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  • 1
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    Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study
    Springer Science and Business Media LLC ; 2023
    In:  Scientific Reports Vol. 13, No. 1 ( 2023-04-21)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2023-04-21)
    Kurzfassung: 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.
    Materialart: Online-Ressource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-023-32265-5
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2023
    ZDB Id: 2615211-3
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  • 2
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    Clinical characteristics, systemic complications, and in-hospital outcomes for patients with COVID-19 in Latin America. LIVEN-Covid-19 study: A prospective, multicenter, multinational, cohort study
    Public Library of Science (PLoS) ; 2022
    In:  PLOS ONE Vol. 17, No. 3 ( 2022-3-31), p. e0265529-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 17, No. 3 ( 2022-3-31), p. e0265529-
    Kurzfassung: The COVID-19 pandemic has spread worldwide, and almost 396 million people have been infected around the globe. Latin American countries have been deeply affected, and there is a lack of data in this regard. This study aims to identify the clinical characteristics, in-hospital outcomes, and factors associated with ICU admission due to COVID-19. Furthermore, to describe the functional status of patients at hospital discharge after the acute episode of COVID-19. Material and methods This was a prospective, multicenter, multinational observational cohort study of subjects admitted to 22 hospitals within Latin America. Data were collected prospectively. Descriptive statistics were used to characterize patients, and multivariate regression was carried out to identify factors associated with severe COVID-19. Results A total of 3008 patients were included in the study. A total of 64.3% of patients had severe COVID-19 and were admitted to the ICU. Patients admitted to the ICU had a higher mean (SD) 4C score (10 [3] vs. 7 [3)] , p 〈 0.001). The risk factors independently associated with progression to ICU admission were age, shortness of breath, and obesity. In-hospital mortality was 24.1%, whereas the ICU mortality rate was 35.1%. Most patients had equal self-care ability at discharge 43.8%; however, ICU patients had worse self-care ability at hospital discharge (25.7% [497/1934] vs. 3.7% [40/1074] , p 〈 0.001). Conclusions This study confirms that patients with SARS CoV-2 in the Latin American population had a lower mortality rate than previously reported. Systemic complications are frequent in patients admitted to the ICU due to COVID-19, as previously described in high-income countries.
    Materialart: Online-Ressource
    ISSN: 1932-6203
    URL: Article
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    DOI: 10.1371/journal.pone.0265529
    DOI: 10.1371/journal.pone.0265529.g001
    DOI: 10.1371/journal.pone.0265529.g002
    DOI: 10.1371/journal.pone.0265529.t001
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    Sprache: Englisch
    Verlag: Public Library of Science (PLoS)
    Publikationsdatum: 2022
    ZDB Id: 2267670-3
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  • 3
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    Invasive pneumococcal disease burden in hospitalized adults in Bogota, Colombia
    Springer Science and Business Media LLC ; 2021
    In:  BMC Infectious Diseases Vol. 21, No. 1 ( 2021-12)
    Details
    In: BMC Infectious Diseases, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Kurzfassung: The incidence of invasive pneumococcal disease (IPD) varies depending on a number of factors, including vaccine uptake, in both children and adults, the geographic location, and local serotype prevalence. There are limited data about the burden of  Streptococcus pneumoniae ( Spn ), serotype distribution, and clinical characteristics of adults hospitalized due to IPD in Colombia. The objectives of this study included assessment of Spn serotype distribution, clinical characteristics, mortality, ICU admission, and the need for mechanical ventilation. Methods This was an observational, retrospective, a citywide study conducted between 2012 and 2019 in Bogotá, Colombia. We analyzed reported positive cases of IPD from 55 hospitals in a governmental pneumococcal surveillance program. Pneumococcal strains were isolated in each hospital and typified in a centralized laboratory. This is a descriptive study stratified by age and subtypes of IPD obtained through the analysis of medical records. Results A total of 310 patients with IPD were included, of whom 45.5% were female. The leading cause of IPD was pneumonia (60%, 186/310), followed by meningitis. The most frequent serotypes isolated were 19A (13.87%, 43/310) and 3 (11.94%, 37/310). The overall hospital mortality rate was 30.3% (94/310). Moreover, 52.6% (163/310 patients) were admitted to the ICU, 45.5% (141/310) required invasive mechanical ventilation and 5.1% (16/310) non-invasive mechanical ventilation. Conclusion Pneumococcal pneumonia is the most prevalent cause of IPD, with serotypes 19A and 3 being the leading cause of IPD in Colombian adults. Mortality due to IPD in adults continues to be very high.
