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OBJECTIVE: To compare the diversity and composition of the gastrointestinal microbiome of patients with SpA. METHODS: MiSeq sequencing of the V3-V4 region of the 16S ribosomal RNA gene was performed on DNA isolated from stool. Patients with concurrent SpA and IBD were excluded. Differences were assessed for richness and diversity indices by QIIME 2™. Differences between means >0,2% with a p-value<0,05 were assumed significant. Institutional Ethics Committee endorsement. RESULTS: 69 individuals included, 49 with SpA (ankylosing spondylitis-AS 72,9%, psoriatic arthritis-PsA 18,8%, reactive arthritis-ReA 8,3%) 5 positive controls-dysbiosis and 15 controls-eubiosis. Conventional treatment in 42,9%, anti-IL-17 16,3% and anti-TNF 40,8%. By subtype, statistically significant differences in favour of AS were found for the diversity indices. AS vs PsA there was a difference in favour of AS for Clostridium clostridioforme (p=0,002), Gemmiger formicilis (p=0,009), Roseburia inulivorans (p=0,008) and Lachnospira pectinoschiza. AS vs ReA there was a difference in favour of AS for L. pectinoschiza (p=0,009), Ruminococcus callidus (p=0.006), Clostridium ruminantium (p=0.031); G. formicilis (p=0,034). Diversity and richness showed differences in patients with high activity for Simpson's and Pielou's indices. In high activity, lower enrichment of Bacteroides eggerthii (p= 0,0003), C. ruminantium (p= 0,026) and Alistipes putredinis (p=0,035) was found. The number of ASV was higher in the anti-IL-17 vs conventional group (p=0.025) and a trend between anti-IL-17 vs anti-TNF (p=0.09). In anti-TNF there was a lower proportion for C. clostridioforme (p=0.023), G. formicilis (p=0.030) and R. callidus (p= 0.003). In anti IL-17, Alistipes indistinctus (p= 0.012) was decreased. CONCLUSIONS: There are differences in microbial diversity for SpA subtypes. The level of disease activity is plausible to influence the composition of the faecal microbiota. Anti-TNFα treatment may influence the microbiome environment favouring restoration of the gut microbiota, while anti-IL-17 may maintain an inflammatory environment.
OBJETIVO: Comparar la diversidad y composición del microbioma gastrointestinal de pacientes con EspA. MÉTODOS: La secuenciación MiSeq de la región V3-V4 del gen ARN ribosomal 16, se realizó en ADN aislado de heces. Se excluyeron pacientes con EspA y EII simultánea. Se evaluaron diferencias para los índices de riqueza y diversidad por medio de QIIME 2™. Las diferencias entre medias> 0,2%, con un valor de p< 0,05, se asumieron significativas. Aval del Comité de Ética Institucional. RESULTADOS: 69 individuos incluidos, 49 con EspA (espondilitis anquilosante-EA 72,9%, artritis psoriásica-APs 18,8%, artritis reactiva-ARe 8,3%), cinco controles positivos-disbiosis y 15 controles-eubiosis. El tratamiento convencional en 42,9%, anti-IL-17 16,3%, y anti-TNF 40,8%. Por subtipo-EasP, se encontraron diferencias estadísticamente significativas a favor de EA para los índices de diversidad. Entre EA vs APs, hubo diferencia a favor de EA para Clostridium clostridioforme (p=0,002), Gemmiger formicilis (p=0,009), Roseburia inulivorans (p=0,008) y Lachnospira pectinoschiza. Entre EA vs ARe hubo diferencia a favor de EA para L. pectinoschiza (p=0,009), Ruminococcus callidus (p = 0,006), Clostridium ruminantium (p=0,031); G. formicilis (p=0,034). La diversidad y riqueza mostraron diferencias en pacientes con alta actividad para los índices de Simpson y Pielou. En alta actividad, se encontró menor enriquecimiento de Bacteroides eggerthii (p=0,0003), C. ruminantium (p= 0,026) y Alistipes putredinis (p= 0,035). El número de ASV fue superior en el grupo de anti IL-17 vs convencional (p=0.025), y una tendencia entre anti IL-17 vs anti-TNF (p=0,09). En anti TNF hubo menor proporción para C. clostridioforme (p=0,023), G. formicilis (p=0,030) y R. callidus (p= 0,003). Y en anti IL-17, Alistipes indistinctus (p= 0,012), estuvo disminuida. CONCLUSIONES: Existen diferencias en la diversidad microbiana para los subtipos de EspA. El nivel de actividad de la enfermedad es plausible para influir en la composición de microbiota fecal. El tratamiento con anti-TNFα, puede influenciar el ambiente del microbioma favoreciendo la restauración de la microbiota intestinal, mientras los anti IL-17 podrían mantener un ambiente inflamatorio.
