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Papers by Liliana Clara
[Argentine Intersociety Consensus on Urinary Infection 2018-2019 - Part II]
Medicina, 2020
The second part of the Inter-Society Argentine Consensus on Urinary Tract Infection (UTI) include... more The second part of the Inter-Society Argentine Consensus on Urinary Tract Infection (UTI) includes the analysis of special situations. In patients with urinary catheter, urine culture should be requested only in the presence of UTI symptomatology, before instrumentation of the urinary tract, or as a post-transplant control. The antibiotics recommended for empirical treatment in patients without risk factors are third-generation cephalosporins or aminoglycosides. UTIs associated with stones are always considered complicated. In case of obstruction with urosepsis, an emergency drainage should be performed via a percutaneous nefrostomy or ureteral stenting. In patients with stents or ureteral prostheses, such as double J catheters, empirical treatment should be based on epidemiology, prior antibiotics, and clinical status. Before the extracorporeal lithotripsy procedure, bacteriuria should be investigated and antibiotic prophylaxis should be administered in case of positive result, acc...
Report of two events of nosocomial outbreak and pseudo-outbreak due to contamination with Achromobacter spp
Revista Argentina de Microbiología, 2022
Achromobacter spp. are increasingly recognized as emerging pathogens in immunocompromised patient... more Achromobacter spp. are increasingly recognized as emerging pathogens in immunocompromised patients or suffering cystic fibrosis, but unusual in immunocompetent hosts or individuals that underwent surgery. In this study we describe two simultaneous events attributable to two different Achromobacter spp. contaminated sources. One event was related to an episode of pseudo-bacteremia due to sodium citrate blood collection tubes contaminated with Achromobacter insuavis and the other to Achromobacter genogroup 20 infection and colonization caused by an intrinsically contaminated chlorhexidine soap solution. Both threatened the appropriate use of antimicrobials. Molecular approaches were critical to achieving the accurate species identification and to assess the clonal relationship, strengthening the need for dedicated, multidisciplinary and collaborative work of microbiologists, specialists in infectious diseases, epidemiologists and nurses in the control of infections to clarify these epidemiological situations.
Revista Panamericana de Salud Pública, 2020
Objetivo. Evaluar el nivel de adherencia a las guías de profilaxis quirúrgica (AG) en institucion... more Objetivo. Evaluar el nivel de adherencia a las guías de profilaxis quirúrgica (AG) en instituciones de salud de Argentina y los determinantes de la falta de adherencia (NA). Métodos. Estudio multicéntrico de corte transversal en 35 centros de Argentina. Se determinaron el nivel de AG y las formas de NA y se comparó según características de la indicación antibiótica, anestesista, cirugía, institución y edad del paciente. Se ajustó un modelo de regresión logística. Resultados. Se revisaron 1 083 procedimientos quirúrgicos (PQ). La AG fue de 67%. Las formas más frecuentes de NA fueron: antibiótico incorrecto (28,9%), profilaxis innecesaria (25,5%) y profilaxis prolongada (24,4%). La AG fue mayor en menores de 18 años (84,9% frente a 65,5%, P < 0,001); según la dependencia (obra social, privada, pública o comunitaria) fue de 33,3%, 64,4%, 78,8% y 83,3%, respectivamente; P < 0,001) y según la población (maternoinfantil, pediátrica, con patología específica y general) fue de 97,9%, ...
Revista del Hospital Italiano de Buenos Aires
Introducción: el impacto de la resistencia antimicrobiana (RAM) generará un aumento de las muerte... more Introducción: el impacto de la resistencia antimicrobiana (RAM) generará un aumento de las muertes relacionadas de 10 millones anuales hacia 2050. El 70% de la dispensación de antimicrobianos (ATB) se utiliza en la agroveterinaria y no en salud humana. Es fundamental conocer la portación de RAM en trabajadores de cría de animales y en los animales, para acciones tempranas de salud pública. Métodos: bajo metodología PRISMA se realizó la búsqueda bibliográfica en distintas fuentes disponibles hasta octubre de 2020. Se priorizaron revisiones sistemáticas, metanálisis, ensayos clínicos y estudios observacionales para determinar la RAM en trabajadores de cría de cerdos. De 990 artículos identificados se incluyeron 8 estudios. Resultados: la tasa de colonización por Staphylococcus aureus resistente a la meticilina (SAMR) en trabajadores fue mayor que la de la población general. La prevalencia de SAMR fue significativamente mayor en trabajadores en contacto directo con animales y los de gr...
