Empirical treatment and mortality in bacteremia due to extended spectrum ß-lactamase producing Enterobacterales (ESßL-E), a retrospective cross-sectional study in a tertiary referral hospital from Colombia.

BACKGROUND: Infections caused by extended spectrum ß-lactamase (ESßL) producing bacteria are common and problematic. When they cause bloodstream infections, they are associated with significant morbidity and mortality. METHODS: A retrospective cross-sectional observational study was conducted in a single center in Pereira, Colombia. It included people hospitalized with bacteremia due to gram-negative bacilli with the extended-spectrum ß-lactamase producing phenotype. A logistic regression analysis was constructed. Clinical characteristics and risk factors for death from sepsis were established. RESULTS: The prevalence of bacteremia due to Enterobacterales with extended-spectrum ß-lactamase producing phenotype was 17%. 110 patients were analyzed. Most patients were men (62%) with a median age of 58 years, hospital mortality was 38%. Admission to intensive care was 45%. The following risk factors for mortality were established: shock requiring vasoactive support, Pitt score > 3 points, and not having an infectious disease consultation (IDC). CONCLUSIONS: bacteremia due to Enterobacterales with extended-spectrum ß-lactamase producing phenotype have a high mortality. Early recognition of sepsis, identification of risk factors for antimicrobial resistance, and prompt initiation of appropriate empiric antibiotic treatment are important. An infectious disease consultation may help improve outcomes.

Susceptibility to endemic Aedes-borne viruses among pregnant women in Risaralda, Colombia.

OBJECTIVES: Aedes-borne viruses (ABV) affect humans on every inhabited continent and frequently cause epidemics. Recent epidemics of chikungunya and Zika viruses (ZIKV) highlight that preparedness for future epidemics requires assessment of susceptibility, particularly among high-risk groups. We sought to determine immunity against the three major circulating ABV among pregnant women in an ABV-endemic area of Colombia. METHODS: A cross-sectional seroprevalence study was performed, enrolling women presenting to Labor and Delivery. Cord blood and maternal peripheral blood samples were obtained. IgG seroprevalence to flaviviruses and chikungunya was determined by ELISA. An abbreviated neutralization test was used to estimate the frequency and magnitude of immunity to Zika and four dengue serotypes. Cluster analyses explored epidemiologic factors associated with seroprevalence. RESULTS: Most women exhibited high levels of neutralizing antibodies to one or more ABV; however, nearly 20% were seronegative for flaviviruses. Our research took place after the epidemic peak of the ZIKV outbreak in Colombia in 2016. However, only 20% of pregnant women had high levels of Zika-neutralizing antibodies consistent with likely protective immunity to ZIKV. CONCLUSION: Hence, a high proportion of pregnant women in Risaralda remain susceptible to one or more ABV including the teratogenic ZIKV, indicating a risk for future epidemics in this region.

Severe and critical COVID-19 in a tertiary center in Colombia, a retrospective cross-sectional study.

BACKGROUND: Colombia has been one of the Latin American countries seriously affected by the covid-19 pandemic. Risk factors for severe disease and death in COVID 19 have been described across the world. Here we report the outcomes, clinical characteristics and risk factors for invasive mechanical ventilation and in-hospital death in a tertiary center in Palmira, Colombia. METHODS: This was a retrospective cross-sectional study involving one single center in Palmira, Colombia. People hospitalized with severe and critical covid-19, during the first pandemic wave, were included. The clinical characteristics and risk factors for in-hospital mortality and invasive mechanical ventilation were mean to be stablished by using a logistic regression analysis. RESULTS: One hundred and fifty-eight patients were analyzed. Most patients were male (70%) with a mean age of 63 years, invasive mechanical ventilation was provided to 39%, in-hospital mortality was 36%, mainly caused by refractory hypoxemia and septic shock, admission to intensive care was as high as 65%. The logistic regression analysis showed that the risk factors for in-hospital mortality were elevated levels of lactic dehydrogenase and high-sensitivity troponin I, acute renal failure, COPD, and > 10 points on the MuLBSTA score. The risk factors for invasive mechanical ventilation were high levels of C-reactive protein and very low lymphocyte counts, a PaO2/FiO2 < 70 and some clinical scores like CURB65, NEWS 2, and PSI/PORT. CONCLUSIONS: During the first pandemic wave in Colombia, for the experience of a tertiary center with a mainly elderly population, a high prevalence of severe ARDS was found, high requirement of intensive care, invasive ventilatory support, bacterial sepsis and an elevated mortality rate were found. The risk factors for in-hospital death and invasive mechanical ventilation were stablished.

Human visceral leishmaniasis prevalence by different diagnostic methods in Latin America: a systematic review and meta-analysis.

