Prospective cohort study of incidence and risk factors for catheter-associated urinary tract infections in 145 intensive care units of 9 Latin American countries: INICC findings.

PURPOSE: Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in Latin American Countries. METHODS: From 01/01/2014 to 02/10/2022, we conducted a prospective cohort study in 145 ICUs of 67 hospitals in 35 cities in nine Latin American countries: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Peru. To estimate CAUTI incidence, we used the number of UC-days as the denominator, and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: gender, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, UC-type, hospitalizationtype, ICU type, facility ownership, and time period. RESULTS: 31,631 patients, hospitalized for 214,669 patient-days, acquired 305 CAUTIs. The pooled CAUTI rate per 1000 UC-days was 2.58, for those using suprapubic catheters, it was 2.99, and for those with indwelling catheters, it was 2.21. The following variables were independently associated with CAUTI: age, rising risk 1% yearly (aOR = 1.01; 95% CI 1.01-1.02; p < 0.0001 female gender (aOR = 1.28; 95% CI 1.01-1.61; p = 0.04), LOS before CAUTI acquisition, rising risk 7% daily (aOR = 1.07; 95% CI 1.06-1.08; p < 0.0001, UC/DU ratio (aOR = 1.14; 95% CI 1.08-1.21; p < 0.0001, public facilities (aOR = 2.89; 95% CI 1.75-4.49; p < 0.0001. The periods 2014-2016 and 2017-2019 had significantly higher risks than the period 2020-2022. Suprapubic catheters showed similar risks as indwelling catheters. CONCLUSION: The following CAUTI RFs are unlikely to change: age, gender, hospitalization type, and facility ownership. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.

Associated factors for mortality in a COVID-19 colombian cohort: is the third wave relevant when Mu variant was predominant epidemiologically?

OBJECTIVES: To evaluate the association between Colombia's third wave when the Mu variant was predominant epidemiologically (until 75%) in Colombia and COVID-19 all-cause in-hospital mortality. METHODS: In this retrospective cohort, we included hospitalized patients ≥18 years with SARS-CoV-2 infection between March 2020 to September 2021 in ten hospitals from three cities in Colombia. Description analysis, survival, and multivariate Cox regression analyses were performed to evaluate the association between the third epidemic wave and in-hospital mortality. RESULTS: A total of 25,371 patients were included. The age-stratified time-to-mortality curves showed differences according to epidemic waves in patients ≥75 years (log-rank test p = 0.012). In the multivariate Cox analysis, the third wave was not associated with increased mortality relative to the first wave (aHR 0.95; 95%CI 0.84-1.08), but there was an interaction between age ≥75 years and the third wave finding a lower HR for mortality (aHR 0.56, 95%CI 0.36-0.86). CONCLUSIONS: We did not find an increase in in-hospital mortality during the third epidemic wave in which the Mu variant was predominant in Colombia. The reduced hazard in mortality in patients ≥75 years hospitalized in the third wave could be explained by the high coverage of SARS-CoV-2 vaccination in this population and patients with underlying conditions.

Multinational prospective cohort study of incidence and risk factors for central line-associated bloodstream infections in ICUs of 8 Latin American countries.

BACKGROUND: Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors in Latin-America. METHODS: From January 1, 2014 to February 10, 2022, we conducted a multinational multicenter prospective cohort study in 58 ICUs of 34 hospitals in 21 cities in 8 Latin American countries (Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama). We applied multiple-logistic regression. Outcomes are shown as adjusted-odds ratios (aOR). RESULTS: About 29,385 patients were hospitalized during 92,956 days, acquired 400 CLABSIs, and pooled CLABSI rate was 4.30 CLABSIs per 1,000 CL-days. We analyzed following 10 variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization (DU) ratio, CL-type, tracheostomy use, hospitalization type, intensive care unit (ICU) type, and facility ownership, Following variables were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 3% daily (aOR=1.03;95%CI=1.02-1.04; P < .0001); number of CL-days before CLABSI acquisition, rising risk 4% per CL-day (aOR=1.04;95%CI=1.03-1.05; P < .0001); publicly-owned facility (aOR=2.33;95%CI=1.79-3.02; P < .0001). ICU with highest risk was medical-surgical (aOR=2.61;95%CI=1.41-4.81; P < .0001). CL with the highest risk were femoral (aOR=2.71;95%CI=1.61-4.55; P < .0001), and internal-jugular (aOR=2.62;95%CI=1.82-3.79; P < .0001). PICC (aOR=1.25;95%CI=0.63-2.51; P = .52) was not associated with CLABSI risk. CONCLUSIONS: Based on these findings it is suggested to focus on reducing LOS, CL-days, using PICC instead of femoral or internal-jugular; and implementing evidence-based CLABSI prevention recommendations.

Gonococcal arthritis in a healthy adult. Is it that possible?

