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1.
Med Intensiva (Engl Ed) ; 46(12): 669-679, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36442913

RESUMO

OBJECTIVES: To analyze clinical features associated to mortality in oncological patients with unplanned admission to the Intensive Care Unit (ICU), and to determine whether such risk factors differ between patients with solid tumors and those with hematological malignancies. DESIGN: An observational study was carried out. SETTING: A total of 123 Intensive Care Units across Spain. PATIENTS: All cancer patients with unscheduled admission due to acute illness related to the background oncological disease. INTERVENTIONS: None. MAIN VARIABLES: Demographic parameters, severity scores and clinical condition were assessed, and mortality was analyzed. Multivariate binary logistic regression analysis was performed. RESULTS: A total of 482 patients were included: solid cancer (n=311) and hematological malignancy (n=171). Multivariate regression analysis showed the factors independently associated to ICU mortality to be the APACHE II score (OR 1.102; 95% CI 1.064-1.143), medical admission (OR 3.587; 95% CI 1.327-9.701), lung cancer (OR 2.98; 95% CI 1.48-5.99) and mechanical ventilation after the first 24h of ICU stay (OR 2.27; 95% CI 1.09-4.73), whereas no need for mechanical ventilation was identified as a protective factor (OR 0.15; 95% CI 0.09-0.28). In solid cancer patients, the APACHE II score, medical admission, antibiotics in the previous 48h and lung cancer were identified as independent mortality indicators, while no need for mechanical ventilation was identified as a protective factor. In the multivariate analysis, the APACHE II score and mechanical ventilation after 24h of ICU stay were independently associated to mortality in hematological cancer patients, while no need for mechanical ventilation was identified as a protective factor. Neutropenia was not identified as an independent mortality predictor in either the total cohort or in the two subgroups. CONCLUSIONS: The risk factors associated to mortality did not differ significantly between patients with solid cancers and those with hematological malignancies. Delayed intubation in patients requiring mechanical ventilation might be associated to ICU mortality.


Assuntos
Neoplasias Hematológicas , Neoplasias Pulmonares , Humanos , Estudos Prospectivos , Unidades de Terapia Intensiva , Hospitalização , Neoplasias Hematológicas/terapia
2.
Med Intensiva ; 40(4): 216-29, 2016 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-26456793

RESUMO

OBJECTIVE: To describe the case-mix of patients admitted to intensive care units (ICUs) in Spain during the period 2006-2011 and to assess changes in ICU mortality according to severity level. DESIGN: Secondary analysis of data obtained from the ENVN-HELICS registry. Observational prospective study. SETTING: Spanish ICU. PATIENTS: Patients admitted for over 24h. INTERVENTIONS: None. VARIABLES: Data for each of the participating hospitals and ICUs were recorded, as well as data that allowed to knowing the case-mix and the individual outcome of each patient. The study period was divided into two intervals, from 2006 to 2008 (period 1) and from 2009 to 2011 (period 2). Multilevel and multivariate models were used for the analysis of mortality and were performed in each stratum of severity level. RESULTS: The study population included 142,859 patients admitted to 188 adult ICUs. There was an increase in the mean age of the patients and in the percentage of patients >79 years (11.2% vs. 12.7%, P<0.001). Also, the mean APACHE II score increased from 14.35±8.29 to 14.72±8.43 (P<0.001). The crude overall intra-UCI mortality remained unchanged (11.4%) but adjusted mortality rate in patients with APACHE II score between 11 and 25 decreased modestly in recent years (12.3% vs. 11.6%, odds ratio=0.931, 95% CI 0.883-0.982; P=0.008). CONCLUSION: This study provides observational longitudinal data on case-mix of patients admitted to Spanish ICUs. A slight reduction in ICU mortality rate was observed among patients with intermediate severity level.


