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Abstract Background Breast Cancer (BC) is associated with substantial costs of healthcare; however, real-world data regarding these costs in Colombia is scarce. The contributory regime provides healthcare services to formal workers and their dependents and covers almost half of the population in Colombia. This study aims to describe the net costs of healthcare in women with BC covered by the contributory regime in Colombia in 2019 from the perspective of the Colombian Health System. Methods The main data source was the Capitation Sufficiency Database, an administrative database that contains patient-level data on consumption of services included in the National Formulary (PBS, in Spanish Plan de Beneficios en Salud). Data on consumption of services not included in the PBS (non-PBS) were calculated using aggregated data from MIPRES database. All direct costs incurred by prevalent cases of BC, from January 1 to December 31, 2019, were included in the analysis. The net costs of the disease were estimated by multiplying the marginal cost and the expected number of cases with BC by region and age group. Marginal costs were defined as the costs of services delivered to patients with BC after subtracting the expected costs of health services due to age, comorbidity burden or region of residence. To calculate these costs, we used Propensity Score Matching in the main analysis. All costs were expressed in 2019 international dollars. Productivity losses, transportation expenses, and caregiving costs were not included. Results A total of 46,148 patients with BC were identified. Total net costs were $387 million (95% CI $377 to $396 million), 60% associated with non-PBS services. Marginal costs were $8,366 (95% Confidence Interval $8,170 to $8,573), with substantial variations between regions age groups (from $3,919 for older patients in the Amazonia region to $10,070 for younger patients in the Pacific region). The costs for PBS services were higher for ambulatory services and for patients who died during 2020. Conclusions BC imposes a substantial economic burden for the Colombian Health System with important variations in net costs between regions and age groups. Patients near death and ambulatory services were associated with higher costs of healthcare.

ABSTRACT BACKGROUND: Colon cancer is the third most common malignancy in Colombia, only exceeded by prostate and breast cancers. It is the second most common cancer among females and the third most common among males. The epidemiology of this disease has changed in Colombia, and its peak incidence has now surpassed that of gastric cancer. AIMS: We aimed to determine the association between hospital surgical volume and mortality in patients with colon cancer undergoing surgical resection in Colombia. METHODS: This was a national retrospective cohort study based on administrative data and included adult patients undergoing surgical resection for colon cancer who were enrolled in Colombia’s contributory health system between 2012 and 2017. We defined exposure as the hospital’s surgical volume where the colon cancer surgery was performed. We classified the patients as exposed to a high surgical volume (above the 90th percentile of the provider distribution) and a low surgical volume (under the 90th percentile). The main outcomes were 30-day and 1-year mortality. Multivariate Poisson regressions were used to identify the association between exposure and mortality rates. RESULTS: The study included 4,647 patients, of which 4,188 underwent surgery at hospitals with a colectomy volume lower than 33 per year and 459 underwent surgery at institutions with volumes equal to or higher than 33 per year. In the multivariate analysis, after adjusting for observable variables, a lower risk of 30-day mortality was found in patients who underwent surgery at high surgical volume institutions (relative risk - RR 0.57, 95% confidence interval - 95%CI 0.033-0.97). No differences were found in the one-year mortality. CONCLUSION: The high surgical volume of a hospital is associated with a 30-day mortality in colon cancer, as described in other studies, but the 1-year mortality did not show this association. Prospective studies are required to establish a causal relationship.

Abstract Background Birth outcomes could have been affected by the COVID-19 pandemic through changes in access to prenatal services and other pathways. The aim of this study was to examine the effects of the COVID-19 pandemic on fetal death, birth weight, gestational age, number of prenatal visits, and caesarean delivery in 2020 in Colombia. Methods We conducted a secondary analysis of data on 3,140,010 pregnancies and 2,993,534 live births from population-based birth certificate and fetal death certificate records in Colombia between 2016 and 2020. Outcomes were compared separately for each month during 2020 with the same month in 2019 and pre-pandemic trends were examined in regression models controlling for maternal age, educational level, marital status, type of health insurance, place of residence (urban/rural), municipality of birth, and the number of pregnancies the mother has had before last pregnancy. Results We found some evidence for a decline in miscarriage risk in some months after the pandemic start, while there was an apparent lagging increase in stillbirth risk, although not statistically significant after correction for multiple comparisons. Birth weight increased during the onset of the pandemic, a change that does not appear to be driven by pre-pandemic trends. Specifically, mean birth weight was higher in 2020 than 2019 for births in April through December by about 12 to 21 g (p

ABSTRACT BACKGROUND: There are no information in the literature associating the volume of gastrectomies with survival and costs for the health system in the treatment of patients with gastric cancer in Colombia. AIMS: The aim of this study was to analyze how gastrectomy for gastric cancer is associated with hospital volume, 30-day and 180-day postoperative mortality, and healthcare costs in Bogotá, Colombia. METHODS: A retrospective cohort study based on hospital data of all adult patients with gastric cancer who underwent gastrectomy between 2014 and 2016 using a paired propensity score. The surgical volume was identified as the average annual number of gastrectomies performed by the hospital. RESULTS: A total of 743 patients were included in the study. Hospital mortality at 30 and 180 days postoperatively was 36 (4.85%) and 127 (17.09%) patients, respectively. The average health care cost was USD 3,200. A total of 26 or more surgeries were determined to be the high surgical volume cutoff. Patients operated on in hospitals with a high surgical volume had lower 6-month mortality (HR 0.44; 95%CI 0.27–0.71; p=0.001), and no differences were found in health costs (mean difference 398.38; 95%CI–418.93–1,215.69; p=0.339). CONCLUSIONS: This study concluded that in Bogotá (Colombia), surgery in a high-volume hospital is associated with better 6-month survival and no additional costs to the health system.

Abstract Background The use of respiratory devices can mitigate the spread of diseases such as COVID-19 in community settings. We aimed to determine the effectiveness of closed face shields with surgical face masks to prevent SARS-CoV-2 transmission in working adults during the COVID-19 pandemic in Bogotá, Colombia. Methods An open-label non-inferiority randomized controlled trial that randomly assigned participants to one of two groups: the intervention group was instructed to wear closed face shields with surgical face masks, and the active control group was instructed to wear only surgical face masks. The primary outcome was a positive reverse transcription polymerase chain reaction test, IgG/IgM antibody test for SARS-CoV-2 detection, or both during and at the end of the follow-up period of 21 days. The non-inferiority limit was established at − 5%. Results A total of 316 participants were randomized, 160 participants were assigned to the intervention group and 156 to the active control group. In total, 141 (88.1%) participants in the intervention group and 142 (91.0%) in the active control group completed the follow-up. Primary outcome: a positive SARS-CoV-2 test result was identified in one (0.71%) participant in the intervention group and three (2.1%) in the active control group. In the intention-to-treat analysis, the absolute risk difference was − 1.40% (95% CI [− 4.14%, 1.33%]), and in the per-protocol analysis, the risk difference was − 1.40% (95% CI [− 4.20, 1.40]), indicating non-inferiority of the closed face shield plus face mask (did not cross the non-inferiority limit). Conclusions The use of closed face shields and surgical face masks was non-inferior to the surgical face mask alone in the prevention of SARS-CoV-2 infection in highly exposed groups. Settings with highly active viral transmission and conditions such as poor ventilation, crowding, and high mobility due to occupation may benefit from the combined use of masks and closed face shields to mitigate SARS-CoV-2 transmission. Trial registration ClinicalTrials.gov NCT04647305 . Registered on November 30, 2020

Abstract Across the world, the COVID-19 pandemic has disproportionately affected economically disadvantaged groups. This differential impact has numerous possible explanations, each with significantly different policy implications. We examine, for the first time in a low- or middle-income country, which mechanisms best explain the disproportionate impact of the virus on the poor. Combining an epidemiological model with rich data from Bogotá, Colombia, we show that total infections and inequalities in infections are largely driven by inequalities in the ability to work remotely and in within-home secondary attack rates. Inequalities in isolation behavior are less important but non-negligible, while access to testing and contract-tracing plays practically no role because it is too slow to contain the virus. Interventions that mitigate transmission are often more effective when targeted on socioeconomically disadvantaged groups.