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Disbiosis , Heces , Microbioma Gastrointestinal , Humanos , Disbiosis/microbiología , Masculino , Femenino , Adulto , Heces/microbiología , Persona de Mediana Edad , Prohibitinas , Espondiloartritis/microbiología , Espondiloartritis/tratamiento farmacológico , Espondilitis Anquilosante/tratamiento farmacológico , Espondilitis Anquilosante/microbiología , Artritis Psoriásica/microbiología , Artritis Psoriásica/tratamiento farmacológico , Artritis Reactiva/microbiología , Artritis Reactiva/tratamiento farmacológicoRESUMEN
BACKGROUND: Geographical variations in mood and psychotic disorders have been found in upper-income countries. We looked for geographic variation in these disorders in Colombia, a middle-income country. We analyzed electronic health records from the Clínica San Juan de Dios Manizales (CSJDM), which provides comprehensive mental healthcare for the one million inhabitants of Caldas. METHODS: We constructed a friction surface map of Caldas and used it to calculate the travel-time to the CSJDM for 16,295 patients who had received an initial diagnosis of mood or psychotic disorder. Using a zero-inflated negative binomial regression model, we determined the relationship between travel-time and incidence, stratified by disease severity. We employed spatial scan statistics to look for patient clusters. RESULTS: We show that travel-times (for driving) to the CSJDM are less than 1 h for ~50% of the population and more than 4 h for ~10%. We find a distance-decay relationship for outpatients, but not for inpatients: for every hour increase in travel-time, the number of expected outpatient cases decreases by 20% (RR = 0.80, 95% confidence interval [0.71, 0.89], p = 5.67E-05). We find nine clusters/hotspots of inpatients. CONCLUSIONS: Our results reveal inequities in access to healthcare: many individuals requiring only outpatient treatment may live too far from the CSJDM to access healthcare. Targeting of resources to comprehensively identify severely ill individuals living in the observed hotspots could further address treatment inequities and enable investigations to determine factors generating these hotspots.
The frequencies of mental disorders vary by geographic region. Investigating such variations may lead to more equitable access to mental healthcare and to scientific discoveries that reveal specific localized factors that contribute to the causes of mental illness. This study examined the frequency of three disorders with a major impact on public health schizophrenia, bipolar disorder, and major depressive disorder by analyzing electronic health records from a hospital providing comprehensive mental health care for a large region in Colombia. We show that individuals receiving outpatient care mainly live relatively near the facility. Those receiving inpatient care live throughout the region, but cluster in a few scattered locations. Future research could lead to strategies for more equitable provision of mental healthcare in Colombia and identify environmental or genetic factors that affect the likelihood that someone will develop one of these disorders.
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The carbide precipitation kinetics in a Fe-22Mn-0.45C TWIP steel subjected to three different cold-deformation levels, annealed at various temperatures, were studied. The studied carbides included chemical compositions, morphology, precipitation sites, volume fraction, and size. Manganese carbides were precipitated in a temperature range between 525 and 650 °C. Volume fraction increased with cold-deformation and decreased with annealing temperature. Carbide size increased with cold-deformation and annealing temperatures up to 625 °C, suffering a notable reduction at 650 °C. Precipitation kinetics were described by means of precipitation curves for 0.1% (vol.) of Fe-Mn-carbides. A kinetic model was used, and two stages were found. Complementarily, austenite grain size and microhardness were also measured. With increases in annealing time, microhardness decreased until it reached a nearly constant value, indicating that recrystallization was complete, while, with increases in annealing temperature, grain size increased.
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OBJECTIVES: Persistent colonization with Staphylococcus aureus is associated with a higher risk of invasive infections. With increasing rates of colonization, especially with antibiotic-resistant strains, it may be useful to identify specific characteristics of colonization that confer a greater infection risk. Therefore, whole-genome sequencing (WGS) of an S. aureus strain isolated from a medical student identified as a persistent carrier in Cartagena, Colombia, was performed to better characterize the strain and to identify genetic components associated with virulence and antimicrobial resistance. METHODS: Antimicrobial susceptibility testing was performed for several antibiotics. Total genomic DNA was extracted and WGS was performed on a PacBio RS II sequencing platform. Whole-genome assembly was generated using PacBio SMRT Analysis v.2.3.0 and HGAP v.1.2. In silico analysis of the chromosomal and plasmid components of this strain was performed using tools available online. RESULTS: Strain COL52-A5 was identified as a Panton-Valentine leukocidin (PVL)-positive methicillin-resistant S. aureus (MRSA) carrying staphylococcal cassette chromosome mec (SCCmec) type IVa and was resistant to cefoxitin, erythromycin, clindamycin and tetracycline. The completely closed genome of strain COL52-A5 was 2 820 086 bp with a GC content of 32.84% and it harboured one large plasmid, two active prophages, five antimicrobial resistance determinants and several virulence factors. The allelic profile was consistent with sequence type ST923 (CC8). CONCLUSION: Genome analysis of strain COL52-A5 found numerous virulence and resistance factors. Further comparison of genomic sequences from persistent and intermittent strains is required to gain insights into the genomic features that favour persistent carriage in healthy individuals.
