Sarampión: Pasado y presente

Corre el año 1991 y pacientes procedentes de Playón Chico, Comarca Guna Yala comienzan a llegar con síntomas respiratorios, exantema macular generalizado, conjuntivitis purulenta, fiebre mayor de 39°C, estamos ante una epidemia de sarampión, es mi segundo año de residencia de pediatría y las imágenes siguen en mi mente, todas las complicaciones como croup, bronquiolitis, neumonía, enfisema subcutáneo, neumotórax y fallecimientos. ¿Qué tenían en común? Además de proceder la mayoría de ellos de la misma área, no habían recibido la vacuna de sarampión. (provisto por Infomedic International)

The year is 1991 and patients from Playón Chico, Guna Yala Region begin to arrive with respiratory symptoms, generalized macular rash, purulent conjunctivitis, fever greater than 39°C, we are facing a measles epidemic, it is my second year of pediatric residency and the images are still in my mind, all the complications such as croup, bronchiolitis,  pneumonia, subcutaneous emphysema, pneumothorax, and deaths. What did they have in common? In addition to most of them coming from the same area, they had not received the measles vaccine. (provided by Infomedic International)

Prospective cohort study of incidence and risk factors for catheter-associated urinary tract infections in 145 intensive care units of 9 Latin American countries: INICC findings.

PURPOSE: Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in Latin American Countries. METHODS: From 01/01/2014 to 02/10/2022, we conducted a prospective cohort study in 145 ICUs of 67 hospitals in 35 cities in nine Latin American countries: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Peru. To estimate CAUTI incidence, we used the number of UC-days as the denominator, and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: gender, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, UC-type, hospitalizationtype, ICU type, facility ownership, and time period. RESULTS: 31,631 patients, hospitalized for 214,669 patient-days, acquired 305 CAUTIs. The pooled CAUTI rate per 1000 UC-days was 2.58, for those using suprapubic catheters, it was 2.99, and for those with indwelling catheters, it was 2.21. The following variables were independently associated with CAUTI: age, rising risk 1% yearly (aOR = 1.01; 95% CI 1.01-1.02; p < 0.0001 female gender (aOR = 1.28; 95% CI 1.01-1.61; p = 0.04), LOS before CAUTI acquisition, rising risk 7% daily (aOR = 1.07; 95% CI 1.06-1.08; p < 0.0001, UC/DU ratio (aOR = 1.14; 95% CI 1.08-1.21; p < 0.0001, public facilities (aOR = 2.89; 95% CI 1.75-4.49; p < 0.0001. The periods 2014-2016 and 2017-2019 had significantly higher risks than the period 2020-2022. Suprapubic catheters showed similar risks as indwelling catheters. CONCLUSION: The following CAUTI RFs are unlikely to change: age, gender, hospitalization type, and facility ownership. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.

Multinational Prospective Cohort Study of Mortality Risk Factors in 198 ICUs of 12 Latin American Countries over 24 Years: The Effects of Healthcare-Associated Infections.

BACKGROUND: The International Nosocomial Infection Control Consortium (INICC) has found a high ICU mortality rate in Latin America. METHODS: A prospective cohort study in 198 ICUs of 96 hospitals in 46 cities in 12 Latin American countries to identify mortality risk factors (RF), and data were analyzed using multiple logistic regression. RESULTS: Between 07/01/1998 and 02/12/2022, 71,685 patients, followed during 652,167 patient-days, acquired 4700 HAIs, and 10,890 died. We prospectively collected data of 16 variables. Following 11 independent mortality RFs were identified in multiple logistic regression: ventilator-associated pneumonia (VAP) acquisition (adjusted odds ratio [aOR] = 1.17; 95% CI: 1.06-1.30; p < 0.0001); catheter-associated urinary tract infection (CAUTI) acquisition (aOR = 1.34; 95% CI: 1.15-1.56; p < 0.0001); older age, rising risk 2% yearly (aOR = 1.02; 95% CI: 1.01-1.02; p < 0.0001); longer indwelling central line(CL)-days, rising risk 3% daily (aOR = 1.03; 95% CI: 1.02-1.03; p < 0.0001); longer indwelling urinary catheter(UC)-days, rising risk 1% daily (aOR = 1.01; 95% CI: 1.01-1.26; p < 0.0001); higher mechanical ventilation (MV) (aOR = 6.47; 95% CI: 5.96-7.03; p < 0.0001) and urinary catheter-utilization ratio (aOR = 1.19; 95% CI: 1.11-1.27; p < 0.0001); lower-middle level income country (aOR = 2.94; 95% CI: 2.10-4.12; p < 0.0001); private (aOR = 1.50; 95% CI: 1.27-1.77; p < 0.0001) or public hospital (aOR = 1.47; 95% CI: 1.24-1.74; p < 0.0001) compared with university hospitals; medical hospitalization instead of surgical (aOR = 1.67; 95% CI: 1.59-1.75; p < 0.0001); neurologic ICU (aOR = 4.48; 95% CI: 2.68-7.50; p < 0.0001); adult oncology ICU (aOR = 3.48; 95% CI: 2.14-5.65; p < 0.0001); and others. CONCLUSION: Some of the identified mortality RFs are unlikely to change, such as the income level of the country, facility ownership, hospitalization type, ICU type, and age. But some of the mortality RFs we found can be changed, and efforts should be made to reduce CL-days, UC-days, MV-utilization ratio, UC-utilization ratio, and lower VAPs and CAUTI rates.

