RESUMO
Introduction: With the use of pneumococcal conjugate vaccines(PCV), the behavior of invasive pneumococcal disease(IPD) has changed relative to serotype distribution. The introduction of these vaccines in national immunization programs has reduced the incidence of IPD, with a marked decrease in the circulation of the serotypes included in the vaccine used in each country. However, the subsequent emergence of other serotypes not included in the vaccine, such 19A in case of PCV7 and PCV10, has been documented. Materials and methods: This was case series study (2008-2017) in pediatric patients admitted to 10 hospitals in Bogota who were diagnosed with IPD. It was conducted during the transitional period of implementing the PCV10 vaccine in Colombia in 2012. Cases of bacteremic pneumococcal pneumonia, meningitis, primary bacteremia and osteoarticular infection were included. A descriptive analysis of the demographic, clinical and laboratory variables of patients with IPD by Spn19A, its trend over time, profiles of antimicrobial susceptibility and clinical outcomes was performed. Results: There were 463 cases of IPD, 315(68%) with known serotypes. The prevalence of IPD by Spn19A was 17.7%(56 cases), tending to increase over time. During 2008-2011, the prevalence was 4.4%, and during 2014-2017, it was 32.4%, The most frequent diagnosis was pneumonia(80.4%). In nonmeningeal isolates, 39.6% were not susceptible to penicillin. An increase in the resistance was observed over time. Conclusion: Spn19A is a prevalent cause of IPD in the pediatric population of the analyzed cohort, with an increasing trend of this serotype during the surveillance period after the introduction of PCV10, being the most common serotype identified in recent years.
Assuntos
Infecções Pneumocócicas , Streptococcus pneumoniae , Criança , Colômbia/epidemiologia , Humanos , Incidência , Lactente , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas , Sorogrupo , SorotipagemRESUMO
INTRODUCTION: Resistant infections, especially those involving the bloodstream, are associated with a greater use of resources. Their estimates are variable and depend on the methodology used. Staphylococcus aureus is the main pathogen isolated in blood in our hospitals. There is no consolidated data about economic implications of methicillin-resistant S. aureus infection. OBJECTIVE: To describe the cost of care of methicillin-resistant S. aureus bacteremia in a reference population from nine hospitals in Bogotá. Materials y methods: A multicenter cohort study included 204 patients in a 1:1 ratio according to resistance. Direct medical costs were calculated from hospitalization bills, while the bacteremia period was calculated by applying microcosting based on standard fares. RESULTS: We found no significant differences between groups in demographic and clinical characteristics, except for resistance risk factors. Fifty-three percent of patients died during hospitalization. Hospital stay and total invoiced value during hospitalization were significantly higher in the group with methicillin-resistant S. aureus bacteremia. For this group, higher costs in ICU stay, antibiotics use, intravenous fluids, laboratory tests and respiratory support were recorded. A crude increase of 31% and an adjusted increase of 70% in care costs associated with methicillin resistance were registered. CONCLUSION: Our study supports decision makers in finding and funding infection prevention programs, especially those infections caused by resistant organisms.
