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1.
Cochrane Database Syst Rev ; 1: CD000022, 2021 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-33481250

RESUMO

BACKGROUND: Patients treated with mechanical ventilation in intensive care units (ICUs) have a high risk of developing respiratory tract infections (RTIs). Ventilator-associated pneumonia (VAP) has been estimated to affect 5% to 40% of patients treated with mechanical ventilation for at least 48 hours. The attributable mortality rate of VAP has been estimated at about 9%. Selective digestive decontamination (SDD), which consists of the topical application of non-absorbable antimicrobial agents to the oropharynx and gastroenteric tract during the whole period of mechanical ventilation, is often used to reduce the risk of VAP. A related treatment is selective oropharyngeal decontamination (SOD), in which topical antibiotics are applied to the oropharynx only. This is an update of a review first published in 1997 and updated in 2002, 2004, and 2009. OBJECTIVES: To assess the effect of topical antibiotic regimens (SDD and SOD), given alone or in combination with systemic antibiotics, to prevent mortality and respiratory infections in patients receiving mechanical ventilation for at least 48 hours in ICUs. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register, PubMed, and Embase on 5 February 2020. We also searched the WHO ICTRP and ClinicalTrials.gov for ongoing and unpublished studies on 5 February 2020. All searches included non-English language literature. We handsearched references of topic-related systematic reviews and the included studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) and cluster-RCTs assessing the efficacy and safety of topical prophylactic antibiotic regimens in adults receiving intensive care and mechanical ventilation. The included studies compared topical plus systemic antibiotics versus placebo or no treatment; topical antibiotics versus no treatment; and topical plus systemic antibiotics versus systemic antibiotics. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included a total of 41 trials involving 11,004 participants (five new studies were added in this update). The minimum duration of mechanical ventilation ranged from 2 (19 studies) to 6 days (one study). Thirteen studies reported the mean length of ICU stay, ranging from 11 to 33 days. The percentage of immunocompromised patients ranged from 0% (10 studies) to 22% (1 study). The reporting quality of the majority of included studies was very poor, so we judged more than 40% of the studies as at unclear risk of selection bias. We judged all studies to be at low risk of performance bias, though 47.6% were open-label, because hospitals usually have standardised infection control programmes, and possible subjective decisions on who should be tested for the presence or absence of RTIs are unlikely in an ICU setting. Regarding detection bias, we judged all included studies as at low risk for the outcome mortality. For the outcome RTIs, we judged all double-blind studies as at low risk of detection bias. We judged five open-label studies as at high risk of detection bias, as the diagnosis of RTI was not based on microbiological exams; we judged the remaining open-label studies as at low risk of detection bias, as a standardised set of diagnostic criteria, including results of microbiological exams, were used. Topical plus systemic antibiotic prophylaxis reduces overall mortality compared with placebo or no treatment (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.73 to 0.96; 18 studies; 5290 participants; high-certainty evidence). Based on an illustrative risk of 303 deaths in 1000 people this equates to 48 (95% CI 15 to 79) fewer deaths with topical plus systemic antibiotic prophylaxis. Topical plus systemic antibiotic prophylaxis probably reduces RTIs (RR 0.43, 95% CI 0.35 to 0.53; 17 studies; 2951 participants; moderate-certainty evidence). Based on an illustrative risk of 417 RTIs in 1000 people this equates to 238 (95% CI 196 to 271) fewer RTIs with topical plus systemic antibiotic prophylaxis. Topical antibiotic prophylaxis probably reduces overall mortality compared with no topical antibiotic prophylaxis (RR 0.96, 95% CI 0.87 to 1.05; 22 studies, 4213 participants; moderate-certainty evidence). Based on an illustrative risk of 290 deaths in 1000 people this equates to 19 (95% CI 37 fewer to 15 more) fewer deaths with topical antibiotic prophylaxis. Topical antibiotic prophylaxis may reduce RTIs (RR 0.57, 95% CI 0.44 to 0.74; 19 studies, 2698 participants; low-certainty evidence). Based on an illustrative risk of 318 RTIs in 1000 people this equates to 137 (95% CI 83 to 178) fewer RTIs with topical antibiotic prophylaxis. Sixteen studies reported adverse events and dropouts due to adverse events, which were poorly reported with sparse data. The certainty of the evidence ranged from low to very low. AUTHORS' CONCLUSIONS: Treatments based on topical prophylaxis probably reduce respiratory infections, but not mortality, in adult patients receiving mechanical ventilation for at least 48 hours, whereas a combination of topical and systemic prophylactic antibiotics reduces both overall mortality and RTIs. However, we cannot rule out that the systemic component of the combined treatment provides a relevant contribution in the observed reduction of mortality. No conclusion can be drawn about adverse events as they were poorly reported with sparse data.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Respiração Artificial/efeitos adversos , Infecções Respiratórias/prevenção & controle , Administração Tópica , Adulto , Antibacterianos/efeitos adversos , Antibioticoprofilaxia/efeitos adversos , Viés , Cuidados Críticos , Infecção Hospitalar/mortalidade , Infecção Hospitalar/prevenção & controle , Mortalidade Hospitalar , Humanos , Pneumonia Associada à Ventilação Mecânica/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecções Respiratórias/mortalidade
2.
Colomb Med (Cali) ; 51(2): e4270, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-33012885

