Producción científica peruana sobre resistencia a los antimicrobianos de bacterias priorizadas por la OMS / Peruvian scientific production on antimicrobial-resistant bacteria prioritized by WHO

Introducción: La resistencia a los antimicrobianos (RAM) es una crisis de salud pública a nivel mundial. La Organización Mundial de la Salud (OMS) estableció una lista de bacterias resistentes priorizadas para orientar investigaciones y alternativas de mejora. Objetivo: Describir la producción científica del Perú sobre RAM de bacterias priorizadas por la Organización Mundial de la Salud, entre 2012 y 2021. Métodos: Estudio descriptivo observacional de tipo bibliométrico en revistas indexadas en Scopus durante el período 2012-2021. La selección de los estudios y la extracción de datos se realizó manualmente por duplicado. Se clasificaron las bacterias resistentes estudiadas, según las prioridades (crítica, alta y media). Resultados: Se incluyeron 118 artículos. Durante el período 2014-2021 hubo un aumento de publicaciones. El 61,9 por ciento fueron artículos publicados en inglés, 98,3 por ciento con filiación en Perú y el 77,1 por ciento fueron realizados en Lima. Se publicaron más estudios sobre las bacterias de prioridad crítica que sobre las de alta o media. El 79,7 por ciento buscó determinar la prevalencia o caracterizar y el 26,1 por ciento mencionó algún financiamiento de instituciones del país. Conclusión: La producción científica peruana sobre RAM ha aumentado en los últimos años y se cuenta con más publicaciones de bacterias de prioridad crítica. Sin embargo, estos estudios se centran en Lima y solo la cuarta parte ha sido financiada por alguna entidad peruana(AU)

Introduction: Antimicrobial resistance (AMR) is a worldwide public health crisis. The World Health Organization (WHO) established a priority list of resistant bacteria to guide research and alternatives for improvement. Objective: To describe the scientific production of Peru on AMR of bacteria prioritized by the World Health Organization, between 2012 and 2021. Methods: Observational descriptive study of bibliometric type in journals indexed in Scopus during the period 2012-2021. The selection of studies and data extraction were performed manually in duplicate. Resistant bacteria studied were classified based on priority (critical, high, and medium). Results: A total of 118 articles were included. During the period 2014-2021, the number of publications increased. The articles published in English accounted for 61.9 percent, 98.3 percent had their affiliation in Peru, and 77.1 percent were conducted in Lima. Most publications focused on bacteria of critical priority than high and medium priority. A total of 79.7 percent sought to determine prevalence or characterize and 26.1 percent referred to funding from Peruvian institutions. Conclusions: Peruvian scientific production on AMR has increased in recent years and there are more publications on critical priority bacteria. However, these studies are centered in Lima and only a quarter of them have been financed by a Peruvian entity(AU)

Indicadores basados en consumo en una Unidad de Cuidados Intensivos sin implantación de PROA / Indicators based on consumption in an intensive care unit without antimicrobial stewardship programs implementation

Objetivo: Medir los indicadores del uso hospitalario de antibióticos basados en datos de consumo, comparando datos entre 2018 y 2019 en una Unidad de Medicina Intensiva de un hospital de tercer nivel sin implantación de Programas de Optimización de Antibióticos (PROA). Métodos: Asignar un valor a cada indicador evaluado en base a datos de consumo empleando los datos del programa de gestión del Servicio de Farmacia y las DDD porcada 100 estancias. En base a la diferencia de las medias obtenidas entre 2018 y 2019 se calculó la significación estadística mediante la t-Student de medidas pareadas. Resultados: Se evaluaron 13 indicadores, de los cuales sólo 2(15%) presentaron diferencias estadísticamente significativas, el consumo de fluorquinolonas y el ratio fluconazol/equinocandinas, mostrando una evolución positiva. Conclusiones: El empleo de estos indicadores deberían estandarizarse para la evaluación de las políticas antibióticas de los centros, lo que serviría para establecer comparaciones entre centros de similares características o bien la evolucióntemporal para un mismo centro y/o servicio. Esto permitiríadetectar puntos críticos y establecer acciones de mejora, entre ellas la creación de equipos PROA, especialmente en unidades de pacientes críticos. (AU)

