Capacitación para Campaña de Vacunación Encuentro 5

El encuentro con pediatras y médicos generalistas en vista de la campaña de seguimiento de sarampión y rubeola

2021 update of the AGIHO guideline on evidence-based management of COVID-19 in patients with cancer regarding diagnostics, viral shedding, vaccination and therapy.

The worldwide spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated infectious coronavirus disease (COVID-19) has posed a unique challenge to medical staff, patients and their families. Patients with cancer, particularly those with haematologic malignancies, have been identified to be at high risk to develop severe COVID-19. Since publication of our previous guideline on evidence-based management of COVID-19 in patients with cancer, research efforts have continued and new relevant data has come to light, maybe most importantly in the field of vaccination studies. Therefore, an update of our guideline on several clinically important topics is warranted. Here, we provide a concise update of evidence-based recommendations for rapid diagnostics, viral shedding, vaccination and therapy of COVID-19 in patients with cancer. This guideline update was prepared by the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology by critically reviewing the currently available data on these topics applying evidence-based medicine criteria.

Management of a "suspected ward" in a COVID-19 designated hospital in Wuhan.

During December 2019, an outbreak of unexplained pneumonia occurred in Wuhan, Hubei Province. The disease was subsequently named coronavirus disease 2019 (COVID-19) and the causative virus as severe acute respiratory syndrome conronavirus-2 (SARS-CoV-2). Based on experience, it is vital to exclude or diagnose suspected patients as soon as possible to prevent disease spread. Our hospital is a COVID-19 designated hospital in Wuhan. During the epidemic period, there was a reconstruction of the medical facilities to accommodate patients with different disease status. We document the development of "suspected ward," a ward that cared for patients with suspected COVID-19, in a large designated hospital during the COVID-19 outbreak in Wuhan City, China, and explain the suspected ward spatial layout, organization structure, diagnosis, and treatment flow chart of suspected cases. The key characteristics of our "suspected ward" is isolation, triage, fast diagnosis, and rapid referral. Our description of this suspected ward provides a reference for further improvements in the care of patients with suspected disease in emergency medical institutions.

Federal and State Action Needed to End the Infectious Complications of Illicit Drug Use in the United States: IDSA and HIVMA's Advocacy Agenda.

In response to the opioid crisis, IDSA and HIVMA established a working group to drive an evidence- and human rights-based response to illicit drug use and associated infectious diseases. Infectious diseases and HIV physicians have an opportunity to intervene, addressing both conditions. IDSA and HIVMA have developed a policy agenda highlighting evidence-based practices that need further dissemination. This paper reviews (1) programs most relevant to infectious diseases in the 2018 SUPPORT Act; (2) opportunities offered by the "End the HIV Epidemic" initiative; and (3) policy changes necessary to affect the trajectory of the opioid epidemic and associated infections. Issues addressed include leveraging harm reduction tools and improving integrated prevention and treatment services for the infectious diseases and substance use disorder care continuum. By strengthening collaborations between infectious diseases and addiction specialists, including increasing training in substance use disorder treatment among infectious diseases and addiction specialists, we can decrease morbidity and mortality associated with these overlapping epidemics.

Pathways to Leadership: Reflections of Recent Infectious Diseases Society of America (IDSA) Leaders During Conception and Launch of the Inclusion, Diversity, Access, and Equity Movement Within the IDSA.

Opportunities for leadership in the specialty of infectious diseases (ID) have markedly increased over the last decade, including in newly recognized areas. Commensurate with the expansion of opportunities in ID, pathways to leadership positions within the Infectious Diseases Society of America (IDSA) are expanding as the Society seeks to advance the field for IDSA members. Acknowledging both the importance of diverse leaders to organizational success and shortfalls in diverse representation within IDSA leadership led to concentrated efforts to enhance transparency and opportunities for members to participate broadly in the work of IDSA. Herein, IDSA leaders reflect on their paths to IDSA leadership, hoping to help guide members seeking to partner with the Society. Features identified as important to individual success include mentorship, networking, participation in ID and IDSA volunteer experiences, passion for ID, and working with IDSA staff to advance the programs and initiatives of IDSA on behalf of members.

