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J A Capdevila

Publications and source records attributed to J A Capdevila.

At least 19 recordsLinked to original sources
PubMed2006

Sporadic and epidemic community legionellosis: two faces of the same illness.

The present study compares the risk factors, presentation and outcome of community-acquired Legionella pneumophila pneumonia in 138 sporadic-case patients (1994-2004) and 113 outbreak-case patients (2002) treated in two hospitals in Catalonia (Spain) since urinary antigen assays were adopted. Univariate and multivariate analysis were performed to compare epidemiological and clinical features, blood chemistry values, radiological findings and outcome of sporadic and epidemic legionnaires' disease. Univariate analysis showed that male sex, chronic lung disease, HIV infection and immunosuppressive therapy prevailed in sporadic cases. Presentation with respiratory symptoms, confusion and blood chemistry alterations, such as hyponatraemia, aspartate aminotransferase and blood urea nitrogen elevation, and partial pressure of oxygen P(O)(2) <7.98 KPa (60 mmHg) were also more frequent in sporadic cases, while headache prevailed in outbreak cases. Sporadic cases had a greater delay in treatment, were more severe and had a worse outcome than epidemic cases. Multivariate analysis showed significant differences in sex, chronic lung disease, HIV infection and headache. The clinical and outcome differences between the two groups may be explained by the detection of milder forms of legionnaires' disease, the earlier treatment and the lower severity of underlying disease in the outbreak cases.

Adult↗
PubMed2001

Bacteremia caused by Capnocytophaga species in patients with neutropenia and cancer: results of a multicenter study.

We investigated 28 cases of bacteremia caused by Capnocytophaga species that occurred during an 8-year period, most of which were in patients with hematologic malignancy and neutropenia. Infections were uncomplicated, without serious organ involvement and without any apparent source except ulcerations of the oropharyngeal mucosa, and only 1 isolate showed resistance to beta-lactam antibiotics; 9 of 16 isolates were resistant to ciprofloxacin.

Adolescent↗
PubMed2001

Lack of antimicrobial activity of sodium heparin for treating experimental catheter-related infection due to Staphylococcus aureus using the antibiotic-lock technique.

OBJECTIVE: To elucidate the potential antimicrobial activity of sodium heparin in the treatment of catheter-infection using the antibiotic-lock technique. METHODS: We performed in vitro studies of the antibiotic susceptibility, stability and synergy of sodium heparin, vancomycin and ciprofloxacin. Efficacy studies were performed in a new animal model of Staphylococcus aureus catheter-related infection in which infection was produced via the endoluminal route. White New Zealand rabbits were surgically implanted with a sylastic catheter into the inferior cava vein. Immediately afterwards, infection was induced by filling and locking the catheters with 0.7 mL of broth culture containing 108 colony-forming units of S. aureus. Eighteen hours later the antibiotic-lock technique was started. Treatment groups were: control without treatment, sodium heparin at 2500 IU/mL, vancomycin at 2500 mg/L, ciprofloxacin at 1000 mg/L, vancomycin plus heparin and ciprofloxacin plus heparin. RESULTS: Sodium heparin showed an MIC90 higher than 6000 UI/mL against S. aureus causing catheter infection. Studies of antimicrobial synergy by the time-kill method between vancomycin and ciprofloxacin at MIC with sodium heparin at 2500 IU/mL showed no interactions. Vancomycin (2000 microg/mL) and ciprofloxacin (1000 microg/mL) in a solution containing sodium heparin (2500 IU/mL) were stable at 37 degrees C for a 72-h period. Two sets of in vivo experiments were carried out using differents strains of S. aureus. In both cases, sodium heparin showed no therapeutic efficacy when compared to control group and did not increase the antibiotic efficacy when used in combination with vancomycin or ciprofloxacin. CONCLUSION: Sodium heparin lacked antibacterial activity against S. aureus causing catheter-related infections.

Animals↗
PubMed2000

[A pancreatic pseudotumour of tuberculous etiology].

