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1.
Infect Dis Ther ; 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32020522

RESUMO

INTRODUCTION: To evaluate the clinical impact of a comprehensive care bundle for the management of candidemia. METHODS: A quasi-experimental pre-post study was implemented. During the pre-intervention period (May 2014-September 2015), a non-mandatory antifungal stewardship program (ASP) was implemented, and patients with candidemia were visited by an infectious disease specialist who provided diagnostic and therapeutic advice according to standard of care as soon as possible. During the post-intervention period (October 2015-May 2017), patients were managed according to a candidemia care bundle with clear and structured recommendations written in their medical history. RESULTS: Overall, 109 patients were included, 56 in the pre-intervention and 53 in the post-intervention period. Overall, compliance with the Candida bundle significantly improved between the pre- [27/56 (48.2%)] and post-intervention [43/53 (81.1%); p = 0.01] period. Individual bundle components that significantly improved in the post-intervention period were early adequate antifungal therapy [47/56 (83.9%) vs. 51/53 (96.2%), p = 0.05], early adequate source control of the infection [37/56 (82.2%) vs. 41/53 (97.6%), p = 0.03] and appropriate duration of therapy [27/56 (48.2%) vs. 43/53 (81.1%), p = 0.01]. Adherence to follow-up blood cultures, ophthalmologic examination and echocardiography improved in the post-intervention period, but the difference was not statistically significant. Multivariate analysis revealed that being managed according to candidemia bundle had a favorable impact on 14-day mortality (HR 0.08, 95% CI 0.01-0.45, p = 0.02) and 30-day mortality (HR 0.40, 95% CI 0.18-0.89, p = 0.02). CONCLUSIONS: A simple bundle focused on increasing adherence to a few evidence-based interventions contributed to a significant reduction in 14- and 30-day mortality in patients with candidemia.

2.
Med Mycol ; 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32022851

RESUMO

The capacity of Candida spp. to form biofilms allows them to attach either to living or inert surfaces, promoting their persistence in hospital environments. In a previous study, we reported strain-to-strain variations in Candida spp. biofilm development, suggesting that some genotypes may be greater biofilm formers than others. In this study, we hypothesize that isolates pertaining to clusters may be found more frequently in the environment due to their ability to form biofilms compared to singleton genotypes. Two hundred and thirty-nine Candida spp. isolates (78 clusters) from candidemia patients admitted to 16 hospitals located in different cities and countries-and the same number of singleton genotypes used as controls-were tested in terms of biofilm formation using the crystal violet and the XTT reduction assays. Candida albicans clusters showed higher biofilm formation in comparison to singleton genotypes (P < .01). The biofilms formed by intra-hospital C. albicans clusters showed higher metabolic activity (P < .05). Furthermore, marked variability was found among species and type of cluster. We observed that the higher the number of isolates, the higher the variability of biofilm production by isolates within the cluster, suggesting that the production of biofilm by isolates of the same genotype is quite diverse and does not depend on the type of cluster studied. In conclusion, candidemia Candida spp. clusters-particularly in the case of C. albicans-show significantly more biomass production and metabolic activity than singleton genotypes.

3.
Infect Dis Ther ; 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32026399

RESUMO

INTRODUCTION: This study aimed to examine the relationship among adequate dose, serum concentration and clinical outcome in a non-selected group of hospitalized patients receiving antifungals. METHODS: Prospective cross-sectional study performed between March 2015 and June 2015. Dosage of antifungals was considered adequate according to the IDSA guidelines, whereas trough serum concentrations (determined with HPLC) were considered adequate as follows: fluconazole > 11 µg/ml, echinocandins > 1 µg/ml, voriconazole 1-5.5 µg/ml and posaconazole > 0.7 µg/ml. RESULTS: During the study period, 84 patients (65.4% male, 59.6 years) received antifungals for prophylaxis (40.4%), targeted (31.0%) and empirical therapy (28.6%). The most frequent drug was micafungin (28/84; 33.3%) followed by fluconazole (23/84; 27.4%), voriconazole (15/84; 17.9%), anidulafungin (8/84; 9.5%), posaconazole (7/84; 8.3%) and caspofungin (3/84; 3.6%). Considerable interindividual variability was observed for all antifungals with a large proportion of the patients (64.3%) not attaining adequate trough serum concentrations, despite receiving an adequate antifungal dose. Attaining the on-target serum antifungal level was significantly associated with a favorable clinical outcome (OR = 0.02; 95% CI 0.01-0.64; p = 0.03), whereas the administration of an adequate antifungal dosage was not. CONCLUSIONS: With the standard antifungal dosage, a considerable proportion of patients have low drug concentrations, which are associated with poor clinical outcome.

