Pre-operative Colonization by Staphylococcus aureus and Cephalosporin Non-susceptible Bacteria in Patients with Proximal Femoral Fractures / Colonização pré-operatória por Staphylococcus aureus e as bactérias não suscetíveis à cefalosporina, em pacientes com fratura proximal do fêmur

Abstract Objective To estimate the frequency of Staphylococcus aureus and cephalosporin nonsusceptible bacteria colonization in patients with proximal femoral fracture during preoperative hospitalization. Methods Prevalence and incidence assessment in 63 hospitalized patients over 1 year. The median time of pretreatment hospitalization was 12 days. Samples were collected from the nostrils, groin skin and anal mucosa during the pretreatment hospitalization and were tested by the disc-diffusion technique. Results The hospital colonization incidence and the prevalence of positive results were 14.3 and 44.4% for S. aureus; 3.2 and 6.4% for meticillin-resistant S. aureus; 28.6 and 85.7% for meticillin-resistant coagulase-negative Staphylococcus; 28.6 and 61.9% for cefazolin nonsusceptible Enterobacteriaceae (KFNSE); and 20.6 and 28.6% for cefuroxime nonsusceptible Enterobacteriaceae (CXNSE). In addition, factors such as to the duration of the pretreatment hospitalization period, being non-walker before fracture, antimicrobial use, American Society of Anesthesiologists (ASA) 4 surgical risk, and previous hospitalization, were related to an increase in the incidence of hospital acquisition and prevalence of colonization by the evaluated strains. The prevalence of colonization by KFNSE was three times higher than by CXNSE on admission, and twice as high at the time of fracture treatment. Conclusion There was a high incidence of hospital colonization and prevalence of colonization by all strains studied, which may guide the indication of prophylactic measures for infection.

Resumo Objetivo Estimar a frequência da colonização por Staphylococcus aureus e as bactérias não suscetíveis à cefalosporina, em pacientes com fratura proximal do fêmur durante a internação pré-operatória. Métodos Avaliação da prevalência e incidência em 63 pacientes hospitalizados ao longo de um ano. O tempo médio de internação pré-tratamento foi de 12 dias. As amostras foram coletadas das narinas, pele da virilha e mucosa anal, durante a internação prévia ao tratamento e testadas pela técnica de disco-difusão. Resultados A incidência da colonização hospitalar e a prevalência de resultados positivos foram de 14,3% e 44,4% para Staphylococcus aureus; 3,2% e 6,4% para S. aureus resistente à meticilina; 28,6% e 85,7% para Staphylococcus coagulase-negativo resistente à meticilina; 28,6% e 61,9% para Enterobacteriaceae não suscetível à cefazolina (KFNSE); e 20,6% e 28,6% para Enterobacteriaceae não suscetível à cefuroxima (CXNSE). Além da duração do período de internação pré-tratamento, os pacientes não deambularam previamente à ocorrência da fratura e nem fizeram uso de antimicrobiano. Além disso, a duração do período de internação pré-tratamento cirúrgico, ser não-deambulador antes da fratura, uso de antimicrobianos, risco cirúrgico IV pela American Society of Anesthesiologists (ASA) e internação anterior, estiveram relacionados a um aumento na incidência de aquisição hospitalar e prevalência de colonização pelas cepas avaliadas. A prevalência de colonização pela KFNSE foi três vezes maior do que pela CXNSE na admissão e duas vezes maior no momento do tratamento da fratura. Conclusão Observou-se uma alta incidência da colonização hospitalar e prevalência da colonização por todas as cepas estudadas, o que pode orientar a indicação de medidas profiláticas contra a infecção.

Detection of beta-lactamase-producing Enterobacteriaceae in a veterinary hospital environment / Detecção de Enterobactérias produtoras de beta-lactamases em ambiente hospitalar veterinário

Due to the strong selective pressure resulting from the misuse of antibiotics, the natural process of bacterial resistance has been accelerated, leading to the increasingly constant appearance of multiresistant isolates. The high number of multi-resistant bacteria is a one health problem. Enterobacteriaceae are usually commensal bacteria of the gastrointestinal tract. However, they can cause infections, and the most important resistance characteristic among them is the production of ß-lactamases. This study aimed to identify ESBL-producing Enterobacteriaceae of types of TEM, SHV, and the CTX-Mgroups. To isolate the enterobacteria, swabs were collected by swiping objects that had contact with the patients and professionals, and the water of the hospital environment. Ten collections were carried out, yielding 306 samples, from which 118 enterobacteria were identified: Escherichia coli, Enterobacter spp., Klebsiella spp., Proteus mirabilis, Serratiaspp., and Citrobacter spp. Isolates. The genes TEM and CTX-M, for the production of ß-lactamases, were detected in 12.7% of the 118 enterobacterial isolates. It is very important to know the bacterial population circulating in the veterinary hospital environment and its resistance to antimicrobials so that professionals can take appropriate measures to minimize the risks of transmission, especially from cages and consultation tables. In addition, the correct control of the microbiological quality of the supply water, as well as environmental cleaning procedures, are essential to prevent the transmission of these microorganisms.(AU)

Devido à grande pressão seletiva decorrente do uso indevido de antibióticos, tem se acelerado o processo natural de resistência das bactérias, levando ao aparecimento cada vez mais constante de isolados multirresistentes. O elevado número de bactérias multirresistentes identificadas é um problema da saúde única. As enterobactérias são bactérias geralmente comensais do trato gastrointestinal, entretanto podem causar infecções, e a característica de resistência mais importante entre elas é a produção de ß-lactamases. Buscando caracterizar melhor os microrganismos circulantes e potencialmente causadores de infecções em ambiente hospitalar veterinário, este estudo objetivou identificar as enterobactérias produtoras de ESBL do tipo TEM, SHV e os cinco grupos de CTX-M presentes em isolados circulantes em hospital veterinário. Foi realizada coleta de suabes de arrasto de objetos que entram em contato com os pacientes e com os profissionais que ali trabalham, bem como de água, para a identificação das enterobactérias. Foram realizadas 10 coletas, obtendo-se 306 amostras, dessas, 118 enterobactérias foram identificadas: Escherichia coli, Enterobacter, Klebsiella, Proteus mirabilis, Serratia e Citrobacter. Dentre as enterobactérias identificadas, alguns isolados possuíam genes para a produção de ß-lactamases, do tipo TEM e CTX-M. É de grande importância conhecer a população bacteriana circulante no ambiente hospitalar veterinário, e a sua resistência aos antimicrobianos, para que os profissionais possam tomar medidas apropriadas para minimizar os riscos de transmissão, principalmente a partir de gaiolas e mesas de atendimento. Além disso, o correto controle da qualidade microbiológica da água de abastecimento, bem como dos procedimentos de higienização do ambiente, são fundamentais para evitar a transmissão destes microrganismos.(AU)

