Uso de Ceftazidima/Avibactam + Aztreonam en las infecciones por Pseudomonas metalobetalactamasas positivas en el Hospital México durante el periodo 2020 a 2022: estudio de cohorte retrospectivo
Fecha
2024
Tipo
tesis
Autores
Pérez Jaén, Marcia Milena
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Resumen
Antecedentes: La resistencia bacteriana es un problema de salud pública, se ha observado un aumento en las infecciones por microrganismos multidrogo resistentes incluyendo Pseudomonas. Las opciones terapéuticas son limitadas y la implementación de nuevos esquemas terapéuticos está en proceso.
Materiales y métodos: Se realizó un estudio de cohorte observacional, descriptivo y retrospectivo en el cual se incluyeron los casos de infecciones por Pseudomonas metalobetalactamasas positivas en el periodo del 2020 al 2022 en el Hospital México de la CCSS, con el objetivo principal de evaluar la respuesta en curación según evolución clínica y la erradicación microbiológica a la combinación de Ceftazidima/Avibactam + Aztreonam.
Resultados: Se incluyeron 42 aislamientos de Pseudomonas metalobetalactamasa positivas. Los principales factores de riesgo para mortalidad fueron shock séptico (HR 1.014, IC 95% [1.966-23.810], p 0.003), ventilación mecánica (HR 2.67, IC 95% [1.397-26.741], p 0.016) y diabetes mellitus (HR 2.53, IC 95% [0.995-6.477], p 0.051). El descenso de la procalcitonina se asoció con mayor probabilidad de sobrevida, con una sensibilidad de 41%, una especificidad de 83%. Un 28.57% de la muestra recibió Ceftazidima/Avibactam + Aztreonam y de estos un 59% logro la erradicación clínica y el descenso de procalcitonina.
Conclusión: Se demostró la erradicación clínica y microbiológica en la mitad de los pacientes que utilizaron el esquema de Ceftazidima/Avibactam + Aztreonam. No fue posible realizar una comparación de resultados entre esquemas terapéuticos dada la heterogeneidad de las terapias utilizadas.
Fuente de financiamiento externa: Ninguna
Background: Bacterial resistance is a public health problem; an increase in infections by multidrugresistant microorganisms including Pseudomonas has been observed. Therapeutic options are limited and the implementation of new therapeutic regimens is in process. Materials and methods: An observational, descriptive and retrospective cohort study was carried out in which cases of positive Pseudomonas metallobetalactamase infections were included in the period from 2020 to 2022 at the Hospital México de la CCSS, with the main objective of evaluating the Healing according to clinical evolution and microbiological eradication to the combination of Ceftazidime/Avibactam + Aztreonam. Results: 42 Pseudomonas metallobetalactamase positive isolates were included. The main risk factors for mortality were septic shock (HR 1.014, 95% CI [1.966-23.810], p 0.003), mechanical ventilation (HR 2.67, 95% CI [1.397-26.741], p 0.016) and diabetes mellitus (HR 2.53, 95% CI [0.995-6.477], p 0.051). The decrease in procalcitonin is controlled with a greater probability of survival, with a sensitivity of 41%, a specificity of 83%. 28.57% of the sample received Ceftazidime/Avibactam + Aztreonam and of these, 59% achieved clinical eradication and a decrease in procalcitonin. Conclusion: Clinical and microbiological eradication was demonstrated in half of the patients who used the Ceftazidime/Avibactam + Aztreonam regimen. It was not possible to compare results between therapeutic regimens given the heterogeneity of the therapies used. External financing source: None
Background: Bacterial resistance is a public health problem; an increase in infections by multidrugresistant microorganisms including Pseudomonas has been observed. Therapeutic options are limited and the implementation of new therapeutic regimens is in process. Materials and methods: An observational, descriptive and retrospective cohort study was carried out in which cases of positive Pseudomonas metallobetalactamase infections were included in the period from 2020 to 2022 at the Hospital México de la CCSS, with the main objective of evaluating the Healing according to clinical evolution and microbiological eradication to the combination of Ceftazidime/Avibactam + Aztreonam. Results: 42 Pseudomonas metallobetalactamase positive isolates were included. The main risk factors for mortality were septic shock (HR 1.014, 95% CI [1.966-23.810], p 0.003), mechanical ventilation (HR 2.67, 95% CI [1.397-26.741], p 0.016) and diabetes mellitus (HR 2.53, 95% CI [0.995-6.477], p 0.051). The decrease in procalcitonin is controlled with a greater probability of survival, with a sensitivity of 41%, a specificity of 83%. 28.57% of the sample received Ceftazidime/Avibactam + Aztreonam and of these, 59% achieved clinical eradication and a decrease in procalcitonin. Conclusion: Clinical and microbiological eradication was demonstrated in half of the patients who used the Ceftazidime/Avibactam + Aztreonam regimen. It was not possible to compare results between therapeutic regimens given the heterogeneity of the therapies used. External financing source: None
Descripción
****REVISAR FIRMAS CON MEI, PORQUE SE VE UN POCO BORROSAS****
Palabras clave
INFECCIÓN, SALUD, CIENCIAS MÉDICAS, TRATAMIENTO MÉDICO, MEDICAMENTO