Browsing by Author "Diaz, Ana Maria"

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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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    What Is the Price of Freedom? Estimating Women's Willingness to Pay for Job Schedule Flexibility
    (Univ. Chicago Press, 2023) Bustelo, Monserrat; Diaz, Ana Maria; Lafortune, Jeanne; Piras, Claudia; Salas, Luz Magdalena; Tessada, Jose
    We conducted a discrete choice experiment to elicit women's revealed preferences regarding job schedule flexibility (flexible scheduling and part-time employment) in a developing country context. We did so with an incentivized methodology for job seekers. On average, women have a high willingness to pay for a flexible schedule within a full-time contract but a much lower desire to trade wages for part-time contracts. The willingness to pay for a flexible work arrangement is largest for more affluent women, while willingness to pay for part-time employment is highest among those with higher time demands.