in patients with concurrent hematologic conditions. We conducted a retrospective observational study to characterize the epidemiology of IF in 18 Spanish hospitals during 2000-2015. In that time, the frequency of IF in nonneutropenic patients increased from 0.08 cases per 100,000 admissions in 2000-2009 to 0.22 cases per 100,000 admissions in 2010-2015. Nonneutropenic IF patients often had nonhematologic conditions, such as chronic cardiac or lung disease, rheumatoid arthritis, history of solid organ transplantation, or localized fusariosis. The 90-day death rate among nonneutropenic patients (28.6%) and patients with resolved neutropenia (38.1%) was similar. However, the death rate among patients with persistent neutropenia (91.3%) was significantly higher. We used a multivariate Cox regression analysis to characterize risk factors for death: persistent neutropenia was the only risk factor for death, regardless of antifungal therapy.
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http://dx.doi.org/10.3201/eid2701.190782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774531PMC
January 2021

Do high MICs predict the outcome in invasive fusariosis?

J Antimicrob Chemother 2020 Dec 16. Epub 2020 Dec 16.

Istituto di Ematologia, Fondazione Policlinico Universitario A. Gemelli-IRCCS-Università Cattolica del Sacro Cuore - Largo Francesco Vito, 1, 00168 Roma RM, Italy.

Background: Invasive fusariosis (IF) affects mostly severely immunocompromised hosts and is associated with poor outcome. Since Fusarium species exhibit high MICs for most antifungal agents, this could explain the poor prognosis. However, a clear-cut correlation between MIC and outcome has not been established.

Objective: To evaluate the correlation between MIC and outcome (6 week death rate) in patients with IF.

Methods: We performed a multicentre retrospective study of patients with IF who received treatment and had MIC levels determined by EUCAST or CLSI for the drug(s) used during treatment. We compared the MIC50 and MIC distribution among survivors and patients who died within 6 weeks from the diagnosis of IF.

Results: Among 88 patients with IF, 74 had haematological diseases. Primary treatment was monotherapy in 52 patients (voriconazole in 27) and combination therapy in 36 patients (liposomal amphotericin B + voriconazole in 23). The MIC50 and range for the five most frequent agents tested were: voriconazole 8 mg/L (range 0.5-64), amphotericin B 2 mg/L (range 0.25-64), posaconazole 16 mg/L (range 0.5-64), itraconazole 32 mg/L (range 4-64), and isavuconazole 32 mg/L (range 8-64). There was no difference in MIC50 and MIC distribution among survivors and patients who died. By contrast, persistent neutropenia and receipt of corticosteroids were strong predictors of 6 week mortality.

Conclusions: Our study did not show any correlation between MIC and mortality at 6 weeks in patients with IF.
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http://dx.doi.org/10.1093/jac/dkaa516DOI Listing
December 2020

Methicillin-susceptible staphylococcus aureus in community-acquired pneumonia: Risk factors and outcomes.

J Infect 2021 Jan 2;82(1):76-83. Epub 2020 Nov 2.

Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES) Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Spain. Electronic address:

Objectives: We aimed to describe the prevalence, risk factors and outcomes of Methicillin-susceptible S. aureus (MSSA) community-acquired pneumonia (CAP) and compare them with those associated with CAP due to Streptococcus pneumoniae, the most frequent causative microorganism, in a large cohort of patients.

Methods: This was an observational study of prospectively collected data of consecutive adults with CAP and a definitive etiology enrolled between 2004 and 2018. Patients were divided into MSSA CAP and pneumococcal CAP groups for analysis.

Results: A microbial etiology was established in 1,548 (33%) cases: S. aureus caused 6% of microbiologically-confirmed CAP cases. In the latter, 52 were due to MSSA (60% of S. aureus CAP cases, and 3% of microbiologically-confirmed CAP cases) and 34 were due to MRSA (40% of S. aureus CAP cases, and 2% of microbiologically-confirmed CAP cases). S. pneumoniae was identified in 734 (47%) microbiologically-confirmed CAP cases. The presence of fever was independently associated with a lower risk of MSSA CAP (OR 0.53; 95% CI, 0.28-0.99). Patients with MSSA CAP had higher 30-day mortality than patients with pneumococcal CAP, both before and after adjustment for potential confounders (21% vs 7%, p = 0.002). MSSA was independently associated with 30-day mortality in the overall population.

