Identification and Clinical Characteristics of Community-Acquired Acinetobacter baumannii in Patients Hospitalized for Moderate or Severe COVID-19 in Peru.

Acinetobacter baumannii has been described as a cause of serious community-acquired infections in tropical countries. Currently, its implications when simultaneously identified with other pathogens are not yet adequately understood. A descriptive study was conducted on hospitalized patients with a diagnosis of moderate/severe SARS-CoV-2-induced pneumonia confirmed via real-time RT-PCR. Patients aged > 18 years who were admitted to a specialized COVID-19 treatment center in Peru were selected for enrollment. A. baumannii was detected via the PCR amplification of the blaOXA-51 gene obtained from nasopharyngeal swabs within 48 h of hospitalization. A total of 295 patients with COVID-19 who met the study inclusion criteria were enrolled. A. baumannii was simultaneously identified in 40/295 (13.5%) of COVID-19-hospitalized patients. Demographic data and comorbidities were comparable in both Acinetobacter-positive and -negative subgroups. However, patients identified as being infected with Acinetobacter were more likely to have received outpatient antibiotics prior to hospitalization, had a higher requirement for high-flow nasal cannula and a higher subjective incidence of fatigue, and were more likely to develop Acinetobacter-induced pneumonia during hospitalization. Conclusions: The group in which SARS-CoV-2 and A. baumannii were simultaneously identified had a higher proportion of fatigue, a higher frequency of requiring a high-flow cannula, and a higher proportion of superinfection with the same microorganism during hospitalization.

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.

Identification of Coinfections by Viral and Bacterial Pathogens in COVID-19 Hospitalized Patients in Peru: Molecular Diagnosis and Clinical Characteristics.

The impact of respiratory coinfections in COVID-19 is still not well understood despite the growing evidence that consider coinfections greater than expected. A total of 295 patients older than 18 years of age, hospitalized with a confirmed diagnosis of moderate/severe pneumonia due to SARS-CoV-2 infection (according to definitions established by the Ministry of Health of Peru) were enrolled during the study period. A coinfection with one or more respiratory pathogens was detected in 154 (52.2%) patients at hospital admission. The most common coinfections were Mycoplasma pneumoniae (28.1%), Chlamydia pneumoniae (8.8%) and with both bacteria (11.5%); followed by Adenovirus (1.7%), Mycoplasma pneumoniae/Adenovirus (0.7%), Chlamydia pneumoniae/Adenovirus (0.7%), RSV-B/Chlamydia pneumoniae (0.3%) and Mycoplasma pneumoniae/Chlamydia pneumoniae/Adenovirus (0.3%). Expectoration was less frequent in coinfected individuals compared to non-coinfected (5.8% vs. 12.8%). Sepsis was more frequent among coinfected patients than non-coinfected individuals (33.1% vs. 20.6%) and 41% of the patients who received macrolides empirically were PCR-positive for Mycoplasma pneumoniae and Chlamydia pneumoniae.

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.

Uso racional de antimicrobianos en tiempos de COVID-19 en Perú: rol de los programas de optimización del uso de antimicrobianos e intervenciones desde el punto de vista de control de infecciones

La resistencia antimicrobiana (RAM) es una pandemia adicional de lenta evolución que precede a la pandemia de COVID-19 y continuará cuando esta termine. Sin embargo, en países como Perú, donde existe un alto consumo y prescripción inadecuada de antimicrobianos, puede pasar desapercibida y se puede esperar, en el futuro, un escenario más desafiante. Los programas de optimización de uso de antimicrobianos (PROA) son equipos multidisciplinarios de profesionales que tienen como objetivo retardar la aparición de organismos multirresistentes a través de estrategias como la auditoría de prescripciones o la creación de algoritmos de tratamiento antimicrobiano basados en las tasas locales de RAM. La dificultad en el diagnóstico oportuno de coinfecciones o superinfecciones en el curso clínico y progresión de la COVID-19 predisponen al uso inadecuado de antimicrobianos, lo que obliga a los PROA a adaptar sus estrategias en este panorama cambiante. En Latinoamérica, los PROA no solo tienen que fomentar el cambio de comportamiento en los prescriptores de antimicrobianos, sino también luchar contra la epidemia de información falsa (infodemia) y las campañas de desinformación sobre la COVID-19. Además, la pobre cultura local de prevención y control de infecciones obliga a revisar estrategias para mitigar el impacto posterior en la RAM.

