Admissions by tuberculosis in a regional reference Center. A complex and worrying scenario.

OBJECTIVES: To characterize clinical aspects, evaluate the diagnostic opportunity, and identify factors associated with mortality in patients hospitalized for tuberculosis (TB). METHODS: Retrospective study of patients admitted for TB to a Regional Hospital in Chile between 2011 and 2019. RESULTS: 142 TB events required hospitalization in this period (38.2% of total cases). All risk groups were identified, with a significant increase in patients with diabetes mellitus. The pulmonary location was the most frequent (71.1%), followed by disseminated forms (16.2%). The sensitivity of microscopy smear in cases of pulmonary TB (isolated or combined) was 78.8% and lower in cases of bronchoalveolar lavage (58.3%). PCR was only occasionally applied (< 10%) with a sensitivity of 100% in sputum samples. Its use increased progressively and reached a positivity of 33% (6 out of 18 cases) in cases with negative sputum staining. The median time between symptom onset and diagnosis was prolonged (9 weeks), and 32.5% of all regional events were diagnosed at the hospital. Dose adjustments (22.1%), corticosteroid use (25%), and treatment interruptions were frequent (11%). Lethality reached 19%, and by multivariate analysis, only shock was associated with a fatal outcome. CONCLUSIONS: In this case series, the diagnosis of TB cases was delayed, scarcely diagnosed by molecular methods, highly concentrated at the hospital level, required admission in a large percentage of cases, and had a high case-fatality rate.

No seroconversion among healthcare workers exposed to SARS-CoV-2 during the early phase of the pandemic.

BACKGROUND: The SARS-CoV-2 pandemic is associated with morbidity, hospitalizations, absenteeism, and mortality among healthcare workers (HCW). AIM: To evaluate the seroconversion rate in HCW exposed to SARS-CoV-2 in the early pandemic phase in 2020 at a regional reference hospital. MATERIAL AND METHODS: One hundred seventy-nine HCW working at a regional hospital were invited to a longitudinal study performed between April-July 2020. A serological analysis by ELISA IgG for viral nucleoprotein and protein S with a secondary analysis by ELISA IgG protein S1/S2 for samples with positive or doubtful result was carried out together with a complementary online survey to inquire about occupational or community exposures to SARS-CoV-2. RESULTS: Two cases with baseline infection were detected (1.1%, one symptomatic and one asymptomatic) and no cases of seroconversion were detected. During the study period, there were 136 patients hospitalized with COVID-19, and regional weekly COVID-19 incidence ranged from 2.7 to 24.4 per 100,000 inhabitants. No SARS-CoV-2 cases were detected by PCR among 27 HCW who consulted for respiratory symptoms in the period. Online surveys confirmed direct care of COVID-19 patients and also detected a high degree of unprotected social interaction at work. CONCLUSIONS: There was no evidence of seroconversion in this group of HCW exposed to the risk of infection by SARS-CoV-2 during the onset of the COVID-19 pandemic. Personal protective equipment and other measures used by the HCW were extremely useful for their protection in the initial phase of the pandemic.

Brain lesions associated with eosinophilia. A useful clue for neurotoxocariasis. Report of one case.

Neurotoxocariasis is uncommon. Its manifestations include events of meningitis, encephalitis and less frequently vasculitis, which manifest as headache, seizures, focalization, confusion, cognitive alterations and /or fever. Peripheral eosinophilia with clinical and neurological imaging elements, allow its early suspicion. We report a 48-year-old agricultural worker, admitted in our hospital for one week of gastrointestinal complaints, headache, progressive left hemiparesis and impaired consciousness. He had leukocytosis (13,530/µL) with peripheral eosinophilia (25%, absolute count 3,400 /µL). CSF analysis revealed no abnormalities and brain CT showed poorly defined hypodense lesions on subcortical areas and semioval centers. Magnetic resonance imaging showed multiple foci with increased signals predominantly in the white matter in both hemispheres, especially at frontal and occipital regions and at semioval centers. Lesions reinforced after paramagnetic contrast. Serological studies found specific IgG antibodies by ELISA against antigens of the genus Toxocara, which were confirmed by a positive IgG Western Blot. The patient was treated with albendazole (800 mg/d) for 14 days associated with parenteral and then oral corticosteroids with a favorable response and gradual complete recovery.

