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Aldás I, Menéndez R, Méndez R, España PP, Almirall J, Boderías L, Rajas O, Zalacaín R, Vendrell M, Mir I, Torres A. Early and Late Cardiovascular Events in Patients Hospitalized for Community-Acquired Pneumonia. Arch Bronconeumol 2019; 56:551-558. [PMID: 31791646 DOI: 10.1016/j.arbres.2019.10.009] [Citation(s) in RCA: 5] [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: 03/16/2019] [Revised: 09/22/2019] [Accepted: 10/17/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Community-acquired pneumonia increases the risk of cardiovascular events (CVE). The objective of this study was to analyze host, severity, and etiology factors associated with the appearance of early and late events and their impact on mortality. METHOD Prospective multicenter cohort study in patients hospitalized for pneumonia. CVE and mortality rates were collected at admission, 30-day follow-up (early events), and one-year follow-up (late events). RESULTS In total, 202 of 1,967 (10.42%) patients presented early CVE and 122 (6.64%) late events; 16% of 1-year mortality was attributed to cardiovascular disease. The host risk factors related to cardiovascular complications were: age ≥65 years, smoking, and chronic heart disease. Alcohol abuse was a risk factor for early events, whereas obesity, hypertension, and chronic renal failure were related to late events. Severe sepsis and Pneumonia Severity Index (PSI) ≥3 were independent risk factors for early events, and only PSI ≥3 for late events. Streptococcus pneumoniae was the microorganism associated with most cardiovascular complications. Developing CVE was an independent factor related to early (OR 2.37) and late mortality (OR 4.05). CONCLUSIONS Age, smoking, chronic heart disease, initial severity, and S. pneumoniae infection are risk factors for early and late events, complications that have been related with an increase of the mortality risk during and after the pneumonia episode. Awareness of these factors can help us make active and early diagnoses of CVE in hospitalized CAP patients and design future interventional studies to reduce cardiovascular risk.
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Affiliation(s)
- Irene Aldás
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria (IIS) La Fe, Universidad de Valencia, Valencia, España
| | - Rosario Menéndez
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria (IIS) La Fe, Universidad de Valencia, Valencia, España.
| | - Raúl Méndez
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria (IIS) La Fe, Universidad de Valencia, Valencia, España
| | | | - Jordi Almirall
- Servicio de Medicina Intensiva, Hospital de Mataró, Mataró, España
| | - Luis Boderías
- Servicio de Neumología, Hospital San Jorge, Huesca, España
| | - Olga Rajas
- Servicio de Neumología, Hospital de la Princesa, Madrid, España
| | | | - Montserrat Vendrell
- Servicio de Neumología, Hospital Universitario Josep Trueta/Institut d'Investigació Biomèdica de Girona (IDIBGI), Universidad de Girona, Girona, España
| | - Isabel Mir
- Servicio de Neumología, Hospital Son Llàtzer, Palma de Mallorca, España
| | - Antoni Torres
- Servicio de Neumología, Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, España
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Montull B, Menéndez R, Torres A, Reyes S, Méndez R, Zalacaín R, Capelastegui A, Rajas O, Borderías L, Martin-Villasclaras J, Bello S, Alfageme I, Rodríguez de Castro F, Rello J, Molinos L, Ruiz-Manzano J. Predictors of Severe Sepsis among Patients Hospitalized for Community-Acquired Pneumonia. PLoS One 2016; 11:e0145929. [PMID: 26727202 PMCID: PMC4699794 DOI: 10.1371/journal.pone.0145929] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/10/2015] [Indexed: 11/18/2022] Open
Abstract
Background Severe sepsis, may be present on hospital arrival in approximately one-third of patients with community-acquired pneumonia (CAP). Objective To determine the host characteristics and micro-organisms associated with severe sepsis in patients hospitalized with CAP. Results We performed a prospective multicenter cohort study in 13 Spanish hospital, on 4070 hospitalized CAP patients, 1529 of whom (37.6%) presented with severe sepsis. Severe sepsis CAP was independently associated with older age (>65 years), alcohol abuse (OR, 1.31; 95% CI, 1.07–1.61), chronic obstructive pulmonary disease (COPD) (OR, 1.75; 95% CI, 1.50–2.04) and renal disease (OR, 1.57; 95% CI, 1.21–2.03), whereas prior antibiotic treatment was a protective factor (OR, 0.62; 95% CI, 0.52–0.73). Bacteremia (OR, 1.37; 95% CI, 1.05–1.79), S pneumoniae (OR, 1.59; 95% CI, 1.31–1.95) and mixed microbial etiology (OR, 1.65; 95% CI, 1.10–2.49) were associated with severe sepsis CAP. Conclusions CAP patients with COPD, renal disease and alcohol abuse, as well as those with CAP due to S pneumonia or mixed micro-organisms are more likely to present to the hospital with severe sepsis.
