scholarly journals COVID-19 in-hospital mortality of a secondary care center of Mexico City in a marginated area during the first months of the Mexican epidemic

2021 ◽  
Author(s):  
José Martín Alanís-Naranjo ◽  
Víctor Manuel Anguiano-Álvarez ◽  
Eduardo Federico Hammeken-Larrondo
Keyword(s):  
Intensive Care ◽  
Hospital Mortality ◽  
Mexico City ◽  
Secondary Care ◽  
Care Center ◽  
Severe Pneumonia ◽  
P Value ◽  
Intravenous Antibiotics ◽  
Tertiary Hospitals ◽  
Hospital Acquired

Abstract Introduction: Low socioeconomic conditions and hospital saturation have been associated with higher mortality rates in hospitalized patients with COVID-19. Mexico City has become the country’s highest death toll. Iztapalapa is the district with the highest population density and marginalization in Mexico City. Most of the information on COVID-19 in-hospital mortality in Mexico comes from intensive care units or tertiary hospitals without considering the level of income. Data regarding hospital mortality in care centers with low availability of intensive care beds has not been explored.Material and methods: A retrospective cohort study in consecutive patients with COVID-19 hospitalized managed outside the intensive care unit in a secondary care center in Mexico City from April 1st, 2020, to May 31st, 2020. Analysis was performed between subgroups with a p-value <0.05 considered statistically significant.Results: A total of 164 patients were recruited; the median age was 52.5 years (IQR 44 - 64.5), 68% were males, 48.7% were obese, and 59.7% had comorbidities. Among those patients, 67% required mechanical ventilation and 32.3% vasopressor support. In this population, 52 recovered (31.7%) and 112 died (68.3%). The main risk factors associated with death were male sex, age > 50 years, diabetes, severe pneumonia on admission, PORT / PSI > 91, SMART-COP > 5, SCAP score > 10, dyspnea on admission, fever during hospitalization [p <0.05] and the administration of intravenous antibiotics [RR 3.45, 95% CI 1.69-7.06, p <0.001].Conclusion: In this study, we found higher in-hospital mortality compared to previous reports. We suggest that the administration of intravenous antibiotics could impact patient survival for the risk of developing hospital-acquired infections.

scholarly journals Impact of ICU saturation on hospital mortality from COVID-19 in a secondary care center in Iztapalapa, Mexico City

2021 ◽  
Author(s):  
José Martín Alanís-Naranjo ◽  
Víctor Manuel Anguiano-Álvarez ◽  
Eduardo Federico Hammeken-Larrondo
Keyword(s):  
Hospital Mortality ◽  
Mexico City ◽  
Care Center ◽  
Severe Disease ◽  
Kidney Injury ◽  
Study Data ◽  
P Value ◽  
Factors Associated ◽  
Intravenous Antibiotics ◽  
Male Sex

Abstract INTRODUCTION: A saturated intensive care unit (ICU) setting and socioeconomic factors such as higher poverty rates have been associated with increased rates of in-hospital mortality in COVID-19 patients. Mexico City has become the national epicenter of the pandemic, with Mexico’s highest death toll. Iztapalapa is the delegation with the highest population density and the most notorious conditions of marginalization in Mexico City. We describe the clinical characteristics and risk factors associated with mortality in 164 patients who received care in a hospital ward setting due to ICU saturation in a hospital in Iztapalapa, Mexico City.MATERIALS AND METHODS: In this retrospective cohort study, data from confirmed COVID-19 patients hospitalized between April 1, 2020 and May 31, 2020 were collected. Patients were categorized into different subgroups: alive vs. deceased and intubated vs. nonintubated for analysis between groups. A p-value <0.05 was considered statistically significant.RESULTS: In this setting, 67% of the patients required mechanical ventilation, and 32.3% needed vasopressor support, with an in-hospital mortality of 68.3%. The most common complications during hospitalization were acute kidney injury (36%) and acute respiratory distress syndrome (34.8%). We observed similar factors associated with death as previous studies: male sex, older age, comorbidities, laboratory values indicating increased inflammatory/organ failure markers, and severe disease at admission. Additionally, we found that routine use of intravenous antibiotics was associated with a higher rate of in-hospital mortality (RR 3.45, 95% CI 1.69-7.06, p <0.001).

