Analía Mykietiuk - Academia.edu (original) (raw)
Papers by Analía Mykietiuk
Medicina, 2017
Uncomplicated urinary tract infections rank among the most frequent bacterial infections in women... more Uncomplicated urinary tract infections rank among the most frequent bacterial infections in women in the outpatient setting and represent a major cause of antimicrobial prescription. The aims of this study were to assess frequencies and antimicrobial resistance of current uropathogens causing uncomplicated urinary tract infection. In a prospective multicenter study, patients were recruited in ambulatory settings of four participating hospitals between June 2011 and December 2013. We analyzed 138 patients that met clinical and bacteriological diagnostic criteria. The mean age was 28 years. Cystitis was defined in 70% (n: 97) and pyelonephritis in 30% (n: 41). Frequencies of isolated microorganisms were: Escherichia coli 70% (n: 97), Staphylococcus saprophyticus 17% (n: 24), Proteus spp. 7% (n: 10), Klebsiella spp. 4% (n: 5), Enterococcus spp. and Pseudomonas aeruginosa 1 (0.7%) each. The antimicrobial resistance was: ampicillin-sulbactam 37% (n: 51) cephalexin 28% (n: 39), trimethopr...
The Lancet Infectious Diseases, 2016
Background Community-acquired bacterial pneumonia (CABP) is a leading cause of morbidity and mort... more Background Community-acquired bacterial pneumonia (CABP) is a leading cause of morbidity and mortality, and treatment recommendations, each with specifi c limitations, vary globally. We aimed to compare the effi cacy and safety of solithromycin, a novel macrolide, with moxifl oxacin for treatment of CABP. Methods We did this global, double-blind, double-dummy, randomised, active-controlled, non-inferiority trial at 114 centres in North America, Latin America, Europe, and South Africa. Patients (aged ≥18 years) with clinically and radiographically confi rmed pneumonia of Pneumonia Outcomes Research Team (PORT) risk class II, III, or IV were randomly assigned (1:1), via an internet-based central block randomisation procedure (block size of four), to receive either oral solithromycin (800 mg on day 1, 400 mg on days 2-5, placebo on days 6-7) or oral moxifl oxacin (400 mg on days 1-7). Randomisation was stratifi ed by geographical region, PORT risk class (II vs III or IV), and medical history of asthma or chronic obstructive pulmonary disease. The study sponsor, investigators, staff , and patients were masked to group allocation. The primary outcome was early clinical response, defi ned as an improvement in at least two of four symptoms (cough, chest pain, sputum production, dyspnoea) with no worsening in any symptom at 72 h after the fi rst dose of study drug, with a 10% non-inferiority margin. The primary analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT-01756339. Findings Between Jan 3, 2013, and Sept 24, 2014, we randomly assigned 860 patients to receive solithromycin (n=426) or moxifl oxacin (n=434). Patients were followed up to days 28-35 after fi rst dose. Solithromycin was non-inferior to moxifl oxacin in achievement of early clinical response: 333 (78•2%) patients had an early clinical response in the solithromycin group versus 338 (77•9%) patients in the moxifl oxacin group (diff erence 0•29, 95% CI-5•5 to 6•1). Both drugs had a similar safety profi le. 43 (10%) of 155 treatment-emergent adverse events in the solithromycin group and 54 (13%) of 154 such events in the moxifl oxacin group were deemed to be related to study drug. The most common adverse events, mostly of mild severity, were gastrointestinal disorders, including diarrhoea (18 [4%] patients in the solithromycin group vs 28 [6%] patients in the moxifl oxacin group), nausea (15 [4%] vs 17 [4%] patients) and vomiting (ten [2%] patients in each group); and nervous system disorders, including headache (19 [4%] vs 11 [3%] patients) and dizziness (nine [2%] vs seven [2%] patients). Interpretation Oral solithromycin was non-inferior to oral moxifl oxacin for treatment of patients with CABP, showing the potential to restore macrolide monotherapy for this indication. Funding Cempra.
