Healthcare workers' perceptions about infection prevention and control in Latin America.

BACKGROUND: Limited information exists regarding healthcare workers' (HCWs) perceptions about infection prevention and control (IPC) in Latin America. METHODS: We conducted an electronic voluntary anonymous survey to assess HCWs' perceptions towards IPC in 30 hospitals in Latin America during August-September 2022. Nurses, physicians, and environmental cleaning (EVC) staff were prioritized for recruitment. RESULTS: Overall, 1,340 HCWs completed the survey. Of these, 28% were physicians, 49% nurses, 8% EVC staff, and 15% had "other" roles. Self-compliance with hand hygiene (HH) and prevention bundles was perceived to be high by 95% and 89% of respondents, respectively; however, ratings were lower when asked about compliance by their peers (reported as high by 81% and 75%, respectively). Regular training on IPC and access to healthcare-associated infections (HAI) rates were more limited among physicians than other HCWs (e.g., 87% of EVC staff and 45% of physicians reported training upon hiring and thereafter, 60% of nurses and 51% of physicians reported regular access to HAI rate reports). CONCLUSIONS: We identified several opportunities to strengthen IPC practices in Latin American hospitals, including improving HCW education and training on IPC and their awareness of HAI rates and compliance with prevention measures.

Knowledge, attitudes and perceptions of Latin American healthcare workers relating to antibiotic stewardship and antibiotic use: a cross-sectional multi-country study.

BACKGROUND: The burden of antimicrobial resistance (AMR) in Latin America is high. Little is known about healthcare workers' (HCWs) knowledge, attitudes, and perceptions of antimicrobial stewardship (AS), AMR, and antibiotic use (AU) in the region. METHODS: HCWs from 42 hospitals from 5 Latin American countries were invited to take an electronic, voluntary, anonymous survey regarding knowledge, attitudes, and perceptions of AS, AMR, and AU between March-April 2023. FINDINGS: Overall, 996 HCWs completed the survey (52% physicians, 32% nurses, 11% pharmacists, 3% microbiologists, and 2% "other"). More than 90% of respondents indicated optimizing AU was a priority at their healthcare facility (HCF), 69% stated the importance of AS was communicated at their HCF, and 23% were unfamiliar with the term "antibiotic stewardship". Most (> 95%) respondents acknowledged that appropriate AU can reduce AMR; however, few thought AU (< 30%) or AMR (< 50%) were a problem in their HCF. Lack of access to antibiogram and to locally endorsed guidelines was reported by 51% and 34% of HCWs, respectively. Among prescribers, 53% did not consider non-physicians' opinions to make antibiotic-related decisions, 22% reported not receiving education on how to select antibiotics based on culture results and 60% stated patients and families influence their antibiotic decisions. CONCLUSIONS: Although HCWs perceived improving AU as a priority, they did not perceive AU or AMR as a problem in their HCF. AS opportunities include improved access to guidelines, access to AMR/AU data, teamwork, and education on AS for HCWs and patients and families.

Impact of the International Nosocomial Infection Control Consortium (INICC)'s Multidimensional Approach on Rates of Central Line-Associated Bloodstream Infection in 14 Intensive Care Units in 11 Hospitals of 5 Cities in Argentina.

OBJECTIVE To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and the INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in 14 intensive care units (ICUs) in Argentina from January 2014 to April 2017. DESIGN This prospective, pre-post surveillance study of 3,940 ICU patients was conducted in 11 hospitals in 5 cities in Argentina. During our baseline evaluation, we performed outcome and process surveillance of CLABSI applying Centers for Disease Control and Prevention/National Health Safety Network (CDC/NHSN) definitions. During the intervention, we implemented the IMA through ISOS: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on CLABSI rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the CLABSI rate. RESULTS During the baseline period, 5,118 CL days and 49 CLABSIs were recorded, for a rate of 9.6 CLABSIs per 1,000 central-line (CL) days. During the intervention, 15,659 CL days and 68 CLABSIs were recorded, for a rate of 4.1 CLABSIs per 1,000 CL days. The CLABSI rate was reduced by 57% (incidence density rate: 0.43; 95% confidence interval, 0.34-0.6; P<.001). CONCLUSIONS Implementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in ICUs in Argentina. Infect Control Hosp Epidemiol 2018;39:445-451.

Impact of the International Nosocomial Infection Control Consortium's multidimensional approach on rates of ventilator-associated pneumonia in 14 intensive care units in 11 hospitals of 5 cities within Argentina.

