PubMed Health⌕ Search

Biomedical subjects

Antoni Torres

Publications and source records attributed to Antoni Torres.

At least 37 records · Page 2Linked to original sources
PubMed2005

Pathophysiology of pneumonia.

The development of pneumonia requires that a pathogen reach the alveoli and that the host defenses are overwhelmed by microorganism virulence or by the inoculum size. The endogenous sources of microorganisms are nasal carriers, sinusitis, oropharynx, gastric, or tracheal colonization, and hematogenous spread. Other external sources of contamination, such as intensive care unit workers, aerosols, or fibrobronchoscopy, must be considered as accidental.

Cross Infection↗
PubMed2005

Microbial airway colonization is associated with noninvasive ventilation failure in exacerbation of chronic obstructive pulmonary disease.

OBJECTIVE: Abnormal airway colonization in patients with chronic obstructive pulmonary disease (COPD) needing invasive mechanical ventilation (IMV) is considered a first step in the acquisition of nosocomial pneumonia. Noninvasive ventilation (NIV) could potentially avoid this, but airway colonization has not been studied in patients who undergo NIV. We hypothesized that patients undergoing NIV would have lower rates of colonization than patients undergoing IMV. The aim of the study was to assess the microbial airway colonization in patients with exacerbated COPD needing NIV and IMV. DESIGN: A 2-yr prospective cohort study. SETTING: Respiratory intensive and intermediate care unit. PATIENTS: Eighty-six patients with exacerbated COPD undergoing NIV on admission (64 successes and 22 failures, according to subsequent intubation), and 51 patients undergoing IMV on admission. INTERVENTIONS: Quantitative culture specimens of sputum or tracheal aspirate were collected on admission and at follow-up (day 3) during NIV or IMV, respectively. Clinical assessment, including severity scores, and arterial blood gas measurements were also determined. MEASUREMENTS AND MAIN RESULTS: Compared with the NIV-success group, colonization by potentially pathogenic microorganisms was greater in the NIV-failure group on admission (13 [59%] vs. 14 [22%]; p < .001) and at follow-up while patients still underwent NIV (14 [93%] vs. 7 [14%]; p < .001), and it was even higher than during IMV at follow-up (20 [50%]; p = .027). Colonization by nonfermenting Gram-negative bacilli, mainly Pseudomonas aeruginosa, was significantly associated with NIV failure on admission (OR, 5.6; p = .016) and at follow-up (OR, 23.5; p < .001). Moreover, colonization by these microorganisms at follow-up (OR, 8.8; p = .008) and inadequate antimicrobial treatment (OR 11.3; p = .001) were associated with increased hospital mortality. CONCLUSIONS: Airway colonization by nonfermenting Gram-negative bacilli is strongly associated with NIV failure. Because it occurs before intubation, this would be a marker rather than just a consequence of NIV failure necessitating intubation. The efficacy of decreasing airway colonization in preventing NIV failure needs to be assessed.

Aged↗
PubMed2005

Pulmonary infections in non-HIV-immunocompromised patients.

PURPOSE OF REVIEW: Pulmonary infections are the most frequent complications in non-HIV-immunocompromised patients and portend a high mortality. This scenario represents a challenging task for clinicians and an important subject of clinical research from different perspectives. This review comments on the results of relevant original articles in this area published from 2003 to the present. RECENT FINDINGS: The present review addresses the etiology of the pulmonary infiltrates in immunocompromised patients, the use of new emerging diagnostic tools and medical devices in the clinical management of these infiltrates, and the greater understanding of the inflammatory immune response associated with infection in this setting. SUMMARY: Advances in diagnostic tests and therapeutic devices are facilitating the clinical management of pulmonary infections. New challenges are emerging, however, such as the growing evidence regarding the important role of respiratory viruses as a common cause of lower respiratory tract infections. Finally, new insights into the mechanisms of the inflammatory response associated with pulmonary complications can help understanding their pathogenesis, improve prevention and diagnosis, and anticipate future therapeutic modalities.

Female↗
PubMed2005

Respiratory microbiology patterns within the first 24 h of ARDS diagnosis: influence on outcome.

