Claudia Rocío Sierra

A multicentre, laboratory-based analysis was conducted on aggregated data from 23 hospitals across Colombia. Of 1761 fungal isolates identified, 1642 were yeasts and constitute the focus of this study. Isolates were identified using the VITEK^®2 system, with confirmatory identification by MALDI-TOF-MS for a subset. Antifungal susceptibility testing for fluconazole, voriconazole, amphotericin B, and the echinocandins was performed on Candida albicans, C. parapsilosis, and C. tropicalis. Data were stratified by clinical service: adult ICU, adult wards, paediatric ICU, neonatal ICU, and paediatric wards. Temporal trends were assessed using the Cochran–Armitage test. The most prevalent species were C. albicans (42%), C. parapsilosis (24%), C. tropicalis (11%), C. glabrata (7%), and C. auris (3%). C. albicans predominated in adult services, whereas C. parapsilosis was the leading pathogen across paediatric settings. Among species with validated breakpoints, the overall fluconazole resistance rate was 19%, driven primarily by C. parapsilosis (35%, exceeding 40% in some clinical services). Non-wild-type to voriconazole and amphotericin B was low (C. parapsilosis, together with the emergence of C. auris, underscores the urgent need for sustained surveillance and species-directed antifungal stewardship programmes.

In critically ill patients, identification of the pathogen may allow for the timely adjustment of antibiotics and improved outcomes. Background/Objectives: The aim of the study was to assess whether performing a multiplex PCR pneumonia panel (PN-panel) in patients with pneumonia in the intensive care unit (ICU) had any effect on mortality or other important clinical outcomes. Methods: A retrospective cohort study was conducted on adult patients with pneumonia who required ICU admission in four institutions in Bogotá between November 2019 and June 2023. Mortality at 30 days, the length of the hospital and ICU stay, the duration of antibiotics, and their association with the PN-panel performance were evaluated using an inverse probability of the treatment weighting to adjust for covariates and potential confounders. Results: A total of 304 patients were included, including 150 with PN-panel, with a mean age of 65.0 years (SD 14.6). SARS-CoV-2 was the primary etiologic agent in 186 (61.2%) patients, and 256 (84.2%) patients had community-acquired pneumonia. No association was found between 30-day mortality and the PN-panel, with a HR of 1.14 (CI 95% 0.76–1.70), although the assessment by an infectious disease specialist was associated with a lower mortality HR of 0.29 (CI 95% 0.19–0.45). There was no association between the PN-panel and antimicrobial therapy duration or other clinical outcomes. Conclusions: The use of the PN-panel was not associated with changes in mortality, the duration of antibiotics, or hospital and ICU stays. To acquire greater rational decision-making, microbiological data produced by this test should be interpreted with aid of an antimicrobial stewardship program oriented by an infectious disease team that could take the clinical data and integrate the information provided.

The aim of this study was to evaluate the effect of inappropriate therapy in adult patients with community-acquired pyelonephritis caused by Escherichia coli receiving empirical treatment with cefuroxime during hospital stay and readmission. A retrospective cohort study was performed. Inappropriate treatment was considered treatment for a nonsusceptible isolate according to the results of the urine culture. Adjustment for confounding factors was performed with propensity score-derived inverse probability of treatment weighting. Between 2013 and 2020, 747 patients were included, 102 (13.7%) of whom received inappropriate therapy. Compared to appropriate therapy, inappropriate therapy was associated with a shorter length of stay in the adjusted analysis (Hazard Ratio = 0.34; 95% CI = 0.23–0.49). After 735 patients were discharged from the hospital, 66 were readmitted in the following 30 days. In comparison with appropriate therapy, inappropriate antimicrobial therapy was not related to readmission (OR 1.47; 95% CI = 0.35–2.79). Inappropriate therapy was not related to a longer hospital stay or readmission due to pyelonephritis after adjusting for confounders and covariates.