Archive for April, 2009

Update: Swine-Origin Influenza A (H1N1) Virus — United States and Other Countries

MMWR Weekly May 1, 2009 V.58 N.16 p.421

Full Text

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a1.htm?s_cid=mm5816a1_e

PDF

http://www.cdc.gov/mmwr/PDF/wk/mm5816.pdf

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April 30, 2009 at 6:34 pm Leave a comment

Update: Drug Susceptibility of Swine-Origin Influenza A (H1N1) Viruses, April 2009

MMWR Dispatch  April 28, 2009  V.58  p.1-3
As of April 28, 2009, viruses from 13 (20%) of 64 patients in the United States infected with swine-origin influenza A (H1N1) virus (S-OIV) have been tested for resistance to antiviral medications.
To date, all tested viruses are resistant to amantadine and rimantadine but are susceptible to oseltamivir and zanamivir. This report provides detailed information on the drug susceptibility of the newly detected S-OIVs, which will aid in making recommendations for treatment and prophylaxis for S-OIV infection and will contribute to antiviral-resistance monitoring and diagnostic test development.
Full Text
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0428a1.htm?s_cid=mm58d0428a1_e
PDF
http://www.cdc.gov/mmwr/PDF/wk/mm58d0428.pdf
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April 29, 2009 at 12:00 am Leave a comment

GRIPE ó INFLUENZA PORCINA

From CDC

Preguntas y Respuestas

¿Qué es la influenza porcina?

La influenza porcina (gripe porcina) es una enfermedad respiratoria de los cerdos causada por el virus de la influenza tipo A, el cual provoca brotes comunes de influenza entre estos animales. Los virus de la influenza porcina enferman gravemente a los cerdos pero las tasas de mortalidad son bajas. Estos virus pueden propagarse entre los cerdos durante todo el año, pero la mayoría de los brotes infecciosos ocurren en los meses finales del otoño e invierno, al igual que los brotes en las personas. El virus de la influenza porcina clásico (virus de la influenza H1N1 tipo A) fue aislado por primera vez de un cerdo en 1930.

¿Cuántos virus de la influenza porcina hay?

Al igual que todos los virus de la influenza, los virus de la influenza porcina cambian de manera constante. Los cerdos pueden estar infectados por los virus de la influenza aviar y humana, así como también por los virus de la influenza porcina. Cuando los virus de la influenza de otras especies infectan a los cerdos, los virus pueden reagruparse (es decir cambiar sus genes) y pueden surgir nuevos virus de la mezcla de los virus de la gripe porcina con los de la gripe humana o aviar. A través de los años, han surgido diferentes variaciones de los virus de la influenza porcina. En la actualidad, hay cuatro subtipos principales del virus de la influenza tipo A aislados de cerdos: H1N1, H1N2, H3N2 y H3N1. Sin embargo, la mayoría de los virus de la influenza aislados recientemente de cerdos han sido los virus H1N1.

Influenza porcina en seres humanos

¿Los seres humanos pueden contagiarse de influenza porcina?

Los virus de la influenza porcina por lo general no infectan a los seres humanos. Sin embargo, han ocurrido casos esporádicos de infecciones de influenza porcina en seres humanos. Por lo general, estos casos se presentan en personas que tienen exposición directa a los cerdos (es decir, niños que se acercan a los cerdos en ferias o trabajadores de la industria porcina). Además, ha habido algunos casos documentados de personas que han contagiado el virus de la influenza porcina a otras. Por ejemplo, en 1988, un presunto brote infeccioso de influenza porcina en cerdos en Wisconsin causó múltiples infecciones en seres humanos y, aunque no ocurrió un brote en la comunidad, se identificaron anticuerpos que comprobaron la transmisión del virus de un paciente a personal de atención médica que habían tenido contacto cercano con él.

¿Con qué frecuencia se registran infecciones de influenza porcina en seres humanos?