BACKGROUND: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in 11 hospitals within 5 cities of Argentina from January 2014-April 2017. METHODS: A multicenter, prospective, before-after surveillance study was conducted through the use of International Nosocomial Infection Control Consortium Surveillance Online System. During baseline, we performed outcome surveillance of VAP applying the definitions of the Centers for Disease Control andPrevention's National Healthcare Safety Network. During intervention, we implemented the IMA, which included a bundle of infection prevention practice interventions, education, outcome surveillance, process surveillance, feedback on VAP rates and consequences, and performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention. RESULTS: We recorded 3,940 patients admitted to 14 intensive care units. At baseline, there were 19.9 VAPs per 1,000 mechanical ventilator (MV)-days-with 2,920 MV-days and 58 VAPs, which was reduced during intervention to 9.4 VAPs per 1,000 MV-days-with 9,261 MV-days and 103 VAPs. This accounted for a 52% rate reduction (incidence density rate, 0.48; 95% confidence interval, 0.3-0.7; P .001). CONCLUSIONS: Implementing the IMA was associated with significant reductions in VAP rates in intensive care units within Argentina.

Insuficiencia renal aguda en pacientes tratados con aminoglucósidos / Acute kidney injury in patients treated with aminoglycosides

Introducción: El riesgo de desarrollo de insuficiencia renal asociada al uso de aminoglucósidos es muchas veces una limitación para su uso en muchos profesionales de la salud. El objetivo de este trabajo fue conocer la frecuencia de insuficiencia renal en pacientes tratados con aminoglucósidos y los posibles factores asociados a su aparición. Materiales y métodos: Estudio descriptivo, longitudinal y prospectivo. Se incluyeron pacientes que recibieron aminoglucósidos por al menos 72 horas. Se realizó dosaje de creatinina basal y cada 48 horas durante el tratamiento antibiótico y luego de siete días de finalizado el mismo o posterior. Se definió insuficiencia renal aguda como el aumento de creatinina de 0,3 mg/dl con respecto a la basal. Resultados: Se analizaron datos de 107 pacientes y se halló una frecuencia de insuficiencia renal de 10,3%, siendo 5,8% durante el tratamiento aminoglucósido y 4,5% luego de la suspensión del mismo. Los pacientes que desarrollaron insuficiencia renal tenían mayores dosis de aminoglucósidos con respecto al grupo que no presentó dicho evento, siendo esta diferencia estadísticamente significativa. Conclusiones: La frecuencia de insuficiencia renal en pacientes tratados con aminoglucósidos resultó dentro de los intervalos descritos en la literatura y la mayoría de los pacientes presentaron recuperación completa de la función renal. Consideramos que la insuficiencia renal no supone un efecto adverso clínicamente significativo si los aminoglucósidos se usan con las precauciones adecuadas. Esto, sumado a sus buenos resultados clínicos y al bajo impacto en la ecología bacteriana, los convierte hoy en día en antibióticos de uso frecuente en nuestro hospital

The risk of developing renal failure associated with the use of aminoglycosides is often a limitation for its use in many health professionals. The objective of this study was to know the frequency of renal failure in patients treated with aminoglycosides and the possible factors associated with their appearance. Materials and methods: descriptive, longitudinal and prospective study. Patients who received aminoglycosides for at least 72 hours were included. Basal creatinine was measured and every 48 hours during the antibiotic treatment and after 7 days or more of its suspension. Acute renal failure was defined as an increase in creatinine of 0.3 mg/dl compared to baseline. Results: data from 107 patients were analyzed, and the frequency of renal failure was 10.3%, being 5.8% during the treatment with aminoglycoside and 4.5% after its suspension. The patients who developed renal failure had higher doses of aminoglycoside respect to the group that did not present this event, being this difference statistically significant. Conclusions: the frequency of renal failure in patients treated with aminoglycosides was within the ranges described in the literature and the majority of patients had complete recovery of renal function. We believe that renal failure does not represent a clinically significant adverse effect if aminoglycosides are used with adequate precautions. This, added to their good clinical results and low impact on bacterial ecology, makes them very used antibiotics today in our hospital

Compromiso neurológicoy cardiovascularen pacientes con triquinosis / Neurological and cardiovascular involventin patients with trichinosis

Introducción: La triquinosis es una infección parasitaria causada por nematodos del género Trichinella. El compromiso cardíaco no es habitual, pero representa la causa más frecuente de muerte por triquinosis, mientras que la afectación neurológica ocurre principalmente en pacientes severamente enfermos. Se sabe que a mayor cantidad de larvas ingeridas menor es el tiempo de incubación y mayor es la severidad de la enfermedad. Se presentan dos pacientes con compromiso del sistema nervioso central, uno de ellos cardiovascular, ambos pertenecientes a un brote de triquinosis ocurrido en la ciudad de Bahía Blanca.