Summary: Aim: To determine the impact of bloodstream infection (BSI) and other risk factors for mortality in patients with COVID-19 admitted to the intensive care unit (ICU). Methods: A retrospective cohort was carried out at the Hospital Universitario Nacional (HUN) between March 29 and December 19, 2020. Patients with COVID-19 admitted to the Intensive Care Unit (ICU) were paired 1:4 in two groups, one with BSI and the other without, according to hospital stay and the month of admission. The primary outcome was mortality at 28 days. A Cox proportional hazards model was used to estimate differences in mortality risk. Results: 456 patients were identified and 320 were included in the final cohort, 18% (n = 59) in the BSI group and 82% (n = 261) in the control group. 125 (39%) patients died, 30 (51%) in the BSI group and 95 (36%) in the control group (P = 0.040). BSI was associated with an increased risk of in-hospital mortality at 28 days, [HR] 1.77 (95% CI: 1.03–3.02; P = 0.037). Invasive mechanical ventilation (IMV) and age were associated with increased mortality risk. Some months of the year of the hospital stay were associated with a reduced risk of mortality. There was no difference in mortality between inappropriate and appropriate empirical antimicrobial use. Conclusion: BSI in patients with COVID-19 in ICU increases in-hospital mortality to 28 days. Other risk factors for mortality were IMV and age.

PURPOSEBreast cancer care requires a multimodal approach and a multidisciplinary team who must work together to obtain good clinical results. The fragmentation of care can affect the breast cancer care; however, it has not been measured in a low-resource setting. The aim of this study was to identify fragmentation of care, the geographic variation of this and its association with 4-year overall survival (OS), and costs of care for patients with breast cancer enrolled in Colombia's contributory health care system.MATERIALS AND METHODSA retrospective cohort study was conducted using administrative databases. Women with breast cancer who were treated from January 1, 2013, to December 31, 2015, were included. Fragmentation of care was the exposure, which was measured by the number of different health care provider institutions (HCPIs) that treated a patient during the first year after diagnosis. Crude mortality rates were estimated, survival functions were calculated using the nonparametric Kaplan-Meier approach, and adjusted hazard ratios (HRs) were estimated using multivariate Cox regression model to identify the association of fragmentation with 4-year OS. The association between fragmentation and costs of care was assessed using a multivariate linear regression model.RESULTSA total of 10,999 patients with breast cancer were identified, and 1,332 deaths were observed. The 4-year crude mortality rate was 31.97 (95% CI, 30.25 to 33.69) per 1,000 person-years for the whole cohort, and the highest rate was in the cohort defined for the fourth quartile of the fragmentation measurement (eight or more HCPIs), 40.94 (95% CI, 36.49 to 45.39). The adjusted HR for 4-year OS was 1.04 (95% CI, 1.01 to 1.07) for each HCPI additional. The cost of care is increased for each additional HCPIs (cost ratio, 1.25; 95% CI, 1.23 to 1.26).CONCLUSIONFragmentation of care decreases overall 4-year OS and increases the costs of care in women with breast cancer for Colombia.

Abstract Background We aim to determine the association between out and in-hospital factors with time, from the beginning of the symptoms to the surgery, in patients with acute appendicitis treated at Fundación Hospital Pediatrico La Misericordia (HOMI) in Colombia. Methods Eleven month prospective cohort study of pediatric patients at HOMI with acute appendicitis diagnosis taken to surgery. Data from the out-of-hospital phase was collected by surveying parents, and the data regarding the in-hospital phase was completed with medical records. We analyzed the association between the time from the beginning of the symptoms to the surgery, and out and in-hospital factors associated with this time using generalized linear models. Results Eight hundred three patients were included in the study. Total pre-surgical time was longer in perforated appendicitis (PA) group (2.65 days, standard deviation (SD) 1.88 vs. 2.04 days, SD 1.45) (p

Reliable, timely and detailed information on lung cancer prevalence, mortality and costs from middle-income countries is essential to policy design. Thus, we aimed to develop an electronic algorithm to identify lung cancer prevalent patients in Colombia by using administrative claims databases, as well as to estimate prevalence rates by age, sex and geographic region. We performed a cross-sectional study based on national claim databases in Colombia (Base de datos de suficiencia de la Unidad de Pago por Capitación and Base de Datos Única de Afiliados) to identify lung cancer prevalent patients in 2017, 2018 and 2019. Several algorithms based on the presence or absence of oncological procedures (chemotherapy, radiotherapy and surgery) and a minimum number of months that each individual had lung cancer ICD-10 codes were developed. After testing 16 algorithms, those with the closest prevalence rates to those rates reported by aggregated official sources (Global Cancer Observatory and Cuenta de Alto Costo) were selected. We estimated prevalence rates by age, sex and geographic region. Two algorithms were selected: i) one algorithm that was defined as the presence of ICD-10 codes for 4 months or more (the sensitive algorithm); and ii) one algorithm that was defined by adding the presence of at least one oncological procedure (the specific algorithm). The estimated prevalence rates per 100,000 inhabitants ranged between 11.14 and 18.05 for both, the contributory and subsidized regimes over years 2017, 2018 and 2019. These rates in the contributory regime were higher in women (15.43, 15.61 and 17.03 per 100,000 for years 2017, 2018 and 2019), over 65-years-old (63.45, 56.92 and 61.79 per 100,000 for years 2017, 2018 and 2019) who lived in Central, Bogota and Pacific regions. Selected algorithms showed similar aggregated prevalence estimations to those rates reported by official sources and allowed us to estimate prevalence rates in specific aging, regional and gender groups for Colombia by using national claims databases. These findings could be useful to identify clinical and economical outcomes related to lung cancer patients by using national individual-level databases.

BackgroundThe effect of teaching hospital status on cardiovascular surgery has been of common interest in recent decades, yet its magnitude on heart valve replacement is still a matter of debate. Given the ethical and practical unfeasibility of randomly assigning a patient to such an exposure, we use the inverse probability of treatment weighting (IPTW) to assess this marginal effect on the survival of Colombian patients who underwent a first heart valve replacement between 2016 and 2019.MethodsA retrospective cohort study was conducted based on administrative records. The time-to-death event and cumulative incidences of death, readmission, and reoperation are presented as outcomes. An artificial sample is configured through IPTW, adjusting for sociodemographic variables, comorbidities, technique, and intervention weight.ResultsOf a sample of 3,517 patients, 1,051 (29.9%) were operated on in a teaching hospital. The median age was 65.0 (18.1-91.5), 38.5% of patients were ≤60, and 6.9% were ≥80. The cumulative incidences of death at 30, 90 days, and one year were 5.9%, 8%, and 10.9%, respectively. Furthermore, 23.5% of the patients were readmitted within 90 days and 3.6% underwent reintervention within one year. The odds of 30-day mortality are lower for patients operated in a teaching hospital (OR 0.51; 95% CI 0.29-0.92); however, no effect on survival was identified in terms of time-to-event of death (HR 1.07; 95%CI 0.78-1.46).ConclusionsAfter IPTW, the odds of 30-day mortality are lower for patients operated in a teaching hospital. There was no effect on survival, 90-day or one-year mortality, 90-day readmission, or one-year reintervention. Together, we offer an opening for investigating an exposure that has yet to be explored in Latin America with potential value to understand teaching hospitals as the essential nature of reality of an academic-clinical synergy.

