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Torné-Cachot J, Simonetti AF, Lorenzo-Carrasco V, Gálvez-Barrón C. Utility of a quick diagnostic unit during the SARS-CoV-2 pandemic for the diagnosis of cancer. Rev Clin Esp 2023; 223:470-478. [PMID: 37451541 DOI: 10.1016/j.rceng.2023.07.003] [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: 03/11/2023] [Accepted: 05/21/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To analyse changes in health care activity, time of referral and diagnosis intervals and the incidence of cancer during the first two years of the SARS-CoV-2 pandemic in a quick diagnosis unit. MATERIALS AND METHODS A retrospective observational study was carried out during the prepandemic year (March 1, 2019, to February 29, 2020) and the first two years of the pandemic (March 1, 2020, to February 28, 2022). Demographic and clinical variables, the first visit interval, the diagnosis interval and the first visit-diagnosis interval were evaluated and compared. RESULTS During the first pandemic wave, there was a reduction in referrals (-32.6%), which then increased 8.1% and 17.7% from the second wave until the end of the first pandemic year and the second pandemic year, respectively. An increase in referrals to primary care and a decrease in emergencies were identified. The increase in cancer diagnoses of 2.7% and 15.7% in the two years of the pandemic was proportional to the increase in referrals. No changes were observed in benign processes or in cancer locations and stages. The first visit interval was higher for benign diseases (p<0.0001). A prolongation of the diagnosis interval was observed in cancer patients, although during the three years of the study the median was <15 days. CONCLUSIONS The impact of the pandemic affected the length of intervals and the origins of referrals. The quick diagnosis units constitutes and urgent complementary cancer diagnostic route with a high diagnosis yield.
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Affiliation(s)
- J Torné-Cachot
- Servicio de Medicina Interna, Hospital Sant Camil. Consorci Sanitari Alt Penedès-Garraf. Sant Pere de Ribes, Barcelona, Spain.
| | - A F Simonetti
- Servicio de Medicina Interna, Hospital Sant Camil. Consorci Sanitari Alt Penedès-Garraf. Sant Pere de Ribes, Barcelona, Spain
| | - V Lorenzo-Carrasco
- Servicio de Medicina Interna, Hospital Sant Camil. Consorci Sanitari Alt Penedès-Garraf. Sant Pere de Ribes, Barcelona, Spain
| | - C Gálvez-Barrón
- Área de Investigación, Consorci Sanitari Alt Penedès-Garraf. San Pere de Ribes, Barcelona, Spain
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Viasus D, Simonetti AF, Nonell L, Vidal O, Meije Y, Ortega L, Arnal M, Bódalo-Torruella M, Sierra M, Rombauts A, Abelenda-Alonso G, Blanchart G, Gudiol C, Carratalà J. Whole-Blood Gene Expression Profiles Associated with Mortality in Community-Acquired Pneumonia. Biomedicines 2023; 11:biomedicines11020429. [PMID: 36830965 PMCID: PMC9953679 DOI: 10.3390/biomedicines11020429] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
(1) Background: Information regarding gene expression profiles and the prognosis of community-acquired pneumonia (CAP) is scarce. We aimed to examine the differences in the gene expression profiles in peripheral blood at hospital admission between patients with CAP who died during hospitalization and those who survived. (2) Methods: This is a multicenter study of nonimmunosuppressed adult patients who required hospitalization for CAP. Whole blood samples were obtained within 24 h of admission for genome-expression-profile analysis. Gene expression profiling identified both differentially expressed genes and enriched gene sets. (3) Results: A total of 198 samples from adult patients who required hospitalization for CAP were processed, of which 13 were from patients who died. Comparison of gene expression between patients who died and those who survived yielded 49 differentially expressed genes, 36 of which were upregulated and 13 downregulated. Gene set enrichment analysis (GSEA) identified four positively enriched gene sets in survivors, mainly associated with the interferon-alpha response, apoptosis, and sex hormone pathways. Similarly, GSEA identified seven positively enriched gene sets, associated with the oxidative stress, endoplasmic reticulum stress, oxidative phosphorylation, and angiogenesis pathways, in the patients who died. Protein-protein-interaction-network analysis identified FOS, CDC42, SLC26A10, EIF4G2, CCND3, ASXL1, UBE2S, and AURKA as the main gene hubs. (4) Conclusions: We found differences in gene expression profiles at hospital admission between CAP patients who died and those who survived. Our findings may help to identify novel candidate pathways and targets for potential intervention and biomarkers for risk stratification.