Fallo en cifras del Sistema de Salud

Desde el inicio de la Pandemia de COVID-19 en 2020, el sistema de Salud le ha dedicado partidas, recurso humano y tiempo a la lucha contra esta enfermedad, pero dejó en el olvido el resto de los programas en las instalaciones de salud de primer nivel de atención donde funcionan los programas de prevención como el ampliado de inmunizaciones, ITS, Tuberculosis, VIH y enfermedades transmitidas por vectores. (provisto por Infomedic International)

Since the beginning of the COVID-19 Pandemic in 2020, the Health system has dedicated funds, human resources and time to the fight against this disease, but left in oblivion the rest of the programs in the first level of care health facilities where prevention programs such as the expanded immunization, STI, Tuberculosis, HIV and vector-borne diseases operate. (provided by Infomedic International)

An eight-year multicenter study on short-term peripheral intravenous catheter-related bloodstream infection rates in 100 intensive care units of 9 countries in Latin America: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Venezuela. Findings of the International Nosocomial Infection Control Consortium (INICC).

BACKGROUND: Data on short-term peripheral intravenous catheter-related bloodstream infections per 1,000 peripheral venous catheter days (PIVCR BSIs per 1,000 PVC days) rates from Latin America are not available, so they have not been thoroughly studied. METHODS: International Nosocomial Infection Control Consortium (INICC) members conducted a prospective, surveillance study on PIVCR BSIs from January 2010 to March 2018 in 100 intensive care units (ICUs) among 41 hospitals, in 26 cities of 9 countries in Latin America (Argentina, Brazil, Colombia, Costa Rica, Dominican-Republic, Ecuador, Mexico, Panama, and Venezuela). The Centers for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) definitions were applied, and INICC methodology and INICC Surveillance Online System software were used. RESULTS: In total, 10,120 ICU patients were followed for 40,078 bed days and 38,262 PVC days. In addition, 79 PIVCR BSIs were identified, with a rate of 2.06 per 1,000 PVC days (95% confidence interval [CI], 1.635-2.257). The average length of stay (ALOS) of patients without a PIVCR BSI was 3.95 days, and the ALOS was 5.29 days for patients with a PIVCR BSI. The crude extra ALOS was 1.34 days (RR, 1.33; 95% CI, 1.0975-1.6351; P = .040).The mortality rate in patients without PIVCR BSI was 3.67%, and this rate was 6.33% in patients with a PIVCR BSI. The crude extra mortality was 1.70 times higher. The microorganism profile showed 48.5% gram-positive bacteria (coagulase-negative Staphylococci 25.7%) and 48.5% gram-negative bacteria: Acinetobacter spp, Escherichia coli, and Klebsiella spp (8.5% each one), Pseudomonas aeruginosa (5.7%), and Candida spp (2.8%). The resistances of Pseudomonas aeruginosa were 0% to amikacin and 50% to meropenem. The resistance of Acinetobacter baumanii to amikacin was 0%, and the resistance of coagulase-negative Staphylococcus to oxacillin was 75%. CONCLUSIONS: Our PIVCR BSI rates were higher than rates from more economically developed countries and were similar to those of countries with limited resources.

Manejo y tratamiento antimicrobiano de las mordeduras humanas y de animales en niños / Management and antibiotic treatment of human and animal bites in childrens

Las mordeduras causadas por humanos y animales en niños son relativamente frecuentes y aunque la mayoría son triviales pueden infectarse severamente. Generalmente las víctimas no buscan la atención médica. En esta revisión discutimos la epidemiología, la clínica y el tratamiento de las infecciones asociadas a las mordeduras

Complicaciones infecciosas en el niño leucémico durante los episodios de neutropenia y fiebre: Revisión retrospectiva de 6 años (1985-1990) / Infectious complications in the leukemic child during episodes of neutropenia and fever: A retrospective review of 6 years (1985-1990)

Se realizó una revisión retrospectiva de todos los pacientes pediátricos hospitalizados durante los últimos 6 años (1985-1990) con diagnóstico de leucemia aguda y que habían sido admitidos a este hospital durante un episodio de neutropenia y fiebre. Fueron evaluados un total de 68 pacientes y 94 episodios granulocitopénicos. La neutropenia ocurrió con un promedio de 9 días después de la administración de la quimioterapia inductiva o reinductiva y se resolvió en los sobrevivientes después de un promedio de 16 días de iniciada. La etiología bacteriana del proceso febril fue documentada en el 63 (por ciento) de los episodios de neutropenia y predominaron los gérmenes gram-negativos, especialmente la Pseudomonas aeroginosa. Encontramos una tasa de resistencia antimicrobiana elevada de estos patógenos a los antibióticos utilizados tradicionalmente en el hospital y no así a los agentes antimicrobianos de uso restrigido tales como: netilmicina, amikacina y las cefalosporinas de tercera generación. Hubo evidencia clínica y/o microbiológica de infección por Candida albicans en un número apreciable de casos. La mortalidad global fue del 50 (por ciento), fue menor en los pacientes con (p= 0.008), en los que no tenían evidencia de infección micótica (p= 0.12) y significativamente menor en aquellos pacientes que recuperaban un nivel adecuado de neutrófilos circulantes (p 0.0001) se proponen varios esquemas terapéuticos para tratar de disminuir la alta tasa de mortalidad y la prolongada hospitalización de los pacientes