RESUMO
Introduction: Uncomplicated Staphylococcus aureus bacteremia remains a leading cause of morbidity and mortality in hospitalized patients. Current guidelines recommend a minimum of 14 days of treatment. Objective: To evaluate the efficacy and safety of short versus usual antibiotic therapy in adults with uncomplicated S. aureus bacteremia (SAB). Methods: We developed a search strategy to identify systematic review and meta-analysis of non-randomized studies (NRS), comparing short versus usual or long antibiotic regimens for uncomplicated SAB in MEDLINE, Embase, and the Cochrane Register up to June 2023. The risk of bias was assessed using the ROBINS I tool. The meta-analysis was performed using Review Manager software with a random effect model. Results: Six NRS with a total of 1700 patients were included. No significant differences were found when comparing short versus prolonged antibiotic therapy as defined by the authors for 90-day mortality [odds ratio (OR): 1.09; 95% confidence interval (CI): 0.82-1.46, p: 0.55; I2 = 0%] or 90-day recurrence or relapse of bacteremia [OR: 0.72; 95% CI: 0.31-1.68, p: 0.45; I2 = 26%]. Sensitivity analysis showed similar results when comparing a predefined duration of <14 days versus ⩾14 days and when excluding the only study with a high risk of bias. Conclusion: Shorter-duration regimens could be considered as an alternative option for uncomplicated SAB in low-risk cases. However, based on a small number of studies with significant methodological limitations and risk of bias, the benefits and harms of shorter regimens should be analyzed with caution. Randomized clinical trials are needed to determine the best approach regarding the optimal duration of therapy.
Comparing short and regular antibiotic treatment duration, for a type of blood infection caused by S. aureus We investigated the optimal duration of antibiotic treatment for adults with a specific type of blood infection (uncomplicated Staphylococcus aureus), a condition with a significant global impact on mortality and costs. After a thorough search, only six trials involving 1700 patients were identified. We therefore decided to perform a meta-analysis (a type of statistical analysis). The results showed that the duration of antibiotics, whether short or long (less or more than 14 days), did not significantly affect mortality or recurrence of infection within 90 days. Consequently, we suggested that shorter courses of antibiotics might be appropriate for less severe cases. However, we emphasized caution because of the limitations of the studies. We recommended further research with improved methods to determine the optimal approach to treating this type of infection.
RESUMO
OBJECTIVES: To assess whether the nutrition risk index (NRI) is associated with the risk of bacteremia within the first days after autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM). MATERIALS AND METHODS: Retrospective cohort study of adult patients with MM taken to ASCT at the Hospital Universitario San Ignacio (Bogotá, Colombia) between 2005 and 2019. The outcome of interest was the incidence of bacteremia at 30 days. Multivariate analysis was used to identify whether the NRI was associated with bacteremia, controlling by different confounding variables. RESULTS: One hundred and twenty-four patients with a median age of 58.5 years (IQR: 54-64) were included. 47.1% were in stage ISS III. 36.0% had moderate or severe malnourishment (NRI < 97.5). 11.2% presented bacteremia in the first 30 days after transplantation. In the univariate analysis, the NRI < 97.5 was associated with bacteremia (OR: 1.88; 95% CI: 1.30-2.72, P = .001); however, this association was not significant in the multivariate analysis, unlike the presence of mucositis (OR: 11.59; 95% CI: 1.9-68.3, <0.01), one or more previous lines of therapy (OR: 12.0; 95% CI: 2.1-67.4; P < .01), and duration of aplasia (OR: 1.70; 95% CI: 1.2-2.4, P < .01). CONCLUSIONS: Patients with moderate or severe malnourishment have a higher incidence of bacteremia in the 30 days post-ASCT in patients with MM. Additional risk factors associated with bacteremia include the presence of mucositis, one or more previous lines of therapy, and the duration of aplasia.
Assuntos
Bacteriemia/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Mieloma Múltiplo/complicações , Mieloma Múltiplo/microbiologia , Avaliação Nutricional , Colômbia/epidemiologia , Feminino , Humanos , Incidência , Masculino , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Transplante Autólogo/efeitos adversosRESUMO
Introducción: Candida spp. es una levadura comensal de la microbiota humana. Por características del hospedero, las infecciones del torrente sanguíneo pueden aparecer y causar una gran morbimortalidad. Métodos: Estudio restrospectivo transversal analítico de los cultivos positivos para Candida spp. entre 2008 y 2014 en un hospital universitario en Bogotá, Colombia. Se evaluaron las características clínicas y microbiológicas presentes previo a la toma de la primera muestra de sangre positiva y se determinaron asociaciones con infecciones por especies no C. albicans (NCA). Resultados: Se incluyeron 123 casos de candidemia. C. albicans fue la especie más aislada (42 %). Sin embargo, las especies NCA como grupo fueron observadas más frecuentemente. Más del 70 % de los casos presentaron manejo en la unidad de cuidado intensivo, con una mediana de estancia de 14 días previo a la primera muestra de sangre positiva. Se detectaron numerosas características médicas; sin embargo, ninguna estuvo asociada con candidemia por especies NCA. Se observó resistencia a por lo menos un antifúngico en el 29 % de los casos, aunque en una muestra reducida de pruebas de sensibilidad. Conclusiones: Nuestros resultados sustentan el viraje mundial hacia la candidemia por especies NCA; pero no encontramos asociaciones clínicas en este grupo. Debe dársele prioridad a la identificación de factores de riesgo y a la optimización de los puntajes de predicción, que permitan identificar pacientes en riesgo que se beneficien de terapia preventiva.
