Associated factors for mortality in a COVID-19 colombian cohort: is the third wave relevant when Mu variant was predominant epidemiologically?

OBJECTIVES: To evaluate the association between Colombia's third wave when the Mu variant was predominant epidemiologically (until 75%) in Colombia and COVID-19 all-cause in-hospital mortality. METHODS: In this retrospective cohort, we included hospitalized patients ≥18 years with SARS-CoV-2 infection between March 2020 to September 2021 in ten hospitals from three cities in Colombia. Description analysis, survival, and multivariate Cox regression analyses were performed to evaluate the association between the third epidemic wave and in-hospital mortality. RESULTS: A total of 25,371 patients were included. The age-stratified time-to-mortality curves showed differences according to epidemic waves in patients ≥75 years (log-rank test p = 0.012). In the multivariate Cox analysis, the third wave was not associated with increased mortality relative to the first wave (aHR 0.95; 95%CI 0.84-1.08), but there was an interaction between age ≥75 years and the third wave finding a lower HR for mortality (aHR 0.56, 95%CI 0.36-0.86). CONCLUSIONS: We did not find an increase in in-hospital mortality during the third epidemic wave in which the Mu variant was predominant in Colombia. The reduced hazard in mortality in patients ≥75 years hospitalized in the third wave could be explained by the high coverage of SARS-CoV-2 vaccination in this population and patients with underlying conditions.

Lemierre's syndrome by Bacillus circulans, Fusobacterium nucleatum and Staphylococcus aureus with involvement of the internal and external jugular vein.

INTRODUCTION: Lemierre's syndrome refers to the septic thrombophlebitis of the internal jugular vein, secondary to a pharyngeal infection. Although it mainly affects the internal jugular vein, isolated cases have been described of involvement of the external jugular vein. The main etiological agent is Fusobacterium necrophorum. CASE REPORT: A 27-year-old male, previously healthy, presented with a 7-day history of sore throat and fever. He was diagnosed with Lemierre's syndrome, coinfection by Bacillus circulans, F. nucleatum and Staphylococcus aureus with an atypical presentation due to the involvement of the external jugular vein and the internal jugular vein. CONCLUSIONS: As far as we are aware, we present the first case of Lemierre's syndrome with these characteristics.

A propósito de complicaciones infrecuentes de enfermedades comunes. Síndrome de Ekiri / About Infrequent complications of common diseases: Ekiri Syndrome

Resumen La infección por enterobacterias desencadena usualmente síntomas gastrointestinales caracterizados por vómito, diarrea y dolor abdominal, de severidad y curso variable. El compromiso extraintestinal esta descrito, inclusive sin las manifestaciones gastrointestinales clásicas lo que favorece diagnósticos y tratamientos tardíos pudiendo llegar a ser incapacitantes y letales. El síndrome de Ekiri, también denominado síndrome de encefalopatía letal tóxico, se caracteriza por una disfunción aguda del sistema nervioso central secundaria a infección por enterobacterias las cuales favorecen el desarrollo de microtrombos a nivel cerebral con inflamación mediada por el factor de necrosis tumoral α e IL- 1β y disfunción de la barrera hematoencefálica con una alta tasa de mortalidad. Dentro de nuestro conocimiento, presentamos el primer caso reportado en Colombia sobre el síndrome de Ekiri.

Abstract Gastrointestinal infection usually manifests with nausea, vomit and abdominal pain, all of them wit course and variable severity. Extrainstestinal compromise is described, even without gastrointestinal symptoms, what causes a delay on diagnosis and treatment, worsening the prognosis. Ekiri syndrome, also known as lethal toxic encephalopathy is characterized by an acute neurological dysfunction secondary to enterobacterial infection which favor thrombi development and local inflammation mediated by tumor necrosis factor alpha and IL-1β with blood brain barrier dysfunction and high mortality. As we know, we present the first Ekiri syndrome case reported in Colombia.

