Empirical treatment and mortality in bacteremia due to extended spectrum ß-lactamase producing Enterobacterales (ESßL-E), a retrospective cross-sectional study in a tertiary referral hospital from Colombia.

BACKGROUND: Infections caused by extended spectrum ß-lactamase (ESßL) producing bacteria are common and problematic. When they cause bloodstream infections, they are associated with significant morbidity and mortality. METHODS: A retrospective cross-sectional observational study was conducted in a single center in Pereira, Colombia. It included people hospitalized with bacteremia due to gram-negative bacilli with the extended-spectrum ß-lactamase producing phenotype. A logistic regression analysis was constructed. Clinical characteristics and risk factors for death from sepsis were established. RESULTS: The prevalence of bacteremia due to Enterobacterales with extended-spectrum ß-lactamase producing phenotype was 17%. 110 patients were analyzed. Most patients were men (62%) with a median age of 58 years, hospital mortality was 38%. Admission to intensive care was 45%. The following risk factors for mortality were established: shock requiring vasoactive support, Pitt score > 3 points, and not having an infectious disease consultation (IDC). CONCLUSIONS: bacteremia due to Enterobacterales with extended-spectrum ß-lactamase producing phenotype have a high mortality. Early recognition of sepsis, identification of risk factors for antimicrobial resistance, and prompt initiation of appropriate empiric antibiotic treatment are important. An infectious disease consultation may help improve outcomes.

Bacteremia after Bacillus clausii administration for the treatment of acute diarrhea: A case report. / Bacteriemia tras la administración de Bacillus clausii para el tratamiento de la diarrea aguda: reporte de un caso

Bacillus clausii is a gram-positive rod used as a probiotic to treat diarrhea and the side effects of antibiotics such as pseudomembranous colitis. We report a case of B. clausii bacteremia in a non-immunocompromised patient with active peptic ulcer disease and acute diarrhea. The probiotic was administered during the patient´s hospitalization due to diarrhea of infectious origin. B. clausii was identified in the bloodstream of the patient through Matrix-Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) days after her discharge. Given the wide use of probiotics, we alert clinicians to consider this microorganism as a causative agent when signs of systemic infection, metabolic compromise, and hemodynamic instability establish after its administration and no pathogens have been identified that could explain the clinical course.

Bacillus clausii es un bacilo grampositivo que se utiliza como probiótico para tratar la diarrea y los efectos secundarios de los antibióticos como la colitis pseudomembranosa. Presentamos un caso de bacteriemia por B. clausii en un paciente no inmunodeprimido con enfermedad ulcerosa péptica activa y diarrea aguda. El probiótico se administró durante la hospitalización del paciente por diarrea de origen infeccioso. B. clausii se identificó en el torrente sanguíneo de la paciente a través del tiempo de vuelo por ionización por desorción láser asistida por matriz (MALDI-TOF) días después de su alta. Dado el amplio uso de probióticos, alertamos a los médicos para que consideren este microorganismo como agente causal cuando se establezcan signos de infección sistémica, compromiso metabólico e inestabilidad hemodinámica después de su administración y no se hayan identificado patógenos que puedan explicar el curso clínico.

Bacteremia after Bacillus clausii administration for the treatment of acute diarrhea: A case report / Bacteriemia tras la administración de Bacillus clausii para el tratamiento de la diarrea aguda: reporte de un caso

Abstract | Bacillus clausii is a gram-positive rod used as a probiotic to treat diarrhea and the side effects of antibiotics such as pseudomembranous colitis. We report a case of B. clausii bacteremia in a non-immunocompromised patient with active peptic ulcer disease and acute diarrhea. The probiotic was administered during the patient's hospitalization due to diarrhea of infectious origin. B. clausii was identified in the bloodstream of the patient through Matrix- Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) days after her discharge. Given the wide use of probiotics, we alert clinicians to consider this microorganism as a causative agent when signs of systemic infection, metabolic compromise, and hemodynamic instability establish after its administration and no pathogens have been identified that could explain the clinical course.

