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Publications (3)11.21 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare antibiotic prescribing practices and survival in the intensive care unit (ICU) in pneumococcal severe community-acquired pneumonia (SCAP) between 2000 and 2013. Matched case-control study of two prospectively recorded cohorts in Europe. Eighty patients from CAPUCI II (cases) were matched with 80 patients from CAPUCI I (controls) based on: shock at admission, need of mechanical ventilation, COPD, immunosuppression and age. Demographic data were comparable in the two groups. Combined antibiotic therapy increased from 66.2% to 87.5% (p <0.01) and first dose of antibiotic was given within 3 hours from 27.5% to 70% (p <0.01). ICU mortality was significantly lower (OR 0.82, 95%CI 0.68-0.98) in cases, both in the whole population and in the subgroups of patients with shock (OR 0.67, 95%CI 0.50-0.89) or under mechanical ventilation (OR 0.73, 95%CI 0.55-0.96). In the multivariate analysis, ICU mortality increased in patients requiring mechanical ventilation (OR 5.23, 95%CI 1.60-17.17), and decreased in patients receiving early antibiotic treatment (OR 0.36, 95%CI 0.15-0.87) and combined therapy (OR 0.19, 95%CI 0.07-0.51). In pneumococcal SCAP, early antibiotic prescription and use of combination therapy increased; both were associated with improved survival.
    Chest 12/2013; · 7.13 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: To compare intensive care unit (ICU) mortality in patients with severe community-acquired pneumonia (SCAP) caused by Legionella pneumophila receiving combined therapy or monotherapy. METHODS: A prospective multicenter study was made, including all patients with sporadic, community-acquired Legionnaires' disease (LD) admitted to the ICU. Admission data and information on the course of the disease were recorded. Antibiotic prescriptions were left to the discretion of the attending physician and were not standardized. RESULTS: Twenty-five cases of SCAP due to L. pneumophila were included, and 7 patients (28%) out of 25 died after a median of 7 days of mechanical ventilation. Fifteen patients (60%) presented shock. Levofloxacin and clarithromycin were the antibiotics most commonly used in monotherapy, while the most frequent combination was rifampicin plus clarithromycin. Patients subjected to combination therapy presented a lower mortality rate versus patients subjected to monotherapy (odds ratio for death [OR] 0.15; 95%CI 0.02-1.04; p=0.08). In patients with shock, this association was stronger and proved statistically significant (OR for death 0.06; 95%CI 0.004-0.86; p=0.04). CONCLUSIONS: Combined antibiotic therapy decreases mortality in patients with SCAP and shock caused by L. pneumophila.
    Medicina Intensiva 07/2012; · 1.32 Impact Factor
  • Anna Sánchez, Simone Gattarello, Jordi Rello
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    ABSTRACT: Hospital-acquired infections are one of the most important challenges to patient safety, especially in critical care units. The use of broad-spectrum antibiotics results frequently in multidrug-resistant pathogens. Therefore, we are attending to increased rates of multidrug-resistant microorganisms, especially gram-negative bacilli, that have been associated with prolonged hospital stays, higher costs, and increased mortality. The most important multidrug-resistant pathogens are PSEUDOMONAS AERUGINOSA and ACINETOBACTER BAUMANNII. There has been an important but as yet unsuccessful effort to develop new drugs to treat these pathogens. Nevertheless, old, very well known drugs, such as polymyxins, administered intravenously and aerosolized, have been revisited. Future options include immunotherapy or the continuous infusion of antibiotics. It is also important to emphasize the rational use of antibiotics to diminish the appearance of multiresistant pathogens.
    Seminars in Respiratory and Critical Care Medicine 04/2011; 32(2):151-8. · 2.75 Impact Factor