Prevalence survey of healthcare-associated infections in Argentina; comparison with England, Wales, Northern Ireland and South Africa.

BACKGROUND: Prevalence surveillance methodology is the systematic observation of the occurrence and distribution of healthcare-associated infections (HCAIs) so that appropriate actions can be taken. AIM: The objectives of a prevalence survey with an international validated methodology were to determine the prevalence of HCAIs for the first time in Argentina, and to provide data which could be used for international benchmarking. METHODS: In 2008, an HCAI prevalence survey was carried out in 39 hospitals in seven of 23 provinces in Argentina, with methodology identical to that employed by the Hospital Infection Society in the third prevalence survey of HCAIs in acute hospitals in the British Isles. Data collected were processed and analysed at the Northern Ireland Healthcare-Associated Infection Surveillance Centre at Belfast. FINDINGS: A total of 4249 patients were surveyed; 480 of these had at least one HCAI, resulting in a prevalence of 11.3% of patients. Male prevalence was 13.6% and female 9.0%. The most common HCAIs were pneumonia (3.3%), urinary tract infection (3.1%), surgical site infection (2.9%), primary bloodstream infection (1.5%), and soft tissue infections (1.2%). Among the 1027 patients who underwent surgery, the prevalence of surgical site infection was 10.2%. The prevalence of meticillin-resistant Staphylococcus aureus was 1.1%, accounting for 10.0% of all HCAI isolates. The results for Argentina show higher HCAI rates compared with corresponding findings for England, Wales, Northern Ireland and South Africa. CONCLUSION: This survey will contribute to the prioritization of resources and help to inform Departments of Health and hospitals in the continuing effort to reduce HCAIs.

Antiseptic-impregnated central venous catheters: their evaluation in burn patients.

Central venous catheter-related infections are an important source of morbidity and mortality in burn patients. Antiseptic impregnated catheters have been recommended to prevent infections related to central venous lines in high-risk patients who require short-term catheters. This prospective, randomized, and controlled study compared the efficacy of standard and antiseptic devices in reducing catheter-related infections in burn patients. Twenty-two patients were included in the study with an average age of 47.6 yr and an average burned total body surface area of 38.7%. Thirty-eight silver-sulphadiazine, chlorhexidine catheters were compared with 40 non-antiseptic catheters. No differences in bacteraemia or colonization rates were observed between standard and antiseptic-coated catheters. Antiseptic catheters were more effective in reducing S. epidermidiscolonization than standard catheters (4% vs 31%, p < 0.01). However, Gram-negative bacilli were responsible more often than Gram-positive cocci for catheter tip colonization (53% vs 46%) and they were responsible for all the bacteraemias (5.1%) related to catheters in the present study. We conclude that antiseptic-impregnated catheters could be more effective for Gram-positive cocci and could therefore be less effective in patients with high Gram-negative bacilli bloodstream infection prevalence, as burn patients are.

Peri-Operative Bacteraemia in Burn Patients. What Does it Mean?

Bacteraemias during burn wound manipulation are frequent, especially following burn wound excision. However, these bacteraemias seem not to have any clinical consequences, and their treatment is therefore controversial. Over a 20-month period 35 surgical debridement procedures were recorded prospectively in 18 burn patients. Blood culture samples were drawn before, during, and after surgical excision. Bacteraemias were found in ten out of the 35 patients (28%), and 16 of the 105 blood samples (15%) were positive. All three blood samples were positive in one case ("primary bacteraemia"), while others were "transient bacteraemia". Six positive blood cultures were considered to be "bacteraemias induced by wound manipulation" and seven "bacteraemias of unknown source". Bacteraemias of unknown source were not recorded at any time while "bacteraemias induced by wound manipulation" were recorded after day 5 post-burn. Patients with more than 40% TBSA had 4.3 times more bacteraemic risk than patients with less extensive TBSA. Blood pressure and white blood cell variations were observed in bacteraemic patients but without any clinical relevance. We conclude that bacteraemic rates were high and that there were two different patterns of bacteraemia- both transient and with no clinical relevance.

Toxoplasmic lymphadenitis--clinical and serologic profile.