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Affiliation(s)
- Diego Viasus
- Department of Medicine, Division of Health Sciences, Universidad del Norte and Hospital Universidad del Norte, Barranquilla 081001, Colombia
- Correspondence:
| | - Antonella F. Simonetti
- Department of Internal Medicine, Consorci Sanitari Alt Penedès-Garraf, 08720 Sant Pere de Ribes, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Institulo de Salud Carlos III, 28029 Madrid, Spain
| | - Lara Nonell
- MARGenomics, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Oscar Vidal
- Department of Medicine, Division of Health Sciences, Universidad del Norte and Hospital Universidad del Norte, Barranquilla 081001, Colombia
| | - Yolanda Meije
- Unit of Infectious Disease, Department of Internal Medicine, Hospital de Barcelona—Societat Cooperativa d’Instal·lacions Assistencials Sanitàries (SCIAS), 08029 Barcelona, Spain
| | - Lucía Ortega
- Unit of Infectious Disease, Department of Internal Medicine, Hospital de Barcelona—Societat Cooperativa d’Instal·lacions Assistencials Sanitàries (SCIAS), 08029 Barcelona, Spain
| | - Magdalena Arnal
- MARGenomics, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | | | - Montserrat Sierra
- Microbiology Unit, Department of Clinical Laboratory, Hospital de Barcelona—Societat Cooperativa d’Instal·lacions Assistencials Sanitàries (SCIAS), 08029 Barcelona, Spain
| | - Alexander Rombauts
- Department of Infectious Diseases, Bellvitge University Hospital—Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain
| | - Gabriela Abelenda-Alonso
- Department of Infectious Diseases, Bellvitge University Hospital—Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain
| | - Gemma Blanchart
- Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Carlota Gudiol
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Institulo de Salud Carlos III, 28029 Madrid, Spain
- Department of Infectious Diseases, Bellvitge University Hospital—Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, 08907 Barcelona, Spain
| | - Jordi Carratalà
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Institulo de Salud Carlos III, 28029 Madrid, Spain
- Department of Infectious Diseases, Bellvitge University Hospital—Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, 08907 Barcelona, Spain
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Pallarès N, Tebé C, Abelenda-Alonso G, Rombauts A, Oriol I, Simonetti AF, Rodríguez-Molinero A, Izquierdo E, Díaz-Brito V, Molist G, Gómez Melis G, Carratalà J, Videla S. Characteristics and Outcomes by Ceiling of Care of Subjects Hospitalized with COVID-19 During Four Waves of the Pandemic in a Metropolitan Area: A Multicenter Cohort Study. Infect Dis Ther 2023; 12:273-289. [PMID: 36495405 PMCID: PMC9736710 DOI: 10.1007/s40121-022-00705-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The profiles of patients with COVID-19 have been widely studied, but little is known about differences in baseline characteristics and in outcomes between subjects with a ceiling of care assigned at hospital admission and subjects without a ceiling of care. The aim of this study is to compare, by ceiling of care, clinical features and outcomes of hospitalized subjects during four waves of COVID-19 in a metropolitan area in Catalonia. METHODS Observational study conducted during the first (March-April 2020), second (October-November 2020), third (January-February 2021), and fourth wave (July-August 2021) of COVID-19 in five centers of Catalonia. All subjects were adults (> 18 years old) hospitalized with a proven SARS-CoV-2 infection and with therapeutic ceiling of care assessed by the attending physician at hospital admission. RESULTS A total of 5813 subjects were analyzed. Subjects with a ceiling of care were mainly older (difference in median age of 20 years), with more comorbidities (Charlson index 3 points higher) and with fewer clinical signs at baseline than patients without a ceiling of care. Some features of their clinical profiles changed among waves. There were differences in treatments received during hospital admission across waves, but not between subjects with and without a ceiling of care. Subjects with a ceiling of care had a death incidence more than four times the death incidence of subjects a without a ceiling of care (risk ratio (RR) ranging from 3.5 in the first wave to almost 6 in the third and fourth). Incidence of severe pneumonia and complications for subjects with a ceiling of care was around 1.5 times the incidence in subjects without a ceiling of care. DISCUSSION Analysis of hospitalized subjects with SARS-CoV-2 infection should be stratified according to therapeutic ceiling of care to avoid bias and outcome misestimation.