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Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas , Antibacterianos/farmacología , Humanos , Pruebas de Sensibilidad Microbiana , Plásmidos/genética , Staphylococcus aureus/genéticaRESUMEN
BACKGROUND: Severe mental illness diagnoses have overlapping symptomatology and shared genetic risk, motivating cross-diagnostic investigations of disease-relevant quantitative measures. We analysed relationships between neurocognitive performance, symptom domains, and diagnoses in a large sample of people with severe mental illness not ascertained for a specific diagnosis (cases), and people without mental illness (controls) from a single, homogeneous population. METHODS: In this case-control study, cases with severe mental illness were ascertained through electronic medical records at Clínica San Juan de Dios de Manizales (Manizales, Caldas, Colombia) and the Hospital Universitario San Vicente Fundación (Medellín, Antioquía, Colombia). Participants were assessed for speed and accuracy using the Penn Computerized Neurocognitive Battery (CNB). Cases had structured interview-based diagnoses of schizophrenia, bipolar 1, bipolar 2, or major depressive disorder. Linear mixed models, using CNB tests as repeated measures, modelled neurocognition as a function of diagnosis, sex, and all interactions. Follow-up analyses in cases included symptom factor scores obtained from exploratory factor analysis of symptom data as main effects. FINDINGS: Between Oct 1, 2017, and Nov 1, 2019, 2406 participants (1689 cases [schizophrenia n=160; bipolar 1 disorder n=519; bipolar 2 disorder n=204; and major depressive disorder n=806] and 717 controls; mean age 39 years (SD 14); and 1533 female) were assessed. Participants with bipolar 1 disorder and schizophrenia had similar impairments in accuracy and speed across cognitive domains. Participants with bipolar 2 disorder and major depressive disorder performed similarly to controls, with subtle deficits in executive and social cognition. A three-factor model (psychosis, mania, and depression) best represented symptom data. Controlling for diagnosis, premorbid IQ, and disease severity, high lifetime psychosis scores were associated with reduced accuracy and speed across cognitive domains, whereas high depression scores were associated with increased social cognition accuracy. INTERPRETATION: Cross-diagnostic investigations showed that neurocognitive function in severe mental illness is characterised by two distinct profiles (bipolar 1 disorder and schizophrenia, and bipolar 2 disorder and major depressive disorder), and is associated with specific symptom domains. These results suggest the utility of this design for elucidating severe mental illness causes and trajectories. FUNDING: US National Institute of Mental Health.
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Trastorno Bipolar/psicología , Trastornos del Conocimiento/psicología , Cognición , Trastorno Depresivo Mayor/psicología , Psicología del Esquizofrénico , Adulto , Estudios de Casos y Controles , Colombia , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: Pulmonary arterial hypertension (PAH) is a disease characterized by a progressive rise in pulmonary vascular resistance. Ambrisentan is an oral, propanoic acid based-endothelin receptor antagonist (ERA), selective for the endothelin type-A receptor, which is approved for the treatment of PAH. The Colombia National Food and Drug Surveillance Institute regulatory criteria require demonstrating that the proposed generic product is bioequivalent to its reference-listed drug to obtain marketing approval. OBJECTIVES: The purpose of this study was to test the bioequivalence, pharmacokinetics, and tolerability of ambrisentan 10 mg tablets. METHODS: In this open-label, randomized, oral single-dose, two-way crossover bioequivalence study, 26 Mexican adult healthy male subjects received either the generic product of ambrisentan 10 mg or the reference product Volibris® (ambrisentan) 10 mg tablets during each study period under fasting conditions. There was a 7-day washout period between each dosing. Ambrisentan concentrations in plasma samples were quantified using a validated ultra-performance liquid chromatography coupled with tandem mass spectrometry (UPLC-MS/MS) method. Blood samples were collected up to 72 h post-dose in each study period. The primary end points were maximum plasma concentration (Cmax) and area under the plasma concentration-time (AUC0-t) curve between 0 and 72 h for ambrisentan. RESULTS: The ratios (90% CI) of geometric mean for ambrisentan were 104.3% (97.12-111.98%) and 100.2% (95.56-104.72%). These pharmacokinetic parameter values lie within the INVIMA-specified bioequivalence limits of 80%-125%. Nervous system disorders were the most common adverse events (AEs). All AEs were mild to moderate in nature and were resolved after follow-up or pharmacologic treatment. Both products were safe and well tolerated. CONCLUSIONS: The test product ambrisentan 10 mg tablets is bioequivalent to the reference product Volibris® (ambrisentan) 10 mg tablets. Both treatments were well tolerated in the Mexican male population of this study. TRIAL REGISTRATION: COFEPRIS National Clinical Trials Registry number 183300410B0367/2018.
