Prospective cohort study of incidence and risk factors for catheter-associated urinary tract infections in 145 intensive care units of 9 Latin American countries: INICC findings.

PURPOSE: Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in Latin American Countries. METHODS: From 01/01/2014 to 02/10/2022, we conducted a prospective cohort study in 145 ICUs of 67 hospitals in 35 cities in nine Latin American countries: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Peru. To estimate CAUTI incidence, we used the number of UC-days as the denominator, and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: gender, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, UC-type, hospitalizationtype, ICU type, facility ownership, and time period. RESULTS: 31,631 patients, hospitalized for 214,669 patient-days, acquired 305 CAUTIs. The pooled CAUTI rate per 1000 UC-days was 2.58, for those using suprapubic catheters, it was 2.99, and for those with indwelling catheters, it was 2.21. The following variables were independently associated with CAUTI: age, rising risk 1% yearly (aOR = 1.01; 95% CI 1.01-1.02; p < 0.0001 female gender (aOR = 1.28; 95% CI 1.01-1.61; p = 0.04), LOS before CAUTI acquisition, rising risk 7% daily (aOR = 1.07; 95% CI 1.06-1.08; p < 0.0001, UC/DU ratio (aOR = 1.14; 95% CI 1.08-1.21; p < 0.0001, public facilities (aOR = 2.89; 95% CI 1.75-4.49; p < 0.0001. The periods 2014-2016 and 2017-2019 had significantly higher risks than the period 2020-2022. Suprapubic catheters showed similar risks as indwelling catheters. CONCLUSION: The following CAUTI RFs are unlikely to change: age, gender, hospitalization type, and facility ownership. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.

Mother's smoking habits affects IL10 methylation but not asthma in Ecuadorian children.

There is no evidence evaluating the IL10 epigenetic upregulation among mestizo children in a high-altitude Andean city in Latin America. OBJECTIVE: To identify polymorphisms and methylation profiles in the IL10 gene associated with asthma in children aged 5 to 11. METHODS: A case-control study was conducted with asthmatic and non-asthmatic children aged 5 to 11 years in Cuenca-Ecuador. Data on allergic diseases and risk factors were collected through a questionnaire for parents. Atopy was measured by skin prick test (SPT) to relevant aeroallergens. Three IL10 single nucleotide polymorphisms were evaluated in all participants, and methylation analysis was performed in 54 participants. Association between risk factors, allergic diseases and genetic factors were estimated using multivariate logistic regression. RESULTS: The results of polymorphisms showed no differences between cases and controls when comparing the SNPs rs3024495, rs3024496, rs1800896 allelic and genotypic frequencies. In the methylation analysis, no differences in the IL10 methylation profile were found between cases and controls; however, the multivariate analysis showed an association between the mother's smoking habits and the IL10 methylation profile. CONCLUSION: Smoking habit could be essential as an environmental exposure factor in regulating gene expression in children with asthma.

Examining the impact of a 9-component bundle and the INICC multidimensional approach on catheter-associated urinary tract infection rates in 32 countries across Asia, Eastern Europe, Latin America, and the Middle East.

BACKGROUND: Catheter-Associated Urinary Tract Infections (CAUTIs) frequently occur in the intensive care unit (ICU) and are correlated with a significant burden. METHODS: We implemented a strategy involving a 9-element bundle, education, surveillance of CAUTI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CAUTI rates and performance feedback. This was executed in 299 ICUs across 32 low- and middle-income countries. The dependent variable was CAUTI per 1,000 UC days, assessed at baseline and throughout the intervention, in the second month, third month, 4 to 15 months, 16 to 27 months, and 28 to 39 months. Comparisons were made using a 2-sample t test, and the exposure-outcome relationship was explored using a generalized linear mixed model with a Poisson distribution. RESULTS: Over the course of 978,364 patient days, 150,258 patients utilized 652,053 UC-days. The rates of CAUTI per 1,000 UC days were measured. The rates decreased from 14.89 during the baseline period to 5.51 in the second month (risk ratio [RR] = 0.37; 95% confidence interval [CI] = 0.34-0.39; P < .001), 3.79 in the third month (RR = 0.25; 95% CI = 0.23-0.28; P < .001), 2.98 in the 4 to 15 months (RR = 0.21; 95% CI = 0.18-0.22; P < .001), 1.86 in the 16 to 27 months (RR = 0.12; 95% CI = 0.11-0.14; P < .001), and 1.71 in the 28 to 39 months (RR = 0.11; 95% CI = 0.09-0.13; P < .001). CONCLUSIONS: Our intervention, without substantial costs or additional staffing, achieved an 89% reduction in CAUTI incidence in ICUs across 32 countries, demonstrating feasibility in ICUs of low- and middle-income countries.

