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51. Mortality comparison between the first and second/third waves among 3,795 critical COVID-19 patients with pneumonia admitted to the ICU: A multicentre retrospective cohort study

Author

Raquel Carbonell, Silvia Urgelés, Alejandro Rodríguez, María Bodí, Ignacio Martín-Loeches, Jordi Solé-Violán, Emili Díaz, Josep Gómez, Sandra Trefler, Montserrat Vallverdú, Josefa Murcia, Antonio Albaya, Ana Loza, Lorenzo Socias, Juan Carlos Ballesteros, Elisabeth Papiol, Lucía Viña, Susana Sancho, Mercedes Nieto, Maria del Carmen Lorente, Oihane Badallo, Virginia Fraile, Fernando Arméstar, Angel Estella, Laura Sanchez, Isabel Sancho, Antonio Margarit, and Gerard Moreno

Subjects
Public aspects of medicine, RA1-1270
Abstract

ABSTRACT: Background: It is unclear whether the changes in critical care throughout the pandemic have improved the outcomes in coronavirus disease 2019 (COVID-19) patients admitted to the intensive care units (ICUs). Methods: We conducted a retrospective cohort study in adults with COVID-19 pneumonia admitted to 73 ICUs from Spain, Andorra and Ireland between February 2020 and March 2021. The first wave corresponded with the period from February 2020 to June 2020, whereas the second/third waves occurred from July 2020 to March 2021. The primary outcome was ICU mortality between study periods. Mortality predictors and differences in mortality between COVID-19 waves were identified using logistic regression. Findings: As of March 2021, the participating ICUs had included 3795 COVID-19 pneumonia patients, 2479 (65·3%) and 1316 (34·7%) belonging to the first and second/third waves, respectively. Illness severity scores predicting mortality were lower in the second/third waves compared with the first wave according with the Acute Physiology and Chronic Health Evaluation system (median APACHE II score 12 [IQR 9–16] vs 14 [IQR 10–19]) and the organ failure assessment score (median SOFA 4 [3–6] vs 5 [3–7], p

Published
2021
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52. Colistin versus meropenem in the empirical treatment of ventilator-associated pneumonia (Magic Bullet study): an investigator-driven, open-label, randomized, noninferiority controlled trial

Author

José M. Cisneros, Clara María Rosso-Fernández, Cristina Roca-Oporto, Gennaro De Pascale, Silvia Jiménez-Jorge, Esteban Fernández-Hinojosa, Dimitrios K. Matthaiou, Paula Ramírez, Ramón Ortiz Díaz-Miguel, Angel Estella, Massimo Antonelli, George Dimopoulos, José Garnacho-Montero, and on behalf of the Magic Bullet Working Group WP

Subjects
Colistin, Ventilator-associated pneumonia, Multidrug-resistant bacteria, Carbapenem-resistant gram-negative bacilli, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Colistin is recommended in the empirical treatment of ventilator-associated pneumonia (VAP) with a high prevalence of carbapenem-resistant gram-negative bacilli (CR-GNB). However, the efficacy and safety of colistin are not well defined. Methods A multicenter prospective randomized trial conducted in 32 European centers compared the efficacy and safety of colistin (4.5 million unit loading dose followed by a maintenance dose of 3 million units every 8 h) versus meropenem (2 g every 8 h), both in combination with levofloxacin (500 mg every 12 h) for 7–14 days in patients with late VAP. Between May 2012 and October 2015, 232 patients were randomly assigned to the 2 treatment groups. The primary endpoint was mortality at 28 days after randomization in the microbiologically modified intention-to-treat (mMITT) population. Secondary outcomes included clinical and microbiological cure, renal function at the end of the treatment, and serious adverse events. The study was interrupted after the interim analysis due to excessive nephrotoxicity in the colistin group; therefore, the sample size was not achieved. Results A total of 157 (67.7%) patients were included in the mMITT population, 36 of whom (22.9%) had VAP caused by CR-GNB. In the mMITT population, no significant difference in mortality between the colistin group (19/82, 23.2%) and the meropenem group (19/75, 25.3%) was observed, with a risk difference of − 2.16 (− 15.59 to 11.26, p = 0.377); the noninferiority of colistin was not demonstrated due to early termination and limited number of patients infected by carbapenem-resistant pathogens. Colistin plus levofloxacin increased the incidence of renal failure (40/120, 33.3%, versus 21/112, 18.8%; p = 0.012) and renal replacement therapy (11/120, 9.1%, versus 2/112, 1.8%; p = 0.015). Conclusions This study did not demonstrate the noninferiority of colistin compared with meropenem, both combined with levofloxacin, in terms of efficacy in the empirical treatment of late VAP but demonstrated the greater nephrotoxicity of colistin. These findings do not support the empirical use of colistin for the treatment of late VAP due to early termination. Trial registration ClinicalTrials.gov, NCT01292031. Registered 9 February 2011.