Background: Trichinosis is a parasitic infection caused by nematodes of the genus Trichinella. Cardiac involvement is not usual but represents the most frequent cause of death by trichinosis, while neurological affectation occurs mainly in severely ill patients. A greater number of larvae ingested, the shorter the incubation time and the greater the severity of the disease. We present two patients with compromise of the central nervous system and one of them cardiovascular, both belonging to an outbreak of trichinosis in the city of Bahía Blanca

Colonización por Staphylococcus aureusmeticilino resistente de la comunidad y factores predisponentes en soldados ingresantes a una institución militar / Colonization by community resistant Staphylococcus aureusmeticillin and predisposing factors in soldiers admitted to a military institution

Introducción: La colonización por Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-AC) ha ido en aumento desde su aparición. El objetivo de este trabajo fue conocer la prevalencia de colonización por SAMR-AC en soldados, determinar los factores predisponentes y conocer la dinámica de colonización a los seis meses de convivencia. Materiales y métodos: Estudio descriptivo, de corte transversal. Se incluyó una muestra de los soldados ingresantes a un establecimiento militar. Se tomó una muestra de hisopado nasal y, en caso de aislamiento de Staphylococcus aureus, se determinó la frecuencia de la cepa meticilino resistente de la comunidad. Se realizó una encuesta sobre los posibles factores predisponentes para la colonización. Luego de seis meses de convivencia se efectuó un nuevo hisopado y se analizó el cambio en la prevalencia y la dinámica de colonización. Resultados: Se incluyeron 346 soldados provenientes de diferentes provincias de Argentina. La prevalencia inicial de colonización por Staphylococcus aureus meticilino resistente de la comunidad fue 7,8% y, luego de seis meses, 9,5% (aumento del 21,8%). Los factores que mostraron asociación con la colonización por SAMR-AC fueron los antecedentes de un conviviente con forunculosis (p=0,02), forunculosis previa (p=0,04) y forunculosis en familiar de primer grado no conviviente (p=0.03). Se constató persistencia de colonización en el 79% del grupo inicial. Conclusiones: Se observó una prevalencia de colonización por Staphylococcus aureus meticilino resistente de la comunidad del 7,8%, superior a la encontrada en la mayoría de los estudios publicados

Introduction: Colonization by community-acquired methicillin-resistant Staphylococcus aureus has been on the rise since its appearance. The objective of this study was to estimate the prevalence of colonization by community-acquired methicillin-resistant staphylococcus aureus in soldiers, determine the predisposing factors and know the dynamics of colonization during coexistence. Materials and methods: descriptive, cross-sectional study. A sample of the incoming soldiers in a military establishment was included. A nasal swab was taken and, in case of isolation of Staphylococcus aureus, the frequency of the resistant meticillin strain in the community was determined. A survey was made on possible predisposing factors for colonization by this germ. After 6 months of cohabitation, a new swab was performed and the change in prevalence and colonization dynamics was analyzed. Results: 346 soldiers from different provinces of the country were included. The initial prevalence of soldiers colonized by community-acquired methicillin-resistant was 7.8%, and after 6 months, 9.5% (21.8% increase). The factors associated with SAMR-AC colonization were the antecedent of a household members with forunculosis (p=0.02), history of forunculosis (p=0.04) and the antecedent of forunculosis in a non-cohabiting first-degree relative (p=0.03). Persistence of colonization was found in 79% of the initial group.Conclusion: a prevalence of 7.8% community methicillin resistant Staphylococcus aureus colonization was observed, superior to that found in the majority of published studies.

¿Cumplimos el objetivo de farmacocinética y farmacodinamia en pacientes críticos que reciben antibióticos betalactámicos? / Do we meet the goal of pharmacokinetics and pharmacodynamics in critically ill patients receiving beta-lactam antibiotics?

