Evolución histórica de la Organización Mundial de la Salud y la resistencia a los antimicrobianos / Historical evolution of World Health Organization guidelines on antimicrobial resistance / Evolução histórica da Organização Mundial da Saúde e a resistência aos antimicrobianos

RESUMEN Objetivo. Mostrar la evolución de los lineamientos sobre políticas públicas en salud enfocadas en farmacorresistencia microbiana o resistencia a los antimicrobianos (RAM) que la Organización Mundial de la Salud (OMS) ha emitido desde 1948 hasta 2022. Además, se mencionan otras acciones gubernamentales relacionadas. Métodos. Se llevó a cabo una revisión detallada de los archivos de la Asamblea Mundial de la Salud y el Consejo Ejecutivo de la OMS. Se realizó un análisis textual de resoluciones sobre la RAM, que dan pauta al diseño de políticas y acciones gubernamentales para los Estados Miembros de la OMS. También se realizó una búsqueda sistemática en SCOPUS, Pubmed y literatura gris con categoría de análisis: políticas públicas en salud sobre la RAM. Resultados. La RAM se ha convertido en la mayor amenaza para la salud pública, y compromete el cumplimiento de los objetivos de desarrollo sostenible. Presentamos resoluciones de la OMS como evidencia de lineamientos para combatir la RAM. En consonancia, se menciona el enfoque "Una salud", estrategias, iniciativas, planes y programas relacionados. Se identificó una brecha en la investigación y el desarrollo de antimicrobianos nuevos, que requiere un análisis más profundo. Conclusiones. La OMS ha realizado esfuerzos para combatir la RAM. Esto ha generado un desarrollo integral de políticas públicas en salud, para que los Estados Miembros las apliquen según la soberanía de sus gobiernos.

ABSTRACT Objective. Show the evolution of guidelines on public health policies focused on antimicrobial resistance (AMR) issued by the World Health Organization (WHO) between 1948 and 2022. Other related government actions are also mentioned. Methods. A detailed review was conducted of World Health Assembly and WHO Executive Board archives. A textual analysis was conducted of AMR-related resolutions that guide the design of government policies and actions for WHO Member States. A systematic search was carried out in SCOPUS, PubMed, and grey literature under the category of public health policies on AMR. Results. AMR has become the greatest threat to public health, putting at risk the achievement of the Sustainable Development Goals. WHO resolutions are presented as evidence of guidelines to combat AMR. The One Health approach and related strategies, initiatives, plans, and programs are mentioned. A gap was identified in the research and development of new antimicrobials, requiring further analysis. Conclusions. WHO has made efforts to combat AMR. This has generated comprehensive development of public health policies to be implemented by the governments of Member States as they see fit.

RESUMO Objetivo. Apresentar a evolução das diretrizes sobre políticas públicas de saúde voltadas para a resistência microbiana a medicamentos ou resistência aos antimicrobianos (RAM) publicadas pela Organização Mundial da Saúde (OMS) de 1948 a 2022. Além disso, mencionam-se outras ações governamentais relacionadas. Métodos. Procedeu-se a uma revisão detalhada dos arquivos da Assembleia Mundial da Saúde e do Conselho Executivo da OMS. Realizou-se uma análise textual das resoluções sobre RAM, que orientam a formulação de políticas e ações governamentais para os Estados Membros da OMS. Fez-se também uma busca sistemática nas plataformas SCOPUS e Pubmed e na literatura cinzenta, com a categoria de análise "políticas públicas de saúde sobre RAM". Resultados. A RAM tornou-se a maior ameaça à saúde pública e prejudica o cumprimento dos Objetivos de Desenvolvimento Sustentável. Apresentamos as resoluções da OMS como evidência de diretrizes para combater a RAM. Nesses termos, mencionam-se a abordagem "Saúde Única" e estratégias, iniciativas, planos e programas relacionados. Identificou-se uma lacuna na pesquisa e no desenvolvimento de novos antimicrobianos, o que requer uma análise mais aprofundada. Conclusões. A OMS envidou esforços para combater a RAM, o que levou ao desenvolvimento integral de políticas públicas de saúde a serem aplicadas pelos Estados Membros, em conformidade com a soberania de seus governos.

Resistência microbiana a medicamentos em uma Instituição de Longa Permanência para Idosos / Resistencia microbiana a medicamentos en una institución de larga estadía para adultos mayores / Microbial drug resistance in a Nursing Home

Resumo Objetivo Caracterizar os microrganismos e sua suscetibilidade antimicrobiana em uroculturas de idosos residentes de uma instituição de longa permanência. Métodos Estudo observacional transversal com 116 indivíduos de uma Instituição de Longa Permanência para Idosos de um município do sul da Bahia. O estudo foi aprovado por Comitê de Ética em Pesquisa e utilizou-se Termo de Consentimento Livre e Esclarecido. Foram realizadas coleta e análise laboratorial de urina tipo I e urocultura. Realizaram-se testes de sensibilidade a antimicrobianos conforme os critérios do European Committee on Antimicrobial Susceptibility Testing. Para o diagnóstico de infecção do trato urinário, foram utilizados os critérios de McGeer. A análise de dados se deu por estatística descritiva, com frequências absolutas e relativas. Resultados A prevalência de infecção do trato urinário foi de 33,62%, com predominância no sexo feminino e idade acima de 80 anos. Os uropatógenos foram: 69,2% Escherichia coli, 20,6% Klebsiella pneumoniae e 5,1% Providencia stuartii e Acinetobacter baumannii. As cepas de E. coli apresentaram suscetibilidade para a maior parte dos antimicrobianos; já nas de K. pneumoniae, a suscetibilidade foi variável. P. stuartii e A. baumannii não apresentaram resistência a carbapenêmicos e aos betalactâmicos aztreonam e piperacilina associados a tazobactam. Conclusão As cepas mais prevalentes e o perfil de suscetibilidade seguiram padrão próximo ao hospitalar, o que implica a necessidade de a instituição promover melhores estratégias de controle de infecção e envolver a equipe de enfermagem no gerenciamento dos casos e na qualificação da prescrição antimicrobiana, para reduzir a resistência bacteriana e efeitos adversos nos idosos.

