Prevalencia y caracterización de las neoplasias malignas en personas viviendo con VIH en Colombia

Introducción: En el síndrome de inmunodeficiencia adquirida las neoplasias han jugado un papel preponderante, y con el advenimiento del tratamiento antirretroviral (TAR), la infección por VIH se ha transformado en una enfermedad crónica, siendo los tumores malignos una causa importante de morbilidad y mortalidad. Objetivo: Describir las características demográficas, clínicas y de laboratorio de las personas que viven con VIH (PVVIH) y han sido diagnosticadas con cáncer en Colombia y comparar los grupos de neoplasias definitorias y no definitorias de Sida. Métodos: Revisión multicéntrica retrospectiva, en la que se recolectó y analizó datos relacionados con la infección por VIH y de diagnóstico de cáncer y tipo. Incluyó PVVIH diagnosticadas con neoplasias malignas atendidas en 23 centros de atención de pacientes con VIH en 11 ciudades de Colombia desde 1986 hasta 2018. Resultados: En 23.189 pacientes, se identificaron 650 casos de malignidad (prevalencia de 2,8 % [IC de 95%: 2,6-2,9]). La neoplasia definitoria de Sida (NDS) sigue siendo el tipo de cáncer prevalente (71,1%), las neoplasias malignas más frecuentes fueron sarcoma de Kaposi (n: 330; 50,8%), linfoma no Hodgkin (n: 110; 16,9%), cáncer de piel (n: 48; 7,4%) y linfoma de Hodgkin (n: 25; 3,8%). Los pacientes con NDS tenían más probabilidades de ser HSH y estar en un estadio CDC 3, un recuento de linfocitos T CD4 < 200/μL y una carga viral del VIH ≥ 50 copias/mL al momento del diagnóstico de malignidad. Las personas con neoplasias no definitorias de Sida (NNDS) eran significativamente mayores y tenían más probabilidades de ser fumadores. Conclusiones: Estos hallazgos son relevantes considerando la creciente carga de cáncer en las PVVIH que envejecen y las causas cambiantes de morbilidad y mortalidad. La presentación tardía a la atención del VIH y el retraso en el inicio del TAR son probablemente factores que contribuyen al cambio más lento hacia NNDS en comparación con las regiones de altos ingresos donde hay un acceso más rápido y temprano al TAR. El conocimiento de las tendencias epidemiológicas actuales y el perfil del cáncer en las PVVIH es fundamental para mejorar los esfuerzos de prevención y tratamiento del cáncer en el contexto de la atención integral del VIH.

Background: In the acquired immunodeficiency syndrome, neoplasms have played a preponderant role, and with the advent of antiretroviral treatment (ART), HIV has become a chronic disease, with malignant tumors being an important cause of morbidity and mortality. Aim: To describe the demographic, clinical, and laboratory characteristics of people living with HIV (PLHIV) who have been diagnosed with cancer in Colombia and to compare the groups of AIDS-defining (ADC) and non-AIDS-defining neoplasms (NADC). Methods: Retrospective, multicenter study that included people living with HIV/AIDS (PLHIV) diagnosed with malignancies treated at 23 HIV care centers located in 11 Colombian cities from 1986 to 2018. Data related to HIV infection and cancer diagnosis were collected and analyzed. Results: Among 23,189 patients, 650 malignancy cases were identified (prevalence of 2.8% [95% CI 2.6-2.9]). AIDS-defining neoplasm remains the most prevalent type of cancer (71.1%), The most frequent individual malignancies were Kaposi sarcoma (n: 330; 50.8%), non-Hodgkin lymphoma (n: 110; 16.9%), skin cancer (n: 48; 7.4%), and Hodgkin lymphoma (n: 25; 3.8%). Compared people with NADC, with ADC were more likely to be MSM and have a CDC HIV stage 3, CD4 T cell count < 200/μL, and HIV viral load ≥ 50 copies/mL at the time of malignancy diagnosis. PLHIV and with NADC were significantly older and were more likely to be smokers. Conclusions: These findings are relevant considering the increasing burden of cancer in the aging PLHIV and the changing causes of morbidity and mortality. Late presentation to HIV care and delayed ART initiation are likely factors contributing to the slower shift toward NADCs compared with high-income regions where access to ART is better. Knowledge of the current epidemiological trends and profile of cancer in PLWHA is critical to improve cancer prevention and treatment efforts in the context of comprehensive HIV care.

