Dolors Mariscal

Corporació Sanitària Parc Taulí

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Jordi Rello

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias

Jordi Vallés

Deleted Institution

Miguel Gallego

Corporació Sanitària Parc Taulí

Pere Coll

Belarusian State Medical University

Concepciόn Montόn

Institute of Research and Innovation Parc Tauli

D. Fontanals

Deleted Institution

Christian Domingo

Corporació Sanitària Parc Taulí

Pilar Cortés

Universitat Autònoma de Barcelona

Manel Luján

Corporació Sanitària Parc Taulí

Montserrat Sala

Universitat Autònoma de Barcelona

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Universitat Autònoma de Barcelona

Deleted Institution

Corporació Sanitària Parc Taulí

Institute of Research and Innovation Parc Tauli

Instituto de Salud Carlos III

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias

Universitat de Barcelona

Inserm

Centro de Investigación Biomédica en Red

Hospital de Sant Pau

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Patterns of colonization by Pseudomonas aeruginosa in intubated patients: a 3-year prospective study of 1,607 isolates using pulsed-field gel electrophoresis with implications for prevention of ventilator-associated pneumonia

Intensive Care Medicine (2004)

Jordi Vallés Dolors Mariscal Pilar Cortés Pere Coll Ana Lucía Rincón Villagra

Ventilator-associated Pneumonia

10.1007/s00134-004-2382-6

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Citations (101)

Neumonía por Pseudomonas aeruginosa

Enfermedades Infecciosas y Microbiología Clínica (2005)

Jordi Vallés Dolors Mariscal

10.1157/13091218

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Citations (7)

The Value of Routine Microbial Investigation in Ventilator-Associated Pneumonia

American Journal of Respiratory and Critical Care Medicine (1997)

Jordi Rello Miguel Gallego Dolors Mariscal Rosario Sonora Jordi Vallés

The use of microbiologic investigations in routine clinical practice, their value in guiding antibiotic prescription, and their influence on outcome were prospectively studied in 113 consecutive adults who developed ventilator-associated pneumonia (VAP). Blood cultures were performed in 78.7% of cases, protected specimen brushing in 95.5%, and bronchoalveolar lavage in only 45.1%. No causative agent was identified in 13 episodes (11.5%), and results of microbial tests directed a change in therapy in 43 (38.0%). Bronchoscopic results revealed inadequate initial selection of antibiotic therapy in 27 cases (23.9%) and led to a change in antibiotic treatment. Inadequate initial selection was still associated with a significantly greater increase in related mortality than adequate initial therapy (37.0% versus 15.4%, p < 0.05), although the change in therapy permitted clinical resolution in 17 (62.9%) of these 27 episodes, and 10 patients were discharged alive. Bronchoscopic results also permitted the reduction of the antibiotic spectrum in seven episodes (6.1%). This study suggests that in patients with VAP, bronchoscopic results are frequently associated with changes in antibiotic therapy. Nevertheless, our findings also emphasize the critical importance of an appropriate early antibiotic therapy.

Antibiotic Therapy

Ventilator-associated Pneumonia

10.1164/ajrccm.156.1.9607030

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Citations (486)

Evaluation of the BacT/Alert and VITAL blood culture systems for the diagnosis of bacteremia

Clinical Microbiology and Infection (1998)

D. Fontanals Isabel Sanfeliú Immaculada Pons Dolors Mariscal Montserrat Torra

Blood Culture

Bacteremia

Vital signs

10.1111/j.1469-0691.1998.tb00361.x

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Citations (5)

Invasive Pulmonary Aspergillosis in Patients with Chronic Obstructive Pulmonary Disease: Report of Eight Cases and Review

Clinical Infectious Diseases (1998)

Jordi Rello Maria‐Eugenia Esandi Dolors Mariscal Miguel Gallego Christian Domingo

Pulmonary aspergillosis

10.1086/517672

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Citations (119)

