Background: A traveler's risk for acquiring YF is determined by multiple factors, including immunization status, use of personal protection measures against mosquito bites and local rate of virus transmission. An epidemic started in 2017 in Brazil beaches challenging physicians, because Argentinian people use to spend their holidays there and require vaccination regardless of their age. The aim of the study is to describe the outcome of vaccinating elderly people after a thorough assessment by an infectious disease specialist. Methods & Materials: We examined the clinical reports of all individuals aged ≥60 years vaccinated 2006–2018. We assessed pre-existing conditions and looked 45 days forward for symptoms ascribable to the vaccine. Results: Out of 3978 vaccines 439 were ≥60 years old (60–87, median 64). 205 were female. Most frequent comorbidities were high blood pressure (36%), diabetes (10%) and endocrine disorders other than diabetes (7%). Fifteen patients (3.4%) had ≥3 comorbidities. There were no reports of severe adverse effects among 347 patients, 92 had no data after vaccination date, we assume they did well because, due to our national proceedings, we would have been informed. As most guidelines advice precaution in vaccinating people aged ≥60 years, it was understood, even by non-specialist physicians, as a contraindication and people travelled without vaccination; 7 travelers returned ill. It is known that up to 60% of infections can be subclinical, thus the potential importation and spread of the disease is worrisome. Nowadays a 60–70 year old person is still fit to travel, the decision to vaccinate them needs to weigh the risks and benefits of the vaccination in the context of their destination-specific risk for exposure; the risk of yellow fever to any country where the infection is enzootic or has recently been epidemic continues to exceed the known risk from the vaccine. A travel medicine trained physician is the appropriate person to advise an elderly patient to get the vaccine or to avoid travelling. Conclusion: Although the number of people we vaccinated is not very high we can conclude that with a specialized thorough assessment of the individual patient the risk of vaccinate people aged ≥60 years is very low.

Background: Patients with autologous hematopoietic stem cell transplantation (HSCT) due to solid tumor, malignant and non-malignant hematological diseases may benefit from the use of systemic antibiotic prophylaxis. The aim of this study was to measure the effect of using ciprofloxacin as universal prophylaxis in patients with HSCT, admitted to an acute hospital. Methods & Materials: The study has an uncontrolled before and after quasi-experimental design, with a retrospective analysis. Pre-intervention period: 40 patients under standard care (acyclovir plus fluconazole) for autologous HSCT and post-intervention period: 168 patients under standard care plus prophylaxis with ciprofloxacin 500 mg once daily PO or 20-30 mg/kg IV bid. Comparison: suspected episodes of infection, acute diarrhea, confirmed infections (bacteremias, infections due to multiresistant gram-negative bacilli, infections due to Clostridium difficile), hospital length of stay and mortality due to infection. Statistical analysis was made with tests chosen upon the nature and distribution of the study variables. A significant p value was established at 0.05. Database and calculations: Excel for Office 365 Results: Patients who received ciprofloxacin presented: Statistically significant reduction: a) suspected episodes of infection (97.5% vs 77% - OR 0.01- IC95%: 0.001- 0.08 - p < 0.0001). Non statistically significant reduction: a) confirmed infections (45% vs 36.4% - OR 0.66 - IC 95%: 0.32-1.38 - p: 0.28); b) bacteremias (37.5% vs 25%-OR 0.77-IC95%:0.36-1.62-p:0.49); c) acute diarrhea (50% vs 38.7%- OR 0.63-IC95%: 0.31-1.26- p: 0.19); d) length of stay (average 22.9 vs 20.3 - p: 0.99) Non -statistically significant increase in: a) infections due to multiresistant gram negative bacilli (n = 0 vs 3 -O: 2.18-IC95%: 0.11- 43.2- p: 0.61) b) infections due to Clostridium difficile (n = 0 vs 1 -OR: 0.95- IC95%: 0.04-24.3 - p: 0.97) No episodes of mortality due to infection in either period. Conclusion: We conclude that prophylaxis in patients undergoing autologous HSCT reduces episodes of suspected infection. Study designs with better statistical power should be used to compare confirmed infectious episodes and further prevention, or infections related to antibiotic use.

