Clinical and microbiological characteristics of a hospital outbreak of Candida auris in a referral hospital in Lima, Peru.

BACKGROUND: Candida auris, a multidrug-resistant fungal pathogen, has received considerable attention owing to its recent surge, especially in South America, which coincides with the ongoing global COVID-19 pandemic. Understanding the clinical and microbiological characteristics of outbreaks is crucial for their effective management and control. OBJECTIVE: This retrospective observational study aimed to characterize a C. auris outbreak at a Peruvian referral hospital between January 2021 and July 2023. METHODS: Data were collected from hospitalized patients with positive C. auris culture results. Microbiological data and antifungal susceptibility test results were analysed. Additionally, infection prevention and control measures have been described. Statistical analysis was used to compare the characteristics between the infected and colonized patients. RESULTS: Thirty-three patients were identified, mostly male (66.7%), with a median age of 53 years. Among them, 18 (54.5%) were colonized, and 15 (45.5%) were infected. Fungemia was the predominant presentation (80%), with notable cases of fungemia in tuberculosis patients with long-stay devices for parenteral anti-tuberculosis therapy. Seventy-five percent of the isolates exhibited fluconazole resistance. Echinocandins were the primary treatment, preventing fungemia recurrence within 30 days. Infected patients had significantly longer hospital stays than colonized patients (100 vs. 45 days; p = .023). Hospital mortality rates were 46.7% and 25% in the infected and fungemia patients, respectively. Simultaneous outbreaks of multidrug-resistant bacteria were documented. CONCLUSIONS: This study underscores the severity of a C. auris outbreak at a referral hospital in Peru, highlighting its significant impact on patient outcomes and healthcare resources. The high prevalence of fluconazole-resistant isolates, leading to prolonged hospital stay and high mortality rates, particularly in cases of fungemia, underscores the critical need for effective infection prevention and control strategies.

Identification and Clinical Characteristics of Community-Acquired Acinetobacter baumannii in Patients Hospitalized for Moderate or Severe COVID-19 in Peru.

Acinetobacter baumannii has been described as a cause of serious community-acquired infections in tropical countries. Currently, its implications when simultaneously identified with other pathogens are not yet adequately understood. A descriptive study was conducted on hospitalized patients with a diagnosis of moderate/severe SARS-CoV-2-induced pneumonia confirmed via real-time RT-PCR. Patients aged > 18 years who were admitted to a specialized COVID-19 treatment center in Peru were selected for enrollment. A. baumannii was detected via the PCR amplification of the blaOXA-51 gene obtained from nasopharyngeal swabs within 48 h of hospitalization. A total of 295 patients with COVID-19 who met the study inclusion criteria were enrolled. A. baumannii was simultaneously identified in 40/295 (13.5%) of COVID-19-hospitalized patients. Demographic data and comorbidities were comparable in both Acinetobacter-positive and -negative subgroups. However, patients identified as being infected with Acinetobacter were more likely to have received outpatient antibiotics prior to hospitalization, had a higher requirement for high-flow nasal cannula and a higher subjective incidence of fatigue, and were more likely to develop Acinetobacter-induced pneumonia during hospitalization. Conclusions: The group in which SARS-CoV-2 and A. baumannii were simultaneously identified had a higher proportion of fatigue, a higher frequency of requiring a high-flow cannula, and a higher proportion of superinfection with the same microorganism during hospitalization.

Identification of Coinfections by Viral and Bacterial Pathogens in COVID-19 Hospitalized Patients in Peru: Molecular Diagnosis and Clinical Characteristics.

The impact of respiratory coinfections in COVID-19 is still not well understood despite the growing evidence that consider coinfections greater than expected. A total of 295 patients older than 18 years of age, hospitalized with a confirmed diagnosis of moderate/severe pneumonia due to SARS-CoV-2 infection (according to definitions established by the Ministry of Health of Peru) were enrolled during the study period. A coinfection with one or more respiratory pathogens was detected in 154 (52.2%) patients at hospital admission. The most common coinfections were Mycoplasma pneumoniae (28.1%), Chlamydia pneumoniae (8.8%) and with both bacteria (11.5%); followed by Adenovirus (1.7%), Mycoplasma pneumoniae/Adenovirus (0.7%), Chlamydia pneumoniae/Adenovirus (0.7%), RSV-B/Chlamydia pneumoniae (0.3%) and Mycoplasma pneumoniae/Chlamydia pneumoniae/Adenovirus (0.3%). Expectoration was less frequent in coinfected individuals compared to non-coinfected (5.8% vs. 12.8%). Sepsis was more frequent among coinfected patients than non-coinfected individuals (33.1% vs. 20.6%) and 41% of the patients who received macrolides empirically were PCR-positive for Mycoplasma pneumoniae and Chlamydia pneumoniae.

