Successful treatment of invasive aspergillosis caused by Aspergillus parafelis in a kidney transplant recipient.

Invasive aspergillosis (IA) is associated with a high mortality rate in kidney-transplant recipients. Azole-resistance is increasing in Aspergillus fumigatus. We report a clinical case of a kidney-transplant recipient with cerebellar and pulmonary aspergillosis caused by azole-resistant Aspergillus parafelis (molecular identification through ß-tubulin sequence). The patient experienced an effective resolution after three surgical procedures and associated antifungal therapy. This case highlights that azole-resistant aspergillosis should be considered in every patient with IA as long as susceptibility testing results are not known. Therefore, in selected patients with IA and central nervous system involvement, empirical combination antifungal therapy could be considered.

Infective endocarditis after transcatheter aortic valve implantation: Contributions of a single-centre experience on incidence and associated factors. / Endocarditis infecciosa después de TAVI: aportaciones de la experiencia en un único centro sobre la incidencia y los factores asociados.

INTRODUCTION: Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is an emerging complication. There are incomplete and disparate data on its incidence. We present the experience of a single-centre of incidence, mortality and associated factors of IE after TAVI. METHODS: A retrospective observational study of IE cases in people who received a TAVI, between 06/01/2009 and 11/01/2017, in a university hospital, during a median follow-up period of 15.3months (interquartile range [IQR] 9.1-36.2). Incidence, clinical, microbiological and prognostic data, and factors associated with IE after TAVI were analysed. RESULTS: Eleven patients with IE of 200 TAVI were detected. Global incidence: 5.5% (2.77 cases per 100 patient-year). The median of days from TAVI to IE was 112 (IQR 36-578), the in-hospital mortality rate was 36.4%, and the one-year mortality rate was 54.5%. All the organisms identified were gram-positive (4 Enterococcus faecalis, 3 coagulase-negative Staphylococcus). The patients with IE after TAVI were significantly younger (median 78years, IQR 73-80, versus 82 years, IQR 79-84, P=.002), they had a higher EuroSCORE (5.1±2.4 versus 3.2±1.2, P<.001), and they more frequently had a history of neoplasia (18.2% versus 4.2%, P<.03) CONCLUSIONS: In our area, IE after TAVI has an incidence greater than that described in multicentre series, this is in line with the trend published in the literature. It leads to high mortality and is associated with a worse baseline clinical situation.

Activity of vancomycin, ciprofloxacin, daptomycin, and linezolid against coagulase-negative staphylococci bacteremia.

OBJECTIVE: Multiresistant coagulase-negative staphylococci (CNS) infections are mainly increased in hospitalized patients. We have studied the activity of vancomycin, ciprofloxacin, daptomycin and linezolid in methicillin-resistant CNS strains, isolated from true blood cultures. METHODS: We collected 87 strains of different CNS species from positive blood cultures. Staphylococci were identified by MicroScan Walkaway (Dade Behring, Siemens) and with the Api ID 32 Staph (BioMerieux, France). The susceptibility to oxacillin, vancomycin and ciprofloxacin was performed by automatic microdilution plate as cited above. The susceptibility to daptomycin and linezolid was performed by Etest (AB BioMerieux, Solna, Sweden). Interpretative criteria were done following the CLSI guidelines. RESULTS: Eighty-seven CNS strains were studied: 55 (63%) were S. epidermidis, 15 (17%) S. haemolyticus, 10 (12%) S. hominis, and 7 (8%) other species. Fifty-three (61%) strains showed loss of susceptibility to vancomycin, MIC = 2 mg/L. Ciprofloxacin resistance, MIC > 2 mg/L, was observed in 56 (64%) strains. Daptomycin resistance was not observed, with a susceptibility range between 0.032-1 mg/L and modal value of 0.25 mg/L. Ten strains (11.5%) resistant to linezolid were observed. Nine patients were in ICU, where the average length of stay was 38 days (range 16-58 days) and one belonged to Hepato-Pancreatic Surgery, where he stayed for 64 days. CONCLUSIONS: Low susceptibility to vancomycin is frequent in the CNS strains studied in our hospital. Daptomycin shows a high efficacy against CNS, and it could be useful for the treatment of primary bacteremia or catheter associated bacteremia. The massive and continuous use of linezolid has led to the appearance of resistance.

