Empirical treatment and mortality in bacteremia due to extended spectrum ß-lactamase producing Enterobacterales (ESßL-E), a retrospective cross-sectional study in a tertiary referral hospital from Colombia.

BACKGROUND: Infections caused by extended spectrum ß-lactamase (ESßL) producing bacteria are common and problematic. When they cause bloodstream infections, they are associated with significant morbidity and mortality. METHODS: A retrospective cross-sectional observational study was conducted in a single center in Pereira, Colombia. It included people hospitalized with bacteremia due to gram-negative bacilli with the extended-spectrum ß-lactamase producing phenotype. A logistic regression analysis was constructed. Clinical characteristics and risk factors for death from sepsis were established. RESULTS: The prevalence of bacteremia due to Enterobacterales with extended-spectrum ß-lactamase producing phenotype was 17%. 110 patients were analyzed. Most patients were men (62%) with a median age of 58 years, hospital mortality was 38%. Admission to intensive care was 45%. The following risk factors for mortality were established: shock requiring vasoactive support, Pitt score > 3 points, and not having an infectious disease consultation (IDC). CONCLUSIONS: bacteremia due to Enterobacterales with extended-spectrum ß-lactamase producing phenotype have a high mortality. Early recognition of sepsis, identification of risk factors for antimicrobial resistance, and prompt initiation of appropriate empiric antibiotic treatment are important. An infectious disease consultation may help improve outcomes.

Geographic mapping of Enterobacteriaceae with extended-spectrum ß-lactamase (ESBL) phenotype in Pereira, Colombia.

BACKGROUND: Antimicrobial resistance is an ecological and multicausal problem. Infections caused by extended-spectrum ß-lactamase producing Enterobacteriaceae (ESBL-E) can be acquired and transmitted in the community. Data on community-associated ESBL-E infections/colonizations in Colombia are scarce. Georeferencing tools can be used to study the dynamics of antimicrobial resistance at the community level. METHODS: We conducted a study of geographic mapping using modern tools based on geographic information systems (GIS). Two study centers from the city of Pereira, Colombia were involved. The records of patients who had ESBL-producing Enterobacteriaceae were reviewed. Antimicrobial susceptibility testing and phenotypic detection of ESBL was done according to CLSI standards. RESULTS: A population of 415 patients with community-acquired infections/colonizations and 77 hospital discharges were obtained. Geographic distribution was established and heat maps were created. Several hotspots were evidenced in some geographical areas of the south-west and north-east of the city. Many of the affected areas were near tertiary hospitals, rivers, and poultry industry areas. CONCLUSIONS: There are foci of antimicrobial resistance at the community level. This was demonstrated in the case of antimicrobial resistance caused by ESBL in a city in Colombia. Causality with tertiary hospitals in the city, some rivers and the poultry industry is proposed as an explanation of the evidenced phenomenon. Geographic mapping tools are useful for monitoring antimicrobial resistance in the community.

Opioid Prescribing Patterns and Costs in a Large Group of Patients in Colombia.

The potential for development of tolerance and dependence and the risk of side effects of opioids make it necessary to monitor their prescribing patterns in order to decrease the morbidity and mortality associated with their continued use. The objective of this study was to determine prescription patterns of opioid medication in a group of patients through a cross-sectional study on a population database of 3.5 million people. Patients with three months of continuous opioid use were identified. Pharmacological, co-medication and cost variables were analyzed. We conducted a multivariate analysis. A total of 7,457 patients were included; 72.1% were women, the mean age was 65.1 years, and 3.8% had a diagnosis of cancer. 10.2% of the patients received opioids in combination therapy. The most prescribed opioids were codeine (57.7%), tramadol (30.9%), and hydrocodone (10.4%). The great majority of patients (91.8%) received pharmacological co-medication with antihypertensive agents (54.4%), statins (38.2%) and acetaminophen (35.4%). The use of other analgesics such as acetaminophen (OR: 1.45, 95% CI: 1.22 -1.75) or nonsteroidal anti-inflammatory drugs (OR: 1.98, 95% CI: 1.60 -2.44) was associated with increased risk of receiving opioids in combination therapy. Prescribing habits of weak agonists and short-acting opioids predominate, mainly in monotherapy and at lower than recommended doses.