Antonio Lalueza

Systematic screening and treatment of asymptomatic bacteriuria in renal transplant recipients

We sought to examine the impact of asymptomatic bacteriuria on renal transplant outcome by retrospectively analyzing 189 renal transplant recipients for whom systematic screening uncovered 298 episodes of asymptomatic bacteriuria in 96 recipients. These patients were treated and all were followed for 36 months. Significant risk factors included female gender, glomerulonephritis as the disease that led to transplantation, and double renal transplant. There were no differences in serum creatinine, creatinine clearance, or proteinuria between patients with and without bacteriuria. The incidence of pyelonephritis in these patients was 7.6 episodes per 100 patient-years compared with 1.07 in those without asymptomatic bacteriuria. Between two to five and more than five bacteriuria episodes were significant independent factors associated with pyelonephritis whereas more than five episodes was a significant independent factor associated with rejection. Thus, we found no differences in renal function prognosis between patients who do not develop asymptomatic bacteriuria and those uncovered by systematic screening and who received treatment following kidney transplantation. Despite this treatment, the incidence of pyelonephritis was much higher in the group of patients with detected asymptomatic bacteriuria.

High Vancomycin MIC and Complicated Methicillin-Susceptible Staphylococcus aureus Bacteremia

We conducted a retrospective study of 99 patients with methicillin-suseptible Staphylococcus aureus catheter-related bacteremia in which vancomycin MIC was determined by Etest. High vancomycin MIC (>1.5 μg/mL) was the only independent risk factor for development of complicated bacteremia caused by methicillin-susceptible S. aureus (odds ratio 22.9, 95% confidence interval 6.7–78.1).

Emergence of Cytomegalovirus Disease in Patients Receiving Temozolomide: Report of Two Cases and Literature Review

Temozolomide chemotherapy has become part of the therapy used to treat glioblastoma multiforme and refractory anaplastic astrocytoma. Temozolomide frequently produces profound lymphopenia. We report 2 cases of cytomegalovirus disease that occurred in patients receiving temozolomide therapy and review 4 additional cases reported in the literature. Narrow monitoring with cytomegalovirus antigenemia assay should be considered for recommendation.

High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus

Patients infected with these bacteria were more likely to have local endovascular complications.

Empiema subdural subagudo

Las infecciones intracraneales como el empiema o el absceso cerebral representan el 14% de las causas de muerte después de un proceso neuroquirúrgico1. Habitualmente el diagnóstico de las complicaciones infecciosas tras las intervenciones neuroquirúrgicas no plantea dificultades por la relación temporal con la cirugía y la aparición de fiebre, síndrome confusional y datos de focalidad Caso clínico

Pathogen-related factors affecting outcome of catheter-related bacteremia due to methicillin-susceptible Staphylococcus aureus in a Spanish multicenter study

Even with appropriate clinical management, complicated methicillin-susceptible Staphylococcus aureus (MSSA) catheter-related bacteremia (CRB) is frequent. We investigated the influence of molecular characteristics of MSSA strains on the risk of complicated bacteremia (CB) in MSSA-CRB. A multicenter prospective study was conducted in Spain between 2011 and 2014 on MSSA-CRB. Optimized protocol-guided clinical management was required. CB included endocarditis, septic thrombophlebitis, persistent bacteremia and/or end-organ hematogenous spread. Molecular typing, agr functionality and DNA microarray analysis of virulence factors were performed in all MSSA isolates. Out of 83 MSSA-CRB episodes included, 26 (31.3%) developed CB. MSSA isolates belonged to 16 clonal complexes (CCs), with CC30 (32.5%), CC5 (15.7%) and CC45 (13.3) being the most common. Comparison between MSSA isolates in episodes with or without CB revealed no differences regarding agr type and functionality. However, our results showed that CC15 and the presence of genes like cna, chp and cap8 were associated with the development of CB. The multivariate analysis highlighted that the presence of cna (Hazard ratio 2.9; 95% CI 1.14–7.6) was associated with the development of CB. Our results suggest that particular CCs and specific genes may influence the outcome of MSSA-CRB.