En el pasado, los CDC recibían notificaciones de aproximadamente un caso de infección por el virus de la influenza porcina en seres humanos cada uno o dos años en los Estados Unidos; sin embargo, de diciembre del 2005 a febrero del 2009 se han reportado 12 casos de infecciones por influenza porcina en personas.

¿Cuáles son los síntomas de la influenza porcina en los seres humanos?

Los síntomas de la influenza porcina en las personas son similares a los de la influenza estacional común en seres humanos y entre estos se incluyen fiebre, letargo, falta de apetito y tos. Algunas personas con influenza porcina han reportado también secreciones nasales, dolor de garganta, náuseas, vómitos y diarrea.

¿Las personas pueden contraer influenza porcina por comer carne de cerdo?

No. Los virus de la influenza porcina no se transmiten por los alimentos. Usted no puede contraer influenza porcina por comer carne de cerdo o sus productos derivados. No hay riesgos si se come carne de cerdo y sus derivados que han sido manipulados y cocinados de manera adecuada. Si se cocina la carne de cerdo a una temperatura interna de aproximadamente 71° C (160° F), se eliminan los virus de la influenza porcina, como también otras bacterias y virus.

¿Cómo se propaga la influenza porcina?

Los virus de la influenza se pueden transmitir directamente de los cerdos a las personas y de las personas a los cerdos. Las infecciones en seres humanos por los virus de la influenza provenientes de los cerdos tienen más probabilidad de ocurrir en las personas que están en contacto cercano con cerdos infectados, como las que trabajan en criaderos de cerdos y las que participan en las casetas de cerdos en las ferias de exhibiciones de animales de cría. La transmisión de la influenza porcina de persona a persona también puede ocurrir. Se cree que esta transmisión es igual a la de la influenza estacional en las personas, es decir principalmente de persona a persona cuando las personas infectadas por el virus de la influenza tosen o estornudan. Las personas pueden infectarse al tocar algo que tenga el virus de la influenza y luego llevarse las manos a la boca o la nariz.

¿Qué información tenemos sobre la transmisión de la influenza porcina de persona a persona?

En septiembre de 1988, una mujer embarazada sana de 32 años de edad fue hospitalizada por pulmonía y falleció 8 días después. El virus de la influenza porcina H1N1 fue detectado. Cuatro días antes de enfermarse, la paciente había visitado una exhibición de cerdos en una feria del condado donde se registraba una enfermedad seudogripal generalizada entre los cerdos.

En estudios de seguimiento, el 76% de los expositores de cerdos a los cuales se les realizaron pruebas presentaron anticuerpos que comprobaron infección por influenza porcina, aunque en este grupo no se detectaron enfermedades graves. Estudios adicionales indicaron que de uno a tres empleados del personal de atención médica que habían tenido contacto con la paciente presentaron enfermedad seudogripal leve y anticuerpos contra la infección de la influenza porcina.

¿Cómo se diagnostican las infecciones por influenza porcina en seres humanos?

Para diagnosticar una infección por influenza porcina tipo A, por lo general se debe recoger una muestra de secreción del aparato respiratorio entre los primeros 4 a 5 días de aparecida la enfermedad (cuando una persona infectada tiene más probabilidad de diseminar el virus). Sin embargo, algunas personas, especialmente los niños, pueden propagar el virus durante 10 días o más. Para la identificación del virus de la influenza porcina tipo A es necesario enviar la muestra a los CDC para que se realicen pruebas de laboratorios.

¿Qué medicamentos existen para tratar a las personas con infecciones por influenza porcina?

Existen cuatro medicamentos antivirales diferentes que están autorizados en los Estados Unidos para el tratamiento de la influenza: amantadina, rimantadina, oseltamivir y zanamivir. Aunque la mayoría de los virus de la influenza porcina han sido sensibles a los cuatro tipos de medicamentos, los siete virus más recientes de la influenza porcina asilados de personas son resistentes a la amantadina y la rimantadina. En la actualidad, los CDC recomiendan el uso de oseltamivir o zanamivir para la prevención y el tratamiento de la infección por los virus de la influenza porcina. Puede encontrar más información sobre las recomendaciones para el tratamiento en el sitio http://www.cdc.gov/flu/swine/recommendations.htm.

