OTAVIO TAVARES RANZANI
Projetos de Pesquisa
Unidades Organizacionais
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Intensive care unit acquired pneumonia with or without etiologic diagnosis: A comparison of outcomes(2012) GIUNTA, Valeria; FERRER, Miguel; ESPERATTI, Mariano; RANZANI, Otavio Tavares; SAUCEDO, Lina Maria; BASSI, Gianluigi Li; BLASI, Francesco; TORRES, Antoni- Validation of a Prediction Score for Drug-Resistant Microorganisms in Community-acquired Pneumonia(2021) CECCATO, Adrian; MENDEZ, Raul; EWIG, Santiago; TORRE, Mari C. de la; CILLONIZ, Catia; GABARRUS, Albert; PRINA, Elena; RANZANI, Otavio T.; FERRER, Miquel; ALMIRALL, Jordi; MENENDEZ, Rosario; TORRES, AntoniRationale: Recommended initial empiric antimicrobial treatment covers the most common bacterial pathogens; however, community-acquired pneumonia (CAP) may be caused by microorganisms not targeted by this treatment. Developed in 2015, the PES (Pseudonzonas aeruginosa, extended-spectrum beta-lactamase-producing Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus) score was developed in 2015 to predict the microbiological etiology of CAP caused by PES microorganisms. Objective: To validate the usefulness of the PES score for predicting PES microorganisms in two cohorts of patients with CAP from Valencia and Mataro. Methods: We analyzed two prospective observational cohorts of patients with CAP from Valencia and Mataro. Patients in the Mataro cohort were all admitted to an intensive care unit (ICU). Results: Of the 1,024 patients in the Valencia cohort, 505 (51%) had a microbiological etiology and 31 (6%) had a PES microorganism isolated. The area under the receiver operating characteristic curve was 0.81 (95% confidence interval [95% CI], 0.74-0.88). For a PES score >= 5, sensitivity, specificity, the negative and positive predictive values as well as the negative and positive likelihood ratios were 72%, 74%, 98%, 14%, 0.38, and 2.75, respectively. Of the 299 patients in the Mataro cohort, 213 (71%) had a microbiological etiology and 11 (5%) had a PES microorganism isolated. The area under the receiver operating characteristic curve was 0.73 (95% CI 0.61-0.86). For a PES score >= 5, sensitivity, specificity, the negative and positive predictive values, and the negative and positive likelihood ratios were 36%, 83%, 96%, 11%, 0.77, and 2.09, respectively. The best cutoff for patients admitted to the ICU was 4 points, which improved sensitivity to 86%. The hypothetical application of the PPS score showed high rates of overtreatment in both cohorts (26% and 35%, respectively) and similar rates of undertreatment. Conclusions: The PES score showed good accuracy in predicting the risk for microorganisms that required different empirical therapy; however, its use as a single strategy for detecting noncore pathogens could lead to high rates of overtreatment. Given its high negative predictive value, the PES score may be used as a first step of a wider strategy that includes subsequent advanced diagnostic tests.
conferenceObject Validation Of Predictors Of Adverse Outcomes In Hospital-Acquired Pneumonia In The Intensive Care Unit(2013) ESPERATTI, M.; FERRER, M.; GIUNTA, V.; TAVARES, O.; SAUCEDO, L. M.; BASSI, G. Li; BLASI, F.; RELLO, J.; NIEDERMAN, M. S.; TORRES, A.- New Sepsis Definition (Sepsis-3) and Community-acquired Pneumonia Mortality A Validation and Clinical Decision-Making Study(2017) RANZANI, Otavio T.; PRINA, Elena; MENENDEZ, Rosario; CECCATO, Adrian; CILLONIZ, Catia; MENDEZ, Raul; GABARRUS, Albert; BARBETA, Enric; BASSI, Gianluigi Li; FERRER, Miquel; TORRES, AntoniRationale: The Sepsis-3 Task Force updated the clinical criteria for sepsis, excluding the need for systemic inflammatory response syndrome (SIRS) criteria. The clinical implications of the proposed flowchart including the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and SOFA scores are unknown. Objectives: To perform a clinical decision-making analysis of Sepsis-3 in patients with community-acquired pneumonia. Methods: This was a cohort study including adult patients with community-acquired pneumonia from two Spanish university hospitals. SIRS, qSOFA, the Confusion, Respiratory Rate and Blood Pressure (CRB) score, modified SOFA (mSOFA), the Confusion, Urea, Respiratory Rate, Blood Pressure and Age (CURB-65) score, and Pneumonia Severity Index (PSI) were calculated with data from the emergency department. We used decision-curve analysis to evaluate the clinical usefulness of each score and the primary outcome was in-hospital mortality. Measurements and Main Results: Of 6,874 patients, 442 (6.4%) died in-hospital. SIRS presented the worst discrimination, followed by qSOFA, CRB, mSOFA, CURB-65, and PSI. Overall, overestimation of in-hospital mortality and miscalibration was more evident for qSOFA and mSOFA. SIRS had lower net benefit than qSOFA and CRB, significantly increasing the risk of over-treatment and being comparable with the ""treat-all"" strategy. PSI had higher net benefit than mSOFA and CURB-65 for mortality, whereas mSOFA seemed more applicable when considering mortality/intensive care unit admission. Sepsis-3 flowchart resulted in better identification of patients at high risk of mortality. Conclusions: qSOFA and CRB outperformed SIRS and presented better clinical usefulness as prompt tools for patients with community-acquired pneumonia in the emergency department. Among the tools for a comprehensive patient assessment, PSI had the best decision-aid tool profile.
- Sepsis-3 in Community-acquired Pneumonia: How Reliable Is It? Reply(2018) RANZANI, Otavio T.; TORRES, Antoni
- Association of Sepsis Diagnosis at Daytime and on Weekdays with Compliance with the 3-Hour Sepsis Treatment Bundles A Multicenter Cohort Study(2020) RANZANI, Otavio T.; MONTEIRO, Mariana Barbosa; BESEN, Bruno Adler Maccagnan Pinheiro; AZEVEDO, Luciano Cesar PontesRationale: Compliance with sepsis bundles is associated with better outcomes, but information to support structural actions that might improve compliance is scarce. Few studies have evaluated bundle compliance in different time periods, with conflicting results. Objectives: To evaluate the association of sepsis identification during the daytime versus during the nighttime and on weekdays versus weekends with 3-hour sepsis treatment bundle compliance. Methods: This was an observational, multicenter study including patients with sepsis admitted between 2010 and 2017 to 10 hospitals in Brazil. Our exposures of interest were daytime (7:00 A.M.-6:59 P.M.) versus nighttime (7:00 P.M.-6:59 A.M.) and weekdays (Monday 7:00 A.M.-Friday 6:59 P.M.) versus weekends (Friday 7:00 P.M.-Monday 659 A.M.). Our primary outcome was full compliance with the 3-hour sepsis treatment bundles. We adjusted by potential confounding factors with multivariable logistic regression models. Results: Of 11,737 patients (8,733 sepsis and 3,004 septic shock), 3-hour bundle compliance was 79.1% and hospital mortality was 24.7%. The adjusted odds ratio (adjOR) for 3-hour full bundle compliance for patients diagnosed during the daytime versus during the nighttime was 1.35 (95% confidence interval [CI), 1.23-1.49; P < 0.001) and was more pronounced in the emergency department (adjOR, 1.55; 95% CI, 1.35 1.77; P < 0.001) than in nonemergency areas (adjOR, 1.19; 95% CI, 1.04-1.37; P = 0.014). Overall, there was no association between diagnosis on the weekends versus on weekdays and 3-hour full bundle compliance (adjOR, 1.08; 95% CI, 0.98-1.19; P = 0.115), although there was an association among those diagnosed in nonemergency areas (adjOR, 1.15; 95% CI, 1.00-1.32; P = 0.047). The lower compliance observed for sepsis diagnosed during the nighttime was more evident 2 years after implementation of the quality improvement initiative. Conclusions: Compliance with sepsis bundles was associated with the moment of sepsis diagnosis. The place of diagnosis and the time from campaign implementation were factors modifying this association. Our results support areas for better design of quality improvement initiatives to mitigate the influence of the period of sepsis diagnosis on treatment compliance.
