ABSTRACT
OBJECTIVE: To analyse differences in clinical presentation and outcome between bacteraemic pneumococcal community-acquired pneumonia (B-PCAP) and sSvere Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pneumonia. METHODS: This observational multi-centre study was conducted on patients hospitalized with B-PCAP between 2000 and 2020 and SARS-CoV-2 pneumonia in 2020. Thirty-day survival, predictors of mortality, and intensive care unit (ICU) admission were compared. RESULTS: In total, 663 patients with B-PCAP and 1561 patients with SARS-CoV-2 pneumonia were included in this study. Patients with B-PCAP had more severe disease, a higher ICU admission rate and more complications. Patients with SARS-CoV-2 pneumonia had higher in-hospital mortality (10.8% vs 6.8%; P=0.004). Among patients admitted to the ICU, the need for invasive mechanical ventilation (69.7% vs 36.2%; P<0.001) and mortality were higher in patients with SARS-CoV-2 pneumonia. In patients with B-PCAP, the predictive model found associations between mortality and systemic complications (hyponatraemia, septic shock and neurological complications), lower respiratory reserve and tachypnoea; chest pain and purulent sputum were protective factors in these patients. In patients with SARS-CoV-2 pneumonia, mortality was associated with previous liver and cardiac disease, advanced age, altered mental status, tachypnoea, hypoxaemia, bilateral involvement, pleural effusion, septic shock, neutrophilia and high blood urea nitrogen; in contrast, ≥7 days of symptoms was a protective factor in these patients. In-hospital mortality occurred earlier in patients with B-PCAP. CONCLUSIONS: Although B-PCAP was associated with more severe disease and a higher ICU admission rate, the mortality rate was higher for SARS-CoV-2 pneumonia and deaths occurred later. New prognostic scales and more effective treatments are needed for patients with SARS-CoV-2 pneumonia.
Subject(s)
COVID-19 , Pneumonia, Pneumococcal , Humans , Intensive Care Units , Pneumonia, Pneumococcal/complications , Respiration, Artificial , SARS-CoV-2ABSTRACT
In late December 2019, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) quickly spread worldwide, and the syndrome it causes, coronavirus disease 2019 (COVID-19), has reached pandemic proportions. Around 30% of patients with COVID-19 experience severe respiratory distress and are admitted to the intensive care unit for comprehensive critical care. Patients with COVID-19 often present an enhanced immune response with a hyperinflammatory state characterized by a "cytokine storm," which may reflect changes in the microbiota composition. Moreover, the evolution to acute respiratory distress syndrome (ARDS) may increase the severity of COVID-19 and related dysbiosis. During critical illness, the multitude of therapies administered, including antibiotics, sedatives, analgesics, body position, invasive mechanical ventilation, and nutritional support, may enhance the inflammatory response and alter the balance of patients' microbiota. This status of dysbiosis may lead to hyper vulnerability in patients and an inappropriate response to critical circumstances. In this context, the aim of our narrative review is to provide an overview of possible interaction between patients' microbiota dysbiosis and clinical status of severe COVID-19 with ARDS, taking into consideration the characteristic hyperinflammatory state of this condition, respiratory distress, and provide an overview on possible nutritional strategies for critically ill patients with COVID-19-ARDS.
ABSTRACT
BACKGROUND: Knowing the cost of hospitalizations for exacerbation in bronchiectasis patients is essential to perform cost-effectiveness studies of treatments that aim to reduce exacerbations in these patients. OBJECTIVES: To find out the mean cost of hospitalizations due to exacerbations in bronchiectasis patients, and to identify factors associated with higher costs. METHODS: Prospective, observational, multicenter study in adult bronchiectasis patients hospitalized due to exacerbation. All expenses from the patients' arrival at hospital to their discharge were calculated: diagnostic tests, treatments, transferals, home hospitalization, admission to convalescence centers, and hospitals' structural costs for each patient (each hospital's tariff for emergencies and 70% of the price of a bed for each day in a hospital ward). RESULTS: A total of 222 patients (52.7% men, mean age 71.8 years) admitted to 29 hospitals were included. Adding together all the expenses, the mean cost of the hospitalization was EUR 5,284.7, most of which correspond to the hospital ward (86.9%), and particularly to the hospitals' structural costs. The adjusted multivariate analysis showed that chronic bronchial infection by Pseudomonas aeruginosa, days spent in the hospital, and completing the treatment with home hospitalization were factors independently associated with a higher overall cost of the hospitalization. CONCLUSIONS: The mean cost of a hospitalization due to bronchiectasis exacerbation obtained from the individual data of each episode is higher than the cost per process calculated by the health authorities. The most determining factor of a higher cost is chronic bronchial infection due to P. aeruginosa, which leads to a longer hospital stay and the use of home hospitalization.
