Healthcare-associated infections in burn patients: Timeline and risk factors.

BACKGROUND: Healthcare-associated infections (HAIs) remain a major challenge in burn research and care. We aimed to describe the epidemiology and timeline of HAIs and to estimate the association of demographics and clinical characteristics with time to HAI among burn patients. METHODS: A prospective cohort study was conducted in a referral burn unit in southwestern Colombia. Incidence rates were calculated for HAI types and microorganisms, using a Poisson regression model. Univariable and multivariable Cox proportional hazards regression was used to estimate the effect of risk factors on time to first HAI. RESULTS: Of 165 burn patients, 46 (27.9%) developed at least one HAI (incidence rate of 21.8 per 1000 patient-days). The most frequent HAIs were burn wound infections, followed by bloodstream infections. The most common microorganisms were Staphylococcus aureus, Pseudomonas spp., and Acinetobacter baumannii. Whereas gram-negative bacteria were the most common microorganisms causing HAIs, gram-positive bacteria were the first microorganisms isolated after hospital admission. The independent risk factors associated with time to first HAI were burn size (TBSA>20%), burn mechanism (flames and scalds), central venous catheter use, and mestizo race. CONCLUSION: These data have implications toward generating empirical antibiotic guidelines and preventive strategies targeting the patients at highest risk for HAI.

Fatal Strongyloides stercoralis hyperinfection syndrome in an alcoholic diabetic patient from México / Síndrome de hiperinfección mortal por Strongyloides stercoralis en un paciente diabético y alcohólico de México

Strongyloides stercoralis hyperinfection syndrome is a medical emergency that requires a high level of suspicion. Immunocompromised patients are at high risk of hyperinfection syndrome; however, malnutrition, alcoholism, and diabetes mellitus also need to be considered as predisposing factors. The diagnosis and treatment of Strongyloides hyperinfection are challenging and patients often have severe complications. Consequently, mortality is overwhelmingly high, with proportions above 60%. Herein, we report a case of Strongyloides hyperinfection in a 40-year-old alcoholic diabetic patient living in México. Unfortunately, the late diagnosis resulted in his death despite the treatment and supportive measures. Increased awareness is needed to prevent the dire consequences of strongyloidiasis.

El síndrome de hiperinfección por Strongyloides stercoralis es una emergencia médica que requiere una aguda sospecha clínica. Los pacientes inmunocomprometidos tienen alto riesgo de sufrir el síndrome de hiperinfección; sin embargo, la desnutrición, el alcoholismo y la diabetes mellitus también deben considerarse factores predisponentes. El diagnóstico y el tratamiento de la hiperinfección por S. stercoralis constituyen un desafío y los pacientes a menudo tienen complicaciones graves. Como consecuencia, la mortalidad es abrumadoramente alta, con proporciones superiores al 60 %. Se presenta un caso de hiperinfección por S. stercoralis en un paciente diabético y alcohólico de 40 años que vivía en México. Infortunadamente, el diagnóstico tardío causó su muerte a pesar del tratamiento y las medidas de soporte. Se necesita un mayor conocimiento para prevenir las terribles consecuencias de la estrongiloidiasis.

Fatal Strongyloides stercoralis hyperinfection syndrome in an alcoholic diabetic patient from México / Síndrome de hiperinfección mortal por Strongyloides stercoralis en un paciente diabético y alcohólico de México

Strongyloides stercoralis hyperinfection syndrome is a medical emergency that requires a high level of suspicion. Immunocompromised patients are at high risk of hyperinfection syndrome; however, malnutrition, alcoholism, and diabetes mellitus also need to be considered as predisposing factors. The diagnosis and treatment of Strongyloides hyperinfection are challenging and patients often have severe complications. Consequently, mortality is overwhelmingly high, with proportions above 60%. Herein, we report a case of Strongyloides hyperinfection in a 40-year-old alcoholic diabetic patient living in México. Unfortunately, the late diagnosis resulted in his death despite the treatment and supportive measures. Increased awareness is needed to prevent the dire consequences of strongyloidiasis.