    Materialart: Online-Ressource
    ISSN: 1471-2334
    URL: Article
    DOI: 10.1186/s12879-021-06769-2
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2021
    ZDB Id: 2041550-3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
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    Streptococcus pneumoniae as a colonizing agent of the Nasopharynx - Oropharynx in adults: A systematic review and meta-analysis
    Elsevier BV ; 2024
    In:  Vaccine Vol. 42, No. 11 ( 2024-04), p. 2747-2757
    Details
    In: Vaccine, Elsevier BV, Vol. 42, No. 11 ( 2024-04), p. 2747-2757
    Materialart: Online-Ressource
    ISSN: 0264-410X
    URL: Article
    DOI: 10.1016/j.vaccine.2024.03.041
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2024
    ZDB Id: 1468474-3
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  • 5
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    Major Adverse Cardiovascular Events During Invasive Pneumococcal Disease Are Serotype Dependent
    Oxford University Press (OUP) ; 2021
    In:  Clinical Infectious Diseases Vol. 72, No. 11 ( 2021-06-01), p. e711-e719
    Details
    In: Clinical Infectious Diseases, Oxford University Press (OUP), Vol. 72, No. 11 ( 2021-06-01), p. e711-e719
    Kurzfassung: Up to 30% of patients admitted to hospitals with invasive pneumococcal disease (IPD) experience major adverse cardiovascular event (MACE) including new/worsening heart failure, new/worsening arrhythmia, and/or myocardial infarction. Streptococcus pneumoniae (Spn) is the most frequently isolated bacterial pathogen among community-acquired pneumonia (CAP) patients and the only etiological agent linked independently to MACE. Nevertheless, no clinical data exist identifying which serotypes of Spn are principally responsible for MACE. Methods This was an observational multicenter retrospective study conducted through the Public Health Secretary of Bogotá, Colombia. We included patients with a confirmed clinical diagnosis of IPD with record of pneumococcal serotyping and clinical information between 2012 and 2019. Spn were serotyped using the quellung method by the National Center of Microbiology. MACE were determined by a retrospective chart review. Results The prevalence of MACE was 23% (71/310) in IPD patients and 28% (53/181) in patients admitted for CAP. The most prevalent S. pneumoniae serotype identified in our study was the 19A, responsible for the 13% (42/310) of IPD in our cohort, of which 21% (9/42) presented MACE. Serotypes independently associated with MACE in IPD patients were serotype 3 (odds ratio [OR] 1, 48; 95% confidence interval [CI] [1.21–2.27]; P = .013) and serotype 9n (OR 1.29; 95% CI [1.08–2.24] ; P = .020). Bacteremia occurred in 87% of patients with MACE. Moreover, serum concentrations of C-reactive protein were elevated in patients with MACE versus in non-MACE patients (mean [standard deviation], 138 [145] vs 73 [106], P = .01). Conclusions MACE are common during IPD with serotype 3 and 9n independently of frequency.
