Posts filed under ‘Inmunizaciones’

Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients

Clin Infect Dis. April 24, 2019 V.68 N.9 P.1482-1493. 

Background

The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia.

Methods

We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor.

Results

At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non-community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P < .001).

Conclusions

Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses.

FULL TEXT

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481991/

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481991/pdf/ciy723.pdf

 

July 13, 2020 at 3:53 pm

Summary of the international clinical guidelines for the management of hospital-acquired and ventilator-acquired pneumonia

ERJ Open Res. Jube 26, 2018 V.4 N.2 

FULL TEXT

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018155/

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018155/pdf/00028-2018.pdf

July 13, 2020 at 3:49 pm

International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia

Eur Respir J. September 10, 2017 V.50 N.3 

Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT)

The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent.The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited.A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink).Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population-intervention-comparison-outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention.

FULL TEXT

https://erj.ersjournals.com/content/50/3/1700582.long

PDF

https://erj.ersjournals.com/content/erj/50/3/1700582.full.pdf

July 13, 2020 at 3:45 pm

Is BCG Vaccination Causally Related to Reduced COVID-19 Mortality?

EMBO Mol Med. June 8, 2020 V.12 N.6:e12661. 

The ongoing severe acute respiratory sickness coronavirus 2 (SARS-CoV-2) pandemic has resulted in more than 3,600,000 detected cases of COVID-19 illness and nearly 260,000 deaths worldwide as of May 6, 2020. Recently, BCG vaccination was shown to correlate with reduced COVID-19 case fatality rates (preprint: Miller et al, 2020; preprint: Sala & Miyakawa, 2020; https://www.jsatonotes.com/2020/03/if-i-were-north-americaneuropeanaustral.html). The most recent data from publicly available resources also indicate that both COVID-19 incidence and total deaths are strongly associated with the presence or absence of national mandatory BCG vaccination programs. As seen in Table 1, seven of eight countries with very low numbers of total deaths (< 40 per 1 million population) adopted a mandatory BCG vaccination program using one of a set of 6 separate BCG strains (Table 1). In contrast, COVID-19 mortality was markedly higher in countries where BCG vaccination is not widely administered or is given only to high-risk groups. COVID-19 mortality was also higher in countries where widespread BCG vaccination was discontinued more than 20 years ago and in countries that used the BCG Denmark strain regularly or temporarily. This raises the question of whether BCG vaccination and reduced COVID-19 mortality are causally related. An additional question is why different BCG strains may be variably associated with mortality.

FULL TEXT

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267326/

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267326/pdf/EMMM-12-e12661.pdf

July 11, 2020 at 7:32 pm

REVIEW – BCG-induced Trained Immunity: Can It Offer Protection Against COVID-19?

Nat Rev Immunol. June 2020 V.20 N.6 P.335-337. 

Bacillus Calmette–Guérin (BCG) vaccination has been reported to decrease susceptibility to respiratory tract infections, an effect proposed to be mediated by the general long-term boosting of innate immune mechanisms, also termed trained immunity. Here, we discuss the non-specific beneficial effects of BCG against viral infections and whether this vaccine may afford protection to COVID-19.

PDF

https://www.nature.com/articles/s41577-020-0337-y.pdf

July 11, 2020 at 7:31 pm

Is BCG Vaccination Affecting the Spread and Severity of COVID-19?

Allergy. April 24, 2020  

FULL TEXT

https://onlinelibrary.wiley.com/doi/full/10.1111/all.14344

PDF

https://onlinelibrary.wiley.com/doi/epdf/10.1111/all.14344

July 11, 2020 at 7:29 pm

TB Infection and BCG Vaccination: Are We Protected From COVID-19?

Public Health. May 2020 May V.185 P.91-92.

Objectives

The incidence of emerging coronavirus disease 2019 (COVID-19) disease is variable across the different parts of the world. Apart from travel patterns, other factors determining this difference may include host immune response. The aim of this study was to assess the effect of tuberculosis (TB) endemicity and Bacille Calmette-Guerin (BCG) coverage on COVID-19.

Study design

This was a cross-sectional study.

Methods

We reviewed available data regarding TB incidence, BCG coverage (as per the World Health Organization), and COVID-19 incidence of 174 countries. We divided the countries into four cohorts depending on annual TB incidence and BCG coverage.

Results

Countries with high TB incidence had lower COVID-19 than countries with low TB incidence. Similarly, countries with high BCG coverage had lower incidence of COVID-19, suggesting some protective mechanisms in TB-endemic areas. However, the ecological differences and different testing strategies between countries could not be accounted for in this analysis.

Conclusion

Higher TB incidence and BCG coverage were found to be associated with lesser incidence of COVID-19. This outcome paves the way for further research into pathogenesis and immune response in COVID-19.