Adverse events associated with antimicrobial compounds in a general hospital in Chile.

BACKGROUND: Antimicrobial compounds are associated with a wide range of adverse events (AE) and some of them can be potentially preventable. AIM: To characterize AE associated with antimicrobial compounds. PATIENTS AND METHODS: Retrospective analysis of AEs reported to the National Pharmacological Surveillance System from 2014 to 2017 in a regional hospital. Severity, causality and preventability were analyzed. RESULTS: Sixty events were observed in 56 patients aged 2 months to 96 years. Cases were registered mostly in hospitalized patients. The most frequent AEs were skin disorders (56.7%), followed by hepatobiliary (13.3%), and CNS events (10%). Blood, kidney, respiratory gastrointestinal and immunological disorders were less frequently registered, including cases with anaphylactic shock and Stevens-Johnson syndrome (SJS). Causal analysis indicated a definitive association in 8.3%, probable in 70% and possible in 22%. Skin lesions were mostly associated with beta-lactams, hepatobiliary disorders with antituberculosis drugs and CNS manifestations with carbapenems. Cutaneous, neurological, and hepatobiliary events appeared at a median of 4, 2.5 and 10.5 days after starting the medication, respectively. AEs were managed with withdrawal of the suspected drug (83.3%) and other auxiliary therapies. AEs were categorized as severe in 22% and one case with SJS had a fatal outcome (1.7%). Preventability analysis revealed 25% of potentially avoidable events. CONCLUSIONS: Antimicrobial AE involved a wide diversity of compounds, occurred in different hospitalization units, affected patients of a wide age range and attacked different systems or organs. An important fraction was potentially avoidable.

The resurgence of syphilis among pregnant women in southern Chile.

BACKGROUND: National rates of HIV, gonorrhoeae and syphilis have increased in Chile in recent years, but it is not known if syphilis among pregnant women (PW) is also escalating. AIM: To explore syphilis rates among PW in a southern Chilean region and to describe clinical features of mothers and offspring. PATIENTS AND METHODS: We selected PW with positive VDRL or T. pallidum micro-he-magglutination (MHA-TP) reactive tests, referred to a high-risk obstetrical pathology center between 2011 and 2019. Clinical information of mothers and their offspring was obtained from their medical records. RESULTS: Syphilis rates among PW increased from 0.4 to 7.2 per 1,000 live births in the reference center from 2013 to 2019, along with a national and regional increase in both sexes. Twenty-nine cases of PW with syphilis were identified with a median age of 28 years (interquartile range 23-32). Seventeen percent had a history of drug abuse, and 14% had previous sexually transmitted diseases. In seven cases (24%), the diagnosis occurred at delivery. Three percent of patients had a primary syphilis, 14% a secondary syphilis, 24% an early latent syphilis, and 59% a latent syphilis. All cases except one case were treated with benzathine penicillin G and the remaining with erythromycin due to allergy suspicion. Penicillin desensitization was required in two cases (7%). Treatment timing was inadequate in 10 cases (34.5%). Of 19 patients with available serological follow-up, 10 (53%) showed a significant decrease in VDRL titers (≥ 2 dilutions) and two cases had re-infection. Two patients (7%) had an abortion, two had congenital syphilis (7%), and six had premature births (21%), totaling 35% of adverse-pregnancy outcomes. CONCLUSIONS: Resurgence of syphilis among pregnant women is happening in southern Chile and is associated to adverse-pregnancy outcomes.

Penicillin desensitization in allergic pregnant women with syphilis. Report of two cases.