Peering Through the Glass Ceiling: A Mixed Methods Study of Faculty Perceptions of Gender Barriers to Academic Advancement in Infectious Diseases.

BACKGROUND: The drivers of the gap in advancement between men and women faculty in academic Infectious Diseases (ID) remain poorly understood. This study sought to identify key barriers to academic advancement among faculty in ID and offer policy suggestions to narrow this gap. METHODS: During the 2019 IDWeek, we conducted focus groups with women faculty members at all ranks and men Full Professors, then we administered a brief survey regarding work-related barriers to advancement to the Infectious Disease Society of America (IDSA) membership. We report themes from the 4 focus group discussions that are most closely linked to policy changes and descriptive analyses of the complementary survey domains. RESULTS: Policy change suggestions fell into 3 major categories: (1) Policy changes for IDSA to implement; (2) Future IDWeek Program Recommendations; and (3) Policy Changes for IDSA to Endorse as Best Practices for ID Divisions. Among 790 faculty respondents, fewer women reported that their institutional promotion process was transparent and women Full Professors were significantly more likely to have been sponsored. CONCLUSIONS: Sponsorship and informed advising about institutional promotions tracks may help to narrow the advancement gap. The Infectious Disease Society of America should consider ambitious policy changes within the society and setting expectations for best practices among ID divisions across the United States.

Sepsis - Retrospective Observational Study of Sepsisand Septic Shock treated in internal medicine wards / Sepsis - Estudo Observacional Retrospectivo de Sépsis e Choque Sépticona enfermaria de medicina interna

INTRODUCTION: Sepsis and septic shock are very relevant in clinical practice. Most studies focus on the treatment in Intensive Care Units. Out-side these units, the reality is largely unknown. The aim of this study is to epidemiologically characterize sepsis and septic shock patients admitted at internal medicine wards. MATERIAL AND METHODS: Retrospective observational study, involving patients admitted to internal medicine wards with the diagnosis of sepsis/septic shock during a year. RESULTS: A total of 308 patients were included in the study. 53% were female, with higher levels of comorbidities. Almost 40% were in septic shock, at admittance. Mortality rate was 29,87%. Overall, microbiologic documentation was possible in 92.2% of the cases, with higher prevalence of infection in the urinary (52.6%) and respiratory (34.8%) systems. Initial antibiotic therapy was appropriate in 50% of cases.Previous antibiotic therapy (OR 3.84; IC95% 2.4-6.2; p < 0.0001) and bedridden status (OR 3.15; IC95% 1.7-5.8; p < 0.0002) were independent risk factors to antimicrobial resistance. DISCUSSION: Sepsis outside intensive care units is an escalating reality with high rates of morbidity and mortality. Timely diagnosis and collecting cultures to appropriate treat are primordial to best results. CONCLUSION: This study provides data regarding sepsis/septic shock treated outside intensive care units, that allow a better knowledge of this reality so that it is possible to plan strategies to best attend these patients. Prospective analysis to consolidate criteria for diagnosis, follow-up and prognosis of these patients, as well as review of protocols of action are needed

