Determinants of mortality in cancer patients with unscheduled admission to the Intensive Care Unit: A prospective multicenter study.

Objectives: To analyze clinical features associated to mortality in oncological patients with unplanned admission to the Intensive Care Unit (ICU), and to determine whether such risk factors differ between patients with solid tumors and those with hematological malignancies.

Design: An observational study was carried out.

Setting: A total of 123 Intensive Care Units across Spain.

Invasive fungal infection in crtically ill patients: hurdles and next challenges.

A narrative review from a multidisciplinary task force of experts in critical care medicine and clinical mycology was carried out. The multi drug-resistant species Candida auris has emerged simultaneously on several continents, causing hospital outbreaks, especially in critically ill patients. Although there are not enough data to support the routine use of continuous antibiotic prophylaxis in patients subjected to extracorporeal membrane oxygenator, a clear increase of invasive fungal infection (IFI) has been described with the use of this device.

Characteristics and outcomes of patients admitted to Spanish ICU: A prospective observational study from the ENVIN-HELICS registry (2006-2011).

Objective: To describe the case-mix of patients admitted to intensive care units (ICUs) in Spain during the period 2006-2011 and to assess changes in ICU mortality according to severity level.

Design: Secondary analysis of data obtained from the ENVN-HELICS registry. Observational prospective study.

[Comparative analysis of patients admitted to Spanish Intensive Care Units due to medical and surgical disease].

Objective: To describe the characteristics of the patients case-mix admitted to ICUs due to medical and surgical disease, and to compare both groups.

Design: Analysis of data covering the period 2006-2011 in the ENVIN-HELICS registry. An observational, prospective, multicenter and voluntary participation study.

Epidemiology, antibiotic therapy and clinical outcomes of healthcare-associated pneumonia in critically ill patients: a Spanish cohort study.

Purpose: Information about healthcare-associated pneumonia (HCAP) in critically ill patients is scarce.

Methods: This prospective study compared clinical presentation, outcomes, microbial etiology, and treatment of HCAP, community-acquired pneumonia (CAP), and immunocompromised patients (ICP) with severe pneumonia admitted to 34 Spanish ICUs.

Results: A total of 726 patients with pneumonia (449 CAP, 133 HCAP, and 144 ICP) were recruited during 1 year from April 2011.

Epidemiology, diagnosis and treatment of fungal respiratory infections in the critically ill patient.

Objective: To elaborate practical recommendations based on scientific evidence, when available, or on expert opinions for the diagnosis, treatment and prevention of fungal respiratory infections in the critically ill patient, including solid organ transplant recipients.

Methods: Twelve experts from two scientific societies (The Spanish Society for Chemotherapy and The Spanish Society of Intensive Care and Coronary Units) reviewed in a meeting held in March 2012 epidemiological issues and risk factors as basis for a document about prevention, diagnosis and treatment of respiratory fungal infections caused by Candida spp., Aspergillus spp or Zygomycetes.

Morbidity and mortality associated with primary and catheter-related bloodstream infections in critically ill patients.

Purpose: To analyze the impact of primary and catheterrelated bloodstream infections (PBSI/CRBSI) on morbidity and mortality.

Methods: A matched case-control study (1:4) was carried out on a Spanish epidemiological database of critically ill patients (ENVIN-HELICS). To determine the risk of death in patients with PBSI/CRBSI a matched Cox proportional hazard regression analysis was performed.

Invasive device-related infections after heart surgery.

Objective: To analyze postoperative infections in critically ill patients undergoing heart surgery.

Setting: Intensive care units (ICUs).

Design: An observational, prospective, multicenter study was carried out.

[Multidisciplinary guidelines for the management of community-acquired pneumonia].

Community-acquired pneumonia (CAP) is an infectious respiratory disease with an incidence that ranges from 3 to 8 cases per 1,000 inhabitants per year. This incidence increases with age and comorbidities. Forty per cent of CAP patients require hospitalization and around 10% of these patients are admitted in an Intensive Care Unit (ICU).

Urethral catheter-related urinary infection in critical patients admitted to the ICU. Descriptive data of the ENVIN-UCI study.

Objective: To describe trends in national catheter-related urinary tract infection (CRUTI) rates, as well as etiologies and multiresistance markers.

Design: An observational, prospective, multicenter voluntary participation study was conducted from 1 April to 30 June in the period between 2005 and 2010.

Setting: Intensive Care Units (ICUs) that participated in the ENVIN-ICU registry during the study period.

First influenza season after the 2009 pandemic influenza: report of the first 300 ICU admissions in Spain.

Introduction: During the 2009 influenza pandemic, several reports were published, nevertheless, data on the clinical profiles of critically ill patients with the new virus infection during this second outbreak are still lacking.

Material Methods: Prospective, observational, multi-center study conducted in 148 Spanish intensive care units (ICU) during epidemiological weeks 50-52 of 2010 and weeks 1 - 4 of 2011.

Results: Three hundred patients admitted to an intensive care unit (ICU) with confirmed An/H1N1 infection were analyzed.

[Impact of primary and intravascular catheter-related bacteremia due to coagulase-negative staphylococci in critically ill patients].

Objective: To study the impact of coagulase-negative staphylococcal (CNS) primary and intravascular catheter-related bloodstream infection (PBSI/CRBSI) on mortality and morbidity in critically-ill patients.

Design: We performed a double analysis using data from the ENVIN-HELICS registry data (years 1997 to 2008): 1) We studied the clinical characteristics and outcomes of patients with CNS-induced PBSI/CRBSI and compared them with those of patients with PBSI/CRBSI caused by other pathogens; and 2) We analyzed the impact of CNS-induced PBSI/CRBSI using a case-control design (1:4) in patients without other nosocomial infections.

