Immunosuppressed patients, transplant recipients, and those with acute or chronic respiratory dis... more Immunosuppressed patients, transplant recipients, and those with acute or chronic respiratory disease are at increased risk for invasive fungal infections in Argentina. Although the national public system guarantees universal access to health care for all citizens, little is known about the quality of available diagnostic and treatment armamentaria for invasive fungal infections in the country. Between June and August 2022, infectious disease clinicians from each of the 23 provinces and the Autonomous City of Buenos Aires were contacted to describe local access to fungal diagnostic tools and antifungal agents. The information collected included different aspects such as hospital characteristics, patients admitted and wards, access to diagnostic tools, estimated infection incidence, and treatment capacity. Thirty responses were collected from facilities throughout Argentina. Most institutions were governmental (77%). A mycology department was available in 83% of them. Histopathology ...
BackgroundCOVID-19 severity has been linked to an increased production of inflammatory mediators ... more BackgroundCOVID-19 severity has been linked to an increased production of inflammatory mediators called “cytokine storm”. Available data is mainly restricted to the first international outbreak and reports highly variable results. This study compares demographic and clinical features of patients with COVID-19 from Córdoba, Argentina, during the first two waves of the pandemic and analyzes association between comorbidities and disease outcome with the “cytokine storm”, offering added value to the field.MethodsWe investigated serum concentration of thirteen soluble mediators, including cytokines and chemokines, in hospitalized patients with moderate and severe COVID-19, without previous rheumatic and autoimmune diseases, from the central region of Argentina during the first and second infection waves. Samples from healthy controls were also assayed. Clinical and biochemical parameters were collected.ResultsComparison between the two first COVID-19 waves in Argentina highlighted that p...
The incidence of acute kidney injury (AKI) in hospitalized patients with COVID-19 is variable, be... more The incidence of acute kidney injury (AKI) in hospitalized patients with COVID-19 is variable, being associated with worse outcomes. The objectives of the study were to evaluate the incidence, risk factors (considering demographic characteristics, comorbidities, initial clinical presentation and associated complications) and impact of AKI in subjects hospitalized for COVID-19 in two third-level hospitals in Córdoba, Argentina. A retrospective cohort study was conducted. We included 448 adults who were consecutively hospitalized for COVID-19 between March 3 and October 31, 2020 and were followed throughout the hospitalization. The incidence of AKI was 19% (n = 85; stage I = 43, stage II = 17, and stage III = 25, 18 required renal replacement therapy). In the multivariate analysis, the variables that were independently associated with AKI were: age (for every 10 years, adjusted odd ratio [95%CI] = 1.30 [1.04-1.63], p = 0.022), history of chronic kidney disease -CKD- (9.92 [4.52-21.77], p < 0.001), blood neutrophil count at admission -BNCA- (for every increase of 1000 BNCA, 1.09 [1.01-1.18], p = 0.037) and requirement for mechanical ventilation -MV- (6.69 [2.24-19.90], p = 0.001). AKI was associated with longer hospitalization, higher admission (63.5 vs. 29.7%; p < 0.001) and longer stay in the intensive care unit, a positive association with respiratory bacterial superinfection, sepsis, respiratory distress syndrome, MV requirement and mortality (mortality without AK I = 12.4% vs with AKI = 47.1%; stage I = 26%, stage II = 41% and stage III = 88%; p < 0.001). AKI was independently associated with higher mortality (3.32 [1.6-6.9], p = 0.001). In conclusion, the incidence of AKI in adults hospitalized for COVID-19 was 19% and had a clear impact on morbidity and mortality. The independent risk factors for AKI were: Age, CKD, BNCA and MV.