Published
2019
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53. Prognostic Value of Procalcitonin and C-Reactive Protein in 1608 Critically Ill Patients with Severe Influenza Pneumonia

Author

Raquel Carbonell, Gerard Moreno, Ignacio Martín-Loeches, Frederic Gomez-Bertomeu, Carolina Sarvisé, Josep Gómez, María Bodí, Emili Díaz, Elisabeth Papiol, Sandra Trefler, Mercedes Nieto, Angel Estella, María Jiménez Herrera, Pablo Vidal Cortés, Juan José Guardiola, Jordi Solé-Violán, and Alejandro Rodríguez

Subjects
pneumonia, procalcitonin, C-Reactive protein, mortality, Gram-positive cocci, Gram negative bacilli, Therapeutics. Pharmacology, RM1-950
Abstract

Background: Procalcitonin (PCT) and C-Reactive protein (CRP) are well-established sepsis biomarkers. The association of baseline PCT levels and mortality in pneumonia remains unclear, and we still do not know whether biomarkers levels could be related to the causative microorganism (GPC, GNB). The objective of this study is to address these issues. Methods: a retrospective observational cohort study was conducted in 184 Spanish ICUs (2009–2018). Results: 1608 patients with severe influenza pneumonia with PCT and CRP available levels on admission were included, 1186 with primary viral pneumonia (PVP) and 422 with bacterial Co-infection (BC). Those with BC presented higher PCT levels (4.25 [0.6–19.5] versus 0.6 [0.2–2.3]ng/mL) and CRP (36.7 [20.23–118] versus 28.05 [13.3–109]mg/dL) as compared to PVP (p < 0.001). Deceased patients had higher PCT (ng/mL) when compared with survivors, in PVP (0.82 [0.3–2.8]) versus 0.53 [0.19–2.1], p = 0.001) and BC (6.9 [0.93–28.5] versus 3.8 [0.5–17.37], p = 0.039). However, no significant association with mortality was observed in the multivariate analysis. The PCT levels (ng/mL) were significantly higher in polymicrobial infection (8.4) and GPC (6.9) when compared with GNB (1.2) and Aspergillus (1.7). The AUC-ROC of PCT for GPC was 0.67 and 0.32 for GNB. The AUROC of CRP was 0.56 for GPC and 0.39 for GNB. Conclusions: a single PCT/CRP value at ICU admission was not associated with mortality in severe influenza pneumonia. None of the biomarkers have enough discriminatory power to be used for predicting the causative microorganism of the co-infection.

Published
2021
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54. Usefulness of CURB-65 and Pneumonia Severity Index for Influenza A H1N1v pneumonia

Author

Angel Estella

Subjects
Influenza A H1N1, Pneumonia, Severity index, CURB 65, PSI, Emergency., Medicine
Abstract

Background. Different prognostic scales have been documented to assess the severity and indications for hospitalization and ICU admissions of community acquired pneumonia. During the past two years Influenza A H1N1v infections have been commonly attended to in emergency departments. The aim of the study was to analyse the usefulness of the application of the Pneumonia Severity Index (PSI) and CURB-65 prognostic scales in patients with primary viral pneumonia caused by influenza A H1N1v. Methods. A retrospective study was performed at a community hospital with a 17 bed-Intensive Care Unit. Patients admitted in hospital with influenza A H1N1v pneumonia over a two year period were analysed. CURB 65 and PSI scales were applied in the emergency department and outcome and destination of admission were analysed. Results. 24 patients were registered, 19 required ICU admission and 5 patients were admitted in medical wards. Most of the patients admitted to the intensive care unit (78.9%) required mechanical ventilation. Mortality was 21.1%. Most patients admitted to the ICU had CURB 65 scale of 1 (60%), 13.3% obtained 0 and 26.7% 2. PSI scale resulted class I in a 20%, class II 40%, 26.7% class IV and 13.3% class V. The scales CURB 65 and PSI showed no differences in scores according to the destination of admission and mortality. Conclusions. Use of CURB-65 and PSI in the emergency department may underestimate the risk of patients with Influenza A H1N1v pneumonia. Based in our results, the ability of these scales to predict ICU admissions for Influenza A H1N1v pneumonia is questioned.

Published
2015
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55. Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis

Author

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

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

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

56. Clindamycin but not Intravenous Immunoglobulins reduces mortality in a retrospective cohort of critically ill patients with bacteremic Group A Streptococcal infections.

Author

Fernández-Galilea A, Estella A, García-Garmendia JL, Loza A, Palacios-García I, Sierra-Camerino R, Seller G, Rodríguez-Delgado M, Rodriguez-Higueras I, and Garnacho-Montero J

Subjects
Adult, Clindamycin therapeutic use, Critical Illness therapy, Hospital Mortality, Humans, Immunoglobulins, Intravenous therapeutic use, Intensive Care Units, Middle Aged, Retrospective Studies, Streptococcus pyogenes, Bacteremia drug therapy, Streptococcal Infections drug therapy
Abstract

Objective: Mortality of patients requiring Intensive Care Unit (ICU) admission for an invasive group A streptococcal (GAS) infection continues being high. In critically ill patients with bacteremic GAS infection we aimed at determining risk factors for mortality., Methods: Retrospective multicentre study carried out in nine ICU in Southern Spain. All adult patients admitted to the participant ICUs from January 2014 to June 2019 with one positive blood culture for S. pyogenes were included in this study. Patient characteristics, infection-related variables, therapeutic interventions, failure of organs, and outcomes were registered. Risk factors independently associated with ICU and in-hospital mortalities were determined by multivariate regression analyses., Results: Fifty-seven patients were included: median age was 63 (45-73) years, median SOFA score at admission was 11 (7-13). The most frequent source was skin and soft tissue infection (n=32) followed by unknown origin of bacteremia (n=12). In the multivariate analysis, age (OR 1.079; 95% CI 1.016-1.145), SOFA score (OR 2.129; 95% CI 1.339-3.383) were the risk factors for ICU mortality and the use of clindamycin was identified as a protective factor (OR 0.049; 95% CI 0.003-0.737). Age and SOFA were the independent factors associated with hospital mortality however the use of clindamycin showed a strong trend but without reaching statistical significance (OR 0.085; 95% CI 0.007-1.095)., Conclusions: In this cohort of critically ill patients the use of intravenous immunoglobulin was not identified as a protective factor for ICU or hospital mortality treatment with clindamycin significantly reduced mortality after controlling for confounders., (©The Author 2022. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

Published
2022
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