Reasons for antiretroviral switching in Colombia: A retrospective cohort study.

INTRODUCTION: Long-term use of antiretroviral therapy (ART) for HIV infection might lead to the necessity of switching regimens. We aimed to analyze the reasons for the ART switch, the time-to-switch of ART, and its associated factors in a Colombian cohort. METHODS: We conducted a retrospective cohort in 20 HIV clinics, including participants ≥18 years old with confirmed HIV infection who underwent an ART switch from January 2017 to December 2019 with at least 6 months of follow-up. A time-to-event analysis and an exploratory Cox model were performed. RESULTS: 796 participants switched ART during the study period. The leading cause of ART switch was drug intolerance (n = 449; 56.4%) with a median time-to-switch of 12.2 months. The longest median time-to-switch was due to regimen simplification (42.4 months). People ≥50 years old (HR = 0.6; 95% CI (0.5-0.7) and CDC stage 3 at diagnosis (HR = 0.8; 95% CI (0.6-0.9) had less hazard for switching ART over time. CONCLUSIONS: In this Colombian cohort, drug intolerance was the main cause of the ART switch, and the time-to-switch is shorter than reports from other countries. In Colombia, it is crucial to apply current recommendations for ART initiation to choose regimens with a better tolerability profile.

Diagnostic performance of two rapid tests for syphilis screening in people living with HIV in Cali, Colombia.

INTRODUCTION: There is insufficient evidence supporting the use of rapid diagnostic tests (RDTs) for syphilis in people living with HIV (PLWH). We evaluated the diagnostic performance of two commercially available RDTs (Bioline and Determine) in PLWH in Cali, Colombia. METHODS: A cross-sectional field validation study on consecutive adults with confirmed HIV diagnosis attending three outpatient clinics. Both RDTs were performed on capillary blood (CB), obtained by finger prick, and sera, by venipuncture. A combination of treponemal enzyme linked immunosorbent assay (ELISA) and Treponema pallidum haemagglutination assay (TPHA) on serum samples was the reference standard. Rapid plasma reagin (RPR) and clinical criteria were added to define active syphilis. Sensitivity and specificity, predictive values and likelihood ratios (LR) of RDTs were estimated with their corresponding 95% confidence interval (95% CI). Stratified analyses by sample type, patient characteristics, non-treponemal titers, operator and re-training were performed. RESULTS: 244 PLWH were enrolled, of whom 112 (46%) had positive treponemal reference tests and 26/234 (11.1%) had active syphilis. The sensitivities of Bioline on CB and sera were similar (96.4% vs 94.6%, p = 0.6). In contrast, Determine had a lower sensitivity on CB than sera (87.5% vs 99.1%, p<0.001). Sensitivities were lower in PLWH not receiving ART (Bioline 87.1% and Determine 64.5%, p<0.001) and for one of the operators (Bioline 85% and Determine 60%, p<0.001). Specificities of the RDTs were > 95% in most analyses. Predictive values were 90% or higher. For active syphilis, the RDTs showed a similar performance pattern but with decreased specificities. CONCLUSION: The studied RDTs have an excellent performance in PLWH to screen for syphilis and potentially for active syphilis, yet Determine performs better on sera than CB. Patient characteristics and potential difficulties operators may face in acquiring enough blood volume from finger pricks should be considered for the implementation and the interpretation of RDTs.

