La amenaza silenciosa de las resistencias bacterianas / The silent threat of bacterial resistance

Las resistencias bacterianas a antimicrobianos representan uno de los principales problemas en la actualidad, encontrándose dentro de las principales causas de muerte en todo el mundo. Latinoamérica y Argentina, lejos de ser una excepción,presentan incidencias crecientes de infecciones por gérmenes resistentes. Cada día, se conocen mejor los mecanismos de resistencia que presentan los bacilos gram negativos y algunos cocos positivos. El problema no surge sólo por el sobreuso de antimicrobianos en la medicina clínica. Su sobreutilización para maximizar los beneficios productivos en la pesca, la ganadería y la agricultura contribuyen a esta situación. Desde la perspectiva de la atención primaria de la salud,consideramos fundamental conocer todos los aspectos que forman parte de esta problemática para intentar mitigar el daño que las resistencias bacterianas generan a nivel global. Argentina se transformó en el primer país de la región y del continente en contar con una ley para prevenir y controlar la resistencia a los Antimicrobianos. Consideramos de vital importancia que se fomenten más y mejores políticas sanitarias de orden público para enfrentar este creciente desafío. (AU)

Nowadays, bacterial resistance to antimicrobials is one of the main problems, being one of the leading causes of death worldwide. Latin America and Argentina, far from being an exception, have an increasing incidence of infections by resistant germs. Every day, the resistance mechanisms of gram-negative bacilli and some positive cocci are better known. The problem does not arise only because of the overuse of antimicrobials in clinical medicine. Its overuse to maximize productive benefits in fishing, livestock, and agriculture also contributes to this issue. From the perspective of primary health care,it is essential to know all the aspects of this problem to mitigate the damage that bacterial resistance generates at a global level. Argentina became the first country in the region and the continent to have a law to prevent and control antimicrobial resistance. We consider it vitally important that more and better public health policies are promoted to face this growing challenge. (AU)

Biopsia en ortopedia y riesgo de contaminación bacteriana durante el muestreo de tejidos: hechos y estrategias / Biopsy in orthopaedics and risk of bacterial contamination during tissue sampling: facts and strategies

Las biopsias en el campo de la ortopedia se utilizan para guiar las opciones de diagnóstico y tratamiento para el proceso de la enfermedad que puede estar ocurriendo. La preparación de la piel de estas biopsias sigue la preparación estándar para un procedimiento quirúrgico, con el objetivo de disminuir la cantidad de microbiota que podría conducir a la contaminación del tejido de la biopsia e incluso a una posible infección. El tejido obtenido de la biopsia a menudo se somete a un studio histopatológico y cultivo. La tasa de contaminación bacteriana informada es aproximadamente inferior al 4%. Esta revisión cuestiona si las muestras de las biopsias se contaminan con la microbiota que permanece en la piel y cómo puede afectar el manejo. Además, qué técnicas o pasos pueden disminuir la tasa de contaminación al realizar una biopsia. Nuestra revisión bibliográfica identificó pocos estudios sobre la contaminación bacteriana de las biopsias. Identificamos diferentes factores implicados en el conocimiento de la microbiota de la piel: técnicas y soluciones de preparación de la piel, variación de la microbiota típica que coloniza la piel según la región anatómica, retención preoperatoria versus administración profiláctica de antibióticos y uso de diferentes hojas de bisturí para la piel superficial y para tejidos profundos, entre otros. Aunque no pudimos identificar ningún dato que proporcionara respuestas a nuestra pregunta original y cuantificar cada factor individualmente, la mayoría de los estudios en diferentes campos ortopédicos proporcionaron hallazgos significativos hasta cierto punto. Describimos algunas recomendaciones prácticas basadas en el consenso y la efectividad teórica para disminuir la tasa de contaminación. Se necesitan más investigaciones en el campo de la ortopedia que impliquen la contaminación por microbiota de la piel de una biopsia

Biopsies in the field of orthopaedics are used to guide diagnostics and treatment options for the disease process that may be occurring such as a tumor or infection. Skin preparation of these biopsies follows the standard skin preparation for a surgical procedure, with the aim to decrease the amount of microbiota that could lead to contamination of the tissue biopsy and even possible infection. The tissue obtained from the biopsy often undergoes pathology and culture. The reported bacterial contamination rate is roughly below 4%. This review questions how samples from the biopsies are getting contaminated by microbiota that remains on the skin and how it affects infection management. In addition, which techniques or steps can decrease the rate of contamination when performing a biopsy. Our review identified little to no data on investigating bacterial contamination of biopsies. In doing this, the review identified different factors implicated in skin microbiota awareness: skin preparation techniques and solutions, variation of typical microbiota that colonize the skin based on the anatomical region, preoperative withholding versus administrating antibiotics prophylactically and using different scalpel blades for superficial and deep incisions, among others. Although we failed to identify any data that provided answers to our original question and quantify each factor individually, most studies in different orthopaedic fields provided significant findings to some extent. We outline some practical recommendations based on consensus and theoretical effectiveness in decreasing the contamination rate. Further research entailing skin microbiota contamination of a biopsy is needed in the field of orthopaedics.

