Publications by authors named "Jose M Miro"
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.
Objectives: We aimed to evaluate the usefulness of antistaphylococcal penicillin (ASP) or cephazolin-based combinations versus monotherapy in patients with native-valve infective endocarditis (IE) caused by methicillin-susceptible Staphylococcus aureus (MSSA).
Methods: Post-hoc analysis of a multicentre prospective cohort. We include patients from 2008 to 2022 with definite native-valve, left-side IE due to MSSA treated primarily with ASP/cephazolin.
Introduction: HIV replication leads to a change in lymphocyte phenotypes that impairs immune protection against opportunistic infections. We examined current HIV replication as an independent risk factor for tuberculosis (TB).
Methods: We included people living with HIV from 25 European cohorts 1983-2015.
Article Synopsis
- The study examined SARS-CoV-2 infection rates and risk factors among unvaccinated people living with HIV (PWH), finding an 18% prevalence of infection in this group.
- It involved testing plasma samples from 4,400 PWH and revealed that a significant portion of those infected were asymptomatic or had mild symptoms.
- The research concluded that common risk factors included younger age, female sex, MSM status, and syphilis history, while antiretrovirals, including tenofovir, did not protect against SARS-CoV-2 infection.
Article Synopsis
- The study examines the impact of universal antiretroviral therapy (ART) on people living with HIV (PLHIV) admitted to the ICU, comparing data from 2006-2015 and 2016-2019.
- It found that more patients were on ART before admission after the recommendation was put in place, which led to fewer complications and lower ICU mortality rates (14% vs 7%).
- Key predictors of mortality included the severity of illness and complications during admission, highlighting that ART use during ICU stays offered some protection against mortality.
Background: Infective endocarditis (IE) caused by viridans and gallolyticus group streptococci (VGS-GGS) resistant to penicillin (PEN-R; minimum inhibitory concentration ≥4 mg/L) is rare but poses therapeutic challenges.
Objectives: To describe the characteristics of patients with IE caused by PEN-R VGS-GGS, focusing on antimicrobial management.
Methods: Retrospective analysis of a prospective cohort of definite IE caused by PEN-R VGS-GGS between 2008 and 2023 in 40 Spanish hospitals.
Article Synopsis
- A study was conducted to create a risk score to predict loss to follow-up (LTFU) in patients living with HIV (PLWH) in Catalonia and the Balearic Islands.
- The study analyzed 6,661 PLWH and identified key factors contributing to LTFU, including age, nationality, drug use, viral load, and time since diagnosis.
- The results indicated that a significant portion of PLWH (28.8%) was at medium risk and 3.4% at high risk for LTFU, highlighting the need for targeted interventions to retain patients in HIV care.
Clinical features and prognosis of prosthetic valve endocarditis due to Staphylococcus aureus.
Eur J Clin Microbiol Infect Dis
October 2024
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.
Article Synopsis
- 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.
Article Synopsis
- The study investigates the effects of antiretroviral therapy (ART) interruption on neuro-axonal injury, specifically measuring levels of neurofilament light protein (NfL) in individuals during primary HIV-1 infection.
- Findings show that NfL decreased after 48 weeks of ART, indicating reduced neuronal injury, and remained stable despite viral rebound after ART interruption.
- Additionally, baseline NfL levels correlated with higher plasma HIV-1 RNA and older age but showed no significant relationship with inflammation markers like IL-6 or total HIV-1 DNA.
During the past 6 decades, there have been numerous changes in prosthetic valve endocarditis (PVE), currently affecting an older population and increasing in incidence in patients with transcatheter-implanted valves. Significant microbiologic (molecular biology) and imaging diagnostic (fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography) advances have been incorporated into the 2023 Duke-International Society for Cardiovascular Infectious Diseases infective endocarditis diagnostic criteria, thus increasing the diagnostic sensitivity for PVE without sacrificing specificity in validation studies. PVE is a life-threatening disease requiring management by multidisciplinary endocarditis teams in cardiac centers to improve outcomes.
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- * The study analyzed cause of death using a modified protocol and found a significant decrease in all-cause mortality rates, dropping from 9.6 per 1000 person-years to 3.33. Major causes of death now include non-AIDS cancers, cardiovascular disease, and liver diseases.
- * Key predictors for both AIDS and non-AIDS mortality included factors like age, comorbidities, and ART adherence,
Epidemiology and Risk Factors of Mycotic Aneurysm in Patients With Infective Endocarditis and the Impact of its Rupture in Outcomes. Analysis of a National Prospective Cohort.