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Affiliation(s)
- Beatriz Montull
- Pneumology Department, ISS/Hospital Universitario y Politecnico La Fe, CIBER Enfermedades Respiratorias (CIBERES), Valencia, Spain
| | - Rosario Menéndez
- Pneumology Department, ISS/Hospital Universitario y Politecnico La Fe, CIBER Enfermedades Respiratorias (CIBERES), Valencia, Spain
- * E-mail:
| | - Antoni Torres
- Pneumology Department, Hospital Clínico y Provincial, IDIBAPS, CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Soledad Reyes
- Pneumology Department, ISS/Hospital Universitario y Politecnico La Fe, CIBER Enfermedades Respiratorias (CIBERES), Valencia, Spain
| | - Raúl Méndez
- Pneumology Department, ISS/Hospital Universitario y Politecnico La Fe, CIBER Enfermedades Respiratorias (CIBERES), Valencia, Spain
| | | | | | - Olga Rajas
- Pneumology Department, Hospital La Princesa, Madrid, Spain
| | - Luis Borderías
- Pneumology Department, Hospital San Jorge, Huesca, Spain
| | | | - Salvador Bello
- Pneumology Department, Hospital Miguel Servet, Zaragoza, Spain
| | | | | | - Jordi Rello
- Critical Care Department, Hospital Joan XXII of Tarragona and Hospital Vall Hebron, Universtitat Autonoma de Barcelona, Barcelona, Spain
| | - Luis Molinos
- Pneumology Department, Hospital Central Asturias, Oviedo, Asturias, Spain
| | - Juan Ruiz-Manzano
- Pneumology Department, Hospital Germans Trias i Pujol Badalona, Barcelona, Spain
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Huerta A, Soler N, Esperatti M, Guerrero M, Menendez R, Gimeno A, Zalacaín R, Mir N, Aguado JM, Torres A. Importance of Aspergillus spp. isolation in Acute exacerbations of severe COPD: prevalence, factors and follow-up: the FUNGI-COPD study. Respir Res 2014; 15:17. [PMID: 24517318 PMCID: PMC3996133 DOI: 10.1186/1465-9921-15-17] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 12/27/2013] [Indexed: 11/17/2022] Open
Abstract
Background Acute exacerbations of COPD (AECOPD) are often associated with infectious agents, some of which may be non-usual, including Aspergillus spp. However, the importance of Aspergillus spp. in the clinical management of AECOPD still remains unclear. Objectives The aims of the study were to analyze the prevalence and risk factors associated with Aspergillus spp. isolation in AECOPD, and to investigate the associated clinical outcomes during a 1-year follow-up period. Methods Patients presenting with an AECOPD requiring hospitalization were prospectively included from four hospitals across Spain. Clinical, radiological and microbiological data were collected at admission and during the follow-up period (1, 6 and 12 months after discharge), and re-admissions and mortality data collected during the follow-up. Results A total of 240 patients with severe AECOPD were included. Valid sputum samples were obtained in 144 (58%) patients, and in this group, the prevalence of Aspergillus spp. isolation was 16.6% on admission and 14.1% at one-year follow-up. Multivariate logistic-regression showed that AECOPD in the previous year (OR 12.35; 95% CI, 1.9-29.1; p < 0.001), concurrent isolation of pathogenic bacteria (OR 3.64; 95% CI 1.65-9.45, p = 0.001) and concomitant isolation of Pseudomonas aeruginosa (OR 2.80; 95% IC, 1.81-11.42; p = 0.001) were the main risk factors for Aspergillus spp. isolation. Conclusions The main risk factors for Aspergillus spp. isolation were AECOPD in the previous year and concomitant isolation of Pseudomonas aeruginosa. However, although Aspergillus spp. is often isolated in sputum samples from patients with AECOPD, the pathogenic and clinical significance remains unclear.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Antoni Torres
- Department of Pneumology, Institute of Thorax (ICT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona (UB), CIBER de Enfermedades Respiratorias (CIBERES 06/06/0028), Villarroel 170, 08037 Barcelona, Spain.
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España PP, Capelastegui A, Quintana JM, Bilbao A, Diez R, Pascual S, Esteban C, Zalacaín R, Menendez R, Torres A. Validation and comparison of SCAP as a predictive score for identifying low-risk patients in community-acquired pneumonia. J Infect 2009; 60:106-13. [PMID: 19961875 DOI: 10.1016/j.jinf.2009.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 11/25/2009] [Accepted: 11/26/2009] [Indexed: 11/28/2022]
Abstract
PURPOSES (1) To validate the Severe Community Acquired Pneumonia (SCAP) score in predicting 30-day mortality. (2) To validate its ability to identifying patients at low risk of death. (3) To compare it against the Pneumonia Severity Index (PSI), and the British Thoracic Society's CURB-65 rules. METHODS The SCAP score was validated to predict 30-day mortality in an internal validation cohort of consecutive adult patients seen in one hospital. Consecutive inpatients from other three hospitals were used to externally validate the score and compare the SCAP with the PSI and CURB-65. The discriminatory power of these rules to predict 30-day mortality was tested by the Area under Curve (AUC), and their predictive accuracy with the sensitivity, specificity and predictive values. RESULTS The 30-day mortality rate increased directly with increasing SCAP score (class 0: 0.5%, to class 4: 66.5% risk) in the internal validation cohort, and from 1.3% to 29.2% in external cohort (P<0.001) with an AUC of 0.83 and 0.75, respectively (P=0.024). The SCAP score identified 62.4% (95% IC 58.8-66.0) low-risk patients, 52.5% (95% IC 48.8-56.2) the PSI and 46.2% (95% CI 42.5-49.9) the CURB-65 in the external cohort. Patients classified as low risk by the three rules had similar 30-day mortality (SCAP: 2.5%, PSI: 1.6% and CURB-65: 2.7%). CONCLUSION The SCAP is valid to predict 30-day mortality among low-risk patients and identifies a larger proportion of patients as low-risk than the other studied rules.