conferenceObject Follow-Up Cultures in Ventilator-Associated Pneumonia(2021) CECCATO, A.; DOMINEDO, C.; MONREAL, M. Ferrer; IGNACIO, M.; BARBETA, E. R.; ALBERT, G.; CILLONIZ, C.; RANZANI, O. T.; PASCALE, G. De; STEFANO, N.; GIANNATALE, P. Di; ANTONELLI, M.; TORRES, A.- Utilidade da avaliação de bactérias revestidas por anticorpos em aspirados traqueais para o diagnóstico de pneumonia associada à ventilação mecânica: um estudo caso-controle(2016) RANZANI, Otavio Tavares; FORTE, Daniel Neves; FORTE, Antonio Carlos; MIMICA, Igor; FORTE, Wilma Carvalho NevesObjetivo: A pneumonia associada à ventilação mecânica (PAVM) é o principal tipo de infecção adquirida no ambiente hospitalar em pacientes em UTIs. O diagnóstico de PAVM é desafiador, principalmente devido a limitações dos métodos diagnósticos disponíveis. O objetivo deste estudo foi determinar se a avaliação de bactérias revestidas por anticorpos (BRA) pode melhorar a especificidade de culturas de aspirado traqueal (AT) no diagnóstico de PAVM. Métodos: Estudo diagnóstico caso-controle envolvendo 45 pacientes sob ventilação mecânica. Amostras de AT foram obtidas de pacientes com e sem PAVM (casos e controles, respectivamente), e verificamos o número de bactérias revestidas com anticorpos monoclonais conjugados com FITC (IgA, IgM ou IgG) ou anticorpo polivalente conjugado com FITC. Utilizando microscopia de imunofluorescência, foi determinada a proporção de BRA em um número fixo de 80 bactérias. Resultados: A mediana das proporções de BRA foi significativamente maior nos casos (n = 22) que nos controles (n = 23) — IgA (60,6% vs. 22,5%), IgM (42,5% vs. 12,5%), IgG (50,6% vs. 17,5%) e polivalente (75,6% vs. 33,8%) — p < 0,001 para todos. A acurácia dos melhores pontos de corte para o diagnostico de PAVM em relação aos BRA monoclonais e polivalentes foi > 95,0% e > 93,3%, respectivamente. Conclusões: O número de BRA em amostras de AT foi maior nos casos que nos controles. Nossos achados indicam que a avaliação de BRA no AT é uma ferramenta promissora para aumentar a especificidade do diagnóstico de PAVM. A técnica pode ser custo-efetiva e, portanto, útil em locais com poucos recursos, com as vantagens de minimizar resultados falso-positivos e evitar o tratamento excessivo.
- Prevention of VAP: role of the artificial airway, body position and setting the ventilator(2012) BASSI, G. Li; FERRER, M.; RANZANI, O. T.; MARTI, J-D.; BERRA, L.; FERNANDEZ, L.; TORRES, A.Ventilator associated pneumonia (VAP) is associated with increased morbidity, mortality and burden for the healthcare system. Oropharyngeal secretions, pooled above the endotracheal tube (ETT) cuff, are the primary source of pathogens in this iatrogenic infection. Improvements in the ETT cuff design to achieve tracheal sealing and maintaining the internal cuff pressure within the recommended range (25-30 cmH(2)O) have a pivotal role in the prevention of pulmonary aspiration of colonised oropharyngeal secretions and VAP. Additionally, ETTs coated with antimicrobial agents prevent colonisation of their internal lumen and biofilm formation; however, further evidence is necessary to assess the role of biofilm in the pathogenesis of VAP. The semirecumbent position is universally recommended; yet, laboratory studies challenge the benefits of such a position. Finally, during positive pressure ventilation, the ventilatory parameters that influence the inspiratory flow, i.e. the duty cycle, have a significant effect on retention of mucus and, potentially, on risks of lung infections. Further clinical evidence is necessary to assess benefits and limitations of ventilatory settings on VAP prevention.
- Evaluation of the 2016 Infectious Diseases Society of America/American Thoracic Society Guideline Criteria for Risk of Multidrug-Resistant Pathogens in Patients with Hospital-acquired and Ventilator-associated Pneumonia in the ICU(2018) EKREN, Pervin Korkmaz; RANZANI, Otavio T.; CECCATO, Adrian; BASSI, Gianluigi Li; CONEJERO, Eva Munoz; FERRER, Miquel; NIEDERMAN, Michael S.; TORRES, Antoni
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