Resumen Objetivo Caracterizar los microorganismos y su susceptibilidad antimicrobiana en urocultivos de adultos mayores residentes en una institución de larga estadía. Métodos Estudio observacional transversal con 116 individuos de una institución de larga estadía para adultos mayores de un municipio del sur del estado de Bahia. El estudio fue aprobado por el Comité de Ética de Investigación y se utilizó Consentimiento Informado. Se obtuvieron muestras de orina, con las cuales se realizó análisis de laboratorio tipo I y urocultivo. Se realizaron pruebas de sensibilidad a antimicrobianos según los criterios del European Committee on Antimicrobial Susceptibility Testing. Para el diagnóstico de infección del tracto urinario, se utilizaron los criterios de McGeer. El análisis de datos se obtuvo mediante estadística descriptiva, con frecuencias absolutas y relativas. Resultados La prevalencia de infección del tracto urinario fue del 33,62 %, con predominancia del sexo femenino y edad superior a 80 años. Los uropatógenos fueron: 69,2 % Escherichia coli, 20,6 % Klebsiella pneumoniae y 5,1 % Providencia stuartii y Acinetobacter baumannii. Las cepas de E. coli presentaron susceptibilidad en la mayor parte de los antimicrobianos, en las de K. pneumoniae, la susceptibilidad fue variable. P. stuartii y A. baumannii no presentaron resistencia a carbapenémicos ni a los betalactámicos aztreonam y piperacilina asociados a tazobactam. Conclusión Las cepas más prevalentes y el perfil de susceptibilidad presentaron un patrón parecido al hospitalario, lo que implica la necesidad de que la institución promueva mejores estrategias de control de infecciones e involucre al equipo de enfermería en la gestión de los casos y en la cualificación de la prescripción antimicrobiana para reducir la resistencia bacteriana y los efectos adversos en los adultos mayores.

Resumo Objetivo Caracterizar os microrganismos e sua suscetibilidade antimicrobiana em uroculturas de idosos residentes de uma instituição de longa permanência. Métodos Estudo observacional transversal com 116 indivíduos de uma Instituição de Longa Permanência para Idosos de um município do sul da Bahia. O estudo foi aprovado por Comitê de Ética em Pesquisa e utilizou-se Termo de Consentimento Livre e Esclarecido. Foram realizadas coleta e análise laboratorial de urina tipo I e urocultura. Realizaram-se testes de sensibilidade a antimicrobianos conforme os critérios do European Committee on Antimicrobial Susceptibility Testing. Para o diagnóstico de infecção do trato urinário, foram utilizados os critérios de McGeer. A análise de dados se deu por estatística descritiva, com frequências absolutas e relativas. Resultados A prevalência de infecção do trato urinário foi de 33,62%, com predominância no sexo feminino e idade acima de 80 anos. Os uropatógenos foram: 69,2% Escherichia coli, 20,6% Klebsiella pneumoniae e 5,1% Providencia stuartii e Acinetobacter baumannii. As cepas de E. coli apresentaram suscetibilidade para a maior parte dos antimicrobianos; já nas de K. pneumoniae, a suscetibilidade foi variável. P. stuartii e A. baumannii não apresentaram resistência a carbapenêmicos e aos betalactâmicos aztreonam e piperacilina associados a tazobactam. Conclusão As cepas mais prevalentes e o perfil de suscetibilidade seguiram padrão próximo ao hospitalar, o que implica a necessidade de a instituição promover melhores estratégias de controle de infecção e envolver a equipe de enfermagem no gerenciamento dos casos e na qualificação da prescrição antimicrobiana, para reduzir a resistência bacteriana e efeitos adversos nos idosos.

Resistencia antibiótica de Escherichia coli y Staphylococcus saprophyticus en la infección urinaria de un hospital público / Antibiotic resistance of Escherichia coli and Staphylococcus saprophyticus in urinary tract infection in a public hospital

La resistencia de antibióticos puede llegar a causar una amplia morbilidad y complicaciones. Objetivo: Determinar el perfil de resistencia antimicrobiana de Escherichia Coli y de Staphylococcus Saprophyticus, en pacientes con infección urinaria hospitalizados en el servicio de Medicina Interna del Hospital Municipal Los Olivos. Métodos: Estudio descriptivo, retrospectivo de corte transversal. Se realizó en el servicio de Medicina Interna del Hospital Municipal los Olivos (HMLO). Participantes: historia clínica de pacientes hospitalizados con infección urinaria en el servicio de Medicina Interna. Intervenciones: Según los criterios de inclusión y exclusión se obtuvieron, 96 historias clínicas (HC) del año 2013. Se utilizó un instrumento de recolección validado. Se realizó el análisis descriptivo con software estadístico STATA versión 25. Resultados: De las 96 HC, la edad promedio fue 55,04 años, los agentes microbianos más frecuentes fueron: la Escherichia coli con 85,3%, Staphylococcus saprophyticus 4.2% y Klebsiella pneumoniae 3,1%. La prevalencia de productores de betalactamasa espectro extendido (BLEE) fue 10,4%. Los antibióticos más resistentes fueron: trimetoprim/sulfametoxazol 89,6%, ampicilina 86%, piperacilina 84,6%, tetraciclina 79,2% y ciprofloxacino 70,8%. Los antibióticos más sensibles fueron: amikacina 100%, imipenem 100%, ertapenem 98%, meropenem 96% y piperacilina/tazobactam 96%. Conclusión: El uropatógeno más frecuente en pacientes con ITU hospitalizados fue la E. coli. Los antibióticos que presentaron resistencia a la E. coli fueron: trimetoprim/sulfametoxazol, ampicilina, piperacilina, tetraciclina y ciprofloxacino, y para el S. Saprophyticus fueron: amoxicilina/ ácido clavulánico, trimetoprim/sulfametoxazol, ceftriaxona y ciprofloxacino(AU)

Resistance to antibiotics may actually cause extensive morbidity and complications. Objective: To determine the antimicrobial resistance profile of Escherichia coli and Staphylococcus saprophyticus, in patients with urinary infection hospitalized in the Internal Medicine service of the Los Olivos Municipal Hospital. Methods: Descriptive, retrospective cross-sectional study. It was carried out in the Internal Medicine service of the Los Olivos Municipal Hospital (HMLO). Participants: clinical history of hospitalized patients with urinary infection in the Internal Medicine service. Interventions: According to the inclusion and exclusion criteria, 96 clinical records (HC) from 2013 were obtained. A validated collection instrument was used. Descriptive analysis was performed with STATA version 25 statistical software. Results: Of the 96 CHs, the average age was 55.04 years, the most frequent microbial agents were: Escherichia Coli with 85.3%, Staphylococcus saprophyticus 4.2% and Klebsiella pneumoniae 3.1%. The prevalence of extended spectrum beta-lactamase producers (ESBL) was 10.4%. The most resistant antibiotics were trimethoprim / sulfamethoxazole 89.6 %, ampicillin 86 %, piperacillin 84.6 %, tetracycline 79.2 % and ciprofloxacin 70.8 %. The most sensitive antibiotics were: amikacin 100%, imipenem 100%, ertapenem 98%, meropenem 96% and piperacillin / tazobactam 96%. Conclusion: The most common uropathogen in hospitalized UTI patients was E. coli. The antibiotics that showed resistance to E. coli were: trimethoprim/sulfamethoxazole, ampicillin, piperacillin, tetracycline, and ciprofloxacin, and for S. saprophyticus they were: amoxicillin/clavulanic acid, trimethoprim / sulfamethoxazole, ceftriaxone and ciprofloxacin(AU)

