Hospital Son Espases

Hospital de Órbigo, Spain

Hospital Son Espases

Hospital de Órbigo, Spain
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Garcia Del Muro Solans X.,Institute Catala DOncologia LHospitalet | Martin Broto J.,Hospital Son Espases | Lianes Barragan P.,Hospital Of Mataro | Cubedo Cervera R.,Hospital Puerta Of Hierro
Clinical and Translational Oncology | Year: 2012

Soft tissue sarcomas are uncommon tumors of mesenchimal cell origin. Criteria for suspicion is a soft tissue mass that is increasing in size, and has a size greater than 5 cm or is located under the deep fascia. Diagnosis and management of these patients should preferably be performed by a specialist multidisciplinary team in a referral center. Assessment of a patient with a suspect of sarcoma should include magnetic resonance and biopsy performed prior to surgery. Primary local therapy for patients with localized sarcoma is based on wide surgical resection with a tumor-free tissue margin, in association in most cases with radiotherapy. Adjuvant chemotherapy constitutes an option that could be considered in high-risk sarcomas of the extremities. When metastasis are present, surgery of pulmonary lesions, in some selected patients, and chemotherapy are current available options.


Juan C.,Hospital Son Espases | Conejo M.C.,University of Seville | Tormo N.,Hospital General Of Valencia | Gimeno C.,Hospital General Of Valencia | And 3 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2013

Objectives: To evaluate the proficiency of Spanish laboratories regarding accurate susceptibility testing, detection and interpretation of Pseudomonas aeruginosa β-lactam resistance phenotypes. Methods: Thirteen characterized strains were sent to 54 participating centres: clinical strains producing horizontally acquired β-lactamases [extended-spectrum β-lactamases (ESBLs; PER-1 and OXA-161) and class A (GES-5) and B (VIM-2) carbapenemases] and mutants with combinations of chromosomal mechanisms (AmpC, OprD and/or efflux). The centres were requested to evaluate six antipseudomonal β-lactams, provide raw/interpreted clinical categories and detect/infer the resistance mechanisms. Consensus results from reference centres were used to assign minor, major or very major errors (mEs, MEs or VMEs). Results: Vitek2, MicroScan WalkAway and Wider were the most used devices (25%-30% each). CLSI/EUCAST breakpoints were used in 86%/14% of the determinations. Discrepancies exclusively due to the differential application of breakpoints were highest for aztreonam, followed by piperacillin/tazobactam. The lowest percentage of VMEs was for Vitek2, followed by Wider. The highest percentages of VMEs (6%) were for the AmpC-hyperproducing OprD. - strain and for the GES-5 producer, while among antibiotics the highest percentage of VMEs (22%) involved piperacillin/tazobactam. Appropriate inference of resistance mechanisms was high for the VIM-2-producing strain (83%), but low (<40%) for strains producing ESBLs or non-metallo-β-lactamase carbapenemases. Conclusions: The use of different breakpoints and devices, the complexity of mutation-driven resistance mechanisms and the lack of unequivocal tests to detect ESBLs or carbapenemases in P. aeruginosa leads to extraordinary variability and low accuracy in susceptibility testing, which may have consequences for the treatment and control of nosocomial infections. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


Garcia-Castillo M.,CIBER ISCIII | Del Campo R.,CIBER ISCIII | Morosini M.I.,CIBER ISCIII | Riera E.,Hospital Son Espases | And 5 more authors.
Journal of Clinical Microbiology | Year: 2011

