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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.
Braz J Infect Dis ; 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31344357

RESUMO

BACKGROUND: Recent studies suggest that sustained use of generic antibiotics may be associated with clinical failure and emergence of antibacterial resistance. The present study was designed to determine the clinical outcome between the use of generic meropenem (GM) and brand-name meropenem (BNM). Additionally, this study evaluated the economic impact of GM and BNM to determine if the former represents a cost-effective alternative to the latter. METHODS: Patients treated between January 2011 and May 2014 received GM while patients treated between June 2014 and March 2017 received BNM. Mortality was compared between groups. Total infection cost was defined by the cost of antimicrobial consumption, length of stay, and laboratory and imaging exams until infection resolution. FINDINGS: A total of 168 patients were included; survival rate for the 68 patients treated with GM was 38% compared to 59% in the patients treated with BNM. Multivariate analysis showed that the variables most strongly-associated with mortality were cardiovascular disease (OR 18.18, 95% CI 1.25-262.3, p = 0.033) and treatment with generic meropenem (OR 18.45, 95% CI 1.45-232.32, p = 0.024). On the other hand, total infection cost did not show a significant difference between groups (BNM $10,771 vs. GM $11,343; p = 0.91). INTERPRETATION: The present study suggests that patients treated with GM have a risk of death 18 times higher compared to those treated with BNM. Furthermore, economic analysis shows that GM is not more cost effective than BNM. SUMMARY: More studies measuring clinical outcomes are needed to confirm the clinical equivalence of brand-name versus generic antibiotics, not only for meropenem but also for other molecules.

3.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30898368

RESUMO

INTRODUCTION: The carbapenem inactivation method (CIM) is a cost-effective assay for detecting carbapenemases. However, its interpretation is unclear for Pseudomonas spp. We evaluate its accuracy when meropenem is changed to imipenem. METHODS: We analyzed 266 P. aeruginosa isolates. The CIM method consists of: resuspend bacterial colonies (a full 10µL loop) in 400µL water, in which a 10µg disk of meropenem/imipenem is immersed. After 2h of incubation (35°C), remove the disk, place it onto a Mueller-Hinton agar plate previously inoculated with Escherichia coli (ATCC 25922), and incubate at 35 ̊C between 18-24 h. Interpretation criteria (mm of inhibition zone): ≤19mm, positive; ≥25mm negative; 20-24mm, undetermined. RESULTS: Imipenem improves the sensitivity and specificity of CIM when compared to meropenem (99.4% and 98.9%, vs. 91.9% and 94.7%, respectively). CONCLUSIONS: The accuracy of CIM for carbapenemase detection in P. aeruginosa is increased with the use of imipenem.

4.
Am J Trop Med Hyg ; 100(2): 411-419, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30652671

RESUMO

According to the World Health Organization, 98% of fatal dengue cases can be prevented; however, endemic countries such as Colombia have recorded higher case fatality rates during recent epidemics. We aimed to identify the predictors of mortality that allow risk stratification and timely intervention in patients with dengue. We conducted a hospital-based, case-control (1:2) study in two endemic areas of Colombia (2009-2015). Fatal cases were defined as having either 1) positive serological test (IgM or NS1), 2) positive virological test (RT-PCR or viral isolation), or 3) autopsy findings compatible with death from dengue. Controls (matched by state and year) were hospitalized nonfatal patients and had a positive serological or virological dengue test. Exposure data were extracted from medical records by trained staff. We used conditional logistic regression (adjusting for age, gender, disease's duration, and health-care provider) in the context of multiple imputation to estimate exposure to case-control associations. We evaluated 110 cases and 217 controls (mean age: 35.0 versus 18.9; disease's duration pre-admission: 4.9 versus 5.0 days). In multivariable analysis, retro-ocular pain (odds ratios [OR] = 0.23), nausea (OR = 0.29), and diarrhea (OR = 0.19) were less prevalent among fatal than nonfatal cases, whereas increased age (OR = 2.46 per 10 years), respiratory distress (OR = 16.3), impaired consciousness (OR = 15.9), jaundice (OR = 32.2), and increased heart rate (OR = 2.01 per 10 beats per minute) increased the likelihood of death (AUC: 0.97, 95% confidence interval: 0.96, 0.99). These results provide evidence that features of severe dengue are associated with higher mortality, which strengthens the recommendations related to triaging patients in dengue-endemic areas.

