Socioeconomic factors associated with antimicrobial resistance of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli in Chilean hospitals (2008-2017).

OBJECTIVE: To identify socioeconomic factors associated with antimicrobial resistance of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli in Chilean hospitals (2008-2017). METHODS: We reviewed the scientific literature on socioeconomic factors associated with the emergence and dissemination of antimicrobial resistance. Using multivariate regression, we tested findings from the literature drawing from a longitudinal dataset on antimicrobial resistance from 41 major private and public hospitals and a nationally representative household survey in Chile (2008-2017). We estimated resistance rates for three priority antibiotic-bacterium pairs, as defined by the Organisation for Economic Co-operation and Development; i.e., imipenem and meropenem resistant P. aeruginosa, cloxacillin resistant S. aureus, and cefotaxime and ciprofloxacin resistant E. coli. RESULTS: Evidence from the literature review suggests poverty and material deprivation are important risk factors for the emergence and transmission of antimicrobial resistance. Most studies found that worse socioeconomic indicators were associated with higher rates of antimicrobial resistance. Our analysis showed an overall antimicrobial resistance rate of 32.5%, with the highest rates for S. aureus (40.6%) and the lowest for E. coli (25.7%). We found a small but consistent negative association between socioeconomic factors (income, education, and occupation) and overall antimicrobial resistance in univariate (p < 0.01) and multivariate analyses (p < 0.01), driven by resistant P. aeruginosa and S. aureus. CONCLUSION: Socioeconomic factors beyond health care and hospital settings may affect the emergence and dissemination of antimicrobial resistance. Preventing and controlling antimicrobial resistance requires efforts above and beyond reducing antibiotic consumption

Antimicrobial stewardship programs in seven Latin American countries: facing the challenges

Antecedentes: Diversos estudios han demostrado que más del 50% de los antibióticos utilizados en los hospitales son innecesarios o inadecuados y que la resistencia a los antimicrobianos puede suponer cada año hasta 20.000 millones de dólares de sobrecostes médicos. Por otro lado, los programas de administración de antimicrobianos (PEA) reducen significativamente el uso inadecuado de antimicrobianos, la aparición de resistencias a los antimicrobianos, las infecciones asociadas a la atención sanitaria y los costes en el ámbito hospitalario. Objetivo: Evaluar el desarrollo de ASP y el ahorro de antibióticos en 7 hospitales latinoamericanos utilizando indicadores cuantitativos estandarizados en todas las instituciones de salud participantes. Métodos: Se realizó un estudio de intervención, donde se realizaron evaluaciones pre y post utilizando una herramienta de puntuación estandarizada adaptada de los estándares de acreditación de la Joint Commission International y, del Instituto Colombiano de Normas Técnicas y Certificación. Se evaluó ASP de 7 hospitales latinoamericanos entre 2019 y 2020. Se realizó una evaluación pre-intervención en cada hospital para cuantificar el grado de desarrollo de la ASP (ASP Development score). Con base en estos resultados, se implementó una capacitación in situ adaptada en cada hospital, seguida de una evaluación posterior a la intervención para cuantificar la mejora de los indicadores de desarrollo de ASP. Además, se estimó el ahorro monetario en antimicrobianos derivado de la intervención del PEA. Resultados: En la evaluación previa a la intervención, la puntuación media de desarrollo del PEA en las 7 instituciones fue del 65,8% (40-94,3%). Los puntos con la puntuación más baja fueron los relacionados con el seguimiento y la comunicación de los progresos y el éxito del PEA. Para la evaluación posterior a la intervención, 2 instituciones no pudieron participar debido a la presión impuesta por la pandemia COVID-19. Para los 5/7 hospitales restantes, la puntuación media del desarrollo del PEA fue del 82,3%, con un aumento del 12,0% en comparación con la medición previa a la intervención de las mismas instituciones (puntuación media previa a la intervención 70,3% (48,2%-94,3%) Los puntos con un aumento significativo fueron los indicadores clave de rendimiento, la educación de los AMS y la formación de los prescriptores. Tres de los siete (3/7) hospitales informaron de ahorros monetarios en antibióticos asociados a la intervención ASP. Conclusiones: El uso de la herramienta descrita demostró ser útil para evaluar áreas específicas del desarrollo del PEA que eran deficientes y adaptar las intervenciones para los hospitales participantes, en consecuencia, ayudó a mejorar el desarrollo del PEA en las instituciones que se sometieron al análisis previo y posterior a la intervención. Además, las estrategias mostraron ahorros monetarios en los costes antimicrobianos cuando se midieron. © 2023, Los autores.Background: Studies have shown that more than 50% of the antibiotics used in hospitals are unnecessary or inappropriate and, that antimicrobial resistance may cost up to 20 billion USD in excess medical costs each year. On the other hand, Antimicrobial Stewardship Programs (ASP) significantly reduce inappropriate antimicrobial use, emergence of antimicrobial resistance, healthcare associated infections, and costs in hospital settings. Objective: To evaluate the development of ASP and antibiotic savings in 7 Latin American hospitals using standardized quantitative indicators in all the participating health care institutions. Methods: An interventional study was conducted, where pre- and post- evaluations were performed using a standardized score tool adapted from the Joint Commission International accreditation standards and, the Colombian Institute of Technical Standards and Certification. We evaluated ASP from 7 Latin American hospitals between 2019 and 2020. A pre-intervention evaluation was done in each hospital to quantify the degree of development of the ASP (ASP Development score). Based on these results, tailored on-site training was implemented in each hospital, followed by a post-intervention evaluation to quantify improvement of ASP-development indicators. In addition, monetary savings in antimicrobials derived from the ASP intervention were estimated. Results: In the pre-intervention evaluation, the average ASP development score for the 7 institutions was 65.8% (40-94.3%). The items with the lowest development score were those related to monitoring and communicating the ASP progress and success. For the post-intervention evaluation, 2 institutions couldn’t participate due to the pressure imposed by the COVID-19 pandemic. For the remaining 5/7 hospitals, the average ASP development score was 82.3% with an increase of 12.0% when compared to the pre-intervention measurement of the same institutions (average pre-intervention score 70.3% (48.2%-94.3%) The items with a significant increase were key performance indicators, AMS education and training of the prescribers. Three of the seven (3/7) hospitals reported antibiotic monetary savings associated to the ASP intervention. Conclusions: The use of the tool described shown to be useful to evaluate specific areas of ASP-development that were lacking and tailor interventions for the participating hospitals, consequently, it helped improve ASP-development in the institutions that underwent pre- intervention and post-intervention analysis. In addition, the strategies showed monetary savings on antimicrobial costs when measured. © 2023, The Author(s)

