Publications by authors named "Aristides De Alarcon"

Background: Coagulase-negative staphylococci (CoNS) are an increasingly common cause of infective endocarditis (IE) and lack recent data from large studies.

Objectives: Our aim was to describe the epidemiology, clinical characteristics, and outcomes of staphylococcal IE in a contemporary nationwide cohort study, while comparing coagulase-negative staphylococcal IE (CoNSIE) to IE from Staphylococcus aureus (SAIE), and among IE caused by Staphylococcus epidermidis (SE), S. lugdunensis (SL), and other CoNS.

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Background: Multiple studies have demonstrated the utility of sonication to improve culture yield in patients with cardiovascular implantable electronic device (CIED) infections.

Objective: To analyze the usefulness of sonication in the microbiological diagnosis of CIED infections in comparison with traditional cultures.

Methods: Systematic database searches were performed to identify studies that provided enough data concerning both sensitivity and specificity of traditional (non-sonicated) and sonicated cultures from CIED samples.

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Purpose: Staphylococcus aureus prosthetic valve endocarditis (SAPVE) is a serious infection with high mortality. The main objective of this study was to identify factors associated with in-hospital mortality.

Methods: From January 2008 to December 2021, consecutive patients from a Spanish cohort of infective endocarditis with a definitive diagnosis of SAPVE were analyzed.

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  • A study analyzed data from 5667 patients diagnosed with infective endocarditis (IE) across 46 hospitals in Spain from 2008 to 2021, finding that only 1.7% were HIV-infected.
  • HIV-infected patients tended to be younger, predominantly male, and had specific features like higher rates of tricuspid location and community-acquired infections, but fewer surgical interventions.
  • Despite these differences, the study concluded that HIV status did not significantly affect in-hospital or one-year mortality rates for patients with IE.
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  • Information on infective endocarditis (IE) caused by Cutibacterium spp. is scarce, and the effectiveness of new Duke-ISCVID criteria for diagnosis is still under study.
  • A national study from 2008 to 2023 found that 1% of IE cases were caused by Cutibacterium, predominantly in men, leading to serious intracardiac complications and significant mortality rates.
  • The new diagnostic criteria and molecular testing show promise for identifying Cutibacterium IE, highlighting the importance of cardiac surgery and device removal in reducing patient mortality.
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  • A study of infective endocarditis (IE) in Spain revealed that 19.8% of patients also suffered from acute stroke, with most cases being ischemic strokes.* -
  • Patients with stroke had higher risks of complications, surgical needs, and mortality rates compared to those without stroke, indicating more severe health impacts.* -
  • Factors like the location of infection and the presence of other medical issues were found to increase the likelihood of stroke and its associated mortality in these patients.*
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Cardiac device infections are serious adverse events associated with considerable morbidity and mortality, significant costs, and increased healthcare utilization. The aim of this study is to calculate the costs of treatment of cardiac implantable electrostimulation device (CIED)-related infections for different types of infection (local or systemic) and therapeutic approaches. : Single-center cohort (1985-2018).

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Background: Several aspects of the occurrence and management of mycotic aneurysm (MA) in patients with infective endocarditis (IE) have not been studied.

Objectives: To determine the incidence and factors associated with MA presence and rupture and to assess the evolution of those initially unruptured MA.

Methods: Prospective multicenter cohort including all patients with definite IE between January 2008 and December 2020.

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Infective endocarditis (IE) caused by represents the third most common cause of IE, with high rates of relapse compared with other bacteria. Interestingly, late relapses (>6 months) have only been described in but here we describe the first reported IE relapse with more than a year (17 months) after the initial endocarditis episode. Firstly, by multi locus sequence typing (MLST), we demonstrated that both isolates (EF646 and EF641) belong to the same sequence type (ST117).

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Outpatient parenteral antimicrobial therapy (OPAT) is a useful treatment strategy against and other multidrug-resistant bacteria. However, it is hindered by the lack of stability data for the administration of antibiotics under OPAT conditions. Our objective was to investigate the stability of nine antipseudomonal and broad-spectrum beta lactam antibiotics (aztreonam, cefepime, cefiderocol, ceftazidime, ceftazidime/avibactam, ceftolozane/tazobactam, meropenem, meropenem/vaborbactam, and piperacillin/tazobactam) to allow the spread of OPAT programs.

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Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP).

Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events.

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Background: Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment.

Methods: Study on clinical characteristics and prognosis of a large contemporary prospective cohort of prosthetic valve endocarditis (PVE) that included patients diagnosed between January 2008 and December 2020. Univariate and multivariate analysis of factors associated with in-hospital mortality was performed.

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Background: Temocillin is an interesting alternative to carbapenems for susceptible Enterobacteriaceae. Although its use in outpatient parenteral antimicrobial therapy (OPAT) programmes has generated interest, this has been hampered by the lack of stability data.