Infecciones asociadas a la atención sanitaria en el Instituto Nacional de Angiología y Cirugía Vascular / Infections associated with health care at the National Institute of Angiology and Vascular Surgery

Introducción: Las infecciones asociadas a la asistencia sanitaria constituyen un problema de salud. Objetivo: Caracterizar las infecciones asociadas a la asistencia sanitaria en los tres servicios del Instituto Nacional de Angiología y Cirugía Vascular durante 2019. Métodos: Estudio longitudinal de epidemiología clínica en 89 pacientes ingresados en 2019, a los que se les diagnosticó una infección asociada a la asistencia sanitaria. Las variables de estudio fueron: edad, sexo, meses del año, servicio asistencial, enfermedades asociadas, gérmenes más frecuentes y principales localizaciones. Se calcularon las frecuencias absolutas y relativas. Resultados: Se encontró una tasa porcentual acumulada de 6,6 por cada 100 egresos, con predominio del sexo masculino y mayor frecuencia en los pacientes de la quinta década de vida. La herida quirúrgica contribuyó con 43 casos de los 89 reportados, seguida por la bronconeumonía bacteriana con 18. La principal enfermedad asociada fue la diabetes mellitus y los gérmenes más frecuentes aislados resultaron Stafilococus aureus, Pseudomona sp y Acinetobacter bawmani. Conclusiones: La tasa de incidencia de infecciones asociadas a la asistencia sanitaria en el Instituto Nacional de Angiología y Cirugía Vascular durante 2019 no difiere de las presentadas en años anteriores y se corresponden con los reportes internacionales(AU)

Introduction: Health care associated infections are a health problem. Objective: Characterize healthcare associated infections in the three services of the National Institute of Angiology and Vascular Surgery during 2019. Methods: Longitudinal study of clinical epidemiology in 89 patients admitted in 2019, who were diagnosed with an infection associated with health care. The study variables were: age, sex, months of the year, care service, associated diseases, more frequent germs and main locations. Absolute and relative frequencies were calculated. Results: A cumulative percentage rate of 6.6 per 100 discharges was found, with male predominance and higher frequency in patients in the fifth decade of life. The surgical wound was present in 43 of the 89 cases reported, followed by bacterial bronchopneumonie with 18. The main associated disease was diabetes mellitus and the most common isolated germs were Stafilococus aureus, Pseudomonasp and Acinetobacter baumannii. Conclusions: The incidence rate of healthcare associated infections at the National Institute of Angiology and Vascular Surgery during 2019 does not differ from those presented in previous years and corresponds to international reports(AU)

Infección nosocomial en Cuidados Intensivos del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas / Nosocomial infection in the Intensive Care Unit of the Teaching Clinic-Surgical Hospital Faustino Pérez Hernández, of Matanzas

RESUMEN Introducción: la diseminación de microorganismos multirresistentes en el hospital, constituye un importante problema epidemiológico y terapéutico que afecta especialmente a pacientes de la Unidad de Cuidados Intensivos. Objetivo: escribir el comportamiento de las infecciones nosocomiales y la resistencia antimicrobiana en la Unidad de Cuidados Intensivos. Materiales y métodos: se realizó un estudio de tipo descriptivo, observacional y prospectivo en la Unidad de Cuidados Intensivos del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, durante el primer semestre de 2020. El universo estuvo constituido por 102 pacientes que ingresaron en la Unidad de Cuidados Intensivos en el período estudiado, a los que se les realizó estudios microbiológicos. Las variables analizas fueron: causas de ingreso, edad, infecciones nosocomiales, neumonía en ventilados, gérmenes, resistencia antimicrobiana y mortalidad. Se expresaron en tablas y gráficos porcentuales. Resultados: el sexo masculino presentó mayor número de infección nosocomial respecto al femenino, en edades diferentes de la vida. La causa más frecuente de ingreso fue el politrauma. El sitio más común de infección nosocomial fue la vía respiratoria. Predominaron gérmenes como los bacilos gramnegativos fermentadores y las enterobacterias. Antibióticos como los inhibidores de las betalactamasas, otras penicilinas, quinolonas, cefalosporinas, aminoglucósidos y meropenen han adquirido un mayor porciento de resistencia. Conclusiones: la infección nosocomial por bacterias multirresistentes a los antibióticos estratégicos, es un problema dentro de la Unidad de Cuidados Intensivos asociado a la ventilación mecánica, que provoca una elevada mortalidad (AU).

ABSTRACT Introduction: the spread of multi-resistant microorganisms in the hospital is a major epidemiological and therapeutic problem that particularly affects critical patients admitted to the Intensive Care Unit. Objective: to describe the behavior of nosocomial infections and antimicrobial resistance in the Intensive Care Unit. Materials and Methods: a descriptive, observational and prospective study was carried out in the Intensive Care Unit of the Teaching Clinic-Surgical Hospital Faustino Pérez Hernández, during the first half of 2020. The universe was formed by 102 patients who entered the Intensive Care Unit during the studied period, to whom microbiological studies were carried out. The analyzed variables were the following: causes of admission, age, nosocomial infections, ventilator-associated pneumonia, germs, antimicrobial resistance and mortality. The results were expressed in tables and percentage charts. Results: Male sex showed the highest number of nosocomial infection compared to the female, at different ages of life. The most common cause of admission was polytrauma. The most common site of nosocomial infection was the airway. Germs like fermentative Gram-negative bacilli and enterobacteria predominated. Antibiotics such as beta-lactamase inhibitors, other kinds of penicillin, quinolones, cephalosporin, aminoglycosides and meropenen have acquired a higher percent of resistance. Conclusions: nosocomial infection caused by bacteria that have developed multi-resistance to strategic antibiotics is a problem within the Intensive Care Unit, associated to mechanical ventilation, and leads to high mortality (AU).