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Antihipertensivos/administración & dosificación , Medicamentos Genéricos/administración & dosificación , Fenilpropionatos/administración & dosificación , Piridazinas/administración & dosificación , Administración Oral , Adulto , Antihipertensivos/efectos adversos , Antihipertensivos/farmacocinética , Área Bajo la Curva , Cromatografía Líquida de Alta Presión , Estudios Cruzados , Medicamentos Genéricos/efectos adversos , Medicamentos Genéricos/farmacocinética , Humanos , Masculino , México , Fenilpropionatos/efectos adversos , Fenilpropionatos/farmacocinética , Piridazinas/efectos adversos , Piridazinas/farmacocinética , Comprimidos , Espectrometría de Masas en Tándem , Equivalencia Terapéutica , Adulto JovenAsunto(s)
Trastorno Bipolar/etnología , Cultura , Etnopsicología , Humanos , Pueblos Indígenas , Perú , Trastornos Psicóticos/etnologíaRESUMEN
Objetivo: realizar una aproximación al clima organizacional de una empresa promotora de salud a partir del análisis de los niveles de motivación de los empleados. Métodos: análisis descriptivo cuali-cuantitativo realizado en Santa Marta, Colombia entre marzo y septiembre de 2014 en una población de 35 empleados. Se aplicó una adaptación del test de motivación y satisfacción laboral y una guía de observación participante para indagar acerca de las mismas variables del test y además, el nivel de compromiso y pertenencia con la organización. Resultados: el 70,3 por ciento de los trabajadores se encontraba medianamente motivado, el 18,5 por ciento muy motivado, y solo el 11,11 por ciento poco motivado. Esto último afectaba el clima organizacional de la empresa, influenciado por variables internas: estrategias de motivación ineficientes, grupos informales, pagos desiguales, y externas: incertidumbre legislativa y laboral, que incidieron en la productividad. Conclusiones: los relativamente bajos niveles de motivación influyen de manera negativa en el clima organizacional y, por lo tanto, en el rendimiento y productividad de la empresa. Esta investigación es un referente para el estudio de las variables psicosociales de los empleados en las empresas que integran el sistema de salud en Colombia y América Latina(AU)
Objective: to approach to the organizational climate of a health-promoting company based on the analysis of the levels of motivation of its workers. Methods: qualitative-quantitative and descriptive analysis made in a group of 35 workers from March to September 2014 in Santa Marta, Colombia. A modified motivation and work satisfaction test in addition to a participant observational guideline were used to determine the same variables in the test and also, the level of commitment to and the sense of belonging to the organization. Results: in the group, 70.3 percent was fairly motivated, 18.5 percent was highly motivated and just 11.11percent was poorly motivated. The latter affected the company´s organizational climate influenced by the internal variables such as ineffective motivational strategies, informal groups, unequal payments and the external ones like uncertainties about legislation and work that have their impact on productivity. Conclusions: the motivational levels negatively affect the organizational climate and thus, performance and productivity of the company. This research work is a reference for the study of psychosocial variables related to the employees in the companies making up the health system in Colombia and in Latin America as well(AU)
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Humanos , Sistemas de Salud/organización & administración , Política Organizacional , Promoción de la Salud , Satisfacción en el Trabajo , Motivación , Epidemiología Descriptiva , ColombiaRESUMEN
The duration of untreated psychosis (DUP) is a key determinant in the severity of symptoms in patients with schizophrenia. DUP is a modifiable factor that if reduced can improve patient outcome and treatment response. We sought to decrease DUP in rural Argentina by instituting annual training of local health agents to better identify signs of mental illness and offer earlier intervention. DUP was estimated using Schedules of Clinical Assessment in Neuropsychiatry (SCAN). Ongoing training was correlated with a reduction in DUP. Reducing DUP through better screening can decrease the psychosocial burden of disease and improve the trajectory of psychosis.
