Prevalencia de ß-lactamasas de espectro extendido en Escherichia coli y Klebsiella pneumoniae identificados en una institución de salud en Barranquilla / Prevalence of extended spectrum ß-lactamases in Escherichia coli and Klebsiella pneumoniae identified in a health institution in Barranquilla

Introducción: Uno de los mecanismos de resistencia en Gram negativos es la producción de ß-lactamasas de espectro extendido (BLEE), capaces de otorgar resistencia a penicilinas y cefalosporinas. Objetivo. Determinar la prevalencia de ß-lactamasas de amplio espectro en aislamientos de Escherichia coli y Klebsiella pneumoniae identificados en una institución de salud. Metodología: Se tomaron los resultados del laboratorio clínico de los pacientes hospitalizados por enfermedades infecciosas identificados en un hospital de 4º nivel de complejidad en Barranquilla durante el año 2018 asociados a E. coli y K. pneumoniae, y se evaluó la resistencia de los mismos. Resultados: De 471 aislamientos identificados en diversas muestras clínicas, 317 están asociados a E. coli, y para ambos microorganismos presentaron mayores porcentajes de resistencias al tratamiento antibiótico en áreas no UCI, y evidenciando una resistencia a fármacos como ampicilina y cefalotina, por debajo de 60%, y 75%, respectivamente. Conclusión: Estas bacterias evaluadas, al ser de mayor relevancia clínica, pueden lograr un impacto no deseado por su presencia en áreas no UCI, siendo crítico para E. coli con resistencia a cefalosporinas de tercera y cuarta generación.

Introduction: One of the resistance mechanisms in Gram negative is the production of extended spectrum ß-lactamases (ESBL), capable of conferring resistance to penicillins and cephalosporins. Objective: To determine the prevalence of broad-spectrum ß-lactamases in Escherichia coli and Klebsiella pneumoniae isolates identified in a health institution. Methodology: Results were taken from the clinical laboratory of patients hospitalized for infectious diseases identified in a 4th level hospital in Barranquilla during 2018 associated with E. coli and K. pneumoniae, and their resistance was evaluated. Results: Of 471 isolates identified in various clinical samples, 317 are associated with E. coli, and for both microorganisms they presented higher percentages of resistance to antibiotic treatment in non-ICU areas, and showing resistance to drugs such as ampicillin and cephalothin, below 60%, and 75%, respectively. Conclusion: These evaluated bacteria, being of greater clinical relevance, can achieve an unwanted impact due to their presence in non-ICU areas, being critical for E. coli with resistance to third and fourth generation cephalosporins.

Estudio de utilización de antibióticos y adherencia a las guías en el servicio de consulta externa de una IPS indígena de Valledupar (Colombia) / Study of use of antibiotics and adherence to guides in the external consultation service of an indigenous IPS of Valledupar (Colombia)

Introduction: The deficiency in the adherence to medical guidelines is a factor that has been observed since their appearance, which has generated an inappropriate use of medications, the creation of resistance and the ineffectiveness of treatments. Objective: The present study sought to determine compliance with the management guidelines for the main infectious pathologies and the consumption of antibiotics in the outpatient service at the Institution of Health Provider. Methodology: To determine compliance with the Management Guidelines, medical records of antibiotics provided by the pharmacy for pathologies were reviewed, made up of 740 data from patients who attended for the 6 main infectious pathologies that also had medical management guidelines in an outpatient clinic of a Clinic of III level of complexity of La Guajira. Results: The main diseases that were identified were urinary tract infections (IVU) with 40%, followed by vaginitis (27%), vaginosis (17%), acute pharynx-tonsillitis (FAA) with 9%, acute respiratory infection (pneumonia and bronchopneumonia and bronchitis) with 5% acute otitis media with 3%. The antibiotics most used for the various pathologies were nitroimidazoles (28.42%), beta-lactams (19.20%), cephalosporins (14.06%), among others. Conclusions: The above, could generate ineffectiveness and resistance in treatments, which is reflected in the increased morbidity and mortality of patients treated with infectious diseases, in addition, the medical management guidelines must be updated with the criteria recommended by the Ministry of Social protection