Medicina, 2012
Upper respiratory tract infections are the most common source of antibiotic prescriptions. Acute ... more Upper respiratory tract infections are the most common source of antibiotic prescriptions. Acute pharyngitis is caused mainly by viruses, viral cases can be distinguished from acute streptococcal pharyngitis using Centor clinical epidemiological criteria, by rapid antigen tests or throat culture. Treatment of choice for streptococcal infection is penicillin V given in two daily doses. In children, acute otitis media (AOM) is the infection for which antibiotics are most often prescribed. Predominant causative pathogens include Streptococcus pneumoniae, Haemophilus influenzae non-type b and Moraxella catarrhalis. Diagnosis is based on history, physical examination and otoscopic exam. Antibiotic treatment should be initiated promptly in all children<2 years of age, and in older children presenting bilateral AOM, otorrhoea, co-morbidities or severe illness. In Argentina, amoxicillin is the drug of choice given the low penicillin resistance rates for S. pneumoniae. In children who fai...
Journal of Antimicrobial Chemotherapy, 2011
†Investigators are listed in the Acknowledgements section. Objectives: Ceftaroline (active form o... more †Investigators are listed in the Acknowledgements section. Objectives: Ceftaroline (active form of the prodrug ceftaroline fosamil) is a novel cephalosporin with activity against pathogens commonly associated with community-acquired pneumonia (CAP), including Streptococcus pneumoniae and Gram-negative pathogens. This randomized, double-blind, Phase III study evaluated the efficacy and safety of ceftaroline fosamil in treating patients with CAP. The primary objective was to determine non-inferiority [lower limit of 95% confidence interval (CI) ≥ 210%] of clinical cure rates achieved with ceftaroline fosamil compared with those achieved with ceftriaxone in the clinically evaluable (CE) and modified intentto-treat efficacy (MITTE) populations. Methods: Patients hospitalized in a non-intensive care unit setting with CAP of Pneumonia Outcomes Research Team (PORT) risk class III or IV requiring intravenous (iv) therapy were randomized (1:1) to receive 600 mg of ceftaroline fosamil iv every 12 h or 1 g of ceftriaxone iv every 24 h. Clinical cure, microbiological response, adverse events (AEs) and laboratory tests were assessed. FOCUS 2 registration number NCT00509106 (http:// clinicaltrials.gov/ct2/show/NCT00509106). Results: The study enrolled 627 patients, 315 of whom received ceftaroline fosamil and 307 of whom received ceftriaxone. Patients in both treatment groups had comparable baseline characteristics. Clinical cure rates were as follows: CE population, 82.1% (193/235) for ceftaroline fosamil and 77.2% (166/215) for ceftriaxone [difference (95% CI), 4.9% (22.5, 12.5)]; and MITTE population, 81.3% (235/289) for ceftaroline fosamil and 75.5% (206/273) for ceftriaxone [difference (95% CI), 5.9% (21.0, 12.7)]. Clinical cure rates for CAP caused by S. pneumoniae in the microbiological MITTE (mMITTE) population were 83.3% (35/42) and 70.0% (28/40) for ceftaroline fosamil and ceftriaxone, respectively. Ceftaroline fosamil and ceftriaxone were well tolerated, with similar rates of AEs, serious AEs, deaths and discontinuations due to an AE. The most common AEs for ceftaroline fosamil-treated patients were diarrhoea, headache, hypokalaemia, insomnia and phlebitis, and the most common AEs for ceftriaxone-treated patients were diarrhoea, insomnia, phlebitis and hypertension. Conclusions: Ceftaroline fosamil achieved high clinical cure and microbiological response rates in patients hospitalized with CAP of PORT risk class III or IV. Ceftaroline fosamil was well tolerated, with a safety profile that is similar to that of ceftriaxone and other cephalosporins. Ceftaroline fosamil is a promising agent for the treatment of CAP.
The Lancet Respiratory Medicine, 2019
Open Forum Infectious Diseases
Background The role of respiratory viruses other than influenza in acute respiratory tract infect... more Background The role of respiratory viruses other than influenza in acute respiratory tract infections (ARTI) among elderly adults has probably been underestimated. Recent advances in molecular diagnosis have made the rapid identification of RSV infection possible.The aim of our study was to assess the role of RSV in patients older than 65 years. Methods Prospective observational study (April 2018–February 2019) conducted in a 137-bed institution in Buenos Aires, Argentina. All consecutive elderly patients (>65 years) admitted with ARTI were included. Clinical and laboratory parameters as well as nasopharyngeal swab for respiratory viruses were obtained. Blood cultures and sputum collection, were analyzed. Viral detection was performed according to CDC real-time RT–PCR assay. All patients underwent clinical follow-up during hospitalization and up to 30 days after discharge. Results A total of 124 patients were recruited (mean age 82 years; range: 65–98) 58% female. Clinical diagno...
