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116 results on '"Rello Jordi"'

1. Predicting the next pandemic: VACCELERATE ranking of the World Health Organization's Blueprint for Action to Prevent Epidemics

Author: Hart- en Vaatziekten Team A, Epi Infectieziekten Team 1, Child Health, Infection & Immunity, JC onderzoeksprogramma Infectious Diseases, MMB Medische Staf, Salmanton-García, Jon, Wipfler, Pauline, Leckler, Janina, Nauclér, Pontus, Mallon, Patrick W., Bruijning-Verhagen, Patricia C.J.L., Schmitt, Heinz Joseph, Bethe, Ullrich, Olesen, Ole F., Stewart, Fiona A., Albus, Kerstin, Cornely, Oliver A., Busch, Martin, Seifert, Ulrike, Widmer, Andreas, Nagao, Miki, Rello, Jordi, Todorova, Tatina, Cviljević, Sabina, Heath, Christopher H., Jančorienė, Ligita, Fischer, Thea Koelsen, Orth, Hans Martin, Johansen, Isik Somuncu, Doymaz, Mehmet, Tragiannidis, Athanasios, Löscher, Thomas, Xu, Jin Fu, Husa, Petr, Oteo, José Antonio, Issack, Mohammad I., Zeitlinger, Markus, Le Grand, Roger, Zdziarski, Przemysław, Demirkan, Fatih, Amador, Paloma Merino, García-Lozano, Tomás, Cao, Qing, Vázquez, Lourdes, Caeiro, Juan Pablo, Hermans, Peter, Nahrwar, Shahroch, Avsar, Korkut, Kumar, Deepak, Fernández, Norma, Mardani, Masoud, Segal, Esther, Pan, Angelo, Gkentzi, Despoina, Gioula, Georgia, Cortés, Jorge Alberto, Oliveira, Joaquim, van Damme, Pierre, Bin Mohd Zaili, Mohd Zaki, Antinori, Spinello, Zablockienė, Birutė, Papazisis, Georgios, Aneke, Chioma Inyang, Valerio, Maricela, McConkey, Samuel, Aujayeb, Avinash, Azzini, Anna Maria, Roganović, Jelena, Greve-Isdahl Mohn, Kristin, Kremsner, Peter, Gkrania-Klotsas, Effrossyni, Corzo, Dora, Khanna, Nina, Smiatacz, Tomasz, Scheithauer, Simone, Merelli, Maria, Klempa, Boris, Vrḫovac, Radovan, Ruggiero, Antonio, Chaudhary, Pankaj, Maquera-Afaray, Julio, Ekkelenkamp, Miquel, Jindra, Pavel, Pantić, Nikola, Guerra, Gemma Jiménez, Weiss, Guenter, Roohi, Behrad, Argyropoulos, Christos D., Silfverdal, Sven Aprne, van Praet, Jens, Bal, Zumrut Sahbudak, Kanj, Souha, Young, Barnaby, Pana, Zoi Dorothea, Roilides, Emmanuel, Stearns, Stephen C., Wauters, Joost, Baño, Jesús Rodríguez, Pletz, Mathias W., Travar, Maja, Kühn, Steven, Riera, Fernando, Cornely, Daniel, Laura, Vlad Jeni, Koehler, Philipp, Eley, Brian, Nair, Pravin K., Ciesek, Sandra, Olaru, Ioana Diana, Marques, Laura, Pontali, Emanuele, Naunheim, Alexandra, Lieb, Adrian, Gerhard, Markus, Farooqi, Joveria Qais, Turtle, Lance, Méndez, Gustavo Adolfo, Cox, Rebecca Jane, Goodman, Nigel, Caceca, Billie, Pemán, Javier, Dawood, Halima, Askling, Helena Hervius, Fomsgaard, Anders, Hernández, Alejandra Calderón, Staehelin, Cornelia, Liu, Chia Ying, Icardi, Giancarlo, Castagnola, Elio, Salzer, Helmut J.F., Lundgren, Jens, Javadli, Samir, Forghieri, Fabio, Hart- en Vaatziekten Team A, Epi Infectieziekten Team 1, Child Health, Infection & Immunity, JC onderzoeksprogramma Infectious Diseases, MMB Medische Staf, Salmanton-García, Jon, Wipfler, Pauline, Leckler, Janina, Nauclér, Pontus, Mallon, Patrick W., Bruijning-Verhagen, Patricia C.J.L., Schmitt, Heinz Joseph, Bethe, Ullrich, Olesen, Ole F., Stewart, Fiona A., Albus, Kerstin, Cornely, Oliver A., Busch, Martin, Seifert, Ulrike, Widmer, Andreas, Nagao, Miki, Rello, Jordi, Todorova, Tatina, Cviljević, Sabina, Heath, Christopher H., Jančorienė, Ligita, Fischer, Thea Koelsen, Orth, Hans Martin, Johansen, Isik Somuncu, Doymaz, Mehmet, Tragiannidis, Athanasios, Löscher, Thomas, Xu, Jin Fu, Husa, Petr, Oteo, José Antonio, Issack, Mohammad I., Zeitlinger, Markus, Le Grand, Roger, Zdziarski, Przemysław, Demirkan, Fatih, Amador, Paloma Merino, García-Lozano, Tomás, Cao, Qing, Vázquez, Lourdes, Caeiro, Juan Pablo, Hermans, Peter, Nahrwar, Shahroch, Avsar, Korkut, Kumar, Deepak, Fernández, Norma, Mardani, Masoud, Segal, Esther, Pan, Angelo, Gkentzi, Despoina, Gioula, Georgia, Cortés, Jorge Alberto, Oliveira, Joaquim, van Damme, Pierre, Bin Mohd Zaili, Mohd Zaki, Antinori, Spinello, Zablockienė, Birutė, Papazisis, Georgios, Aneke, Chioma Inyang, Valerio, Maricela, McConkey, Samuel, Aujayeb, Avinash, Azzini, Anna Maria, Roganović, Jelena, Greve-Isdahl Mohn, Kristin, Kremsner, Peter, Gkrania-Klotsas, Effrossyni, Corzo, Dora, Khanna, Nina, Smiatacz, Tomasz, Scheithauer, Simone, Merelli, Maria, Klempa, Boris, Vrḫovac, Radovan, Ruggiero, Antonio, Chaudhary, Pankaj, Maquera-Afaray, Julio, Ekkelenkamp, Miquel, Jindra, Pavel, Pantić, Nikola, Guerra, Gemma Jiménez, Weiss, Guenter, Roohi, Behrad, Argyropoulos, Christos D., Silfverdal, Sven Aprne, van Praet, Jens, Bal, Zumrut Sahbudak, Kanj, Souha, Young, Barnaby, Pana, Zoi Dorothea, Roilides, Emmanuel, Stearns, Stephen C., Wauters, Joost, Baño, Jesús Rodríguez, Pletz, Mathias W., Travar, Maja, Kühn, Steven, Riera, Fernando, Cornely, Daniel, Laura, Vlad Jeni, Koehler, Philipp, Eley, Brian, Nair, Pravin K., Ciesek, Sandra, Olaru, Ioana Diana, Marques, Laura, Pontali, Emanuele, Naunheim, Alexandra, Lieb, Adrian, Gerhard, Markus, Farooqi, Joveria Qais, Turtle, Lance, Méndez, Gustavo Adolfo, Cox, Rebecca Jane, Goodman, Nigel, Caceca, Billie, Pemán, Javier, Dawood, Halima, Askling, Helena Hervius, Fomsgaard, Anders, Hernández, Alejandra Calderón, Staehelin, Cornelia, Liu, Chia Ying, Icardi, Giancarlo, Castagnola, Elio, Salzer, Helmut J.F., Lundgren, Jens, Javadli, Samir, and Forghieri, Fabio
Published: 2024

2. Safety and Efficacy of Devices Delivering Inhaled Antibiotics among Adults with Non-Cystic Fibrosis Bronchiectasis : A Systematic Review and a Network Meta-Analysis

Author: Tejada, Sofia, Ramírez-Estrada, Sergio, Forero, Carlos G., Gallego, Miguel, Soriano, Joan B., Cardinal-Fernández, Pablo A., Ehrmann, Stephan, Rello, Jordi, Tejada, Sofia, Ramírez-Estrada, Sergio, Forero, Carlos G., Gallego, Miguel, Soriano, Joan B., Cardinal-Fernández, Pablo A., Ehrmann, Stephan, and Rello, Jordi
Abstract: It remains unknown whether the type of aerosol generating device is affecting efficacy and safety among non-cystic fibrosis bronchiectasis (NCFB) adults. The proposal of this network meta-analysis (NMA) is to evaluate effectiveness and safety of inhaled antibiotics administered via dry powder inhaler (DPI) and via nebulizers (SVN) among adult patients with NCFB. Inclusion criteria were randomized-controlled trials, adults (≥18 years) with NCFB, and inhaled antibiotics administered via DPI as intervention. Search strategy was performed in PubMed, Web of Science, and Cochrane Library from 2000 to 2019. Sixteen trials (2870 patients) were included. Three trials (all ciprofloxacin) used DPIs and thirteen used SVN (three ciprofloxacin). Both DPI and SVN devices achieved similar safety outcomes (adverse events, antibiotic discontinuation, severe adverse events, and bronchospasm). Administration of ciprofloxacin via DPI significantly improved time to first exacerbation (87 days, 95% CI 34.3-139.7) and quality of life (MD −7.52; 95% CI −13.06 to −1.98) when compared with via SVN. No other significant differences were documented in clinical efficacy (at least one exacerbation, FEV% predicted) and microbiologic response (bacterial eradication, emergence of new potential pathogens, and emergence of antimicrobial resistance) when comparing devices. Our NMA documented that time to first exacerbation and quality of life, were more favorable for DPIs. Decisions on the choice of devices should incorporate these findings plus other criteria, such as simplicity, costs or maintenance requirements.
Published: 2022

3. Self-reported antibiotic stewardship and infection control measures from 57 intensive care units: An international ID-IRI survey

Author: El-Sokkary, Rehab, Erdem, Hakan, Kullar, Ravina, Pekok, Abdullah Umut, Amer, Fatma, Grgić, Svjetlana, Carevic, Biljana, El-Kholy, Amani, Liskova, Anna, Özdemir, Mehmet, Khan, Ejaz Ahmed, Kizmaz, Yesim Uygun, Pandak, Nenad, Pandya, Nirav, Arapović, Jurica, Karaali, Rıdvan, Oztoprak, Nefise, Petrov, Michael M., Alabadla, Rami, Alay, Handan, El Kholy, Jehan Ali, Landelle, Caroline, Khedr, Reham, Mamtora, Dhruv, Dragovac, Gorana, Fernandez, Ricardo, Evren, Emine Unal, Raka, Lul, Cascio, Antonio, Dauby, Nicolas, Oncul, Ahsen, Balin, Safak Ozer, Cag, Yasemin, Dirani, Natalia, Dogan, Mustafa, Dumitru, Irina Magdalena, Gad, Maha Ali, Darazam, Ilad Alavi, Naghili, Behrouz, Del Vecchio, Rosa Fontana, Licker, Monica, Marino, Andrea, Akhtar, Nasim, Kamal, Mostafa, Angioni, Goffredo, Medić, Deana, Esmaoğlu, Aliye, Gergely, Szabo Balint, Silva-Pinto, André, Santos, Lurdes, Miftode, Ionela Larisa, Tekin, Recep, Wongsurakiat, Phunsup, Khan, Mumtaz Ali, Kurekci, Yesim, Pilli, Hema Prakash, Grozdanovski, Krsto, Miftode, Egidia, Baljic, Rusmir, Uysal, Serhat, Vahabolgu, Haluk, Rello, Jordi, El-Sokkary, Rehab, Erdem, Hakan, Kullar, Ravina, Pekok, Abdullah Umut, Amer, Fatma, Grgić, Svjetlana, Carevic, Biljana, El-Kholy, Amani, Liskova, Anna, Özdemir, Mehmet, Khan, Ejaz Ahmed, Kizmaz, Yesim Uygun, Pandak, Nenad, Pandya, Nirav, Arapović, Jurica, Karaali, Rıdvan, Oztoprak, Nefise, Petrov, Michael M., Alabadla, Rami, Alay, Handan, El Kholy, Jehan Ali, Landelle, Caroline, Khedr, Reham, Mamtora, Dhruv, Dragovac, Gorana, Fernandez, Ricardo, Evren, Emine Unal, Raka, Lul, Cascio, Antonio, Dauby, Nicolas, Oncul, Ahsen, Balin, Safak Ozer, Cag, Yasemin, Dirani, Natalia, Dogan, Mustafa, Dumitru, Irina Magdalena, Gad, Maha Ali, Darazam, Ilad Alavi, Naghili, Behrouz, Del Vecchio, Rosa Fontana, Licker, Monica, Marino, Andrea, Akhtar, Nasim, Kamal, Mostafa, Angioni, Goffredo, Medić, Deana, Esmaoğlu, Aliye, Gergely, Szabo Balint, Silva-Pinto, André, Santos, Lurdes, Miftode, Ionela Larisa, Tekin, Recep, Wongsurakiat, Phunsup, Khan, Mumtaz Ali, Kurekci, Yesim, Pilli, Hema Prakash, Grozdanovski, Krsto, Miftode, Egidia, Baljic, Rusmir, Uysal, Serhat, Vahabolgu, Haluk, and Rello, Jordi
Abstract: We explored the self-reported antibiotic stewardship (AS), and infection prevention and control (IPC) activities in intensive care units (ICUs) of different income settings. A cross-sectional study was conducted using an online questionnaire to collect data about IPC and AS measures in participating ICUs. The study participants were Infectious Diseases–International Research Initiative (IDI-IR) members, committed as per their institutional agreement form. We analyzed responses from 57 ICUs in 24 countries (Lower-middle income (LMI), n = 13; Upper-middle income (UMI), n = 33; High-income (HI), n = 11). This represented (~5%) of centers represented in the ID-IRI. Surveillance programs were implemented in (76.9%−90.9%) of ICUs with fewer contact precaution measures in LMI ones (p = 0.02); (LMI:69.2%, UMI:97%, HI:100%). Participation in regional antimicrobial resistance programs was more significantly applied in HI (p = 0.02) (LMI:38.4%,UMI:81.8%,HI:72.2%). AS programs are implemented in 77.2% of institutions with AS champions in 66.7%. Infectious diseases physicians and microbiologists are members of many AS teams (59%&50%) respectively. Unqualified healthcare professionals(42.1%), and deficient incentives(28.1%) are the main barriers to implementing AS. We underscore the existing differences in IPC and AS programs’ implementation, team composition, and faced barriers. Continuous collaboration and sharing best practices on APM is needed. The role of regional and international organizations should be encouraged. Global support for capacity building of healthcare practitioners is warranted., SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2022

4. Epidemiology and age-related mortality in critically ill patients with intra-abdominal infection or sepsis: an international cohort study

Author: Arvaniti, Kostoula, Dimopoulos, George, Antonelli, Massimo, Blot, Koen, Creagh-Brown, Ben, Deschepper, Mieke, de Lange, Dylan, De Waele, Jan, Dikmen, Yalim, Eckmann, Christian, Einav, Sharon, Francois, Guy, Fjeldsoee-Nielsen, Han, Girardis, Massimo, Jovanovic, Bojan, Lindner, Matthia, Koulenti, Despoina, Labeau, Sonia, Lipman, Jeffrey, Lipovestky, Fernando, Daniel Umezawa Makikado, Lui, Maseda, Emilio, Mikstacki, Adam, Montravers, Philippe, Artur Paiva, José, Pereyra, Cecilia, Rello, Jordi, Timsit, Jean-Francoi, Tomescu, Dana, Vogelaers, Dirk, Blot, Stijn, Sepsis Study (AbSeS) Group on behalf of the Trials Group of the European Society of Intensive Care Medicine, Abdominal, Massimo Antonelli (ORCID:0000-0003-3007-1670), Arvaniti, Kostoula, Dimopoulos, George, Antonelli, Massimo, Blot, Koen, Creagh-Brown, Ben, Deschepper, Mieke, de Lange, Dylan, De Waele, Jan, Dikmen, Yalim, Eckmann, Christian, Einav, Sharon, Francois, Guy, Fjeldsoee-Nielsen, Han, Girardis, Massimo, Jovanovic, Bojan, Lindner, Matthia, Koulenti, Despoina, Labeau, Sonia, Lipman, Jeffrey, Lipovestky, Fernando, Daniel Umezawa Makikado, Lui, Maseda, Emilio, Mikstacki, Adam, Montravers, Philippe, Artur Paiva, José, Pereyra, Cecilia, Rello, Jordi, Timsit, Jean-Francoi, Tomescu, Dana, Vogelaers, Dirk, Blot, Stijn, Sepsis Study (AbSeS) Group on behalf of the Trials Group of the European Society of Intensive Care Medicine, Abdominal, and Massimo Antonelli (ORCID:0000-0003-3007-1670)
Published: 2022

5. Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Author: Reyes, Luis Felipe, Murthy, Srinivas, Garcia-Gallo, Esteban, Merson, Laura, Ibáñez-Prada, Elsa E.D., Rello, Jordi, Fuentes, Yuli Viviana, Martin-Loeches, Ignacio, Bozza, Fernando, Duque, Sara, Taccone, Fabio, Fowler, Robert R.A., Kartsonaki, Christiana, Gonçalves, Bronner B.P., Citarella, Barbara Wanjiru, Aryal, Diptesh, Burhan, Erlina, Cummings, Matthew M.J., Delmas, Christelle, Diaz, Rodrigo, Figueiredo-Mello, Claudia, Hashmi, Madiha, Panda, Prasan Kumar, Jiménez, Miguel Pedrera, Rincon, Diego Fernando Bautista, Thomson, David, Nichol, A.D., Marshall, John C, Olliaro, Piero P.L., Reyes, Luis Felipe, Murthy, Srinivas, Garcia-Gallo, Esteban, Merson, Laura, Ibáñez-Prada, Elsa E.D., Rello, Jordi, Fuentes, Yuli Viviana, Martin-Loeches, Ignacio, Bozza, Fernando, Duque, Sara, Taccone, Fabio, Fowler, Robert R.A., Kartsonaki, Christiana, Gonçalves, Bronner B.P., Citarella, Barbara Wanjiru, Aryal, Diptesh, Burhan, Erlina, Cummings, Matthew M.J., Delmas, Christelle, Diaz, Rodrigo, Figueiredo-Mello, Claudia, Hashmi, Madiha, Panda, Prasan Kumar, Jiménez, Miguel Pedrera, Rincon, Diego Fernando Bautista, Thomson, David, Nichol, A.D., Marshall, John C, and Olliaro, Piero P.L.
Abstract: BACKGROUND: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). METHODS: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. RESULTS: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypn, SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2022

6. Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis

Author: De Pascale, Gennaro, Antonelli, Massimo, Deschepper, Mieke, Arvaniti, Kostoula, Blot, Koen, Brown, Ben Creagh, de Lange, Dylan, De Waele, Jan, Dikmen, Yalim, Dimopoulos, George, Eckmann, Christian, Francois, Guy, Girardis, Massimo, Koulenti, Despoina, Labeau, Sonia, Lipman, Jeffrey, Lipovetsky, Fernando, Maseda, Emilio, Montravers, Philippe, Mikstacki, Adam, Paiva, José-Artur, Pereyra, Cecilia, Rello, Jordi, Timsit, Jean-Francoi, Vogelaers, Dirk, Blot, Stijn, Lamrous, Amin, Lipovestky, Fernando, Rezende-Neto, Joao, Vymazal, Toma, Fjeldsoee-Nielsen, Han, Kott, Matthia, Kostoula, Arvaniti, Javeri, Yash, Einav, Sharon, Makikado, Luis Daniel Umezawa, Tomescu, Dana, Gritsan, Alexey, Jovanovic, Bojan, Venkatesan, Kumaresh, Mirkovic, Tomislav, Creagh-Brown, Benedict, Emmerich, Monica, Canale, Mariana, Dietz, Lorena Silvina, Ilutovich, Santiago, Miñope, John Thomas Sanchez, Silva, Ramona Baldomera, Montenegro, Martin Alexi, Martin, Patricio, Saul, Pablo, Chediack, Viviana, Sutton, Giselle, Couce, Rocio, Balasini, Carina, Gonzalez, Susana, Lascar, Florencia Maria, Descotte, Emiliano Jorge, Gumiela, Natalia Soledad, Pino, Carina Alejandra, Cesio, Cristian, Valgolio, Emanuel, Cunto, Eleonora, Dominguez, Cecilia, Nelson, Nydia Fune, Abegao, Esteban Martin, Pozo, Norberto Christian, Bianchi, Luciana, Correger, Enrique, Pastorino, Maria Laura, Miyazaki, Erica Aurora, Grubissich, Nicola, Garcia, Mariel, Bonetto, Natalia, Quevedo, Noelia Elizabeth, Gomez, Cristina Delia, Queti, Felipe, Estevarena, Luis Gonzalez, Fernandez, Ruben, Santolaya, Ignacio, Grangeat, Sergio Hugo, Doglia, Juan, Zakalik, Graciela, Pellegrini, Carlo, Lloria, Maria Monserrat, Chacon, Mercedes Esteban, Fumale, Mariela, Leguizamon, Mariela, Hidalgo, Irene Beatriz, Tiranti, Roberto Juli an, Capponi, Paola, Tita, Agustin, Cardonnet, Lui, Bettini, Lisandro, Ramos, Agñel, Lovesio, Luciano, Miranda, Edith Miriam, Farfan, Angelica Beatriz, Tolosa, Carina, Segura, Lise, Bellocchio, Adelina, Alvarez, Brian, Manzur, Adriana, Lujan, Rodolfo, Fernandez, Natalia, Scarone, Nahuel, Zazu, Alan, Groh, Carina, Fletcher, Jason, Smith, Julie, Azad, Raman, Chavan, Nitin, Kol, Mark, Campbell, Lewi, Starr, Therese, Roberts, Brigit, Wibrow, Bradley, Warhurst, Timothy, Chinthamuneedi, Meher, Ferney, Bernal Buitrago, Simon, Marc, De Backer, Daniel, Wittebole, Xavier, De Bels, David, Collin, Vincent, Dams, Karolien, Jorens, Philippe, Dubois, Jasperina, Gunst, Jan, Haentjens, Lionel, De Schryver, Nicola, Dugernier, Thierry, Rizoli, Sandro, Santillan, Paul, Han, Yi, Biskup, Ewelina, Qu, Changjing, Li, Xinyu, Yu, Tao, Weihua, Lu, Molano-Franco, Daniel, Rojas, José, Oviedo, Juan Mauricio Pardo, Pinilla, Dario, Cardenas, Yenny, Celis, Edgar, Arias, Mario, Vukovic, Anita, Vudrag, Maja, Belavic, Matija, Zunic, Josip, Kuharic, Janja, Kricka, Irena Bozanic, Filipovic-Grcic, Ina, Tomasevic, Bori, Obraz, Melanija, Bodulica, Bruna, Dohnal, Martin, Malaska, Jan, Kratochvil, Milan, Satinsky, Igor, Schwarz, Peter, Kos, Zdenek, Blahut, Ladislav, Maca, Jan, Protus, Marek, Kieslichová, Eva, Nielsen, Louise Gramstrup, Krogh, Birgitte Marianne, Rivadeneira, Francisco, Morales, Freddy, Mora, José, Orozco, Alexandra Saraguro, Morochotutillo, Diego Rolando, Vargas, Nelson Remache, Yepez, Estuardo Salgado, Villamagua, Bori, Alsisi, Adel, Fahmy, Abdelraouf, Dupont, Hervé, Lasocki, Sigismond, Paugam-Burtz, Catherine, Foucrier, Arnaud, Nica, Alexandru, Barjon, Geneviève, Mallat, Jihad, Marcotte, Guillaume, Leone, Marc, Duclos, Gary, Burtin, Philippe, Atchade, Enora, Mahjoub, Yazine, Misset, Benoît, Timsit, Jean-Françoi, Dupuis, Claire, Veber, Benoît, Debarre, Matthieu, Collange, Oliver, Pottecher, Julien, Hecketsweiler, Stephane, Fromentin, Mélanie, Tesnière, Antoine, Koch, Christian, Sander, Michael, Elke, Gunnar, Wrigge, Hermann, Simon, Philipp, Chalkiadaki, Anthoula, Tzanidakis, Charalampo, Pneumatikos, Ioanni, Sertaridou, Eleni, Mastora, Zafiria, Pantazopoulos, Ioanni, Papanikolaou, Metaxia, Papavasilopoulou, Theonymfi, Floros, John, Diakaki, Chryssa, Rallis, Michael, Paridou, Alexandra, Kalogeromitros, Alexandro, Romanou, Vasiliki, Nikolaou, Charikleia, Kounougeri, Katerina, Tsigou, Evdoxia, Psallida, Vasiliki, Karampela, Niki, Mandragos, Konstantino, Kontoudaki, Eftychia, Pentheroudaki, Alexandra, Farazi-Chongouki, Christo, Karakosta, Agathi, Chouris, Isaac, Radu, Vasiliki, Malliotakis, Polychroni, Kokkini, Sofia, Charalambous, Eliana, Kyritsi, Aikaterini, Koulouras, Vasilio, Papathanakos, Georgio, Nagky, Eva, Lampiri, Clairi, Tsimpoukas, Fotio, Sarakatsanos, Ioanni, Georgakopoulos, Panagioti, Ravani, Ifigeneia, Prekates, Athanasio, Sakellaridis, Konstantino, Christopoulos, Christo, Vrettou, Efstratia, Stokkos, Konstantino, Pentari, Anastasia, Marmanidou, Kyriaki, Kydona, Christina, Tsoumaropoulos, Georgio, Bitzani, Militisa, Kontou, Paschalina, Voudouris, Antonio, Flioni, Elli-Nikki, Antypa, Elli, Chasou, Eleftheria, Anisoglou, Souzana, Papageorgiou, Eirini, Paraforou, Theoniki, Tsioka, Agoritsa, Karathanou, Antigoni, Vakalos, Aristeidi, Shah, Bhagyesh, Thakkar, Chirag, Jain, Nikhilesh, Gurjar, Mohan, Baronia, Arvind, Sathe, Prachee, Kulkarni, Shilpa, Paul, Cherish, Paul, John, Masjedi, Mansoor, Nikandish, Reza, Zand, Farid, Sabetian, Golnar, Mahmoodpoor, Ata, Hashemian, Seyed Mohammadreza, Bala, Miklosh, Flocco, Romeo, Torrente, Sergio, Pota, Vincenzo, Spadaro, Savino, Volta, Carlo, Serafini, Giulia, Boraso, Sabrina, Tiberio, Ivo, Cortegiani, Andrea, Misseri, Giovanni, Barbagallo, Maria, Nicolotti, Davide, Forfori, Francesco, Corradi, Francesco, Pelagalli, Lorella, Brazzi, Luca, Vittone, Ferdinando Giorgio, Russo, Alessandro, Simion, Davide, Cotoia, Antonella, Toppin, Gilda Cinnella Patrick, Johnson-Jackson, Roxanne, Hayashi, Yoshiro, Yamamoto, Ryohei, Yasuda, Hideto, Kishihara, Yuki, Shiotsuka, Junji, Sanchez-Hurtado, Luis Alejandro, Tejeda-Huezo, Brigitte, Gorordo, Lui, Ñamendys-Silva, Silvio A, Garcia-Guillen, Francisco J, Martinez, Manuel, Romero-Meja, Erick, Colorado-Dominguez, Ever, van den Oever, Huub, Kalff, Karel Martijn, Vermeijden, Wytze, Cornet, Alexander Daniel, Beck, Oliver, Cimic, Nedim, Dormans, Tom, Bormans, Laura, Bakker, Jan, Van Duijn, Ditty, Bosman, Gerrit, Vos, Piet, Kesecioglu, Jozef, Haas, Lenneke, Henein, Akram, Miranda, Ariel M, Malca, Gonzalo Ernesto Gianella, Arroyo-Sanchez, Abel, Misiewska-Kaczur, Agnieszka, Akinyi, Frisch, Czuczwar, Miroslaw, Luczak, Karolina, Sulkowski, Wiktor, Tamowicz, Barbara, Swit, Beata, Baranowski, Bronisław, Smuszkiewicz, Piotr, Trojanowska, Iwona, Rzymski, Stanislaw, Sawinski, Mariusz, Trosiak, Marta, Mikaszewska-Sokolewicz, Malgorzata, Alves, Ricardo, Leal, Dina, Krystopchuk, Andriy, Mendonca, Pedro Muguel Hilario, Pereira, Rui Antune, de Carvalho, Maria Raquel Lopes Marque, Candeias, Carlo, Molinos, Elena, Ferreira, Amélia, Castro, Guiomar, Pereira, José-Manuel, Santos, Lurde, Ferreira, Alcina, Pascoalinho, Dulce, Ribeiro, Rosa, Domingos, Guilherme, Gomes, Pedro, Nora, David, Costa, Rui Pedro, Santos, Anabela, Alsheikhly, Ahmed Subhy, Popescu, Mihai, Grigoras, Ioana, Patrascanu, Emilia, Zabolotskikh, Igor, Musaeva, Tatiana, Gaigolnik, Deni, Kulabukhov, Vladimir, Belskiy, Vladislav, Zubareva, Nadezhda, Tribulev, Maxim, Abdelsalam, Ahmed, Aldarsani, Ayman, Al-Khalid, Muhammad, Almekhlafi, Ghaleb, Mandourah, Yasser, Doklestic, Krstina, Velickovic, Jelena, Velickovic, Dejan, Jankovic, Radmilo, Skoric-Jokic, Svetlana, Radovanovic, Dragana, Richards, Guy, Alli, Ahmad, Cordoba Nielfa, del Carmen, Iniesta, Rafael Sánchez, Martínez, Adela Benítez-Cano, Bernedo, Carlos Garcia, Gil, Santiago Alberto Pico, Nuvials, Xavier, Garcia, Joseba Gonzalez, Peña, Jose Manuel Garcia, Jimenez, Roberto, Herrera, Lui, Barrachina, Laura Galarza, Monzon, Ignacio Catalan, Redondo, Francisco Javier, Villazala, Ruben, Zapata, Diego Fernando Matallana, Lopez, Isabel Maria Villa, Moreno-Gonzalez, Gabriel, Lopez-Delgado, Juan Carlo, Marin, Jorge Solera, Sanchez-Zamora, Purificacion, Vidal, Montserrat Vallverdú, González, Jesús Flore, Salinas, Irene, Hermosa, Cecilia, Martinez-Sagasti, Fernando, Domingo-Marín, Sara, Victorino, Johanna Abril, Garcia-Alvarez, Raquel, Calleja, Pablo López-Arca, de la Torre-Prados, Maria Victoria, Vidal-Cortes, Pablo, del Río-Carbajo, Lorena, Izura, Javier, Minguez, Victoria, Alvarez, Josep Trenado, Prous, Anna Parera, Paz, Daniel, Roche-Campo, Ferran, Aguilar, Gerardo, Belda, Javier, Rico-Feijoo, Jesu, Aldecoa, Cesat, Zalba-Etayo, Begoña, Dullenkopf, Alexander, Trongtrakul, Konlawij, Chtsomkasem, Anusang, Akbaş, Türkay, Unal, Mustafa Necmettin, Gumus, Ayca, Ramazanoglu, Atilla, Memis, Dilek, Mehmet, Inal, Urkmez, Seval, Ozgultekin, Asu, Demirkiran, Oktay, Aslan, Nesrin Ahu, Kizilaslan, Deniz, Kahveci, Ferda, Ünlü, Nurdan, Ozkan, Zeynep, Kaye, Callum, Jansen, Jan, O’Neill, Orla, Nutt, Christopher, Jha, Rajeev, Hooker, Nicola, Grecu, Irina, Petridou, Christina, Shyamsundar, Murali, Mcnamee, Lia, Trinder, John, Hagan, Samantha, Kelly, Catriona, Silversides, Jonathon, Groba, Casiano Barrera, Boyd, Owen, Bhowmick, Kaushik, Humphreys, Sally, Summers, Charlotte, Polgarova, Petra, Margarson, Michael, Dickens, Justin, Pearson, Suzanne, Chinery, Elaine, Hemmings, Noel, O’Kane, Sinead, Austin, Pauline, Cole, Stephen, Plowright, Catherine, Box, Roberta, Wright, Christopher, Young, Lorna, Creagh-Brown, Ben, Montague, Laura, Parker, Robert, Morton, Ben, Ostermann, Marlie, Bilinska, Julia, Rose, Bernd Oliver, Reece-Anthony, Rosie, Ryan, Christine, Hamilton, Mark, Hopkins, Philip, Wendon, Julia, Brescia, Giovanni, Ijaz, Nazia, Wood, Jame, George, Michelle, Toth-Tarsoly, Piroska, Yates, Bryan, Armstrong, Maureen, Scott, Carmen, Boyd, Christine, Szakmany, Tama, Rees, David, Pulak, Paul, Coggon, Mandy, Saha, Bhaskar, Kent, Linda, Gibson, Bethan, Camsooksai, Julie, Reschreiter, Henrik, Morgan, Pat, Sangaralingham, Sivatharshini, Lowe, Alastair, Vondras, Petr, Jamadarkhana, Sunil, Cruz, Carina, Bhandary, Rakesh, Hersey, Peter, Furneval, Julie, Innes, Richard, Doble, Patricia, Attwood, Ben, Parsons, Penny, Page, Valerie, Zhao, Xiaobei, Dalton, Julian, Hegazy, Mohammed, Awad, Yasser, Naylor, Dougla, Naylor, Amanda, Lee, Sarah, Brevard, Sidney, Davis, Noelle, Null, Null, De Pascale, Gennaro (ORCID:0000-0002-8255-0676), Antonelli, Massimo (ORCID:0000-0003-3007-1670), De Pascale, Gennaro, Antonelli, Massimo, Deschepper, Mieke, Arvaniti, Kostoula, Blot, Koen, Brown, Ben Creagh, de Lange, Dylan, De Waele, Jan, Dikmen, Yalim, Dimopoulos, George, Eckmann, Christian, Francois, Guy, Girardis, Massimo, Koulenti, Despoina, Labeau, Sonia, Lipman, Jeffrey, Lipovetsky, Fernando, Maseda, Emilio, Montravers, Philippe, Mikstacki, Adam, Paiva, José-Artur, Pereyra, Cecilia, Rello, Jordi, Timsit, Jean-Francoi, Vogelaers, Dirk, Blot, Stijn, Lamrous, Amin, Lipovestky, Fernando, Rezende-Neto, Joao, Vymazal, Toma, Fjeldsoee-Nielsen, Han, Kott, Matthia, Kostoula, Arvaniti, Javeri, Yash, Einav, Sharon, Makikado, Luis Daniel Umezawa, Tomescu, Dana, Gritsan, Alexey, Jovanovic, Bojan, Venkatesan, Kumaresh, Mirkovic, Tomislav, Creagh-Brown, Benedict, Emmerich, Monica, Canale, Mariana, Dietz, Lorena Silvina, Ilutovich, Santiago, Miñope, John Thomas Sanchez, Silva, Ramona Baldomera, Montenegro, Martin Alexi, Martin, Patricio, Saul, Pablo, Chediack, Viviana, Sutton, Giselle, Couce, Rocio, Balasini, Carina, Gonzalez, Susana, Lascar, Florencia Maria, Descotte, Emiliano Jorge, Gumiela, Natalia Soledad, Pino, Carina Alejandra, Cesio, Cristian, Valgolio, Emanuel, Cunto, Eleonora, Dominguez, Cecilia, Nelson, Nydia Fune, Abegao, Esteban Martin, Pozo, Norberto Christian, Bianchi, Luciana, Correger, Enrique, Pastorino, Maria Laura, Miyazaki, Erica Aurora, Grubissich, Nicola, Garcia, Mariel, Bonetto, Natalia, Quevedo, Noelia Elizabeth, Gomez, Cristina Delia, Queti, Felipe, Estevarena, Luis Gonzalez, Fernandez, Ruben, Santolaya, Ignacio, Grangeat, Sergio Hugo, Doglia, Juan, Zakalik, Graciela, Pellegrini, Carlo, Lloria, Maria Monserrat, Chacon, Mercedes Esteban, Fumale, Mariela, Leguizamon, Mariela, Hidalgo, Irene Beatriz, Tiranti, Roberto Juli an, Capponi, Paola, Tita, Agustin, Cardonnet, Lui, Bettini, Lisandro, Ramos, Agñel, Lovesio, Luciano, Miranda, Edith Miriam, Farfan, Angelica Beatriz, Tolosa, Carina, Segura, Lise, Bellocchio, Adelina, Alvarez, Brian, Manzur, Adriana, Lujan, Rodolfo, Fernandez, Natalia, Scarone, Nahuel, Zazu, Alan, Groh, Carina, Fletcher, Jason, Smith, Julie, Azad, Raman, Chavan, Nitin, Kol, Mark, Campbell, Lewi, Starr, Therese, Roberts, Brigit, Wibrow, Bradley, Warhurst, Timothy, Chinthamuneedi, Meher, Ferney, Bernal Buitrago, Simon, Marc, De Backer, Daniel, Wittebole, Xavier, De Bels, David, Collin, Vincent, Dams, Karolien, Jorens, Philippe, Dubois, Jasperina, Gunst, Jan, Haentjens, Lionel, De Schryver, Nicola, Dugernier, Thierry, Rizoli, Sandro, Santillan, Paul, Han, Yi, Biskup, Ewelina, Qu, Changjing, Li, Xinyu, Yu, Tao, Weihua, Lu, Molano-Franco, Daniel, Rojas, José, Oviedo, Juan Mauricio Pardo, Pinilla, Dario, Cardenas, Yenny, Celis, Edgar, Arias, Mario, Vukovic, Anita, Vudrag, Maja, Belavic, Matija, Zunic, Josip, Kuharic, Janja, Kricka, Irena Bozanic, Filipovic-Grcic, Ina, Tomasevic, Bori, Obraz, Melanija, Bodulica, Bruna, Dohnal, Martin, Malaska, Jan, Kratochvil, Milan, Satinsky, Igor, Schwarz, Peter, Kos, Zdenek, Blahut, Ladislav, Maca, Jan, Protus, Marek, Kieslichová, Eva, Nielsen, Louise Gramstrup, Krogh, Birgitte Marianne, Rivadeneira, Francisco, Morales, Freddy, Mora, José, Orozco, Alexandra Saraguro, Morochotutillo, Diego Rolando, Vargas, Nelson Remache, Yepez, Estuardo Salgado, Villamagua, Bori, Alsisi, Adel, Fahmy, Abdelraouf, Dupont, Hervé, Lasocki, Sigismond, Paugam-Burtz, Catherine, Foucrier, Arnaud, Nica, Alexandru, Barjon, Geneviève, Mallat, Jihad, Marcotte, Guillaume, Leone, Marc, Duclos, Gary, Burtin, Philippe, Atchade, Enora, Mahjoub, Yazine, Misset, Benoît, Timsit, Jean-Françoi, Dupuis, Claire, Veber, Benoît, Debarre, Matthieu, Collange, Oliver, Pottecher, Julien, Hecketsweiler, Stephane, Fromentin, Mélanie, Tesnière, Antoine, Koch, Christian, Sander, Michael, Elke, Gunnar, Wrigge, Hermann, Simon, Philipp, Chalkiadaki, Anthoula, Tzanidakis, Charalampo, Pneumatikos, Ioanni, Sertaridou, Eleni, Mastora, Zafiria, Pantazopoulos, Ioanni, Papanikolaou, Metaxia, Papavasilopoulou, Theonymfi, Floros, John, Diakaki, Chryssa, Rallis, Michael, Paridou, Alexandra, Kalogeromitros, Alexandro, Romanou, Vasiliki, Nikolaou, Charikleia, Kounougeri, Katerina, Tsigou, Evdoxia, Psallida, Vasiliki, Karampela, Niki, Mandragos, Konstantino, Kontoudaki, Eftychia, Pentheroudaki, Alexandra, Farazi-Chongouki, Christo, Karakosta, Agathi, Chouris, Isaac, Radu, Vasiliki, Malliotakis, Polychroni, Kokkini, Sofia, Charalambous, Eliana, Kyritsi, Aikaterini, Koulouras, Vasilio, Papathanakos, Georgio, Nagky, Eva, Lampiri, Clairi, Tsimpoukas, Fotio, Sarakatsanos, Ioanni, Georgakopoulos, Panagioti, Ravani, Ifigeneia, Prekates, Athanasio, Sakellaridis, Konstantino, Christopoulos, Christo, Vrettou, Efstratia, Stokkos, Konstantino, Pentari, Anastasia, Marmanidou, Kyriaki, Kydona, Christina, Tsoumaropoulos, Georgio, Bitzani, Militisa, Kontou, Paschalina, Voudouris, Antonio, Flioni, Elli-Nikki, Antypa, Elli, Chasou, Eleftheria, Anisoglou, Souzana, Papageorgiou, Eirini, Paraforou, Theoniki, Tsioka, Agoritsa, Karathanou, Antigoni, Vakalos, Aristeidi, Shah, Bhagyesh, Thakkar, Chirag, Jain, Nikhilesh, Gurjar, Mohan, Baronia, Arvind, Sathe, Prachee, Kulkarni, Shilpa, Paul, Cherish, Paul, John, Masjedi, Mansoor, Nikandish, Reza, Zand, Farid, Sabetian, Golnar, Mahmoodpoor, Ata, Hashemian, Seyed Mohammadreza, Bala, Miklosh, Flocco, Romeo, Torrente, Sergio, Pota, Vincenzo, Spadaro, Savino, Volta, Carlo, Serafini, Giulia, Boraso, Sabrina, Tiberio, Ivo, Cortegiani, Andrea, Misseri, Giovanni, Barbagallo, Maria, Nicolotti, Davide, Forfori, Francesco, Corradi, Francesco, Pelagalli, Lorella, Brazzi, Luca, Vittone, Ferdinando Giorgio, Russo, Alessandro, Simion, Davide, Cotoia, Antonella, Toppin, Gilda Cinnella Patrick, Johnson-Jackson, Roxanne, Hayashi, Yoshiro, Yamamoto, Ryohei, Yasuda, Hideto, Kishihara, Yuki, Shiotsuka, Junji, Sanchez-Hurtado, Luis Alejandro, Tejeda-Huezo, Brigitte, Gorordo, Lui, Ñamendys-Silva, Silvio A, Garcia-Guillen, Francisco J, Martinez, Manuel, Romero-Meja, Erick, Colorado-Dominguez, Ever, van den Oever, Huub, Kalff, Karel Martijn, Vermeijden, Wytze, Cornet, Alexander Daniel, Beck, Oliver, Cimic, Nedim, Dormans, Tom, Bormans, Laura, Bakker, Jan, Van Duijn, Ditty, Bosman, Gerrit, Vos, Piet, Kesecioglu, Jozef, Haas, Lenneke, Henein, Akram, Miranda, Ariel M, Malca, Gonzalo Ernesto Gianella, Arroyo-Sanchez, Abel, Misiewska-Kaczur, Agnieszka, Akinyi, Frisch, Czuczwar, Miroslaw, Luczak, Karolina, Sulkowski, Wiktor, Tamowicz, Barbara, Swit, Beata, Baranowski, Bronisław, Smuszkiewicz, Piotr, Trojanowska, Iwona, Rzymski, Stanislaw, Sawinski, Mariusz, Trosiak, Marta, Mikaszewska-Sokolewicz, Malgorzata, Alves, Ricardo, Leal, Dina, Krystopchuk, Andriy, Mendonca, Pedro Muguel Hilario, Pereira, Rui Antune, de Carvalho, Maria Raquel Lopes Marque, Candeias, Carlo, Molinos, Elena, Ferreira, Amélia, Castro, Guiomar, Pereira, José-Manuel, Santos, Lurde, Ferreira, Alcina, Pascoalinho, Dulce, Ribeiro, Rosa, Domingos, Guilherme, Gomes, Pedro, Nora, David, Costa, Rui Pedro, Santos, Anabela, Alsheikhly, Ahmed Subhy, Popescu, Mihai, Grigoras, Ioana, Patrascanu, Emilia, Zabolotskikh, Igor, Musaeva, Tatiana, Gaigolnik, Deni, Kulabukhov, Vladimir, Belskiy, Vladislav, Zubareva, Nadezhda, Tribulev, Maxim, Abdelsalam, Ahmed, Aldarsani, Ayman, Al-Khalid, Muhammad, Almekhlafi, Ghaleb, Mandourah, Yasser, Doklestic, Krstina, Velickovic, Jelena, Velickovic, Dejan, Jankovic, Radmilo, Skoric-Jokic, Svetlana, Radovanovic, Dragana, Richards, Guy, Alli, Ahmad, Cordoba Nielfa, del Carmen, Iniesta, Rafael Sánchez, Martínez, Adela Benítez-Cano, Bernedo, Carlos Garcia, Gil, Santiago Alberto Pico, Nuvials, Xavier, Garcia, Joseba Gonzalez, Peña, Jose Manuel Garcia, Jimenez, Roberto, Herrera, Lui, Barrachina, Laura Galarza, Monzon, Ignacio Catalan, Redondo, Francisco Javier, Villazala, Ruben, Zapata, Diego Fernando Matallana, Lopez, Isabel Maria Villa, Moreno-Gonzalez, Gabriel, Lopez-Delgado, Juan Carlo, Marin, Jorge Solera, Sanchez-Zamora, Purificacion, Vidal, Montserrat Vallverdú, González, Jesús Flore, Salinas, Irene, Hermosa, Cecilia, Martinez-Sagasti, Fernando, Domingo-Marín, Sara, Victorino, Johanna Abril, Garcia-Alvarez, Raquel, Calleja, Pablo López-Arca, de la Torre-Prados, Maria Victoria, Vidal-Cortes, Pablo, del Río-Carbajo, Lorena, Izura, Javier, Minguez, Victoria, Alvarez, Josep Trenado, Prous, Anna Parera, Paz, Daniel, Roche-Campo, Ferran, Aguilar, Gerardo, Belda, Javier, Rico-Feijoo, Jesu, Aldecoa, Cesat, Zalba-Etayo, Begoña, Dullenkopf, Alexander, Trongtrakul, Konlawij, Chtsomkasem, Anusang, Akbaş, Türkay, Unal, Mustafa Necmettin, Gumus, Ayca, Ramazanoglu, Atilla, Memis, Dilek, Mehmet, Inal, Urkmez, Seval, Ozgultekin, Asu, Demirkiran, Oktay, Aslan, Nesrin Ahu, Kizilaslan, Deniz, Kahveci, Ferda, Ünlü, Nurdan, Ozkan, Zeynep, Kaye, Callum, Jansen, Jan, O’Neill, Orla, Nutt, Christopher, Jha, Rajeev, Hooker, Nicola, Grecu, Irina, Petridou, Christina, Shyamsundar, Murali, Mcnamee, Lia, Trinder, John, Hagan, Samantha, Kelly, Catriona, Silversides, Jonathon, Groba, Casiano Barrera, Boyd, Owen, Bhowmick, Kaushik, Humphreys, Sally, Summers, Charlotte, Polgarova, Petra, Margarson, Michael, Dickens, Justin, Pearson, Suzanne, Chinery, Elaine, Hemmings, Noel, O’Kane, Sinead, Austin, Pauline, Cole, Stephen, Plowright, Catherine, Box, Roberta, Wright, Christopher, Young, Lorna, Creagh-Brown, Ben, Montague, Laura, Parker, Robert, Morton, Ben, Ostermann, Marlie, Bilinska, Julia, Rose, Bernd Oliver, Reece-Anthony, Rosie, Ryan, Christine, Hamilton, Mark, Hopkins, Philip, Wendon, Julia, Brescia, Giovanni, Ijaz, Nazia, Wood, Jame, George, Michelle, Toth-Tarsoly, Piroska, Yates, Bryan, Armstrong, Maureen, Scott, Carmen, Boyd, Christine, Szakmany, Tama, Rees, David, Pulak, Paul, Coggon, Mandy, Saha, Bhaskar, Kent, Linda, Gibson, Bethan, Camsooksai, Julie, Reschreiter, Henrik, Morgan, Pat, Sangaralingham, Sivatharshini, Lowe, Alastair, Vondras, Petr, Jamadarkhana, Sunil, Cruz, Carina, Bhandary, Rakesh, Hersey, Peter, Furneval, Julie, Innes, Richard, Doble, Patricia, Attwood, Ben, Parsons, Penny, Page, Valerie, Zhao, Xiaobei, Dalton, Julian, Hegazy, Mohammed, Awad, Yasser, Naylor, Dougla, Naylor, Amanda, Lee, Sarah, Brevard, Sidney, Davis, Noelle, Null, Null, De Pascale, Gennaro (ORCID:0000-0002-8255-0676), and Antonelli, Massimo (ORCID:0000-0003-3007-1670)
Abstract: Purpose To describe data on epidemiology, microbiology, clinical characteristics and outcome of adult patients admitted in the intensive care unit (ICU) with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (< 2 h), 'urgent' (2-6 h), and 'delayed' (> 6 h). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and 95% confidence interval (CI). Results The cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs. 61.3%, p = 0.1). A stepwise increase in mortality was observed with increasing Sequential Organ Failure Assessment (SOFA) scores (19.6% for a value <= 4-55.4% for a value > 12, p < 0.001). The highest odds of death were associated with septic shock (OR 3.08 [1.42-7.00]), late-onset hospital-acquired peritonitis (OR 1.71 [1.16-2.52]) and failed source control evidenced by persistent inflammation at day 7 (OR 5.71 [3.99-8.18]). Compared with 'emergency' source control intervention (< 2 h of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34-0.73]). Conclusion 'Urgent' and successful source control was associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome.
Published: 2022

7. Nebulized Colistin in Ventilator-Associated Pneumonia and Tracheobronchitis: Historical Background, Pharmacokinetics and Perspectives.

Author: UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service de soins intensifs, Zhu, Yinggang, Monsel, Antoine, Roberts, Jason A, Pontikis, Konstantinos, Mimoz, Olivier, Rello, Jordi, Qu, Jieming, Rouby, Jean-Jacques, European Investigator Network for Nebulized Antibiotics in Ventilator-Associated Pneumonia (ENAVAP), Laterre, Pierre-François, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service de soins intensifs, Zhu, Yinggang, Monsel, Antoine, Roberts, Jason A, Pontikis, Konstantinos, Mimoz, Olivier, Rello, Jordi, Qu, Jieming, Rouby, Jean-Jacques, European Investigator Network for Nebulized Antibiotics in Ventilator-Associated Pneumonia (ENAVAP), and Laterre, Pierre-François
Abstract: Clinical evidence suggests that nebulized colistimethate sodium (CMS) has benefits for treating lower respiratory tract infections caused by multidrug-resistant Gram-negative bacteria (GNB). Colistin is positively charged, while CMS is negatively charged, and both have a high molecular mass and are hydrophilic. These physico-chemical characteristics impair crossing of the alveolo-capillary membrane but enable the disruption of the bacterial wall of GNB and the aggregation of the circulating lipopolysaccharide. Intravenous CMS is rapidly cleared by glomerular filtration and tubular excretion, and 20-25% is spontaneously hydrolyzed to colistin. Urine colistin is substantially reabsorbed by tubular cells and eliminated by biliary excretion. Colistin is a concentration-dependent antibiotic with post-antibiotic and inoculum effects. As CMS conversion to colistin is slower than its renal clearance, intravenous administration can lead to low plasma and lung colistin concentrations that risk treatment failure. Following nebulization of high doses, colistin (200,000 international units/24h) lung tissue concentrations are > five times minimum inhibitory concentration (MIC) of GNB in regions with multiple foci of bronchopneumonia and in the range of MIC breakpoints in regions with confluent pneumonia. Future research should include: (1) experimental studies using lung microdialysis to assess the PK/PD in the interstitial fluid of the lung following nebulization of high doses of colistin; (2) superiority multicenter randomized controlled trials comparing nebulized and intravenous CMS in patients with pandrug-resistant GNB ventilator-associated pneumonia and ventilator-associated tracheobronchitis; (3) non-inferiority multicenter randomized controlled trials comparing nebulized CMS to intravenous new cephalosporines/ß-lactamase inhibitors in patients with extensive drug-resistant GNB ventilator-associated pneumonia and ventilator-associated tracheobronchitis.
Published: 2021

8. Nebulized antibiotics for ventilator-associated pneumonia: methodological framework for future multicenter randomized controlled trials.