Factores pronósticos de mortalidad por agente infeccioso en un hospital de alta complejidad de Cartagena-Colombia / Prognostic factors for mortality caused by an infectious agent in a high complexity hospital in Cartagena-Colombia

Introducción: La identificación de los principales factores clínico-epidemiológicos que determinan causas de mortalidad en pacientes hospitalizados es una necesidad apremiante, principalmente cuando los esfuerzos realizados en la actualidad no permiten asumir acciones fundamentadas en la identificación de las causas de dicho evento. Objetivo: Establecer cuáles son los factores pronósticos de mortalidad por agente infeccioso en un hospital de alta complejidad de la ciudad de Cartagena- Colombia. Material y Métodos: Se realizó un estudio de casos y controles retrospectivo, con muestra proyectada de 86 casos y 258 controles, en una relación 1:3, que cumplieron con los criterios de elegibilidad respectivos y en los que realizaron análisis bivariados y posteriormente un análisis multivariado que incluyó métodos de regresión logística binaria. Resultados: El riesgo de mortalidad en el análisis multivariado está determinado por variables como sexo masculino (ORa 1,695 IC 95 por ciento: 1,005-2,856); Cáncer (ORa 2,389 IC 95 por ciento 1,230-4,642); inmunosupresión (ORa 3,211 IC 95 por ciento 1,004-10,26); Ventilación mecánica (ORa 2,541 IC 95 por ciento 1,128-5,722); Estancia en la UCI (ORa 2,331 IC 95 por ciento1,227-4,425) e Infección por bacterias productoras de carbapenemasas (ORa 4,778 IC95 por ciento 1,313-17,38). Conclusiones: En pacientes masculinos con cáncer o cualquier otra forma de inmunosupresión, en los que se requiera el uso del ventilador mecánico o estancia en la unidad de cuidado intensivo y que además desarrollen infecciones por bacterias productoras de carbapenemasas existe mayor riesgo de muerte por agente infeccioso(AU)

Introduction: The identification of the main epidemiological clinical factors that determine the causes of mortality in hospitalized patients is a pressing need, mainly when the efforts made at present do not allow us to take actions based on the identification of the causes of the aforementioned event. Objective: To identify the prognostic factors for mortality caused by infectious agents in a high complexity hospital in the city of Cartagena, Colombia. Material and Methods: A retrospective case-control study was conducted in 86 cases and 258 control samples that met the eligibility criteria, at the 1: 3 ratio. Bivariate analyses and a subsequent multivariate analysis that included binary logistic regression methods were also performed. Results: In the multivariate analysis, the risk of mortality is determined by variables such as male sex (ORa 1,695 95 percent CI: 1.005-2.856); cancer (ORa 2,389 95 percent CI 1,230-4,642); immunosuppression (ORa 3.211 95 percent CI 1.004-10.26); mechanical ventilation (ORa 2.541 95 percent CI 1.128-5.722); stay in the ICU (ORa 2,331 95 percent CI 1,227-4,425) and infection caused by carbapenemase-producing bacteria (ORa 4,778 95 percent CI 1,313-17.38). Conclusions: Male patients with cancer or any other form of immunosuppression who require the use of a mechanical ventilator or admission to the intensive care unit who also develop infections caused by carbapenemase-producing bacteria, are at greater risk of death from an infectious agent(AU)

Caracterización clínica y epidemiológica de infección asociada a atención en salud por virus influenza en pacientes críticos / Clinical and epidemiological characterization of healthcare acquired influenza in critical ill patients

Resumen Introduccion: Las infecciones asociadas a atencion de salud (IAAS) aumentan la morbilidad y mortalidad. Durante 2014, en Hospital Clinico Red de Salud UC Christus (RS-UCCH) se estimo que 15% de las infecciones virales respiratorias fueron adquiridas durante la atencion de salud, siendo mas frecuente el virus influenza. Objetivos: Caracterizacion clinico-epidemiologica de IAAS por influenza en pacientes hospitalizados en unidades de pacientes criticos (UPC) y cuidados especiales. Material y Metodos: Estudio descriptivo. Se incluyeron pacientes en UPC y cuidados especiales con IAAS influenza entre 2014 y 2017 en RS-UCCH. IAAS por influenza se definio como: inicio de sintomas y/o RPC-TR positiva para virus influenza ≥ 48 h de ingreso hospitalario, sin sintomatologia respiratoria o estudio negativo previo. Resultados: Se identificaron 22 pacientes, edad mediana 74 anos. La influenza fue adquirida en promedio al dia 13; el 77% fue por influenza A y el 27% presento coinfeccion respiratoria. Trece (59%) estaban hospitalizados en UPC, dos (15%) por problemas pulmonares. El 86% tenia co-morbilidad y el 50% descompensacion de ella. No estaba vacunado 59%; la letalidad observada fue 18%. Conclusiones: IAAS por influenza ocurrio en pacientes cronicos, de mayor edad y no vacunados. Es primordial educar en prevencion de IAAS y mantener altas coberturas de vacunacion.

Background: Healthcare-associated infections (HAIs) increase morbidity and mortality. During 2014, at the Hospital Clinico Red de Salud UC Christus (RS-UCCH) it was estimated that 15% of respiratory viral infections were acquired during hospitalization and influenza A was more frequent. Aims: Clinical and epidemiological characterization of HAIs due to influenza virus in patients hospitalized in critical care units (CCU) and special care. Methods: Descriptive study. We included patients hospitalized in CCU and special care with hospital acquired influenza during 2014-2017. HAI due to influenza was defined as: symptom onset and/or positive influenza PCR after ≥ 48 hours of hospital admission, without previous respiratory symptoms or previous negative influenza test study. Results: 22 patients were identified, median age was 74 years. Influenza was acquired average on day 13. Influenza A was detected in 77% and 27% had respiratory co-infection. Thirteen (59%) were hospitalized in CCU, only 2 (15%) due to lung problems. Comorbidity was present in 86% and decompensation in 50%. Only 41% received influenza vaccine. The associated lethality was 18%. Conclusions: HAI due to influenza occurred in chronic, older and unvaccinated patients. Education about HAIs and continuous high vaccination coverage must be reinforced.

Parte III. Apoyo del laboratorio de microbiología y anatomía patológica en el diagnóstico y manejo de infecciones en el paciente con cáncer y trasplante de precursores hematopoyéticos / Support of the laboratory of microbiology and pathological anatomy in the diagnosis and management of infections in cancer patients and transplantation of hematopoietic stem cell transplant receptors

Resumen El enfrentamiento del diagnóstico diferencial y etiológico de las enfermedades infecciosas de los pacientes con cáncer, incluyendo los receptores de trasplante de precursores hematopoyéticos (TPH), debe corresponder a una decisión informada, oportuna y que repercuta directamente en una conducta médica que determine una mejor sobrevida y calidad de vida de los pacientes. El objetivo de este trabajo fue aportar en el manejo de estos pacientes desarrollando una herramienta útil al médico clínico para tomar estas decisiones. Para ello se agruparon las infecciones por sistemas comprometidos diferenciando los posibles agentes etiológicos en bacterias, virus, hongos y parásitos, explicitando los exámenes diagnósticos más relevantes, mencionando la o las técnicas recomendadas, junto con el tipo de muestra óptima para su adecuado procesamiento. De manera adicional, se incorporó el ítem "nivel de requerimiento" para sugerir lo que, a juicio de los autores y la evidencia existente, debe estar presente obligatoriamente en el centro o puede ser derivable a otro laboratorio.

