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The use of colchicine is associated with a significant reduction of cardiac adverse events in patients with coronary artery disease. Past small randomized trials with oral immunosuppressive or anti-inflammatory therapies have demonstrated a reduction of adverse clinical events after bare metal stent implantation. The potential role of adjunctive colchicine after bare-metal stent implantation, compared with drug-eluting stent alone, is unknown. The primary end point of the study will be to compare cost-effectiveness at 1 year of follow-up of coronary intervention with bare-metal stent implantation plus 1 mg of colchicine during 3 months versus percutaneous coronary intervention with drug-eluting stent implantation alone. ClinicalTrials.gov identifier: NCT04382443. [ABSTRACT FROM AUTHOR]

The rational use of antimicrobials is essential and can be achieved through antimicrobial stewardship programs. Although several studies identify the clonal relationships of nosocomial carbapenemase KPC-producing Klebsiella pneumoniae (KPC-Kp) strains, none of them, at our knowledge, investigates at the same time clonal status of colonizing KPC-Kp strains. Our aim was to perform a whole-genome sequencing (WGS) of both, colonizing and infecting KPC-Kp strains, to perform genomic analysis, and identification of acquired antimicrobial resistance genes (ARG). A 38 years old woman received a deceased donor kidney transplant in 2013 after 11 years of hemodialysis. The patient developed recurrent urinary tract infections (UTI) with high antibiotic exposition. First sample analyzed was a colonizing strain isolated the first day of hospitalization (HAp39) from a surveillance rectal swab. The second strain was isolated 7 days after hospitalization (HA40) from a urine sample taken in context of UTI suspicion. Both strains showed reduced susceptibility to β-lactams, sulfamethoxazole, trimethoprim, chloramphenicol, tetracycline, and ciprofloxacin according to CLSI, 2020. WGS was carried out using Illumina MiSeq-I, and de novo assembly was performed using SPAdes v.3.11. Genomic analysis was made. Both strains belonged to ST11. They possessed in common a total of 21 transferable ARG, aadA1, aac(6′)-Ib, aph(3′')-Ib, aph(6)-Id, arr-3, bla KPC-2, bla OXA-1 , bla OXA-9 , bla TEM-1A , catB3, floR, fosA, mph(E), msr(E), oqxA, oqxB, qacEΔ1, qnrB19, sul1, sul2 , and tet(A). HAp39 strain also harbored a second carbapenemase bla OXA-163 , and a dfrA22 -like gene. bla OXA-163 had as flanking sequences IS 4 (TnpA)- bla OXA-163- HP-Tn 3 family (TnpA). Loss of bla OXA-163 , and dfrA22 -like gene was observed in HA40 strain, though acquisition of bla CTX-M-2 , rmtD and a cat -like genes were identified in this strain. The bla KPC-2 gene was located in the same genetic platform (IS Kpn27 -bla KPC2 - IS Kpn6- HP-Tn 3 (TnpR)) in both strains Colonizing and infecting KPC-Kp strains showed to belong to the same ST11 with a high similarity at DNA level, suggesting they are the same strains. Loss and acquisition of ARG during the hospitalization was observed. Also, a change in epidemiology is being observed displacing KPC-Kp ST258 isolates suggesting that molecular surveillance of ST11 KPC-Kp should be performed in our region to prevent further spread. [ABSTRACT FROM AUTHOR]

Rapid spread of multidrug resistant Gram-negative bacilli (MDR-GNB) infection in Coronavirus disease (COVID-19) critically ill patients was observed even in those without underlying diseases and in all age groups. We conducted a prospective cohort study to assess the risk factors for acquisition of MDR-GNB infection in COVID-19 patients and its impact on patients´ outcome. We included 43 consecutive patients with COVID-19 from a total of 8874 patients with COVID-19 admitted into the ICU of Aleman Hospital, Argentina, from May 1st 2020 to June 30th 2021. Followed up until death or 30 days after hospital discharge. We divided them into 4 groups: colonized with MDR-GNB (G1), colonized with MDR-GNB and infected with non-carbapenem resistant bacteria (G2), colonized and infected with MDR-GNB (G3), and infected with MDR-GNB without previous colonization (G4). Microbiological sampling was performed according to patient's conditions or epidemiological surveillance. Outcomes considered were length of hospital stay (LOS), mortality and readmission rate. Seven, five, six and twenty five patients were distributed respectively in G1, G2, G3 and G4. Male/female ratio was 2:1 with a median age of 68 years (IQR 62–75). Chronic pulmonary disease (18.6%) was the main comorbidity. Mean LOS was 40.16 days (P=0.79). Prolonged biomedical devices used were observed in 93% of patients (P=0.33). Ventilator associated pneumonia (n:15/36) and catheter-related bloodstream infection (n:16/36) were the most frequent infections (P=0.29, P=0.69). The most common carbapenem-resistant pathogens were Klebsiella pneumoniae (n: 38/60) and Pseudomonas aeruginosa (n:8/60). All patients were exposed to antibiotics before MDR-GNB was diagnosed. The first isolation of MDR-GNB was on average 14 days after hospital admission (P=0,84). Time between MDR-GNB colonization and infection was twice as much between G2 and G3 (8.4 Vs. 4 days, P=0.83). We observed no difference in all-cause mortality rate and readmission rate between the groups (P=0.75, P=0.97). Prolonged ICU hospitalizations in addition to use of invasive devices and antibiotics exposure correlate with a higher risk of developing MDR-GNB colonization and infection in COVID-19 critically ill patients. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to analyze the performance of two scores developed for predicting diabetes in nontransplant populations for identifying kidney transplant recipients with a higher new-onset diabetes mellitus after transplantation (NODAT) risk beyond the first year after transplantation.Research Design and Methods: We analyzed 191 kidney transplants, which had at least 1-year follow-up posttransplant. First-year posttransplant variables were collected to estimate the San Antonio Diabetes Prediction Model (SADPM) and Framingham Offspring Study-Diabetes Mellitus (FOS-DM) algorithm.Results: Areas under the receiver operating characteristic curve of FOS-DM and SADPM scores to predict NODAT were 0.756 and 0.807 (P < 0.001), respectively. FOS-DM and SADPM scores over 75 percentile (hazard ratio 5.074 and 8.179, respectively, P < 0.001) were associated with NODAT.Conclusions: Both scores can be used to identify kidney recipients at higher risk for NODAT beyond the first year. SADPM score detects some 25% of kidney transplant patients with an eightfold risk for NODAT. [ABSTRACT FROM AUTHOR]

