1
|
Rosenthal VD, Jin Z, Valderrama-Beltran SL, Gualtero SM, Linares CY, Aguirre-Avalos G, Mijangos-Méndez JC, Ibarra-Estrada MÁ, Jiménez-Alvarez LF, Reyes LP, Alvarez-Moreno CA, Zuniga-Chavarria MA, Quesada-Mora AM, Gomez K, Alarcon J, Millan-Oñate J, Aguilar-de-Moros D, Castaño-Guerrero E, Córdoba J, Sassoe-Gonzalez A, Millán-Castillo CM, Leyva-Xotlanihua L, Aguilar-Moreno LA, Bravo-Ojeda JS, Gutierrez-Tobar IF, Aleman-Bocanegra MC, Echazarreta-Martínez CV, Flores-Sánchez BM, Cano-Medina YA, Chapeta-Parada EG, Gonzalez-Niño RA, Villegas-Mota MI, Montoya-Malváez M, Cortés-Vázquez MÁ, Medeiros EA, Fram D, Vieira-Escudero D, Dueñas L, Carreazo NY, Salgado E, Yin R. Multinational prospective cohort study of incidence and risk factors for central line-associated bloodstream infections in ICUs of 8 Latin American countries. Am J Infect Control 2023; 51:1114-1119. [PMID: 36921694 DOI: 10.1016/j.ajic.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors in Latin-America. METHODS From January 1, 2014 to February 10, 2022, we conducted a multinational multicenter prospective cohort study in 58 ICUs of 34 hospitals in 21 cities in 8 Latin American countries (Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama). We applied multiple-logistic regression. Outcomes are shown as adjusted-odds ratios (aOR). RESULTS About 29,385 patients were hospitalized during 92,956 days, acquired 400 CLABSIs, and pooled CLABSI rate was 4.30 CLABSIs per 1,000 CL-days. We analyzed following 10 variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization (DU) ratio, CL-type, tracheostomy use, hospitalization type, intensive care unit (ICU) type, and facility ownership, Following variables were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 3% daily (aOR=1.03;95%CI=1.02-1.04; P < .0001); number of CL-days before CLABSI acquisition, rising risk 4% per CL-day (aOR=1.04;95%CI=1.03-1.05; P < .0001); publicly-owned facility (aOR=2.33;95%CI=1.79-3.02; P < .0001). ICU with highest risk was medical-surgical (aOR=2.61;95%CI=1.41-4.81; P < .0001). CL with the highest risk were femoral (aOR=2.71;95%CI=1.61-4.55; P < .0001), and internal-jugular (aOR=2.62;95%CI=1.82-3.79; P < .0001). PICC (aOR=1.25;95%CI=0.63-2.51; P = .52) was not associated with CLABSI risk. CONCLUSIONS Based on these findings it is suggested to focus on reducing LOS, CL-days, using PICC instead of femoral or internal-jugular; and implementing evidence-based CLABSI prevention recommendations.
Collapse
Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; INICC Foundation, International Nosocomial Infection Control Consortium, Miami, FL, USA.
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Julio Cesar Mijangos-Méndez
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Miguel Ángel Ibarra-Estrada
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | | | | | | | - Judith Córdoba
- Hospital del Niño Dr José Renán Esquivel, Panama, Panama
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dayana Fram
- Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Nilton Yhuri Carreazo
- Hospital de Emergencias Pediatricas, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
2
|
Ortiz-Roa C, Valderrama-Rios MC, Sierra-Umaña SF, Rodríguez JY, Muñetón-López GA, Solórzano-Ramos CA, Escandón P, Alvarez-Moreno CA, Cortés JA. Mortality Caused by Candida auris Bloodstream Infections in Comparison with Other Candida Species, a Multicentre Retrospective Cohort. J Fungi (Basel) 2023; 9:715. [PMID: 37504704 PMCID: PMC10381160 DOI: 10.3390/jof9070715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Candida auris is an emerging pathogen considered to be critical in the World Health Organization fungal organisms list. The study aims to determine the mortality and hospital stays attributed to Candida auris (C. auris) compared to other Candida species in adult patients with candidemia. A retrospective cohort of adults with candidemia was examined from seven centres in Colombia between 2016 and 2021. The primary outcome was 30-day mortality, and the secondary outcome was the length of hospital stay among survivors. Adjustment of the confounding variables was performed using inverse probability weights of exposure propensity score (candidemia by C. auris), survival regression models (Weibull distribution), and a counting model (negative binomial distribution). A value of 244 (47.6%) of the 512 patients with candidemia died within the first 30 days. The crude mortality in C. auris was 38.1% vs. 51.1% in Candida non-auris (CNA). In the Weibull model, mortality in the C. auris group was lower (adjusted HR: aHR- 0.69, 95% CI: 0.53-0.90). Antifungal treatment also decreased mortality, with an aHR of 0.36 (95% CI 0.27-0.47), while the presence of septic shock on patient progression increased it, with an aHR of 1.73 (95% CI 1.41-2.13). Among the patients who survived, no differences in the length of hospital stay were observed between the C. auris and the CNA groups, with an incidence rate ratio of 0.92 (95% CI: 0.68-1.22). Mortality in patients with C. auris bloodstream infections appears lower when adjusted for numerous confounding variables regarding treatment and the presence of septic shock in patient progression. We identified no significant effect of C. auris on the length of hospital stay in surviving patients.
