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1.
Infectio ; 23(3): 271-304, July-Sept. 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1002162

RESUMO

Abstract Invasive Candidiasis (IC) and candidemia (as its most frequent manifestation) have become the main cause of opportunistic mycosis at hospital settings. This study, made by members of the Colombian Association of Infectious Diseases (ACIN), was aimed at providing a set of recommendations for the management, follow-up and prevention of IC / candidemia and mucous membrane candida infection in adult, pediatric and neonatal patients in a hospital setting, including the hemato-oncological and critical care units. All the data obtained through an exhaustive search were reviewed and analyzed in a comprehensive manner by all the members of the group, and the recommendations issued are being made after a careful review of the scientific literature available and the consensus of all specialists involved; the emergence of Candida Spp. problem is highlighted and a correct orientation to health professionals regarding the management of patients with candidiasis is provided in a rational and practical way, emphasizing patient evaluation, diagnostic strategies, prophylaxis, empirical treatment, directed treatment and preventative therapy.


Resumen La Candidiasis Invasora (CI) y la candidemia, como su manifestación más frecuente, se ha convertido en la principal causa de micosis oportunista a nivel hospitalario. Este manuscrito realizado por miembros de la Asociación Colombiana de Infectología (ACIN), tuvo como objetivo proporcionar un conjunto de recomendaciones para manejo, seguimiento y prevención de la CI/candidemia y de la infección candidiásica de mucosas, en población adulta, pediátrica y neonatal, en un entorno hospitalario, incluyendo las unidades hemato-oncológicas y unidades de cuidado crítico. Todos los datos obtenidos mediante una búsqueda exhaustiva, fueron revisados y analizados de manera amplia por todos los miembros del grupo, y las recomendaciones emitidas se elaboraron luego de la evaluación de la literatura científica disponible, y el consenso de todos los especialistas involucrados, reconociendo el problema de la emergencia de las infecciones por Candida Spp. y brindando una correcta orientación a los profesionales de la salud sobre el manejo de pacientes con enfermedad candidiásica, de una forma racional y práctica, enfatizando en la evaluación del paciente, estrategias de diagnóstico, profilaxis, tratamiento empírico, tratamiento dirigido y terapia preventiva.

2.
Curr Opin Infect Dis ; 32(5): 426-434, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31313714

RESUMO

PURPOSE OF REVIEW: To discuss available information on the effectiveness of anti-toxoplasma therapy for ocular toxoplasmosis and to provide clinicians with a practical approach to the disease. RECENT FINDINGS: Only eleven randomized studies were identified. In the three studies for acute retinitis, there was a clear trend in favor of treatment. In the two studies for the prevention of recurrences, trimethoprim-sulfamethoxazole prophylaxis was superior to placebo. In the six studies comparing different regimens, there was no statistically significant difference between the regimens. In the setting of acute posterior uveitis suspected to be caused by toxoplasma, serological testing should always be obtained, and anti-toxoplasma drug treatment, and corticosteroids should be instituted for at least 6 weeks. Toxoplasmic chorioretinitis during pregnancy represents a particular challenge. SUMMARY: Treatment with at least two drugs and corticosteroids should be offered to patients with active toxoplasmic chorioretinitis. Pregnant women with confirmed acute infection and concomitant acute retinitis should be treated for the ocular lesion(s) and to prevent vertical transmission. Pregnant women with chronic Toxoplasma infection acquired prior to gestation and concomitant retinitis by reactivation should be treated for the retinitis and monitored for vertical transmission.

3.
Biomédica (Bogotá) ; 39(supl.1): 10-18, mayo 2019. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1011451

RESUMO

Resumen La melioidosis es una enfermedad infecciosa causada por Burkholderia pseudomallei cuyo diagnóstico clínico puede ser difícil debido a su variada presentación clínica y a las dificultades del diagnóstico microbiológico, por lo cual pueden requerirse técnicas moleculares para su adecuada identificación una vez se sospecha su presencia. Son pocos los antibióticos disponibles para el tratamiento de esta enfermedad y, además, deben usarse durante un tiempo prolongado. Aunque se conoce por ser endémica en Tailandia, Malasia, Singapur, Vietnam y Australia, en Colombia se han reportado algunos pocos casos. Se presenta un caso de melioidosis en la región norte de Colombia, se hace una revisión de las características clínicas y el tratamiento, y se describe la epidemiología local de esta enfermedad.