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , APACHE , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Infecção Hospitalar/epidemiologia , Grupos Diagnósticos Relacionados , Feminino , Mortalidade Hospitalar/tendências , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Espanha/epidemiologia , Resultado do Tratamento
3.
Med Intensiva ; 39(5): 279-89, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-25282571

RESUMO

OBJECTIVE: To describe the characteristics of the patients case-mix admitted to ICUs due to medical and surgical disease, and to compare both groups. DESIGN: Analysis of data covering the period 2006-2011 in the ENVIN-HELICS registry. An observational, prospective, multicenter and voluntary participation study. SETTING: A total of 188 Spanish ICUs. PATIENTS: All patients admitted for more than 24 hours. MAIN VARIABLES: Demographic data, cause of admission, severity scores, length of stay, mortality. RESULTS: A total of 138,999 patients were analyzed. Of these, 65,467 (47.1%) were admitted due to a non-coronary medical cause, 27,785 (20,0%) due to coronary-related illness, 28,044 (20,2%) after elective surgery and 17,613 (12.7%) after urgent surgery. Use of devices, nosocomial infections and isolation of multirresistant organisms were more prevalent in urgent surgery patients. Longer length of stay (median 5 days; interquartile range 2-11) as well as higher severity scale values (APACHE II and SAPS II) corresponded to this same group of patients. Mortality was higher in non-coronay medical patients. On categorizing the patients according to the APACHE II score, mortality was seen to be higher in urgent surgery cases than in elective surgery patients in all groups. The largest difference was observed in the APACHE II score 6-10 group (3% vs. 0.9%) (OR: 2.14, 95% CI 1.825-2.513; p<0.001). CONCLUSIONS: The mortality rate is higher in non-coronary medical patients, though resource use per patient is greater in the urgent surgery cases. The APACHE II scale underestimates mortality in emergency surgery patients.


Assuntos
Grupos Diagnósticos Relacionados , Unidades de Terapia Intensiva/estatística & dados numéricos , APACHE , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/epidemiologia , Infecção Hospitalar/epidemiologia , Feminino , Mortalidade Hospitalar , Hospitais/classificação , Humanos , Lactente , Recém-Nascido , Medicina Interna , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Espanha/epidemiologia , Procedimentos Cirúrgicos Operatórios , Adulto Jovem
4.
Med Intensiva ; 37(9): 584-92, 2013 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-23473741

RESUMO

OBJECTIVE: To analyze postoperative infections in critically ill patients undergoing heart surgery. SETTING: Intensive care units (ICUs). DESIGN: An observational, prospective, multicenter study was carried out. PATIENTS: Patients in the postoperative period of heart surgery admitted to the ICU and included in the ENVIN-HELICS registry between 2005 and 2011. MAIN OUTCOME VARIABLES: Mechanical ventilation associated pneumonia (MVP), urinary catheter-related infection (UCI), primary bacteremia (PB), PB related to vascular catheters (PB-VC) and secondary bacteremia. RESULTS: Of a total of 97,692 patients included in the study, 9089 (9.3%) had undergone heart surgery. In 440 patients (4.8%), one or more infections were recorded. Infection rates were 9.94 episodes of MVP per 1000 days of mechanical ventilation, 3.4 episodes of UCI per 1000 days of urinary catheterization, 3.10 episodes of BP-VC per 1000 days of central venous catheter, and 1.84 episodes of secondary bacteremia per 1000 days of ICU stay. Statistically significant risk factors for infection were ICU stay (odds ratio [OR] 1.18, 95%CI 1.16-1.20), APACHE II upon admission to the ICU (OR 1.05, 95%CI 1.03-1.07), emergency surgery (OR 1.67, 95%CI 1.13-2.47), previous antibiotic treatment (OR 1.38, 95%CI 1.04-1.83), and previous colonization by Pseudomonas aeruginosa (OR 18.25, 95%CI 3.74-89.06) or extended spectrum beta-lactamase producing enterobacteria (OR 16.97, 95%CI 5.4-53.2). The overall ICU mortality rate was 4.1% (32.2% in patients who developed one or more infections and 2.9% in uninfected patients) (P < .001). CONCLUSIONS: Of the patients included in the ENVIN-HELICS registry, 9.3% were postoperative heart surgery patients. The overall mortality was low but increased significantly in patients who developed one or more infection episodes.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Infecções Relacionadas a Cateter , Pneumonia Associada à Ventilação Mecânica , Complicações Pós-Operatórias , Idoso , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Feminino , Humanos , Masculino , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fatores de Risco
5.
Med Intensiva ; 37(2): 75-82, 2013 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-22579562

