Analysis of Healthcare-associated Infections before and during the COVID-19 pandemic in a Colombian hospital

Introduction: Healthcare-associated infections pose a significant challenge, contributing to hospital morbidity and mortality. Objective: To describe the behavior of Healthcare Associated Infections before and during the pandemic reported to a high-complexity health institution in Colombia. Material and Methods: In our retrospective observational study on Healthcare-Associated Infections (HAIs), we analyzed data from all in-patients diagnosed with HAIs between 2018 and 2020. This included clinical, demographic, microbiological, and microbial susceptibility information collected from the Committee on Nosocomial Infections' prospective database. Data from 391 isolates were obtained using Whonet software for antimicrobial resistance surveillance. Results: We found 504 cases of HAIs (2018-2020) with an overall in-hospital infection rate of 2.55/1000 patient-days. The median age for pediatric patients was 5 years, and for adults, 56 years, with 57% male. The leading admission diagnoses were oncologic disease complications (31%). Bacteremia had a 30-day mortality rate of 13%, predominantly catheter-associated (37%). Gram-negative bacilli, notably Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa, represented 58% cases of HAI. Discussion: The critical need for specific interventions and antimicrobial management to control HAIs, especially given the challenges posed by the COVID-19 pandemic, is highlighted. Conclusions: This is the first report on HAIs incidence at a tertiary hospital in Bucaramanga, Santander (Colombia). Bacteremia was predominant; 75% of HAIs patients had comorbidities. Gram-negative bacilli prevailed; a notable rise in ICU respiratory infections occurred during the 2020 COVID-19 pandemic. Resistance to cephalosporins and carbapenems was prevalent.

Maternal-Fetal Results of COVID-19-Infected Pregnant Women Treated with Extracorporeal Membrane Oxygenation: A Descriptive Report.

OBJECTIVE: COVID-19 infection may produce severe pneumonia, mainly in the adult population. Pregnant women with severe pneumonia are at high risk of developing complications, and conventional therapy sometimes fails to reverse hypoxemia. Therefore, extracorporeal membrane oxygenation (ECMO) is an option in cases with refractory hypoxemic respiratory failure. This study aims to evaluate the maternal-fetal risk factors, clinical characteristics, complications, and outcomes of 11 pregnant or peripartum patients with COVID-19 treated with ECMO. STUDY DESIGN: This is a retrospective descriptive study of 11 pregnant women undergoing ECMO therapy during the COVID-19 pandemic. RESULTS: In our cohort, four patients underwent ECMO during pregnancy (36.3%) and 7 during the postpartum period. Initially, they started on venovenous ECMO, and three patients were required to change modality due to clinical conditions. In total, 4/11 pregnant women (36.3%) died. We established two periods that differed in the implementation of a standardized care model for reducing associated morbidities and mortality. Neurological complications were responsible for most deaths. Regarding fetal outcomes at early-stage pregnancies on ECMO (4), we report three stillbirths (75%), and one newborn (twin pregnancy) survived and had a favorable evolution. CONCLUSION: At later-stage pregnancies, all newborns survived, and we did not identify any vertical infection. ECMO therapy is an alternative for pregnant women with severe hypoxemic respiratory failure due to COVID-19, and may improve maternal and neonatal results. Regarding fetal outcomes, the gestational age played a definitive role. However, the main complications reported in our series and others are neurological. It is essential to develop novel, future interventions to prevent these complications.

Efficacy of vitamin D supplementation in reducing body mass index and lipid profile in healthy young adults in Colombia: a pilot randomised controlled clinical trial.

