ORCID Profile
0000-0002-5386-7463
Current Organisations
University of Barcelona
,
Hospital Clínic de Barcelona
,
Barnaclínic
,
Universitat de Barcelona
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Publications
A Contemporary Picture of Enterococcal Endocarditis
Publisher: Elsevier BV
Date: 02-2020
Infective Endocarditis in Patients With Bicuspid Aortic Valve or Mitral Valve Prolapse
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.JACC.2018.03.534
Abstract: There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions. This study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions. This analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group n = 1,839), and IE with BAV (n = 54) or MVP (n = 89). BAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0% all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients. IE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered.
Aspergillus endocarditis in the recent years, report of cases of a multicentric national cohort and literature review
Publisher: Wiley
Date: 12-01-2022
DOI: 10.1111/MYC.13415
Abstract: (1) To describe the incidence, clinical characteristics, treatment and outcome of Aspergillus Endocarditis (AE) in a nationwide multicentric cohort (GAMES). (2) To compare the AE cases of the GAMES cohort, with the AE cases reported in the literature since 2010. (3) To identify variables related to mortality. We recruited 10 AE cases included in the GAMES cohort (January 2008‐December 2018) and 51 cases from the literature published from January 2010 to July 2019. 4528 patients with infectious endocarditis (IE) were included in the GAMES cohort, of them 10 (0.2%) were AE. After comparing our 10 cases with the 51 of the literature, no differences were found. Analysing the 61 AE cases together, 55.7% were male, median age 45 years. Their main underlying conditions were as follows: prosthetic valve surgery (34.4%) and solid organ transplant (SOT) (19.7%). Mainly affecting mitral (36.1%) and aortic valve (29.5%). Main isolated species were as follows: Aspergillus fumigatus (47.5%) and Aspergillus flavus (24.6%). Embolisms occurred in 54%. Patients were treated with antifungals (90.2%), heart surgery (85.2%) or both (78.7%). Overall, 52.5% died. A greater mortality was observed in immunosuppressed patients (59.4% vs. 24.1%, OR = 4.09, 95%CI = 1.26–13.19, p = .02), and lower mortality was associated with undergoing cardiac surgery plus azole therapy (28.1% vs. 65.5%, OR = 0.22, 95%CI = 0.07–0.72, p = .01). AE accounts for 0.2% of all IE episodes of a national multicentric cohort, mainly affecting patients with previous valvular surgery or SOT recipients. Mortality remains high especially in immunosuppressed hosts and azole‐based treatment combined with surgical resection are related to a better outcome.
Role of age and comorbidities in mortality of patients with infective endocarditis
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.EJIM.2019.03.006
Abstract: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. A total of 3120 patients with IE (1327 < 65 years 65-80 years ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years 20.5%,65-79 years 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years .1%,65-79 years .7%,≥80 years < 0.001) as well as 1-year mortality (3.2%, <65 years 5.5%, 65-80 years .6%,≥80 years p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78 % confidence interval [CI]:2.32-3.34), CCI ≥ 3 (HR:1.62 95% CI:1.39-1.88),and non-performed surgery (HR:1.64 % CI:11.16-1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group.
Outpatient Parenteral Antibiotic Treatment for Infective Endocarditis: A Prospective Cohort Study From the GAMES Cohort
Publisher: Oxford University Press (OUP)
Date: 14-01-2019
DOI: 10.1093/CID/CIZ030
Abstract: Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT). Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008–2012) was performed. A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56–76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32–54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT P .001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21 95% confidence interval [CI], 1.04–1.42 P = .01) and cardiac surgery (OR, 0.24 95% CI, .09–.63 P = .04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47 95% CI, .22–.98 P = .007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission. OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded.
