Carlos Arturo Álvarez

Mortality among critically ill patients with methicillin-resistant Staphylococcus aureus bacteremia: a multicenter cohort study in Colombia

OBJECTIVEnTo evaluate risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia emergence, its prognosis, and mortality-determining factors in critically ill patients in Colombia.nnnMETHODSnA multicenter, retrospective cohort study conducted in 2005-2008 at 16 public and private reference health care institutions in Bogotá, Colombia, that form part of a national epidemiological surveillance network and a hospital network with 4 469 beds. Methicillin-resistant emergence and mortality were analyzed using descriptive and time-to-event analysis; a multivariate Cox proportional hazard regression model was built to test the association between methicillin resistance and mortality.nnnRESULTSnA total of 372 patients were studied: 186 with MRSA bacteremia, randomly matched with 186 with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Previous surgery, antibiotic exposure, and hospital-acquired infections were independently associated with methicillin resistance. MRSA caused longer hospital stays among survivors (median 24 versus 18 days, P = 0.014). Mortality predictors were: patient age, creatinine level over 1.21 mg/dl at ICU admission, severe sepsis, and inotropic requirement. Appropriate antimicrobial therapy and antimicrobial therapy change were independent protective factors, as was male gender.nnnCONCLUSIONSnMethicillin resistance per se was not a mortality-independent prognostic factor. Previous conditions, such as age, baseline renal impairment, severe sepsis, and inotropy demand explained the observed mortality. Appropriate antimicrobial therapy remained a protective factor. A call to improve infection control measures in Colombia is mandatory.

Transmisión de enfermedades en los vuelos comerciales: del mito a la realidad

Air transport could disseminate infectious diseases in a few hours around the world. Although it is considered one of the safest means of transportation, little is known about its public health safety impact, keeping in mind that it is expanding and increasing the amount of users who can acquire and spread these diseases.The critical point to avoid a pandemic outbreak is to foresee and to be prepared; this could be done with health and aviation personnel training. Thus, this paper shows a general background about the aeronautical impact on infectious diseases transmission and all strategies created to get an early activation of epidemiological alarms to control any outbreak. They include from health, flight staff and passenger education on ground to prevention, prophylaxis, early disease identification as well as both immediate and retrospective post-flight event management.n Resumenn n En pocas horas el transporte aéreo puede diseminar enfermedades infecto-contagiosas alrededor del mundo. Aunque se considera uno de los medios de transporte más seguros, poco se conoce sobre qué tanto lo es para la salud pública internacional, teniendo en cuenta que se está expandiendo e incrementando la cantidad de usuarios que pueden llegar a adquirir y diseminar este tipo de enfermedades.n El punto crítico para evitar una pandemia es prever y estar preparados; esto se logra con el entrenamiento del personal de la salud y el de aviación. Por estas razones, este manuscrito busca mostrar el panorama general del impacto que tiene el ambiente aeronáutico sobre la transmisión de enfermedades infecciosas y las estrategias que se han ideado para lograr activar las alertas epidemiológicas tempranamente y controlar un posible brote, las cuales abarcan la educación del personal de salud, el de vuelo y el pasajero en tierra, la prevención, profilaxis e identificación temprana de la enfermedad y el manejo inmediato y retrospectivo del evento después del vuelo.n n n Abstractn n Air transport could disseminate infectious diseases in a few hours around the world. Although it is considered one of the safest means of transportation, little is known about its public health safety impact, keeping in mind that it is expanding and increasing the amount of users who can acquire and spread these diseases.n The critical point to avoid a pandemic outbreak is to foresee and to be prepared; this could be done with health and aviation personnel training. Thus, this paper shows a general background about the aeronautical impact on infectious diseases transmission and all strategies created to get an early activation of epidemiological alarms to control any outbreak. They include from health, flight staff and passenger education on ground to prevention, prophylaxis, early disease identification as well as both immediate and retrospective post-flight event management.n n

Risk factors for methicillin-resistant Staphylococcus aureus bacteremia: A multicenter matched case-control study

INTRODUCTIONnMethicillin-resistant Staphylococcus aureus is a frequent pathogen at critical care services. Its presence leads to increased hospital stays and mortality risk in patients with bacteremia. However, the etiology of this resistance marker has not been fully studied.nnnOBJECTIVEnTo identify risk factors associated with the emergence of methicillin-resistant S. aureus bacteremia in critically ill patients treated at intensive care units in Bogotá, Colombia.nnnMATERIALS AND METHODSnWe conducted a retrospective paired case-control study, nested in a cohort of patients diagnosed with S. aureus bacteremia and treated at intensive care units between 2006 and 2008 in Bogotá. Cases were patients with positive blood culture to methicillin resistance, matched in a 1:1 ratio with methicillin-sensitive controls isolated from the same institution and hospitalization year. We used conditional logistic regression to analyze the risk factors associated with the presence of resistance, with emphasis on prior antibiotic therapy.nnnRESULTSnWe included 372 patients with S. aureus bacteremia. Factors such as the use of pre-hospital devices: vascular (OR=1.986, 95% CI 1.038 to 3.801) and urinary (OR=2.559, 95% CI: 1.170 to 5.596), along with the number of previously used antibiotics, were associated with the emergence of resistance. The number of antibiotics used previously was determined to have a gradient effect, particularly carbapenems.nnnCONCLUSIONSnThe rational use of antibiotics and surveillance of exposure to surgical procedures or use of invasive devices are interventions that could diminish the emergence of methicillin-resistant S. aureus bacteremia causes.

La prevención de las infecciones asociadas a la atención en salud: un reto en el mejoramiento de la seguridad del paciente

Las infecciones intrahospitalarias, concepto queha evolucionado recientemente en infeccionesasociadas a la atencion en salud, representan unproblema de salud publica y son un indicador dela calidad de la prestacion y gestion del servicio.Implican un aumento del uso de antimicrobianosy de la estancia hospitalaria y se asocian aun mayor riesgo de mortalidad, con consecuenciassociales y economicas para pacientes e institucionesy, por ende, un aumento de los costosde atencion para el sistema de salud.

Comparación de dos pruebas de aglutinación (Toxolatex ® y Toxoscreen ®) en el diagnóstico de la toxoplasmosis: propuesta de inclusión en un programa de control

Este estudio evaluo las pruebas de aglutinacion en Iatex. Toxolatex ®. Furnouze (.T L). .v aglutinacion directa. Toxoscreen ®, Biomerieux (TS), mediante la comparacion con las pruebas de referencia: prueba de neutralizacion, dye test (DT) e inmunofluorescencia indirecta (IFI). En los 500 sueros estudiados, se encontro una buena concordancia entre las tecnicas estudiadas y las de referencia asi: DT (TI, 963% y TS. 98.6%) e IFI (TI 95,4% y TS 97.2%) El TL, ademas de detectar anticuerpos de clase IgM antitoxoplasma, es una tecnica poco costosa y de facil y rapida realizacion. Los resultados de este estudio permiten recomendar las pruebas de aglutinacion para el tamizaje de anticuerpos especificas antitoxoplasma en los programas de control prenatal y en los estudios seroepidemiologicos.