Implementación de un programa para mitigar la resistencia a los antimicrobianos en escenarios de bajos recursos / Implementation of a program to face antimicrobial resistance on a low resources hospital

Estudio cuasi-experimental desarrollado para disminuir el impacto de la resistencia a los antimicrobianos a través de un programa de prevención de infecciones y optimización del uso de antimicrobianos construido "a medida" según las posibilidades de la institución. Se implementó: vigilan-cia de colonización e infección por enterobacterias pro-ductoras de carbapenemasas (EPC); vigilancia y medidas preventivas para infecciones urinarias asociadas a sonda vesical (ITU); vigilancia e intervenciones para mejorar la higiene de manos; guías locales de tratamiento de enfer-medades infecciosas con evaluación de adherencia a las mismas y consumo de antibióticos (ATB). Resultados: Comparando periodo pre y postintervención: tasa de EPC en muestras clínicas: 1,1 a 0/días paciente; razón de tasas de incidencia (IRR: 0.00, p: 0.033); tasa de colonización: 3,3 a 0,61/días paciente (IRR: 0.18, p: 0.5). Tasa de ITU 8,9 a 7,2/1000 días catéter urinario (IRR: 0.81, p 0.5). Adherencia a higiene de manos: 77,5% a 70,38% (p 0.0067). Consumo de ATB: 376,24 a 176,82 DDD, (disminu-ción 53%). Adherencia a guías en elección de ATB: 57,1% a 95,4% (p 0.00031); duración de ATB: 92,8% a 98,4% (p 0.16); adecuación según rescate microbiológico: 57,1% a 100% (p <0.01). Conclusión: Un programa con medidas simples, a medida, con supervisión externa, redujo en un tiempo relativamente corto las infecciones por EPC, el consumo y uso apropiado de ATB en un hospital público de medianos/bajos recursos

This quasi-experimental study was developed in a public hospital with the goal of reducing the impact of antimicrobial resistance through an infection prevention and antimicrobial stewardship program. The following measures were implemented: surveillance of colonization and infection by carbapenemase-producing Enterobacteriaceae (CPE); surveillance and preventive measures for urinary catheter-associated infections (UTIs); surveillance and interventions for hand hygiene; local guidelines for treatment of infectious diseases with compliance and antibiotic (ATB) consumption metrics.Results: comparing the pre-intervention and post-intervention period, CPE rate in clinical samples 1.1 to 0/patient days, incidence rate ratio (IRR): 0.00, p: 0.033 and colonization of 3.3 to 0.61/days patient, IRR: 0.18, p-value: 0.5. UTI rate 8.9 to 7.2/1000 days urinary catheter IRR: 0.81, p 0.5. Hand Hygiene compliance: 77.5% to 70.38%, p 0.0067. ATB consumption: 376.24 to 176.82 DDD, 53% decrease. Compliance to guidelines in ATB selection: 57.1% to 95.4% p 0.00031, duration of ATB from 92.8% to 98.4% p 0.16, and adequacy to microbiological rescue of 57.1% at 100%, p <0.01. Conclusion: it is possible to reduce CPE infections, the consumption of antimicrobials and optimize their use in a public hospital in a country with medium/low resources through a program with basic and tailored measures

Development and differentiation of the extrafloral nectaries from flower buds in Vigna luteola (Leguminosae, Phaseolinae).

To study the ontogeny of the extrafloral nectaries present in the inflorescences of Vigna luteola (Jacq.) Benth (Leguminosae, Phaseolinae), the location, morphology, anatomy of the earliest stages, histology of the definitive structures and ultrastructure of the secretory stage were analyzed. The extrafloral nectaries at different developmental stages were examined with light microscopy and scanning electron microscopy. The secretory stage was also examined with transmission electron microscopy. The racemose inflorescence of V. luteola has six nodes. At each node, a short globose secondary axis bears two flowers and one to three extrafloral nectaries. Each extrafloral nectary originates from the abscission of a flower bud and is formed by two differentiated zones: a ring of epidermal cells surrounding a group of longitudinally enlarged papillose central cells, both with underlying secretory parenchyma. The primary secretory tissue consists of the central cells, while the ring contributes to secretion to a lesser degree. Secretion is granulocrine, by means of exocytotic vesicles and plasmalemma invaginations. Four developmental stages succeed; the third one being the secretory. The extrafloral nectaries activity period starts when the flowers of the same secondary axis open and ceases before fruit development.

Ontogeny of the extrafloral nectaries of Vigna adenantha (Leguminosae, Phaseolae) and its relation with floral development.

BACKGROUND: The inflorescences of the genus Vigna Savi have extrafloral nectaries (EFNs) among the flowers whose origin is still unknown. The disposition, anatomy and morphology, as well as the ontogeny of the extrafloral nectaries (EFNs) associated with the inflorescences of Vigna adenantha (G.F.W. Meyer) Maréchal, Mascherpa & Stainier (Leguminosae, Papilionoideae, Phaseolae) were studied. Besides, the ultrastructure of the secretory stage was described. RESULTS: The inflorescence, a raceme, bears a brief globose secondary axis in each node with 2 flowers and 5-7 EFNs, which develop in acropetal direction. Each EFN originates from the abscission of a flower bud that interrupts its development, resulting in an elevated EFN. This secretory structure is formed by a ring of epidermal and parenchymatic cells surrounding a group of elongated central cells. The nectary is irrigated by phloem and xylem. Four developmental stages proceed; each one relates to a different embryological stage of the flowers in each secondary axis. CONCLUSIONS: The first functional EFN of each secondary axis of the inflorescence reaches its maturity when both the pollen grains and the embryo sacs are completely developed and the flowers begin to open. The secretion is granulocrine. The following EFNs develop in the same way.