Diagnóstico de la vigilancia, prevención y control de la COVID-19 en el trabajo minero peruano

Introducción: En Perú, las empresas mineras debían registrar e implementar el plan para la vigilancia, prevención y control de la COVID-19 en el trabajo (requerido por el Ministerio de Salud), previo al reinicio de actividades suspendidas debido a la pandemia. Objetivo: Describir el estado situacional de los planes para la vigilancia, prevención y control de la COVID-19 en el trabajo del sector minero (1ra y 2da fase de reactivación económica, 2020). Métodos: Se realizó un estudio transversal de la base de datos del sistema SISCOVID-Empresas. Se reportaron frecuencias y proporciones de las características de los planes (región de procedencia, número de trabajadores, número de profesionales de salud, existencia de comité o supervisor de seguridad y salud en el trabajo, estado de registro y reporte de presupuesto) según el número de trabajadores de la empresa. Resultados: Se revisaron 2 236 registros de planes. El 6,2 % indica no contar con supervisor o comité de seguridad y salud en el trabajo y el 71,5 % no cuenta con profesional de la salud. El 81,2 % de las empresas con más de 500 trabajadores contaban con profesionales de medicina y enfermería. El 89,2 % de las empresas con 1 a 20 trabajadores no contaban con profesionales de la salud. Conclusiones: Tres de cada 4 empresas del sector minero incumplen lo requerido en el plan para la vigilancia, prevención y control de la COVID-19 en el trabajo.

Introduction: In Peru, mining companies had to register and implement the Plan for the surveillance, prevention, and control of COVID-19 at work (requested by the Ministry of Health), prior to restarting activities suspended due to the pandemic. Objective: To describe the situational status of the plans for the surveillance, prevention, and control of COVID-19 at work in the mining sector (1st and 2nd phases of economic reactivation, 2020). Methods: A cross-sectional study was carried out of the database from the SISCOVID- Empresas system. Frequencies and proportions of the characteristics of the plans were reported (region of origin, number of workers, number of health professionals, existence of an occupational health and safety committee or supervisor, status of registration and budget report) according to the number of company workers. Results: In total 2,236 plan records were reviewed. Of the total, 6.2% of the registered plans indicate that they do not have an occupational health and safety supervisor or committee, and 71.5% do not have a health professional. Furthermore, 81.2% of the companies with more than 500 workers had medicine and nursing professionals, and 89.2% of companies with 1 to 20 workers did not have health professionals. Conclusions: Three out of 4 companies in the mining sector fail to comply with the requirements of the plan for the surveillance, prevention, and control of COVID-19 at work.

Situational diagnosis of plans for the surveillance, prevention and control of COVID-19 at work in the hydrocarbon sector.

Introduction: During the COVID-19 pandemic in Peru, economic activities were restricted to limit the risk of contagion, and companies were required to prepare and register the plan for COVID-19 surveillance, prevention and control in the workplace prior to resuming activities. Objective: To describe the status of plan registration in the hydrocarbon sector during the first half of 2020, as well as the characteristics of health professionals and occupational health and safety supervisors or committees. Methods: Cross-sectional study with secondary analysis of databases obtained from the Integrated System for COVID-19 of Companies (Sistema Integrado para COVID-19 de Empresas, SISCOVID Empresas) and government public data on the mining sector. Results: We reviewed 2,566 plans and identified 54 198 hydrocarbon companies in the 2020 period. Regarding the plans registered, 5.9% of companies did not have an occupational safety and health supervisor or committee, and 63% do not have a health professional. Conclusions: There is evidence of non-compliance with plan registration requirements among hydrocarbon companies. There is also non-compliance with the requirement of having a health professional, occupational safety and health committee or supervisor. The findings show serious deficiencies in plan registration, which could lead to inadequate management of the activities to monitor, prevent and control COVID-19 in the workplace. Companies are advised to develop, register, and implement their plans to protect the health of their employees.