Syphilis during pregnancy has a high risk of congenital transmission with disastrous fetal consequences. Penicillin (PNC) is the only effective antimicrobial for the treatment of pregnant women with syphilis. Chilean guidelines do not consider desensitization to PNC in these women. We report two cases of pregnant women aged 32 and 23 years, with immediate allergy to PNC and syphilis who were safely and successfully desensitized using a four-hour intravenous protocol in the critical care unit and who subsequently received benzathine G PNC. An electronic survey was conducted among approximately 100 Clinical Pharmacists (CP) in the country. Of these, 16 answered and 13 reported having experience in drug desensitization, in at least five cases with PNC and none reported deaths or cardiorespiratory arrest. Desensitization to PNC can be carried out safely and in Chile, this alternative should be incorporated to the management of pregnant women with syphilis and immediate allergy to PNC, instead of using erythromycin.

Cytomegalovirus infection in AIDS patients. An illustrative case series.

BACKGROUND: Cytomegalovirus (CMV) is an opportunistic infection (OI) in immunosuppressed patients. However, there are no clear cut-off values available for quantitative plasmatic CMV measures (viral load [VL]) to discriminate those with CMV illness from those infected suffering a transient viral reactivation. AIM: To estimate a CMV VL cut-off point that discriminates infected patients and those with CMV related diseases, and to clinically characterize AIDS patients with this OI. PATIENTS AND METHODS: Retrospective analysis of AIDS patients admitted by any reason between years 2017 and 2019 and who had a positive plasma CMV VL at any titer. Cases were categorized with illness or infected using accepted criteria and the cut-off value was obtained by receiver operating characteristic curve (ROC) analysis. RESULTS: Twelve patients were identified as having a CMV-associated illness and seven with CMV infection. A CMV VL of 3,800 copies/mL had a sensitivity of 91.6% and 100% specificity to discriminate both states. Of the 12 patients with CMV illness, all were in AIDS stage and only five were receiving HIV therapy. Predominant clinical presentations were gastrointestinal (50%), followed by liver involvement (25%) and CMV disease (25%). All patients were treated with ganciclovir or valganciclovir. Ten patients had a favorable response (83.3%), one patient only had a laboratory improvement (8.3%) and one died during treatment (8.3%). Drug toxicity was recorded in nine patients but in only three cases, a dose adjustment was necessary. CONCLUSIONS: The predominant clinical manifestation in our series was gastrointestinal. A CMV VL cutoff level of CMV VL of 3,800 copies / mL is useful to discriminate infected patients from those with CMV related disease.

[Type I Brugada electrocardiographic pattern associated with Influenza B and fever. Report of a case]. / Patrón electrocardiográfico Brugada tipo I asociado a un cuadro febril por Influenza B. A propósito de la pandemia de COVID-19. Caso clínico.

We report a 44-year-old male who was admitted for Influenza B and fever, presenting a type I Brugada pattern on the electrocardiogram. He evolved without cardiovascular symptoms. The pharmacological test with intravenous Procainamide reproduced type I Brugada pattern and the programmed electrical stimulation was negative for ventricular arrhythmias. He was discharged without incidents. Clinical aspects of Brugada syndrome and the importance of fever are discussed in the current context of the COVID-19 pandemic.

Clinical features of 47 patients infected with COVID-19 admitted to a Regional Reference Center.

BACKGROUND: During the first pandemic wave, Covid-19 reached Latin America cities. AIM: To report clinical features and outcomes of a group of patients with Covid-19 admitted to a Chilean regional reference Center. MATERIAL AND METHODS: Cases were identified by a compatible clinical picture and a positive PCR or serological test. Clinical features of patients were retrieved from medical records. RESULTS: Forty-seven adult patients (45 diagnosed by PCR, 2 by serology) were admitted between epidemiological weeks 13 to 33, corresponding to 4.4% of total regional cases. Hospitalization occurred at a median of 10 days after onset of symptoms. Fifty one percent of patients had 60 years or more. Hypertension, obesity and diabetes mellitus were present in 57, 45 and 32 % of cases, respectively. Nineteen percent of patients had no comorbid condition nor were elderly. Two cases were women in their second trimester of pregnancy. Positive IgM or IgM/IgG results obtained by rapid serological testing, had limited sensitivity during the first week (67%). Seventeen patients (36.2%) were transferred to an intensive care unit (ICU) due to respiratory failure. Chest imaging demonstrated a classical COVID-19 pattern in 87%. By univariate analysis, admission to ICU was significantly associated with tachypnea and higher CALL (comorbidity, age, lymphocyte count and lactate dehydrogenase) score. Four patients died (rendering a hospital mortality of 8.5%) and length of stay was ≥ 14 days in 46.8% of patients. By univariate analysis, mortality was associated with immunosuppression and ICU admission. CONCLUSIONS: In our regional Center, patients admitted with COVID-19 had usual risk factors and had a prolonged stay. Hospital mortality was associated with immunosuppression and ICU admission.

