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Biomedical subjects

Emilio Bouza

Publications and source records attributed to Emilio Bouza.

At least 19 recordsLinked to original sources
PubMed2007

Direct E-test (AB Biodisk) of respiratory samples improves antimicrobial use in ventilator-associated pneumonia.

BACKGROUND: Ventilator-associated pneumonia is the most frequently observed nosocomial infection in intensive care units, and it is associated with high morbidity and mortality. Early microbiological diagnosis and the initial administration of appropriate antimicrobial therapy are associated with decreased mortality and potentially reduced costs. Our study evaluates the clinical and financial impact of performing rapid antimicrobial susceptibility tests directly on samples obtained from the lower respiratory tract. METHODS: A prospective, randomized study was performed over a 2-year period. Patients who had a lower respiratory tract infection that was acquired during mechanical ventilation and for whom samples obtained from the respiratory tract were sent for culture were randomized to 1 of 2 groups. Samples were cultured for the control group, and results were reported using standard procedures. Samples were also cultured for the test subject group using standard procedures, but in addition, a rapid antibiogram was immediately performed by placing E-test antibiotic strips (AB Biodisk) directly on respiratory tract samples. Patients in the E-test group received a preliminary laboratory report when it became available. The 2 patient groups were compared according to the following variables: type and severity of underlying conditions, total days of antimicrobial use, number of defined daily doses, cost of acquisition of the antimicrobial agent per episode, days of fever, days receiving mechanical ventilation, days in the intensive care unit, incidence of Clostridium difficile-associated diarrhea, and mortality. RESULTS: Reporting a rapid E-test was associated with fewer days of fever, fewer days of antibiotic administration until resolution of the episode of ventilator-associated pneumonia, decreased antibiotic consumption, less C. difficile-associated diarrhea, lower costs of antimicrobial agents, and fewer days receiving mechanical ventilation. CONCLUSIONS: A rapid E-test of respiratory tract samples improves antimicrobial use in cases of ventilator-associated pneumonia.

Aged↗
PubMed2006

In vitro activities of tigecycline and eight other antimicrobials against different Nocardia species identified by molecular methods.

The in vitro activities of tigecycline and other antimicrobials against 51 isolates of Nocardia spp. were evaluated. MIC(90)s and MIC ranges were as follows: tigecycline, 4 and < or =0.06 to 8 mg/liter, respectively; minocycline, 2 and < or =0.06 to 2 mg/liter, respectively; linezolid, 1 and < or =0.06 to 2 mg/liter, respectively; moxifloxacin, 2 and < or =0.06 to >64 mg/liter, respectively; ertapenem, 32 and < or =0.06->64 mg/liter, respectively; imipenem, 2 and < or =0.06 to >64 mg/liter, respectively; meropenem, 8 and < or =0.06 to >64 mg/liter, respectively; amikacin, 1 and < or =0.06 to 32 mg/liter, respectively; and trimethoprim-sulfamethoxazole, 1/19 and < or =0.5/9.5 to >2/38 mg/liter, respectively.

Anti-Bacterial Agents↗
PubMed2006

In vitro activities of amphotericin B, caspofungin, itraconazole, posaconazole, and voriconazole against 45 clinical isolates of zygomycetes: comparison of CLSI M38-A, Sensititre YeastOne, and the Etest.

We evaluated the activities of amphotericin B, itraconazole, voriconazole, caspofungin, and posaconazole against zygomycetes by CLSI M38-A, Etest and Sensititre. The most active drug was posaconazole, followed by amphotericin B and itraconazole. The correlation of the Etest and Sensititre with CLSI M38-A was moderate for posaconazole but poor for the others.

Antifungal Agents↗
PubMed2006

Correlation between the E test and the CLSI M-38 A microdilution method to determine the activity of amphotericin B, voriconazole, and itraconazole against clinical isolates of Aspergillus fumigatus.

The in vitro activities of amphotericin B, itraconazole, and voriconazole against 283 clinical isolates of Aspergillus fumigatus were studied by comparing the E test method with the reference procedure NCCLS (CLSI) M-38A. The methods were considered to agree when the results of the MICs by E test were within +/-2 dilutions of the MICs obtained by CLSI M-38 A. Agreement of readings at 24, 48, and 72 h of incubation was as follows: amphotericin B: 4.2%, 98%, and 40.6%; itraconazole: 92.5%, 100%, and 89.9%; and voriconazole: 98.9%, 100%, and 99.7%. The correlation between methods to classify the strains as "susceptible" or "resistant" was very good for itraconazole and voriconazole after 48 h of incubation, but 23% of the strains were incorrectly classified by E test for amphotericin B. The E test is an efficacious method for antifungal susceptibility testing in A. fumigatus for itraconazole and voriconazole when the plates are read after 48 h of incubation. The use of the E test to study the activity of amphotericin B should be avoided.