Resumen | Bacillus clausii es un bacilo Gram positivo usado como probiótico para tratar la diarrea y efectos adversos de los antibióticos, como la colitis pseudomembranosa. Se reporta un caso de bacteriemia por B. clausii en una paciente inmunocompetente con enfermedad ulcerosa péptica activa y diarrea aguda. El probiótico le fue administrado durante la hospitalización debido al origen infeccioso de la diarrea. B. clausii se identificó en el torrente sanguíneo de la paciente, utilizando espectrometría de desorción/ionización mediante láser asistido por matriz (Matrix-Assisted Laser Desorption/Ionization, MALDI), acoplada a un detector de iones (Time of Flight, TOF) (MALDI-TOF), días después de haber sido dada de alta. Dado el amplio uso de los probióticos, alertamos a los clínicos para que consideren este microorganismo como agente causal cuando se detecten signos de infección sistémica, compromiso metabólico, e inestabilidad hemodinámica tras su administración, y no se haya identificado ningún patógeno que pueda explicar el cuadro clínico.

Geographic mapping of Enterobacteriaceae with extended-spectrum ß-lactamase (ESBL) phenotype in Pereira, Colombia.

BACKGROUND: Antimicrobial resistance is an ecological and multicausal problem. Infections caused by extended-spectrum ß-lactamase producing Enterobacteriaceae (ESBL-E) can be acquired and transmitted in the community. Data on community-associated ESBL-E infections/colonizations in Colombia are scarce. Georeferencing tools can be used to study the dynamics of antimicrobial resistance at the community level. METHODS: We conducted a study of geographic mapping using modern tools based on geographic information systems (GIS). Two study centers from the city of Pereira, Colombia were involved. The records of patients who had ESBL-producing Enterobacteriaceae were reviewed. Antimicrobial susceptibility testing and phenotypic detection of ESBL was done according to CLSI standards. RESULTS: A population of 415 patients with community-acquired infections/colonizations and 77 hospital discharges were obtained. Geographic distribution was established and heat maps were created. Several hotspots were evidenced in some geographical areas of the south-west and north-east of the city. Many of the affected areas were near tertiary hospitals, rivers, and poultry industry areas. CONCLUSIONS: There are foci of antimicrobial resistance at the community level. This was demonstrated in the case of antimicrobial resistance caused by ESBL in a city in Colombia. Causality with tertiary hospitals in the city, some rivers and the poultry industry is proposed as an explanation of the evidenced phenomenon. Geographic mapping tools are useful for monitoring antimicrobial resistance in the community.

Thinking in paracoccidioidomycosis: a delayed diagnosis of a neglected tropical disease, case report and review of clinical reports and eco-epidemiologic data from Colombia since the 2000.

BACKGROUND: Paracoccidioidomycosis is a neglected tropical disease, endemic in several countries of South America including Colombia. We report a case of a patient with Chronic Multifocal Paracoccidioidomycosis with long-standing symptoms and a delayed diagnosis caused by several barriers to achieve it. We did a review of the papers published in Colombia about this disease, focusing in clinical data and eco-epidemiology with the finding of a lack of new information on this topic since the 2000 in our region. CASE PRESENTATION: We present a 54-year-old man, farmer in his youth, with a chronic ulcerated lesion in the lower lip similar to a lip carcinoma, a deforming lesion in the nose, and respiratory symptoms with emphysematous lung. Lip biopsy with silver methenamine stain revealed small and large budding yeasts that resembles a "mariner's wheel" confirming Chronic Multifocal Paracoccidioidomycosis. He was treated successfully but subsequently lost to follow up. CONCLUSIONS: It is very important to focus attention, reinforce the search and create networks for the study of neglected tropical diseases. The presented case illustrates a usual clinical presentation, but with a delayed diagnosis due to the difficulties that still occur in some regions like ours for the early recognition of a case of chronic multifocal paracoccidioidomycosis.

Cryptococcal fungemia and probable histoplasmosis in a patient infected with HIV. Case report.