Evaluation of an ozone generation system for the control of microorganisms in the indoor air of sanitary environments / Evaluación de un sistema de generación de ozono para el control de microorganismos en el aire interior de ambientes sanitarios

Objetive: Evaluate an Ozone Generating System (OGS) through of the microorganisms count and identificated in the air of the sanitary environments of the National Institute of Health (INS) from Peru. These were The study:exposed to OGS for 1 min per m2, air samples were collected at volumes of 200L, 500Land 1000Lby impaction, pre and post exposure to OGS, cultures were obtained on Plate Count Agar (PCA) and Oxytetracycline Glucose Agar (OGA) grown at 35°C±2°C for 48 hours and 25°C ± 2°C for 5 days.Adecrease Findings:in the count of fungi after exposure to OGS, the difference being statistically significant for the volumes of 200L(p=0.047) and 1000 L(p<0.005); Aspergillus spp. species were identified in most cultures, in bacteria no significant difference was observed.The OGS is a method that inhibits the Conclusions:growth of most fungi in sanitary environments.

Objetivo: Evaluar un Sistema Generador de Ozono (SGO) a través del recuento e identificación de microorganismos en el aire de los ambientes sanitarios del Instituto Nacional de Salud (INS) del Perú. El estudio: Los ambientes fueron expuestos a SGO por 1 min por m2, se recolectaron muestras de aire en volúmenes de 200L, 500L y 1000L por impactación, pre y post exposición a SGO; los cultivos se obtuvieron en Plate Count Agar (PCA) y Oxitetracicline Glucose Agar (OGA) cultivados a 35 °C ± 2 °C durante 48 horas y 25 °C ± 2 °C durante 5 días. Hallazgos: Disminución del recuento de hongos post exposición a SGO, la diferencia fue estadísticamente significativa para los volúmenes de 200L (p=0.047) y 1000 L (p<0.005); especies de Aspergillus spp. fueron identificados en la mayoría de los cultivos; en bacterias no se observaron diferencias significativas. Conclusiones: El SGO es un método que inhibe el crecimiento de la mayoría de hongos en ambientes sanitarios.

Enterobacterales productores de betalactamasas de espectro extendido portadores del gen mcr-1 en Lima, Perú / Extended-spectrum beta-lactamase-producing enterobacterales carrying the mcr-1 gene in Lima, Peru

RESUMEN Se analizó la presencia del gen mcr-1 en 165 enterobacterales productores de betalactamasas de espectro extendido (EP-BLEE) recuperados en 2017 de sangre (40), orina (57), secreciones respiratorias bajas (12) e hisopados rectales (56) de pacientes hospitalizados en el Instituto Nacional de Enfermedades Neoplásicas (Perú). La identificación y la susceptibilidad antimicrobiana se determinaron por el sistema automatizado Phoenix M50; la resistencia a colistina por Colistin Agar-Spot (CAS); la detección de mrc-1 por el método fenotípico de predifusión de colistina e inhibición con EDTA (CPD-E) y por reacción en cadena de la polimerasa (PCR, por sus siglas en inglés). De los 165 EP-BLEE 25 fueron positivos para mcr-1 por el método CPD-E y se confirmó por PCR. Por el método CAS, 20/165 fueron resistentes a colistina. Además, mostraron resistencia a las fluoroquinolonas y a la gentamicina, y permanecieron sensibles a la amikacina; dos aislamientos presentaron metalocarbapenemasas. La obtención de datos sobre la resistencia a antimicrobianos considerados de última línea (colistina) es crucial para establecer medidas para su control.

