Características del almacenamiento de antibióticos en una población suburbana de México

Objetivo: Determinar las características de almacenamiento de los antibióticos de las familias en una población suburbana en México. Metodología: El enfoque del estudio es cuantitativo, observacional, de corte transversal y alcance descriptivo. La unidad de estudio fueron las familias que vivían en el área de estudio de una zona suburbana en México. Resultados: Se encuestaron un total de 235 familias, dentro de las cuales existen diversos grupos etarios, de los cuales predominaron las edades de entre 36 a 64 años en 153 familias. Se obtuvo que más del 70 % presentaban enfermedades y, respecto a la posibilidad de que tuviesen almacenados medicamentos antibióticos caducados o próximos a caducar, el 68.1 % mencionó que no era probable. Conclusiones: El importante número de población adulta, la amplia presencia de comorbilidades y diversos factores sociodemográficos impactan en las prácticas y actitudes en relación con las formas en que las familias obtienen, usan, almacenan y desechan los medicamentos dentro de sus hogares. Esta investigación busca contribuir a la concientización y creación de diversos programas para la adopción de medidas de seguridad para el almacenamiento de medicamentos dentro del hogar, así como servir de guía en la identificación de procedimientos óptimos, eficientes y eficaces para tratar este fenómeno.

Objetivo: Determinar as características do armazenamento de antibióticos das famílias em uma população suburbana no México. Metodologia: A abordagem do estudo é quantitativa, observacional, transversal e de escopo descritivo. A unidade de estudo foram as famílias que viviam na área de estudo de uma zona suburbana no México. Resultados: Foram pesquisadas 235 famílias, de diversas faixas etárias, das quais predominaram as idades de 36 a 64 anos em 153 famílias. Verificou-se que mais de 70% apresentavam enfermidades, e com relação à possibilidade de terem medicamentos antibióticos vencidos ou prestes a vencer armazenados, 68,1 % mencionaram que não era provável. Conclusões: O significativo número de população adulta, a ampla presença de comorbidades e vários fatores sociodemográficos impactam nas práticas e atitudes relativas às formas como as famílias obtêm, usam, armazenam e descartam medicamentos em suas residências. Esta pesquisa busca contribuir para a conscientização e a criação de vários programas para a adoção de medidas de segurança para o armazenamento de medicamentos em casa, bem como servir de guia na identificação de procedimentos ideais, eficientes e eficazes para lidar com esse fenômeno.

Objective: To determine the antibiotic storage characteristics of families in a suburban population in Mexico. Methodology: The study approach is quantitative, observational, cross-sectional and descriptive in scope. The unit of study was families living in the area under study in a suburban zone of Mexico. Results: A total of 235 families were surveyed, within which there are different age groups, with 153 families predominantly aged between 36 and 64 years old. It was obtained that more than 70 % presented illnesses and, regarding the possibility that they had stored expired or soon to expire antibiotic drugs, 68.1 % mentioned that it was not likely. Conclusions: The significant number of adult population, the wide presence of comorbidities and various sociodemographic factors impact practices and attitudes regarding the ways in which families obtain, use, store and dispose of medications within their homes. This research seeks to contribute to the awareness and creation of various programs for the adoption of safety measures for the storage of medicines within the home, as well as to serve as a guide in the identification of optimal, efficient and effective procedures to deal with this phenomenon.

Tuberculosis: a narrative review on epidemiology, risks, implications, preventions and treatments

Tuberculosis (TB) is an airborne disease that generally affects the pulmonary portion of the human body leading to severe coughing, fever and chest pain. It is caused by a bacterium known as Mycobacterium tuberculosis, which kills human beings each and every year globally more than the death toll of combined HIV and malaria. However, it is preventable, treatable, and curable. The world is suffering due to this dreaded disease with an approximate number of 11 million TB cases and 1.6 million deaths annually. Tuberculosis increases the public health attention because of its high mortality rates after HIV/AIDS. World Health Organisation (WHO) and Centre for Chronic Disease Control (CCDC) are the leading organizations playing an important role to combat against TB by publishing proper health guidelines and treatments through reliable awareness campaigns whenever there is sudden outbreaks of TB, COVID-19 and related diseases. A wide range of research findings, clinical reports and new treatment methods like multi-drug therapy have been developed to combat TB. It is still necessary to develop new research and innovative ideas and proper implementations of the treatment and prevention guidelines of WHO and CCDC to fight against this fatal disease. In countries having higher increase of populations due to immunosuppressed chronic diseases like HIV, diabetes and pandemics like COVID-19, eradication of TB infection is a very difficult and challenging task. This mini review is based on the critical analyses of the data available from the official websites of WHO (Global Tuberculosis Report), CCDC, and search engines like Medline, PubMed, Google Scholar, and research findings of selected articles, textbooks were used as additional sources which are cited in the reference section.

Characterization of vancomycin resistance mechanisms in Enterococcus faecium isolates from a Brazilian tertiary hospital / Caracterização dos mecanismos de resistência à vancomicina em isolados de Enterococcus faecium de um hospital terciário brasileiro / Caracterización de los mecanismos de resistencia a la vancomicina en aislamientos de Enterococcus faecium de un hospital terciario brasileño

Background and Objectives: Vancomycin-resistant Enterococcus faecium (VREf) is an opportunistic pathogen responsible for hospital infections, characterized by increasing prevalence and a lack of comprehensive epidemiological studies. We aimed to assess the occurrence of VREf and vancomycin resistance genetic elements vanA and vanB in strains isolated from clinical samples of patients treated at a tertiary hospital in Brazil. Methods: The isolates were obtained from convenience sampling according to routine medical requests for nine months. Enterococcus faecium strains were identified by routine biochemical tests, BD Phoenix® Automated Microbiology System and confirmed by MALDI-TOF Mass Spectrometry. The antimicrobial sensitivity profile was determined by disk-diffusion method and BD Phoenix® Automated Microbiology System. Vancomycin resistance was specially assessed and confirmed by the conventional microdilution technique. Molecular detection of vanA and vanB resistance genes was investigated by polymerase chain reaction (PCR) and confirmed by Sanger DNA sequencing. Results: A total of 8,376 cultures was performed, of which 19 (0.22%) were identified as Enterococcus sp. and nine (47%) as vancomycin-resistant E. faecium. The antimicrobial susceptibility testing analysis of E. faecium showed high resistance to antimicrobial agents. The analysis to determine the genetic profile of E. faecium isolates by PCR showed that all of them carried the vanA gene associated with vancomycin resistance. Conclusion: During the study period, there was low occurrence of Enterococcus species observed. However, all VREf isolates carried the vanA gene associated with vancomycin resistance and showed resistance to commonly used antimicrobial agents, highlighting concerns about the effectiveness of available antimicrobial treatments for infections caused by these isolates.(AU)