Antimicrobial resistance (AMR) is an additional slow-evolving pandemic that precedes the COVID-19 pandemic and will continue when it ends. However, in countries like Peru, where high consumption and inadequate prescription of antimicrobials occur, AMR may go unnoticed and a more challenging future scenario can be expected. Antimicrobial stewardship programs (ASPs) consist of multidisciplinary teams of professionals that aim to slow down the emergence of multidrug-resistant organisms through strategies such as prescription auditing or creation of antimicrobial treatment guidelines based on local AMR rates. The difficulty in the timely diagnosis of co-infections or superinfections in the clinical course and progression of COVID-19 leads to inappropriate use of antimicrobials, forcing ASPs to adapt their strategies in this changing scenario. In Latin America, ASPs not only have to promote behavior change in antimicrobial prescribers but also fight the epidemic of false information (infodemic) and disinformation campaigns on COVID-19. Furthermore, poor-quality infection prevention and control principles require evaluating strategies to mitigate the subsequent impact on AMR.

Liver abscess caused by Candida haemulonii var. vulnera. First case report in Peru.

BACKGROUND: Liver abscesses caused by Candida species are mainly found in immunocompromised hosts, associated with conditions (such as neutropenia and mucositis) that facilitate the spreading of microorganisms from the gastrointestinal tract. CASE REPORT: We present the case of a non-immunocompromised 72-year-old woman with a liver abscess caused by Candida haemulonii var. vulnera, in whom potential associated conditions could be polycystic kidney disease and renal replacement therapy. The patient experienced clinical resolution after percutaneous drainage and treatment with caspofungin. CONCLUSIONS: To our knowledge, this is the first case reported in Peru of a liver abscess due to Candida haemulonii var. vulnera, a clinical presentation that has not been described previously. This finding should prompt us to establish active surveillance of causal agents of systemic candidiasis.

[Duodenal obstruction by Strongyloides stercoralis, an unusual complication]. / Obstrucción duodenal por Strongyloides stercoralis, una complicación inusual.

Strongyloidiasis is a neglected disease in Latin America. Gastrointestinal manifestations are nonspecific and duodenal obstruction is a rare complication. Here we present the case of a 31-year-old male from the central jungle of Peru, admitted due to a high intestinal obstruction, with duodenal ulcers and stenosis evidenced in the upper endoscopy. The histopathological report revealed presence of larvae of Strongyloides stercoralis. Clinical and endoscopic follow up were favorable with ivermectin treatment. There are near 20 reported cases of duodenal obstruction due to S. stercoralis. Additionally, infection by HTLV-1 was confirmed, being this a frequent association.

First outbreak of Oropouche Fever reported in a non-endemic western region of the Peruvian Amazon: Molecular diagnosis and clinical characteristics.

INTRODUCTION: Oropouche fever is an under-reported and emerging infectious disease caused by Oropouche virus (OROV). Its incidence is under-estimated mainly due to clinical similarities with other endemic arboviral diseases and the lack of specific diagnostic tests. We report the first outbreak of Oropouche fever in a western region of the Peruvian Amazon in Huanuco, Peru. METHODS: A transversal study was carried out during an outbreak in the western Region of Huanuco, Peru between January and July of 2016. Blood samples of 268 patients with acute febrile syndrome were collected and analyzed for OROV via RT- PCR and genetic sequencing. RESULTS: Of all 268 patients, 46 (17%) cases tested positive for OROV. The most common symptoms reported were headache with a frequency of 87% (n = 40) followed by myalgia with 76% (n = 35), arthralgia with 65.2% (n = 30), retro-ocular pain 60.8% (n = 28) and hyporexia with 50% (n = 23). Some patients showed a clinical presentation suggestive of severe OROV infection, of which 4.3% (n = 2) had low platelet count, 8.6% (n = 4) had intense abdominal pain, and 2.1% (n = 1) had a presentation with thoracic pain. CONCLUSION: This study reports an outbreak of OROV in a region where this virus was not previously identified. The disease caused by OROV is an emerging, underdiagnosed infection that requires further research to determine its virulence, pathogenesis, host range and vectors involved in the urban and sylvatic cycles as well as identifying new genotypes to implement sensitive and specific diagnostic tools that can be applied to endemic regions.

