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Background: Staphylococcus aureus infections are a significant cause of morbidity and mortality in pediatric populations worldwide. The Staphylo Research Network conducted an extensive study on pediatric patients across Colombia from 2018 to 2021. The aim of this study was to describe the epidemiological and microbiological characteristics of S. aureus in this patient group. Methods: We analyzed S. aureus isolates from WHONET-reporting centers. An "event" was a positive culture isolation in a previously negative individual after 2 weeks. We studied center characteristics, age distribution, infection type, and antibiotic susceptibilities, comparing methicillin sensitive (MSSA) and resistant S. aureus (MRSA) isolates. Results: Isolates from 20 centers across 7 Colombian cities were included. Most centers (80%) served both adults and children, with 55% offering oncology services and 85% having a PICU. We registered 8,157 S. aureus culture isolations from 5,384 events (3,345 MSSA and 1,961 MRSA) in 4,821 patients, with a median age of 5 years. Blood (26.2%) and skin/soft tissue (18.6%) were the most common infection sources. Most isolates per event remained susceptible to oxacillin (63.2%), clindamycin (94.3%), and TMP-SMX (98.3%). MRSA prevalence varied by city (<0.001), with slightly higher rates observed in exclusively pediatric hospitals. In contrast, the MRSA rate was somewhat lower in centers with Antimicrobial Stewardship Program (ASP). MRSA was predominantly isolated from osteoarticular infections and multiple foci, while MSSA was more frequently associated with recurrent infections compared to MRSA. Conclusions: This is the largest study of pediatric S. aureus infections in Colombia. We found MSSA predominance, but resistance have important regional variations. S. aureus remains susceptible to other commonly used antibiotics such as TMP-SMX and clindamycin. Ongoing monitoring of S. aureus infections is vital for understanding their behavior in children. Prospective studies within the Staphylored LATAM are underway for a more comprehensive clinical and genetic characterization.

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Introduction: Invasive Pneumococcal Disease (IPD) causes significant morbidity and mortality in children under 5 y. Colombia introduced PCV10 vaccination in 2012, and the Neumocolombia network has been monitoring IPD in pediatric patients since 2008. Materials and methods: This study is a secondary analysis of a prospective cohort involving pediatric patients with IPD admitted to 17 hospitals in Colombia, from January 1st, 2017, to December 31st, 2022. We present data on serotypes (Spn), clinical characteristics, and resistance patterns. Results: We report 530 patients, 215 (40.5%) were younger than 24 months. Among these, 344 cases (64.7%) presented with pneumonia, 95 (17.9%) with primary bacteremia, 53 (10%) with meningitis, 6 (1.1%) had pneumonia and meningitis, and 32 (6%) had other IPD diagnosis. The median hospital stay was 12 days (RIQ 8-14 days), and 268 (50.6%) were admitted to the ICU, of whom 60 (11.3%) died. Serotyping was performed in 298 (56.1%). The most frequent serotypes were Spn19A (51.3%), Spn6C (7.7%), Spn3 (6.7%), Spn6A (3.6%), and Spn14 (3.6%). Of 495 (93%) isolates with known susceptibility, 46 (9.2%) were meningeal (M) and 449 (90.7%) non-meningeal (NM). Among M isolates, 41.3% showed resistance to penicillin, and 21.7% decreased susceptibility to ceftriaxone. For NM isolates, 28.2% had decreased susceptibility to penicilin, and 24.2% decreased susceptibility to ceftriaxone. Spn19A showed the highest resistant to penicillin at 47% and was linked to multiresistance. Conclusion: The prevalence of PCV10-included serotypes decreased, while serotypes 19A and 6C increased, with Spn19A being associated with multiresistance. These findings had played a crucial role in the decision made by Colombia to modify its immunization schedule by switching to PCV13 in July 2022.

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The microbiological diagnosis of pleural effusion is based largely on classical microbiology methods, but these methods have a high rate of false negative results. Some previous studies have shown improved diagnostic performance for pathogens such as Streptococcus pneumoniae using molecular biology methods. We present the use of a multiplex PCR platform (BIOFIRE FILMARRAY Pneumonia Panel) for the aetiological diagnosis of pleural effusion in paediatric pneumonia. We present a case series of 17 pleural fluid samples that were processed by culture-based microbiology and molecular biology methods. Microbiological isolation was successful in four cases (25 %) through traditional culture methods. In contrast, the molecular biology panels allowed for detection in 16 out of 17 cases (94 %). The results from these panels led to a change in management for nine out of the 17 cases (52 %). This study found an increase in aetiological diagnosis in complicated pneumonia in children by using molecular biology methods, which led to a significant change in patient management.