International Nosocomial Infection Control Consortium (INICC) report of health care associated infections, data summary of 45 countries for 2015 to 2020, adult and pediatric units, device-associated module.

BACKGROUND: Reporting on the International Nosocomial Infection Control Consortium study results from 2015 to 2020, conducted in 630 intensive care units across 123 cities in 45 countries spanning Africa, Asia, Eastern Europe, Latin America, and the Middle East. METHODS: Prospective intensive care unit patient data collected via International Nosocomial Infection Control Consortium Surveillance Online System. Centers for Disease Control and Prevention/National Health Care Safety Network definitions applied for device-associated health care-associated infections (DA-HAI). RESULTS: We gathered data from 204,770 patients, 1,480,620 patient days, 936,976 central line (CL)-days, 637,850 mechanical ventilators (MV)-days, and 1,005,589 urinary catheter (UC)-days. Our results showed 4,270 CL-associated bloodstream infections, 7,635 ventilator-associated pneumonia, and 3,005 UC-associated urinary tract infections. The combined rates of DA-HAIs were 7.28%, and 10.07 DA-HAIs per 1,000 patient days. CL-associated bloodstream infections occurred at 4.55 per 1,000 CL-days, ventilator-associated pneumonias at 11.96 per 1,000 MV-days, and UC-associated urinary tract infections at 2.91 per 1,000 UC days. In terms of resistance, Pseudomonas aeruginosa showed 50.73% resistance to imipenem, 44.99% to ceftazidime, 37.95% to ciprofloxacin, and 34.05% to amikacin. Meanwhile, Klebsiella spp had resistance rates of 48.29% to imipenem, 72.03% to ceftazidime, 61.78% to ciprofloxacin, and 40.32% to amikacin. Coagulase-negative Staphylococci and Staphylococcus aureus displayed oxacillin resistance in 81.33% and 53.83% of cases, respectively. CONCLUSIONS: The high rates of DA-HAI and bacterial resistance emphasize the ongoing need for continued efforts to control them.

Assessing the impact of a multidimensional approach and an 8-component bundle in reducing incidences of ventilator-associated pneumonia across 35 countries in Latin America, Asia, the Middle East, and Eastern Europe.

BACKGROUND: Ventilator associated pneumonia (VAP) occurring in the intensive care unit (ICU) are common, costly, and potentially lethal. METHODS: We implemented a multidimensional approach and an 8-component bundle in 374 ICUs across 35 low and middle-income countries (LMICs) from Latin-America, Asia, Eastern-Europe, and the Middle-East, to reduce VAP rates in ICUs. The VAP rate per 1000 mechanical ventilator (MV)-days was measured at baseline and during intervention at the 2nd month, 3rd month, 4-15 month, 16-27 month, and 28-39 month periods. RESULTS: 174,987 patients, during 1,201,592 patient-days, used 463,592 MV-days. VAP per 1000 MV-days rates decreased from 28.46 at baseline to 17.58 at the 2nd month (RR = 0.61; 95% CI = 0.58-0.65; P < 0.001); 13.97 at the 3rd month (RR = 0.49; 95% CI = 0.46-0.52; P < 0.001); 14.44 at the 4-15 month (RR = 0.51; 95% CI = 0.48-0.53; P < 0.001); 11.40 at the 16-27 month (RR = 0.41; 95% CI = 0.38-0.42; P < 0.001), and to 9.68 at the 28-39 month (RR = 0.34; 95% CI = 0.32-0.36; P < 0.001). The multilevel Poisson regression model showed a continuous significant decrease in incidence rate ratios, reaching 0.39 (p < 0.0001) during the 28th to 39th months after implementation of the intervention. CONCLUSIONS: This intervention resulted in a significant VAP rate reduction by 66% that was maintained throughout the 39-month period.

Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries: An INICC approach.

BACKGROUND: Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the intensive care unit (ICU) are common and associated with a high burden. METHODS: We implemented a multidimensional approach, incorporating an 11-element bundle, education, surveillance of CLABSI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CLABSI rates and clinical outcomes, and performance feedback in 316 ICUs across 30 low- and middle-income countries. Our dependent variables were CLABSI per 1,000-CL-days and in-ICU all-cause mortality rates. These variables were measured at baseline and during the intervention, specifically during the second month, third month, 4 to 16 months, and 17 to 29 months. Comparisons were conducted using a two-sample t test. To explore the exposure-outcome relationship, we used a generalized linear mixed model with a Poisson distribution to model the number of CLABSIs. RESULTS: During 1,837,750 patient-days, 283,087 patients, used 1,218,882 CL-days. CLABSI per 1,000 CL-days rates decreased from 15.34 at the baseline period to 7.97 in the 2nd month (relative risk (RR) = 0.52; 95% confidence interval [CI] = 0.48-0.56; P < .001), 5.34 in the 3rd month (RR = 0.35; 95% CI = 0.32-0.38; P < .001), and 2.23 in the 17 to 29 months (RR = 0.15; 95% CI = 0.13-0.17; P < .001). In-ICU all-cause mortality rate decreased from 16.17% at baseline to 13.68% (RR = 0.84; P = .0013) at 17 to 29 months. CONCLUSIONS: The implemented approach was effective, and a similar intervention could be applied in other ICUs of low- and middle-income countries to reduce CLABSI and in-ICU all-cause mortality rates.

Incidence and risk factors for catheter-associated urinary tract infection in 623 intensive care units throughout 37 Asian, African, Eastern European, Latin American, and Middle Eastern nations: A multinational prospective research of INICC.

OBJECTIVE: To identify urinary catheter (UC)-associated urinary tract infection (CAUTI) incidence and risk factors. DESIGN: A prospective cohort study. SETTING: The study was conducted across 623 ICUs of 224 hospitals in 114 cities in 37 African, Asian, Eastern European, Latin American, and Middle Eastern countries. PARTICIPANTS: The study included 169,036 patients, hospitalized for 1,166,593 patient days. METHODS: Data collection took place from January 1, 2014, to February 12, 2022. We identified CAUTI rates per 1,000 UC days and UC device utilization (DU) ratios stratified by country, by ICU type, by facility ownership type, by World Bank country classification by income level, and by UC type. To estimate CAUTI risk factors, we analyzed 11 variables using multiple logistic regression. RESULTS: Participant patients acquired 2,010 CAUTIs. The pooled CAUTI rate was 2.83 per 1,000 UC days. The highest CAUTI rate was associated with the use of suprapubic catheters (3.93 CAUTIs per 1,000 UC days); with patients hospitalized in Eastern Europe (14.03) and in Asia (6.28); with patients hospitalized in trauma (7.97), neurologic (6.28), and neurosurgical ICUs (4.95); with patients hospitalized in lower-middle-income countries (3.05); and with patients in public hospitals (5.89).The following variables were independently associated with CAUTI: Age (adjusted odds ratio [aOR], 1.01; P < .0001), female sex (aOR, 1.39; P < .0001), length of stay (LOS) before CAUTI-acquisition (aOR, 1.05; P < .0001), UC DU ratio (aOR, 1.09; P < .0001), public facilities (aOR, 2.24; P < .0001), and neurologic ICUs (aOR, 11.49; P < .0001). CONCLUSIONS: CAUTI rates are higher in patients with suprapubic catheters, in middle-income countries, in public hospitals, in trauma and neurologic ICUs, and in Eastern European and Asian facilities.Based on findings regarding risk factors for CAUTI, focus on reducing LOS and UC utilization is warranted, as well as implementing evidence-based CAUTI-prevention recommendations.

Prospective study of factors associated with asthma attack recurrence (ATTACK) in children from three Ecuadorian cities during COVID-19: a study protocol.