Objective: The aim of our study is tocalculate the indicators of hospital useof antimicrobial agents based on consumption, comparing data from 2018with data from 2019 in an IntensiveCare Unit of a third level hospital without an stewardship program.Methods: Retrospective study in whichwe assigned a value to each indicatorbased on consumption using DDD per100 bed-stays. Data was obtainedusing the pharmacy management software. Statistical analysis was performed by t-Student test based on thedifference of means obtained in 2018and 2019 respectively.Results: 13 indicators were evaluated,only 2 of them (15%) showed an statistically significant difference betweenperiods, the consumption of fluoroquinolones and the fluconazole/ echinocandin ratio, both showing a positiveevolution.Conclusions: The use of these indicatorsshould be standardized in order to evaluate antibiotic policies, which will helpestablishing comparisons between centers of specific characteristics or studying the temporal evolution for thesame center and/or service. This willallow detecting critical points and establishing improvement actions, includingthe creation of stewardship programs,especially in critical care units. (AU)

Antimicrobial therapy in palliative care: an overview.

In the advanced stages of illness, patients often face challenging decisions regarding their treatment and overall medical care. Terminal ill patients are commonly affected by infections. However, in palliative care, the use of antimicrobials can be an ethical dilemma. Deciding whether to treat, withhold, or withdraw the antimicrobial treatment for an infection can be difficult. Antimicrobial administration can lead to adverse outcomes but the two main benefits, longer survival and symptom relief, are the main reasons why physicians prescribe antimicrobial when treating terminally ill patients. For the patient who has an irreversible advanced heart or lung disease, or an advanced dementia, or a metastatic cancer, it is easier the decision of withholding mechanical ventilation, tube feeding, and dialysis than antibiotherapy. To characterize infections, agents, and their treatments in palliative care, we conducted a review of the literature. We also included some tips to help health professionals to guide their clinical approach.

Aislamiento del estreptococo beta-hemolítico en niños asintomáticos / Isolation of the beta-hemolytic streptococcus in asymptomatic children

Introducción: las faringoamigdalitis se encuentran entre las enfermedades infecciosas que más afectan a los niños en edad escolar, cuya primera causa bacteriana es el estreptococo beta-hemolítico del grupo A. Objetivo: determinar la presencia de dicha bacteria en exudados faríngeos de niños asintomáticos. Métodos: se realizó un estudio transversal y descriptivo de 80 niños de ambos sexos en el Círculo Infantil Alberto Fernández de Santiago de Cuba, durante el año 2014. Resultados: se obtuvo un elevado porcentaje de infectados por bacterias potencialmente patógenas, con predominio del estreptococo beta-hemolítico del grupo A, así como una mayor frecuencia de niños en las edades de 4 y 5 años y del sexo masculino; asimismo, los antibióticos de mayor sensibilidad fueron la penicilina y amoxicilina, mientras que la kanamicina fue el de mayor resistencia. Conclusiones: esta investigación posibilitó conocer las características de colonización de esta bacteria, así como su sensibilidad antimicrobiana

Introduction: pharyngotonsillitis is among the infectious diseases that most affect children in school age whose first bacterial cause is the group A beta-hemolytic streptococcus. Objective: to be determine the presence of this bacteria in throat swabs of asymptomatic children. Methods: a cross-sectional and descriptive study of 80 children from both sexes was carried out in Alberto Fernández day care center in Santiago de Cuba, during 2014. Results: a high percentage of infected children by potentially pathogens bacterias was obtained, with prevalence of group A beta-hemolytic streptococcus, as well as a higher frequency of children of the male sex aged 4 and 5; also, the antibiotics of more sensitivity were penicillin and amoxicillin, while kanamycin was that of higher resistance. Conclusions: with this investigation the colonization characteristics of this bacteria were known, as well as its antimicrobian sensitivity

