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Article ; Online: Multidrug-resistant, gram-negative infections in high-risk haematologic patients: an update on epidemiology, diagnosis and treatment.

Garcia-Vidal, Carolina / Stern, Anat / Gudiol, Carlota

2021 Volume 34, Issue 4, Page(s) 314–322

Abstract: Purpose of review: Multidrug-resistant Gram-negative bacilli (MDR-GNB) infections are a significant cause of morbidity and mortality in high-risk hematologic patients. Early diagnosis and management of antibiotic treatment in these patients is a ... ...

Abstract	Purpose of review: Multidrug-resistant Gram-negative bacilli (MDR-GNB) infections are a significant cause of morbidity and mortality in high-risk hematologic patients. Early diagnosis and management of antibiotic treatment in these patients is a challenge for physicians. This review focuses on the latest literature reports that concern the epidemiology, diagnosis and treatment of MDR-GNB infections in this population. Recent findings: High-risk haematological patients have several risk factors that make them particularly susceptible to MDR-GNB infections. Few studies have examined the implementation of rapid diagnostic methods for multidrug resistance, and their impact on management in this population. Inappropriate empiric antibiotic treatment in these patients has been described frequently and is associated with poor outcomes. Summary: Knowledge of the local epidemiology of MDR-GNB is a basic requirement to guide empiric antibiotic treatments in each centre. New diagnosic tests might help in faster identification of MDR-GNB infections. Appropriate empiric antibiotic treatment is crucial for improving patients' prognosis. Important strategies to reduce inadequate antibiotic treatment include better risk stratification for MDR-GNB infection and the introduction of new, more broad-spectrum antibiotic therapies.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Drug Resistance, Multiple, Bacterial ; Gram-Negative Bacteria ; Gram-Negative Bacterial Infections/diagnosis ; Gram-Negative Bacterial Infections/drug therapy ; Gram-Negative Bacterial Infections/epidemiology ; Humans ; Risk Factors
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2021-06-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	645085-4
ISSN	1473-6527 ; 1535-3877 ; 0951-7375 ; 1355-834X
ISSN (online)	1473-6527 ; 1535-3877
ISSN	0951-7375 ; 1355-834X
DOI	10.1097/QCO.0000000000000745
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Article: An Ocean between the Waves: Trends in Antimicrobial Consumption in Hospitalized Patients with COVID-19.

Durà-Miralles, Xavier / Abelenda-Alonso, Gabriela / Bergas, Alba / Laporte-Amargós, Júlia / Sastre-Escolà, Enric / Padullés, Ariadna / Carratalà, Jordi / Gudiol, Carlota

Antibiotics (Basel, Switzerland)

2024 Volume 13, Issue 1

Abstract: We assessed the antibiotic use in SARS-CoV-2-infected patients during four different waves of the COVID-19 pandemic, as well as its trends over the period and associated risk factors. We performed a cross-sectional retrospective analysis nested in a ... ...

Abstract	We assessed the antibiotic use in SARS-CoV-2-infected patients during four different waves of the COVID-19 pandemic, as well as its trends over the period and associated risk factors. We performed a cross-sectional retrospective analysis nested in a prospectively collected cohort of hospitalized adult patients with COVID-19 at a university hospital in Spain. A total of 2415 patients were included in this study, among whom 1120 corresponded to the first wave. The highest percentage of patients receiving some sort of antibiotic treatment was higher during the first wave (77.6%) than during the others; nevertheless, our calculation of the average DOT (days of antibiotic treatment) per 100 patient days of stay found that the highest antibiotic prescription rate corresponded to the second pandemic wave (61.61 DOT/100 patient days), which was associated with a higher ICU admission rate and a lower SpO
Language	English
Publishing date	2024-01-05
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2681345-2
ISSN	2079-6382
ISSN	2079-6382
DOI	10.3390/antibiotics13010055
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Article ; Online: Chimeric antigen receptor T-cell therapy for the treatment of lymphoid malignancies: is there an excess risk for infection?

Gudiol, Carlota / Lewis, Russell E / Strati, Paolo / Kontoyiannis, Dimitrios P

The Lancet. Haematology

2021 Volume 8, Issue 3, Page(s) e216–e228

Abstract: Therapy with genetically engineered chimeric antigen receptor (CAR) T cells targeting the CD19 antigen is promising for a number of refractory or relapsed B-cell malignancies. Information on the infectious complications of this immunotherapeutic strategy ...

