The effect of the efflux pump inhibitor Carbonyl Cyanide m-Chlorophenylhydrazone (CCCP) on the susceptibility to imipenem and cefepime in clinical strains of Acinetobacter baumannii.

INTRODUCTION: In the last years the rapid expansion of multidrug-resistant A. baumannii strains have become a major health problem. Efflux pumps are a group of transport proteins that contribute to the development of antibiotic resistance. The aim of this study was to evaluate the effect of the efflux pump inhibitor carbonyl cyanide 3-chlorophenylhydrazone (CCCP) on the antimicrobial action of imipenem and cefepime on clinical strains of A. baumannii. MATERIALS AND METHODS: A total of 49 non-duplicate clinical samples were collected during January through December of 2018 from patients hospitalized in the Hospital Regional Docente de Cajamarca. Of the 49 samples obtained, the confirmatory identification of A. baumannii was performed on 47 samples by molecular methods. The amplification of the blaOXA-51-like gene was carried out by polymerase chain reaction (PCR). The determination of the minimum inhibitory concentration (MIC) was calculated using the microdilution method in culture broth. The susceptibility to both antibiotics (cefepime and imipenem) was evaluated in the presence and absence of the inhibitor carbonyl cyanide 3-chlorophenylhydrazone (CCCP). RESULTS: A total of 47 strains of A. baumannii were isolated: 97.87% (46/47) were resistant to Imipenem, 2.13% (1/47) of them were classified as intermediate and none of these strains were susceptible. On the other hand, 51.06% (24/47) of isolates were resistant to cefepime; 19.15% (9/47) intermediate and 29.79% (14/47) susceptible. We considered a significant difference in antibiotic susceptibility if the MIC changed at least 4 dilutions, after the addition of the inhibitor. In the case of CCCP in addition to imipenem, 2.1% (1/47) had a significant change of 4 or more reductions in MIC, 59.6% (28/47) achieved a change equal or less than 3 dilutions and 17.0% (8/47) did not have any change. In the case of CCCP with cefepime the percentage of strains with the significant change of MIC was 8.5% (4/47). On the other hand, 53.2% (24/47) presented a reduction equal or less than 3 dilutions and 12.8% (6/47) did not show changes. CONCLUSION: In conclusion, our results demonstrate that the use of CCCP may improve the antibiotic effect of imipenem and cefepime on clinical strains of A. baumannii. The relevance of this study is that it provides evidence that this efflux pump inhibitor may be an alternative treatment against multidrug-resistant A. baumannii.

[Seroprevalence of hepatitis B in adult population of a district of Cajamarca]. / Seroprevalencia de hepatitis B en población adulta de un distrito de Cajamarca.

INTRODUCTION: Hepatitis B is a transmissible disease, it is estimated that globally more than two billion people in the world have been infected with hepatitis B virus, of which 350 million are chronic carriers of hepatitis B surface antigen, and this chronic infection causes cirrhosis and liver cancer. In Peru, hyperendemic zones have been detected in the country's jungle. Cajamarca is the third department with the highest rates of liver and bile duct cancer. Celendín is a district located in Cajamarca, which borders the jungle, and maintains a high contact with it for trade and tourism. There have been no previous studies of this virus in Cajamarca ́s population. OBJECTIVE: to determine if there is a high seroprevalence of the hepatitis B virus in the adult population of the Celendín-Cajamarca district, in 2018. MATERIAL AND METHODS: a cross-sectional study was carried out in 404 inhabitants of the Celendín district: a venous blood sample was taken to search for hepatitis B surface antigen and antibody, both by ELISA technique, and a survey was applied which included sociodemographic factors and associated risk factors. RESULTS: it was obtained that 1.24% (n=5) asymptomatic habitants were positive for the surface antigen of hepatitis B. The age over sixty five years was associated with the antigen positivity. 67.86% of the population included, do not have protective levels of antibodies against the hepatitis B virus, of which 10% even refer to being vaccinated. CONCLUSIONS: there is a low seroprevalence of the hepatitis B virus in the population of the district of Celendín-Cajamarca in 2018. More than half of the population does not have protection for this virus, many even when vaccinated.

