Epidemiology of Candidemia at a University Hospital in Colombia, 2008-2014

RESUMEN Introducción: Candida spp. es una levadura comensal de la microbiota humana. Por características del hospedero, las infecciones del torrente sanguíneo pueden aparecer y causar una gran morbimortalidad. Métodos: Estudio restrospectivo transversal analítico de los cultivos positivos para Candida spp. entre 2008 y 2014 en un hospital universitario en Bogotá, Colombia. Se evaluaron las características clínicas y microbiológicas presentes previo a la toma de la primera muestra de sangre positiva y se determinaron asociaciones con infecciones por especies no C. albicans (NCA). Resultados: Se incluyeron 123 casos de candidemia. C. albicans fue la especie más aislada (42 %). Sin embargo, las especies NCA como grupo fueron observadas más frecuentemente. Más del 70 % de los casos presentaron manejo en la unidad de cuidado intensivo, con una mediana de estancia de 14 días previo a la primera muestra de sangre positiva. Se detectaron numerosas características médicas; sin embargo, ninguna estuvo asociada con candidemia por especies NCA. Se observó resistencia a por lo menos un antifúngico en el 29 % de los casos, aunque en una muestra reducida de pruebas de sensibilidad. Conclusiones: Nuestros resultados sustentan el viraje mundial hacia la candidemia por especies NCA; pero no encontramos asociaciones clínicas en este grupo. Debe dársele prioridad a la identificación de factores de riesgo y a la optimización de los puntajes de predicción, que permitan identificar pacientes en riesgo que se beneficien de terapia preventiva.Artículo original1-9Introduction: Candida species are commensal yeasts of the human microbiota. However, due to several host’s conditions, bloodstream infections may arise causing high morbimortality. Methods: Retrospective cross-sectional analytical study of positive blood cultures for Candida spp. between 2008-2014 at a university hospital in Bogota, Colombia. We evaluated clinical and microbiological characteristics prior to the first positive blood sample was obtained and determined associations with non-C. albicans (NCA) species infections. Results: We included 123 candidemia cases. C. albicans was the most frequently isolated species (42%). However, NCA species as a group were observed more often. Over 70% of cases were managed at the ICU, with a median stay of 14 days. Several medical factors were frequently observed, however none appeared to be associated with NCA species candidemia. Resistance to at least one antifungal agent was observed in 29% of cases, although a reduced sample of susceptibility tests was available. Conclusions: Our results support a worldwide shift towards NCA candidemia. However, clinical features were not associated with NCA infections. The identification of risk factors and the improvement of prediction scores must be prioritized, in order to identify patients at high risk who may benefit of pre-emptive therapy

Development and Implementation of DIALOG+S in the School Setting as a Tool for Promoting Adolescent Mental Well-Being and Resilience in a Post–Armed Conflict Area in Colombia: Exploratory Cluster Randomized Controlled Trial