¿Qué otros casos de brotes de influenza porcina hay?

Probablemente el caso más conocido sea el brote de influenza porcina entre los soldados de Fort Dix, Nueva Jersey, en 1976 . Este virus causó pulmonía, demostrada mediante radiografías, a por lo menos 4 soldados y 1 muerte; todos estos pacientes anteriormente gozaban de buena salud. El virus se transmitió a contactos cercanos en un ambiente de entrenamiento básico, y no ocurrió transmisión afuera del grupo de entrenamiento básico. Se cree que el virus permaneció en ese lugar un mes y desapareció. Se desconocen la fuente del virus, la fecha exacta de su ingreso a Fort Dix, los factores que limitaron su transmisión y su duración. El brote de Fort Dix pudo haber sido causado por el ingreso de un virus de un animal a una población humana bajo estrés en contacto cercano con instalaciones saturadas de gente y durante el invierno. El virus de la influenza porcina tipo A recogido de un soldado de Fort Dix fue bautizado A/New Jersey/76 (Hsw1N1).

¿El virus de la influenza porcina H1N1 es igual a los virus H1N1 de la influenza en seres humanos?

No. Los virus de la influenza porcina H1N1 son antigénicamente muy diferentes de los virus H1N1 de los seres humanos, por consiguiente las vacunas de la influenza estacional para las personas no proporcionan protección contra los virus de la influenza porcina H1N1.

Influenza porcina en cerdos

¿Cómo se propaga la influenza porcina entre los cerdos?

Se cree que los virus de la influenza porcina se transmiten principalmente mediante el contacto cercano entre cerdos y posiblemente mediante objetos contaminados que se mueven entre los cerdos infectados y sanos. Las manadas de cerdos con continuas infecciones de influenza porcina y las manadas que son vacunadas contra esta enfermedad pueden enfermarse de manera esporádica, pueden ser asintomáticas o solo presentar síntomas leves de la infección.

¿Cuáles son los signos de la influenza porcina en los cerdos?

Los signos de la influenza porcina puede ser la aparición súbita de fiebre, depresión, tos (gruñido), secreciones de la nariz y los ojos, estornudos, dificultad para respirar, enrojecimiento o inflamación de ojos y pérdida del interés en la comida.

¿Qué tan frecuente es la influenza porcina entre los cerdos?

Los virus de la influenza porcina H1N1 y H3N2 son endémicos entre las poblaciones de cerdos en los Estados Unidos y es una situación que la industria aborda de manera habitual. Los brotes entre los cerdos se presentan por lo general en los meses de temperaturas frías (finales del otoño y el invierno) y a veces con el ingreso de nuevos cerdos a manadas vulnerables. Los estudios han demostrado que la influenza porcina H1N1 es común entre las poblaciones de cerdos de todo el mundo y que un 25 por ciento de los animales presentan evidencia de anticuerpos de la infección. Los estudios en los Estados Unidos han demostrado que el 30 por ciento de la población de los cerdos sometidos a pruebas han presentado evidencia de anticuerpos por la infección H1N1. Para ser más precisos, se ha comprobado la presencia de los anticuerpos de la infección H1N1 en el 51 por ciento de los cerdos en el norte de la región central de los Estados Unidos. Las infecciones en las personas por los virus H1N1 de la influenza porcina son poco comunes. En la actualidad, no hay forma de diferenciar en los cerdos los anticuerpos producidos en reacción a la vacunación de los anticuerpos generados ante las infecciones por influenza porcina H1N1.

Aunque los virus de la influenza porcina H1N1 se han encontrado en las poblaciones de cerdos desde por lo menos 1930, los virus de la influenza porcina H3N2 no comenzaron a presentarse entre los cerdos en los Estados Unidos hasta 1998. Los virus H3N2 inicialmente ingresaron a las poblaciones de cerdos por los humanos. Los virus actuales de la influenza porcina H3N2 están estrechamente asociados a los virus H3N2 de los seres humanos.