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Agentes Comunitarios de Salud/educación , Intervención Médica Temprana , Educación en Salud/organización & administración , Trastornos Psicóticos/terapia , Adolescente , Adulto , Argentina , Femenino , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Estudios Retrospectivos , Población Rural , Adulto JovenRESUMEN
UNLABELLED: Introduction : One of the major worldwide public health problems today are the infections caused by carbapenem-resistant Enterobacteriaceae (CRE), among which carbapenem-resistant Klebsiella pneumoniae (CRKP), constitutes one of the most common pathogens causing nosocomial infection. OBJECTIVE: This study was aimed at describing the dissemination of KPC-3 enzyme-producing Klebsiella pneumoniae in clinical isolates from hospitals in Bogotá. MATERIALS AND METHODS: Eighty-two CRKP isolates collected from 10 hospitals in Bogotá from 2008-2010 were analysed; disk diffusion and microdilution were used for phenotypic detection of enzymes and PCR for genotyping. Automated and manual methods were used for determining profiles for antimicrobial susceptibility testing (AST) with 13 agents. PFGE was used for obtaining the isolates´ genetic relationship. RESULTS: This study gives an overview of CRKP patterns in 10 hospitals in Bogota which were found to present resistance to multiple antibiotic families. The CRKPs were grouped in different clones, each having different subtypes, and were spread in the 10 hospitals over the three-year period (2008-2010). CONCLUSIONS: The dissemination of KPC-3-producing Klebsiella pneumoniae nosocomial isolates in Bogota highlights the need for strengthening epidemiological surveillance against this type of microorganism and the development of specific priority activities for preventing and controlling such infection.
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Proteínas Bacterianas/análisis , Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana Múltiple/genética , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/enzimología , Resistencia betalactámica/genética , beta-Lactamasas/análisis , Técnicas de Tipificación Bacteriana , Células Clonales , Colombia/epidemiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/transmisión , Electroforesis en Gel de Campo Pulsado , Hospitales Urbanos/estadística & datos numéricos , Humanos , Infecciones por Klebsiella/epidemiología , Infecciones por Klebsiella/transmisión , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , Pruebas de Sensibilidad Microbiana/métodos , Vigilancia de la Población , Centros de Atención Terciaria/estadística & datos numéricosRESUMEN
OBJECTIVE: To test the hypothesis that an initial fraction of inspired oxygen (FiO2) of 30% during resuscitation of preterm infants results in less oxidative stress and is associated with improved clinical outcomes compared with an FiO2 of 65%. STUDY DESIGN: Preterm infants of gestational age <32 weeks (n = 193) were randomized to start resuscitation with either 30% oxygen (low-oxygen group) or 65% oxygen (high-oxygen group), after which the FiO2 was adjusted based on oxygen saturation values. The primary outcome was bronchopulmonary dysplasia (BPD) assessed at 36 weeks postmenstrual age. Secondary outcomes included major neonatal illnesses and markers of oxidative stress. RESULTS: The median gestational age of included infants was 28(6)/7 weeks (IQR, 26(5)/7-30(3)/7 weeks). The incidence of BPD was not significantly different between the low-oxygen and high-oxygen groups (24% vs. 17%; P = .15). The FiO2 in both groups was adjusted to a mean of 40% by 7 minutes in the low-oxygen group and by 11 minutes in the high-oxygen group. No differences in markers of oxidative stress were noted between groups. CONCLUSION: Initial supplementation of preterm infants with 30% oxygen during the fetal-to-neonatal transition is as safe as 65% oxygen, with no differences in oxidative stress markers or BPD.
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Recien Nacido Prematuro , Consumo de Oxígeno/fisiología , Terapia por Inhalación de Oxígeno/métodos , Oxígeno/uso terapéutico , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Resucitación/métodos , Método Doble Ciego , Femenino , Estudios de Seguimiento , Edad Gestacional , Mortalidad Hospitalaria/tendencias , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Cuidado Intensivo Neonatal/métodos , Masculino , Estrés Oxidativo/fisiología , Terapia por Inhalación de Oxígeno/efectos adversos , Embarazo , Síndrome de Dificultad Respiratoria del Recién Nacido/diagnóstico , Síndrome de Dificultad Respiratoria del Recién Nacido/mortalidad , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
PURPOSE: This study describes causal beliefs about depression among Dominican, Colombian, and Ecuadorian immigrants. The authors describe participants' narratives about how particular supernatural or religious beliefs may contribute to or alleviate depression. METHOD: Latino primary care patients (n = 177) were interviewed with the Beliefs About Causes of Depression Scale, a list of 35 items rated from not at all important to extremely important. Participants had the option of expanding on responses using an informal conversational approach. Underlying themes of these explanatory comments were derived from narrative and content analysis. RESULTS: Major themes that emerged were Psychosocial and Religious and Supernatural causal beliefs. A third theme emerged that represented the integration of these categories in the context of the immigrant experience. DISCUSSION AND CONCLUSIONS: This article adds to the understanding of cross-cultural beliefs about depression. Psychosocial stressors related to the immigrant experience and adverse life events were highly endorsed, but the meaning of these stressors was construed in terms of religious and cultural values. To provide culturally appropriate services, nurses should be aware of and discuss the patient's belief systems, illness interpretations, and expectations of treatment.
