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1. Association of COVID-19-Associated Pulmonary Aspergillosis with Cytomegalovirus Replication: A Case–Control Study

Author

Jorge Calderón-Parra, Victor Moreno-Torres, Patricia Mills-Sanchez, Sandra Tejado-Bravo, Isabel Romero-Sánchez, Bárbara Balandin-Moreno, Marina Calvo-Salvador, Francisca Portero-Azorín, Sarela García-Masedo, Elena Muñez-Rubio, Antonio Ramos-Martinez, and Ana Fernández-Cruz

Subjects
Microbiology (medical), COVID-associated pulmonary aspergillosis, CAPA, prevalence, risk factors, cytomegalovirus infection, Plant Science, Ecology, Evolution, Behavior and Systematics
Abstract

Introduction: Cytomegalovirus (CMV) infection is a well-known factor associated with invasive aspergillosis in immunocompromised hosts. However, its association with COVID-19-associated pulmonary aspergillosis (CAPA) has not been described. We aimed to examine the possible link between CMV replication and CAPA occurrence. Methods: A single-center, retrospective case–control study was conducted. A case was defined as a patient diagnosed with CAPA according to 2020 ECMM/ISHAM consensus criteria. Two controls were selected for each case among critically ill COVID-19 patients. Results: In total, 24 CAPA cases were included, comprising 14 possible CAPA and 10 probable CAPA. Additionally, 48 matched controls were selected. CMV replication was detected more frequently in CAPA than in controls (75.0% vs. 35.4%, p = 0.002). Probable CMV end-organ disease was more prevalent in CAPA (20.8% vs. 4.2%, p = 0.037). After adjusting for possible confounding factors, CMV replication persisted strongly associated with CAPA (OR 8.28 95% CI 1.90–36.13, p = 0.005). Among 11 CAPA cases with CMV PCR available prior to CAPA, in 9 (81.8%) cases, CMV replication was observed prior to CAPA diagnosis. Conclusions: Among critically ill COVID-19 patients, CMV replication was associated with CAPA and could potentially be considered a harbinger of CAPA. Further studies are needed to confirm this association.

Published
2022
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2. Multicenter study of ceftolozane/tazobactam for treatment of Pseudomonas aeruginosa infections in critically ill patients

Author

Bárbara Balandin, Marta Chicot, Vicente Pintado, Cruz Soriano-Cuesta, Loreto López-Vergara, Daniel Ballesteros, Reyes Iranzo, Milagros Sancho-Gonzalez, Inamculada Fernández-Simón, Ana Royuela, Rafael Ruiz de Luna, Maria José Asensio-Martín, Alberto Silva, Fernando Martínez-Sagasti, Maria José Pérez-Pedrero, and Diego Rodriguez-Serrano

Subjects
Adult, Male, 0301 basic medicine, Microbiology (medical), Tazobactam, medicine.medical_specialty, Combination therapy, medicine.drug_class, Critical Illness, 030106 microbiology, Antibiotics, Microbial Sensitivity Tests, medicine.disease_cause, law.invention, Sepsis, 03 medical and health sciences, 0302 clinical medicine, law, Drug Resistance, Multiple, Bacterial, Internal medicine, medicine, Humans, Pseudomonas Infections, Pharmacology (medical), 030212 general & internal medicine, Aged, Retrospective Studies, Aged, 80 and over, Cross Infection, Dose-Response Relationship, Drug, business.industry, Pseudomonas aeruginosa, Septic shock, General Medicine, Middle Aged, medicine.disease, Intensive care unit, Anti-Bacterial Agents, Cephalosporins, Intensive Care Units, Pneumonia, Treatment Outcome, Infectious Diseases, Spain, Bacteremia, Female, business
Abstract