International Journal of Infectious Diseases, 2018
Background: The treatment of intrabdominal infections are empirically performed on the basis of e... more Background: The treatment of intrabdominal infections are empirically performed on the basis of existing epidemiological data. There are data in Argentine that present an increased resistance more than 30% to Ciprofloxacin and Ampicilin/sulbactam in E. coli and K. pneumoniae. The following study is performed in order to know the etiology and antimicrobial resistance in our region. Methods & Materials: Retrospective, descriptive and observational study. The patients included not only had intraabdominal infection diagnosis but also any kind of surgery in order to control the source in the "Hospital Escuela de Agudos Dr. Ramón Madariaga" with positive aerobic bacteriological results between January 1st, 2016 and December 31st, 2016. Data were analyzed by the statistical support of IBM SPSS statistics v. 19.0. Epidemic registries were done. The analysis of bacteriological samples were developed in the "Laboratorio Nacional de Referencia del Instituto Carlos Malbrán (LNR)". Results: There were analyzed 69 intrabdominal infections, 59 acute appendicitis, male 45/69 (65.2%), middle aged 41 (15-86), comorbidities 23/69 (33%), previous use of antibiotics 10/69 (14.5%), previous hospital admission 4/69 (5.8%). The empirical treatment used was based on one drug with activity against aerobic pathogens in 68 cases (98.6%). The most frequent active drugs used were ciprofloxacin plus metronidazole 62/69 (89.9%) and ampicillin/sulbactam 4/69 (5.8%). 94 aerobic bacterias were isolated (1.4 bacterias/episodes), gram negative bacteria 82/94 (87.2%), Escherichia coli 55/94 (58.5%), Klebsiella pneumonia 10/94 (10.6%) and Pseudomonas aeruginosa 8/94 (8.5%). The resistance profile of the enterobacterias was ampicillin/sulbactam 27/69 (39%), ciprofloxacin 18/70 (26%), gentamicin 8/71 (11%), cefotaxime 4/71(6%) and piperacillin/tazobactam 3/71 (4%). In E. coli was ampicillin/sulbactam 23/55(42%), ciprofloxacin 15/55 (28%), gentamicin 6/53 (11%), amikacin 1/28 (4%), piperacillin/tazobactam 1/55 (2%) and cefotaxime 2/55(4%). In K. pneumoniae was ampicillin/sulbactam 3/10 (30%), ciprofloxacin 3/10 (30%), gentamicin 2/10(20%), piperacillin/tazobactam 2/10 (20%), cefotaxime 2/10 (20%), amikacin 0/5 (0%). There were no resistant in P. aeruginosa. Beta lactamase of extended spectrum 4/71.
International Journal of Infectious Diseases, 2018
Background: Salmonella is a Gram negative bacteria that colonizes the intestinal tract of humans ... more Background: Salmonella is a Gram negative bacteria that colonizes the intestinal tract of humans and animals. Infections with S. Enteritca are of great concern to the public health, being one of the main causes of foodborne diseases in Chile and the world. Wild birds are of increasing importance to public health, because of their association with highly transmisible zoonotic pathogens, and their hability to disseminate them. In this work, the S. Enteritis strains isolated from different hosts were charactherized to enlighten the human-animal interfase of this bacteria in Chile. Phenotypic assays were done to determine the pathogenic potential of the isolates of Salmonella of different hosts. Methods & Materials: In this work we determined the oxidative stress survival (H 2 O 2 15 mM and NaNO 2 10 mM), acidic pH (pH3), starvation (D10 and D20) and antimicrobial susceptibility of 90 S. Enteritidis strains, isolated from poultry, shore birds and humans from different regions of the country, comparing between each strain and among hosts. The statistical analysis were done with InfostatÒ software. Results: The results show that there is statistical differences among the studied strains in all stress survival assays. When analyzed by host, significant differences (p < 0.05) were found in starvation assays (D10 and D20). No differences were found in the oxidative stress and acidic pH assays when grouped by host. When analyzing antimicrobial susceptibility, most of the strains have resistance to at least one antimicrobial. The strains isolated from shore birds had a high resistance to tetracycline (73,3%), human strains had a higher resistance to sulfisoxazol (40%) and in poultry the highest resistance was for nalidixic acid (43,3%). We detected multiresistance in the 36,7% of the strains, most of which came from shore birds (42,4%). Finally, grouped by host, there are no differences (p > 0.05) in the presentation of the resistance. Conclusion: Shore birds can be reservoirs of Salmonella strains with potential risk to public and animal health, and could partially explain the progressive rise in the incidence of these serotypeassociated outbreaks. There is a high resistance rate of AM commonly use in Chile, which justifies monitoring these hosts as bio-indicators of AM resistance spread in the environment.