BACKGROUND: To review the clinical findings of pancreatic tuberculosis and to establish a differential diagnosis with pancreatic tumours. PATIENTS AND METHODS: To describe three cases of pancreatic tuberculosis diagnosed in a 850 bed teaching hospital during the last two years. RESULTS: In the three case the imaging procedures showed a pancreatic mass with hypodense area. One of the cases was erroneously initially diagnosed of a pancreatic tumour. In one case was diagnosed by a subcutaneous abscess puncture, in another by clinical suspicion and in third patient by laparotomy. Only one patient was immunosuppressed. All patients were cured with standard antituberculous therapy. CONCLUSIONS: Pancreatic tuberculosis should be considered in patients presenting with pancreatic tumours.

Aged↗
PubMed2000

[Infections related to parenteral nutrition catheter].

Infectious complications related to total parenteral nutrition (TPN) catheters were prospectively evaluated during a four-month period in a third level teaching hospital in which a protocol on parenteral nutrition is implemented. The study included 102 catheters inserted for a total of 1,448 days (mean 12.06 day/catheter). Local pain, redness, and fever were recorded among 1.9%, 9.8% and 10.7% of cases, respectively. In no case were the defined criteria for catheter related sepsis fulfilled. Catheter tips were cultured in 72.5% of the studied catheters. Tip colonization was observed in 4.1% of cultured tips whereas infection was detected in 8% of them according to microbiological criteria. During the same time period in the hospital, 15 episodes of catheter bacteremia among 6,874 inpatients were observed which were not related to parenteral nutrition, which represents 0.22% of inpatients. The conclusion of our study is that adhering to a parenteral nutrition protocol, with special emphasis in catheter and connection management involves a very low incidence of infectious complications related to parenteral nutrition.

Bacterial Infections↗
PubMed1999

Efficacy of ampicillin plus ceftriaxone in treatment of experimental endocarditis due to Enterococcus faecalis strains highly resistant to aminoglycosides.

The purpose of this work was to evaluate the in vitro possibilities of ampicillin-ceftriaxone combinations for 10 Enterococcus faecalis strains with high-level resistance to aminoglycosides (HLRAg) and to assess the efficacy of ampicillin plus ceftriaxone, both administered with humanlike pharmacokinetics, for the treatment of experimental endocarditis due to HLRAg E. faecalis. A reduction of 1 to 4 dilutions in MICs of ampicillin was obtained when ampicillin was combined with a fixed subinhibitory ceftriaxone concentration of 4 micrograms/ml. This potentiating effect was also observed by the double disk method with all 10 strains. Time-kill studies performed with 1 and 2 micrograms of ampicillin alone per ml or in combination with 5, 10, 20, 40, and 60 micrograms of ceftriaxone per ml showed a > or = 2 log10 reduction in CFU per milliliter with respect to ampicillin alone and to the initial inoculum for all 10 E. faecalis strains studied. This effect was obtained for seven strains with the combination of 2 micrograms of ampicillin per ml plus 10 micrograms of ceftriaxone per ml and for six strains with 5 micrograms of ceftriaxone per ml. Animals with catheter-induced endocarditis were infected intravenously with 10(8) CFU of E. faecalis V48 or 10(5) CFU of E. faecalis V45 and were treated for 3 days with humanlike pharmacokinetics of 2 g of ampicillin every 4 h, alone or combined with 2 g of ceftriaxone every 12 h. The levels in serum and the pharmacokinetic parameters of the humanlike pharmacokinetics of ampicillin or ceftriaxone in rabbits were similar to those found in humans treated with 2 g of ampicillin or ceftriaxone intravenously. Results of the therapy for experimental endocarditis caused by E. faecalis V48 or V45 showed that the residual bacterial titers in aortic valve vegetations were significantly lower in the animals treated with the combinations of ampicillin plus ceftriaxone than in those treated with ampicillin alone (P < 0.001). The combination of ampicillin and ceftriaxone showed in vitro and in vivo synergism against HLRAg E. faecalis.