Perfil de suscetibilidade antimicrobiana em infecções do sítio cirúrgico em um hospital público de traumato-ortopedia no Nordeste do Brasil / Antimicrobial susceptibility profile in surgical site infections in the trauma and orthopedic service of a public hospital in the Brazilian Northeast region

Objetivo: As infecções de sítios cirúrgicos (ISC) constituem a terceira maior classe de infecções relacionadas à assistência à saúde no Brasil e estão consideravelmente aumentadas em pacientes submetidos a procedimentos cirúrgicos ortopédicos. Grande parte das ISC ortopédicas relacionam-se a bactérias Gram-positivas, dentre elas Staphylococcus ssp. Outros microrganismos comumente encontrados são: Enterococcus ssp., assim como bactérias Gram-negativas, com destaque para Escherichia coli, e Pseudomonas aeruginosa. O presente estudo objetivou identificar a frequência de infecções bacterianas em sítios cirúrgicos e perfil de suscetibilidade antimicrobiana. Métodos: Estudo retrospectivo com análise de resultados microbiológicos de pacientes atendidos no serviço de traumato-ortopedia em hospital público de referência, entre agosto de 2016 a setembro de 2018. Resultados: Do total de 258 amostras enviadas ao laboratório, 138 isolados foram positivos, 84% foram pacientes masculinos, nos quais 32 espécies de bactérias foram identificadas, sendo as mais frequentes Staphylococcus aureus (25,2%), Enterococcus faecalis (10,8%), seguido das bactérias Gram-negativas Escherichia coli (9,9%) e Pseudomonas aeruginosa (9,9%). A suscetibilidade antimicrobiana revelou que 87,5% dos Staphylococcus aureus isolados eram MRSA (Staphylococcus aureus resistentes a meticilina) e sensíveis a vancomicina (96,4%) e Teicoplanina (98,2%). Considerando as Gram negativas, este estudo mostrou que houve frequência similar entre Escherichia coli (9,9%) e Pseudomonas aeruginosa (9,9%), seguido de Klebsiella pneumoniae (8,1%). A Escherichia coli, apresentou altas taxas de resistência às cefalosporinas e penicilinas. Conclusão: O perfil microbiológico e a suscetibilidade antimicrobiana devem ser considerados na determinação das terapias antimicrobianas adequadas para controle das infecções hospitalares, possibilitando uso racional de antibióticos e diminuição da resistência bacteriana.

Objective: Surgical site infections (SSIs) represent the third largest class of infections related to health care in Brazil. Risk of SSIs increase in patients undergoing orthopedic surgical procedures. Most orthopedic SSI are related to Gram-positive bacteria, among them Staphylococcus ssp. Other microorganisms commonly found are Enterococcus, as well as Gram-negative bacteria, especially Escherichia coli e Pseudomonas aeruginosa. The present study aimed to identify the frequency of bacterial infections in surgical sites and antimicrobial susceptibility profile. Methods: Retrospective study analyzed microbiological results from patients attending the orthopedic trauma service in a public referral hospital from August 2016 to September 2018. Results: Of the 258 samples sent to the laboratory, 138 isolates were positive, 84% were from male patients and more than 31 species of bacteria were identified, with the most frequent being Gram positive Staphylococcus aureus (25,2%) and the second most frequent being Enterococcus faecalis (10.8%), followed by Gram negative bacteria Escherichia coli (9.9%) and Pseudomonas aeruginosa (9.9%). The antimicrobial susceptibility showed that 87.5% of Staphylococcus aureus isolates were MRSA (methicillin resistant Staphylococcus aureus) and presented sensitivity to vancomycin (96.4%) and Teicoplanine (98.2%). Considering gram-negative bacteria, this study showed that there was a technical tie between Escherichia coli (9.9%) and Pseudomonas aeruginosa (9.9%) followed by Klebsiella pneumoniae (8.1%). Regarding the antimicrobial susceptibility profile, Escherichia coli presented high resistance to cephalosporin and Penicillin. Conclusion: Microbiological profile and susceptibility to antimicrobials must be considered when determining the most appropriate antibiotic therapies to control hospital infections and decrease emergence of bacterial resistance.

Los antibióticos y su impacto en la sociedad / Antibiotics and their impact on society

RESUMEN La introducción de los antibióticos en el siglo pasado ha sido uno de los ejemplos que brinda la historia de intervenciones médicas que cambiaron drásticamente la esperanza de vida de la población. La época dorada de los antibióticos, cuando la aparición de nuevas moléculas era lo habitual, ha dado paso a otra de sequía, en la que es raro el desarrollo de este grupo farmacológico debido al largo período de tiempo que requieren las investigaciones de nuevos fármacos, su elevado costo y al aumento de las exigencias regulatorias. Este progreso médico ganado en décadas pasadas, está amenazado por el aumento de la resistencia de las bacterias a los antibióticos; constituye un grave riesgo mundial por lo que requiere una mayor atención y la coherencia a nivel internacional, nacional y regional. La resistencia bacteriana tiene un gran impacto microbiológico, terapéutico, económico, epidemiológico y en la salud pública; cuesta dinero, medios de subsistencia, vidas humanas y amenaza con socavar la eficacia de los programas de atención a la salud. La presente revisión bibliográfica propone reflexionar sobre los aspectos más significativos del desarrollo de los antibióticos y su impacto en la sociedad.

ABSTRACT The introduction of antibiotics in the last century has been one of the examples that history provides of medical interventions that drastically changed the life expectancy of the population. The golden age of antibiotics, where the appearance of new molecules was what usual, has given way to another of drought, in which the development of this pharmacological group is rare due to the long period of time required for research into new drugs, their high cost and the increase in regulatory requirements. This medical progress gained in past decades is threatened by the increase in the resistance of bacteria to antibiotics, constituting a serious global risk for which it requires greater attention and coherence at the international, national and regional levels. Bacterial resistance has a great microbiological, therapeutic, economic, epidemiological and public health impact; it costs money, livelihoods, human lives, and threatens to undermine the effectiveness of health care programs. This bibliographic review proposes to reflect on the most significant aspects of the development of antibiotics and their impact on society.