Abstract Melioidosis is an infectious disease caused by Burkholderia pseudomallei whose clinical diagnosis can be difficult due not only to its varied clinical presentation but also to the difficulties in the microbiological diagnosis.Thus, it may be necessary to use molecular techniques for its proper identification once it is suspected. There are few antibiotics available for the treatment of this disease, which must be used over a long period of time. Although it is known to be endemic in Thailand, Malaysia, Singapore, Vietnam, and Australia, in Colombia there are few reported cases. We describe a case of melioidosis in the northern region of Colombia. Additionally, we review its clinical characteristics and treatment and we describe the local epidemiology of this disease.

5.
Arch Argent Pediatr ; 115(1): 65-70, 2017 02 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28097843

RESUMO

Healthcare-associated infections are a major problem in newborn infants, considering their high morbidity, mortality, and long-term sequelae. In preterm infants, it has been shown that skin and gastrointestinal tract colonization undergoes variations compared to healthy term infants, and that preterm infants are more exposed to nosocomial microorganisms given their higher probability of being admitted to the neonatal intensive care unit where they are cared for. This document reviews normal colonization, the changes observed during hospitalization, prematurity, and the potential role of chlorhexidine in the prevention of resistant microorganism transmission, as well as its side effects in newborn infants admitted to the neonatal intensive care unit.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Clorexidina/uso terapêutico , Infecção Hospitalar/prevenção & controle , Trato Gastrointestinal/microbiologia , Humanos , Recém-Nascido , Pele/microbiologia
6.
Rev Chilena Infectol ; 33(2): 177-86, 2016 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-27314995

RESUMO

Community acquired pneumonia (CAP) is an important cause of morbidity and mortality around the world, with high treatment costs due to hospitalization and complications (adverse events due to medications, antibiotic resistance, healthcare associated infections, etc.). It has been proposed administration of short courses and early switch of intravenous administration to oral therapy to avoid costs and complications. There are recommendations about these topics in national and intemational guidelines, based on clinical trials which do not demónstrate diffe-rences in mortality and complications when there is an early change from intravenous administration to the oral route. There are no statistically significant differences in safety and resolution of the disease when short and long treatment schemes were compared. In this review we present the most important guidelines and clinical studies, taking into account the pharmacological differences between different medications. It is considered that early switch from intravenous to oral administration route and use of short cycles in CAP is safe and brings benefits to patients and institutions.


Assuntos
Antibacterianos/administração & dosagem , Pneumonia Bacteriana/tratamento farmacológico , Administração Oral , Adulto , Antibacterianos/efeitos adversos , Antibacterianos/economia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Relação Dose-Resposta a Droga , Esquema de Medicação , Humanos , Guias de Prática Clínica como Assunto , Fatores de Tempo , Resultado do Tratamento
7.
Rev. chil. infectol ; 33(2): 177-186, abr. 2016. tab
Artigo em Espanhol | LILACS-Express | ID: lil-784868

RESUMO

Community acquired pneumonia (CAP) is an important cause of morbidity and mortality around the world, with high treatment costs due to hospitalization and complications (adverse events due to medications, antibiotic resistance, healthcare associated infections, etc.). It has been proposed administration of short courses and early switch of intravenous administration to oral therapy to avoid costs and complications. There are recommendations about these topics in national and intemational guidelines, based on clinical trials which do not demónstrate diffe-rences in mortality and complications when there is an early change from intravenous administration to the oral route. There are no statistically significant differences in safety and resolution of the disease when short and long treatment schemes were compared. In this review we present the most important guidelines and clinical studies, taking into account the pharmacological differences between different medications. It is considered that early switch from intravenous to oral administration route and use of short cycles in CAP is safe and brings benefits to patients and institutions.


La neumonía adquirida en la comunidad (NAC) es una causa importante de morbilidad y mortalidad en el mundo, con costos elevados por cuenta de las hospitalizaciones y las complicaciones (infección asociada al cuidado de la salud, efectos adversos de medicamentos, resistencia antimicrobiana, etc.). Ante este panorama se ha propuesto administrar ciclos cortos y el cambio temprano de la vía administración de antimicrobianos de endovenosa a oral. Existen recomendaciones acerca de los puntos anteriores en guías locales e internacionales, así como ensayos clínicos que no demuestran diferencias en cuanto a mortalidad y complicaciones cuando se realiza un cambio temprano de vía de administración de endovenosa a oral en NAC. Tampoco hay diferencias estadísticamente significativas en seguridad y resolución de enfermedad cuando se compararon esquemas cortos y prolongados. En esta revisión se presentan las guías y estudios más importantes, considerando las diferencias farmacológicas de los diferentes medicamentos. Se considera que el cambio temprano de vía de administración y el uso de ciclos cortos en NAC es seguro y presenta beneficios para pacientes e instituciones.