Macro level influences on strategic responses to the COVID-19 pandemic – an international survey and tool for national assessments

Background Variation in the approaches taken to contain the SARS-CoV-2 (COVID-19) pandemic at country level has been shaped by economic and political considerations, technical capacity, and assumptions about public behaviours. To address the limited application of learning from previous pandemics, this study aimed to analyse perceived facilitators and inhibitors during the pandemic and to inform the development of an assessment tool for pandemic response planning. Methods A cross-sectional electronic survey of health and non-health care professionals (5 May - 5 June 2020) in six languages, with respondents recruited via email, social media and website posting. Participants were asked to score inhibitors (-10 to 0) or facilitators (0 to +10) impacting country response to COVID-19 from the following domains – Political, Economic, Sociological, Technological, Ecological, Legislative, and wider Industry (the PESTELI framework). Participants were then asked to explain their responses using free text. Descriptive and thematic analysis was followed by triangulation with the literature and expert validation to develop the assessment tool, which was then compared with four existing pandemic planning frameworks. Results 928 respondents from 66 countries (57% health care professionals) participated. Political and economic influences were consistently perceived as powerful negative forces and technology as a facilitator across high- and low-income countries. The 103-item tool developed for guiding rapid situational assessment for pandemic planning is comprehensive when compared to existing tools and highlights the interconnectedness of the 7 domains. Conclusions The tool developed and proposed addresses the problems associated with decision making in disciplinary silos and offers a means to refine future use of epidemic modelling

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Extended spectrum β-lactamase producers among nosocomial Enterobacteriaceae in Latin America

To review the epidemiology of nosocomial extended spectrum β-lactamase-producing Enterobacteriaceae in Latin America, a systematic search of the biomedical literature (PubMed) was performed for articles published since 2005. Rates of nosocomial infections caused by extended spectrum β-lactamase-producing Enterobacteriaceae in Latin America have increased since 2005. Up to 32% of Escherichia coli and up to 58% of Klebsiella pneumoniae isolates are extended spectrum β-lactamase-positive, rates that are higher than in other world regions. From a region-wide perspective, 11–25% of E. coli isolates and 45–53% of K. pneumoniae isolates were nonsusceptible to third-generation cephalosporins. At the country level, there was a wide range in Enterobacteriaceae resistance rates to third-generation cephalosporins, with especially high rates of resistance to E. coli in Guatemala, Honduras, and Mexico, and high resistance rates to Klebsiella spp. in Argentina, Brazil, Chile, Guatemala, Honduras, and Paraguay. Susceptibility of extended spectrum β-lactamase-producing Enterobacteriaceae to cefepime, fluoroquinolones, ampicillin/sulbactam, aminoglycosides, and piperacillin/tazobactam has also been compromised, leaving the carbapenems, tigecycline, and colistin as the only antibiotics with >90% susceptibility rates. There is a steady increase in the prevalence and types of extended spectrum β-lactamases produced by Enterobacteriaceae isolates in Latin American hospitals (particularly CTX-Ms), suggesting endemic conditions overlaid by clonal outbreaks. Appropriate treatment decisions and infection control strategies informed by surveillance of regional and local susceptibilities and mechanisms of resistance are required to mitigate this major public health concern. Keywords: Escherichia coli, Klebsiella, Latin America, Bacterial resistanc

Assessment of hospital daily cleaning practices using ATP bioluminescence in a developing country

Visual assessment of surfaces may not be enough to document the level of cleanliness in the hospital setting. It is necessary to introduce quantitative methods to document the results of this practice.Objective:To evaluate the efficacy of hospital terminal cleaning procedures, using an adenosine triphosphate (ATP) bioluminescence method in a teaching hospital.Method:During 2008 we conducted an evaluation using ATP bioluminescence LIGHTNING MVP&#8482; (Arquimed) of external and internal housekeeping service. After conducting an initial evaluation we implemented education of cleaning practices and finally we did a post intervention evaluation. Using chi-square method we compared prior versus after cleaning, quality of cleaning performed by external versus internal personnel, single versus double terminal cleaning procedures and prior versus after intervention. A finding of three RLU or less was considered a clean surface.Results:We performed 198 evaluations in 33 patient units and nine OR. Internal personnel accomplished 25.37% of clean surfaces before and 80% after the education intervention (p = 0.01). In contrast, external personnel obtained 68.8% before and 73.33% after intervention (p = 0.3).Conclusions:This study suggests that visual assessment is not enough to ensure quality of the process and it is necessary to document the level of cleanliness by quantitative methods