Severe acute respiratory infections (SARI) from influenza in adult patients in Chile: the experience of a sentinel hospital.

OBJECTIVE: To 1) describe clinical characteristics of adult patients in Chile with severe acute respiratory infections (SARI) associated with influenza viruses, and 2) analyze virus subtypes identified in specimens collected from those patients, hospital resources used in clinical management, clinical evolution, and risk factors associated with a fatal outcome, using observational data from the SARI surveillance network (SARInet). METHODS: Adults hospitalized from 1 July 2011 to 31 December 2015 with influenza-associated SARI at a SARI sentinel surveillance hospital in Santiago were identified and the presence of influenza in all cases confirmed by reverse transcription polymerase chain reaction (RT-PCR), using respiratory samples. RESULTS: A total of 221 patients (mean age: 74.1 years) were hospitalized with influenza-associated SARI during the study period. Of this study cohort, 91.4% had risk factors for complications and 34.3% had been vaccinated during the most recent campaign. Pneumonia was the most frequent clinical manifestation, occurring in 57.0% of the cohort; other manifestations included influenza-like illness, exacerbated chronic bronchitis, decompensated heart failure, and asthmatic crisis. Cases occurred year-round, with an epidemic peak during autumn-winter. Both influenza A (H1N1pdm09 and H3N2) and B virus co-circulated. Critical care beds were required for 26.7% of the cohort, and 19.5% needed ventilatory assistance. Multivariate analysis identified four significant factors associated with in-hospital mortality: 1) being bedridden (adjusted odds ratio (aOR): 22.3; 95% confidence interval (CI): 3.0-164); 2) admission to critical care unit (aOR: 8.9; CI: 1.44-55); 3) Pa02/Fi02 ratio < 250 (aOR: 5.8; CI: 1.02-33); and 4) increased serum creatinine concentration (> 1 mg/dL) (aOR: 5.47; CI: 1.20-24). Seasonal influenza vaccine was identified as a significant protective factor (aOR: 0.14; CI: 0.021-0.90). CONCLUSIONS: Influenza-associated SARI affected mainly elderly patients with underlying conditions. Most patients evolved to respiratory failure and more than one-quarter required critical care beds. Clinical presentation was variable. Death was associated with host characteristics and disease-associated conditions, and vaccine was protective. Virus type did not influence outcome.

[Worsening situation of tuberculosis in Chile]. / El deterioro de la tuberculosis en Chile.

BACKGROUND: Recent data suggest an increase in tuberculosis (TB) incidence in Chile. AIM: To evaluate recent epidemiological trends, geographic extension and potential factors associated with TB reemergence in Chile. MATERIAL AND METHODS: Data analysis from official sources and trend analysis. RESULTS: TB incidence rate increased from 12.3 (2014) to 14.7 (2017) per 100,000 inhabitants. Morbidity rates also increased in nine out of 15 regions. The proportion of TB cases in specific groups has also increased in the last six years: HIV/AIDS (68%), immigrants (118%), drug users/alcoholics (267%) and homeless people (370%). Several indicators of the national TB program performance have deteriorated including TB case detection, HIV co-infection study and contact tracing activities. Overall results indicate a higher than expected case-fatality ratio (> 3%), high rates of loss from follow-up (> 5%), and low percentage of cohort healing rate (< 90%). This decline is associated with a Control Program with scarce human resources whose central budget decreased by 90% from 2008 to 2014. New molecular diagnostic tools and liquid media culture were only recently implemented. CONCLUSIONS: TB trends and overall program performance indicators have deteriorated in recent years in Chile and several factors appear to be involved. Multiple strategies will be required to rectify this situation.

