Incidencia y factores asociados a bacteriemia por enterobacterias productoras de carbapenemasas en pacientes con neutropenia febril e hisopado rectal positivo

Introducción: La forma de identificar a los pacientes hematoncológicos con riesgo de bacteriemia en el contexto de lesión de barrera mucosa está asociada a lo profundo de la neutropenia. La posibilidad de identificar a través del hisopado rectal la colonización por enterobacterias productoras de car...

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Autores:
González Plata, Fabio Alberto
Tipo de recurso:
Fecha de publicación:
2020
Institución:
Universidad Autónoma de Bucaramanga - UNAB
Repositorio:
Repositorio UNAB
Idioma:
spa
OAI Identifier:
oai:repository.unab.edu.co:20.500.12749/7187
Acceso en línea:
http://hdl.handle.net/20.500.12749/7187
Palabra clave:
Internal medicine
Medicine
Medical sciences
Health sciences
Neutropenia
Fever
Chemotherapy
Bacteremia
Enterobacteria
Mucosal barrier injury
Neoplasia
Treatment
Antibiotics
Medicina interna
Medicina
Ciencias médicas
Neoplasia
Tratamiento
Antibióticos
Ciencias de la salud
Neutropenia
Fiebre
Quimioterapia
Bacteriemia
Enterobacterias
Lesión de barrera mucosa
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openAccess
License
http://creativecommons.org/licenses/by-nc-nd/2.5/co/
id UNAB2_a1b973e17969887370cf6b8620150de1
oai_identifier_str oai:repository.unab.edu.co:20.500.12749/7187
network_acronym_str UNAB2
network_name_str Repositorio UNAB
repository_id_str
dc.title.spa.fl_str_mv Incidencia y factores asociados a bacteriemia por enterobacterias productoras de carbapenemasas en pacientes con neutropenia febril e hisopado rectal positivo
dc.title.translated.eng.fl_str_mv Incidence and factors associated with bacteremia due to carbapenemase-producing enterobacteriaceae in patients with febrile neutropenia and positive rectal swab
title Incidencia y factores asociados a bacteriemia por enterobacterias productoras de carbapenemasas en pacientes con neutropenia febril e hisopado rectal positivo
spellingShingle Incidencia y factores asociados a bacteriemia por enterobacterias productoras de carbapenemasas en pacientes con neutropenia febril e hisopado rectal positivo
Internal medicine
Medicine
Medical sciences
Health sciences
Neutropenia
Fever
Chemotherapy
Bacteremia
Enterobacteria
Mucosal barrier injury
Neoplasia
Treatment
Antibiotics
Medicina interna
Medicina
Ciencias médicas
Neoplasia
Tratamiento
Antibióticos
Ciencias de la salud
Neutropenia
Fiebre
Quimioterapia
Bacteriemia
Enterobacterias
Lesión de barrera mucosa
title_short Incidencia y factores asociados a bacteriemia por enterobacterias productoras de carbapenemasas en pacientes con neutropenia febril e hisopado rectal positivo
title_full Incidencia y factores asociados a bacteriemia por enterobacterias productoras de carbapenemasas en pacientes con neutropenia febril e hisopado rectal positivo
title_fullStr Incidencia y factores asociados a bacteriemia por enterobacterias productoras de carbapenemasas en pacientes con neutropenia febril e hisopado rectal positivo
title_full_unstemmed Incidencia y factores asociados a bacteriemia por enterobacterias productoras de carbapenemasas en pacientes con neutropenia febril e hisopado rectal positivo
title_sort Incidencia y factores asociados a bacteriemia por enterobacterias productoras de carbapenemasas en pacientes con neutropenia febril e hisopado rectal positivo
dc.creator.fl_str_mv González Plata, Fabio Alberto
dc.contributor.advisor.spa.fl_str_mv Bernal García, Edgar Augusto
Peña Castellanos, Angela María
Ochoa Vera, Miguel Enrique
dc.contributor.author.spa.fl_str_mv González Plata, Fabio Alberto
dc.contributor.cvlac.*.fl_str_mv https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000898465
dc.contributor.orcid.*.fl_str_mv https://orcid.org/0000-0003-1693-9429
https://orcid.org/0000-0002-4552-3388