Conclusion: MSSA CAP was associated with worse outcomes than pneumococcal CAP in our cohort. MSSA was an independent factor of mortality.
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http://dx.doi.org/10.1016/j.jinf.2020.10.032DOI Listing
January 2021

Aspergillosis Complicating Severe Coronavirus Disease.

Emerg Infect Dis 2021 01 21;27(1). Epub 2020 Oct 21.

Aspergillosis complicating severe influenza infection has been increasingly detected worldwide. Recently, coronavirus disease-associated pulmonary aspergillosis (CAPA) has been detected through rapid reports, primarily from centers in Europe. We provide a case series of CAPA, adding 20 cases to the literature, with review of pathophysiology, diagnosis, and outcomes. The syndromes of pulmonary aspergillosis complicating severe viral infections are distinct from classic invasive aspergillosis, which is recognized most frequently in persons with neutropenia and in other immunocompromised persons. Combined with severe viral infection, aspergillosis comprises a constellation of airway-invasive and angio-invasive disease and results in risks associated with poor airway fungus clearance and killing, including virus- or inflammation-associated epithelial damage, systemic immunosuppression, and underlying lung disease. Radiologic abnormalities can vary, reflecting different pathologies. Prospective studies reporting poor outcomes in CAPA patients underscore the urgent need for strategies to improve diagnosis, prevention, and therapy.
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http://dx.doi.org/10.3201/eid2701.202896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774554PMC
January 2021

Fungal co-infection in COVID-19 patients: Should we be concerned?

Rev Iberoam Micol 2020 Apr - Jun;37(2):41-46. Epub 2020 Sep 14.

Departamento de Inmunología, Microbiología y Parasitología, Facultad de medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Spain.

Critically ill COVID-19 patients have higher pro-inflammatory (IL-1, IL-2, IL-6, tumor necrosis alpha) and anti-inflammatory (IL-4, IL-10) cytokine levels, less CD interferon-gamma expression, and fewer CD and CD cells. This severe clinical situation increases the risk of serious fungal infections, such as invasive pulmonary aspergillosis, invasive candidiasis or Pneumocystis jirovecii pneumonia. However, few studies have investigated fungal coinfections in this population. We describe an update on published reports on fungal coinfections and our personal experience in three Spanish hospitals. We can conclude that despite the serious disease caused by SARS-CoV-2 in many patients, the scarcity of invasive mycoses is probably due to the few bronchoscopies and necropsies performed in these patients because of the high risk in aerosol generation. However, the presence of fungal markers in clinically relevant specimens, with the exception of bronchopulmonary colonization by Candida, should make it advisable to early implement antifungal therapy.
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http://dx.doi.org/10.1016/j.riam.2020.07.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489924PMC
November 2020

Recommendations for screening, monitoring, prevention, and prophylaxis of infections in adult and pediatric patients receiving CAR T-cell therapy: a position paper.

Infection 2020 Sep 26. Epub 2020 Sep 26.

Infectious Diseases Department, Hospital Universitari Vall D'Hebron, Barcelona, Spain.

Chimeric antigen receptor (CAR) T-cell therapy is one of the most promising emerging treatments for B-cell malignancies. Recently, two CAR T-cell products (axicabtagene ciloleucel and tisagenlecleucel) have been approved for patients with aggressive B-cell lymphoma and acute lymphoblastic leukemia; many other CAR-T constructs are in research for both hematological and non-hematological diseases. Most of the patients receiving CAR-T therapy will develop fever at some point after infusion, mainly due to cytokine release syndrome (CRS). The onset of CRS is often indistinguishable from an infection, which makes management of these patients challenging. In addition to the lymphodepleting chemotherapy and CAR T cells, the treatment of complications with corticosteroids and/or tocilizumab increases the risk of infection in these patients. Data regarding incidence, risk factors and prevention of infections in patients receiving CAR-T cell therapy are scarce. To assist in patient care, a multidisciplinary team from hospitals designated by the Spanish Ministry of Health to perform CAR-T therapy prepared these recommendations. We reviewed the literature on the incidence, risk factors, and management of infections in adult and pediatric patients receiving CAR-T cell treatment. Recommendations cover different areas: monitoring and treatment of hypogammaglobulinemia, prevention, prophylaxis, and management of bacterial, viral, and fungal infections as well as vaccination prior and after CAR-T cell therapy.
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http://dx.doi.org/10.1007/s15010-020-01521-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518951PMC
September 2020

Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study.

