Secondary respiratory early and late infections in mechanically ventilated patients with COVID-19.

BACKGROUND: Patients with COVID-19 receiving mechanical ventilation may become aggravated with a secondary respiratory infection. The aim of this study was to describe secondary respiratory infections, their predictive factors, and outcomes in patients with COVID-19 requiring mechanical ventilation. METHODS: A cohort study was carried out in a single tertiary hospital in Santiago, Chile, from 1st June to 31st July 2020. All patients with COVID-19 admitted to the intensive care unit that required mechanical ventilation were included. RESULTS: A total of 175 patients were enrolled, of which 71 (40.6%) developed at least one secondary respiratory infection during follow-up. Early and late secondary infections were diagnosed in 1.7% and 31.4% respectively. Within late secondary infections, 88% were bacterial, 10% were fungal, and 2% were of viral origin. One-third of isolated bacteria were multidrug-resistant. Bivariate analysis showed that the history of corticosteroids used before admission and the use of dexamethasone during hospitalization were associated with a higher risk of secondary infections (p = 0.041 and p = 0.019 respectively). Multivariate analysis showed that for each additional day of mechanical ventilation, the risk of secondary infection increases 1.1 times (adOR = 1.07; 95% CI 1.02-1.13, p = 0.008) CONCLUSIONS: Patients with COVID-19 admitted to the intensive care unit and requiring mechanical ventilation had a high rate of secondary infections during their hospital stay. The number of days on MV was a risk factor for acquiring secondary respiratory infections.

[Predictive model preparation for surgical wound infection in adult patients undergoing total hip arthroplasty in high complexity hospital for years 2012 and 2014]. / Confección de un modelo predictor para infección de herida operatoria en pacientes adultos intervenidos de artroplastía total de cadera en un hospital de alta complejidad, años 2012 y 2014.

INTRODUCTION: Operative wound infections of patients undergoing total hip arthroplasty have an incidence from 2% to 5%, generating impact on hospital stay, resource use, prolonged antibiotic therapy, including temporary or definitive sequelae. OBJECTIVE: To generate a predictive model for surgical wound infection in patients undergoing total hip arthroplasty between 2012 and 2014 at the High Complexity Hospital. MATERIAL AND METHOD: Cohort of patients with total hip arthroplasty. A description of the epidemiological variables was made and a predictive model was generated by means of logistic regression. RESULTS: 441 patients were analyzed. The predictive model obtained included the variables: days of post-operative stay (OR 1.11 IC95% [1.03 - 1.20]), transfusion of at least one unit of red blood cells (OR 3.13 IC95% [1.17 - 10.86]), diagnosis of previous depression to surgery (OR 5.75 IC95% [1.32 - 25.32], non-compliance with antibioprophylaxis administration time (OR 5.46 IC95% [1.68 - 17.78], P < 0.001) and pseudo R2 = 0.2293. Score point of 13 points with sensitivity 44.4%, specificity of 91.6%, LR (+) 5.29, LR (-) 0.61, 1 to 6 points "low risk", 7 to 12 points "medium risk", 13 to 18 points "high risk", from 19 points as "maximum risk". CONCLUSION: the model presents a good predictive capacity of operative wound infection and adequately represents the cohort under study.

[Consensus of infectious complications in patients treated with selected biological therapies: first Part]. / Consenso sobre riesgo de complicaciones infecciosas en pacientes usuarios de medicamentos biológicos seleccionados. Parte I.

The use of biological therapies has meant a great improvement in the management of several conditions like autoimmune, neoplastic or others diseases. Although its use has implied significant improvements in the prognosis of these diseases, it is not exempt from complications: infectious diseases as one of them. The objective of this consensus was to evaluate, from an infectious viewpoint, the safeness of the most frequently used biological therapies and give recommendations for the prevention of infections in patients treated with these drugs. These recommendations were based on the highest quality evidence available for the selected biologics. The consensus counts of two manuscripts. This first part details the risks of developing infectious complications depending on the type of biological used for a certain pathology. This evaluation included a broad search in MEDLINE and Epistemonikos of systematic reviews and meta-analyzes of controlled clinical trials and casecontrol examining post-treatment infections with anti-TNF alpha, anti-CD20, anti-CD52, CTLA4-Ig and anti-integrins. The research was complemented by a review of: multicentre cohorts of biological users, the MMWR of the CDC, Atlanta, U.S.A., and national registers and scientific societies in which infectious complications derived from the use of biological therapies were mentioned.

