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Lozada J, Gómez JO, Serrano-Mayorga CC, Viñán Garcés AE, Enciso V, Mendez-Castillo L, Acosta-González A, Bustos IG, Fuentes YV, Ibáñez-Prada ED, Crispin AM, Delgado-Cañaveral MC, Morales Celis LM, Jaimes D, Turner P, Reyes LF. Streptococcus pneumoniae as a colonizing agent of the Nasopharynx - Oropharynx in adults: A systematic review and meta-analysis. Vaccine 2024; 42:2747-2757. [PMID: 38514352 DOI: 10.1016/j.vaccine.2024.03.041] [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: 12/12/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Streptococcus pneumoniae (Spn) is a commensal pathogen that usually colonizes the upper respiratory tract of children. Likewise, Spn colonization has been considered a critical factor in the development of pneumococcal invasive disease. However, Spn prevalence in adults remains unclear. This study performs a systematic review and meta-analysis to explore the prevalence of Spn Nasopharynx - Oropharynx Colonization (NOC) in adults. METHODS A Systematic review of scientific databases was utilized to identify eligible studies that follow strict selection criteria. Subsequently, a meta-analysis was conducted to establish NOC prevalence in adults (≥18 years old). The heterogeneity and sensitivity analyses were assessed using the microorganism identification technique, sample type, and age subgroups. RESULTS Initial selection includes 69 studies, with 37 selected for the meta-analysis, involving 23,724 individuals. The overall prevalence (95 % CI) of Spn NOC among adults was 6 % (5-9). The subgroup analysis revealed that young adults (YA), 18-64 years old, had a prevalence of 10 %, whereas older adults (OA), ≥65 years old, had a prevalence of 2 %. The identification of Spn NOC may vary depending on the method of diagnosis used. High heterogeneity (I2 > 90 %) was observed but diminished to 70 % when the analysis was restricted to oropharyngeal swabs as an identification method. Furthermore, heterogeneity decreased to 58 % when exclusively employing traditional culture as the identification method. CONCLUSIONS This study found a low prevalence of Spn NOC in adults. Notably, the prevalence of Spn NOC was higher in younger adults than in older adults. It is essential to highlight a significant heterogeneity among studies, which indicates there is no standardized method of Spn NOC identification.
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Affiliation(s)
- Julián Lozada
- School of Medicine, Universidad de La Sabana, Chía, Colombia; Clínica Universidad de La Sabana, Chía, Colombia; Bioscience PhD, Engineering School, Universidad de La Sabana, Chía, Colombia
| | - Juan Olivella Gómez
- School of Medicine, Universidad de La Sabana, Chía, Colombia; Clínica Universidad de La Sabana, Chía, Colombia; Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Cristian C Serrano-Mayorga
- School of Medicine, Universidad de La Sabana, Chía, Colombia; Clínica Universidad de La Sabana, Chía, Colombia; Bioscience PhD, Engineering School, Universidad de La Sabana, Chía, Colombia; Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - André Emilio Viñán Garcés
- School of Medicine, Universidad de La Sabana, Chía, Colombia; Clínica Universidad de La Sabana, Chía, Colombia; Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Valeria Enciso
- School of Medicine, Universidad de La Sabana, Chía, Colombia
| | | | - Alejandro Acosta-González
- Bioscience PhD, Engineering School, Universidad de La Sabana, Chía, Colombia; Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Ingrid G Bustos
- School of Medicine, Universidad de La Sabana, Chía, Colombia; Bioscience PhD, Engineering School, Universidad de La Sabana, Chía, Colombia
| | - Yuli V Fuentes
- School of Medicine, Universidad de La Sabana, Chía, Colombia; Clínica Universidad de La Sabana, Chía, Colombia
| | - Elsa D Ibáñez-Prada
- School of Medicine, Universidad de La Sabana, Chía, Colombia; Clínica Universidad de La Sabana, Chía, Colombia; Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Ana M Crispin
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | | | | | - Diego Jaimes
- School of Medicine, Universidad de La Sabana, Chía, Colombia; Clínica Universidad de La Sabana, Chía, Colombia
| | - Paul Turner
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Luis Felipe Reyes
- School of Medicine, Universidad de La Sabana, Chía, Colombia; Clínica Universidad de La Sabana, Chía, Colombia; Pandemic Sciences Institute, University of Oxford, Oxford, UK.
