Search

Your search keyword '"Cillóniz C"' showing total 123 results
Start Over Author "Cillóniz C"
123 results on '"Cillóniz C"'

1. Ceftobiprole for the treatment of pneumonia: a European perspective

Author

Liapikou A, Cillóniz C, and Torres A

Subjects
Therapeutics. Pharmacology, RM1-950
Abstract

Adamantia Liapikou,1 Catia Cillóniz,2 Antonio Torres216th Respiratory Department, Sotiria Chest Diseases Hospital, Athens, Greece; 2Pulmonology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Spain Insitut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, SpainAbstract: Ceftobiprole, a new broad spectrum, parenteral cephalosporin, exhibits potent in vitro activity against a number of Gram-positive pathogens, including methicillin-resistant Staphylococcus aureus and penicillin-resistant Streptococcus pneumoniae, and Gram-negative pathogens associated with hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP). Ceftobiprole has demonstrated noninferiority in two large-scale pivotal studies comparing it to ceftriaxone with or without linezolid in CAP, with clinical cure rates 86.6% versus 87.4%, or ceftazidime in HAP, with clinical cure rates of 77% versus 76%, respectively. However, ceftobiprole was inferior in the subgroup of patients undergoing mechanical ventilation. Ceftobiprole has so far demonstrated a good safety profile in preliminary studies, with similar tolerability to comparators. The most commonly observed adverse events of ceftobiprole included headache and gastrointestinal upset. It is the first cephalosporin monotherapy approved in the EU for the treatment of both CAP and HAP (excluding ventilator-associated pneumonia).Keywords: antibiotic resistance, methicillin-resistant staphylococci, community-acquired pneumonia, hospital-acquired pneumonia, cephalosporins

Published
2015

9. Predicción de la gravedad de neumonías por SARS-CoV-2 a partir de información clínica y contaminación, mediante inteligencia artificial

Author

Bronte Moreno, O., Urrutia Landa, I., García, F., Martínez-Minaya, J., Uranga Echeverria, A., Lee, D.-J., García Hontoria, P., Jódar Samper, A., Arostegui, I., Menéndez Villanueva, R., Méndez Ocaña, R., Torres Marti, A., Cillóniz, C., Zalacain Jorge, R., Ruiz Aldaiturriaga, L.A., Serrano Fernández, L., and España Yandiola, P.P.

Abstract

Introducción La contaminación del aire exterior se ha relacionado con mayor gravedad de las infecciones respiratorias. Por tanto, su inclusión en algoritmos predictivos podrían añadir información para pronosticar la gravedad de neumonías SARS-CoV-2. Material y métodos Estudio observacional longitudinal retrospectivo de cohortes, multicéntrico en 4 hospitales. Se incluyeron ingresos por neumonía SARS-CoV-2 en el primer pico epidémico de COVID-19 (febrero-mayo 2020). Se recogieron hasta 93 variables clínicas, analíticas y radiológicas por cada paciente (sexo, edad, peso, comorbilidades, síntomas, variables fisiológicas en urgencias, sangre, gasometría, etc.). Además, se calcularon los niveles exposición a contaminación por PM$_{10}$, PM$_{2.5}$, O$_{3}$, NO$_{2}$, NO, NO$_{X}$, SO$_{2}$ y CO en su código postal. En función de la evolución clínica de la neumonía, se definieron 3 niveles de gravedad [Tabla 1]. Para predecir dicha gravedad, se desarrolló un algoritmo de inteligencia artificial (IA), tipo ‘Random Forest’ con balanceo y ajuste automático de sus parámetros internos. El algoritmo se entrenó y evaluó mediante 20 repeticiones de validación cruzada 10-fold (90% entrenamiento, 10% validación), estratificando aleatoriamente por hospital y gravedad. Resultados En los conjuntos de validación, el algoritmo alcanzó una capacidad predictiva (área bajo la curva ROC) promedio AUC=0.834 para gravedad nivel 0, AUC=0.724 para 1 y AUC=0.850 para 2 [Figura 1]. Sin la información de contaminantes, su capacidad predictiva se degradó ligeramente (AUCs = 0.829, 0.722, 0.844; respectivamente). Conclusiones Nuestro algoritmo IA es capaz de predecir de manera satisfactoria la evolución de la gravedad en la neumonía; en particular para los casos más leves y más severos. El algoritmo IA extrae las reglas más relevantes a partir principalmente de la información clínica, analítica y radiológica de cada individuo; no obstante, la incorporación de la exposición a contaminantes mejora ligeramente la capacidad predictiva. El impacto de la contaminación podría estar ya reflejado en las analíticas de sangre, a través de su efecto en los niveles de inflamación del paciente (PCT, PCR, LDH, etc.).

Published
2021

10. Impacto cuantitativo de la contaminación en la probabilidad de muerte por neumonía por SARS-CoV-2

Author

Bronte Moreno, O., Urrutia Landa, I., Martínez-Minaya, J., García, F., Lee, D.-J., Jódar Samper, A., García Hontoria, P., Arostegui, I., Artaraz Ereño, A., Menéndez Villanueva, R., Méndez Ocaña, R., Torres Marti, A., Cillóniz, C., Zalacain Jorge, R., Ruiz Iturriaga, L.A., Serrano Fernández, L., and España Yandiola, P.P.

Abstract

Introducción La evidencia científica disponible señala que la contaminación del aire exterior podría agravar la severidad de la COVID-19 y por ende, incrementar las probabilidades de fallecimiento. Material y métodos Estudio observacional longitudinal retrospectivo de cohortes, multicéntrico en 4 hospitales: 2 en Bizkaia (1 urbano, 1 urbano-rural), Valencia y Barcelona (urbanos). Se incluyeron ingresos por neumonía SARS-CoV-2 en el primer pico epidémico de COVID-19 (febrero-mayo 2020). Para determinar la exposición a contaminación por PM$_{10}$ y NO$_{2}$, se obtuvieron los datos publicados por los organismos autonómicos de calidad del aire, para 2019 y 1er semestre 2020. Se utilizó un Modelo Aditivo Generalizado (GAM) para estimar el nivel diario de contaminante en cada código postal, en función de las coordenadas geográficas y la altitud de las estaciones de medición [Figura 1]. Para determinar la exposición crónica, se calcularon media y máximo en 2019; la aguda se caracterizó por media y máximo en los 7 días anteriores al ingreso. Se estudió la razón de probabilidades (‘odds ratio’, OR) de muerte frente a supervivencia entre nuestra cohorte. Se modeló mediante un GAM con regresión logística, incorporando como efectos fijos sexo, edad y contaminante; hospital como efecto aleatorio e índice de comorbilidad de Charlson como función suave mediantes splines penalizados. Resultados De los 1548 pacientes reclutados, 243 (15.7%) fallecieron durante su hospitalización y/o 30 días postingreso. Según los modelos [Tabla 1], existe evidencia estadística significativa de que la exposición crónica a PM$_{10}$ y NO$_{2}$ incrementan la probabilidad de muerte por neumonía SARS-CoV-2. Compensando por sexo, edad y Charlson -todos factores relacionados positivamente con el OR de muerte- así como por hospital; por cada incremento de 10 μg/m$^{3}$ en el nivel de PM$_{10}$ (máximo anual) el OR aumenta en 10.5%, linealmente proporcional al incremento en la contaminación. Mientras, cada 10 μg/m$^{3}$ más de NO2 (media anual) aumentan OR en 35.7%; cada 10 μg/m$^{3}$ más en exposición aguda a NO2 (media semana pre-ingreso): 62.9%; y NO$_{2}$ (máximo semana): 34.4%. Conclusiones Se cuantificaron y compensaron los efectos de los factores sexo, edad, Charlson y hospital. A igualdad de estos, incrementos en la exposición crónica y aguda a PM$_{10}$ y NO$_{2}$ aumentan de manera lineal y estadísticamente significativa la probabilidad de muerte por neumonía SARS-CoV-2.

Published
2021

12. Ceftobiprole for the treatment of pneumonia

Author

Cillóniz C, Dominedò C, Carolina Garcia-Vidal, and Torres A

Subjects
Community-Acquired Infections, Clinical Trials as Topic, Cross Infection, Ceftobiprole Review, Critical Illness, Pneumonia, Bacterial, Humans, Renal Insufficiency, Drug Administration Schedule, respiratory tract diseases, Anti-Bacterial Agents, Cephalosporins
Abstract

Ceftobiprole is a fifth-generation cephalosporin with potent antimicrobial activity against Gram positive and Gram-negative bacteria. It has been approved in major European countries for the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), excluding ventilator-associated pneumonia (VAP). Ceftobiprole is currently in a phase 3 clinical program for registration in the U.S. In 2015, it was designated as an infectious disease product qualified for the treatment of lung and skin infections by the FDA. The efficacy of ceftobiprole in pneumonia has been demonstrated in two-phase III clinical trials conducted in patients with CAP and HAP. The recommended dose in the adult with pneumonia is 500 mg every 8 h infused in 2 h; in case of renal failure, the regimen of administration must be adjusted according to the patient's renal function. It is not necessary to adjust the dose according to gender, age, body weight or liver failure. In case of hyperfiltration, an extension to 4 h infusion of the 500mg TID is required.

Published
2019

13. Bacteraemia and antibiotic-resistant pathogens in community acquired pneumonia: risk and prognosis

Author

Torres A, Cillóniz C, Ferrer M, Gabarrús A, Polverino E, Villegas S, Marco F, Mensa J, Menéndez R, and Niederman M

Subjects
bacterial infections and mycoses
Abstract

The sensitivity of blood cultures in the diagnosis of bacteraemia for community-acquired pneumonia is low. Recommendations, by guidelines, to perform blood cultures are discordant. We aimed to determine the incidence, microbial aetiology, risk factors and outcomes of bacteraemic patients with community-acquired pneumonia, including cases with antibiotic-resistant pathogens (ARP). A prospective, observational study was undertaken on consecutive adult patients admitted to the Hospital Clinic of Barcelona (Barcelona, Spain) with community-acquired pneumonia and blood cultures were obtained. Of the 2892 patients included, bacteraemia was present in 297 (10%) patients; 30 (10%) of whom had ARP (multidrug-resistant Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and an extended spectrum of beta-lactamase producing Enterobacteriaceae). In multivariate analyses, pleuritic pain, C-reactive protein >= 21.6 mg.dL(-1) and intensive care unit admissions were independently associated with bacteraemia, while prior antibiotic treatment and pneumococcal vaccine were protective factors. The risk factors for ARP bacteraemia were previous antibiotics and C-reactive protein

Published
2015

14. Risk Factors Associated with Potentially Antibiotic-Resistant Pathogens in Community-Acquired Pneumonia

Author

Prina E, Ranzani OT, Polverino E, Cillóniz C, Ferrer M, Fernandez L, Puig de la Bellacasa J, Menéndez R, Mensa J, and Torres A

Subjects
body regions, community-acquired pneumonia, antibiotic therapy, human activities, infection
Abstract

Rationale: To identify pathogens that require different treatments in community-acquired pneumonia (CAP), we propose an acronym, "PES" (Pseudomonas aeruginosa, Enterobacteriaceae extended-spectrum beta-lactamase-positive, and methicillin-resistant Staphylococcus aureus). Objectives: To compare the clinical characteristics and outcomes between patients with CAP caused by PES versus other pathogens, and to identify the risk factors associated with infection caused by PES. Methods: We conducted an observational prospective study evaluating only immunocompetent patients with CAP and an established etiological diagnosis. We included patients from nursing homes. We computed a score to identify patients at risk of PES pathogens. Measurement and Main Results: Of the 4,549 patients evaluated, we analyzed 1,597 who presented an etiological diagnosis. Pneumonia caused by PES was identified in 94 (6%) patients, with 108 PES pathogens isolated (n = 72 P. aeruginosa, n = 15 Enterobacteriaceae extended-spectrum beta-lactamase positive, and n = 21 methicillin-resistant Staphylococcus aureus). These patients were older (P = 0.001), had received prior antibiotic treatment more frequently (P < 0.001), and frequently presented with acute renal failure (P = 0.004). PES pathogens were independently associated with increased risk of 30-day mortality (adjusted odds ratio = 2.51; 95% confidence interval = 1.20-5.25; P = 0.015). The area under the curve for the score we computed was 0.759 (95% confidence interval, 0.713-0.806; P < 0.001). Conclusions: PES pathogens are responsible for a small proportion of CAP, resulting in high mortality. These pathogens require a different antibiotic treatment, and identification of specific risk factors could help to identify these microbial etiologies.