Background: Contact precautions (CP) are widely recommended to prevent multidrug-resistant organism (MDRO) transmission avoiding colonization and infection. However, conflicting data exist regarding their effectiveness. Recent studies suggest that for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant Enterococcus (VRE), standard measures and decolonization for MRSA could be effective. In Argentina there is no formal recommendation, however, most centers implement CP and only a few discontinue them. Our purpose is to evaluate the impact on the EVR infections after discontinuing CP in centers located in Buenos Aires. Methods & Materials: Multicenter, retrospective, quasi-experimental study of patients admitted to acute care facilities in Buenos Aires. We included centers that perform health care associated infections surveillance according to NHSN definitions and discontinued CP for more than 1 year. The CP included the use of gloves, gowns, personnel items or their subsequent disinfection and individual or cohort rooms. EVR infection was defined as the presence of signs and symptoms associated with EVR isolation in clinical samples 48 hours after admission. We compared the number of cases of VRE infections/1000 discharges 1 year before and after discontinuing CP. P 0 .05 was considered statistically significant. During the study, CP were continued for other MDRO (MRSA, multidrug resistant gram-negative bacilli and Clostridium difficile) in addition with the hand hygiene program. Results: Five institutions were included (4 tertiary acute care University Private - 1 Public), 4 polyvalent. Total beds 1308, only 2 centers have shared rooms. One institution reported UCI data. In the preintervention period occurred 27 infections / 61099 discharges (rate 0.44 / 1000 discharges), after CP discontinuation there were 32 infections / 61668 discharges (rate 0.52 / 1000 discharges) (p0.62). The average adherence to hand hygiene in the initial period was 58% and post-intervention 66%. Conclusion: This experience, in different centers, shows that discontinuation of CP was not associated with a significant increase of VRE infections and should be accompanied by cross-sectional measures such as Hand Hygiene. The prevalence of different MDRO infections should be considered to evaluate the cost effectiveness of CP.

Background: It is known that patient's flora contaminates the environment favoring microorganism's dissemination. Hospital Hygiene is therefore critical as an infection control measure. Aiming to improve it we decided to measure it and give feed-back to the cleaning staff in order to stimulate them. We also tried to assess if effectiveness gained was maintained through time. Methods & Materials: Prospective before-after study in the 30-bed CCU of a private hospital in Buenos Aires, Argentina (Ten intensive care beds, 10 intermediate care beds and 10 coronary care beds). Pre-intervention (3 months): With an invisible-ink pen we made ten marks in different surfaces of each room and controlled if they persisted 24 hours later. We calculated percentage of marks vanished. Intervention: We showed the results to the cleaning-staff and reviewed the right technique with them. Post-intervention (3 months): During the first 3 months, we evaluated the hygiene monthly and informed the results obtained. The cleaning staff was asked to complete a satisfaction survey. Follow up: After 9 months without controls we began to perform them every 3 months to assess continuity. Results: Cleaning efficacy improved statistically significant after the intervention Percentage of marks cleaned The less cleaned components were the infusion pumps (84%) and the ends of the beds (87%). The 84% of the survey-responders thought cleaning had improved and 79% perceived their work was more appreciated. Continuous controls are required to sustain achievements through time. Conclusion: To retrieve results is a beneficial strategy to improve cleaning. To analyze data together with the staff allows finding out real and specific goals. Control is essential to sustain results through time.

Background: Since the first renal transplantation performed in Boston in 1954, solid organ transplantation became a common strategy against end-stage diseases. The German Hospital in Buenos Aires performed its first renal transplantation in 2000 and since then practice grew including also liver and heart transplantations. After 15 years it is time to evaluate the current infectious complications, aiming to discover useful variables to work on. Methods & Materials: This analysis is a retrospective observational study, for which we have reviewed the medical records of all patients undergoing transplantation surgeries from 1-Jan-2014 to 31-Dec-2014. On an excel sheet we have analyzed information such as: age, gender, underlying disease, type of immune suppression, time of onset of the infectious event and type and source of microorganisms involved. Results: Forty-six patients were transplanted during 2014, 33 (71.7%) of them had at least one infectious event. Median age was 55 (8-78, 70% between 31-65 years), 74% males. There was no difference between infected and not-infected regarding these 2 points. Organs transplanted: 2 hearts, 21 kidneys and 23 livers. Percentage of infections was similar in the different groups. Twenty-seven (33%) of infectious events were due to urinary tract infections, 19 of them in renal transplants (70%, p=0.02). CMV-reactivation was seen in 12 cases, 9 (75%) of them in liver-transplantations. Primary bacteremia was in third place (9, 13%) and surgical site infection in fourth (7, 10%). Low numbers prevent from calculating rates. Most of the infections (88%) showed up during the first 3 months, only 1 (3%) after 6 months. There was a wide range of microorganisms involved, 68% bacteria (70% GNB), 19% virus, 95 fungus and 4% TB. Regarding the storage fluid, 24% presented bacterial growth. There wasn’t an increase incidence of infectious events in those in which the storage fluid was contaminated. Conclusion: Urinary tract infection was the main complication as literature mentions. Surgical site infections were not prevalent in a particular group, which rules out inappropriate surgical technique. The variety of microorganisms involved rules out a common source. CMV prophylaxis strategy in hepatic transplant patients has to be reviewed.