Uso de antimicrobiano nanoparticulado para o tratamento da mastite subclínica de ovelhas de corte no período seco / Use of nanoparticulated antimicrobians to treat subclinical mastitis of ewes during the dry period

A inflamação da glândula mamária é uma das principais causas de prejuízo na ovinocultura. Este estudo teve como objetivo investigar as taxas de cura do tratamento da mastite subclínica após infusão intramamária de princípio ativo antimicrobiano no momento da secagem, em formulações convencional e nanoparticulada. Os rebanhos estavam localizados em São Carlos, São Paulo, Brasil. Analisou-se um total de 584 glândulas mamárias de 307 ovelhas de aptidão para produção de carne. Triagem prévia dos casos subclínicos de mastite foi efetuada por meio do California Mastitis Test (CMT) e/ou da contagem de células somáticas (CCS). Análises microbiológicas foram realizadas para confirmação da etiologia infecciosa. As glândulas mamárias com mastite subclínica foram distribuídas em três grupos: G1 (Controle; glândulas mamárias que não receberam tratamento antimicrobiano); G2 (glândulas mamárias em que foi administrado 100 mg de cloxacilina benzatina em estrutura convencional) e G3 (glândulas mamárias em que foi administrado 50 mg de cloxacilina benzatina em estrutura nanoencapsulada). O tratamento aplicado ao G3 mostrou-se mais eficiente (P=0,047) na cura de glândulas mamárias com mastite subclínica. O uso da cloxacilina nanoencapsulada no momento da secagem de ovelhas de corte auxilia no controle da mastite subclínica infecciosa e reduz os prejuízos consequentes.(AU)

Inflammation of the mammary gland is one of the main causes of losses in sheep-rearing. This study aimed to investigate the cure rates from treating subclinical mastitis after intramammary infusion of active antimicrobial agents as conventional formulations or as nanoparticles, at the time when the ewes are being dried off. A total of 584 mammary glands in 307 ewes in meat-producing herds located in São Carlos, São Paulo, Brazil, were analyzed. Prescreening of subclinical mastitis cases was done using the California mastitis test (CMT) and/or the somatic cell count (SCC). Microbiological analyses were performed to confirm the infectious etiology. The mammary glands with subclinical mastitis were distributed into three groups: G1 (control; mammary glands that did not receive any antimicrobial treatment); G2 (mammary glands to which 100mg of benzathine cloxacillin in conventional form were administered); and G3 (mammary glands to which 50mg of benzathine cloxacillin in nanoparticulate form were administered). The treatment applied to G3 was more efficient (P=0.047) in curing mammary glands with subclinical mastitis. Use of cloxacillin nanoparticles at the time when the ewes are being dried off helps to control infectious subclinical mastitis and reduces consequential losses among meat-producing herds.(AU)

Principales aspectos clínicos y epidemiológicos en pacientes con dermopatías por medicamentos / Main clinical and epidemiological aspects in patient with dermopathies due to drugs

Se realizó un estudio descriptivo y transversal de los 51 pacientes con dermopatías por medicamentos, ingresados en el Servicio de Dermatología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde enero del 2011 hasta diciembre del 2012, para determinar las características clínicas y epidemiológicas de ellos. A tal fin se analizaron las variables: edad, sexo, cuadro clínico, fármacos ingeridos y vía de administración, persona que indicó el medicamento, entre otras. Las erupciones cutáneas por medicamentos se presentaron en una amplia variedad clínica, con predominio del eritema multiforme menor, el tratamiento fue indicado por facultativos en la mayoría de los casos, y entre los grupos de fármacos consumidos con más frecuencia figuraron los antimicrobianos y los analgésicos antiinflamatorios no esteroideos.

