Kick Vaping: Feasibility, acceptability, and preliminary impact of a vaping cessation text messaging intervention for Latino young adults.

OBJECTIVE: To assess the feasibility, acceptability, and preliminary impact of Kick Vaping among Latino young adults. METHODS: Forty Latino young adults (ages 18 to 25) who were currently vaping received Kick Vaping, a vaping cessation text messaging intervention available in English and Spanish. Feasibility was measured by the eligibility, enrollment, and follow-up rates. Acceptability was measured by overall satisfaction with the intervention. Preliminary impact was measured by self-reported 7-day point prevalence abstinence and changes in self-efficacy. RESULTS: Two hundred three individuals were identified, 61 were assessed for eligibility, and 55 were eligible. Forty individuals consented to participate and were enrolled in Kick Vaping. At baseline, most participants used disposable devices (70%), vaped daily (97.5%), had low (37.5%) or medium (35.0%) e-cigarette dependence, and had attempted to quit in the past year (72.5%). At Month 3, the follow-up rate was 90% (36/40). Treating those lost to follow-up as participants who continued vaping, 75% (30/40) of participants self-reported 7-day point prevalence abstinence. Self-efficacy mean scores significantly increased from 30.65 (SD 8.07) at baseline to 50.11 (SD 10.57) at follow-up (p < 0.01). Most participants (88.9%, 32/36) reported being satisfied/extremely satisfied with Kick Vaping. CONCLUSION: It is feasible to recruit and retain Latino young adults in a vaping cessation text messaging intervention. Kick Vaping generated high satisfaction among Latino young adults, significantly increased self-efficacy, and resulted in a notable vaping cessation rate at Month 3. Additional testing in a randomized controlled trial is warranted to assess the efficacy of the intervention.

Proactive and Reactive Recruitment of Black and Latino Adolescents in a Vaping Prevention Randomized Controlled Trial.

The purpose of this study was to assesses the effectiveness of proactive and reactive methods in the recruitment of Black and Latino adolescents into a vaping-prevention randomized controlled trial (RCT). This study also assessed the characteristics of study participants by recruitment method. Proactive recruitment strategies included study presentations at community-based events (e.g., festivals, health fairs), school-based events (e.g., back-to-school events, after-school programs), and recreational centers (e.g., fitness centers, malls). Reactive recruitment strategies included study advertisements via social media (e.g., Facebook posts shared by local community-based organizations), word of mouth, and an academic-based research hub. Using proactive and reactive methods, in a 4-month period, 362 Black and Latino adolescents were successfully enrolled into the RCT. Compared to the proactive method, adolescents screened reactively were equally likely to be eligible but significantly more likely to enroll in the study. However, both proactive and reactive strategies made notable contributions to the overall recruitment effort. Moreover, proactive and reactive methods attracted adolescents with different characteristics (e.g., age, gender, sexual orientation, etc.). These findings suggest that both proactive and reactive recruitment strategies should be implemented for studies interested in recruiting a diverse sample of Black and Latino adolescents.

Evidence of bovine leukemia virus circulating in sheep and buffaloes in Colombia: insights into multispecies infection.

Bovine leukemia virus (BLV) is the causative agent of leukemia/lymphoma in cattle. However, previous evidence has shown its presence in other species of livestock as well as in humans, suggesting that other species can be accidental hosts of the virus. In viral infections, receptors that are common to different animal species are proposed to be involved in cross-species infections. For BLV, AP3D1 has been proposed to be its receptor, and this protein is conserved in most mammalian species. In Colombia, BLV has been reported in cattle with high prevalence rates, but there has been no evidence of BLV infections in other animal species. In this study, we tested for the virus in sheep (n = 44) and buffaloes (n = 61) from different regions of Colombia by nested PCR, using peripheral blood samples collected from the animals. BLV was found in 25.7% of the animals tested (12 buffaloes and 15 sheep), and the results were confirmed by Sanger sequencing. In addition, to gain more information about the capacity of the virus to infect these species, the predicted interactions of AP3D1 of sheep and buffaloes with the BLV-gp51 protein were analyzed in silico. Conserved amino acids in the binding domains of the proteins were identified. The detection of BLV in sheep and buffaloes suggests circulation of the virus in multiple species, which could be involved in dissemination of the virus in mixed livestock production settings. Due to the presence of the virus in multiple species and the high prevalence rates observed, integrated prevention and control strategies in the livestock industry should be considered to decrease the spread of BLV.

