Risk factors of catheter- associated bloodstream infection: Systematic review and meta-analysis.

INTRODUCTION: The prevalence of catheter-associated bloodstream infections (CLABSI) is high and is a severe health problem associated with an increase in mortality and elevated economic costs. There are discrepancies related to the risk factors of CLABSI since the results published are very heterogeneous and there is no synthesis in the description of all the predisposing factors. OBJECTIVE: We aimed to perform a systematic review and meta-analysis to synthesize and establish the risk factors predisposing to CLABSI reported in the literature. METHOD: This is a systematic review of observational studies following the PRISMA recommendations. MEDLINE and CINAHL databases were searched for primary studies from 2007 to 2021. The protocol was registered in PROSPERO CRD42018083564. RESULTS: A total of 654 studies were identified, 23 of which were included in this systematic review. The meta-analysis included 17 studies and 9 risk factors were analyzed (total parenteral nutrition (TPN), chemotherapy, monolumen and bilumen catheters, days of catheterization, immunosuppression, kidney disease and diabetes mellitus) due to the homogeneity of their definitions and measurements. The risk factors found to increase the probability of developing CLABSI were TPN, multilumen devices, chemotherapy treatment, immunosuppression and the number of days of catheterization. On the other hand, monolumen devices presented a lower likelihood of triggering this infection.

[Program for the prevention of Carbapenemase-Producing Enterobacteria in critical units in Argentina during the COVID-19 pandemic]. / Programa de prevención de enterobacterias productoras de carbapenemasas en unidades críticas durante la pandemia COVID-19 en Argentina.

INTRODUCTION: The problem of carbapenemase-producing Enterobacteriaceae (CPE) was exacerbated by the COVID-19 pandemic in countries with a previous high incidence, such as Argentina. This study describes the development and results of a CPE prevention program, mainly carbapenemase-producing Klebsiellas (KPC), in three critical units of two public hospitals during 6 months of the pandemic. METHODS: The objective was to reduce the incidence of KPC in clinical and colonization samples. This quasi-experimental study was based on a cycle of improvement and implementation of three measures: hand hygiene, environmental hygiene, and periodic surveillance with rectal swabs. RESULTS: Regarding the measures, all the units optimized active surveillance, and two of these also improved hand and environmental hygiene. Comparing the pre- and post-intervention periods in the three units, no significant change was observed in the rate of KPC positive clinical samples. KPC colonization was significantly reduced in two units (unit 2: 51.6-18.5 p 0.0004, unit 3: 62.5-5.2 p < 0.0000001). All units showed a downtrend in both rates towards the end of the study. CONCLUSION: Containing or reducing the advance of the KPC in our region is possible even in difficult scenarios such as the pandemic. More studies are needed in low- and middle-income countries to demonstrate the impact of KPC prevention programs in these situations.

Introducción: La problemática de las enterobacterias productoras de carbapenemasas (EPC) se exacerbó con la pandemia por COVID-19 en países con una incidencia previa elevada, como la Argentina. Este estudio describe el desarrollo y resultados de un programa de prevención de EPC, fundamentalmente Klebsiellas productoras de carbapenemasas (KPC), en tres unidades críticas de dos hospitales públicos durante 6 meses de la pandemia. Métodos: El objetivo fue reducir la incidencia de KPC en muestras clínicas y de colonización. Este estudio, quasi experimental, se basó en un ciclo de mejora e implementación de tres medidas: higiene de manos, higiene ambiental y vigilancia periódica con hisopados rectales. Resultados: Respecto a las medidas, todas las unidades mejoraron la vigilancia activa y dos de estas tuvieron además mejoría en la higiene de manos e higiene ambiental. Comparando los períodos pre y post intervención en las tres unidades no se observaron cambios significativos en la tasa de muestras clínicas KPC positivas. Se logró disminuir en forma significativa la colonización por KPC en dos unidades (unidad 2: 51.6-18.5 p 0.0004, unidad 3: 62.5-5.2 p < 0.0000001). Todas las unidades mostraron hacia el final del estudio una tendencia al descenso en ambas tasas. Conclusión: Contener o reducir el avance de KPC en nuestra región es posible incluso en escenarios difíciles como el de la pandemia. Se necesitan más estudios en países de ingresos bajos y medianos, para demostrar el impacto de los programas de prevención de KPC en estas situaciones.

Programa de prevención de Enterobacterias Productoras de Carbapenemasas en unidades críticas en Argentina durante la pandemia COVID-19 / Program for the prevention of Carbapenemase-Producing Enterobacteria in critical units in Argentina during the COVID-19 pandemic

