Posts filed under ‘CONSENSOS’

Recommendations for prevention of surgical site infection in adult elective arthroplasty.

Medicina (B Aires). 2017;77(2):143-157.

[Article in Spanish]

Chuluyán JC1, Vila A2, Chattás AL3, Montero M3, Pensotti C4, Tosello C5, Sánchez M6, Vera Ocampo C7, Kremer G8, Quirós R8, Benchetrit GA9, Pérez CF10, Terusi AL11, Nacinovich F12.

Author information

1 Grupo de Trabajo Infectología, Hospital General de Agudos Dr. T. álvarez, Argentina. E-mail:

2 Servicio de Infectología, Hospital Italiano de Mendoza, Mendoza, Argentina.

3 Hospital General de Agudos Dr. Pirovano, Argentina.

4 Clínica Monte Grande, Buenos Aires, Argentina.

5 Hospital de Clínicas José de San Martín, UBA, Buenos Aires, Argentina.

6 Hospital Italiano de Buenos Aires, Argentina.

7 Sanatorio Dupuytren, Argentina.

8 Hospital Universitario Austral, Argentina.

9 Instituto de Investigaciones Médicas A. Lanari, UBA, Buenos Aires, Argentina.

10 Policlínico del Docente-Centro Médico Huésped, Argentina.

11 Instituto César Milstein, Argentina.

12 Instituto Cardiovascular de Buenos Aires, Centros Médicos Dr. Stamboulian, Argentina.


Surgical site infections complicating orthopedic implant surgeries prolong hospital stay and increase risk of readmission, hospitalization costs and mortality. These recommendations are aimed at:

(i) optimizing compliance and incorporating habits in all surgery phases by detecting risk factors for surgical site infections which are potentially correctable or modifiable; and

(ii) optimizing preoperative antibiotic prophylaxis as well as intraoperative and postoperative care.



August 31, 2017 at 3:49 pm

2017-07 Guidelines for the managing advanced HIV disease and rapid initiation of antiretroviral therapy. WHO 56 pags


The objectives of these guidelines are to provide recommendations outlining a public health approach to managing people presenting with advanced HIV disease, and to provide guidance on the timing of initiation of antiretroviral therapy (ART) for all people living with HIV.

The first set of recommendations addresses the specific needs of people with advanced HIV disease and defines a package of interventions aimed at reducing HIV-associated morbidity and mortality. WHO recommends that a package of screening, prophylaxis, rapid ART initiation and intensified adherence interventions be offered to everyone living with HIV presenting with advanced disease. This is a strong recommendation that applies to all populations and age groups. The guidelines also include an algorithm to support decision making for providing care for people with advanced HIV disease.

The second set of recommendations defines how rapidly ART should be initiated within the context of the “treat all” policy, especially when coinfections are present. WHO strongly recommends that rapid ART initiation should be offered to people living with HIV following confirmed diagnosis and clinical assessment. Rapid initiation of ART is defined as within seven days of HIV diagnosis. WHO further strongly recommends ART initiation on the same day as HIV diagnosis based on the person’s willingness and readiness to start ART immediately, unless there are clinical reasons to delay treatment. Both of these recommendations apply to all populations and age groups. People with advanced HIV disease should be given priority for clinical assessment and treatment initiation.


August 7, 2017 at 9:56 am

Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure — United States (Including U.S. Territories), July 2017

MMWR July 28, 2017 V.66 N.29 P.781-793


Titilope Oduyebo, MD1; Kara D. Polen, MPH1; Henry T. Walke, MD1; Sarah Reagan-Steiner, MD1; Eva Lathrop, MD1; Ingrid B. Rabe, MBChB1; Wendi L. Kuhnert-Tallman, PhD1; Stacey W. Martin, MSc1; Allison T. Walker, PhD1; Christopher J. Gregory, MD1; Edwin W. Ades, PhD1; Darin S. Carroll, PhD1; Maria Rivera, MPH1; Janice Perez-Padilla, MPH1; Carolyn Gould, MD1; Jeffrey B. Nemhauser, MD1; C. Ben Beard, PhD1; Jennifer L. Harcourt, PhD1; Laura Viens, MD1; Michael Johansson, PhD1; Sascha R. Ellington, MSPH1; Emily Petersen, MD1; Laura A. Smith, MA1; Jessica Reichard, MPA1; Jorge Munoz-Jordan, PhD1; Michael J. Beach, PhD1; Dale A. Rose, PhD1; Ezra Barzilay, MD1; Michelle Noonan-Smith1; Denise J. Jamieson, MD1; Sherif R. Zaki, MD1; Lyle R. Petersen, MD1; Margaret A. Honein, PhD1; Dana Meaney-Delman, MD1

CDC has updated the interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure in response to 1) declining prevalence of Zika virus disease in the World Health Organization’s Region of the Americas (Americas) and 2) emerging evidence indicating prolonged detection of Zika virus immunoglobulin M (IgM) antibodies.

