Factores asociados: características clínicas, microbiológicas y perfiles de resistencia en infecciones urinarias asociadas a catéter en dos hospitales de alta complejidad / Associated factors clinical and microbiological characteristics and resistance profiles in catheter-associated urinary tract infections in two highly complex hospitals

Resumen Objetivo: Determinar los factores asociados, las características clínicas, microbiológicas y perfiles de resistencia en las infecciones sintomáticas de tracto urinario asociado a catéter (ISTU-AC) en los dos Instituciones de alto nivel de complejidad. Materiales y métodos: Se llevó a cabo un estudio de casos y controles. Se incluyeron todos los pacientes con más de 48 horas de hospitalización con inserción de catéter urinario y se recolectaron todas las variables clínicas y microbiológicas de cada paciente. Se incluyeron 446 pacientes, 223 con infección sintomática del tracto urinario asociado a catéter. El análisis multivariado se realizó por medio de regresión logística. Resultados: Se evidenció una mayor proporción de hombres en los controles (60,5%) en comparación con los casos (51,1%), la mediana de la edad fue muy similar para los dos grupos de estudio. Se evidenció por el análisis de regresión logística multivariado que la estancia en UCI (OR 2,176; IC de 95% 1,332 - 3,555), más de 10 días de catéter urinario (OR 2,907; IC de 95% 1,744 - 4,846) y la terapia antibiótica previa (OR 0,060; IC de 95% 0,037 - 0,103) fueron los principales factores asociados con la ocurrencia de ISTU-AC. No se encontró asociación entre presentar el evento de interés y la edad, esta variable no está relacionada con la pre sencia de infecciones intrahospitalarias. Es probable que las comorbilidades, presentes con más frecuencia en el adulto mayor, hayan sobrepasado el efecto de la edad en esos estudios. La asociación con género no fue identificada como un factor de riesgo, lo cual podría esperarse, dado que el uso de la sonda vesical hace equiparable el riesgo entre los hombres y las mujeres. Conclusiones: Este estudio mostró que la infecciones sintomáticas de tracto urinario asociado a catéter sigue siendo la entidad más frecuente) en el ámbito hospi talario, poniendo en riesgo la seguridad de los pacientes y aumentando tanto las tasas de morbi-mortalidad

Summary Objective: To determine the associated factors, clinical and microbiological characteristics, and resistance profiles in symptomatic urinary tract infections associated with catheters in the two institutions with a high level of complexity. Materials and methods: A case-control study was carried out. All patients with more than 48 hours of hospitalization with urinary catheter insertion were included and all the clinical and microbiological variables of each patient were collected. 446 patients were included, 223 with symptomatic urinary tract infection associated with a catheter. The multivariate analysis was carried out by means of logistic regression. Results: A greater proportion of men was evidenced in the controls (60.5%) compared to the cases (51.1%), the median age was very similar for the two study groups. It was evidenced by the multivariate logistic regression analysis that the stay in the ICU (OR 2.176; 95% CI 1.322 - 3.555), more than 10 days of urinary catheter (OR 2.907; 95% CI 1.744 - 4.846) and antibiotic therapy previous (OR 0.060; 95% CI 0.037 - 0.103) were the main factors associated with the occurrence of CA-UTI. No association was found between presenting the event of interest and age, this variable is not related to the presence of intrahospital infections. Co morbidities, which are more frequently present in the elderly, are likely to have outweighed the effect of age in these studies. The association with gender was not identified as a risk factor, which could be expected, since the use of the urinary catheter makes the risk comparable between men and women. Conclusions: This study showed that symptomatic urinary tract infections associated with catheters are still a frequent entity in the hospital setting, putting the safety of patients at risk and increasing both morbidity and mortality rates

Hospitalization causes and outcomes in HIV patients in the late antiretroviral era in Colombia.

