Rafael Juan

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Papers by Rafael Juan

Tuberculosis after Solid‐Organ Transplant: Incidence, Risk Factors, and Clinical Characteristics in the RESITRA (Spanish Network of Infection in Transplantation) Cohort

Clinical Infectious Diseases, 2009

Background. It is necessary to clarify the incidence of and risk factors for tuberculosis (TB) am... more Background. It is necessary to clarify the incidence of and risk factors for tuberculosis (TB) among solidorgan transplant (SOT) recipients as well as changes in the chronology, clinical presentation, and prognosis of the disease. Methods. A total of 4388 SOT recipients were monitored prospectively at 16 transplant centers included in the Spanish Network for Research in Infectious Diseases (REIPI). TB episodes were studied, and the incidence rate was calculated. Certain variables were analyzed, by Cox regression analysis, as potential risk factors for TB. Results. Among the 4388 SOT recipients, 21 cases of TB were reported (0.48%). The median duration of follow-up was 360 days (range, 0-720 days). The global incidence of TB was 512 cases per 10 5 patients per year (95% confidence interval [CI], 317-783), which was higher than that in the general population in Spain (18.9 cases per 10 5 inhabitants per year; relative risk [RR], 26.6). The highest incidence (2072 cases per 10 5 patients per year; 95% CI, 565-5306) was observed among lung transplant recipients (RR, 73.3). Of the TB cases, 95% occurred within the first year after transplant, and 76% were pulmonary forms. Crude mortality was 19.0%, and attributable mortality was 9.5%. Multivariate analysis identified recipient age (RR, 1.05; 95% CI, 1.0-1.1) and receipt of a lung transplant (RR, 5.6; 95%, 1.9-16.9) as independent risk factors. Conclusions. TB incidence is increased among SOT recipients. The risk factors identified were age and receipt of a lung transplant. TB-attributable mortality (9.5%) is still high. The incidence of tuberculosis (TB) among solid-organ transplant (SOT) recipients has not been well defined. Previous studies have calculated the relative frequency of TB rather than its incidence . Furthermore,

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Preemptive approach against toxoplasmosis in allogeneic hematopoietic cell transplantation. Still far away from experience in CMV. Commentary on: toxoplasmosis after allogeneic hematopoietic cell transplantation: experience using a PCR-guided pre-emptive approach

Clinical Microbiology and Infection

Experience With Moxifloxacin for the Treatment of Latent Tuberculosis Infection in Liver Transplantation: A Single‐Center Prospective Study

Liver Transplantation, 2020

Active tuberculosis (TB) after liver transplantation (LT) is associated with poor outcomes. Most ... more Active tuberculosis (TB) after liver transplantation (LT) is associated with poor outcomes. Most cases arise from the reactivation of latent tuberculosis infection (LTBI). Current guidelines recommend LTBI treatment for all LT candidates with compensated cirrhosis, with isoniazid plus pyridoxine as the preferred regimen. Nevertheless, both completion rates and tolerability are low. Fluoroquinolones exhibit good antimycobacterial activity and favorable safety profile. We report our single-center experience with a 9-month moxifloxacin regimen (400 mg daily) for the treatment of LTBI in the LT setting. Between 2015 and 2019, 28 candidates and 10 recipients received moxifloxacin for a median of 260 days (interquartile range: 180 - 274). The 9-month course was completed in 60.5% (23/38) of patients. Adverse events (AEs) requiring permanent treatment discontinuation occurred in 21.0% (8/38) of patients (Clostridioides difficile infection [5 cases], diffuse arthralgias [2 cases], and hemat...

[Cloxacillin-susceptible Staphylococcus aureus with high MIC to glycopeptides. Ever we use cloxacillin?]

Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia, 2015

Staphylococcus aureus infections are yet an important cause of morbidity and mortality despite of... more Staphylococcus aureus infections are yet an important cause of morbidity and mortality despite of numerous effective anti-staphylococcal antibiotics available. There has been an increasing incidence of methicillin-resistant strains which might have led to a wider use of vancomycin. This seems to ride alongside a covert progressive increase of S. aureus vancomycin minimum inhibitory concentration. In this way, the emergence of vancomycin-intermediate S. aureus (VISA) strains and heteroresistant-VISA has raised concern for the scarcity of alternative treatment options. Equally alarming, though fortunately less frequent, is the emergence of vancomycin-resistant S. aureus. Ultimately, various debate issues have arisen regarding the emergence of S. aureus strains with decreased vancomycin susceptibility, within the range still considered sensitive. These strains have shown a different clinical behaviour regardless of vancomycin use, both in methicillin resistant and sensitive S. aureus. ...

