Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 928
Filtrar
2.
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
3.
BMC Infect Dis ; 19(1): 975, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31747887

RESUMO

BACKGROUND: The current evidence of extra length of stay (LOS) attributable to healthcare-associated infection (HCAI) scarcely takes time-dependent bias into consideration. Plus, limited evidences were from developing countries. We aim to estimate the extra LOS and risk factors of mortality attributable to HCAI for inpatients. METHODS: Multi-state model (MSM) was adopted to estimate the extra LOS attributable to HCAI of each type and subgroup. COX regression model was used to examine the risk of mortality. RESULTS: A total of 51,691 inpatients were included and 1709 (3.31%) among them developed HCAI. Lower respiratory tract infection and Acinetobacter baumannii were the most prevalent HCAI and causative pathogen in surveyed institute. Generally, the expected extra LOS attributable to HCAI was 2.56 days (95% confidence interval: 2.54-2.61). Patients below 65 had extra LOS attributable to HCAI longer about 2 days than those above. The extra LOS attributable to HCAI of male patients was 1.33 days longer than female. Meanwhile, age above 65 years old and HCAI were the risk factors of mortality for inpatients. CONCLUSIONS: HCAI contributes to an increase in extra LOS of inpatients in China. The effect of HCAI on extra LOS is different among subgroups, with the age below 65, male and medicine department more sensitive.


Assuntos
Infecção Hospitalar/diagnóstico , Tempo de Internação , Infecções Respiratórias/diagnóstico , Acinetobacter baumannii/isolamento & purificação , Fatores Etários , Idoso , China , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidade , Fatores de Risco , Fatores Sexuais , Taxa de Sobrevida
4.
Medicine (Baltimore) ; 98(41): e17535, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593129

RESUMO

Scedosporium genus as a significant emerging opportunist causes a broad spectrum of disease in not only immunosuppressed but also immunocompetent patients. The lung is one of the most commonly encountered sites of Scedosporium infection. Due to its very high levels of antifungal resistance, surgery has been recommended as an important part in the treatment of pulmonary Scedosporium spp infection, even in immunocompetent cases. However, whether lung surgery could help to reduce the risk of death in immunocompetent patients is not clear.We retrospectively retrieved the records of pulmonary infections with Scedosporium species in immunocompetent patients through a comprehensive literature search. The association of surgery on all-cause mortality was explored using binary logistic regression (BLR). Receiver operating characteristic (ROC) curve analysis was carried out to evaluate the capability of the model.The comprehensive searching strategy yielded 33 case reports and 3 case series in total, with 40 individual patients being included. The overall mortality was 12.50%. The fatality rate was 9.09% (2/22) in cases with surgery and 16.67% (3/18) in cases without surgery (odds ratio, 0.50; 95% confidence interval, 0.07-3.38; P = .48). Consistently, BLR analysis identified no statistical association between surgery and reduced mortality (odds ratio, 1.19; 95% confidence interval, 0.09-15.64; P = .89), after adjusting for age, gender, and antifungal chemotherapy. The area under the ROC curve was 0.88.For immunocompetent patients with pulmonary Scedosporium spp infection, surgical therapy may not be associated with reduced mortality. Surgical excision could be considered but is not imperative in this group of patients.


Assuntos
Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/cirurgia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/cirurgia , Scedosporium/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Farmacorresistência Fúngica/fisiologia , Feminino , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/microbiologia , Micoses/mortalidade , Estudos Observacionais como Assunto , Cuidados Pós-Operatórios , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Scedosporium/isolamento & purificação , Voriconazol/administração & dosagem , Voriconazol/uso terapêutico
5.
Environ Pollut ; 255(Pt 1): 113173, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521993

RESUMO

Ambient particulate matter is a public health concern. We aimed (1) to estimate national and provincial long-term exposure of Iranians to ambient particulate matter (PM) < 2.5 µm (PM2.5) from 1990 to 2016, and (2) to estimate the national and provincial burden of disease attributable to PM2.5 in Iran. We used all available ground measurements of PM < 10 µm (PM10) (used to estimate PM2.5) from 91 monitoring stations. We estimated the annual mean exposure to PM2.5 for all Iranian population from 1990 to 2016 through a multi-stage modeling process. By applying comparative risk assessment methodology and using life table for years of life lost (YLL), we estimated the mortality and YLL attributable to PM2.5 for five outcomes. The predicted provincial annual mean PM2.5 concentrations range was between 21.7 µg/m3 (UI: 19.03-24.9) and 35.4 µg/m3 (UI: 31.4-39.4) from 1990 to 2016. We estimated in 2016, about 41,000 deaths (95% uncertainty interval [UI] 35634, 47014) and about 3,000,000 YLL (95% UI: 2632101, 3389342) attributable to the long-term exposure to PM2.5 in Iran. Ischemic heart disease was the leading cause of mortality by 31,363 deaths (95% UI: 27520, 35258), followed by stroke (7012 (5999, 8062) deaths), lower respiratory infection (1210 (912, 1519) deaths), chronic obstructive pulmonary disease (1019 (715, 1328) deaths), and lung cancer (668 (489, 848) deaths). In 2016, about 43% of all PM2.5 related mortality in Iran was, respectively, in the following provinces: Tehran (12.6%), Isfahan (9.3%), Khorasan Razavi (8.0%), Fars (6.5%), and Khozestan (6.4%). In summary, we found that the majority of Iranians were exposed to the levels of ambient particulate matter exceeding the WHO guidelines from 1990 to 2016. Further, we found that there was an increasing trend of total mortality attributed to PM2.5 in Iran from 1990 to 2016 where the slope was higher in western provinces.


Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Material Particulado/toxicidade , Poluentes Atmosféricos/análise , Poluição do Ar/análise , China , Exposição Ambiental/estatística & dados numéricos , Humanos , Irã (Geográfico) , Neoplasias Pulmonares/induzido quimicamente , Neoplasias Pulmonares/mortalidade , Isquemia Miocárdica/induzido quimicamente , Isquemia Miocárdica/mortalidade , Material Particulado/análise , Saúde Pública , Doença Pulmonar Obstrutiva Crônica/induzido quimicamente , Doença Pulmonar Obstrutiva Crônica/mortalidade , Infecções Respiratórias/induzido quimicamente , Infecções Respiratórias/mortalidade , Acidente Vascular Cerebral/induzido quimicamente , Acidente Vascular Cerebral/mortalidade
6.
BMC Public Health ; 19(1): 1132, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31420035

RESUMO

BACKGROUND: The mortality rate in children under 5 years old (U5MR) has decreased considerably in Ecuador in the last decade; however, thousands of children continue to die from causes related to poverty. A social program known as Bono de Desarrollo Humano (BDH) was created to guarantee a minimum level of consumption for families and to reduce chronic malnutrition and preventable childhood diseases. We sought to evaluate the effect of the BDH program on mortality of children younger than 5 years, particularly from malnutrition, diarrheal diseases, and lower respiratory tract infections. METHODS: Mortality rates and BDH coverage from 2009 to 2014 were evaluated from the 144 (of 222) Ecuadorian counties with intermediate and high quality of vital information. A multivariable regression analyses for panel data was conducted by using a negative binomial regression model with fixed effects, adjusted for all relevant demographic and socioeconomic covariates. RESULTS: Our research shows that for each 1% increase in BDH county coverage there would be a decrease in U5MR from malnutrition of 3% (RR 0.971, 95% CI 0.953-0.989). An effect of BDH county coverage on mortality resulting from respiratory infections was also observed (RR 0.992, 95% CI 0.984-0.999). The BDH also reduced hospitalization rates in children younger than 5 years, overall and for diarrhea. CONCLUSIONS: A conditional cash transfer program such as BDH could contribute to the reduction of mortality due to causes related to poverty, such as malnutrition and respiratory infections. The coverage should be maintained -or increased in a period of economic crisis- and its implementation strengthened.


Assuntos
Saúde da Criança/economia , Mortalidade da Criança/tendências , Pobreza/economia , Assistência Pública/economia , Transtornos da Nutrição Infantil/economia , Transtornos da Nutrição Infantil/mortalidade , Pré-Escolar , Diarreia/economia , Diarreia/mortalidade , Equador/epidemiologia , Feminino , Hospitalização/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Análise de Regressão , Infecções Respiratórias/economia , Infecções Respiratórias/mortalidade
7.
J Hosp Infect ; 103(2): 134-141, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31228511