Author: UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service de soins intensifs, Monsel, Antoine, Torres, Antoni, Zhu, Yinggang, Pugin, Jerome, Rello, Jordi, Rouby, Jean-Jacques, European Investigators Network for Nebulized Antibiotics in Ventilator-associated Pneumonia (ENAVAP), Laterre, Pierre-François, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service de soins intensifs, Monsel, Antoine, Torres, Antoni, Zhu, Yinggang, Pugin, Jerome, Rello, Jordi, Rouby, Jean-Jacques, European Investigators Network for Nebulized Antibiotics in Ventilator-associated Pneumonia (ENAVAP), and Laterre, Pierre-François
Abstract: PURPOSE OF REVIEW: Although experimental evidence supports the use of nebulized antibiotics in ventilator-associated pneumonia (VAP), two recent multicenter randomized controlled trials (RCTs) have failed to demonstrate any benefit in VAP caused by Gram-negative bacteria (GNB). This review examines the methodological requirements concerning future RCTs. RECENT FINDINGS: High doses of nebulized antibiotics are required to reach the infected lung parenchyma. Breath-synchronized nebulizers do not allow delivery of high doses. Mesh nebulizers perform better than jet nebulizers. Epithelial lining fluid concentrations do not reflect interstitial lung concentrations in patients receiving nebulized antibiotics. Specific ventilator settings for optimizing lung deposition require sedation to avoid patient's asynchrony with the ventilator. SUMMARY: Future RCTs should compare a 3-5 day nebulization of amikacin or colistimethate sodium (CMS) to a 7-day intravenous administration of a new cephalosporine/ß-lactamase inhibitor. Inclusion criteria should be a VAP or ventilator-associated tracheobronchitis caused by documented extensive-drug or pandrug resistant GNB. If the GNB remains susceptible to aminoglycosides, nebulized amikacin should be administered at a dose of 40 mg/kg/day. If resistant to aminoglycosides, nebulized CMS should be administered at a dose of 15 millions international units (IU)/day. In VAP caused by pandrug-resistant GNB, 15 millions IU/day nebulized CMS (substitution therapy) should be compared with a 9 millions IU/day intravenous CMS.
Published: 2021

9. The effect of renal replacement therapy and antibiotic dose on antibiotic concentrations in critically ill patients: Data from the multinational SMARRT Study.

Author: UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service de soins intensifs, Roberts, Jason A, Joynt, Gavin, Lee, Anna, Choi, Gordon, Bellomo, Rinaldo, Kanji, Salmaan, Mudaliar, M Yugan, Peake, Sandra L, Stephens, Dianne, Taccone, Fabio Silvio, Ulldemolins, Marta, Valkonen, Miia Maaria, Agbeve, Julius, Baptista, João P, Bekos, Vasileios, Boidin, Clement, Brinkmann, Alexander, Buizen, Luke, Castro, Pedro, Cole, C Louise, Creteur, Jacques, De Waele, Jan J, Deans, Renae, Eastwood, Glenn M, Escobar, Leslie, Gomersall, Charles, Gresham, Rebecca, Jamal, Janattul Ain, Kluge, Stefan, König, Christina, Koulouras, Vasilios P, Lassig-Smith, Melissa, Laterre, Pierre-François, Lei, Katie, Leung, Patricia, Lefrant, Jean-Yves, Llauradó-Serra, Mireia, Martin-Loeches, Ignacio, Mat Nor, Mohd Basri, Ostermann, Marlies, Parker, Suzanne L, Rello, Jordi, Roberts, Darren M, Roberts, Michael S, Richards, Brent, Rodríguez, Alejandro, Roehr, Anka C, Roger, Claire, Seoane, Leonardo, Sinnollareddy, Mahipal, Sousa, Eduardo, Soy, Dolors, Spring, Anna, Starr, Therese, Thomas, Jane, Turnidge, John, Wallis, Steven C, Williams, Tricia, Wittebole, Xavier, Zikou, Xanthi T, Paul, Sanjoy, Lipman, Jeffrey, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service de soins intensifs, Roberts, Jason A, Joynt, Gavin, Lee, Anna, Choi, Gordon, Bellomo, Rinaldo, Kanji, Salmaan, Mudaliar, M Yugan, Peake, Sandra L, Stephens, Dianne, Taccone, Fabio Silvio, Ulldemolins, Marta, Valkonen, Miia Maaria, Agbeve, Julius, Baptista, João P, Bekos, Vasileios, Boidin, Clement, Brinkmann, Alexander, Buizen, Luke, Castro, Pedro, Cole, C Louise, Creteur, Jacques, De Waele, Jan J, Deans, Renae, Eastwood, Glenn M, Escobar, Leslie, Gomersall, Charles, Gresham, Rebecca, Jamal, Janattul Ain, Kluge, Stefan, König, Christina, Koulouras, Vasilios P, Lassig-Smith, Melissa, Laterre, Pierre-François, Lei, Katie, Leung, Patricia, Lefrant, Jean-Yves, Llauradó-Serra, Mireia, Martin-Loeches, Ignacio, Mat Nor, Mohd Basri, Ostermann, Marlies, Parker, Suzanne L, Rello, Jordi, Roberts, Darren M, Roberts, Michael S, Richards, Brent, Rodríguez, Alejandro, Roehr, Anka C, Roger, Claire, Seoane, Leonardo, Sinnollareddy, Mahipal, Sousa, Eduardo, Soy, Dolors, Spring, Anna, Starr, Therese, Thomas, Jane, Turnidge, John, Wallis, Steven C, Williams, Tricia, Wittebole, Xavier, Zikou, Xanthi T, Paul, Sanjoy, and Lipman, Jeffrey
Abstract: BACKGROUND: The optimal dosing of antibiotics in critically ill patients receiving renal replacement therapy (RRT) remains unclear. In this study, we describe the variability in RRT techniques and antibiotic dosing in critically ill patients receiving RRT and to relate observed trough antibiotic concentrations to optimal targets. METHODS: We performed a prospective, observational, multi-national, pharmacokinetic study in 29 intensive care units from 14 countries. We collected demographic, clinical and RRT data. We measured trough antibiotic concentrations of meropenem, piperacillin-tazobactam and vancomycin and related them to high and low target trough concentrations. RESULTS: We studied 381 patients and obtained 508 trough antibiotic concentrations. There was wide variability (4-8 fold) in antibiotic dosing regimens; RRT prescription, and estimated endogenous renal function. The overall median estimated total renal clearance (eTRCL) was 50 mL/min (interquartile range [IQR] 35-65) and higher eTRCL was associated with lower trough concentrations for all antibiotics (p<0.05). The median (IQR) trough concentration for meropenem was 12.1 mg/L (7.9-18.8), piperacillin 78.6 mg/L (49.5-127.3), tazobactam 9.5 mg/L (6.3-14.2) and vancomycin 14.3 mg/L (11.6-21.8). Trough concentrations failed to meet optimal higher limits in 26%, 36%, 72%, and optimal lower limits in 4%, 4%, and 55% of patients for meropenem, piperacillin and vancomycin respectively. CONCLUSIONS: In critically ill patients treated with RRT, antibiotic dosing regimens, RRT prescription and eTRCL varied markedly and resulted in highly variable antibiotic concentrations that failed to meet therapeutic targets in many patients.
Published: 2021

10. Invasive pulmonary aspergillosis in solid organ transplant patients in the ICU.

Author: UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (MGD) Services des soins intensifs, Klein, Joachim, Rello, Jordi, Dimopoulos, George, Bulpa, Pierre, Blot, Koen, Vogelaers, Dirk, Blot, Stijn, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (MGD) Services des soins intensifs, Klein, Joachim, Rello, Jordi, Dimopoulos, George, Bulpa, Pierre, Blot, Koen, Vogelaers, Dirk, and Blot, Stijn
Abstract: Solid organ transplantation (SOT) is a well-known risk factor for invasive pulmonary aspergillosis (IPA). We report on the epidemiology and outcome of SOT patients with IPA in an ICU setting. This is a secondary study based on a subset of SOT-patients from a prospective observational multicenter cohort (the AspICU project) including ICU patients with at least one Aspergillus spp. positive culture. Cases were classified as proven, probable, or putative IPA, or as Aspergillus-colonized. Mortality was reported at 12 weeks. The study included 52 SOT-patients (of which 18 lung, 17 liver, 12 kidney and 5 heart transplants. Sixteen patients had proven IPA, 28 were categorized as putative IPA (of which only 5 reached a probable IPA diagnosis according to EORTC/MSGERC criteria) and 8 as Aspergillus-colonization. Among patients with IPA, 20 (45.5%) developed IPA during their ICU stay following transplantation whereas 24 patients (54.5%) had a medical ICU admission. Regarding medical imaging, nearly all IPA cases presented with non-specific findings as only 9 demonstrated robust findings suggestive for invasive fungal disease. Overall, severity of disease was reflected by a high prevalence of underlying conditions and acute organ derangements. Mortality among patients with IPA was 68%. Lung transplantation was associated with better survival (50%). IPA in SOT patients in the ICU develops in the presence of an overall high severity of disease. It rarely presents with suggestive medical imaging thereby hampering diagnosis. IPA in ICU patients with SOT carries a grim prognosis. This article is protected by copyright. All rights reserved.
Published: 2021

11. Profiles of multidrug-resistant organisms among patients with bacteremia in intensive care units: an international ID-IRI survey

Author: El-Sokkary, Rehab, Uysal, Serhat, Erdem, Hakan, Kullar, Ravina, Pekok, Abdullah Umut, Amer, Fatma, Grgić, Svjetlana, Carevic, Biljana, El-Kholy, Amani, Liskova, Anna, Özdemir, Mehmet, Khan, Ejaz Ahmed, Uygun-Kizmaz, Yesim, Pandak, Nenad, Pandya, Nirav, Arapović, Jurica, Karaali, Rıdvan, Oztoprak, Nefise, Petrov, Michael M., Alabadla, Rami, Alay, Handan, Kholy, Jehan Ali El, Landelle, Caroline, Khedr, Reham, Mamtora, Dhruv, Dragovac, Gorana, Fernandez, Ricardo, Evren, Emine Unal, Raka, Lul, Cascio, Antonio, Dauby, Nicolas, Oncul, Ahsen, Balin, Safak Ozer, Cag, Yasemin, Dirani, Natalia, Dogan, Mustafa, Dumitru, Irina Magdalena, Gad, Maha Ali, Darazam, Ilad Alavi, Naghili, Behrouz, Del Vecchio, Rosa Fontana, Licker, Monica, Marino, Andrea, Akhtar, Nasim, Kamal, Mostafa, Angioni, Goffredo, Medić, Deana, Esmaoğlu, Aliye, Gergely, Szabo Balint, Silva-Pinto, André, Santos, Lurdes, Miftode, Ionela Larisa, Tekin, Recep, Wongsurakiat, Phunsup, Khan, Mumtaz Ali, Kurekci, Yesim, Pilli, Hema Prakash, Grozdanovski, Krsto, Miftode, Egidia, Baljic, Rusmir, Vahabolgu, Haluk, Rello, Jordi, El-Sokkary, Rehab, Uysal, Serhat, Erdem, Hakan, Kullar, Ravina, Pekok, Abdullah Umut, Amer, Fatma, Grgić, Svjetlana, Carevic, Biljana, El-Kholy, Amani, Liskova, Anna, Özdemir, Mehmet, Khan, Ejaz Ahmed, Uygun-Kizmaz, Yesim, Pandak, Nenad, Pandya, Nirav, Arapović, Jurica, Karaali, Rıdvan, Oztoprak, Nefise, Petrov, Michael M., Alabadla, Rami, Alay, Handan, Kholy, Jehan Ali El, Landelle, Caroline, Khedr, Reham, Mamtora, Dhruv, Dragovac, Gorana, Fernandez, Ricardo, Evren, Emine Unal, Raka, Lul, Cascio, Antonio, Dauby, Nicolas, Oncul, Ahsen, Balin, Safak Ozer, Cag, Yasemin, Dirani, Natalia, Dogan, Mustafa, Dumitru, Irina Magdalena, Gad, Maha Ali, Darazam, Ilad Alavi, Naghili, Behrouz, Del Vecchio, Rosa Fontana, Licker, Monica, Marino, Andrea, Akhtar, Nasim, Kamal, Mostafa, Angioni, Goffredo, Medić, Deana, Esmaoğlu, Aliye, Gergely, Szabo Balint, Silva-Pinto, André, Santos, Lurdes, Miftode, Ionela Larisa, Tekin, Recep, Wongsurakiat, Phunsup, Khan, Mumtaz Ali, Kurekci, Yesim, Pilli, Hema Prakash, Grozdanovski, Krsto, Miftode, Egidia, Baljic, Rusmir, Vahabolgu, Haluk, and Rello, Jordi
Abstract: Evaluating trends in antibiotic resistance is a requisite. The study aimed to analyze the profile of multidrug-resistant organisms (MDROs) among hospitalized patients with bacteremia in intensive care units (ICUs) in a large geographical area. This is a 1-month cross-sectional survey for blood-borne pathogens in 57 ICUs from 24 countries with different income levels: lower-middle-income (LMI), upper-middle-income (UMI), and high-income (HI) countries. Multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant isolates were searched. Logistic regression analysis determined resistance predictors among MDROs. Community-acquired infections were comparable to hospital-acquired infections particularly in LMI (94/202; 46.5% vs 108/202; 53.5%). Although MDR (65.1%; 502/771) and XDR (4.9%; 38/771) were common, no pan-drug-resistant isolate was recovered. In total, 32.1% of MDR were Klebsiella pneumoniae, and 55.3% of XDR were Acinetobacter baumannii. The highest MDR and XDR rates were in UMI and LMI, respectively, with no XDR revealed from HI. Predictors of MDR acquisition were male gender (OR, 12.11; 95% CI, 3.025–15.585) and the hospital-acquired origin of bacteremia (OR, 2.643; 95%CI, 1.462–3.894), and XDR acquisition was due to bacteremia in UMI (OR, 3.344; 95%CI, 1.189–5.626) and admission to medical-surgical ICUs (OR, 1.481; 95% CI, 1.076–2.037). We confirm the urgent need to expand stewardship activities to community settings especially in LMI, with more paid attention to the drugs with a higher potential for resistance. Empowering microbiology laboratories and reports to direct prescribing decisions should be prioritized. Supporting stewardship in ICUs, the mixed medical-surgical ones in particular, is warranted., SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2021

12. Timing of elective tracheotomy and duration of mechanical ventilation among patients admitted to intensive care with severe COVID-19: A multicenter prospective cohort study

Author: Universitat Rovira i Virgili, Prats-Uribe, Albert; Tobed, Marc; Miguel Villacampa, Jose; Aguero, Adriana; Garcia-Bastida, Clara; Ignacio Tato, Jose; Rodriganez, Laura; Duque Holguera, Victoria; Hernandez-Garcia, Estefania; Poletti, Daniel; Simonetti, Gabriela; Villarraga, Vanessa; Meler-Claramonte, Carla; Sanchez Barrueco, Alvaro; Chiesa-Estomba, Carlos; Casasayas, Maria; Parente-Arias, Pablo; Mata-Castro, Nieves; Rello, Jordi; Castro, Pedro; Prieto-Alhambra, Daniel; Vilaseca, Isabel; Xavier Aviles-Jurado, Francesc;TraqueoCOVID SEORL Grp, Universitat Rovira i Virgili, and Prats-Uribe, Albert; Tobed, Marc; Miguel Villacampa, Jose; Aguero, Adriana; Garcia-Bastida, Clara; Ignacio Tato, Jose; Rodriganez, Laura; Duque Holguera, Victoria; Hernandez-Garcia, Estefania; Poletti, Daniel; Simonetti, Gabriela; Villarraga, Vanessa; Meler-Claramonte, Carla; Sanchez Barrueco, Alvaro; Chiesa-Estomba, Carlos; Casasayas, Maria; Parente-Arias, Pablo; Mata-Castro, Nieves; Rello, Jordi; Castro, Pedro; Prieto-Alhambra, Daniel; Vilaseca, Isabel; Xavier Aviles-Jurado, Francesc;TraqueoCOVID SEORL Grp
Abstract: Background Optimal timing for tracheotomy for critically ill COVID-19 patients requiring invasive mechanical ventilation (IMV) is not established. Methods Multicenter prospective cohort including all COVID-19 patients admitted to intensive care units (ICUs) in 36 hospitals who required tracheotomy during first pandemic wave. With a target emulation trial framework, we studied the causal effects of early (7-10 days) versus late (>10 days) tracheotomy (LT) on time from tracheotomy to weaning, postoperative mortality, and tracheotomy complications. Results Of 696 patients, 20.4% received early tracheotomy (ET). ET was associated with faster weaning (hazard ratio [HR] [95% confidence interval, CI]: 1.25 [1.00-1.56]) without differences in mortality (HR [95% CI]: 0.85 [0.60-1.21]) or complications (adjusted rate ratio [95% CI]: 0.56 [0.23-1.33]). Conclusions ET had a similar or lower post-tracheotomy weaning time than LT, potentially shortening IMV and ICU stays, without changing complication or mortality rates in COVID-19 patients.
Published: 2021

13. Efficacy, immunogenicity, and safety of IC43 recombinant Pseudomonas aeruginosa vaccine in mechanically ventilated intensive care patients - A randomized clinical trial

Author: Adlbrecht, Christopher, Wurm, Raphael, Depuydt, Pieter, Spapen, Herbert D. M., Lorente, José Ángel J.A., Staudinger, Thomasa, Creteur, Jacques, Zauner, Christian, Meier-Hellmann, Andreas, Eller, Philipp, Laenen, Margot Vander, Molnár, Zsolt, Várkonyi, István, Schaaf, Bernhard, Héjja, Mária, Šrámek, Vladimír, Schneider, Hauke, Kanesa-Thasan, Niranjan, Eder-Lingelbach, Susanne, Klingler, Anton, Dubischar, Katrin, Wressnigg, Nina, Rello, Jordi, Adlbrecht, Christopher, Wurm, Raphael, Depuydt, Pieter, Spapen, Herbert D. M., Lorente, José Ángel J.A., Staudinger, Thomasa, Creteur, Jacques, Zauner, Christian, Meier-Hellmann, Andreas, Eller, Philipp, Laenen, Margot Vander, Molnár, Zsolt, Várkonyi, István, Schaaf, Bernhard, Héjja, Mária, Šrámek, Vladimír, Schneider, Hauke, Kanesa-Thasan, Niranjan, Eder-Lingelbach, Susanne, Klingler, Anton, Dubischar, Katrin, Wressnigg, Nina, and Rello, Jordi
Abstract: Background: Pseudomonas aeruginosa infections are a serious threat in intensive care units (ICUs). The aim of this confirmatory, randomized, multicenter, placebo-controlled, double-blind, phase 2/3 study was to assess the efficacy, immunogenicity, and safety of IC43 recombinant Pseudomonas aeruginosa vaccine in non-surgical ICU patients. Methods: Eight hundred patients aged 18 to 80 years admitted to the ICU with expected need for mechanical ventilation for ≥ 48 h were randomized 1:1 to either IC43 100 μg or saline placebo, given in two vaccinations 7 days apart. The primary efficacy endpoint was all-cause mortality in patients 28 days after the first vaccination. Immunogenicity and safety were also evaluated. Findings: All-cause mortality rates at day 28 were 29.2% vs 27.7% in the IC43 and placebo groups, respectively (P =.67). Overall survival (Kaplan-Meier survival estimates, P =.46) and proportion of patients with ≥ one confirmed P. aeruginosa invasive infection or respiratory tract infection also did not differ significantly between both groups. The geometric mean fold increase in OprF/I titers was 1.5 after the first vaccination, 20 at day 28, after the second vaccination, and 2.9 at day 180. Significantly more patients in the placebo group (96.5%) had ≥ one adverse event (AE) versus the IC43 100 μg group (93.1%) (P =.04). The most frequently reported severe AEs in the IC43 and placebo groups were respiratory failure (6.9% vs 5.7%, respectively), septic shock (4.1% vs 6.5%), cardiac arrest (4.3% vs 5.7%), multiorgan failure (4.6% vs 5.5%), and sepsis (4.6% vs 4.2%). No related serious AEs were reported in the IC43 group. Interpretation: The IC43 100 μg vaccine was well tolerated in this large population of medically ill, mechanically ventilated patients. The vaccine achieved high immunogenicity but provided no clinical benefit over placebo in terms of overall mortality. Trial registration: https://clinicaltrials.gov (NCT01563263). Registration was sent to Clin, SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2020

14. Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS A Secondary Analysis of the EFRAIM Study

Author: Demoule, Alexandre, Demoule, Alexandre, Antonelli, Massimo, Schellongowski, Peter, Pickkers, Peter, Soares, Marcio, Meyhoff, Tine, Rello, Jordi, Bauer, Philippe R., van de Louw, Andry, Lemiale, Virgine, Grimaldi, David, Martin-Loeches, Ignacio, Balik, Martin, Mehta, Sangeeta, Kouatchet, Achille, Barratt-Due, Andreas, Valkonen, Miia, Reignier, Jean, Metaxa, Victoria, Moreau, Anne-Sophie, Burghi, Gaston, Mokart, Djamel, Mayaux, Julien, Darmon, Michael, Azoulay, Elie, EFRAIM Investigators, Bergmans, Dennis, Demoule, Alexandre, Demoule, Alexandre, Antonelli, Massimo, Schellongowski, Peter, Pickkers, Peter, Soares, Marcio, Meyhoff, Tine, Rello, Jordi, Bauer, Philippe R., van de Louw, Andry, Lemiale, Virgine, Grimaldi, David, Martin-Loeches, Ignacio, Balik, Martin, Mehta, Sangeeta, Kouatchet, Achille, Barratt-Due, Andreas, Valkonen, Miia, Reignier, Jean, Metaxa, Victoria, Moreau, Anne-Sophie, Burghi, Gaston, Mokart, Djamel, Mayaux, Julien, Darmon, Michael, Azoulay, Elie, EFRAIM Investigators, and Bergmans, Dennis
Abstract: BACKGROUND: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement.RESEARCH QUESTION: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [Delta Prs]).STUDY DESIGN AND METHODS: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, Delta Prs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality.RESULTS: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.012.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher Delta Prs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: Delta Prs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality.INTERPRETATION: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.
Published: 2020

15. Antimicrobial de-escalation in critically ill patients: a position statement from a task force of the European Society of Intensive Care Medicine (ESICM) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Critically Ill Patients Study Group (ESGCIP)

Author: Tabah, Alexis, Bassetti, Matteo, Kollef, Marin H., Zahar, Jean-Ralph, Paiva, José-Artur, Timsit, Jean-Francois, Roberts, Jason A., Schouten, Jeroen, Giamarellou, Helen, Rello, Jordi, Waele, Jan De, Shorr, Andrew F., Leone, Marc, Poulakou, Garyphallia, Depuydt, Pieter, Garnacho-Montero, Jose, Tabah, Alexis, Bassetti, Matteo, Kollef, Marin H., Zahar, Jean-Ralph, Paiva, José-Artur, Timsit, Jean-Francois, Roberts, Jason A., Schouten, Jeroen, Giamarellou, Helen, Rello, Jordi, Waele, Jan De, Shorr, Andrew F., Leone, Marc, Poulakou, Garyphallia, Depuydt, Pieter, and Garnacho-Montero, Jose
Abstract: Background: Antimicrobial de-escalation (ADE) is a strategy of antimicrobial stewardship, aiming at preventing the emergence of antimicrobial resistance (AMR) by decreasing the exposure to broad-spectrum antimicrobials. There is no high-quality research on ADE and its effects on AMR. Its definition varies and there is little evidence-based guidance for clinicians to use ADE in the intensive care unit (ICU). Methods: A task force of 16 international experts was formed in November 2016 to provide with guidelines for clinical practice to develop questions targeted at defining ADE, its effects on the ICU population and to provide clinical guidance. Groups of 2 experts were assigned 1–2 questions each within their field of expertise to provide draft statements and rationale. A Delphi method, with 3 rounds and an agreement threshold of 70% was required to reach consensus. Results: We present a comprehensive document with 13 statements, reviewing the evidence on the definition of ADE, its effects in the ICU population and providing guidance for clinicians in subsets of clinical scenarios where ADE may be considered. Conclusion: ADE remains a topic of controversy due to the complexity of clinical scenarios where it may be applied and the absence of evidence to the effects it may have on antimicrobial resistance.
Published: 2020

16. Ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria: understanding nebulization of aminoglycosides and colistin.

Author: UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, UCL - (SLuc) Service de soins intensifs, UCL - (SLuc) Service de médecine physique et de réadaptation motrice, Rouby, Jean-Jacques, Sole-Lleonart, Candela, Rello, Jordi, European Investigators Network for Nebulized Antibiotics in Ventilator-associated Pneumonia, Dugernier, Jonathan, Laterre, Pierre-François, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, UCL - (SLuc) Service de soins intensifs, UCL - (SLuc) Service de médecine physique et de réadaptation motrice, Rouby, Jean-Jacques, Sole-Lleonart, Candela, Rello, Jordi, European Investigators Network for Nebulized Antibiotics in Ventilator-associated Pneumonia, Dugernier, Jonathan, and Laterre, Pierre-François
Abstract: The use of nebulized antibiotics for treating ventilatorassociated pneumonia (VAP) caused by multidrugresistant (MDR) Gram-negative bacteria (GNB) increases worldwide. There is a paradox, however, between the large body of experimental evidence supporting the administration of nebulized rather than intravenous aminoglycosides and colistin to treat inoculation pneumonia caused by GNB [1, 2], and the paucity of clinical studies confirming such a benefit in VAP. Based on the recommendations of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) [3, 4], the present article examines this apparent contradiction and suggests some directions for further research and clinical practice. [...]
Published: 2020

17. Correction to: Ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria: understanding nebulization of aminoglycosides and colistin.