¿Hay alguna vacuna para la influenza porcina?

Existen vacunas que se administran a los cerdos para la prevención de la influenza porcina. Sin embargo, no hay una vacuna para proteger a las personas contra la influenza porcina. Es posible que la vacuna contra la influenza estacional proporcione protección parcial contra los virus H3N2, pero no contra los virus H1N1 de la influenza porcina.

* Esta página fue actualizada el 23 de abril de 2009

* Fuente del contenido: Centro Coordinador de Enfermedades Infecciosas (CCID)

Versión en ingles

Swine Influenza and You

Questions & Answers

What is swine flu?

Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses. Outbreaks of swine flu happen regularly in pigs. People do not normally get swine flu, but human infections can and do happen. Most commonly, human cases of swine flu happen in people who are around pigs but it’s possible for swine flu viruses to spread from person to person also.

Are there human infections with swine flu in the U.S.?

In late March and early April 2009, cases of human infection with swine influenza A (H1N1) viruses were first reported in Southern California and near San Antonio, Texas. CDC and local and state health agencies are working together to investigate this situation.

Is this swine flu virus contagious?

CDC has determined that this virus is contagious and is spreading from human to human. However, at this time, it not known how easily the virus spreads between people.

What are the signs and symptoms of swine flu in people?

The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

How serious is swine flu infection?

Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later. A swine flu outbreak in Fort Dix, New Jersey occurred in 1976 that caused more than 200 cases with serious illness in several people and one death.

How do you catch swine flu?

Spread of swine flu can occur in two ways:

* Through contact with infected pigs or environments contaminated with swine flu viruses.

* Through contact with a person with swine flu. Human-to-human spread of swine flu has been documented also and is thought to occur in the same way as seasonal flu. Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.

Are there medicines to treat swine flu?

Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).

How long can an infected person spread swine flu to others?

People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possible for up to 7 days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.

What can I do to protect myself from getting sick?

There is no vaccine available right now to protect against swine flu. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

* Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are

also effective.

* Try to avoid close contact with sick people.

* If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them. Avoid touching your eyes, nose or mouth. Germs spread

this way.

What should I do if I get sick?

If you live in San Diego County or Imperial County California or Guadalupe County, Texas and become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you may want to contact their health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed.

If you are sick, you should stay home and avoid contact with other people as much as possible to keep from spreading your illness to others.

If you become ill and experience any of the following warning signs, seek emergency medical care.

In children emergency warning signs that need urgent medical attention include:

* Fast breathing or trouble breathing

* Bluish skin color

* Not drinking enough fluids

* Not waking up or not interacting

* Being so irritable that the child does not want to be held

* Flu-like symptoms improve but then return with fever and worse cough

* Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

* Difficulty breathing or shortness of breath

* Pain or pressure in the chest or abdomen

* Sudden dizziness

* Confusion

* Severe or persistent vomiting

Can I get swine influenza from eating or preparing pork?

No. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe.

# Page last updated April 24, 2009

# Content source: Centers for Disease Control and Prevention

http://www.cdc.gov/swineflu/swineflu_you.htm

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April 25, 2009 at 6:14 pm Leave a comment

Swine Flu – CDC

Presented by the Centers for Disease Control and Prevention. CDC

I’m Dr. Joe Bresee with the CDC Influenza Division. I’m here to speak with you today about swine flu.

First, I’ll begin by explaining what swine flu is. Swine flu is a respiratory disease of pigs caused by type A influenza viruses. Outbreaks of swine flu happen regularly in pigs. People do not normally get swine flu, but human infections can and do occur. Most commonly, human cases of swine flu happen in people who are around pigs, but it’s possible for swine flu viruses to spread from person to person, also.

The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills, and fatigue. Some people have reported diarrhea and vomiting associated with swine flu, as well. In the past, severe illnesses, such as pneumonia and respiratory failure, as well as deaths, have been reported with swine influenza infection in people, as well. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

I’ll now discuss the severity of swine flu illness in people. Similar to seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the United States with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu, and she died eight days later. A swine flu outbreak in Fort Dix, New Jersey occurred in 1976 that caused more than 200 cases with severe illness in several people and one death.