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Affiliation(s)
- Pedro P España
- Pneumology Service Hospital Galdakao, E-48960 Galdakao, Bizkaia, Spain.
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Torres Martí A, Quintano Jiménez JA, Martínez Ortiz de Zárate M, Rodríguez Pascual C, Prieto J, Zalacaín R. [Antimicrobial treatment of COPD in the elderly]. Rev Esp Quimioter 2006; 19:167-83. [PMID: 16964335] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- A Torres Martí
- Instituto Clínico de Neumología y Cirugía Torácica, Hospital Clínico de Barcelona, Barcelona, and Departamento de Microbiología, Facultad de Medicina, Universidad Complutense de Madrid, Spain
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Alfageme I, Aspa J, Bello S, Blanquer J, Blanquer R, Borderías L, Bravo C, de Celis R, de Gracia X, Dorca J, Gallardo J, Gallego M, Menéndez R, Molinos L, Paredes C, Rajas O, Rello J, Rodríguez de Castro F, Roig J, Sánchez-Gascón F, Torres A, Zalacaín R. [Guidelines for the diagnosis and management of community-acquired pneumonia. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR)]. Arch Bronconeumol 2005. [PMID: 15919009 PMCID: PMC7131668 DOI: 10.1157/13074594] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Menéndez R, Torres A, Zalacaín R, Aspa J, Martín-Villasclaras JJ, Borderías L, Benítez-Moya JM, Ruiz-Manzano J, de Castro FR, Blanquer J, Pérez D, Puzo C, Sánchez-Gascón F, Gallardo J, Alvarez C, Molinos L. Guidelines for the Treatment of Community-acquired Pneumonia. Am J Respir Crit Care Med 2005; 172:757-62. [PMID: 15937289 DOI: 10.1164/rccm.200411-1444oc] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [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: 11/16/2022] Open
Abstract
RATIONALE Some studies highlight the association of better clinical responses with adherence to guidelines for empiric treatment of community-acquired pneumonia (CAP), but little is known about factors that influence this adherence. OBJECTIVES Our objectives were to identify factors influencing adherence to the guidelines for empiric treatment of CAP, and to evaluate the impact of adherence on outcome. METHODS We studied 1,288 patients with CAP admitted to 13 Spanish hospitals. Collected variables included the patients' clinical and demographic data, initial severity of the disease, antibiotic treatment, and specialty and training status of the prescribing physician. MEASUREMENTS AND MAIN RESULTS Adherence to guidelines was high (79.7%), with significant differences between hospitals (range, 47-97%) and physicians (pneumologists, 81%; pneumology residents, 84%; nonpneumology residents, 82%; other specialists, 67%). The independent factors related to higher adherence were hospital, physician characteristics, and initial high-risk class of Fine, whereas admission to intensive care unit decreased adherence. Seventy-four patients died (6.1%), and treatment failure was found in 175 patients (14.2%). After adjusting for Fine risk class, adherence to the guidelines was found protective for mortality (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.3-0.9) and for treatment failure (OR, 0.65; 95% CI, 0.5-0.9). Treatment prescribed by pneumologists and residents was associated with lower treatment failure (OR, 0.6; 95% CI, 0.4-0.9). CONCLUSIONS Adherence to guidelines mainly depends on the hospital and the specialty and training status of prescribing physicians. Nonadherence was higher in nonpneumology specialists, and is an independent risk factor for treatment failure and mortality.
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Affiliation(s)
- Rosario Menéndez
- Servicio de Neumología, Hospital Universitario La Fe, Avda. de Campanar 21, 46009 Valencia, Spain.