Objectives To estimate the risk factors for SARS-CoV-2 transmission in close contacts of adults at high risk of infection due to occupation, participants of the CoVIDA study, in Bogotá D.C., Colombia.Setting The CoVIDA study was the largest COVID-19 intensified sentinel epidemiological surveillance study in Colombia thus far, performing over 60 000 RT-PCR tests for SARS-CoV-2 infection. The study implemented a contact tracing strategy (via telephone call) to support traditional surveillance actions performed by the local health authority.Participants Close contacts of participants from the CoVIDA study.Primary and secondary outcome measures SARS-CoV-2 testing results were obtained (RT-PCR with CoVIDA or self-reported results). The secondary attack rate (SAR) was calculated using contacts and primary cases features.Results The CoVIDA study performed 1257 contact tracing procedures on primary cases. A total of 5551 close contacts were identified and 1050 secondary cases (21.1%) were found. The highest SAR was found in close contacts: (1) who were spouses (SAR=32.7%; 95% CI 29.1% to 36.4%), (2) of informally employed or unemployed primary cases (SAR=29.1%; 95% CI 25.5% to 32.8%), (3) of symptomatic primary cases (SAR of 25.9%; 95% CI 24.0% to 27.9%) and (4) living in households with more than three people (SAR=22.2%; 95% CI 20.7% to 23.8%). The spouses (OR 3.85; 95% CI 2.60 to 5.70), relatives (OR 1.89; 95% CI 1.33 to 2.70) and close contacts of a symptomatic primary case (OR 1.48; 95% CI 1.24 to 1.77) had an increased risk of being secondary cases compared with non-relatives and close contacts of an asymptomatic index case, respectively.Conclusions Contact tracing strategies must focus on households with socioeconomic vulnerabilities to guarantee isolation and testing to stop the spread of the disease.

Detailed information on SARS-CoV-2 infection rates in Latin America by occupation, socioeconomic group and geographic area are rarely available. Here, the authors provide these estimates for in Bogota, Colombia using data from a sentinel surveillance scheme, and find that over half the population had been infected by March 2021.

Abstract Background Between 30 and 70% of patients admitted to the intensive care unit (ICU) have acute kidney injury (AKI), and 10% of these patients will require renal replacement therapy (RRT). A significant number of studies have compared the mortality of patients who require RRT versus those who do not require it, finding an increase in mortality rates in the short and medium term; however, few studies have evaluated the long-term survival in a mixture of patients admitted to the ICU. Objective To evaluate the impact of RRT on 5-year survival in patients with AKI admitted to the ICU Methods Using administrative databases of insurers of the Colombian health system, a cohort of patients admitted to the ICU between 1 January 2012 and 31 December 2013 was followed until 31 December 2018. ICD-10 diagnoses, procedure codes, and prescribed medications were used to establish the frequencies of the comorbidities included in the Charlson index. Patients were followed for at least 5 years to evaluate survival and establish the adjusted risks by propensity score matching. Results Of the 150,230 patients admitted to the ICU, 4366 (2.9%) required RRT in the ICU. Mortality rates for patients with RRT vs no RRT evaluated at ICU discharge, 1 year, and 5 years were 35%, 57.4%, and 67.9% vs 7.4%, 17.6%, and 30.1%, respectively. After propensity score matching, the hazard ratio was calculated for patients who received RRT and those who did not (HR, 2.46; 95% CI 2.37 to 2.56; p < 0.001), with a lower difference in years of survival for patients with RRT (mean effect in the treated) of − 1.86 (95% CI − 2.01 to to1.65; p < 0.001). Conclusions The impact of acute renal failure with the consequent need for RRT in patients admitted to the ICU is reflected in a decrease of approximately one quarter in 5-year survival, regardless of the different comorbidities.

Symptoms-based models for predicting SARS-CoV-2 infection may improve clinical decision-making and be an alternative to resource allocation in under-resourced settings. In this study we aimed to test a model based on symptoms to predict a positive test result for SARS-CoV-2 infection during the COVID-19 pandemic using logistic regression and a machine-learning approach, in Bogotá, Colombia. Participants from the CoVIDA project were included. A logistic regression using the model was chosen based on biological plausibility and the Akaike Information criterion. Also, we performed an analysis using machine learning with random forest, support vector machine, and extreme gradient boosting. The study included 58,577 participants with a positivity rate of 5.7%. The logistic regression showed that anosmia (aOR = 7.76, 95% CI [6.19, 9.73]), fever (aOR = 4.29, 95% CI [3.07, 6.02]), headache (aOR = 3.29, 95% CI [1.78, 6.07]), dry cough (aOR = 2.96, 95% CI [2.44, 3.58]), and fatigue (aOR = 1.93, 95% CI [1.57, 2.93]) were independently associated with SARS-CoV-2 infection. Our final model had an area under the curve of 0.73. The symptoms-based model correctly identified over 85% of participants. This model can be used to prioritize resource allocation related to COVID-19 diagnosis, to decide on early isolation, and contact-tracing strategies in individuals with a high probability of infection before receiving a confirmatory test result. This strategy has public health and clinical decision-making significance in low- and middle-income settings like Latin America.

Rationale & Objective: This study investigated the effects on patients’ outcomes of using medium cutoff (MCO) versus high-flux (HF) dialysis membranes. Study Design: A retrospective, observational, multicenter, cohort study. Setting & Participants: Patients aged greater than 18 years receiving hemodialysis at the Baxter Renal Care Services dialysis network in Colombia. The inception of the cohort occurred from September 1, 2017, to November 30, 2017, with follow-up to November 30, 2019. Exposure: The patients were divided into 2 cohorts according to the dialyzer used at the inception: (1) MCO membrane or (2) HF membrane. Outcomes: Primary outcomes were the hospitalization rate from any cause and hospitalization days per patient-year. Secondary outcomes were acute cardiovascular events and mortality rates from any cause and secondary to cardiovascular causes. Laboratory parameters were assessed throughout the 2-year follow-up period. Analytical Approach: Descriptive statistics were used to report population characteristics. Inverse probability of treatment weighting was applied to each group before analysis. All categorical variables were compared using Pearson’s χ2 test, and continuous variables were analyzed with the t test. Baseline differences between groups with a value of >10% were considered clinically meaningful. Laboratory variables were measured at 5 consecutive time points. A between-patient effect was analyzed using a split-plot factorial analysis of variance. Results: The analysis included 1,098 patients, of whom 564 (51.3%) were dialyzed with MCO membranes and 534 (48.7%) with HF membranes. Patients receiving hemodialysis with MCO membranes had a lower all-cause hospitalization incidence rate (IR) per patient-year (IR = 0.93; 95% CI, 0.82-1.03) than those receiving hemodialysis with HF membranes (IR = 1.13; 95% CI, 0.96-1.30), corresponding to a significant incident rate ratio (MCO/HF) of 0.82 (95% CI, 0.68-0.99; P = 0.04). The frequency of nonfatal cardiovascular events showed statistical significance, with a lower incidence in the MCO group (incident rate ratio = 0.66; 95% CI, 0.46-0.96; P = 0.03). No statistically significant differences in all-cause time until death were observed (P = 0.48). Albumin levels were similar between the 2 dialyzer cohorts. Limitations: Despite the robust statistical analysis, there remains the possibility that unmeasured variables may still generate residual imbalance and, therefore, skew the results. Conclusions: The incidences of hospitalization and cardiovascular events in patients receiving hemodialysis were lower when dialyzed with MCO membranes than HF membranes. A randomized controlled trial would be desirable to confirm these results. Trial Registration: Clinical Trials.gov, ISRCTN12403265.