[Q fever in Extremadura: an emerging infection]. / Fiebre Q en Extremadura: una infección emergente.

INTRODUCTION AND OBJECTIVES: Q fever (Coxiella burnetii infection) is an underdiagnosed zoonosis in our area, Extremadura, a rural region in the Southwest of Spain. The characteristics of Q fever and the changes in this infection seen over the last decade in our hospital are described. MATERIAL AND METHODS: A total of 124 cases of Q fever diagnosed in the Infectious Diseases Unit of a tertiary hospital Hospital Universitario Infanta Cristina de Badajoz) during the years 1992-2005 were analyzed. The epidemiological, clinical, serological and therapeutic data of the patients, and the factors related with hospital admittance are described. RESULTS: Mean age was 41 +/- 16 years, most patients were males (4:1 ratio), 61% lived in rural areas and 47% mentioned some kind of contact with farm animals. The clinical presentation included non-focalized fever (53%), hepatitis (43%), pneumonia (11%), and endocarditis (6%). The factors related with the need for hospital admission were diagnosis after 1999 (OR: 12.2; 95% CI: 3.2-47.6), pneumonia (OR: 4.1; 95% CI: 1.1-15.9), and hepatitis (OR: 2.7; 95% CI: 1.2-6.3). During the second half of the study period there were more cases of Q fever, the interval of time to diagnosis was shorter (P = 0.042), and there was a significant increase in hospitalizations (55% versus 9%; P < 0.0001). CONCLUSIONS: In Extremadura, Q fever is an emerging infection that predominates in males who are in contact with animals for work purposes. Non-focalized fever is the most frequent form of clinical presentation; pneumonia is rare. Hospitalization for Q fever infection has increased over the last years.

[Hepatitis C virus infection in a first level rural hospital: descriptive study in the decade 1991-1999]. / Infección por el virus de la hepatitis C en un hospital de primer nivel de ámbito rural: estudio descriptivo en la década 1991-1999.

INTRODUCTION: To assess epidemiology, clinical manifestations and prognostic factors in subjects diagnosed with hepatitis C virus (HCV) infection in a first level rural hospital. METHODS: This retrospective study includes 142 patients diagnosed with HCV infection at the Hospital de Llerena, from August 1991 to December 1999. Epidemiological and clinical parameters were collected at a mean of 2.7 years after diagnosis and prognostic factors were analyzed. RESULTS: HCV infection predominated in males (69%) and the mean age of patients was 48.3 6 19.3 years. Mechanisms of transmission included unknown (46.5%), intravenous drug use (39.4%), and transfusions (14.1%). Human immunodeficiency virus coinfection was present in 23% of patients and hepatitis B virus (HBV) coinfection in 5.6%. At the time of diagnosis, 111 patients (78.2%) were asymptomatic; 26 (18.3%) presented with complications of portal hypertension and 5 (3.5%) with extrahepatic symptoms. Ultrasonographic signs of portal hypertension were observed in 32.4% of cases. Hepatocarcinoma was detected in 17 patients (12.0%) and extrahepatic neoplasms in 14 (9.9%). Twenty-eight patients died (19.7%). Independent risk factors for mortality included HBV coinfection (OR 26.9; 95% CI 2.19-331.47), ultrasonographic signs of portal hypertension (OR 11.0; 95% CI 3.38-32.61) and diagnosis of hepatocarcinoma (OR 182.7; 95% CI 14.85-2248.21). CONCLUSIONS: Between 1990 and 1999 in our hospital HCV infection was frequently diagnosed in advanced stages and was associated with high mortality, particularly when ultrasonographic signs of portal hypertension or HBV coinfection were present.