8.
Biomedica ; 34(3): 345-53, 2014 Jul-Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-25504122

RESUMO

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/microbiologia
9.
Rev Chilena Infectol ; 31(5): 518-27, 2014 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-25491449

RESUMO

Amphotericin B deoxycholate use has increased during the past years in parallel with the increase in the number of immunosuppressed patients suffering invasive fungal infections. This drug is associated with a high rate of side effects, especially renal toxicity. Lipid formulations (liposomal, lipid complex, colloidal suspension and the Indian liposomal formulation) have been developed, which share the same antifungal spectrum but differ in efficacy and toxicity. A review of amphotericin lipid formulations is presented, focusing on differences in efficacy and, especially renal toxicity. The main problem for use of these formulations in Latin America is their highcost.


Assuntos
Anfotericina B/química , Antifúngicos/química , Lipídeos/química , Anfotericina B/efeitos adversos , Antifúngicos/efeitos adversos , Coloides , Excipientes , Humanos , Leishmaniose/tratamento farmacológico , Lipossomos , Micoses/tratamento farmacológico
10.
Rev. chil. infectol ; 31(5): 518-527, oct. 2014. tab
Artigo em Espanhol | LILACS-Express | ID: lil-730267

RESUMO

Amphotericin B deoxycholate use has increased during the past years in parallel with the increase in the number of immunosuppressed patients suffering invasive fungal infections. This drug is associated with a high rate of side effects, especially renal toxicity. Lipid formulations (liposomal, lipid complex, colloidal suspension and the Indian liposomal formulation) have been developed, which share the same antifungal spectrum but differ in efficacy and toxicity. A review of amphotericin lipid formulations is presented, focusing on differences in efficacy and, especially renal toxicity. The main problem for use of these formulations in Latin America is their highcost.


Dado el aumento en el número de pacientes inmunosuprimidos en los últimos años, el uso de anfotericina B desoxicolato también se incrementó debido a una mayor incidencia de las infecciones fúngicas invasoras en esta población. Este medicamento tiene una alta frecuencia de efectos adversos, especialmente nefrotoxicidad. Se han desarrollado modificaciones de la presentación de anfotericina B con el desarrollo de formas lipídicas (liposomal, complejo lipídico, suspensión coloidal y fórmula liposomal procedente de la India) que tienen el mismo espectro y con variaciones en su efectividad y toxicidad. Se presenta una revisión de las formas lipídicas de anfotericina, sus diferencias en efectividad y, especialmente, nefrotoxicidad. El principal problema para su implementación en América Latina es el alto costo de estas presentaciones.

11.
Biomédica (Bogotá) ; 34(3): 345-353, July-Sept. 2014. tab
Artigo em Espanhol | LILACS | ID: lil-726784

RESUMO

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/microbiologia
12.
Mycoses ; 57(7): 429-36, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24589065

RESUMO

Patients with heart transplantation have a high incidence of infectious complications, especially fungal infections. The aim of the systematic review was to determine the best pharmacological strategy to prevent fungal infections among patients with heart transplant. We searched the PubMed and Embase databases for studies reporting the effectivenesss of pharmacologic strategies to prevent fungal infections in adult patient with a heart transplant. Our search yielded five studies (1176 patients), four of them with historical controls. Two studies used inhaled amphotericin B deoxycholate, three used itraconazole and one used targeted echinocandin. All studies showed significant reduction in the prophylaxis arm. Different products, doses and outcomes were noted. There is a highly probable benefit of prophylaxis use, however, better studies with standardised doses and comparators should be performed.


Assuntos
Antifúngicos/uso terapêutico , Micoses/prevenção & controle , Transplante de Coração/efeitos adversos , Humanos , Micoses/etiologia , Fatores de Risco
13.
Rev. chil. infectol ; 30(6): 599-604, dic. 2013. graf, tab
Artigo em Espanhol | LILACS | ID: lil-701706

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. 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 Retrospectivos
14.
Rev. chil. infectol ; 30(6): 605-610, dic. 2013. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-701707

RESUMO

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 & purificação
15.
BMC Pharmacol Toxicol ; 14: 59, 2013 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-24286231

