Epidemiological and clinical characteristics of patients with carbapenem-resistant Enterobacterales in a university hospital of Colombia: Enzyme coproductions in rise.

The distribution of carbapenemases in Carbapenem-Resistant Enterobacterales (CRE) has recently undergone a change in our region. According to the Colombian National Institute of Health, there is an increasing prevalence of NDM and NDM-KPC co-producing strains. We carried-out an ambispective cohort study of adult inpatients from Hospital Universitario San Ignacio (2021-2023), infected or colonized with CRE, in which carbapenemases immunochromatographic assay was performed. Out of the 150 patients included in the study, 71.3 % presented with an infection, and carbapenemases were detected in 92.7 % of these cases. Among them, KPC predominated (54 %), while 16.7 % demonstrated enzyme coproductions, mainly KPC-NDM. CRE infected patients had an 18.7 % 30-days mortality, but we could not demonstrate an association between type of carbapenemase and mortality rate (p = 0.82). Logistic regression analysis suggested that ICU admission was independently correlated to fatality (OR 5.08; CI 1.68-16.01). NDM and KPC-NDM presence in CRE poses a public health threat and a therapeutic challenge, with unknown mortality differences according to the carbapenemases pattern. Nevertheless, there was not an association between enzyme type and mortality.

In-house protocol and performance of MALDI-TOF MS in the early diagnosis of bloodstream infections in a fourth-level hospital in Colombia: Jumping to full use of this technology.

BACKGROUND: Bloodstream infections (BSIs) are a major cause of mortality in hospitalized patients. Rapid diagnosis is crucial because any delay in the antimicrobial treatment is associated with an increase in adverse patient outcomes. The application of matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) technology directly to blood cultures permits earlier identification of BSIs and facilitates treatment management. METHODS: A total of 470 positive blood cultures from patient samples were analyzed using Standard Aerobic/F and Anaerobic/F blood culture media. Isolates were identified using conventional identification methods and by the direct method using the MALDI-TOF MS system. RESULTS: In 470 blood cultures, the direct method showed good identification results (420/470, 89%); specifically, accurate species and genus identification in 283/470 (60%), and only correct genus identification in 137/470 (29%). The direct protocol had better performance for Gram-negative compared to Gram-positive bacteria (97% vs 76%) and was unable to identify the positive blood cultures for both yeasts and some bacteria, mostly Gram-positive (50/470). CONCLUSIONS: The protocol used here gave good and reliable results, being available up to 24 h earlier, while also leading to better use of MALDI-TOF.

Pseudobrote por Burkholderia cepacia en dos unidades de cuidados intensivos de un Hospital Universitario en Bogotá - Colombia / Pseudo-Outbreak of Burkholderia cepacia in two intensive care unit in a University Hospital in Bogotá - Colombia

Introducción: Burkholderia cepacia es causante de brotes cuyo origen frecuentemente son fuentes ambientales. Materiales y métodos: Ante la sospecha de brote por B. cepacia en hemocultivos. Se realizó toma de cultivos ambientales y de insumos. Los aislamientos microbiológicos fueron sometidos a análisis molecular. Resultados: Se identificaron 8 pacientes con hemocultivos para B. cepacia en la UCI Adultos y UCI Pediátrica, edades entre 3 meses y 88 años, Los hemocultivos fueron tomados a través de catéter venoso central. Ningún paciente presentó infección por este microorganismo. Se documentó crecimiento de B. cepacia en lote de bolsitas ("sachet") jabón de clorhexidina al 4% y en lavamanos que se correlacionaron con el clon identificado en los pacientes. Con el retiro del lote de jabón de clorhexidina, optimización de los procesos de limpieza y desinfección, lavado de manos y medidas de aislamiento se controló el pseudobrote. Conclusiones: Se presenta un pseudobrote por B. cepacia causado por la contaminación de un lote de clorhexidina jabón y de los lavamanos, llamando la atención acerca de la posibilidad de contaminación de antisépticos con este microorganismo.

Introduction: The Burkholderia cepacia has been described as an outbreaks-causing agent, in which case frequently corresponds to environmental sources. Materials and Methods: Having the clinical suspicion of an outbreak or a pseudo-outbreak of B. cepacia in an Intensive Care Unit (ICU), samples in sterile solutions were sent to the laboratory for microbiologic study and molecular analysis. Results: Eigth patients with positive blood cultures for B. cepacia were identifed in the adults and pediatric ICU, ages between 3 months to 88 years. Blood cultures were taken through a central venous catheter. None of the patients presented clinical manifestations of infection. There was a positive culture of B. cepacia in a chlorhexidine sachet soap batch and in samples from the washbasin that was correlated with molecular analysis with patient samples. The withdrawal of the chlorhexidine sachet soap batch plus the optimization of cleaning and disinfection processes and patient isolation, were effective to control the pseudo-outbreak, without presenting infection. Conclusions: One pseudo-outbreak was documented by B. cepacia, affecting the adult and pediatric ICU caused by the contamination of a chlorhexidine sachet soap batch and the washbasins.