OBJECTIVE: To study the serologic profile of several types of test for toxoplasmosis, in order to contribute to the interpretation of antibody kinetics. METHODS: The clinical and serologic features of 120 cases of lymphadenopathy with known time of clinical onset were studied during 18 months postinfection. Antibody kinetics was determined by Sabin-Feldman dye test, complement fixation with light antigen, IgM immunofluorescent antibody test, and IgM immunosorbent agglutination assay (IgM-ISAGA). Cell-mediated immunity was evaluated by the toxoplasmin skin test. RESULTS: Seventy-five female patients aged 11-54 years (median 27 years) and 45 male patients aged 3-59 years (median 17 years) were studied, 85% of whom were under 30 years of age. Cervical lymph nodes were involved throughout, generally on both sides, with more than one affected ganglion group in 88%. The predominant symptom was asthenia (69%), which persisted in some cases for several months. A negative Sabin-Feldman dye test in a lymphadenopathy with more than three weeks' evolution excludes a toxoplasma etiology. A positive Sabin-Feldman dye test with negative IgM-ISAGA almost invariably excludes recent infection. The Sabin-Feldman dye test was positive in 94% of patients with titers higher than 1 : 16 000 within the first three months. The IgM-ISAGA yielded 98% of positive results, of which 94% were high titers. Titers >/= 1 : 160 in the IgM immunofluorescent antibody test and complement fixation were found to be highly indicative of recent infection, since 87% and 91%, respectively, were found within the first three months. A negative skin test plus positive serology values indicates recent infection. CONCLUSION: Our results indicate that estimation of time of infection on the basis of serologic results is improved by the simultaneous application of several tests, and correlates closely with the presence of clinical lymphadenitis.

Efficacy and pharmacodynamics of teicoplanin given daily during the first 3 days and then on alternate days for methicillin-resistant Staphylococcus aureus infections.

Fifteen evaluable patients (mean age, 67 years) were enrolled to assess the efficacy of teicoplanin, 6 mg/kg given daily during the first 3 days and then on alternate days, for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. Eight patients had soft tissue infections, four catheter-associated bacteraemia, two osteomyelitis and one pneumonia. Clinical cure was observed in 13 of 15 patients. Both clinical and bacteriological failures were shown in the two patients with osteomyelitis. The mean serum levels of teicoplanin (mg/L) were 22, 8 and 6.7 for peak, 24 h and 48 h troughs, respectively. The dosage employed in this study proved effective in non-deep-seated MRSA infections.

Síndrome de shock tóxico: presentación de 10 casos / Toxic shock syndrome: presentation of 10 cases

El objetivo de este trabajo fue analizar las condiciones predisponentes, presentación clínica, evolución y complicaciones en un grupo de pacientes con el síndrome de shock tóxico. Se estudiaron 10 casos (en 9 pacientes), en una población de 18 meses a 73 años de edad, atendidos en el Hospital Alemán de Buenos Aires desde julio de 1982 a julio de 1991. Todos los pacientes incluidos presentaron los criterios diagnósticos del CDC: temperatura > 38,9º, hipotensión arterial severa, eritrodermia maculopapular, hiperemia de mucosas, descamación cutánea difusa, y despellejamiento en palmas y plantas en la convalecencia. El síndrome se presentó en el contexto de un postoperatorio (4 casos), de infecciones localizadas (5 casos) y uso de tampones vaginales (1 caso). Todos los pacientes presentaron falla multiparenquimatosa (X 3,8 órganos comprometidos simultáneamente), la más frecuente fue la insuficiencia renal (7 casos). Se aisló Staphylococcus aureus sensible a la oxacilina del foco séptico involucrado en todos los casos. Las fallas orgánicas recibieron el tratamiento convencional adecuado. Ningún paciente requirió asistencia respiratoria mecánica ni técnicas dialíticas. Todos los pacientes sobrevivieron. El SST es una entidad poco frecuente, asociada a infecciones por S. aureus meticilino sensible, que se presenta como un cuadro grave con afección multisistémica, pero que responde favorablemente al tratamiento antibiótico y de sostén de los parénquimas afectados y sin mortalidad en nuestra serie

Síndrome de shock tóxico: presentación de 10 casos / Toxic shock syndrome: presentation of 10 cases