RESUMO

OBJECTIVE: To describe trends in national catheter-related urinary tract infection (CRUTI) rates, as well as etiologies and multiresistance markers. DESIGN: An observational, prospective, multicenter voluntary participation study was conducted from 1 April to 30 June in the period between 2005 and 2010. SETTING: Intensive Care Units (ICUs) that participated in the ENVIN-ICU registry during the study period. PATIENTS: We included all patients admitted to the participating ICUs and patients with urinary catheter placement for more than 24 hours (78,863 patients). INTERVENTION: Patient monitoring was continued until discharge from the ICU or up to 60 days. VARIABLES OF INTEREST: CRUTIs were defined according to the CDC system, and frequency is expressed as incidence density (ID) in relation to the number of urinary catheter-patients days. RESULTS: A total of 2329 patients (2.95%) developed one or more CRUTI. The ID decreased from 6.69 to 4.18 episodes per 1000 days of urinary catheter between 2005 and 2010 (p<0.001). In relation to the underlying etiology, gramnegative bacilli predominated (55.6 to 61.6%), followed by fungi (18.7 to 25.2%) and grampositive cocci (17.1 to 25.9%). In 2010, ciprofloxacin-resistant E. coli strains (37.1%) increased, as well as imipenem-resistant (36.4%) and ciprofloxacin-resistant (37.1%) strains of P. aeruginosa. CONCLUSIONS: A decrease was observed in CRUTI rates, maintaining the same etiological distribution and showing increased resistances in gramnegative pathogens, especially E. coli and P. aeruginosa.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Cateteres Urinários/efeitos adversos , Estado Terminal , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
Med Intensiva ; 35(4): 208-16, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21496964

RESUMO

INTRODUCTION: During the 2009 influenza pandemic, several reports were published, nevertheless, data on the clinical profiles of critically ill patients with the new virus infection during this second outbreak are still lacking. MATERIAL METHODS: Prospective, observational, multi-center study conducted in 148 Spanish intensive care units (ICU) during epidemiological weeks 50-52 of 2010 and weeks 1 - 4 of 2011. RESULTS: Three hundred patients admitted to an intensive care unit (ICU) with confirmed An/H1N1 infection were analyzed. The median age was 49 years [IQR=38-58] and 62% were male. The mean APACHE II score was 16.9 ± 7.5 and the mean SOFA score was 6.3 ± 3.5 on admission. Comorbidities were present in 76% (n=228) of cases and 111 (37.4%) patients were reportedly obese and 59 (20%) were COPD. The main presentation was viral pneumonia with severe hypoxemia in 65.7% (n=197) of the patients whereas co-infection was identified in 54 (18%) patients. All patients received antiviral treatment and initiated empirically in 194 patients (65.3%), however only 53 patients (17.6%) received early antiviral treatment. Vaccination was only administered in 22 (7.3%) patients. Sixty-seven of 200 patients with ICU discharge died. Haematological disease, severity of illness, infiltrates in chest X-ray and need for mechanical ventilation were variables independently associated with ICU mortality. CONCLUSIONS: In patients admitted to the ICU in the post-pandemic seasonal influenza outbreak vaccination was poorly implemented and appear to have higher frequency of severe comorbidities, severity of illness, incidence of primary viral pneumonia and increased mortality when compared with those observed in the 2009 pandemic outbreak.


Assuntos
Surtos de Doenças , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , APACHE , Adolescente , Corticosteroides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Terapia Combinada , Comorbidade , Infecção Hospitalar/epidemiologia , Feminino , Humanos , Vírus da Influenza A Subtipo H1N1/genética , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Pneumonia Viral/terapia , Estudos Prospectivos , Sistema de Registros , Respiração Artificial/estatística & dados numéricos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Choque/tratamento farmacológico , Choque/etiologia , Espanha/epidemiologia , Taxa de Sobrevida , Adulto Jovem
8.
Med Intensiva ; 35(4): 217-25, 2011 May.
Artigo em Espanhol | MEDLINE | ID: mdl-21130534