[Encephalitis caused by type B influenza virus in an adult. Report of one case]. / Encefalitis por virus influenza B en un paciente adulto. Reporte de caso.

Neurological manifestations associated with influenza virus infection include encephalitis, encephalopathy, acute necrotizing encephalitis, transverse myelitis, acute disseminated encephalomyelitis, mild encephalitis with reversible splenial syndrome (MERS), and Guillaín Barré syndrome. We report a 16-year-old female who was admitted at our emergency department with seizures, confusion, nystagmus and motor clumsiness five days after an upper a respiratory tract infection. Influenza type B virus infection was confirmed by chain polymerase reaction analysis. The initial electroencephalogram demonstrated a pattern of global slowness without epileptic discharges. One week later, it showed a progression to slow-wave focal bilateral discharges at both temporal and occipital lobes. The patient had a favorable evolution and was discharged 19 days after admission with phenytoin to prevent seizures.

Fatal nosocomial hemorrhagic enterocolitis probably caused by adenovirus. Report of one case.

Adenovirus (ADV) is a recognized cause of severe disease among immunocompromised patients. We report a previously healthy 39-year-old female, admitted with influenza pneumonia and evolving with lung hemorrhage and acute renal failure requiring mechanical ventilation and hemodialysis. She received high corticosteroid doses due to an initial suspicion of alveolar hemorrhage. Lymphopenia already present before steroid use (567/µL), was maintained during the whole hospital stay (mean 782/µL). From the second week of admission she presented a high-volume diarrhea (mean 2.5 L/day) associated to intermittent bloody stools. An ulcerative enterocolitis was confirmed by CT images and colonoscopy. ADV was detected in a colonic tissue sample by real time PCR but not by a commercial filmarray test. Cidofovir-probenecid and racecadotril therapy were indicated without changing the clinical course of diarrhea and the patient finally died.

Infectious endocarditis by Bartonella species. Report of two cases.

Infectious endocarditis (IE) by Bartonella species is an emerging problem worldwide. We report two cases of native valve Bartonella-associated IE events, both affecting adult male patients with a history of alcohol abuse and a low socioeconomic status. Admissions were due to pancytopenia and bleeding in one case and embolic stroke in the other. Blood cultures were negative and IgG indirect immunofluorescence assays (IFA) were positive for B. henselae/B. quintana in high titers (1/16,384-1/16,384, and 1/32,768 -1/16,384, respectively). Cases were classified as definitive IE events according to modified Duke criteria due to the presence of valve vegetations with at least three minor criteria. One patient required aortic mechanical valve replacement and survived, and the other died after a massive hemorrhagic transformation of his stroke. PCR amplification and sequencing of the 16S ribosomal bacterial DNA from a valve tissue sample obtained at surgery in the patient who survived, confirmed B. quintana as the etiological agent. Bartonella-associated IE is an emerging problem in Chile, present in disadvantaged populations. It should be suspected in patients with culture-negative IE. IFA does not discriminate between B. henselae and B. quintana infection, but high titers suggest IE. Complementary PCR techniques may help to elucidate the final causative agent.

Host characteristics predict outcome among adult patients admitted by severe acute respiratory infection.

BACKGROUND: Except for influenza pandemics, different observational studies have failed to demonstrate differences in mortality between various etiologies in adult patients hospitalized for respiratory infections. AIM: To compare clinical and mortality differences between different viral pathogens associated with severe acute respiratory infections (SARI) in hospitalized adults. MATERIAL AND METHODS: One-year prospective study in a sentinel center. We included 132 patients with SARI hospitalized for any of the nine viruses under study by PCR. Clinical variables were compared, excluding cases of coinfection. RESULTS: A viral coinfection was identified in 12% and influenza infection in 56% of cases. Eighty percent of patients were aged ≥ 65 years, with a high frequency of comorbidities, 27% were bedridden. Twenty four percent were admitted to critical care units, 20% required ventilatory assistance and 16% died. Cases occurred throughout the year, with an expected seasonal peak between autumn and spring and a predominance of infections not associated with influenza during summer months. In the multivariate analysis, only being bedridden was significantly associated with mortality at discharge (Odds ratio 23.46; 95% confidence intervals 3.33-165.12, p < 0.01), without association with age, comorbidity, viral pathogen involved, laboratory parameters, clinical presentation or CURB65 score. No major clinical dissimilarities were found between different viral pathogens. CONCLUSIONS: In our series of patients, mostly elderly, only bedridden status was significantly associated with mortality at discharge in patients hospitalized for SARI. Viral pathogens were not relevant.

