Nasopharyngeal carriage of Streptococcus pneumoniae in Latin America and the Caribbean: A systematic review and meta-analysis.

BACKGROUND: Streptococcus pneumoniae is a leading cause of morbidity and mortality globally, causing bacteremic pneumonia, meningitis, sepsis, and other invasive pneumococcal diseases. Evidence supports nasopharyngeal pneumococcal carriage as a reservoir for transmission and precursor of pneumococcal disease. OBJECTIVES: To estimate the pneumococcal nasopharyngeal burden in all age groups in Latin America and the Caribbean (LAC) before, during, and after the introduction of pneumococcal vaccine conjugate (PVC). METHODS: Systematic literature review of international, regional, and country-published and unpublished data, together with reports including data from serotype distribution in nasopharyngeal carriage in children and adults from LAC countries following Cochrane methods. The protocol was registered in PROSPERO database (ID: CRD42023392097). RESULTS: We included 54 studies with data on nasopharyngeal pneumococcal carriage and serotypes from 31,803 patients. In children under five years old, carriage was found in 41% and in adults over 65, it was 26%. During the study period, children under five showed a colonization proportion of 34% with PCV10 serotypes and 45% with PCV13 serotypes. When we analyze the carriage prevalence of PCV serotypes in all age groups between 1995 and 2019, serotypes included in PCV10 and those included in PCV13, both showed a decreasing trend along analysis by lustrum. CONCLUSION: The data presented in this study highlights the need to establish national surveillance programs to monitor pneumococcal nasopharyngeal carriage to monitor serotype prevalence and replacement before and after including new pneumococcal vaccines in the region. In addition, to analyze differences in the prevalence of serotypes between countries, emphasize the importance of approaches to local realities to reduce IPD effectively.

Alactic base excess (ABE): a novel internal milieu parameter-its concept and clinical importance.

Inspired by the Stewart-Figge acid-base approach, Gattinoni et al. recently introduced a new internal milieu parameter known as alactic base excess (ABE). The authors defined ABE as the sum of lactate and standard base excess. In the context of sepsis, ABE has been proposed as a valuable marker to discern between metabolic acidosis resulting from the accumulation of lactate and the retention of fixed acids, which can occur in cases of renal failure. Multiple studies have demonstrated that a negative ABE value (<-3 mmol/L) represents an early marker of renal dysfunction, and significantly correlates with higher mortality rates in septic patients. In conclusion, ABE is a simple and useful parameter that can be used to better interpret a patient's acid-base status, assess renal function, and general prognosis in sepsis. By incorporating ABE into clinical practice, healthcare professionals can enhance their understanding of the complex acid-base imbalances in their patients and tailor more individualized, effective treatment plans.

Antimicrobial resistance of Streptococcus pneumoniae from invasive pneumococcal diseases in Latin American countries: a systematic review and meta-analysis.

Background: Invasive pneumococcal disease has declined since pneumococcal conjugate vaccine introduction in Latin America and the Caribbean (LAC). However, serotype distribution and antimicrobial resistance patterns have changed. Methods: We conducted a systematic review to evaluate the frequency of antimicrobial resistance of Streptococcus pneumoniae from invasive disease in LAC. Articles published between 1 January 2000, and 27 December 2022, with no language restriction, were searched in major databases and gray literature. Pairs of reviewers independently selected extracted data and assessed the risk of bias in the studies. The quality of antimicrobial resistance (AMR) studies was evaluated according to WHO recommendations (PROSPERO CRD42023392097). Results: From 8,600 records identified, 103 studies were included, with 49,660 positive samples of S. pneumoniae for AMR analysis processed. Most studies were from Brazil (29.1%) and Argentina (18.4%), were cross-sectional (57.3%), reported data on AMR from IPD cases (52.4%), and were classified as moderate risk of bias (50.5%). Resistance to penicillin was 21.7% (95%IC 18.7-25.0, I2: 95.9), and for ceftriaxone/cefotaxime it was 4.7% (95%IC 3.2-6.9, I2: 96.1). The highest resistance for both penicillin and ceftriaxone/cefotaxime was in the age group of 0 to 5 years (32.1% [95%IC 28.2-36.4, I2: 87.7], and 9.7% [95%IC 5.9-15.6, I2: 96.9] respectively). The most frequent serotypes associated with resistance were 14 for penicillin and 19A for ceftriaxone/cefotaxime. Conclusion: Approximately one-quarter of invasive pneumococcal disease isolates in Latin America and the Caribbean displayed penicillin resistance, with higher rates in young children. Ongoing surveillance is essential to monitor serotype evolution and antimicrobial resistance patterns following pneumococcal conjugate vaccine introduction.