Liver Transplantation, 2005
Chagas' disease is an endemic zoonosis of South America caused by a protozoan parasite Trypanosom... more Chagas' disease is an endemic zoonosis of South America caused by a protozoan parasite Trypanosoma cruzi. About 30% of infected people develop the disease. This disease is known to reactivate in immunocompromised hosts, such as patients with acquired immunodeficiency syndrome, leukemia, and transplantation. There is some experience with transplantation of infected renal grafts into negative recipients, resulting in an index of transmission of 35%. No cases have been reported involving other organ transplants up to 2002, when the Centers for Disease Control and Prevention reported 3 cases of Chagas' disease transmission to 3 recipients (liver, kidney, and pancreas-kidney) from a single chagas infected donor. Here we report on a case of orthotopic liver transplant from a chagas infected donor into a negative recipient in clinical emergency status. The recipient was monitored by direct parasitological Strout method and serological tests with detection of transmission on the 84th day by both studies, without clinical signs. The patient was put on benznidazole with rapid clearance of the parasitemia. However, we propose that chagas infected donors may be accepted for liver transplant recipients only in emergency status. (Liver Transpl 2005;11:1112-1116.) C hagas' disease is an endemic zoonosis of South America, although the parasite exists from the south of the United States to the southernmost end of Argentina. Ninety million people are estimated to live in endemic areas at risk for infection, and 25% of them are considered to be infected.
Enfisema subcutáneo cervico-facial y mediastinal post-extracción dentaria. Presentación de caso y revisión de la literatura
Nexo Rev Hosp Ital B Aires, Dec 1, 1998
92 Infections in liver transplantation for HCV cirrhosis
Liver Transplantation, 2000
85 Chagas disease in liver transplant recipients: No evidence of reactivation
Liver Transplantation, 2000
[Consensus guidelines for the management of upper respiratory tract infections]
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...
Antibioticoterapia en estadios finales de la vida
Introduction: The indiscriminate use of antibiotics is associated with increased resistance. In t... more Introduction: The indiscriminate use of antibiotics is associated with increased resistance. In the care of patients in late stages of advanced diseases, antibiotic management is the subject of multiple controversies. In this review we will evaluate the published evidence on this topic, based on the answer to three questions: why are antibiotics indicated in terminal patients? What are the potential consequences? Is there a single perspective? Discussion: The indication of antibiotics in the final stages of life is often due to doctors' insecurity regarding the advantages and disadvantages of their use in this scenario, patient and family preferences, possibility of comfort or symptom control, and fear of legal problems. However, the benefit of antibiotics in symptom control or their impact on survival is not clear. Conclusions: The SADI Appropriate Use of Resources Commission proposes to analyze in each case: 1) The decision of prescribing antibiotics must be taken together wit...
Medicina, 1999
Resumen La trovafloxacina se absorbe rápidamente después de su administración oral y llega a su c... more Resumen La trovafloxacina se absorbe rápidamente después de su administración oral y llega a su concentración sérica máxima alrededor de una hora. La alatrofloxacina es la prodroga que, al administrarse por vía endovenosa, se hidroliza rápidamente a su estado original. La biodisponibilidad es equivalente cuando se administra por vía oral o endovenosa. La trovafloxacina es una fluoroquinolona de amplio espectro in vitro, con mayor actividad para cocos positivos, anaerobios y para bacterias productoras de neumonías atípicas. Presenta una vida media cercana a las 11 horas y una mayor unión proteica, lo que permite su dosificación única diaria. La excreción renal es inferior al 8% y no requiere ajuste de dosis en la insuficiencia renal. La trovafloxacina alcanza mayores concentraciones tisulares e intracelulares que las fluoroquinolonas clásicas. Todas estas características farmacocinéticas y farmacodinámicas permiten considerarla como una droga de posible aplicación para el tratamiento de infecciones mixtas o resistentes a drogas de primera línea.
