Knowledge, attitudes and perceptions of Latin American healthcare workers relating to antibiotic stewardship and antibiotic use: a cross-sectional multi-country study.

BACKGROUND: The burden of antimicrobial resistance (AMR) in Latin America is high. Little is known about healthcare workers' (HCWs) knowledge, attitudes, and perceptions of antimicrobial stewardship (AS), AMR, and antibiotic use (AU) in the region. METHODS: HCWs from 42 hospitals from 5 Latin American countries were invited to take an electronic, voluntary, anonymous survey regarding knowledge, attitudes, and perceptions of AS, AMR, and AU between March-April 2023. FINDINGS: Overall, 996 HCWs completed the survey (52% physicians, 32% nurses, 11% pharmacists, 3% microbiologists, and 2% "other"). More than 90% of respondents indicated optimizing AU was a priority at their healthcare facility (HCF), 69% stated the importance of AS was communicated at their HCF, and 23% were unfamiliar with the term "antibiotic stewardship". Most (> 95%) respondents acknowledged that appropriate AU can reduce AMR; however, few thought AU (< 30%) or AMR (< 50%) were a problem in their HCF. Lack of access to antibiogram and to locally endorsed guidelines was reported by 51% and 34% of HCWs, respectively. Among prescribers, 53% did not consider non-physicians' opinions to make antibiotic-related decisions, 22% reported not receiving education on how to select antibiotics based on culture results and 60% stated patients and families influence their antibiotic decisions. CONCLUSIONS: Although HCWs perceived improving AU as a priority, they did not perceive AU or AMR as a problem in their HCF. AS opportunities include improved access to guidelines, access to AMR/AU data, teamwork, and education on AS for HCWs and patients and families.

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.

Deep Dive Into Gaps and Barriers to Implementation of Antimicrobial Stewardship Programs in Hospitals in Latin America.

BACKGROUND: Antimicrobial resistance has worsened in Latin America. There is an urgent need to understand the development of antimicrobial stewardship programs (ASPs) and the barriers to implementing effective ASPs in light of limited national action plans or policies to promote ASPs in the region. METHODS: We performed a descriptive mixed-methods study of ASPs in 5 Latin American countries in March-July 2022. An electronic questionnaire with an associated scoring system (hospital ASP self-assessment) was used, and ASP development was classified based on the scores (inadequate, 0-25; basic, 26-50; intermediate, 51-75; or advanced, 76-100). Interviews among healthcare workers (HCWs) involved in antimicrobial stewardship (AS) inquired about behavioral and organizational factors that influence AS activities. Interview data were coded into themes. Results from the ASP self-assessment and interviews were integrated to create an explanatory framework. RESULTS: Twenty hospitals completed the self-assessment, and 46 AS stakeholders from these hospitals were interviewed. ASP development was inadequate/basic in 35% of hospitals, intermediate in 50%, and advanced in 15%. For-profit hospitals had higher scores than not-for-profit hospitals. Interview data validated the self-assessment findings and provided further insight into ASP implementation challenges, which included limited formal hospital leadership support, inadequate staffing and tools to perform AS work more efficiently, limited awareness of AS principles by HCWs, and limited training opportunities. CONCLUSIONS: We identified several barriers to ASP development in Latin America, suggesting the need to create accurate business cases for ASPs to obtain the necessary funding for their effective implementation and sustainability.

Artritis séptica causada por Kingella kingae en pediatría / Septic arthritis caused by Kingella kingae in children

Introducción. Aproximadamente un 50% de los casos de artritis bacteriana ocurre en la infancia. En la actualidad, se considera Kingella kingae como un patógeno emergente. Caso clínico. Varón de 10 meses que consulta por fiebre y dolor en la rodilla. Se realizó artrocentesis. La muestra se sembró en frasco de hemocultivo. Se identificó Kingella kingae. Recibió tratamiento con ampicilina por 14 días. Discusión. La patogenia de la enfermedad articular causada por Kingella kingae comienza con la colonización de la faringe posterior. El aislamiento en los medios de cultivo sólidos puede ser difícil. Conclusión. Se destaca la necesidad de tener en cuenta este patógeno y de utilizar, en forma rutinaria, frascos de hemocultivo para el procesamiento de las muestras de líquido sinovial.