El objetivo de este trabajo fue analizar las condiciones predisponentes, presentación clínica, evolución y complicaciones en un grupo de pacientes con el síndrome de shock tóxico. Se estudiaron 10 casos (en 9 pacientes), en una población de 18 meses a 73 años de edad, atendidos en el Hospital Alemán de Buenos Aires desde julio de 1982 a julio de 1991. Todos los pacientes incluidos presentaron los criterios diagnósticos del CDC: temperatura > 38,9º, hipotensión arterial severa, eritrodermia maculopapular, hiperemia de mucosas, descamación cutánea difusa, y despellejamiento en palmas y plantas en la convalecencia. El síndrome se presentó en el contexto de un postoperatorio (4 casos), de infecciones

Piperacillin/tazobactam in the treatment of hospitalized patients with urinary tract infections: an open non-comparative and multicentered trial.

The aim of this multicentered, prospective and open study was to determine the clinical and bacteriological efficacy and safety of piperacillin/tazobactam (4g/500 mg IV tid) in the treatment of 79 adult patients with complicated urinary tract infections (UTI) requiring hospitalization. Forty-seven women and 32 men (mean age 54.2 years, and range 21-91) from 4 Argentinean and 6 Mexican hospitals were enrolled. Sixty-one clinically and bacteriologically evaluable patients were treated for a mean of 9.1 days (range 5-15). A favorable clinical response was seen in 83.6% and 80% at early and late assessment, respectively. Bacteriological eradication was achieved in 85.3% and 80% at early and late estimation, respectively. Escherichia coli was isolated in 33 cases, Klebsiella pneumoniae in 8, Enterococcus spp. in 7, Proteus mirabilis in 6, Pseudomonas aeruginosa in 3, Enterobacter spp. and Morganella morganii in 2. While 21% of all the clinical isolates were resistant to piperacillin, none of them was initially resistant to piperacillin/tazobactam. However, one female patient with a persistent UTI caused by E. coli developed resistance to piperacillin/tazobactam during treatment. A 64-year-old man with frontal meningioma developed purulent meningitis due to Enterobacter cloacae after neurosurgery. He was initially treated with ciprofloxacin, rifampin and amikacin and because of persistence of fever, he was moved to piperacillin/tazobactam. After 5 days of therapy, he developed coma secondary to intracranial hemorrhage and died. By then, the platelet count was normal (220,000/microliters), but the prothrombin time (19.5 seconds) and the partial thromboplastin time (63 seconds) were significantly prolonged. Our data suggest that piperacillin/tazobactam is a reliable therapy for complicated, non-complicated, community or hospital-acquired UTI.

Guidelines for optimal medical care of persons with Down syndrome. International League of Societies for Persons with Mental Handicap (ILSMH).

There are numerous clinical conditions observed in persons with Down syndrome, as described above, which should be taken into consideration in the course of their medical care and management. If provided with optimal medical services, pursuing specific evaluations and examinations, with a focus on preventive aspects and fostering well being in all areas of human functioning, the quality of life of individuals with Down syndrome can be enhanced significantly and their contribution to society substantial.

Sacroileitis bacteriana. Hallazgos clínicos y evolutivos en 9 casos / [Bacterial sacroileitis. Clinical findinds and clinical course in 9 cases]

Since septic sacroileitis is one of the less frequent localizations among joint infections, we decided to review 9 cases in a retrospective study of 5 females and 4 males, aged between 22 and 60 years old. None had a clinically predisposing condition. The initiating factor was gynecologic-obstetric in 4 women, the irruption of the skin barrier in 3 cases and finally in one case the infection reached the joint through the psoas muscle. Fever and lumbar pain were present in all cases and allowed diagnostic orientation. Radiologic and centellographic alterations were useful for clinical confirmation. An articular biopsypunction was performed in 4 cases, while in the other 5 cases the clinical and radiologic features and the bacteriologic positivity in the blood cultures were enough criteria for diagnosis. The bacteriologic findings were Staphylococcus aureus (4 cases), Streptococcus group A beta hemolítico (1 case), Staphylococcus coagulase negative (1 case), Streptococcus agalactiae (1 case), Proteus mirabilis (2 cases). Eight out of 9 patients were treated with a B-lactamic and aminoglycoside association. One patient received her treatment per os, with quinolones. Six patients recovered, 2 died and one needed to be sent to another hospital.