5.
J Glob Antimicrob Resist ; 13: 184-189, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29274468

RESUMO

OBJECTIVES: The aim of this study was to examine the population structure of representative carbapenem-resistant Enterobacter cloacae complex (CR-Ecl) isolates from eight different Colombian regions and to characterise their associated ß-lactamases. METHODS: A total of 28 CR-Ecl isolates collected in Colombia between 2009-2013 through the Colombian Nosocomial Network were included in this study. Antimicrobial susceptibility testing was performed by the broth microdilution method. Molecular detection of carbapenemase and extended-spectrum ß-lactamase (ESBL) genes and the presence of transposon Tn4401 was evaluated by PCR and DNA sequencing. Genetic relatedness was assessed by multilocus sequencing typing (MLST) and repetitive sequence-based PCR (rep-PCR). RESULTS: PCR and DNA sequencing revealed that 19/28 (68%) of the CR-Ecl isolates carried blaKPC-2. Analysis of the genetic environment found blaKPC-2 within transposon Tn4401b in 8/19 isolates (42%). Population genetic analysis using rep-PCR revealed four clonal groups. MLST showed a variety of sequence types (STs), among which ST510 was the most common (10/28 isolates; 36%). CONCLUSIONS: blaKPC-2 was discovered as the most common mechanism of carbapenem resistance in CR-Ecl and was disseminated among different STs. Although none of the previously reported major clonal complexes were identified, it appears that local strain lineages are associated with the spread of blaKPC within CR-Ecl in various regions of Colombia.

6.
Microb Drug Resist ; 24(1): 48-54, 2018 Jan/Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28570118

RESUMO

The global success of multidrug-resistant Acinetobacter baumannii has been associated with the dissemination of a high-risk clone designated clonal complex (CC) 92B (Bartual scheme)/CC2P (Pasteur scheme), which is the most frequent genetic lineage in European, Asian, and North American carbapenem-resistant Acinetobacter isolates. In these isolates, carbapenem resistance is mainly mediated by ß-lactamases encoded by blaOXA-23-like, blaOXA-24-like, blaOXA-51-like, and/or blaOXA-58-like genes. In this study, we characterized the population genetics of 121 carbapenem-resistant A. baumannii complex isolates recovered from 14 hospitals in seven cities in Colombia (2008-2010). Multiplex PCR was used to detect blaOXA-23-like, blaOXA-24-like, blaOXA-51-like, and blaOXA-58-like genes. Molecular typing was performed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). PCR showed that 118 (97.5%) of the isolates were positive for both blaOXA-23-like and blaOXA-51-like genes, and three other isolates were only positive for blaOXA-51-like. PFGE identified 18 different pulsotypes, while MLST identified 11 different sequence types (STs), seven of which had not been previously described in Acinetobacter. None of the STs found in this study was associated with CC92B/CC2P. The most widespread STs in our isolates belonged to ST636 and their single-locus variants ST121/ST124/ST634 (CC636B) followed by STs belonging to CC110B. Our observations suggest a wide distribution of diverse A. baumannii complex clones containing blaOXA-23-like in Colombian hospitals (especially CC636B and CC110B) that differ from the high-risk clones commonly found in other regions of the world, indicating a distinct molecular epidemiology of carbapenem-resistant Acinetobacter spp. in Colombia.


Assuntos
Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii/genética , Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Regulação Bacteriana da Expressão Gênica , Resistência beta-Lactâmica/genética , beta-Lactamases/genética , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/classificação , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/crescimento & desenvolvimento , Células Clonais , Colômbia/epidemiologia , Eletroforese em Gel de Campo Pulsado , Variação Genética , Hospitais , Humanos , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Reação em Cadeia da Polimerase Multiplex , Sorogrupo , beta-Lactamases/classificação , beta-Lactamases/metabolismo
7.
Rev Chilena Infectol ; 34(3): 205-211, 2017 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-28991315

RESUMO

BACKGROUND: The increasing resistance of bacteria to antibiotics threatens the survival of patients and health costs. AIM: To determine the impact of an antimicrobial stewardship program in bacterial resistance and antibiotic consumption. MATERIALS AND METHODS: Quasi experimental study in a third level clinic in the city of Medellin, that evaluate in two time periods (pre-intervention between October 2012 and September 2013 and post intervention between October 2013 and September 2014) the impact of an antimicrobial stewardship program in terms of antibiotic consumption and bacterial ecology. RESULTS: Adherence to institutional guidelines for management of infections in the post-intervention period was 82%. Antibiotic consumption of meropenem, ceftriaxone, vancomycin and colistin decreased, and imipenem, daptomycin and linezolid was increased. A significant decrease in antibiotic resistance in Pseudomonas aeruginosa was observed, including carbapenems. An increase of extended spectrum beta lactamase production (ESBL) in Enterobacteriaceae (especially E. coli) and piperacillin/tazobactam resistance was observed. CONCLUSIONS: The construction and implementation of a strategy in hospitals with guidelines for managing infectious diseases, restrictions in antibiotic use, a permanent monitoring system for the formulation of antibiotics, achieved a positive impact on reducing antibiotic use and bacterial resistance.