RESUMO

INTRODUCTION: Patients with febrile neutropenia (FN) exhibit changes in extracellular fluid that may alter the plasma concentrations of beta-lactams and result in therapeutic failure or toxicity. We evaluated the pharmacokinetics of piperacillin/tazobactam in patients with hematological malignancies and FN after receiving chemotherapy at a primary public cancer center. METHODS: This was an open, nonrandomized, observational, descriptive, and prospective study. Samples from 15 patients with hematological malignancies and FN were evaluated after the administration of chemotherapy. Five blood samples were taken from each patient when the antibiotic level was at steady-state 10, 60, 120, 180, and 350 min after each dose. Antibiotic concentrations were measured using gel diffusion with Bacillus subtilis. All study participants provided written informed consent. RESULTS: We investigated the pharmacokinetics of piperacillin in 14 patients between the ages of 18 years and 59 years and with a mean absolute neutrophil count of 208 cells per mm³ (standard deviation (SD) ± 603.2). The following pharmacokinetic measurements were obtained: maximum concentration, 94.1-1133 mg/L; minimum concentration, 0.47-37.65 mg/L; volume of distribution, 0.08-0.65 L/kg (mean, 0.34 L/kg); drug clearance (CL), 4.42-27.25 L/h (mean, 9.93 L/h); half-life (t(1/2)), 0.55-2.65 h (mean, 1.38 h); and area under the curve, 115.12-827.16 mg · h/L. CONCLUSION: Patients with FN after receiving chemotherapy exhibited significant variations in the pharmacokinetic parameters of piperacillin compared with healthy individuals; specifically, FN patients demonstrated an increase in t1(/2) and decreased CL.


Assuntos
Antibacterianos/farmacocinética , Neutropenia Febril Induzida por Quimioterapia/metabolismo , Neoplasias Hematológicas/tratamento farmacológico , Ácido Penicilânico/análogos & derivados , Adolescente , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/sangue , Antibacterianos/uso terapêutico , Neutropenia Febril Induzida por Quimioterapia/tratamento farmacológico , Neutropenia Febril Induzida por Quimioterapia/etiologia , Feminino , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/metabolismo , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos/citologia , Ácido Penicilânico/administração & dosagem , Ácido Penicilânico/sangue , Ácido Penicilânico/farmacocinética , Ácido Penicilânico/uso terapêutico , Piperacilina/administração & dosagem , Piperacilina/sangue , Piperacilina/farmacocinética , Piperacilina/uso terapêutico , Combinação Piperacilina e Tazobactam , Estudos Prospectivos , Adulto Jovem
17.
Biomedica ; 33(1): 70-7, 2013 Jan-Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23715309

RESUMO

INTRODUCTION: Febrile neutropenia is a common complication of chemotherapy treatment of malignant hematological diseases. However, there is insufficient information regarding the infectious complications of febrile neutropenia in our country. Objective. We will evaluate the microbial characteristics of bacterial and fungal isolates and the clinical outcome of patients with febrile neutropenia who received medical attention at an oncological reference center in Colombia. MATERIALS AND METHODS: A prospective case series included patients with histologically confirmed oncological disease, who were admitted because of febrile neutropenia or presented with febrile neutropenia during hospitalization. Patients with benign hematological diseases were excluded. Demographic, microbiological, and clinical features as well as treatment and outcome information from patients with febrile neutropenia were obtained. We performed univariate and multivariate analyses, with mortality defined as the outcome. RESULTS: One hundred and thirty episodes of febrile neutropenia were identified in 104 patients. The mean patient age was 19, and 53% of the patients were male. Approximately 86% of the episodes occurred in patients with hematological disorders. An infectious site was identified in 65% of patients; 41% and 24% of the febrile neutropenia pateints´ episodes exhibited a localized infectious focus and developed bloodstream infections, respectively. The majority of infections were found in blood, urine, gastrointestinal tract, and soft tissue. Distribution analysis of microbiological isolates revealed 46.4% Gram-negative bacilli, 38.4% Gram-positive cocci, 8% fungi, and 7.1% parasites; there was a 7.7% mortality rate. Appropriate empirical antimicrobial therapy was a protection-related factor in multivariate analyses (OR= 0.17; 0.034 - 0.9 95% CI; p= 0.037). CONCLUSIONS: The mortality rate was relatively low and comparable to the rate reported by developed countries. Inappropriate empirical antimicrobial therapy was the main factor associated with mortality.


Assuntos
Infecções Bacterianas/etiologia , Institutos de Câncer , Neutropenia Febril Induzida por Quimioterapia/epidemiologia , Prescrição Inadequada/estatística & dados numéricos , Micoses/etiologia , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/estatística & dados numéricos , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Neutropenia Febril Induzida por Quimioterapia/complicações , Criança , Pré-Escolar , Colômbia/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Entamebíase/tratamento farmacológico , Entamebíase/epidemiologia , Entamebíase/etiologia , Entamebíase/parasitologia , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/microbiologia , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Especificidade de Órgãos , Estudos Prospectivos , Recidiva , Adulto Jovem
18.
Biomédica (Bogotá) ; 33(1): 70-77, ene.-mar. 2013. graf, tab
Artigo em Inglês | LILACS | ID: lil-675134

