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En el año 2019 se publicó la guía de práctica clínica para el diagnóstico y manejo de las infecciones de piel y tejidos blandos en Colombia. Dicha guía excluía a la población pediátrica por sus consideraciones especiales. Teniendo en cuenta que estas infecciones representan un motivo de consulta frecuente en pediatría y que la emergencia del Staphylococcus aureus resistente a meticilina generan la necesidad de actualizar conocimientos y estrategias para el manejo de las infecciones de piel y tejidos blandos superficiales, se presenta esta guía de práctica clínica que da respuesta basada en la evidencia a 12 preguntas. Dicha evidencia fue adaptada y graduada bajo el sistema GRADE posterior a un proceso de adaptación de tres guías publicadas. Adicionalmente, se realizó una actualización de la evidencia científica bajo una búsqueda sistemática. Por último, se realizó un consenso de expertos para la evaluación de las potenciales barreras para la implementación de las recomendaciones en el contexto local.

Introduction: HIV is an independent risk factor for cardiovascular diseases (CVD). There is insufficient information regarding comorbidities and cardiovascular risk factors in the Colombian HIV population. The aim of this study is to describe the prevalence of cardiovascular risk factors and comorbidities in patients from the HIV Colombian Group VIHCOL. Methods: This is a multicenter, cross-sectional study conducted in the VIHCOL network in Colombia. Patients 18 years or older who had at least 6 months of follow-up were included. A stratified random sampling was performed to estimate the adjusted prevalence of cardiovascular risk factors and comorbidities. Results: A total of 1616 patients were included. 83.2% were men, and the median age was 34 years. The adjusted prevalence for dyslipidemia, active tobacco use, hypothyroidism, and arterial hypertension was 51.2% (99% CI: 48.0%–54.4%), 7.6% (99% CI: 5.9%–9.3%), 7.4% (99% CI: 5.7%–9.1%), and 6.3% (99% CI: 4.8%–7.9%), respectively. Conclusions: In this Colombian HIV cohort, there is a high prevalence of modifiable CVD risk factors such as dyslipidemia and active smoking. Non-pharmacological and pharmacological measures for the prevention and management of these risk factors should be reinforced.

Background Infections are common complications in patients with cancer. Data on antimicrobial resistance is important to guide empirical antimicrobial therapy. However, resistance rates varies among different regions and countries and, in general, is higher in Latin America. There are limited data from these patients in this region. The aim of this work is to determine the frequency and antibiotic susceptibility profiles, as well as to identify the most frequent genes related to resistance, among microorganisms implicated in bacteremia in patients diagnosed with cancer Methods A cross-sectional multicenter study conducted in six hospitals in Colombia. An active laboratory search was carried out for adult patients with cancer and bacteremia. Data was obtained from the electronic medical records, and according to the resistance of the microorganisms, molecular tests were performed in a standardized way to identify genes related to methicillin-resistance, extended spectrum beta lactamases and carbapenemases. In addition, an exploratory multivariate analysis was performed using a logistic regression method to predict mortality Results 195 patients from 6 hospitals were included in the study. The clinical variables of the patients are described in Table 1. Gram-negative bacteria were more common and their resistance rates were high. The genes found in the different resistant bacterial isolates are described in Table 2; The main resistance genes identified were blaCTX-M and blaKPC, generating ESLB-type beta-lactamases and carbapenemases, respectively. 30 day-mortality was 26%, which is similar to other studies. Multivariate analysis showed that adequate antibiotic treatment (OR: 0.26 (95%CI 0.1-0.63)) and higher number of platelets (per 10,000, OR: 0.97 (95%CI 0.94-0.99)) were associated with survival. Mortality was associated with patients in palliative care (OR 3.51 (95%CI 1.05-12.04)). Conclusion Gram-negative bacilli are frequently found in patients with cancer and bacteremia. A high level of resistance was identified. The frequency of the genes identified varies from what has been described in other regions of the world. Appropriate and prompt treatment in these patient would improve the outcomes. Disclosures Jorge A. Cortés, MD, pfizer: Grant/Research Support Carlos Saavedra-Trujillo, MD, pfizer and merck: Grant/Research Support.