Objective To validate the Charlson Comorbidity Index (CCI) for the Colombian population using administrative databases from the health insurance system.Design Retrospective cohort study.Setting Database reports of events related to services that insurers provided (Health Promoter Enterprises, EPS in Spanish) in the Colombian health system, which covered 22.19 million residents in 2016.Participants The study cohort comprised 3 849 849 patients aged 18 years and up admitted to the Colombian hospitals between 1 January and 31 December 2016.Primary outcome The study aimed to gauge the CCI’s predictive value for mortality by comparing the calibration and discrimination of three different versions of the index, with mortality information obtained from death certificates, including date of death and diagnoses associated with cause of death. Follow-up was conducted for at least 1 year.Results Altogether, 46 429 patients died within 1 year (1.21%). Discriminatory power in predicting 1-year mortality was calculated for three versions of the ICC. In the original CCI model, the area under the Receiver operating characteristic (ROC) curve was 0.906 (95% CI (0.906 to 0.907), p

Introducción. La hipocalcemia es la complicación más frecuente de la tiroidectomía. La profilaxis con calcio/ calcitriol es una alternativa costo-efectiva, sencilla y expedita para disminuir esta situación, sin alterar la función paratiroidea residual. Lo que no está claro es si hay superioridad de una dosis frente a otra, por lo que el objetivo de este estudio fue evaluar el comportamiento entre diferentes esquemas de profilaxis para hipocalcemia. Métodos. Estudio de cohorte retrospectivo de adultos operados en un hospital de cuarto nivel, entre febrero de 2017 y diciembre de 2020. Se calculó la tasa de síntomas, la hipocalcemia e hipercalcemia bioquímica en el control postquirúrgico durante las siguientes dos semanas. Se hizo análisis bivariado y multivariado entre dosis de calcio/ calcitriol, otros factores asociados y los desenlaces mencionados. Resultados. Se incluyeron 967 pacientes. El 10 % presentaron síntomas. No hubo diferencias significativas en el calcio sérico del control posquirúrgico entre los grupos con distintas dosis de calcio. La dosis de carbonato de calcio >3600 mg/día y el calcio en las primeras 24 horas de cirugía se asociaron a la presencia de síntomas. La dosis de calcitriol

Los experimentos de elección discreta (DCE, su sigla en inglés), son una metodología usada para evaluar preferencias de desenlaces o intervenciones relacionadas con salud. A diferencia de otras técnicas de medición que utilizan métodos simples de elección o herramientas estadísticas básicas que fallan al evaluar los beneficios específicos de una intervención, proceso de entrega, beneficio, satisfacción y preferencia de los usuarios en términos de tiempo, calidad o atributo específico, los DCE combinan, en la generación de atributos y modelamiento matemático, complejas tareas de diseño y ejecución, que mejoran la calidad y optimizan la cantidad necesaria de información mediante el uso eficiente de recursos y resultados de excelente calidad. Este documento presenta la historia, el desarrollo y la fundamentación teórica de los DCE y muestra las críticas, las potenciales limitaciones y las precauciones.

Background: Epidemiologic surveillance of COVID-19 is essential to collect and analyse data to improve public health decision making during the pandemic. There are few initiatives led by public-private alliances in Colombia and Latin America. The CoVIDA project contributed with RT-PCR tests for SARS-CoV-2 in mild or asymptomatic populations in Bogotá. The present study aimed to determine the factors associated with SARS-CoV-2 infection in working adults. Methods: COVID-19 intensified sentinel epidemiological surveillance study, from April 18, 2020, to March 29, 2021. The study included people aged 18 years or older without a history of COVID-19. Two main occupational groups were included: healthcare and essential services workers with high mobility in the city. Social, demographic, and health-related factors were collected via phone survey. Afterwards, the molecular test was conducted to detect SARS-CoV-2 infection. Findings: From the 58,638 participants included in the study, 3,310 (5·6%) had a positive result. A positive result was associated with the age group (18-29 years) compared with participants aged 60 or older, participants living with more than three cohabitants, living with a confirmed case, having no affiliation to the health system compared to those with social health security, reporting a very low socioeconomic status compared to those with higher socioeconomic status, and having essential occupations compared to healthcare workers. Interpretation: The CoVIDA study showed the importance of intensified epidemiological surveillance to identify groups with increased risk of infection. These groups should be prioritised in the screening, contact tracing, and vaccination strategies to mitigate the pandemic. Funding: The CoVIDA study was funded through donors managed by the philanthropy department of Universidad de los Andes.

Objective: To quantify the costs of Chagas disease in Colombia from a societal perspective in 2017. Methods: A cost-of-illness analysis was carried out using a prevalence-based approach. Costs attributable to Chagas were estimated from a bottom-up strategy, using population attributable fractions. Indirect costs were calculated using the human capital approach. Results: The estimated total cost of diagnosed Chagas disease was US $13.1 million and included $5.7 million in direct medical costs, $1.5 million in direct nonmedical costs, and $5.8 million in indirect costs: absenteeism ($2.2 million), presenteeism ($3.1 million), and premature deaths ($515228). On average, people diagnosed with Chagas disease incurred $594 in medical expenses, and more than half of that expense was directly attributable to Chagas. The annual cost to society for a person with chronic Chagas disease was $4226. Conclusions: Chagas disease imposes a substantial financial burden on healthcare system and society. Economic cost of illness-related productivity losses is much more significant. Our research suggests that a health policy framework addressing as many of the social determinants of health as possible may be pivotal in containing social costs. Therefore, reducing this burden is not only the responsibility of the health system. Keywords: Chagas disease, Cost of illness, Costs and cost analysis, Health expenditures, Health care costs

Introducción. Existen diferencias entre la concordancia de la puntuación de Gleason en biopsias prostática y la patología final. Objetivos. Determinar la concordancia de las puntuaciones de Gleason obtenidas por biopsia de próstata y por prostatectomía radical (PR) en un hospital de IV nivel en Bogotá D.C., Colombia. Materiales y métodos. Estudio retrospectivo de pruebas diagnósticas realizado en un hospital de alta complejidad de Bogotá D.C. Fueron resisados los resultados de las PR y las biopsias prostáticas, clasificando los pacientes según D’Amico y la división por grupos realizada por patólogos. La concordancia diagnóstica se determinó mediante la estimación del coeficiente de Kappa ponderado. Resultados. Se incluyeron 180 pacientes con promedio de edad de 61 años. La exactitud diagnóstica de la puntuación de Gleason dada por biopsia fue de 52%, con supraestadificación del 34% y subestadificación del 14%. El índice Kappa ponderado entre la puntuación de Gleason de la biopsia prostática y la PR fue de 0.37 (p=0.000), y por grupos de 0.4 (p=0.000), con concordancia aceptable para la muestra. Conclusiones. La concordancia de la biopsia de próstata con la PR es baja con tendencia a la supraestadificación, lo que podría tener un impacto negativo en el manejo de los pacientes con cáncer de próstata localizado.