Open Forum Infect Dis
March 2024
Article Synopsis
Objectives: To assess the effect of COVID-19 on the postacute risk of cardiovascular events (CVEs) among people with HIV (PWH).
Methods: Population-based matched cohort, including all PWH ≥16 years in the Catalan PISCIS HIV cohort. We estimated the incidence rate of the first CVE after COVID-19, analysed it a composite outcome (2020-2022).
Article Synopsis
- - The 2023 Duke-ISCVID criteria were developed to enhance the classification of infective endocarditis (IE) for better research and clinical outcomes, requiring further external validation.
- - A study at Amsterdam University Medical Center reviewed 595 patients with suspected IE, finding that the new criteria were more sensitive and specific compared to earlier criteria, highlighting their effectiveness in diagnosis.
- - Overall, the new criteria showed significant improvements in diagnostic accuracy, particularly due to changes in major microbiological and imaging requirements, marking a notable advancement in how suspected IE cases are classified.
antibacterial activity of antiretroviral drugs on key commensal bacteria from the human microbiota.
Front Cell Infect Microbiol
January 2024
Article Synopsis
- * This study assessed the antibacterial activity of 16 antiretroviral drugs on key bacterial strains and found that 5 of these drugs showed effectiveness against important gut and vaginal bacteria.
- * Notably, elvitegravir demonstrated strong antibacterial effects against multidrug-resistant bacteria, suggesting its potential for repurposing in clinical treatment, which calls for further study.
Article Synopsis
- * PWH had higher booster vaccination rates (68.5% vs. 63.1%) than PWoH, particularly among those with advanced HIV profiles, like low CD4 counts.
- * The study identified factors such as prior SARS-CoV-2 diagnosis, migrant status, and socioeconomic challenges as barriers to primary vaccination for PWH, emphasizing the need for targeted interventions to enhance vaccine access and coverage.
Article Synopsis
- COVID-19 has a greater impact on migrants and ethnic minorities, including people with HIV, highlighting the need for detailed studies on their risks and outcomes.
- A study in Catalonia analyzed data from over 10,000 people with HIV, comparing COVID-19 testing, vaccination rates, and clinical outcomes between migrants and Spanish natives.
- Results showed migrants had lower testing and vaccination rates, faced higher hospitalization and ICU admission rates, but had similar COVID-19 diagnosis rates and mortality compared to non-migrants, indicating the necessity for targeted health policies.
The impact of the COVID-19 pandemic on healthcare services utilization among people living with HIV in Catalonia, Spain: A population-based cohort study.
Enferm Infecc Microbiol Clin (Engl Ed)
December 2024
Article Synopsis
- The COVID-19 pandemic led to a notable decrease in healthcare services usage among people living with HIV (PLWH) in Catalonia, particularly in HIV units, hospitals, and emergency departments.
- During the lockdown, overall medical visits decreased by 17.1%, with significant drops in specific healthcare facilities, while primary care visits remained relatively stable.
- CD4 and HIV RNA monitoring saw significant declines, emphasizing the need for better preparedness for future pandemics to maintain healthcare access for PLWH.
Update on Cardiovascular Implantable Electronic Device Infections and Their Prevention, Diagnosis, and Management: A Scientific Statement From the American Heart Association: Endorsed by the International Society for Cardiovascular Infectious Diseases.
Circulation
January 2024
Article Synopsis
- The American Heart Association first addressed cardiovascular implantable electronic device infections in a 2010 scientific statement but needed an update due to significant advancements since then.
- An expert group of 11 members from cardiology and infectious diseases convened in October 2022 to draft this updated statement aimed at improving patient outcomes.
- The new statement emphasizes recent progress in prevention, diagnosis, and management of these infections and offers guidance for complex patient care.
Efficacy and safety of raltegravir plus lamivudine maintenance therapy.
J Antimicrob Chemother
February 2024
Background: Decreasing medication burden with raltegravir plus lamivudine in virologically suppressed persons with HIV (PWH) maintained efficacy and was well tolerated at 24 weeks, but more comprehensive data over longer follow-up are required.
Methods: Prospective 48 week extension phase of the raltegravir plus lamivudine arm from a previous 24 week pilot randomized clinical trial in which virologically suppressed PWH were randomized 2:1 to switch to fixed-dose combination 150 mg lamivudine/300 mg raltegravir twice daily or to continue therapy. In this 48 week extension phase, raltegravir was dosed at 1200 mg/day and lamivudine 300 mg/day.