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Papers by Moira Taicz
Archivos Argentinos De Pediatria, Jun 1, 2015
![Research paper thumbnail of [Reasons for inappropriate prescribing of antibiotics in a high-complexity pediatric hospital]](https://attachments.academia-assets.com/107854428/thumbnails/1.jpg)
](PubMed, Dec 1, 2011
Objective: Determine the reasons for inappropriate prescription of antibiotics and identify oppor... more Objective: Determine the reasons for inappropriate prescription of antibiotics and identify opportunities to improve prescription of these drugs in pediatric patients hospitalized in intermediate and intensive care units. Methods: A prospective, descriptive longitudinal study was conducted of pediatric patients in intermediate and intensive care units who received parenteral administration of antibiotics, with the exception of newborns, burn unit patients, and surgical prophylaxis patients. A univariate analysis and multiple logistic regression were performed. Results: A total of 376 patients with a median of age of 50 months were studied (interquartile range [IQR] 14.5-127 months). Out of the total patients studied, 75% had one or more underlying conditions. A total of 40.6% of these patients had an oncologic pathology and 33.5% had neurological conditions. The remaining 25.9% had other underlying conditions. Antibiotic treatment was inappropriate in 35.6% of the patients studied (N = 134). In 73 (54.4%) of the 134 cases, inappropriate use was due to the type of antibiotic prescribed, the dose administered, or the treatment period. The 61 (45.5%) remaining cases did not require antibiotic treatment. In the multivariate analysis, the risk factors for inappropriate use of antibiotics were: administration of ceftriaxone OR 2 (95% CI, 1.3-3.7; P = 0.02); acute lower respiratory tract infection OR 1.8 (95% CI, 1.1-3.3; P < 0.04); onset of fever of unknown origin in hospital inpatients OR 5.55 (95% CI, 2.5-12; P < 0.0001); and febrile neutropenia OR 0.3 (95% CI, 0.1-0.7; P = 0.009). Conclusions: Inappropriate use of antibiotics was less common in the clinical conditions that were well-characterized. Prescribing practices that could be improved were identified through the preparation and circulation of guidelines for antibiotic use in hospital inpatients.
Archivos Argentinos De Pediatria, Jun 1, 2017
La hidatidosis es una zoonosis con una amplia distribución en Argentina y en el mundo. Se adquier... more La hidatidosis es una zoonosis con una amplia distribución en Argentina y en el mundo. Se adquiere en la infancia, pero se presenta, más frecuentemente, en la edad adulta. La población pediátrica representa el 10%-20% del total de los casos. Se presentan 47 niños con diagnóstico de hidatidosis durante un período de 20 años. La mediana de edad fue de 8 años (rango: 3-17) y, en su mayoría, tenían algún antecedente epidemiológico orientador, como la procedencia de un área endémica, rural y/o la tenencia de perros alimentados con vísceras. El 85% fueron quistes únicos localizados en un solo parénquima. Las localizaciones quísticas pulmonares y hepáticas fueron las más frecuentemente encontradas. El tratamiento fue médicoquirúrgico en 45 pacientes (96%). Trece (28%) presentaron alguna complicación posterior, que fue más frecuente en aquellos con localización pulmonar. Tres (6%) recayeron entre el mes y los 24 meses, y requirieron una nueva cirugía. Ninguno falleció a causa de la enfermedad parasitaria.
Archivos Argentinos De Pediatria, Jun 1, 2017
Echinococcosis is a zoonotic disease that is widely spread across Argentina and worldwide. It is ... more Echinococcosis is a zoonotic disease that is widely spread across Argentina and worldwide. It is acquired during childhood but it is more common during adulthood. The pediatric population accounts for 10-20% of all cases. This study included 47 children diagnosed with echinococcosis over a 20-year period. Their median age was 8 years old (range: 3-17); most patients had some epidemiological history, such as having lived or living in an endemic or rural area and/ or having dogs that are fed with viscera. Findings included 85% of single cysts in only one parenchyma. Cysts were most commonly located in the liver and lungs. Medical/surgical treatment was carried out in 45 patients (96%). Subsequent complications were observed in 13 patients (28%), which were more common in those with lung cysts. Three patients (6%) relapsed 1-24 months later and required a new surgery. No patient died as a result of the parasitic disease.
Archivos Argentinos De Pediatria, Feb 15, 2014
Efectividad de un programa para mejorar el uso de antibióticos en niños internados en un hospital... more Efectividad de un programa para mejorar el uso de antibióticos en niños internados en un hospital pediátrico de tercer nivel de atención en Argentina Effectiveness of a program to improve antibiotic use in children hospitalized in a children's tertiary care facility in Argentina a.
