Contaminación microbiana durante la atención odontológica por la producción de aerosoles y salpicaduras / Microbial contamination during dental care due to aerosol and splash production

RESUMEN Objetivo: Analizar la contaminación microbiana durante la atención odontológica por la producción de aerosoles y salpicaduras. Metodología: De tipo documental, bibliográfica. La búsqueda se realizó a través de las bases de datos PubMed y Scopus. Considerando los lineamientos de la declaración PRISMA obteniendo un total de 221 artículos. Posteriormente se aplicaron los criterios de exclusión como de inclusión, obteniendo un total de 25 artículos. Resultados: La carga microbiana presente en el ambiente odontológico ha sido analizada de manera cuantitativa a través de las Unidades Formadoras de Colonias (UFC) en diferentes espacios y superficies de las clínicas dentales. En conclusión: La contaminación microbiológica asociada con la generación de aerosoles es una problemática que se experimenta en la consulta diaria, relacionándose principalmente con procedimientos asociados con equipos como las piezas de mano de alta velocidad, el equipo ultrasónico y la jeringa triple.

ABSTRACT Objective: To analyze microbial contamination during dental care due to the production of aerosols and splashes. Methodology: Documentary, bibliographic type. The search was carried out through the Pubmed and SCOPUS databases. Considering the guidelines of the PRISMA declaration, a total of 221 articles were obtained. Subsequently, the exclusion and inclusion criteria were applied, obtaining a total of 25 articles. Results: The microbial load present in the dental environment has been analyzed quantitatively through Colony Forming Units (CFU) in different spaces and surfaces of dental clinics. In conclusion: Microbiological contamination associated with the generation of aerosols is a problem that is experienced in the daily dental practice, mainly related to procedures associated with equipment such as high-speed handpieces, ultrasonic equipment and triple syringe.

International Epidemiology of Carbapenemase-Producing Escherichia coli.

BACKGROUND: Carbapenemase-producing (CP) Escherichia coli (CP-Ec) are a global public health threat. We aimed to describe the clinical and molecular epidemiology and outcomes of patients from several countries with CP-Ec isolates obtained from a prospective cohort. METHODS: Patients with CP-Ec were enrolled from 26 hospitals in 6 countries. Clinical data were collected, and isolates underwent whole-genome sequencing. Clinical and molecular features and outcomes associated with isolates with or without metallo-ß-lactamases (MBLs) were compared. The primary outcome was desirability of outcome ranking (DOOR) at 30 days after the index culture. RESULTS: Of the 114 CP-Ec isolates in Consortium on resistance against carbapenems in Klebsiella and other Enterobacterales-2 (CRACKLE-2), 49 harbored an MBL, most commonly blaNDM-5 (38/49, 78%). Strong regional variations were noted with MBL-Ec predominantly found among patients in China (23/49). Clinically, MBL-Ec were more often from urine sources (49% vs 29%), less often met criteria for infection (39% vs 58%, P = .04), and had lower acuity of illness when compared with non-MBL-Ec. Among patients with infection, the probability of a better DOOR outcome for a randomly selected patient with MBL-Ec as compared with non-MBL-Ec was 62% (95% CI: 48.2-74.3%). Among infected patients, non-MBL-Ec had increased 30-day (26% vs 0%; P = .02) and 90-day (39% vs 0%; P = .001) mortality compared with MBL-Ec. CONCLUSIONS: Emergence of CP-Ec was observed with important geographic variations. Bacterial characteristics, clinical presentations, and outcomes differed between MBL-Ec and non-MBL-Ec. Mortality was higher among non-MBL isolates, which were more frequently isolated from blood, but these findings may be confounded by regional variations.

Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study.