RESUMO

Introduction: The COVID-19 disease pandemic is a health emergency. Older people and those with chronic noncommunicable diseases are more likely to develop serious illnesses, require ventilatory support, and die from complications. Objective: To establish deaths from respiratory infections and some chronic non-communicable diseases that occurred in Cali, before the SARS-CoV-2 disease pandemic. Methods: During the 2003-2019 period, 207,261 deaths were registered according to the general mortality database of the Municipal Secretary of Health of Cali. Deaths were coded with the International Classification of Diseases and causes of death were grouped according to WHO guidelines. Rates were standardized by age and are expressed per 100,000 people-year. Results: A direct relationship was observed between aging and mortality from respiratory infections and chronic non-communicable diseases. Age-specific mortality rates were highest in those older than 80 years for all diseases evaluated. Seasonal variation was evident in respiratory diseases in the elderly. Comments: Estimates of mortality rates from respiratory infections and chronic non-communicable diseases in Cali provide the baseline that will serve as a comparison to estimate the excess mortality caused by the COVID-19 pandemic. Health authorities and decision makers should be guided by reliable estimates of mortality and of the proportion of infected people who die from SARS-CoV-2 virus infection.


Assuntos
Causas de Morte/tendências , Doenças não Transmissíveis/epidemiologia , Infecções Respiratórias/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Colômbia/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Humanos , Doenças não Transmissíveis/mortalidade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Infecções Respiratórias/mortalidade , Fatores de Risco , Estações do Ano
3.
Emerg Microbes Infect ; 9(1): 1958-1964, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32815458

RESUMO

Objectives Severe or critical COVID-19 is associated with intensive care unit admission, increased secondary infection rate, and would lead to significant worsened prognosis. Risks and characteristics relating to secondary infections in severe COVID-19 have not been described. Methods Severe and critical COVID-19 patients from Shanghai were included. We collected lower respiratory, urine, catheters, and blood samples according to clinical necessity and culture and mNGS were performed. Clinical and laboratory data were archived. Results We found 57.89% (22/38) patients developed secondary infections. The patient receiving invasive mechanical ventilation or in critical state has a higher chance of secondary infections (P<0.0001). The most common infections were respiratory, blood-stream and urinary infections, and in respiratory infections, the most detected pathogens were gram-negative bacteria (26, 50.00%), following by gram-positive bacteria (14, 26.92%), virus (6, 11.54%), fungi (4, 7.69%), and others (2, 3.85%). Respiratory Infection rate post high flow, tracheal intubation, and tracheotomy were 12.90% (4/31), 30.43% (7/23), and 92.31% (12/13) respectively. Secondary infections would lead to lower discharge rate and higher mortality rate. Conclusion Our study originally illustrated secondary infection proportion in severe and critical COVID-19 patients. Culture accompanied with metagenomics sequencing increased pathogen diagnostic rate. Secondary infections risks increased after receiving invasive respiratory ventilations and intravascular devices, and would lead to a lower discharge rate and a higher mortality rate.