[Consensus of infectious complications in patients treated with selected biological therapies.Screening of hepatitis B in high risk Chilean and immigrant pregnant women: Management of mother to child transmission Second part: Chilean Guidelines for Prevention of Infections associated to use of Biological Therapies (PREVITEB)]. / Consenso sobre riesgo de complicaciones infecciosas en pacientes usuarios de medicamentos biológicos seleccionados.Parte II: Guía clínica chilena de Prevención de Infecciones Asociadas al Uso de Terapias Biológicas (PREVITEB).

The use of biological therapies has meant a great improvement in the management of several conditions like autoimmune, neoplastic or others diseases. Although its use has implied significant improvements in the prognosis of these diseases, it is not exempt from complications: infectious diseases as one of them. The objective of this consensus was to evaluate, from an infectious viewpoint, the safeness of the most frequently used biological therapies and give recommendations for the prevention of infections in patients treated with these drugs. These recommendations were based on the highest quality evidence available for the selected biologics. The consensus counts of 2 manuscripts. This second part is a guideline that details these recommendations through screening strategies, prophylactic therapies and vaccines indications for bacterial, mycobacterial, viral, fungal and parasitic infections, both for adults and children.

Consenso sobre riesgo de complicaciones infecciosas en pacientes usuarios de medicamentos biológicos seleccionados. Parte I / Consensus of infectious complications in patients treated with selected biological therapies: first Part

Resumen La incorporación de terapias biológicas ha significado un gran avance en el manejo de diversas patologías de origen autoinmune, neoplásico u otros. Si bien su uso ha implicado mejoras significativas en el pronóstico de estas enfermedades, no está exento de complicaciones, entre estas, las infecciosas. El objetivo de este consenso fue evaluar el perfil de seguridad, desde la mirada infectológica, de las terapias biológicas de uso más frecuente y dar recomendaciones para la prevención de infecciones en pacientes tratados con ellas, basándose en la evidencia de mayor calidad disponible para los biológicos seleccionados. El consenso cuenta de dos manuscritos. Esta primera parte detalla los riesgos de desarrollar complicaciones infecciosas dependiendo del tipo de biológico utilizado para determinada patología. La revisión incluyó búsqueda amplia en MEDLINE y Epistemonikos de revisiones sistemáticas y meta-análisis de estudios clínicos controlados y caso/control que examinaban infecciones posteriores al tratamiento con anti-TNF alfa, anti-CD20, anti-CD52, CTLA4-Ig y anti-integrinas. Esta búsqueda se complementó con revisión de cohortes multicéntricas de usuarios de biológicos, del MMWR del CDC, Atlanta, E.U.A. y de registros nacionales y/o de sociedades científicas en la que se hiciera mención a complicaciones infecciosas derivadas del uso de biológicos.

The use of biological therapies has meant a great improvement in the management of several conditions like autoimmune, neoplastic or others diseases. Although its use has implied significant improvements in the prognosis of these diseases, it is not exempt from complications: infectious diseases as one of them. The objective of this consensus was to evaluate, from an infectious viewpoint, the safeness of the most frequently used biological therapies and give recommendations for the prevention of infections in patients treated with these drugs. These recommendations were based on the highest quality evidence available for the selected biologics. The consensus counts of two manuscripts. This first part details the risks of developing infectious complications depending on the type of biological used for a certain pathology. This evaluation included a broad search in MEDLINE and Epistemonikos of systematic reviews and meta-analyzes of controlled clinical trials and casecontrol examining post-treatment infections with anti-TNF alpha, anti-CD20, anti-CD52, CTLA4-Ig and anti-integrins. The research was complemented by a review of: multicentre cohorts of biological users, the MMWR of the CDC, Atlanta, U.S.A., and national registers and scientific societies in which infectious complications derived from the use of biological therapies were mentioned.

Consenso sobre riesgo de complicaciones infecciosas en pacientes usuarios de medicamentos biológicos seleccionados. Parte II: Guía clínica chilena de Prevención de Infecciones Asociadas al Uso de Terapias Biológicas (PREVITEB) / Consensus of infectious complications in patients treated with selected biological therapies. Screening of hepatitis B in high risk Chilean and immigrant pregnant women: Management of mother to child transmission Second part: Chilean Guidelines for Prevention of Infections associated to use of Biological Therapies (PREVITEB)

Resumen La incorporación de terapias biológicas ha significado un gran avance en el manejo de diversas patologías de origen autoinmune, neoplásico u otros. Si bien su uso ha implicado mejoras significativas en el pronóstico de estas enfermedades, no está exento de complicaciones, entre éstas, las infecciosas. El objetivo de este consenso fue evaluar el perfil de seguridad, desde la mirada infectológica, de las terapias biológicas de uso más frecuente y dar recomendaciones para la prevención de infecciones en pacientes tratados con ellas, basándose en la evidencia de mayor calidad disponible para los biológicos seleccionados. El consenso cuenta de dos manuscritos. Esta segunda parte corresponde a la guía clínica que detalla estas recomendaciones mediante estrategias de cribado, terapias profilácticas e indicación de vacunas, según corresponde, para infecciones bacterianas, y por micobacterias en particular, virus, hongos y parásitos, tanto para adultos como para niños.

