Prevalence of Antimicrobial Resistance in Gram-Negative Bacteria Bloodstream Infections in Peru and Associated Outcomes: VIRAPERU Study.

Surveillance of antimicrobial resistance among gram-negative bacteria (GNB) is of critical importance, but data for Peru are not available. To fill this gap, a non-interventional hospital-based surveillance study was conducted in 15 hospitals across Peru from July 2017 to October 2019. Consecutive unique blood culture isolates of key GNB (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter spp.) recovered from hospitalized patients were collected for centralized antimicrobial susceptibility testing, along with linked epidemiological and clinical data. A total of 449 isolates were included in the analysis. Resistance to third-generation cephalosporins (3GCs) was present in 266 (59.2%) GNB isolates. Among E. coli (n = 199), 68.3% showed 3GC resistance (i.e., above the median ratio for low- and middle-income countries in 2020 for this sustainable development goal indicator). Carbapenem resistance was present in 74 (16.5%) GNB isolates, with wide variation among species (0% in E. coli, 11.0% in K. pneumoniae, 37.0% in P. aeruginosa, and 60.8% in Acinetobacter spp. isolates). Co-resistance to carbapenems and colistin was found in seven (1.6%) GNB isolates. Empiric treatment covered the causative GNB in 63.3% of 215 cases. The in-hospital case fatality ratio was 33.3% (92/276). Pseudomonas aeruginosa species and carbapenem resistance were associated with higher risk of in-hospital death. In conclusion, an important proportion of bloodstream infections in Peru are caused by highly resistant GNB and are associated with high in-hospital mortality.

Underutilization and Quality Gaps in Blood Culture Processing in Public Hospitals of Peru.

Correct processing of blood cultures may impact individual patient management, antibiotic stewardship, and scaling up of antimicrobial resistance surveillance. To assess the quality of blood culture processing, we conducted four assessments at 16 public hospitals across different regions of Peru. We assessed the following standardized quality indicators: 1) positivity and contamination rates, 2) compliance with recommended number of bottles/sets and volume of blood sampled, 3) blood culture utilization, and 4) possible barriers for compliance with recommendations. Suboptimal performance was found, with a median contamination rate of 4.2% (range 0-15.1%), with only one third of the participating hospitals meeting the target value of < 3%; and a median positivity rate of 4.9% (range 1-8.1%), with only 6 out of the 15 surveilled hospitals meeting the target of 6-12%. None of the assessed hospitals met both targets. The median frequency of solitary blood cultures was 71.9% and only 8.9% (N = 59) of the surveyed adult bottles met the target blood volume of 8 - 12 mL, whereas 90.5% (N = 602) were underfilled. A high frequency of missed opportunities for ordering blood cultures was found (69.9%, 221/316) among patients with clinical indications for blood culture sampling. This multicenter study demonstrates important shortcomings in the quality of blood culture processing in public hospitals of Peru. It provides a national benchmark of blood culture utilization and quality indicators that can be used to monitor future quality improvement studies and diagnostic stewardship policies.

Prevalencia de portadores de staphylococcus aureus en personal de salud del Hospital Victor Lazarte Echegaray y Sensibilidad antimicrobiana en vitro / Prevalence of Staphylococcus aureus carriers in the health workforce Victor Lazarte Echegaray Hospital and in vitro antimicrobial sensitivity

El presente estudio se realizó con la finalidad de determinar la prevalencia de portadores de Staphylococcus aureus en personal de salud del Hospital Víctor Lazarte Echegaray, durante el mes de agosto del 2003 y determinar su sensibilidad a los antimicrobianos in vitro. Se tomaron muestras de hisopados nasales y faríngeos a personal de cirugía, UCI-UCIN y sala de operaciones las cuales de cultivaron en medio tioglicolato, agar sangre y agar Manitol. Las cepas aisladas se identificaron mediante las pruebas catalasa, coagulasa, coloración gram, acción sobre el manitol y luego se realizaron antibiogramas mediante el método de Kirby y Bauer. Los resultados muestran una prevalencia de 28,6% en personal de salud, en personal médico 38,5%, en técnicos 23,1 % y en enfermeras el 20,8%. En personal del servicio de UCI-UCIN, se halló 46,7%, en cirugía 28,6% y en SOP 15%. Los portadores nasales fueron el 23,8% y faríngeos el 15,9%. De los antimicrobianos utilizados se presentó 100% de sensibilidad a vancomicina, 94,44% a amikacina, 77,78% a oxacilina y ciprofloxacina, el 72,22% a cefalexina, el 55,56% a amoxil/ac. clavulánico y ceclor, el 27,78% a clindamicina y el 16,67% a penicilina.

The present study was carried out with the purpose of determining the prevalencia of payees of Staphylococcus aureus in personal of health of the Hospital Victor to Rope you Echegaray, during the month of August of the 2003 and to determine its sensibility to the antimicrobianos in vitro. They took samples of nasal and pharyngeal hisopados to personal of surgery, UCI-UCIN and room of operations those which of they cultivated between tioglicolato, agar bleeds and agar Manitol. The isolated stumps were identified by means of the tests catalasa, coagulasa, coloration gram, action on the manitol and then they were carried out antibiogramas by means ofthe method of Kirby and Bauer. The results show a prevalencia of 28,6% in personal of health, inpersonnel medical 38,5%, in technicians 23,1% and in nurses 20,8%. In personal of the service of UCI-UCIN, he/she was 46,7%, in surgery 28,6% and in SOP 15%. The nasal payees were 23,8% and pharyngeal 15,9%. Of the used antimicrobianos 100% of sensibility was presented to vancomicina, 94,44% to amikacina, 77,78% to oxacilina and ciprofloxacina, 72,22% to cefalexina, 55,56% to amoxil/ac. clavulánico and ceclor, 27,78% to clindamicina and 16,67% to penicillin.