Justificativa e Objetivos: Enterococcus faecium resistente à vancomicina (VREf) é um patógeno oportunista responsável por infecções hospitalares, caracterizado por crescente prevalência e falta de estudos epidemiológicos abrangentes. O objetivo foi avaliar a ocorrência de VREf e dos elementos genéticos de resistência à vancomicina vanA e vanB em cepas isoladas de pacientes atendidos em um hospital terciário no Brasil. Métodos: Os isolados foram obtidos por amostragem de conveniência de acordo com as solicitações médicas de rotina durante nove meses. As cepas foram identificadas por testes bioquímicos, Sistema de Microbiologia Automatizada BD Phoenix®, e confirmadas por MALDI-TOF. O perfil de sensibilidade aos antimicrobianos foi determinado por difusão em disco e pelo BD Phoenix®. A resistência à vancomicina foi avaliada e confirmada pela técnica de microdiluição. A detecção molecular dos genes de resistência vanA e vanB foi investigada por reação em cadeia da polimerase (PCR) e sequenciamento de DNA. Resultados: Um total de 8.376 culturas foi realizado, sendo 19 (0.22%) identificadas como Enterococcus sp., e nove (47%), como Enterococcus faecium resistente à vancomicina. A análise do teste de sensibilidade aos antimicrobianos do E. faecium mostrou alta resistência aos antimicrobianos. A análise para determinar o perfil genético dos isolados de E. faecium por PCR mostrou que todos eles carregavam o gene vanA associado à resistência à vancomicina. Conclusão: Durante o período de estudo, observou-se baixa ocorrência de espécies de Enterococcus. No entanto, todos os isolados de VREf apresentaram o gene vanA associado à resistência à vancomicina e mostraram resistência aos antimicrobianos comumente utilizados, alertando sobre a eficácia dos tratamentos antimicrobianos disponíveis para infecções causadas por esses isolados.(AU)

Justificación y Objetivos: Enterococcus faecium resistente a vancomicina (VREf) es un patógeno oportunista responsable de infecciones hospitalarias, caracterizado por su creciente prevalencia y la falta de estudios epidemiológicos exhaustivos. El objetivo fue evaluar la ocurrencia de VREf y los elementos genéticos de resistencia a vancomicina vanA y vanB en cepas aisladas de muestras clínicas de pacientes tratados en un hospital terciario en Brasil. Métodos: Los aislamientos se obtuvieron mediante muestreo de conveniencia según las solicitudes médicas de rutina durante nueve meses. Las cepas fueron identificadas mediante pruebas bioquímicas, utilizando el BD Phoenix® y MALDI-TOF. El perfil de sensibilidad a los antimicrobianos se determinó mediante difusión en disco y el BD Phoenix®. La resistencia a vancomicina se evaluó mediante microdilución. La detección molecular de los genes de resistencia vanA y vanB se investigó mediante reacción en cadena de la polimerasa (PCR) y secuenciación de ADN. Resultados: Se realizaron un total de 8,376 cultivos, identificándose 19 (0.22%) como Enterococcus sp., de las cuales 9 (47%) fueron VREf. El análisis de la sensibilidad a los antimicrobianos mostró una alta resistencia. El análisis para determinar el perfil genético de los aislados de E. faecium mediante PCR mostró que todos portaban el gen vanA asociado a la resistencia a la vancomicina. Conclusión: Durante el período de estudio, se observó una baja incidencia de especies de Enterococcus. Sin embargo, todos los aislamientos de VREf presentaron el gen vanA asociado con resistencia a la vancomicina y mostraron resistencia a los antimicrobianos comúnmente utilizados, lo cual alerta sobre la eficacia de los tratamientos antimicrobianos disponibles para infecciones causadas por VREf.(AU)

Presencia de integrones y su correlación con la multirresistencia en Salmonella entérica serovar Typhimurium: revisión sistemática exploratoria / Presence of integrons and their correlation with multidrug resistance in Salmonella entérica serovar Typhimurium: Exploratory systematic review

La multirresistencia a los antibióticos en Salmonella entérica serovar Typhimurium (Typhimurium) se asocia con integrones que portan genes de resistencia y que son dispersados por elementos genéticos móviles. En esta revisión sistemática exploratoria, se buscó identificar los tipos de integrones y sus genes de resistencia en aislamientos de Typhimurium multirresistentes a antibióticos. Se realizó una búsqueda de artículos en Medline, PubMed, SciELO, ScienceDirect, Redalyc y Google Académico, publicados entre el 2012 y el 2020, en español o inglés, con las palabras claves: "integrons", "antibiotic resistance" y "Salmonella Typhimurium". En el análisis se incluyeron 38 artículos que reportaron multirresistencia a cinco familias de antibióticos. Los integrones de clase 1 con casetes de genes aadA2 y blaPSE-1 fueron los predominantes, algunos probablemente relacionados con la isla genómica de Salmonella 1. No se encontraron integrones de clase 1 y 2 en un mismo aislamiento, ni se reportaron integrones de clase 3. La presencia de integrones explica en gran medida los perfiles de resistencia encontrados en aislamientos de diferentes fuentes de 15 países.

In Salmonella enterica serovar Typhimurium (Typhimurium), multidrug resistance is associated with integrons carrying resistance genes dispersed by mobile genetic elements. This exploratory systematic review sought to identify integron types and their resistance genes in multidrug resistance Typhimurium isolates. We used Medline, PubMed, SciELO, ScienceDirect, Redalyc, and Google Scholar as motor searchers for articles in Spanish or English published between 2012 and 2020, including the keywords "integrons", "antibiotic resistance", and "Salmonella Typhimurium". We included 38 articles reporting multidrug resistance up to five antibiotic families. Class 1 integrons with aadA2 and blaPSE-1 gene cassettes were predominant, some probably related to the Salmonella genomic island 1. We did not find studies detailing class 1 and 2 integrons in the same isolate, nor class 3 integrons reported. The presence of integrons largely explains the resistance profiles found in isolates from different sources in 15 countries.