La humanidad enfrenta un desastre: la resistencia antimicrobiana / Humanity faces disaster: antimicrobial resistance

Introducción: La resistencia bacteriana pone en peligro la salud y la supervivencia de los seres humanos, aumenta la carga económica de la sociedad y los pacientes. Es un fenómeno global por lo que Cuba no queda exenta. Objetivos: Exponer el impacto social y económico de la resistencia antimicrobiana desde el punto de vista filosófico y describir el rol de una medida preventiva en la contención de la resistencia antimicrobiana. Material y Métodos: Se realizó una revisión de fuentes bibliográficas que fueron localizadas mediante la base de datos Pubmed, Portal Regional de la Biblioteca Virtual de Salud y el motor de búsqueda Google Académico. Desarrollo: Se analizan los aspectos sociales, económicos y éticos relacionados con la resistencia bacteriana y se ejemplifica una medida preventiva en la contención de la resistencia antimicrobiana. Además, se analiza la relación entre fármacos antibacterianos, resistencia bacteriana y medidas de prevención y control desde el punto de vista de ciencia-tecnología-sociedad. Conclusiones: La sociedad humana se desarrolla y progresa constantemente bajo la promoción de la ciencia y la tecnología. En pocas décadas, los antibióticos han pasado de ser "drogas milagrosas de gran impacto para la salud" a ser "un recurso no renovable en vías de extinción". Se deben adoptar las acciones pertinentes para frenar el desarrollo de la resistencia bacteriana con un enfoque multisectorial. Se requiere una gobernanza, optimización del uso de antibióticos, apoyos de políticas de salud y un fortalecimiento de los programas de prevención y control de infecciones(AU)

Introduction: Bacterial resistance endangers the health and survival of human beings and increases the economic burden on society and patients. It is a global phenomenon; therefore, Cuba is not exempted from it. Objective: To present the social and economic impact of antimicrobial resistance from a philosophical point of view as well as to describe the role of a preventive measure to stop antimicrobial resistance. Material and Methods: A review of bibliographic sources was carried out in databases such as PubMed and the Regional Portal of the Virtual Health Library; Google Scholar search engine was also used. Development: Social, economic and ethical aspects related to bacterial resistance are analyzed. A preventive measure to stop antimicrobial resistance is described. In addition, the relationship between antibacterial drugs, bacterial resistance and prevention and control measures is analyzed from the point of view of science-technology-society. Conclusions: Human society is constantly developing and progressing under the promotion of science and technology. In just a few decades, antibiotics have gone from being "miracle drugs of great impact on health" to being "a non-renewable resource in danger of extinction". Necessary measures such as the optimization of the use of antibiotics, a health policy support, and a health strategy for the prevention and control of infections must be taken to stop the development of bacterial resistance(AU)

Panorama de resistencia antimicrobiana de los aislamientos urinarios de pacientes adultos en los servicios de urgencias de Manizales, Caldas, durante el 2018 / Overview of antimicrobial resistance in urinary tract isolates from adult patients in the emergency room service of Manizales, Caldas, in 2018

Introducción: los servicios de urgencias requieren de la toma de medidas eficaces y oportunas en el manejo de los pacientes, esto incluye el uso adecuado de antibióticos. La resistencia antimicrobiana dificulta la instauración de terapias empíricas adecuadas, por lo que su vigilancia toma un papel fundamental en los programas de optimización de uso de antimicrobianos. Objetivo: describir el perfil microbiológico y la resistencia antibiótica de los aislamientos urinarios obtenidos de pacientes adultos de los servicios de urgencias de 7 instituciones de tercer nivel de la ciudad de Manizales, durante el año 2018. Resultados: se recolectaron 1991 aislamientos urinarios, el microorganismo más frecuentemente aislado fue Escherichia coli con un 62%. Se encontraron altas tasas de resistencia a cefazolina, trimetoprim/sulfametoxazol, ciprofloxacina y ampicilina/sulbactam. La resistencia a nitrofurantoína y fosfomicina al igual que a carbapenémicos es baja para Escherichia coli. Los aislamientos urinarios de Pseudomonas aeruginosa muestran niveles de resistencia superiores al promedio nacional. Conclusiones: es importante individualizar el manejo antibiótico empírico, teniendo en cuenta la estratificación por severidad, la presencia de factores de riesgo para bacterias multidrogorresistentes, y la epidemiología local; los análisis de cada institución y los resultados de este trabajo, pueden ser utilizados para establecer conductas terapéuticas más precisas en los casos de infecciones del tracto urinario, mejorando los desenlaces de estos pacientes y los costos derivados de la atención en salud.

Introduction: patient management in emergency rooms require swift and effective clinical decisions; this includes choosing antibiotics correctly. Antimicrobial resistance impairs the adequate choice of empirical therapy, making the surveillance of utmost importance for antimicrobial stewardship programs. Objective: we aimed to describe the microbiological and antimicrobial resistance profile of urinary isolates obtained from adult patients of the emergency services of seven tertiary institutions in the city of Manizales, during the year 2018. Results: from a total of 1991 urinary tract isolates, 62% corresponded to Escherichia coli, the most common bacteria cultured from the emergency room. Susceptibility analysis revealed high resistance levels to cefazolin, trimethoprim-sulfamethoxazole, and ciprofloxacin. Resistance to nitrofurantoin, fosfomycin, and carbapenems was low for Escherichia coli isolates. Pseudomonas aeruginosa showed antimicrobial resistance levels above national averages. Conclusions: empirical antibiotic therapy must be tailored on a patient by patient basis, taking into account the severity of the disease, risk factors for multi-drug resistance bacteria, the institutional and local epidemiology depicted in this work. By using these results, the adjustment of empirical antimicrobial regimens for urinary tract infections could improve clinical outcomes and reduce health care costs.

Perfil biopsicosocial del paciente con tuberculosis y factores asociados a la adherencia terapéutica+ / Biopsychosocial profile of the patient with tuberculosis and factors associated with therapeutic adherence

INTRODUCCIÓN: La resistencia antibiótica y una inadecuada adherencia terapéutica son fenómenos que favorecen la proliferación de la tuberculosis. Los cambios sociodemográficos nos desafían a conocer la realidad actual de la enfermedad a través de antecedentes que nos permitan contextualizar un nuevo escenario. OBJETIVO: Caracterizar el perfil biopsicosocial del paciente con tuberculosis y su relación con la adherencia terapéutica. MATERIAL Y MÉTODO: Estudio descriptivo, transversal, correlacional. Muestra de 90 pacientes tratados en 35 Centros de Salud Familiar de los Servicios de Salud de Iquique, Metropolitano Norte, Concepción y Reloncaví. RESULTADOS: los componentes biopsicosociales como edad, antecedentes de enfermedad mental, autoestima, situación sentimental, pertenencia a grupos de riesgo, alcoholismo, drogadicción y situación de calle presentaron una relación estadísticamente significación con la adherencia terapéutica. CONCLUSIONES: La caracterización biopsicosocial del paciente con tuberculosis visibiliza nuevos factores relacionados con la adherencia que deben ser considerados para una atención interdisciplinaria.