To determine whether non-steroidal anti-inflammatory drug (NSAIDs) exposure prior to intensive care unit (ICU) admission affects the development of acute kidney injury (AKI) with renal replacement therapy (RRT). An administrative database is used to establish a cohort of patients who were admitted to the ICU. The exposure to NSAIDs that the patients had before admission to the ICU is determined. Demographic variables, comorbidities, AKI diagnoses requiring RRT, and pneumonia during the ICU stay are also measured. Multivariate logistic regression and inverse probability weighting (IPW) are used to calculate risks of exposure to NSAIDs for patients with AKI requiring RRT. In total, 96,235 patients were admitted to the ICU, of which 16,068 (16.7%) were exposed to NSAIDs. The incidence of AKI with RRT was 2.71% for being exposed to NSAIDs versus 2.24% for those not exposed (p < 0.001). For the outcome of AKI, the odds ratio weighted with IPW was 1.28 (95% CI: 1.15–1.43), and for the outcome of pneumonia as a negative control, the odds ratio was 1.07 (95% CI: 0.98–1.17). The impact of prior exposure to NSAIDs over critically ill patients in the development of AKI is calculated as 8 patients per 1000 exposures. The negative control with the same sources of bias did not show an association with NSAID exposure.

BackgroundThe relationship between exposure to conflict violence during pregnancy and the risks of miscarriage, stillbirth, and perinatal mortality has not been studied empirically using rigorous methods and appropriate data. We investigated the association between reduced exposure to conflict violence during pregnancy and the risks of adverse pregnancy outcomes in Colombia.Methods and findingsWe adopted a regression discontinuity (RD) design using the July 20, 2015 cease-fire declared during the Colombian peace process as an exogenous discontinuous change in exposure to conflict events during pregnancy, comparing women with conception dates before and after the cease-fire date. We constructed the cohorts of all pregnant women in Colombia for each day between January 1, 2013 and December 31, 2017 using birth and death certificates. A total of 3,254,696 women were followed until the end of pregnancy. We measured conflict exposure as the total number of conflict events that occurred in the municipality where a pregnant woman lived during her pregnancy. We first assessed whether the cease-fire did induce a discontinuous fall in conflict exposure for women with conception dates after the cease-fire to then estimate the association of this reduced exposure with the risks of miscarriage, stillbirth, and perinatal mortality. We found that the July 20, 2015 cease-fire was associated with a reduction of the average number of conflict events (from 2.64 to 2.40) to which women were exposed during pregnancy in their municipalities of residence (mean differences -0.24; 95% confidence interval [CI] -0.35 to -0.13; p < 0.001). This association was greater in municipalities where Fuerzas Armadas Revolucionarias de Colombia (FARC) had a greater presence historically. The reduction in average exposure to conflict violence was, in turn, associated with a decrease of 9.53 stillbirths per 1,000 pregnancies (95% CI -16.13 to -2.93; p = 0.005) for municipalities with total number of FARC-related violent events above the 90th percentile of the distribution of FARC-related conflict events and a decrease of 7.57 stillbirths per 1,000 pregnancies (95% CI -13.14 to -2.00; p = 0.01) for municipalities with total number of FARC-related violent events above the 75th percentile of FARC-related events. For perinatal mortality, we found associated reductions of 10.69 (95% CI -18.32 to -3.05; p = 0.01) and 6.86 (95% CI -13.24 to -0.48; p = 0.04) deaths per 1,000 pregnancies for the 2 types of municipalities, respectively. We found no association with miscarriages. Formal tests support the validity of the key RD assumptions in our data, while a battery of sensitivity analyses and falsification tests confirm the robustness of our empirical results. The main limitations of the study are the retrospective nature of the information sources and the potential for conflict exposure misclassification.ConclusionsOur study offers evidence that reduced exposure to conflict violence during pregnancy is associated with important (previously unmeasured) benefits in terms of reducing the risk of stillbirth and perinatal deaths. The findings are consistent with such beneficial associations manifesting themselves mainly through reduced violence exposure during the early stages of pregnancy. Beyond the relevance of this evidence for other countries beset by chronic armed conflicts, our results suggest that the fledgling Colombian peace process may be already contributing to better population health.

Introducción. Los microcarcinomas papilares de tiroides son tumores de hasta 10 mm en su diámetro mayor. Su tratamiento es sujeto de debate y se propone, desde seguimiento clínico, hasta intervención quirúrgica temprana. Este estudio buscó identificar factores de riesgo relacionados con compromiso ganglionar, que permitan una mejor selección de los pacientes en nuestro medio, en quienes se propone manejo quirúrgico inmediato o vigilancia activa, en consonancia con la clasificación del riesgo de progresión. Métodos. Estudio de cohorte analítica ambispectiva que incluyó pacientes con microcarcinoma papilar de tiroides llevados a tiroidectomía más vaciamiento central. Se caracterizó la población y se realizó un análisis de regresión logística multivariado para definir factores preoperatorios asociados al compromiso ganglionar. Adicionalmente, se evaluó de manera retrospectiva la eventual asignación a grupos de riesgo de progresión, según los criterios de Miyauchi, y su comportamiento respecto al estado nodal. Resultados. Se incluyeron 286 pacientes. El 48,9 % presentó compromiso ganglionar, y de estos, el 33,5 % presentó compromiso ganglionar significativo, que modificó su clasificación de riesgo de recaída. De estos últimos, el 59,5 % hubiesen sido manejados con vigilancia activa, según los criterios propuestos por Miyauchi. Se identificó que la edad menor de 55 años, los ganglios sospechosos en la ecografía y los nódulos mayores de 5 mm, se relacionan con compromiso ganglionar significativo. Discusión. El manejo quirúrgico inmediato parece ser una opción adecuada para pacientes con sospecha de compromiso ganglionar en ecografía preoperatoria, pacientes menores de 55 años y nódulos mayores de 5 mm. Es posible que los actuales criterios para definir vigilancia activa no seleccionen adecuadamente a los pacientes en nuestro medio.

