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Evans-Gilbert T, Figueroa JP, Bonvehí P, Melgar M, Stecher D, Kfouri R, Munoz G, Bansie R, Valenzuela R, Verne E, Salas D, Jennifer Sanwogou N. Establishing priorities to strengthen National Immunization Technical Advisory Groups in Latin America and the Caribbean. Vaccine 2024; 42:2310-2316. [PMID: 38438288 DOI: 10.1016/j.vaccine.2024.02.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
Following the COVID-19 pandemic, the Americas faced a significant decline in vaccination coverage as well as increased vaccine hesitancy. The objective of this paper is to summarize the challenges and opportunities outlined by the National Immunization Technical Advisory Groups (NITAGs) in Latin America and the Caribbean (LAC) and prioritize targeted interventions. The exploratory survey included open-ended questions on two primary components: challenges, and opportunities. Free-text comments presented by each NITAG were collated and classified using indicators and sub-indicators of the NITAG Maturity Assessment Tool (NMAT). Opportunities were classified thematically, and priority actions were generated from the responses. All 21 NITAGs in LAC, representing 40 countries, 76 % of which have been active for over a decade, responded to the survey. The most common challenges were establishment and composition (62 %), integration into policymaking (62 %), resources and secretariat (52 %), and stakeholder recognition (48 %). The distribution of responses was seen across the whole sample and did not suggest a more pronounced need in relation to year of establishment. Opportunities included maximizing the Regional NITAG Network of the Americas (RNA) to facilitate collaboration, information sharing, visibility, and communication; existing global, regional, and systemic analyses; the World Health Organization/Pan American Health Organization (WHO/PAHO) templates for standard operating procedures; twinning programs with mature NITAGs; and NITAGs in governance structures. Action plans were outlined to formalize the establishment of NITAGs and broaden their composition; strengthen decision-making and access to data resources; and enhance the credibility of evidence-based recommendations and their uptake by policymakers and the public. NITAG challenges are not unique to LAC. NITAGs have outlined a short-term prioritized action plan which is critical to enhancing NITAG value and importance in countries.
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Affiliation(s)
- Tracy Evans-Gilbert
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica.
| | - J Peter Figueroa
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Kingston, Jamaica.
| | - Pablo Bonvehí
- Center for Medical Education and Clinical Research, Av. Las Heras 2929, 1425 Buenos Aires, Argentina.
| | - Mario Melgar
- Hospital Roosevelt, Ciudad de Guatemala 01011, Guatemala.
| | - Daniel Stecher
- Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, C1121 ABG Buenos Aires, Argentina.
| | - Renato Kfouri
- Immunization Department, Brasilian Society of Pediatrics, R. Santa Clara, 292 - Copacabana, Rio de Janeiro, RJ 22041-012, Brazil.
| | - Greta Munoz
- Hospital Pediátrico Baca Ortiz, S/N y D.M., Avenida 6 de Diciembre & Av. Cristóbal Colón, Quito, Ecuador.
| | - Rakesh Bansie
- Academic Hospital Paramaribo, RRP8+PQ7, Flustraat, Paramaribo, Suriname.
| | | | - Eduardo Verne
- Hospital Nacional Cayetano Heredia, Av. Honorio Delgado 262, San Martín de Porres 15102, Peru.
| | - Daniel Salas
- Pan American Health Organization/World Health Organization, 525 23 Street NW, Washington, DC 20037, USA.
| | - N Jennifer Sanwogou
- Pan American Health Organization/World Health Organization, 525 23 Street NW, Washington, DC 20037, USA.