RESUMO

BACKGROUND: Multi-drug resistant (MDR) Pseudomonas aeruginosa can negatively affect patients and hospitals. AIM: To evaluate excess mortality and cost burden among patients hospitalized with suspected respiratory infections due to MDR P. aeruginosa vs patients with non-MDR P. aeruginosa in 78 United States (US) hospitals. METHODS: This study analyzed electronically captured microbiological and outcomes data of patients hospitalized with non-duplicate P. aeruginosa isolates from respiratory sources collected ≥3 days after admission to identify hospital-onset MDR or non-MDR P. aeruginosa per the Centers for Disease Control and Prevention definition. The risk of multi-drug resistance was estimated on mortality, length of stay (LOS), cost, operation gain/loss, and 30-day readmission. A sensitivity analysis was conducted utilizing a cohort with pharmacy data available. FINDINGS: Of 523 MDR and 1381 non-MDR P. aeruginosa cases, unadjusted mortality was 23.7% vs 18.0% and multi-variable-adjusted mortality was 20.0% (95% confidence interval (CI): 14.3-27.2%) vs 15.5% (95% CI: 11.2-20.9%; P=0.026), the average adjusted excess LOS was 6.7 days (P<0.001); excess cost per case was US$22,370 higher (P=0.002) and operational loss per case was US$10,661 (P=0.024) greater, and the multi-variable adjusted readmission rate was 16.2% (95% CI: 11.2-22.9%) vs 11.1% (95% CI: 7.8-15.6%; P=0.006). The sensitivity analysis yielded similar results. CONCLUSIONS: Compared with suspected infections due to non-MDR P. aeruginosa, patients with MDR P. aeruginosa had higher risk of mortality, readmission, and longer LOS, as well as US$20,000 incremental cost and >US$10,000 incremental net loss per case after controlling for patient and hospital characteristics.


Assuntos
Efeitos Psicossociais da Doença , Farmacorresistência Bacteriana Múltipla , Infecções por Pseudomonas/economia , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Infecções Respiratórias/economia , Infecções Respiratórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Custos de Cuidados de Saúde , Hospitais , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/mortalidade , Pseudomonas aeruginosa/isolamento & purificação , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidade , Análise de Sobrevida , Estados Unidos/epidemiologia , Adulto Jovem
8.
Am J Forensic Med Pathol ; 40(3): 232-237, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31205057

RESUMO

Sudden infant deaths might be attributable to adverse reaction to vaccination, but separating them from coincidental occurrences is difficult. This study retrospectively investigated vaccination-related details and postmortem findings for 57 cases of sudden death in children 2 years or younger. Data were extracted from autopsy files at the Department of Forensic Medicine, Tokai University School of Medicine. Vaccination histories were available in 50 cases based on the maternity passbook. Of the 32 cases in which any vaccines were administered, 7 infants (21.9%) had received immunization within 7 days of death. The most frequent vaccine cited as the last immunization before death was Haemophilus influenzae B. Although a temporal association of vaccines with sudden death was present for two 3-month-old and one 14-month-old infants in whom death occurred within 3 days of receiving the H. influenzae type b and other vaccinations, a definitive relationship between the vaccine and death could not be identified. Histopathological examinations revealed pneumonia and upper respiratory infection as contributing to death in their cases. Moreover, all 3 cases showed hemophagocytosis in the spleen and lymph nodes, which are similar features to hemophagocytic lymphohistiocytosis. Judgment of the disorders as truly related to vaccination is difficult, but suspicious cases do exist. Forensic pathologists must devote more attention to vaccination in sudden infant death cases.


Assuntos
Morte Súbita do Lactente/epidemiologia , Vacinação/efeitos adversos , Encefalopatias/mortalidade , Enterite/mortalidade , Feminino , Patologia Legal , Cardiopatias Congênitas/mortalidade , Humanos , Íleus/mortalidade , Lactente , Recém-Nascido , Vírus da Influenza A/isolamento & purificação , Japão/epidemiologia , Linfonodos/patologia , Masculino , Fagocitose , Pneumonia/mortalidade , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Baço/patologia , Streptococcus/isolamento & purificação
9.
BMC Public Health ; 19(1): 499, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053069

RESUMO

BACKGROUND: Acute respiratory infection (ARI) is an important cause of mortality in children and adults. However, studies assessing risk factors for ARI-related deaths in low- and middle-income settings are limited. We describe ARI-related death and associated factors among children aged < 2 years and adults aged ≥18 years hospitalized with ARI in Guatemala. METHODS: We used respiratory illness surveillance data in Guatemala from 2007 to 2013. ARI was defined as evidence of acute infection and ≥ 1 sign/symptom of respiratory disease in hospitalized patients. Clinical, sociodemographic, and follow-up data were gathered. Nasopharyngeal/oropharyngeal swabs were collected from patients with ARI and tested for 6 respiratory viruses; urine was collected only from adults with ARI and tested for pneumococcal antigen. Blood cultures and chest radiographs were performed at the physician's discretion. Radiographs were interpreted per World Health Organization guidelines to classify endpoint pneumonia (i.e. suggestive of bacterial pneumonia). Multivariable logistic regression was used to compare characteristics of patients with fatal cases, including those who died in-hospital or were discharged in a moribund state, with those of patients with non-fatal cases. RESULTS: Among 4109 ARI cases identified in hospitalized children < 2 years old, 174 (4%) were fatal. Median age at admission was 4 and 6 months for children with fatal and non-fatal cases, respectively. Factors associated with fatality included low weight-for-age, low family income, heart disease, and endpoint pneumonia; breastfeeding and respiratory syncytial virus (RSV) detection were negatively associated with fatality. Among 1517 ARI cases identified in hospitalized adults ≥18 years, 181 (12%) episodes were fatal. Median age at admission was 57 years for adults with fatal and non-fatal cases. Low body mass index, male sex, kidney disease, and endpoint pneumonia were significantly more common among patients with fatal versus non-fatal cases. CONCLUSIONS: Our findings highlight some of the factors that must be addressed in order to reduce ARI-related mortality, including promotion of good nutrition, breastfeeding, management and prevention of chronic comorbidities, and poverty reduction. Although no specific pathogen increased risk for death, endpoint pneumonia was significantly associated with fatality, suggesting that the pneumococcal conjugate vaccine could contribute to future reductions in ARI-related mortality.