Published
2015

15. Sensitivity, Specificity, and Positivity Predictors of the Pneumococcal Urinary Antigen Test in Community-Acquired Pneumonia

Author

Molinos L, Zalacain R, Menéndez R, Reyes S, Capelastegui A, Cillóniz C, Rajas O, Borderías L, Martín-Villasclaras JJ, Bello S, Alfageme I, Rodríguez de Castro F, Rello J, Ruiz-Manzano J, Gabarrús A, Musher DM, and Torres A

Subjects
community-acquired pneumonia, pneumococcal urinary antigen, positive predictor factors, specificity, sensitivity
Abstract

RATIONALE: Detection of the C-polysaccharide of Streptococcus pneumoniae in urine by an immune-chromatographic test is increasingly used to evaluate patients with community-acquired pneumonia. OBJECTIVES: We assessed the sensitivity and specificity of this test in the largest series of cases to date and used logistic regression models to determine predictors of positivity in patients hospitalized with community-acquired pneumonia. METHODS: We performed a multicenter, prospective, observational study of 4,374 patients hospitalized with community-acquired pneumonia. MEASUREMENTS AND MAIN RESULTS: The urinary antigen test was done in 3,874 cases. Pneumococcal infection was diagnosed in 916 cases (21%); 653 (71%) of these cases were diagnosed exclusively by the urinary antigen test. Sensitivity and specificity were 60 and 99.7%, respectively. Predictors of urinary antigen positivity were female sex; heart rate>/=125 bpm, systolic blood pressure/=30 mg/dl. With at least six of all these predictors present, the probability of positivity was 52%. With only one factor present, the probability was only 12%. CONCLUSIONS: The urinary antigen test is a method with good sensitivity and excellent specificity in diagnosing pneumococcal pneumonia, and its use greatly increased the recognition of community-acquired pneumonia due to S. pneumoniae. With a specificity of 99.7%, this test could be used to direct simplified antibiotic therapy, thereby avoiding excess costs and risk for bacterial resistance that result from broad-spectrum antibiotics. We also identified predictors of positivity that could increase suspicion for pneumococcal infection or avoid the unnecessary use of this test.

Published
2015

16. Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study

Author

Polverino E, Torres A, Menendez R, Cillóniz C, Valles JM, Capelastegui A, Marcos MA, Alfageme I, Zalacain R, Almirall J, Molinos L, Bello S, Rodríguez F, Blanquer J, Llevat N, and Rello J

Subjects
RISK, HOSPITALIZED-PATIENTS, CLINICAL-OUTCOMES, PREDICTION, EPIDEMIOLOGY, COMMUNITY-ACQUIRED PNEUMONIA, ANTIBIOTIC-THERAPY, GUIDELINES, SINGLE-CENTER EXPERIENCE, COLONIZATION
Abstract

Healthcare-associated pneumonia (HCAP) is actually considered a subgroup of hospital-acquired pneumonia due to the reported high risk of multidrug-resistant pathogens in the USA. Therefore, current American Thoracic Society/Infectious Diseases Society of America guidelines suggest a nosocomial antibiotic treatment for HCAP. Unfortunately, the scientific evidence supporting this is contradictory.

Published
2013

17. Thrombocytosis is a marker of poor outcome in community-acquired pneumonia

Author

Prina E, Ferrer M, Ranzani OT, Polverino E, Cillóniz C, Moreno E, Mensa J, Montull B, Menéndez R, Cosentini R, and Torres A

Subjects
SEVERE SEPSIS, INTENSIVE-CARE-UNIT, SEVERITY, PARAPNEUMONIC EFFUSION, SEPTIC SHOCK, RISK-FACTORS, MANAGEMENT, ANTIMICROBIAL THERAPY, PLATELET COUNT, GUIDELINES
Abstract

Thrombocytosis, often considered a marker of normal inflammatory reaction of infections, has been recently associated with increased mortality in hospitalized patients with community-acquired pneumonia (CAP). We assessed the characteristics and outcomes of patients with CAP and thrombocytosis (platelet count = 4 × 105/mm3) compared with thrombocytopenia (platelet count < 105/mm3) and normal platelet count.

Published
2013

18. Systemic corticosteroids for community-acquired pneumonia: reasons for use and lack of benefit on outcome

Author

Polverino E, Cillóniz C, Dambrava P, Gabarrús A, Ferrer M, Agustí C, Prina E, Montull B, Menendez R, Niederman MS, and Torres A

Abstract

Although the benefits of systemic corticosteroids in community-acquired pneumonia (CAP) are not clear, their use is frequent in clinical practice. We described the frequency of this practice, patients' characteristics and its clinical impact.

Published
2013

19. Bacterial co-infection with H1N1 infection in patients admitted with community acquired pneumonia

Author

Cillóniz C, Ewig S, Menéndez R, Ferrer M, Polverino E, Reyes S, Gabarrús A, Marcos MA, Cordoba J, Mensa J, and Torres A

Subjects
virus diseases, respiratory tract diseases
Abstract

Bacterial co-infection is an important contributor to morbidity and mortality during influenza pandemics .We investigated the incidence, risk factors and outcome of patients with influenza A H1N1 pneumonia and bacterial co-infection.

Published
2012

20. Cytokine activation patterns and biomarkers are influenced by microorganisms in community-acquired pneumonia

Author

Menéndez R, Sahuquillo-Arce JM, Reyes S, Martínez R, Polverino E, Cillóniz C, Córdoba JG, Montull B, and Torres A

Subjects
parasitic diseases, bacterial infections and mycoses, hormones, hormone substitutes, and hormone antagonists
Abstract

The inflammatory response in community-acquired pneumonia (CAP) depends on the host and on the challenge of the causal microorganism. Here, we analyze the patterns of inflammatory cytokines, procalcitonin (PCT), and C-reactive protein (CRP) in order to determine their diagnostic value.

Published
2012

21. Impact of age and comorbidity on cause and outcome in community-acquired pneumonia

Author

Cillóniz, C, Polverino, E, Ewig, S, Aliberti, S, Gabarrús, A, Menéndez, R, Mensa, J, Blasi, F, Torres, A, ALIBERTI, STEFANO, Torres, A., Cillóniz, C, Polverino, E, Ewig, S, Aliberti, S, Gabarrús, A, Menéndez, R, Mensa, J, Blasi, F, Torres, A, ALIBERTI, STEFANO, and Torres, A.

Abstract

Background: Prolonged life expectancy has currently increased the proportion of the very elderly among patients with community-acquired pneumonia (CAP). The aim of this study was to determine the infl uence of age and comorbidity on microbial patterns in patients over 65 years of age with CAP. Methods: This study was a prospective observational study of adult patients with CAP (excluding those in nursing homes) over a 12-year period. We compared patients aged 65 to 74 years, 75 to 84 years, and > 85 years for potential differences in clinical presentation, comorbidities, severity on admission, microbial investigations, causes, antimicrobial treatment, and outcomes. Results: We studied a total of 2,149 patients: 759 patients (35.3%) aged 65 to 74 years, 941 patients (43.7%) aged 75 to 84 years, and 449 patients (20.8%) aged > 85 years. At least one comorbidity was present in 1,710 patients (79.6%). Streptococcus pneumoniae was the most frequent pathogen in all age groups, regardless of comorbidity. Staphylococcus aureus, Enterobacteriaceae, and Pseudomonas aeruginosa accounted for 9.1% of isolates, and Haemophilus infl uenzae, 6.4%. All these pathogens were isolated only in patients with at least one comorbidity. Mortality increased with age (65-74 years, 6.9%; 75-84 years, 8.9%; > 85 years, 17.1%; P < .001) and was associated with increased comorbidities (neurologic; OR, 2.1; 95% CI, 1.5-2.1), Pneumonia Severity Index IV or V (OR, 3.2; 95% CI, 1.8-6.0), bacteremia (OR, 1.7; 95% CI, 1.1-2.7), the presence of a potential multidrug-resistant (MDR) pathogen (S aureus, P aeruginosa, Enterobacteriaceae; OR, 2.4; 95% CI, 1.3-4.3), and ICU admission (OR, 4.2; 95% CI, 2.9-6.1) on multivariate analysis. Conclusions: Age does not infl uence microbial cause itself, whereas comorbidities are associated with specifi c causes such as H infl uenzae and potential MDR pathogens. Mortality in the elderly is mainly driven by the presence of comorbidities and potential MDR p