Assuntos
Bacteriemia/patologia , Infecções Bacterianas/patologia , Infecções por Coronavirus/patologia , Fungemia/patologia , Micoses/patologia , Infecções Oportunistas/patologia , Pneumonia Viral/patologia , Infecções Respiratórias/patologia , Infecções Urinárias/patologia , Idoso , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Bacteriemia/virologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Infecções Bacterianas/virologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/microbiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Estado Terminal , Feminino , Fungemia/microbiologia , Fungemia/mortalidade , Fungemia/virologia , Fungos/patogenicidade , Bactérias Gram-Negativas/patogenicidade , Bactérias Gram-Positivas/patogenicidade , Humanos , Unidades de Terapia Intensiva , Pulmão/microbiologia , Pulmão/patologia , Pulmão/virologia , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Micoses/mortalidade , Micoses/virologia , Infecções Oportunistas/microbiologia , Infecções Oportunistas/mortalidade , Infecções Oportunistas/virologia , Pandemias , Pneumonia Viral/microbiologia , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Respiração Artificial/efeitos adversos , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidade , Infecções Respiratórias/virologia , Estudos Retrospectivos , Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Infecções Urinárias/microbiologia , Infecções Urinárias/mortalidade , Infecções Urinárias/virologia
4.
Int J Antimicrob Agents ; 56(4): 106093, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32653618

RESUMO

This study was conducted to assess the spread of SARS-CoV-2 in Russia and the adaptation of the population to the virus in March to June 2020. Two groups were investigated: 1) 12 082 individuals already proven positive for SARS-CoV-2 (clinical information was studied); 2) 7864+4458 individuals with suspected respiratory infections (polymerase chain reaction [PCR] tests and clinical information were studied). In the latter, SARS-CoV-2-positive individuals comprised 5.37% in March and 11.42% in June 2020. Several viral co-infections were observed for SARS-CoV-2. Rhinoviruses accounted for the largest proportion of co-infections (7.91% of samples were SARS-CoV-2-positive); followed by respiratory syncytial virus (7.03%); adenoviruses (4.84%); metapneumoviruses (3.29%); parainfluenza viruses (2.42%); enterovirus D68 (1.10%) and other viruses (entero-, echo-, parecho-) (<1%). Average SARS-CoV-2 case fatality rate in the group of 12 537 individuals was determined to be 0.6% (in contrast to official Russian government statistics of 1.5% mortality). This rate is within the range of mortality caused by other common seasonal respiratory viruses (0.01-2.21% in Russia in 2012 to 2020). Most fatalities occurred in individuals with comorbidities, as for other respiratory viruses. The proportion of SARS-CoV-2 asymptomatic carriers was 56.68% in March and 70.67% in June 2020. This new pathogen presents a substantial risk to human beings as it was not contained at the start of its outbreak in Wuhan and spread worldwide. However, surveillance, prevention and treatment must be strictly evidence-based and not dictated by fear.


Assuntos
Betacoronavirus/patogenicidade , Doenças Cardiovasculares/epidemiologia , Doença das Coronárias/epidemiologia , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/epidemiologia , Obesidade/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Infecções Respiratórias/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Criança , Pré-Escolar , Comorbidade , Doença das Coronárias/diagnóstico , Doença das Coronárias/mortalidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/transmissão , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Medo/psicologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/mortalidade , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/transmissão , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/mortalidade , Infecções Respiratórias/transmissão , Estudos Retrospectivos , Federação Russa/epidemiologia , Índice de Gravidade de Doença , Análise de Sobrevida
6.
Int J Infect Dis ; 98: 41-50, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32535299

RESUMO

OBJECTIVES: Alternative dosing strategies for ß-lactams - the most common antibiotics used to treat critically ill patients with respiratory tract infections - have been recommended to maximize the duration of exposure and reduce drug resistance. The objective of this study was to evaluate whether extended infusion of antipseudomonal ß-lactams improves mortality and clinical efficacy. METHODS: Two independent authors identified eligible trials by searching the PubMed, Cochrane Library, Scopus, and ICHUSHI databases, in both English and Japanese, up to June 2019. Data were extracted from both randomized controlled and observational trials comparing extended infusion (≥3h) with intermittent infusion in critically ill patients. The primary outcome was all-cause mortality. Risk differences (RD) and 95% confidential intervals (CI) were calculated using a random-effects model and subgroup analyses were performed. Sensitivity and heterogeneity were also evaluated. RESULTS: Nine studies involving 1508 participants were included in the meta-analysis. Mortality was lower for extended infusion than for intermittent infusion (RD -0.10; 95% CI -0.15 to -0.04). However, no significant between-group differences in clinical success, length of ICU stay, length of hospital stay, and antibiotic duration were observed. CONCLUSIONS: Extended infusions of ß-lactams were associated with reduced mortality rates but not with clinical success.