Abstract INTRODUCTIOn: Studies on Chagas disease-related mortality assist in decision-making in health policies. We analyzed the epidemiological characteristics, temporal trends, and regional differences in Chagas disease-related mortality in Colombia from 1979 to 2018. METHODS: A time-series study was conducted using death records and population data from the National Administrative Department of Statistics, using categorizations from the International Classification of Disease (ICD)-9 and ICD-10 systems. All deaths with Chagas disease as an underlying or associated cause of death were included. Crude and age-sex standardized mortality rates per 100,000 inhabitants and the annual percent change (APC) were calculated. RESULTS: Of the 7,287,461 deaths recorded in Colombia during 1979-2018, 3,276 (0.04%) deaths were related to Chagas disease-2,827 (86.3%) as an underlying cause and 449 (13.7%) as an associated cause. The average annual age-sex standardized mortality rate was 0.211 (95% confidence interval [CI]: 0.170-0.252) deaths/100,000 inhabitants, with a significant upward trend (APC = 6.60%; 95% CI: 5.9-7.3). The highest Chagas disease-related death rates were in males (0.284 deaths/100,000 inhabitants), those ≥65 years old (1.296 deaths/100,000 inhabitants), and residents of the Orinoco region (1.809 deaths/100,000 inhabitants). There was a significant increase in mortality in the Orinoco (APC = 8.28%; 95% CI: 6.4-10.2), Caribbean (APC = 5.06%; 95% CI: 3.6-6.5), and Andean (APC = 4.63%; 95% CI: 3.9-5.3) regions. CONCLUSIONS: Chagas disease remains a major public health issue in Colombia with high mortality rates in older age groups, a wide geographic distribution, regional differences, and the potential to increase.

Introducción. La mortalidad perioperatoria se considera una de las herramientas clave para medir la fuerza del sistema de salud de un país en el área quirúrgica. Actualmente, no se cuenta con las cifras totales de las apendicectomías realizadas en nuestro pais, a pesar de ser un procedimiento quirúrgico extremadamente común. Métodos. Estudio de cohorte retrospectivo con datos de pacientes de todas las edades, reportados como afiliados al sistema de salud contributivo de Colombia y a quienes se les realizó una apendicectomía entre el 1° de enero de 2011 y el 31 de diciembre de 2016. La información se obtuvo de bases de datos nacionales y se procesó a partir del cálculo de variables, como la tasa de mortalidad perioperatoria y el volumen quirúrgico, estimando una tasa de mortalidad a treinta días, por sexo, grupo etario y región geográfica. Resultados. Entre las 231.570 apendicectomías que se identificaron, se halló una mayor tasa de mortalidad perioperatoria en el grupo etario de hombres mayores de 80 años con 17,3 %. La región oriental presentó la menor tasa de mortalidad con 0,01 %. El mayor volumen quirúrgico se presentó en el año 2012 y el menor en el año 2016. Discusión. La tasa de mortalidad de apendicectomía en diferentes grupos etarios es similar a la de otros países de ingresos medios y bajos, en tanto que la mayor heterogeneidad de la tasa de mortalidad entre las diferentes regiones, se percibe en los grupos de menores de un año y de mayores de 65 años. Este estudio se constituye como una aproximación inicial a la tasa de mortalidad en apendicectomías realizadas en Colombia.

ObjectiveTo examine socioeconomic inequalities in birth outcomes among infants born between 2008 and 2018 and assessed trends in inequalities during that period in Colombia, a middle-income country with high levels of inequality emerging from a long internal armed conflict.MethodsUsing birth certificate data in Colombia, we analysed the outcomes of low birth weight, an Apgar score ResultsAmong the 5,433,265 full-term singleton births analysed, there was a slight improvement in the outcomes analysed over the study period (lower low-birth-weight and ApgarConclusionThe lack of a consistent improvement in the magnitude of inequalities in birth outcomes over an 11-year period is a worrying issue because it could aggravate the cycle of inequality, given the influence of birth outcomes on health, social and economic outcomes throughout the life course. The findings of our analysis emphasize the importance of policies aimed at providing access to quality education and providing a health care system with universal coverage and high levels of integration.

Introducción. La patología biliar es una causa frecuente de intervención quirúrgica, Pero en Colombia no se cuenta con datos oficiales de mortalidad ni volumen quirúrgico asociados a este procedimiento. El objetivo de este estudio fue determinar el volumen de colecistectomías y describir la tasa general de mortalidad perioperatoria en seis regiones geográficas del país, en el periodo de 2012 a 2016. Métodos. Estudio de cohortes retrospectivo que incluyó pacientes mayores de 18 años, afiliados al régimen contributivo de salud, llevados a colecistectomía. Se utilizó la base de datos de suficiencia de la Unidad de Pago por Capitación (UPC), la base de estadísticas vitales del Departamento Administrativo Nacional de Estadística (DANE) y la del Sistema Integrado de Información de la Protección Social (SISPRO). Resultados. Durante el periodo de estudio, se realizaron 192.080 colecistectomías, lo que corresponde a 206 colecistectomías por 100.000 habitantes. Se encontró mayor volumen quirúrgico en personas entre los 65 y 80 años, en el sexo femenino y en la ciudad de Bogotá. La mortalidad perioperatoria encontrada correspondió al 0,6 %, siendo mayor en los pacientes de sexo masculino, de edad avanzada, en aquellos en quienes se practicó laparotomía y en los pacientes operados en la ciudad de Bogotá. Discusión. De acuerdo con los hallazgos, esta investigación puede servir de base para estudios posteriores, que muestren claramente las cifras oficiales de volumen quirúrgico y de mortalidad por colecistectomía en Colombia.

Background:. The purpose of this study was to determine the perioperative mortality rate, reintervention rate, and total healthcare costs for head and neck cancer patients who underwent free tissue transfer (FTT) in Colombia. The prognostic factors associated with those results were estimated. Methods:. A retrospective cohort study was performed using administrative data from patients of all ages diagnosed with head and neck cancer who underwent FTT between 2013 and 2016 in Colombia’s contributory health system. Postoperative mortality rates were estimated at 30, 90, and 180 days, as well as reintervention rates at 30 and 90 days. Total healthcare costs were calculated. Generalized linear models were generated to determine prognostic factors associated with outcomes. Results:. A total of 485 patients were included, 215 (44.33%) of which were women. Mean age was 61.4 years. Mortality rate was 3.09 at 30 days, 9.28 at 90 days, and 15.26 at 180 days, per 100 surgeries. Reintervention rate was 5.77 at 30 days and 8.25 at 90 days, per 100 surgeries. The 30-day reintervention rate was lower for 40- to 59-year-old group and for a Charlson Index ≤ 3. The median total healthcare cost of an episode was USD 12,403.68 (interquartile range, 5754–16,736). The bivariate and multivariate models determined that age, the Charlson Index, and geographic region were associated with outcomes. Conclusion:. For patients undergoing FTT in Colombia, differences in reintervention and total costs incurred by the national health system exist, and these differences are associated with age, the Charlson Index, and the geographic region.

Introduction: Urinary tract infection is the most common pathology in diabetic patients, and an important determinant of morbidity and mortality among them. The increasing resistance of uropathogens acquired in the community to commonly used antibiotics is alarming. Objective: To identify the profile of antibiotic susceptibility of uropathogens responsible for communityacquired infections among diabetic patients in hospitals in Colombia. Materials and methods: We conducted a descriptive study in a subgroup of diabetic patients in the framework of a larger study in adults with urinary tract infection acquired in the community. Over one year, we collected Escherichia coli, Klebsiella spp. and Proteus mirabilis isolates from nine hospitals in Colombia. Their susceptibility profile was determined using microbiological and molecular methods to establish the presence of extended-spectrum AmpC betalactamases and KPC carbapenemases. Results: We collected 68 isolates (58 E. coli, nine Klebsiella spp. and one Proteus mirabilis). Four (6.9%) of the E. coli isolates expressed extended spectrum betalactamases, two (3.4%) of them belonged to the phylogenetic group B2 and to ST131 clone and expressed the TEM-1 and CTM-X-15 betalactamases. The AmpC phenotype was found in four (6.9%) of the E. coli isolates, three of which produced TEM-1 and CMY-2 betalactamases. One K. pneumoniae isolate expressed the KPC-3 carbapenemase. Conclusion: The presence of extended spectrum betalactamases and carbapenemases in uropathogens responsible for community-acquired infection was confirmed in diabetic patients.

