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Uropatogenos : su resistencia antimicrobiana en 10 países y el comportamiento de la edad y sexo como factores asociados

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dc.contributor.advisorTorres De Galvis, Yolanda
dc.creatorContreras Parra, Diana Paola
dc.creatorOtero Rosales, Aurelio
dc.creatorParra Abaunza, Katherine
dc.creator.degreeMagíster en epidemiologíaspa
dc.creator.degreetypeFull timespa
dc.date.accessioned2019-10-31T12:02:08Z
dc.date.available2019-10-31T12:02:08Z
dc.date.created2019-10-17
dc.descriptionANTECEDENTES: La resistencia bacteriana es un problema de salud pública mundial, puede atravesar fronteras nacionales e internacionales, a la preocupación global por el incremento en la resistencia bacteriana, se suma la disminución significativa en el desarrollo de nuevas moléculas con actividad antimicrobiana aprobadas por la Agencia Reguladora de Alimentos y medicamentos (FDA por sus siglas en Ingles) con lo cual está generando la “Tormenta perfecta”. JUSTIFICACIÓN: Los antibióticos están dentro de las drogas más prescritas y usadas en la práctica clínica, entre el 20– 50% no son bien utilizados siendo una de las causas del desarrollo de microorganismos multirresistentes. Si no se toma acciones de forma oportuna para reducir el incremento de la resistencia bacteriana, se estima que para el año 2050 el número de muertes ocasionado por esta causa alcanzará los 10 millones anuales y se estaría generando un costo acumulado a la economía global de USD 100 trillones de dólares. OBJETIVO: Determinar si factores como el sexo y la edad están asociados al desarrollo de resistencia antimicrobiana en dos uropatógenos de mayor prevalencia, analizando el programa de vigilancia epidemiológica SMART de los años 2013 al 2017 en 10 países. METODOLOGÍA: Mega estudio observacional analítico transversal utilizando 9,090 registros de la base de datos SMART del 2013 al 2017, que cumplen los criterios de inclusión y exclusión en tres etapas: la primera, descriptiva donde se caracterizó las variables demográficas y clínicas; la segunda consistió en análisis bivariado para estimar la asociación entre la variable dependiente (resistencia antimicrobiana) y las independientes, estimando prevalencia, intervalos de confianza IC 95% y RD. La tercera, obteniendo modelos de predicción que determinan el impacto de los factores y la fuerza de asociación. RESULTADOS: Se incluyeron 9,090 registros 6,332 (69,7%) del sexo femenino, 68,2% >51 años; 24,1% adultos, 2,4% adolescentes y 5,3% niño. El 48,8% de los registros correspondían a pacientes con 48 o más horas de hospitalización y 7% estaban hospitalizados en la unidad de cuidados intensivos; el 94,5% de los uropatógenos fue aislado en orina. Los factores asociados a la resistencia de E. coli a Ertapenem fueron: género masculino (RD 1,69; IC 95%: 1,28-2,23), tiempo de hospitalización mayor de 48 horas (RD 1,50; IC 95%: 1,14-1,98) y estar en UCI (RD 1,82; IC 95%: 1,17-2,85). Respecto a E. coli cuando el tratamiento es con Ceftriaxona los siguientes fueron los factores asociados significativamente: género masculino (RD 1,69; IC 95%: 1,52-1,89), más de 48 horas hospitalizado (RD 1,68; IC 95%: 1,52-1,86). En Klebsiella pneumoniae los factores que explican el desarrollo de resistencia antimicrobiana fueron: género masculino (RD 1,54; IC 95%: 1,24-1,91), más de 48 horas de hospitalización (RD 1,72; IC 95%: 1,39-2,14), atención en UCI (RD 2,02; IC 95%: 1,48-2,75) edad adolescente (RD 2,79; IC 95%: 1,09-7,15), adulto (RD 2,91; IC 95%: 1,43-5,93) y adulto mayor (RD 2,62; IC 95%: 1,32-5,20). Respecto a la resistencia a Ceftriaxona se explica por los siguientes factores: género masculino (RD 1,61; IC 95%: 1,34-1,92), más de 48 horas hospitalizado (OR 1,84; IC 95%: 1,54-2,19) UCI (OR 1,61; IC 95%: 1,21-2,15). CONCLUSIONES: De acuerdo a los hallazgos del estudio el género masculino, la estancia hospitalaria mayor a 48 horas, explican la disminución en la susceptibilidad de E. coli y Klebsiella pneumoniae a Ertapenem y Ceftriaxona; además la resistencia antimicrobiana es directamente proporcional al aumento de la edad. En nuestro estudio ser menor de 8 años fue un factor protector. Nuevas investigaciones son necesarias para evaluar otros factores clínicos que no se incluyeron en el presente estudio, así como los mecanismos de resistencia asociados.spa
