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A surveillance study was conducted at a University Hospital in Buenos Aires City aimed to assess the rates of colonization with carbapenemase-producing strains of Klebsiella pneumoniae, which are bacteria of utmost epidemiological importance. To this end, rectal swabs collected from all inpatients were cultured for the presence of these bacteria. Two point prevalence surveys showed high prevalence rates (up to 25%). The following variables were evaluated in all inpatients: place of origin (home or other chronic care center), age, prolonged hospitalization, antibiotics for at least 72 hours prior to swabbing, intensive care unit requirements for at least 24 hours, mechanical ventilation assistance for more than 4 days, hemodialysis requirements, need for surgery, enteral feeding through a nasogastric tube, and functional evaluation according to the Karnofsky performance scale. The variable associated with the highest statistical significance was the use of nasogastric enteral feeding. Also, the length of stay was significantly higher and the functional status was significantly worse in colonized patients. As for the prior use of antibiotics, results were close to statistical significance but without reaching it. Measures were implemented in order to control the spread of the microorganism in the acute setting and beyond. Upon implementation of such measures, a third prevalence survey was performed that showed a decrease in the horizontal transmission of the microorganism

Nocardia brasiliensis is a gram-positive, branched, aerobic, acid-resistant, rod-shaped bacillus that inhabits in soil, rotten organic matter and waters. Cutaneous nocardiosis in immunocompetent individuals can manifest in three different forms: actinomycetoma, superficial skin infection or lymphocutaneous infection. A case of an 85-year-old woman with an ulcerated lesion on the back of her left hand with erythematous papules in the lymphatic tract infected by N. brasiliensis is described. The microorganism was presumptively identified by conventional and inexpensive methods for a medium complexity laboratory at the species level. The morphological characteristics of colonies, the mold smell, a positive Kinyoun stain and the presence of aerial mycelium were the key tests to identify the genus. Species level identification was confirmed by mass spectrometry (MALDI-TOF MS). The trimethoprim-sulfamethoxazole treatment was effective as this agent was active in the susceptibility testing.

Objectives: Trypanosoma cruzi reactivation in HIV patients is considered an opportunistic infection, usually with a fatal outcome. The aim of this study was to describe the epidemiological and clinical features of T. cruzi infection in HIV patients and to compare these findings between patients with and without Chagas disease reactivation. Methods: The medical records of T. cruzi–HIV co-infected patients treated at the Muñiz Infectious Diseases Hospital from January 2005 to December 2014 were reviewed retrospectively. Epidemiological and clinical features were assessed and compared between patients with and without Chagas disease reactivation. Results: The medical records of 80 T. cruzi–HIV co-infected patients were reviewed. The most likely route of T. cruzi infection was vector-borne (32/80 patients), followed by intravenous drug use (12/80). Nine of 80 patients had reactivation. Patients without reactivation had a significantly higher CD4 T-cell count at diagnosis of T. cruzi infection (144 cells/μl vs. 30 cells/μl, p = 0.026). Chagas disease serology was negative in two of nine patients with reactivation. Conclusions: Serological assays for T. cruzi infection may be negative in severely immunocompromised patients. Direct parasitological techniques should be performed in the diagnosis of patients for whom there is a suspicion of T. cruzi reactivation. HIV patients with a lower CD4 count are at higher risk of reactivation. Fil: Benchetrit, Andres Guillermo. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: Fernández, Marisa. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: Bava, Amadeo Javier. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: Corti, Marcelo. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: Porteiro, Norma. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: Martinez Peralta, Liliana A.. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones en Microbiología y Parasitología Médica. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones en Microbiología y Parasitología Médica; Argentina

Background Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of this study was to define the clinical outcomes of patients with CAP and bacteremia treated with and without a macrolide. Materials and methods Secondary analysis of the Community-Acquired Pneumonia Organization database of hospitalized patients with CAP. Patients with a positive blood culture were categorized based on the presence or absence of a macrolide in their initial antimicrobial regimen, and severity of their CAP. Outcomes included in-hospital all-cause mortality, 30-day mortality, length of stay, and time to clinical stability. Results Among 549 patients with CAP and bacteremia, 247 (45%) were treated with a macrolide and 302 (55%) were not. The primary pathogen was Streptococcus pneumoniae (74%). Poisson regression with robust error variance models were used to compare the adjusted effects of each study group on the outcomes. The unadjusted 30-day mortality was 18.4% in the macrolide group, and 29.6% in the non-macrolide group (adjusted relative risk (aRR)0.81; 95% confidence interval (CI)0.50–1.33; P = 0.41). Unadjusted in-hospital all-cause mortality was 7.3% in the macrolide group, and 18.9% in the non-macrolide group (aRR 0.54, 95% CI 0.30–0.98; P = 0.043). Length of stay and time to clinical stability were not significantly different. Conclusions In-hospital mortality, but not 30-day mortality, was significantly better in the macrolide group. Our data support the use of a macrolide in hospitalized patients with CAP and bacteraemia.