revista.hospitalitaliano.org.ar
Inés Sammartino, Ana Laura Torlaschi, María Victoria Schang, Martín Silveira, Ingrid Andrés, Leon... more Inés Sammartino, Ana Laura Torlaschi, María Victoria Schang, Martín Silveira, Ingrid Andrés, Leonardo Garfi, Diego Giunta, Liliana Clara y ... De todas maneras solo el 21% se medicó y nin-guno refirió complicaciones graves (síndrome de Guillain-Barré, encefalitis, convulsiones ...
Transplant Infectious Disease - TRANSPL INFECT DIS, 2002
Toxoplasmosis is an infrequent infection in solid organ transplantation, except in heart transpla... more Toxoplasmosis is an infrequent infection in solid organ transplantation, except in heart transplantation, where the grafting of a positive organ in a negative recipient transmits the infection in a high percentage of cases, in the absence of prophylaxis. We report a case of pneumonia by Toxoplasma gondii in a woman who received a liver transplant and had pre-transplant positive serology. Diagnosis was made by cytologic examination of bronchoalveolar lavage fluid, where the parasite was observed with hematoxylin±eosin and Giemsa staining. That finding was confirmed by direct immunofluorescence and positive polymerase chain reaction. The patient had a favorable outcome, although she had not initially received firstchoice drugs. This was a case of severe illness secondary to reactivation of Toxoplasma infection, diagnosed pre-mortem and with a favorable outcome. Duration of treatment and need for secondary prophylaxis in these patients are discussed in the literature. Although infrequent, toxoplasmosis must be considered among the differential diagnoses of pulmonary infiltrates in solid organ transplantation.
[Inter-society consensus for the management of respiratory infections: acute bronchitis and chronic obstructive pulmonary disease]
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...
Revista chilena de infectología, 2002
We report the results of a case-control study of post-surgical mediastinitis, that we conducted f... more We report the results of a case-control study of post-surgical mediastinitis, that we conducted for eighteen months. The aim of the study was to detect possible risk factors for mediastinal infection after cardiovascular surgery as well as to analyze related clinical features. Thirty episodes of mediastinal infections over 687 consecutive cardiovascular surgeries (4,4%) were registered during a control period of 18 month at Hospital Italiano of Buenos Aires, Argentina. Among all variables analyzed only the following were significantly associated to mediastinal infection in the postoperative period: time elapsed at the recovery unit (p < 0.01) total time with catheter placed in the pulmonary artery (p: 0.05) and the rate of postoperative complications (p < 0.01). Six patients with mediastinal infection (20%) had undergone reoperation shortly after main surgery compared to only 3 (5%) in the control group (p: 0.05). The association with surgical events may be related to post-surgical causation. The presence of fever, only after 72 hours from surgery, allowed discrimination between patients with and without mediastinal infection. All case patients showed abnormalities in surgical wound, and 28 of these patients (93%) had at least two local signs of infection. Among the 37 types of microorganisms isolated from sternal secretion, 22 (59%) were gram-positive cocci, with Staphylococcus as the predominant genus. While 40% of the recovered gram-positive bacteria were methicillin-resistant, only 50% of the gram-negative bacteria were sensitive to aminoglycosides and ceftazidime. The in-hospital time was significantly longer in patients with mediastinitis compared to control patients (p < 0.001). The mortality rate inpatients mediastinitis was 33%. In conclusion, mediastinal infection actually remains representing a severe and costly complication of cardiovascular surgery due to its high morbidity and mortality rates.