Published
2013

23. ESICM LIVES 2016: part one: Milan, Italy. 1-5 October 2016

Author

Bos, L., Schouten, L., van Vught, L., Wiewel, M., Ong, D., Cremer, O., Artigas, A., Martin-Loeches, I., Hoogendijk, A., van der Poll, T., Horn, J., Juffermans, N., Schultz, M., de Prost, N., Pham, T., Carteaux, G., Dessap, A. Mekontso, Brun-Buisson, C., Fan, E., Bellani, G., Laffey, J., Mercat, A., Brochard, L., Maitre, B., Howells, P. A., Thickett, D. R., Knox, C., Park, D. P., Gao, F., Tucker, O., Whitehouse, T., McAuley, D. F., Perkins, G. D., Pisani, L., Roozeman, J. P., Simonis, F. D., Giangregorio, A., Schouten, L. R., Van der Hoeven, S. M., Neto, A. Serpa, Festic, E., Dondorp, A. M., Grasso, S., Bos, L. D., Schultz, M. J., Koster-Brouwer, M., Verboom, D., Scicluna, B., van de Groep, K., Frencken, J., Bonten, M., Ko, J. I., Kim, K. S., Suh, G. J., Kwon, W. Y., Kim, K., Shin, J. H., Ranzani, O. T., Prina, E., Menendez, R., Ceccato, A., Mendez, R., Cilloniz, C., Gabarrus, A., Ferrer, M., Torres, A., Urbano, A., Zhang, L. A., Swigon, D., Pike, F., Parker, R. S., Clermont, G., Scheer, C., Kuhn, S. O., Modler, A., Vollmer, M., Fuchs, C., Hahnenkamp, K., Rehberg, S., Gründling, M., Taggu, A., Darang, N., Öveges, N., László, I., Tánczos, K., Németh, M., Lebák, G., Tudor, B., Érces, D., Kaszaki, J., Huber, W., Trásy, D., Molnár, Z., Ferrara, G., Edul, V. S. Kanoore, Canales, H. S., Martins, E., Canullán, C., Murias, G., Pozo, M. O., Eguillor, J. F. Caminos, Buscetti, M. G., Ince, C., Dubin, A., Aya, H. D., Rhodes, A., Fletcher, N., Grounds, R. M., Cecconi, M., Jacquet-Lagrèze, M., Riche, M., Schweizer, R., Portran, P., Fornier, W., Lilot, M., Neidecker, J., Fellahi, J. L., Escoresca-Ortega, A., Gutiérrez-Pizarraya, A., Charris-Castro, L., Corcia-Palomo, Y., Fernandez-Delgado, E., Garnacho-Montero, J., Roger, C., Muller, L., Elotmani, L., Lipman, J., Lefrant, J. Y., Roberts, J. A., Muñoz-Bermúdez, R., Samper, M., Climent, C., Vasco, F., Sara, V., Luque, S., Campillo, N., Cerrato, S. Grau, Masclans, J. R., Alvarez-Lerma, F., Brugger, S. Carvalho, Jimenez, G. Jimenez, Torner, M. Miralbés, Cabello, J. Trujillano, Garrido, B. Balsera, Casals, X. Nuvials, Gaite, F. Barcenilla, Vidal, M. Vallverdú, Martínez, M. Palomar, Gusarov, V., Shilkin, D., Dementienko, M., Nesterova, E., Lashenkova, N., Kuzovlev, A., Zamyatin, M., Demoule, A., Carreira, S., Lavault, S., Palancca, O., Morawiec, E., Mayaux, J., Arnulf, I., Similowski, T., Rasmussen, B. S., Maltesen, R. G., Hanifa, M., Pedersen, S., Kristensen, S. R., Wimmer, R., Panigada, M., Bassi, G. Li, Kolobow, T., Zanella, A., Cressoni, M., Berra, L., Parrini, V., Kandil, H., Salati, G., Livigni, S., Amatu, A., Andreotti, A., Tagliaferri, F., Moise, G., Mercurio, G., Costa, A., Vezzani, A., Lindau, S., Babel, J., Cavana, M., Consonni, D., Pesenti, A., Gattinoni, L., Mansouri, P., Zand, F., Zahed, L., Dehghanrad, F., Bahrani, M., Ghorbani, M., Cambiaghi, B., Moerer, O., Mauri, T., Kunze-Szikszay, N., Ritter, C., Quintel, M., Vilander, L. M., Kaunisto, M. A., Vaara, S. T., Pettilä, V., Mulier, J. L. G. Haitsma, Rozemeijer, S., Spoelstra-de Man, A. M. E., Elbers, P. E., Tuinman, P. R., de Waard, M. C., Oudemans-van Straaten, H. M., Liberatore, A. M. A., Souza, R. B., Martins, A. M. C. R. P. F., Vieira, J. C. F., Koh, I. H. J., Martínez, M. Galindo, Sánchez, R. Jiménez, Gascón, L. Martínez, Mulero, M. D. Rodríguez, Freire, A. Ortín, Muñoz, A. Ojados, Acebes, S. Rebollo, Martínez, Á. Fernández, Aliaga, S. Moreno, Para, L. Herrera, Payá, J. Murcia, Mulero, F. Rodríguez, Guerci, P., Ince, Y., Heeman, P., Ergin, B., Uz, Z., Massey, M., Papatella, R., Bulent, E., Toraman, F., Longbottom, E. R., Torrance, H. D., Owen, H. C., Hinds, C. J., Pearse, R. M., O’Dywer, M. J., Trogrlic, Z., van der Jagt, M., Lingsma, H., Ponssen, H. H., Schoonderbeek, J. F., Schreiner, F., Verbrugge, S. J., Duran, S., van Achterberg, T., Bakker, J., Gommers, D. A. M. P. J., Ista, E., Krajčová, A., Waldauf, P., Duška, F., Shah, A., Roy, N., McKechnie, S., Doree, C., Fisher, S., Stanworth, S. J., Jensen, J. F., Overgaard, D., Bestle, M. H., Christensen, D. F., Egerod, I., Pivkina, A., Zhivotneva, I., Pasko, N., Alklit, A., Hansen, R. L., Knudsen, H., Grode, L. B., Hravnak, M., Chen, L., Dubrawski, A., Pinsky, M. R., Parry, S. M., Knight, L. D., Connolly, B. C., Baldwin, C. E., Puthucheary, Z. A., Denehy, L., Hart, N., Morris, P. E., Mortimore, J., Granger, C. L., Jensen, H. I., Piers, R., Van den Bulcke, B., Malmgren, J., Metaxa, V., Reyners, A. K., Darmon, M., Rusinova, K., Talmor, D., Meert, A. P., Cancelliere, L., Zubek, L., Maia, P., Michalsen, A., Decruyenaere, J., Kompanje, E., Vanheule, S., Azoulay, E., Vansteelandt, S., Benoit, D., Ryan, C., Dawson, D., Ball, J., Noone, K., Aisling, B., Prudden, S., Ntantana, A., Matamis, D., Savvidou, S., Giannakou, M., Gouva, M., Nakos, G., Koulouras, V., Aron, J., Lumley, G., Milliken, D., Dhadwal, K., McGrath, B. A., Lynch, S. J., Bovento, B., Sharpe, G., Grainger, E., Pieri-Davies, S., Wallace, S., McGrath, B., Jung, M., Cho, J., Park, H., Suh, G., Kousha, O., Paddle, J., Gripenberg, L. Gamrin, Rehal, M. Sundström, Wernerman, J., Rooyackers, O., de Grooth, H. J., Choo, W. P., Spoelstra-de Man, A. M., Swart, E. L., Talan, L., Güven, G., Altıntas, N. D., Padar, M., Uusvel, G., Starkopf, L., Starkopf, J., Blaser, A. Reintam, Kalaiselvan, M. S., Arunkumar, A. S., Renuka, M. K., Shivkumar, R. L., Volbeda, M., ten Kate, D., Hoekstra, M., van der Maaten, J. M., Nijsten, M. W., Komaromi, A., Norberg, Å., Smedberg, M., Mori, M., Pettersson, L., Theodorakopoulou, M., Christodoulopoulou, T., Diamantakis, A., Frantzeskaki, F., Kontogiorgi, M., Chrysanthopoulou, E., Lygnos, M., Diakaki, C., Armaganidis, A., Gundogan, K., Dogan, E., Coskun, R., Muhtaroglu, S., Sungur, M., Ziegler, T., Guven, M., Kleyman, A., Khaliq, W., Andreas, D., Singer, M., Meierhans, R., Schuepbach, R., De Brito-Ashurst, I., Sabetian, G., Nikandish, R., Hagar, F., Masjedi, M., Maghsudi, B., Vazin, A., Asadpour, E., Kao, K. C., Chiu, L. C., Hung, C. Y., Chang, C. H., Li, S. H., Hu, H. C., El Maraghi, S., Ali, M., Rageb, D., Helmy, M., Marin-Corral, J., Vilà, C., Vàzquez, A., Martín-Loeches, I., Díaz, E., Yébenes, J. C., Rodriguez, A., Álvarez-Lerma, F., Varga, N., Cortina-Gutiérrez, A., Dono, L., Martínez-Martínez, M., Maldonado, C., Papiol, E., Pérez-Carrasco, M., Ferrer, R., Nweze, K., Morton, B., Welters, I., Houard, M., Voisin, B., Ledoux, G., Six, S., Jaillette, E., Nseir, S., Romdhani, S., Bouneb, R., Loghmari, D., Aicha, N. Ben, Ayachi, J., Meddeb, K., Chouchène, I., Khedher, A., Boussarsar, M., Chan, K. S., Yu, W. L., Nolla, J., Vidaur, L., Bonastre, J., Suberbiola, B., Guerrero, J. E., Coll, N. Ramon, Jiménez, G. Jiménez, Calero, J. Codina, García, M., de la Torre, M. C., Vendrell, E., Palomera, E., Güell, E., Serra-Prat, M., Bermejo-Martín, J. F., Almirall, J., Tomas, E., Escoval, A., Froe, F., Pereira, M. H. Vitoria, Velez, N., Viegas, E., Filipe, E., Groves, C., Reay, M., Ballin, A., Facchin, F., Sartori, G., Zarantonello, F., Campello, E., Radu, C. M., Rossi, S., Ori, C., Simioni, P., Umei, N., Shingo, I., Santos, A. C., Candeias, C., Moniz, I., Marçal, R., e Silva, Z. Costa, Ribeiro, J. M., Georger, J. F., Ponthus, J. P., Tchir, M., Amilien, V., Ayoub, M., Barsam, E., Martucci, G., Panarello, G., Tuzzolino, F., Capitanio, G., Ferrazza, V., Carollo, T., Giovanni, L., Arcadipane, A., Sánchez, M. López, González-Gay, M. A., Díaz, F. J. Llorca, López, M. I. Rubio, Zogheib, E., Villeret, L., Nader, J., Bernasinski, M., Besserve, P., Caus, T., Dupont, H., Morimont, P., Habran, S., Hubert, R., Desaive, T., Blaffart, F., Janssen, N., Guiot, J., Pironet, A., Dauby, P., Lambermont, B., Pettenuzzo, T., Citton, G., Kirakli, C., Ediboglu, O., Ataman, S., Yarici, M., Tuksavul, F., Keating, S., Gibson, A., Gilles, M., Dunn, M., Price, G., Young, N., Remeta, P., Bishop, P., Zamora, M. D. Fernández, Muñoz-Bono, J., Curiel-Balsera, E., Aguilar-Alonso, E., Hinojosa, R., Gordillo-Brenes, A., Arboleda-Sánchez, J. A., Skorniakov, I., Vikulova, D., Whiteley, C., Shaikh, O., Jones, A., Ostermann, M., Forni, L., Scott, M., Sahatjian, J., Linde-Zwirble, W., Hansell, D., Laoveeravat, P., Srisawat, N., Kongwibulwut, M., Peerapornrattana, S., Suwachittanont, N., Wirotwan, T. O., Chatkaew, P., Saeyub, P., Latthaprecha, K., Tiranathanagul, K., Eiam-ong, S., Kellum, J. A., Berthelsen, R. E., Perner, A., Jensen, A. E. K., Jensen, J. U., Gebhard, D. J., Price, J., Kennedy, C. E., Akcan-Arikan, A., Kang, Y. R., Nakamae, M. N., Hamed, K., Khaled, M. M., Soliman, R. Aly, Mokhtar, M. Sherif, Seller-Pérez, G., Arias-Verdú, D., Llopar-Valdor, E., De-Diós-Chacón, I., Quesada-García, G., Herrera-Gutierrez, M. E., Hafes, R., Carroll, G., Doherty, P., Wright, C., Vera, I. G. Guerra, Ralston, M., Gemmell, M. L., MacKay, A., Black, E., Docking, R. I., Appleton, R., Ralston, M. R., Gemmell, L., Mackay, A., Röttgering, J. G., Elbers, P. W. G., Mejeni, N., Nsiala, J., Kilembe, A., Akilimali, P., Thomas, G., Andersson, A. E., Fagerdahl, A. M., Knudsen, V., Cheikh, A. Ben, Hamdaoui, Y., Guiga, A., Fraj, N., Sma, N., Chouchene, I., Bouafia, N., Amirian, A., Ziaian, B., Fleischmann, C., Thomas-Rueddel, D. O., Schettler, A., Schwarzkopf, D., Stacke, A., Reinhart, K., Martins, A., Sousa, P., Snell, G., Matsa, R., Paary, T. T. S., Cavalheiro, A. M., Rocha, L. L., Vallone, C. S., Tonilo, A., Lobato, M. D. S., Malheiro, D. T., Sussumo, G., Lucino, N. M., Rosenthal, V. D., Dashti, A. Sanaei, Yousefipour, A., Goodall, J. R., Williamson, M., Tant, E., Thomas, N., Balci, C., Gonen, C., Haftacı, E., Gurarda, H., Karaca, E., Paldusová, B., Zýková, I., Šímová, D., Houston, S., D’Antona, L., Lloyd, J., Garnelo-Rey, V., Sosic, M., Sotosek-Tokmazic, V., Kuharic, J., Antoncic, I., Dunatov, S., Sustic, A., Chong, C. T., Sim, M., Lyovarin, T., Díaz, F. M. Acosta, Galdó, S. Narbona, Garach, M. Muñoz, Romero, O. Moreno, Bailón, A. M. Pérez, Pinel, A. Carranza, Colmenero, M., Gritsan, A., Gazenkampf, A., Korchagin, E., Dovbish, N., Lee, R. M., Lim, M. P. P., Lim, B. C. L., See, J. J., Assis, R., Filipe, F., Lopes, N., Pessoa, L., Pereira, T., Catorze, N., Aydogan, M. S., Aldasoro, C., Marchio, P., Jorda, A., Mauricio, M. D., Guerra-Ojeda, S., Gimeno-Raga, M., Colque-Cano, M., Bertomeu-Artecero, A., Aldasoro, M., Valles, S. L., Tonon, D., Triglia, T., Martin, J. C., Alessi, M. C., Bruder, N., Garrigue, P., Velly, L., Spina, S., Scaravilli, V., Marzorati, C., Colombo, E., Savo, D., Vargiolu, A., Cavenaghi, G., Citerio, G., Andrade, A. H. V., Bulgarelli, P., Araujo, J. A. P., Gonzalez, V., Souza, V. A., Massant, C., Filho, C. A. C. Abreu, Morbeck, R. A., Burgo, L. E., van Groenendael, R., van Eijk, L. T., Leijte, G. P., Koeneman, B., Kox, M., Pickkers, P., García-de la Torre, A., de la Torre-Prados, M., Fernández-Porcel, A., Rueda-Molina, C., Nuevo-Ortega, P., Tsvetanova-Spasova, T., Cámara-Sola, E., García-Alcántara, A., Salido-Díaz, L., Liao, X., Feng, T., Zhang, J., Cao, X., Wu, Q., Xie, Z., Li, H., Kang, Y., Winkler, M. S., Nierhaus, A., Mudersbach, E., Bauer, A., Robbe, L., Zahrte, C., Schwedhelm, E., Kluge, S., Zöllner, C., Mitsi, E., Pennington, S. H., Reine, J., Wright, A. D., Parker, R., Welters, I. D., Blakey, J. D., Rajam, G., Ades, E. W., Ferreira, D. M., Wang, D., Kadioglu, A., Gordon, S. B., Koch, R., Rahamat-Langedoen, J., Schloesser, J., de Jonge, M., Bringue, J., Guillamat-Prats, R., Torrents, E., Martinez, M. L., Camprubí-Rimblas, M., Blanch, L., Park, S. Y., Park, Y. B., Song, D. K., Shrestha, S., Park, S. H., Koh, Y., Park, M. J., Hong, C. W., Lesur, O., Coquerel, D., Sainsily, X., Cote, J., Söllradl, T., Murza, A., Dumont, L., Dumaine, R., Grandbois, M., Sarret, P., Marsault, E., Salvail, D., Auger-Messier, M., Chagnon, F., Lauretta, M. P., Greco, E., Dyson, A., Preau, S., Ambler, M., Sigurta, A., Saeed, S., Sarıca, L. Topcu, Zibandeh, N., Genc, D., Gul, F., Akkoc, T., Kombak, E., Cinel, L., Cinel, I., Pollen, S. J., Arulkumaran, N., Warnes, G., Pennington, D. J., Brohi, K., O’Dwyer, M. J., Kim, H. Y., Na, S., Kim, J., Chang, Y. F., Chao, A., Shih, P. Y., Lee, C. T., Yeh, Y. C., Chen, L. W., Adriaanse, M., Rietdijk, W., Funcke, S., Sauerlaender, S., Saugel, B., Pinnschmidt, H., Reuter, D. A., Nitzschke, R., Perbet, S., Biboulet, C., Lenoire, A., Bourdeaux, D., Pereira, B., Plaud, B., Bazin, J. E., Sautou, V., Mebazaa, A., Constantin, J. M., Legrand, M., Boyko, Y., Jennum, P., Nikolic, M., Oerding, H., Holst, R., Toft, P., Nedergaard, H. K., Haberlandt, T., Park, S., Kim, S., Cho, Y. J., Lim, Y. J., Chan, A., Tang, S., Nunes, S. L., Forsberg, S., Blomqvist, H., Berggren, L., Sörberg, M., Sarapohja, T., Wickerts, C. J., Hofhuis, J. G. M., Rose, L., Blackwood, B., Akerman, E., Mcgaughey, J., Fossum, M., Foss, H., Georgiou, E., Graff, H. J., Kalafati, M., Sperlinga, R., Schafer, A., Wojnicka, A. G., Spronk, P. E., Khalili, F., Afshari, R., Khodaei, H. Haddad, Javadpour, S., Petramfar, P., Nasimi, S., Tabei, H., Gunther, A., Hansen, J. O., Sackey, P., Storm, H., Bernhardsson, J., Sundin, Ø., Bjärtå, A., Bienert, A., Smuszkiewicz, P., Wiczling, P., Przybylowski, K., Borsuk, A., Trojanowska, I., Matysiak, J., Kokot, Z., Paterska, M., Grzeskowiak, E., Messina, A., Bonicolini, E., Colombo, D., Moro, G., Romagnoli, S., De Gaudio, A. R., Corte, F. Della, Romano, S. M., Silversides, J. A., Major, E., Mann, E. E., Ferguson, A. J., Mcauley, D. F., Marshall, J. C., Diaz-Rodriguez, J. A., Silva-Medina, R., Gomez-Sandoval, E., Gomez-Gonzalez, N., Soriano-Orozco, R., Gonzalez-Carrillo, P. L., Hernández-Flores, M., Pilarczyk, K., Lubarksi, J., Wendt, D., Dusse, F., Günter, J., Huschens, B., Demircioglu, E., Jakob, H., Palmaccio, A., Dell’Anna, A. M., Grieco, D. L., Torrini, F., Iaquaniello, C., Bongiovanni, F., Antonelli, M., Toscani, L., Antonakaki, D., Bastoni, D., Jozwiak, M., Depret, F., Teboul, J. L., Alphonsine, J., Lai, C., Richard, C., Monnet, X., Demeter, G., Kertmegi, I., Hasanin, A., Lotfy, A., El-adawy, A., Nassar, H., Mahmoud, S., Abougabal, A., Mukhtar, A., Quinty, F., Habchi, S., Luzi, A., Antok, E., Hernandez, G., Lara, B., Enberg, L., Ortega, M., Leon, P., Kripper, C., Aguilera, P., Kattan, E., Lehmann, M., Sakka, S., Bein, B., Schmid, R. M., Preti, J., Creteur, J., Herpain, A., Marc, J., Trojette, F., Bar, S., Kontar, L., Titeca, D., Richecoeur, J., Gelee, B., Verrier, N., Mercier, R., Lorne, E., Maizel, J., Slama, M., Abdelfattah, M. E., Eladawy, A., Elsayed, M. A. Ali, Montenegro, A. Pedraza, Zepeda, E. Monares, Granillo, J. Franco, Sánchez, J. S. Aguirre, Alejo, G. Camarena, Cabrera, A. Rugerio, Montoya, A. A. Tanaka, Lee, C., Hatib, F., Cannesson, M., Theerawit, P., Morasert, T., Sutherasan, Y., Zani, G., Mescolini, S., Diamanti, M., Righetti, R., Scaramuzza, A., Papetti, M., Terenzoni, M., Gecele, C., Fusari, M., Hakim, K. A., Chaari, A., Ismail, M., Elsaka, A. H., Mahmoud, T. M., Bousselmi, K., Kauts, V., Casey, W. F., Hutchings, S. D., Naumann, D., Wendon, J., Watts, S., Kirkman, E., Jian, Z., Buddi, S., Settels, J., Bertini, P., Guarracino, F., Trepte, C., Richter, P., Haas, S. A., Eichhorn, V., Kubitz, J. C., Soliman, M. S., Hamimy, W. I., Fouad, A. Z., Mukhtar, A. M., Charlton, M., Tonks, L., Mclelland, L., Coats, T. J., Thompson, J. P., Sims, M. R., Williams, D., Roushdy, D. Z., Soliman, R. A., Nahas, R. A., Arafa, M. Y., Hung, W. T., Chiang, C. C., Huang, W. C., Lin, K. C., Lin, S. C., Cheng, C. C., Kang, P. L., Wann, S. R., Mar, G. Y., Liu, C. P., Carranza, M. Lopez, Fernandez, H. Sancho, Roman, J. A. Sanchez, Lucena, F., Garcia, A. Campanario, Vazquez, A. Loza, Serrano, A. Lesmes, Moreira, L. Sayagues, Vidal-Perez, R., Herranz, U. Anido, Acuna, J. M. Garcia, Gil, C. Pena, Allut, J. L. Garcia, Sedes, P. Rascado, Lopez, C. Martin, Paz, E. Saborido, Rodriguez, C. Galban, Gonzalez-Juanatey, J. R., Vallejo-Baez, A., de