¿Son útiles los antimicrobianos en pacientes con trabajo de parto prematuro, espontáneo, membranas intactas e infección bacteriana ascendente? Una revisión narrativa / Are antibiotics useful in patients with preterm and spontaneous labor, intact membranes and ascendant bacterial infection? A narrative review

El parto prematuro (PP) es la principal causa de morbilidad/mortalidad perinatal y frecuentemente es espontáneo, con membranas intactas (MI). La infección intrauterina es su causa más común en un hospital público de Chile. Existe evidencia que la infección bacteriana ascendente desde la vagina es responsable de la infección/inflamación intraamniótica, del PP y de los resultados adversos maternos y perinatales. Esta revisión narrativa incluye ensayos controlados aleatorizados (ECAs), publicados en PubMed, Cochrane, Embase, Scielo, Science Direct, Wiley Online Library, sobre los mecanismos que intervienen en el ascenso de la infección vaginal, los factores infecciosos que participan en el resultado adverso materno-perinatal y la eficacia de los antimicrobianos en estos casos. Estos trabajos no recomiendan usar antimicrobianos profilácticos porque producen daño a corto y largo plazo en los hijos. Pero este resultado tiene sesgo porque no se evaluó la presencia de infección/inflamación subclínica, lo que disminuye el grado de recomendación. También existen ECAs, que erradican la infección/inflamación intraamniótica, reducen la morbilidad/mortalidad neonatal, pero son trabajos aislados, obtenidos de subanálisis, con bajo nivel de evidencia. Se requieren revisiones sistemáticas y metaanális de ECAs con estudio de infección/inflamación subclínica para evaluar si son útiles los antimicrobianos en el PP espontáneo con MI.

Preterm labor (PL) is the leading cause of perinatal morbidity/ mortality and is frequently spontaneous with intact membranes (IM). Intrauterine infection is its most common cause in a public hospital in Chile. There is evidence that ascending bacterial infection from the vagina is responsible for intraamniotic infection/inflammation, PL, and adverse maternal and perinatal outcomes. This narrative review includes randomized controlled trials (RCTs), published in PubMed, Cochrane, Embase, Scielo, Science Direct, Wiley Online Library on the mechanisms involved in the rise of vaginal infection, the infectious factors involved in adverse maternal-perinatal outcomes, and the efficacy of antibiotics in these cases. They do not recommend the use of prophylactic antibiotics because they cause short and long-term damage to children. But this result is biased because the presence of subclinical infection/inflammation was not evaluated, which lowers the degree of recommendation. There are also RCTs that eradicate intra-amniotic infection/inflammation, reduce neonatal morbidity/ mortality, but they are isolated studies, obtained from subanalyses, with a low level of evidence. Systematic reviews and meta-analyses of RCTs with subclinical infection/inflammation study are required to assess whether antibiotics are useful in spontaneous PL with IM.

Advance on research and application of laboratory pathogen monitoring and early warning technology of bacterial infectious diseases / 中华预防医学杂志

Human beings are still facing the public health challenges from bacterial infectious diseases. Carrying out systematic infectious disease monitoring and early warning is the most direct solution to prevent and control infectious diseases. Etiology is an important part of infectious disease monitoring and early warning. Effective pathogen monitoring can identify pathogens, outbreaks and sources at the first time. In this study, we have reviewed the research and application of etiology monitoring and early warning technology of bacterial infectious diseases and summarized the importance and application scenarios of etiology in infectious disease monitoring and early warning, as well as the research progress of etiology monitoring and early warning technology. Based on the work of existing laboratory monitoring networks, such as Chinese Pathogen Identification Network, the development trend and prospect of infectious disease laboratory network monitoring are put forward to provide a reference for establishing and perfecting the infectious disease monitoring and early warning system.

Vaccination in older adults with cancer and older cancer survivors / Vacinação em idosos com câncer e idosos sobreviventes de câncer

Vaccination is one of the most effective means of preventing infections and should be widely promoted, especially in immunocompromised patients, such as older adults with cancer and older cancer survivors. However, adherence is low, which is due in part to lack of awareness, fear of side effects, hesitancy to vaccinate and rejection of vaccination, especially for COVID-19. The objective of this paper is to clarify current indications for vaccination in these populations and underscore its importance.

A vacinação é uma das medidas mais eficazes para prevenir infecções e deve ser amplamente promovida, especialmente em pacientes imunocomprometidos, como idosos com câncer e idosos sobreviventes de câncer. No entanto, a adesão a esta recomendação é baixa, devido em parte à falta de conhecimento, medo dos efeitos colaterais, e hesitação e rejeição da vacina, especialmente no caso do COVID-19. O objetivo desse artigo é esclarecer as atuais indicações de vacinação nessas populações e ressaltar sua importância.

