Publicado

2021-07-01

Clinical practice guideline for screening of patients at risk of colonization by carbapenemase-producing Enterobacterales and the treatment of infections caused by these bacteria

Guía de práctica clínica para la tamización de pacientes con riesgo de colonización por Enterobacterales productores de carbapenemasas y el manejo de infecciones causadas por estas bacterias

Palabras clave:

Clinical guidelines as Topic, Enterobacteriaceae, Enterobacteriaceae Infections, Polymyxins, Klebsiella pneumoniae, Drug resistance, Bacterial (en)
Guías de práctica clínica como asunto, Enterobacterales, Enterobacteriaceae, Poliximinas, Klebsiella pneumoniae, Farmacorresistencia bacteriana (es)

Autores/as

  • Jorge Alberto Cortés Universidad Nacional de Colombia, Facultad de Medicina, Departamento de Medicina Interna, Bogotá, Colombia | Hospital Universitario Nacional de Colombia, Comité de Infecciones Asociadas a la Atención en Salud, Bogotá, Colombia https://orcid.org/0000-0002-0882-9652
  • Aura Lucía Leal Hospital Universitario Nacional de Colombia, Comité de Infecciones Asociadas a la Atención en Salud, Bogotá, Colombia. | 3. Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. https://orcid.org/0000-0003-3063-3821
  • Gerardo Muñetón-López Universidad Nacional de Colombia, Facultad de Medicina, Departamento de Medicina Interna, Bogotá, Colombia. https://orcid.org/0000-0002-9049-4678
  • Juan Sebastián Bravo-Ojeda Universidad Nacional de Colombia, Facultad de Medicina, Departamento de Medicina Interna, Bogotá, Colombia. https://orcid.org/0000-0002-8767-7609
  • Laura Cristina Nócua-Báez Universidad Nacional de Colombia, Facultad de Medicina, Departamento de Medicina Interna, Bogotá, Colombia. https://orcid.org/0000-0003-2869-2339
  • Vaneza Avila Hospital Universitario San Ignacio, Unidad de Infectología, Bogotá, Colombia. | Pontificia Universidad Javeriana, Facultad de Medicina, Bogotá D.C., Colombia. https://orcid.org/0000-0002-0050-6883
  • Edwin Silva Fundación Clínica Shaio, Servicio de Infectología, Bogotá D.C., Colombia https://orcid.org/0000-0001-8117-0957
  • Carlos Arturo Álvarez-Moreno Universidad Nacional de Colombia - Sede Bogotá - Facultad de Medicina - Departamento de Medicina Interna - Bogotá D.C. - Colombia. https://orcid.org/0000-0001-5419-4494
  • Pilar Espitia Secretaría Distrital de Salud - División de Salud Pública - Bogotá D.C. - Colombia. https://orcid.org/0000-0002-6287-7006
  • Sandra Milena Gualtero Hospital Universitario San Ignacio - Unidad de Infectología - Bogotá. D.C. - Colombia. | Pontificia Universidad Javeriana - Facultad de Medicina - Bogotá D.C. - Colombia. https://orcid.org/0000-0003-3348-2387
  • Sandra Liliana Valderrama Hospital Universitario San Ignacio - Unidad de Infectología - Bogotá. D.C. - Colombia. | Pontificia Universidad Javeriana - Facultad de Medicina - Bogotá D.C. - Colombia. https://orcid.org/0000-0003-1833-1599
  • Freddy Orlando Guevara Clínica Reina Sofía - Departamento de Enfermedades Infecciosas - Bogotá D.C. - Colombia. | Clínica Colsanitas - Departamento de Enfermedades Infecciosas - Bogotá D.C. - Colombia. https://orcid.org/0000-0002-6256-4130
  • Germán Esparza PROASECAL SAS - Programa de Aseguramiento de la Calidad en el Laboratorio - Bogotá D.C. - Colombia. https://orcid.org/0000-0002-8395-6803
  • Carlos Humberto Saavedra Universidad Nacional de Colombia - Sede Bogotá - Facultad de Medicina - Departamento de Medicina Interna - Bogotá D.C. - Colombia. https://orcid.org/0000-0003-0068-6631
  • Jorge Augusto Díaz Universidad Nacional de Colombia - Facultad de Ciencias - Departamento de Farmacia - Bogotá D.C. - Colombia. https://orcid.org/0000-0003-0875-4846
  • Martha Carolina Valderrama-Ríos Universidad Nacional de Colombia - Sede Bogotá - Facultad de Medicina - Departamento de Medicina Interna - Bogotá D.C. - Colombia. | Hospital Universitario Nacional de Colombia - Comité de Infecciones Asociadas a la Atención en Salud - Bogotá D.C. - Colombia. https://orcid.org/0000-0003-4971-9692

