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.

Brucellosis and sacroiliitis: A differential diagnosis to keep in mind / Sacroiliitis por brucelosis: Un diagnóstico diferencial para tener presente

ABSTRACT Brucellosis is a zoonosis that causes a multi-organ granulomatous infection. It has diverse and non-specific clinic features that can make diagnosis difficult. Medical personnel often do not recognize it early. Delayed treatment is associated with high morbidity and even mortality. Its timely diagnosis requires a high index of suspicion. The case is presented of a 35-year-old male zootechnologist, previously healthy, with a progressive picture of two months of evolution of irradiated low back pain to the left hip, nocturnal diaphoresis, and unintentional weight loss. Elevation of acute phase reactants was documented and magnetic resonance imaging found signs of iliopsoas tendonitis and inflammatory changes in the left sacroiliac joint. The IgG and IgM antibodies using an immunoassay forbrucella were positive. After establishing antibiotic treatment, a marked clinical improvement, with resolution of the inflammatory process was evident.

RESUMEN La brucelosis es una zoonosis que genera una infección granulomatosa multiorgánica. Tiene una clínica diversa e inespecífica que puede hacer difícil el diagnóstico. Con frecuencia, el personal médico no la reconoce de forma temprana. El retraso en el tratamiento se asocia con una gran morbilidad e incluso mortalidad. Su diagnóstico oportuno requiere un alto índice de sospecha. Se presenta el caso de un hombre de 35 arios, zootecnista, previamente sano, con un cuadro progresivo de dos meses de evolución de dolor lumbar irradiado a cadera izquierda, diaforesis nocturna y pérdida no intencional de peso. Se documentó elevación de reactantes de fase aguda y en la resonancia magnética se encontraron signos de tendinitis del psoas y cambios inflamatorios en la articulación sacroilíaca izquierda. Los anticuerpos IgG e IgM por inmunoensayo para Brucella fueron positivos, y luego de instaurar tratamiento antibiótico se evidenció marcada mejoría clínica con resolución del proceso inflamatorio.

An unexpected pathogen causing multiple intra-abdominal abscesses in an immunocompetent patient / Un patógeno inesperado como causa de múltiples abscesos intrabdominales en un paciente inmunocompetente

Abstract Streptococcus constellatus is a member of the group now called Streptococcus anginosus. This microorganism is part of the normal oropharyngeal, gastrointestinal and genitourinary microbiota. However, it may cause serious infections such as pharyngitis, bacteremia and invasive pyogenic infections in immunocompromised patients. We report the first case in Colombia of an adult male with no relevant medical history and with an unusual presentation of infection by S. constellatus and whose laboratory results showed an important systemic inflammatory response and radiographic evidence of abdominal involvement with poor response to medical and surgical management. Since there are few reports in international medical journals about intra-abdominal infection by S. constellatus and taking into consideration the need of a multidisciplinary intervention, this report may be of interest for both clinical and surgical practitioners.

Resumen Streptococcus constellatus es un miembro del grupo ahora llamado Streptococcus anginosus. Este microorganismo es parte de la microbiota orofaríngea, gastrointestinal y genitourinaria normal. Sin embargo, puede causar infecciones graves como faringitis, bacteriemia e infecciones piógenas invasivas en pacientes inmunocomprometidos. Presentamos el primer caso en Colombia de un hombre adulto sin antecedentes médicos relevantes y con una presentación inusual de infección por S. constellatus, dada por una gran respuesta inflamatoria sistémica y evidencia radiográfica de afectación abdominal con mala respuesta al tratamiento médico y quirúrgico. Dado que hay pocos informes en revistas médicas internacionales sobre la infección intraabdominal por S. constellatus y teniendo en cuenta la necesidad de intervenciones multidisciplinarias, este reporte puede ser de interés tanto para los médicos clínicos como para los quirúrgicos.

Closing gaps in histoplasmosis: clinical characteristics and factors associated with probable/histoplasmosis in HIV/AIDS hospitalized patients, a retrospective cross-sectional study in two tertiary centers in Pereira, Colombia.