dc.contributor.scopus.*.fl_str_mv https://www.scopus.com/authid/detail.uri?authorId=36987156500
dc.contributor.researchgate.*.fl_str_mv https://www.researchgate.net/profile/Miguel_Ochoa7
dc.subject.keywords.eng.fl_str_mv Internal medicine
Medicine
Medical sciences
Health sciences
Neutropenia
Fever
Chemotherapy
Bacteremia
Enterobacteria
Mucosal barrier injury
Neoplasia
Treatment
Antibiotics
topic Internal medicine
Medicine
Medical sciences
Health sciences
Neutropenia
Fever
Chemotherapy
Bacteremia
Enterobacteria
Mucosal barrier injury
Neoplasia
Treatment
Antibiotics
Medicina interna
Medicina
Ciencias médicas
Neoplasia
Tratamiento
Antibióticos
Ciencias de la salud
Neutropenia
Fiebre
Quimioterapia
Bacteriemia
Enterobacterias
Lesión de barrera mucosa
dc.subject.lemb.spa.fl_str_mv Medicina interna
Medicina
Ciencias médicas
Neoplasia
Tratamiento
Antibióticos
dc.subject.proposal.spa.fl_str_mv Ciencias de la salud
Neutropenia
Fiebre
Quimioterapia
Bacteriemia
Enterobacterias
Lesión de barrera mucosa
description Introducción: La forma de identificar a los pacientes hematoncológicos con riesgo de bacteriemia en el contexto de lesión de barrera mucosa está asociada a lo profundo de la neutropenia. La posibilidad de identificar a través del hisopado rectal la colonización por enterobacterias productoras de carbapenemasas ha cambiado el enfoque de la terapia antibiótica empírica dado que en este lapso de tiempo podemos impactar drásticamente en la mortalidad, bacteriemia por EPC es una verdadera emergencia médica (equiparable a Infarto de miocardio con elevación del ST y ECV isquémico en ventana) engloba la Neutropenia febril, inmunosupresión y severas comorbilidades como las Neoplasias hematolinfoides. Sin embargo se desconoce la correlación entre colonización rectal del hisopado y la predicción de la bacteriemia, esto ha motivando a conocer que otros factores de riesgo están asociados y la utilidad del hisopado rectal como predictor de bacteriemia. Evaluar la incidencia de bacteriemia por enterobacterias productoras de carbapenemasas, en pacientes que se encontraran recibiendo quimioterapia con neutropenia severa, fiebre e hisopado rectal positivo, en el servicio de Hemato-oncología. de la clínica la FOSCAL, en el periodo comprendido entre Enero 1 de 2016 y Diciembre 31 de 2018.
publishDate 2020
dc.date.accessioned.none.fl_str_mv 2020-08-15T05:57:00Z
dc.date.available.none.fl_str_mv 2020-08-15T05:57:00Z
dc.date.issued.none.fl_str_mv 2020
dc.type.driver.none.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.local.spa.fl_str_mv Tesis
dc.type.redcol.none.fl_str_mv http://purl.org/redcol/resource_type/TM
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/20.500.12749/7187
dc.identifier.instname.spa.fl_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional UNAB
dc.identifier.repourl.spa.fl_str_mv repourl:https://repository.unab.edu.co
url http://hdl.handle.net/20.500.12749/7187
identifier_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
reponame:Repositorio Institucional UNAB
repourl:https://repository.unab.edu.co
dc.language.iso.spa.fl_str_mv spa
language spa
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78. Bulik CC, Christensen H, Li P, Sutherland CA, Nicolau DP, Kuti JL. Comparison of the Activity of a Human Simulated, High-Dose, Prolonged Infusion of Meropenem against Klebsiella pneumoniae Producing the KPC Carbapenemase versus That against Pseudomonas aeruginosa in an In Vitro Pharmacodynamic Model. Antimicrob Agents Chemother [Internet]. 2010 Feb 1 [cited 2018 Nov 25];54(2):804–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19995927
79. Daikos GL, Markogiannakis A. Carbapenemase-producing Klebsiella pneumoniae: (when) might we still consider treating with carbapenems? Clin Microbiol Infect [Internet]. 2011 Aug [cited 2018 Nov 25];17(8):1135–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21635663
