Factores asociados con infecciones por bacterias multirresistentes en el Hospital “Vicente Corral Moscoso” de Cuenca, 2018-2019

Abstract

BACKGROUND: Bacterial resistance constitutes a set of processes that allow microorganisms to adapt to a hostile environment, paradoxically driven by antimicrobials, through the process of selective pressure, which results in the ineffectiveness of therapeutic measures, triggering an increase in morbidity and mortality rates and greater expenditure of medical resources; therefore, the aim of this study is to determine the factors associated with infections caused by multidrug-resistant bacteria at Hospital "Vicente Corral Moscoso" in the city of Cuenca-Ecuador. METHODS: retrospective case-control study, with a sample of 147 cases of hospitalized patients with infections by multiresistant bacterial agents randomly chosen, and 147 control patients with infections by multisensitive bacterial agents matched by age and sex. The studied variables were: age, sex, hospital service, origin of the biological sample, infectious bacterial agent, mechanism of resistance and risk factors. The probability of association between the variables was calculated by means of the Odds Ratio, with a confidence interval (CI) of 95% and significance level of p< 0.05, calculated by McNemar's test. RESULTS: there was a slight predominance of male sex and age of 60 years or more in this sample of 294 patients. Most cultures (32%) were from sputum samples. The most frequently isolated bacterial agent was E. coli. The most common mechanism of resistance was the production of extended-spectrum beta-lactamases (54%). The statistically significant associated factors with infections by multidrug-resistant bacteria were: the presence of central venous catheter (OR: 3.35, CI: 1.71-6.75, p˂0. 001), previous hospitalization (OR: 2.43, CI: 1.33-4.5, p=0.0003), mechanical ventilation (OR: 3.16 CI: 1.21-9.68, p=0.014) and previous antibiotic therapy (OR: 5.58, CI: 2.60-12.61, p˂0.001). CONCLUSION: The most frequently isolated bacteria were E. coli. The most common mechanism of resistance was the production of extended-spectrum beta-lactamases. This study determined the statistically significant association between infections by multidrug-resistant bacteria and the following factors: the presence of central venous catheter, previous hospitalization, history of mechanical ventilation and previous antibiotic therapy.< jats:p> 08 22 2023 08 07 2023 11 16 10.14410/2023.15.1.ao.0 https://revistamedicahjca.iess.gob.ec/ojs2/index.php/HJCA2/article/view/36 Trephine Colostomy vs Conventional Colostomy in patients with intestinal obstruction of malignant etiology at Instituto Oncológico Nacional Dr. Juan Tanca Marengo SOLCA, Guayaquil - Ecuador Juan Bernardo Pazmiño Palacios https://orcid.org/0000-0002-4743-7627 Luis Andrés Idrovo Murillo https://orcid.org/0000-0003-1393-012X Fernando David Miñan Arana https://orcid.org/0000-0001-8203-6848 BACKGROUND: 60% of large bowel obstructions are caused by cancer. The prevalence of malignant bowel obstruction globally varies between 3 and 15 %. Ostomy-related complication rates vary between 21% and 60%. At Instituto Oncologico Nacional Dr. Juan Tanca Marengo, in the city of Guayaquil, intestinal obstruction due to malignant etiology is among the 3 main surgical causes in the surgery service. The surgical alternatives to solve the obstructive condition are conventional colostomy or Trephine colostomy. The aim of this research was to compare colostomy by Trephine technique versus colostomy by laparotomy technique as a derivative method in patients with intestinal obstruction of malignant etiology. METHODS: A descriptive retrospective study was conducted, including 142 patients who underwent derivative treatment (colostomy) for intestinal obstruction of confirmed oncological cause, at Instituto Oncológico Nacional Dr. Juan Tanca Marengo SOLCA, in a period of 36 months from January 2015 - December 2017. The following variables were included: surgical technique (conventional colostomy and Trephine colostomy), age, sex, tumor location, surgical time and complications. The Chi-square test was used, with a significance level of 95%, considering statistical significance with a p value of less than 0.05. RESULTS: The most common age of presentation of malignant obstruction was between 41 - 65 years, in both groups. The most affected sex in both groups was female. The main tumor location was at the level of the anus and rectum in both groups (58%). The surgical time was longer in the group that underwent conventional colostomy, in 84% of the patients the time was longer than 120 minutes, in comparison with the group that underwent Trephine colostomy, in which the surgical time was less than 120 minutes in 61% of the patients (X2 = 31.77, p<0.0001). Complications were more common in the conventional colostomy (75%), the most frequent being abscesses, followed by periostomal infection and necrosis; in comparison with the Trephine colostomy, in which the frequency of complications was 16.7%, the most common being bleeding, prolapse and stenosis (X2=45.694, p <0.0001). CONCLUSION: Surgical time is significantly shorter when performing colostomy with the Threpine technique (p <0.0001); likewise, the percentage of complications obtained with this method is much lower (p <0.0001) compared to conventional colostomy.< jats:p> 08 22 2023 08 07 2023 17 21 10.14410/2023.15.1.ao.03 https://revistamedicahjca.iess.gob.ec/ojs2/index.php/HJCA2/article/view/37 Observational study: Occupational participation and quality of life in people with systemic lupus erythematosus David Vázquez Abadía https://orcid.org/0000-0003-2729-9842 Iván de Rosende Celeiro https://orcid.org/0000-0002-4569-2050 María Dolores Sánchez Maldonado https://orcid.org/0000-0002-7443-9855 BACKGROUND: Lupus is a chronic, multisystemic health condition; its manifestations have special impact on the quality of life and occupational performance of people who suffer from it. Therefore, the present research, related to this topic, has been developed in the autonomous community of Galicia-Spain, in the population of users of the autonomous association of Systemic Lupus Erythematosus, known as AGAL; whose aim was to find the relationship between occupational performance, evaluated through validated tools, and the variables: fatigue, pain and quality of life, in patients with this pathology. METHODS: an observational, descriptive, cross-sectional study was carried out. The study universe consisted of all patients between 18 and 65 years of age, with a diagnosis of SLE, residing in any of the provinces of the Autonomous Community of Galicia, members of AGAL. Each participant underwent a structured interview in which different standardized tools were applied, aimed to evaluate occupational performance, level of fatigue, perception of pain in daily life and the level of quality of life perceived by the participants. Spearman's rho nonparametric correlation coefficient was used to study the possible relationship between the variables. In all tests, a p value of less than 0.05 was considered statistically significant. RESULTS: The mean age of the sample was 50.5 years, 90.9% were female. The mean number of years elapsed since SLE diagnosis was 21 years (SD 11.9). 59.1% of the participants perceived their health as "fair" or "poor"; also more than half of the patients said that they had to stop performing some daily activities due to their physical or emotional health condition. The great majority of participants presented difficulties in daily occupations (basic, instrumental, work/educational, leisure, social participation) due to pain (86.4%). CONCLUSION: The level of fatigue and the level of pain are statistically significantly and positively associated with the performance of basi