scholarly journals Impact of ICU saturation on hospital mortality from COVID-19 in a secondary care center in Iztapalapa, Mexico City

2021 ◽  
Author(s):  
José Martín Alanís-Naranjo ◽  
Víctor Manuel Anguiano-Álvarez ◽  
Eduardo Federico Hammeken-Larrondo
Keyword(s):  
Hospital Mortality ◽  
Mexico City ◽  
Care Center ◽  
Severe Disease ◽  
Kidney Injury ◽  
Study Data ◽  
P Value ◽  
Factors Associated ◽  
Intravenous Antibiotics ◽  
Male Sex

Abstract INTRODUCTION: A saturated intensive care unit (ICU) setting and socioeconomic factors such as higher poverty rates have been associated with increased rates of in-hospital mortality of COVID-19 patients. Mexico City has become the national epicenter of the pandemic, with Mexico’s highest death toll. Iztapalapa is the delegation with the highest population density and the most notorious conditions of marginalization in Mexico City. We describe the clinical characteristics and risk factors associated with mortality in 164 patients who received care in a hospital ward setting due to ICU saturation in a hospital in Iztapalapa, Mexico City.MATERIALS AND METHODS: In this retrospective cohort study, data from confirmed COVID-19 patients hospitalized between April 1, 2020 and May 31, 2020 were collected. Patients were categorized into different subgroups: alive vs. deceased and intubated vs. non-intubated for analysis between groups. A p-value <0.05 was considered statistically significant.RESULTS: In this setting, 67% of the patients required mechanical ventilation, and 32.3% needed vasopressor support, with in-hospital mortality of 68.3%. The most common complications during hospitalization were acute kidney injury (36%) and acute respiratory distress syndrome (34.8%). We observed similar factors associated with death as previous studies: male sex, older age, comorbidities, laboratory values indicating increased inflammatory/organ failure markers, and severe disease at admission. Additionally, we found that routine use of intravenous antibiotics was associated with a higher rate of in-hospital mortality (RR 3.45, 95% CI 1.69-7.06, p <0.001).CONCLUSIONS: Patients hospitalized due to COVID-19 in a saturated ICU setting had higher mortality than the rates in other studies reported globally.

scholarly journals Impact of ICU saturation on hospital mortality from COVID-19 in a secondary care center in Iztapalapa, Mexico City

2021 ◽  
Author(s):  
José Martín Alanís-Naranjo ◽  
Víctor Manuel Anguiano-Álvarez ◽  
Eduardo Federico Hammeken-Larrondo
Keyword(s):  
Hospital Mortality ◽  
Mexico City ◽  
Care Center ◽  
Severe Disease ◽  
Kidney Injury ◽  
Study Data ◽  
P Value ◽  
Factors Associated ◽  
Intravenous Antibiotics ◽  
Male Sex

