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Cilloniz C, Torres A. Diabetes Mellitus and Pneumococcal Pneumonia. Diagnostics (Basel) 2024; 14:859. [PMID: 38667504 PMCID: PMC11049506 DOI: 10.3390/diagnostics14080859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Currently, there are more than 500 million people suffering from diabetes around the world. People aged 65 years or older are the most affected by this disease, and it is estimated that approximately 96% of diabetes cases worldwide are type 2 diabetes. People with diabetes mellitus are at an increased risk of infections such as pneumonia, due to a series of factors that may contribute to immune dysfunction, including hyperglycemia, inhibition of neutrophil chemotaxis, impaired cytokine production, phagocytic cell dysfunction, altered T cell-mediated immune responses and the co-existence of chronic comorbidities. Rates of infection, hospitalization and mortality in diabetic patients are reported to be higher than in the general population. Research into the risk of infectious diseases such as pneumonia in these patients is very important because it will help improve their management and treatment.
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Affiliation(s)
- Catia Cilloniz
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Faculty of Health Sciences, Continental University, Huancayo 12001, Peru
| | - Antoni Torres
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Pulmonary Department, Hospital Clinic of Barcelona, C/Villarroel 170, 08036 Barcelona, Spain
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Cilloniz C, Dy-Agra G, Pagcatipunan RS, Torres A. Viral Pneumonia: From Influenza to COVID-19. Semin Respir Crit Care Med 2024; 45:207-224. [PMID: 38228165 DOI: 10.1055/s-0043-1777796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Respiratory viruses are increasingly recognized as a cause of community-acquired pneumonia (CAP). The implementation of new diagnostic technologies has facilitated their identification, especially in vulnerable population such as immunocompromised and elderly patients and those with severe cases of pneumonia. In terms of severity and outcomes, viral pneumonia caused by influenza viruses appears similar to that caused by non-influenza viruses. Although several respiratory viruses may cause CAP, antiviral therapy is available only in cases of CAP caused by influenza virus or respiratory syncytial virus. Currently, evidence-based supportive care is key to managing severe viral pneumonia. We discuss the evidence surrounding epidemiology, diagnosis, management, treatment, and prevention of viral pneumonia.
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Affiliation(s)
- Catia Cilloniz
- Hospital Clinic of Barcelona, IDIBAPS, CIBERESA, Barcelona, Spain
- Faculty of Health Sciences, Continental University, Huancayo, Peru
| | - Guinevere Dy-Agra
- Institute of Pulmonary Medicine, St Luke's Medical Center-Global City, Taguig, Metro Manila, Philippines
| | - Rodolfo S Pagcatipunan
- Institute of Pulmonary Medicine, St Luke's Medical Center-Global City, Taguig, Metro Manila, Philippines
| | - Antoni Torres
- Hospital Clinic of Barcelona, IDIBAPS, CIBERESA, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
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Menéndez R, Torres A, España PP, Fernández-Villar JA, Marimón JM, Méndez R, Cilloniz C, Egurrola M, Botana-Rial M, Ercibengoa M, Méndez C, Cifuentes I, Gessner BD. Pneumococcal Serotypes Associated with Community-Acquired Pneumonia Hospitalizations in Adults in Spain, 2016-2020: The CAPA Study. Microorganisms 2023; 11:2781. [PMID: 38004792 PMCID: PMC10673231 DOI: 10.3390/microorganisms11112781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Newer higher valency pneumococcal conjugate vaccines (PCVs) have the potential to reduce the adult community-acquired pneumonia (CAP) burden. We describe the evolution and distribution of adult community-acquired pneumonia (CAP) serotypes in Spain, focusing on serotypes contained in the 20-valent PCV (PCV20). This was a prospective, observational study of chest X-ray (CXR)-confirmed CAP in immunocompetent adults hospitalized in one of four Spanish hospitals between November 2016 and November 2020. Pneumococci were isolated from cultures and detected in urine using BinaxNow® and Pfizer serotype-specific urinary antigen tests UAD1 and UAD2. We included 1948 adults hospitalized with CXR-CAP. The median age was 69.0 years (IQR: 24 years). At least one comorbidity was present in 84.8% (n = 1653) of patients. At admission, 76.1% of patients had complicated pneumonia. Pneumococcus was identified in 34.9% (n = 680) of study participants. The PCV20 vaccine-type CAP occurred in 23.9% (n = 465) of all patients, 68.4% (n = 465) of patients with pneumococcal CAP, and 82.2% (83/101) of patients who had pneumococcus identified by culture. Serotypes 8 (n = 153; 7.9% of all CAP) and 3 (n = 152; 7.8% of all CAP) were the most frequently identified. Pneumococcus is a common cause of hospitalized CAP among Spanish adults and serotypes contained in PCV20 caused the majority of pneumococcal CAP.
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Affiliation(s)
- Rosario Menéndez
- Hospital Universitario y Politécnico la Fe, 46026 Valencia, Spain; (R.M.); (R.M.)
- Biomedical Research Center Network for Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - Antoni Torres
- Biomedical Research Center Network for Respiratory Diseases (CIBERES), 28029 Madrid, Spain
- Hospital Clinic, 08036 Barcelona, Spain;
| | | | - Jose Alberto Fernández-Villar
- Hospital Alvaro Cunqueiro, Instituto de Investigación Biomédica Galicia Sur, 36312 Vigo, Spain; (J.A.F.-V.); (M.B.-R.)
| | - José María Marimón
- Biodonostia, Hospital Universitario Donostia, 20014 San Sebastián, Spain; (J.M.M.); (M.E.)
| | - Raúl Méndez
- Hospital Universitario y Politécnico la Fe, 46026 Valencia, Spain; (R.M.); (R.M.)
- Biomedical Research Center Network for Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - Catia Cilloniz
- Hospital Clinic, 08036 Barcelona, Spain;
- Faculty of Health Sciences, Continental University, Huancayo 12001, Peru
| | - Mikel Egurrola
- Hospital Galdakao-Usansolo, 48960 Galdácano, Spain; (P.P.E.); (M.E.)
| | - Maribel Botana-Rial
- Hospital Alvaro Cunqueiro, Instituto de Investigación Biomédica Galicia Sur, 36312 Vigo, Spain; (J.A.F.-V.); (M.B.-R.)
| | - María Ercibengoa
- Biodonostia, Hospital Universitario Donostia, 20014 San Sebastián, Spain; (J.M.M.); (M.E.)
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Cilloniz C, Dela Cruz C, Curioso WH, Vidal CH. World Pneumonia Day 2023: the rising global threat of pneumonia and what we must do about it. Eur Respir J 2023; 62:2301672. [PMID: 37945031 DOI: 10.1183/13993003.01672-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Catia Cilloniz
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
- Department of Health Sciences, Continental University, Huancayo, Peru
| | - Charles Dela Cruz
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Walter H Curioso
- Department of Health Sciences, Continental University, Lima, Peru
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Cilloniz C, Motos A, Canseco J, Peñasco Y, Ricart P, Abril E, García JMG, Ortiz AB, Mateo NG, Sánchez-Miralles Á, Franco N, Riera J, Ferrer R, Bustamante-Munguira E, Caballero J, Gándara AMDL, Sancho S, Masclans JR, Urrelo-Cerrón L, Carbonell N, Socías L, Barberà C, Lorente JA, Rodríguez ÓP, Menéndez R, de Gonzalo-Calvo D, Ceccato A, Fernandez-Barat L, Garcia-Gasulla D, Gabarrus A, Garcia-Vidal C, Moreno A, Barbé F, Miro JM, Torres A. Clinical Outcomes of Critical COVID-19 in HIV-Infected Adults: A Propensity Score Matched Analysis. Arch Bronconeumol 2023; 59:772-778. [PMID: 37661559 DOI: 10.1016/j.arbres.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Catia Cilloniz
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain; University of Barcelona, Spain; Faculty of Health Sciences, Continental University, Huancayo, Peru.
| | - Anna Motos
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain; University of Barcelona, Spain
| | - Joan Canseco
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain
| | - Yhivian Peñasco
- Intensive Medicine Department, Hospital Universitario Marqués of Valdecilla, Santander, Spain
| | - Pilar Ricart
- Intensive Medicine Department, Hospital Universitari Germans Trias, Badalona, Spain
| | - Elena Abril
- Hospital Universitario Torrejón, Madrid, Spain
| | | | - Aaron Blandino Ortiz
- Intensive Care Department, Hospital Universitario Ramón y Cajal, Madrid, Spain; Universidad de Alcalá, Madrid, Spain
| | - Nadia García Mateo
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, Salamanca, Spain
| | | | | | - Jordi Riera
- Intensive Care Department, Vall d'Hebron Hospital Universitari, SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron Hospital Universitari, SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | | | - Jesús Caballero
- Critical Care Department, Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain
| | | | - Susana Sancho
- Critical Care Department, Hospital Universitario y Politecnico de La Fe, Valencia, Spain
| | - Joan-Ramon Masclans
- Critical Care Department, Hospital del Mar, Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - Nieves Carbonell
- Intensive Care Unit, Hospital Clinico Universitario de Valencia, Spain
| | - Lorenzo Socías
- Intensive Care Unit, Hospital Son Llàtzer, Palma de Mallorca, Illes Balears, Spain
| | | | - José A Lorente
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; Hospital Universitario de Getafe, Madrid, Spain
| | - Óscar Peñuelas Rodríguez
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; Hospital Universitario de Getafe, Madrid, Spain
| | - Rosario Menéndez
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; Pulmonology Service, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - David de Gonzalo-Calvo
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; Hospital Santa Maria, IRBLleida, Lleida, Spain
| | - Adrian Ceccato
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; Critical Care Center, ParcTaulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain; Intensive Care Unit, Hospital Universitari Sagrat Cor, Grupo Quironsalud, Barcelona, Spain
| | - Laia Fernandez-Barat
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain; University of Barcelona, Spain
| | | | - Albert Gabarrus
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ferran Barbé
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; Pulmonary Department, Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Spain
| | - José M Miro
- Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
| | - Antoni Torres
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain; University of Barcelona, Spain; Pulmonology Department, Hospital Clinic of Barcelona, Spain
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Bronte O, García-García F, Lee DJ, Urrutia I, Uranga A, Nieves M, Martínez-Minaya J, Quintana JM, Arostegui I, Zalacain R, Ruiz-Iturriaga LA, Serrano L, Menéndez R, Méndez R, Torres A, Cilloniz C, España PP. Impact of outdoor air pollution on severity and mortality in COVID-19 pneumonia. Sci Total Environ 2023; 894:164877. [PMID: 37331396 PMCID: PMC10275649 DOI: 10.1016/j.scitotenv.2023.164877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023]
Abstract
The relationship between exposure to air pollution and the severity of coronavirus disease 2019 (COVID-19) pneumonia and other outcomes is poorly understood. Beyond age and comorbidity, risk factors for adverse outcomes including death have been poorly studied. The main objective of our study was to examine the relationship between exposure to outdoor air pollution and the risk of death in patients with COVID-19 pneumonia using individual-level data. The secondary objective was to investigate the impact of air pollutants on gas exchange and systemic inflammation in this disease. This cohort study included 1548 patients hospitalised for COVID-19 pneumonia between February and May 2020 in one of four hospitals. Local agencies supplied daily data on environmental air pollutants (PM10, PM2.5, O3, NO2, NO and NOX) and meteorological conditions (temperature and humidity) in the year before hospital admission (from January 2019 to December 2019). Daily exposure to pollution and meteorological conditions by individual postcode of residence was estimated using geospatial Bayesian generalised additive models. The influence of air pollution on pneumonia severity was studied using generalised additive models which included: age, sex, Charlson comorbidity index, hospital, average income, air temperature and humidity, and exposure to each pollutant. Additionally, generalised additive models were generated for exploring the effect of air pollution on C-reactive protein (CRP) level and SpO2/FiO2 at admission. According to our results, both risk of COVID-19 death and CRP level increased significantly with median exposure to PM10, NO2, NO and NOX, while higher exposure to NO2, NO and NOX was associated with lower SpO2/FiO2 ratios. In conclusion, after controlling for socioeconomic, demographic and health-related variables, we found evidence of a significant positive relationship between air pollution and mortality in patients hospitalised for COVID-19 pneumonia. Additionally, inflammation (CRP) and gas exchange (SpO2/FiO2) in these patients were significantly related to exposure to air pollution.
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Affiliation(s)
- O Bronte
- Galdakao-Usansolo University Hospital, Pulmonology Department, Galdakao, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain.
| | | | - D-J Lee
- Basque Center for Applied Mathematics (BCAM), Bilbao, Spain
| | - I Urrutia
- Galdakao-Usansolo University Hospital, Pulmonology Department, Galdakao, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain
| | - A Uranga
- Galdakao-Usansolo University Hospital, Pulmonology Department, Galdakao, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain
| | - M Nieves
- Galdakao-Usansolo University Hospital, Pulmonology Department, Galdakao, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain
| | | | - J M Quintana
- Galdakao-Usansolo University Hospital, Research Unit, Galdakao, Spain
| | - I Arostegui
- University of the Basque Country (UPV/EHU), Department of Applied Mathematics, Statistics and Operative Research, Leioa, Spain; Basque Center for Applied Mathematics (BCAM), Bilbao, Spain
| | - R Zalacain
- Cruces University Hospital, Pulmonology Department, Baracaldo, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain
| | - L A Ruiz-Iturriaga
- Cruces University Hospital, Pulmonology Department, Baracaldo, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain
| | - L Serrano
- Cruces University Hospital, Pulmonology Department, Baracaldo, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain
| | - R Menéndez
- Hospital Universitari i Politècnic La Fe de Valencia, Pulmonology Department, Valencia, Spain
| | - R Méndez
- Hospital Universitari i Politècnic La Fe de Valencia, Pulmonology Department, Valencia, Spain
| | - A Torres
- Hospital Clínic i Provincial de Barcelona, Pulmonology Department, University of Barcelona, Barcelona, Spain
| | - C Cilloniz
- Hospital Clínic i Provincial de Barcelona, Pulmonology Department, University of Barcelona, Barcelona, Spain; Faculty of Health Sciences, Continental University, Huancayo, Peru
| | - P P España
- Galdakao-Usansolo University Hospital, Pulmonology Department, Galdakao, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain
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Cilloniz C, Torres A. The pharmacokinetic evaluation of omadacycline (Oral Only Dosing Regimen) for the treatment of Community-Acquired Bacterial Pneumonia (CABP). Expert Opin Drug Metab Toxicol 2023; 19:569-576. [PMID: 37728376 DOI: 10.1080/17425255.2023.2261376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/18/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Omadacycline is a new analog of the tetracycline class active against atypical bacteria, as well as against staphylococci, including methicillin-resistant strains, and Streptococcus pneumoniae. AREAS COVERED This review has summarized the available clinical evidence on the use of oral omadacycline in the treatment of community-acquired pneumonia (CAP) and described the mechanism of action, pharmacokinetic/pharmacodynamic (PK/PD) parameters in healthy and special populations and the latest research on omadacycline. EXPERT OPINION The available clinical evidence on oral omadacycline for the treatment of CAP shows that its properties provide reliable empirical coverage for pathogens such as Haemophilus influenzae, Moraxella catarrhalis, and species of Legionella, Chlamydia, and Mycoplasma. Omadacycline is also active against methicillin-resistant Staphylococcus aureus (MRSA); penicillin-resistant and multidrug-resistant Streptococcus pneumoniae, Streptococcus pyogenes, and Streptococcus agalactiae; and vancomycin-resistant Enterococcus spp. A dose of 450 mg orally once daily is recommended, followed by a maintenance dose of 300 mg orally once daily. Importantly, omadacycline does not require dose adjustment for patients based on BMI, age, gender, or renal or hepatic impairment.