Spread of swine flu can occur in two ways. The first way is through contact with infected pigs or environments contaminated with swine flu viruses. The second way is through contact with a person infected with a swine flu virus. Human-to-human spread of swine flu has also been documented and is thought to occur in the same way as seasonal flu. Influenza is thought to be spread mainly person-to-person through coughing or sneezing of infected people.

Next, I would like to tell you about medicines that can be used to treat swine flu. CDC recommends the use of oseltamivir or zanamivir for the treatment and, alternatively, prevention of infection with these swine flu viruses. Antiviral drugs are prescription medicines, such as pills, liquids, or inhaler that fights against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and can make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick, specifically within two days of symptoms.

People with swine influenza infection should be considered potentially contagious as long as they are symptomatic, and possibly for up to seven days following the illness onset. Children, especially younger children, might potentially be contagious for longer periods.

There is no vaccine available right now to protect against swine flu. However, there are everyday actions that people can take to help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.

• Try to avoid close contact with sick people. If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

• Avoid touching your eyes, nose, or mouth because germs can spread that way.

Now, I will move on to discuss what you should do if you get sick. If you live in an area where swine flu infections have been reported, and if you become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you may want to contact your health care provider, particularly if you’re worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed. If you’re sick, you should stay home and avoid contact with other people as much as possible to keep from spreading your illness to others.

If you become ill and experience any of the following warning signs, seek emergency medical care. In children, emergency warning signs that need urgent medical attention include: fast breathing or trouble breathing, bluish skin color, not drinking enough fluids, not waking up or not interacting, being so irritable that the child does not want to be held, fever with a rash, or flu-like symptoms that improve but then return with a fever and worse cough.

In adults, emergency warning signs that need urgent medical attention include: difficulty breathing or shortness of breath, pain or pressure in the chest or abdomen, sudden dizziness, confusion, and severe or persistent vomiting.

People don’t need to worry about eating or preparing pork. Swine influenza viruses are not spread by food. Eating properly handled and cooked pork products is safe.

http://www2a.cdc.gov/podcasts/player.asp?f=11226#transcript

PDF

http://www2a.cdc.gov/podcasts/media/pdf/SwineFlu.pdf

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April 25, 2009 at 6:08 pm Leave a comment

Cases of Swine Influenza in Humans: A Review of the Literature

Clinical Infectious Diseases 15 April 2007 V.44 N.8 p.1084–8

REVIEW ARTICLE

Kendall P. Myers,1,2 Christopher W. Olsen,3 and Gregory C. Gray1

1Center for Emerging Infectious Diseases, Department of Epidemiology, and 2Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City; and 3Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin–Madison

As the threat of a pandemic looms, improvement in our understanding of interspecies transmission of influenza is necessary. Using the search terms “swine,” “influenza,” and “human,” we searched the PubMed database in April 2006 to identify publications describing symptomatic infections of humans with influenza viruses of swine origin. From these reports, we extracted data regarding demographic characteristics, epidemiological investigations, and laboratory results. We found 50 cases of apparent zoonotic swine influenza virus infection, 37 of which involved civilians and 13 of which involved military personnel, with a case‐fatality rate of 14% (7 of 50 persons). Most civilian subjects (61%) reported exposure to swine. Although sporadic clinical cases of swine influenza occur in humans, the true incidence of zoonotic swine influenza virus infection is unknown. Because prior studies have shown that persons who work with swine are at increased risk of zoonotic influenza virus infection, it is prudent to include them in pandemic planning efforts.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/512813

PDF

http://www.journals.uchicago.edu/doi/pdf/10.1086/512813

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April 25, 2009 at 2:34 am Leave a comment

