Analysis of Healthcare-associated Infections before and during the COVID-19 pandemic in a Colombian hospital

Introduction: Healthcare-associated infections pose a significant challenge, contributing to hospital morbidity and mortality. Objective: To describe the behavior of Healthcare Associated Infections before and during the pandemic reported to a high-complexity health institution in Colombia. Material and Methods: In our retrospective observational study on Healthcare-Associated Infections (HAIs), we analyzed data from all in-patients diagnosed with HAIs between 2018 and 2020. This included clinical, demographic, microbiological, and microbial susceptibility information collected from the Committee on Nosocomial Infections' prospective database. Data from 391 isolates were obtained using Whonet software for antimicrobial resistance surveillance. Results: We found 504 cases of HAIs (2018-2020) with an overall in-hospital infection rate of 2.55/1000 patient-days. The median age for pediatric patients was 5 years, and for adults, 56 years, with 57% male. The leading admission diagnoses were oncologic disease complications (31%). Bacteremia had a 30-day mortality rate of 13%, predominantly catheter-associated (37%). Gram-negative bacilli, notably Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa, represented 58% cases of HAI. Discussion: The critical need for specific interventions and antimicrobial management to control HAIs, especially given the challenges posed by the COVID-19 pandemic, is highlighted. Conclusions: This is the first report on HAIs incidence at a tertiary hospital in Bucaramanga, Santander (Colombia). Bacteremia was predominant; 75% of HAIs patients had comorbidities. Gram-negative bacilli prevailed; a notable rise in ICU respiratory infections occurred during the 2020 COVID-19 pandemic. Resistance to cephalosporins and carbapenems was prevalent.

Factores asociados a la decisión paterna sobre el retorno a clases presenciales en Colombia durante la pandemia COVID-19 / Associated factors with the paternal decision on the return to face-to-face classes in Colombia during the COVID-19 pandemic

Resumen Introducción: La pandemia por SARS-CoV-2 generó el cierre de los colegios y el inicio de la educación virtual, como medida para disminuir la propagación del virus. Rápidamente, se planteó el regreso a los colegios; sin embargo, es probable que exista un rechazo de los padres por el regreso a clases de forma presencial o mediante alternancia. Por esta razón, se evaluaron los factores asociados a esta oposición. Material y métodos: Se realizó un estudio analítico de corte transversal mediante una encuesta, dirigida a padres que acuden a consultorios con sus hijos en varias ciudades de Colombia. Se determinó el porcentaje de padres que deseaban mantener la escolarización mediante la virtualidad y los factores asociados que motivan a no aceptar el pronto retorno a clases presenciales. Se realizó un análisis de regresión binomial para estimar razones de prevalencia (RP), ajustado a la edad de los padres, tomando como variable dependiente la aceptación de la virtualidad como estrategia para no regresar a los colegios, y se determinaron los factores de mayor importancia en la no aceptación del retorno a clases. Resultados: El 81,06 % de los padres no acepta el retorno a clase de forma presencial. El principal factor asociados a esta decisión fue que alguno de los padres presentara alguna comorbilidad, principalmente, hipertensión y obesidad. Tener hijos mayores de 10 años (RP: 2,64: IC 95 %: 1,48-4,72), convivir con personas mayores de 70 años (RP: 2,2; IC 95 %; 1,46-3,29) y conocer alguna persona fallecida por COVID-19 (RP: 1,86; IC 95 %: 1,42-2,44) también fueron asociadas a no aceptar el retorno a clase presencial. Conclusiones: Existe una clara tendencia a mantener la virtualidad como opción educativa en Colombia para el no regreso a clases presenciales en población de estrato medio y alto. Los factores asociados sugieren una forma de protección familiar. Esta evidencia debe considerarse específica para el periodo de recolección de datos y el grupo incluido en el estudio. Se requieren estudios en los estratos socioeconómicos más bajos, donde se supone ocurren más efectos adversos asociados al no retorno a clases presenciales.

Abstract Introduction: The SARS-CoV-2 pandemic led to the closure of schools and the beginning of virtual education, as a measure to reduce the spread of the virus. Shortly after, there was a planned return to in-person learning, however, there existed the possibility of parents rejecting the notion of returning to in-person learning or a hybrid model of in-person and online learning, there is likely a rejection of parents to return to classes in person. For this reason, the factors possibly associated with this opposition were evaluated. Material and methods: A cross-sectional analytical study was carried out through an online survey aimed at parents who attend private clinics with their children, in several cities of Colombia. The percentage of parents who wished to maintain their children's schooling through virtuality and the factors associated with not accepting the prompt return to face-to-face classes were determined. A binomial regression analysis, to estimate Prevalence Ratios (PR), adjusted for the age of the parents was carried out, taking as a dependent variable the acceptance of virtuality as a strategy for not returning to school and the most important factors in the non-acceptance of returning to school were determined. Results: 81.06% of the parents did not accept the return to class in person. The main factors associated with this decision were that one of the parents had some comorbidity, mainly hypertension and obesity. Having children older than 10 years (PR: 2.64; 95% CI: 1.48-4.72), living with people older than 70 years (PR: 2.2; 95% CI;1.46-3.29), and knowing someone who died from COVID-19 (PR: 1.86; 95% CI 1.42- 2.44) were associated with not accepting the return to face classes. Conclusions: There is a clear tendency to maintain virtuality as an educational option in Colombia for not returning to face-to-face classes in the middle and upper stratum population. Associated factors suggest a form of family protection. This evidence should be considered specific for the data collection period and the group included in the study. Studies are required in the lowest socioeconomic strata, where it is assumed that there are more adverse effects associated with not returning to face-to-face classes.