Experiencia en el diagnóstico de tuberculosis meníngea en un hospital de alta complejidad en Colombia / The experience of a tertiary care hospital in Colombia in the diagnosis of meningeal tuberculosis

Resumen Introducción: la tuberculosis es una de las enfermedades infecciosas de mayor distribución mundial y la tuberculosis meníngea es una de sus manifestaciones más devastadoras. Su diagnóstico y confirmación microbiológica no siempre es fácil. Objetivo: describir la experiencia en el diagnóstico de tuberculosis meníngea por pruebas moleculares comparado con cultivo, caracterizando las principales manifestaciones clínicas y determinar los factores asociados a mortalidad. Métodos: identificamos retrospectivamente a los pacientes adultos con diagnóstico de tuberculosis meníngea, mediante técnicas de pruebas moleculares y/o cultivo para M. tuberculosis, que ingresaron en nuestra institución entre enero de 2018 y marzo de 2020, se realizó un análisis estadístico descriptivo. Se excluyeron mujeres gestantes, pacientes que no contaran con prueba molecular para M. tuberculosis. Resultados: se obtuvo una muestra de 33 pacientes, los hallazgos más relevantes en el citoquímico de líquido cefalorraquídeo (LCR) fue la presencia de hipoglucorraquia, con una mediana de 34.2 mg/dL (RIQ 2.0-95.0 mg/dL) y de hiperproteinorraquia, con mediana de 265 mg/dL (RIQ 24.0-600 mg/dL). El resultado más significativo fue la presencia de proteína C reactiva elevada en suero en todos los casos, con una mediana de 53.3 mg/L (RIQ 22.9-89.6 mg/L) y neutrofilia en 75.8% (25). La mortalidad fue de 54.5% (18), la sensibilidad de la prueba molecular en LCR fue del 38.46% y el valor predictivo positivo de 58.82%. Conclusiones: el diagnóstico de TB meníngea sigue siendo todo un reto, aunque las pruebas moleculares pueden ayudar en el diagnóstico temprano, su sensibilidad es baja en formas extrapul-monares. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2115).

Abstract Introduction: tuberculosis is one of the most widely disseminated infectious diseases worldwide, and meningeal tuberculosis is one of its most devastating manifestations. Its diagnosis and microbiological confirmation is not always easy. Objective: to describe the experience in diagnosing meningeal tuberculosis through molecular tests compared to a culture, characterize the main clinical manifestations, and determine factors associated with mortality. Methods: we retrospectively identified adult patients diagnosed with meningeal tuberculosis through molecular and/or culture tests for M. tuberculosis who were admitted to our institution between January 2018 and March 2020. A descriptive analysis was performed. Pregnant women and patients who did not have a molecular test for M. tuberculosis were excluded. Results: a sample of 33 patients was obtained. The most relevant cerebrospinal fluid (CSF) cytochemical analysis findings were low glucose, with a median of 34.2 mg/dL (IQR 2.0-95.0 mg/ dL) and high protein, with a median of 265 mg/dL (IQR 24.0-600 mg/dL). The most significant result was elevated serum C-reactive protein in all cases, with a median of 53.3 mg/L (IQR 22.9 -89.6 mg/L) and neutrophilia in 75.8% (25). Mortality was 54.5% (18), the sensitivity of the CSF molecular test was 38.46% and the positive predictive value was 58.82%. Conclusions: the diagnosis of meningeal TB continues to be a challenge. While molecular tests can help provide an early diagnosis, their sensitivity is low in extrapulmonary forms. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2115).

AC-2020-12-1420.R1 - HIV care providers' familiarity, concerns, and attitudes about HIV PrEP in Colombia: insights from the PrEP-Col-Study.

In 2019, Colombia approved the combination of tenofovir disoproxil fumarate/emtricitabine for HIV Pre-Exposure Prophylaxis (PrEP). Therefore, we conducted a situational analysis in HIV-care providers to identify barriers and facilitators for PrEP implementation. A survey was applied to a non-probabilistic sample of health care workers of HIV-specialized clinics. We examined PrEP awareness and familiarity, comfort with PrEP-related activities, perceived barriers for PrEP implementation, concerns, and attitudes. Poisson regressions assessed the relationship between these factors and the variable "having a plan to offer PrEP". The participation rate was 41% and included physicians (42.6%) and other health professionals (57.4%). Fifty-one percent of the participants reported more than five years of experience caring for people living with HIV. Forty-two percent of non-physician health care workers were nurses. Most reported high familiarity/comfort with PrEP-relevant activities. Concerns about PrEP were prevalent (> 50%) and included causing more harm than good, reducing condom use, medication non-adherence, drug resistance, and healthcare system barriers. Physicians had a plan to offer PrEP (72.2%) more often than other health professionals (52.6). Having a plan to offer PrEP was related to PrEP knowledge and comfort assessing sexual behavior and providing HIV counseling. Overall, about half of HIV-care providers seemed ready to offer PrEP and constitute an asset for PrEP implementation efforts in Colombia. PrEP awareness among non-physicians, PrEP concerns, and negative attitudes need to be addressed to enhance implementation.