The use of biological therapies has meant a great improvement in the management of several conditions like autoimmune, neoplastic or others diseases. Although its use has implied significant improvements in the prognosis of these diseases, it is not exempt from complications: infectious diseases as one of them. The objective of this consensus was to evaluate, from an infectious viewpoint, the safeness of the most frequently used biological therapies and give recommendations for the prevention of infections in patients treated with these drugs. These recommendations were based on the highest quality evidence available for the selected biologics. The consensus counts of 2 manuscripts. This second part is a guideline that details these recommendations through screening strategies, prophylactic therapies and vaccines indications for bacterial, mycobacterial, viral, fungal and parasitic infections, both for adults and children.

[Support of the laboratory of microbiology and pathological anatomy in the diagnosis and management of infections in cancer patients and transplantation of hematopoietic stem cell transplant receptors]. / Parte III. Apoyo del laboratorio de microbiología y anatomía patológica en el diagnóstico y manejo de infecciones en el paciente con cáncer y trasplante de precursores hematopoyéticos.

The confrontation of the differential and etiological diagnosis of the infectious diseases of cancer patients, including hematopoietic stem cells transplant (HSCT) recipients, must correspond to an informed, timely decision that directly affects medical behavior that determines a better survival and quality of life for patients. The main goal of this work was to contribute to the management of these patients developing a useful tool for the clinician to make these decisions. For that, infections were grouped by compromised systems, differentiating the possible etiological agents in bacteria, viruses, fungi and parasites, highlighting the relevant diagnostic tests, mentioning the recommended techniques together with the optimal sample type for proper processing. In addition, under each group of techniques we added the item "level of requirement" to suggest what, in the opinion of the authors and the existing evidence, must be mandatory to have at local level or can be derivable to another laboratory.

Confección de un modelo predictor para infección de herida operatoria en pacientes adultos intervenidos de artroplastía total de cadera en un hospital de alta complejidad, años 2012 y 2014 / Predictive model preparation for surgical wound infection in adult patients undergoing total hip arthroplasty in high complexity hospital for years 2012 and 2014

Resumen Introducción: Las infecciones de herida operatoria de pacientes intervenidos de artroplastía total de cadera, presentan una incidencia desde 2 a 5%, generando impacto en la estadía hospitalaria, uso de recursos, antibioterapia prolongada y secuelas temporales o definitivas. Objetivo: Generar un modelo predictivo para la infección de herida operatoria en pacientes intervenidos de artroplastía total de cadera, entre los años 2012 y 2014, en un hospital de alta complejidad. Material y Método: Cohorte de pacientes con artroplastía total de cadera. Se efectuó la descripción de las variables epidemiológicas y se generó un modelo predictivo por regresión logística. Resultados: Se analizaron 441 pacientes. El modelo predictivo obtenido incluyó las variables: días de estadía post operatoria (OR 1,11 IC95% [1,03-1,20]), transfusión de al menos una unidad de glóbulos rojos (OR 3,13 IC95% [1,17-10,86]), diagnóstico de depresión previo a la cirugía (OR 5,75 IC95% [1,32-25,32], incumplimiento del tiempo de administración de la antibioprofilaxis (OR 5,46 IC95% [1,68-17,78]; p < 0,001) y pseudo R2 = 0,2293. Punto de corte de "score" de 13 puntos con sensibilidad 44,4%, especificidad de 91,6%, LR (+) 5,29, LR (-) 0,61, considerando además la siguiente clasificación: 1 a 6 puntos "bajo riesgo", 7 a 12 puntos "mediano riesgo", 13 a 18 puntos "alto riesgo", desde 19 puntos como "máximo riesgo". Conclusión: El modelo presenta una buena capacidad de predicción de infección de herida operatoria y representa adecuadamente a la cohorte en estudio.

