Has the COVID-19 pandemic wiped out the seasonality of outpatient antibiotic use and influenza activity? A time-series analysis from 2014 to 2021.

OBJECTIVE: To assess the influence of the emergence of severe acute respiratory syndrome coronavirus 2 and the implementation of public health measures on the seasonality of outpatient antibiotic use and their possible association with the incidence of influenza. METHODS: We performed a time-series ecological study in 1516 primary care centres of Andalusia, Spain, comparing the coronavirus disease 2019 period (April 2020 to March 2021) with the 6 previous years. We assessed the number of packs and defined daily doses per 1000 inhabitants of antibacterials and key antibiotics commonly used for acute respiratory tract infections and the number of influenza-positive cases per 100 000 inhabitants. We calculated the correlation between variables and analyzed the seasonal patterns and differences in quarterly antibiotic use. RESULTS: For all quarters, a significant correlation was observed between influenza activity and antibiotic use (Spearman's r = 0.94; p < 0.001). Before the pandemic period, both variables presented similar seasonal patterns. After the start of the pandemic, influenza activity was suppressed and the pattern of antibiotic use flattened into a straight line (R2 = 0.96; p = 0.022) with a quarterly change of 3.9% (p = 0.007). Total antibiotic use and antibiotics used for treating acute respiratory tract infections showed significant reductions in all quarters compared to the previous year (p < 0.01). DISCUSSION: The coronavirus disease 2019 pandemic has strongly influenced the seasonality of antibiotic use in primary care. The decline in respiratory viruses, among which the influenza virus is a major player that may act as a proxy for general prevalence, is proposed as a reason for the flattening of the seasonal fluctuations of outpatient antibiotic use in our region.

Long-Term Impact of an Educational Antimicrobial Stewardship Program on Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections: A Quasi-Experimental Study of Interrupted Time-Series Analysis.

BACKGROUND: The global crisis of bacterial resistance urges the scientific community to implement intervention programs in healthcare facilities to promote an appropriate use of antibiotics. However, the clinical benefits or the impact on resistance of these interventions has not been definitively proved. METHODS: We designed a quasi-experimental intervention study with an interrupted time-series analysis. A multidisciplinary team conducted a multifaceted educational intervention in our tertiary-care hospital over a 5-year period. The main activity of the program consisted of peer-to-peer educational interviews between counselors and prescribers from all departments to reinforce the principles of the proper use of antibiotics. We assessed antibiotic consumption, incidence density of Candida and multidrug-resistant (MDR) bacteria bloodstream infections (BSIs) and their crude death rate per 1000 occupied bed days (OBDs). RESULTS: A quick and intense reduction in antibiotic consumption occurred 6 months after the implementation of the intervention (change in level, -216.8 defined daily doses per 1000 OBDs; 95% confidence interval, -347.5 to -86.1), and was sustained during subsequent years (average reduction, -19,9%). In addition, the increasing trend observed in the preintervention period for the incidence density of candidemia and MDR BSI (+0.018 cases per 1000 OBDs per quarter; 95% confidence interval, -.003 to .039) reverted toward a decreasing trend of -0.130 per quarter (change in slope, -0.029; -.051 to -.008), and so did the mortality rate (change in slope, -0.015; -.021 to -.008). CONCLUSIONS: This education-based antimicrobial stewardship program was effective in decreasing the incidence and mortality rate of hospital-acquired candidemia and MDR BSI through sustained reduction in antibiotic use.

Salud bucal y calidad de vida en gestantes del Centro de Salud Cooperativa Universal febrero-julio 2016 / Oral health and Quality of Life in Pregnant Women at the Centro de Salud Cooperativa Universal During February-July 2016