Anales De Pediatria, Sep 1, 2013
Open Forum Infectious Diseases, 2017
Background. In April 2017, CDC recommended testing Shigella isolates at ciprofloxacin concentrati... more Background. In April 2017, CDC recommended testing Shigella isolates at ciprofloxacin concentration down to 0.12 μg/mL, to detect potential novel resistance in isolates with MICs 0.12-1 μg/mL. The CLSI breakpoint for ciprofloxacin susceptibility (S) is 1 μg/mL and the Vitek®2 system currently tests only down to 0.25 μg/mL. Our objective was to perform S testing by Vitek2 and Etest to assess frequency of ciprofloxacin MIC ≥ 0.12 μg/mL and antibiotic S discrepancies between tests in clinical Shigella isolates. Methods. Retrospective query of microbiologic data was performed to identify Shigella isolates from 2010 to 2016 to trend epidemiology and antibiotic S by Vitek. Shigella isolates recovered between June and October, 2016 were tested in parallel using Vitek2 and Etest. MIC interpretation disagreements were defined as very major error (S by Vitek2 but resistant [R] by Etest) and major error (R by Vitek2 and S by Etest). Results. There was marked increase in shigellosis in 2016 (Fig 1). S. sonnei accounted for 90% of sporadic and outbreak isolates. Ampicillin resistance increased over time (21% in 2010, 90% in 2016) (Fig 2). Parallel testing of 36 isolates revealed 7 instances of antimicrobial S discrepancy with 5 very major errors (S by Vitek2 to ampicillin and TMP-SMX, R by Etest) and 2 major errors (R by Vitek2 to TMP-SMX, S by Etest) (Table 1). All 36 isolates were inhibited at the lowest Vitek2 concentration of ciprofloxacin (0.25 μg/mL); Etest confirmed that 34/36 had MIC ≤ 0.12 μg/mL, and 2 had MIC > 0.12 μg/mL (Fig 3). Conclusion. MIC by Vitek2 and Etest had major discrepancies among 7/36 isolates, for antibiotics other than ciprofloxacin. Etest mirrored Vitek2 for ciprofloxacin testing. Etest revealed that 2/36 isolates with Vitek2 MICs of 0.25 μg/mL (i.e. lowest concentration tested) had MICs greater than 0.12 μg/mL. Vitek2 system adjustments to test ciprofloxacin at lower concentrations would address the CDC advisory. Data are needed to determine clinical relevance of Shigella susceptibility test results.
Archivos Argentinos De Pediatria, Feb 1, 2015
Evaluación del valor de la proteína C reactiva y de la procalcitonina en la predicción de infecci... more Evaluación del valor de la proteína C reactiva y de la procalcitonina en la predicción de infección y mortalidad en los niños quemados Assessment of C-reactive protein and procalcitonin levels to predict infection and mortality in burn children a. Servicio de Control Epidemiológico e Infectología. b. Cirugía Plástica y Quemados.
Enfermedades infecciosas y microbiología clínica, Oct 1, 2018
Introduction: Community-acquired Staphylococcus aureus (SA) bacteraemia is a common cause of hosp... more Introduction: Community-acquired Staphylococcus aureus (SA) bacteraemia is a common cause of hospitalisation in children. The occurrence of secondary foci (SF) of SA infection is associated with higher morbidity and mortality. Objectives: To identify risk factors for SF of infection in children with community-acquired SA bacteraemia. Material and methods: Prospective cohort. All children aged from 30 days to 16 years admitted to a paediatric referral hospital between January 2010 and December 2016 for community-acquired infections, with SA isolated in blood cultures, were included. Microbiological, demographic and clinical characteristics were compared, with or without SF infection after 72 h of hospitalisation. Results: A total of 283 patients were included, 65% male (n = 184), with a median age of 60 months (IQR: 30-132). Seventeen per cent (n = 48) had at least one underlying disease and 97% (n = 275) had some clinical focus of infection, the most common being: osteoarticular 55% (n = 156) and soft tissue abscesses 27% (n = 79). A total of 65% (n = 185) were resistant to methicillin. A SF of infection was found in 16% of patients (n = 44). The SF identified were pneumonia 73% (n = 32), osteoarticular 11% (n = 5), soft tissue 11% (n = 5) and central nervous system 5% (n = 2). In the multivariate analysis, the persistence of positive blood cultures after the fifth day (OR: 2.40, 95%CI: 1.07-5.37, p < 0.001) and sepsis (OR: 17.23, 95%CI 5.21-56.9, p < 0.001) were predictors of SF. There was no association with methicillin sensitivity. Conclusions: In this cohort, methicillin-resistant SA infections predominated. The occurrence of SF of infection was associated with the persistence of bacteraemia after the fifth day and sepsis on admission.
