Endodontic variables in patients with SARS-CoV-2 infection (COVID-19) in relation to the severity of the disease.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is the cause of the ongoing coronavirus disease 2019 (COVID-19) pandemic. It has been hypothesized oral health may be related to the severity and complications of COVID-19. The aim of this study was to analyze the prevalence of apical periodontitis and the frequency of root canal treatment in a sample of patients with SARS-CoV-2 infection (COVID-19), correlating them with the severity of the disease. MATERIAL AND METHODS: This retrospective study was conducted following the Strengthening Reporting Observational Studies in Epidemiology (STROBE) guidelines. The study examined 280 patients with positive real time PCR COVID-19 test whose treatment was performed in our hospital. Fifty-two patients aged 52.3 ± 17.3 years, including 30 males and 22 females, who had an orthopantomography in their clinical record, performed in the last 2 years, were included. Patients with SARS-CoV-2 infection were grouped as mild or moderate (MM) and severe or critical (SC) illness groups, according to the NIH COVID-19 Treatment Guidelines (Wu & McGoogan 2020). Radiographic records were analyzed and apical periodontitis (AP) was diagnosed as radiolucent periapical lesions (RPLs), using the periapical index score (PAI). Student's t test, χ2 test and multivariate logistic regression were used in the statistical analysis. RESULTS: The number of carious teeth was significantly higher in the SC group (3.4 ± 4.1), which showed more than twice as many teeth with carious lesions than the MM group (1.4 ± 1.8) (p = 0.02). Multivariate regression analysis showed association between the number of carious teeth and the severity of SARS-CoV-2 disease (OR = 1.5; 95% CI = 1.1-2.1; p = 0.017). Endodontic status (OR = 7.12; 95% CI = 1.2-40.9; p = 0.027) also correlated with the disease severity. CONCLUSIONS: The results suggest that the oral health status of COVID-19 patients correlated with the severity of the SARS-CoV-2 virus infection. Significant association has been found between the severity of COVID-19 disease and the presence of a greater number of teeth with caries lesions, as well as with endodontic status.

Administration of taurolidine-citrate lock solution for prevention of central venous catheter infection in adult neutropenic haematological patients: a randomised, double-blinded, placebo-controlled trial (TAURCAT).

BACKGROUND: Catheter-related bloodstream infection (CRBSI) is one of the most frequent complications in patients with cancer who have central venous catheters (CVCs) implanted and is associated with substantial morbidity and mortality. Taurolidine is a non-antibiotic agent with broad-spectrum antimicrobial activity, which has been used as a lock solution to prevent CRBSI in some settings. However, little is known about its usefulness in high-risk adult neutropenic patients with cancer. This prospective randomised clinical trial aims to test the hypothesis that taurolidine-citrate lock solution is more effective than placebo for preventing catheter infection in neutropenic haematological patients. METHODS: This study is a prospective, multicentre, randomised, double-blinded, parallel, superiority, placebo-controlled trial. Patients with haematological cancer who are expected to develop prolonged neutropenia (> 7 days) and who have a non-tunnelled CVC implanted will be randomised to receive prophylactic taurolidine-citrate-heparin solution using a lock technique (study group) or heparin alone (placebo group). The primary endpoint will be bacterial colonisation of the CVC hubs. The secondary endpoints will be the incidence of CRBSI, CVC removal, adverse events, and 30-day case-fatality rate. DISCUSSION: The lock technique is a preventive strategy that inhibits bacterial colonisation in the catheter hubs, which is the initial step of endoluminal catheter colonisation and the development of infection. Taurolidine is a nontoxic agent that does not develop antibiotic resistance because it acts as an antiseptic rather than an antibiotic. Taurolidine has shown controversial results in the few trials conducted in cancer patients. These studies have important limitations due to the lack of data on adult and/or high-risk neutropenic patients, the type of catheters studied (tunnelled or ports), and the lack of information regarding the intervention (e.g. dwelling of the solution, time, and periodicity of the lock technique). If our hypothesis is proven, the study could provide important solid evidence on the potential usefulness of this preventive procedure in a population at high risk of CRBSI, in whom this complication may significantly impair patient outcome. TRIAL REGISTRATION: ISRCTN, ISRCTN47102251 . Registered on 9 September 2015.