ABSTRACT We analyzed the presence of the mcr-1 gene in 165 extended-spectrum beta-lactamase-producing enterobacterales (ESBL-PE) obtained during 2017, from blood (40), urine (57), lower respiratory secretions (12) and rectal swabs (56) of patients hospitalized in the Instituto Nacional de Enfermedades Neoplásicas (Peru). Antimicrobial identification and susceptibility were determined by the Phoenix M50 automated system; colistin resistance by Colistin Agar-Spot (CAS); mrc-1 detection by colistin pre-diffusion and inhibition with EDTA test (CPD-E) and by polymerase chain reaction (PCR). We found that from the 165 ESBL-PE, 25 were positive for mcr-1 by the CPD-E method and confirmed by PCR. Colistin resistance was found in 20/165 by using the CAS method. Additionally, they showed resistance to fluoroquinolones and gentamicin, while remaining sensitive to amikacin; two isolates presented metallo-carbapenemases. Obtaining data on resistance to last-line antimicrobials (colistin) is crucial to establish measures for its control.

Extended-spectrum beta-lactamase-producing enterobacterales carrying the mcr-1 gene in Lima, Peru. / Enterobacterales productores de betalactamasas de espectro extendido portadores del gen mcr-1 en Lima, Perú.

We analyzed the presence of the mcr-1 gene in 165 extended-spectrum beta-lactamase-producing enterobacterales (ESBL-PE) obtained during 2017, from blood (40), urine (57), lower respiratory secretions (12) and rectal swabs (56) of patients hospitalized in the Instituto Nacional de Enfermedades Neoplásicas (Peru). Antimicrobial identification and susceptibility were determined by the Phoenix M50 automated system; colistin resistance by Colistin Agar-Spot (CAS); mrc-1 detection by colistin pre-diffusion and inhibition with EDTA test (CPD-E) and by polymerase chain reaction (PCR). We found that from the 165 ESBL-PE, 25 were positive for mcr-1 by the CPD-E method and confirmed by PCR. Colistin resistance was found in 20/165 by using the CAS method. Additionally, they showed resistance to fluoroquinolones and gentamicin, while remaining sensitive to amikacin; two isolates presented metallo-carbapenemases. Obtaining data on resistance to last-line antimicrobials (colistin) is crucial to establish measures for its control.

Se analizó la presencia del gen mcr-1 en 165 enterobacterales productores de betalactamasas de espectro extendido (EP-BLEE) recuperados en 2017 de sangre (40), orina (57), secreciones respiratorias bajas (12) e hisopados rectales (56) de pacientes hospitalizados en el Instituto Nacional de Enfermedades Neoplásicas (Perú). La identificación y la susceptibilidad antimicrobiana se determinaron por el sistema automatizado Phoenix M50; la resistencia a colistina por Colistin Agar-Spot (CAS); la detección de mrc-1 por el método fenotípico de predifusión de colistina e inhibición con EDTA (CPD-E) y por reacción en cadena de la polimerasa (PCR, por sus siglas en inglés). De los 165 EP-BLEE 25 fueron positivos para mcr-1 por el método CPD-E y se confirmó por PCR. Por el método CAS, 20/165 fueron resistentes a colistina. Además, mostraron resistencia a las fluoroquinolonas y a la gentamicina, y permanecieron sensibles a la amikacina; dos aislamientos presentaron metalocarbapenemasas. La obtención de datos sobre la resistencia a antimicrobianos considerados de última línea (colistina) es crucial para establecer medidas para su control.

Phenotypic Detection of Plasmid-Mediated Colistin Resistance in Enterobacteriaceae.

The aim of this work was to evaluate an easy-to-perform assay based upon inhibition of mobile colistin resistance (MCR) activity by EDTA. We included 92 nonrelated isolates of Enterobacteriaceae (74 Escherichia coli, 17 Klebsiella pneumoniae, and 1 Serratia marcescens). Our proposed method is based on a modification of the colistin agar-spot screening test (CAST), a plate containing 3 µg/ml colistin, by adding an extra plate of colistin agar-spot supplemented with EDTA (eCAST). Bacterial growth was evaluated after 24 h of incubation at 35°C. All the colistin-resistant isolates showed development on the CAST plates. Colistin-resistant K. pneumoniae without mcr-1 and S. marcescens also grew on the eCAST plates. In contrast, colistin-resistant MCR-producing E. coli was not able to grow in eCAST plates. The combined CAST/eCAST test could provide a simple and easy-to-perform method to differentiate MCR-producing Enterobacteriaceae from those in which colistin resistance is mediated by chromosomal mechanisms.