Introduction: Operative wound infections of patients undergoing total hip arthroplasty have an incidence from 2% to 5%, generating impact on hospital stay, resource use, prolonged antibiotic therapy, including temporary or definitive sequelae. Objective: To generate a predictive model for surgical wound infection in patients undergoing total hip arthroplasty between 2012 and 2014 at the High Complexity Hospital. Material and Method: Cohort of patients with total hip arthroplasty. A description of the epidemiological variables was made and a predictive model was generated by means of logistic regression. Results: 441 patients were analyzed. The predictive model obtained included the variables: days of post-operative stay (OR 1.11 IC95% [1.03 - 1.20]), transfusion of at least one unit of red blood cells (OR 3.13 IC95% [1.17 - 10.86]), diagnosis of previous depression to surgery (OR 5.75 IC95% [1.32 - 25.32], non-compliance with antibioprophylaxis administration time (OR 5.46 IC95% [1.68 - 17.78], P < 0.001) and pseudo R2 = 0.2293. Score point of 13 points with sensitivity 44.4%, specificity of 91.6%, LR (+) 5.29, LR (-) 0.61, 1 to 6 points "low risk", 7 to 12 points "medium risk", 13 to 18 points "high risk", from 19 points as "maximum risk". Conclusion: the model presents a good predictive capacity of operative wound infection and adequately represents the cohort under study.

Parte III. Apoyo del laboratorio de microbiología y anatomía patológica en el diagnóstico y manejo de infecciones en el paciente con cáncer y trasplante de precursores hematopoyéticos / Support of the laboratory of microbiology and pathological anatomy in the diagnosis and management of infections in cancer patients and transplantation of hematopoietic stem cell transplant receptors

Resumen El enfrentamiento del diagnóstico diferencial y etiológico de las enfermedades infecciosas de los pacientes con cáncer, incluyendo los receptores de trasplante de precursores hematopoyéticos (TPH), debe corresponder a una decisión informada, oportuna y que repercuta directamente en una conducta médica que determine una mejor sobrevida y calidad de vida de los pacientes. El objetivo de este trabajo fue aportar en el manejo de estos pacientes desarrollando una herramienta útil al médico clínico para tomar estas decisiones. Para ello se agruparon las infecciones por sistemas comprometidos diferenciando los posibles agentes etiológicos en bacterias, virus, hongos y parásitos, explicitando los exámenes diagnósticos más relevantes, mencionando la o las técnicas recomendadas, junto con el tipo de muestra óptima para su adecuado procesamiento. De manera adicional, se incorporó el ítem "nivel de requerimiento" para sugerir lo que, a juicio de los autores y la evidencia existente, debe estar presente obligatoriamente en el centro o puede ser derivable a otro laboratorio.

The confrontation of the differential and etiological diagnosis of the infectious diseases of cancer patients, including hematopoietic stem cells transplant (HSCT) recipients, must correspond to an informed, timely decision that directly affects medical behavior that determines a better survival and quality of life for patients. The main goal of this work was to contribute to the management of these patients developing a useful tool for the clinician to make these decisions. For that, infections were grouped by compromised systems, differentiating the possible etiological agents in bacteria, viruses, fungi and parasites, highlighting the relevant diagnostic tests, mentioning the recommended techniques together with the optimal sample type for proper processing. In addition, under each group of techniques we added the item "level of requirement" to suggest what, in the opinion of the authors and the existing evidence, must be mandatory to have at local level or can be derivable to another laboratory.

Tratamiento antibiótico empírico de elección en pacientes con urosepsis secundaria a litiasis ureteral: reporte de sensibilidad local / Antimicrobial susceptibility of bacteria causing urosepsis

Background: Early inappropriate antibiotic therapy for the management of urosepsis is associated with higher mortality. Therefore, to establish an adequate empirical therapy is crucial. Aim: To determine an optimal antibiotic treatment, adjusted according local bacterial resistance in patients diagnosed with urosepsis secondary to ureteral lithiasis. Material and Methods: Urine cultures and blood cultures from a prospective cohort of patients with ureteral lithiasis admitted for urosepsis in our center between November 2013 and May 2016, were reviewed. Patients who presented two or more criteria of systemic inflammatory response syndrome (SIRS) and positive blood or urine cultures were admitted. Antimicrobial sensitivity patters derived from cultures were analyzed to describe bacterial susceptibility to commonly used antibiotics. Results: Data from 31 patients were analyzed. Seventeen blood cultures (55%) and 29 urine cultures (94%) were positive. The most commonly isolated pathogens were Escherichia coli in 65% of the cultures, followed by Klebsiella pneumoniae, Proteus mirabilis and Enterococcus faecalis. After performing an analysis of sensitivity and resistance for all bacteria in both blood and urine cultures, amikacin showed the highest sensitivity (100%), followed by 2nd and 3rd generation cephalosporins. Conclusions: Amikacin demonstrated higher antibiotic sensitivity in comparison to other antibiotics for empirical management of patients with urosepsis secondary to ureteral lithiasis.