la Torre-Prados, M. V., Marharaj, R., Gervasio, K., Bottiroli, M., Mondino, M., De Caria, D., Calini, A., Montrasio, E., Milazzo, F., Gagliardone, M. P., Vallejo-Báez, A., Anido, U., Cheikh-Bouhlel, M., Dela Cruz, M. P. R. D. L., Bernardo, J. M., Galfo, F., Marino, A., Chao, C. C., Hou, P., Hung, C. C., Chiang, C. H., Liou, Y. J., Hung, S. M., Lin, Y. S., Kuo, F. Y., Chiou, K. R., Chen, C. J., Yan, L. S., Liu, C. Y., Wang, H. H., Chen, H. L., Ho, C. K., Grewal, S., Gopal, S., Corbett, C., Wilson, A., Capps, J., Ayoub, W., Lomas, A., Ghani, S., Moore, J., Atkinson, D., Sharman, M., Swinnen, W., Pauwels, J., Mignolet, K., Pannier, E., Koch, A., Sarens, T., Temmerman, W., Elmenshawy, A. M., Fayed, A. M., Elboriuny, M., Hamdy, E., Zakaria, E., Falk, A. C., Petosic, A., Olafsen, K., Wøien, H., Flaatten, H., Sunde, K., Agra, J. J. Cáceres, Cabrera, J. L. Santana, Santana, J. D. Martín, Alzola, L. Melián, Pérez, H. Rodríguez, Pires, T. Castro, Calderón, H., Pereira, A., Castro, S., Granja, C., Norkiene, I., Urbanaviciute, I., Kezyte, G., Ringaitiene, D., Jovaisa, T., Vogel, G., Johansson, U. B., Sandgren, A., Svensen, C., Joelsson-Alm, E., Leite, M. A., Murbach, L. D., Osaku, E. F., Costa, C. R. L. M., Pelenz, M., Neitzke, N. M., Moraes, M. M., Jaskowiak, J. L., Silva, M. M. M., Zaponi, R. S., Abentroth, L. R. L., Ogasawara, S. M., Jorge, A. C., Duarte, P. A. D., Barreto, J., Duarte, S. T., Taba, S., Miglioranza, D., Gund, D. P., Lordani, C. F., Vollmer, H., Gager, M., Waldmann, C., Mazzeo, A. T., Tesio, R., Filippini, C., Vallero, M. E., Giolitti, C., Caccia, S., Medugno, M., Tenaglia, T., Rosato, R., Mastromauro, I., Brazzi, L., Terragni, P. P., Urbino, R., Fanelli, V., Ranieri, V. M., Mascia, L., Ballantyne, J., Paton, L., Perez-Teran, P., Roca, O., Ruiz-Rodriguez, J. C., Zapatero, A., Serra, J., Bianzina, S., Cornara, P., Rodi, G., Tavazzi, G., Pozzi, M., Iotti, G. A., Mojoli, F., Braschi, A., Vishnu, A., Buche, D., Pande, R., Moolenaar, D. L. J., Bakhshi-Raiez, F., Dongelmans, D. A., de Keizer, N. F., de Lange, D. W., Fernández, I. Fuentes, Baño, D. Martínez, Moreno, J. L. Buendía, Rubio, R. Jara, Scott, J., Phelan, D., Morely, D., O’Flynn, J., Stapleton, P., Lynch, M., Marsh, B., Carton, E., O’Loughlin, C., Cheng, K. C., Sung, M. I., Elghonemi, M. O., Saleh, M. H., Meyhoff, T. S., Krag, M., Hjortrup, P. B., Møller, M. H., Öhman, T., Sigmundsson, T., Redondo, E., Hallbäck, M., Suarez-Sipmann, F., Björne, H., Sander, C. Hällsjö, Chiumello, D., Chiurazzi, C., Brioni, M., Algieri, I., Guanziroli, M., Vergani, G., Tonetti, T., Tomic, I., Colombo, A., Crimella, F., Carlesso, E., Gasparovic, V., El-Sherif, R., Al-Basser, M. Abd, Raafat, A., El-Sherif, A., Schouten, L. R. A., Cremer, O. L., Ong, D. S. Y., Amoruso, G., Cinnella, G., Bos, L. D. J., Schmidle, P., Findeisen, M., Hoppmann, P., Jaitner, J., Brettner, F., Lahmer, T., Rajagopalan, G., Bansal, V., Frank, R., Hinds, R., Levitt, J., Siddiqui, S., Gilbert, J. P., Sim, K., Wang, C. H., Li, I. J., Tang, W. R., Persona, P., De Cassai, A., Franco, M., Goffi, A., Ruiz, B. Llorente, Varas, J. Lujan, Montero, R. Molina, Delgado, C. Pintado, Navarrete, O., Mezquita, M. Vazquez, Peces, E. Alonso, Nakamura, M. A. M., Hajjar, L. A., Galas, F. R. B. G., Ortiz, T. A., Amato, M. B. P., Bitker, L., Costes, N., Le Bars, D., Lavenne, F., Mojgan, D., Richard, J. C., Massari, D., Gotti, M., Cadringher, P., Zerman, A., Türkoğlu, M., Arık, G., Yıldırım, F., Güllü, Z., Kara, I., Boyacı, N., Aydoğan, B. Basarık, Gaygısız, Ü., Gönderen, K., Aygencel, G., Aydoğdu, M., Ülger, Z., Gürsel, G., Riera, J., Toral, C. Maldonado, Mazo, C., Martínez, M., Baldirà, J., Lagunes, L., Roman, A., Deu, M., Rello, J., Levine, D. J., Mohus, R. M., Askim, Å., Paulsen, J., Mehl, A., Dewan, A. T., Damås, J. K., Solligård, E., Åsvold, B. O., DeWan, A., Aktepe, O., Kara, A., Yeter, H., Topeli, A., Norrenberg, M., Devroey, M., Khader, H., Preiser, J. C., Tang, Z., Qiu, C., Tong, L., Cai, C., Apostolopoulou, O., Moon, J. Y., Park, M. R., Kwon, I. S., Chon, G. R., Ahn, J. Y., Kwon, S. J., Chang, Y. J., Lee, J. Y., Yoon, S. Y., Lee, J. W., Kostalas, M., Mckinlay, J., Kooner, G., Dudas, G., Horton, A., Kerr, C., Karanjia, N., Creagh-Brown, B., Altintas, N. D., Izdes, S., Keremoglu, O., Alkan, A., Neselioglu, S., Erel, O., Tardif, N., Gustafsson, T., MacEachern, K. N., Traille, M., Bromberg, I., Lapinsky, S. E., Moore, M. J., García-Garmendia, J. L., Villarrasa-Clemente, F., Maroto-Monserrat, F., Rufo-Tejeiro, O., Jorge-Amigo, V., Sánchez-Santamaría, M., Colón-Pallarés, C., Barrero-Almodóvar, A., Gallego-Lara, S., Anthon, C. T., Müller, R. B., Haase, N., Møller, K., Wetterslev, J., Nakanishi, M., Kuriyama, A., Fukuoka, T., Abd el Halim, M. A., Elsaid hafez, M. H., Moktar, A. M., Elazizy, H. M., Hakim, K. Abdel, Elbahr, M., Mahmoud, T., Khalil, E., Casey, W., Zaky, S. H., Rizk, A., Ahmed, R., Ospina-Tascón, G. A., Marin, A. F. Garcia, Echeverry, G. J., Bermudez, W. F., Madriñan-Navia, H. J., Valencia, J. D., Quiñonez, E., Marulanda, A., Arango-Dávila, C. A., Bruhn, A., De Backer, D., Cortes, D. Orbegozo, Su, F., Vincent, J. L., Tullo, L., Mirabella, L., Di Molfetta, P., Dambrosio, M., Lujan, C. Villavicencio, irigoyen, J. Leache, Cartanya ferré, M., García, R. Carbonell, Ahmed, M., El Ayashi, M., Ayman, E., Salem, M., Fathy, S., Zaghlol, A., Arzapalo, M. F. Aguilar, Valsø, Å., Rustøen, T., Schou-Bredal, I., Skogstad, L., Tøien, K., Padilla, C., Palmeiro, Y., Egbaria, W., Kigli, R., Maertens, B., Blot, K., Blot, S., Santana-Santos, E., dos Santos, E. R., Ferretti-Rebustini, R. E. D. L., dos Santos, R. D. C. C. D. O., Verardino, R. G. S., Bortolotto, L. A., Doyle, A. M., Naldrett, I., Tillman, J., Price, S., Pearson, P., Greaves, J., Goodall, D., Berry, A., Richardson, A., Odundo, G. O., Omengo, P., Obonyo, P., Chanzu, N. M., Kleinpell, R., Sarris, S. J., Nedved, P., Heitschmidt, M., Ben-Ghezala, H., Snouda, S., Djobbi, S., Adhikari, N. K. J., Leasa, D., Fergusson, D., Mckim, D. A., Weblin, J., McWilliams, D., Doesburg, F., Cnossen, F., Dieperink, W., Bult, W., Nijsten, M. W. N., Galvez-Blanco, G. A., Guzman, C. I. Olvera, Stroud, J. Santos, Thomson, R., Llaurado-Serra, M., Lobo-Civico, A., Pi-Guerrero, M., Blanco-Sanchez, I., Piñol-Tena, A., Paños-Espinosa, C., Alabart-Segura, Y., Coloma-Gomez, B., Fernandez-Blanco, A., Braga-Dias, F., Treso-Geira, M., Valeiras-Valero, A., Martinez-Reyes, L., Sandiumenge, A., Jimenez-Herrera, M. F., Prada, R., Juárez, P., Argandoña, R., Díaz, J. J., Ramirez, C. Sánchez, Saavedra, P., Santana, S. Ruiz, Obukhova, O., Kashiya, S., Kurmukov, I. A., Pronina, A. M., Simeone, P., Puybasset, L., Auzias, G., Coulon, O., Lesimple, B., Torkomian, G., Bartkowska-Sniatkowska, A., Szerkus, O., Siluk, D., Bartkowiak-Wieczorek, J., Rosada-Kurasinska, J., Warzybok, J., Kaliszan, R., Caballero, C. Hernandez, Roberts, S., Isgro, G., Hall, D., Guillaume, G., Passouant, O., Dumas, F., Bougouin, W., Champigneulle, B., Arnaout, M., Chelly, J., Chiche, J. D., Varenne, O., Mira, J. P., Marijon, E., Cariou, A., Beerepoot, M., Touw, H. R., Parlevliet, K., Boer, C., Elbers, P. W., Reina, Á. J. Roldán, Palomo, Y. Corcia, Bermúdez, R. Martín, Villén, L. Martín, García, I. Palacios, Izurieta, J. R. Naranjo, Bernal, J. B. Pérez, Jiménez, F. J. Jiménez, Cota-Delgado, F., Kaneko, T., Tanaka, H., Kamikawa, M., Karashima, R., Iwashita, S., Irie, H., Kasaoka, S., Arola, O., Laitio, R., Saraste, A., Airaksinen, J., Pietilä, M., Hynninen, M., Wennervirta, J., Bäcklund, M., Ylikoski, E., Silvasti, P., Nukarinen, E., Grönlund, J., Harjola, V. P., Niiranen, J., Korpi, K., Varpula, M., Roine, R. O., Laitio, T., Salah, S., Hassen, B. G., Fehmi, A. Mohamed, Hsu, Y. C., Barea-Mendoza, J., García-Fuentes, C., Castillo-Jaramillo, M., Dominguez-Aguado, H., Viejo-Moreno, R., Terceros-Almanza, L., Aznárez, S. Bermejo, Mudarra-Reche, C., Xu, W., Chico-Fernández, M., Montejo-González, J. C., Crewdson, K., Thomas, M., Merghani, M., Fenner, L., Morgan, P., Lockey, D., van Lieshout, E. J., Oomen, B., Binnekade, J. M., de Haan, R. J., Juffermans, N. P., Vroom, M. B., Algarte, R., Martínez, L., Sánchez, B., Romero, I., Martínez, F., Quintana, S., Trenado, J., Sheikh, O., Pogson, D., Clinton, R., Riccio, F., Arthur, A., Young, L., Sinclair, A., Markopoulou, D., Venetsanou, K., Filippou, L., Salla, E., Stratouli, S., Alamanos, I., Guirgis, A. H., Rodriguez, R. Gutiérrez, Lorente, M. J. Furones, Guarasa, I. Macias, Ukere, A., Meisner, S., Greiwe, G., Opitz, B., Benten, D., Nashan, B., Fischer, L., Trepte, C. J. C., Behem, C. R., Ana, B., Vazir, A., Gibson, D., Hadavi, M. R., alam, M. Riahi, Sasani, M. R., Parenti, N., Agrusta, F., Palazzi, C., Pifferi, B., Sganzerla, R., Tagliazucchi, F., Luciani, A., Möller, M., Müller-Engelmann, J., Montag, G., Adams, P., Lange, C., Neuzner, J., Gradaus, R., Wodack, K. H., Thürk, F., Waldmann, A. D., Grässler, M. F., Nishimoto, S., Böhm, S. H., Kaniusas, E., Trepte, C. J., Wallin, M., Sipman, F. Suarez, Oldner, A., Colinas, L., Vicho, R., Serna, M., Cuena, R., Canabal, A., Etman, M., El Bahr, M., El Sakka, A., Arali, A., Bond, O., De Santis, P., Iesu, E., Franchi, F., Scolletta, S., Taccone, F. S., Marutyan, Z., Hamidova, L., Shakotko, A., Movsisyan, V., Uysupova, I., Evdokimov, A., Petrikov, S., Calvo, F. J. Redondo, Bejarano, N., Baladron, V., Villazala, R., Redondo, J., Padilla, D., Villarejo, P., Gomez-Gonzalez, C., Mas-Font, S., Puppo-Moreno, A., Herrera-Gutierrez, M., Garcia-Garcia, M., Aldunate-Calvo, S., Plata-Menchaca, E. P., Pérez-Fernández, X. L., Estruch, M., Betbese-Roig, A., Campos, P. Cárdenas, Lora, M. Rojas, Gaibor, N. D. Toapanta, Medina, R. S. Contreras, Sanguino, V. D. Gumucio, Casanova, E. J., Riera, J. Sabater, Kritmetapak, K., Peerapornratana, S., Kittiskulnam, P., Dissayabutra, T., Susantithapong, P., Praditpornsilpa, K., Tungsanga, K., Eiam-Ong, S., Winkelmann, T., Busch, T., Meixensberger, J., Bercker, S., Cabeza, E. M. Flores, Sánchez, M. Sánchez, Giménez, N. Cáceres, Melón, C. Gutierrez, de Lucas, E. Herrero, Estañ, P. Millán, Bernal, M. Hernández, de Lorenzo y Mateos, A. Garcia, Specht, P. A. C., Balik, M., Zakharchenko, M., Los, F., Brodska, H., de Tymowski, C., Augustin, P., Desmard, M., Montravers, P., Stapel, S. N., de Boer, R., Oudemans, H. M., Hollinger, A., Schweingruber, T., Jockers, F., Dickenmann, M., Siegemund, M., Runciman, N., Alban, L., Turrini, C., Sasso, T., Langer, T., Taccone, P., Marenghi, C., Grasselli, G., Wibart, P., Reginault, T., Garcia, M., Barbrel, B., Benard, A., Bader, C., Vargas, F., Bui, H. N., Hilbert, G., Simón, J. M. Serrano, Sánchez, P. Carmona, Ferrón, F. Ruiz, de Acilu, M. García, Marin, J., Antonia, V., Ruano, L., Monica, M., Hong, G., Kim, D. H., Kim, Y. S., Park, J. S., Jee, Y. K., xiang, Z. Yu, Jia-xing, W., dan, W. Xiao, long, N. Wen, Yu, W., Yan, Z., Cheng, X., Kobayashi, T., Onodera, Y., Akimoto, R., Sugiura, A., Suzuki, H., Iwabuchi, M., Nakane, M., Kawamae, K., Sanchez, P. Carmona, Rodriguez, M. D. Bautista, Delgado, M. Rodriguez, Sánchez, V. Martínez de Pinillos, Gómez, A. Mula, Beuret, P., Fortes, C., Lauer, M., Reboul, M., Chakarian, J. C., Fabre, X., Philippon-Jouve, B., Devillez, S., Clerc, M., Rittayamai, N., Sklar, M., Dres, M., Rauseo, M., Campbell, C., West, B., Tullis, D. E., Okada, M., Ahmad, N., Wood, M., Glossop, A., Lucas, J. Higuera, Ortiz, A. Blandino, Alonso, D. Cabestrero, De Pablo Sánchez, R., González, L. Rey, Costa, R., Spinazzola, G., Pizza, A., Ferrone, G., Rossi, M., Conti, G., Ribeiro, H., Alves, J., Sousa, M., Reis, P., Socolovsky, C. S., Cauley, R. P., Frankel, J. E., Beam, A. L., Olaniran, K. O., Gibbons, F. K., Christopher, K. B., Pennington, J., Zolfaghari, P., King, H. S., Kong, H. H. Y., Shum, H. P., Yan, W. W., Kaymak, C., Okumus, N., Sari, A., Erdogdu, B., Aksun, S., Basar, H., Ozcan, A., Ozcan, N., Oztuna, D., Malmgren, J. A., Lundin, S., Torén, K., Eckerström, M., Wallin, A., Waldenström, A. C., Riccio, F. C., Antonio, A. C. P., Leivas, A. F., Kenji, F., James, E., Jonnada, S., Gerrard, C. S., Jones, N., Salciccioli, J. D., Marshall, D. C., Komorowski, M., Hartley, A., Sykes, M. C., Goodson, R., Shalhoub, J., Villanueva, J. R. Fernández, Garda, R. Fernández, Lago, A. M. López, Ruiz, E. Rodríguez, Vaquero, R. Hernández, Rodríguez, C. Galbán, Pérez, E. Varo, Hilasque, C., Oliva, I., Sirgo, G., Martin, M. C., Olona, M., Gilavert, M. C., Bodí, M., Ebm, C., Aggarwal, G., Huddart, S., Quiney, N., Fernandes, S. M., Silva, J. Santos, Gouveia, J., Silva, D., Marques, R., Bento, H., Alvarez, A., Silva, Z. Costa, Diaz, D. Díaz, Martínez, M. Villanova, Herrejon, E. Palencia, de la Gandara, A. Martinez, Gonzalo, G., Lopez, M. A., de Gopegui Miguelena, P. Ruíz, Matilla, C. I. Bernal, Chueca, P. Sánchez, Longares, M. D. C. Rodríguez, Abril, R. Ramos, Aguilar, A. L. Ruíz, de Murillas, R. Garrido López, Fernández, R. Fernández, Laborías, P. Morales, Castellanos, M. A. Díaz, Laborías, M. E. Morales, Park, J., Woo, S., West, T., Powell, E., Rimmer, A., Orford, C., Williams, J., de Gopegui Miguelena, P. Ruiz, Bourne, R. S., Shulman, R., Tomlin, M., Mills, G. H., Borthwick, M., Berry, W., Huertas, D. García, Manzano, F., Villagrán-Ramírez, F., Ruiz-Perea, A., Rodríguez-Mejías, C., Santiago-Ruiz, F., Colmenero-Ruiz, M., König, C., Matt, B., Kortgen, A., Hartog, C. S., Wong, A., Balan, C., Barker, G., Tachaboon, S., Paratz, J., Kayambu, G., Boots, R., Vlasenko, R., Gromova, E., Loginov, S., Kiselevskiy, M., Dolgikova, Y., Tang, K. B., Chau, C. M., Lam, K. N., Gil, E., Suh, G. Y., Park, C. M., Chung, C. R., Lai, C. H., Cheng, Y. J., Colella, V., Zarrillo, N., D’Amico, M., Forfori, F., Pezza, B., Laddomada, T., Beltramelli, V., Pizzaballa, M. L., Doronzio, A., Balicco, B., Kiers, D., van der Heijden, W., Gerretsen, J., de Mast, Q., el Messaoudi, S., Rongen, G., Gomes, M., Riksen, N. P., Kashiwagi, Y., Hayashi, K., Inagaki, Y., Fujita, S., Blet, A., Sadoune, M., Lemarié, J., Bihry, N., Bern, R., Polidano, E., Merval, R., Launay, J. M., Lévy, B., Samuel, J. L., Hartmann, J., Harm, S., and Weber, V.

