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A program for the hematologic patient at very high risk of infections (HAR, from its initials in Spanish) was implemented, based on a multidisciplinary team and six measures intended to reduce the colonization and subsequent sepsis by multidrug-resistant organisms (MDRO). We aimed at evaluating the effectiveness of the HAR program in terms of MDRO infections mainly caused by Klebsiella pneumoniae carbapenemase-producing and multidrug-resistant Pseudomona aeruginosa, and sepsis-related mortality. We established retrospective comparisons between the pre-HAR period (2016–2018) and the post-HAR period (2018–2019), in patients who received a hematopoietic stem cell transplant (HSCT) and/or intensive chemotherapy to treat non-M3 acute myeloid leukemia (CH-AML). We included 262 patients: 176 pre-HAR and 86 post-HAR. MDRO infection was 4.6% at 30 days and 6.1% at 90 days (all the cases during the pre-HAR period). Sepsis-related mortality was 6.5%, considering a median follow-up of 608 days: 6.1% in the HSCT group and 12.4% in the CH-AML group (p = 0.306). Sepsis-related mortality was 8.7% in the pre-HAR period and 0% in the post-HAR period (p = 0.014). The implementation of this multidisciplinary program based in preventive measures and the appropriate use of antibiotics enabled a decrease in sepsis-related mortality in very high-risk hematologic patients.

Adult T-cell lymphoma is an aggressive and poor prognosis HTLV1-associated lymphoma. There is no standard treatment, but it is known that intensive chemotherapy regimens are necessary, with or without concomitant antiretroviral therapy, plus consolidation with allogeneic stem cell transplantation. Our case report shows a favorable outcome after 2 cycles of chemotherapy and allogeneic stem cell transplantation without antiretroviral agents, achieving complete remission, and a negative proviral load.

Background Current information regarding bacteriemia in patients with solid tumors is scarce Methods To assess the etiology, clinical features and outcome in patients with solid tumors and bacteremia, we carried out a prospective multicenter study. Episodes of bacteriemia in adult cancer patients in 9 centers, from May 2014 to February 2021, were recorded. To identify factors associated with 30-day mortality, variables with p < 0.05 in univariate analysis were included in a logistic regression model for multivariate analysis Results Three hundred and thirty-two episodes of bacteremia were included, with 51% being women (mean age 59). The state of underlying disease was: recent diagnosis 27%, remission 27%, relapsed 29% and refractory 17%. Seventy-three percent had received chemotherapy in the last 30 days, 25% were receiving steroids. Neutropenia was present in 23% (mean duration 3 days). The most frequent sources were: abdominal 39%, urinary tract 21%, respiratory 15%, catheter 10% and skin and soft tissue 9%. The microorganisms were: Gram negative bacilli (GNB) 67% (Enterobacterales 84%), Gram positive cocci 36% (Staphylococcus aureus 33%) and polimicorbial 11%; 20% were multidrug resistant organisms (MDR-O), being 88% of them GNB (MDR-GNB). ESBL and KPC carbapenemase producing were the most frequent mechanisms of resistance. Mortality at day 7 and day 30 was 16% and 27%, respectively. In the univariate analysis, the risk factors for 30-day mortality were Charlson index, refractory underlying disease, use of steroids, polimicrobial bacteremia, Staphylococcus aureus, GNB resistant to carbapenems, APACHE and Pitt scores, hypotension, respiratory source and ICU admission. In multivariate analysis, risk factors for 30-day mortality were refractory underlying disease, GNB resistant to carbapenems and ICU admission, while 7-day clinical response was associated with lower mortality Conclusion Bacteremia is a serious complication in cancer patients, with high mortality. The state of underlying disease, infection caused by GNB resistant to carbapenems, and the severity of presentation are associated with increased mortality. Our results stress the importance of infection control measures and antibiotic stewardship to prevent colonization with MDR-O Disclosures All Authors: No reported disclosures