Seroprevalencia de hepatitis B en población adulta de un distrito de Cajamarca

Introducción : La hepatitis B es una enfermedad transmisible, se estima que globalmente más de dos mil millones de habitantes del mundo han sido infectados por el virus de la hepatitis B (VHB), de los cuales 350 millones son portadores crónicos del antígeno de superficie de la hepatitis B (AgsHB). En el Perú, se han detectado zonas hiperendémicas en la selva del país. Esta infección crónica es una causa de cirrosis y cáncer de hígado. Cajamarca es el tercer departamento con más altos índices de cáncer de hígado y vías biliares del país. Celendín es un distrito ubicado en Cajamarca, que colinda con zonas hiperendémicas de la selva, y mantiene un elevado contacto con esta por comercio y turismo. No se han realizado estudios previos de este virus en esta población cajamarquina. Objetivo : Determinar si existe una alta seroprevalencia del HVB en población adulta del distrito de Celendín-Cajamarca. Evaluar la protección inmunológica de la población hacia este virus. Materiales y métodos: Se realizó un estudio transversal en 404 pobladores del distrito de Celendín, en los que se tomó una muestra de sangre venosa para buscar AgsHB, y anticuerpo del mismo (Anti-HBs), ambos mediante técnica ELISA, además se aplicó una encuesta que incluía factores sociodemográficos y factores de riesgo asociados. Resultados : se obtuvo que 1,24% (n=5) pobladores asintomáticos fueron positivos para AgsHB. Se asoció a la positividad del antígeno la edad mayor a 65 años. Un 67% de la población incluida no poseen niveles protectores de Anti-HBs, de los que un 10% refirió estar vacunado. Conclusiones : Existe una baja seroprevalencia del HVB en la población del distrito de Celendín - Cajamarca en el 2018. Más de la mitad de la población no posee protección para este virus, muchos incluso estando vacunados.

Introduction : Hepatitis B is a transmissible disease, it is estimated that globally more than two billion people in the world have been infected with hepatitis B virus, of which 350 million are chronic carriers of hepatitis B surface antigen, and this chronic infection causes cirrhosis and liver cancer. In Peru, hyperendemic zones have been detected in the country's jungle. Cajamarca is the third department with the highest rates of liver and bile duct cancer. Celendín is a district located in Cajamarca, which borders the jungle, and maintains a high contact with it for trade and tourism. There have been no previous studies of this virus in Cajamarca´s population. Objective : to determine if there is a high seroprevalence of the hepatitis B virus in the adult population of the Celendín-Cajamarca district, in 2018. Material and methods : a cross-sectional study was carried out in 404 inhabitants of the Celendín district: a venous blood sample was taken to search for hepatitis B surface antigen and antibody, both by ELISA technique, and a survey was applied which included sociodemographic factors and associated risk factors. Results: it was obtained that 1.24% (n=5) asymptomatic habitants were positive for the surface antigen of hepatitis B. The age over sixty five years was associated with the antigen positivity. 67.86% of the population included, do not have protective levels of antibodies against the hepatitis B virus, of which 10% even refer to being vaccinated. Conclusions : there is a low seroprevalence of the hepatitis B virus in the population of the district of Celendín-Cajamarca in 2018. More than half of the population does not have protection for this virus, many even when vaccinated.

Nitazoxanide for the empiric treatment of pediatric infectious diarrhea.

We conducted a double-blind, placebo-controlled clinical trial to demonstrate the efficacy of nitazoxanide suspension for the treatment of presumed infectious diarrhea in children. Eligible patients must have had diarrheal illness lasting 3-29 days. Patients were randomized to receive either nitazoxanide or placebo twice daily for three days. The primary endpoint was time from first dose to resolution of symptoms. One hundred children mean age 3.3 years were enrolled. The median time to resolution of symptoms for nitazoxanide treated patients was 23 hours (IQR 4-48 hours) vs 103.5 hours (IQR 63->168 hours) for placebo (p<0.001). An analysis by disease subset indicated nitazoxanide treated patients had statistically shorter durations of diarrheal illness associated with Giardia lamblia (n=32, p<0.001) and those with no identified enteropathogen (n=38, p=0.008), when compared to placebo. The study medication was well tolerated. Overall, nitazoxanide was effective at reducing the duration of diarrheal illness associated with multiple etiologies, including patients with no identified enteropathogen. These results suggest nitazoxanide may be a viable therapeutic option for the empiric treatment of diarrheal illness in children where the etiology is unknown or presumed to be of infectious origin. Clinical trial registry number NCT01326338.