Estudio multicéntrico de incidencia y determinantes de COVID-19 en médicos de Argentina / Multicenter study of COVID-19 incidence and determinants in Argentinian physicians

Resumen Introducción: La información sobre COVID en médicos es limitada. Su conocimiento permitiría implementar acciones para reducir su impacto. El objetivo general fue determinar la incidencia de infección por SARS-CoV-2 en médicos de instituciones de salud de Argentina, sus características y factores aso ciados. Materiales y Métodos: Se realizó un estudio multicéntrico de cohorte prospectiva/retrospectiva con estudio de casos-controles anidado. Se incluyeron médicos activos al inicio de la pandemia no exceptuados por riesgo. Se estimó incidencia de casos confirmados. Se compararon factores asociados en casos y controles y se creó un modelo de regresión logística con las variables significativas del análisis bivariado. Resultados: Se incluyeron 343 médicos con COVID de 8 centros. La incidencia de la enfermedad fue de 12.1% y la de ausentismo global relacionado a COVID, de 34.1%. El 70% de los contactos estrechos fueron laborales. En el análisis multivariado de casos y controles, la residencia en la Ciudad Autónoma de Buenos Aires (OR 0.19, p = 0.01), el trabajo en áreas de alto riesgo (OR 0.22, p = 0.01) y vehículo individual (OR 0.34, p = 0.03) redujeron el riesgo de COVID. El odds de enfermar aumentó 4.6 veces (p = 0.02) por cada aislamiento por contacto estrecho. Discusión: El riesgo de enfermar aumentó considerablemente con cada aislamiento por contacto estrecho. La residencia en Ciudad Autónoma, el traslado en vehículo individual y el trabajo en áreas de alto riesgo lo redujeron. Dada la alta frecuencia de contactos estrechos en el ámbito laboral recomendamos reforzar las medidas de prevención en áreas de descanso y no COVID.

Abstract Background: Information about COVID infection in physicians is limited. This knowledge would allow the implementation of actions to reduce its impact. The objective was determining the incidence of SARS-CoV-2 infection in physicians from health institutions in Argentina, its characteristics, and associated factors. Methods: We conducted a multicenter prospective / retrospective cohort study with nested case-control study. Physicians active at the beginning of the pandemic were included, those on leave due to risk factors were excluded. The incidence of confirmed cases was estimated. We conducted bivariate analyses with various factors and used those significant in a logistic regression. Results: Three hundred and forty three physicians with COVID-infection from 8 centers were included. The incidence of disease was 12.1% and that of global absenteeism related to COVID, 34.1%. Almost 70% of close contacts were work-related. In the multivariate analysis living in Autonomous City of Buenos Aires (CABA) (OR 0.19, p = 0.01), working in high-risk areas (OR 0.22, p = 0.01) and individual transportation (OR 0, 34, p = 0.03) reduced the risk of COVID. The odds of infection increased 5.6 times (p = 0.02) for each close contact isolation. Discussion: The number of close contact isolation increased considerably the risk of infection. Living in Buenos Aires City, individual transpor tation and working in high-risk areas reduced it. Given the high frequency of close contact in the workplace, we strongly recommend the reinforcement of prevention measures in rest areas and non-COVID-wards.

Neumonía asociada a ventilación mecánica: Actualización y recomendaciones inter-sociedades, Sociedad Argentina de infectología - Sociedad Argentina de terapia intensiva / Pneumonia associated with mechanical ventilation. Update and recommendations inter- Societies SADI-SATI