The confrontation of the differential and etiological diagnosis of the infectious diseases of cancer patients, including hematopoietic stem cells transplant (HSCT) recipients, must correspond to an informed, timely decision that directly affects medical behavior that determines a better survival and quality of life for patients. The main goal of this work was to contribute to the management of these patients developing a useful tool for the clinician to make these decisions. For that, infections were grouped by compromised systems, differentiating the possible etiological agents in bacteria, viruses, fungi and parasites, highlighting the relevant diagnostic tests, mentioning the recommended techniques together with the optimal sample type for proper processing. In addition, under each group of techniques we added the item "level of requirement" to suggest what, in the opinion of the authors and the existing evidence, must be mandatory to have at local level or can be derivable to another laboratory.

Costos atribuidos a las infecciones asociadas con la atención en salud en un hospital de Colombia, 2011-2015 / Attributed costs of health care-associated infections in a Colombian hospital, 2011- 2015

Resumen Introducción. El análisis de los costos derivados de las infecciones asociadas con la atención en salud representa un desafío para el sistema de salud en Colombia dados sus factores determinantes. Objetivo. Determinar los factores relacionados con el aumento y la variabilidad de los costos de la atención hospitalaria por las infecciones asociadas con la atención en salud en un hospital de cuarto nivel de Bogotá, entre el 2011 y el 2015. Materiales y métodos. Se analizaron los costos de la atención de 292 pacientes, los cuales se estimaron para cada una de las actividades realizadas desde el momento de sospechar el cuadro infeccioso hasta su resolución. Dichos costos se estandarizaron según el valor del manual tarifario del Instituto de Seguros Sociales, ajustándolos por el índice de precios al consumidor para salud hasta el año 2014. Se determinaron los factores relacionados con el aumento del costo del manejo mediante un modelo logístico condicional. Resultados. La estancia hospitalaria de nueve días o más antes de la infección, se asoció con el aumento del costo directo del manejo de las infecciones relacionadas con la atención en salud (odds ratio, OR=2,06; IC95% 1,11-3,63). El costo medio del manejo de las infecciones fue de COP $1.190.879. Los antibióticos representaron el 41 % del valor total del tratamiento, seguidos de los exámenes de laboratorio, con un costo equivalente al 13,5 %. Conclusión. Se encontró una relación entre el costo del manejo de las infecciones asociadas con la atención en salud y la estancia hospitalaria previa a su aparición. Los antecedentes patológicos de los pacientes no se relacionaron con el aumento de los costos.

Abstract Introduction: The cost analysis of infections associated with health care represents a challenge for the health system in Colombia given their determinants. Objective: To determine the factors related to the increase and variability in the costs of hospital care for infections associated with health care in a fourth-level hospital in Bogotá from 2011 to 2015. Materials and methods: The costs of the care for 292 patients were analyzed including each of the activities carried out since the suspicion of the infectious disease until its resolution. These costs were standardized to the value of the Instituto de Seguros Sociales tariff manual adjusted by the annual consumer price index for health until 2014. The factors related to the increase in management costs were identified using a conditional logistic regression model. Results: A hospital stay of nine days or more prior to the infection was a factor associated with the increase of direct costs in the management of infections associated with health care (OR=2.06; 95% CI: 1.11-3.63). The median cost of the infections was COP $1.190.879. The antibiotic treatment represented 41% of the total value of the treatment, followed by laboratory tests with a cost equivalent to 13.5%. Conclusions: We found a relationship between the cost of the management of infections associated with health care and the hospital stay prior to their appearance. The pathological antecedents of the patients were not related to the increase in the cost.

Fatal nosocomial hemorrhagic enterocolitis probably caused by adenovirus: report of one case / Enterocolitis hemorrágica fatal nosocomial probablemente causada por adenovirus: informe de un caso

ABSTRACT Adenovirus (ADV) is a recognized cause of severe disease among immunocompromised patients. We report a previously healthy 39-year-old female, admitted with influenza pneumonia and evolving with lung hemorrhage and acute renal failure requiring mechanical ventilation and hemodialysis. She received high corticosteroid doses due to an initial suspicion of alveolar hemorrhage. Lymphopenia already present before steroid use (567/μL), was maintained during the whole hospital stay (mean 782/μL). From the second week of admission she presented a high-volume diarrhea (mean 2.5 L/day) associated to intermittent bloody stools. An ulcerative enterocolitis was confirmed by CT images and colonoscopy. ADV was detected in a colonic tissue sample by real time PCR but not by a commercial filmarray test. Cidofovir-probenecid and racecadotril therapy were indicated without changing the clinical course of diarrhea and the patient finally died.

Adenovirus (ADV) es una causa reconocida de enfermedades graves en pacientes inmunocomprometidos. Informamos el caso de una mujer de 39 años, previamente sana, que ingresó por neumonía grave por influenza, evolucionando con hemorragia pulmonar y falla renal aguda, requiriendo ventilación mecánica y hemodiálisis. Recibió altas dosis de corticoides por la sospecha inicial de una hemorragia alveolar. Tuvo linfopenia durante toda su estadía (promedio 782/μL), la que ya estaba presente antes del uso de los corticoides (567/μL). Desde la segunda semana de hospitalización, presentó una diarrea de alto volumen (promedio 2,5 L/día) asociada a la presencia de sangre en deposiciones en forma intermitente. Se confirmó una enterocolitis ulcerativa por tomografía computada y colonoscopía. Se detectó ADV en muestras de biopsia colónica por PCR en tiempo real pero no por un test de PCR múltiples automatizado comercial. Fue tratada con cidofovir-probenecid y racecadrotrilo sin impacto clínico y la paciente finalmente falleció.