Assuntos
Bacteriemia/economia , Cuidados Críticos/economia , Infecção Hospitalar/economia , Hospitais Privados/economia , Hospitais Públicos/economia , Hospitais Urbanos/economia , Unidades de Terapia Intensiva/economia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/economia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Técnicas de Laboratório Clínico/economia , Colômbia , Custos e Análise de Custo , Estado Terminal , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Custos de Medicamentos , Feminino , Hidratação/economia , Gastos em Saúde , Custos Hospitalares , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Terapia Respiratória/economia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologiaRESUMO
Introducción. Las infecciones por microorganismos resistentes, especialmente las que involucran el torrente sanguíneo, se asocian a un mayor uso de recursos. Sus estimaciones son variables y dependen de la metodología utilizada. Staphylococcus aureus es el agente de sangre aislado con mayor frecuencia en nuestro medio. No existe información sobre el costo asociado con la atención de bacteriemias por S. aureus resistente a meticilina en nuestro país. Objetivo. Presentar una aproximación del costo de atención de las bacteriemias por S. aureus resistente a la meticilina en nueve hospitales de Bogotá. Materiales y métodos. Se incluyeron 204 pacientes en un estudio de cohortes multicéntrico en una razón de 1:1 según la resistencia. Se aproximaron los costos médicos directos con base en las facturas del período de hospitalización; en cuanto al período de la bacteriemia, los costos detallados se calcularon aplicando las tarifas estandarizadas. Resultados. No se encontraron diferencias significativas en las características clínicas y demográficas de los grupos, salvo en los antecedentes de la bacteriemia. El 53 % de los sujetos falleció durante la hospitalización. La estancia y el valor total facturado por la hospitalización fueron significativamente mayores en el grupo con bacteriemia por S. aureus resistente a la meticilina, así como los costos de la estancia en cuidados intensivos, de los antibióticos, los líquidos parenterales, los exámenes de laboratorio y la terapia respiratoria. El incremento crudo del costo de la atención asociado con la resistencia a meticilina fue de 31 % y, el ajustado, de 70 %. Conclusión. Este estudio constituye un respaldo a los tomadores de decisiones para la búsqueda y la financiación de programas de prevención de infecciones causadas por microorganismos resistentes.
Introduction: Resistant infections, especially those involving the bloodstream, are associated with a greater use of resources. Their estimates are variable and depend on the methodology used. Staphylococcus aureus is the main pathogen isolated in blood in our hospitals. There is no consolidated data about economic implications of methicillin-resistant S. aureus infection. Objective: To describe the cost of care of methicillin-resistant S. aureus bacteremia in a reference population from nine hospitals in Bogotá. Materials y methods: A multicenter cohort study included 204 patients in a 1:1 ratio according to resistance. Direct medical costs were calculated from hospitalization bills, while the bacteremia period was calculated by applying microcosting based on standard fares. Results: We found no significant differences between groups in demographic and clinical characteristics, except for resistance risk factors. Fifty-three percent of patients died during hospitalization. Hospital stay and total invoiced value during hospitalization were significantly higher in the group with methicillin-resistant S. aureus bacteremia. For this group, higher costs in ICU stay, antibiotics use, intravenous fluids, laboratory tests and respiratory support were recorded. A crude increase of 31% and an adjusted increase of 70% in care costs associated with methicillin resistance were registered. Conclusion: Our study supports decision makers in finding and funding infection prevention programs, especially those infections caused by resistant organisms.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bacteriemia/economia , Cuidados Críticos/economia , Infecção Hospitalar/economia , Hospitais Privados/economia , Hospitais Públicos/economia , Hospitais Urbanos/economia , Unidades de Terapia Intensiva/economia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/economia , Antibacterianos/economia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Colômbia , Custos e Análise de Custo , Estado Terminal , Técnicas de Laboratório Clínico/economia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Custos de Medicamentos , Hidratação/economia , Gastos em Saúde , Custos Hospitalares , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Terapia Respiratória/economia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologiaRESUMO
Introduction: Candidemia is an infectious complication with high morbidity and mortality in intensive care patients. Objective: The aim of this study was to determine the incidence and prevalence of candidemia in critically ill patients in Colombian hospitals between 2004 and 2008. Materials and Methods: Data from microbiologically confirmed candidemia cases, ICU stay and admissions were retrospectively recorded in 7 Colombian hospitals between 2004 and 2008. Time series analysis was performed with monthly incidence (number of cases of candidemia in relation to the number of patient-days) and prevalence (number of cases of candidemia in relation to the number of admissions) for each institution and the whole group. Results: 382 cases of candidemia were identified, with an incidence of 2,3 cases per 1.000 patient-days in ICU, and a prevalence of 1,4%. There was a trend to increased incidence (0,0066 additional cases per 1.000 ICU-days per month) and prevalence (0,0016 additional cases por 100 patients per month) of candidemia. This increase of candidemia cases was due to a rise of non- albicans Candida species, which corresponded to 44% of total isolates. Discusion and Conclusions: Candidemia cases in colombian ICUs are increasing, especially those caused by non albicans Candida species.