RESUMO

OBJECTIVE: To study the impact of coagulase-negative staphylococcal (CNS) primary and intravascular catheter-related bloodstream infection (PBSI/CRBSI) on mortality and morbidity in critically-ill patients. DESIGN: We performed a double analysis using data from the ENVIN-HELICS registry data (years 1997 to 2008): 1) We studied the clinical characteristics and outcomes of patients with CNS-induced PBSI/CRBSI and compared them with those of patients with PBSI/CRBSI caused by other pathogens; and 2) We analyzed the impact of CNS-induced PBSI/CRBSI using a case-control design (1:4) in patients without other nosocomial infections. SETTING: 167 Spanish Intensive Care Units. PATIENTS: Patients admitted to ICU for more than 24 hours. RESULTS: 2,252 patients developed PBSI/CRBSI, of which 1,133 were caused by CNS. The associated mortality for PBSI/CRBSI caused by non-CNS pathogens was higher than that of the CNS group (29.8% vs. 25.9%; P=.039) due exclusively to the mortality of patients with candidemia (mortality: 45.9%). In patients without other infections, PBSI/CRBSI caused by CNS (414 patients) is an independent risk factor for a higher than average length of ICU stay (OR: 5.81, 95% CI: 4.31-7.82; P<.001). CONCLUSION: Crude mortality of patients with CNS-induced BPSI/CRBSI is similar to that of patients with BPSI/CRBSI caused by other bacteria, but lower than that of patients with candidemia. Compared to patients without nosocomial infections, CNS-induced PBSI/CRBSI is associated with a significant increase in length of ICU stay.


Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Estado Terminal , Infecção Hospitalar/epidemiologia , Infecções Estafilocócicas/epidemiologia , Adulto , Idoso , Bacteriemia/microbiologia , Bacteriemia/prevenção & controle , Estudos de Casos e Controles , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/prevenção & controle , Coagulase , Comorbidade , Estado Terminal/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Feminino , Fungemia/epidemiologia , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Espanha/epidemiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/prevenção & controle
9.
Med Intensiva ; 34(4): 256-67, 2010 May.
Artigo em Espanhol | MEDLINE | ID: mdl-20096484

RESUMO

Nosocomial infections are one of the most important problems occurring in Intensive Care Units. For this reason, the epidemiology and impact of these infections on critical patients must be known. Based on the data from the ENVIN-UCI study, the rates and etiology of the main nosocomial infections, such as ventilator-associated pneumonia, urinary tract infection and primary and secondary bloodstream infection, have been described. A review of the literature regarding the impact of different nosocomial infections on critically ill patients, particularly those caused by multidrug-resistant bacteria, was also performed.


Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/complicações , Humanos
10.
Rev Esp Quimioter ; 21(1): 60-82, 2008 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-18443934

RESUMO

Beta-lactam antibiotics are the cornerstone of most of the severe bacterial infections. However, their use can be limited by resistances and allergic reactions. Allergic reactions to beta-lactam antibiotics account for only a small proportion of reported adverse drug reactions, but they are related with an important morbidity, mortality and increase of the health care costs. Drug-specific IgE antibodies cause early reactions, whereas T cells play a predominant role in delayed hypersensitivity reactions. For penicillin a major antigenic determinant and several minor determinants have been identified. Clinical assessment is mandatory by medical history, skin and other testing, including provocation. If the beta-lactam should be avoided or a desensitization procedure should be performed depends on the nature and severity of the reaction. Several new antibiotics are currently available (tigecycline, linezolid, daptomycin, etc.) that are as effective and safe as beta-lactams. In this article we have developed a few recommendations for the management of patients with allergy to beta-lactams on the basis of evidence and expert opinion.