Detection of plasmid-mediated colistin resistance by colistin pre-diffusion and inhibition with EDTA test (CPD-E) in Enterobactereaceae.

A phenotypic assay based on colistin pre-diffusion and differential inhibition of Mobile Colistin Resistance (MCR) protein activity by EDTA showed that, of the 92 strains tested, all MCR producers (49) exhibited an increase ≥5 mm in the inhibition zone around the area of pre-diffusion in the presence of EDTA, in comparison with colistin alone. Results suggest that CPD-E may differentiate MCR-producing microorganisms from resistant microorganisms without this marker.

Desempeño de cinco métodos fenotípicos para la detección de metalobetalactamasas en bacilos gram negativos tipificados genotípicamente / Performance of five phenotypic methods for the detection of metallo-betalactamasas in gram negative bacilli genotypically defined

Con el objetivo de evaluar el desempeño de cinco métodos fenotípicos para la detección de metalobetalactamasas (MBL) en bacilos Gram negativos, se realizó un estudio observacional, descriptivo y de corte transversal. Se incluyeron 100 aislamientos de bacilos Gram negativos tipificados genotípicamente en estudios preliminares. Los métodos evaluados fueron: Prueba de discos combinados con inhibidor (EDTA), Prueba de sinergia de doble disco, Test de Hodge Modificado (cepa E. coli ATCC 25922), Test de Hodge Modificado (cepa K. pneumoniae ATCC 700603) y Blue Carba Test. De los 32 aislamientos productores de MBL, 27 fueron del tipo IMP, 3 del tipo VIM y 2 del tipo NDM. De los 68 aislamientos no productores de MBL, 66 fueron aislamientos no poseedores de MBL, 1 del tipo CTX + impermeabilidad y 1 aislamiento del tipo. El Método de discos combinados con inhibidor y el Método de sinergia de doble disco demostraron ser los más específicos (100 por ciento) y el Blue Carba Test el más sensible (100 por ciento). Respecto a los discos de EDTA se encontró un índice Kappa de 1.0 entre los discos comerciales y los discos in-house, es decir una concordancia perfecta. En conclusión, los cinco métodos presentaron un buen desempeño para la detección de MBL. Se recomienda la implementación de un método fenotípico para la detección de MBL en los laboratorios clínicos de rutina. El método debe ser elegido según costo-beneficio de acuerdo a las características de la cepa MBL prevalente.

In order to assess the performance of five phenotypic methods for the detection of metallo-B-lactamase (MBL)-producing Gram-negative bacilli, an observational, descriptive and cross sectional study was implemented. 100 isolates of Gram-negative bacilli previously typed genotypically were included. The methods evaluated were: the combination disc test with inhibitor (EDTA), the double disc synergy test, the modified Hodge test (strain E. coli ATCC 25922), the modified Hodge test (strain K. pneumoniae ATCC 700603) and the Blue Carba Test. Of the 32 MBL-producing isolates, 27 were IMP, 3 VIM and 2 NDM. Of the 68 non-MBL producing isolates, 66 were non-MBL-carrying isolates, 1 CTX + impermeability and 1 KPC. The combination disc with inhibitor and the double disc synergy tests were the most specific (100 per cent) and the Blue Carba Test was the most sensitive (100 per cent). Regarding EDTA discs, the Kappa index was 1.0 among commercial discs and in-house discs, a perfect match. In conclusion, the five methods had a good performance for the detection of MBL-producing Gram-neqative bacilli. The implementation of a phenotypic method for the detection of MBL-producing in routine clinical laboratories is strongly recommended. A cost-effective screening method should be chosen according to the characteristics of MBL producer prevalent.