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Affiliation(s)
- Natàlia Pallarès
- grid.417656.7Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Avinguda de la Granvia de l’Hospitalet, 199, 08908 Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Cristian Tebé
- grid.417656.7Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Avinguda de la Granvia de l’Hospitalet, 199, 08908 Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Gabriela Abelenda-Alonso
- grid.411129.e0000 0000 8836 0780Department of Infectious Diseases, Bellvitge University Hospital, Barcelona, Spain ,grid.418284.30000 0004 0427 2257Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Alexander Rombauts
- grid.411129.e0000 0000 8836 0780Department of Infectious Diseases, Bellvitge University Hospital, Barcelona, Spain ,grid.418284.30000 0004 0427 2257Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Isabel Oriol
- grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain ,grid.418284.30000 0004 0427 2257Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain ,Department of Internal Medicine, Consorci Sanitari Integral, Barcelona, Spain
| | - Antonella F. Simonetti
- grid.413448.e0000 0000 9314 1427CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain ,Department of Internal Medicine, Consorci Sanitari Alt Penedès Garraf, Barcelona, Spain
| | | | | | - Vicens Díaz-Brito
- grid.466982.70000 0004 1771 0789Department Infectious Diseases, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain
| | - Gemma Molist
- grid.417656.7Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Avinguda de la Granvia de l’Hospitalet, 199, 08908 Barcelona, Spain
| | - Guadalupe Gómez Melis
- grid.6835.80000 0004 1937 028XDepartment of Statistics and Operations Research, Universitat Politècnica de Catalunya/Barcelonatech, Barcelona, Spain
| | - Jordi Carratalà
- grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain ,grid.411129.e0000 0000 8836 0780Department of Infectious Diseases, Bellvitge University Hospital, Barcelona, Spain ,grid.418284.30000 0004 0427 2257Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Sebastián Videla
- grid.411129.e0000 0000 8836 0780Department of Clinical Pharmacology, Bellvitge University Hospital, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Viasus D, Simonetti AF, Estupiñan-Bohórquez AF, Carratalà J. Effects of age and comorbidities on serum levels of inflammatory markers in community-acquired pneumonia. Eur J Clin Invest 2021; 51:e13480. [PMID: 33350464 DOI: 10.1111/eci.13480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Studies have suggested that an inappropriate inflammatory response is a major cause of treatment failure and mortality in patients with community-acquired pneumonia (CAP). We aimed to determine the effect of age and comorbidities on serum inflammatory markers in CAP. METHODS We performed a prospective cohort study of adults hospitalized with CAP. For the purposes of this study, we compared patients according to comorbidities and age. Inflammatory markers were measured at hospital admission, focusing on acute phase proteins, cytokines and monocyte human leucocyte antigen DR (mHLA-DR) expression. RESULTS In patients with chronic pulmonary disease (COPD), serum cytokines had significantly decreased levels of tumour necrosis factor (TNF)-α, interleukin (IL)-6 and mHLA-DR expression, as well as the C-reactive protein (CRP), compared with patients who had no comorbidities. Similarly, patients with chronic heart disease had a significantly reduced CRP levels and mHLA-DR expression, whereas patients with chronic kidney disease had significantly higher serum levels of procalcitonin and TNF-α. Lower procalcitonin, IL-6 and IL-10 levels, as well as mHLA-DR expression, were documented in older patients, but with no significant differences compared to younger patients. Multimorbidity in older patients was associated with significant lower levels of CRP and mHLA-DR expression. CONCLUSIONS The circulating inflammatory markers to CAP have profiles that differ with age and underlying comorbidities. Multimorbidity in the elderly is also associated with lower serum levels of some inflammatory markers. Our findings suggest that inflammatory markers in CAP should be interpreted after considering age and comorbid conditions.
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Affiliation(s)
- Diego Viasus
- Health Sciences Division, Universidad del Norte and Hospital Universidad del Norte, Barranquilla, Colombia
| | - Antonella F Simonetti
- Internal Medicine Department, Consorci Sanitari Alt Penedès-Garraf, Barcelona, Spain
| | | | - Jordi Carratalà
- Faculty of Medicine, Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, Spanish Network for Research in Infectious Diseases (REIPI), and Clinical Science Department, University of Barcelona, Barcelona, Spain
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Oriol I, Sabé N, Simonetti AF, Lladó L, Manonelles A, González J, Tubau F, Carratalà J. Changing trends in the aetiology, treatment and outcomes of bloodstream infection occurring in the first year after solid organ transplantation: a single-centre prospective cohort study. Transpl Int 2017; 30:903-913. [PMID: 28500792 DOI: 10.1111/tri.12984] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 03/16/2017] [Revised: 04/24/2017] [Accepted: 05/08/2017] [Indexed: 12/15/2022]
Abstract
To analyse trends in the aetiology, treatment and outcomes of bloodstream infection (BSI) within the first year post-transplant over the last 10-year period, we prospectively recorded all episodes of BSI occurring in solid organ transplant (SOT) recipients during the first year post-transplant from 2007 to 2016. Trends of factors were analysed by 2-year periods. Of 475 consecutive episodes of BSI, 218 occurred within a year of SOT in 178 SOT recipients. Gram-positive BSI decreased over time (40.5-2.2%). In contrast, there was a steady increase in Gram-negative bacilli (GNB) BSI (54.1-93.3%; P < 0.001), mainly due to Pseudomonas aeruginosa (2.4-20.4%) and Klebsiella pneumoniae (7.1-26.5%). Multidrug-resistant (MDR) GNB (4.8-38.8%; P < 0.001) rose dramatically, especially due to extended-spectrum β-lactamase (ESBL) production (7.1-34.7%). There was a sharp rise in the use of carbapenems, both as empirical (11.9-55.3%; P < 0.001) and as targeted antibiotic treatment (11.9-46.9%; P < 0.001). In conclusion, today, GNB are the leading causative agents of BSI in SOT recipients within the first year after SOT. In addition, MDR GNB have emerged mainly due to ESBL-producing strains. In spite of these changes, length of hospital stay, days of treatment and mortality have remained stable over time.
