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Esparza G.F.,PROASECAL SAS | Motoa G.,Centro Internacional Of Entrenamiento E Investigaciones Medicas Cideim | Robledo C.,Laboratorio Medico Of Referencia | Villegas M.V.,Centro Internacional Of Entrenamiento E Investigaciones Medicas Cideim

Background Urinary tract infections (UTI) are one of the most frequent reasons for consultation in outpatient and emergency settings. The absence of guidelines and consensus from the microbiology laboratory for the diagnosis of UTI may affect the relevance and reliability of the results and delay the physician's treatment determination. Objective To create an algorithm for the laboratory diagnosis of UTI in Colombia based on current evidence, in order to provide recommendations regarding sample collection, storage, transport and processing and to provide guidance for physicians' decision making. Methods We reviewed the current standards and guidelines for the diagnosis of UTI and considered comments from microbiology and infectious disease experts based on a literature search using relevant search terms and emphasizing local studies. Results We generated recommendations for collecting samples, storage, transport, culture and susceptibility testing for the reliable diagnosis of UTI in patients in Colombia. © 2015 ACIN. Published by Elsevier España, S.L.U. Source

Maldonado N.,Laboratorio Medico Of Referencia | Castro B.,CES University | Robledo C.,Laboratorio Medico Of Referencia | Robledo J.,Laboratorio Medico Of Referencia | Robledo J.,Pontifical Bolivarian University
Enfermedades Infecciosas y Microbiologia Clinica

Introduction: Carbapenems resistance is a growing phenomenon and a threat to public health because of the reduced therapeutic options for resistant infections. Methods: A retrospective case-control study was conducted in 2 tertiary-care hospitals in Medellín, Colombia. Fifty patients infected with ertapenem-resistant enterobacteriaceae were compared with a control group consisting of 100 patients with infections caused by ertapenem susceptible enterobacteriaceae. A multivariate logistic regression model was used to identify factors that best explain ertapenem-resistant enterobacteriaceae infections. Results: The factors associated with ertapenem-resistant enterobacteriaceae infections were prior exposure to carbapenems (adjusted OR 3.43; 95% IC 1.08-10.87) and prior exposure to cefepime (adjusted OR 6.46; 95% IC 1.08-38.38). Conclusion: Prior exposure to antibiotics is the factor that best explains the ertapenem-resistant enterobacteriaceae infection in this population, highlighting the importance of antimicrobial stewardship programs in hospitals. © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Source

Lizarazo N.A.M.,Laboratorio Medico Of Referencia | Villamil M.A.L.,Contratista | Velasquez V.L.,Secretaria de Salud de Medellin | Robledo J.,Pontifical Bolivarian University | Restrepo C.G.R.,Laboratorio Medico Of Referencia

Objectives: To characterize the infection prevention and control programs of 16 hospitals in Medellin, Colombia, 2011. Methods: This study was performed by a local surveillance network for antibiotic resistance (GERMEN Group), with technical and financial support from the Secretaría de Salud de Medellín. A survey, adapted from the Rapid Evaluation Guide for Hospital Programs for Prevention and Control of Nosocomial Infections of Panamerican Health Organization, 2011 was conducted to each institution. Results: The results revealed that all of the institutions have committees for infection prevention and control. The search for healthcare-associated infections (HAIs) is conducted by nursing assistants in 68.8% of these institutions. All of the institutions have definitions for the diagnosis of HAIs, using different versions of the international recommended guidelines. All of the institutions have protocols for hand hygiene, standard precautions and isolation, and 62.5% have a protocol for the study of outbreaks. All of the institutions have pharmacy and therapy committees, and 68.8% have programs for the rational use of antibiotics. All of the microbiology laboratories are equipped to identify microorganisms and to perform susceptibility test; 33.3% have protocols for the preservation of isolates. Conclusions: The creation of committees by institutional directive, the surveillance strategies and written protocols for the prevention and control of HAIs, as well as the capabilities of the microbiology laboratories are a number of the strengths found. However, there was a lackof standardization and shortcomings in the training of personnel and in the programs for the rational use of antibiotics. ©2013 ACIN. Published by Elsevier Españha, S.L. All rights reserved. Source

Maldonado N.A.,Laboratorio Medico Of Referencia | Cano L.E.,University of Antioquia | Arbelaez C.A.,Laboratorio Clinico Y Servicio Of Medicina Transfusional | Roncancio G.,Clinica CardioVID | And 4 more authors.
Diagnostic Microbiology and Infectious Disease

Candida is the most important agent of fungal infections. Several risk factors have been described associated with invasive infection by fluconazole-resistant Candida spp. A prospective cross-sectional study with case-control analysis was conducted. Case group patients with fluconazole-resistant Candida isolate were included; control group were patients with fluconazole-susceptible Candida spp. A multivariate logistic regression model was performed. Three hundred isolates of Candida spp. were analyzed. Most frequent species were Candida albicans/. Candida dubliniensis (48.3%) and Candida tropicalis (22.3%). Posaconazole susceptibility was 93.7%; voriconazole, 84%; and fluconazole, 78.7%. Susceptibility to anidulafungin and caspofungin was 92.7% and 92.3%, respectively. Neutropenia (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 1.0-43.1), antifungal exposure (aOR 5.1, 95% CI 2.3-11.2), and antituberculosis therapy (aOR 7.7, 95% CI 1.4-43.2) were associated to fluconazole resistance. Susceptibility results are useful to guide the selection of empiric antifungal treatment and the design of local therapeutic guidelines. Previous antifungal exposure suggests possible resistance to fluconazole, pointing towards the selection of a different class of antifungal agents. © 2014 Elsevier Inc. Source

Maldonado N.A.,Laboratorio Medico Of Referencia Sas | Lopez J.A.,Laboratorio Clinico Hematologico S.A | Sierra P.,Control de Infecciones | Robledo C.,Laboratorio Medico Of Referencia Sas | And 48 more authors.

Introduction: Bacterial resistance is a global phenomenon, but it presents geographic and temporal variations; this is the importance of local surveillance programs. Objective: To determine trends in antibiotic resistance in hospitals between 2007 and 2012 in Medellín and its Metropolitan Area. Materials and methods: Percentages of antibiotic resistance between 2007 and 2012 in 22 institutions were obtained using WHONET 5.6 program. For interpretation of susceptibility results, CLSI standards of 2009 and 2012 were used. Using the Epi-Info 6.04 program a trends analysis of antibiotic resistance was done using the chi-square for linear trend with a confidence level of 95%, a value of p=0.05 was considered significant. Results: In six years of surveillance of antibiotic resistance we found a decrease of oxacillin resistance in Staphylococcus aureus (p=0.0006) and an increase of vancomycin resistance in Enterococcus faecium (p=0.0000). In Escherichia coli and Serratia marcescens an increase of resistance to ceftazidime was found, in contrast to a decrease in Klebsiella pneumoniae (p=0.0000) and Enterobacter cloacae (p=0.058). K. pneumoniae, S. marcescens and E. cloacae showed an increase of carbapenem resistance in contrast to a reduction of carbapenem resistance in Pseudomonas aeruginosa and Acinetobacter baumannii. Conclusions: The resistance surveillance identified important findings as the emergence of E. faecium resistant to vancomycin and carbapenem-resistant Enterobacteriaceae. It is essential to determine the antibiotic use in the region to establish their influence on the resistance profiles, as well as ensuring the quality of information and microbiological procedures in the microbiology laboratories. Source

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