![Research paper thumbnail of [Guidelines for management of community-acquired pneumonia in adults]](https://attachments.academia-assets.com/40151122/thumbnails/1.jpg)
](Medicina, 2015
Community-acquired pneumonia in adults is a common cause of morbidity and mortality particularly ... more Community-acquired pneumonia in adults is a common cause of morbidity and mortality particularly in the elderly and in patients with comorbidities. Most episodes are of bacterial origin, Streptococcus pneumoniae is the most frequently isolated pathogen. Epidemiological surveillance provides information about changes in microorganisms and their susceptibility. In recent years there has been an increase in cases caused by community-acquired meticillin resistant Staphylococcus aureus and Legionella sp. The chest radiograph is essential as a diagnostic tool. CURB-65 score and pulse oximetry allow stratifying patients into those who require outpatient care, general hospital room or admission to intensive care unit. Diagnostic studies and empirical antimicrobial therapy are also based on this stratification. The use of biomarkers such as procalcitonin or C-reactive protein is not part of the initial evaluation because its use has not been shown to modify the initial approach. We recommend...
Background: Implementing and maintaining an ACP in a hospital for a long period may be difficult.... more Background: Implementing and maintaining an ACP in a hospital for a long period may be difficult. Herein, we analyze the impact of an ACP on antibiotic (ATB) use and cost savings after 3 years of implementation. Methods: From 03/01 to 12/04, the infectious diseases (ID) faculties at CEMIC prospectively evaluated every ATB prescription made prior to and during implementation of an ACP. The ACP included creation of consensus guidelines for prophylaxis and ATB treatment, involving all medical departments of our institution; daily control of ATB prescriptions; and recommendations by an ID physician to change prescriptions. Ultimately, the attending physician would make a final decision regarding changing the ATB prescription. Funding for this program was allocated to include an ID faculty on the medical staff. Prior to implementing the ACP, an ATB prescription was considered appropriate if it were the standard of care. After the program was started, prescription was considered appropria...
Background: Infections due to MRO are increasing in KT and SPK recipients. Objective: To assess i... more Background: Infections due to MRO are increasing in KT and SPK recipients. Objective: To assess incidence, associated factors and outcome of infections due to MRO in KT and SPK recipients. Methods: Retrospective study in patients with KT and SPK transplantation from January 2004 through December 2007. Clinical and demographic features were collected. Logistic regression was used to identify factors associated with MRO. Results: We included 108 transplant (91 KT and 17 SPK). One hundred and six patients had 182 clinical episodes of infection. Per transplant mean age 46.6 (±12.4) years, female 52%; underlying diseases: 25% unknown etiology, 24% gromerulonephritis, 21% Diabetes (DM), 11% policystic kidney disease. Pathogens were isolated at baseline in 111 episodes among 48 patients; 38 episodes (34%) were caused by MRO. Klebsiella sp, Enterobacter sp, and polimicrobial were the commonly pathogens . Urinary tract infection (UTI) was the most frequent clinical episode (71%) followed by ...
Background: Colistin is a polypeptide antibiotic that was classically associated with neuropathy ... more Background: Colistin is a polypeptide antibiotic that was classically associated with neuropathy and nephrotoxicity. In many instances the emergence of multiresistant Acinetobacter leaves Colistin as the only active antibacterial agent to be used in practice. Recent data indicate that Colistin-related nephrotoxicity may be less frequent than previously thought. Methods: Retrospective cohort of hospitalized adults with infections due to multiresistant Acinetobacter sp who received ≥2 days of Colistin therapy admitted to 2 medical centers in Buenos Aires, Argentina, from March 2002 to February 2006. Renal impairment was defined as a) pre-treatment: creatinine serum level >1.5 mg /dL, and b) post-treatment: increase in ≥ 50% creatinine serum level resulting in an absolute value ≥ 1.5 mg/dL. Results: A total of 54 patients were included. Mean age was 65 (±14) years old, 81% of patients were admitted to ICU, 78% were ventilated and 70% had normal renal function at baseline. Mean serum...