[Cerebral cryptococcosis and immune reconstitution inflammatory syndrome. Case report]. / Criptococosis cerebral, voriconazol, niveles plasmáticos y síndrome de reconstitución inmune. Reporte de un caso.

We report a 45-year-old male with AIDS who had a Cryptococcus neoformans central nervous system infection. He was treated with amphotericin B deoxycholate subsequently changed to voriconazole due to systemic toxicity of the former. Plasma levels of voriconazole were insufficient with a standard dose (0.7 µg/mL), therefore, the dose was increased thereafter to reach appropriate levels (4.5 µg/mL). Anti-retroviral therapy was started five weeks after voriconazole initiation with non-interacting drugs and he was discharged after a favorable evolution. He was re-admitted three months later due to seizures; a brain magnetic resonance showed new sub-cortical nodules. After excluding alternative causes and demonstrating fungal eradication, an immune reconstitution inflammatory syndrome (IRIS) event was suspected and treated with a short course of steroids. His evolution was satisfactory.

Long-term impact of competitive biddings and an antimicrobial stewardship program in a general hospital in Chile.

BACKGROUND: The long-term effect of an antimicrobial stewardship program (ASP) and its integrated impact with competitive biddings have been seldom reported. AIM: To evaluate the long-term effect of an ASP on antimicrobial consumption, expenditure, antimicrobial resistance and hospital mortality. To estimate the contribution of competitive biddings on cost-savings. MATERIAL AND METHODS: A comparison of periods prior (2005-2008) and posterior to ASP initiation (2009 and 2015) was done. An estimation of cost savings attributable to ASP and to competitive biddings was also performed. RESULTS: Basal median antimicrobial consumption decreased from 221.3 to 170 daily defined doses/100 beds after the start of the ASP. At the last year, global antimicrobial consumption declined by 28%. Median antimicrobial expenditure per bed (initially US$ 13) declined to US$ 10 at the first year (-28%) and to US$ 6 the last year (-57%). As the reduction in consumption was lower than the reduction in expenditure during the last year, we assumed that only 48.4% of savings were attributable to the ASP. According to antimicrobial charges per bed from prior and after ASP implementation, we estimated global savings of US$ 393072 and US$ 190000 directly attributable to the ASP, difference explained by parallel competitive biddings. Drug resistance among nosocomial bacterial isolates did not show significant changes. Global and infectious disease-associated mortality per 1000 discharges significantly decreased during the study period (p < 0.05). CONCLUSIONS: The ASP had a favorable impact on antimicrobial consumption, savings and mortality rates but did not have effect on antimicrobial resistance in selected bacterial strains.

[Severe acute disseminated encephalomyelitis associated with parainfluenza 3 infection: Case report]. / Encefalomielitis aguda diseminada grave: Comunicación de un caso asociado a infección por virus parainfluenza 3.

Disseminated encephalomyelitis (ADEM) is an infrequent condition with considerable morbidity and mortality in adult patients. It requires a high level of suspicion and diagnosis emerges by gathering clinical information, laboratory exams and images studies. ADEM is related to an immunological phenomena occurring after a bacterial/viral infection or recent vaccination. Glucocorticoids are the first line treatment, reserving immunoglobulins and plasmapheresis to refractory cases. We report a male patient aged 25, with ADEM associated to parainfluenza 3 virus respiratory infection that required mechanical ventilation and that had a complete recovery only after plasmapheresis.