Hallazgos microbiológicos y susceptibilidad antimicrobiana en cirugía abdominal de urgencia / Microbiological findings and antimicrobial susceptibility in emergency abdominal surgery

Resumen Introducción: Es importante mantener programas de vigilancia bacteriana para disminuir resistencia y definir esquemas farmacológicos adecuados. Los pacientes con abdomen agudo representan un grupo microbiológico especial. Objetivos: Hacer una revisión de agentes patógenos en pacientes adultos operados en nuestro Servicio de Urgencia por patología abdominal con líquido libre y analizar los resultados obtenidos de cultivos respecto a las cepas y la susceptibilidad a los antibióticos. Materiales y Método: Estudio de cohorte prospectiva con estadística descriptiva. Se incluyen pacientes consecutivos, mayores de 18 años, operados por abdomen agudo que presentan líquido libre intraperitoneal entre noviembre de 2017 y abril de 2018. Se excluyen casos con terapia antimicrobiana, hospitalización y/o cirugía en los 3 meses previos. Se registran los cultivos positivos, cepas aisladas, susceptibilidad antimicrobiana, datos demográficos y evolución clínica. Resultados: De 63 pacientes 55% fueron hombres, edad promedio 52,2 años. Las patologías más frecuentes fueron de origen apendicular (62%) y de causa entérica (30%). En un 44% el cultivo fue positivo y en 36% con más de un germen. Escherichia coli fue el patógeno más frecuente (64,2%) seguidos de Enterococcus faecium y Streptococcus anginosus (7,1%). De los otros patógenos cultivados sólo se observó resistencia múltiple en un caso aislado de Morganella Morganii. Conclusiones: Estos datos constituyen la realidad microbiológica local en abdomen agudo. La Escherichia Coli sigue siendo el germen más frecuente, debe enfrentarse con profilaxis y tratamiento antibiótico adecuado. Es necesario mantener vigilancia microbiología local para un manejo acorde.

Introduction: It is important to maintain bacterial surveillance programs to decrease resistance and define adequate pharmacological schemes. Patients with abdomen represent a special microbiological group. Objetives: Make a review of pathogens in adult patients operated in our Emergency Service for abdominal pathology with free fluid and analyze the results obtained from cultures with respect to the strains and susceptibility to antibiotics. Materials and Method: Prospective cohort study with descriptive statistics. We include consecutive patients, older than 18 years old, operated on by abdomen who present free intraperitoneal fluid between November 2017 and April 2018. Cases with antimicrobial therapy, hospitalization and/or surgery 3 months prior are excluded. Positive cultures, isolated strains, antimicrobial susceptibility, demographic data and clinical evolution are recorded. Results: Of 63 patients, 55% were men and the average age was 52.2 years. The most frequent pathologies were of appendicular origin (62%) and of enteric origin (30%). In 44% the crop was positive and in 36% with more than one germ. Escherichia coli was the most frequent pathogen (64.2%) followed by Enterococcus faecium and Streptococcus anginosus (7.1%). Of the others, cultivated pathogens have only observed multiple resistance in an isolated case of Morganella Morganii. Conclusions: These data include the local microbiological reality in acute abdomen. Escherichia coli is still the most frequent germ that must be faced with the profile and the appropriate treatment. It is necessary to maintain local microbiology surveillance for a proper management.

Resistencia antimicrobiana. Importancia y esfuerzos por contenerla / Antimicrobial resistance. Its importance and efforts to control it

Resumen La Organización Mundial de la Salud estima que en 2050 la resistencia bacteriana ocasionará 10 millones de muertes. Como parte del Plan de Acción Mundial sobre la Resistencia a los Antimicrobianos propuso redes de laboratorios especializados, para conservar cepas y optimizar el uso de los antimicrobianos. En un estudio de 2019 se identificó que las principales bacterias del grupo ESKAPE (con alta resistencia a los antibióticos más usados) que causan infecciones en hospitales de México son Klebsiella spp. resistentes a múltiples fármacos (MDR) y productoras de betalactamasa de espectro extendido (BLEE), Enterobacter spp. BLEE, Acinetobacter baumannii, Pseudomonas aeruginosa MDR, Staphylococcus aureus meticilinorresistente y Enterococcus faecium resistente a vancomicina. Con la información de resistencia a los fármacos se recomiendan esquemas para tratar la infección causada por Helicobacter pylori, relacionado con el desarrollo de cáncer y cuya prevalencia en la población adulta de Latinoamérica se estima es de entre 60 y 70 %.

Abstract The World Health Organization estimates that bacterial resistance will cause 10 million deaths by 2050. As part of the Global Action Plan on Antimicrobial Resistance, it proposed networks of specialized laboratories in order to preserve strains and optimize the use of antimicrobials. In a 2019 study, the main bacteria of the ESKAPE group (which are highly-resistant to the most widely used antibiotics) that cause infections in Mexican hospitals were identified to be multidrug-resistant (MDR) and extended spectrum beta-lactamase (ESBL)-producing Klebsiella spp., ESBL-producing Enterobacter spp., Acinetobacter baumannii, MDR Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium. With information on drug resistance, regimens are recommended to treat infection caused by Helicobacter pylori, a pathogen related to the development of cancer and whose prevalence in the adult population of Latin America is estimated to range between 60 and 70%.

Reflexões sobre a biossegurança em acupuntura / Reflections on biosafety in acupuncture

Introdução: A acupuntura integra o escopo das práticas integrativas e complementares em saúde, sendo de extrema importância o uso das normas de biossegurança durante essa técnica. Objetivo: Refletir sobre biossegurança em acupuntura visando diminuir riscos ocupacionais relacionados ao evento adverso de infecção, tanto para o profissional quanto para o paciente. Método: Para a elaboração desta reflexão teórica, utilizaram-se estudos da literatura selecionados de forma intencional. As reflexões sobre biossegurança em acupuntura ocorreram no período de junho a outubro de 2019. Resultados: As infecções constituem os efeitos adversos associados à acupuntura mais relatados na literatura. Nessa prática, verifica-se elevado potencial de inoculação de microrganismos. Assim, devem-se seguir os princípios de promoção em biossegurança conscientizando os profissionais sobre a importância de tais cuidados para a própria segurança e a do paciente, sem minimizar a eficácia do tratamento. Conclusões: Recomenda-se adoção das práticas universais de biossegurança durante a realização de procedimentos de acupuntura.