4.
J Am Coll Cardiol ; 75(5): 482-494, 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32029130

RESUMO

BACKGROUND: Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking. OBJECTIVES: The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort. METHODS: This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses. RESULTS: Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p = 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%; p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse. CONCLUSIONS: Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE.

5.
APMIS ; 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32012332

RESUMO

We assessed the success rate of vancomycin catheter lock therapy (VLT) in combination with systemic antimicrobials in patients with staphylococcal catheter-related bloodstream infection (C-RBSI). Over a 6-year period, we retrospectively collected clinical and microbiological data from patients with long-term central venous catheters and staphylococcal C-RBSI who were treated with systemic antimicrobials and VLT. We then assessed the success rate of VLT based on two criteria: 1) catheter retention time > 3 months and 2) catheter in place until end of use. We found 217 staphylococcal C-RBSI episodes, 115 (53.0%) of which were managed with conservative therapy. Of these, 76 (66.1%) were treated with VLT (85.5% coagulase negative staphylococci and 14.5% Staphylococcus aureus). The success rate of VLT was 42.1% with criterion 1 and 71.1% with criterion 2. We did not find statistically significant differences between success and failure in the majority of the clinical data recorded. We only found differences for crude mortality in criterion 1 and for parenteral nutrition in criterion 2. The success of catheter retention using VLT was moderate, reaching slightly more than 70% when the catheter was kept in place until the end of use.

6.
Transplant Rev (Orlando) ; : 100528, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-32001103

RESUMO

The immunosuppressive treatment that recipients receive from a solid organ transplantation hinders the defensive response to infection. Its transmission from the donor can cause dysfunction or loss of the graft and even death of the recipient if proper preventive measures are not established. This potential risk should be thoroughly evaluated to minimise the risk of infection transmission from donor to recipient, especially with organ transplantation from donors with infections, without increasing graft dysfunction and morbidity and mortality in the recipient. This document aims to review current knowledge about infection screening in potential donors and offer clinical and microbiological recommendations about the use of organs from donors with infection based on available scientific evidence.

7.
Infect Dis Ther ; 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32086777

RESUMO

INTRODUCTION: To assess the association between exposure to micafungin, other echinocandins, or azoles and the development of short-term liver injury (STLI) or long-term liver injury (LTLI) in patients with Child-Pugh B or C liver disease. METHODS: Multicenter case-control study of patients with Child-Pugh B or C liver disease who received antifungals (AF) for ≥ 72 h (May 2009-May 2015) in six Spanish and Italian hospitals. All micafungin patients were randomly matched with one patient who received another echinocandin and with one patient who received azole treatment. Primary outcome was development of STLI or LTLI (development of any type of liver tumor during the follow-up period). RESULTS: Of 2335 patients with chronic liver disease admitted to the six centers, 20 (0.85%) were found to have Child-Pugh B or C liver disease and received micafungin for ≥ 72 h. During AF treatment, the frequency of STLI was 10% in each group. Most cases of STLI were asymptomatic, and AFs had to be switched to another class of AF in only two patients (one micafungin and one azole). No patients developed acute liver insufficiency, were admitted to the ICU, or had to undergo transplantation. Follow-up data (median of 1.3 years) were available for 30 patients. LTLI was observed in only one patient, who had previously received treatment with azoles. CONCLUSIONS: Our study suggests that the administration of micafungin to patients with end-stage liver disease does not imply a higher risk of developing STLI or LTLI.