    Materialart: Online-Ressource
    ISSN: 1058-4838 , 1537-6591
    URL: Article
    DOI: 10.1093/cid/ciaa1427
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2021
    ZDB Id: 2002229-3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
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    Comparison of systemic inflammatory profiles in COVID-19 and community-acquired pneumonia patients: a prospective cohort study
    Springer Science and Business Media LLC ; 2023
    In:  Respiratory Research Vol. 24, No. 1 ( 2023-02-22)
    Details
    In: Respiratory Research, Springer Science and Business Media LLC, Vol. 24, No. 1 ( 2023-02-22)
    Kurzfassung: Inflammatory responses contribute to tissue damage in COVID-19 and community-acquired pneumonia (CAP). Although predictive values of different inflammatory biomarkers have been reported in both, similarities and differences of inflammatory profiles between these conditions remain uncertain. Therefore, we aimed to determine the similarities and differences of the inflammatory profiles between COVID-19 and CAP, and their association with clinical outcomes. Methods We report a prospective observational cohort study; conducted in a reference hospital in Latin America. Patients with confirmed COVID-19 pneumonia and CAP were included. Multiplex (Luminex) cytokine assays were used to measure the plasma concentration of 14 cytokines at hospital admission. After comparing similarities and differences in the inflammatory profile between COVID-19 and CAP patients, an unsupervised classification method (i.e., hierarchical clustering) was used to identify subpopulations within COVID-19 and CAP patients. Results A total of 160 patients were included, 62.5% were diagnosed with COVID-19 (100/160), and 37.5% with CAP (60/160). Using the hierarchical clustering, COVID-19 and CAP patients were divided based on its inflammatory profile: pauci, moderate, and hyper-inflammatory immune response. COVID-19 hyper-inflammatory subpopulation had the highest mortality. COVID-19 hyper-inflammatory subpopulation, compared to pauci-inflammatory, had higher levels of IL-10 (median [IQR] 61.4 [42.0–109.4] vs 13.0 [5.0–24.9], P :  〈  0.001), IL-6 (48.1 [22.3–82.6] vs 9.1 [0.1–30.4] , P :  〈  0.001), among others. Hyper-inflammatory vs pauci-inflammatory CAP patients were characterized by elevation of IFN2 (48.8 [29.7–110.5] vs 3.0 [1.7–10.3] , P :  〈  0.001), TNFα (36.3 [24.8–53.4] vs 13.1 [11.3–16.9] , P :  〈  0.001), among others. Hyper-inflammatory subpopulations in COVID-19 and CAP compared to the corresponding pauci-inflammatory subpopulations had higher MCP-1. Conclusions Our data highlights three distinct subpopulations in COVID-19 and CAP, with differences in inflammatory marker profiles and risks of adverse clinical outcomes. Trial registration: This is a prospective study, therefore no health care intervention were applied to participants and trial registration is not applicable.
    Materialart: Online-Ressource
    ISSN: 1465-993X
    URL: Article
    DOI: 10.1186/s12931-023-02352-2
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2023
    ZDB Id: 2041675-1
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  • 7
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    Impact of macrolide treatment on long-term mortality in patients admitted to the ICU due to CAP: a targeted maximum likelihood estimation and survival analysis
    Springer Science and Business Media LLC ; 2023
    In:  Critical Care Vol. 27, No. 1 ( 2023-05-31)
    Details
    In: Critical Care, Springer Science and Business Media LLC, Vol. 27, No. 1 ( 2023-05-31)
    Kurzfassung: Patients with community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU) have high mortality rates during the acute infection and up to ten years thereafter. Recommendations from international CAP guidelines include macrolide-based treatment. However, there is no data on the long-term outcomes of this recommendation. Therefore, we aimed to determine the impact of macrolide-based therapy on long-term mortality in this population. Methods Registered patients in the MIMIC-IV database 16 years or older and admitted to the ICU due to CAP were included. Multivariate analysis, targeted maximum likelihood estimation (TMLE) to simulate a randomised controlled trial, and survival analyses were conducted to test the effect of macrolide-based treatment on mortality six-month (6 m) and twelve-month (12 m) after hospital admission. A sensitivity analysis was performed excluding patients with Pseudomonas aeruginosa or MRSA pneumonia to control for Healthcare-Associated Pneumonia (HCAP). Results 3775 patients were included, and 1154 were treated with a macrolide-based treatment. The non-macrolide-based group had worse long-term clinical outcomes, represented by 6 m [31.5 (363/1154) vs 39.5 (1035/2621), p   〈  0.001] and 12 m mortality [39.0 (450/1154) vs 45.7 (1198/2621), p   〈  0.001]. The main risk factors associated with long-term mortality were Charlson comorbidity index, SAPS II, septic shock, and respiratory failure. Macrolide-based treatment reduced the risk of dying at 6 m [HR (95% CI) 0.69 (0.60, 0.78), p   〈  0.001] and 12 m [0.72 (0.64, 0.81), p   〈  0.001]. After TMLE, the protective effect continued with an additive effect estimate of − 0.069. Conclusion Macrolide-based treatment reduced the hazard risk of long-term mortality by almost one-third. This effect remains after simulating an RCT with TMLE and the sensitivity analysis for the HCAP classification.