Abstract	Therapy with genetically engineered chimeric antigen receptor (CAR) T cells targeting the CD19 antigen is promising for a number of refractory or relapsed B-cell malignancies. Information on the infectious complications of this immunotherapeutic strategy is scarce and difficult to interpret, as many factors influence infection incidence and outcomes. CAR T-cell therapy is usually given to patients with haematological cancers who have been heavily pretreated and are severely immunosuppressed. Moreover, the risk of infection is increased by the administration of lymphodepleting chemotherapy before CAR T-cell infusion, and by the development of complications such as cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome, which are managed with anti-interleukin-6 antibodies, or corticosteroids, or both. On-target, off-tumour toxicities, such as B-cell aplasia, hypogammaglobulinaemia, and persistent or biphasic cytopenia, are common. In this Review, we evaluate the reported infectious complications of CAR T-cell therapy and associated risk factors and offer perspectives on its infection risk.
MeSH term(s)	Agammaglobulinemia/etiology ; Bacterial Infections/etiology ; Comorbidity ; Cytokine Release Syndrome/etiology ; Hematologic Neoplasms/therapy ; Humans ; Immunotherapy, Adoptive/adverse effects ; Neurotoxicity Syndromes/etiology ; Risk Factors ; Virus Diseases/etiology
Language	English
Publishing date	2021-01-15
Publishing country	England
Document type	Journal Article ; Review
ISSN	2352-3026
ISSN (online)	2352-3026
DOI	10.1016/S2352-3026(20)30376-8
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Article: Understanding and Managing Sepsis in Patients With Cancer in the Era of Antimicrobial Resistance.

Gudiol, Carlota / Albasanz-Puig, Adaia / Cuervo, Guillermo / Carratalà, Jordi

Frontiers in medicine

2021 Volume 8, Page(s) 636547

Abstract: Sepsis is a frequent complication in immunosuppressed cancer patients and hematopoietic stem cell transplant recipients that is associated with high morbidity and mortality rates. The worldwide emergence of antimicrobial resistance is of special concern ... ...

Abstract	Sepsis is a frequent complication in immunosuppressed cancer patients and hematopoietic stem cell transplant recipients that is associated with high morbidity and mortality rates. The worldwide emergence of antimicrobial resistance is of special concern in this population because any delay in starting adequate empirical antibiotic therapy can lead to poor outcomes. In this review, we aim to address: (1) the mechanisms involved in the development of sepsis and septic shock in these patients; (2) the risk factors associated with a worse prognosis; (3) the impact of adequate initial empirical antibiotic therapy given the current era of widespread antimicrobial resistance; and (4) the optimal management of sepsis, including adequate and early source control of infection, optimized antibiotic use based on the pharmacokinetic and pharmacodynamics changes in these patients, and the role of the new available antibiotics.
Language	English
Publishing date	2021-03-31
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2021.636547
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Article: Current Challenges in the Management of Infective Endocarditis.

Cuervo, Guillermo / Escrihuela-Vidal, Francesc / Gudiol, Carlota / Carratalà, Jordi

Frontiers in medicine

2021 Volume 8, Page(s) 641243

Abstract: Infective endocarditis is a relatively rare, but deadly cause of sepsis, with an overall mortality ranging from 20 to 25% in most series. Although the classic clinical classification into syndromes of acute or subacute endocarditis have not completely ... ...

Abstract	Infective endocarditis is a relatively rare, but deadly cause of sepsis, with an overall mortality ranging from 20 to 25% in most series. Although the classic clinical classification into syndromes of acute or subacute endocarditis have not completely lost their usefulness, current clinical forms have changed according to the profound epidemiological changes observed in developed countries. In this review, we aim to address the changing epidemiology of endocarditis, several recent advances in the understanding of the pathophysiology of endocarditis and endocarditis-triggered sepsis, new useful diagnostic tools as well as current concepts in the medical and surgical management of this disease. Given its complexity, the management of infective endocarditis requires the close collaboration of multidisciplinary endocarditis teams that must decide on the diagnostic approach; the appropriate initial treatment in the critical phase; the detection of patients needing surgery and the timing of this intervention; and finally the accurate selection of patients for out-of-hospital treatment, either at home hospitalization or with oral antibiotic treatment.
Language	English
Publishing date	2021-02-22
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2021.641243
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Article: Infections Simulating Immune Checkpoint Inhibitor Toxicities: Uncommon and Deceptive.