[Bacterial sacroileitis. Clinical findinds and clinical course in 9 cases]. / Sacroileitis bacteriana. Hallazgos clínicos y evolutivos en 9 casos.

Since septic sacroileitis is one of the less frequent localizations among joint infections, we decided to review 9 cases in a retrospective study of 5 females and 4 males, aged between 22 and 60 years old. None had a clinically predisposing condition. The initiating factor was gynecologic-obstetric in 4 women, the irruption of the skin barrier in 3 cases and finally in one case the infection reached the joint through the psoas muscle. Fever and lumbar pain were present in all cases and allowed diagnostic orientation. Radiologic and centellographic alterations were useful for clinical confirmation. An articular biopsypunction was performed in 4 cases, while in the other 5 cases the clinical and radiologic features and the bacteriologic positivity in the blood cultures were enough criteria for diagnosis. The bacteriologic findings were Staphylococcus aureus (4 cases), Streptococcus group A beta hemolítico (1 case), Staphylococcus coagulase negative (1 case), Streptococcus agalactiae (1 case), Proteus mirabilis (2 cases). Eight out of 9 patients were treated with a B-lactamic and aminoglycoside association. One patient received her treatment per os, with quinolones. Six patients recovered, 2 died and one needed to be sent to another hospital.

Sacroileitis bacteriana. Hallazgos clínicos y evolutivos en 9 casos. / [Bacterial sacroileitis. Clinical findinds and clinical course in 9 cases]

Since septic sacroileitis is one of the less frequent localizations among joint infections, we decided to review 9 cases in a retrospective study of 5 females and 4 males, aged between 22 and 60 years old. None had a clinically predisposing condition. The initiating factor was gynecologic-obstetric in 4 women, the irruption of the skin barrier in 3 cases and finally in one case the infection reached the joint through the psoas muscle. Fever and lumbar pain were present in all cases and allowed diagnostic orientation. Radiologic and centellographic alterations were useful for clinical confirmation. An articular biopsypunction was performed in 4 cases, while in the other 5 cases the clinical and radiologic features and the bacteriologic positivity in the blood cultures were enough criteria for diagnosis. The bacteriologic findings were Staphylococcus aureus (4 cases), Streptococcus group A beta hemolítico (1 case), Staphylococcus coagulase negative (1 case), Streptococcus agalactiae (1 case), Proteus mirabilis (2 cases). Eight out of 9 patients were treated with a B-lactamic and aminoglycoside association. One patient received her treatment per os, with quinolones. Six patients recovered, 2 died and one needed to be sent to another hospital.

Litiasis renal coraliforme tratada con ondas de choque: aspectos bacteriológicos / Coraliform renal lithiasis treated with shockwaves: bacteriologic aspects

Se estudió mediante urocultivos pre y post-ESWL (litotricia extracorpórea con ondas de choque) y hemocultivos a pacientes, con cálculos coraliformes y sin signos clínicos de infección urinaria. Se incorporaron al estudio 80 pacientes adultos, 47 del sexo femenino y 33 del sexo masculino. A los 50 primeros pacientes se les tomaron 3 muestras de hemocultivos, durante el procedimiento. Los 150 hemocultivos fueron negativos y ninguno de los 80 pacientes tuvo fiebre, escalofríos e temblores durante el ESWL. Cuarenta y dos pacientes presentaron urocultivo pre-ESWL positivo (52,5 por ciento) con un total de 43 especies bacterianas, ya que hubo un caso con infección mixta. Se aislaron 49 especies bacterianas en 48 urocultivos positivos post-ESWL (60 por ciento. Seis casos presentaron bacteriuria post-ESWL que no había estado presente en el examen pre-ESWL. Los hallazgos bacteriológicos pre-post-ESWL fueron: Proteus mirabilis (22/22). E. coli (11/11), P. aeruginosa (4/5), Klebsiella pneumoniae (2/2). Enterobacter cloacae (0/1), Alcaligenes odorans (1/2), Enterococcus faecalis (1/3), Staphylococcus saprophyticus (1/2) y Candida albicans (1/1). En total 43/49, y la diferencia fueron 6 especies bacterianas. De acuerdo con nuestros resultados el riesgo de bacteriemia para este grupo sería muy bajo. En el 60 por ciento de los cálculos coraliformes se pudo demostrar una infección bacteriana