BACKGROUND: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a global threat, but the distribution and clinical significance of carbapenemases are unclear. The aim of this study was to define characteristics and outcomes of CRPA infections and the global frequency and clinical impact of carbapenemases harboured by CRPA. METHODS: We conducted an observational, prospective cohort study of CRPA isolated from bloodstream, respiratory, urine, or wound cultures of patients at 44 hospitals (10 countries) between Dec 1, 2018, and Nov 30, 2019. Clinical data were abstracted from health records and CRPA isolates were whole-genome sequenced. The primary outcome was 30-day mortality from the day the index culture was collected. We compared outcomes of patients with CRPA infections by infection type and across geographic regions and performed an inverse probability weighted analysis to assess the association between carbapenemase production and 30-day mortality. FINDINGS: We enrolled 972 patients (USA n=527, China n=171, south and central America n=127, Middle East n=91, Australia and Singapore n=56), of whom 581 (60%) had CRPA infections. 30-day mortality differed by infection type (bloodstream 21 [30%] of 69, respiratory 69 [19%] of 358, wound nine [14%] of 66, urine six [7%] of 88; p=0·0012) and geographical region (Middle East 15 [29%] of 52, south and central America 20 [27%] of 73, USA 60 [19%] of 308, Australia and Singapore three [11%] of 28, China seven [6%] of 120; p=0·0002). Prevalence of carbapenemase genes among CRPA isolates also varied by region (south and central America 88 [69%] of 127, Australia and Singapore 32 [57%] of 56, China 54 [32%] of 171, Middle East 27 [30%] of 91, USA ten [2%] of 527; p<0·0001). KPC-2 (n=103 [49%]) and VIM-2 (n=75 [36%]) were the most common carbapenemases in 211 carbapenemase-producing isolates. After excluding USA patients, because few US isolates had carbapenemases, patients with carbapenemase-producing CRPA infections had higher 30-day mortality than those with non-carbapenemase-producing CRPA infections in both unadjusted (26 [22%] of 120 vs 19 [12%] of 153; difference 9%, 95% CI 3-16) and adjusted (difference 7%, 95% CI 1-14) analyses. INTERPRETATION: The emergence of different carbapenemases among CRPA isolates in different geographical regions and the increased mortality associated with carbapenemase-producing CRPA infections highlight the therapeutic challenges posed by these organisms. FUNDING: National Institutes of Health.

Clinical outcomes and bacterial characteristics of carbapenem-resistant Klebsiella pneumoniae complex among patients from different global regions (CRACKLE-2): a prospective, multicentre, cohort study.

BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a global threat. We therefore analysed the bacterial characteristics of CRKP infections and the clinical outcomes of patients with CRKP infections across different countries. METHODS: In this prospective, multicentre, cohort study (CRACKLE-2), hospitalised patients with cultures positive for CRKP were recruited from 71 hospitals in Argentina, Australia, Chile, China, Colombia, Lebanon, Singapore, and the USA. The first culture positive for CRKP was included for each unique patient. Clinical data on post-hospitalisation death and readmission were collected from health records, and whole genome sequencing was done on all isolates. The primary outcome was a desirability of outcome ranking at 30 days after the index culture, and, along with bacterial characteristics and 30-day all-cause mortality (a key secondary outcome), was compared between patients from China, South America, and the USA. The desirability of outcome ranking was adjusted for location before admission, Charlson comorbidity index, age at culture, Pitt bacteremia score, and anatomical culture source through inverse probability weighting; mortality was adjusted for the same confounders, plus region where relevant, through multivariable logistic regression. This study is registered at ClinicalTrials.gov, NCT03646227, and is complete. FINDINGS: Between June 13, 2017, and Nov 30, 2018, 991 patients were enrolled, of whom 502 (51%) met the criteria for CRKP infection and 489 (49%) had positive cultures that were considered colonisation. We observed little intra-country genetic variation in CRKP. Infected patients from the USA were more acutely ill than were patients from China or South America (median Pitt bacteremia score 3 [IQR 2-6] vs 2 [0-4] vs 2 [0-4]) and had more comorbidities (median Charlson comorbidity index 3 [IQR 2-5] vs 1 [0-3] vs 1 [0-2]). Adjusted desirability of outcome ranking outcomes were similar in infected patients from China (n=246), South America (n=109), and the USA (n=130); the estimates were 53% (95% CI 42-65) for China versus South America, 50% (41-61) for the USA versus China, and 53% (41-66) for the USA versus South America. In patients with CRKP infections, unadjusted 30-day mortality was lower in China (12%, 95% CI 8-16; 29 of 246) than in the USA (23%, 16-30; 30 of 130) and South America (28%, 20-37; 31 of 109). Adjusted 30-day all-cause mortality was higher in South America than in China (adjusted odds ratio [aOR] 4·82, 95% CI 2·22-10·50) and the USA (aOR 3·34, 1·50-7·47), with the mortality difference between the USA and China no longer being significant (aOR 1·44, 0·70-2·96). INTERPRETATION: Global CRKP epidemics have important regional differences in patients' baseline characteristics and clinical outcomes, and in bacterial characteristics. Research findings from one region might not be generalisable to other regions. FUNDING: The National Institutes of Health.