dc.description.abstractBACKGROUND: Bacterial resistance is a global public health problem. It can cross national and international borders. In addition to the global concern for the increase in bacterial resistance is the significant decrease in the development of new molecules with antimicrobial activity approved by the regulatory agency of food and medicine (fda), which is generating the “perfect storm.” JUSTIFICATION: Antibiotics are among the most prescribed and used drugs in clinical practice. Between 20-50% are not well used, being one of the causes of the development of multidrug-resistant microorganisms. If actions are not taken in a timely manner to reduce the increase in bacterial resistance, it is estimated that by 2050 the number of deaths caused by this cause will reach 10 million annually and a cumulative cost of USD $100 trillion to the global economy would be generated. OBJECTIVE: The objective is to determine if factors such as sex and age are associated with the development of antimicrobial resistance in two most prevalent uropathogens and analyze the SMART epidemiological surveillance program from 2013 to 2017 in 10 countries. METHODOLOGY: To use a mega cross-sectional analytical observational study using 9,090 records from the SMART database from 2013 to 2017, which meet the inclusion and exclusion criteria in three stages: the first, descriptive where demographic and clinical variables were characterized; the second one consisted of bivariate analysis to estimate the association between the dependent variable (antimicrobial resistance) and the independent ones estimating prevalence. 95% CI and RD confidence intervals; and the third one obtaining prediction models that determine the impact of the factors and strength of association. RESULTS: 9,090 records were included: 6,332 (69.7%) of the female sex, 68.2%> 51 years; 24.1% adults, 2.4% adolescents, and 5.3% children. 48.8% of the records corresponded to patients with 48 or more hours of hospitalization and 7% were hospitalized in the intensive care unit; 94.5% of uropathogens were isolated in urine. Factors associated with the resistance of E. coli to Ertapenem were: male gender (RD 1.69; 95% CI 1.28-2.23), hospitalization time greater than 48 hours (RD 1.50; CI 95 %: 1.14-1.98), and being in ICU (RD 1.82; 95% CI: 1.17-2.85). Regarding E. coli when the treatment is with Ceftriaxone, the following factors were significantly associated: male gender (RD 1.69; 95% CI 1.52-1.89), more than 48 hours hospitalized (RD 1.68; 95% CI: 1.52-1.86). In Klebsiella pneumoniae, the factors that explain the development of antimicrobial resistance were: male gender (RD 1.54; 95% CI: 1.24-1.91), more than 48 hours of hospitalization (RD 1.72; 95% CI : 1.39-2.14), ICU care (RD 2.02; 95% CI: 1.48-2.75) adolescent age (RD 2.79; 95% CI: 1.09-7.15 ), adult (RD 2.91; 95% CI: 1.43-5.93), and senior (RD 2.62; 95% CI: 1.32-5.20). Regarding Ceftriaxone resistance, it is explained by the following factors: male gender (RD 1.61; 95% CI 1.34-1.92), more than 48 hours hospitalized (OR 1.84; 95% CI: 1, 54-2,19), and ICU (OR 1.61; 95% CI: 1.21-2.15). CONCLUSIONS: According to the finding of the study of the male gender, hospital stay longer than 48 hours explain the decrease in the susceptibility of E. coli and Klebsiella pneumoniae to Ertapenem and Ceftriaxone. In addition, antimicrobial resistance is directly proportional to the increase in age. In our study, being under 8 years old was a protective factor. New research is necessary to evaluate other clinical factors that were not included in the present study, as well as the associated resistance mechanisms.spa
dc.description.embargo2021-11-01 01:01:01: Script de automatizacion de embargos. info:eu-repo/date/embargoEnd/2021-10-31
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dc.identifier.doihttps://doi.org/10.48713/10336_20514
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/20514
dc.language.isospaspa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentMaestría en Actividad Física y Saludspa
dc.publisher.otherUniversidad CESspa
dc.publisher.programMaestría en Epidemiologíaspa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)spa
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dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subjectResistencia antimicrobianaspa
dc.subjectAgentes antibacterianosspa
dc.subjectβ-lactamasas y resistencia a antibióticosspa
dc.subjectE. colispa
dc.subjectOrinaspa
dc.subjectAntibacterianosspa
dc.subjectFarmacorresistencia bacterianaspa
dc.subjectEdadspa
dc.subjectSexospa
dc.subject.ddcCiencias médicas, Medicinaspa
dc.subject.keywordAntimicrobial resistancespa
dc.subject.keywordand antibiotic resistanceeng
dc.subject.keywordβ-lactamaseseng
dc.subject.keywordKlebsiella pneumoniaespa
dc.subject.keywordUrinespa
dc.subject.keywordAntibacterialspa
dc.subject.keywordBacterial drug resistancespa
dc.subject.keywordAgespa
dc.subject.keywordSexspa
dc.subject.lembMedicinaspa
dc.subject.lembEpidemiologíaspa
dc.titleUropatogenos : su resistencia antimicrobiana en 10 países y el comportamiento de la edad y sexo como factores asociadosspa
dc.title.TranslatedTitleUropatogens : their antimicrobial resistance in 10 countries and the behavior of age and sex as associated factorseng
dc.typemasterThesiseng
dc.type.documentTesisspa
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTesis de maestríaspa
local.department.reportEscuela de Medicina y Ciencias de la Saludspa
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