T cell–mediated response to SARS‐CoV‐2 in liver transplant recipients with prior COVID‐19

American Journal of Transplantation

Whether immunosuppression impairs severe acute respiratory syndrome coronavirus 2‐specific T cell... more Whether immunosuppression impairs severe acute respiratory syndrome coronavirus 2‐specific T cell–mediated immunity (SARS‐CoV‐2‐CMI) after liver transplantation (LT) remains unknown. We included 31 LT recipients in whom SARS‐CoV‐2‐CMI was assessed by intracellular cytokine staining (ICS) and interferon (IFN)‐γ FluoroSpot assay after a median of 103 days from COVID‐19 diagnosis. Serum SARS‐CoV‐2 IgG antibodies were measured by ELISA. A control group of nontransplant immunocompetent patients were matched (1:1 ratio) by age and time from diagnosis. Post‐transplant SARS‐CoV‐2‐CMI was detected by ICS in 90.3% (28/31) of recipients, with higher proportions for IFN‐γ‐producing CD4+ than CD8+ responses (93.5% versus 83.9%). Positive spike‐specific and nucleoprotein‐specific responses were found by FluoroSpot in 86.7% (26/30) of recipients each, whereas membrane protein‐specific response was present in 83.3% (25/30). An inverse correlation was observed between the number of spike‐specific IFN‐γ‐producing SFUs and time from diagnosis (Spearman's rho: −0.418; p value = .024). Two recipients (6.5%) failed to mount either T cell–mediated or IgG responses. There were no significant differences between LT recipients and nontransplant patients in the magnitude of responses by FluoroSpot to any of the antigens. Most LT recipients mount detectable—but declining over time—SARS‐CoV‐2‐CMI after a median of 3 months from COVID‐19, with no meaningful differences with immunocompetent patients.

Inhaled budesonide for early treatment of COVID-19

The Lancet Respiratory Medicine

CMV infection, valganciclovir exposure, and the risk of BK viremia and associated nephropathy after kidney transplantation: Is there a link?

Transplant Infectious Disease

Immunomodulatory effects attributable to cytomegalovirus (CMV) would predispose to BK polyomaviru... more Immunomodulatory effects attributable to cytomegalovirus (CMV) would predispose to BK polyomavirus (BKPyV) infection after kidney transplantation (KT), although available evidence is conflicting. It has been suggested that (val)ganciclovir therapy may increase the risk of BKPyV viremia and BKPyV‐associated nephropathy (BKPyVAN) as a result of drug‐induced T‐cell impairment.

Tocilizumab for the treatment of adult patients with severe COVID‐19 pneumonia: A single‐center cohort study

Journal of Medical Virology

Coronavirus disease 2019 (COVID‐19) can lead to a massive cytokine release. The use of the anti‐i... more Coronavirus disease 2019 (COVID‐19) can lead to a massive cytokine release. The use of the anti‐interleukin‐6 receptor monoclonal antibody tocilizumab (TCZ) has been proposed in this hyperinflammatory phase, although supporting evidence is limited. We retrospectively analyzed 88 consecutive patients with COVID‐19 pneumonia that received at least one dose of intravenous TCZ in our institution between 16 and 27 March 2020. Clinical status from day 0 (first TCZ dose) through day 14 was assessed by a 6‐point ordinal scale. The primary outcome was clinical improvement (hospital discharge and/or a decrease of ≥2 points on the 6‐point scale) by day 7. Secondary outcomes included clinical improvement by day 14 and dynamics of vital signs and laboratory values. Rates of clinical improvement by days 7 and 14 were 44.3% (39/88) and 73.9% (65/88). Previous or concomitant receipt of subcutaneous interferon‐β (adjusted odds ratio [aOR]: 0.23; 95% confidence interval [CI]: 0.06‐0.94; P = .041) and serum lactate dehydrogenase more than 450 U/L at day 0 (aOR: 0.25; 95% CI: 0.06‐0.99; P = .048) were negatively associated with clinical improvement by day 7. All‐cause mortality was 6.8% (6/88). Body temperature and respiratory and cardiac rates significantly decreased by day 1 compared to day 0. Lymphocyte count and pulse oximetry oxygen saturation/FiO2 ratio increased by days 3 and 5, whereas C‐reactive protein levels dropped by day 2. There were no TCZ‐attributable adverse events. In this observational single‐center study, TCZ appeared to be useful and safe as immunomodulatory therapy for severe COVID‐19 pneumonia.