Epidemiological and clinical aspects of Brucella suis infection in 17 workers from a pork processing plant in Argentina occurring between January 2014 and July 2015 are presented. All patients reported working 9 h daily without adequate personal protection garment. Blood cultures were positive for Brucella spp. in 14 of the 17 patients (82.3%). All isolates were identified as B. suis biovar 1. Although fever, sweats, asthenia, myalgia and hepatic involvement were the most frequent clinical manifestations, an unusually high incidence of respiratory involvement was found. From 13 patients in which chest radiography was performed, four (30%) had radiological abnormalities, including lobar pneumonia in two cases (one with pleural effusion) and interstitial involvement in other two. The high frequency of respiratory involvement in our series makes necessary to consider brucellosis in the differential diagnosis of respiratory diseases in pork processing plant employees. Fil: Wallach, Jorge Carlos. Hospital de Infecciosas “Dr. Francisco Javir Muñiz"; Argentina Fil: García, J. L.. Hospital de Infecciosas “Dr. Francisco Javir Muñiz"; Argentina Fil: Cardinali, P. S.. Hospital de Infecciosas “Dr. Francisco Javir Muñiz"; Argentina Fil: Seijo, A. P.. Hospital de Infecciosas “Dr. Francisco Javir Muñiz"; Argentina Fil: Benchetrit, Andres Guillermo. Hospital de Infecciosas “Dr. Francisco Javir Muñiz"; Argentina Fil: Echazarreta, S. E.. Hospital de Infecciosas “Dr. Francisco Javir Muñiz"; Argentina Fil: Garro, S. L.. Hospital de Infecciosas “Dr. Francisco Javir Muñiz"; Argentina Fil: Deodato, B.. Hospital de Infecciosas “Dr. Francisco Javir Muñiz"; Argentina Fil: Baldi, Pablo Cesar. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni; Argentina

La infección por Plasmodium vivax se caracteriza por la formación de hipnozoítos que permanecen quiescentes en los hepatocitos del hospedero y son responsables de las recaídas de la malaria. Primaquina es el único fármaco en uso para la erradicación de los hipnozoítos y asociado a un agente esquizonticida, constituye el tratamiento radical. Las fallas al tratamiento radical están relacionados con una dosificación subóptima, adherencia inadecuada y reinfección. Sin embargo, cuando estos factores están ausentes, se han postulado mecanismos propios del metabolismo del hospedero y de tolerancia del parásito. Se describe un caso de malaria por P. vivax adquirido en la región amazónica asistido fuera de la zona endémica, con múltiples recaídas a pesar del tratamiento radical adecuado.

We evaluated the impact of the International Nosocomial Infection Control Consortium multidimensional approach to hand hygiene in 11 intensive care units in 4 cities in Argentina and analyzed predictors of poor hand hygiene compliance. We had a baseline period and a follow-up period. We observed 21 100 hand hygiene opportunities. Hand hygiene compliance increased from 28.3% to 64.8% (P = .0001). Males versus females (56.8% vs 66.4%; P < .001) and physicians versus nurses (46.6% vs 67.8%; P < .001) were significantly associated with poor hand hygiene compliance.

BACKGROUND: Community-acquired pneumonia (CAP) severity scores can identify patients at low risk for mortality who may be suitable for ambulatory care. Here, we follow the clinical course of hospitalized patients with CAP due to 2009 H1N1 influenza. OBJECTIVE: To evaluate the role of CAP severity scores as predictors of mortality. METHODS: This was a secondary data analysis of patients hospitalized with CAP due to 2009 H1N1 influenza confirmed by reverse transcriptase polymerase chain reaction enrolled in the CAPO (Community-Acquired Pneumonia Organization) international cohort study. CAP severity scores PSI (Pneumonia Severity Index), CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) and CRB-65 (confusion, respiratory rate, blood pressure, age ≥ 65 years) were calculated. Actual and predicted mortality rates were compared. A total of 37 predictor variables were evaluated to define those associated with mortality. RESULTS: Data from 250 patients with CAP due to 2009 H1N1 influenza were analyzed. Patients with low predicted mortality rates (0-1.5%) had actual mortality rates ranging from 2.6% to 17.5%. Obesity and wheezing were the only novel variables associated with mortality. CONCLUSIONS: The decision to hospitalize a patient with CAP due to 2009 H1N1 influenza should not be based on current CAP severity scores, as they underestimate mortality rates in a significant number of patients. Patients with obesity or wheezing should be considered at an increased risk for mortality. © 2011 The Union.