Background: Acupuncture is an integrative and complementary practice for which biosafety standards are essential. Objective: To elicit a reflection on biosafety in acupuncture to reduce occupational hazards associated with infection as adverse effect for both provider and patient. Methods: The present theoretical essay is grounded on references intentionally selected from June through October 2019. Results: Infection is the adverse effect most frequently reported for acupuncture practice, which involves considerable risk of microorganism inoculation. Provider awareness should be raised to comply with biosafety principles and thus ensure their and patient safety without any negative implications for the effectiveness of treatment. Conclusion: We recommended providers to adopt universal biosafety practices during acupuncture procedures.

Impacto de un programa de optimización de uso de antimicrobianos en un hospital pediátrico de tercer nivel en Panamá / Impact of an antimicrobial stewardship program in a pediatric third level hospital in Panama

Resumen Introducción: Los programas de optimización de uso de antimicrobianos (PROA) se enfocan en el uso apropiado de antimicrobianos para ofrecer mejores resultados clínicos y menores riesgos de eventos adversos. Objetivos: Comparar consumo y costos de antimicrobianos antes y después de instauración de un programa de regulación de antimicrobianos y describir la proporción de resistencia de bacterias prioritarias. Métodos: Estudio cuasi-experimental, retrospectivo y prospectivo, descriptivo y analítico, que comparó el consumo y costo de antimicrobianos en un período pre- intervención (2007-2010) y un período post-intervención (2011-2017). Se realizó análisis descriptivo de resistencias bacterianas prioritarias. Resultados: El consumo de gentamicina, vancomicina, meropenem, cefotaxima, ceftazidima e imipenem disminuyó significativamente en el período post-intervención comparado con el período pre-intervención (p < 0,05), mientras que el consumo de amikacina, piperacilina/tazobactam, cefepime y levofloxacina en el período post-intervención mostró un aumento significativo. La reducción de costos no fue significativa para gentamicina, vancomicina, meropenem, cefotaxima, ceftazidima e imipenem. Para amikacina, cefepime, piperacilina/tazobactam y levofloxacina el aumento de costos no fue significativo. Los aislamientos de Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus y Enterococcus faecalis disminuyeron durante el período post-intervención. Conclusión: el PROA demostró disminución en consumo y costos de algunos antimicrobianos.

Abstract Background: Antimicrobial Stewardship Programs (ASP) focus in the appropriate use of antimicrobials to improve clinical results and minimize risk of adverse events. Aims: To compare consumption and costs of antimicrobials before and after the establishment of an antimicrobial stewardship program and to describe the resistance proportion of priority bacteria. Methods: Quasi-experimental, retrospective and prospective, descriptive and analytical study, to compare consumption and costs of antimicrobials in a pre- intervention period (2007-2010) and a post- intervention period (2011-2017). Additionally, a descriptive analysis of bacterial resistance from 2010 was performed. Results: Gentamicin, vancomycin, meropenem, cefotaxime, ceftazidime and imipenem consumption decreased significantly in the post-intervention period compared to the pre-intervention period (p < 0.05) while consumption of amikacin, piperacillin/tazobactam, cefepime and levofloxacin increased significantly in the post-intervention period. The reduction in costs was not significant for gentamicin, vancomycin, meropenem, cefotaxime, ceftazidime and imipenem, meanwhile, costs increased for amikacin, piperacillin/tazobactam, cefepime and levofloxacin, but this was not significant. The isolation of Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus and Enterococcus faecalis decreased during the post-intervention period. Conclusion: The ASP showed a decrease in consumption and costs of some antimicrobials.

Surgical antibiotic prophylaxis: is the clinical practice based on evidence? / Antibioticoprofilaxia cirúrgica: sua prática clínica está baseada em evidências?

ABSTRACT Objective: To assess the surgical antibiotic prophylaxis. Methods: This was a descriptive study performed at a public tertiary care university hospital gathering prescription, sociodemographic and hospitalization data of inpatients admitted in 2014 who used antimicrobial drugs. This data were obtained from the hospital electronic database. The antimicrobial data were classified according to the anatomical, therapeutic chemical/defined daily dose per 1,000 inpatients. An exploratory analysis was performed using principal component analysis. Results: A total of 5,182 inpatients were prescribed surgical antibiotic prophylaxis. Of the total antimicrobial use, 11.7% were for surgical antibiotic prophylaxis. The orthopedic, thoracic and cardiovascular postoperative units, and postoperative intensive care unit comprised more than half of the total surgical antibiotic prophylaxis use (56.3%). The duration of antimicrobial use of these units were 2.2, 2.0, and 1.4 days, respectively. Third-generation cephalosporins and fluoroquinolones had the longest use among antimicrobial classes. Conclusion: Surgical antibiotic prophylaxis was inadequate in the orthopedic, postoperative intensive care, thoracic and cardiovascular postoperative, gynecology and obstetrics, and otolaryngology units. Therefore, the development and implementation of additional strategies to promote surgical antibiotic stewardship at hospitals are essential.