First Clinical Cases of OXA-48-Producing Klebsiella pneumoniae in Peru / Primeros casos clínicos de infecciones por Klebsiella pneumoniae productora de OXA-48 en Perú

Background: Carbapenemase-producing Enterobacteriaceae(CPE) represents a global public health concern and systemic infectionsassociatedwithOXA-48 carbapenemase are increasingly being reported in Latin America. Here, we present the first 2 cases of systemic infections by OXA-48-ProducingKlebsiellapneumoniaein Peru. A favorable clinical response was observed after targeted treatment with colistin as a backbone.

Introducción: Las enterobacterias productoras de carbapenemasas (EPC) representan un problema de salud pública y cada vez hay más reportes de infecciones sistémicas asociadas con la carbapenemasa OXA-48 en America Latina. Presentamos los primeros 2 casos de infecciones sistémicas por Klebsiella pneumoniae productora de OXA-48 en Perú. Se observó una respuesta clínica favorable luego del tratamiento dirigido con colistina como base.

Antibiotic Consumption and Its Relationship with Bacterial Resistance Profiles in ESKAPE Pathogens in a Peruvian Hospital.

A descriptive design was carried out studying the correlation between antimicrobial consumption and resistance profiles of ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) in a Peruvian hospital, including the surgical, clinical areas and the intensive care unit (ICU) during the time period between 2015 and 2018. There was a significant correlation between using ceftazidime and the increase of carbapenem-resistant Pseudomonas aeruginosa isolations (R = 0.97; p < 0.05) and the resistance to piperacillin/tazobactam in Enterobacter spp. and ciprofloxacin usage (R = 0.97; p < 0.05) in the medical wards. The Pseudomonas aeruginosa resistance to piperacillin/tazobactam and amikacin in the intensive care unit (ICU) had a significant reduction from 2015 to 2018 (67% vs. 28.6%, 65% vs. 34.9%, p < 0.001). These findings give valuable information about the rates and dynamics in the relationship between antibiotic usage and antimicrobial resistance patterns in a Peruvian hospital and reinforce the need for continuous support and assessment of antimicrobial stewardship strategies, including microbiological indicators and antimicrobial consumption patterns.

[Myths about organ donation on health personnel, potential recipients and relatives of potential donors in a peruvian hospital: a qualitative study]. / Mitos sobre la donación de órganos en personal de salud, potenciales receptores y familiares de potenciales donantes en un hospital peruano: estudio cualitativo.

OBJECTIVES: To explore the myths regarding organ donation at a national hospital in Lambayeque, Peru during 2014. MATERIALS AND METHODS: A qualitative-phenomenological study was performed using 24 unstructured in-depht interview of health personnel, potential recipients and relatives of potential donors. Sampling was intentional opinion-based, completed by theoretical saturation in each group. An interview guide was used, which was assessed by five experts, and data triangulation was performed. RESULTS: Twenty-three interviewees (95,8%) reported a favorable attitude towards organ donation. On their National Identification Document, thirteen (54,2%) had marked "no" for donation. The myths were: age or illness can preclude donation; that the recipient may experience the donor's behaviours and lives in it; brain death is undestood as the immobility of the body and a reversible state; religions do not accept organ donation because it affects physical integrity and resurrection; and that there are preferences on the organ donor waiting list and that organ trafficking taxes place. CONCLUSIONS: Myths explored in this study involved religious, socio-cultural, psychological and ethical misperceptions. The apparent lack of knowledge of the brain death diagnosis is the starting point of the donation process. Therefore, the presence of a hospital coordinator, the role of spiritual leaders and the correct information provided by media would be key parts to dispell these myths.

Mitos sobre la donación de órganos en personal de salud, potenciales receptores y familiares de potenciales donantes en un hospital peruano: estudio cualitativo / Myths about organ donation on health personnel, potential recipients and relatives of potential donors in a peruvian hospital: a qualitative study

Explorar los mitos sobre la donación de órganos en un hospital nacional de Lambayeque-Perú, en el año 2014. Materiales y métodos. Se realizó un estudio cualitativo-fenomenológico con veinticuatro entrevistas a profundidad no estructuradas a personal de salud, potenciales receptores y familiares de potenciales donantes. El muestreo fue intencional opinático finalizado por saturación teórica de cada estamento. Se utilizó una guía de entrevista evaluada por cinco expertos. Se realizó triangulación de datos. Resultados. Veintitrés entrevistados (95,8%) mostraron actitud favorable hacia la donación de órganos. En el Documento Nacional de Identidad, trece (54,2%) refieren ônoõ a la donación. Los mitos fueron: la edad o enfermedades contraindican la donación; el receptor de un órgano experimenta actitudes de su donador y vive en él; la muerte cerebral es inmovilidad del cuerpo y un estado reversible; las religiones no aceptan la donación de órganos, esta afecta la integridad física y la resurrección, y existen preferencias en la lista de espera de donantes así como el tráfico de órganos. Conclusiones. Los mitos explorados en el presente estudio muestran perspectivas religiosas, socioculturales, psicológicas y éticas. La aparente falta de conocimiento del diagnóstico de muerte cerebral es el punto de partida que marca el proceso de donación. La existencia de un coordinador hospitalario, el rol de los guías espirituales y la correcta información brindada por medios de comunicación serían piezas clave para derribar estos mitos...

