Consenso de uso de antimicrobianos en pacientes críticamente enfermos con falla renal o en riesgo de padecerla / Consensus for antimicrobial use in critically ill patients with renal failure or at risk of suffering it

Un número creciente de pacientes críticamente enfermos son atendidos por sepsis secundaria a infecciones bacterianas o micóticas. En este grupo de pacientes la sepsis per se es un factor de riesgo para el desarrollo de falla renal, la cual implica un mayor riesgo de mortalidad. Un panel de expertos en las áreas de infectología, cuidado crítico y nefrología prepararon un consenso basado en la información actual (“evidencia”) sobre el uso de antimicrobianos (antibióticos y antifúngicos) en pacientes críticamente enfermos con falla renal o en riesgo de padecerla. Se identificó la literatura científica relevante mediante un proceso de búsqueda sistemática y se generaron recomendaciones por medio del método presencial Delphi. Se propone que las recomendaciones de este consenso sean utilizadas por los trabajadores de la salud que manejen este grupo de pacientes,con el fin de identificar aquellos en mayor riesgo de progresión a falla renal y establecer las estrategias terapéuticas que tengan el mayor beneficio con la menor probabildad de efectos secundarios serios sobre la función renal. Se adicionó una estrategia para la implmentación de estas recomendaciones.

A growing number of critically ill patients are being taken care with sepsis secondary to bacterial or mycotic infections. In this group of patients, sepsis per se is a risk factor for the development of renal failure, which has been related to an increased risk of hospital mortality. An expert panel in infectious diseases, critical care and renal diseases prepared an evidence based consensus over the use of antimicrobials (antibacterial and antifungal agents) in critically ill patients with renal failure or at risk of suffering it. A sytematic review of the scientific literature was performed and recommendations were established by means of a consensus using the Delphi method. Recommendations proposed by this consensus are intended to be use by healthcare workers who are in charge of this kind of patients with the aim to identify the group of patients with higher risk of developing renal failure and to establish the therapeutic measures theat have the best outcome and lower frequenc of severe side effects in renal function. An implementation strategy was added with the recommendations.

Novel VIM metallo-beta-lactamase variant, VIM-24, from a Klebsiella pneumoniae isolate from Colombia.

We report the emergence of a novel VIM variant (VIM-24) in a Klebsiella pneumoniae isolate in Colombia. The isolate displays MICs for carbapenems below the resistance breakpoints, posing a real challenge for its detection. The blaVIM-24 gene was located within a class 1 integron carried on a large plasmid. Further studies are needed to clarify its epidemiological and clinical impact.