RESUMO Objetivo: Avaliar a utilização de antibioticoprofilaxia cirúrgica. Métodos: Foi realizado um estudo descritivo em um hospital universitário de cuidado terciário por meio de coleta de dados de prescrição, sociodemográficos e de hospitalização sobre todos os pacientes internados em 2014 que utilizaram pelo menos um medicamento antimicrobiano. Esses dados foram coletados da base de dados eletrônica do hospital. O consumo de antimicrobianos foi analisado de acordo com a classificação anatômica terapêutica e química/dose diária definida por mil pacientes-dia. Realizou-se uma análise exploratória por meio da análise de componentes principais. Resultados: Um total de 5.182 pacientes internados receberam prescrição de antibioticoprofilaxia cirúrgica, que corresponde a 11,7% do total de antibióticos utilizados no hospital. As unidades de ortopedia, pós-operatória de cirurgia torácica e cardiovascular e terapia intensiva pós-operatória foram responsáveis pela utilização de mais da metade (56,3%) da antibioticoprofilaxia cirúrgica. A duração de uso desses antimicrobianos nessas unidades foi 2,2, 2,0 e 2,4 dias, respectivamente. Cefalosporinas de terceira geração e fluoroquinolonas foram as classes de antimicrobianos com tempo de utilização mais longo. Conclusão: A utilização de antibioticoprofilaxia cirúrgica foi inadequada nas unidades de ortopedia, pós-operatória de cirurgia torácica e cardiovascular, terapia intensiva pós-operatória, ginecologia e obstetrícia e otorrinolarigonlogia. Portanto, são importantes o desenvolvimento e a implantação de estratégias que promovam o uso racional de antibioticoprofilaxia cirúrgica nos hospitais.

Colonización bacteriana después de la aplicación de un programa educativo: estudio cuasi experimental / Bacterial colonization after applying an educational program: A quasi-experimental study

INTRODUCCIÓN: La intervención en poblaciones por medio de programas educativos logra aumentar el conocimiento en un determinado grupo y además, en algunos casos, se logra un cambio de conducta. OBJETIVO: Determinar si el programa educativo de lavado de manos aplicado a los estudiantes de educación secundaria reduce la colonización de bacterias infecciosas en las manos. METODOLOGÍA: Se realizó un estudio cuasi experimental no aleatorizado mediante muestreo consecutivo a los alumnos del último año de secundaria, quienes fueron divididos en dos grupos de intervención y control, analizados en dos etapas antes y después de la aplicación del programa educativo. Se tomaron las muestras de la mano dominante para el cultivo bacteriano. Además, se aplicó un cuestionario que evaluó los conocimientos sobre higiene de manos antes y después de la aplicación del programa, que estuvo dirigido a mejorar el nivel de conocimiento y de las actitudes de los estudiantes en relación a la higiene de manos. RESULTADOS: De 208 muestras obtenidas los agentes más frecuentes antes y después de la aplicación del programa educativo fueron Staphylococcus epidermidis (39% versus 23%) y Staphylococcus aureus (21%versus15%); el promedio del número de colonias fue 236 y 183 respectivamente (p = 0,35). CONCLUSIÓN: La aplicación del programa educativo logró mejorar el nivel de conocimiento sobre la higiene de manos. Sin embargo, no fue suficiente para reducir la colonización bacteriana, por lo que debería agregarse otras conductas como la supervisión directa.

INTRODUCTION: Educational interventions can raise awareness and understanding in population groups and may help to achieve changes in behavior. OBJECTIVE: To determine if the educational handwashing program applied to high-school students reduces the colonization of infectious bacteria on the hands. METHODS: A non-randomized quasi-experimental study was carried out using consecutive sampling of the students of the last year of high-school who were divided into an intervention group and a control group. Data were obtained before and after the implementation of the educational program. Samples were taken from the dominant hand for bacterial culture, and a questionnaire was applied that assessed knowledge of hand hygiene before and after the program. The program was aimed at improving the level of understanding and attitudes of students regarding hand hygiene. RESULTS: Of 208 samples obtained, the most frequent agents before and after the educational program were Staphylococcus epidermidis (39% versus 23%) and Staphylococcus aureus (21% versus 15%). The average number of colonies was 236 and 183 respectively (p = 0.35). CONCLUSION: The educational program managed to improve the level of understanding about hand hygiene; however, it was not enough to reduce bacterial colonization, so other behaviors such as direct supervision should be considered.

What's new in infection on surgical site and antibioticoprophylaxis in surgery? / O que há de novo em infecção do sítio cirúrgico e antibioticoprofilaxia em cirurgia?