Liver Transplantation, 2005
91 Incidence of infections in liver transplantation due to fulminant hepatitis
Liver Transplantation, 2000
85 Chagas disease in liver transplant recipients: No evidence of reactivation
Liver Transplantation, 2000
[Argentine Intersociety Consensus on Urinary Infection 2018-2019 - Part II]
Medicina, 2020
The second part of the Inter-Society Argentine Consensus on Urinary Tract Infection (UTI) include... more The second part of the Inter-Society Argentine Consensus on Urinary Tract Infection (UTI) includes the analysis of special situations. In patients with urinary catheter, urine culture should be requested only in the presence of UTI symptomatology, before instrumentation of the urinary tract, or as a post-transplant control. The antibiotics recommended for empirical treatment in patients without risk factors are third-generation cephalosporins or aminoglycosides. UTIs associated with stones are always considered complicated. In case of obstruction with urosepsis, an emergency drainage should be performed via a percutaneous nefrostomy or ureteral stenting. In patients with stents or ureteral prostheses, such as double J catheters, empirical treatment should be based on epidemiology, prior antibiotics, and clinical status. Before the extracorporeal lithotripsy procedure, bacteriuria should be investigated and antibiotic prophylaxis should be administered in case of positive result, acc...
Report of two events of nosocomial outbreak and pseudo-outbreak due to contamination with Achromobacter spp
Revista Argentina de Microbiología, 2022
Achromobacter spp. are increasingly recognized as emerging pathogens in immunocompromised patient... more Achromobacter spp. are increasingly recognized as emerging pathogens in immunocompromised patients or suffering cystic fibrosis, but unusual in immunocompetent hosts or individuals that underwent surgery. In this study we describe two simultaneous events attributable to two different Achromobacter spp. contaminated sources. One event was related to an episode of pseudo-bacteremia due to sodium citrate blood collection tubes contaminated with Achromobacter insuavis and the other to Achromobacter genogroup 20 infection and colonization caused by an intrinsically contaminated chlorhexidine soap solution. Both threatened the appropriate use of antimicrobials. Molecular approaches were critical to achieving the accurate species identification and to assess the clonal relationship, strengthening the need for dedicated, multidisciplinary and collaborative work of microbiologists, specialists in infectious diseases, epidemiologists and nurses in the control of infections to clarify these epidemiological situations.
Revista Panamericana de Salud Pública, 2020
Objetivo. Evaluar el nivel de adherencia a las guías de profilaxis quirúrgica (AG) en institucion... more Objetivo. Evaluar el nivel de adherencia a las guías de profilaxis quirúrgica (AG) en instituciones de salud de Argentina y los determinantes de la falta de adherencia (NA). Métodos. Estudio multicéntrico de corte transversal en 35 centros de Argentina. Se determinaron el nivel de AG y las formas de NA y se comparó según características de la indicación antibiótica, anestesista, cirugía, institución y edad del paciente. Se ajustó un modelo de regresión logística. Resultados. Se revisaron 1 083 procedimientos quirúrgicos (PQ). La AG fue de 67%. Las formas más frecuentes de NA fueron: antibiótico incorrecto (28,9%), profilaxis innecesaria (25,5%) y profilaxis prolongada (24,4%). La AG fue mayor en menores de 18 años (84,9% frente a 65,5%, P < 0,001); según la dependencia (obra social, privada, pública o comunitaria) fue de 33,3%, 64,4%, 78,8% y 83,3%, respectivamente; P < 0,001) y según la población (maternoinfantil, pediátrica, con patología específica y general) fue de 97,9%, ...
Revista del Hospital Italiano de Buenos Aires
Introducción: el impacto de la resistencia antimicrobiana (RAM) generará un aumento de las muerte... more Introducción: el impacto de la resistencia antimicrobiana (RAM) generará un aumento de las muertes relacionadas de 10 millones anuales hacia 2050. El 70% de la dispensación de antimicrobianos (ATB) se utiliza en la agroveterinaria y no en salud humana. Es fundamental conocer la portación de RAM en trabajadores de cría de animales y en los animales, para acciones tempranas de salud pública. Métodos: bajo metodología PRISMA se realizó la búsqueda bibliográfica en distintas fuentes disponibles hasta octubre de 2020. Se priorizaron revisiones sistemáticas, metanálisis, ensayos clínicos y estudios observacionales para determinar la RAM en trabajadores de cría de cerdos. De 990 artículos identificados se incluyeron 8 estudios. Resultados: la tasa de colonización por Staphylococcus aureus resistente a la meticilina (SAMR) en trabajadores fue mayor que la de la población general. La prevalencia de SAMR fue significativamente mayor en trabajadores en contacto directo con animales y los de gr...