BACKGROUND: The HIV pandemic continues to cause a high burden of morbidity and mortality due to delayed diagnosis. Histoplasmosis is prevalent in Latin America and Colombia, is difficult to diagnose and has a high mortality. Here we determined the clinical characteristics and risk factors of histoplasmosis in people living with HIV (PLWH) in Pereira, Colombia. MATERIALS AND METHODS: This was a retrospective cross-sectional study (2014-2019) involving two tertiary medical centers in Pereira, Colombia. People hospitalized with HIV were included. Histoplasma antigen detection was performed in urine samples. Probable histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. RESULTS: 172 HIV-infected patients were analyzed. Histoplasmosis was confirmed in 29% (n = 50/172) of patients. The logistic regression analysis showed that the risk factors for histoplasmosis were pancytopenia (OR 4.1, 95% CI 1.6-10.3, P = 0.002), < 50 CD4 + cells/µL (OR 3.1, 95% CI 1.3-7.3, P = 0.006) and Aspartate transaminase (AST) levels > 46 IU/L (OR 3.2, 95% CI 1.3-8, P = 0.010). CONCLUSIONS: Histoplasmosis is highly prevalent in hospitalized patients with HIV in Pereira, Colombia. The clinical findings are nonspecific, but there are some clinical abnormalities that can lead to suspicion of the disease, early diagnosis and prompt treatment. Urine antigen detection is useful for diagnosis, but is not widely available. An algorithmic approach is proposed for low-resource clinical settings.

Hallazgo inusual en la tinción de Gram de hemocultivos en una paciente con neutropenia febril prolongada y leucemia mieloide aguda / Unusual finding in Gram staining of blood cultures in a patient with prolonged febrile neutropenia and acute myeloid leukaemia

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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.

Anticholinergic Risk and Frequency of Anticholinergic Drug Prescriptions in a Population Older Than 65.

OBJECTIVE: To determine the risk and frequency of anticholinergic drug prescriptions in a population affiliated with the Colombian General System of Social Security in Health. DESIGN: A cross-sectional study was conducted in 2013. PARTICIPANTS: Patients older than 65 years who received drugs with the potential to block cholinergic receptors, in accordance with an anticholinergic risk scale. MEASUREMENTS: The total anticholinergic load was determined by the sum of the risk of each prescribed drug. RESULTS: The study included a total of 27,654 patients with a mean age of 76.1 ± 7.6 years, and 61.9% were women. A total of 9.1% of the population older than 65 years had received a prescription of at least one of these drugs, and the prevalence of these prescriptions was 112.5 per 1000 members. The average number of drugs prescribed per patient was 1.4, and the drugs most frequently prescribed contained trazodone, methocarbamol, and loratadine. Being prescribed by practitioners of surgical or related specialties was the only variable significantly associated with prescriptions with high anticholinergic risk in the multivariate analysis (odds ratio 1.61; 95% confidence interval 1.335-1.934; P < .001). CONCLUSION: We found a high frequency of prescription medications with some degree of anticholinergic load, and in almost half of the patients, the anticholinergic risk score was very high. The prevalence of prescription of these drugs falls in the range of that reported globally. It is essential to educate prescribers about the risk to their patients.

Enfermedad de Moyamoya: Reporte de caso y revisión de la literatura / Moyamoya disease: Case report and review of literature

Mujer de 46 años que ingreso por cefalea súbita, hemiparesia izquierda y disartria, con tomografía axial computarizada cerebral simple que mostró hemorragia frontoparietal derecha drenada a ventrículos y arteriografía con patrón Moyamoya. Reingreso 3 meses después con deterioro del estado de consciencia y tomografía axial computarizada cerebral simple que mostró hemorragia intraparenquimatosa temporoparietal izquierda con extensión intraventricular y desviación de la línea media, se manejo en Unidad de Cuidados Intensivos con traqueostomía y gastrostomía, presentó neumonía y sepsis nosocomial, finalmente falleció en la Unidad de Cuidados Intensivos.

Woman of 46 years old that income for left hemiplegia and dysarthria, with brain computed tomography showed right frontoparietal hemorrhage drained ventricles and arteriography with Moyamoya pattern. Readmission 3 months later with deterioration of consciousness and brain computed tomography showed temporoparietal intracerebral hemorrhage with intraventricular extension and deviation from the midline, was managed with tracheostomy and gastrostomy, presented nosocomial pneumonia and sepsis, finally, after 15 days of hospitalization she died at the intensive care unit.