Archive for July 29, 2018

Carbapenemases in the UCI: A constant challenge

International Journal of Infectious Diseases August 2018 V.73 Supplement P.29

Cornistein, W. Cox, M. Torres Boden, C. Cozzani, G. Cueto, L. Lopez Moral, N. Gomez, M. Badia, C. Rodriguez

Background

Carbapenemase-producing enterobacteria (CPE) infections increase morbi-mortality and hospital costs,becoming a serious problem for public health and a constant challenge for the health team.

Argentina has a prevalence of 10%, including the three classes of carbapenemases (OXA, NDM and KPC) with different patterns of sensitivity and geographical distribution.

In the last decade we have observed an exponential increase in CPE infections mainly in the ICU, hence affecting empirical treatments (ET)and limiting de-escalation and therapeutic options.

Objective

To analyze the CPE infections in the ICU and the impact of the ET.

Methods & Materials

Retrospective analysis of case series from January-September 2017 in 2 intensive care unit medical surgical (UCIA – UCIB) in a general hospital in Buenos Aires city (20 beds). We analyzed the episodes of CPE infections, demographic characteristics of the affected population, adequate ET, in vitro sensitivity and evolution. Adequate ET was defined when at least one drug was sensitive in vitro.

Results

There were 485 discharges (3934 patient days) during the analyzed period, episodes of infections 45.7% (222) with 19%(42) by CPE. The number of patients with CPE infections was 36; 61% men, mean age 55 and reason for admission was distributed as follows: liver disease or transplant 19%, neurology 19%, intraabdominal 17%, respiratory 14%; mean APACHE 20, mortality 52.7% (47% related to CPE infection). KPC Colonization 70%. CPE infections were urinary 55%, bloodstream 31%, abdominal 14.4%, respiratory 9.5%. Time from admission to CPE infections was 21 days. Treatment analysis showed: adequate empirical treatment 57%, two or more drugs 63% (24) (mero-col 45.8%, mero-amika 12.5%), definitive treatment combined amikacin 46%, fosfomycin 46%, tigeciclin 21.4%, colistin 25%, monotherapy 39% (mainly in urinary infection). In vitro results: Sensible (S) phosphomycin 78.5%, amikacin 52%, Tigecycline 90%, colistin 21%, meropenem (MIC <16) 4.7%.

Conclusion

CPE infections is one of most important challenges in ICU patients with prolonged stay who are seriously ill and colonized by KPC. Half received adequate combined empirical treatment, with fosfomycin and tigecycline being the most active drugs in vitro. The mortality associated to the infection continues being high, so this data analysis is very useful to improve initial treatments.

PDF

https://www.ijidonline.com/article/S1201-9712(18)33572-0/pdf

July 29, 2018 at 12:00 pm

Mobile phones: a potential source of nosocomial infection?

International Journal of Infectious Diseases August 2018 V.73 Supplement P.26

Guzzi, M.G. Hinojosa, M.D. Christin, A.H. Pescio, M.A. Rodríguez, P.A. Dimitroff

Background

Mobile phones are widely used and are integrated into the professional practice of healthcare workers, even in critical areas and operating rooms. Recent studies suggest that these devices are reservoirs for pathogens with potential to cause nosocomial infections.

Main objective

To evaluate the bacterial colonization rate of mobile phones of healthcare workers. Secondary objectives: To determine if disinfection with alcohol 70% is useful to reduce the bacterial colonization of telephones and know the perception of healthcare workers regarding the colonization of their phones and the impact that may have on their clinical/surgical practice.

Methods & Materials

45 mobile phones of the healthcare workers were included, 20 of operating room and 25 of other areas. A trained investigator took swabs from the front and back of the devices (Group A), then the telephones were cleaned with 70% alcohol and 10 minutes later, they were swabbed again with the same technique (Group B). The samples were transported in Stuart’s medium and planted on CLDE agar. The colonies were manually identified and confirmed with Phoenix BD automated equipment. Simultaneously 171 healthcare workers answered an anonymous survey about the use, cleaning and perception of colonization of mobile phones.

Results

35/45 samples of group A (78%) and 4/45 of group B (9%) developed pathogenic bacteria. 6 cases in group A were polymicrobial, the others developed: methicilin-sensitive CoNS 23%, methicilin-resistant CoNS 18%, nonfermenting Gram-negative bacilli 28%, MSSA 5%. Alcohol disinfection reduced bacterial colonization by 69%; IC95% (50-86%) p < 0.0001.