Collapse
Affiliation(s)
- Cynthia Ortiz-Roa
- Department of Internal Medicine, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | | | | | - José Yesid Rodríguez
- Clínica Integral de Emergencias Laura Daniela, Instituto Cardiovascular del Cesar, Centro de Investigaciones Microbiológicas del Cesar (CIMCE), Valledupar 200001, Colombia
| | | | | | - Patricia Escandón
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá 111321, Colombia
| | | | - Jorge Alberto Cortés
- Department of Internal Medicine, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá 111321, Colombia
- Infectious Diseases Unit, Hospital Universitario Nacional, Bgootá 111321, Colombia
| |
Collapse
|
3
|
Kim JYH, Ragusa M, Tortosa F, Torres A, Gresh L, Méndez-Rico JA, Alvarez-Moreno CA, Lisboa TC, Valderrama-Beltrán SL, Aldighieri S, Reveiz L. Viral reactivations and co-infections in COVID-19 patients: a systematic review. BMC Infect Dis 2023; 23:259. [PMID: 37101275 PMCID: PMC10131452 DOI: 10.1186/s12879-023-08117-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/24/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Viral reactivations and co-infections have been reported among COVID-19 patients. However, studies on the clinical outcomes of different viral reactivations and co-infections are currently in limit. Thus, the primary purpose of this review is to perform an overarching investigation on the cases of latent virus reactivation and co-infection in COVID-19 patients to build collective evidence contributing to improving patient health. The aim of the study was to conduct a literature review to compare the patient characteristics and outcomes of reactivations and co-infections of different viruses. METHODS Our population of interest included confirmed COVID-19 patients who were diagnosed with a viral infection either concurrently or following their COVID-19 diagnosis. We extracted the relevant literature through a systematic search using the key terms in the online databases including the EMBASE, MEDLINE, Latin American Caribbean Health Sciences Literature (LILACS), from inception onwards up to June 2022. The authors independently extracted data from eligible studies and assessed the risk of bias using the Consensus-based Clinical Case Reporting (CARE) guidelines and the Newcastle-Ottawa Scale (NOS). Main patient characteristics, frequency of each manifestation, and diagnostic criteria used in studies were summarized in tables. RESULTS In total, 53 articles were included in this review. We identified 40 reactivation studies, 8 coinfection studies, and 5 studies where concomitant infection in COVID-19 patients was not distinguished as either reactivation or coinfection. Data were extracted for 12 viruses including IAV, IBV, EBV, CMV, VZV, HHV-1, HHV-2, HHV-6, HHV-7, HHV-8, HBV, and Parvovirus B19. EBV, HHV-1, and CMV were most frequently observed within the reactivation cohort, whereas IAV and EBV within the coinfection cohort. In both reactivation and coinfection groups, patients reported cardiovascular disease, diabetes, and immunosuppression as comorbidities, acute kidney injury as complication, and lymphopenia and elevated D-dimer and CRP levels from blood tests. Common pharmaceutical interventions in two groups included steroids and antivirals. CONCLUSION Overall, these findings expand our knowledge on the characteristics of COVID-19 patients with viral reactivations and co-infections. Our experience with current review indicates a need for further investigations on virus reactivation and coinfection among COVID-19 patients.
