Biomedical subjects

M Almela

Publications and source records attributed to M Almela.

At least 19 recordsLinked to original sources

PubMed2003

Trends in frequency and in vitro susceptibilities to antifungal agents, including voriconazole and anidulafungin, of Candida bloodstream isolates. Results from a six-year study (1996-2001).

The frequency of isolation and antifungal susceptibility patterns to established and two new antifungal agents were determined for 218 Candida spp isolates causing bloodstream infection from 1996 to 2001. Overall, 41.7% of the candidemias were due to C. albicans, followed by C. parapsilosis (22%), C. tropicalis (16.1%), C. glabrata (11.9%), C. krusei (6%) and miscellaneous Candida spp (2.3%). Isolates of C. albicans C. parapsilosis and C. tropicalis (80% of isolates) were highly susceptible to fluconazole (94 to 100% at </= 8 microg/ml) and voriconazole (97 to 100% at </= 1 microg/ml). By comparison with the newer agents itraconazole was less active (77 to 97% at </=0.12 microg/ml). Only 77% and 15% of C. glabrata isolates were inhibited by fluconazole at </= 8 microg/ml and itraconazole at </=0.12 microg/ml, respectively. Voriconazole showed a remarkable in vitro potency against C. glabrata as well as C. krusei isolates (100% at </= 1 microg/ml). Anidulafungin was very active against Candida spp isolates (MIC90: </= 0.5 microg/ml), except C. parapsilosis (MIC90: 4 microg/ml) and two C. guilliermondii isolates (MIC: >/= 32 microg/ml).

Anidulafungin↗

PubMed2003

Bacteraemia in adults due to glucose non-fermentative Gram-negative bacilli other than P. aeruginosa.

BACKGROUND: Glucose non-fermentative Gram-negative bacilli other than P. aeruginosa (NF) are emerging pathogens. AIM: To evaluate the epidemiology, clinical characteristics, predictors of acquisition, and outcome of bacteraemia due to NF. DESIGN: Retrospective analysis of prospectively recorded data. METHODS: We reviewed episodes of NF bacteraemia in patients older than 14 years, recorded through a blood culture surveillance program. Patients were identified at the time of their bacteraemia and prospectively followed. RESULTS: Between January 1991 and December 2000, 296 episodes of NF bacteraemia were detected: 87% were due to Acinetobacter sp., Pseudomonas sp. other than P. aeruginosa, or Stenotrophomonas maltophilia. The global incidence (0.87 cases per 1000 discharges) remained stable during the study period. Patients were of all ages and both sexes, and 282/296 (95.3%) had some predisposing underlying disease or condition, the most common being haematological malignancies without transplantation (85/296, 28.7%), treatment with steroids (78/296, 26.3%), and transplantation (bone marrow or solid organ) (70/296, 23.6%). Fifty (16.9%) were neutropenic. The most common sources of bacteraemia were central venous catheter infection (117/296, 39.5%) and unknown primary site (97/296, 32.8%). Sixty-one episodes (20.6%) were community-acquired and 235 (79.4%) were nosocomial. Forty-three patients (14.5%) died. Pneumonia (RR 1.5, 95%CI 1.1-14.2), age<65 (RR 3.1, 95%CI 1.4-10.3), hospitalization in the intensive care unit (ICU) (RR 3.2, 95%CI 1.3-9.8), rapidly fatal disease (RR 4.9, 95%CI 3.1-12.6), and severe sepsis (RR 9.8, 95%CI 1.6-19.7) were independent predictors of death. Factors predicting the probability that an episode of nosocomial bacteraemia was due to NF included: rapidly fatal disease (RR 1.23, 95%CI 1.02-4.1), age<65 (RR 2.05, 95%CI 1.4-3), hospitalization in the ICU (RR 2.06, 95%CI 1.4-3, and pneumonia (RR 2.1, 95%CI 1.05-4.8). DISCUSSION: NF bacteraemia mainly affects patients with malignant haematological disease, with and without transplantation, and patients in the ICU. The most common known source is a central venous catheter, though many sources are unknown. Mortality is relatively low, and depends on the severity of the underlying disease.

Adolescent↗

PubMed2001

New rapid antigen test for diagnosis of pneumococcal meningitis.

