An Emergent Change in Epidemiologic and Microbiological Characteristics of Bloodstream Infections in Adults With Febrile Neutropenia Resulting From Chemotherapy for Acute Leukemia and Lymphoma at Reference Centers in Chile, Ecuador, and Peru.

Background: Febrile neutropenia is a life-threatening condition commonly observed in patients with hematologic malignancies. The aim of this article is to provide updated knowledge about bloodstream infections in febrile neutropenia episodes within the Andean region of Latin America. Method: This retrospective study was based in 6 hospitals in Chile, Ecuador, and Peru and included adult patients with acute leukemia or lymphoma and febrile neutropenia between January 2019 and December 2020. Results: Of the 416 febrile neutropenia episodes, 38.7% had a bloodstream infection, 86% of which were caused by gram-negative rods, with Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa being the most frequently identified bacteria. K pneumoniae isolates were more frequently resistant than E coli to cefotaxime (65% vs 39.6%), piperacillin-tazobactam (56.7% vs 27.1%), and imipenem (35% vs 2.1%) and were more frequently multidrug resistant (61.7% vs 12.5%). Among P aeruginosa, 26.7% were resistant to ceftazidime, piperacillin-tazobactam, and imipenem, and 23.3% were multidrug resistant. Overall 30-day mortality was 19.8%, being higher with vs without a bloodstream infection (26.7% vs 15.3%, P = .005). Fever duration was also significantly longer, as well as periods of neutropenia and length of hospital stay for patients with bloodstream infection. Additionally, the 30-day mortality rate was higher for episodes with inappropriate vs appropriate empirical antibiotic therapy (41.2% vs 26.6%, P = .139). Conclusions: Considering the high rates of bacteria-resistant infection and 30-day mortality, it is imperative to establish strategies that reduce the frequency of bloodstream infections, increasing early identification of patients at higher risks of multidrug bacteria resistance, and updating existing empirical antibiotic recommendations.

[Cedecea lapagei traumatic wound infection: case report and literature review]. / Infección de herida traumática por Cedecea lapagei: Comunicación de un caso y revisión de la literatura.

Cedecea lapagei is a gram-negative, facultative anaerobic, non-spore-forming bacteria, belonging to the family Enterobacteriaceae. It has been reported as a pathogen in few cases of bacterial peritonitis, wound infection, chemicals burns and pneumonia. We report a case of traumatic wound infection by this pathogen with a pertinent review.

E-Learning versus Face-to-Face Methodology for Learning Antimicrobial Resistance and Prescription Practice in a Tertiary Hospital of a Middle-Income Country.

Background: Antimicrobial resistance is a growing health problem worldwide. One strategy to face this problem in a reasonable way is training health personnel for the rational use of antimicrobials. There are some difficulties associated with medical staff to receiving training with E-learning education, but there is a lack of studies and insufficient evidence of the effectiveness of this method compared to face-to-face learning. Methods: An educational intervention on antimicrobial resistance (AMR) and antimicrobial prescription practice (APP) was designed and implemented using two approaches: face-to-face and E-learning among physicians of the intensive care unit (ICU) and internal medicine ward (IMW) at Eugenio Espejo Hospital in Quito. Modalities of interventions were compared to propose a strategy of continuous professional development (CPD) for all hospital staff. An interventional study was proposed using a quasi-experimental approach that included 91 physicians, of which 49 belong to the IMW and 42 to the ICU. All of them received training on AMR­half in a face-to-face mode and the other half in an asynchronous E-learning mode. They then all participated on APP training but with switched groups; those who previously participated in the face-to-face experience participated in an E-learning module and vice-versa. We evaluated self-perception about basic knowledge, attitudes and referred practices towards AMR and APP before and after the intervention. A review of medical records was conducted before and after training by checking antimicrobial prescriptions for all patients in the ICU and IMW with bacteremia, urinary tract infection (UTI), pneumonia, and skin and soft tissue infection. The study received IRB clearance, and we used SPSS for statistical analysis. Results: No statistically significant difference was observed between the E-learning and the face-to-face methodology for AMR and APP. Both methodologies improved knowledge, attitudes and referred practices. In the case of E-learning, there was a self-perception of improved attitudes (p < 0.05) and practices (p < 0.001) for both AMR and APP. In face-to-face, there was a perception of improvement only in attitudes (p < 0.001) for APP. In clinical practice, the use of antimicrobials significantly improved in all domains after training, including empirical and targeted treatment of bacteremia and pneumonia (p < 0.001) and targeted treatment of UTI (p < 0.05). For the empirical treatment of pneumonia, the mean number of antibiotics was reduced from 1.87 before to 1.05 after the intervention (p = 0.003), whereas in the targeted management of bacteremia, the number of antibiotics was reduced from 2.19 to 1.53 (p = 0.010). Conclusions: There was no statistically significant difference between the effect of E-learning and face-to-face strategy in terms of teaching AMR and APP. Adequate self-reported attitudes and practices in E-learning exceed those of the face-to-face approach. The empiric and targeted use of antimicrobials improved in all reviewed cases, and we observed an overall decrease in antibiotic use. Satisfaction with training was high for both methods, and participants valued the flexibility and accessibility of E-learning.