BACKGROUND: Antiretroviral therapy (ART) has modified the natural history of HIV-infection: the incidence of opportunistic infections (OIs) has decreased and mortality associated to HIV has improved dramatically. The reasons for hospitalization have changed; OIs are no longer the most common reason for admission. This study describes the patient population, admission diagnosis and hospital course of HIV patients in Colombia in the ART era. METHODS: Patients admitted with HIV/AIDS at six hospitals in Medellin, Colombia between August 1, 2014 and July 31, 2015 were included. Demographic, laboratory, and clinical data were prospectively collected. RESULTS: 551 HIV-infected patients were admitted: 76.0% were male, the median age was 37 (30-49). A new diagnosis of HIV was made in 22.0% of patients during the index admission. 56.0% of patients of the entire cohort had been diagnosed with HIV for more than 1 year and 68.9% were diagnosed in an advanced stage of the disease. More than 50.0% of patients had CD4 counts less than 200 CD4 cells/µL and viral loads greater than 100,000 copies. The main reasons for hospital admissions were OIs, tuberculosis, esophageal candidiasis and Toxoplasma encephalitis. The median hospital stay was 14 days (IQR 8-23). Admission to the intensive care unit (ICU) was required in 10.3% of patients and 14.3% were readmitted to the hospital; mortality was 5.4%. CONCLUSIONS: Similar to other countries in the developing world, in Colombia, the leading cause of hospitalization among HIV-infected patients remain opportunistic infections. However, in-hospital mortality was low, similar to those described for high-income countries. Strategies to monitor and optimize the adherence and retention in HIV programs are fundamental to maximize the benefit of ART.

Sensibilidad a fluconazol y voriconazol de especies de Candida aisladas de pacientes provenientes de unidades de cuidados intensivos en Medellín, Colombia (2001–2007) / Susceptibility to fluconazole and voriconazole of Candida species isolated from intensive care units patients in Medellin, Colombia (2001–2007)

Antecedentes. Diferentes especies de Candida causan candidiasis diseminada, y esta afecta especialmente a pacientes inmunodeprimidos y a los que se encuentran hospitalizados en unidades de cuidados intensivos (UCI). Objetivo. Determinar la frecuencia y sensibilidad al fluconazol y al voriconazol de aislamientos de Candida spp. provenientes de pacientes en UCI y remitidos a la Corporación para Investigaciones Biológicas para estudios de sensibilidad entre el 2001–2007. Métodos. Se utilizó la técnica de difusión en agar siguiendo las especificaciones del Clinical and Laboratory Standard Institute (M44A). La prueba de Chi2 y la prueba de Kruskal Wallis se utilizaron para comparar los cambios en la frecuencia de aislamientos de Candida spp. y la sensibilidad a los azoles según el año de aislamiento. Resultados. Del total de 337 aislamientos, 147 (43,6%) correspondieron a Candida albicans, seguidos por Candida tropicalis con 79 aislamientos (23,4%), Candida parapsilosis con 47 aislamientos (13,9%), Candida glabrata con 32 aislamientos (9,5%), Candida guilliermondii con 12 aislamientos (3,6%) y Candida krusei con 11 aislamientos (3,3%). El 2,7% restante correspondió a otras especies (Candida famata, Candida lusitaniae, Candida lipolytica, Candida pelliculosa y Candida spp.). De estos aislamientos, el 78,3% fue sensible, el 11,9% sensible dependiente de la dosis y el 9,8% resistente al fluconazol. Para el voriconazol, el 94% sensible, el 2,4% sensible dependiente de la dosis y el 3,6% fue resistente. Conclusiones. Estos datos señalan un cambio en la frecuencia de especies aisladas así como la presencia de nuevos patrones de sensibilidad, lo que hace necesario la tipificación y la realización de pruebas de sensibilidad a los antifúngicos para conocer las características de los aislamientos circulantes y, de esta manera, predecir un tratamiento exitoso(AU)

