208 ABSTRACTS INFECTOLOGY / INFECTOLOGÍA P-15-01 | BACTEREMIA EN HOSPITALIZED ADULTS PA- TIENTS. PREVALENCE AND DISTINCTIVES CLINICAL PATTERNS Mosso, Marcelo; De Schutter, Emiliano; Salomón, Susana; Attorri, Silvia; Carena, José Hospital L. Lagomaggiore - Universidad Nacional de Cuyo; Mendoza. Ar- gentina Background: Despite the availability of antibiotics and other therapies the bloodstream infections remain an important cause of morbidity and are associated with 20-50% mortality. We performed this study to asses the clinical and microbiological features and to identify the clinical variables associated with poor outcome. PATIENTS AND Methods: This is a study of 759 patients with bacteremia, defined as the isolation of the same organism in two blood cultures in association with signs of infection. Data was analyzed with Epi Info 6.04, and the criteria of statistically significance was p1cm) valvular vegetations (74.2 vs 48.8%), heart failure (65.1 vs 27.4%), renal insufficiency (48.8 vs 17.7%) and surgery indication (46.5 vs 21%) were significant in the deceased group (p
P-15-05 | SEPSIS BY CAMRSA Speziale, C.; De Marco, V.; Farinella, M.; Jaques, N.; Restano, M. Internal Medicine, Ezeiza Hospital; Argentina Case Report: We present the case of a 43, male patient, with familiar history of type II Diabetes and non HIV, who is admitted because of acute abdominal pain and sepsis by MRSA, without history of internments and/or suspicious contacts. He had pustules in limbs. TE ultrasonography of the heart, without vegetations. Arterial obstruction of right leg, confirmed by Echodoppler, that motivates infrapatelar amputation. Multiple abscesses in lung, spleen and brain, that healed with treatment. He was treated with vancomicine, 30 days, with good evolution. Daily insulin requirements , until discharge. Discussion: MRSA is endemic in many hospitals, causing 50% of infections (pneumonia, surgical infections and bacteriemia). Many community individuals have infections by MRSA. Many of them had been admitted previously (the status of nasal carrier of MRSA has prolonged time of latency). There is another group that has never been admitted before, but has visited some patient infected by MRSA, or received a carrier of MRSA in house, after its hospitable discharge . Other surce of transference of MRSA to the community, is composed by those people that require intravenous parenteral therapies (diabetic, haemodialisis). Also, intravenous drug users, and people confined to geriatric day-care centers. Unlike the multiresistant varieties, the CAMRSA are usually resistant to betalactamics, but susceptible to other antibiotics. There is an increasing number of cases in which a predisposing factor is not detected. Comments: We present this case, because the infection by MRSA has increased, being a common cause of nosocomial infection, with a mortality rate between 15-60%. P-15-07 | COLONIZATION/ INFECTION BY ACINETO- BACTER BAUMANNII Ruiz, I.; Novo, I.; López, M.D.; Escalante, M.; Iturzaeta, A. Department of Internal Medicine, Familiy Medicine, Laboratory and Clinical Analysis. Hospital of Zumarraga (Guipuzcoa);Spain Objetive To evaluate the repercussion and risk factors for the appearance of the A baumannii in the health area of Goiherri ( Guipuzcoa), where the population of 90.000 inhabitants is treated. Material and Methods: A retrospective study is carried out in every sample in which A baumannii appears: urine, sputum, wound exudate/postsurgical drainage and blood ,on all 14 + year old inpatients and outpatients from 2002 to 2007. Colonization is considered when the germ is isolated without serious clinical data. Results: Incidence : 20 cases have been reported in the last 6 years ( 18 patients, in two cases the germen appears twice after 6 months). 2c 2002, 2c 2003, 3c 2004, 1c 2005, 3c 2006 and 9c 2007.Incidence 0’0002/c year , average 3’3 = annual repercussion of 2’19 and 4’48 confidence interval of 95%. Age: average (58-94). Sex: 14 males and 4 females. Patients- samples: a) outpatients 12c: 8c urine, 4c exudate. General practitioner 7c, urology 2c, nephrology 1c, surgery 1c, otorhinolaryngology 1c. b) Inpatients 8c: 3c urine, 2c sputum, 2c exudate, 1c blood .Internal medicine 5c, nephrology 1c, urology 1c, anaesthesia 1c. Culture: a) pure 11c: 8c urine, 1c blood, 1c sputum, 1c exudate. b) Polymicrobiological 9c: 5c wound, 3c urine, 1c sputum; 8 of them associated with Serratia spp, Stenotrophomona m, Pseudomona spp,Staphylococcus aureus. Treatment –evolution: Despite being considered colonizations only the 5c seen in the department of internal medicine got treatment. All of them had favourable evolution. Discussion: Point out the high incidence of A. baumannii in our health area and the significant rise in the number of cases 2007. 