Assuntos
Antibacterianos/administração & dosagem , Estado Terminal/terapia , Infecções Respiratórias/tratamento farmacológico , beta-Lactamas/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Gerenciamento de Dados , Humanos , Bombas de Infusão , Tempo de Internação , Pessoa de Meia-Idade , Pseudomonas/efeitos dos fármacos , Pseudomonas/fisiologia , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidade , Fatores de Tempo , Resultado do Tratamento
7.
PLoS One ; 15(5): e0220164, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32433685

RESUMO

Acute respiratory infection (ARI) and diarrhoea are two major causes of child morbidity and mortality in Bangladesh. National and regional level prevalence of ARI and diarrhoea are calculated from nationwide surveys; however, prevalence at micro-level administrative units (say, district and sub-district) is not possible due to lack of sufficient data at those levels. In such a case, small area estimation (SAE) methods can be applied by combining survey data with census data. Using an SAE method for the dichotomous response variable, this study aims to estimate the proportions of under-5 children experienced with ARI and diarrhoea separately as well as either ARI or diarrhoea within a period of two-week preceding the survey. The ARI and diarrhoea data extracted from Bangladesh Demographic and Health Survey 2011 are used to develop a random effect logistic model for each of the indicators, and then the prevalence is estimated adapting the World Bank SAE approach for the dichotomous response variable using a 5% sample of the Census 2011. The estimated prevalence of each indicator significantly varied by district and sub-district (1.4-11.3% for diarrhoea, 2.2-11.8% for ARI and 4.3-16.5% for ARI/diarrhoea at sub-district level). In many sub-districts, the proportions are found double of the national level. District and sub-district levels spatial distributions of the indicators might help the policymakers to identify the vulnerable disaggregated and remote hotspots. Particularly, aid industries can provide effective interventions at the highly vulnerable spots to overcome the gaps between micro and macro level administrative units.


Assuntos
Diarreia/epidemiologia , Infecções Respiratórias/epidemiologia , Bangladesh/epidemiologia , Censos , Criança , Pré-Escolar , Diarreia/mortalidade , Inquéritos Epidemiológicos/métodos , Humanos , Modelos Logísticos , Prevalência , Infecções Respiratórias/mortalidade
8.
J Clin Virol ; 128: 104436, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32447256

RESUMO

AIMS: During the ongoing COVID-19 outbreak, co-circulation of other common respiratory viruses can potentially result in co-infections; however, reported rates of co-infections for SARS-CoV-2 vary. We sought to evaluate the prevalence and etiology of all community acquired viral respiratory infections requiring hospitalization during an ongoing COVID-19 outbreak, with a focus on co-infection rates and clinical outcomes. METHODS: Over a 10-week period, all admissions to our institution, the largest tertiary hospital in Singapore, were screened for respiratory symptoms, and COVID-19 as well as a panel of common respiratory viral pathogens were systematically tested for. Information was collated on clinical outcomes, including requirement for mechanical ventilation and in hospital mortality. RESULTS: One-fifth (19.3%, 736/3807) of hospitalized inpatients with respiratory symptoms had a PCR-proven viral respiratory infection; of which 58.5% (431/736) tested positive for SARS-CoV-2 and 42.2% (311/736) tested positive for other common respiratory viruses. The rate of co-infection with SARS-CoV-2 was 1.4% (6/431); all patients with co-infection had mild disease and stayed in communal settings. The in-hospital mortality rate and proportion of COVID-19 patients requiring invasive ventilation was low, at around 1% of patients; these rates were lower than patients with other community-acquired respiratory viruses admitted over the same period (p < 0.01). CONCLUSION: Even amidst an ongoing COVID-19 outbreak, common respiratory viruses still accounted for a substantial proportion of hospitalizations. Coinfections with SARS-CoV-2 were rare, with no observed increase in morbidity or mortality.


Assuntos
Betacoronavirus/isolamento & purificação , Coinfecção/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Pneumonia Viral/epidemiologia , Infecções Respiratórias/epidemiologia , Viroses/epidemiologia , Adulto , Betacoronavirus/genética , Coinfecção/mortalidade , Coinfecção/virologia , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/virologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Hospitalização , Humanos , Pacientes Internados , Masculino , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Infecções Respiratórias/mortalidade , Infecções Respiratórias/virologia , Singapura/epidemiologia , Centros de Atenção Terciária , Viroses/mortalidade , Viroses/virologia
9.
J Clin Virol ; 126: 104338, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32278299