Author: UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, UCL - (SLuc) Service de soins intensifs, UCL - (SLuc) Service de médecine physique et de réadaptation motrice, Rouby, Jean-Jacques, Sole-Lleonart, Candela, Rello, Jordi, European Investigators Network for Nebulized Antibiotics in Ventilator-associated Pneumonia, Dugernier, Jonathan, Laterre, Pierre-François, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, UCL - (SLuc) Service de soins intensifs, UCL - (SLuc) Service de médecine physique et de réadaptation motrice, Rouby, Jean-Jacques, Sole-Lleonart, Candela, Rello, Jordi, European Investigators Network for Nebulized Antibiotics in Ventilator-associated Pneumonia, Dugernier, Jonathan, and Laterre, Pierre-François
Abstract: The original version of this article unfortunately contained a mistake. There was a typographical error in Figure 1: "Nebulization time ≤ 30 min" (first light blue square) should be replaced by "Nebulization time ≤ 90 min". The authors apologize for the mistake.
Published: 2020

18. Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS A Secondary Analysis of the EFRAIM Study

Author: Demoule, Alexandre, Demoule, Alexandre, Antonelli, Massimo, Schellongowski, Peter, Pickkers, Peter, Soares, Marcio, Meyhoff, Tine, Rello, Jordi, Bauer, Philippe R., van de Louw, Andry, Lemiale, Virgine, Grimaldi, David, Martin-Loeches, Ignacio, Balik, Martin, Mehta, Sangeeta, Kouatchet, Achille, Barratt-Due, Andreas, Valkonen, Miia, Reignier, Jean, Metaxa, Victoria, Moreau, Anne-Sophie, Burghi, Gaston, Mokart, Djamel, Mayaux, Julien, Darmon, Michael, Azoulay, Elie, EFRAIM Investigators, Bergmans, Dennis, Demoule, Alexandre, Demoule, Alexandre, Antonelli, Massimo, Schellongowski, Peter, Pickkers, Peter, Soares, Marcio, Meyhoff, Tine, Rello, Jordi, Bauer, Philippe R., van de Louw, Andry, Lemiale, Virgine, Grimaldi, David, Martin-Loeches, Ignacio, Balik, Martin, Mehta, Sangeeta, Kouatchet, Achille, Barratt-Due, Andreas, Valkonen, Miia, Reignier, Jean, Metaxa, Victoria, Moreau, Anne-Sophie, Burghi, Gaston, Mokart, Djamel, Mayaux, Julien, Darmon, Michael, Azoulay, Elie, EFRAIM Investigators, and Bergmans, Dennis
Abstract: BACKGROUND: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement.RESEARCH QUESTION: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [Delta Prs]).STUDY DESIGN AND METHODS: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, Delta Prs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality.RESULTS: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.012.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher Delta Prs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: Delta Prs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality.INTERPRETATION: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.
Published: 2020

19. Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020).

Author: Bai, Chunxue, Bai, Chunxue, Chotirmall, Sanjay H, Rello, Jordi, Alba, George A, Ginns, Leo C, Krishnan, Jerry A, Rogers, Robert, Bendstrup, Elisabeth, Burgel, Pierre-Regis, Chalmers, James D, Chua, Abigail, Crothers, Kristina A, Duggal, Abhijit, Kim, Yeon Wook, Laffey, John G, Luna, Carlos M, Niederman, Michael S, Raghu, Ganesh, Ramirez, Julio A, Riera, Jordi, Roca, Oriol, Tamae-Kakazu, Maximiliano, Torres, Antoni, Watkins, Richard R, Barrecheguren, Miriam, Belliato, Mirko, Chami, Hassan A, Chen, Rongchang, Cortes-Puentes, Gustavo A, Delacruz, Charles, Hayes, Margaret M, Heunks, Leo MA, Holets, Steven R, Hough, Catherine L, Jagpal, Sugeet, Jeon, Kyeongman, Johkoh, Takeshi, Lee, May M, Liebler, Janice, McElvaney, Gerry N, Moskowitz, Ari, Oeckler, Richard A, Ojanguren, Iñigo, O'Regan, Anthony, Pletz, Mathias W, Rhee, Chin Kook, Schultz, Marcus J, Storti, Enrico, Strange, Charlie, Thomson, Carey C, Torriani, Francesca J, Wang, Xun, Wuyts, Wim, Xu, Tao, Yang, Dawei, Zhang, Ziqiang, Wilson, Kevin C, Bai, Chunxue, Bai, Chunxue, Chotirmall, Sanjay H, Rello, Jordi, Alba, George A, Ginns, Leo C, Krishnan, Jerry A, Rogers, Robert, Bendstrup, Elisabeth, Burgel, Pierre-Regis, Chalmers, James D, Chua, Abigail, Crothers, Kristina A, Duggal, Abhijit, Kim, Yeon Wook, Laffey, John G, Luna, Carlos M, Niederman, Michael S, Raghu, Ganesh, Ramirez, Julio A, Riera, Jordi, Roca, Oriol, Tamae-Kakazu, Maximiliano, Torres, Antoni, Watkins, Richard R, Barrecheguren, Miriam, Belliato, Mirko, Chami, Hassan A, Chen, Rongchang, Cortes-Puentes, Gustavo A, Delacruz, Charles, Hayes, Margaret M, Heunks, Leo MA, Holets, Steven R, Hough, Catherine L, Jagpal, Sugeet, Jeon, Kyeongman, Johkoh, Takeshi, Lee, May M, Liebler, Janice, McElvaney, Gerry N, Moskowitz, Ari, Oeckler, Richard A, Ojanguren, Iñigo, O'Regan, Anthony, Pletz, Mathias W, Rhee, Chin Kook, Schultz, Marcus J, Storti, Enrico, Strange, Charlie, Thomson, Carey C, Torriani, Francesca J, Wang, Xun, Wuyts, Wim, Xu, Tao, Yang, Dawei, Zhang, Ziqiang, and Wilson, Kevin C
Abstract: BackgroundCoronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research.MethodsAn International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion.ResultsThe Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder.ConclusionsThe Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities.
Published: 2020

20. Aminoglycosides in Immunocompromised Critically Ill Patients With Bacterial Pneumonia and Septic Shock: A Post-Hoc Analysis of a Prospective Multicenter Multinational Cohort

Author: Lopez, René, Rello, Jordi, Silvio Taccone, Fabio, Ben Hadj Salem, Omar, R Bauer, Philippe, Séguin, Amélie, van de Louw, Andry, Metaxa, Victoria, Klouche, Kada, Martin Loeches, Ignacio, Montini, Luca, Mehta, Sangeeta, Bruneel, Fabrice, Lisboa, T, Viana, William, Pickkers, Peter, Russell Katerina Rusinova, Lene, Kouatchet, Achille, Barbier, Françoi, Mokart Elie Azoulay, Djamel, Darmon, Michael, Luca Montini (ORCID:0000-0003-4602-5134), Lopez, René, Rello, Jordi, Silvio Taccone, Fabio, Ben Hadj Salem, Omar, R Bauer, Philippe, Séguin, Amélie, van de Louw, Andry, Metaxa, Victoria, Klouche, Kada, Martin Loeches, Ignacio, Montini, Luca, Mehta, Sangeeta, Bruneel, Fabrice, Lisboa, T, Viana, William, Pickkers, Peter, Russell Katerina Rusinova, Lene, Kouatchet, Achille, Barbier, Françoi, Mokart Elie Azoulay, Djamel, Darmon, Michael, and Luca Montini (ORCID:0000-0003-4602-5134)
Abstract: BACKGROUND: The routine use of empiric combination therapy with aminoglycosides during critical illness is associated with uncertain benefit and increased risk of acute kidney injury. This study aimed to assess the benefits of aminoglycosides in immunocompromised patients with suspected bacterial pneumonia and sepsis. METHODS: Secondary analysis of a prospective multicenter study. Adult immunocompromised patients with suspected bacterial pneumonia and sepsis or septic shock were included. Primary outcome was hospital mortality. Secondary outcomes were needed for renal replacement therapy (RRT). Mortality was also assessed in neutropenic patients and in those with confirmed bacterial pneumonia. Results were further analyzed in a cohort matched on risk of receiving aminoglycosides combination. RESULTS: Five hundred thirty-five patients were included in this analysis, of whom 187 (35%) received aminoglycosides in addition to another antibiotic effective against gram-negative bacteria. Overall hospital mortality was 59.6% (58.3% vs. 60.3% in patients receiving and not receiving combination therapy; P = 0.71). Lack of association between mortality and aminoglycosides was confirmed after adjustment for confounders and center effect (adjusted OR 1.14 [0.69-1.89]) and in a propensity matched cohort (adjusted OR = 0.89 [0.49-1.61]). No association was found between aminoglycosides and need for RRT (adjusted OR = 0.83 [0.49-1.39], P = 0.477), nor between aminoglycoside use and outcome in neutropenic patients or in patients with confirmed bacterial pneumonia (adjusted OR 0.66 [0.23-1.85] and 1.25 [0.61-2.57], respectively). CONCLUSION: Aminoglycoside combination therapy was not associated with hospital mortality or need for renal replacement therapy in immunocompromised patients with pulmonary sepsis.
Published: 2020

21. Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS

Author: Demoule, Alexandre, Antonelli, Massimo, Schellongowski, Peter, Pickkers, Peter, Soares, Marcio, Meyhoff, Tine Sylvest, Rello, Jordi, Bauer, Philippe, Van De Louw, Andry, Lemiale, Virgine, Grimaldi, David, Martin-loeches, Ignacio, Balik, Martin, Mehta, Sangeeta, Kouatchet, Achille, Barratt-due, Andreas, Valkonen, Miia, Reignier, Jean, Metaxa, Victoria, Moreau, Anne Sophie, Burghi, Gaston, Mokart, Djamel, Mayaux, Julien, Darmon, Michael, Azoulay, Elie, Amrein, Karin, Staundinger, Thomas, Heinz, Gottfried, Sengölge, Gürkan, Zauner, Christian, Jaksch, Peter, Taccone, Fabio S., Meert, Anne Pascale, Benoît, Dominique, Silva, Ulysses V.a., Pierre De Moraes, Ana Paula, Lishoa, Thiago, Salluh, Jorge, Viana, William, Moralez, Guilliana, Correa, Thiago Domingos, Shah, Umesh, Karvunidis, Thomas, Martin, Balik, Russinova, Katerina, Perner, Anders, Jonas, Nielsen, Bukan, Ramin Brandt, Moeller, Ann M., Nielsen, Lene B., Seguin, Amélie, Chermak, Akli, Terzi, Nicolas, Vinatier, Isabelle, Wallet, Florent, Klouche, Kada, Platon, Laura, Gaborit, Benjamin, Barbier, François, Pène, Frederic, Rabbat, Antoine, Lemiale, Virginie, N'yunga, Martine, Girault, Christophe, Lemaitre, Caroline, Artaud-macari, Elise, Bruneel, F., Kuitunen, Anne, Marsh, Brian, Misericordia, Mater, Mahon, Aisling Mc, Cinnella, Gilda, Cotoia, Antonella, Riuniti, Ospedali, Montini, Lucas, Spoelstra De Man, Angélique, Landburg, Precious Pearl, Bergmans, Dennis, Hemelaar, Pleun, Kaufmann, Thomas, Barrat-due, Andreas, Klepstad, Pål, Encina, Belen, Moreno, Gabriel, Crespi, Llorenç Socias, Rodriguez-ruiz, Emilio, Hemang, Yadav, Demoule, Alexandre, Antonelli, Massimo, Schellongowski, Peter, Pickkers, Peter, Soares, Marcio, Meyhoff, Tine Sylvest, Rello, Jordi, Bauer, Philippe, Van De Louw, Andry, Lemiale, Virgine, Grimaldi, David, Martin-loeches, Ignacio, Balik, Martin, Mehta, Sangeeta, Kouatchet, Achille, Barratt-due, Andreas, Valkonen, Miia, Reignier, Jean, Metaxa, Victoria, Moreau, Anne Sophie, Burghi, Gaston, Mokart, Djamel, Mayaux, Julien, Darmon, Michael, Azoulay, Elie, Amrein, Karin, Staundinger, Thomas, Heinz, Gottfried, Sengölge, Gürkan, Zauner, Christian, Jaksch, Peter, Taccone, Fabio S., Meert, Anne Pascale, Benoît, Dominique, Silva, Ulysses V.a., Pierre De Moraes, Ana Paula, Lishoa, Thiago, Salluh, Jorge, Viana, William, Moralez, Guilliana, Correa, Thiago Domingos, Shah, Umesh, Karvunidis, Thomas, Martin, Balik, Russinova, Katerina, Perner, Anders, Jonas, Nielsen, Bukan, Ramin Brandt, Moeller, Ann M., Nielsen, Lene B., Seguin, Amélie, Chermak, Akli, Terzi, Nicolas, Vinatier, Isabelle, Wallet, Florent, Klouche, Kada, Platon, Laura, Gaborit, Benjamin, Barbier, François, Pène, Frederic, Rabbat, Antoine, Lemiale, Virginie, N'yunga, Martine, Girault, Christophe, Lemaitre, Caroline, Artaud-macari, Elise, Bruneel, F., Kuitunen, Anne, Marsh, Brian, Misericordia, Mater, Mahon, Aisling Mc, Cinnella, Gilda, Cotoia, Antonella, Riuniti, Ospedali, Montini, Lucas, Spoelstra De Man, Angélique, Landburg, Precious Pearl, Bergmans, Dennis, Hemelaar, Pleun, Kaufmann, Thomas, Barrat-due, Andreas, Klepstad, Pål, Encina, Belen, Moreno, Gabriel, Crespi, Llorenç Socias, Rodriguez-ruiz, Emilio, and Hemang, Yadav
Published: 2020

22. Acute respiratory failure in immunocompromised patients: outcome and clinical features according to neutropenia status

Author: Mokart, Djamel, Darmon, Michael, Schellongowski, Peter, Pickkers, Peter, Soares, Marcio, Rello, Jordi, Bauer, Philippe P.R., Van de Louw, Andry, Lemiale, Virginie, Taccone, Fabio, Martin-Loeches, Ignacio, Salluh, Jorge, Rusinova, Katerina, Mehta, Sangeeta, Antonelli, Massimo, Kouatchet, Achille, Barratt-Due, Andreas, Valkonen, Miia, Landburg, Precious Pearl, Bukan, Ramin Brandt, Pène, Frédéric, Metaxa, Victoria, Burghi, Gastón, Saillard, Colombe, Nielsen, Lene L.B., Canet, Emmanuel, Bisbal, Magali, Azoulay, Elie, Mokart, Djamel, Darmon, Michael, Schellongowski, Peter, Pickkers, Peter, Soares, Marcio, Rello, Jordi, Bauer, Philippe P.R., Van de Louw, Andry, Lemiale, Virginie, Taccone, Fabio, Martin-Loeches, Ignacio, Salluh, Jorge, Rusinova, Katerina, Mehta, Sangeeta, Antonelli, Massimo, Kouatchet, Achille, Barratt-Due, Andreas, Valkonen, Miia, Landburg, Precious Pearl, Bukan, Ramin Brandt, Pène, Frédéric, Metaxa, Victoria, Burghi, Gastón, Saillard, Colombe, Nielsen, Lene L.B., Canet, Emmanuel, Bisbal, Magali, and Azoulay, Elie
Abstract: Background: The impact of neutropenia in critically ill immunocompromised patients admitted in a context of acute respiratory failure (ARF) remains uncertain. The primary objective was to assess the prognostic impact of neutropenia on outcomes of these patients. Secondary objective was to assess etiology of ARF according to neutropenia. Methods: We performed a post hoc analysis of a prospective multicenter multinational study from 23 ICUs belonging to the Nine-I network. Between November 2015 and July 2016, all adult immunocompromised patients with ARF admitted to the ICU were included in the study. Adjusted analyses included: (1) a hierarchical model with center as random effect; (2) propensity score (PS) matched cohort; and (3) adjusted analysis in the matched cohort. Results: Overall, 1481 patients were included in this study of which 165 had neutropenia at ICU admission (11%). ARF etiologies distribution was significantly different between neutropenic and non-neutropenic patients, main etiologies being bacterial pneumonia (48% vs 27% in neutropenic and non-neutropenic patients, respectively). Initial oxygenation strategy was standard supplemental oxygen in 755 patients (51%), high-flow nasal oxygen in 165 (11%), non-invasive ventilation in 202 (14%) and invasive mechanical ventilation in 359 (24%). Before adjustment, hospital mortality was significantly higher in neutropenic patients (54% vs 42%; p = 0.006). After adjustment for confounder and center effect, neutropenia was no longer associated with outcome (OR 1.40, 95% CI 0.93–2.11). Similar results were observed after matching (52% vs 46%, respectively; p = 0.35) and after adjustment in the matched cohort (OR 1.04; 95% CI 0.63–1.72). Conclusion: Neutropenia at ICU admission is not associated with hospital mortality in this cohort of critically ill immunocompromised patients admitted for ARF. In neutropenic patients, main ARF etiologies are bacterial and fungal infections., SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2020

23. Etiologies and Outcomes of Acute Respiratory Failure in Solid Organ Transplant Recipients: Insight Into the EFRAIM Multicenter Cohort

Author: Messika, Jonathan, Darmon, Michael, Mal, Hervé, Pickkers, Peter, Soares, Marcio, Canet, Emmanuel, Rello, Jordi, Bauer, Philippe P.R., Van de Louw, Andry, Lemiale, Virginie, Taccone, Fabio, Loeches, Ignacio Martin, Schellongowski, Peter, Mehta, Sangeeta, Antonelli, Massimo, Kouatchet, Achille, Barratt-Due, Andreas, Valkonen, Miia, Bruneel, Fabrice, Pène, Frédéric, Metaxa, Victoria, Moreau, Anne Sophie, Burghi, Gastón, Montini, Luca, Barbier, François, Nielsen, Lene L.B., Mokart, Djamel, Chevret, Sylvie, Zafrani, Lara, Azoulay, Elie, Messika, Jonathan, Darmon, Michael, Mal, Hervé, Pickkers, Peter, Soares, Marcio, Canet, Emmanuel, Rello, Jordi, Bauer, Philippe P.R., Van de Louw, Andry, Lemiale, Virginie, Taccone, Fabio, Loeches, Ignacio Martin, Schellongowski, Peter, Mehta, Sangeeta, Antonelli, Massimo, Kouatchet, Achille, Barratt-Due, Andreas, Valkonen, Miia, Bruneel, Fabrice, Pène, Frédéric, Metaxa, Victoria, Moreau, Anne Sophie, Burghi, Gastón, Montini, Luca, Barbier, François, Nielsen, Lene L.B., Mokart, Djamel, Chevret, Sylvie, Zafrani, Lara, and Azoulay, Elie
Abstract: Background: Respiratory complications of solid organ transplant (SOT) are a diagnostic and therapeutic challenge when requiring intensive care unit (ICU) admission. We aimed at describing this challenge in a prospective cohort of SOT recipients admitted in the ICU. Methods: In this post hoc analysis of an international cohort of immunocompromised patients admitted in the ICU for an acute respiratory failure, we analyzed all SOT recipients and compared their severity, etiologic diagnosis, prognosis, and outcome according to the performance of an invasive diagnostic strategy (encompassing a fiber-optic bronchoscopy and bronchoalveolar lavage), the type of transplanted organ, and the need of invasive ventilation at day 1. Results: Among 1611 patients included in the primary study, 142 were SOT recipients (kidney, n = 73; 51.4%; lung, n = 33; 23.2%; liver, n = 29; 20.4%; heart, n = 7; 4.9%). Lung transplant recipients were younger than other SOT recipients, and severity did not differ across type of received organ. An invasive diagnostic strategy was more frequently performed in lung transplant recipients with a trend toward a higher rate of bacterial etiology in lung than kidney transplant recipients. Overall ICU survival of SOT recipients was 75.4%. Invasive diagnostic strategy, type of transplanted organ, and need of invasive mechanical ventilation at day 1 did not affect ICU prognosis. Conclusions: ICU management of hypoxemic acute respiratory failure in SOT recipients translated into a low ICU mortality rate, whatever the transplanted organ or the acute respiratory failure cause. The post-ICU burden of acute respiratory failure SOT recipients remains to be investigated., SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2020

24. Diagnosis of severe respiratory infections in immunocompromised patients

Author: Azoulay, Elie, Russell, Lene, Van de Louw, Andry, Metaxa, Victoria, Bauer, Philippe, Povoa, Pedro, Montero, José Garnacho, Loeches, Ignacio Martin, Mehta, Sangeeta, Puxty, Kathryn, Schellongowski, Peter, Rello, Jordi, Mokart, Djamel, Lemiale, Virginie, Mirouse, Adrien, Azoulay, Elie, Russell, Lene, Van de Louw, Andry, Metaxa, Victoria, Bauer, Philippe, Povoa, Pedro, Montero, José Garnacho, Loeches, Ignacio Martin, Mehta, Sangeeta, Puxty, Kathryn, Schellongowski, Peter, Rello, Jordi, Mokart, Djamel, Lemiale, Virginie, and Mirouse, Adrien
Abstract: An increasing number of critically ill patients are immunocompromised. Acute hypoxemic respiratory failure (ARF), chiefly due to pulmonary infection, is the leading reason for ICU admission. Identifying the cause of ARF increases the chances of survival, but may be extremely challenging, as the underlying disease, treatments, and infection combine to create complex clinical pictures. In addition, there may be more than one infectious agent, and the pulmonary manifestations may be related to both infectious and non-infectious insults. Clinically or microbiologically documented bacterial pneumonia accounts for one-third of cases of ARF in immunocompromised patients. Early antibiotic therapy is recommended but decreases the chances of identifying the causative organism(s) to about 50%. Viruses are the second most common cause of severe respiratory infections. Positive tests for a virus in respiratory samples do not necessarily indicate a role for the virus in the current acute illness. Invasive fungal infections (Aspergillus, Mucorales, and Pneumocystis jirovecii) account for about 15% of severe respiratory infections, whereas parasites rarely cause severe acute infections in immunocompromised patients. This review focuses on the diagnosis of severe respiratory infections in immunocompromised patients. Special attention is given to newly validated diagnostic tests designed to be used on non-invasive samples or bronchoalveolar lavage fluid and capable of increasing the likelihood of an early etiological diagnosis., An increasing number of critically ill patients are immunocompromised. Acute hypoxemic respiratory failure (ARF), chiefly due to pulmonary infection, is the leading reason for ICU admission. Identifying the cause of ARF increases the chances of survival, but may be extremely challenging, as the underlying disease, treatments, and infection combine to create complex clinical pictures. In addition, there may be more than one infectious agent, and the pulmonary manifestations may be related to both infectious and non-infectious insults. Clinically or microbiologically documented bacterial pneumonia accounts for one-third of cases of ARF in immunocompromised patients. Early antibiotic therapy is recommended but decreases the chances of identifying the causative organism(s) to about 50%. Viruses are the second most common cause of severe respiratory infections. Positive tests for a virus in respiratory samples do not necessarily indicate a role for the virus in the current acute illness. Invasive fungal infections (Aspergillus, Mucorales, and Pneumocystis jirovecii) account for about 15% of severe respiratory infections, whereas parasites rarely cause severe acute infections in immunocompromised patients. This review focuses on the diagnosis of severe respiratory infections in immunocompromised patients. Special attention is given to newly validated diagnostic tests designed to be used on non-invasive samples or bronchoalveolar lavage fluid and capable of increasing the likelihood of an early etiological diagnosis.
Published: 2020

25. Aminoglycosides in Immunocompromised Critically Ill Patients With Bacterial Pneumonia and Septic Shock: A Post-Hoc Analysis of a Prospective Multicenter Multinational Cohort

Author: Lopez, Rene, Rello, Jordi, Taccone, Fabio Silvio, Salem, Omar Ben Hadj, Bauer, Philippe R., Seguin, Amelie, van de Louw, Andry, Metaxa, Victoria, Klouche, Kada, Loeches, Ignacio Martin, Montini, Luca, Mehta, Sangeeta, Bruneel, Fabrice, Lisboa, T., Viana, William, Pickkers, Peter, Russell, Lene, Rusinova, Katerina, Kouatchet, Achille, Barbier, Francois, Mokart, Djamel, Azoulay, Elie, Darmon, Michael, Lopez, Rene, Rello, Jordi, Taccone, Fabio Silvio, Salem, Omar Ben Hadj, Bauer, Philippe R., Seguin, Amelie, van de Louw, Andry, Metaxa, Victoria, Klouche, Kada, Loeches, Ignacio Martin, Montini, Luca, Mehta, Sangeeta, Bruneel, Fabrice, Lisboa, T., Viana, William, Pickkers, Peter, Russell, Lene, Rusinova, Katerina, Kouatchet, Achille, Barbier, Francois, Mokart, Djamel, Azoulay, Elie, and Darmon, Michael
Abstract: Background: The routine use of empiric combination therapy with aminoglycosides during critical illness is associated with uncertain benefit and increased risk of acute kidney injury. This study aimed to assess the benefits of aminoglycosides in immunocompromised patients with suspected bacterial pneumonia and sepsis. Methods: Secondary analysis of a prospective multicenter study. Adult immunocompromised patients with suspected bacterial pneumonia and sepsis or septic shock were included. Primary outcome was hospital mortality. Secondary outcomes were needed for renal replacement therapy (RRT). Mortality was also assessed in neutropenic patients and in those with confirmed bacterial pneumonia. Results were further analyzed in a cohort matched on risk of receiving aminoglycosides combination. Results: Five hundred thirty-five patients were included in this analysis, of whom 187 (35%) received aminoglycosides in addition to another antibiotic effective against gram-negative bacteria. Overall hospital mortality was 59.6% (58.3% vs. 60.3% in patients receiving and not receiving combination therapy; P = 0.71). Lack of association between mortality and aminoglycosides was confirmed after adjustment for confounders and center effect (adjusted OR 1.14 [0.69–1.89]) and in a propensity matched cohort (adjusted OR = 0.89 [0.49–1.61]). No association was found between aminoglycosides and need for RRT (adjusted OR = 0.83 [0.49–1.39], P = 0.477), nor between aminoglycoside use and outcome in neutropenic patients or in patients with confirmed bacterial pneumonia (adjusted OR 0.66 [0.23–1.85] and 1.25 [0.61–2.57], respectively). Conclusion: Aminoglycoside combination therapy was not associated with hospital mortality or need for renal replacement therapy in immunocompromised patients with pulmonary sepsis.
Published: 2020