Epidemiología de neutropenia febril en pacientes adultos con leucemia aguda y linfoma: Estudio de cohorte en hospitales público y privado de Santiago, Chile / Epidemiology of febrile neutropenia in adult patients with acute leukemia and lymphoma: Cohort study of public and private hospital of Santiago, Chile

Introduction: Febrile neutropenia (FN) is a common complication of patients undergoing chemotherapy (QMT). Clinical presentation is varied, from mild fever to severe sepsis with invasive bacterial infection (IBI) or invasive fungal infection (IFI), with great impact on prognosis and patient mortality. Patients and Methods: Prospective cohort study of FN episodes in adult patients with acute leukemia (AL) or lymphoma (L), diagnosed and treated at the Hospital Clínico Universidad Católica and Hospital Dr. Sótero del Río in Santiago from April 2010 to January 2012. Results: 130 patients were included with 105 episodes of NF, with an incidence of 0.65 per 100 days of observation, higher in AL than L (1.31 vs 0.25, p = 0.001). Etiology or clinical focus was documented in 67 (63.8%) episodes, with IBI in 33 (31.4%) and IFI in 21 (20%) cases. Mortality related to infection occurred in 4 (6.2%) patients. Conclusions: This study reports that the FN incidence and frequency of IBI and IFI during episodes are higher in AL vs. L. It is necessary to evaluate the impact of interventions to reduce its incidence, including the benefit and risk of using antibacterial and antifungal prophylaxis in high-risk subgroups.

Introducción: La neutropenia febril (NF) es una complicación frecuente de pacientes sometidos a quimioterapia (QMT). Su presentación clínica es amplia, desde cuadros leves a sepsis grave con infección bacteriana invasora (IBI) o infección fúngica invasora (IFI), con gran impacto en el pronóstico y mortalidad de los pacientes. Pacientes y Métodos: Estudio prospectivo de episodios de NF en cohorte de pacientes adultos con leucemia aguda (LA) o linfoma (L) diagnosticados y tratados en el Hospital Clínico Pontificia Universidad Católica de Chile y Hospital Dr. Sótero del Río en Santiago, desde abril de 2010 hasta enero de 2012. Resultados: Se reclutaron 130 pacientes que presentaron 105 episodios de NF, con incidencia de 0,65 por 100 días de observación, mayor en LA que en L (1,31 vs 0,25, p: 0,001), documentándose etiología o foco infeccioso en 67 (63,8%) de los episodios, con 33 (31,4%) IBI y 21 (20%) IFI. Hubo mortalidad relacionada a infección en 4 (6,2%) pacientes. Conclusiones: Se define la incidencia de NF (LA > L) y frecuencia de IBI e IFI durante el episodio (LA > L). Es necesario evaluar el impacto de intervenciones destinadas a disminuir la incidencia de NF, entre las que se debe incluir el beneficio y riesgo del uso sistemático de profilaxis antibacteriana y antifúngica en los subgrupos de mayor riesgo.

[Pneumocystis jiroveci pneumonia: comparative study of cases in HIV-infected patients and immunocompromised non-HIV-infected patients]. / Características clínicas, diagnósticas y pronosticas de pacientes con neumonía por Pneumocystis jiroveci en individuos infectados por virus de inmunodeficiencia humana e individuos inmunocomprometidos por otra etiología: comparative study of cases in HIV-infected patients and immunocompromised non-HIV-infected patients.

BACKGROUND: Although P. jiroveci pneumonia affects immunocompromised (IC) patients of any etiology, clinical features and prognostic outcomes are different depending if they are patients with HIV infection or other causes of IC. OBJECTIVES: To compare clinical and laboratory features as well as outcomes of P. jiroveci pneumonia in HIV versus non-HIV patients. METHODS: Retrospective review of clinical records of HIV and non-HIV patients with P. jiroveci pneumonia managed at the Hospital Clínico Universidad Católica in Santiago, Chile, between 2005 and 2007. RESULTS: We included 28 HIV and 45 non-HIV patients with confirmed P. jiroveci pneumonia. The non-HIV population was older (65 vs 36,2 years, p < 0,01), had shorter duration of symptoms (7 [1-21] vs 14 [2-45] days, p < 0,01), required more invasive techniques (60 vs 21%, p < 0,01) and RT-PCR to confirm the diagnosis (93 vs 68%, p < 0,01), were more frequently treated at intensive care units (58 vs. 25%, p < 0,01) requiring artificial ventilation (56 vs 11%, p < 0,01), and had a higher attributable mortality (33% vs 0%, p < 0,01). CONCLUSIONS: Our study confirmed that P. jiroveci pneumonia in non-HIV IC patients is more severe, more difficult to diagnose and has higher mortality that in HIV patients. Therefore, it is mandatory to optimize diagnostic and therapeutic strategies for this patients group.