Medicina, 2013
The Argentine Society for Infectious Diseases and other national societies issued updated practic... more The Argentine Society for Infectious Diseases and other national societies issued updated practical guidelines for the management of acute bronchitis (AB) and reactivations of chronic obstructive pulmonary disease (COPD) with the aim of promoting rational use of diagnostic and therapeutic resources. AB is a condition characterized by inflammation of the bronchial airways which affects adults and children without underlying pulmonary disease. It is usually caused by a virus. The diagnosis is based on clinical findings after community acquired pneumonia has been ruled out. Treatment of AB is mainly symptomatic. Antibiotics should be used in immune-compromised hosts, patients with chronic respiratory or cardiac diseases and in the elderly with co-morbidities. Reactivation of COPD is defined as an acute change in the patient's baseline clinical situation beyond normal day to day variations, with an increase in dyspnea, sputum production and/or sputum purulence, warranting a change i...
Scandinavian Journal of Infectious Diseases, 2001
Ritonavir strongly inhibits cytochrome P450, thus altering the metabolism of other drugs. We repo... more Ritonavir strongly inhibits cytochrome P450, thus altering the metabolism of other drugs. We report on an HIV-positive man who, on his 13th day of ritonavir therapy, developed severe ergotism after self-administration of low doses of ergotamine. Drug interactions, the degree of responsibility of the patient and the availability of over-the-counter medications must be considered when prescribing antiretroviral therapy.
Scandinavian Journal of Infectious Diseases, 2009
We retrospectively assessed the renal toxicity associated with the use of intravenous colistin. F... more We retrospectively assessed the renal toxicity associated with the use of intravenous colistin. Fifty-four patients with multidrug-resistant Acinetobacter infections were included. At the end of therapy 6/54 patients (11%) suffered renal impairment. Renal impairment associated with the use of colistin is less frequent than initially reported.
PLoS ONE, 2013
Background: Statins have immunomodulatory properties and hinder Candida growth. However, it is un... more Background: Statins have immunomodulatory properties and hinder Candida growth. However, it is unknown whether they may improve prognosis in patients with candidemia. We sought to determine the effect of prior statin use on the clinical outcomes of patients suffering candidemia.
International Journal of Antimicrobial Agents, 2007
European Journal of Clinical Microbiology and Infections Diseases, 2001
Staphylococcus aureus caused 30 of 438 (7%) cases of bacteremia in neutropenic patients with canc... more Staphylococcus aureus caused 30 of 438 (7%) cases of bacteremia in neutropenic patients with cancer during a 10-year study period. Acute leukemia as an underlying disease and severe oral mucositis were more frequent among patients with Staphylococcus aureus bacteremia (57% vs. 33%, P = 0.01, and 32% vs. 12%, P = 0.006, respectively) than among the 151 patients who had gram-negative bacteremia during the same study period. The most frequent source of Staphylococcus aureus bacteremia was the venous catheter (35% vs. 1%; P = 0.00001). Septic metastases were more frequent in patients with Staphylococcus aureus bacteremia (14% vs. 4%, P = 0.03). Attributable mortality was 10% and overall mortality 23%. Staphylococcus aureus bacteremia remains a significant cause of morbidity and mortality in neutropenic patients with cancer.
European Journal of Clinical Microbiology & Infectious Diseases, 2006
The aim of this study was to evaluate the effect of prior pneumococcal vaccination on the clinica... more The aim of this study was to evaluate the effect of prior pneumococcal vaccination on the clinical outcome of 554 consecutive hospitalized adults with community-acquired pneumococcal pneumonia from 1995 to 2004, 61 of whom had been vaccinated in the 5 years before admission. Outcome variables that were compared in vaccinated and unvaccinated adults included the occurrence of bacteremia, the time to resolution of pneumonia symptoms, the length of hospital stay, and mortality. Prior pneumococcal vaccination was associated with a lower risk of bacteremia (odds ratio 0.46, 95% CI 0.22-0.98). Compared with unvaccinated patients, vaccine recipients had better clinical outcomes, which included a faster resolution of pneumonia symptoms. The median length of hospital stay was shorter in vaccinated patients (8.0 vs. 9.0 days; p=0.032). Overall case-fatality rates did not differ significantly between groups (1.6% vs. 6.2%; p=0.233). In conclusion, prior pneumococcal vaccination appears to be associated with a lower risk of bacteremia, a faster time to resolution of symptoms, and a shorter hospital stay in adults with pneumococcal pneumonia. The findings presented here provide additional support to the current vaccine recommendations and should encourage healthcare providers to increase pneumococcal vaccine coverage among targeted adult populations.