ABSTRACT Introduction: Infection of the surgical site is the common complication, with significant rates of morbidity and mortality, representing a considerable economic problem for the health system. Objective: To carry out a narrative review of the literature on surgical site infection and the principles of antibiotic prophylaxis to update the knowledge of its use in surgery. Method: Medline, Ovid, Google Scholar, National Library of Medicine (PubMed), Cochrane and SciELO were used for the research. The keywords used were "anti-bacterial agents"; "antibioticoprophylaxis" AND "surgical wound infection". The inclusion criteria were articles of recent publication, with full texts available and performed in humans. Result: A total of 29 articles were evaluated and selected according to the eligibility criteria. Conclusion: Infection of the surgical site is the most common postoperative complication. The key point of its prevention is the combination of several interventions that aim to reduce risk factors, such as: compliance with the new guidelines of the Center for Disease Control and Prevention; the principles of the use of prophylactic antibiotics; factors and risk index of the surgical site; administration time; duration and dosage of antibiotics. These data are available in this article.

RESUMO Introdução: A infecção do sítio cirúrgico é a complicação comum, com taxas significativas de morbimortalidade, representando considerável problema econômico para o sistema de saúde. Objetivo: Realizar revisão narrativa da literatura sobre infecção de sítio cirúrgico e os princípios da antibioticoprofilaxia para atualizar o conhecimento de seu uso em cirurgia. Método: Utilizou-se para a pesquisa a base de dados Medline, Ovid, Google Scholar, National Library of Medicine (PubMed), Cochrane e SciELO. As palavras-chave usadas foram "anti-bacterial agents"; "antibioticoprophylaxis" AND "surgical wound infection". Os critérios de inclusão foram artigos de publicação recente, com textos completos disponíveis e realizados em humanos. Resultado: Um total de 29 artigos foi avaliado e selecionado de acordo com os critérios de elegibilidade. Conclusão: A infecção do sítio cirúrgico é a complicação pós-operatória mais comum. O ponto-chave da sua prevenção consiste na combinação de várias intervenções que visam reduzir os fatores de risco, tais como: a obediência às novas diretrizes do Centro de Controle e Prevenção de Doenças; aos princípios do uso de antibióticos profiláticos; fatores e índice de risco do local cirúrgico; tempo de administração; duração e dosagem dos antibióticos. Esses dados estão disponíveis neste artigo.

Flora bacteriana después del lavado de manos quirúrgico. Estudio piloto / Bacterial flora after surgical hand scrubbing. A pilot study

RESUMEN Introducción: La técnica de lavado de manos quirúrgico es imprescindible para la prevención de las infecciones posoperatorias en el sitio de la intervención, lo que constituye un problema actual y en evolución. Objetivo: Determinar la técnica de lavado de manos quirúrgico con mayor eficacia sobre la flora bacteriana en estudiantes de cirugía. Métodos: Ensayo controlado, aleatorio, de tratamientos no farmacológicos. Se seleccionaron 12 estudiantes de cirugía de la Facultad de Odontología, Universidad de San Martín de Porres, que cumplían con los criterios de inclusión y exclusión. Los estudiantes se dividieron en dos grupos y se les asignó una técnica de lavado de manos quirúrgico: Grupo A: técnica de una fase, y Grupo B: técnica tradicional (tres fases); para ambas técnicas se utilizó escobilla y jabón en barra. Resultados: En el medio de cultivo agar manitol salado, la técnica tradicional presentó una mediana de 52 000 UFC/mL con un mínimo de 10 000 UFC/mL y un máximo de 56 800 UFC/mL, en comparación con la técnica de una fase que presentó 19 600 UFC/mL con un mínimo de 4 400 UFC/mL y un máximo de 38 000 UFC/mL, con un valor de p= 0,117. En el agar MacConkey, la técnica tradicional presentó una mediana de 300 UFC/mL con un mínimo de 0 UFC/mL y un máximo de 18 000 UFC/mL, en comparación con la técnica de una fase que presentó 0 UFC/mL, con un valor de p= 0,054. Conclusiones: No se mostraron diferencias estadísticamente significativas en ambos grupos(AU)

ABSTRACT Introduction: Surgical hand scrubbing is indispensable to prevent postoperative infection at the intervention site, a problem both current and in progress. Objective: Determine the most effective surgical hand scrubbing technique against bacterial flora among surgery students. Methods: A controlled randomized study was conducted of non-pharmacological treatments. Twelve surgery students were selected from the School of Dentistry at the University of San Martín de Porres who met the inclusion and exclusion criteria. The students were divided into two groups and assigned one of two surgical hand scrubbing techniques: Group A: one-step technique and Group B: traditional technique (three steps). Both techniques used bar soap and a brush. Results: In the culture medium mannitol salt agar, the traditional technique obtained a median of 52 000 CFU/mL, with a minimum 10 000 CFU/mL and a maximum 56 800 CFU/mL, whereas the one-step technique obtained a median of 19 600 CFU/mL, with a minimum of 4 400 CFU/mL and a maximum of 38 000 CFU/mL (p= 0.117). In MacConkey agar, the traditional technique obtained a median of 300 UFC/mL, with a minimum of 0 CFU/mL and a maximum of 18 000 CFU/mL, whereas the one-step technique obtained 0 UFC/mL (p= 0.054). Conclusions: No statistically significant differences were found in the groups(AU)

¿Se puede prevenir el parto prematuro por infección bacteriana ascendente y sus resultados adversos en los hospitales públicos de Chile? / Can preterm birth be prevented from ascending bacterial infection and its adverse results in the public hospitals of Chile?