This study aimed to assess the efficacy of ceftolozane-tazobactam (C/T) for treating infections due to Pseudomonas aeruginosa (P. aeruginosa) in critically ill patients.A multicenter, retrospective and observational study was conducted in critically ill patients receiving different C/T dosages and antibiotic combinations for P. aeruginosa infections. Demographic data, localisation and severity of infection, clinical and microbiological outcome, and mortality were evaluated.Ninety-five patients received C/T for P. aeruginosa serious infections. The main infections were nosocomial pneumonia (56.2%), intra-abdominal infection (10.5%), tracheobronchitis (8.4%), and urinary tract infection (6.3%). Most infections were complicated with sepsis (49.5%) or septic shock (45.3%), and bacteraemia (10.5%). Forty-six episodes were treated with high-dose C/T (3 g every 8 hours) and 38 episodes were treated with standard dosage (1.5 g every 8 hours). Almost half (44.2%) of the patients were treated with C/T monotherapy, and the remaining group received combination therapy with other antibiotics. Sixty-eight (71.6%) patients presented a favourable clinical response. Microbiological eradication was documented in 42.1% (40/95) of the episodes. The global ICU mortality was 36.5%. Univariate analysis showed that 30-day mortality was significantly associated (P0.05) with Charlson Index at ICU admission and the need of life-supporting therapies.C/T appeared to be an effective therapy for severe infections due to P. aeruginosa in critically ill patients. Mortality was mainly related to the severity of the infection. No benefit was observed with high-dose C/T or combination therapy with other antibiotics.

Published
2021
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3. Impact of early oseltamivir treatment on outcome in critically ill patients with 2009 pandemic influenza A

Author

José Albofedo-Sánchez, M. Blasco Navalpotro, Paloma Dorado Regil, S. Tormo, Luis Regalado, Eduardo Palencia, A. Tellería, Raul José González, J.M. Añón, Antonio Jareño, Jose Ramon Iruretagoyena Amiano, Elena Gallego, Angel Arenzana, Cecilia Hermosa, Laura Macaya, Luis Álvarez–Rocha, R. Granada, Antonio Albaya, Carlos Velayos, Dolores Ocaña Fernández, Ignacio Amestarán, Josep Ballus, Emilio Robles-Musso, José Mª Molina, Sonia Gómez-Rosado, Carlos Pey, Fernándo Bueno, Luis Miguel Prado López, Iñaki Catalán, Rosa María Díaz, Ana Trujillo, B. Santamaría, Virgilio Paricio, Antonia Socias, José Luis Ballesteros, Julio Canabal, J.C. Pozo, César Pérez–Calvo, Mónica Magret, B. Suberviola, P. Ugarte, Joaquim Ramón Cervelló, S Barbadillo, Loreto Vidaur, Pedro Ibañez, Bárbara Baladín, Pilar Luque, J Nolla, José Cuñat, Juan C. Figueira, Fernando Barcenilla, S. Garrido Ramírez de Arellano, Sisón, Fernando Arméstar, Arantxa Lander, M. Martín, Inés Navarrete, Antonio Cárdenas, M. Cruz Soriano, Miguel Angel Díaz Castellanos, Diego de Mendoza, Javier Pérez, Francisco del Río, Medhi Zaheri Beryanaki, Miguel González, I. Jimenez Urra, David Hernandez, Sandra Trefler, Lisardo Iglesias, Antonio Álvarez Terrero, JJ Díaz, Marta Ortíz, Francisco Álvarez-Lerma, A. Liétor, Concepción Vaquero, Susana Altaba, Isidro Prieto, M. Badia, Ángel Sánchez-Miralles, Almudena Simón, Nerea López de Arbina, Mª Jesús Huertos, Zoran Josic, M. I. Marquina Lacueva, Santiago Macias, J. Nava, C. Ferri, José A. Pastor, Rafael Sierra, Antoli Ribas, Quiroga, Ignacio Martin-Loeches, Eleuterio Merayo, Santiago Freita, Nieves Carrasco, L. Macaya Redin, Ana María Rojo López, F. Felices Abad, Patricia Albert, Leonardo Lorente, Rafael Caballero, Sergio Ruiz-Santana, Javier Martins, José M. Bonell, Eva Vilaboy, Juan B. López Messa, Xavier Balanzó, José Luna, Cristóbal León, Abilio Arrascaeta, M. C. Martín, Joaquim Páez, Ana Loza, Juliá-Narváez José, José Garnacho-Montero, Jordi Almirall, Zulema Ferreras, Elena Arnau, L. Cabre, Guillermo Sevilla, S. García, José Eugenio Guerrero, R. Guerrero, Enrique Marquez, José Luis Monzón, Yolanda Fernández, A. del Castillo, Thiago Lisboa, Teresa Recio, Asunción Marques, Ignacio Sánchez, Lluis Llopart, M. Rodriguez, José Pomares, Marcío Borges-Sa, José Blanquer, Juan Carlos Montejo, Mercedes Díaz, Carmen González, Rosa Mª Catalán, Fernández del Cabo, Rafael Mañez, Enrique Ferres, Bernardo Gil Rueda, Alejandro Algora, Jesús Blanco Varela, L. Canadell, Jordi Rello, Alberto Manzano, A. Andaluz Ojeda, Jaime Benitez Peyrat, Félix Goñi, Rafael Zaragoza, Miquel Ferrer, Eduard Mesalles, A. Alonso, Alberto Fernández-Zapata, Frutos Del Nogal Sáez, Alejandro Rodríguez, Águeda García-Rodríguez, Ignacio González, Antonio Pasilla, A. Vazquez, Zulema Paez, Assumpta Rovira, Alberto Sandiumenge, M. F. Esteban, Dolores Ocaña, Josu Insansti, José F. Prieto, Pedro Cobo, Manuel Alvarez, Luis Arnaiz, Javier Cebrian, Carlos Castillo Arenal, Ricard Jordà Marcos, Manuel Luis Avellanas, Emili Diaz, Santiago Alberto Picos, Juan Carlos Vergara, Montserrat Valverdú-Vidal, J. J. Cáceres, Enrique Maraví-Poma, Diego López, Juan Bonastre, Esteban Fernández, P. Galdós, Sofía Martínez, Bernabé Alvarez-Sánchez, Fabiola Tena Ezpeleta, Ana de Pablo, R. Ramos, Eva Maria Saborido, Roberto Reig Valero, Enrique Cerdá, S. Sánchez-Alonso, Mercedes Catalán, Victor Jose López-Ciudad, M. Ortiz Piquer, Mariano Martínez, Amparo Paredes, Belén Agrela Romero, Jordi Vallés, M. Palamo, Jos M. Latour, J. González de Molina, Francisco Gurri, Jose Mª Montón, Juan José Díaz, Ana Díaz Lamas, Álvaro García, Josep Mª Sirvent, Jose Ángel Berezo, Mª José García-Ramos, Sergio Manuel Butí, Federico Gordo, Lorenzo Socias, Manuel Rodríguez-Carvajal, Mª Lourdes Cordero, Mercedes Palomar, Fernando García-López, Cecilia Carbayo, Pilar Martínez, R. Hinojosa, Dolores Vila, Francisco Lobato, Francisco Fernández, Juan Cortez, Pedro Olaechea, M. Ángel García, Mª Jesús López Pueyo, Antoni Torres, Beatriz Galván, Mª Carmen García-Torrejón, J. A. Cambronero, Bárbara Balandin Moreno, A. Canabal, Sergio F. Martínez, Nagore González, A. Belenger, Francisco Mariscal, P. Marco, Luis Marina, Francisco García, Mª Luisa Gómez Grande, S. Sánchez-Morcillo, Javier Fierro, and C. Guía

