Hospital In Santiago Research Articles

Frequency of Mutations in the TPO Gene in Patients with Congenital Hypothyroidism Due to Dyshormonogenesis in Chile.

Background and Objectives: Congenital thyroid dyshormonogenesis is caused by alterations in the synthesis of thyroid hormones in a newborn. Additionally, 10 to 20% of these cases are hereditary, caused by defects in proteins involved in hormonal synthesis. One of the most common causes is mutations in the thyroid peroxidase (TPO) enzyme gene, an autosomal recessive disease. We aimed to detect mutations of the TPO gene in 12 Chilean patients with congenital hypothyroidism due to dyshormonogenesis (CHD) and to characterize these patients clinically and molecularly. Materials and Methods: Twelve patients under 20 years of age with CHD, controlled at San Juan de Dios Hospital in Santiago, Chile, were selected according to the inclusion criteria: elevated neonatal TSH, persistent hypothyroidism, and thyroid normotopic by imaging study. Those with deafness, Down syndrome, and central or transient congenital hypothyroidism were excluded. Blood samples were taken for DNA extraction, and the 17 exons and exon-intron junctions of the TPO gene were amplified by PCR. The PCR products were sequenced by Sanger. Results: Two possibly pathogenic mutations of the TPO gene were detected: c.2242G>A (p.Val748Met) and c.1103C>T (p.Pro368Leu). These mutations were detected in 2 of 12 patients (16.6%): 1 was compound heterozygous c.1103C>T/c.2242G>A, and the other was heterozygous for c.2242G>A. In the diagnostic confirmation test, both patients presented diffuse hyper-uptake goiter on thyroid scintigraphy and high TSH in venous blood (>190 uIU/mL). Conclusions: The frequency of patients with possibly pathogenic mutations in TPO with CHD was 16.6%. Its study would allow for genetic counseling to be offered to the families of affected patients.

Characteristics of HIV-associated cryptococcal meningitis in a tertiary Chilean hospital: An observational retrospective study

BackgroundCentral nervous system opportunistic infections can be the first presentation of an HIV infection. Our aim is to describe clinical and laboratory characteristics of HIV-associated Cryptococcal Meningitis (CM), in-hospital outcomes and analyze associations of these parameters with adverse outcomes. MethodsObservational study of local cohort of HIV-associated cryptococcal meningitis in a high complexity tertiary urban hospital in Santiago, Chile.Descriptive analysis through chart review of all episodes of HIV-associated CM in adults, from 1995 to 2019.Inclusion criteria were confirmed CM with cerebrospinal fluid culture or India ink in the appropriate clinical context and HIV diagnosis. We selected relevant variables that have been described as predictors of adverse outcomes in the literature and explore associations in our cohort. ResultsThere were 37 HIV associated CM cases, occurring from 2000 to 2019. Majority were men (86 %) with a median age of 35 years. CM was the first HIV manifestation in 32 %. Opening pressure was measured in 10 % of patients at admission. Most CSF parameters were mildly altered, and two patients presented with completely normal CSF findings. Most patients −94,4 %- suffered adverse events secondary to antifungal therapy. Despite of recommendations against their use, steroids were frequently prescribed. Mortality was 18,9 %, and was associated with older age, and more days of headache prior to admission. ConclusionsCM clinical presentation and CSF characteristics are variable at presentation, which can lead to delayed diagnosis. Inappropriate use of corticosteroids, antifungal toxicity and suboptimal management of elevated intracranial pressure are key aspects to improve.

Feverphobia: Frecuency and related factors associated

Fever is common in childhood and there is a high level of concern on behalf of caregivers to manage it, this is called "feverphobia". The objective was to evaluate the presence of feverphobia and associated factors in the study population. Methods: observational, cross-sectional, prospective, and analytical study during 2021 to 2022 through an ad hoc survey self-administered to parents and/or caregivers of patients under 6 years of age who consulted the emergency room of the Dr. Roberto del Río Children's Hospital in Santiago, Chile. The association between sociodemographic variables, knowledge, attitudes, and fears regarding febrile children was analyzed by Chi square and Fisher’s test in addition to univariate logistic regression analysis. A total of 381 surveys were carried out. 98% presented some degree of feverphobia. A fever below 38°C was defined by 40.6%. Physical measures were used by 56% of caregivers. The main sequelae feared were convulsions in 82% and 42.7% reported that it could be lethal. A total of 92.1% used unreliable sources of information and 66% had never received education from health personnel on this subject. Logistic regression showed that being a parent, basic or high school level and a thermal threshold below 38°C were the most associated variables. Feverphobia is a current phenomenon in our population and health education to the parents and caregivers could prevent it.