Ralstonia mannitolilytica bacteremia in a neonatal intensive care unit

Abstract Ralstonia mannitolilytica, a Gram-negative bacterium, is rarely isolated in clinical laboratories. It has been associated with outbreaks due to its ability to survive in liquid media and hospital devices. We describe three cases of bacteremia caused by R. mannitolilytica in a neonatal intensive care unit in Curitiba, Southern Brazil. All isolates presented the same PFGE profile. The common source of infection was undetected in surveillance cultures for the outbreak survey. All patients received antimicrobial treatment and were discharged from the maternity. Due to the characteristics of the microorganism, clinicians and microbiologists should pay attention to the emergence of Ralstonia spp. infections.

Detecção de patógenos em ponta de cateter venoso central por reação em cadeia da polimerase / Detecção de patógenos em ponta de cateter venoso central por reação em cadeia da polimerase

As infecções relacionadas à assistência à saúde (IRAS) são eventos adversos preocupantes em saúde pública, que se configuram como importante causa de morbidade e mortalidade em unidades de terapia intensiva. Dispositivos invasivos como o cateter venoso central (CVC) favorecem um tipo de IRAS, a infecção da corrente sanguínea. Esse evento é comumente diagnosticado por hemocultura e ou cultura da ponta do cateter, entretanto nem sempre o tempo de resposta dos exames ou os achados contribuem com o adequado tratamento. Os avanços em biotecnologia apontam ferramentas capazes de contribuir com diagnósticos de infecção. O objetivo da presente tese foi testar a técnica de reação em cadeia da polimerase (PCR) como ferramenta para detecção de bactérias potencialmente patogênicas em ponta de CVC de pacientes com suspeita de infecção da corrente sanguínea relacionada ao cateter, internados na Unidade de Terapia Intensiva de Adultos de um hospital filantrópico e de ensino no interior de Minas Gerais. Foram abordados os temas extração de DNA e rastreamento molecular em CVC. Tratou-se de um estudo molecular, transversal, descritivo e exploratório. Testes laboratoriais de comparação entre métodos de extração de DNA foram realizados com cepa da bactéria Staphylococcus aureus para posterior aplicação em cateteres coletados de pacientes. Durante um período de seis meses, uma amostra de conveniência com trinta e quarto cateteres removidos de pacientes internados na Unidade de Terapia Intensiva de Adultos, sob suspeita de infecção da corrente sanguínea, foram submetidos à extração de DNA do material biológico contido na parede externa e no interior dos lúmens dos mesmos. Procedeu-se a identificação de bactérias por PCR utilizando um padrão de reagentes e temperaturas. Os resultados encontrados na análise por biologia molecular foram comparados com os resultados das culturas desses pacientes, realizadas pelo hospital. Houve ainda, o levantamento em prontuário de dados dos pacientes: sexo, idade, uso de outros dispositivos invasivos, tempo de permanência do CVC e local de inserção do cateter; e presença de sinais flogísticos no local de inserção do dispositivo. Testes estatísticos com auxílio do programa Stata, versão 15, foram utilizados. A prevalência das bactérias no CVC por teste de PCR foi: Staphylococcus aureaus (50%), Enterococcus faecalis (41,2%), Klebsiella pneumoniae (32,4%), Pseudomonas aeruginosa (20,6%), Acinetobacter baumannii (38,2%) e Escherichia coli (2,9%). Todas as hemoculturas realizadas tiveram ausência de bactérias como resultado do exame. A cultura de ponta de cateter revelou bactérias em 21 (61,8%) dispositivos, enquanto a PCR apresentou positividade em 31 (91,2%). Os patógenos mais detectados são comumente encontrados no ambiente e no microbioma humano, transmitidos aos pacientes inclusive pelas mãos dos profissionais de saúde. Estes achados são relevantes ao se programar medidas de prevenção de infecção da corrente sanguínea relacionada ao CVC. O método de extração do material genômico, o painel de primers e protocolo de amplificação deste estudo identificaram os principais bactérias comumente prevalentes nas infecções da corrente sanguínea. Desta forma, a identificação molecular de bactérias poderá auxiliar na detecção de infecção da corrente sanguínea e a tomada de decisão relativa à escolha da melhor terapia.

Healthcare-associated infections (HAIs) are worrying adverse events in public health. They are an important cause of morbidity and mortality in intensive care units. Invasive devices such as the central venous catheter (CVC) favors a type of HAIs, the bloodstream infection. This event is commonly diagnosed by blood culture and/or culture of the catheter tip, however, the response time of these tests or their results not always contribute to the appropriate treatment. Advances in biotechnology provide tools capable of contributing to diagnoses of infection. The aim of the present thesis was to detect potentially pathogenic bacteria at the tip of a central venous catheter through polymerase chain reaction (PCR). Subjects were treated with DNA extraction and molecular tracing in CVC. It is a cross-sectional molecular study. Laboratory tests comparing DNA extraction methods were performed with the Staphylococcus aureus bacterium for subsequent application to catheters collected from patients. Over a period of 6 months, in an Adult Intensive Care Unit of a philanthropic and training hospital, (n=34) catheters were removed from patients under suspicion of bloodstream infection. All the thirty-four catheters were subjected to DNA extraction from the biological material contained in their wall and inside their lumens. The bacteria were identified by PCR using a standard set of reagents and temperatures. The results found in the analysis by molecular biology were compared with the results of the cultures of these patients, performed by the hospital. Collection of patients' data was also carried out: sex, age, use of other invasive devices, CVC insertion location and period of catheters use; and presence of phlogistic signs in the insertion site of the device. Statistical tests were used with the help of the Stata software, version 15. The prevalence of bacteria in CVCs was: Staphylococcus aureaus (50%), Enterococcus faecalis (41,2%), Klebsiella pneumoniae (32,4%), Pseudomonas aeruginosa (20,6%), Acinetobacter baumannii (38,2%) and Escherichia coli (2,9%). All blood cultures performed had no bacteria as a result of the examination. Catheter-tip culture revealed microorganisms in 21 (61.8%) devices, whereas PCR showed positivity in 31 (91.2%). The most commonly detected pathogens are usually found in the environment and in the microbioma of the skin and they are possibly transmitted to patients by the hands of health professionals. These findings are relevant when programming CVC-related bloodstream infection prevention measures. The genomic material extraction method, primers panel and amplification protocol of this study identified the major pathogens prevalent in bloodstream infections. In this way, molecular identification of bacteria may assist in the detection of bloodstream infection and decision-making regarding the choice of the best therapy.

