Universidad del Desarrollo

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Increased mortality in hospital- compared to community-onset carbapenem-resistant enterobacterales infections
(2024)
Angelique E Boutzoukas
;
Natalie Mackow
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Abhigya Giri
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Lauren Komarow
;
Carol Hill
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>The CDC reported a 35% increase in hospital-onset (HO) carbapenem-resistant Enterobacterales (CRE) infections during the COVID-19 pandemic. We evaluated patient outcomes following HO and community-onset (CO) CRE bloodstream infections (BSI).</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Patients prospectively enrolled in CRACKLE-2 from 56 hospitals in 10 countries between 30 April 2016 and 30 November 2019 with a CRE BSI were eligible. Infections were defined as CO or HO by CDC guidelines, and clinical characteristics and outcomes were compared. The primary outcome was desirability of outcome ranking (DOOR) 30 days after index culture. Difference in 30-day mortality was calculated with 95% CI.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Among 891 patients with CRE BSI, 65% were HO (582/891). Compared to those with CO CRE, patients with HO CRE were younger [median 60 (Q1 42, Q3 70) years versus 65 (52, 74); P &lt; 0.001], had fewer comorbidities [median Charlson comorbidity index 2 (1, 4) versus 3 (1, 5); P = 0.002] and were more acutely ill (Pitt bacteraemia score ≥4: 47% versus 32%; P &lt; 0.001). The probability of a better DOOR outcome in a randomly selected patient with CO BSI compared to a patient with HO BSI was 60.6% (95% CI: 56.8%–64.3%). Mortality at 30-days was 12% higher in HO BSI (192/582; 33%) than CO BSI [66/309 (21%); P &lt; 0.001].</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>We found a disproportionately greater impact on patient outcomes with HO compared to CO CRE BSIs; thus, the recently reported increases in HO CRE infections by CDC requires rigorous surveillance and infection prevention methods to prevent added mortality.</jats:p> </jats:sec>
Scopus© Citations 1 3
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Coronavirus disease 2019 in patients with inborn errors of immunity: An international study
(2021)
Isabelle Meyts
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Giorgia Bucciol
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Isabella Quinti
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Bénédicte Neven
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Alain Fischer
Scopus© Citations 309 3
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Toma de decisiones en hemodiálisis crónica: estudio cualitativo en adultos mayores
(2020)
María Isabel Catoni
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Sofía P. Salas
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ROESSLER BONZI, EMILIO JOSE
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Andrés Valdivieso
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Antonio Vukusich
7 1Scopus© Citations 2
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Análisis de sobrevida en pacientes incidentes de hemodiálisis en Chile, 2013-2019
(2020)
Rodrigo A. Sepúlveda
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Andrés Pavlovic
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Oscar Corsi
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Aquiles Jara
17Scopus© Citations 3
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Oxidative Stress Markers in COPD Patients Admitted to Pulmonary Rehabilitation
(2021)
Carolina Romero
;
Rodrigo L. Castillo
<jats:sec> <jats:title>Background:</jats:title> <jats:p>Chronic obstructive pulmonary disease (COPD) is a pathology, which leads to an irreversible and progressive reduction of the airflow, usually caused by smoking, but only present in 25% of smokers. Some mechanisms involved in the onset and progression of the disease are local and systemic factors such as inflammation, exacerbated immune response and the appearance of oxidative stress. For all these reasons, the use of oxidative stress parameters as progression markers or even as a way to monitor the response of any kind of non-pharmacological interventions, like the use of pulmonary rehabilitation (PR), is feasible.</jats:p> </jats:sec> <jats:sec> <jats:title>Aims:</jats:title> <jats:p>The study aims to determine markers of oxidative stress levels in plasma and erythrocytes in patients with COPD through the application of a PR protocol.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>The study included 25 patients diagnosed with COPD according to the GOLD criteria with a medical indication of PR and attendance at the gym in San José Hospital, Santiago, Chile. Blood samples were obtained before the start of the protocol, in the 10<jats:sup>th</jats:sup> session, and at the end of the protocol (20<jats:sup>th</jats:sup> session). These samples were stored for oxidative stress determinations: FRAP (ferric reducing ability of plasma), F2-isoprostanes, reduced (GSH)/oxidized (GSSG) ratio and antioxidant enzyme activity in the erythrocyte. In all stages, associations between events and clinical parameters in patients have been observed. The clinical parameters assessed were the six-minute walking test (6MWT), maximal inspiratory and expiratory pressure, the BODE index and Saint George’s respiratory questionnaire, which includes quality of life.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>The intracellular and extracellular capacity (GSH/GSSG and FRAP) in patients in PR at the 10<jats:sup>th</jats:sup> session were 53.1 and 34% higher than basal values, respectively. Only the GSH/GSSG ratio was 38.2% lower at the 20<jats:sup>th</jats:sup> session, related in part with higher plasma and erythrocyte lipid peroxidation at baseline. This could be due to the high concentration of reactive oxygen species in the first sessions, which has been reported in the literature as the acute effect of controlled exercise. Blood lipid peroxidation was 43.34 and 58.34% lower at the 10<jats:sup>th</jats:sup> and 20<jats:sup>th</jats:sup> sessions, respectively, demonstrating the improvements in the oxidative parameters with long-term exercise. With respect to oxidative enzyme activity, superoxide dismutase and catalase showed higher values of activity at the 10th and 20th sessions compared to the baseline. In the clinical parameters of the PR, significant changes were found in the BODE index and Saint George’s questionnaire, with these results being associated with a less predictive mortality score and a better understanding of the disease. This may be because the patients achieved longer distances in the 6MWT and better understood the disease at the end of the PR.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>The goal of this study was to contribute to the pathophysiological basis for further research on COPD patients, a disease of high prevalence in Chile. This study could support the basis for non-pharmacological strategies such a PR.</jats:p> </jats:sec>
2Scopus© Citations 1
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Recommendations of the Ethics Committee of the Chilean Society of Nephrology for the management of ethical problems in adult end stage renal disease patients
(2014)
Antonio Vukusich
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María Isabel Catoni
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Sofía P Salas
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Andrés Valdivieso
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Emilio Roessler
1Scopus© Citations 1 1
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Near-Apneic Ventilation Decreases Lung Injury and Fibroproliferation in an ARDS Model with ECMO
(2019)
Joaquin Araos
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Leyla Alegria
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Patricio Garcia
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Pablo Cruces
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Dagoberto Soto
13Scopus© Citations 96

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