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Cultura , Trastorno Depresivo/etnología , Emigrantes e Inmigrantes/psicología , Conocimientos, Actitudes y Práctica en Salud/etnología , Hispánicos o Latinos/psicología , Adolescente , Adulto , Colombia/etnología , Trastorno Depresivo/etiología , Trastorno Depresivo/terapia , República Dominicana/etnología , Ecuador/etnología , Femenino , Humanos , Acontecimientos que Cambian la Vida , Masculino , Persona de Mediana Edad , Religión , Factores Socioeconómicos , Adulto JovenRESUMEN
INTRODUCTION: Urinary tract infection (UTI) is a common disease in the community, and a matter of concern due to the increasing resistance of microorganisms to first line antibiotics and the emergence of multiresistant strains producing extended spectrum beta lactamases (ESBL) in the community. METHODS: An analytical case-control study was conducted over twelve months in 9 hospitals in Colombia. We collected isolates of E. coli, Klebsiella spp. and Proteus spp. from patients with community-onset UTI. The presence of ESBL, AmpC and KPC beta-lactamases were characterized by microbiological and molecular methods. The aim of this study was to determine factors related to the presence of these mechanisms of the resistance to third generation cephalosporins. RESULTS: A total of 325 isolates (287 E. coli, 29 Klebsiella spp. and 9 Proteus spp.) were included. The most frequent comorbidities among the patients were hypertension (n=82; 25.2%) and diabetes mellitus (n=68; 20.9%). Previous use of antimicrobials was found in 23% of patients, and 29% had a previous UTI. Resistance to third and fourth generation cephalosporins varied between 3.4% and 6.3% in E. coli and between 6.9% and 17.8% in K. pneumoniae. Seven (2.4%) CTX-M-15 ESBL-producing E. coli isolates were detected; four of them belonged to ST 131 clone. In K. pneumoniae we detected three KPC-3 carbapenemases (10.3%). CONCLUSIONS: This study confirms the emergence of resistance to third generation cephalosporins enterobacteriaceae as a cause of community-onset UTI. We emphasize the presence of ST 131 clone and KPC carbapenemases circulating in Colombia outside the hospital environment.
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Resistencia a las Cefalosporinas , Cefalosporinas/farmacología , Cefalosporinas/uso terapéutico , Escherichia coli/efectos de los fármacos , Klebsiella pneumoniae/efectos de los fármacos , Proteus mirabilis/efectos de los fármacos , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Anciano , Anciano de 80 o más Años , Proteínas Bacterianas , Estudios de Casos y Controles , Colombia , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Femenino , Hospitales , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Factores de Riesgo , beta-LactamasasRESUMEN
The dissemination of a clone of community genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) that is related to USA300 has been reported in Latin America. We recently detected isolates of a new clone of CG-MRSA (spa type t1635 and ACME-negative) that was genetically unrelated to the USA300 clone and that causes infections in children in Colombia. This finding indicates the appearance of a new clone of CG-MRSA in our region.
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Genotipo , Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/genética , Infecciones Estafilocócicas/diagnóstico , Adolescente , Niño , Preescolar , Colombia/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Infecciones Estafilocócicas/epidemiologíaRESUMEN
INTRODUCTION: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are found with increasing the frequency, both in healthy individuals in the community and in hospitalized patients. In Colombia and the Andean region, CA-MRSA isolates have a genetic background that is related to the pandemic USA300 clone. OBJECTIVE: Two molecular methods are designed and standardized for the rapid differentiation of Colombian community-acquired and hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) isolates. MATERIALS AND METHODS: Two molecular methods were standardized for the identification of CA-MRSA isolates. The first method was based on the differential digestion of the carbamate kinase (arcC)and guanylate kinase (gmk) genes in the sequences type 5 (ST5) in the HA-MRSA isolates and 8 (ST8) in the CA-MRSA isolates. The second method was based on the PCR amplification of 5 specific virulence factors found in CA-MRSA and HA-MRSA isolates. The specificity and precision of each method were evaluated using 237 clinical MRSA isolates. RESULTS: The first method identified 100% and 93.2% of the CA-MRSA and HA-MRSA isolates, respectively. The second method also correctly identified the two isolates types (CA-MRSA and HA-MRSA). CONCLUSIONS: These two methods are a convenient alternative for the rapid identification of the CA-MRSA isolates, compared with other techniques such as pulsed field gel electrophoresis and multilocus sequence typing, which are time-consuming and more expensive.