Amphotericin B↗
PubMed2006

Analysis of changes in recent tuberculosis transmission patterns after a sharp increase in immigration.

We conducted a population-based molecular epidemiological study of tuberculosis (TB) in Madrid, Spain (2002 to 2004), to define transmission patterns and factors associated with clustering. We particularly focused on examining how the increase in TB cases among immigrants in recent years (2.8% in 1997 to 1999 to 36.2% during the current study) was modifying transmission patterns. Mycobacterium tuberculosis isolates obtained from patients living in nine districts of Madrid (1,459,232 inhabitants) were genotyped. The TB case rate among foreign-born people was three to four times that of Spanish-born people, and the median time from arrival to the onset of treatment was 22.4 months. During the study period, 227 (36.3%) patients were grouped in 64 clusters, and 115 (50.7%) of them were in 21 clusters with mixed Spanish-born and foreign-born patients. Three of the 21 mixed clusters accounted for 21.1% of clustered patients. Twenty-two of 38 (57.9%) immigrants in mixed clusters were infected with TB strains that had already been identified in the native population in 1997 to 1999, including the three most prevalent strains. Factors identified as independent predictors of clustering were homelessness (odds ratio [OR], 2.3; 95% confidence interval [95% CI], 1.2 to 4.5; P = 0.011) and to be born in Spain (OR, 1.8; 95% CI, 1.2 to 2.6; P = 0.002). The results indicated that (i) TB transmission was higher in Spanish-born people, associated mainly with homelessness, (ii) that foreign-born people were much less likely to be clustered, suggesting a higher percentage of infection before arriving in Spain, and (iii) that an extensive transmission between Spanish- and foreign-born populations, caused mainly by autochthonous strains, was taking place in Madrid.

Adolescent↗
PubMed2006

Cultures of sternal wound and mediastinum taken at the end of heart surgery do not predict postsurgical mediastinitis.

The aim of the study was to assess of the role of intraoperative cultures taken at the end of major heart surgery (MHS) in the prediction of postoperative mediastinitis (PM) in patients undergoing MHS over a 6-month period in a tertiary university hospital. Just before wound closure, a sample of the sternal border was taken, swabbing back and forth the sternal border and the subcutaneous tissues. A second sample was taken after irrigation of the deep mediastinal structures with 10 mL of Ringer lactate. Swabs were processed semiquantitatively and the mediastinal fluid with a quantitative technique. The observation of one or more colonies per plate was considered a positive culture. Cultures obtained at the end of 229 surgical interventions (227 patients) were positive with the semiquantitative or with the quantitative procedures in 31.0% (95% confidence interval [CI], 25.1-37.4%) and 34.5% (95% CI, 28.4-41.0%) of the times, respectively (P = NS). The number of microorganisms isolated in the wound swab or mediastinal fluid was 91 and 110, respectively. Of the 227 patients, 7 developed an episode of PM (3.1%; 95% CI, 1.2-6.2%) after a median time of 11 days (range, 5-19 days). The microorganisms causing the 7 cases of mediastinitis were not isolated in the intraoperative cultures in any of the cases. The value of intraoperative cultures as a test for prediction of PM depending on the breakpoint chosen were as follows: sensitivity (0%), specificity (66.2-97.3%), and positive (0%) and negative predictive values (96.8-98.0%). We recommend against surveillance cultures taken intraoperatively in patients undergoing MHS.

Cardiac Surgical Procedures↗
PubMed2006

An instant procedure to demonstrate catheter-tip colonization may help clinicians.

This study compared the acridine orange and Gram stains of an external smear of intravascular catheter-tip segments with the culture results obtained 24 to 48 h later. Both staining techniques were randomly assigned to be performed either before (group A) or after (group B) rolling on the agar plate. Of the 425 catheter tips processed, 25.7% were significantly colonized and 6.1% were from patients with catheter-related bloodstream infections (CRBSIs). The yield of group A was superior to that of group B for the prediction of colonization (sensitivity, 94.3%/69.6%; specificity, 92.4%/96.2%; positive predictive value (PPV), 80.6%/86.7%; negative predictive value (NPV), 98.0%/90.0%; and full concordance, 91.9%/89.3%). The values for the prediction of CRBSIs were as follows for group A and group B: sensitivity, 100%/69.2%; specificity, 96.3%/100%; PPV, 86.7%/100.0%; NPV, 100%/93.9%; and full concordance, 97.0%/94.7%. Catheter-tip staining before culture is an easy-to-perform, cheap, and effective procedure to anticipate catheter colonization and rule out CRBSIs.