Perfil epidemiológico das infecções hospitalares na unidade de terapia intensiva de um hospital terciário / Epidemiological profile of infections in the unit of therapy intensive care of a tertiary hospital

O estudo objetivou conhecer o perfil das infecções hospitalares na Unidade de Terapia Intensiva de um hospital, interior de São Paulo.Estudo retrospectivo, quantitativo, sendo os dados coletados através da CCIH. A taxa de pacientes com infecções hospitalares foi de 21,8%,o trato respiratório o sítio mais acometido (60,9%) e Acinetobacter spp e Staphylococcus aureus os patógenos mais encontrados. O óbito por infecções hospitalares foi mais frequente em mulheres (p=0,0322), idosos (p=0,0002) e em pacientes com maior dias de internação(p=0,0143). Os resultados apontam a necessidade de ações de prevenção e controle deste agravo.

This study aimed to know the profile of hospital infections (HI) in the Intensive Care Unit of a countryside hospital in São Paulo. It is a retrospective,quantitative study, with data collected through the CCIH. The rate of patients with HI was 21,8% and respiratory tract (60.9%) wasthe most affected site, and Acinetobacter spp and Staphylococcus aureus were the most found pathogens. The death for HI was found morefrequent in women (p=0.0322), in the elderly (p=0,0002) and patients with more days of admission (p=0.0143).The results show the needfor prevention and control of this disease.

El objetivo fue conocer el perfil de las infecciones hospitalarias (IH) en la unidad de terapia intensiva de un hospital en el interior de São Paulo.Estudio retrospectivo, cuantitativo y con datos recogidos a través de CCIH. La tasa de pacientes con IH fue 21,8%, el sitio más afectado eltracto respiratorio (60,9%), y Acinetobacter spp y Staphylococcus aureus los patógenos predominantes. La muerte por IH fue predominante en las mujeres (p=0,0322), ancianos (p=0,0002) y en pacientes con mayor número de días de hospitalización (p=0,0143). Son necesarias acciones de prevención y control de esto agravio.

Increasing rates of Clostridium difficile infection in Mexican hospitals

Abstract Introduction The epidemiology of Clostridium difficile infection (CDI) has changed in the last two decades. There is a lack of information regarding incidence and severity of CDI, especially in the developing world. Methods This was a retrospective and observational study from four hospitals of three Mexican cities. Patients were diagnosed with CDI when presented with loose stools and had at least one of the following tests positive: toxins assay, real-time PCR, or an endoscopic image compatible with pseudomembranous colitis. CDI was classified according to international guidelines. Demographic and clinical data as well as information regarding total hospital admissions, total length-of-hospital stay, and other variables related to hospitalization were gathered from the epidemiology and administration departments of each hospital. Results A total of 2050 hospital beds were analyzed with 288,171 patients hospitalized accumulating 1,576,446 days of hospitalization during the study period. The average rate of CDI per 1000 hospital-days was lower than the rates reported in the US and Europe, although in 2015 CDI rates were almost persistently above the mean rate for the study period. More than half of PCR positive patients were ribotype 027. Conclusion Hospital rates of CDI are increasing in Mexican hospitals with a predominance of infections caused by ribotype 027.

Agua potable como posible fuente de brote de diarrea por Microsporidium spp. en pacientes inmunocomprometidos en un hospital pediátrico / The water supply of a pediatric hospital as a possible source of an outbreak of diarrhea due to Microsporidium spp. in immunocompromised patients

Introduction: The hospital water supply is a reservoir of a variety of potentially pathogenic microorganisms that can particularly affect children and immunocompromised patients. Potentially pathogenic Microsporidium spp. have been identified in water. Microsporidiosis is an emerging parasitic and opportunistic infection in immunocompromised patients. Objective and Method: to describe an outbreak of nosocomial diarrhea due to Microsporidium, species Encephalitozoon intestinalis. Results: Seven cases of E. intestinalis associated diarrhea were reported between november 2012 and february 2013, in a unit of immunocompromised patients in L. Calvo Mackenna Children's Hospital. Microsporidium spp. was found in the hospital water supply and water reservoir tank. Secondary cases were transmitted by contact. Control measures included contact precautions, not to use faucet water for hand washing, bottled water for drinking and water reservoir tank sanitation. Conclusions: This research is about a nosocomial outbreak associated with water supply. Water quality in Chilean hospitals is an unresolved issue, especially in immunocompromised patient areas. Compliance of cleaning and disinfection of water supply systems in hospitals must be ensured.

Introducción: Los sistemas de suministro de agua potable de los hospitales constituyen un reservorio de una variedad de microorganismos potencialmente patógenos que pueden afectar especialmente a niños y pacientes inmunocomprometidos. Especies de Microsporidium spp. potencialmente patógenos para el hombre han sido identificadas en el agua potable. La microsporidiosis es una infección parasitaria oportunista en pacientes inmunocomprometidos. Objetivos y Método: Describir un brote de diarrea nosocomial por Microsporidium de la especie Encephalitozoon intestinalis. Resultados: Se registraron siete casos de diarrea por E. intestinalis, entre noviembre de 2012 y febrero de 2013, en una unidad de pacientes inmunocomprometidos del Hospital de Niños Luis Calvo Mackenna, comprobándose la presencia de Microsporidium spp. abundante en el agua potable y estanques del hospital. Los casos secundarios pudieron transmitirse por contacto. Las medidas de control fueron precauciones de contacto, no usar agua de grifos para lavado de manos, ingesta de agua envasada y desinfección de estanques. Conclusiones: Esta investigación corresponde a un brote nosocomial transmitido por agua potable. La importancia de la calidad del agua en los hospitales de nuestro país es un tema no resuelto, especialmente en áreas que atienden pacientes inmunocomprometidos. Debe asegurarse el cumplimiento de limpieza y desinfección de los sistemas de suministro de agua en los hospitales.

Caracterización clínica, microbiológica y epidemiológica en neonatos con infecciones relacionadas con la atención sanitaria / Clinical, microbiological and epidemiological characterization of neonates with health care-related infections