A case report is presented of a 50-year-old woman who was seen in Accident and Emergency because of pain in the lumbar area. She was subsequently diagnosed with septic arthritis of the left hip due to being Neisseria gonorrhoeae positive for beta-lactamase. She responded to treatment with ceftriaxone, but later required a total hip replacement.

Presentamos el caso de una mujer de 50 arios, sin antecedentes de importancia, a quien se le diagnosticó inicialmente lumbago e infección de vías urinarias. Por persistencia del dolor y limitación de la movilidad en la cadera izquierda se inicia el estudio de artritis séptica, que fue provocada por Neisseria gonorrhoeae betalactamasa positiva, sensible a tratamiento con ceftriaxona, con posterior deterioro articular, el cual requirió reemplazo total de cadera.

Clinical practice guideline for screening of patients at risk of colonization by carbapenemase-producing Enterobacterales and the treatment of infections caused by these bacteria / Guía de práctica clínica para la tamización de pacientes con riesgo de colonización por Enterobacterales productores de carbapenemasasy el manejo de infecciones causadas por estas bacterias

Abstract Carbapenemase-producing Enterobacterales (CPE) infections have increased in recent years. Colombia has become an endemic country for this group of microorganisms, and the infections they cause have a serious impact in terms of morbidity and mortality. The early identification of CPE carriers who are admitted to health care centers as patients is necessary to implement adequate isolation and infection control measures to limit the spread of this type of microorganisms in hospitals. Furthermore, treating these infections is a challenging task due to the limited therapeutic alternatives available and the fact that there are only a few studies proving their effectiveness in this setting. Therefore, the objective of the present work is to develop a clinical practice guideline (CPG) for the screening of patients at risk of CPE colonization and the treatment of inpatients with suspected or confirmed infections caused by this type of bacteria through a CPG adaptation process based on the ADAPTE methodology. With this purpose in mind, evidence-informed recommendations for the screening and timely identification of CPE carriers admitted to hospitals are made, as well as for the adequate pharmacological treatment of CPE infections in this context.

Resumen Las infecciones por Enterobacterales productores de carbapenemasas (EPC) han aumentado en los últimos años. Colombia se ha convertido en un país endémico para este grupo de microorganismos y las infecciones que causan tienen un impacto importante en términos de morbimortalidad. La identificación temprana de los portadores de EPC que ingresan como pacientes a las instituciones de salud es necesaria para implementar medidas de aislamiento y control de infecciones adecuadas que limiten la diseminación de este tipo de microorganismos en los hospitales. Además, el tratamiento de estas infecciones es difícil debido a las limitadas alternativas terapéuticas disponibles y la escasez de estudios que demuestren su efectividad en este escenario. Por lo anterior, el objetivo del presente trabajo es desarrollar una guía de práctica clínica (GPC) para la tamización de pacientes con riesgo de colonización por EPC y para el manejo de pacientes con infecciones, ya sea sospechadas o confirmadas, causadas por este tipo de bacterias, mediante un proceso de adaptación de GPC basado en la metodología ADAPTE. Con este propósito en mente, se hacen recomendaciones informadas en evidencia para realizar la tamización y oportuna identificación de portadores de EPC admitidos en instituciones hospitalarias, así como para el adecuado manejo farmacológico de las infecciones por CPE en este escenario.

Correlation between videothoracoscopy and biopsy in patients with pleural effusion and suspected tuberculosis in a high complexity military hospital / Correlación entre videotoracoscopia y biopsia en pacientes con derrame pleural y sospecha de tuberculosis en Hospital Militar de alta complejidad

Background: In the diagnostic process of pleural tuberculosis, the findings from video-assisted thoracoscopy (VATS) can be highly suggestive for the diagnosis of infection. Methods: We reviewed VATS records between the years 2012 to 2016 of patients over 16 years of age with pleural effusion and suspected pleural tuberculosis. Symptoms, macroscopic and chemical characteristics of the fluid, surgical descriptions and visual diagnosis of the surgeon were recorded and were compared with the histopathology. Results: 106 patients were selected, most of them men (71.7%), of whom approximately half were active military (51.3%). The predominant symptoms were dyspnea, pleuritic pain, fever and evolution time greater than 15 days (94.3%, 80.2%, 50% and 46,2%, respectively). These symptoms, in turn, were present more frequently in pleural tuberculosis patients than in non-tuberculosis patients. The fluid was mostly turbid yellow (44%) and lymphocytic cellularity exudate (77.4%). The VATS findings in patients with confirmed TBC included nodules (96.9%), adhesions (87.5%) and thickening (78.1%). The diagnosis made by the surgeon in relation to the histopathological diagnosis showed a sensitivity of 88.6% and a specificity of 98.4%. Conclusion: There are highly suggestive characteristics of the macroscopic report of VATS that would allow a quicker diagnosis of pleural tuberculosis.