26. Diagnosis of severe respiratory infections in immunocompromised patients

Author: Azoulay, Elie, Russell, Lene, Van de Louw, Andry, Metaxa, Victoria, Bauer, Philippe, Povoa, Pedro, Montero, José Garnacho, Loeches, Ignacio Martin, Mehta, Sangeeta, Puxty, Kathryn, Schellongowski, Peter, Rello, Jordi, Mokart, Djamel, Lemiale, Virginie, Mirouse, Adrien, Azoulay, Elie, Russell, Lene, Van de Louw, Andry, Metaxa, Victoria, Bauer, Philippe, Povoa, Pedro, Montero, José Garnacho, Loeches, Ignacio Martin, Mehta, Sangeeta, Puxty, Kathryn, Schellongowski, Peter, Rello, Jordi, Mokart, Djamel, Lemiale, Virginie, and Mirouse, Adrien
Abstract: An increasing number of critically ill patients are immunocompromised. Acute hypoxemic respiratory failure (ARF), chiefly due to pulmonary infection, is the leading reason for ICU admission. Identifying the cause of ARF increases the chances of survival, but may be extremely challenging, as the underlying disease, treatments, and infection combine to create complex clinical pictures. In addition, there may be more than one infectious agent, and the pulmonary manifestations may be related to both infectious and non-infectious insults. Clinically or microbiologically documented bacterial pneumonia accounts for one-third of cases of ARF in immunocompromised patients. Early antibiotic therapy is recommended but decreases the chances of identifying the causative organism(s) to about 50%. Viruses are the second most common cause of severe respiratory infections. Positive tests for a virus in respiratory samples do not necessarily indicate a role for the virus in the current acute illness. Invasive fungal infections (Aspergillus, Mucorales, and Pneumocystis jirovecii) account for about 15% of severe respiratory infections, whereas parasites rarely cause severe acute infections in immunocompromised patients. This review focuses on the diagnosis of severe respiratory infections in immunocompromised patients. Special attention is given to newly validated diagnostic tests designed to be used on non-invasive samples or bronchoalveolar lavage fluid and capable of increasing the likelihood of an early etiological diagnosis., An increasing number of critically ill patients are immunocompromised. Acute hypoxemic respiratory failure (ARF), chiefly due to pulmonary infection, is the leading reason for ICU admission. Identifying the cause of ARF increases the chances of survival, but may be extremely challenging, as the underlying disease, treatments, and infection combine to create complex clinical pictures. In addition, there may be more than one infectious agent, and the pulmonary manifestations may be related to both infectious and non-infectious insults. Clinically or microbiologically documented bacterial pneumonia accounts for one-third of cases of ARF in immunocompromised patients. Early antibiotic therapy is recommended but decreases the chances of identifying the causative organism(s) to about 50%. Viruses are the second most common cause of severe respiratory infections. Positive tests for a virus in respiratory samples do not necessarily indicate a role for the virus in the current acute illness. Invasive fungal infections (Aspergillus, Mucorales, and Pneumocystis jirovecii) account for about 15% of severe respiratory infections, whereas parasites rarely cause severe acute infections in immunocompromised patients. This review focuses on the diagnosis of severe respiratory infections in immunocompromised patients. Special attention is given to newly validated diagnostic tests designed to be used on non-invasive samples or bronchoalveolar lavage fluid and capable of increasing the likelihood of an early etiological diagnosis.
Published: 2020

27. Human metapneumovirus as cause of severe community-acquired pneumonia in adults: insights from a ten-year molecular and epidemiological analysis

Author: Medicina preventiva y salud pública, Prebentzio medikuntza eta osasun publikoa, Vidaur, Loreto, Totorika, Izarne, Montes, Milagrosa, Vicente Anza, Diego, Rello, Jordi, Cilla Eguiluz, Carlos Gustavo, Medicina preventiva y salud pública, Prebentzio medikuntza eta osasun publikoa, Vidaur, Loreto, Totorika, Izarne, Montes, Milagrosa, Vicente Anza, Diego, Rello, Jordi, and Cilla Eguiluz, Carlos Gustavo
Abstract: BackgroundInformation on the clinical, epidemiological and molecular characterization of human metapneumovirus in critically ill adult patients with severe community-acquired pneumonia (CAP) and the role of biomarkers identifying bacterial coinfection is scarce.MethodsThis is a retrospective epidemiological study of adult patients with hMPV severe CAP admitted to ICU during a ten-year period with admission PSI score >= 3.ResultsThe 92.8% of the 28 patients with severe CAP due to human metapneumovirus were detected during the first half of the year. Median age was 62years and 60.7% were male. The genotyping of isolated human metapneumovirus showed group B predominance (60.7%). All patients had acute respiratory failure. Median APACHE II and SOFA score were 13 and 6.55, respectively. The 25% were coinfected with Streptococcus pneumoniae. 60.7% of the patients had shock at admission and 50% underwent mechanical ventilation. Seven patients developed ARDS, three of them younger than 60years and without comorbidities. Mortality in ICU was 14.3%. Among survivors, ICU and hospital stay were 6.5 and 14days, respectively. Plasma levels of procalcitonin were higher in patients with bacterial coinfection (18.2 vs 0.54; p<0.05). The levels of C-reactive protein, however, were similar.ConclusionHuman metapneumovirus was associated with severe CAP requiring ICU admission among elderly patients or patients with comorbidities, but also in healthy young subjects. These patients often underwent mechanical ventilation with elevated health resource consumption. While one out of four patients showed pneumococcal coinfection, plasma procalcitonin helped to implement antimicrobial stewardship.
Published: 2019

28. Ventilator-Associated Pneumonia due to Drug-Resistant Acinetobacter baumannii : Risk Factors and Mortality Relation with Resistance Profiles, and Independent Predictors of In-Hospital Mortality

Author: Čiginskienė, Aušra, Dambrauskienė, Asta, Rello, Jordi, Adukauskienė, Dalia, Universitat Autònoma de Barcelona, Čiginskienė, Aušra, Dambrauskienė, Asta, Rello, Jordi, Adukauskienė, Dalia, and Universitat Autònoma de Barcelona
Abstract: Background and objectives: High mortality and healthcare costs area associated with ventilator-associated pneumonia (VAP) due to Acinetobacter baumannii (A. baumannii). The data concerning the link between multidrug-resistance of A. baumannii strains and outcomes remains controversial. Therefore, we aimed to identify the relation of risk factors for ventilator-associated pneumonia (VAP) and mortality with the drug resistance profiles of Acinetobacter baumannii (A. baumannii) and independent predictors of in-hospital mortality. Methods: A retrospective ongoing cohort study of 60 patients that were treated for VAP due to drug-resistant A. baumannii in medical-surgical intensive care units (ICU) over a two-year period was conducted. Results: The proportions of multidrug-resistant (MDR), extensively drug-resistant (XDR), and potentially pandrug-resistant (pPDR) A. baumannii were 13.3%, 68.3%, and 18.3%, respectively. The SAPS II scores on ICU admission were 42.6, 48.7, and 49 (p = 0.048); hospital length of stay (LOS) prior to ICU was 0, one, and two days (p = 0.036), prior to mechanical ventilation (MV)-0, 0, and three days (p = 0.013), and carbapenem use prior to VAP-50%, 29.3%, and 18.2% (p = 0.036), respectively. The overall in-hospital mortality rate was 63.3%. In MDR, XDR, and pPDR A. baumannii VAP groups, it was 62.5%, 61.3%, and 72.7% (p = 0.772), respectively. Binary logistic regression analysis showed that female gender (95% OR 5.26; CI: 1.21-22.83), SOFA score on ICU admission (95% OR 1.28; CI: 1.06-1.53), and RBC transfusion (95% OR 5.98; CI: 1.41-25.27) were all independent predictors of in-hospital mortality. Conclusions: The VAP risk factors: higher SAPS II score, increased hospital LOS prior to ICU, and MV were related to the higher resistance profile of A. baumannii. Carbapenem use was found to be associated with the risk of MDR A. baumannii VAP. Mortality due to drug-resistant A. baumannii VAP was high, but it was not associated with the A. baumannii r
Published: 2019

29. Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy

Author: Bauer, Philippe R., Bauer, Philippe R., Chevret, Sylvie, Yadav, Hemang, Mehta, Sangeeta, Pickkers, Peter, Bukan, Ramin B., Rello, Jordi, van de Louw, Andry, Klouche, Kada, Meert, Anne-Pascale, Martin-Loeches, Ignacio, Marsh, Brian, Crespi, Lorenzo Socias, Moreno-Gonzalez, Gabriel, Buchtele, Nina, Amrein, Karin, Balik, Martin, Antonelli, Massimo, Nyunga, Martine, Barratt-Due, Andreas, Bergmans, Dennis C. J. J., Spoelstra-de Man, Angelique M. E., Kuitunen, Anne, Wallet, Florent, Seguin, Amelie, Metaxa, Victoria, Lemiale, Virginie, Burghi, Gaston, Demoule, Alexandre, Karvunidis, Thomas, Cotoia, Antonella, Klepstad, Pal, Moller, Ann M., Mokart, Djamel, Azoulay, Elie, Rabbat, Antoine, Darmon, Michael, Platon, Laura, Mayaux, Julien, Chermak, Akli, Lemaitre, Caroline, Artaud-Macari, Elise, Nelsen, Jonas, Kaufmann, Thomas, Viana, William, Lishoa, Thiago, Correa, Thiago Domingos, Encina, Belen, Socias, Antonio, Efraim Investigators Nine-I Study, Bauer, Philippe R., Bauer, Philippe R., Chevret, Sylvie, Yadav, Hemang, Mehta, Sangeeta, Pickkers, Peter, Bukan, Ramin B., Rello, Jordi, van de Louw, Andry, Klouche, Kada, Meert, Anne-Pascale, Martin-Loeches, Ignacio, Marsh, Brian, Crespi, Lorenzo Socias, Moreno-Gonzalez, Gabriel, Buchtele, Nina, Amrein, Karin, Balik, Martin, Antonelli, Massimo, Nyunga, Martine, Barratt-Due, Andreas, Bergmans, Dennis C. J. J., Spoelstra-de Man, Angelique M. E., Kuitunen, Anne, Wallet, Florent, Seguin, Amelie, Metaxa, Victoria, Lemiale, Virginie, Burghi, Gaston, Demoule, Alexandre, Karvunidis, Thomas, Cotoia, Antonella, Klepstad, Pal, Moller, Ann M., Mokart, Djamel, Azoulay, Elie, Rabbat, Antoine, Darmon, Michael, Platon, Laura, Mayaux, Julien, Chermak, Akli, Lemaitre, Caroline, Artaud-Macari, Elise, Nelsen, Jonas, Kaufmann, Thomas, Viana, William, Lishoa, Thiago, Correa, Thiago Domingos, Encina, Belen, Socias, Antonio, and Efraim Investigators Nine-I Study
Abstract: Objective: We wished to explore the use, diagnostic capability and outcomes of bronchoscopy added to noninvasive testing in immunocompromised patients. In this setting, an inability to identify the cause of acute hypoxaemic respiratory failure is associated with worse outcome. Every effort should be made to obtain a diagnosis, either with noninvasive testing alone or combined with bronchoscopy. However, our understanding of the risks and benefits of bronchoscopy remains uncertain.Patients and methods: This was a pre-planned secondary analysis of Efraim, a prospective, multinational, observational study of 1611 immunocompromised patients with acute respiratory failure admitted to the intensive care unit (ICU). We compared patients with noninvasive testing only to those who had also received bronchoscopy by bivariate analysis and after propensity score matching.Results: Bronchoscopy was performed in 618 (39%) patients who were more likely to have haematological malignancy and a higher severity of illness score. Bronchoscopy alone achieved a diagnosis in 165 patients (27% adjusted diagnostic yield). Bronchoscopy resulted in a management change in 236 patients (38% therapeutic yield). Bronchoscopy was associated with worsening of respiratory status in 69 (11%) patients. Bronchoscopy was associated with higher ICU (40% versus 28%; p<0.0001) and hospital mortality (49% versus 41%; p=0.003). The overall rate of undiagnosed causes was 13%. After propensity score matching, bronchoscopy remained associated with increased risk of hospital mortality (OR 1.41, 95% CI 1.08-1.81).Conclusions: Bronchoscopy was associated with improved diagnosis and changes in management, but also increased hospital mortality. Balancing risk and benefit in individualised cases should be investigated further.
Published: 2019

30. Developing definitions for invasive fungal diseases in critically ill adult patients in intensive care units. Protocol of the FUNgal infections Definitions in ICU patients (FUNDICU) project

Author: Bassetti, Matteo, Scudeller, Luigia, Giacobbe, Daniele R., Lamoth, Frederic, Righi, Elda, Zuccaro, Valentina, Grecchi, Cecilia, Rebuffi, Chiara, Akova, Murat, Alastruey-Izquierdo, Ana, Arikan-Akdagli, Sevtap, Azoulay, Elie, Blot, Stijn I., Cornely, Oliver A., Lass-Floerl, Cornelia, Koehler, Philipp, Cuenca-Estrella, Manuel, de Lange, Dylan W., De Rosa, Francesco G., De Waele, Jan J., Dimopoulos, George, Garnacho-Montero, Jose, Hoenigl, Martin, Kanj, Souha S., Maertens, Johan, Martin-Loeches, Ignacio, Munoz, Patricia, Kullberg, Bart J., Agvald-Ohman, Christina, Poulakou, Garyphallia, Rello, Jordi, Sanguinetti, Maurizio, Taccone, Fabio S., Timsit, Jean-Francois, Torres, Antoni, Vazquez, Jose A., Calandra, Thierry, Bassetti, Matteo, Scudeller, Luigia, Giacobbe, Daniele R., Lamoth, Frederic, Righi, Elda, Zuccaro, Valentina, Grecchi, Cecilia, Rebuffi, Chiara, Akova, Murat, Alastruey-Izquierdo, Ana, Arikan-Akdagli, Sevtap, Azoulay, Elie, Blot, Stijn I., Cornely, Oliver A., Lass-Floerl, Cornelia, Koehler, Philipp, Cuenca-Estrella, Manuel, de Lange, Dylan W., De Rosa, Francesco G., De Waele, Jan J., Dimopoulos, George, Garnacho-Montero, Jose, Hoenigl, Martin, Kanj, Souha S., Maertens, Johan, Martin-Loeches, Ignacio, Munoz, Patricia, Kullberg, Bart J., Agvald-Ohman, Christina, Poulakou, Garyphallia, Rello, Jordi, Sanguinetti, Maurizio, Taccone, Fabio S., Timsit, Jean-Francois, Torres, Antoni, Vazquez, Jose A., and Calandra, Thierry
Abstract: Background The reliability of diagnostic criteria for invasive fungal diseases (IFD) developed for severely immunocompromised patients is questionable in critically ill adult patients in intensive care units (ICU). Objectives To develop a standard set of definitions for IFD in critically ill adult patients in ICU. Methods Based on a systematic literature review, a list of potential definitions to be applied to ICU patients will be developed by the ESCMID Study Group for Infections in Critically Ill Patients (ESGCIP) and the ESCMID Fungal Infection Study Group (EFISG) chairpersons. The proposed definitions will be evaluated by a panel of 30 experts using the RAND/UCLA appropriateness methods. The panel will rank each of the proposed definitions on a 1-9 scale trough a dedicated questionnaire, in two rounds: one remote and one face-to-face. Based on their median rank and the level of agreement across panel members, selected definitions will be organised in a main consensus document and in an executive summary. The executive summary will be made available online for public comments. Conclusions The present consensus project will seek to provide standard definitions for IFD in critically ill adult patients in ICU, with the ultimate aims of improving their clinical outcome and facilitating the comparison and generalizability of research findings.
Published: 2019

31. Elaboration of Consensus Clinical Endpoints to Evaluate Antimicrobial Treatment Efficacy in Future Hospital-acquired/Ventilator-associated Bacterial Pneumonia Clinical Trials

Author: Weiss, Emmanuel, Zahar, Jean-Ralph, Alder, Jeff, Asehnoune, Karim, Bassetti, Matteo, Bonten, Marc J. M., Chastre, Jean, De Waele, Jan, Dimopoulos, George, Eggimann, Philippe, Engelhardt, Marc, Ewig, Santiago, Kollef, Marin, Lipman, Jeffrey, Luna, Carlos, Martin-Loeches, Ignacio, Pagani, Leonardo, Palmer, Lucy B., Papazian, Laurent, Poulakou, Garyphallia, Prokocimer, Philippe, Rello, Jordi, Rex, John H., Shorr, Andrew F., Talbot, George H., Thamlikitkul, Visanu, Torres, Antoni, Wunderink, Richard G., Timsit, Jean-Francois, Weiss, Emmanuel, Zahar, Jean-Ralph, Alder, Jeff, Asehnoune, Karim, Bassetti, Matteo, Bonten, Marc J. M., Chastre, Jean, De Waele, Jan, Dimopoulos, George, Eggimann, Philippe, Engelhardt, Marc, Ewig, Santiago, Kollef, Marin, Lipman, Jeffrey, Luna, Carlos, Martin-Loeches, Ignacio, Pagani, Leonardo, Palmer, Lucy B., Papazian, Laurent, Poulakou, Garyphallia, Prokocimer, Philippe, Rello, Jordi, Rex, John H., Shorr, Andrew F., Talbot, George H., Thamlikitkul, Visanu, Torres, Antoni, Wunderink, Richard G., and Timsit, Jean-Francois
Published: 2019

32. Human metapneumovirus as cause of severe community-acquired pneumonia in adults: insights from a ten-year molecular and epidemiological analysis

Author: Medicina preventiva y salud pública, Prebentzio medikuntza eta osasun publikoa, Vidaur, Loreto, Totorika, Izarne, Montes, Milagrosa, Vicente Anza, Diego, Rello, Jordi, Cilla Eguiluz, Carlos Gustavo, Medicina preventiva y salud pública, Prebentzio medikuntza eta osasun publikoa, Vidaur, Loreto, Totorika, Izarne, Montes, Milagrosa, Vicente Anza, Diego, Rello, Jordi, and Cilla Eguiluz, Carlos Gustavo
Abstract: BackgroundInformation on the clinical, epidemiological and molecular characterization of human metapneumovirus in critically ill adult patients with severe community-acquired pneumonia (CAP) and the role of biomarkers identifying bacterial coinfection is scarce.MethodsThis is a retrospective epidemiological study of adult patients with hMPV severe CAP admitted to ICU during a ten-year period with admission PSI score >= 3.ResultsThe 92.8% of the 28 patients with severe CAP due to human metapneumovirus were detected during the first half of the year. Median age was 62years and 60.7% were male. The genotyping of isolated human metapneumovirus showed group B predominance (60.7%). All patients had acute respiratory failure. Median APACHE II and SOFA score were 13 and 6.55, respectively. The 25% were coinfected with Streptococcus pneumoniae. 60.7% of the patients had shock at admission and 50% underwent mechanical ventilation. Seven patients developed ARDS, three of them younger than 60years and without comorbidities. Mortality in ICU was 14.3%. Among survivors, ICU and hospital stay were 6.5 and 14days, respectively. Plasma levels of procalcitonin were higher in patients with bacterial coinfection (18.2 vs 0.54; p<0.05). The levels of C-reactive protein, however, were similar.ConclusionHuman metapneumovirus was associated with severe CAP requiring ICU admission among elderly patients or patients with comorbidities, but also in healthy young subjects. These patients often underwent mechanical ventilation with elevated health resource consumption. While one out of four patients showed pneumococcal coinfection, plasma procalcitonin helped to implement antimicrobial stewardship.
Published: 2019

33. Elaboration of Consensus Clinical Endpoints to Evaluate Antimicrobial Treatment Efficacy in Future Hospital-acquired/Ventilator-associated Bacterial Pneumonia Clinical Trials

Author: Weiss, Emmanuel, Zahar, Jean-Ralph, Alder, Jeff, Asehnoune, Karim, Bassetti, Matteo, Bonten, Marc J. M., Chastre, Jean, De Waele, Jan, Dimopoulos, George, Eggimann, Philippe, Engelhardt, Marc, Ewig, Santiago, Kollef, Marin, Lipman, Jeffrey, Luna, Carlos, Martin-Loeches, Ignacio, Pagani, Leonardo, Palmer, Lucy B., Papazian, Laurent, Poulakou, Garyphallia, Prokocimer, Philippe, Rello, Jordi, Rex, John H., Shorr, Andrew F., Talbot, George H., Thamlikitkul, Visanu, Torres, Antoni, Wunderink, Richard G., Timsit, Jean-Francois, Weiss, Emmanuel, Zahar, Jean-Ralph, Alder, Jeff, Asehnoune, Karim, Bassetti, Matteo, Bonten, Marc J. M., Chastre, Jean, De Waele, Jan, Dimopoulos, George, Eggimann, Philippe, Engelhardt, Marc, Ewig, Santiago, Kollef, Marin, Lipman, Jeffrey, Luna, Carlos, Martin-Loeches, Ignacio, Pagani, Leonardo, Palmer, Lucy B., Papazian, Laurent, Poulakou, Garyphallia, Prokocimer, Philippe, Rello, Jordi, Rex, John H., Shorr, Andrew F., Talbot, George H., Thamlikitkul, Visanu, Torres, Antoni, Wunderink, Richard G., and Timsit, Jean-Francois
Published: 2019

34. Elaboration of Consensus Clinical Endpoints to Evaluate Antimicrobial Treatment Efficacy in Future Hospital-acquired/Ventilator-associated Bacterial Pneumonia Clinical Trials

Author: Epi Infectieziekten, MMB, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Weiss, Emmanuel, Zahar, Jean-Ralph, Alder, Jeff, Asehnoune, Karim, Bassetti, Matteo, Bonten, Marc J. M., Chastre, Jean, De Waele, Jan, Dimopoulos, George, Eggimann, Philippe, Engelhardt, Marc, Ewig, Santiago, Kollef, Marin, Lipman, Jeffrey, Luna, Carlos, Martin-Loeches, Ignacio, Pagani, Leonardo, Palmer, Lucy B., Papazian, Laurent, Poulakou, Garyphallia, Prokocimer, Philippe, Rello, Jordi, Rex, John H., Shorr, Andrew F., Talbot, George H., Thamlikitkul, Visanu, Torres, Antoni, Wunderink, Richard G., Timsit, Jean-Francois, Epi Infectieziekten, MMB, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Weiss, Emmanuel, Zahar, Jean-Ralph, Alder, Jeff, Asehnoune, Karim, Bassetti, Matteo, Bonten, Marc J. M., Chastre, Jean, De Waele, Jan, Dimopoulos, George, Eggimann, Philippe, Engelhardt, Marc, Ewig, Santiago, Kollef, Marin, Lipman, Jeffrey, Luna, Carlos, Martin-Loeches, Ignacio, Pagani, Leonardo, Palmer, Lucy B., Papazian, Laurent, Poulakou, Garyphallia, Prokocimer, Philippe, Rello, Jordi, Rex, John H., Shorr, Andrew F., Talbot, George H., Thamlikitkul, Visanu, Torres, Antoni, Wunderink, Richard G., and Timsit, Jean-Francois
Published: 2019

35. Developing definitions for invasive fungal diseases in critically ill adult patients in intensive care units. Protocol of the FUNgal infections Definitions in ICU patients (FUNDICU) project

Author: Bassetti, Matteo, Scudeller, Luigia, Giacobbe, Daniele R., Lamoth, Frederic, Righi, Elda, Zuccaro, Valentina, Grecchi, Cecilia, Rebuffi, Chiara, Akova, Murat, Alastruey-Izquierdo, Ana, Arikan-Akdagli, Sevtap, Azoulay, Elie, Blot, Stijn I., Cornely, Oliver A., Lass-Floerl, Cornelia, Koehler, Philipp, Cuenca-Estrella, Manuel, de Lange, Dylan W., De Rosa, Francesco G., De Waele, Jan J., Dimopoulos, George, Garnacho-Montero, Jose, Hoenigl, Martin, Kanj, Souha S., Maertens, Johan, Martin-Loeches, Ignacio, Munoz, Patricia, Kullberg, Bart J., Agvald-Ohman, Christina, Poulakou, Garyphallia, Rello, Jordi, Sanguinetti, Maurizio, Taccone, Fabio S., Timsit, Jean-Francois, Torres, Antoni, Vazquez, Jose A., Calandra, Thierry, Bassetti, Matteo, Scudeller, Luigia, Giacobbe, Daniele R., Lamoth, Frederic, Righi, Elda, Zuccaro, Valentina, Grecchi, Cecilia, Rebuffi, Chiara, Akova, Murat, Alastruey-Izquierdo, Ana, Arikan-Akdagli, Sevtap, Azoulay, Elie, Blot, Stijn I., Cornely, Oliver A., Lass-Floerl, Cornelia, Koehler, Philipp, Cuenca-Estrella, Manuel, de Lange, Dylan W., De Rosa, Francesco G., De Waele, Jan J., Dimopoulos, George, Garnacho-Montero, Jose, Hoenigl, Martin, Kanj, Souha S., Maertens, Johan, Martin-Loeches, Ignacio, Munoz, Patricia, Kullberg, Bart J., Agvald-Ohman, Christina, Poulakou, Garyphallia, Rello, Jordi, Sanguinetti, Maurizio, Taccone, Fabio S., Timsit, Jean-Francois, Torres, Antoni, Vazquez, Jose A., and Calandra, Thierry
Abstract: Background The reliability of diagnostic criteria for invasive fungal diseases (IFD) developed for severely immunocompromised patients is questionable in critically ill adult patients in intensive care units (ICU). Objectives To develop a standard set of definitions for IFD in critically ill adult patients in ICU. Methods Based on a systematic literature review, a list of potential definitions to be applied to ICU patients will be developed by the ESCMID Study Group for Infections in Critically Ill Patients (ESGCIP) and the ESCMID Fungal Infection Study Group (EFISG) chairpersons. The proposed definitions will be evaluated by a panel of 30 experts using the RAND/UCLA appropriateness methods. The panel will rank each of the proposed definitions on a 1-9 scale trough a dedicated questionnaire, in two rounds: one remote and one face-to-face. Based on their median rank and the level of agreement across panel members, selected definitions will be organised in a main consensus document and in an executive summary. The executive summary will be made available online for public comments. Conclusions The present consensus project will seek to provide standard definitions for IFD in critically ill adult patients in ICU, with the ultimate aims of improving their clinical outcome and facilitating the comparison and generalizability of research findings.
Published: 2019

