Perfil de sensibilidad antimicrobiana de microorganismos causantes de infecciones urinarias adquiridas en la comunidad en pacientes con diabetes mellitus en Colombia

Introduction: Urinary tract infection is the most common pathology in diabetic patients, and an important determinant of morbidity and mortality among them. The increasing resistance of uropathogens acquired in the community to commonly used antibiotics is alarming.Objective: To identify the profile of antibiotic susceptibility of uropathogens responsible for communityacquired infections among diabetic patients in hospitals in Colombia.Materials and methods: We conducted a descriptive study in a subgroup of diabetic patients in the framework of a larger study in adults with urinary tract infection acquired in the community. Over one year, we collected Escherichia coli, Klebsiella spp. and Proteus mirabilis isolates from nine hospitals in Colombia. Their susceptibility profile was determined using microbiological and molecular methods to establish the presence of extended-spectrum AmpC betalactamases and KPC carbapenemases.Results: We collected 68 isolates (58 E. coli, nine Klebsiella spp. and one Proteus mirabilis). Four (6.9%) of the E. coli isolates expressed extended spectrum betalactamases, two (3.4%) of them belonged to the phylogenetic group B2 and to ST131 clone and expressed the TEM-1 and CTM-X-15 betalactamases. The AmpC phenotype was found in four (6.9%) of the E. coli isolates, three of which produced TEM-1 and CMY-2 betalactamases. One K. pneumoniae isolate expressed the KPC-3 carbapenemase. Conclusion: The presence of extended spectrum betalactamases and carbapenemases in uropathogens responsible for community-acquired infection was confirmed in diabetic patients.Introducción. La infección de las vías urinarias es la más frecuente en pacientes diabéticos, y es un factor determinante de la morbilidad y la mortalidad en este grupo de pacientes. El aumento de la resistencia de los microorganismos adquiridos en la comunidad a los antibióticos comúnmente utilizados para combatirla es alarmante.Objetivo. Determinar el perfil de sensibilidad a los antibióticos de los microorganismos responsables de infecciones urinarias adquiridas en la comunidad en pacientes diabéticos atendidos en algunos hospitales de Colombia.Materiales y métodos. Se hizo un estudio descriptivo de un subgrupo de pacientes diabéticos en el marco de una investigación en adultos con infección de origen comunitario de las vías urinarias. Durante un año, se recolectaron aislamientos de Escherichia coli, Klebsiella spp. y Proteus mirabilis en nueve hospitales de Colombia y se determinó su perfil de sensibilidad mediante métodos microbiológicos y moleculares, para establecer la presencia de betalactamasas de espectro extendido del tipo AmpC y de carbapenemasas del tipo KPC.Resultados. Se recolectaron 68 aislamientos (58 de E. coli, nueve de Klebsiella spp. y uno de P. mirabilis). Cuatro (6,9 %) de los aislamientos de E. coli expresaron dichas betalactamasas, en dos (3,4 %) de ellos, pertenecientes al grupo filogenético B2 y al clon ST131, se detectaron las betalactamasas TEM-1 y CTM-X-15. En otros cuatro (6,9 %) aislamientos de E. coli se encontró el fenotipo AmpC, y en tres de ellos se produjeron las betalactamasas TEM-1 y CMY-2. Un aislamiento de K. pneumoniae expresó la carbapenemasa KPC-3.Conclusión. Se confirmó la presencia de cepas productoras de betalactamasas de espectro extendido y carbapenemasas en microorganismos responsables de infección urinaria adquirida en la comunidad en pacientes diabéticos

Anti-microbial sensitivity of enterobacteria identified in community-acquired urinary tract infection in pregnant women in 9 Colombian hospitals