Antifungal therapy and surgical drainage for the treatment of a cerebral abscess caused by in aSc... more Antifungal therapy and surgical drainage for the treatment of a cerebral abscess caused by in aScedosporium apiospermum renal transplant patient- a case report [version 1; referees: 1 approved, 1 approved with reservations]
Durante los ultimos anos, el aumento de las infecciones fungicas invasivas en humanos, emerge aso... more Durante los ultimos anos, el aumento de las infecciones fungicas invasivas en humanos, emerge asociado a la falta de diagnostico precoz, terapias antifungicas efectivas y al desarrollo de vacunas. Perturbaciones en la homeostasis inmune debido a intervenciones medicas o a estados de inmunosupresion inducidos por diferentes enfermedades, son conocidos factores de riesgo para la adquisicion de estas micosis. Las celulas del sistema inmune innato estan equipadas con receptores de superficie y citoplasmaticos que permiten el reconocimiento de diferentes microorganismos y que colectivamente han sido denominados Receptores de Reconocimiento de Patrones (PRRs). Estos PRRs reconocen estructuras altamente conservadas en los microorganismos identificadas como Patrones Moleculares Asociados a Patogenos (PAMPs), que son claves para la activacion del sistema inmune y la induccion de muerte de estos patogenos fungicos. Esta revision explora el rol de los PRRs, la participacion de diferentes celul...
La resistencia a los antimicrobianos (RAM) amenaza la salud publica mundial [1]. Con el fin de en... more La resistencia a los antimicrobianos (RAM) amenaza la salud publica mundial [1]. Con el fin de enlentecer el desarrollo de la RAM y preservar la efectividad de estos agentes, la organizacion mundial de la salud (OMS) ha desarrollado un plan de accion mundial que incluye, entre otros objetivos estrategicos, la optimizacion del uso de los antimicrobianos [1].
Bloodstream infections (BI) are an important cause of morbidity and mortality in cancer patients.... more Bloodstream infections (BI) are an important cause of morbidity and mortality in cancer patients. A retrospective study was performed in two hospitals aimed to evaluate characteristics of BI episodes occurred in adult patients with hematologic (HN) and solid (SN) neoplasia other than non-melanoma skin cancers in the period 2009-2016. A total of 467 episodes of bacteremia and 16 of fungemia were identified. A total of 200 (41.4%) bacteremias occurred in patients with HN and 283 (58.6%) in patients with SN. The most frequent SN and HN were colon cancer (18.7%) and non-Hodgkin lymphoma (27%), respectively. The main risk factors for BI were a previous surgical procedure in SN and chemotherapy in the previous 30 days and use of central venous catheter in HN. Infections were mainly acquired in the hospital environment and the most frequent presentation was bacteremia without focus, mostly in HN (38% vs. 20.8%, p < 0.001). Gram negative bacilli (GNB) were isolated in 336 (69.5%) episode...
The incidence of acute kidney injury (AKI) in hospitalized patients with coronavirus disease 2019... more The incidence of acute kidney injury (AKI) in hospitalized patients with coronavirus disease 2019 (COVID-19) is variable, being associated with worse outcomes. The objectives of the study were to evaluate the incidence, risk factors and impact of AKI in subjects hospitalized for COVID-19 in two third- level hospitals in Córdoba, Argentina.A retrospective cohort study was conducted. 448 adults who were consecutively hospitalized for COVID-19 between March and the end of October 2020 at Hospital Privado Universitario de Córdoba and Hospital Raúl Angel Ferreyra were included. The incidence of AKI was 19% (n = 85). 50.6% presented AKI stage 1 (n=43), 20% stage 2 (n=17) and 29.4% stage 3 (n=25, of which 18 required renal replacement therapy). In the multivariate analysis, the variables that were independently associated with AKI were: age (adjusted Odd ratio -aOR- =1.30, 95%CI=1.04-1.63, p=0.022), history of chronic kidney disease (aOR=9.92, 95%CI=4.52-21.77, p<0.001), blood neutrophi...
Infections are frequent complications of kidney transplants. We aimed at determining the frequenc... more Infections are frequent complications of kidney transplants. We aimed at determining the frequency and type of infections that occur in renal transplant recipients during the early (0-1 month), intermediate (1-6 months) and late (6-12 months) post-transplant period and analyzing the risk factors for infection. To this aim, we conducted a retrospective cohort study on 1-year post-transplant follow-up in two third-level university hospitals in Cordoba city. All consecutive recipients of renal transplants performed between 2009 and 2015 were included, except those with multiple solid organ transplantation and pediatric patients. We included 375 recipients, of which 235 (62.7%) had at least one episode of infection during follow-up. There were 504 episodes of infection, of which 131 (26%) occurred in the early, 272 (53.9%) in the intermediate, and 101 (20.1%) in the late post-transplant period. The most frequent infections in all periods were caused by bacteria (mainly urinary tract inf...