36. Human metapneumovirus as cause of severe community-acquired pneumonia in adults: insights from a ten-year molecular and epidemiological analysis

Author: Medicina preventiva y salud pública, Prebentzio medikuntza eta osasun publikoa, Vidaur, Loreto, Totorika, Izarne, Montes, Milagrosa, Vicente Anza, Diego, Rello, Jordi, Cilla Eguiluz, Carlos Gustavo, Medicina preventiva y salud pública, Prebentzio medikuntza eta osasun publikoa, Vidaur, Loreto, Totorika, Izarne, Montes, Milagrosa, Vicente Anza, Diego, Rello, Jordi, and Cilla Eguiluz, Carlos Gustavo
Abstract: BackgroundInformation on the clinical, epidemiological and molecular characterization of human metapneumovirus in critically ill adult patients with severe community-acquired pneumonia (CAP) and the role of biomarkers identifying bacterial coinfection is scarce.MethodsThis is a retrospective epidemiological study of adult patients with hMPV severe CAP admitted to ICU during a ten-year period with admission PSI score >= 3.ResultsThe 92.8% of the 28 patients with severe CAP due to human metapneumovirus were detected during the first half of the year. Median age was 62years and 60.7% were male. The genotyping of isolated human metapneumovirus showed group B predominance (60.7%). All patients had acute respiratory failure. Median APACHE II and SOFA score were 13 and 6.55, respectively. The 25% were coinfected with Streptococcus pneumoniae. 60.7% of the patients had shock at admission and 50% underwent mechanical ventilation. Seven patients developed ARDS, three of them younger than 60years and without comorbidities. Mortality in ICU was 14.3%. Among survivors, ICU and hospital stay were 6.5 and 14days, respectively. Plasma levels of procalcitonin were higher in patients with bacterial coinfection (18.2 vs 0.54; p<0.05). The levels of C-reactive protein, however, were similar.ConclusionHuman metapneumovirus was associated with severe CAP requiring ICU admission among elderly patients or patients with comorbidities, but also in healthy young subjects. These patients often underwent mechanical ventilation with elevated health resource consumption. While one out of four patients showed pneumococcal coinfection, plasma procalcitonin helped to implement antimicrobial stewardship.
Published: 2019

37. Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy

Author: Bauer, Philippe R., Chevret, Sylvie, Yadav, Hemang, Mehta, Sangeeta, Pickkers, Peter, Bukan, Ramin B., Rello, Jordi, van de Louw, Andry, Klouche, Kada, Meert, Anne-Pascale, Martin-Loeches, Ignacio, Marsh, Brian, Crespi, Lorenzo Socias, Moreno-Gonzalez, Gabriel, Buchtele, Nina, Amrein, Karin, Balik, Martin, Antonelli, Massimo, Nyunga, Martine, Barratt-Due, Andreas, Bergmans, Dennis C. J. J., Spoelstra-de Man, Angelique M. E., Kuitunen, Anne, Wallet, Florent, Seguin, Amelie, Metaxa, Victoria, Lemiale, Virginie, Burghi, Gaston, Demoule, Alexandre, Karvunidis, Thomas, Cotoia, Antonella, Klepstad, Pal, Moller, Ann M., Mokart, Djamel, Azoulay, Elie, Rabbat, Antoine, Darmon, Michael, Platon, Laura, Mayaux, Julien, Chermak, Akli, Lemaitre, Caroline, Artaud-Macari, Elise, Nelsen, Jonas, Kaufmann, Thomas, Viana, William, Lishoa, Thiago, Correa, Thiago Domingos, Encina, Belen, Socias, Antonio, Efraim investigators and the Nine-I study group, Bauer, Philippe R., Chevret, Sylvie, Yadav, Hemang, Mehta, Sangeeta, Pickkers, Peter, Bukan, Ramin B., Rello, Jordi, van de Louw, Andry, Klouche, Kada, Meert, Anne-Pascale, Martin-Loeches, Ignacio, Marsh, Brian, Crespi, Lorenzo Socias, Moreno-Gonzalez, Gabriel, Buchtele, Nina, Amrein, Karin, Balik, Martin, Antonelli, Massimo, Nyunga, Martine, Barratt-Due, Andreas, Bergmans, Dennis C. J. J., Spoelstra-de Man, Angelique M. E., Kuitunen, Anne, Wallet, Florent, Seguin, Amelie, Metaxa, Victoria, Lemiale, Virginie, Burghi, Gaston, Demoule, Alexandre, Karvunidis, Thomas, Cotoia, Antonella, Klepstad, Pal, Moller, Ann M., Mokart, Djamel, Azoulay, Elie, Rabbat, Antoine, Darmon, Michael, Platon, Laura, Mayaux, Julien, Chermak, Akli, Lemaitre, Caroline, Artaud-Macari, Elise, Nelsen, Jonas, Kaufmann, Thomas, Viana, William, Lishoa, Thiago, Correa, Thiago Domingos, Encina, Belen, Socias, Antonio, and Efraim investigators and the Nine-I study group
Abstract: Objective: We wished to explore the use, diagnostic capability and outcomes of bronchoscopy added to noninvasive testing in immunocompromised patients. In this setting, an inability to identify the cause of acute hypoxaemic respiratory failure is associated with worse outcome. Every effort should be made to obtain a diagnosis, either with noninvasive testing alone or combined with bronchoscopy. However, our understanding of the risks and benefits of bronchoscopy remains uncertain.Patients and methods: This was a pre-planned secondary analysis of Efraim, a prospective, multinational, observational study of 1611 immunocompromised patients with acute respiratory failure admitted to the intensive care unit (ICU). We compared patients with noninvasive testing only to those who had also received bronchoscopy by bivariate analysis and after propensity score matching.Results: Bronchoscopy was performed in 618 (39%) patients who were more likely to have haematological malignancy and a higher severity of illness score. Bronchoscopy alone achieved a diagnosis in 165 patients (27% adjusted diagnostic yield). Bronchoscopy resulted in a management change in 236 patients (38% therapeutic yield). Bronchoscopy was associated with worsening of respiratory status in 69 (11%) patients. Bronchoscopy was associated with higher ICU (40% versus 28%; p<0.0001) and hospital mortality (49% versus 41%; p=0.003). The overall rate of undiagnosed causes was 13%. After propensity score matching, bronchoscopy remained associated with increased risk of hospital mortality (OR 1.41, 95% CI 1.08-1.81).Conclusions: Bronchoscopy was associated with improved diagnosis and changes in management, but also increased hospital mortality. Balancing risk and benefit in individualised cases should be investigated further.
Published: 2019

38. Influenza and associated co-infections in critically ill immunosuppressed patients

Author: Martin-Loeches, Ignacio, Lemiale, Virginie, Geoghegan, Pierce, McMahon, Mary Aisling, Pickkers, Peter, Soares, Marcio, Perner, Anders, Meyhoff, Tine Sylvest, Bukan, Ramin Brandt, Rello, Jordi, Bauer, Philippe R., Van De Louw, Andry, Taccone, Fabio Silvio, Salluh, Jorge, Hemelaar, Pleun, Schellongowski, Peter, Rusinova, Katerina, Terzi, Nicolas, Mehta, Sangeeta, Antonelli, Massimo, Kouatchet, Achille, Klepstad, Pål, Valkonen, Miia, Landburg, Precious Pearl, Barratt-Due, Andreas, Bruneel, Fabrice, Pène, Frédéric, Metaxa, Victoria, Moreau, Anne Sophie, Souppart, Virginie, Burghi, Gaston, Girault, Christophe, Silva, Ulysses V.A., Montini, Luca, Barbier, Francois, Nielsen, Lene B., Gaborit, Benjamin, Mokart, Djamel, Chevret, Sylvie, Azoulay, Elie, Martin-Loeches, Ignacio, Lemiale, Virginie, Geoghegan, Pierce, McMahon, Mary Aisling, Pickkers, Peter, Soares, Marcio, Perner, Anders, Meyhoff, Tine Sylvest, Bukan, Ramin Brandt, Rello, Jordi, Bauer, Philippe R., Van De Louw, Andry, Taccone, Fabio Silvio, Salluh, Jorge, Hemelaar, Pleun, Schellongowski, Peter, Rusinova, Katerina, Terzi, Nicolas, Mehta, Sangeeta, Antonelli, Massimo, Kouatchet, Achille, Klepstad, Pål, Valkonen, Miia, Landburg, Precious Pearl, Barratt-Due, Andreas, Bruneel, Fabrice, Pène, Frédéric, Metaxa, Victoria, Moreau, Anne Sophie, Souppart, Virginie, Burghi, Gaston, Girault, Christophe, Silva, Ulysses V.A., Montini, Luca, Barbier, Francois, Nielsen, Lene B., Gaborit, Benjamin, Mokart, Djamel, Chevret, Sylvie, and Azoulay, Elie
Abstract: Background: It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. Methods: Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. Results: Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. Conclusions: Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was
Published: 2019

39. Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy

Author: Bauer, Philippe P.R., Chevret, Sylvie, Yadav, Hemang, Mehta, Sangeeta, Pickkers, Peter, Bukan, Ramin Brandt, Rello, Jordi, Van de Louw, Andry, Klouche, Kada, Meert, Anne-Pascale, Martin-Loeches, Ignacio, Marsh, Brian, Socias Crespi, Lorenzo, Moreno-Gonzalez, Gabriel, Buchtele, Nina, Amrein, Karin, Balik, M., Antonelli, Massimo, Nyunga, Martine, Barratt-Due, Andreas, Bergmans, Dennis D.C.J.J., Spoelstra-de Man, Angélique Maria Elisabeth, Kuitunen, Anne, Wallet, Florent, Seguin, Amélie, Metaxa, Victoria, Lemiale, Virginie, Burghi, Gastón, Demoule, Alexandre, Karvunidis, Thomas, Cotoia, Antonella, Klepstad, Pål, Møller, Ann, Mokart, Djamel, Azoulay, Elie, Bauer, Philippe P.R., Chevret, Sylvie, Yadav, Hemang, Mehta, Sangeeta, Pickkers, Peter, Bukan, Ramin Brandt, Rello, Jordi, Van de Louw, Andry, Klouche, Kada, Meert, Anne-Pascale, Martin-Loeches, Ignacio, Marsh, Brian, Socias Crespi, Lorenzo, Moreno-Gonzalez, Gabriel, Buchtele, Nina, Amrein, Karin, Balik, M., Antonelli, Massimo, Nyunga, Martine, Barratt-Due, Andreas, Bergmans, Dennis D.C.J.J., Spoelstra-de Man, Angélique Maria Elisabeth, Kuitunen, Anne, Wallet, Florent, Seguin, Amélie, Metaxa, Victoria, Lemiale, Virginie, Burghi, Gastón, Demoule, Alexandre, Karvunidis, Thomas, Cotoia, Antonella, Klepstad, Pål, Møller, Ann, Mokart, Djamel, and Azoulay, Elie
Abstract: OBJECTIVE: We wished to explore the use, diagnostic capability and outcomes of bronchoscopy added to noninvasive testing in immunocompromised patients. In this setting, an inability to identify the cause of acute hypoxaemic respiratory failure is associated with worse outcome. Every effort should be made to obtain a diagnosis, either with noninvasive testing alone or combined with bronchoscopy. However, our understanding of the risks and benefits of bronchoscopy remains uncertain. PATIENTS AND METHODS: This was a pre-planned secondary analysis of Efraim, a prospective, multinational, observational study of 1611 immunocompromised patients with acute respiratory failure admitted to the intensive care unit (ICU). We compared patients with noninvasive testing only to those who had also received bronchoscopy by bivariate analysis and after propensity score matching. RESULTS: Bronchoscopy was performed in 618 (39%) patients who were more likely to have haematological malignancy and a higher severity of illness score. Bronchoscopy alone achieved a diagnosis in 165 patients (27% adjusted diagnostic yield). Bronchoscopy resulted in a management change in 236 patients (38% therapeutic yield). Bronchoscopy was associated with worsening of respiratory status in 69 (11%) patients. Bronchoscopy was associated with higher ICU (40% versus 28%; p<0.0001) and hospital mortality (49% versus 41%; p=0.003). The overall rate of undiagnosed causes was 13%. After propensity score matching, bronchoscopy remained associated with increased risk of hospital mortality (OR 1.41, 95% CI 1.08-1.81). CONCLUSIONS: Bronchoscopy was associated with improved diagnosis and changes in management, but also increased hospital mortality. Balancing risk and benefit in individualised cases should be investigated further., SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2019

40. Influenza and associated co-infections in critically ill immunosuppressed patients

Author: Martin-Loeches, Ignacio, Lemiale, Virginie, Geoghegan, Pierce, McMahon, Mary Aisling, Pickkers, Peter, Soares, Marcio, Perner, Anders, Meyhoff, Tine Sylvest, Bukan, Ramin Brandt, Rello, Jordi, Bauer, Philippe R., Van De Louw, Andry, Taccone, Fabio Silvio, Salluh, Jorge, Hemelaar, Pleun, Schellongowski, Peter, Rusinova, Katerina, Terzi, Nicolas, Mehta, Sangeeta, Antonelli, Massimo, Kouatchet, Achille, Klepstad, Pål, Valkonen, Miia, Landburg, Precious Pearl, Barratt-Due, Andreas, Bruneel, Fabrice, Pène, Frédéric, Metaxa, Victoria, Moreau, Anne Sophie, Souppart, Virginie, Burghi, Gaston, Girault, Christophe, Silva, Ulysses V.A., Montini, Luca, Barbier, Francois, Nielsen, Lene B., Gaborit, Benjamin, Mokart, Djamel, Chevret, Sylvie, Azoulay, Elie, Martin-Loeches, Ignacio, Lemiale, Virginie, Geoghegan, Pierce, McMahon, Mary Aisling, Pickkers, Peter, Soares, Marcio, Perner, Anders, Meyhoff, Tine Sylvest, Bukan, Ramin Brandt, Rello, Jordi, Bauer, Philippe R., Van De Louw, Andry, Taccone, Fabio Silvio, Salluh, Jorge, Hemelaar, Pleun, Schellongowski, Peter, Rusinova, Katerina, Terzi, Nicolas, Mehta, Sangeeta, Antonelli, Massimo, Kouatchet, Achille, Klepstad, Pål, Valkonen, Miia, Landburg, Precious Pearl, Barratt-Due, Andreas, Bruneel, Fabrice, Pène, Frédéric, Metaxa, Victoria, Moreau, Anne Sophie, Souppart, Virginie, Burghi, Gaston, Girault, Christophe, Silva, Ulysses V.A., Montini, Luca, Barbier, Francois, Nielsen, Lene B., Gaborit, Benjamin, Mokart, Djamel, Chevret, Sylvie, and Azoulay, Elie
Abstract: Background: It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. Methods: Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. Results: Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. Conclusions: Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was
Published: 2019

41. Influenza and associated co-infections in critically ill immunosuppressed patients

Author: Martin-Loeches, Ignacio, Lemiale, Virginie, Geoghegan, Pierce, McMahon, Mary Aisling, Pickkers, Peter, Soares, Marcio, Perner, Anders, Meyhoff, Tine Sylvest, Bukan, Ramin Brandt, Rello, Jordi, Bauer, Philippe P.R., Van de Louw, Andry, Taccone, Fabio, Salluh, Jorge, Hemelaar, Pleun, Schellongowski, Peter, Rusinova, Katerina, Terzi, Nicolas, Mehta, Sangeeta, Antonelli, Massimo, Kouatchet, Achille, Klepstad, Pål, Valkonen, Miia, Landburg, Precious Pearl, Barratt-Due, Andreas, Bruneel, Fabrice, Pène, Frédéric, Metaxa, Victoria, Moreau, Anne Sophie, Souppart, Virginie, Burghi, Gastón, Girault, Christophe, Silva, Ulysses U.V.A., Montini, Luca, Barbier, François, Nielsen, Lene L.B., Gaborit, Benjamin, Mokart, Djamel, Chevret, Sylvie, Azoulay, Elie, Martin-Loeches, Ignacio, Lemiale, Virginie, Geoghegan, Pierce, McMahon, Mary Aisling, Pickkers, Peter, Soares, Marcio, Perner, Anders, Meyhoff, Tine Sylvest, Bukan, Ramin Brandt, Rello, Jordi, Bauer, Philippe P.R., Van de Louw, Andry, Taccone, Fabio, Salluh, Jorge, Hemelaar, Pleun, Schellongowski, Peter, Rusinova, Katerina, Terzi, Nicolas, Mehta, Sangeeta, Antonelli, Massimo, Kouatchet, Achille, Klepstad, Pål, Valkonen, Miia, Landburg, Precious Pearl, Barratt-Due, Andreas, Bruneel, Fabrice, Pène, Frédéric, Metaxa, Victoria, Moreau, Anne Sophie, Souppart, Virginie, Burghi, Gastón, Girault, Christophe, Silva, Ulysses U.V.A., Montini, Luca, Barbier, François, Nielsen, Lene L.B., Gaborit, Benjamin, Mokart, Djamel, Chevret, Sylvie, and Azoulay, Elie
Abstract: Background: It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. Methods: Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. Results: Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. Conclusions: Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was associat, SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2019

42. Raising concerns about the Sepsis-3 definitions

Author: Universitat Rovira i Virgili, Catena, Fausto, Yuan, Kuo-Ching, Ulrych, Jan, Trana, Cristian, Talving, Peep, Siribumrungwong, Boonying, Shah, Jay N., Sato, Norio, Kafil, Hossein Samadi, Sakakushev, Boris, Reis, Tarcisio, Pupelis, Guntars, Ponce-de-Leon, Alfredo, Pintar, Tadeja, Picetti, Edoardo, Paolillo, Ciro, Ouadii, Mouaqit, Ordonez, Carlos A., Olaoye, Iyiade, Ofori-Asenso, Richard, Negoi, Ionut, Naidoo, Noel, Moore, Frederick A., Moore, Ernest E., Mesina, Cristian, Memish, Ziad A., McFarlane, Michael, Marwah, Sanjay, Major, Piotr, Manzano-Nunez, Ramiro, Machain, Gustavo M., Litvin, Andrey, Lee, Jae G., Latifi, Rifat, Labricciosa, Francesco M., Isik, Arda, Kok, Kenneth Y. Y., Koike, Kaoru, Khokha, Vladimir, Khamis, Faryal, Kenig, Jakub, Karamarkovic, Aleksandar, Kanj, Souha S., Gomes, Carlos A., Ghnnam, Wagih, Frattima, Sabrina, Fraga, Gustavo P., Ferrada, Paula, Enani, Mushira A., Elmangory, Mutasim M., Dogjani, Agron, Di Saverio, Salomone, Diaz, Jose J., Dhingra, Sameer, Davies, R. Justin, Cui, Yunfeng, de Souza, Hamilton P., De Simone, Belinda, Demetrashvili, Zaza, Jusoh, Asri Che, Beltran, Marcelo A., Baraket, Oussema, Bala, Miklosh, Baiocchi, Gian L., Augustin, Goran, Adesunkanmi, Abdulrashid K., Abu-Zidan, Fikri M., Coccolini, Federico, Giamarellou, Eleni, Bassetti, Matteo, Watkins, Richard R., Rello, Jordi, Hardcastle, Timothy C., Ansaloni, Luca, Kluger, Yoram, Sartelli, Massimo, Universitat Rovira i Virgili, Catena, Fausto, Yuan, Kuo-Ching, Ulrych, Jan, Trana, Cristian, Talving, Peep, Siribumrungwong, Boonying, Shah, Jay N., Sato, Norio, Kafil, Hossein Samadi, Sakakushev, Boris, Reis, Tarcisio, Pupelis, Guntars, Ponce-de-Leon, Alfredo, Pintar, Tadeja, Picetti, Edoardo, Paolillo, Ciro, Ouadii, Mouaqit, Ordonez, Carlos A., Olaoye, Iyiade, Ofori-Asenso, Richard, Negoi, Ionut, Naidoo, Noel, Moore, Frederick A., Moore, Ernest E., Mesina, Cristian, Memish, Ziad A., McFarlane, Michael, Marwah, Sanjay, Major, Piotr, Manzano-Nunez, Ramiro, Machain, Gustavo M., Litvin, Andrey, Lee, Jae G., Latifi, Rifat, Labricciosa, Francesco M., Isik, Arda, Kok, Kenneth Y. Y., Koike, Kaoru, Khokha, Vladimir, Khamis, Faryal, Kenig, Jakub, Karamarkovic, Aleksandar, Kanj, Souha S., Gomes, Carlos A., Ghnnam, Wagih, Frattima, Sabrina, Fraga, Gustavo P., Ferrada, Paula, Enani, Mushira A., Elmangory, Mutasim M., Dogjani, Agron, Di Saverio, Salomone, Diaz, Jose J., Dhingra, Sameer, Davies, R. Justin, Cui, Yunfeng, de Souza, Hamilton P., De Simone, Belinda, Demetrashvili, Zaza, Jusoh, Asri Che, Beltran, Marcelo A., Baraket, Oussema, Bala, Miklosh, Baiocchi, Gian L., Augustin, Goran, Adesunkanmi, Abdulrashid K., Abu-Zidan, Fikri M., Coccolini, Federico, Giamarellou, Eleni, Bassetti, Matteo, Watkins, Richard R., Rello, Jordi, Hardcastle, Timothy C., Ansaloni, Luca, Kluger, Yoram, and Sartelli, Massimo
Abstract: The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use of the Sepsis-3 definitions.
Published: 2018

43. Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia

Author: Arnold, F, Lopardo, G, Wiemken, T, Kelley, R, Peyrani, P, Mattingly, W, Feldman, C, Gnoni, M, Maurici, R, Ramirez, J, Ayesu, K, File, T, Burdette, S, Blatt, S, Restrepo, M, Bordon, J, Gross, P, Musher, D, Marrie, T, Weiss, K, Roig, J, Lode, H, Welte, T, Aliberti, S, Blasi, F, Cosentini, R, Legnani, D, Franzetti, F, Montano, N, Cervi, G, Rossi, P, Voza, A, Ostrowsky, B, Pesci, A, Nava, S, Viale, P, Galavatti, V, Patricia, A, Dimas, C, Piro, R, Viscoli, C, Torres, A, Valenti, V, Ojales, D, Bodi, M, Porras, J, Rello, J, Menendez, R, Stolz, D, Schuetz, P, Haubitz, S, Chalmers, J, Fardon, T, Benchetrit, G, Rodriguez, E, Corral, J, Gonzalez, J, de Vedia, L, Luna, C, Martinez, J, Marzoratti, L, Rodriguez, M, Videla, A, Saavedra, F, Lopez, H, Victorio, C, Riera, F, Jimenez, P, Fernandez, P, Parada, M, Fuenzalida, A, Riquelme, R, Barros, M, Luna, J, Toala, I, Oze de Morvil, G, Fernandez, R, Aiello, G, Alvarez, P, Soca, A, Arteta, F, Delgado, J, Levy, G, Rivero, L, Rodriguez, B, Mirabal, M, Mateo, M, Mendoza, M, Arnold, Forest W., Lopardo, Gustavo, Wiemken, Timothy L., Kelley, Robert, Peyrani, Paula, Mattingly, William A., Feldman, Charles, Gnoni, Martin, Maurici, Rosemeri, Ramirez, Julio A., Arnold, Forest, Ramirez, Julio, Ayesu, Kwabena, File, Thomas, Burdette, Steven, Blatt, Stephen, Restrepo, Marcos, Bordon, Jose, Gross, Peter, Musher, Daniel, Marrie, Thomas, Weiss, Karl, Roig, Jorge, Lode, Harmut, Welte, Tobias, Aliberti, Stephano, Blasi, Francesco, Cosentini, Roberto, Legnani, Delfino, Franzetti, Fabio, Montano, Nicola, Cervi, Giulia, Rossi, Paolo, Voza, Antonio, Ostrowsky, Belinda, Pesci, Alberto, Nava, Stefano, Viale, Pierluigi, Galavatti, Vanni, Patricia, Aruj, Dimas, Carlos, Piro, Roberto, Viscoli, Claudio, Torres, Antoni, Valenti, Vincenzo, Ojales, Daniel Portela, Bodi, Maria, Porras, Jose, Rello, Jordi, Menendez, Rosario, Stolz, Daiana, Schuetz, Philipp, Haubitz, Sebastian, Chalmers, James, Fardon, Tom, Benchetrit, Guillermo, Rodriguez, Eduardo, Corral, Jorge, Gonzalez, Jose, de Vedia, Lautaro, Luna, Carlos, Martinez, Jorge, Marzoratti, Lucia, Rodriguez, Maria, Videla, Alejandro, Saavedra, Federico, Lopez, Horacio, Victorio, Carlos, Riera, Fernando, Jimenez, Patricio, Fernandez, Patricia, Parada, Maria, Fuenzalida, Alejandro Díaz, Riquelme, Raul, Barros, Manuel, Luna, Juan Manuel, Toala, Ivan, Oze de Morvil, Guillermo Arbo, Fernandez, Ricardo, Aiello, Gonzalo, Alvarez, Pablo, Soca, Ana, Arteta, Federico, Delgado, Jose, Levy, Gur, Rivero, Ludwig, Rodriguez, Benito, Mirabal, Mario Perez, Mateo, Marilyn, Mendoza, Myrna, Arnold, F, Lopardo, G, Wiemken, T, Kelley, R, Peyrani, P, Mattingly, W, Feldman, C, Gnoni, M, Maurici, R, Ramirez, J, Ayesu, K, File, T, Burdette, S, Blatt, S, Restrepo, M, Bordon, J, Gross, P, Musher, D, Marrie, T, Weiss, K, Roig, J, Lode, H, Welte, T, Aliberti, S, Blasi, F, Cosentini, R, Legnani, D, Franzetti, F, Montano, N, Cervi, G, Rossi, P, Voza, A, Ostrowsky, B, Pesci, A, Nava, S, Viale, P, Galavatti, V, Patricia, A, Dimas, C, Piro, R, Viscoli, C, Torres, A, Valenti, V, Ojales, D, Bodi, M, Porras, J, Rello, J, Menendez, R, Stolz, D, Schuetz, P, Haubitz, S, Chalmers, J, Fardon, T, Benchetrit, G, Rodriguez, E, Corral, J, Gonzalez, J, de Vedia, L, Luna, C, Martinez, J, Marzoratti, L, Rodriguez, M, Videla, A, Saavedra, F, Lopez, H, Victorio, C, Riera, F, Jimenez, P, Fernandez, P, Parada, M, Fuenzalida, A, Riquelme, R, Barros, M, Luna, J, Toala, I, Oze de Morvil, G, Fernandez, R, Aiello, G, Alvarez, P, Soca, A, Arteta, F, Delgado, J, Levy, G, Rivero, L, Rodriguez, B, Mirabal, M, Mateo, M, Mendoza, M, Arnold, Forest W., Lopardo, Gustavo, Wiemken, Timothy L., Kelley, Robert, Peyrani, Paula, Mattingly, William A., Feldman, Charles, Gnoni, Martin, Maurici, Rosemeri, Ramirez, Julio A., Arnold, Forest, Ramirez, Julio, Ayesu, Kwabena, File, Thomas, Burdette, Steven, Blatt, Stephen, Restrepo, Marcos, Bordon, Jose, Gross, Peter, Musher, Daniel, Marrie, Thomas, Weiss, Karl, Roig, Jorge, Lode, Harmut, Welte, Tobias, Aliberti, Stephano, Blasi, Francesco, Cosentini, Roberto, Legnani, Delfino, Franzetti, Fabio, Montano, Nicola, Cervi, Giulia, Rossi, Paolo, Voza, Antonio, Ostrowsky, Belinda, Pesci, Alberto, Nava, Stefano, Viale, Pierluigi, Galavatti, Vanni, Patricia, Aruj, Dimas, Carlos, Piro, Roberto, Viscoli, Claudio, Torres, Antoni, Valenti, Vincenzo, Ojales, Daniel Portela, Bodi, Maria, Porras, Jose, Rello, Jordi, Menendez, Rosario, Stolz, Daiana, Schuetz, Philipp, Haubitz, Sebastian, Chalmers, James, Fardon, Tom, Benchetrit, Guillermo, Rodriguez, Eduardo, Corral, Jorge, Gonzalez, Jose, de Vedia, Lautaro, Luna, Carlos, Martinez, Jorge, Marzoratti, Lucia, Rodriguez, Maria, Videla, Alejandro, Saavedra, Federico, Lopez, Horacio, Victorio, Carlos, Riera, Fernando, Jimenez, Patricio, Fernandez, Patricia, Parada, Maria, Fuenzalida, Alejandro Díaz, Riquelme, Raul, Barros, Manuel, Luna, Juan Manuel, Toala, Ivan, Oze de Morvil, Guillermo Arbo, Fernandez, Ricardo, Aiello, Gonzalo, Alvarez, Pablo, Soca, Ana, Arteta, Federico, Delgado, Jose, Levy, Gur, Rivero, Ludwig, Rodriguez, Benito, Mirabal, Mario Perez, Mateo, Marilyn, and Mendoza, Myrna
Abstract: Background: Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of this study was to define the clinical outcomes of patients with CAP and bacteremia treated with and without a macrolide. Materials and methods: Secondary analysis of the Community-Acquired Pneumonia Organization database of hospitalized patients with CAP. Patients with a positive blood culture were categorized based on the presence or absence of a macrolide in their initial antimicrobial regimen, and severity of their CAP. Outcomes included in-hospital all-cause mortality, 30-day mortality, length of stay, and time to clinical stability. Results: Among 549 patients with CAP and bacteremia, 247 (45%) were treated with a macrolide and 302 (55%) were not. The primary pathogen was Streptococcus pneumoniae (74%). Poisson regression with robust error variance models were used to compare the adjusted effects of each study group on the outcomes. The unadjusted 30-day mortality was 18.4% in the macrolide group, and 29.6% in the non-macrolide group (adjusted relative risk (aRR)0.81; 95% confidence interval (CI)0.50–1.33; P = 0.41). Unadjusted in-hospital all-cause mortality was 7.3% in the macrolide group, and 18.9% in the non-macrolide group (aRR 0.54, 95% CI 0.30–0.98; P = 0.043). Length of stay and time to clinical stability were not significantly different. Conclusions: In-hospital mortality, but not 30-day mortality, was significantly better in the macrolide group. Our data support the use of a macrolide in hospitalized patients with CAP and bacteraemia
Published: 2018

44. Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia

Author: Arnold, F, Lopardo, G, Wiemken, T, Kelley, R, Peyrani, P, Mattingly, W, Feldman, C, Gnoni, M, Maurici, R, Ramirez, J, Ayesu, K, File, T, Burdette, S, Blatt, S, Restrepo, M, Bordon, J, Gross, P, Musher, D, Marrie, T, Weiss, K, Roig, J, Lode, H, Welte, T, Aliberti, S, Blasi, F, Cosentini, R, Legnani, D, Franzetti, F, Montano, N, Cervi, G, Rossi, P, Voza, A, Ostrowsky, B, Pesci, A, Nava, S, Viale, P, Galavatti, V, Patricia, A, Dimas, C, Piro, R, Viscoli, C, Torres, A, Valenti, V, Ojales, D, Bodi, M, Porras, J, Rello, J, Menendez, R, Stolz, D, Schuetz, P, Haubitz, S, Chalmers, J, Fardon, T, Benchetrit, G, Rodriguez, E, Corral, J, Gonzalez, J, de Vedia, L, Luna, C, Martinez, J, Marzoratti, L, Rodriguez, M, Videla, A, Saavedra, F, Lopez, H, Victorio, C, Riera, F, Jimenez, P, Fernandez, P, Parada, M, Fuenzalida, A, Riquelme, R, Barros, M, Luna, J, Toala, I, Oze de Morvil, G, Fernandez, R, Aiello, G, Alvarez, P, Soca, A, Arteta, F, Delgado, J, Levy, G, Rivero, L, Rodriguez, B, Mirabal, M, Mateo, M, Mendoza, M, Arnold, Forest W., Lopardo, Gustavo, Wiemken, Timothy L., Kelley, Robert, Peyrani, Paula, Mattingly, William A., Feldman, Charles, Gnoni, Martin, Maurici, Rosemeri, Ramirez, Julio A., Arnold, Forest, Ramirez, Julio, Ayesu, Kwabena, File, Thomas, Burdette, Steven, Blatt, Stephen, Restrepo, Marcos, Bordon, Jose, Gross, Peter, Musher, Daniel, Marrie, Thomas, Weiss, Karl, Roig, Jorge, Lode, Harmut, Welte, Tobias, Aliberti, Stephano, Blasi, Francesco, Cosentini, Roberto, Legnani, Delfino, Franzetti, Fabio, Montano, Nicola, Cervi, Giulia, Rossi, Paolo, Voza, Antonio, Ostrowsky, Belinda, Pesci, Alberto, Nava, Stefano, Viale, Pierluigi, Galavatti, Vanni, Patricia, Aruj, Dimas, Carlos, Piro, Roberto, Viscoli, Claudio, Torres, Antoni, Valenti, Vincenzo, Ojales, Daniel Portela, Bodi, Maria, Porras, Jose, Rello, Jordi, Menendez, Rosario, Stolz, Daiana, Schuetz, Philipp, Haubitz, Sebastian, Chalmers, James, Fardon, Tom, Benchetrit, Guillermo, Rodriguez, Eduardo, Corral, Jorge, Gonzalez, Jose, de Vedia, Lautaro, Luna, Carlos, Martinez, Jorge, Marzoratti, Lucia, Rodriguez, Maria, Videla, Alejandro, Saavedra, Federico, Lopez, Horacio, Victorio, Carlos, Riera, Fernando, Jimenez, Patricio, Fernandez, Patricia, Parada, Maria, Fuenzalida, Alejandro Díaz, Riquelme, Raul, Barros, Manuel, Luna, Juan Manuel, Toala, Ivan, Oze de Morvil, Guillermo Arbo, Fernandez, Ricardo, Aiello, Gonzalo, Alvarez, Pablo, Soca, Ana, Arteta, Federico, Delgado, Jose, Levy, Gur, Rivero, Ludwig, Rodriguez, Benito, Mirabal, Mario Perez, Mateo, Marilyn, Mendoza, Myrna, Arnold, F, Lopardo, G, Wiemken, T, Kelley, R, Peyrani, P, Mattingly, W, Feldman, C, Gnoni, M, Maurici, R, Ramirez, J, Ayesu, K, File, T, Burdette, S, Blatt, S, Restrepo, M, Bordon, J, Gross, P, Musher, D, Marrie, T, Weiss, K, Roig, J, Lode, H, Welte, T, Aliberti, S, Blasi, F, Cosentini, R, Legnani, D, Franzetti, F, Montano, N, Cervi, G, Rossi, P, Voza, A, Ostrowsky, B, Pesci, A, Nava, S, Viale, P, Galavatti, V, Patricia, A, Dimas, C, Piro, R, Viscoli, C, Torres, A, Valenti, V, Ojales, D, Bodi, M, Porras, J, Rello, J, Menendez, R, Stolz, D, Schuetz, P, Haubitz, S, Chalmers, J, Fardon, T, Benchetrit, G, Rodriguez, E, Corral, J, Gonzalez, J, de Vedia, L, Luna, C, Martinez, J, Marzoratti, L, Rodriguez, M, Videla, A, Saavedra, F, Lopez, H, Victorio, C, Riera, F, Jimenez, P, Fernandez, P, Parada, M, Fuenzalida, A, Riquelme, R, Barros, M, Luna, J, Toala, I, Oze de Morvil, G, Fernandez, R, Aiello, G, Alvarez, P, Soca, A, Arteta, F, Delgado, J, Levy, G, Rivero, L, Rodriguez, B, Mirabal, M, Mateo, M, Mendoza, M, Arnold, Forest W., Lopardo, Gustavo, Wiemken, Timothy L., Kelley, Robert, Peyrani, Paula, Mattingly, William A., Feldman, Charles, Gnoni, Martin, Maurici, Rosemeri, Ramirez, Julio A., Arnold, Forest, Ramirez, Julio, Ayesu, Kwabena, File, Thomas, Burdette, Steven, Blatt, Stephen, Restrepo, Marcos, Bordon, Jose, Gross, Peter, Musher, Daniel, Marrie, Thomas, Weiss, Karl, Roig, Jorge, Lode, Harmut, Welte, Tobias, Aliberti, Stephano, Blasi, Francesco, Cosentini, Roberto, Legnani, Delfino, Franzetti, Fabio, Montano, Nicola, Cervi, Giulia, Rossi, Paolo, Voza, Antonio, Ostrowsky, Belinda, Pesci, Alberto, Nava, Stefano, Viale, Pierluigi, Galavatti, Vanni, Patricia, Aruj, Dimas, Carlos, Piro, Roberto, Viscoli, Claudio, Torres, Antoni, Valenti, Vincenzo, Ojales, Daniel Portela, Bodi, Maria, Porras, Jose, Rello, Jordi, Menendez, Rosario, Stolz, Daiana, Schuetz, Philipp, Haubitz, Sebastian, Chalmers, James, Fardon, Tom, Benchetrit, Guillermo, Rodriguez, Eduardo, Corral, Jorge, Gonzalez, Jose, de Vedia, Lautaro, Luna, Carlos, Martinez, Jorge, Marzoratti, Lucia, Rodriguez, Maria, Videla, Alejandro, Saavedra, Federico, Lopez, Horacio, Victorio, Carlos, Riera, Fernando, Jimenez, Patricio, Fernandez, Patricia, Parada, Maria, Fuenzalida, Alejandro Díaz, Riquelme, Raul, Barros, Manuel, Luna, Juan Manuel, Toala, Ivan, Oze de Morvil, Guillermo Arbo, Fernandez, Ricardo, Aiello, Gonzalo, Alvarez, Pablo, Soca, Ana, Arteta, Federico, Delgado, Jose, Levy, Gur, Rivero, Ludwig, Rodriguez, Benito, Mirabal, Mario Perez, Mateo, Marilyn, and Mendoza, Myrna
Abstract: Background: Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of this study was to define the clinical outcomes of patients with CAP and bacteremia treated with and without a macrolide. Materials and methods: Secondary analysis of the Community-Acquired Pneumonia Organization database of hospitalized patients with CAP. Patients with a positive blood culture were categorized based on the presence or absence of a macrolide in their initial antimicrobial regimen, and severity of their CAP. Outcomes included in-hospital all-cause mortality, 30-day mortality, length of stay, and time to clinical stability. Results: Among 549 patients with CAP and bacteremia, 247 (45%) were treated with a macrolide and 302 (55%) were not. The primary pathogen was Streptococcus pneumoniae (74%). Poisson regression with robust error variance models were used to compare the adjusted effects of each study group on the outcomes. The unadjusted 30-day mortality was 18.4% in the macrolide group, and 29.6% in the non-macrolide group (adjusted relative risk (aRR)0.81; 95% confidence interval (CI)0.50–1.33; P = 0.41). Unadjusted in-hospital all-cause mortality was 7.3% in the macrolide group, and 18.9% in the non-macrolide group (aRR 0.54, 95% CI 0.30–0.98; P = 0.043). Length of stay and time to clinical stability were not significantly different. Conclusions: In-hospital mortality, but not 30-day mortality, was significantly better in the macrolide group. Our data support the use of a macrolide in hospitalized patients with CAP and bacteraemia
Published: 2018

45. Developing definitions for invasive fungal diseases in critically ill adult patients in intensive care units. Protocol of the FUNgal infections Definitions in ICU patients (FUNDICU) project

Author: Bassetti, Matteo, Scudeller, Luigia, Giacobbe, Daniele R., Lamoth, Frederic, Righi, Elda, Zuccaro, Valentina, Grecchi, Cecilia, Rebuffi, Chiara, Akova, Murat, Alastruey-Izquierdo, Ana, Arikan-Akdagli, Sevtap, Azoulay, Elie, Blot, Stijn I., Cornely, Oliver A., Lass-Flörl, Cornelia, Koehler, Philipp, Cuenca-Estrella, Manuel, de Lange, Dylan W., De Rosa, Francesco G., De Waele, Jan J., Dimopoulos, George, Garnacho-Montero, José, Hoenigl, Martin, Kanj, Souha S., Maertens, Johan, Martin-Loeches, Ignacio, Muñoz, Patricia, Kullberg, Bart J., Agvald-Ohman, Christina, Poulakou, Garyphallia, Rello, Jordi, Sanguinetti, Maurizio, Taccone, Fabio S., Timsit, Jean-Françoi, Torres, Antoni, Vazquez, Jose A., Calandra, Thierry, Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Bassetti, Matteo, Scudeller, Luigia, Giacobbe, Daniele R., Lamoth, Frederic, Righi, Elda, Zuccaro, Valentina, Grecchi, Cecilia, Rebuffi, Chiara, Akova, Murat, Alastruey-Izquierdo, Ana, Arikan-Akdagli, Sevtap, Azoulay, Elie, Blot, Stijn I., Cornely, Oliver A., Lass-Flörl, Cornelia, Koehler, Philipp, Cuenca-Estrella, Manuel, de Lange, Dylan W., De Rosa, Francesco G., De Waele, Jan J., Dimopoulos, George, Garnacho-Montero, José, Hoenigl, Martin, Kanj, Souha S., Maertens, Johan, Martin-Loeches, Ignacio, Muñoz, Patricia, Kullberg, Bart J., Agvald-Ohman, Christina, Poulakou, Garyphallia, Rello, Jordi, Sanguinetti, Maurizio, Taccone, Fabio S., Timsit, Jean-Françoi, Torres, Antoni, Vazquez, Jose A., Calandra, Thierry, and Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059)
Abstract: Background: The reliability of diagnostic criteria for invasive fungal diseases (IFD) developed for severely immunocompromised patients is questionable in critically ill adult patients in intensive care units (ICU). Objectives: To develop a standard set of definitions for IFD in critically ill adult patients in ICU. Methods: Based on a systematic literature review, a list of potential definitions to be applied to ICU patients will be developed by the ESCMID Study Group for Infections in Critically Ill Patients (ESGCIP) and the ESCMID Fungal Infection Study Group (EFISG) chairpersons. The proposed definitions will be evaluated by a panel of 30 experts using the RAND/UCLA appropriateness methods. The panel will rank each of the proposed definitions on a 1-9 scale trough a dedicated questionnaire, in two rounds: one remote and one face-to-face. Based on their median rank and the level of agreement across panel members, selected definitions will be organised in a main consensus document and in an executive summary. The executive summary will be made available online for public comments. Conclusions: The present consensus project will seek to provide standard definitions for IFD in critically ill adult patients in ICU, with the ultimate aims of improving their clinical outcome and facilitating the comparison and generalizability of research findings.
Published: 2018

46. A randomized placebo-controlled phase II study of a Pseudomonas vaccine in ventilated ICU patients

Author: Rello, Jordi, Depuydt, Pieter, Vincent, Jean Louis, Bogár, Lajos, Szabó, Zsuzsanna, Völgyes, Barbara, Máñez, Rafael, Cakar, Nahit, Ramazanoglu, Atilla, Topeli, Arzu, Mastruzzo, Maria M.A., Krenn, Claus Georg, Jasovich, Abel, Remolif, Christian C.G., del Carmen Soria, Liliana, Andresen Hernandez, Max M.A., Ruiz Balart, Carolina, Krémer, Ildikó, Molnár, Zsolt, von Sonnenburg, Frank, Lyons, Arthur, Joannidis, Michael, Locker, Gottfried, Burgmann, Heinz, Welte, Tobias, Klingler, Anton, Hochreiter, Romana, Westritschnig, Kerstin, Pilger, Ernst, Madl, Christian, Balica, Laura, Dugernier, Thierry, Laterre, Pierre-Francois, Spapen, Herbert D. M., Rello, Jordi, Depuydt, Pieter, Vincent, Jean Louis, Bogár, Lajos, Szabó, Zsuzsanna, Völgyes, Barbara, Máñez, Rafael, Cakar, Nahit, Ramazanoglu, Atilla, Topeli, Arzu, Mastruzzo, Maria M.A., Krenn, Claus Georg, Jasovich, Abel, Remolif, Christian C.G., del Carmen Soria, Liliana, Andresen Hernandez, Max M.A., Ruiz Balart, Carolina, Krémer, Ildikó, Molnár, Zsolt, von Sonnenburg, Frank, Lyons, Arthur, Joannidis, Michael, Locker, Gottfried, Burgmann, Heinz, Welte, Tobias, Klingler, Anton, Hochreiter, Romana, Westritschnig, Kerstin, Pilger, Ernst, Madl, Christian, Balica, Laura, Dugernier, Thierry, Laterre, Pierre-Francois, and Spapen, Herbert D. M.
Abstract: Background: Currently, no vaccine against Pseudomonas is available. IC43 is a new, recombinant, protein (OprF/I)-based vaccine against the opportunistic pathogen, Pseudomonas aeruginosa, a major cause of serious hospital-acquired infections. IC43 has proven immunogenicity and tolerability in healthy volunteers, patients with burns, and patients with chronic lung diseases. In order to assess the immunogenicity and safety of IC43 in patients who are most at risk of acquiring Pseudomonas infections, it was evaluated in mechanically ventilated ICU patients. Methods: We conducted a randomized, placebo-controlled, partially blinded study in mechanically ventilated ICU patients. The immunogenicity of IC43 at day 14 was determined as the primary endpoint, and safety, efficacy against P. aeruginosa infections, and all-cause mortality were evaluated as secondary endpoints. Vaccinations (100 μg or 200 μg IC43 with adjuvant, or 100 μg IC43 without adjuvant, or placebo) were given twice in a 7-day interval and patients were followed up for 90 days. Results: Higher OprF/I IgG antibody titers were seen at day 14 for all IC43 groups versus placebo (P < 0.0001). Seroconversion (≥4-fold increase in OprF/I IgG titer from days 0 to 14) was highest with 100 μg IC43 without adjuvant (80.6%). There were no significant differences in P. aeruginosa infection rates, with a low rate of invasive infections (pneumonia or bacteremia) in the IC43 groups (11.2-14.0%). Serious adverse events (SAEs) considered possibly related to therapy were reported by 2 patients (1.9%) in the group of 100 μg IC43 with adjuvant. Both SAEs resolved and no deaths were related to study treatment. Local tolerability symptoms were mild and rare (<5% of patients), a low rate of treatment-related treatment-emergent adverse events (3.1-10.6%) was observed in the IC43 groups. Conclusion: This phase II study has shown that IC43 vaccination of ventilated ICU patients produced a significant immunogenic effect. P. aeruginosa i, SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2017

47. Drivers and Impact of Antifungal Therapy in Critically Ill Patients with Aspergillus-Positive Respiratory Tract Cultures.

Author: UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (MGD) Services des soins intensifs, Paiva, José Artur, Mergulhão, Paulo, Gomes, André, Taccone, Fabio Silvio, Van den Abeele, Anne-Marie, Bulpa, Pierre, Misset, Benoît, Meersseman, Wouter, Dimopoulos, George, Rello, Jordi, Vogelaers, Dirk, Blot, Stijn, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (MGD) Services des soins intensifs, Paiva, José Artur, Mergulhão, Paulo, Gomes, André, Taccone, Fabio Silvio, Van den Abeele, Anne-Marie, Bulpa, Pierre, Misset, Benoît, Meersseman, Wouter, Dimopoulos, George, Rello, Jordi, Vogelaers, Dirk, and Blot, Stijn
Abstract: Invasive pulmonary aspergillosis (IPA) is an increasingly recognised problem in critically ill patients. Little is known about how intensivists react to an Aspergillus-positive respiratory sample or the efficacy of antifungal therapy (AFT). This study aimed to identify drivers of AFT prescription and diagnostic workup in patients with Aspergillus isolation in respiratory specimens as well as the impact of AFT in these patients. ICU patients with an Aspergillus-positive respiratory sample from the database of a previous observational, multicentre study were analysed. Cases were classified as proven/putative IPA or Aspergillus colonisation. Demographic, microbiological, diagnostic and therapeutic data were collected. Outcome was recorded 12 weeks after Aspergillus isolation. Patients with putative/proven IPA were more likely to receive AFT than colonised patients (78.7% vs. 25.5%; P <0.001). Patients with host factors for invasive fungal disease were more likely to receive AFT (72.5% vs. 37.4%) as were those with multiorgan failure (SOFA score >7) (68.4% vs. 36.9%) (both P <0.001). Once adjusted for disease severity, initiation of AFT did not alter the odds of survival (HR = 1.40, 95% CI 0.89-2.21). Likewise, treatment within 48 h following diagnosis did not change the clinical outcome (75.7% vs. 61.4%; P = 0.63). Treatment decisions appear to be based on diagnostic criteria and underlying disease severity at the time of Aspergillus isolation. IPA in this population has a dire prognosis and AFT is not associated with reduced mortality. This may be explained by delayed diagnosis and an often inevitable death due to advanced multiorgan failure.
Published: 2017

48. Which algorithm diagnoses invasive pulmonary aspergillosis best in ICU patients with COPD?

Author: UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (MGD) Services des soins intensifs, UCL - (MGD) Unité de support scientifique, Bulpa, Pierre, Bihin, Benoît, Dimopoulos, George, Taccone, Fabio S, Van den Abeele, Anne-Marie, Misset, Benoît, Meersseman, Wouter, Spapen, Herbert, Cardoso, Teresa, Charles, Pierre-Emmanuel, Rello, Jordi, Vogelaers, Dirk, Blot, Stijn, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (MGD) Services des soins intensifs, UCL - (MGD) Unité de support scientifique, Bulpa, Pierre, Bihin, Benoît, Dimopoulos, George, Taccone, Fabio S, Van den Abeele, Anne-Marie, Misset, Benoît, Meersseman, Wouter, Spapen, Herbert, Cardoso, Teresa, Charles, Pierre-Emmanuel, Rello, Jordi, Vogelaers, Dirk, and Blot, Stijn
Abstract: Invasive pulmonary aspergillosis (IPA) is a potentially lethal opportunistic infection, mainly affecting immunocompromised patients, particularly those with prolonged neutropenia [1]. Several reports have shown that Aspergillus spp. can also cause IPA in patients with a priori less severe immune dysfunction, such as those in intensive care units (ICUs) [2–5] or with chronic obstructive pulmonary disease (COPD) [5–8]. In these patients, diagnosis of IPA remains a challenge, because the reference diagnostic criteria (defined by the European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG)) were developed for research in high-risk patients and not specifically for patients in the ICU or patients with COPD [9]. Two alternative algorithms have been proposed for this setting: the COPD algorithm for patients with COPD [6] and the Clinical algorithm for patients in the ICU [10]. [...]
Published: 2017