Algorithms↗
PubMed1999

[Eikenella corrodens: five year experience in a general hospital].

BACKGROUND: Eikenella corrodens is a Gram negative bacillus that colonizes oropharyngeal and digestive mucous membranes. It is difficult to isolate in the laboratory. This might be the reason why its implication in different types of infection is not well known. We report a five year experience in a general hospital. METHODS: Charts of 125 infections have been retrospectively reviewed. No selective medium was employed for the isolation. RESULTS: Infections were related to oral cavity in 68 patients (54%) and to gastrointestinal tract in 45 (36%); in 12 no clear source could be found. The prevailing infections were: postsurgical 32, apendiceal 22, abscesses 22, and traumatic wounds 12. Seventy two percent of the patients were adults and 93% were hospitalized. Eighteen patients had a neoplasia, 6 were diabetic, and 3 had some kind of immunodeficiency. Etiology was polymicrobial in 91% of the cases, the prevailing association being with Streptococcus spp. (74%). Only 15 patients had a pure culture, 11 of which had received previous antibiotic treatment. The most serious infections were a subdural empyema secondary to sinusitis, a mediastinitis following a mouth floor abscess, and a peritonitis with pleural empyema preceded by an hepatic abscess. The three were polymicrobial. Outcome was always satisfactory with no associated death. CONCLUSIONS: The origin of these infections is almost always clearly related with its habitat, but their spectrum is wide. Polymicrobial condition of most of them makes diagnosis as well as interpretation of its clinical meaning difficult. Nevertheless, association of E. corrodens with serious or slow healing infections fully justifies the efforts towards its isolation and the choice of antibiotics to which it is susceptible.

Adult↗
PubMed1998

[Enterobacter amnigenus. An unusual human pathogen].

BACKGROUND: Enterobacter amnigenus is a bacteria with doubtful pathogenicity. The observation of a patient with a well-documented E. amnigenus infection has prompted us to review the pathology caused by this microorganism. METHODS: Retrospective evaluation of the clinical charts of patients with any isolate positive for E. amnigenus over a period of 46 months. Based on the clinical data, presence or absence of other causal microorganisms and/or alternative diagnosis, E. amnigenus was classified as definitive, probable, or improbable cause of infection. RESULTS: We analyzed 15 E. amnigenus isolates, representing 0.97 of 10,000, the total bacterial isolates in our laboratory for this period, and 0.52% of those corresponding to Enterobacter sp. We were able to clinically evaluate E. amnigenus in 7 patients, in whom infection by this microorganism was classified as definitive in 4, probable in 1, and improbable in 2. Antibiotic susceptibility studies showed a resistance level of 83% to ampicillin, 75% to cefazoline and cefoxitine, and 33% to amoxicillin-clavulanic acid. All isolates were susceptible to third-generation cephalosporins, aztreonam, ciprofloxacin, cotrimoxazole and aminoglycosides. CONCLUSIONS: E. amnigenus cause well-documented bacterial infection in man. Thus, isolation of this microorganism should not be considered as a contaminant or simple colonizer. The clinical behavior and antimicrobial susceptibility of E. amnigenus is similar to that of E. cloacae, a taxonomically-related species.

Aged↗
PubMed1997

Treatment of experimental pneumonia due to penicillin-resistant Streptococcus pneumoniae in immunocompetent rats.

