Características de la infección por Clostridium difficile en una institución de alta complejidad y reporte de la circulación en Colombia de la cepa hipervirulenta NAP1/027

Introduction: Clostridium difficile is the main pathogen related to healthcare-associated diarrhea and it is the cause of 20 to 30% of diarrhea cases caused by antibiotics. In Colombia and Latin America, the knowledge about the epidemiological behavior of this infection is limited.Objective: To describe the characteristics of a series of patients with C. difficile infection.Materials and methods: We performed a descriptive case series study of patients with C. difficile infection hospitalized in the Fundación Clínica Shaio from January, 2012, to November, 2015.Results: We analyzed 36 patients. The average age was 65 years. The risk factors associated with the infection were: previous use of antibiotics (94.4%), prior hospitalization in the last three months (66.7%) and use of proton pump inhibitors (50%). The most common comorbidities were chronic kidney disease (41.7%) and diabetes mellitus (30.6%). The most frequent symptoms were more than three loose stools per day (97.1%) and abdominal pain (42.9%). According to the severity of the disease, 44.4% of cases were classified as mild to moderate, 38.9% as severe, and 11.1% as complicated or severe. The detection of the toxin by PCR (GeneXpert) was the most common diagnostic procedure (63.8%). Global mortality during hospitalization was 8%. We identified four strains with serotype NAP1/027 and nine samples positive for binary toxin.Conclusion: Clostridium difficile infection should be suspected in patients with diarrhea and traditional risk factors associated with this disease. We report the circulation of the hypervirulent strain serotype NAP1/027 in Colombia, which should be countered with epidemiological surveillance and a prompt diagnosis.Introducción. Clostridium difficile es el principal responsable de la diarrea asociada al uso de antibióticos. En Colombia y en Latinoamérica, el conocimiento sobre el comportamiento epidemiológico de la infección por C. difficile todavía es limitado.Objetivo. Describir las características de una serie de pacientes con infección por C. difficile.Materiales y métodos. Se hizo un estudio descriptivo de una serie de casos de pacientes con infección por C. difficile atendidos en la Fundación Clínica Shaio, entre enero de 2012 y noviembre de 2015.Resultados. Se estudiaron 36 pacientes con una edad promedio de 65 años. Se determinaron los siguientes factores relacionados con la infección por C. difficile: uso previo de antimicrobianos (94,4 %), hospitalización en los últimos tres meses (66,7 %) y uso de inhibidores de la bomba de protones (50 %). Las comorbilidades más comunes fueron la enfermedad renal crónica (41,7 %) y la diabetes mellitus (30,6 %). Los síntomas más frecuentes fueron más de tres deposiciones diarreicas (97,1 %) y dolor abdominal (42,9 %). En cuanto a la gravedad de los casos, 44,4 % se clasificó como leve a moderado, 38,9 % como grave, y 11,1 % como complicado o grave. El método de diagnóstico más utilizado (63,8% de los pacientes) fue la identificación de la toxina mediante reacción en cadena de la polimerasa (PCR). La mortalidad global durante la hospitalización fue de 8 %. Se identificaron cuatro cepas del serotipo NAP1/027 y nueve muestras fueron positivas para la toxina binaria.Conclusión. La infección por C. difficile debe sospecharse en pacientes con deposiciones diarreicas y factores asociados tradicionalmente a esta enfermedad. Se reportó la circulación de cepas hipervirulentas del serotipo NAP1/027 en Colombia, lo cual debe enfrentarse con la vigilancia epidemiológica y el diagnóstico tempran

Evaluation and management of cardiovascualr risk in VIH infection : Expert consensus of ACIN (Colombian Association of Infectious Diseases)

Los pacientes con infección por VIH tienen una mayor incidencia de eventos cardiovasculares en comparación con la población general; los factores que contribuyen al incremento del riesgo de eventos cardiovasculares son la prevalencia de factores de riesgo cardiovascular tradicionales (FRCV), la infección por VIH que condiciona tanto un proceso de inflamación crónica como alteración de la función endotelial y la exposición a los antirretrovirales. Los factores que deben ser objeto de intervención son los FRCV tradicionales, en especial la alta tasa de fumadores entre este grupo de pacientes, la tamización y tratamiento de HTA, el síndrome metabólico y el acceso temprano a la terapia antirretroviral con medicamentos con mayor perfil de seguridad . Esta guía pretende proveer información y recomendaciones en el ámbito nacional acerca de la relación entre la infección por VIH/SIDA (Síndrome de Inmunodeficiencia Adquirida), uso de antirretrovirales y riesgo cardiovascular.Q1Artículo original73-91Patients with VIH infection have greater risk for cardiovascular diseases compared to general population. Risk factors that increase the frequency of cardiovascular events are: presence of cardiovascular traditional risk factors, chronic inflammation by HIV that impairs endothelial function and the exposure to antiretrovirals. The factors that should be the target for intervention are the traditional know cardiovascular factors such, especially high rate of smokers, screening and treatment for hypertension, metabolic syndrome and early access to HAART. The present guidelines provides information about the use of antiretrovirals in patients with HIV and its relation with cardiovascular risk

Experiencias en el aula: cuarto encuentro de prácticas pedagógicas innovadoras.