Published
2016
Full Text
View/download PDF

25. Community-acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis.

Author

Cillóniz C, Ewig S, Ferrer M, Polverino E, Gabarrús A, Puig de la Bellacasa J, Mensa J, Torres A, Cillóniz, Catia, Ewig, Santiago, Ferrer, Miquel, Polverino, Eva, Gabarrús, Albert, Puig de la Bellacasa, Jorge, Mensa, Josep, and Torres, Antoni

Abstract

Introduction: The frequency and clinical significance of polymicrobial aetiology in community-acquired pneumonia (CAP) patients admitted to the ICU have been poorly studied. The aim of the present study was to describe the prevalence, clinical characteristics and outcomes of severe CAP of polymicrobial aetiology in patients admitted to the ICU.Methods: The prospective observational study included 362 consecutive adult patients with CAP admitted to the ICU within 24 hours of presentation; 196 (54%) patients had an established aetiology.Results: Polymicrobial infection was present in 39 (11%) cases (20% of those with defined aetiology): 33 cases with two pathogens, and six cases with three pathogens. The most frequently identified pathogens in polymicrobial infections were Streptococcus pneumoniae (n = 28, 72%), respiratory viruses (n = 15, 39%) and Pseudomonas aeruginosa (n = 8, 21%). Chronic respiratory disease and acute respiratory distress syndrome criteria were independent predictors of polymicrobial aetiology. Inappropriate initial antimicrobial treatment was more frequent in the polymicrobial aetiology group compared with the monomicrobial aetiology group (39% vs. 10%, P < 0.001), and was an independent predictor of hospital mortality (adjusted odds ratio = 10.79, 95% confidence interval = 3.97 to 29.30; P < 0.001). The trend for higher hospital mortality of the polymicrobial aetiology group compared with the monomicrobial aetiology group (n = 8, 21% versus n = 17, 11%), however, was not significantly different (P = 0.10).Conclusions: Polymicrobial pneumonia occurs frequently in patients admitted to the ICU. This is a risk factor for inappropriate initial antimicrobial treatment, which in turn independently predicts hospital mortality. [ABSTRACT FROM AUTHOR]

Published
2011
Full Text
View/download PDF

26. Impact of age and comorbidity on cause and outcome in community-acquired pneumonia

Author

Stefano Aliberti, Josep Mensa, Antoni Torres, Catia Cilloniz, Albert Gabarrus, Francesco Blasi, Eva Polverino, Rosario Menéndez, Santiago Ewig, Cillóniz, C, Polverino, E, Ewig, S, Aliberti, S, Gabarrús, A, Menéndez, R, Mensa, J, Blasi, F, and Torres, A

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Multivariate analysis, Comorbidity, Critical Care and Intensive Care Medicine, medicine.disease_cause, Risk Assessment, Haemophilus influenzae, Community-acquired pneumonia, Risk Factors, Internal medicine, Streptococcus pneumoniae, medicine, Humans, Prospective Studies, Prospective cohort study, Aged, pneumonia, comorbidities, CAP, age, Aged, 80 and over, MED/10 - MALATTIE DELL'APPARATO RESPIRATORIO, business.industry, Age Factors, Pneumonia, medicine.disease, Surgery, Community-Acquired Infections, Survival Rate, MED/17 - MALATTIE INFETTIVE, Spain, Bacteremia, Female, MED/09 - MEDICINA INTERNA, Cardiology and Cardiovascular Medicine, business
Abstract