Enfermedades Infecciosas Y Microbiologia Clinica, Oct 1, 2018
Introducción: La bacteriemia por Staphylococcus aureus (SA) adquirida en la comunidad representa ... more Introducción: La bacteriemia por Staphylococcus aureus (SA) adquirida en la comunidad representa una causa frecuente de ingreso en niños. La aparición de focos secundarios (FS) condiciona una mayor morbimortalidad. Objetivos: Identificar factores de riesgo de aparición de FS de infección en niños con bacteriemia por SA de la comunidad. Material y métodos: Cohorte prospectiva. Desde enero de 2010 a diciembre de 2016 se incluyeron todos los niños (de 30 días a 16 años), hospitalizados en un hospital pediátrico de derivación por infecciones adquiridas en la comunidad, con aislamiento de SA en hemocultivos. Se compararon características microbiológicas, demográficas y clínicas según presentaran o no FS de infección tras 72 h de hospitalización. Resultados: Se incluyeron 283 niños, el 65% varones (n = 184), con una mediana de edad de 60 meses (RIC: 30-132). El 17% (n = 48) tenían alguna enfermedad de base y el 97% (n = 275) un foco clínico de infección, siendo los más frecuentes: osteoarticular el 55% (n = 156) y abscesos de partes blandas el 27% (n = 79). El 65% (n = 185) eran SA resistentes a meticilina. Presentaron FS el 16% de los pacientes (n = 44): neumonía el 73% (n = 32), osteoarticular el 11% (n = 5), partes blandas el 11% (n = 5) y sistema nervioso central el 5% (n = 2). En el análisis multivariado fueron predictores de FS la persistencia de hemocultivos positivos tras el quinto día (OR: 2,40; IC95%: 1,07-5,37; p < 0,001) y la sepsis (OR: 17,23; IC95%: 5,21-56,9; p < 0,001). No hubo asociación con la sensibilidad a la meticilina. Conclusiones: En esta cohorte predominaron las infecciones por SA resistente a la meticilina. La aparición de FS se asoció con la persistencia de la bacteriemia después del quinto día y la sepsis al ingreso.
Journal of Antimicrobial Chemotherapy, May 5, 2022
Background Increasing evidence from adult cohorts suggests an important role of HIV-1 pretreatmen... more Background Increasing evidence from adult cohorts suggests an important role of HIV-1 pretreatment drug resistance (PDR) in ART failure, in spite of treatment being fully active according to baseline genotyping tests. Whether this is also true for children is unknown. Methods Virological and immunological parameters were longitudinally assessed in a group of 39 HIV-1 vertically infected children starting first-line lopinavir/ritonavir-based ART at a median of 5.0 months (IQR = 3.0–9.0). Evolution of viral load (VL) over time was compared between children with and without baseline PDR, as defined by the WHO mutation list. Results Resistance-associated mutations (RAMs) in the HIV-1 pol gene were present in nine HIV-1-infected children (23%) before initiation of first-line ART (PDR group). Of them, six carried RAMs associated with NNRTIs (NNRTI-PDR subgroup). At 4–8 weeks after ART initiation, the proportion of children achieving ≥1 log VL reduction was 87% for the no-PDR group versus 33% and 16.7% for the PDR group and the NNRTI-PDR subgroup, respectively. During follow-up, children with no PDR reached virological suppression almost four times faster than children with PDR or NNRTI-PDR [no-PDR = 631 days and PDR = 2134 days (P = 0.1249) and NNRTI-PDR = 2134 days (P = 0.0447)]. CD4 T cells remained similar between the study groups over time. Conclusions HIV-1 baseline genotyping at diagnosis in vertically infected children is important for improved personalized medicine. While the mechanism is unclear, cases with PDR (particularly to NNRTIs) require closer monitoring of their first-line ART regimens in order to avoid early virological failures and prevent further accumulation of resistance.
Open Forum Infectious Diseases, Oct 1, 2019
Background Enterococcus spp. (E) is an important cause of nosocomial bacteremia. The emergence of... more Background Enterococcus spp. (E) is an important cause of nosocomial bacteremia. The emergence of vancomycin-resistant E in the nosocomial setting conditions the empirical treatment and limits therapeutic options. Methods A retrospective cohort study of children ≥1 month with E bacteremia in a reference pediatric hospital was performed. Study period January 1, 2016–December 31, 2018. Outcome: to describe clinical and epidemiological characteristics of children with bacteremia due to Enterococcus spp. resistant to vancomycin (VRE) vs. sensitive (VSE). Identify variables associated with VRE. STATA 13 was used. Results N = 82 patients. Median age was 37.6 months (IQR 2–48), 45 patients (54.9%) were male; 76 patients (92.7%) had underlying disease (intestinal failure (21.9%), heart disease (17.1%), preterm births (12.2%), hematological disease (10.9%), and liver failure (7.3%); 16 patients (19.5%) received immunosuppressive therapy. Sixty bacteremia (73.2%) were by E. faecalis and 22 (26, 8%) by E. faecium. Vancomycin resistance was documented in 13 patients (15.8%), all of which were E. faecium. In the bivariate analysis, patients with VRE bacteremia were significantly older in months than those with VSE bacteremia [75.4 (IQR 6–151) vs. 30.5 (IQR 2–33), P &amp;amp;amp;lt;0.02]; had more frequency of previous colonization with VRE [n: 8 (61.5%) vs. n: 4 (5.8%) P &amp;amp;amp;lt; 0.001], hematological disease [n: 5 (38.5%) vs. n: 5 (5.8%), P = 0.01], liver failure [n: 3 (23.1%) vs. n: 3 (4.4%), P = 0.02] and immunosuppressive therapy [n: 6 (46.2%) vs. n: 10 (14.5%) P = 0.008]. Patients with VRE bacteremia had a lower median white blood cell count [7040 (IQR 2150–10250) vs. 14474 (IQR 6160–17090), P &amp;amp;amp;lt;0.03]. Mortality in P with VRE was 15.4% (n: 2) and 4.3% in P with VSE (n: 3), P = 0.1. No statistically significant differences were found according to history of surgery, previous hospitalization, antibiotic therapy in the last 3 months or clinical presentation. In the multivariate model, predictors of VRE bacteremia adjusted for the rest of the significant variables were hematological disease OR 11.1 (95% CI 2.3–53.8) P = 0.003, and liver failure OR 7.7 (95% CI 1.2–50.4), P = 0.03. Conclusion In this cohort of children with enterococcal bacteremia, hematological disease and liver failure were predictive variables of VRE bacteremia. Disclosures All authors: No reported disclosures.
