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Enlace permanente de la investigaciónAntimicrobial agent prescription: a prospective cohort study in patients with sepsis and septic shock / Fabián Alberto Jaimes Barragán
Título : Antimicrobial agent prescription: a prospective cohort study in patients with sepsis and septic shock Tipo de documento : documento electrónico Autores : Fabián Alberto Jaimes Barragán, Fecha de publicación : 2019 Títulos uniformes : Tropical Medicine & International Health Idioma : Inglés (eng) Palabras clave : Antibacterial agents hospital mortality length of stay shock Resumen : Objective: To assess the true association between appropriate prescription of antibiotics and prognosis in patients with sepsis, a key issue in health care and quality improvement strategies. Methods: Prospective cohort study in three university hospitals to determine whether the empirical prescription of antibiotics was adequate or inadequate, and to compare hospital death rates and length of stay according to different classifications of antibiotics prescription. Logistic regression models for risk estimation were fitted. Results: A total of 705 patients with severe sepsis were included. No differences were found in positive-culture patients (n = 545) regarding the risk of death with insufficient spectrum antibiotics, compared to patients who received adequate spectrum antibiotics (OR = 0.90; 95% CI = 0.55-1.48). Delay in initiating antibiotics was not associated with the risk of death in patients with adequate spectrum of antibiotics, either with positive (OR = 1.04; 95% CI = 0.99-1.08) or negative cultures (OR = 0.98; 95% CI = 0.92-1.04). There were no differences in the length of hospital stay, according to the antibiotic prescription (median 11 days, IQR = 7-18 days for the whole cohort). Conclusions: No associations were found between inadequate antibiotic prescription or delay to initiate therapy and mortality or length of stay Mención de responsabilidad : Pablo Castaño, Maribel Plaza, Fernando Molina, Carolina Hincapié, Wilmar Maya, Juan Cataño, Javier González, Alba León, Fabián Jaimes Referencia : Trop Med Int Health. 2019 Feb;24(2):175-184 DOI (Digital Object Identifier) : 10.1111/tmi.13186 PMID : 30489005 En línea : https://onlinelibrary.wiley.com/doi/abs/10.1111/tmi.13186 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4266 Antimicrobial agent prescription: a prospective cohort study in patients with sepsis and septic shock [documento electrónico] / Fabián Alberto Jaimes Barragán, . - 2019.
Obra : Tropical Medicine & International Health
Idioma : Inglés (eng)
Palabras clave : Antibacterial agents hospital mortality length of stay shock Resumen : Objective: To assess the true association between appropriate prescription of antibiotics and prognosis in patients with sepsis, a key issue in health care and quality improvement strategies. Methods: Prospective cohort study in three university hospitals to determine whether the empirical prescription of antibiotics was adequate or inadequate, and to compare hospital death rates and length of stay according to different classifications of antibiotics prescription. Logistic regression models for risk estimation were fitted. Results: A total of 705 patients with severe sepsis were included. No differences were found in positive-culture patients (n = 545) regarding the risk of death with insufficient spectrum antibiotics, compared to patients who received adequate spectrum antibiotics (OR = 0.90; 95% CI = 0.55-1.48). Delay in initiating antibiotics was not associated with the risk of death in patients with adequate spectrum of antibiotics, either with positive (OR = 1.04; 95% CI = 0.99-1.08) or negative cultures (OR = 0.98; 95% CI = 0.92-1.04). There were no differences in the length of hospital stay, according to the antibiotic prescription (median 11 days, IQR = 7-18 days for the whole cohort). Conclusions: No associations were found between inadequate antibiotic prescription or delay to initiate therapy and mortality or length of stay Mención de responsabilidad : Pablo Castaño, Maribel Plaza, Fernando Molina, Carolina Hincapié, Wilmar Maya, Juan Cataño, Javier González, Alba León, Fabián Jaimes Referencia : Trop Med Int Health. 2019 Feb;24(2):175-184 DOI (Digital Object Identifier) : 10.1111/tmi.13186 PMID : 30489005 En línea : https://onlinelibrary.wiley.com/doi/abs/10.1111/tmi.13186 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4266 Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD001245 AC-2019-034 Archivo digital Producción Científica Artículos científicos Disponible 
