Interlaboratory Comparative Study to Detect Potentially Infectious Human Enteric Viruses in Influent and Effluent Waters.

Wastewater represents the main reusable water source after being adequately sanitized by wastewater treatment plants (WWTPs). In this sense, only bacterial quality indicators are usually checked to this end, and human pathogenic viruses usually escape from both sanitization procedures and controls, posing a health risk on the use of effluent waters. In this study, we evaluated a protocol based on aluminum adsorption-precipitation to concentrate several human enteric viruses, including norovirus genogroup I (NoV GI), NoV GII, hepatitis A virus (HAV), astrovirus (HAstV), and rotavirus (RV), with limits of detection of 4.08, 4.64, 5.46 log genomic copies (gc)/L, 3.31, and 5.41 log PCR units (PCRU)/L, respectively. Furthermore, the method was applied in two independent laboratories to monitor the presence of NoV GI, NoV GII, and HAV in effluent and influent waters collected from five WWTPs at two different sampling dates. Concomitantly, a viability PMAxx-RT-qPCR was applied to all the samples to get information on the potential infectivity of both influent and effluent waters. The ranges of the titers in influent waters for NoV GI, NoV GII, RV, and HAstV were 4.80-7.56, 5.19-7.31 log gc/L, 5.41-6.52, and 4.59-7.33 log PCRU/L, respectively. In effluent waters, the titers ranged between 4.08 and 6.27, 4.64 and 6.08 log gc/L, < 5.51, and between 3.31 and 5.58 log PCRU/L. Moreover, the viral titers detected by viability RT-qPCR showed statistical differences with RT-qPCR alone, suggesting the potential viral infectivity of the samples despite some observed reductions. The proposed method could be applied in ill-equipped laboratories, due to the lack of a requirement for a specific apparatus (i.e., ultracentrifuge).

Relación entre desarrollo de los programas para la gestión del uso de antimicrobianos, apropiabilidad y consumo de antibióticos en hospitales de Argentina / Relationship between the antimicrobial stewardship program development, appropriateness and antimicrobial consumption in Argentinean hospitals

Introducción: La implementación de Programas para la Optimización de Uso de Antimicrobianos (PROAs) ha resultado una estrategia útil para mejorar los resultados asistenciales, de manera segura y costo-efectiva, reduciendo el desarrollo de la resistencia a los antimicrobianos.Objetivo: Estimar la relación entre nivel de desarrollo de los PROAs, apropia-bilidad y consumo de antimicrobianos en hospitales ArgentinosMaterial y métodos: Entre Jul-2016 y Ene-2017, 111 hospitales condujeron una autoevaluación del nivel de desarrollo de sus PROAs usando un instrumen-to basado en los lineamientos del CDC (0 a 100 puntos), además de un cor-te de prevalencia para evaluar la apropiabilidad de las prescripciones de an-timicrobianos y su consumo mensual [Dosis Diarias Definidas (DDD) c/100 días-paciente]. Para la comparación de estos indicadores, los centros fueron dicotomizados tomando como punto de corte el percentilo 75 (p75) de la au-toevaluación.Resultados: La comparación entre hospitales con puntaje ≥p75 vs.

Objective: To assess the association between the level of AMS programs development, appropriateness and antimicrobial consumption in Argentinean hospitalsMaterial and methods: Between Jul-2016 and Jan-2017, 111 hospitals performed a self-assessment survey of their AMS programs using a standardized tool based on CDC recommendations (0­100 scale). In addition, the appropriateness of antimicrobial prescription was measured through one-day prevalence study using specific criteria. The monthly consumption of a group of antimicrobials was calculated using Defined Daily Doses (DDD) per 100 patient-days. To assess the relationship between the level of AMS programs development and the appropriateness and antimicrobial consumption indicators, participating centers were grouped into two categories by using the 75th percentile (75thp) of the self-assessment scoreResults: Comparison between hospitals with score ≥75thp vs <75thp showed significant differences in all indicators analyzed (self-assessment score: 51.6 vs 25.4; diff. 26.2; 95%CI 30.3 to 22.0, p<0.000; surgical prophylaxis: ≤ 24 hs 64.8% vs 52.3%; diff. 12.5%; 95%CI 5.1% to 20.0%, p<0.002; compliance with guidelines: 77.6% vs 47.0%; diff. 30.6%; 95%CI 28.1% to 33.0%, p<0.000; prospective audit with feedback: 69.4% vs 46.8%; diff. 22.6%; 95%CI 20.0% to 25.2%, p<0.000; antimicrobial consumption: 114.8 DDDs vs 259.2 DDDs; diff.­144.4; 95%CI ­140.6 to ­148.2, p<0.000)Conclusions: Hospitals with higher self-assessment score showed better appropriateness and consumption antimicrobial indicators, reinforcing the relevance of an effective implementation of AMS programs