Se estima que un 3,2% de pacientes internados padecen de infecciones intrahospitalarias. Las medi... more Se estima que un 3,2% de pacientes internados padecen de infecciones intrahospitalarias. Las medidas de control de infecciones para instituciones de salud requieren un cuidado continuo y minucioso y conllevan un costo elevado al cuidado del paciente. Las medidas horizontales de control de infecciones son aquellas que se aplican a todos los pacientes y probablemente sean la forma mas adecuada para control de infecciones en esta epoca. Lamentablemente, los procesos de prevencion de infecciones se implementan con variabilidad en el mejor de los casos. Ejemplos de medidas horizontales son, higiene de manos, limpieza ambiental, higiene de pacientes con desinfectantes. Otras medidas son los paquetes de medidas para insercion de cateter central y paquetes de medidas de respirador. Lista de chequeo de seguridad de aplicacion general en todos los hospitales.
Revista de la Facultad de Ciencias Médicas de Córdoba, 2021
Introducción: La enfermedad COVID-19 muestra una marcada heterogeneidad en su curso clínico, habi... more Introducción: La enfermedad COVID-19 muestra una marcada heterogeneidad en su curso clínico, habiéndose descripto algunos factores que se asocian un peor pronóstico. El conocimiento del comportamiento de la enfermedad en el escenario local es de gran relevancia para permitir un mejor abordaje. Métodos: Estudio retrospectivo en dos hospitales de la ciudad de Córdoba, Argentina, de pacientes de 18 años o más hospitalizados por infección activa por SARS-CoV-2, desde marzo a octubre del año 2020. Resultados: Se incluyeron 448 pacientes, de los cuales el 95.75% correspondieron a neumonía COVID-19. La mayoría de los episodios ocurrieron en hombres (63.6%), la mediana de edad fue 63 años (RIC:53-75), y las comorbilidades más frecuentes fueron hipertensión arterial (55.1%), obesidad (31.7%) y diabetes mellitus (28.1%). Requirieron ingreso a unidad de cuidados intensivos 162 pacientes (36.2%) y 66 (14.7%), asistencia respiratoria mecánica. Fallecieron 67 pacientes (15%) dentro de los prime...
International Journal of Infectious Diseases, 2018
Background: Gram-negative bacteremia (GNB) in cancer and hematopoietic stem cell transplant (HSCT... more Background: Gram-negative bacteremia (GNB) in cancer and hematopoietic stem cell transplant (HSCT) patients is a major cause of infection-related mortality. We performed a study to identify factors associated with 7-day and 30-day mortality during GNB episodes in cancer and HSCT patients. Methods & Materials: Prospective multicenter study. Episodes of GNB in adult cancer and HSCT patients were included in 10 centers of Argentina, from May 2014 to November 2016. To identify factors associated with 7-day and 30-day mortality, variables with p < 0.05 in univariate analysis and clinically relevant variables were included in a logistic regression model for multivariate analysis. Results: 460 episodes of GNB were included. From these, 295 (64.13%) had haematological malignancies, 80 (17.39%) solid tumors and 85 (18.47%) HSCT. 7-day and 30-day mortality was 18.04% and 25.2%, respectively. In the univariate analysis, the factors associated with mortality were: treatment with corticosteroids, combined antibiotic treatment, skin and soft tissue source, respiratory source, breakthrough bacteremia, multidrug-resistant GNB, hypotension, intensive care requirement, shock, multiorgan failure, Pitt score > 4, Charlson score > 4 and APACHE II score > 24. In multivariate analysis, factors independently associated with 7day mortality were: multidrug-resistant GNB (
Immunosuppressed patients, transplant recipients, and those with acute or chronic respiratory dis... more Immunosuppressed patients, transplant recipients, and those with acute or chronic respiratory disease are at increased risk for invasive fungal infections in Argentina. Although the national public system guarantees universal access to health care for all citizens, little is known about the quality of available diagnostic and treatment armamentaria for invasive fungal infections in the country. Between June and August 2022, infectious disease clinicians from each of the 23 provinces and the Autonomous City of Buenos Aires were contacted to describe local access to fungal diagnostic tools and antifungal agents. The information collected included different aspects such as hospital characteristics, patients admitted and wards, access to diagnostic tools, estimated infection incidence, and treatment capacity. Thirty responses were collected from facilities throughout Argentina. Most institutions were governmental (77%). A mycology department was available in 83% of them. Histopathology ...
