Prior influenza vaccine is not a risk factor for bacterial coinfection in patients admitted to the ICU due to severe influenza.

OBJECTIVE: To determine whether the prior usage of the flu vaccine is a risk factor for bacterial co-infection in patients with severe influenza. DESIGN: This was a retrospective observational cohort study of subjects admitted to the ICU. A propensity score matching, and logistic regression adjusted for potential confounders were carried out to evaluate the association between prior influenza vaccination and bacterial co-infection. SETTINGS: 184 ICUs in Spain due to severe influenza. PATIENTS: Patients included in the Spanish prospective flu registry. INTERVENTIONS: Flu vaccine prior to the hospital admission. RESULTS: A total of 4175 subjects were included in the study. 489 (11.7%) received the flu vaccine prior to develop influenza infection. Prior vaccinated patients were older 71 [61-78], and predominantly male 65.4%, with at least one comorbid condition 88.5%. Prior vaccination was not associated with bacterial co-infection in the logistic regression model (OR: 1.017; 95%CI 0.803-1.288; p=0.885). After matching, the average treatment effect of prior influenza vaccine on bacterial co-infection was not statistically significant when assessed by propensity score matching (p=0.87), nearest neighbor matching (p=0.59) and inverse probability weighting (p=0.99). CONCLUSIONS: No association was identified between prior influenza vaccine and bacterial coinfection in patients admitted to the ICU due to severe influenza. Post influenza vaccination studies are necessary to continue evaluating the possible benefits.

Prior influenza vaccine is not a risk factor for bacterial coinfection in patients admitted to the ICU due to severe influenza.

OBJECTIVE: To determine whether the prior usage of the flu vaccine is a risk factor for bacterial co-infection in patients with severe influenza. DESIGN: This was a retrospective observational cohort study of subjects admitted to the ICU. A propensity score matching, and logistic regression adjusted for potential confounders were carried out to evaluate the association between prior influenza vaccination and bacterial co-infection. SETTINGS: 184 ICUs in Spain due to severe influenza. PATIENTS: Patients included in the Spanish prospective flu registry. INTERVENTIONS: Flu vaccine prior to the hospital admission. RESULTS: A total of 4175 subjects were included in the study. 489 (11.7%) received the flu vaccine prior to develop influenza infection. Prior vaccinated patients were older 71 [61-78], and predominantly male 65.4%, with at least one comorbid condition 88.5%. Prior vaccination was not associated with bacterial co-infection in the logistic regression model (OR: 1.017; 95%CI 0.803-1.288; p=0.885). After matching, the average treatment effect of prior influenza vaccine on bacterial co-infection was not statistically significant when assessed by propensity score matching (p=0.87), nearest neighbor matching (p=0.59) and inverse probability weighting (p=0.99). CONCLUSIONS: No association was identified between prior influenza vaccine and bacterial coinfection in patients admitted to the ICU due to severe influenza. Post influenza vaccination studies are necessary to continue evaluating the possible benefits.

Time- and momentum-resolved photoemission studies using time-of-flight momentum microscopy at a free-electron laser.

Time-resolved photoemission with ultrafast pump and probe pulses is an emerging technique with wide application potential. Real-time recording of nonequilibrium electronic processes, transient states in chemical reactions, or the interplay of electronic and structural dynamics offers fascinating opportunities for future research. Combining valence-band and core-level spectroscopy with photoelectron diffraction for electronic, chemical, and structural analyses requires few 10 fs soft X-ray pulses with some 10 meV spectral resolution, which are currently available at high repetition rate free-electron lasers. We have constructed and optimized a versatile setup commissioned at FLASH/PG2 that combines free-electron laser capabilities together with a multidimensional recording scheme for photoemission studies. We use a full-field imaging momentum microscope with time-of-flight energy recording as the detector for mapping of 3D band structures in (kx, ky, E) parameter space with unprecedented efficiency. Our instrument can image full surface Brillouin zones with up to 7 Å-1 diameter in a binding-energy range of several eV, resolving about 2.5 × 105 data voxels simultaneously. Using the ultrafast excited state dynamics in the van der Waals semiconductor WSe2 measured at photon energies of 36.5 eV and 109.5 eV, we demonstrate an experimental energy resolution of 130 meV, a momentum resolution of 0.06 Å-1, and a system response function of 150 fs.

