Incidencia y factores asociados a bacteriemia por enterobacterias productoras de carbapenemasas en pacientes con neutropenia febril e hisopado rectal positivo

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dc.contributor.advisorBernal García, Edgar Augustospa
dc.contributor.advisorPeña Castellanos, Angela Maríaspa
dc.contributor.advisorOchoa Vera, Miguel Enriquespa
dc.contributor.authorGonzález Plata, Fabio Albertospa
dc.contributor.cvlachttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000898465*
dc.contributor.orcidhttps://orcid.org/0000-0003-1693-9429*
dc.contributor.orcidhttps://orcid.org/0000-0002-4552-3388*
dc.contributor.researchgatehttps://www.researchgate.net/profile/Miguel_Ochoa7*
dc.contributor.scopushttps://www.scopus.com/authid/detail.uri?authorId=36987156500*
dc.coverage.campusUNAB Campus Bucaramangaspa
dc.coverage.spatialFloridablanca (Santander, Colombia)spa
dc.coverage.temporal2016-2018spa
dc.date.accessioned2020-08-15T05:57:00Z
dc.date.available2020-08-15T05:57:00Z
dc.date.issued2020
dc.degree.nameEspecialista en Medicina Internaspa
dc.description.abstractIntroducción: La forma de identificar a los pacientes hematoncológicos con riesgo de bacteriemia en el contexto de lesión de barrera mucosa está asociada a lo profundo de la neutropenia. La posibilidad de identificar a través del hisopado rectal la colonización por enterobacterias productoras de carbapenemasas ha cambiado el enfoque de la terapia antibiótica empírica dado que en este lapso de tiempo podemos impactar drásticamente en la mortalidad, bacteriemia por EPC es una verdadera emergencia médica (equiparable a Infarto de miocardio con elevación del ST y ECV isquémico en ventana) engloba la Neutropenia febril, inmunosupresión y severas comorbilidades como las Neoplasias hematolinfoides. Sin embargo se desconoce la correlación entre colonización rectal del hisopado y la predicción de la bacteriemia, esto ha motivando a conocer que otros factores de riesgo están asociados y la utilidad del hisopado rectal como predictor de bacteriemia. Evaluar la incidencia de bacteriemia por enterobacterias productoras de carbapenemasas, en pacientes que se encontraran recibiendo quimioterapia con neutropenia severa, fiebre e hisopado rectal positivo, en el servicio de Hemato-oncología. de la clínica la FOSCAL, en el periodo comprendido entre Enero 1 de 2016 y Diciembre 31 de 2018.spa
dc.description.abstractenglishIntroduction: The way to identify hematoncological patients at risk of bacteremia in the context of mucosal barrier injury is associated with the depth of neutropenia. The possibility of identifying colonization by carbapenemase-producing enterobacteria through the rectal swab has changed the focus of empirical antibiotic therapy given that in this period of time we can dramatically impact mortality, EPC bacteremia is a true medical emergency (comparable to Myocardial infarction with ST elevation and ischemic CVD in the window) includes febrile neutropenia, immunosuppression and severe comorbidities such as hematolymphoid neoplasms. However, the correlation between rectal swab colonization and the prediction of bacteremia is unknown, which has motivated us to know that other risk factors are associated and the usefulness of rectal swab as a predictor of bacteremia. To assess the incidence of bacteremia due to carbapenemase-producing enterobacteriaceae, in patients who were receiving chemotherapy with severe neutropenia, fever and positive rectal swab, in the Hemato-oncology department. of the FOSCAL clinic, in the period between January 1, 2016 and December 31, 2018.eng
dc.description.degreelevelEspecializaciónspa
dc.description.learningmodalityModalidad Presencialspa