Características clínicas, diagnósticas y pronosticas de pacientes con neumonía por Pneumocystis jiroveci en individuos infectados por virus de inmunodeficiencia humana e individuos inmunocomprometidos por otra etiología: comparative study of cases in HIV-infected patients and immunocompromised non-HIV-infected patients / Pneumocystis jiroveci pneumonia

Background: Although P. jiroveci pneumonia affects immunocompromised (IC) patients of any etiology, clinical features and prognostic outcomes are different depending if they are patients with HIV infection or other causes of IC. Objectives: To compare clinical and laboratory features as well as outcomes of P. jiroveci pneumonia in HIV versus non-HIV patients. Methods: Retrospective review of clinical records of HIV and non-HIV patients with P. jiroveci pneumonia managed at the Hospital Clínico Universidad Católica in Santiago, Chile, between 2005 and 2007. Results: We included 28 HIV and 45 non-HIV patients with confirmed P. jiroveci pneumonia. The non-HIV population was older (65 vs 36,2 years, p < 0,01), had shorter duration of symptoms (7 [1-21] vs 14 [2-45] days, p < 0,01), required more invasive techniques (60 vs 21%, p < 0,01) and RT-PCR to confirm the diagnosis (93 vs 68%, p < 0,01), were more frequently treated at intensive care units (58 vs. 25%, p < 0,01) requiring artificial ventilation (56 vs 11%, p < 0,01), and had a higher attributable mortality (33% vs 0%, p < 0,01). Conclusions: Our study confirmed that P. jiroveci pneumonia in non-HIV IC patients is more severe, more difficult to diagnose and has higher mortality that in HIV patients. Therefore, it is mandatory to optimize diagnostic and therapeutic strategies for this patients group.

Introducción: Pneumocystis jiroveci puede causar neumonía en pacientes inmunocomprometidos de cualquier etiología, pero las diferencias clínicas y pronósticas entre inmunocomprometidos por VIH y por otras causas han sido poco exploradas. Objetivo: Comparar las características clínicas, de laboratorio y pronóstico de neumonía por P. jiroveci en pacientes inmunocomprometidos por infección VIH versus no infectados por VIH. Métodos: Análisis retrospectivo de casos confirmados de neumonía por P. jiroveci en adultos con infección por VIH y no infectados, entre los años 2005 y 2007. Resultados: Se incluyeron 28 pacientes infectados por VIH y 45 no infectados, con neumonía por P. jiroveci confirmada. La población no infectada por VIH presentaba mayor edad (65 vs 36,2 años, p < 0,01), menor duración de síntomas previos a la consulta (7 [121] vs 14 [2-45] días, p < 0,01), mayor requerimiento de técnica invasora (60 vs 21%, p < 0,01) y estudio molecular (93 vs 68%, p < 0,01) para confirmación diagnóstica, mayor requerimiento de camas críticas (58 vs 25%, p < 0,01), y ventilación mecánica (56 vs 11%, p < 0,01), con mayor mortalidad atribuible (33 vs 0%, p < 0,01). Conclusiones: La neumonía por P. jiroveci en pacientes inmunocomprometidos no infectados por VIH ofrece más dificultades diagnósticas y presenta mayor gravedad y mortalidad que en pacientes con infección por VIH; por esto, es mandatario optimizar los procesos diagnóstico y terapéutico en esta población.

Invasive pulmonary aspergillosis in heart transplant recipients: two radiologic patterns with a different prognosis.