To explore the myths regarding organ donation at a national hospital in Lambayeque, Peru during 2014. Materials and methods. A qualitative-phenomenological study was performed using 24 unstructured in-depht interview of health personnel, potential recipients and relatives of potential donors. Sampling was intentional opinion-based, completed by theoretical saturation in each group. An interview guide was used, which was assessed by five experts, and data triangulation was performed. Results. Twenty-three interviewees (95,8%) reported a favorable attitude towards organ donation. On their National Identification Document, thirteen (54,2%) had marked "no" for donation. The myths were: age or illness can preclude donation; that the recipient may experience the donor's behaviours and lives in it; brain death is undestood as the immobility of the body and a reversible state; religions do not accept organ donation because it affects physical integrity and resurrection; and that there are preferences on the organ donor waiting list and that organ trafficking taxes place. Conclusions. Myths explored in this study involved religious, socio-cultural, psychological and ethical misperceptions. The apparent lack of knowledge of the brain death diagnosis is the starting point of the donation process. Therefore, the presence of a hospital coordinator, the role of spiritual leaders and the correct information provided by media would be key parts to dispell these myths...

Validación de un instrumento para medir el nivel de conocimiento sobre depresión mayor en médicos de atención primaria en Chiclayo, Perú / Validation of an instrument to measure the level of knowledge about major depression in general practitioners in Chiclayo, Peru

Objetivo: Diseñar y validar un instrumento para evaluar el nivel de conocimientos sobre Depresión Mayor en médicos de atención primaria en Chiclayo. Material y Métodos: Estudio descriptivo, transversal, tipo validación de un instrumento. El primer constructo se desarrolló en el 2010 en base al marco teórico y sometido a juicio de expertos. En el 2011 nuevamente se sometió el cuestionario a 12 expertos según la metodología Delphi, obteniéndose un constructo de 14 preguntas: 7 de diagnóstico y 7 de tratamiento; se realizó un estudio piloto para evaluar la inteligibilidad y pertinencia del instrumento. Se evaluó la confiabilidad con el coeficiente de Kuder-Richardson y el Alfa de Cronbach. La validez de constructo se realizó mediante análisis factorial. Se utilizó SPSS v. 15. Resultados: Se entrevistaron 34 médicos generales (90%) y 6 alumnos (10%) que habían terminado el curso de Salud mental: 36 (90%) fueron varones; la media de edad fue de 37,5 ± 15 años. Los percentiles 25, 50 y 75 de la puntuación total del instrumento fueron: 4, 6 y 9, respectivamente. El Coeficiente de Kuder-Richardson fue 0,62; el Alfa de Cronbach de cada una de las preguntas fue mayor de 0,55. Las pruebas de Kaiser Meyer Olkin y de esfericidad de Bartlett mostraron que el instrumento era unidimensional. Conclusiones: Se obtuvo un instrumento válido, confiable y unidimensional para determinar el nivel de conocimientos sobre depresión mayor en médicos de atención primaria.

Objective: To design and validate an instrument to assess the level of knowledge of major depression in general practitioners in Chiclayo. Methods: A descriptive, cross sectional study for instrument validation. The first construct was developed in the year 2010 based on the theoretical framework and was subject to expert judgment. During the year 2011, the questionnaire was subjected again to 12 experts according to the Delphi methodology, yielding a construct of 14 questions: 7 for diagnosis and 7 for treatment. A pilot study was conducted to evaluate the relevance and understandability of the instrument The reliability of the instrument was evaluated with the Kuder-Richardson coefficient and the CronbachÆs Alpha. Construct validity was performed by factorial analysis. We used the statistical software SPSS v. 15. Results: We interviewed 34 general practitioners (90%) and 6 students (10%) who had completed the courses of Mental Health: 36 (90%) were male and the mean age was 37.5 ± 15 years. The percentiles 25, 50 and 75 of the total score of the instrument were: 4, 6 and 9, respectively. The Kuder-Richardson coefficient was 0.62, the CronbachÆs alpha for each questions was greater than 0.55. The Kaiser Meyer Olkin test and BartlettÆs sphere city showed that the instrument was one-dimensional. Conclusions: We obtained a valid, reliable and one dimensional instrument to determine the level of knowledge of major depression in general practitioners.