A model of pneumonia due to Streptococcus pneumoniae resistant to penicillin was developed in immunocompetent Wistar rats and was used to evaluate the efficacies of different doses of penicillin, cefotaxime, cefpirome, and vancomycin. Adult Wistar rats were challenged by intratracheal inoculation with 3 x 10(9) CFU of one strain of S. pneumoniae resistant to penicillin (MICs of penicillin, cefotaxime, cefpirome, and vancomycin, 2, 1, 0.5, and 0.5 microg/ml, respectively) suspended in brain heart broth supplemented with 0.7% agar. The rats experienced a fatal pneumonia, dying within 5 days and with peak mortality (70 to 80%) occurring 48 to 72 h after infection, and the bacterial counts in the lungs persisted from 8.87 +/- 0.3 log10 CFU/g of lung at 24 h of the infection to 9.1 +/- 0.3 log10 CFU/g at 72 h. Four hours after infection the animals were randomized into the following treatment groups: (i) control without treatment, (ii) penicillin G at 100,000 IU/kg of body weight every 2 h, (iii) penicillin G at 250,000 IU/kg every 2 h, (iv) cefotaxime at 100 mg/kg every 2 h, (v) cefpirome at 200 mg/kg every 2 h, and (vi) vancomycin at 50 mg/kg every 8 h. Two different protocols were used for the therapeutic efficacy studies: four doses of beta-lactams and one dose of vancomycin or eight doses of beta-lactams and two doses of vancomycin. Results of the therapy for experimental pneumonia caused by penicillin-resistant S. pneumoniae showed that initially, all the antimicrobial agents tested had similar efficacies, but when we prolonged the treatment, higher doses of penicillin, cefotaxime, and cefpirome were more effective than penicillin at lower doses in decreasing the residual bacterial titers in the lungs. Also, when we extended the treatment, vancomycin was more efficacious than penicillin at lower doses but was less efficacious than higher doses of penicillin or cefpirome. The model that we have developed is simple and amenable for inducing pneumonia in immunocompetent rats and could be used to explore the pathophysiology and to evaluate optimal therapy of this infection in the immunocompetent host.

Animals↗
PubMed1997

Rhodococcus equi pneumonia in patients infected with the human immunodeficiency virus. Report of 2 cases and review of the literature.

Rhodococcus equi is a cause of lung infection in immunosuppressed hosts. Since the start of the HIV epidemic, 76 cases of R. equi lung infection (MEDLINE 1985-96) affecting this population have been described. We report 2 additional cases and review the clinical data, radiological findings, treatment and outcome of these 78 patients. The mean age of these patients was 33 y; 69 were male. 71 met the criteria for AIDS (CDC 1993). Fever and cough were the presenting complaints in the majority of patients (84.3%). A single cavitary lung lesion in the upper lobes was the most common radiological finding (57.7%), although multiple cavitations, alveolar infiltrates and pleural effusion were also found. Treatment usually was based on synergistic antibiotic combinations for a long period of time determined on an individual basis. Surgery was performed only in 11 patients. Death attributable directly to R. equi infection is low (15.4%), however only half of the patients (53.8%) were completely cured. We conclude that R. equi infection should be strongly considered in any HIV patient who presents with cavitary lesions in the lung, especially if mycobacteria are not identified. Treatment must be based on synergistic antibiotic combinations, and surgery relegated to cases of chronic single cavitary lesions not responding to antibiotics.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[Thrombosis of the superior longitudinal sinus in patients with AIDS. A review of the literature].

Cerebral dural sinus thrombosis (CSDT) is a rare disease with a high rate of mortality. Until now it has not been well-documented in patients with the acquired immunodeficiency syndrome (AIDS). Prompt diagnosis is essential for initiation of suitable treatment, especially in cases with progressive neurological involvement. The diagnostic methods include computed tomography (CT), magnetic resonance imaging (MRI) and conventional angiography. MRI and magnetic resonance angiography (MRA) have become the methods of choice because of their sensitivity and noninvasive nature. An unusual AIDS-patient, who at the time of CSDT presentation had an associated toxoplasmosis infection is described. To our knowledge, this is the first case of CSDT diagnosed by MRI and MRA in an AIDS patient. In the follow-up, MRI and MRA showed the repermeabilitation of the sinus thrombosis. Cerebral dural sinus thrombosis should be considered as a possible cause of neurological decline in a HIV-patient with central nervous system opportunistic infection.

Acquired Immunodeficiency Syndrome↗