Litiasis renal coraliforme tratada con ondas de choque: aspectos bacteriológicos / Coraliform renal lithiasis treated with shockwaves: bacteriologic aspects

Se estudió mediante urocultivos pre y post-ESWL (litotricia extracorpórea con ondas de choque) y hemocultivos a pacientes, con cálculos coraliformes y sin signos clínicos de infección urinaria. Se incorporaron al estudio 80 pacientes adultos, 47 del sexo femenino y 33 del sexo masculino. A los 50 primeros pacientes se les tomaron 3 muestras de hemocultivos, durante el procedimiento. Los 150 hemocultivos fueron negativos y ninguno de los 80 pacientes tuvo fiebre, escalofríos e temblores durante el ESWL. Cuarenta y dos pacientes presentaron urocultivo pre-ESWL positivo (52,5 por ciento) con un total de 43 especies bacterianas, ya que hubo un caso con infección mixta. Se aislaron 49 especies bacterianas en 48 urocultivos positivos post-ESWL (60 por ciento. Seis casos presentaron bacteriuria post-ESWL que no había estado presente en el examen pre-ESWL. Los hallazgos bacteriológicos pre-post-ESWL fueron: Proteus mirabilis (22/22). E. coli (11/11), P. aeruginosa (4/5), Klebsiella pneumoniae (2/2). Enterobacter cloacae (0/1), Alcaligenes odorans (1/2), Enterococcus faecalis (1/3), Staphylococcus saprophyticus (1/2) y Candida albicans (1/1). En total 43/49, y la diferencia fueron 6 especies bacterianas. De acuerdo con nuestros resultados el riesgo de bacteriemia para este grupo sería muy bajo. En el 60 por ciento de los cálculos coraliformes se pudo demostrar una infección bacteriana (AU)

[Staghorn renal lithiasis treated with shock waves. Bacteriologic aspects]. / Litiasis renal coraliforme tratada con ondas de choque. Aspectos bacteriológicos.

Struvite renal stones are caused by infection of the urine with bacteria that synthesize the enzyme urease. Ammonium is released by the breakdown of urea by urease, the urine becomes highly alkaline, and magnesium ammonium phosphate (struvite) and carbonate apatite crystallize. Incorporation of the infecting bacteria within the developing stone, results in a focus of infection that is resistant to conventional antimicrobial therapy, and which is manifested clinically by repeated urinary tract infection caused by persistent bacteriuria. Extracorporeal shock wave lithotripsy (ESWL) currently is accepted as the election treatment for most renal calculi. This trial examines the bacteriologic aspects pre and post-ESWL. Eighty adult patients, 47 females and 33 males, without clinical signs of urinary tract infections (UTI) were submitted to urine cultures pre and post-ESWL. The first 50 patients underwent during and post-ESWL, 150 blood cultures, which all proved to be negative, confirming very low risk of generalized sepsis. No patient presented fever, chills or rigors pre or postprocedures. With respect to urine cultures 43 patients (52.5%) had a pre-ESWL UTI, in comparison to 49 (60%) who had a UTI post-ESWL. The distribution of organisms pre and post-ESWL was as follows: Proteus mirabilis (22/22), Escherichia coli (11/11), Pseudomonas aeruginosa (4/5), Klebsiella pneumoniae (2/2), Enterobacter cloacae (0/1), Alcaligenes odorans (1/2) Enterococcus faecalis (1/3), Staphylococcus saprophyticus (1/2) and Candida albicans (1/1). In this study 6 patients presented bacteriuria post-ESWL probably due to bacteria from inside the calculi. According to these results, the risk of bacteremia seems to be very low. In 60% of staghorn renal stones we could demonstrate a bacterial infection.

[Kaposi's sarcoma in young adults without evidence of HIV infection]. / Sarcoma de Kaposi en adultos jóvenes sin evidencia de infección por HIV.