INTRODUCCIÓN: las infecciones relacionadas con la atención sanitaria representan un problema importante en la etapa neonatal por el compromiso con la mortalidad. OBJETIVO: caracterizar clínica, microbiológica y epidemiológicamente a los neonatos con infecciones relacionadas con la atención sanitaria. MÉTODOS: estudio descriptivo, transversal, retrospectivo, realizado en el Hospital "Eusebio Hernández Pérez" (2007-2014), en 151 neonatos, con análisis de variables epidemiológicas, clínicas y microbiológicas. Se estimaron: tasa de infección, de mortalidad e índice de letalidad, y porcentaje de resistencia antimicrobiana. RESULTADOS: la tasa de infección fue de 3,76 × 100 egresados, la de mortalidad de 1,96 × 100 egresados, y el índice de letalidad de 6,9 × 100 pacientes infectados. Como factores intrínsecos predisponentes se citan la prematuridad (83,1 %) y el bajo peso al nacer (85,6 %); y como extrínsecos, el catéter percutáneo (86,1 %) y la infección sistémica en 50 % de los pacientes. Los microorganismos mayormente aislados fueron: Estafilococo coagulasa negativo (25,3 %), Klebsiella spp. (16,9 %), Candida spp. (13,3 %) y Enterococcus faecalis (10,9 %), que se distribuyen diferentes significativamente (p= 0,000). La resistencia del Estafilococo coagulasa negativo se manifestó en las penicilinas (78,6 %), la eritromicina (63,0 %) y el cefoxitín (35,7 %). CONCLUSIONES: los factores de riesgo conocidos predominantes son la prematuridad, el bajo peso al nacer y el cateterismo percutáneo. Las principales características clínicas y microbiológicas son: la infección sistémica, la identificación de Estafilococo coagulasa negativo resistente a penicilinas, eritromicina y cefoxitìn; y bacilos gramnegativos resistentes a las cefalosporinas y la gentamicina.

INTRODUCTION: health care-related infections represent an important problem in the neonatal phase because of its association with mortality. OBJECTIVE: to characterize neonates with health-care related infections from the clinical, microbiological and epidemiological viewpoints. METHODS: retrospective, cross-sectional and descriptive study of 151 newborns conducted in ¨Eusebio Hernández Pérez¨ hospital from 2007 to 2014, with the analysis of epidemiological, clinical and microbiological variables. The infection rate, the mortality rate and the fatality index, and the antimicrobial resistance percentages were all estimated. RESULTS: the infection rate was 3.76 x 100 discharges; the mortality rate was 1.96 x 100 discharges and the fatality index reached 6.9 x 100 infected patients. Predisposing intrinsic factors were prematurity (83.1 %) and low birthweight (85.6 %) and the extrinsic ones were percutaneous catheter (86.1 %) and systemic infection (50 %) of the patients. The most isolated microorganisms included negative staphylococcus coagulasa (25.3 %), Klebsiella spp. (16.9), Candida spp. (13.3 %) and Enterococcus faecalis (10.9 %), with a significantly different distribution. It was observed that negative Staphylococcus coagulasa was resistant to penicillin (78.6 %), erythromycin (63 %) and cefoxitin (35.7 %). CONCLUSIONS: the predominant risk factors are prematurity, low birth weight and percutaneous catheterism. The main clinical and microbiological characteristics include systemic infections, detection of penicillin, erythromycin and cefoxitin-resistant negative Staphylococcus coagulase and cephalosporin-and gentamycin-resistant Gram-negative bacilli.

Caracterización clínica y epidemiológica de pacientes con bacteriemia en la Unidad de Cuidados Intensivos de Medicina Interna y Cirugía. Hospital Roosevelt-Guatemala / Clinical and epidemiological characterization of patients with bacteremia in the Intensive Care Unit of Internal Medicine and Surgery. Roosevelt Hospital-Guatemala

Antecedentes: La bacteriemia constituye un problema de salud prioritario debido al obstáculo que impone al proceso curativo de los pacientes, involucrando al personal y a los sistemas de salud. Objetivo: Caracterizar clínica y epidemiológicamente pacientes con bacteriemia. Materiales y Métodos: Se realizó una revisión retrospectiva de pacientes con hemocultivos positivo del año 2013, en el Intensivo médico-quirúrgico, del Hospital Roosevelt, con instrumento estandarizado, que incluyó: datos demográficos, morbilidades, comorbilidades, registro de morbilidad y mortalidad. Se calcularon intervalos de confianza al 95% y odds ratio (OR). Resultados: De 47 expedientes y 87 hemocultivos, 55% fueron femeninos, con predominio de edad de 30-49 años, en su mayoría, amas de casa. El 49%, presentó una o más condiciones médicas asociadas. La mayoría de casos de bacteriemia fueron asociados a cuidados de salud, de origen secundario. El principal foco infeccioso fue respiratorio. Los principales microorganismos aislados fueron A. baumannii, K. pneumoniae y S. haemolyticus. Los procedimientos invasivos más frecuentes fueron uso de catéter venoso central y periférico. La tasa de letalidad al día 14 fue del 30%. Conclusiones: Se observó predominio de bacteriemias secundarias, asociadas a los cuidados de la salud, cuyos principales microorganismos aislados coinciden con literatura internacional. La mayor mortalidad fue observada en el sexo femenino.(AU)

Background: Bacteremia known as a major public health problem, because of the limitation it causes to the healing process among patients, involving both health care workers, and health system.Objectives: Characterize the clinical and epidemiological profile among patients with bacteremia.Materials and methods: A retrospective review was made, including positive blood culture patients, admitted to the medical and surgical Intensive Care Unit during 2013, with a standardized instrument which included: demographical data, morbidities and co-morbidities, including a morbidity and morta-lity. The statistics included 95% confidence intervals and odds ratio (OR).Results: Of 47 clinical files, 87 blood cultures, 55% were females. The mostly affected age group was the one within 30-49 years, mainly housewives. 49% presented one or more than one associated con-dition. Most cases of bacteremia were secondary, nosocomial and health care associated. The main origin was the respiratory tract. Main microorganisms isolated were A. baumannii, K. pneumoniae and S. haemolyticus. The most frequent invasive dispositive was central and peripheral venous catheteri-zation. The mortality rate at day 14 was 30%.Conclusions: A predominance of secondary bacteremia, health care associated was observed, who-se main isolated microorganisms agree with international literature. The highest mortality rate was observed in the female sex (AU)

Facility characteristics as independent prognostic factors of nursing home-acquired pneumonia

BACKGROUND/AIMS: Recently, the incidence of nursing home-acquired pneumonia (NHAP) has been increasing and is now the leading cause of death among nursing home residents. This study was performed to identify risk factors associated with NHAP mortality, focusing on facility characteristics. METHODS: Data on all patients > or = 70 years of age admitted with newly diagnosed pneumonia were reviewed. To compare the quality of care in nursing facilities, the following three groups were defined: patients who acquired pneumonia in the community, care homes, and care hospitals. In these patients, 90-day mortality was compared. RESULTS: Survival analyses were performed in 282 patients with pneumonia. In the analyses, 90-day mortality was higher in patients in care homes (12.2%, 40.3%, and 19.6% in community, care homes, and care hospitals, respectively). Among the 118 NHAP patients, residence in a care home, structural lung diseases, treatment with inappropriate antimicrobial agents for accompanying infections, and a high pneumonia severity index score were risk factors associated with higher 90-day mortality. However, infection by potentially drug-resistant pathogens was not important. CONCLUSIONS: Unfavorable institutional factors in care homes are important prognostic factors for NHAP.