BackgroundCOVID-19 severity has been linked to an increased production of inflammatory mediators ... more BackgroundCOVID-19 severity has been linked to an increased production of inflammatory mediators called “cytokine storm”. Available data is mainly restricted to the first international outbreak and reports highly variable results. This study compares demographic and clinical features of patients with COVID-19 from Córdoba, Argentina, during the first two waves of the pandemic and analyzes association between comorbidities and disease outcome with the “cytokine storm”, offering added value to the field.MethodsWe investigated serum concentration of thirteen soluble mediators, including cytokines and chemokines, in hospitalized patients with moderate and severe COVID-19, without previous rheumatic and autoimmune diseases, from the central region of Argentina during the first and second infection waves. Samples from healthy controls were also assayed. Clinical and biochemical parameters were collected.ResultsComparison between the two first COVID-19 waves in Argentina highlighted that p...
The incidence of acute kidney injury (AKI) in hospitalized patients with COVID-19 is variable, be... more The incidence of acute kidney injury (AKI) in hospitalized patients with COVID-19 is variable, being associated with worse outcomes. The objectives of the study were to evaluate the incidence, risk factors (considering demographic characteristics, comorbidities, initial clinical presentation and associated complications) and impact of AKI in subjects hospitalized for COVID-19 in two third-level hospitals in Córdoba, Argentina. A retrospective cohort study was conducted. We included 448 adults who were consecutively hospitalized for COVID-19 between March 3 and October 31, 2020 and were followed throughout the hospitalization. The incidence of AKI was 19% (n = 85; stage I = 43, stage II = 17, and stage III = 25, 18 required renal replacement therapy). In the multivariate analysis, the variables that were independently associated with AKI were: age (for every 10 years, adjusted odd ratio [95%CI] = 1.30 [1.04-1.63], p = 0.022), history of chronic kidney disease -CKD- (9.92 [4.52-21.77], p < 0.001), blood neutrophil count at admission -BNCA- (for every increase of 1000 BNCA, 1.09 [1.01-1.18], p = 0.037) and requirement for mechanical ventilation -MV- (6.69 [2.24-19.90], p = 0.001). AKI was associated with longer hospitalization, higher admission (63.5 vs. 29.7%; p < 0.001) and longer stay in the intensive care unit, a positive association with respiratory bacterial superinfection, sepsis, respiratory distress syndrome, MV requirement and mortality (mortality without AK I = 12.4% vs with AKI = 47.1%; stage I = 26%, stage II = 41% and stage III = 88%; p < 0.001). AKI was independently associated with higher mortality (3.32 [1.6-6.9], p = 0.001). In conclusion, the incidence of AKI in adults hospitalized for COVID-19 was 19% and had a clear impact on morbidity and mortality. The independent risk factors for AKI were: Age, CKD, BNCA and MV.