Prevalence of Colorectal Neoplasms Among Patients With Enterococcus faecalis Endocarditis in the GAMES Cohort (2008–2017)
Publisher: Elsevier BV
Date: 2021
Infective Endocarditis in Patients on Chronic Hemodialysis
Publisher: Elsevier BV
Date: 04-2021
Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study
Publisher: Oxford University Press (OUP)
Date: 25-10-2017
DOI: 10.1093/CID/CIX913
Abstract: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment. We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome. Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal hotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects. L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients.
Mural Endocarditis: The GAMES Registry Series and Review of the Literature
Publisher: Springer Science and Business Media LLC
Date: 26-07-2021
Characteristics and Outcome of Streptococcus pneumoniae Endocarditis in the XXI Century
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2015
2023 ESC Guidelines for the management of endocarditis
Publisher: Oxford University Press (OUP)
Date: 25-08-2023
Gentamicin may have no effect on mortality of staphylococcal prosthetic valve endocarditis
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.JIAC.2018.03.003
Abstract: To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rif icin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE). From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-four patients (28.1%) received treatment based on β-lactam or vancomycin plus rif icin and were included in the study. Variables were analyzed which related to patient survival during admission, including having received treatment with gentamicin. Seventy-seven (81.9%) were treated with cloxacillin (or vancomycin) plus rif icin plus gentamicin, and 17 patients (18.1%) received the same regimen without gentamicin. The causative microorganism was Staphylococcus aureus in 40 cases (42.6%) and coagulase-negative staphylococci in 54 cases (57.4%). Overall, 40 patients (42.6%) died during hospital admission, 33 patients (42.9%) in the group receiving gentamicin and 7 patients in the group that did not (41.2%, P = 0.899). Worsening renal function was observed in 42 patients (54.5%) who received gentamicin and in 9 patients (52.9%) who did not (p = 0.904). Heart failure as a complication of endocarditis (OR: 4.58 CI 95%: 1.84-11.42) and not performing surgery when indicated (OR: 2.68 CI 95%: 1.03-6.94) increased mortality. Gentamicin administration remained unrelated to mortality (OR: 1.001 CI 95%: 0.29-3.38) in the multivariable analysis. The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rif icin in SPVE was not associated to better outcome.
Infective endocarditis in patients with cancer
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2017
Mitral valve repair in infective endocarditis is not inferior to valve replacement: results from a Spanish nationwide prospective registry
Publisher: Springer Science and Business Media LLC
Date: 21-01-2019
DOI: 10.1007/S11748-019-01063-0
Abstract: Infective endocarditis (IE) still carries high morbidity and mortality and frequently requires surgery. The benefit of mitral valve repair (MVr) in the setting of IE is yet to be proven. The goal of this study was to assess the results of MVr in patients with IE after a minimum follow-up of 1 year. This study is based on a Spanish nationwide prospective registry that included patients operated on for native mitral valve IE. The collaborating Institutions pooled their pre-, peri-, and postoperative data into the database of the GAMES group [Grupo de Apoyo al Manejo de la EndocarditiS (Group for support and management of infective endocarditis)]. Data from 27 hospitals were recorded and 3524 cases of active IE identified between 2008 and 2016. There were 1513 cases of mitral IE, of which 898 involved native valves. Of these, 437 patients underwent surgical treatment, and 369 completed the 1-year follow-up. The valve was repaired in 68 cases (18.4%). Preoperative groups were comparable (EuroSCORE MVr 7.7 vs MVR 8.0 p = ns). Mortality in the repair group was inferior to that in the replacement group (16.2% vs 27.2%, p = 0.058). At 1 year, mortality remained higher in the replacement group: 3.7% vs 2.9%. Relapse of the infection was slightly more frequent in the repair group (7.1% vs 3.7% p = ns), although this did not lead to higher rates of reintervention (MVr/MVR: 2.9% vs 4.9%). MVr is an attractive option for specific patients with IE and does not seem to negatively impact on relapses.
Related Organisations
Related Funding Activities
No related grants have been discovered for Eduard Quintana.