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Publications (15)16.19 Total impact

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    ABSTRACT: The presence of respiratory fungal infection in the critically ill patient is associated with high morbidity and mortality. To assess the incidence of respiratory infection caused by Aspergillus spp. independently of the origin of infection in patients admitted to Spanish ICUs, as well as to describe the rates, characteristics, outcomes and prognostic factors in patients with this type of infection. An observational, retrospective, open-label and multicenter study was carried out in a cohort of patients with respiratory infection caused by Aspergillus spp. admitted to Spanish ICUs between 2006 and 2012 (months of April, May and June), and included in the ENVIN-HELICS registry (108,244 patients and 825,797 days of ICU stay). Variables independently related to in-hospital mortality were identified by multiple logistic regression analysis. A total of 267 patients from 79 of the 198 participating ICUs were included (2.46 cases per 1000 ICU patients and 3.23 episodes per 10,000 days of ICU stay). From a clinical point of view, infections were classified as ventilator-associated pneumonia in 93 cases (34.8%), pneumonia unrelated to mechanical ventilation in 120 cases (44.9%), and tracheobronchitis in 54 cases (20.2%). The study population included older patients (mean 64.8±17.1 years), with a high severity level (APACHE II score 22.03±7.7), clinical diseases (64.8%) and prolonged hospital stay before the identification of Aspergillus spp. (median 11 days), transferred to the ICU mainly from hospital wards (58.1%) and with high ICU (57.3%) and hospital (59.6%) mortality rates, exhibiting important differences depending on the type of infection involved. Independent mortality risk factors were previous admission to a hospital ward (OR=7.08, 95%CI: 3.18-15.76), a history of immunosuppression (OR=2.52, 95%CI: 1.24-5.13) and severe sepsis or septic shock (OR=8.91, 95%CI: 4.24-18.76). Respiratory infections caused by Aspergillus spp. in critically ill patients admitted to the ICU in Spain are infrequent, and affect a very selected group of patients, characterized by high mortality and conditioned by non-modifiable risk factors.
    Medicina Intensiva 04/2014; · 1.32 Impact Factor
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    ABSTRACT: The presence of respiratory fungal infection in the critically ill patient is associated with high morbidity and mortality. Objectives To assess the incidence of respiratory infection caused by Aspergillus spp. independently of the origin of infection in patients admitted to Spanish ICUs, as well as to describe the rates, characteristics, outcomes and prognostic factors in patients with this type of infection. Material and methods An observational, retrospective, open-label and multicenter study was carried out in a cohort of patients with respiratory infection caused by Aspergillus spp. admitted to Spanish ICUs between 2006 and 2012 (months of April, May and June), and included in the ENVIN-HELICS registry (108,244 patients and 825,797 days of ICU stay). Variables independently related to in-hospital mortality were identified by multiple logistic regression analysis. Results A total of 267 patients from 79 of the 198 participating ICUs were included (2.46 cases per 1000 ICU patients and 3.23 episodes per 10,000 days of ICU stay). From a clinical point of view, infections were classified as ventilator-associated pneumonia in 93 cases (34.8%), pneumonia unrelated to mechanical ventilation in 120 cases (44.9%), and tracheobronchitis in 54 cases (20.2%). The study population included older patients (mean 64.8 ± 17.1 years), with a high severity level (APACHE II score 22.03 ± 7.7), clinical diseases (64.8%) and prolonged hospital stay before the identification of Aspergillus spp. (median 11 days), transferred to the ICU mainly from hospital wards (58.1%) and with high ICU (57.3%) and hospital (59.6%) mortality rates, exhibiting important differences depending on the type of infection involved. Independent mortality risk factors were previous admission to a hospital ward (OR = 7.08, 95%CI: 3.18-15.76), a history of immunosuppression (OR = 2.52, 95%CI: 1.24-5.13) and severe sepsis or septic shock (OR = 8.91, 95%CI: 4.24-18.76). Conclusions Respiratory infections caused by Aspergillus spp. in critically ill patients admitted to the ICU in Spain are infrequent, and affect a very selected group of patients, characterized by high mortality and conditioned by non-modifiable risk factors.