Background The coronavirus disease 2019 (COVID-19) pandemic is the largest global event in recent times, with millions of infected people and hundreds of thousands of deaths worldwide. Colombia has also been affected by the pandemic, including by the cancellation of medically necessary surgical procedures that were categorized as nonessential. The objective of this study was to show the results of the program implemented in two institutions in Bogotá, Colombia, in April 2020 to support the performance of elective essential and nonessential low- and medium-complexity orthopedic surgeries during the mitigation phase of the COVID-19 pandemic, which involved a presurgical clinical protocol without serological or molecular testing. Methods This was a multicenter, observational, retrospective, descriptive study of a cohort of patients who underwent elective orthopedic surgery at two institutions in the city of Bogota, Colombia, in April 2020. We implemented a preoperative clinical protocol that did not involve serological or molecular tests; the protocol consisted of a physical examination, a survey of symptoms and contact with confirmed or suspected cases, and presurgical isolation. We recorded the types of surgeries, the patients’ scores on the medically necessary, time-sensitive (MeNTs) scale, the presence of signs, symptoms, and mortality associated with COVID-19 developed after the operation. Results A total of 179 patients underwent orthopedic surgery. The average age was 47 years (Shapiro-Wilk, P = 0.021), and the range was between 18 and 81 years. There was a female predominance (61.5%). With regard to the types of surgeries, 86 (48%) were knee operations, 42 (23.5%) were hand surgeries, 34 (19%) were shoulder surgeries, and 17 (9.5%) were foot and ankle surgeries. The average MeNTs score was 44.6 points. During the 2 weeks after surgery, four patients were suspected of having COVID-19 because they developed at least two symptoms associated with the disease. The incidence of COVID-19 in the postoperative period was 2.3%. Two (1.1%) of these four patients visited an emergency department where RT-PCR tests were performed, and they tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). No patients died or were hospitalized for symptoms of COVID-19. Conclusion Through the implementation of a presurgical clinical protocol consisting of a physical examination; a clinical survey inquiring about signs, symptoms, and epidemiological contact with suspected or confirmed cases; and presurgical isolation but not involving the performance of molecular or serological diagnostic tests, positive results were obtained with regard to the performance of low- and medium-complexity elective orthopedic surgeries in an early stage of the COVID-19 pandemic. Level of evidence IV.

Background: The COVID-19 (Coronavirus disease 2019) pandemic is the largest global event of recent times, leaving millions infected and hundreds of thousands of dead worldwide. Colombia is no stranger to this situation, being subject to massive cancellations of medically necessary surgical procedures categorized as ¨non vital¨. The objective of this study is to show the results of a program of elective essential and non-essential low and medium complexity orthopedic surgeries performed during the mitigation phase of the COVID-19 pandemic with a pre-surgical clinical protocol, without serological or molecular testing, during April, 2020 in two institutions in Bogotá, Colombia. Methodology​ :​ A multicenter, observational, retrospective, descriptive study of a cohort of patients who underwent elective orthopedic surgery at two institutions in the city of Bogota, Colombia, during April 2020. We performed a preoperative clinical protocol without including serological or molecular tests, an epidemiological survey, describing the type of surgery, their score in the MeNTs (medically necessary time sensitive) scale, and the presence of suggestive symptoms of COVID-19 postoperatively. Results​ :​ A total of 179 patients underwent orthopedic surgery with an average age of 47 years (swilk= 0.021) (Shapiro-Wilk) ranging between 18 and 81 years, with a majority of females (61.5%). As for the surgeries, 86 (48%) were knee operations, 42 (23.5%) hand surgeries, 34 (19%) shoulder surgeries, and 17 (9.5%) foot and ankle surgeries. The average MeNTS of all patients was 44.6 points. During the two weeks after surgery, four patients were considered suspects for COVID-19 for presenting at least two symptoms associated with the disease representing an incidence of 2.3%. Two (1.1%) of these four patients consulted an emergency department where RT-PCR(reverse transcription polymerase chain reaction) type tests were performed, obtaining a negative result for SARSCov-2 (severe acute respiratory syndrome Coronavirus-2). No patients died or were hospitalized for symptoms associated with COVID-19. Conclusion​ :​ Through the implementation of a pre-surgical clinical protocol (physical examination, clinical survey inquiring about signs, symptoms and epidemiological contacts), a pre-surgical isolation and without the performance of molecular or serological diagnostic tests, the present study showed good results in the performance of low and medium complexity elective orthopedic surgery at an early stage of the COVID-19 pandemic. Level of evidence​ :​ IV.