Assuntos
Antibacterianos/administração & dosagem , Prescrição Inadequada/prevenção & controle , Colômbia , Resistência Microbiana a Medicamentos , Humanos , Serviço de Farmácia Hospitalar , Estudos Prospectivos , Centros de Atenção Terciária
8.
Rev. chil. infectol ; 34(3): 205-211, jun. 2017. graf, tab
Artigo em Espanhol | LILACS-Express | ID: biblio-899702

RESUMO

Background: The increasing resistance of bacteria to antibiotics threatens the survival of patients and health costs. Aim: To determine the impact of an antimicrobial stewardship program in bacterial resistance and antibiotic consumption. Materials and Methods: Quasi experimental study in a third level clinic in the city of Medellin, that evaluate in two time periods (pre-intervention between October 2012 and September 2013 and post intervention between October 2013 and September 2014) the impact of an antimicrobial stewardship program in terms of antibiotic consumption and bacterial ecology. Results: Adherence to institutional guidelines for management of infections in the post-intervention period was 82%. Antibiotic consumption of meropenem, ceftriaxone, vancomycin and colistin decreased, and imipenem, daptomycin and linezolid was increased. A significant decrease in antibiotic resistance in Pseudomonas aeruginosa was observed, including carbapenems. An increase of extended spectrum beta lactamase production (ESBL) in Enterobacteriaceae (especially E. coli) and piperacillin/tazobactam resistance was observed. Conclusions: The construction and implementation of a strategy in hospitals with guidelines for managing infectious diseases, restrictions in antibiotic use, a permanent monitoring system for the formulation of antibiotics, achieved a positive impact on reducing antibiotic use and bacterial resistance.


Introducción: El aumento progresivo de la resistencia bacteriana a antimicrobianos amenaza la sobrevida de los pacientes y los costos en salud. Objetivo: Determinar el impacto de un programa para el uso racional de antimicrobianos en resistencia bacteriana y consumo de antimicrobianos en una institución de tercer nivel de atención. Materiales y Métodos: Estudio cuasi experimental realizado en una clínica de tercer nivel de la ciudad de Medellín, donde se comparó en dos períodos de tiempo (pre intervención entre octubre de 2012 y septiembre de 2013 y post intervención entre octubre de 2013 y septiembre de 2014) el consumo y la resistencia a antimicrobianos de las bacterias hospitalarias. Resultados: La adherencia a las guías institucionales para el manejo de la patología infecciosa en el período post intervención fue 82%. Se observó una disminución en el consumo de meropenem, ceftriaxona, colistín, vancomicina, y un incremento en el consumo de imipenem, daptomicina y linezolid. Se observó una disminución significativa en la resistencia de Pseudomonas aeruginosa a los antimicrobianos, incluyendo los carbapenémicos. Se presentó un incremento en la proporción de enterobacteriaceas productoras de BLEE (principalmente Escherichia coli) y resistencia a piperacilina/tazobactam. Conclusiones: La construcción e implementación en las instituciones hospitalarias de una estrategia conformada por guías de manejo de la patología infecciosa, restricción en el uso de antimicrobianos y un sistema de vigilancia y un monitoreo permanente a la formulación de éstos, logra un impacto positivo en disminución del consumo de antimicrobianos y resistencia bacteriana.

10.
Rev. iberoam. micol ; 34(1): 17-22, ene.-mar. 2017. tab, graf
Artigo em Inglês | IBECS | ID: ibc-160729

RESUMO

Background. The frequency of Candida isolates as a cause of hospital infections has risen in recent years, leading to high rates of morbidity and mortality. The knowledge of the epidemiology of those hospital acquired fungal infections is essential to implement an adequate antifungal therapy. Aims. To describe the epidemiology of Candida infections in Intensive Care Units (ICUs) from a surveillance network in Colombia. Methods. Information was collected from the microbiology laboratories of 20 tertiary healthcare institutions from 10 Colombian cities using the Whonet® software version 5.6. A general descriptive analysis of Candida species and susceptibility profiles focusing on fluconazole and voriconazole was completed between 2010 and 2013, including a sub-analysis of healthcare associated infections (HAIs) during the last year. Results. Candida isolates made up 94.5% of the 2680 fungal isolates considered, with similar proportions for Candida albicans and non-C. albicans Candida species (48.3% and 51.7%, respectively). Among the latter, Candida tropicalis (38.6%) and Candida parapsilosis (28.5%) were the most frequent species. Of note, among the blood isolates C. albicans was not the main species. Most of the species isolated were susceptible to fluconazole and voriconazole. From the HAIs reported, 25.5% were caused by Candida; central line-associated bloodstream infection was the most common HAI (58.8%). There were no statistically significant differences regarding length of hospital stay and device days among HAIs. Conclusions. In ICUs of Colombia, non-C. albicans Candida species are as frequent as C. albicans, except in blood samples where non-C. albicans Candida isolates predominate. Further studies are needed to evaluate Candida associated risk factors and to determine its clinical impact (AU)


