RESUMO
Cefepime and piperacillin/tazobactam are antimicrobials recommended by IDSA/ATS guidelines for the empirical management of patients admitted to the intensive care unit (ICU) with community-acquired pneumonia (CAP). Concerns have been raised about which should be used in clinical practice. This study aims to compare the effect of cefepime and piperacillin/tazobactam in critically ill CAP patients through a targeted maximum likelihood estimation (TMLE). A total of 2026 ICU-admitted patients with CAP were included. Among them, (47%) presented respiratory failure, and (27%) developed septic shock. A total of (68%) received cefepime and (32%) piperacillin/tazobactam-based treatment. After running the TMLE, we found that cefepime and piperacillin/tazobactam-based treatments have comparable 28-day, hospital, and ICU mortality. Additionally, age, PTT, serum potassium and temperature were associated with preferring cefepime over piperacillin/tazobactam (OR 1.14 95% CI [1.01-1.27], p = 0.03), (OR 1.14 95% CI [1.03-1.26], p = 0.009), (OR 1.1 95% CI [1.01-1.22], p = 0.039) and (OR 1.13 95% CI [1.03-1.24], p = 0.014)]. Our study found a similar mortality rate among ICU-admitted CAP patients treated with cefepime and piperacillin/tazobactam. Clinicians may consider factors such as availability and safety profiles when making treatment decisions.
Assuntos
Antibacterianos , Cefepima , Infecções Comunitárias Adquiridas , Estado Terminal , Unidades de Terapia Intensiva , Combinação Piperacilina e Tazobactam , Humanos , Cefepima/uso terapêutico , Cefepima/administração & dosagem , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/mortalidade , Combinação Piperacilina e Tazobactam/uso terapêutico , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Funções Verossimilhança , Pneumonia/tratamento farmacológico , Pneumonia/mortalidade , Piperacilina/uso terapêuticoRESUMO
PURPOSE: To provide information about which pneumococcal vaccine could have greater coverage in Colombia. METHODS: This is a retrospective analysis of patients diagnosed with invasive pneumococcal disease (IPD) between 2015 and 2019 in Bogotá, Colombia. We compared the theoretical serotype coverage of the available anti-pneumococcal vaccines (i.e., PCV-10, PCV-10 SII, PCV-13, PCV-15, PCV-20, PCV-21, PCV24, PPSV-23) and the non-vaccine-covered serotypes stratified by age. RESULTS: 690 IPD cases were included. In children ≤5 y/o, of the approved vaccines PCV-20 showed the most theoretical protection (71.3 % [149/209]), while in adults aged 18-64 y/o was PCV-20 (61.8 % [164/265]), and in those ≥65 y/o was PPSV-23 (58.1 % [100/172]) followed by PCV-20 (55.2 % [95/172]). The non-covered serotypes represented one-third of the cohort (33.9 % [234/690]), being 6C (20.5 % [48/234]), 15A (12.8 % [30/234]), and 23A (11.5 % [27/234]) the most prevalent. CONCLUSION: Introducing PCV-20 for children and PCV-20 along with a PPSV-23 booster in adults may reduce IPD frequency in all ages in Colombia. The inclusion of non-covered serotypes is required for future vaccines.
