Infección por Clostridium difficile: descripción de las cepas NAP1/027 y de otros serotipos en un centro de alta complejidad de Cali, Colombia, 2012-2015

Introduction: Clostridium difficile causes nosocomial infections leading to high morbidity and mortality. The NAP1/027 strain is associated with a higher toxin production and disease severity, which increases the load of the disease.Objective: To describe the epidemiology of the infections associated with C. difficile and the characteristics related to the NAP1/027 strain.Materials and methods: This was an observational study based on the revision of clinical registries of patients with fecal samples that were positive for C. difficile identified by the Xpert test™ between 2012 and 2015 in a high complexity institution. The severity of the disease was evaluated by means of the ATLAS score.Results: We included 42 infected cases, 9 of which were positive for the NAP1/027strain. The use of antibiotics previous to the infection for more than seven days was more frequent in patients with negative results for NAP1/027. The duration of diarrhea in half of the patients was longer than five days and there were no differences according to the type of strain (p>0.05). Positive cases for the NAP1/027 strain were characterized by presenting fetid and bloody stools. The severity of the infection was similar between the groups. Conclusions: In Colombia, the NAP1/027 strain circulates without significant clinical differences, which could be due to the limited number of patients. Nevertheless, the existence of NAP1/027 should alert physicians and health institutions because of its high association with severity and mortality.Introducción. Clostridium difficile ocasiona infecciones hospitalarias que resultan en altas tasas de morbilidad y mortalidad. La cepa NAP1/027 se ha asociado con una mayor producción de toxinas y con una mayor gravedad, lo que aumenta la carga de la enfermedad.Objetivo. Describir la epidemiología de las infecciones asociadas con C. difficile y las características de la cepa NAP1/027.Materiales y métodos. Se hizo un estudio observacional basado en la revisión de las historias clínicas de los pacientes con muestras de heces positivas para C. difficile identificadas mediante la prueba Xpert™ entre el 2012 y el 2015 en un hospital de alta complejidad. La gravedad de la enfermedad se evaluó con el índice ATLAS.Resultados. Se incluyeron 42 casos de pacientes infectados, 9 de los cuales fueron positivos para la cepa NAP1/027. El uso de antibióticos antes de la infección durante más de siete días fue más frecuente en los casos de pacientes con muestras negativas para NAP1/027. En la mitad de los pacientes, la duración de la diarrea fue mayor de cinco días y no hubo diferencias según el tipo de cepa (p>0,05). Los casos de pacientes positivos para la cepa NAP1/027 se caracterizaron por presentar deposiciones fétidas y sanguinolentas. La gravedad de la infección fue similar entre los grupos.Conclusión. Se comprobó la circulación de la cepa NAP1/027, pero su presencia no supuso diferencias clínicas significativas con respecto a otras cepas, lo cual podría deberse al limitado número de pacientes en este estudio. Sin embargo, su presencia debe alertar a los médicos y a las instituciones de salud, dada su frecuente asociación con la gravedad de la infección y la mortalidad

Clinical practice guideline for surgical antimicrobial prophylaxis

La infección del sitio quirúrgico (ISQ) es una de las principales causas de infecciones asociadas a la atención en salud (IAAS), con un impacto significativo en la mortalidad y morbilidad del paciente quirúrgico, así como en los costos asociados a la atención en salud. El adecuado uso de la profilaxis quirúrgica antimicrobiana es un aspecto fundamental en la reducción del riesgo de ISQ, dado que su utilización inapropiada o indiscriminada puede representar un riesgo para los pacientes y contribuir al desarrollo de resistencia a los antimicrobianos, por lo que resulta de importancia generar directrices que permitan orientar el uso adecuado de antimicrobianos en la profilaxis del paciente quirúrgico, con el objetivo de obtener mejores desenlaces clínicos y propender por un uso racional de antibióticos. La presente guía contiene recomendaciones para profilaxis antibiótica de pacientes sometidos a procedimiento quirúrgico, basadas en la evidencia, realizadas mediante el proceso de adaptación de guías de práctica clínica para el contexto colombiano.Q4Pacientes sometidos a Profilaxis quirúrgica antimicrobianaSurgical site infection (SSI) is one of the main causes of healthcare associated infections (HAI), with a significant impact on the mortality and morbidity of the surgi-cal patient, as well as on the costs associated with health care. The adequate use of surgical antimicrobial prophylaxis being a fundamental aspect in reducing the risk of SSI, taking into account that the inappropriate or indiscriminate use of antibiotics in surgical prophylaxis may represent a risk for patients and contribute to the development of antimicrobial resistance, so it is important to generate guidelines that guide the appropriate antimicrobial prophylaxis in the surgical patient, with the aim of obtaining better clinical outcomes and promoting a rational use of antibiotics. This guide contains recommendations for antibiotic prophylaxis in patients undergoing a surgical procedure, based on evidence, carried out through the process of adapting clinical practice guidelines for the Colombian context.https://orcid.org/0000-0002-5392-7083https://orcid.org/0000-0003-2568-4667Revista Nacional - IndexadaCN

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

Prevalencia y factores relacionados con la infección por Clostridium difficile en un centro hospitalario de alta complejidad en Cali (Colombia)