Consensus Recommendations Based on Evidence for Abdominal Sepsis in the Pediatric and Adult Population of Colombia / Consenso colombiano de la sepsis abdominal en la poblacion pediatrica y de adultos: Recomendaciones basadas en la evidencia

Abstract Intra-abdominal infections are frequent at all levels of health care, therefore, it is necessary to maintain a high level of clinical suspicion, performing the fastest and most cost-effective measures to confirm the diagnosis and offer a precise and targeted multidisciplinary therapy, this being the only way to have an impact on the morbidity of this infection, reducing mortality and minimizing the complications and costs of health care. Intra-abdominal infections are linked to the appearance and selection of resistant mutants in both bacteria and fungi, becoming currently a major public health problem. Increasing bacterial resistance when associated with a greater possibility of difficulties in antimicrobial treatment increases mortality. This evidence-based consensus brings together the recommendations for the diagnosis and treatment of intra-abdominal infections in the pediatric and adult population. With strict monitoring of bacterial resistance and stimulating the control of the risk factors that have the greatest impact on the appearance of this phenomenon, this consensus is intended to be a practical guide that is easy to implement, and with periodic updates it will favor and facilitate multidisciplinary and the adequacy of the therapeutic management of intra-abdominal infections.

Resumen Las infecciones intrabdominales son frecuentes en todos los niveles de atención en salud, por ende, es necesario mantener un alto nivel de sospecha clínica, realizando las medidas más rápidas y costoefectivas para confirmar el diagnóstico y así ofrecer de una forma precisa y dirigida la terapéutica multidisciplinaria, siendo esta la única manera de tener impacto en la morbilidad de esta infección, disminuyendo la mortalidad y minimizando las complicaciones y los costos de la atención en salud. Las infecciones intrabdominales se encuentran ligadas a la aparición y selección de las mutantes resistentes tanto en las bacterias como en los hongos, convirtiéndose en la actualidad en una gran problemática en la salud pública. La creciente resistencia bacteriana al asociarse a mayor posibilidad de dificultades en el tratamiento antimicrobiano incrementa la mortalidad. Este consenso basado en la evidencia, reúne las recomendaciones en el diagnóstico y en el tratamiento de las infecciones intrabdominales en la población pediátrica y de adultos. Con un estricto seguimiento de la resistencia bacteriana y estimulando el control de los factores de riesgo que tienen mas impacto en la aparición de este fenómeno, este consenso pretende ser una practica guía de fácil implementación, y con periódicas actualizaciones favorecerá y facilitará el manejo multidisciplinario y la adecuación del manejo terapéutico de las infecciones intrabdominales.

Bienestar psicológico y estrategias de afrontamiento frente a la COVID-19 en universitarios / Psychological well-being and coping strategies in dealing with COVID-19 in university students

Resumen Introducción: La pandemia causada por la COVID-19 es una situación sin precedentes a nivel mundial, y es previsible que tenga un importante impacto en los seres humanos, al causar un cambio en las dinámicas, hábitos y rutinas que inciden en el bienestar psicológico y las estrategias de afrontamiento. Objetivo: Identificar si existe asociación entre el bienestar psicológico y las diferentes estrategias de afrontamiento frente al impacto psicosocial de la COVID-19 en universitarios. Materiales y métodos: Estudio cuantitativo, no experimental, de tipo descriptivo-correlacional y transversal, con una muestra de 201 estudiantes universitarios del sur-occidente de Colombia. Se administró la Escala de Bienestar Psicológico de Ryff y la Escala de Estrategias de Coping - Modificada (EEC-M). El análisis de datos se realizó con el Software SPSS. Resultados: Se encontró una asociación directa estadísticamente significativa entre el bienestar psicológico y las estrategias de afrontamiento, solución de problemas, búsqueda de apoyo social, religión, evitación cognitiva, reevaluación positiva y negación. Conclusiones: Las estrategias de afrontamiento se encuentran asociadas con el bienestar psicológico de los estudiantes, y su intervención podría generar insumos importantes para el afrontamiento de las consecuencias psicosociales generadas por la pandemia.