Antifungal therapy and surgical drainage for the treatment of a cerebral abscess caused by in aSc... more Antifungal therapy and surgical drainage for the treatment of a cerebral abscess caused by in aScedosporium apiospermum renal transplant patient- a case report [version 1; referees: 1 approved, 1 approved with reservations]
Durante los ultimos anos, el aumento de las infecciones fungicas invasivas en humanos, emerge aso... more Durante los ultimos anos, el aumento de las infecciones fungicas invasivas en humanos, emerge asociado a la falta de diagnostico precoz, terapias antifungicas efectivas y al desarrollo de vacunas. Perturbaciones en la homeostasis inmune debido a intervenciones medicas o a estados de inmunosupresion inducidos por diferentes enfermedades, son conocidos factores de riesgo para la adquisicion de estas micosis. Las celulas del sistema inmune innato estan equipadas con receptores de superficie y citoplasmaticos que permiten el reconocimiento de diferentes microorganismos y que colectivamente han sido denominados Receptores de Reconocimiento de Patrones (PRRs). Estos PRRs reconocen estructuras altamente conservadas en los microorganismos identificadas como Patrones Moleculares Asociados a Patogenos (PAMPs), que son claves para la activacion del sistema inmune y la induccion de muerte de estos patogenos fungicos. Esta revision explora el rol de los PRRs, la participacion de diferentes celul...
La resistencia a los antimicrobianos (RAM) amenaza la salud publica mundial [1]. Con el fin de en... more La resistencia a los antimicrobianos (RAM) amenaza la salud publica mundial [1]. Con el fin de enlentecer el desarrollo de la RAM y preservar la efectividad de estos agentes, la organizacion mundial de la salud (OMS) ha desarrollado un plan de accion mundial que incluye, entre otros objetivos estrategicos, la optimizacion del uso de los antimicrobianos [1].
Bloodstream infections (BI) are an important cause of morbidity and mortality in cancer patients.... more Bloodstream infections (BI) are an important cause of morbidity and mortality in cancer patients. A retrospective study was performed in two hospitals aimed to evaluate characteristics of BI episodes occurred in adult patients with hematologic (HN) and solid (SN) neoplasia other than non-melanoma skin cancers in the period 2009-2016. A total of 467 episodes of bacteremia and 16 of fungemia were identified. A total of 200 (41.4%) bacteremias occurred in patients with HN and 283 (58.6%) in patients with SN. The most frequent SN and HN were colon cancer (18.7%) and non-Hodgkin lymphoma (27%), respectively. The main risk factors for BI were a previous surgical procedure in SN and chemotherapy in the previous 30 days and use of central venous catheter in HN. Infections were mainly acquired in the hospital environment and the most frequent presentation was bacteremia without focus, mostly in HN (38% vs. 20.8%, p < 0.001). Gram negative bacilli (GNB) were isolated in 336 (69.5%) episode...
The incidence of acute kidney injury (AKI) in hospitalized patients with coronavirus disease 2019... more The incidence of acute kidney injury (AKI) in hospitalized patients with coronavirus disease 2019 (COVID-19) is variable, being associated with worse outcomes. The objectives of the study were to evaluate the incidence, risk factors and impact of AKI in subjects hospitalized for COVID-19 in two third- level hospitals in Córdoba, Argentina.A retrospective cohort study was conducted. 448 adults who were consecutively hospitalized for COVID-19 between March and the end of October 2020 at Hospital Privado Universitario de Córdoba and Hospital Raúl Angel Ferreyra were included. The incidence of AKI was 19% (n = 85). 50.6% presented AKI stage 1 (n=43), 20% stage 2 (n=17) and 29.4% stage 3 (n=25, of which 18 required renal replacement therapy). In the multivariate analysis, the variables that were independently associated with AKI were: age (adjusted Odd ratio -aOR- =1.30, 95%CI=1.04-1.63, p=0.022), history of chronic kidney disease (aOR=9.92, 95%CI=4.52-21.77, p<0.001), blood neutrophi...
Infections are frequent complications of kidney transplants. We aimed at determining the frequenc... more Infections are frequent complications of kidney transplants. We aimed at determining the frequency and type of infections that occur in renal transplant recipients during the early (0-1 month), intermediate (1-6 months) and late (6-12 months) post-transplant period and analyzing the risk factors for infection. To this aim, we conducted a retrospective cohort study on 1-year post-transplant follow-up in two third-level university hospitals in Cordoba city. All consecutive recipients of renal transplants performed between 2009 and 2015 were included, except those with multiple solid organ transplantation and pediatric patients. We included 375 recipients, of which 235 (62.7%) had at least one episode of infection during follow-up. There were 504 episodes of infection, of which 131 (26%) occurred in the early, 272 (53.9%) in the intermediate, and 101 (20.1%) in the late post-transplant period. The most frequent infections in all periods were caused by bacteria (mainly urinary tract inf...