Traqueobronquitis y neumonía asociadas a ventilación mecánica en unidades de cuidado intensivo de Latinoamérica: epidemiología, curso clínico y desenlaces (Estudio LATINAVE) / Epidemiology, clinical evolution and outcomes of tracheobronchitis and pneumonia associated with mechanical ventilation in intensive care units of Latin America (LATINAVE study)

Introducción: Las infecciones asociadas a ventilación mecánica son causa importante de morbimortalidad en el paciente crítico. La diferenciación entre traqueobronquitis y neumonía no es siempre fácil, y es controvertida. Algunos trabajos describen aumento de mortalidad, mayor estancia en Unidades de Cuidado Intensivo (UCI), mayor requerimiento de ventilación mecánica e incremento de costos en pacientes con traqueobronquitis asociada a ventilador (TAV), sin diferencias significativas en pacientes con neumonía asociada a ventilador (NAV). Estos estudios no describen el comportamiento clínico y epidemiológico de la TAV y la NAV como 2 entidades independientes, por lo que es necesario describirlo. Métodos: Estudio multicéntrico de cohorte prospectiva, de pacientes adultos que desarrollaron TAV o NAV durante su estancia en UCI, entre noviembre de 2013 y octubre de 2014. A cada una de las variables demográficas, clínicas, de laboratorio y de desenlace, como tiempo de ventilación mecánica, estancia hospitalaria y muerte, se le realizó análisis descriptivo; para evaluar las diferencias entre los grupos se utilizó test de chi cuadrado, t de Student o U de Mann Whitney. Resultados: Se incluyó a 143 pacientes, con edad promedio de 55 años, 57% eran hombres, de 6 países en Latinoamérica; 63% con NAV y 37% con TAV. Las comorbilidades más frecuentes fueron cardiovascular (44%) y neurológica (30%); esta última fue más frecuente en TAV (41,5 vs. 23%; p = 0,02). No se encontró diferencia en APACHE II de ingreso. El índice SOFA fue mayor en NAV (8 vs. 5; p = 0,02). No hubo diferencias en el aislamiento microbiológico, ni en los patrones de resistencia bacteriana entre las 2 entidades. Se observó mayor número de complicaciones cardiovasculares y SDRA en pacientes con NAV. No se encontró diferencia entre los 2 grupos en estancia en UCI, los días de ventilación mecánica ni en mortalidad. Conclusiones: La prevalencia de TAV fue mayor a lo descrito hasta ahora en la literatura. No se encontraron diferencias significativas en el aislamiento microbiológico, la resistencia bacteriana ni el esquema antibiótico utilizado en los 2 grupos. Aunque la NAV cursó con mayor proporción de complicaciones médicas asociadas, el hallazgo de una estancia hospitalaria, tiempo de ventilación mecánica y mortalidad similares sustenta la importancia clínica de la TAV.

Introduction: The infections associated with mechanical ventilation are a major cause of morbidity and mortality in critically ill patients. Limited studies report increased mortality and intensive care units (ICU) stays, requirements for mechanical ventilation and higher costs in ventilator-associated tracheobronchitis (TAV) in comparison to patients with ventilator-associated pneumonia (NAV). These studies do not describe the clinical and epidemiological behavior in the same population as independent entities, so it is necessary to describe the epidemiology of patients with TAV and NAV. Methods: Multicenter cross-sectional study of adult patients who developed TAV and/or NAV during their stay in the ICU in 2013 to 2014. A descriptive analysis was performed on each of the variables. For qualitative variables we assessed differences between groups using the Chi-squared test; for continuous variables, we used Student's t test or the Mann Whitney U test. Results: A total of 147 patients from 6 countries in Latin America were included; 63% with NAV and 37% with TAV. The average age was 55 years; 57% male. The most frequent comorbidity was cardiovascular (44%) and neurological (30%), the latter was more frequent in those with TAV (41.5 vs. 23%, P = .02). No differences were found in APACHE II on entry, but the difference appears in the SOFA index (8 vs. 5, P = .02). There were no differences in microbiological isolation, or bacterial resistance patterns between the 2 entities. A greater number of cardiovascular complications and ARDS were observed in patients with NAV. The ICU stay, days on mechanical ventilation and mortality were not different between the 2 groups. Conclusions: The TAV prevalence was higher than heretofore described in the literature. No significant differences were found in the microbiological isolation, bacterial resistance and antibiotic therapy used in the 2 groups, which might suggest that therapeutic approach be similar to that recommended for NAV. No differences were observed in clinical outcomes such as hospital stay, duration of mechanical ventilation and mortality, although NAV was associated with a greater proportion of medical complications.