Assuntos
Infecções Pneumocócicas , Streptococcus pneumoniae , Adulto , Criança , Humanos , Lactente , Colômbia/epidemiologia , Estudos Retrospectivos , Vacinação , Vacinas Conjugadas/uso terapêutico , Vacinas Pneumocócicas/uso terapêutico , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , SorogrupoRESUMO
Around one-third of patients diagnosed with COVID-19 develop a severe illness that requires admission to the Intensive Care Unit (ICU). In clinical practice, clinicians have learned that patients admitted to the ICU due to severe COVID-19 frequently develop ventilator-associated lower respiratory tract infections (VA-LRTI). This study aims to describe the clinical characteristics, the factors associated with VA-LRTI, and its impact on clinical outcomes in patients with severe COVID-19. This was a multicentre, observational cohort study conducted in ten countries in Latin America and Europe. We included patients with confirmed rtPCR for SARS-CoV-2 requiring ICU admission and endotracheal intubation. Only patients with a microbiological and clinical diagnosis of VA-LRTI were included. Multivariate Logistic regression analyses and Random Forest were conducted to determine the risk factors for VA-LRTI and its clinical impact in patients with severe COVID-19. In our study cohort of 3287 patients, VA-LRTI was diagnosed in 28.8% [948/3287]. The cumulative incidence of ventilator-associated pneumonia (VAP) was 18.6% [610/3287], followed by ventilator-associated tracheobronchitis (VAT) 10.3% [338/3287]. A total of 1252 bacteria species were isolated. The most frequently isolated pathogens were Pseudomonas aeruginosa (21.2% [266/1252]), followed by Klebsiella pneumoniae (19.1% [239/1252]) and Staphylococcus aureus (15.5% [194/1,252]). The factors independently associated with the development of VA-LRTI were prolonged stay under invasive mechanical ventilation, AKI during ICU stay, and the number of comorbidities. Regarding the clinical impact of VA-LRTI, patients with VAP had an increased risk of hospital mortality (OR [95% CI] of 1.81 [1.40-2.34]), while VAT was not associated with increased hospital mortality (OR [95% CI] of 1.34 [0.98-1.83]). VA-LRTI, often with difficult-to-treat bacteria, is frequent in patients admitted to the ICU due to severe COVID-19 and is associated with worse clinical outcomes, including higher mortality. Identifying risk factors for VA-LRTI might allow the early patient diagnosis to improve clinical outcomes.Trial registration: This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.
Assuntos
Bronquite , COVID-19 , Pneumonia Associada à Ventilação Mecânica , Infecções Respiratórias , Humanos , Estudos Prospectivos , COVID-19/complicações , SARS-CoV-2 , Respiração Artificial/efeitos adversos , Infecções Respiratórias/complicações , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Bronquite/tratamento farmacológico , Ventiladores Mecânicos/efeitos adversos , Fatores de Risco , Unidades de Terapia IntensivaRESUMO
BACKGROUND: Acute respiratory illness (ARI) remains the leading cause of global morbidity. Its primary etiology is viral; nevertheless, viral pathogen identification is limited. Clinical information about Latin America's viral etiology, outcomes, and severity is unknown. This study aims to identify the clinical burden of respiratory viral infections, severity, and adult outcomes. METHODS: This multicentric, population-based study was conducted through the Health Institute of Bogotá, Colombia, including adult patients diagnosed with ARI between 2013 and 2019. Data collection followed ARI public health surveillance program. Incidence, etiological pathogens, and mortality were calculated. RESULTS: A total of 2304 patients were included in the study. ARI was most frequently reported in 2018 (23.3% [538/2304]). Incidence varies between years, maintaining a range between 3.5 and 8.4. The most frequent clinical diagnosis was pneumonia in 59.1%. Etiological viral detection was obtained in 21.5% of patients [495/2304], principally by Influenza A. Mortality was 21.8%, and ICU admission was 7.3%. The type of event did not predict the causative pathogen, disease severity, or mortality. CONCLUSIONS: ARI is a leading cause of morbidity and mortality in Colombia. ARI incidence varies per year and is caused mainly by Influenza A. The classification used in the surveillance program does not correlate with viral etiology, disease severity, and mortality.
Assuntos
COVID-19 , Influenza Humana , Infecções Respiratórias , Adulto , Humanos , Colômbia/epidemiologia , Incidência , Influenza Humana/epidemiologia , Prevalência , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , COVID-19/epidemiologia , PandemiasRESUMO
The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use.
Assuntos
COVID-19 , Hospitalização , Humanos , Pandemias , Estudos Prospectivos , SARS-CoV-2RESUMO
INTRODUCTION: Turtles can be hosts of Salmonella enterica serovars which can cause disease both in the animals themselves and in people they come into contact with, especially when the turtles are kept as pets. To investigate the prevalence of Salmonella in turtles in Colombia, we studied animals at a wildlife protection centre. The turtles had either been confiscated or donated to the centre. METHODOLOGY: Detection of Salmonella spp. was conducted in feces samples using bacteriological cultures and polymerase chain reaction to identify genus and serovar. RESULTS: By PCR and culture, 30/110 samples (27%) were positive while by PCR alone eight further samples were positive (total of 38/110 (35%) positive). The most common serovar was S. Enteritidis (26/38 (68%) with only one isolate being S. Typhimurium (3%). Four (11%) samples were positive for both serovars and seven (18%) could only be identified as Salmonella enterica spp. CONCLUSIONS: These results show that turtles in Colombia are commonly infected with Salmonella and are a risk for infection to people who come into contact with them.