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Affiliation(s)
- Catia Cilloniz
- University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); CIBER of Respiratory Diseases (CIBERES), Spain
- Department of Health Sciences, Continental University, Huancayo, Peru
| | - Antoni Torres
- University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); CIBER of Respiratory Diseases (CIBERES), Spain
- Pulmonology Department, Hospital Clinic of Barcelona, Barcelona, Spain
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Cilloniz C, Motos A, Pericàs JM, Castañeda TG, Gabarrús A, Ferrer R, García-Gasulla D, Peñuelas O, de Gonzalo-Calvo D, Fernandez-Barat L, Barbé F, Torres A. Risk factors associated with mortality among elderly patients with COVID-19: Data from 55 intensive care units in Spain. Pulmonology 2023; 29:362-374. [PMID: 36906462 PMCID: PMC9935281 DOI: 10.1016/j.pulmoe.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Critically-ill elderly ICU patients with COVID-19 have poor outcomes. We aimed to compare the rates of in-hospital mortality between non-elderly and elderly critically-ill COVID-19 ventilated patients, as well as to analyze the characteristics, secondary outcomes and independent risk factors associated with in-hospital mortality of elderly ventilated patients. PATIENTS AND METHODS We conducted a multicentre, observational cohort study including consecutive critically-ill patients admitted to 55 Spanish ICUs due to severe COVID-19 requiring mechanical ventilation (non-invasive respiratory support [NIRS; include non-invasive mechanical ventilation and high-flow nasal cannula] and invasive mechanical ventilation [IMV]) between February 2020 and October 2021. RESULTS Out of 5,090 critically-ill ventilated patients, 1,525 (27%) were aged ≥70 years (554 [36%] received NIRS and 971 [64%] received IMV. In the elderly group, median age was 74 years (interquartile range 72-77) and 68% were male. Overall in-hospital mortality was 31% (23% in patients <70 years and 50% in those ≥70 years; p<0.001). In-hospital mortality in the group ≥70 years significantly varied according to the modality of ventilation (40% in NIRS vs. 55% in IMV group; p<0.001). Factors independently associated with in-hospital mortality in elderly ventilated patients were age (sHR 1.07 [95%CI 1.05-1.10], p<0.001); previous admission within the last 30 days (sHR 1.40 [95%CI 1.04-1.89], p = 0.027); chronic heart disease (sHR 1.21 [95%CI 1.01-1.44], p = 0.041); chronic renal failure (sHR 1.43 [95%CI 1.12- 1.82], p = 0.005); platelet count (sHR 0.98 [95% CI 0.98-0.99], p<0.001); IMV at ICU admission (sHR 1.41 [95% CI 1.16- 1.73], p<0.001); and systemic steroids (sHR 0.61 [95%CI 0.48- 0.77], p<0.001). CONCLUSIONS Amongst critically-ill COVID-19 ventilated patients, those aged ≥70 years presented significantly higher rates of in-hospital mortality than younger patients. Increasing age, previous admission within the last 30 days, chronic heart disease, chronic renal failure, platelet count, IMV at ICU admission and systemic steroids (protective) all comprised independent factors for in-hospital mortality in elderly patients.
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Affiliation(s)
- C Cilloniz
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Institute of Health Carlos III, Madrid, Spain; Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain; Facultad de Ciencias de la Salud, Universidad Continental, Huancayo, Perú.
| | - A Motos
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Institute of Health Carlos III, Madrid, Spain; Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J M Pericàs
- Liver Unit, Internal Medicine Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute for Research, CIBERehd, Barcelona, Spain
| | - T G Castañeda
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Gabarrús
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - R Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute for Research, Barcelona, Spain
| | | | - O Peñuelas
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Institute of Health Carlos III, Madrid, Spain; Hospital Universitario de Getafe, Madrid; Universidad Europea, Madrid, Spain
| | - D de Gonzalo-Calvo
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Institute of Health Carlos III, Madrid, Spain; Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria; IRBLleida, Lleida, Spain
| | - L Fernandez-Barat
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - F Barbé
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Institute of Health Carlos III, Madrid, Spain; Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria; IRBLleida, Lleida, Spain
| | - A Torres
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Institute of Health Carlos III, Madrid, Spain; Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain.
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Cilloniz C, Pericas JM, Curioso WH. Interventions to improve outcomes in community-acquired pneumonia. Expert Rev Anti Infect Ther 2023; 21:1071-1086. [PMID: 37691049 DOI: 10.1080/14787210.2023.2257392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is a common infection associated with high morbimortality and a highly deleterious impact on patients' quality of life and functionality. We comprehensively review the factors related to the host, the causative microorganism, the therapeutic approach and the organization of health systems (e.g. setting for care and systems for allocation) that might have an impact on CAP-associated outcomes. Our main aims are to discuss the most controversial points and to provide some recommendations that may guide further research and the management of patients with CAP, in order to improve their outcomes, beyond mortality. AREA COVERED In this review, we aim to provide a critical account of potential measures to improve outcomes of CAP and the supporting evidence from observational studies and clinical trials. EXPERT OPINION CAP is associated with high mortality and a highly deleterious impact on patients' quality of life. To improve CAP-associated outcomes, it is important to understand the factors related to the patient, etiology, therapeutics, and the organization of health systems.
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Affiliation(s)
- Catia Cilloniz
- IDIBAPS, Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Barcelona, Spain
- Facultad de Ciencias de la Salud, Universidad Continental, Huancayo, Peru
| | - Juan Manuel Pericas
- Liver Unit, Internal Medicine Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute for Research (VHIR), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain
| | - Walter H Curioso
- Facultad de Ciencias de la Salud, Universidad Continental, Huancayo, Peru
- Health Services Administration, Continental University of Florida, Margate, FL, USA
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Cilloniz C, Torres A. A Novel Approach to Temperature Profiling in Relation to Clinical Outcomes in Oncological Patients with Neutropenia. Am J Respir Crit Care Med 2023; 207:1257-1259. [PMID: 36525672 PMCID: PMC10595455 DOI: 10.1164/rccm.202212-2270ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Catia Cilloniz
- Department of Pulmonology Hospital Clinic of Barcelona Barcelona, Spain
- Faculty of Health Sciences Continental University Huancayo, Peru
| | - Antoni Torres
- Department of Pulmonology, Hospital Clinic of Barcelona School of Medicine, University of Barcelona Barcelona, Spain
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11
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Cheng GS, Crothers K, Aliberti S, Bergeron A, Boeckh M, Chien JW, Cilloniz C, Cohen K, Dean N, Dela Cruz CS, Dickson RP, Greninger AL, Hage CA, Hohl TM, Holland SM, Jones BE, Keane J, Metersky M, Miller R, Puel A, Ramirez J, Restrepo MI, Sheshadri A, Staitieh B, Tarrand J, Winthrop KL, Wunderink RG, Evans SE. Immunocompromised Host Pneumonia: Definitions and Diagnostic Criteria: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2023; 20:341-353. [PMID: 36856712 PMCID: PMC9993146 DOI: 10.1513/annalsats.202212-1019st] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Pneumonia imposes a significant clinical burden on people with immunocompromising conditions. Millions of individuals live with compromised immunity because of cytotoxic cancer treatments, biological therapies, organ transplants, inherited and acquired immunodeficiencies, and other immune disorders. Despite broad awareness among clinicians that these patients are at increased risk for developing infectious pneumonia, immunocompromised people are often excluded from pneumonia clinical guidelines and treatment trials. The absence of a widely accepted definition for immunocompromised host pneumonia is a significant knowledge gap that hampers consistent clinical care and research for infectious pneumonia in these vulnerable populations. To address this gap, the American Thoracic Society convened a workshop whose participants had expertise in pulmonary disease, infectious diseases, immunology, genetics, and laboratory medicine, with the goal of defining the entity of immunocompromised host pneumonia and its diagnostic criteria.
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12
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Cilloniz C, Ferrer M, Pericàs JM, Serrano L, Méndez R, Gabarrús A, Peroni HJ, Ruiz LA, Menéndez R, Zalacain R, Torres A. Validation of IDSA/ATS Guidelines for ICU Admission in Adults Over 80 Years Old With Community-Acquired Pneumonia. Arch Bronconeumol 2023; 59:19-26. [PMID: 36184303 DOI: 10.1016/j.arbres.2022.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/26/2022] [Accepted: 08/18/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The 2007 IDSA/ATS guidelines for community-acquired pneumonia (CAP) recommended intensive care unit (ICU) admission for adults meeting severe CAP criteria. We aimed to validate the accuracy of IDSA/ATS criteria in patients≥80 years old (very elderly patients, VEP) with CAP. METHODS Prospective cohort study of VEP with CAP admitted to three Spanish hospitals between 1996 and 2019. We compared patients who did and did not require ICU admission. We also assessed factors independently associated with ICU admission, as well as the accuracy of severe CAP criteria for ICU admission and mortality. Major criteria include septic shock and invasive mechanical ventilation while minor criteria encompass other variables related to hemodynamics and respiratory insufficiency as well as level of consciousness, renal function, blood parameters indicative of sepsis and body temperature. RESULTS Of the 2006 VEP with CAP, 519 (26%) met severe CAP criteria, while 204 (10%) required ICU admission. Concordance between severe CAP criteria and the decision to admit the patient to the ICU occurred in 1591 (79%) cases (k coefficient, 0.33), with a sensitivity of 75% and specificity of 80% in predicting ICU admission. All patients with invasive mechanical ventilation received care in ICUs, while 45 (44%) patients with septic shock-previously stabilized in the emergency room-did not. Thirty-day mortality of ICU-admitted patients with septic shock was lower than that of patients in wards (30% vs. 60%, p=0.013). In contrast, patients with severe CAP and only minor criteria had similar mortality. CONCLUSIONS IDSA/ATS criteria for severe CAP predict ICU admission in VEP moderately well. While patients with septic shock and invasive mechanical ventilation warrant ICU admission, severe CAP without major severity criteria in VEP may be acceptably manageable in wards.
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Affiliation(s)
- Catia Cilloniz
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911 - Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain; Facultad de Ciencias de la Salud, Universidad Continental, Huancayo, Perú.
| | - Miquel Ferrer
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911 - Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Juan M Pericàs
- Infectious Disease Department, Hospital Clínic of Barcelona, Spain; Liver Unit, Internal Medicine Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute for Research, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Leyre Serrano
- Pulmonology Department, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Immunology, Microbiology and Parasitology Department, School of Medicine and Nurse, University of the País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain
| | - Raúl Méndez
- Pulmonology Department, Hospital La Fe in Valencia, Valencia, Spain
| | - Albert Gabarrús
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911 - Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Héctor José Peroni
- Internal Medicine Department, Respiratory Medicine Unit and Emergency Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luis Alberto Ruiz
- Pulmonology Department, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Rosario Menéndez
- Pulmonology Department, Hospital La Fe in Valencia, Valencia, Spain
| | - Rafael Zalacain
- Pulmonology Department, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Antoni Torres
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911 - Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain.
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13
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Luque N, Cilloniz C, Pons MJ, Donaires F, Albornoz R, Mendocilla-Risco M, Espinoza M. Clinical-epidemiological characteristics of deaths due to dengue during an outbreak in northern Peru. Rev Peru Med Exp Salud Publica 2023; 40:67-72. [PMID: 37377238 DOI: 10.17843/rpmesp.2023.401.12148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/22/2023] [Indexed: 06/29/2023] Open
Abstract
Motivation for the study. To describe the characteristics of patients who died from severe dengue fever during the 2017 El Niño in Piura. Main findings. Mortality from severe dengue was higher in adult women. First contact with healthcare took place mostly in higher level hospitals. Admission to a specialized unit was late for severe dengue cases. Implications. Control of dengue fever involves several aspects, such as, access to health, prevention, water availability, vector control and education; therefore, it is important to strengthen public health policies in this regard. In order to achieve this goal, local and central government sectors must be involved.
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Affiliation(s)
- Néstor Luque
- Escuela de Medicina Humana, Facultad de Ciencias de la Salud, Universidad Peruana Unión (UPeU), Lima, Perú
| | | | - María J Pons
- Grupo enfermedades infecciosas re-emergentes, Universidad Científica del Sur, Lima, Perú
| | | | - Roger Albornoz
- Escuela de Medicina Humana, Facultad de Ciencias de la Salud, Universidad Peruana Unión (UPeU), Lima, Perú
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Cilloniz C, Pericàs JM, Motos A, Gabarrús A, Ferrer R, Menéndez R, Riera J, García-Gasulla D, Peñuelas O, Fernández-Barat L, Ángel Lorente J, de Gonzalo-Calvo D, Barbé F, Torres A. Hyperglycemia in Acute Critically Ill COVID-19 Patients. Arch Bronconeumol 2023; 59:51-56. [PMID: 36167740 PMCID: PMC9461233 DOI: 10.1016/j.arbres.2022.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Catia Cilloniz
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB),Facultad de Ciencias de la Salud, Universidad Continental, Huancayo, Perú,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Corresponding authors
| | - Juan M. Pericàs
- Liver Unit, Internal Medicine Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute for Research (VHIR), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain,Infectious Disease Service, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Anna Motos
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB),CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Albert Gabarrús
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)
| | - Ricard Ferrer
- Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute for Research, Barcelona, Spain
| | - Rosario Menéndez
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Pulmonary Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Jordi Riera
- Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute for Research, Barcelona, Spain
| | | | - Oscar Peñuelas
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Hospital Universitario de Getafe, Madrid; Universidad Europea, Madrid, Spain
| | - Laia Fernández-Barat
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB),CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - José Ángel Lorente
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Hospital Universitario de Getafe, Madrid; Universidad Europea, Madrid, Spain
| | - David de Gonzalo-Calvo
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria; IRBLleida, Lleida, Spain
| | - Ferran Barbé
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria; IRBLleida, Lleida, Spain
| | - Antoni Torres
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB),CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Corresponding authors
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15
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Cilloniz C, Ward L, Mogensen ML, Pericàs JM, Méndez R, Gabarrús A, Ferrer M, Garcia-Vidal C, Menendez R, Torres A. Machine-Learning Model for Mortality Prediction in Patients With Community-Acquired Pneumonia: Development and Validation Study. Chest 2023; 163:77-88. [PMID: 35850287 DOI: 10.1016/j.chest.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Artificial intelligence tools and techniques such as machine learning (ML) are increasingly seen as a suitable manner in which to increase the prediction capacity of currently available clinical tools, including prognostic scores. However, studies evaluating the efficacy of ML methods in enhancing the predictive capacity of existing scores for community-acquired pneumonia (CAP) are limited. We aimed to apply and validate a causal probabilistic network (CPN) model to predict mortality in patients with CAP. RESEARCH QUESTION Is a CPN model able to predict mortality in patients with CAP better than the commonly used severity scores? STUDY DESIGN AND METHODS This was a derivation-validation retrospective study conducted in two Spanish university hospitals. The ability of a CPN designed to predict mortality in sepsis (SepsisFinder [SeF]), and adapted for CAP (SeF-ML), to predict 30-day mortality was assessed and compared with other scoring systems (Pneumonia Severity Index [PSI], Sequential Organ Failure Assessment [SOFA], quick Sequential Organ Failure Assessment [qSOFA], and CURB-65 criteria [confusion, urea, respiratory rate, BP, age ≥ 65 years]). The SeF models are proprietary software. Differences between receiver operating characteristic curves were assessed by the DeLong method for correlated receiver operating characteristic curves. RESULTS The derivation cohort comprised 4,531 patients, and the validation cohort consisted of 1,034 patients. In the derivation cohort, the areas under the curve (AUCs) of SeF-ML, CURB-65, SOFA, PSI, and qSOFA were 0.801, 0.759, 0.671, 0.799, and 0.642, respectively, for 30-day mortality prediction. In the validation study, the AUC of SeF-ML was 0.826, concordant with the AUC (0.801) in the derivation data (P = .51). The AUC of SeF-ML was significantly higher than those of CURB-65 (0.764; P = .03) and qSOFA (0.729, P = .005). However, it did not differ significantly from those of PSI (0.830; P = .92) and SOFA (0.771; P = .14). INTERPRETATION SeF-ML shows potential for improving mortality prediction among patients with CAP, using structured health data. Additional external validation studies should be conducted to support generalizability.
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Affiliation(s)
- Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain; Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain; Faculty of Health Sciences, Continental University, Huancayo, Peru
| | | | | | - Juan M Pericàs
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain; Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institute for Research (VHIR), Barcelona, Spain
| | - Raúl Méndez
- Department of Pneumology, University Hospital La Fe of Valencia, Valencia, Valencia
| | - Albert Gabarrús
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain; Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Miquel Ferrer
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain; Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | | | - Rosario Menendez
- Department of Pneumology, University Hospital La Fe of Valencia, Valencia, Valencia
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain; Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.