Conventional diagnostic methods for bacterial meningitis are frequently not rapid or sensitive enough to guide initial antimicrobial therapy. Streptococcus pneumoniae is the most frequent and severe cause of community-acquired bacterial meningitis and treatment is complicated by the increasing prevalence of antimicrobial resistance to third-generation cephalosporins. We used a new rapid antigen test in the cerebrospinal fluid and urine of patients with suspected bacterial meningitis, and found it to be highly sensitive and specific for the detection of pneumococci. This test might help guide initial therapy for bacterial meningitis according to the local rates of pneumococcal antimicrobial resistance.

Adult↗

PubMed2000

Prospective study of prognostic factors in community-acquired bacteremic pneumococcal disease in 5 countries.

To define the influence of prognostic factors in patients with community-acquired pneumococcal bacteremia, a 2-year prospective study was performed in 5 centers in Canada, the United States, the United Kingdom, Spain, and Sweden. By multivariate analysis, the independent predictors of death among the 460 patients were age >65 years (odds ratio [OR], 2.2), living in a nursing home (OR, 2.8), presence of chronic pulmonary disease (OR, 2.5), high acute physiology score (OR for scores 9-14, 7.6; for scores 15-17, 22; and for scores >17, 41), and need for mechanical ventilation (OR, 4.4). Of patients with meningitis, 26% died. Of patients with pneumonia without meningitis, 19% of those with >/=2 lobes and 7% of those with only 1 lobe involved (P=.0016) died. The case-fatality rate differed significantly among the centers: 20% in the United States and Spain, 13% in the United Kingdom, 8% in Sweden, and 6% in Canada. Differences of disease severity and of frequencies and impact of underlying chronic conditions were factors of probable importance for different outcomes.

Aged↗

PubMed2000

Molecular epidemiology of Streptococcus pneumoniae causing invasive disease in 5 countries.

A multicenter study was done during 1993-1995 to investigate prospectively the influence of several prognostic factors for predicting the risk of death among patients with pneumococcal bacteremia. Five centers located in Canada, the United Kingdom, Spain, Sweden, and the United States participated. Clinical parameters were correlated to antibiotic susceptibility and serotyping of the 354 invasive pneumococcal isolates collected and to molecular typing of 173 isolates belonging to the 5 most common serotypes (14, 9V, 23F, 3, and 7F). Serotype 14 was the most common among all isolates, but serotype 3 dominated in fatal cases and in isolates from Spain and the United States, the countries with the highest case-fatality rates. Fewer different patterns were found among the type 3 isolates, which suggests a closer clonal relationship than that among isolates belonging to other serotypes. Of type 3 isolates from fatal cases, 1 clone predominated. Other penicillin-susceptible invasive clones were also shown to spread in and between countries.

Adult↗

PubMed2000

[Left to right shunt for congenital coronary arterio-venous fistulas].

Congenital coronary artery fistulas are rare malformations that may evolve to pulmonary hypertension, heart failure and myocardial ischemia, although some may close spontaneously. Complications such as endocarditis, rupture, aneurysm or thrombosis may also be observed. Most patients are asymptomatic and the fistulas are usually detected by doppler echocardiography and angiography. We report the case of an asymptomatic 10-year-old male who was submitted because he of a heart murmur, and three coronary fistulas were diagnosed. Two originated in the left coronary artery draining into the right ventricle and the other origin was in the right coronary artery draining into the pulmonary artery trunk.

Arteriovenous Fistula↗

PubMed2000

In vitro activities of 22 antimicrobial agents against Listeria monocytogenes strains isolated in Barcelona, Spain. The Collaborative Study Group of Listeriosis of Barcelona.

The in vitro activity of 22 antimicrobial agents against 82 human Listeria monocytogenes strains isolated in Barcelona from 1994 to 1998 was determined. Ampicillin and gentamicin showed good in vitro activity against all strains (MIC90: 1 and < or = 0.25 microg/ml, respectively). No resistance to rifampin or co-trimoxazole was detected and only one strain was resistant to tetracycline. Of the nine fluoroquinolones tested, clinafloxacin and gemifloxacin were the most active compounds (MIC90: 0.12 and 0.25 microg/ml, respectively). No increasing MICs values were observed during the five-year period.

Anti-Bacterial Agents↗

PubMed2000

Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia.