INTRODUCTION: Asthma is a growing health problem in children in marginalised urban settings in low-income and middle-income countries. Asthma attacks are an important cause of emergency care attendance and long-term morbidity. We designed a prospective study, the Asthma Attacks study, to identify factors associated with recurrence of asthma attacks (or exacerbations) among children and adolescents attending emergency care in three Ecuadorian cities. METHODS AND ANALYSIS: Prospective cohort study designed to identify risk factors associated with recurrence of asthma attacks in 450 children and adolescents aged 5-17 years attending emergency care in public hospitals in three Ecuadorian cities (Quito, Cuenca and Portoviejo). The primary outcome will be rate of asthma attack recurrence during up to 12 months of follow-up. Data are being collected at baseline and during follow-up by questionnaire: sociodemographic data, asthma history and management (baseline only); recurrence of asthma symptoms and attacks (monthly); economic costs of asthma to family; Asthma Control Test; Pediatric Asthma Quality of life Questionnaire; and Newcastle Asthma Knowledge Questionnaire (baseline only). In addition, the following are being measured at baseline and during follow-up: lung function and reversibility by spirometry before and after salbutamol; fractional exhaled nitric oxide (FeNO); and presence of IgG antibodies to SARS-CoV-2 in blood. Recruitment started in 2019 but because of severe disruption to emergency services caused by the COVID-19 pandemic, eligibility criteria were modified to include asthmatic children with uncontrolled symptoms and registered with collaborating hospitals. Data will be analysed using logistic regression and survival analyses. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Hospital General Docente de Calderon (CEISH-HGDC 2019-001) and Ecuadorian Ministry of Public Health (MSP-CGDES-2021-0041-O N° 096-2021). The study results will be disseminated through presentations at conferences and to key stakeholder groups including policy-makers, postgraduate theses, peer-review publications and a study website. Participants gave informed consent to participate in the study before taking part.

Enterotoxigenic Escherichia coli multilocus sequence types in Guatemala and Mexico.

The genetic backgrounds of 24 enterotoxigenic Escherichia coli (ETEC) strains from Mexico and Guatemala expressing heat-stable toxin (ST) and coli surface antigen 6 (CS6) were analyzed. US travelers to these countries and resident children in Guatemala were infected by ETEC strains of sequence type 398, expressing STp and carrying genetically identical CS6 sequences.

Development of multiplex PCR assays for detection of enterotoxigenic Escherichia coli colonization factors and toxins.

Four multiplex PCR assays for detection of 19 enterotoxigenic Escherichia coli (ETEC) colonization factors and an improved ETEC toxin multiplex PCR were developed and tested on Bangladeshi and Bolivian ETEC strain collections. The assays will be useful for surveillance of ETEC infections in diagnostic laboratories that have access to PCR.

Clonal relatedness of enterotoxigenic Escherichia coli (ETEC) strains expressing LT and CS17 isolated from children with diarrhoea in La Paz, Bolivia.

BACKGROUND: Enterotoxigenic Escherichia coli (ETEC) is a major cause of traveller's and infantile diarrhoea in the developing world. ETEC produces two toxins, a heat-stable toxin (known as ST) and a heat-labile toxin (LT) and colonization factors that help the bacteria to attach to epithelial cells. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we characterized a subset of ETEC clinical isolates recovered from Bolivian children under 5 years of age using a combination of multilocus sequence typing (MLST) analysis, virulence typing, serotyping and antimicrobial resistance test patterns in order to determine the genetic background of ETEC strains circulating in Bolivia. We found that strains expressing the heat-labile (LT) enterotoxin and colonization factor CS17 were common and belonged to several MLST sequence types but mainly to sequence type-423 and sequence type-443 (Achtman scheme). To further study the LT/CS17 strains we analysed the nucleotide sequence of the CS17 operon and compared the structure to LT/CS17 ETEC isolates from Bangladesh. Sequence analysis confirmed that all sequence type-423 strains from Bolivia had a single nucleotide polymorphism; SNP(bol) in the CS17 operon that was also found in some other MLST sequence types from Bolivia but not in strains recovered from Bangladeshi children. The dominant ETEC clone in Bolivia (sequence type-423/SNP(bol)) was found to persist over multiple years and was associated with severe diarrhoea but these strains were variable with respect to antimicrobial resistance patterns. CONCLUSION/SIGNIFICANCE: The results showed that although the LT/CS17 phenotype is common among ETEC strains in Bolivia, multiple clones, as determined by unique MLST sequence types, populate this phenotype. Our data also appear to suggest that acquisition and loss of antimicrobial resistance in LT-expressing CS17 ETEC clones is more dynamic than acquisition or loss of virulence factors.