Collapse
Affiliation(s)
- Jenny Yeon Hee Kim
- Knowledge Translation Program, Evidence and Intelligence for Action in Health Department, Pan American Health Organization, Washington, DC USA
| | - Martin Ragusa
- Knowledge Translation Program, Evidence and Intelligence for Action in Health Department, Pan American Health Organization, Washington, DC USA
- Incident Management System for the COVID-19 Response, Pan American Health Organization, Washington, DC USA
| | - Fernando Tortosa
- Knowledge Translation Program, Evidence and Intelligence for Action in Health Department, Pan American Health Organization, Washington, DC USA
- Incident Management System for the COVID-19 Response, Pan American Health Organization, Washington, DC USA
| | - Ana Torres
- Knowledge Translation Program, Evidence and Intelligence for Action in Health Department, Pan American Health Organization, Washington, DC USA
- Incident Management System for the COVID-19 Response, Pan American Health Organization, Washington, DC USA
| | - Lionel Gresh
- Incident Management System for the COVID-19 Response, Pan American Health Organization, Washington, DC USA
- Department of Health Emergencies, Pan American Health Organization, Washington, DC USA
| | - Jairo Andres Méndez-Rico
- Incident Management System for the COVID-19 Response, Pan American Health Organization, Washington, DC USA
- Department of Health Emergencies, Pan American Health Organization, Washington, DC USA
| | | | - Thiago Costa Lisboa
- Critical Care Department, Hospital de Clinicas de Porto Alegre, PPG Ciencias Pneumologicas, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
| | - Sandra Liliana Valderrama-Beltrán
- Ph.D. Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- Internal Medicine Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sylvain Aldighieri
- Incident Management System for the COVID-19 Response, Pan American Health Organization, Washington, DC USA
- Department of Health Emergencies, Pan American Health Organization, Washington, DC USA
| | - Ludovic Reveiz
- Knowledge Translation Program, Evidence and Intelligence for Action in Health Department, Pan American Health Organization, Washington, DC USA
- Incident Management System for the COVID-19 Response, Pan American Health Organization, Washington, DC USA
| |
Collapse
|
4
|
Rosenthal VD, Jin Z, Valderrama-Beltran SL, Gualtero SM, Linares CY, Aguirre-Avalos G, Mijangos-Méndez JC, Ibarra-Estrada MÁ, Jimenez-Alvarez LF, Reyes LP, Alvarez-Moreno CA, Zuniga-Chavarria MA, Quesada-Mora AM, Gomez K, Alarcon J, Oñate JM, Aguilar-De-Moros D, Castaño-Guerra E, Córdoba J, Sassoe-Gonzalez A, Millán-Castillo CM, Xotlanihua LL, Aguilar-Moreno LA, Bravo-Ojeda JS, Gutierrez-Tobar IF, Aleman-Bocanegra MC, Echazarreta-Martínez CV, Flores-Sánchez BM, Cano-Medina YA, Chapeta-Parada EG, Gonzalez-Niño RA, Villegas-Mota MI, Montoya-Malváez M, Cortés-Vázquez MÁ, Medeiros EA, Fram D, Vieira-Escudero D, Yin R. Multinational prospective cohort study over 24 years of the risk factors for ventilator-associated pneumonia in 187 ICUs in 12 Latin American countries: Findings of INICC. J Crit Care 2023; 74:154246. [PMID: 36586278 DOI: 10.1016/j.jcrc.2022.154246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/07/2022] [Accepted: 12/22/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA; International Nosocomial Infection Control Consortium (INICC) Foundation, Miami, USA.
