Epidemiología de la sepsis en unidades de cuidado intensivo en Colombia

Ortíz, Guillermo; Dueñas, Carmelo; Rodríguez, F. J.; Barrera, Lena; Rosa, Gisela De La; Dennis, Rodolfo; Granados, Marcela; Londoño, Darı́o; Molina, Francisco; Jaimes, Fabián

doi:10.7705/biomedica.v34i1.1439

Cited by 30 publications

(15 citation statements)

References 54 publications

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“…[5] Recent publications indicate VAP rates between 1 and 4 cases per 1000 DMV in developed countries; [6] the International Nosocomial Infection Control Consortium reported 5 cases of VAP per 1000 DMV in the United States. [7] In different regions, reported rates per 1000 DMV were 7.9 in Colombia [8] and 18.2 in Poland. [9] In 2009, rates per 1000 DMV in ICUs in central Cuba were recorded up to 19.5.…”

Section: Introductionmentioning

confidence: 99%

Nosocomial Ventilator-Associated Pneumonia in Cuban Intensive Care Units: Bacterial Species and Antibiotic Resistance

Medell

Hart²,

Duquesne

et al. 2013

MEDICC Review

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INTRODUCTION Nosocomial pneumonia associated with use of mechanical ventilators is one of the greatest challenges confronted by intensivists worldwide. The literature associates several bacteria with this type of infection; most common in intensive care units are Acinetobacter baumannii, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and some of the Enterobacteriaceae family.OBJECTIVES To identify the causal agents of nosocomial ventilatorassociated pneumonia in patients receiving mechanical ventilation in the intensive care units of Havana's Hermanos Ameijeiras Clinical-Surgical Teaching Hospital in 2011, and to characterize their antibiotic resistance. METHODS A cross-sectional descriptive study was conducted using hospital administrative data of quantitative cultures from positive tracheal aspirates for January through December, 2011. Records were analyzed from 77 intensive care unit patients who developed nosocomial ventilator-associated pneumonia. Variables examined were age and sex, and pathogens identifi ed from culture of tracheal aspirate and related antibiotic susceptibility.RESULTS Species most frequently isolated were: Acinetobacter baumannii in 53 patients (68.8%), Pseudomonas aeruginosa in 34 patients (44.2%), other species of Pseudomonas in 15 patients (19.5%), and Serratia marcescens, Klebsiella pneumoniae, and Escherichia coli in 12 patients each (15.6%). Some patients presented more than one pathogen in concurrent or successive infections. Antimicrobial susceptibility testing found high percentages of resistance to antibiotics in all these pathogens. Least resistance was found to colistin. CONCLUSIONSThe prevalence of antibiotic resistance in bacteria causing nosocomial ventilator-associated pneumonia is of concern. Colistin is the drug of choice among the antibiotics reviewed, but sensitivity to other antibiotics should be assessed to search for more appropriate broad-spectrum antibiotics for treating nosocomial ventilator-associated pneumonia. Our results also suggest the need to strengthen infection control efforts, particularly in intensive care units, and to reassess compliance with quality control procedures. Multidisciplinary research involving microbiologists, epidemiologists, internists and intensivists is needed to fully understand the etiological and resistance patterns observed.

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Section: Introductionmentioning

confidence: 99%

Nosocomial Ventilator-Associated Pneumonia in Cuban Intensive Care Units: Bacterial Species and Antibiotic Resistance

Medell

Hart²,

Duquesne

et al. 2013

MEDICC Review

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“…The mortality rate observed in the septic group (73.3%) was higher than in other countries with limited resources, such as Haiti—24.2% [17], Uganda—45.7% [18], Colombia—33.6% [19], and several Asian countries—44.5% [20]. A Brazilian study which analyzed data from 4271 hospitals over 10 years estimated the overall sepsis mortality at 46.3%.…”