Introducción: debido a la emergencia del coronavirus SARS-CoV-2 desde diciembre del 2019, se ha generado un gran volumen de producción científica, en algún caso incierta o controvertida especialmente en el manejo farmacológico de los pacientes con esta infección; por lo tanto, se considera relevante buscar alternativas metodológicas para realizar su síntesis rigurosa, sistemática y de calidad, pero con menor tiempo de ejecución y menor costo. Objetivo: presentar la evidencia disponible respecto al manejo farmacológico de personas con sospecha o diagnóstico de infección respiratoria por SARS-CoV-2 (COVID-19) utilizando el método de revisiones sistemáticas rápidas (RS-R) en medicamentos poten- cialmente eficaces para su manejo. Metodología: se realizó una búsqueda sistemática y estructurada en Medline, Embase, Scopus, Cochrane Library, Clinical trials y Google Scholar en inglés. Los estudios incluidos fueron guías de práctica clínica, consensos, revisiones sistemáticas, metaanálisis, ensayos clínicos y otros estudios primarios. La búsqueda y extracción de datos se realizó por múltiples revisores, pero ninguna fue pareada. Resultados: dieciseis preguntas de interés clínico fueron resueltas, relacionadas con el uso en COVID-19 de lopinavir/ ritonavir, nelfinavir, oseltamivir, remdesivir, ribavirina, teicoplanina, umifenovir, favipiravir, tocilizumab, ivermectina y plasma convaleciente; también se evaluó el uso de medicamentos de soporte e incluidos en el manejo como la dexametasona, así como el uso concomitante de medicamentos que generaron dudas como son los AINES, los IECA y los ARA II. Conclusiones: los resúmenes de evidencia se muestran dentro del escenario de la pandemia como una buena alternativa metodológica para ofrecer información de calidad a corto plazo para los tomadores de decisiones

La leptospirosis es una enfermedad infecciosa aguda generalizada, provocada por espiroquetas del género Leptospira, caracterizada por una extensa vasculitis. Siempre debe considerarse entre los diagnósticos diferenciales de síndrome febril en nuestra población. Se reporta una serie de catorce casos con clínica indicativa de leptospirosis, que presentó resultado positivo de serología para Leptospira spp., lo cual confirma el diagnóstico. Se describen las características demográficas en la población estudiada: fue más frecuente en población entre 20 y 35 años de edad. En el 35,7 % existía un antecedente de desplazamiento reciente a municipios del norte del departamento del Tolima y en el 14,2 %, a municipios del sur de Cundinamarca. El 71,4 % de los pacientes tuvo factores de riesgo para adquirir la infección. La mayoría de las consultas a urgencias se presentó siete días de iniciados los síntomas. En todos los pacientes hubo fiebre, cefalea, mialgias y artralgias, y en menor proporción, dolor abdominal y diarreas.

El artículo presenta el caso de un hombre sin antecedentes previos de enfermedad, que consultó inicialmente por dolor abdominal. Se documentó colecistitis aguda, en la patología con hallazgos de citomegalovirus; adicionalmente, presentaba múltiples manifestaciones: síntomas respiratorios, sangrado gastrointestinal y pancitopenia. Se documentó infección por VIH y muestras serológicas e histológicas de citomegalovirus. Se hace diagnóstico de citomegalovirus diseminado en el contexto de infección por VIH.

La leptospirosis es una enfermedad infecciosa aguda generalizada, provocada por espiroquetas del género Leptospira, caracterizada por una extensa vasculitis. Siempre debe considerarse entre los diagnósticos diferenciales de síndrome febril en nuestra población. Se reporta una serie de catorce casos con clínica indicativa de leptospirosis, que presentó resultado positivo de serología para Leptospira spp., lo cual confirma el diagnóstico. Se describen las características demográficas en la población estudiada: fue más frecuente en población entre 20 y 35 años de edad. En el 35,7 % existía un antecedente de desplazamiento reciente a municipios del norte del departamento del Tolima y en el 14,2 %, a municipios del sur de Cundinamarca. El 71,4 % de los pacientes tuvo factores de riesgo para adquirir la infección. La mayoría de las consultas a urgencias se presentó siete días de iniciados los síntomas. En todos los pacientes hubo fiebre, cefalea, mialgias y artralgias, y en menor proporción, dolor abdominal y diarreas.

