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Rodriguez-Bano J.,Hospital Universitario Virgen Macarena
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases | Year: 2012

The impact of recent changes in and discrepancies between the breakpoints for cephalosporins and other antimicrobials, as determined by CLSI and European Committee on Antimicrobial Susceptibility Testing (EUCAST), was analysed in patients with bloodstream infections caused by extended-spectrum β-lactamase (ESBL) producing Escherichia coli in Spain, was analysed. We studied a cohort of 191 episodes of bloodstream infection caused by ESBL-producing E. coli in 13 Spanish hospitals; the susceptibility of isolates to different antimicrobials was investigated by microdilution and interpreted according to recommendations established in 2009 and 2010 by CLSI, and in 2011 by EUCAST. Overall, 58.6% and 14.7% of isolates were susceptible to ceftazidime, and 35.1% and 14.7% to cefepime using the CLSI-2010 and EUCAST-2009/2011 recommendations, respectively (all isolates would have been considered resistant using the previous guidelines). Discrepancies between the CLSI-2010 and the EUCAST-2011 recommendations were statistically significant for other antimicrobials only in the case of amikacin (98.4% versus 75.9% of susceptible isolates; p <0.01). The results varied depending on the ESBL produced. No significant differences were found in the percentage of patients classified as receiving appropriate therapy, following the different recommendations. Four out of 11 patients treated with active cephalosporins according to CLSI-2010 guidelines died (all had severe sepsis or shock); these cases would have been considered resistant according to EUCAST-2011. In conclusion, by using current breakpoints, extended-spectrum cephalosporins would be regarded as active agents for treating a significant proportion of patients with bloodstream infections caused by ESBL-producing E. coli. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.

Mendonca F.M.I.,Hospital Universitario Virgen Macarena
Dermatology | Year: 2016

Background: Bullous pemphigoid (BP) is an acquired subepidermal autoimmune blistering disease in which there are humoral and cellular responses against the BP180 and BP230 antigens. Dipeptidyl peptidase (DPP)-4 inhibitors enhance endogenous glucagon peptide-1 and glucose-dependent insulinotropic polypeptide secretion with food intake, which leads to insulin secretion, as well as to the reduction of glucagon secretion. Recently, several cases of DPP-4 inhibitor-associated BP have been reported. Objectives: To report 3 cases of DPP-4 inhibitor-associated BP, one of which is due to linagliptin use, as well as to review all currently published cases of DPP-4 inhibitor-associated BP. Case Reports: Three patients diagnosed with BP at our department showed a clear temporal relationship between the introduction of DPP-4 for the treatment of diabetes and the onset of BP. One case was due to linagliptin use, while the other 2 cases were due to an association with vildagliptin-metformin use. Conclusions: This is the first report of linagliptin-associated BP. Furthermore, 2 other cases of vildagliptin-associated BP are reported. © 2016 S. Karger AG, Basel Copyright © 2016, S. Karger AG. All rights reserved.

The hospital environment is both a reservoir and source of infection for the hospital patient. Several areas around the patient should be considered: air, toilet water coming into contact with the patient, staff and medical devices, food, surfaces, and instruments contacting the patient's skin and mucosa, and sterile solutions. There are pathogens classically associated with each mode of transmission and environmental reservoir, but multi-resistant microorganisms have also been recently been associated with environmental acquisition. Protocols are currently available for the prevention of some classic environmental pathogens, as well as recommendations for the prevention of contamination in some procedures. However, these situations do not cover all forms of transmission, and most investigations of reservoirs or environmental sources are restricted to outbreak situations. © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica.

Larkin J.,Royal Marsden Hospital | Ascierto P.A.,Istituto Nazionale Tumori Fondazione G. Pascale | Dreno B.,Hotel Dieu Place Alexis Ricordeau | Atkinson V.,Princess Alexandra Hospital | And 15 more authors.
New England Journal of Medicine | Year: 2014

Background The combined inhibition of BRAF and MEK is hypothesized to improve clinical outcomes in patients with melanoma by preventing or delaying the onset of resistance observed with BRAF inhibitors alone. This randomized phase 3 study evaluated the combination of the BRAF inhibitor vemurafenib and the MEK inhibitor cobimetinib.Methods We randomly assigned 495 patients with previously untreated unresectable locally advanced or metastatic BRAF V600 mutation-positive melanoma to receive vemurafenib and cobimetinib (combination group) or vemurafenib and placebo (control group). The primary end point was investigator-assessed progression-free survival.Results The median progression-free survival was 9.9 months in the combination group and 6.2 months in the control group (hazard ratio for death or disease progression, 0.51; 95% confidence interval [CI], 0.39 to 0.68; P<0.001). The rate of complete or partial response in the combination group was 68%, as compared with 45% in the control group (P<0.001), including rates of complete response of 10% in the combination group and 4% in the control group. Progression-free survival as assessed by independent review was similar to investigator-assessed progression-free survival. Interim analyses of overall survival showed 9-month survival rates of 81% (95% CI, 75 to 87) in the combination group and 73% (95% CI, 65 to 80) in the control group. Vemurafenib and cobimetinib was associated with a nonsignificantly higher incidence of adverse events of grade 3 or higher, as compared with vemurafenib and placebo (65% vs. 59%), and there was no significant difference in the rate of study-drug discontinuation. The number of secondary cutaneous cancers decreased with the combination therapy. © 2014 Massachusetts Medical Society. All rights reserved.

Alameda-Palacios J.,Hospital Universitario Virgen Macarena | Ruiz-Ramos M.,Servicio de Informacion y Evaluacion | Garcia-Robredo B.,Servicio de Promocion Del Uso Racional Del Medicamento
Gaceta Sanitaria | Year: 2014

Objectives: To analyze the trend in suicide mortality in Andalusia from 1975 to 2012 and its relationshipwith unemployment and the use of antidepressants. Methods: Poisson's segmented regression models were used to estimate changes over time. The associa-tion between suicide and the factors examined was measured using Spearman's correlation coefficient. Results: Suicide mortality patterns in men and women are rising. The largest increase was found in peopleaged from 15 to 44 years, with an annual percentage rate change of 1.21 (95%CI: 0.7-1.7) for men and0.93 (95%CI: 0.4-1.4) for women. Conclusions: Mortality by suicide has increased in Andalusia since 1975 in all age and gender groupsexcept for women aged 65 years or above. During the last few decades, an upward trend has been observedin young people and a stable or falling trend in the remaining population. Temporary variations in suiciderates are not associated with unemployment rates or with changes in antidepressant prescription. © 2013 SESPAS.

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