Hydrocarbon decomposition kinetics on the Ir(111) surface.

The kinetics of the thermal decomposition of hydrocarbons on the Ir(111) surface is determined using kinetic Monte Carlo (kMC) and rate equations simulations, both based on the density functional theory (DFT) calculated energy barriers of the involved reaction processes. This decomposition process is important for understanding the early stages of epitaxial graphene growth where the deposited hydrocarbon acts as a carbon feedstock for graphene formation. The methodology of the kMC simulations and the rate equation approaches is discussed and a comparison between the results obtained from both approaches is made in the case of the temperature programmed decomposition of ethylene for different initial coverages. The theoretical results are verified against experimental data from in situ X-ray photoelectron spectroscopy (XPS) experiments. Both theoretical approaches give reasonable results; however we find that, as expected, rate equations are less reliable at high coverages. We find that the agreement between experiment and theory can be improved in all cases if slight adjustments are made to the energy barriers in order to account for the intrinsic errors in DFT. Finally we extend our approach to the case where hydrocarbon species are dosed onto the substrate continuously, as in the chemical vapour deposition (CVD) graphene growth method. For ethylene and methane the thermal decomposition mechanism is determined, and it is found that in both cases the formation of C monomers is to be expected, which is limited by the presence of hydrogen atoms.

Antibiotic prescriptions in critically-ill patients: a latin american experience.

BACKGROUND: It is widely acknowledged that the presence of infection is an important outcome determinant for intensive care unit (ICU) patients. In fact, antibiotics are one of the most common therapies administered in the ICU settings. AIM: To evaluate the current usage of antibiotics in Latin American ICUs. SUBJECTS AND METHODS: A one-day p-oint prevalence study to investigate the patterns of antibiotic was undertaken in 72 Latin American (LA) ICUs. Data was analyzed using the Statistix 8 statistical software, version 2.0 (USA). Results were expressed as proportions. When applicable, two tailed hypothesis testing for difference in proportions was used (Proportion Test); a P value of <0.05 was considered significant. RESULTS: Of 704 patients admitted, 359 received antibiotic treatment on the day of the study (51%), of which 167/359 cases (46.5%) were due to hospital-acquired infections. The most frequent infection reorted was nosocomial pneumonia (74/359, 21%). Only in 264/359 patients (73.5%), cultures before starting antibiotic treatment were performed. Thirty-eight percent of the isolated microorganisms were Enterobacteriaceae extended-spectrum ß-lactamase-producing, 11% methicillin-resistant Staphylococcus aureus and 10% carbapenems-resistant non-fermentative Gram-negatives. The antibiotics most frequently prescribed were carbapenems (125/359, 35%), alone or in combination with vancomycin or other antibiotic. There were no significant differences in the "restricted" antibiotic prescription (carbapenems, vancomycin, piperacillin-tazobactam, broad-spectrum cephalosporins, fluoroquinolones, tigecycline and linezolid) between patients with APACHE II score at the beginning of the antibiotic treatment <15 [83/114 (72.5%)] and ≥15 [179/245 (73%)] (P = 0.96). Only 29% of the antibiotic treatments were cultured directed (104/359). CONCLUSION: Carbapenems (alone or in combination) were the most frequently prescribed antibiotics in LA ICUs. However, the problem of carbapenem resistance in LA requires that physicians improve the use of this class of antibiotics. Our findings show that our web-based method for collection of one-day point prevalence was implemented successfully. However, based on the limitations of the model used, the results of this study must be taken with caution.

Medidas de resucitación precoz durante la pandemia de gripe A (H1N1). ¿Se beneficiaron los pacientes? / Resuscitation measures early in the pandemic of influenza A (H1N1). HE benefited the patients?