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16
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Cilloniz C, Luna CM, Hurtado JC, Marcos MÁ, Torres A. Respiratory viruses: their importance and lessons learned from COVID-19. Eur Respir Rev 2022; 31:31/166/220051. [PMID: 36261158 DOI: 10.1183/16000617.0051-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/30/2022] [Indexed: 01/08/2023] Open
Abstract
Respiratory virus infection can cause severe illnesses capable of inducing acute respiratory failure that can progress rapidly to acute respiratory distress syndrome (ARDS). ARDS is related to poor outcomes, especially in individuals with a higher risk of infection, such as the elderly and those with comorbidities, i.e. obesity, asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. Despite this, effective antiviral treatments available for severe viral lung infections are scarce. The coronavirus disease 2019 (COVID-19) pandemic demonstrated that there is also a need to understand the role of airborne transmission of respiratory viruses. Robust evidence supporting this exists, but better comprehension could help implement adequate measures to mitigate respiratory viral infections. In severe viral lung infections, early diagnosis, risk stratification and prognosis are essential in managing patients. Biomarkers can provide reliable, timely and accessible information possibly helpful for clinicians in managing severe lung viral infections. Although respiratory viruses highly impact global health, more research is needed to improve care and prognosis of severe lung viral infections. In this review, we discuss the epidemiology, diagnosis, clinical characteristics, management and prognosis of patients with severe infections due to respiratory viruses.
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Affiliation(s)
- Catia Cilloniz
- Pneumology Dept, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain .,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain.,Faculty of Health Sciences, Continental University, Huancayo, Peru
| | - Carlos M Luna
- Pneumology Division, Hospital of Clínicas, Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Juan Carlos Hurtado
- Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
| | - María Ángeles Marcos
- Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
| | - Antoni Torres
- Pneumology Dept, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
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17
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Cilloniz C, Torres A. Host-targeted approaches to sepsis due to community-acquired pneumonia. EBioMedicine 2022; 86:104335. [PMID: 36470827 PMCID: PMC9782809 DOI: 10.1016/j.ebiom.2022.104335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/18/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Catia Cilloniz
- Pulmonology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain,Faculty of Health Sciences, Continental University, Huancayo, Peru,Corresponding author. Department of Pneumology, Hospital Clinic of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain.
| | - Antoni Torres
- Pulmonology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Corresponding author. Department of Pneumology, Hospital Clinic of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain.
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18
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Saura O, Rouzé A, Martin-Loeches I, Povoa P, Kreitmann L, Torres A, Metzelard M, Du Cheyron D, Lambiotte F, Tamion F, Labruyere M, Boulle Geronimi C, Luyt CE, Nyunga M, Pouly O, Thille AW, Megarbane B, Saade A, Magira E, Llitjos JF, Ioannidou I, Pierre A, Reignier J, Garot D, Baudel JL, Voiriot G, Plantefeve G, Morawiec E, Asfar P, Boyer A, Mekontso-Dessap A, Bardaka F, Diaz E, Vinsonneau C, Floch PE, Weiss N, Ceccato A, Artigas A, Nora D, Duhamel A, Labreuche J, Nseir S, Bouchereau M, Boyd S, Coelho L, Maizel J, Cuchet P, Zarrougui W, Boyer D, Quenot JP, Imouloudene M, Pineton de Chambrun M, Van der Linden T, Arrive F, Voicu S, Azoulay E, Moglia E, Pene F, Cilloniz C, Thevenin D, Larrat C, Argaud L, Guidet B, Contou D, Beurton A, Meguerditchian D, Razazi K, Tsolaki V, Marzouk M, Brunin G, Marois C, Morales L. Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study. Crit Care 2022; 26:292. [PMID: 36167550 PMCID: PMC9513297 DOI: 10.1186/s13054-022-04170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/12/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Ventilator-associated pneumonia (VAP) is common in patients with severe SARS-CoV-2 pneumonia. The aim of this ancillary analysis of the coVAPid multicenter observational retrospective study is to assess the relationship between adjuvant corticosteroid use and the incidence of VAP.
Methods
Planned ancillary analysis of a multicenter retrospective European cohort in 36 ICUs. Adult patients receiving invasive mechanical ventilation for more than 48 h for SARS-CoV-2 pneumonia were consecutively included between February and May 2020. VAP diagnosis required strict definition with clinical, radiological and quantitative microbiological confirmation. We assessed the association of VAP with corticosteroid treatment using univariate and multivariate cause-specific Cox’s proportional hazard models with adjustment on pre-specified confounders.
Results
Among the 545 included patients, 191 (35%) received corticosteroids. The proportional hazard assumption for the effect of corticosteroids on the incidence of VAP could not be accepted, indicating that this effect varied during ICU stay. We found a non-significant lower risk of VAP for corticosteroid-treated patients during the first days in the ICU and an increased risk for longer ICU stay. By modeling the effect of corticosteroids with time-dependent coefficients, the association between corticosteroids and the incidence of VAP was not significant (overall effect p = 0.082), with time-dependent hazard ratios (95% confidence interval) of 0.47 (0.17–1.31) at day 2, 0.95 (0.63–1.42) at day 7, 1.48 (1.01–2.16) at day 14 and 1.94 (1.09–3.46) at day 21.
Conclusions
No significant association was found between adjuvant corticosteroid treatment and the incidence of VAP, although a time-varying effect of corticosteroids was identified along the 28-day follow-up.
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Serrano L, Ruiz LA, Pérez S, España PP, Gomez A, Cilloniz C, Uranga A, Torres A, Zalacain R. ESTIMATING THE RISK OF BACTERAEMIA IN HOSPITALISED PATIENTS WITH PNEUMOCOCCAL PNEUMONIA. J Infect 2022; 85:644-651. [PMID: 36154852 DOI: 10.1016/j.jinf.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 10/14/2022]
Abstract
Objective To construct a prediction model for bacteraemia in patients with pneumococcal community-acquired pneumonia (P-CAP) based on variables easily obtained at hospital admission. MethodsThis prospective observational multicentre derivation-validation study was conducted in patients hospitalised with P-CAP between 2000-2020. All cases were diagnosed based on positive urinary antigen tests in the emergency department and had blood cultures taken on admission. A risk score to predict bacteraemia was developed. Results We included 1783 patients with P-CAP (1195 in the derivation and 588 in the validation cohort). A third (33.3%) of the patients had bacteraemia. In the multivariate analysis, the following were identified as independent factors associated with bacteraemia: no influenza vaccination the last year, no pneumococcal vaccination in the last 5 years, blood urea nitrogen (BUN) ≥30 mg/dL, sodium <130 mmol/L, lymphocyte count <800/µl, C-reactive protein ≥200 mg/L, respiratory failure, pleural effusion and no antibiotic treatment before admission. The score yielded good discrimination (AUC 0.732; 95% CI: 0.695-0.769) and calibration (Hosmer-Lemeshow p-value 0.801), with similar performance in the validation cohort (AUC 0.764; 95% CI:0.719-0.809). Conclusions We found nine predictive factors easily obtained on hospital admission that could help achieve early identification of bacteraemia. The prediction model provides a useful tool to guide diagnostic decisions.
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Affiliation(s)
- Leyre Serrano
- Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Department of Immunology, Microbiology and Parasitology. Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo. Bizkaia, Spain.
| | - Luis Alberto Ruiz
- Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Department of Immunology, Microbiology and Parasitology. Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo. Bizkaia, Spain.
| | - Silvia Pérez
- Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo. Bizkaia, Spain.
| | - Pedro Pablo España
- Pneumology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
| | - Ainhoa Gomez
- Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.
| | - Catia Cilloniz
- Pneumology Service, Hospital Clinic. Institut D´Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona Spain.
| | - Ane Uranga
- Pneumology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
| | - Antoni Torres
- Pneumology Service, Hospital Clinic. Institut D´Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona Spain.
| | - Rafael Zalacain
- Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.
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Cilloniz C, Ferrer M, Pericàs JM, Serrano L, Méndez R, Gabarrús A, Peroni HJ, Ruiz LA, Menéndez R, Zalacain R, Torres A. Validation of IDSA/ATS Guidelines for ICU Admission in Adults Over 80 Years Old With Community-acquired Pneumonia. Arch Bronconeumol 2022:S0300-2896(22)00528-2. [PMID: 36163305 DOI: 10.1016/j.arbres.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The 2007 IDSA/ATS guidelines for community-acquired pneumonia (CAP) recommended intensive care unit (ICU) admission for adults meeting severe CAP criteria. We aimed to validate the accuracy of IDSA/ATS criteria in patients ≥80 years old (very elderly patients, VEP) with CAP. METHODS Prospective cohort study of VEP with CAP admitted to three Spanish hospitals between 1996 and 2019. We compared patients who did and did not require ICU admission. We also assessed factors independently associated with ICU admission, as well as the accuracy of severe CAP criteria for ICU admission and mortality. Major criteria include septic shock and invasive mechanical ventilation while minor criteria encompass other variables related to hemodynamics and respiratory insufficiency as well as level of consciousness, renal function, blood parameters indicative of sepsis and body temperature. RESULTS Of the 2006 VEP with CAP, 519 (26%) met severe CAP criteria, while 204 (10%) required ICU admission. Concordance between severe CAP criteria and the decision to admit the patient to the ICU occurred in 1591 (79%) cases (k coefficient, 0.33), with a sensitivity of 75% and specificity of 80% in predicting ICU admission. All patients with invasive mechanical ventilation received care in ICUs, while 45 (44%) patients with septic shock-previously stabilized in the emergency room-did not. Thirty-day mortality of ICU-admitted patients with septic shock was lower than that of patients in wards (30% vs. 60%, P=0.013). In contrast, patients with severe CAP and only minor criteria had similar mortality. CONCLUSIONS IDSA/ATS criteria for severe CAP predict ICU admission in VEP moderately well. While patients with septic shock and invasive mechanical ventilation warrant ICU admission, severe CAP without major severity criteria in VEP may be acceptably manageable in wards.
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Affiliation(s)
- Catia Cilloniz
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain.
| | - Miquel Ferrer
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Juan M Pericàs
- Infectious Disease Department, Hospital Clínic of Barcelona, Spain; Liver Unit, Internal Medicine Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute for Research, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Leyre Serrano
- Pulmonology Department, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Immunology, Microbiology and Parasitology Department, School of Medicine and Nurse, University of the País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain
| | - Raúl Méndez
- Pulmonology Department, Hospital La Fe in Valencia, Valencia, Spain
| | - Albert Gabarrús
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Héctor José Peroni
- Internal Medicine Department, Respiratory Medicine Unit and Emergency Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luis Alberto Ruiz
- Pulmonology Department, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Rosario Menéndez
- Pulmonology Department, Hospital La Fe in Valencia, Valencia, Spain
| | - Rafael Zalacain
- Pulmonology Department, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Antoni Torres
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain.
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Abstract
The growing population of older people worldwide represents a great challenge for health systems. The elderly are at increased risk of infectious diseases such as pneumonia, which is associated with increased morbidity and mortality related mainly to age-related physiological changes in the immune system (immunosenescence), the presence of multiple chronic comorbidities, and frailty. In pneumonia, microaspiration is recognized as the main pathogenic mechanism; while macroaspiration which refers to the aspiration of a large amount of oropharyngeal or upper gastrointestinal content passing through the vocal cords and trachea into the lungs is identified as “aspiration pneumonia”. Although there are strategies for the prevention and management of patients with pneumonia that have been shown to be effective in older people with pneumonia, more research is needed on aspiration pneumonia, its risk factors and outcomes, especially since there are no specific criteria for its diagnosis and consequently, the studies on aspiration pneumonia include heterogeneous populations.
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Affiliation(s)
- M S Niederman
- Professor. Michael S. Niederman, Division of Pulmonary and Critical Care Medicine, New York Presbyterian, Weill Cornell Medical Center, New York, USA.
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22
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Torres A, Cilloniz C. Steroid therapy and antiviral treatment in SARSCoV-2 pneumonia: clinical contexts and indications. Rev Esp Quimioter 2022; 35 Suppl 1:54-58. [PMID: 35488828 PMCID: PMC9106207 DOI: 10.37201/req/s01.13.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Critically ill patients with COVID-19 face a higher risk of disease progression and complications. The current standard of care includes supportive care measures and fluid management. The Recovery trial observed a reduction in all-cause, 28-day mortality (p<0.001) when patients with COVID-19 requiring oxygen therapy received 6 mg of dexamethasone per day for 10 days. In contrast, in patients not requiring oxygen, no benefit was observed: 28-day mortality rates for the dexamethasone and routine care groups were 17.8% and 14%, respectively. To corroborate these results, the World Health Organization (WHO) performed a meta-analysis. The study showed that the use of systemic corticosteroids compared with routine care placebo was associated with a decrease in all-cause, 28-day mortality. With respect to the effectiveness of remdesivir, the ACTT-1 trial found that the drug conferred a benefit on time to clinical improvement. The subgroup analysis in the clinical trial also showed a benefit per mortality in patients requiring supplemental oxygen, albeit not those in need of mechanical ventilation.
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Affiliation(s)
- A Torres
- Antoni Torres, Pulmonology Department, Hospital Clinic of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain.
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Cilloniz C, Pericàs JM, Rojas J. Ceftaroline in severe community-acquired pneumonia. Rev Esp Quimioter 2022; 35 Suppl 1:28-30. [PMID: 35488821 PMCID: PMC9106200 DOI: 10.37201/req/s01.06.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Severe community-acquired pneumonia (SCAP) is associated with high mortality. Factor such as early adequate antibiotic therapy, delay in intensive care unit (ICU) care and pneumonia caused by resistant pathogens are associated with worse outcomes in SCAP patients. Ceftaroline is a fifth-generation cephalosporin with bactericidal activity against Gram-positive pathogens (including methicillin-resistant Staphylococcus aureus [MRSA] and multidrug-resistant Streptococcus pneumoniae) and common Gram-negative organisms. The efficacy and safety for the treatment of pneumonia was evaluated in three randomized control trials were ceftaroline demonstrated superiority against ceftriaxone for the treatment of pneumonia in hospitalized patients with Pneumonia Severity Index (PSI) III - IV.
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Affiliation(s)
- C Cilloniz
- Catia Cillóniz, Pulmonology Department, Hospital Clinic of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain.
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Cilloniz C, Torres A. What's Next in Pneumonia? Arch Bronconeumol 2022; 58:208-210. [PMID: 35312596 DOI: 10.1016/j.arbres.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Spain; Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), Barcelona, Spain
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Spain; Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), Barcelona, Spain.
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Cilloniz C, Mendez R, Peroni H, Garcia-Vidal C, Rico V, Gabarrus A, Menéndez R, Torres A, Soriano A. Impact on in-hospital mortality of ceftaroline versus standard of care in community-acquired pneumonia: a propensity-matched analysis. Eur J Clin Microbiol Infect Dis 2022; 41:271-279. [PMID: 34767120 PMCID: PMC8588767 DOI: 10.1007/s10096-021-04378-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to evaluate the in-hospital mortality of community-acquired pneumonia (CAP) treated with ceftaroline in comparison with standard therapy. This was a retrospective observational study in two centers. Hospitalized patients with CAP were grouped according to the empiric regimen (ceftaroline versus standard therapy) and analyzed using a propensity score matching (PSM) method to reduce confounding factors. Out of the 6981 patients enrolled, 5640 met the inclusion criteria, and 89 of these received ceftaroline. After PSM, 78 patients were considered in the ceftaroline group (cases) and 78 in the standard group (controls). Ceftaroline was mainly prescribed in cases with severe pneumonia (67% vs. 56%, p = 0.215) with high suspicion of Staphylococcus aureus infection (9% vs. 0%, p = 0.026). Cases had a longer length of hospital stay (13 days vs. 10 days, p = 0.007), while an increased risk of in-hospital mortality was observed in the control group compared to the case group (13% vs. 21%, HR 0.41; 95% CI 0.18 to 0.62, p = 0.003). The empiric use of ceftaroline in hospitalized patients with severe CAP was associated with a decreased risk of in-hospital mortality.