International Journal of Infectious Diseases, Aug 1, 2018
Background: Viridans Streptococci (VS) bacteremia in patients with fever and leukemia has signifi... more Background: Viridans Streptococci (VS) bacteremia in patients with fever and leukemia has significantly increased over the last years. Risk factors described in this population include severe neutropenia, oral mucositis, administration of high-dose cytosine arabinoside, and antimicrobial prophylaxis with either trimethoprim-sulfamethoxazole or a fluoroquinolone. Literature on pediatric patients is scarce Methods & Materials: Case Control retrospective study. Patients with Acute Leukemia admitted between July 2016 and October 2017 in a high-complexity pediatric hospital were included. Patients with fever and VS bacteremia were defined as cases. Patients with fever were defined as controls. Two controls were included by each case. Predisposing factors, clinical and microbiological characteristics were compared. STATA 10 was used Results: n: 90 (30 cases and 60 controls). Fifty one (57%) were male. Mean age was 67 months (IQR 38-107) St mitis/oralis was the most frequent (27/30), followed by St. salivarius (2/30) and St. sanguinis (1/30). Out of 30 isolates of VS 10% exhibited penicillin resistance and 30% intermediate penicillin resistance. Twenty percent of the strains were resistant to ceftriaxone In bivariate analysis, AML (OR 6.8, 95% CI 2.5-18.2 p < 0.001), severe neutropenia (OR 16.9, 95%CI 2.1-133.1, p 0.007), high doses cytosine arabinoside (OR 4.
Open Forum Infectious Diseases, 2014
Background. Hydatid disease (HD) is a zoonosis caused by larval forms of Echinococcus granulosus,... more Background. Hydatid disease (HD) is a zoonosis caused by larval forms of Echinococcus granulosus, and is the most frequent cause of liver cysts; however HD is one of the most neglected diseases. In Argentina, the pathology is endemic, with more than 300 new cases per year. The objective is to identify the epidemiology, clinical features, treatment, and outcome of children with HD admitted to a public tertiary care institution. Methods. Observational study. Patients (p) ≤ 18 years old with Echinococcus granulosus infection based on WHO International diagnostic criteria were included. Epidemiology, clinical criteria, typical organ lesions by imaging techniques, histopathology, serology and parasitological studies were evaluated. Study period: from May 1993 to October 2013.
Revista Chilena De Infectologia, Dec 1, 2013
Revista Iberoamericana De Micologia, Apr 1, 2014
Antecedentes: La paracoccidioidomicosis es la micosis sistémica más frecuente en las zonas tropic... more Antecedentes: La paracoccidioidomicosis es la micosis sistémica más frecuente en las zonas tropicales y subtropicales de Latinoamérica; el agente etiológico es Paracoccidioides. La enfermedad se presenta preferentemente en la población adulta, por lo que existen pocos reportes en la edad pediátrica. El objetivo del presente trabajo es describir las características clínicas, epidemiológicas y diagnósticas, y la evolución de los casos de paracoccidioidomicosis diagnosticados en el Hospital de Pediatría Prof. Dr. Juan P. Garrahan entre los años 2000 y 2010. Casos clínicos: Se presentan los casos de 4 pacientes previamente sanos procedentes del norte argentino con paracoccidioidomicosis diseminada juvenil y diagnóstico confirmatorio anatomopatológico o microbiológico. Conclusiones: La paracoccidioidomicosis debe ser considerada dentro de los diagnósticos diferenciales en niños con síndrome febril y compromiso linfoganglionar, acompañado por anemia, hipereosinofilia e hipergammaglobulinemia, procedentes de áreas endémicas del país.
