Recomendaciones higiénicas para servicios alimenticios en entornos hospitalarios durante el confinamiento por COVID-19: Revisión Panorámica / Hygienic Recommendations for Food Service in Hospital Environments During COVID-19 Confinement: Scoping Review

Objetivo: Explorar las principales medidas de higiene alimentaria para servicios alimentarios en contextos hospitalarios durante el período de pandemia por COVID-19.Métodos: Se desarrolló una revisión panorámica de artículos publicados entre el 1 de diciembre 2019 al 30 de octubre del año 2020, en las bases de datos de EMBASE y PubMed respectivamente. Como criterios de elegibilidad se incluyeron estudios que informaran medidas de resultado, como lavado de manos, distanciamiento social, contaminación de alimentos y desinfección de superficies. Resultados: Se identificaron 151 artículos, de los cuales10 fueron analizados. Los resultados sugieren que las medidas higiénicas recomendadas como el lavado de manos, distanciamiento social, supervisión en la manipulación de alimentos son fundamentales para la prevención de la contaminación por el SARS-CoV-2, en servicios alimentarios en contextos hospitalarios. Conclusiones: La literatura analizada da cuenta de la necesidad de contar con mayor evidencia científica para respaldar los efectos de las recomendaciones higiénicas indicadas a los servicios alimentarios en contextos hospitalarios. Este estudio sienta las bases para futuras revisiones sistemáticas y metaanálisis para las principales medidas de prevención establecidas por los organismos sanitarios. (AU)

Objective: Explore the main hygienic measures for food services in hospital contexts during the period of the COVID-19 pandemic. Methods: A panoramic review of articles published between December 1, 2019, and October 30, 2020, was developed in the EMBASE and Pubmed/MEDLINE databases respectively. Studies reporting outcome measures such as hand washing, social distancing, food contamination, and surface disinfection were included as eligibility criteria. Results: Based on the search strategy, 150 articles were identified, of which 10 research papers were incorporated into the analysis. The results show that the recommended hygienic measures such as hand washing, social distancing, and supervision in the handling of food are essential for the prevention of the spread of COVID-19, in-hospital food services. Conclusions: The data analyzed shows the need for more scientific evidence to support the effects of the hygienic recommendations indicated to food services in hospital contexts. This study lays the foundations for future systematic reviews and meta-analysis for the main prevention measures established for health agencies. (AU)

Lactobacilli isolated from vaginal vault of dairy and meat cows during progesteronic stage of estrous cycle.

Lactobacilli have been barely studied in cows. We proposed isolate and characterize lactic acid bacteria from dairy cows as compared to those raised for meat production and elucidate the presence of strains with evident probiotic employment's potential. For this, isolation and quantification of LAB mainly lactobacilli were realized from vaginal cattle samples in MRS medium. Each selected microorganism was then briefly characterized. The MATH method was employed using hexadecane, xilene an toluene as solvent. According to the hydrophobic characteristics, strains were classified into three categories: high (71-100%), medium (36-70%) and low (0-35%). Hydrogen peroxide qualitative production was studies too, lactobacilli were streaked onto an MRS agar plate containing 5 mg of 3,3',5,5'-tetramethylbenzidine and 0.20 mg of horseradish peroxidase. Twenty-one sampled cows (78%) were positive for lactic acid microflora, 12 belonging to the dairy group and 17 of the meat group. Total LAB counting including dairy and meat cows were log 2,41 CFU/ml. Of overall identified strains, an 83% corresponded to lactobacilli. Most strains belonged to the heterofermentative facultative group (75%), with L. plantarum as the most frequent specie. The highest proportion of isolated vaginal strains (69%) had low hydrophobicity, the LAB with highest hydrophobic characteristics (3 strains) were found only in meat cows. In the qualitative evaluation of H(2)O(2) production, a positive reaction was observed in 13 of 29 strains (45%). The role of lactobacilli in vaginal microbiota is limited, and therefore the present work is interesting in incorporate knowledge of normal microflora of progesteronic healthy cows, in this case in production animals. The isolation and characterization data obtained are consistent in consider the study of particular strains with great potential in the development of a probiotic for production cows.

Prospective evaluation of a model of prediction of invasive bacterial infection risk among children with cancer, fever, and neutropenia.

A risk prediction model for invasive bacterial infection (IBI) was prospectively evaluated among children presenting with cancer, fever, and neutropenia. The model incorporated assessment of 5 previously identified risk factors: serum level of C-reactive protein (CRP) >/=90 mg/L, hypotension, identification of relapse of leukemia as the cancer type, platelet count of

Prospective, multicenter evaluation of risk factors associated with invasive bacterial infection in children with cancer, neutropenia, and fever.

