ABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Drug Implants/therapeutic use , Clarithromycin/therapeutic use , Electric Countershock/instrumentation , Electric Countershock/methods , Electric Countershock , Sarcopenia/complications , Sarcopenia/drug therapy , Dermatomycoses/complications , Dermatomycoses/drug therapy , Vancomycin/therapeutic use , Defibrillators, Implantable/adverse effects , Prosthesis-Related Infections/complications , Prosthesis-Related Infections/drug therapySubject(s)
Anti-Bacterial Agents/therapeutic use , Clarithromycin/therapeutic use , Defibrillators, Implantable/adverse effects , Linezolid/therapeutic use , Prosthesis-Related Infections/drug therapy , Staphylococcal Infections/drug therapy , Aged , Echocardiography , Humans , Male , Myocardial Ischemia/complications , Myocardial Ischemia/therapy , Prosthesis-Related Infections/diagnostic imaging , Prosthesis-Related Infections/microbiology , Staphylococcal Infections/microbiology , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Heart Neoplasms/diagnostic imaging , Myxoma/diagnostic imaging , Tomography, X-Ray Computed , Blood Sedimentation , Comorbidity , Heart Murmurs , Heart Neoplasms/surgery , Myxoma/surgery , UltrasonographyABSTRACT
Background and objectives: Whether the use of tumor necrosis factor antagonists increases the risk of infection remains a subject of open debate. Developing effective strategies of prevention and empirical treatment entails carefully establishing the etiology and prognosis of the infections.Patients and methods: Analysis of the Spanish registry BIOBADASER (Feb-2000 to Jan-2006), a national drug safety registry of patients with rheumatic diseases. Results: 907 episodes of infection occurring in 6,969 patients were analyzed. The infection incidence observed was 53.09 cases/1,000 patients-years (CI 95% 49.69-56.66). The most frequent infections were skin infection (12.18 cases/1,000 patients-yrs), pneumonia (5.97 cases/1,000 patients-yrs), cystitis (3.92 cases/1,000 patients-yrs), tuberculosis (3.51 cases/1,000 patients-yrs) and arthritis (3.76 cases/1,000 patients-yrs). Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa and Salmonella spp. emerged as important pathogens. Varicella zoster virus and Herpes simplex virus caused most cases of viral infections. Mucocutaneous candidiasis accounted for most fungal infections. Mortality was increased in infected patients (log-rank test p<0.0001). Pneumonia, sepsis, tuberculosis, abdominal infection and endocarditis were associated with significant attributable mortality.Conclusions: A significant number of bacterial, viral and fungal infections occurred in patients with rheumatic diseases treated with TNF antagonists. The information of this study can illuminate clinicians globally on how to address infection in this vulnerable group of patients (AU)
Fundamento y objetivo: El aumento del riesgo de infección en la utilización de los antagonistas del factor de necrosis tumoral (TNF) sigue siendo un tema de debate abierto. El desarrollo de estrategias eficaces de prevención y tratamiento empírico implica establecer la etiología y el pronóstico de las infecciones. Pacientes y métodos: Análisis del registro español BIOBADASER (febrero 2000 a enero 2006), un registro de terapias biológicas en pacientes con enfermedades reumáticas.Resultados: En los 6.969 pacientes registrados a la fecha del análisis, se produjeron 907 episodios de infección. La incidencia de infección observada fue de 53,09 casos/1.000 pacientes-año (IC 95% 49,69-56,66). Las infecciones más frecuentes fueron las de piel (12,18 casos/1.000 pacientes-año), neumonía (5,97 casos/1.000 pacientes-año), cistitis (3,92 casos/1.000 pacientes-año), tuberculosis (3,51 casos/1.000 pacientes-año) y articulares (3,76 casos/1.000 pacientes-año). Emergen como patógenos importantes Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa y Salmonella spp. El virus de la varicela zóster y el virus del herpes simple causaron la mayoría de los casos de infecciones virales con germen identificable. La candidiasis mucocutánea fue la más frecuente entre las infecciones fúngicas. La mortalidad fue mayor en los pacientes infectados (p-log-rank<0,0001). La aparición de una neumonía, sepsis, tuberculosis, infección abdominal y endocarditis se asociaron significativamente con la mortalidad. Conclusiones: Un número significativo de infecciones bacterianas, víricas y fúngicas se produjeron en pacientes con enfermedades reumáticas tratadas con antagonistas del TNF. La información de este estudio puede suponer un avance para la medicina sobre cómo tratar la infección en este grupo vulnerable de pacientes (AU)
Subject(s)
Humans , Tumor Necrosis Factors/antagonists & inhibitors , Infections/chemically induced , Biological Therapy/adverse effects , Diseases Registries/statistics & numerical data , Rheumatic Diseases/drug therapyABSTRACT
BACKGROUND AND OBJECTIVES: Whether the use of tumor necrosis factor antagonists increases the risk of infection remains a subject of open debate. Developing effective strategies of prevention and empirical treatment entails carefully establishing the etiology and prognosis of the infections. PATIENTS AND METHODS: Analysis of the Spanish registry BIOBADASER (Feb-2000 to Jan-2006), a national drug safety registry of patients with rheumatic diseases. RESULTS: 907 episodes of infection occurring in 6,969 patients were analyzed. The infection incidence observed was 53.09 cases/1,000 patients-years (CI 95% 49.69-56.66). The most frequent infections were skin infection (12.18 cases/1,000 patients-yrs), pneumonia (5.97 cases/1,000 patients-yrs), cystitis (3.92 cases/1,000 patients-yrs), tuberculosis (3.51 cases/1,000 patients-yrs) and arthritis (3.76 cases/1,000 patients-yrs). Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa and Salmonella spp. emerged as important pathogens. Varicella zoster virus and Herpes simplex virus caused most cases of viral infections. Mucocutaneous candidiasis accounted for most fungal infections. Mortality was increased in infected patients (log-rank test p<0.0001). Pneumonia, sepsis, tuberculosis, abdominal infection and endocarditis were associated with significant attributable mortality. CONCLUSIONS: A significant number of bacterial, viral and fungal infections occurred in patients with rheumatic diseases treated with TNF antagonists. The information of this study can illuminate clinicians globally on how to address infection in this vulnerable group of patients.