Objetivo: Determinar la relación entre la salud bucal y la calidad de vida de las gestantes del Centro de Salud Cooperativa Universal. Materiales y métodos: Estudio cuantitativo, observacional, descriptivo, transversal, retroprospectivo en una población de 116 gestantes durante los tres trimestres de gestación, en el periodo de febrero a julio de 2016, que asistieron al área de consulta externa odontológica del Centro de Salud Cooperativa Universal. Resultados: El rango de edad materna más frecuente fue entre los 20 y 34 años (65,1%), y el tercer trimestre de gestación fue el más frecuente (57%). El 65,1% de las gestantes presentaron un nivel regular de calidad de vida; el 20,9%, un nivel bueno y el 14%, una mala calidad de vida. El 87,2% de las gestantes presentaron un nivel regular de higiene bucal con una prevalencia de caries del 11,2%. Conclusiones: La salud bucal y la calidad de vida de las gestantes presentaron una relación directa y moderada, debido a un nivel de higiene bucal regular y una alta prevalencia de caries dental. Ambas variables se encuentran estrechamente ligadas, demostrando la repercusión en su salud general y calidad de vida

Objective: To determine the relationship between oral health and quality of life of pregnant women at the Centro de Salud Cooperativa Universal. Materials and methods: A quantitative, observational, descriptive, cross-sectional, retrospective-prospective study of a population of 116 pregnant women during the three trimesters of pregnancy, from February to July 2016, who attended the dental outpatient department of the Centro de Salud Cooperativa Universal. Results: The most frequent maternal age ranged from 20 to 34 years old (65.1%), and the third trimester of pregnancy was the most common one (57%). Sixty-five point one percent (65.1%) of pregnant women had a fair quality of life, 20.9% had a good quality of life and 14% had a poor one. Eighty-seven point two percent (87.2%) of pregnant women had a fair level of oral hygiene with a prevalence of cavities of 11.2%. Conclusions: Oral health and quality of life of pregnant women showed a direct and moderate relationship, due to a fair level of oral hygiene and a high prevalence of dental caries. Both variables are closely linked, demonstrating their impact on pregnant women's general health and quality of life

Incorporación de la prescripción electrónica en un distrito de atención primaria: implicaciones en el gasto farmacéutico y factores determinantes de su utilización / Introduction of the electronic prescription in a primary care district: Impact on pharmaceutical expenditure and the factors determining its use

OBJETIVO: Analizar las implicaciones del uso de receta electrónica sobre el gasto farmacéutico (GF) así como explorar factores determinantes de su utilización. MÉTODOS: Construcción de 2 modelos de regresión múltiple, tomando en uno de ellos como variable dependiente el GF y en el otro el porcentaje de prescripción mediante receta electrónica, incluyendo datos referidos a 9 centros de atención primaria de Andalucía. RESULTADOS: Cada incremento en un punto de prescripción por principio activo (PPA) se relacionó con una reducción media del GF de 2.079 €/año, mientras que cada incremento porcentual en el uso de receta electrónica se relacionó con un aumento de 1.027 € anuales. También se relacionaron con un mayor GF cada tarjeta ajustada por edad y tipo de farmacia (TAFE) asignada (36,71 €/año), la presión asistencial (2.585 €/año) y la frecuentación (2.17.148 €/año). Los factores que se relacionaron con un mayor uso de receta electrónica fueron un menor índice de ruralidad, una mayor distancia a la capital, una mayor PPA y una menor frecuentación. CONCLUSIONES: La prescripción mediante receta electrónica parece ser una variable predictora del gasto farmacéutico, relacionándose cada incremento porcentual con un incremento medio anual de 1.027 euros. Esta variable, junto con la prescripción mediante principio activo, el número de TAFE asignadas, la frecuentación y la presión asistencial media, contribuyen a explicar más del 65% de la variabilidad en el GF entre facultativos. El incremento del gasto relacionado con la receta electrónica parece producirse a expensas del aumento en el número de prescripciones por paciente