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Affiliation(s)
- Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain.
| | - Raúl Mendez
- Department of Pneumology, Hospital La Fe de Valencia, Valencia, Spain
| | - Héctor Peroni
- Internal Medicine Department, Respiratory Medicine Unit and Emergency Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Verónica Rico
- Department of Infectious Diseases, Hospital Clinic of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Albert Gabarrus
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Rosario Menéndez
- Department of Pneumology, Hospital La Fe de Valencia, Valencia, Spain
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain.
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García-Río F, Alcázar-Navarrete B, Castillo-Villegas D, Cilloniz C, García-Ortega A, Leiro-Fernández V, Lojo-Rodriguez I, Padilla-Galo A, Quezada-Loaiza CA, Rodriguez-Portal JA, Sánchez-de-la-Torre M, Sibila O, Martínez-García MA. [Translated article] Biological Biomarkers in Respiratory Diseases. Archivos de Bronconeumología 2022. [DOI: 10.1016/j.arbres.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Garcia-Rio F, Alcázar B, Castillo D, Cilloniz C, García-Ortega A, Leiro-Fernández V, Lojo-Rodriguez I, Padilla A, Quezada CA, Rodriguez-Portal JA, Sánchez-de-la-Torre M, Sibila O, Martinez-Garcia MA. Biomarcadores biológicos en las enfermedades respiratorias. Arch Bronconeumol 2022; 58:323-333. [DOI: 10.1016/j.arbres.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
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28
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Ceccato A, Russo A, Barbeta E, Oscanoa P, Tiseo G, Gabarrus A, Di Giannatale P, Nogas S, Cilloniz C, Menichetti F, Ferrer M, Niederman M, Falcone M, Torres A. Real-world corticosteroid use in severe pneumonia: a propensity-score-matched study. Crit Care 2021; 25:432. [PMID: 34915895 PMCID: PMC8674860 DOI: 10.1186/s13054-021-03840-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/24/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide despite correct antibiotic use. Corticosteroids have long been evaluated as a treatment option, but heterogeneous effects on survival have precluded their widespread implementation. We aimed to evaluate whether corticosteroids might improve clinical outcomes in patients with severe CAP and high inflammatory responses. STUDY DESIGN AND METHODS We analyzed two prospective observational cohorts of patients with CAP in Barcelona and Rome who were admitted to intensive care with a high inflammatory response. Propensity score (PS) matching was used to obtain balance among the baseline variables in both groups, and we excluded patients with viral pneumonia or who received hydrocortisone. RESULTS Of the 610 patients admitted with severe CAP, 198 (32%) received corticosteroids and 387 had major criteria for severe CAP. All patients had a baseline serum C-reactive protein above 15 mg/dL. Patients who received corticosteroids were more commonly male, had more comorbidities (e.g., cancer or chronic obstructive pulmonary disease), and presented with significantly higher sequential organ failure assessment scores. Eighty-nine patients met major severity criteria (invasive mechanical ventilation and/or septic shock) and were matched per group. Twenty-eight-day mortality was lower among patients receiving corticosteroids (16 patients, 18%) than among those not receiving them (28 patients, 31%; p = 0.037). After PS matching, corticosteroid therapy reduced the 28-day mortality risk in patients who met major severity criteria (hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.29-0.98) (p = 0.043). In patients who did not meet major severity criteria, no benefits were observed with corticosteroid use (HR 0.88 (95%CI 0.32-2.36). CONCLUSIONS Corticosteroid treatment may be of benefit for patients with CAP who have septic shock and/or a high inflammatory response and requirement for invasive mechanical ventilation. Corticosteroids appear to have no impact on mortality when these features are not present.
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Affiliation(s)
- A Ceccato
- Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
| | - A Russo
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - E Barbeta
- Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - P Oscanoa
- Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - G Tiseo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Gabarrus
- Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - P Di Giannatale
- Department of Medical, Oral and Biotechnological Sciences, School of Medicine and Health Sciences, Section of Anesthesia Analgesia, Perioperative and Intensive Care, SS. Annunziata Hospital, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - S Nogas
- Dipartimento Scienze Chirurgiche E Diagnostiche Integrate (DISC), Università Degli Studi Di Genova, Genova, Italy
| | - C Cilloniz
- Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - F Menichetti
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Ferrer
- Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - M Niederman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - M Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Torres
- Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain.
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
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Pérez de Llano LA, Golpe R, Pérez-Ortiz D, Menéndez R, España Yandiola PP, Artaraz A, Zalacain R, Cilloniz C, Torres A. [Early initiation of corticosteroids might be harmful in patients hospitalized with COVID-19 pneumonia: A multicenter propensity score analysis.]. Arch Bronconeumol 2021; 58:281-283. [PMID: 34720332 PMCID: PMC8541830 DOI: 10.1016/j.arbres.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Luis A Pérez de Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo. C039 Biodiscovery Research Group HULA-USC, Health Research Institute of Santiago de Compostela (IDIS), Spain
| | - Rafael Golpe
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo. C039 Biodiscovery Research Group HULA-USC, Health Research Institute of Santiago de Compostela (IDIS), Spain.
| | - Diego Pérez-Ortiz
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo. C039 Biodiscovery Research Group HULA-USC, Health Research Institute of Santiago de Compostela (IDIS), Spain
| | - Rosario Menéndez
- Hospital Universitario y Politécnico la Fe, Valencia, Spain; Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain
| | | | - Amaia Artaraz
- Pneumology Service, Galdakao-Usansolo University Hospital, Galdakao, Bizkaia, Spain
| | - Rafael Zalacain
- Pneumology Service, Cruces University Hospital, Bizkaia, Spain
| | - Catia Cilloniz
- Hospital Clinic, Barcelona, Spain; Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain
| | - Antoni Torres
- Hospital Clinic, Barcelona, Spain; Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain
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Torres A, Menéndez R, España PP, Fernández-Villar JA, Marimón JM, Cilloniz C, Méndez R, Egurrola M, Botana-Rial M, Ercibengoa M, Méndez C, Cifuentes I, Gessner BD. The Evolution and Distribution of Pneumococcal Serotypes in Adults Hospitalized With Community-Acquired Pneumonia in Spain Using a Serotype-Specific Urinary Antigen Detection Test: The CAPA Study, 2011-2018. Clin Infect Dis 2021; 73:1075-1085. [PMID: 33851220 PMCID: PMC8442776 DOI: 10.1093/cid/ciab307] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/09/2021] [Indexed: 11/12/2022] Open
Abstract
Background Spain introduced the 13-valent pneumococcal conjugate vaccine (PCV13) in the childhood National Immunization Program in 2015–2016 with coverage of 3 doses of 94.8% in 2018. We assessed the evolution of all pneumococcal, PCV13 vaccine type (VT), and experimental PCV20-VT (PCV13 + serotypes 8, 10A, 11A, 12F, 15B, 22F, 33F) hospitalized community-acquired pneumonia (CAP) in adults in Spain from 2011–2018. Methods A prospective observational study of immunocompetent adults (≥18 years) admitted to 4 Spanish hospitals with chest X-ray–confirmed CAP between November 2011 and November 2018. Microbiological confirmation was obtained using the Pfizer serotype-specific urinary antigen detection tests (UAD1/UAD2), BinaxNow test for urine, and conventional cultures of blood, pleural fluid, and high-quality sputum. Results Of 3107 adults hospitalized with CAP, 1943 were ≥65 years. Underlying conditions were present in 87% (n = 2704) of the participants. Among all patients, 895 (28.8%) had pneumococcal CAP and 439 (14.1%) had PCV13-VT CAP, decreasing from 17.9% (n = 77) to 13.2% (n = 68) from 2011–2012 to 2017–2018 (P = .049). PCV20-VT CAP occurred in 243 (23.8%) of those included in 2016–2018. The most identified serotypes were 3 and 8. Serotype 3 accounted for 6.9% (n = 215) of CAP cases, remaining stable during the study period, and was associated with disease severity. Conclusions PCV13-VT caused a substantial proportion of CAP in Spanish immunocompetent adults 8 years after introduction of childhood PCV13 immunization. Improving direct PCV13 coverage of targeted adult populations could further reduce PCV13-VT burden, a benefit that could be increased further if PCV20 is licensed and implemented.
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Affiliation(s)
- Antoni Torres
- Hospital Clinic, Barcelona, Spain.,Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain
| | - Rosario Menéndez
- Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain.,Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | | | | | | | | | - Raúl Méndez
- Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | | | | | - María Ercibengoa
- Biodonostia, Hospital Universitario Donostia, San Sebastian, Spain
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Haas LEM, Boumendil A, Flaatten H, Guidet B, Ibarz M, Jung C, Moreno R, Morandi A, Andersen FH, Zafeiridis T, Walther S, Oeyen S, Leaver S, Watson X, Boulanger C, Szczeklik W, Schefold JC, Cecconi M, Marsh B, Joannidis M, Nalapko Y, Elhadi M, Fjølner J, Artigas A, de Lange DW, Joannidis M, Eller P, Helbok R, Schmutz R, Nollet J, de Neve N, De Buysscher P, Oeyen S, Swinnen W, Mikačić M, Bastiansen A, Husted A, Dahle BES, Cramer C, Sølling C, Ørsnes D, Thomsen JE, Pedersen JJ, Enevoldsen MH, Elkmann T, Kubisz-Pudelko A, Pope A, Collins A, Raj AS, Boulanger C, Frey C, Hart C, Bolger C, Spray D, Randell G, Filipe H, Welters ID, Grecu I, Evans J, Cupitt J, Lord J, Henning J, Jones J, Ball J, North J, Salaunkey K, De Gordoa LOR, Bell L, Balasubramaniam M, Vizcaychipi M, Faulkner M, Mupudzi M, Lea-Hagerty M, Reay M, Spivey M, Love N, Spittle NSN, White N, Williams P, Morgan P, Wakefield P, Savine R, Jacob R, Innes R, Kapoor R, Humphreys S, Rose S, Dowling S, Leaver S, Mane T, Lawton T, Ogbeide V, Khaliq W, Baird Y, Romen A, Galbois A, Guidet B, Vinsonneau C, Charron C, Thevenin D, Guerot E, Besch G, Savary G, Mentec H, Chagnon JL, Rigaud JP, Quenot JP, Castaneray J, Rosman J, Maizel J, Tiercelet K, Vettoretti L, Hovaere MM, Messika M, Djibré M, Rolin N, Burtin P, Garcon P, Nseir S, Valette X, Rabe C, Barth E, Ebelt H, Fuest K, Franz M, Horacek M, Schuster M, Meybohm P, Bruno RR, Allgäuer S, Dubler S, Schaller SJ, Schering S, Steiner S, Dieck T, Rahmel T, Graf T, Koutsikou A, Vakalos A, Raitsiou B, Flioni EN, Neou E, Tsimpoukas F, Papathanakos G, Marinakis G, Koutsodimitropoulos I, Aikaterini K, Rovina N, Kourelea S, Polychronis T, Zidianakis V, Konstantinia V, Aidoni Z, Marsh B, Motherway C, Read C, Martin-Loeches I, Cracchiolo AN, Morigi A, Calamai I, Brusa S, Elhadi A, Tarek A, Khaled A, Ahmed H, Belkhair WA, Cornet AD, Gommers D, de Lange D, van Boven E, Haringman J, Haas L, van den Berg L, Hoiting O, de Jager P, Gerritsen RT, Dormans T, Dieperink W, Breidablik ABA, Slapgard A, Rime AK, Jannestad B, Sjøbøe B, Rice E, Andersen FH, Strietzel HF, Jensen JP, Langørgen J, Tøien K, Strand K, Hahn M, Klepstad P, Biernacka A, Kluzik A, Kudlinski B, Maciejewski D, Studzińska D, Hymczak H, Stefaniak J, Solek-Pastuszka J, Zorska J, Cwyl K, Krzych LJ, Zukowski M, Lipińska-Gediga M, Pietruszko M, Piechota M, Serwa M, Czuczwar M, Ziętkiewicz M, Kozera N, Nasiłowski P, Sendur P, Zatorski P, Galkin P, Gawda R, Kościuczuk U, Cyrankiewicz W, Gola W, Pinto AF, Fernandes AM, Santos AR, Sousa C, Barros I, Ferreira IA, Blanco JB, Carvalho JT, Maia J, Candeias N, Catorze N, Belskiy V, Lores A, Mira AP, Cilloniz C, Perez-Torres D, Maseda E, Rodriguez E, Prol-Silva E, Eixarch G, Gomà G, Aguilar G, Velasco GN, Jaimes MI, Villamayor MI, Fernández NL, Cubero PJ, López-Cuenca S, Tomasa T, Sjöqvist A, Brorsson C, Schiöler F, Westberg H, Nauska J, Sivik J, Berkius J, Thiringer KK, De Geer L, Walther S, Boroli F, Schefold JC, Hergafi L, Eckert P, Yıldız I, Yovenko I, Nalapko Y, Nalapko Y, Pugh R. Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs. Age Ageing 2021; 50:1719-1727. [PMID: 33744918 DOI: 10.1093/ageing/afab036] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear. OBJECTIVE To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function. DESIGN Prospective cohort study. SETTING 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019. SUBJECTS Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2. METHODS Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients' characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected. RESULTS Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09-1.25, P < 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14-1.17, P < 0.0001) and frailty (CFS > 4): HR, 1.34 (95% CI, 1.18-1.51, P < 0.0001). CONCLUSIONS There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.