Representantes de la Sociedad Argentina de Infectología (SADI) y la Sociedad Argentina de Terapia Intensiva (SATI) se unieron para trabajar en la elaboración de recomendaciones de diagnóstico, tratamiento y prevención de la neumonía asociada a ventilación mecánica (NAVM). La metodología utilizada fue el análisis de la bibliografía publicada en los últimos 15 años, complementada con la opinión de expertos y los datos locales. En este documento se pretende ofrecer herramientas básicas de optimización del diagnóstico en base a criterios clínicos y microbiológicos, orientación en los esquemas antibióticos empíricos y dirigidos, novedades en posología y administración de antibióticos en pacientes críticos y promocionar las medidas efectivas para reducir el riesgo de NAVM. Asimismo, ofrece un algoritmo de diagnóstico y tratamiento y consideraciones sobre antibióticos inhalados. El trabajo conjunto de ambas sociedades, infectólogos y terapistas, pone en evidencia la preocupación por el manejo de la NAVM y la importancia de velar por la mejora en las prácticas cotidianas. A través de esta recomendación se establecen pautas locales para optimizar el diagnóstico, tratamiento y prevención de la NAVM con el objeto de disminuir la morbimortalidad, días de internación, costos y resistencia a antibióticos debida al mal uso de los antimicrobianos.

Representatives of the Argentine Society of Infectious Diseases (SADI) and the Argentine Society of Intensive Therapy (SATI) worked together on the development of specific recommendations for the diagnosis, treatment and prevention of ventilator-associated pneumonia (VAP). The methodology used was the analysis of the literature published in the last 15 years, complemented with the opinion of experts and local data. This document aims to offer basic tools to optimize diagnosis based on clinical and microbiological criteria, orientation in empirical and targeted antibiotic schemes, news on posology and administration of antibiotics in critical patients and to promote effective measures to reduce the risk of VAP. It also offers a diagnostic and treatment algorithm and considerations on inhaled antibiotics. The joint work of both societies -infectious diseases and intensive care- highlights the concern for the management of VAP and the importance of ensuring improvement in daily practices. This guideline established recommendations to optimize the diagnosis, treatment and prevention of VAP in order to reduce morbidity and mortality, days of hospitalization, costs and resistance to antibiotics due to misuse of antimicrobials.

Leucoencefalopatía multifocal progresiva (LMP) con cd4 > 200 mm3 / Progressive multifocal leukoencephalopathy (PML) with cd4> 200 mm3

Introducción: La LMP es una enfermedad causada por el virus JC.Afecta la sustancia encefálica provocando desmielinización progresiva. La infección se produce en la infancia y es en general asintomática. En condiciones de inmunosupresión, adquiere potencial neuropatógeno destruyendo los oligodendrocitos. Generalmente se presenta en pacientes bajo tratamiento QMT o personas HIV + CD4<100 mm3. Objetivos:presentación de un caso clínico y revisión bibliográfica. Reporte de caso: Paciente de 37 años, con diagnóstico reciente HIV, en tratamiento con antirretrovirales, inicia cuadro clínico com impotencia funcional en miembro inferior izquierdo. En un mes, el paciente evolucionó con progresión del foco neurológico,desarrollando plejía FBC izquierda + plejía crural derecha, disartria, trastornos deglutorios, desorientación culminando finalmente condeterioro del sensorio. El paciente fallece a los dos meses derealizado el diagnóstico.Discusión: El diagnóstico de LMP debe plantearse ante um paciente inmunodeprimido, que presenta un cuadro de deterioro cognitivo o déficit neurológico de curso progresivo. La mayoría delos casos ocurre en HIV + con recuento de CD4 muy bajos. Aunque no existe tratamiento específico para LMP, las terapias antirretrovirales de alta potencia (HAART) parecen influir en la supervivência.

Introduction: PML is a disease caused by the JC virus. It affects the brain substance causing progressive demyelination. The infection occurs in childhood and is generally asymptomatic. Under conditions of immunosuppression, acquired destroying oligodendrocytes neuropathogenic potential. It usually occurs in patients receiving QMT or HIV + CD4 <100 mm3. Objectives: clinical case report and literature review. Case report: Patient 35 years old, with newly diagnosed HIV in antiretroviral therapy, clinical starts with loss of function of the left lower limb. In one month, the patient developed focal neurologic progression, developing hemiplegia FBC crural left + right crural pegia, dysarthria, swallowing disorders, disorientation, culminating with sensory impairment. The patient died two months after the diagnosis. Discussion: The diagnosis of PML should be raised in an immunocompromised patient, presented symptoms of cognitive decline or neurological deficits progressive course. Most cases occur in HIV + with very low CD4 count. Although there is no specific treatment for PML, antiretroviral.