Antimicrobial Susceptibility Patterns in Adult Patients Hospitalized for Community-Acquired Urinary Tract Infections in Two Tertiary Hospitals in Santiago, Chile

The constant increase of factors associated with the presence of resistant strains, makes empirical antibiotic selection a challenge in patients hospitalized for community-acquired urinary tract infection. We characterized the bacteria and their antimicrobial susceptibility pattern in cultures obtained from adult patients that needed hospitalization for this disease in two tertiary hospitals in Santiago, Chile. We conducted a prospective cross-sectional study in adults hospitalized for community-acquired urinary tract infection between 2017 and 2022. All patients with positive urine cultures were included in the analysis. A total of 830 patients were included. Escherichia coli was the most frequent infectious agent (68.1%), followed by Klebsiella spp. (17.7%) and Enterococcus faecalis (6.7%). Among Enterobacteriaceae strains, 35.2%, 19.7% and 27.2% were resistant to first, second and third-generation cephalosporin, respectively. 36.9% were resistant to ciprofloxacin and 1.8% to amikacin. Gram-positive bacteria were resistant to oxacillin and ampicillin in 25% and 18%, respectively. We detected a high prevalence of community-acquired urinary tract infections caused by bacteria resistant to commonly used antibiotics in adult patients that need to be hospitalized.

Terapeutas ocupacionais novatos em unidades de cuidados críticos: quais estratégias educativas de reabilitação e cuidados são implementadas em sua formação?

Abstract Introduction Practical training for occupational therapists in critical care units is essential for professional performance in rehabilitation and clinical care areas. Objective To analyze the use of educational strategies employed in critical care units and their integration into the professional development process for novice occupational therapists. Methodology A qualitative research with a phenomenological approach and descriptive design was conducted. Intentional sampling was employed. Data was obtained through the application of semi-structured interviews, direct observation, and documentary review. Four occupational therapists working in a high-complexity hospital in Santiago, Chile, participated. The data was coded into themes, categories, and subcategories for analysis, considering the units of meaning present in the messages from a hermeneutic perspective. Results The necessary theoretical-practical integration required for the development of high-quality professional competencies in critical care environments is emphasized. Effective educational strategies for novice occupational therapists are considered, including systematic mentoring, participation in interdisciplinary teams, and ongoing feedback from experiences in intensive medicine. Conclusion The importance of achieving high-quality professional training for occupational therapists is emphasized through the implementation of interdisciplinary collaboration strategies, recognizing the significance of strengthening effective communication skills between occupational therapists and critical care patients. The need to establish a specific training field for educational strategies in the development of professional competencies for novice occupational therapists is identified.

Usefulness of Peripheral Blood Cultures in Children With Cancer and Episodes of Fever and Neutropenia.

The collection of blood cultures (BC) is key for guiding antimicrobial therapy in children with febrile neutropenia (FN), more than 90% have central venous catheters (CVC). There is no consensus on the need for peripheral BC over central BC in this population. The aim of this study was to determine the contribution of peripheral BC over central BC in the diagnosis of bloodstream infections in children with FN. Descriptive, retrospective study, episodes of FN recorded prospectively in 6 hospitals in Santiago, Chile, from 2016 to 2021. Central and peripheral BC were drawn upon admission. All episodes with at least one (+) BC were allocated to one of these groups: consistent (+) BC, inconsistent (+) BC, only CVC (+) BC and only peripheral (+) BC. The volume of the samples was recorded. The analysis included 241 episodes of FN with at least one (+) BC. The median age was 7.2 years, 51% were female, 84% had hematological cancer and 98% had episodes of high-risk FN. Of a total of 241 episodes, 135 (56%) had consistent (+) BC, 13 (5%) had inconsistent (+) BC, 35 (15%) had only CVC (+) BC and 58 (24%) had only peripheral (+) BC. There were no significant differences in the volume of the samples between central and peripheral BC. The proportion of bloodstream infections detected only through peripheral BC was 24%, higher than previously reported, not due to sample volume. We recommend obtaining peripheral as well CVC BC in children with FN.