Introducción: La infección del tracto urinario adquirida en la comunidad, es la patología infecciosa más frecuente durante el embarazo y un factor de riesgo importante para parto pretérmino y bajo peso al nacer; se desconoce la frecuencia de la resistencia a las diferentes alternativas terapéuticas en Colombia. Métodos: Se realizó un estudio descriptivo de infecciones urinarias de la comunidad que requirieron hospitalización y se analizó el subgrupo de gestantes. Se recolectaron durante 12 meses aislamientos de Escherichia coli, Klebsiella spp .y Proteus mirabilis en 9 hospitales de Colombia y se determinó su perfil de susceptibilidad, por microdilución en caldo y pruebas de difusión por gradiente, y se caracterizó la presencia de betalactamasas de espectro extendido, con métodos microbiológicos y moleculares. Resultados: Se recogieron 74 aislamientos (64 de E. coli, 7 de Klebsiella spp. y 3 de P. mirabilis) en 73 pacientes. En 58% de las pacientes se reportó uso previo de antibióticos. La resistencia a ampicilina/sulbactam, cefazolina y ceftriaxona fue de 15,6%, 17,2% y 4,7%, respectivamente. Tres aislamientos, dos de E. coli y uno de Klebsiella spp., expresaron betalactamasas de espectro extendido (3,1%, en E. coli y 14,3% Klebsiella spp.) Un aislamiento de E. coli expresó enzimas tipo AmpC. Conclusión: Se confirmó la presencia de cepas resistentes a cefalosporinas de tercera generación en enterobacterias responsables de infección del tracto urinario adquirida en la comunidad en embarazadas, producida por enzimas de tipo beta lactamasas de espectro extendido tipo CTX M-15 y AmpC.Objective: To identify sensitivity profiles of the main anti-microbial agents used in the management of community-acquired urinary tract infection in pregnant women, and to make the molecular characterisation in order to confirm the existence of bacterial resistance in this population group.Materials and methods: Descriptive cross-sectional study that included pregnant women with community-acquired urinary tract infection requiring admission to hospital. They were part of a study conducted in the general population. The microbiological results of the urine cultures were analysed. Isolates of Escherichia coli, Klebsiella spp. and Proteus mirabilis were identified over a period of 12 months in 9 Colombian hospitals, and their sensi-tivity profiles were determined using microdilution broth and gradient diffusion tests, and the presence of extended spectrum beta-lactamases was charac-terised using microbiological and molecular methods. The sociodemographic and clinical characteristics of these patients are presented.Results: Overall, 74 isolates were collected (64 E. coli, 7 Klebsiella spp. and 3 P. mirabilis isolates) in 73 patients. Prior use of antibiotics was documented in 58% of the patients. Resistance to ampicillin/sulbactam, cefazolin and ceftriaxone was 15.6%, 17.2% and 4.7%, respectively. There was extended spectrum beta-lactamase expression in three of the isolates, 2 of E. coli and 1 of Klebsiella spp. (3.1% E. coli and 14.3% Klebsiella spp.) One E. coli isolate expressed enzymes of the AmpC type.Conclusion: The presence of resistant strains to antibiotics used as first-line empirical treatment and to third-generation cephalosporins was confirmed in enterobacteria responsible for community-acquired urinary tract infection in pregnant women, produced by type CTX M-15 and AmpC extended spectrum betalactamase enzymes.Key words: Urinary tract infections, pregnancy, enterobacteria, microbial drug resistance, beta-lactamases

Perfil de sensibilidad antimicrobiana de microorganismos causantes de infecciones urinarias adquiridas en la comunidad en pacientes con diabetes mellitus en Colombia