Antecedentes. La frecuencia de aislamientos de Candida causantes de infecciones hospitalarias ha aumentado en los últimos años, lo que implica altas tasas de morbimortalidad. El conocimiento de la epidemiología de estas infecciones nosocomiales asociadas con hongos es indispensable para instaurar una terapia antifúngica adecuada. Objetivos. Describir la epidemiologia de las infecciones causadas por Candida en las unidades de cuidados intensivos (UCI) de una red de vigilancia de Colombia. Métodos. La información se recogió en los laboratorios de microbiología de 20 instituciones de tercer nivel en 10 ciudades de Colombia a través de Whonet® versión 5.6. Se realizó un análisis descriptivo general de las especies de Candida más frecuentes y de su perfil de sensibilidad al fluconazol y al voriconazol desde 2010 hasta 2013, incluyendo un subanálisis de las infecciones asociadas con la atención de salud (IAAS) durante el último año. Resultados. De los 2.680 aislamientos de hongos, el 94,5% correspondió a especies de Candida, con proporciones similares entre Candida albicans y el resto de especies del género halladas (el 48,3 y el 51,7%, respectivamente). La mayor prevalencia entre estas últimas correspondió a Candida tropicalis (38,6%) y Candida parapsilosis (28,5%). En muestras de sangre, C. albicans no fue la especie más frecuente. La mayoría de especies fue sensible al fluconazol y al voriconazol. Candida causó el 25,5% de las IAAS reportadas, con la infección del torrente circulatorio asociada con catéter (58,8%) como la más frecuente de las patologías. No hubo diferencias estadísticamente significativas en el tiempo de estancia hospitalaria o en el de uso de cualquier eventual dispositivo entre las IAAS. Conclusiones. En las UCI de Colombia, la prevalencia de C. albicans es muy similar al del resto de especies en conjunto. Únicamente en sangre fue evidente el predominio de otras especies del género diferentes de C. albicans. Otros estudios son necesarios para evaluar factores asociados con la infección por Candida y determinar su impacto en estos pacientes (AU)


Assuntos
Humanos , Masculino , Feminino , Candida/isolamento & purificação , Candidíase/epidemiologia , Candidíase/microbiologia , Cuidados Críticos/tendências , Unidades de Terapia Intensiva/normas , Candida tropicalis/isolamento & purificação , Colômbia/epidemiologia , Testes de Sensibilidade Microbiana/métodos , Sensibilidade e Especificidade , Atenção à Saúde , Fungos/isolamento & purificação , Fluconazol/uso terapêutico , Voriconazol/uso terapêutico
11.
Rev Iberoam Micol ; 34(1): 17-22, 2017 Jan - Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27810262

RESUMO

BACKGROUND: The frequency of Candida isolates as a cause of hospital infections has risen in recent years, leading to high rates of morbidity and mortality. The knowledge of the epidemiology of those hospital acquired fungal infections is essential to implement an adequate antifungal therapy. AIMS: To describe the epidemiology of Candida infections in Intensive Care Units (ICUs) from a surveillance network in Colombia. METHODS: Information was collected from the microbiology laboratories of 20 tertiary healthcare institutions from 10 Colombian cities using the Whonet® software version 5.6. A general descriptive analysis of Candida species and susceptibility profiles focusing on fluconazole and voriconazole was completed between 2010 and 2013, including a sub-analysis of healthcare associated infections (HAIs) during the last year. RESULTS: Candida isolates made up 94.5% of the 2680 fungal isolates considered, with similar proportions for Candida albicans and non-C. albicans Candida species (48.3% and 51.7%, respectively). Among the latter, Candida tropicalis (38.6%) and Candida parapsilosis (28.5%) were the most frequent species. Of note, among the blood isolates C. albicans was not the main species. Most of the species isolated were susceptible to fluconazole and voriconazole. From the HAIs reported, 25.5% were caused by Candida; central line-associated bloodstream infection was the most common HAI (58.8%). There were no statistically significant differences regarding length of hospital stay and device days among HAIs. CONCLUSIONS: In ICUs of Colombia, non-C. albicans Candida species are as frequent as C. albicans, except in blood samples where non-C. albicans Candida isolates predominate. Further studies are needed to evaluate Candida associated risk factors and to determine its clinical impact.