Immigration and C-sections incidence: Maternal care and perinatal outcomes in the context of the pandemic in Chile

IntroductionImmigration has increased significantly in Chile. Despite that all pregnant women, regardless of nationality and immigration status, have the right to access to all healthcare services during pregnancy, childbirth, and postpartum, inequities in health care outcomes and health provision have been reported. During COVID-19 pandemic, these inequities are completely unknown.ObjectiveThe aim of this study was to compare the incidence of c-sections according to mother's migration status, as well as other maternal care and perinatal outcomes in women giving birth at San José Hospital in Santiago, Chile, during the COVID-19 pandemic.MethodsA retrospective cohort study was designed including 10,166 registered single births at the San José Hospital between March 2020 and August 2021. To compare between groups, statistical tests such as Chi-square and Fisher's exact were used. Log Binomial regression models were performed adjusted for potential confounding variables. To estimate the strength of association the relative risk was used.ResultsImmigrant mothers account for 48.1% of the registered births. Compared to non-immigrant women, immigrants exhibit a higher proportion of c-section, specifically, emergency c-section (28.64% vs. 21.10%; p-value < 0.001) but a lower proportion of and having a preterm birth (8.24% vs. 13.45%; p < 0.05), receiving personalized childbirth care (13.02% vs. 14.60%; p-value < 0.05), companion during labor and childbirth (77.1% vs. 86.95%; p-value < 0.001), And postpartum attachment to newborn (73% vs. 79.50%; p-value < 0.001). The proportion of COVID exposure was not significant between groups, not the severity also. Haitians had a highest risk of undergoing emergency c-section (aRR = 1.61) and Venezuelans had a highest risk of elective c-section (aRR = 2.18) compared to non-immigrants.ConclusionThis study reports high rates of c-sections in the entire population, but in immigrant populations it is even higher. Additionally, it found gaps in maternal care and perinatal outcomes between immigrants and non-immigrants. More studies are needed to elucidate the possible causes of these differences and establish new regulations to protect the reproductive rights of the immigrant population.

Surgical Outcomes of Infective Native Aortoiliac Aneurysms in a Chilean Academic Center

Infective native aortic aneurysms (INAAs), formerly called mycotic aneurysms, remain an uncommon disease with significant heterogeneity among cases; hence, there is lack of solid evidence to opt for the best treatment strategy. The present study aims to describe a 20-year experience at a single institution treating this uncommon condition. Retrospective study of all patients treated for INAA at a single academic hospital in Santiago, Chile, between 2002 and 2022. Clinical characteristics are described, as well as operative outcomes per type of treatment. Nonparametric Mann-Whitney U-test or Kruskal-Wallis tests were performed when appropriate, and results were reported as median and ranges. Survival at given timeframes was determined by a Kaplan-Meier curve, with analysis performed through a Cox regression model. During the study period, 1,798 patients underwent aortic procedures at our center, of which 35 (1.9%) were treated for INAA. Of them, 25 (71.4%) were male. One patient had 2 INAAs. Median age was 69.5years (range: 34-89years). Of the 36 INAAs, the most frequent location was the abdominal and thoracic aorta in 20 (55.5%) and 11 (30.5%) cases, respectively, followed by the iliac arteries in 4 (11.1%) cases. One (2.7%) patient presented a thoracoabdominal INAA. Overall, endovascular treatment associated with long-term antibiotics was used in 20 (57.1%) patients: 4 of them underwent hybrid treatment. Fifteen (42.8%) patients underwent direct aortic debridement followed by in situ or extra anatomic revascularization. There was a significant difference in age between both treatment strategies (a median of 76.5years for endovascular versus a median of 57years for open, P=0.011). The median hospital stay was 15days (range: 2-70days). The early complications rate (<30 postoperative days) was 20% (n=7). Early mortality rate (inhospital or before postoperative 30days) was 14.2% (n=5). Median follow-up was 33months (range: 6-216months). The overall survival rates at 1, 3, and 5 years were 69.9% (standard error [SE] 8.0), 61.7% (SE 9.8), and 50.9% (SE 11.8), respectively. Five-year survival rate of patients undergoing endovascular treatment compared with open approach was 45.9% (SE 15.1) versus 80.0% (SE 17.8), respectively (P=0.431). There were no significant differences in survival between open and endovascular treatment, hazard ratio 3.58 (confidence interval 95%: 0.185-1.968, SE±0.45 P=0.454). Patients treated by endovascular approach were older than patients treated by open approach. Even though, the open group had a higher 5-year survival rate than the endovascular group, not statically significance differences were found between treatments.

