The Costa Rican Social Security Fund (Spanish: Caja Costarricense de Seguro Social) is in charge of most of the nation's public health sector. Its role in public health (as the administrator of health institutions) is key in Costa Rica, playing an important part in the state's national health policy making.Its services are available to all citizens and permanent legal residents. This governmental entity's functions encompass both the administrative and functional aspects. Originally, services were carried out at private hospitals but funded by the Costa Rican Social Security Fund. Not until the mid-1960s did the Caja begin constructing its own hospitals staffed by public employees. It has the obligation (as a public institution) to formulate and execute health programs that are both preventive (such as: vaccination, informational, fumigation, etc.) and healing (such as: surgery, radiation therapy, pharmacy, clinical, etc.) in nature.The Costa Rican Social Security Fund is also charged with the administration of the public pension system.
Histoplasmosis remains an important endemic mycosis in tropical countries, yet comprehensive epidemiological data from Central America are limited. We aimed to describe the epidemiologic characteristics of histoplasmosis in Costa Rica during a 16-year period.Annual Distribution and Demographic CharacteristicsAnnual Distribution and Demographic Characteristics of Histoplasmosis in Costa Rica, 2000-2015Clinical Characteristics and Mortality RatesClinical Characteristics and Mortality Rates of Histoplasmosis in Costa Rica, 2000-2015 We conducted a retrospective, descriptive study analyzing all histoplasmosis cases (n=434) registered in the national hospital discharge database of Costa Rica's Social Security System from 2000-2015. We calculated cumulative incidence per 100,000 population, analyzed demographic distribution, comorbidities, clinical presentations, and in-hospital mortality.Relationship Between HIV Status and Type of HistoplasmosisRelationship Between HIV Status and Type of Histoplasmosis in Costa Rica, 2000-2015Geographic Distribution and Seasonal Patterns of HistoplasmosisGeographic Distribution and Seasonal Patterns of Histoplasmosis in Costa Rica, 2000-2015 The cumulative incidence was 0.62 cases/100,000 person-years, with temporal variations showing an initial increase followed by a slight decline. Males were predominantly affected (73.3%; RR=2.68, 95%CI:2.17-3.31). Median age was 31 years (IQR:18-43), with 26% of cases in patients < 19 years and 59% between 20-49 years. HIV infection was present in 49.3% of patients, while 46% had other comorbidities including cancer (5.3%), chronic liver disease (2.5%), and kidney transplant (2.5%); 5.1% had no underlying conditions. Clinical presentations were classified as pulmonary (25.8%), disseminated (27.6%), and undetermined (46.5%). Overall in-hospital mortality was 14.5%, being significantly higher in disseminated disease (25%) and elderly patients (31.3% in 60-69 age group). Surprisingly, patients without documented comorbidities had the highest mortality rate (27.3%). Geographic distribution showed predominance in San José (36.9%), Alajuela (18.2%), and Limón (13.8%) provinces. Incidence peaks occurred during 2005-2006 (44 cases/year), with July showing the highest diagnostic frequency (12.9%). Histoplasmosis in Costa Rica maintains a relatively stable incidence, primarily affecting young adults with a strong association with HIV infection. The unexpectedly high mortality in patients without apparent risk factors suggests potential delayed diagnosis or unidentified factors requiring further investigation. The disseminated form carries the highest mortality risk, emphasizing the need for early detection strategies, particularly in high-risk populations. All Authors: No reported disclosures
Objective: To analyze the risk of avoidable hospitalizations due to type 2 diabetes mellitus (DM2) within the Costa Rican Social Security Fund (CCSS) during the period 2019–2024 using Bayesian hierarchical spatio-temporal models. Methods: A longitudinal ecological study was conducted using data from the Health Services Performance Evaluation of health areas and hospital discharge records for DM2 (ICD-10: E11). Bayesian spatio-temporal models were fitted using the Integrated Nested Laplace Approximation (INLA) approach, incorporating structured and unstructured spatial effects as well as temporal dependence. Model selection was based on the Deviance Information Criterion (DIC) and the Watanabe–Akaike Information Criterion (WAIC). The association between avoidable hospitalizations due to DM2 and geographic, temporal, clinical, and community-level factors was assessed. Results: The best-fitting model corresponded to a BYM2 spatial structure and included suboptimal glycemic control, obesity, rural population, and primary health care (PHC) coverage as covariates. All variables showed positive and statistically significant associations with hospitalization risk. Rural population exhibited the largest relative effect, followed by PHC coverage, suboptimal glycemic control, and obesity. The spatio-temporal analysis revealed a reduction in the number of health areas classified as high risk by 2024; however, several areas remained at elevated risk, including Coto Brus, Golfito, Limón, Quepos, and Turrialba-Jiménez. Conclusions: Avoidable hospitalizations due to DM2 showed heterogeneous spatial patterns and were associated with individual, community, and health service-related factors. Bayesian spatio-temporal models constitute a useful tool for identifying priority areas and supporting decision-making aimed at improving the effectiveness of primary health care and DM2 management.