INTRODUÇÃO: A sépsis e o choque séptico apresentam grande relevância na prática clínica. A maioria dos estudos abordam o tratamento em Unidades de Cuidados Intensivos. A realidade fora destas unidades é amplamente desconhecida. O objectivo deste estudo é caracterizar epidemiologicamente doentes com sépsis/choque séptico internados na enfermaria de medicina interna. MATERIAL E MÉTODOS: Estudo observacional, retrospectivo, dos doentes admitidos no serviço de Medicina Interna com o diagnóstico de sépsis/choque séptico durante um ano. RESULTADOS: Foram incluídos 308 doentes, 53% do sexo feminino, com maior grau de comorbilidades. Cerca de 40% apresentavam choque séptico à admissão. A taxa de mortalidade foi de 29,87%. Globalmente, foi possível documentação microbiológica em 92.2% dos casos, sendo as infecções dos aparelhos urinário (52.6%) e respiratório (34.8%) as mais prevalentes. A antibioterapia inicial foi adequada em 50% dos doentes.Antibioterapia prévia (OR 3.84; IC95% 2.4-6.2; p < 0.0001) e o estado de dependência (OR 3.15; IC95% 1.7-5.8; p < 0.0002) foram factores de risco independentes para a presença de resistência antimicrobiana. DISCUSSÃO: A sépsis fora das unidades de cuidados intensivos constitui uma realidade crescente com elevada morbimortalidade. O diagnóstico precoce e a colheita de exames culturais para tratar de forma dirigida são primordiais para melhores resultados. CONCLUSÃO: Este estudo fornece dados de sépsis/choque séptico tratados fora de unidades de cuidados intensivos, que permitem um melhor conhecimento desta realidade para planear estratégias para melhor tratar estes doentes. Análises prospectivas para consolidar critérios de diagnóstico, seguimento e prognóstico destes doentes, bem como a revisão de protocolos de actuação são necessárias

No disponible

Hospital Pharmacy in the multidisciplinary team of COVID inpatient units.

Since the implementation of the Antimicrobial Therapy Optimization Programme, hospital pharmacy specialists have collaborated with infectious disease specialists on a regular basis in most hospitals in Spain.  Cooperation between these professionals ensures the integrated management of patients with infectious diseases and the appropriate use of antimicrobials in  hospitals. The COVID-19 pandemic forced hospital pharmacists to abruptly  suspend all their structured activities and concentrate on the health crisis.  Realtime information sharing between different medicine specialties is an  effective strategy to generate and maintain treatment protocols adapted to each center, with continuous evidence-based modifications as new publications appear. Hospital pharmacies had to reorganize their activities to  respond to the pandemic. On the one side were patients with COVID-19, and on  the other were routine hospital pharmacy tasks, with the added difficulty of  adapting to individual protection measures. New communication and  collaboration strategies were adopted. Protocols were established for the  management of COVID-19 patients, with continuous changes; special  medications had to be prepared and distributed; circuits were designed for the  home- or institution-based care of patients; internal circuits were created to  minimize the movements of hospital staff and professionals caring for COVID-19  patients. The most effective antiviral drug and anti inflammatory therapy  remains elusive. In this scenario, hospital pharmacists emerge as a key player,  as they have a deep understanding of the mechanisms of action of drugs and  potential interactions. In a setting where experimental drugs preferably tested in clinical trials are being used, the role of hospital pharmacists in interdisciplinary  teams has become essential for the optimization of clinical outcomes.

La colaboración entre los especialistas en farmacia hospitalaria y enfermedades infecciosas está implantada en la mayoría de los hospitales españoles desde 2012, a raíz de los Programas de Optimización de  Antibióticos. Los objetivos principales de esta colaboración son el abordaje integral de los pacientes con enfermedades infecciosas y el uso  adecuado de los antimicrobianos en el hospital. Las actividades estructuradas y  organizadas que los farmacéuticos tenían dentro de los grupos se vieron  truncadas por la pandemia por SARS­CoV-2, que requirió una alta dedicación. El  intercambio de información en tiempo real entre las especialidades ha sido una  vía efectiva para generar y mantener protocolos de tratamiento adaptados a  cada centro, con continuas modificaciones basadas en las publicaciones que iban apareciendo. Los servicios de farmacia se tuvieron que reorganizar para dar  respuesta, por un lado, a los pacientes que ingresaban por esta infección, y por otro, para continuar con las actividades anteriores, con las dificultades  añadidas que exigían las normativas para la protección del personal sanitario. Hubo que reinventarse para establecer otros sistemas de comunicación y de colaboración, protocolizando el tratamiento farmacológico de estos  pacientes, con modificaciones continuas, gestión de medicamentos a través de  medicamentos especiales, diseño de circuitos para tratar a pacientes en su  domicilio y en centros sociosanitarios y modificación de circuitos internos para  minimizar los desplazamientos de los profesionales en el hospital, así como del  personal que atendía a pacientes con SARS-CoV-2. A día de hoy, se desconoce el mejor fármaco antiviral y el mejor tratamiento antiinflamatorio, pero la  colaboración del farmacéutico hospitalario es fundamental, pues dispone del  conocimiento de los mecanismos de acción de fármacos tan diferentes y de las  interacciones que pueden ocasionar. La urgente necesidad de utilizar fármacos  experimentales, preferiblemente dentro de ensayos clínicos, coloca al  farmacéutico en un papel clave dentro del equipo interdisciplinario  imprescindible para conseguir los mejores resultados.