Introducción: La candidemia es una complicación con alta morbilidad y mortalidad en pacientes en cuidado intensivo. Objetivo: Determinar la incidencia y prevalencia de candidemia en hospitales colombianos entre 2004 y 2008. Materiales y Métodos: En siete hospitales colombianos se obtuvieron retrospectivamente los datos de candidemia confirmada por el laboratorio y de estancia y egreso en unidades de cuidado intensivo. Se construyeron series de tiempo de densidad de incidencia (definida como el número de casos de candidemias en el mes en relación al número de días-pacientes hospitalizados) y de densidad de prevalencia mensuales (número de casos de candidemias en el mes en relación al número de egresos) para cada institución y para el conjunto de hospitales. Resultados: Se identificaron 3 82 casos, con una incidencia de 2,3 casos por 1.000 días de estancia en UCI, y una prevalencia fue de 1,4%. Se observó una tendencia al aumento en la incidencia (0,0066 casos adicionales por cada 1.000 días de estancia por mes) y en la prevalencia de candidemia (0,0016 casos adicionales por 100 pacientes por mes). El aumento en la prevalencia y en la incidencia se observó a partir de un incremento en las especies de Candida no albicans, la cual correspondió a 44% de los aislados totales. Discusión y conclusiones: La incidencia y la prevalencia de candidemia en Colombia son elevadas y van en aumento, especialmente a expensas de casos de Candida no albicans.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Candidemia/epidemiologia , Infecção Hospitalar/epidemiologia , Estado Terminal , Candidemia/microbiologia , Colômbia/epidemiologia , Infecção Hospitalar/microbiologia , Incidência , Prevalência , Estudos RetrospectivosRESUMO
Pseudomonas aeruginosa infections cause high morbidity and mortality. We performed a descriptive analysis of the rates of antibiotic resistance in isolates of P. aeruginosa in 33 hospitals enrolled in a surveillance network in Colombia. The study was conducted between January 2005 and December 2009 .9905 isolates of P. aeruginosa were identified, (4.9% of all strains). In intensive care units (ICU) P. aeruginosa showed an overall resistance to aztreonam, cefepime , ceftazidime, imipenem, meropenem , and piperacillin / tazobactam of 31.8% , 23.9% , 24.8%, 22.5%, 20.3% and 22.3%, respectively. Resistance rates increased for piperacillin/tazobactam, cefepime, and imipenem; remained unchanged for meropenem; and decreased for aminoglycosides, quinolones and ceftazidime. Resistance to one, two and three or more families of antibiotics was found in 17%, 12.5%, and 32.1%, respectively. In samples collected from the wards, the resistance rate was lower but usually over 10%. Antibiotic resistance in P. aeruginosa isolates in hospitalized patients and particularly in those admitted to ICUs in Colombia is high.