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Affiliation(s)
- Lenneke E M Haas
- Department of Intensive Care Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Ariane Boumendil
- Assistance Publique-Hôpital de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale. Paris F-75012, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Bertrand Guidet
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Service de Réanimation, Sorbonne Université, INSERM, F75012 Paris, France
| | - Mercedes Ibarz
- Department of Intensive Care Medicine, Universitary Hospital Sagrat Cor Barcelona, Spain
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Centro Hospitalar, Faculdade de Ciências Médicas de Lisboa (Nova Medical School), Universitário de Lisboa Central, Lisbon, Portugal
| | - Alessandro Morandi
- Department of Rehabilitation and Aged Care, Hospital Ancelle, Cremona, Italy. Parc Sanitari Pere Virgili and Vall d’Hebrón Institute of Research, Barcelona, Spain
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway, Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway
| | | | - Sten Walther
- Department of Cardiothoracic and Vascular Surgery, Heart Centre, Linköping University Hospital, Linköping, Sweden
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Susannah Leaver
- Research Lead Critical Care Directorate St George's University Hospital, NHS Foundation Trust, London, UK
| | | | - Carole Boulanger
- Chair NAHP Section ESICM, Intensive Care Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, MI, Italy
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Yuriy Nalapko
- European Wellness International, ICU, Luhansk, Ukraine
| | | | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona. Sabadell, Spain
| | - Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
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Cilloniz C, Simonds A, Hansen K, Alouch J, Zar H, Nakanishi Y, Levine S, Cohen M, Dela Cruz C, Evans SE, Sanguinetti M, Vila J, Díez Manglano J, Ferrer R, Criado L, Polo García J, Correcher Z, Rodriguez-Hurtado D, Terrazas C, Muñoz-Almagro C, Garcia-Vidal C, Aoun Z, Amirav I. Pulse oximetry is an essential tool that saves lives: a call for standardisation. Eur Respir J 2021; 57:57/6/2100815. [PMID: 34088755 DOI: 10.1183/13993003.00815-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/15/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Catia Cilloniz
- Pulmonology Dept, Hospital Clinic of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Anita Simonds
- Sleep and Ventilation Unit, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, London, UK
| | - Kjeld Hansen
- Copenhagen Business School, Frederiksberg, Copenhagen, Denmark.,Kristiania University College, Oslo, Norway
| | - Josep Alouch
- Dept of Medicine, University of Nairobi, Nairobi, Kenya
| | - Heather Zar
- Dept of Paediatrics and Child Health and SA Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Yoichi Nakanishi
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Kitakyushu City Hospital Organisation, Fukuoka, Japan
| | - Stephanie Levine
- University of Texas Health San Antonio and the South Texas Veterans Healthcare System, San Antonio, TX, USA
| | - Mark Cohen
- Pulmonary and Intensive Care Unit, Centro Medico Hospital, Guatemala, Guatemala
| | - Charles Dela Cruz
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Scott E Evans
- Dept of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Centre, Houston, TX, USA
| | | | - Jordi Vila
- Microbiology Dept, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Ricard Ferrer
- Intensive Care Dept, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Lucio Criado
- Dept of Medicine, Hospital del Bicentenario, Ituzaingo, Argentina
| | | | - Zaira Correcher
- General University Hospital and CS Almassora, Castello, Spain
| | - Diana Rodriguez-Hurtado
- Dept of Medicine, National Hospital 'Arzobispo Loayza', Peruvian University 'Cayetano Heredia', Lima, Perú
| | | | | | | | - Zeina Aoun
- Dept of Pulmonary and Critical Care, Hôtel Dieu de France University Hospital, Beirut, Lebanon
| | - Israel Amirav
- Paediatric Dept, University of Alberta, Edmonton, AB, Canada.,Paediatric Pulmonology Unit, Ichilov Tel-Aviv Medical Centre, Tel-Aviv, Israel
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Rouze A, Martin-Loeches I, Povoa P, Metzelard M, Du Cheyron D, Lambiotte F, Tamion F, Labruyere M, Boulle Geronimi C, Nieszkowska A, Nyunga M, Pouly O, Thille AW, Megarbane B, Saade A, Diaz E, Magira E, Llitjos JF, Cilloniz C, Ioannidou I, Pierre A, Reignier J, Garot D, Kreitmann L, Baudel JL, Fartoukh M, Plantefeve G, Beurton A, Asfar P, Boyer A, Mekontso-Dessap A, Makris D, Vinsonneau C, Floch PE, Weiss N, Ceccato A, Artigas A, Bouchereau M, Duhamel A, Labreuche J, Nseir S. Early Bacterial Identification Among Intubated Patients with COVID-19 or Influenza Pneumonia: A European Multicenter Comparative Cohort Study. Am J Respir Crit Care Med 2021; 204:546-556. [PMID: 34038699 PMCID: PMC8491267 DOI: 10.1164/rccm.202101-0030oc] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Rationale: Early empirical antimicrobial treatment is frequently prescribed to critically ill patients with coronavirus disease (COVID-19) based on Surviving Sepsis Campaign guidelines. Objectives: We aimed to determine the prevalence of early bacterial identification in intubated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, as compared with influenza pneumonia, and to characterize its microbiology and impact on outcomes. Methods: A multicenter retrospective European cohort was performed in 36 ICUs. All adult patients receiving invasive mechanical ventilation >48 hours were eligible if they had SARS-CoV-2 or influenza pneumonia at ICU admission. Bacterial identification was defined by a positive bacterial culture within 48 hours after intubation in endotracheal aspirates, BAL, blood cultures, or a positive pneumococcal or legionella urinary antigen test. Measurements and Main Results: A total of 1,050 patients were included (568 in SARS-CoV-2 and 482 in influenza groups). The prevalence of bacterial identification was significantly lower in patients with SARS-CoV-2 pneumonia compared with patients with influenza pneumonia (9.7 vs. 33.6%; unadjusted odds ratio, 0.21; 95% confidence interval [CI], 0.15–0.30; adjusted odds ratio, 0.23; 95% CI, 0.16–0.33; P < 0.0001). Gram-positive cocci were responsible for 58% and 72% of coinfection in patients with SARS-CoV-2 and influenza pneumonia, respectively. Bacterial identification was associated with increased adjusted hazard ratio for 28-day mortality in patients with SARS-CoV-2 pneumonia (1.57; 95% CI, 1.01–2.44; P = 0.043). However, no significant difference was found in the heterogeneity of outcomes related to bacterial identification between the two study groups, suggesting that the impact of coinfection on mortality was not different between patients with SARS-CoV-2 and influenza. Conclusions: Bacterial identification within 48 hours after intubation is significantly less frequent in patients with SARS-CoV-2 pneumonia than patients with influenza pneumonia.Clinical trial registered with www.clinicaltrials.gov (NCT 04359693).
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Affiliation(s)
| | - Ignacio Martin-Loeches
- St James's University Hospital. , Multidisciplinary Intensive Care Research Organization (MICRO). , Dublin, Ireland
| | - Pedro Povoa
- Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | | | | | - Fabien Lambiotte
- General hospital of Valenciennes, Intensive Care Medicine, Valenciennes, France
| | - Fabienne Tamion
- CHU Charles Nicolle, Service de Réanimation Médicale, Rouen, France
| | - Marie Labruyere
- François Mitterrand University Hospital, Department of Intensive Care, Dijon, France
| | - Claire Boulle Geronimi
- Centre Hospitalier de Douai, 55156, Service de réanimation et de soins intensifs, Douai, France
| | - Ania Nieszkowska
- Groupe Hospitalier Pitié-Salpêtrière, Service de réanimation médicale, Paris, France
| | - Martine Nyunga
- Hopital Victor Provo, 88633, Medical ICU, Roubaix, France
| | - Olivier Pouly
- Hôpital Saint Philibert, 61883, Service de médecine intensive réanimation, Lomme, France
| | - Arnaud W Thille
- Centre Hospitalier Universitaire de Poitiers, Réanimation Médicale, Poitiers, France.,Université de Poitiers, 27077, Groupe ALIVE INSERM, CIC 1402,, Poitiers, France
| | - Bruno Megarbane
- Groupe hospitalier Lariboisiere Fernand-Widal, 26934, Paris, France
| | - Anastasia Saade
- Hôpital Saint-Louis, 55663, Service de médecine intensive réanimation, Paris, France
| | - Emili Diaz
- Hospital de Sabadell, 203277, Critical Care Department, Sabadell, Spain
| | | | | | - Catia Cilloniz
- Hospital Clinic i Provincial de Barcelona, Pneumology, Barcelona, Spain
| | - Iliana Ioannidou
- Sotiria Hospital, 221171, First Department of Pulmonary Medicine and Intensive Care Unit, Athens, Greece
| | - Alexandre Pierre
- Centre Hospitalier de Lens, 55638, Service de réanimation polyvalente, Lens, France
| | - Jean Reignier
- Centre Hospitalier Universitaire de Nantes, 26922, Nantes, France
| | - Denis Garot
- Bretonneau Hospital, 26927, Service de Médecine Intensive Réanimation, Tours, France
| | - Louis Kreitmann
- Hospices Civils de Lyon, 26900, Service de Médecine Intensive - Réanimation, Lyon, France
| | - Jean-Luc Baudel
- Hôpital Saint-Antoine, AP-HP, Service de Réanimation Médicale, Paris, France
| | - Muriel Fartoukh
- Assistance Publique Hopitaux de Paris. Sorbonne Université, Hôpital Tenon, Médecine intensive Réanimatio, Paris, France
| | - Gaëtan Plantefeve
- Centre Hospitalier d'Argenteuil, Réanimation polyvalente, Argenteuil, France
| | - Alexandra Beurton
- Groupe Hospitalier Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Service de Pneumologie et Réanimation Médicale, Paris, France
| | - Pierre Asfar
- university hospital, department of medical intensive care, Angers, France
| | - Alexandre Boyer
- Hôpital Pellegrin-Tripode , Service de Reanimation , Bordeaux, France
| | - Armand Mekontso-Dessap
- Hopital Henri Mondor, Service de Réanimation Médicale, Creteil, France.,UPEC, Groupe de recherche clinique CARMAS, IMRB, Faculté de médecine de Créteil, Creteil, France
| | - Demosthenes Makris
- University of Thessaly Faculty of Medicine, 37787, Larissa, Greece.,University Hospital Centre Nice Pasteur Hospital, 55185, Service de Pneumologie, Nice, France
| | | | | | - Nicolas Weiss
- Sorbonne University Faculty of Medicine, 517733, Paris, France
| | - Adrian Ceccato
- CIBERES, 568067, Madrid, Spain.,Hospital Universitari Sagrat Cor, 126700, Barcelona, Spain
| | | | | | | | | | - Saad Nseir
- Salengro hospital, CHRU de Lille, ICU, Lille, France;
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Osuchowski MF, Winkler MS, Skirecki T, Cajander S, Shankar-Hari M, Lachmann G, Monneret G, Venet F, Bauer M, Brunkhorst FM, Weis S, Garcia-Salido A, Kox M, Cavaillon JM, Uhle F, Weigand MA, Flohé SB, Wiersinga WJ, Almansa R, de la Fuente A, Martin-Loeches I, Meisel C, Spinetti T, Schefold JC, Cilloniz C, Torres A, Giamarellos-Bourboulis EJ, Ferrer R, Girardis M, Cossarizza A, Netea MG, van der Poll T, Bermejo-Martín JF, Rubio I. The COVID-19 puzzle: deciphering pathophysiology and phenotypes of a new disease entity. Lancet Respir Med 2021; 9:622-642. [PMID: 33965003 PMCID: PMC8102044 DOI: 10.1016/s2213-2600(21)00218-6] [Citation(s) in RCA: 298] [Impact Index Per Article: 99.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/06/2021] [Accepted: 03/11/2021] [Indexed: 01/08/2023]
Abstract
The zoonotic SARS-CoV-2 virus that causes COVID-19 continues to spread worldwide, with devastating consequences. While the medical community has gained insight into the epidemiology of COVID-19, important questions remain about the clinical complexities and underlying mechanisms of disease phenotypes. Severe COVID-19 most commonly involves respiratory manifestations, although other systems are also affected, and acute disease is often followed by protracted complications. Such complex manifestations suggest that SARS-CoV-2 dysregulates the host response, triggering wide-ranging immuno-inflammatory, thrombotic, and parenchymal derangements. We review the intricacies of COVID-19 pathophysiology, its various phenotypes, and the anti-SARS-CoV-2 host response at the humoral and cellular levels. Some similarities exist between COVID-19 and respiratory failure of other origins, but evidence for many distinctive mechanistic features indicates that COVID-19 constitutes a new disease entity, with emerging data suggesting involvement of an endotheliopathy-centred pathophysiology. Further research, combining basic and clinical studies, is needed to advance understanding of pathophysiological mechanisms and to characterise immuno-inflammatory derangements across the range of phenotypes to enable optimum care for patients with COVID-19.
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Affiliation(s)
- Marcin F Osuchowski
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Vienna, Austria
| | - Martin S Winkler
- Department of Anaesthesiology, University of Göttingen Medical Center, Göttingen, Georg-August University of Göttingen, Göttingen, Germany
| | - Tomasz Skirecki
- Laboratory of Flow Cytometry, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Sara Cajander
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Manu Shankar-Hari
- Guy's and St Thomas' NHS Foundation Trust, ICU support offices, St Thomas' Hospital, London, UK; School of Immunology & Microbial Sciences, Kings College London, London, UK
| | - Gunnar Lachmann
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Guillaume Monneret
- Hospices Civils de Lyon, Immunology Laboratory, Edouard Herriot Hospital, Lyon, France; Pathophysiology of Injury-Induced Immunosuppression, Equipe d'Accueil 7426, Université Claude Bernard Lyon 1 - bioMérieux - Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Fabienne Venet
- Hospices Civils de Lyon, Immunology Laboratory, Edouard Herriot Hospital, Lyon, France; Pathophysiology of Injury-Induced Immunosuppression, Equipe d'Accueil 7426, Université Claude Bernard Lyon 1 - bioMérieux - Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Michael Bauer
- Department of Anesthesiology and Intensive Care Medicine and Center for Sepsis Control and Care, Jena University Hospital-Friedrich Schiller University, Jena, Germany
| | - Frank M Brunkhorst
- Department of Anesthesiology and Intensive Care Medicine and Center for Sepsis Control and Care, Jena University Hospital-Friedrich Schiller University, Jena, Germany; Center for Clinical Studies, Jena University Hospital-Friedrich Schiller University, Jena, Germany
| | - Sebastian Weis
- Department of Anesthesiology and Intensive Care Medicine and Center for Sepsis Control and Care, Jena University Hospital-Friedrich Schiller University, Jena, Germany; Institute for Infectious Disease and Infection Control, Jena University Hospital-Friedrich Schiller University, Jena, Germany
| | - Alberto Garcia-Salido
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Matthijs Kox
- Department of Intensive Care Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Florian Uhle
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefanie B Flohé
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - W Joost Wiersinga
- Division of Infectious Diseases and Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Raquel Almansa
- Group for Biomedical Research in Sepsis, Hospital Universitario Río Hortega de Valladolid, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, Instituto de salud Carlos III, Madrid, Spain
| | - Amanda de la Fuente
- Group for Biomedical Research in Sepsis, Hospital Universitario Río Hortega de Valladolid, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization, St James's Hospital, Dublin, Ireland
| | - Christian Meisel
- Institute for Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Immunology, Labor Berlin-Charité Vivantes, Berlin, Germany
| | - Thibaud Spinetti
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Catia Cilloniz
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, ICREA, CIBERESUCICOVID, Spain
| | - Antoni Torres
- Division of Infectious Diseases and Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, ICREA, CIBERESUCICOVID, Spain; SGR 911-ICREA Academia, Barcelona, Spain
| | | | - Ricard Ferrer
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, Instituto de salud Carlos III, Madrid, Spain; Intensive Care Department and Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Massimo Girardis
- Department of Anesthesia and Intensive Care, University Hospital of Modena, Modena, Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Mihai G Netea
- Department of Intensive Care Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands; Human Genomics Laboratory, Craiova University of Medicine and Pharmacy, Craiova, Romania; Department for Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Tom van der Poll
- Division of Infectious Diseases and Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jesús F Bermejo-Martín
- Group for Biomedical Research in Sepsis, Hospital Universitario Río Hortega de Valladolid, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, Instituto de salud Carlos III, Madrid, Spain
| | - Ignacio Rubio
- Department of Anesthesiology and Intensive Care Medicine and Center for Sepsis Control and Care, Jena University Hospital-Friedrich Schiller University, Jena, Germany.
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Lazar Neto F, Marino LO, Torres A, Cilloniz C, Meirelles Marchini JF, Garcia de Alencar JC, Palomeque A, Albacar N, Brandão Neto RA, Souza HP, Ranzani OT. Community-acquired pneumonia severity assessment tools in patients hospitalized with COVID-19: a validation and clinical applicability study. Clin Microbiol Infect 2021; 27:1037.e1-1037.e8. [PMID: 33813111 PMCID: PMC8016546 DOI: 10.1016/j.cmi.2021.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/16/2021] [Accepted: 03/20/2021] [Indexed: 12/24/2022]
Abstract
Objective To externally validate community-acquired pneumonia (CAP) tools on patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia from two distinct countries, and compare their performance with recently developed COVID-19 mortality risk stratification tools. Methods We evaluated 11 risk stratification scores in a binational retrospective cohort of patients hospitalized with COVID-19 pneumonia in São Paulo and Barcelona: Pneumonia Severity Index (PSI), CURB, CURB-65, qSOFA, Infectious Disease Society of America and American Thoracic Society Minor Criteria, REA-ICU, SCAP, SMART-COP, CALL, COVID GRAM and 4C. The primary and secondary outcomes were 30-day in-hospital mortality and 7-day intensive care unit (ICU) admission, respectively. We compared their predictive performance using the area under the receiver operating characteristics curve (AUC), sensitivity, specificity, likelihood ratios, calibration plots and decision curve analysis. Results Of 1363 patients, the mean (SD) age was 61 (16) years. The 30-day in-hospital mortality rate was 24.6% (228/925) in São Paulo and 21.0% (92/438) in Barcelona. For in-hospital mortality, we found higher AUCs for PSI (0.79, 95% CI 0.77–0.82), 4C (0.78, 95% CI 0.75–0.81), COVID GRAM (0.77, 95% CI 0.75–0.80) and CURB-65 (0.74, 95% CI 0.72–0.77). Results were similar for both countries. For the 1%–20% threshold range in decision curve analysis, PSI would avoid a higher number of unnecessary interventions, followed by the 4C score. All scores had poor performance (AUC <0.65) for 7-day ICU admission. Conclusions Recent clinical COVID-19 assessment scores had comparable performance to standard pneumonia prognostic tools. Because it is expected that new scores outperform older ones during development, external validation studies are needed before recommending their use.