Revista Chilena De Infectologia, Aug 1, 2021
Sin conflictos de interés. Este estudio no recibió financiamiento.
Archivos Argentinos De Pediatria, Jun 1, 2015
PubMed, Dec 1, 2011
Objective: Determine the reasons for inappropriate prescription of antibiotics and identify oppor... more Objective: Determine the reasons for inappropriate prescription of antibiotics and identify opportunities to improve prescription of these drugs in pediatric patients hospitalized in intermediate and intensive care units. Methods: A prospective, descriptive longitudinal study was conducted of pediatric patients in intermediate and intensive care units who received parenteral administration of antibiotics, with the exception of newborns, burn unit patients, and surgical prophylaxis patients. A univariate analysis and multiple logistic regression were performed. Results: A total of 376 patients with a median of age of 50 months were studied (interquartile range [IQR] 14.5-127 months). Out of the total patients studied, 75% had one or more underlying conditions. A total of 40.6% of these patients had an oncologic pathology and 33.5% had neurological conditions. The remaining 25.9% had other underlying conditions. Antibiotic treatment was inappropriate in 35.6% of the patients studied (N = 134). In 73 (54.4%) of the 134 cases, inappropriate use was due to the type of antibiotic prescribed, the dose administered, or the treatment period. The 61 (45.5%) remaining cases did not require antibiotic treatment. In the multivariate analysis, the risk factors for inappropriate use of antibiotics were: administration of ceftriaxone OR 2 (95% CI, 1.3-3.7; P = 0.02); acute lower respiratory tract infection OR 1.8 (95% CI, 1.1-3.3; P < 0.04); onset of fever of unknown origin in hospital inpatients OR 5.55 (95% CI, 2.5-12; P < 0.0001); and febrile neutropenia OR 0.3 (95% CI, 0.1-0.7; P = 0.009). Conclusions: Inappropriate use of antibiotics was less common in the clinical conditions that were well-characterized. Prescribing practices that could be improved were identified through the preparation and circulation of guidelines for antibiotic use in hospital inpatients.
Archivos Argentinos De Pediatria, Jun 1, 2017
La hidatidosis es una zoonosis con una amplia distribución en Argentina y en el mundo. Se adquier... more La hidatidosis es una zoonosis con una amplia distribución en Argentina y en el mundo. Se adquiere en la infancia, pero se presenta, más frecuentemente, en la edad adulta. La población pediátrica representa el 10%-20% del total de los casos. Se presentan 47 niños con diagnóstico de hidatidosis durante un período de 20 años. La mediana de edad fue de 8 años (rango: 3-17) y, en su mayoría, tenían algún antecedente epidemiológico orientador, como la procedencia de un área endémica, rural y/o la tenencia de perros alimentados con vísceras. El 85% fueron quistes únicos localizados en un solo parénquima. Las localizaciones quísticas pulmonares y hepáticas fueron las más frecuentemente encontradas. El tratamiento fue médicoquirúrgico en 45 pacientes (96%). Trece (28%) presentaron alguna complicación posterior, que fue más frecuente en aquellos con localización pulmonar. Tres (6%) recayeron entre el mes y los 24 meses, y requirieron una nueva cirugía. Ninguno falleció a causa de la enfermedad parasitaria.
Archivos Argentinos De Pediatria, Jun 1, 2017
Echinococcosis is a zoonotic disease that is widely spread across Argentina and worldwide. It is ... more Echinococcosis is a zoonotic disease that is widely spread across Argentina and worldwide. It is acquired during childhood but it is more common during adulthood. The pediatric population accounts for 10-20% of all cases. This study included 47 children diagnosed with echinococcosis over a 20-year period. Their median age was 8 years old (range: 3-17); most patients had some epidemiological history, such as having lived or living in an endemic or rural area and/ or having dogs that are fed with viscera. Findings included 85% of single cysts in only one parenchyma. Cysts were most commonly located in the liver and lungs. Medical/surgical treatment was carried out in 45 patients (96%). Subsequent complications were observed in 13 patients (28%), which were more common in those with lung cysts. Three patients (6%) relapsed 1-24 months later and required a new surgery. No patient died as a result of the parasitic disease.
Archivos Argentinos De Pediatria, Feb 15, 2014
Efectividad de un programa para mejorar el uso de antibióticos en niños internados en un hospital... more Efectividad de un programa para mejorar el uso de antibióticos en niños internados en un hospital pediátrico de tercer nivel de atención en Argentina Effectiveness of a program to improve antibiotic use in children hospitalized in a children's tertiary care facility in Argentina a.