dc.description.tableofcontents1. RESUMEN DEL PROYECTO. 10 2. PLANTEAMIENTO Y JUSTIFICACIÓN 11 3. MARCO TEORICO Y ESTADO DEL ARTE 13 4. OBJETIVOS 33 4.1. Objetivo General 33 4.2. Objetivos específicos 33 5. METODOLOGÍA 33 5.1. Tipo de estudio 33 5.2. Población 33 5.3. Criterios de inclusión 34 5.4. Criterios de exclusión 34 5.5. Muestra 34 5.6. Recolección de la información 34 6. VARIABLES 35 6.1. DEFINICION DE LAS VARIABLES 43 7. PLAN DE ANÁLISIS DE DATOS 44 8. CONSIDERACIONES ÉTICAS 45 9. RESULTADOS / PRODUCTOS ESPERADOS Y POTENCIALES BENEFICIARIOS 46 10. CRONOGRAMA 47 11. PRESUPUESTO 48 12. RESULTADOS 48 12.1. Características demográficas de la población 49 12.1.2 Comorbilidades de los pacientes colonizados por hisopado rectal positivo para EPC 50 12.2 Tipo de Neoplasia Hemato-oncológica: 51 12.2.1 Esquema de Quimioterapia 52 12.2.2 Dia de quimioterapia en relación con el día cero de fiebre 53 12.2.3 Duración de la neutropenia febril 54 12.3 Severidad de la neutropenia al momento de la colonización por EPC 55 12.3.1 Día de inicio de fiebre pos hisopado (+) 55 12.4 Recuento de neutrófilos al inicio de la bacteriemia 56 12.4.1 Profilaxis farmacológica antimicrobiana 56 12.4.2 Antibioticoterapia recibida en el último mes 57 12.4.3 Antibioticoterapia empírica 57 12.4.4 Perfil de resistencia antibiótica del hisopado rectal para Enterobacterias Productoras de Cabapenemasas 58 12.4.5 Antibioticoterapia indicada según sensibilidad del hisopado 59 12.5 Terapia inmunomoduladora 59 12.6 Bacteriemia por Enterobacterias Productoras de Carbapenemasas 59 12.6.1 Bacteriemia por enterobacterias no productoras de carbapenemasa y bacilos gram negativos no fermentadores 60 12.6.2 Antibioticoterapia Dirigida según resultados de hemocultivo y antibiograma 61 12.6.3 Desescalamiento y escalonamiento antibiótico según resultado de Hemocultivo 62 12.6.4 Tiempo de defervescencia de la fiebre con respecto al inicio del antibiótico 63 12.6.5 SOFA score en el momento de inicio de fiebre y mortalidad 63 13. ANÁLISIS BIVARIADO 65 14. DISCUSIÓN 66 15. CONCLUSIONES 73 16. BIBLIOGRAFIA 79spa
dc.format.mimetypeapplication/pdfspa
dc.identifier.instnameinstname:Universidad Autónoma de Bucaramanga - UNABspa
dc.identifier.reponamereponame:Repositorio Institucional UNABspa
dc.identifier.repourlrepourl:https://repository.unab.edu.cospa
dc.identifier.urihttp://hdl.handle.net/20.500.12749/7187
dc.language.isospaspa
dc.publisher.facultyFacultad Ciencias de la Saludspa
dc.publisher.grantorUniversidad Autónoma de Bucaramanga UNABspa
dc.publisher.programEspecialización en Medicina Internaspa
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dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.accessrightshttp://purl.org/coar/access_right/c_abf2spa
dc.rights.creativecommonsAtribución-NoComercial-SinDerivadas 2.5 Colombia*
dc.rights.localAbierto (Texto Completo)spa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/*
dc.subject.keywordsInternal medicineeng
dc.subject.keywordsMedicineeng
dc.subject.keywordsMedical scienceseng
dc.subject.keywordsHealth scienceseng
dc.subject.keywordsNeutropeniaeng
dc.subject.keywordsFevereng
dc.subject.keywordsChemotherapyeng
dc.subject.keywordsBacteremiaeng
dc.subject.keywordsEnterobacteriaeng
dc.subject.keywordsMucosal barrier injuryeng
dc.subject.keywordsNeoplasiaeng
dc.subject.keywordsTreatmenteng
dc.subject.keywordsAntibioticseng
dc.subject.lembMedicina internaspa
dc.subject.lembMedicinaspa
dc.subject.lembCiencias médicasspa
dc.subject.lembNeoplasiaspa
dc.subject.lembTratamientospa
dc.subject.lembAntibióticosspa
dc.subject.proposalCiencias de la saludspa
dc.subject.proposalNeutropeniaspa
dc.subject.proposalFiebrespa
dc.subject.proposalQuimioterapiaspa
dc.subject.proposalBacteriemiaspa
dc.subject.proposalEnterobacteriasspa
dc.subject.proposalLesión de barrera mucosaspa
dc.titleIncidencia y factores asociados a bacteriemia por enterobacterias productoras de carbapenemasas en pacientes con neutropenia febril e hisopado rectal positivospa
dc.title.translatedIncidence and factors associated with bacteremia due to carbapenemase-producing enterobacteriaceae in patients with febrile neutropenia and positive rectal swabeng
dc.type.coarhttp://purl.org/coar/resource_type/c_bdcc
dc.type.driverinfo:eu-repo/semantics/masterThesis
dc.type.hasversioninfo:eu-repo/semantics/acceptedVersion
dc.type.localTesisspa
dc.type.redcolhttp://purl.org/redcol/resource_type/TM

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