    Materialart: Online-Ressource
    ISSN: 1364-8535
    URL: Article
    DOI: 10.1186/s13054-023-04466-x
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2023
    ZDB Id: 2051256-9
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  • 8
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    Major adverse cardiovascular events are associated with necroptosis during severe COVID-19
    Springer Science and Business Media LLC ; 2023
    In:  Critical Care Vol. 27, No. 1 ( 2023-04-20)
    Details
    In: Critical Care, Springer Science and Business Media LLC, Vol. 27, No. 1 ( 2023-04-20)
    Kurzfassung: The mechanisms used by SARS-CoV-2 to induce major adverse cardiac events (MACE) are unknown. Thus, we aimed to determine if SARS-CoV-2 can induce necrotic cell death to promote MACE in patients with severe COVID-19. Methods This observational prospective cohort study includes experiments with hamsters and human samples from patients with severe COVID-19. Cytokines and serum biomarkers were analysed in human serum. Cardiac transcriptome analyses were performed in hamsters' hearts. Results From a cohort of 70 patients, MACE was documented in 26% (18/70). Those who developed MACE had higher Log copies/mL of SARS-CoV-2, troponin-I, and pro-BNP in serum. Also, the elevation of IP-10 and a major decrease in levels of IL-17ɑ, IL-6, and IL-1rɑ were observed. No differences were found in the ability of serum antibodies to neutralise viral spike proteins in pseudoviruses from variants of concern. In hamster models, we found a stark increase in viral titters in the hearts 4 days post-infection. The cardiac transcriptome evaluation resulted in the differential expression of ~ 9% of the total transcripts. Analysis of transcriptional changes in the effectors of necroptosis (mixed lineage kinase domain-like, MLKL) and pyroptosis (gasdermin D) showed necroptosis, but not pyroptosis, to be elevated. An active form of MLKL (phosphorylated MLKL, pMLKL) was elevated in hamster hearts and, most importantly, in the serum of MACE patients. Conclusion SARS-CoV-2 identification in the systemic circulation is associated with MACE and necroptosis activity. The increased pMLKL and Troponin-I indicated the occurrence of necroptosis in the heart and suggested necroptosis effectors could serve as biomarkers and/or therapeutic targets. Trial registration Not applicable.
    Materialart: Online-Ressource
    ISSN: 1364-8535
    URL: Article
    DOI: 10.1186/s13054-023-04423-8
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2023
    ZDB Id: 2051256-9
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  • 9
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    508. Prevalence of nasopharyngeal colonization by Staphylococcus aureus in adults with chronic diseases in Colombia.