Background: Prolonged life expectancy has currently increased the proportion of the very elderly among patients with community-acquired pneumonia (CAP). The aim of this study was to determine the infl uence of age and comorbidity on microbial patterns in patients over 65 years of age with CAP. Methods: This study was a prospective observational study of adult patients with CAP (excluding those in nursing homes) over a 12-year period. We compared patients aged 65 to 74 years, 75 to 84 years, and > 85 years for potential differences in clinical presentation, comorbidities, severity on admission, microbial investigations, causes, antimicrobial treatment, and outcomes. Results: We studied a total of 2,149 patients: 759 patients (35.3%) aged 65 to 74 years, 941 patients (43.7%) aged 75 to 84 years, and 449 patients (20.8%) aged > 85 years. At least one comorbidity was present in 1,710 patients (79.6%). Streptococcus pneumoniae was the most frequent pathogen in all age groups, regardless of comorbidity. Staphylococcus aureus, Enterobacteriaceae, and Pseudomonas aeruginosa accounted for 9.1% of isolates, and Haemophilus infl uenzae, 6.4%. All these pathogens were isolated only in patients with at least one comorbidity. Mortality increased with age (65-74 years, 6.9%; 75-84 years, 8.9%; > 85 years, 17.1%; P < .001) and was associated with increased comorbidities (neurologic; OR, 2.1; 95% CI, 1.5-2.1), Pneumonia Severity Index IV or V (OR, 3.2; 95% CI, 1.8-6.0), bacteremia (OR, 1.7; 95% CI, 1.1-2.7), the presence of a potential multidrug-resistant (MDR) pathogen (S aureus, P aeruginosa, Enterobacteriaceae; OR, 2.4; 95% CI, 1.3-4.3), and ICU admission (OR, 4.2; 95% CI, 2.9-6.1) on multivariate analysis. Conclusions: Age does not infl uence microbial cause itself, whereas comorbidities are associated with specifi c causes such as H infl uenzae and potential MDR pathogens. Mortality in the elderly is mainly driven by the presence of comorbidities and potential MDR pathogens.

Published
2013

27. Basic host response parameters to classify mortality risk in COVID-19 and community-acquired pneumonia.

Author

Menéndez R, Méndez R, González-Jiménez P, Latorre A, Reyes S, Zalacain R, Ruiz LA, Serrano L, España PP, Uranga A, Cillóniz C, Gaetano-Gil A, Fernández-Félix BM, Pérez-de-Llano L, Golpe R, and Torres A

Subjects
Humans, Male, Female, Middle Aged, Aged, C-Reactive Protein analysis, C-Reactive Protein metabolism, SARS-CoV-2, Intensive Care Units, Biomarkers blood, Risk Assessment methods, Lymphocyte Count, Severity of Illness Index, Aged, 80 and over, Pneumonia mortality, Pneumonia virology, COVID-19 mortality, COVID-19 immunology, COVID-19 virology, Community-Acquired Infections mortality, Community-Acquired Infections virology, Hospital Mortality
Abstract

Improved phenotyping in pneumonia is necessary to strengthen risk assessment. Via a feasible and multidimensional approach with basic parameters, we aimed to evaluate the effect of host response at admission on severity stratification in COVID-19 and community-acquired pneumonia (CAP). Three COVID-19 and one CAP multicenter cohorts including hospitalized patients were recruited. Three easily available variables reflecting different pathophysiologic mechanisms-immune, inflammation, and respiratory-were selected (absolute lymphocyte count [ALC], C-reactive protein [CRP] and, SpO 2 /FiO 2 ). In-hospital mortality and intensive care unit (ICU) admission were analyzed as outcomes. A multivariable, penalized maximum likelihood logistic regression was performed with ALC (< 724 lymphocytes/mm 3 ), CRP (> 60 mg/L), and, SpO 2 /FiO 2 (< 450). A total of 1452, 1222 and 462 patients were included in the three COVID-19 and 1292 in the CAP cohort for the analysis. Mortality ranged between 4 and 32% (0 to 3 abnormal biomarkers) and 0-9% in SARS-CoV-2 pneumonia and CAP, respectively. In the first COVID-19 cohort, adjusted for age and sex, we observed an increased odds ratio for in-hospital mortality in COVID-19 with elevated biomarkers altered (OR 1.8, 3, and 6.3 with 1, 2, and 3 abnormal biomarkers, respectively). The model had an AUROC of 0.83. Comparable findings were found for ICU admission, with an AUROC of 0.76. These results were confirmed in the other COVID-19 cohorts Similar OR trends were reported in the CAP cohort; however, results were not statistically significant. Assessing the host response via accessible biomarkers is a simple and rapidly applicable approach for pneumonia., (© 2024. The Author(s).)

Published
2024
Full Text
View/download PDF

28. Systematic review of ceftaroline fosamil in the management of patients with methicillin-resistant Staphylococcus aureus pneumonia.

Author

Torres A, Kuraieva A, Stone GG, and Cillóniz C

Subjects
Adult, Child, Humans, Linezolid, Vancomycin, Cephalosporins adverse effects, Anti-Bacterial Agents adverse effects, Ceftaroline, Methicillin-Resistant Staphylococcus aureus, Community-Acquired Infections diagnosis, Community-Acquired Infections drug therapy, Pneumonia, Ventilator-Associated diagnosis, Pneumonia, Ventilator-Associated drug therapy
Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for an array of problematic community- and healthcare-acquired infections, including pneumonia, and is frequently associated with severe disease and high mortality rates. Standard recommended treatments for empiric and targeted coverage of suspected MRSA in patients with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), including ventilator-associated pneumonia (VAP), are vancomycin and linezolid. However, adverse events such as acute kidney injury and Clostridium difficile infection have been associated with these antibiotics. Ceftaroline fosamil is a β-lactam/extended-spectrum cephalosporin approved for the treatment of adults and children with CAP and complicated skin and soft tissue infections. Ceftaroline has in vitro activity against a range of common Gram-positive bacteria and is distinct among the β-lactams in retaining activity against MRSA. Due to the design of the pivotal randomised controlled trials of ceftaroline fosamil, outcomes in patients with MRSA CAP were not evaluated. However, various reports of real-world outcomes with ceftaroline fosamil for pneumonia caused by MRSA, including CAP and HAP/VAP, been published since its approval. A systematic literature review and qualitative analysis of relevant publications was undertaken to collate and summarise relevant published data on the efficacy and safety of ceftaroline fosamil in patients with MRSA pneumonia. While relatively few real-world outcomes studies are available, the available data suggest that ceftaroline fosamil is a possible alternative to linezolid and vancomycin for MRSA pneumonia. Specific scenarios in which ceftaroline fosamil might be considered include bacteraemia and complicating factors such as empyema., Competing Interests: Conflict of interest: A. Torres has no conflicts of interest related to the current article. A. Kuraieva is an employee of Pfizer. G.G. Stone is an employee of Pfizer. C. Cillóniz has no conflicts of interest related to the current article., (Copyright ©The authors 2023.)

Published
2023
Full Text
View/download PDF

29. Is the long-term mortality similar in COVID-19 and community-acquired pneumonia?

Author

Méndez R, González-Jiménez P, Latorre A, Mengot N, Zalacain R, Ruiz LA, Serrano L, España PP, Uranga A, Cillóniz C, Hervás D, Torres A, Menéndez R, Pablo España P, Borderías L, Rajas O, Almirall J, Zalacaín R, Vendrell M, Bello S, Mir I, Morales C, Molinos L, Ferrer R, Briones M, Malo R, Sayago Reza I, Almonte Batista W, Moreno Galarraga L, Sibila Vidal O, Luis Rodríguez Hermosa J, Vargas Centanaro G, de Vega Sánchez B, Solís García E, Rodríguez Florez E, José M, Estaba C, Molina Molina M, Bordas J, Estela González Castro M, Badenes Bonet D, Domínguez Álvarez M, Pérez-Rodas EN, Marín Arguedas A, Román Bernal B, Estrada Trigueros G, Cuenca Peris S, Martín Royo M, Torres García M, Portillo Sánchez J, Lerenas Bernal F, Salome Ros Braquehais M, Alfonso García Guerra J, Dolores Martínez Pitarch M, Arroyo Fernández I, Guevara Velázquez V, Martínez Olondris P, Francisco Pereyra Barrionuevo M, Lázaro Sierra J, Clavería P, Luis Wangüemert Pérez A, Joel Ruiz Lacambra J, Fernández Ramos N, Guanche Dorta S, Macias Paredes A, de la Rosa Carrillo D, Palones Femenia E, Podzamczer Valls I, Peñacoba Toribio P, Muñoz Zara P, García García R, Del Mar Marrube Fernández M, Villar Aguilar L, de Jorge Domínguez Pazos S, Pereiro Brea T, Pando-Sandoval A, María García Clemente M, Alzueta Álvarez A, García Coya E, de Freitas González E, Pablo España Yandiola P, Uranga A, Raboso Moreno B, Panadero C, Abad A, Cano I, Pérez Orbis I, Gotera Rivera C, Ruiz Pérez C, Menéndez Villanueva R, Méndez R, Latorre A, González P, Ramírez Prieto T, Ángel Salvador Maya M, Valenzuela C, Cifrián Martínez JM, Marco Figueira Gonçalves J, Baeza Ruiz A, Expósito Marrero A, Gurbani N, Malo de Molina Ruiz R, Galdeano Lozano M, Villanueva Montes M, Toledo Pons N, Ramón Clar L, Esperanza Barrios A, Cejudo Ramos P, López Ramírez C, Gaboli M, Almadana Pacheco V, Eduard Barbé Illa F, Clara A, Gutiérrez González N, and Cabrera César E

Abstract

Introduction: There are no data on the association of type of pneumonia and long-term mortality by the type of pneumonia (COVID-19 or community-acquired pneumonia [CAP]) on long-term mortality after an adjustment for potential confounding variables. We aimed to assess the type of pneumonia and risk factors for long-term mortality in patients who were hospitalized in conventional ward and later discharged., Methods: Retrospective analysis of two prospective and multicentre cohorts of hospitalized patients with COVID-19 and CAP. The main outcome under study was 1-year mortality in hospitalized patients in conventional ward and later discharged. We adjusted a Bayesian logistic regression model to assess associations between the type of pneumonia and 1-year mortality controlling for confounders., Results: The study included a total of 1,693 and 2,374 discharged patients in the COVID-19 and CAP cohorts, respectively. Of these, 1,525 (90.1%) and 2,249 (95%) patients underwent analysis. Until 1-year follow-up, 69 (4.5%) and 148 (6.6%) patients from the COVID-19 and CAP cohorts, respectively, died ( p  = 0.008). However, the Bayesian model showed a low probability of effect (PE) of finding relevant differences in long-term mortality between CAP and COVID-19 (odds ratio 1.127, 95% credibility interval 0.862-1.591; PE = 0.774)., Conclusion: COVID-19 and CAP have similar long-term mortality after adjusting for potential confounders., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Méndez, González-Jiménez, Latorre, Mengot, Zalacain, Ruiz, Serrano, España, Uranga, Cillóniz, Hervás, Torres, Menéndez, NEUMONAC and RECOVID.)

Published
2023
Full Text
View/download PDF

31. Remdesivir and survival outcomes in critically ill patients with COVID-19: A multicentre observational cohort study.

Author

Cillóniz C, Motos A, Castañeda T, Gabarrús A, Barbé F, and Torres A

Subjects
Humans, Critical Illness, COVID-19 Drug Treatment, Cohort Studies, Intensive Care Units, COVID-19
Abstract

Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Published
2023
Full Text
View/download PDF

32. Early Recognition of Low-Risk SARS-CoV-2 Pneumonia: A Model Validated With Initial Data and Infectious Diseases Society of America/American Thoracic Society Minor Criteria.

Author

Menéndez R, Méndez R, González-Jiménez P, Zalacain R, Ruiz LA, Serrano L, España PP, Uranga A, Cillóniz C, Pérez-de-Llano L, Golpe R, and Torres A

Subjects
C-Reactive Protein, Cohort Studies, Humans, Intensive Care Units, Pandemics, SARS-CoV-2, Severity of Illness Index, Urea, COVID-19, Communicable Diseases, Community-Acquired Infections epidemiology, Pneumonia epidemiology
Abstract

Background: A shortage of beds in ICUs and conventional wards during the COVID-19 pandemic led to a collapse of health care resources., Research Question: Can admission data and minor criteria by the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) help identify patients with low-risk SARS-CoV-2 pneumonia?, Study Design and Methods: This multicenter cohort study included 1,274 patients in a derivation cohort and 830 (first wave) and 754 (second wave) patients in two validation cohorts. A multinomial regression analysis was performed on the derivation cohort to compare the following patients: those admitted to the ward (assessed as low risk); those admitted to the ICU directly; those transferred to the ICU after general ward admission; and those who died. A regression analysis identified independent factors for low-risk pneumonia. The model was subsequently validated., Results: In the derivation cohort, similarities existed among those either directly admitted or transferred to the ICU and those who died. These patients could, therefore, be merged into one group. Five independently associated factors were identified as being predictors of low risk (not dying and/or requiring ICU admission) (ORs, with 95% CIs): peripheral blood oxygen saturation/Fio 2 > 450 (0.233; 0.149-0.364); < 3 IDSA/ATS minor criteria (0.231; 0.146-0.365); lymphocyte count > 723 cells/mL (0.539; 0.360-0.806); urea level < 40 mg/dL (0.651; 0.426-0.996); and C-reactive protein level < 60 mg/L (0.454; 0.285-0.724). The areas under the curve were 0.802 (0.769-0.835) in the derivation cohort, and 0.779 (0.742-0.816) and 0.801 (0.757-0.845) for the validation cohorts (first and second waves, respectively)., Interpretation: Initial biochemical findings and the application of < 3 IDSA/ATS minor criteria make early identification of low-risk SARS-CoV-2 pneumonia (approximately 80% of hospitalized patients) feasible. This scenario could facilitate and streamline health care resource allocation for patients with COVID-19., (Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Published
2022
Full Text
View/download PDF

33. Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study.