Study of utilization of antimicrobial drugs and its resistance pattern in patients with septicemia at a tertiary care hospital

Background: Many types of bacteria can produce septicemia. The most common infections that lead to septicemia are urinary tract infections, pneumonia, nephritis and abdominal infections. Methods: The study aims to assess the pattern of antimicrobial drugs used in septicemia and to assess the etiological organisms and their drug sensitivity and resistance pattern. Study participants admitted to tertiary health care centre and who are having septicemia were included in this prospective observational study. Blood culture, bronchial secretions were subjected to microbiological analysis. The etiological organisms, their drug sensitivity and resistance pattern and the outcome of drug therapy were recorded. The clinical course of the study participants was monitored till cure either the resolution of pneumonia. Qualitative data were analyzed using the chi-square test or Fischer's exact test and quantitative data using the independent t test. Results: Mean duration of hospital stay in all patients 13.22±0.45 days and in resistance cases it was found 19.22±0.45 days. Mean duration of ICU stay in all patients was 4.34±0.45 days and in resistant cases mean duration of ICU stay was 8.18±0.45 days. Clinical outcome in overall admitted patients recovered was 97 patients (80.83%) death was 16 patients (13.33%). Clinical outcome in resistant patients recovered 16 patients (13.33%) and death 26 patients (21.66%). Conclusions: The organisms had a varied sensitivity and resistance pattern. The clinical outcome was multifactorial.

Questionnaire-based assessment on knowledge, attitude and practice of fixed-dose combination in medical undergraduates of a tertiary care teaching hospital, Kanpur

Background: Aim was to assess knowledge, attitude and practice of second-year medical undergraduates towards FDC. Methods: A cross-sectional questionnaire-based study was conducted among second-year medical undergraduates of GSVM, medical college, Kanpur in the form of a pre-test, and after sensitizing the students about FDC, the same questionnaire was given as a post-test. Results: A total of 251 students, 157 students participated in the pre-test and 140 participated in the post-test. The percentage of male students in pre and post-test were more (58% and 61.4%) compared to female students (42% and 38.6%). After conducting a post-test survey, there is a significant improvement in knowledge and attitude toward FDC. Conclusions: The inclusion of FDC in the undergraduate curriculum is a good initiative by NMC but there is a need to conduct more CME, symposiums, and workshops in medical colleges to update the knowledge regarding FDC among medical undergraduates.

Antibiotic resistance pattern of Pseudomonas aeruginosa isolated from pus samples at tertiary care cancer hospital

Background: Pseudomonas aeruginosa is one of the most frequent opportunistic microorganisms causing infections in cancer patients. The aim of the study was to determine the antibiotic susceptibility of Pseudomonas aeruginosa and multidrug-resistant (MDR) isolates in cancer patients. Methods: A retrospective study was conducted from January 2022 to December 2022 at Government Cancer Hospital, Aurangabad. A total of 143 pus samples were collected from both IPD and OPD patients. Pus samples were collected as per standard procedure and were inoculated on blood and MacConkey agar. The isolates were identified by standard protocols using biochemical tests. The antibiotic susceptibility pattern of each isolate was checked as per Clinical and Laboratory Standards Institute (CLSI) guidelines 2022 using Kirby-Bauer's disc diffusion method and VITEK 2 Automation. Data analysis was done by statical method with statistical software SPSS version 22. Results: Out of 143 clinical samples 33 samples (23%) were positive for Pseudomonas aeruginosa growth. mean age of patients was 50 years old out of 33 isolates 12 (36%) isolates were multidrug-resistant, 11 (33%) isolates were extensively drug-resistant and 1 (3%) were pan-drug-resistant. The majority of isolates were responsive to polymyxin B 32 (96%) and colistin 32 (96%); However, the resistance to gentamycin, ceftazidime, and amikacin was higher, at 66%, 60%, and 57%, respectively. Conclusions: This hospital-based retrospective study will help to implement better infection control strategies and improve the knowledge of antibiotic resistance patterns among clinicians. Thus, there is a need for an antibiotic stewardship program to monitor the resistant pattern in a tertiary care cancer hospital.

Detection of colistin susceptibility in extended spectrum ? lactamases positive Klebsiella pneumoniae and Escherichia coli clinical isolates by broth disc elution method

Background: Antibiotic resistance is one of the greatest threats in human health. Extended spectrum ? lactamases mediated resistance is prevalent worldwide, Klebsiella pneumoniae and Escherichia coli leap out as this significant ESBL producers conferring resistance to the expanded spectrum cephalosporins. Colistin is being administered as last line therapy for patients that have failed to respond to other available antibiotics that are active against Gram-negative bacteria. Methods: The present study was conducted at school of medical education Kottayam, Kerala from January 2023 to November 2023.During the period of study 150 isolates of K. pneumoniae and 136 isolates of E. coli were collected from various diagnostic microbiology laboratories in Kerala. The colistin susceptibility pattern of ESBL producing isolates was detected by broth disc elution method recommended by CLSI. Results: In this study prevalence of multi-drug resistant is 6% and 9.6% and Extensively-drug resistant is 62% and 63.9% for K. pneumoniae and E. coli respectively. ESBL production was detected as 72% in K. pneumoniae and 79% in E. coli. The colistin susceptibility pattern of ESBL producing K. pneumoniae and E. coli was detected as 76.9% and 87.9% respectively Conclusions: Our result demonstrated that the recent use of colistin as last resort treatment for extensively drug resistant gram-negative bacilli, it is essential to know the prevalence of susceptibility pattern to this antibiotic.