Clin Microbiol Infect 2021 Jan 31;27(1):83-88. Epub 2020 Jul 31.

Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain.

Objectives: To describe the burden, epidemiology and outcomes of co-infections and superinfections occurring in hospitalized patients with coronavirus disease 2019 (COVID-19).

Methods: We performed an observational cohort study of all consecutive patients admitted for ≥48 hours to the Hospital Clinic of Barcelona for COVID-19 (28 February to 22 April 2020) who were discharged or dead. We describe demographic, epidemiologic, laboratory and microbiologic results, as well as outcome data retrieved from electronic health records.

Results: Of a total of 989 consecutive patients with COVID-19, 72 (7.2%) had 88 other microbiologically confirmed infections: 74 were bacterial, seven fungal and seven viral. Community-acquired co-infection at COVID-19 diagnosis was uncommon (31/989, 3.1%) and mainly caused by Streptococcus pneumoniae and Staphylococcus aureus. A total of 51 hospital-acquired bacterial superinfections, mostly caused by Pseudomonas aeruginosa and Escherichia coli, were diagnosed in 43 patients (4.7%), with a mean (SD) time from hospital admission to superinfection diagnosis of 10.6 (6.6) days. Overall mortality was 9.8% (97/989). Patients with community-acquired co-infections and hospital-acquired superinfections had worse outcomes.

Conclusions: Co-infection at COVID-19 diagnosis is uncommon. Few patients developed superinfections during hospitalization. These findings are different compared to those of other viral pandemics. As it relates to hospitalized patients with COVID-19, such findings could prove essential in defining the role of empiric antimicrobial therapy or stewardship strategies.
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http://dx.doi.org/10.1016/j.cmi.2020.07.041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836762PMC
January 2021

Profile of patients with COVID-19 treated in Spanish emergency departments during the 2020 pandemic.

Emergencias 2020 Ago;32(4):225-226

Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS, Barcelona, España. Universidad de Barcelona, España.

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July 2020

Personalized therapy approach for hospitalized patients with COVID-19.

Clin Infect Dis 2020 Jul 10. Epub 2020 Jul 10.

Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.

Hospitalized patients with COVID-19 experiencing respiratory symptoms have different complications (inflammatory, co-infection and thrombotic) that are identifiable by analytics patterns. Personalized treatment decisions decreased early mortality (OR 0.144, CI 0.03-0.686; p=0.015). Increasing age (OR 1.06; p=0.038) and therapeutic effort limitation (OR 9.684; p<0.001) were associated with higher mortality.
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http://dx.doi.org/10.1093/cid/ciaa964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454444PMC
July 2020

Promoting the use of social networks in pneumonia.

Pneumonia (Nathan) 2020 25;12. Epub 2020 May 25.

Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.

Background: Pneumonia is a serious health concern, but it does not attract the attention it warrants. Perhaps this is due to a lack of understanding of the real extent of this infectious disease in the general population.

Methods: A literature review was performed to assess the role of social networks as a means to raise awareness over pneumonia worldwide and increase its visibility.

Results: In 2017, approximately 800,000 children under 5 years and approximately one million older people died of pneumonia. The importance of this pathology remains underestimated, despite the publication of many articles, comments, and editorials dedicated to rectifying the imbalance and to reduce its impact and associated mortality. Current misperceptions about pneumonia are alarming. Education and awareness are essential in the fight against this major public health threat; in this endeavor, social networks can be used to distribute science-based information about the disease and thus raise awareness among the general public about the dangers it poses. Approximately 3.8 billion people were using social media at the beginning of 2020, representing more than half of the world's population.