BACKGROUND: Airway colonization and infection are frequent complications during the course of ARDS. The impact on outcomes of microbiological patterns recovered within the first 24 h after diagnosis has not been evaluated. OBJECTIVES: To describe the incidence and patterns of bronchial colonization and lung infection within the first 24 h of ARDS diagnosis and to evaluate the influence on ICU outcomes. METHODS: Prospective study of ARDS patients evaluated within 24 h of diagnosis. Patients were studied with tracheobronchial aspirate and right and left bronchoscopic protected specimen brush. All samples were cultured quantitatively. RESULTS: Fifty-five consecutive patients were included. Twelve patients (22%) were clinically suspected of having nosocomial pneumonia (NP), which was confirmed microbiologically in 7 patients, a frequency of 13%. In those patients without suspected pneumonia, we also found potentially pathogenic microorganisms (PPMs) and potentially drug-resistant microorganisms (PDRMs) in 36% and 31%, respectively. Mortality was not significantly higher in those patients with recovery of a PPM (87% vs 73%, p = 0.31), PDRM (89% vs 74%, p = 0.18), or with NP (79% vs 85%, p = 1.0). CONCLUSION: There is a strikingly high rate of PPM recovery in early ARDS. However, neither isolation of pathogenic microorganisms nor the confirmation of NP could be associated with an increased mortality.

APACHE↗
PubMed2005

Bronchial colonization and postoperative respiratory infections in patients undergoing lung cancer surgery.

STUDY OBJECTIVES: To evaluate the risk factors associated with postoperative respiratory infection in patients undergoing lung cancer surgery, with special emphasis on the perioperative pattern of airway colonization. DESIGN: Prospective cohort study. SETTING: Department of Pneumology and Thoracic Surgery of a tertiary hospital. PATIENTS: Seventy-eight consecutive patients undergoing lung cancer surgery were evaluated. Patients were followed up until hospital discharge or death. INTERVENTIONS: Fiberoptic bronchoscopies with bilateral protected specimen brush or bronchial aspirates were performed during anesthesia prior to the initiation of the surgical procedure. RESULTS: Sixty-five patients (83%) had perioperative bronchial colonization by either potentially pathogenic microorganisms (PPMs) [28 patients, 36%] or non-potentially pathogenic microorganisms (56 patients, 72%). The 24 patients (31%) with a postoperative respiratory infection (pneumonia, purulent tracheobronchitis, or pleural empyema) had significantly higher perioperative bronchial colonization by PPMs (15 patients [63%] vs 13 patients [24%], p = 0.003) and a higher bacterial index (mean +/- SD, 3.6 +/- 3.3 vs 0.9 +/- 1.4; p = 0.003), compared to patients without infection. The agreement between pathogens found in perioperative evaluation and during postoperative infection was total in 5 patients (21%), partial in 5 patients (21%), and no concordance in 14 patients (58%). In the multivariate analysis, the presence of perioperative airway colonization by a PPM (odds ratio [OR], 6.9; p = 0.001) and a higher postoperative pain score (OR, 4.1; p = 0.014) were independent predictors of postoperative respiratory infection. CONCLUSION: Adequate control of postoperative pain, as well as the conditions that potentially cause airway colonization by PPMs, could be beneficial in preventing postoperative respiratory infections after lung cancer surgery.

Aged↗
PubMed2004

Ethics roundtable debate: A patient dies from an ICU-acquired infection related to methicillin-resistant Staphylococcus aureus--how do you defend your case and your team?

An elderly patient dies from septic shock in the intensive care unit. This is perhaps not an unusual scenario, but in this case the sepsis happens to have been due to methicillin-resistant Staphylococcus aureus, possibly related to a catheter, and possibly transmitted from a patient in a neighbouring room by less than adequate compliance with infection control procedures. The family decides to sue. We present how experts from four different countries assess the medicolegal issues involved in this case.

Aged↗
PubMed2004

Reaching stability in community-acquired pneumonia: the effects of the severity of disease, treatment, and the characteristics of patients.