Frecuencia de E. coli y Klebsiella spp productoras de betalactamasas en cultivos procesados en un laboratorio clínico / Frequency of E. coli and betalactamase-producing Klebsiella spp in cultures processed in a clinical laboratory / Frequência de E. coli e Klebsiella spp produtoras de betalactamase em culturas processadas em laboratório clínico

Introducción: la resistencia antibiótica en bacterias patógenas como Escherichia coli y Klebsiella spp. productoras de betalactamasas, han surgido como un problema global de salud pública. Su presencia, se asocia con infecciones intrahospitalarias y comunitarias, aumentando la morbilidad y la mortalidad de los pacientes. Objetivo: determinar la frecuencia de E.coli y Klebsiella spp productoras de betalactamasas en cultivos procesados en un laboratorio clínico. Métodos: se realizó un estudio descriptivo de diseño documental. La muestra estuvo constituida por un total de 1465 resultados de cultivos positivos para Escherichia coli o Klebsiella spp. en el periodo 2022. Para la recolección de la información, se tuvo acceso a la base de datos anonimizada del laboratorio en una hoja de Excel para su posterior análisis. Los datos fueron tabulados en SPSS versión 25. Resultados: el análisis de bacterias productoras de BLEE mostró una positividad del 22,3% en E. coli y 46,1% en Klebsiella spp. E. coli presentó mayor frecuencia de negativos (77,7%) en comparación con Klebsiella spp. La presencia de E. coli fue más común en muestras de orina (90,6%) y en otras muestras como esputo y heridas cutáneas (21,3%). Se evaluaron 8 antibióticos, y se destacó la alta sensibilidad para amikacina (AK) (99,6% y 98,0%) y elevada resistencia ampicilina (AM) (91,5% y 100%) en ambas especies. Ciprofloxacino (CIP) y Trimetropin/Sulfametoxazol (STX) mostraron relativa frecuencia mayor de resistencia. Conclusión: los resultados muestran una alta frecuencia de bacterias productoras de BLEE en E. coli y Klebsiella spp., con una mayor prevalencia en Klebsiella spp. Además, la resistencia a AM, CIP y STX destaca la importancia de una gestión adecuada de la resistencia antimicrobiana.

Introduction: antibiotic resistance in pathogenic bacteria such as Escherichia coli and Klebsiella spp. producing beta-lactamases has emerged as a global public health problem. Their presence has been associated with both hospital-acquired and community-acquired infections, leading to increased morbidity and mortality in patients. Objective: to determine the frequency of betalactamase-producing E. coli and Klebsiella spp. in cultures processed in a clinical laboratory. Methods: a descriptive documentary design study was conducted. The sample consisted of a total of 1465 positive culture results for Escherichia coli or Klebsiella spp. in the year 2022. Data collection involved accessing the laboratory's anonymized database in an Excel sheet for subsequent analysis. The data were tabulated in SPSS version 25. Results: the analysis of ESBL-producing bacteria showed a positivity of 22.3% in E. coli and 46.1% in Klebsiella spp. E. coli showed a higher frequency of negatives (77.7%) compared to Klebsiella spp. The presence of E. coli was more common in urine samples (90.6%) and in other samples such as sputum and skin wounds (21.3%). Eight antibiotics were evaluated, with high sensitivity noted for amikacin (AK) (99.6% and 98.0%) and high resistance for ampicillin (AM) (91.5% and 100%) in both species. Ciprofloxacin (CIP) and Trimethoprim/Sulfamethoxazole (STX) showed a relatively higher frequency of resistance. Conclusion: the results show a high frequency of ESBL-producing bacteria in E. coli and Klebsiella spp., with a higher prevalence in Klebsiella spp. Furthermore, the resistance to AM, CIP, and STX highlights the importance of proper management of antimicrobial resistance.

Introdução: a resistência antibiótica em bactérias patogênicas como Escherichia coli e Klebsiella spp., produtoras de beta-lactamases, emergiu como um problema de saúde pública global. Sua presença tem sido associada a infecções hospitalares e comunitárias, aumentando a morbidade e a mortalidade dos pacientes. Objetivo: determinar a frequência de E. coli e Klebsiella spp. produtoras de betalactamase em culturas processadas em laboratório clínico. Métodos: foi realizado um estudo descritivo de design documental. A amostra consistiu em um total de 1465 resultados de cultura positiva para Escherichia coli ou Klebsiella spp. no ano de 2022. A coleta de dados envolveu o acesso ao banco de dados anonimizado do laboratório em uma planilha do Excel para análise subsequente. Os dados foram tabulados na versão 25 do SPSS. Resultados: a análise de bactérias produtoras de BLEE mostrou uma positividade de 22,3% em E. coli e 46,1% em Klebsiella spp. E. coli apresentou uma frequência maior de resultados negativos (77,7%) em comparação com Klebsiella spp. A presença de E. coli foi mais comum em amostras de urina (90,6%) e em outras amostras, como escarro e feridas na pele (21,3%). Foram avaliados oito antibióticos, com alta sensibilidade observada para amicacina (AK) (99,6% e 98,0%) e alta resistência para ampicilina (AM) (91,5% e 100%) em ambas as espécies. Ciprofloxacina (CIP) e Trimetoprima/Sulfametoxazol (STX) mostraram uma frequência relativamente maior de resistência. Conclusão: os resultados mostram uma alta frequência de bactérias produtoras de BLEE em E. coli e Klebsiella spp., com uma maior prevalência em Klebsiella spp. Além disso, a resistência a AM, CIP e STX destaca a importância da adequada gestão da resistência antimicrobiana.

Antimicrobial use in long-term care facilities: the participation of nurses / Indicação de antimicrobianos em instituições de longa permanência: participação do enfermeiro

Objective: To identify how antimicrobials are prescribed in long-term care facilities from the perspective of nurses. Methods: This descriptive study was conducted using an online survey. Participants were selected through conventional sampling methods and online recruitment. Data were collected through a 2-section self-administered questionnaire: the first section characterized the respondent and the institution, while the second investigated the antimicrobial prescription and usage in the institution. Results: Thirty-five responses were received, representing institutions from every state in Brazil. Sixty percent of the institutions had a part-time physician. More than 90% of the respondents said they contacted a prescriber to report signs and symptoms suggestive of infection, which led to subsequent antimicrobial use. Conclusions: The opinion of nurses has a significant impact on the prescriber's decision to begin antibiotic therapy in long-term care facilities, which indicates that nurses need training about the rational use of antimicrobials. (AU)