Conclusion: Social networks offer a valuable tool for disseminating scientific information about pneumonia, increasing its visibility, and in general raising awareness about this preventable disease.
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http://dx.doi.org/10.1186/s41479-020-00066-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247122PMC
May 2020

Difficult to treat microorganisms in patients aged over 80 years with community-acquired pneumonia: the prevalence of PES pathogens.

Eur Respir J 2020 10 8;56(4). Epub 2020 Oct 8.

Dept of Pulmonology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain.

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http://dx.doi.org/10.1183/13993003.00773-2020DOI Listing
October 2020

Factors associated with the development of septic shock in patients with candidemia: a post hoc analysis from two prospective cohorts.

Crit Care 2020 03 26;24(1):117. Epub 2020 Mar 26.

Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Background: Almost one third of the patients with candidemia develop septic shock. The understanding why some patients do and others do not develop septic shock is very limited. The objective of this study was to identify variables associated with septic shock development in a large population of patients with candidemia.

Methods: A post hoc analysis was performed on two prospective, multicenter cohort of patients with candidemia from 12 hospitals in Spain and Italy. All episodes occurring from September 2016 to February 2018 were analyzed to assess variables associated with septic shock development defined according to The Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3).

Results: Of 317 candidemic patients, 99 (31.2%) presented septic shock attributable to candidemia. Multivariate logistic regression analysis identifies the following factors associated with septic shock development: age > 50 years (OR 2.57, 95% CI 1.03-6.41, p = 0.04), abdominal source of the infection (OR 2.18, 95% CI 1.04-4.55, p = 0.04), and admission to a general ward at the time of candidemia onset (OR 0.21, 95% CI, 0.12-0.44, p = 0.001). Septic shock development was independently associated with a greater risk of 30-day mortality (OR 2.14, 95% CI 1.08-4.24, p = 0.02).

Conclusions: Age and abdominal source of the infection are the most important factors significantly associated with the development of septic shock in patients with candidemia. Our findings suggest that host factors and source of the infection may be more important for development of septic shock than intrinsic virulence factors of organisms.
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http://dx.doi.org/10.1186/s13054-020-2793-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7099832PMC
March 2020

Impact of intensifying primary antibiotic prophylaxis in at-home autologous stem cell transplantation program for lymphoma patients.

Leuk Lymphoma 2020 07 25;61(7):1565-1574. Epub 2020 Mar 25.

Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain.

Despite the use of fluoroquinolone (FQ) prophylaxis, neutropenic fever (NF) is the most frequent cause of hospital readmission in ambulatory care programs for patients treated with autologous stem cell transplantation (ASCT). We analyzed the impact of intensifying primary prophylaxis with the addition of piperacillin/tazobactam (PT) to FQ. Between January 2002 and August 2018, 154 lymphoma patients conditioned with BEAM were included (40% received ceftriaxone (Ct) plus FQ and 60% PT plus FQ). NF and hospital readmission were required in 84 vs. 41% ( < .0001) and 12 vs. 1% ( = .007) of patients within the Ct and PT groups, respectively. The multivariate analysis showed that PT plus FQ retained its independent protective factor for NF (odds ratio (OR): 0.13;  < .001) and for hospital readmission (OR: 0.07;  = .01). The use of PT and FQ prophylaxis may effectively prevent episodes of NF and hospitalizations in lymphoma patients managed in our at-home ASCT care model.
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http://dx.doi.org/10.1080/10428194.2020.1742901DOI Listing
July 2020

Defining Community-Acquired Pneumonia as a Public Health Threat: Arguments in Favor from Spanish Investigators.

Med Sci (Basel) 2020 Jan 25;8(1). Epub 2020 Jan 25.

Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona; Center for Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), 08036 Barcelona, Spain.