Detection of equine herpesvirus 1 and 4 and its association with latency-associated transcripts in naturally infected horses in Colombia / Detección de los herpesvirus equinos 1 y 4 y su relación con transcriptos asociados a la latencia en caballos infectados naturalmente en Colombia

ABSTRACT Objective. Determine the presence of antibodies and viral genomes of EHV-1 and EHV-4, as well as to detect the presence of latency associated transcripts (LATs) in a selected population of Colombian horses. Materials and methods. Serum samples, submandibular lymph nodes and trigeminal ganglion were obtained from 50 horses and analyzed. Sera were evaluated for the presence of antibodies against EHV-1 and EHV-4 while tissues were initially evaluated for the presence of viral genome by nPCR. Finally, samples were used for the detection of LATs through RT-PCR. Results. In general, 6/50 samples showed antibodies to EHV-1 and 44/50 were positive for EHV-4. As for viral genome detection, 10/50 samples were positive for EHV-1 and 30/50 were positive for EHV-4; in addition, 22/35 horses positive for EHV DNA were positive for LATs. The use of these tests led to eight possible combinations of results. Conclusions. The evidence used shows that horses can have simple viral infection, co-infections with both viruses, latency due to the presence of LATs and the simultaneous presence of LATs and viral genome replication at a given time. It contributes to the understanding of the behavior of the disease in Colombia and calls attention to the importance of implementing complementary diagnoses to the serology for the control of these viruses.

RESUMEN Objetivo. Determinar presencia de anticuerpos y genoma viral de EHV-1 y EHV-4, como también detectar la presencia de transcriptos asociados a latencia (LATs) en una población seleccionada de caballos colombianos. Materiales y métodos. Muestras de suero, nódulos linfáticos submandibulares y ganglio trigémino se obtuvieron de 50 caballos y fueron analizadas. Los sueros se evaluaron para la presencia de anticuerpos contra EHV-1 y EHV-4 mientras que los tejidos se evaluaron inicialmente para la presencia de genoma viral por nPCR. Finalmente, las muestras se emplearon para la detección de LATs a través de RT-PCR. Resultados. En general, 6/50 muestras mostraron anticuerpos para EHV-1 y 44/50 fueron positivos para EHV-4. En cuanto a la detección del genoma viral, 10/50 muestras fueron positivas para EHV-1 y 30/50 fueron positivas para EHV-4; además, 22/35 caballos positivos para DNA de EHV fueron positivos para LATs. El empleo de estas pruebas llevó a ocho posibles combinaciones de resultados. Conclusiones. Se confirma la presencia de estos virus en la población equina colombiana. Las pruebas empleadas demuestran que los caballos pueden tener infección viral simple, co-infecciones con ambos virus, estado de latencia debido a la presencia de los LATs y presencia simultánea de LATs y de replicación de genoma viral en un momento dado. Se aporta al entendimiento del comportamiento de la enfermedad en Colombia y se llama la atención sobre la importancia de implementar diagnósticos complementarios a la serología para el control de estos virus.

Molecular characterization of rotaviruses isolated from calves with bovine neonatal diarrhea (BND) in Colombia / Caracterizacion molecular de rotavirus aislados a partir de terneros con diarrea neonatal bovina (dnb) en colombia

Bovine rotaviruses are one of the main agents involved in the presentation of Bovine Neonatal Diarrhea (BND), a disease that affects calves in the first month of life. Objective: The present study aimed to determine the types of bovine rotaviruses that affect dairy herds in the Sabana region of Bogotá, Colombia. Materials and methods: 132 fecal samples were obtained from calves of less than five weeks of age and subjected to an ELISA test. MA104 cell cultures were infected with positive samples in order to isolate rotaviruses. The presence of the viral genome was confirmed by amplification and sequencing of a region of the viral VP7 protein-encoding gene. Results: Of the 132 samples, 26 (19, 7%) were ELISA-positive and nine samples were used for viral isolation. PCR amplification was achieved in all infected cultures. Sequencing showed homology of five samples to the G6 genotype. In addition, the presence of the G10 genotype was first determined for the country. Discussion: A greater presence of the G6 genotype from lineage V was found in the Sabana region of Bogota, showing a high prevalence in cattle and association with the presence of BND. The presence of the G10 genotype is a new report for the country and constitutes a new element of investigation in these viruses.