A descriptive, cross sectional and prospective study of the 51 patients with dermopathies due to drugs, admitted to the Dermatology Service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out from January, 2011 to December, 2012, to determine the clinical and epidemiological characteristics of them. For this purpose, the variables age, sex, clinical pattern, ingested drugs and administration route, person who indicated the drug, among others, were analyzed. The skin eruptions due to drugs were presented in a wide clinical variety, with prevalence of the minor multiform erythema, the treatment was indicated by doctors in most of the cases, and among the groups of consumed drugs with more frequency there were the antimicrobians and the non steroids analgesic anti-inflammatory drugs.

Contaminação fecal da ostra Crassostrea rhizophorae e da água de cultivo do estuário do rio pacoti (Eusébio-, Estado do Ceará): isolamento e identificação de Escherichia coli e sua susceptibilidade a diferentes antimicrobianos / Fecal contamination of the mangrove oyster Crassostrea rhizophorae and the cultivation water at the river pacoti estuary (Eusébio ? Ceará State): identification and isolation of Escherichia coli and its susceptibility to different antimicrobians

Este estudo objetivou avaliar a qualidade microbiológica da água do cultivo de ostras, do Estuário do Rio Pacoti, assim como a qualidade das ostras, através do Número Mais Provável (NMP) de coliformes totais (Ct) e termotolerantes (CT). Foram realizadas 15 colheitas, entre junho e novembro de 2006. A água do cultivo se manteve dentro dos limites permitidos pela Legislação vingente. O NMP de Ct/100 mL variou de < 1,8 a 18.000 e de CT/100 mL de < 1,8 a 2.000, enquanto as ostras variaram os Ct e CT/g de < 1,8 a 3.500 e < 1,8 a 2.800, respectivamente. Vinte e cinco cepas de Escherichia coli isoladas da água de cultivo testadas quanto a susceptibilidade a alguns antimicrobianos se mostraram resistentes a ampicilina, nitrofurantoína, tetraciclina, sulfazotrin, ácido nalidíxico, ciprofloxacim, e a imipenem. Das ostras, somente quatro cepas, identificadas como E.coli mostraram-se resistentes a tetraciclina e a imipenem. Baseado nos valores obtidos de Ct e CT da amostra de água e ostras, foi possível constatar que: as águas do Rio Pacoti estão em boas condições segundo a legislação nacional; que a maioria das cepas de E. coli (59,43%), isoladas da água do Rio Pacoti foi sensível aos antimicrobianos testados, exceção do imipenem para o qual as cepas de E.coli apresentaram alto percentual de resistência (80%); a sensibilidade das cepas de E.coli isoladas das amostras de ostras apresentou-se alta à maioria dos antibióticos testados.

This study has been designed to assess the microbiological quality of oyster Crassostrea rhizophorae and of the water used in farms located at the Pacoti River estuary, Ceará State, by means of the MPN of total coliforms (Ct) and thermtolerant coliforms (CT). The database consisted of 15 samples collected from June to November, 2006. The water was kept within the limits set up by the current legislation. MPN values were in the ranges of <1.8 - 18,000 Ct per 100 ml and <1.8 - 2,000 CT per 100 ml, for the water, and <1.8 - 3,500 Ct per gram and <1.8 - 2,800 CT per gram for the oyster itself. Twenty-five strains isolated from the cultivation water and identified as Escherichia coli were tested for susceptibility to a few antimicrobians and proved resistant to ampicillin, nitrofurantoin, tetracycline, sulfazotrin, nalidixic acid, ciprofloxacin and imipenem. From the oysters, four strains were identified as E. coli and proved resistant to tetracycline and imipenem. From the afore-mentioned results, it can be concluded that: Pacoti River waters have received a clean bill of health according to the national legislation; the majority of water-isolated E.coli strains (59.43%) were sensitive to the currently used antimicrobians, except for imipenem to which 80% of the identified E. coli strains proved resistant; sensitivity of the oyster-isolated E. coli strains was found to be high to most of the tested antimicrobians. In all, it is suggested that more clear management measures be made available so as to allow for microbiological quality evaluation of raw-consumed mollusks.