BACKGROUND: The natural history of the resolution of infectious parameters in patients with community-acquired pneumonia (CAP) is not completely known. The aim of our study was to identify those factors related to host characteristics, the severity of pneumonia, and treatment that influence clinical stability. METHODS: In a prospective, multicenter, observational study, we observed 1424 patients with CAP who were admitted to 15 Spanish hospitals. The main outcome variable was the number of days needed to reach clinical stability (defined as a temperature of or=90 mm Hg, and oxygen saturation >or=90% or arterial oxygen partial pressure of >or=60 mm Hg). RESULTS: The median time to stability was 4 days. A Cox proportional hazard model identified 6 independent variables recorded during the first 24 h after hospital admission related to the time needed to reach stability: dyspnea (hazard ratio [HR], 0.76), confusion (HR, 0.66), pleural effusion (HR, 0.67), multilobed CAP (HR, 0.72), high pneumonia severity index (HR, 0.73), and adherence to the Spanish guidelines for treatment of CAP (HR, 1.22). A second Cox model was performed that included complications and response to treatment. This model identified the following 10 independent variables: chronic bronchitis (HR, 0.81), dyspnea (HR, 0.79), confusion (HR, 0.61), multilobed CAP (HR, 0.84), initial severity of disease (HR, 0.73), treatment failure (HR, 0.31), cardiac complications (HR, 0.66), respiratory complications (HR, 0.77), empyema (HR, 0.57), and admission to the intensive care unit (HR, 0.57). CONCLUSIONS: Some characteristics of CAP are useful at the time of hospital admission to identify patients who will need a longer hospital stay to reach clinical stability. Empirical treatment that follows guidelines is associated with earlier clinical stability. Complications and treatment failure delay clinical stability.

Community-Acquired Infections↗
PubMed2004

Disposition of instilled versus nebulized tobramycin and imipenem in ventilated intensive care unit (ICU) patients.

BACKGROUND: Delivery of antibiotics to the lower respiratory tract could potentially achieve antimicrobial bronchial drug concentrations without toxicity. AIM: To assess bronchial and serum concentrations of imipenem or tobramycin obtained by nebulization or instillation in critically ill mechanically ventilated patients. METHODS: Prospective randomized open trial. Eighteen patients ventilated for more than 48 h were included. Two doses of imipenem/cilastatin (1000/500 mg) separated by 8 h, or two doses of tobramycin 200 mg separated by 12 h were randomly nebulized or instilled into the tracheal tube. Five bronchoaspirates (two bronchoscopic, three blind) and five blood samples were collected on a timed schedule after the second dose. Respiratory and serum samples were analysed by HPLC, and a subset of blood samples was also evaluated by enzyme-immunoassay. RESULTS: When instilled, imipenem/cilastatin obtained higher concentrations in respiratory secretions than when nebulized (P=0.022, 1 h after the last dose; P=0.029, 2 h after the last dose). Tobramycin showed equally high concentrations when nebulized or instilled. Instillation of tobramycin may result in significant accumulation in patients with renal failure. CONCLUSIONS: High bronchial concentrations of imipenem could only be achieved by instillation, whereas tobramycin seems suitable for both modes of administration. Instillation of these antibiotics is a safe procedure that achieves high drug concentrations in respiratory secretions.

Administration, Inhalation↗
PubMed2004

Drug-resistant pneumococcal pneumonia: clinical relevance and related factors.

A multicenter study of 638 cases of community-acquired pneumonia due to Streptococcus pneumoniae (SP-CAP) was performed to assess current levels of resistance. Of the pneumococcal strains, 35.7% had an minimum inhibitory concentration (MIC) of penicillin of > or =0.12 microg/mL (3 isolates had an MIC of 4 microg/mL), 23.8% had an MIC of erythromycin of 128 microg/mL, and 22.2% were multidrug resistant. Logistic regression determined that chronic pulmonary disease (odds ratio [OR], 1.44], human immunodeficiency virus infection (OR, 1.98), clinically suspected aspiration (OR, 2.12), and previous hospital admission (OR, 1.69) were related to decreased susceptibility to penicillin, and previous admission (OR, 1.89) and an MIC of penicillin of MIC > or =0.12 microg/mL (OR, 15.85) were related to erythromycin resistance (MIC, > or =1 microg/mL). The overall mortality rate was 14.4%. Disseminated intravascular coagulation, empyema, and bacteremia were significantly more frequent among patients with penicillin-susceptible SP-CAP. Among isolates with MICs of penicillin of > or =0.12 microg/mL, serotype 19 was predominant and was associated with a higher mortality rate. In summary, the rate of resistance to beta -lactams and macrolides among S. pneumoniae that cause CAP remains high, but such resistance does not result in increased morbidity.