Despite advances in its prevention, pneumonia remains associated with high morbidity, mortality, and health costs worldwide. Studies carried out in the last decade have indicated that more patients with community-acquired pneumonia (CAP) now require hospitalization. In addition, pneumonia management poses many challenges, especially due to the increase in the number of elderly patients with multiple comorbidities, antibiotic-resistant pathogens, and the difficulty of rapid diagnosis. In this new call to action, we present a wide-ranging review of the information currently available on CAP and offer some reflections on ways to raise awareness of this disease among the general public. We discuss the burden of CAP and the importance of attaining better, faster microbiological diagnosis and initiating appropriate treatment. We also suggest that closer cooperation between health professionals and the population at large could improve the management of this largely preventable infectious disease that takes many lives each year.
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http://dx.doi.org/10.3390/medsci8010006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151587PMC
January 2020

Can Artificial Intelligence Improve the Management of Pneumonia.

J Clin Med 2020 Jan 17;9(1). Epub 2020 Jan 17.

Infectious Diseases Department, Hospital Clínic of Barcelona, 08036 Barcelona, Spain.

The use of artificial intelligence (AI) to support clinical medical decisions is a rather promising concept. There are two important factors that have driven these advances: the availability of data from electronic health records (EHR) and progress made in computational performance. These two concepts are interrelated with respect to complex mathematical functions such as machine learning (ML) or neural networks (NN). Indeed, some published articles have already demonstrated the potential of these approaches in medicine. When considering the diagnosis and management of pneumonia, the use of AI and chest X-ray (CXR) images primarily have been indicative of early diagnosis, prompt antimicrobial therapy, and ultimately, better prognosis. Coupled with this is the growing research involving empirical therapy and mortality prediction, too. Maximizing the power of NN, the majority of studies have reported high accuracy rates in their predictions. As AI can handle large amounts of data and execute mathematical functions such as machine learning and neural networks, AI can be revolutionary in supporting the clinical decision-making processes. In this review, we describe and discuss the most relevant studies of AI in pneumonia.
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http://dx.doi.org/10.3390/jcm9010248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019351PMC
January 2020

Fungal infections following treatment with monoclonal antibodies and other immunomodulatory therapies.

Rev Iberoam Micol 2020 Jan - Mar;37(1):5-16. Epub 2019 Dec 14.

Department of Clinical Microbiology and Infectious Diseases, University and Polytechnic Hospital La Fe, Valencia, Spain.

Tumor necrosis factor (TNF) is a proinflammatory cytokine involved in a wide range of important physiologic processes and has a pathologic role in some diseases. TNF antagonists (infliximab, adalimumab, etanercept) are effective in treating inflammatory conditions. Antilymphocyte biological agents (rituximab, alemtuzumab), integrin antagonists (natalizumab, etrolizumab and vedolizumab), interleukin (IL)-17A blockers (secukinumab, ixekizumab) and IL-2 antagonists (daclizumab, basiliximab) are widely used after transplantation and for gastroenterological, rheumatological, dermatological, neurological and hematological disorders. Given the putative role of these host defense elements against bacterial, viral and fungal agents, the risk of infection during a treatment with these antagonists is a concern. Fungal infections, both opportunistic and endemic, have been associated with these biological therapies, but the causative relationship is unclear, especially among patients with poor control of their underlying disease or who are undergoing steroid therapy. Potential recipients of these drugs should be screened for latent endemic fungal infections. Cotrimoxazole prophylaxis could be useful for preventing Pneumocystis jirovecii infection in patients over 65 years of age who are taking TNF antagonists, antilymphocyte biological agents or who have lymphopenia and are undergoing concomitant steroid therapy. As with other immunosuppressant drugs, TNF antagonists and antilymphocyte antibodies should be discontinued for patients with active infectious disease.
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http://dx.doi.org/10.1016/j.riam.2019.09.001DOI Listing
February 2021

Macrolide combination therapy for hospitalised CAP patients? An individualised approach supported by machine learning.

Eur Respir J 2019 12 12;54(6). Epub 2019 Dec 12.

Dept of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES) Barcelona, Barcelona, Spain

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http://dx.doi.org/10.1183/13993003.02111-2019DOI Listing
December 2019

An evidence-based bundle improves the quality of care and outcomes of patients with candidaemia.

J Antimicrob Chemother 2020 03;75(3):730-737

Hospital Clínic, IDIBAPS (Institut d'Investigacions biomèdiques Agust Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain.