International Journal of Infectious Diseases, 2018
Background: The treatment of intrabdominal infections are empirically performed on the basis of e... more Background: The treatment of intrabdominal infections are empirically performed on the basis of existing epidemiological data. There are data in Argentine that present an increased resistance more than 30% to Ciprofloxacin and Ampicilin/sulbactam in E. coli and K. pneumoniae. The following study is performed in order to know the etiology and antimicrobial resistance in our region. Methods & Materials: Retrospective, descriptive and observational study. The patients included not only had intraabdominal infection diagnosis but also any kind of surgery in order to control the source in the "Hospital Escuela de Agudos Dr. Ramón Madariaga" with positive aerobic bacteriological results between January 1st, 2016 and December 31st, 2016. Data were analyzed by the statistical support of IBM SPSS statistics v. 19.0. Epidemic registries were done. The analysis of bacteriological samples were developed in the "Laboratorio Nacional de Referencia del Instituto Carlos Malbrán (LNR)". Results: There were analyzed 69 intrabdominal infections, 59 acute appendicitis, male 45/69 (65.2%), middle aged 41 (15-86), comorbidities 23/69 (33%), previous use of antibiotics 10/69 (14.5%), previous hospital admission 4/69 (5.8%). The empirical treatment used was based on one drug with activity against aerobic pathogens in 68 cases (98.6%). The most frequent active drugs used were ciprofloxacin plus metronidazole 62/69 (89.9%) and ampicillin/sulbactam 4/69 (5.8%). 94 aerobic bacterias were isolated (1.4 bacterias/episodes), gram negative bacteria 82/94 (87.2%), Escherichia coli 55/94 (58.5%), Klebsiella pneumonia 10/94 (10.6%) and Pseudomonas aeruginosa 8/94 (8.5%). The resistance profile of the enterobacterias was ampicillin/sulbactam 27/69 (39%), ciprofloxacin 18/70 (26%), gentamicin 8/71 (11%), cefotaxime 4/71(6%) and piperacillin/tazobactam 3/71 (4%). In E. coli was ampicillin/sulbactam 23/55(42%), ciprofloxacin 15/55 (28%), gentamicin 6/53 (11%), amikacin 1/28 (4%), piperacillin/tazobactam 1/55 (2%) and cefotaxime 2/55(4%). In K. pneumoniae was ampicillin/sulbactam 3/10 (30%), ciprofloxacin 3/10 (30%), gentamicin 2/10(20%), piperacillin/tazobactam 2/10 (20%), cefotaxime 2/10 (20%), amikacin 0/5 (0%). There were no resistant in P. aeruginosa. Beta lactamase of extended spectrum 4/71.
International Journal of Infectious Diseases, 2018
Background: Salmonella is a Gram negative bacteria that colonizes the intestinal tract of humans ... more Background: Salmonella is a Gram negative bacteria that colonizes the intestinal tract of humans and animals. Infections with S. Enteritca are of great concern to the public health, being one of the main causes of foodborne diseases in Chile and the world. Wild birds are of increasing importance to public health, because of their association with highly transmisible zoonotic pathogens, and their hability to disseminate them. In this work, the S. Enteritis strains isolated from different hosts were charactherized to enlighten the human-animal interfase of this bacteria in Chile. Phenotypic assays were done to determine the pathogenic potential of the isolates of Salmonella of different hosts. Methods & Materials: In this work we determined the oxidative stress survival (H 2 O 2 15 mM and NaNO 2 10 mM), acidic pH (pH3), starvation (D10 and D20) and antimicrobial susceptibility of 90 S. Enteritidis strains, isolated from poultry, shore birds and humans from different regions of the country, comparing between each strain and among hosts. The statistical analysis were done with InfostatÒ software. Results: The results show that there is statistical differences among the studied strains in all stress survival assays. When analyzed by host, significant differences (p < 0.05) were found in starvation assays (D10 and D20). No differences were found in the oxidative stress and acidic pH assays when grouped by host. When analyzing antimicrobial susceptibility, most of the strains have resistance to at least one antimicrobial. The strains isolated from shore birds had a high resistance to tetracycline (73,3%), human strains had a higher resistance to sulfisoxazol (40%) and in poultry the highest resistance was for nalidixic acid (43,3%). We detected multiresistance in the 36,7% of the strains, most of which came from shore birds (42,4%). Finally, grouped by host, there are no differences (p > 0.05) in the presentation of the resistance. Conclusion: Shore birds can be reservoirs of Salmonella strains with potential risk to public and animal health, and could partially explain the progressive rise in the incidence of these serotypeassociated outbreaks. There is a high resistance rate of AM commonly use in Chile, which justifies monitoring these hosts as bio-indicators of AM resistance spread in the environment.
