Homero Bagnulo

Community- acquired Methicillin-resistant Staphylococcus aureus, Uruguay

A novel, methicillin-resistant Staphylococcus aureus clone (Uruguay clone) with a non–multidrug-resistant phenotype caused a large outbreak, including 7 deaths, in Montevideo, Uruguay. The clone was distinct from the highly virulent community clone represented by strain MW2, although both clones carried Panton-Valentine leukocidin gene and cna gene.

Community-acquired Methicillin-resistant Staphylococcusaureus, Uruguay

A novel, methicillin-resistant Staphylococcus aureus clone (Uruguay clone) with a non–multidrug-resistant phenotype caused a large outbreak, including 7 deaths, in Montevideo, Uruguay. The clone was distinct from the highly virulent community clone represented by strain MW2, although both clones carried Panton-Valentine leukocidin gene and cna gene.

Clinical characteristics and outcomes of patients with 2009 influenza A(H1N1) virus infection with respiratory failure requiring mechanical ventilation

PURPOSE The purpose of the study was to describe the clinical characteristics and outcomes of critically ill patients with 2009 influenza A(H1N1). METHODS An observational study of patients with confirmed or probable 2009 influenza A(H1N1) and respiratory failure requiring mechanical ventilation was performed. RESULTS We studied 96 patients (mean age, 45 [14] years [mean, SD]; 44% female). Shock and acute respiratory distress syndrome were diagnosed during the first 72 hours of admission in 43% and 72% of patients, respectively. Noninvasive positive pressure ventilation was used in 45% of the patients, but failed in 77% of them. Bacterial pneumonia was diagnosed in 33% of cases, 8% during the first week (due to community-acquired microorganisms) and 25% after the first week (due to gram-negative bacilli and resistant gram-positive cocci). Intensive care unit mortality was 50%. Nonsurvivors differed from survivors in the prevalence of cardiovascular, respiratory, and hematologic failure on admission and late pneumonia. Reported causes of death were refractory hypoxia, multiorgan failure, and shock (50%, 38%, and 12% of all causes of death, respectively). CONCLUSIONS Patients with 2009 influenza A(H1N1) and respiratory failure requiring mechanical ventilation often present with clinical criteria of acute respiratory distress syndrome and shock. Bacterial pneumonia is a frequent complication. Mortality is high and is primarily due to refractory hypoxia.

Community strains of methicillin-resistant Staphylococcus aureus as potential cause of healthcare-associated infections, Uruguay, 2002-2004.

Community-associated MRSA appears to be replacing healthcare-associated MRSA strain types in at least 1 facility and is a cause of healthcare-onset infections.

Prevalence, risk factors and consequences of severe burnout syndrome in ICU

Dear Editor, Burnout Syndrome (BOS) is common in intensive care unit (ICU) clinicians [1, 2]. BOS leads to loss of psychological wellbeing, increased absenteeism, and deterioration of the work performance. As burnout is favored by stressful work elements, ICU clinicians who have to deal with sick patients, family distress, and urgent decisions that impact immediately on outcomes have been reported with high levels of severe burnout [1–3]. Moreover, there is a complex relationship between ICU conflicts and BOS, as well as common risk factors for the two entities, raising the interest of global preventive strategies [4]. The prevalence of BOS in health care professionals may differ across countries. We sought to report on prevalence, determinants and consequences of BOS in Uruguay. Our aims were to both highlight the importance of the problem and identify determinants of BOS on which preventive strategies could be implemented. The study was conducted in 12 Uruguayan ICUs. Each ICU staff member received an anonymous questionnaire including demographics, ICU organization, relationship with ICU colleagues on a 0 (poor relationship) to 10 (best possible relationship) scale, end-of-life care, the Maslach Burnout Inventory (MBI) and items providing information on the clinician’s private life. High level of burnout was defined by an MBI score of -8 to ?34, while a moderate/low level is defined by a score from -9 to -45 [5]. Of the 414 questionnaires returned, 364 (88 %) with no missing MBI data from 282 ICU-nurses and 82 ICUphysicians were collected and analysed. Using the MBI, a severe level of burnout was identified in 51 % of intensivists and 42 % of the nursing staff. The general characteristics associated with the development of BOS by univariate analysis are listed in Table 1. Of striking finding, the relationship with nurses, physicians and patients was associated with

Neumonía aguda adquirida en la comunidad en adultos: Actualización de los lineamientos para el tratamiento antimicrobiano inicial basado en la evidencia local del Grupo de Trabajo de Sudamérica (ConsenSur II)