Subjects
Microbiology (medical), Adult, Male, medicine.medical_specialty, Oseltamivir, Time Factors, medicine.drug_class, medicine.medical_treatment, Critical Illness, Antiviral Agents, law.invention, chemistry.chemical_compound, Influenza A Virus, H1N1 Subtype, law, Internal medicine, Influenza, Human, medicine, Humans, Pharmacology (medical), Prospective Studies, Prospective cohort study, Pharmacology, Mechanical ventilation, Neuraminidase inhibitor, business.industry, Middle Aged, medicine.disease, Intensive care unit, Surgery, Pneumonia, Infectious Diseases, Treatment Outcome, chemistry, Propensity score matching, Cohort, Female, business
Abstract

Received 8 October 2010; returned 9 November 2010; revised 2 December 2010; accepted 6 December 2010Objectives: The impact of oseltamivir on mortality in critically ill patients with 2009 pandemic influenza A(2009 H1N1) is not clear. The main objective of this study was to investigate the relationship between thetiming of antiviral administration and intensive care unit (ICU) outcomes.Methods: Prospective, observational study of a cohort of ICU patients with confirmed 2009 H1N1 infection.Clinical data, treatment and outcome were compared between patients receiving early treatment (ET) withoseltamivir, initiated within 2 days, and patients administered late treatment (LT), initiated after this timepoint.Multivariate analysis and propensity score were used to determine the effect of oseltamivir on ICU mortality.Results: Six hundred and fifty-seven patients were enrolled. Four hundred and four (61.5%) patients requiredmechanical ventilation (MV; mortality 32.6%). Among them, 385 received effective antiviral therapy andwere included in the study group. All patients received oseltamivir for a median duration of 10 days (interquar-tile range 8–14 days). Seventy-nine (20.5%) ET patients were compared with 306 LT patients. The two groupswere comparable in terms of main clinical variables. ICU length of stay (22.7+16.7 versus 18.4+14.2 days;P¼0.03), hospital length of stay (34.0+20.3 versus 27.2+18.2 days; P¼0.001) and MV days (17.4+15.2versus 14.0+12.4; P¼0.04) were higher in the LT group. ICU mortality was also higher in LT (34.3%) than inET (21.5%; OR¼1.9; 95% CI 1.06–3.41). A multivariate model identified ET (OR¼0.44; 95% CI 0.21–0.87) asan independent variable associated with reduced ICU mortality. These results were confirmed by propensityscore analysis (OR¼0.44; 95% CI 0.22–0.90; P,0.001).Conclusions: Our findings suggest that early oseltamivir administration was associated with favourableoutcomes among critically ill ventilated patients with 2009 H1N1 virus infection.Keywords: antiviral treatment, prognosis, pneumonia

Published
2011

4. [Massive mesenteric ischemia]

Author

Bárbara, Balandin Moreno, Alfonso, Ortega López, and Matías, Cea Soriano

Subjects
Radiography, Ischemia, Multiple Organ Failure, Intestine, Small, Mesenteric Vascular Occlusion, Humans, Female, Middle Aged, Pneumatosis Cystoides Intestinalis, Abdominal Pain, Colon, Transverse
Published
2009

5. Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis

Author

Alejandro H. Rodríguez, Francesc X. Avilés-Jurado, Emili Díaz, Philipp Schuetz, Sandra I. Trefler, Jordi Solé-Violán, Lourdes Cordero, Loreto Vidaur, Ángel Estella, Juan C. Pozo Laderas, Lorenzo Socias, Juan C. Vergara, Rafael Zaragoza, Juan Bonastre, José E. Guerrero, Borja Suberviola, Catia. Cilloniz, Marcos I. Restrepo, Ignacio Martín-Loeches, Pedro Cobo, Javier Martins, Cecilia Carbayo, Emilio Robles-Musso, Antonio Cárdenas, Javier Fierro, Dolores Ocaña Fernández, Rafael Sierra, Mª Jesús Huertos, Mª Luz Carmona Pérez, Juan Carlos Pozo Laderas, R. Guerrero, Juan Carlos Robles, Melissa Echevarría León, Alberto Bermejo Gómez, Enrique Márquez, Manuel Rodríguez-Carvajal, José Pomares, José Luis Ballesteros, Olga Moreno Romero, Yolanda Fernández, Francisco Lobato, José F. Prieto, José Albofedo-Sánchez, Pilar Martínez, María Victoria de la Torre, María Nieto, Estefanía Camara Sola, Miguel Angel Díaz Castellanos, Guillermo Sevilla Soler, Carlos Ortiz Leyba, José Garnacho-Montero, Rafael Hinojosa, Esteban Fernández, Ana Loza, Cristóbal León, Samuel González López, Angel Arenzana, Dolores Ocaña, Inés Navarrete, Medhi Zaheri Beryanaki, Ignacio Sánchez, Manuel Pérez Alé, Ana Mª Poullet Brea, Juan Francisco Machado Casas, Carlos Serón, Manuel Luis Avellanas, Arantxa Lander, S. Garrido Ramírez de Arellano, M.I. Marquina Lacueva, Pilar Luque, Elena Plumed Serrano, Juan Francisco Martín Lázaro, Carlos Sánchez Polo, Isabel Gutiérrez Cia, Belén Jiménez Bartolomé, Carlos López Nuñez, Ignacio González, José Ignacio Tomás Marsilla, Clara Jaques Andrés, Pablo Gtiérrez Ibañes, Pilar Araujo Aguilar, Jose Mª Montón, Paloma Dorado Regil, Lisardo Iglesias, Carmen Pascual González, Brígida Quindós Fernández, Lorena Martín Iglesias, Lucía Viña Soria, Raquel Yano Escudero, Mª del Rosario Mtnez Revuelta, null Quiroga, Águeda García-Rodríguez, Marta Martín Cuadrado, Ana Luz Balán Mariño, Pedro Ibánez, Marcío Borges-Sa, A. Socias, A. Del Castillo, Ricard Jordà Marcos, Cristina Muñoz, José M. Bonell, Ignacio Amestarán, M. Angeles González López, Cecilia Vilanova Pàmies, José Ma. Bonell Goytisolo, José Antonio Morales Carbonero, Rossana Pérez Senoff, Marta Generelo López de Medrano, Sergio Ruiz-Santana, Juan José Díaz, Catalina Sánchez Ramírez, Montse Sisón, David Hernández, Ana Trujillo, Luis Regalado, Sonia Rodríguez Fndez, Leonardo Lorente, Judith Cabrera Rivero, Mª Luisa Mora Quintero, Mar Martín, Sergio Martínez, J.J. Cáceres, Manuel Sanchez Palacio, null Marcos, D. García Rodríguez, María Ripoll Leria, P. Ugarte, Fernando García-López, Rafael Sánchez Iniesta, Angel Álvaro Alonso, Antonio Padilla, Basi Martínez Palacios, Mª Luisa Gómez Grande, Ma. Carmen Martín Rodríguez, Hasania Adbel-Hadi Álvarez, Alfonso Ambros Checa, Higinio Martín Hernández, Antonio Albaya, Alberto Silva Obregón, Carlos Marian Crespo, Carlos Armendariz Estrella, Carmen Benito Puncel, Eduardo Quirós Oyargue, Alfonso Canabal, Luis Marina, Ismael López de Toro, Almudena