Liver Transplantation, 2005
Chagas' disease is an endemic zoonosis of South America caused by a protozoan parasite Trypanosom... more Chagas' disease is an endemic zoonosis of South America caused by a protozoan parasite Trypanosoma cruzi. About 30% of infected people develop the disease. This disease is known to reactivate in immunocompromised hosts, such as patients with acquired immunodeficiency syndrome, leukemia, and transplantation. There is some experience with transplantation of infected renal grafts into negative recipients, resulting in an index of transmission of 35%. No cases have been reported involving other organ transplants up to 2002, when the Centers for Disease Control and Prevention reported 3 cases of Chagas' disease transmission to 3 recipients (liver, kidney, and pancreas-kidney) from a single chagas infected donor. Here we report on a case of orthotopic liver transplant from a chagas infected donor into a negative recipient in clinical emergency status. The recipient was monitored by direct parasitological Strout method and serological tests with detection of transmission on the 84th day by both studies, without clinical signs. The patient was put on benznidazole with rapid clearance of the parasitemia. However, we propose that chagas infected donors may be accepted for liver transplant recipients only in emergency status. (Liver Transpl 2005;11:1112-1116.) C hagas' disease is an endemic zoonosis of South America, although the parasite exists from the south of the United States to the southernmost end of Argentina. Ninety million people are estimated to live in endemic areas at risk for infection, and 25% of them are considered to be infected.
Enfisema subcutáneo cervico-facial y mediastinal post-extracción dentaria. Presentación de caso y revisión de la literatura
Nexo Rev Hosp Ital B Aires, Dec 1, 1998
92 Infections in liver transplantation for HCV cirrhosis
Liver Transplantation, 2000
85 Chagas disease in liver transplant recipients: No evidence of reactivation
Liver Transplantation, 2000
[Consensus guidelines for the management of upper respiratory tract infections]
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...
Antibioticoterapia en estadios finales de la vida
Introduction: The indiscriminate use of antibiotics is associated with increased resistance. In t... more Introduction: The indiscriminate use of antibiotics is associated with increased resistance. In the care of patients in late stages of advanced diseases, antibiotic management is the subject of multiple controversies. In this review we will evaluate the published evidence on this topic, based on the answer to three questions: why are antibiotics indicated in terminal patients? What are the potential consequences? Is there a single perspective? Discussion: The indication of antibiotics in the final stages of life is often due to doctors' insecurity regarding the advantages and disadvantages of their use in this scenario, patient and family preferences, possibility of comfort or symptom control, and fear of legal problems. However, the benefit of antibiotics in symptom control or their impact on survival is not clear. Conclusions: The SADI Appropriate Use of Resources Commission proposes to analyze in each case: 1) The decision of prescribing antibiotics must be taken together wit...
Medicina, 1999
Resumen La trovafloxacina se absorbe rápidamente después de su administración oral y llega a su c... more Resumen La trovafloxacina se absorbe rápidamente después de su administración oral y llega a su concentración sérica máxima alrededor de una hora. La alatrofloxacina es la prodroga que, al administrarse por vía endovenosa, se hidroliza rápidamente a su estado original. La biodisponibilidad es equivalente cuando se administra por vía oral o endovenosa. La trovafloxacina es una fluoroquinolona de amplio espectro in vitro, con mayor actividad para cocos positivos, anaerobios y para bacterias productoras de neumonías atípicas. Presenta una vida media cercana a las 11 horas y una mayor unión proteica, lo que permite su dosificación única diaria. La excreción renal es inferior al 8% y no requiere ajuste de dosis en la insuficiencia renal. La trovafloxacina alcanza mayores concentraciones tisulares e intracelulares que las fluoroquinolonas clásicas. Todas estas características farmacocinéticas y farmacodinámicas permiten considerarla como una droga de posible aplicación para el tratamiento de infecciones mixtas o resistentes a drogas de primera línea.