Subject(s)
Bronchiectasis/economics , Hospitalization/economics , Adult , Aged , Aged, 80 and over , Disease Progression , Female , Hospital Costs , Humans , Male , Middle Aged , Prospective Studies , Spain , Young AdultABSTRACT
La infl uenza A/H1N1 se diagnosticó por primera vez en México y Estados Unidos en abril de 2009. La rapidezde su diseminación mundial ha alertado a las autoridades sanitarias y a la comunidad científi ca internacional.Los síntomas clínicos habituales de esta enfermedad pueden no distinguirse de la infl uenza estacionale incluyen: tos, fi ebre, mal estado general, odinofagia y dolores musculares. Hasta el momento latasa de hospitalización es relativamente baja (menos de un 15%). De la población afectada, hay 2 gruposque presentan una mayor morbimortalidad: embarazadas y mayores de 65 años. El tratamiento es con losinhibidores de la neuraminidasa: oseltamivir, zanamivir y peramivir, que ayudarían a disminuir las complicacionesy el tiempo de duración de los síntomas. El diagnóstico defi nitivo se hace basándose en técnicasde rt-PCR. El resto del tratamiento consiste en las medidas universales de aislamiento, antitérmicos y reposo.La tasa de casos fatales (aunque en Latinoamérica parece ser más alta) se reporta globalmente comomenor del 1%. En este estudio se hace una recopilación de la información disponible acerca de las manifestaciones,criterios de diagnóstico y tratamiento/profi laxis de la enfermedad(AU)
Influenza A (H1N1) was fi rst diagnosed in Mexico and the United States in April 2009. The rapidity of itsworldwide spread has alerted the health authorities and international scientifi c community. The usualclinical symptoms of this disease cannot be distinguished from those of seasonal infl uenza and includecough, fever, poor general status, odynophagia and muscular aches. To date, the hospitalization rate hasbeen relatively low (less than 15%). Among the affected population, there are two groups with highmorbidity and mortality: pregnant women and persons aged more than 65 years. Treatment consists of theneuroaminidase inhibitors oseltamivir, zanamivir and peramivir, which can help to reduce complicationsand symptom duration. Defi nitive diagnosis is based on reverse-transcriptase polymerase chain reactiontechniques. The remaining treatment options consist of universal measures of isolation, antipyretics andrest. Mortality is less than 1% globally but seems to be higher in Latin America. The present study gathersthe available information on the manifestations, diagnostic criteria and treatment/prophylaxis of thedisease(AU)
Subject(s)
Humans , Male , Female , Pregnancy , Aged , Influenza A Virus, H1N1 Subtype/classification , Influenza A Virus, H1N1 Subtype/immunology , Influenza A Virus, H1N1 Subtype/pathogenicity , Indicators of Morbidity and Mortality , Oseltamivir/pharmacology , Oseltamivir/therapeutic use , Zanamivir/pharmacology , Zanamivir/therapeutic useABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Pulmonary Disease, Chronic Obstructive/drug therapy , Anti-Infective Agents/therapeutic use , Respiratory Tract Infections/drug therapy , Respiratory Tract Infections/epidemiology , Bronchitis/drug therapy , Severity of Illness Index , Respiratory Function Tests , Hospitalization/statistics & numerical dataABSTRACT
No disponible
Subject(s)
Aged , Humans , Pulmonary Disease, Chronic Obstructive/drug therapy , Anti-Bacterial Agents/therapeutic use , Clinical Protocols , Severity of Illness IndexABSTRACT
No disponible