Simón, José María Añón, Juan B. López Messa, Mª Jesús López Pueyo, Ortíz María del valle Sergio Ossa Echeverri, Zulema Ferreras, Juan C. Ballesteros Herraez, Santiago Macias, José Ángel Berezo, Jesús Blanco Varela, Pablo Blanco Schweizer, Angela González Salamanca, Luis Tamayo Lomas, Andaluz Ojeda Anzález, Ramón Cicuéndez Avila, Pérez G. Francisco Javier, Antonio Álvarez Terrero, Fabiola Tena Ezpeleta, Christian Sala, Oliverio López, Zulema Paez, Álvaro García, Demetrio Carriedo Ule, Miriam Riesco Crespo, Jesús Pino Rebolledo, Nicolás Hidalgo Andrés, Ana Carolina Caballero Zirena, Belén Román García, Juan Bautista López Messa, María del Valle Ortiz, Sergio Ossa Echeverri, Rosa Mª Catalán, Miquel Ferrer, Antoni Torres, Catia Cilloniz, Sandra Barbadillo Ansorregui, Lluís Cabré, Ignacio Baeza, Assumpta Rovira, Francisco Álvarez-Lerma, Antonia Vázquez, Joan Nolla, Francisco Fernández, Joaquim Ramón Cervelló, Raquel Iglesia, Rafael Mañéz, J. Ballús, Rosa Mª Granada, Jordi Vallés, Marta Ortíz, C. Guía, Joaquim Páez, Jordi Almirall, Xavier Balanzo, Estel Güell, Juan Carlos Yebenes, Jordi Rello, Elena Arnau, Marcos Pérez, César Laborda, Jesica Souto, Leonel Lagunes, Iñaki Catalán, Josep Mª Sirvent, Nerea López de Arbina, Anna Baró Serra, Adriana Sánchez, Silvia M. Cuenca, Mariona Badía, Begonia Baseda-Garrido, Montserrat Valverdú-Vidal, Fernando Barcenilla, Mercedes Palomar, Xavier Nuvials, Pedro Garrido Benedicto, Ferran Roche Campo, M.F. Esteban, José Luna, Gaspar Masdeu Eixarch, Angels Pascual Diago, Juan Mª Nava, J. González de Molina, Josep Trenado, Ricard Ferrer, Zoran Josic, Montserrat Casanovas, Francisco Gurri, Paula Rodríguez, Alejandro Rodríguez, Laura Claverias, Sandra Trefler, María Bodí, Mónica Magret, Cristina Ferri, Rosa María Díaz, Eduard Mesalles, Fernando Arméstar, Diego de Mendoza, Carmen Lomas Fernández, José Julián Berrade, Alfonso Bonet Saris, Marina Pechkova, Cristina Mora Jiménez, Santiago Picos Gil, José Juliá-Narváez, Manuel Robles Marcos, Vanessa Farje Mallqui, Mª. Angeles Santiago Triviño, Pablo Martínez García, Alberto Fernández-Zapata, Teresa Recio, Abilio Arrascaeta, Mª José García-Ramos, Elena Gallego, Esther Saiz Rodrigo, Fernándo Bueno, Mercedes Díaz, Noemí Gil Pérez, David López Hormigo, Juan Diego Jiménez Delgado, Pérez Frutos, M.J. Rivera Pinna, Mª Lourdes Cordero, José A. Pastor, Luis Álvarez-Rocha, Alexandra Ceniceros Barros, Alejandra Virgós Pedreira, Dolores Vila, Carmen Fernández González, Javier Blanco Pérez, M. Ortiz Piquer, Eleuterio Merayo, Victor Jose López-Ciudad, Juan Cortes Cañones, Eva Vilaboy, José Villar Chao, Francisco Savira Cid López, Pablo Vidal Cortés, Marcos A. Pérez Veloso, Eva Maria Saborido, Enrique Alemparte Pardavila, Ana Ortega Montes, Raul José González, Santiago Freita, Enrique Alemparte, Ana Ortega, Ana María López, Julio Canabal, Enrique Ferres, Santiago Freitas Ramos, Lucas Lage Cendón, Vanesa Gómez Casal, Sabela Vara Adrio, Eva Menor Fernández, Susana González Prado, Antonio Varela Franco, José Luis Monzón, Félix