Trends in Inpatient Antibiotic Use Among Adults Hospitalized During the Coronavirus Disease 2019 Pandemic in Argentina, Brazil, and Chile, 2018-2021.

BACKGROUND: High rates of antibiotic use (AU) among inpatients with coronavirus disease 2019 (COVID-19) despite low rates of bacterial coinfection and secondary infection have been reported. We evaluated the impact of the COVID-19 pandemic on AU in healthcare facilities (HCFs) in South America. METHODS: We conducted an ecologic evaluation of AU in inpatient adult acute care wards in 2 HCFs each in Argentina, Brazil, and Chile. The AU rates for intravenous antibiotics were calculated as the defined daily dose per 1000 patient-days, using pharmacy dispensing records and hospitalization data from March 2018-February 2020 (prepandemic) and March 2020-February 2021 (pandemic). Differences in median AU were compared between the prepandemic and pandemic periods, using the Wilcoxon rank sum test to determine significance. Interrupted time series analysis was used to analyze changes in AU during the COVID-19 pandemic. RESULTS: Compared with the prepandemic period, the median difference in AU rates for all antibiotics combined increased in 4 of 6 HCFs (percentage change, 6.7%-35.1%; P < .05). In the interrupted time series models, 5 of 6 HCFs had significant increases in use of all antibiotics combined immediately at the onset of the pandemic (immediate effect estimate range, 15.4-268), but only 1 of these 5 HCFs experienced a sustained increase over time (change in slope, +8.13; P < .01). The effect of the pandemic onset varied by antibiotic group and HCF. CONCLUSIONS: Substantial increases in AU were observed at the beginning of the COVID-19 pandemic, suggesting the need to maintain or strengthen antibiotic stewardship activities as part of pandemic or emergency HCF responses.

A Multicenter Study To Evaluate Ceftaroline Breakpoints: Performance in an Area with High Prevalence of Methicillin-Resistant Staphylococcus aureus Sequence Type 5 Lineage.

Ceftaroline (CPT) is a broad-spectrum agent with potent activity against methicillin-resistant Staphylococcus aureus (MRSA). The sequence type 5 (ST5) Chilean-Cordobés clone, associated with CPT nonsusceptibility, is dominant in Chile, a region with high rates of MRSA infections. Here, we assessed the in vitro activity of CPT against a collection of MRSA isolates collected between 1999 and 2018 from nine hospitals (n = 320) and community settings (n = 41) in Santiago, Chile, and evaluated performance across testing methodologies. We found that our hospital-associated isolates exhibited higher CPT MIC distributions (MIC50 and MIC90 of 2 mg/liter) than the community isolates (MIC50 and MIC90 of 0.5 mg/liter), a finding that was consistent across time and independent of the culture source. High proportions (64%) of isolates were CPT nonsusceptible despite the absence of CPT use in Chile. Across methodologies, the Etest underestimated the MIC relative to the gold standard broth microdilution (BMD) test (MIC50 and MIC90 of 1 and 1.5 mg/liter, respectively). There was low (∼51%) categorical agreement (CA) between Etest and BMD results across CLSI and EUCAST breakpoints. The recent revision of CLSI guidelines abolished "very major error" (VME) from the previous guidelines (81%), which perform similarly to the EUCAST guidelines. The level of concordance between CLSI and EUCAST for BMD testing and Etest was >95%. Disk diffusion performed poorly relative to BMD under CLSI (CA, 55%) and EUCAST (CA, 36%) guidelines. Comparison of EUCAST to CLSI for disk diffusion (with EUCAST used as the reference) showed low agreement (CA, 25%; VME, 70%). In summary, CPT-nonsusceptible MRSA are dominant in clinical settings in Chile. Our results provide data to support the reevaluation of CPT breakpoints and to improve agreement across methodologies and agencies.

Increased fibroblast density in actinic cheilitis: association with tryptase-positive mast cells, actinic elastosis and epithelial p53 and COX-2 expression.