Late presentation of HIV‐infected individuals is gaining attention because of the negative impact on the patient and the society at a whole. In January 2011 the European Late Presenter Consensus working group published a consensus definition of “late presentation” and asked researchers to implement it. Objective: to identify presentation stage of HIV‐infected individuals at diagnosis at the German Hospital in Buenos Aires, Argentina, and describe epidemiological features of them. The German Hospital is an acute care community hospital that assists around 600 000 out‐patient consultations per year. We examine the clinical reports of all our HIV patients, diagnosed 1984–2011, and grouped them as “late” or “not late” presentation according their status following the consensus definition criteria. We also looked for data, such as age, sex and year of diagnosis, that could differ between the groups. We reviewed 284 clinical records, 7 of which were excluded because of lack of data; 105 belonged to last century records. Median age for 1984–1999 group: 32 (16–73), for 2000–2010 group: 40 (180–78). 77% of the first group were men, and 88% of the second one. 1984–1999 1984–1999 No late 1984–1999 Late 1984–1999 % (Late/total) 1984–1999 Total 2000–2010 No late 2000–2010 Late 2000–2010 % (Late/total) 2000–2010 Total Total 61 44 42 105 102 70 40,7 172 Age group <20 6 0 0 6 3 3 50 6 21–30 25 13 34,2 38 33 7 17,5 40 31–40 14 15 51,7 29 35 18 34 53 41–50 10 12 54,5 22 16 18 52,9 34 51–60 6 1 14,3 7 9 17 65,4 26 61–70 0 2 100 2 6 4 40 10 >71 0 1 100 1 0 3 100 3 Sex Female 18 6 25 24 8 8 38 21 Male 43 38 47 81 62 62 41 151 In 55,5% of the 1984–1999 group diagnosis was due to an opportunistic infection, whereas the same applied to only 32,8% of the 2000–2010 group. In both groups there were a high proportion of male, due to the population profile of our hospital. The most frequent reason for testing was screening, but there is still a high number of late diagnosis and OI as first sign of the infection. Younger people are more aware of the need of testing. Female have the advantage of being tested when planning or becoming pregnant. We could not find statistical differences comparing data of both centuries. Forty percent of infections were diagnosed in a “not late” stage, but that was more evident in younger people. People in general and physicians in particular should be more aware of HIV in elderly people.

BACKGROUND:Prevalence surveillance methodology is the systematic observation of the occurrence and distribution of healthcare-associated infections (HCAIs) so that appropriate actions can be taken.AIM:The objectives of a prevalence survey with an international validated methodology were to determine the prevalence of HCAIs for the first time in Argentina, and to provide data which could be used for international benchmarking.METHODS:In 2008, an HCAI prevalence survey was carried out in 39 hospitals in seven of 23 provinces in Argentina, with methodology identical to that employed by the Hospital Infection Society in the third prevalence survey of HCAIs in acute hospitals in the British Isles. Data collected were processed and analysed at the Northern Ireland Healthcare-Associated Infection Surveillance Centre at Belfast.FINDINGS:A total of 4249 patients were surveyed; 480 of these had at least one HCAI, resulting in a prevalence of 11.3% of patients. Male prevalence was 13.6% and female 9.0%. The most common HCAIs were pneumonia (3.3%), urinary tract infection (3.1%), surgical site infection (2.9%), primary bloodstream infection (1.5%), and soft tissue infections (1.2%). Among the 1027 patients who underwent surgery, the prevalence of surgical site infection was 10.2%. The prevalence of meticillin-resistant Staphylococcus aureus was 1.1%, accounting for 10.0% of all HCAI isolates. The results for Argentina show higher HCAI rates compared with corresponding findings for England, Wales, Northern Ireland and South Africa.CONCLUSION:This survey will contribute to the prioritization of resources and help to inform Departments of Health and hospitals in the continuing effort to reduce HCAIs.