Author

Torres A, Motos A, Cillóniz C, Ceccato A, Fernández-Barat L, Gabarrús A, Bermejo-Martin J, Ferrer R, Riera J, Pérez-Arnal R, García-Gasulla D, Peñuelas O, Lorente JÁ, de Gonzalo-Calvo D, Almansa R, Menéndez R, Palomeque A, Villar RA, Añón JM, Balan Mariño A, Barberà C, Barberán J, Blandino Ortiz A, Boado MV, Bustamante-Munguira E, Caballero J, Cantón-Bulnes ML, Carbajales Pérez C, Carbonell N, Catalán-González M, de Frutos R, Franco N, Galbán C, Gumucio-Sanguino VD, de la Torre MDC, Díaz E, Estella Á, Gallego E, García Garmendia JL, Gómez JM, Huerta A, García RNJ, Loza-Vázquez A, Marin-Corral J, Martin Delgado MC, Martínez de la Gándara A, Martínez Varela I, López Messa J, Albaiceta GM, Nieto M, Novo MA, Peñasco Y, Pérez-García F, Pozo-Laderas JC, Ricart P, Sagredo V, Sánchez-Miralles A, Sancho Chinesta S, Serra-Fortuny M, Socias L, Solé-Violan J, Suarez-Sipmann F, Tamayo Lomas L, Trenado J, Úbeda A, Valdivia LJ, Vidal P, and Barbé F

Subjects
Adrenal Cortex Hormones therapeutic use, Critical Illness therapy, Humans, Intensive Care Units, Precision Medicine, Respiration, Artificial, Steroids therapeutic use, COVID-19 Drug Treatment
Abstract

Purpose: Although there is evidence supporting the benefits of corticosteroids in patients affected with severe coronavirus disease 2019 (COVID-19), there is little information related to their potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) with COVID-19. We aim to investigate to find candidate variables to guide personalized treatment with steroids in critically ill patients with COVID-19., Methods: Multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (≥ 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment (< 7 days since symptom onset) and long term of corticosteroids (≥ 10 days) were also investigated., Results: Between February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 [0.65-0.92], p = 0.003) and in-hospital mortality (SHR 0.70 [0.58-0.84], p < 0.001). Significant effect modification was found after adjustment for covariates using propensity score for age (p = 0.001 interaction term), Sequential Organ Failure Assessment (SOFA) score (p = 0.014 interaction term), and mechanical ventilation (p = 0.001 interaction term). We observed a beneficial effect of corticosteroids on 90-day mortality in various patient subgroups, including those patients aged ≥ 60 years; those with higher baseline severity; and those receiving invasive mechanical ventilation at ICU admission. Early administration was associated with a higher risk of 90-day mortality in the overall population (HR 1.32 [1.14-1.53], p < 0.001). Long-term use was associated with a lower risk of 90-day mortality in the overall population (HR 0.71 [0.61-0.82], p < 0.001). No effect was found regarding the dosage of corticosteroids. Moreover, the use of corticosteroids was associated with an increased risk of nosocomial bacterial pneumonia and hyperglycaemia., Conclusion: Corticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful., (© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2022
Full Text
View/download PDF

35. Prediction of ventilator-associated pneumonia outcomes according to the early microbiological response: a retrospective observational study.

Author

Ceccato A, Dominedò C, Ferrer M, Martin-Loeches I, Barbeta E, Gabarrús A, Cillóniz C, Ranzani OT, De Pascale G, Nogas S, Di Giannatale P, Antonelli M, and Torres A

Subjects
Humans, Intensive Care Units, Prospective Studies, Respiration, Artificial adverse effects, Retrospective Studies, Pneumonia, Ventilator-Associated diagnosis, Pneumonia, Ventilator-Associated drug therapy, Superinfection diagnosis, Superinfection etiology
Abstract

Background: Ventilator-associated pneumonia (VAP) is a leading infectious cause of morbidity in critically ill patients, yet current guidelines offer no indications for follow-up cultures. We aimed to evaluate the role of follow-up cultures and microbiological response 3 days after diagnosing VAP as predictors of short- and long-term outcomes., Methods: We performed a retrospective analysis of a cohort prospectively collected from 2004 to 2017. VAP was diagnosed based on clinical, radiographical and microbiological criteria. For microbiological identification, a tracheobronchial aspirate was performed at diagnosis and repeated after 72 h. We defined three groups when comparing the two tracheobronchial aspirate results: persistence, superinfection and eradication of causative pathogens., Results: 157 patients were enrolled in the study, among whom microbiological persistence, superinfection or eradication was present in 67 (48%), 25 (16%) and 65 (41%), respectively, after 72 h. Those with superinfection had the highest mortalities in the intensive care unit (p=0.015) and at 90 days (p=0.036), while also having the fewest ventilator-free days (p=0.019). Multivariable analysis revealed shock at VAP diagnosis (OR 3.43, 95% CI 1.25-9.40), Staphylococcus aureus isolation at VAP diagnosis (OR 2.87, 95% CI 1.06-7.75) and hypothermia at VAP diagnosis (OR 0.67, 95% CI 0.48-0.95, per +1°C) to be associated with superinfection., Conclusions: Our retrospective analysis suggests that VAP short- and long-term outcomes may be associated with superinfection in follow-up cultures. Follow-up cultures may help guide antibiotic therapy and its duration. Further prospective studies are necessary to verify our findings., Competing Interests: Conflict of interest: A. Ceccato has nothing to disclose. Conflict of interest: C. Dominedò has nothing to disclose. Conflict of interest: M. Ferrer has nothing to disclose. Conflict of interest: I. Martin-Loeches has nothing to disclose. Conflict of interest: E. Barbeta has nothing to disclose. Conflict of interest: A Gabarrús has nothing to disclose. Conflict of interest: C. Cilloniz has nothing to disclose. Conflict of interest: O. Ranzani has nothing to disclose. Conflict of interest: G. De Pascale has nothing to disclose. Conflict of interest: S. Nogas has nothing to disclose. Conflict of interest: P. Di Giannatale has nothing to disclose. Conflict of interest: M. Antonelli has nothing to disclose. Conflict of interest: A. Torres has nothing to disclose., (Copyright ©The authors 2022. For reproduction rights and permissions contact permissions@ersnet.org.)

Published
2022
Full Text
View/download PDF

36. Severe Infections Due to Respiratory Viruses.

Author

Cillóniz C, Pericàs JM, Rojas JR, and Torres A

Subjects
Aged, Coronavirus, Humans, Patient Acuity, Prognosis, Respiratory Tract Infections diagnosis, Respiratory Tract Infections epidemiology, Respiratory Tract Infections therapy, Respiratory Tract Infections virology, Virus Diseases diagnosis, Virus Diseases epidemiology, Virus Diseases therapy
Abstract

Severe viral infections may result in severe illnesses capable of causing acute respiratory failure that could progress rapidly to acute respiratory distress syndrome (ARDS), related to worse outcomes, especially in individuals with a higher risk of infection, including the elderly and those with comorbidities such as asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. In addition, in cases of severe viral pneumonia, co-infection with bacteria such as Streptococcus pneumoniae and Staphylococcus aureus is related to worse outcomes. Respiratory viruses like influenza, rhinovirus, parainfluenza, adenovirus, metapneumovirus, respiratory syncytial virus, and coronavirus have increasingly been detected. This trend has become more prevalent, especially in critically ill patients, due to the availability and implementation of molecular assays in clinical practice. Respiratory viruses have been diagnosed as a frequent cause of severe pneumonia, including cases of community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia. In this review, we will discuss the epidemiology, diagnosis, clinical characteristics, management, and prognosis of patients with severe infections due to respiratory viruses, with a focus on influenza viruses, non-influenza viruses, and coronaviruses., Competing Interests: None declared., (Thieme. All rights reserved.)

Published
2022
Full Text
View/download PDF

37. Management of pneumonia in critically ill patients.

Author

Cillóniz C, Torres A, and Niederman MS

Subjects
Anti-Infective Agents pharmacology, Critical Care standards, Critical Illness therapy, Drug Resistance, Multiple, Guideline Adherence statistics & numerical data, Humans, Intensive Care Units standards, Pneumonia diagnosis, Pneumonia epidemiology, Pneumonia microbiology, Practice Guidelines as Topic, Risk Factors, Severity of Illness Index, Treatment Outcome, Anti-Infective Agents therapeutic use, Antimicrobial Stewardship standards, Critical Care methods, Pneumonia therapy
Abstract

Severe pneumonia is associated with high mortality (short and long term), as well as pulmonary and extrapulmonary complications. Appropriate diagnosis and early initiation of adequate antimicrobial treatment for severe pneumonia are crucial in improving survival among critically ill patients. Identifying the underlying causative pathogen is also critical for antimicrobial stewardship. However, establishing an etiological diagnosis is challenging in most patients, especially in those with chronic underlying disease; those who received previous antibiotic treatment; and those treated with mechanical ventilation. Furthermore, as antimicrobial therapy must be empiric, national and international guidelines recommend initial antimicrobial treatment according to the location's epidemiology; for patients admitted to the intensive care unit, specific recommendations on disease management are available. Adherence to pneumonia guidelines is associated with better outcomes in severe pneumonia. Yet, the continuing and necessary research on severe pneumonia is expansive, inviting different perspectives on host immunological responses, assessment of illness severity, microbial causes, risk factors for multidrug resistant pathogens, diagnostic tests, and therapeutic options., Competing Interests: Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: AT has participated in advisory boards for Pfizer. MN has participated in advisory boards for Pfizer, Merck, Bayer, Gilead, and Abbvie., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Published
2021
Full Text
View/download PDF

39. Predictive Performance of Risk Factors for Multidrug-Resistant Pathogens in Nosocomial Pneumonia.

Author

Dominedò C, Ceccato A, Niederman M, Cillóniz C, Gabarrús A, Martin-Loeches I, Ferrer M, Antonelli M, and Torres A

Subjects
Adult, Anti-Bacterial Agents therapeutic use, Humans, Intensive Care Units, Risk Factors, Cross Infection drug therapy, Cross Infection epidemiology, Healthcare-Associated Pneumonia drug therapy, Healthcare-Associated Pneumonia epidemiology, Pneumonia drug therapy
Abstract

Rationale: In 2017, the International European Respiratory Society/European Society of Intensive Care Medicine/European Society of Clinical Microbiology and Infectious Diseases/Latin American Thoracic Society (European) guidelines defined new risk factors for multidrug-resistant (MDR) pathogens in patients with nosocomial pneumonia. Objectives: To assess the predictive performance of these newly defined risk factors for MDR pathogens. Methods: We enrolled 507 adult patients with nosocomial pneumonia who were treated in six intensive care units at the Hospital Clinic of Barcelona in Spain. Of the 503 patients at high MDR pathogen and mortality risk, 275 (54%) had no septic shock and 228 (46%) had septic shock. Results: Admission to hospital settings with high rates of MDR pathogens ( n  = 421; 83%) and prior antibiotic use ( n  = 399; 79%) showed the highest prevalence in the overall population, with sensitivities of 92% and 85% and negative predictive values of 85% and 82%, respectively. However, low specificities and low positive predictive values were found. Previous respiratory MDR pathogen isolation was less common ( n  = 17; 3%) but presented a specificity and positive predictive value of 100%. The area under the receiver operating characteristic curve was less than 0.6 for all risk factors and combinations. Conclusions: The risk factors proposed by the European Respiratory Society/European Society of Intensive Care Medicine/European Society of Clinical Microbiology and Infectious Diseases/Latin American Thoracic Society showed low accuracy for predicting MDR pathogens in intensive care unit acquired pneumonia (ICU-AP). Admission to hospital settings with high rates of MDR pathogens and prior antibiotic use were the most prevalent risk factors, with a high sensitivity for predicting these microorganisms; prior positive cultures for MDR pathogens showed high specificity but very low sensitivity. Combinations of risk factors did not show any great accuracy for predicting these microorganisms. Further studies assessing combined strategies of risk stratification and complementary methods are now warranted.

Published
2021
Full Text
View/download PDF

41. Systemic Inflammatory Response and Outcomes in Community-Acquired Pneumonia Patients Categorized According to the Smoking Habit or Presence of Chronic Obstructive Pulmonary Disease.

Author

Crisafulli E, Cillóniz C, Liapikou A, Ferrari M, Busti F, Girelli D, and Torres A

Abstract

The systemic inflammatory response (SIR) may help to predict clinical progression, treatment failure, and prognosis in community-acquired pneumonia (CAP). Exposure to tobacco smoke may affect the SIR; the role of smoking in CAP has not been consolidated. We evaluated the SIR and outcomes of hospitalized CAP patients stratified by smoking habits and the presence of COPD. This retrospective analysis was conducted at the Hospital Clinic of Barcelona. Baseline, clinical, microbiological, and laboratory variables were collected at admission, using C-reactive protein (CRP) levels as a marker of SIR. The study outcomes were pleural complications, hospital stay, non-invasive and invasive mechanical ventilation (IMV), and intensive care unit (ICU) admission. We also considered the in-hospital and 30-day mortality. Data were grouped by smoking habit (non-, former-, and current-smokers) and the presence of COPD. Current smokers were younger, had fewer comorbidities, and fewer previous pneumonia episodes. CRP levels were higher in current smokers than in other groups. Current smokers had a higher risk of pleural complications independent of CRP levels, the presence of pleuritic pain, and a higher platelet count. Current smokers more often required IMV and ICU admission. Current smokers have a greater inflammatory response and are at increased risk of pleural complications.