Assuntos
Hospitalização/estatística & dados numéricos , Pneumonia Bacteriana/mortalidade , Infecções Respiratórias/mortalidade , Adulto , Pré-Escolar , Feminino , Guatemala/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Vacinas Pneumocócicas , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/terapia , Vírus Sincicial Respiratório Humano/isolamento & purificação , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/terapia , Adulto Jovem
10.
Nutr Hosp ; 36(3): 538-544, 2019 Jul 01.
Artigo em Espanhol | MEDLINE | ID: mdl-30958689

RESUMO

Introduction: Introduction: obesity is related to a higher morbidity and mortality in adults with respiratory infections but in children the evidence is limited. Objective: to study the association between overweight and clinical course in children younger than two years of age, hospitalized for lower respiratory tract infections (LRTI). Methods: retrospective study reviewing clinical records of children hospitalized by LRTI from 2009 to 2015. Demographic data, anthropometry, nutritional status (World Health Organization [OMS] 2006 reference) and clinical course. Results: we included 678 patients with a median age of 9.9 (range: 6.4 to 14.7) months, 55% were boys and 67% had viral pneumonia (67%). Treatment: 54.7% received basic care, 98.7% oxygen therapy, 35.4% noninvasive ventilation (NIV), 26.1% antibiotics and 47.5% corticosteroids. Regarding nutritional status, 10% had undernutrition (W/Az ≤ -1 in infants or W/Hz in the older ones), 55.2% were eutrophic and 34.8% were overweight (ME, W/Hz ≥ +1). Boys with overweight had higher frequency of viral pneumonia (75.4% vs 60.2%, p = 0.014), need for more complex care (27.7% vs 19.9%, p = 0.018) and length of NIV (4,5 [3-5.5] vs. [2-5.5] days, p = 0.007) than eutrophic. Infants had longer time of NIV than the older ones. In girls, no associations were found between nutritional status and clinical course. Conclusions: in this sample of young children hospitalized with LRTI,obesity and overweight, masculine sex and younger age were associated to worse clinical outcomes.


Assuntos
Sobrepeso/epidemiologia , Infecções Respiratórias/epidemiologia , Antropometria , Progressão da Doença , Feminino , Hospitalização , Humanos , Lactente , Tempo de Internação , Masculino , Desnutrição/mortalidade , Estado Nutricional , Obesidade , Sobrepeso/complicações , Sobrepeso/mortalidade , Infecções Respiratórias/complicações , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Caracteres Sexuais
11.
Int J Rheum Dis ; 22(6): 1077-1083, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30968568

RESUMO

OBJECTIVE: The impact of pulmonary infection (PI) on mortality of patients with systemic lupus erythematosus (SLE) has been established. Nevertheless, the effect of risk factors in mortality remains controversial. The objective of this study is to determine the risk factors of short-term mortality among SLE patients with PI. METHOD: The clinical data of 54 SLE patients with 59 episodes of PI who were hospitalized from January 2013 to May 2018 was retrospectively analyzed. Demographic data, clinical features, and outcomes were collected. Logistic regression analysis was carried out to determine the independent predictors of 60-day mortality during hospitalization. We used receiver operating characteristics (ROC) curves to verify the indices as mortality predictors in the study patients. RESULTS: There were a total of 54 patients with 59 episodes of PI. There were 12 deaths during hospitalization. In multivariate analysis, 24-hour urinary protein (24h-PRO) (odds ratio [OR]: 2.713, 95% CI: 1.234-5.965, P = 0.013), peripheral lymphocyte count (OR: 0.066, 95% CI: 0.005-0.887, P = 0.040), and serum complement 3 level (C3) (OR: 0.097, 95% CI: 0.010-0.954, P = 0.045) were associated with mortality among our cohort of SLE patients with PI. ROC curve values were 0.818 for lymphocyte count (95% CI: 0.696-0.907, P = 0.001), 0.894 for 24h-PRO (95% CI: 0.786-0.959, P < 0.001) and 0.825 for C3 (95% CI: 0.704-0.912, P = 0.001). The cut-off value of lymphocytes, 24h-PRO and C3 were 0.53 × 109 /L, 0.92 g and 0.52 g/L, respectively. CONCLUSION: The presence of albuminuria, lymphopenia and low complement C3 levels were independent prognostic predictors of short-term mortality in SLE patients with PI.