OBJECTIVE: To analyse the impact of using the electronic prescription on pharmaceutical expenditure (PE), and to explore the factors determining its use. METHODS: Two multiple regression models were constructed. For these two models, the PE and the percentage of electronic prescription use were taken respectively as dependent variables. Data from nine Primary care centres were included. RESULTS: Each point increase in prescription by active principle (PAP) was associated with an average reduction of 2,079 PE € per year. In contrast, every percentage increase in the use of electronic prescriptions was associated with an annual increase of 1,027 €. In addition, factors like card adjusted for age and type of pharmacy (TAFE) allocated (€ 36.71/year), the burden of care (€ 2,585/year) and frequency of clinic visits (€ 17,148/year), were also associated with increased PE. The other factors associated with an increase in the electronic prescriptions were, lower rurality rates, greater distance from the capital, greater PAP, as well as less clinic visits. CONCLUSIONS: Electronic prescription use seems to be a predictor of pharmaceutical expenditure in which every percentage increase relates to an average annual increase of 1,027 Euros. This variable along with the prescription by active principle, and the amount of TAFEs assigned, as well as the burden of care and number of visits, are variables which help to explain more than 65% of the PE variability between physicians. Likewise, the increase in expenditures related to electronic prescriptions seems to occur at the expense of increasing number of prescriptions per patient

[Introduction of the electronic prescription in a primary care district: impact on pharmaceutical expenditure and the factors determining its use]. / Incorporación de la prescripción electrónica en un distrito de atención primaria: implicaciones en el gasto farmacéutico y factores determinantes de su utilización.

OBJECTIVE: To analyse the impact of using the electronic prescription on pharmaceutical expenditure (PE), and to explore the factors determining its use. METHODS: Two multiple regression models were constructed. For these two models, the PE and the percentage of electronic prescription use were taken respectively as dependent variables. Data from nine Primary care centres were included. RESULTS: Each point increase in prescription by active principle (PAP) was associated with an average reduction of 2,079 PE € per year. In contrast, every percentage increase in the use of electronic prescriptions was associated with an annual increase of 1,027 €. In addition, factors like card adjusted for age and type of pharmacy (TAFE) allocated (€ 36.71/year), the burden of care (€ 2,585/year) and frequency of clinic visits (€ 17,148/year), were also associated with increased PE. The other factors associated with an increase in the electronic prescriptions were, lower rurality rates, greater distance from the capital, greater PAP, as well as less clinic visits. CONCLUSIONS: Electronic prescription use seems to be a predictor of pharmaceutical expenditure in which every percentage increase relates to an average annual increase of 1,027 Euros. This variable along with the prescription by active principle, and the amount of TAFEs assigned, as well as the burden of care and number of visits, are variables which help to explain more than 65% of the PE variability between physicians. Likewise, the increase in expenditures related to electronic prescriptions seems to occur at the expense of increasing number of prescriptions per patient.

Quantitative real-time PCR for detection of Acinetobacter baumannii colonization in the hospital environment.

A real-time PCR assay was developed for detecting the presence of Acinetobacter baumannii on hospital equipment and compared to conventional bacterial culture using 100 hospital environmental samples. The real-time PCR detected contaminated surfaces in 4 h with high sensitivity (100%) compared to conventional culture. Thirty-eight percent of samples were positive by real-time PCR and negative by bacterial culture (false positives), possibly indicating the widespread presence of bacterial DNA that is not associated with viable bacteria.

Servicios amigables para jóvenes: construcción conjunta entre jóvenes y funcionarios / Health care services for young people: a joint construction among youth and health personnel

Antecedentes: La atención integrada y amigable a los adolescentes en salud es un aspecto de vital importancia para el logro de indicadores en salud y para la prevención de comportamientos de riesgo que dejan consecuencias severas.Objetivos: Identificar la percepción, experiencias y expectativas de jóvenes y funcionarios de salud sobre los servicios a jóvenes de la zona de ladera de Cali, Colombia. Desarrollar una estrategia conjunta entre jóvenes y funcionarios para el mejoramiento de los mismos servicios de salud a partir de los lineamientos de los Servicios Amigables para Jóvenes (SAJ).Métodos: Estudio de investigación-acción-participación con jóvenes y funcionarios de una ESE de Cali. La población de jóvenes se encontraba entre los 10 a 19 años. Inicialmente se aplicó un instrumento de evaluación al personal de salud y luego una encuesta sobre los SAJ. Se e realizaron entrevistas grupales y grupos de discusión para analizar los resultados. Se hizo abogacía y se formularon propuestas ante las autoridades locales y tomadores de decisiones sobre el manejo de los recursos.Resultados: La encuesta al personal de salud mostró que en la mayoría de las instituciones prestadoras de salud, no se cuenta con espacios y horarios definidos para la atención a los jóvenes, falta capacitación y número adecuado de funcionarios para la atención, ausencia de material de apoyo para educación en salud. La encuesta de jóvenes fue respondida por 100 jóvenes, el 76% fueron mujeres. El promedio de edad fue de 15.7 años con un rango entre los 12 y 26 años; con relación a la satisfacción en la atención brindada por el personal de salud, el porcentaje más alto lo obtuvo el personal médico y el más bajo el personal auxiliar de enfermería. El servicio más consultado es la consulta con médico general y los servicios más frecuentados en el último mes fueron vacunación (19.7%), odontología y urgencias (11.8% para cada uno).