Objectives: The purpose of the present study was to evaluate the physical and chemical stability of temocillin at the recommended dose for its use in OPAT programmes, contained in polypropylene infusion bags or polyisoprene elastomeric devices at different temperatures, and to describe a novel LC-MS/MS developed for the quantification of temocillin.

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Background: Patients who acquire infective endocarditis (IE) following contact with the healthcare system, but outside the hospital, are classified as having non-nosocomial healthcare-associated IE (HCIE). Our aim was to characterize HCIE and establish whether its etiology, diagnosis, and therapeutic approach suggest it should be considered a distinct entity.

Methods: This study retrospectively analyzes data from a nationwide, multicenter, prospective cohort including consecutive cases of IE at 45 hospitals across Spain from 2008 to 2021.

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Article Synopsis
  • The study investigates the effectiveness and safety of combining beta-lactam and aminoglycoside (C-BA) treatments versus using third-generation cephalosporin alone for endocarditis caused by viridans and gallolyticus group streptococci (VGS-GGS) with penicillin intermediate susceptibility.
  • A retrospective analysis of 914 endocarditis cases from 40 Spanish hospitals found that 75.3% were penicillin-susceptible and 24.7% had intermediate susceptibility, with C-BA used in 54.6% of cases.
  • The results indicate that cephalosporin monotherapy is effective and associated with lower rates of nephrotoxicity, as it
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Today, is one of the main causes of infective endocarditis in the world, generally affecting an elderly and fragile population, with a high mortality rate. Enterococci are partially resistant to many commonly used antimicrobial agents such as penicillin and ampicillin, as well as high-level resistance to most cephalosporins and sometimes carbapenems, because of low-affinity penicillin-binding proteins, that lead to an unacceptable number of therapeutic failures with monotherapy. For many years, the synergistic combination of penicillins and aminoglycosides has been the cornerstone of treatment, but the emergence of strains with high resistance to aminoglycosides led to the search for new alternatives, like dual beta-lactam therapy.

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  • Ampicillin plus ceftriaxone (AC) is a common treatment for infective endocarditis, but there is limited stability data on their combination in elastomeric devices, making it difficult to use in outpatient settings.
  • A study was conducted to determine the stability of AC in elastomeric pumps at different temperatures (8°C, 25°C, 30°C, and 37°C) over 48 hours using LC-MS/MS.
  • Results showed that AC was stable for 48 hours at 8°C, 24 hours at 25°C and 30°C, and was unstable at 37°C, suggesting it could be safely used in outpatient antimicrobial therapy programs.
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It is not known whether sequential outpatient parenteral antimicrobial (OPAT) is as safe and effective as conventional hospitalization in patients with S. aureus bacteremia (SAB). A post-hoc analysis of the comparative effectiveness of conventional hospitalization versus sequential OPAT was performed in two prospective Spanish cohorts of patients with S.

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Background: Outpatient parenteral antibiotic treatment (OPAT) programs are increasingly used to manage infective endocarditis (IE), but current criteria for indicating OPAT are markedly conservative. We aimed to investigate whether more liberal criteria for indicating OPAT in IE can be safely used.

Methods: This was a prospective multicenter nationwide cohort study (2008-2018).

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Background. Infective endocarditis (IE) is a severe condition. Our aim was to describe the profile and prognosis of patients with multivalvular infective endocarditis (MIE) and compare them to single-valve IE (SIE).

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  • Infective endocarditis (IE) in patients aged 80 and over is linked to high rates of morbidity, mortality, and functional impairment, highlighting significant health risks in this age group.
  • A study analyzed data from 726 octogenarians with IE, revealing that nearly half had a high Charlson Comorbidity Index (CCI ≥ 3) which strongly predicted increased in-hospital and 1-year mortality rates.
  • Surgical intervention was less frequently performed in patients with higher comorbidity, and those treated conservatively faced higher mortality rates compared to those who underwent surgery, indicating that surgical delay or underperformance may negatively impact outcomes.
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  • Infective Endocarditis (IE) is a serious illness, and diabetes mellitus (DM) has been linked to worse outcomes for patients with IE.
  • A study analyzing data from the Spanish IE Registry (2008−2020) found that almost 30% of IE patients had DM, with higher in-hospital and one-year mortality rates for those with DM compared to those without.
  • The presence of organ damage in DM patients further increases the risks of mortality, indicating that diabetes management is crucial for improving prognosis in these patients.
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Cefazolin is a recommended treatment for methicillin-susceptible Staphylococcus aureus (MSSA) infections that has been successfully used in outpatient parenteral antibiotic therapy (OPAT) programs. The aim of this study was to assess the clinical outcomes of cefazolin delivered each day (Group 24) vs. every two days (Group 48) for MSSA infections in OPAT programs.

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