RESUMO

BACKGROUND: The World Health Organization has highlighted the need for improved surveillance and understanding of the health burden imposed by non-influenza RNA respiratory viruses. Human coronaviruses (CoVs) are a major cause of respiratory and gastrointestinal tract infections with associated morbidity and mortality. OBJECTIVES: The objective of our study was to characterize the epidemiology of CoVs in our tertiary care centre, and identify clinical correlates of disease severity. STUDY DESIGN: A cross-sectional study was performed of 226 patients admitted with confirmed CoV respiratory tract infection between 2010 and 2016. Variables consistent with a severe disease burden were evaluated including symptoms, length of stay, intensive care unit (ICU) admission and mortality. RESULTS: CoVs represented 11.3% of all positive respiratory virus samples and OC43 was the most commonly identified CoV. The majority of infections were community-associated while 21.6% were considered nosocomial. The average length of stay was 11.8 days with 17.3% of patients requiring ICU admission and an all-cause mortality of 7%. In a multivariate model, female gender and smoking were associated with increased likelihood of admission to ICU or death. CONCLUSION: This study highlights the significant burden of CoVs and justifies the need for surveillance in the acute care setting.


Assuntos
Fumar Cigarros/efeitos adversos , Infecções por Coronavirus/diagnóstico , Coronavirus/fisiologia , Infecções Respiratórias/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Estudos Transversais , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Prevalência , Prognóstico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/mortalidade , Infecções Respiratórias/virologia , Fatores Sexuais , Adulto Jovem
11.
PLoS One ; 15(2): e0229393, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32084236

RESUMO

OBJECTIVE: We aimed to describe the clinical and economic burden attributable to carbapenem-nonsusceptible (C-NS) respiratory infections. METHODS: This retrospective matched cohort study assessed clinical and economic outcomes of adult patients (aged ≥18 years) who were admitted to one of 78 acute care hospitals in the United States with nonduplicate C-NS and carbapenem-susceptible (C-S) isolates from a respiratory source. A subset analysis of patients with principal diagnosis codes denoting bacterial pneumonia or other diagnoses was also conducted. Isolates were classified as community- or hospital-onset based on collection time. A generalized linear mixed model method was used to estimate the attributable burden for mortality, 30-day readmission, length of stay (LOS), cost, and net gain/loss (payment minus cost) using propensity score-matched C-NS versus C-S cohorts. RESULTS: For C-NS cases, mortality (25.7%), LOS (29.4 days), and costs ($81,574) were highest in the other principal diagnosis, hospital-onset subgroup; readmissions (19.4%) and net loss (-$9522) were greatest in the bacterial pneumonia, hospital-onset subgroup. Mortality and readmissions were not significantly higher for C-NS cases in any propensity score-matched subgroup. Significant C-NS-attributable burden was found for both other principal diagnosis subgroups for LOS (hospital-onset: 3.7 days, P = 0.006; community-onset: 1.5 days, P<0.001) and cost (hospital-onset: $12,777, P<0.01; community-onset: $2681, P<0.001). CONCLUSIONS: Increased LOS and cost burden were observed in propensity score-matched patients with C-NS compared with C-S respiratory infections; the C-NS-attributable burden was significant only for patients with other principal diagnoses.


Assuntos
Carbapenêmicos/farmacologia , Farmacorresistência Bacteriana , Infecções por Bactérias Gram-Negativas/economia , Infecções por Bactérias Gram-Negativas/mortalidade , Custos de Cuidados de Saúde/estatística & dados numéricos , Infecções Respiratórias/economia , Infecções Respiratórias/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Seguimentos , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/crescimento & desenvolvimento , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prognóstico , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
12.
Medicine (Baltimore) ; 99(4): e18584, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977849

RESUMO

To evaluate epidemiology and risk factors of severe adenovirus respiratory infection in hospitalized children in Guangzhou, China.A retrospective review study was conducted, and 542 children hospitalized for adenovirus respiratory infection, were included from January 2011 to December 2014. Patients were younger than 14 years. Disease severity was classified into severe and mild. Laboratory tests and clinical characteristics were analyzed for risk factors of adenovirus respiratory infection by multivariable logistic regression.Among these 542 children, 92.1% were aged < 6 years. Clinical diagnoses were upper respiratory infections in 11.6%, bronchiolitis in 16%, and mild pneumonia in 62.0% of children. Severe pneumonia rate was 10.3% (56/542) with a mortality rate of 0.9% (5/542). The cohort comprised 542 patients; 486 patients with mild adenovirus respiratory infection and 56 patients with severe adenovirus respiratory infection. Multivariable logistic regression was used to confirm associations between variables and adenovirus respiratory infection, after age and gender adjustment. Hospital stay, still significantly associated with adenovirus respiratory infection. Patients with longer hospital stay (odds ratio [OR] = 1.20, 95% confidence interval [CI]: 1.13-1.28, P < .001), lower LYMPH (OR = 0.73 95% CI: 0.55-0.99, P = .039), and increased LDH (OR = 1.002, 95% CI: 1.001-1.003, P =  .001) had a higher risk of severe adenovirus respiratory infection.Adenovirus is a major pathogen in hospitalized children with respiratory infection. High serum LDH level and low lymphocyte count could be used as predictors of adenovirus respiratory infection severity in children.