Objetivo: Identificar como ocorre a indicação de antimicrobianos nas instituições de longa permanência na perspectiva do profissional enfermeiro. Metodologia: Foi realizado um estudo descritivo por meio de um Survey online. Os participantes foram selecionados por meio de amostra convencional e o recrutamento foi realizado por meio de convite online. A coleta de dados foi feita a partir de um questionário autoaplicável constituído de dois blocos: o primeiro contemplando itens para a caracterização do respondente e da instituição; e o segundo, questões relacionadas ao uso e à indicação de antimicrobianos na instituição. Resultados: Foram recebidas 35 respostas, representando instituições de todos os estados brasileiros. A presença de médico em tempo parcial foi apontada em 60% das instituições. Mais de 90% dos participantes apontaram que acontecia o contato com prescritor para o relato de sinais e sintomas sugestivos de infecção apresentados pelo residente, implicando em uso subsequente de antimicrobianos. Conclusões: A opinião do profissional da Enfermagem tem grande impacto na decisão do prescritor em iniciar a antibioticoterapia nas instituições de longa permanência, demonstrando a necessidade de qualificação desse profissional direcionada ao uso racional de antimicrobianos. (AU)

Prevalence of bacterial infections and antimicrobial resistance profile in hospitalized patients with COVID-19 / Prevalência de infecções bacterianas e perfil de resistência aos antimicrobianos em pacientes internados com COVID-19 / Prevalencia de infecciones bacterianas y perfil de resistencia antimicrobiana en pacientes hospitalizados con COVID-19

Background and Objectives: bacterial resistance is an important public health problem worldwide and is related to the indiscriminate use of antimicrobials, limiting the available therapeutic options. The COVID-19 pandemic aggravated this scenario, since the lack of a standardized therapy led to a considerable increase in the prescription of these drugs. Therefore, we proposed to investigate the prevalence of bacterial infections and the profile of antimicrobial resistance in patients diagnosed with COVID-19 as well as to point out possible risk factors. Methods: a retrospective study based on the analysis of medical records of patients hospitalized with COVID-19 over the age of 18. Information such as age, gender, length of stay, hospitalization unit, bacterial species and resistance profile and previous use of antimicrobials by patients diagnosed with COVID-19 were collected and analyzed using Excel® 2016. Results: of the 268 patients with COVID-19, 162 had suspected bacterial infections, and 26 patients (9.7%) were confirmed from positive cultures. Furthermore, around 80% of these patients underwent empirical treatment with antimicrobials, the majority of whom were male and admitted to the Intensive Care Unit. A total of 32 bacterial isolates were recovered, of which 59.4% were resistant to at least one class of antimicrobials, with 21.8% being multidrug resistant. Conclusion: despite the low percentage found of patients with COVID-19 who had bacterial infections and of these 21.8% were by multidrug-resistant bacteria, the reinforcement in infection prevention policies and the adequate management in the release of antimicrobials is necessary to reduce the hospital dissemination rates of such bacteria.(AU)

Justificativa e Objetivos: a resistência bacteriana é um importante problema de saúde pública mundial relacionado ao uso indiscriminado de antimicrobianos, limitando as opções terapêuticas disponíveis. A pandemia de COVID-19 agravou esse cenário, uma vez que a falta de uma terapia padronizada resultou no aumento considerável na prescrição desses fármacos. Diante disso, propôs-se investigar a prevalência de infecções bacterianas e o perfil de resistência aos antimicrobianos em pacientes diagnosticados com COVID-19, bem como apontar possíveis fatores de risco. Métodos: estudo retrospectivo baseado na análise de prontuários de pacientes internados com COVID-19 com idade superior a 18 anos. Informações como idade, gênero, tempo de internação, unidade de internação, espécie bacteriana e perfil de resistência e uso prévio de antimicrobianos pelos pacientes diagnosticados com COVID-19 foram coletadas e analisadas pelo software Excel® 2016. Resultados: dos 268 pacientes com COVID-19, 162 apresentaram suspeitas de infecções bacterianas, sendo 26 pacientes (9,7%) confirmados a partir de culturas positivas. Ainda, cerca de 80% desses pacientes realizaram tratamento empírico com antimicrobianos, sendo a maioria do sexo masculino e internados em Unidade de Terapia Intensiva. Foram recuperados um total de 32 isolados bacterianos, dos quais 59,4% apresentaram resistência a pelo menos uma classe de antimicrobianos, sendo 21,8% multidroga resistente. Conclusão: apesar do baixo percentual encontrado de pacientes com COVID-19 que apresentaram infecções bacterianas e, desses, 21,8% serem causados por bactérias multirresistentes, o reforço nas políticas de prevenção de infecções e o adequado gerenciamento na liberação de antimicrobianos se fazem necessários para a redução das taxas de disseminação hospitalar de tais bactérias.(AU)

Justificación y Objetivos: la resistencia bacteriana es un importante problema de salud pública en todo el mundo y está relacionada con el uso indiscriminado de antimicrobianos, lo que limita las opciones terapéuticas disponibles. La pandemia por COVID-19 agravó este escenario, ya que la falta de una terapia estandarizada llevó a un aumento considerable en la prescripción de estos fármacos. Por ello, nos propusimos investigar la prevalencia de infecciones bacterianas y el perfil de resistencia antimicrobiana en pacientes diagnosticados de COVID-19, así como señalar posibles factores de riesgo. Métodos: estudio retrospectivo basado en el análisis de historias clínicas de pacientes hospitalizados con COVID-19 mayores de 18 años. Información como edad, sexo, duración de la estadía, unidad de hospitalización, especies bacterianas y perfil de resistencia y uso previo de antimicrobianos por parte de pacientes diagnosticados con COVID-19 fueron recopiladas y analizadas mediante el software Excel® 2016. Resultados: de los 268 pacientes con COVID-19, 162 tenían sospecha de infección bacteriana, con 26 pacientes (9,7%) confirmada a partir de cultivos positivos. Además, alrededor del 80% de estos pacientes recibieron tratamiento empírico con antimicrobianos, la mayoría de los cuales eran hombres e ingresaron en la Unidad de Cuidados Intensivos. Se recuperaron un total de 32 aislados bacterianos, de los cuales el 59,4% eran resistentes a al menos una clase de antimicrobianos y el 21,8% eran resistentes a múltiples fármacos. Conclusión: a pesar del bajo porcentaje encontrado de pacientes con COVID-19 que presentaron infecciones bacterianas, y de éstas cerca del 21,8% fueron por bacterias multirresistentes, es necesario reforzar las políticas de prevención de infecciones y una gestión adecuada en la liberación de antimicrobianos para reducir las tasas de diseminación hospitalaria de dichas bacterias.(AU)

Antimicrobial prescription and bacterial resistance in a Brazilian Intensive Care Unit / Prescrição antimicrobiana e resistência bacteriana em uma Unidade de Terapia Intensiva Brasileira / Prescripción antimicrobiana y resistencia bacteriana en una Unidad de Cuidados Intensivos Brasileña