Abstract Introduction: The pandemic caused by COVID-19 is an unprecedented worldwide situation. It is predicted that COVID-19 will have a significant impact on humans as it can cause changes in their dynamics, habits, and routines that affect their psychological well-being and coping strategies. Objective: To identify whether there is an association between psychological well-being and the different coping strategies in confronting the psychological impact of COVID-19 in university students. Materials and methods: A quantitative, non-experimental, descriptive-correlational, and cross-sectional study was carried out on a sample of 201 university students from the southwestern region of Colombia. The Ryff 's Psychological Well-Being Scale and the Modified Coping Strategies Scale (EEC-M) were used. Data analysis was performed with SPSS software. Results: A statistically significant direct association was found between psychological well-being and coping strategies, problem solving, seeking social support, religion, cognitive avoidance, positive reassessment, and denial. Conclusion: Coping strategies are related to the psychological well-being of students, so their use can provide important inputs to face the psychological consequences generated by the pandemic.

Closing gaps in histoplasmosis: clinical characteristics and factors associated with probable/histoplasmosis in HIV/AIDS hospitalized patients, a retrospective cross-sectional study in two tertiary centers in Pereira, Colombia.

BACKGROUND: The HIV pandemic continues to cause a high burden of morbidity and mortality due to delayed diagnosis. Histoplasmosis is prevalent in Latin America and Colombia, is difficult to diagnose and has a high mortality. Here we determined the clinical characteristics and risk factors of histoplasmosis in people living with HIV (PLWH) in Pereira, Colombia. MATERIALS AND METHODS: This was a retrospective cross-sectional study (2014-2019) involving two tertiary medical centers in Pereira, Colombia. People hospitalized with HIV were included. Histoplasma antigen detection was performed in urine samples. Probable histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. RESULTS: 172 HIV-infected patients were analyzed. Histoplasmosis was confirmed in 29% (n = 50/172) of patients. The logistic regression analysis showed that the risk factors for histoplasmosis were pancytopenia (OR 4.1, 95% CI 1.6-10.3, P = 0.002), < 50 CD4 + cells/µL (OR 3.1, 95% CI 1.3-7.3, P = 0.006) and Aspartate transaminase (AST) levels > 46 IU/L (OR 3.2, 95% CI 1.3-8, P = 0.010). CONCLUSIONS: Histoplasmosis is highly prevalent in hospitalized patients with HIV in Pereira, Colombia. The clinical findings are nonspecific, but there are some clinical abnormalities that can lead to suspicion of the disease, early diagnosis and prompt treatment. Urine antigen detection is useful for diagnosis, but is not widely available. An algorithmic approach is proposed for low-resource clinical settings.

A Test for the Rapid Detection of the Cefazolin Inoculum Effect in Methicillin-Susceptible Staphylococcus aureus.