Section: Discussionmentioning

confidence: 99%

Triage and flow management in sepsis

2019

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BackgroundSepsis is a major public health problem, with a growing incidence and mortality rates still close to 30% in severe cases. The speed and adequacy of the treatment administered in the first hours of sepsis, particularly access to intensive care, are important to reduce mortality. This study compared the triage strategies and intensive care rationing between septic patients and patients with other indications of intensive care. This study included all patients with signs for intensive care, enrolled in the intensive care management system of a Brazilian tertiary public emergency hospital, from January 1, 2010, to December 31, 2016. The intensivist periodically evaluated the requests, prioritizing them according to a semi-quantitative scale. Demographic data, Charlson Comorbidity Index (CCI), Sequential Organ Failure Assessment (SOFA), and quick SOFA (qSOFA), as well as surgical interventions, were used as possible confounding factors in the construction of incremental logistic regression models for prioritization and admission to intensive care outcomes.ResultsThe study analyzed 9195 ICU requests; septic patients accounted for 1076 cases (11.7%), 293 (27.2%) of which were regarded as priority 1. Priority 1 septic patients were more frequently hospitalized in the ICU than nonseptic patients (52.2% vs. 34.9%, p < 0.01). Septic patients waited longer for the vacancy, with a median delay time of 43.9 h (interquartile range 18.2–108.0), whereas nonseptic patients waited 32.5 h (interquartile range 11.5–75.8)—p < 0.01. Overall mortality was significantly higher in the septic group than in the group of patients with other indications for intensive care (72.3% vs. 39.8%, p < 0.01). This trend became more evident after the multivariate analysis, and the mortality odds ratio was almost three times higher in septic patients (2.7, 2.3–3.1).ConclusionSeptic patients had a lower priority for ICU admission and longer waiting times for an ICU vacancy than patients with other critical conditions. Overall, this implied a 2.7-fold increased risk of mortality in septic patients.

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“…En México se encontró que el 52 % de los aislamientos eran dominados por bacterias Gram negativas, el 38% por Gram positivas y el 10% por hongos [4]. Otros reportes en Colombia, también reportan a las bacterias Gram negativas como las más aisladas [5,28,29]. En este estudio, la mayor prevalencia de bacteria Gram negativas representadas por Escherichia.…”

Section: Discussionunclassified

Niveles Plasmáticos de la Interlucina-1 β (IL-1β) en pacientes colombianos con sepsis y choque séptico

Vivas

Caicedo²,

Puerta

2019

archmed

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La sepsis representa un alto riesgo de mortalidad. En este estudio, se evaluó los niveles plasmáticos de IL-1β como biomarcador de sepsis bacteriana en pacientes de una clínica de la ciudad de Cali.Se realizó un estudio prospectivo en 62 pacientes con sepsis y 20 adultos sanos como control, empleando la prueba de ELISA para medir los niveles plasmáticos de las citocinas. Un análisis de regresión logística se utilizó para estimar Odds Ratio (OR), expresado con su 95% intervalos de confianza (IC del 95%) para el resultado de la sepsis en relación a los niveles de IL-1β. La prueba de Chi-cuadrado y la U de Mann-Whitney se emplearon cuando correspondió, valores de p<0,05, fueron considerados significativos y se empleó el paquete estadístico SPSS. Vs 23.00.La edad promedio de los pacientes fue de 53 años y de estancia en la UCI de 7,00 días, 59,7% de ellos eran hombres. El foco pulmonar (43,5%), la hipertensión arterial (41,9%) y bacterias Gram negativas (59,7%) fueron los más prevalentes con una mortalidad del 16,1%. Los altos niveles de IL-1β se asoció al desarrollo de choque séptico (OR=28,050; IC95%5,512-142,740;P=0,000) y con padecer insuficiencia respiratoria (OR=9,009;IC95%:0,013-0,941; P=0,019). En este estudio de encontró diferencias significativas en los niveles de IL-1β durante las primeras 48 horas en pacientes con choque séptico. Sin embargo, el nivel plasmático de la citocina no se relacionó con la mortalidad

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Epidemiología de la sepsis en unidades de cuidado intensivo en Colombia

Cited by 30 publications

References 54 publications

Nosocomial Ventilator-Associated Pneumonia in Cuban Intensive Care Units: Bacterial Species and Antibiotic Resistance

Nosocomial Ventilator-Associated Pneumonia in Cuban Intensive Care Units: Bacterial Species and Antibiotic Resistance

Triage and flow management in sepsis

Niveles Plasmáticos de la Interlucina-1 β (IL-1β) en pacientes colombianos con sepsis y choque séptico

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