Background. Disseminated candidiasis is caused by different Candida species and mainly affects immunocompromised patients and those hospitalized in intensive care units (ICU). Objective. Our aim was to determine the frequency and susceptibility of Candida spp. isolates to fluconazole and voriconazole, obtained from patients hospitalized in ICU in the city of Medellin during the years 2001–2007. Methods. The agar diffusion technique based on the protocols recommended by the CLSI from the United States (M44A) was used. The Chi2 test and the Kruskal Wallis statistical methods were used to compare changes in the frequency of Candida spp. isolates and their susceptibility to azoles by year of isolation. Results. A total of 337 isolates were analyzed, 147 (43.6%) of which corresponded to Candida albicans, followed by 79 (23.4%) Candida tropicalis, 47 (13.9%) Candida parapsilosis, 32 (9.5%) Candida glabrata, 12 (3.6%) Candida guilliermondii and 11 (3.3%) Candida krusei. The remaining isolates (2.7%) were distributed among other species (Candida famata, Candida lusitaniae, Candida lipolytica, Candida pelliculosa and Candida spp.) Most of these isolates (78.3%) were susceptible; 11.9% were dose-dependent susceptible (DDS) and 9.8% resistant to fluconazole. For voriconazole, we observed that 94.1% of the isolates were susceptible, 2.4% DDS and 3.6% resistant. Conclusions. These data indicate a notable change in the species frequency, as well as a new susceptibility patterns that requires the precise identification of the causative organism and susceptibility testing in order to determine the characteristics of the isolates circulating in ICUs and then to treat them appropriately(AU)

Pacientes con tromboembolismo pulmonar: caracterizacion / Patients with pulmonary thromboembolism: characterization

El tromboembolismo pulmonar, es una complicacion frecuente en la practica medica, con una letalidad que oscila entre 13 y 58 %, de acuerdo con su gravedad. Es por esta razon, que es necesario conocer las caracteristicas epidemiologicas y clinicas, de los pacientes con esta patologia en nuestro medio. Metodos:se reslizó un estudio descriptivo retrospectivo,en pacientes atendidos en la Clínica Cardiovascular Sabta María de la ciudad de Medellín, durante los años 1996 a 2004. Resultados: en total, se encontraron 94 registros con diagnóstico de tromboembolismo pulmonar confirmado. el 51% de los pacientes, se encontraban hospitalizados. los principales factores de riesgo encontrados, fueron: trombosis venosa profunda, reposo en cama, síndrome de falla cardíaca y antecedente de enfermedad tromboembolitica...

Background: Pulmonary embolism (PE), is a common complication in clinical practice. Mortality is between 13% and 58%, according to severity. Because of that, it is very important to know the epidemiologic and clinic characteristics of patients in our city. Methods: This was a retrospective descriptive study on patients admitted at the Santa Maria Cardiovascular Clinic ofMedellín, between 1994 and 2004. Results: We found 94 charts with confirmed diagnosis of PE, 51% belonged to inpatients. The main risk factors found, were deep venous thrombosis (DVT), being bedridden, heart failure and patients with priorvenous embolism...

El caso de infecciosas. Histoplasmosis osea / The case of infectious diseases. Histoplasmosis bone

Se presenta el caso de un paciente de 11 años de edad con una lesión lítica en la tibia izquierda, diagnosticada como linfoma de células B y tratado con quimioterapia durante nueve meses, al final de los cuales se observó la presencia de nuevas lesiones líricas en el miembro inferior derecho y la persistencia de las lesiones tibiales izquierdas. La biopsia de estas lesiones reportó estructuras compatibles con H. capsulatum. El paciente fue tratado con itraconazol por 12 meses, terapia que controló adecuadamente el proceso micótico.

This is a case ofa 11 years old boy with a lytic lesion on his left tibia, diagnosed as a B Cell Lymphoma and treated with chemotherapy during nine months, atter which new lytic lesions where noticed on his right inferior limb as well as the persistence of the left tibial lesions. The biopsy yielded structures compatible with H. capsulatum. The patient was treated with ltraconazol during 12 months; the mycotic process was appropriately treated with this therapy.