RESUMO
BACKGROUND: Carbapenemase-producing (CP) Escherichia coli (CP-Ec) are a global public health threat. We aimed to describe the clinical and molecular epidemiology and outcomes of patients from several countries with CP-Ec isolates obtained from a prospective cohort. METHODS: Patients with CP-Ec were enrolled from 26 hospitals in 6 countries. Clinical data were collected, and isolates underwent whole-genome sequencing. Clinical and molecular features and outcomes associated with isolates with or without metallo-ß-lactamases (MBLs) were compared. The primary outcome was desirability of outcome ranking (DOOR) at 30 days after the index culture. RESULTS: Of the 114 CP-Ec isolates in Consortium on resistance against carbapenems in Klebsiella and other Enterobacterales-2 (CRACKLE-2), 49 harbored an MBL, most commonly blaNDM-5 (38/49, 78%). Strong regional variations were noted with MBL-Ec predominantly found among patients in China (23/49). Clinically, MBL-Ec were more often from urine sources (49% vs 29%), less often met criteria for infection (39% vs 58%, P = .04), and had lower acuity of illness when compared with non-MBL-Ec. Among patients with infection, the probability of a better DOOR outcome for a randomly selected patient with MBL-Ec as compared with non-MBL-Ec was 62% (95% CI: 48.2-74.3%). Among infected patients, non-MBL-Ec had increased 30-day (26% vs 0%; P = .02) and 90-day (39% vs 0%; P = .001) mortality compared with MBL-Ec. CONCLUSIONS: Emergence of CP-Ec was observed with important geographic variations. Bacterial characteristics, clinical presentations, and outcomes differed between MBL-Ec and non-MBL-Ec. Mortality was higher among non-MBL isolates, which were more frequently isolated from blood, but these findings may be confounded by regional variations.
Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos , beta-Lactamases , Humanos , Estudos Prospectivos , beta-Lactamases/genética , Escherichia coli/genética , Proteínas de Bactérias/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Testes de Sensibilidade MicrobianaRESUMO
Objetivo Identificar los conocimientos, actitudes y prácticas sobre dengue en propietarios y trabajadores de llantería, así como los niveles de infestación del vector en llanterías del Departamento del Atlántico. Métodos Se realizó un estudio tipo descriptivo. Las variables se describieron a partir de porcentajes y medidas de tendencia central y dispersión. Se calculó el índice de infestación larvario para llanterías y el índice de depósitos en cada uno de los municipios muestreados. Se visitaron e inspeccionaron 111 llanterías; el 26,1 % (29/111) de estas se encontraron positivas para formas larvarias del vector Ae. aegypti. Los municipios de Piojó, Santo Tomas, Santa Lucia, Sabanagrande y Luruaco presentaron los índices de infestación larvaria en llanterías más altos (IIL: 50-100 %). Resultados Con respecto al dengue, el 90,9 % de los entrevistados lo consideró un problema para ellos y sus familias. El 94,6 % conoce que es transmitido por mosquitos; el 91,1 % conoce a la larva del vector como "sarapico", el 3,6 % como "gusarapo". El 98,2 % consideró que existe una relación entre la larva y el mosquito Ae. aegypti. El 100 % reconoce las llantas como un criadero para el mosquito. El 85,7 % consideró la fiebre como el síntoma más frecuente, el 83% manifestó asistir al puesto de salud para curar la enfermedad. El 90,8 % arroja las llantas no utilizables como basura. Conclusión En la población estudiada existen buenos conocimientos acerca del dengue y su vector; sin embargo, existen problemas de actitudes y prácticas para su prevención.(AU)
Objective To identify the awareness, attitudes and practices related to dengue in owners and workers of tire ships, as well as the levels of mosquito infestation in tire shops in Atlántico department - Colombia. Methods We conducted a descriptive study. The variables were described as percentages and measures of central tendency and dispersion. Index of larval infestation and containers were calculated in each of the municipalities studied. We visited and inspected 111 tire shops. 26.1 % (29/111) of these were found positive for Ae. aegypti larvae. The municipalities of Piojó, Santo Tomás, Santa Lucia, Sabanagrande and Luruaco were characterized by a higher larval infestation index. Results Regarding dengue, 90.9 % of respondents considered it a problem for them and their families. 94.6 % know that is transmitted by mosquitoes. 91.1 % know the vector larvae under the name "sarapico", 3.6 % as "gusarapo". 98.2 % felt that there is a relationship between the larva and Ae. aegypti mosquito. 100 % of participantes recognized tires to be a breeding for mosquitoes. 85.7% believed fever to be the most common symptom. 83 % reported accessing the health post to cure the disease. 90.8 % throw out unusable tires as if they were garbage. Conclusion In the population studied, there is good awareness of dengue and its vector. Nevertheless, there are problems related to attitudes and prevention practices.(AU)
Assuntos
Humanos , Conhecimentos, Atitudes e Prática em Saúde , Aedes/microbiologia , Dengue/epidemiologia , Epidemiologia Descritiva , Colômbia/epidemiologiaRESUMO
Objective To identify the awareness, attitudes and practices related to dengue in owners and workers of tire ships, as well as the levels of mosquito infestation in tire shops in Atlántico department - Colombia. Methods We conducted a descriptive study. The variables were described as percentages and measures of central tendency and dispersion. Index of larval infestation and containers were calculated in each of the municipalities studied. We visited and inspected 111 tire shops. 26.1 % (29/111) of these were found positive for Ae. aegypti larvae. The municipalities of Piojó, Santo Tomás, Santa Lucia, Sabanagrande and Luruaco were characterized by a higher larval infestation index. Results Regarding dengue, 90.9 % of respondents considered it a problem for them and their families. 94.6 % know that is transmitted by mosquitoes. 91.1 % know the vector larvae under the name "sarapico", 3.6 % as "gusarapo". 98.2 % felt that there is a relationship between the larva and Ae. aegypti mosquito. 100 % of participantes recognized tires to be a breeding for mosquitoes. 85.7% believed fever to be the most common symptom. 83 % reported accessing the health post to cure the disease. 90.8 % throw out unusable tires as if they were garbage. Conclusion In the population studied, there is good awareness of dengue and its vector. Nevertheless, there are problems related to attitudes and prevention practices.