77% males. 60% in the community and 40% in the hospital. Main manifestation urine 55% (37% inpatients, 66% outpatients) as well as in exudate 33%, sputum 11% and blood 5’5%. In pure culture 55% and 45% in polymicrobiological, of which 40% associated to other multiresistant germs. In pure culture it appears in urine 72% and if it is polymicrobiological in exudate 83% and urine 27%. It is not clear yet whether the colonization by A baumannii, an aggressive and multiresistant germ, should be treated in both inpatients and outpatients. Bibliography: Nosocomial infection/colonization of the respiratory tract caused by Acinetobacter baumannii in an internal medicine ward.( An Med Interna – Madrid 2002,). Community acquired Acinetobacter infections ( Eur J Clin Microbiol Infect Dis 2007 ) Clinical impact and pathogenicity of Acinetobacter ( Clin Microbiol Infect 2006). P-15-06 | TUBERCULOSIS OF THE THYROID ABSTRACTS Testa, M.; Ferreira, I.; De Marco, V.; Carvallo, H.; Peñaranda, O Internal Medicine, Ezeiza Hospital; Argentina We present the case of a female patient, 80, admitted because of thyroid swelling, together with lymphatic node of the neck. Fine needle bipsy was consistent with papillar carcinoma, so a radical thyroidectomy was performed. During it, Pathology found tuberculoid invasion of the gland, mimicking carcinoma. Thyroidectomy was completed. No primary TBC impact could be detected. The patient received both hormonal and antituberculosis treatments, simultaneously. Comments: some cases of thyoid tuberculosis have mimicked carcinoma, thus causing diagnostic difficulties Bruns first described the case of a middle- aged woman, with progressive swelling of the thyoid and enlarged lymphatic node of the neck, that happened to be TBC. Twenty one cases out of 20,758 thyroidectomies performed at the Mayo Clinic turned out to be TBC (01 %). In another series, eight cases out of 2426 surgeries proved to be TBC. From the, five had definite goiter, and the rest, just a solitary node. Only one of these cases was diagnosed by fine needle biopsy; in the others, diagnosis was achieved after thyroidectomy. There is a slight prevalence of females, with ages ranging between 9 and 83 (male media of 40, and female media of 44). Manifestations ranged form solitary node to evident goiter. Pazitou et al, in three cases with rapid swelling, suspected carcinoma. Two fo them were diagnosed as TBC after thyroidectomy; the other one, by fine needle biopsy. Another case (an 80-year-old female), was mistaken with anaplastic carcinoma with lung MTS, that turned out to be primary, miliar distribution of tuberculosis. In another report, two cases mimicked carcinoma: one was a solitary node; the other, an abscess. No primary tuberculosis site could be detected. P-15-08 | A RARE CASE OF PASTEURELLA MULTOCIDA BACTEREMIA IN THE ABSCENCE OF LOCALIZED IN- FECTION Skrapari, I.; Kritikos, K.; Palia, M.; Gounaris, T.; Sioula, E. Evangelismos General Hospital. Athens.;Greece INFECTOLOGY / INFECTOLOGÍA Introduction: Pasteurella multocida is a normal upper respiratory tract flora of mammals, especially of felines. Most human infections are caused by cat’s bites or scratches and include: cellulitic, arthritis, osteomyelitis, oral and respiratory infections. Rare cases of meningitis, intraabdominal infection, endocarditis, or ocular infections havebeen reported. Case Report: We present a 58 years-old patient who presented with fever of 2 mo. She reported arthralgias, anorexia and fatigue. Her past medical history included coronary heart disease, chronic atrial fibrillation and an ischemic stroke. She also had a metalic prosthetic mitral valve (due to valvular rheumatic disease). The patient reported recent contact with a cat about 1 mo. prior to fever.Physical examination revealed a high frequency mitral valve sound and temperature was 37,6ªC. Laboratory: White Blood Cells: 10.190 cells/mm3 (N:71,2%, L:23,1%), Hb: 12 mg/dl, ESR: 91mm at first hour, CRP: 2,9 mg/dl (Reference Values
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