Antecedentes: Los hallazgos de toracoscopia asistida por video (VATS) durante el diagnostico de tuberculosis pleural, que son altamente sugestivos de la infección han sido poco descritos. Metodos: Se revisaron los registros de VATS entre los años 2012 a 2016 of de pacientes mayores de 16 años con efusión pleural y sospechosos de etiología tuberculosa. Se analizaron los síntomas, las características macroscópicas y bioquímicas del líquido, la descripción quirúrgica y el diagnostico visual y se compararon con los resultados de la histopatologia. Resultados: Se estudiaron los registros de 106 pacientes, la mayoría fueron sexo masculino (71.7%), y aproximadamente la mitad en servicio militar activo (51.3%). Los síntomas predominantes fueron disnea, dolor pleuritico, fiebre y tiempo de evolución mayor a 15 días (94.3%, 80.2%, 50% y 46,2%, respectivamente). Estos sintomas a su vez fueron más frecuentes en tuberculosis pleural que en no tuberculosis. El liquido fue más amarillo turbio (44%) y con exudado de tipo linfocitario (77.4%). Los hallazgos de VATS en pacientes con tuberculosis confirmada incluyeron nodulos (96.9%), adhesiones (87.5%) y engrosamiento (78.1%). El diagnóstico hecho por el cirujano con relación al histopatológico, tuvo una sensibilidad de 88.6% y una especificidad de 98.4%. Conclusion: Existen características en el VATS altamente sugestivas de tuberculosis pleural.

Caracterización de neumonía por Staphylococcus aureus meticilino resistente en hospital militar de alta complejidad / Characterization of Methicillin-resistant Staphylococcus aureus pneumonia in high complex militar hospital

Introducción: Por su capacidad de resistencia, las cepas de Staphylococcus aureus resistentes a la meticilina (SAMR) representan un reto importante en la terapéutica. Se desarrolló este estudio con el fin de caracterizar la población con neumonía por SAMR del Hospital Militar Central. Métodos: Se condujo un estudio descriptivo de corte transversal, en pacientes con diagnóstico de neumonía bacteriana con aislamiento microbiológico positivo para SAMR. El análisis de los datos se realizó a través de medidas de tendencia central y de dispersión. Resultados: Durante el periodo de 4 años de estudio hubo 211 aislamientos correspondientes a S. aureus de los cuales 22 correspondieron a neumonía bacteriana por SAMR. La neumonía nosocomial fue la forma más frecuente de presentación (54,5%), seguida por neumonía adquirida en la comunidad (36,3%). El 36,3% de los pacientes eran militares activos, el 31,8% militares retirados o civiles. La frecuencia de comorbilidades fue del 92,3% siendo la enfermedad renal crónica y malignidad las más frecuentes. Conclusión: Desde el punto de vista clínico la neumonía por SAMR se caracterizó por una mayor cantidad de pacientes jóvenes y sin comorbilidades contrastando con neumonía nosocomial que se caracterizó por una población de más edad y con mayor prevalencia de comorbilidades.

Introduction: Strains methicillin-resistant Staphylococcus aureus (MRSA), to be resistant to most beta-lactam available and different families of antibiotics, represent a major challenge in therapeutics; for this reason, it is necessary to conduct studies to characterize better patients with MRSA infection. Methods: A descriptive study of cross section of patients diagnosed with bacterial pneumonia with positive microbiological isolation for MRSA was conducted by reviewing medical records and susceptibility testing relevant demographic and clinical data were extracted. The data analysis was conducted through measures of central tendency and dispersion. Results: During the period of 4 years of study; there were 211 isolates corresponding to S. aureus; of which 22 were for MRSA bacterial pneumonia. Nosocomial pneumonia was the most common presentation (54,5%); followed by community-acquired pneumonia (36,3%). 36,3% of patients were military personnel, 31,8% retired military or civilians. The frequency of comorbidities was 92,3% being chronic kidney disease and the most common malignancy. Conclusion: From the clinical point of view MRSA pneumonia it was characterized by a greater number of young patients without comorbidities; which contrasted with nosocomial pneumonia was characterized by an aging population and higher prevalence of comorbidities.

Colección cornell intraestromal y queratitis po fusarium spp: presentación de dos casos y revisión de la literatura / Collection ntrasstromal corneal and keratits by fusarium spp: report of twwo cases and review of the literature / Recolha cornano intra-estromal e ceratite pr fusarium spp: relato de dois casos e revisão da literatura

Las infecciones oculares por hongos filamentosos han aumentado su incidencia con el pasar de los años. Los traumas corneales, la terapia inmunosupresora y el uso de lentes de contacto han hecho que éstas aumenten su incidencia, pero existe un pequeño porcentaje de paciente que sin ningún factor de riesgo presentan infecciones por estos mohos. En este artículo reportamos dos casos de infección ocular por Fusarium spp. en dos pacientes de 21 y 30 años de edad respectivamente, inmunocompetentes, pertenecientes a las Fuerzas Militares y sin factores de riesgo asociados.