PURPOSE: To identify clinical and laboratory parameters present at the time of a first evaluation that could help predict which children with cancer, fever, and neutropenia were at high risk or low risk for an invasive bacterial infection. PATIENTS AND METHODS: Over a 17-month period, all children with cancer, fever, and neutropenia admitted to five hospitals in Santiago, Chile, were enrolled onto a prospective protocol. Associations between admission parameters and risk for invasive bacterial infection were assessed by univariate and logistic regression analyses. RESULTS: A total of 447 febrile neutropenic episodes occurred in 257 children. Five parameters were statistically independent risk factors for an invasive bacterial infection. Ranked by order of significance, they were as follows: C-reactive protein levels of 90 mg/L or higher (relative risk [RR], 4.2; 95% confidence interval [CI], 3.6 to 4.8); presence of hypotension (RR, 2.7; 95% CI, 2.3 to 3.2); relapse of leukemia as cancer type (RR, 1.8, 95% CI, 1.7 to 2.3); platelet count less than or equal to 50,000/mm(3) (RR, 1.7; 95% CI, 1.4 to 2.2); and recent (< or = 7 days) chemotherapy (RR, 1.3; 95% CI, 1.1 to 1.6). Other previously postulated risk factors (magnitude of fever, monocyte count) were not independent risk factors in this study population. CONCLUSION: In a large population of children, common clinical and laboratory admission parameters were identified that can help predict the risk for an invasive bacterial infection. These results encourage the possibility of a more selective management strategy for these children.

[Causative agents of bloodstream infections in children with neoplasm, in 5 hospitals of Santiago (1994-1998)]. / Agentes causantes de infecciones del torrente circulatorio en niños con cáncer, en cinco hospitales de Santiago (1994-1998).

BACKGROUND: Pediatric patients in treatment for cancer can have fatal bacterial infections. Thus, in the presence of fever or other signs infection, antimicrobials have to be prescribed empirically. AIM: To know the causative agents of bacteremia in children with cancer, their changes with time and between different hospitals and their patterns of susceptibility. MATERIAL AND METHODS: We reviewed the blood cultores of children with cancer in five hospitals of Santiago, from 1994 at 1998. RESULTS: During the study period, 707 agents were isolated. The most frequently isolated species or genus were coagulase negative Staphylococcus (43%), Staphylococcus aureus (16%), Escherichia coli (9%), Klebsiella spp. (8%), Pseudomonas spp. (5%) and Candida spp. (4%). Coagulase negative Staphylococcus was 55% resistant to meticilin and S. aureus was 44% resistant. Enterobacteriaceae had 15% resistance to gentamicin and amikacin, 2% to imipenem, 26% to ceftriaxone, 21% to cefotaxime and 20% to ceftazidime. Among non fermenting agents resistance was 6% for imipenem, 9% for amikacin 10% for ciprofloxacin, 19% for ceftazidime and 22% for cefoperazone. The resistance of Streptococcus spp. (non pneumoniae) to penicillin reached 50% and that of Enterococcus spp. was of 33%. CONCLUSIONS: Treatment for pediatric patients with cancer must be modified and new guidelines including more active medications for patients at risk for bacteremia, should be devised.

Cloning and expression in Escherichia coli of genetic determinants for production of and immunity to microcin E492 from Klebsiella pneumoniae.

Microcin E492 is a polypeptide antibiotic that is produced and excreted by Klebsiella pneumoniae RYC492. The genetic determinants for microcin synthesis and immunity were cloned in Escherichia coli VCS257 into the cosmid vector pHC79, starting from total DNA of K. pneumoniae RYC492. The microcin E492 expressed in E. coli had the same properties as that of K. pneumoniae, i.e., the same molecular weight, the ability to form ionic channels in planar phospholipid bilayers, and essentially identical biological properties. Microcin E492 expression in E. coli, like that in K. pneumoniae, was mainly in the exponential phase of growth, declining in the stationary phase. The immunity determinant was subcloned into the same vector, and its expression was found to disappear in the stationary phase. This phenomenon is not dependent on rpoS, the stationary-phase sigma factor.

Discontinuation of antimicrobial therapy for febrile, neutropenic children with cancer: a prospective study.

During a 2-year period, all children with cancer, neutropenia, and fever who were admitted to Hospital de Niños Luis Calvo Mackenna (Santiago, Chile) were enrolled in a study of the safety of stopping antibiotic therapy on day 3 of treatment. Children who met predefined criteria for nonbacterial fever were randomized on day 3 to stop (group A) or continue (group B) antibiotic therapy. A total of 220 children with cancer had 238 episodes of fever and neutropenia; 68 children with 75 episodes met entry criteria for nonbacterial fever (group A, 36; group B, 39). Both groups were comparable in terms of age, gender, oncological disease, chemotherapy status, and initial neutrophil count. Resolution of symptoms occurred in 34 of 36 episodes in group A and 36 of 39 episodes in group B (P > .05). No deaths occurred, and bacterial superinfections were uncommon. For children with cancer as well as episodes of fever and neutropenia without an identifiable bacterial etiology at admission, stopping antibiotic therapy on day 3 was safe and not associated with a higher risk of bacterial superinfections.