Published
2020
Full Text
View/download PDF

42. Q Fever (Coxiella Burnetii).

Author

España PP, Uranga A, Cillóniz C, and Torres A

Subjects
Acute Disease, Adult, Animals, Anti-Bacterial Agents therapeutic use, Child, Coxiella burnetii immunology, Diagnosis, Differential, Humans, Hydroxychloroquine therapeutic use, Zoonoses transmission, Coxiella burnetii isolation & purification, Q Fever diagnosis, Q Fever drug therapy, Q Fever epidemiology, Q Fever transmission
Abstract

Q fever is a zoonotic infectious disease caused by the Coxiella burnetii bacterium. It is an obligate intracellular pathogen with a high infection capacity that proliferates exclusively in an acidified medium, forming a lysosome-like vacuole. It presents a peculiar phenomenon called "antigenic phase variation," produced by a modification in the complexity of the membrane lipopolysaccharides. Q fever can be found worldwide and presents variable clinical features and geographical distribution. It mostly affects people in rural areas who are in contact with animals. The most common type of transmission to humans is via the inhalation of aerosols containing the pathogen, especially those formed from placental derivatives. Wild animals, domestic animals, and ticks are the principal reservoirs.Diagnosis is mainly made by indirect methods such as serology or by direct methods such as microbiological cultures or tests that detect the specific DNA. Typically, there are two clinical presentations: the acute disease, which is more frequent and often asymptomatic, and a persistent focalized infection in 4 to 5% of patients, generally with a poor evolution. Treatment of the acute form in both children and adults consists of administering doxycycline, while persistent focalized infection should be treated with at least two antibiotics, such as doxycycline and hydroxychloroquine. Several measures should be undertaken to minimize exposure among people working with animals or handling birth products. Different vaccines have been developed to prevent infection, though few data are available., Competing Interests: None declared., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Published
2020
Full Text
View/download PDF

43. Promoting the use of social networks in pneumonia.

Author

Cillóniz C, Greenslade L, Dominedò C, and Garcia-Vidal C

Abstract

Background: Pneumonia is a serious health concern, but it does not attract the attention it warrants. Perhaps this is due to a lack of understanding of the real extent of this infectious disease in the general population., Methods: A literature review was performed to assess the role of social networks as a means to raise awareness over pneumonia worldwide and increase its visibility., Results: In 2017, approximately 800,000 children under 5 years and approximately one million older people died of pneumonia. The importance of this pathology remains underestimated, despite the publication of many articles, comments, and editorials dedicated to rectifying the imbalance and to reduce its impact and associated mortality. Current misperceptions about pneumonia are alarming. Education and awareness are essential in the fight against this major public health threat; in this endeavor, social networks can be used to distribute science-based information about the disease and thus raise awareness among the general public about the dangers it poses. Approximately 3.8 billion people were using social media at the beginning of 2020, representing more than half of the world's population., Conclusion: Social networks offer a valuable tool for disseminating scientific information about pneumonia, increasing its visibility, and in general raising awareness about this preventable disease., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Published
2020
Full Text
View/download PDF

44. Gender differences in community-acquired pneumonia.

Author

Barbagelata E, Cillóniz C, Dominedò C, Torres A, Nicolini A, and Solidoro P

Subjects
Adult, Age Factors, Aged, Biomarkers blood, Child, Community-Acquired Infections etiology, Community-Acquired Infections immunology, Community-Acquired Infections mortality, Disease Susceptibility, Gonadal Steroid Hormones blood, Hospitalization statistics & numerical data, Humans, Inflammation Mediators blood, Pneumonia immunology, Pneumonia mortality, Pneumonia, Bacterial microbiology, Quality of Health Care, Severity of Illness Index, Sexism, Delivery of Health Care, Pneumonia etiology, Sex Factors
Abstract

Introduction: Community-acquired pneumonia (CAP) is the most common type of lower respiratory tract infection and a major cause of morbidity and mortality in adults worldwide. Sex and gender play an active role in the incidence and outcomes of major infectious diseases, including CAP., Evidence Acquisition: We searched the following electronic databases from January 2001 to December 2018: MEDLINE, EMBASE, CINHAIL, CENTRAL (Cochrane Central register of Controlled Trials), DARE (Database of Abstracts of Reviews of Effectiveness), Cochrane Database of Systematic Reviews and ACP Journal Club database., Evidence Synthesis: Several studies have reported higher male susceptibility to pulmonary infections and higher risk of death due to sepsis. Biological differences (e.g. hormonal cycles and cellular immune-mediated responses) together with cultural, behavioral and socio-economic differences are important determinants of the course and outcome of CAP. However, gender-related bias in the provision of care and use of hospital resources has been reported among women, resulting in delayed hospital admission and consequently necessary care., Conclusions: CAP is more severe in males than in females, leading to higher mortality in males, especially in older age. To identify gender differences in CAP can guide patient's prognostication and management.

Published
2020
Full Text
View/download PDF

45. Community-acquired pneumonia in critically ill very old patients: a growing problem.

Author

Cillóniz C, Dominedò C, Pericàs JM, Rodriguez-Hurtado D, and Torres A

Subjects
Age Factors, Aged, Aged, 80 and over, Community-Acquired Infections diagnosis, Community-Acquired Infections mortality, Community-Acquired Infections physiopathology, Comorbidity, Critical Illness, Functional Status, Geriatric Assessment, Humans, Pneumonia diagnosis, Pneumonia mortality, Pneumonia physiopathology, Polypharmacy, Prognosis, Risk Assessment, Risk Factors, Community-Acquired Infections therapy, Frail Elderly, Pneumonia therapy
Abstract

Very old (aged ≥80 years) adults constitute an increasing proportion of the global population. Currently, this subgroup of patients represents an important percentage of patients admitted to the intensive care unit. Community-acquired pneumonia (CAP) frequently affects very old adults. However, there are no specific recommendations for the management of critically ill very old CAP patients. Multiple morbidities, polypharmacy, immunosenescence and frailty contribute to an increased risk of pneumonia in this population. CAP in critically ill very old patients is associated with higher short- and long-term mortality; however, because of its uncommon presentation, diagnosis can be very difficult. Management of critically ill very old CAP patients should be guided by their baseline characteristics, clinical presentation and risk factors for multidrug-resistant pathogens. Hospitalisation in intermediate care may be a good option for critical ill very old CAP patients who do not require invasive procedures and for whom intensive care is questionable in terms of benefit., Competing Interests: Conflict of interest: C. Cillóniz has nothing to disclose. Conflict of interest: C. Dominedò has nothing to disclose. Conflict of interest: J.M. Pericàs has nothing to disclose. Conflict of interest: D. Rodriguez-Hurtado has nothing to disclose. Conflict of interest: A. Torres has nothing to disclose., (Copyright ©ERS 2020.)

Published
2020
Full Text
View/download PDF

46. Defining Community-Acquired Pneumonia as a Public Health Threat: Arguments in Favor from Spanish Investigators.

Author

Cillóniz C, Menéndez R, García-Vidal C, Péricas JM, and Torres A

Abstract

Despite advances in its prevention, pneumonia remains associated with high morbidity, mortality, and health costs worldwide. Studies carried out in the last decade have indicated that more patients with community-acquired pneumonia (CAP) now require hospitalization. In addition, pneumonia management poses many challenges, especially due to the increase in the number of elderly patients with multiple comorbidities, antibiotic-resistant pathogens, and the difficulty of rapid diagnosis. In this new call to action, we present a wide-ranging review of the information currently available on CAP and offer some reflections on ways to raise awareness of this disease among the general public. We discuss the burden of CAP and the importance of attaining better, faster microbiological diagnosis and initiating appropriate treatment. We also suggest that closer cooperation between health professionals and the population at large could improve the management of this largely preventable infectious disease that takes many lives each year., Competing Interests: The authors declare that they have no competing interests.

Published
2020
Full Text
View/download PDF

47. Can Artificial Intelligence Improve the Management of Pneumonia.

Author

Chumbita M, Cillóniz C, Puerta-Alcalde P, Moreno-García E, Sanjuan G, Garcia-Pouton N, Soriano A, Torres A, and Garcia-Vidal C

Abstract

The use of artificial intelligence (AI) to support clinical medical decisions is a rather promising concept. There are two important factors that have driven these advances: the availability of data from electronic health records (EHR) and progress made in computational performance. These two concepts are interrelated with respect to complex mathematical functions such as machine learning (ML) or neural networks (NN). Indeed, some published articles have already demonstrated the potential of these approaches in medicine. When considering the diagnosis and management of pneumonia, the use of AI and chest X-ray (CXR) images primarily have been indicative of early diagnosis, prompt antimicrobial therapy, and ultimately, better prognosis. Coupled with this is the growing research involving empirical therapy and mortality prediction, too. Maximizing the power of NN, the majority of studies have reported high accuracy rates in their predictions. As AI can handle large amounts of data and execute mathematical functions such as machine learning and neural networks, AI can be revolutionary in supporting the clinical decision-making processes. In this review, we describe and discuss the most relevant studies of AI in pneumonia.

Published
2020
Full Text
View/download PDF

48. Macrolide combination therapy for hospitalised CAP patients? An individualised approach supported by machine learning.

Author

Garcia-Vidal C, Cillóniz C, and Torres A

Subjects
Anti-Bacterial Agents, Humans, Machine Learning, Macrolides, Community-Acquired Infections, Pneumonia
Abstract

Competing Interests: Conflict of interest: C. Garcia-Vidal has nothing to disclose. Conflict of interest: C. Cilloniz has nothing to disclose. Conflict of interest: A. Torres has nothing to disclose.

Published
2019
Full Text
View/download PDF

49. An overview of guidelines for the management of hospital-acquired and ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria.

Author

Cillóniz C, Dominedò C, and Torres A

Subjects
Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents adverse effects, Disease Management, Drug Therapy, Combination, Humans, Practice Guidelines as Topic, Treatment Outcome, Anti-Bacterial Agents therapeutic use, Cross Infection, Drug Resistance, Multiple, Bacterial, Gram-Negative Bacteria drug effects, Gram-Negative Bacterial Infections drug therapy, Gram-Negative Bacterial Infections microbiology, Pneumonia, Ventilator-Associated drug therapy, Pneumonia, Ventilator-Associated microbiology
Abstract

Purpose of Review: Multidrug-resistant (MDR) Gram-negative pathogens in hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are associated with poor clinical outcomes. These pathogens represent a global threat with few therapeutic options. In this review, we discuss current guidelines for the empiric management of HAP/VAP caused by MDR Gram-negative pathogens., Recent Findings: The incidence of MDR Gram-negative bacteria is rising among cases of nosocomial pneumonia, such that it is now becoming a significant challenge for clinicians. Adherence to international guidelines may ensure early and adequate antimicrobial therapy, guided by local microbiological data and awareness of the risk factors for MDR bacteria., Summary: Due to the increasing prevalence of HAP/VAP caused by MDR Gram-negative pathogens, management should be guided by the local ecology and the patient's risk factors for MDR pathogens. The main risk factors are prior hospitalization for at least 5 days, prior use of broad-spectrum antibiotics, prior colonization with resistant pathogens, admission to hospital settings with high rates of MDR pathogens, and septic shock at the time of diagnosis with nosocomial pneumonia.

Published
2019
Full Text
View/download PDF

50. Pneumocystis pneumonia in the twenty-first century: HIV-infected versus HIV-uninfected patients.

Author

Cillóniz C, Dominedò C, Álvarez-Martínez MJ, Moreno A, García F, Torres A, and Miro JM

Subjects
AIDS-Related Opportunistic Infections epidemiology, Animals, Humans, Pneumonia, Pneumocystis diagnosis, Pneumonia, Pneumocystis immunology, Randomized Controlled Trials as Topic, HIV Infections complications, Immunocompromised Host, Pneumonia, Pneumocystis epidemiology
Abstract

Introduction : Pneumocystis pneumonia (PcP) has classically been described as a serious complication in patients infected with the human immunodeficiency virus (HIV). However, the emerging number of conditions associated with immunosuppression has led to its appearance in other patient populations. Areas covered : This article reviews the most recent publications on PcP in the HIV-infected and HIV-uninfected population, focusing on epidemiology, diagnostic, therapy and prevention. The data discussed here were mainly obtained from a non-systematic review using Medline and references from relevant articles including randomized clinical trials, meta-analyses, observational studies and clinical reviews. Expert opinion : The growing incidence of Pneumocystis infection in the HIV-uninfected population suggests the need for new global epidemiological studies in order to identify the true scale of the disease in this population. These data would allow us to improve diagnosis, therapeutic strategies, and clinical management. It is very important that both patients and physicians realize that HIV-uninfected patients are at risk of PcP and that rapid diagnosis and early initiation of treatment are associated with better prognosis. Currently, in-hospital mortality rates are very high: 15% for HIV-infected patients and 50% in some HIV-uninfected patients. Therefore, adequate preventive measures should be implemented to avoid the high mortality rates seen in recent decades.

Published
2019
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results