Acridine Orange↗
PubMed2006

Comparison of Sensititre YeastOne with the NCCLS M38-A microdilution method to determine the activity of amphotericin B, voriconazole, and itraconazole against clinical isolates of Aspergillus fumigatus.

The in vitro activities of amphotericin B, itraconazole, and voriconazole against 279 clinical isolates of Aspergillus fumigatus were studied by comparing Sensititre YeastOne with the reference method NCCLS (CLSI) M38-A. The methods were considered to agree when the results of the MICs by Sensititre were within 2 dilutions of the MICs obtained by NCCLS M38-A. Agreement of readings at 24, 48, and 72 h was as follows: amphotericin B (0%, 31.5%, 82.1%), itraconazole (86.7%, 98.3%, 98.2%), and voriconazole (92.8%, 98.3%, 98.9%). Sensititre YeastOne is a suitable alternative for the determination of the MICs of itraconazole and voriconazole against A. fumigatus when results are read at 48 h of incubation.

Amphotericin B↗
PubMed2006

Bloodstream infections among heart transplant recipients.

BACKGROUND: Heart transplant (HT) recipients are prone to life-threatening infections, including bloodstream infection (BSI), but information on this topic is particularly scarce. METHODS: We studied 309 consecutive HT performed at our institution between 1988 and 2003. We assessed the characteristics of each episode of BSI, prophylaxis and immunosuppression used, and possible related factors. RESULTS: Sixty episodes of BSI occurred in 15.8% of all HT recipients. Rates of BSI/transplanted patient decreased progressively throughout the study period: 21.2%, 14.3%, and 7.5% in each 5-year period (P=0.03). BSI episodes occurred a median of 51 days after transplantation. The main BSI origins were: lower respiratory tract (23%), urinary tract (20%), and catheter-related-BSI (16%). Gram-negative organisms predominated (55.3%), followed by Gram-positive (44.6%). Mortality was 59.2%, with 12.2% directly attributable to BSI. Independent risk factors for BSI after HT were: hemodialysis (OR 6.5; 95% CI 3.2-13), prolonged intensive care unit stay (OR 3.6; 95% CI 1.6-8.1), and viral infection (OR 2.1; 95% CI 1.1-4). BSI was a risk factor for mortality (OR 1.8; 95% CI 1.2-2.8). CONCLUSION: BSIs have decreased in HT recipients, but still contribute to mortality, mainly if related to pneumonia or polymicrobial infections. Reduction of early postoperative complications and viral infections are amenable goals that may further reduce BSI in this population.

Bacteremia↗
PubMed2006

Antimicrobial therapy of Clostridium difficile-associated diarrhea.

Clostridium difficile-associated diarrhea (CDAD) is the most common etiologically-defined cause of hospital-acquired diarrhea. Caused by the toxins of certain strains of C difficile, CDAD represents a growing concern, with epidemic outbreaks in some hospitals where very aggressive and difficult-to-treat strains have recently been found. Incidence of CDAD varies ordinarily between 1 to 10 in every 1,000 admissions. Evidence shows that CDAD increases morbidity, length of stay, and costs. This article described the clinical manifestations of CDAD, related risk factors, considerations for confirming CDAD, antimicrobial and non-antimicrobial treatment of CDAD, and issues related to relapses. The article concludes with a discussion of recent epidemic outbreaks involving CDAD.

Aged↗
PubMed2006

Outdoor environmental levels of Aspergillus spp. conidia over a wide geographical area.

Unfortunately, little information is available on the 'normal' air and water load of Aspergillus spores and their seasonal changes. We describe the air and water load of Aspergillus spores across the province of Madrid (Spain). We collected samples of air and water (332 samples of air and 148 of water) from selected points and taps (urban and rural environment) in summer, autumn, winter and spring. Temperature, wind speed and humidity at each point were obtained. We collected a total of 369 Aspergillus spp. isolates: 200 A. fumigatus, 94 A. niger, 40 A. flavus, 16 A. nidulans, two A. terreus, and 17 Aspergillus spp. We always found more isolates in the urban environment than in the rural environment (P=0.11). This was also true of A. fumigatus (P=0.014). The autumn collection yielded more isolates than that of the other seasons. The level of conidia in air varied from 0 to 85 c.f.u./m3: 6.4 c.f.u./m3 in summer, 12 in autumn, 2.5 in winter and 1.3 in spring. Changes in atmospheric parameters influenced the levels in air. None of the water samples were positive. Counts of Aspergillus spp. spores were always under 85 c.f.u./m3. Public water does not seem to contain Aspergillus spores.