Se estima que un 3,2% de pacientes internados padecen de infecciones intrahospitalarias. Las medi... more Se estima que un 3,2% de pacientes internados padecen de infecciones intrahospitalarias. Las medidas de control de infecciones para instituciones de salud requieren un cuidado continuo y minucioso y conllevan un costo elevado al cuidado del paciente. Las medidas horizontales de control de infecciones son aquellas que se aplican a todos los pacientes y probablemente sean la forma mas adecuada para control de infecciones en esta epoca. Lamentablemente, los procesos de prevencion de infecciones se implementan con variabilidad en el mejor de los casos. Ejemplos de medidas horizontales son, higiene de manos, limpieza ambiental, higiene de pacientes con desinfectantes. Otras medidas son los paquetes de medidas para insercion de cateter central y paquetes de medidas de respirador. Lista de chequeo de seguridad de aplicacion general en todos los hospitales.
Revista de la Facultad de Ciencias Médicas de Córdoba, 2021
Introducción: La enfermedad COVID-19 muestra una marcada heterogeneidad en su curso clínico, habi... more Introducción: La enfermedad COVID-19 muestra una marcada heterogeneidad en su curso clínico, habiéndose descripto algunos factores que se asocian un peor pronóstico. El conocimiento del comportamiento de la enfermedad en el escenario local es de gran relevancia para permitir un mejor abordaje. Métodos: Estudio retrospectivo en dos hospitales de la ciudad de Córdoba, Argentina, de pacientes de 18 años o más hospitalizados por infección activa por SARS-CoV-2, desde marzo a octubre del año 2020. Resultados: Se incluyeron 448 pacientes, de los cuales el 95.75% correspondieron a neumonía COVID-19. La mayoría de los episodios ocurrieron en hombres (63.6%), la mediana de edad fue 63 años (RIC:53-75), y las comorbilidades más frecuentes fueron hipertensión arterial (55.1%), obesidad (31.7%) y diabetes mellitus (28.1%). Requirieron ingreso a unidad de cuidados intensivos 162 pacientes (36.2%) y 66 (14.7%), asistencia respiratoria mecánica. Fallecieron 67 pacientes (15%) dentro de los prime...
International Journal of Infectious Diseases, 2018
Background: Gram-negative bacteremia (GNB) in cancer and hematopoietic stem cell transplant (HSCT... more Background: Gram-negative bacteremia (GNB) in cancer and hematopoietic stem cell transplant (HSCT) patients is a major cause of infection-related mortality. We performed a study to identify factors associated with 7-day and 30-day mortality during GNB episodes in cancer and HSCT patients. Methods & Materials: Prospective multicenter study. Episodes of GNB in adult cancer and HSCT patients were included in 10 centers of Argentina, from May 2014 to November 2016. To identify factors associated with 7-day and 30-day mortality, variables with p < 0.05 in univariate analysis and clinically relevant variables were included in a logistic regression model for multivariate analysis. Results: 460 episodes of GNB were included. From these, 295 (64.13%) had haematological malignancies, 80 (17.39%) solid tumors and 85 (18.47%) HSCT. 7-day and 30-day mortality was 18.04% and 25.2%, respectively. In the univariate analysis, the factors associated with mortality were: treatment with corticosteroids, combined antibiotic treatment, skin and soft tissue source, respiratory source, breakthrough bacteremia, multidrug-resistant GNB, hypotension, intensive care requirement, shock, multiorgan failure, Pitt score > 4, Charlson score > 4 and APACHE II score > 24. In multivariate analysis, factors independently associated with 7day mortality were: multidrug-resistant GNB (
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