The cefazolin inoculum effect (CzIE) has been associated with therapeutic failures and mortality in invasive methicillin-susceptible Staphylococcus aureus (MSSA) infections. A diagnostic test to detect the CzIE is not currently available. We developed a rapid (∼3 h) CzIE colorimetric test to detect staphylococcal-ß-lactamase (BlaZ) activity in supernatants after ampicillin induction. The test was validated using 689 bloodstream MSSA isolates recovered from Latin America and the United States. The cefazolin MIC determination at a high inoculum (107 CFU/ml) was used as a reference standard (cutoff ≥16 µg/ml). All isolates underwent genome sequencing. A total of 257 (37.3%) of MSSA isolates exhibited the CzIE by the reference standard method. The overall sensitivity and specificity of the colorimetric test was 82.5% and 88.9%, respectively. Sensitivity in MSSA isolates harboring type A BlaZ (the most efficient enzyme against cefazolin) was 92.7% with a specificity of 87.8%. The performance of the test was lower against type B and C enzymes (sensitivities of 53.3% and 72.3%, respectively). When the reference value was set to ≥32 µg/ml, the sensitivity for isolates carrying type A enzymes was 98.2%. Specificity was 100% for MSSA lacking blaZ The overall negative predictive value ranged from 81.4% to 95.6% in Latin American countries using published prevalence rates of the CzIE. MSSA isolates from the United States were genetically diverse, with no distinguishing genomic differences from Latin American MSSA, distributed among 18 sequence types. A novel test can readily identify most MSSA isolates exhibiting the CzIE, particularly those carrying type A BlaZ. In contrast to the MIC determination using high inoculum, the rapid test is inexpensive, feasible, and easy to perform. After minor validation steps, it could be incorporated into the routine clinical laboratory workflow.

Novel Insights into the Classification of Staphylococcal ß-Lactamases in Relation to the Cefazolin Inoculum Effect.

Cefazolin has become a prominent therapy for methicillin-susceptible Staphylococcus aureus (MSSA) infections. However, an important concern is the cefazolin inoculum effect (CzIE), a phenomenon mediated by staphylococcal ß-lactamases. Four variants of staphylococcal ß-lactamases have been described based on serological methodologies and limited sequence information. Here, we sought to reassess the classification of staphylococcal ß-lactamases and their correlation with the CzIE. We included a large collection of 690 contemporary bloodstream MSSA isolates recovered from Latin America, a region with a high prevalence of the CzIE. We determined cefazolin MICs at standard and high inoculums by broth microdilution. Whole-genome sequencing was performed to classify the ß-lactamase in each isolate based on the predicted full sequence of BlaZ. We used the classical schemes for ß-lactamase classification and compared it to BlaZ allotypes found in unique sequences using the genomic information. Phylogenetic analyses were performed based on the BlaZ and core-genome sequences. The overall prevalence of the CzIE was 40%. Among 641 genomes, type C was the most predominant ß-lactamase (37%), followed by type A (33%). We found 29 allotypes and 43 different substitutions in BlaZ. A single allotype, designated BlaZ-2, showed a robust and statistically significant association with the CzIE. Two other allotypes (BlaZ-3 and BlaZ-5) were associated with a lack of the CzIE. Three amino acid substitutions (A9V, E112A, and G145E) showed statistically significant association with the CzIE (P = <0.01). CC30 was the predominant clone among isolates displaying the CzIE. Thus, we provide a novel approach to the classification of the staphylococcal ß-lactamases with the potential to more accurately identify MSSA strains exhibiting the CzIE.

Clinical and economic impact of generic versus brand name meropenem use in an intensive care unit in Colombia

Abstract Background: Recent studies suggest that sustained use of generic antibiotics may be associated with clinical failure and emergence of antibacterial resistance. The present study was designed to determine the clinical outcome between the use of generic meropenem (GM) and brand-name meropenem (BNM). Additionally, this study evaluated the economic impact of GM and BNM to determine if the former represents a cost-effective alternative to the latter. Methods: Patients treated between January 2011 and May 2014 received GM while patients treated between June 2014 and March 2017 received BNM. Mortality was compared between groups. Total infection cost was defined by the cost of antimicrobial consumption, length of stay, and laboratory and imaging exams until infection resolution. Findings: A total of 168 patients were included; survival rate for the 68 patients treated with GM was 38% compared to 59% in the patients treated with BNM. Multivariate analysis showed that the variables most strongly-associated with mortality were cardiovascular disease (OR 18.18, 95% CI 1.25-262.3, p = 0.033) and treatment with generic meropenem (OR 18.45, 95% CI 1.45-232.32, p = 0.024). On the other hand, total infection cost did not show a significant difference between groups (BNM $10,771 vs. GM $11,343; p = 0.91). Interpretation: The present study suggests that patients treated with GM have a risk of death 18 times higher compared to those treated with BNM. Furthermore, economic analysis shows that GM is not more cost effective than BNM. Summary: More studies measuring clinical outcomes are needed to confirm the clinical equivalence of brand-name versus generic antibiotics, not only for meropenem but also for other molecules.