Anales De Pediatria, Sep 1, 2013
Open Forum Infectious Diseases, 2017
Background. In April 2017, CDC recommended testing Shigella isolates at ciprofloxacin concentrati... more Background. In April 2017, CDC recommended testing Shigella isolates at ciprofloxacin concentration down to 0.12 μg/mL, to detect potential novel resistance in isolates with MICs 0.12-1 μg/mL. The CLSI breakpoint for ciprofloxacin susceptibility (S) is 1 μg/mL and the Vitek®2 system currently tests only down to 0.25 μg/mL. Our objective was to perform S testing by Vitek2 and Etest to assess frequency of ciprofloxacin MIC ≥ 0.12 μg/mL and antibiotic S discrepancies between tests in clinical Shigella isolates. Methods. Retrospective query of microbiologic data was performed to identify Shigella isolates from 2010 to 2016 to trend epidemiology and antibiotic S by Vitek. Shigella isolates recovered between June and October, 2016 were tested in parallel using Vitek2 and Etest. MIC interpretation disagreements were defined as very major error (S by Vitek2 but resistant [R] by Etest) and major error (R by Vitek2 and S by Etest). Results. There was marked increase in shigellosis in 2016 (Fig 1). S. sonnei accounted for 90% of sporadic and outbreak isolates. Ampicillin resistance increased over time (21% in 2010, 90% in 2016) (Fig 2). Parallel testing of 36 isolates revealed 7 instances of antimicrobial S discrepancy with 5 very major errors (S by Vitek2 to ampicillin and TMP-SMX, R by Etest) and 2 major errors (R by Vitek2 to TMP-SMX, S by Etest) (Table 1). All 36 isolates were inhibited at the lowest Vitek2 concentration of ciprofloxacin (0.25 μg/mL); Etest confirmed that 34/36 had MIC ≤ 0.12 μg/mL, and 2 had MIC > 0.12 μg/mL (Fig 3). Conclusion. MIC by Vitek2 and Etest had major discrepancies among 7/36 isolates, for antibiotics other than ciprofloxacin. Etest mirrored Vitek2 for ciprofloxacin testing. Etest revealed that 2/36 isolates with Vitek2 MICs of 0.25 μg/mL (i.e. lowest concentration tested) had MICs greater than 0.12 μg/mL. Vitek2 system adjustments to test ciprofloxacin at lower concentrations would address the CDC advisory. Data are needed to determine clinical relevance of Shigella susceptibility test results.
Archivos Argentinos De Pediatria, Feb 1, 2015
Evaluación del valor de la proteína C reactiva y de la procalcitonina en la predicción de infecci... more Evaluación del valor de la proteína C reactiva y de la procalcitonina en la predicción de infección y mortalidad en los niños quemados Assessment of C-reactive protein and procalcitonin levels to predict infection and mortality in burn children a. Servicio de Control Epidemiológico e Infectología. b. Cirugía Plástica y Quemados.
Enfermedades infecciosas y microbiología clínica, Oct 1, 2018
Introduction: Community-acquired Staphylococcus aureus (SA) bacteraemia is a common cause of hosp... more Introduction: Community-acquired Staphylococcus aureus (SA) bacteraemia is a common cause of hospitalisation in children. The occurrence of secondary foci (SF) of SA infection is associated with higher morbidity and mortality. Objectives: To identify risk factors for SF of infection in children with community-acquired SA bacteraemia. Material and methods: Prospective cohort. All children aged from 30 days to 16 years admitted to a paediatric referral hospital between January 2010 and December 2016 for community-acquired infections, with SA isolated in blood cultures, were included. Microbiological, demographic and clinical characteristics were compared, with or without SF infection after 72 h of hospitalisation. Results: A total of 283 patients were included, 65% male (n = 184), with a median age of 60 months (IQR: 30-132). Seventeen per cent (n = 48) had at least one underlying disease and 97% (n = 275) had some clinical focus of infection, the most common being: osteoarticular 55% (n = 156) and soft tissue abscesses 27% (n = 79). A total of 65% (n = 185) were resistant to methicillin. A SF of infection was found in 16% of patients (n = 44). The SF identified were pneumonia 73% (n = 32), osteoarticular 11% (n = 5), soft tissue 11% (n = 5) and central nervous system 5% (n = 2). In the multivariate analysis, the persistence of positive blood cultures after the fifth day (OR: 2.40, 95%CI: 1.07-5.37, p < 0.001) and sepsis (OR: 17.23, 95%CI 5.21-56.9, p < 0.001) were predictors of SF. There was no association with methicillin sensitivity. Conclusions: In this cohort, methicillin-resistant SA infections predominated. The occurrence of SF of infection was associated with the persistence of bacteraemia after the fifth day and sepsis on admission.