Medicina, 2017
Uncomplicated urinary tract infections rank among the most frequent bacterial infections in women... more Uncomplicated urinary tract infections rank among the most frequent bacterial infections in women in the outpatient setting and represent a major cause of antimicrobial prescription. The aims of this study were to assess frequencies and antimicrobial resistance of current uropathogens causing uncomplicated urinary tract infection. In a prospective multicenter study, patients were recruited in ambulatory settings of four participating hospitals between June 2011 and December 2013. We analyzed 138 patients that met clinical and bacteriological diagnostic criteria. The mean age was 28 years. Cystitis was defined in 70% (n: 97) and pyelonephritis in 30% (n: 41). Frequencies of isolated microorganisms were: Escherichia coli 70% (n: 97), Staphylococcus saprophyticus 17% (n: 24), Proteus spp. 7% (n: 10), Klebsiella spp. 4% (n: 5), Enterococcus spp. and Pseudomonas aeruginosa 1 (0.7%) each. The antimicrobial resistance was: ampicillin-sulbactam 37% (n: 51) cephalexin 28% (n: 39), trimethopr...
The Lancet Infectious Diseases, 2016
Background Community-acquired bacterial pneumonia (CABP) is a leading cause of morbidity and mort... more Background Community-acquired bacterial pneumonia (CABP) is a leading cause of morbidity and mortality, and treatment recommendations, each with specifi c limitations, vary globally. We aimed to compare the effi cacy and safety of solithromycin, a novel macrolide, with moxifl oxacin for treatment of CABP. Methods We did this global, double-blind, double-dummy, randomised, active-controlled, non-inferiority trial at 114 centres in North America, Latin America, Europe, and South Africa. Patients (aged ≥18 years) with clinically and radiographically confi rmed pneumonia of Pneumonia Outcomes Research Team (PORT) risk class II, III, or IV were randomly assigned (1:1), via an internet-based central block randomisation procedure (block size of four), to receive either oral solithromycin (800 mg on day 1, 400 mg on days 2-5, placebo on days 6-7) or oral moxifl oxacin (400 mg on days 1-7). Randomisation was stratifi ed by geographical region, PORT risk class (II vs III or IV), and medical history of asthma or chronic obstructive pulmonary disease. The study sponsor, investigators, staff , and patients were masked to group allocation. The primary outcome was early clinical response, defi ned as an improvement in at least two of four symptoms (cough, chest pain, sputum production, dyspnoea) with no worsening in any symptom at 72 h after the fi rst dose of study drug, with a 10% non-inferiority margin. The primary analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT-01756339. Findings Between Jan 3, 2013, and Sept 24, 2014, we randomly assigned 860 patients to receive solithromycin (n=426) or moxifl oxacin (n=434). Patients were followed up to days 28-35 after fi rst dose. Solithromycin was non-inferior to moxifl oxacin in achievement of early clinical response: 333 (78•2%) patients had an early clinical response in the solithromycin group versus 338 (77•9%) patients in the moxifl oxacin group (diff erence 0•29, 95% CI-5•5 to 6•1). Both drugs had a similar safety profi le. 43 (10%) of 155 treatment-emergent adverse events in the solithromycin group and 54 (13%) of 154 such events in the moxifl oxacin group were deemed to be related to study drug. The most common adverse events, mostly of mild severity, were gastrointestinal disorders, including diarrhoea (18 [4%] patients in the solithromycin group vs 28 [6%] patients in the moxifl oxacin group), nausea (15 [4%] vs 17 [4%] patients) and vomiting (ten [2%] patients in each group); and nervous system disorders, including headache (19 [4%] vs 11 [3%] patients) and dizziness (nine [2%] vs seven [2%] patients). Interpretation Oral solithromycin was non-inferior to oral moxifl oxacin for treatment of patients with CABP, showing the potential to restore macrolide monotherapy for this indication. Funding Cempra.