92% of workers answered that the cell phone helps them solve work issues, 92% said they clean the phone and of them 58% once a day, 83% with alcohol. 86% think that their phone is contaminated but only 41% believe that this has clinical impact.

Conclusion

Mobile phones of healthcare workers have a high rate of colonization with bacteria potentially causing nosocomial infections. Disinfection with 70% alcohol was effective in reducing bacterial colonization. For the most part, healthcare workers think that mobile phones are contaminated, but less than half believe that this has a clinical impact. We believe that guidelines are necessary to protocolize the type and frequency of cleaning cell phones.

PDF

https://www.ijidonline.com/article/S1201-9712(18)33567-7/pdf

July 29, 2018 at 11:59 am

Analysis of 10 years of surveillance of infections associated with hip and knee prostheses

International Journal of Infectious Diseases August 2018 V.73 Supplement P.21

Corral, L. Guerriero, L. Fernandez, D. Arcidiacono, R. Giordano Lerena, N. Peralta

Background

Surgical site infections are the third reported cause of healthcare-associated infections (HAIs), representing 14% to 16% of them.

Prosthetic joint infection (PJI) are one of the most frequent complications that lead to an increase in morbidity and mortality.

In the first world countries, surveillance systems report an approximate infection rate for total hip arthroplasties (THAs) and total knee arthroplasties (TKAs), from 0.5 to 1% and 0,5 to 2% respectively.

Due to the lack of knowledge of local epidemiology, we propose to describe the rates associated with these procedures, the most frequent microbiological isolations and their resistance patterns.

Methods & Materials

A retrospective study, from 2006 to 2016, of the PJI episodes of THAs and TKAs was carried out through the review of the events reported by all the institutions in Argentina that voluntarily joined the National Surveillance System (VIHDA) for HAI and selected such procedures.

Results

They were surveyed 11114 THAs and 4262 TKAs, presenting 410 and 157 PJIs respectively, which constituted a global rate for the period described of 3.68% for THAs and 3.69% for TKAs.

The mean age for THAs and AR were 65.5 and 71 years, respectively.

Female sex predominated for both procedures with 62.7% (hips) and 61.8% (knees).

The main etiologies for THAs infections were Staphylococcus aureus (n = 153, 43% MRSA), Pseudomonas aeruginosa (n = 69, 22% resistant to ciprofloxacin), Escherichia coli (n = 62, 42% resistant to ciprofloxacin), and coagulase-negative Staphylococcus (n = 52, 54% methicillin-resistant). In TKAs infections, the most commonly found microorganisms were: Staphylococcus aureus (n = 41, 20% MRSA), coagulase-negative Staphylococcus (n = 38, 32% methicillin-resistant), Enterococcus sp. (n = 9; 0% resistant to vancomycin) and Pseudomonas aeruginosa (n = 8; 50% resistant to ciprofloxacin). 32% of THAs infections and 18% of TKAs infections were polymicrobial.

Conclusion

The infection rates in both procedures were similar, being relatively low.

The mean age was lower for THAs and the female sex predominated in both surgeries.

In TKAs, gram-positive cocci (77%) predominated over gram-negative bacilli (23%).

The THAs perceives the similar percentages of Gram-positive cocci isolates (48%) and Gram-negative bacilli (52%), with 2/3 of the Enterobacteriae.

A high rate of isolations of resistant microorganisms was observed.

PDF

https://www.ijidonline.com/article/S1201-9712(18)33556-2/pdf

July 29, 2018 at 11:57 am

Invasive disease due to B-hemolytic Streptococcus. Epidemiology and mortality

International Journal of Infectious Diseases August 2018 V.73 Supplement P.20

M.S. Martinez, A. Salmeron Olsina, M. Gordovil, L. de wouters, C. Michelud, A. Martorano, M. Vallejo, V. Fanjul

Background

B-hemolytic streptococci(EBH) are responsible for diseases such as necrotizing fasciitis, toxic shock syndrome(SSTE) and post-infectious complications. EBHGA can present fulminant manifestations, as well as subtypes of EBHGC and EBHGG, which express homologous proteins.

Objective

To characterize invasive disease due to EBH(EI) in adults, incidence, risk factors, presentation, subtypes, sensitivity and mortality in a period of 5.5 years in a Private Hospital

Methods & Materials

Clinical, observational, descriptive and analytical study, transversal design. Retrospective review of positive EBH cultures during the period 01/01/2012-30/06/2017.

