Carbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-haematopoietic stem cell transplant: a retrospective cohort study

Background Risk factors for carbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-HSCT have not been thoroughly explored. Methods All children with cancer or post-HSCT who developed Enterobacterales bloodstream infections in two cancer referral centres in major Colombian cities between 2012 and 2021 were retrospectively examined. When the infection episode occurred, carbapenem resistance mechanisms were evaluated according to the available methods. Data were divided in a training set (80%) and a test set (20%). Three internally validated carbapenem-resistant Enterobacterales (CRE) prediction models were created: a multivariate logistic regression model, and two data mining techniques. Model performances were evaluated by calculating the average of the AUC, sensitivity, specificity and predictive values. Results A total of 285 Enterobacterales bloodstream infection episodes (229 carbapenem susceptible and 56 carbapenem resistant) occurred [median (IQR) age, 9 (3.5–14) years; 57% male]. The risk of CRE was 2.1 times higher when the infection was caused by Klebsiella spp. and 5.8 times higher when a carbapenem had been used for ≥3 days in the previous month. A model including these two predictive variables had a discriminatory performance of 77% in predicting carbapenem resistance. The model had a specificity of 97% and a negative predictive value of 81%, with low sensitivity and positive predictive value. Conclusions Even in settings with high CRE prevalence, these two variables can help early identification of patients in whom CRE-active agents are unnecessary and highlight the importance of strengthening antibiotic stewardship strategies directed at preventing carbapenem overuse.Q1Q1Los factores de riesgo de resistencia a los carbapenémicos en las infecciones del torrente sanguíneo por Enterobacterales entre niños con cáncer o después de un TCMH no se han explorado a fondo. Métodos Se examinaron retrospectivamente todos los niños con cáncer o post-TCMH que desarrollaron infecciones del torrente sanguíneo por Enterobacterales en dos centros de referencia de cáncer en las principales ciudades de Colombia entre 2012 y 2021. Cuando ocurrió el episodio de infección, se evaluaron los mecanismos de resistencia a los carbapenémicos según los métodos disponibles. Los datos se dividieron en un conjunto de entrenamiento (80%) y un conjunto de prueba (20%). Se crearon tres modelos de predicción de Enterobacterales resistentes a carbapenémicos (CRE) validados internamente: un modelo de regresión logística multivariante y dos técnicas de minería de datos. El rendimiento del modelo se evaluó calculando el promedio del AUC, la sensibilidad, la especificidad y los valores predictivos. Resultados Se produjeron un total de 285 episodios de infección del torrente sanguíneo por Enterobacterales (229 susceptibles a carbapenémicos y 56 resistentes a carbapenémicos) [mediana de edad (RIQ), 9 (3,5 a 14) años; 57% hombres]. El riesgo de CRE fue 2,1 veces mayor cuando la infección fue causada por Klebsiella spp. y 5,8 veces mayor cuando se había utilizado un carbapenem durante ≥3 días en el mes anterior. Un modelo que incluía estas dos variables predictivas tuvo un rendimiento discriminatorio del 77% en la predicción de la resistencia a los carbapenémicos. El modelo tuvo una especificidad del 97% y un valor predictivo negativo del 81%, con baja sensibilidad y valor predictivo positivo. Conclusiones Incluso en entornos con una alta prevalencia de CRE, estas dos variables pueden ayudar a la identificación temprana de pacientes en quienes los agentes activos de CRE son innecesarios y resaltar la importancia de fortalecer las estrategias de administración de antibióticos dirigidas a prevenir el uso excesivo de carbapenémicos.N/AS

American palm ethnomedicine: A meta-analysis

<p>Abstract</p> <p>Background</p> <p>Many recent papers have documented the phytochemical and pharmacological bases for the use of palms (<it>Arecaceae</it>) in ethnomedicine. Early publications were based almost entirely on interviews that solicited local knowledge. More recently, ethnobotanically guided searches for new medicinal plants have proven more successful than random sampling for identifying plants that contain biodynamic ingredients. However, limited laboratory time and the high cost of clinical trials make it difficult to test all potential medicinal plants in the search for new drug candidates. The purpose of this study was to summarize and analyze previous studies on the medicinal uses of American palms in order to narrow down the search for new palm-derived medicines.</p> <p>Methods</p> <p>Relevant literature was surveyed and data was extracted and organized into medicinal use categories. We focused on more recent literature than that considered in a review published 25 years ago. We included phytochemical and pharmacological research that explored the importance of American palms in ethnomedicine.</p> <p>Results</p> <p>Of 730 species of American palms, we found evidence that 106 species had known medicinal uses, ranging from treatments for diabetes and leishmaniasis to prostatic hyperplasia. Thus, the number of American palm species with known uses had increased from 48 to 106 over the last quarter of a century. Furthermore, the pharmacological bases for many of the effects are now understood.</p> <p>Conclusions</p> <p>Palms are important in American ethnomedicine. Some, like <it>Serenoa repens </it>and <it>Roystonea regia</it>, are the sources of drugs that have been approved for medicinal uses. In contrast, recent ethnopharmacological studies suggested that many of the reported uses of several other palms do not appear to have a strong physiological basis. This study has provided a useful assessment of the ethnobotanical and pharmacological data available on palms.</p