Background and Objectives: antimicrobial resistance is one of the main public health concerns worldwide. Intensive Care Units have a high prevalence of resistant microorganisms and infections, and the rational use of antibiotics is one of the main strategies for tackling this problem. This work aimed to describe patterns associated with antimicrobial drugs as well as the resistance profile of microorganisms. Methods: an observational study was carried out using data from patients hospitalized in the Intensive Care Unit who used antimicrobial agents. Results: respiratory and cardiological causes were the most frequent reasons for admission, with cephalosporins (29.02%), with penicillin (25.84%) and macrolides (16.10%) being the most used classes of antibiotics. The predominant microorganisms were Klebsiella pneumoniae (13.98%), Staphylococcus aureus (13.44%) and Acinetobacter baumannii (11.83%). Urine cultures and tracheal aspirate were the culture tests with the highest growth of gram-negative microorganisms. Patients with bacteria isolated in tracheal aspirate had longer hospital stays; 20 patients had positive surveillance cultures; and the mortality rate found was 55.45%. Conclusion: the study combined the institution's epidemiological profile with patient characteristics, isolated microorganisms and outcomes.(AU)

Justificativa e Objetivos: a resistência antimicrobiana é uma das principais preocupações de saúde pública em todo o mundo. As Unidades de Terapia Intensiva têm uma alta prevalência de microorganismos resistentes e infecções, e o uso racional de antibióticos é uma das principais estratégias para lidar com esse problema. Este trabalho teve como objetivo descrever padrões associados a medicamentos antimicrobianos, bem como o perfil de resistência dos microorganismos. Métodos: foi realizado um estudo observacional utilizando dados de pacientes hospitalizados na Unidade de Terapia Intensiva que utilizaram agentes antimicrobianos. Resultados: causas respiratórias e cardiológicas foram os motivos mais frequentes de admissão, com cefalosporinas (29,02%), penicilina (25,84%) e macrolídeos (16,10%) sendo as classes de antibióticos mais utilizadas. Os microorganismos predominantes foram Klebsiella pneumoniae (13,98%), Staphylococcus aureus (13,44%) e Acinetobacter baumannii (11,83%). Culturas de urina e aspirado traqueal foram os testes de cultura com maior crescimento de microorganismos gram-negativos. Pacientes com bactérias isoladas no aspirado traqueal tiveram internações mais longas; 20 pacientes tiveram culturas de vigilância positivas; e a taxa de mortalidade encontrada foi de 55,45%. Conclusão: o estudo combinou o perfil epidemiológico da instituição com características dos pacientes, microorganismos isolados e resultados.(AU)

Antecedentes y Objetivos: la resistencia antimicrobiana es una de las principales preocupaciones de salud pública en todo el mundo. Las Unidades de Cuidados Intensivos tienen una alta prevalencia de microorganismos resistentes e infecciones, y el uso racional de antibióticos es una de las principales estrategias para abordar este problema. Este trabajo tuvo como objetivo describir patrones asociados con medicamentos antimicrobianos, así como el perfil de resistencia de los microorganismos. Métodos: se llevó a cabo un estudio observacional utilizando datos de pacientes hospitalizados en la Unidad de Cuidados Intensivos que utilizaron agentes antimicrobianos. Resultados: las causas respiratorias y cardiológicas fueron las razones más frecuentes de admisión, con cefalosporinas (29,02%), penicilina (25,84%) y macrólidos (16,10%) siendo las clases de antibióticos más utilizadas. Los microorganismos predominantes fueron Klebsiella pneumoniae (13,98%), Staphylococcus aureus (13,44%) y Acinetobacter baumannii (11,83%). Los cultivos de orina y el aspirado traqueal fueron las pruebas de cultivo con mayor crecimiento de microorganismos gramnegativos. Los pacientes con bacterias aisladas en el aspirado traqueal tuvieron estancias hospitalarias más largas; 20 pacientes tuvieron cultivos de vigilancia positivos; y la tasa de mortalidad encontrada fue del 55,45%. Conclusión: el estudio combinó el perfil epidemiológico de la institución con las características de los pacientes, los microorganismos aislados y los resultados.(AU)

El enfoque Una Salud y la resistencia a los antimicrobianos: Implementación en el Perú / The One Health Approach and Antimicrobial Resistance: Implementation in Peru

RESUMEN La Resistencia a los Antimicrobianos (RAM) es un problema de salud pública de alcance global. De no lograrse contener su propagación, para el año 2050 se convertiría en la primera causa de muerte a nivel mundial, con un serio impacto en la economía mundial. Esta situación ha determinado la aplicación del enfoque «Una Salud¼ para su contención. Este enfoque reconoce que la salud de las personas, los animales, las plantas y el medio ambiente están estrechamente relacionados y son interdependientes. Desde el año 2015, la Organización Mundial de la Salud, en coordinación con otras organizaciones aprobaron el Plan de Acción Mundial para enfrentar la RAM, esto determinó que los estados miembros elaboraran e implementaran sus planes nacionales. El Perú inició el abordaje para la contención de la RAM aplicando el enfoque «Una Salud¼ desde el año 2017. Se registran algunos avances en la implementación de Plan nacional pero también los retos y acciones pendientes de alcanzar.

ABSTRACT Antimicrobial Resistance (AMR) is a public health problem of global scope, whose projections if its spread is not contained indicate that by the year 2050 it would become the leading cause of death worldwide with a serious impact on the world economy. This situation has determined the application of the "One Health" approach for its containment. The approach recognizes that the health of people, animals, plants and the environment are closely related and interdependent. Since 2015, the WHO, in coordination with other organizations, approved the Global Action Plan to face AMR, this determined that the Member States elaborate and implement their national plans. Peru began the approach to contain AMR applying the "One Health" approach since 2017. Some progress has been made in the implementation of the National Plan but also the challenges and actions pending to be achieved.