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Affiliation(s)
- Isabel Oriol
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain.,Spanish Network for Research in Infectious Diseases (REIPI), and Clinical Science Department, Faculty of Medicine, University of Barcelona, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Núria Sabé
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain.,Spanish Network for Research in Infectious Diseases (REIPI), and Clinical Science Department, Faculty of Medicine, University of Barcelona, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Antonella F Simonetti
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain.,Spanish Network for Research in Infectious Diseases (REIPI), and Clinical Science Department, Faculty of Medicine, University of Barcelona, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Laura Lladó
- Liver Transplant Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Anna Manonelles
- Department of Nephrology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Jose González
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Fe Tubau
- Spanish Network for Research in Infectious Diseases (REIPI), and Clinical Science Department, Faculty of Medicine, University of Barcelona, L'Hospitalet de Llobregat (Barcelona), Spain.,Department of Microbiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Jordi Carratalà
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain.,Spanish Network for Research in Infectious Diseases (REIPI), and Clinical Science Department, Faculty of Medicine, University of Barcelona, L'Hospitalet de Llobregat (Barcelona), Spain
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Simonetti AF, van Werkhoven CH, Schweitzer VA, Viasus D, Carratalà J, Postma DF, Oosterheert JJ, Bonten MJM. Predictors for individual patient antibiotic treatment effect in hospitalized community-acquired pneumonia patients. Clin Microbiol Infect 2017; 23:774.e1-774.e7. [PMID: 28336384 DOI: 10.1016/j.cmi.2017.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 01/04/2017] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Our objective was to identify clinical predictors of antibiotic treatment effects in hospitalized patients with community-acquired pneumonia (CAP) who were not in the intensive care unit (ICU). METHODS Post-hoc analysis of three prospective cohorts (from the Netherlands and Spain) of adult patients with CAP admitted to a non-ICU ward having received either β-lactam monotherapy, β-lactam + macrolide, or a fluoroquinolone-based therapy as empirical antibiotic treatment. We evaluated candidate clinical predictors of treatment effects in multiple mixed-effects models by including interactions of the predictors with empirical antibiotic choice and using 30-day mortality, ICU admission and length of hospital stay as outcomes. RESULTS Among 8562 patients, empirical treatment was β-lactam in 4399 (51.4%), fluoroquinolone in 3373 (39.4%), and β-lactam + macrolide in 790 (9.2%). Older age (interaction OR 1.67, 95% CI 1.23-2.29, p 0.034) and current smoking (interaction OR 2.36, 95% CI 1.34-4.17, p 0.046) were associated with lower effectiveness of fluoroquinolone on 30-day mortality. Older age was also associated with lower effectiveness of β-lactam + macrolide on length of hospital stay (interaction effect ratio 1.14, 95% CI 1.06-1.22, p 0.008). CONCLUSIONS Older age and smoking could influence the response to specific antibiotic regimens. The effect modification of age and smoking should be considered hypothesis generating to be evaluated in future trials.
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Affiliation(s)
- A F Simonetti
- Hospital Universitari de Bellvitge, Institut D'investigació Biomèdica de Bellvitge, Barcelona, Spain.