Visceral leishmaniasis is a neglected zoonotic disease that affects animals and humans in different tropical and subtropical regions and even beyond, with variable prevalence among infected hosts. To date, there have been no systematic reviews on human visceral leishmaniasis prevalence in Latin America. We therefore performed a systematic literature review with meta-analysis, using six databases to assess prevalence of visceral leishmaniasis in human patients in Latin American countries. Observational studies were included but analyzed separately. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI). In all, 10,435 articles were retrieved for the time frame (1950-2019). After initial screening, 120 articles were selected for full-text assessment, 97 being finally included for qualitative and quantitative analyses. Overall, VL pooled prevalence was estimated at 38.8% (95% CI 33.8-43.8%), derived from 97 studies, including 44,986 individuals. Many aspects of the transmission dynamics of Leishmania and the exact burden of this parasitosis on public health remain largely unknown. Although the elimination of zoonotic VL in the Americas appears an unrealistic goal, additional efforts need to be put in place to achieve better diagnosis, treatment, and prevention of VL.

Geographic mapping of Enterobacteriaceae with extended-spectrum ß-lactamase (ESBL) phenotype in Pereira, Colombia.

BACKGROUND: Antimicrobial resistance is an ecological and multicausal problem. Infections caused by extended-spectrum ß-lactamase producing Enterobacteriaceae (ESBL-E) can be acquired and transmitted in the community. Data on community-associated ESBL-E infections/colonizations in Colombia are scarce. Georeferencing tools can be used to study the dynamics of antimicrobial resistance at the community level. METHODS: We conducted a study of geographic mapping using modern tools based on geographic information systems (GIS). Two study centers from the city of Pereira, Colombia were involved. The records of patients who had ESBL-producing Enterobacteriaceae were reviewed. Antimicrobial susceptibility testing and phenotypic detection of ESBL was done according to CLSI standards. RESULTS: A population of 415 patients with community-acquired infections/colonizations and 77 hospital discharges were obtained. Geographic distribution was established and heat maps were created. Several hotspots were evidenced in some geographical areas of the south-west and north-east of the city. Many of the affected areas were near tertiary hospitals, rivers, and poultry industry areas. CONCLUSIONS: There are foci of antimicrobial resistance at the community level. This was demonstrated in the case of antimicrobial resistance caused by ESBL in a city in Colombia. Causality with tertiary hospitals in the city, some rivers and the poultry industry is proposed as an explanation of the evidenced phenomenon. Geographic mapping tools are useful for monitoring antimicrobial resistance in the community.

MERS-CoV and SARS-CoV infections in animals: a systematic review and meta-analysis of prevalence studies.

INTRODUCTION: Coronaviruses are zoonotic viruses that include human epidemic pathogens such as the Middle East Respiratory Syndrome virus (MERS-CoV), and the Severe Acute Respiratory Syndrome virus (SARS-CoV), among others (e.g., COVID-19, the recently emerging coronavirus disease). The role of animals as potential reservoirs for such pathogens remains an unanswered question. No systematic reviews have been published on this topic to date. METHODS: We performed a systematic literature review with meta-analysis, using three databases to assess MERS-CoV and SARS-CoV infection in animals and its diagnosis by serological and molecular tests. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI). RESULTS: 6,493articles were retrieved (1960-2019). After screening by abstract/title, 50 articles were selected for full-text assessment. Of them, 42 were finally included for qualitative and quantitative analyses. From a total of 34 studies (n=20,896 animals), the pool prevalence by RT-PCR for MERS-CoV was 7.2% (95%CI 5.6-8.7%), with 97.3% occurring in camels, in which pool prevalence was 10.3% (95%CI 8.3-12.3). Qatar was the country with the highest MERS-CoV RT-PCR pool prevalence: 32.6% (95%CI 4.8-60.4%). From 5 studies and 2,618 animals, for SARS-CoV, the RT-PCR pool prevalence was 2.3% (95%CI 1.3-3.3). Of those, 38.35% were reported on bats, in which the pool prevalence was 14.1% (95%CI0.0-44.6%). DISCUSSION: A considerable proportion of infected animals tested positive, particularly by nucleic acid amplification tests (NAAT). This essential condition highlights the relevance of individual animals as reservoirs of MERS-CoV and SARS-CoV. In this meta-analysis, camels and bats were found to be positive by RT-PCR in over 10% of the cases for both; thus, suggesting their relevance in the maintenance of wild zoonotic transmission.

Paederus dermatitis - A bibliometric analysis of an emerging disease in travelers.

Not available.

Coronavirus infections reported by ProMED, February 2000-January 2020.

INTRODUCTION: Sources describing the global burden of emerging diseases accurately are still limited. We reviewed coronavirus infections reported by ProMED and assessed the reliability of the data retrieved compared to published reports. We evaluated the effectiveness of ProMED as a source of epidemiological data on coronavirus. METHODS: Using the keyword "coronavirus" in the ProMED search engine, we reviewed all the information from the reports and collected data using a structured form, including year, country, gender, occupation, the number of infected individuals, and the number of fatal cases. RESULTS: We identified 109 entries reported between February 29, 2000 and January 22, 2020. A total of 966 cases were reported, with death reported in 188 cases, suggesting an overall case fatality rate (CFR) of 19.5%. Of 70 cases for which the gender was reported, 47 (67.1%) were male. Most of the cases were reported from China, the United Arab Emirates, and Saudi Arabia, with reports from other countries, including imported cases in Europe and North America. CONCLUSIONS: Internet-based reporting systems such as ProMED are useful to gather information and synthesize knowledge on emerging infections. Although certain areas need to be improved, ProMED provided useful information about coronaviruses especially during outbreaks.