Los rotavirus bovinos son unos de los principales agentes involucrados en la presentación del síndrome de Diarrea Neonatal Bovina (DNB), una enfermedad que afecta terneros en el primer mes de vida. Objetivo: El presente estudio buscó determinar los tipos de rotavirus que afectan los hatos ganaderos de leche en la región de la Sabana de Bogotá, Colombia. Materiales y métodos: Se evaluaron a través de una prueba de ELISA, 132 muestras de materia fecal provenientes de terneros de menos de cinco semanas de edad. Con las muestras positivas, se infectaron células MA 104 con el fin hacer aislamiento. La presencia del genoma viral se verificó por amplificación de una región del gen que codifica para la proteína viral VP-7 y luego se secuenció. Resultados: De las 132 muestras evaluadas, 26 (19,7%) fueron positivas por ELISA. De estas, 9 muestras se emplearon para aislamiento viral. La amplificación de genoma viral por PCR se obtuvo en todos los cultivos infectados. La secuenciación evidenció una homología de 5 muestras con el genotipo G6 y la presencia del genotipo G10, que se encontró por primera vez en el país. Discusión: En la Sabana de Bogotá se encontró una mayor presencia del genotipo G6, linaje V, que tiene alta prevalencia en bovinos y está asociado mayoritariamente con la presencia de DNB. La presencia del genotipo G10 constituye un elemento nuevo de investigación en estos virus.

Bacteriuria is not associated with surgical site infection in patients undergoing cardiovascular surgery.

BACKGROUND: Despite absence of evidence, in practice, asymptomatic bacteriuria is perceived as a risk factor for surgical site infection (SSI) among patients with cardiac surgery. We aimed to identify whether an association exists between the preoperative presence of asymptomatic bacteriuria or urinary tract infection and SSI in patients undergoing cardiovascular surgery. METHODS: This is an analytical study with a retrospective cohort of patients undergoing coronary revascularization or valve replacement surgery. We identified cases of bacteriuria, urinary tract infection, and cardiovascular SSI and adjusted the results according to exposure to antibiotics and known risk factors for SSI using a multivariate logistic regression analysis. RESULTS: A total of 840 patients were included in the study, of whom 33 (3.9%) had asymptomatic bacteriuria and 13 (1.5%) had urinary tract infections. The incidence of SSI was 9.5% (80 patients), with 2.3% of cases having mediastinitis. In the multivariate analysis, asymptomatic bacteriuria (relative risk, 0.83; 95% confidence interval, 0.26-2.56; P = .74) and urinary tract infection (relative risk, 2.54; 95% confidence interval, 0.60-10.69; P = .20) were not risk factors for SSI. Traditional risk factors were found to increase the risk of SSI. CONCLUSIONS: The presence of bacteriuria is not a risk factor for presenting SSI in cardiovascular surgery. Screening with urinalysis or urine culture would not be recommended for patients undergoing cardiac surgery.

Factores generadores de estrés en el paciente adulto hospitalizado en la UCI: una revisión integrativa / Factors that generate stress in the adult patient hospitalized in the ICU: an integrative review

El presente trabajo tiene como objetivo realizar una revisión integrativa con el fin de identificar los factores estresores en el paciente critico adulto hospitalizado en la unidad de cuidado intensivo, tanto desde el reconocimiento a partir de la perspectiva personal así como la del profesional de enfermería. La búsqueda en diversas bases de datos con revistas indexadas comprendió un total de 22 artículos, que abordaran la temática relacionada bajo los términos claves en su búsqueda y contenido. Desde su análisis, se obtuvieron resultados acerca de los factores estresores en la UCI, a partir de perspectivas tanto del paciente como del profesional de enfermería, evidenciando el déficit de información, y el ambiente de la UCI como transversales; adicionalmente desde la perspectiva del paciente se encontró el déficit de sueño, desprendimiento de la realidad, la dificultad para entablar una comunicación efectiva y la interrupción de la cotidianidad. Se concluye que el profesional de enfermería debe considerar la gama de expresiones del paciente con el fin de formular una comprensión de la experiencia del individuo y reflexionar sobre su significado. La clasificación de experiencias y las sensaciones experimentadas permiten otorgar el carácter único de la percepción del paciente de manera singular y de esta manera acceder un plan de cuidado individualizado basado en la integralidad.