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Gomez-Gonzalez C, Mas-Font S, Herrera-Rojas MD, Sanchez Moran F, Gomez E, Mudarra C, Enciso V. Contrast-associated acute kidney injury (CA-AKI) according to the type and dose of contrast in contrast-enhanced radiographic examinations. preliminay results of the nefrocon study. Intensive Care Med Exp 2015. [PMCID: PMC4798352 DOI: 10.1186/2197-425x-3-s1-a64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abella A, Enciso V, Torrejón I, Hermosa C, Mozo T, Molina R, Janeiro D, Díaz M, Homez M, Gordo F, Salinas I. Effect upon mortality of the extension to holidays and weekends of the "ICU without walls" project. A before-after study. Med Intensiva 2015; 40:273-9. [PMID: 26547480 DOI: 10.1016/j.medin.2015.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 05/19/2015] [Revised: 07/30/2015] [Accepted: 09/01/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine whether extension to holidays and weekends of the protocol for the early proactive detection of severity in hospital ("ICU without walls" project) results in decreased mortality among patients admitted to the ICU during those days. DESIGN A quasi-experimental before-after study was carried out. SETTING A level 2 hospital with 210 beds and a polyvalent ICU with 8 beds. PATIENTS OR PARTICIPANTS The control group involved no "ICU without walls" activity on holidays or weekends and included those patients admitted to the ICU on those days between 1 January 2010 and 30 April 2013. The intervention group in turn extended the "ICU without walls" activity to holidays and weekends, and included those patients admitted on those days between 1 May 2013 and 31 October 2014. Patients arriving from the operating room after scheduled surgery were excluded. VARIABLES OF INTEREST An analysis was made of the demographic variables (age, gender), origin (emergency room, hospital ward, operating room), type of patient (medical, surgical), reason for admission, comorbidities and SAPS 3 score as a measure of severity upon admission, stay in the ICU and in hospital, and mortality in the ICU and in hospital. RESULTS A total of 389 and 161 patients were included in the control group and intervention group, respectively. There were no differences between the 2 groups except as regards cardiovascular comorbidity (49% in the control group versus 33% in the intervention group; P<.001), severity upon admission (median SAPS 3 score 52 [percentiles 25-75: 42-63) in the control group versus 48 [percentiles 25-75: 40-56] in the intervention group; P=.008) and mortality in the ICU (11% in the control group [95% CI 8-14] versus 3% [95% CI 1-7] in the intervention group; P=.003). In the multivariate analysis, the only 2 factors associated to mortality in the ICU were the SAPS 3 score (OR 1.08; 95% CI 1.06-1.11) and inclusion in the intervention group (OR 0.33; 95% CI 0.12-0.89). CONCLUSIONS Extension of the "ICU without walls" activity to holidays and weekends results in a decrease in mortality in the ICU.
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Affiliation(s)
- A Abella
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - V Enciso
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - I Torrejón
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - C Hermosa
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - T Mozo
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - R Molina
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - D Janeiro
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - M Díaz
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - M Homez
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - F Gordo
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España; Grado de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España.
