Asociación de la resistencia bacteriana con la mortalidad en pacientes hematooncológicos con neutropenia febril en dos clínicas en Barranquilla (atl, co) entre los años 2021 y 2023
| dc.contributor.advisor | Bilbao Ramirez, Jorge Luis | |
| dc.contributor.advisor | Fernandez Chica, Dinno Alberto | |
| dc.contributor.author | Pretelt Gazabon, Juan Manuel | |
| dc.contributor.author | Manrique Moreno, Mayra Alejandra | |
| dc.coverage.spatial | Barranquilla | spa |
| dc.creator.email | juanm-preteltg@unilibre.edu.co | spa |
| dc.creator.email | mayraa-manriquem@unilibre.edu.co | spa |
| dc.date.accessioned | 2025-07-30T15:23:21Z | |
| dc.date.available | 2025-07-30T15:23:21Z | |
| dc.date.created | 2025-06-27 | |
| dc.description.abstract | Introducción: La neutropenia febril es una complicación frecuente y potencialmente mortal en pacientes hematooncológicos sometidos a quimioterapia. La emergencia de bacterias multirresistentes ha modificado el pronóstico de estos eventos infecciosos, especialmente en contextos de alta presión antimicrobiana como el hospitalario. Objetivo: Evaluar la asociación de la resistencia bacteriana con la mortalidad de pacientes hematooncológicos con neutropenia febril en dos instituciones prestadoras de salud en Barranquilla (Atlántico, Colombia) entre los años 2021 y 2023. Materiales y Métodos: Se desarrolló un estudio analítico, retrospectivo, incluyendo a pacientes adultos con diagnóstico de enfermedad hematooncológica en tratamiento activo que presentaron neutropenia febril. Se recolectaron variables sociodemográficas, clínicas, microbiológicas y terapéuticas. Se analizaron las asociaciones entre perfiles de resistencia bacteriana y mortalidad mediante modelos de regresión logística multivariados. Resultados: Se analizaron 628 historias clínicas y finalmente se incluyeron 311 pacientes en el estudio. La mortalidad global fue del 23%, no siendo significativamente mayor en casos de infecciones por microorganismos multirresistentes. La mortalidad se asoció con factores microbiológicos, clínicos y de tratamiento. En las características de los pacientes la mayoría eran varones por encima de los 50 años, con neoplasias tipo leucemia o linfoma, las comorbilidades más frecuentes fueron hipertensión arterial y diabetes mellitus tipo 2, el 89% de los pacientes recibió quimioterapia sistémica; las infecciones más frecuentes relacionadas fueron de foco desconocido, hematógenas y urinarias. El perfil microbiológico estuvo dominado por bacilos gramnegativos, principalmente Escherichia coli (34%) y Klebsiella pneumoniae (21%), con una alta frecuencia de cepas productoras de BLEE. El esquema Antimicrobiano inicial más frecuente fue adherente a las guías internacionales con tratamiento con cefepime o piperacilina tazobactam. El grado de neutropenia más frecuente fue la profunda/grave y no se asoció a mortalidad. Conclusiones: La resistencia bacteriana no presentó una asociación en la mortalidad de pacientes hematooncológicos con neutropenia febril, por el contrario, la presencia de neutropenia severa, el aislamiento microbiológico y el esquema FLAG se asociaron con mortalidad en los pacientes estudiados. Se destaca la necesidad de fortalecer la vigilancia microbiológica local, optimizar los protocolos de tratamiento empírico y diseñar estrategias individualizadas de prevención y manejo en esta población de alto riesgo. | spa |
| dc.description.abstractenglish | Background: Febrile neutropenia is a frequent and potentially life-threatening complication in hemato-oncological patients undergoing chemotherapy. The emergence of multidrug-resistant bacteria has significantly altered the clinical course and prognosis of infectious episodes, especially in hospital environments with high antimicrobial selection pressure. Objective: To evaluate the association of bacterial resistance on mortality in hemato-oncological patients with febrile neutropenia treated in two healthcare institutions in Barranquilla (Atlántico, Colombia) between 2021 and 2023. Materials and Methods: An analytical, retrospective study was conducted, including adult patients with a confirmed diagnosis of hemato-oncological malignancy under active treatment who developed febrile neutropenia. Sociodemographic, clinical, microbiological, and therapeutic variables were collected. Associations between microbial profiles, resistance patterns, and mortality were analyzed using multivariate logistic regression. Results: A total of 628 medical records were analyzed, and 311 patients were ultimately included in the study. Overall mortality was 23%, not significantly higher in cases of multidrug-resistant infections. Mortality was associated with microbiological, clinical, and treatment factors. Patient characteristics included the majority of patients aged over 50 years, with leukemia or lymphoma-type malignancies. The most frequent comorbidities were hypertension and type 2 diabetes mellitus. 