Objective.To perform active targeted prospective surveillance to measure device-associated infection (DAI) rates, attributable mortality due to DAI, and the microbiological and antibiotic resistance profiles of infecting pathogens at 10 intensive care units (ICUs) in 9 hospitals in Colombia, all of which are members of the International Infection Control Consortium.Methods.We conducted prospective surveillance of healthcare-associated infection in 9 hospitals by using the definitions of the US Centers for Disease Control and Prevention National Nosocomial Surveillance System (NNIS). DAI rates were calculated as the number of infections per 100 ICU patients and per 1,000 device-days.Results.During the 3-year study, 2,172 patients hospitalized in an ICU for an aggregate duration of 14,603 days acquired 266 DAIs, for an overall DAI rate of 12.2%, or 18.2 DAIs per 1,000 patient-days. Central venous catheter (CVC)–related bloodstream infection (BSI) (47.4% of DAIs; 11.3 cases per 1,000 catheter-days) was the most common DAI, followed by ventilator-associated pneumonia (VAP) (32.3% of DAIs; 10.0 cases per 1,000 ventilator-days) and catheter-associated urinary tract infection (CAUTI) (20.3% of DAIs; 4.3 cases per 1,000 catheter-days). Overall, 65.4% of all Staphylococcus aureus infections were caused by methicillin-resistant strains; 40.0% of Enterobacteriaceae isolates were resistant to ceftriaxone and 28.3% were resistant to ceftazidime; and 40.0% of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones, 50.0% were resistant to ceftazidime, 33.3% were resistant to piperacillin-tazobactam, and 19.0% were resistant to imipenem. The crude unadjusted attributable mortality was 16.9% among patients with VAP (relative risk [RR], 1.93; 95% confidence interval [CI], 1.24-3.00; P = .002); 18.5 among those with CVC-associated BSI (RR, 2.02; 95% CI, 1.42-2.87; PP = .19).Conclusion.The rates of DAI in the Colombian ICUs were lower than those published in some reports from other Latin American countries and were higher than those reported in US ICUs by the NNIS. These data show the need for more-effective infection control interventions in Colombia.

Objectives: The aim of this study was to analyze the effect of the International Nosocomial Infection Control Consortium’s multidimensional approach on the reduction of ventilator-associated pneumonia in patients hospitalized in intensive care units. Design: A prospective active surveillance before–after study. The study was divided into two phases. During phase 1, the infection control team at each intensive care unit conducted active prospective surveillance of ventilator-associated pneumonia by applying the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the methodology of International Nosocomial Infection Control Consortium. During phase 2, the multidimensional approach for ventilator-associated pneumonia was implemented at each intensive care unit, in addition to the active surveillance. Setting: Forty-four adult intensive care units in 38 hospitals, members of the International Nosocomial Infection Control Consortium, from 31 cities of the following 14 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, and Turkey. Patients: A total of 55,507 adult patients admitted to 44 intensive care units in 38 hospitals. Interventions: The International Nosocomial Infection Control Consortium ventilator-associated pneumonia multidimensional approach included the following measures: 1) bundle of infectioncontrol interventions; 2) education; 3) outcome surveillance; 4) process surveillance; 5) feedback of ventilator-associated pneumonia rates; and 6) performance feedback of infection-control practices. Measurements: The ventilator-associated pneumonia rates obtained in phase 1 were compared with the rates obtained in phase 2. We performed a time-series analysis to analyze the impact of our intervention. Main Result: During phase 1, we recorded 10,292 mechanical ventilator days, and during phase 2, with the implementation of the multidimensional approach, we recorded 127,374 mechanical ventilator days. The rate of ventilator-associated pneumonia was 22.0 per 1,000 mechani cal ventilator days during phase 1, and 17.2 per 1,000 mechanical ventilator days during phase 2.The adjusted model of linear trend shows a 55.83% reduction in the rate of ventilator-associated pneumonia at the end of the study period; that is, the ventilator-associated pneumonia rate was 55.83% lower than it was at the beginning of the study. Conclusion: The implementation the International Nosocomial Infection Control Consortium multidimensional approach for ventilator-associated pneumonia was associated with a significant reduction in the ventilator-associated pneumonia rate in the adult intensive care units setting of developing countries. (Crit Care Med 2012; 00:0–0)