    Medicina Intensiva 01/2014; · 1.32 Impact Factor
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    ABSTRACT: In recent years, changes have occurred in the setting of bacteriemia related with the use of vascular catheters (BVC) and with the appearance of multiresistant gram positive cocci (MR-GPC), knowledge of the limitations regarding the antibiotics used most for their treatment (glycopeptides) and the appearance of new antibiotics active against these pathogens. This article analyzes the evolution of the rates, etiologies and markers of multiresistance of the most common pathogens in the BVC (including the primary bacteriemias) in the Spanish Intensive Medicine Departments (ICU). A multicenter, prospective, observational study of incidence, with voluntary participation, was conducted. A total of 74, 105, 112 and 121 ICUs belonging to 71, 97, 103 and 112 hospitals, respectively, collaborated including the years 2005-2008. The information included in the ENVIN-HELICS registry was used. The rates of this complication have decreased and are now at about 5 episodes per 1,000 days of central venous catheter (CVC). One third of the episodes occur with significant systemic response (severe sepsis or septic shock). The MR-GPC were the most frequent, however Gram-negative bacilli (GNB) were identified in 30% of the cases and fungi (different species of Candida) in 6%. Staphylococcus epidermidis and coagulase-negative, methicillin-resistant staphylococci (CNS) persist in a proportion greater than 80%, while methicillin-resistance S. aureus have decreased to less than 40%. The empirical treatment in situations of extreme seriousness should consider coverage of the most frequent pathogens such as the MR-GPC and GNB and in special conditions, the fungi.
    Medicina Intensiva 10/2010; 34(7):437-45. · 1.32 Impact Factor
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    ABSTRACT: Objective In recent years, changes have occurred in the setting of bacteriemia related with the use of vascular catheters (BVC) and with the appearance of multiresistant gram positive cocci (MR-GPC), knowledge of the limitations regarding the antibiotics used most for their treatment (glycopeptides) and the appearance of new antibiotics active against these pathogens. This article analyzes the evolution of the rates, etiologies and markers of multiresistance of the most common pathogens in the BVC (including the primary bacteriemias) in the Spanish Intensive Medicine Departments (ICU).
    Medicina Intensiva 01/2010; 34(7):437-445. · 1.32 Impact Factor
  • P M Olaechea Astigarraga, S Grau Cerrato, F Alvarez-Lerma, J Garnacho-Montero
    Medicina Intensiva 05/2008; 32(3):154-5. · 1.32 Impact Factor
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    ABSTRACT: In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired-infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients.
    Enfermedades Infecciosas y Microbiología Clínica 08/2007; 25(7):446–466. · 1.48 Impact Factor
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    ABSTRACT: In recent years there has been an increase in infections caused by gram-positive cocci in critical patients, together with a rapid development of resistance to the antibiotics which are normally used to treat them. The objective is to prepare an antibiotic treatment guide for the most common infections caused by gram positive cocci in critical patients. This guide will help in the decision-making process regarding the care of such patients. Experts from two scientific societies worked together to prepare a consensus document. They were members of the Study Group on Infections in Critical Patients (GEIPC), which is part of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and the Infectious Diseases Working Group (GTEI), belonging to the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC). There was a systematic review of the literature published up to September 2006 regarding this type of infections and the antibiotic treatments marketed to that date. An evidence grading system was applied according to the strength of the recommendation (categories A, B or C) and the level of evidence (categories I, II or III). Recommendations were given if there was consensus among the experts from both societies. The antibiotic regimens recommended for treating infections caused by gram-positive cocci were presented in the form of tables, showing the recommendation grade. Alternatives were given for allergic patients. The scientific basis supporting the aforementioned recommendations is explained within the text and the references upon which they are based are cited. A summary of an evidence-based practical guide for the treatment of infections caused by gram-positive cocci in critical patients is presented.
    Farmacia Hospitalaria 01/2007; 31(6):353-69.
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    ABSTRACT: In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Critico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients.