Fractional excretion of sodium and potassium and urinary strong ion difference in the evaluation of persistent AKI in sepsis.

OBJECTIVE: To evaluate the diagnostic performance of FENa (Fractional excretion of sodium), FEK (fractional excretion of potassium) and uSID (urinary strong ion difference) in predicting pAKI in sepsis and septic shock. DESIGN: Retrospective cohort study. SETTING: Two intensive care units in Argentina. PATIENTS: Adult patients with a confirmed diagnosis of sepsis or septic shock and AKI, and had a urinary biochemistry within 24h of the AKI diagnosis. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: We evaluated the diagnostic accuracy of FENa, FEK and uSID through a ROC (Receiver Operating Characteristic) curve analysis. RESULTS: 80 patients were included. 40 patients presented pAKI. pAKI group had higher APACHE, SOFA score, and mortality rate. In the ROC curve analysis, uSID had no diagnostic utility (AUC=0.52, p=0.69). FENa presented moderate accuracy showing an AUC of 0.71 (95% CI 0.60-0.83; p=0.001), while FEK presented low accuracy with an AUC of 0.69 (95% CI 0.57-0.80; p=0.04). The optimal Youden point for identifying pAKI was at a FENa higher than 0.51 % with a specificity of 72.5% and a sensitivity of 65.0%. In the case of FEK, a value higher than 21.9 % presented the best relation, with a specificity of 67.5% and a sensitivity of 65.0%. CONCLUSIONS: urine biochemistry interpretation in septic patients must be revised. FENa and FEK are related to the severity of AKI and could be helpful complementary tools for diagnosing pAKI.

The effect of increased positive end expiratory pressure on brain tissue oxygenation and intracranial pressure in acute brain injury patients.

Cerebral hypoxia is an important cause of secondary brain injury. Improving systemic oxygenation may increase brain tissue oxygenation (PbtO2). The effects of increased positive end-expiratory pressure (PEEP) on PbtO2 and intracranial pressure (ICP) needs to be further elucidated. This is a single center retrospective cohort study (2016-2021) conducted in a 34-bed Department of Intensive Care unit. All patients with acute brain injury under mechanical ventilation who were monitored with intracranial pressure and brain tissue oxygenation (PbtO2) catheters and underwent at least one PEEP increment were included in the study. Primary outcome was the rate of PbtO2 responders (increase in PbtO2 > 20% of baseline) after PEEP increase. ΔPEEP was defined as the difference between PEEP at 1 h and PEEP at baseline; similarly ΔPbtO2 was defined as the difference between PbtO2 at 1 h after PEEP incrementation and PbtO2 at baseline. We included 112 patients who underwent 295 episodes of PEEP increase. Overall, the median PEEP increased form 6 (IQR 5-8) to 10 (IQR 8-12) cmH2O (p = 0.001), the median PbtO2 increased from 21 (IQR 16-29) mmHg to 23 (IQR 18-30) mmHg (p = 0.001), while ICP remained unchanged [from 12 (7-18) mmHg to 12 (7-17) mmHg; p = 0.42]. Of 163 episode of PEEP increments with concomitant PbtO2 monitoring, 34 (21%) were PbtO2 responders. A lower baseline PbtO2 (OR 0.83 [0.73-0.96)]) was associated with the probability of being responder. ICP increased in 142/295 episodes of PEEP increments (58%); no baseline variable was able to identify this response. In PbtO2 responders there was a moderate positive correlation between ΔPbtO2 and ΔPEEP (r = 0.459 [95% CI 0.133-0.696]. The response in PbtO2 and ICP to PEEP elevations in brain injury patients is highly variable. Lower PbtO2 values at baseline could predict a significant increase in brain oxygenation after PEEP increase.

Bronchoscopy-guided percutaneous tracheostomy during the COVID-19 pandemic.

