Christian Pallares

Characterization and Clinical Impact of Bloodstream Infection Caused by Carbapenemase-Producing Enterobacteriaceae in Seven Latin American Countries.

Introduction Infections caused by carbapenem-resistant Enterobacteriaceae are a public health problem associated with higher mortality rates, longer hospitalization and increased healthcare costs. We carried out a study to describe the characteristics of patients with carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE bloodstream infection (BSI) from Latin American hospitals and to determine the clinical impact in terms of mortality and antibiotic therapy. Methods Between July 2013 and November 2014, we conducted a multicenter observational study in 11 hospitals from 7 Latin American countries (Argentina, Colombia, Ecuador, Guatemala, Mexico, Peru, Venezuela). Patients with BSI caused by Enterobacteriaceae were included and classified either as CPE or non-CPE based on detection of blaKPC, blaVIM, blaIMP, blaNDM and blaOXA-48 by polymerase chain reaction. Enrolled subjects were followed until discharge or death. Demographic, microbiological and clinical characteristics were collected from medical records. Both descriptive and inferential statistics were used to analyze the information. Results A total of 255 patients with Enterobacteriaceae BSI were included; CPE were identified in 53 of them. In vitro non-susceptibility to all screened antibiotics was higher in the patients with CPE BSI, remaining colistin, tigecycline and amikacin as the most active drugs. Combination therapy was significantly more frequent in the CPE BSI group (p < 0.001). The most common regimen was carbapenem + colistin or polymyxin B. The overall mortality was 37% (94/255). Overall and attributable mortality were significantly higher in patients with CPE BSI (p < 0.001); however, we found that patients with CPE BSI who received combination therapy and those who received monotherapy had similar mortality. After multivariate adjustment, CPE BSI (adjusted odds ratio [aOR] 4; 95% confidence interval [CI] 1.7–9.5; p = 0.002) and critical illness (aOR 6.5; 95% CI 3.1–13.7; p < 0.001) were independently associated with in-hospital mortality. Conclusions This study provides valuable data on the clinical characteristics and mortality risk factors in patients with CPE BSI. We determined that CPE infection is an independent mortality predictor and thus Latin American hospitals should perform campaigns on prevention and control of CPE BSI.

Prevalencia y factores de riesgo para infecciones del tracto urinario de inicio en la comunidad causadas por Escherichia coli productor de betalactamasas de espectro extendido en Colombia

INTRODUCTION Urinary tract infections (UTI) are common in the community. However, information of resistant isolates in this context is limited in Latin America. This study aims to determine the prevalence and risk factors associated with community-onset UTI (CO-UTI) caused by extended-spectrum β-lactamase (ESBL)-Producing Escherichia coli in Colombia. MATERIALS AND METHODS A case-control study was conducted between August and December of 2011 in three Colombian tertiary-care institutions. All patients who were admitted to the Emergency Department with a probable diagnosis of CO-UTI were invited to participate. All participating patients were asked for a urine sample. ESBL confirmatory test, antibiotic susceptibility, and molecular epidemiology were performed in these E.coli isolates (Real Time-PCR for bla genes, repetitive element palindromic PCR [rep-PCR], multilocus sequence typing [MLST] and virulence factors by PCR). Clinical and epidemiological information was recorded, and a statistical analysis was performed. RESULTS Of the 2124 recruited patients, 629 had a positive urine culture, 431 of which grew E.coli; 54 were positive for ESBL, of which 29 were CTX-M-15. The majority of ESBL isolates were susceptible to ertapenem, phosphomycin and amikacin. Complicated UTI was strongly associated with ESBL-producing E.coli infections (OR=3.89; 95%CI: 1.10-13.89; P=.03). CTX-M-15-producing E.coli showed 10 different pulsotypes, 65% were PT1 or PT4, and corresponded to ST131. Most of these isolates had 8 out of the 9 analysed virulence factors. DISCUSSION E.coli harbouring blaCTX-M-15 associated with ST131 is still frequent in Colombia. The presence of complicated CO-UTI increases the risk of ESBL-producing E.coli, and must be taken into account in order to provide an adequate empirical therapy.

Infecciones del tracto urinario bajo en adultos y embarazadas: consenso para el manejo empírico

Introduccion: La infeccion no complicada del tracto urinario bajo y la bacteriuria asintomatica son causas frecuentes de consulta medica ambulatoria y en el servicio de urgencias en Colombia y el mundo. La falta de pautas y consenso para el manejo, asi como la emergencia de resistencia a las multiples opciones terapeuticas disponibles en los uropatogenos provenientes de la comunidad, hacen necesario elaborar unas recomendaciones que orienten al clinico sobre el abordaje optimo de estas entidades.