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Urueña A, Machado R, Cunha J, López Colmano C, Rancaño C, Kfouri R, Pírez C, Bonvehí P, Calvo M, Cuadros R, Muñoz G, Rodríguez M, Torres J, Cahn F, Ballalai I. Opinions, Attitudes and Factors Related to SARS-CoV-2 Vaccine Uptake in Eight South American Countries. Vaccines (Basel) 2023; 11:1660. [PMID: 38005992 PMCID: PMC10675814 DOI: 10.3390/vaccines11111660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/09/2023] [Accepted: 10/20/2023] [Indexed: 11/26/2023] Open
Abstract
This article presents attitudes and practices regarding COVID-19 vaccination in the South American population. The study collected data from a self-administered survey distributed through social media platforms between February and April 2022 (N = 6555). The survey included questions related to participants' sociodemographic background, flu vaccination practices, sources of information about COVID-19, and opinions regarding pandemic management and vaccination against SARS-CoV-2. The respondents agreed with the statement that COVID-19 vaccines were necessary (86.4%), effective (79.8%), safe (79.1%), and should be mandatory (64%). Overall, 83.4% accepted vaccination and 12.3% refused it completely. Main rejection reasons were safety (65.8%) and efficacy (54.9%) issues, and rushed development and approvals (49.1%). Vaccine uptake was associated with being ≥60 years, being a healthcare worker, previous influenza vaccine uptake, adherence to preventive measures, the death of ≥1 close people from COVID-19, and being informed through mass media or health authorities' channels. Vaccine uptake inversely correlated with male gender, low educational level, and use of closed social networks for COVID-19 information purposes. This study provides valuable insights into COVID-19 vaccination attitudes and practices in South America that may be used to promote vaccine uptake in the region. Higher COVID-19 vaccination acceptance among people with previously acquired prevention habits reinforces the importance of routine health promotion strategies.
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Affiliation(s)
- Analía Urueña
- Centro de Estudios para la Prevención y Control de Enfermedades Transmisibles, Universidad Isalud, Venezuela 931, Ciudad Autónoma de Buenos Aires C1095AAS, Argentina
- Sociedad Argentina de Vacunología y Epidemiología (SAVE), Ciudad Autónoma de Buenos Aires, Argentina
| | - Ricardo Machado
- Sociedade Brasileira de Imunizações (Sbim), R. Luís Coelho, 308-Consolação, São Paulo 01309-000, SP, Brazil (I.B.)
| | - Juarez Cunha
- Sociedade Brasileira de Imunizações (Sbim), R. Luís Coelho, 308-Consolação, São Paulo 01309-000, SP, Brazil (I.B.)
| | - Clara López Colmano
- Sociedad Argentina de Vacunología y Epidemiología (SAVE), Ciudad Autónoma de Buenos Aires, Argentina
| | - Carolina Rancaño
- Sociedad Argentina de Vacunología y Epidemiología (SAVE), Ciudad Autónoma de Buenos Aires, Argentina
| | - Renato Kfouri
- Sociedade Brasileira de Imunizações (Sbim), R. Luís Coelho, 308-Consolação, São Paulo 01309-000, SP, Brazil (I.B.)
| | - Catalina Pírez
- Sociedad Uruguaya de Pediatría, Comité de Infectología y Vacunas, Lord Ponsonby 2410, Montevideo 11600, Uruguay
| | - Pablo Bonvehí
- Sociedad Argentina de Vacunología y Epidemiología (SAVE), Ciudad Autónoma de Buenos Aires, Argentina
- Servicio de Infectología, Hospital Universitario CEMIC, Dr. Ricardo Balbín 4459, Ciudad Autónoma de Buenos Aires C1430ABC, Argentina
| | - Mario Calvo
- Instituto de Medicina, Facultad de Medicina, Universidad Austral de Chile, Coronel Santiago Bueras 1003, Valdivia 5110566, Chile;
| | - Robinson Cuadros
- Asociación Internacional de Gerontología y Geriatría, Comité Latinoamericano y del Caribe, Carrera 7C Bis 139-17, Bogotá 110121, Colombia;
| | - Greta Muñoz
- Sociedad Ecuatoriana de Pediatría (SEP), Av. Naciones Unidas E2-17 e, Quito 170135, Ecuador
| | - Mónica Rodríguez
- Hospital Central, Instituto de Previsión Social, PCH9+4RX, Santísimo Sacramento, Asunción 1519, Paraguay
| | - Jaime Torres
- Sección de Enfermedades Infecciosas, Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas 1040, Venezuela
| | - Florencia Cahn
- Sociedad Argentina de Vacunología y Epidemiología (SAVE), Ciudad Autónoma de Buenos Aires, Argentina
| | - Isabella Ballalai
- Sociedade Brasileira de Imunizações (Sbim), R. Luís Coelho, 308-Consolação, São Paulo 01309-000, SP, Brazil (I.B.)
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Herrera F, Torres D, Carena A, Nicola F, Rearte A, Temporiti E, Jorge L, Valentini R, Bues F, Relloso S, Bonvehí P. Short Course of Antibiotic Therapy for Gram-Negative Bacilli Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation: Less Is Possible. Microorganisms 2023; 11:microorganisms11020511. [PMID: 36838476 PMCID: PMC9963170 DOI: 10.3390/microorganisms11020511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
Data about short courses of antibiotic therapy for Gram-negative bacilli (GNB) bacteremia in immunosuppressed patients are limited. This is a prospective observational study performed on adult patients with cancer and hematopoietic stem cell transplant (HSCT) who developed GNB bacteremia and received appropriate empirical antibiotic therapy (EAT), had a clinical response within 7 days and survived 48 h after the end of therapy. They received antibiotic therapy in the range of 7-15 days and were divided into short course, with a median of 7 days (SC), or long course, with a median of 14 days (LC). Seventy-four patients were included (SC: 36 and LC: 38). No differences were observed in baseline characteristics or in the presence of neutropenia: 58.3% vs. 60.5% (p = 0.84). Clinical presentation and microbiological characteristics were similar in SC and LC, respectively: clinical source of bacteremia 72.2% vs. 76.3% (p = 0.68); shock 2.8% vs. 10.5% (p = 0.35) and multidrug-resistant GNB 27.8% vs. 21.1% (p = 0.50). Overall, mortality was 2.8% vs. 7.9% (p = 0.61), and bacteremia relapse was 2.8% vs. 0 (p = 0.30). The length of hospitalization since bacteremia was 7 days (interquartile range (IQR), 6-15) for SC and 12 days (IQR, 7-19) (p = 0.021) for LC. In the case of patients with cancer or HSCT and GNB bacteremia who receive appropriate EAT with clinical response, 7 days of antibiotic therapy might be adequate.
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Affiliation(s)
- Fabián Herrera
- Infectious Diseases Section, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
- Correspondence: ; Tel.: +54-911-58628323
| | - Diego Torres
- Infectious Diseases Section, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
| | - Alberto Carena
- Infectious Diseases Section, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
| | - Federico Nicola
- Microbiology Laboratory, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
| | - Andrés Rearte
- Infectious Diseases Section, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
| | - Elena Temporiti
- Infectious Diseases Section, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
| | - Laura Jorge
- Infectious Diseases Section, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
| | - Ricardo Valentini
- Internal Medicine Department, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
| | - Florencia Bues
- Infectious Diseases Section, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
| | - Silvia Relloso
- Microbiology Laboratory, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
| | - Pablo Bonvehí
- Infectious Diseases Section, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
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Villaverde MC, Sogga Alfano M, Fiori A, Rubio Ruiz R, Leone MV, Bonvehí P, Lopardo G. [Human monkeypox: epidemiological and clinical characteristics of a series of cases]. Medicina (B Aires) 2023; 83:569-578. [PMID: 37582131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
INTRODUCTION Monkeypox It is a zoonotic disease. The etiologic agent is the monkeypox virus. Since January 1, 2022, monkeypox cases have been reported to the World Health Organization (WHO) in 110 Member States across 6 WHO regions. METHODS The present work is a descriptive-observational-retrospective cohort in the first instance, and prospective at the end, where the epidemiological characteristics, clinical presentation and complications collected by telephone call on day 28, are described 75 patients diagnosed with monkeypox, confirmed by RT-PCR (corresponding to 7% of the cases reported in Argentina). It was developed between July 12, 2022 and October 6, 2022. RESULTS The affected population was entirely cisgender men, 70 (93.3%) identified as men who have sex with men (MSM). Fifty-one (68%) were co-infected with HIV, 50 (98%) were receiving ART. All patients presented mucocutaneous manifestations. The rash manifested with a variety of lesions: papular, vesicular, and pustular. In 26 (44.1%) the systemic symptoms presented prior to the appearance of the rash, being the increase in body temperature the most frequent. Thirty-four (45.3%) of the patients reported some complication, with proctitis being the most frequent followed by penile edema. Sequelae were observed in 40 (53.3%), the most frequent being skin scars. CONCLUSION In this case series we were able to observe mostly mild symptoms, with anogenital lesions being the most frequent clinical presentation. The presence of sequelae, the social and emotional impact of this disease make a multidisciplinary approach necessary.