Abstract INTRODUCTION: A saturated intensive care unit (ICU) setting and socioeconomic factors such as higher poverty rates have been associated with increased rates of in-hospital mortality of COVID-19 patients. Mexico City has become the national epicenter of the pandemic, with Mexico’s highest death toll. Iztapalapa is the delegation with the highest population density and the most notorious conditions of marginalization in Mexico City. We describe the clinical characteristics and risk factors associated with mortality in 164 patients who received care in a hospital ward setting due to ICU saturation in a hospital in Iztapalapa, Mexico City.MATERIALS AND METHODS: In this retrospective cohort study, data from confirmed COVID-19 patients hospitalized between April 1, 2020 and May 31, 2020 were collected. Patients were categorized into different subgroups: alive vs. deceased and intubated vs. non-intubated for analysis between groups. A p-value <0.05 was considered statistically significant.RESULTS: In this setting, 67% of the patients required mechanical ventilation, and 32.3% needed vasopressor support, with in-hospital mortality of 68.3%. The most common complications during hospitalization were acute kidney injury (36%) and acute respiratory distress syndrome (34.8%). We observed similar factors associated with death as previous studies: male sex, older age, comorbidities, laboratory values indicating increased inflammatory/organ failure markers, and severe disease at admission. Additionally, we found that routine use of intravenous antibiotics was associated with a higher rate of in-hospital mortality (RR 3.45, 95% CI 1.69-7.06, p <0.001).CONCLUSIONS: Patients hospitalized due to COVID-19 in a saturated ICU setting had higher mortality than the rates in other studies reported globally.

scholarly journals 388. Epidemiologic and Microbiologic Characteristics of Hospital-acquired Infections in Patients with COVID-19 at Intensive Care Unit, Mexico City

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S296-S296
Author(s):  
Paulo Castañeda-Méndez ◽  
Maria Lorena Cabrera-Ruiz ◽  
Armando Barragán-Reyes ◽  
Esperanza Aleman Aguilar ◽  
Brenda Aceves Sanchez ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mexico City ◽  
Antimicrobial Susceptibility ◽  
Severe Pneumonia ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Hospital Acquired Infections ◽  
Hospital Acquired ◽  
Stay Hospital

Abstract Background Patients with severe SARS-CoV-2 infection are at high risk of complications due to the intensive care unit stay. Hospital-acquired infections (HAI) are one of the most common complication and cause of death in this group of patients, it is important to know the epidemiology and microbiology of this hospital-acquired infections in order to begin to the patients a proper empirical treatment. We describe the epidemiologic and microbiologic characteristics of HAI in patients with COVID-19 hospitalized at intensive care unit (ICU) in a tertiary level private hospital in Mexico City. Methods From April to December 2020, data from all HAIs in patients with severe pneumonia due to SARS-CoV-2 infection with mechanical ventilation at ICU were obtained. The type of infection, microorganisms and antimicrobial susceptibility patterns were determined. Results A total of 61 episodes of HAIs were obtained, the most common was ventilator associated pneumonia (VAP) in 52.4% (n=32) followed by urinary tract infection (UTI) 34.4%(n=21) and bloodstream infection (BSI) 9.84% (n=6). Only two episodes corresponded to C. difficile associated diarrhea. We identified 82 different microorganisms, the most frequent cause of VAP was P. aeruginosa 22% (10/45) followed by K. pneumoniae 20% (9/45); for UTI, E. coli 28.5% (6/21), and S. marcescens 19% (4/21); for BSI the most frequent microorganism was S. aureus 28.5 (2/7). Regarding the antimicrobial susceptibility patters the most common were Extended Spectrum Beta-Lactamase (ESBL) Gram-negative rods followed by Methicillin-resistant Staphylococcus aureus. Conclusion In patients with severe COVID-19 hospitalized in the ICU the most frequent HAIs were VAP and UTI caused by P. aeruginosa and E. coli respectively. ESBL enterobacteriaceae was the most common resistant pattern identifed in the bacterial isolations in our series. Disclosures All Authors: No reported disclosures

Hospital-acquired pressure ulcers and risk of hospital mortality in intensive care patients on mechanical ventilation

2014 ◽  
Vol 20 (4) ◽  
pp. 362-368 ◽  
Author(s):  
Francisco Manzano ◽  
Ana M. Pérez-Pérez ◽  
Susana Martínez-Ruiz ◽  
Cristina Garrido-Colmenero ◽  
Delphine Roldan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Pressure Ulcers ◽  
Intensive Care Patients ◽  
Hospital Acquired

scholarly journals Renal Replacement Therapy in Intensive Care Unit at a Tertiary Care Center in Nepal

2019 ◽  
Vol 21 (1) ◽  
pp. 74-79
Author(s):  
Pramod Kumar Chhetri ◽  
DN Manandhar ◽  
P Poudel ◽  
S Baidya ◽  
SB Raju ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Hospital Mortality ◽  
Replacement Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Intermittent Hemodialysis ◽  
Low Efficiency

 Acute kidney injury is a major complication in intensive care unit patients. It is associated with increased in-hospital mortality and length of stay. The provision of renal replacement therapy in intensive care is not widely available in resource poor countries like Nepal. The study aims to look into clinical profile and outcome of patients who received renal replacement therapy in intensive care unit. It was an observational study done from 1st October 2016 till 30th September 2017. Patient’s demographic data, indications, biochemical tests, outcomes, modality of renal replacement therapy were recorded. Statistical package for the social sciences version 17 was used for statistical analysis. There were total of 649 admissions in intensive care, among which 148 had kidney related complications. Of 148 patients, 69 (47%) received renal replacement therapy. Mean age, urea and creatinine on admission were 50.17 ± 18.42 years, 174.54 ± 63.46 mg/dl and 8.05 ± 3.49 mg/ dl respectively. They underwent 4.32 ± 3.09 sessions and 14.94 ± 10.88 hours of renal replacement therapy. Total 42 (61%) had septic shock on admission and underwent sustained low efficiency dialysis as the modality of renal replacement therapy. In-hospital mortality was 19 (28%). Presence of septic shock on admission and mean number of ionotropes required 2.05 ± 1.12 was statistically significant for in-hospital mortality (p=0.01). About half of the patients were on mechanical ventilation which was statistically significant for in-hospital mortality (p<0.001). Sustained low efficiency dialysis can be done in patients on ionotropes and patients can be switched over to intermittent hemodialysis.

The Relationship of Paranasal Sinus Opacification to Hospital-Acquired Pneumonia in the Neurologic Intensive Care Unit Patient

2017 ◽  
Vol 34 (10) ◽  
pp. 844-850
Author(s):  
Phillip Huyett ◽  
Nicholas R. Rowan ◽  
Berrylin J. Ferguson ◽  
Stella Lee ◽  
Eric W. Wang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Paranasal Sinus ◽  
Care Center ◽  
Tertiary Care ◽  
Lower Airway ◽  
Icu Admission ◽  
Airway Infections ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Background: The association between intensive care unit (ICU) sinusitis and the development of lower airway infections remains unclear. The objective of this study was to determine the correlation between the development of radiographic sinus opacification and pneumonia in the neurologic ICU setting. Methods: A retrospective review of head computed tomography or magnetic resonance imaging of 612 patients admitted to the neurocritical care unit at a tertiary care center from April 2013 through April 2014 was performed. Paranasal sinus opacification was measured using Lund-Mackay scores (LMS). A diagnosis of pneumonia was determined by the ICU team from radiographic, laboratory, and pulmonary data. Exclusion criteria included a history of endonasal surgery, sinonasal malignancy, facial fractures, ICU admission less than 3 days, or inadequate imaging. Results: Worsening sinus opacification occurred in 42.6% of patients and pneumonia in 18.5% of patients during ICU admission. Of the patients who developed pneumonia, 71.7% also developed worsening sinus opacification ( P < .001). In 80.2% of cases, the sinus opacification developed prior to the diagnosis of pneumonia. The mean highest LMS for patients who developed pneumonia was 4.24 compared to 1.99 in patients who did not develop pneumonia ( P < .001). Sinus air–fluid levels or complete sinus opacification occurred in a larger proportion of patients who developed pneumonia (46.9% vs 19.4%, P < .001). Mortality rates for patients with no pneumonia or sinusitis, pneumonia only, sinusitis only, and sinusitis with pneumonia were 7.6%, 15.6%, 18.3%, and 25.9%, respectively ( P < .001). Conclusions: This study finds a strong relationship between worsening sinus opacification in the neurologic ICU patient to the development of hospital-acquired pneumonia and increased mortality.

scholarly journals Outbreak of NDM-1-Producing Escherichia coli in a Coronavirus Disease 2019 Intensive Care Unit in a Mexican Tertiary Care Center

2022 ◽  
Author(s):  
Oscar A. Fernández-García ◽  
María F. González-Lara ◽  
Marco Villanueva-Reza ◽  
Nereyda de-León-Cividanes ◽  
Luis F. Xancal-Salvador ◽  
...  
Keyword(s):  
Intensive Care ◽  
Care Center ◽  
Tertiary Care ◽  
Collateral Damage ◽  
Surge Capacity ◽  
Hospital Acquired Infections ◽  
High Workload ◽  
Pandemic Response ◽  
Hospital Acquired

The SARS-CoV-2 pandemic has resulted in a surge of critically ill patients. Hospitals have had to adapt to the demand by repurposing areas as intensive care units. This has resulted in high workload and disruption of usual hospital workflows. Surge capacity guidelines and pandemic response plans do not contemplate how to limit collateral damage from issues like hospital-acquired infections. It is vital to ensure quality of care in surge scenarios.

Nhận xét về hiệu quả của Tocilizumab trong điều trị hỗ trợ bệnh nhân Covid-19

2022 ◽  
Author(s):  
Hong Quan Hoang
Keyword(s):  
Clinical Trial ◽  
Intensive Care ◽  
Interleukin 6 ◽  
Care Center ◽  
Severe Pneumonia ◽  
Ho Chi Minh City ◽  
Supportive Treatment ◽  
Central Hospital ◽  
Global Pandemic ◽  
Pcr Method

TÓM TẮT Đặt vấn đề: Sự bùng phát Coronavirus 2019 (COVID-19) đã lây lan nhanh chóng trên toàn thế giới và trở thành một đại dịch toàn cầu, nhiều phương pháp điều trị đang được nghiên cứu, trong đó ức chế interleukin 6 là một phương pháp tỏ ra hiệu quả. Báo cáo này nhằm đánh giá hiệu quả của Tocilizumab trong điều trị hỗ trợ bệnh nhân Covid-19. Báo cáo trường hợp: 4 trường hợp bệnh nhân được xác nhận Covid-19 bằng phương pháp PCR, đang được điều trị Trung tâm Hồi sức tích cực người bệnh Covid-19 thuốc bệnh viện Trung Ương Huế tại thành phố Hồ Chí Minh, viêm phổi nặng cần phải thông khí hỗ trợ. Bệnh nhân được điều trị phác đồ bao gồm tocilizumab cho kết quả tăng interleukin 6 sau 1 tuần điều trị. Kết luận: Trong thử nghiệm lâm sàng liên quan đến bệnh nhân viêm phổi nặng do Covid-19, cho thấy Interleukin - 6 tăng sau 1 tuần điều trị. ABSTRACT COMMENTS ON THE EFFECTIVENESS OF TOCILIZUMAB IN THE SUPPORTIVE TREATMENT OF COVID-19 PATIENTS Introduction: The outbreak of Coronavirus 2019 (COVID-19) has spread rapidly across the globe and has become a global pandemic. Many treatments are being studied, of which interleukin 6 inhibition is an effective method. Case report: Fourcases of patients confirmed covid-19 by PCR method, being treated at COVID-19 Intensive Care Center of Hue Central Hospital in Ho Chi Minh city, severe pneumonia requires ventilation assistance. The patients were treated with a regimen including Tocilizumab that resulted in increased interleukin 6 results after 1 week of treatment. Conclusion: In a clinical trial involving patients with severe pneumonia caused by Covid-19, it was found that Interleukin 6 increased after 1 week of treatment. Keywords: Interleukin 6, Tocilizumab, Covid-19

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