Introducción. La infección de las vías urinarias es la más frecuente en pacientes diabéticos, y es un factor determinante de la morbilidad y la mortalidad en este grupo de pacientes. El aumento de la resistencia de los microorganismos adquiridos en la comunidad a los antibióticos comúnmente utilizados para combatirla es alarmante. Objetivo. Determinar el perfil de sensibilidad a los antibióticos de los microorganismos responsables de infecciones urinarias adquiridas en la comunidad en pacientes diabéticos atendidos en algunos hospitales de Colombia. Materiales y métodos. Se hizo un estudio descriptivo de un subgrupo de pacientes diabéticos en el marco de una investigación en adultos con infección de origen comunitario de las vías urinarias. Durante un año, se recolectaron aislamientos de Escherichia coli, Klebsiella spp. y Proteus mirabilis en nueve hospitales de Colombia y se determinó su perfil de sensibilidad mediante métodos microbiológicos y moleculares, para establecer la presencia de betalactamasas de espectro extendido del tipo AmpC y de carbapenemasas del tipo KPC. Resultados. Se recolectaron 68 aislamientos (58 de E. coli, nueve de Klebsiella spp. y uno de P. mirabilis). Cuatro (6,9 %) de los aislamientos de E. coli expresaron dichas betalactamasas, en dos (3,4 %) de ellos, pertenecientes al grupo filogenético B2 y al clon ST131, se detectaron las betalactamasas TEM-1 y CTM-X-15. En otros cuatro (6,9 %) aislamientos de E. coli se encontró el fenotipo AmpC, y en tres de ellos se produjeron las betalactamasas TEM-1 y CMY-2. Un aislamiento de K. pneumoniae expresó la carbapenemasa KPC-3. Conclusión. Se confirmó la presencia de cepas productoras de betalactamasas de espectro extendido y carbapenemasas en microorganismos responsables de infección urinaria adquirida en la comunidad en pacientes diabéticos.Q4Q3Artículo original353-36

Association between long term exposure to particulate matter and incident hypertension in Spain

Exposure to air particulate matter has been linked with hypertension and blood pressure levels. The metabolic risks of air pollution could vary according to the specific characteristics of each area, and has not been sufficiently evaluated in Spain. We analyzed 1103 individuals, participants in a Spanish nationwide population based cohort study ([email protected]), who were free of hypertension at baseline (2008-2010) and completed a follow-up exam of the cohort (2016-2017). Cohort participants were assigned air pollution concentrations for particulate matter < 10 mu m (PM10) and < 2.5 mu m (PM2.5) during follow-up (2008-2016) obtained through modeling combined with measurements taken at air quality stations (CHIMERE chemistry-transport model). Mean and SD concentrations of PM10 and PM2.5 were 20.17 +/- 3.91 mu g/m(3) and 10.83 +/- 2.08 mu g/m(3) respectively. During follow-up 282 cases of incident hypertension were recorded. In the fully adjusted model, compared with the lowest quartile of PM10, the multivariate weighted ORs (95% CIs) for developing hypertension with increasing PM10 exposures were 0.82 (0.59-1.14), 1.28 (0.93-1.78) and 1.45 (1.05-2.01) in quartile 2, 3 and 4 respectively (p for a trend of 0.003). The corresponding weighted ORs according to PM2.5 exposures were 0.80 (0.57-1.13), 1.11 (0.80-1.53) and 1.48 (1.09-2.00) (p for trend 0.004). For each 5-mu g/m(3) increment in PM10 and PM2.5 concentrations, the odds for incident hypertension increased 1.22 (1.06-1.41) p = 0.007 and 1.39 (1.07-1.81) p = 0.02 respectively. In conclusion, our study contributes to assessing the impact of particulate pollution on the incidence of hypertension in Spain, reinforcing the need for improving air quality as much as possible in order to decrease the risk of cardiometabolic disease in the population

Association between exposure to air pollution and blood lipids in the general population of Spain.

