Evaluación del impacto del uso de PCR-multiplex en la detección de multidrogo-rresistencia en neumonía en un hospital de alta complejidad en Bogotá, Colombia

Introducción y objetivos: La resistencia antimicrobiana representa una amenaza creciente para la salud global. En el manejo de la neumonía bacteriana, es esencial conocer la epidemiología local y los factores de riesgo para optimizar el tratamiento empírico. Este estudio buscó identificar factores a...

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Autores:
Hernández Linares, Isabel Virginia
Martínez Ávila, María Cristina
Tipo de recurso:
https://purl.org/coar/resource_type/c_7a1f
Fecha de publicación:
2025
Institución:
Universidad El Bosque
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Repositorio U. El Bosque
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spa
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Acceso en línea:
https://hdl.handle.net/20.500.12495/15612
Palabra clave:
Neumonía bacteriana
PCR-multiplex
Resistencia antimicrobiana
Post-COVID-19
Concordancia diagnóstica
Bacterial pneumonia
Multiplex PCR
Antimicrobial resistance
Post-COVID-19
Diagnostic concordance
WB 115
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License
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dc.title.none.fl_str_mv Evaluación del impacto del uso de PCR-multiplex en la detección de multidrogo-rresistencia en neumonía en un hospital de alta complejidad en Bogotá, Colombia
dc.title.translated.none.fl_str_mv Evaluation of the impact of using PCR-multiplex in detecting multidrug resistance in pneumonia at a high-complexity hospital in Bogotá, Colombia
title Evaluación del impacto del uso de PCR-multiplex en la detección de multidrogo-rresistencia en neumonía en un hospital de alta complejidad en Bogotá, Colombia
spellingShingle Evaluación del impacto del uso de PCR-multiplex en la detección de multidrogo-rresistencia en neumonía en un hospital de alta complejidad en Bogotá, Colombia
Neumonía bacteriana
PCR-multiplex
Resistencia antimicrobiana
Post-COVID-19
Concordancia diagnóstica
Bacterial pneumonia
Multiplex PCR
Antimicrobial resistance
Post-COVID-19
Diagnostic concordance
WB 115
title_short Evaluación del impacto del uso de PCR-multiplex en la detección de multidrogo-rresistencia en neumonía en un hospital de alta complejidad en Bogotá, Colombia
title_full Evaluación del impacto del uso de PCR-multiplex en la detección de multidrogo-rresistencia en neumonía en un hospital de alta complejidad en Bogotá, Colombia
title_fullStr Evaluación del impacto del uso de PCR-multiplex en la detección de multidrogo-rresistencia en neumonía en un hospital de alta complejidad en Bogotá, Colombia
title_full_unstemmed Evaluación del impacto del uso de PCR-multiplex en la detección de multidrogo-rresistencia en neumonía en un hospital de alta complejidad en Bogotá, Colombia
title_sort Evaluación del impacto del uso de PCR-multiplex en la detección de multidrogo-rresistencia en neumonía en un hospital de alta complejidad en Bogotá, Colombia
dc.creator.fl_str_mv Hernández Linares, Isabel Virginia
Martínez Ávila, María Cristina
dc.contributor.advisor.none.fl_str_mv Aguirre Rodríguez, Angela Patricia
Iregui, Alejandro Eduardo
García, Olga Milena
Plata-Puyana, Juan David
Roa Buitrago, Jairo Hildebrando
dc.contributor.author.none.fl_str_mv Hernández Linares, Isabel Virginia
Martínez Ávila, María Cristina
dc.contributor.orcid.none.fl_str_mv 0000-0002-6877-2555
0000-0002-1542-0249
dc.subject.none.fl_str_mv Neumonía bacteriana
PCR-multiplex
Resistencia antimicrobiana
Post-COVID-19
Concordancia diagnóstica
topic Neumonía bacteriana
PCR-multiplex
Resistencia antimicrobiana
Post-COVID-19
Concordancia diagnóstica
Bacterial pneumonia
Multiplex PCR
Antimicrobial resistance
Post-COVID-19
Diagnostic concordance
WB 115
dc.subject.keywords.none.fl_str_mv Bacterial pneumonia
Multiplex PCR
Antimicrobial resistance
Post-COVID-19
Diagnostic concordance
dc.subject.nlm.none.fl_str_mv WB 115