BACKGROUND: Antibiotic resistance and inadequate therapeutic adherence are phenomena that promote the proliferation of tuberculosis. Sociodemographic changes challenge us to know the real situation of the disease and allows us to contextualize a new scenario. OBJECTIVE: To characterize the biopsychosocial profile of the patient with tuberculosis and its relationship to therapeutic adherence. MATERIAL AND METHOD: Descriptive, cross-sectional, correlational study. Sample of 90 patients treated at 35 Family Health Centers from the following Chilean Public Health Services: Iquique, Metropolitan northern (Santiago), Concepción and Reloncaví. RESULTS: Biopsychosocial components such as age, history of mental illness, self-esteem, sentimental status, belonging to risk groups, alcoholism, drug addiction and homeless situation presented a statistically significant relationship with therapeutic adherence. CONCLUSIONS: The biopsychosocial characterization of the TB patient evidence a new adherence-related factors that should be considered for interdisciplinary care.

Resistencia antimicrobiana de uropatógenos en adultos mayores de una clínica privada de Lima, Perú / Antimicrobial resistance of uropathogens in older adults in a private clinic in Lima, Peru

RESUMEN Se describen los principales mecanismos de resistencia antimicrobiana mediante el sistema Vitek® 2 en uropatógenos aislados en adultos mayores de una clínica privada en Lima. Estudio descriptivo realizado entre enero de 2014 y octubre de 2016. Escherichia coli, Klebsiella pneumoniae y Proteus mirabilis obtuvieron una sensibilidad mayor a 80% frente a piperacilina/tazobactam, amikacina y carbapenems. Asimismo, 83,6% de Escherichia coli fueron cepas sensibles a nitrofurantoina. El 41,7% de Escherichia coli, 50,9% de Klebsiella pneumoniae y 50% de Proteus mirabilis fueron productoras de betalactamasas de espectro extendido. De igual modo, 60% de Pseudomonas aeruginosa fueron productoras de carbapenemasas. La modificación de sitio activo (PBP) y la inactivación enzimática por penicilinasas se presentaron en el 7,8% de Enterococcus faecalis. La resistencia a aminoglicósidos se presentó en Escherichia coli (27,1%), Klebsiella pneumoniae (46,7%) y Proteus mirabilis (84,6%) por la producción de enzimas modificadoras. Existe un incremento de la resistencia bacteriana en relación a la edad. La inactivación enzimática de betalactámicos y aminoglicósidos es el mecanismo de resistencia más frecuente.

ABSTRACT The main mechanisms of antimicrobial resistance are described using the Vitek® 2 system in uropathogens isolated in older adults from a private clinic in Lima. Descriptive study conducted between January 2014 and October 2016. Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis obtained a sensitivity greater than 80% against piperacillin/ tazobactam, amikacin, and carbapenems. Moreover, 83.6% of Escherichia coli were nitrofurantoin-sensitive strains. A 41.7% of Escherichia coli, 50.9% of Klebsiella pneumoniae, and 50% of Proteus mirabilis were producers of extended spectrum beta-lactamases (ESBL). Similarly, 60% of Pseudomonas aeruginosa were producers of carbapenemases. Active site modification (PBP) and enzymatic inactivation by penicillinases occurred in 7.8% of Enterococcus faecalis. Resistance to aminoglycosides was presented in Escherichia coli (27.1%), Klebsiella pneumoniae (46.7%), and Proteus mirabilis (84.6%) for the production of modifier enzymes. There is an increase in bacterial resistance in relation to age. Enzymatic inactivation of beta-lactam antibiotics and aminoglycosides is the most common resistance mechanism.

Antibiotic sensitivity pattern of bacterial isolates in patients with chronic rhinosinusitis in Kaduna, Nigeria

Introduction: A common practice in the management of patients with chronic rhinosinusitis (CRS), the empirical use of antibiotics may contribute to treatment failure and to the development of antimicrobial resistance. Objective: To determine the antibiotic sensitivity pattern of aerobic and anaerobic bacteria associated with CRS. Methods: This was a prospective cross-sectional study in which endoscopically guided middlemeatal swabs (IBMSpss, version 16.0, Chicago, IL, USA) were aseptically taken from patients diagnosed with CRS after obtaining informed consent and ethical clearance. The samples were sent to the laboratory for qualitative and semiquantitative analysis via gram stain, aerobic, anaerobic cultures and antibacterial sensitivity tests. The collected data was analyzed using SPSS for Windows, version 16 (SPSS Inc, Chicago, IL, USA). Simple statistical parameters and paired sample t-test were used, as appropriate. Results: There were 74 (56.92%) bacterial growths, out of which 55 (74.32%) were aerobic and 19 (25.68%) were anaerobic isolates, from a total of 130 patients. About 13 (17.5%- 18%) of these bacterial growths yielded a mixed growth of aerobic and anaerobic isolates. Themost common bacterial isolates were 26 (35.14%) Staphylococcus aureus, Haemophilus influenzae 9 (12.16%), Streptococcus viridians 8 (10.81%), and Streptococcus pneumoniae 5 (6.76%). Augmentin, ciprofloxacin, and Peflacine were found to bemost effective, followed by levofloxacin, Rocephin, erythromycin and Zinat in that order (AU)

Averting the AMR crisis: what are the avenues for policy action for countries in Europe?

This policy brief summarizes some of the key policy avenues for tackling antimicrobial resistance (AMR). Following the widely accepted ‘One Health’ approach to combating AMR, the brief aims to support the implementation of national action plans (NAPs) on AMR, drawing on numerous examples of effective policies implemented by European Union Member States and involving the human, animal and environmental health sectors.

Prevalencia y perfil de susceptibilidad antimicrobiana en bacterias aisladas de úlceras crónicas infectadas en adultos / Prevalence and susceptibility pattern of bacteria isolated from infected chronic wounds in adult patients

Resumen Introducción: Las úlceras crónicas son un problema de salud pública, agravándose por infecciones bacterianas causadas principalmente por agentes resistentes. Objetivo: Estudiar prevalencia y perfil de susceptibilidad en bacterias aisladas de úlceras crónicas en pacientes adultos. Pacientes y Métodos: Pacientes atendidos en la Fundación Instituto Nacional de Heridas entre mayo y julio de 2014, con úlceras crónicas en extremidades inferiores con signos inflamatorios clínicos. Las muestras fueron cultivadas en aerobiosis y anaerobiosis y para la identificación bacteriana se empleó el sistema de galerías API (Biomerieux). La susceptibilidad in vitro se evaluó según el método de Kirby Bauer. Resultados: Se reclutaron 73 pacientes, entre quienes 46 presentaron úlceras infectadas, diagnosticándose 33 úlceras venosas con predominio de infección polimicrobiana y 10 úlceras de pie diabético con predominio de infección monomicrobiana (p ≤ 0,05). Se aislaron 68 cepas de los 46 pacientes con úlcera infectada. Las enterobacterias predominaron en infección monomicrobiana (p ≤ 0,05) y los demás grupos bacterianos fueron levemente más frecuentes en infección polimicrobiana. La especie prevalente fue Staphylococcus aureus (24%) seguida de Pseudomonas aeruginosa (18%). Cincuenta cepas (77%) presentaron resistencia a uno o más antibacterianos. Destacamos resistencia de S. aureus a ciprofloxacina (50%) y cefoxitina (37,5%) identificándose así resistencia a meticilina en la comunidad (SARM-AC), siendo todas sensibles a cotrimoxazol. Las enterobacterias presentaron resistencia a sensibilidad a amikacina (95,5%), P. aeruginosa evidenció resistencia a ciprofloxacina (33,3%) con alta sensibilidad a gentamicina (91,7%) y amikacina (83,3%), mientras Acinetobacter spp presentó resistencia a ciprofloxacina y ceftazidima en 60%, con 100% de sensibilidad a imipenem. Streptococcus β hemolítico presentó 50% de resistencia a clindamicina y penicilina. Conclusión: Estos datos entregan información epidemiológica de infecciones de úlceras crónicas, representando un apoyo al diagnóstico, tratamiento y manejo de esta patología.