    Medicina Intensiva 01/2007; 31(6):294-317. · 1.32 Impact Factor
  • P M Olaechea Astigarraga, J Garnacho-Montero, Santiago Grau Cerrato
    Enfermedades infecciosas y microbiología clínica, ISSN 0213-005X, Vol. 25, Nº. 7, 2007, pags. 446-466. 01/2007;
  • P M Olaechea Astigarraga, F Alvarez Lerma, E Zaldíbar Enriquez
    Medicina Intensiva 12/2006; 30(8):386-91. · 1.32 Impact Factor
  • P. M. Olaechea Astigarraga, F. Álvarez Lerma, E. Zaldibar Enriquez
    Medicina Intensiva 01/2006; 30(8):386-391. · 1.32 Impact Factor
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    ABSTRACT: ObjetivoLa pancreatitis aguda grave (PAG) no se ha estudiado desde la Medicina Intensiva y menos su manejo integral. El objetivo es consensuar el diagnóstico y tratamiento en una UCI, con todas las Sociedades implicadas y ofrecer unas recomendaciones que uniformicen el manejo integral de las PAG.ÁmbitoEspañol. Pamplona, 11 y 12 de marzo de 2004.ParticipantesIntensivistas nacionales, gastroenterólogos de la Asociación Española de Gastroenterología (AEGE) y Club Español Biliopancreático (CEBP), cirujanos de la Asociación Española de Cirugía, Sección de Infección Quirúrgica (IQ-AEC), radiólogos de la Sociedad Española de Radiología Médica (SERAM), y Sección de Imagen Abdominal (SEDIA) y miembros de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES).Niveles de evidencia y grados de recomendación. Se eligieron las escalas del Oxford Centre for Evidence based Medicine.Elaboración de las recomendacionesSe realizó una convocatoria pública en la que se discutieron todos los temas previamente seleccionados, que se distribuyeron en 4 bloques de preguntas: 1.ª ¿Diagnóstico, criterios precoces de gravedad y de ingreso de las PAG en UCI?. 2.ª ¿Cuáles son las medidas más relevantes y aplicables en el tratamiento del paciente con PAG en UCI?. 3.ª ¿Cuál es el tratamiento actual de la PAG?. 4.ª ¿Qué actitud quirúrgica se debe adoptar ante la PAG con necrosis no-infectada y la sepsis pancreática?Tras la discusión pública el Jurado elaboró un documento de recomendaciones. Este documento fue enviado para su comentario a los miembros del Comité Organizador, a los ponentes y a los asistentes a la Conferencia de Consenso. Por último, las recomendaciones fueron de nuevo discutidas en una sesión pública y abierta en el Congreso Nacional de la SEMICYUC.ConclusionesRecomendaciones en PAG entre las que destacamos: la disminución de la mortalidad de la PAG depende de la estratificación temprana de las formas graves a la puerta del hospital, durante las primeras 48-96 horas y del ingreso precoz en Intensivos. Los pacientes que muestran un progresivo deterioro orgánico, aunque no precisen soporte ventilatorio, deben ingresar en UCI. Cada Centro debe consensuar un protocolo interdisciplinario. Los antibióticos como profilaxis no tienen una base de evidencia potente sólo estarían indicados en las formas necrotizantes y a la espera de un nuevo ensayo doble-ciego con meropenem en marcha. El tratamiento quirúrgico se indica en la necrosis pancreática infectada o absceso identificadas por radiología o punción radiodirigida. El manejo de las formas estériles debe ser conservador.ObjectiveSevere acute pancreatitis (SAP) has not been studied from the point of view of Intensive Medicine and even less its integral management. The objective is to reach a consensus on the diagnosis and treatment in an ICU with all the societies involved and to offer some recommendations that make the integral management of SAP uniform.ScopeSpanish. He took place in Pamplona, the 11-12 March 2004.ParticipantsNational Intensivists, Gastroenterologists of the Spanish Association of Gastroenterology (AEGE) and Biliopancreatic Spanish Club (CEBP), Surgeons of the Spanish Association of Surgery, Surgical Infection Section (IQ-AEC), Radiologists of the Spanish Society of Medical Radiology (SERAM), and Abdominal Image Section (SEDIA) as well as member of the Spanish Society of Urgency and Emergency Medicine (SEMES).Evidence levels and recommendation gradesThe Oxford Centre for Evidence based Medicine scales were chosen.Elaboration of the recommendationsA public examination session was called in which all the previously selected subjects were discussed. They were distributed into 4 blocks of questions: 1) Diagnostic, Early Severity criteria and