Adolescent↗
PubMed2004

Non-infectious and unusual infectious mimics of community-acquired pneumonia.

Noninfectious or unusual infectious diseases may present with clinical, radiological and laboratorial characteristics of community-acquired pneumonia (CAP). Usually their presence is only suspected after treatment failure, leading to inappropriate interventions, unnecessary costs and risks related to the untreated potentially life-threatening disease. The present study aimed to assess the noninfectious or unusual infectious diseases that may be misdiagnosed as CAP that progresses with treatment failure. Sixteen hospitalized patients with presumptive diagnosis of CAP and treatment failure were described. The most prevalent symptoms were fever and cough. Radiological pattern of air-space disease was observed in 10 (62%) patients. The diagnosis was established by autopsy (12%) or invasive procedures (88%), as follows: open lung biopsy (nine), flexible fiberoptic bronchoscopy (two), transthoracic fine needle aspiration (two) and bone marrow aspiration (one). Eight patients had noninfectious diseases: pulmonary embolism, cryptogenic organizing pneumonia, Wegener's granulomatosis, hypersensitivity pneumonitis, bronchocentric granulomatosis, neoplastic disease and acute leukemia. The unusual infectious diseases were: tuberculosis, cryptococcosis, actinomycosis, histoplasmosis and paracoccidioidomycosis. Patients with noninfectious or unusual infectious diseases may present with symptoms and radiological findings that mimic CAP. These diseases should always be suspected in patients who do not respond to initial empirical antimicrobial treatment, especially young patients or those without comorbidity.

Adolescent↗
PubMed2004

Causes and predictors of nonresponse to treatment of intensive care unit-acquired pneumonia.

OBJECTIVE: To prospectively evaluate the predictive factors for the nonresponse to empirical antibiotic treatment and mortality in patients with intensive care unit-acquired pneumonia. DESIGN: A 1-yr prospective cohort of patients with suspicion of intensive care unit-acquired pneumonia. SETTING: Five medical and surgical intensive care units of Hospital Clinic in Barcelona. PATIENTS: A total of 71 patients with intensive care unit-acquired pneumonia were studied. The definition of nonresponse included at least one of the following: failure to improve the Pao2/Fio2 ratio or need of intubation because of pneumonia, persistence of fever or hypothermia and purulent respiratory secretions, worsening of pulmonary infiltrates, or occurrence of septic shock or multiple organ dysfunction not present at onset of pneumonia. INTERVENTIONS: Clinical assessment, including severity scores, blood and quantitative cultures of respiratory secretions, and cytokine measurements in serum and bronchoalveolar lavage at onset of pneumonia and 72 hrs after antimicrobial treatment. MEASUREMENTS AND RESULTS: A total of 44 patients (62%) fulfilled criteria of nonresponse, and at least one cause of nonresponse could be determined in 28 cases (64%): inappropriate treatment in ten (23%), superinfection in six (14%), concomitant foci of infection in 12 (27%), and noninfectious causes in seven cases (16%). The remaining 16 patients with no definite cause of nonresponse presented with septic shock, multiple organ dysfunction, or acute respiratory distress syndrome. Increased levels of interleukin-6 at onset of pneumonia (odds ratio, 9.7; p =.014) was an independent predictor of nonresponse to treatment. Likewise, increased level of interleukin-6 at follow-up (odds ratio, 27; p =.001) was the only independent predictor for hospital mortality. CONCLUSION: Increased systemic inflammatory response was the main predictor of nonresponse to treatment and mortality.

Aged↗
PubMed2004

Diagnosis of infection in sepsis: an evidence-based review.