Chromosome-Mediated Colistin Resistance in Clinical Isolates of Klebsiella pneumoniae and Escherichia coli: Mutation Analysis in the Light of Genetic Background.

Colistin resistance mechanisms involving mutations in chromosomal genes associated with LPS modification are not completely understood. Mutations in genes coding for the MgrB regulator frequently account for colistin resistance in Klebsiella pneumoniae, whereas mutations in genes coding for PhoPQ and PmrAB are frequent in E. coli. Our aim was to perform a genetic analysis of chromosomal mutations in colistin-resistant (MIC ≥4 µg/mL) clinical isolates of K. pneumoniae (n = 8) and E. coli (n = 7) of different STs. Isolates were obtained in a 3-year period in a university hospital in Santiago, Chile. Susceptibility to colistin, aminoglycosides, cephalosporins, carbapenems and ciprofloxacin was determined through broth microdilution. Whole genome sequencing was performed for all isolates and chromosomal gene sequences were compared with sequences of colistin-susceptible isolates of the same sequence types. None of the isolates carried mcr genes. Most of the isolates were susceptible to all the antibiotics analyzed. E. coli isolates were ST69, ST127, ST59, ST131 and ST14, and K. pneumoniae isolates were ST454, ST45, ST6293, ST380 and ST25. All the isolates had mutations in chromosomal genes analyzed. K. pneumoniae had mutations mainly in mgrB gene, whereas E. coli had mutations in pmrA, pmrB and pmrE genes. Most of the amino acid changes in LPS-modifying enzymes of colistin-resistant isolates were found in colistin-susceptible isolates of the same and/or different ST. Eleven of them were found only in colistin-resistant isolates. Colistin resistance mechanisms depend on genetic background, and are due to chromosomal mutations, which implies a lower risk of transmission than plasmid-mediated genes. Colistin resistance is not associated with multidrug-resistance, nor to high-risk sequence types.

Software-guided (PREVEDEL) cognitive stimulation to prevent delirium in hospitalised older adults: study protocol

BackgroundDelirium is a clinical condition characterised by acute and fluctuating deterioration of the cognitive state, generally secondary to an acute pathology. Delirium is associated with negative outcomes in older adults, such as longer hospitalisations, higher mortality, and short and medium-term institutionalisation. Randomised clinical trials have shown that delirium is preventable through non-pharmacological prevention measures, decreasing its incidence by 30–50%. These interventions include promoting physical activity, facilitating the use of glasses and hearing aids, cognitive stimulation, and providing frequent reorientation of time and space, among others. These measures are currently seldom applied in hospitals in Chile and around the world for reasons including the heavy workload of clinical staff, the lack of trained personnel, and in general the absence of a systematic implementation processes.We developed a software called PREVEDEL, which includes non-pharmacological strategies such as cognitive stimulation, early mobilisation, orientation, and pain assessment. We propose a randomised clinical trial to evaluate whether cognitive stimulation guided by PREVEDEL software prevents delirium status (full/subsyndromal delirium) in hospitalised older adults.MethodA randomised controlled trial, with parallel, multicentre groups. We will recruite patients 65 years or older who have been hospitalised for less than 48 h in the general ward or the intermediate care units of four hospitals in Santiago, Chile. The participants in the intervention group will use a tablet with cognitive stimulation software for delirium prevention for five continuous days versus the control group who will use the tablet without the software.We will evaluate the incidence, duration, density of delirium, subsyndromal delirium with the Confusion Assessment Method, cognitive with the Montreal Cognitive Assessment, and functional status with the Functional Independence Measure at discharge. Moreover, we will evaluate the adherence to prevention measures, as well as demographic variables of interest.DiscussionThe use of cognitive PREVEDEL software could increase and improve the implementation of non-pharmacological prevention measures for delirium in hospitalised older adults, thus reducing its incidence and contributing to patients and health professionals.Trial registrationNCT05108207 ClinicalTrials.gov. Registered 4 November 2021.

Factors influencing the implementation of shared decision-making in breast cancer care: protocol for a mixed-methods study

IntroductionChile is committed to actively involving patients in their healthcare. However, little is known about how this is translated into clinical encounters. Breast cancer (BC) is the first cause of...