description Introducción y objetivos: La resistencia antimicrobiana representa una amenaza creciente para la salud global. En el manejo de la neumonía bacteriana, es esencial conocer la epidemiología local y los factores de riesgo para optimizar el tratamiento empírico. Este estudio buscó identificar factores asociados a neumonía bacteriana multidrogorresistente (MDR) y evaluar el impacto clínico y microbiológico de la PCR-multiplex antes y después de la pandemia por COVID-19. Métodos: Estudio de cohorte analítico, observacional y retrospectivo realizado en un hospital de alta complejidad en Bogotá, Colombia, entre 2018 y 2024. Se comparó el desempeño de PCR-multiplex frente a cultivos tradicionales en pacientes adultos con neumonía bacteriana. Resultados: Se incluyeron 882 pacientes, con mediana de edad de 68 años; el 47% eran mujeres, el 34% ingresó a UCI y la mortalidad fue del 22%. Los patógenos más frecuentes fueron Klebsiella pneumoniae, Staphylococcus aureus, Enterobacter cloacae complex y Acinetobacter baumannii. Se observó un aumento en la detección de virus respiratorios y mecanismos de resistencia post-COVID, destacando KPC (27.9%), CTX-M (22.8%) y mecA/C (13.2%). La falla renal, uso previo de antibióticos e intubación se asociaron a MDR. La PCR-multiplex mostró alta concordancia con cultivos (PCP: 100%, Kappa: 0.72), especialmente para patógenos atípicos. Conclusión: La PCR-multiplex demostró ser una herramienta diagnóstica valiosa, especialmente en la era post-COVID, al detectar con mayor sensibilidad patógenos respiratorios y mecanismos de resistencia. El incremento en la resistencia bacteriana destaca la necesidad de estrategias diagnósticas rápidas y vigilancia continua. Palabras clave: Neumonía bacteriana, PCR-multiplex, Resistencia antimicrobiana, Post-COVID-19, Concordancia diagnóstica.
publishDate 2025
dc.date.accessioned.none.fl_str_mv 2025-07-31T19:43:05Z
dc.date.available.none.fl_str_mv 2025-07-31T19:43:05Z
dc.date.issued.none.fl_str_mv 2025-06
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.local.spa.fl_str_mv Tesis/Trabajo de grado - Monografía - Especialización
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dc.type.driver.none.fl_str_mv info:eu-repo/semantics/bachelorThesis
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dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/20.500.12495/15612
dc.identifier.instname.spa.fl_str_mv instname:Universidad El Bosque
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional Universidad El Bosque
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identifier_str_mv instname:Universidad El Bosque
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language spa
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25. Leung V, Gill S, Sauve J, Walker K, Stumpo C, Powis J. Growing a “positive culture” of antimicrobial stewardship in a community hospital. Can J Hosp Pharm. 2011;64(5):314–20.
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27. Rodríguez-Baño J, Paño-Pardo JR, Alvarez-Rocha L, Asensio Á, Calbo E, Cercenado E, et al. Programas de optimización de uso de antimicrobianos (PROA) en hospitales españoles: documento de consenso GEIH-SEIMC, SEFH y SEMPSPH. Farm Hosp. 2012 Jan-Feb;36(1):33.e1-30.
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31. Bălan AM, Bodolea C, Trancă SD, Hagău N. Trends in Molecular Diagnosis of Nosocomial Pneumonia Classic PCR vs. Point-of-Care PCR: A Narrative Review. Healthcare (Basel). 2023 May 7;11(9):1345.
32. Torres A, Lee N, Cilloniz C, Vila J, Van der Eerden M. Laboratory diagnosis of pneumonia in the molecular age. Eur Respir J. 2016 Dec;48(6):1764-1778. doi: 10.1183/13993003.01144-2016.
33. Poole S, Clark TW. Rapid syndromic molecular testing in pneumonia: The current landscape and future potential. J Infect. 2020 Jan;80(1):1-7. doi: 10.1016/j.jinf.2019.11.021.
34. Molina FJ, Botero LE, Isaza JP, Cano LE, López L, Tamayo L, Torres A. Diagnostic concordance between BioFire® FilmArray® Pneumonia Panel and culture in patients with COVID-19 pneumonia admitted to intensive care units: the experience of the third wave in eight hospitals in Colombia. Crit Care. 2022 May 9;26(1):130. doi: 10.1186/s13054-022-04006-z. PMID: 35534867; PMCID: PMC9084542.
35. Cillóniz C, Dominedò C, Torres A. Multidrug Resistant Gram-Negative Bacteria in Community-Acquired Pneumonia. Crit Care. 2019 Mar 9;23(1):79. doi: 10.1186/s13054-019-2371-3.