Resumen La neumonia adquirida por adultos en la comunidad (NAC) es, probablemente, una de las infecciones que afecta a los pacientes ambulatorios para la cual se ha escrito la mayor diversidad de lineamientos en todo el mundo. La mayoria de ellos concuerdan en que el tra-tamiento antimicrobiano debe ser ajustado inicialmente de acuerdo con la gravedad de la infeccion o con la presencia de co-morbilidades y el patogeno etiologico. Aun asi, se puede notar una gran variabilidad entre los diferentes paises en la seleccion de la eleccion primaria de los agentes antimicrobianos, incluso en los casos considerados como de bajo riesgo. Este hecho puede de-berse a las multiples causas microbianas de la NAC y las especialidades medicas involucradas, como asi tambien los diferentes sistemas de asistencia de salud que afectan la disponibilidad o el costo de los antimicrobianos. No obstante, muchos paises o regiones adoptan alguno de los lineamientos o disenan sus propias recomendaciones independientemente de los datos locales, probablemente debido a la escasez de dichos datos. Por esta razon desarrollamos lineamientos para el tratamiento inicial de la NAC hacia el ano 2002, sobre la base de varias evidencias locales en Sudamerica (ConsenSur I). Sin embargo, varios temas merecen discutirse nuevamente

Incidence rate of community-acquired pneumonia in adults: a population-based prospective active surveillance study in three cities in South America

Objective To determine the incidence rate and mortality of community-acquired pneumonia (CAP) in adults in three cities in Latin America during a 3-year period. Design Prospective population-based surveillance study. Setting Healthcare facilities (outpatient centres and hospitals) in the cities of General Roca (Argentina), Rivera (Uruguay) and Concepción (Paraguay). Participants 2302 adults aged 18 years and older with CAP were prospectively enrolled between January 2012 and March 2015. Main outcome measures Incidence rates of CAP in adults, predisposing conditions for disease, mortality at 14 days and at 1 year were estimated. Incidence rate of CAP, within each age group, was calculated by dividing the number of cases by the person-years of disease-free exposure time based on the last census; incidence rates were expressed per 1000 person-years. Results Median age of participants was 66 years, 46.44% were men, 68% were hospitalised. Annual incidence rate was 7.03 (95% CI 6.64 to 7.44) per 1000 person-years in General Roca, 6.33 (95% CI 5.92 to 6.78) per 1000 person-years in Rivera and 1.76 (95% CI 1.55 to 2.00) per 1000 person-years in Concepción. Incidence rates were highest in participants aged over 65 years. 82.4% had at least one predisposing condition and 48% had two or more (multimorbidity). Chronic heart disease (43.6%) and smoking (37.3%) were the most common risk factors. 14-day mortality rate was 12.1% and 1-year mortality was 24.9%. Multimorbidity was associated with an increased risk of death at 14 days (OR 2.91; 95% CI 2.23 to 3.80) and at 1 year (OR 3.00; 95% CI 2.44 to 3.70). Conclusions We found a high incidence rate of CAP in adults, ranging from 1.76 to 7.03 per 1000 person-years, in three cities in South America, disclosing the high burden of disease in the region. Efforts to improve prevention strategies are needed.

Updated Acute Community-Acquired Pneumonia in Adults: Guidelines for Initial Antimicrobial Therapy Based on Local Evidence from the South American Working Group (Consensur II)

Community-acquired pneumonia (CAP) in adults is probably one of the infections affecting ambulatory patients for which the highest diversity of guidelines has been written worldwide. Most of them agree in that antimicrobial therapy should be initially tailored according to either the severity of the infection or the presence of comorbidities and the etiologic pathogen. Nevertheless, a great variability may be noted among the different countries in the selection of the primary choice in the antimicrobial agents, even for the cases considered as at a low-risk class. This fact may be due to the many microbial causes of CAP and specialties involved, as well as the different health-care systems effecting on the availability or cost of antibiotics. However, many countries or regions adopt some of the guidelines or design their own recommendations regardless of the local data, probably because of the scarcity of such data. This is the reason why we have developed a guideline for the initial treatment of CAP by 2002 upon the basis of several local evidences in South América (ConsenSur I). However, several issues deserve to be currently rediscussed as follows: certain clinical scores other than the Physiological Severity índex (PSI) have become more popular in clinical practice (i.e. CURB-65, CRB-65); some pathogens have emerged in the región, such as community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) and Legionella spp; new evidences on the performance of the rapid test for the etiologic diagnosis in CAP have been reported (eg. urinary Legionella andpneumococcus antigens); new therapeutic considerations needs to be approached (i.e. dosage reformulation, duration of treatment, emergence of novel antibiotics and clinical impact of combined therapy). Like in the first versión of the ConsenSur (ConsenSur I), the various current guidelines have helped to organize and stratify the present proposal, ConsenSur II.

Community-acquired Methicillin-resistantStaphylococcus aureus, Uruguay

A novel, methicillin-resistant Staphylococcus aureus clone (Uruguay clone) with a non–multidrug-resistant phenotype caused a large outbreak, including 7 deaths, in Montevideo, Uruguay. The clone was distinct from the highly virulent community clone represented by strain MW2, although both clones carried Panton-Valentine leukocidin gene and cna gene.