Assuntos
Antibacterianos/efeitos adversos , Infecções Bacterianas/tratamento farmacológico , Hipersensibilidade a Drogas/etiologia , beta-Lactamas/efeitos adversos , Algoritmos , Antibacterianos/uso terapêutico , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/imunologia , Epitopos , Humanos , beta-Lactamas/imunologia
11.
Med Clin (Barc) ; 131 Suppl 3: 48-55, 2008 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-19572453

RESUMO

Nosocomial infection indicators are a reflection of healthcare quality and patient safety in hospitals. Infection indicators are calculated using surveillance programs and/or systems. Current nosocomial infection surveillance systems are based on both prevalence and incidence studies. Since 1990 the EPINE prevalence study, promoted by the Spanish Society for Preventive Medicine, Public Health and Hygiene, has developed 25 nosocomial infection indicators in hospital patients in Spain. And since 1994 the ENVIN-HELICS incidence study, promoted by the Infectious Diseases Working Group of the Spanish Society for Intensive and Critical Care Medicine and Coronary Units, has developed nine ICU-acquired infection indicators in critical patients. Participation in both surveillance systems is voluntary and has gradually increased over the years. These two control systems present the results of two different situations in the area of nosocomial infection and each complements the other; in addition, they have helped to train health professionals and to raise their awareness of nosocomial infection and patient safety. This article presents the indicators obtained in 2007 through both surveillance programs as well as their standards of reference.


Assuntos
Infecção Hospitalar/epidemiologia , Indicadores de Qualidade em Assistência à Saúde/normas , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos
12.
Med Intensiva ; 31(1): 6-17, 2007.
Artigo em Espanhol | MEDLINE | ID: mdl-17306135

RESUMO

OBJECTIVE: Describe the national rates of acquired invasive device-related infections in the ICU during 2003, 2004 and 2005, their etiology and evolution of the multiresistance markers. DESIGN: Prospective, observational study. SCOPE: Intensive Care Unit or other units where critical patients are admitted. PATIENTS: 21,608 patients admitted for more than 24 hours in the participating ICUs. MAIN VARIABLES OF INTEREST: Device related infections: pneumonias related with mechanical ventilation (N-MV), urinary infections related with urethral probe (UI-UP) and primary bacteriemias (PB) and/or those related with at risk vascular catheters (BCV). RESULTS: In 2,279 (10.5%) patients, 3,151 infections were detected: 1,469 N-MV, 808 UI-UP and 874 PB/RVC. Incidence rates ranged from 15.5 to 17.5 N-MV per 1,000 days of mechanical ventilation, 5.0 to 6.7 UI-UP per 1,000 days of urethral probe and 4.0 to 4.7 PB/RVC per 1,000 days of vascular catheter. The predominant etiology in the N-MV was meticillin susceptible Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii. The UI-UP were originated predominantly by Escherichia coli, Candida albicans and Enterococcus faecalis. A. baumannii and E. coli have increased their resistance to imipenem and ciprofloxacin or cefotaxime, respectively, in the last year controlled. CONCLUSIONS: Elevated rates persist in all the infections controlled, without change in the etiology and increase of resistance of gram-negative bacilli.


Assuntos
Infecção Hospitalar/epidemiologia , Unidades de Terapia Intensiva , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/epidemiologia , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Estudos Prospectivos
13.
Med Intensiva ; 29(1): 21-62, 2005 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-38620135

RESUMO

Community acquired pneumonia is still an important health problem. In Spain the year incidence is 162 cases per 100,000 inhabitants with 53,000 hospital admission costing 115 millions of euros per year. In the last years there have been significant advances in the knowledge of: aetiology, diagnostic tools, treatment alternatives and antibiotic resistance. The Spanish Societies of Intensive and Critical Care (SEMICYUC), Infectious Diseases and Clinical Microbiology (SEIMC) and Pulmonology and Thoracic Surgery (SEPAR) have produced these evidence-based Guidelines for the management of community acquired pneumonia in Adults. The main objective is to help physicians to make decisions about this disease. The different points that have been developed are: aetiology, diagnosis, treatment and prevention.

