Etiología bacteriana y susceptibilidad antibiótica en infecciones urinarias en adultos atendidos ambulatoriamente en el Hospital Nacional Sergio E. Bernales, enero-diciembre 2014

Objetivo General: Determinar la frecuencia de los agentes etiológicos bacterianos y su respectiva susceptibilidad antibiótica en las infecciones urinarias de los adultos atendidos ambulatoriamente, en consultorio externo y en emergencia, en el Hospital Nacional “Sergio E. Bernales” durante el periodo Enero-Diciembre 2014. Metodología: El estudio es de tipo descriptivo, observacional, retrospectivo y de corte transversal. La unidad de análisis fue cada resultado de urocultivo positivo cuya muestra perteneció a un paciente adulto (≥ 18 años) procedente de emergencia o consultorio externo del Hospital Nacional Sergio E. Bernales durante el periodo Enero – Diciembre 2014. Se registró la información proveniente de los urocultivos y sus respectivos antibiogramas mediante una ficha de recolección de datos, estos fueron analizados posteriormente utilizando el paquete estadístico SPSS 23. Resultados: Se incluyeron 327 urocultivos positivos de pacientes diferentes y sus respectivos antibiogramas. Se encontraron en total 15 agentes patógenos diferentes, de los cuales se halló en mayor proporción a Escherichia coli, quien presentó tasas de resistencia altas para ampicilina, ampicilina/sulbactam, cefazolina, cefepima, ceftazidima, ceftriaxona, ciprofloxacino, gentamicina y trimetoprima/sulfametoxazol; del mismo modo, en ambos sexos y en todos los rangos de edad se encontraron tasas de resistencia altas para los mismos antibióticos. Conclusiones: Los agentes etiológicos causantes de infección urinaria hallados con mayor frecuencia en el Hospital Nacional Sergio E. Bernales fueron Escherichia coli, Klebsiella pneumoniae ssp pneumoniae, Proteus mirabilis y Pseudomona aeruginosa, en ese orden; los cuales fueron altamente resistentes a ampicilina, ampicilina/sulbactam, cefazolina, cefepima, ceftazidima, ceftriaxona, ciprofloxacino, gentamicina y trimetoprima/sulfametoxazol. Palabras clave: Infección urinaria, susceptibilidad antibiótica, antibiograma, Escherichia coli--- General Objective: To determine the frequency of bacterial etiologic agents and their respective antibiotic susceptibility in urinary tract infections in adults cared for outpatients, external clinic and emergency, at the National Hospital "Sergio E. Bernales" during the period January-December 2014. Methodology: The study is descriptive, observational, retrospective and cross-sectional. The unit of analysis was each result of positive urine culture whose sample belong to an adult patient (≥ 18 years) from emergency or outpatient clinic of the National Hospital Sergio E. Bernales during the period January - December 2014. Information was recorded from the urine cultures and their respective antibiogram by a data collection sheet, these were analyzed later using the statistical package SPSS 23. Results: 327 positive urine cultures of different patients and their respective antibiogram were included. Were isolated in total 15 different pathogens, which is found in greater proportion to Escherichia coli, who presented high rates of resistance to ampicillin, ampicillin/sulbactam, cefazolin, cefepime, ceftazidime, ceftriaxone, ciprofloxacin, gentamicin and trimethoprim/sulfamethoxazole; in the same way, in both sexes and all age ranges were found high rates of resistance to the same antibiotics. Conclusions: Urinary tract infection-causing etiologic agents found most frequently in the Hospital Nacional Sergio E. Bernales were Escherichia coli, Klebsiella pneumoniae ssp. pneumoniae, Proteus mirabilis and Pseudomonas aeruginosa, in that order; which were highly resistant to ampicillin, ampicillin/sulbactam, cefazolin, cefepime, ceftazidime, ceftriaxone, ciprofloxacin, gentamicin and trimethoprim/sulfamethoxazole. Keywords: urinary tract infection, antibiotic susceptibility, antibiogram, Escherichia coli.Tesi

Scale-up of Multidrug-Resistant Tuberculosis Laboratory Services, Peru

One-sentence summary for table of contents: Strategic design and implementation of these services is feasible in resource-poor settings

Targeted Drug-Resistance Testing Strategy for Multidrug-Resistant Tuberculosis Detection, Lima, Peru, 2005–2008

Running head: Targeted Drug-Resistance Testing Strategy for MDR T

Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: a prospective cohort study