Antibiotic Consumption During the Coronavirus Disease 2019 Pandemic and Emergence of Carbapenemase-Producing Klebsiella pneumoniae Lineages Among Inpatients in a Chilean Hospital: A Time-Series Study and Phylogenomic Analysis.

The impact of coronavirus disease 2019 (COVID-19) on antimicrobial use (AU) and resistance has not been well evaluated in South America. These data are critical to inform national policies and clinical care. At a tertiary hospital in Santiago, Chile, between 2018 and 2022, subdivided into pre- (3/2018-2/2020) and post-COVID-19 onset (3/2020-2/2022), we evaluated intravenous AU and frequency of carbapenem-resistant Enterobacterales (CRE). We grouped monthly AU (defined daily doses [DDD]/1000 patient-days) into broad-spectrum β-lactams, carbapenems, and colistin and used interrupted time-series analysis to compare AU during pre- and post-pandemic onset. We studied the frequency of carbapenemase-producing (CP) CRE and performed whole-genome sequencing analyses of all carbapenem-resistant (CR) Klebsiella pneumoniae (CRKpn) isolates collected during the study period. Compared with pre-pandemic, AU (DDD/1000 patient-days) significantly increased after the pandemic onset, from 78.1 to 142.5 (P < .001), 50.9 to 110.1 (P < .001), and 4.1 to 13.3 (P < .001) for broad-spectrum β-lactams, carbapenems, and colistin, respectively. The frequency of CP-CRE increased from 12.8% pre-COVID-19 to 51.9% after pandemic onset (P < .001). The most frequent CRE species in both periods was CRKpn (79.5% and 76.5%, respectively). The expansion of CP-CRE harboring blaNDM was particularly noticeable, increasing from 40% (n = 4/10) before to 73.6% (n = 39/53) after pandemic onset (P < .001). Our phylogenomic analyses revealed the emergence of two distinct genomic lineages of CP-CRKpn: ST45, harboring blaNDM, and ST1161, which carried blaKPC. AU and the frequency of CP-CRE increased after COVID-19 onset. The increase in CP-CRKpn was driven by the emergence of novel genomic lineages. Our observations highlight the need to strengthen infection prevention and control and antimicrobial stewardship efforts.

Association between psychosocial factors and satisfaction with communication in family members of intensive care unit patients during COVID-19 pandemic: An exploratory cross-sectional study

ObjectiveTo investigate the relationship between satisfaction with communication and perceived stress, depressive symptoms and perceived social support among family members of critically ill. Research Methodology/DesignExploratory, cross-sectional study was conducted. SettingPrivate teaching hospital in Santiago, Chile. Main Outcomes MeasuresFamily members of critically ill patients with 3–7 days of stay and respiratory support were approached. Questionnaires were used to assess satisfaction with communication (Family Satisfaction in the Intensive Care Unit-24), perceived stress (Perceived Stress Scale-10), depressive symptoms (Patient Health Questionnaire-9) and perceived social support (Medical Outcomes Study Social Support Survey). The relationship between satisfaction with communication and relevant variables was investigated using bivariate analyses and a beta regression. ResultsThe study included 42 family members, with 71.4% being female and 52.4% having prior critical care experience. There was a positive correlation between perceived stress and depressive symptoms (r = 0.32, p = 0.039). According to the beta regression, perceived social support (B; 95% confidence interval, 0.44 [1.05–2.29]) and the number of calls with unit staff (0.17 [1.06–1.32]) were positively associated with satisfaction with communication but negatively with college education (−1.86 [0.04–0.64]) and perceived stress (−0.07 [0.87–0.99]). ConclusionPsychosocial factors, such as higher educational level, perceived stress and perceived social support, can influence family members’ evaluation of communication with staff. Current communication practices in acute care settings should be adapted to family members’ psychosocial context to improve their satisfaction with the communication process. Implications for clinical practiceCritical care professionals must be aware of the influence of family member-related factors on the quality and effectiveness of the communication process. Psychosocial features of the family members are likely to impact their satisfaction with communication and should be assessed on admission and during their stay to assist clinicians to adjust and improve their communication practices.