Medicina, 2012
Upper respiratory tract infections are the most common source of antibiotic prescriptions. Acute ... more Upper respiratory tract infections are the most common source of antibiotic prescriptions. Acute pharyngitis is caused mainly by viruses, viral cases can be distinguished from acute streptococcal pharyngitis using Centor clinical epidemiological criteria, by rapid antigen tests or throat culture. Treatment of choice for streptococcal infection is penicillin V given in two daily doses. In children, acute otitis media (AOM) is the infection for which antibiotics are most often prescribed. Predominant causative pathogens include Streptococcus pneumoniae, Haemophilus influenzae non-type b and Moraxella catarrhalis. Diagnosis is based on history, physical examination and otoscopic exam. Antibiotic treatment should be initiated promptly in all children<2 years of age, and in older children presenting bilateral AOM, otorrhoea, co-morbidities or severe illness. In Argentina, amoxicillin is the drug of choice given the low penicillin resistance rates for S. pneumoniae. In children who fai...
Journal of Antimicrobial Chemotherapy, 2011
†Investigators are listed in the Acknowledgements section. Objectives: Ceftaroline (active form o... more †Investigators are listed in the Acknowledgements section. Objectives: Ceftaroline (active form of the prodrug ceftaroline fosamil) is a novel cephalosporin with activity against pathogens commonly associated with community-acquired pneumonia (CAP), including Streptococcus pneumoniae and Gram-negative pathogens. This randomized, double-blind, Phase III study evaluated the efficacy and safety of ceftaroline fosamil in treating patients with CAP. The primary objective was to determine non-inferiority [lower limit of 95% confidence interval (CI) ≥ 210%] of clinical cure rates achieved with ceftaroline fosamil compared with those achieved with ceftriaxone in the clinically evaluable (CE) and modified intentto-treat efficacy (MITTE) populations. Methods: Patients hospitalized in a non-intensive care unit setting with CAP of Pneumonia Outcomes Research Team (PORT) risk class III or IV requiring intravenous (iv) therapy were randomized (1:1) to receive 600 mg of ceftaroline fosamil iv every 12 h or 1 g of ceftriaxone iv every 24 h. Clinical cure, microbiological response, adverse events (AEs) and laboratory tests were assessed. FOCUS 2 registration number NCT00509106 (http:// clinicaltrials.gov/ct2/show/NCT00509106). Results: The study enrolled 627 patients, 315 of whom received ceftaroline fosamil and 307 of whom received ceftriaxone. Patients in both treatment groups had comparable baseline characteristics. Clinical cure rates were as follows: CE population, 82.1% (193/235) for ceftaroline fosamil and 77.2% (166/215) for ceftriaxone [difference (95% CI), 4.9% (22.5, 12.5)]; and MITTE population, 81.3% (235/289) for ceftaroline fosamil and 75.5% (206/273) for ceftriaxone [difference (95% CI), 5.9% (21.0, 12.7)]. Clinical cure rates for CAP caused by S. pneumoniae in the microbiological MITTE (mMITTE) population were 83.3% (35/42) and 70.0% (28/40) for ceftaroline fosamil and ceftriaxone, respectively. Ceftaroline fosamil and ceftriaxone were well tolerated, with similar rates of AEs, serious AEs, deaths and discontinuations due to an AE. The most common AEs for ceftaroline fosamil-treated patients were diarrhoea, headache, hypokalaemia, insomnia and phlebitis, and the most common AEs for ceftriaxone-treated patients were diarrhoea, insomnia, phlebitis and hypertension. Conclusions: Ceftaroline fosamil achieved high clinical cure and microbiological response rates in patients hospitalized with CAP of PORT risk class III or IV. Ceftaroline fosamil was well tolerated, with a safety profile that is similar to that of ceftriaxone and other cephalosporins. Ceftaroline fosamil is a promising agent for the treatment of CAP.
The Lancet Respiratory Medicine, 2019
Open Forum Infectious Diseases
Background The role of respiratory viruses other than influenza in acute respiratory tract infect... more Background The role of respiratory viruses other than influenza in acute respiratory tract infections (ARTI) among elderly adults has probably been underestimated. Recent advances in molecular diagnosis have made the rapid identification of RSV infection possible.The aim of our study was to assess the role of RSV in patients older than 65 years. Methods Prospective observational study (April 2018–February 2019) conducted in a 137-bed institution in Buenos Aires, Argentina. All consecutive elderly patients (>65 years) admitted with ARTI were included. Clinical and laboratory parameters as well as nasopharyngeal swab for respiratory viruses were obtained. Blood cultures and sputum collection, were analyzed. Viral detection was performed according to CDC real-time RT–PCR assay. All patients underwent clinical follow-up during hospitalization and up to 30 days after discharge. Results A total of 124 patients were recruited (mean age 82 years; range: 65–98) 58% female. Clinical diagno...