This work aims to carry out an integrative review in order to identify stressors critical factors in the adult patient hospitalized in the intensive care unit, both recognition from the personal perspective as well as professional nursing. Search multiple databases with journals indexed included a total of 22 articles, which addressed the topic under the key terms related to your search and content. From his analysis, results about stress factors were obtained in the ICU, from perspectives of both the patient and nurse, showing the information gap, and the ICU environment as cross; further from the patient's perspective sleep deficit, detachment from reality, the difficulty was found to engage in effective communication and disruption of everyday life. It is concluded that the nurse should consider the range of expressions of the patient in order to formulate an understanding of the individual's experience and reflect on its meaning. The classification of experiences and sensations experienced grant allow the uniqueness of the patient's perception uniquely and thus access individualized care plan based on comprehensiveness.

Barreras de acceso a la atención odontológica durante la primera infancia. Medellín, 2007 / Barriers to dental care access during early childhood. Medellín, 2007

INTRODUCCIÓN: el acceso es un elemento de los sistemas de salud, relacionado con la organización de los servicios, para garantizar la entrada al sistema y la continuidad del tratamiento. El objetivo de este estudio fue reconocer las barreras de acceso a la atención odontológica en menores de seis años, desde la experiencia relatada por las madres y cuidadoras. MÉTODOS: se hizo un estudio descriptivo basado en una entrevista individual semiestructurada a 11 madres comunitarias (cuidadoras), y entrevistas grupales a 37 madres biológicas, de las cuales 20 participaron en una segunda entrevista individual, por su antecedente de haber asistido a consulta odontológica para sus hijos. RESULTADOS: las madres comunitarias son importantes en la identificación de problemas bucales en los niños, pero consideran que la responsabilidad de la demanda de atención es de los padres. Las madres valoran positivamente la salud bucal de sus hijos, pero no demandan la atención por el temor a una situación traumática. Las instituciones de salud estimulan la demanda de la atención en edades más avanzadas. El acceso a los servicios presenta más barreras para los afiliados al SISBEN. CONCLUSIÓN: durante la primera infancia, los niños de estratos bajos encuentran múltiples barreras para acceder a la atención odontológica. Aun el aseguramiento no les garantiza el acceso. Las barreras más frecuentes son económicas, pero se imponen también barreras culturales y de organización del sistema, como la escasa edad del niño, que es usada como pretexto de las madres y de las instituciones para no demandar u ofrecer atención oportuna.

INTRODUCTION: in health systems, access refers to the organization of services to ensure entry into the system and treatment continuity. The objective of this study was to identify dental care access barriers in children under the age of six from the experience reported by mothers and caregivers. METHODS: this was a descriptive study based on an individual semi-structured interview to 11 community mothers (caregivers) and group interviews with 37 biological mothers, of whom 20 participated in a second individual interview because they had attended dental consultation for their children in the past. RESULTS: community mothers are important in identifying children's oral problems but they consider that oral care demands are a responsibility of parents. Mothers value their children's oral health but they do not demand health care due to the fear of a traumatic situation. Health institutions encourage health care demands at more advanced ages. Access to services is even harder for SISBEN members. CONCLUSSION: during early childhood, children of lower socioeconomic levels face multiple barriers to dental care access. Even health insurance fails to guarantee access. The most frequent barriers are of economic nature, but there are also cultural barriers and those related to the system's organization, such as children's short age, often used by mothers and institutions as an excuse to avoid requesting or providing timely care.

Febrile neutropenia in the tropics: a description of clinical and microbiological findings and their impact on inappropriate therapy currently used at an oncological reference center in Colombia.

INTRODUCTION: Febrile neutropenia is a common complication of chemotherapy treatment of malignant hematological diseases. However, there is insufficient information regarding the infectious complications of febrile neutropenia in our country. Objective. We will evaluate the microbial characteristics of bacterial and fungal isolates and the clinical outcome of patients with febrile neutropenia who received medical attention at an oncological reference center in Colombia. MATERIALS AND METHODS: A prospective case series included patients with histologically confirmed oncological disease, who were admitted because of febrile neutropenia or presented with febrile neutropenia during hospitalization. Patients with benign hematological diseases were excluded. Demographic, microbiological, and clinical features as well as treatment and outcome information from patients with febrile neutropenia were obtained. We performed univariate and multivariate analyses, with mortality defined as the outcome. RESULTS: One hundred and thirty episodes of febrile neutropenia were identified in 104 patients. The mean patient age was 19, and 53% of the patients were male. Approximately 86% of the episodes occurred in patients with hematological disorders. An infectious site was identified in 65% of patients; 41% and 24% of the febrile neutropenia pateints´ episodes exhibited a localized infectious focus and developed bloodstream infections, respectively. The majority of infections were found in blood, urine, gastrointestinal tract, and soft tissue. Distribution analysis of microbiological isolates revealed 46.4% Gram-negative bacilli, 38.4% Gram-positive cocci, 8% fungi, and 7.1% parasites; there was a 7.7% mortality rate. Appropriate empirical antimicrobial therapy was a protection-related factor in multivariate analyses (OR= 0.17; 0.034 - 0.9 95% CI; p= 0.037). CONCLUSIONS: The mortality rate was relatively low and comparable to the rate reported by developed countries. Inappropriate empirical antimicrobial therapy was the main factor associated with mortality.

