RESUMO
UNLABELLED: 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.
Assuntos
Estado Terminal , Unidades de Terapia Intensiva , Aspergilose Pulmonar/epidemiologia , APACHE , Idoso , Comorbidade , Grupos Diagnósticos Relacionados , Feminino , Mortalidade Hospitalar , Humanos , Hospedeiro Imunocomprometido , Incidência , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Sepse/epidemiologia , EspanhaAssuntos
Abscesso do Psoas/complicações , Choque Séptico/etiologia , Infecções Estafilocócicas/complicações , Alcoolismo/complicações , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Transtornos Cerebrovasculares/complicações , Cloxacilina/administração & dosagem , Cloxacilina/uso terapêutico , Terapia Combinada , Diabetes Mellitus Tipo 2/complicações , Drenagem , Quimioterapia Combinada , Evolução Fatal , Gentamicinas/administração & dosagem , Gentamicinas/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/microbiologia , Abscesso do Psoas/cirurgia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Mielinólise Central da Ponte/diagnóstico , Síndrome Maligna Neuroléptica/complicações , Respiração Artificial , Antipsicóticos/efeitos adversosRESUMO
Presentamos un caso de insuficiencia cardíaca a las 48 h de una cesárea en una mujer de 23 años adicta a la cocaína por vía inhalada. La paciente presentó un cuadro súbito de edema agudo de pulmón cardiogénico asociado con cambios electrocardiográficos y ecocardiográficos con una recuperación posterior de la función ventricular tras tratamiento médico de la insuficiencia cardíaca y con evolución posterior favorable (AU)