Admission of SAP in the ICU? 2) What are the most relevant and applicable measures in the treatment of the patients with SAP in the ICU? 3) What is the present treatment of SAP? 4) What surgical attitude should be adopted in the face of SAP with non-infected necrosis and pancreatic sepsis?After the public discussion, the Jury elaborated a recommendations document. This document was sent to the members of the Organizing Committee, to the speakers and those attending the consensus Conference for their comments. Finally, the recommendations were discussed again in a public and open session in the National Congress of SEMICYUC.ConclusionsRecommendations in SAP, among which we emphasize: Decrease in mortality of SAP depends on the early stratifying of the serious forms to the hospital door, during the first 48-96 hours and early admission in Intensive Care. Patient who have a progressive organic deterioration, although they do not require ventilatory support, should be admitted to the ICU. Each Center should agree on an interdisciplinary protocol. Antibiotics as prophylaxis do not have a strong evidence base. They would only be indicated in necrotizing forms and while waiting for a new on-going double blind clinical trial with meropenem. Surgical treatment is indicated in infected pancreatic necrosis or abscess, identified by radiology or radioguided puncture. Management of the sterile forms should be conservative.
    Medicina Intensiva. 07/2005;
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    ABSTRACT: Objective To identify national rates of hospital-acquired infections acquired in ICUs and related to instrumentalization, corresponding to the year 2002, as well as to define their etiologies and the evolution of the resistances of more prevalent microorganisms. Design A study of cases series, observational and prospective. Context Eighty five ICUs, Intensive Care Units departments, or other units where critical patients are admitted, from 80 different hospitals. Patients and methods Patients included were consecutively admitted during more than 24 hours in the participating ICUs, with follow-up to their discharge of ICU or until 30 days post-admission. Infections evaluated were: respirator-associated pneumonias (RAM), urinary tract infections secondary to urethral catheter (UTI), primary bacteremias (PB) and bacteremias related to vascular catheters (BCVC), and secondary bacteremias. Results 6,868 admitted patients were included. In 684 (10%) patients 1,019 infections were detected, 445 RAM (43.7%), 229 UTI (22.5%), 100 PB (9.8%), 135 BCVC (13.2%) and 110 secondary bacteremias (10.8%). The incidence-density with regard to the days of exposure to the risk factor were 18.0 RAM for 1,000 days of respirator, 6.0 UTI for 1,000 days of urethral catheter, and 4.5 BCVC for 1,000 days of central venous catheter. Predominant etiologies in early RAM were methicillin sensitive Staphylococcus aureus and Haemophilus influenzae, and in late RAM were Pseudomonas aeruginosa and Acinetobacter baumannii. Escherichia coli and Enterococcus faecalis were the predominant etiology in UTI, and Staphylococcus epidermidis and coagulase-negative Staphylococcus in BCVC. Among the resistance markers pointed out because of their frequency: P. aeruginosa resistant to imipenem-cilastatin (34.7%) and to ceftazidime (29.5%); S. aureus resistant to methicillin (35.3%); A. baumannii resistant to imipenem (33.9%), and E. coli resistant to ciprofloxacin (20.0%). No Enterococcus spp. or Staphylococcus aureus strains resistant to vancomycin were detected. Conclusions In this study we have been identified for the year 2002 the national rates of hospital-acquired infections related to respirator, urethral catheter, and central venous catheter, as well as the pathogens that predominate in each one and the state of the markers of multiple resistance.
    Medicina Intensiva 01/2005; 29(1):1-12. · 1.32 Impact Factor
  • Pedro M. Olaechea Astigarraga, Josu Insausti OrdeÑana
    Medicina Intensiva 26(9):448–451. · 1.32 Impact Factor
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    ABSTRACT: In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired-infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients.
    Enfermedades Infecciosas y Microbiología Clínica 25(7):446-66. · 1.48 Impact Factor