36. Torres A, Chalmers JD, Dela Cruz CS, Dominedò C, Kollef M, Martin-Loeches I, Niederman M, Wunderink RG. Challenges in severe community-acquired pneumonia: a point-of-view review. Intensive Care Med. 2019 Feb;45(2):159-171. doi: 10.1007/s00134-019-05519-y.
37. Pourajam S, Kalantari E, Talebzadeh H, Mellali H, Sami R, Soltaninejad F, Amra B, Sajadi M, Alenaseri M, Kalantari F, Solgi H. Secondary Bacterial Infection and Clinical Characteristics in Patients With COVID-19 Admitted to Two Intensive Care Units of an Academic Hospital in Iran During the First Wave of the Pandemic. Front Cell Infect Microbiol. 2022 Feb 23;12:784130. doi: 10.3389/fcimb.2022.784130. PMID: 35281440; PMCID: PMC8904895.
38. Langford BJ, So M, Simeonova M, Leung V, Lo J, Kan T, Raybardhan S, Sapin ME, Mponponsuo K, Farrell A, Leung E, Soucy JR, Cassini A, MacFadden D, Daneman N, Bertagnolio S. Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis. Lancet Microbe. 2023 Mar;4(3):e179-e191. doi: 10.1016/S2666-5247(22)00355-X. Epub 2023 Jan 31. PMID: 36736332; PMCID: PMC9889096.
39. Kosai K, Akamatsu N, Ota K, Mitsumoto-Kaseida F, Sakamoto K, Hasegawa H, Izumikawa K, Mukae H, Yanagihara K. BioFire FilmArray Pneumonia Panel enhances detection of pathogens and antimicrobial resistance in lower respiratory tract specimens. Ann Clin Microbiol Antimicrob. 2022 Jun 4;21(1):24. doi: 10.1186/s12941-022-00512-8. PMID: 35659683; PMCID: PMC9166201.
40. Falsey AR, Branche AR, Croft DP, Formica MA, Peasley MR, Walsh EE. Real-life Assessment of BioFire FilmArray Pneumonia Panel in Adults Hospitalized With Respiratory Illness. J Infect Dis. 2024 Jan 12;229(1):214-222. doi: 10.1093/infdis/jiad221. PMID: 37369370; PMCID: PMC10786250.
41. Ramos-Castañeda JA, Ruano-Ravina A, Barbosa-Lorenzo R, Paillier-Gonzalez JE, Saldaña-Campos JC, Salinas DF, Lemos-Luengas EV. Mortality due to KPC carbapenemase-producing Klebsiella pneumoniae infections: Systematic review and meta-analysis: Mortality due to KPC Klebsiella pneumoniae infections. J Infect. 2018 May;76(5):438-448. doi: 10.1016/j.jinf.2018.02.007. Epub 2018 Mar 1. PMID: 29477802.
42. Berteau F, Kouatchet A, Le Gall Y, Pouplet C, Delbove A, Darreau C, Lemarie J, Jarousseau F, Reizine F, Giacardi C, Allo G, Aubron C, Eveillard M, Dubee V, Mahieu R. Epidemiology and prediction of non-targeted bacteria by the filmarray pneumonia plus panel in culture-positive ventilator-associated pneumonia: a retrospective multicentre analysis. Ann Intensive Care. 2025 Apr 28;15(1):57. doi: 10.1186/s13613-025-01468-6. PMID: 40293547; PMCID: PMC12037957.