Background: Candidaemia is a leading cause of bloodstream infections in hospitalized patients all over the world. It remains associated with high mortality.

Objectives: To assess the impact of implementing an evidence-based package of measures (bundle) on the quality of care and outcomes of candidaemia.

Methods: A systematic review of the literature was performed to identify measures related to better outcomes in candidaemia. Eight quality-of-care indicators (QCIs) were identified and a set of written recommendations (early treatment, echinocandins in septic shock, source control, follow-up blood culture, ophthalmoscopy, echocardiography, de-escalation, length of treatment) was prospectively implemented. The study was performed in 11 tertiary hospitals in Spain. A quasi-experimental design before and during bundle implementation (September 2016 to February 2018) was used. For the pre-intervention period, data from the prospective national surveillance were used (May 2010 to April 2011).

Results: A total of 385 and 263 episodes were included in the pre-intervention and intervention groups, respectively. Adherence to all QCIs improved in the intervention group. The intervention group had a decrease in early (OR 0.46; 95% CI 0.23-0.89; P = 0.022) and overall (OR 0.61; 95% CI 0.4-0.94; P = 0.023) mortality after controlling for potential confounders.

Conclusions: Implementing a structured, evidence-based intervention bundle significantly improved patient care and early and overall mortality in patients with candidaemia. Institutions should embrace this objective strategy and use the bundle as a means to measure high-quality medical care of patients.
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http://dx.doi.org/10.1093/jac/dkz491DOI Listing
March 2020

[Erratum to: "Current therapeutic options in invasive mycosis and potential therapeutic role of isavuconazole"].

Rev Iberoam Micol 2019 Jul - Sep;36(3):169

Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona-IDIBAPS; Universitat de Barcelona, FungiCLINIC Research group (AGAUR), Barcelona. España. Electronic address:

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http://dx.doi.org/10.1016/j.riam.2019.10.001DOI Listing
October 2019

Critical role of interleukin (IL)-17 in inflammatory and immune disorders: An updated review of the evidence focusing in controversies.

Autoimmun Rev 2020 Jan 15;19(1):102429. Epub 2019 Nov 15.

Rheumatology División, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain; University of Cantabria, Santander, Spain.

Interleukin 17 (IL-17) is a proinflammatory cytokine that has been the focus of intensive research because of its crucial role in the pathogenesis of different diseases across many medical specialties. In this context, the present review in which a panel of 13 experts in immunology, dermatology, rheumatology, neurology, hematology, infectious diseases, hepatology, cardiology, ophthalmology and oncology have been involved, puts in common the mechanisms through which IL-17 is considered a molecular target for the development of novel biological therapies in these different fields. A comprehensive review of the literature and analysis of the most outstanding evidence have provided the basis for discussing the most relevant data related to IL-17A blocking agents for the treatment of different disorders, such as psoriasis, psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, cardiovascular disorders, non alcoholic fatty liver disease, multiple sclerosis, inflammatory bowel disease, uveitis, hematological and solid cancer. Current controversies are presented giving an opening line for future research.
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http://dx.doi.org/10.1016/j.autrev.2019.102429DOI Listing
January 2020

[GEMICOMED/GEIRAS-SEIMC recommendations for the management of Candida auris infection and colonization].

Rev Iberoam Micol 2019 Jul - Sep;36(3):109-114. Epub 2019 Nov 3.

Servicio de Microbiología, Hospital Universitari i Politécnic La Fe, Valencia, España.

Candida auris is a new species of Candida that causes nosocomial outbreaks in several countries around the world, including Spain. C.auris is resistant to fluconazole and multi- and pan-resistant strains have been described. It is highly transmissible and can survive long term in the hospital environment, causing long-lasting outbreaks that are difficult to detect in early stages, and making it difficult to control and eradicate. It is currently an emerging threat to global health. This document provides a set of guidelines, developed by a multidisciplinary team, to limit the impact and facilitate the control of C.auris infection based on the experiences gathered in the Spanish and English outbreaks. The implementation of early and strict surveillance and control measures is essential to prevent the spread of the outbreak, which can spread over time, posing a significant risk to complex, critical and immunocompromised surgical patients. Immediate notification of C.auris isolation to clinical and infection control teams, as well as to health authorities and institutions, is essential to implement infection control measures at all levels in a timely manner, to prevent internal and inter-centre transmission, and to ensure a proper surveillance and prevention to patients who are already colonized and can develop an infection.
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http://dx.doi.org/10.1016/j.riam.2019.06.001DOI Listing
May 2020

Acute liver failure due to visceral leishmaniasis in Barcelona: a case report.