Background: To accomplish health indicators among youth and prevent risks that leave severe consequences, it is important to offer integral health care.Objectives: To identify perceptions, experiences and expectations about health services for youth and health care agents from the Zona de Ladera in the city of Cali. To develop a concerted strategy with youth and health care agents to improve health services under the ®Friendly Youth Services¼ (SAJ abbreviation in Spanish) guide. Methods: Action - Research with participation of health-care personnel, youth, and adolescents from 10 to 19 years of age, was conducted in a public health-care institution in the city of Cali. The methodology included interviews, focal and discussion groups to analyze results and define steps to change services for adolescents. Advocacy and proposals about resource management were made to the local authorities and decision makers.Results: The main findings were lack of time schedules for services to adolescents and the absence of educational materials for them. The study noted a lack of resources like equipment, well-trained personnel – especially with positive attitude toward adolescents, appropriate location for delivery of services, and community participation in health matters. The interview was answered by 100 young individuals, 76% were female, ranging from 12 to 26 years of age; the higher score about satisfaction was for physicians and the lowest was for nursing assistants. Respondents mainly seek physician attention. The service most frequently sought in the last three months was dentistry, vaccinations, and emergency attention (19.7%, and 11.8%, respectively).Conclusions: It is necessary and useful to reorient health-care services for young individuals according to SAJ principles to emphasize health promotion, access to services, and skills and knowledge of health personnel to most appropriately care for the youth.

Nosocomial outbreak of infection with pan-drug-resistant Acinetobacter baumannii in a tertiary care university hospital.

OBJECTIVE: To describe what is, to our knowledge, the first nosocomial outbreak of infection with pan-drug-resistant (including colistin-resistant) Acinetobacter baumannii, to determine the risk factors associated with these types of infections, and to determine their clinical impact. DESIGN: Nested case-control cohort study and a clinical-microbiological study. SETTING: A 1,521-bed tertiary care university hospital in Seville, Spain. PATIENTS: Case patients were inpatients who had a pan-drug-resistant A. baumannii isolate recovered from a clinical or surveillance sample obtained at least 48 hours after admission to an intensive care unit (ICU) during the time of the epidemic outbreak. Control patients were patients who were admitted to any of the "boxes" (ie, rooms that partition off a distinct area for a patient's bed and the equipment needed to care for the patient) of an ICU for at least 48 hours during the time of the epidemic outbreak. RESULTS: All the clinical isolates had similar antibiotic susceptibility patterns (ie, they were resistant to all the antibiotics tested, including colistin), and, on the basis of repetitive extragenic palindromic-polymerase chain reaction, it was determined that all of them were of the same clone. The previous use of quinolones and glycopeptides and an ICU stay were associated with the acquisition of infection or colonization with pan-drug-resistant A. baumannii. To control this outbreak, we implemented the following multicomponent intervention program: the performance of environmental decontamination of the ICUs involved, an environmental survey, a revision of cleaning protocols, active surveillance for colonization with pan-drug-resistant A. baumannii, educational programs for the staff, and the display of posters that illustrate contact isolation measures and antimicrobial use recommendations. CONCLUSIONS: We were not able to identify the common source for these cases of infection, but the adopted measures have proven to be effective at controlling the outbreak.

Aportaciones del Laboratorio de Microbiología a la Vigilancia Epidemiológica / Contribution of the microbiology laboratory to epidemiologic surveillance

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