COVID-19 and VIH.

Throughout the COVID-19 pandemic, the main risk factors associated with the progression to severe disease or death have been typically advanced age, diabetes mellitus, obesity, high blood pressure, heart disease, and chronic pneumopathy. Because of their immunosuppression status, persons with HIV were also expected to have a higher susceptibility to infection or a poor clinical evolution. So far, this has not been confirmed to happen, giving way to hypotheses about the role of immunosuppression or the use of antiretrovirals, which could explain this paradox. In this article we present the existing data on the epidemiology and characteristics of HIV-COVID-19 co-infection, discuss the available evidence on the possible factors involved in the evolution of individuals affected by both viruses, analyze other determinants that may negatively affect persons with HIV during the pandemic, and present recommendations for the prevention and care of COVID-19 infection in the context of HIV.

A través de la pandemia por COVID-19, los factores de riesgo que se han asociado con progresión a enfermedad severa o muerte han sido característicamente la edad avanzada, diabetes mellitus, obesidad, hipertensión arterial, cardiopatía y neumopatía crónica. Por su condición de inmunosupresión, se esperaba que las personas viviendo con VIH (PVV) también presentaran una mayor susceptibilidad a la infección o una pobre evolución clínica. Hasta el momento no se ha confirmado que esto suceda, dando paso a hipótesis sobre el papel de la inmunodepresión o el uso de antirretrovirales, que podrían explicar esta paradoja. En este artículo presentamos la información que existe hasta el momento sobre la epidemiología y características de la coinfección VIH/COVID-19, discutiendo la evidencia disponible sobre los posibles factores implicados en la evolución de los individuos afectados por ambos virus, analizamos otros determinantes que pueden afectar de forma negativa a las PVV durante la pandemia y presentamos recomendaciones para la prevención y el cuidado de la infección por COVID-19 en el contexto de VIH.

COVID-19 and VIH / Covid-19 y hiv

Abstract Throughout the COVID-19 pandemic, the main risk factors associated with the progression to severe disease or death have been typically advanced age, diabetes mellitus, obesity, high blood pressure, heart disease, and chronic pneumopathy. Because of their immunosuppression status, persons with HIV were also expected to have a higher susceptibility to infection or a poor clinical evolution. So far, this has not been confirmed to happen, giving way to hypotheses about the role of immunosuppression or the use of antiretrovirals, which could explain this paradox. In this article we present the existing data on the epidemiology and characteristics of HIV-COVID-19 co-infection, discuss the available evidence on the possible factors involved in the evolution of individuals affected by both viruses, analyze other determinants that may negatively affect persons with HIV during the pandemic, and present recommendations for the prevention and care of COVID-19 infection in the context of HIV.

Resumen A través de la pandemia por COVID-19, los factores de riesgo que se han asociado con progresión a enfermedad severa o muerte han sido característicamente la edad avanzada, diabetes mellitus, obesidad, hipertensión arterial, cardiopatía y neumopatía crónica. Por su condición de inmunosupresión, se esperaba que las personas viviendo con VIH (PVV) también presentaran una mayor susceptibilidad a la infección o una pobre evolución clínica. Hasta el momento no se ha confirmado que esto suceda, dando paso a hipótesis sobre el papel de la inmunodepresión o el uso de antirretrovirales, que podrían explicar esta paradoja. En este artículo presentamos la información que existe hasta el momento sobre la epidemiología y características de la coinfección VIH/COVID-19, discutiendo la evidencia disponible sobre los posibles factores implicados en la evolución de los individuos afectados por ambos virus, analizamos otros determinantes que pueden afectar de forma negativa a las PVV durante la pandemia y presentamos recomendaciones para la prevención y el cuidado de la infección por COVID-19 en el contexto de VIH.