Assuntos
Lúpus Eritematoso Sistêmico/mortalidade , Infecções Respiratórias/mortalidade , Adolescente , Adulto , Idoso de 80 Anos ou mais , Albuminúria/mortalidade , Biomarcadores/sangue , Complemento C3/análise , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/terapia , Linfopenia/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
12.
PLoS One ; 14(3): e0210102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30840626

RESUMO

Pneumonia severity index (PSI) is an important scoring system that can assess the severity of community acquired pneumonia and determine admission status. However, there is a lack of research on whether this scoring system can be applied to viral community acquired pneumonia. The purpose of this study was to evaluate the usefulness of PSI in viral community acquired pneumonia. This retrospective cohort study included 1,434 adult patients (aged ≥18 years) who were admitted to the emergency department of a university hospital during 2013-2015 because of community-acquired pneumonia. Viral infections were diagnosed by multiplex PCR. Patients diagnosed with non-viral community-acquired pneumonia were included in the control group (N = 1,173). The main outcome was 30-day all-cause mortality. multivariate Cox regression analyses were performed to calculate the risk of death. Respiratory viruses were detected in 261 (18.2%) patients with community-acquired pneumonia. Two types of respiratory viruses were detected in 7 cases. Of the 254 cases detected with only one virus, 62 were influenza A, 18 were influenza B, 65 were rhinovirus, 35 were respiratory syncytial virus, 25 were metapneumovirus, 20 were parainfluenza, 17 were coronavirus, 7 were bocavirus, and 5 were adenovirus. Mortality was not significantly different between patients with respiratory virus and those without respiratory virus; the 30-day all-cause mortality rates were 20.3% and 22.4%, respectively (P = 0.45). Mortality rate increased with an increasing PSI score with or without respiratory viral infection. Pulmonary severity index was significantly associated with mortality adjusted for respiratory virus detection (hazard ratio = 1.024, 95% confidence interval = 1.020-1.028). Pneumonia severity index score is an important factor for assessing the prognosis of patients with community-acquired pneumonia, regardless of respiratory virus detection.


Assuntos
Infecções Comunitárias Adquiridas/mortalidade , Pneumonia Viral/mortalidade , Pneumovirus/patogenicidade , Infecções Respiratórias/mortalidade , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Pneumovirus/classificação , Pneumovirus/isolamento & purificação , Prognóstico , República da Coreia/epidemiologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/virologia , Estudos Retrospectivos , Taxa de Sobrevida
13.
Artigo em Inglês | MEDLINE | ID: mdl-30774328

RESUMO

Background: Etiologies of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are heterogeneous. We phenotyped severe AECOPD based on molecular pathogen detection of sputum samples collected at hospitalization of COPD patients and determined their outcomes. Methods: We phenotyped 72 sputum samples of COPD patients who were hospitalized with a primary diagnosis of AECOPD using a molecular array that detected common bacterial and viral respiratory pathogens. Based on these results, the patients were classified into positive or negative pathogen groups. The pathogen-positive group was further divided into virus or bacteria subgroups. Admission day 1 blood samples were assayed for N-terminal prohormone brain natriuretic peptide, CRP, and complete blood counts. Results: A total of 52 patients had a positive result on the array, while 20 patients had no pathogens detected. The most common bacterial pathogen detected was Haemophilus influenzae and the most common virus was rhinovirus. The pathogen-negative group had the worse outcomes with longer hospital stays (median 6.5 vs 5 days for bacteria-positive group, P=0.02) and a trend toward increased 1-year mortality (P=0.052). The bacteria-positive group had the best prognosis, whereas the virus-positive group had outcomes somewhere in between the bacteria-positive and pathogen-negative groups. Conclusion: Molecular diagnostics on sputum can rapidly phenotype serious AECOPD into bacteria-, virus-, or pathogen-negative groups. The bacteria-positive group appears to have the best prognosis, while pathogen-negative group has the worst. These data suggest that AECOPD is a heterogeneous event and that accurate phenotyping of AECOPD may lead to novel management strategies that are personalized and more precise.