Daptomycin Plus Fosfomycin Versus Daptomycin Alone for Methicillin-resistant Staphylococcus aureus Bacteremia and Endocarditis: A Randomized Clinical Trial

Clinical Infectious Diseases

Background We aimed to determine whether daptomycin plus fosfomycin provides higher treatment suc... more Background We aimed to determine whether daptomycin plus fosfomycin provides higher treatment success than daptomycin alone for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and endocarditis. Methods A randomized (1:1) phase 3 superiority, open-label, and parallel group clinical trial of adult inpatients with MRSA bacteremia was conducted at 18 Spanish hospitals. Patients were randomly assigned to receive either 10 mg/kg of daptomycin intravenously daily plus 2 g of fosfomycin intravenously every 6 hours, or 10 mg/kg of daptomycin intravenously daily. Primary endpoint was treatment success 6 weeks after the end of therapy. Results Of 167 patients randomized, 155 completed the trial and were assessed for the primary endpoint. Treatment success at 6 weeks after the end of therapy was achieved in 40 of 74 patients who received daptomycin plus fosfomycin and in 34 of 81 patients who were given daptomycin alone (54.1% vs 42.0%; relative risk, 1.29 [95% confidence interval...

Combination therapy with tocilizumab and corticosteroids for aged patients with severe COVID-19 pneumonia: a single-center retrospective study

Background: The role of combination immunomodulatory therapy with systemic corticosteroids and to... more Background: The role of combination immunomodulatory therapy with systemic corticosteroids and tocilizumab (TCZ) for aged patients with COVID19 associated cytokine release syndrome remains unclear. Methods: We conducted a retrospective single center study including consecutive patients older than 65 years that developed severe COVID19 between March 3 and May 1, 2020 and were treated with corticosteroids at various doses (methylprednisolone [0.5 mg/Kg/12 hours to 250 mg/24 hours]), either alone (CS group) or associated to intravenous tocilizumab (400 to 600 mg, one to three doses) (CS/TCZ group). Primary outcome was all cause mortality by day +14, whereas secondary outcomes included mortality by day +28 and clinical improvement (discharge and/or a 2 point decrease on a six point ordinal scale) by day +14. Propensity score (PS)based adjustment and inverse probability of treatment weights (IPTW) were applied. Results: Overall, 181 and 80 patients were included in the CS and CS TCZ grou...

A new clinical and immuno-virological score for predicting the risk of late severe infection in solid organ transplant recipients: the CLIV Score

The Journal of Infectious Diseases

Background We aimed at constructing a composite score based on EBVd and simple clinical and immun... more Background We aimed at constructing a composite score based on EBVd and simple clinical and immunological parameters to predict late severe infection (LI) beyond month 6 in SOT recipients. Methods Kidney and liver transplant recipients between May 2014-August 2016 at four participating centers were included. Serum immunoglobulins and complement factors, peripheral blood lymphocyte subpopulations, and whole-blood EBVd were determined at months 1, 3 and 6. Cox regression analyses were performed to generate a weighted score for the prediction of LI. Results Overall, 309 SOT recipients were followed-up for a median of 1,000 days from transplant (IQR: 822-1124). LI occurred in 104 patients (33.6%). The CLIV score consisted of the following variables at month 6: high-level EBVd (>1,500 IU/ml) and recurrent infection during the previous months (6 points); recipient age ≥70 years and chronic graft dysfunction (5 points); CMV mismatch (4 points); and CD8+ T-cell count <400 cells/μL (2 ...

