Predictores clínicos de bacteriemia en adultos inmunocompetentes hospitalizados por neumonía adquirida en la comunidad

P, Fernando Saldías; B, Tomás Reyes; B, Josefina Sáez; M, Carmen Rain; C, Pamela Illanes; Briceño, Catalina; P, Orlando Díaz

doi:10.4067/s0034-98872015000500001

Cited by 4 publications

(3 citation statements)

References 34 publications

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“…Because samples for the investigation of the etiological agent are not always collected, pathogens are detected in only one third of all cases of community-acquired pneumonia (CAP) [ 15 ] and, due to limitations in the sensitivity and specificity of the available diagnostic test, the cause of pneumonia cannot be identified in most hospitalized patients [ 16 ]. Therefore, CAP is an outcome of public health relevance that does not depend on the etiologic diagnosis, and thus the study of PPSV23 vaccine effectiveness (VE) against hospitalized cases of CAP may be considered a proxy of VE against pneumococcal pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain

et al. 2017

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Pneumococcal pneumonia is a serious cause of morbidity and mortality in the elderly, but investigation of the etiological agent of community-acquired pneumonia (CAP) is not possible in most hospitalized patients. The aim of this study was to estimate the effect of pneumococcal polysaccharide vaccination (PPSV23) in preventing CAP hospitalization and reducing the risk of intensive care unit admission (ICU) and fatal outcomes in hospitalized people aged ≥65 years. We made a multicenter case-control study in 20 Spanish hospitals during 2013–2014 and 2014–2015. We selected patients aged ≥65 years hospitalized with a diagnosis of pneumonia and controls matched by sex, age and date of hospitalization. Multivariate analysis was performed using conditional logistic regression to estimate vaccine effectiveness and unconditional logistic regression to evaluate the reduction in the risk of severe and fatal outcomes. 1895 cases and 1895 controls were included; 13.7% of cases and 14.4% of controls had received PPSV23 in the last five years. The effectiveness of PPSV23 in preventing CAP hospitalization was 15.2% (95% CI -3.1–30.3). The benefit of PPSV23 in avoiding ICU admission or death was 28.1% (95% CI -14.3–56.9) in all patients, 30.9% (95% CI -32.2–67.4) in immunocompetent patients and 26.9% (95% CI -38.6–64.8) in immunocompromised patients. In conclusion, PPSV23 showed a modest trend to avoidance of hospitalizations due to CAP and to the prevention of death or ICU admission in elderly patients hospitalized with a diagnosis of CAP.

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Section: Introductionmentioning

confidence: 99%

Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain

et al. 2017

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“…In this study, patients with negative and positive cultures had a similar presence of clinical factors that indicate disease severity, while in our study there was a tendency to greater severity in patients with negative cultures. Saldías et al, 23 in a cohort of 605 immunocompetent adults with community-acquired pneumonia, compared the clinical and laboratory characteristics with the risk of having bacteremia. The mortality of patients with positive blood cultures was similar to those who had negative blood cultures, that is, 9 (11.8%) cases versus 56 (10.6%) cases, respectively, with no difference in hospital stay (median: 7 days, interquartile range: 5-11 in both groups), equal to the previous study without differences in factors indicating greater severity of the disease.…”

Section: Discussionmentioning

confidence: 99%

Positive Culture and Prognosis in Patients With Sepsis: A Prospective Cohort Study

Molina

Castaño

Plaza

et al. 2018

J Intensive Care Med

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Purpose: To analyze the prognostic role of positive cultures in patients with sepsis. Methods: A prospective cohort study in a tertiary referral hospital in Medellín, Colombia. Adults older than 18 years of age with a bacterial infection diagnosis according to Centers for Disease Control criteria and sepsis (evidence of organ dysfunction) were included. A logistic regression model was used to determine the association between positive cultures and hospital mortality, and a Cox regression with a competing risk modeling approach was used to determine the association between positive cultures and hospital stay as well as secondary infections. Results: Overall, 408 patients had positive cultures, of which 257 were blood culture, and 153 had negative cultures. Patients with positive cultures had a lower risk of mortality (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.27-0.68), but this association was not maintained after adjusting for confounding factors (OR, 0.56; 95% CI, 0.31-1.01). No association was found with the hospital stay (adjusted subhazard ratio [SHR], 1.06; 95% CI, 0.83-1.35). There was no association between positive cultures and the presence of secondary infections (adjusted SHR, 0.99; 95% CI, 0.58-1.71). Conclusion: Positive cultures are not associated with prognosis in patients with sepsis.

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“…En los estudios clínicos, usualmente la bacteriemia se identificó en menos de 13% de los pacientes incluidos; un meta-análisis de dichos estudios no encontró deferencias en la mortalidad entre los pacientes con tratamiento largo vs tratamiento cortos 33 . Un estudio en Chile confirmó lo mencionado, con una frecuencia de bacteriemia de 12,6%, más frecuentemente causada por S. pneumoniae o Haemophilus influenzae, y con una mayor frecuencia de alteraciones hemodinámicas o de marcadores de gravedad 34 .…”

Section: Infectología Al Díaunclassified

Duración del tratamiento y administración oral de antimicrobianos en neumonía adquirida en la comunidad

Bernal-Vargas

Cortés

2016

Rev. chil. infectol.

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Community acquired pneumonia (CAP) is an important cause of morbidity and mortality around the world, with high treatment costs due to hospitalization and complications (adverse events due to medications, antibiotic resistance, healthcare associated infections, etc.). It has been proposed administration of short courses and early switch of intravenous administration to oral therapy to avoid costs and complications. There are recommendations about these topics in national and intemational guidelines, based on clinical trials which do not demónstrate diffe-rences in mortality and complications when there is an early change from intravenous administration to the oral route. There are no statistically significant differences in safety and resolution of the disease when short and long treatment schemes were compared. In this review we present the most important guidelines and clinical studies, taking into account the pharmacological differences between different medications. It is considered that early switch from intravenous to oral administration route and use of short cycles in CAP is safe and brings benefits to patients and institutions.

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Predictores clínicos de bacteriemia en adultos inmunocompetentes hospitalizados por neumonía adquirida en la comunidad

Abstract: Blood cultures do not contribute significantly to the initial management of patients hospitalized for community-acquired pneumonia. The main clinical predictors of bacteremia were antibiotic use, hypotension, renal dysfunction and systemic inflammation.

Cited by 4 publications

References 34 publications

Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain

Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain

Positive Culture and Prognosis in Patients With Sepsis: A Prospective Cohort Study

Duración del tratamiento y administración oral de antimicrobianos en neumonía adquirida en la comunidad

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