BACKGROUND: Computed tomography (CT) findings can be used to classify invasive pulmonary aspergillosis (IPA) in 2 patterns: airway-invasive (AIR) or angioinvasive (ANG). METHODS: AIR-IPA was considered when the CT revealed peribronchial consolidation or a tree-in-bud pattern and ANG-IPA when a nodule, cavity, halo sign, infarct-shaped, or mass-like consolidation was found. We evaluated the correlation among IPA patterns on CT and outcomes in heart transplant (HT) recipients. RESULTS: The study included 27 HT recipients with a CT scan performed at the time of IPA diagnosis. The study interval was from 1988 to 2011. Ten AIR-IPA patients (37.1%) were compared with 17 ANG-IPA patients (62.9%). During the post-transplantation period before IPA developed, AIR patients required hemodialysis more frequently (40% vs 5.9%, p = 0.04). AIR patients also had more intercurrent bacterial pneumonia (23.5% vs 70%, p < 0.001), and IPA was diagnosed later after onset of symptoms (2.7 vs 8.5 d, p = 0.09). After diagnosis, AIR-IPA patients required more mechanical ventilation (23.5% vs 90%, p < 0.01) and had a higher related mortality rate (23.5% vs 70%, p = 0.04). CONCLUSIONS: Our study shows that the AIR pattern represents 37% of IPA episodes in HT recipients and is associated with a more protracted clinical presentation, later diagnosis, and higher mortality rate.

Invasive aspergillosis among heart transplant recipients: a 24-year perspective.

BACKGROUND: Invasive aspergillosis is a well-known complication in severely immunosuppressed patients, including heart transplant recipients, and associated mortality is high. Despite the severity of the disease in this population, few recent series with secular trends have addressed the problem. METHODS: We performed a descriptive study of 479 consecutive heart transplant recipients from 1988 to 2011 in a single institution. RESULTS: Overall invasive aspergillosis incidence in heart transplant recipients was 6.5% (31 of 479). Incidence decreased from 8.7% (24 of 277) in the period 1988 to 2000 (historical cohort) to 3.5% (7 of 202) afterward (p = 0.02); 4 of the 7 cases were in the context of an outbreak. The most common presentation was lung infection, but episodes occurring >3 months after transplantation (late aspergillosis) showed a higher frequency of disseminated disease and involvement of the central nervous system and of atypical sites compared with early (first 3 months) episodes. Related mortality was 36%, with a significant decrease between the historical cohort and the present cohort: 46% vs 0% (p = 0.04) and a trend toward lower related death in early vs late cases (26% vs 63%, p = 0.09). CONCLUSIONS: In our series, both incidence and mortality associated with invasive aspergillosis in heart transplant recipients showed a decrease in recent years. Careful environmental management and targeted anti-fungal prophylaxis may minimize the incidence of invasive aspergillosis in this setting.

[Epidemiology of febrile neutropenia in adult patients with acute leukemia and lymphoma: Cohort study of public and private hospital of Santiago, Chile]. / Epidemiología de neutropenia febril en pacientes adultos con leucemia aguda y linfoma: Estudio de cohorte en hospitales público y privado de Santiago, Chile.

INTRODUCTION: Febrile neutropenia (FN) is a common complication of patients undergoing chemotherapy (QMT). Clinical presentation is varied, from mild fever to severe sepsis with invasive bacterial infection (IBI) or invasive fungal infection (IFI), with great impact on prognosis and patient mortality. PATIENTS AND METHODS: Prospective cohort study of FN episodes in adult patients with acute leukemia (AL) or lymphoma (L), diagnosed and treated at the Hospital Clínico Universidad Católica and Hospital Dr. Sótero del Río in Santiago from April 2010 to January 2012. RESULTS: 130 patients were included with 105 episodes of NF, with an incidence of 0.65 per 100 days of observation, higher in AL than L (1.31 vs 0.25, p = 0.001). Etiology or clinical focus was documented in 67 (63.8%) episodes, with IBI in 33 (31.4%) and IFI in 21 (20%) cases. Mortality related to infection occurred in 4 (6.2%) patients. CONCLUSIONS: This study reports that the FN incidence and frequency of IBI and IFI during episodes are higher in AL vs. L. It is necessary to evaluate the impact of interventions to reduce its incidence, including the benefit and risk of using antibacterial and antifungal prophylaxis in high-risk subgroups.