Medicina, 2015
Community-acquired pneumonia in adults is a common cause of morbidity and mortality particularly ... more Community-acquired pneumonia in adults is a common cause of morbidity and mortality particularly in the elderly and in patients with comorbidities. Most episodes are of bacterial origin, Streptococcus pneumoniae is the most frequently isolated pathogen. Epidemiological surveillance provides information about changes in microorganisms and their susceptibility. In recent years there has been an increase in cases caused by community-acquired meticillin resistant Staphylococcus aureus and Legionella sp. The chest radiograph is essential as a diagnostic tool. CURB-65 score and pulse oximetry allow stratifying patients into those who require outpatient care, general hospital room or admission to intensive care unit. Diagnostic studies and empirical antimicrobial therapy are also based on this stratification. The use of biomarkers such as procalcitonin or C-reactive protein is not part of the initial evaluation because its use has not been shown to modify the initial approach. We recommend...
Background: Implementing and maintaining an ACP in a hospital for a long period may be difficult.... more Background: Implementing and maintaining an ACP in a hospital for a long period may be difficult. Herein, we analyze the impact of an ACP on antibiotic (ATB) use and cost savings after 3 years of implementation. Methods: From 03/01 to 12/04, the infectious diseases (ID) faculties at CEMIC prospectively evaluated every ATB prescription made prior to and during implementation of an ACP. The ACP included creation of consensus guidelines for prophylaxis and ATB treatment, involving all medical departments of our institution; daily control of ATB prescriptions; and recommendations by an ID physician to change prescriptions. Ultimately, the attending physician would make a final decision regarding changing the ATB prescription. Funding for this program was allocated to include an ID faculty on the medical staff. Prior to implementing the ACP, an ATB prescription was considered appropriate if it were the standard of care. After the program was started, prescription was considered appropria...
Background: Infections due to MRO are increasing in KT and SPK recipients. Objective: To assess i... more Background: Infections due to MRO are increasing in KT and SPK recipients. Objective: To assess incidence, associated factors and outcome of infections due to MRO in KT and SPK recipients. Methods: Retrospective study in patients with KT and SPK transplantation from January 2004 through December 2007. Clinical and demographic features were collected. Logistic regression was used to identify factors associated with MRO. Results: We included 108 transplant (91 KT and 17 SPK). One hundred and six patients had 182 clinical episodes of infection. Per transplant mean age 46.6 (±12.4) years, female 52%; underlying diseases: 25% unknown etiology, 24% gromerulonephritis, 21% Diabetes (DM), 11% policystic kidney disease. Pathogens were isolated at baseline in 111 episodes among 48 patients; 38 episodes (34%) were caused by MRO. Klebsiella sp, Enterobacter sp, and polimicrobial were the commonly pathogens . Urinary tract infection (UTI) was the most frequent clinical episode (71%) followed by ...
Background: Colistin is a polypeptide antibiotic that was classically associated with neuropathy ... more Background: Colistin is a polypeptide antibiotic that was classically associated with neuropathy and nephrotoxicity. In many instances the emergence of multiresistant Acinetobacter leaves Colistin as the only active antibacterial agent to be used in practice. Recent data indicate that Colistin-related nephrotoxicity may be less frequent than previously thought. Methods: Retrospective cohort of hospitalized adults with infections due to multiresistant Acinetobacter sp who received ≥2 days of Colistin therapy admitted to 2 medical centers in Buenos Aires, Argentina, from March 2002 to February 2006. Renal impairment was defined as a) pre-treatment: creatinine serum level >1.5 mg /dL, and b) post-treatment: increase in ≥ 50% creatinine serum level resulting in an absolute value ≥ 1.5 mg/dL. Results: A total of 54 patients were included. Mean age was 65 (±14) years old, 81% of patients were admitted to ICU, 78% were ventilated and 70% had normal renal function at baseline. Mean serum...