Carbapenemase-producing Enterobacterales (CPE) infections have increased in recent years. Colombia has become an endemic country for this group of microorganisms, and the infections they cause have a serious impact in terms of morbidity and mortality. The early identification of CPE carriers who are admitted to health care centers as patients is necessary to implement adequate isolation and infection control measures to limit the spread of this type of microorganisms in hospitals. Furthermore, treating these infections is a challenging task due to the limited therapeutic alternatives available and the fact that there are only a few studies proving their effectiveness in this setting.

Therefore, the objective of the present work is to develop a clinical practice guideline (CPG) for the screening of patients at risk of CPE colonization and the treatment of inpatients with suspected or confirmed infections caused by this type of bacteria through a CPG adaptation process based on the ADAPTE methodology. With this purpose in mind, evidence-informed recommendations for the screening and timely identification of CPE carriers admitted to hospitals are made, as well as for the adequate pharmacological treatment of CPE infections in this context.

Taking this into account, the objective of this work is to develop a clinical practice guideline (CPG) for the screening of patients at risk of CPE colonization and for the management of inpatients with suspected or confirmed infections caused by this type of enterobacteriaceae  by means of a CPGs adaptation process based on the ADAPTE methodology. With this purpose in mind, evidence-informed recommendations for the screening and timely identification of CPE carriers admitted to hospitals are made, as well as for the adequate pharmacological management of CPE infections in this setting.

Las infecciones por Enterobacterales productores de carbapenemasas (EPC) han aumentado en los últimos años. Colombia se ha convertido en un país endémico para este grupo de microorganismos y las infecciones que causan tienen un impacto importante en términos de morbimortalidad. La identificación temprana de los portadores de EPC que ingresan como pacientes a las instituciones de salud es necesaria para implementar medidas de aislamiento y control de infecciones adecuadas que limiten la diseminación de este tipo de microorganismos en los hospitales. Además, el tratamiento de estas infecciones es difícil debido a las limitadas alternativas terapéuticas disponibles y la escasez de estudios que demuestren su efectividad en este escenario.

Por lo anterior, el objetivo del presente trabajo es desarrollar una guía de práctica clínica (GPC) para la tamización de pacientes con riesgo de colonización por EPC y para el manejo de pacientes con infecciones, ya sea sospechadas o confirmadas, causadas por este tipo de bacterias, mediante un proceso de adaptación de GPC basado en la metodología ADAPTE. Con este propósito en mente, se hacen recomendaciones informadas en evidencia para realizar la tamización y oportuna identificación de portadores de EPC admitidos en instituciones hospitalarias, así como para el adecuado manejo farmacológico de las infecciones por CPE en este escenario.

Por lo anterior, el objetivo del presente trabajo es desarrollar una guía de práctica clínica (GPC) para la tamización de pacientes con riesgo de colonización por EPC y para el manejo de pacientes con   infecciones, ya sea sospechadas o confirmadas, causadas por este tipo de bacterias, mediante un proceso de adaptación de GPC basado en la metodología ADAPTE. Con este propósito en mente, se hacen recomendaciones informadas en evidencia para realizar la tamización y oportuna identificación de portadores de EPC admitidos en instituciones hospitalarias, así como para el adecuado manejo farmacológico de las infecciones por EPC en este escenario.

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