Background: The fact that individuals in higher income brackets have easier access to general information raises the question whether the individuals in lower brackets are receiving insufficient medical knowledge. The countrywide vaccination campaign against rubella allowed us to observe a young and healthy adult population that was a fair representation of two social strata; this was ideal for the purpose of our investigation. So, we tried to assess the degree of knowledge regarding vertically transmitted diseases by these two groups of citizens of different social and cultural levels. Methods: Our population performed two groups, the first one attending a community hospital of a very high social and cultural level in the city (GROUP #1, with 508 males and 966 females), and a second one belonging to a low income health center in a lower income area outside the city (GROUP #2, with 84 males and 94 females). Both groups responded anonymously to the survey on vertically transmitted diseases.Tabled 1Results: DiseaseHospital AlemánWilliam MorrisToxoplasmosis46%46%HIV81%76%HBV53%40%Rubella24%48%Syphilis24%30%HPV21%35% Open table in a new tab GROUP #1 showed to have a better knowledge than GROUP #2 regarding HIV and Hepatitis B (81% to 76%). However GROUP #2 identified Chagas disease and Syphilis more readily than GROUP #1 (30% to 24% and 35% to 21% respectively) as vertically transmitted diseases; for German Measles the proportion was even higher (GROUP#1: 24% and GROUP #2: 48%). Conclusion: Possibly, the higher incidence of Chagas disease and the compulsory testing for Syphilis in the health center attended by GROUP #2 are the variables that led to a slight increase of awareness of these illnesses by the latter. It is surprising though that, despite the fact that this study was conducted at the time of the German Measles vaccination process, both groups showed a low recognition level of this disease being vertically transmitted. The degree of awareness of vertically transmitted infections is generally low, and better access to information does not seem to play a determining role in the level of awareness amongst a healthy, young population. Other strategies have to be tried. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive

Background: The aim of this report is to describe the impact of educational measures during the influenza A(H1N1) pandemic in an acute-care hospital in Buenos Aires. Methods: This is a retrospective descriptive study based on own data and data from the National Health System during epidemiological weeks 20 to 30 (17th May-1st August). Results: Because of the influenza epidemic a crisis committee was organized under the leadership of the Infectious Diseases Department and constituted by the heads of the Internal Medicine and Pediatric Departments, the Emergency Room Coordinator, and the head of nurses. They published a daily report and outlined common guidelines about diagnostic and treatment proceedings, prevention measures, and overall hospital performance. A call center with specially trained physicians answering the phone decreased patients and community anxiety, advising asymptomatic patients or patients without risk to stay at home. Visits to hospital patients were restricted to 2 hours per day and suppressed for pregnant women. Alcohol for hand hygiene was offered at hospital entrances. Respiratory masks were given to symptomatic patients until physician's evaluation. Of 1520 employees, 1083 in contact with patients, only two servants became infected, thus reflecting overall community risk. The hospital cares for 47000 members, 439 (0,93%) were studied because of influenza A(H1N1) suspicion, media age 15 years, 48% men. Forty-one required admission and 3 died.Tabled 1DataSuspected influenzaConfirmed InfluenzaDeathsDeaths/suspected influenzaDeaths/confirmed influenzaBuenos Aires City22502930 (4.13%)270.12%p < 0.012.90%p = 0.89Hospital Alemán43948 (10.93%)30.68%6.25% Open table in a new tab There is a statistically significant difference between the number of patients in which we confirmed diagnosis compared with the overall data in the rest of the city. Also the mortality rate was similar in both populations if only confirmed influenza-patients were regarded, but much higher in ours if the suspected patients were taken in account. Conclusion: The suspicion of influenza in our population was much better established leading to a greater diagnosis accuracy, certainly due to the impact of the educational efforts we did. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive

La infección de la vía biliar por Candida es una enfermedad de baja frecuencia que se asocia a procedimientos quirúrgicos o invasores de la vía biliar, a situaciones críticas, a inmunodepresión o a la utilización de antibióticos. Se presenta un caso de colecistitis aguda por Candida albicans en una paciente de 85 años sin factores de riesgo previos, además de una revision bibliográfica del tema. Sólo en cuatro casos de los publicados, los pacientes no habían presentado factores de riesgo asociados.

Candida biliary tract infection is a rare disease. Most of the reported cases have been diagnosed in patients with surgery or invasive procedures of the biliary tract, critical illness, immunosuppression or antibiotic treatment. This report deals with an 85 years old female patient with Candida albicans cholecystitis without previous risk factors and with a literature review on the subject. Only four patients without risk factors have been so far reported.

Fifteen evaluable patients (mean age, 67 years) were enrolled to assess the efficacy of teicoplanin, 6 mg/kg given daily during the first 3 days and then on alternate days, for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. Eight patients had soft tissue infections, four catheter-associated bacteraemia, two osteomyelitis and one pneumonia. Clinical cure was observed in 13 of 15 patients. Both clinical and bacteriological failures were shown in the two patients with osteomyelitis. The mean serum levels of teicoplanin (mg/L) were 22, 8 and 6.7 for peak, 24 h and 48 h troughs, respectively. The dosage employed in this study proved effective in non-deep-seated MRSA infections.