Background and Aims: We aimed to assess the associations of exposure to air pollutants and standard and advanced lipoprotein measures, in a nationwide sample representative of the adult population of Spain.Methods: We included 4647 adults (>18 years), participants in the national, cross- sectional, population- based [email protected] study, conducted in 2008– 2010. Standard lipid measurements were analysed on an Architect C8000 Analyzer (Abbott Laboratories SA). Lipoprotein analysis was made by an advanced 1H- NMR lipoprotein test (Liposcale®). Participants were assigned air pollution con-centrations for particulate matter <10 μm (PM10), <2.5 μm (PM2.5) and nitrogen dioxide (NO2), corresponding to the health examination year, obtained by mod-elling combined with measurements taken at air quality stations (CHIMERE chemistry- transport model).Results: In multivariate linear regression models, each IQR increase in PM10, PM2.5 and NO2 was associated with 3.3%, 3.3% and 3% lower levels of HDL- c and 1.3%, 1.4% and 1.1% lower HDL particle (HDL- p) concentrations (p< .001 for all associations). In multivariate logistic regression, there was a significant associa-tion between PM10, PM2.5 and NO2 concentrations and the odds of presenting low HDL- c (<40 mg/dL), low HDL- p (<p25) and higher LDL particle (LDL- p) concentrations (≥p75). In subgroup analyses there were stronger associations be-tween PM10 and NO2 and low HDL- p in men (p for interaction .008 and .034), and between NO2 and low HDL- p in individuals with obesity (p for interaction .015).Conclusions: Our study shows an association between the exposure to air pol-lutants and blood lipids in the general population of Spain, suggesting a link to atherosclerosisFunding for open access charge: Universidad de Málaga / CBU

FATORES DE RISCO E PREVENÇÃO DA PREMATURIDADE

Objective: To identify the risk factors and causes of neonatal (NB) births in hospitals. Methods: Documentary, descriptive and quantitative research was carried out in hospitals in the state of Rio Grande do Sul. The population consisted of 58 newborns whose medical records were completed at the university. The search for premature babies was carried out in the obstetrics and gynecology department of the institution, and data was collected through the medical records of newborns and mothers. For data entry and analysis, Microsoft Excel 2013 software was used and for statistical analysis, the Nursing Database (BDENF), Scientific Electronic Library Online (SCIELO), PubMed and Literature in Health Sciences of Latin America and the Caribbean were used. (LILACS). Results: The results obtained from the study on risk factors associated with stillbirth include maternal age, gestational age, genetic and physical history, lifestyle and many birth histories. And the stated reasons are female reproductive system, menstrual changes and hypertensive disease. The study also presents data on two types of births: accidental births and elective births. Conclusion: It is important for health professionals to identify the risk factors and causes of premature birth when caring for pregnant women through prenatal counseling. Therefore, the conclusions of this study related to the educational training and technical development of professionals can contribute to optimizing the planning of health policies aimed at specific populations.Objetivo: Identificar os fatores de risco e causas de partos neonatais (RN) em hospitais. Métodos: Pesquisa documental, descritiva e quantitativa foi realizada em hospitais do estado do Rio Grande do Sul. A população foi composta por 58 recém-nascidos cujos prontuários foram preenchidos na universidade. A busca dos prematuros foi realizada no setor de obstetrícia e ginecologia da instituição, e os dados foram coletados por meio dos prontuários dos recém-nascidos e das mães. Para entrada e análise dos dados foi utilizado o software Microsoft Excel 2013 e para análise estatística foi utilizado a Base de Dados de Enfermagem (BDENF), Biblioteca Eletrônica Científica Online (SCIELO), PubMed e Literatura em Ciências da Saúde da América Latina e do Caribe (LILACS). Resultados: Os resultados obtidos no estudo sobre os fatores de risco associados ao natimorto incluem idade materna, idade gestacional, genética e história física, estilo de vida e muitas histórias de nascimento. E os motivos declarados são aparelho reprodutor feminino, alterações menstruais e doença hipertensiva. O estudo também apresenta dados sobre dois tipos de partos: partos acidentais e partos eletivos. Conclusão: É importante que os profissionais de saúde identifiquem os fatores de risco e as causas do parto prematuro no atendimento às gestantes por meio do aconselhamento pré-natal. Dessa forma, as conclusões deste estudo relacionadas à formação educacional e ao desenvolvimento técnico-técnico dos profissionais, podem contribuir para otimizar o planejamento de políticas de saúde voltadas para populações específicas

Ambient air pollution and thyroid function in Spanish adults. A nationwide population-based study ([email protected] study)