Air Microbiology↗
PubMed2006

Complex clonal features in an mycobacterium tuberculosis infection in a two-year-old child.

The focus of this report is to describe the highly complex clonal features of the Mycobacterium tuberculosis (MTB) isolates cultured from a 2-year-old child with no risk factors for tuberculosis. Molecular analysis showed that she was coinfected by 2 MTB isolates. The coinfecting isolates showed only subtle genetic differences and shared equivalent infectivity in vitro; however, they were infecting independent anatomic sites (compartmentalized infection). One of the MTB isolates was cultured only from respiratory specimens, whereas the other was isolated from extrarespiratory site (central nervous system).

Bacterial Typing Techniques↗
PubMed2006

Treatment of solid organ transplant patients with invasive fungal infections: should a combination of antifungal drugs be used?

PURPOSE OF REVIEW: Combined antifungal drug therapy is widely used in severe invasive mycoses in solid organ transplant (SOT) recipients. We have reviewed the available data in the literature. RECENT FINDINGS: No single randomized study on antifungal combination therapy in SOT patients has been performed. Existing information does not support the use of combination therapy in invasive candidiasis in SOT patients. Indeed, initial combination therapy with amphotericin B and 5-flucytosine is recommended for SOT patients with central nervous system cryptococcosis, mainly with increased white blood cell counts in the cerebrospinal fluid or with altered mental status. No impact on outcome was observed with combination therapy in Scedosporium infections in SOT patients. The combination of voriconazole and terbinafine may be an attractive option for S. prolificans infections. A prospective study of voriconazole plus caspofungin as initial therapy for invasive aspergillosis in SOT patients found that combination therapy was independently associated with reduced mortality in patients with renal failure and in those with Aspergillus fumigatus infection, even when adjusted for other factors predictive of mortality in the study population. SUMMARY: Combination therapy should be considered for severe forms of invasive fungal infections in SOT patients; however, multicenter studies of such patients are urgently needed.

Antifungal Agents↗
PubMed2006

Impact of laboratory cross-contamination on molecular epidemiology studies of tuberculosis.

Laboratory cross-contamination by Mycobacterium tuberculosis is known to be responsible for the misdiagnosis of tuberculosis, but its impact on other contexts has not been analyzed. We present the findings of a molecular epidemiology analysis in which the recent transmission events identified by a genotyping reference center were overestimated as a result of unnoticed laboratory cross-contamination in the original diagnostic laboratories.

Bacterial Typing Techniques↗
PubMed2006

Comparison of phenotypic with genotypic procedures for confirmation of coagulase-negative Staphylococcus catheter-related bloodstream infections.

We sought here to review the present definition of catheter-related bloodstream infections (CR-BSI) due to coagulase-negative staphylococci (CNS) by comparing the routine phenotypic methods with a genotypic procedure that considers different morphotypes. Our phenotypic characterization of CNS isolates included routine identification with biotype and antibiotype. The genotypic diagnosis was based on longer incubation periods with the consideration of all morphotypes and molecular typing by pulsed-field gel electrophoresis techniques. We prospectively selected 61 episodes of suspected CR-BSI by CNS occurring during 1 year, based on the presence of a compatible clinical setting and the isolation of one or more CNS from blood and catheter tip. Of these episodes, 47 (77%) were identified as true episodes of CR-BSI based on the presence of microorganisms of the same genotype in the blood and on the catheter tip. The sensitivity, specificity, positive predictive, negative predictive, accuracy, positive likelihood ratio, and negative likelihood ratio values obtained by different phenotypic microbiological approaches to establish the diagnosis of CR-BSI were as follows: identity at species level (78.7%, 85.7%, 94.9%, 54.5%, 80.3%, 5.51, and 0.25, respectively); identity of species and biotype (59.6%, 92.9%, 96.6%, 40.6%, 67.2%, 8.34, and 0.44, respectively); identity of species and antibiotype (61.7%, 92.9%, 96.7%, 41.9%, 68.8%, 8.64, and 0.41, respectively); and identity of species, biotype, and antibiotype (48.9%, 92.9%, 95.8%, 35.1%, 59%, 6.85, and 0.55, respectively). Our study demonstrates the inaccuracy of the diagnosis of CNS CR-BSI when the current definition based on conventional routine microbiological practice is followed. A new definition of CNS CR-BSI is necessary, at least as an epidemiological and research tool.

Bacteremia↗