Assuntos
Candida/isolamento & purificação , Candidíase/epidemiologia , Candidíase/microbiologia , Colômbia/epidemiologia , Monitoramento Epidemiológico , Humanos , Unidades de Terapia Intensiva , Estudos Retrospectivos , Fatores de Tempo
12.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 34(9): 559-565, nov. 2016. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-157122

RESUMO

Introducción: Las infecciones del tracto urinario (ITU) son frecuentes en la comunidad. Sin embargo, la información de aislamientos resistentes en este contexto es limitada en Latinoamérica. Este estudio tiene como objetivo determinar la prevalencia y los factores de riesgo asociados con ITU de inicio en la comunidad (ITU-IC) causadas por Escherichia coli productor de betalactamasas de espectro extendido (BLEE) en Colombia. Materiales y métodos: Entre agosto y diciembre de 2011 se realizó un estudio de casos y controles en 3 instituciones de salud de tercer nivel en Colombia. Se invitó a participar a todos los pacientes admitidos a urgencias con diagnóstico probable de ITU-IC, y se les pidió una muestra de orina. En los aislamientos de E.coli se realizaron pruebas confirmatorias para BLEE, susceptibilidad antibiótica, caracterización molecular (PCR en tiempo real para genes bla, repetitive element palindromic PCR [rep-PCR], multilocus sequence typing [MLST] y factores de virulencia por PCR). Se obtuvo información clínica y epidemiológica, y posteriormente se realizó el análisis estadístico. Resultados: De los 2.124 pacientes seleccionados, 629 tuvieron un urocultivo positivo, en 431 de estos se aisló E.coli, 54 fueron positivos para BLEE y 29 correspondieron a CTX-M-15. La mayoría de los aislamientos de E.coli productor de BLEE fueron sensibles a ertapenem, fosfomicina y amikacina. La ITU complicada se asoció fuertemente con infecciones por E.coliproductor de BLEE (OR=3,89; IC95%: 1,10-13,89; p=0,03). E.coli productor de CTX-M-15 mostró 10 electroferotipos diferentes; de estos, el 65% correspondieron al ST131. La mayoría de estos aislamientos tuvieron 8 de los 9 factores de virulencia analizados. Discusión: E.coli portador del gen blaCTX-M-15 asociado al ST131 sigue siendo frecuente en Colombia. La presencia de ITU-IC complicada aumenta el riesgo de tener E.coli productor de BLEE, lo cual debe tenerse en cuenta para ofrecer una terapia empírica adecuada (AU)


Introduction: Urinary tract infections (UTI) are common in the community. However, information of resistant isolates in this context is limited in Latin America. This study aims to determine the prevalence and risk factors associated with community-onset UTI (CO-UTI) caused by extended-spectrum β-lactamase (ESBL)-Producing Escherichia coli in Colombia. Materials and methods: A case-control study was conducted between August and December of 2011 in three Colombian tertiary-care institutions. All patients who were admitted to the Emergency Department with a probable diagnosis of CO-UTI were invited to participate. All participating patients were asked for a urine sample. ESBL confirmatory test, antibiotic susceptibility, and molecular epidemiology were performed in these E.coli isolates (Real Time-PCR for blagenes, repetitive element palindromic PCR [rep-PCR], multilocus sequence typing [MLST] and virulence factors by PCR). Clinical and epidemiological information was recorded, and a statistical analysis was performed. Results: Of the 2124 recruited patients, 629 had a positive urine culture, 431 of which grew E.coli; 54 were positive for ESBL, of which 29 were CTX-M-15. The majority of ESBL isolates were susceptible to ertapenem, phosphomycin and amikacin. Complicated UTI was strongly associated with ESBL-producing E.coli infections (OR=3.89; 95%CI: 1.10-13.89; P=.03). CTX-M-15-producing E.coli showed 10 different pulsotypes, 65% were PT1 or PT4, and corresponded to ST131. Most of these isolates had 8 out of the 9 analysed virulence factors. Discussion: E.coli harbouring blaCTX-M-15 associated with ST131 is still frequent in Colombia. The presence of complicated CO-UTI increases the risk of ESBL-producing E.coli, and must be taken into account in order to provide an adequate empirical therapy (AU)


Assuntos
Humanos , Infecções Urinárias/microbiologia , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/epidemiologia , Fatores de Risco , Infecções Urinárias/epidemiologia , Estudos de Casos e Controles , beta-Lactamases/análise
13.
PLoS One ; 11(4): e0154092, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27104910