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Rosell A, Monsó E, Soler N, Torres F, Angrill J, Riise G, Zalacaín R, Morera J, Torres A. Microbiologic determinants of exacerbation in chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2005; 165:891-7. [PMID: 15851640 DOI: 10.1001/archinte.165.8.891] [Citation(s) in RCA: 223] [Impact Index Per Article: 11.7] [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: 11/14/2022]
Abstract
BACKGROUND The culture of bronchial secretions from the lower airway has been reported to be positive for potentially pathogenic microorganisms (PPMs) in patients with stable chronic obstructive pulmonary disease (COPD), but the determinants and effects of this bacterial load in the airway are not established. METHODS To determine the bronchial microbial pattern in COPD and its relationship with exacerbation, we pooled analysis of crude data from studies that used protected specimen brush sampling, with age, sex, smoking, lung function, and microbiologic features of the lower airway as independent variables and exacerbation as the outcome, using logistic regression modeling. RESULTS Of 337 study participants, 70 were healthy, 181 had stable COPD, and 86 had exacerbated COPD. Differences in the microbial characteristics in the participating laboratories were not statistically significant. A cutoff point of 10(2) colony-forming units (CFU) per milliliter or greater for the identification of abnormal positive culture results for PPMs was defined using the 95th percentile in the pooled analysis of healthy individuals. Bronchial colonization of 10(2) CFU/mL or greater by PPMs was found in 53 patients with stable COPD (29%) and in 46 patients with exacerbated COPD (54%) (P<.001, chi(2) test), with a predominance of Haemophilus influenzae and Pseudomonas aeruginosa. Higher microbial loads were associated with exacerbation and showed a statistically significant dose-response relationship after adjustment for covariates (odds ratio, 3.62; 95% confidence interval, 1.47-8.90), but P aeruginosa persisted as a statistically significant risk factor after adjustment for microbial load (odds ratio, 11.12; 95% confidence interval, 1.17-105.82). CONCLUSIONS One quarter of the patients with COPD are colonized by PPMs during their stable periods. Exacerbation is associated with the overgrowth of PPMs and with the appearance of P aeruginosa in the lower airway, which is associated with exacerbation symptoms independent of load.
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Affiliation(s)
- Antoni Rosell
- Servei de Pneumologia, Hospital Germans Trias i Pujol, 08916 Badalona, Spain
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Menéndez R, Torres A, Rodríguez de Castro F, Zalacaín R, Aspa J, Martín Villasclaras JJ, Borderías L, Benítez Moya JM, Ruiz-Manzano J, Blanquer J, Pérez D, Puzo C, Sánchez-Gascón F, Gallardo J, Alvarez CJ, Molinos L. Reaching Stability in Community-Acquired Pneumonia: The Effects of the Severity of Disease, Treatment, and the Characteristics of Patients. Clin Infect Dis 2004; 39:1783-90. [PMID: 15578400 DOI: 10.1086/426028] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2004] [Accepted: 08/02/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The natural history of the resolution of infectious parameters in patients with community-acquired pneumonia (CAP) is not completely known. The aim of our study was to identify those factors related to host characteristics, the severity of pneumonia, and treatment that influence clinical stability. METHODS In a prospective, multicenter, observational study, we observed 1424 patients with CAP who were admitted to 15 Spanish hospitals. The main outcome variable was the number of days needed to reach clinical stability (defined as a temperature of <or=37.2 degrees C, a heart rate of <or=100 beats/min, a respiratory rate of <or=24 breaths/min, systolic blood pressure of >or=90 mm Hg, and oxygen saturation >or=90% or arterial oxygen partial pressure of >or=60 mm Hg). RESULTS The median time to stability was 4 days. A Cox proportional hazard model identified 6 independent variables recorded during the first 24 h after hospital admission related to the time needed to reach stability: dyspnea (hazard ratio [HR], 0.76), confusion (HR, 0.66), pleural effusion (HR, 0.67), multilobed CAP (HR, 0.72), high pneumonia severity index (HR, 0.73), and adherence to the Spanish guidelines for treatment of CAP (HR, 1.22). A second Cox model was performed that included complications and response to treatment. This model identified the following 10 independent variables: chronic bronchitis (HR, 0.81), dyspnea (HR, 0.79), confusion (HR, 0.61), multilobed CAP (HR, 0.84), initial severity of disease (HR, 0.73), treatment failure (HR, 0.31), cardiac complications (HR, 0.66), respiratory complications (HR, 0.77), empyema (HR, 0.57), and admission to the intensive care unit (HR, 0.57). CONCLUSIONS Some characteristics of CAP are useful at the time of hospital admission to identify patients who will need a longer hospital stay to reach clinical stability. Empirical treatment that follows guidelines is associated with earlier clinical stability. Complications and treatment failure delay clinical stability.
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Affiliation(s)
- Rosario Menéndez
- Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain.
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Menéndez R, Torres A, Zalacaín R, Aspa J, Martín Villasclaras JJ, Borderías L, Benítez Moya JM, Ruiz-Manzano J, Rodríguez de Castro F, Blanquer J, Pérez D, Puzo C, Sánchez Gascón F, Gallardo J, Alvarez C, Molinos L. Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome. Thorax 2004; 59:960-5. [PMID: 15516472 PMCID: PMC1746855 DOI: 10.1136/thx.2003.017756] [Citation(s) in RCA: 189] [Impact Index Per Article: 9.5] [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: 11/03/2022]
Abstract
BACKGROUND An inadequate response to initial empirical treatment of community acquired pneumonia (CAP) represents a challenge for clinicians and requires early identification and intervention. A study was undertaken to quantify the incidence of failure of empirical treatment in CAP, to identify risk factors for treatment failure, and to determine the implications of treatment failure on the outcome. METHODS A prospective multicentre cohort study was performed in 1424 hospitalised patients from 15 hospitals. Early treatment failure (<72 hours), late treatment failure, and in-hospital mortality were recorded. RESULTS Treatment failure occurred in 215 patients (15.1%): 134 early failure (62.3%) and 81 late failure (37.7%). The causes were infectious in 86 patients (40%), non-infectious in 34 (15.8%), and undetermined in 95. The independent risk factors associated with treatment failure in a stepwise logistic regression analysis were liver disease, pneumonia risk class, leucopenia, multilobar CAP, pleural effusion, and radiological signs of cavitation. Independent factors associated with a lower risk of treatment failure were influenza vaccination, initial treatment with fluoroquinolones, and chronic obstructive pulmonary disease (COPD). Mortality was significantly higher in patients with treatment failure (25% v 2%). Failure of empirical treatment increased the mortality of CAP 11-fold after adjustment for risk class. CONCLUSIONS Although these findings need to be confirmed by randomised studies, they suggest possible interventions to decrease mortality due to CAP.