Resistencia a los inhibidores de la integrasa en niños con el virus de la inmunodeficiencia humana por transmisión vertical: primeros casos en Uruguay / Resistance to integrase inhibitors in children with vertically-transmitted human immunodeficiency virus: First cases in Uruguay

La resistencia a los antirretrovirales (ARV) es un problema de salud pública. Con el uso de inhibidores de la integrasa (INSTI) en pediatría, también comienzan a aparecer resistencias. El objetivo de esta comunicación es describir 3 casos con resistencia a los INSTI. Se describen 3 pacientes pediátricos con transmisión vertical del virus de la inmunodeficiencia humana (VIH). Iniciaron ARV de lactantes y preescolares, con mala adherencia al tratamiento, cursaron con diferentes planes secundarios a comorbilidades asociadas y fallas virológicas por resistencia. Los 3 casos clínicos describen la rápida aparición de resistencia frente a la falla virológica y el compromiso de los INSTI. La adherencia debe ser supervisada para detectar precozmente el aumento de la viremia. La falla virológica en un paciente tratado con raltegravir obliga a un rápido cambio de esquema ARV, ya que continuar utilizándolo podría favorecer nuevas mutaciones y resistencia a los INSTI de segunda generación.

Antiretroviral (ARV) drug resistance is a public health issue. Resistance has also been observed in the case of integrase strand transfer inhibitors (INSTIs) used in pediatrics. The objective of this article is to describe 3 cases of INSTI resistance. These are the cases of 3 children with vertically-transmitted human immunodeficiency virus (HIV). They were started on ARVs as infants and preschoolers, with poor treatment adherence, and had different management plans due to associated comorbidities and virological failure due to resistance. In the 3 cases, resistance developed rapidly as a result of virological failure and INSTI involvement. Treatment adherence should be monitored so that any increase in viremia can be detected early. Virological failure in a patient treated with raltegravir forces to a rapid change in ARV therapy because its continued use may favor new mutations and resistance to second-generation INSTIs.

Emerging bacterial and fungal pathogens in healthcare and the threat of drug resistance

Managing the treatment of fungal infections, in healthcare facilities is extremely important as drug resistance continues to rise. It's crucial to have programs that oversee the use of antibiotics which can help reduce the emergence of resistance. Rapid diagnostic tools like polymerase chain reaction and next generation sequencing (PCR and NGS) are helpful in targeting treatment plans. Implementing rigorous infection control protocols can effectively reduce the transmission of infections, within healthcare facilities. Collaborative efforts between specialists ensure customized treatment plans that address resistance profiles. Combating evolving drug resistance involves approaches such as combination therapy and immunotherapies. Educating healthcare workers and patients about infection prevention and control is essential. Surveillance and epidemiology play a role in tracking resistance patterns, which in turn guide interventions. International cooperation is crucial due to travel patterns. Continuous research and innovation are essential for management providing insights into treatment effectiveness and mechanisms of resistance. The clinical implications of drug resistance such as increased severity, treatment failures and limited options underscore the need, for an approach. In conclusion, it is imperative to have clinical management strategies to tackle the challenges posed by emerging drug pathogens while safeguarding patient outcomes and public health.

A multidimensional platform of patient-derived tumors identifies drug susceptibilities for clinical lenvatinib resistance

Lenvatinib, a second-generation multi-receptor tyrosine kinase inhibitor approved by the FDA for first-line treatment of advanced liver cancer, facing limitations due to drug resistance. Here, we applied a multidimensional, high-throughput screening platform comprising patient-derived resistant liver tumor cells (PDCs), organoids (PDOs), and xenografts (PDXs) to identify drug susceptibilities for conquering lenvatinib resistance in clinically relevant settings. Expansion and passaging of PDCs and PDOs from resistant patient liver tumors retained functional fidelity to lenvatinib treatment, expediting drug repurposing screens. Pharmacological screening identified romidepsin, YM155, apitolisib, NVP-TAE684 and dasatinib as potential antitumor agents in lenvatinib-resistant PDC and PDO models. Notably, romidepsin treatment enhanced antitumor response in syngeneic mouse models by triggering immunogenic tumor cell death and blocking the EGFR signaling pathway. A combination of romidepsin and immunotherapy achieved robust and synergistic antitumor effects against lenvatinib resistance in humanized immunocompetent PDX models. Collectively, our findings suggest that patient-derived liver cancer models effectively recapitulate lenvatinib resistance observed in clinical settings and expedite drug discovery for advanced liver cancer, providing a feasible multidimensional platform for personalized medicine.

A novel TNKS/USP25 inhibitor blocks the Wnt pathway to overcome multi-drug resistance in TNKS-overexpressing colorectal cancer

Modulating Tankyrases (TNKS), interactions with USP25 to promote TNKS degradation, rather than inhibiting their enzymatic activities, is emerging as an alternative/specific approach to inhibit the Wnt/β-catenin pathway. Here, we identified UAT-B, a novel neoantimycin analog isolated from Streptomyces conglobatus, as a small-molecule inhibitor of TNKS-USP25 protein-protein interaction (PPI) to overcome multi-drug resistance in colorectal cancer (CRC). The disruption of TNKS-USP25 complex formation by UAT-B led to a significant decrease in TNKS levels, triggering cell apoptosis through modulation of the Wnt/β-catenin pathway. Importantly, UAT-B successfully inhibited the CRC cells growth that harbored high TNKS levels, as demonstrated in various in vitro and in vivo studies utilizing cell line-based and patient-derived xenografts, as well as APCmin/+ spontaneous CRC models. Collectively, these findings suggest that targeting the TNKS-USP25 PPI using a small-molecule inhibitor represents a compelling therapeutic strategy for CRC treatment, and UAT-B emerges as a promising candidate for further preclinical and clinical investigations.

Isolation of Enterobacteriaceae strains carrying mcr-1 resistance gene from Shanghai wastewater treatment plants and quantification of their copy number / 上海预防医学

ObjectiveTo provide technical support for the molecular surveillance of pathogenic bacteria strains carrying mobile colistin resistance-1 （mcr⁃1） gene isolate from inlet of wastewater treatment plants （WWTP）. MethodsThe Enterobacteriaceae strains carrying mcr⁃1 resistance gene isolate from inlet of WWTP during April 1 to June 30， 2023 in Shanghai were cultured on blood-rich and SS culture medium and were identified using a mass spectrometry analyzer. The mcr⁃1 gene and copy number were detected by real-time fluorescence quantitative PCR. Drug susceptibility test was performed by microbroth dilution method. The copy numbers of Escherichia coli carrying mcr⁃1 gene isolated from wastewater and human fecel were statistically analyzed by SPSS 25.0. ResultsA total of 14 strains carrying the mcr⁃1 gene were isolated from 49 WWTP samples， and the positive isolation rate was 28.6%， including 12 non-diarrheal E. coli strains and 2 Klebsiella pneumoniae strains. The drug susceptibility results showed that all 14 strains were multi-drug resistant bacteria. They were all sensitive to imipenem and tigecycline， but were ampicillin- and cefazolin-resistant. There was no significant difference in the copy number between human-sourced diarrheal E. coli and wastewater-sourced non-diarrheal E. coli （t=0.647， P>0.05）. ConclusionThe isolation and identification of strains carrying the mcr⁃1 gene from inlet of WWTP samples were firstly established in Shanghai. The multi-drug resistance among the isolated strains is severe. To effectively prevent and control the spread of colistin-resistant bacteria， more attention should be paid to the surveillance of mcr⁃1 gene.