The objective of the present study was to evaluate the efficacy of oral administration of vitamin D supplementation in reducing BMI and lipid profile in adolescents and young adults from a cohort in Bucaramanga, Colombia. One hundred and one young adults were randomly assigned to one of two doses of vitamin D [1000 international units (IU) or 200 IU] administered daily for 15 weeks. The primary outcomes were serum 25(OH)D levels, BMI and lipid profile. The secondary outcomes were waist-hip ratio, skinfolds and fasting blood glucose. We found a mean ± sd plasma concentration of 25-hydroxyvitamin D [25(OH)D] was 25⋅0 ± 7⋅0 ng/ml at baseline, and after 15 weeks, it increased to 31⋅0 ± 10⋅0 ng/ml in the participants who received a daily dose of 1000 IU, (P < 0⋅0001). For the participants in the control group (200 IU), it went from 26⋅0 ± 8⋅0 ng/ml to 29⋅0 ± 8⋅0 ng/ml (P = 0⋅002). There were no differences between groups in body mass index. There was a statistically significant decrease in LDL-cholesterol between the intervention group v. the control group (mean difference -11⋅50 mg/dl (95 % CI -21⋅86 to -1⋅15; P = 0⋅030). The conclusions of the present study were two different doses of vitamin D supplementation (200 IU v. 1000 IU) produced changes in serum 25(OH)D levels over 15 weeks of administration in healthy young adults. No significant changes were found in the body mass index when the effect of the treatments was compared. A significant reduction in LDL-cholesterol was found when comparing the two intervention groups. Trial registration: NCT04377386.

Uric acid and risk of pre-eclampsia: results from a large case-control study and meta-analysis of prospective studies.

To quantify the association between maternal uric acid levels and pre-eclampsia risk in a large collection of primigravid women. A case-control study (1365 cases of pre-eclampsia and 1886 normotensive controls) was conducted. Pre-eclampsia was defined as blood pressure ≥ 140/90 mmHg and proteinuria ≥ 300 mg/24 h. Sub-outcome analysis included early, intermediate, and late pre-eclampsia. Multivariable analysis for pre-eclampsia and its sub-outcomes was conducted using binary and multinomial logistic regression, respectively. Additionally, a systematic review and meta-analysis of cohort studies measuring uric acid levels < 20 weeks of gestation was performed to rule out reverse causation. There was a positive linear association between increasing uric acid levels and presence of pre-eclampsia. Adjusted odds ratio of pre-eclampsia was 1.21 (95%CI 1.11-1.33) for every one standard deviation increase in uric acid levels. No differences in the magnitude of association were observed between early and late pre-eclampsia. Three studies with uric acid measured < 20 weeks' gestation were identified, with a pooled OR for pre-eclampsia of 1.46 (95%CI 1.22-1.75) for a top vs. bottom quartile comparison. Maternal uric acid levels are associated with risk of pre-eclampsia. Mendelian randomisation studies would be helpful to further explore the causal role of uric acid in pre-eclampsia.

Association of social determinants with the severity of congenital heart disease.

BACKGROUND: Congenital heart diseases are the most prevalent congenital malformations and cause greater morbi-mortality in newborns and infants. The aim of this study was to analyze the social determinants in families with children with the severity of congenital heart disease. METHODS: Analytical cross-sectional study in 140 families of children with congenital heart disease to whom a structured survey was applied addressing topics related to family structure, health, economic conditions, exposure factors, and other social conditions relevant to the study, during 1 year. RESULTS: In all, 53.7% of the studied population belonged to low socioeconomic levels. No association was found between the severity of the heart disease and the presence of pathological antecedents in the parents. The families resided in urban areas. Also, 28.3% of the mothers had four or fewer prenatal controls during pregnancy. Only 22% of heart diseases were diagnosed during pregnancy. It was found that exposure to cigarette and wood smoke during pregnancy, in addition to low socioeconomic status, was associated with greater severity of heart disease (RACHS-1 and STS-Score), when evaluated by pathophysiological groups (cyanotic/non-cyanotic/single ventricle). CONCLUSIONS: Exposure to cigarette smoke, wood smoke during pregnancy, and low socioeconomic status turned out to be social determinants associated with the severity of heart disease analyzed by pathophysiological groups. IMPACT: The social component has not been well characterized as a cause of congenital heart disease, especially in countries like ours, where the existence of gaps and social inequities have a high impact. The findings of this study could have an impact on public health to the extent that policies are implemented to reduce exposure to cigarettes, especially during pregnancy. Knowledge of these changes and their measurement in this type of pathology could open the door to the creation of policies aimed at their prevention, focusing on the local risk factors found, which can impact the disease.

Seroprevalence of SARS-CoV-2 Infection among Occupational Groups from the Bucaramanga Metropolitan Area, Colombia.