Introduction. Approximately 50% of cases of bacterial arthritis occur in childhood. Currently Kingella kingae is considered as an emerging pathogen.Clinical case. A ten month old male patient presented joint immobility in right knee. Arthrocentesis was performed. Kingella kingae was identified. He received treatment with ampiciline for 14 days.Discussion. This pathogen colonizes the posterior pharynx. Isolation in solid culture media may be difficult.Conclusion.It is essential to consider this pathogen when septic arthritis is suspected, and to routinely use blood culture bottles for processing samples of synovial fluid.

Artritis séptica causada por Kingella kingae en pediatría / Septic arthritis caused by Kingella kingae in children

Introducción. Aproximadamente un 50% de los casos de artritis bacteriana ocurre en la infancia. En la actualidad, se considera Kingella kingae como un patógeno emergente. Caso clínico. Varón de 10 meses que consulta por fiebre y dolor en la rodilla. Se realizó artrocentesis. La muestra se sembró en frasco de hemocultivo. Se identificó Kingella kingae. Recibió tratamiento con ampicilina por 14 días. Discusión. La patogenia de la enfermedad articular causada por Kingella kingae comienza con la colonización de la faringe posterior. El aislamiento en los medios de cultivo sólidos puede ser difícil. Conclusión. Se destaca la necesidad de tener en cuenta este patógeno y de utilizar, en forma rutinaria, frascos de hemocultivo para el procesamiento de las muestras de líquido sinovial.(AU)

[Septic arthritis caused by Kingella kingae in children]. / Artritis séptica causada por Kingella kingae en pediatría.

INTRODUCTION: Approximately 50% of cases of bacterial arthritis occur in childhood. Currently Kingella kingae is considered as an emerging pathogen. CLINICAL CASE: A ten month old male patient presented joint immobility in right knee. Arthrocentesis was performed.Kingella kingae was identified. He received treatment with ampiciline for 14 days. DISCUSSION: This pathogen colonizes the posterior pharynx.Isolation in solid culture media may be difficult. CONCLUSION: It is essential to consider this pathogen when septic arthritis is suspected, and to routinely use blood culture bottles for processing samples of synovial fluid.

Hypocalcemia in a paediatric case: from the clinical features to diagnosis.

Pseudohypoparathyroidism refers to end-organ resistance that primarily impairs the renal actions of parathyroid hormone (PTH), a key regulator of calcium homeostasis. Its diagnosis is complex because of the multiple variants of this entity, and more so because intravenous PTH is not available for the Ellsworth-Howard test. We report a symptomatic paediatric case of hypocalcaemia, the clinical features of which, and the course after treatment, suggest that it is most probably a case of pseudohypoparathyroidism type Ib.

[26 year-old male patient with bone marrow transplantation. Report of a partial autopsy]. / Paciente de 26 años trasplantado de médula ósea. Reporte de autopsia parcial.

26 year-old male patient with diagnosis of acute lymphoblastic leukemia in 2006, who underwent chemotherapy and suffered a relapse and pulmonary aspergillosis as a complication. In 2009, he received bone marrow transplant. After it, he developed cutaneous and intestinal graft versus host disease (GVH). He was admitted for diarrhea. Then he presented grade IV dyspnea, patchy alveolar infiltrates on chest computed tomography and pancytopenia with impaired renal function as laboratory findings. He entered Intensive Care Unit, dying 7 days later. The oncologist who discussed the case defined this patient as a high risk case because of type of transplant received, relapse and complications. His diagnostic hypotheses were: CMV infection, pulmonary aspergillosis reactivation, chronic GVH, Pneumocystis jiroveci infection, mycobacteriosis and pseudomembranous colitis. Partial autopsy revealed diffuse intra-alveolar hemorrhage, diffuse alveolar damage, right pulmonary infarction with microthrombosis and bronchiolitis obliterans organizing pneumonia.