Clinical and sociodemographic profile of epilepsy in adults from a reference centre in Colombia. / Perfil clínico y sociodemográfico de la epilepsia en adultos de un centro de referencia de Colombia.

OBJECTIVES: To describe the sociodemographic and clinical characteristics of a cohort of patients with epilepsy from a reference centre in Colombia. METHODS: Cross-sectional study including patients diagnosed with epilepsy who attended our epilepsy centre (Neurocentro) between 2013 and 2016. Data were gathered from patients' medical histories. RESULTS: We gathered data from a total of 354 patients diagnosed with epilepsy. Median age was 37 years; 52% were men. Seizures were focal in 57% of the patients and generalised in 38%; seizure type was not determined in 6% of the sample. The most frequent aetiology was cryptogenic (21%), followed by traumatic (14%). Median time of disease progression and age at onset were 23 and 11 years, respectively. Psychiatric comorbidities were found in 18% of the patients and 40% had some degree of cognitive impairment. Around 40% of our sample reported adverse reactions to antiepileptic drugs at some point during treatment. Antiepileptic drugs were administered in monotherapy in 36% of the patients. Around 37% had drug-resistant epilepsy and 14% underwent surgery. CONCLUSIONS: Psychiatric comorbidities, cognitive impairment, adverse drug reactions, and drug-resistant epilepsy are common among epileptic patients in Colombia. Knowledge of the factors with an impact on epilepsy may lay the foundations for improving management of these patients on the administrative level and improving quality of life.

Effect of chlorhexidine baths on central-line-associated bloodstream infections in a neonatal intensive care unit in a developing country.

Healthcare-associated infections, particularly central-line-associated bloodstream infections (CLABSIs), are worrisome in neonates. This study describes the impact of chlorhexidine baths on CLABSI rates in a neonatal intensive care unit in a developing country, through a quasi-experimental study undertaken over 62 months (January 2012 to February 2017) divided into two periods: before and after the implementation of a protocol for chlorhexidine baths in July 2014. The rate of CLABSIs per 1000 central-line-days decreased from 8.64 to 4.28 after implementation of the protocol. The use of chlorhexidine baths appears to reduce the number of CLABSIs in neonates.

Pneumocystis jirovecii pneumonia in two patients with systemic lupus erythematosus after rituximab therapy.

New cases of Pneumocystis jirovecii pneumonia (PJP) have recently been reported in patients with systemic lupus erythematosus (SLE) after rituximab therapy. Several factors may contribute to susceptibility to P. jirovecii infection in this type of patients, including the immunological characteristics of the disease, the mechanisms of rituximab action, environmental factors, and the biological characteristics of the fungus. We report two patients with SLE who developed PJP after rituximab therapy.

Overinfection by Paracoccidioides brasiliensis in Gouty Crystal Arthritis.

Paracoccidioidomycosis is an endemic South American systemic mycosis caused by the dimorphic fungus Paracoccidioides brasiliensis (P. brasiliensis). The main clinical form of disease is pulmonary, but all organs may be involved. We report a case of overinfection by P. brasiliensis in chronic gouty arthritis affecting the proximal phalanx of the right hallux. The patient required proximal amputation and long-term antifungal therapy.

Outbreak of carbapenem-resistant Pseudomonas aeruginosa producing VIM-8, a novel metallo-beta-lactamase, in a tertiary care center in Cali, Colombia.

The prevalence of imipenem resistance among Pseudomonas aeruginosa isolates at a 195-bed tertiary care medical center in Cali, Colombia, rose from 2% in 1996 to 28% in 1997 and to over 40% in 2003. Many isolates showed high-level multiresistance, and phenotypic characterization suggested the spread of a predominant strain with minor variants. Sixty-six resistant isolates collected between February 1999 and July 2003 from hospitalized patients (n = 54) and environmental samples (n = 12) were subjected to a fuller analysis. Genetic fingerprints were compared by pulsed-field gel electrophoresis (PFGE) of SpeI-digested genomic DNA, and bla(IMP) and bla(VIM) genes were sought by PCR. PFGE and serotyping indicated that 52 of the 66 isolates belonged to a single strain, with 82% similarity; the PFGE pattern for this organism was designated pattern A. Two further pairs of isolates represented single strains; the remaining nine isolates were unique, and in the case of one isolate, no satisfactory PFGE profile could be obtained. The pattern A isolates were mostly of serotype O12 and were highly resistant to imipenem (MICs, 32 to >256 microg/ml), with this resistance decreased eightfold or more in the presence of EDTA. They yielded amplicons with bla(VIM)-specific primers, and sequencing of DNA from a representative isolate revealed bla(VIM-8), a novel allele with three polymorphisms compared with the sequence of bla(VIM-2). Two of these nucleotide changes were silent, but the third determined a Thr139Ala substitution. Only 4 of 13 resistant isolates (2 clinical isolates and 2 environmental isolates) assigned to other PFGE types carried bla(VIM) alleles, whereas the others were less multiresistant and mostly had lower levels of imipenem resistance (MICs, < or =32 microg/ml) which was not significantly reduced by EDTA. No bla(IMP) alleles were detected. During 2003, when the environmental study was undertaken, serotype O12 isolates with bla(VIM) were recovered from sinks and stethoscopes in the most-affected units, although not from the hands of staff; the problem declined once these reservoirs were disinfected and hygienic precautions were reinforced.

Correlation of in vitro azole susceptibility with in vivo response in a murine model of cryptococcal meningitis.

Correlations between in vitro susceptibility and in vivo responses to fluconazole were sought in a mouse model of cryptococcal meningitis. Twenty clinical isolates were used. Two distinct populations were noted. Eight high-virulence isolates had an LD50 of < or = 252 cfu of Cryptococcus neoformans. Twelve low-virulence isolates had an LD50 of > 252 cfu. For 7 low-virulence isolates, the LD50 was > 20,000 cfu. C. neoformans also had a broad range of in vitro susceptibilities (MICs of 1.25 to > 80 micrograms/mL) at 24 h. A correlation was found between the MIC and the minimum effective dose of fluconazole in mice. This was observed with both survival and tissue counts as parameters of efficacy. This study documents for the first time the in vivo relevance of in vitro susceptibility to an azole antifungal for C. neoformans.