The negative effects of coronavirus disease 2019 (COVID-19) pandemic have impacted the world economy due to the absence from work because of SARS-CoV-2 infection in workers, among other reasons. However, some economic areas are essential to society and people must continue working outside the home to support economic reactivation; their serological profile could be different from that of the global population. Cross-sectional study: Workers from health, construction, public transportation, public force, bike delivery messengers, independent or informal commerce areas, and residents of Bucaramanga or its metropolitan area were invited to participate. All participants self-completed a virtual survey and a blood test was taken to assess IgG and IgM with the ARC COV2 test. Seroprevalence was estimated considering a complex survey design, correcting for a finite population effect and adjusting for test performance. A total of 7045 workers were enrolled; 59.9% were women and most were residents of Bucaramanga and working in health occupations. The global adjusted seroprevalence was 19.5% (CI: 95% 18.6-20.4), being higher for Girón (27.9%; 95% CI: 24.5-31.30). Workers with multiple contact with people during working hours or using public transportation to go to work had a higher frequency of seropositivity for SARS-CoV-2. The seroprevalence among workers living in these four municipalities from the Colombian northeast area is still low.

Factores asociados a la decisión paterna sobre el retorno a clases presenciales en Colombia durante la pandemia COVID-19 / Associated factors with the paternal decision on the return to face-to-face classes in Colombia during the COVID-19 pandemic

Resumen Introducción: La pandemia por SARS-CoV-2 generó el cierre de los colegios y el inicio de la educación virtual, como medida para disminuir la propagación del virus. Rápidamente, se planteó el regreso a los colegios; sin embargo, es probable que exista un rechazo de los padres por el regreso a clases de forma presencial o mediante alternancia. Por esta razón, se evaluaron los factores asociados a esta oposición. Material y métodos: Se realizó un estudio analítico de corte transversal mediante una encuesta, dirigida a padres que acuden a consultorios con sus hijos en varias ciudades de Colombia. Se determinó el porcentaje de padres que deseaban mantener la escolarización mediante la virtualidad y los factores asociados que motivan a no aceptar el pronto retorno a clases presenciales. Se realizó un análisis de regresión binomial para estimar razones de prevalencia (RP), ajustado a la edad de los padres, tomando como variable dependiente la aceptación de la virtualidad como estrategia para no regresar a los colegios, y se determinaron los factores de mayor importancia en la no aceptación del retorno a clases. Resultados: El 81,06 % de los padres no acepta el retorno a clase de forma presencial. El principal factor asociados a esta decisión fue que alguno de los padres presentara alguna comorbilidad, principalmente, hipertensión y obesidad. Tener hijos mayores de 10 años (RP: 2,64: IC 95 %: 1,48-4,72), convivir con personas mayores de 70 años (RP: 2,2; IC 95 %; 1,46-3,29) y conocer alguna persona fallecida por COVID-19 (RP: 1,86; IC 95 %: 1,42-2,44) también fueron asociadas a no aceptar el retorno a clase presencial. Conclusiones: Existe una clara tendencia a mantener la virtualidad como opción educativa en Colombia para el no regreso a clases presenciales en población de estrato medio y alto. Los factores asociados sugieren una forma de protección familiar. Esta evidencia debe considerarse específica para el periodo de recolección de datos y el grupo incluido en el estudio. Se requieren estudios en los estratos socioeconómicos más bajos, donde se supone ocurren más efectos adversos asociados al no retorno a clases presenciales.

Abstract Introduction: The SARS-CoV-2 pandemic led to the closure of schools and the beginning of virtual education, as a measure to reduce the spread of the virus. Shortly after, there was a planned return to in-person learning, however, there existed the possibility of parents rejecting the notion of returning to in-person learning or a hybrid model of in-person and online learning, there is likely a rejection of parents to return to classes in person. For this reason, the factors possibly associated with this opposition were evaluated. Material and methods: A cross-sectional analytical study was carried out through an online survey aimed at parents who attend private clinics with their children, in several cities of Colombia. The percentage of parents who wished to maintain their children's schooling through virtuality and the factors associated with not accepting the prompt return to face-to-face classes were determined. A binomial regression analysis, to estimate Prevalence Ratios (PR), adjusted for the age of the parents was carried out, taking as a dependent variable the acceptance of virtuality as a strategy for not returning to school and the most important factors in the non-acceptance of returning to school were determined. Results: 81.06% of the parents did not accept the return to class in person. The main factors associated with this decision were that one of the parents had some comorbidity, mainly hypertension and obesity. Having children older than 10 years (PR: 2.64; 95% CI: 1.48-4.72), living with people older than 70 years (PR: 2.2; 95% CI;1.46-3.29), and knowing someone who died from COVID-19 (PR: 1.86; 95% CI 1.42- 2.44) were associated with not accepting the return to face classes. Conclusions: There is a clear tendency to maintain virtuality as an educational option in Colombia for not returning to face-to-face classes in the middle and upper stratum population. Associated factors suggest a form of family protection. This evidence should be considered specific for the data collection period and the group included in the study. Studies are required in the lowest socioeconomic strata, where it is assumed that there are more adverse effects associated with not returning to face-to-face classes.