Cuarto encuentro de prácticas pedagógicas innovadoras, evento que se llevo a cabo los días 7 y 8 de Octubre de 2019

Experiencias en el aula: cuarto encuentro de prácticas pedagógicas innovadoras.

Cuarto encuentro de prácticas pedagógicas innovadoras, evento que se llevo a cabo los días 7 y 8 de Octubre de 2019

Neoplasias definitorias de SIDA AIDS-defining Neoplams

Desde el inicio de la pandemia por VIH/sida se estimaba que cerca de 36% de los pacientes desarrollarían una neoplasia durante el curso de la enfermedad.El sarcoma de Kaposi y el linfoma no Hodgkin dan cuenta de 95% de estas neoplasias, motivo por el cual se consideraron como enfermedades definitorias de sida en la clasificación de la enfermedad de los Centers for Disease Control and Prevention (CDC) desde 1985. Con la introducción de la terapia antirretroviral altamente efectiva la incidencia de estas neoplasias relacionadas con la infección por VIH/sida han mostrado un descenso importante, a pesar de que sólo uno de los 48 millones de personas con VIH/sida en el mundo tienen acceso a estos medicamentos. En esta breve revisión se mencionan los principales aspectos epidemiológicos, clínicos y terapéuticos de las neoplasias relacionadas con la infección VIH/sida y su presentación actual a la luz de la terapia antirretroviral altamente activa.Near 36% of HIV infected patients developed neoplasms in the early years of the AIDS epidemic. Kaposi’ sarcoma and non-Hodgkin lymphoma were 95% of these neoplasms and they were included in the CDC classification of AIDS defining illnesses since 1985. With the introduction of the combined antiretroviral therapy, the incidence of AIDS related neoplasms has shown an important lowering, although only one million people has access to these therapies around the world. In this concise review the main epidemiological, clinical and therapeutic issues of the AIDS-defining neoplams are presented

Factors associated with mortality in Infections caused by Carbapenem-resistant Enterobacteriaceae

Introduction: There is little information about weigh of factors possibly associated with mortality, in infections caused by Carbapenem-resistant Enterobacteriaceae (CRE) in Latin America. Methodology: A case-controls study nested in a historical cohort was performed including all patients with CRE infections diagnosed between June 2013 and December 2018 at Hospital Universitario San Ignacio in Bogotá, Colombia. Univariate and multivariate analysis were performed to compare cases of mortality within the first month after the infection diagnosis with surviving patients. Results: A total of 131 patients were included. The overall 30-day mortality rate was 38.17%. In the multivariate analysis, a direct association was found between mortality and septic shock (OR 26.7 CI6.6-107.3 p < 0.01), post-chemotherapy febrile neutropenia (OR 3.3 CI1.06–10.8 p = 0.04) and Charlson Index ≥ 3 (OR 5.5 CI 1.5-20.06 p < 0.01). An inverse association was found with interventions to control the infectious focus (OR 0.3 CI0.1-0.7 p < 0.01). The MIC of different antibiotics and the use of combined antibiotic therapy (triple therapy vs. double therapy or monotherapy) were not associated with mortality. Conclusions: In patients with CRE infections, septic shock, a Charlson comorbidity index ≥ 3, and post-chemotherapy febrile neutropenia are independently related to an increase in mortality. The control of the infectious focus is a protective factor. A rapid identification of these patients, and the implementation of measures to control infectious focus and to detect CRE colonization in patients who are going to be taken to myelosuppressive chemotherapy could impact positively the prognosis of these patients.Q4Q3Introduction: There is little information about weigh of factors possibly associated with mortality, in infections caused by Carbapenem-resistant Enterobacteriaceae (CRE) in Latin America. Methodology: A case-controls study nested in a historical cohort was performed including all patients with CRE infections diagnosed between June 2013 and December 2018 at Hospital Universitario San Ignacio in Bogotá, Colombia. Univariate and multivariate analysis were performed to compare cases of mortality within the first month after the infection diagnosis with surviving patients. Results: A total of 131 patients were included. The overall 30-day mortality rate was 38.17%. In the multivariate analysis, a direct association was found between mortality and septic shock (OR 26.7 CI6.6-107.3 p < 0.01), post-chemotherapy febrile neutropenia (OR 3.3 CI1.06–10.8 p = 0.04) and Charlson Index ≥ 3 (OR 5.5 CI 1.5-20.06 p < 0.01). An inverse association was found with interventions to control the infectious focus (OR 0.3 CI0.1-0.7 p < 0.01). The MIC of different antibiotics and the use of combined antibiotic therapy (triple therapy vs. double therapy or monotherapy) were not associated with mortality. Conclusions: In patients with CRE infections, septic shock, a Charlson comorbidity index ≥ 3, and post-chemotherapy febrile neutropenia are independently related to an increase in mortality. The control of the infectious focus is a protective factor. A rapid identification of these patients, and the implementation of measures to control infectious focus and to detect CRE colonization in patients who are going to be taken to myelosuppressive chemotherapy could impact positively the prognosis of these patients.https://orcid.org/0000-0003-3348-2387Revista Internacional - IndexadaA2S