Resumen El parto prematuro (PP) es el principal contribuyente de la morbilidad/mortalidad perinatal. A pesar del conocimiento de los factores de riesgo y de la introducción de intervenciones médicas destinadas a la prevención del nacimiento prematuro, su frecuencia ha aumentado. La infección bacteriana ascendente (IBA) es la condición obstétrica más frecuente asociada al PP ocasionando un importante resultado perinatal adverso en un hospital público de Chile. Esta revisión muestra la asociación entre PP e IBA, analiza la fisiopatología y la inmunología de las infecciones vaginales en la mujer embarazada susceptible, como asimismo la aplicación en este grupo de medidas con evidencia clínica que han demostrado ser eficientes, tales como la pesquisa rutinaria y el tratamiento de las infecciones genitourinarias (IGU), el cerclaje profiláctico o terapéutico, uso de probióticos, de progesterona vaginal, control metabólico de la diabetes mellitus y del peso de la obesa. El tratamiento de las IGU, conjuntamente con el uso de intervenciones que mejoran la inmunidad vaginal en la población de riesgo, permiten predecir una reducción del PP por IBA, de sus consecuencias inmediatas y de largo plazo y costos asociados elevados, con el consiguiente beneficio de la salud pública de Chile.

Preterm birth (PB) is the main contributor to the perinatal morbidity/mortality. In spite of the knowledge of the risk factors and the introduction of medical interventions intended to prevent PB, its frequency has increased. Ascending bacterial infection (ABI) is the obstetric condition most frequently associated to PB causing an important adverse perinatal outcome in a public hospital in Chile. This review shows the association between PB and ABI, analyzes the physiopathology and immunology of vaginal infections in the susceptible pregnant woman., as well as their application in this group of effective measures demonstrated by evidence, such as routine control, treatment of genitourinary tract infections (GTI), prophylactic or therapeutic cerclage, use of probiotics, use of vaginal progesterone, metabolic control of diabetes mellitus and weight of the obese woman. Treatment GTI together with the use of medical interventions that improve the vaginal immunity in the risk population allow to predict a reduction of PB by ABI and of its immediate consequences, long term sequels and high associated costs, with the consequent benefit of the public health in Chile.

Parte I. Requerimientos básicos de infectología para hospitales que atienden pacientes hemato-oncológicos: ambiente hospitalario, protocolos diagnósticos y arsenal terapéutico. Fundamentación / Basic requirements of facilities for hospitals that treat hemato-oncological patients: hospital environment, diagnostic protocols and therapeutic arsenal

Resumen La atención de pacientes con cáncer, incluyendo los receptores de trasplantes de precursores hematopoyéticos, plantea numerosos desafíos para los hospitales que deben proveer ambientes seguros, en que se logre aminorar al máximo posible la exposición a patógenos que generan morbilidad y mortalidad. Al mismo tiempo deben contar con protocolos establecidos que permitan realizar un estudio racional de las posibles etiologías infecciosas que pueden presentar estos pacientes. A su vez, deben asegurar la existencia de un arsenal terapéutico adecuado, junto a algoritmos de tratamiento oportuno, actualizado según guías consensuadas y efectivo según la infección sospechada o confirmada. En este artículo se introducen algunos de los argumentos que sustentan estos requerimientos que luego se desarrollan en tres artículos sucesivos dedicados al ambiente hospitalario, protocolos diagnósticos y arsenal terapéutico.

The care of cancer patients, including recipients of hematopoietic stem cell transplantation, has numerous challenges for hospitals that must provide safe environments in which exposure to pathogens that generate morbidity and mortality is reduced at maximum. At the same time, they must have established protocols that allow a rational study of the possible infectious etiologies and the existence of an adequate therapeutic arsenal together with timely treatment algorithms, updated according to consensus guidelines and effective according to the suspected or confirmed infection. This article introduces some of the arguments that support these requirements, then that are developed in three successive articles dedicated to the hospital environment, diagnostic protocols and therapeutic arsenal.

Avaliação dos casos de infecção por bactérias isoladas em hemoculturas de um hospital filantrópico: estratégia de enfrentamento da infecção de corrente sanguínea associada ao cateter venoso central / Evaluation of infection cases by bacteria isolated from blood cultures from a philanthropic hospital: coping strategy of bloodstream infection associated to central venous catheter