Prevalence of vitamin D status and its association with overweight or obesity in a population of Colombian children and adolescents.

The present study aimed to estimate the prevalence of 25-OH-D status (insufficiency and deficiency) in children and adolescents residing in Bucaramanga, Colombia and to determine its association with excess weight. A case-control study was nested in the SIMBA II cohort in children and adolescents between the ages of 11 and 20 years old. Cases were defined as those children and adolescents with overweight or obesity. The control group was composed of children and adolescents from the same population sample with similar sociodemographic and economic characteristics but without overweight or obesity diagnosis. 25-hydroxyvitamin D (25-OH-D) was quantified in serum using a chemiluminescent microparticle immunoassay. Logistic regression models were used to assess the association between vitamin D status and overweight or obesity adjusted for the main confounding variables. A total of 494 children and adolescents cases were 138 (52⋅17% boys and 47⋅83% girls; median age 16⋅0 [Q1 15; Q3 18]). The median BMI S-Score minors age in the cases was 1⋅36 [Q1 1⋅06; Q3 2⋅00] and BMI (kg/m2) 28⋅0 [Q1 26⋅2; Q3 30⋅8]. The prevalence of vitamin D in the cases was deficiency 16⋅67%, insufficiency 57⋅25%, sufficiency 26⋅09. 25-OH-D insufficiency was associated with overweight or obesity after adjusting for the main confounding variables (OR 1⋅73; 95% CI 1⋅05-2⋅84). Our study concludes that the 25-OH-D insufficiency is common in children and adolescents in Bucaramanga, Colombia, and it was associated with overweight or obesity.

Daily intake of macronutrients and energy in childhood and its association with cardiometabolic risk factors in Colombians.

OBJECTIVES: Determine the intake and percentage of adequacy of macronutrients and their association with cardiovascular risk factors in a sample of Colombian schoolchildren. METHODS: Cross-sectional study nested in a prospective population-based cohort in schoolchildren between 6 and 10 years of age; cardiovascular risk markers and anthropometric measures were measured. Macronutrient intake was established through a food consumption frequency questionnaire (FFQ). The percentage of adequacy was evaluated by comparison with the dietary reference intakes (DRI) and the recommendations for energy and nutrient intake (RIEN) for the Colombian population. Linear regression analysis was performed to assess the association between daily macronutrient/energy intake and cardiometabolic risk factors. RESULTS: A total of 1,282 school children (51.09% boys and 48.91% girls; mean age 8.4 ± 1.4 years). The percentage of energy adequacy was 107% (Q1=87.5; Q3=127.2). The macronutrients in overadequacy were proteins and carbohydrates. The total fiber had a low adequacy around 26.0% (Q1=15.8; Q3=38.6). Fat intake was positively associated with BMI, insulin, and HOMA-IR index, while carbohydrate consumption was related to these same factors, although negatively in tight models. CONCLUSIONS: Schoolchildren in this study had an inadequate protein, carbohydrate, and fiber intake. The results suggest a significant positive and negative relationship between the consumption of both fat and carbohydrates and cardiometabolic risk factors such as BMI, insulin levels, and HOMA-IR.

C-reactive protein, interleukin-6 and pre-eclampsia: large-scale evidence from the GenPE case-control study.