The filamentous fungal eye infections have been increasing in incidence in the last years. Corneal trauma, immunosuppressive therapy and use of contact lenses have increased their incidence, nonetheless a small percentage of patients with no risk factors still present with these mold infections. In this article we report a case of ocular infection by Fusarium spp. in two patients, a 21-year-old and a 30-year-old males. They work with the Military Forces, and were immunocompetent with no risk factors associated to the problem.

As infecções oculares por fungos filamentosos têm aumentado a sua incidência com o passar dos anos. Os traumas da córnea, a terapia imunossupressora e o uso de lentes de contato têm feito que estas aumentem a sua incidência, mas existe uma pequena percentagem de pacientes que semnenhumfator de riscoapresentam infecções por estes bolores. Em este artigo reportamos dois casos de infecção ocular por Fusarium spp. em dois pacientes de 21 e 30 anos de idade respectivamente, imunocompetentes, pertencentes às Forças Militares e semfatores de risco associados.

Microorganismosppresentes en fonendoscopios, maos, cavidad oral y nasal de esttudiantes de una facultad de medicina / Microorganiss inn stethoscopes, hands,oral ad nasal cavity from students inn a school of medicine / Microorganimos ppresentes em estetoscópios, mãos, cavidade ral e nasal de estudantes de uma faculdade de medicnaa

La formación académica de estudiantes de medicina implica interacción con pacientes y superficies del entorno hospitalario, los microorganismos presentes allí pueden ser adquiridos y transmitidos con los riesgos consecuentes para la comunidad hospitalaria. El presente es un estudio descriptivo cuantitativo donde se analizan muestras provenientes de estudiantes de medicina (n= 155) en rotaciones de 3 semanas, tomando hisopados de nariz, boca, manos y fonendoscopio, gram y cultivo en agar sangre, incubación 24 horas a 37°C y 5% de CO2. Se hizo la identificación mediante gram y pruebas de biotipificación convencionales y susceptibilidad antibiótica según técnica de kirbybauer. Los hallazgos aquí presentados evidencian alta frecuencia de bacterias patógenas en las fuentes de aislamiento, siendo relevante la presencia del Staphylococcus aureus en un 41,7% y la resistencia a antibióticos tanto por gram positivos como por gram negativos; por tanto, es de considerar la implementación de estrategias que minimicen la circulación de estos microorganismos en el ambiente hospitalario. El objetivo de este estudio es establecer la frecuencia de los microorganismos aislados en estudiantes de una Facultad de Medicina.

The academic training of medical students involves interaction with patients, where microorganisms in contact with different surfaces can be acquired and transmitted with the consequent risk to the community hospital.This is a quantitative descriptive study on students of medicine (n = 155) with clinic rotations of 3 weeks, swabs were taking from the nose, mouth, hands and stethoscope, following by gram and blood agar cultures, incubation 24 hours at 37° C and 5% CO2, final Identification was performed by gram, biotyping tests and antibiotic susceptibility by kirbybauer technique.The findings presented here show high frequency of bacterial pathogens in source isolation, to be relevant the presence of Staphylococcus aureus in 41.7% and resistan cetoantibiotics both grampositive andgramnegative, therefore is to consider the implementation of strategies to minimize the movement of these microorganisms in the hospital environment.The objective of this study is to establish the frequency of microorganisms isolated from students at a medical school.

A formação acadêmica dos estudantes de medicina implica interação com pacientes e superfícies do entorno hospitalar, os microorganismos presentes ali podem ser adquiridos e transmitidos com os riscos consequentes para a comunidade hospitalar. O presente é um estudo descritivo quantitativo onde foram analisadas amostras provenientes de estudantes de medicina (n= 155) em rotações de 3 semanas, colhidas do nariz, da boca, das mãos e de estetoscópios, gram e cultivo em ágar sangue, incubação 24 horas a 37°C e 5% de CO2, foi feita a identificação mediante gram e testes de biotipificação convencionais e suscetibilidade antibiótica segundo técnica de kirbybauer. Os descobrimentos aqui apresentados evidenciam alta frequência de bactérias patógenas nas fontes de isolamento, sendo relevante a presença do Staphylococcus aureus em 41,7% e a resistência a antibióticos tanto por gram positivos como por gram negativos; portanto, é necessário considerar a implementação de estratégias que minimizem a circulação destes microorganismos no ambiente hospitalar. O objetivo deste estudo foi estabelecer a frequência dos microorganismos isolados em estudantes de uma Faculdade de Medicina.