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Monitoring of CMV‐specific cell‐mediated immunity with a commercial ELISA‐based interferon‐γ release assay in kidney transplant recipients treated with antithymocyte globulin

American Journal of Transplantation

Monitoring for cytomegalovirus (CMV)‐specific cell‐mediated immunity (CMV‐CMI) may be useful for ... more Monitoring for cytomegalovirus (CMV)‐specific cell‐mediated immunity (CMV‐CMI) may be useful for individualizing valganciclovir (VGCV) prophylaxis after kidney transplantation (KT). We performed a commercial ELISA‐based interferon (IFN)‐γ release assay (QTF‐CMV) from posttransplant months 2‐5 (362 points) in 120 CMV‐seropositive KT recipients that received antithymocyte globulin as induction therapy and VGCV prophylaxis (median of 92 days). Forty‐seven patients (39.3%) had CMV infection after discontinuation of prophylaxis. The QTF‐CMV assay was reactive, nonreactive, and indeterminate in 264 (72.9%), 90 (24.9%), and 8 points (2.2%). The QTF‐CMV assay at prophylaxis discontinuation exhibited suboptimal accuracy for predicting protective CMV‐CMI (sensitivity: 77.4%; specificity: 34.3%; positive predictive value [PPV]: 64.1%; negative predictive value [NPV]: 50.0%), with no differences in 1‐year CMV infection rates between patients with negative (nonreactive or indeterminate) or reactive results (45.8% vs 36.1%; P = .244). Specificity and PPV to predict protective CMV‐CMI improved by elevating the IFN‐γ cutoff value to 1.13 IU/mL (65.7% and 71.4%) and 7.0 IU/mL (85.7% and 76.2%), although NPVs decreased. The QTF‐CMV assay as per manufacturer's interpretative criteria performed poorly to predict protection from CMV infection following discontinuation of VGCV prophylaxis among ATG‐treated CMV‐seropositive KT recipients. This performance is slightly improved by modifying the IFN‐γ positivity threshold.

Fluoroquinolones for the treatment of latent Mycobacterium tuberculosis infection in liver transplantation

World Journal of Gastroenterology

Author contributions: Silva JT was responsible for the literature review and the drafting and wri... more

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A short course of antibiotic treatment is safe after catheter withdrawal in catheter-related bloodstream infections due to coagulase-negative staphylococci

European Journal of Clinical Microbiology & Infectious Diseases

CoNS is the main cause of catheter-related bloodstream infections (CRBSI). Current guidelines rec... more CoNS is the main cause of catheter-related bloodstream infections (CRBSI). Current guidelines recommend catheter withdrawal followed by antibiotics for at least 5 days. We aimed to assess the efficacy and safety of a shorter course of antibiotherapy in patients with CoNS CRBSI. All proven cases of CoNS CRBSI at our institution (Jan 12/Dec 17) were retrospectively analysed. Comparison of clinical characteristics and outcomes between patients receiving a short (SC ≤ 3 days) versus long antibiotic course (LC > 3 days) was performed. Cox regression models predicting the risk for complications (including propensity score [PS] for treatment assignment as covariate) were designed to adjust baseline differences among both treatment groups. A total of 79 cases were included. Most patients (75.9%) showed clinical response at day 7 after catheter removal. Complications occurred in 3.8% (three cases of septic thrombophlebitis) with no cases of endocarditis. Microbiological relapse (MR) occurred in 13 patients (16.5%). SC and LC were administered to 25 (31.6%) and 54 (68.4%) patients, respectively, with no significant differences in MR-free survival between SC and LC groups (87.8 vs 86.3%; P = 0.6). In PS-adjusted Cox regression analyses, a tunnelled catheter as the source of CRBSI was the only independent risk factor for MR (hazard ratio, 5.71; 95% confidence interval, 1.6–21) whereas the duration of therapy had no apparent impact. Shortening antibiotic therapy to ≤ 3 days is not associated with a poorer outcome or a greater risk of MR in patients with CoNS CRBI with catheter withdrawal.

Monitoring of alphatorquevirus DNA levels for the prediction of immunosuppression-related complications after kidney transplantation