Objetivo. Evaluar el impacto del uso de un protocolo de medidas de detección y resucitación precoz durante la pandemia de gripe A (H1N1) sobre el ingreso de pacientes en el Servicio de Terapia Intensiva (STI). Diseño. Estudio de observación y retrospectivo de pacientes críticos. Ámbito. Un STI médico-quirúrgico. Pacientes. Adultos que ingresaron en el STI desde el Servicio de Urgencia entre el 28 de abril de 2009 y el 4 de septiembre de 2009. Variables de interés principal. Sexo, edad, comorbilidades, APACHE II, SOFA al ingreso en el STI, sintomatología clínica, imágenes radiográficas, necesidad de asistencia respiratoria mecánica (ARM), ácido láctico (AL), creatinfosfoquinasa (CPK), lactato deshidrogenasa (LDH), leucocitosis, saturación de O2 (SatO2) y PaO2/FiO2 al ingresar en el STI, presión al final de la espiración (PEEP), días de ARM, tratamiento con oseltamivir (dosis/tiempo), aislamiento bacteriológico y virológico en secreción bronquial, tratamiento con corticoides, estadía en el STI y mortalidad. Resultados. Se incluyeron 13 pacientes que ingresaron en el STI durante el período estudiado; media de la edad 45 ± 3; mujeres: 8 (61,5%), comorbilidades (n = 7, 53,8%): enfermedad pulmonar obstructiva crónica (n = 3), diabetes (n = 2), insuficiencia cardíaca (n = 1), cirrosis (n = 1), APACHE II: 18, SOFA: 9 ± 2. La sintomatología clínica predominante fue la siguiente: fiebre (n = 13, 100%), tos (n = 11, 84,6%), disnea (n = 9, 69,2%), infiltrados intersticiales (5/13, 38,4%), opacidades alveolares (6/13, 46,1%), opacidades mixtas (2/13, 15,3%), cuatro cuadrantes (9/13, 69,2%) y dos cuadrantes (4/13, 30,7%); se hallaron los siguientes valores medios: AL 25 mg/dl, CPK 480 U/l (p <0,05), LDH 2100 U/l (p <0,001), leucocitosis 12.500 mm3 , PEEP 18 cm H2O, SatO2 <91% (n = 11, 84,6%), PaO2/FiO2 <150 (n = 11, 84,6%), necesidad de ARM (n = 11, 84,6%), días de ARM 9,5 ± 3 días. Oseltamivir: dosis 150 mg/12 h; aislamiento bacteriológico: neumococo (n = 7, 53,8%); aislamiento virológico: H1N1 (n = 5, 38,4%); duración: 9,5 ± 3 días, corticoides (n = 8, 61,5%). Tiempo en el STI: 11 ± 4. No hubo muertes.    Conclusión. La aplicación de un protocolo inicial en el que además se evalúo la gravedad benefició la correcta evaluación y resucitación inicial en el grupo estudiado. Los valores de CPK y de LDH se acompañaron de hipoxemia severa y mayor compromiso pulmonar en la radiología de tórax(AU)

Objective. To evaluate the impact of a protocol for screening and resuscitation measures during the pandemic H1N1 on patients´ admission to the Intensive Care Unit (ICU). Design. Retrospective observational study of critically ill patients. Place. A medical-surgical Intensive Care Unit (ICU). Patients. Adults admitted to the ICU from the Emergency Department from April 28th 2009 to September 4th 2009. Variables of primary interest. Sex, age, comorbidities, APACHE II, SOFA at admission to the ICU, clinical symptoms, radiographic images, need for mechanical ventilation (MV), lactic acid (AL), creatine kinase (CPK), lactate dehydrogenase (LDH), leukocytosis, O2 saturation (O2Sat) and PaO2/FiO2 at admission to the ICU, end-expiratory pressure (PEEP), days of MV (DMV), oseltamivir (dose/time), bacteriological and virological isolations in bronchial secretions, corticosteroid treatment, stay in the ICU and mortality. Results. We included 13 patients admitted to ICU during the study period; mean age: 45 ± 3; females: 8 (61.5%); comorbidities (n = 7, 53.8%): COPD (n = 3), diabetes (n = 2), heart failure (n = 1), cirrhosis (n = 1), APACHE II: 18, SOFA: 9 ±-2. Clinical symptoms were: fever (n = 13, 100%), cough (n = 11, 84.6%), dyspnea (n = 9, 69.2%), interstitial infiltrates (5/13, 38.4%), alveolar opacities (6/13, 46.1%), mixed opacities (2/13, 15.3%), four quadrants (9/13, 69.2%) and two quadrants (4/13, 30.7%), average measures: AL 25 mg/dL, CPK 480 U/L (p <0.05), LDH 2,100 U/L (p <0.001), leukocytosis 12,500 mm3 , PEEP 18 cm H2O, O2Sat <91% (n = 11, 84.6%), PaO2/FiO2 <150 (n = 11, 84.6%), MV (n = 11, 84.6%), DMV: 9.5 ± 3; oseltamivir: 150 mg/12 hours; bacteriological isolation (Pneumococcus: n = 7, 53.8%), virological isolation (H1N1: n = 5, 38.4%); length: 9.5 ± 3 days, corticosteroids (n = 8, 61.5%); ICU stay 11 ± 4; no deaths were reported. Conclusion. The application of a protocol in which severity was also evaluated benefited in the correct assessment and initial resuscitation. The values of CPK and LDH were associated with severe hypoxemia and lung involvement in the thorax xrays. (AU)