Introduction: Multidrug-resistant gram-negative rods (MDR GNR) represent a growing threat for patients with cancer. Our objective was to determine the characteristics of and risk factors for MDR GNR bacteremia in patients with cancer and to develop a clinical score to predict MDR GNR bacteremia. Material and Methods: Multicenter prospective study analyzing initial episodes of MDR GNR bacteremia. Risk factors were evaluated using a multiple logistic regression (forward-stepwise selection) analysis including variables with a p < 0.10 in univariate analysis. Results: 394 episodes of GNR bacteremia were included, with 168 (42.6 %) being MDR GNR. Five variables were identified as independent risk factors: recent antibiotic use (OR = 2.8, 95 % CI 1.7-4.6, p = 0.001), recent intensive care unit admission (OR = 2.9, 95 % CI 1.1-7.8, p = 0.027), hospitalization ≥ 7 days prior to the episode of bacteremia (OR = 3.5, 95 % CI 2-6.2, p = 0.005), severe mucositis (OR = 5.3, 95 % CI 1.8-15.6, p = 0.002), and recent or previous colonization/infection with MDR GNR (OR = 2.3, 95 % CI 1.2-4.3, p = 0.028). Using a cut-off value of two points, the score had a sensitivity of 66.07 % (95 % CI 58.4-73.2 %), a specificity of 77.8 % (95 % CI 71.4-82.7 %), a positive predictive value of 68 % (95 % CI 61.9-73.4 %), and a negative predictive value of 75.9 % (95 % CI 71.6-79.7 %). The overall performance of the score was satisfactory (AUROC 0.78; 95 % CI 0.73-0.82). In the cases with one or none of the risk factors identified, the negative likelihood ratio was 0.18 and the post-test probability of having MDR GNR was 11.68 %. Conclusions: With the growing incidence of MDR GNR as etiologic agents of bacteremia in cancer patients, the development of this score could be a potential tool for clinicians.

Estimados lectores: Una de las complicaciones frecuentes en los pacientes oncológicos son las infecciones. Estas se deben tanto a las alteraciones producidas por la enfermedad de base como a aquellas secundarias a los tratamientos y son responsables de una importante morbi-mortalidad así como de un retraso en la administración de los tratamientos oncoespecíficos. El presente suplemento de Actualizaciones en Sida e Infectología contiene tres artículos que abordan tanto la epidemiología como los factores de riesgo, las medidas preventivas y el diagnóstico y tratamiento de las infecciones en pacientes oncológicos, según diferentes patologías. Guerrini et al. realizan una revisión de las infecciones en leucemia mieloide aguda, Costantini y Mora se ocupan de otra revisión, en este caso sobre infecciones en tumores sólidos, y Mónaco, también en una revisión, dedica su análisis a las infecciones en niños con aplasia medular. Se trata en todos los casos de documentos elaborados a partir del taller “Consenso, prevención, diagnóstico y manejo de complicaciones infecciosas en patologías oncohematológicas” realizado el 10 de noviembre de 2014 en la ciudad de Buenos Aires. Creemos que este suplemento será de utilidad para infectólogos, clínicos, oncólogos, hematólogos y otros especialistas que asisten a estos pacientes. Las presentes guías deben ser aplicadas en conjunto con una cuidadosa evaluación clínica y teniendo en cuenta los factores epidemiológicos locales. Patricia Costantini (1) y Claudia Salgueira (2)Coordinadoras de la Comisión de Infecciones en el Paciente InmunocomprometidoPeriodo (1) 2011-2015 y (2) 2015 a la actualidad Alejandra Valledor (1) y Rosana Jordán (2)Secretarias de la Comisión de Infecciones en el Paciente InmunocomprometidoPeriodo (1) 2011-2015 y (2) 2015 a la actualidad

