Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Óptica de nanopartículas y nanocompuestos

IP 1101-05-036-99of the XV latinamerican symposium on solid state physics (SlafesXV), Cartagena de Indias, Colombia, November;1 to 5, 1999 / latinamerican simposium on solid state physics(slafes XV)(15: 1999 nov. 1-5 : Cartagena de;Indias, Colombia) Guest editors J. Giraldo, L. Quiroga, R.Merlin, J.R. Leite. -- En: Physica status solidi;(b) : Basic research Vol. 220, no. 1 (july 2000): p. 1-804. --ISSN 03701972.;Oaxaca: Sociedad Mexicana de ciencia de superficies y vacio A.C., 2000. --28 cm. -- REVISTA(S): Proceedings;ARTICULOS EN REVISTA: Funcion dielectrica de un medio quepercola / Adriana Gutierrez Rodriguez, Jairo;Giraldo Gallo. -- En: Revista colombiana de un medio que percola. -- Vol.32, no. 1 (2000). -- A statistical;model for flash thermal desorption of carbon dioxide frompolycrystallinemolybdenum / L.D Lopez Carreño, A.J.;Ramirez Cuesta, L.Viscido, J.M Heras. -- En: Journal of molecular catalysis a: chemical. -- Vol. 167 (june;2001); p. 157-163. -- Diffusive like minibands in finite superlattices ofdisordered quantum wells / R.R. Rey;Gonzalez, E. Machado -- En: Brazilian journal of physics.'-- Vol. 31 no. 4(dic. 2001). -- RF sputtered a Si:H;and aGe:H films: a comparative study / A.R. Zanatta, F. Fajardo,M. Mulato, M.M. Lima, F.C. Marques, I.;Chambouleyron. -- En: Asian journal of physics. -- Vol. 9(2000); p. 681.'-- PONENCIA(S) en Congreso: Atomic;ordering in Cd1-xZnxTe for low Zn concentration: optical,thermal and structural characterization / A.;Guterrez, M.E. Rodriguez, O. Zelaya, C. Vasquez, L. Baños,JairoGiraldo Gallo. -- En: Sociedad mexicana de;ciencia de superficies y vacio A.C. 20 congreso nacional.(20:2000 ago.28 - sep.1 :Oxaca, Mexico). -

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes