Antimicrobial resistance in Peruvian hospital settings

Antimicrobial resistance and antimicrobial misuse are of global concern but affect more the resource-constrained settings. Limited research has been done in Peru in order to address these topics. We interviewed 256 physicians of two hospitals of Lima in order to assess the knowledge, attitudes, and practices about antimicrobial resistance and antimicrobials use. Most of them agreed that antimicrobial resistance is a problem worldwide and within Peru, but only 20% correctly estimated the level of resistance of Klebsiella pneumoniae to third generation cephalosporins. We also developed a network of nine hospitals in Lima to perform a resistance surveillance of key isolates causing bacteremia. We found during a one-year period that Staphylococcus aureus was the most frequently Gram positive isolated (22%). K. pneumoniae and Escherichia coli were the most frequent Gram-negative bacilli, >75% of both produced extended-spectrum β-lactamases (ESBLs). ESBL-producers microorganisms had also higher level of co-resistance to ciprofloxacin and gentamicin. Finally, to explore the antimicrobial resistance and molecular characteristics of methicillin-resistant S. aureus, we analyzed isolates from patients and healthcare workers (HCWs). Fifty percent of 338 blood isolates were methicillin-resistant (MRSA); one predominant multidrug-resistant MRSA strain was found in all hospitals (ST 5 spa t149-SCCmec I-, the Cordobes-Chilean clone. MRSA nasal carriage rate of 8.7%, was found among HCWs. The two most common clones circulating among HCWs were also the two predominant among patients with bacteremia. There is a need to implement cost-effective infection control policies to reduce the transmission of multidrug resistant microorganisms in these settings.La résistance aux antibiotiques et leur utilisation inappropriée constituent un problème majeur de santé publique qui affecte particulièrement les pays à revenus faibles et intermédiaires. Les données concernant cette problématique sont très limitées au Pérou. Nous avons interrogé 256 médecins de deux hôpitaux à Lima afin d’évaluer leurs connaissances et leurs pratiques vis-à-vis de l’utilisation des antibiotiques et de la résistance aux antibiotiques. La plupart des médecins étaient conscientisés à la problématique de la multirésistance chez les entérobactéries, mais seulement 20% d’entre eux estimaient correctement le taux résistance de Klebsiella pneumoniae aux céphalosporines à large spectre au sein de leurs institutions. Au cours de ce travail, un réseau entre neuf hôpitaux de Lima a été implémenté afin de suivre la résistance aux antimicrobiens des souches isolées d’hémocultures. Au cours des années 2008-2009, le Staphylococcus aureus était la bactérie Gram-positive la plus fréquente (22%) ;K. pneumoniae et Escherichia coli représentaient les bactéries Gram-négatives les plus souvent isolées d’hémocultures. Parmi ces dernières entérobactéries, 75% produisaient des β-lactamases à spectre étendu (BLSE) avec un taux élevé de co- résistance à la ciprofloxacine et à la gentamicine. Les souches de S. aureus isolées d’hémocultures chez les patients hospitalisés et de dépistage chez les professionnels de santé (PS) ont été caractérisées pour leur profil de résistance aux antibiotiques et génotypées par biologie moléculaire. La moitié des 338 souches isolées d’hémocultures étaient résistantes à la méticilline (« MRSA ») et appartenaient à un clone prédominant disséminés dans ces différents hôpitaux, appelé le ST 5- spa t149-SCCmec I, ou le clone Cordobes-Chilien. Le taux de portage nasal de MRSA parmi les PS était à 8,7% ;les deux génotypes les plus fréquemment observés chez les PS appartenaient aux mêmes clones que ceux retrouvés majoritairement chez les patients hospitalisés. Cette observation suggère une transmission horizontale. L’implémentation de politiques de contrôle de l'infection est primordiale dans les établissements de santé au Pérou afin de réduire la transmission de micro-organismes multi-résistants.Doctorat en Sciences biomédicales et pharmaceutiques (Médecine)info:eu-repo/semantics/nonPublishe

Bacteremia por Staphylococcus epidermidis y abceso de partes blandas en un paciente postoperado: Reporte de un caso.