Introducción: Pseudomonas aeruginosa causa infecciones con altas tasas de morbilidad y mortalidad. Objetivo: Conocer las tasas de resistencia de P. aeruginosa en instituciones hospitalarias colombianas. Material y Métodos: Se realizó un análisis descriptivo de las tasas de resistencia a los antimicrobianos en los aislados de P. aeruginosa en 33 hospitales inscritos a una red de vigilancia en Colombia. Se estudió la resistencia entre enero de 2005 y diciembre de 2009. Se usaron las normas del Clinical and Laboratory Standard Institute (2009) para determinar la resistencia. Resultados: Se identificaron 9.905 aislados de P. aeruginosa (4,9% de todos los aislados). En las unidades de cuidado intensivo (UCI) P. aeruginosa mostró una resistencia global a aztreonam, cefepime, ceftazidima, imipenem, meropenem y piperacilina/tazobactam de 31,8%, 23,9%, 24,8%, 22,5%, 20,3%, y 22,3%, respectivamente. Las tasas de resistencia aumentaron para piperacilina/tazobactam, cefepime e imipenem; se mantuvo sin cambios para meropenem y disminuyó para los aminoglucósidos, quinolonas y ceftazidima. Resistencia a uno, dos y tres o más familias de antimicrobianos se encontró en 17%, 12,5% y 32,1%, respectivamente. En las salas de hospitalización la resistencia fue ligeramente inferior, pero usualmente mayor a 10%. Conclusión: La resistencia en los aislados de P. aeruginosa en pacientes hospitalizados y especialmente en los admitidos a las UCI, en Colombia es elevada, incluyendo los aislados con multi-resistencia.
Assuntos
Humanos , Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla , Pseudomonas aeruginosa/efeitos dos fármacos , Colômbia , Testes de Sensibilidade Microbiana , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/isolamento & purificaçãoRESUMO
ß-Lactam resistance in Pseudomonas aeruginosa clinical isolates is driven by a number of mechanisms. Whilst several are understood, how they act co-operatively in pathogenic strains is less clear. In some isolates, resistance profiles cannot always be explained by identifying the common resistance-determining pathways, suggesting that other mechanisms may be important. Pathogenic P. aeruginosa isolates from four countries were characterised by PCR. Quantitative expression analysis was also assessed for the activity of several pathways that influence antibiotic resistance, and culture experiments were conducted to test how random transposition of the insertion sequence IS26 during growth may influence resistance to some antibiotics. In most strains, antibiotic resistance was being driven by changes in multiple pathways and by the presence or absence of genes acquired by lateral gene transfer. Multiple mechanisms of resistance were prevalent in strains from all of the countries examined, although regional differences in the type of interacting mechanisms were apparent. Changes in chromosomal pathways included overexpression of AmpC and two efflux pumps. Also, gain or loss of IS26 at some chromosomal locations, most notably oprD, could influence resistance to carbapenems. IS26-related resistance was found in strains from Argentina and geographically linked Uruguay, but not in strains from either Colombia or Australia. Pseudomonas aeruginosa pathogenic strains are evolving to become multidrug-resistant in more complex ways. This is being influenced by single strains acquiring changes in numerous known pathways as well as by newly emerging resistance mechanisms in this species.
RESUMO
INTRODUCTION: Candidemia is an infectious complication with high morbidity and mortality in intensive care patients. OBJECTIVE: The aim of this study was to determine the incidence and prevalence of candidemia in critically ill patients in Colombian hospitals between 2004 and 2008. MATERIALS AND METHODS: Data from microbiologically confirmed candidemia cases, ICU stay and admissions were retrospectively recorded in 7 Colombian hospitals between 2004 and 2008. Time series analysis was performed with monthly incidence (number of cases of candidemia in relation to the number of patient-days) and prevalence (number of cases of candidemia in relation to the number of admissions) for each institution and the whole group. RESULTS: 382 cases of candidemia were identified, with an incidence of 2,3 cases per 1.000 patient-days in ICU, and a prevalence of 1,4%. There was a trend to increased incidence (0,0066 additional cases per 1.000 ICU-days per month) and prevalence (0,0016 additional cases por 100 patients per month) of candidemia. This increase of candidemia cases was due to a rise of non- albicans Candida species, which corresponded to 44% of total isolates. DISCUSSION AND CONCLUSIONS: Candidemia cases in colombian ICUs are increasing, especially those caused by non albicans Candida species.