Piperacilina-tazobactam en perfusión continua o expandida frente a perfusión intermitente / Piperacillin-tazobactam in continuous or expanded perfusion vs intermittent perfusion

Objetivo: El objetivo principal de esta revisión es analizar las diferencias de eficacia entre la administración en perfusión intermitente y la administración en perfusión continua/expandida de piperacilina-tazobactam. Como objetivos secundarios se analizan las diferencias en seguridad, parámetros farmacocinéticos/farmacodinámicos y coste-efectividad entre las 2 formas de administración. Método Se realizaron 2 búsquedas bibliográficas independientes. Se encontraron un total de 38 artículos y finalmente se incluyeron en el estudio 6. Se analizaron los artículos incluidos y se recogieron las variables diseño, tratamiento administrado a cada grupo, número de pacientes total y perteneciente a cada grupo, variables recogidas en cada estudio y resultados. Resultados Se hallaron diferencias significativas en la variable principal en 2 de los 6 estudios incluidos a favor de la perfusión continua/expandida. En el estudio de Lodise et al. se encontraron diferencias (p = 0,04) en mortalidad (31,6% en perfusión intermitente vs 12,2% en perfusión continua/expandida). En el estudio de Lorente et al. se encontraron diferencias (p = 0,001) en curación clínica (56,5% perfusión intermitente vs 89,2% en perfusión continua/expandida). En cuanto a las variables secundarias solo se encontraron diferencias en uno de los estudios en la relación coste-efectividad a favor del grupo de perfusión continua/expandida. Conclusión Los datos analizados indican que la perfusión continua/expandida sería al menos igual de eficaz que la perfusión intermitente, y que podría ser más eficaz en pacientes más graves, o con infecciones por microorganismos más resistentes, como Pseudomonas aeruginosa. Además esta forma de administración es, en teoría, más coste-efectiva (AU)

Objective: The primary objective of this review was to analyse the differences in efficacy between the administration of intermittent and continuous/expanded perfusion of piperacillin-tazobactam. Secondary objectives were to analyse the differences in safety, pharmacokinetic/pharmacodynamic parameters, and cost-effectiveness between the two forms of administration. Method: We performed two different independent bibliographic searches. We encountered a total of 38 articles, and the final number included in the study was 6. We analysed the articles and collected the following variables: design, treatment administered to each group, total number of patients and number of patients in each study, variables collected in each study, and results. Results: We encountered significant differences in the primary variable in two of the six studies favouring continuous/expanded perfusion. The study by Lodise et al found differences (P=.04)in mortality (31.6% for intermittent perfusion vs 12.2% for continuous/expanded perfusion).The study by Lorente et al found differences (P=.001) in terms of clinical recovery (56.5% for intermittent perfusion vs 89.2% for continuous/expanded perfusion). As for secondary variables, we only found differences in one of the studies in relation to cost-effectiveness, in favour of the group who underwent continuous/expanded perfusion method. Conclusion: The analysed data suggest that continuous/expanded perfusion would be at least as effective as intermittent perfusion, and that it could be more effective in severe patients with infections from more resistant micro-organisms such as Pseudomonas aeruginosa. Additionally, this form of administration is more cost-effective, at least in theory (AU)

[Piperacillin-tazobactam in continuous or expanded perfusion vs intermittent perfusion]. / Piperacilina-tazobactam en perfusión continua o expandida frente a perfusión intermitente.

OBJECTIVE: The primary objective of this review was to analyse the differences in efficacy between the administration of intermittent and continuous/expanded perfusion of piperacillin-tazobactam. Secondary objectives were to analyse the differences in safety, pharmacokinetic/pharmacodynamic parameters, and cost-effectiveness between the two forms of administration. METHOD: We performed two different independent bibliographic searches. We encountered a total of 38 articles, and the final number included in the study was 6. We analysed the articles and collected the following variables: design, treatment administered to each group, total number of patients and number of patients in each study, variables collected in each study, and results. RESULTS: We encountered significant differences in the primary variable in two of the six studies favouring continuous/expanded perfusion. The study by Lodise et al found differences (P=.04) in mortality (31.6% for intermittent perfusion vs 12.2% for continuous/expanded perfusion). The study by Lorente et al found differences (P=.001) in terms of clinical recovery (56.5% for intermittent perfusion vs 89.2% for continuous/expanded perfusion). As for secondary variables, we only found differences in one of the studies in relation to cost-effectiveness, in favour of the group who underwent continuous/expanded perfusion method. CONCLUSION: The analysed data suggest that continuous/expanded perfusion would be at least as effective as intermittent perfusion, and that it could be more effective in severe patients with infections from more resistant micro-organisms such as Pseudomonas aeruginosa. Additionally, this form of administration is more cost-effective, at least in theory.