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81. Giamarellou H, Galani L, Baziaka F, Karaiskos I. Effectiveness of a Double-Carbapenem Regimen for Infections in Humans Due to Carbapenemase-Producing Pandrug-Resistant Klebsiella pneumoniae. Antimicrob Agents Chemother [Internet]. 2013 May [cited 2018 Nov 25];57(5):2388–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23439635
82. Ceccarelli G, Falcone M, Giordano A, Mezzatesta ML, Caio C, Stefani S, et al. Successful ertapenem-doripenem combination treatment of bacteremic ventilator-associated pneumonia due to colistin-resistant KPC-producing Klebsiella pneumoniae. Antimicrob Agents Chemother [Internet]. 2013 Jun [cited 2018 Nov 25];57(6):2900–1. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23571536
83. Mimoz O, Grégoire N, Poirel L, Marliat M, Couet W, Nordmann P. Broad-Spectrum β-Lactam Antibiotics for Treating Experimental Peritonitis in Mice Due to Klebsiella pneumoniae Producing the Carbapenemase OXA-48. Antimicrob Agents Chemother [Internet]. 2012 May [cited 2018 Nov 25];56(5):2759–60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22330912
84. Wagenlehner FM, Sobel JD, Newell P, Armstrong J, Huang X, Stone GG, et al. Ceftazidime-avibactam Versus Doripenem for the Treatment of Complicated Urinary Tract Infections, Including Acute Pyelonephritis: RECAPTURE, a Phase 3 Randomized Trial Program. Clin Infect Dis [Internet]. 2016 Sep 15 [cited 2018 Nov 25];63(6):754–62. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27313268
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spelling Bernal García, Edgar Augusto572826e3-f6ee-4c13-930c-c37276d64bc6Peña Castellanos, Angela Maríafec92ee7-2a6b-44c8-88bb-b252fd21f567Ochoa Vera, Miguel Enriquebf83ca83-93c9-401e-91d3-b424889e868fGonzález Plata, Fabio Alberto943c1a57-5043-4fe8-89fb-c02b0bcd9ef9https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000898465https://orcid.org/0000-0003-1693-9429https://orcid.org/0000-0002-4552-3388https://www.scopus.com/authid/detail.uri?authorId=36987156500https://www.researchgate.net/profile/Miguel_Ochoa7Floridablanca (Santander, Colombia)2016-20182020-08-15T05:57:00Z2020-08-15T05:57:00Z2020http://hdl.handle.net/20.500.12749/7187instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABrepourl:https://repository.unab.edu.coIntroducción: La forma de identificar a los pacientes hematoncológicos con riesgo de bacteriemia en el contexto de lesión de barrera mucosa está asociada a lo profundo de la neutropenia. La posibilidad de identificar a través del hisopado rectal la colonización por enterobacterias productoras de carbapenemasas ha cambiado el enfoque de la terapia antibiótica empírica dado que en este lapso de tiempo podemos impactar drásticamente en la mortalidad, bacteriemia por EPC es una verdadera emergencia médica (equiparable a Infarto de miocardio con elevación del ST y ECV isquémico en ventana) engloba la Neutropenia febril, inmunosupresión y severas comorbilidades como las Neoplasias hematolinfoides. Sin embargo se desconoce la correlación entre colonización rectal del hisopado y la predicción de la bacteriemia, esto ha motivando a conocer que otros factores de riesgo están asociados y la utilidad del hisopado rectal como predictor de bacteriemia. Evaluar la incidencia de bacteriemia por enterobacterias productoras de carbapenemasas, en pacientes que se encontraran recibiendo quimioterapia con neutropenia severa, fiebre e hisopado rectal positivo, en el servicio de Hemato-oncología. de la clínica la FOSCAL, en el periodo comprendido entre Enero 1 de 2016 y Diciembre 31 de 2018.1. RESUMEN DEL PROYECTO. 