BMC Infect Dis 2019 Oct 22;19(1):874. Epub 2019 Oct 22.

Infectious Diseases Service Hospital Clinic-IDIBAPS, Villarroel 170, 08032, Barcelona, Spain.

Background: Leishmaniasis is an emerging infectious disease. Due to human migration and tourism, visceral leishmaniasis may become more common in non-endemic areas. In the Mediterranean basin, visceral leishmaniasis typically occurs in rural regions.

Case Presentation: We present an unusual urban case of acute liver failure due to visceral leishmaniasis, following a prolonged fever of unknown origin. After obtaining negative results from the bone marrow aspirate, we performed a liver biopsy that elucidated the diagnosis. The liver involvement in visceral leishmaniasis may appear as chronic granulomatous hepatitis. However diffuse hepatitis process, a necro-inflammatory pattern, without forming granulomas were observed in the liver biopsy specimens in this case. Intracytoplasmic Leishmania amastigotes were observed in the liver biopsy specimens and a polymerase chain reaction confirmed the diagnosis. Only five pathological confirmed cases of acute hepatitis due to visceral leishmaniasis have been described so far, just two in adults and both from Barcelona. A revision of the literature is performed.

Conclusions: Acute hepatitis is an uncommon debut of visceral leishmaniasis in immunocompetent patients. Furthermore there are only few cases in the literature that describe the histopathological changes that we found in this patient. In conclusion, in case of acute hepatitis leading to liver failure, leishmaniasis should be considered a differential diagnosis (even in non-endemic countries and without clear epidemiological exposure) and liver biopsy can elucidate the diagnosis.
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http://dx.doi.org/10.1186/s12879-019-4553-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6805620PMC
October 2019

Candidemia in solid organ transplant recipients in Spain: Epidemiological trends and determinants of outcome.

Transpl Infect Dis 2019 Dec 26;21(6):e13195. Epub 2019 Oct 26.

Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain.

Background: Despite being considered a high-risk population for invasive fungal disease, specific features of candidemia among solid organ transplant (SOT) recipients remain poorly characterized.

Methods: We compiled prospective data from two multicenter studies on candidemia performed over two consecutive periods in Spain: the CANDIPOP Study (2010-2011) and the CANDI-Bundle Study (2016-2018). Episodes diagnosed in adult SOT recipients in 10 participating centers were included. Risk factors for clinical failure (all-cause 7-day mortality and/or persistent candidemia for ≥72 hours) and 30-day mortality were investigated by univariate analysis.

Results: We included 55 episodes of post-transplant candidemia (32 and 23 of which occurred during the first and second periods). Kidney (38.2%) and liver recipients (30.9%) were the most common populations. Candida albicans accounted for 27.3% of episodes. The proportion of C glabrata increased over time (18.8% vs 30.4% for the first and second periods). There were no differences in the rate of fluconazole non-susceptible isolates (50.0% vs 60.0%, respectively). Clinical failure and 30-day mortality occurred in 25.5% and 27.3% of episodes and were associated with the severity of candidemia (Pitt score and severe sepsis/septic shock). Kidney transplantation (unadjusted odds ratio [uOR]: 0.17; 95% confidence interval [CI]: 0.03-0.85; P-value = .020), early catheter removal (uOR: 0.15; 95% CI: 0.03-0.76; P-value = .013), and appropriate early antifungal therapy (uOR: 0.14; 95% CI: 0.02-0.89; P-value = .041) were protective for 30-day mortality.

Conclusions: High rates of non-albicans species and fluconazole non-susceptibility must be taken into account to optimize therapeutic management and outcomes in SOT recipients with candidemia.
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http://dx.doi.org/10.1111/tid.13195DOI Listing
December 2019

Changing epidemiology of bloodstream infection in a 25-years hematopoietic stem cell transplant program: current challenges and pitfalls on empiric antibiotic treatment impacting outcomes.