Candida species represent 80% of nosocomial fungal infections, with candidemia being the most frequent invasive disease. In Latin America, Candida resistance is generally low, but information from Central America is scarce. We aimed to describe antifungal susceptibility of Candida species isolated from bloodstream infections at two national adult hospitals in Costa Rica from 2012 to 2023. This retrospective study analyzed the first isolate from candidemia episodes caused by C. albicans, C. tropicalis, C. parapsilosis, and C. glabrata with available susceptibility results. Testing used VITEK 2 system. Interpretation followed CLSI M27M44S-Ed3 guidelines. Amphotericin B susceptibility was defined as MIC ≤1μg/ml. Differences between species were assessed using Fisher's exact test, and temporal trends with chi-square test. We analyzed 1,390 isolates: C. parapsilosis 689 (49.6%), C. albicans 448 (32.2%), C. tropicalis 131 (9.4%), and C. glabrata 122 (8.8%). Fluconazole susceptibility was high in C. albicans (97.1%) and C. tropicalis (96.2%), but lower in C. parapsilosis (40.6%, p< 0.001). C. glabrata isolates were predominantly susceptible-dose dependent (96.1%). Voriconazole showed high activity against C. albicans (98.7%) and C. tropicalis (96.9%), but resistance in C. parapsilosis (20.2%). Amphotericin B maintained excellent activity against all species (98.7% overall). Echinocandins demonstrated high efficacy against C. albicans, C. tropicalis, and C. parapsilosis (≥99%), but reduced activity against C. glabrata (caspofungin 41.3% susceptible, micafungin with 70.6% intermediate and 29.4% resistant). No significant temporal trends in susceptibility were observed over the 12-year period. Our findings reveal significant azole resistance in C. parapsilosis, particularly to fluconazole (59.4%) and voriconazole (20.2%). Amphotericin B maintains excellent activity against all species. Echinocandins remain highly effective against most Candida species except C. glabrata. These patterns have important implications for empirical antifungal therapy selection in our region. All Authors: No reported disclosures
Respiratory Syncytial Virus (RSV) infection in adults can evolve into severe conditions. Identifying risk factors for Severe Acute Respiratory Infection (SARI) would optimize clinical management. To develop and validate a predictive model to identify adult patients with RSV at risk of developing SARI.Independent Risk FactorsIndependent Risk Factors for SARI in Adult RSV PatientsClinical Prediction ScoreClinical Prediction Score for SARI Risk in Adult RSV Patients Analysis of 187 adults with PCR-confirmed RSV (Mexico Hospital, 2022-2024). Using multivariate logistic regression, independent factors associated with SARI were identified. A clinical scoring system was developed, and its diagnostic performance was evaluated through ROC analysis and internal validation by bootstrap.ROC CurveROC Curve for SARI Risk Prediction ModelCalibration PlotCalibration Plot of Predicted vs Observed SARI Risk Six independent risk factors for SARI were identified: age ≥80 years (OR 3.86, 95%CI 1.47-10.13), preexisting lung disease (OR 3.52, 95%CI 1.68-7.37), presence of dyspnea (OR 4.25, 95%CI 1.98-9.13), fever (OR 2.87, 95%CI 1.31-6.30), ≥3 comorbidities (OR 2.34, 95%CI 1.08-5.05), and temperature >36.5°C (OR 2.15, 95%CI 1.01-4.59). The scoring system assigned 2 points to age ≥80 years, lung disease, and dyspnea; 1 point to fever, ≥3 comorbidities, and temperature >36.5°C. The model showed excellent discriminative capacity (AUC 0.82, 95%CI 0.74-0.89) with sensitivity 76.9%, specificity 75.6%, and negative predictive value 89.5%. Internal validation confirmed the model's robustness (optimism-corrected AUC 0.79). The developed scoring system effectively stratifies SARI risk in adult patients with RSV, with four categories: low risk (0-1 points, < 10%), moderate (2-3 points, 10-30%), high (4-5 points, 30-60%), and very high (6-9 points, >60%). This tool could optimize clinical decisions, facilitating identification of patients requiring closer monitoring or early intervention. External validation is required before widespread implementation. All Authors: No reported disclosures
Objective: To describe the perception, knowledge, and access to Clinical Bioethics Committees (CBCs) in healthcare facilities of the Costa Rican Social Security Fund (CCSS), to assess the extent to which this institutional capacity is recognized and used by healthcare and administrative personnel. Materials and methods: A descriptive, cross-sectional, exploratory study was conducted using a voluntary, anonymous, self-administered survey administered between February and April 2025 to healthcare and administrative personnel from different disciplines. The survey was disseminated through the CCSS WebMaster platform, institutional social media channels, and the CENDEISSS website. Closed-ended questions were analyzed using descriptive statistics. Open-ended responses were examined through thematic content analysis, using manual coding and grouping of recurrent themes related to visibility, functional knowledge, perceived accessibility, and improvement proposals. Results: A total of 558 responses were obtained. Overall, 57.5% of respondents reported being aware of the existence of CBCs; 46.2% identified their functions; 15.8% had requested ethical consultation; and 41.6% perceived them as accessible. Among those who had requested consultation, 80.7% reported that the committee response helped resolve the bioethical problem. In addition, 92.7% identified that anyone who recognizes an ethical problem may consult a CBC. The most frequently identified areas requiring bioethical guidance were informed consent, protection of the rights of persons in vulnerable situations, ethical-clinical decision-making in critical situations, and confidentiality. Open-ended responses pointed to barriers related to institutional visibility, limited knowledge of consultation procedures, and insufficient integration of committees into clinical and educational settings. Conclusions: CBCs constitute a strategic institutional capacity for quality of care, protection of rights, and the legitimacy of clinical decision-making. However, respondents reported a low level of committee use. Strengthening their visibility, consultation procedures, bioethics training, and integration into clinical practice and institutional management is essential to consolidate them as an effective resource for supporting ethically justified decision-making.