Evaluación y manejo del riesgo cardiovascular en infección por VIH. Consenso de expertos ACIN / Evaluation and management of cardiovascualr risk in VIH infection: Expert consensus of ACIN (Colombian Association of Infectious Diseases)

Los pacientes con infección por VIH tienen una mayor incidencia de eventos cardiovasculares en comparación con la población general; los factores que contribuyen al incremento del riesgo de eventos cardiovasculares son la prevalencia de factores de riesgo cardiovascular tradicionales (FRCV), la infección por VIH que condiciona tanto un proceso de inflamación crónica como alteración de la función endotelial y la exposición a los antirretrovirales. Los factores que deben ser objeto de intervención son los FRCV tradicionales, en especial la alta tasa de fumadores entre este grupo de pacientes, la tamización y tratamiento de HTA, el síndrome metabólico y el acceso temprano a la terapia antirretroviral con medicamentos con mayor perfil de seguridad . Esta guía pretende proveer información y recomendaciones en el ámbito nacional acerca de la relación entre la infección por VIH/SIDA (Síndrome de Inmunodeficiencia Adquirida), uso de antirretrovirales y riesgo cardiovascular.

Patients with VIH infection have greater risk for cardiovascular diseases compared to general population. Risk factors that increase the frequency of cardiovascular events are: presence of cardiovascular traditional risk factors, chronic inflammation by HIV that impairs endothelial function and the exposure to antiretrovirals. The factors that should be the target for intervention are the traditional know cardiovascular factors such, especially high rate of smokers, screening and treatment for hypertension, metabolic syndrome and early access to HAART. The present guidelines provides information about the use of antiretrovirals in patients with HIV and its relation with cardiovascular risk.

HLA-B*57:01 allele prevalence in treatment-Naïve HIV-infected patients from Colombia.

BACKGROUND: The HLA-B*57:01 allele is associated with a hypersensitivity reaction to abacavir. Due to the lack of knowledge of HLA-B*57:01 prevalence in Colombia, routine screening is not performed and is not recommended by the national guidelines. We aimed to determine the prevalence of HLA-B*57:01 in HIV population from Colombia. METHODS: This cross-sectional study included naïve HIV-infected adults from 13 cities of the country. The presence of HLA-B*57:01 was determined by using SSP-PCR in blood samples. Prevalence rates were stratified by sex, race, and region of origin. RESULTS: HLA-B*57:01 allele prevalence in Colombian HIV-infected individuals was 2.7%. When stratifying for the race, the prevalence was 4% for whites, 2.6% for other race (mainly mestizo), and 1.9% for Afro-Colombians. The prevalence varied from 0% up to 11.4% depending on the department of origin. The highest prevalence rates were found in Caldas (11.4%), Antioquia (5%), Risaralda (4.8%), and Valle del Cauca (4.3%). When distributed by country zones, the central, with a racial predominance of Caucasians and mestizos, was the highest (6.0%, 0R = 4.1, CI 1.2-12.8, p = 0,016). CONCLUSIONS: The overall prevalence of HLA-B*57:01 in Colombia was lower than the reported rates for other Latin American countries such as Brazil, Costa Rica, and Argentina, but similar in comparison to Chile and Mexico. The diversity in the racial and ethnic heritage shown in our data supports the recommendation to implement routine screening for the HLA-B*57:01 allele before initiation of abacavir-containing antiretroviral therapy in the Colombian HIV management guidelines.

Tigeciclina en infecciones intraabdominales complicadas / Tigecycline in complicated intra-abdominal infections

Objetivo: evaluar la mejor evidencia actual disponible para generar recomendaciones, con respecto a la efectividad y seguridad del uso de tigeciclina en adultos con infección intraabdominal complicada. Materiales y métodos: se realizó una revisión sistemática de la literatura, seleccionando los metaanálisis y experimentos clínicos controlados, los cuales se valora- ron utilizando la herramienta SIGN, con el fin de generar tablas de evidencia según GRADE de los estudios de tigeciclina en la indicación infección intraabdominal complicada, para posteriormente utilizar un proceso Delphi modificado para calificar las diferentes recomendaciones con el fin de generar un consenso. Resultados: se analizaron los resultados basados en la revisión sistemática de la literatura en la que se incluyeron 5 metaanálisis que cumplieron los criterios de selección comparando tigeciclina con otros tratamientos antibióticos en infección intraabdominal complicada; de los cuales, 2711 pacientes recibieron al menos una dosis del antibiótico (1382 tigeciclina y 1389 el comparador) y en los que no se observaron diferencias estadísticamente significativas en los desenlaces evaluados al comparar tigeciclina con otros antibióticos. Conclusión: en pacientes adultos con infección intraabdominal complicada, se considera que el uso de tigeciclina en monoterapia es equivalente en eficacia y seguridad a otras opciones terapéuticas antimicrobianas y no representa un exceso de mortalidad en comparación a otros antibióticos