Guía de práctica clínica para el diagnóstico y manejo de las infecciones de piel y tejidos blandos en Colombia

Skin and soft tissue infections (SSTI) represent the third leading cause of infectious disease consultation for medical services after respiratory and urinary tract infections. This document generates a clinical practice guideline with 38 recommendations based on evidence, graduated under the SIGN system for the diagnosis and treatment for SSTI infections in adult patients in Colombia, following a process of adaptation of guidelines published, and the systematic search and synthesis of literature for the updating of scientific evidence. In addition, a consensus of experts was made for the evaluation of the potential barriers for the implementation of the recommendations and the evaluation of the degree of recommendation in the local context. © 2019 Asociacion Colombiana de Infectologia. All rights reserved

Clinical practice guidelines for the diagnosis and management of skin and soft tissue infections in Colombia

Las infecciones de piel y tejidos blandos (IPTB) representan la tercera causa de consulta por enfermedad infecciosas a los servicios médicos, después de las infec- ciones respiratorias y urinarias. Se presenta una guía de práctica clínica (GPC) con 38 recomendaciones basadas en la evidencia, graduadas bajo el sistema SIGN, para el diagnóstico y tratamiento de pacientes adultos con IPTB en el contexto colombiano, posterior a un proceso de adaptación de GPC publicadas y la búsqueda sistemática y síntesis de literatura para la actualización de la evidencia científica. Además, se realizó un consenso de expertos para la evaluación de las potenciales barreras para la implementación de las recomendaciones y la evaluación del grado de recomendación en el contexto local.Q4Skin and soft tissue infections (SSTI) represent the third leading cause of infectious disease consultation for medical services after respiratory and urinary tract infections. This document generates a clinical practice guideline with 38 recommendations based on evidence, graduated under the SIGN system for the diagnosis and treatment for SSTI infections in adult patients in Colombia, following a process of adaptation of guidelines published, and the systematic search and synthesis of literature for the updating of scientific evidence. In addition, a consensus of experts was made for the evaluation of the potential barriers for the implementation of the recommendations and the evaluation of the degree of recommendation in the local context.https://orcid.org/0000-0003-1833-1599Revista Nacional - IndexadaBS

Staphylococcus aureus bloodstream infections in Latin America: results of a multinational prospective cohort study

Background:Substantial heterogeneity in the epidemiology and management ofStaphylococcus aureusbacter-aemia (SAB) occurs in Latin America. We conducted a prospective cohort study in 24 hospitals from nine LatinAmerican countries.Objectives:To assess the clinical impact of SAB in Latin America.Patients and methods:We evaluated differences in the 30 day attributable mortality among patients with SABdue to MRSA compared with MSSA involving 84 days of follow-up. Adjusted relative risks were calculated using ageneralized linear model.Results:A total of 1030 patients were included. MRSA accounted for 44.7% of cases with a heterogeneous geo-graphical distribution. MRSA infection was associated with higher 30 day attributable mortality [25% (78 of 312)versus 13.2% (48 of 363), adjusted RR: 1.94, 95% CI: 1.38–2.73,P,0.001] compared with MSSA in the multivari-able analysis based on investigators’ assessment, but not in a per-protocol analysis [13% (35 of 270) versus8.1% (28 of 347), adjusted RR: 1.10, 95% CI: 0.75–1.60,P"0.616] or in a sensitivity analysis using 30 day all-cause mortality [36% (132 of 367) versus 27.8% (123 of 442), adjusted RR: 1.09, 95% CI: 0.96–1.23,P"0.179].MRSA infection was not associated with increased length of hospital stay. Only 49% of MSSA bloodstream infec-tions (BSI) received treatment withb-lactams, but appropriate definitive treatment was not associated withlower mortality (adjusted RR: 0.93, 95% CI: 0.70–1.23,P"0.602).Conclusions:MRSA-BSIs in Latin America are not associated with higher 30 day mortality or longer length ofstay compared with MSSA. Management of MSSA-BSIs was not optimal, but appropriate definitive therapy didnot appear to influence mortalit