Background Recent reports have suggested that air pollution may impact thyroid function, although the evidence is still scarce and inconclusive. In this study we evaluated the association of exposure to air pollutants to thyroid function parameters in a nationwide sample representative of the adult population of Spain. Methods The [email protected] study is a national, cross-sectional, population-based survey which was conducted in 2008-2010 using a random cluster sampling of the Spanish population. The present analyses included 3859 individuals, without a previous thyroid disease diagnosis, and with negative thyroid peroxidase antibodies (TPO Abs) and thyroid-stimulating hormone (TSH) levels of 0.1-20 mIU/L. Participants were assigned air pollution concentrations for particulate matter <2.5 mu m (PM2.5) and Nitrogen Dioxide (NO2), corresponding to the health examination year, obtained by means of modeling combined with measurements taken at air quality stations (CHIMERE chemistry-transport model). TSH, free thyroxine (FT4), free triiodothyronine (FT3) and TPO Abs concentrations were analyzed using an electrochemiluminescence immunoassay (Modular Analytics E170 Roche). Results In multivariate linear regression models, there was a highly significant negative correlation between PM2.5 concentrations and both FT4 (p<0.001), and FT3 levels (p<0.001). In multivariate logistic regression, there was a significant association between PM2.5 concentrations and the odds of presenting high TSH [OR 1.24 (1.01-1.52) p=0.043], lower FT4 [OR 1.25 (1.02-1.54) p=0.032] and low FT3 levels [1.48 (1.19-1.84) p=<0.001] per each IQR increase in PM2.5 (4.86 mu g/m(3)). There was no association between NO2 concentrations and thyroid hormone levels. No significant heterogeneity was seen in the results between groups of men, pre-menopausal and post-menopausal women. Conclusions Exposures to PM2.5 in the general population were associated with mild alterations in thyroid function.CIBERDEM (Ministerio de Economia, Industria y Competitividad-ISCIII), Ministerio de Sanidad, Servicios Sociales e Igualdad-ISCIII, Instituto de Salud Carlos III (PI17/02136, PI20/01322), Consejeria de Salud y familias (PI-0144-2018), European Regional Development Fund (ERDF) "A way to build Europe". GRM belongs to the regional Nicolas Monardes research program of the Consejeria de Salud (RC-0006-2016; Junta de Andalucia, Spain). CMA is recipient of a "Rio Hortega" research contract (CM19/00186, Instituto de Salud Carlos III). VKDG is recipient of a "Rio Hortega" research contract (CM21/00214, Instituto de Salud Carlos III)

Fatty liver index as a predictor for type 2 diabetes in subjects with normoglycemia in a nationwide cohort study

Our aim was to evaluate whether fatty liver index (FLI) is associated with the risk of type 2 diabetes (T2DM) development within the Spanish adult population and according to their prediabetes status; additionally, to examine its incremental predictive value regarding traditional risk factors. A total of 2260 subjects (Prediabetes: 641 subjects, normoglycemia: 1619 subjects) from the [email protected] cohort study were studied. Socio-demographic, anthropometric, clinical data and survey on habits were recorded. An oral glucose tolerance test was performed and fasting determinations of glucose, lipids and insulin were made. FLI was calculated and classified into three categories: Low ( 60). In total, 143 people developed diabetes at follow-up. The presence of a high FLI category was in all cases a significant independent risk factor for the development of diabetes. The inclusion of FLI categories in prediction models based on different conventional T2DM risk factors significantly increase the prediction power of the models when all the population was considered. According to our results, FLI might be considered an early indicator of T2DM development even under normoglycemic condition. The data also suggest that FLI could provide additional information for the prediction of T2DM in models based on conventional risk factors