Febrile neutropenia in the tropics: A description of clinical and microbiological findings and their impact on inappropriate therapy currently used at an oncological reference center in Colombia / Neutropenia febril en el trópico: una descripción de los hallazgos clínicos y microbiológicos y el impacto de la terapia inapropiada que utilizan en un centro de referencia oncológica en Colombia

Introduction. Febrile neutropenia is a common complication of chemotherapy treatment of malignant hematological diseases. However, there is insufficient information regarding the infectious complications of febrile neutropenia in our country. Objective. We will evaluate the microbial characteristics of bacterial and fungal isolates and the clinical outcome of patients with febrile neutropenia who received medical attention at an oncological reference center in Colombia. Materials and methods. A prospective case series included patients with histologically confirmed oncological disease, who were admitted because of febrile neutropenia or presented with febrile neutropenia during hospitalization. Patients with benign hematological diseases were excluded. Demographic, microbiological, and clinical features as well as treatment and outcome information from patients with febrile neutropenia were obtained. We performed univariate and multivariate analyses, with mortality defined as the outcome. Results. One hundred and thirty episodes of febrile neutropenia were identified in 104 patients. The mean patient age was 19, and 53% of the patients were male. Approximately 86% of the episodes occurred in patients with hematological disorders. An infectious site was identified in 65% of patients; 41% and 24% of the febrile neutropenia pateints´ episodes exhibited a localized infectious focus and developed bloodstream infections, respectively. The majority of infections were found in blood, urine, gastrointestinal tract, and soft tissue. Distribution analysis of microbiological isolates revealed 46.4% Gram-negative bacilli, 38.4% Gram-positive cocci, 8% fungi, and 7.1% parasites; there was a 7.7% mortality rate. Appropriate empirical antimicrobial therapy was a protection-related factor in multivariate analyses (OR= 0.17; 0.034 - 0.9 95% CI; p= 0.037). Conclusions. The mortality rate was relatively low and comparable to the rate reported by developed countries. Inappropriate empirical antimicrobial therapy was the main factor associated with mortality.

Introducción. La neutropenia febril es una complicación frecuente de la quimioterapia para las neoplasias hematológicas. Se dispone de escasa información de sus complicaciones infecciosas en nuestro medio. Objetivo. Evaluar las características clínicas y microbiológicas de pacientes con neutropenia febril, así como su resultado clínico en una institución de referencia oncológica en Colombia. Materiales y métodos. Se conformó prospectivamente una serie de casos con pacientes con enfermedad oncológica confirmada, que consultaron o presentaron neutropenia febril durante la hospitalización. Se excluyeron aquellos con enfermedad hematológica benigna. Se recolectaron datos sobre variables demográficas, microbiológicas, clínicas, de tratamiento y de resultado de los pacientes. Se llevaron a cabo un análisis univariado y uno multivariado, con la mortalidad como resultado. Resultados. Se identificaron 130 episodios de neutropenia febril en 104 pacientes, con una edad media de 19 años y 53 % masculinos. El 86 % de los episodios ocurrieron en pacientes con alteraciones hematológicas. Se demostró infección en 65 % de los casos: 41 % con un foco infeccioso localizado y 27,7 % con bacteriemia. Los principales focos infecciosos se localizaron en el torrente sanguíneo, el aparato urinario, el sistema gastrointestinal, la piel y los tejidos blandos. De los aislamientos microbiológicos, 46,4 % fueron bacilos Gram negativos, 38,4 %, cocos Gram positivos, 9 %, hongos y, 7,1%, parásitos. La mortalidad global fue de 7,7 %. En el análisis multivariado la utilización de un tratamiento empírico apropiado se correlacionó con una menor mortalidad, de forma independiente (OR=0,17; IC 95% 0,034-0,9; p=0,037). Conclusiones. La tasa de mortalidad fue relativamente baja y fue comparable con lo reportado en países desarrollados. El tratamiento antimicrobiano inapropiado fue el principal factor asociado con mortalidad.