European confederation of medical mycology expert consult-An ECMM excellence center initiative.

OBJECTIVES: Difficult-to-treat invasive fungal infections require infectious diseases expert consultation to improve treatment outcome and increase survival rates. METHODS: The European Confederation of Medical Mycology (ECMM) intends to provide expert help free of charge by a newly founded ECMM Expert Consultation Service for medical centres around the globe seeking advice when there is no fungal infection consultant available. The expert consult will provide recommendations and broad expertise on difficult-to-treat invasive fungal infections (eg azole-resistant Aspergillus species, Candida auris, mucormycosis) to improve diagnostic and therapeutic management and outcome. RESULTS: The initiative plans global outreach through video conferencing between ECMM Excellence Centers and treating physicians. FungiScope® registries will be used to structure case information and to evaluate the impact of the collegial advice system at regular intervals. Advice will follow recent guidelines, and EQUAL Scores will be used to measure guideline adherence. CONCLUSIONS: Infectious diseases expert consultation should be an integral component of care for patients with difficult-to-treat invasive fungal infections. The ECMM Expert Consult will attend to this matter on a global scale.

COVID-19: A global transplant perspective on successfully navigating a pandemic.

The COVID-19 pandemic has rapidly evolved and changed our way of life in an unprecedented manner. The emergence of COVID-19 has impacted transplantation worldwide. The impact has not been just restricted to issues pertaining to donors or recipients, but also health-care resource utilization as the intensity of cases in certain jurisdictions exceeds available capacity. Here we provide a personal viewpoint representing different jurisdictions from around the world in order to outline the impact of the current COVID-19 pandemic on organ transplantation. Based on our collective experience, we discuss mitigation strategies such as donor screening, resource planning, and a staged approach to transplant volume considerations as local resource issues demand. We also discuss issues related to transplant-related research during the pandemic, the role of transplant infectious diseases, and the influence of transplant societies for education and disseminating current information.

Evaluation of Influenza Intervention Strategies in Turkey with Fuzzy AHP-VIKOR.

In this study, a fuzzy AHP-VIKOR method is presented to help decision makers (DMs), especially physicians, evaluate and rank intervention strategies for influenza. Selecting the best intervention strategy is a sophisticated multiple criteria decision-making (MCDM) problem with potentially competing criteria. Two fuzzy MCDM methods, fuzzy analytic hierarchy process (F-AHP) and fuzzy VIsekriterijumska optimizacija i KOmpromisno Resenje (F-VIKOR), are integrated to evaluate and rank influenza intervention strategies. In fuzzy AHP-VIKOR, F-AHP is used to determine the fuzzy criteria weights and F-VIKOR is implemented to rank the strategies with respect to the presented criteria. A case study is given where a professor of infectious diseases and clinical microbiology, an internal medicine physician, an ENT physician, a family physician, and a cardiologist in Turkey act as DMs in the process.

[Career Prospects for Young Physicians in Infectious Diseases]. / Perspektiven für junge Ärztinnen und Ärzte in der Infektiologie.

Infectious Diseases are a cross-sectional area connected to various medical disciplines and offer interested physicians multiple working opportunities. The spectrum of infectious diseases covers both out- and inpatient care as well as basic, clinical and epidemiological research. The need for infectious diseases specialists is increasing, thus career prospects are promising. Working conditions in infectious diseases are comparatively family-friendly. With this article we intend to arouse interest for working in the fascinating fields of infectious diseases and provide information on career opportunities. Data from a recently conducted survey among members of the German Society of Infectious Diseases deliver insight, how infectious disease specialists work today.