Enfermedades Infecciosas Y Microbiologia Clinica, Oct 1, 2018
Introducción: La bacteriemia por Staphylococcus aureus (SA) adquirida en la comunidad representa ... more Introducción: La bacteriemia por Staphylococcus aureus (SA) adquirida en la comunidad representa una causa frecuente de ingreso en niños. La aparición de focos secundarios (FS) condiciona una mayor morbimortalidad. Objetivos: Identificar factores de riesgo de aparición de FS de infección en niños con bacteriemia por SA de la comunidad. Material y métodos: Cohorte prospectiva. Desde enero de 2010 a diciembre de 2016 se incluyeron todos los niños (de 30 días a 16 años), hospitalizados en un hospital pediátrico de derivación por infecciones adquiridas en la comunidad, con aislamiento de SA en hemocultivos. Se compararon características microbiológicas, demográficas y clínicas según presentaran o no FS de infección tras 72 h de hospitalización. Resultados: Se incluyeron 283 niños, el 65% varones (n = 184), con una mediana de edad de 60 meses (RIC: 30-132). El 17% (n = 48) tenían alguna enfermedad de base y el 97% (n = 275) un foco clínico de infección, siendo los más frecuentes: osteoarticular el 55% (n = 156) y abscesos de partes blandas el 27% (n = 79). El 65% (n = 185) eran SA resistentes a meticilina. Presentaron FS el 16% de los pacientes (n = 44): neumonía el 73% (n = 32), osteoarticular el 11% (n = 5), partes blandas el 11% (n = 5) y sistema nervioso central el 5% (n = 2). En el análisis multivariado fueron predictores de FS la persistencia de hemocultivos positivos tras el quinto día (OR: 2,40; IC95%: 1,07-5,37; p < 0,001) y la sepsis (OR: 17,23; IC95%: 5,21-56,9; p < 0,001). No hubo asociación con la sensibilidad a la meticilina. Conclusiones: En esta cohorte predominaron las infecciones por SA resistente a la meticilina. La aparición de FS se asoció con la persistencia de la bacteriemia después del quinto día y la sepsis al ingreso.
Journal of Antimicrobial Chemotherapy, May 5, 2022
Background Increasing evidence from adult cohorts suggests an important role of HIV-1 pretreatmen... more Background Increasing evidence from adult cohorts suggests an important role of HIV-1 pretreatment drug resistance (PDR) in ART failure, in spite of treatment being fully active according to baseline genotyping tests. Whether this is also true for children is unknown. Methods Virological and immunological parameters were longitudinally assessed in a group of 39 HIV-1 vertically infected children starting first-line lopinavir/ritonavir-based ART at a median of 5.0 months (IQR = 3.0–9.0). Evolution of viral load (VL) over time was compared between children with and without baseline PDR, as defined by the WHO mutation list. Results Resistance-associated mutations (RAMs) in the HIV-1 pol gene were present in nine HIV-1-infected children (23%) before initiation of first-line ART (PDR group). Of them, six carried RAMs associated with NNRTIs (NNRTI-PDR subgroup). At 4–8 weeks after ART initiation, the proportion of children achieving ≥1 log VL reduction was 87% for the no-PDR group versus 33% and 16.7% for the PDR group and the NNRTI-PDR subgroup, respectively. During follow-up, children with no PDR reached virological suppression almost four times faster than children with PDR or NNRTI-PDR [no-PDR = 631 days and PDR = 2134 days (P = 0.1249) and NNRTI-PDR = 2134 days (P = 0.0447)]. CD4 T cells remained similar between the study groups over time. Conclusions HIV-1 baseline genotyping at diagnosis in vertically infected children is important for improved personalized medicine. While the mechanism is unclear, cases with PDR (particularly to NNRTIs) require closer monitoring of their first-line ART regimens in order to avoid early virological failures and prevent further accumulation of resistance.
Open Forum Infectious Diseases, Oct 1, 2019
Background Enterococcus spp. (E) is an important cause of nosocomial bacteremia. The emergence of... more Background Enterococcus spp. (E) is an important cause of nosocomial bacteremia. The emergence of vancomycin-resistant E in the nosocomial setting conditions the empirical treatment and limits therapeutic options. Methods A retrospective cohort study of children ≥1 month with E bacteremia in a reference pediatric hospital was performed. Study period January 1, 2016–December 31, 2018. Outcome: to describe clinical and epidemiological characteristics of children with bacteremia due to Enterococcus spp. resistant to vancomycin (VRE) vs. sensitive (VSE). Identify variables associated with VRE. STATA 13 was used. Results N = 82 patients. Median age was 37.6 months (IQR 2–48), 45 patients (54.9%) were male; 76 patients (92.7%) had underlying disease (intestinal failure (21.9%), heart disease (17.1%), preterm births (12.2%), hematological disease (10.9%), and liver failure (7.3%); 16 patients (19.5%) received immunosuppressive therapy. Sixty bacteremia (73.2%) were by E. faecalis and 22 (26, 8%) by E. faecium. Vancomycin resistance was documented in 13 patients (15.8%), all of which were E. faecium. In the bivariate analysis, patients with VRE bacteremia were significantly older in months than those with VSE bacteremia [75.4 (IQR 6–151) vs. 30.5 (IQR 2–33), P &amp;amp;amp;lt;0.02]; had more frequency of previous colonization with VRE [n: 8 (61.5%) vs. n: 4 (5.8%) P &amp;amp;amp;lt; 0.001], hematological disease [n: 5 (38.5%) vs. n: 5 (5.8%), P = 0.01], liver failure [n: 3 (23.1%) vs. n: 3 (4.4%), P = 0.02] and immunosuppressive therapy [n: 6 (46.2%) vs. n: 10 (14.5%) P = 0.008]. Patients with VRE bacteremia had a lower median white blood cell count [7040 (IQR 2150–10250) vs. 14474 (IQR 6160–17090), P &amp;amp;amp;lt;0.03]. Mortality in P with VRE was 15.4% (n: 2) and 4.3% in P with VSE (n: 3), P = 0.1. No statistically significant differences were found according to history of surgery, previous hospitalization, antibiotic therapy in the last 3 months or clinical presentation. In the multivariate model, predictors of VRE bacteremia adjusted for the rest of the significant variables were hematological disease OR 11.1 (95% CI 2.3–53.8) P = 0.003, and liver failure OR 7.7 (95% CI 1.2–50.4), P = 0.03. Conclusion In this cohort of children with enterococcal bacteremia, hematological disease and liver failure were predictive variables of VRE bacteremia. Disclosures All authors: No reported disclosures.
