Incidence and impact of hospital-acquired pneumonia: a Portuguese nationwide four-year study

This article presents the incidence of hospital-acquired pneumonia (HAP) in Portugal during a four-year period (2014-2017). Data were retrieved from the 100 Portuguese hospital diagnosis discharge database for adult patients and included gender, age, chronic comorbidities, mortality and hospital length of stay. There were 28,632 episodes of HAP, an incidence of 0.95 per 100 admissions. HAP patients had both a prolonged hospital length of stay (mean 26.4 days) and high mortality (33.6%). Most episodes occurred in patients aged ≥65 years and in males (76.1% and 61.7%, respectively). Invasive ventilation was required in 18.8%.info:eu-repo/semantics/publishedVersio

Pneumococcal vaccination and chronic respiratory diseases

Patients with COPD and other chronic respiratory diseases are especially vulnerable to viral and bacterial pulmonary infections, which are major causes of exacerbations, hospitalization, disease progression, and mortality in COPD patients. Effective vaccines could reduce the burden of respiratory infections and acute exacerbations in COPD patients, but what is the evidence for this? This article reviews and discusses the existing evidence for pneumococcal vaccination efficacy and its changing role in patients with chronic respiratory diseases, especially COPD. Specifically, the recent Community-Acquired Pneumonia Immunization Trial in Adults (CAPITA) showed the efficacy of pneumococcal conjugate vaccine in older adults, many of whom had additional risk factors for pneumococcal disease, including chronic lung diseases. Taken together, the evidence suggests that pneumococcal and influenza vaccinations can prevent community-acquired pneumonia and acute exacerbations in COPD patients, while pneumococcal vaccination early in the course of COPD could help maintain stable health status. Despite the need to prevent pulmonary infections in patients with chronic respiratory diseases and evidence for the efficacy of pneumococcal conjugate vaccine, pneumococcal vaccine coverage and awareness are low and need to be improved. Respiratory physicians need to communicate the benefits of vaccination more effectively to their patients who suffer from chronic respiratory diseases. Keywords: COPD, COPD exacerbation, infection, pneumococcal vaccine

Evidence Associated with the Use of Oxazolidinones for the Treatment of Skin and Skin Structure Infections: A Retrospective Study

INTRODUCTION: Skin and skin structure infections are an increasing cause of hospitalization. Although mortality is relatively low, skin and skin structure infections are associated with prolonged hospital length of stay and high costs. Oxazolidinones have been suggested as a tool to treat infected patients in the ambulatory setting in order to decrease hospital length of stay. We wanted to address the evidence associated with the use of oxazolidinones in the treatment of skin and skin structure infections. MATERIAL AND METHODS: In this observational retrospective study we analyzed the anonymized diagnosis related group coded information from the Portuguese database for hospital admissions, that included all adult patients with a diagnosis of oxazolidinone use and a SSSI, discharged between 2010 and 2015. RESULTS: During the study period, a total of 5518 patients had a diagnosis of oxazolidinone treatment. We selected 483 of those who were also diagnosed with a skin and skin structure infections. Their mean age was 64.9 years and 62.7% were male. The median hospital length of stay was 27 days (Inter quartile range 13 - 56) and the mortality rate was 12.6%. The prevalence of secondary anemia and of thrombocytopenia in the whole group treated with oxazolidinones was 2.5% and 3%, respectively. DISCUSSION: Despite the high bioavailability of oxazolidinones, we were not able to find evidence that its use was associated with a decrease of mortality or hospital length of stay (due to early discharge) of patients with skin and skin structure infections. CONCLUSION: In this study we were not able to find evidence that oxazolidinones had any clinically significant benefit. A structured approach, including antibiotics with favorable pharmacokinetic and safety profile as well as a carefully planned ambulatory follow up may be needed.info:eu-repo/semantics/publishedVersio

Impact of antibiotic therapy in severe community-acquired pneumonia: Data from the Infauci study

Antibiotic therapy (AT) is the cornerstone of the management of severe community-acquired pneumonia (CAP). However, the best treatment strategy is far from being established. To evaluate the impact of different aspects of AT on the outcome of critically ill patients with CAP, we performed a post hoc analysis of all CAP patients enrolled in a prospective, observational, multicentre study. Of the 502 patients included, 76% received combination therapy, mainly a β-lactam with a macrolide (80%). AT was inappropriate in 16% of all microbiologically documented CAP (n=177). Hospital and 6months mortality were 34% and 35%. In adjusted multivariate logistic regression analysis, combination AT with a macrolide was independently associated with a reduction in hospital (OR 0.17, 95%CI 0.06-0.51) and 6months (OR 0.21, 95%CI 0.07-0.57) mortality. Prolonged AT (>7days) was associated with a longer ICU (14 vs. 7days; p7days had no survival benefit and was associated with a longer LOS.info:eu-repo/semantics/publishedVersio