    Oxford University Press (OUP) ; 2022
    In:  Open Forum Infectious Diseases Vol. 9, No. Supplement_2 ( 2022-12-15)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 9, No. Supplement_2 ( 2022-12-15)
    Kurzfassung: Staphylococcus aureus is a significant cause of morbidity and mortality worldwide. It is responsible for many infections, especially soft tissues, and bacteremia. S. aureus is also a commensal microorganism in humans, usually found in the nasopharynx. Colonized subjects, especially adults with comorbidities, have a higher risk of developing clinical infections such as community-acquired pneumonia (CAP). Some researchers have hypothesized that nasopharyngeal colonization is the etiology that could predict the etiology of CAP. Therefore, the objective of this study was to establish the prevalence of nasopharyngeal colonization by S. aureus in adults with comorbidities in a Colombian cohort. Methods This was a multicenter prospective cohort study in 3 centers in Colombia, conducted between December 2020 and March 2021. Patients older than 18 years with a diagnosis of chronic disease were included. Subjects with evidence or diagnosis of CAP before 90 days and subjects admitted to hospitalization during the last seven days were excluded. Nasopharyngeal aspirate (NPA) sampling in each participant according to WHO guidelines. A seeding of 100 ¼L of NPA by counting method on blood agar. The colonies in these cultures were identified by MALDI-TOF. Results NPAs were obtained in 810 subjects. S. aureus was isolated in 16.9% [137/810] of participants, with an average concentration of 148 CFU/100 µL [IQR 1 – 5500] . All the obtained colonies were confirmed by MALDI-TOFF. Patients had a mean age of 61.4 years [IQR 26 – 98], and 48.7% [67/137] were women. All of the subjects presented at least one comorbidity (51,1% [70/137] Arterial hypertension, 21,9% [30/137] chronic kidney disease, 16,8% [23/137] Diabetes and Heart failure). Notably, only 5.8% [8/137] developed pneumonia during the first six months of follow-up. Conclusion Our results confirm that S. aureus is a prevalent microorganism that colonizes the nasopharynx in adults with comorbidities. We will follow up with the patients for two years to determine if the nasopharyngeal colonization due to S. aureus is a risk factor for developing CAP. Disclosures All Authors: No reported disclosures.
    Materialart: Online-Ressource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofac492.564
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2022
    ZDB Id: 2757767-3
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  • 10
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    2186. Risk Factors to predict one-year Community-Acquired Pneumonia in a Low-Middle Income Country: A Prospective Cohort Study
    Oxford University Press (OUP) ; 2022
    In:  Open Forum Infectious Diseases Vol. 9, No. Supplement_2 ( 2022-12-15)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 9, No. Supplement_2 ( 2022-12-15)
    Kurzfassung: Community-acquired pneumonia (CAP) is the principal cause of mortality due to infectious diseases globally. Some risk factors have been identified for CAP, such as age, smoking, environmental exposures, malnutrition, previous CAP, chronic bronchitis/chronic obstructive pulmonary disease (COPD), asthma, functional impairment, poor dental health, and immunosuppressive therapy, among others. However, these studies were conducted in high-income countries and patients without comorbid conditions. Therefore, we aimed to identify the risk factors associated with CAP development within a one-year follow-up in a prospective cohort of patients with comorbid conditions in Colombia. Table 1.Logistic Regression Analysis Methods This prospective cohort of adult patients with chronic comorbidities between 2020-and 2022 in Bogotá, Colombia. Univariate analysis and multivariate logistic regression model were developed to identify the variables associated with CAP development within a one-year follow-up. The logistic regression model included variables with a p-value & lt;0.20 in the univariate analysis. Results A total of 810 patients were included in the program. Median [IQR] age was 63 [53-62] and the most common comorbidities were 52.2% [423/810] arterial hypertension, 21.7% [176/810] coronary disease, and 19.0% [154/810] congestive heart failure. To date, 678 follow-ups have been made. Thirty-four patients died before the 6-month follow-up, and 46 were lost, leaving 598 patients included in the analysis. The cumulative incidence of CAP was 4.3% [26/598] during one year. After adjusting the logistic regression model, the main risk factors associated with pneumonia development were COPD [OR 4.30, 95% CI 1.66-11.11, p & lt; 0.01], and previous antibiotic treatment [OR 4.08, 95% CI 1.08-15.29, p=0.04] (Table 1). Conclusion Patients with a history of COPD or previous antibiotic treatment have a more than 300% higher risk of developing pneumonia within one year. Robust vaccination programs for adults are needed in Colombia. Disclosures All Authors: No reported disclosures.
    Materialart: Online-Ressource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofac492.1805
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2022
    ZDB Id: 2757767-3
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