Mieloma múltiple en el Hospital Carlos Andrade Marín, estado clínico al diagnóstico y sobrevida / Multiple myeloma in Carlos Andrade Marin Hospital, diagnostic and survival clinical status

Introducción: la mortalidad asociada a los pacientes con mieloma múltiple (MM) son los únicos datos disponibles en Ecuador. El presente estudio tiene por objetivo caracterizar la enfermedad, definir la tasa de mortalidad y describir los factores relacionados en los casos de MM tratados en el Hospital Carlos Andrade Marín. Materiales y métodos: análisis retrospectivo de datos demográficos, características clínicas de los pacientes con MM, recogidos de enero a diciembre de 2011. Resultados: 52 pacientes entre 29 a 89 años (media 61), 15 fueron mujeres (29%). 73% tenía un mieloma IgG, el 28% IgA y 19% fueron cadenas ligeras. Según el sistema de estadificación Durie y Salmon (D&S), 13% en etapa I, 25% en etapa II, 33% en estadío III. Fue excluido el 41% ya que la información no estaba disponible. Mortalidad en el estadío clínico avanzado del Mieloma (D&S etapa III) fue de 10%, en las etapas I y II no fueron registradas muertes. El daño renal fue más frecuente en la etapa III (33%) comparado con las etapas I (13%) y II (25%). Conclusiones: la mortalidad se asoció a un estadío avanzado del MM (etapa III) y al daño renal presente (29%).

Introduction: mortality associated with patients with multiple myeloma (MM) is the only data available in Ecuador. This study aims to characterize the disease, determine its mortality rate and describe related factors in the cases of MM treated at the Carlos Andrade Marin Hospital. Materials and methods: retrospective analysis of demographic data, clinical characteristics of patients with MM, collected between january and december 2011. Results: 52 patients between 29 to 89 years (mean 61), 15 were women (29%). 73% had an IgG myeloma, 28% IgA and 19% were light chains. According to the staging system Durie and Salmon (D & S) 13% in stage I, stage II 25%, 33% stage III. 41% was excluded because information was not available. Mortality in the advanced clinical stage of myeloma (D & S stage III) was 10% in stages I and II were not registering deaths. Renal damage was more frequent in stage III (33%) compared with stages I (13%) and II (25%). Conclusions: mortality was associated with advanced stages of MM (stage III) and kidney damage present (29%).

Infección de herida traumática por Cedecea lapagei: Comunicación de un caso y revisión de la literatura / Cedecea lapagei traumatic wound infection: Case report and literature review

Cedecea lapagei is a gram-negative, facultative anaerobic, non-spore-forming bacteria, belonging to the family Enterobacteriaceae. It has been reported as a pathogen in few cases of bacterial peritonitis, wound infection, chemicals burns and pneumonia. We report a case of traumatic wound infection by this pathogen with a pertinent review.

Cedecea lapagei es un bacilo gramnegativo, anaerobio facultativo, no formador de esporas, perteneciente a la familia Enterobacteriaceae. Se han comunicado escasos casos en la literatura científica entre los cuales se destacan una peritonitis bacteriana, una infección de herida por quemadura química y una neumonía. A continuación se presenta el caso de una infección por este patógeno en una herida traumática. Se realiza una revisión bibliográfica del tema.

Linfoma subcutáneo de células T tipo paniculitis con síndrome hemofagocítico / SUBCUTANEUS T LYMPHOMA PANICULITIS TYPE WITH HEMOFAGOCITICUS SYNDROME

El linfoma subcutáneo de células T tipo paniculitis (SPTCL) es una raraneoplasia cuya presentación clínica, evolución natural y tratamiento noestán bien establecidos. El SPTCL proviene de una célula citotóxica Tque comúnmente imita a la paniculitis. Los pacientes presentan placassubcutáneas o nódulos cuya evaluación demuestra infiltrados celularesde grasa subcutánea, generalmente con preservación de la epidermissuprayacente.Presentamos un interesante caso que esquivó el diagnóstico durantedos años, y remarca la importancia de realizar biopsias repetidas ante lasospecha de enfermedad maligna, especialmente en la niñez (AU)

The T-cell lymphoma subcutaneous panniculitis is a rare neoplasmwhose clinical presentation, natural history, and treatment are not wellestablished.The SPTCL is derived from a cytotoxic T cell mimics commonlypanniculitis. Patients usually present with plates or subcutaneousnodules, when evaluated demonstrate cellular infiltrates subcutaneous fat,generally with preserving the overlying epidermis.We present a major case that elusive diagnosis for two years andhighlights the importance of repeated biopsies of suspected malignantdisease, especially in childhood.