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BACKGROUND: Pediatric Antimicrobial Stewardship Programs (ASP) consider DOT a fundamental measure to quantify the impact of ASP. Novel strategies have been described, but no endemic channels (EC) have been reported to compare antibiotic use within historical patterns. This report describes the process of constructing an EC and analyzing its interpretation. METHODS: This was a descriptive study of the construction, implementation, and analysis of EC. The median and quartile method, as well as the geometric mean (GM) and confidence interval (CI) methods using DOT for the last 4 years were used. ECs have also been elaborated on in critical services (PICU). RESULTS: GM and CI method seem to be more sensitive in identifying changes in antimicrobial use. Ceftriaxone increased its use starting in December 2021, reaching the warning zone in March 2022 in relation to increased cases of bacterial and complicated pneumonia. Piperacillin-tazobactam showed an important increase in PICU during the first 8 months of 2021, reaching the alert zone until August 2021; thereafter, its use decreased, and this variation was related to a modification in the presentation of complicated appendicitis during the COVID 19 pandemic restrictions. The use of ampicillin-sulbactam has increased since January 2022 because of a change in local guidelines regarding its use in appendicitis and peritonitis. The changes identified in each EC allowed ASP to take different conducts. CONCLUSION: EC allowed us to construct a new tool to measure ASP impact, internal comparison of antibiotic use facilitated taking timely interventions. EC could be useful for all pediatric and adult ASP.

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BACKGROUND: Pneumococcal conjugate vaccines (PCVs) have decreased pneumonia in children. Colombia introduced mass vaccination with PCV10 in 2012. METHODS: Cases of pneumococcal pneumonia from 10 hospitals were included. Two periods were compared: pre-PCV10: 2008-2011 and post-PCV10: 2014-2019. The objective was to compare epidemiological and clinical characteristics before and after PCV10 vaccination. RESULTS: A total of 370 cases were included. Serotypes 1 (15, 11.2%) and 14 (33, 24.6%) were the most frequent in the pre-PCV10 period, with only 4 (3%) cases of serotype 19A and 1 case (0.7%) serotype 3. From the pre-PCV10 period to the post-PCV10 period, cases of serotypes 1 (6, 3.1%) and 14 (1, 7.8%) decreased, while cases of serotypes 19A (58, 30.2%), serotype 3 (32, 16.7%) and 6A (7, 3.6%) increased (p < 0.001); complicated pneumonia (CP) increased significantly (13.4% to 31.8%) (p < 0.001); hospitalizations increased from 8 (5.5-15) to 12 (7-22) days (p < 0.001); and the frequency of PICU admission increased from 32.8% to 51.6% (p = 0.001). The use of ampicillin-sulbactam (0.7% to 24%) and ceftriaxone/clindamycin (0.7% to 5.7%) increased in the post-PCV10 period. The duration of empirical antibiotic treatment was 7 (4-11) days in the pre-PCV10 period and increased to 10 (6-17) days (p < 0.001) in the post-PCV10 period. Lethality showed a slight nonsignificant increase (7.5% vs. 9.9%; p = 0.57) in the post-PCV10 period. CONCLUSIONS: PCV10 significantly decreased cases of serotypes 1 and 14, with an increase in cases of serotypes 19A, 3 and 6A, which were the predominant serotypes and had greater severity (e.g., admission to the PICU, CP and more resistance, with an increase in the use of broad-spectrum antibiotics and longer hospitalization) and subsequently included in PCV13. Current data support national and regional evidence on the importance of replacing PCV10 with a higher valence that includes 19A, such as PCV13, with the aim of reducing circulation, particularly of this serotype.