Subject(s)
Antibodies, Monoclonal/adverse effects , Antirheumatic Agents/adverse effects , Bacterial Infections/etiology , Mycoses/etiology , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Virus Diseases/etiology , Antibodies, Monoclonal/pharmacokinetics , Antibodies, Monoclonal/therapeutic use , Antirheumatic Agents/pharmacokinetics , Antirheumatic Agents/therapeutic use , Arthritis, Infectious/epidemiology , Arthritis, Infectious/etiology , Bacterial Infections/epidemiology , Cohort Studies , Disease Susceptibility , Follow-Up Studies , Humans , Immunocompromised Host , Incidence , Kaplan-Meier Estimate , Leishmaniasis/epidemiology , Leishmaniasis/etiology , Mycoses/epidemiology , Registries , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/etiology , Rheumatic Diseases/drug therapy , Sepsis/epidemiology , Sepsis/etiology , Skin Diseases, Infectious/epidemiology , Skin Diseases, Infectious/etiology , Spain/epidemiology , Tuberculosis/epidemiology , Tuberculosis/etiology , Urinary Tract Infections/epidemiology , Urinary Tract Infections/etiology , Virus Diseases/epidemiologyABSTRACT
Cytomegalovirus (CMV) infection is an important and frequent complication in solid organ transplant (SOT) recipients. This infection causes direct effects by viral inclusion in the cells of various tissues, as well as indirect effects by interaction between low levels of viremia and the host immune response. These indirect effects, such as increased incidence of graft rejection and opportunistic infections or decreased recipient survival, can be as severe as the direct effects, and thus require implementation of preventative practice guidelines. Universal prophylaxis against CMV has shown to be effective for preventing CMV disease and asymptomatic CMV replication, and can be considered the treatment of choice for preventing the indirect effects of this infection.
Subject(s)
Cytomegalovirus Infections/complications , Postoperative Complications/etiology , Transplantation , Antiviral Agents/therapeutic use , Bronchiolitis Obliterans/epidemiology , Bronchiolitis Obliterans/etiology , Cytomegalovirus Infections/drug therapy , Cytomegalovirus Infections/epidemiology , Cytomegalovirus Infections/immunology , Cytomegalovirus Infections/prevention & control , Cytomegalovirus Infections/virology , Graft Rejection/etiology , Heart Diseases/epidemiology , Heart Diseases/etiology , Humans , Immunocompromised Host , Incidence , Kidney Diseases/epidemiology , Kidney Diseases/etiology , Liver Diseases/epidemiology , Liver Diseases/etiology , Opportunistic Infections/epidemiology , Opportunistic Infections/etiology , Postoperative Complications/epidemiology , Postoperative Complications/virology , Premedication , Viremia/immunology , Virus Activation , Virus LatencyABSTRACT
La infección por citomegalovirus (CMV) es una complicación importante y frecuente en los receptores de trasplante de órgano sólido (TOS). La infección por este virus da lugar a unos efectos directos, debido a su inclusión en las células de los diferentes tejidos, y a una serie de efectos indirectos, provocados por la interacción de niveles bajos de viremia con la respuesta inmune del huésped. Estos efectos indirectos, entre los que se encuentran un aumento en la incidencia de rechazo del injerto, un mayor número de infecciones oportunistas, así como un descenso de la supervivencia del receptor, son tan graves como los efectos directos, por lo que es necesaria una pauta de actuación para poder prevenirlos. La profilaxis universal frente a CMV ha demostrado ser efectiva en la prevención tanto de la enfermedad como de la replicación asintomática del CMV, por lo que podría considerarse como alternativa de elección en la prevención de los efectos indirectos (AU)
Cytomegalovirus (CMV) infection is an important and frequent complication in solid organ transplant (SOT) recipients. This infection causes direct effects by viral inclusion in the cells of various tissues, as well as indirect effects by interaction between low levels of viremia and the host immune response. These indirect effects, such as increased incidence of graft rejection and opportunistic infections or decreased recipient survival, can be as severe as the direct effects, and thus require implementation of preventative practice guidelines. Universal prophylaxis against CMV has shown to be effective for preventing CMV disease and asymptomatic CMV replication, and can be considered the treatment of choice for preventing the indirect effects of this infection (AU)