Assuntos
Infecções por Adenovirus Humanos/epidemiologia , Criança Hospitalizada/estatística & dados numéricos , Infecções Respiratórias/epidemiologia , Infecções por Adenovirus Humanos/mortalidade , Adolescente , Fatores Etários , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Lactente , Tempo de Internação , Modelos Logísticos , Masculino , Pneumonia/epidemiologia , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
14.
Transplantation ; 104(4): e98-e106, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31895333

RESUMO

BACKGROUND: Multidrug-resistant (MDR) bacteria in the lower respiratory tracts of allografts may be risk factors for early posttransplant pneumonia (PTP) that causes detrimental outcomes in lung transplant recipients (LTRs). We evaluated the effects of immediate changes in MDR bacteria in allografts on early PTP and mortality rates in LTRs. METHODS: We reviewed 90 adult bilateral LTRs without pretransplant infections who underwent lung transplantation between October 2012 and May 2018. Quantitative cultures were performed with the bronchoalveolar lavage fluids of the allografts preanastomosis and within 3 days posttransplant. The International Society for Heart and Lung Transplantation consensus defines early PTP as pneumonia acquired within 30 days posttransplant and not associated with acute rejection. RESULTS: MDR Acinetobacter baumannii (11/34, 32.4%) and Staphylococcus aureus (9/34, 26.5%) were identified in 24.4% (22/90) of the preanastomosis allografts. Four LTRs had the same MDR bacteria in allografts preanastomosis and posttransplant. Allograft MDR bacteria disappeared in 50% of the LTRs within 3 days posttransplant. Early PTP and all-cause in-hospital mortality rates were not different between LTRs with and without preanastomosis MDR bacteria (P = 0.75 and 0.93, respectively). MDR bacteria ≥10 CFU/mL in the lungs within 3 days posttransplant was associated with early PTP (odds ratio, 5.8; 95% confidence interval, 1.3-27.0; P = 0.03). CONCLUSIONS: High levels of preexisting MDR bacteria in allografts did not increase early PTP and mortality rates in LTRs. Despite the small and highly selective study population, lung allografts with MDR bacteria may be safely transplanted with appropriate posttransplant antibiotic therapy.


Assuntos
Seleção do Doador , Farmacorresistência Bacteriana Múltipla , Transplante de Pulmão , Pulmão/cirurgia , Pneumonia Bacteriana/microbiologia , Infecções Respiratórias/microbiologia , Doadores de Tecidos , Adulto , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Feminino , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Mortalidade Hospitalar , Humanos , Pulmão/microbiologia , Pulmão/fisiopatologia , Transplante de Pulmão/efeitos adversos , Transplante de Pulmão/mortalidade , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/mortalidade , Pneumonia Bacteriana/prevenção & controle , Recuperação de Função Fisiológica , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
Clin Respir J ; 14(3): 205-213, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31799802

RESUMO

PURPOSES: Escherichia coli is one of the most common pathogens in nosocomial and community-acquired infections, but is an uncommon respiratory pathogen. However, this pathogen may at times be seen in respiratory secretions. The study aims to determine the clinical and prognostic value of E. coli in respiratory secretions. METHODS: Cultures of respiratory secretions from hospitalized and outpatients between 2009 and 2016 were screened for isolation of E. coli. We defined three groups of patients: "Sensitive (S)"-growth of E. coli sensitive to all antimicrobials tested; Intermediate (I)-resistant to 1-2 antimicrobial classes; and "Resistant (R)"-resistant to at least three antibiotic classes. We compared factors associated with resistant strains and outcomes between the groups. RESULTS: Eighty patients with E. coli isolates from respiratory secretions were identified while screening 177 712 (4.5: 10 000 samples). Of the E. Coli-positive cultures, 11 were from ambulatory patients, 31 patients were hospitalized and 37 were hospitalized and intubated. Ten people had bronchiectasis and 29 had COPD. Patients with resistant E. coli had significantly more hospitalization days prior to positive culture (S = 1.2 ± 1.89 days, I = 1.23 ± 1.5 days and R = 3.7 ± 5.4 days, respectively; P = 0.002). Mortality was higher in patients with a resistant strain (R) versus (I) or (S) (76.7%, 31.8% and 26.7%, respectively; P < 0.0001) and remained significantly elevated after correction for prior hospital days. CONCLUSIONS: Pulmonary infection due to E. coli is uncommon. Isolation of resistant E. coli is associated with length of previous hospitalization, elevated mortality and may be viewed as a nosocomial pathogen.