BACKGROUND: Those infected by human immunodeficiency virus (HIV) have a higher risk of opportunistic infections. The risk is related to the level of immunosuppression. We report a case of a young male with the unusual scenario of three opportunistic infections occurring simultaneously: Cryptococcosis, Histoplasmosis and Cryptosporidiosis. Histoplasmosis and cryptococcosis are major causes of morbimortality in immunocompromised patients due to HIV infection. CASE PRESENTATION: We report the case of a patient with HIV infection with a CD4 T lymphocyte cell (CD4) count of 2 cells/mm3, who presented with 6 months of diarrhea, non-productive dry cough, nocturnal diaphoresis, fever, weight loss, and a maculopapular rash. He had a concurrent infection with three opportunistic microorganisms: fungemia by cryptococcosis, disseminated histoplasmosis confirmed by detection of the antigen in urine and chronic diarrhea by cryptosporidiosis confirmed by direct observation in feces by modified Ziehl-Neelsen stain. The patient received antifungal treatment with a satisfactory outcome. CONCLUSIONS: There are still regions where HIV detection programs are deficient thus facilitating occurrence of HIV infection cases in advanced stages of immunosuppression. A high level of suspicion of systemic mycoses and concurrent infection by several opportunistic pathogens is required in severely immunocompromised patients.

Metalobetalactamasa de tipo Nueva Delhi en Risaralda (Colombia): reporte de un caso / New Dehli metallobectalamase in Risaralda (Colombia): Case report

Se presenta un caso de un hombre con diagnóstico de osteomielitis crónica con aislamiento en cultivo de hueso de Providencia rettgeri productora de carbapenemasa de tipo Nueva Delhi. El paciente presentó control de la infección por este germen con terapia antibióticacombinada con cefepime y gentamicina. Es el primer reporte de una infección por enterobacterias con este mecanismo de resistencia en la región.

We reported a case in a man with chronic osteomyelitis of an isolate of Providencia rettgeri carrying New-Delhi metallo-beta-lactamase. The isolate was obtained from the patient's bone culture. The infection was controlled with combined antibiotic therapy (cefepime and gentamicine). This is the first report of an infection produced by Enterobacteriaceae carrier of this metallo-beta-lactamase in the region.

Neuritis óptica en presencia de anticuerpos antifosfolipidos de origen sifilítico: un diagnostico olvidado / Optic neuritis in the presence of antiphospholipid antibodies of syphilitic origin: a forgotten diagnosis

Resumen: la neuritis óptica es infrecuente como manifestación de sífilis ocular, la falta de características típicas genera retraso en el diagnóstico. Describimos el caso de una mujer de 47 años , inmunocompetente con historia de 4 meses de disminución progresiva de la agudeza visual de predominio izquierdo, asociado a dolor, inyección conjuntival y cefalea, al examen físico con visión de bultos y al fondo de ojo con signos de inflamación ocular dentro de la evaluación diagnostica presenta: VDRL y FTA-ABS positivo en suero, positividad de ANAS y anticuerpos anticardiolipinas igG, LCR con VDRL reactivo, se diagnostica neuritis óptica por neurosifilis en presencia de anticuerpos antifosfolipidos, iniciando tratamiento con penicilina cristalina 24 000 000 de unidades día por 14 días. En pacientes con signos de inflamación ocular debe realizarse VDRL, confirmarse con prueba treponemica, y realizar punción lumbar, el tratamiento precoz se asocia a mejora de desenlaces visuales.

Abstract :optic neuritis is uncommon as an ocular syphilis clinical presentation; the lack of typical features generates delay in the diagnosis. We describe the case of a 47-year-old woman, immunocompetent with a 4-month history of left visual acuity progressive of left side reduction, associated with pain, conjunctival injection and headache, physical examination with lumpy vision and fundus with signs of ocular inflammation, within the diagnostic evaluation, serum VDRL, FTA-ABS was reactive, with ANAS and IgG anticardiolipin antibodies serum positivity, lumbar punction was taken with reactive VDRL, optic neuritis by neurosyphilis was diagnosed, with antiphospholipid antibodies cross reactivity , treatment with crystalline penicillin 24 000 000 of units day for 14 days was started . In patients with signs of ocular inflammation, VDRL should be performed, confirmed with a treponemal test, and a lumbar puncture should be performed. Early treatment is associated with improvement of visual outcomes.