Avaliação de substratos de húmus de minhoca na produção de mudas de alface (Lactuca sativa) cultivar Lucy Brown.

bitstream/item/68817/1/020-nascimento-avaliacao.pdfPublicado também no Cadernos de Agroecologia, v. 7, n.2, 2012

The INFAUCI study

Funding Information: Financial support: this work was supported by an unrestricted grant from GIS (Grupo de Infecção e Sepsis, Hospital de São João, Porto, Portugal). Publisher Copyright: © 2014 European Society of Clinical Microbiology and Infectious Diseases2012 December 2014 10.1111/1469-0691.12738 Original Article INFECTIOUS DISEASES Original Articles © 2014 The Authors Clinical Microbiology and Infection © 2014 European Society of Clinical Microbiology and Infectious Diseases.A prospective, cohort, clinical, observational study was performed in 14 Intensive Care Units (ICUs) to evaluate the contemporary epidemiology, morbi-mortality and determinants of outcome of the population with an infection on admission. All 3766 patients admitted during a consecutive 12-month period were screened. Their median age was 63 [26-83], 61.1% were male and 69.8% had significant comorbidities. On admission to the ICU 1652 patients (43.9%) had an infection, which was community acquired in 68.2% (one-fifth with healthcare-associated criteria) and ward-acquired in the others. Roughly half presented to the ICU with septic shock. As much as 488 patients with community-acquired infections were deemed stable enough to be first admitted to the ward, but had similar mortality to unstable patients directly admitted to the ICU (35.9% vs. 35.1%, p 0.78). Only 48.3% of this infected population had microbiological documentation and almost one-quarter received inappropriate initial antibiotic therapy. This, along with comorbidities, was a main determinant of mortality. Overall, infected patients on admission had higher mortality both in the ICU (28.0% vs. 19.9%, p <0.001) and in the hospital (38.2% vs. 27.5%, p <0.001) and even after being discharged to the ward (14.2% vs. 9.6%, p <0.001). Also, patients not infected on admission who acquired an infection in the ICU, had an increased risk of dying in the hospital (odds ratio 1.41 [1.12-1.83]). Consequently, infection, regardless of its place of acquisition, was associated with increased mortality. Improving the process of care, especially first-line antibiotic appropriateness, and preventing ICU-acquired infections, may lead to better outcomes.publishersversionpublishe

Intra-hospital mortality for community-acquired pneumonia in mainland Portugal between 2000 and 2009

Introduction: Community-acquired pneumonia (CAP) remains a common and serious infection with wide variability in intra-hospital mortality. Methods: We performed a retrospective analysis of adult patients admitted with CAP in mainland Portugal between the years 2000 and 2009. Results: The intra-hospital mortality rate was 20.4% with deaths in all age groups. The average age of deceased patients was 79.8 years, significantly higher than surviving patients with 71.3 years. Patients aged 50 or more presented a relative risk of death 4.4 times the risk of patients under this age group. Likewise, in patients aged 65 or more the risk of death was 3.2 times the risk of patients <65 years. Men died more at a younger age than women, the men who died were, on average, 4 years younger than women, 78.1 vs 82.1 years old. Relative risk of death in men was 17% higher than women after adjustment for year of admission and age. Conclusion: CAP remains an important cause of hospital mortality in all age groups.info:eu-repo/semantics/publishedVersio

Nanostructured materials: A novel approach to enhanced performance. Final report

Nanostuctured materials are an emerging class of materials that can exhibit physical and mechanical characteristics often exceeding those exhibited by conventional course grained materials. A number of different techniques can be employed to produce these materials. In this program, the synthesis methods were (a) mechanical alloying , (b) physical vapor deposition, and (c) plasma processing. The physical vapor deposition and plasma processing were discontinued after initial testing with subsequent efforts focused on mechanical alloying. The major emphasis of the program was on the synthesis, consolidation, and characterization of nanostructured Al-Fe, Ti-Al, Ti-Al-Nb, and Fe-Al by alloying intermetallics with a view to increase their ductilities. The major findings of this project are reported