Gudiol, Carlota / Hicklen, Rachel S / Okhyusen, Pablo C / Malek, Alexandre E / Kontoyiannis, Dimitrios P

Open forum infectious diseases

2022 Volume 9, Issue 11, Page(s) ofac570

Abstract: Use of immune checkpoint inhibitors (ICIs), a revolutionary treatment in modern oncology, is frequently complicated by immune-related adverse events (irAEs), which can be confused with infections, and vice versa, thus complicating management decisions. ... ...

Abstract	Use of immune checkpoint inhibitors (ICIs), a revolutionary treatment in modern oncology, is frequently complicated by immune-related adverse events (irAEs), which can be confused with infections, and vice versa, thus complicating management decisions. In this study, we review the published cases of infections as simulators of irAEs in cancer patients.
Language	English
Publishing date	2022-10-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofac570
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Article ; Online: Optimizing therapy of bloodstream infection due to extended-spectrum β-lactamase-producing Enterobacteriaceae.

Gudiol, Carlota / Cuervo, Guillermo / Carratalà, Jordi

Current opinion in critical care

2019 Volume 25, Issue 5, Page(s) 438–448

Abstract: Purpose of review: Infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are increasing worldwide. Carbapenems are usually regarded as the antibiotics of choice for the treatment of serious ESBL infections. However, ... ...

Abstract	Purpose of review: Infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are increasing worldwide. Carbapenems are usually regarded as the antibiotics of choice for the treatment of serious ESBL infections. However, because of the alarming emergence or carbapenem resistance, interest in effective alternatives has emerged. The present review summarizes the findings published on the antibiotics currently available for treatment of patients with an ESBL-E bloodstream infection (BSI). Recent findings: Meropenem and imipenem are the drugs recommended for treatment of ESBL BSIs in critically ill patients, and in infections with high bacterial loads or elevated β-lactam minimum inhibitory concentrations. Ertapenem should be reserved for patients with less severe presentations, and should be used at high doses. In milder presentations or BSIs from low-risk sources, other carbapenem-sparing alternatives could be considered: cephamycins, fluoroquinolones, and particularly a β-lactam/β-lactam inhibitor combination (particularly piperacillin/tazobactam). Optimized dosing of piperacillin/tazobactam is recommended (high doses and extended infusion). There are few data on the use of the promising newly available drugs (e.g. ceftolozane/tazobactam, ceftazidime/avibactam, cefiderocol, and plazomicin), and it seems reasonable to reserve them as last-resort drugs. Summary: Carbapenems should be used in patients with serious infections; alternatives could be used individually, particularly for definitive treatment of patients with milder presentations.
MeSH term(s)	Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Bacteremia/drug therapy ; Critical Care ; Enterobacteriaceae/drug effects ; Enterobacteriaceae/enzymology ; Enterobacteriaceae Infections/drug therapy ; Humans ; Microbial Sensitivity Tests ; beta-Lactamases/metabolism
Chemical Substances	Anti-Bacterial Agents ; beta-Lactamases (EC 3.5.2.6)
Language	English
Publishing date	2019-03-13
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1235629-3
ISSN	1531-7072 ; 1070-5295
ISSN (online)	1531-7072
ISSN	1070-5295
DOI	10.1097/MCC.0000000000000646
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Article ; Online: Role of the inflammatory response in community-acquired pneumonia: clinical implications.

Rombauts, Alexander / Abelenda-Alonso, Gabriela / Cuervo, Guillermo / Gudiol, Carlota / Carratalà, Jordi

Expert review of anti-infective therapy

2021 Volume 20, Issue 10, Page(s) 1261–1274

Abstract: Introduction: Despite adequate antibiotic coverage, community-acquired pneumonia (CAP) remains a leading cause of hospitalization and mortality worldwide. It induces both a local pulmonary and a systemic inflammatory response, particularly significant ... ...