We report a case of an 11 year old male who presented with bacteremia by S. epidermidis and soft tissue abscesses after a bone autograft procedure. The patient received only medical treatment, resolving the abscesses successfully. We also did a review of the literature on S. epidermidis bacteremia, an entity which has acquired increasing importance in the etiology of hospital infections. (Rev Med Hered 2003; 14:221-223

Síndrome respiratorio agudo severo (SRAS).

En esta revisión actualizada presentamos los principales aspectos históricos, epidemiológicos, clínicos, terapéuticos y medidas de control y prevención de esta nueva enfermedad conocida como SRAS ( Síndrome Respiratorio Agudo Severo), que se ha considerado como la primera enfermedad infecciosa de origen viral epidémica del siglo XXI afectando principalmente áreas de China, incluyendo Taiwán y Hong Kong, así como Vietnam, Singapur y Canadá (Toronto). El agente viral causante de esta enfermedad es un nuevo coronavirus. El tratamiento mas efectivo aun no ha sido definido

Bacteremia por Staphylococcus epidermidis y abceso de partes blandas en un paciente post-operado: reporte de un caso

We report a case of an 11 year old male who presented with bacteremia by S. epidermidis and soft tissue abscesses after a bone autograft procedure. The patient received only medical treatment, resolving the abscesses successfully. We also did a review of the literature on S. epidermidis bacteremia, an entity which has acquired increasing importance in the etiology of hospital infections. (Rev Med Hered 2003; 14:221-223)

Síndrome respiratorio agudo severo (SRAS)

In this review we present the main historical, epidemiological, clinical and control& prevention aspects of this new disease known as Severe Acute Respiratory Syndrome (SARS). This has been considered the first epidemic infectious disease of the XXI century caused by a virus that principally has affected some areas of China (including Taiwan and Hong Kong), Vietnam, Singapur and Canada (Toronto). The discovered agent is a new virus belonged to the coronavirus family. An effective treatment has not been found yet. ( Rev Med Hered 2003; 14: 89-93)

Spread of community-associated methicillin-resistant Staphylococcus aureus to Peru.

LETTERSCOPUS: le.jinfo:eu-repo/semantics/publishe

Dynamics of nasal carriage of methicillin-resistant Staphylococcus aureus among healthcare workers in a tertiary-care hospital in Peru

The study aims were to describe the frequency and dynamics of methicillin-resistant Staphylococcus aureus (MRSA) carriage among healthcare workers (HCWs), and to compare the molecular epidemiology of MRSA isolates from HCWs with those from patients with bacteremia. HCWs were interviewed and three nasal swabs were collected in a hospital in Lima, Peru, during 2009–2010. Consecutive S. aureus blood culture isolates from patients with bacteremia in the same hospital were also collected. SCCmec, multilocus sequence typing (MLST), and spa typing were performed. Persistent carriage was defined if having at least two consecutive cultures grown with S. aureus harboring an identical spa type. Among 172 HCWs included, the proportions of S. aureus and MRSA nasal carriage during first sampling were 22.7 % and 8.7 %, respectively. From 160 HCWs who were sampled three times, 12.5 % (20/160) were persistent S. aureus carriers and 26.9 % (43/160) were intermittent carriers. MRSA carriage among persistent and intermittent S. aureus carriers was 45.0 % (9/20) and 37.2 % (16/43), respectively. Fifty-six S. aureus blood culture isolates were analyzed, and 50 % (n = 28) were MRSA. Multidrug resistant ST5-spa t149-SCCmec I and ST72-spa t148-SCCmec non-typeable were the two most frequent genotypes detected among HCWs (91.7 %, i.e. 22/24 HCW in whom MRSA was isolated in at least one sample) and patients (24/28, 85.7 %). In conclusion, we found high proportions of MRSA among persistent and intermittent S. aureus nasal carriers among HCWs in a hospital in Lima. They belonged to similar genetic lineages as those recovered from patients with bacteremia.SCOPUS: ar.jinfo:eu-repo/semantics/publishe