2068. Molecular and Clinical Features of New HIV-1 diagnoses in Northern Dominican Republic

Abstract Background Surveillance of transmitted drug resistance (TDR) and molecular epidemiology of newly diagnosed persons with HIV can impact care and prevention and inform efforts towards ending the HIV epidemic. Both interventions are not routinely available in the Dominican Republic (DO). Methods During 10/2019-4/2021, we attempted to enroll all newly HIV-diagnosed antiretroviral naïve adults (≥18 years) presenting at the regional hospital in Santiago, DO. Demographic, clinical and laboratory data were collected, and blood samples obtained for partial pol genotyping. Subtyping and resistance interpretation were done with Stanford Database tools. Maximum likelihood phylogenies were inferred by RAxML and clusters were defined as clades with bootstrap support of ≥0.8. Extended phylogenetic analyses included ∼1,500 publicly available Caribbean sequences. Demographics and TDR were compared by cluster status using Fisher Exact or Wilcoxon rank sum tests. Results Of 100 HIV-diagnosed participants (mean age 40 years; 61% male; 84% heterosexual; 50% never tested prior), 56% were hospitalized, 48% tested via doctor advise and 28% for feeling sick. Available CD4 count was &amp;lt; 200 cells/µL in 49% (43/87) more prevalent (vs CD4 &amp;gt;200) in heterosexuals (93% vs 7% in gay/bisexuals; p=0.003). Genotyping from 68/100, were 29% HIV-1 subtype B, 69% B-containing recombinants and one HIV-1 subtype C. TDR was in 12% (95% CI: 5-22%), all to NNRTIs (K103N and Y188L most common; two with multiple mutations). Six identified clusters included 25% of participants, 92% from downtown Santiago. Individuals in the largest 6-member cluster met partners online and were gay/bisexual. Participants in clusters had higher TDR (24% vs 8%, p=0.100), were younger (34 vs 43 years, p=0.01), and were gay/bisexual (41% vs 8%, p=0.003). In extended phylogenetic analyses participant sequences clustered with other DO sequences, as well as some from Haiti. Conclusion In this snapshot of new HIV diagnoses in the DO, findings of high AIDS at diagnosis, particularly in heterosexuals, high TDR, more clustering in gay/bisexual younger individuals, and existing non-local-only transmission networks, should inform focused surveillance and prevention strategies to disrupt HIV transmission and improve care. Disclosures All Authors: No reported disclosures.

Clinical Outcome in Children With Cancer With Two or More Microorganisms Isolated From Blood Cultures During Episodes of Fever and Neutropenia.

Bacterial bloodstream infections are a major cause of morbidity and mortality in children with cancer and episodes of fever and neutropenia (FN). The aim of this study was to evaluate the clinical outcome in children with cancer with 2 or more microorganisms isolated from blood cultures during their episodes of FN. Between 2016 and 2021, children presenting with high-risk FN, admitted to any of the 6 participating hospitals in Santiago, Chile, were included in this study if they have positive blood cultures. We compared the clinical outcome of children with 2 or more microorganisms versus those with single agent isolation. A total of 1074 episodes of high-risk FN were enrolled in the study period, of which 27% (298) had positive blood cultures and 3% (32) had 2 or more microorganisms isolated from blood cultures. The most frequent identified agents were Viridans group streptococci and Escherichia coli in 20%, followed by Coagulase negative staphylococci in 14%. Children with 2 or more microorganisms presented more days of fever (7 vs. 4 days, P = 0.02), needed longer courses of antimicrobial therapy (16 vs. 14 days, P = 0.04) and had higher mortality at day 30 (13% vs. 1%, P = 0.003). Children with cancer and FN with 2 or more microorganisms isolated from blood cultures had a worse clinical outcome than children with single agent isolation.

Secondary respiratory early and late infections in mechanically ventilated patients with COVID-19

BackgroundPatients with COVID-19 receiving mechanical ventilation may become aggravated with a secondary respiratory infection. The aim of this study was to describe secondary respiratory infections, their predictive factors, and outcomes in patients with COVID-19 requiring mechanical ventilation.MethodsA cohort study was carried out in a single tertiary hospital in Santiago, Chile, from 1st June to 31st July 2020. All patients with COVID-19 admitted to the intensive care unit that required mechanical ventilation were included.ResultsA total of 175 patients were enrolled, of which 71 (40.6%) developed at least one secondary respiratory infection during follow-up. Early and late secondary infections were diagnosed in 1.7% and 31.4% respectively. Within late secondary infections, 88% were bacterial, 10% were fungal, and 2% were of viral origin. One-third of isolated bacteria were multidrug-resistant. Bivariate analysis showed that the history of corticosteroids used before admission and the use of dexamethasone during hospitalization were associated with a higher risk of secondary infections (p = 0.041 and p = 0.019 respectively). Multivariate analysis showed that for each additional day of mechanical ventilation, the risk of secondary infection increases 1.1 times (adOR = 1.07; 95% CI 1.02–1.13, p = 0.008)ConclusionsPatients with COVID-19 admitted to the intensive care unit and requiring mechanical ventilation had a high rate of secondary infections during their hospital stay. The number of days on MV was a risk factor for acquiring secondary respiratory infections.