RESUMO

INTRODUCTION: Infections caused by carbapenem-resistant Enterobacteriaceae are a public health problem associated with higher mortality rates, longer hospitalization and increased healthcare costs. We carried out a study to describe the characteristics of patients with carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE bloodstream infection (BSI) from Latin American hospitals and to determine the clinical impact in terms of mortality and antibiotic therapy. METHODS: Between July 2013 and November 2014, we conducted a multicenter observational study in 11 hospitals from 7 Latin American countries (Argentina, Colombia, Ecuador, Guatemala, Mexico, Peru, Venezuela). Patients with BSI caused by Enterobacteriaceae were included and classified either as CPE or non-CPE based on detection of blaKPC, blaVIM, blaIMP, blaNDM and blaOXA-48 by polymerase chain reaction. Enrolled subjects were followed until discharge or death. Demographic, microbiological and clinical characteristics were collected from medical records. Both descriptive and inferential statistics were used to analyze the information. RESULTS: A total of 255 patients with Enterobacteriaceae BSI were included; CPE were identified in 53 of them. In vitro non-susceptibility to all screened antibiotics was higher in the patients with CPE BSI, remaining colistin, tigecycline and amikacin as the most active drugs. Combination therapy was significantly more frequent in the CPE BSI group (p < 0.001). The most common regimen was carbapenem + colistin or polymyxin B. The overall mortality was 37% (94/255). Overall and attributable mortality were significantly higher in patients with CPE BSI (p < 0.001); however, we found that patients with CPE BSI who received combination therapy and those who received monotherapy had similar mortality. After multivariate adjustment, CPE BSI (adjusted odds ratio [aOR] 4; 95% confidence interval [CI] 1.7-9.5; p = 0.002) and critical illness (aOR 6.5; 95% CI 3.1-13.7; p < 0.001) were independently associated with in-hospital mortality. CONCLUSIONS: This study provides valuable data on the clinical characteristics and mortality risk factors in patients with CPE BSI. We determined that CPE infection is an independent mortality predictor and thus Latin American hospitals should perform campaigns on prevention and control of CPE BSI.


Assuntos
Proteínas de Bactérias/biossíntese , Infecções por Enterobacteriaceae/epidemiologia , Sepse/epidemiologia , beta-Lactamases/biossíntese , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Enterobacteriaceae/efeitos dos fármacos , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/fisiopatologia , Feminino , Humanos , Lactente , Recém-Nascido , América Latina/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Sepse/tratamento farmacológico , Sepse/microbiologia , Sepse/fisiopatologia , Adulto Jovem
14.
Enferm Infecc Microbiol Clin ; 34(9): 559-565, 2016 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-26774256

RESUMO

INTRODUCTION: Urinary tract infections (UTI) are common in the community. However, information of resistant isolates in this context is limited in Latin America. This study aims to determine the prevalence and risk factors associated with community-onset UTI (CO-UTI) caused by extended-spectrum ß-lactamase (ESBL)-Producing Escherichia coli in Colombia. MATERIALS AND METHODS: A case-control study was conducted between August and December of 2011 in three Colombian tertiary-care institutions. All patients who were admitted to the Emergency Department with a probable diagnosis of CO-UTI were invited to participate. All participating patients were asked for a urine sample. ESBL confirmatory test, antibiotic susceptibility, and molecular epidemiology were performed in these E.coli isolates (Real Time-PCR for bla genes, repetitive element palindromic PCR [rep-PCR], multilocus sequence typing [MLST] and virulence factors by PCR). Clinical and epidemiological information was recorded, and a statistical analysis was performed. RESULTS: Of the 2124 recruited patients, 629 had a positive urine culture, 431 of which grew E.coli; 54 were positive for ESBL, of which 29 were CTX-M-15. The majority of ESBL isolates were susceptible to ertapenem, phosphomycin and amikacin. Complicated UTI was strongly associated with ESBL-producing E.coli infections (OR=3.89; 95%CI: 1.10-13.89; P=.03). CTX-M-15-producing E.coli showed 10 different pulsotypes, 65% were PT1 or PT4, and corresponded to ST131. Most of these isolates had 8 out of the 9 analysed virulence factors. DISCUSSION: E.coli harbouring blaCTX-M-15 associated with ST131 is still frequent in Colombia. The presence of complicated CO-UTI increases the risk of ESBL-producing E.coli, and must be taken into account in order to provide an adequate empirical therapy.


Assuntos
Infecção Hospitalar/epidemiologia , Infecções por Escherichia coli/epidemiologia , Infecções Urinárias/epidemiologia , Escherichia coli Uropatogênica/enzimologia , beta-Lactamases/biossíntese , Adulto , Estudos de Casos e Controles , Colômbia/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/microbiologia , Estudos Transversais , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Reação em Cadeia da Polimerase/métodos , Prevalência , Fatores de Risco , Infecções Urinárias/microbiologia
16.
Biomedica ; 34 Suppl 1: 148-55, 2014 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-24968046