Ductus arterioso persistente y morbilidades intrahospitalarias en Recién Nacidos de muy bajo peso al nacer

Introducción: El ductus arterioso persistente (DAP) es el defecto cardiocirculatorio más frecuente en prematuros, está inversamente relacionado con la edad gestacional y el peso al nacimiento; y se asocia a diversas complicaciones. Objetivo: Evaluar la morbilidad asociada a la presencia de ductus arterioso persistente (DAP) en Recién Nacidos de muy bajo peso al nacer (RMBPN). Materiales y Métodos: Estudio retrospectivo de casos y controles anidado en una cohorte de RMBPN admitidos en la UCIN, de enero de 2013 a diciembre de 2015. Excluidos RN con malformaciones congénitas, fallecidos en sala de parto, fallecidos el primer día de vida asociados a asfixia perinatal severa y trasladados a otras instituciones. Las características basales fueron: peso, edad gestacional, sexo, control prenatal, hipertensión materna, embarazo múltiple, restricción del crecimiento, corticoide prenatal, ruptura prolongada de membranas, tipo de parto, Apgar. Las morbilidades analizadas fueron: distres respiratorio (SDR), hemorragia pulmonar, enterocolitis necrozante (ECN), hemorragia intraventricular (HIV), sepsis, soporte respiratorio, broncodisplasia pulmonar (DBP), ruptura alveolar, retinopatía del prematuro (ROP), días de internación y muerte. Se consignaron los datos en SSPS 17 y Epi info 7.2, se aplicó la prueba X² o Fischer, t de Student o la prueba de Mann Whitney. Significancia p< 0,05 con intervalo de confianza 95%. Resultados: Se incluyeron 131 RN, con DAP 62 y sin DAP 69, cuyas características basales fueron similares, salvo el uso de corticoides prenatales para el grupo sin DAP (p 0.035) RR 0,7 (0,5-0,9). Los RN con DAP tuvieron SDR (p 0,0003) RR 1,5 (1,1-1,9), hemorragia pulmonar (p 0,024) RR 8,9 (1,1-69), ventilación mecánica (p 0,0001) RR 1,7(1,3-2,2), oxígeno a los 28 días (p 0,001) RR 2,2 (1,3-3,8), mayor duración de NPT (p 0.01), trasfusiones (p 0,01) RR 1,7(1,3-2,2), HIV (p 0,003) RR 2,1 (1,2-3,6), BDP (p 0,0001) RR 2,6(1,5-4,5), y mayor cantidad de días de internación (p 0,008). Riesgo de muerte (p 0,001) RR 3,5 (1,5-8,2). Sin asociación con ENC (p 0,195), ROP (p 0,739), Sepsis clínica (p 0,123) ni sepsis tardía (p 0,12). Conclusión: Los RMBN con DAP tuvieron mayor riesgo de muerte y morbilidades graves en comparación con los que no desarrollaron DAP.