Background: Chronic wounds are considered a public health problem that may be complicated by bacterial infections, mainly caused by resistant strains. Aim: To study the bacteria prevalence and antimicrobial susceptibility in samples from adult patients with chronic wounds. Methods: Patients treated at National Institute of Wounds Foundation between May and July 2014, with chronic ulcers in lower extremities with clinical inflammatory signs were recluted. Samples were cultured in aerobic and anaerobic atmosphere and species identification was performed by API (Biomerieux) galleries. The in vitro susceptibility was evaluated according to the Kirby Bauer method. Results: From 73 patients, 46 had infected wounds most of them were venous ulcers (33) with prevalence in polymicrobial infections and 10 with foot-diabetes ulcers with prevalence in monomicrobial infections (p ≤ 0.05). Sixty-eight strains were isolated and Enterobacteriaceae were predominant in monomicrobial infection (p ≤ 0.05) and the other groups were slightly higher in polymicrobial infection. The main species were Staphylococcus aureus (24%) followed by P. aeruginosa (18%). Fifty strains (77%) were resistant or multi-resistance. We emphasize resistance of S. aureus to ciprofloxacin (50%) and cefoxitin (37.5%), thus identifying resistance to methicillin in the community (CA-SAMR), all of which are sensitive to cotrimoxazole. Enterobacteria showed sensitivity to amikacin (95.5%), P. aeruginosa showed resistance to ciprofloxacin (33.3%) with high sensitivity to gentamicin (91.7%) and amikacin (83.3%), while Acinetobacter spp showed resistance to ciprofloxacin and ceftazidime in 60%, with 100% sensitivity to imipenem. 50% Streptococcus β hemolytic showed resistance to clindamycin and penicillin. Conclusion: These data provide epidemiological information on chronic wound infections, representing support for diagnosis, treatment and management of this pathology.

Factores predictores de mortalidad intrahospitalaria en pacientes adultos con infecciones por Klebsiella pneumoniae resistente a carbapenémicos y colistín: un estudio de cohorte retrospectivo / Risk factors for in-hospital mortality among adult patients infected with colistin-resistant carbapenemase producing Klebsiella pneumoniae: a retrospective cohort study

Resumen Introducción: La emergencia de Klebsiella productora de carbapenemasas resistente a colistín representa un desafío clínico y un problema emergente. Objetivo: Evaluar la mortalidad intrahospitalaria y sus potenciales factores de riesgo en pacientes internados con infecciones clínicas por Klebsiella pneumoniae productora de carbapenemasas (KPC) resistente a colistín. Material y Método: Realizamos un estudio de cohorte retrospectivo, incluyendo pacientes adultos admitidos a un hospital universitario de tercer nivel en Buenos Aires, infectados por KPC resistente a colistín. El evento primario considerado fue la mortalidad intrahospitalaria. Se utilizaron modelos generalizados lineales para evaluar potenciales predictores de dicho evento. Resultados: En total, se identificaron 18 pacientes hospitalizados que presentaron una infección clínica por esta bacteria durante el año 2016 y que fueron incluidos en el análisis final. La mortalidad intrahospitalaria en esta cohorte fue de 38,9%. La presencia de bacteriemia, la injuria renal aguda al momento del diagnóstico y la presencia de shock séptico se asociaron a la ocurrencia del evento primario. Conclusión: El desarrollo de infecciones clínicamente relevantes por KPC resistente a colistín en pacientes internados es frecuente y presenta una elevada mortalidad. En nuestra cohorte, la presencia de shock e injuria renal aguda al momento del diagnóstico se asociaron a un incrementado riesgo de mortalidad intrahospitalaria. Futuras investigaciones deberían corroborar estos hallazgos e investigar factores adicionales que permitan identificar tempranamente a aquellos pacientes que presentarán eventos desfavorables.

ABSTRACT Background: The emergence of colistin resistant carbapenemase-producing Klebsiella represents a therapeutic challenge and a worldwide problem. Aim: To estimate the in-hospital mortality and identify the associated risk factors among patients with colistin-resistant carbapenemase-producing Klebsiella pneumoniae (KPC) that present with a clinical infection. Methods: We carried a retrospective cohort study, including adult patients infected with colistin-resistant KPC hospitalized at a tertiary teaching hospital in Buenos Aires, Argentina during the year 2016. The main outcome was in-hospital mortality. We used generalized lineal models to evaluate potential predictors of mortality. Results: 18 patients that developed a colistin-resistant KPC clinical infection were identified and included in the final analysis. In-hospital mortality in this cohort was 38.9%. The presence of bacteremia, acute renal injury at the time of diagnosis and septic shock were associated with the main outcome. Conclusions: Infections due to colistin-resistant KPC among in-hospital patients was frequent and was associated with high mortality rate. In our cohort, both shock and acute kidney injury were associated with a higher likelihood of poor outcomes. Further studies are warranted to evaluate the role of these and others risk factors so as to aid in the early detection of high risk patients.

Risk factors for mortality in patients with ventilator-associated pneumonia caused by carbapenem-resistant Enterobacteriaceae

Abstract Background: The ideal therapeutic option for ventilator associated pneumonia caused by carbapenem-resistant Enterobacteriaceae is not defined. The aim of this study was to assess mortality-associated risk factors in patients with VAP by CRE and determine the outcome of several treatment options. Methods: This was a retrospective study performed in two tertiary hospitals involving patients with VAP caused by CRE between January 2010 and August 2014. The outcomes were mortality within 30 days of VAP diagnosis and overall mortality during hospital admission. Risk factors for mortality were assessed by comparing variables of survivors and non-survivors. Results: One hundred and twelve patients with CRE-VAP were included, 73 (65%) male, median age 56 years. The 30-day mortality was 57.1% and the overall hospital mortality was 67%. In the binary logistic regression analysis, only age >50 years was independently associated to increased mortality. Polymyxin was the most used drug (47.5%), followed by tigecycline (29.2%) and aminoglycosides (2.4%). Combined therapy with two active drugs was used by 17 patients (20.8%). No therapeutic option was independently associated to survival. However, combined therapy with two active drugs was superior to the therapy with a single active drug when inappropriate therapy was the comparator (p = 0.044). The addition of carbapenem was not associated with increased survival. Conclusion: The best therapeutic option for VAP by CRE is still not completely defined, but the therapy with at least two active drugs was superior in this study.