| | - C H van Werkhoven
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - V A Schweitzer
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - D Viasus
- Division of Health Sciences, Faculty of Medicine, Universidad del Norte, and Hospital Universidad del Norte, Barranquilla, Colombia
| | - J Carratalà
- Hospital Universitari de Bellvitge, Institut D'investigació Biomèdica de Bellvitge, Barcelona, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - D F Postma
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J J Oosterheert
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M J M Bonten
- Departments of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Puerta-Alcalde P, Cuervo G, Simonetti AF, Gracia-Sánchez L, Ortiz D, Garcia-Vidal C. PET/CT added to Duke criteria facilitates diagnosis and monitoring of long-term suppressive therapy of prosthetic endocarditis. Infect Dis (Lond) 2017; 49:698-701. [PMID: 28298163 DOI: 10.1080/23744235.2017.1300683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Pedro Puerta-Alcalde
- a Department of Infectious Diseases , Hospital Universitari de Bellvitge , Barcelona , Spain
| | - Guillermo Cuervo
- a Department of Infectious Diseases , Hospital Universitari de Bellvitge , Barcelona , Spain
| | - Antonella F Simonetti
- a Department of Infectious Diseases , Hospital Universitari de Bellvitge , Barcelona , Spain
| | - Laura Gracia-Sánchez
- b Department of Nuclear Medicine , Hospital Universitari de Bellvitge , Barcelona , Spain
| | - Daniel Ortiz
- c Department of Cardiac Surgery , Hospital Universitari de Bellvitge , Barcelona , Spain
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Garcia-Vidal C, Sanchez-Rodriguez I, Simonetti AF, Burgos J, Viasus D, Martin MT, Falco V, Carratalà J. Levofloxacin versus azithromycin for treating legionella pneumonia: a propensity score analysis. Clin Microbiol Infect 2017; 23:653-658. [PMID: 28267637 DOI: 10.1016/j.cmi.2017.02.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 10/10/2016] [Revised: 02/21/2017] [Accepted: 02/25/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Concerns have arisen regarding the equivalence of levofloxacin and some macrolides for treating community-acquired legionella pneumonia (LP). We aimed to compare the outcomes of current patients with LP treated with levofloxacin, azithromycin and clarithromycin. METHODS Observational retrospective multicentre study of consecutive patients with LP requiring hospitalization (2000-2014) conducted in two hospitals. The primary outcome assessed was 30-day mortality. To control for confounding, therapy was assessed by multivariate analysis. RESULTS We documented 446 patients with LP, of which 175 were treated with levofloxacin, 177 with azithromycin and 58 with clarithromycin. No significant differences in time to defervescence (2 (interquartile range (IQR) 1-4) versus 2 (IQR 1-3) days; p 0.453), time to achieve clinical stability (3 (2-5) versus 3 (2-5) days; p 0.486), length of intravenous therapy (3 (2-5.25) versus 4 (3-6) days; p 0.058) and length of hospital stay (7 (5-10) versus 6 (5-9) days; p 0.088) were found between patients treated with levofloxacin and those treated with azithromycin. Patients treated with clarithromycin had longer intravenous antibiotic treatment (3 (2-5.25) versus 5 (3-6.25) days; p 0.002) and longer hospital stay (7 (5-10) versus 9 (7-14) days; p 0.043) compared with those treated with levofloxacin. The overall mortality was 4.3% (19 patients). Neither univariate nor multivariate analysis showed a significant association of levofloxacin versus azithromycin on mortality (4 (2.3%) versus 9 (5.1%) deaths; p 0.164). The results did not change after incorporation of the propensity score into the models. CONCLUSIONS In our study, no significant differences in most outcomes were found between patients treated with levofloxacin and those treated with azithromycin. Due to the small number of deaths, results regarding mortality should be interpreted with caution.
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Affiliation(s)
- C Garcia-Vidal
- Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain; REIPI (Spanish Network for the Research in Infectious Diseases), Instituto de Salud Carlos III, Madrid, Spain.
| | - I Sanchez-Rodriguez
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A F Simonetti
- Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain
| | - J Burgos
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Viasus
- Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain; Health Science Division, Universidad del Norte and Hospital Universidad del Norte, Barranquilla, Colombia
| | - M T Martin
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V Falco
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Carratalà
- Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain; REIPI (Spanish Network for the Research in Infectious Diseases), Instituto de Salud Carlos III, Madrid, Spain
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Abstract
INTRODUCTION Community-acquired pneumonia is a major public health problem worldwide. In recent years, there has been an increase in the frequency of resistance to the antimicrobials such as β-lactams or macrolides which have habitually been used against the causative pathogens. Solithromycin, a next-generation macrolide, is the first fluoroketolide with activity against most of the frequently isolated bacteria in community-acquired pneumonia, including typical and atypical bacteria as well as macrolide-resistant Streptococcus pneumoniae. Areas covered: A detailed assessment of the literature relating to the antimicrobial activity, pharmacokinetic/pharmacodynamic properties, efficacy, tolerability and safety of solithromycin for the treatment of community-acquired bacterial pneumonia Expert commentary: Recent randomized controlled phase II/III trials have demonstrated the equivalent efficacy of oral and intravenous solithromycin compared with fluoroquinolones in patients with lower mild-to-moderate respiratory infections, and have shown that systemic adverse events are comparable between solithromycin and alternative treatments. However, studies of larger populations which are able to identify infrequent adverse events are now needed to confirm these findings. On balance, current data supports solithromycin as a promising therapy for empirical treatment in adults with community-acquired bacterial pneumonia.