Medeiros, Eduardo A/0000-0002-6205-259X; Garcell, Humberto Guanche/0000-0001-7279-0062; Leblebicioglu, Hakan/0000-0002-6033-8543; Dikmen, Yalim/0000-0002-3122-5099; Abouqal, Redouane/0000-0002-6117-4341; Kendirli, Tanil/0000-0001-9458-2803; Tsioutis, Constantinos/0000-0002-7865-8529; Yalcin, Ata Nevzat/0000-0002-7243-7354; Abouqal, Redouane/0000-0002-6117-4341; Acar, Ali/0000-0003-2008-5112; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Ozdemir, Halil/0000-0002-7318-1688; Satti, Asim/0000-0001-8432-6101; Barahona G., Nayide/0000-0003-3559-6900; Gikas, Achilleas/0000-0002-8455-9631; Mitrev, Zan/0000-0001-7859-8821; Jayatilleke, Kushlani/0000-0002-3931-6630; Unal, Necmettin/0000-0002-9440-7893; Kanj, Souha/0000-0001-6413-3396; Gonzalez Martinez, Marisela del Rocio/0000-0003-1474-736X; Rodriguez Ferrer, Marena Luz/0000-0002-8053-8454 WOS: 000304378300003 PubMed: 21908073 The results of a surveillance study conducted by the International Nosocomial Infection Control Consortium (INICC) from January 2004 through December 2009 in 422 intensive care units (ICUs) of 36 countries in Latin America, Asia, Africa, and Europe are reported. During the 6-year study period, using Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infections, we gathered prospective data from 313,008 patients hospitalized in the consortium's ICUs for an aggregate of 2,194,897 ICU bed-days. Despite the fact that the use of devices in the developing countries' ICUs was remarkably similar to that reported in US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were significantly higher in the ICUs of the INICC hospitals; the pooled rate of central line-associated bloodstream infection in the INICC ICUs of 6.8 per 1,000 central line-days was more than 3-fold higher than the 2.0 per 1,000 central line-days reported in comparable US ICUs. The overall rate of ventilator-associated pneumonia also was far higher (15.8 vs 3.3 per 1,000 ventilator-days), as was the rate of catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). Notably, the frequencies of resistance of Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%), were also higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 7.3% (for catheter-associated urinary tract infection) to 15.2% (for ventilator-associated pneumonia). Copyright (C) 2011 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Leblebicioglu, Hakan/0000-0002-6033-8543; Salomao, Reinaldo/0000-0003-1149-4598; Abouqal, Redouane/0000-0002-6117-4341; Abouqal, Redouane/0000-0002-6117-4341; Unal, Necmettin/0000-0002-9440-7893 WOS: 000241315700004 PubMed: 17043340 Background: Health care-associated infections from invasive medical devices in the intensive care unit (ICU) are a major threat to patient safety. Most published studies of ICU-acquired infections have come from industrialized western countries. In a Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance (NNIS) System report, the U.S. pooled mean rates of central venous catheter (CVC)-related bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections were 4.0 per 1000 CVC days, 5.4 per 1000 mechanical ventilator days, and 3.9 per Foley catheter days, respectively. Objective: To ascertain the incidence of device-associated infections in the ICUs of developing countries. Design: Multicenter, prospective cohort surveillance of device-associated infection by using the CDC NNIS System definitions. Setting: 55 ICUs of 46 hospitals in Argentina, Brazil, Colombia, India, Mexico, Morocco, Peru, and Turkey that are members of the International Nosocomial Infection Control Consortium (INICC). Measurements: Rates of device-associated infection per 100 patients and per 1000 device days. Results: During 2002-2005, 21 069 patients who were hospitalized in ICUs for an aggregate 137 740 days acquired 3095 device-associated infections for an overall rate of 14.7% or 22.5 infections per 1000 ICU days. Ventilator-associated pneumonia posed the greatest risk (41% of all device-associated infections or 24.1 cases [range, 10.0 to 52.7 cases] per 1000 ventilator days), followed by CVC-related bloodstream infections (30% of all device-associated infections or 12.5 cases [range, 7.8 to 18.5 cases] per 1000 catheter days) and catheter-associated urinary tract infections (29% of all device-associated infections or 8.9 cases (range, 1.7 to 12.8 cases) per 1000 catheter days). Notably, 84% of Staphylococcus aureus infections were caused by methicillin-resistant strains, 51% of Enterobacteriaceae isolates were resistant to ceftriaxone, and 59% of Pseudomonas aeruginosa isolates were resistant to fluoro-quinolones. The crude mortality rate for patients with device-associated infections ranged from 35.2% (for CVC-associated bloodstream infection) to 44.9% (for ventilator-associated pneumonia). Limitations: These initial data are not adequate to represent any entire country, and likely variations in the efficiency of surveillance and institutional resources may have affected the rates that were detected. Conclusions: Device-associated infections in the ICUs of these developing countries pose greater threats to patient safety than in U.S. ICUs. Active infection control programs that perform surveillance of infection and implement guidelines for prevention can improve patient safety and must become a priority in every country.