9.
Int J Cardiol ; 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32081472

RESUMO

INTRODUCTION: We sought to study the prevalence of cardiac troponin T (TnT) elevation in patients with infective endocarditis (IE) and its association with in-hospital outcomes. METHODS AND RESULTS: Retrospective single-center study. From 2008 to 2018, 528 patients were diagnosed with IE and 250 (47.3%) had at least a TnT determination during hospital admission, 103 with conventional TnT assay and 147 with high-sensitive assay. Elevated TnT levels were found in 210 patients (84.0%). Compared with patients with normal TnT levels, patients with TnT elevation presented higher in-hospital mortality (5 [12.5%] vs. 77 [36.7%], p < 0.001) and more frequent complications: heart failure (9 [22.5%] vs. 106 [50.5%], p < 0.001), cardiac abscesses (4 [10.0%] vs 58 [27.6%], p = 0.03), conduction disorders (0 vs. 26 [12,4%]; p = 0.04), and involvement of the central nervous system (1 [2.5%] vs. 38 [18.1%];p = 0.02). Patients with elevated TnT had more frequent indication for surgery (24 [60.0%] vs. 179 [85.2%], p < 0.001) and were operated on more frequently (16 [40.0%] vs 123 [58.6%], p = 0.03). TnT elevation was an independent predictor of in-hospital mortality (OR 3.31; 95% CI 1.02-10.72, p = 0.05). Adding TnT data to conventional clinical models improved the predictive capability of in-hospital mortality (R2: 0.407 vs. 0.388, χ2: 85.03 vs. 80.40, p < 0.001), resulting in a net reclassification improvement of 0.29 (95% CI: 0.13-0.46, p < 0.01). CONCLUSIONS: TnT elevation is very common in patients with IE and is associated with increased in-hospital mortality and complications, thus routine monitoring should be recommended.

10.
Sci Rep ; 10(1): 2704, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066749

RESUMO

It is relevant to evaluate MDR-tuberculosis in prisons and its impact on the global epidemiology of this disease. However, systematic molecular epidemiology programs in prisons are lacking. A health-screening program performed on arrival for inmates transferred from Peruvian prisons to Spain led to the diagnosis of five MDR-TB cases from one of the biggest prisons in Latin America. They grouped into two MIRU-VNTR-clusters (Callao-1 and Callao-2), suggesting a reservoir of two prevalent MDR strains. A high-rate of overexposure was deduced because one of the five cases was coinfected by a pansusceptible strain. Callao-1 strain was also identified in 2018 in a community case in Spain who had been in the same Peruvian prison in 2002-5. A strain-specific-PCR tailored from WGS data was implemented in Peru, allowing the confirmation that these strains were currently responsible for the majority of the MDR cases in that prison, including a new mixed infection.

11.
Int J Infect Dis ; 90: 161-166, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31693939

RESUMO

OBJECTIVE: To analyse all cases of Nocardia pneumonia occurring between 2010 and 2016 in five Spanish hospitals. METHODS: This was a retrospective observational analysis of clinical and microbiological data collected from 55 cases of Nocardia pneumonia. RESULTS: There were one to 20 cases per hospital and six to nine cases per year. Chronic obstructive pulmonary disease, bronchiectasis, and asthma were the main predisposing underlying respiratory conditions. Thirty-four patients were receiving systemic and/or inhaled corticosteroids prior to infection, eight had neoplasia, and six had haematological malignancies. Clinical and radiological findings were common to pneumonia of other infectious aetiologies, except for the frequent presence of nodules and cavitation. Overall, the 1-year mortality was high (38.2%), and mortality was directly related to the pulmonary disease in 15 patients (27.3%). The most frequently identified species were N. cyriacigeorgica (n=21), N. abscessus (n=8), and N. farcinica (n=5). All Nocardia isolates were susceptible to linezolid and all but two were susceptible to amikacin and trimethoprim-sulfamethoxazole. CONCLUSIONS: Nocardia pneumonia-associated mortality remains high, probably because of the debilitated status of patients in whom this pathogen is able to cause pulmonary infection.

