Atraumatic (pencil-point) versus conventional needles for lumbar puncture:a clinical practice guideline

Is the needle tip configuration important when performing a lumbar puncture for any indication? A systematic review published in the Lancet in December 2017 suggests that it is. The review found that using atraumatic (pencil-point) lumbar puncture needles instead of conventional lumbar puncture needles reduced the risk of post-dural-puncture headache and of return to hospital for additional pain control.1 This guideline recommendation aims to promptly and transparently translate this evidence to a clinical recommendation, following standards for GRADE methodology and trustworthy guidelines.2 The BMJ Rapid Recommendations panel makes a strong recommendation for the use of atraumatic needles for lumbar puncture in all patients regardless of age (adults and children) or indication instead of conventional needles.3 4 Box 1 shows the article and evidence linked to this Rapid Recommendation. The main infographic provides an overview of the absolute benefits and harms (although none were present here) of atraumatic needles. Table 1 below shows any evidence that has emerged since the publication of this guideline.publishedVersio

Confronting the challenge: a regional perspective by the Latin American pediatric infectious diseases society (SLIPE) expert group on respiratory syncytial virus—tackling the burden of disease and implementing preventive solutions

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections in children around the world. The post-pandemic era has resulted in a notable increase in reported cases of RSV infections, co-circulation of other respiratory viruses, shifts in epidemiology, altered respiratory season timing, and increased healthcare demand. Low- and middle-income countries are responsible for the highest burden of RSV disease, contributing significantly to health expenses during respiratory seasons and RSV-associated mortality in children. Until recently, supportive measures were the only intervention to treat or prevent RSV-infection, since preventive strategies like palivizumab are limited for high-risk populations. Advances in new available strategies, such as long-acting monoclonal antibodies during the neonatal period and vaccination of pregnant women, are now a reality. As the Regional Expert Group of the Latin American Pediatric Infectious Diseases Society (SLIPE), we sought to evaluate the burden of RSV infection in Latin America and the Caribbean (LAC) region, analyze current strategies to prevent RSV infection in children, and provide recommendations for implementing new strategies for preventing RSV infection in children in LAC region

Colombian consensus recommendations for diagnosis, management and treatment of the infection by SARS-COV-2/ COVID-19 in health care facilities - Recommendations from expert´s group based and informed on evidence

La Asociación Colombiana de Infectología (ACIN) y el Instituto de Evaluación de Nuevas Tecnologías de la Salud (IETS) conformó un grupo de trabajo para desarrollar recomendaciones informadas y basadas en evidencia, por consenso de expertos para la atención, diagnóstico y manejo de casos de Covid 19. Estas guías son dirigidas al personal de salud y buscar dar recomendaciones en los ámbitos de la atención en salud de los casos de Covid-19, en el contexto nacional de Colombia

Impacto de la disponibilidad de la prueba molecular multiplex M/E en la duración del tratamiento antibiótico en niños con sospecha de infección del sistema nervioso central. Un estudio cuasi-experimental

RESUMEN: Introducción: El pronóstico de las infecciones del sistema nervioso central (SNC) depende del diagnóstico oportuno y el inicio precoz de un tratamiento adecuado. El panel molecular para meningitis y encefalitis FilmArray (MEFA) permite la detección de patógenos implicados en infecciones de SNC de forma rápida y con ello, se pretende agilizar la toma de decisiones en los pacientes. Este estudio pretende evaluar el impacto que tiene el uso del panel MEFA en la duración de la terapia antibiótica y antiviral. Métodos: se realizó un estudio cuasi-experimental, ambispectivo, en un hospital infantil de tercer nivel, en niños con sospecha clínica de neuroinfección. Se analizaron tres períodos de tiempo según la disponibilidad del panel MEFA. Grupo 1: no disponible, grupo 2: disponible según contratación de la aseguradora y bajo autorización administrativa, grupo 3 disponible en forma gratuita para toda la población. Resultados: En 490 pacientes (187 en el grupo 1, 189 en el grupo 2 y 114 en el grupo 3) con sospecha de neuroinfección, se realizaron 182 paneles MEFA, y fueron positivos 31 (17%). De estos, 54.8% (17 pacientes) tuvieron una detección viral y 38.7% (12 pacientes) una detección bacteriana. No tuvieron ninguna detección 151 pacientes. En 22/151 (14.6%) se suspendió el tratamiento antibiótico con el resultado de la prueba y en 20/151 (13.2%) pacientes, se evitó el inicio del mismo. Lo anterior resultó en la disminución significativa de 7 días en el total de días de tratamiento antibiótico en el grupo 2 (p=0.02) y de 4.5 días en el grupo 3 (p=0.01). Sin embargo, al comparar entre grupos los desenlaces tales como duración de tratamiento y estancia hospitalaria, no hubo significancia estadística. Conclusión: cuando se realiza el panel MEFA en pacientes con sospecha de infecciones del SNC, un resultado negativo de la prueba, probablemente asociado a otras características clínicas y de estudios diagnósticos ayuda al clínico a tomar la decisión de la suspensión de terapia antibiótica empírica o no iniciar su us

