[Impact of rational use of antibiotics in a third level clinic in Colombia]. / Impacto del uso racional de antimicrobianos en una clínica de tercer nivel en Colombia.

BACKGROUND: The increasing resistance of bacteria to antibiotics threatens the survival of patients and health costs. AIM: To determine the impact of an antimicrobial stewardship program in bacterial resistance and antibiotic consumption. MATERIALS AND METHODS: Quasi experimental study in a third level clinic in the city of Medellin, that evaluate in two time periods (pre-intervention between October 2012 and September 2013 and post intervention between October 2013 and September 2014) the impact of an antimicrobial stewardship program in terms of antibiotic consumption and bacterial ecology. RESULTS: Adherence to institutional guidelines for management of infections in the post-intervention period was 82%. Antibiotic consumption of meropenem, ceftriaxone, vancomycin and colistin decreased, and imipenem, daptomycin and linezolid was increased. A significant decrease in antibiotic resistance in Pseudomonas aeruginosa was observed, including carbapenems. An increase of extended spectrum beta lactamase production (ESBL) in Enterobacteriaceae (especially E. coli) and piperacillin/tazobactam resistance was observed. CONCLUSIONS: The construction and implementation of a strategy in hospitals with guidelines for managing infectious diseases, restrictions in antibiotic use, a permanent monitoring system for the formulation of antibiotics, achieved a positive impact on reducing antibiotic use and bacterial resistance.

Impacto del uso racional de antimicrobianos en una clínica de tercer nivel en Colombia / Impact of rational use of antibiotics in a third level clinic in Colombia

Background: The increasing resistance of bacteria to antibiotics threatens the survival of patients and health costs. Aim: To determine the impact of an antimicrobial stewardship program in bacterial resistance and antibiotic consumption. Materials and Methods: Quasi experimental study in a third level clinic in the city of Medellin, that evaluate in two time periods (pre-intervention between October 2012 and September 2013 and post intervention between October 2013 and September 2014) the impact of an antimicrobial stewardship program in terms of antibiotic consumption and bacterial ecology. Results: Adherence to institutional guidelines for management of infections in the post-intervention period was 82%. Antibiotic consumption of meropenem, ceftriaxone, vancomycin and colistin decreased, and imipenem, daptomycin and linezolid was increased. A significant decrease in antibiotic resistance in Pseudomonas aeruginosa was observed, including carbapenems. An increase of extended spectrum beta lactamase production (ESBL) in Enterobacteriaceae (especially E. coli) and piperacillin/tazobactam resistance was observed. Conclusions: The construction and implementation of a strategy in hospitals with guidelines for managing infectious diseases, restrictions in antibiotic use, a permanent monitoring system for the formulation of antibiotics, achieved a positive impact on reducing antibiotic use and bacterial resistance.

Introducción: El aumento progresivo de la resistencia bacteriana a antimicrobianos amenaza la sobrevida de los pacientes y los costos en salud. Objetivo: Determinar el impacto de un programa para el uso racional de antimicrobianos en resistencia bacteriana y consumo de antimicrobianos en una institución de tercer nivel de atención. Materiales y Métodos: Estudio cuasi experimental realizado en una clínica de tercer nivel de la ciudad de Medellín, donde se comparó en dos períodos de tiempo (pre intervención entre octubre de 2012 y septiembre de 2013 y post intervención entre octubre de 2013 y septiembre de 2014) el consumo y la resistencia a antimicrobianos de las bacterias hospitalarias. Resultados: La adherencia a las guías institucionales para el manejo de la patología infecciosa en el período post intervención fue 82%. Se observó una disminución en el consumo de meropenem, ceftriaxona, colistín, vancomicina, y un incremento en el consumo de imipenem, daptomicina y linezolid. Se observó una disminución significativa en la resistencia de Pseudomonas aeruginosa a los antimicrobianos, incluyendo los carbapenémicos. Se presentó un incremento en la proporción de enterobacteriaceas productoras de BLEE (principalmente Escherichia coli) y resistencia a piperacilina/tazobactam. Conclusiones: La construcción e implementación en las instituciones hospitalarias de una estrategia conformada por guías de manejo de la patología infecciosa, restricción en el uso de antimicrobianos y un sistema de vigilancia y un monitoreo permanente a la formulación de éstos, logra un impacto positivo en disminución del consumo de antimicrobianos y resistencia bacteriana.

Higher SLPI expression, lower immune activation, and increased frequency of immune cells in a cohort of Colombian HIV-1 controllers.

BACKGROUND: There are 2 new phenotypes of HIV-1-positive individuals who exhibit a spontaneous and sustained control of viral replication at least for 1 year without antiretroviral therapy (elite controllers <50 copies/mL and viremic controllers <2000 copies/mL). Mechanisms related to this spontaneous control of viral replication are poorly understood. METHODS: The study included HIV-1 controllers (patients with at least 1 year of HIV-1 diagnosis, highly active antiretroviral therapy naive, and with viral loads less than 2000 copies/mL) and HIV-1 progressors without antiretroviral therapy (viral load >2500 copies/mL, and CD4 T-cell count >250 cells/µL at the time of sampling). The expression of soluble factors, leukocyte protease inhibitor (SLPI) and human α-defensins-1 (HAD-1), was measured by real-time polymerase chain reaction from neutrophil cultures with or without HIV stimulation; the frequency and phenotype of innate and adaptive immune cells were determined by flow cytometry, and frequency of human leukocyte antigen alleles was determined by polymerase chain reaction sequence-specific oligonucleotide typing. RESULTS: As expected, HIV-1 controllers had higher CD4 T-cell counts and lower viral load when compared with HIV-1 progressor individuals; in addition, they exhibited lower expression of activation markers, higher frequency of myeloid dendritic cell, lower percentage of regulatory T cells and natural killer cells, and higher expression of SLPI. CONCLUSIONS: All together, these findings suggest that the control of the immune activation status and the production of antiviral proteins by innate immune cells could be associated to the mechanisms involved in the control of HIV-1 replication and better preservation of the CD4 T-cell count.

Potential therapeutic failure of generic vancomycin in a liver transplant patient with MRSA peritonitis and bacteremia.

We report a case of generic vancomycin treatment failure in a liver transplant patient with MRSA peritonitis and bacteremia, followed by a rapid sterilization of blood and peritoneal fluid after switching to the branded product. It raises concern about therapeutic equivalence of generic vancomycin.

Invariant NKT cells from HIV-1 or Mycobacterium tuberculosis-infected patients express an activated phenotype.

The frequency, subsets and activation status of peripheral blood invariant NKT (iNKT) cells were evaluated in pulmonary tuberculosis (TB) patients and in chronically HIV-1-infected subjects. The absolute numbers of iNKT cells were significantly decreased in TB patients and in HIV-1+ individuals who were antiretroviral therapy naive or had detectable viremia despite receiving HAART. iNKT cell subset analysis demonstrated a decreased percentage of CD4(+) iNKT cells in HIV-1+ subjects, and a decreased percentage of double negative iNKT cells in TB patients. Peripheral blood iNKT cells from HIV-1+ and TB patients had significantly increased expression of CD69, CD38, HLA-DR, CD16, CD56, and CD62L. The expression of CD25 was significantly increased only on iNKT cells from TB patients. These findings indicate that peripheral blood iNKT cells in these two chronic infections show an up-regulated expression of activation markers, suggesting their role in the immune response to infection.