Objective: To assess current best evidence available to generate recommendations regarding the effectiveness and safety of tigecycline use in adults with complicated intra-abdominal infection (cIAIs). Materials and methods: We conducted a systematic review of published meta-analysis that evaluated tigecycline compared to other antimicrobials and included the indication of cIAI. Quality of the evidence was evaluated by using the SIGN tool (Scottish Intercollegiate Guidelines Network) according to GRADE, and final recommendations were assessed by a modified Delphi Method in order to develop a consensus. Results: Five meta-analyzes met the selection criteria comparing tigecycline with other antibiotic treatments in complicated intra-abdominal infection. Five randomized clinical trials comprised in these meta-analysis included 2711 patients that received at least one dose of antibiotic (1382 tigecycline and 1389 the comparator regimen), We found no statistically significant differences in the evaluated outcomes by comparing tigecycline with other antibiotics, including clinical and microbiologic efficacy, safety and drug related mortality Conclusion: In adult patients with cIAIs, the use of tigecycline as monotherapy is equivalent in effectiveness to other antimicrobial therapeutic options and does not represent an increase in mortality compared to other antibiotics.

The HIV care continuum in Latin America: challenges and opportunities.

Combination antiretroviral therapy (ART), also known as highly active antiretroviral therapy, provides clinical and immunological benefits for people living with HIV and is an effective strategy to prevent HIV transmission at the individual level. Early initiation of ART as part of a test and treat approach might decrease HIV transmission at the population level, but to do so the HIV continuum of care, from diagnosis to viral suppression, should be optimised. Access to ART has improved greatly in Latin America, and about 600,000 people are on treatment. However, health-care systems are deficient in different stages of the HIV continuum of care, and in some cases only a small proportion of individuals achieve the desired outcome of virological suppression. At present, data for most Latin American countries are not sufficient to build reliable metrics. Available data and estimates show that many people living with HIV in Latin America are unaware of their status, are diagnosed late, and enter into care late. Stigma, administrative barriers, and economic limitations seem to be important determinants of late diagnosis and failure to be linked to and retained in care. Policy makers need reliable data to optimise the HIV care continuum and improve individual-based and population-based outcomes of ART in Latin America.

Frecuencia de aislamientos microbiológicos y perfil de resistencia bacteriana en 13 clínicas y hospitales de alta complejidad en Santiago de Cali - Colombia / Frequency and antibiotics resistance profi les of microbiological isolates at 13 clinics and referral hospitals in Santiago de Cali - Colombia

Introducción: La resistencia bacteriana se consolida como una amenaza para los sistemas de salud en el manejo de las enfermedades infecciosas. La vigilancia epidemiológica de la resistencia bacteriana ha demostrado ser una estrategia efectiva para conocer los patrones de susceptibilidad a los antimicrobianos regionales para el desarrollo de medidas de contención y gestión del uso adecuado de antimicrobianos. Objetivo: Describir los aislamientos microbiológicos y perfiles de resistencia a los antimicrobianos de las principales bacterias gram-negativas y gram-positivas en clínicas y hospitales de alta complejidad de Santiago de Cali, Colombia. Metodología: Estudio descriptivo enmarcado en la estrategia de vigilancia epidemiológica de la resistencia bacteriana desarrollado entre el año 2010 al 2012 en 13 instituciones de alta complejidad. Se recolectaron archivos mensualmente en formato WHONET, se realizaron pruebas de calidad de datos. El análisis fue estratificado por tipos de localización hospitalaria, además de análisis de tendencia a través de los 3 años de seguimiento. Resultados: El 65% de los aislamientos son bacterias de la familia enterobacteriaceae y el 11,4% corresponden a Staphylococcus spp., Escherichia coli presenta hasta un 17% de resistencia a cefalosporinas de 3.ª generación mientras que Klebsiella pneumoniae ha incrementado su perfil de resistencia a carbapenémicos hasta un 2,7% en las UCI; Pseudomonas aeruginosa presenta un perfil MDR de hasta el 21% en UCI y salas de hospitalización general. Conclusiones: Existen altas prevalencias de resistencia a los antimicrobianos en la región; se requiere fortalecer estrategias de vigilancia, prevención y control de la resistencia bacteriana en ambientes hospitalarios y de la comunidad.