[Patterns of antiretroviral drug prescription in 997 Colombian patients]. / Patrones de prescripción de antirretrovirales en 997 pacientes colombianos.

INTRODUCTION: Antiretroviral therapy for treatment of human immunodeficiency virus type 1 (HIV-1) infection has improved steadily since the advent of combination therapy in 1996. OBJECTIVE: The pharmacological therapies of the infection by HIV/AIDS were documented in order to determine if effective treatment regimes were prescribed. MATERIALS AND METHODS: Pharmacological therapies of the human immunodeficiency virus infection were compared in 997 patients affiliated with the health security system, of both sexes and all ages. All had been in treatment for more than three months (July--September 2006) and were distributed in 15 Colombian cities. The data were retrieved from medication consumption files which were maintained by the institutions that had distributed medications to the selected patients. RESULTS: The average age of patients was 37.7+/-13.2 and 82.6% were men. All the patients received between three to five antiretrovirals. The medications most commonly prescribed were nucleoside reverse transcriptase inhibitors (96.4%), nonnucleoside reverse transcriptase inhibitors (54.9%), protease inhibitors (39.8%) and others (0.4%). All of the doses were at recommended levels. The most common combinations were lamivudine-zidovudine-efavirenz (35%), lamivudine-zidovudine+lopinavir/ritonavir (8.4%), abacavir+lamivudine-zidovudine (5.5%), lamivudine-zidovudine+nevirapine (5.2 %) and others (45.9%), consisting of 65 different combinations. CONCLUSIONS: All agents were used at internationally recommended doses and rational prescription patterns prevailed in the initial therapy. However, the use of 69 different associations suggested that after the beginning of treatment, clinicians do not have adequate criteria to prescribe in accordance with international guidelines of antiretroviral therapy; they adopt a variety of options that may be outside of established recommendations.

Patrones de prescripción de antirretrovirales en 997 pacientes colombianos / Patterns of antiretroviral drug prescripcion in 997 Colombian patients

Introducción. El tratamiento antirretroviral de la infección por virus de inmunodeficiencia humanaha mejorado la supervivencia y la calidad de vida de los pacientes desde el advenimiento de la terapia combinada en 1996. Objetivos. Conocer el manejo farmacológico de la infección por VIH/sida. Materiales y métodos. Estudio descriptivo observacional con selección de pacientes coninfección por VIH/sida, de ambos sexos, de todas las edades, en tratamiento, al menos, durante tres meses (julio a septiembre de 2006) localizados en diferentes ciudades colombianas y afiliados al Sistema General de Seguridad Social en Salud. Se diseñó una base de datos con registros sobre el consumo de medicamentos antirretrovirales, recolectados por la empresa que dispensa dichos fármacos a los pacientes de las entidades promotoras de salud. Resultados. Se estudiaron 997 pacientes con edad promedio de 37,7±13,2 años, 82,6 por ciento de hombres. Todos los pacientes recibían terapia con tres o más antirretrovirales; el orden de prescripción de medicamentos fue: inhibidores de nucleósidos de transcriptasa inversa (96,4 por ciento), inhibidores de transcriptasa inversa no nucleósidos (54,9 por ciento), inhibidores de proteasa (39,8 por ciento) y otros (0,4 por ciento), todos a dosis adecuadas. Las combinaciones más empleadas fueron: lamivudina-zidovudina-efavirenz (35 por ciento), lamivudina-zidovudina con lopinavir/ritonavir (8,4 por ciento), abacavir con lamivudina-zidovudina (5,5 por ciento), lamivudina-zidovudina con nevirapina (5,2 por ciento) y otras 65 asociaciones diferentes (45,9 por ciento). Conclusiones. Todos los antirretrovirales se están utilizando a las dosis establecidas internacionalmente y predominan patrones de prescripción racionales para iniciar la terapia. Sin embargo, el encontrar 69 asociaciones diferentes de antirretrovirales lleva a considerar que no hay adecuados criterios para la implementación de los esquemas después del inicio del tratamiento, guiados según lo...