Introducción: La deficiencia en la adherencia a las guías médicas es un factor que se viene observando desde la aparición de las mismas, lo que ha generado un uso inadecuado de medicamentos, la creación de resistencias y la inefectividad de tratamientos. Objetivo: El presente estudio buscó determinar el cumplimiento de las guías de manejo de las principales patologías infecciosas y el consumo de antibióticos en el servicio de consulta externa en la Institución Prestadora de Salud. Metodología: Para determinar el cumplimiento a las Guías de Manejo, se revisaron historias clínicas de antibióticos proporcionados por farmacia para patologías, conformado por 740 datos de pacientes que asistieron por las 6 principales patologías infecciosas que además tuvieran guía de manejo médico en consulta externa de una Clínica de III nivel de complejidad de la Guajira. Resultados: Las principales enfermedades que se identificaron fueron las infecciones de vías urinarias (IVU) con 40%, seguida por la vaginitis (27%), vaginosis (17%), faringo-amigdalitis aguda (FAA) con 9%, infección respiratoria aguda (neumonía y bronconeumonía y bronquitis) con 5% la otitis media aguda con 3%. Los antibióticos más utilizados para las diversas patologías fueron los nitroimidazoles (28,42%), betalactamicos (19,20%), cefalosporinas (14,06%), entre otros. Conclusiones: Lo anterior, podría generar una inefectividad y resistencias en tratamientos, lo cual se ve reflejado en el aumento de la morbimortalidad de pacientes tratados con patologías infecciosas, además, las guías de manejo médico deben ser actualizadas con los criterios recomendados por el Ministerio de Protección Social.

Caracterización de resistencia a antimicrobianos en microorganismos gram-positivos y gram-negativos identificados en una IPS de 4° nivel de complejidad de Barranquilla durante el año 2013 / Characterization of antimicrobial resistance in Gram-positive organisms identified in a fourth level of complexity ips in Barranquilla in 2013

La aparición de resistencias bacterianas con todas las complicaciones asociadas a su presencia, constituye un problema de primera línea en salud pública a nivel local y mundial. El presente estudio describe de forma general la resistencia a antimicrobianos en microorganismos Gram-positivos y Gram-negativos identificados en una IPS de 4° nivel de complejidad de Barranquilla durante el año 2013; para esto fueron revisados los datos de tipo descriptivo y retrospectivo del epicentro de microbiología que cumplieron criterios de inclusión; de los cuales se encontraron un 21 % (1.208) casos, predominando bacilos Gram-negativos y cocos Gram-positivos, presentando mayor prevalencia: Escherichia coli (E. coli) 16,88 %; Klebsiella pneumoniae, (K. pneumoniae) 11,92 %; Pseudo-mona aeruginosa, (P. aeruginosa) 9,02 %, Staphylococcus aureus (S. aureus) 8,70 %, Staphylococcus coagulasa negativo (Scn) 0,41 %. La infección más frecuente se identificó en muestras de urocultivos con 218 casos, seguido de 171 casos en hemocultivos, 117 casos en tejidos blandos, finalmente con 68 casos en respiratorios y 2 casos en cultivos de líquidos. Siendo las áreas de mayor infección: Urgencias con el 31,44 % (178) casos, seguido con el 8,65 % (49) casos hospitalización, con el 8,48 %. (48) casos UCI coronaria, posteriormente con el 5,87 % (32) casos UCI pediátrica, con el 4,24 % (26) UCI neurológica y con el 4,4 % (25) casos área del 4 piso. La tasa de fenotipos de resistencia encontrados son: En E. coli, se presentaron 36,27 % (74) casos de resistencia por ß-lactamasas de es-pectro extendido (BLEE) y 12,74 % (26) casos por Carbapenemasas (KPC); seguido de Klebsiella p, con un 36,80 % (53) casos de resistencia por BLEE y 26,38 % (38) casos por KPC; el S. aureus, presentó un 54,23 % (57) casos de Staphylococcus aureusmeticilino resistente(SAMR) respectivamente. Siendo el universo de estudio todas las muestras de pacientes hospitalizados por enfermedades infecciosas. De los antimicrobianos prescritos pocos pre-sentaron susceptibilidad del 90-100 %, por lo cual podría sugerirse como opción para tratamiento de las infeccio-nes causadas por agentes Gram-positivos y Gram-negativos. Es necesario optimizar y extender la efectividad de los agentes antimicrobianos disponibles, llevar restricción de su uso y la prescripción aprobada por el comité de infecciones de acuerdo a los parámetros estipulados por la OMS.