Setting: 167 Spanish Intensive Care Units.

[Epidemiology and impact of nosocomial infections].

Nosocomial infections are one of the most important problems occurring in Intensive Care Units. For this reason, the epidemiology and impact of these infections on critical patients must be known. Based on the data from the ENVIN-UCI study, the rates and etiology of the main nosocomial infections, such as ventilator-associated pneumonia, urinary tract infection and primary and secondary bloodstream infection, have been described.

[Nosocomial infection indicators].

Nosocomial infection indicators are a reflection of healthcare quality and patient safety in hospitals. Infection indicators are calculated using surveillance programs and/or systems. Current nosocomial infection surveillance systems are based on both prevalence and incidence studies.

[Bacterial infections in critically ill patients: review of studies published between 2006 and 2008].

A systematic revision of medical publications between 2006 and 2008 regarding bacterial infections that affect the critical patients was performed. Four subjects were selected: Community-acquired pneumonia, ventilator-associated pneumonia, catheter-related bloodstream infection and new antimicrobial treatments. When dealing with community-acquired pneumonia and due to the absence of completely reliable standards, it is necessary to follow the locally adapted guidelines of clinical practice, to identify patients related to the health-care system and admit patients to the ICU in accordance with the criteria.

[Evaluation of the status of patients with severe infection, criteria for intensive care unit admittance. Spanish Society for Infectious Diseases and Clinical Microbiology. Spanish Society of Intensive and Critical Medicine and Coronary Units].

Recent studies have shown that early attention in patients with serious infections is associated with a better outcome. Assistance in intensive care units (ICU) can effectively provide this attention; hence patients should be admitted to the ICU as soon as possible, before clinical deterioration becomes irreversible. The objective of this article is to compile the recommendations for evaluating disease severity in patients with infections and describe the criteria for ICU admission, updating the criteria published 10 years ago.

[Recommendations for antibiotic monitoring in ICU patients].

Monitoring plasma concentrations of antimicrobial agents used to treat infection in critically ill patients is one of the recommended strategies for improving clinical outcome. Drug monitoring has a double aim: to limit adverse events and to increase the effectiveness of the drugs. In clinical practice, however, this approach is mainly limited to monitoring plasma concentrations of vancomycin and aminoglycosides, although future extension to other antimicrobial agents would be desirable.

[Recommendations of antimicrobial treatment in patients allergic to beta-lactam antibiotics].

Beta-lactam antibiotics are the cornerstone of most of the severe bacterial infections. However, their use can be limited by resistances and allergic reactions. Allergic reactions to beta-lactam antibiotics account for only a small proportion of reported adverse drug reactions, but they are related with an important morbidity, mortality and increase of the health care costs.

[Recommendations for antibiotic monitoring in ICU patients].

Unlabelled: Monitoring plasma concentrations of antimicrobial agents used to treat infection in critically ill patients is one of the recommended strategies for improving clinical outcome. Drug monitoring has a double

Aim: to limit adverse events and to increase the effectiveness of the drugs. In clinical practice, however, this approach is mainly limited to monitoring plasma concentrations of vancomycin and aminoglycosides, although future extension to other antimicrobial agents would be desirable.

[National Study of Control of Nosocomial Infection in Intensive Care Units. Evolutive report of the years 2003-2005].

Objective: Describe the national rates of acquired invasive device-related infections in the ICU during 2003, 2004 and 2005, their etiology and evolution of the multiresistance markers.

Design: Prospective, observational study.

Scope: Intensive Care Unit or other units where critical patients are admitted.

[Staphylococcus aureus nosocomial infections in critically ill patients admitted in intensive care units].

Background And Objective: To investigate the frequency of nosocomial infections caused by Staphylococcus aureus in critically ill patients admitted to Spanish intensive care units (ICUs) and to describe the characteristics and outcome of patients in whom this pathogen was isolated.

Patients And Method: Prospective, observational, and multicenter study. All patients admitted during one or 2 months to the participating ICUs in the National Nosocomial Infection Surveillance Study (ENVIN) between 1997 and 2003 were included.

[Monitoring plasma antibiotic concentrations in Spanish hospitals].

Background: Monitoring of plasma aminoglycoside and vancomycin concentrations is a measure of good clinical practice in critically ill patients. However, the frequency and application of this practice in Spanish hospitals is unknown.

Methods: Observational, multicenter study based on a survey designed by the Study Group for Infection in the Critically Ill Patient of the Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC, Spanish Society of Infectious Diseases and Clinical Microbiology).

[Infections caused by Acinetobacter spp. in critically ill ICU patients].

Introduction: To determine the frequency of infections caused by Acinetobacter spp. in critically ill patients admitted to Spanish intensive care units (ICUs) and to assess the clinical features and outcome.

Patients And Method: Prospective, observational, multicenter study.

Levofloxacin in the treatment of pneumonia in intensive care unit patients.

In this study, we analyzed 302 patients with pneumonia admitted to the Intensive Care Unit (ICU) who were treated with levofloxacin (LFX) either as monotherapy or combined therapy. Pneumonia was classified as community-acquired in 220 (73%) patients, extra-ICU nosocomial-acquired in 43 (14%), and intra-ICU nosocomial-acquired in 39 (13%) patients. Treatment with LFX was used empirically in 85.

[Guidelines for the management of community pneumonia in adult who needs hospitalization].

Community acquired pneumonia is still an important health problem. In Spain the year incidence is 162 cases per 100,000 inhabitants with 53,000 hospital admission costing 115 millions of euros per year. In the last years there have been significant advances in the knowledge of: aetiology, diagnostic tools, treatment alternatives and antibiotic resistance.