12.
Med Mycol ; 58(1): 83-92, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30874807

RESUMO

We aim to assess intra- and interspecies differences in the virulence of Candida spp. strains causing candidemia using the invertebrate Galleria mellonella model. We studied 739 Candida spp. isolates (C. albicans [n = 373], C. parapsilosis [n = 203], C. glabrata [n = 92], C. tropicalis [n = 53], and C. krusei [n = 18]) collected from patients with candidemia admitted to Gregorio Marañon Hospital (Madrid, Spain). Species-specific infecting inocula (yeast cells/larva) were adjusted (5 × 105 [C. albicans, and C. tropicalis], 2 × 106-5 × 106 [C. parapsilosis, C. glabrata, and C. krusei]) and used to infect 10 larvae per isolate; percentage of survival and median survival per isolate were calculated. According to the interquartile range of the median survival, isolates with a median survival under P25 were classified as of high-virulence and isolates with a median survival over P75 as of low virulence. The median survival of larvae infected with different species was variable: C. albicans (n = 2 days, IQR <1-3 days), C. tropicalis (n = 2 days, IQR 1.5-4 days), C. parapsilosis (n = 2 days, IQR 2-3.5 days), C. glabrata (n = 3 days, IQR 2-3 days), and C. krusei (n = 7 days, 6.5->8 days) (P < .001). Differences in virulence among species were validated by histological examination (day +1 post-infection) in the larvae infected by the isolates of each virulence category and species. Virulence-related gene expression in C. albicans isolates did not reach statistical significance. We report species-specific virulence patterns of Candida spp. and show that isolates within a given species have different degrees of virulence in the animal model.

13.
Artigo em Inglês | MEDLINE | ID: mdl-31807286

RESUMO

Background: In patients with suspected ventilator-associated pneumonia, a rapid etiological diagnosis is crucial as incorrect or delayed treatment in the first few hours leads to a worse prognosis and a higher mortality rate. This study examines the efficacy of a rapid antibiogram on bronchial aspirates in patients with suspected ventilator-associated pneumonia (VAP). Methods: The direct gradient diffusion susceptibility testing method (GDM) on respiratory samples was compared with a standard broth microdilution method (BMD) after quantitative cultures in patients with suspicion of VAP. Samples were preselected by Gram staining (for good quality microbiological samples with a predominant single bacterial morphotype). The antibiotics tested were ceftazidime, ceftobiprole, ceftolozane-tazobactam, meropenem, doripenem, and tedizolid. Results: Over a 16-month study period, 445 bronchial aspirate samples were selected from 1376 samples received at our laboratory from 672 adult patients. By direct plating on Mueller-Hinton agar, we recovered 504 (95.5%) of the 528 microorganisms identified by the standard semiquantitative method. Antimicrobial susceptibility testing by GDM was compared with the BMD method in 472 strains (216 Enterobacteriaceae, 138 P. aeruginosa and 118 S. aureus.) and 1652 individual microorganism-antimicrobial agent combinations. There was total agreement between both methods in 98% of combinations. The Kappa index between both techniques was excellent (over 80%). There was only one potential major error for P. aeruginosa susceptibility to ceftazidime. Conclusions: The six GDM strips directly placed on plated bronchial aspirates obtained from patients with a suspicion of VAP provided accurate and reliable susceptibility results within 24 h.