Zika virus cases were first reported in the Americas during 2015–2016; however, the incidence of Zika virus disease has since declined.

As the prevalence of Zika virus disease declines, the likelihood of false-positive test results increases. In addition, emerging epidemiologic and laboratory data indicate that, as is the case with other flaviviruses, Zika virus IgM antibodies can persist beyond 12 weeks after infection.

Therefore, IgM test results cannot always reliably distinguish between an infection that occurred during the current pregnancy and one that occurred before the current pregnancy, particularly for women with possible Zika virus exposure before the current pregnancy.

These limitations should be considered when counseling pregnant women about the risks and benefits of testing for Zika virus infection during pregnancy.

This updated guidance emphasizes a shared decision-making model for testing and screening pregnant women, one in which patients and providers work together to make decisions about testing and care plans based on patient preferences and values, clinical judgment, and a balanced assessment of risks and expected outcomes…..


July 28, 2017 at 5:17 pm

Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention.

MMWR Recomm Rep. 2002 Aug 9;51(RR-10):1-29.

O’Grady NP1, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA.

Author information

1 National Institutes of Health, Bethesda, Maryland, USA.


These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings.

This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery anesthesiology interventional radiology pulmonary medicine, pediatric medicine, and nursing.

The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology ofAmerica (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device-Related Infections published in 1996 These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections.

Major areas of emphasis include

1) educating and training health-care providers who insert and maintain catheters;

2) using maximal sterile barrier precautions during central venous catheter insertion;

3) using a 2% chlorhexidine preparation for skin antisepsis;

4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and

5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis).

These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.



July 26, 2017 at 4:47 pm

LEPTOSPIROSIS – GUIA para el Equipo de Salud. Ministerio de Salud de la Nación Argentina – ABRIL 2014


Pág 3. Información para el equipo de salud:

  1. Introducción
  2. Manifestaciones clínicas
  3. ¿Cuándo sospechar leptospirosis?
  4. ¿Cómo confirmar leptospirosis?
  5. ¿Cómo notificar el caso de leptospirosis?
  6. ¿Cómo se trata el paciente con leptospirosis?
  7. Flujograma de manejo de casos sospechosos de leptospirosis
  8. Diagnóstico diferencial
  9. ¿Qué hacer si se confirma?
  10. ¿Cómo se tratan los casos caninos de leptospirosis?
  11. Prevención de la leptospirosis en la familia y la comunidad

Pág 25. Recomendaciones para la organización de las actividades en el Equipo de Salud

  1. ¿Qué pueden Ud y su equipo de salud hacer para contribuir al control de la leptospirosis en su área?

Pág 29. Información para la población

  1. ¿Qué es la leptospirosis?
  2. ¿Cómo se transmite la leptospirosis?
  3. ¿Cómo ingresa la bacteria?
  4. ¿Cuáles son los síntomas de la leptospirosis?
  5. ¿Qué hacer en caso de padecer de algunos de los síntomas mencionados antes?
  6. ¿Cuál es el tratamiento?

7 ¿Cómo afecta la enfermedad a los animales domésticos?

  1. ¿Qué podemos hacer para prevenir la leptospirosis?

Pág 35. Anexos

  1. Muestras clínicas para examen
  2. Notificación a través del Módulo SIVILA del SNVS
  3. Bioseguridad
  4. Laboratorios de la Red de leptospirosis
  5. Algoritmo de diagnóstico y notificación por laboratorio
  6. Ficha de notificación de casos de síndrome febril
  7. Ficha de notificación de caso leptospirosis canina


July 17, 2017 at 8:32 am

Aspergilosis. Formas clínicas y tratamiento

Enf Infecciosas & Microbiologia Clínica Abril 2012 V.30 N.4

Jesús Fortún, Yolanda Meije, Gema Fresco, Santiago Moreno.

Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España


La aspergilosis invasiva junto con la aspergilosis crónica pulmonar y la aspergilosis broncopulmonar alérgica, constituyen las formas clínicas de aspergilosis.

Aunque el número de especies de Aspergillus spp. es muy numeroso, Aspergillus fumigatus-complex es el agente etiológico más frecuente, independientemente de la forma clínica y la afección de base del paciente.

El incremento de los diferentes tratamientos inmunosupresores y el mayor uso de corticoides en pacientes con enfermedad obstructiva crónica han condicionado un mayor protagonismo de la aspergilosis en los últimos años.

El uso de galactomanano y las pruebas de imagen complementan las limitaciones microbiológicas en el diagnóstico de estos pacientes. Voriconazol y anfotericina liposomal constituyen la base del tratamiento en todas las formas de aspergilosis, y posaconazol, itraconazol, caspofungina y otras equinocandinas son alternativas eficaces.

El pronóstico depende de la forma clínica y las características del huésped, pero es sombrío fundamentalmente en las formas invasivas diseminadas.



July 17, 2017 at 8:11 am

Profilaxis antibiótica en el paciente poli-traumatizado. Guías 2011 elaboradas por los Comités de Infectología Crítica y de Trauma de la Sociedad Argentina de Terapia Intensiva (SATI)


Rosa Reina,* Guillermo Ramos,** Carina Balasini,* Héctor Canales,** Wanda Cornistein,* Alberto Cremona,* Eleonora Cunto,* Mercedes Esteban,* Alberto Legarto,** Romina Lendaro,** Candela Llerena,* Monserrat Lloria,* Mónica Quinteros,** Juan Videla* * Comité de Infectología Crítica ** Comité de Trauma Sociedad Argentina de Terapia Intensiva Buenos Aires, Argentina



Elaborar guías de profilaxis antibiótica (P-ATB) para pacientes politraumatizados.


Sistema GRADE para calidad y fuerza de la evidencia.


1) P-ATB prequirúrgica, desbridamiento amplio: 1-A.

2) Trauma de abdomen sin lesión de víscera hueca, con o sin packing: 2-D; con lesión de víscera hueca, con o sin packing, P-ATB hasta 24 h del posoperatorio: 1-A.

3) Trauma de cráneo: a) colocación de sensor de presión intracraneal: 2-D; b) fractura de base de cráneo: no administrar P-ATB: 1-A; c) fractura con hundimiento, por arma de fuego, con atricción de partes blandas o sin ella (la P-ATB no previene meningitis o absceso): 2-D.

4) Trauma maxilofacial: a) cerrado: con hemoseno o sin él, no administrar P-ATB: 1-A; b) penetrante (ruptura de senos, pérdida de piezas dentarias, con laceración de mucosa o sin ella): P-ATB por un día: 1-A; c) fractura mandibular: reducción cerrada/abierta: P-ATB posoperatoria: 2-D; d) cara sin fractura, lesión de partes blandas: 2-D; e) trauma ocular penetrante: PATB durante un día: 2-D.

5) Quemados: a) prevenir sepsis temprana e infección de herida: 1-C; b) quemados graves, de alto riesgo, en asistencia respiratoria mecánica: prevención de neumonía e infecciones intrahospitalarias: 2-B; c) quemadura <40%: curación simple, balneoterapia y resecciones de escaras: 1-C; d) procedimientos en quemaduras >40%, P-ATB perioperatoria para reducir la bacteriemia y la infección de la quemadura: 2-C; e) prevenir la pérdida de injertos de piel autóloga: 2-C.

6) Trauma de tórax: a) colocación de drenaje: 2-D; b) aspiración de contenido gástrico: no administrar P-ATB: 1-A.

7) Trauma pelviano-genitourinario abierto a vagina/recto y lesión de víscera hueca: P-ATB hasta 24 h del posoperatorio: 1-A.

8) Fractura expuesta de huesos largos: a) iniciar P-ATB rápidamente: 1-A; b) Gustillo I-II: suspender antibiótico a las 24 h del cierre de las heridas: 1-B; c) Gustillo III: continuar antibiótico por 72 h luego del trauma y 24 h después del cierre de las heridas: 1-B.


Pocas indicaciones con fuerte nivel de evidencia para P-ATB


July 17, 2017 at 8:03 am

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