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Differences in hospital- and ventilator-associated pneumonia due to Staphylococcus aureus (methicillin-susceptible and methicillin-resistant) between Europe and Latin America: A comparison of the EUVAP and LATINVAP study cohorts
J. Relloa,
, D. Molanob, M. Villabonb, R. Reinad, R. Rita-Quispee, I. Previglianoc, E. Afonsoa, M.I. Restrepof
Corresponding author
a Critical Care Department, Vall d’Hebron University Hospital, IRVH, CIBERes, Barcelona, Spain
b Critical Care Department, University Hospital of San José, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
c Critical Care Department, Hospital Fernadez, Capital Federal, Argentina
d Critical Care Department, Hospital San Martin de la Plata, Argentina
e Critical Care Department, Hospital Nacional Dos de Mayo, Lima, Peru
f Veterans Evidence Research Dissemination and Implementation Center (VERDICT), Department of Medicine, The University of Texas Health Science Center at San Antonio, USA
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The LATINVAP project was a multicenter prospective observational study, with an identical design, performed in 17 ICUs from 4 Latin American countries involving 99 patients who developed HAP/VAP. Episodes of VAP/HAP caused by <span class="elsevierStyleItalic">S. aureus</span>, MSSA, and MRSA were compared in both cohorts.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Forty-five patients had <span class="elsevierStyleItalic">S. aureus</span> HAP/VAP in the EUVAP cohort vs. 11 patients in the LATINVAP cohort. More patients had MRSA in the LATINVAP study than in the EUVAP (45% vs. 33%). ICU mortality among patients with MSSA HAP/VAP in EUVAP was 10% vs. 50% for LATINVAP (OR = 9.75, <span class="elsevierStyleItalic">p</span> = 0.01). Fifteen patients in the EUVAP cohort developed MRSA HAP/VAP as opposed to 5 in LATINVAP. In the EUVAP study there was an ICU mortality rate of 33.3%. In the LATINVAP cohort, the ICU mortality rate was 60% (OR for death = 3.0; 95%CI 0.24---44.7).</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">MRSA pneumonia was associated with poorer outcomes in comparison with MSSA. Our study suggests significant variability among European and Latin American ICU practices that may influence clinical outcomes. Furthermore, patients with pneumonia in Latin America have different outcomes.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">comparar las variables epidemiológicas (características demográficas y clínicas) y los efectos en pacientes con neumonía intrahospitalaria (NIH) o neumonía asociada a la ventilación (NAV) causada por <span class="elsevierStyleItalic">Staphylococcus aureus</span> susceptible a la meticilina (SASM) y resistente a la meticilina (SARM) en las cohortes LATINVAP y EUVAP de pacientes admitidos en unidades de cuidados intensivos (UCI).</p> <span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El proyecto EUVAP fue un estudio prospectivo, multicéntrico y observacional sobre 827 pacientes con NIH/NAV de 27 UCI de 9 países europeos. El proyecto LATINVAP fue un estudio pospectivo, multicéntrico y observacional de idéntico disen¿o que se llevó a cabo en 17 UCI de 4 países latinoamericanos y en el que se evaluaron 99 pacientes que habían desarrollado HAP/VAP. Se compararon entre las cohortes los episodios de VAP/HAP causados por <span class="elsevierStyleItalic">S. aureus</span> (SASM y SARM).</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cuarenta y cinco pacientes presentaron NIH/NAV por <span class="elsevierStyleItalic">S. aureus</span> en la cohorte EUVAP frente a 11 pacientes en la cohorte LATINVAP. El número de pacientes con SARM en el estudio LATINVAP fue superior al del estudio EUVAP (45% frente al 33%). La mortalidad en la UCI entre los pacientes con NIH/NAV por SASM del estudio EUVAP fue del 10% frente al 50% en el caso del estudio LATINVAP (OR = 9,75, p = 0,01). Quince pacientes de la cohorte EUVAP desarrollaron NIH/NAV por SARM frente a 5 de la cohorte LATINVAP. En el estudio EUVAP se registró una tasa de mortalidad del 33,3%. En la cohorte LATINVAP la tasa de mortalidad en la UCI fue del 60% (OR de muerte = 3,0; IC del 95% de 0,24 a 44,7).</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La neumonía por SARM se asoció a unos peores resultados en comparación con la neumonía por SASM. Nuestro estudio sugiere una variabilidad importante entre las prácticas de las UCI europeas y latinoamericanas que podría influir sobre los resulta- dos clínicos. Además, los pacientes con neumonía de Latinoamérica presentaron resultados diferentes.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rello J., et al. Diferencias entre la neumonía de origen nosocomial y asociada a la ventilación por <span class="elsevierStyleItalic">Staphylococcus aureus</span> (susceptible a la meticilina y resistente a la meticilina) en europa y latinoamérica: comparación de las cohortes de estudio EUVAP y LATINVAP. Med Intensiva. 2012. http://dx.doi.org/10.1016/j.medine.2012.04.008.</p>" ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000003700000004/v1_201307160921/S2173572713000532/v1_201307160921/en/main.assets" "Apartado" => array:4 [ "identificador" => "411" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000003700000004/v1_201307160921/S2173572713000532/v1_201307160921/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572713000532?idApp=WMIE" ]
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