Medicina, 2013
The Argentine Society for Infectious Diseases and other national societies issued updated practic... more The Argentine Society for Infectious Diseases and other national societies issued updated practical guidelines for the management of acute bronchitis (AB) and reactivations of chronic obstructive pulmonary disease (COPD) with the aim of promoting rational use of diagnostic and therapeutic resources. AB is a condition characterized by inflammation of the bronchial airways which affects adults and children without underlying pulmonary disease. It is usually caused by a virus. The diagnosis is based on clinical findings after community acquired pneumonia has been ruled out. Treatment of AB is mainly symptomatic. Antibiotics should be used in immune-compromised hosts, patients with chronic respiratory or cardiac diseases and in the elderly with co-morbidities. Reactivation of COPD is defined as an acute change in the patient's baseline clinical situation beyond normal day to day variations, with an increase in dyspnea, sputum production and/or sputum purulence, warranting a change i...
Scandinavian Journal of Infectious Diseases, 2001
Ritonavir strongly inhibits cytochrome P450, thus altering the metabolism of other drugs. We repo... more Ritonavir strongly inhibits cytochrome P450, thus altering the metabolism of other drugs. We report on an HIV-positive man who, on his 13th day of ritonavir therapy, developed severe ergotism after self-administration of low doses of ergotamine. Drug interactions, the degree of responsibility of the patient and the availability of over-the-counter medications must be considered when prescribing antiretroviral therapy.
Scandinavian Journal of Infectious Diseases, 2009
We retrospectively assessed the renal toxicity associated with the use of intravenous colistin. F... more We retrospectively assessed the renal toxicity associated with the use of intravenous colistin. Fifty-four patients with multidrug-resistant Acinetobacter infections were included. At the end of therapy 6/54 patients (11%) suffered renal impairment. Renal impairment associated with the use of colistin is less frequent than initially reported.
PLoS ONE, 2013
Background: Statins have immunomodulatory properties and hinder Candida growth. However, it is un... more Background: Statins have immunomodulatory properties and hinder Candida growth. However, it is unknown whether they may improve prognosis in patients with candidemia. We sought to determine the effect of prior statin use on the clinical outcomes of patients suffering candidemia.
International Journal of Antimicrobial Agents, 2007
European Journal of Clinical Microbiology and Infections Diseases, 2001
Staphylococcus aureus caused 30 of 438 (7%) cases of bacteremia in neutropenic patients with canc... more Staphylococcus aureus caused 30 of 438 (7%) cases of bacteremia in neutropenic patients with cancer during a 10-year study period. Acute leukemia as an underlying disease and severe oral mucositis were more frequent among patients with Staphylococcus aureus bacteremia (57% vs. 33%, P = 0.01, and 32% vs. 12%, P = 0.006, respectively) than among the 151 patients who had gram-negative bacteremia during the same study period. The most frequent source of Staphylococcus aureus bacteremia was the venous catheter (35% vs. 1%; P = 0.00001). Septic metastases were more frequent in patients with Staphylococcus aureus bacteremia (14% vs. 4%, P = 0.03). Attributable mortality was 10% and overall mortality 23%. Staphylococcus aureus bacteremia remains a significant cause of morbidity and mortality in neutropenic patients with cancer.
European Journal of Clinical Microbiology & Infectious Diseases, 2006
The aim of this study was to evaluate the effect of prior pneumococcal vaccination on the clinica... more The aim of this study was to evaluate the effect of prior pneumococcal vaccination on the clinical outcome of 554 consecutive hospitalized adults with community-acquired pneumococcal pneumonia from 1995 to 2004, 61 of whom had been vaccinated in the 5 years before admission. Outcome variables that were compared in vaccinated and unvaccinated adults included the occurrence of bacteremia, the time to resolution of pneumonia symptoms, the length of hospital stay, and mortality. Prior pneumococcal vaccination was associated with a lower risk of bacteremia (odds ratio 0.46, 95% CI 0.22-0.98). Compared with unvaccinated patients, vaccine recipients had better clinical outcomes, which included a faster resolution of pneumonia symptoms. The median length of hospital stay was shorter in vaccinated patients (8.0 vs. 9.0 days; p=0.032). Overall case-fatality rates did not differ significantly between groups (1.6% vs. 6.2%; p=0.233). In conclusion, prior pneumococcal vaccination appears to be associated with a lower risk of bacteremia, a faster time to resolution of symptoms, and a shorter hospital stay in adults with pneumococcal pneumonia. The findings presented here provide additional support to the current vaccine recommendations and should encourage healthcare providers to increase pneumococcal vaccine coverage among targeted adult populations.