Teicoplanina en el tratamiento de las infecciones osteoarticulares por Staphylococcus meticilino-resistente. Experiencia en adultos / Teicoplanin in the treatment of bone and joint infections due to methicillin resistant staphylococci. Experience in adult patients

We retrospectively evaluated 89 episodes of bone and joint infections due to methicillin-resistant staphylococci: 56 chronic osteomyelitis (CO), 10 septic arthritis (SA) and 23 infections associated to arthroplasties (IAA). We analyzed the efficacy of Teicoplanin (T) in three times a week or daily administration schemes and adequate surgery (AS). Also, we determined cost savings derived from outpatient parenteral antibiotic therapy (OPAT). The overall efficacy of T in CO and both in cases with and without implants, was higher when antibiotic therapy was associated to AS (86 vs. 46, p = 0.001; 100 vs. 33, p = 0.0049 and 76 vs. 50, p = 0.09). All SA were cured. The overall efficacy of T was higher in IAA with implant removal vs. surgical debridement (100 vs. 54, p = 0.045). In all cases, T was similarly effective when administered three times a week vs. daily administration, when associated to AS. The savings derived from OPAT were 897 days/bed and USS 179,400. Adverse effects were few and light (8 episodes, 9). The results obtained are similar to those published in the literature and show that T administered daily or in a three times a week scheme and associated to AS, is effective and safe for the treatment of bone and joint infections. The savings derived from OPAT, mainly related to reduced hospitalization, are significant in these pathologies, which usually require long treatment periods

Nuevas modalidades terapéuticas en el uso de teicoplanina / [New therapeutic strategies with teicoplanin]

Teicoplanin is a glycopeptide antibiotic with similar spectrum to vancomycin. However, unlike this drug, teicoplanin can be administered by i.v. or i.m. route once daily thanks to its long half-life (88 to 182 hours). This pharmacokinetic characteristic is particularly interesting in infections that require extended antimicrobial therapy, where new therapeutic strategies may be considered. Long-term treatment with teicoplanin proved effective in the treatment of bone and joint infections due to methicillin-resistant staphylococci. Teicoplanin administered three times a week yields comparable clinical efficacy than daily administration with considerably improved cost-effectiveness. This aspect merits special attention, particularly when evaluating prolonged outpatient antibiotic therapy regimens. For synergic effects it is possible to associate teicoplanin with other antibiotics. Chronic suppressive antibiotic therapy with teicoplanin may be an alternative in carefully selected patients, particularly those carrying prosthetic devices.

Guias para el manejo de las infecciones osteoarticulares por Staphylococcus meticilino-resistente / [Guidelines for the management of bone and joint infections due to methicillin resistant staphylococci]

Bone and joint infections are a group of complicated diseases with high morbidity. Emerging resistant microorganisms and the use of prosthetic devices have increased the difficulty in the medical treatment of patients. The purpose of these guidelines is to offer information on the management of bone and joint infections (post-invasive septic arthritis, chronic osteomyelitis and infected arthroplasty) produced by methicillin resistant staphylococci. They are oriented to physicians dedicated to internal medicine, infectious diseases, trauma and orthopedist surgeons as well as to everybody interested in this issue. The guidelines mainly point to the rational use of diagnostic methods and describe the new treatment modalities. A group of experts analyzed the different strategies for diagnosing and treating bone and joint infections due to methicillin resistant staphylococci and attempted at setting a level of evidence level and the strength of each recommendation.