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Affiliation(s)
- María Clara Villaverde
- Fundación del Centro de Estudios Infectológicos (FUNCEI), Buenos Aires, Argentina. E-mail:
| | - Micaela Sogga Alfano
- Fundación del Centro de Estudios Infectológicos (FUNCEI), Buenos Aires, Argentina
| | - Agustina Fiori
- Fundación del Centro de Estudios Infectológicos (FUNCEI), Buenos Aires, Argentina
| | - Rubiela Rubio Ruiz
- Fundación del Centro de Estudios Infectológicos (FUNCEI), Buenos Aires, Argentina
| | - María Victoria Leone
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Pablo Bonvehí
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Gustavo Lopardo
- Fundación del Centro de Estudios Infectológicos (FUNCEI), Buenos Aires, Argentina
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Nicola F, Cejas D, González-Espinosa F, Relloso S, Herrera F, Bonvehí P, Smayevsky J, Figueroa-Espinosa R, Gutkind G, Radice M. Outbreak of Klebsiella pneumoniae ST11 Resistant To Ceftazidime-Avibactam Producing KPC-31 and the Novel Variant KPC-115 during COVID-19 Pandemic in Argentina. Microbiol Spectr 2022; 10:e0373322. [PMID: 36445147 PMCID: PMC9769968 DOI: 10.1128/spectrum.03733-22] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022] Open
Abstract
We describe an outbreak of Klebsiella pneumoniae sequence type 11 (ST11) producing KPC variants resistant to ceftazidime-avibactam. Six patients hospitalized in the intensive care unit (mostly due to critical COVID pneumonia) presented infection or colonization by this bacterium. They had several comorbidities and required mechanical ventilation, central venous catheters, and urinary catheters. All 6 patients had a history of fecal colonization with KPC-producing Enterobacterales (KPC-E). Three of them had previous episodes of infection with ceftazidime-avibactam-susceptible KPC-producing K. pneumoniae, which were treated with ceftazidime-avibactam. Several phenotypic methods failed to detect carbapenemase production in these 6 ceftazidime-avibactam-resistant isolates, and they showed in vitro susceptibility to imipenem and meropenem. All of them rendered positive results for blaKPC by PCR, and amplicon sequencing identified blaKPC-31 variant in 5 isolates and a novel variant, named blaKPC-115, in the other. Moreover, matrix-assisted laser desorption ionization-time of flight mass spectrometry was able to detect KPC in all isolates. Ceftazidime-avibactam-resistant isolates, as well as those recovered from previous infection episodes (KPC-3-producing K. pneumoniae, ceftazidime-avibactam susceptible), displayed a unique pulse type and belonged to ST11. Based on whole-genome sequencing results of selected isolates, less than 7 single-nucleotide polymorphisms were identified among them, which was indicative of the presence of a unique clone. Both in vivo selection and horizontal transmission seemed to have occurred in our hospital. Detection of these strains is challenging for the laboratory. History of previous KPC-E infections or colonization and systematic testing for resistance to ceftazidime-avibactam might help raise awareness of this possibility. IMPORTANCE Klebsiella pneumoniae is one of the main bacteria that cause infections in health care settings. This pathogen has developed a high level of resistance to many antibiotics. Some K. pneumoniae isolates can produce an enzyme known as carbapenemase KPC, making carbapenems (considered the last line for therapy) not effective to treat their infections. The combination ceftazidime-avibactam, approved by FDA in 2015, is useful to treat infections caused by KPC-producing K. pneumoniae. This study describes the emergence, in one hospital in Argentina, of K. pneumoniae isolates that produce KPC variants (KPC-31 and KPC-115) resistant to ceftazidime-avibactam. The ceftazidime-avibactam-resistant bacteria were isolated in inpatients, including some that previously received this combination as treatment. Transmission of this strain to other patients also occurred in the studied period. Detection of these bacteria is challenging for the laboratory. The knowledge and awareness of the emergence of this pathogen in our region are highly valuable.