Resumen Objetivos: Estimar la prevalencia y los factores relacionados con la infección por Clostridium difficile en un hospital de alta complejidad en Cali (Colombia). Métodos: Se realizó un estudio de casos y controles en pacientes que consultaron por diarrea o la desarrollaron durante la hospitalización y que tuvieron un resultado positivo en la prueba de PCR para Clostridium difficile. Durante el 2012 a 2014, se incluyeron 29 casos y 58 controles. Resultados: La prevalencia de Clostridium difficile hospitalaria en la institución fue de 10 por 10.000 pacientes hospitalizados; en 3 casos se identificó la cepa NAP1-027. Los factores relacionados a Clostridium difficile fueron la diabetes mellitus (OR = 7,4; IC 95%: 1,1-47,6; p = 0,035), la leucemia (OR: 4,1; IC 95%: 1,0-16,5; p =0,043) y el consumo de antibióticos por más de 7 días (OR = 7,0; IC 95%: 2,3-21,1; p = 0,001). Conclusión: Se confirmó la asociación entre el uso previo de antibióticos y la infección por Clostridium difficile, de acuerdo con lo reportado en la literatura mundial. Este estudio describe por primera vez en nuestro país la cepa hipervirulenta NAP1/O27 en pacientes hospitalizados

A first attempt of acoustically assessing the shallow waters (<20 m depth) off the Gulf of Cadiz (ICES Subdivision IXa South): the ECOCÁDIZ-COSTA 0709 Spanish Survey (July 2009).

The present working document summarises the main results from one IEO’s coastal (50 – 7 m depth) survey (ECOCÁDIZ-COSTA 0709) complementary and almost synchronous (2nd-9thJuly 2009, R/VFrancisco de Paula Navarro) to the Spanish “standard” acoustic (pelagic ecosystem-) survey (ECOCÁDIZ 0609; 27thJune-6th July 2009; Portuguese and Spanish shelf waters off the Gulf of Cadiz: 20-200 m isobaths; R/V Cornide de Saavedra). Unfortunately, the impossibility of fishing in waters deeper than 25 m depth with an appropiate gear resulted in a relatively high percentage (51.5%) of Not Identified NASCs in relation to the total sampled back-scattering energy attributed to fish, although these energies were mainly concentrated in the deepest ESDUs previously sampled and assessed by the conventional survey. Acoustic energies in the coastal survey were not very high in the shallower waters, which is reflected in the contribution to the total energy by the most coastal species.Versión del edito

Successful recovery of COVID-19 pneumonia in a patient from Colombia after receiving chloroquine and clarithromycin

BACKGROUND: COVID-19 pandemics is a challenge for public health and infectious diseases clinicians, especially for the therapeutical approach that is not yet adequately defined. Amid this situation, investigational agents are being used, including chloroquine. We report here the clinical features and therapeutic course of the first reported patient with confirmed COVID-19 pneumonia that recovered in Colombia, after the use of chloroquine and clarithromycin. CASE REPRESENTATION: A 34-year-old male, returning from Spain, presented with complaints of fever, and cough, and class-II obesity, being hospitalized. The respiratory viruses and bacteria tested by FilmArray® PCR were negative. Two days later, clarithromycin was started because the patient was suspected as community-acquired pneumonia. At the third day, the rRT-PCR confirmed the SARS-CoV-2 infection. A day later, chloroquine was started because of that. His chest computed tomography was performed and showed bilateral multifocal ground-glass opacities with consolidation, which suggested viral pneumonia as a differential diagnosis. Progressively his clinical condition improved and at day 9, patient rRT-PCR for SARS-CoV-2 became negative. The patient was discharged and isolated at home per 14 days. CONCLUSIONS: Our patient improved significantly. This and other COVID-19 cases are urgently demanding results from clinical trials that support evidence-based therapeutical approaches to this pandemic and the clinical management of patients, especially those at critical care

<i>Plasmodium vivax</i> Sporozoite Challenge in Malaria-Naïve and Semi-Immune Colombian Volunteers

<div><p>Background</p><p>Significant progress has been recently achieved in the development of <i>Plasmodium vivax</i> challenge infections in humans, which are essential for vaccine and drug testing. With the goal of accelerating clinical development of malaria vaccines, the outcome of infections experimentally induced in naïve and semi-immune volunteers by infected mosquito bites was compared.</p><p>Methods</p><p>Seven malaria-naïve and nine semi-immune Colombian adults (n = 16) were subjected to the bites of 2–4 <i>P. vivax</i> sporozoite-infected <i>Anopheles</i> mosquitoes. Parasitemia levels, malaria clinical manifestations, and immune responses were assessed and compared.</p><p>Results</p><p>All volunteers developed infections as confirmed by microscopy and RT-qPCR. No significant difference in the pre-patent period (mean 12.5 and 12.8 days for malaria-naïve and malaria-exposed, respectively) was observed but naïve volunteers developed classical malaria signs and symptoms, while semi-immune volunteers displayed minor or no symptoms at the day of diagnosis. A malaria-naïve volunteer developed a transient low submicroscopic parasitemia that cured spontaneously. Infection induced an increase in specific antibody levels in both groups.</p><p>Conclusion</p><p>Sporozoite infectious challenge was safe and reproducible in semi-immune and naïve volunteers. This model will provide information for simultaneous comparison of the protective efficacy of <i>P. vivax</i> vaccines in naïve and semi-immune volunteers under controlled conditions and would accelerate <i>P. vivax</i> vaccine development.</p><p>Trial Registration</p><p>clinicaltrials.gov <a href="http://clinicaltrials.gov/ct2/show/NCT01585077" target="_blank">NCT01585077</a></p></div

Specific antibody responses against <i>P. vivax</i> antigens in naïve and semi-immune volunteers.

<p>Antibodies are expressed as reactivity index defined as OD values of tested sample divided by the cut-off value. Reactivity indexes against (A) <i>Pvs</i>Cs and (B) <i>Pv</i>MSP-1 in naïve volunteers (n = 7). Reactivity indexes against (C) <i>Pvs</i>CS and (D) <i>Pv</i>MSP-1 in semi-immune volunteers (n = 9).</p