CUIDADOS DA EQUIPE MULTIDISCIPLINAR AO RECÉM-NASCIDO COM ENTEROCOLITE NECROSANTE: SCOPING REVIEW

Necrotizing Enterocolitis (NEC) is considered the most prevalent disease that affects the gastrointestinal tract (GIT) of newborns (NB), presenting significant morbidity and mortality rates. This pathology is defined as an ulcerative lesion of the intestinal wall whose main characteristic is inflammation and local ischemic necrosis. Therefore, the objective of this study is to analyze available studies in the literature about multidisciplinary care in the care of newborns with Necrotizing Enterocolitis. This is a scoping review, which used 07 articles from the last 10 years, available in the databases. VHL (Virtual Health Library), Lilacs (Latin American and Caribbean Literature in Health Sciences), Medline (Medical Literature Analysis and Retrieval System Online), SciELO (Scientific Electronic Library Online) and BDENF (Nursing Database) . It was found that encouraging breastfeeding, adequate administration of colostrum and supplements, installing a probe and the like are measures instituted by the team and are relevant to providing care. It is noted that multidisciplinary assistance in the care of newborns with Necrotizing Enterocolitis is essential, as it requires integrated care from different professionals to minimize injuries and reduce the length of hospital stay. Keywords: Newborn; Necrotizing Enterocolitis; Multidisciplinary Team.La enterocolitis necrotizante (ECN) es considerada la enfermedad más prevalente que afecta el tracto gastrointestinal (TGI) de los recién nacidos (RN), presentando importantes tasas de morbimortalidad. Esta patología se define como una lesión ulcerosa de la pared intestinal cuya principal característica es la inflamación y la necrosis isquémica local. Por lo tanto, el objetivo de este estudio es analizar los estudios disponibles en la literatura sobre la atención multidisciplinaria en la atención del recién nacido con Enterocolitis Necrosante. Se trata de una revisión de alcance, que utilizó 07 artículos de los últimos 10 años, disponibles en las bases de datos. BVS (Biblioteca Virtual en Salud), Lilacs (Literatura Latinoamericana y del Caribe en Ciencias de la Salud), Medline (Sistema de Análisis y Recuperación de Literatura Médica en Línea), SciELO (Biblioteca Electrónica Científica en Línea) y BDENF (Base de Datos de Enfermería). Se constató que fomentar la lactancia materna, la administración adecuada de calostro y suplementos, instalar una sonda y similares, son medidas instituidas por el equipo y relevantes para la prestación de cuidados. Se destaca que la asistencia multidisciplinaria en el cuidado del recién nacido con Enterocolitis Necrosante es fundamental, ya que requiere atención integrada de diferentes profesionales para minimizar las lesiones y reducir la estancia hospitalaria. Palabras clave: Recién nacido; Enterocolitis necrotizante; Equipo multidisciplinario.A Enterocolite Necrosante (ECN) é considerada como a doença mais prevalente que acomete o trato gastrointestinal (TGI) de recém-nascidos (RN), apresentando valores significativos de morbidade e mortalidade. Essa patologia é definida como uma lesão ulcerativa da parede intestinal que apresenta como característica principal a inflamação e necrose isquêmica local. Destarte, o objetivo desse estudo é analisar&nbsp; na literatura estudos disponíveis acerca da assistência multiprofissional no cuidado ao recém-nascido com Enterocolite Necrosante. Trata-se de uma revisão de escopo, que utilizou 07 artigos dos últimos 10 anos, disponíveis nas bases de dados. BVS (Biblioteca Virtual da Saúde), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde), Medline (Medical Literature Analysis and Retrieval System Online), SciELO (Scientific Electronic Library Online) e BDENF (Base de Dados de Enfermagem). Foi constatado que o incentivo ao aleitamento materno, a administração adequada do colostro e dos suplementos, a instalação da sondagem e afins são medidas instituídas pela equipe e relevantes para a realização do cuidado. Nota-se que a assistência multiprofissional no cuidado ao recém-nascido com Enterocolite Necrosante é essencial, visto que o mesmo requer cuidados integrados dos diferentes profissionais para a minimização de agravos e diminuição do tempo de internação hospitalar. &nbsp; Palavras-chave: Recém-nascido; Enterocolite Necrosante; Equipe Multidisciplinar