Introduction: Candida species are commensal yeasts of the human microbiota. However, due to several host's conditions, bloodstream infections may arise causing high morbimortality. Methods: Retrospective cross-sectional analytical study of positive blood cultures for Candida spp. between 2008'2014 at a university hospital in Bogotá. Colombia. We evaluated clinical and microbiological characteristics prior to the first positive blood sample was obtained and determined associations with non'C. albicans (NCA) species infections. Results: We included 123 candidemia cases. C. albicans was the most frequently isolated species (42%). However; NCA species as a group were observed more often. Over 70% of cases were managed at the ICU, with a median stay of 14 days. Several medical factors were frequently observed, however none appeared to be associated with NCA species candidemia. Resistance to at least one antifungal agent was observed in 29% of cases, although a reduced sample of susceptibility tests was available. Conclusions: Our results support a worldwide shift towards NCA candidemia. However, clinical features were not associated with NCA infections. The identification of risk factors and the improvement of prediction scores must be prioritized, in order to identify' patients at high risk who may benefit of pre-emptive therapy.
Assuntos
Candidíase/epidemiologia , Farmacorresistência Fúngica , Candidemia/históriaRESUMO
Antecedentes: la colonización por Pneumocystis jirovecci (P. jirovecii) se ha postulado como causa de deterioro de la función pulmonar en pacientes con Enfermedad Pulmonar Obstructiva Crónica (EPOC). Se desconocía la frecuencia de aparición de la colonización por P. jirovencii en esa población en Colombia. Objetivo: documentar la frecuencia de colonización por P. jirovecii en mayores de 40 años con EPOC excluyendo a los pacientes que requirieran manejo inmunosupresor y a las personas infectadas por el Virus de la Inmunodeficiencia Humana (VIH). Materiales y métodos: se trató de un estudio de corte transversal, que contó con muestreo no probabilístico por conveniencia y selección continua de pacientes. Se realizó PCR (reacción en cadena de polimerasa) en tiempo real (rt-PCR) del esputo inducido con el Kit LighMix de P. jirovecii (Roche®-Suiza) amplificándose un fragmento de 244 pares de bases a partir del gen de la glicoproteína de superficie del hongo. Resultados: para una muestra de 52 pacientes en total, se documentó una frecuencia de colonización del 15,4% en todos los participantes mayores de 65 años, quienes además presentaron altos índices de sintomatología según la escala modificada Medical Research Council (MR Cm) y el cuestionario de evaluación de la EPOC (CAT). La mayoría de pacientes analizados se clasificó como GOLD D (63%) en la clasificación por la Iniciativa Global para la EPOC. Conclusiones: la frecuencia de colonización por P. jirovecii en pacientes con EPOC detectada por rt-PCR en el esputo inducido fue del 15,4%. Este constituye el primer estudio colombiano que evalúa la frecuencia de colonización del hongo.
Background: Pneumocystis jirovecii colonization has been proposed as the explanation for lung function decline in patients with Chronic Obstructive Pulmonary Disease (COPD). The colonization frequency due to Pneumocystis jirovecii in this group of patients was yet unknown in Colombia. Objective: To document the frequency of colonization in patients over 40 years old with COPD diagnosis. The study excludes patients who require immunosuppressive treatment and who are infected with Human Immunodeficiency Virus (HIV). Materials and methods: A cross-sectional study was held, using non-probabilistic convenience sampling with continuous patient selection. Real time PCR (rt-PCR) of P. jirovecii was performed in an induced sputum sample, the fragment of 244 base pairs from the major surface glycoprotein gene of the fungus was amplified using the LighMix Kit (Roche®-Switzerland). Results: From the sample of 52 patients, we found a frequency of colonization of 15.4%. All colonized patients were over 65 years old with high symptomatology levels according to the modified Medical Research Council scale (MRCm), and the COPD Evaluation Test (CAT). Most of the colonized patients were classified as GOLD D (63%), as rated by the Global Initiative for COPD. Conclusions: The colonization frequency due to P. jirovecii in COPD patients detected by rt-PCR in induced sputum was 15.4%. This is the first study to assess the frequency of P. jirovecii colonization in Colombia.