Swine Influenza A (H1N1) Infections California and Texas, April 2009

MMWR Dispatch April 24, 2009 V.58 p.1-3

Update

CDC has identified six new cases of a novel swine influenza A (H1N1) virus first identified on April 17 in two children in southern California. The six additional cases were reported in San Diego County (three cases) and Imperial County, California (one case), and in Guadalupe County, Texas (two cases). In addition, CDC has confirmed that the same unique strain of swine influenza A (H1N1) virus has been isolated among specimens from patients in Mexico. CDC continues to recommend that any influenza A viruses that cannot be subtyped be sent promptly for testing to CDC

Full Text

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0424a1.htm?s_cid=mm58d0424a1_e

PDF

http://www.cdc.gov/mmwr/PDF/wk/mm58d0424.pdf

April 25, 2009 at 2:19 am Leave a comment

PIRO score for community-acquired pneumonia: A new prediction rule for assessment of severity in intensive care unit patients with community-acquired pneumonia

Critical Care Medicine February 2009 V.37 N.2 p.456-462

Rello, Jordi MD, PhD; Rodriguez, Alejandro MD, PhD; Lisboa, Thiago MD; Gallego, Miguel MD; Lujan, Manel MD; Wunderink, Richard MD, PhD

Objective: To develop a severity assessment tool to predict mortality in community-acquired pneumonia (CAP) patients in intensive care unit (ICU), comparing its performance with Acute Physiology and Chronic Health Evaluation (APACHE) II score and American Thoracic Society/Infectious Disease Society of America (ATS/IDSA) criteria as a prognostic index in CAP patients requiring ICU admission.

Design: Secondary analysis of prospective observational cohort study.

Setting: Thirty-three ICUs.

Patients: Five hundred and twenty-nine adult patients with CAP requiring ICU admission.

Measurements and Main Results: A severity assessment score was developed based on the PIRO (predisposition, insult, response, and organ dysfunction) concept including the presence of the following variables: Comorbidities (chronic obstructive pulmonary disease, immunocompromise); age >70 years; multilobar opacities in chest radiograph; shock, severe hypoxemia; acute renal failure; bacteremia and acute respiratory distress syndrome. PIRO score was obtained at ICU within 24 hours from admission, and one point was given for each present feature (range, 0-8 points). The mean PIRO score was significantly higher in nonsurvivors than in survivors (4.6 +/- 1.2 vs. 2.3 +/- 1.4). Considering the observed mortality for each PIRO score, the patients were stratified in four levels of risk: a) Low, 0-2 points; b) Mild, 3 points; c) high, 4 points; and d) Very high, 5-8 points. Mild-risk (hazard ratio [HR] 1.8; 95% confidence interval [CI] 1.1-2.9; p < 0.05), high-risk (HR 3.1; 95% CI = 2.0-4.7; p < 0.001), and very high risk levels (HR 6.3; 95% CI = 4.2-9.4; p < 0.001) were significantly associated with higher risk of death in Cox proportional hazards regression analysis. Furthermore, analysis of variance showed that higher levels of PIRO score were significantly associated with higher mortality (p < 0.001), prolonged length of stay in the ICU (p < 0.001), and days of mechanical ventilation (p < 0.001). Receiver operating characteristic curves showed that PIRO score (area under the curve [AUC] = 0.88) performed better than APACHE II (AUC = 0.75, p < 0.001) and ATS/IDSA criteria (AUC = 0.80, p < 0.001) to predict 28-day mortality.

Conclusions: The PIRO score performed well as 28-day mortality prediction tool in CAP patients requiring ICU admission with a better performance than APACHE II and ATS/IDSA criteria in this subset of patients. Furthermore, PIRO score also is associated with increased healthcare resource utilization in CAP patients admitted in the ICU.

abstract

http://www.ccmjournal.com/pt/re/ccm/abstract.00003246-200902000-00009.htm;jsessionid=JxQGjYPd9v43l84L1ZWwjFRvv8YT6qhlnB1ShGsJVCTLQypvqcyT!928310026!181195629!8091!-1

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April 24, 2009 at 1:59 pm Leave a comment

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