RESUMO

INTRODUCTION: Nosocomial infections are a public health threat. Despite multiple efforts, its incidence is still significant and it generates high costs in health care. OBJECTIVE: To determine risk factors associated with mortality in patients with healthcare infections in a tertiary level hospital in Colombia. MATERIALS AND METHODS: A prospective cohort observational study was performed between January and December 2011. One thousand one hundred and fifteen patients with health care infections using the CDC definition criteria were included. Exclusion criteria were those patients with no microbiologic isolate associated with the infection or hospital readmissions in the last year. Socio-demographic and clinical variables, bacterial resistance profiles and antibiotic use were evaluated. Death was the primary outcome. Survival analysis for each variable was performed using statistical significance defined by the log-rank test. Multivariate and Cox regression analyses were done. Values of p less than 0.05 were considered statistically significant. RESULTS: Mean age was 43 years old (57% men and 47% women); 53% of patients had a medical condition and 47% surgical diagnosis; 54% of health care infections were surgical site infections and 62% were associated to Gram-negative bacilli. The mortality rate during follow-up was 24.4%. On multivariate analysis we found an association with intensive care stay (HR=1.51; 95% CI: 1.13-2.01), inappropriate use of antibiotics (HR=3.05; 95% CI: 2.34-3.98) and use of generic antibiotics or copies (HR=1.91; 95%CI: 1.43-2.55). CONCLUSIONS: The use of generic molecules of antibiotics and inappropriate antibiotic treatments in patients with health care infections are modifiable factors to decrease mortality.


Assuntos
Infecção Hospitalar/mortalidade , Mortalidade Hospitalar , Hospitais Universitários/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Colômbia/epidemiologia , Infecção Hospitalar/tratamento farmacológico , Farmacorresistência Bacteriana , Medicamentos Genéricos/uso terapêutico , Feminino , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/mortalidade , Humanos , Prescrição Inadequada , Lactente , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
17.
Biomédica (Bogotá) ; 34(supl.1): 148-155, abr. 2014. graf, tab
Artigo em Espanhol | LILACS | ID: lil-712431

RESUMO

Introducción. Las infecciones hospitalarias son una amenaza para la salud pública. A pesar de los esfuerzos para contenerlas, su incidencia sigue siendo grande y genera altos costos en la atención en salud. Objetivo. Determinar los factores asociados a mortalidad en pacientes con diagnóstico de infecciones hospitalarias en nuestra institución. Materiales y métodos. Se llevó a cabo un estudio prospectivo de cohortes entre enero y diciembre del 2011 por medio de la observación de 1.015 pacientes con diagnóstico de infección de acuerdo a los criterios del sistema de vigilancia hospitalaria sugeridos por los Centers for Disease Control and Prevention (CDC). Se excluyó a quienes no tenían cultivo microbiológico de la infección o habían tenido reingresos hospitalarios en menos de un año. Se evaluaron variables sociodemográficas y clínicas, perfiles de resistencia microbiológica y uso de antibióticos. La variable de desenlace fue la muerte. Se realizó un análisis de supervivencia para cada variable, estableciendo significación estadística con la prueba de log-rank , así como un análisis multivariado mediante regresión de Cox. Se consideraron significativos los valores de p menores de 0,05. Resultados. El promedio de edad fue de 43 años (57 % hombres y 43 % mujeres); 53 % de los pacientes tuvo diagnóstico clínico y 47 %, quirúrgico; 54 % de las infecciones se presentó en la herida quirúrgica y 62 % de ellas se asociaron a microorganismos Gram negativos. La mortalidad durante el seguimiento fue de 24,4 %. En el análisis multivariado se encontró asociación con mortalidad para las variables de estancia en cuidado intensivo ( hazard ratio (HR)=1,51; IC 95% 1,13-2,01), uso inapropiado de antibióticos (HR=3,05; IC 95% 2,34-3,98) y uso de antibiótico genérico o copia (HR=1,91; IC IC 95% 1,43-2,55). Conclusiones. El empleo de moléculas genéricas y el uso inadecuado de antibióticos en pacientes con infecciones hospitalarias son factores que pueden modificarse para disminuir la mortalidad.


Introduction: Nosocomial infections are a public health threat. Despite multiple efforts, its incidence is still significant and it generates high costs in health care. Objective: To determine risk factors associated with mortality in patients with healthcare infections in a tertiary level hospital in Colombia. Materials and methods: A prospective cohort observational study was performed between January and December 2011. One thousand one hundred and fifteen patients with health care infections using the CDC definition criteria were included. Exclusion criteria were those patients with no microbiologic isolate associated with the infection or hospital readmissions in the last year. Socio-demographic and clinical variables, bacterial resistance profiles and antibiotic use were evaluated. Death was the primary outcome. Survival analysis for each variable was performed using statistical significance defined by the log-rank test. Multivariate and Cox regression analyses were done. Values of p less than 0.05 were considered statistically significant. Results: Mean age was 43 years old (57% men and 47% women); 53% of patients had a medical condition and 47% surgical diagnosis; 54% of health care infections were surgical site infections and 62% were associated to Gram-negative bacilli. The mortality rate during follow-up was 24.4%. On multivariate analysis we found an association with intensive care stay (HR=1.51; 95% CI: 1.13-2.01), inappropriate use of antibiotics (HR=3.05; 95% CI: 2.34-3.98) and use of generic antibiotics or copies (HR=1.91; 95%CI: 1.43-2.55). Conclusions: The use of generic molecules of antibiotics and inappropriate antibiotic treatments in patients with health care infections are modifiable factors to decrease mortality.