Título : Association between site of infection and in-hospital mortality in patients with sepsis admitted to emergency departments of tertiary hospitals in Medellin, Colombia Otros títulos : Asociación entre el sitio de infección y la mortalidad hospitalaria en pacientes con sepsis atendidos en urgencias de hospitales de tercer nivel en Medellín, Colombia Tipo de documento : documento electrónico Autores : Elisa Bernal Sierra, Fecha de publicación : 2019 Títulos uniformes : Revista Brasileira de Terapia Intensiva Idioma : Inglés (eng) Palabras clave : Sepsis septic shock shock mortality prognosis infection intensive care Resumen : Objective: To determine the association between the primary site of infection and in-hospital mortality as the main outcome, or the need for admission to the intensive care unit as a secondary outcome, in patients with sepsis admitted to the emergency department.Methods: This was a secondary analysis of a multicenter prospective cohort. Patients included in the study were older than 18 years with a diagnosis of severe sepsis or septic shock who were admitted to the emergency departments of three tertiary care hospitals. Of the 5022 eligible participants, 2510 were included. Multiple logistic regression analysis was performed for mortality.Results: The most common site of infection was the urinary tract, present in 27.8% of the cases, followed by pneumonia (27.5%) and intra-abdominal focus (10.8%). In 5.4% of the cases, no definite site of infection was identified on admission. Logistic regression revealed a significant association between the following sites of infection and in-hospital mortality when using the urinary infection group as a reference: pneumonia (OR 3.4; 95%CI, 2.2 - 5.2; p Mención de responsabilidad : César Caraballo, Johana Ascuntar, Carolina Hincapié, Camilo Restrepo, Elisa Bernal, Fabián Jaimes Referencia : Rev Bras Ter Intensiva. 2019 Jan-Mar;31(1):47-56 DOI (Digital Object Identifier) : 10.5935/0103-507X.20190011 PMID : 30970091 Derechos de uso : CC BY En línea : http://www.rbti.org.br/artigo/detalhes/0103507X-31-1-8 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4254 Association between site of infection and in-hospital mortality in patients with sepsis admitted to emergency departments of tertiary hospitals in Medellin, Colombia = Asociación entre el sitio de infección y la mortalidad hospitalaria en pacientes con sepsis atendidos en urgencias de hospitales de tercer nivel en Medellín, Colombia [documento electrónico] / Elisa Bernal Sierra, . - 2019.
Obra : Revista Brasileira de Terapia Intensiva
Idioma : Inglés (eng)
Palabras clave : Sepsis septic shock shock mortality prognosis infection intensive care Resumen : Objective: To determine the association between the primary site of infection and in-hospital mortality as the main outcome, or the need for admission to the intensive care unit as a secondary outcome, in patients with sepsis admitted to the emergency department.Methods: This was a secondary analysis of a multicenter prospective cohort. Patients included in the study were older than 18 years with a diagnosis of severe sepsis or septic shock who were admitted to the emergency departments of three tertiary care hospitals. Of the 5022 eligible participants, 2510 were included. Multiple logistic regression analysis was performed for mortality.Results: The most common site of infection was the urinary tract, present in 27.8% of the cases, followed by pneumonia (27.5%) and intra-abdominal focus (10.8%). In 5.4% of the cases, no definite site of infection was identified on admission. Logistic regression revealed a significant association between the following sites of infection and in-hospital mortality when using the urinary infection group as a reference: pneumonia (OR 3.4; 95%CI, 2.2 - 5.2; p Mención de responsabilidad : César Caraballo, Johana Ascuntar, Carolina Hincapié, Camilo Restrepo, Elisa Bernal, Fabián Jaimes Referencia : Rev Bras Ter Intensiva. 2019 Jan-Mar;31(1):47-56 DOI (Digital Object Identifier) : 10.5935/0103-507X.20190011 PMID : 30970091 Derechos de uso : CC BY En línea : http://www.rbti.org.br/artigo/detalhes/0103507X-31-1-8 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4254 Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD001233 AC-2019-022 Archivo digital Producción Científica Artículos científicos Disponible Documentos electrónicos
2019-022.pdfAdobe Acrobat PDF