Presence of Polyclonal Pseudomonas aeruginosa in an Intensive Care Unit A 27-Month Prospective Study on Molecular Epidemiology

Infection Control and Hospital Epidemiology (2001)

Pilar Cortés Dolors Mariscal Jordi Vallés Jordi Rello Pere Coll

Abstract Pseudomonas aeruginosa was isolated in 22.2% of 305 intensive care unit environmental cultures. A high genetic heterogeneity (18 pulsotypes) was evident. Taps and related surfaces were a stable reservoir for certain pulsotypes. The 15.4% of the P aerugi- Mosa-positive cultures were polyclonal. Different colony morpho-types should be assayed in surveillance studies.

Polyclonal antibodies

Molecular Epidemiology

10.1086/501853

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Citations (7)

The Role of Candida sp Isolated From Bronchoscopic Samples in Nonneutropenic Patients

CHEST Journal (1998)

Jordi Rello Maria‐Eugenia Esandi Emili Díaz Dolors Mariscal Miguel Gallego

Chest radiograph

Systemic candidiasis

Clinical Significance

10.1378/chest.114.1.146

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Citations (159)

Type III protein secretion is associated with poor clinical outcomes in patients with ventilator-associated pneumonia caused by Pseudomonas aeruginosa

Critical Care Medicine (2002)

Alan R. Hauser Enesha M. Cobb María Bodí Dolors Mariscal Jordi Vallés

Objective Pseudomonas aeruginosa is a frequent cause of ventilator-associated pneumonia. Recent evidence suggests that production of type III secretion proteins is correlated with increased pathogenicity in both cellular and animal models of infection. The objective of this study was to determine whether this system contributes to disease severity in humans with ventilator-associated pneumonia. Design Retrospective pilot cohort study. Setting University hospital. Patients Thirty-five mechanically ventilated patients with bronchoscopically confirmed ventilator-associated pneumonia caused by P. aeruginosa. Measurements and Main Results Ventilator-associated pneumonia was categorized as severe (patients died or had a recurrence of their pneumonia despite appropriate antibiotic therapy) or mild (patients uneventfully recovered from their pneumonia). The type III secretion genotypes and phenotypes of isolates cultured from the patients with ventilator-associated pneumonia were determined. Whereas every examined isolate harbored type III secretion genes, only 27 (77%) were capable of secreting detectable amounts of type III proteins in vitro. Twenty-two (81%) of the patients infected with these 27 isolates had severe disease. Of the eight isolates that did not secrete type III proteins, only three (38%) were cultured from patients with severe disease. Thus, infection with a type-III-secreting isolate correlated with severe disease (p < .05). In vitro assays indicated that ExoU, the type III effector protein most closely linked to mortality in animal models, was secreted in detectable amounts in vitro by 10 (29%) of the 35 examined isolates. Nine (90%) of these 10 isolates were cultured from patients with severe disease (p < .05 when compared with the nonsecreting isolates). In contrast, ExoS was secreted by 16 (46%) of the 35 examined isolates. Twelve (75%) of these 16 isolates were cultured from patients with severe disease (p = .14 when compared with the nonsecreting isolates). Conclusions In patients with ventilator-associated pneumonia, type-III-secreting isolates were associated with worse clinical outcomes, suggesting that this secretion system plays an important role in human disease. Our findings support the hypothesis that antibodies targeted against these proteins may be useful as adjunctive therapy in intubated patients with P. aeruginosa colonization or infection.

Ventilator-associated Pneumonia

10.1097/00003246-200203000-00005

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Citations (387)

Presence of PolyclonalPseudomonas aeruginosain an Intensive Care Unit A 27-Month Prospective Study on Molecular Epidemiology

Infection Control and Hospital Epidemiology (2001)

Pilar Cortés Dolors Mariscal Jordi Vallés Jordi Rello Pere Coll

Polyclonal antibodies

Molecular Epidemiology

10.1017/s0195941700072726

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Citations (2)