Besides the AIDS-related form of Kaposi sarcoma (KS) there are few well-known aggressive types of this disease. These non-epidemic invasive variants of KS have been recognized in young black males of equatorial Africa and in renal transplant recipients after iatrogenic immunosuppression. We report on two white patients without known risk factors who presented an invasive clinical form of KS with negative serology for HIV infection. Patient 1: 46 year-old white male of Italian origin without known risk factors. He consulted in September 1990 because of a nephrotic syndrome associated with membranoproliferative glomerulonephritis. On physical examination he presented a violaceous nodule in one toe of the right foot. He received prednisolone with amelioration of the renal disorder, but consulted again some months later because of fever, marked weight loss, generalized enlargement of superficial lymph nodes, autoimmune hemolytic anemia and polyclonal hypergammaglobulinemia. ELISA tests, Western-blot and HIV-antigen investigations were repeatedly negative. CD4 and CD8 counts were 450 and 365 per microlitre respectively. A lymph node biopsy demonstrated KS associated to Castleman's disease. KS was also diagnosed in the skin biopsy. The hemolytic anemia was treated with prednisolone without success and KS cutaneous lesions extended to both legs and ulcerated even after a short course of bleomycin and radiotherapy. The patient died nine months later. Patient 2: 38 year-old white male of German origin, with a history of alcoholism. He was admitted to the hospital because of septic shock associated with hepatic failure. On physical examination he presented ascites, liver and spleen enlargement, and a big subcutaneous nodule on the knee covered with normal skin.(ABSTRACT TRUNCATED AT 250 WORDS)

Sarcoma de Kaposi en adultos jóvenes sin evidencia de infección por HIV / Kaposi's sarcoma in middle age males without evidence of HIV infection

El sarcoma de Kaposi (SK) es una entidad que ha aumentado significativamente en la última década debido al surgimiento del SIDA. La evolución y pronóstico en estos pacientes se diferencia a la del SK clásico. Ultimamente se ha informado acerca de su observación en pacientes con serología negativa para el HIV, pero con factores de riesgo para contraer dicho virus. Presentamos acá dos pacientes jóvenes SK, diagnosticados en nuestro hospital en el último año, con serologia negativa para HIV, y sin conductas admitidas de riesgo para SIDA. El primer paciente debutó con un síndrome nefrótico. Luego del tratamento del mismo presentó cuadro de impregnación general, fiebre y adenopatías. La anatomia patológica de una de ellas reveló SK asociado a enfermedad de Castleman. Se realizaron estudios serológicos para HIV en repetidas ocasiones, que resultaron negativos. El segundo paciente ingresó al hospital por una sepsis a Proteus mirabilis y falleció a las 48 hs. La serología para HIV habia sido negativa. Exámenes post-mortem del hígado y de una tumoración que presentaba en rodilla revelaron SK. Nos ha resultado difícil incluir a estos pacientes en algunas de las variantes de SK descriptas habitualmente

Sarcoma de Kaposi en adultos jóvenes sin evidencia de infección por HIV / Kaposis sarcoma in middle age males without evidence of HIV infection

El sarcoma de Kaposi (SK) es una entidad que ha aumentado significativamente en la última década debido al surgimiento del SIDA. La evolución y pronóstico en estos pacientes se diferencia a la del SK clásico. Ultimamente se ha informado acerca de su observación en pacientes con serología negativa para el HIV, pero con factores de riesgo para contraer dicho virus. Presentamos acá dos pacientes jóvenes SK, diagnosticados en nuestro hospital en el último año, con serologia negativa para HIV, y sin conductas admitidas de riesgo para SIDA. El primer paciente debutó con un síndrome nefrótico. Luego del tratamento del mismo presentó cuadro de impregnación general, fiebre y adenopatías. La anatomia patológica de una de ellas reveló SK asociado a enfermedad de Castleman. Se realizaron estudios serológicos para HIV en repetidas ocasiones, que resultaron negativos. El segundo paciente ingresó al hospital por una sepsis a Proteus mirabilis y falleció a las 48 hs. La serología para HIV habia sido negativa. Exámenes post-mortem del hígado y de una tumoración que presentaba en rodilla revelaron SK. Nos ha resultado difícil incluir a estos pacientes en algunas de las variantes de SK descriptas habitualmente (AU)