revista.hospitalitaliano.org.ar
Inés Sammartino, Ana Laura Torlaschi, María Victoria Schang, Martín Silveira, Ingrid Andrés, Leon... more Inés Sammartino, Ana Laura Torlaschi, María Victoria Schang, Martín Silveira, Ingrid Andrés, Leonardo Garfi, Diego Giunta, Liliana Clara y ... De todas maneras solo el 21% se medicó y nin-guno refirió complicaciones graves (síndrome de Guillain-Barré, encefalitis, convulsiones ...
Transplant Infectious Disease - TRANSPL INFECT DIS, 2002
Toxoplasmosis is an infrequent infection in solid organ transplantation, except in heart transpla... more Toxoplasmosis is an infrequent infection in solid organ transplantation, except in heart transplantation, where the grafting of a positive organ in a negative recipient transmits the infection in a high percentage of cases, in the absence of prophylaxis. We report a case of pneumonia by Toxoplasma gondii in a woman who received a liver transplant and had pre-transplant positive serology. Diagnosis was made by cytologic examination of bronchoalveolar lavage fluid, where the parasite was observed with hematoxylin±eosin and Giemsa staining. That finding was confirmed by direct immunofluorescence and positive polymerase chain reaction. The patient had a favorable outcome, although she had not initially received firstchoice drugs. This was a case of severe illness secondary to reactivation of Toxoplasma infection, diagnosed pre-mortem and with a favorable outcome. Duration of treatment and need for secondary prophylaxis in these patients are discussed in the literature. Although infrequent, toxoplasmosis must be considered among the differential diagnoses of pulmonary infiltrates in solid organ transplantation.
[Inter-society consensus for the management of respiratory infections: acute bronchitis and chronic obstructive pulmonary disease]
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...
Revista chilena de infectología, 2002
We report the results of a case-control study of post-surgical mediastinitis, that we conducted f... more We report the results of a case-control study of post-surgical mediastinitis, that we conducted for eighteen months. The aim of the study was to detect possible risk factors for mediastinal infection after cardiovascular surgery as well as to analyze related clinical features. Thirty episodes of mediastinal infections over 687 consecutive cardiovascular surgeries (4,4%) were registered during a control period of 18 month at Hospital Italiano of Buenos Aires, Argentina. Among all variables analyzed only the following were significantly associated to mediastinal infection in the postoperative period: time elapsed at the recovery unit (p < 0.01) total time with catheter placed in the pulmonary artery (p: 0.05) and the rate of postoperative complications (p < 0.01). Six patients with mediastinal infection (20%) had undergone reoperation shortly after main surgery compared to only 3 (5%) in the control group (p: 0.05). The association with surgical events may be related to post-surgical causation. The presence of fever, only after 72 hours from surgery, allowed discrimination between patients with and without mediastinal infection. All case patients showed abnormalities in surgical wound, and 28 of these patients (93%) had at least two local signs of infection. Among the 37 types of microorganisms isolated from sternal secretion, 22 (59%) were gram-positive cocci, with Staphylococcus as the predominant genus. While 40% of the recovered gram-positive bacteria were methicillin-resistant, only 50% of the gram-negative bacteria were sensitive to aminoglycosides and ceftazidime. The in-hospital time was significantly longer in patients with mediastinitis compared to control patients (p < 0.001). The mortality rate inpatients mediastinitis was 33%. In conclusion, mediastinal infection actually remains representing a severe and costly complication of cardiovascular surgery due to its high morbidity and mortality rates.
Liver Transplantation, 2005
91 Incidence of infections in liver transplantation due to fulminant hepatitis
Liver Transplantation, 2000
85 Chagas disease in liver transplant recipients: No evidence of reactivation
Liver Transplantation, 2000