Prevención de la transmisión vertical y efectos secundarios de la terapia anti-retroviral en hijos nacidos de madres seropositivas para VIH en el área Sur-Oriente de Santiago, Chile: perspectiva de 15 años / Prevention of vertical transmission and side effects of antiretroviral therapy in children born to HIV-positive South Eastern area of Santiago, Chile: 15-years perspective

Antiretroviral therapy (ART) has shown to be an effective measure in decreasing HIV vertical transmission (VT). Nevertheless, it is not free from adverse effects in the newborn: risk of prematurity, low birth weight, metabolic disorders, among others. Despite the importance of the subject, there are few national data that analyze the problem. We performed a retrospective analysis of a cohort of HIV positive mother/child binomial, followed between 1995 and 2010. Ninety-four pregnancies and 96 children (2 twin pregnancies) were analyzed. The rate of VT was 2.1%. Adverse effects attributed to ART were found on 85.4% of the newborn; highlighting the presence of anemia (70.8%) and several metabolic disorders [elevated lactate without acidosis (29.2%), lactic acidosis (12.5%), hyperkalemia (14.6%), metabolic acidosis (9.4%)]. Maternal exposure to protease inhibitors proved to be an independent risk factor for the development of metabolic disorders in newborns (OR 0.15 [0.04-0.48], p < 0.01). In our series, ART was effective in reducing the VT, however exposed newborns showed a high frequency of adverse effects, so it is advisable to implement programs for monitoring these patients to prevent sequelae.

La terapia anti-retroviral (TARV) es efectiva en disminuir la transmisión vertical (TV) del VIH, pero no está exenta de efectos adversos en los recién nacidos: riesgo de prematurez, bajo peso al nacer, alteraciones metabólicas y otros. Pese a lo relevante del tema, existen pocos datos nacionales que analicen el problema. Realizamos un estudio observacional, retrospectivo, de una serie de binomios madre infectada por VIH/hijo atendidos entre los años 1995 y 2010. Se analizaron 94 embarazos y 96 hijos (2 embarazos gemelares). La tasa de TV fue 2,1%. De los recién nacidos, 85,4% presentó efectos adversos atribuibles a la exposición a TARV destacando la presencia de anemia (70,8%) y alteraciones metabólicas varias [hiperlactacidemia sin acidosis (29,2%), acidosis láctica (12,5%), hiperkalemia (14,6%) y acidosis metabólica (9,4%). La exposición materna al uso de IP demostró ser un factor de riesgo independiente para el desarrollo de alteraciones metabólicas en los recién nacidos (OR 4 [1,58-10,12], p 0,003). En nuestra serie, la TARV demostró ser efectiva en reducir la TV. Sin embargo, los recién nacidos expuestos presentaron alta frecuencia de efectos adversos, por lo que es recomendable la implementación de programas de seguimiento de estos pacientes para prevenir secuelas.

[Prevention of vertical transmission and side effects of antiretroviral therapy in children born to HIV-positive South Eastern area of Santiago, Chile: 15-years perspective]. / Prevención de la transmisión vertical y efectos secundarios de la terapia anti-retroviral en hijos nacidos de madres seropositivas para VIH en el área Sur-Oriente de Santiago, Chile: perspectiva de 15 años.

Antiretroviral therapy (ART) has shown to be an effective measure in decreasing HIV vertical transmission (VT). Nevertheless, it is not free from adverse effects in the newborn: risk of prematurity, low birth weight, metabolic disorders, among others. Despite the importance of the subject, there are few national data that analyze the problem. We performed a retrospective analysis of a cohort of HIV positive mother/child binomial, followed between 1995 and 2010. Ninety-four pregnancies and 96 children (2 twin pregnancies) were analyzed. The rate of VT was 2.1%. Adverse effects attributed to ART were found on 85.4% of the newborn; highlighting the presence of anemia (70.8%) and several metabolic disorders [elevated lactate without acidosis (29.2%), lactic acidosis (12.5%), hyperkalemia (14.6%), metabolic acidosis (9.4%)]. Maternal exposure to protease inhibitors proved to be an independent risk factor for the development of metabolic disorders in newborns (OR 0.15 [0.04-0.48], p < 0.01). In our series, ART was effective in reducing the VT, however exposed newborns showed a high frequency of adverse effects, so it is advisable to implement programs for monitoring these patients to prevent sequelae.

[Mirtazapine and antiretroviral therapy in the treatment of progressive multifocal leukoencephalopathy associated with HIV-1 infection: report of a case and review of literature]. / Tratamiento conjunto con mirtazapina y terapia antiretroviral para la leucoencefalopatía multifocal progresiva asociada a infección por VIH-1: presentación de un caso clínico y revisión de la literatura.

We report a 43 years old HIV-1 infected male who developed a severe subacute neurological damage because of a progressive multifocal leukoencephalopathy confirmed by PCR for JC virus. The patient was treated with antiretroviral therapy in adequate doses for CNS penetration and mirtazapine, an antidepressant inhibitor of serotonin receptors. His evolution during one year follow up has been favorable in both, clinically and images.