El síndrome de hiperinfección por Strongyloides stercoralis es una emergencia médica que requiere una aguda sospecha clínica. Los pacientes inmunocomprometidos tienen alto riesgo de sufrir el síndrome de hiperinfección; sin embargo, la desnutrición, el alcoholismo y la diabetes mellitus también deben considerarse factores predisponentes. El diagnóstico y el tratamiento de la hiperinfección por S. stercoralis constituyen un desafío y los pacientes a menudo tienen complicaciones graves. Como consecuencia, la mortalidad es abrumadoramente alta, con proporciones superiores al 60 %. Se presenta un caso de hiperinfección por S. stercoralis en un paciente diabético y alcohólico de 40 años que vivía en México. Infortunadamente, el diagnóstico tardío causó su muerte a pesar del tratamiento y las medidas de soporte. Se necesita un mayor conocimiento para prevenir las terribles consecuencias de la estrongiloidiasis.

Opportunistic intestinal parasites in immunocompromised patients from a tertiary hospital in Monterrey, Mexico.

Opportunistic parasites are still important agents causing morbidity and mortality in immunocompromised patients, particularly those living with HIV/AIDS. Few studies in Mexico have attempted to determine the prevalence of opportunistic intestinal parasites causing diarrhea in immunocompromised patients. A study was conducted to determine the intestinal parasites in HIV-positive and HIV-negative immunocompromised patients with diarrhea admitted to a tertiary care hospital in Monterrey, Mexico, from 2014 to 2015. Stool samples were examined for trophozoites, cysts, and eggs using the EGRoPe sedimentation-concentration technique and special techniques (modified Ziehl-Neelsen stain, modified trichrome stain). A total of 56 patients were included. The overall prevalence of intestinal parasitism was 64% (36/56); 22/36 patients were HIV-positive. Prevalence of opportunistic parasites was 69% in HIV-infected patients compared to 44% in HIV-negative patients (P = 0.06). Microsporidia were the most frequently identified parasites (24/36, 67%), followed by Cryptosporidium sp. (6/36, 17%), Sarcocystis sp. (4/36, 11%), Cystoisospora belli (3/36, 8%), and Cyclospora cayetanensis (1/36, 3%). Overall prevalence rates of microsporidiosis and cryptosporidiosis were 43% and 11%, respectively. Among HIV-infected patients, prevalence rates of microsporidiosis and cryptosporidiosis were 48% and 14%, respectively. We also report the first cases of intestinal sarcocystosis in Mexico, all in HIV-infected patients. In conclusion, microsporidia and coccidia are major parasitic agents causing diarrhea in immunocompromised patients, particularly HIV-infected patients.

De novo histoid leprosy in a Colombian patient with multiple skin nodules on the ears and extremities.

Histoid leprosy is an uncommon form of lepromatous leprosy with distinct clinical, histopathological, immunological, and bacteriological features. This variant usually occurs in multibacillary patients who have irregular or inadequate treatment. Herein, we report a case of de novo histoid leprosy diagnosed in a patient from Cali, Colombia. In endemic areas, histoid leprosy should be in the differential diagnosis of any patient presenting with skin nodules. Early diagnosis and appropriate treatment are recommended for mitigating the impact of histoid leprosy cases, which are important reservoirs of Mycobacterium leprae.

Detection of pathogenic Leptospira in ornamental water fountains from urban sites in Cali, Colombia.

Leptospirosis is a disease endemic to both rural and urban areas of tropical countries and resource-poor communities. Little information is available on the presence of Leptospira spp. in urban water sources. A study was conducted to detect pathogenic Leptospira in ornamental water fountains in Cali, Colombia. Twenty-seven water fountains were tested for pathogenic Leptospira using a multiplex PCR assay targeting the secY and the flaB genes. Pathogenic Leptospira was confirmed in 11 (41%) ornamental water fountains. Plazas, building exteriors, and sidewalks presented the highest proportion (67%) of pathogenic Leptospira-positive water fountains. Urban ornamental water fountains might be sources of pathogenic Leptospira and might pose a risk to humans who come into close contact, although relevance from a public health perspective is yet to be established.

De novo histoid leprosy in a Colombian patient with multiple skin nodules on the ears and extremities

Abstract Histoid leprosy is an uncommon form of lepromatous leprosy with distinct clinical, histopathological, immunological, and bacteriological features. This variant usually occurs in multibacillary patients who have irregular or inadequate treatment. Herein, we report a case of de novo histoid leprosy diagnosed in a patient from Cali, Colombia. In endemic areas, histoid leprosy should be in the differential diagnosis of any patient presenting with skin nodules. Early diagnosis and appropriate treatment are recommended for mitigating the impact of histoid leprosy cases, which are important reservoirs of Mycobacterium leprae.

Distinct Genetic Diversity of Carbapenem-Resistant Acinetobacter baumannii from Colombian Hospitals.