Goñi, Frutos Del Nogal Sáez, M. Blasco Navalpotro, Ricardo Díaz Abad, José Luis Flordelis Lasierra, Mª Carmen García-Torrejón, César Pérez–Calvo, Diego López, Luis Arnaiz, S. Sánchez-Alonso, Carlos Velayos, Francisco del Río, Miguel Ángel González, Mercedes Nieto, Carmen Sánchez Cesteros, María Cruz Martín, José Mª Molina, Juan Carlos Montejo, Mercedes Catalán, Patricia Albert, Ana de Pablo, José Eugenio Guerrero, María Zurita, Jaime Benitez Peyrat, Miriam Díaz Cámara, Enrique Cerdá, Manuel Alvarez, Carlos Pey, Eva Manteiga Riestra, Concepción Martinez-Fidalgo, Montse Rodríguez, Eduardo Palencia, Rafael Caballero, Concepción Vaquero, Francisco Mariscal, S. García, Rico Cepeda, Nieves Carrasco, Isidro Prieto, A. Liétor, R. Ramos, Rosario Cuadra Casas, Cruz Soriano Cuesta, Susana Sánchez Alonso, Beatriz Galván, Juan C. Figueira, M. Cruz Soriano, Bélen Civantos Martín, Alejgandro Robles Caballero, P. Galdós, Bárbara Balandin Moreno, Sara Alcántara Carmona, Fernández del Cabo, Cecilia Hermosa, Federico Gordo, Alejandro Algora, Amparo Paredes, Teodoro Grau Carmona, J.A. Cambroner, Esther López Ramos, Yaiza Ortiz de Zárate, Sonia Gómez-Rosado, Margarita Mas Lodo, Nieves Franco Garrobo, Silvia Álvarez Hernández, Teresa Honrubia, Luis Miguel Prado López, A. Esteban, J.A. Lorente, N. Nin, Carlos Jaramillo Sotomayor, Esperanza Molero Silvero, Eduardo Morales Fdez. de la Reguera, Rosa Mª de la Casa Monje, Fátima Martín Serrano, Mª Victoria Trasmonte Martínez, M. Cruz Martín Delgado, Sofía Martínez, F. Felices Abad, Isabel Cremades Navalon, Martín Vigil Velis, Mariano Martínez, Domingo Martínez Baño, Enriqueta Andreu, Sergio Manuel Butí, Bernardo Gil Rueda, Francisco García, Noemí Llamas Fernández, Luis Herrera Para, Alejandro Ortín Freire, Mª Rosa Nvarro Ruiz, C.R. Hernández Romero, Enrique Maraví-Poma, I. Jimenez Urra, Laura Macaya Redin, A. Tellería, Josu Insansti, Noelia Artesero Garcia, Laura Macaya, Joaquín Lobo Palanco, Nagore González, Pilar Marco, Estibaliz Salas, Ruth Salaberría Udabe, B. Santamaría, Tomás Rodríguez, Juan Carlos Vergara, Jose Ramon Iruretagoyena Amiano, Iratí Garrido Santos, Alberto Manzano, Carlos Castillo Arenal, Pedro María Olaechea, Alejandro Martín López, Fernando Fonseca San Miguel, José Blanquer, Nieves Carbonell, José Ferreres Franco, Roberto Reig Valero, A. Belenger, Susana Altaba, Bernabé Álvarez–Sánchez, José Canovas Robles, Jaime Sánchez Francisco, Mar Ruiz Sánchez, Santiago Alberto Picos, Abilio Arrascaeta Llanes, Eugenio Herrero Gutiérrez, Alberto Fernández Zapata, Ángel Sánchez-Miralles, José Luis Antón Pascual, M. Palamo, Javier Cebrian, José Cuñat, Mónica Gordón Sahuquillo, Belén Romero, Santiago Borrás Pallé, Javier de León Belmar, Constantino Tormo, Susana Sancho Chinesta, Virgilio Paricio, Asunción Marques, S. Sánchez-Morcillo, S. Tormo, J. Latour, M. Ángel García, Manuel Palomo, Francisco Tarín Royo, Pedro Manzano Hinojosa, Mª Salomé Sánchez Pino, Concha Maragues Ribes, Rubén González Luis, Antoli Ribas, and Universitat de Barcelona