Caracterización de aislamientos intrahospitalarios de Klebsiella pneumoniae en un hospital terciario / Characterization of nosocomial isolates of Klebsiella pneumoniae in a tertiary hospital

INTRODUCCIÓN: las enterobacterias son una familia heterogénea de microorganismos que se asocia con relativa frecuencia a infecciones intrahospitalarias y, en el contexto local, ocupan el segundo lugar del mapa microbiano. OBJETIVO: caracterizar fenotípicamente aislamientos de Klebsiella pneumoniae procedentes de pacientes ingresados en el Hospital Clinicoquirúrgico "Hermanos Ameijeiras" en el período 2013-2014. MÉTODOS: se realizó un estudio descriptivo de corte transversal de todos los aislamientos de Klebsiella pneumoniae identificados en el servicio de microbiología de este hospital. Se determinó la susceptibilidad antimicrobiana así como los mecanismos de resistencia a los antibióticos betalactámicos y aminoglucósidos; se clasificaron, además, según los patrones de resistencia. RESULTADOS: en las Unidades de Cuidados Intensivos se encontró el 41,3 % de los aislados seguido de los servicios quirúrgicos que representaron el 32,1 %. Teniendo en cuenta el sitio de obtención de la muestra, el 55,9 % se aisló en los hemocultivos. Los resultados de susceptibilidad mostraron que la ampicillina con el sulbactam constituía el antimicrobiano con mayor porcentaje de resistencia (75,2 %) y en orden decreciente, las cefalosporinas. El grupo de los carbapenémicos (1,8 % y 5,5 % para imipenem y meropenem, respectivamente) y la amikacina (24,7 %) tuvieron bajos porcentajes de resistencia. Los aislamientos con perfiles multidrogorresistentes fueron los más frecuentes (92,1 %) y las enzimas más detectadas, las betalactamasas de espectro extendido frente a betalactámicos y la AAC (3)-VI frente a aminoglucósidos. CONCLUSIONES: en las UCI y en muestras de hemocultivos existe el mayor porcentaje de aislamientos; la ampicillina con el sulbactam mostró los mayores niveles de resistencia y, por el contrario, la amikacina y los carbapenémicos los más bajos. El patrón multidrogorresistente fue el más frecuente, sin relación entre los patrones de resistencia y el sitio de obtención de la muestra o el servicio de procedencia; las betalactamasas de espectro extendido fueron las enzimas que predominaron frente a betalactámicos, y la AAC (3)-VI, frente a los aminoglucósidos lo cual constituye un hecho trascendental: la detección del primer aislamiento Klebsiella pneumoniae productora de carbapenemasa.

INTRODUCTION: enterobacteria are a heterogeneous family of microorganisms that are relatively frequently associated with nosocomial infections and, in the local context, are second in the microbial map. OBJECTIVE: phenotypically characterize Klebsiella pneumoniae isolates from patients admitted to Hermanos Ameijeiras Clinical Hospital drom 2013 to 2014. METHODS: adescriptive cross-sectional study was performed of all Klebsiella pneumoniae isolates identified in this hospital microbiology department. Antimicrobial susceptibility and resistance mechanisms to beta-lactam and aminoglycoside antibiotics were determined; they are further classified according to resistance patterns. RESULTS: 41.3 % of isolates was found at intensive care units, followed by 32.1 % accounted for surgical services. Considering the site of sample collection, 55.9 % was isolated from blood cultures. The results showed that susceptibility to ampicillin sulbactam was the highest percentage of antimicrobial resistance (75.2 %) and in descending order, cephalosporins. Carbapenems group (1.8 % and 5.5 % for imipenem and meropenem, respectively) and amikacin (24.7 %) had low rates of resistance. MDR isolates profiles were the most frequent (92.1%) and the most detected enzymes, extended spectrum beta-lactamases against beta-lactams and AAC (3)-VI against aminoglycosides. CONCLUSIONS: in the ICU and blood cultures there is a higher percentage of isolates; ampicillin with sulbactam showed the highest resistance levels and, conversely, amikacin and carbapenems showed lower. The MDR was the most common pattern, unrelated resistance patterns and site of specimen collection or service of origin. Extended-spectrum beta-lactamase enzymes dominated in comparison to beta-lactams, and AAC (3)-VI, compared to aminoglycosides which is an important fact: the detection of the first insulation KPC.

Brote de infección nosocomial por Serratia marcescens asociado a contaminación intrínseca de clorhexidina acuosa / Outbreak due to Serratia marcescens associated with intrinsic contamination of aqueous chlorhexidine

Serratia marcescens is a widely distributed gram-negative rod, often associated to nosocomial infections. Some outbreaks linked to contaminated antiseptic solutions have been reported. In this study we report a nosocomial outbreak of surgical site infection and catheter insertion site infection due to S. marcescens. 33 patients with positive cultures were studied after an index case was identified. Epidemiological, microbiological and molecular analysis demostrated an intrinsic contamination of alcohol free chlorhexidine solution as causal factor. Positive cultures were associated with 13 clinical infections, 9 colonized patients, 6 pseudobacteremia episodes and 5 patients without documented exposure. Hospital and national recall of contaminated chlorhexidine solution was performed after this study. Intrinsic contamination of antiseptic solutions is an infrequent cause of nosocomial infections with major epidemiological relevance.

Serratia marcescens es un bacilo gramnegativo de amplia distribución, frecuentemente asociado a infecciones nosocomiales. Se han descrito brotes asociados a la contaminación de diversas soluciones antisépticas. Describimos a continuación un brote de infección de sitio operatorio (ISO) y de infección de sitio de inserción de catéter vascular (ISC) por S. marcescens. A raíz de un caso índice se estudió un total de 33 pacientes con cultivo positivo para S. marcescens. El análisis epidemiológico, microbiológico y molecular logró demostrar la contaminación intrínseca de un lote de clorhexidina acuosa, como fuente común de exposición. Las muestras positivas correspondieron a 13 infecciones clínicas, nueve colonizaciones, seis pseudo-bacteriemias y cinco pacientes sin exposición demostrada. Los resultados de este estudio determinaron el retiro del producto de la institución y posteriormente a nivel nacional. La contaminación intrínseca de antisépticos es una causa poco frecuente de brotes de infecciones nosocomiales cuya identificación posee un gran impacto epidemiológico.