[Streptococcus gallolyticus (ex S. bovis) bacteremia and its relationship with colonic or hepatobiliary disease and endocarditis]. / Bacteriemias por Streptococcus gallolyticus (ex S. bovis) y su relación con patología colónica o hepatobiliar y endocarditis.

BACKGROUND: Bacteremia due to Streptococcus bovis (now S. gallolyticus) has been traditionally associated to colon or hepatobiliar disease and endocarditis but there is no information on this matter in Chile. AIMS: To describe clinical features of adult patients suffering bacteremia by S. bovis/S. gallolyticus, identify the source of the bacteremia and the frequency of endocarditis. METHODS: Retrospective-descriptive study using laboratory records. RESULTS: Between January 2003 and August 2014, 23 S. bovis/S. gallolyticus bacteremic events were identified among 22 patients. Mean age was 72.7 years (range 46-96). Co-morbidities were frequent (9.1 to 47.6%). The primary source of bacteremia was intestinal in 52.2%; hepatobiliar in 17.4% and in 34.8% it was not elucidated. Six patients had infective endocarditis (26.1%) and one patient had espondylodiscitis (4.3%). S. bovis represented 39.1% of isolates (all until 2008), S. gallolyticus subsp pasteurianus 39.1% and, S. gallolyticus subsp infantarius and S. gallolyticus subsp gallolyticus 8.7% each one, respectively. Association studies between the bacteremic source or endocarditis with specific S. gallolyticus subspecies were limited by the small number of isolates. Seven patients (30.4%) underwent surgical interventions. In-hospital mortality reached 21.7% (n=5). CONCLUSIONS: Although infrequent, bacteremic events by S. gallolyticus/S. bovis have increased in-hospital mortality, require surgical intervention and affect older patients with co-morbidities. Near two-thirds suffer from colonic or hepatobiliary disease that act as the primary source of bacteremia. In addition, near one fourth is affected by infective endocarditis. Detection of S. gallolyticus/S. bovis in blood cultures prompts a thorough clinical evaluation in order to clarify the source of the bloodstream infection and the presence of complications.

[HIV/AIDS patients in a Critical Care Unit: The experience of a general hospital in a developing country]. / Pacientes con infección por VIH/SIDA en una Unidad de Pacientes Críticos: La experiencia de un hospital general en un país en desarrollo.

INTRODUCTION AND AIMS: Despite general availability of HAART in Chile, admissions of HIV/AIDS patients to Intensive-Intermediate Care Units (IICU) are still happening, and a characterization of patient's profile, mortality and potentially avoidable admissions is necessary. METHODS: Observational retrospective study in one general hospital in Chile of HIV/AIDS patients admitted to IICU during 9 years. RESULTS: During 2005-2013, 32 patients were admitted to IICU, with 87,5% in AIDS stage, only 53,1% knew his/her condition, 43,8% were receiving HAART and 16.6% chemoprophylaxis for opportunistic infections, A CD4 count < 200/µL was registered in 75,9% of patients. Most admissions were driven by infectious conditions (84,4%) and 48,1% developed septic shock, IICU hospitalizations were motivated by respiratory failure, neurologic compromise, sepsis or a mixture of them (87,5%), By univariate analysis, admissions by respiratory failure were associated to no HAART, oral candidiasis or CD4 < 250/µL (p < 0.01). Eight patients died during their first hospitalization (25%) and other 5 in the following month after discharge. Death during hospitalization was significantly associated to vasoactive drug use ≥ 7 days (OR 16.5; IC95 2.1-128 p < 0.01). In multivariate analysis, APACHE score ≥ 18 was associated with death during hospitalization of after discharge (OR 3,3 IC95 1,1-10; p < 0,05), Four patients (12,5%) had potentially avoidable admissions. CONCLUSIONS: Despite HAART availability in Chile, hospitalizations of patients with HIV/AIDS are still happening, affecting those that either are unaware of his/her condition, are not receiving HAART and/or chemoprophylaxis. These admissions generate premature deaths and happen even after discharge in severely ill patients.