Introducción: Los pacientes críticamente enfermos presentan cambios fisiopatológicos que alteran las concentraciones de antibióticos betalactámicos. El objetivo fue determinar si las dosis de uso habitual en pacientes críticos alcanzan las concentraciones asociadas con mayor actividad y establecer las variables de PK/PD que se asocian con concentraciones subóptimas de antibiótico.Métodos: Estudio prospectivo realizado en una terapia intensiva de adultos en un periodo de 13 meses. Se incluyeron pacientes que recibieron cefazolina, ceftriaxona, ceftazidima o meropenem. Se realizó dosaje de concentración de antibiótico en plasma en el 50% del intervalo de dosis. Se calculó la concentración de antibiótico libre y se comparó con el objetivo 50% fT>CIM y el objetivo 50% fT>CIM x 4 para los microorganismos susceptibles definidos, según criterios del CLSI. Se comparó el grupo de pacientes que cumplió el objetivo 50% fT>CIM x 4 con el que no, en términos de variables de PK/PD.Resultados: Se incluyeron 29 determinaciones y 55 comparaciones. En el 92,7% de los casos se alcanzó el objetivo 50% fT>CIM y en el 61,8% el objetivo 50% fT>CIM x 4. En el peor escenario, es decir considerando el germen susceptible con CIM más alta, solo el 48,3% de los pacientes cumplieron el objetivo 50% fT>CIM x 4. Los pacientes que no llegaron al objetivo 50% fT>CIM x 4 tuvieron mayor RESUMENARTÍCULO ORIGINALaclaramiento renal que los que sí lo hicieron (160 vs 108,5 ml/min/1,73m2, p= 0,01). Conclusiones: un gran porcentaje de pacientes críticos que recibe betalactámicos no alcanza las metas de PK/PD recomendadas en la actualidad

Introduction: critically ill patients have physiopathological changes that upset the concentrations of beta-lactam antibiotics. The aim was to determine if the doses of usual use in critically ill patients reach the concentrations associated with maximal activity and to establish the variables of PK/PD that are associated with suboptimal concentrations of antibiotic. Methods: prospective study conducted in an intensive therapy of adults in a period of 13 months. Patients who received cefazolin, ceftriaxone, ceftazidime or meropenem were included. Dosage of antibiotic concentration in plasma was performed at 50% of the dose interval. The concentration of free antibiotic was calculated and compared with the objective 50% fT>MIC and the objective 50% fT>MIC x 4 for susceptible microorganisms, according to CLSI criteria. The group of patients who met the 50% objective fT>MIC x 4 was compared with the one who did not, in terms of PK/PD variables. Results: 29 determinations and 55 comparisons were included. The objective 50% fT>MIC was reached in 92.7% of the cases and the target 50% fT>MIC x 4 was achieved in 61.8%. In the worst scenario, that is, considering the germ susceptible with MIC higher, only 48.3% of patients met the objective 50% fT>MIC x 4. Patients who did not reach the goal 50% fT>MIC x 4 had greater renal clearance than those who reached the goal (160 vs 108.5 ml/min/1.73m2, p=0.01). Conclusions: a large percentage of critically ill patients receiving beta-lactams do not reach the PK/PD goals recommended nowadays

Relación entre desarrollo de los programas para la gestión del uso de antimicrobianos, apropiabilidad y consumo de antibióticos en hospitales de Argentina / Relationship between the antimicrobial stewardship program development, appropriateness and antimicrobial consumption in Argentinean hospitals

Introducción: La implementación de Programas para la Optimización de Uso de Antimicrobianos (PROAs) ha resultado una estrategia útil para mejorar los resultados asistenciales, de manera segura y costo-efectiva, reduciendo el desarrollo de la resistencia a los antimicrobianos.Objetivo: Estimar la relación entre nivel de desarrollo de los PROAs, apropia-bilidad y consumo de antimicrobianos en hospitales ArgentinosMaterial y métodos: Entre Jul-2016 y Ene-2017, 111 hospitales condujeron una autoevaluación del nivel de desarrollo de sus PROAs usando un instrumen-to basado en los lineamientos del CDC (0 a 100 puntos), además de un cor-te de prevalencia para evaluar la apropiabilidad de las prescripciones de an-timicrobianos y su consumo mensual [Dosis Diarias Definidas (DDD) c/100 días-paciente]. Para la comparación de estos indicadores, los centros fueron dicotomizados tomando como punto de corte el percentilo 75 (p75) de la au-toevaluación.Resultados: La comparación entre hospitales con puntaje ≥p75 vs.