Infección por parvovirus B19: diagnóstico y tratamiento en un paciente sometido a trasplante renal / No disponible

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Results of a prospective allocation policy of expanded criteria donors kidneys based on clinical parameters.

The ideal system to allocate expanded criteria donors (ECD) kidneys has not been fully elucidated. In a previous retrospective study, we reported that donor clinical characteristics were more predictive of transplant outcome than biopsy findings. Subsequently, we decided to use ECD kidneys solely based on a clinical scoring system. To elucidate the value of the pre-transplant biopsy, the patients were divided in two groups according to the suitability of the kidney they received for single or double transplantation as determined by a histological scoring system (HS). All kidneys were transplanted as a single (vs. dual) transplant. We studied whether a HS of the pre-transplant biopsy was predictive of outcome of single transplant ECD kidneys. Recipients (n = 48) were divided into two groups by whether the histologic system suggested single or double transplants be done. There were no differences between groups in two-yr outcomes. We conclude that a clinical scoring system can predict which ECD kidney donors can be safely used as single transplants in a cohort of low immunological risk de novo kidney transplant recipients. Use of the clinical scoring system maximizes organ use.

Prescription of antibiotics in intensive care units in Latin America: an observational study.

A one-day point prevalence study to investigate the patterns of antibiotic use was undertaken in 43 latin American (LA) intensive care units. Of 510 patients admitted, 231 received antibiotic treatment on the day of the study (45%); in 125 cases (54%) due to nosocomial-acquired infections. The most frequent infection reported was nosocomial pneumonia (43%). Only in 122 patients (53%) were cultures performed before starting antibiotic treatment. 33% of the isolated microorganisms were enterobacteriaceae (40% extended-spectrum beta-lactamase-producing), 23% methicillin-resistant Staphylococcus aureus and 17% carbapenems-resistant non-fermentative Gram-negatives. The antibiotics most frequently prescribed were carbapenems (99/231, 43%); alone (60/99, 60%) or in combination with vancomycin (39/99, 40%). "Restricted" antibiotics (carbapenems, vancomycin, piperacillin-tazobactam, broad-spectrum cephalosporins, tigecycline, polymixins and linezolid) were most frequently indicated in severely ill patients (APACHE II score at admission >15, p=0.0007 and, SOFA score at the beginning of the antibiotic treatment >3, p=0.0000). Only 36% of antibiotic treatments were cultured-directed.Our findings help explain the high rates of multidrug-resistant pathogens in LA settings (i.e. ESBL-producing Gram-negatives) and the severity of the registered patients illnesses.

Comparative in vitro activity of tigecycline against bacteria recovered from clinical specimens in Latin America.

The present study was performed to evaluate the in vitro activity of tigecycline in comparison to other agents against isolates recovered from patients hospitalized in latin American. Organisms were collected in 47 clinical laboratories from 4 countries of latin America between November 2005 and October 2006 and were tested by using disk diffusion method as described by the CLSI. A total of 7966 isolates were assessed. Tigecycline proved highly active against staphylococci and enterococci (>99% susceptibility). Imipenem was the most active agent against Escherichia coli (100% susceptibility), followed by tigecycline, 98.6% susceptibility. Resistance to cefotaxime in this species was 15.3%. Global tigecycline susceptibility of Klebsiella species was 90.2%, but the susceptibility rate was significantly slower in Venezuela (82%) than in Argentina, Colombia and Chile (93%) (p<0.01). Global cefotaxime resistance to Klebsiella spp. was 32.2% and carbapenem resistance was detected in all countries. By adopting a susceptible breakpoint >or =16mm, 91.3% of the Acinetobacter isolates proved susceptible to tigecycline. Results from the present study suggest that tigecycline may be a suitable option in latin America, a region where multidrug resistance seems to be a dramatic, increasing problem and new antimicrobial choices are urgently needed.