RESUMO

Introduction. Febrile neutropenia is a common complication of chemotherapy treatment of malignant hematological diseases. However, there is insufficient information regarding the infectious complications of febrile neutropenia in our country. Objective. We will evaluate the microbial characteristics of bacterial and fungal isolates and the clinical outcome of patients with febrile neutropenia who received medical attention at an oncological reference center in Colombia. Materials and methods. A prospective case series included patients with histologically confirmed oncological disease, who were admitted because of febrile neutropenia or presented with febrile neutropenia during hospitalization. Patients with benign hematological diseases were excluded. Demographic, microbiological, and clinical features as well as treatment and outcome information from patients with febrile neutropenia were obtained. We performed univariate and multivariate analyses, with mortality defined as the outcome. Results. One hundred and thirty episodes of febrile neutropenia were identified in 104 patients. The mean patient age was 19, and 53% of the patients were male. Approximately 86% of the episodes occurred in patients with hematological disorders. An infectious site was identified in 65% of patients; 41% and 24% of the febrile neutropenia pateints´ episodes exhibited a localized infectious focus and developed bloodstream infections, respectively. The majority of infections were found in blood, urine, gastrointestinal tract, and soft tissue. Distribution analysis of microbiological isolates revealed 46.4% Gram-negative bacilli, 38.4% Gram-positive cocci, 8% fungi, and 7.1% parasites; there was a 7.7% mortality rate. Appropriate empirical antimicrobial therapy was a protection-related factor in multivariate analyses (OR= 0.17; 0.034 - 0.9 95% CI; p= 0.037). Conclusions. The mortality rate was relatively low and comparable to the rate reported by developed countries. Inappropriate empirical antimicrobial therapy was the main factor associated with mortality.


Introducción. La neutropenia febril es una complicación frecuente de la quimioterapia para las neoplasias hematológicas. Se dispone de escasa información de sus complicaciones infecciosas en nuestro medio. Objetivo. Evaluar las características clínicas y microbiológicas de pacientes con neutropenia febril, así como su resultado clínico en una institución de referencia oncológica en Colombia. Materiales y métodos. Se conformó prospectivamente una serie de casos con pacientes con enfermedad oncológica confirmada, que consultaron o presentaron neutropenia febril durante la hospitalización. Se excluyeron aquellos con enfermedad hematológica benigna. Se recolectaron datos sobre variables demográficas, microbiológicas, clínicas, de tratamiento y de resultado de los pacientes. Se llevaron a cabo un análisis univariado y uno multivariado, con la mortalidad como resultado. Resultados. Se identificaron 130 episodios de neutropenia febril en 104 pacientes, con una edad media de 19 años y 53 % masculinos. El 86 % de los episodios ocurrieron en pacientes con alteraciones hematológicas. Se demostró infección en 65 % de los casos: 41 % con un foco infeccioso localizado y 27,7 % con bacteriemia. Los principales focos infecciosos se localizaron en el torrente sanguíneo, el aparato urinario, el sistema gastrointestinal, la piel y los tejidos blandos. De los aislamientos microbiológicos, 46,4 % fueron bacilos Gram negativos, 38,4 %, cocos Gram positivos, 9 %, hongos y, 7,1%, parásitos. La mortalidad global fue de 7,7 %. En el análisis multivariado la utilización de un tratamiento empírico apropiado se correlacionó con una menor mortalidad, de forma independiente (OR=0,17; IC 95% 0,034-0,9; p=0,037). Conclusiones. La tasa de mortalidad fue relativamente baja y fue comparable con lo reportado en países desarrollados. El tratamiento antimicrobiano inapropiado fue el principal factor asociado con mortalidad.


Assuntos
Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Infecções Bacterianas/etiologia , Institutos de Câncer , Neutropenia Febril Induzida por Quimioterapia/epidemiologia , Prescrição Inadequada/estatística & dados numéricos , Micoses/etiologia , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Neutropenia Febril Induzida por Quimioterapia/complicações , Colômbia/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Entamebíase/tratamento farmacológico , Entamebíase/epidemiologia , Entamebíase/etiologia , Entamebíase/parasitologia , Mortalidade Hospitalar , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/microbiologia , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Especificidade de Órgãos , Estudos Prospectivos , Recidiva
19.
Rev Chilena Infectol ; 30(6): 599-604, 2013 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-24522301

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 Retrospectivos
20.
Rev Chilena Infectol ; 30(6): 605-10, 2013 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-24522302

RESUMO

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 & purificação
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