Genomic Analysis of Carbapenem-Resistant Acinetobacter baumannii Strains Recovered from Chilean Hospitals Reveals Lineages Specific to South America and Multiple Routes for Acquisition of Antibiotic Resistance Genes.

ABSTRACTCarbapenem-resistant Acinetobacter baumannii (CRAb) is a public health threat accounting for a significant number of hospital-acquired infections. Despite the importance of this pathogen, there is scarce literature on A. baumannii molecular epidemiology and evolutionary pathways relevant to resistance emergence in South American strains. We analyzed the genomic context of 34 CRAb isolates recovered from clinical samples between 2010 and 2013 from two hospitals in Santiago, Chile, using whole-genome sequencing. Several Institut Pasteur scheme sequence types (STs) were identified among the 34 genomes studied here, including ST1, ST15, ST79, ST162, and ST109. No ST2 (the most widespread sequence type) strain was detected. Chilean isolates were phylogenetically closely related, forming lineages specific to South America (e.g., ST1, ST79, and ST15). The genomic contexts of the resistance genes were diverse: while genes were present in a plasmid in ST15 strains, all genes were chromosomal in ST79 strains. Different variants of a small Rep_3 plasmid played a central role in the acquisition of the oxa58 carbapenem and aacC2 aminoglycoside resistance genes in ST1, ST15, and ST79 strains. The aacC2 gene along with blaTEM were found in a novel transposon named Tn6925 here. Variants of Tn7 were also found to play an important role in the acquisition of the aadA1 and dfrA1 genes. This work draws a detailed picture of the genetic context of antibiotic resistance genes in a set of carbapenem-resistant A. baumannii strains recovered from two Chilean hospitals and reveals a complex evolutionary picture of antibiotic resistance gene acquisition events via multiple routes involving several mobile genetic elements.IMPORTANCE Treating infections caused by carbapenem-resistant A. baumannii (CRAb) has become a global challenge given that CRAb strains are also often resistant to a wide range of antibiotics. Analysis of whole-genome sequence data is now a standard approach for studying the genomic context of antibiotic resistance genes; however, genome sequence data from South American countries are scarce. Here, phylogenetic and genomic analyses of 34 CRAb strains recovered from 2010 to 2013 from two Chilean hospitals revealed a complex picture leading to the generation of resistant lineages specific to South America. From these isolates, we characterized several mobile genetic elements, some of which are described for the first time. The genome sequences and analyses presented here further our understanding of the mechanisms leading to multiple-drug resistance, extensive drug resistance, and pandrug resistance phenotypes in South America. Therefore, this is a significant contribution to elucidating the global molecular epidemiology of CRAb.

Does “good acting requires a good cast”? A replication study of how team deep acting dispersion influence individual outcomes

Previous research shows that emotional labor, or having to display certain emotions in the workplace, has significant implications for employees and their working environments. In this study, we replicate the claim from Becker and Cropanzano (2015) who suggests that the effect of individual deep acting on job performance would be moderated by team-level deep acting dispersion, such that the relationship between deep acting and performance would be positive and stronger in teams with low dispersion. Our replication included 130 participants with complete data, nested in 23 teams, in a high complexity and high demand public hospital in Santiago, Chile. We collected data in December-January of 2021. We focused on testing the interaction term alone but we also replicated the entire original model from Becker and Cropanzano (2015). Although the targeted interaction effect was not significant in our study (not replicated effect), it is interesting to note that other hypotheses in Becker and Cropanzano (2015) were indeed replicated. For example, team-level deep acting dispersion was indeed a significant cross-level moderator of the relationship between individual deep acting and emotional exhaustion. We discuss the main results, the replication conditions, and the managerial implications for a Chilean population.