14.
Rev Esp Quimioter ; 17(1): 57-63, 2004 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-15201925

RESUMO

This study aimed to identify factors that influence the selection of different approaches to prescribing levofloxacin (e.g., monotherapy vs. combined therapy, 12-h vs. 24-h interval) and the effect on mortality in the ICU. An observational, prospective, multicenter study was conducted. A logistic regression analysis was performed to identify factors associated with the prescription of levofloxacin in combined therapy and at a dose of 500 mg every 12 hours. In addition, a logistic regression analysis was conducted to determine the impact of the different prescribing methods on mortality in the ICU. The most frequently administered initial dose was 500 mg/24 h (48.5%) and 500 mg/12 h (48.3%). No factors were found to influence the choice of daily dose. A total of 49.7% of levofloxacin prescriptions were in combined therapy. Factors influencing the decision to prescribe a combined regimen included diagnosis of extra-ICU nosocomial infection (OR: 1.97; 95% CI: 1.13-3.42); severe sepsis (OR: 2.56; 95% CI: 1.66-3.94); septic shock (OR: 6.22; 95% CI: 3.54-10.9); and identification of the causative pathogen (OR: 1.99: 95% CI: 1.34-2.95). The mortality rate was 21.4% and the related factors were septic shock (OR: 3.09; 95% CI: 1.38-6.91); treatment failure (OR: 23.4; 95% CI: 12.3-44.6); and combined therapy (OR: 2.36; 95% CI: 1.21-4.59). The selection of the initial dose of levofloxacin was not influenced by any factor, as long as the antibiotic was given in combined therapy in patients in whom the cause of the infection had been identified, in patients with greater systemic response, and in nosocomial infection outside the ICU. The selection of combined therapy was associated with a worse prognosis.


Assuntos
Anti-Infecciosos/administração & dosagem , Cuidados Críticos , Quimioterapia Combinada/administração & dosagem , Infecções/tratamento farmacológico , Levofloxacino , Ofloxacino/administração & dosagem , Humanos , Unidades de Terapia Intensiva , Pessoa de Meia-Idade
15.
Eur J Clin Microbiol Infect Dis ; 23(4): 323-30, 2004 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15024623

RESUMO

The objective of the study presented here was to assess the economic impact of Candida colonization and Candida infection in critically ill patients admitted to intensive care units (ICUs). For this purpose, a prospective, cohort, observational, and multicenter study was designed. A total of 1,765 patients over the age of 18 years who were admitted for at least 7 days to 73 medical-surgical ICUs in 70 Spanish hospitals between May 1998 and January 1999 were studied. From day 7 of ICU admission to ICU discharge, samples of tracheal aspirates, pharyngeal exudates, gastric aspirates and urine were collected every week for culture. Prolonged length of stay was associated with severity of illness, Candida colonization or infection, infection by other fungi, antifungal therapy, treatment with more than one antifungal agent, and toxicity associated with this therapy. Compared to non-colonized, non-infected patients (n=720), patients with Candida colonization (n=880) had an extended ICU stay of 6.2 days (OR, 1.69; 95%CI, 1.53-1.87; P<0.001) and an extended hospital stay of 8.6 days (OR, 1.27; 95%CI, 1.16-1.40; P<0.001). The corresponding figures for patients with Candida infection (n=105) were 12.7 days for ICU stay (OR, 2.13; 95%CI, 1.72-2.64; P<0.001) and 15.5 days for hospital stay (OR, 1.23; 95%CI, 0.99-1.52; P=0.060). Candida colonization resulted in an additional 8,000 EUR in direct costs and Candida infection almost 16,000 EUR. Both Candida colonization and Candida infection had an important economic impact in terms of cost increases due to longer stays in both the ICU and in the hospital.


Assuntos
Candida/isolamento & purificação , Candidíase/diagnóstico , Candidíase/economia , Fungemia/economia , Custos Hospitalares , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Antifúngicos/economia , Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Estudos de Coortes , Contagem de Colônia Microbiana/economia , Estado Terminal , Feminino , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Humanos , Unidades de Terapia Intensiva , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Probabilidade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Espanha , Estatísticas não Paramétricas
16.
J Chemother ; 16(6): 549-56, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15700846