14.
Top Curr Chem (Cham) ; 378(1): 6, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31840192

RESUMO

Ferrites are a large class of oxides containing Fe3+ and at least another metal cation that have been investigated for and applied to a wide variety of fields ranging from mature technologies like circuitry, permanent magnets, magnetic recording and microwave devices to the most recent developments in areas like bioimaging, gas sensing and photocatalysis. In the last respect, although ferrites have been less studied than other types of semiconductors, they present interesting properties such as visible light absorption, tuneable optoelectronic properties and high chemical and photochemical stability. The versatility of their chemical composition and of their crystallographic structure opened a playground for developing new catalysts with enhanced efficiency. This article reviews the recent development of the application of ferrites to photoassisted processes for environmental remediation and for the synthesis of solar fuels. Applications in the photocatalytic degradation of pollutants in water and air, photo-Fenton, and solar fuels production, via photocatalytic and photoelectrochemical water splitting and CO2 reduction, are reviewed paying special attention to the relationships between the physico-chemical characteristics of the ferrite materials and their photoactivated performance.


Assuntos
Compostos Férricos/química , Luz Solar , Poluentes Atmosféricos/química , Dióxido de Carbono/química , Dióxido de Carbono/metabolismo , Catálise , Hidrogênio/química , Hidrogênio/metabolismo , Água/química , Purificação da Água
15.
Artigo em Inglês | MEDLINE | ID: mdl-31819991

RESUMO

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.

16.
FEBS J ; 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31869496

RESUMO

Annexin A6 (AnxA6), a member of the calcium (Ca2+ ) and membrane binding annexins, is known to stabilize and establish the formation of multifactorial signaling complexes. At the plasma membrane, AnxA6 is a scaffold for protein kinase Cα (PKCα) and GTPase-activating protein p120GAP to promote downregulation of epidermal growth factor receptor (EGFR) and Ras/mitogen-activated protein kinase (MAPK) signaling. In human squamous A431 epithelial carcinoma cells, which overexpress EGFR, but lack endogenous AnxA6, restoration of AnxA6 expression (A431-A6) promotes PKCα-mediated threonine 654 (T654)-EGFR phosphorylation, which inhibits EGFR tyrosine kinase activity. This is associated with reduced A431-A6 cell growth, but also decreased migration and invasion in wound healing, matrigel, and organotypic matrices. Here, we show that A431-A6 cells display reduced EGFR activity in vivo, with xenograft analysis identifying increased pT654-EGFR levels, but reduced tyrosine EGFR phosphorylation compared to controls. In contrast, PKCα depletion in A431-A6 tumors is associated with strongly reduced pT654 EGFR levels, yet increased EGFR tyrosine phosphorylation and MAPK activity. Moreover, tyrosine kinase inhibitors (TKIs; gefitinib, erlotinib) more effectively inhibit cell viability, clonogenic growth, and wound healing of A431-A6 cells compared to controls. Likewise, the ability of AnxA6 to inhibit A431 motility and invasiveness strongly improves TKI efficacy in matrigel invasion assays. This correlates with a greatly reduced invasion of the surrounding matrix of TKI-treated A431-A6 when cultured in 3D spheroids. Altogether, these findings implicate that elevated AnxA6 scaffold levels contribute to improve TKI-mediated inhibition of growth and migration, but also invasive properties in EGFR overexpressing human squamous epithelial carcinoma.

17.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31870646

RESUMO

The immunosuppressive treatment that recipients receive from a solid organ transplantation hinders the defensive response to infection. Its transmission from the donor can cause dysfunction or loss of the graft and even death of the recipient if proper preventive measures are not established. This potential risk should be thoroughly evaluated to minimise the risk of infection transmission from donor to recipient, especially with organ transplantation from donors with infections, without increasing graft dysfunction and morbidity and mortality in the recipient. This document aims to review current knowledge about infection screening in potential donors and offer clinical and microbiological recommendations about the use of organs from donors with infection based on available scientific evidence.

18.
Med Mycol ; 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31782486

RESUMO

The incidence of infections by uncommon Candida species has increased in recent years, however, in vitro susceptibility data are scarce. Here we assess the susceptibility of C. krusei, C. dubliniensis, C. lusitaniae, and C. guilliermondii complex isolates (n = 120) to antifungal agents by the EUCAST methodology. C. dubliniensis proved to be the most susceptible species, similar to that of C. albicans (P < .05), whereas C. guilliermondii was the least susceptible. Two C. krusei isolates were echinocandin-resistant and harbored a point mutation (L701M) in the FKS1. Some isolates were either fluconazole-resistant (C. lusitaniae, n = 2) or fluconazole non-wild type (C. guilliermondii, n = 3).