Assuntos
DNA Bacteriano/genética , DNA Viral/genética , Pulmão/microbiologia , Pulmão/virologia , Técnicas de Diagnóstico Molecular , Admissão do Paciente , Doença Pulmonar Obstrutiva Crônica/microbiologia , Doença Pulmonar Obstrutiva Crônica/virologia , Infecções Respiratórias/microbiologia , Infecções Respiratórias/virologia , Idoso , Progressão da Doença , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Fenótipo , Valor Preditivo dos Testes , Prognóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Escarro/microbiologia , Escarro/virologia , Fatores de Tempo
14.
J Med Microbiol ; 68(1): 31-40, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30516469

RESUMO

PURPOSE: Acinetobacter baumannii is a major cause of multidrug-resistant nosocomial infections. The characteristics of A. baumannii at two hospitals in a city in Central Brazil are described by analysing the phenotypes and molecular profiles of isolates recovered from 87 patients. METHODOLOGY: The isolates were identified and their antimicrobial susceptibility was evaluated using the the Bact/Alert 3D and Vitek2 methods. Patients' clinical data were obtained from medical files. Genes associated with resistance to carbapenems were analysed by multilocus sequence typing, clinical and bacteriological variables were analysed by descriptive statistics, and logistic models were generated to adjust the associations. RESULTS: Sixty-four (73.5 %) out of 87 A. baumannii isolates analysed were from patients in intensive care. The mortality rate was 43.7 %. Eighty (91.9 %) isolates were resistant to imipenem and 86 were susceptible to colistin (98.8 %). The blaOXA-23 gene (78.2 %) and its upstream insertion ISAba1 (55.2 %) were predominant, followed by blaOXA-24 (55.2 %) and blaOXA-143 (28.7 %). The blaOXA-23 gene and ISAba1 were independently associated with resistance to imipenem (P<0.05). There were 13 different sequence types (STs) among the 35 isolates. ST1 (nine; 25.7 %), ST162 (eight; 22.8 %) and ST730 (six; 17.1 %) were the most common, and four new STs were identified. The isolates were grouped into five clonal complexes (CC1, CC15, CC79, CC108 and CC162) plus a singleton using eburst. CONCLUSION: Respiratory infection, age >60 years and use of noradrenaline were factors associated with fatality. ST730 (CC79) was associated with higher mortality (P<0.05) and ST162 (CC162) was associated with increased survival probability (P<0.05).


Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/genética , Carbapenêmicos/farmacologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Infecções Respiratórias/microbiologia , Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/mortalidade , Acinetobacter baumannii/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Brasil/epidemiologia , Criança , Pré-Escolar , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/mortalidade , Feminino , Variação Genética , Hospitais , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Norepinefrina/efeitos adversos , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/mortalidade , Adulto Jovem , beta-Lactamases/genética
15.
Am J Respir Crit Care Med ; 199(4): 518-528, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30230909

RESUMO

RATIONALE: Noninvasive diagnostic multiplex molecular tests may enable the early identification and treatment of viral infections in critically ill immunocompromised patients. OBJECTIVES: To assess the association between viral detection in nasopharyngeal swabs and ICU mortality in critically ill hematology patients. METHODS: This was a post hoc analysis of a prospective cohort of critically ill hematology patients admitted to 17 ICUs. Nasal swabs sampled and frozen at ICU admission were tested using a multiplex PCR assay. Predictors of ICU mortality and assay positivity were identified. MEASUREMENTS AND MAIN RESULTS: Of the 747 patients (447 with acute respiratory failure [ARF]), 21.3% had a virus detected (56.4% rhinovirus/enterovirus and 30.7% influenza/parainfluenza/respiratory syncytial viruses). Overall ICU and hospital mortality rates were 26% and 37%, respectively. Assay positivity was associated with lymphoproliferative disorders, hematopoietic stem cell transplantation, treatment with steroids or other immunosuppressants, ARF (25.5% vs. 16.3%; P = 0.004), and death in the ICU (28.9% vs. 19.3%; P = 0.008). The association with ICU mortality was significant for all viruses and was strongest for influenza/parainfluenza/respiratory syncytial viruses. In patients with ARF, detection of any respiratory virus was independently associated with ICU mortality (odds ratio, 2.07; 95% confidence interval, 1.22-3.50). CONCLUSIONS: Respiratory virus detection in the upper airway by multiplex PCR assay is common in critically ill hematology patients. In patients with ARF, respiratory virus detection was independently associated with ICU mortality. Multiplex PCR assay may prove helpful for the risk stratification of hematology patients with ARF. Studies to understand whether respiratory tract viruses play a causal role in outcomes are warranted.