To assess whether methicillin resistance is a microbial characteristic associated with deleterious clinical outcome, we performed a cohort study on 908 consecutive episodes of Staphylococcus aureus bacteremia and a case-control study involving 163 pairs of patients matched for preexisting comorbidities, prognosis of the underlying disease, length of hospitalization, and age. Of 908 bacteremic episodes, 225 (24.8%) were due to methicillin-resistant S. aureus (MRSA). Multivariate analysis did not reveal that methicillin resistance was an independent predictor for mortality when shock, source of bacteremia, presence of an ultimately or rapidly fatal underlying disease, acquisition of the infection in an intensive care unit (ICU), inappropriate empirical therapy, female sex, and age were taken into account. Nonetheless, methicillin resistance was an independent predictor for shock. The case-control study could not confirm that shock was linked to MRSA when prior antimicrobial therapy, inappropriate treatment, ICU residence, and female sex were considered. Our data suggest that cohort studies tend to magnify the relationship of MRSA with clinical markers of microbial pathogenicity and that this effect is a shortcoming of these kind of studies that is caused by inadequate control for underlying diseases.

Adult↗

PubMed2000

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Journal Article↗

PubMed2000

[Bacteremia and meningitis caused by Yersinia spp].

Yersinia spp infection in human people are increasing attention last thirty years. We have reviewed the bacteremia in our hospital last five years. Three episodes were Yersinia spp bacteremia. Presence of disease or predisponent therapy were present in most of episodes. All patients were more than seventy years old. The septic metastasis were present in all the cases: one with meningitis, other with liver abscess and one with septic arthritis. We have documented a good clinical evolution, though the mortality in different reports is around 50%. The election therapy for all episodes were cephalosporins, and in two cases we added quinolones.

Aged↗

PubMed2000

[Tolerability and safety of levofloxacinin long-term treatment].

Levofloxacin is a useful quinolone for patients infected with osteomyelitis or tuberculosis. There is little information on the tolerance and safety of levofloxacin in long-term treatment. Fifteen patients (10 men and 5 women) with prosthetic joint infection or chronic osteomyelitis were analyzed. The treatment was levofloxacin (500 mg/d) and rifampicin (600 mg/d). Controls were performed monthly during the treatment, and after that every six months. Problems that were likely related to medication were noted by medical interview. Analyses of hepatic and renal function were performed at each visit. The mean age was 64 years. Ten patients had prosthetic joint infection, two chronic osteomyelitis, two osteosynthetic device infection and one silicone graft infection. Staphylococcus aureus was isolated in eight cases, staphylococcus coagulase being negative in five, and the cultures negative in two cases. The mean duration of treatment was 3.6 months (range 2-6 months). No adverse reactions were observed in seven patients (46%). Occasional digestive symptoms were reported in six patients (40%), and two cases (13%) presented light diarrhea. These patients also took antiinflammatory treatment. Sleeplessness was observed in one patient (6%). Tendinitis or alterations in hepatic function were not observed. In no case was the treatment changed due to adverse reactions. It was concluded that levofloxacin is well tolerated and safe and could be an option for infections that require long-term treatment.

Aged↗

PubMed1999

[Predictive factors of the presence of bacteremia in males with urinary infection].

UNLABELLED: BACKGROUND AND PATIENTS AND METHODS: Possible predictive factors of the presence of bacteremia in 135 males with parenchymatous urinary tract infection (PUI) are studied by means of univariate and multivariate analysis. RESULTS: Thirty percent of the patients had bacteremia. In the multivariate analysis the following factors were significative: duration of symptoms > 5 days, a serum creatinine level > 1.2 mg/dl and duration of symptoms > 5 days. CONCLUSIONS: One third of the males with community acquired PUI have bacteremia. The best predictors of the presence of bacteremia are a serum creatinine level > 1.2 mg/dl and duration of symptoms > 5 days.

Acute Disease↗

PubMed1999

Pseudomonas aeruginosa bacteremia in patients infected with human immunodeficiency virus type 1.

A prospective analysis of 43 episodes of Pseudomonas aeruginosa bacteremia in HIV-1-infected subjects was performed and the results compared with the incidence and outcome of Pseudomonas aeruginosa bacteremia in other high-risk patients, such as transplant recipients, leukemia patients, or patients hospitalized in the intensive care unit. The incidence of bacteremia/fungemia as a whole and of gram-negative and Pseudomonas aeruginosa bacteremia in particular was greater in HIV-1-infected subjects than in the unselected general population admitted. In contrast, the incidence of Pseudomonas aeruginosa bacteremia in HIV-1-infected patients did not differ from that in patients with other high-risk conditions. In patients with HIV-1 infection, independent risk factors for presenting Pseudomonas aeruginosa bacteremia were nosocomial origin (OR, 2.7; 95% CI, 1.3-5.7), neutropenia (OR, 2.7; 95% CI, 1.07-6.8), previous treatment with cephalosporins (OR, 3.6; 95% CI, 1.1-11.6), and a CD4+ cell count lower than 50 cells/mm3 (OR, 3.1; 95% CI, 1.7-8.6). Primary bacteremia and pneumonia were the most common forms of presentation. Fourteen (33%) patients died as a consequence of the bacteremia. The presence of severe sepsis (OR, 17.5; 95% CI, 3.2-68) and the institution of inappropriate definitive antibiotic therapy (OR, 2.7; 95% CI, 1.1-13) were independently associated with a poor outcome. One year after the development of bacteremia, only eight (19%) patients remained alive.