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Affiliation(s)
- R Menéndez
- Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain.
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Benito JR, Montejo JM, Cancelo L, Zalacaín R, López L, Fernández Gil de Pareja J, Alonso E, Oñate J. [Community-acquired pneumonia due to Legionella pneumophila serogroup 1. Study of 97 cases]. Enferm Infecc Microbiol Clin 2003; 21:394-400. [PMID: 14525703] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
INTRODUCTION Legionella pneumophila is the causal agent of 5% to 12% of sporadic community-acquired pneumonia cases, though rates are changing with the use of new diagnostic methods. METHODS This is a retrospective study of all patients admitted to our hospital with community-acquired pneumonia due to Legionella pneumophila between 1997 and 2001. Diagnostic criteria included either a positive Legionella serogroup 1 urinary antigen test or seroconversion and a chest radiograph consistent with pneumonia. RESULTS A total of 97 patients were studied. Ninety cases (92.8%) were community-acquired and 7 (7.2%) were associated with travelling. In 82 cases (84.5%) the presentation was sporadic. Seventy-five patients were smokers (77.3%). The most common symptoms were fever in 91 patients (93.8%) and cough in 67 (68.1%). In five patients (5.2%) creatine phosphokinase concentrations were over 5 times their baseline values (in two over 100 times); four of these patients presented acute renal failure. Seroconversion was observed in 23/42 patients (54.8%). There were no statistically significant differences between the administration of erythromycin or clarithromycin in monotherapy, or in combination with rifampin. Nineteen patients (19.6%) presented acute renal failure and mechanical ventilation was necessary in 22 (22.7%). Twelve patients died (12.5%). Independent prognostic factors associated with death included respiratory rate > 30 breaths/min, urea > 60 mg/dL and PaO2 < 60 mmHg. A significant linear association was found between severity scale scores and the presence of complications or mortality. CONCLUSION The Legionella urinary antigen test permits early diagnosis and treatment of this disease. The severity scale is an indicator of complications or death.
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Affiliation(s)
- José Ramón Benito
- Servicios de Urgencias Generales. Hospital de Cruces. Baracaldo. Bizkaia. Spain.
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Benito JR, Montejo JM, Cancelo L, Zalacaín R, López L, Fernández Gil de Pareja J, Alonso E, Oñate J. Neumonía comunitaria por Legionella pneumophila serogrupo 1> Estudio de 97 casos. Enferm Infecc Microbiol Clin 2003. [DOI: 10.1157/13051902] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ramón Benito J, Miguel Montejo J, Cancelo L, Zalacaín R, López L, Fernández Gil de Pareja J, Alonso E, Oñate J. Neumonía comunitaria por Legionella pneumophila serogrupo 1. Estudio de 97 casos. Enferm Infecc Microbiol Clin 2003. [DOI: 10.1016/s0213-005x(03)72975-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Celis MR, Torres A, Zalacaín R, Aspa J, Blanquer J, Blanquer R, Gallardo J, España PP. [Diagnostic methods and treatment of community-acquired pneumonia in Spain: NACE study]. Med Clin (Barc) 2002; 119:321-6. [PMID: 12356360 DOI: 10.1016/s0025-7753(02)73405-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 10/27/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is one of the most frequent infectious disease conditions. With the aim of knowing the diagnostic and therapeutic strategies of CAP in Spanish hospitals we performed a prospective, observational and multicenter study. PATIENTS AND METHOD Observational study of 468 patients with CAP consecutively evaluated in 21 Spanish hospitals. Clinical, diagnostic, therapeutic and evolutive variables were recorded. RESULTS We included 468 patients with a mean age of 63 (18) years; 75% of them had some comorbidity. 380 (81%) patients required hospitalization in a conventional ward while 19 (4%) were admitted in an Intensive Care Unit (ICU). 69 patients (15%) required ICU admission. During the first 24 h of admission, biochemical determinations were performed in 98% of cases, blood gas measurements in 88%, blood cultures in 265 (58%), sputum cultures in 149 (41%) and an invasive diagnostic technique was carried out in 17 cases. In 62 cases (14%), a microbiological diagnosis was achieved. Streptococcus pneumoniae (28 cases) was the most frequent isolate followed by Legionella pneumophila (6 cases). Clarithromycin was the most frequent antibiotic prescribed (38%), either as monotherapy (28) or in combination (148), followed by amoxicillin-clavulanate (124 cases). Nine percent of patients were considered non-responders to initial empirical antibiotic tretament. Overall mortality was 6% (25%) and it was significanty higher in non-responders. CONCLUSIONS In most patients with CAP admitted in Spanish hospitals, a systematic diagnostic approach is lacking. There is an important variability in the administration of antimicrobials, the association of a betalactam plus clarithromycin being the most frequent strategy. Overall mortality is low and significantly higher in those patients with a lack of response to initial antibiotic treatment.