A travel medicine trained physician is the appropriate person to advise an elderly patient to get the vaccine or to avoid travelling. An epidemic started in 2017 in Brazil beaches challenging physicians, because Argentinian people use to spend their holidays there and require vaccination regardless of their age. B Background: b A traveler's risk for acquiring YF is determined by multiple factors, including immunization status, use of personal protection measures against mosquito bites and local rate of virus transmission. [Extracted from the article]

Background: It is known that patient's flora contaminates the environment favoring microorganism's dissemination. Hospital Hygiene is therefore critical as an infection control measure. Aiming to improve it we decided to measure it and give feed-back to the cleaning staff in order to stimulate them. We also tried to assess if effectiveness gained was maintained through time. Methods & Materials: Prospective before-after study in the 30-bed CCU of a private hospital in Buenos Aires, Argentina (Ten intensive care beds, 10 intermediate care beds and 10 coronary care beds). Pre-intervention (3 months): With an invisible-ink pen we made ten marks in different surfaces of each room and controlled if they persisted 24 hours later. We calculated percentage of marks vanished. Intervention: We showed the results to the cleaning-staff and reviewed the right technique with them. Post-intervention (3 months): During the first 3 months, we evaluated the hygiene monthly and informed the results obtained. The cleaning staff was asked to complete a satisfaction survey. Follow up: After 9 months without controls we began to perform them every 3 months to assess continuity. Results: Cleaning efficacy improved statistically significant after the intervention Percentage of marks cleaned. The less cleaned components were the infusion pumps (84%) and the ends of the beds (87%). The 84% of the survey-responders thought cleaning had improved and 79% perceived their work was more appreciated. Continuous controls are required to sustain achievements through time. Conclusion: To retrieve results is a beneficial strategy to improve cleaning. To analyze data together with the staff allows finding out real and specific goals. Control is essential to sustain results through time. [ABSTRACT FROM AUTHOR]

Background: Since the first renal transplantation performed in Boston in 1954, solid organ transplantation became a common strategy against end-stage diseases. The German Hospital in Buenos Aires performed its first renal transplantation in 2000 and since then practice grew including also liver and heart transplantations. After 15 years it is time to evaluate the current infectious complications, aiming to discover useful variables to work on. Methods & Materials: This analysis is a retrospective observational study, for which we have reviewed the medical records of all patients undergoing transplantation surgeries from 1-Jan-2014 to 31-Dec-2014. On an excel sheet we have analyzed information such as: age, gender, underlying disease, type of immune suppression, time of onset of the infectious event and type and source of microorganisms involved. Results: Forty-six patients were transplanted during 2014, 33 (71.7%) of them had at least one infectious event. Median age was 55 (8-78, 70% between 31-65 years), 74% males. There was no difference between infected and not-infected regarding these 2 points. Organs transplanted: 2 hearts, 21 kidneys and 23 livers. Percentage of infections was similar in the different groups. Twenty-seven (33%) of infectious events were due to urinary tract infections, 19 of them in renal transplants (70%, p=0.02). CMV-reactivation was seen in 12 cases, 9 (75%) of them in liver-transplantations. Primary bacteremia was in third place (9, 13%) and surgical site infection in fourth (7, 10%). Low numbers prevent from calculating rates. Most of the infections (88%) showed up during the first 3 months, only 1 (3%) after 6 months. There was a wide range of microorganisms involved, 68% bacteria (70% GNB), 19% virus, 95 fungus and 4% TB. Regarding the storage fluid, 24% presented bacterial growth. There wasn't an increase incidence of infectious events in those in which the storage fluid was contaminated. Conclusion: Urinary tract infection was the main complication as literature mentions. Surgical site infections were not prevalent in a particular group, which rules out inappropriate surgical technique. The variety of microorganisms involved rules out a common source.CMVprophylaxis strategy in hepatic transplant patients has to be reviewed. [ABSTRACT FROM AUTHOR]