Obstrucción duodenal por Strongyloides stercoralis, una complicación inusual / Duodenal obstruction by Strongyloides stercoralis, an unusual complication

Resumen La estrongiloidiasis es una enfermedad desatendida en Latinoamérica. Las manifestaciones gastrointestinales son inespecíficas y la obstrucción duodenal es una complicación infrecuente. Presentamos el caso clínico de un varón de 31 años, procedente de la selva central de Perú, que ingresó por una obstrucción intestinal alta, con úlceras y una estenosis duodenal evidenciadas en la endoscopia digestiva alta. El informe histopatológico reveló la presencia de larvas de Strongyloides stercoralis. La evolución clínica y endoscópica fueron favorables con el tratamiento con ivermectina. Existen poco más de 20 casos publicados de obstrucción duodenal por S. stercoralis. Adicionalmente, se confirmó una infección por HTLV-1, asociación descrita frecuente.

Strongyloidiasis is a neglected disease in Latin America. Gastrointestinal manifestations are nonspecific and duodenal obstruction is a rare complication. Here we present the case of a 31-year-old male from the central jungle of Peru, admitted due to a high intestinal obstruction, with duodenal ulcers and stenosis evidenced in the upper endoscopy. The histopathological report revealed presence of larvae of Strongyloides stercoralis. Clinical and endoscopic follow up were favorable with ivermectin treatment. There are near 20 reported cases of duodenal obstruction due to S. stercoralis. Additionally, infection by HTLV-1 was confirmed, being this a frequent association.

Criptococosis cutánea localizada en paciente trasplantada renal: una entidad infrecuente / Localized cutaneous cryptococcosis in a patient who underwent a kidney transplantation: an unusual condition

La criptococosis cutánea es una entidad infrecuente en pacientes receptores de trasplante de órganos sólidos (TOS). La forma cutánea localizada es descrita en pacientes inmunocomprometidos y probablemente sea secundaria a una reactivación de un estado latente en ganglios linfáticos o pulmón, además requiere exclusión de compromiso sistémico. Presentamos el caso de una mujer de 40 años receptora de trasplante renal hace 1 año, en inmunosupresión con tacrolimus y prednisona, que desarrolló en 1 semana lesión en cara interna de muslo izquierdo sugestiva de celulitis bacteriana. Se inició tratamiento antibiótico de amplio espectro, pero la lesión progresó a una úlcera necrótica con necesidad de limpieza quirúrgica. La biopsia cutánea evidenció dermatitis nodular crónica granulomatosa no caseificante con múltiples levaduras de criptococo. Se aisló Cryptococcus neoformans y se inició tratamiento antifúngico con respuesta favorable. Es necesario establecer estrategias de screening para prevenir la infección por criptococo en receptores de TOS

Cutaneous cryptococcosis is an uncommon condition in patients undergoing solid-organ transplantation (SOT). The localized cutaneous form has been described in immunosuppressed patients, and it may likely be secondary to a reactivation of a dormant infection in the lymph nodes or in the lungs; also, systemic involvement should be ruled out. We present the case of a 40-year old woman who underwent a renal transplantation one year ago. She received tacrolimus and prednisone for rejection control, and after one week she developed a lesion in the internal aspect of her left thigh, which suggested a bacterial skin and soft-tissues infection. Wide spectrum antimicrobials were started, but the lesion progressed to a necrotic ulcer which had to undergo surgical cleansing. The skin biopsy revealed chronic non-caseating nodular granulomatous dermatitis, with the presence of multiple Cryptococcus yeasts. Cryptococcus neoformans was isolated in the cultured material and antifungal therapy was started. A satisfactory response was achieved. It is necessary to establish screening strategies aiming to prevent cryptococcal infections in patients undergoing SOT