BACKGROUND: Assessment of the efficacy and complications associated with performing bronchoscopy-guided percutaneous tracheostomy in COVID-19 and non-COVID-19 patients. METHODS: Prospective observational study conducted between March of 2020 and February of 2022. All adult patients who underwent elective bronchoscopy-guided percutaneous tracheostomy were included. The efficacy of the procedure was evaluated based either on the success rate in the execution or on the need for conversion to open technique. Percutaneous tracheostomy-related complications were registered during the procedure. We performed 6-month follow-up for identifying late complications. RESULTS: During the study period, 312 bronchoscopy-guided percutaneous tracheostomies were analyzed. One hundred and eighty-three were performed in COVID-19 patients and 129 among non-COVID-19 patients. Overall, 64.1% (200) of patients were male, with a median age of 66 (interquartile range 54-74), and 65% (205) presented at least 1 comorbidity. Overall, oxygen desaturation was the main complication observed (20.8% [65]), being more frequent in the COVID-19 group occurring in 27.3% (50) with a statistically significant difference versus the non-COVID-19 patients' group (11.6% [15]); P < .01). Major complications such as hypotension, arrhythmias, and pneumothorax were more frequently observed among COVID-19 patients as well but with no significant differences. Percutaneous tracheostomy could be executed quickly and satisfactorily in all the patients with no need for conversion to the open technique. Likewise, no suspension of the procedure was required in any case. During 6-month follow-up, we found an incidence of 0.96% (n = 3) late complications, 2 tracheal granulomas, and 1 ostomal infection. CONCLUSION: Bronchoscopy-guided percutaneous tracheostomy can be considered an effective and safe procedure in COVID-19 patients. Nevertheless, it is highly remarkable that in the series under study, a great number of COVID-19 patients presented oxygen desaturation during the procedure.

Alactic base excess is an independent predictor of death in sepsis: A propensity score analysis.

PURPOSE: Alactic base excess (ABE) is a novel biomarker defined as the sum of lactate and standard base excess and estimates the renal capability of handling acid-base disturbances in sepsis. The objective of this study is to see if ABE is an independent predictor of mortality in septic patients with and without renal dysfunction. MATERIALS AND METHODS: We retrospectively studied 1178 patients with sepsis and septic shock. Patients were divided according to ABE values: 1) negative ABE (<-3 mmol/L); 2) neutral ABE (≥ - 3 and < 4 mmol/L); and 3) positive ABE (≥4 mmol/L). The effect of ABE on mortality was evaluated using Cox regression weight by inverse probability weighting (IPWT) analysis after propensity score assessment. Additionally, we performed a stratified analysis in patients with GFR > 60 mL/min/1.73 m2. RESULTS: Negative ABE patients had higher mortality than patients with neutral ABE (adjusted HR 1.43; 95%CI 1.02-2.01). Also, in patients with GFR > 60 mL/min/1.73 m2 (n = 493), we observed higher mortality in patients with negative ABE (adjusted HR 2.43; 95%CI 1.07-5.53). CONCLUSIONS: Negative ABE is an independent predictor of in-hospital mortality in septic patients with and without renal dysfunction.

Influenza season 2019. Analysis of 143 hospitalized patients.

Influenza infection is a latent public health problem, affecting millions of people throughout the world, which imposes high morbidity and economic burden on the region. In Argentina, influenza-associated mortality is estimated at 6/100 000 person-years, and is higher among men = 65 years old. The knowledge of the baseline characteristics and outcomes of hospitalized patients is crucial for public health officials planning interventions to address local outbreaks. Thus, in this retrospective, single-center study, performed in a highcomplexity university hospital, we aimed to analyze clinical characteristics, image findings, and laboratory variables of patients with laboratory-confirmed influenza requiring hospitalization in our hospital during 2019. Cases were confirmed by real-time reverse transcription-polymerase chain reaction. One hundred and forty-three patients with influenza were hospitalized during the study period; 141 (98.6%) were infected with influenza virus type A, including 88 (61.5%) with the H1N1 subtype. The median age was 71 years (IQR 60- 82), 111 (77.6%) were older than 70 years, and 126 (88.1%) had at least one coexisting illness; 56 (39.1%) patients required intensive care unit, 16 (11.1%) invasive mechanical ventilation, and 6 (4.1%) died during hospitalization. In this study, in-hospital mortality was similar to that reported in previous series of non-pandemic influenza, even though the majority of the cases in this study were older than 70 years and had at least one coexisting illness.