International Journal of Infectious Diseases, Aug 1, 2018
Background: Viridans Streptococci (VS) bacteremia in patients with fever and leukemia has signifi... more Background: Viridans Streptococci (VS) bacteremia in patients with fever and leukemia has significantly increased over the last years. Risk factors described in this population include severe neutropenia, oral mucositis, administration of high-dose cytosine arabinoside, and antimicrobial prophylaxis with either trimethoprim-sulfamethoxazole or a fluoroquinolone. Literature on pediatric patients is scarce Methods & Materials: Case Control retrospective study. Patients with Acute Leukemia admitted between July 2016 and October 2017 in a high-complexity pediatric hospital were included. Patients with fever and VS bacteremia were defined as cases. Patients with fever were defined as controls. Two controls were included by each case. Predisposing factors, clinical and microbiological characteristics were compared. STATA 10 was used Results: n: 90 (30 cases and 60 controls). Fifty one (57%) were male. Mean age was 67 months (IQR 38-107) St mitis/oralis was the most frequent (27/30), followed by St. salivarius (2/30) and St. sanguinis (1/30). Out of 30 isolates of VS 10% exhibited penicillin resistance and 30% intermediate penicillin resistance. Twenty percent of the strains were resistant to ceftriaxone In bivariate analysis, AML (OR 6.8, 95% CI 2.5-18.2 p < 0.001), severe neutropenia (OR 16.9, 95%CI 2.1-133.1, p 0.007), high doses cytosine arabinoside (OR 4.
Open Forum Infectious Diseases, 2014
Background. Hydatid disease (HD) is a zoonosis caused by larval forms of Echinococcus granulosus,... more Background. Hydatid disease (HD) is a zoonosis caused by larval forms of Echinococcus granulosus, and is the most frequent cause of liver cysts; however HD is one of the most neglected diseases. In Argentina, the pathology is endemic, with more than 300 new cases per year. The objective is to identify the epidemiology, clinical features, treatment, and outcome of children with HD admitted to a public tertiary care institution. Methods. Observational study. Patients (p) ≤ 18 years old with Echinococcus granulosus infection based on WHO International diagnostic criteria were included. Epidemiology, clinical criteria, typical organ lesions by imaging techniques, histopathology, serology and parasitological studies were evaluated. Study period: from May 1993 to October 2013.
Revista Chilena De Infectologia, Dec 1, 2013
Revista Iberoamericana De Micologia, Apr 1, 2014
Antecedentes: La paracoccidioidomicosis es la micosis sistémica más frecuente en las zonas tropic... more Antecedentes: La paracoccidioidomicosis es la micosis sistémica más frecuente en las zonas tropicales y subtropicales de Latinoamérica; el agente etiológico es Paracoccidioides. La enfermedad se presenta preferentemente en la población adulta, por lo que existen pocos reportes en la edad pediátrica. El objetivo del presente trabajo es describir las características clínicas, epidemiológicas y diagnósticas, y la evolución de los casos de paracoccidioidomicosis diagnosticados en el Hospital de Pediatría Prof. Dr. Juan P. Garrahan entre los años 2000 y 2010. Casos clínicos: Se presentan los casos de 4 pacientes previamente sanos procedentes del norte argentino con paracoccidioidomicosis diseminada juvenil y diagnóstico confirmatorio anatomopatológico o microbiológico. Conclusiones: La paracoccidioidomicosis debe ser considerada dentro de los diagnósticos diferenciales en niños con síndrome febril y compromiso linfoganglionar, acompañado por anemia, hipereosinofilia e hipergammaglobulinemia, procedentes de áreas endémicas del país.
Revista Chilena De Infectologia, Aug 1, 2021
Sin conflictos de interés. Este estudio no recibió financiamiento.