Influenza-Associated Hemophagocytic Syndrome in Adults: Case Report and Review

Hemophagocytic syndrome (HPS) is a rare, but increasingly reported disease characterized by severe dysfunction of cytotoxic T cells and NK cells, often associated with poor outcome. It has been related to multiple processes including a large variety of infections. Even though viral infections have been described as triggers of HPS, influenza associated hemophagocytic syndrome in adults has been rarely reported. Here, we present a case of an 85 year-old man with essential thrombocytemia who developed HPS triggered by influenza A H1N1 infection and a review of the literature with special emphasis on the importance of a prompt diagnosis and an early treatment to achieve a more favourable outcome. Hemophagocytic syndrome secondary to influenza virus infection is a rare condition with high mortality that should be suspected in patients with an aggressive disease course. Early diagnosis and initiation of antiviral treatment and in some cases immunomodulatory therapy are crucial for the prognosis.

Recurrent Aortitis Associated With IgG4-Related Disease

rent IgG4-RD aortitis successfully treated with azathioprine. The patient was a 46-year-old man with a history of nonmetastatic clear-cell renal carcinoma (pT1aN0M0) treated with right radical nephrectomy 5 months previously. On admission, he reported progressive lumbar pain, night sweats, fatigue ascular involvement as the clinical presentation of IgG4-related disease (IgG4-RD) is rare. Here, we report a case of aortic involvement with recurrence after initial response to steroids, subsequently treated with azathioprine. To our knowledge, this is the first case of recurV

Spontaneous mediastinitis with multiple esophageal abscess in the esophagus

Acute mediastinitis (AM) is a rare and deadly disease without appropriate treatment. It is usually due to invasive medical procedures, being uncommon the spontaneous onset. We report a case of 49-year-old patient whose starting symptoms were dyspnea and oppressive epigastric pain.

Impact on mortality of adherence to evidence-based interventions in patients with catheter-related bloodstream infection due to methicillin-sensitive Staphylococcus aureus

Abstract Background: Recent studies have demonstrated improved survival when the management of Staphylococcus aureus bloodstream infection (BSI) is compliant with evidence-based therapeutic interventions. Whether this effect extends to low-risk sources, such as catheter-related BSI, remains unclear. Methods: We retrospectively included 225 episodes of methicillin-sensitive S. aureus catheter-related BSI diagnosed in our centre during two non-consecutive periods: 2002–2004 (first period (101 episodes)) and 2009–2013 (second period (124 episodes)). We evaluated the adherence (percentage of compliance = (no. of interventions performed/no. of interventions recommended) × 100) to the following bundle: early catheter removal (≤72 hours), early initiation of appropriate antibiotic therapy, adequate sampling of follow-up blood cultures, transthoracic echocardiography (TTE) during hospitalization and adequate duration of therapy. Results: Patients in the second period had a higher burden of comorbidities and more severe underlying conditions. All-cause 30-day mortality was 9.3%, with a significant difference between the first and second periods (13.9% versus 5.6%; p value = .035). Bundle adherence was significantly higher in the second period, particularly for follow-up blood cultures (26.7% versus 48.4%; p value = .001), performance of TTE (45.5% versus 84.7%; p value < .001) and appropriate duration of therapy (34.7% versus 50.0%; p value = .022). Bundle adherence ≥ 55% was associated with lower 30-day mortality (hazard ratio: 0.31; 95% confidence interval: 0.13–0.76). This effect remained significant across propensity score-based models adjusted for septic shock, study period and underlying conditions. Conclusions: There was a survival benefit in adhering to a bundle of evidence-based interventions in the specific setting of catheter-related BSI due to methicillin-sensitive S. aureus.