Epidemiology of Candida isolates from Intensive Care Units in Colombia from 2010 to 2013

BACKGROUND The frequency of Candida isolates as a cause of hospital infections has risen in recent years, leading to high rates of morbidity and mortality. The knowledge of the epidemiology of those hospital acquired fungal infections is essential to implement an adequate antifungal therapy. AIMS To describe the epidemiology of Candida infections in Intensive Care Units (ICUs) from a surveillance network in Colombia. METHODS Information was collected from the microbiology laboratories of 20 tertiary healthcare institutions from 10 Colombian cities using the Whonet® software version 5.6. A general descriptive analysis of Candida species and susceptibility profiles focusing on fluconazole and voriconazole was completed between 2010 and 2013, including a sub-analysis of healthcare associated infections (HAIs) during the last year. RESULTS Candida isolates made up 94.5% of the 2680 fungal isolates considered, with similar proportions for Candida albicans and non-C. albicans Candida species (48.3% and 51.7%, respectively). Among the latter, Candida tropicalis (38.6%) and Candida parapsilosis (28.5%) were the most frequent species. Of note, among the blood isolates C. albicans was not the main species. Most of the species isolated were susceptible to fluconazole and voriconazole. From the HAIs reported, 25.5% were caused by Candida; central line-associated bloodstream infection was the most common HAI (58.8%). There were no statistically significant differences regarding length of hospital stay and device days among HAIs. CONCLUSIONS In ICUs of Colombia, non-C. albicans Candida species are as frequent as C. albicans, except in blood samples where non-C. albicans Candida isolates predominate. Further studies are needed to evaluate Candida associated risk factors and to determine its clinical impact.

Effect of Generic vs. Brand-Name Meropenem on Mortality in a Colombian Hospital’s Intensive Care Unit

Abstract Background The quality of antibiotics is a crucial element in successful treatment of infections. Recently, the use of generic antibiotics has caused controversy because of studies reporting clinical failure and the emergence of antibacterial resistance associated with the sustained use of generic antibiotics. The present study was designed to determine the mortality associated with the use of generic meropenem (GM) and brand-name meropenem (BNM) used to treat Gram-negative infections. Methods We conducted an ambispective cohort study comparing adult patients who received GM and BNM while in the intensive care unit of a tertiary care hospital in Colombia. Patients treated between January 2011 and May 2014 received GM while patients treated between June 2014 and March 2017 received BNM. Patients were included in the study only if the infecting organism was susceptible to meropenem. The GM and BNM cohorts were paired by age, infection type, and infection severity as measured by Sequential Organ Failure Assessment score. Mortality was compared between groups. Data were analyzed using descriptive and inferential statistics. Results A total of 168 patients were included; 68 patients (40%) were treated with GM and 100 (60%) were treated with BNM. The mean age was 57 years old; 72 (43%) women and 96 (57%) men. The most common infecting organism was E. coli (35%) followed by K. pneumoniae (19%). Bacteremia (49%) was the most common infection type, followed by intraabdominal infection (24%). Multivariate analysis demonstrated that patients treated with GM had a risk of death 18 times higher (OR: 18.45 95% CI 1.47-232, P = 0.024) than patients treated with BNM. Patients with a history of cardiovascular disease had an independent risk of death compared with those without cardiovascular disease. Other comorbidities and time between bacterial culture and initiation of treatment with meropenem did not have a statistically significant effect on mortality. Conclusion The present study suggests that patients treated with GM have worse clinical outcomes compared with those treated with BNM. More studies are needed to confirm the clinical superiority of brand-name vs. generic antibiotics, not only for meropenem but also for other commonly-used molecules. Disclosures C. Pallares, Merck Sharp & Dohme, Pfizer: Consultant, Consulting fee. C. Hernández-Gómez, Merck Sharp & Dohme: Consultant, Consulting fee. Pfizer: Consultant, Consulting fee. M. V. Villegas, Merck Sharp & Dohme: Consultant, Consulting fee and Research support. Pfizer: Consultant, Consulting fee and Research support.

Antimicrobial Stewardship Challenges: Could Generic Antibiotic Use Policies Improve Economic Outcomes in Acute Care Hospitals?

Abstract Background The main goal of an Antimicrobial Stewardship Program (ASP) is to optimize clinical outcomes while minimizing unintended consequences of antimicrobial use. However, the healthcare resource manager’s primary goal for ASP is to reduce the cost of patient care without adversely affecting quality. Globally, generic drugs facilitate access to medication, especially in resource-limited settings, provided that they prove as effective as the brand molecule. Economical evaluation (EE) studies aim to find the most cost effective alternatives. This study was designed to determine the incremental cost-effectiveness ratio (ICER) of generic meropenem (GM) use vs. brand-name meropenem (BNM) to treat Gram-negative infections. Methods We conducted a double cohort EE study of adult patients who received GM vs. patients who received BNM. All patients with meropenem-susceptible infections were treated in the intensive care unit (ICU) of a Colombian acute care hospital. Survival rates were defined as the clinical outcome for effectiveness. Total infection cost was defined by the cost (USD) of antimicrobial consumption, length of stay, and laboratory and imaging exams until infection resolution. ICER was calculated using a decision tree model. Results A total of 168 patients were included; survival rate for the 68 patients treated with GM was 38% vs. 59% for the 100 patients treated with BNM (death risk OR: 18.4 95% CI 1.47–232, P = 0.024). The total antimicrobial consumption cost was lower in the BNM cohort (

Plasmid Promiscuity Explains High Endemicity of KPC-2 Among Colombian Enterobacteriaceae

303 vs.

Molecular characterisation of carbapenem-resistant Enterobacter cloacae complex in Colombia: blaKPC and the ‘changing landscape’

588) explained by fewer consumption doses. ICU stay costs were higher in the GM cohort (

Improved Outcomes When Antibiotic Prescribing Guidelines Are Followed by Healthcare Providers: A Colombian Example to Encourage Adherence in Hospital Settings

8,896 vs.

Clinical Impact of Antimicrobial Stewardship Programs in Colombian Acute Care Hospitals

7,705), however, laboratory and imaging exam costs were lower in the GM cohort (