A committee of six scientific organizations from Argentina developed guidelines for the management of patients with community-acquired pneumonia (CAP).The objective of this study was to evaluate the level of adherence with the recommended care suggested by the guidelines in patients hospitalized with CAP in Argentina. Using quality indicators the management of 436 patients who were hospitalized in 12 Argentinean institutions was evaluated. The care given among the following areas was reviewed: need for hospitalization, need for oxygen therapy, empiric antibiotic therapy, switch therapy, hospital discharge, and prevention. The level of adherence was classified as optimal (90%), intermediate (60% to 90%), and low (60%).The selection of the empiric antibiotic therapy and the administration of antibiotics between the first 8 hours after arrival had an adherence greater to 80%. A low level of adherence was found in the areas of switch therapy (53%), prevention of CAP with pneumococcal vaccine (51%) and smoking cessation offered (29%). Using quality indicators it is possible to identify specific areas of management in patients with CAP to a low level of adherence with national guidelines. In Argentina interventions to improve switch therapy and prevention of CAP should be developed.

The reactive hemophagocytic syndrome is a condition characterized by systemic proliferation of benign hemophagocytic histiocytes, fever, cytopenia, abnormal liver function, and frequently coagulopathy and hepatospleno- megaly. Its occurrence has been documented in association with viral, bacterial, fungal, and parasitic infections; a wide spectrum of malignant neoplasms; some miscellaneous disorders; and Phenytoin. Disseminated strongyloidiasis is reported in a patient with systemic lupus erythematosus treated with corticosteroids in whom a reactive hemophagocytic syndrome developed and who finally died. This reactive hemophagocytic syndrome is reported for the first time in strongyloidiasis and may not have been recognized in former reports.

The objective of the study was to evaluate antibody response, autoantibodies induction and disease activity in systemic lupus erythematosus (SLE) patients after polyvalent pneumococcal vaccination. SLE patients (n 37) were vaccinated with 23 valent pneumococcal vaccine. Systemic lupus erythematosus disease activity index (SLEDAI) and specific IgG antibodies against pneumococcus were measured before and after vaccination. After inoculation 30 patients (85.7%) duplicated IgG anti pneumococcus baseline value, reaching protective levels of antibodies. We did not find significant differences in disease activity up to three months after vaccination.after vaccination of this lupus population an 85.0% antibody response was obtained, without temporal associated disease flare or any serious adverse event.

Clinical practice guidelines for community-acquired pneumonia (CAP) contribute to improve patient's management. CAP undergoes continuous changes in etiology, epidemiology and antimicrobial sensitivity, requiring periodic guidelines revisions. An inter-society committee designed this guidelines dividing it into several topics based on prior guidelines and recent clinical studies. CAP compromises annually more than 1% of the population; most of the cases only require outpatient care but others are severe cases, reaching the 6th cause of death in Argentina. The cases are distributed unevenly into ambulatory, admitted in the general ward or in the intensive care unit. There is no way to predict the etiology. Unfavorable outcome predictors include age, antecedents and physical, laboratory and radiography findings. Ten to 25% of inpatients need to be admitted to the intensive care unit at the onset or during the follow-up, for mechanical ventilation or hemodynamic support (severe CAP). Severe CAP is associated with high mortality and requires adequate and urgent therapy. Pregnant, COPD and nursing home patients require special recommendations. Diagnosis is clinical, while complementary methods are useful to define etiology and severity; chest X-ray is the only one universally recommended. Other studies, including microbiologic evaluation are particularly appropriate in the hospitalized patients. The initial therapy is empiric, it must begin early, using antimicrobials active against the target microorganisms, avoiding their inappropriate use which can lead to the development of resistance. Length of therapy must not be unnecessarily prolonged. Hydratation, nutrition, oxygen and therapy of complications must complement antibiotic treatment. Prevention is based on influenza prophylaxis, anti-pneumococcal vaccine, aspiration prevention and other general measures.