During the COMParative Activity of Carbapenems Testing (COMPACT) surveillance study, 448 Pseudomonas aeruginosa clinical isolates were obtained from 16 Spanish hospitals. Nonsusceptibility (EUCAST breakpoints) to imipenem (35%), meropenem (33%), and/or doripenem (33%) was observed with 175 isolates (39%). Simultaneous resistance to these three drugs was observed with 126 of the 175 isolates (72%). Except for colistin, high resistance rates were observed among noncarbapenem antibiotics. Clonal relatedness was investigated by pulsed-field gel electrophoresis (PFGE) with SpeI, discriminating 68 patterns. Multilocus sequence typing (MLST) was performed on 84 isolates representing different PFGE types and all participating hospitals. Thirty-nine sequence types (STs) could be distinguished, and of these, ST175 (48 isolates, 10 hospitals), ST646 (16 isolates, 4 hospitals), ST532 (13 isolates, 3 hospitals), and ST111 (13 isolates, 7 hospitals) were the most frequently encountered. Minimum-spanning tree analysis confirmed a wide dissemination of different clones among participant hospitals, particularly ST175. PFGE pattern comparison within the four most frequent STs revealed that ST175 isolates were relatively uniform, while ST646, ST532, and ST111 isolates were highly diverse, with almost every isolate belonging to a unique pulsotype, even when originating from the same center. The population of carbapenem-nonsusceptible P. aeruginosa isolates from 16 hospitals is highly diverse, with one ST (ST175) representing a highly conserved clone disseminated in 10 of the 16 participant hospitals. This ST175 clone should be added to the list of P. aeruginosa clones at high risk for epidemic spread, such as the Liverpool, Manchester, and Melbourne clones previously found in cystic fibrosis patients and ST235 in the nosocomial setting. Copyright © 2011, American Society for Microbiology. All Rights Reserved.


Fajardo A.,CSIC - National Center for Biotechnology | Hernando-Amado S.,CSIC - National Center for Biotechnology | Oliver A.,Hospital Son Espases | Ball G.,Aix - Marseille University | And 2 more authors.
The Journal of antimicrobial chemotherapy | Year: 2014

OBJECTIVES: Previous work showed that PA5542 inactivation increases Pseudomonas aeruginosa 59.20 susceptibility to carbapenems. The objective of the current study was to purify PA5542, to determine its role in carbapenem resistance and to analyse the kinetic constants of this putative new β-lactamase.METHODS: PA5542 was cloned and expressed in Escherichia coli. The enzyme was purified by affinity as a GST fusion protein and, after that, cleaved to remove the GST tag. β-Lactamase activity was measured spectrophotometrically using imipenem as substrate. Susceptibility to antibiotics was determined by Etest. Zn(2+) was added when needed. The expression levels of PA5542, ampC, poxB, mexA and oprD were determined by real-time RT-PCR.RESULTS: Lack of PA5542 increases P. aeruginosa 59.20 susceptibility to carbapenems and its overexpression reduces E. coli susceptibility to these β-lactams. PA5542 is highly conserved in all sequenced P. aeruginosa strains. The clinical isolate 59.20 is resistant to imipenem (MIC >32 mg/L) and to meropenem (MIC 24 mg/L) and presents high-level expression of PA5542 in comparison with the wild-type strain PAO1. Spectrophotometric analyses showed that PA5542 is a Zn(2+)-dependent imipenemase. Analysis of the PA5542 sequence indicates that it does not belong to the classical categories of β-lactamases.CONCLUSIONS: PA5542 encodes a new Zn(2+)-dependent imipenemase. The presence of PA5542 in all sequenced P. aeruginosa genomes, maintaining the synteny and without adjacent gene-mobility elements, indicates that it belongs to the P. aeruginosa core genome. High PA5542 expression in 59.20 suggests it may contribute to the resistance to carbapenems of this P. aeruginosa clinical isolate. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.


Alcala-Franco B.,San Raffaele Scientific Institute | Montanari S.,San Raffaele Scientific Institute | Cigana C.,San Raffaele Scientific Institute | Bertoni G.,University of Milan | And 2 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2012