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Affiliation(s)
- Diego Viasus
- a Faculty of Medicine, Health Sciences Division , Hospital Universidad del Norte and Universidad del Norte , Barranquilla , Colombia
| | - Oscar Ramos
- a Faculty of Medicine, Health Sciences Division , Hospital Universidad del Norte and Universidad del Norte , Barranquilla , Colombia
| | - Leidy Ramos
- a Faculty of Medicine, Health Sciences Division , Hospital Universidad del Norte and Universidad del Norte , Barranquilla , Colombia
| | - Antonella F Simonetti
- b Infectious Disease Department , Hospital Universitari de Bellvitge - IDIBELL , Barcelona , Spain
| | - Jordi Carratalà
- b Infectious Disease Department , Hospital Universitari de Bellvitge - IDIBELL , Barcelona , Spain.,c Spanish Network for Research in Infectious Diseases (REIPI), and Clinical Science Department, Faculty of Medicine , University of Barcelona , Barcelona , Spain
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Viasus D, Simonetti AF, Garcia-Vidal C, Niubó J, Dorca J, Carratalà J. Impact of antibiotic de-escalation on clinical outcomes in community-acquired pneumococcal pneumonia. J Antimicrob Chemother 2016; 72:547-553. [PMID: 27798219 DOI: 10.1093/jac/dkw441] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/22/2016] [Accepted: 09/19/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although antibiotic de-escalation is regarded as a measure that reduces selection pressure, adverse drug effects and costs, evidence supporting this practice in community-acquired pneumococcal pneumonia (CAPP) is lacking. METHODS We carried out a retrospective analysis of prospectively collected data of a cohort of hospitalized adults with CAPP. Pneumococcal aetiology was established in patients with one or more positive cultures for Streptococcus pneumoniae obtained from blood, sterile fluids or sputum, and/or a positive urinary antigen test. De-escalation therapy was considered when the initial antibiotic therapy was narrowed to penicillin, amoxicillin or amoxicillin/clavulanate within the first 72 h after admission. The primary outcomes were 30 day mortality and length of hospital stay (LOS). Adjustment for confounders was performed with multivariate and propensity score analyses. RESULTS Of 1410 episodes of CAPP, antibiotic de-escalation within the first 72 h after admission was performed in 166 cases. After adjustment, antibiotic de-escalation was not associated with a higher risk of mortality (OR = 0.83, 95% CI = 0.24-2.81), but it was found to be a protective factor for prolonged LOS (above the median) (OR = 0.46, 95% CI = 0.30-0.70). Similar results were found in patients classified into high-risk pneumonia severity index classes (IV-V), those with clinical instability and those with bacteraemia. No significant differences were documented in adverse drug reactions or readmission (<30 days). CONCLUSIONS Antibiotic de-escalation seems to be safe and effective in reducing the duration of LOS, and did not adversely affect outcomes of patients with CAPP, even those with bacteraemia and severe disease, and those who were clinically unstable.
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Affiliation(s)
- Diego Viasus
- Health Sciences Division, Faculty of Medicine, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia
| | - Antonella F Simonetti
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Sevilla, Spain
| | - Jordi Niubó
- Microbiology Department, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain.,Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Jordi Dorca
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain.,Respiratory Medicine Department, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain
| | - Jordi Carratalà
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Sevilla, Spain.,Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
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Simonetti AF, Garcia-Vidal C, Viasus D, García-Somoza D, Dorca J, Gudiol F, Carratalà J. Declining mortality among hospitalized patients with community-acquired pneumonia. Clin Microbiol Infect 2016; 22:567.e1-7. [PMID: 27021421 DOI: 10.1016/j.cmi.2016.03.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 08/07/2015] [Revised: 01/25/2016] [Accepted: 03/13/2016] [Indexed: 11/15/2022]
Abstract
Little information is available on the changes over time in community-acquired pneumonia (CAP) management and their impact on 30-day mortality in hospitalized patients. We performed a prospective, observational study of non-severely immunosuppressed hospitalized adults with CAP from 1995 to 2014. A total of 4558 patients were included. Thirty-day mortality decreased from 9.6% in the first study period (1995-99) to 4.1% in the last period (2010-14); with a progressive downward trend (-0.2% death/year; p for trend = 0.003). Over time, patients were older (p 0.02), had more co-morbidities (p 0.037), more frequently presented severe illness according to the Pneumonia Severity Index (p <0.001) and septic shock (p <0.001), and more often required intensive care unit admission (p <0.001). Combination antibiotic therapy (p <0.001) and fluoroquinolone use (p <0.001) increased. Factors independently associated with 30-day mortality were increasing age (OR 1.04; 95% CI 1.03-1.05), co-morbidities (OR 1.48; 95% CI 1.04-2.11), shock at admission (OR 4.95; 95% CI 3.49-7.00), respiratory failure (OR 1.89; 95% CI 1.42-2.52), bacteraemia (OR 2.16; 95% CI 1.58-2.96), Gram-negative bacilli aetiology (OR 4.79; 95% CI 2.52-9.10) and fluoroquinolone use (OR 0.45; 95% CI 0.29-0.71). When we adjusted for a propensity score to receive fluoroquinolones, the protective effect of fluoroquinolone use was not confirmed. In conclusion, 30-day mortality decreased significantly over time in hospitalized patients with CAP in spite of an upward trend in patient age and other factors associated with poor outcomes. Several changes in the management of CAP and a general improvement in global care over time may have caused the observed outcomes.