19.
Artigo em Inglês | MEDLINE | ID: mdl-31782783

RESUMO

OBJECTIVES: Several risk prediction models have been developed to estimate the risk of mortality after valve surgery for active infective endocarditis (IE), but few external validations have been conducted to assess their accuracy. We previously developed a systematic review and meta-analysis of the impact of IE-specific factors for the in-hospital mortality rate after IE valve surgery, whose obtained pooled estimations were the basis for the development of a new score (APORTEI). The aim of the present study was to assess its prognostic accuracy in a nationwide cohort. METHODS: We analysed the prognostic utility of the APORTEI score using patient-level data from a multicentric national cohort. Patients who underwent surgery for active IE between 2008 and 2018 were included. Discrimination was evaluated using the area under the receiver operating characteristic curve, and the calibration was assessed using the calibration slope and the Hosmer-Lemeshow test. Agreement between the APORTEI and the EuroSCORE I was also analysed by Lin's concordance correlation coefficient (CCC), the Bland-Altman agreement analysis and a scatterplot graph. RESULTS: The 11 variables that comprised the APORTEI score were analysed in the sample. The APORTEI score was calculated in 1338 patients. The overall observed surgical mortality rate was 25.56%. The score demonstrated adequate discrimination (area under the receiver operating characteristic curve = 0.75; 95% confidence interval 0.72-0.77) and calibration (calibration slope = 1.03; Hosmer-Lemeshow test P = 0.389). We found a lack of agreement between the APORTEI and EuroSCORE I (concordance correlation coefficient = 0.55). CONCLUSIONS: The APORTEI score, developed from a systematic review and meta-analysis, showed an adequate estimation of the risk of mortality after IE valve surgery in a nationwide cohort.

20.
Clin Infect Dis ; 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31680136

RESUMO

BACKGROUND: The clinical relevance and the potential prognostic role of persistently negative (1,3)-ß-D-glucan (BDG) in adults with proven candidemia is unknown. METHODS: This retrospective study included all adults diagnosed with candidemia our tertiary university hospital from 2012-2017 who had at least 2 serum BDG determinations throughout the episode of fungemia (Fungitell Assay; positive cut-off ≥80pg/mL). Epidemiology and clinical outcomes were compared between patients with all negative versus any positive BDG tests. Poor clinical outcomes included complications due to candidemia or 30-day all-cause mortality. RESULTS: Overall, 26/148 (17.6%) candidemic adults had persistently negative BDG tests. These patients were less likely to present Candida growth in all 3 sets of blood cultures (15.4% vs 45.1%; P = .005) and had less severe clinical presentations (median Pitt score, 0 [interquartile range {IQR} 0-1] vs 1 [IQR 0-2] in patients with any positive BDG test; P = .039). Although adequate treatment was equally provided to both groups (96.2% in persistently negative group vs 93.4 in positive group; P = .599), the persistently negative group had a higher rate of microbiological clearance in the first follow-up blood cultures (92.3% vs 69.7% in positive group; P = .005), fewer complications due to candidemia (7.7% vs 33.6% in positive group; P = .008), a lower 30-day mortality rate (3.8% vs 23.8% in positive group; P = .004), and a shorter in-hospital stay (34 days [IQR 18-55] vs 51 days [IQR 35-91] in positive group; P = .003). In the multivariate analysis, persistently negative BDG tests were independently associated with better prognoses (odds ratio 0.12, 95% confidence interval 0.03-0.49; P = .003). CONCLUSIONS: Candidemic patients with persistently negative BDG tests present a better prognosis than the comparative group, probably due to a lower systemic fungal burden. In this context, the appropriate use of persistently negative BDG results could be an aid to individualize therapeutic management in the near future.

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