Aztreonam plus ceftazidime-avibactam as treatment of NDM-1-producing Klebsiella pneumoniae bacteraemia in a neutropenic patient: Last resort therapy?

Objectives: We report the successful treatment of a bloodstream infection caused by Klebsiella pneumoniae harbouring NDM-1 using aztreonam-ceftazidime-avibactam in a neutropenic patient in whom colistin and meropenem therapy had previously failed. Methods: A clinical isolate was evaluated to determine the presence of NDM, TEM, SHV, CTX, and CMY, and the killing kinetics of aztreonam (ATM; 4 mg/mL), aztreonam-avibactam (ATM-AVI; 4/4 mg/mL), and colistin (2 and 4 mg/mL) were tested. Results: ATM-AVI showed in vitro activity against the Klebsiella pneumoniae harbouring NDM-1, whereas colistin allowed re-growth. Conclusions: This report supports reconsideration of use of colistin for treatment of infections caused by K. pneumoniae harbouring NDM. CZA/ATM use should be kept in mind as a treatment option, perhaps earlier than colistin

La Imagen y la Narrativa como Herramientas para el Abordaje Psicosocial en Escenarios de Violencia. Departamento de Cundinamarca

Los fragmentos que se evidencian en aquellos relatos, son el reflejo de la realidad del país y de lo que sucede con los pobladores afectados de una u otra forma por el conflicto armado; la violencia a causa del conflicto se presenta en muchas ciudades del país afectando principalmente a las más alejadas, las más recónditas y vulnerable, causado así la posibilidad de invadir territorios por parte de la guerrilla. Hay que tener en cuenta que estos pobladores como se evidencia en cada uno de los relatos, vive la guerra de diferentes formas y no a todos les llega por igual, se tiene el caso tanto de víctimas como de victimarios cada uno es una cara de la moneda pero siguen teniendo el mismo factor en común y es que la violencia tocó a sus puertas y cambio sus vidas para siempre, atrás quedaron sus sueños, ilusiones, esperanzas y deseos, todo cambio para ellos de la noche a la mañana y ahora deben vivir bajo el yugo de la guerra que los espera día tras día y que en muchas ocasiones, espera el menor descuido de las personas inmersas en ella, para atacar y arrebatarles todo lo que tienen. Este texto muestra y define como llevan a cabo el proceso de catarsis cada uno de los personajes estudiados, en que forma sienten que la guerra no los ha abandonado y que de algún modo existen ocasiones en las cuales sienten que siguen allí, perseguidos, asechados y atacados en su diario vivir. Por lo anterior, es muy importante conocer y reconocer cada una de las señales que nos dejan ver estas personas para poder implementar estrategias y planes de acción los cuales sean la clave para incluirlos socialmente y que ellos mismos puedan tomar las riendas de su vida, comprendiendo que el pasado no es modificable pero su futuro si lo puede ser, comenzando por dejar atrás todas aquellas afectaciones y pensando solamente en ir hacia adelante y hacia arriba.The fragments that are evident in those stories are a clear reflection of the reality in the country and of everything that happens with the families and residents affected in one way or another by the armed conflict; This not only happens in one part of the country or in a specific town, violence due to the conflict occurs in many cities of the country affecting mainly the most remote, the most remote and vulnerable, thus the possibility of invading territories by The guerrilla. It must be borne in mind that these settlers, as evidenced in each of the stories, live the war in different ways and not all reach them equally, there is the case of both victims and perpetrators, each one is a face of the currency but they still have the same factor in common and that is that violence knocked on their doors and changed their lives forever, their dreams, illusions, hopes and desires were left behind, all change for them overnight and now they must live under the yoke of war that awaits them day after day and that on many occasions expects the slightest carelessness from the people immersed in it to attack and snatch everything they have. This text shows and defines how each of the studied characters carry out the process of catharsis, in which way they feel that the war has not abandoned them and that somehow there are occasions in which they feel that they are still there, persecuted, stalked and attacked in their daily lives. Therefore, it is very important to know and recognize each of the signs that these people let us see in order to implement strategies and action plans which are the key to include them socially and that they themselves can take charge of their lives understanding that the past is not modifiable but its future can be, beginning by leaving behind all those affectations and thinking only of going forward and upward

The successful containment of a hospital outbreak caused by NDM-1-producing Klebsiella pneumoniae ST307 using active surveillance

The worldwide dissemination of high-risk carbapenemase-producing Klebsiella pneumoniae clones has become a major threat to healthcare facilities. This study describes the successful containment of a hospital outbreak caused by NDM-1-producing K. pneumoniae Sequence Type (ST) 307 using active surveillance. The outbreak began when a patient was transferred from a local hospital. After 48 hours in our hospital, a tracheal aspirate was positive for a meropenem resistant and carbapenemase-producing K. pneumoniae. All patients in the medical intensive care unit (ICU) and the neurology wards were subject to contact precautions. The hospital surfaces and devices, healthcare workers, and patients from these wards were screened by cultures. Fecal swabs were placed into broth and PCR for blaKPC, blaOXA-48, blaIMP, blaVIM, and blaNDM, which were performed directly from the broth after 12 hours. PCRs were also performed on DNA extracted from carbapenemase-producing species from subcultured broths. Five and nine days later, two more patients’ rectal swabs tested positive. Molecular assays identified K. pneumoniae blaNDM-1 onto a 130-kb conjugative plasmid (IncY, IncFIIs, and IncFIIY), ST307. After the three patients were discharged, monitoring continued, and after three weeks with negative results, rectal swabbing ended. In conclusion, it was possible to contain a hospital outbreak caused by NDM-1-producing K. pneumoniae ST307 through epidemiological and microbiological surveillance. With the methodology used, the detection of NDM-type genes in fecal samples was obtained in approximately 15 hours after obtaining the fecal sample