The appearance of bacterial resistances with all the complications associated to its presence, it constitutes a prob -lem of first line in public health on a global scale. The present study describes in a general form the resistance to antimicrobial in Gram-positive and Gram-negatives microorganisms identified in an IPS of 4 ° level of complexity of Barranquilla during the year 2013; this is why there was checked the information that fulfilled criteria of inclusion of descriptive and retrospective type of the epicentre of microbiology; where there was found 21 % (1.208) cases, predominating over bacilli Gram-negatives and Coccus Gram-positive, presenting more prevalence: Escherichia coli (E. coli) 16.88 %; Klebsiella pneumoniae, (Klebsiella p.) 11.92 %; Pseudomonas aeruginosa (P. aeruginosa)9.02 %, Staphylococcus Aureus (S. Aureus) 8.70 %, Staphylococcus coagulase-negative (CoNS) 0.41 %. The most frequent infection identified in urine culture with 218 cases, followed by 171 cases in blood culture, 117 cases in soft tissues, finally with 68 cases in respiratory and 2 cases in culture of liquids; being the areas of major infection: Urgencies with 31.44 % (178) cases, followed by 8.65 % (49) cases in hospitalization, 8.48 % (48) cases in coronary ICU, later with 5.87 % (32) cases in pediatric ICU, 4.24 % (26) cases in neurological ICU and 4.4 % (25) cases in the area of 4th floor. The tax of phenotypical profile of resistance found is: In E. coli, they were presented 36.27 % (74) cases of resistance by extended spectrum beta-lactamase (ESBL) and 12.74 % by Carbapenemases(KPC); followed by Klebsiella p, with 36.80 % (53) cases of resistance by ESBL and 26.38 % (38) cases by KPC; S. aureus presented 54.23 % (57) cases of methicillin-resistant Staphylococcus aureus (MRSA)respectively. Being the universe of study all the samples of patients hospitalized due to infectious illnesses; from those antimicrobial used as the prescribed ones, a few of them presented sensibility of 90-100 %, a reason why they could be suggested as an option for treatment of the infections caused by Gram-positives and Gram-negatives agents. It is required to optimize and extend the effectiveness of the antimicrobial available agents and follow the restriction of their uses and the prescription approved by the committee of infections in accordance with the parameters stipulated by the WHO.

Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in three cities of Colombia.

OBJECTIVE: To assess the feasibility and effectiveness of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene (HH) approach in Colombia, and analyze predictors of poor HH compliance. METHODS: An observational, prospective, interventional, before-and-after study was conducted from May 2003 through September 2010 in 10 intensive care units (ICUs) of six hospitals in three cities. The study was divided into two periods: a baseline and a follow-up period. Observations for HH compliance were done in each ICU during randomly selected 30-min periods. The multidimensional HH approach included: (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance, and (6) performance feedback. RESULTS: A total of 13 187 opportunities for HH were observed. Overall HH compliance increased from 50% to 77% (relative risk 1.55, 95% confidence interval 1.43-1.68; p=0.0001). Multivariate and univariate analyses showed that several variables were significantly associated with poor HH compliance: males vs. females (67% vs. 77%; p=0.0001), physicians vs. nurses (59% vs. 78%; p<0.0001), and adult vs. pediatric ICUs (76% vs. 42%; p<0.001), among others. CONCLUSIONS: Adherence to HH was increased by 55% with the INICC approach. Programs targeted at improving HH in variables found to be predictors of poor compliance should be implemented.

Findings of the International Nosocomial Infection Control Consortium (INICC), Part I: Effectiveness of a multidimensional infection control approach on catheter-associated urinary tract infection rates in pediatric intensive care units of 6 developing countries.

DESIGN: A before-after prospective surveillance study to assess the impact of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infection (CAUTI) rates. SETTING: Pediatric intensive care units (PICUs) of hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of the following 6 developing countries: Colombia, El Salvador, India, Mexico, Philippines, and Turkey. PATIENTS: PICU inpatients. METHODS: We performed a prospective active surveillance to determine rates of CAUTI among 3,877 patients hospitalized in 10 PICUs for a total of 27,345 bed-days. The study was divided into a baseline period (phase 1) and an intervention period (phase 2). In phase 1, surveillance was performed without the implementation of the multidimensional approach. In phase 2, we implemented a multidimensional infection control approach that included outcome surveillance, process surveillance, feedback on CAUTI rates, feedback on performance, education, and a bundle of preventive measures. The rates of CAUTI obtained in phase 1 were compared with the rates obtained in phase 2, after interventions were implemented. RESULTS: During the study period, we recorded 8,513 urinary catheter (UC) days, including 1,513 UC-days in phase 1 and 7,000 UC-days in phase 2. In phase 1, the CAUTI rate was 5.9 cases per 1,000 UC-days, and in phase 2, after implementing the multidimensional infection control approach for CAUTI prevention, the rate of CAUTI decreased to 2.6 cases per 1,000 UC-days (relative risk, 0.43 [95% confidence interval, 0.21-1.0]), indicating a rate reduction of 57%. CONCLUSIONS: Our findings demonstrated that implementing a multidimensional infection control approach is associated with a significant reduction in the CAUTI rate of PICUs in developing countries.