AIDS-Related Opportunistic Infections↗

PubMed1999

Prospective assessment of the risk of bacteremia in cirrhotic patients undergoing lower intestinal endoscopy.

BACKGROUND: Patients who have prosthetic heart valves, previous history of endocarditis, and surgically constructed systemic-pulmonary shunts or conduits should receive prophylactic antibiotics before colonoscopy. The usefulness of this approach in cirrhotic patients remains unknown. The present study prospectively assesses the incidence of bacteremia in these patients. METHODS: Lower intestinal endoscopy was performed in 58 cirrhotic patients. Two blood samples were obtained from every patient (just before endoscopy and within 5 minutes of withdrawal of the endoscope) and were incubated for 7 days and examined daily for growth of bacteria. Patients were closely monitored for 72 hours after endoscopy to detect the development of infectious complications. RESULTS: Only 6 cultures from 6 patients were positive. Four were obtained post-endoscopy and the remaining 2 before colonoscopy but the corresponding post-endoscopy samples were negative. All organisms recovered were normal skin flora. All patients, including those with positive cultures, remained asymptomatic during the 72 hours after the procedure. CONCLUSIONS: Our findings indicate that lower intestinal endoscopy does not induce bacteremia in cirrhotic patients with or without ascites in the absence of gastrointestinal bleeding and do not support the routine use of prophylactic antibiotics in these patients.

Bacteremia↗

PubMed1999

Central venous catheter exchange by guidewire for treatment of catheter-related bacteraemia in patients undergoing BMT or intensive chemotherapy.

Current guidelines for the treatment of catheter-related bacteraemia (CRB) advise against central venous catheter (CVC) exchange because of the potential risk of prolonging infection. However, there are no consistent data proving this recommendation. We evaluated prospectively the usefulness of CVC exchange by guidewire for the treatment of CRB in patients undergoing BMT or intensive chemotherapy. CVC exchange was considered when fever and positive blood cultures persisted after 2 days of adequate antimicrobial therapy and no potential source of bacteraemia other than CVC could be identified. The guidewire exchange was preceded and followed by a slow infusion of adequate antimicrobial therapy. Bacteraemia was confirmed as catheter-related by demonstrating concordance between isolates from the tip and blood cultures by pulsed-field electrophoresis of genomic DNA. This procedure was performed in 19 episodes of bacteraemia during a 1-year period. Fourteen episodes (74%) were catheter-related and 71% of these were due to coagulase-negative staphylococci. Guidewire replacement was accomplished uneventfully 4 days after development of sepsis (range 3-6). In all cases, clinical signs of sepsis disappeared in less than 24 h after replacement. Definitive catheter withdrawal was carried out a median of 16 days (range 3-42) after guidewire exchange; in all cases, the tip culture was negative. We conclude that CVC replacement by guidewire under adequate antimicrobial therapy may be a reasonable option for the treatment of CRB when antimicrobial therapy alone has been unsuccessful.

Adult↗

PubMed1998

[Cefixime versus amoxicillin plus netilmicin in the treatment of community-acquired non-complicated acute pyelonephritis].

BACKGROUND: Community-acquired non-complicated acute pyelonephritis (APN) is a frequent, occasionally serious infection (around 20% of the cases are bacteremic) that usually requires hospital admission. The third generation oral cephalosporins which are active against more than 95% of E. coli strains should allow the outpatient management of these patients. OBJECTIVE: To evaluate the bacteriological and clinical efficacy of oral cefixime in comparison to amoxicilin plus netilcilin in the treatment of APN. PATIENTS AND METHODS: Patients older than 18 years affected by APN were included in a fourteen month prospective study. According to a random numbers chart, the patients received cefixime (400 mg/24 h in a single daily dose for 12 days) or amoxicilin (1 g/8 h per os) plus netilmicin (4 mg/kg/24 h in a single intramuscular daily dose) during five days followed by 7 days of an oral treatment chosen according to the susceptibility pattern of isolated microorganism. RESULTS: Sixty-one patients received cefixime and 65 amoxicillin plus retilmicin. There were no significant differences between both groups of patients. Thirty-two patients presented bacteremia (25.4%). The mean (SD) eak and trough concentrations of netilmicin were 11.4 (2.8) mg/l and 0.38 (0.4) mg/l, respectively. Clinical response was favorable in 97% of patients treated with cefixime and in 98% of those treated with amoxicilin plus netilmicin (p = NS). The infection recurred in 10 out of 59 patients (16.9%) in the cefixime arm of the study and in 9 out of 64 patients (14%) treated with amoxicillin plus netilmicin (p = NS). Tolerance to the study drugs was good in both arms of the study, and renal function remained normal. CONCLUSION: Cefixime seems to be an acceptable alternative to the regimens containing an aminopenicillin and an aminoglycoside for the treatment of community-acquired non-complicated APN.

Acute Disease↗

PubMed1998

Perinatal listeriosis: a population-based multicenter study in Barcelona, Spain (1990-1996).

The aim off this study was to describe the incidence, epidemiology, clinical presentation, and outcome of perinatal listeriosis for a 7-year period (1990-1996) based on data of an active population-based surveillance project implemented in the city of Barcelona, Spain. There were 30 cases (20.8%) associated with pregnancy (15 pregnant women, 13 neonates, and 2 fetal deaths). The incidence of perinatal listeriosis varied from 4.1 to 0 per 10,000 live births. The proportion of perinatal cases in relation to the total number of cases of listeriosis varied between 0 and 42%. Early-onset neonatal sepsis accounted for 12 of 13 live births. The mean age of infected pregnant women with listeriosis was 30.1+/-2.0 years. Chorioamnionitis was the predominant clinical form (86.7%). Only two mothers had primary bacteremia by L. monocytogenes in the second trimester of pregnancy. Both infants were born healthy, without signs of infection. One of these mothers was infected with the human immunodeficiency virus (HIV). Since January 1994, 12 strains were available for serotyping and phagotyping; 9 belonged to serovar 4b, 2 to serovar 1/2b, and 1 to serovar 1/2a. No outbreaks of L. monocytogenes infection occurred during the study period. The overall neonatal mortality rate was 7.7% among infected live births. All pregnant women were treated with ampicillin and none died. Early antenatal treatment with ampicillin improves neonatal outcome and can result in the birth of healthy babies.

Adult↗

PubMed1997

[Yield of blood cultures in relation to the cultured blood volume in Bactec 6A bottles].

BACKGROUND: Concentration of microorganisms in blood is low in bacteremia from extravascular sources. The best yield from blood cultures is achieved by culturing a minimum of 10-20 ml, although in some processing blood culture systems such as Bactec NR-860, smaller volume is used. The objectives of the present study were to establish the frequency in which inadequate small blood volumes are employed for culturing and to analyze the relation between the cultured blood volume in Bactec 6A bottles and the yield achieved. MATERIAL AND METHODS: We weighed 2000 Bactec 6A bottles pertaining to consecutive blood cultures obtained from untreated patients with clinical suspicion of Infection. The cultured blood volume was estimated subtracting the mean empty bottle weight. RESULTS: Microorganisms were recovered from 251 bottles (12.5%). One hundred and thirty one (6.8%) isolates were considered as clinically significant and 115 (5.7%) as contaminant. The inoculated blood volume in both significant (5.532 +/- 1.587 ml) and non-significant (5.471 +/- 1.563 ml) recoveries was superior than that of bottles without microbiologic growth (5.209 +/- 1.575 ml, p = 0.016 and p = 0.06, respectively). A linear positive trend was found between the cultivated blood volume and the rate of recoveries (p = 0.008). Within the range of 1 up to 10 ml, the rate of recoveries increased 2.28% for each additional ml of cultivated blood (r = 0.953, p < 0.0001). Out of the 2,000 weighed bottles 127 (6.3%) contained less than 3 ml of blood and 576 (29%) between 3 and 5 ml. CONCLUSIONS: We have proved that the rate of recoveries from Bactec 6A bottles increased with the volume of cultured blood. In untreated patients, this increase is maintained up to volumes of 7 to 10 ml.

Adult↗