Título : Antibiotics has more impact on mortality than other early goal-directed therapy components in patients with sepsis: An instrumental variable analysis Tipo de documento : documento electrónico Autores : Jessica María Londoño Agudelo, ; Andrea Yiseth Archila León, ; Diana Patricia Cárdenas Cuervo, ; Mayla Andrea Perdomo Amar, ; Jairo Giovanni Moncayo Viveros, Fecha de publicación : 2018 Títulos uniformes : Journal of Critical Care Idioma : Inglés (eng) Palabras clave : Sepsis resuscitation lactic acid antibiotics shock hyperlactatemia Resumen : Purpose: To estimate the effect of each of the EGDT components, as well as of the antibiotics, on length-of-stay and mortality. Methods: Prospective cohort in three hospitals. Adult patients admitted by the Emergency Rooms (ER) with infection and any of systolic blood pressure b 90 mmHg or lactate N4 mmol/L. An instrumental analysis with hospital of admission as the instrumental variable was performed to estimate the effect of each intervention on hospital mortality and secondary outcomes. Results: Among 2587 patients evaluated 884 met inclusion criteria, with a hospital mortality rate of 17% (n =150). In the instrumental analysis, the only intervention associated with an absolute reduction in mortality (21%) was the use of antibiotics in the first 3 h. In patients with lactate values ≥4 mmol/L in the ER, a nondecrease of at least 10% at six hours was independently associated with mortality (OR = 3.1; 95%CI = 1.5–6.2). Conclusions: Among patients entering ER with infection and shock or hypoperfusion criteria, the use of appropriate antibiotics in the first 3 h is the measure that has the greatest impact on survival. In addition, among patients with hyperlactatemia N4 mmol/L, the clearance of N10% of lactate during resuscitation is associated with better outcomes. Mención de responsabilidad : Jessica Londoño, César Niño, Andrea Archila, Marta Valencia, Diana Cárdenas, Mayla Perdomo, Giovanny Moncayo, César Vargas, Carlos E Vallejo, Carolina Hincapié, Johana Ascuntar, Alba León, Fabián Jaimes Referencia : J Crit Care. 2018 Dec;48:191-197. DOI (Digital Object Identifier) : 10.1016/j.jcrc.2018.08.035 PMID : 30218959 En línea : https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(18)30531-8 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4175 Antibiotics has more impact on mortality than other early goal-directed therapy components in patients with sepsis: An instrumental variable analysis [documento electrónico] / Jessica María Londoño Agudelo, ; Andrea Yiseth Archila León, ; Diana Patricia Cárdenas Cuervo, ; Mayla Andrea Perdomo Amar, ; Jairo Giovanni Moncayo Viveros, . - 2018.
Obra : Journal of Critical Care
Idioma : Inglés (eng)
Palabras clave : Sepsis resuscitation lactic acid antibiotics shock hyperlactatemia Resumen : Purpose: To estimate the effect of each of the EGDT components, as well as of the antibiotics, on length-of-stay and mortality. Methods: Prospective cohort in three hospitals. Adult patients admitted by the Emergency Rooms (ER) with infection and any of systolic blood pressure b 90 mmHg or lactate N4 mmol/L. An instrumental analysis with hospital of admission as the instrumental variable was performed to estimate the effect of each intervention on hospital mortality and secondary outcomes. Results: Among 2587 patients evaluated 884 met inclusion criteria, with a hospital mortality rate of 17% (n =150). In the instrumental analysis, the only intervention associated with an absolute reduction in mortality (21%) was the use of antibiotics in the first 3 h. In patients with lactate values ≥4 mmol/L in the ER, a nondecrease of at least 10% at six hours was independently associated with mortality (OR = 3.1; 95%CI = 1.5–6.2). Conclusions: Among patients entering ER with infection and shock or hypoperfusion criteria, the use of appropriate antibiotics in the first 3 h is the measure that has the greatest impact on survival. In addition, among patients with hyperlactatemia N4 mmol/L, the clearance of N10% of lactate during resuscitation is associated with better outcomes. Mención de responsabilidad : Jessica Londoño, César Niño, Andrea Archila, Marta Valencia, Diana Cárdenas, Mayla Perdomo, Giovanny Moncayo, César Vargas, Carlos E Vallejo, Carolina Hincapié, Johana Ascuntar, Alba León, Fabián Jaimes Referencia : J Crit Care. 2018 Dec;48:191-197. DOI (Digital Object Identifier) : 10.1016/j.jcrc.2018.08.035 PMID : 30218959 En línea : https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(18)30531-8 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4175 Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD000789 AC-2018-076 Archivo digital Producción Científica Artículos científicos Disponible