Assuntos
Doenças Hematológicas/virologia , Hospedeiro Imunocomprometido , Infecções Respiratórias/virologia , Idoso , Estado Terminal , Feminino , Doenças Hematológicas/complicações , Doenças Hematológicas/mortalidade , Mortalidade Hospitalar , Humanos , Influenza Humana/complicações , Influenza Humana/diagnóstico , Influenza Humana/mortalidade , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Multiplex , Infecções por Paramyxoviridae/complicações , Infecções por Paramyxoviridae/diagnóstico , Infecções por Paramyxoviridae/mortalidade , Infecções por Picornaviridae/complicações , Infecções por Picornaviridae/diagnóstico , Infecções por Picornaviridae/mortalidade , Infecções por Vírus Respiratório Sincicial/complicações , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/mortalidade , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/mortalidade
16.
Biol Blood Marrow Transplant ; 25(1): 163-171, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30149147

RESUMO

Parainfluenza virus (PIV) infection can progress from upper respiratory tract infection (URTI) to lower respiratory tract disease (LRTD) in immunocompromised hosts. Risk factors for progression to LRTD and presentation with LRTD without prior URTI are poorly defined. Hematopoietic cell transplant (HCT) recipients with PIV infection were retrospectively analyzed using standardized definitions of LRTD. PIV was detected in 540 HCT recipients; 343 had URTI alone and 197 (36%) had LRTD (possible, 76; probable, 19; proven, 102). Among 476 patients with positive nasopharyngeal samples, the cumulative incidence of progression to probable/proven LRTD by day 40 was 12%, with a median time to progression of 7 days (range, 2 to 40). In multivariable analysis monocytopenia (hazard ratio, 2.22; P = .011), steroid use ≥1mg/kg prior to diagnosis (hazard ratio, 1.89; P = .018), co-pathogen detection in blood (hazard ratio, 3.21; P = .027), and PIV type 3 (hazard ratio, 3.57; P = .032) were associated with increased progression risk. In the absence of all 4 risk factors no patients progressed to LRTD, whereas progression risk increased to >30% if 3 or more risk factors were present. Viral load or ribavirin use appeared to have no effect on progression. Among 121 patients with probable/proven LRTD, 64 (53%) presented LRTD without prior URTI, and decreased lung function before infection and lower respiratory co-pathogens were risk factors for this presentation. Mortality was unaffected by the absence of prior URTI. We conclude that the risk of progression to probable/proven LRTD exceeded 30% with ≥3 risk factors. To detect all cases of LRTD, virologic testing of lower respiratory samples is required regardless of URTI symptoms.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Hospedeiro Imunocomprometido , Infecções por Paramyxoviridae , Infecções Respiratórias , Ribavirina/administração & dosagem , Adulto , Aloenxertos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Paramyxoviridae/sangue , Infecções por Paramyxoviridae/tratamento farmacológico , Infecções por Paramyxoviridae/etiologia , Infecções por Paramyxoviridae/mortalidade , Infecções Respiratórias/sangue , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/etiologia , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Fatores de Risco
17.
J Infect Dis ; 219(3): 358-364, 2019 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-30165655

RESUMO

Background: Numerous deaths in children aged <5 years in the developing world occur at home. Acute respiratory infections (ARIs) are thought to play an important role in these deaths. Risk factors and pathogens linked to fatal episodes remain unclear. Methods: A case-control study among low-income children aged <5 years was performed in Buenos Aires, Argentina, to define risk factors and viral pathogens among those who died of ARI at home. Results: A total of 278 families of children aged <5 years (of whom 104 died and 174 were healthy controls) participated in the study. A total of 87.5% of ARI-associated deaths occurred among infants aged <12 months. The estimated mortality rate due to ARI among infants was 5.02 deaths/1000 live births. Dying at home from ARI was associated with living in a crowded home (odds ratio [OR], 3.73; 95% confidence interval [CI], 1.41-9.88), having an adolescent mother (OR, 4.89; 95% CI, 1.37-17.38), lacking running water in the home (OR, 4.39; 95% CI, 1.11-17.38), incomplete vaccinations for age (OR, 3.39; 95% CI, 1.20-9.62), admission to a neonatal intensive care unit (OR, 7.17; 95% CI, 2.21-23.27), and no emergency department visit during the ARI episode (OR, 72.32; 95% CI, 4.82-1085.6). The at-home death rate due to respiratory syncytial virus infection among infants was 0.26 deaths/100 live births and that due to influenza was 0.07 deaths/1000 live births. Conclusions: Social vulnerabilities underlie at-home mortality due to ARI. Mortality rates due to RSV and influenza virus infection are high among infants at home and are similar to those reported for hospitalized children.