Cervical Artery Dissection in Postpartum Women after Cesarean and Vaginal Delivery

Background and aimsCervical artery dissection (CAD) is an infrequent but potentially disabling and fatal disease, accounting for up to 25 % of strokes in young adults. Pregnancy-related hormonal changes and increased hemodynamic stress on artery walls during vaginal delivery have been associated to CAD. We aim to describe a series of women presenting CAD during postpartum (PP) after cesarean and vaginal delivery. MethodsCAD women admitted to one hospital in Santiago, Chile, between July 2018 and October 2020 were included in a prospective cohort. Demographic, clinical and imaging data were registered for the PP group. ResultsSixty-seven women were diagnosed with CAD, from which 10 were PP. Seven women had cesarean section and 3 had vaginal delivery. They presented CAD related symptoms after a median of 10.5 (IQR 5-15) days from delivery. All of them had headache as initial symptom, 9 presented cervical pain and 8 had a family history of stroke. Four patients presented preeclampsia during pregnancy. Acute treatment consisted mostly in antiplatelet agents and analgesics. None of these patients had a CAD related stroke. Demographic, clinical and imaging characteristics of these women with CAD during PP are described. ConclusionsThis case series underpins the importance of clinical suspicion of CAD after delivery, highlighting the fact that CAD is not limited to women with vaginal delivery, thus alternative causes beyond acute hemodynamic stress could be involved. Further research is required to determine genetic components, along with deeper knowledge of modulating factors related to CAD in this setting.

#43 Fungal colonization by Pneumocystis is highly frequent in the human placenta at birth.

Abstract Background Pneumocystis is well-known as a pathogen of the severily immunocompromised host. However, this fungus is also, a frequent colonizer of immunocompetent hosts inducing subclinical characteristic histologic features of Th2-type lung inflammation, and is associated to asthma. The pathology that Pneumocystis induces in the lung of non-severily immunocompromised hosts warrants exploring whether it colonizes and induces pathology in other organs. Physiologically immunosupressed pregnant women display increased nasal carriage of Pneumocystis and, of interest, Pneumocystis pneumonia were reported in neonates or still-born infants before the AIDS epidemic, and Pneumocystis-DNA has recently been identified in formalin fixed fetal organs. In addition, transplacental transmission has been documented in rabbit does that have an hemo-monochorial placenta similar to humans. Moreover, fungal species are a frequent cause of chorioamnionitis and fetal death in farm cattle. Motivated by these observations, we undertook a search for Pneumocystis in the placenta of full term pregnancies in Santiago, Chile. Method 106 prospective volunteer mothers were approached during early labor at the San Jose Maternity Hospital in Santiago. After signed informed consent, the placenta of 91 full-term deliveries (37-42 weeks) was collected in a sterile bag and transported at 4°C to the research laboratory for immediate surgical removal of 0.5 cm of surface of each cotyledon at the maternal side in a laminar flow hood before sampling. The exposed cotyledons were then dissected to obtain approx 2 g (1.02-2.2 g) tissue from each cotyledon and samples from 3-4 cotyledons were pooled in two samples of approx. 7 (5.34-8.06) grams per each placenta. A 2 gram aliquot from each sample was homogeneized and DNA was extracted using QIAmp DNA extraction kit (QIAGEN) with an additional bead beating step. Pneumocystis was diagnosed by nested-PCR amplifying the mtLSUrRNA and the beta-tubulin loci of P. jirovecii. Pneumocystis was additionally examined by microscopy immunofluorescence in a subset of DNA-positive samples using immunofluorescence kit (Meridian). Results Pneumocystis jirovecii-DNA was detected by amplification of the two loci in 35 (38.5%) of 91 placentas; In 25 after analysis of the first sample tissue pool, and the other 10 after analysis of the second pooled sample. Characteristic Pneumocystis cyst forms were documented by IF microscopy in 4 P. jirovecii DNA positive samples. Conclusion Pneumocystis colonization of the placenta at full term is highly frequent and can be detected by DNA amplification and, more laboriously, by immunofluorescence microscopy. Placental colonization is focal, similar to what occurs in the lung during primary infection. Data suggests transplacental as a route of transmission of Pneumocystis in addition to the aerial route in humans. It also warrants exploring placental inflammation associated to Pneumocystis as documented in the colonized lung. Further studies are needed to determine the significance of placental colonization by Pneumocystis in the placental unit.