Colombian consensus on vaccination in patients with chronic kidney disease

Introducción: los pacientes con enfermedad renal son una población de alta complejidad por sus condiciones de multimorbilidad, riesgo cardiovascular y requerimiento de terapias inmunosupresoras. La vacunación es una de las principales estrategias para mitigar el riesgo de infecciones, no obstante, la respuesta a las vacunas se ve afectada por la pérdida de la calidad de la función inmunológica, efecto que es mayor en la medida en que la enfermedad renal progresa o se requiere el uso de medicamentos inmunosupresores. Por ello, las prácticas de inmunización deben ser incentivadas en los pacientes en estadios más precoces de su enfermedad. Desafortunadamente, existe un amplio desconocimiento por parte de los prestadores de atención respecto de las mejores prácticas de inmunización, adicionalmente, en Colombia no existe cobertura de aseguramiento en el plan de beneficios de salud para muchos de los biológicos requeridos. Objetivo: generar recomendaciones informadas en evidencia sobre vacunación en pacientes con enfermedad renal y condiciones especiales relacionadas. Metodología: a partir de una revisión y un análisis crítico de evidencia, el grupo desarrollador formuló recomendaciones sobre indicaciones, contraindicaciones y consideraciones especiales de inmunización en pacientes con enfermedad renal. Se consultó a un colectivo de expertos en infectología y nefrología sobre el acuerdo con las recomendaciones propuestas. Se definió un umbral de acuerdo del 80?%. Resultados: inicialmente se formularon 135 recomendaciones, de las cuales 124 recomendaciones fueron aprobadas en la consulta virtual, aquellas que no superaron el umbral fueron consensuadas en una sesión virtual. Al final del proceso se obtuvieron 142 recomendaciones. Conclusiones: la vacunación es una estrategia de prevención altamente recomendable en pacientes con enfermedad renal, con impactos favorables sobre la carga de enfermedad y la supervivencia. Se espera que las recomendaciones propuestas permitan orientar y estandarizar las prácticas de inmunización en estos pacientes y mejorar los desenlaces en salud para esta población.Introduction: Patients with kidney disease are a highly complex population due to their multimorbidity conditions, cardiovascular risk, and requirement for immunosuppressive therapies. Vaccination is one of the main strategies to mitigate the risk of infections, however, the response to vaccines is affected by the loss of the quality of immune function, an effect that is greater as kidney disease progresses or the use of immunosuppressive drugs is required. Therefore, immunization practices should be encouraged in patients in earlier stages of their disease. Unfortunately, there is a wide lack of knowledge among care providers regarding the best immunization practices, additionally, in Colombia, there is no insurance coverage in the health benefit plan for many of the required vaccines. Purpose: Generate evidence-informed recommendations on vaccination in patients with kidney disease and related special conditions. Methodology: Based on a critical review and analysis of the evidence, the developer group formulated recommendations on the indications, contraindications and special considerations for immunization in patients with kidney disease. A group of experts in infectious diseases and nephrology were consulted about their agreement with the proposed recommendations. An agreement threshold of 80% was defined. Results: Initially, 135 recommendations were formulated, of which 124 were approved in the virtual consultation, those that did not exceed the threshold were agreed upon in a virtual session. At the end of the process, 142 recommendations were obtained. Conclusions: Vaccination is a highly recommended prevention strategy in patients with kidney disease, with favorable impacts on disease burden and survival. The proposed recommendations are expected to guide and standardize immunization practices in these patients and improve health outcomes for this population

Implementation of an integrated care strategy for child contacts of tuberculosis patients: a quasi-experimental study protocol

Abstract Background Childhood tuberculosis continues to be a major public health problem. Although the visibility of the epidemic in this population group has increased, further research is needed. Objective To design, implement and evaluate an integrated care strategy for children under five years old who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients in Medellín and the Metropolitan Area. Methods A quasi-experimental study in which approximately 300 children who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients from Medellín and the Metropolitan Area will be evaluated and recruited over one year. A subgroup of these children, estimated at 85, who require treatment for latent tuberculosis, will receive an integrated care strategy that includes: some modifications of the current standardized scheme in Colombia, with rifampicin treatment daily for four months, follow-up under the project scheme with nursing personnel, general practitioners, specialists, professionals from other disciplines such as social work, psychology, and nutritionist. Additionally, transportation and food assistance will be provided to encourage treatment compliance. This strategy will be compared with isoniazid treatment received by a cohort of children between 2015 and 2018 following the standardized scheme in the country. The study was approved by the CIB Research Ethics Committee and UPB. ClinicalTrials.gov identifier NCT04331262. Discussion This study is expected to contribute to the development of integrated care strategies for the treatment of latent tuberculosis in children. The results will have a direct impact on the management of childhood tuberculosis contributing to achieving the goals proposed by the World Health Organization's End TB Strategy. Trial registration ClinicalTrials.gov identifier NCT04331262 . Implementation of an Integrated Care Strategy for Children Contacts of Patients with Tuberculosis. Registered 2 April 2020.

A global point prevalence survey of antimicrobial use in neonatal intensive care units : The no-more-antibiotics and resistance (NO-MAS-R) study

Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings: On July 1, 2019, 26% of infants (580/2,265; range, 0-100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received >= 1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were "rule-out" sepsis (32%) and "culture-negative" sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and "culture-negative" infections was 12 days (median; IQR, 8-14) and 7 days (median; IQR, 5-10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0.02). Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide

Colombian surgical outcomes study insights on perioperative mortality rate, a main indicator of the lancet commission on global surgery – a prospective cohort studyResearch in context

Summary: Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. Methods: A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. Findings: 3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively. Interpretation: The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. Funding: This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017