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Affiliation(s)
- Federico Nicola
- Laboratorio de Bacteriología, Micología y Parasitología, Departamento de Análisis Clínicos, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Daniela Cejas
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Francisco González-Espinosa
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Silvia Relloso
- Laboratorio de Bacteriología, Micología y Parasitología, Departamento de Análisis Clínicos, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Fabián Herrera
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Pablo Bonvehí
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Jorgelina Smayevsky
- Laboratorio de Bacteriología, Micología y Parasitología, Departamento de Análisis Clínicos, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Roque Figueroa-Espinosa
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Gabriel Gutkind
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Marcela Radice
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Jorge L, Azula N, Smayevsky J, Herrera F, Temporiti E, Bonvehí P. [Incidence, clinical characteristic and evolution of Clostridioides difficile infection]. Medicina (B Aires) 2021; 81:931-938. [PMID: 34875590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
Clostridioides difficile infection (CDi) is one of the foremost hospital-acquired infections. We present an observational study aimed to describe the incidence, epidemiology, and clinical outcome of CDi in a tertiary university hospital in Buenos Aires. The episodes, diagnosed in 117 consecutive adult patients in the period 01/01/2017 to 01/04/2020, were distributed in three groups: 63 (53.9%) were classified as hospital-acquired infections (HA), 25 (21.4%) as community onset-health care-associated infections (CO-HCA) and 29 (24.8%) as community-associated infections (CA). The incidence of HA CDi infections was 3.1, 5. 2 and 2.8 every 10 000 patient days in 2017, 2018 and 2019, respectively. The microbiological diagnosis was made by immunochromatography with antigen GDH and C. difficile toxin positive in 51 episodes (43.6%) and by GDH positive, toxin negative and PCR positive in 66 episodes (56.4%). Older age (p = 0.018), chronic kidney disease (p = 0.013), immunosuppression (p = 0.021), and higher comorbidity Charlson score (p = 0.001) were observed in patients with IH and CA-HCA infections. No significant differences in clinical features were found among groups. During the hospital st ay, 13 patients (11.1%) required admission to the intensive care unit. Ten recurrences occurred, representing 8.5% of CDI episodes. The 90-day mortality was 19.8%, being significantly higher in HA and CO-HCA infections (p = 0.014). Our findings highlight both the local burden of CDi morbidity and mortality and the need for the implementation of preventive strategies.
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Affiliation(s)
- Laura Jorge
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno - CEMIC, Buenos Aires, Argentina. E-mail:
| | - Natalia Azula
- Laboratorio de Bacteriología, Micología y Parasitología, Departamento de Análisis Clínicos, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno - CEMIC, Buenos Aires, Argentina
| | - Jorgelina Smayevsky
- Laboratorio de Bacteriología, Micología y Parasitología, Departamento de Análisis Clínicos, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno - CEMIC, Buenos Aires, Argentina
| | - Fabián Herrera
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno - CEMIC, Buenos Aires, Argentina
| | - Elena Temporiti
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno - CEMIC, Buenos Aires, Argentina
| | - Pablo Bonvehí
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno - CEMIC, Buenos Aires, Argentina
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Herrera F, Bues F, Rojas R, Temporiti E, Videla C, Dupont J, Bonvehí P. [SARS-COV-2 infection in patients with hematological malignancies and transplants]. Medicina (B Aires) 2021; 81:396-400. [PMID: 34137699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
SARS-CoV-2 infection in patients with hematological malignancies and hematopoietic stem cell transplants (HSCT) can be severe and with significant mortality. We carried out a prospective and observational study to describe the clinical and epidemiological characteristics and outcome of SARS-CoV-2 infection in patients with hematological malignancies and HSCT. Twenty adult patients were included with a median age of 58 years and a median Charlson score of 3. Infections were community-acquired and nosocomial in 60% and 40%, respectively, and 30% of the patients had a history of contact with a SARS-CoV-2 infected person. Sixty-five percent had pulmonary infiltrates, mostly with a ground-glass pattern on CT scan. Almost half of the patients had a severe and critical illness, and a high proportion received convalescent plasma as treatment. Twenty percent and 15% had complications and hospital infections, respectively, and had prolonged hospitalization expressed as median days of it. The 30-day mortality was 10%. SARS-CoV-2 infection in our population had a considerable clinical and epidemiological impact.
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Affiliation(s)
- Fabián Herrera
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina. E-mail:
| | - Florencia Bues
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Rocío Rojas
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Elena Temporiti
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Cristina Videla
- Laboratorio de Virología, Departamento de Análisis Clínicos, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Juan Dupont
- Sección Hematología, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Pablo Bonvehí
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
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Panero MS, Khuri-Bulos N, Biscayart C, Bonvehí P, Hayajneh W, Madhi SA. The role of National Immunization Technical Advisory Groups (NITAG) in strengthening health system governance: Lessons from three middle-income countries-Argentina, Jordan, and South Africa (2017-2018). Vaccine 2020; 38:7118-7128. [PMID: 32950303 PMCID: PMC10783979 DOI: 10.1016/j.vaccine.2020.08.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Toward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance. METHODS In 2017-2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC). RESULTS Document review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation. CONCLUSIONS Systematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making.