Objective: To assess the association between the level of AMS programs development, appropriateness and antimicrobial consumption in Argentinean hospitalsMaterial and methods: Between Jul-2016 and Jan-2017, 111 hospitals performed a self-assessment survey of their AMS programs using a standardized tool based on CDC recommendations (0­100 scale). In addition, the appropriateness of antimicrobial prescription was measured through one-day prevalence study using specific criteria. The monthly consumption of a group of antimicrobials was calculated using Defined Daily Doses (DDD) per 100 patient-days. To assess the relationship between the level of AMS programs development and the appropriateness and antimicrobial consumption indicators, participating centers were grouped into two categories by using the 75th percentile (75thp) of the self-assessment scoreResults: Comparison between hospitals with score ≥75thp vs <75thp showed significant differences in all indicators analyzed (self-assessment score: 51.6 vs 25.4; diff. 26.2; 95%CI 30.3 to 22.0, p<0.000; surgical prophylaxis: ≤ 24 hs 64.8% vs 52.3%; diff. 12.5%; 95%CI 5.1% to 20.0%, p<0.002; compliance with guidelines: 77.6% vs 47.0%; diff. 30.6%; 95%CI 28.1% to 33.0%, p<0.000; prospective audit with feedback: 69.4% vs 46.8%; diff. 22.6%; 95%CI 20.0% to 25.2%, p<0.000; antimicrobial consumption: 114.8 DDDs vs 259.2 DDDs; diff.­144.4; 95%CI ­140.6 to ­148.2, p<0.000)Conclusions: Hospitals with higher self-assessment score showed better appropriateness and consumption antimicrobial indicators, reinforcing the relevance of an effective implementation of AMS programs

Infecciones asociadas a catéteres en terapia intensiva del Hospital Privado del Sur de Bahía Blanca / Catheter-associated infections at the intensive care unit of the hospital Privado del Sur, Bahía Blanca

Introducción: El uso de accesos venosos centrales (AVC) es útil para tratamiento y monitoreo hemodinámico del paciente. Sin embargo, su implementación no está exenta de complicaciones, siendo el principal problema las complicaciones infecciosas asociadas al catéter. Materiales y Métodos. En el servicio de Terapia Intensiva del Hospital Privado del Sur (HPS), se realizó un estudio descriptivo, retrospectivo acerca de la incidencia de infecciones asociadas a catéter (IAC) en la población de pacientes adultos internados durante el período 2006 ­ 2011; y se midió el impacto del paquete de medidas propuestas por el Comité de Control de Infecciones diseñadas para reducir la incidencia de las IAC. Resultados: La tasa de uso de AVC fue de 73,76% y la tasa total de IAC fue de 7,16/1000 día catéter. Se observa un descenso de IAC, de 15/1000 día catéter en 2006 a 7,8 en el año 2011. De la flora predominante 53,8% fueron bacilos Gram negativos, cocos Gram positivo el 46,2% restante, y entre ellos sólo 5,13% fue por Staphylococcus aureus meticilinorresistente. Conclusiones: Nuestros datos muestran un importante descenso en las tasas de infección desde la implementación del Programa de Control de Infecciones diseñado por el Comité de Control de Infecciones del HPS, en 2008.

Introduction: The use of central venous accesses (CVA) is useful for the hemodynamic monitoring and treatment of patients. However, its implementation may present some complications being catheter-associated infections the major problem. Materials and Methods: In the Intensive Care Unit of the Hospital Privado del Sur (HPS), we conducted a descriptive study on the incidence of catheter-associated infections (CAI) in an adult patient population admitted during the period 2006-2011, and we measured the impact of the set of measures proposed by the Infection Control Committee designed to reduce the incidence of CAI. Results: The CVA prevalence rate was 73.76% and the overall rate was 7.16 CAI / 1000 catheter days. We observed a decrease in CAI, 15/1000 catheter days in 2006 to 7.8 in the year 2011. Predominant flora were Gram negative bacteria 53.8%, and Gram positive cocci the remaining 46.2%. Among them there was only 5.13% infections caused by methicillin-resistant Staphylococcus aureus. Conclusions: Our data show a significant decrease in infection rates since the implementation of the Infection Control Program designed by the Infection Control Committee of the HPS in 2008.