Subjects
Male, Procalcitonin, 0302 clinical medicine, Community-acquired pneumonia, Septic shock, Prospective Studies, 030212 general & internal medicine, Coinfection, Bacterial Infections, Middle Aged, Prognosis, Intensive Care Units, Infectious Diseases, Female, Pèptids, Adult, Calcitonin, Microbiology (medical), medicine.medical_specialty, Icu patients, Calcitonin Gene-Related Peptide, CHAID analysis, Respiratory coinfection, Sensitivity and Specificity, Influenzavirus, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, Influenza, Human, parasitic diseases, medicine, Humans, Influenza viruses, Protein Precursors, Intensive care medicine, Influenza A(H1N1)pmd, business.industry, Decision Trees, 030208 emergency & critical care medicine, Influenza a, medicine.disease, CHAID, Observational study, business, Peptides, Biomarkers
Abstract

Objectives: To define which variables upon ICU admission could be related to the presence of coinfection using CHAID (Chi-squared Automatic Interaction Detection) analysis. Methods: A secondary analysis from a prospective, multicentre, observational study (2009 -2014) in ICU patients with confirmed A(H1N1)pdm09 infection. We assessed the potential of biomarkers and clinical variables upon admission to the ICU for coinfection diagnosis using CHAID analysis. Performance of cut-off points obtained was determined on the basis of the bi-nominal distributions of the true (+) and true (-) results. Results: Of the 972 patients included, 196 (20.3%) had coinfection. Procalcitonin (PCT; ng/mL 2.4 vs. 0.5, p < 0.001), but not C-reactive protein (CRP; mg/dL 25 vs. 38.5; p = 0.62) was higher in patients with coinfection. In CHAID analyses, PCT was the most important variable for coinfection. PCT < 0.29 ng/mL showed high sensitivity (Se = 88.2%), low Sp (33.2%) and high negative predictive value (NPV = 91.9%). The absence of shock improved classification capacity. Thus, for PCT < 0.29 ng/mL, the Se was 84%, the Sp 43% and an NPV of 94% with a post-test probability of coinfection of only 6%. Conclusion: PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock. (C) 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

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