Assuntos
Antibacterianos/uso terapêutico , Escherichia coli/isolamento & purificação , Infecções Respiratórias/tratamento farmacológico , Escarro/microbiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/classificação , Bronquiectasia/epidemiologia , Bronquiectasia/microbiologia , Estudos de Casos e Controles , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/mortalidade , Fibrose Cística/epidemiologia , Fibrose Cística/microbiologia , Farmacorresistência Bacteriana , Escherichia coli/crescimento & desenvolvimento , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Feminino , Hospitalização , Humanos , Masculino , Testes de Sensibilidade Microbiana/métodos , Pessoa de Meia-Idade , Infecções Respiratórias/mortalidade
16.
Am J Emerg Med ; 38(7): 1389-1395, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31859198

RESUMO

OBJECTIVE: To evaluate the added value of inflammatory markers to vital signs to predict mortality in patients suspected of severe infection. METHODS: This study was conducted at an acute care hospital (471-bed capacity). Consecutive adult patients suspected of severe infection who presented to either ambulatory care or the emergency department from April 2015 to March 2017 were retrospectively evaluated. A prognostic model for predicting 30-day in-hospital mortality based on previously established vital signs (systolic blood pressure, respiratory rate, and mental status) was compared with an extended model that also included four inflammatory markers (C-reactive protein, neutrophil-lymphocyte ratio, mean platelet volume, and red cell distribution width). Measures of interest were model fit, discrimination, and the net percentage of correctly reclassified individuals at the pre-specified threshold of 10% risk. RESULTS: Of the 1015 patients included, 66 (6.5%) died. The extended model including inflammatory markers performed significantly better than the vital sign model (likelihood ratio test: p < 0.001), and the c-index increased from 0.69 (range 0.67-0.70) to 0.76 (range 0.75-0.77) (p = 0.01). All included markers except C-reactive protein showed significant contribution to the model improvement. Among those who died, 9.1% (95% CI -2.8-21.8) were correctly reclassified by the extended model at the 10% threshold. CONCLUSIONS: The inflammatory markers except C-reactive protein showed added predictive value to vital signs. Future studies should focus on developing and validating prediction models for use in individualized predictions including both vital signs and the significant markers.


Assuntos
Proteína C-Reativa/imunologia , Mortalidade Hospitalar , Infecções Intra-Abdominais/mortalidade , Neutrófilos , Infecções Respiratórias/mortalidade , Sepse/mortalidade , Dermatopatias Infecciosas/mortalidade , Infecções Urinárias/mortalidade , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Tomada de Decisão Clínica , Técnicas de Apoio para a Decisão , Índices de Eritrócitos , Feminino , Humanos , Inflamação , Infecções Intra-Abdominais/sangue , Infecções Intra-Abdominais/imunologia , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Volume Plaquetário Médio , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Prognóstico , Taxa Respiratória , Infecções Respiratórias/sangue , Infecções Respiratórias/imunologia , Estudos Retrospectivos , Sepse/sangue , Sepse/imunologia , Dermatopatias Infecciosas/sangue , Dermatopatias Infecciosas/imunologia , Infecções Urinárias/sangue , Infecções Urinárias/imunologia
17.
Br J Haematol ; 188(4): 560-569, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31566733