89% of patients received systemic chemotherapy. The most frequent related infections were of unknown source, hematogenous, and urinary tract infections. The microbiological profile was dominated by gram-negative bacilli, primarily Escherichia coli (34%) and Klebsiella pneumoniae (21%), with a high frequency of ESBL-producing strains. The most common initial antimicrobial regimen adhered to international guidelines, with treatment with cefepime or piperacillin/tazobactam. The most frequent degree of neutropenia was profound/severe and was not associated with mortality. Conclusions: Bacterial resistance was not associated with mortality in hematological-oncological patients with febrile neutropenia. However, the presence of severe neutropenia, microbiological isolation, and the FLAG regimen were associated with mortality in the patients studied. The need to strengthen local microbiological surveillance, optimize empirical treatment protocols, and design individualized prevention and management strategies in this high-risk population is highlighted. | spa |
| dc.description.sponsorship | Universidad Libre - Facultad Ciencias de la salud - Especialización en medicina interna | spa |
| dc.format | spa | |
| dc.identifier.uri | https://hdl.handle.net/10901/31626 | |
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| dc.relation.references | Alonso JJ, Cánovas A, Barreiro JG, Aguirre C. Infectious complications of chemotherapy in clinically aggressive mature B and T cell lymphomas. Eur J Intern Med. 2012 Apr;23(3):255–60. | spa |
| dc.relation.references | Aguado JM, Cruz JJ, Virizuela JA, Aguilar M, Carmona A, Cassinello J, et al. Manejo de la infección y la neutropenia febril en el paciente con cáncer sólido. Enferm Infecc Microbiol Clin. 2017 Aug;35(7):451–60. | spa |
| dc.relation.references | Trecarichi EM, Tumbarello M. Therapeutic options for carbapenem-resistant Enterobacteriaceae infections. Virulence. 2017 May;8(4):470–84. | spa |
| dc.relation.references | Trecarichi EM, Tumbarello M. Antimicrobial-resistant Gram-negative bacteria in febrile neutropenic patients with cancer: current epidemiology and clinical impact. Curr Opin Infect Dis. 2014 Apr;27(2):200–10. | spa |
| dc.relation.references | Regino-Cáceres R, Teherán-Cárdenas A, Sarmiento-Villa G, Camacho-Romero O, Campo-Urbina M. Prevalencia de β-lactamasas de espectro extendido en Escherichia coli y Klebsiella pneumoniae identificados en una institución de salud en Barranquilla. Biociencias. 2022;16(1). | spa |
| dc.relation.references | Gustinetti G, Mikulska M. Bloodstream infections in neutropenic cancer patients: A practical update. Virulence. 2016 Apr;7(3):280–97. | spa |
| dc.relation.references | Carter P, Lagan J, Fortune C, Bhatt DL, Vestbo J, Niven R, et al. Association of Cardiovascular Disease With Respiratory Disease. J Am Coll Cardiol. 2019 May;73(17):2166–77. | spa |
| dc.rights.accessrights | info:eu-repo/semantics/restrictedAccess | spa |
| dc.rights.coar | http://purl.org/coar/access_right/c_abf2 | spa |
| dc.rights.license | Atribución-NoComercial-SinDerivadas 2.5 Colombia | spa |
| dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/2.5/co/ | spa |
| dc.subject | Neutropenia febril | spa |
| dc.subject | Resistencia bacteriana | spa |
| dc.subject | Hemato-oncología | spa |
| dc.subject | Mortalidad | spa |
| dc.subject | Infecciones multirresistentes | spa |
| dc.subject.lemb | Agranulocitosis | spa |
| dc.subject.lemb | Especies promisorias | spa |
| dc.subject.lemb | Convulsiones | spa |
| dc.subject.subjectenglish | Febrile neutropenia | spa |
| dc.subject.subjectenglish | Bacterial resistance | spa |
| dc.subject.subjectenglish | Hemato-oncology | spa |
| dc.subject.subjectenglish | Mortality | spa |
| dc.subject.subjectenglish | Multidrug-resistant infections | spa |
| dc.title | Asociación de la resistencia bacteriana con la mortalidad en pacientes hematooncológicos con neutropenia febril en dos clínicas en Barranquilla (atl, co) entre los años 2021 y 2023 | spa |
| dc.type.coar | http://purl.org/coar/resource_type/c_7a1f | spa |
| dc.type.driver | info:eu-repo/semantics/bachelorThesis | spa |
| dc.type.hasversion | info:eu-repo/semantics/acceptedVersion | spa |
| dc.type.local | Tesis de Especialización | spa |
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