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Affiliation(s)
- María Rosa Celis
- Institut Clínic de Pneumologia i Cirurgia Toràcica. Hospital Clínic de Barcelona. IDIBAPS. Barcelona. España
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Frías J, Gomis M, Prieto J, Mensa J, Bouza E, García-Rodríguez JA, Torres A, Dorca J, Zalacaín R, García de Lomas J. [Initial empirical antibiotic treatment of community-acquired pneumonia]. Rev Esp Quimioter 1998; 11:255-61. [PMID: 9795313] [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] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- J Frías
- Hospital La Paz, Madrid, Spain
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16
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Affiliation(s)
- A Torres
- Servei de Pneumologia, Hospital Clínic i Provincial, Barcelona
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17
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Abstract
The Steris system for cold sterilization with peracetic acid was evaluated by effecting a series of contaminations of a fiberoptic bronchoscope (FB) with specimens of Pseudomonas aeruginosa, Acinetobacter baumanii and Mycobacterium kansasi. The FB was contaminated 24 times, 8 times by each microorganism, using specimens containing more than 10(8) cfu/ml. After fixing the secretions on the FB and washing it with enzyme soap, the BF was sterilized. Specimens were taken for culturing after contamination of the FB, after washing, immediately after sterilization and 1 hour after sterilization. No microorganism growth of any of the samples was detected either immediately after sterilization or one hour later. Microbiological data confirmed contamination of the FB after aspiration and fixation of the inoculate. Chemical and biological tests with B. stearothermophilus spores as specified by the manufacturer were correct in all cases: 24 contaminations and 52 processes of prior training. The efficacy of washing with enzyme soap before sterilization stands out. In 14 of the 24 samples, culture was negative after washing and in 7 the concentration of microorganisms was less than 500 cfu/ml, which confirms the need for appropriate washing before any disinfection or sterilization process is begun. In conclusion, the Steris system based on peracetic acid is an alternative to other systems for cold sterilization or high level disinfection.
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Affiliation(s)
- J I Villate
- Servicio de Medicina Preventiva, Hospital de Cruces, Baracaldo, Vizcaya
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18
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Canalis E, Castella J, Díaz P, Freixinet J, Rivas J, Zalacaín R, Pac J. [Minimal requirements for a respiratory endoscopy unit. Area of Diagnostic and Therapeutic Techniques of the Spanish Society of Pneumology and Thoracic Surgery]. Arch Bronconeumol 1997; 33:92-8. [PMID: 9091121 DOI: 10.1016/s0300-2896(15)30661-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- E Canalis
- Hospital Clínic i Provincial, Barcelona
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19
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Torres A, Dorca J, Zalacaín R, Bello S, El-Ebiary M, Molinos L, Arévalo M, Blanquer J, Celis R, Iriberri M, Prats E, Fernández R, Irigaray R, Serra J. Community-acquired pneumonia in chronic obstructive pulmonary disease: a Spanish multicenter study. Am J Respir Crit Care Med 1996; 154:1456-61. [PMID: 8912764 DOI: 10.1164/ajrccm.154.5.8912764] [Citation(s) in RCA: 131] [Impact Index Per Article: 4.7] [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: 02/03/2023] Open
Abstract
Community-acquired pneumonia (CAP) is an infectious illness that frequently motivates hospital admission when comorbid conditions are present. However, the epidemiology of CAP in relation to the underlying disease of the patients is not well known. We performed a prospective multicenter study with the aim of assessing the clinical characteristics, etiology, and outcome of chronic obstructive pulmonary disease (COPD) patients with CAP. Between October 1992 and December 1994 we studied 124 COPD patients (mean FEV1 40 +/- 11% of predicted, mean FVC/FEV1 49 +/- 10) admitted because of CAP to one of the participating centers. An attempt to obtain an etiologic diagnosis was performed by means of blood cultures (n = 123), sputum cultures (n = 97), pleural fluid cultures (n = 17), protected specimen brush samples (n = 41), percutaneous transthoracic needle aspiration (n = 41), and serology (n = 106). Etiologic diagnosis was achieved in 80 (64%) of cases, however, diagnosis based upon valid techniques was only possible in 73 (59%) cases. The main causal microorganisms were the following: Streptococcus pneumoniae in 32 (43%), Chlamydia pneumoniae in 9 (12%), Hemophilus influenzae in 7 (9%), Legionella pneumophila in 7 (9%), Streptococcus viridans in 3 (4%), Coxiella burnetii in 3 (4%), Mycoplasma pneumoniae in 2 (3%), Nocordia asteroides 2, Aspergillus ssp. 1, and others 10. In three of these cases the etiology was polymicrobial. Bacteremia was present in 19 (15%) cases; S. pneumoniae was the most frequent isolate (13 cases). Antibiotic treatment was modified in 22 cases due to etiologic findings, and in 9 due to therapeutic failure. Ten patients died (8%), and 22 needed mechanical ventilation, the mortality rate in the latter population being 23%. Total or partial resistance of S. pneumoniae to penicillin was observed in 10 of 32 (31%) isolations, and to erythromycin in 2 (6%). The results of this study are important for the standardization of empiric antibiotic strategies in COPD patients with pneumonia.