RESUMO

Viral respiratory infections (VRIs) contribute to the morbidity and transplant-related mortality (TRM) after allogeneic haematopoietic stem cell transplantation (HSCT) and strategies to prevent and treat VRIs are warranted. We monitored VRIs before and after transplant in children undergoing allogeneic HSCT with nasopharyngeal aspirates (NPA) and assessed the impact on clinical outcome. Between 2007 and 2017, 585 children underwent 620 allogeneic HSCT procedures. Out of 75 patients with a positive NPA screen (12%), transplant was delayed in 25 cases (33%), while 53 children started conditioning with a VRI. Patients undergoing HSCT with a positive NPA screen had a significantly lower overall survival (54% vs. 79%) and increased TRM (26% vs. 7%) compared to patients with a negative NPA. Patients with a positive NPA who delayed transplant and cleared the virus before conditioning had improved overall survival (90%) and lower TRM (5%). Pre-HSCT positive NPA was the only significant risk factor for progression to a lower respiratory tract infection and was a major risk factor for TRM. Transplant delay, whenever feasible, in case of a positive NPA screen for VRIs can positively impact on survival of children undergoing HSCT.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Infecções Respiratórias/mortalidade , Condicionamento Pré-Transplante , Viroses/mortalidade , Adolescente , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo
19.
BMJ Open ; 10(11): e040990, 2020 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-33444207

RESUMO

OBJECTIVES: To assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with viral respiratory infections on acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival. DESIGN: Rapid systematic review. PARTICIPANTS: Humans with viral respiratory infections, exposed to systemic NSAIDs. PRIMARY OUTCOMES: Acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival. RESULTS: We screened 10 999 titles and abstracts and 738 full texts, including 87 studies. No studies addressed COVID-19, Severe Acute Respiratory Syndrome or Middle East Respiratory Syndrome; none examined inpatient healthcare utilisation, quality of life or long-term survival. Effects of NSAIDs on mortality and cardiovascular events in adults with viral respiratory infections are unclear (three observational studies; very low certainty). Children with empyema and gastrointestinal bleeding may be more likely to have taken NSAIDs than children without these conditions (two observational studies; very low certainty). In patients aged 3 years and older with acute respiratory infections, ibuprofen is associated with a higher rate of reconsultations with general practitioners than paracetamol (one randomised controlled trial (RCT); low certainty). The difference in death from all causes and hospitalisation for renal failure and anaphylaxis between children with fever receiving ibuprofen versus paracetamol is likely to be less than 1 per 10 000 (1 RCT; moderate/high certainty). Twenty-eight studies in adults and 42 studies in children report adverse event counts. Most report that no severe adverse events occurred. Due to methodological limitations of adverse event counts, this evidence should be interpreted with caution. CONCLUSIONS: It is unclear whether the use of NSAIDs increases the risk of severe adverse outcomes in patients with viral respiratory infections. This absence of evidence should not be interpreted as evidence for the absence of such risk. This is a rapid review with a number of limitations. PROSPERO REGISTRATION NUMBER: CRD42020176056.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/virologia , Humanos , Qualidade de Vida , Infecções Respiratórias/mortalidade , Análise de Sobrevida
20.
Pan Afr Med J ; 37: 211, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33520050

RESUMO

Introduction: acute lower respiratory infections (ALRI) are a leading killer of children under five worldwide including the Democratic Republic of the Congo (DR Congo). We aimed to determine the morbidity and case fatality rate due to ALRI before and after introduction of the 13-valent pneumococcal conjugate vaccine (PVC13) in DR Congo 2013. Methods: data were collected from medical records of children with a diagnosis of ALRI, aged from 2 to 59 months, treated at four hospitals in the Eastern DR Congo. Two study periods were defined; from 2010 to 2012 (before introduction of PCV13) and from 2014 to 2015 (after PCV13 introduction). Results: out of 21,478 children admitted to the hospitals during 2010-2015, 2,007 were treated for ALRI. The case fatality rate among these children was 4.9%. Death was significantly and independently associated with malnutrition, severe ALRI, congenital disease and symptoms of fatigue. Among the ALRI hospitalised children severe ALRI decreased from 31% per year to 18% per year after vaccine introduction (p = 0.0002) while the fatality rate remained unchanged between the two study periods. Following introduction of PCV13, 63% of the children diagnosed with ALRI were treated with ampicillin combined with gentamicin while 33% received ceftriaxone and gentamicin. Conclusion: three years after PCV13 introduction in the Eastern part of the DR Congo, we found a reduced risk of severe ALRI among children below five years. Broad-spectrum antibiotics were frequently used for the treatment of ALRI in the absence of any microbiological diagnostic support.


Assuntos
Antibacterianos/administração & dosagem , Hospitalização/estatística & dados numéricos , Vacinas Pneumocócicas/administração & dosagem , Infecções Respiratórias/epidemiologia , Doença Aguda , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , República Democrática do Congo , Fadiga/epidemiologia , Feminino , Humanos , Lactente , Transtornos da Nutrição do Lactente/epidemiologia , Masculino , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
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