Clinical and economic impact of generic versus brand name meropenem use in an intensive care unit in Colombia.

BACKGROUND: Recent studies suggest that sustained use of generic antibiotics may be associated with clinical failure and emergence of antibacterial resistance. The present study was designed to determine the clinical outcome between the use of generic meropenem (GM) and brand-name meropenem (BNM). Additionally, this study evaluated the economic impact of GM and BNM to determine if the former represents a cost-effective alternative to the latter. METHODS: Patients treated between January 2011 and May 2014 received GM while patients treated between June 2014 and March 2017 received BNM. Mortality was compared between groups. Total infection cost was defined by the cost of antimicrobial consumption, length of stay, and laboratory and imaging exams until infection resolution. FINDINGS: A total of 168 patients were included; survival rate for the 68 patients treated with GM was 38% compared to 59% in the patients treated with BNM. Multivariate analysis showed that the variables most strongly-associated with mortality were cardiovascular disease (OR 18.18, 95% CI 1.25-262.3, p = 0.033) and treatment with generic meropenem (OR 18.45, 95% CI 1.45-232.32, p = 0.024). On the other hand, total infection cost did not show a significant difference between groups (BNM $10,771 vs. GM $11,343; p = 0.91). INTERPRETATION: The present study suggests that patients treated with GM have a risk of death 18 times higher compared to those treated with BNM. Furthermore, economic analysis shows that GM is not more cost effective than BNM. SUMMARY: More studies measuring clinical outcomes are needed to confirm the clinical equivalence of brand-name versus generic antibiotics, not only for meropenem but also for other molecules.

[Nosocomial infections impact in a hospital in Bogota, Colombia: effects on mortality and hospital costs]. / Impacto de la infección nosocomial en un hospital de Bogotá, Colombia: efectos en mortalidad y costos.

BACKGROUND: Nosocomial infections (NI) are events associated with high impact on hospital costs and mortality. AIM: To evaluate from the health provider's perspective the costs and mortality attributable to NI. METHODS: We selected a sample of patients with and without NI matched by age and diagnosis at admission. Costs were calculated and converted from Colombian pesos to US dollars using the average exchange rate of 2008. We evaluated the mortality rate in both groups. RESULTS: We collected data on 187 patients with NI and 276 without NI. Median total hospitalization cost was US$ 6,329 (95% CI US$5,527-7,934) in NI patients, while in non-infected patients this median was US$1,207 (95% CI US$ 974-1,495). Mortality was higher in the NI group (31.6% versus 5.1%). Patients with NI had longer hospital stays (median 21 days, 95% CI 18-24 days) than non-infected patients (median 5 days, 95% CI 5-6 days). Mortality was also markedly higher in the NI group than in the non-infected group (31.6% versus 5.1%). CONCLUSION: NI are adverse and costly events related to patient attention that affect adversely the quality of attention.

Impacto de la infección nosocomial en un hospital de Bogotá (Colombia): efectos en mortalidad y costos / Nosocomial infections impact in a hospital in Bogota (Colombia): effects on mortality and hospital costs

Background: Nosocomial infections (NI) are events associated with high impact on hospital costs and mortality. Aim: To evaluate from the health provider's perspective the costs and mortality attributable to NI. Methods: We selected a sample of patients with and without NI matched by age and diagnosis at admission. Costs were calculated and converted from Colombian pesos to US dollars using the average exchange rate of 2008. We evaluated the mortality rate in both groups. Results: We collected data on 187 patients with NI and 276 without NI. Median total hospitalization cost was US$ 6,329 (95% CI US$5,527-7,934) in NI patients, while in non-infected patients this median was US$1,207 (95% CI US$ 974-1,495). Mortality was higher in the NI group (31.6% versus 5.1%). Patients with NI had longer hospital stays (median 21 days, 95% CI 18-24 days) than non-infected patients (median 5 days, 95% CI 5-6 days). Mortality was also markedly higher in the NI group than in the non-infected group (31.6% versus 5.1%). Conclusion: NI are adverse and costly events related to patient attention that affect adversely the quality of attention.

Introducción: Las infecciones asociadas a la atención en salud (IAAS) están relacionadas con un incremento en los costos de hospitalización y un mayor riesgo de mortalidad. Objetivo: Establecer los costos y la mortalidad asociados a la presentación IAAS en una institución de cuarto nivel. Métodos: Se hizo una selección pareada de pacientes con IAAS y sin IAAS para calcular el costo por medio de costeo directo y emparejamiento. Los costos fueron calculados en pesos colombianos y convertidos a dólares estadounidenses según la tasa de cambio de 2008. Resultados: Se incluyeron 187 pacientes con IAAS y 276 pacientes sin IAAS. La tasa de IAAS fue de 1,8% La mediana del costo de hospitalización en los pacientes con IAAS fue US$ 6.329 (95% CI US$ 5.527-7.934) y en los no infectados de US$1,207 (95% CI US$ 974-1.495). Los pacientes con IAAS presentaron mayor tiempo de estancia hospitalaria, con una diferencia de 16 días respecto a los no infectados (21 días (IC 95% 18-24) vs 5 días (IC 95% 5-6)). Se encontró una mortalidad atribuible de 26,4%. Conclusiones: Las IAAS son eventos adversos a la atención, que se asocian con mayor mortalidad y generación de costos extra.

[Left-sided infective endocarditis caused by Pseudomonas aeruginosa treated medically]. / Endocarditis infecciosa izquierda por Pseudomonas aeruginosa tratada médicamente.

Infective endocarditis due to Pseudomonas aeruginosa is a rare clinical condition, difficult to diagnose and associated with high mortality. Herein we present a case of a 51 years old male without history of intravenous drug use or valvular disease, with past medical history of cholecystectomy in the previous month, who presented to the emergency department with fever, gastrointestinal symptoms, and subsequent signs of distant embolization, positive blood cultures for P. aeruginosa and development of multiple complications of the disease. The clinical presentation of infective endocarditis is nonspecific, leading to delayed diagnosis, and preventing early and effective treatment. Valvular replacement is indicated in fungal or P. aeruginosa endocarditis. This case is notable because of the resolution with amikacin combined with meropenem, in a patient with several complications that contraindicated surgery.

Endocarditis infecciosa izquierda por Pseudomonas aeruginosa tratada médicamente / Left-sided infective endocarditis caused by Pseudomonas aeruginosa treated medically

La endocarditis infecciosa por Pseudomonas aeruginosa es una entidad poco frecuente, de difícil diagnóstico y alta mortalidad. Se presenta a continuación el caso de un hombre de 51 años, sin antecedentes de uso de drogas intravenosas ni enfermedad valvular, con antecedentes de colecistectomía en el mes anterior, quien se presentó a urgencias con un cuadro febril asociado a síntomas gastrointestinales, y, posteriormente mostró signos de embolismo a distancia, hemocultivos positivos para P. aeruginosa y desarrollo de múltiples complicaciones propias de la enfermedad. La presentación clínica de la endocarditis infecciosa es inespecífica, lo cual genera diagnósticos tardíos que impiden la instauración de un tratamiento precoz y eficaz, como el reemplazo valvular, indicado en endocarditis por hongos o por gérmenes como P. aeruginosa. Este caso es fortuito por su resolución solamente con tratamiento médico combinado, con amikacina y meropenem, ya que tuvo varias complicaciones que ontraindicaron el manejo quirúrgico.

Infective endocarditis due to Pseudomonas aeruginosa is a rare clinical condition, difficult to diagnose and associated with high mortality. Herein we present a case of a 51 years old male without history of intravenous drug use or valvular disease, with past medical history of cholecystectomy in the previous month, who presented to the emergency department with fever, gastrointestinal symptoms, and subsequent signs of distant embolization, positive blood cultures for P. aeruginosa and development of multiple complications of the disease. The clinical presentation of infective endocarditis is nonspecific, leading to delayed diagnosis, and preventing early and effective treatment. Valvular replacement is indicated in fungal or P. aeruginosa endocarditis. This case is notable because of the resolution with amikacin combined with meropenem, in a patient with several complications that contraindicated surgery.