American Journal of Transplantation

The replication kinetics of nonpathogenic anelloviruses belonging to the Alphatorquevirus genus (... more The replication kinetics of nonpathogenic anelloviruses belonging to the Alphatorquevirus genus (such as torque teno virus) might reflect the overall state of posttransplant immunosuppression. We analyzed 221 kidney transplant (KT) recipients in whom plasma alphatorquevirus DNA load was quantified by real-time polymerase chain reaction at baseline and regularly through the first 12 posttransplant months. Study outcomes included posttransplant infection and a composite of opportunistic infection and/or de novo malignancy (immunosuppression-related adverse event [iRAE]). Alphatorquevirus DNA loads at month 1 were higher among patients who subsequently developed posttransplant infection (P = .023) or iRAE (P = .009). Likewise, those with iRAE beyond months 3 and 6 also exhibited higher peak viral loads over the preceding periods. Areas under the curve for log alphatorquevirus DNAemia estimated by months 1 or 6 were significantly higher in patients experiencing study outcomes. Alphatorquevirus DNA loads above 3.15 and 4.56 log copies/mL at month 1 predicted the occurrence of posttransplant infection (adjusted hazard ratio [aHR]: 2.88; 95% confidence interval [CI]: 1.13-7.36; P = .027) and iRAE (aHR: 5.17; 95% CI: 2.01-13.33; P = .001). In conclusion, posttransplant monitoring of plasma alphatorquevirus DNA kinetics may be useful to identify KT recipients at increased risk of immunosuppression-related complications.

Vitamin D deficiency and infection risk in kidney transplant recipients: a single-center cohort study

Transplant infectious disease : an official journal of the Transplantation Society, Jan 5, 2018

Recent studies have reported an increased susceptibility to infection among vitamin D-deficient k... more Recent studies have reported an increased susceptibility to infection among vitamin D-deficient kidney transplant (KT) recipients, although methodological concerns remain. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured in 246 KT recipients at post-transplant months 1, 3, 6 and 12. Vitamin D status was analysed in terms of deficiency (Endocrine Society [<20 ng/mL] and Institute of Medicine [<12 ng/mL] criteria) and as a continuous variable. Cox models for overall, bacterial and opportunistic infection were adjusted for nutritional status and immunosuppression-related covariates. Median serum 25(OH)D increased from month 1 (10.5 ng/mL) to month 6 (16.3 ng/mL; P-value = 0.001). Prevalence of vitamin D deficiency at month 1 ranged from 87.0% to 61.0% (depending on the diagnostic criteria) and significantly decreased over the next months. After adjustment for age and nutritional status, vitamin D deficiency (serum 25(OH)D <12 ng/mL) at month 1 was an independent risk f...

Diagnosis and management of asymptomatic bacteriuria in kidney transplant recipients: a survey of current practice in Europe

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Apr 9, 2018

Asymptomatic bacteriuria is frequent in kidney transplant recipients (KTRs). However, there is no... more Asymptomatic bacteriuria is frequent in kidney transplant recipients (KTRs). However, there is no consensus on diagnosis or management. We conducted a European survey to explore current practice related to the diagnosis and management of asymptomatic bacteriuria in adult KTRs. A panel of experts from the European Renal Association-European Dialysis Transplant Association/Developing Education Science and Care for Renal Transplantation in European States working group and the European Study Group for Infections in Compromised Hosts of the European Society of Clinical Microbiology and Infectious Diseases designed this cross-sectional, questionnaire-based, self-administered survey. Invitations to participate were e-mailed to European physicians involved in the care of KTRs. Two hundred and forty-four participants from 138 institutions in 25 countries answered the survey (response rate 30%). Most participants [72% (176/244)] said they always screen for asymptomatic bacteriuria in KTRs. S...

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Experience with leflunomide as treatment and as secondary prophylaxis for cytomegalovirus infection in lung transplant recipients: a case series and review of the literature

Clinical transplantation, Jan 11, 2017

Data concerning the use of leflunomide -a drug approved for rheumatoid arthritis with in vitro an... more Data concerning the use of leflunomide -a drug approved for rheumatoid arthritis with in vitro anti-cytomegalovirus (CMV) activity- in lung transplant (LT) recipients are scarce. We performed a single center retrospective study including LT recipients who received leflunomide for CMV infection or as secondary prophylaxis after viremia clearance. We also conducted a full systematic PubMed search until June 30, 2017. We identified 5 LT recipients in our center, plus 7 patients reported in the literature. All patients had previously received ganciclovir (GCV) and foscarnet, with drug-induced adverse effects described in 6 recipients (50%). Antiviral resistance mutations were observed in 8 patients (66.7%). Leflunomide was prescribed for CMV infection in 9 of 12 patients (75%) and as secondary prophylaxis in 3 patients (25%). Initial decrease of CMV viremia after starting leflunomide was observed in 7 of 9 recipients (77.7%), although this response was only transient in two patients. Lo...