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Introducción. La cirugía de hernia ventral implica una situación de complejidad, dadas las múltiples variables que se deben controlar para estimar los posibles factores determinantes del éxito quirúrgico y la aparición de complicaciones. Según la literatura científica mundial, la incidencia de hernia ventral se estima entre el 10 y el 15 %, y la tasa promedio de complicaciones de esta cirugía varía entre el 10 y el 37 %. El objetivo del presente estudio fue describir la experiencia y los resultados de la cirugía de hernia ventral en dos instituciones de IV nivel, en el periodo de enero de 2015 a marzo de 2019.Métodos. Se trata de un estudio observacional, descriptivo y de cohorte histórica, de pacientes mayores de edad sometidos a corrección de hernia ventral en las Clínicas Colsanitas en los últimos cinco años. Los datos se tomaron del registro estadístico de las instituciones en mención. Resultados. Se incluyeron 612 pacientes en un periodo de cinco años, la mayoría de los cuales era de sexo femenino, con sobrepeso, y predominantemente, con defectos combinados mediales; la tasa general de complicaciones fue del 20 % y, el porcentaje de infección del sitio operatorio, de 9 %; para el desarrollo de esta infección, la técnica de separación de componentes se encontró como un factor de riesgo (p=0,01; RR=2,9; IC 95% 1,32-6,5). En este estudio, no se analizó la recidiva como factor de los diferentes resultados. Conclusiones. Existen pocos datos en la literatura nacional sobre los resultados de este tipo de procedimiento quirúrgico. Es por ello que se procuró brindar a la comunidad científica los resultados de morbimortalidad de esta muestra de pacientes intervenidos por hernia ventral en los últimos cinco años

Introduction: Ventral hernia surgery involves a complex scenario, given the multiple variables that must be controlled to estimate the possible determinants of surgical success and the appearance of complications. Ac-cording to the world literature, the incidence of ventral hernia is estimated between 10% and 15%, and the average complication rate of this surgery varies between 10% and 37%. The objective of this study was to describe the experience and outcomes in ventral hernia surgery in two insti-tutions of IV level, in the period from January 2015 to March 2019.Methods: This is an observational, descriptive and historical cohort study of patients undergoing correction of ventral hernia at Colsanitas Clinics in the last five years. The data were collected from the statistical record of the mentioned institutions.Results: A total of 612 patients were included in a five-year period, most of whom were female, overweight, and predominantly with medial combined defects; the overall complication rate was 20%, and the percentage of op-erative site infection, 9%. From the development of this infection, the component separation was found as a risk factor (p= 0.01; RR= 2.9; CI95% 1.32-6.5). In this study, recurrence was not analyzed as an outcome factor.Conclusions: There is little data in the national literature on the results of this type of surgical procedure, which is why we tried to provide the scientific community with the morbidity and mortality results in our population of patients operated for ventral hernia in the last five years.

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Introducción. Analizamos los costos en el reparo extraperitoneal de la hernia ventral por laparoscopia, desde la perspectiva del sistema general de salud de Colombia, con el fin de mostrar los beneficios de dicho abordaje y su impacto económico, al compararlo con la técnica más implementada, el IPOM plus. Métodos. Se realizó un análisis económico de costo-beneficio, desde la perspectiva del Sistema General de Seguridad Social en Salud (SGSSS) de Colombia, comparando los costos del reparo de hernia ventral con la técnica extraperitoneal, TAPP o TEP, versus el IPOM plus. Se tomaron como costos de referencia lo establecido en el manual tarifario del Instituto de Seguros Sociales. Los datos fueron analizados con Stata V.15 Resultados. Se recolectó y analizó información de 109 procedimientos; 59 del grupo extraperitoneal TAPP/TEP y 50 del grupo IPOM plus, realizados durante los años 2015 a 2018, por el grupo de pared abdominal de Clínica Colsanitas, identificando un ahorro del 69,8 % o resultados de costo-beneficio a favor del grupo extraperitoneal.Discusión. El abordaje extraperitoneal en el reparo de hernia ventral se consideró una estrategia de alto costo-beneficio para el sistema de salud, validado por la experiencia del grupo de pared abdominal de Clínica Colsanitas, al compararla con el abordaje habitual. Teniendo en cuenta que los insumos utilizados para la disección no cambian, la prótesis utilizada para cada una de las técnicas representa un costo importante a considerar, tanto para el sistema como para las instituciones de salud