Introduction: Patent ductus arteriosus (PDA) is the most frequent cardiocirculatory defect in preterm infants; it is inversely related to gestational age and birth weight; it is also associated with various complications. Objective: To determine the intrahospital morbidities in very low birth weight infants (VLBWI) with and without PDA. Materials and Methods: This was a retrospective study of cases and controls nested in a cohort of VLBWI admitted in the NICU, from January 2013 to December 2015. We excluded newborns with congenital malformations, who died in the delivery room, who died on the first day of life because of severe perinatal asphyxia or who were transferred to other institutions. The baseline characteristics were: weight, gestational age, sex, prenatal, maternal hypertension, multiple pregnancy, growth restriction, prenatal corticosteroids, prolonged rupture of membranes, type of delivery, and Apgar score. The morbidities analyzed were respiratory distress (RDS), pulmonary hemorrhage, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), sepsis, respiratory support, bronchopulmonary dysplasia (BPD), alveolar rupture, retinopathy of prematurity (ROP) and death. The data were recorded in SSPS 17 and Epi info 7.2, the X² or Fischer test, Student t test and the Mann Whitney test were applied. Significance was defined as p <0.05 with a 95% confidence interval. Results: We included 131 newborns, 62 with PDA and 69 without PDA, whose baseline characteristics were similar, except for the use of prenatal corticosteroids in the group without PDA (p 0.035) RR 0.7 (0.5-0.9). Newborns with PDA had more RDS (p 0.0003) RR 1.5 (1.1-1.9), pulmonary hemorrhage (p 0.024) RR 8.9 (1,1-69), mechanical ventilation (p 0, 0001) RR 1.7 (1.3-2.2), oxygen at 28 days (p 0.001) RR 2.2 (1.3-3.8), longer duration of TPN (p 0.01), transfusions (p 0.01) RR 1.7 (1.3-2.2), IVH (p 0.003) RR 2.1 (1.2-3.6), BPD (p 0.0001) RR 2.6 1.5-4.5), more hospitalization days (p 0.008) and a risk of death (p 0.001) RR 3.5 (1.5-8.2). No association with was observed with NEC (p 0.195), ROP (p 0.739), clinical sepsis (p 0.123) or late sepsis (p0.12). Conclusion: VLBWI with PDA had a higher risk of death and severe morbidity compared to those who did not have PDA.

Enterotoxins, colonization factors, serotypes and antimicrobial resistance of enterotoxigenic Escherichia coli (ETEC) strains isolated from hospitalized children with diarrhea in Bolivia.

UNLABELLED: Enterotoxigenic Escherichia coli (ETEC) is recognized as the main cause of bacterial diarrhoea among children in Asia, Africa and Latin America but less investigated in Bolivia. OBJECTIVE: To determine the relation between enterotoxins, CFs and serotypes as well as the antimicrobial resistance patterns in a set of ETEC isolates collected from hospitalized children with acute diarrhea. In the present study we characterized 43 ETEC strains isolated from 2002 to 2006 from hospitalized children (0-5 years) with acute diarrhea in Bolivia. The strains were analyzed for heat-labile (LT) and heat-stable (ST) enterotoxins and colonization factor (CF) profiles, as well as for serogroups and antimicrobial resistance using phenotypic (ELISA, dot blot, slide agglutination and disc diffusion) and genotypic (Multiplex PCR) methods. Among the ETEC isolates tested, 30 were positive for LT, 3 for STh and 10 for LT/STh. Sixty-five percent (28/43) of the strains expressed one or more CF. The most common CFs were CS17 (n = 8) and CFA/I (n = 8). The phenotypical and genotypical results for toxins and CFs were congruent except for CS21 that was amplified in 10 of the strains by multiplex PCR, but CS21 pili was only detected phenotypically in four of these strains. The ETEC strains had diverse O and H antigens and the most common types were O8:H9 LT CS17 (n = 6; 14%) and O78:HNM LT-ST CFA/I (n = 4; 9%). The analysis of antibiotic resistance showed that 67% (n = 29/43) of the strains were resistant to one or several of the antimicrobial agents tested. Presence of CFs was associated with antibiotic resistance. CONCLUSION: The most common toxin profile was LT 70%, LT/STh 23% and STh 7%. High antimicrobial resistance to ampicillin among serogroups O6, O8 and O78 were the most common.

Enterotoxins, colonization factors, serotypes and antimicrobial resistance of enterotoxigenic Escherichia coli (ETEC) strains isolated from hospitalized children with diarrhea in Bolivia