Multiple small studies have suggested that women with pre-eclampsia present elevated levels of C-reactive protein (CRP) and interleukin-6 (IL-6). However, little is known regarding the source of this CRP and IL-6 increase. Therefore, the aim of this study was to evaluate the relationship between CRP and IL-6 levels with pre-eclampsia considering different confounding factors. Using data from a large Colombian case-control study (3,590 cases of pre-eclampsia and 4,564 normotensive controls), CRP and IL-6 levels were measured in 914 cases and 1297 controls. The association between maternal serum levels of CRP and IL-6 with pre-eclampsia risk was evaluated using adjusted logistic regression models. Pre-eclampsia was defined as presence of blood pressure ≥140/90 mmHg and proteinuria ≥300mg/24 h (or ≥1 + dipstick). There was no evidence of association between high levels of CRP and IL-6 with pre-eclampsia after adjusting for the following factors: maternal and gestational age, ethnicity, place and year of recruitment, multiple-pregnancy, socio-economic position, smoking, and presence of infections during pregnancy. The adjusted OR for 1SD increase in log-CRP and log-IL-6 was 0.96 (95%CI 0.85, 1.08) and 1.09 (95%CI 0.97, 1.22), respectively. Although previous reports have suggested an association between high CRP and IL-6 levels with pre-eclampsia, sample size may lack the sufficient power to draw robust conclusions, and this association is likely to be explained by unaccounted biases. Our results, the largest case-control study reported up to date, demonstrate that there is not a causal association between elevated levels of CRP and IL-6 and the presence of pre-eclampsia.

Pentraxin-3 is a candidate biomarker on the spectrum of severity from pre-eclampsia to HELLP syndrome: GenPE study.

Pentraxin-3 has been reported as a promising biomarker of pre-eclampsia and its severity; however, available studies have small sample sizes, and analyses are not always adjusted for confounders. The aim of this study is to establish the strength of the association between maternal Pentraxin-3 level and pre-eclampsia or HELLP syndrome. It was a case-control study. Women with pre-eclampsia or HELLP syndrome were defined as cases, and women with healthy pregnancies at term (>37 weeks) were classified as controls. Plasma concentrations of Pentraxin-3 were determined at the time of delivery by quantitative enzyme immunoassay. Associations between Pentraxin-3 and pre-eclampsia and HELLP syndrome were assessed by multinomial logistic regression. Subsidiary analysis for the time of disease onset was also carried out. Odds ratios and 95% confidence intervals are reported. A total of 1024 pregnant women were included (461 controls, 368 pre-eclampsia, 195 HELLP). A positive log-linear relationship was found between the top pentraxin-3 quintile and HELLP syndrome. After adjustment for confounders (maternal age, ethnicity, socioeconomic position, date and place of recruitment, family history of pre-eclampsia, smoking, body mass index at beginning of pregnancy, gestational age and multiple pregnancy), the strength of the association was higher for HELLP syndrome [OR 1.13 (95% CI 1.08; 1.18)] than for pre-eclampsia [OR 1.03 (95% CI 1.03; 1.10)]. No difference according to time of onset or pentraxin-3 level was found. In summary, pentraxin-3 level was associated with pre-eclampsia, but it was more strongly associated with HELLP syndrome. Longitudinal studies with a lower probability of residual confounding are necessary to improve our knowledge about the role of pentraxin-3 in pre-eclampsia.

Dietary patterns and breast cancer in Colombia: an ecological study.

BACKGROUND: The role that diet plays in the development of breast cancer is unclear and breast cancer continues to increase in Colombia and worldwide. The objective of this study was to assess the association between patterns of dietary consumption and the incidence of breast cancer. METHODS: An ecological study was conducted in 24 geodemographic units in which 95% of the women of Colombia live. The association between breast cancer rate (dependent variable) and three dietary patterns established with factor analysis (traditional/starch, fiber/dairy and snack) was investigated using simple and multiple linear regression. The use of variables related to socioeconomic context and the duration of breastfeeding allowed for the control of possible confounding. All information was derived from concurrent national surveys or was obtained directly over a period of time close to the period during which the study was conducted. RESULTS: There is an inverse relationship between breast cancer rate and illiteracy rate (ß=-2808.3), duration of breastfeeding (ß=-3354.1), adherence to traditional/fiber dietary patterns (ß=-30467) and adherence to the snack dietary pattern (ß=-43612). The goodness of fit for the model was R2=84%. CONCLUSIONS: Increasing the duration of breastfeeding, ensuring education to promote health and following traditional food consumption patterns, regardless of what foods are consumed, can protect against the development of breast cancer.