Resumen Introducción: La problemática de las enterobacterias productoras de carbapenemasas (EPC) se exacerbó con la pandemia por COVID-19 en países con una incidencia previa elevada, como la Argentina. Este estudio describe el desarrollo y resultados de un programa de prevención de EPC, fundamental mente Klebsiellas productoras de carbapenemasas (KPC), en tres unidades críticas de dos hospitales públicos durante 6 meses de la pandemia. Métodos: El objetivo fue reducir la incidencia de KPC en muestras clínicas y de colonización. Este estudio, quasi experimental, se basó en un ciclo de mejora e implementación de tres me didas: higiene de manos, higiene ambiental y vigilancia periódica con hisopados rectales. Resultados: Respecto a las medidas, todas las unidades mejoraron la vigilancia activa y dos de estas tuvieron además mejoría en la higiene de manos e higiene ambiental. Comparando los períodos pre y post intervención en las tres unidades no se observaron cambios significativos en la tasa de muestras clínicas KPC positivas. Se logró disminuir en forma significativa la colonización por KPC en dos unidades (unidad 2: 51.6-18.5 p 0.0004, unidad 3: 62.5-5.2 p < 0.0000001). Todas las unidades mostraron hacia el final del estudio una tendencia al descenso en ambas tasas. Conclusión: Contener o reducir el avance de KPC en nuestra región es posible incluso en escenarios difíciles como el de la pandemia. Se necesitan más estudios en países de ingresos bajos y medianos, para demostrar el impacto de los programas de prevención de KPC en estas situaciones.

Abstract Introduction: The problem of carbapenemase-producing Enterobacteriaceae (CPE) was exacerbated by the COVID-19 pandemic in countries with a previous high incidence, such as Argentina. This study describes the development and results of a CPE prevention program, mainly carbapenemase-producing Klebsiellas (KPC), in three critical units of two public hospitals during 6 months of the pandemic. Methods: The objective was to reduce the incidence of KPC in clinical and colonization samples. This quasi-experimental study was based on a cycle of improvement and implementation of three measures: hand hygiene, environmental hygiene, and periodic surveillance with rectal swabs. Results: Regarding the measures, all the units optimized active surveillance, and two of these also improved hand and environmental hygiene. Comparing the pre- and post-intervention periods in the three units, no significant change was observed in the rate of KPC positive clinical samples. KPC coloni zation was significantly reduced in two units (unit 2: 51.6-18.5 p 0.0004, unit 3: 62.5-5.2 p < 0.0000001). All units showed a downtrend in both rates towards the end of the study. Conclusion: Containing or reducing the advance of the KPC in our region is possible even in difficult scenarios such as the pandemic. More studies are needed in low- and middle-income countries to demonstrate the impact of KPC prevention programs in these situations.

Viruela símica: zoonosis emergente con impacto global / Monkeypox: emerging zoonosis with unprecedentedglobal impact

El virus de la viruela símica es un orthopoxvirus de características zoonóticas endémico en las regiones de África Central y África Occidental, donde causa brotes desde 1970. En las últimas décadas se registró un aumento exponencial de casos, probablemente asociado a la disminución en la inmunidad conferida por la vacuna antivariólica, discontinuada luego de la erradicación de la viruela. En los últimos años se registraron casos esporádicos fuera del continente africano, siempre relacionados epidemiológicamente a la permanencia en áreas endémicas o contacto con animales infectados. Desde el 13 de mayo de 2022 se encuentra en curso el mayor brote de viruela símica registrado fuera de las áreas endémicas de África, con casos en los cinco continentes. La extensión, el impacto y la duración del brote permanecen aún inciertos.

Monkeypox virus is an orthopoxvirus with zoonotic characteristics endemic in Central and West Africa regions, where it has caused outbreaks since 1970. An exponential increase in cases has been registered in the last decades, probably associated with a decrease in the immunity conferred by the smallpox vaccine, discontinued after smallpox eradication. In recent years, sporadic cases have been reported outside the African continent, always epidemiologically related to permanence in endemic areas or contact with infected animals. Since May 13, 2022, the largest monkeypox outbreak ever reported outside Africa endemic areas, with cases on the five continents, is unfolding. The extent, impact and duration of this outbreak still remain uncertain

Impact of a Nosocomial COVID-19 Outbreak on a Non-COVID-19 Nephrology Ward during the First Wave of the Pandemic in Spain.

INTRODUCTION: The aim of this study was to analyze a nosocomial coronavirus disease 2019 (COVID-19) outbreak that occurred on a polyvalent non-COVID-19 ward at a tertiary care university hospital in Spain during the first wave of the pandemic and to describe the containment measures taken. The outbreak affected healthcare workers (HCWs) and kidney disease patients including transplant patients and those requiring maintenance hemodialysis. METHODS: The outbreak investigation and report were conducted in accordance with the Orion statement guidelines. RESULTS: In this study, 15 cases of COVID-19 affecting 10 patients and 5 HCWs were identified on a ward with 31 beds and 43 HCWs. The patients had tested negative for severe acute respiratory syndrome coronavirus 2 infection on admission. One of the HCWs was identified as the probable index case. Five patients died (mortality rate, 50%). They were all elderly and had significant comorbidities. The infection control measures taken included the transfer of infected patients to COVID-19 isolation wards, implementation of universal preventive measures, weekly PCR testing of patients and HCWs linked to the ward, training of HCWs on infection control and prevention measures, and enhancement of cleaning and disinfection. The outbreak was contained in 2 weeks, and no new cases occurred. CONCLUSION: Nosocomial COVID-19 outbreaks can have high attack rates involving both patients and HCWs and carry a high risk of patient mortality. Hospitals need to implement effective infection prevention and control strategies to prevent nosocomial COVID-19 spread.