Parathyroidectomy (PTX) is one of the most frequently performed surgeries in chronic kidney disease (CKD) patients. The objective of this study was to determine the intensive care unit (ICU) admission, mortality and hospital readmission rates within the 30-day postoperative period, and the total cost of the care episode and to determine possible prognostic factors in end-stage renal disease (ESRD) adult patients taken to PTX in the Colombian contributory health system. Methods. Retrospective cohort study of ESRD adult patients affiliated to the Colombian contributory health system, on dialysis for at least 3 months, undergoing PTX between January 1, 2012, and November 30, 2016. The clinical outcomes evaluated were rehospitalization at 30 days, hospital stay, and ICU requirement. The costs associated with the hospitalization event in which the PTX was performed from the perspective of the third payer were estimated. Results. The study included 478 patients. The mortality rate was 2.09 per 100 surgeries, the ICU admission rate was 32.64 per 100 surgeries, the 30-day hospital readmission percentage of the postoperative period was 16.74%, and the average length of hospital stay was 5.02 days. The median total costs of care for the entire procedure was USD $ 7,814.27 (p25-p75: 3,922.03–9,372.68), with significant regional differences. The geographical region was shown as a prognostic factor associated with clinical outcomes and the cost of care. Conclusions. There are large regional differences in readmission, ICU admission and mortality rates, and costs of dialysis ESRD patients undergoing PTX belonging to the Colombian contributory regime. The geographic region behaves as an independent predictor of clinical outcomes and costs.

Patients undergoing arthroplasty are exposed to different interventions that can lead to renal dysfunction. There is abundant evidence of the incidence and factors associated with acute kidney injury (AKI); however, the incidence and the factors associated with chronic kidney disease (CKD) are not clear. The objective of this study is to determine the incidence and associated factors in arthroplasty patients. A systematic review of the literature was carried out following the recommendations of PRISMA and the Cochrane Collaboration (PROSPERO Protocol CRD42018075929). The search was carried out in Medline, Embase, Cochrane and LILACS. No language or date limits were set. Observational studies were included: cases and controls, and cohorts. The revision of titles and abstracts and the reading of the full texts was performed in a paired manner. The quality of the evidence was evaluated with the Newcastle-Ottawa tool. The initial search found 1279 titles and abstracts. We excluded 115 duplicates, and 1153 in the reading of titles and abstracts. Three articles met the inclusion criteria and were of acceptable quality. The incidence of severe CKD after hip or knee arthroplasty was 1.2% at 1 year up to 6.5% at 9 years. The evidence of the incidence and risk factors associated with CKD in patients undergoing arthroplasty is very scarce and heterogeneous. Further primary studies are required in order to have more valid and trustable results.

BackgroundDespite the adoption of campaigns to interrupt the main vector and to detect Trypanosoma cruzi in blood banks, millions of people are still chronically infected; however, the prevalence data are limited, and the epidemiology of Chagas disease has not been systematically evaluated. This study aimed to estimate the prevalence of Chagas disease in Colombia.MethodsA systematic literature review and meta-analysis was conducted to select all observational studies reporting the prevalence of Chagas disease in Colombia, based on serological diagnosis in participants of any age and published between January 2007 and November 2017. Pooled estimates and 95% confidence intervals (95% CIs) were calculated using random-effects models. In addition, the I2 statistic was calculated.ResultsThe literature search yielded a total of 1,510 studies; sixteen articles with relevant prevalence data were included in the systematic review. Of these, only 12 articles were included for entry in the meta-analysis. The pooled prevalence of Chagas disease across studies was 2.0% (95% CI: 1.0-4.0). A high degree of heterogeneity was found among studies (I2 > 75%; p < 0.001). The publication bias was not statistically significant (Egger's test, p = 0.078). The highest pooled prevalences were found in the adult population (3.0%, 95% CI: 1.0-4.0), pregnant women (3.0%, 95% CI: 3.0-4.0) and the Orinoco region (7.0%, 95% CI: 2.2-12.6).ConclusionsThe results indicate that the T. cruzi-infected population is aging, the adult population, pregnant women and that the Orinoco region (department of Casanare) have the highest prevalences. These results highlight the need to maintain screening and surveillance programs to identify people with chronic T. cruzi infections.

Introducción: La infección del tracto urinario adquirida en la comunidad, es la patología infecciosa más frecuente durante el embarazo y un factor de riesgo importante para parto pretérmino y bajo peso al nacer; se desconoce la frecuencia de la resistencia a las diferentes alternativas terapéuticas en Colombia. Métodos: Se realizó un estudio descriptivo de infecciones urinarias de la comunidad que requirieron hospitalización y se analizó el subgrupo de gestantes. Se recolectaron durante 12 meses aislamientos de Escherichia coli, Klebsiella spp .y Proteus mirabilis en 9 hospitales de Colombia y se determinó su perfil de susceptibilidad, por microdilución en caldo y pruebas de difusión por gradiente, y se caracterizó la presencia de betalactamasas de espectro extendido, con métodos microbiológicos y moleculares. Resultados: Se recogieron 74 aislamientos (64 de E. coli, 7 de Klebsiella spp. y 3 de P. mirabilis) en 73 pacientes. En 58% de las pacientes se reportó uso previo de antibióticos. La resistencia a ampicilina/sulbactam, cefazolina y ceftriaxona fue de 15,6%, 17,2% y 4,7%, respectivamente. Tres aislamientos, dos de E. coli y uno de Klebsiella spp., expresaron betalactamasas de espectro extendido (3,1%, en E. coli y 14,3% Klebsiella spp.) Un aislamiento de E. coli expresó enzimas tipo AmpC. Conclusión: Se confirmó la presencia de cepas resistentes a cefalosporinas de tercera generación en enterobacterias responsables de infección del tracto urinario adquirida en la comunidad en embarazadas, producida por enzimas de tipo beta lactamasas de espectro extendido tipo CTX M-15 y AmpC.

OBJECTIVE: The aim of this study was to describe the most frequently found bacterial microorganisms in bloodstream isolates taken from patients in intensive care units in Colombia and their resistance profiles. METHODS: This was a multicentre descriptive observational study that was carried out between January 2001 and June 2008 with laboratory data from 33 participating hospitals in a surveillance network. RESULTS: The most frequently found microorganisms were coagulase-negative Staphylococci 39.6%, Staphylococcus aureus 12.3%, Klebsiella pneumoniae 8.2%, Escherichia coli 5.7%, Acinetobacter baumannii, 4.0% and Pseudomonas aeruginosa 3.8%. Coagulase-negative Staphylococci registered greater than 70% oxacillin resistance rate. S. aureus presented a change in its multiresistance profile during the years of follow-up. There was a trend towards a lower resistance rate among E. coli and K. pneumoniae isolates during the study period while A. baumannii carbapenem resistance rate exceeded 50%. DISCUSSION: There has been a change in the frequency of species being isolated with a higher frequency of enterobacteriaceae compared to Gram-positive microorganisms, in general with a high resistance rate.