Adherence to a snacking dietary pattern is decreasing in Colombia among the youngest and the wealthiest: results of two representative national surveys.

BACKGROUND: A common recommendation is to reduce the consumption of snack food and replace this consumption with nutrient-dense foods. The objective was to assess whether in Colombian children and adults there were changes in the consumption of the snack dietary pattern (SP) in the 5 years 2010-2015. In addition, this study aimed to establish the relationship between the SP and some biological, socioeconomic, and geographic variables in Colombia, South America. METHODS: Based on a Food Frequency Questionnaire (FFQ) applied both in 2010 and 2015 in the national nutritional situation surveys, the adherence to the snack consumption pattern was established through factor analysis. The change in the adherence of consumption to the SP was established for the five-year period [2015 minus 2010], using multiple linear regression models. Crude and adjusted differences were estimated by the following covariables: sex, age, marital status, food security, wealth index, ethnicity, education of the head of the household, area and region. In total, 37,981 subjects were analyzed. In 2010, 10,150 children (5 to 17 years old) and 5145 adults (18 to 64 years old) were included, and in 2015, 13,243 children and 9443 adults. RESULTS: In children, the adjusted difference in the adherence to SP was - 0.37 (95% CI: - 0.42, - 0.32). In adults, the adjusted difference in the adherence to SP was - 0.27 (95% CI: - 0.31, - 0.24). In all categories of covariables, consumption decreased, for all p < 0.0001. In children, the decrease in consumption was inversely associated with height-age. The decrease was smaller at the extremes of the BMI distribution, Z < -2 and Z > 2. The decrease in consumption was directly associated with the level of food security in the home and the wealth index. In adults, the decrease in consumption was inversely related to age and was directly related to the level of food security of the household, wealth index, and education level. The BMI decrease was greater in subjects with 18.5-24.9. In subjects with 30+, it was lower than in subjects with 25.0-29.9. CONCLUSIONS: In the 5 years 2010-2015, snack consumption is decreasing. The region, the richest subjects, those with adequate BMI, and in households with more educated heads of household, achieved a greater decrease in SP.

Vitamin D deficiency and pre-eclampsia in Colombia: PREVitD study.

PURPOSE: Pre-eclampsia is a multisystem disorder characterized by new-onset hypertension and proteinuria during pregnancy. Pre-eclampsia remains a major cause of maternal death in low-income countries. Vitamin D has a very diverse biological role in cardiovascular diseases. This study will evaluate the association of vitamin D levels and relevance to pre-eclampsia. METHODS: We conducted a case-control study of women recruited from the GenPE (Genetics and Pre-eclampsia) Colombian registry. This is a multicenter case-control study conducted in eight Colombian cities. 25-Hydroxyvitamin D (25(OH)D) concentration was measured using liquid-chromatography-tandem mass spectrometry from 1013 women with pre-eclampsia and 1015 mothers without pre-eclampsia (controls). RESULTS: Fifty-two percent of women with pre-eclampsia were vitamin D deficient. The 25(OH)D concentrations were significantly lower in the pre-eclampsia (mean 29.99 ng/mL; 95% CI: 29.40-30.58 ng/mL) group compared to controls (mean 33.7 ng/mL; 95% CI: 33.20-34.30 ng/mL). In the unadjusted model, maternal vitamin D deficiency, defined by maternal 25(OH)D concentration <30 ng/mL, was associated with an increased probability of suffering from pre-eclampsia (OR 2.10; 95% CI, 1.75-2.51). After adjusting for covariates, a similarly increased probability of having pre-eclampsia was observed (OR 2.18; 95% CI, 1.80-2.64) among women with vitamin D deficiency, relative to controls. CONCLUSION: Although the results suggest that low maternal concentrations of 25(OH)D increase pre-eclampsia risk, this evidence may not be indicative of a causal association. Future studies are needed to confirm a definite causal relationship between concentrations of vitamin D and the risk of pre-eclampsia, by means of powered clinical trials.