Background: Human immunodeficiency virus (HIV)-associated tuberculosis deaths have decreased worldwide over the past decade. We sought to evaluate the effect of HIV status on tuberculosis mortality among patients undergoing treatment for tuberculosis in Lima, Peru, a low HIV prevalence setting. Methods: We conducted a prospective cohort study of patients treated for tuberculosis between 2005 and 2008 in two adjacent health regions in Lima, Peru (Lima Ciudad and Lima Este). We constructed a multivariate Cox proportional hazards model to evaluate the effect of HIV status on mortality during tuberculosis treatment. Results: Of 1701 participants treated for tuberculosis, 136 (8.0 %) died during tuberculosis treatment. HIV-positive patients constituted 11.0 % of the cohort and contributed to 34.6 % of all deaths. HIV-positive patients were significantly more likely to die (25.1 vs. 5.9 %, P < 0.001) and less likely to be cured (28.3 vs. 39.4 %, P = 0.003). On multivariate analysis, positive HIV status (hazard ratio [HR] = 6.06; 95 % confidence interval [CI], 3.96–9.27), unemployment (HR = 2.24; 95 % CI, 1.55–3.25), and sputum acid-fast bacilli smear positivity (HR = 1.91; 95 % CI, 1.10–3.31) were significantly associated with a higher hazard of death. Conclusions: We demonstrate that positive HIV status was a strong predictor of mortality among patients treated for tuberculosis in the early years after Peru started providing free antiretroviral therapy. As HIV diagnosis and antiretroviral therapy provision are more widely implemented for tuberculosis patients in Peru, future operational research should document the changing profile of HIV-associated tuberculosis mortality

Tradable Pollution Permits and the Regulatory Game

This paper analyzes polluters\u27 incentives to move from a traditional command and control (CAC) environmental regulatory regime to a tradable permits (TPP) regime. Existing work in environmental economics does not model how firms contest and bargain over actual regulatory implementation in CAC regimes, and therefore fail to compare TPP regimes with any CAC regime that is actually observed. This paper models CAC environmental regulation as a bargaining game over pollution entitlements. Using a reduced form model of the regulatory contest, it shows that CAC regulatory bargaining likely generates a regulatory status quo under which firms with the highest compliance costs bargain for the smallest pollution reductions, or even no reduction at all. As for a tradable permits regime, it is shown that all firms are better off under such a regime than they would be under an idealized CAC regime that set and enforced a uniform pollution standard, but permit sellers (low compliance cost firms) may actually be better off under a TPP regime with relaxed aggregate pollution levels. Most importantly, because high cost firms (or facilities) are the most weakly regulated in the equilibrium under negotiated or bargained CAC regimes, they may be net losers in a proposed move to a TPP regime. When equilibrium costs under a TPP regime are compared with equilibrium costs under a status quo CAC regime, several otherwise paradoxical aspects of firm attitudes toward TPP type reforms can be explained. In particular, the otherwise paradoxical pattern of allowances awarded under Phase II of the 1990 Clean Air Act\u27s acid rain program, a pattern tending to favor (in Phase II) cleaner, newer generating units, is explained by the fact that under the status quo regime, a kind of bargained CAC, it was the newer cleaner units that were regulated, and which therefore had higher marginal control costs than did the largely unregulated older, plants. As a normative matter, the analysis here implies that the proper baseline for evaluating TPP regimes such as those contained in the Bush Administration\u27s recent Clear Skies initiative is not idealized, but nonexistent CAC regulatory outcomes, but rather the outcomes that have resulted from the bargaining game set up by CAC laws and regulations

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Análisis de costos de los métodos rápidos para diagnóstico de Tuberculosis multidrogorresistente en diferentes grupos epidemiológicos del Perú Cost analysis of rapid methods for diagnosis of multidrug resistant Tuberculosis in different epidemiologic groups in Perú

Objetivos. Evaluar los costos de tres métodos diagnósticos para susceptibilidad a drogas antituberculosas y comparar el costo por caso de tuberculosis multidrogorresistente (TB MDR) diagnosticado con estos (MODS; GRIESS y Genotype MTBDR plus ® en cuatro grupos epidemiológicos en el Perú. Materiales y métodos. En base a cifras programáticas, se dividió a la población en cuatro grupos: pacientes nuevos de Lima/Callao; nuevos de otras provincias; los antes tratados de Lima/Callao y de otras provincias. Se calcularon los costos de cada prueba en base a la metodología estándar utilizada por el Ministerio de Salud, desde la perspectiva de los servicios de salud. Basado en ello, se calculó el costo por paciente TB MDR diagnosticado para cada grupo epidemiológico. Resultados. Los costos estimados por prueba para MODS, GRIESS, y Genotype MTBDR plus ® fueron de 14,83; 15,51 y 176,41 nuevos soles, respectivamente. El costo por paciente TB MDR diagnosticado con GRIESS y MODS fue menor a los 200 nuevos soles en tres de los cuatro grupos. El costo por TB MDR diagnosticado fue de más de 2000 nuevos soles con el Genotype MTBDR plus ® en los dos grupos de pacientes nuevos y, menores a 1000 nuevos soles en los grupos de pacientes antes tratados. Conclusiones. En grupos de alta prevalencia, como son los pacientes antes tratados, los costos por caso diagnosticado de TB MDR con las tres pruebas evaluadas fueron bajos, sin embargo, con la prueba molecular en los grupos de baja prevalencia, fueron elevados. El uso de las pruebas moleculares debe optimizarse en grupos de altas prevalencias.<br>Objectives.To evaluate the costs of three methods for the diagnosis of drug susceptibility in tuberculosis, and to compare the cost per case of Multidrug-resistant tuberculosis (MDR TB) diagnosed with these (MODS, GRIESS and Genotype MTBDR plus ® in 4 epidemiologic groups in Peru. Materials and methods.In the basis of programmatic figures, we divided the population in 4 groups: new cases from Lima/Callao, new cases from other provinces, previously treated patients from Lima/Callao and previously treated from other provinces. We calculated the costs of each test with the standard methodology of the Ministry of Health, from the perspective of the health system. Finally, we calculated the cost per patient diagnosed with MDR TB for each epidemiologic group. Results. The estimated costs per test for MODS, GRIESS, and Genotype MTBDR plus® were 14.83. 15.51 and 176.41 nuevos soles respectively (the local currency, 1 nuevos sol=0.36 US dollars for August, 2011). The cost per patient diagnosed with GRIESS and MODS was lower than 200 nuevos soles in 3 out of the 4 groups. The costs per diagnosed MDR TB were higher than 2,000 nuevos soles with Genotype MTBDR plus ® in the two groups of new patients, and lower than 1,000 nuevos soles in the group of previously treated patients. Conclusions. In high-prevalence groups, like the previously treated patients, the costs per diagnosis of MDR TB with the 3 evaluated tests were low, nevertheless, the costs with the molecular test in the low- prevalence groups were high. The use of the molecular tests must be optimized in high prevalence areas