Inpatients and outpatients older than 18 years were included. EIE was defined for the isolation of EBHGA, B, C, G and F in sterile place(blood, CSF, joint fluid, pleural, ascitic and collection)

Blood cultures were performed in BACT/ALERT, cultured on sheep blood agar and latex particle agglutination typing. Sensitivity:disc diffusion and CIM using test strips(Etest)

Data analysis:EPI Info7, P2α < 0.05 statistically significant.

Results

141 patients:male 51.7%, median age 72 years, 92.2% of cases in hospitalized patients. Total Mortality was 21.3%(30/141), 83.3% of the deceased(25/30) had comorbidities, with Age >65 years being a statistically significant variable with an impact on mortality, both in the bivariate and multivariate analysis.

The absence of clinical focus showed a statistically significant higher mortality with high RR(2.84). The 81.25%(13/16) of bacteremia without focus ocurred in >65 years old, with a mortality of 75%(6/8). The SBHGB was responsible for 50%(8/16). The SBHGB was the most frequent agent(39.72%), with a mortality of 19.6%(11/56).

The incidence in >65 years was 60.7% with a mortality of 90.9%(10/11). The clinical foci:deep abscess(29/141) and meningitis (6/141) had an impact on mortality, a statistically significant result in the multivariate analysis for meningeal focus and SSTE(30/141) p < 0.001 RR:6.39

Sensitivity to penicillin 100%, to clindamycin 80.5% of the strains tested.

Conclusion

The EIE continues to be a prevalent disease, with a great impact on the elderly population and a high rate of lethality in the presence of risk factors. Greater mortality is highlighted in the absence of clinical focus and with SBHGB compared to other publications. The SSTE was caused equally by SBHGA and B.

PDF

https://www.ijidonline.com/article/S1201-9712(18)33555-0/pdf

July 29, 2018 at 11:56 am

Infective Endocarditis in Argentina: What have we learn in the last 25 years?

International Journal of Infectious Diseases August 2018 V.73 Supplement P.19

Burgos, P. Fernandez Oses, A. Iribarren, R. Ronderos, M. Vrancic, M. Pennini, M. Merkt, F. Nacinovich

Background

The epidemiology of Endocarditid (IE) is changing due to a number of factors, including aging, health-related comorbidities and medical procedures.

The aim of this study is to assess the main clinical, epidemiologic and etiologic changes of IE in the last 25 years in Argentina.

Methods & Materials

Comparative analysis of three cross-sectional, observational registries which enrolled consecutive patients with IE: 2 multicentric studies (EIRA-1 [1992-1994] and EIRA-2 [2001-2002]) and 1 single third level cardiology referral center (CRC [2002-2017]). Categorical variables were compared using Chi-square test; continuous variables with Student’s t test or Mann-Whitney U test was used as applicable. A value of p < 0.05 was considered significant.

Results

A total of 1065 IE episodes were included; definite IE (modified Duke Criteria) >70% in the three periods considered. There were no differences regarding sex; patients were older in each period (p < 0.001). Device associated IE was more frequent in the last decade: pacemaker IE 5.4% vs 23% (p < 0.0001); PVIE 8.5% vs 19.2% vs 47.5% (p < 0.0001). IVDA (p < 0.0001) and congenital heart diseases (p = 0.001) significantly decrease as predisposing factors and pts without known predisposing heart diseases has increased (45% vs 33.8% vs 47.8%; p < 0.0001). Etiology changes were observed: VGS (30.8% vs 26.8% vs 15.94%; p < 0.001) and S. aureus IE (26% vs 30% vs 16.27%; p = 0.014) decreased significantly, being more frequent the infection by CNS (1.7% vs 8% vs 18,3%; p < 0.0001). Surgical treatment was more frequently implemented in the last decade (28.2% vs 24.3% vs 41.86%; p < 0.00001). Mortality remained stable in the three periods, with a tendency to decrease in the last period (23.5% vs 24.3% vs 17.2%; p = 0.06).

Conclusion

In Argentina, IE affects older people, particularly with intracardiac device (PM and PV). This is remarkable when comparing the multicenter studies with CRC. Staphylococcus spp predominates, with CNS being more frequent than S. aureus. Mortality showed a tendency to decrease probably related to the fact that surgery is more frequently implemented in CRC. These findings show a change in the profile of IE in Argentina and highlights the importance of managing this complex disease in centers with extensive experience in the care of patients with IE.