RESUMO

In this study, we analyzed 302 patients with pneumonia admitted to the Intensive Care Unit (ICU) who were treated with levofloxacin (LFX) either as monotherapy or combined therapy. Pneumonia was classified as community-acquired in 220 (73%) patients, extra-ICU nosocomial-acquired in 43 (14%), and intra-ICU nosocomial-acquired in 39 (13%) patients. Treatment with LFX was used empirically in 85.7% of the cases. Initial doses of LFX were 500 mg every 24 h in 48.5% of the cases and 500 mg every 12 hours in 48.3%. Treatment was maintained for a mean (SD) of 12.6 (21.9) days. Treatment began as monotherapy in 116 (38.4%) patients and as combination therapy in 186 (61.6%). The factors that influenced the choice of combined treatment were septic shock (odds ratio [OR] 3.03; 95% confidence interval [CI] 1.50-6.12) and the presence of two or more extrinsic factors (OR 1.83; 95% CI 1.04-3.23), while young age was a variable associated with monotherapy (OR 0.98; 95% CI 0.96-0.99). An etiological diagnosis was made in 61.6% of the cases. LFX administration was changed from the intravenous route to oral administration in 85 (28.6%) patients. Satisfactory clinical response (cure and improvement) was achieved in 69.4% of the community-acquired pneumonia, in 55.8% of the extra-ICU nosocomial infection, and in 78.3% of the intra-ICU nosocomial infection. The overall mortality rate was 31.5%. Variables associated with death during ICU stay were combined therapy (OR 3.07; 95% CI 1.23-7.65), septic shock (OR 3.49; 95% CI 1.30-9.39), or therapeutic failure (OR 32.6; 95% CI 13.5-78.9). A total of 15% of the patients experienced adverse effects possibly or probably related the antibiotic given.


Assuntos
Antibacterianos/uso terapêutico , Levofloxacino , Ofloxacino/uso terapêutico , Pneumonia/tratamento farmacológico , Adulto , Idoso , Infecções Comunitárias Adquiridas/tratamento farmacológico , Estado Terminal , Infecção Hospitalar/tratamento farmacológico , Esquema de Medicação , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pneumonia/mortalidade , Resultado do Tratamento
17.
Enferm Infecc Microbiol Clin ; 19(5): 211-8, 2001 May.
Artigo em Espanhol | MEDLINE | ID: mdl-11446909

RESUMO

OBJECTIVE: Afer twenty years of commercial availability of cefotaxime, the objective of this study was to know the reasons and modes of use, administration dosage as well as its effectiveness and tolerance in critically ill patients admitted to Intensive Care Units (ICU) in our country. DESIGN: Open, prospective, observational, multicenter study. SUBJECTS: All patients who had cefotaxime administered in monotherapy or in combination with other antibiotics were included as cases in this study. RESULTS: A total of 624 patients were included in 44 ICUs (average 14 cases). Cefotaxime was indicated for therapy of 274 community-acquired infections (43.9%), 194 prophylaxis (31.1%), and 156 nosocomial infections (25.0%). Both community-acquired pneumonia (149, 34.7%) and mechanical ventilation associated pneumonia (62, 14.4%) predominated, followed by trachebronchitis (60, 13.9%) and central nervous system infections (42, 9.8%). Over half of infections (222, 51.6%) presented as systemic inflammatory response syndrome (SIRS), 133 (30.9%) as severe sepsis, and 75 (17.4%) as septic shock. In 374 (87.0%) out of the 430 cases of infection treatment, cefotaxime wan prescribed on an empirical basis and in 150 of them (40.1%) a further confirmation of the causative agent was obtained. In 120 (27.9%) cases, cefotaxime was administered as monotherapy and in the remaining cases in association with one or more antibiotics.The use of cefotaxime as prophylaxis was evaluated as failure in 31 (16.0%) of the cases, whereas in treatment it was considered as failure in 98 (22.8%) of the 430 cases, 51 community-acquired infections, 27 (27.3%) of ICU-acquired infections, and 20 (35.1%) nosocomial infections acquired outside the ICU. In 127 (29.5%) of the 430 infection treatments the initial treatment was changed. The reasons for the change included clinical failure (36, 28.3%), recovery of an uncovered pathogen with the antibiotic (40, 31.5%), emergence of multi-resistant pathogens (28, 22.0%), to decrease the therapeutic spectrum (7, 5.5%), and other reasons (16). Cefotoxime was also changed in 21 (6.0%) of the 194 cases in which it was used as prophylaxis. In 32 (5.1%) patients 37 adverse effects were noted which were associated with a possible or likely use of cefotaxime. Most notably, diarrhoea in 15 (2.4%) occasions and skin rash in 6 cases (1.0%). CONCLUSIONS: Cefotaxime is still one of the therapies of choice for community-acquired and nosocomial infections as well as in different prophylactic modes. It is mostly used on an empirical basis and associated with other antibiotics. Clinical and microbiological efficiency is high whereas adverse effects related to its use have been scarce.