Enterotoxigenic Escherichia coli (ETEC) is recognized as the main cause of bacterial diarrhoea among children in Asia, Africa and Latin America but less investigated in Bolivia. OBJECTIVE: To determine the relation between enterotoxins, CFs and serotypes as well as the antimicrobial resistance patterns in a set of ETEC isolates collected from hospitalized children with acute diarrhea. In the present study we characterized 43 ETEC strains isolated from 2002 to 2006 from hospitalized children (0-5 years) with acute diarrhea in Bolivia. The strains were analyzed for heat-labile (LT) and heat-stable (ST) enterotoxins and colonization factor (CF) profiles, as well as for serogroups and antimicrobial resistance using phenotypic (ELISA, dot blot, slide agglutination and disc diffusion) and genotypic (Multiplex PCR) methods. Among the ETEC isolates tested, 30 were positive for LT, 3 for STh and 10 for LT/STh. Sixty-five percent (28/43) of the strains expressed one or more CF. The most common CFs were CS17 (n = 8) and CFA/I (n = 8). The phenotypical and genotypical results for toxins and CFs were congruent except for CS21 that was amplified in 10 of the strains by multiplex PCR, but CS21 pili was only detected phenotypically in four of these strains. The ETEC strains had diverse O and H antigens and the most common types were O8:H9 LT CS17 (n = 6; 14 percent) and O78:HNM LT-ST CFA/I (n = 4; 9 percent). The analysis of antibiotic resistance showed that 67 percent (n = 29/43) of the strains were resistant to one or several of the antimicrobial agents tested. Presence of CFs was associated with antibiotic resistance. CONCLUSION: The most common toxin profile was LT 70 percent, LT/STh 23 percent and STh 7 percent. High antimicrobial resistance to ampicillin among serogroups O6, O8 and O78 were the most common.

[Prevalence of latex hypersensitivity in operating room workers of the University of Chile Clinical Hospital]. / Prevalencia de sensibilización a látex en personal de pabellones quirúrgicos del Hospital Clínico de la Universidad de Chile.

BACKGROUND: Health care workers (HCW) are a high risk group for developing natural rubber latex (NRL) hypersensitivity and allergy. Some studies showed a correlation between time and frequency of exposure to NRL gloves and hypersensitivity, but a recent meta-analysis showed no clear evidences for such assumption. AIM: To determine the prevalence of NRL hypersensitivity and allergy in a group of HCW at the University of Chile Clinical Hospital. MATERIALS AND METHODS: Ninety five HCW (aged 37+/-10 years, 59 females) were interviewed about time of exposure, atopic diseases and latex-related allergy symptoms. Different NRL extracts and seven NRL gloves brands were tested by the prick test method. RESULTS: Twenty four workers (25%, 95% CI = 16.9%-35.2%) were sensitized. No gender differences were found. No symptomatic cases were found in the sensitized group. In the workplace, six and two non sensitized subjects had respiratory symptoms or contact urticaria, respectively. Sensitivity to bananas, avocadoes, kiwi and chestnut was not significantly more common among latex sensitive individuals. No differences between sensitized and non sensitized subjects were observed for the presence of atopic diseases or the mean number of years at the workplace. The sensitization rate to NRL increased along with years of work, from 18.6% in patients working less than 10 years, to 28.1% in the group between 10 and 20 years and to 35% in those working more than 21 years (p=0.693). Sensitization was also related to the weekly hours of exposure: 1-10 hours, 17%; 11-20 hours, 23.5%; 21-30 hours, 50% and 31-40 hours, 28.5% (p=0.036). CONCLUSIONS: Sensitization increased proportionally to the years and weekly hours wearing NLR gloves. We did not find symptomatic patients in the sensitized group.

Multiresistencia antimicrobiana asociada a integrones en enteropatógenos de la diarrea infantil y Escherichia coli de la flora normal en niños menores de 5 años en la ciudad de La Paz / Antimicrobic multiresistence assocised to integrons in enteropathogens of the childrens diarrea and escherichia coli of the normal flora in children under 5 years of age in thy ciy of La Paz

Con el objeto de evaluar la resistencia antimicrobiana a 11 antibióticos y su relación con la presencia de integrones (clase 1-3), se analizó un total de 138 muestras que incluyen enteropatógenos (Shigella spp, EPEC, ETEC y EHEC) aislados de heces de niños con diarrea, así como E. coli no diarreogénica, aislada de heces de niños sanos de la ciudad de La Paz. Entre los marcadores de resistencia más frecuentemente encontrados, se destacan Ampicilina (95%) y Estreptomicina (90%) seguido por Cotrimoxazol (60%). Se encontró un elevado porcentaje (96%) de aislados resistentes al menos a 1 antibiótico, donde la multiresistencia de 3 hasta 6 antibióticos representó el 82%. Los aislados de Shigella spp y E. coli no diarreogénica presentaron perfiles de resistencia similares, predominando la multiresistencia (a 4 antibióticos, en contraste a ETEC y EPEC, con menores porcentajes de resistencia. Esto sugiere que E. coli no diarreogénica puede servir de reservorio de genes de multiresistencia a otros patógenos y viceversa y que la expansión de la multiresistencia estaría relacionada a la prevalencia de enteropatógenos circulantes. Se observó una asociación significativa entre la presencia del integrón de clase 2 con la multiresistencia (a 4 antibióticos en todos los aislados analizados y con el integrón de clase 1 (Shigella spp y E. coli no diarreogénica). La presencia de integrones estuvo asociada en mayor frecuencia a aislados resistentes a 7 antibióticos analizados. Este estudio constituye el primer reporte en nuestro medio de la multiresistencia antimicrobiana asociada a integrones detectados por métodos moleculares, y refleja la amplia distribución de los mismos, tanto en la flora normal como patogénica de la población infantil de la ciudad de La Paz. En conjunto, los datos obtenidos tienen relevancia para el tratamiento antimicrobiano de enfermedades diarreicas y control de la diseminación de la resistencia.

A total of 138 samples collected in the city of La Paz, including enteropathogens isolated from stools of children with diarrhea as well as fecal E. coli from healthy children, were analyzed to evaluate integron-associated antimicrobial multi-resistance distribution. The highest rate of resistance was against Ampicillin (95%), Streptomycin (90%) followed by Cotrimoxazole (60%). A high percentage (96%) of antimicrobial resistance and that multi-resistance expansion may be associated with the circulating enteropathogens prevalence. In all isolates, a significant association among class 2 integron and (4 antibiotic multi-resistance was found, as well as between class 1 integron and isolates from Shigella and non-diarrheogenic E coli. Integron presence was associated with the resistance to 7 antibiotics. This is the first report of molecular detection of integrons among pathogenic and normal flora of child population of city of La Paz demonstrating isolates to at least one antibiotic and multiresistance to between 3-6 antibiotics (82%) was found. Resistance patterns were similar among Shigella spp and non-diarrheogenic E coli, showing high multi-resistance prevalence to (4 antibiotics, in contrast to ETEC and EPEC. These data suggest, that non-diarrheogenic E coli can serve as multi-resistance genes reservoir to other pathogens and vice versa, a wide integron-associated antimicrobial multi-resistance. These results are relevant to antimicrobial diarrhea treatment and resistance dissemination control.

El abuso verbal dentro de la violencia doméstica / Verbal abuse in domestic violence

En este ensayo se analizan las legislaciones vigentes y los tipos de violencia intra familiar, haciendo énfasis en la agresión verbal y el daño que provoca el callar este tipo de agresión. La violencia intra familiar es un mal que históricamente ha aquejado a nuestra sociedad, de modo que a través de la transmisión intergeneracional se ha arraigado como una lamentable costumbre de dificil, pero no imposible, erradicación. Los funcionarios encargados del procedimiento que regula la violencia doméstica en general, deben ser funcionarios, no solo con conocimiento de la ley, sino personas con cogniciones médicas, sociales, culturales e históricas, pues deben ser hábiles para localizar y diagnosticar el problema, sus posibles soluciones y velar por los derechos de las partes. Estos conocimientos especiales deben ser introducidos o bien alimentados por el mismo Estado. Así que el poder Judicial, estaría en la obligación de realizar una serie de actividades académicas, que profundicen sobre el tema, capaciten y actualicen al personal señalado. La educación también debe ser para la población, ya que es el método específico, para evitar la reiteración de conductas que una sociedad considera lesivas, dado que no son las penas, ni las leyes, las que evitan la comisión de estos actos hostiles. Palabras clave: Bloquear, desviar, acusar, culpar, juzgar, criticar, trivializar, socavar, amenazar, insultar, olvidar, ordenar,, negar, actuar con ira, abuso verbal, violencia doméstica.