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Julio Cesar Mijangos-Méndez
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Miguel Ángel Ibarra-Estrada
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dayana Fram
- Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| |
Collapse
|
5
|
Rosenthal VD, Yin R, Valderrama-Beltran SL, Gualtero SM, Linares CY, Aguirre-Avalos G, Mijangos-Méndez JC, Ibarra-Estrada MÁ, Jimenez-Alvarez LF, Reyes LP, Alvarez-Moreno CA, Zuniga-Chavarria MA, Quesada-Mora AM, Gomez K, Alarcon J, Oñate JM, Aguilar-De-Moros D, Castaño-Guerra E, Córdoba J, Sassoe-Gonzalez A, Millán-Castillo CM, Xotlanihua LL, Aguilar-Moreno LA, Ojeda JSB, Tobar IFG, Aleman-Bocanegra MC, Echazarreta-Martínez CV, Flores-Sánchez BM, Cano-Medina YA, Chapeta-Parada EG, Gonzalez-Niño RA, Villegas-Mota MI, Montoya-Malváez M, Cortés-Vázquez MÁ, Medeiros EA, Fram D, Vieira-Escudero D, Jin Z. Multinational Prospective Cohort Study of Mortality Risk Factors in 198 ICUs of 12 Latin American Countries over 24 Years: The Effects of Healthcare-Associated Infections. J Epidemiol Glob Health 2022; 12:504-515. [PMID: 36197596 DOI: 10.1007/s44197-022-00069-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/23/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The International Nosocomial Infection Control Consortium (INICC) has found a high ICU mortality rate in Latin America. METHODS A prospective cohort study in 198 ICUs of 96 hospitals in 46 cities in 12 Latin American countries to identify mortality risk factors (RF), and data were analyzed using multiple logistic regression. RESULTS Between 07/01/1998 and 02/12/2022, 71,685 patients, followed during 652,167 patient-days, acquired 4700 HAIs, and 10,890 died. We prospectively collected data of 16 variables. Following 11 independent mortality RFs were identified in multiple logistic regression: ventilator-associated pneumonia (VAP) acquisition (adjusted odds ratio [aOR] = 1.17; 95% CI: 1.06-1.30; p < 0.0001); catheter-associated urinary tract infection (CAUTI) acquisition (aOR = 1.34; 95% CI: 1.15-1.56; p < 0.0001); older age, rising risk 2% yearly (aOR = 1.02; 95% CI: 1.01-1.02; p < 0.0001); longer indwelling central line(CL)-days, rising risk 3% daily (aOR = 1.03; 95% CI: 1.02-1.03; p < 0.0001); longer indwelling urinary catheter(UC)-days, rising risk 1% daily (aOR = 1.01; 95% CI: 1.01-1.26; p < 0.0001); higher mechanical ventilation (MV) (aOR = 6.47; 95% CI: 5.96-7.03; p < 0.0001) and urinary catheter-utilization ratio (aOR = 1.19; 95% CI: 1.11-1.27; p < 0.0001); lower-middle level income country (aOR = 2.94; 95% CI: 2.10-4.12; p < 0.0001); private (aOR = 1.50; 95% CI: 1.27-1.77; p < 0.0001) or public hospital (aOR = 1.47; 95% CI: 1.24-1.74; p < 0.0001) compared with university hospitals; medical hospitalization instead of surgical (aOR = 1.67; 95% CI: 1.59-1.75; p < 0.0001); neurologic ICU (aOR = 4.48; 95% CI: 2.68-7.50; p < 0.0001); adult oncology ICU (aOR = 3.48; 95% CI: 2.14-5.65; p < 0.0001); and others. CONCLUSION Some of the identified mortality RFs are unlikely to change, such as the income level of the country, facility ownership, hospitalization type, ICU type, and age. But some of the mortality RFs we found can be changed, and efforts should be made to reduce CL-days, UC-days, MV-utilization ratio, UC-utilization ratio, and lower VAPs and CAUTI rates.
Collapse
Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA. .,INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Julio Cesar Mijangos-Méndez
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Miguel Ángel Ibarra-Estrada
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | | | | | | | - Judith Córdoba
- Hospital del Nino Dr Jose Renan Esquivel, Panama, Panama
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dayana Fram
- Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
6
|
Cifuentes MP, Rodriguez-Villamizar LA, Rojas-Botero ML, Alvarez-Moreno CA, Fernández-Niño JA. Socioeconomic inequalities associated with mortality for COVID-19 in Colombia: a cohort nationwide study. J Epidemiol Community Health 2021; 75:610-615. [PMID: 33674459 PMCID: PMC7934198 DOI: 10.1136/jech-2020-216275] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/11/2021] [Accepted: 02/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND After 8 months of the COVID-19 pandemic, Latin American countries have some of the highest rates in COVID-19 mortality. Despite being one of the most unequal regions of the world, there is a scarce report of the effect of socioeconomic conditions on COVID-19 mortality in their countries. We aimed to identify the effect of some socioeconomic inequality-related factors on COVID-19 mortality in Colombia. METHODS We conducted a survival analysis in a nation-wide retrospective cohort study of confirmed cases of COVID-19 in Colombia from 2 March 2020 to 26 October 2020. We calculated the time to death or recovery for each confirmed case in the cohort. We used an extended multivariable time-dependent Cox regression model to estimate the HR by age groups, sex, ethnicity, type of health insurance, area of residence and socioeconomic strata. RESULTS There were 1 033 218 confirmed cases and 30 565 deaths for COVID-19 in Colombia between 2 March and 26 October. The risk of dying for COVID-19 among confirmed cases was higher in males (HR 1.68 95% CI 1.64 to 1.72), in people older than 60 years (HR 296.58 95% CI 199.22 to 441.51), in indigenous people (HR 1.20 95% CI 1.08 to 1.33), in people with subsidised health insurance regime (HR 1.89 95% CI 1.83 to 1.96) and in people living in the very low socioeconomic strata (HR 1.44 95% CI 1.24 to 1.68). CONCLUSION Our study provides evidence of socioeconomic inequalities in COVID-19 mortality in terms of age groups, sex, ethnicity, type of health insurance regimen and socioeconomic status.