Las intervenciones de salud mental en contextos escolares tienen un gran potencial en la prevención e identificación temprana de trastornos de salud mental en adolescentes. Explorar el papel activo de los profesores y consejeros escolares en la salud mental de sus estudiantes es imperativo, especialmente después de los desafíos impuestos por la pandemia de COVID-19. Objetivo: Nuestra investigación tuvo como objetivo adaptar una intervención digital existente centrada en el paciente llamada DIALOG+ desde un entorno clínico para adultos a un entorno educativo para adolescentes. Nuestro objetivo era evaluar la viabilidad, aceptabilidad y efecto estimado de implementar esta intervención como una herramienta para mitigar el impacto de las dificultades sociales y promover la calidad de vida, el bienestar mental y la resiliencia. Métodos: Realizamos un estudio exploratorio de métodos mixtos en escuelas públicas en áreas de posconflicto en Tolima, Colombia. El estudio se llevó a cabo en 3 fases. La fase de adaptación identificó los cambios que la intervención requería para ser utilizada en el ámbito escolar. La fase de exploración consistió en un ensayo aleatorio grupal exploratorio con maestros y consejeros escolares donde se recopilaron datos sobre los síntomas de salud mental y el bienestar de los adolescentes antes y después del uso de DIALOG+S. Por último, una fase de consolidación exploró las experiencias y la aceptabilidad de los profesores y estudiantes de DIALOG+S a través de discusiones de grupos focales. Resultados: Los cambios sugeridos por los participantes en la fase de adaptación resaltaron la importancia central del entorno escolar en la salud mental de los adolescentes. En la fase exploratoria se incluyeron un total de 70 participantes con una edad media de 14,6 años. Los cambios observados en el grupo de intervención sugieren que la intervención tiene el potencial de mejorar aspectos de su salud mental, especialmente en lo que respecta a su calidad de vida y resiliencia. La fase de consolidación mostró que los actores sintieron que el uso de esta intervención en el ámbito escolar era factible y aceptable y pensaron que su uso era una experiencia enriquecedora que generaba cambios en la salud mental percibida y el comportamiento de los participantes. Conclusiones: Nuestros resultados son alentadores y muestran que la intervención DIALOG+S es factible y aceptable como una oportunidad prometedora para promover el bienestar y prevenir e identificar problemas de salud mental en el contexto escolar de una zona de posconflicto en Colombia. Se justifican estudios más amplios y con todo el poder estadístico para evaluar adecuadamente la eficacia y el impacto potencial de la intervención y perfeccionar los planes de implementación. Ensayo clínico: Registro ISRCTN ISRCTN14396374.Q3Q3Mental health interventions in school contexts have great potential in the prevention and early identification of mental health disorders in adolescents. Exploring the active role of the teachers and school counsellors in the mental health of their students is imperative especially after the challenges imposed by the COVID-19 pandemic. Objective: Our research aimed to adapt an existing patient-centered digital intervention called DIALOG+ from an adult clinical setting to an adolescent educational setting. We aimed to evaluate the feasibility, acceptability, and estimated effect of implementing this intervention as a tool to mitigate the impact of social difficulties and to promote quality of life, mental well-being and resilience. Methods: We conducted an exploratory mixed methods study in public schools in post-conflict areas in Tolima, Colombia. The study was carried out in 3 phases. The adaptation phase identified changes that the intervention required to be used in the school setting. The exploration phase consisted of an exploratory cluster randomized trial with teachers and school counsellors where data about adolescent's mental health symptoms and well-being were collected before and after the use of DIALOG+S. Lastly, a consolidation phase explored the experiences of and acceptability to teachers and students of DIALOG+S through focus group discussions. Results: The changes suggested by participants in the adaptation phase highlighted the central importance of the school setting in the mental health of adolescents. In the exploratory phase a total of 70 participants with a mean age of 14.6 years were included. Changes seen in the intervention group suggest that the intervention has the potential to improve aspects of their mental health, especially regarding their quality of life and resilience. The consolidation phase showed that stakeholders felt that the use of this intervention in the school setting was feasible and acceptable and thought that using it was an enriching experience that generated changes in the perceived mental health and the behavior of participants. Conclusions: Our results are encouraging and show that the DIALOG+S intervention is feasible and acceptable as a promising opportunity to promote well-being and to prevent and identify mental health problems in the school context of a post-conflict area in Colombia. Larger, fully powered studies are warranted to properly assess the efficacy and potential impact of the intervention and to refine implementation plans. Clinical Trial: ISRCTN Registry ISRCTN14396374.Revista Internacional - IndexadaS

Epidemiología de los casos de candidemia en un hospital universitario en Colombia, 2008-2014

Introduction: Candida species are commensal yeasts of the human microbiota. However, due to several host’s conditions, bloodstream infections may arise causing high morbimortality. Methods: Retrospective cross-sectional analytical study of positive blood cultures for Candida spp. between 2008-2014 at a university hospital in Bogota, Colombia. We evaluated clinical and microbiological characteristics prior to the first positive blood sample was obtained and determined associations with non-C. albicans (NCA) species infections. Results: We included 123 candidemia cases. C. albicans was the most frequently isolated species (42%). However, NCA species as a group were observed more often. Over 70% of cases were managed at the ICU, with a median stay of 14 days. Several medical factors were frequently observed, however none appeared to be associated with NCA species candidemia. Resistance to at least one antifungal agent was observed in 29% of cases, although a reduced sample of susceptibility tests was available. Conclusions: Our results support a worldwide shift towards NCA candidemia. However, clinical features were not associated with NCA infections. The identification of risk factors and the improvement of prediction scores must be prioritized, in order to identify patients at high risk who may benefit of pre-emptive therapy.Introducción: Candida spp. es una levadura comensal de la microbiota humana. Por características del hospedero, las infecciones del torrente sanguíneo pueden aparecer y causar una gran morbimortalidad. Métodos: Estudio restrospectivo transversal analítico de los cultivos positivos para Candida spp. entre 2008 y 2014 en un hospital universitario en Bogotá, Colombia. Se evaluaron las características clínicas y microbiológicas presentes previo a la toma de la primera muestra de sangre positiva y se determinaron asociaciones con infecciones por especies no C. albicans (NCA). Resultados: Se incluyeron 123 casos de candidemia. C. albicans fue la especie más aislada (42 %). Sin embargo, las especies NCA como grupo fueron observadas más frecuentemente. Más del 70 % de los casos presentaron manejo en la unidad de cuidado intensivo, con una mediana de estancia de 14 días previo a la primera muestra de sangre positiva. Se detectaron numerosas características médicas; sin embargo, ninguna estuvo asociada con candidemia por especies NCA. Se observó resistencia a por lo menos un antifúngico en el 29 % de los casos, aunque en una muestra reducida de pruebas de sensibilidad. Conclusiones: Nuestros resultados sustentan el viraje mundial hacia la candidemia por especies NCA; pero no encontramos asociaciones clínicas en este grupo. Debe dársele prioridad a la identificación de factores de riesgo y a la optimización de los puntajes de predicción, que permitan identificar pacientes en riesgo que se beneficien de terapia preventiva

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)