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4 results on '"Chirino, Alejandro"'

1. RECOMENDACIONES ACTUALIZADAS PARA LA VACUNACIÓN DE ADULTOS CON ENFERMEDADES RESPIRATORIAS ASOCIACIÓN ARGENTINA DE MEDICINA RESPIRATORIA, 2023.

Author

Luna, Carlos M., Pulido, Laura, Rizzo, Oscar, Gauna, María Laura, Chirino, Alejandro, and Videla, Alejandro J.

Abstract

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Published
2024

3. Qualitative cultures in ventilator-associated pneumonia - can they be used with confidence?

Author

Luna, Carlos M and Chirino, Alejandro

Subjects
Male, Microbiological Techniques, Critical Illness, Colony Count, Microbial, antibacterial agents, respiratory tract infections, Gram-Positive Bacteria, Sensitivity and Specificity, ventilator-associated pneumonia, Drug Utilization Review, bacterial pneumonia, Predictive Value of Tests, Gram-Negative Bacteria, Bronchoscopy, Pneumonia, Bacterial, qualitative evaluation, Humans, Prospective Studies, Aged, Aged, 80 and over, Bacteriological Techniques, Cross Infection, Ventilators, Mechanical, diagnostic techniques, Research, microbiology, Fungi, Sputum, Pneumonia, Middle Aged, quantitative evaluation, Respiration, Artificial, respiratory tract diseases, Anti-Bacterial Agents, Trachea, Intensive Care Units, Cross-Sectional Studies, Commentary, tracheal aspirates, Female, Bronchoalveolar Lavage Fluid, Brazil
Abstract

Introduction Deferred or inappropriate antibiotic treatment in ventilator-associated pneumonia (VAP) is associated with increased mortality, and clinical and radiological criteria are frequently employed to establish an early diagnosis. Culture results are used to confirm the clinical diagnosis and to adjust or sometimes withdraw antibiotic treatment. Tracheal aspirates have been shown to be useful for these purposes. Nonetheless, little is known about the usefulness of quantitative findings in tracheal secretions for diagnosing VAP. Methods To determine the value of quantification of bacterial colonies in tracheal aspirates for diagnosing VAP, we conducted a prospective follow-up study of 106 intensive care unit patients who were under ventilatory support. In total, the findings from 219 sequential weekly evaluations for VAP were examined. Clinical and radiological parameters were recorded and evaluated by three independent experts; a diagnosis of VAP required the agreement of at least two of the three experts. At the same time, cultures of tracheal aspirates were analyzed qualitatively and quantitatively (105 colony-forming units [cfu]/ml and 106 cfu/ml) Results Quantitative cultures of tracheal aspirates (105 cfu/ml and 106 cfu/ml) exhibited increased specificity (48% and 78%, respectively) over qualitative cultures (23%), but decreased sensitivity (26% and 65%, respectively) as compared with the qualitative findings (81%). Quantification did not improve the ability to predict a diagnosis of VAP. Conclusion Quantitative cultures of tracheal aspirates in selected critically ill patients have decreased sensitivity when compared with qualitative results, and they should not replace the latter to confirm a clinical diagnosis of VAP or to adjust antimicrobial therapy.

Published
2004

4. [Updated recommendations for vaccination in adults with respiratory diseases. Argentine Association of Respiratory Medicine, 2023].

Author

Luna CM, Pulido L, Rizzo O, Gauna ML, Chirino A, and Videla AJ

Subjects
Adult, Humans, Infant, Aged, Vaccination, Pneumococcal Vaccines, Pulmonary Medicine, Influenza Vaccines, COVID-19 prevention & control
Abstract

Adult smokers, those with comorbidities, and the elderly, are at greater risk of contracting infections and their complications. Community acquired respiratory infections due to viruses, pneumococcus and other bacteria, affect both healthy and sick adults. There are vaccines that the pulmonologist must know and prescribe. The target strains of the influenza vaccine are defined by the WHO for the Southern hemisphere considering those involved in the previous influenza season in the Northern hemisphere. Its effectiveness depends on virulence, concordance between circulating and vaccine strains, and population coverage. The anti-pneumococcal polysaccharide vaccine available since 1983 is being replaced by more effective conjugate vaccines to prevent infections related to serotypes present in them. Immunization against SARS-CoV-2 reduced the contagion, severity, and lethality of COVID-19. The acellular vaccine against Bordetella pertussis for adults is present for specific situations in the adult calendar; vaccinating them strengthens the control of childhood contagion. The double (diphtheria + tetanus), and triple (double + pertussis) bacterial vaccines, and the vaccines against measles, chickenpox, rubella, human papillomavirus, Haemophilus influenzae, meningococcus, herpes zoster, Argentine hemorrhagic fever and yellow fever, are of a more limited use. Soon we will have new vaccines such as the one recently approved by the FDA against respiratory syncytial virus. Through a consensus of experts in respiratory infections, we review the new evidence regarding the immunization of adults who consult a pulmonologist, and thus update the recommendations on vaccination made eight years ago.

Published
2024

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