Saber pedagógico en Interculturalidad, ciudadanía global y cultura de paz

198 p. Libro electronicoprimera ediciónPublicación resultado del programa Maestros y Maestras que Inspiran, una apuesta para la educación del siglo XXI, adelantada desde la línea Interculturalidad, Ciudadanía Global y Cultura de Paz, por los autores de este texto, con el acompañamiento del siguiente equipo: Mentor Jairzinho Francisco Panqueba Cifuentes Asistente de línea Vanessa Julieth Cabrales Parr

Clinical Presentation and Outcomes of Kawasaki Disease in Children from Latin America: A Multicenter Observational Study from the REKAMLATINA Network

Objetivos: Describir la presentación clínica, el manejo y los resultados de la enfermedad de Kawasaki (EK) en Latinoamérica y evaluar los indicadores pronósticos tempranos de aneurisma de la arteria coronaria (AAC). Diseño del estudio: Se realizó un estudio observacional basado en el registro de la EK en 64 centros pediátricos participantes de 19 países latinoamericanos de forma retrospectiva entre el 1 de enero de 2009 y el 31 de diciembre de 2013, y de forma prospectiva desde el 1 de junio de 2014 hasta el 31 de mayo de 2017. Se recopilaron datos demográficos, clínicos y de laboratorio iniciales. Se utilizó una regresión logística que incorporaba factores clínicos y la puntuación z máxima de la arteria coronaria en la presentación inicial (entre 10 días antes y 5 días después de la inmunoglobulina intravenosa [IGIV]) para desarrollar un modelo pronóstico de AAC durante el seguimiento (>5 días después de la IGIV). Resultados: De 1853 pacientes con EK, el ingreso tardío (>10 días tras el inicio de la fiebre) se produjo en el 16%, el 25% tuvo EK incompleta y el 11% fue resistente a la IGIV. Entre los 671 sujetos con puntuación z de la arteria coronaria notificada durante el seguimiento (mediana: 79 días; IQR: 36, 186), el 21% presentaba AAC, incluido un 4% con aneurismas gigantes. Un modelo pronóstico simple que utilizaba sólo una puntuación z de la arteria coronaria máxima ≥2,5 en la presentación inicial fue óptimo para predecir la AAC durante el seguimiento (área bajo la curva: 0,84; IC del 95%: 0,80, 0,88). Conclusiones: De nuestra población latinoamericana, la puntuación z de la arteria coronaria ≥2,5 en la presentación inicial fue el factor pronóstico más importante que precedió a la AAC durante el seguimiento. Estos resultados resaltan la importancia de la ecocardiografía temprana durante la presentación inicial de la EK. © 2023 Los autoresObjectives: To describe the clinical presentation, management, and outcomes of Kawasaki disease (KD) in Latin America and to evaluate early prognostic indicators of coronary artery aneurysm (CAA). Study design: An observational KD registry-based study was conducted in 64 participating pediatric centers across 19 Latin American countries retrospectively between January 1, 2009, and December 31, 2013, and prospectively from June 1, 2014, to May 31, 2017. Demographic and initial clinical and laboratory data were collected. Logistic regression incorporating clinical factors and maximum coronary artery z-score at initial presentation (between 10 days before and 5 days after intravenous immunoglobulin [IVIG]) was used to develop a prognostic model for CAA during follow-up (>5 days after IVIG). Results: Of 1853 patients with KD, delayed admission (>10 days after fever onset) occurred in 16%, 25% had incomplete KD, and 11% were resistant to IVIG. Among 671 subjects with reported coronary artery z-score during follow-up (median: 79 days; IQR: 36, 186), 21% had CAA, including 4% with giant aneurysms. A simple prognostic model utilizing only a maximum coronary artery z-score ≥2.5 at initial presentation was optimal to predict CAA during follow-up (area under the curve: 0.84; 95% CI: 0.80, 0.88). Conclusion: From our Latin American population, coronary artery z-score ≥2.5 at initial presentation was the most important prognostic factor preceding CAA during follow-up. These results highlight the importance of early echocardiography during the initial presentation of KD. © 2023 The Author(s

Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA)

Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-beta-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results. Interpretation The main risk factors for CRE infections in hospitals with high incidence included previous coloni-zation, urinary catheter and exposure to broad spectrum antibiotics

Resultados Semilleros de Investigación 2009-2010

La publicación recoge los doce informes finales de investigación presentados por los estudiantes de ocho Semilleros 1 y cuatro Semilleros 2, correspondientes a la convocatoria 2009–2010 y se constituye en el Número 25 de la Serie de Investigaciones en Construcción, si bien este es el primer Número publicado en formato digital que UNIJUS se permite poner a disposición no sólo de la comunidad universitaria, sino también de la sociedad colombiana e internacional, interesada en los temas estudiados por los jóvenes investigadores de la Facultad de Derecho, Ciencias Políticas y Sociales de la Universidad Nacional de Colombia