Browsing by Author "Rodriguez, Alejandro"

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    Dexamethasone as risk-factor for ICU-acquired respiratory tract infections in severe COVID-19
    (W B SAUNDERS CO-ELSEVIER INC, 2022) Felipe Reyes, Luis; Rodriguez, Alejandro; Bastidas, Alirio; Parra-Tanoux, Daniela; Fuentes, Yuli, V; Garcia-Gallo, Esteban; Moreno, Gerard; Ospina-Tascon, Gustavo; Hernandez, Gleen; Silva, Edwin; Diaz, Ana Maria; Jibaja, Manuel; Vera-Alarcon, Magdalena; Diaz, Emilio; Bodi, Maria; Sole-Violan, Jordi; Ferrer, Ricard; Albaya-Moreno, Antonio; Socias, Lorenzo; Estella, Angel; Loza-Vazquez, Ana; Jorge-Garcia, Ruth; Sancho, Isabel; Martin-Loeches, Ignacio
    Purpose: Dexamethasone is the only drug that has consistently reduced mortality in patients with COVID-19, es-pecially in patients needing oxygen or invasive mechanical ventilation. However, there is a growing concern about the relation of dexamethasone with the unprecedented rates of ICU-acquired respiratory tract infections (ICU-RTI) observed in patients with severe COVID-19. Methods: This was a multicenter, prospective cohort study; conducted in ten countries in Latin America and Europe. We included patients older than 18 with confirmed SARS-CoV-2 requiring ICU admission. A multivariate logistic regression and propensity score matching (PSM) analysis was conducted to determine the relation be-tween dexamethasone treatment and ICU-RTI. Results: A total of 3777 patients were included. 2065 (54.7%) were treated with dexamethasone within the first 24 h of admission. After performing the PSM, patients treated with dexamethasone showed significantly higher proportions of VAP (282/1652 [17.1%] Vs. 218/1652 [13.2%], p = 0.014). Also, dexamethasone treatment was identified as an adjusted risk factor of ICU-RTI in the multivariate logistic regression model (OR 1.64; 95%CI: 1.37-1.97; p < 0.001).
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    Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study
    (NATURE PORTFOLIO, 2023) Reyes, Luis Felipe; Rodriguez, Alejandro; Fuentes, Yuli V.; Duque, Sara; Garcia-Gallo, Esteban; Bastidas, Alirio; Serrano-Mayorga, Cristian C.; Ibanez-Prada, Elsa D.; Moreno, Gerard; Ramirez-Valbuena, Paula C.; Ospina-Tascon, Gustavo; Hernandez, Glenn; Silva, Edwin; Diaz, Ana Maria; Jibaja, Manuel; Vera-Alarcon, Magdalena; Diaz, Emili; Bodi, Maria; Sole-Violan, Jordi; Ferrer, Ricard; Albaya-Moreno, Antonio; Socias, Lorenzo; Figueroa, William; Lozano-Villanueva, Jose L.; Varon-Vega, Fabio; Estella, Angel; Loza-Vazquez, Ana; Jorge-Garcia, Ruth; Sancho, Isabel; Shankar-Hari, Manu; Martin-Loeches, Ignacio
    Around one-third of patients diagnosed with COVID-19 develop a severe illness that requires admission to the Intensive Care Unit (ICU). In clinical practice, clinicians have learned that patients admitted to the ICU due to severe COVID-19 frequently develop ventilator-associated lower respiratory tract infections (VA-LRTI). This study aims to describe the clinical characteristics, the factors associated with VA-LRTI, and its impact on clinical outcomes in patients with severe COVID-19. This was a multicentre, observational cohort study conducted in ten countries in Latin America and Europe. We included patients with confirmed rtPCR for SARS-CoV-2 requiring ICU admission and endotracheal intubation. Only patients with a microbiological and clinical diagnosis of VA-LRTI were included. Multivariate Logistic regression analyses and Random Forest were conducted to determine the risk factors for VA-LRTI and its clinical impact in patients with severe COVID-19. In our study cohort of 3287 patients, VA-LRTI was diagnosed in 28.8% [948/3287]. The cumulative incidence of ventilator-associated pneumonia (VAP) was 18.6% [610/3287], followed by ventilator-associated tracheobronchitis (VAT) 10.3% [338/3287]. A total of 1252 bacteria species were isolated. The most frequently isolated pathogens were Pseudomonas aeruginosa (21.2% [266/1252]), followed by Klebsiella pneumoniae (19.1% [239/1252]) and Staphylococcus aureus (15.5% [194/1,252]). The factors independently associated with the development of VA-LRTI were prolonged stay under invasive mechanical ventilation, AKI during ICU stay, and the number of comorbidities. Regarding the clinical impact of VA-LRTI, patients with VAP had an increased risk of hospital mortality (OR [95% CI] of 1.81 [1.40-2.34]), while VAT was not associated with increased hospital mortality (OR [95% CI] of 1.34 [0.98-1.83]). VA-LRTI, often with difficult-to-treat bacteria, is frequent in patients admitted to the ICU due to severe COVID-19 and is associated with worse clinical outcomes, including higher mortality. Identifying risk factors for VA-LRTI might allow the early patient diagnosis to improve clinical outcomes.
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    Species delimitation and intraspecific diversification in recently diverged South American foxes
    (2024) Pizarro, Eduardo J.; Julio-Kalajzic, Bernardita; Sallaberry-Pincheira, Nicole; Munoz, Valentina; Gonzalez-Acuna, Daniel; Cabello, Javier; Acosta-Jamett, Gerardo; Bonacic, Cristian; Iriarte, Agustin; Rodriguez, Alejandro; Travaini, Alejandro; Cevidanes, Aitor; Brito, Jose Luis; Millan, Javier; Marin, Juan Carlos; Vianna, Juliana A.
    The divergence between the Andean fox (Lycalopex culpaeus) and the South American gray fox (L. griseus) represents a recent speciation event in South America. These taxa are partially sympatric and share biological, morphological, and ecological traits. Previous studies failed to recover reciprocal monophyly, suggesting the occurrence of introgression or incomplete lineage sorting (ILS). Here, we obtained mitochondrial and nuclear markers for 140 L. culpaeus and 134 L. griseus from the Southern Cone of South America to assess their inter and intraspecific divergence. We recovered reciprocal monophyly of L. culpaeus and L. griseus, with mild signatures of introgression or ILS. Therefore, taxonomic misidentification and the use of a limited number of markers may be the main reason behind the past debate about the delimitation of both species. Two main divergent clades were found in L. culpaeus with a phylogeographical boundary in the High Plateau of northeastern Chile. The southern clade along with three northern sub-clades corresponded to four morphological subspecies. Less genetic differentiation was found in L. griseus with a spatial population structure that does not support the occurrence of distinct subspecies. The results found in this study suggest the extant evolutionary significant units that need to be considered for biological conservation management of these species.