Asunto(s)
Técnicas de Tipificación Bacteriana/métodos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Polimorfismo de Longitud del Fragmento de Restricción , Infecciones Estafilocócicas/microbiología , Alelos , Proteínas Bacterianas/genética , Técnicas de Tipificación Bacteriana/normas , Colombia , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Electroforesis en Gel de Campo Pulsado , Genes Bacterianos , Guanilato-Quinasas/genética , Humanos , Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/genética , Fosfotransferasas (aceptor de Grupo Carboxilo)/genética , Reproducibilidad de los Resultados , Alineación de Secuencia , Análisis de Secuencia de ADN , Infecciones Estafilocócicas/epidemiología , Factores de Tiempo , Virulencia/genéticaRESUMEN
Introduction. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are found with increasing the frequency, both in healthy individuals in the community and in hospitalized patients. In Colombia and the Andean region, CA-MRSA isolates have a genetic background that is related to the pandemic USA300 clone. Objective. Two molecular methods are designed and standardized for the rapid differentiation of Colombian community-acquired and hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) isolates. Materials and methods. Two molecular methods were standardized for the identification of CA-MRSA isolates. The first method was based on the differential digestion of the carbamate kinase (arcC)and guanylate kinase (gmk) genes in the sequences type 5 (ST5) in the HA-MRSA isolates and 8 (ST8) in the CA-MRSA isolates. The second method was based on the PCR amplification of 5 specific virulence factors found in CA-MRSA and HA-MRSA isolates. The specificity and precision of each method were evaluated using 237 clinical MRSA isolates. Results. The first method identified 100% and 93.2% of the CA-MRSA and HA-MRSA isolates, respectively. The second method also correctly identified the two isolates types (CA-MRSA and HA-MRSA). Conclusions. These two methods are a convenient alternative for the rapid identification of the CA-MRSA isolates, compared with other techniques such as pulsed field gel electrophoresis and multilocus sequence typing, which are time-consuming and more expensive.
Introducción. Los aislamientos de Staphylococcus aureus resistente a la meticilina asociado a la comunidad (SARM-AC), están aumentando la frecuencia de infecciones en personas sanas de la comunidad y en pacientes hospitalizados. En Colombia y en la región andina estos aislamientos tienen un componente genético relacionado con el clon pandémico USA300. Objetivo. Diseñar y estandarizar dos metodologías para la diferenciación rápida de aislamientos colombianos de S. aureus resistente a la meticilina asociado a la comunidad de los asociados al hospital (SARM-AH). Materiales y métodos. Se estandarizaron dos metodologías moleculares para la identificación de aislamientos de S. aureus resistente a la meticilina asociado a la comunidad. La primera se basa en la digestión diferencial con tres enzimas de restricción de los genes cinasa de carbamato (arcC)y cinasa de guanilato (gmk)para los tipos de secuencia 5 (ST5) y 8 (ST8), correspondientes a aislamientos de S. aureus resistente a la meticilina asociado al hospital y asociado a la comunidad, respectivamente. La segunda se basa en la amplificación por reacción en cadena de la polimerasa de cinco factores de virulencia que se encuentran de manera diferencial en estos aislamientos. Las dos metodologías fueron validadas en 237 aislamientos clínicos de S. aureus resistente a la meticilina. Resultados. Con la primera metodología se identificaron el 100 % y 93,2 % de los aislamientos de S. aureus resistente a la meticilina asociado a la comunidad y asociado al hospital, respectivamente. Con la segunda metodología se identificaron correctamente los dos tipos de aislamientos. Conclusiones. Estas dos metodologías son una buena alternativa en términos de ahorro en tiempo y dinero comparadas con otras técnicas, como la electroforesis en campo pulsado y la tipificación de secuencias multilocus para la rápida identificación de aislamientos de S. aureus resistente a la meticilina asociado a la comunidad en Colombia.