La influenza es un problema latente de salud pública que afecta a millones de personas en todo el planeta e impone una alta morbilidad y carga económica para la región. En Argentina, la mortalidad asociada a la influenza se estima en 6/100 000 personas-año y es mayor entre los hombres mayores de 65 años. El conocimiento de las características clínicas y la evolución de los pacientes hospitalizados es fundamental para planificar el abordaje de los brotes locales. En este estudio retrospectivo, realizado en un hospital universitario de alta complejidad, nuestro objetivo fue analizar las características clínicas, los hallazgos de imágenes y las variables de laboratorio en 143 pacientes con influenza confirmada por laboratorio que requirieron hospitalización durante 2019. Los casos fueron confirmados mediante la reacción en cadena de la polimerasa con transcripción inversa en tiempo real. El 98.6% (n: 141) estaban infectados por influenza tipo A y 61.5% (n: 88) correspondía al subtipo H1N1. La mediana de edad fue 71 años (IQR 60-82), el 77.6% (n: 111) tenía más de 70 años y el 88.1% (n: 126) al menos una enfermedad coexistente. El 39.1% (n: 56) requirió internación en unidad de cuidados intensivos, el 11.1% (n: 16) ventilación mecánica invasiva y seis pacientes (4.1%) fallecieron durante la hospitalización. En este estudio, la mortalidad hospitalaria fue similar a la publicada en series previas de influenza no pandémica, aunque la mayoría de los pacientes eran mayores de 70 años y presentaban al menos una enfermedad coexistente.

Influenza season 2019. Analysis of 143 hospitalized patients / Temporada de influenza 2019. Análisis de 143 pacientes hospitalizados

Abstract Influenza infection is a latent public health problem, affecting millions of people throughout the world, which imposes high morbidity and economic burden on the region. In Argentina, influenza‐associ ated mortality is estimated at 6/100 000 person‐years, and is higher among men ≥ 65 years old. The knowledge of the baseline characteristics and outcomes of hospitalized patients is crucial for public health officials planning interventions to address local outbreaks. Thus, in this retrospective, single-center study, performed in a high-complexity university hospital, we aimed to analyze clinical characteristics, image findings, and laboratory variables of patients with laboratory-confirmed influenza requiring hospitalization in our hospital during 2019. Cases were confirmed by real-time reverse transcription-polymerase chain reaction. One hundred and forty-three patients with influenza were hospitalized during the study period; 141 (98.6%) were infected with influenza virus type A, including 88 (61.5%) with the H1N1 subtype. The median age was 71 years (IQR 60- 82), 111 (77.6%) were older than 70 years, and 126 (88.1%) had at least one coexisting illness; 56 (39.1%) patients required intensive care unit, 16 (11.1%) invasive mechanical ventilation, and 6 (4.1%) died during hospitalization. In this study, in-hospital mortality was similar to that reported in previous series of non-pandemic influenza, even though the majority of the cases in this study were older than 70 years and had at least one coexisting illness.

Resumen La influenza es un problema latente de salud pública que afecta a millones de personas en todo el planeta e impone una alta morbilidad y carga económica para la región. En Argentina, la mortalidad asociada a la influenza se estima en 6/100 000 personas-año y es mayor entre los hombres mayores de 65 años. El conocimiento de las características clínicas y la evolución de los pacientes hospitalizados es fundamental para planificar el abordaje de los brotes locales. En este estudio retrospectivo, realizado en un hospital universitario de alta complejidad, nuestro objetivo fue analizar las características clínicas, los hallazgos de imágenes y las variables de laboratorio en 143 pacientes con influenza confirmada por laboratorio que requirieron hospitalización durante 2019. Los casos fueron confirmados mediante la reacción en cadena de la polimerasa con transcripción inversa en tiempo real. El 98.6% (n: 141) estaban infectados por influenza tipo A y 61.5% (n: 88) correspondía al subtipo H1N1. La mediana de edad fue 71 años (IQR 60-82), el 77.6% (n: 111) tenía más de 70 años y el 88.1% (n: 126) al menos una enfermedad coexistente. El 39.1% (n: 56) requirió internación en unidad de cuidados intensivos, el 11.1% (n: 16) ventilación mecánica invasiva y seis pacientes (4.1%) fallecieron durante la hospitalización. En este estudio, la mortalidad hospitalaria fue similar a la publicada en series previas de influenza no pandémica, aunque la mayoría de los pacientes eran mayores de 70 años y presentaban al menos una enfermedad coexistente.

Data acquisition, analysis and transmission platform for a Pay-As-You-Drive system.

This paper presents a platform used to acquire, analyse and transmit data from a vehicle to a Control Centre as part of a Pay-As-You-Drive system. The aim is to monitor vehicle usage (how much, when, where and how) and, based on this information, assess the associated risk and set an appropriate insurance premium. To determine vehicle usage, the system analyses the driver's respect for speed limits, driving style (aggressive or non-aggressive), mobile telephone use and the number of vehicle passengers. An electronic system on board the vehicle acquires these data, processes them and transmits them by mobile telephone (GPRS/UMTS) to a Control Centre, at which the insurance company assesses the risk associated with vehicles monitored by the system. The system provides insurance companies and their customers with an enhanced service and could potentially increase responsible driving habits and reduce the number of road accidents.