Assuntos
Candidemia/epidemiologia , Infecção Hospitalar/epidemiologia , Candidemia/microbiologia , Colômbia/epidemiologia , Estado Terminal , Infecção Hospitalar/microbiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos RetrospectivosRESUMO
Pseudomonas aeruginosa infections cause high morbidity and mortality. We performed a descriptive analysis of the rates of antibiotic resistance in isolates of P. aeruginosa in 33 hospitals enrolled in a surveillance network in Colombia. The study was conducted between January 2005 and December 2009 .9905 isolates of P. aeruginosa were identified, (4.9% of all strains). In intensive care units (ICU) P. aeruginosa showed an overall resistance to aztreonam, cefepime , ceftazidime, imipenem, meropenem , and piperacillin / tazobactam of 31.8% , 23.9% , 24.8%, 22.5%, 20.3% and 22.3%, respectively. Resistance rates increased for piperacillin/tazobactam, cefepime, and imipenem; remained unchanged for meropenem; and decreased for aminoglycosides, quinolones and ceftazidime. Resistance to one, two and three or more families of antibiotics was found in 17%, 12.5%, and 32.1%, respectively. In samples collected from the wards, the resistance rate was lower but usually over 10%. Antibiotic resistance in P. aeruginosa isolates in hospitalized patients and particularly in those admitted to ICUs in Colombia is high.
Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla , Pseudomonas aeruginosa/efeitos dos fármacos , Colômbia , Humanos , Testes de Sensibilidade Microbiana , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/isolamento & purificaçãoRESUMO
Objetivo. Evaluar los factores de riesgo asociados con la aparición de bacteriemia por Staphylococcus aureus resistente a la meticilina (MRSA), su pronóstico y los factores determinantes de la mortalidad en pacientes gravemente enfermos en Colombia. Métodos. Estudio retrospectivo multicéntrico de cohortes realizado en el período del 2005 al 2008 en 16 instituciones de atención de salud de referencia públicas y privadas de Bogotá, Colombia, que forman parte de una red nacional de vigilancia epidemiológica y de una red hospitalaria de 4 469 camas. Se analizaron la aparición de resistencia a la meticilina y la mortalidad mediante análisis descriptivos y de tiempo transcurrido hasta un suceso; se estableció un modelo multifactorial de regresión de riesgos proporcionales de Cox para evaluar la asociación entre la resistencia a la meticilina y la mortalidad. Resultados. Se estudiaron 372 pacientes: 186 con bacteriemia por MRSA, apareados aleatoriamente con 186 con bacteriemia por Staphylococcus aureus sensible a la meticilina (MSSA). La cirugía previa, el tratamiento con antibióticos y las infecciones intrahospitalarias se asociaron independientemente con la resistencia a la meticilina. El MRSA provocó hospitalizaciones más prolongadas en los sobrevivientes (mediana de 24 frente a 18 días, P = 0,014). Los factores predictivos de mortalidad fueron: la edad del paciente, un nivel de creatinina superior a 1,21 mg/dl al ingresar en la UCI, la septicemia grave y el requerimiento de inotrópicos. El tratamiento antimicrobiano apropiado y el cambio de tratamiento antimicrobiano constituyeron factores protectores independientes, igual que el sexo masculino. Conclusiones. La resistencia a la meticilina per se no fue un factor pronóstico independiente de la mortalidad. Las condiciones previas, como la edad, la insuficiencia renal inicial, la septicemia grave y el requerimiento de inotrópicos explicaron la mortalidad observada. El tratamiento antimicrobiano apropiado seguía siendo un factor protector. Es obligatorio hacer un llamamiento para mejorar las medidas de control de las infecciones en Colombia y en otros contextos similares.