OBJECTIVE: In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for the diagnosis of infection in sepsis that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis. DESIGN: The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. METHODS: The modified Delphi methodology used for grading recommendations built on a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along five levels to create recommendation grades from A to E, with A being the highest grade. Pediatric considerations to contrast adult and pediatric management are in the article by Parker et al. on p. S591. CONCLUSIONS: Obtaining a precise bacteriological diagnosis before starting antibiotic therapy is, when possible, of paramount importance for the success of therapeutic strategy during sepsis. Two to three blood cultures should be performed, preferably from a peripheral vein, without interval between samples to avoid delaying therapy. A quantitative approach is preferred in most cases when possible, in particular for catheter-related infections and ventilator-associated pneumonia. Diagnosing community-acquired pneumonia is complex, and a diagnostic algorithm is proposed. Appropriate samples are indicated during soft tissue and intraabdominal infections, but cultures obtained through the drains are discouraged.

Abdomen↗
PubMed2004

Severe community-acquired pneumonia.

PURPOSE OF REVIEW: Community-acquired pneumonia remains a prevalent and potentially life-threatening infection. In general, the disease is considered severe when inpatient care including ICU admission is required, and this often suggests a poorer prognosis. Severe community-acquired pneumonia continues to be an important subject of research from different perspectives, including assessment of illness severity, etiology, diagnostic tests, and treatment options. The aim of this descriptive review is to comment on the results of the relevant original articles in this area published since April 1, 2003. RECENT FINDINGS: The main themes in the literature covered by the review include the time course of serum concentrations of different markers of the inflammatory response, validation of severity scores to optimize hospital and ICU admission, outcome improvement (duration of therapy and optimal dosing, time to antibiotic administration, adequate initial treatment, and the impact of positive microbiological diagnosis on management and prognosis), and the efficacy of new antimicrobials. SUMMARY: The usefulness of inflammatory markers to assess the outcome of the disease is unclear. Data on severity scores are conclusive and different validated and simple predictive rules are available for the classification of patients into risk classes. Therapeutic strategies that have been investigated confirm the impact of adequate empiric antibiotic treatment on clinical outcome and the equivalence between short and long courses in the duration of therapy. A definitive beneficial effect of early administration of antimicrobials or the knowledge of the etiology of pneumonia on the clinical course of the disease has not been demonstrated.

Anti-Bacterial Agents↗
PubMed2004

Inflammatory responses in blood samples of human immunodeficiency virus-infected patients with pulmonary infections.

We analyzed the characteristics of the inflammatory response occurring in blood during pulmonary infections in human immunodeficiency virus (HIV)-infected patients. A prospective study of consecutive hospital admissions of HIV-infected patients with new-onset radiologic pulmonary infiltrates was carried out in a tertiary university hospital from April 1998 to May 2001. Plasma cyclic AMP receptor protein (CRP), interleukin 1beta (IL-1beta), IL-6, IL-8, IL-10, and tumor necrosis factor alpha (TNF-alpha) levels were determined at the time of admission and 4, 5, and 6 days later. Patients were included in a protocol addressed to study etiology and outcome of disease. A total of 249 episodes of infection were included, with the main diagnoses being bacterial pneumonia (BP) (118 episodes), Pneumocystis carinii pneumonia (PCP) (41 episodes), and mycobacteriosis (36 episodes). For these three patient groups, at the time of admission the median CRP and cytokine levels were as follows: CRP, 10.2, 3.8 and 5 mg/dl, respectively (P = 0.0001); IL-8, 19, 3, and 2.9 pg/ml (P = 0.045); and TNF-alpha, 46.4, 44, and 75 pg/ml, respectively (P = 0.029). There were no significant differences in levels of IL-1beta, IL-6, or IL-10 among the patient groups. A total of 23 patients died. At the time of admission, HIV-infected patients with BP had higher plasma CRP and IL-8 levels than did PCP and mycobacteriosis patients. TNF-alpha levels were higher in patients with mycobacteriosis. An elevated IL-8 level (>61 pg/ml) at the time of admission was an independent factor associated with higher mortality (odds ratio, 12; 95% confidence interval, 1.2 to 235.5).

AIDS-Related Opportunistic Infections↗