Objectives: Hypermutable strains of Pseudomonas aeruginosa frequently emerge during chronic airways infection in cystic fibrosis (CF) patients. While the increased accumulation of mutations by hypermutable strains determines a biological cost for the colonization of secondary environments, the mutator phenotypes might confer a selective advantage under antibiotic treatment in a CF airways environment. Methods: To test this hypothesis, the reference strain PAO1 and clonal pairs of CF clinical hypermutable and wild-type P. aeruginosa strains belonging to different genotypes were subjected to competition experiments in vitro and in a mouse model of chronic infection. Results: Both in vitro and in vivo, under antibiotic selection pressure, clinical hypermutable P. aeruginosa strains and the reference PAO1ΔmutS outcompeted their wild-type strains, promoting P. aeruginosa hypermutable strains in the airways colonization. This advantage for the hypermutable strain did not occur in the absence of antibiotic treatments. Severe histopathological lesions were detected during chronic murine airways infection after antibiotic pressure, indicating that the advantage of the hypermutable population in the lungs may contribute to disease progression. Conclusions: Overall, these results showed that P. aeruginosa hypermutability, previously associated with a biological cost, increases colonization potential under selection pressure in a context of CF chronic airways infection and can contribute to lung damage during long-term persistence. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


Garcia-Toro M.,Hospital Son Llatzer | Garcia-Toro M.,University of the Balearic Islands | Ibarra O.,Hospital Son Espases | Ibarra O.,University of the Balearic Islands | And 5 more authors.
Journal of Affective Disorders | Year: 2012

Background: Modifying diet, exercise, sunlight exposure and sleep patterns may be useful in the treatment of depression. Method: Eighty nonseasonal depressive outpatients on anti-depressant treatment were randomly assigned either to the active or control group. Four hygienic-dietary recommendations were prescribed together. Outcome measures were blinded assessed before and after the six month intervention period. Results: A better evolution of depressive symptoms, a higher rate of responder and remitters and a lesser psychopharmacological prescription was found in the active group. Limitations: Small sample size. Lacked homogeneity concerning affective disorders (major depression, dysthimia, bipolar depression). Conclusions: This study suggests lifestyle recommendations can be used as an effective antidepressant complementary strategy in daily practice. © 2012 Elsevier B.V.


Mondon M.,University of Poitiers | Hur S.,Simon Fraser University | Vadlamani G.,University of Manitoba | Rodrigues P.,University of Manitoba | And 5 more authors.
Chemical Communications | Year: 2013

AmpC β-lactamase confers resistance to β-lactam antibiotics in many Gram negative bacteria. Inducible expression of AmpC requires an N-acetylglucosaminidase termed NagZ. Here we describe the synthesis and characterization of hydroxyazepane inhibitors of NagZ. We find that these inhibitors enhance the susceptibility of clinically relevant Pseudomonas aeruginosa to β-lactams. This journal is © The Royal Society of Chemistry 2013.


Sabate M.,University of Barcelona | Brugaletta S.,University of Barcelona | Cequier A.,University of Barcelona | Iniguez A.,Hospital Do Meixoeiro | And 13 more authors.
The Lancet | Year: 2016

Summary Background Data for the safety and efficacy of new-generation drug-eluting stents at long-term follow-up, and specifically in patients with ST-segment elevation myocardial infarction, are scarce. In the EXAMINATION trial, we compared everolimus-eluting stents (EES) with bare-metal stents (BMS) in an all-comer population with ST-segment elevation myocardial infarction. In this study, we assessed the 5-year outcomes of the population in the EXAMINATION trial. Methods In the multicentre EXAMINATION trial, done in Italy, Spain, and the Netherlands, patients with ST-segment elevation myocardial infarction were randomly assigned in a 1:1 ratio to receive EES or BMS. The random allocation schedule was computer-generated and central randomisation (by telephone) was used to allocate patients in blocks of four or six, stratified by centre. Patients were masked to treatment assignment. At 5 years, we assessed the combined patient-oriented outcome of all-cause death, any myocardial infarction, or any revascularisation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00828087. Findings 1498 patients were randomly assigned to receive either EES (n=751) or BMS (n=747). At 5 years, complete clinical follow-up data were obtained for 731 patients treated with EES and 727 treated with BMS (97% of both groups). The patient-oriented endpoint occurred in 159 (21%) patients in the EES group versus 192 (26%) in the BMS group (hazard ratio 0·80, 95% CI 0·65-0·98; p=0·033). This difference was mainly driven by a reduced rate of all-cause mortality (65 [9%] vs 88 [12%]; 0·72, 0·52-0·10; p=0·047). Interpretation Our findings should be taken as a point of reference for the assessment of new bioresorbable polymer-based metallic stents or bioresorbable scaffolds in patients with ST-segment elevation myocardial infarction. Funding Spanish Heart Foundation. © 2016 Elsevier Ltd.