Objective. To evaluate risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia emergence, its prognosis, and mortality-determining factors in critically ill patients in Colombia. Methods. A multicenter, retrospective cohort study conducted in 20052008 at 16 public and private reference health care institutions in Bogotá, Colombia, that form part of a national epidemiological surveillance network and a hospital network with 4 469 beds. Methicillinresistant emergence and mortality were analyzed using descriptive and time-to-event analysis; a multivariate Cox proportional hazard regression model was built to test the association between methicillin resistance and mortality. Results. A total of 372 patients were studied: 186 with MRSA bacteremia, randomly matched with 186 with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Previous surgery, antibiotic exposure, and hospital-acquired infections were independently associated with methicillin resistance. MRSA caused longer hospital stays among survivors (median 24 versus 18 days, P = 0.014). Mortality predictors were: patient age, creatinine level over 1.21mg/dl at ICU admission, severe sepsis, and inotropic requirement. Appropriate antimicrobial therapy and antimicrobial therapy change were independent protective factors, as was male gender. Conclusions. Methicillin resistance per se was not a mortality-independent prognostic factor. Previous conditions, such as age, baseline renal impairment, severe sepsis, and inotropy demand explained the observed mortality. Appropriate antimicrobial therapy remained a protective factor. A call to improve infection control measures in Colombia is mandatory.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/mortalidade , Estudos de Coortes , Colômbia/epidemiologia , Estado Terminal , Estudos RetrospectivosRESUMO
OBJECTIVE: To evaluate risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia emergence, its prognosis, and mortality-determining factors in critically ill patients in Colombia. METHODS: A multicenter, retrospective cohort study conducted in 2005-2008 at 16 public and private reference health care institutions in Bogotá, Colombia, that form part of a national epidemiological surveillance network and a hospital network with 4 469 beds. Methicillin-resistant emergence and mortality were analyzed using descriptive and time-to-event analysis; a multivariate Cox proportional hazard regression model was built to test the association between methicillin resistance and mortality. RESULTS: A total of 372 patients were studied: 186 with MRSA bacteremia, randomly matched with 186 with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Previous surgery, antibiotic exposure, and hospital-acquired infections were independently associated with methicillin resistance. MRSA caused longer hospital stays among survivors (median 24 versus 18 days, P = 0.014). Mortality predictors were: patient age, creatinine level over 1.21 mg/dl at ICU admission, severe sepsis, and inotropic requirement. Appropriate antimicrobial therapy and antimicrobial therapy change were independent protective factors, as was male gender. CONCLUSIONS: Methicillin resistance per se was not a mortality-independent prognostic factor. Previous conditions, such as age, baseline renal impairment, severe sepsis, and inotropy demand explained the observed mortality. Appropriate antimicrobial therapy remained a protective factor. A call to improve infection control measures in Colombia is mandatory.
Assuntos
Bacteriemia/microbiologia , Bacteriemia/mortalidade , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/mortalidade , Adolescente , Adulto , Idoso , Estudos de Coortes , Colômbia/epidemiologia , Estado Terminal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemAssuntos
Infecções Bacterianas , Staphylococcus aureus Resistente à Meticilina , Fatores de Risco , Colômbia , Infecções Bacterianas , Staphylococcus aureus Resistente à Meticilina , Avaliação de Resultados em Cuidados de Saúde , Fatores de Risco , Mortalidade , Bacteriemia , Staphylococcus aureus Resistente à Meticilina , Colômbia , Estado Terminal , Infecções Estafilocócicas , Estudos de Coortes , Estudos RetrospectivosRESUMO