Abstract	Introduction: Despite adequate antibiotic coverage, community-acquired pneumonia (CAP) remains a leading cause of hospitalization and mortality worldwide. It induces both a local pulmonary and a systemic inflammatory response, particularly significant in severe cases. The intensity of the dysregulated host response varies from patient to patient and has a negative impact on survival and other outcomes. Areas covered: This comprehensive review summarizes the pathophysiological aspects of the inflammatory response in CAP, briefly discusses the usefulness of biomarkers, and assesses the clinical evidence for modulating the inflammatory pathways. We searched PubMed for the most relevant studies, reviews, and meta-analysis until August 2020. Expert opinion: Notable efforts have been made to identify biomarkers that can accurately differentiate between viral and bacterial etiology, and indeed, to enhance risk stratification in CAP. However, none has proven ideal and no recommended biomarker-guided algorithms exist. Biomarker signatures from proteomic and metabolomic studies could be more useful for such assessments. To date, most studies have produced contradictory results concerning the role of immunomodulatory agents (e.g. corticosteroids, macrolides, and statins) in CAP. Adequately identifying the population who may benefit most from effective modulation of the inflammatory response remains a challenge.
MeSH term(s)	Adrenal Cortex Hormones ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Biomarkers ; Community-Acquired Infections/diagnosis ; Community-Acquired Infections/drug therapy ; Community-Acquired Infections/microbiology ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Macrolides/pharmacology ; Pneumonia/diagnosis ; Pneumonia/drug therapy ; Pneumonia/epidemiology ; Proteomics
Chemical Substances	Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Biomarkers ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Macrolides
Language	English
Publishing date	2021-01-04
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Review
ZDB-ID	2181279-2
ISSN	1744-8336 ; 1478-7210
ISSN (online)	1744-8336
ISSN	1478-7210
DOI	10.1080/14787210.2021.1834848
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Article: Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients.

Laporte-Amargos, Julia / Sastre, Enric / Bergas, Alba / Pomares, Helena / Paviglianiti, Annalisa / Rodriguez-Arias, Marisol / Pallares, Natalia / Badia-Tejero, Ana Maria / Pons-Oltra, Paula / Carratalà, Jordi / Gudiol, Carlota

Pathogens (Basel, Switzerland)

2023 Volume 12, Issue 2

Abstract: ... ...

Abstract	Background
Language	English
Publishing date	2023-02-01
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2695572-6
ISSN	2076-0817
ISSN	2076-0817
DOI	10.3390/pathogens12020228
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Article: Whole-Blood Gene Expression Profiles Associated with Mortality in Community-Acquired Pneumonia.

Viasus, Diego / Simonetti, Antonella F / Nonell, Lara / Vidal, Oscar / Meije, Yolanda / Ortega, Lucía / Arnal, Magdalena / Bódalo-Torruella, Marta / Sierra, Montserrat / Rombauts, Alexander / Abelenda-Alonso, Gabriela / Blanchart, Gemma / Gudiol, Carlota / Carratalà, Jordi

Biomedicines

2023 Volume 11, Issue 2

Abstract: 1) Background: Information regarding gene expression profiles and the prognosis of community-acquired pneumonia (CAP) is scarce. We aimed to examine the differences in the gene expression profiles in peripheral blood at hospital admission between ... ...

Abstract	(1) Background: Information regarding gene expression profiles and the prognosis of community-acquired pneumonia (CAP) is scarce. We aimed to examine the differences in the gene expression profiles in peripheral blood at hospital admission between patients with CAP who died during hospitalization and those who survived. (2) Methods: This is a multicenter study of nonimmunosuppressed adult patients who required hospitalization for CAP. Whole blood samples were obtained within 24 h of admission for genome-expression-profile analysis. Gene expression profiling identified both differentially expressed genes and enriched gene sets. (3) Results: A total of 198 samples from adult patients who required hospitalization for CAP were processed, of which 13 were from patients who died. Comparison of gene expression between patients who died and those who survived yielded 49 differentially expressed genes, 36 of which were upregulated and 13 downregulated. Gene set enrichment analysis (GSEA) identified four positively enriched gene sets in survivors, mainly associated with the interferon-alpha response, apoptosis, and sex hormone pathways. Similarly, GSEA identified seven positively enriched gene sets, associated with the oxidative stress, endoplasmic reticulum stress, oxidative phosphorylation, and angiogenesis pathways, in the patients who died. Protein-protein-interaction-network analysis identified
Language	English
Publishing date	2023-02-01
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2720867-9
ISSN	2227-9059
ISSN	2227-9059
DOI	10.3390/biomedicines11020429
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