Time to positivity of blood culture association with clinical presentation, prognosis and ESBL-production in Escherichia coli bacteremia.

The time to positivity (TTP) of blood cultures has been associated with increased mortality in bacteremia caused by several microorganisms. The aim of this study is to evaluate the relationship between TTP and prognosis, clinical presentation and extended spectrum B-lactamase (ESBL)-production in patients with Escherichia coli bacteremia. This is a retrospective observational study involving 226 adult patients with E. coli bacteremia. Data collected included underlying diseases, clinical presentation, prognosis factors, TTP, ESBL-production and outcome. Thirty-one (14%) patients had severe sepsis and 29 (13%) septic shock at presentation. Thirty-three (14%) strains were ESBL-producers. Thirty-nine (17%) patients died during admission and 17 (7.5%) within 48 hours. The median TTP was 8.3 hours (range, 0.42­76.5). It was significantly shorter in patients with septic shock (6.23 h, range 1.12­47.29 h vs. 8.51 h, range 0.42­76.50 h; p = 0.018). Rapid growth of E. coli, Pitt index >1.5, non-urinary source and Charlson score >2 were selected as independent risk factors of in-hospital mortality by the multivariate analysis. ESBL-production was not associated with modifications in TTP. Lower TTP is an independent risk factor for septic shock and poor outcome in episodes of E. coli bacteremia. The TTP in E. coli bacteremia is not significantly modified by ESBL-production.

Clinical utility of real-time polymerase chain reaction to quantify cytomegalovirus replication in allogeneic stem cell transplant recipients with different prevention strategies.

Cytomegalovirus (CMV) end-organ disease is a serious, frequent complication after allogenic stem cell transplantation (Allo-SCT). There are two prevention strategies: universal prophylaxis and preemptive therapy. Preemptive therapy is administered based on the results of sensitive techniques that detect the viral infection. We analyzed 41 peripheral blood Allo-SCT recipients: 34 received prophylaxis and seven preemptive treatment. Viral infections determined using real-time polymerase chain reaction (RT-PCR) assays occurred at an overall incidence of 65.8%. The viral loads quantified by RT-PCR were compared among the prophylaxis versus the preemptive group. Overall, the median viral load was significantly higher in the preemptive compared with the prophylaxis group (P=.002). Furthermore, within the first 100 days posttransplantation, viral load values were higher among patients undergoing preemptive therapy (P=.009).

Differences in cytomegalovirus replication quantified using quantitative polymerase chain reaction and antigenemia after allogeneic stem cell transplantation.

Fifty percent of allogeneic stem cell recipients develop cytomegalovirus (CMV) infection in the first 100 days posttransplantation. Various methods have been used to determine CMV infections, including antigenemia assay and real-time polymerase chain reaction (RT-PCR). Although antigenemia assay has been used more frequently, this technique is less sensitive than RT-PCR. In contrast, RT-PCR has a low positive predictive value for CMV end-organ disease. Cytomegalovirus infections were analyzed in 41 peripheral blood samples from allogeneic stem cell recipients using both antigenemia assay and RT-PCR; results were discordant in 36.6% of patients. Although the antigenemia assay detected CMV replication in 29.2% of cases, RT-PCR was positive in 65.8%. In 83.3% of patients, results detected using the antigenemia assay were delayed by a median (range) of 5 (2-20) weeks compared with positive RT-PCR results. Within the first 100 days posttransplantation, higher levels of viral replication measured using RT-PCR were observed in patients with vs without antigenemia. In addition, in patients with antigenemia, viral load was significantly higher before day 100 than after (P=.01 and P=.008, respectively) compared with those without antigenemia.

Preemptive therapy for cytomegalovirus disease in allogeneic stem cell transplant recipients.