PDF

https://www.ijidonline.com/article/S1201-9712(18)33552-5/pdf

July 29, 2018 at 11:54 am

2007-2017: 10 years of Rickettsia parkeri rickettsiosis in Argentina

International Journal of Infectious Diseases August 2018 V.73 Supplement P.18

Borras, J. Carranza, S. Lloveras, T. Orduna, F. Troglio, F. Govedic, S.L. Garro, S. Giamperetti, R. Armitano, C. Biscayart, M.S. Santini, J. Correa, A. Seijo, R. Contreras, Y. Romer

Background

Rickettsia parkeri spotted fever (RpSF) is a tick-borne disease, emergent in Argentina. The first cases were related to transmission through the tick Amblyomma triste, but a role was son after described for A.tigrinum, a relevant fact since this supposed an expansion of the endemic area, given its wide distribution in our country. The aim of this study was to describe clinical and epidemiological characteristics of the disease in our country.

Methods & Materials

A retrospective analysis through revision of medical records (n: 20) of a series of cases of patients with diagnosis of RpSF. A case was considered probable in the presence of clinical and epidemiological clues associated to seroconversion to Rickettsia spp., and confirmed when Rp was identified by means of a positive PCR in a tissue biopsy.

Results

60% were women (n:12/20). Average age was 48 years (Rank: 15-73). Geographical distribution by provinces: 40% Buenos Aires, 25% San Luis, 10% San Juan, 10% Córdoba, 5% La Rioja, 5% Entre Ríos, 5% La Pampa. Environment where contact with the vector took place: 45% peri-urban, 25% rural, 30% wild areas. Activity performed at contact with the vector: 30% occupational, 20% recreational, 50% household. 35% of patients had confirmed contact with dogs. Clinical characteristics: see Table 1. Eschar distribution: 30% scalp and neck, 30% trunk, 20% lower limbs, 5% hands, upper limbs, mammary glands and disseminated (each). 80% were treated with doxicycline, 20% received no antimicrobial treatment. All cases resolved without sequelae.

Conclusion

Described for the first time as a human pathogen in USA in 2004, Rp was shortly after reported in Argentina. RpSF represents a major challenge for the health system, with increasing number of reports throughout the country. Urbanization in the rural-urban interfase and lack of ectoparasite control in dogs could favour its dissemination

PDF

https://www.ijidonline.com/article/S1201-9712(18)33550-1/pdf

July 29, 2018 at 11:53 am

2016 dengue outbreak in Buenos Aires: A case series

International Journal of Infectious Diseases August 2018 V.73 Supplement P.17

Y.L. Paredes Falzone, J. Carranza, P. Machuca, J. Monroig, L. Cusmano, G. Ortega, S. Giamperetti, B. Deodato, N. Gomez, M.B. Bouzas, C. Nogueras, M. Cantero, J. Riveros, J. Coronel, S. Lloveras

Background

In 2016, the Metropolitan Area of Buenos Aires suffered the largest dengue outbreak ever recalled with 12495 cases assisted in the city. The main circulating serotype was DEN-1 and affected a population predominantly non-immune.

Methods & Materials

Description of clinical and biochemical characteristics of suspected dengue cases (as defined by argentinian guidelines), in adults attended on a specialized hospital between the 11th and the 18th epidemiological week of 2016, when the outbreak was officially announced.

Results

1728 adults with an acute febrile illness were assisted; 1468 fulfilled the inclusion criteria. 57 cases had recently travelled to areas with active circulation of dengue and 124 had risk factors for severe dengue. The median age was 34 (range 18-80) and 50% were women. The symptoms most frequently associated were headache (87%), myalgia or arthralgia (83%), nausea or vomiting (55%), diarrhea (24%), abdominal pain (29%), rash or pruritus (36%). 7.5% presented with bleeding, mainly epistaxis (28%), gingival hemorrhage (29%) and metrorrhagia (22%).

Blood tests were performed in 1300 patients. Before the fifth day of symptoms (n = 924), 66% of patients presented with laboratory findings suggestive of dengue: hematocrit > 47 (11%), leucopenia (44%) and thrombocytopenia (41%).

During the overall follow-up period (median of 2 consults, range 1-10), 82% showed laboratory findings suggestive of dengue, mainly thrombocytopenia (64%), leucopenia (54%) and relative lymphocytosis (32%).

222 patients required IV fluids and 49 of them were hospitalized.

Conclusion

In these series, there was a high frequency of gastrointestinal symptoms, supposing a challenge for the differential diagnosis. The course of the illness was benign in most cases.

A normal CBC before the fifth day of symptoms should not exclude the diagnosis of dengue. In the context of an outbreak, a close follow up is essential for the diagnosis and the early detection of alarm signs, in order to prevent the progression to severe dengue.

PDF

https://www.ijidonline.com/article/S1201-9712(18)33549-5/pdf

July 29, 2018 at 11:51 am

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