Un número creciente de pacientes críticamente enfermos son atendidos por sepsis secundaria a infecciones bacterianas o micóticas. En este grupo de pacientes la sepsis per se es un factor de riesgo para el desarrollo de falla renal, la cual implica un mayor riesgo de mortalidad. Un panel de expertos en las áreas de infectología, cuidado crítico y nefrología prepararon un consenso basado en la información actual (“evidencia”) sobre el uso de antimicrobianos (antibióticos y antifúngicos) en pacientes críticamente enfermos con falla renal o en riesgo de padecerla. Se identificó la literatura científica relevante mediante un proceso de búsqueda sistemática y se generaron recomendaciones por medio del método presencial Delphi. Se propone que las recomendaciones de este consenso sean utilizadas por los trabajadores de la salud que manejen este grupo de pacientes,con el fin de identificar aquellos en mayor riesgo de progresión a falla renal y establecer las estrategias terapéuticas que tengan el mayor beneficio con la menor probabildad de efectos secundarios serios sobre la función renal. Se adicionó una estrategia para la implmentación de estas recomendaciones.A growing number of critically ill patients are being taken care with sepsis secondary to bacterial or mycotic infections. In this group of patients, sepsis per se is a risk factor for the development of renal failure, which has been related to an increased risk of hospital mortality. An expert panel in infectious diseases, critical care and renal diseases prepared an evidence based consensus over the use of antimicrobials (antibacterial and antifungal agents) in critically ill patients with renal failure or at risk of suffering it. A sytematic review of the scientific literature was performed and recommendations were established by means of a consensus using the Delphi method. Recommendations proposed by this consensus are intended to be use by healthcare workers who are in charge of this kind of patients with the aim to identify the group of patients with higher risk of developing renal failure and to establish the therapeutic measures theat have the best outcome and lower frequenc of severe side effects in renal function. An implementation strategy was added with the recommendations.

Staphylococcus aureus es una de los principales causas de infección de pacientes en estado crítico. La información de vigilancia muestra 32,9 % de resistencia a la meticilina y una frecuencia de aislamiento como causante de infección de 12,15 % en las unidades de cuidados intensivos, especialmente infecciones del torrente sanguíneo. No se encontraron artículos de síntesis de de los datos sobre el impacto de la resistencia de esta bacteria en la mortalidad de los pacientes gravemente comprometidos. Esta revisión de la literatura resume los estudios de pronóstico sobre la infección del torrente sanguíneo por S. aureus resistente a meticilina (SARM) en pacientes de la unidad de cuidados intensivos. Se incluyeron los artículos que evaluaron la mortalidad por bacteriemias primarias o secundarias, comparándola con controles sensibles a la meticilina o infectados por otra bacteria. No se incluyeron estudios con bacteriemias polimicrobianas. De 387 referencias, seis estudios cumplieron los criterios de inclusión. Los datos disponibles no permiten generar una conclusión sobre la mortalidad relacionada con SARM en la unidad de cuidados intensivos. Los análisis bivariados muestran un incremento de la mortalidad, el cual tiende a desaparecer cuando se controla por otras variables, como el tratamiento inicial apropiado y la gravedad del cuadro clínico. La participación de este microorganismo en la mortalidad de pacientes de la unidad de cuidados intensivos y sus determinantes, permanecen aún sin explicar.Staphylococcus aureus is an important infectious pathogen in critically ill patients. Local surveillance shows its isolation as infectious causative pathogen at intensive care units in 12.15% of cases and a methicillin resistance rate of 32.9%, specially related with bloodstream infections. This review summarizes available prognosis studies related to methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections at intensive care unit (ICU). References with primary or secondary bacteremia patients compared with susceptible pathogen controls or different pathogen were included. Polymicrobial bacteremias were not included. 387 references were retrieved, only six studies met the inclusion criteria. The available evidence does not support a definitive conclusion about MRSA-related mortality in ICU. Increased mortality registered in bivariate analysis disappears when other covariates as appropriate initial therapy and baseline severity are adjusted. The involvement of this marker in ICU patient´s mortality and their prognosis determinants still remain unexplained.

Antecedentes: las “Guías de Práctica Clínica (GPC) para la prevención, detección temprana y tratamiento de las alteraciones del embarazo, parto y el puerperio” fueron desarrolladas por la alianza conformada por la Universidad Nacional de Colombia, la Universidad de Antioquia, la Universidad Pontificia Javeriana y el Centro de investigaciones en evaluación de tecnologías en salud (CINETS) dentro de la convocatoria del Ministerio de Salud y Protección Social y Colciencias en el año 2010 para el desarrollo de GPC en temas prioritarios de salud. Materiales y métodos: basados en la “Guía Metodológica para la elaboración de GPC” del Centro de Estudios e Investigación en Salud (CEIS), se conformó el grupo desarrollador, se definieron los tópicos por desarrollar, el alcance, los objetivos y las preguntas por resolver en las GPC. Se realizó una búsqueda sistemática de GPC para los tópicos seleccionados, priorizando la opción de adaptar antes que desarrollar una guía de novo, según la calidad metodológica de las guías identificadas. Se realizó la revisión sistemática de la literatura para responder preguntas huérfanas. Se formularon las recomendaciones con niveles de evidencia graduados bajo el sistema SIGN. Se favoreció la participación de pacientes y de los diferentes grupos de interés. Resultados: se adaptaron seis GPC para responder las preguntas de los tópicos incluidos en la GPC desarrollada. El tópico de toxoplasmosis requirió el desarrollo de recomendaciones de novo. Conclusiones: estas GPC fueron elaboradas con procedimientos sistemáticos y la mejor evidencia disponible. Se espera que contribuya a mejorar la calidad de la atención de las gestantes y a la disminución de la morbilidad y mortalidad materna y perinatal.

Objetivo: realizar recomendaciones para la atención de las complicaciones hipertensivas en el embarazo como parte integral de la “Guía de Práctica Clínica (GPC) para la prevención, detección temprana y tratamiento de las complicaciones del embarazo en Colombia”. Materiales y métodos: el grupo desarrollador de la Guía (GDG) elaboró esta GPC durante 2011-2012 acorde con la Guía Metodológica para la elaboración de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud colombiano, basándose en la evidencia científica disponible y sumando la participación activa de grupos de pacientes, sociedades científicas y grupos de interés. En particular, la evidencia de esta sección fue adaptada de la GPC “Hypertension in pregnancy: the management of hypertensive disorders during pregnancy” (National Institute of Care and Health Excellence - NICE - 2010) y actualizada por medio de procedimientos sistemáticos, tanto para la búsqueda y valoración de la evidencia como para la generación de recomendaciones. El nivel de evidencia y la fuerza de las recomendaciones fueron expresados por medio del sistema del Scottish Intercollegiate Guidelines Network (SIGN). Resultados: se presentan las recomendaciones para la atención de las complicaciones hipertensivas en el embarazo. Estas incluyen cambios en la conducta del personal de salud y las instituciones para aumentar la probabilidad de obtener un resultado materno-fetal exitoso en las gestaciones con estas condiciones. Conclusiones: se presenta una versión resumida de las recomendaciones y evidencia para la atención de las complicaciones hipertensivas en el embarazo, la cual se espera sea adoptada por los profesionales de salud encargados de la atención del embarazo en el país para disminuir la morbilidad y mortalidad asociada a la gestación.