The global success of multidrug-resistant Acinetobacter baumannii has been associated with the dissemination of a high-risk clone designated clonal complex (CC) 92B (Bartual scheme)/CC2P (Pasteur scheme), which is the most frequent genetic lineage in European, Asian, and North American carbapenem-resistant Acinetobacter isolates. In these isolates, carbapenem resistance is mainly mediated by ß-lactamases encoded by blaOXA-23-like, blaOXA-24-like, blaOXA-51-like, and/or blaOXA-58-like genes. In this study, we characterized the population genetics of 121 carbapenem-resistant A. baumannii complex isolates recovered from 14 hospitals in seven cities in Colombia (2008-2010). Multiplex PCR was used to detect blaOXA-23-like, blaOXA-24-like, blaOXA-51-like, and blaOXA-58-like genes. Molecular typing was performed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). PCR showed that 118 (97.5%) of the isolates were positive for both blaOXA-23-like and blaOXA-51-like genes, and three other isolates were only positive for blaOXA-51-like. PFGE identified 18 different pulsotypes, while MLST identified 11 different sequence types (STs), seven of which had not been previously described in Acinetobacter. None of the STs found in this study was associated with CC92B/CC2P. The most widespread STs in our isolates belonged to ST636 and their single-locus variants ST121/ST124/ST634 (CC636B) followed by STs belonging to CC110B. Our observations suggest a wide distribution of diverse A. baumannii complex clones containing blaOXA-23-like in Colombian hospitals (especially CC636B and CC110B) that differ from the high-risk clones commonly found in other regions of the world, indicating a distinct molecular epidemiology of carbapenem-resistant Acinetobacter spp. in Colombia.

Epidemiology of septic meningitis associated with neuraxial anesthesia: a historical review and meta-analysis.

INTRODUCTION: Neuraxial anesthesia in the form of spinal and epidural are two of the most frequent forms of regional anesthesia. We aimed to describe and compare the relevant epidemiological, clinical and microbiological characteristics of all reported cases of septic meningitis associated with the use of spinal and epidural anesthetics. EVIDENCE ACQUISITION: We performed a systematic review of septic meningitis associated with neuraxial anesthesia. We included all relevant case-reports and observational studies in which authors described septic meningitis in association with spinal, epidural or combined neuraxial anesthesia using local anesthetics. EVIDENCE SYNTHESIS: A total of 234 cases of septic meningitis were reported following review of 71 case-report articles and 22 epidemiological studies. In total, there have been 199, 25 and 10 reported cases of septic meningitis associated to spinal, epidural and combined neuraxial anesthesia, respectively. The lack of use of surgical masks was the most common risk factor (41, 16.7%). Streptococcus salivarius was the most common bacteria (17.0%) related to spinal anesthesia and Staphylococcus aureus (26.7%) was the most common one related to epidural. The time to symptom onset was significantly reduced in spinal (median time, 24 hours IQR [8-72] vs. 96 hours IQR [84-240]; P=0.003) compared to epidural anesthesia. The overall mortality rate is 15.3% and 13.3% for reported cases related to spinal and epidural anesthesia, respectively. CONCLUSIONS: While the true incidence remains speculative, this review suggests that given increasing indications for spinals and epidurals, septic meningitis remains an important associated with neuraxial anesthesia.

La importancia del control y prevención de enfermedades infecciosas en anestesiología / The importance of infection control and prevention in anesthesiology

ABSTRACT The key role of the field of infectious diseases in other medical specialties, including anesthesiology, is currently well known. The anesthesiologist faces a potential risk of con tributing to the development of healthcare associated infections in the operating rooms; however, the infectious complications derived from anesthesia have been underestimated. It is important to acknowledge that there are some deficiencies in research, notification, and publication of reports on anesthesia-associated infectious events in developing countries, particularly in Colombia, which is the focus of our attention in this article. As far as we know, only five countries 一 most of them developed 一 have carried out studies on the practices and knowledge of the anesthesiology personnel with regards to universal recommendations for the prevention and control of anesthesia-associated infections. This document discusses the importance of infections in the area of anesthesiology and at present in Colombia. Fur thermore, the need to comply with basic infection prevention and control precautions and of creating awareness of safe injection practices is recognized.

