José Yesid Rodríguez

Invasive Infections with Multidrug-Resistant Yeast Candida auris, Colombia

Candida auris is an emerging multidrug-resistant fungus that causes a wide range of symptoms. We report finding 17 cases of C. auris infection that were originally misclassified but correctly identified 27.5 days later on average. Patients with a delayed diagnosis of C. auris had a 30-day mortality rate of 35.2%.

Risk factors for mortality caused by Staphylococcus aureus bacteremia in cancer patients

INTRODUCTION Staphylococcus aureus is the cause of 11-33% of nosocomial bloodstream infections and has a complication rate close to 50%. S. aureus accounts for 31% of isolates in the Instituto Nacional de Cancerología (INC), in Bogotá, Colombia, and is the main etiological agent of bacteremia. This study describes the risk factors for mortality caused by S. aureus bacteremia in cancer patients. METHODS This is a retrospective, analytical, observational cohort study of 267 cases of bacteremia caused by S. aureus. Data from all bacteremic patients with proven cancer were extracted, and variables were introduced in a multivariate analysis using a Cox proportional hazards model. RESULTS A total of 354 bacteremic patients were identified between 2001 and 2005, and 267 patients met the specified inclusion and exclusion criteria. Among these, death was considered secondary to S. aureus infection in 31%. Independent predictors of mortality related to S. aureus bacteremia in the multivariate analysis were: severity of sepsis at onset of bacteremia (HR 6.5, 95% CI 3.1-13.6), age (HR 1.03, 95% CI 1.01-1.04), non-eradicable source of infection (HR 36.3, 95% CI 5.2-254.1), heart failure (HR 10.6; 95% CI 1.8-63.7), and primary bacteremia (HR 6.3, 95% CI 1.3-31.0). CONCLUSION Severity of sepsis at the time bacteremia was detected, a non-eradicable source of infection (including primary bacteremia), and comorbid conditions were risk factors for mortality caused by S. aureus bacteremia in cancer patients. These risk factors do not differ considerably from those of patients who do not have cancer.

Single-tube classical PCR for Candida auris and Candida haemulonii identification

BACKGROUND Candida auris and Candida haemulonii are emerging and multiresistant pathogens. C. auris has produced hospital outbreaks and is misidentified by phenotypic-based methods. The only reliable identification methods are DNA sequencing and MALDI-TOF. AIMS To develop a classical-PCR method capable of rapidly and accurately identify C. auris and C. haemulonii. METHODS A multiplex PCR was carried out in one tube that included an internal control and oligonucleotides that specifically hybridize to the ITS2 region of C. auris and C. haemulonii. The usefulness of the new method was verified by testing a collection of 50 strains of 20 different species (previously identified by ITS sequencing). The selection of species was made in order to emulate the C. auris panel used by the CDC to validate diagnostic tools. In addition, other yeast species not included in the aforementioned panel were incorporated based on reported identification errors. RESULTS The results obtained with the proposed protocol were in total agreement with those obtained by ITS sequencing. CONCLUSIONS We present a PCR method able to unequivocally identify C. auris and differentiate it from C. haemulonii. It is inexpensive, fast and it could be a useful tool to reduce the chances of a C. auris outbreak.

Necrotizing fasciitis caused by Apophysomyces variabilis in an immunocompetent patient

Mucormycosis caused by Apophysomyces variabilis is rarely reported in humans. A case of A. variabilis infection in an immunocompetent men after friction burns in a car accident is described. The infection presented as a rapidly progressive necrotizing infection of the skin and soft tissue, which required extensive surgical debridement and total colonic defunctioning colostomy associated with prolonged antifungal therapy. A. variabilis infection should be considered as a differential diagnosis of rapidly progressive necrotizing skin and soft tissue infections in immunocompetent individuals.

Melioidosis en Colombia, descripción de un caso clínico y consideraciones epidemiológicas

Melioidosis is an infectious disease caused by Burkholderia pseudomallei whose clinical diagnosis can be difficult due not only to its varied clinical presentation but also to the difficulties in the microbiological diagnosis.Thus, it may be necessary to use molecular techniques for its proper identification once it is suspected. There are few antibiotics available for the treatment of this disease, which must be used over a long period of time. Although it is known to be endemic in Thailand, Malaysia, Singapore, Vietnam, and Australia, in Colombia there are few reported cases. We describe a case of melioidosis in the northern region of Colombia. Additionally, we review its clinical characteristics and treatment and we describe the local epidemiology of this disease.

