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.

Resistencia a cefalosporinas y quinolonas en Escherichia coli aisladas de agua de riego en río Rímac de Lima Este, Perú / Resistance to cephalosporins and quinolones by Escherichia coli isolated from irrigation water from eastern Lima, Perú

OBJETIVOS. Evaluar la presencia y sensibilidad a los antimicrobianos de cepas de Escherichia coli aisladas de 24 muestras de agua de riego del río Rímac de Lima Este, Perú. MATERIALES Y METODOS. Las cepas de E. coli fueron identificadas por PCR. La susceptibilidad a los antibióticos se procesaron por el método de difusión en disco. Los genes implicados en betalactamasas de espectro extendido (BLEE), quinolonas y virulencia se determinaron por PCR. RESULTADOS. Todas las muestras superaron los límites permisibles establecidos en las Normas de Calidad Ambiental para el riego de hortalizas. De los 94 aisaldos, el 72,3% mostró resistencia al menos a un antibiótico, el 24,5% eran multirresistentes (MDR) y el 2,1% extremadamente resistentes. Los ma-yores porcentajes de resistencia se observaron para ampicilina-sulbactam (57,1%), el ácido nalidíxico (50%), trimetoprim-sulfametoxazol (35,5%) y ciprofloxacino (20,4%). Entre los aislados, el 3,2% presentaba fenotipo BLEE relacionado con el gen bla CTX-M-15. Los mecanismos transferibles de resistencia a las quinolonas, qnrB fueron más frecuentes (20,4%), y el 2,04% tenían el qnrS. Se calcularon que el 5,3% eran E. coli diarreagénicas y de estas, el 60% eran E. coli enterotoxigénicas, el 20% E. coli enteropatógenas y el 20% E. coli enteroagregantes. CONCLUSIONES. Los resultados muestran la existencia de patotipos diarreogénicos en el agua utilizada para el riego de productos frescos y destaca la presencia de E. coli productores de BLEE y MDR, demostrando el papel que juega el agua de riego en la diseminación de genes de resistencia en el Perú.

Impact of Adding a Rapid PCR-Based Blood Culture Identification Panel to the Antimicrobial Stewardship Program of Patients with Febrile Neutropenia in a Peruvian Referral Hospital.

The addition of Biofire® FilmArray® Blood Culture Identification panel 2 (BCID2) to the antimicrobial stewardship program (ASP) could improve outcomes in bloodstream infections (BSI) of patients with febrile neutropenia (FN). A pre- and post-quasi-experimental single-center study was conducted at a reference hospital in Peru. Three groups were considered: patients with BSI before ASP intervention (control group), patients with BSI after ASP intervention (group 1), and patients with BSI after ASP intervention plus BCID2 PCR Panel implementation (group 2). Overall, 93 patients were identified (32 control, 30 group 1, 31 group 2). The median time to effective therapy was significantly shorter in group 2 compared to group 1 and control group, respectively (3.75 vs. 10 h, p = 0.004; 3.75 vs. 19 h, p < 0.001). No significant differences in terms of relapse of bacteremia, in-hospital mortality (all cause), and 30-day-all-cause hospital readmission between the three study periods were found. The appropriateness of empirical antimicrobial use, adding or change, and the following de-escalation or discontinuation was significant when the two intervention periods were compared with the control group (p < 0.001). In addition to the lack of local studies documenting the microbiological profile of FN episodes, adding syndromic panels-based testing could allow for the consolidation of ASP strategies.

Bacteremia due to Ralstonia mannitolilytica: A report of the first case in Peru. / Bacteremia por Ralstonia mannitolilytica: primer reporte de caso en Perú.

The first report of Ralstonia mannitolilytica bacteremia in Peru is presented. The patient was a pediatric cancer patient with a long-term central venous access device. For the diagnosis, the MicroScan Walk Away 96 automated system was used. 16S rDNA was amplified by conventional PCR, and the bacterial genus and species were identified by genetic sequencing. In addition, the bacterial resistance profile to major antimicrobials was determined. The article discusses the need to actively monitor Ralstonia mannitolilytica, especially in hospital areas of immunocompromised patients.

Se presenta el primer reporte de una bacteriemia por Ralstonia mannitolilytica en Perú. Se trata de un paciente pediátrico con cáncer que porta un dispositivo de acceso venoso central de larga duración. Para establecer el diagnóstico, se utilizó el sistema automático MicroScan Walk Away 96. Se amplificó el rADN 16S mediante PCR convencional y se identificó el género y la especie bacteriana mediante secuenciación genética. Además, se determinó el perfil de resistencia bacteriana a los principales antimicrobianos. El artículo discute la necesidad de monitorizar activamente la presencia de Ralstonia mannitolilytica, especialmente en áreas hospitalarias de pacientes inmunodeprimidos.