Background: Bacterial resistance has established itself as a threat to healthcare systems in the management of infectious diseases. Epidemiological surveillance of bacterial resistance has proven to be an effective strategy to examine the patterns of antimicrobial susceptibility in order to develop regional containment strategies and to manage the appropriate use of antibiotics. Objective: To describe the microbiological profiles of isolates and the antimicrobial resistance of major gram-negative and gram-positive bacteria in clinics and hospitals of Santiago de Cali, Colombia. Methods: Descriptive study framed by the epidemiological surveillance strategy of the bacterial resistance developed between the years 2010 to 2012 in 13 institutions of higher complexity. Files were collected monthly in WHONET format and were tested for data quality. The analysis was stratified by type of hospital location, in addition to a trend analysis over the 3-year follow-up period. Results: A total of 65% of the isolates were of the Enterobacteriaceae family and 11.4% were Staphylococcus spp . Escherichia coli showed up to 17% resistance to 3rd generation cephalosporins, while Klebsiella pneumoniae increased its carbapenem resistance profile to 2.7% in the ICU. Pseudomonas aeruginosa presented a multidrug resistant (MDR) profile of up to 21% in ICU and in the general ward. Conclusions: There is a high prevalence of antimicrobial resistance in the region; we must strengthen strategies for surveillance, prevention and control of bacterial resistance in hospital settings and in the community .

Recomendaciones para el diagnóstico, tratamiento y prevención de la neumonía adquirida en la comunidad en adultos / Diagnosis, treatment and prevention recommendations for adult community-acquired pneumonia

Definición: la NAC es la infección aguda del parénquima pulmonar que se desarrolla fuera del ambiente hospitalario, se maniefiesta en las primeras 48 horas del ingreso al hospital o después de siete días de haber egresado. Cuadro clínico: Síntomas de una infección aguda del tracto respiratorio inferior: tos y por lo menos uno de los siguientes: expectoración mucopurulenta, dolor torácico de tipo pleurítico, disnea. Por lo menos un síntoma o signo sistémico: sensación de fiebre, suduración, dolores, malestar general y/o temperatura de 38.3°C O más. Infiltrado focal o asimétrico, en la radiografía del tórax, que no se haya observado o descrito previamente y para el cual no se tenga otra explicación. Al examen físico del tórax se puede encontrar o no anormalidades, generalmente localizadas o asimétricas, o signos de consolidación pulmonar. Epidemiología: la NAC es una enfermedad frecuente cuya incidencia varía de acuerdo con la edad, es mayor en los extremos de la vida (mayores de 65 años y menores de cinco) La neumonía es una enfermedad con un alto índice de morbilidad y mortalidad. La mortalidad general producida por la NAC oscila entre 1 por ciento y 25 por ciento, y depende de múltiples factores, entre los que destacan la severidad de la enfermedad y el german causante. Etiología: la posivilidad de identificar el german causante NAC, aun en las mejores condiciones, es relativamente baja (40 por ciento a 60 por ciento). Para el caso colombiano es importante destacar: La causa más frecuente es el S.pneumoniae. M. tuberculosis debe considerarse como causa de NAC en el país, aunque su frecuencia real se desconoce, pero pueden presentarse hasta en 20 por ciento de casos...(AU: Asociación Colombiana de Neumología y Cirugía de Tórax; Asociación Colombiana de Infectología; Asociación Colombiana de Medicina Interna)