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Affiliation(s)
- A F Simonetti
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - C Garcia-Vidal
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain.
| | - D Viasus
- Division of Health Sciences, Faculty of Medicine, Universidad del Norte, and Hospital Universidad del Norte, Barranquilla, Colombia
| | - D García-Somoza
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Dorca
- Department of Respiratory Diseases, Hospital Universitari de Bellvitge Barcelona, Spain
| | - F Gudiol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
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Viasus D, Del Rio-Pertuz G, Simonetti AF, Garcia-Vidal C, Acosta-Reyes J, Garavito A, Carratalà J. Biomarkers for predicting short-term mortality in community-acquired pneumonia: A systematic review and meta-analysis. J Infect 2016; 72:273-82. [PMID: 26777314 DOI: 10.1016/j.jinf.2016.01.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 10/07/2015] [Revised: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The pneumonia severity index and CURB-65 are risk assessment tools widely used in community-acquired pneumonia (CAP). However, limitations in these prognostic scores have led to increasing interest in finding biomarkers that might provide additional information. To date, the role of these biomarkers has not been fully elucidated. METHODS We systematically searched the Medline, Web of Knowledge, Science Direct, and LILACS databases. We included studies that assessed the accuracy of biomarkers for the prediction of in-hospital or ≤30-day mortality, in hospitalized adults with CAP. Two independent investigators extracted patient and study characteristics, which were thereafter pooled using a random effects model. Relationships between sensitivity and specificity of biomarkers and prognostic scores were plotter using the area under the receiver operator characteristic curve (AUC). RESULTS We included 24 articles and 2 databases from 1069 reviewed abstracts, which provided 10,319 patients for analysis. Reported mortality rates varied from 2.4% to 34.6%. The highest AUC values for predicting mortality were associated with pro-adrenomedullin (0.80) and prohormone forms of atrial natriuretic peptide (0.79), followed by cortisol (0.78), procalcitonin (0.75), copeptin (0.71), and C-reactive protein (0.62). There were no statistically significant differences between the AUCs of the studied biomarkers, other than for copeptin and C-reactive protein, which performed comparatively poorly. When compared with the CAP-specific scores, the AUCs were not significantly different from those of most biomarkers. CONCLUSIONS The identified biomarkers are able to predict mortality with moderate to good accuracy in CAP. However, biomarkers have no clear advantage over CAP-specific scores for predicting mortality.
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Affiliation(s)
- Diego Viasus
- Division of Health Sciences, Faculty of Medicine, Universidad del Norte, and Hospital Universidad del Norte, Colombia.