Asunto(s)
Humanos , Técnicas de Tipificación Bacteriana/métodos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Polimorfismo de Longitud del Fragmento de Restricción , Reacción en Cadena de la Polimerasa/métodos , Infecciones Estafilocócicas/microbiología , Alelos , Proteínas Bacterianas/genética , Técnicas de Tipificación Bacteriana/normas , Colombia , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Electroforesis en Gel de Campo Pulsado , Genes Bacterianos , Guanilato-Quinasas/genética , Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/genética , Fosfotransferasas (aceptor de Grupo Carboxilo)/genética , Reproducibilidad de los Resultados , Alineación de Secuencia , Análisis de Secuencia de ADN , Infecciones Estafilocócicas/epidemiología , Factores de Tiempo , Virulencia/genéticaRESUMEN
Introducción. Staphylococcus aureus resistente a la meticilina (SARM) causa infecciones adquiridas en la comunidad y en el ámbito hospitalario. El ser portador de SARM se ha descrito como factor de riesgo para desarrollar infección clínica. Objetivo. Caracterizar la colonización por SARM en pacientes adultos de una unidad de cuidados intensivos colombiana, utilizando herramientas de biología molecular.Materiales y métodos. Entre febrero de 2007 y febrero de 2008 se tamizaron mediante hisopado nasofaríngeo, 705 pacientes al ingresar a la unidad de cuidados intensivos, de los cuales, 683 (96,9%) fueron seguidos semanalmente y al egreso de la unidad. Se determinó el perfil de sensibilidad de los aislamientos a 11 antibióticos por el método de dilución en agar; el 62,0% de los aislamientos de SARM fueron caracterizados genética y molecularmente. Resultados. Se tamizaron 705 pacientes al ingreso; 182 (25,8%) estaban colonizados por S. aureus, de los cuales, 51 (7,2%) eran resistentes a la meticilina. Se hizo el seguimiento durante la estancia en la unidad de cuidados intensivos a 683 pacientes, de los cuales, 62 (9,1%) fueron colonizados por SARM en dicha unidad. La prevalencia del clon chileno fue de 76,5% al ingreso y de 88,9% durante la estancia. El 16,0% de los pacientes colonizados desarrollaron algún tipo de infección por SARM. Se encontraron tres pacientes colonizados con SARM adquirido en la comunidad, los cuales fueron positivos para la leucocidina Panton-Valentine (Panton-Valentine leukocidin, PVL). Conclusiones. El 7,2% de los pacientes que ingresaron a la unidad de cuidados intensivos estaban colonizados con SARM. Éste es el primer reporte de colonización por aislamientos de SARM-ST8-SCCmec IVc adquirido en la comunidad y relacionado genéticamente con el clon pandémico USA300-0114 en Colombia.
Introduction. Methicillin-resistant Staphylococcus aureus (MRSA) cause nosocomial and community infections. MRSA colonization in hospitals has been described as an important risk factor during hospitalization. Objective. The colonization characteristics of MRSA was described using the tools of molecular biology. Materials and methods. Between February 2007 and February 2008, 705 patients entering a Colombian intensive care unit (ICU) were screened for MRSA by taking nasopharyngeal samples. For 683 of these patients, a weekly follow-up was provided after they left the ICU. The susceptibility of each S. aureus isolate was tested against 11 antibiotics using agar dilution methods. Sixty two percent (62.0%) of the MRSA isolates were characterized at genetic and molecular level with the detection of resistant genes, SCCmec typing using PCR and the genetic profile with pulsed field gel electrophoresis (PFGE). Results. Of the 705 patients screened at entry to the ICU, 182 (25.8%) were colonized by S. aureus, and of these, 51 (7.2%) were MRSA. Of the 683 patients with follow-up, 62 (9.1%) were infected by MRSA contracted in the hospital ICU. The prevalence of the Chilean clone was 76.5% at entry and 88.9% for follow-up patients. Of the 113 patients colonized with MRSA, nosocomial infection was present in 18 patients (16.0%). Three community-acquired MRSA isolates related to the USA300-0114 pandemic clone were identified. These were also positive for Panton-Valentine leucidin cytotoxin genes of S.aureus. Conclusions. This is the first report in Colombia of patients colonized with CA-MRSA-ST8-SCCmec IVc isolates, and it is a probable source of dissemination of this bacteria in Colombian hospitals.
Asunto(s)
Humanos , Cuidados Críticos , Staphylococcus aureus , Portador SanoRESUMEN
INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) cause nosocomial and community infections. MRSA colonization in hospitals has been described as an important risk factor during hospitalization. OBJECTIVE: The colonization characteristics of MRSA was described using the tools of molecular biology. MATERIALS AND METHODS: Between February 2007 and February 2008, 705 patients entering a Colombian intensive care unit (ICU) were screened for MRSA by taking nasopharyngeal samples. For 683 of these patients, a weekly follow-up was provided after they left the ICU. The susceptibility of each S. aureus isolate was tested against 11 antibiotics using agar dilution methods. Sixty two percent (62.0%) of the MRSA isolates were characterized at genetic and molecular level with the detection of resistant genes, SCCmec typing using PCR and the genetic profile with pulsed field gel electrophoresis (PFGE). RESULTS: Of the 705 patients screened at entry to the ICU, 182 (25.8%) were colonized by S. aureus, and of these, 51 (7.2%) were MRSA. Of the 683 patients with follow-up, 62 (9.1%) were infected by MRSA contracted in the hospital ICU. The prevalence of the Chilean clone was 76.5% at entry and 88.9% for follow-up patients. Of the 113 patients colonized with MRSA, nosocomial infection was present in 18 patients (16.0%). Three community-acquired MRSA isolates related to the USA300-0114 pandemic clone were identified. These were also positive for Panton-Valentine leucidin cytotoxin genes of S.aureus. CONCLUSIONS: This is the first report in Colombia of patients colonized with CA-MRSA-ST8-SCCmec IVc isolates, and it is a probable source of dissemination of this bacteria in Colombian hospitals.