Objective This study was aimed at analyzing the phenotypical behavior of Acinetobacter baumannii resistance to antibiotics currently available in Colombia for its treatment. Methods An ecological time-series study was conducted based on information regarding A. baumannii resistance to available antibiotics gathered through a Colombian surveillance system involving 33 reference hospitals. Descriptive analysis and modeling forecasting were also carried out. Results The sample included 5.415 A. baumannii isolates collected from 33 hospitals throughout Colombia. This microorganism was the eighth most frequently isolated pathogen in hospital settings, having 3.8 % isolation frequency in intensive care units (ICUs).The study recorded the presence of multidrug-resistant A. baumannii strains since 2001, as well as a dramatic increase in A. baumannii strains having decreased susceptibility to the antibiotics currently available on the market (30 % to 70 %). Conclusion A. baumannii has shown a clear transition to a multidrug resistance profile in Colombia during recent years which includes resistance to important second-line antibiotics, such as carbapenems.(AU)
Objetivo Analizar la conducta fenotípica de resistencia del Acinetobacter baumannii a los antibióticos disponibles para su tratamiento en Colombia. Métodos Se llevó a cabo un estudio ecológico de series de tiempo basado en la información de resistencia del A. baumannii a los antibióticos, a partir del sistema de vigilancia colombiana de 33 hospitales de referencia. Se realizaron análisis descriptivos y un modelo de pronóstico. Resultados Se incluyeron 5 415 aislamientos de A. baumannii recolectados en 33 hospitales a través del país. Este microorganismo fue el octavo patógeno más aislado en el escenario hospitalario, con una frecuencia de aislamiento de 3,9 % en unidades de cuidado intensivo (UCIs). Se registra la presencia de cepas de A. baumannii multirresistentes desde el año 2001, así como un dramático incremento de cepas de A. baumannii con menor susceptibilidad a los antibióticos disponibles en el mercado, con una variación del 30 al 70 %. Conclusión En los últimos años, en Colombia, el A. baumannii ha mostrado una clara transición hacia un perfil multirresistente que incluye la resistencia a antibióticos de segunda línea como los carbapenems.(AU)
Assuntos
Humanos , Resistência a Medicamentos , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/isolamento & purificação , Estudos de Séries Temporais , Colômbia , Estudos EcológicosAssuntos
Infecções Comunitárias Adquiridas/microbiologia , Fasciite Necrosante/microbiologia , Resistência a Meticilina , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/crescimento & desenvolvimento , Adulto , Antibacterianos/uso terapêutico , Colômbia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/cirurgia , Fasciite Necrosante/tratamento farmacológico , Fasciite Necrosante/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgia , Staphylococcus aureus/genéticaRESUMO
OBJECTIVES: Investigating the prevalence and sensitivity of germs isolated from newborn in a referral hospital in Bogotá. Suggesting an empirical antibiotic treatment for neonatal infection. METHODS: Cultures taken between February and December 2002 were analysed. Blood cultures were processed using BacT/ALERT (Durham, NC), urine cultures by UROCULT (Bio-Bacter) and catheter tips in thioglycollate. BBL CRYSTAL identification system (BD, Sparks, MD) was used for identifying germs. Antibiotic sensitivity was determined by disk diffusion. RESULTS: There were 1,097 positive aerobic and facultative aerobic germ cultures; 64.3% were Gram-positive, 30.6% Gram-negative and 4.9% were yeasts. Gram-positive germs consisted of coagulase-negative staphylococci (64.2%), enterococcus (13.8%) and coagulase-positive staphylococci (13.3%). The most frequent Gram-negatives were Klebsiella (45.2%), Eschericha coli (30.9%) and Serratia (10.1%). Staphylococcus epidermidis accounted for 64% of the coagulase-negative staphylococci. S. epidermidis susceptibility to vancomycin was 100%. Coagulase-negative staphylococci susceptibility to rifampin and amikacin was 59% and 67.4% (respectively). Coagulase-negative staphylococci resistance to beta-lactams was 86.4% (95% CI: 82.3-89.9). Coagulase-positive staphylococci sensitivity to vancomycin was 100%. Gram-negative susceptibility to imipenem was 98.1% (95% CI: 89.9-99.9), 78.1% to gentamicin (95% CI: 64.9-88.2) and 46.6% to amikacin (95% CI: 28.3-65.7). CONCLUSIONS: There was high coagulase-negative staphylococci prevalence in neonatal infection (particularly S. epidermidis). All S. epidermidis and coagulase-positive staphylococci were sensitive to vancomycin. There was increasing coagulase-negative staphylococci and Gram-negative resistance to oxacillin and amikacin, respectively.