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Affiliation(s)
- A Torres
- Servei de Pneumologia i Al.lèrgia Respiratòria, Hospital Clínic, Universitat de Barcelona, Spain
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Llorente JL, Zalacaín R, Gaztelurrutia L, Talayero N, Antoñana JM, Sobradillo V. [Pneumonia in alcoholic patients: the clinical and etiological characteristics]. Arch Bronconeumol 1994; 30:136-40. [PMID: 8186905 DOI: 10.1016/s0300-2896(15)31106-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 01/29/2023]
Abstract
Twenty-four alcoholic patients with community-acquired pneumonia were studied for 2 years in order to define clinical signs and etiology. Blood cultures and serological profiles were done for all patients in addition to standard blood analyses. All had an invasive procedure -transthoracic puncture with an ultrafine 25G needle (20 patients) or telescopic catheter with bacteriologic brush (4 patients). When we were unable to obtain a good sputum sample (5 patients), a culture was grown. The patients' mean age was 48 and 83% had an acute clinical profile (< or = 7 days with symptoms) with "typical" signs. The X-rays showed an alveolar pattern in all patients, with cavitation in 29%. Etiological diagnosis was reached in 17 (71%) cases, with St. Pneumoniae (25%), anaerobic microorganisms (20%) and C. burnetii (12.5%) being the germs found most frequently. The invasive techniques were more useful (54%) than the blood cultures (17%) or sputum cultures (4%), and they were well tolerated and uncomplicated. Empirical antibiotic treatment was modified for 12 patients (50%). Seventeen percent required intensive care treatment and mortality was 12.5%.
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Affiliation(s)
- J L Llorente
- Servicio de Neumología, Hospital de Cruces, Vizcaya
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21
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Gaztelurrutia L, Zalacaín R, Rubio G, Hernández JL, Urra E, Hernández M, Garea C, Barrón J. [Current use of penicillin in community-acquired pneumococcal pneumonias]. Enferm Infecc Microbiol Clin 1994; 12:17-20. [PMID: 8155749] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND A retrospective study was performed to know the clinical and microbiologic aspects of community-acquired pneumococcal pneumonia in adult patients admitted to a general hospital from 1990-1992. METHODS AND RESULTS The medical records of 55 patients, aged 20-86 years (man age: 58 year) were reviewed. Streptococcus pneumoniae was isolated from blood in 45 cases (81.8%), transparietal lung puncture in 5 (9.1%), pleural fluid 3 (5.5%) and protected specimen brushing (> 1,000 UFC/ml) in 2 (3.6%) Most isolated (80%) were sensitive to penicillin (CIM < 0.1 microgram/ml); intermediate (CIM > or = 0.1 microgram/ml) 9 (16.4%) and resistant (> 1 microgram/ml) 2 (3.6%). Underlying diseases were present in 39 (70.9%) cases. All patients received empiric treatment with one or more antibiotics effective against Streptococcus pneumoniae. Only in 2 of the 9 cases treated with erythromycin the microorganism was resistant to this drug. Eleven patients died (20%), 5 died before to the fifth day of admission. Mortality was influenced by involvement of 2 or more lobes and immunosuppression (p < 0.05). CONCLUSIONS This study suggests that 80% of the community-acquired pneumococcal pneumonia in a population with a high prevalence rate of disease requiring hospital admission are very sensitive in vitro to penicillin in contrast with its seldom clinical use in the authors environment. No microorganism presented with CIM above 2 micrograms/ml. Mortality was not due to inadequate therapy but rather to the severity of the underlying disease.
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Affiliation(s)
- L Gaztelurrutia
- Servicio de Microbiología, Hospital de Cruces, Baracaldo, Vizcaya
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Llorente JL, Zalacaín R, Gaztelurrutia L, Talayero N, Pérez M, Badiola C, Sobradillo V. [Clinical and etiological features of community-acquired pneumonia in the elderly]. Enferm Infecc Microbiol Clin 1994; 12:21-5. [PMID: 8155750] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The aim of the present study was to know the clinical and etiologic features of community-acquired pneumonia (CAP) in elderly patients requiring hospital admission. METHODS A prospective study of 36 consecutive patients aged over 70 years, admitted to a general hospital was performed. Standard analytical determinations, blood cultures, and serologic studies were performed in all patients using invasive techniques: aspirative transthoracic puncture (ATP) with ultrafine needle in 35 (97%) cases, and telescopic catheter (TC) in 1 case. RESULTS The mean age was 79 years (range: 71-90). Twenty-two patients had received antibiotic treatment prior to admission (61%) and 17 (47%) presented chronic debilitating diseases. The clinical characteristics of CAP were "typical" with acute presentation in most. Fifteen cases (42%) were etiologically diagnosed and the most frequently isolated agents were Streptococcus pneumoniae (22%) and Haemophilus influenzae (8%). Empiric treatment was changed on the basis of isolations in 7 cases (19%). Eight patients died (22%). CONCLUSIONS According to our results community-acquired pneumonia in the population studied: 1) generally showed an acute presentation with "typical" characteristics, carrying a high mortality rate (22%), 2) is of bacterial etiology, with S. pneumoniae and H. influenzae being the most frequently isolated microorganisms, 3) the use of ATP in community-acquired pneumonia offers a high diagnostic effectiveness, good tolerance and low risk of complications.