Título : Association of Clinical Hypoperfusion Variables With Lactate Clearance and Hospital Mortality Tipo de documento : documento electrónico Autores : Jessica María Londoño Agudelo, ; Elisa Bernal Sierra, ; Fabián Alberto Jaimes Barragán, Fecha de publicación : 2018 Títulos uniformes : Shock Idioma : Inglés (eng) Palabras clave : Hyperlactatemia lactic acid multiple trauma oxygen consumption patient outcome assessment resuscitation sepsis shock vasopressors Resumen : Background: Lactate has shown utility in assessing the prognosis of patients admitted to the hospital with confirmed or suspected shock. Some findings of the physical examination may replace it as screening tool. We have determined the correlation and association between clinical perfusion parameters and lactate at the time of admission; the correlation between the change in clinical parameters and lactate clearance after 6 and 24 h of resuscitation; and the association between clinical parameters, lactate, and mortality. Methods: Prospective cohort study of adult patients hospitalized in the emergency room with infection, polytrauma, or other causes of hypotension. We measured serum lactate, capillary refill time, shock index, and pulse pressure at 0, 6, and 24 h after admission. A Spearman's correlation was performed between clinical variables and lactate levels, as well as between changes in clinical parameters and lactate clearance. The operative characteristics of these variables were determined by area under the receiver operating characteristic curve analysis and the association between lactate, clinical variables, and mortality through logistic regression. Results: A total of 1,320 patients met the inclusion criteria, 66.7% (n = 880) confirmed infection, 19% (n = 251) polytrauma, and 14.3% (n = 189) another etiology. No significant correlation was found between any clinical variable and lactate values (r Mención de responsabilidad : Jessica Londoño, César Niño, James Díaz, Carlos Morales, Jimmy León, Elisa Bernal, Cesar Vargas, Leonardo Mejía, Carolina Hincapié, Johana Ascuntar, Alba León, Fabián Jaimes Referencia : Shock. 2018 Sep;50(3):286-292. DOI (Digital Object Identifier) : 10.1097/SHK.0000000000001066 PMID : 29206763 En línea : https://journals.lww.com/shockjournal/fulltext/2018/09000/Association_of_Clinica [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4199 Association of Clinical Hypoperfusion Variables With Lactate Clearance and Hospital Mortality [documento electrónico] / Jessica María Londoño Agudelo, ; Elisa Bernal Sierra, ; Fabián Alberto Jaimes Barragán, . - 2018.
Obra : Shock
Idioma : Inglés (eng)
Palabras clave : Hyperlactatemia lactic acid multiple trauma oxygen consumption patient outcome assessment resuscitation sepsis shock vasopressors Resumen : Background: Lactate has shown utility in assessing the prognosis of patients admitted to the hospital with confirmed or suspected shock. Some findings of the physical examination may replace it as screening tool. We have determined the correlation and association between clinical perfusion parameters and lactate at the time of admission; the correlation between the change in clinical parameters and lactate clearance after 6 and 24 h of resuscitation; and the association between clinical parameters, lactate, and mortality. Methods: Prospective cohort study of adult patients hospitalized in the emergency room with infection, polytrauma, or other causes of hypotension. We measured serum lactate, capillary refill time, shock index, and pulse pressure at 0, 6, and 24 h after admission. A Spearman's correlation was performed between clinical variables and lactate levels, as well as between changes in clinical parameters and lactate clearance. The operative characteristics of these variables were determined by area under the receiver operating characteristic curve analysis and the association between lactate, clinical variables, and mortality through logistic regression. Results: A total of 1,320 patients met the inclusion criteria, 66.7% (n = 880) confirmed infection, 19% (n = 251) polytrauma, and 14.3% (n = 189) another etiology. No significant correlation was found between any clinical variable and lactate values (r Mención de responsabilidad : Jessica Londoño, César Niño, James Díaz, Carlos Morales, Jimmy León, Elisa Bernal, Cesar Vargas, Leonardo Mejía, Carolina Hincapié, Johana Ascuntar, Alba León, Fabián Jaimes Referencia : Shock. 2018 Sep;50(3):286-292. DOI (Digital Object Identifier) : 10.1097/SHK.0000000000001066 PMID : 29206763 En línea : https://journals.lww.com/shockjournal/fulltext/2018/09000/Association_of_Clinica [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4199 Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD000813 AC-2018-100 Archivo digital Producción Científica Artículos científicos Disponible