Efecto de la mattitis subclínica sobre el rendimiento en la fabricación del queso costeño / The efect of subbclinical mastitis on coastal cheese production efficiency

La inflamación de las glándulas mamarias produce un descenso en la síntesis de los diferentes componentes de la leche, como respuesta para neutralizar agentes infecciosos, reparar el epitelio alveolar y retornar a la función normal. En la mastitis clínica y subclínica, hay un aumento del número de células somáticas cuya función es fagocitar, lisar a los patógenos, remover los deshechos producidos en el foco de infección mediante enzimas bacterianas que se incorporan a la leche reduciendo la vida útil de los diferentes derivados. El objetivo de esta investigación fue evaluar el efecto de la mastitis subclínica sobre el rendimiento del queso costeño. Se realizó un estudio observacional transversal, en una empresa ganadera con dos grupos, seleccionando cinco cuartos con resultados grado 3 del CMT y 5 cuartos con reacciones negativas al CMT. Se minimizó la variabilidad por raza y lactancia. Los análisis fisicoquímicos se efectuaron por triplicado y se llevaron a cabo, teniendo en cuenta los métodos referenciados, el RCS se realizó en un contador electrónico de células somáticas. Los resultados de la calidad fisicoquímica de la leche con y sin mastitis, se compararon por medio de la prueba t-Student y se procesaron en el software SAS 9.0. Los quesos elaborados con leches sin mastitis subclínicas mostraron un 5.8 % de mayor rendimiento sobre los quesos elaborados con leches provenientes de vacas con mastitis subclínica. El rendimiento de la leche en la elaboración de queso costeño está directamente relacionado con el número de células somáticas.

The mammary gland inflammation diminishes the synthesis of different milk compounds as a response to neutralize pathogens, repair the alveolar epithelium and return to normal functioning. In clinical and subclinical mastitis there is a significant increase of somatic cell count whose function is to phagocytose, lyse pathogens, and to remove wastes in the infection focus through bacterial enzymes that are added to milk, reducing the life span of different derivates. The aim of this study was to evaluate the effect of subclinical mastitis on coastal cheese production efficiency. A cross sectional observational study was carried out in a cattle enterprise having two groups from which five quarters with California Mastitis Test grade 3 and five quarters with negative California Mastitis Test reaction were selected. The variability by breed and lactation was minimized. The physical and chemical milk analyses were done in triplicate and were carried put considering reference methods. The somatic cells count was measured with an electronic somatic cell counter. The results of the physicochemical quality of the milk with and without mastitis were compared using the t-Student test and were processed using the SAS software 9.0. The cheese made using milk without sub clinic mastitis showed 5.8% better output over the cheese prepared with milk coming from cows with sub clinic mastitis. The efficiency of milk in the production of coastal cheese is directly related with somatic cell counts.

Identifying and controlling a multiresistant pseudomonas aeruginosa outbreak in a latin-american cancer centre and its associated risk factors

Pseudomonas aeruginosa is an important and frightening microorganism for patients suffering from cancer. Multiresistant P. aeruginosa (MRPA) may appear as a consequence of exposure to multiple antibiotics or from a breakdown in infection control practices. This article reports an MRPA outbreak in a cancer treatment centre and the consequent case control study. Mechanical ventilation was identified as being the main risk factor for developing MRPA colonisation or infection; molecular analysis confirmed the outbreak. A multifaceted strategy was adopted, involving reinforcing hand-washing practices, contact isolation, antibiotic restriction and suction devices for mechanically-ventilated patients. MRPA was controlled and the outbreak ended. Such strategy may be effective in controlling MRPS in low-resource environments amongst high risk cancer patients.

Identifying and controlling a multiresistant Pseudomonas aeruginosa outbreak in a Latin-American cancer centre and its associated risk factors.