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Affiliation(s)
- Felippe Lazar Neto
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Lucas Oliveira Marino
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES, CIBERESUCICOVID), Barcelona, Spain
| | - Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES, CIBERESUCICOVID), Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | | | | | - Andrea Palomeque
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES, CIBERESUCICOVID), Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Núria Albacar
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES, CIBERESUCICOVID), Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | | | - Heraldo Possolo Souza
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Otavio T Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Pulmonary Division, Heart Institute (InCor), Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Cilloniz C, Peroni HJ, Gabarrús A, García-Vidal C, Pericàs JM, Bermejo-Martin J, Torres A. Lymphopenia Is Associated With Poor Outcomes of Patients With Community-Acquired Pneumonia and Sepsis. Open Forum Infect Dis 2021; 8:ofab169. [PMID: 34189165 PMCID: PMC8231373 DOI: 10.1093/ofid/ofab169] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/30/2021] [Indexed: 12/29/2022] Open
Abstract
Background Lymphopenia is a marker of poor prognosis in patients with community-acquired pneumonia (CAP), yet its impact on outcomes in patients with CAP and sepsis remains unknown. We aim to investigate the impact of lymphopenia on outcomes, risk of intensive care unit (ICU) admission, and mortality in CAP patients with sepsis. Methods This was a retrospective, observational study of prospectively collected data from an 800-bed tertiary teaching hospital (2005–2019). Results Of the 2203 patients with CAP and sepsis, 1347 (61%) did not have lymphopenia, while 856 (39%) did. When compared with the nonlymphopenic group, patients with sepsis and lymphopenia more frequently required ICU admission (P = .001), had a longer hospital length of stay (P ˂ .001), and presented with a higher rate of in-hospital (P ˂ .001) and 30-day mortality (P = .001). Multivariable analysis showed that C-reactive protein ≥15 mg/dL, lymphopenia, pleural effusion, and acute respiratory distress syndrome within 24 hours of admission were risk factors for ICU admission; age ≥80 years was independently associated with decreased ICU admission. In addition, age ≥80 years, chronic renal disease, chronic neurologic disease, being a nursing home resident, lymphopenia, and pleural effusion were independently associated with increased 30-day mortality, whereas pneumococcal vaccination, diabetes mellitus, and fever were independently associated with reduced 30-day mortality. Conclusions Lymphopenia was independently associated with risk of ICU admission and higher in-hospital and 30-day mortality in patients with CAP and sepsis. Early identification of lymphopenia could help identify septic patients with CAP who require or will shortly require critical care.
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Affiliation(s)
- Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain.,Biomedical Research Networking Centres in Respiratory Diseases (Ciberes) Barcelona, Spain
| | - Héctor José Peroni
- Respiratory Medicine Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Emergency Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Albert Gabarrús
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain.,Biomedical Research Networking Centres in Respiratory Diseases (Ciberes) Barcelona, Spain
| | | | - Juan M Pericàs
- Infectious Disease Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Vall d'Hebron Institute for Research, Barcelona, Spain
| | - Jesús Bermejo-Martin
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, Salamanca, Spain.,Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain
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37
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Banfi P, Garuti G, Diaz de Teran T, Ruiz J, Ferraioli G, Russo G, Casu F, Gandolfo C, Cinque E, Gallo F, Cilloniz C, Torres A, Nicolini A. Differences between sexes concerning COVID-19-related pneumonia. Panminerva Med 2021; 64:517-524. [PMID: 33618509 DOI: 10.23736/s0031-0808.21.04165-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Pneumonia is both the most common type of lower respiratory tract infection and a major cause of morbidity and mortality worldwide. The COVID-19 pandemic caused by the SARS-CoV-2 raised an extremely serious concern, because its most frequent clinical presentation was pneumonia. Features such as sex play an active role in the incidence and outcomes of pneumonia. This study aimed to evaluate differences between sexes concerning COVID-19-related pneumonia. METHODS This was a retrospective, multicentre study that enrolled 340 consecutive adult patients admitted to hospital for COVID-19-related pneumonia. Of these patients, 219 were males (64.4%) and 121, females (35.6%). Primary endpoints were differences between both sexes as per clinical features, laboratory and radiologic results, and inhospital and 30-day mortality. Secondary outcomes included differences between both sexes and factors associated with mortality. RESULTS Males admitted to the COVID-19 Unit were older than females (74.5 ± 15.7 vs. 64.5 ± 11.9). Cardiovascular disorders were more frequent in males (19.17% vs 13.25%), whereas obesity was more common in females (54.5% vs 37.45%). In-hospital and 30-day mortality were higher in males than in females (23.3% vs 15.7%; 24.6% vs 19.8%, respectively). No differences were observed in hospital stay; however, males had a longer ICU stay when compared with females (11.04±5.4 vs 7.05±3.4). Variables associated with a higher mortality rate included older age, a lower number of lymphocytes upon admission and higher levels of ferritin and troponin upon admission. CONCLUSIONS Males had significantly higher mortality and longer ICU stay than females. More comorbidities in males than in females could explain the difference in mortality rates. The protective role of genetic factors can partially explain the better outcomes observed in female patients with COVID-19.
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Affiliation(s)
- Paolo Banfi
- Rehabilitation Pulmonology, Don Gnocchi Foundation, IRCCS, Milan, Italy
| | - Giancarlo Garuti
- Pulmonology Unit, Santa Maria Bianca Hospital, Mirandola, Modena, Italy
| | - Teresa Diaz de Teran
- Pulmonary, Sleep Disorders and Non-invasive Ventilation Unit, Hospital Marqués de Valdecilla, Santander, Spain
| | - Juan Ruiz
- Pulmonary, Sleep Disorders and Non-invasive Ventilation Unit, Hospital Marqués de Valdecilla, Santander, Spain
| | | | - Giuseppe Russo
- COVID Unit, General Hospital, Sestri Levante, Genoa, Italy
| | - Francesco Casu
- COVID Unit, General Hospital, Sestri Levante, Genoa, Italy
| | | | - Enrico Cinque
- Intensive Care Unit, Tigullio Hospital, Lavagna, Genoa, Italy
| | - Fabrizio Gallo
- COVID Unit, General Hospital, Sestri Levante, Genoa, Italy
| | - Catia Cilloniz
- Pulmonology Department, Hospital Clinic of Barcelona, University of Barcelona, CIBERES, Barcelona, Spain
| | - Antoni Torres
- Pulmonology Department, Hospital Clinic of Barcelona, University of Barcelona, CIBERES, Barcelona, Spain
| | - Antonello Nicolini
- Respiratory Diseases Unit, General Hospital, Sestri Levante, Genoa, Italy -
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38
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Garcia-Vidal C, Cózar-Llistó A, Meira F, Dueñas G, Puerta-Alcalde P, Cilloniz C, Garcia-Pouton N, Chumbita M, Cardozo C, Hernández M, Rico V, Bodro M, Morata L, Castro P, Almuedo-Riera A, García F, Mensa J, Antonio Martínez J, Sanjuan G, Torres A, Nicolás JM, Soriano A. Trends in mortality of hospitalised COVID-19 patients: A single centre observational cohort study from Spain. Lancet Reg Health Eur 2021; 3:100041. [PMID: 33870249 PMCID: PMC7830193 DOI: 10.1016/j.lanepe.2021.100041] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background We aimed to describe changes in characteristics and treatment strategies of hospitalised patients with COVID-19 and detail the mortality trend over time. Methods Observational cohort study of all consecutive patients admitted ≥ 48 h to Hospital Clinic of Barcelona for COVID-19 (1 March-30 September 2020). Findings A total of 1645 consecutive patients with COVID-19 were assessed over a 7-month period. Overall mortality (≤30 days) was 9.7% (159 patients), 7.7% in patients hospitalised in regular wards and 16.7 % in patients requiring ICU admission. Overall mortality decreased from 11.6% in the first month to 1.4% in the last month, reflecting a progressive, significant downward trend (p for trend <0.001). Patients' age changed over time, peaking in June. Most changes in the use of antivirals and anti-inflammatory treatments were documented. Age (OR 1.1, CI 1.1-1.12), chronic heart disease, (OR 1.7, CI 1.1-2.9), D-dimer>700 ng/mL (OR 2.3, CI 1.3-4.1), ferritin>489 ng/mL (OR 1.9; CI 1.5-3.2), C-RP>7 mg/dL (OR 2.6; CI 1.5-4.6), and shorter duration from symptom onset to hospital admission (OR 1.11; CI 1.04-1.17) were factors associated with 30-day mortality at hospital admission. Conversely, hospital admission in the last months (OR 0.80; CI 0.65-0.98) was significantly associated with lower mortality. Interpretation In-hospital mortality has decreased in patients with COVID-19 over the last, few months, even though main patient characteristics remain similar. Several changes made when managing patients may explain this decreasing trend. Our study provides current data on mortality of patients hospitalised with COVID-19 that might be useful in establishing quality of standard of care. Funding EIT Health, European Union´s Horizon 2020 Research and Innovation Programme), EDRD. PPA [CM18/00132], NGP [FI19/00133], and CGV [FIS PI18/01061], have received grants from Ministerio de Sanidad y Consumo, ISCIII.
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Affiliation(s)
- Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Alberto Cózar-Llistó
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Fernanda Meira
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Gerard Dueñas
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona, Spain.,Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain.,Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Nicole Garcia-Pouton
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Mariana Chumbita
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Celia Cardozo
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Marta Hernández
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Verónica Rico
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alex Almuedo-Riera
- Centre for Research in International Health (CRESIB), Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Felipe García
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Josep Mensa
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - José Antonio Martínez
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Gemma Sanjuan
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain.,Computer System Unit, Hospital Clinic, Barcelona, Spain
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, Spain.,Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain.,Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - J M Nicolás
- Medical Intensive Care Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
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Cilloniz C, Dominedò C, Gabarrús A, Garcia-Vidal C, Becerril J, Tovar D, Moreno E, Pericás JM, Vargas CR, Torres A. Methicillin-susceptible staphylococcus aureus in community-acquired pneumonia: Risk factors and outcomes. J Infect 2020; 82:76-83. [PMID: 33144192 DOI: 10.1016/j.jinf.2020.10.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We aimed to describe the prevalence, risk factors and outcomes of Methicillin-susceptible S. aureus (MSSA) community-acquired pneumonia (CAP) and compare them with those associated with CAP due to Streptococcus pneumoniae, the most frequent causative microorganism, in a large cohort of patients. METHODS This was an observational study of prospectively collected data of consecutive adults with CAP and a definitive etiology enrolled between 2004 and 2018. Patients were divided into MSSA CAP and pneumococcal CAP groups for analysis. RESULTS A microbial etiology was established in 1,548 (33%) cases: S. aureus caused 6% of microbiologically-confirmed CAP cases. In the latter, 52 were due to MSSA (60% of S. aureus CAP cases, and 3% of microbiologically-confirmed CAP cases) and 34 were due to MRSA (40% of S. aureus CAP cases, and 2% of microbiologically-confirmed CAP cases). S. pneumoniae was identified in 734 (47%) microbiologically-confirmed CAP cases. The presence of fever was independently associated with a lower risk of MSSA CAP (OR 0.53; 95% CI, 0.28-0.99). Patients with MSSA CAP had higher 30-day mortality than patients with pneumococcal CAP, both before and after adjustment for potential confounders (21% vs 7%, p = 0.002). MSSA was independently associated with 30-day mortality in the overall population. CONCLUSION MSSA CAP was associated with worse outcomes than pneumococcal CAP in our cohort. MSSA was an independent factor of mortality.
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Affiliation(s)
- Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES) Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Cristina Dominedò
- Department of Shock e Trauma, San Camillo Forlanini Hospital, Rome, Italy
| | - Albert Gabarrús
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES) Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | | | - José Becerril
- National Polytechnic Institute, Ciudad de México, México
| | - Diego Tovar
- National Polytechnic Institute, Ciudad de México, México
| | - Estela Moreno
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Spain
| | - Juan M Pericás
- Clinical Direction of Infectious Diseases and Microbiology, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Carmen Rosa Vargas
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES) Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES) Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Spain.
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40
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Cilloniz C, Dominedo C, Peroni HJ, Di Giannatale P, Garcia-Vidal C, Gabarrus A, Liapikou A, Ceccato A, Torres A. Difficult to treat microorganisms in patients aged over 80 years with community-acquired pneumonia: the prevalence of PES pathogens. Eur Respir J 2020; 56:13993003.00773-2020. [PMID: 32430413 DOI: 10.1183/13993003.00773-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/28/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Catia Cilloniz
- Dept of Pulmonology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Cristina Dominedo
- Dept of Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Héctor José Peroni
- Servicio de Clínica Medica, Sección de Neumonología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pierluigi Di Giannatale
- Dept of Anaesthesiology, Critical Care and Pain Management, "Gabriele d'Annunzio" University of Chieti-Pescara and "SS. Annunziata" Hospital of Chieti, Chieti, Italy
| | | | - Albert Gabarrus
- Dept of Pulmonology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
| | | | - Adrian Ceccato
- Dept of Pulmonology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Antoni Torres
- Dept of Pulmonology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
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Venkatesan S, Myles PR, Bolton KJ, Muthuri SG, Al Khuwaitir T, Anovadiya AP, Azziz-Baumgartner E, Bajjou T, Bassetti M, Beovic B, Bertisch B, Bonmarin I, Booy R, Borja-Aburto VH, Burgmann H, Cao B, Carratala J, Chinbayar T, Cilloniz C, Denholm JT, Dominguez SR, Duarte PAD, Dubnov-Raz G, Fanella S, Gao Z, Gérardin P, Giannella M, Gubbels S, Herberg J, Higuera Iglesias AL, Hoeger PH, Hu XY, Islam QT, Jiménez MF, Keijzers G, Khalili H, Kusznierz G, Kuzman I, Langenegger E, Lankarani KB, Leo YS, Libster RP, Linko R, Madanat F, Maltezos E, Mamun A, Manabe T, Metan G, Mickiene A, Mikić D, Mohn KGI, Oliva ME, Ozkan M, Parekh D, Paul M, Rath BA, Refaey S, Rodríguez AH, Sertogullarindan B, Skręt-Magierło J, Somer A, Talarek E, Tang JW, To K, Tran D, Uyeki TM, Vaudry W, Vidmar T, Zarogoulidis P, Nguyen-Van-Tam JS. Neuraminidase Inhibitors and Hospital Length of Stay: A Meta-analysis of Individual Participant Data to Determine Treatment Effectiveness Among Patients Hospitalized With Nonfatal 2009 Pandemic Influenza A(H1N1) Virus Infection. J Infect Dis 2020; 221:356-366. [PMID: 31314899 PMCID: PMC7313925 DOI: 10.1093/infdis/jiz152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/16/2019] [Indexed: 02/05/2023] Open
Abstract
Background The effect of neuraminidase inhibitor (NAI) treatment on length of stay (LoS) in patients hospitalized with influenza is unclear. Methods We conducted a one-stage individual participant data (IPD) meta-analysis exploring the association between NAI treatment and LoS in patients hospitalized with 2009 influenza A(H1N1) virus (A[H1N1]pdm09) infection. Using mixed-effects negative binomial regression and adjusting for the propensity to receive NAI, antibiotic, and corticosteroid treatment, we calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Patients with a LoS of <1 day and those who died while hospitalized were excluded. Results We analyzed data on 18 309 patients from 70 clinical centers. After adjustment, NAI treatment initiated at hospitalization was associated with a 19% reduction in the LoS among patients with clinically suspected or laboratory-confirmed influenza A(H1N1)pdm09 infection (IRR, 0.81; 95% CI, .78–.85), compared with later or no initiation of NAI treatment. Similar statistically significant associations were seen in all clinical subgroups. NAI treatment (at any time), compared with no NAI treatment, and NAI treatment initiated <2 days after symptom onset, compared with later or no initiation of NAI treatment, showed mixed patterns of association with the LoS. Conclusions When patients hospitalized with influenza are treated with NAIs, treatment initiated on admission, regardless of time since symptom onset, is associated with a reduced LoS, compared with later or no initiation of treatment.