Análisis de costos de los métodos rápidos para diagnóstico de Tuberculosis multidrogorresistente en diferentes grupos epidemiológicos del Perú

Objectives.To evaluate the costs of three methods for the diagnosis of drug susceptibility in tuberculosis, and to compare the cost per case of Multidrug-resistant tuberculosis (MDR TB) diagnosed with these (MODS, GRIESS and Genotype MTBDR plus ®) in 4 epidemiologic groups in Peru. Materials and methods.In the basis of programmatic figures, we divided the population in 4 groups: new cases from Lima/Callao, new cases from other provinces, previously treated patients from Lima/Callao and previously treated from other provinces. We calculated the costs of each test with the standard methodology of the Ministry of Health, from the perspective of the health system. Finally, we calculated the cost per patient diagnosed with MDR TB for each epidemiologic group. Results. The estimated costs per test for MODS, GRIESS, and Genotype MTBDR plus® were 14.83. 15.51 and 176.41 nuevos soles respectively (the local currency, 1 nuevos sol=0.36 US dollars for August, 2011). The cost per patient diagnosed with GRIESS and MODS was lower than 200 nuevos soles in 3 out of the 4 groups. The costs per diagnosed MDR TB were higher than 2,000 nuevos soles with Genotype MTBDR plus ® in the two groups of new patients, and lower than 1,000 nuevos soles in the group of previously treated patients. Conclusions. In high-prevalence groups, like the previously treated patients, the costs per diagnosis of MDR TB with the 3 evaluated tests were low, nevertheless, the costs with the molecular test in the low- prevalence groups were high. The use of the molecular tests must be optimized in high prevalence areas.Objetivos. Evaluar los costos de tres métodos diagnósticos para susceptibilidad a drogas antituberculosas y comparar el costo por caso de tuberculosis multidrogorresistente (TB MDR) diagnosticado con estos (MODS; GRIESS y Genotype MTBDR plus ®) en cuatro grupos epidemiológicos en el Perú. Materiales y métodos. En base a cifras programáticas, se dividió a la población en cuatro grupos: pacientes nuevos de Lima/Callao; nuevos de otras provincias; los antes tratados de Lima/Callao y de otras provincias. Se calcularon los costos de cada prueba en base a la metodología estándar utilizada por el Ministerio de Salud, desde la perspectiva de los servicios de salud. Basado en ello, se calculó el costo por paciente TB MDR diagnosticado para cada grupo epidemiológico. Resultados. Los costos estimados por prueba para MODS, GRIESS, y Genotype MTBDR plus ® fueron de 14,83; 15,51 y 176,41 nuevos soles, respectivamente. El costo por paciente TB MDR diagnosticado con GRIESS y MODS fue menor a los 200 nuevos soles en tres de los cuatro grupos. El costo por TB MDR diagnosticado fue de más de 2000 nuevos soles con el Genotype MTBDR plus ® en los dos grupos de pacientes nuevos y, menores a 1000 nuevos soles en los grupos de pacientes antes tratados. Conclusiones. En grupos de alta prevalencia, como son los pacientes antes tratados, los costos por caso diagnosticado de TB MDR con las tres pruebas evaluadas fueron bajos, sin embargo, con la prueba molecular en los grupos de baja prevalencia, fueron elevados. El uso de las pruebas moleculares debe optimizarse en grupos de altas prevalencias

Calidad de registro en historias clínicas en un centro de salud del Callao, Perú 2013

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