Effect of downregulating proline-rich protein 11 expression on drug resistance of esophageal cancer drug resistant cell EC9706/DDP and its mechanism / 吉林大学学报(医学版)

Objective:To discuss the effect of downregulating the proline-rich protein 11(PRR11)expression on drug resistance of the esophageal cancer drug resistant cells,and to clarify the related mechanism.Methods:The drug resistant cells EC9706/cisplatin(DDP)were established by incrementally stimulating the human esophageal cancer EC9706 cells with the increasing concentrations of DDP.The drug sensitivity of the EC9706/DDP cells was detected by MTT assay;the expression levels of PRR11 mRNA and protein in the EC9706/DDP cells and their parent EC9706 cells were detected by real-time fluorescence quantitative PCR(RT-qPCR)and Western blotting methods.The EC9706/DDP cells were divided into control group,sh-NC group(infected with sh-NC),sh-PRR11 group(infected with sh-PRR11),sh-NC+DDP group(infected with sh-NC and treated with 4 mg·L-1 DDP),and sh-PRR11+DDP group(infected with sh-PRR11 and treated with 4 mg·L-1 DDP).The expression levels of PRR11 mRNA in the cells in various groups were detected by RT-qPCR method;the expression levels of PRR11,phosphoinositide 3-kinase(PI3K)p110α,protein kinase B(AKT),phosphorylated AKT(p-AKT),P-glycoprotein(P-gp),and multidrug resistance-associated protein 1(MRP1)proteins in the cells in various groups were detected by Western blotting method;the apoptotic rates of the cells in various groups were detected by flow cytometry.Results:The DDP-resistant cell line EC9706/DDP was successfully obtained,and the drug resistance index was 7.23±0.86.Compared with the EC9706 cells,the expression levels of PRR11 mRNA and protein in the EC9706/DDP cells were increased(P<0.05).Compared with control and sh-NC groups,the expression levels of PRR11 mRNA and protein in the cells in sh-PRR11 group were decreased(P<0.05),and the 50%inhibitory concentration(IC50)of DDP was decreased(P<0.05).Compared with sh-NC group,the expression levels of PI3K p110α,p-AKT,P-gp,and MRP1 proteins in the cells in sh-NC+DDP and sh-PRR11 groups were decreased(P<0.05),and the apoptotic rate of the cells was increased(P<0.05).Compared with sh-NC+DDP group and sh-PRR11 group,the expression levels of PI3K p110α,p-AKT,P-gp,and MRP1 proteins in the cells in sh-PRR11+ DDP group were increased(P<0.05),and the apoptotic rate of the cells was increased(P<0.05).Conclusion:Downregulating the expression of PRR11 gene in the drug resistant EC9706/DDP cells can inhibit the expressions of drug resistance-related proteins,reverse the resistance to DDP,and induce the apoptosis;its mechanism may be related to the inhibition of activation of the PI3K/AKT signaling pathway.

Analysis of mutation characteristics in TKI-resistant chronic myeloid leukemia patients based on next-generation sequencing technology / 白血病·淋巴瘤

Objective:To explore the characteristics and patterns of gene mutations in tyrosine kinase inhibitor (TKI)-resistant chronic myeloid leukemia (CML) patients and their relationship with TKI-resistant CML.Methods:A retrospective case series study was performed. Clinical data and next-generation sequencing results from TKI-resistant CML patients in Nanfang Hospital of Southern Medical University and Yuebei People's Hospital of Shantou University Medical College from August 2018 to November 2022 were retrospectively analyzed, and the gene mutations of the patients in general and at different disease stages were analyzed.Results:Sixty patients were enrolled, with the age [ M ( Q1, Q3)] of 41.5 years old (32 years old, 53 years old); 38 cases (63.33%) were male and 22 cases (36.67%) were female; 43 cases were in the chronic stage, and 17 cases were in the progression stage (3 cases were in the accelerated stage and 14 cases were in the blast stage). non-ABL1 mutations were detected in 30 patients (50.00%) including 45 times of 15 non-ABL1 genes. The number of non-ABL1 mutation gene was 1 (0, 2) in 60 patients. Of the 60 patients, 21 (35.00%) had ASXL1 mutations, 5 (8.33%) had DNMT3A mutations, 5 (8.33%) had RUNX1 mutations, and 3 (5.00%) had SETBP1 mutations; the proportions of patients with 1 and ≥2 non-ABL1 mutations were 33.33% (20/60) and 16.67% (10/60), respectively. The total detection rates of non-ABL1 mutations were 52.94% (9/17) and 48.84% (21/43), and the detection rates of ≥2 non-ABL1 mutations were 23.53% (4/17) and 13.95% (6/43) in patients with progression and patients with chronic disease, and the differences were not statistically significant ( χ2 = 0.08, P = 0.774; χ2 = 0.80, P = 0.370). Seventeen of 60 patients (28.33%) had mutations in the ABL1 kinase region, of which 14 (82.35%) had non-ABL1 mutations; of these 17 cases, 6 patients with progressive disease all had non-ABL1 mutations, in 11 patients with chronic disease, 8 patients had non-ABL1 mutations, and the difference was not statistically significant ( P = 0.452). Conclusions:Patients with TKI-resistant CML have high frequencies of non-ABL1 mutations, and there is a trend for higher mutation rates in patients with progressive disease than in patients with chronic disease, and these may be related to the abnormal activation of ABL1 kinase by BCR-ABL1 fusion gene in patients with drug-resistant CML, which leads to the genome-level and epigenome-level mutations, and driving disease progression from chronic phase to accelerated or blast phase.