RESUMEN Actualmente es bien conocido el protagonismo que el campo de las enfermedades infecciosas desempeña en otras especialidades médicas, incluyendo la anestesiología. El anestesiologo tiene un riesgo potencial de contribuir al desarrollo de infecciones asocia das a la atención en salud en los quirófanos; sin embargo, las complicaciones infecciosas derivadas de la anestesia han sido subestimadas. Es importante reconocer que existen deficiencias en la investigación, notificación y publicación de reportes de eventos infecciosos asociados a la anestesia en países en vías de desarrollo, en particular en Colombia, en el cual nos hemos enfocado en el presente artículo. Hasta donde se sabe, solo 5 países, la mayoría de ellos desarrollados, han realizado estudios sobre prácticas y conocimientos del personal de anestesiología respecto a las recomendaciones universales para la prevención y el control de infecciones asociadas a la anestesia. En el presente documento se discute la importancia de las infecciones en el campo de la anestesiología y el panorama actual de su situación en Colombia. Además, se resalta la necesidad de adherencia a precauciones básicas de prevención y control de infecciones y de concientización sobre las prácticas seguras de inyección.

[Blood-feeding of Rhodnius prolixus].

Triatomines (Hemiptera: Reduviidae) are blood-sucking insect vectors of the protozoan Trypanosoma cruzi which is the causative agent of Chagas' disease. Rhodnius prolixus is the most epidemiologically important vector of T. cruzi in Colombia. Triatomines are regarded to be vessel-feeders as they obtain their blood meals from vertebrate hosts by directly inserting their mouthparts into vessels. Microscopic techniques are useful for visualizing and describing the morphology of biological structures. Here, we show images of the blood-feeding of R. prolixus, including some histological features by light microscopy and scanning electron microscopy of the mouthparts of R. prolixus when feeding on a laboratory mouse.

Blood-feeding of Rhodnius prolixus

Triatomines (Hemiptera: Reduviidae) are blood-sucking insect vectors of the protozoan Trypanosoma cruzi which is the causative agent of Chagas' disease. Rhodnius prolixus is the most epidemiologically important vector of T. cruzi in Colombia. Triatomines are regarded to be vessel-feeders as they obtain their blood meals from vertebrate hosts by directly inserting their mouthparts into vessels. Microscopic techniques are useful for visualizing and describing the morphology of biological structures. Here, we show images of the blood-feeding of R. prolixus, including some histological features by light microscopy and scanning electron microscopy of the mouthparts of R. prolixus when feeding on a laboratory mouse.

Los triatominos (Hemiptera: Reduviidae) son insectos hematófagos vectores del protozooTrypanosoma cruzi, el cual causa la enfermedad de Chagas. Rhodnius prolixus es el vector de T. cruzi de mayor importancia epidemiológica en Colombia. Para alimentarse, los triatominos introducen su probóscide directamente en los vasos sanguíneos de los huéspedes vertebrados. La microscopía es una técnica útil para visualizar y describir la morfología de estructuras biológicas. Se presentan imágenes de la hematofagia de R. prolixus, incluidas algunas características histológicas visibles por microscopía de luz y microscopía electrónica de barrido de las partes bucales de R. prolixus al alimentarse de un ratón de laboratorio.

Seroprevalence and factors associated with Leptospira infection in an urban district of Cali, Colombia.

Few studies have addressed Leptospira seroprevalence and risk factors in urban populations in Colombia. This study aimed to determine seroprevalence and factors associated with Leptospira infection in inhabitants of an urban district of Cali, Colombia. We collected sociodemographic and environmental data, as well as blood samples, from 353 subjects selected through a multistage cluster sampling design. We performed microagglutination test for the eight main Leptospira serogroups circulating in the region, considering a cut-off titer of ≥ 1:100. Most participants were female (226, 64.8%), with mean age 41.4 years, and 89 (32.6%) lived in low-low socioeconomic stratum (SES-1). Overall seroprevalence was 12.2% (95%CI: 10.3%-14.4%). Factors associated with Leptospira infection were SES 1, older age, single marital status, ethnic groups (Afro-Colombian and white/mestizo), school students, absence of toilet, barefoot walking, travel outside Cali in the previous month, and absence of skin and mucous-membrane lesions in the previous month. Our study suggests domestic and peridomiciliary transmission of Leptospira likely related to activities of daily living and inadequate environmental conditions. SES-1 is a major factor associated with Leptospira infection (adjusted OR = 4.08; 95%CI: 2.54-6.53; p < 0.001), suggesting that social and environmental conditions are key elements for endemicity of Leptospira infection in the study area. Epidemiological surveillance, improvement of environmental and sanitary conditions in various SES-1 areas, and community educational campaigns are recommended.