Assuntos
Infecções por Vírus Respiratório Sincicial/mortalidade , Infecções Respiratórias/mortalidade , Argentina/epidemiologia , Estudos de Casos e Controles , Assistência à Saúde , Hospitalização , Humanos , Lactente , Recém-Nascido , Influenza Humana/mortalidade , Unidades de Terapia Intensiva , Análise Multivariada , Razão de Chances , Orthomyxoviridae , Pobreza , Características de Residência , Infecções por Vírus Respiratório Sincicial/virologia , Vírus Sinciciais Respiratórios , Infecções Respiratórias/virologia , Fatores de Risco , Fatores Socioeconômicos
18.
Clin Chem Lab Med ; 57(5): 679-689, 2019 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-30267624

RESUMO

Background Sphingolipids - the structural cell membrane components - and their metabolites are involved in signal transduction and participate in the regulation of immunity. We investigated the prognostic implications of sphingolipid metabolic profiling on mortality in a large cohort of patients with lower respiratory tract infections (LRTIs). Methods We measured 15 different sphingomyelin (SM) types in patients with LRTIs from a previous Swiss multicenter trial that examined the impact of procalcitonin-guided antibiotic therapy on total antibiotic use and rates and duration of hospitalization. Primary and secondary end points were adverse outcomes - defined as death or intensive care unit admission within 30 days - and 6-year mortality. Results Of 360 patients, 8.9% experienced an adverse outcome within 30 days and 46% died within 6 years. Levels of all SM types were significantly lower in pneumonia patients vs. those with chronic obstructive pulmonary disease (COPD) exacerbation (p<0.0001 for all comparisons). Sphingomyelin subspecies SM (OH) C22:1 and SM (OH) C22:2 were associated with lower risk for short-term adverse outcomes (sex-, gender- and comorbidity-adjusted odds ratios [OR]: 0.036; 95% confidence interval [CI], 0.002-0.600; p=0.021 and 0.037; 95% CI, 0.001-0.848; p=0.039, respectively). We found no significant associations with 6-year mortality for any SM. Conclusions Circulating sphingolipid levels are lower in inflammatory conditions such as pneumonia and correlate with adverse short-term outcomes. Further characterization of the physiological, pathophysiological and metabolic roles of sphingolipids under inflammatory conditions may facilitate understanding of their roles in infectious disease.


Assuntos
Infecções Respiratórias/diagnóstico , Esfingomielinas/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Seguimentos , Hospitalização , Humanos , Masculino , Metaboloma , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Estudos Prospectivos , Infecções Respiratórias/mortalidade
19.
Intern Med ; 58(4): 557-561, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30333399

RESUMO

We herein report a case involving a 64-year-old Japanese woman with a pulmonary Mycobacterium abscessus infection complicated by reactive AA amyloidosis, which, to our knowledge, has not been reported to date. The patient underwent gastrointestinal endoscopy for diarrhea during the treatment of pulmonary M. abscessus infection and was diagnosed with AA amyloidosis according to the histopathological findings from the endoscopic specimen. She died four months later. The prognosis of AA amyloidosis associated with pulmonary M. abscessus infection may be very poor, and physicians should pay attention to this rare condition when difficult-to-treat diarrhea occurs in patients with pulmonary M. abscessus infection.


Assuntos
Amiloidose/etiologia , Amiloidose/mortalidade , Infecções por Micobactéria não Tuberculosa/complicações , Infecções por Micobactéria não Tuberculosa/mortalidade , Infecções Respiratórias/complicações , Infecções Respiratórias/mortalidade , Amiloidose/complicações , Amiloidose/terapia , Grupo com Ancestrais do Continente Asiático , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/terapia , Infecções Respiratórias/terapia
20.
Int J Nurs Knowl ; 30(2): 87-92, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29427536

RESUMO

PURPOSE: To establish prognostic indicators of survival for impaired gas exchange (IGE) (00030). METHODS: Secondary analysis of data from an open prospective cohort developed with a group of 136 children with acute respiratory infection (ARI). FINDINGS: On Day 1, IGE (00030) was present in 42.6% of the sample. New cases arose until the last day of evaluation. With regards to defining characteristics, only hypoxemia and abnormal skin color were associated with a higher risk of developing diagnosis. CONCLUSIONS: Children with ARI who exhibit hypoxemia and abnormal skin color had a worse prognosis for IGE (00030). IMPLICATIONS FOR NURSE PRACTICE: Nurses can use the research findings as a predictive marker of the evolution of the patient's health status.


Assuntos
Troca Gasosa Pulmonar , Infecções Respiratórias/fisiopatologia , Análise de Sobrevida , Doença Aguda , Criança , Pré-Escolar , Humanos , Lactente , Prognóstico , Estudos Prospectivos , Infecções Respiratórias/mortalidade , Infecções Respiratórias/enfermagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA