Artículos (Microbiología)
URI permanente para esta colecciónhttps://hdl.handle.net/11441/10904
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Examinando Artículos (Microbiología) por Premio "Premio Anual Publicación Científica Destacada de la US. Facultad de Medicina"
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Artículo Impact of De-escalation on Prognosis of Patients With Bacteremia due to Enterobacteriaceae: A Post Hoc Analysis From a Multicenter Prospective Cohort(Oxford University Press, 2019) Palacios-Baena, ZR; Delgado Valverde, Mercedes; Mendez, AV; Almirante, Benito; Gomez-Zorrilla, S; Borrell, N; Corzo Delgado, Juan Enrique; Pascual Hernández, Álvaro; Rodríguez-Baño, Jesús; Cueto López, Marina de; Lepe Jiménez, José Antonio; Cisneros, José Miguel; Lara, R; Universidad de Sevilla. Departamento de Microbiología; Universidad de Sevilla. Departamento de Medicina; European Development Regional Fund "A Way to Achieve Europe," Spanish Network for Research in Infectious DiseasesBackground More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. The aims of this study were to investigate predictors of de-escalation and its impact on the outcome of patients with bloodstream infection due to Enterobacteriaceae (BSI-E). Methods A post hoc analysis was performed on a prospective, multicenter cohort of patients with BSI-E initially treated with ertapenem or antipseudomonal β-lactams. Logistic regression was used to analyze factors associated with early de-escalation (EDE) and Cox regression for the impact of EDE and late de-escalation (LDE) on 30-day all-cause mortality. A propensity score (PS) for EDE vs no de-escalation (NDE) was calculated. Failure at end of treatment and length of hospital stay were also analyzed. Results Overall, 516 patients were included. EDE was performed in 241 patients (46%), LDE in 95 (18%), and NDE in 180 (35%). Variables independently associated with a lower probability of EDE were multidrug-resistant isolates (odds ratio [OR], 0.50 [95% confidence interval {CI}, .30–.83]) and nosocomial infection empirically treated with imipenem or meropenem (OR, 0.35 [95% CI, .14–.87]). After controlling for confounders, EDE was not associated with increased risk of mortality; hazard ratios (HR) (95% CIs) were as follows: general model, 0.58 (.25–1.31); model with PS, 0.69 (.29–1.65); and PS-based matched pairs, 0.98 (.76–1.26). LDE was not associated with mortality. De-escalation was not associated with clinical failure or length of hospital stay. Conclusions De-escalation in patients with monomicrobial bacteremia due to Enterobacteriaceae was not associated with a detrimental impact on clinical outcome.Artículo Population pharmacokinetics and pharmacodynamics of fosfomycin in non-critically ill patients with bacteremic urinary infection caused by multidrug-resistant Escherichia coli(Elsevier, 2018) Merino Bohórquez, Vicente; Docobo Pérez, Fernando; Sojo Dorado, Jesús; Morales, Isabel; Lupión Mendoza, Carmen; Martín, D.; Pascual Hernández, Álvaro; Rodríguez-Baño, Jesús; Universidad de Sevilla. Departamento de Microbiología; Universidad de Sevilla. Departamento de Farmacología; Universidad de Sevilla. Departamento de MedicinaObjectives: To describe the population pharmacokinetics of fosfomycin for patients with bacteraemic urinary tract infection (BUTI). The analysis identified optimal regimens on the basis of pharmacodynamic targets and assessed the adequacy of Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) susceptibility breakpoints for Escherichia coli. Methods: Data of 16 patients with BUTI caused by multidrug-resistant E. coli (FOREST clinical trial) received intravenous fosfomycin (4 g every 6 hours) were analysed. A population pharmacokinetic analysis was performed, and Monte Carlo simulations were undertaken using 4 g every 6 hours and 8 g every 8 hours. The probability of pharmacodynamic target attainment was assessed using pharmacodynamic targets for E. coli for static effect, 1-log drop in bacterial burden and resistance suppression. Results: Sixty-four plasma samples were collected over a single dosing interval (day 2 or 3 after starting fosfomycin treatment). Fosfomycin concentrations were highly variable. Pharmacodynamic target attainment analysis showed mild improvement by increasing fosfomycin dosing (4 g every 6 hours vs. every 8 hours). These dosages showed success for decreasing 1-log bacterial burden in 89% to 96% (EUCAST breakpoints) and 33% to 54% (CLSI breakpoints) of patients, but they were unable to reach bacterial resistance suppression targets. Conclusions: Fosfomycin concentrations are highly variable-a fact partially explained by renal impairment. The present work supports the use of 4 g every 6 hours as an effective regimen for the treatment of non-critically ill patients with BUTI caused by multidrug-resistant E. coli, as higher dosages might increase toxicity but may not significantly increase efficacy. The current information may suggest that fosfomycin susceptibility breakpoints need to be reappraised.Artículo Role of blaTEM and OmpC in the piperacillin-tazobactam resistance evolution by E. coli in patients with complicated intra-abdominal infection(Elsevier, 2023) Galvez-Benitez, Lydia; Ortiz de la Rosa, Jose Manuel; Rodríguez-Villodres, Angel; Casimiro-Soriguer, Carlos S.; Molina-Panadero, Irene; Alvarez-Marín, Rocío; Bonnin, Remy A; Naas, Thierry; Pachón Díaz, Jerónimo; Cisneros, José Miguel; Lepe Jiménez, José Antonio; Smani, Younes; Universidad de Sevilla. Departamento de Microbiología; Universidad de Sevilla. Departamento de Medicina; Economa y Competitividad, Spain; Universidad Pablo de OlavidePiperacillin-tazobactam resistance (P/T-R) is increasingly reported among Escherichia coli isolates. Although in vitro experiments have suggested that blaTEM gene plays a key role in the P/T-R acquisition, no clinical in vivo study has yet confirmed the role of blaTEM or other genes. Therefore, we aimed to identify the mechanisms underlying P/T-R by following up patients with E. coli complicated intra-abdominal infections (cIAI) who experienced P/T treatment failure. Four pairs of strains, clonally related from four patients, were isolated both before and after treatment with P/T dosed at 4 g/0.5 g intravenously. The P/T MIC was tested using broth microdilution, and β-lactamase activity was determined in these isolates. Whole-genome sequencing (WGS) was performed to decipher the role of blaTEM and other genes associated with P/T-R. Changes in the outer membrane protein (OMP) profile were analyzed using SDS-PAGE, and blaTEM and ompC transcription levels were measured by RT-qPCR. In addition, in vitro competition fitness was performed between each pairs of strains (P/T-susceptible vs. P/T-resistant). We found a higher copy number of blaTEM gene in P/T-R isolates, generated by three different genetic events: (1) IS26-mediated duplication of the blaTEM gene, (2) generation of a small multicopy plasmid (ColE-like) carrying blaTEM, and (3) adaptive evolution via reduction of plasmid size, leading to a higher plasmid copy number. Moreover, two P/T-R strains showed reduced expression of OmpC. This study describes the mechanisms involved in the acquisition of P/T-R by E. coli in patients with cIAI. The understanding of P/T-R evolution is crucial for effectively treating infected patients and preventing the spread of resistant microorganisms.Artículo Serum IFN-γ and RNAemia temporal profiles as biomarkers of severe COVID-19 in solid organ transplant and immunocompetent patients(Elsevier, 2023) Salto Alejandre, Sonsoles; Carretero-Ledesma, Marta; Camacho-Martínez, Pedro; Berastegui-Cabrera, Judith; Infante, Carmen; Rodríguez-Álvarez, Regino; Pérez Palacios, Patricia; Gómez Bravo, Miguel Ángel; Pascual Hernández, Álvaro; Lepe Jiménez, José Antonio; Rodríguez-Baño, Jesús; Cisneros, José Miguel; Pachón, Jerónimo; Sánchez-Céspedes, Javier; Cordero, Elisa; COVIDSOT working team; Universidad de Sevilla. Departamento de Microbiología; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Medicina; CIBERINFEC - Consorcio Centro de Investigacion Biomedica en Red, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovacion; European Development Regional Fund "A way to achieve Europe", Operative Program Intelligence Growth 2014-2020; Instituto de Salud Carlos III, Ministerio de Ciencia e Innovacion, Proyectos de Investigacion sobre el SARS-CoV-2 y la enfermedad COVID-19; Instituto de Salud Carlos III, Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Ciencia, Innovacion y Universidades, Spanish Network for Research in Infectious Diseases; Plan Nacional de I + D +i 2013-2016; Servicio Andaluz de Salud, Junta de Andalucia, Spain; Union Europea - NextGenerationEU