| | - I Salinas
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España; Grado de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España
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Abella A, Hermosa C, Enciso V, Torrejón I, Molina R, Díaz M, Mozo T, Gordo F, Salinas I. Effect of the timing of admission upon patient prognosis in the Intensive Care Unit: On-hours versus off-hours. Med Intensiva 2015; 40:26-32. [PMID: 25682488 DOI: 10.1016/j.medin.2014.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 08/25/2014] [Revised: 11/24/2014] [Accepted: 11/24/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the repercussion of the timing of admission to the ICU upon patient prognosis. DESIGN A prospective, observational, non-interventional cohort study was carried out. SCOPE A second level hospital with 210 operational beds and a general ICU with 8 operational beds. PATIENTS OR PARTICIPANTS The study comprised all patients admitted to the ICU during 3 years (January 2010 to December 2012), excluding those subjects admitted from the operating room after scheduled surgery. The patients were divided into 2 groups according to the timing of admission (on-hours or off-hours). INTERVENTIONS Non-interventional study. VARIABLES OF INTEREST An analysis was made of demographic variables (age, sex), origin (emergency room, hospital ward, operating room), comorbidities and SAPS 3 as severity score upon admission, length of stay in the ICU and hospital ward, and ICU and hospital mortality. RESULTS A total of 504 patients were included in the on-hours group, versus 602 in the off-hours group. Multivariate analysis showed the factors independently associated to hospital mortality to be SAPS 3 (OR 1.10; 95% CI 1.08-1.12), and off-hours admission (OR 2.00; 95% CI 1.20-3.33). In a subgroup analysis of the off-hours group, the admission of patients on weekends or non-working days compared to daily night shifts was found to be independently associated to hospital mortality (OR 2.30; 95% CI 1.23-4.30). CONCLUSIONS Admission to the ICU in off-hours is independently associated to patient mortality, which is also higher in patients admitted on weekends and non-working days compared to the daily night shifts.
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Affiliation(s)
- A Abella
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - C Hermosa
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - V Enciso
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - I Torrejón
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - R Molina
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - M Díaz
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - T Mozo
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - F Gordo
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España.
| | - I Salinas
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
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Kang SHL, Scheffer A, Ou Z, Li J, Scaglia F, Belmont J, Lalani SR, Roeder E, Enciso V, Braddock S, Buchholz J, Vacha S, Chinault AC, Cheung SW, Bacino CA. Identification of proximal 1p36 deletions using array-CGH: a possible new syndrome. Clin Genet 2007; 72:329-38. [PMID: 17850629 DOI: 10.1111/j.1399-0004.2007.00876.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [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: 11/27/2022]
Abstract
Monosomy 1p36 is the most common terminal deletion syndrome with an estimated occurrence of 1:5000 live births. Typically, the deletions span <10 Mb of 1pter-1p36.23 and result in mental retardation, developmental delay, sensorineural hearing loss, seizures, cardiomyopathy and cardiovascular malformations, and distinct facies including large anterior fontanel, deep-set eyes, straight eyebrows, flat nasal bridge, asymmetric ears, and pointed chin. We report five patients with 'atypical' proximal interstitial deletions from 1p36.23-1p36.11 using array-comparative genomic hybridization. Four patients carry large overlapping deletions of approximately 9.38-14.69 Mb in size, and one patient carries a small 2.97 Mb deletion. Interestingly, these patients manifest many clinical characteristics that are different from those seen in 'classical' monosomy 1p36 syndrome. The clinical presentation in our patients included: pre- and post-natal growth deficiency (mostly post-natal), feeding difficulties, seizures, developmental delay, cardiovascular malformations, microcephaly, limb anomalies, and dysmorphic features including frontal and parietal bossing, abnormally shaped and posteriorly rotated ears, hypertelorism, arched eyebrows, and prominent and broad nose. Most children also displayed hirsutism. Based on the analysis of the clinical and molecular data from our patients and those reported in the literature, we suggest that this chromosomal abnormality may constitute yet another deletion syndrome distinct from the classical distal 1p36 deletion syndrome.
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Affiliation(s)
- S-H L Kang
- Department of Molecular and Human Genetics, Baylor College of Medicine, Clinical Care Center, 6701 Fannin Street, Houston, TX 77030, USA
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