C-reactive protein: a valuable aid for the management of febrile children with cancer and neutropenia.

The usefulness of determining serum levels of C-reactive protein (CRP) for the identification of bacterial infections in febrile neutropenic patients with cancer was evaluated. Two hundred children with cancer were monitored prospectively for the occurrence of neutropenia and fever; serum was collected from these children for determining baseline levels of CRP. Of these 200 children, 75 had 85 febrile neutropenic episodes; serum was collected daily from these 75 children for CRP analysis by nephelometry. Children were included into one of the three following groups by physicians blinded to results of CRP analysis: group I, demonstrated bacterial infection (24 episodes); group II, probable bacterial infection (31 episodes); and group III, viral infection or no infection (30 episodes). Baseline CRP values were low (mean, 9 mg/L; range, 0-35 mg/L) irrespective of tumor type or stage of therapy. Mean CRP values on day 1 for children in groups I and II (194 and 143 mg/L, respectively) were higher than those for children in group III (29 mg/L) (P < .001). A CRP value of > 40 mg/L discriminated children with a demonstrated bacterial infection (sensitivity, 100%; specificity, 76.6%). Children with an unfavorable outcome had persistently high levels of serum CRP. For children with cancer, neutropenia, and fever, determination of the serum CRP level is useful for early diagnosis of bacterial infections and for monitoring the course of infection.

Serum adenosine deaminase in the early diagnosis of typhoid fever.

To study the usefulness of the enzyme adenosine deaminase for the early diagnosis of typhoid fever, its activity in serum was assayed in 277 children admitted to the Hospital Guillermo Grant Benavente at Concepción, Chile, from March, 1988, to December, 1990. The children were distributed into seven groups: control, N = 82; bacteremia, N = 8; acute viral respiratory infection, N = 43; febrile children with miscellaneous etiologies, N = 49; pulmonary tuberculosis, N = 3; hepatitis A virus infection, N = 30; and typhoid fever, N = 62. The medium serum adenosine deaminase values were significantly higher in children with typhoid fever (P < 0.0001) in relation to the values in the control group (122.2 +/- 40.7 vs 28.1 +/- 8.4 units/liter at 37 degrees C). This test had a sensitivity of 91.9% and a specificity of 92.5% in identifying the patient with typhoid fever when using 80 units/liter as the cutoff values. The positive predictive value of the test was 83.8% and the negative predictive value was 96%. Determination of adenosine deaminase values in serum could be helpful in the early diagnosis of typhoid fever.

[Adenosine deaminase in typhoid fever and other febrile diseases]. / Adenosina deaminasa en fiebre tifoidea y otras enfermedades febriles.

The contribution of serum adenosine deaminase (ADA) activity to the diagnosis of typhoid fever was assessed in 246 children and in 46 adults, by Giusti's original technique. Children included otherwise healthy patients admitted for elective surgical conditions or under follow up for epilepsy which were considered to be a control group (n: 81), presumptive viral diseases (n: 31), miscellaneous febrile diseases except for typhoid fever (n: 41), different kinds of bacteremia (n: 6), diarrhea due to Salmonella typhimurium (n: 14), viral hepatitis (n: 24), and culture proven typhoid fever (n: 49). Adult's group included 39 healthy controls and 7 patients with culture proven typhoid fever. Among children mean ADA activity was as follows: control group 28 +/- 7.8, viral disease 35.3 +/- 13.1, miscellaneous febrile disease 36.1 +/- 15.6, bacteremia group: 30.3 +/- 10.3, salmonellosis group 51.6 +/- 9, hepatitis group 68.3 +/- 34.5, typhoid fever group 124.4 +/- 40.8 U/I 37 degrees C. Among adults, values were 18.4 +/- 7.5 for controls and 112.8 +/- 19.2 U/I 37 degrees C in typhoid fever patients. In both adults and children ADA activity was significantly higher in the typhoid fever group (p < 0.0001). Untreated typhoid fever patients had their higher ADA activity between 10th and 15th day of illness. When ADA cut point was set at 80 U/I, sensitivity of the test was 91.8% and specificity was 91.4% as a preliminary clue to the recognition of typhoid fever.

Ceftriaxone in the treatment of bacterial meningitis in children.

A total of 24 pediatric patients with a diagnosis of meningitis, confirmed by positive CFS culture, were enrolled in the study. All patients received ceftriaxone in different doses. No difference in clinical outcome was found between the patients who received ceftriaxone twice a day and the 11 who received the drug as a single daily dose. The latter dosage proves to be preferable. The therapeutic outcome in this series of patients was 22 cured and 2 failures. Bacteriological and pharmacokinetic findings are discussed.