Collapse
Affiliation(s)
- Myriam Patricia Cifuentes
- Direction of Epidemiology and Demography, Government of Colombia Ministry of Health and Social Protection, Bogota, Colombia
| | | | - Maylen Liseth Rojas-Botero
- Direction of Epidemiology and Demography, Government of Colombia Ministry of Health and Social Protection, Bogota, Colombia
| | - Carlos Arturo Alvarez-Moreno
- Faculty of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
- Clínica Universitaria, Clínica Colsanitas, Bogotá, Colombia
| | - Julián Alfredo Fernández-Niño
- Direction of Epidemiology and Demography, Government of Colombia Ministry of Health and Social Protection, Bogota, Colombia
- Departament of Public Health, Universidad del Norte, Barranquilla, Colombia
| |
Collapse
|
7
|
Fay FF, Alvarez-Moreno CA, Bonvehi PE, Espinoza CC, Hidalgo MLH, Marcano-Lozada M, Perez CM, Pulchinelli A, Sáenz-Flor KV, Condino-Neto A. A simplified alternative diagnostic algorithm for SARS-CoV-2 suspected symptomatic patients and confirmed close contacts (asymptomatic): A consensus of Latin American experts. Int J Infect Dis 2021; 117:130-136. [PMID: 34022333 PMCID: PMC8133827 DOI: 10.1016/j.ijid.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Latin America accounts for one-quarter of global COVID-19 cases and one-third of deaths. Inequalities in the region lead to barriers regarding the best use of diagnostic tests during the pandemic. There is a need for a simplified guideline, considering the region's health resources' low availability, international guidelines, medical literature, and local expertise. METHODS Nine experts from Latin American countries developed a simplified algorithm for COVID-19 diagnosis, using a modified Delphi method. Twenty-four questions related to diagnostic settings were proposed, followed by discussion of the literature and experts' experience. RESULTS The algorithm considers three timeframes (≤7 days, 8-13 days, and ≥ 14 days) and discusses diagnostic options for each one. SARS-CoV-2 rRT-PCR is the test of choice from day 1 to day 14 after symptom onset or close contact, although antigen testing may be used in particular situations, from days 5 to 7. Antibody assays may be used for confirmation, mainly after day 14. If the clinical suspicion is very high, but other tests are negative, these assays may be used as an adjunct to decision-making from day 8 to day 13. CONCLUSION The proposed algorithm aims to support COVID-19 diagnosis decision-making in Latin America.
Collapse
Affiliation(s)
| | - Carlos Arturo Alvarez-Moreno
- Facultad de Medicina, Universidad Nacional de Colombia, Clinica Universitaria Colombia, Clinica Colsanitas, Bogotá, Colombia
| | - Pablo E Bonvehi
- Infectious Diseases Unit, Clinical Investigation and Medical Education Center, Buenos Aires, Argentina
| | | | | | - Marcel Marcano-Lozada
- Angios Vascular Center and Wound Clinic, Caracas, Venezuela; Juan Pablo II University, San Jose, Costa Rica
| | - Carlos M Perez
- Faculty of Medicine and Science, Universidad San Sebastian, Clinica Universidad de los Andes, Santiago, Chile
| | - Alvaro Pulchinelli
- Federal University of São Paulo, Brazilian Society of Clinical Pathology, Fleury Medicina e Saúde Laboratory, São Paulo, Brazil
| | | | - Antonio Condino-Neto
- Department of Immunology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
8
|
Alvarez-Moreno CA. Clinical practice guidelines: An Opportunity to provide health care with excellence and the new Colombian Guidelines for the diagnosis and management of Skin and Soft tissue infections (SSTIs). Infect 2019. [DOI: 10.22354/in.v23i4.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
9
|
Alvarez-Moreno CA. Antifungal stewardship: consensus on the diagnosis, treatment, and prevention of Candida spp. disease is a fundamental step in the road map to achieve it. Infect 2019. [DOI: 10.22354/in.v23i3.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Antifungal stewardship: consensus on the diagnosis, treatment, and prevention of Candida spp. disease is a fundamental step in the road map to achieve it
Collapse
|