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Affiliation(s)
- Maria S Panero
- US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Cristián Biscayart
- Dirección de Control de Enfermedades Inmunoprevenibles, Ministerio de Salud de la Nación, Argentina
| | - Pablo Bonvehí
- Sociedad Argentina de Infectología, Buenos Aires, Argentina
| | | | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Valentini R, Fernández J, Riveros D, Pálizas F, Solimano J, Saúl P, Medina J, Falasco V, Dupont ML, Laviano J, Fornillo F, Maymó D, Gotta D, Martínez A, Bonvehí P, Dupont J. [Convalescent plasma as a therapy for severe COVID-19 pneumonia]. Medicina (B Aires) 2020; 80 Suppl 6:9-17. [PMID: 33481727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
The COVID-19 pandemic presented high mortality from its beginning, without effective treatment for seriously ill patients. Build on the experience in Argentine hemorrhagic fever with convalescent plasma, we incorporated 90 patients with COVID-19, of which 87 were evaluable, into a multicenter study. We collected 397 plasma donations from 278 convalescent donors. Patients received plasma with an IgG concentration of 0.7-0.8 (measured by Abbott chemiluminescence) for every 10 kg of body weight. Survival during the first 28 days was the primary objective; 77% were male, age 54 ± 15.6 y/o (range 27-85), body mass index 29.7 ± 4.4; hypertension 39% and diabetes 20.7%; 19.5% had an immunosuppressive condition, 23% were health workers. Plasma was administered to 55 (63%) on spontaneous breathing with oxygen supplementation (mainly oxygen mask with reservoir bag in 80%), and to 32 patients (37%) on mechanical ventilation. The 28-day survival rate was 80%; 91% in patients infused on spontaneous breathing and 63% in those on mechanical ventilation (p = 0.0002). There was a significant improvement in the WHO pneumonia clinical scale at 7 and 14 days, and in PaO2 / FiO2, ferritin and LDH, in the week post-infusion. We observed an episode of circulatory volume overload and a febrile reaction, both mild. Convalescent plasma infusions are feasible, safe, and potentially effective, especially before requiring mechanical ventilation. They are an attractive clinical option for treating severe forms of COVID-19 until other effective therapies become available.
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Affiliation(s)
| | | | | | | | | | - Pablo Saúl
- Servicio de Infectología, Policlínico de Unión Obrera Metalúrgica, Buenos Aires, Argentina
| | - Juan Medina
- Terapia Intensiva, Sanatorio Itoiz, Buenos Aires, Argentina
| | - Viviana Falasco
- Servicio de Clínica Médica, Hospital Pedro Fiorito, Buenos Aires, Argentina
| | | | | | | | | | - Daniel Gotta
- Sección Hematología, CEMIC, Buenos Aires, Argentina
| | - Alfredo Martínez
- Departamento de Análisis Clínicos, CEMIC, Buenos Aires, Argentina
| | - Pablo Bonvehí
- Sección Infectología, CEMIC, Buenos Aires, Argentina
| | - Juan Dupont
- Sección Hematología, CEMIC, Buenos Aires, Argentina
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10
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Carena AA, Jorge L, Bonvehí P, Temporiti E, Zárate MS, Herrera F. [Levofloxacin prophylaxis in neutropenic patients]. Medicina (B Aires) 2016; 76:295-303. [PMID: 27723617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Fluorquinolone-prophylaxis has proven useful in preventing infections in high risk neutropenic patients. The objective of this study was to describe the clinical, microbiological and therapeutic characteristics, and outcome of patients in the first episode of febrile neutropenia, comparing those who received levofloxacin prophylaxis with those who didn't. It was a prospective observational study that included all the episodes of inpatients with febrile neutropenia (February 1997- November 2014), also including the first episode in a same patient in different hospitalizations. Of 946 episodes here included, 821 presented high risk febrile neutropenia. A total of 264 cases (27.9%) received levofloxacin prophylaxis. This group consisted of a higher proportion of high risk febrile neutropenia (99.2% vs. 82.3%, p = 0.0001) and patients that had received an hematopoietic stem cell transplant (67.8% vs. 29.3%, p = 0.0001) compared to those who didn't receive prophylaxis. Those who received levofloxacin prophylaxis presented a similar frequency of clinically diagnosed but a lower proportion of microbiologically documented infections (28.8% vs. 37.5%, p = 0.012) than those who didn't receive prophylaxis. The episodes of bacteremia that occurred in the first group were more frequently caused by multidrug resistant bacteria (MDRB) (34.5% vs. 17.3%, p = 0.007) and by extended spectrum beta lactamase producing Enterobacteriaceae (19% vs. 3.8%, p = 0.0001). The group that received prophylaxis had a lower proportion of adequate empirical antibiotic treatment (69.7% vs. 83.7%, p = 0.009), with similar outcomes in both groups. We suggest that levofloxacin prophylaxis should be stopped whenever there is a rise in the frequency of MDRB infections in this population.
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Affiliation(s)
- Alberto A Carena
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina. E-mail:
| | - Laura Jorge
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina
| | - Pablo Bonvehí
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina
| | - Elena Temporiti
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina
| | - Mariela S Zárate
- Sección Bacteriología, Micología y Parasitología, Departamento de Análisis Clínicos, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina
| | - Fabián Herrera
- Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina
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11
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Stecher D, Gaiano A, Biscayart C, Gentile A, Ayala SG, López E, Bonvehí P, Yedlin P, Janusz C, Vizzotti C. National Immunization Commission: Strengthening evidence-based decision making in Argentina. Vaccine 2014; 32:1778-80. [DOI: 10.1016/j.vaccine.2014.01.080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 01/25/2014] [Accepted: 01/30/2014] [Indexed: 11/16/2022]
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12
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Sosa Liprandi MI, Sosa Liprandi A, Fernández A, Stecher D, Bonvehí P, Verón MT. [Influenza and pneumococcal immunization in cardiovascular prevention]. Medicina (B Aires) 2014; 74:245-253. [PMID: 24918678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
A group of interdisciplinary experts (cardiologists, clinicians, infectologists met with the purpose of analyzing the evidence revealed by the relationship between respiratory diseases caused by influenza, pneumococcal diseases and cardiovascular events, and the role played by immunization strategies applied in cardiovascular prevention. The present statement summarizes the conclusions reached by the expertise of the aforementioned professionals. Systematic revisions imply consistent evidence that influenza and pneumococcal infection lead to acute myocardial infarction and cardiovascular death. Studies published during the last 15 years suggest that vaccination against influenza and S. pneumoniae reduce the risk of acute coronary syndromes. With the current evidence, and considering cost-effectiveness, reducing operating expenses and safety profile of the vaccines, scientific societies, national and international government health agencies strongly recommend incorporating immunization programs in those patients with chronic cardiovascular disease.
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Affiliation(s)
- María Inés Sosa Liprandi
- Sanatorio Güemes, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Argentina. E-mail:
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Querci M, Stryjewski ME, Herrera F, Temporiti E, Alcalá W, Chavez N, Figueras L, Barberis F, Echavarría M, Videla C, Martínez A, Carballal G, Bonvehí P. Healthcare personnel infected with novel influenza A H1N1 virus in university hospitals in Buenos Aires, Argentina. ACTA ACUST UNITED AC 2010; 43:70-4. [PMID: 20854220 DOI: 10.3109/00365548.2010.515244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Data on the clinical presentation, risk factors, and outcomes for healthcare personnel (HCP) infected with influenza A H1N1 virus (H1N1) are limited. From June to July 2009, a prospective study was conducted among HCP with influenza-like illness (ILI) at university hospitals in Buenos Aires. A reverse transcription polymerase chain reaction (RT-PCR) was used to diagnose H1N1. A logistic regression model was developed to identify factors associated with H1N1. Among 1519 HCP, 96 (6.3%) were diagnosed with an ILI. Of these, 85 (88.5%) were swabbed for H1N1 detection, with 43 positive cases (2.8%). Seasonal influenza immunization was recorded in 76%. Comparison of H1N1-positive vs. H1N1-negative cases showed that H1N1-positive cases more frequently had asthenia (72% vs. 48%, p = 0.03) and cough (79% vs. 43%, p = 0.008) and less frequently had diarrhoea (9% vs. 29%, p = 0.03) and prior prophylaxis with oseltamivir (5% vs. 31%, p = 0.002). The logistic regression model showed that presence of cough (odds ratio (OR) 6.93, 95% confidence interval (CI) 2.24, 21.4) was associated with an increased risk of H1N1. Prior prophylaxis with oseltamivir (OR 0.08, 95% CI 0.01, 0.43) was associated with a lower probability of H1N1 infection. A high proportion of HCP with an ILI were infected with H1N1. Complication rates were relatively low. Prior prophylaxis with oseltamivir was associated with a lower risk of developing H1N1.