Assuntos
Cefotaxima/uso terapêutico , Cefalosporinas/uso terapêutico , Antibioticoprofilaxia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Estado Terminal , Infecção Hospitalar/tratamento farmacológico , Uso de Medicamentos , Humanos , Unidades de Terapia Intensiva , Estudos Prospectivos , Espanha
18.
Enferm Infecc Microbiol Clin ; 15 Suppl 3: 41-6, 1997 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-9410082

RESUMO

There is no precise definition for severe community-acquired pneumonia (SEHP), but there are a number of factors which are associated with a greater severity, and which therefore recommended the admission of these patients in an intensive care unit (ICU). In the present article, we mainly refer to SEHP in the immune competent population. SEHP makes up 8-10% of the total number of admissions of an ICU although this depends greatly on the type of unit concerned. The majority of patients admitted, do so because they need mechanical ventilation, because they present a shock situation, or because they develop a multi-organ failure in the course of the disease. The battery of usual tests recommended basically includes a chest x-ray, arterial gas, a count of red and white blood cells, biochemical profile, blood cultures, analysis and culture of the pleural liquid (if this is present), and respiratory samples. The therapeutic strategies tend to guarantee the simultaneous coverage of S. pneumoniae, H. influenzae, and the so-called atypical pathogens. Keeping in mind the considerable percentage of penicillin resistant pneumococcus existing in our country, in a general manner it is recommended to use a combination of a macrolide with a 3rd generation cephalosporin against this organism. They should be detected early, especially those situations in which there is respiratory failure and shock which shall require the use of mechanical ventilation and inotropics as well as an adequate monitoring.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia , Idoso , Antibacterianos , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Cuidados Críticos , Testes Diagnósticos de Rotina , Quimioterapia Combinada/uso terapêutico , Infecções por HIV/complicações , Humanos , Imunocompetência , Insuficiência de Múltiplos Órgãos/etiologia , Pneumonia/complicações , Pneumonia/diagnóstico , Pneumonia/tratamento farmacológico , Pneumonia/epidemiologia , Respiração Artificial , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Fatores de Risco , Sepse/etiologia
19.
Intensive Care Med ; 22(12): 1294-300, 1996 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-8986476

RESUMO

OBJECTIVE: To create a predictive model for the treatment approach to community-acquired pneumonia (CAP) in patients needing Intensive Care Unit (ICU) admission. DESIGN: Multicenter prospective study. SETTING: Twenty-six Spanish ICUs. PATIENTS: One hundred seven patients with CAP, all of them with accurate etiological diagnosis, divided in three groups according to their etiology in typical (bacterial pneumonia), Legionella and other atypical (Mycoplasma, Chlamydia spp. and virus). For the multivariate analysis we grouped Legionella and other atypical etiologies in the same category. METHODS: We recorded 34 variables including clinical characteristics, risk factors and radiographic pattern. We used a multivariate logistic regression analysis to find out a predictive model. RESULTS: We have the complete data in 70 patients. Four variables: APACHE II, (categorized as a dummy variable) serum sodium and phosphorus and "length of symptoms" gave an accurate predictive model (c = 0.856). From the model we created a score that predicts typical pneumonia with a sensitivity of 90.2% and specificity 72.4%. CONCLUSION: Our model is an attempt to help in the treatment approach to CAP in ICU patients based on a predictive model of basic clinical and laboratory information. Further studies, including larger numbers of patients, should validate and investigate the utility of this model in different clinical settings.


Assuntos
Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/terapia , Cuidados Críticos , Pneumonia/microbiologia , Pneumonia/terapia , APACHE , Adulto , Idoso , Infecções Comunitárias Adquiridas/diagnóstico por imagem , Análise Discriminante , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico por imagem , Prognóstico , Estudos Prospectivos , Radiografia , Fatores de Risco , Sensibilidade e Especificidade
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