BACKGROUND: Actinic cheilitis (AC) is characterized by epithelial and connective tissue alterations caused by ultraviolet sunlight overexposure known as photodamage. Fibroblasts have been linked to photodamage and tumor progression during skin carcinogenesis; however, their role in early lip carcinogenesis remains unknown. The aim of this study was to assess the density of fibroblasts in AC and normal lip (NL) samples and determine their association with markers of lip photodamage. METHODS: Fibroblasts, mast cells, p53, COX-2, and elastin were detected in NL (n = 20) and AC (n = 28) biopsies using immunohistochemistry/histochemistry. Mast cell and fibroblast density and epithelial p53 and COX-2 expression scores were then obtained. Elastosis was scored 1-4 according to elastin fiber density and tortuosity. RESULTS: Fibroblasts, mast cells, p53, COX-2, and elastosis were increased in AC as compared to NL (P < 0.001). Multivariate analysis showed an association between fibroblast and mast cell density at the papillary and reticular areas of AC and NL (P < 0.05). Papillary fibroblast density was also associated with epithelial p53 and COX-2 expression (P < 0.05). Increased fibroblast density, both papillary and reticular, was found in the high elastosis group (scores 3-4) as compared to the low elastosis group (scores 1-2) (P < 0.01). Increased reticular mast cell density was detected only in the high elastosis group (P < 0.01). CONCLUSIONS: Fibroblasts are increased in AC, and they are associated with mast cell density, epithelial p53 and COX-2 expression, and actinic elastosis. Therefore, fibroblasts may contribute to lip photodamage and could be considered useful markers of early lip carcinogenesis.

Concordance Analysis of ALK Gene Fusion Detection Methods in Patients with Non-Small-Cell Lung Cancer from Chile, Brazil, and Peru.

About 4% to 7% of the non-small-cell lung cancer patients have anaplastic lymphoma kinase (ALK) rearrangements, and specific targeted therapies improve patients' outcomes significantly. ALK gene fusions are detected by immunohistochemistry or fluorescent in situ hybridization as gold standards in South America. Next-generation sequencing-based assays are a reliable alternative, able to perform simultaneous detection of multiple events from a single sample. We analyzed 4240 non-small-cell lung cancer samples collected in 37 hospitals from Chile, Brazil, and Peru, where ALK rearrangements were determined as part of their standard of care (SofC) using either immunohistochemistry or fluorescent in situ hybridization. A subset of 1450 samples was sequenced with the Oncomine Focus Assay (OFA), and the concordance with the SofC tests was measured. An orthogonal analysis was performed using a real-time quantitative PCR echinoderm microtubule-associated protein-like 4-ALK fusion detection kit. ALK fusion prevalence is similar for Chile (3.67%; N = 2142), Brazil (4.05%; N = 1013), and Peru (4.59%; N = 675). Although a comparison between OFA and SofC assays showed similar sensitivity, OFA had significantly higher specificity and higher positive predictive value, which opens new opportunities for a more specific determination of ALK gene rearrangements.

CD8+ and FoxP3+ T-cell infiltration in actinic cheilitis.

BACKGROUND: Differences in immune profile between actinic cheilitis (AC), a precursor of lip squamous cell carcinoma, and normal lip vermillion (NL) have not been elucidated. OBJECTIVES: To compare density, distribution, and ratios of CD8+ and FoxP3+ cells between AC and NL and assess their associations with clinicopathologic variables. METHODS: Samples of AC and NL obtained between 2001 and 2013 at the College of Dentistry of the University of Concepcion, Chile, were retrospectively analyzed for immunohistochemical detection of CD8+ and FoxP3+ cells. Differences between groups were tested by Mann-Whitney U and Fisher's exact tests. Independent effects of cell densities and CD8/FoxP3 ratio with AC were assessed by multiple logistic regression analysis after adjustment for potential confounding. RESULTS: A total of 62 AC and 24 NL biopsies were included. Densities of CD8+ and FoxP3+ cells in AC were significantly higher than in NL. Conversely, the CD8+/FoxP3+ ratio was significantly lower in AC as compared to NL. After adjustment for sun exposure, age, gender, and smoking status, a stromal FoxP3+ cell density higher than 0.35 cells/field was significantly associated with increased odds of AC (odds ratio [OR] = 5.01, 95% confidence interval [CI]: 1.18-21.31), while a stromal CD8+/FoxP3+ ratio higher than 5.91 was associated with decreased odds of AC (OR = 0.29, 95% CI: 0.08-1.08). CONCLUSIONS: AC is characterized by increased FoxP3+ cell infiltration and a reduced CD8/FoxP3 ratio as compared to NL. Therefore, increased infiltration of FoxP3+ cells relative to CD8+ cells may contribute to the transition from normal to preneoplastic stages in lip carcinogenesis.

