ABSTRACT
Candida auris is an emerging pathogen considered to be critical in the World Health Organization fungal organisms list. The study aims to determine the mortality and hospital stays attributed to Candida auris (C. auris) compared to other Candida species in adult patients with candidemia. A retrospective cohort of adults with candidemia was examined from seven centres in Colombia between 2016 and 2021. The primary outcome was 30-day mortality, and the secondary outcome was the length of hospital stay among survivors. Adjustment of the confounding variables was performed using inverse probability weights of exposure propensity score (candidemia by C. auris), survival regression models (Weibull distribution), and a counting model (negative binomial distribution). A value of 244 (47.6%) of the 512 patients with candidemia died within the first 30 days. The crude mortality in C. auris was 38.1% vs. 51.1% in Candida non-auris (CNA). In the Weibull model, mortality in the C. auris group was lower (adjusted HR: aHR- 0.69, 95% CI: 0.53-0.90). Antifungal treatment also decreased mortality, with an aHR of 0.36 (95% CI 0.27-0.47), while the presence of septic shock on patient progression increased it, with an aHR of 1.73 (95% CI 1.41-2.13). Among the patients who survived, no differences in the length of hospital stay were observed between the C. auris and the CNA groups, with an incidence rate ratio of 0.92 (95% CI: 0.68-1.22). Mortality in patients with C. auris bloodstream infections appears lower when adjusted for numerous confounding variables regarding treatment and the presence of septic shock in patient progression. We identified no significant effect of C. auris on the length of hospital stay in surviving patients.
ABSTRACT
Abstract Carbapenemase-producing Enterobacterales (CPE) infections have increased in recent years. Colombia has become an endemic country for this group of microorganisms, and the infections they cause have a serious impact in terms of morbidity and mortality. The early identification of CPE carriers who are admitted to health care centers as patients is necessary to implement adequate isolation and infection control measures to limit the spread of this type of microorganisms in hospitals. Furthermore, treating these infections is a challenging task due to the limited therapeutic alternatives available and the fact that there are only a few studies proving their effectiveness in this setting. Therefore, the objective of the present work is to develop a clinical practice guideline (CPG) for the screening of patients at risk of CPE colonization and the treatment of inpatients with suspected or confirmed infections caused by this type of bacteria through a CPG adaptation process based on the ADAPTE methodology. With this purpose in mind, evidence-informed recommendations for the screening and timely identification of CPE carriers admitted to hospitals are made, as well as for the adequate pharmacological treatment of CPE infections in this context.
Resumen Las infecciones por Enterobacterales productores de carbapenemasas (EPC) han aumentado en los últimos años. Colombia se ha convertido en un país endémico para este grupo de microorganismos y las infecciones que causan tienen un impacto importante en términos de morbimortalidad. La identificación temprana de los portadores de EPC que ingresan como pacientes a las instituciones de salud es necesaria para implementar medidas de aislamiento y control de infecciones adecuadas que limiten la diseminación de este tipo de microorganismos en los hospitales. Además, el tratamiento de estas infecciones es difícil debido a las limitadas alternativas terapéuticas disponibles y la escasez de estudios que demuestren su efectividad en este escenario. Por lo anterior, el objetivo del presente trabajo es desarrollar una guía de práctica clínica (GPC) para la tamización de pacientes con riesgo de colonización por EPC y para el manejo de pacientes con infecciones, ya sea sospechadas o confirmadas, causadas por este tipo de bacterias, mediante un proceso de adaptación de GPC basado en la metodología ADAPTE. Con este propósito en mente, se hacen recomendaciones informadas en evidencia para realizar la tamización y oportuna identificación de portadores de EPC admitidos en instituciones hospitalarias, así como para el adecuado manejo farmacológico de las infecciones por CPE en este escenario.
ABSTRACT
OBJECTIVE: The aim of this study was to design and validate LupusCol, an instrument for the evaluation of health-related quality of life (HRQoL) in Colombian adult patients with SLE. METHODS: Items and domains of the initial instrument were defined. Preliminary tests were made with the participation of patients. Validity and reliability tests of the administration method were conducted. Usability tests were applied to the version obtained in the previous phases to complete the validation process. RESULTS: Following preliminary tests, six items and one domain were excluded and two new items were added to the instrument, producing a form with 44 questions and 7 domains, which was submitted for validity and reliability tests. Factor analysis excluded three items, obtaining a Pearson's correlation (PC) for the criteria validity of -0, 48; a Cronbach's α coefficient for internal consistency of 0, 96; an intraclass correlation coefficient (ICC) for personal test-retest-telephone of 0.96 and an ICC personal test-retest-personal of 0.96. For interrater concordance a PC of 0.8, an ICC of 0.77 and a Lin's coefficient of 0.86 were found. Sensitivity to change was demonstrated through analysis of variance, obtaining significant indicators about the scale, demonstrating the instrument's ability to detect changes in HRQoL. CONCLUSION: The design and validation process was completed successfully. The scale has significant values for validity, reliability and sensitivity to change in the studied population.