Conhecer o cenário da microbiota proveniente de hemoculturas de uma instituição de saúde, bem como implementar medidas para o enfrentamento da Infecção da Corrente Sanguínea (ICS) Associada ao Cateter Venoso Central (CVC) são medidas essenciais para a melhoria da qualidade e segurança da assistência prestada aos pacientes. O objetivo desta pesquisa foi avaliar os casos de infecção por bactérias isoladas em hemoculturas de um hospital filantrópico antes e após a implementação de um pacote de medidas para a prevenção de Infecção Primária da Corrente Sanguínea Laboratorial Relacionada ao Cateter Venoso Central (IPCSL/CVC) durante o período de 2014 a 2017. Trata-se de um estudo retrospectivo e transversal com dados obtidos a partir de um hospital filantrópico. A maior frequência de distribuição da infecção hospitalar da instituição foi relacionada ao acesso vascular (60,6%) quando comparada com as outras infecções (39,4%) classificadas como do sítio cirúrgico, do trato respiratório e do trato urinário. Após a implementação do pacote de medidas para prevenção de IPCSL/CVC, ocorreu um decréscimo na densidade de incidência de IPCSL/CVC de 23 para 9,2 para cada 1.000 cateteres/dia, todavia um aumento da incidência de IPCSL do acesso vascular periférico de 22,4 para 45,3 para cada 1.000 cateteres/dia. Houve também uma redução nas densidades de incidência de IPCSL/CVC na UTI de 26 para 3,7 para cada 1.000 CVC/dia, bem como na UHR de 86 para 41,1 para cada 1.000 CVC/dia. Antes da implementação do pacote de medidas para prevenção de IPCSL/CVC, as bactérias isoladas foram Staphylococcus aureus resistente à meticilina (MRSA) e Staphylococcus sensível à meticilina (MSSA). Por outro lado, o isolamento e o perfil de suscetibilidade das bactérias após a implementação do pacote de medidas para prevenção de IPCSL/CVC evidenciaram MRSA, MSSA, Klebsiliella pneumoniae resistente à polimixina e Escherichia coli sensível aos carbapenêmicos e resistente às cefalosporinas de amplo espectro (terceira e/ou quarta gerações). Em conclusão, a implementação do pacote de medidas para prevenção de IPCSL/CVC reduziu, nesta instituição, as densidades de infecção relacionada ao CVC nas unidades de terapia intensiva e de hemodiálise renal. Além disso, houve uma alteração quanto ao tipo e perfil de suscetibilidade da microbiota nas hemoculturas dos pacientes

To know the microbiota setting from blood cultures from a health institution as well as implementing measures for coping Bloodstream Infections (BSI) Associated to Central Venous Catheter (CVC) are essential measures for quality and security improvement of patient health care. The objective of this study was to evaluate the infection cases by bacteria isolated from blood cultures from a philanthropic hospital before and after the implementation of a package of measures for the prevention of Primary Infection of Laboratory Bloodstream Related to Central Venous Catheter (PILB/CVC) during the period 2014 to 2017. It is a retrospective and transversal study with data obtained from a philanthropic hospital. The highest distribution frequency of hospital infection in the institution was related to vascular access (60.6%) when compared with the others (39.4%) classified as surgical site, respiratory tract and urinary tract infections. After the implementation of the package of measures for prevention of PILB/CVC, a decrease in incidence density of PILB/CVC of 23 to 9.2 to every 1,000 catheters/day occurred, but an increase in incidence of PILB of peripheral vascular access of 22.4 to 45.3 to every 1,000 catheters/day. There is also a reduction in incidence densities of PILB/CVC in intensive care unit of 26 to 3.7 for every 1,000 CVC/day. Before the implementation of the package of measures for prevention of PILB/CVC, the isolated bacteria were Methicillin-Resistant Staphylococcus aureus (MRSA) and Methicillin-Sensitive Staphylococcus (MSSA). On the other hand, the isolation and susceptibility profile after the implementation of the package of measures for prevention of PILB/CVC evidenced MRSA, MSSA, polymyxin-resistant Klebsiliella pneumoniae and Escherichia coli sensitive to carbapenems and resistant to broad-spectrum cephalosporins (third and/or forth generations). In conclusion, the implementation of the package of measures for prevention of PILB/CVC reduced, in this institution, the infection densities related to CVC in the intensive care and renalhemodialysis units. Moreover, there is a change in type and profile of microbiota susceptibility in patient blood cultures

Changes in antimicrobial susceptibility of commonly clinically significant isolates before and after the interventions on surgical prophylactic antibiotics (SPAs) in Shanghai

Abstract Surveillances and interventions on antibiotics use have been suggested to improve serious drug-resistance worldwide. Since 2007, our hospital have proposed many measures for regulating surgical prophylactic antibiotics (carbapenems, third gen. cephalosporins, vancomycin, etc.) prescribing practices, like formulary restriction or replacement for surgical prophylactic antibiotics and timely feedback. To assess the impacts on drug-resistance after interventions, we enrolled infected patients in 2006 (pre-intervention period) and 2014 (post-intervention period) in a tertiary hospital in Shanghai. Proportions of targeted pathogens were analyzed: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), imipenem-resistant Escherichia coli (IREC), imipenem-resistant Klebsiella pneumoniae (IRKP), imipenem-resistant Acinetobacter baumannii (IRAB) and imipenem-resistant Pseudomonas aeruginosa (IRPA) isolates. Rates of them were estimated and compared between Surgical Department, ICU and Internal Department during two periods. The total proportions of targeted isolates in Surgical Department (62.44%, 2006; 64.09%, 2014) were more than those in ICU (46.13%, 2006; 50.99%, 2014) and in Internal Department (44.54%, 2006; 51.20%, 2014). Only MRSA has decreased significantly (80.48%, 2006; 55.97%, 2014) (p < 0.0001). The percentages of VRE and IREC in 3 departments were all <15%, and the slightest change were also both observed in Surgical Department (VRE: 0.76%, 2006; 2.03%, 2014) (IREC: 2.69%, 2006; 2.63%, 2014). The interventions on surgical prophylactic antibiotics can be effective for improving resistance; antimicrobial stewardship must be combined with infection control practices.