Enfermedad de creutzfeldt-jakob. Presentación de un caso / Creutzfeldt-jakob disease. A case report

La enfermedad de Creutzfeld-Jakob es una enfermedad degenerativa subaguda del encéfalo clasificada dentro de las encefalopatías espongiformes transmisibles. La incidencia en el mundo entero es de 1 /1 millón. En la Argentina, no existen datos para evaluación de incidencia ni mortalidad. Desde 1945 a 1997 se informaron 50 casos confirmados con anatomía patológica. La edad promedio de los pacientes afectados fue de 55, 8 años. La relación hombre-mujer fue 1:0,70 . Se presenta el caso clínico de una mujer de 72 años ,que comienza 40 días previos al ingreso con diplopía, alteraciones en el campo visual y en la visión en colores, acúfenos, cambios en la conducta y alteraciones del ritmo sueño-vigilia. Luego se agregan alteraciones en la marcha, desviaciones posturales y debilidad de miembros inferiores hasta llegar a la postración. Se interpreta el cuadro como demencia subaguda con etiología desconocida. La RMI de cerebro mostró lesiones focales difusas en sustancia blanca; el EEG complejos de 1/segundo periódicas, difusamente distribuidas, por lo que se sospecha encefalopatía espongiforme de Creutzfeldt-Jakob. La determinación de proteína 14-3-3 en líquido cefalorraquídeo, fué positiva. Se realiza tratamiento de sostén, presentando estabilidad inicial, pero desarrolla en forma posterior una neumonía intrahospitalaria y fallece. Se toma biopsia cerebral post mortem donde se observan cambios espongiformes en todas las capas, con lo que se obtiene diagnóstico definitivo. Se presenta dicho caso por su baja frecuencia de presentación y la complejidad del diagnóstico diferencial de las demencias subagudas.

Creufeldt-Jakob disease is a transmissible spongiform encephalopathy (TSE) that affects the CNS with no treatment and ominous prognosis in less than a year. It may occur in an inherited, infectious or sporadic form with a prevalence of less than 1 case/per million worldwide.There are no exact data in Argentina on the incidence or mortality of this disease, but between 1945 and 1997, 50 cases were confirmed either by biopsy or autopsy. It affects patients in their fifties (mean 55.8 years) with a slight prevalence in men (1:0.7). The clinical case of a 72 year old woman is presented here. Symptoms started 40 days before being admitted at the hospital with diplopia, visual field and color vision alterations, acufens, behavioral changes, and sleep/wake rhythm alterations. Later, walking alterations, postural deviations, and weakness in lower limbs appeared leading to patient postration. The case is interpreted as sub-acute dementia of unknown etiology. The brain MRI scan showed diffused white-matter focal lesions; the EEG showed periodic 1/second, diffusely distributed complexes, thus Creutzfeldt-Jakob spongiform encephalopathy is suspected. Protein 14-3-3 determination in cerebroespinal fluid was positive. Support treatment is carried out, showing initial stability; however, the patient later develops intra-hospital pneumonia and dies. A brain biopsy is performed and spongiform changes are observed in all the layers, thus obtaining the final diagnosis. This case is presented because of its low occurrence and the complexity of differential diagnosis of sub-acute dementias.

Sindrome de desmielinización osmótica. Sindrome de mielinolisis extrapontina. Presentación de un caso / Osmotic demyelinization syndrome. Extrapontine myelinolysis syndrome. A case report

Presentamos el caso de una paciente que ingresa a la Unidad de Terapia Intensiva (UTI) por una sepsis grave de la comunidad secundaria a una neumonía a neumococco y que en su evolución presenta un cuadro clínico de mielinolisis extrapontina no asociada a trastornos del sodio. La clínica y la buena evolución del cuadro neurológico sugieren la búsqueda de los síndromes desmielinizantes en aquellos pacientes internados en UTI con cuadros neurológicos atípicos. Creemos que existe un subdiagnóstico de estos síndromes de desmielinización osmótica.

In this paper we present the case of a female patient admitted at an Intensive Care Unit (ICU) due to a serious community-acquired sepsis secondary to a pneumococal pneumonia that in its evolution showed a clinical condition of extrapontine myelinolysis not associated to sodium disorders. The clinical evaluation and good evolution of the neurological condition suggest the search for demyielinizing syndromes in those patients hospitalized at an ICU with atypical neurological conditions. We believe there is a sub-diagnosis of these osmotic demyelinization syndromes.