Late onset ventilator-associated pneumonia due to multidrug-resistant Acinetobacter spp.: experience with tigecycline.

The aim of the study was to evaluate the clinical success rate of 73 patients with ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR)-Acinetobacter spp. treated with tigecycline in seven intensive Care Units in Argentina and to determine which predictor variables were significant in this context. Clinical success in our patients was 69.86% (Ci= 58.65-81.07%) 51/73, without significant differences between patients with VAP due to MDR-Acinetobacter spp. carbapenem-susceptible or carbapenem-resistant and only susceptible to colistin, minocyline and tigecycline (70% 44/73 vs. 69% 29/73 respectively, p=0.9006), and between patients who received <48h of prior antibiotics (including those who did not receive any) and those who received >48h of prior antibiotics (73.3% 22/30 vs 67.4% 29/43 respectively, p=0.7791). Age >67 and using other method than BAL for respiratory sampling were identified as predicting variables for negative clinical outcome. Our results suggest that tigecycline may be an acceptable alternative for therapy in patients with VAP caused by MDR-Acinetobacter spp. Nevertheless, only controlled clinical trials will provide the evidence to support approval for new indications.

Strategic alliance between the infectious diseases specialist and intensive care unit physician for change in antibiotic use.

There is a general consensus that antimicrobial use in intensive care units (ICU) is greater than that in general wards. By implementing a strategy of systematic infectious disease consultations in agreement with the ICU chief, we have modified the antibiotic prescription habits of the ICU physician. A reduction was observed in the use of selected antibiotics (third-generation cephalosporins, vancomycin, carbapenems and piperacillin-tazobactam), with a significant reduction in the length of hospital stay for ICU patients and lower antibiotic costs without negative impact on patient mortality. Leadership by the infectious diseases consultant in combination with commitment by ICU physicians is a simple and effective method to change antibiotic prescription habits in the ICU.

Efficacy of amoxicillin-sulbactam, given twice-a-day, for the treatment of community-acquired pneumonia: a clinical trial based on a pharmacodynamic model.

The present multicenter study reports the results of a clinical trial, designed on the basis of a pharmacodynamic study published previously (Bantar et al., J. Chemother 2000; 12: 223-227) to assess the efficacy of amoxicillin/sulbactam (875 mg/125 mg), given orally twice-a-day for 7 days in the treatment of patients with community-acquired pneumonia (CAP). Eighty-four evaluable subjects older than 19 years with clinical symptoms and features suggestive of CAP, consulting from June 2000 to March 2002 and meeting the PORT risk class I through III, were enrolled in the study. Mean age (y +/- standard deviation) was 46.7 +/- 16.3 and 62% of the patients had some co-morbidity predisposing for CAP. Several individuals (77.4%) fell into a low-risk class (i.e. PORT I or II) and 22.6% of patients belonged to a moderate-risk class at the start of treatment. Six patients (6.45%) had pneumococcal bacteremia. Streptococcus pneumoniae was the organism most frequently isolated (61.9% of all the patients in whom an etiologic diagnosis was made), followed by Haemophilus influenzae. Clinical success was observed in 97.6% of the patients (confidence interval 95%, 94.3%-100%). Almost all the individuals with clinical success became afebrile within the first 3 days of therapy. Ten patients (11.8%) reported mild or moderate adverse events (especially diarrhea) possibly related to the antimicrobial therapy, but this did not lead to withdrawal from the trial. The results of this study suggest that amoxicillin/sulbactam (875 mg/125 mg) is an efficacious and well tolerated option for treating patients with CAP belonging to a low-moderate risk class and support the use of a short, oral (7-day) b.i.d. regimen.