Actividad in vitro de Tedizolid y comparadores en aislamientos de Staphylococcus aureus resistentes a meticilina en infecciones de piel y tejidos blandos en 7 hospitales de Colombia

Introducción. Staphylococcus aureus resistente a meticilina (SARM) causa infecciones graves de la piel y los tejidos blandos en los hospitales y, en los últimos años, en la comunidad. El tedizolid es una nueva oxazolidinona cuya potencia in vitro ha demostrado ser mayor que la del linezolid frente a este microorganismo.Objetivo. Conocer la actividad antimicrobiana del tedizolid y de algunos antibióticos de comparación en aislamientos de SARM causante de infecciones de piel y tejidos blandos en hospitales de Colombia.Materiales y métodos. Se hizo un estudio multicéntrico prospectivo y descriptivo a lo largo de doce meses en siete hospitales de tercer nivel de Colombia. Se recolectaron aislamientos de SARM de pacientes adultos con infección de piel y tejidos blandos. Se determinó la concentración inhibitoria mínima (CIM) mediante la técnica de ETEST® (bioMérieux) del tedizolid, el linezolid, la vancomicina, la daptomicina, el trimetoprim-sulfametoxazol y la clindamicina.Resultados. Se obtuvieron aislamientos de SARM de 102 pacientes, de los cuales 56 (54,9 %) eran hombres; el promedio de edad fue de 46,8 años. La infección tuvo origen en la comunidad en 77 casos (75,4 %). El tipo de muestra que predominó fue el absceso (69 pacientes: 67,6 %). Todos los aislamientos fueron sensibles a tedizolid, linezolid, daptomicina, trimetoprim-sulfametoxazol y vancomicina. La actividad in vitro del tedizolid fue mayor que la del linezolid. Los intervalos de la CIM del tedizolid oscilaron entre 0,125 μg/ml y 0,5 μg/ml en tanto que los del linezolid fluctuaron entre 1 μg/m y 2 μg/ml.Conclusiones. Las cepas circulantes de SARM en Colombia presentaron una gran sensibilidad al tedizolid, por lo cual sería una alternativa terapéutica para las infecciones de piel y tejidos blandos en nuestro medio.

Lingual tuberculosis in an HIV/AIDS patient

• Oral tuberculosis should be included in the differential diagnosis of oral lesions, irrespective of the existence of pulmonary signs and symptoms.

Manifestaciones clínicas y radiológicas de infección respiratoria por virus de influenza A H1N1

Resumen Entre junio de 2009 y agosto de 2010 la Organizacion Mundial de la Salud (OMS) declaro una pandemia por el virus de influenza AH1N1. Para junio 2010 se habian confirmado en Colombia 3.572 casos de infeccion respiratoria por el virus de influenza AH1N1 con una mortalidad de 239 pacientes. Objetivos Describir las manifestaciones radiologicas de un grupo de 38 pacientes con diagnostico confirmado de infeccion respiratoria por influenza A(H1N1) que requirieron hospitalizacion. Correlacionar las alteraciones radiologicas con la presentacion clinica de los pacientes estudiados en la serie. Metodologia Analisis retrospectivo de historias clinicas y estudios de imagenes de una cohorte de 38 pacientes con diagnostico confirmado de infeccion por influenza A (H1N1) hospitalizados en el Hospital Universitario Mayor – Mederi en Bogota entre junio de 2009 y marzo de 2010. Los pacientes fueron divididos en dos grupos de acuerdo a la necesidad de soporte ventilatorio durante la hospitalizacion. Los estudios de imagenes fueron revisados en consenso por dos radiologos con experiencia en radiologia toracica. Resultados De las 38 radiografias de torax analizadas, 23 (60%) fueron normales. En las radiografias anormales (40% de los casos), las alteraciones mas importantes fueron consolidacion y vidrio esmerilado. En el grupo que requirio ventilacion mecanica, todas las radiografias fueron anormales. Conclusiones En nuestra serie, los hallazgos en los estudios de imagenes se correlacionaron con la severidad del cuadro clinico. En los pacientes que no requirieron ventilacion mecanica, la radiografia de torax fue normal en un 60%. Todos los pacientes que necesitaron soporte ventilatorio tenian alteraciones radiologicas al ingreso. En los pacientes que requirieron ventilacion mecanica, la alteracion radiologica predominante fue consolidacion de predominio basal.