Bone Marrow Transplant 2020 03 30;55(3):603-612. Epub 2019 Sep 30.

Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain.

We aimed to describe epidemiology changes in bloodstream infections (BSI) episodes in hematopoietic stem cell transplant (HSCT) recipients throughout a 25-year period (1993-2017), comparing five-year time spans, and we evaluate their impact on inappropriate empirical antibiotic treatment (IEAT) and mortality. During the study period, 1164 BSI episodes were documented in patients undergoing HSCT (71.6% allogenic and 29% autologous). A significant decrease in gram-positive cocci (GPC) and increase in gram-negative bacilli (GNB) were observed (p < 0.001). Among GP, coagulase-negative staphylococci (CoNS) significantly decreased whereas rising E. faecium BSI was documented. Among GNB, E. coli, Pseudomonas aeruginosa and K. pneumoniae rates increased. Multidrug-resistant (MDR) GNB, especially ESBL-E. coli and MDR-P. aeruginosa, emerged in 2008 and has gradually increased. IEAT against MDR-P. aeruginosa, but not in other MDR-GNB, augmented throughout the study period. Overall, 30-day and related mortality rates were 12.7% and 7.7% respectively, both increasing over time (p < 0.001 and p = 0.025). In GNB, 30-day and related mortality were 18.5% and 12.8%, respectively, increasing over time (p < 0.001 and p = 0.004). To conclude, important BSI epidemiological changes were described in a 25-year period. Concerning increase in IEAT for P. aeruginosa infections and rising 30-day mortality rate were documented.
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http://dx.doi.org/10.1038/s41409-019-0701-3DOI Listing
March 2020

Matched-paired analysis of patients treated for invasive mucormycosis: standard treatment versus posaconazole new formulations (MoveOn).

J Antimicrob Chemother 2019 11;74(11):3315-3327

University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Cologne, Germany.

Background: First-line antifungal treatment for invasive mucormycosis (IM) consists of liposomal amphotericin B. Salvage treatment options are limited and often based on posaconazole oral suspension. With the approval of posaconazole new formulations, patients could benefit from improved pharmacokinetics, safety and tolerability.

Objectives: Our aim was to assess the effectiveness of posaconazole new formulations for IM treatment.

Methods: We performed a case-matched analysis with proven or probable IM patients from the FungiScope® Registry. First-line posaconazole new formulations (1st-POSnew) and first-line amphotericin B plus posaconazole new formulations (1st-AMB+POSnew) cases were matched with first-line amphotericin B-based (1st-AMB) treatment controls. Salvage posaconazole new formulations (SAL-POSnew) cases were matched with salvage posaconazole oral suspension (SAL-POSsusp) controls. Each case was matched with up to three controls (based on severity, haematological/oncological malignancy, surgery and/or renal dysfunction).

Results: Five patients receiving 1st-POSnew, 18 receiving 1st-AMB+POSnew and 22 receiving SAL-POSnew were identified. By day 42, a favourable response was reported for 80.0% (n = 4/5) of patients receiving 1st-POSnew, for 27.8% (n = 5/18) receiving 1st-AMB+POSnew and for 50.0% (n = 11/22) receiving SAL-POSnew. Day 42 all-cause mortality of patients receiving posaconazole new formulations was lower compared with controls [20.0% (n = 1/5) in 1st-POSnew versus 53.3% (n = 8/15) in 1st-AMB; 33.3% (n = 6/18) in 1st-AMB+POSnew versus 52.0% (n = 26/50) in 1st-AMB; and 0.0% (n = 0/22) in SAL-POSnew versus 4.4% (n = 2/45) in SAL-POSsusp].

Conclusions: Posaconazole new formulations were effective in terms of treatment response and associated mortality of IM. While posaconazole new formulations may be an alternative for treatment of IM, the limited sample size of our study calls for a cautious interpretation of these observations.
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http://dx.doi.org/10.1093/jac/dkz344DOI Listing
November 2019