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spelling Aguirre Rodríguez, Angela PatriciaIregui, Alejandro EduardoGarcía, Olga MilenaPlata-Puyana, Juan DavidRoa Buitrago, Jairo HildebrandoHernández Linares, Isabel VirginiaMartínez Ávila, María Cristina0000-0002-6877-25550000-0002-1542-02492025-07-31T19:43:05Z2025-07-31T19:43:05Z2025-06https://hdl.handle.net/20.500.12495/15612instname:Universidad El Bosquereponame:Repositorio Institucional Universidad El Bosquerepourl:https://repositorio.unbosque.edu.coIntroducción y objetivos: La resistencia antimicrobiana representa una amenaza creciente para la salud global. En el manejo de la neumonía bacteriana, es esencial conocer la epidemiología local y los factores de riesgo para optimizar el tratamiento empírico. Este estudio buscó identificar factores asociados a neumonía bacteriana multidrogorresistente (MDR) y evaluar el impacto clínico y microbiológico de la PCR-multiplex antes y después de la pandemia por COVID-19. Métodos: Estudio de cohorte analítico, observacional y retrospectivo realizado en un hospital de alta complejidad en Bogotá, Colombia, entre 2018 y 2024. Se comparó el desempeño de PCR-multiplex frente a cultivos tradicionales en pacientes adultos con neumonía bacteriana. Resultados: Se incluyeron 882 pacientes, con mediana de edad de 68 años; el 47% eran mujeres, el 34% ingresó a UCI y la mortalidad fue del 22%. Los patógenos más frecuentes fueron Klebsiella pneumoniae, Staphylococcus aureus, Enterobacter cloacae complex y Acinetobacter baumannii. Se observó un aumento en la detección de virus respiratorios y mecanismos de resistencia post-COVID, destacando KPC (27.9%), CTX-M (22.8%) y mecA/C (13.2%). La falla renal, uso previo de antibióticos e intubación se asociaron a MDR. La PCR-multiplex mostró alta concordancia con cultivos (PCP: 100%, Kappa: 0.72), especialmente para patógenos atípicos. Conclusión: La PCR-multiplex demostró ser una herramienta diagnóstica valiosa, especialmente en la era post-COVID, al detectar con mayor sensibilidad patógenos respiratorios y mecanismos de resistencia. El incremento en la resistencia bacteriana destaca la necesidad de estrategias diagnósticas rápidas y vigilancia continua. Palabras clave: Neumonía bacteriana, PCR-multiplex, Resistencia antimicrobiana, Post-COVID-19, Concordancia diagnóstica.Fundación Santa Fe de BogotáEspecialista en Medicina InternaEspecializaciónBackground: Multidrug-resistant (MDR) pathogens are a growing concern in pneumonia management, particularly in low- and middle-income countries where surveillance is limited. Rapid molecular diagnostics like multiplex PCR may enhance pathogen detection and support antimicrobial stewardship. Objectives: To evaluate the diagnostic performance of multiplex PCR compared to conventional culture in bacterial pneumonia, identify predictors of MDR infection and mortality, and analyze changes in resistance patterns before and after the COVID-19 pandemic in a tertiary hospital in Bogotá, Colombia. Methods: Retrospective cohort study of 882 adults hospitalized with bacterial pneumonia between 2018 and 2024. Microbiological diagnosis was performed using the BioFire® FilmArray® Pneumonia Panel plus and/or culture. Logistic regression identified predictors of MDR infection, mortality, and post-pandemic increases in resistance. Diagnostic agreement was assessed using percent agreement and Cohen’s Kappa. Results: Most prevalent pathogens were Klebsiella pneumoniae (10.5%), Staphylococcus aureus (10.3%), and Acinetobacter baumannii (7.2%). Most frequent resistance genes were KPC (27.9%), CTX-M (22.8%), and mecA/C-MREJ (13.2%). PCR showed high concordance with culture (positive agreement: 100%, negative agreement: 94%). After the pandemic onset, detection of resistance genes rose significantly: VIM (OR 5.12), IMP (OR 4.18), and mecA/C-MREJ (OR 2.9). PCR-guided diagnosis improved antibiotic appropriateness. KPC and mecA/C-MREJ were independently associated with increased mortality (OR 3.34 and 2.47, respectively). Key predictors of MDR included acute kidney injury, prior antibiotic use, and orotracheal intubation. Conclusion: Multiplex PCR demonstrated strong diagnostic concordance with culture and enabled earlier detection of MDR pathogens and resistance genes, especially in the post-pandemic context. Its integration into clinical practice may enhance antimicrobial stewardship and outcomes, while traditional microbiology remains an essential complementary tool. Keywords: multidrug-resistant pneumonia, multiplex PCR, BioFire FilmArray, antimicrobial resistance, COVID-19, Colombia, diagnostic concordance, empirical therapyapplication/pdfAttribution-NonCommercial-ShareAlike 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-sa/4.0/Acceso abiertohttps://purl.org/coar/access_right/c_abf2http://purl.org/coar/access_right/c_abf2Neumonía bacterianaPCR-multiplexResistencia antimicrobianaPost-COVID-19Concordancia diagnósticaBacterial pneumoniaMultiplex PCRAntimicrobial resistancePost-COVID-19Diagnostic concordanceWB 115Evaluación del impacto del uso de PCR-multiplex en la detección de multidrogo-rresistencia en neumonía en un hospital de alta complejidad en Bogotá, ColombiaEvaluation of the impact of using PCR-multiplex in detecting multidrug resistance in pneumonia at a high-complexity hospital in Bogotá, ColombiaEspecialización en Medicina InternaUniversidad El BosqueFacultad de MedicinaTesis/Trabajo de grado - Monografía - Especializaciónhttps://purl.org/coar/resource_type/c_7a1fhttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesishttps://purl.org/coar/version/c_ab4af688f83e57aa1. 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