Cytomegalovirus (CMV) infection causes high morbidity and mortality among allogeneic stem cell transplant recipients. Preemptive therapy with oral valganciclovir or intravenous ganciclovir has replaced universal prophylaxis. We prospectively studied 19 consecutive adult recipients of allogeneic peripheral blood stem cell transplants from May 2005 through February 2007 to analyze the safety and efficacy of preemptive therapy for the treatment of CMV infection. The antigenemia test was persistently negative in 8 patients (42%) and positive at least once in 11 (58%). Eight patients were treated with oral valganciclovir on an outpatient basis and they all became CMV negative after the first week of treatment. The other 3 patients received intravenous ganciclovir and were also CMV negative after the first week of treatment. No patient abandoned treatment, no severe secondary toxicity was noted, and there was no CMV-associated mortality.

[Bacteremia caused by Stenotrophomonas maltophilia: epidemiology, clinical features, and prognosis factors]. / Bacteriemias por Stenotrophomonas maltophilia: epidemiología, características clínicas y factores pronósticos.

The epidemiologic, clinical and prognostic characteristics of Stenotrophomonas maltophilia bacteremias for a six-year period (January 1993 to December 1998) were reviewed. Twenty episodes of S. maltophilia bacteremia were include, which represented 0.62% of all bacteremias caused by gram-negative rods during that period. Seventy percent of bacteremias were clinically significant. The most common predisposing factors were the previous use of antimicrobial agents and the presence of vascular catheters. In most cases (57%), the origin of bacteremia was the intravascular catheter. The course of patients was favorable and all patients cured.

Bacteriemias por stenotrophomonas maltophilia: epidemiología, características clínicas y factores pronósticos / Stenotrophomonas maltophilia bacteremia: epidemiology, clinical characteristics and prognostic factors

Se revisan las características epidemiológicas, clínicas y pronósticas de las bacteriemias por Stenotrophomonas maltophilia durante un período de seis años (enero de 1993-diciembre de 1998). Se incluyeron 20 episodios de bacteriemia por S. maltophilia que representan el 0,62 por ciento de las bacteriemias por bacilos gramnegativos de ese período. El 70 por ciento de las bacteriemias fueron clínicamente significativas. Los factores predisponentes más frecuentes fueron el uso previo de antimicrobianos y la presencia de catéter vascular. El origen de la bacteriemia fue el catéter intravascular en la mayoría de los casos (57 por ciento). La evolución de los pacientes fue favorable, alcanzando la curación en todos los casos (AU)

[Infectious complications of heart transplantation. A prospective study for the first 6 years of a transplantation program]. / Complicaciones infecciosas de trasplante cardíaco. Estudio prospectivo durante los seis primeros años de programa de trasplante.

OBJECTIVE: To study the infectious complications, mortality, and associated factors in heart transplant recipients. METHODS: Prospective study of the first 69 heart transplantations performed from January 1991 until December 1996 in a university hospital. Description of clinical features of infectious complications during the first year after transplantation. Univariate and multivariate analyses of the risk factors associated with mortality and development of infectious complications. RESULTS: Seventy-three percent of patients had at least one infectious complication; the incidence was 1.13 episodes per patient-year. The etiology of complications was bacterial (50%), viral (31%), Pneumocystis carinii (5%), fungal (4%), and protozoal (4%). The opportunist organisms accounted for 42% of cases. Pneumonia was the most common complication (28%), followed by mucocutaneous herpetic reactivation (19%), bacteremia (13%), urinary tract infection (13%), cytomegalovirus disease (11.5%), pleural empyema (5%) and surgical wound infection (5%). Nosocomial pneumonia accounted for 50% of cases. Gram-negative rods accounted for 41% of pneumonia cases. A total of 62.5% of deaths were directly related to infectious complications. Factors independently associated with mortality were hospital origin at transplantation (RR = 4.5 [2-9], p = 0.034), development of infectious complications in the post-heart transplantation period (RR = 3.2 [1.2-12], p = 0.04) and a more prolonged hospital stay at ICU (p = 0.0004). The factor which was independently associated with the development of infectious complications was one or more severe episodes of acute rejection (RR = 1.5 [1.1-2.2], p = 0.04). Patients who developed infectious complications had a more prolonged accumulated annual hospital stay (p = 0.004) than those without infectious complications. CONCLUSIONS: Infectious complications are very common, prolong hospital stay, and are the first cause of mortality during the first year after transplantation. Bacteria are the most common etiology and pneumonia is the most common infection.