Molecular detection of clarithromycin and fluoroquinolones resistance in helicobacter pylori infection, directly applied to gastric biopsies, in an urban brazilian population

ABSTRACT Background - Antimicrobial resistance is the major factor leading to eradication failure in H. pylori treatment. Molecular tests are useful to detect genetic mutations predictive of clarithromycin and fluoroquinolones resistance. Knowledge of the local prevalence rate of resistance is important to define the best recommended treatment. Objective - To assess the prevalence of primary resistance of H. pylori to clarithromycin and fluoroquinolones, using a molecular test, in a Southeastern urban Brazilian population. Methods - A total of 72 H. pylori seropositive patients [65% female, mean age 39 (19-73) years] never treated before for this infection were studied. All patients underwent gastroscopy in addition to antrum and corpus biopsies and molecular test GenoType HelicoDR (Hain Life Science, Germany) to detect H. pylori and point mutations in genes responsible for clarithromycin and fluoroquinolone resistance. The molecular procedure was divided into three steps: DNA extraction from biopsy samples, a multiplex amplification with biotinylated primers and a reverse hybridization. The most frequent point mutations involved in resistance to the two antibiotics were evaluated. Results - Resistance to clarithromycin was detected in nine (12.5%) patients and to fluoroquinolones in eight (11.1%) patients. The point mutation A2147G was the most common (77.8%) among resistant strains to clarithromycin. In 50% of the resistant strains to fluoroquinolones, the mutant codon couldn't be identified. Conclusion - The resistance rates to clarithromycin and fluorquinolones in a large urban population in the Southeast of Brazil were acceptable, suggesting that these drugs remain appropriate options to first and second-line of H. pylori treatment. The molecular test represents an adequate diagnostic tool for monitoring H. pylori resistance.

RESUMO Contexto - A resistência aos antimicrobianos é o principal fator associado à falha terapêutica no tratamento do H. pylori. Testes moleculares são úteis na detecção das mutações genéticas associadas ao desenvolvimento de resistência à claritromicina e fluorquinolonas. O conhecimento da taxa de prevalência local de resistência é importante na definição do melhor esquema terapêutico. Objetivo - Estimar a prevalência de resistência primária do H. pylori à claritromicina e fluorquinolonas, empregando-se um teste molecular, em uma capital do Sudeste do Brasil. Métodos - Setenta e dois pacientes com sorologia positiva para H. pylori [65% mulheres, idade média 39 (19-73) anos], nunca tratados previamente para essa infecção, foram selecionados. Todos os pacientes submeteram-se à endoscopia digestiva com biópsias de antro e corpo e realização do teste molecular GenoType HelicoDR (Hain Life Science, Alemanha) para a detecção do H. pylori e das mutações pontuais dos genes responsáveis pela resistência à claritromicina e fluorquinolonas. O procedimento molecular constituía-se de três etapas: extração do DNA a partir das amostras endoscópicas, amplificação multiplex com primers biotinilados e hibridização reversa. As mutações pontuais mais frequentemente envolvidas com resistência aos dois antibióticos foram avaliadas. Resultados - Resistência à claritromicina foi detectada em nove (12,5%) pacientes e às fluorquinolonas em oito (11,1%) pacientes. A mutação pontual A2147G foi a mais comum (77,8%) entre as cepas resistentes à claritromicina. Em 50% das cepas resistentes à fluorquinolonas, o códon mutante não pôde ser identificado. Conclusão - As taxas de resistência à claritromicina (12,5%) e às fluorquinolonas (11,1%), em uma importante capital do Sudeste do Brasil, mostraram índices aceitáveis, sugerindo que essas drogas permanecem opções apropriadas para o tratamento de primeira e segunda linha do H. pylori. O teste molecular constitui uma ferramenta diagnóstica adequada para monitorar a resistência do H. pylori.

Características clínicas y microbiológicas de la infección intra-abdominal complicada en Colombia: un estudio multicéntrico / Clinical and microbiological characteristics of complicated intra-abdominal infection in Colombia: a multicenter study

Introducción: La infección intra-abdominal complicada adquirida en la comunidad (IIAc-AC) es una causa frecuente de abdomen agudo. Objetivo: Identificar el perfil clínico y microbiológico de la IIAc-AC en cuatro hospitales de Colombia. Métodos: Estudio descriptivo, prospectivo entre 07-2012 y 09-2014 en pacientes de 15 o más años con IIAc-AC. Se midieron las frecuencias de variables socio-demográficas, clínicas, diagnóstico, aislamientos y susceptibilidad antimicrobiana del primer cultivo obtenido asépticamente del sitio de infección. Resultados: 192 pacientes incluidos, 62% hombres, edad media 47,3 años; 38,4% con co-morbilidad, 13% hospitalizados en el último año y 9,4% recibieron antimicrobianos en los últimos seis meses. Fueron admitidos 44,3%, por apendicitis 17,7% por peritonitis y 16,7% por perforación intestinal. El 64,1% de las IIAc-AC fue moderada y tratada con ampicilina/sulbactam (SAM) y ertapenem. En 70,8% se aisló al menos un microorganismo en: 65,1% bacilos gramnegativos (80,0% Escherichia coli, 44,8% susceptible a piperacilina/tazobactam, 65,7% a SAM y 11,2% Klebsiella pneumoniae, 85% susceptibles a SAM) y en 16,7% especies grampositivas (28,1% Streptococcus grupo viridans). La mediana de hospitalización fue siete días y 15,1% fallecieron. Conclusión: Escherichia coli y K. pneumoniae en IIAc-AC son los principales microorganismos a cubrir en la terapia empírica y es necesario conocer la susceptibilidad antimicrobiana en cada región para seleccionar un tratamiento empírico adecuado.

Introduction: Complicated community-acquired intra-abdominal infections (CA-cIAI) are a common cause of acute abdomen. Objective: To identify the clinical and microbiology profile of CA-cIAI in four Colombian hospitals. Methods: This is a prospective, descriptive study, between 08-2012 and 09-2014, including patients with CA-cIAI > 15 years. Data collected included: socio-demographic, clinical, diagnosis, and isolates of the first culture obtained aseptically during surgery with antimicrobial susceptibility. Results: 192 patients were included, 62% men, median age 47.3 years. Co-morbidities were present in 38.4%, 13% had been hospitalized in the previous year 13%, and 9.4% had received antibiotics in the last 6 months; 44.3% were admitted for appendicitis, 17.7% for peritonitis and 16.7% for bowel perforation. CA-cIAI were assessed as moderate in 64.1% of the cases and were treated with ampicillin/sulbactam (SAM) and ertapenem. In 70.8% of cases a bacteria was isolated: 65.1% were gramnegative rods (80.0% Escherichia coli, 44.8% of them susceptible to pipercillin/tazobactam, 65.7% to SAM; 11.2 % were K.pneumoniae, 85% was susceptible for SAM; 16.7% were grampositive cocci (28.1% Streptococci viridans group). The median hospital stay was 7 days and 15.1% died. Conclusions: E. coli, K. pneumoniae and S. viridans were the main organisms to consider in an empiric therapy for CA-cIAI and it is important to know the local epidemiology in order to choose the right antibiotic.

Epidemiología y pronóstico de pacientes con infección del torrente sanguíneo en 10 hospitales de Colombia / Epidemiology and prognosis of patients with bloodstream infection in 10 hospitals in Colombia

Background: Knowing the local epidemiology and etiology of bloodstream infections allows tailoring the empirical initial antimicrobial therapy to obtain a better outcome for these episodes. Aim: To describe the epidemiological and microbiological aspects as well as the factors associated with mortality in patients with bloodstream infection in Colombian hospitals. Methods: Sub-analysis of a prospective cohort study of 375 consecutive patients with bloodstream infection in 10 hospitals in Colombia, admitted between September first 2007 and Febrnary 29, 2008. Results: The most frequently isolated bacteria were Gram-negative bacilli in 54% of patients, followed by Gram-positive cocci in 38.4%. The source of infection was known in 67%, unknown in 24% and associated with intravascular catheter in 9%. The most frequently isolated bacteria were Escherichia coli (46%), coagulase-negative Staphylococci (16%), Klebsiella pneumoniae (8.9%) and Staphylococcus aureus (7.8%). Staphylococcus aureus was methicillin sensitive in 82% of patients (46/56). Overall 28-day mortality was 25% and their independent associated factors were age, SOFA score and APACHE II score. Conclusions: In our study the most frequently isolated bacteria in bloodstream infections were Gram-negative bacilli, contrasting those reported in developed countries. The overall mortality rate was high and the factors associated with mortality were age and severity scores.

Introducción: Conocer la epidemiología y etiología regional de las infecciones del torrente sanguíneo permite orientar una terapia antimicrobiana inicial empírica mejorando el resultado final del episodio. Objetivo: Describir los aspectos epidemiológicos, microbiológicos y factores asociados a la mortalidad de pacientes con infección del torrente sanguíneo en hospitales colombianos. Métodos: Sub-análisis de cohorte prospectivo de 375 pacientes consecutivos en 10 hospitales de Colombia con diagnóstico de infección del torrente sanguíneo, hospitalizados entre 1 de septiembre de 2007 y 29 de febrero de 2008. Resultados: Los microorganismos más frecuentemente aislados fueron los bacilos gramnegativos en 54% de los pacientes; seguidos por las cocáceas grampositivas en 38,4%. La fuente de infección fue secundaria a un foco conocido en 67%, desconocido en 24% y asociada a catéter intravascular en 9%. Los microorganismos más frecuentemente aislados fueron: Escherichia coli 46%, Staphylococcus coagulasa negativa 16%, Klebsiella pneumoniae 8,9% y Staphylococcus aureus 7,8%. Staphylococcus aureus fue sensible a meticilina en 82% de los pacientes (46/56). La mortalidad global fue de 25%. Los factores asociados con mayor mortalidad fueron: edad, puntaje SOFA y puntaje APACHE II. Conclusiones: En nuestro estudio, los microorganismos más frecuentemente aislados en pacientes que cursaron con bacteriemia fueron los bacilos gramnegativos, a diferencia de lo reportado en países desarrollados. La mortalidad general es alta y los factores asociados con riesgo de muerte fueron: la edad y los mayores puntajes de gravedad.

Ensuring innovation in diagnostics for bacterial infection: implications for policy

The inappropriate use of antibiotics is a primary cause of the ongoing increase in drug resistance amongst pathogenic bacteria. The resulting decrease in the efficacy of antibiotics threatens the ability to combat infectious diseases. Rapid, point-of-care tests to identify pathogens and better target the appropriate treatment could greatly improve the use of antibiotics, yet few such tests are available or being developed, despite the rapid pace of medical innovation. Clearly, something is inhibiting the much-needed development of new and more convenient diagnostic tools. This study delineates priorities for developing diagnostics to improve antibiotic prescription and use, in order to manage and curb the expansion of drug resistance. It calls for new approaches, particularly in the provision of diagnostic devices, and, in doing so, outlines some of the inadequacies in health, science and policy initiatives that have led to the dearth of such devices. The authors make the case that innovation is clearly and urgently needed, not only in the technology of diagnosis but also in public policy and medical practice to support the availability and use of better diagnostic tools. This book explores the complexities of the diagnostics market from the perspective of both supply and demand, unearthing interesting bottlenecks: some obvious, some more subtle. It calls for a broad, multifaceted policy response, and an overhaul of current practice, so that the growth of bacterial resistance can be stemmed.

"Helicobacter pylori, hoy": una historia de 30 años / "Helicobacter pylori, today": a 30 year history

En 1983, hace 30 años, Warren JR y Marshall BJ publican el artículo en Lancet1, que revolucionó el entendimiento de varias patologías gástricas, al encontrar un bacilo curvo no identificado en el epitelio gástrico, en gastritis crónica activa, de forma casi fortuita, al bacilo llamado subsecuentemente, Campylobacter pylori y con la nomenclatura de hoy, Helicobacter pylori. Fue considerado por la OMS carcinogenético gástrico el año 2001 (Figura 1). En el 2005, fueron galardonados con el Premio Nobel de Medicina, por su contribución (Figura 2). Es el tópico que más publicaciones científicas ha generado en la literatura. En la presente revisión, nos ocuparemos de un enfoque eminentemente práctico, sobre hechos de relevancia clínica de su presencia, de su diagnóstico, de la terapéutica y sus variables actuales y de los diferentes escenarios, en los cuales nos desenvolvemos. Se hace mención de un excelente documento generado en un Consenso actualizado en Latinoamérica2.

In 1983, 30 years ago, Warren JR & Marshall BJ, published in Lancet, their leading revolutionary article1, modifying the understanding of several gastric pathologies, thanks to the discovery of an unidentified curved bacilli in the gastric epithelium, in chronic active gastritis, almost unvoluntariously, nominated sequentially Campylobacter pylori and according to the today's nomenclature Helicobacter pylori. It has been considered gastric carcinogen by WHO in 2001 (Figure 1). In 2005, they were awarded with the Nobel Prize of Medicine for their contribution (Figure 2). It is the topic generating the highest number of scientific publications, in the literature. In this publication, we deal with a practical focus on clinical relevant aspects, related with its presence, its diagnosis, the therapeutic approach and its variables, and tackling the different clinical scenarios. A recently published practical Latin American consensus, has been preferently considered2.