Dalbavancin in the treatment of different gram-positive infections: a real-life experience

International journal of antimicrobial agents, Jan 24, 2017

Dalbavancin is a lipoglycopeptide with a very prolonged half-life that enables treatments with a ... more Dalbavancin is a lipoglycopeptide with a very prolonged half-life that enables treatments with a single IV administration that has been approved to treat complicated skin and soft tissue infections. Information on the efficacy and safety of Dalbavancin in other situations is very scarce. This retrospective study includes adult patients who received at least one dose of Dalbavancin between 2016 and 2017 in 29 institutions in Spain. Primary objective was to report the use of Dalbavancin in clinical practice including its efficacy and tolerability. We also tried to evaluate the potential impact of Dalbavancin on reduction of length of hospital stay and hospital costs. A total of 69 patients received Dalbavancin during the study period (58% male, median age 63.5 years). Dalbavancin was used to treat prosthetic joint infections (29.0%), acute bacterial skin and skin structure infection (21.7%), osteomyelitis (17.4%) and catheter-related bacteraemia (11.6%). These infections were mainly c...

Listeria monocytogenes bacteraemia over an 11-year period: Clinical and epidemiologic characteristics in the south area of Madrid

Journal of Infection

Tuberculosis after Solid‐Organ Transplant: Incidence, Risk Factors, and Clinical Characteristics in the RESITRA (Spanish Network of Infection in Transplantation) Cohort

Clinical Infectious Diseases, 2009

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Clinical Microbiology and Infection

Experience With Moxifloxacin for the Treatment of Latent Tuberculosis Infection in Liver Transplantation: A Single‐Center Prospective Study

Liver Transplantation, 2020

[Cloxacillin-susceptible Staphylococcus aureus with high MIC to glycopeptides. Ever we use cloxacillin?]

Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia, 2015

T cell–mediated response to SARS‐CoV‐2 in liver transplant recipients with prior COVID‐19

American Journal of Transplantation

Inhaled budesonide for early treatment of COVID-19

The Lancet Respiratory Medicine

CMV infection, valganciclovir exposure, and the risk of BK viremia and associated nephropathy after kidney transplantation: Is there a link?

Transplant Infectious Disease

Tocilizumab for the treatment of adult patients with severe COVID‐19 pneumonia: A single‐center cohort study

Journal of Medical Virology

Daptomycin Plus Fosfomycin Versus Daptomycin Alone for Methicillin-resistant Staphylococcus aureus Bacteremia and Endocarditis: A Randomized Clinical Trial

Clinical Infectious Diseases

Combination therapy with tocilizumab and corticosteroids for aged patients with severe COVID-19 pneumonia: a single-center retrospective study

A new clinical and immuno-virological score for predicting the risk of late severe infection in solid organ transplant recipients: the CLIV Score

The Journal of Infectious Diseases

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Monitoring of CMV‐specific cell‐mediated immunity with a commercial ELISA‐based interferon‐γ release assay in kidney transplant recipients treated with antithymocyte globulin

American Journal of Transplantation

Fluoroquinolones for the treatment of latent Mycobacterium tuberculosis infection in liver transplantation

World Journal of Gastroenterology

Author contributions: Silva JT was responsible for the literature review and the drafting and wri... more

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A short course of antibiotic treatment is safe after catheter withdrawal in catheter-related bloodstream infections due to coagulase-negative staphylococci

European Journal of Clinical Microbiology & Infectious Diseases

Monitoring of alphatorquevirus DNA levels for the prediction of immunosuppression-related complications after kidney transplantation

American Journal of Transplantation

Vitamin D deficiency and infection risk in kidney transplant recipients: a single-center cohort study

Transplant infectious disease : an official journal of the Transplantation Society, Jan 5, 2018

Diagnosis and management of asymptomatic bacteriuria in kidney transplant recipients: a survey of current practice in Europe

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Apr 9, 2018

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Experience with leflunomide as treatment and as secondary prophylaxis for cytomegalovirus infection in lung transplant recipients: a case series and review of the literature

Clinical transplantation, Jan 11, 2017

Dalbavancin in the treatment of different gram-positive infections: a real-life experience

International journal of antimicrobial agents, Jan 24, 2017

Listeria monocytogenes bacteraemia over an 11-year period: Clinical and epidemiologic characteristics in the south area of Madrid

Journal of Infection

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