10 2. PLANTEAMIENTO Y JUSTIFICACIÓN 11 3. MARCO TEORICO Y ESTADO DEL ARTE 13 4. OBJETIVOS 33 4.1. Objetivo General 33 4.2. Objetivos específicos 33 5. METODOLOGÍA 33 5.1. Tipo de estudio 33 5.2. Población 33 5.3. Criterios de inclusión 34 5.4. Criterios de exclusión 34 5.5. Muestra 34 5.6. Recolección de la información 34 6. VARIABLES 35 6.1. DEFINICION DE LAS VARIABLES 43 7. PLAN DE ANÁLISIS DE DATOS 44 8. CONSIDERACIONES ÉTICAS 45 9. RESULTADOS / PRODUCTOS ESPERADOS Y POTENCIALES BENEFICIARIOS 46 10. CRONOGRAMA 47 11. PRESUPUESTO 48 12. RESULTADOS 48 12.1. Características demográficas de la población 49 12.1.2 Comorbilidades de los pacientes colonizados por hisopado rectal positivo para EPC 50 12.2 Tipo de Neoplasia Hemato-oncológica: 51 12.2.1 Esquema de Quimioterapia 52 12.2.2 Dia de quimioterapia en relación con el día cero de fiebre 53 12.2.3 Duración de la neutropenia febril 54 12.3 Severidad de la neutropenia al momento de la colonización por EPC 55 12.3.1 Día de inicio de fiebre pos hisopado (+) 55 12.4 Recuento de neutrófilos al inicio de la bacteriemia 56 12.4.1 Profilaxis farmacológica antimicrobiana 56 12.4.2 Antibioticoterapia recibida en el último mes 57 12.4.3 Antibioticoterapia empírica 57 12.4.4 Perfil de resistencia antibiótica del hisopado rectal para Enterobacterias Productoras de Cabapenemasas 58 12.4.5 Antibioticoterapia indicada según sensibilidad del hisopado 59 12.5 Terapia inmunomoduladora 59 12.6 Bacteriemia por Enterobacterias Productoras de Carbapenemasas 59 12.6.1 Bacteriemia por enterobacterias no productoras de carbapenemasa y bacilos gram negativos no fermentadores 60 12.6.2 Antibioticoterapia Dirigida según resultados de hemocultivo y antibiograma 61 12.6.3 Desescalamiento y escalonamiento antibiótico según resultado de Hemocultivo 62 12.6.4 Tiempo de defervescencia de la fiebre con respecto al inicio del antibiótico 63 12.6.5 SOFA score en el momento de inicio de fiebre y mortalidad 63 13. ANÁLISIS BIVARIADO 65 14. DISCUSIÓN 66 15. CONCLUSIONES 73 16. BIBLIOGRAFIA 79EspecializaciónIntroduction: The way to identify hematoncological patients at risk of bacteremia in the context of mucosal barrier injury is associated with the depth of neutropenia. The possibility of identifying colonization by carbapenemase-producing enterobacteria through the rectal swab has changed the focus of empirical antibiotic therapy given that in this period of time we can dramatically impact mortality, EPC bacteremia is a true medical emergency (comparable to Myocardial infarction with ST elevation and ischemic CVD in the window) includes febrile neutropenia, immunosuppression and severe comorbidities such as hematolymphoid neoplasms. However, the correlation between rectal swab colonization and the prediction of bacteremia is unknown, which has motivated us to know that other risk factors are associated and the usefulness of rectal swab as a predictor of bacteremia. To assess the incidence of bacteremia due to carbapenemase-producing enterobacteriaceae, in patients who were receiving chemotherapy with severe neutropenia, fever and positive rectal swab, in the Hemato-oncology department. of the FOSCAL clinic, in the period between January 1, 2016 and December 31, 2018.application/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Atribución-NoComercial-SinDerivadas 2.5 ColombiaIncidencia y factores asociados a bacteriemia por enterobacterias productoras de carbapenemasas en pacientes con neutropenia febril e hisopado rectal positivoIncidence and factors associated with bacteremia due to carbapenemase-producing enterobacteriaceae in patients with febrile neutropenia and positive rectal swabEspecialista en Medicina InternaUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludEspecialización en Medicina Internainfo:eu-repo/semantics/masterThesisTesishttp://purl.org/redcol/resource_type/TMInternal medicineMedicineMedical sciencesHealth sciencesNeutropeniaFeverChemotherapyBacteremiaEnterobacteriaMucosal barrier injuryNeoplasiaTreatmentAntibioticsMedicina internaMedicinaCiencias médicasNeoplasiaTratamientoAntibióticosCiencias de la saludNeutropeniaFiebreQuimioterapiaBacteriemiaEnterobacteriasLesión de barrera mucosa1. 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