Sabate M.,University of Barcelona | Brugaletta S.,University of Barcelona | Cequier A.,University of Barcelona | Iniguez A.,Hospital Do Meixoeiro | And 10 more authors.
JACC: Cardiovascular Interventions | Year: 2014

Objectives This study sought to assess the 2-year outcomes of the population included in the EXAMINATION (Everolimus-Eluting Stents Versus Bare-Metal Stents in ST-Segment Elevation Myocardial Infarction) trial beyond the 1-year prescription period of dual antiplatelet therapy. Background The EXAMINATION trial compared the performance of everolimus-eluting stents (EES) versus bare-metal stents (BMS) in an all-comer ST-segment elevation myocardial infarction (STEMI) population. Methods This was a multicenter, multinational, prospective, randomized, single-blind, controlled trial in patients with STEMI. The primary endpoint, which was the combined endpoint of all-cause death, any recurrent myocardial infarction, and any revascularization, and the endpoints target lesion revascularization and stent thrombosis were assessed at 2 years. Results Between December 31, 2008, and May 15, 2010, 1,498 patients were randomized to receive EES (n = 751) or BMS (n = 747). Compliance with dual antiplatelet regimen was reduced at 2 years to a similar degree (17.3% vs. 17.2%, p = 0.91). At 2 years, the primary endpoint occurred in 108 (14.4%) patients of the EES group and in 129 (17.3%) patients of the BMS group (p = 0.11). Rate of target lesion revascularization was significantly lower in the EES group than in the BMS group (2.9% vs. 5.6%; p = 0.009). Rates of definite and definite or probable stent thrombosis were also significantly reduced in the EES group (0.8% vs. 2.1%; p = 0.03, and 1.3% vs. 2.8%; p = 0.04, respectively). Conclusions The 2-year follow-up of the EXAMINATION trial confirms the safety and efficacy of the EES compared with BMS in the setting of STEMI. Specifically, both rates of target lesion revascularization and stent thrombosis were reduced in recipients of EES without any signs of late attrition for either of these endpoints. (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction: EXAMINATION Study; NCT00828087). © 2014 by the American College of Cardiology Foundation.


Cabrerizo M.,Institute Salud Carlos III | Tarrago D.,Institute Salud Carlos III | Munoz-Almagro C.,Hospital San Joan Of Deu | del Amo E.,Hospital San Joan Of Deu | And 9 more authors.
Clinical Microbiology and Infection | Year: 2014

Hand, foot and mouth disease (HFMD) is a childhood illness frequently caused by genotypes belonging to the enterovirus A species, including coxsackievirus (CV)-A16 and enterovirus (EV)-71. Between 2010 and 2012, several outbreaks and sporadic cases of HFMD occurred in different regions of Spain. The objective of the present study was to describe the enterovirus epidemiology associated with HFMD in the country. A total of 80 patients with HFMD or atypical rash were included. Detection and typing of the enteroviruses were performed directly in clinical samples using molecular methods. Enteroviruses were detected in 53 of the patients (66%). CV-A6 was the most frequent genotype, followed by CV-A16 and EV-71, but other minority types were also identified. Interestingly, during almost all of 2010, CV-A16 was the only causative agent of HFMD but by the end of the year and during 2011, CV-A6 became predominant, while CV-A16 was not detected. In 2012, however, both CV-A6 and CV-A16 circulated. EV-71 was associated with HFMD symptoms only in three cases during 2012. All Spanish CV-A6 sequences segregated into one major genetic cluster together with other European and Asian strains isolated between 2008 and 2011, most forming a particular clade. Spanish EV-71 strains belonged to subgenogroup C2, as did most of the European sequences circulated. In conclusion, the recent increase of HFMD cases in Spain and other European countries has been due to a larger incidence of circulating species A enteroviruses, mainly CV-A6 and CV-A16, and the emergence of new genetic variants of these viruses. © 2013 European Society of Clinical Microbiology and Infectious Diseases.

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