Variante rara de disección de aorta: disección circunferencial / Rare variant of aortic dissection: circumferential dissection

No disponible

Strongyloidiasis Outside Endemic Areas: Long-term Parasitological and Clinical Follow-up After Ivermectin Treatment.

Background: Strongyloides stercoralis affects 30-100 million people worldwide. The first-line therapy is ivermectin. Cure is defined as the absence of larvae by parasitological methods 1 year after treatment. To date, no longitudinal parasitological studies for longer periods of time have been conducted to confirm its cure. Here, we evaluated treatment response in long-term follow-up patients with chronic infection using parasitological and molecular methods for larvae or DNA detection. Methods: A prospective, descriptive, observational study was conducted between January 2009 and September 2015 in Buenos Aires, Argentina. Twenty-one patients with S. stercoralis diagnosis were evaluated 30, 60, and 90 days as well as 1, 2, 3, and/or 4 years after treatment by conventional methods (fresh stool, Ritchie method, agar plate culture), S. stercoralis-specific polymerase chain reaction (PCR) in stool DNA, and eosinophil values. Results: During follow-up, larvae were detected by conventional methods in 14 of 21 patients. This parasitological reactivation was observed starting 30 days posttreatment (dpt) and then at different times since 90 dpt. Eosinophil values decreased (P = .001) 30 days after treatment, but their levels were neither associated with nor predicted these reactivations. However, S. stercoralis DNA was detected by PCR in all patients, both in their first and subsequent stool samples, thus reflecting the poor efficacy of ivermectin at eradicating parasite from host tissues. Asymptomatic eosinophilia was the most frequent clinical form among chronically infected patients. Conclusions: These results suggest that the parasitological cure is unlikely. Strongyloidiasis must be considered a chronic infection and ivermectin administration schedules should be reevaluated.

Zoonosis en grupo familiar. Revisión bibliográfica a propósito de un brote Informe de casos / ZOONOSIS IN A FAMILY GROUP: LITERATURE REVIEW OF AN OUTBREAK

Brucelosis es una zoonosis de distribución mundial. Argentina notifica 300 casos anuales. Entre agosto y octubre de 2015 diagnosticamos tres casos en un grupo familiar

The aim of the present report was to describe an outbreak of Brucellosis in a family group due to its unfrequency and etiological value. The infection caused by Brucella is a disease of animals (zoonoses) , and humans are accidental hosts. The major determinant of a human risk of acquiring the disease is the contact with infected animals. The genus Brucella contains four species pathogenic for humans: B. melitensis, B. abortus, B. suis and B. canis. Brucella are intracellular bacteria and among the species pathogenic for humans, B. melitensis are the most virulent. The organisms commonly enter the body through cuts in the skin of people handing infected animals or through their blood or secretions, and also the entry can include the respiratory or gastrointestinal tracts. Brucellosis exists worldwide, and Argentina reports 300 cases annually. Between August and October 2015, we diagnosed four cases in a family group: these cases are reported in the article.

Quiste esplénico gigante. A propósito de un caso / GIANT SPLENIC CYST. CASE REPORT

La hidatidosis o equinococosis quística es una zoonosis causada por el cestode Echinococcus granulosus, responsable de importante morbilidad y mortalidad en todo el mundo. La presentación esplénica aislada tiene escasos reportes en la literatura mundial.

Hydatidosis or cystic echinococcosis is a zoonosis caused by the cestode of Echinococcus granulosus, responsible for significant morbidity and mortality worldwide. Isolated splenic presentation has few reports in the world literature. The aim of this report was to describe an unfrequent case of isolated splenic hydatidosis due to its etiologic value because of the inexistence of a simultaneous hepatic involvement

Comparison between PCR and larvae visualization methods for diagnosis of Strongyloides stercoralis out of endemic area: A proposed algorithm.

Underdiagnosis of chronic infection with the nematode Strongyloides stercoralis may lead to severe disease in the immunosuppressed. Thus, we have set-up a specific and highly sensitive molecular diagnosis in stool samples. Here, we compared the accuracy of our polymerase chain reaction (PCR)-based method with that of conventional diagnostic methods for chronic infection. We also analyzed clinical and epidemiological predictors of infection to propose an algorithm for the diagnosis of strongyloidiasis useful for the clinician. Molecular and gold standard methods were performed to evaluate a cohort of 237 individuals recruited in Buenos Aires, Argentina. Subjects were assigned according to their immunological status, eosinophilia and/or history of residence in endemic areas. Diagnosis of strongyloidiasis by PCR on the first stool sample was achieved in 71/237 (29.9%) individuals whereas only 35/237(27.4%) were positive by conventional methods, requiring up to four serial stool samples at weekly intervals. Eosinophilia and history of residence in endemic areas have been revealed as independent factors as they increase the likelihood of detecting the parasite according to our study population. Our results underscore the usefulness of robust molecular tools aimed to diagnose chronic S. stercoralis infection. Evidence also highlights the need to survey patients with eosinophilia even when history of an endemic area is absent.