49. A Global Declaration on Appropriate Use of Antimicrobial Agents across the Surgical Pathway

Author: Sartelli, Massimo, Kluger, Yoram, Ansaloni, Luca, Carlet, Jean, Brink, Adrian, Hardcastle, Timothy C., Khanna, Ashish, Chicom-Mefire, Alain, Rodriguez-Bano, Jesus, Nathwani, Dilip, Mendelson, Marc, Watkins, Richard R., Pulcini, Celine, Beovic, Bojana, May, Addison K., Itani, Kamal M. F., Mazuski, John E., Fry, Donald E., Coccolini, Federico, Rasa, Kemal, Montravers, Philippe, Eckmann, Christian, Abbo, Lilian M., Abubakar, Salisu, Abu-Zidan, Fikri M., Adesunkanmi, Abdulrashid Kayode, Al-Hasan, Majdi N., Althani, Asma A., Ticas, Jorge Eduardo Alvarenga, Ansari, Shamshul, Ansumana, Rashid, Araujo da Silva, Andre Ricardo, Augustin, Goran, Bala, Miklosh, Balogh, Zsolt J., Baraket, Oussema, Bassett, Matteo, Bellanova, Giovanni, Beltran, Marcelo A., Ben-Ishay, Ofir, Biffl, Walter L., Boermeester, Marja A., Brecher, Stephen M., Bueno, Juan, Cainzos, Miguel A., Cairns, Kelly, Camacho-Ortiz, Adrian, Ceresoli, Marco, Chandy, Sujith J., Cherry-Bukowiec, Jill R., Cirocchi, Roberto, Colak, Elif, Corcione, Antonio, Cornely, Oliver A., Cortese, Francesco, Cui, Yunfeng, Curcio, Daniel, Damaskos, Dimitris, Das, Koray, Delibegovic, Samir, Deme-Trashvili, Zaza, De Simone, Belinda, de Souza, Hamilton Petry, De Waele, Jan, Dhingra, Sameer, Diaz, Jose J., Di Carlo, Isidoro, Di Marzo, Francesco, Di Saverio, Salomone, Dogjani, Agron, Dorj, Gereltuya, Dortet, Laurent, Duane, Therese M., Dupont, Herve, Egiev, Valery N., Eid, Hani O., Elmangory, Mutasim, Marei, Hany El-Sayed, Enani, Mushira Abdulaziz, Escandon-Vargas, Kevin, Faro Junior, Mario P., Ferrada, Paula, Foghetti, Domitilla, Foianini, Esteban, Fraga, Gustavo P., Frattima, Sabrina, Gandhi, Chinmay, Gattuso, Gianni, Giamarellou, Eleni, Ghnnam, Wagih, Gkiokas, George, Girardis, Massimo, Goff, Debbie A., Gomes, Carlos Augusto, Gomi, Harumi, Guerra Gronerth, Rosio Isabel, Guirao, Xavier, Guzman-Blanco, Manuel, Haque, Mainul, Hecker, Andreas, Hell, Markus, Herzog, Torsten, Hicks, Lauri, Kafka-Ritsch, Reinhold, Kao, Lillian S., Kanj, Souha S., Kaplan, Lewis J., Kapoor, Garima, Karamarkovic, Aleksandar, Kashuk, Jeffry, Kenig, Jakub, Khamis, Faryal, Khokha, Vladimir, Kiguba, Ronald, Kirkpatrick, Andrew W., Korner, Hartwig, Koike, Kaoru, Kok, Kenneth Y. Y., Kon, Kateryna, Kong, Victor, Inaba, Kenji, Ioannidis, Orestis, Isik, Arda, Iskandar, Katia, Labbate, Maurizio, Labricciosa, Francesco M., Lagrou, Katrien, Lagunes, Leonel, Latifi, Rifat, Lasithiotakis, Kostas, Laxminarayan, Ramanan, Lee, Jae Gil, Leone, Marc, Leppaniemi, Ari, Li, Yousheng, Liang, Stephen Y., Liau, Kui-Hin, Litvin, Andrey, Loho, Tonny, Lowman, Warren, Machain, Gustavo M., Maier, Ronald V., Manzano-Nunez, Ramiro, Marinis, Athanasios, Marmorale, Cristina, Martin-Loeches, Ignacio, Marwah, Sanjay, Maseda, Emilio, McFarlane, Michael, de Melo, Renato Bessa, Melotti, Maria Rita, Memish, Ziad, Mertz, Dominik, Mesina, Cristian, Menichetti, Francesco, Mishra, Shyam Kumar, Montori, Giulia, Moore, Ernest E., Moore, Frederick A., Naidoo, Noel, Napolitano, Lena, Negoi, Ionut, Nicolau, David P., Nikolopoulos, Ioannis, Nord, Carl Erik, Ofori-Asenso, Richard, Olaoye, Iyiade, Omari, Abdelkarim H., Ordonez, Carlos A., Ouadii, Mouaqit, Ouedraogo, Abdoul-Salam, Pagani, Leonardo, Paiva, Jose Artur, Parreira, Jose Gustavo, Pata, Francesco, Pereira, Jorge, Pereira, Nuno R., Petrosillo, Nicola, Picetti, Edoardo, Pintar, Tadeja, Ponce-de-Leon, Alfredo, Popovski, Zagorka, Poulakou, Garyphallia, Preller, Jacobus, Guerrero, Adrian Puello, Pupelis, Guntars, Quiodettis, Martha, Rawson, Timothy M., Reichert, Martin, Reinhart, Konrad, Rems, Miran, Rello, Jordi, Rizoli, Sandro, Roberts, Jason, Rubio-Perez, Ines, Ruppc, Etienne, Sakakushev, Boris, Sall, Ibrahima, Kafil, Hossein Samadi, Sanders, James, Sato, Norio, Sawyer, Robert G., Scalea, Thomas, Scibe, Rodolfo, Scudeller, Luigia, Segovia Lohse, Helmut, Sganga, Gabriele, Shafiq, Nusrat, Shah, Jay N., Spigaglia, Patrizia, Suroowan, Shanoo, Tsioutis, Constantinos, Sifri, Costi D., Siribumrungwong, Boonying, Sugrue, Michael, Talving, Peep, Tan, Boun Kim, Tarasconi, Antonio, Tascini, Carlo, Tilsed, Jonathan, Timsit, Jean-Francois, Tumbarello, Mario, Ulrych, Jan, Uranues, Selman, Velmahos, George, Vereczkei, Andras G., Viale, Pierluigi, Vila Estape, Jordi, Viscoli, Claudio, Wagenlehner, Florian, Wright, Brian J., Xiao, Yonghong, Yuan, Kuo-Ching, Zachariah, Sanoop K., Zahar, Jean Ralph, Mergulhao, Paulo, Catena, Fausto, Sartelli, Massimo, Kluger, Yoram, Ansaloni, Luca, Carlet, Jean, Brink, Adrian, Hardcastle, Timothy C., Khanna, Ashish, Chicom-Mefire, Alain, Rodriguez-Bano, Jesus, Nathwani, Dilip, Mendelson, Marc, Watkins, Richard R., Pulcini, Celine, Beovic, Bojana, May, Addison K., Itani, Kamal M. F., Mazuski, John E., Fry, Donald E., Coccolini, Federico, Rasa, Kemal, Montravers, Philippe, Eckmann, Christian, Abbo, Lilian M., Abubakar, Salisu, Abu-Zidan, Fikri M., Adesunkanmi, Abdulrashid Kayode, Al-Hasan, Majdi N., Althani, Asma A., Ticas, Jorge Eduardo Alvarenga, Ansari, Shamshul, Ansumana, Rashid, Araujo da Silva, Andre Ricardo, Augustin, Goran, Bala, Miklosh, Balogh, Zsolt J., Baraket, Oussema, Bassett, Matteo, Bellanova, Giovanni, Beltran, Marcelo A., Ben-Ishay, Ofir, Biffl, Walter L., Boermeester, Marja A., Brecher, Stephen M., Bueno, Juan, Cainzos, Miguel A., Cairns, Kelly, Camacho-Ortiz, Adrian, Ceresoli, Marco, Chandy, Sujith J., Cherry-Bukowiec, Jill R., Cirocchi, Roberto, Colak, Elif, Corcione, Antonio, Cornely, Oliver A., Cortese, Francesco, Cui, Yunfeng, Curcio, Daniel, Damaskos, Dimitris, Das, Koray, Delibegovic, Samir, Deme-Trashvili, Zaza, De Simone, Belinda, de Souza, Hamilton Petry, De Waele, Jan, Dhingra, Sameer, Diaz, Jose J., Di Carlo, Isidoro, Di Marzo, Francesco, Di Saverio, Salomone, Dogjani, Agron, Dorj, Gereltuya, Dortet, Laurent, Duane, Therese M., Dupont, Herve, Egiev, Valery N., Eid, Hani O., Elmangory, Mutasim, Marei, Hany El-Sayed, Enani, Mushira Abdulaziz, Escandon-Vargas, Kevin, Faro Junior, Mario P., Ferrada, Paula, Foghetti, Domitilla, Foianini, Esteban, Fraga, Gustavo P., Frattima, Sabrina, Gandhi, Chinmay, Gattuso, Gianni, Giamarellou, Eleni, Ghnnam, Wagih, Gkiokas, George, Girardis, Massimo, Goff, Debbie A., Gomes, Carlos Augusto, Gomi, Harumi, Guerra Gronerth, Rosio Isabel, Guirao, Xavier, Guzman-Blanco, Manuel, Haque, Mainul, Hecker, Andreas, Hell, Markus, Herzog, Torsten, Hicks, Lauri, Kafka-Ritsch, Reinhold, Kao, Lillian S., Kanj, Souha S., Kaplan, Lewis J., Kapoor, Garima, Karamarkovic, Aleksandar, Kashuk, Jeffry, Kenig, Jakub, Khamis, Faryal, Khokha, Vladimir, Kiguba, Ronald, Kirkpatrick, Andrew W., Korner, Hartwig, Koike, Kaoru, Kok, Kenneth Y. Y., Kon, Kateryna, Kong, Victor, Inaba, Kenji, Ioannidis, Orestis, Isik, Arda, Iskandar, Katia, Labbate, Maurizio, Labricciosa, Francesco M., Lagrou, Katrien, Lagunes, Leonel, Latifi, Rifat, Lasithiotakis, Kostas, Laxminarayan, Ramanan, Lee, Jae Gil, Leone, Marc, Leppaniemi, Ari, Li, Yousheng, Liang, Stephen Y., Liau, Kui-Hin, Litvin, Andrey, Loho, Tonny, Lowman, Warren, Machain, Gustavo M., Maier, Ronald V., Manzano-Nunez, Ramiro, Marinis, Athanasios, Marmorale, Cristina, Martin-Loeches, Ignacio, Marwah, Sanjay, Maseda, Emilio, McFarlane, Michael, de Melo, Renato Bessa, Melotti, Maria Rita, Memish, Ziad, Mertz, Dominik, Mesina, Cristian, Menichetti, Francesco, Mishra, Shyam Kumar, Montori, Giulia, Moore, Ernest E., Moore, Frederick A., Naidoo, Noel, Napolitano, Lena, Negoi, Ionut, Nicolau, David P., Nikolopoulos, Ioannis, Nord, Carl Erik, Ofori-Asenso, Richard, Olaoye, Iyiade, Omari, Abdelkarim H., Ordonez, Carlos A., Ouadii, Mouaqit, Ouedraogo, Abdoul-Salam, Pagani, Leonardo, Paiva, Jose Artur, Parreira, Jose Gustavo, Pata, Francesco, Pereira, Jorge, Pereira, Nuno R., Petrosillo, Nicola, Picetti, Edoardo, Pintar, Tadeja, Ponce-de-Leon, Alfredo, Popovski, Zagorka, Poulakou, Garyphallia, Preller, Jacobus, Guerrero, Adrian Puello, Pupelis, Guntars, Quiodettis, Martha, Rawson, Timothy M., Reichert, Martin, Reinhart, Konrad, Rems, Miran, Rello, Jordi, Rizoli, Sandro, Roberts, Jason, Rubio-Perez, Ines, Ruppc, Etienne, Sakakushev, Boris, Sall, Ibrahima, Kafil, Hossein Samadi, Sanders, James, Sato, Norio, Sawyer, Robert G., Scalea, Thomas, Scibe, Rodolfo, Scudeller, Luigia, Segovia Lohse, Helmut, Sganga, Gabriele, Shafiq, Nusrat, Shah, Jay N., Spigaglia, Patrizia, Suroowan, Shanoo, Tsioutis, Constantinos, Sifri, Costi D., Siribumrungwong, Boonying, Sugrue, Michael, Talving, Peep, Tan, Boun Kim, Tarasconi, Antonio, Tascini, Carlo, Tilsed, Jonathan, Timsit, Jean-Francois, Tumbarello, Mario, Ulrych, Jan, Uranues, Selman, Velmahos, George, Vereczkei, Andras G., Viale, Pierluigi, Vila Estape, Jordi, Viscoli, Claudio, Wagenlehner, Florian, Wright, Brian J., Xiao, Yonghong, Yuan, Kuo-Ching, Zachariah, Sanoop K., Zahar, Jean Ralph, Mergulhao, Paulo, and Catena, Fausto
Abstract: This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat posed by antimicrobial resistance and the need for appropriate use of antibiotic agents and antifungal agents in hospitals worldwide especially focusing on surgical infections. As such, it is our intent to raise awareness among healthcare workers and improve antimicrobial prescribing. To facilitate its dissemination, the declaration was translated in different languages.
Published: 2017

50. A Global Declaration on Appropriate Use of Antimicrobial Agents across the Surgical Pathway

Author: Sartelli, Massimo, Kluger, Yoram, Ansaloni, Luca, Carlet, Jean, Brink, Adrian, Hardcastle, Timothy C., Khanna, Ashish, Chicom-Mefire, Alain, Rodriguez-Bano, Jesus, Nathwani, Dilip, Mendelson, Marc, Watkins, Richard R., Pulcini, Celine, Beovic, Bojana, May, Addison K., Itani, Kamal M. F., Mazuski, John E., Fry, Donald E., Coccolini, Federico, Rasa, Kemal, Montravers, Philippe, Eckmann, Christian, Abbo, Lilian M., Abubakar, Salisu, Abu-Zidan, Fikri M., Adesunkanmi, Abdulrashid Kayode, Al-Hasan, Majdi N., Althani, Asma A., Ticas, Jorge Eduardo Alvarenga, Ansari, Shamshul, Ansumana, Rashid, Araujo da Silva, Andre Ricardo, Augustin, Goran, Bala, Miklosh, Balogh, Zsolt J., Baraket, Oussema, Bassett, Matteo, Bellanova, Giovanni, Beltran, Marcelo A., Ben-Ishay, Ofir, Biffl, Walter L., Boermeester, Marja A., Brecher, Stephen M., Bueno, Juan, Cainzos, Miguel A., Cairns, Kelly, Camacho-Ortiz, Adrian, Ceresoli, Marco, Chandy, Sujith J., Cherry-Bukowiec, Jill R., Cirocchi, Roberto, Colak, Elif, Corcione, Antonio, Cornely, Oliver A., Cortese, Francesco, Cui, Yunfeng, Curcio, Daniel, Damaskos, Dimitris, Das, Koray, Delibegovic, Samir, Deme-Trashvili, Zaza, De Simone, Belinda, de Souza, Hamilton Petry, De Waele, Jan, Dhingra, Sameer, Diaz, Jose J., Di Carlo, Isidoro, Di Marzo, Francesco, Di Saverio, Salomone, Dogjani, Agron, Dorj, Gereltuya, Dortet, Laurent, Duane, Therese M., Dupont, Herve, Egiev, Valery N., Eid, Hani O., Elmangory, Mutasim, Marei, Hany El-Sayed, Enani, Mushira Abdulaziz, Escandon-Vargas, Kevin, Faro Junior, Mario P., Ferrada, Paula, Foghetti, Domitilla, Foianini, Esteban, Fraga, Gustavo P., Frattima, Sabrina, Gandhi, Chinmay, Gattuso, Gianni, Giamarellou, Eleni, Ghnnam, Wagih, Gkiokas, George, Girardis, Massimo, Goff, Debbie A., Gomes, Carlos Augusto, Gomi, Harumi, Guerra Gronerth, Rosio Isabel, Guirao, Xavier, Guzman-Blanco, Manuel, Haque, Mainul, Hecker, Andreas, Hell, Markus, Herzog, Torsten, Hicks, Lauri, Kafka-Ritsch, Reinhold, Kao, Lillian S., Kanj, Souha S., Kaplan, Lewis J., Kapoor, Garima, Karamarkovic, Aleksandar, Kashuk, Jeffry, Kenig, Jakub, Khamis, Faryal, Khokha, Vladimir, Kiguba, Ronald, Kirkpatrick, Andrew W., Korner, Hartwig, Koike, Kaoru, Kok, Kenneth Y. Y., Kon, Kateryna, Kong, Victor, Inaba, Kenji, Ioannidis, Orestis, Isik, Arda, Iskandar, Katia, Labbate, Maurizio, Labricciosa, Francesco M., Lagrou, Katrien, Lagunes, Leonel, Latifi, Rifat, Lasithiotakis, Kostas, Laxminarayan, Ramanan, Lee, Jae Gil, Leone, Marc, Leppaniemi, Ari, Li, Yousheng, Liang, Stephen Y., Liau, Kui-Hin, Litvin, Andrey, Loho, Tonny, Lowman, Warren, Machain, Gustavo M., Maier, Ronald V., Manzano-Nunez, Ramiro, Marinis, Athanasios, Marmorale, Cristina, Martin-Loeches, Ignacio, Marwah, Sanjay, Maseda, Emilio, McFarlane, Michael, de Melo, Renato Bessa, Melotti, Maria Rita, Memish, Ziad, Mertz, Dominik, Mesina, Cristian, Menichetti, Francesco, Mishra, Shyam Kumar, Montori, Giulia, Moore, Ernest E., Moore, Frederick A., Naidoo, Noel, Napolitano, Lena, Negoi, Ionut, Nicolau, David P., Nikolopoulos, Ioannis, Nord, Carl Erik, Ofori-Asenso, Richard, Olaoye, Iyiade, Omari, Abdelkarim H., Ordonez, Carlos A., Ouadii, Mouaqit, Ouedraogo, Abdoul-Salam, Pagani, Leonardo, Paiva, Jose Artur, Parreira, Jose Gustavo, Pata, Francesco, Pereira, Jorge, Pereira, Nuno R., Petrosillo, Nicola, Picetti, Edoardo, Pintar, Tadeja, Ponce-de-Leon, Alfredo, Popovski, Zagorka, Poulakou, Garyphallia, Preller, Jacobus, Guerrero, Adrian Puello, Pupelis, Guntars, Quiodettis, Martha, Rawson, Timothy M., Reichert, Martin, Reinhart, Konrad, Rems, Miran, Rello, Jordi, Rizoli, Sandro, Roberts, Jason, Rubio-Perez, Ines, Ruppc, Etienne, Sakakushev, Boris, Sall, Ibrahima, Kafil, Hossein Samadi, Sanders, James, Sato, Norio, Sawyer, Robert G., Scalea, Thomas, Scibe, Rodolfo, Scudeller, Luigia, Segovia Lohse, Helmut, Sganga, Gabriele, Shafiq, Nusrat, Shah, Jay N., Spigaglia, Patrizia, Suroowan, Shanoo, Tsioutis, Constantinos, Sifri, Costi D., Siribumrungwong, Boonying, Sugrue, Michael, Talving, Peep, Tan, Boun Kim, Tarasconi, Antonio, Tascini, Carlo, Tilsed, Jonathan, Timsit, Jean-Francois, Tumbarello, Mario, Ulrych, Jan, Uranues, Selman, Velmahos, George, Vereczkei, Andras G., Viale, Pierluigi, Vila Estape, Jordi, Viscoli, Claudio, Wagenlehner, Florian, Wright, Brian J., Xiao, Yonghong, Yuan, Kuo-Ching, Zachariah, Sanoop K., Zahar, Jean Ralph, Mergulhao, Paulo, Catena, Fausto, Sartelli, Massimo, Kluger, Yoram, Ansaloni, Luca, Carlet, Jean, Brink, Adrian, Hardcastle, Timothy C., Khanna, Ashish, Chicom-Mefire, Alain, Rodriguez-Bano, Jesus, Nathwani, Dilip, Mendelson, Marc, Watkins, Richard R., Pulcini, Celine, Beovic, Bojana, May, Addison K., Itani, Kamal M. F., Mazuski, John E., Fry, Donald E., Coccolini, Federico, Rasa, Kemal, Montravers, Philippe, Eckmann, Christian, Abbo, Lilian M., Abubakar, Salisu, Abu-Zidan, Fikri M., Adesunkanmi, Abdulrashid Kayode, Al-Hasan, Majdi N., Althani, Asma A., Ticas, Jorge Eduardo Alvarenga, Ansari, Shamshul, Ansumana, Rashid, Araujo da Silva, Andre Ricardo, Augustin, Goran, Bala, Miklosh, Balogh, Zsolt J., Baraket, Oussema, Bassett, Matteo, Bellanova, Giovanni, Beltran, Marcelo A., Ben-Ishay, Ofir, Biffl, Walter L., Boermeester, Marja A., Brecher, Stephen M., Bueno, Juan, Cainzos, Miguel A., Cairns, Kelly, Camacho-Ortiz, Adrian, Ceresoli, Marco, Chandy, Sujith J., Cherry-Bukowiec, Jill R., Cirocchi, Roberto, Colak, Elif, Corcione, Antonio, Cornely, Oliver A., Cortese, Francesco, Cui, Yunfeng, Curcio, Daniel, Damaskos, Dimitris, Das, Koray, Delibegovic, Samir, Deme-Trashvili, Zaza, De Simone, Belinda, de Souza, Hamilton Petry, De Waele, Jan, Dhingra, Sameer, Diaz, Jose J., Di Carlo, Isidoro, Di Marzo, Francesco, Di Saverio, Salomone, Dogjani, Agron, Dorj, Gereltuya, Dortet, Laurent, Duane, Therese M., Dupont, Herve, Egiev, Valery N., Eid, Hani O., Elmangory, Mutasim, Marei, Hany El-Sayed, Enani, Mushira Abdulaziz, Escandon-Vargas, Kevin, Faro Junior, Mario P., Ferrada, Paula, Foghetti, Domitilla, Foianini, Esteban, Fraga, Gustavo P., Frattima, Sabrina, Gandhi, Chinmay, Gattuso, Gianni, Giamarellou, Eleni, Ghnnam, Wagih, Gkiokas, George, Girardis, Massimo, Goff, Debbie A., Gomes, Carlos Augusto, Gomi, Harumi, Guerra Gronerth, Rosio Isabel, Guirao, Xavier, Guzman-Blanco, Manuel, Haque, Mainul, Hecker, Andreas, Hell, Markus, Herzog, Torsten, Hicks, Lauri, Kafka-Ritsch, Reinhold, Kao, Lillian S., Kanj, Souha S., Kaplan, Lewis J., Kapoor, Garima, Karamarkovic, Aleksandar, Kashuk, Jeffry, Kenig, Jakub, Khamis, Faryal, Khokha, Vladimir, Kiguba, Ronald, Kirkpatrick, Andrew W., Korner, Hartwig, Koike, Kaoru, Kok, Kenneth Y. Y., Kon, Kateryna, Kong, Victor, Inaba, Kenji, Ioannidis, Orestis, Isik, Arda, Iskandar, Katia, Labbate, Maurizio, Labricciosa, Francesco M., Lagrou, Katrien, Lagunes, Leonel, Latifi, Rifat, Lasithiotakis, Kostas, Laxminarayan, Ramanan, Lee, Jae Gil, Leone, Marc, Leppaniemi, Ari, Li, Yousheng, Liang, Stephen Y., Liau, Kui-Hin, Litvin, Andrey, Loho, Tonny, Lowman, Warren, Machain, Gustavo M., Maier, Ronald V., Manzano-Nunez, Ramiro, Marinis, Athanasios, Marmorale, Cristina, Martin-Loeches, Ignacio, Marwah, Sanjay, Maseda, Emilio, McFarlane, Michael, de Melo, Renato Bessa, Melotti, Maria Rita, Memish, Ziad, Mertz, Dominik, Mesina, Cristian, Menichetti, Francesco, Mishra, Shyam Kumar, Montori, Giulia, Moore, Ernest E., Moore, Frederick A., Naidoo, Noel, Napolitano, Lena, Negoi, Ionut, Nicolau, David P., Nikolopoulos, Ioannis, Nord, Carl Erik, Ofori-Asenso, Richard, Olaoye, Iyiade, Omari, Abdelkarim H., Ordonez, Carlos A., Ouadii, Mouaqit, Ouedraogo, Abdoul-Salam, Pagani, Leonardo, Paiva, Jose Artur, Parreira, Jose Gustavo, Pata, Francesco, Pereira, Jorge, Pereira, Nuno R., Petrosillo, Nicola, Picetti, Edoardo, Pintar, Tadeja, Ponce-de-Leon, Alfredo, Popovski, Zagorka, Poulakou, Garyphallia, Preller, Jacobus, Guerrero, Adrian Puello, Pupelis, Guntars, Quiodettis, Martha, Rawson, Timothy M., Reichert, Martin, Reinhart, Konrad, Rems, Miran, Rello, Jordi, Rizoli, Sandro, Roberts, Jason, Rubio-Perez, Ines, Ruppc, Etienne, Sakakushev, Boris, Sall, Ibrahima, Kafil, Hossein Samadi, Sanders, James, Sato, Norio, Sawyer, Robert G., Scalea, Thomas, Scibe, Rodolfo, Scudeller, Luigia, Segovia Lohse, Helmut, Sganga, Gabriele, Shafiq, Nusrat, Shah, Jay N., Spigaglia, Patrizia, Suroowan, Shanoo, Tsioutis, Constantinos, Sifri, Costi D., Siribumrungwong, Boonying, Sugrue, Michael, Talving, Peep, Tan, Boun Kim, Tarasconi, Antonio, Tascini, Carlo, Tilsed, Jonathan, Timsit, Jean-Francois, Tumbarello, Mario, Ulrych, Jan, Uranues, Selman, Velmahos, George, Vereczkei, Andras G., Viale, Pierluigi, Vila Estape, Jordi, Viscoli, Claudio, Wagenlehner, Florian, Wright, Brian J., Xiao, Yonghong, Yuan, Kuo-Ching, Zachariah, Sanoop K., Zahar, Jean Ralph, Mergulhao, Paulo, and Catena, Fausto
Abstract: This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat posed by antimicrobial resistance and the need for appropriate use of antibiotic agents and antifungal agents in hospitals worldwide especially focusing on surgical infections. As such, it is our intent to raise awareness among healthcare workers and improve antimicrobial prescribing. To facilitate its dissemination, the declaration was translated in different languages.
Published: 2017

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