| | - Gaspar Del Rio-Pertuz
- Division of Health Sciences, Faculty of Medicine, Universidad del Norte, and Hospital Universidad del Norte, Colombia
| | - Antonella F Simonetti
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, and Spanish Network for Research in Infectious Diseases (REIPI), Spain
| | - Carolina Garcia-Vidal
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, and Spanish Network for Research in Infectious Diseases (REIPI), Spain
| | - Jorge Acosta-Reyes
- Department of Public Health, Universidad del Norte, and Hospital Universidad del Norte, Colombia
| | - Argenis Garavito
- Clínica Medilaser S.A. - Sucursal Florencia, Fundación Universitaria Navarra, Colombia
| | - Jordi Carratalà
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, and Spanish Network for Research in Infectious Diseases (REIPI), Spain; Clinical Science Department, Faculty of Medicine, University of Barcelona, Spain
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Viasus D, Garcia-Vidal C, Simonetti AF, Dorca J, Llopis F, Mestre M, Morandeira-Rego F, Carratalà J. The effect of simvastatin on inflammatory cytokines in community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial. BMJ Open 2015; 5:e006251. [PMID: 25564143 PMCID: PMC4289727 DOI: 10.1136/bmjopen-2014-006251] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES It has been suggested that statins have an effect on the modulation of the cytokine cascade and on the outcome of patients with community-acquired pneumonia (CAP). The aim of this prospective, randomised, double-blind, placebo-controlled trial was to determine whether statin therapy given to hospitalised patients with CAP improves clinical outcomes and reduces the concentration of inflammatory cytokines. SETTING A tertiary teaching hospital in Barcelona, Spain. PARTICIPANTS Thirty-four patients were randomly assigned and included in an intention-to-treat analysis (19 to the simvastatin group and 15 to the placebo group). INTERVENTION Patients were randomly assigned to receive 20 mg of simvastatin or placebo administered in the first 24 h of hospital admission and once daily thereafter for 4 days. OUTCOME Primary end point was the time from hospital admission to clinical stability. The secondary end points were serum concentrations of inflammatory cytokines and partial pressure of arterial oxygen/fractional inspired oxygen (PaO2/FiO2) at 48 h after treatment administration. RESULTS The trial was stopped because enrolment was much slower than originally anticipated. The baseline characteristics of the patients and cytokine concentrations at the time of enrolment were similar in the two groups. No significant differences in the time from hospital admission to clinical stability were found between study groups (median 3 days, IQR 2-5 vs 3 days, IQR 2-5; p=0.47). No significant differences in PaO2/FiO2 (p=0.37), C reactive protein (p=0.23), tumour necrosis factor-α (p=0.58), interleukin 6 (IL-6; p=0.64), and IL-10 (p=0.61) levels at 48 h of hospitalisation were found between simvastatin and placebo groups. Similarly, transaminase and total creatine kinase levels were similar between study groups at 48 h of hospitalisation (p=0.19, 0.08 and 0.53, respectively). CONCLUSIONS Our results suggest that the use of simvastatin, 20 mg once daily for 4 days, since hospital admission did not reduce the time to clinical stability and the levels of inflammatory cytokines in hospitalised patients with CAP. TRIAL REGISTRATION NUMBER ISRCTN91327214.
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Affiliation(s)
- Diego Viasus
- Biotechnology and Clinical Research Groups, Department of Internal Medicine, Faculty of Medicine, Universidad del Norte, Barranquilla, Colombia
- Department of Infectious Diseases, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonella F Simonetti
- Department of Infectious Diseases, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Dorca
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Ferran Llopis
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Department of Emergency Medicine, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mariona Mestre
- Department of Immunology, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Morandeira-Rego
- Department of Immunology, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Emergency Medicine, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Abstract
Community-acquired pneumonia (CAP) is an increasing problem among the elderly. Multiple factors related to ageing, such as comorbidities, nutritional status and swallowing dysfunction have been implicated in the increased incidence of CAP in the older population. Moreover, mortality in patients with CAP rises dramatically with increasing age. Streptococcus pneumoniae is still the most common pathogen among the elderly, although CAP may also be caused by drug-resistant microorganisms and aspiration pneumonia. Furthermore, in the elderly CAP has a different clinical presentation, often lacking the typical acute symptoms observed in younger adults, due to the lower local and systemic inflammatory response. Several independent prognostic factors for mortality in the elderly have been identified, including factors related to pneumonia severity, inadequate response to infection, and low functional status. CAP scores and biomarkers have lower prognostic value in the elderly, and so there is a need to find new scales or to set new cut-off points for current scores in this population. Adherence to the current guidelines for CAP has a significant beneficial impact on clinical outcomes in elderly patients. Particular attention should also be paid to nutritional status, fluid administration, functional status, and comorbidity stabilizing therapy in this group of frail patients. This article presents an up-to-date review of the main aspects of CAP in elderly patients, including epidemiology, causative organisms, clinical features, and prognosis, and assesses key points for best practices for the management of the disease.
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Affiliation(s)
- Antonella F Simonetti
- Department of Infectious Diseases, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Diego Viasus
- Department of Infectious Diseases, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain and Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain and Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
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Pacifico L, Panero A, Colarizi P, Matrunola M, Simonetti AF, Chiesa C. Neonatal Candida albicans septic thrombosis of the portal vein followed by cavernous transformation of the vessel. J Clin Microbiol 2004; 42:4379-82. [PMID: 15365049 PMCID: PMC516300 DOI: 10.1128/jcm.42.9.4379-4382.2004] [Citation(s) in RCA: 6] [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: 11/20/2022] Open
Abstract
We report two premature neonates with Candida albicans septic thrombosis of the portal vein who developed, in very early childhood, the sonographic appearance of cavernous transformation of the vessel and/or clinical signs of extrahepatic portal hypertension.
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Affiliation(s)
- Lucia Pacifico
- Institute of Pediatrics, La Sapienza University of Rome, Viale Regina Elena, 324 00161 Rome, Italy
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