FULL TEXT

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260483/

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260483/pdf/main.pdf

July 11, 2020 at 7:28 pm

REVIEW – Perioperative Considerations in Urgent Surgical Care of Suspected and Confirmed COVID-19 Orthopaedic Patients: Operating Room Protocols and Recommendations in the Current COVID-19 Pandemic

J Am Acad Orthop Surg. June 2020 V.28 N.11 P.451-463

Mohamed E. Awad, MD

Jacob C.L. Rumley, DO

Jose A. Vazquez, MD, FACP, FIDSA

John G. Devine, MD, FAOA

From the Hull College of Business, Augusta University (Dr. Awad), the Department of Orthopedic Surgery,

Medical College of Georgia, Augusta University (Dr. Awad, Dr. Rumley, and Dr. Devine), the Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Augusta University (Dr. Vazquez), and Antimicrobial Stewardship Service, Augusta University (Dr. Vazquez), Augusta, GA.

By April 7, 2020, severe acute respiratory syndrome coronavirus 2 was responsible for 1,383,436 confirmed cases of Coronavirus disease 2019 (COVID-19), involving 209 countries around the world; 378,881 cases have been confirmed in the United States. During this pandemic, the urgent surgical requirements will not stop. As an example, the most recent Centers of Disease Control and Prevention reports estimate that there are 2.8 million trauma patients hospitalized in the United States. These data illustrate an increase in the likelihood of encountering urgent surgical patients with either clinically suspected or confirmed COVID-19 in the near future. Preparation for a pandemic involves considering the different levels in the hierarchy of controls and the different phases of the pandemic. Apart from the fact that this pandemic certainly involves many important health, economic, and community ramifications, it also requires several initiatives to mandate what measures are most appropriate to prepare for mitigating the occupational risks. This article provides evidence-based recommendations and measures for the appropriate personal protective equipment for different clinical and surgical activities in various settings. To reduce the occupational risk in treating suspected or confirmed COVID-19 urgent orthopaedic patients, recommended precautions and preventive actions (triage area, emergency department consultation room, induction room, operating room, and recovery room) are reviewed….

FULL TEXT

https://pubmed.ncbi.nlm.nih.gov/32282441/

June 24, 2020 at 3:18 pm

Community-acquired pneumonia in critically ill very old patients – a growing problem

European Respiratory Review March 2020

Los adultos ≥ 80 años constituyen una proporción creciente de la población mundial.

Actualmente, este subgrupo de pacientes representa un porcentaje importante de pacientes ingresados en  UCI.

La neumonía adquirida en la comunidad (NAC) con frecuencia afecta a adultos muy mayores, sin embargo, no hay recomendaciones específicas para el manejo de pacientes crónicamente enfermos con NAC > 80 años.

La morbilidad múltiple, la polifarmacia, la inmunosenescencia y la fragilidad contribuyen a un mayor riesgo de NAC en esta población.

La NAC en pacientes críticos > 80 años se asocia con una mayor mortalidad a corto y largo plazo, sin embargo, debido a su presentación poco común, el diagnóstico puede ser muy difícil.

El manejo de pacientes con NAC críticamente enfermos debe guiarse por sus características basales, presentación clínica y factores de riesgo para patógenos resistentes a múltiples antimicrobianos.

La hospitalización en cuidados intermedios puede ser una buena opción para pacientes > 80 años críticamente enfermos que no requieren procedimientos invasivos y para quienes las UCI son cuestionables en términos de beneficio.

FULL TEXT

https://err.ersjournals.com/content/29/155/190126

PDF

https://err.ersjournals.com/content/errev/29/155/190126.full.pdf

 

April 10, 2020 at 7:45 pm

Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19 – an epidemiological study

Aaron Miller, Mac Josh Reandelar, Kimberly Fasciglione, Violeta Roumenova, Yan Li, Gonzalo H Otazu

COVID-19 se ha extendido a la mayoría de los países del mundo. Curiosamente, el impacto de la enfermedad no es igual en todos los países.

Estas diferencias se atribuyen a ciertas normas culturales, los esfuerzos de mitigación y la infraestructura de salud.

Los investigadores proponen que las diferencias nacionales en el impacto de COVID-19 podrían explicarse en parte por las diferentes políticas nacionales con respecto a la vacunación infantil Bacillus Calmette-Guerin (BCG).

Se ha informado que la vacuna BCG ofrece una amplia protección a las infecciones respiratorias.

Comparan un gran número de países con políticas de vacunación BCG con la morbi-mortalidad de COVID-19.

Descubren que los países sin políticas universales de vacunación con BCG (Italia, Países Bajos, EEUU.) se han visto más gravemente afectados en comparación con los países con políticas de BCG universales de larga data.

Los países que tienen un comienzo tardío de la política universal de BCG (Irán, 1984) tuvieron una alta mortalidad, en consonancia con la idea de que BCG protege a la población de ancianos vacunados.

También encontraron que la vacuna BCG también redujo el número de casos reportados de COVID-19 en un país. La combinación de reducción de la morbi-mortalidad hace que la vacuna BCG sea una nueva herramienta potencial en la lucha contra COVID-19.

PDF

https://www.medrxiv.org/content/10.1101/2020.03.24.20042937v1.full.pdf

April 4, 2020 at 11:57 am

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