Assuntos
Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Infecção Hospitalar/mortalidade , Mortalidade Hospitalar , Hospitais Universitários/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Antibacterianos/uso terapêutico , Colômbia/epidemiologia , Infecção Hospitalar/tratamento farmacológico , Farmacorresistência Bacteriana , Medicamentos Genéricos/uso terapêutico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/mortalidade , Prescrição Inadequada , Estimativa de Kaplan-Meier , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos
18.
Infectio ; 16(4): 192-198, oct.-dic. 2012. graf, tab
Artigo em Espanhol | LILACS-Express | ID: lil-675179

RESUMO

Objetivo: Evaluar el impacto de un programa de uso regulado de antibióticos en adherencia, consumo antibiótico y resistencia bacteriana en 2 unidades de cuidados intensivos (UCI) de un hospital universitario de tercer nivel en Colombia. Materiales y Método: Estudio prospectivo observacional de intervención que analiza 2 períodos en el tiempo en 2 UCI: preintervención (agosto de 2008 a febrero de 2009) y posintervención (marzo a septiembre de 2009). El estudio se llevó a cabo en el Hospital Universitario del Valle Evaristo García E.S.E. Se evaluaron: adherencia a guías de uso de antibióticos creadas por epidemiología hospitalaria, consumo antibiótico en dosis diaria definida e incidencia acumulada mensual de infección por Escherichia coli (E. coli) y Klebsiella pneumoniae (K. pneumoniae) BLEE, Pseudomonas aeruginosa (P. aeruginosa) resistente a quinolonas y cefalosporinas de cuarta generación, Staphylococcus aureus resistente a oxacilina y Acinetobacter baumannii multirresistente. Resultados: Se encontró adherencia a guías de uso de antibióticos superior al 80% para ambas UCI durante la intervención. Se redujo significativamente el consumo de meropenem (UCI-1 p = 0,009/UCI-2 p = 0,000), vancomicina (UCI-1 y UCI-2 p = 0,018), ceftriaxona (UCI-1 p = 0,015/ UCI-2 p = 0,018), ciprofloxacina (UCI-1 p = 0,027/UCI-2 p = 0,018), se incrementó el consumo de piperacilina/tazobactam (UCI-1 p = no significativa/UCI-2 p = 0,017) y cefepime (UCI-1 p = 0,028/UCI-2 p = 0,004). Se redujo la incidencia de infección por E. coli y K. pneumoniae BLEE + (UCI-1 83%/UCI-2 78%), P. aeruginosa resistente a ciprofloxacina (UCI-1 87%/UCI-2 82%) y cefalosporinas de cuarta generación (UCI-1 83%/UCI-2 76%). Conclusiones: La creación de un programa de uso regulado de antibióticos reduce significativamente el consumo y los costos de antibióticos en las UCI del Hospital Universitario del Valle y la infección por microorganismos resistentes.


Objective: To determine the impact of a Program of Regulated Use of Antibiotics in adherence, antibiotic use and bacterial resistance in two medical-surgical Intensive Units Care (ICU´s) in a third level mayor teaching hospital in Colombia. Materials and Methods: Prospective observational study of intervention that examines two time periods in two ICU: pre-intervention (august/2008 to February/2009) and post-intervention (march to September/2009). The study was carried out in the Hospital Universitario del Valle Evaristo García E.S.E. (H.U.V). We evaluated adherence to the antibiotic therapy guidelines established by Hospital Epidemiology, antibiotic use measured by Defined Daily Doses and monthly incidence of infection by ESBL producer E.coli and K.pneumoniae, P.aeruginosa fluoroquinolone and four generation cephalosporin resistant, oxacilin resistant S.aureus and multidrug resistant A.baumannii. Results: The adherence to the antibiotic guidelines of antibiotic use was greater to 80% for the both ICU during the intervention period. Antibiotic use was significantly reduced for meropenem (ICU1 p=0,009/ICU2 p=0,000), vancomycin (ICU1-ICU2 p=0,018), ceftriaxone (ICU1 p=0,015/ICU2 p=0,018), ciprofloxacin (ICU1 p=0,027/ICU2 p=0,018), and increased the used of piperacilin/tazobactam (ICU2 p=0,017), and cefepime (ICU1 p=0,028/ICU2 p=0,004). The incidences of infection by ESBL producer E.coli and K.pneumoniae (ICU1 83%/ ICU2 78%), ciprofloxacin resistant and four generation cephalosporin resistant P.aeruginosa (ICU1 87%/ ICU2 82%) and (ICU1 83%/ICU2 76%) ware also reduced. Conclusions: The implementation of a Program of Regulated Use of Antibiotics reduces antibiotics use and resistant micro-organism specific infection rate in the Hospital Universitario del Valle´s ICU.

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