During the last decades, there has been an increasing proportion of patients susceptible to invasive fungal disease (IFD). The epidemiology of IFD varies mainly due to geography, antifungal exposure, and nosocomial reservoirs. We reviewed the Argentinean epidemiology of invasive mold disease (IMD) by analyzing laboratory and clinical data. Invasive mold disease was the second most prevalent IFD following the yeasts, with a prevalence that ranged from 0.98 to 1.31/100,000 population. The majority (60–85 %) of IMD was caused by hyalohyphomycetes followed by Mucorales (6–21 %) and phaeohyphomycetes (7–13 %). The most prevalent genera were Aspergillus (40–67 % of IMD) followed by Fusarium (10–14 %). The most prevalent species were A. fumigatus (38–50 %) followed by A. flavus (27–43 %). In immunocompromised patients in Argentina the most prevalent agents of IMD are Aspergillus, followed by Fusarium and Mucorales, while the most prevalent Aspergillus species are A. fumigatus followed by A. flavus.

Background Gram-negative bacteremia (GNB) in neutropenic patients is a major cause of infection-related mortality. Our objective was to identify factors associated with 7-day and 30-day mortality during GNB episodes in neutropenic patients. Methods Prospective multicenter study. Episodes of GNB in adult neutropenic cancer and hematopoietic stem cell transplant (HSCT) patients were included in 10 centers of Argentina, from May 2014 to January 2018. To identify factors associated with 7-day and 30-day mortality, variables with P < 0.05 in univariate analysis were included in a logistic regression model for multivariate analysis. Results Four hundred and seventy-six episodes of GNB were included. From these, 68.06% had hematological malignancies, 22.90% HSCT and 9.03% solid tumors. Seven-day and 30-day mortality were 19.53 and 26.47%, respectively. In multivariate analysis, factors independently associated with 7-day mortality were: Meropenem-resistant GNB (OR 8.60, 95% CI 3.06–24.14, P ≤ 0.0001), respiratory source (OR 3.67, 95% CI 1.21–11.10, P = 0.021), skin and soft tissue source (OR 3.89, 95% CI 1.01–14.94, P = 0.048), Charlson score > 4 (OR 2.76, 95% CI 1.06–7.19, P = 0.037) and shock (OR 7.13, 95% CI 2.50–20.33, P ≤ 0.0001). Independent factors for 30-day mortality were: Meropenem-resistant GNB (OR 7.06, 95% CI 2.83–17.64, P ≤ 0.0001), respiratory source (OR 4.41, 95% CI 1.53–12.73, P = 0.006), skin and soft tissue source (OR 3.66, 95% CI 1.00–13.42, P = 0.049), Charlson score > 4 (OR 3.81, 95% CI 1.62–8.91, P = 0.002), intensive care unit requirement (OR 2.46, 95% CI 1.00–6.04, P = 0.049), shock (OR 10.90, 95% CI 4.12–29.85, P ≤ 0.0001) and refractory cancer (OR 4.30, 95% CI 1.57–11.78, P = 0.005). Conclusion The identification of certain prognostic factors would allow the stratification of neutropenic patients at high risk for mortality during GNB episodes. The appropriate medical intervention of a multidisciplinary team on these factors could improve the outcome of these patients. Since Meropenem-resistant GNB is one of strongest prognostic factors, it is essential to identify the patients at risk and treat them appropriately. Disclosures All authors: No reported disclosures.

Chagas’ disease is an endemic zoonosis of South America caused by a protozoan parasite Trypanosoma cruzi. About 30% of infected people develop the disease. This disease is known to reactivate in immunocompromised hosts, such as patients with acquired immunodeficiency syndrome, leukemia, and transplantation. There is some experience with transplantation of infected renal grafts into negative recipients, resulting in an index of transmission of 35%. No cases have been reported involving other organ transplants up to 2002, when the Centers for Disease Control and Prevention reported 3 cases of Chagas’ disease transmission to 3 recipients (liver, kidney, and pancreas-kidney) from a single chagas infected donor. Here we report on a case of orthotopic liver transplant from a chagas infected donor into a negative recipient in clinical emergency status. The recipient was monitored by direct parasitological Strout method and serological tests with detection of transmission on the 84th day by both studies, without clinical signs. The patient was put on benznidazole with rapid clearance of the parasitemia. However, we propose that chagas infected donors may be accepted for liver transplant recipients only in emergency status. (Liver Transpl 2005;11:1112-1116.)