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Affiliation(s)
- Sudhir Venkatesan
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham
- Correspondence: S. Venkatesan, MPH, PhD, Rm B104, Clinical Sciences Bldg, Nottingham City Hospital, Hucknall Rd, Nottingham NG5 1PB, UK ()
| | - Puja R Myles
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham
| | - Kirsty J Bolton
- School of Mathematical Sciences, University of Nottingham, Nottingham
| | - Stella G Muthuri
- MRC Unit for Lifelong Health and Ageing, University College London
| | - Tarig Al Khuwaitir
- Department of Medicine, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ashish P Anovadiya
- Department of Pharmacology, Government Medical College and Sir Takhtasinhji General Hospital, Bhavnagar, India
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tahar Bajjou
- University Mohammed V-Souissi, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Biosafety Level 3 and Research Laboratory, Rabat, Morocco
| | | | - Bojana Beovic
- Department of Infectious Diseases, University Medical Center, Ljubljana
| | | | | | - Robert Booy
- National Centre for Immunisation Research and Surveillance, Children’s Hospital at Westmead, University of Sydney
| | | | | | - Bin Cao
- Beijing Chao-Yang Hospital, Capital Medical University
| | - Jordi Carratala
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Spanish Network for Research in Infectious Diseases
| | - Tserendorj Chinbayar
- National Influenza Center, National Center of Communicable Diseases, Ministry of Health, Ulaanbaatar, Mongolia
| | - Catia Cilloniz
- Hospital Clinic, August Pi I Sunyer Biomedical Research Institute, University of Barcelona, CIBERES, Barcelona
| | - Justin T Denholm
- Victorian Infectious Diseases Service and Department of Microbiology and Immunology, at the Peter Doherty Institute for Infection and Immunity, Parkville
| | - Samuel R Dominguez
- Department of Pediatric Infectious Diseases, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora
| | | | - Gal Dubnov-Raz
- Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat Gan
| | - Sergio Fanella
- Section of Pediatric Infectious Diseases, University of Manitoba, Winnipeg
| | - Zhancheng Gao
- Department of Respiratory and Critical Care Medicine, Peking University People’s Hospital
| | - Patrick Gérardin
- Pôle Femme Mère Enfant
- Center for Clinical Investigation 1410, Institut National de la Santé et de la Recherche Médical (INSERM), Centre Hospitalier Universitaire de la Réunion, Saint Pierre
- Unité Mixte 134 Processus Infectieux en Milieu Insulaire Tropical, Centre National de la Recherche Scientifique 9192, INSERM U1187, Institut Recherche et Développement 249, Université de la Réunion, Cyclotron Réunion-océan Indien, Sainte Clotilde, Reunion
| | - Maddalena Giannella
- Department of Clinical and Surgical Sciences, Sant’Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid
| | - Sophie Gubbels
- Department of Infectious Disease Epidemiology, Sector for National Health Documentation and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Jethro Herberg
- Section of Paediatrics, Division of Infectious Disease, Imperial College, London
| | - Anjarath Lorena Higuera Iglesias
- Department of Research in Clinical Epidemiology, Instituto Nacional de Enfermedades Respiratorias Dr. Ismael Cosío Villegas, Mexico City, Mexico
| | | | - Xiao Yun Hu
- Peking Union Medical College Hospital, Beijing
| | | | - Mirela F Jiménez
- Departamento de Ginecologia e Obstetrícia–UFCSPA, Preceptora da Residência Médica do Hospital Fêmina, Fêmina, Brazil
| | | | - Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Gabriela Kusznierz
- National Institute of Respiratory Diseases “Emilio Coni” ANLIS “C. Malbran,” Santa Fe
| | - Ilija Kuzman
- University Hospital for Infectious Diseases, University of Zagreb School of Medicine, Croatia
| | - Eduard Langenegger
- Department of Obstetrics and Gynaecology, Stellenbosch University–Tygerberg, Cape Town, South Africa
| | - Kamran B Lankarani
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yee-Sin Leo
- Department of Infectious Diseases, Tan Tock Seng Hospital
| | - Romina P Libster
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
- Fundacion INFANT
- National Scientific and Technical Research Council, Buenos Aires
| | | | - Faris Madanat
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
| | - Efstratios Maltezos
- Unit of Infectious Diseases, University General Hospital of Alexandroupolis, Democritus University Thrace, Dragana
| | | | - Toshie Manabe
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Gokhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara
| | - Auksė Mickiene
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dragan Mikić
- Military Medical Academy, Clinic for Infectious and Tropical Diseases, University of Defense, Belgrade, Serbia
| | - Kristin G I Mohn
- Influenza Center, Department of Clinical Science, University of Bergen
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
| | - Maria E Oliva
- Department of Infection Control, Hospital San Martín de Paraná, Entre Ríos, Argentina
| | - Mehpare Ozkan
- Pediatric Neurology Department, Bahçeşehir University
| | - Dhruv Parekh
- Respiratory and Critical Care Medicine, Institute of Inflammation and Ageing, University of Birmingham, Birmingham
| | - Mical Paul
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Barbara A Rath
- Department of Pediatrics, Charité–University Medical Center Berlin, Berlin, Germany
| | - Samir Refaey
- Epidemiology and Surveillance Department, Ministry of Health and Population, Cairo, Egypt
| | | | | | | | - Ayper Somer
- Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul
| | - Ewa Talarek
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Julian W Tang
- Department of Respiratory Sciences, University of Leicester
- University Hospitals Leicester, Leicester, United Kingdom
- Molecular Diagnostic Centre, Department of Laboratory Medicine, National University Hospital, Singapore
| | - Kelvin To
- Carol Yu Centre for Infection and Division of Infectious Diseases, Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dat Tran
- Acute and Communicable Disease Prevention, Public Health Division, Oregon Health Authority, Portland
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wendy Vaudry
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Stollery Children’s Hospital, Edmonton, Canada
| | - Tjasa Vidmar
- General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
| | - Paul Zarogoulidis
- Pulmonary Department, “G. Papanikalaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Martin-Loeches I, Dickson R, Torres A, Hanberger H, Lipman J, Antonelli M, de Pascale G, Bozza F, Vincent JL, Murthy S, Bauer M, Marshall J, Cilloniz C, Bos LD. The importance of airway and lung microbiome in the critically ill. Crit Care 2020; 24:537. [PMID: 32867808 PMCID: PMC7457224 DOI: 10.1186/s13054-020-03219-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/03/2020] [Indexed: 12/17/2022] Open
Abstract
During critical illness, there are a multitude of forces such as antibiotic use, mechanical ventilation, diet changes and inflammatory responses that could bring the microbiome out of balance. This so-called dysbiosis of the microbiome seems to be involved in immunological responses and may influence outcomes even in individuals who are not as vulnerable as a critically ill ICU population. It is therefore probable that dysbiosis of the microbiome is a consequence of critical illness and may, subsequently, shape an inadequate response to these circumstances.Bronchoscopic studies have revealed that the carina represents the densest site of bacterial DNA along healthy airways, with a tapering density with further bifurcations. This likely reflects the influence of micro-aspiration as the primary route of microbial immigration in healthy adults. Though bacterial DNA density grows extremely sparse at smaller airways, bacterial signal is still consistently detectable in bronchoalveolar lavage fluid, likely reflecting the fact that lavage via a wedged bronchoscope samples an enormous surface area of small airways and alveoli. The dogma of lung sterility also violated numerous observations that long predated culture-independent microbiology.The body's resident microbial consortia (gut and/or respiratory microbiota) affect normal host inflammatory and immune response mechanisms. Disruptions in these host-pathogen interactions have been associated with infection and altered innate immunity.In this narrative review, we will focus on the rationale and current evidence for a pathogenic role of the lung microbiome in the exacerbation of complications of critical illness, such as acute respiratory distress syndrome and ventilator-associated pneumonia.
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Affiliation(s)
- Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James Hospital, Dublin 8., Ireland
- Department of Respiratory Medicine, Hospital Clinic, IDIBAPS, CIBERes, Barcelona, Spain
- Trinity College, Dublin, Ireland
| | - Robert Dickson
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, USA
- Michigan Center for Integrative Research in Critical Care, Ann Arbor, MI USA
| | - Antoni Torres
- Deparment of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Håkan Hanberger
- Department of Infectious Diseases, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jeffrey Lipman
- The University of Queensland, Brisbane, Australia
- Scientific Consultant, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Massimo Antonelli
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro de Pascale
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fernando Bozza
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Fiocruz, Rio de Janeiro, Brazil
| | - Jean Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Srinivas Murthy
- University of British Columbia, Vancouver, BC V6H 3V4 Canada
| | - Michael Bauer
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - John Marshall
- The Keenan Research Centre for Biomedical Science, The Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, Ontario Canada
| | - Catia Cilloniz
- Deparment of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Lieuwe D. Bos
- Department of Respiratory Medicine, Infection and Immunity, Amsterdam University Medical Center, AMC, Amsterdam, The Netherlands
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Ielpo A, Crisafulli E, Alcaraz-Serrano V, Gabarrús A, Oscanoa P, Scioscia G, Fernandez-Barat L, Cilloniz C, Amaro R, Torres A. Aetiological diagnosis in new adult outpatients with bronchiectasis:role of predictors derived from real life experience. Respir Med 2020; 172:106090. [PMID: 32916445 DOI: 10.1016/j.rmed.2020.106090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In adult patients with bronchiectasis (BE) the identification of the underlying aetiology may be difficult. In a new patient with BE the performance of a panel of tests is recommended, even though this practice may be expensive and the level of evidence supporting is low. We aimed to identify a panel of variables able to predict the aetiological diagnosis of BE. METHODS Our prospective study derived from our real-life experience on the management of adult stable BE outpatients. We recorded variables concerning clinical, radiological, microbiological and laboratory features. We identified five groups of aetiological diagnosis of BE (idiopathic, post-infective, COPD, asthma and non-common diseases [immunodeficiency or other rare conditions]). Multivariate models were used to identify predictors of each aetiological diagnosis. The suitability of performing a specific test for the diagnosis was also considered. RESULTS We enrolled 354 patients with a new diagnosis of BE. Patients with different aetiological causes differed significantly with regard to age, sex, smoking habit, comorbidities, dyspnoea perception, airflow obstruction and severity scores. Various predictors were assessed, including sex, previous respiratory infections, diffuse localization of BE, risk scores, and laboratory variables (sodium and eosinophils). The levels of autoantibodies or immunoglobulins were reserved for the diagnosis of non-common disease. CONCLUSION Our research confirms that some predictors are specific for the aetiological diagnosis of BE. The possibility of integrating this information may represent a useful tool for the diagnosis. The execution of certain specific tests should be reserved for patients with a non-common disease.
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Affiliation(s)
- Antonella Ielpo
- Pulmonary Division and Pulmonary Rehabilitation Unit, Villa Pineta Hospital, Pavullo, Modena, Italy.
| | - Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit and Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
| | - Victoria Alcaraz-Serrano
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Albert Gabarrús
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Patricia Oscanoa
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Giulia Scioscia
- Department of Medicine and Surgery Science, University of Foggia, Italy.
| | - Laia Fernandez-Barat
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Catia Cilloniz
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Rosanel Amaro
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Antoni Torres
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
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Affiliation(s)
- Catia Cilloniz
- Department of Pulmonary Medicine, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.,Biomedical Research Networking Centers in Respiratory Diseases, Barcelona, Spain
| | - Antoni Torres
- Department of Pulmonary Medicine, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.,Biomedical Research Networking Centers in Respiratory Diseases, Barcelona, Spain
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Bassetti M, Russo A, Cilloniz C, Giacobbe DR, Vena A, Amaro R, Graziano E, Soriano A, Torres A. Ceftaroline for severe community-acquired pneumonia: A real-world two-centre experience in Italy and Spain. Int J Antimicrob Agents 2020; 55:105921. [PMID: 32061999 DOI: 10.1016/j.ijantimicag.2020.105921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/27/2020] [Accepted: 02/08/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Ceftaroline is one of latest additions to the armamentarium for treating community-acquired pneumonia (CAP). This study aimed to describe the outcome of severe CAP (SCAP) in a cohort of hospitalised patients treated with ceftaroline. METHODS A retrospective, observational study of patients with SCAP treated with ceftaroline in two hospitals in Spain and Italy. The primary objective was to explore 30-day mortality after diagnosis of SCAP. RESULTS During the study period the following were observed: there were 89 cases of SCAP treated with ceftaroline and 53 cases used in combination with other antibiotics (60%). Overall, 30-day mortality and clinical failure were 20% (18 of 89) and 36% (32 of 89), respectively. Independent predictors of 30-day mortality were: increasing age (OR for 1 year increase 1.0, 95% CI 1.0-1.1, P 0.043), presence of solid neoplasm (OR 4.0, 95% CI 1.0-15.1, P 0.044) and concomitant therapy with oseltamivir (OR 8.5, 95% CI 1.2°57.3, P 0.029). The only independent predictor of clinical failure was the time elapsing from SCAP diagnosis to ceftaroline therapy (OR for each passing day 1.5, 95% CI 1.1-1.9, P 0.003). The clinical success rate was 64% (57 of 89). In the subgroups of patients with proven Streptococcus pneumoniae, methicillin-susceptible Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) infection, clinical success was 83% (10 of 12), 75% (three of four) and 56% (five of nine), respectively. CONCLUSIONS Considering its spectrum of activity, ceftaroline could represent an important therapeutic option for SCAP. Further studies are needed to identify the precise clinical success rate against MRSA in a larger cohort of patients with SCAP.
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Affiliation(s)
- Matteo Bassetti
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy.
| | - Alessandro Russo
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), Barcelona, Spain
| | - Daniele Roberto Giacobbe
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Antonio Vena
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Rosanel Amaro
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), Barcelona, Spain
| | - Elena Graziano
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Spain
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), Barcelona, Spain
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Adrover JM, Aroca-Crevillén A, Crainiciuc G, Ostos F, Rojas-Vega Y, Rubio-Ponce A, Cilloniz C, Bonzón-Kulichenko E, Calvo E, Rico D, Moro MA, Weber C, Lizasoaín I, Torres A, Ruiz-Cabello J, Vázquez J, Hidalgo A. Programmed 'disarming' of the neutrophil proteome reduces the magnitude of inflammation. Nat Immunol 2020; 21:135-144. [PMID: 31932813 PMCID: PMC7223223 DOI: 10.1038/s41590-019-0571-2] [Citation(s) in RCA: 165] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 12/03/2019] [Indexed: 12/20/2022]
Abstract
The antimicrobial functions of neutrophils are facilitated by a defensive armamentarium of proteins stored in granules, and by the formation of neutrophil extracellular traps (NETs). However, the toxic nature of these structures poses a threat to highly vascularized tissues, such as the lungs. Here, we identified a cell-intrinsic program that modified the neutrophil proteome in the circulation and caused the progressive loss of granule content and reduction of the NET-forming capacity. This program was driven by the receptor CXCR2 and by regulators of circadian cycles. As a consequence, lungs were protected from inflammatory injury at times of day or in mouse mutants in which granule content was low. Changes in the proteome, granule content and NET formation also occurred in human neutrophils, and correlated with the incidence and severity of respiratory distress in pneumonia patients. Our findings unveil a 'disarming' strategy of neutrophils that depletes protein stores to reduce the magnitude of inflammation.