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Affiliation(s)
- Marcia Querci
- Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina.
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15
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Miceli M, Herrera F, Temporiti E, Li D, Vila A, Bonvehí P. Adherence to an occupational blood borne pathogens exposure management program among healthcare workers and other groups at risk in Argentina. Braz J Infect Dis 2005; 9:454-8. [PMID: 16410939 DOI: 10.1590/s1413-86702005000600002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We conducted a retrospective review of 130 occupational blood borne pathogens exposure (BBP-OE) records at Centro de Estudios Médicos e Investigaciones Clínicas, a university hospital with an ongoing educational program and a postexposure management program for healthcare workers (HCWs) since 1995, in order to evaluate adherence to a hospital BBP-OE management program. We compared HCWs from our institution (Group 1) and HCWs from independent institutions that contract our postexposure management program (Group 2). Compliance with standard precautions in Group 1 was inadequate in 77%, 23%, and 16% of nurses, physicians, and others, respectively. A greater proportion of HCWs in Group 1 (74% vs. 40%) reported occupational accidents within two hours after exposure (p = 0.0001). No difference was observed regarding compliance with adherence to schedule, partial adherence, and loss at follow-up (14%, 33%, and 53%; p > 0.05). Adherence to the standard of care for BBP-OE, including postexposure prophylaxis, was low (HIV: 53% and HBV: 63%). Knowledge of the seropositive status of the source patient did not improve adherence. We conclude that postexposure programs do not guarantee appropriate behavior by HCWs. General interventions and ongoing personnel education to modify individual attitudes are needed, as are continued efforts to assess HCWs' experiences with these programs, as well as the identification of strategies to improve adherence.
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Affiliation(s)
- Marisa Miceli
- Division of Infectious Diseases, Department of Internal Medicine, CEMIC, Buenos Aires, Argentina.
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16
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Negroni R, Arechavala A, Bonvehí P. [Clinical problems in medical mycology: problem no. 12. Disseminated coccidioidomycosis]. Rev Iberoam Micol 2004; 21:213-5. [PMID: 15709805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
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17
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Negroni R, Arechavala A, Bonvehí P. [Clinical problems in medical mycology: problem no. 10. Cryptococcosis]. Rev Iberoam Micol 2004; 21:153-4. [PMID: 15709792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Affiliation(s)
- Ricardo Negroni
- Centro de Estudios Micológicos, José Evaristo Uriburu, Buenos Aires, Argentina.
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18
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Negroni R, Abbatte E, Arechavala A, Bonvehí P. [Clinical cases in Medical Mycology. Case No. 7]. Rev Iberoam Micol 2004; 21:44-6. [PMID: 15458364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
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Bantar C, Durlach R, Nicola F, Freuler C, Bonvehí P, Vazquez R, Smayevsky J. Efficacy and pharmacodynamics of teicoplanin given daily during the first 3 days and then on alternate days for methicillin-resistant Staphylococcus aureus infections. J Antimicrob Chemother 1999; 43:737-40. [PMID: 10382901 DOI: 10.1093/jac/43.5.737] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Fifteen evaluable patients (mean age, 67 years) were enrolled to assess the efficacy of teicoplanin, 6 mg/kg given daily during the first 3 days and then on alternate days, for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. Eight patients had soft tissue infections, four catheter-associated bacteraemia, two osteomyelitis and one pneumonia. Clinical cure was observed in 13 of 15 patients. Both clinical and bacteriological failures were shown in the two patients with osteomyelitis. The mean serum levels of teicoplanin (mg/L) were 22, 8 and 6.7 for peak, 24 h and 48 h troughs, respectively. The dosage employed in this study proved effective in non-deep-seated MRSA infections.
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Affiliation(s)
- C Bantar
- Department of Microbiology and Infectious Diseases of the Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina.
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