Pseudomonas aeruginosa is an important and frightening microorganism for patients suffering from cancer. Multiresistant P. aeruginosa (MRPA) may appear as a consequence of exposure to multiple antibiotics or from a breakdown in infection control practices. This article reports an MRPA outbreak in a cancer treatment centre and the consequent case control study. Mechanical ventilation was identified as being the main risk factor for developing MRPA colonisation or infection; molecular analysis confirmed the outbreak. A multifaceted strategy was adopted, involving reinforcing hand-washing practices, contact isolation, antibiotic restriction and suction devices for mechanically-ventilated patients. MRPA was controlled and the outbreak ended. Such strategy may be effective in controlling MRPS in low-resource environments amongst high risk cancer patients.

Impacto de las [beta]-Lactamasas de espectro extendido en pacientes con cáncer / Extended-spectrum [beta]-lactamases in cancer care

En los últimos años ha habido un incremento del interés en las enterobacterias productoras de [beta]-lactamasas de espectro extendido (BLEE). Las cepas que expresan este fenotipo son capaces de hidrolizar un amplio grupo de antibióticos, incluyendo cefalosporinas de tercera generación y aztreonam, por lo que constituyen un reto terapéutico de difícil abordaje. Los pacientes con cáncer, especialmente aquéllos con neutropenia febril, son un grupo que se encuentra en alto riesgo paradesarrollar infecciones por este tipo de bacterias. En el artículo se revisan los distintos tipos de BLEE y su epidemiología, los esquemas de clasificación, los métodos de tamizaje y detección existentes, los factores de riesgo asociados con su aislamiento,las opciones terapéuticas disponibles en la actualidad y el impacto de estas enzimas en los pacientes con cáncer.

Extended-spectrum [beta]-lactamase (ESBL) producing enterobacteriaceae have been a topic of growing concern for the last years. When producing these enzimes, organisms become highly resistant against many classes of antibiotics (including third generation cephalosporins and aztreonam), resulting in difficult-to-treat infections. Cancer patients, especially febrile neutropenic patients, belong to a high risk group. This review covers the different ESBL types and the current epidemiology, classification schemes, laboratory detection techniques, and associated risk factors. Therapeutic options and impact on cancer patients are also discussed.

Infecciones Intrahospitaalarias en el Instituto Nacional de Cancerología, Colombia,2001-2002 / Infections of National Institute of Cancerology

Introducción: Los pacientes con cáncer son más susceptibles a las infecciones, especialmente en el mediohospitalario donde el uso de procedimientos invasivos,quimioterapia y antibióticos de amplio espectro los colocan en riesgo frente a los microorganismos de origen nosocomial. se presentan las características clínicas y microbiológicas de los pacientes con infecciones intrahospitalarias (IIH) en el Instituto Nacional de Cancerología en los años 2001-2002. Materiales y métodos: Se realizó una vigilancia activa de las IIH utilizando las guías de los Centros para el Control de Enfermedades (CDC,Atlanta, EEUU)para la definición de caso. Se estableció la tasa e índice de IIH,proporciones y ji cuadrado para diferencia de proporciones. Resultados: En los años 2001 y 2002 se presentaron 10.950 egresos hospitalarios entre los que se encontraron 1.090 casos de IIH en 732 pacientes. La tasa de IIH fue de 11,7 infecciones por 1.000 pacientes-dias, el índice de IIH fue de 9,9 por ciento y el índice de letalidad del 5,3 por ciento, con un incremento de 31 por ciento en el índice de IIH y de 14.2 por ciento en el índice de letalidad en el 2002. La IIH más frecuente fue la infección del sitio operatorio (ISO),seguido en orden decreciente, de la infección del tracto urinario, la neumonía, las infecciones del torrente sanguíneo y la bacteriemia asociada a catéteres. Los pacientes con neoplasias hamatológicas presentaron la mayor proporción de IIH, con 74,7 por ciento seguido de los pacientes con neoplasias gastrointestinales, con 36,6 por ciento. La neutropenia febril aportó el 24,5 por ciento de las IIH. Los microorganismos más frecuentes asociados a las IIH fueron: Staphylococcus aureus,Escherichia coli, staphylococcus epidermis y pseudomonas aeruginosa. Conclusiones:Los cambios en los indicadores de IIH en los dos años mostraron que las modificaciones en la vigilancia activa de los pcientes con cáncer del INC fueron efectivas y, aunque el periodo de estudio es de transición, el comportamiento clínico y microbiológico es similar a los reportes de otras instituciones oncológicas no nacionales. Los resultados presentados son los primeros que se conocen en pacientes oncológicos en el pais.