Background It is estimated that 1.5 million people are infected with T. cruzi in Argentina (4%). Chagas reactivation rate (R) in patients with solid organ transplantation (SOT) is around 33%, being higher in cardiac transplantation (Tx). Objective To describe the clinical characteristics, evolution, mortality, to evaluate reactivation risk factors and to analyze the usefulness of molecular tests in patients undergoing at SOT with Chagas’ disease risk (ChR) (R or Donor-derived transmission, -DT-), in a hospital in our country. Methods Retrospective cohort from all the patients who received an SOT in our hospital from January 1988 to March 2017. All patients with ChR: either R or DT were analyzed. Inclusion: survival more 30 days and 6 months of follow-up or until death. We performed post-Tx monitoring with parasitaemia (Strout), and serial whole blood polymerase chain reaction (PCR) testing, weekly until 2 months, every 2 weeks until the sixth month and monthly until the year, later annual. PCR monitoring is done since 2006. Results We performed 1932 SOT in 29 years: 54 SOT in patients with ChR, 46 chagasic recipients (CR) and 8 chagasic donors (CD) to negative recipient 24/46 (52%) presented R, (see Table 1), 4 had more than one episode. Time to first R was 67 days (r = 3–296, median 30 days). At the time of the R Strout was performed in 19 episode 13 were negative, PCR was positive in 10/10 of perfcormed test, 32% vs. 100% (P = 0.001). Clinical R: 5 episode in 4 patients (panniculitis 3, 1 with myocarditis, 1 myocarditis). Strout was negative in 2 of these, in the other episode monitoring had not been performed. Immunosuppression (IS): there were no differences in the IS, (induction and treatment of rejections). Reactivation: 21/24 responded to treatment, 2 spontaneously PCR-negative, 1 died. Mortality: 6/24 (25%) in pt. R and 2/17 (12%) in pt no R (P = ns), not related mortality. DT occurred in 1/ 3 liver and in 0/5 renal recipients. Type of Tx All Reactivation Clinic Liver (L) 786 7/26 (27%) 1/7 (14%) Heart 241 13/23 (56%) 2/13 (15%) Kidney (K) 613 2/5 (40%) 1/2 (50%) Lung 105 1/2 (50%) 0 LK 26 1/1 (100% 0 Others 161 0 0 Conclusion PCR was more sensitive than Strout for detection of R or transmission. There was no clinical R in pt monitored by PCR. Also PCR sensitivity allow safe acceptance of Chagasic organs. Disclosures All authors: No reported disclosures.

Background: During March 2009 a novel Influenza A virus emerged in Mexico. We describe the clinical picture of the pandemic Influenza A (H1N1) Influenza in cancer patients during the 2009 influenza season.Methods: Twelve centers participated in a multicenter retrospective observational study of cancer patients with confirmed infection with the 2009 H1N1 Influenza A virus (influenza-like illness or pneumonia plus positive PCR for the 2009 H1N1 Influenza A virus in respiratory secretions). Clinical data were obtained by retrospective chart review and analyzed. Results: From May to August 2009, data of 65 patients were collected. Median age was 51 years, 57 % of the patients were female. Most patients (47) had onco-hematological cancers and 18 had solid tumors. Cancer treatment mainly consisted of chemotherapy (46), or stem cell transplantation (SCT) (16). Only 19 of 64 patients had received the 2009 seasonal Influenza vaccine. Clinical presentation included pneumonia (43) and upper respiratory tract infection (22). Forty five of 58 ambulatory patients were admitted. Mechanical ventilation was required in 12 patients (18%). Treatment included oseltamivir monotherapy or in combination with amantadine for a median of 7 days. The global 30-day mortality rate was 18%. All 12 deaths were among the non-vaccinated patients. No deaths were observed among the 19 vaccinated patients. Oxygen saturation Conclusions: In our cancer patient population, the pandemic 2009 Influenza A (H1N1) virus was associated with high incidence of pneumonia (66%), and 30-day mortality (18.5%). Saturation