Introduction. Costs in the extraperitoneal repair of ventral hernia by laparoscopy were analyzed from the perspective of the general health system of Colombia, in order to show the benefits of this approach and its economic impact, when compared with the most implemented technique, IPOM plus. Methods. A cost-benefit economic analysis was performed from the perspective of the General Social Security System in Health (SGSSS) of Colombia, comparing the costs of ventral hernia repair with the extraperitoneal technique, TAPP or TEP, against IPOM plus. The reference costs were taken as established in the rate manual of the Social Security Institute. Data were analyzed with Stata v.15.Results. Information from 109 procedures was collected and analyzed; 59 of the extraperitoneal group TAPP / TEP and 50 of IPOM plus group, carried out during the years 2015 to 2018, by the abdominal wall group of Clinica Colsanitas, identifying a saving of 69,8 % or cost-benefit results in favor of the extraperitoneal group.Discussion. The extraperitoneal approach in ventral hernia repair was considered a high cost-benefit strategy for the health system, validated by the experience of the abdominal wall group of Clínica Colsanitas, when compared with the usual approach. Given that the inputs used for dissection do not change, the prosthesis used for each of the techniques represents an important cost to consider, both for the system and health institutions

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El desarrollo de la cirugía mínimamente invasiva en los últimos 50 años ha producido un incremento significativo de la cirugía laparoscópica y robótica, las cuales requieren de habilidades y conocimientos específicos. Para conseguir la formación quirúrgica del siglo XXI, se requieren cambios en los programas educativos tradicionales, no sólo por los procesos necesarios para el desarrollo de habilidades quirúrgicas cada vez más complejas, sino por las consideraciones éticas, de seguridad del paciente, médico-legales, de aprendizaje significativo y de costo-efectividad. En el presente artículo se expone la importancia de las rotaciones de cirugía laparoscópica y se hace una aproximación a cómo implementarlas

The development of minimally invasive surgery in the last 50 years has produced a significant increase in laparoscopic and robotic surgery, which requires specific knowledge and skills. To achieve 21st century surgical training, traditional educational programs require changes, not only in the processes necessary for the development of increasingly complex surgical skills, but also the ethical, patient safety, medical - legal, meaningful learning, and cost ­ effectiveness issues should be considered. This article discusses the importance of laparoscopic surgery rotations and approaches how to implement them

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The distribution of conjugated linoleic acid (CLA) in dairy products commercially available in Chile is poorly understood. This study aimed to assess the content of CLA in dairy cow products from Chile and the effect of processing fresh milk into dairy products. Samples of raw milk were categorized into two groups based on the animal feeding system utilized by the dairy farm: 1) grazing based systems (Los Lagos region); and 2) housing systems using total mixed ration (TMR) diets (Los Angeles region). Simultaneously, commercial samples of condensed milk, powdered milk, butter and Gouda cheese were analyzed. Furthermore, samples of raw milk and processed products (powdered and sweetened condensed milk) were also analyzed. Dairy farms based on grazing systems had higher levels of CLA in raw milk than TMR farms. In addition, average values of CLA were 1.72 g 100 g1 of total fatty acids, in spring milk in the Los Lagos region, and 0.42 g 100 g1 in summer milk, in the Los Angeles region. Similarly, the CLA content of dairy products was higher than that of raw milk. Milk processing affected the transferring of CLA from fresh milk into the final products. Sweetened condensed milk presented lower CLA values than raw and powdered milk. In conclusion, this study indicates the importance of the production systems to the CLA content as well as the effects of milk processing into dairy products. To sum up, more research is needed to elucidate the exact effect of the processing conditions of dairy products on the CLA content.

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The distribution of conjugated linoleic acid (CLA) in dairy products commercially available in Chile is poorly understood. This study aimed to assess the content of CLA in dairy cow products from Chile and the effect of processing fresh milk into dairy products. Samples of raw milk were categorized into two groups based on the animal feeding system utilized by the dairy farm: 1) grazing based systems (Los Lagos region); and 2) housing systems using total mixed ration (TMR) diets (Los Angeles region). Simultaneously, commercial samples of condensed milk, powdered milk, butter and Gouda cheese were analyzed. Furthermore, samples of raw milk and processed products (powdered and sweetened condensed milk) were also analyzed. Dairy farms based on grazing systems had higher levels of CLA in raw milk than TMR farms. In addition, average values of CLA were 1.72 g 100 g1 of total fatty acids, in spring milk in the Los Lagos region, and 0.42 g 100 g1 in summer milk, in the Los Angeles region. Similarly, the CLA content of dairy products was higher than that of raw milk. Milk processing affected the transferring of CLA from fresh milk into the final products. Sweetened condensed milk presented lower CLA values than raw and powdered milk. In conclusion, this study indicates the importance of the production systems to the CLA content as well as the effects of milk processing into dairy products. To sum up, more research is needed to elucidate the exact effect of the processing conditions of dairy products on the CLA content.(AU)

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