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Affiliation(s)
- Jose M Adrover
- Area of Cell and Developmental Biology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Alejandra Aroca-Crevillén
- Area of Cell and Developmental Biology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Georgiana Crainiciuc
- Area of Cell and Developmental Biology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Fernando Ostos
- Unidad de Investigación Neurovascular, Department of Pharmacology, Faculty of Medicine, Universidad Complutense and Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Yeny Rojas-Vega
- Advanced Imaging Unit, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Andrea Rubio-Ponce
- Area of Cell and Developmental Biology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Catia Cilloniz
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, and Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Ciber de Enfermedades, Barcelona, Spain
| | - Elena Bonzón-Kulichenko
- Cardiovascular Proteomics Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Enrique Calvo
- Cardiovascular Proteomics Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Daniel Rico
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - María A Moro
- Unidad de Investigación Neurovascular, Department of Pharmacology, Faculty of Medicine, Universidad Complutense and Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Christian Weber
- Institute for Cardiovascular Prevention, Ludwig-Maximillians University, Munich, Germany
- German Cardiovascular Research Centre (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Ignacio Lizasoaín
- Unidad de Investigación Neurovascular, Department of Pharmacology, Faculty of Medicine, Universidad Complutense and Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Antoni Torres
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, and Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Ciber de Enfermedades, Barcelona, Spain
| | - Jesús Ruiz-Cabello
- Advanced Imaging Unit, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- CIC biomaGUNE, Donostia-San Sebastián, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
- Ciber de Enfermedades Respiratorias, Madrid, Spain
- Universidad Complutense Madrid, Madrid, Spain
| | - Jesús Vázquez
- Cardiovascular Proteomics Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Andrés Hidalgo
- Area of Cell and Developmental Biology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
- Institute for Cardiovascular Prevention, Ludwig-Maximillians University, Munich, Germany.
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Ercibengoa M, Càmara J, Tubau F, García-Somoza D, Galar A, Martín-Rabadán P, Marin M, Mateu L, García-Olivé I, Prat C, Cilloniz C, Torres A, Pedro-Botet ML, Ardanuy C, Muñoz P, Marimón JM. A multicentre analysis of Nocardia pneumonia in Spain: 2010-2016. Int J Infect Dis 2019; 90:161-166. [PMID: 31693939 DOI: 10.1016/j.ijid.2019.10.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 10/19/2019] [Accepted: 10/23/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To analyse all cases of Nocardia pneumonia occurring between 2010 and 2016 in five Spanish hospitals. METHODS This was a retrospective observational analysis of clinical and microbiological data collected from 55 cases of Nocardia pneumonia. RESULTS There were one to 20 cases per hospital and six to nine cases per year. Chronic obstructive pulmonary disease, bronchiectasis, and asthma were the main predisposing underlying respiratory conditions. Thirty-four patients were receiving systemic and/or inhaled corticosteroids prior to infection, eight had neoplasia, and six had haematological malignancies. Clinical and radiological findings were common to pneumonia of other infectious aetiologies, except for the frequent presence of nodules and cavitation. Overall, the 1-year mortality was high (38.2%), and mortality was directly related to the pulmonary disease in 15 patients (27.3%). The most frequently identified species were N. cyriacigeorgica (n=21), N. abscessus (n=8), and N. farcinica (n=5). All Nocardia isolates were susceptible to linezolid and all but two were susceptible to amikacin and trimethoprim-sulfamethoxazole. CONCLUSIONS Nocardia pneumonia-associated mortality remains high, probably because of the debilitated status of patients in whom this pathogen is able to cause pulmonary infection.
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Affiliation(s)
- Maria Ercibengoa
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain
| | - Jordi Càmara
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Hospital de Bellvitge-IDIBELL, L'Hospitalet de LLobregat, Spain
| | - Fe Tubau
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Hospital de Bellvitge-IDIBELL, L'Hospitalet de LLobregat, Spain
| | - Dolores García-Somoza
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Hospital de Bellvitge-IDIBELL, L'Hospitalet de LLobregat, Spain
| | - Alicia Galar
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
| | - Pablo Martín-Rabadán
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Mercedes Marin
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Lourdes Mateu
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Unit - Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ignasi García-Olivé
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Department of Pneumology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Cristina Prat
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Microbiology Department - Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Catia Cilloniz
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Department of Pneumology, Hospital Clinic of Barcelona - August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Antonio Torres
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Department of Pneumology, Hospital Clinic of Barcelona - August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maria-Luisa Pedro-Botet
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Unit - Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Carmen Ardanuy
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Hospital de Bellvitge-IDIBELL, L'Hospitalet de LLobregat, Spain; Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose María Marimón
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain.
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48
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Abstract
Introduction: Community-acquired pneumonia is the most common infection leading to hospitalization and death in all age groups, especially in elderly populations. Increasing antibiotic resistance among the common bacterial pathogens associated with community-acquired pneumonia, especially Streptococcus pneumoniae and staphylococci, has made its empirical treatment increasingly problematic, highlighting the need for effective antibiotic therapy.Areas covered: We searched PubMed and ClinicalTrials.gov for English-language reports of phase III clinical trials conducted between 2000 and 2019 concerning the antibiotic treatment of community-acquired pneumonia. We provide a summary of the latest approved drugs for this indication and highlight emerging drugs with a potential indication.Expert opinion: Ceftaroline (a new cephalosporine) and omadacycline (a cycline alternative), either parenterally or orally, are the only two new antibiotics to have been approved by the FDA for the treatment of community-acquired pneumonia in the last five years. Among the antimicrobials in development, Lefamulin (the first pleuromutilin), is currently in phase III development. Among the known antibiotic classes, solithromycin (a macrolide), nemonoxacin (a quinolone), and delafloxacin and zabofloxacin (both fluoroquinolones), have been studied in phase II and III in clinical trials. The availability of these new antibiotics may offer opportunities to improve the empirical treatment for community-acquired pneumonia.
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Affiliation(s)
| | - Catia Cilloniz
- Respiratory Institute, CIBERES- IDIBAPS C, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Andrea Palomeque
- Respiratory Institute, CIBERES- IDIBAPS C, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Toni Torres
- Respiratory Institute, CIBERES- IDIBAPS C, Hospital Clinic de Barcelona, Barcelona, Spain
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49
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Torres A, Ceccato A, Ferrer M, Gabarrus A, Sibila O, Cilloniz C, Mendez R, Menendez R, Bermejo-Martin J, Niederman MS. Effect of Corticosteroids on C-Reactive Protein in Patients with Severe Community-Acquired Pneumonia and High Inflammatory Response: The Effect of Lymphopenia. J Clin Med 2019; 8:jcm8091461. [PMID: 31540339 PMCID: PMC6780068 DOI: 10.3390/jcm8091461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/30/2019] [Accepted: 09/10/2019] [Indexed: 11/29/2022] Open
Abstract
Background: Lymphopenic patients with community-acquired pneumonia (CAP) have shown high mortality rates. Corticosteroids have immunomodulatory properties and regulate cytokine storm in CAP. However, it is not known whether their modulatory effect on cytokine secretion differs in lymphopenic and non-lymphopenic patients with CAP. Therefore, we aimed to test whether the presence of lymphopenia may modify the response to corticosteroids (mainly in C reactive protein (CRP)) in patients with severe CAP and high inflammatory status). Methods: A post hoc analysis of a randomized controlled trial (NCT00908713) which evaluated the effect of corticosteroids in patients with severe CAP and high inflammatory response (CRP > 15 mg/dL). Patients were clustered according to the presence of lymphopenia (lymphocyte count below 1000 cell/mm3). Results: At day 1, 35 patients (59%) in the placebo group presented with lymphopenia, compared to 44 patients (73%) in the corticosteroid group. The adjusted mean changes from day 1 showed an increase of 1.19 natural logarithm (ln) cell/mm3 in the corticosteroid group and an increase of 0.67 ln cell/mm3 in the placebo group (LS mean difference of the changes in ln (methylprednisolone minus placebo) 0.51, 95% CI (0.02 to 1.01), p = 0.043). A significant effect was also found for the interaction (p = 0.043) between corticosteroids and lymphopenia in CRP values at day 3, with lower values in patients without lymphopenia receiving corticosteroids after adjustments for potential confounders. Conclusion: In this exploratory post hoc analysis from ramdomized controlled trial (RCT) data, the response to corticosteroids, measured by CRP, may differ according to lymphocyte count. Further larger studies are needed to confirm this data.
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Affiliation(s)
- Antoni Torres
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain; (A.C.); (A.G.); (C.C.)
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
- Correspondence:
| | - Adrian Ceccato
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain; (A.C.); (A.G.); (C.C.)
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
| | - Miquel Ferrer
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain; (A.C.); (A.G.); (C.C.)
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
| | - Albert Gabarrus
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain; (A.C.); (A.G.); (C.C.)
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
| | - Oriol Sibila
- Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain;
| | - Catia Cilloniz
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain; (A.C.); (A.G.); (C.C.)
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
| | - Raúl Mendez
- Servicio de Neumología, IIS/Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, n° 106 Valencia, CIBERES, 46026 València, Spain;
- PhD program in Medicine and Traslational Research, University of Barcelona, Gran Via de les Corts Catalanes, 585, 08007 Barcelona, Spain
| | - Rosario Menendez
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
- Servicio de Neumología, IIS/Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, n° 106 Valencia, CIBERES, 46026 València, Spain;
| | - Jesus Bermejo-Martin
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
- Group For Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación BIomédica de Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Michael S. Niederman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY 10065, USA;
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50
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Villafuerte D, Aliberti S, Soni NJ, Faverio P, Marcos PJ, Wunderink RG, Rodriguez A, Sibila O, Sanz F, Martin‐Loeches I, Menzella F, Reyes LF, Jankovic M, Spielmanns M, Restrepo MI, Aruj PK, Attorri S, Barimboim E, Caeiro JP, Garzón MI, Cambursano VH, Ceccato A, Chertcoff J, Cordon Díaz A, de Vedia L, Ganaha MC, Lambert S, Lopardo G, Luna CM, Malberti AG, Morcillo N, Tartara S, Pensotti C, Pereyra B, Scapellato PG, Stagnaro JP, Shah S, Lötsch F, Thalhammer F, Anseeuw K, Francois CA, Van Braeckel E, Vincent JL, Djimon MZ, Nouér SA, Chipev P, Encheva M, Miteva D, Petkova D, Balkissou AD, Yone EWP, Ngahane BHM, Shen N, Xu JF, Rico CAB, Buitrago R, Paternina FJP, Ntumba JMK, Carevic VV, Jakopovic M, Jankovic M, Matkovic Z, Mitrecic I, Jacobsson MLB, Christensen AB, Heitmann Bødtger UC, Meyer CN, Jensen AV, El-Said Abd El-Wahhab I, Morsy NE, Shafiek H, Sobh E, Abdulsemed KA, Bertrand F, Brun‐Buisson C, Montmollin ED, Fartoukh M, Messika J, Tattevin P, Khoury A, Ebruke B, Dreher M, Kolditz M, Meisinger M, Pletz MW, Hagel S, Rupp J, Schaberg T, Spielmanns M, Creutz P, Suttorp N, Siaw-Lartey B, Dimakou K, Papapetrou D, Tsigou E, Ampazis D, Kaimakamis E, Bhatia M, Dhar R, D'Souza G, Garg R, Koul PA, Mahesh PA, Jayaraj BS, Narayan KV, Udnur HB, Krishnamurthy SB, Kant S, Swarnakar R, Limaye S, Salvi S, Golshani K, Keatings VM, Martin-Loeches I, Maor Y, Strahilevitz J, Battaglia S, Carrabba M, Ceriana P, Confalonieri M, Monforte AD, Prato BD, Rosa MD, Fantini R, Fiorentino G, Gammino MA, Menzella F, Milani G, Nava S, Palmiero G, Petrino R, Gabrielli B, Rossi P, Sorino C, Steinhilber G, Zanforlin A, Franzetti F, Carone M, Patella V, Scarlata S, Comel A, Kurahashi K, Bacha ZA, Ugalde DB, Zuñiga OC, Villegas JF, Medenica M, van de Garde E, Mihsra DR, Shrestha P, Ridgeon E, Awokola BI, Nwankwo ON, Olufunlola AB, Olumide S, Ukwaja KN, Irfan M, Minarowski L, Szymon S, Froes F, Leuschner P, Meireles M, Ravara SB, Brocovschii V, Ion C, Rusu D, Toma C, Chirita D, Dorobat CM, Birkun A, Kaluzhenina A, Almotairi A, Bukhary ZAA, Edathodu J, Fathy A, Enani AMA, Mohamed NE, Memon JU, Bella A, Bogdanović N, Milenkovic B, Pesut D, Borderìas L, Garcia NMB, Cabello Alarcón H, Cilloniz C, Torres A, Diaz-Brito V, Casas X, González AE, Fernández‐Almira ML, Gallego M, Gaspar‐García I, Castillo JGD, Victoria PJ, Laserna Martínez E, Molina RMD, Marcos PJ, Menéndez R, Pando‐Sandoval A, Aymerich CP, Rello J, Moyano S, Sanz F, Sibila O, Rodrigo‐Troyano A, Solé‐Violán J, Uranga A, van Boven JFM, Torra EV, Pujol JA, Feldman C, Yum HK, Fiogbe AA, Yangui F, Bilaceroglu S, Dalar L, Yilmaz U, Bogomolov A, Elahi N, Dhasmana DJ, Feneley A, Hancock C, Hill AT, Rudran B, Ruiz‐Buitrago S, Campbell M, Whitaker P, Youzguin A, Singanayagam A, Allen KS, Brito V, Dietz J, Dysart CE, Kellie SM, Franco‐Sadud RA, Meier G, Gaga M, Holland TL, Bergin SP, Kheir F, Landmeier M, Lois M, Nair GB, Patel H, Reyes K, Rodriguez‐Cintron W, Saito S, Soni NJ, Noda J, Hinojosa CI, Levine SM, Angel LF, Anzueto A, Whitlow KS, Hipskind J, Sukhija K, Totten V, Wunderink RG, Shah RD, Mateyo KJ, Noriega L, Alvarado E, Aman M, Labra L. Prevalence and risk factors for
Enterobacteriaceae
in patients hospitalized with community‐acquired pneumonia. Respirology 2019; 25:543-551. [PMID: 31385399 DOI: 10.1111/resp.13663] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. METHODS We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when ≥3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. RESULTS Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. CONCLUSION This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP.
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Affiliation(s)
- David Villafuerte
- Division of Pulmonary Diseases and Critical Care MedicineUniversity of Texas Health – San Antonio San Antonio TX USA
- Division of Pulmonary Diseases and Critical Care MedicineSouth Texas Veterans Health Care System San Antonio TX USA
| | - Stefano Aliberti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoRespiratory Unit and Cystic Fibrosis Adult Center Milan Italy
- Department of Pathophysiology and TransplantationUniversity of Milan Milan Italy
| | - Nilam J. Soni
- Division of Pulmonary Diseases and Critical Care MedicineUniversity of Texas Health – San Antonio San Antonio TX USA
- Division of Pulmonary Diseases and Critical Care MedicineSouth Texas Veterans Health Care System San Antonio TX USA
| | - Paola Faverio
- Cardio‐Thoracic‐Vascular Department, University of Milan Bicocca, Respiratory UnitSan Gerardo Hospital, ASST di Monza Monza Italy
| | - Pedro J. Marcos
- Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC)Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC) A Coruña Spain
| | - Richard G. Wunderink
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of MedicineNorthwestern University Chicago IL USA
| | - Alejandro Rodriguez
- Hospital Universitari Joan XXIII, Critical Care MedicineRovira and Virgili University and CIBERes (Biomedical Research Network of Respiratory Disease) Tarragona Spain
| | - Oriol Sibila
- Servei de Pneumologia, Departamento de Medicina, Hospital Santa Creu i Sant PauUniversitat Autònoma de Barcelona Barcelona Spain
| | - Francisco Sanz
- Pulmonology DepartmentConsorci Hospital General Universitari de Valencia Valencia Spain
| | | | - Francesco Menzella
- Department of Cardiac‐Thoracic‐Vascular and Intensive Care Medicine, Pneumology UnitIRCCS – Arcispedale Santa Maria Nuova Reggio Emilia Italy
| | - Luis F. Reyes
- Department of MicrobiologyUniversidad de la Sabana Bogota Colombia
| | - Mateja Jankovic
- School of Medicine, Clinic for Respiratory DiseasesUniversity Hospital Center Zagreb, University of Zagreb Zagreb Croatia
| | - Marc Spielmanns
- Internal Medicine Department, Pulmonary Rehabilitation and Department of Health, School of MedicineUniversity Witten‐Herdecke, St. Remigius‐Hospital Leverkusen Germany
| | - Marcos I. Restrepo
- Division of Pulmonary Diseases and Critical Care MedicineUniversity of Texas Health – San Antonio San Antonio TX USA
- Division of Pulmonary Diseases and Critical Care MedicineSouth Texas Veterans Health Care System San Antonio TX USA
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