[Comparison of Helicobacter pylori in oral cavity and gastric mucosa according to virulence genotype (cagA and vacA m 1)]. / Comparación de Helicobacter pylori en cavidad oral y mucosa gástrica de acuerdo a genotipo de virulencia (cagA y vacAm 1).

OBJECTIVE: To compare the virulence genotype (cagA and vacA ml genes) of Helicobacter pylori obtained simultaneously from gastric mucosa and oral cavity. MATERIAL AND METHODS: Gastric samples of 18 patients were obtained by endoscopic biopsies. Oral samples of these patients were obtained from dental plaque and saliva swabs from the floor of the mouth and the base of the tongue. All samples were studied by conventional PCR and real-time PCR (RT-PCR). Virulence genes cagA and vacA ml were studied by RT- PCR. RESULTS: According to presence and/or absence of cagA and vacAm1 genes, seven different combinations were observed. CONCLUSION: These results suggest that there is a variety of genetic profiles of Helicobacter pylori in the stomach and oral cavity, with a predominance of less virulent genotypes in the patients included in this study (cagA-, vacA m1-).

Adenomatoid odontogenic tumor concomitant with cystic complex odontoma: case report.

This case report describes a 10-year-old female patient with an adenomatoid odontogenic tumor developing together with a cystic complex odontoma. This occurrence is considered very unusual. Immunohistochemical detection of cytokeratins AE1/AE3, CK5, CK8, CK10, CK14, CK19 and Ki-67 was performed.

Intraosseous hemangioma of the mandible: case report and review of the literature / Hemangioma intraóseo de la mandíbula: presentación de un caso y revisión de la literatura

We report on a two year old female patient who presented with expansion to the left side of the ramus and body of the mandibule. Imaging studies revealed a lesion with characteristics suggestive of vascular origin. Histopathological analysis determined the presence of an intraosseous Hemangioma. Embolization guided angiography of the left external carotid artery was performed followed by surveillance to monitor regression of the lesion.

Se presenta en una paciente de sexo femenino de dos años que presentó expansión del lado izquierdo de la rama y cuerpo de la mandíbula. Los estudios de imágenes revelaron una lesión con características sugerentes a un origen vascular. El análisis histopatológico determinó la presencia de un hemangioma intraóseo. Se realizó la embolización guiada por angiografía de la arteria carótida externa izquierda junto y seguimiento de control para supervisar la regresión de la lesión.

Comparación de Helicobacter pylori en cavidad oral y mucosa gástrica de acuerdo a genotipo de virulencia (cagA y vacAm 1) / Comparison of Helicobacter pylori in oral cavity and gastric mucosa according to virulence genotype (cagA and vacA m 1)

Objective: To compare the virulence genotype (cagA and vacA ml genes) of Helicobacter pylori obtained simultaneously from gastric mucosa and oral cavity. Material and Methods: Gastric samples of 18 patients were obtained by endoscopic biopsies. Oral samples of these patients were obtained from dental plaque and saliva swabs from the floor of the mouth and the base of the tongue. All samples were studied by conventional PCR and real-time PCR (RT-PCR). Virulence genes cagA and vacA ml were studied by RT- PCR. Results: According to presence and/or absence of cagA and vacAm1 genes, seven different combinations were observed. Conclusion: These results suggest that there is a variety of genetic profiles of Helicobacter pylori in the stomach and oral cavity, with a predominance of less virulent genotypes in the patients included in this study (cagA-, vacA m1-).

Objetivo: Comparar el genotipo de virulencia (genes cagA y vacA m1) de Helicobacter pylori, obtenido simultáneamente de mucosa gástrica y cavidad oral. Material y Métodos: Para esto se incluyeron muestras de biopsias gástricas de 18 pacientes. Las muestras orales de estos pacientes fueron obtenidas de placa bacteriana y saliva del piso de boca y base de la lengua. Las muestras fueron estudiadas con RPC convencional y RPC en tiempo real (RPC-TR). Los genes de virulencia cagA y vacA m1 fueron estudiados con RPC-TR. Resultados: De acuerdo a la presencia o ausencia de los genes de virulencia cagA y vacA m1 detectados en las muestras gástricas y orales, se pudieron diferenciar siete combinaciones diferentes. Conclusión: Estos resultados sugieren que existe una variedad de genotipos de virulencia en Helicobacter pylori en el estómago y la cavidad oral, predominando en los pacientes incluidos en este estudio las cepas con genotipos asociados a menor virulencia (cagA-, vacA m1-).