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Affiliation(s)
- J L Llorente
- Servicio de Neumología, Hospital de Cruces, Baracalco, Vizcaya
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23
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Zalacaín R, Llorente JL, Gaztelurrutia L, Zenarruzabeitia E, Uresandi F, Sobradillo V. [Transthoracic aspiration punction with ultrafine needle in high risk community acquired pneumonia]. Med Clin (Barc) 1993; 100:567-70. [PMID: 8497144] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The identification of etiologic agents of pneumonias acquired in the community (PAC) with risk factors is difficult. The classical diagnostic methods are not profitable and thus invasive techniques are used. In this study the diagnostic use of an invasive technique such as aspirative transthoracic puncture (ATP) was evaluated in this type of pneumonias. METHODS In 94 patients of high risk suspect of PAC the ATP was carried out. This was performed with an ultrafine needle (25G) without radioscopic control. In all cases blood cultures, serology (Legionella, Mycoplasma pneumoniae, Coxiella burnetti, Chlamydia psittaci) were performed when atypical clinical manifestations were presented and sputum examination (Gram, Ziehl, culture) was undertaken when possible. RESULTS The sensitivity of ATP was 36% and increased to 54.6% in cases previously untreated with antibiotics. Specificity was 96.4%. The sensitivity of blood culture was 8% and sputum 13.6%. ATP was well tolerated in 97.9% with complication in only 4 (4.3%). The results of ATP led to changes in treatment in 23.1% of the cases with definitive diagnosis of pneumonia. CONCLUSIONS Aspirative transthoracic puncture with ultrafine needle without fluoroscopic control was a very well tolerated technique with a minimum number of complications, easy to perform at the patients bedside and was used to modify treatment in 23.1% of the cases.
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Affiliation(s)
- R Zalacaín
- Servicio de Neumología, Hospital de Cruces, Vizcaya
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24
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Aguirrebengoa L, Montejo M, Urkijo JC, Urra E, Gutiérrez A, Mendoza F, Zalacaín R, González de Zárate P, Aguirre C. [Tuberculosis and AIDS. Study of 54 patients]. Enferm Infecc Microbiol Clin 1991; 9:399-404. [PMID: 1799608] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We present 54 cases of tuberculosis (TBC) and Acquired Immunodeficiency Syndrome (AIDS) that were observed during five years and represent 37% of our AIDS patients. TBC was diagnosed before AIDS in 7, after AIDS in 5 and simultaneously in 42. Eighty-seven per cent were intravenous drug users (IVDU) and no hemophilia cases were recorded. The tuberculin skin test (PPD) showed a reaction greater than 5 mm in 43%. Prophylaxis has not been used in any patient. TBC was localized in 39% and disseminated in 61%; the lung was the main organ involved. Diagnosis was established by culture in 42 cases and by pathology exam in 12 cases. Eighteen patients had multiple isolations, while 36 had a single one. Co-occurrence with other opportunistic infections was observed in 27 cases. Death related to TBC was seen in 3 patients, and there were no differences in survival between disseminated and localized presentations. Compliance of treatment was very low and follow-up was not achieved in large number of patients.
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Gaztelurrutia L, Barrón J, Zalacaín R, Rubio G, Urra E, Sánchez I, Urzay L, Sainz de Rozas R. [Evaluation of bronchoalveolar lavage in the microbiological diagnosis of pneumonia in patients at risk]. Enferm Infecc Microbiol Clin 1991; 9:154-8. [PMID: 1863607] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Bronchoalveolar washout was performed in 130 patients with pneumonia during a period of 28 months. Microbiological investigation involved common bacteria, Legionella, fungi, viruses (Cytomegalovirus, herpes, RSV), Mycobacterium, and Pneumocystis carinii. Infection HIV was present in 75% of patients. The remaining patients had malignant diseases or severe pneumonia. The overall sensitivity of the technique was 65.4% and the positive predictive value was 92%. The technique was less sensitive in cases of bacterial pneumonia (sensitivity = 34.4%). This was attributed to the fact that 82.8% of these cases received antibiotic therapy. Pneumocystis carinii and Mycobacterium tuberculosis were the most common agents (44.8% and 34.5%, respectively). In seven instances the clinical picture was related to cytomegalovirus, although this diagnosis can not be easily done.
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Affiliation(s)
- L Gaztelurrutia
- Servicios de Microbiología y de Neumología, Hospital de Cruces, Vizcaya
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26
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Sobradillo V, Zalacaín R. [Bronchoconstriction caused by pressurized aerosol]. Med Clin (Barc) 1987; 88:611. [PMID: 3600063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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