Evolución de la resistencia a fluorquinolonas de Escherichia coli en muestras de orina de la comunidad en laboratorios de vigilancia de la resistencia a los antimicrobianos de la provincia de Buenos Aires (2005 a 2008)

Escherichia coli es el microorganismo más frecuente recuperado en las infecciones urinarias de origen comunitario y su tratamiento se instala en forma empírica con Norfloxacina, por lo cual es importante la vigilancia de la resistencia y la difusión de esos datos. La OPS/OMS ha desarrollado un programa de vigilancia, del cual participan 8 laboratorios de la Provincia de Buenos Aires. Para explorar la magnitud del problema se analizaron 10.350 cepas de pacientes ambulatorios entre los años 2005 y 2008. La resistencia encontrada en este estudio fue del 13% en los dos primeros años, 15% en el 2007 y del 14% en el 2008. Se clasificaron, además la resistencia por sexo y edad y se las comparó con la hallada en los años 2003 (6%) y 2004 (8%), con los demás centros argentinos de la red de Vigilancia y algunos países de Latinoamérica y España. Se concluyó que el uso de las FQ ha favorecido la diseminación de resistencia, y debe racionalizarse su administración en infecciones no complicadas. Para poder utilizarla en infecciones graves, en particular las intrahospitalarias.Facultad de Ciencias Veterinaria

Evolución de la resistencia a fluorquinolonas de <i>Escherichia coli</i> en muestras de orina de la comunidad en laboratorios de vigilancia de la resistencia a los antimicrobianos de la provincia de Buenos Aires (2005 a 2008)

Escherichia coli es el microorganismo más frecuente recuperado en las infecciones urinarias de origen comunitario y su tratamiento se instala en forma empírica con Norfloxacina, por lo cual es importante la vigilancia de la resistencia y la difusión de esos datos. La OPS/OMS ha desarrollado un programa de vigilancia, del cual participan 8 laboratorios de la Provincia de Buenos Aires. Para explorar la magnitud del problema se analizaron 10.350 cepas de pacientes ambulatorios entre los años 2005 y 2008. La resistencia encontrada en este estudio fue del 13% en los dos primeros años, 15% en el 2007 y del 14% en el 2008. Se clasificaron, además la resistencia por sexo y edad y se las comparó con la hallada en los años 2003 (6%) y 2004 (8%), con los demás centros argentinos de la red de Vigilancia y algunos países de Latinoamérica y España. Se concluyó que el uso de las FQ ha favorecido la diseminación de resistencia, y debe racionalizarse su administración en infecciones no complicadas. Para poder utilizarla en infecciones graves, en particular las intrahospitalarias.Facultad de Ciencias Veterinaria

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background: Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods: The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results: Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions: Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence: Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion

Abstract Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons and implement changes within their team. Identifying a local opinion leader to serve as a champion within the surgical department may be important. The “surgeon champion” can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship.https://deepblue.lib.umich.edu/bitstream/2027.42/145433/1/13017_2018_Article_198.pd

The management of intra-abdominal infections from a global perspective : 2017 WSES guidelines for management of intra-abdominal infections

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.Peer reviewe

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Tree mode of death and mortality risk factors across Amazon forests

The&nbsp;carbon sink capacity of tropical forests&nbsp;is substantially affected by tree mortality. However, the main drivers of tropical&nbsp;tree death remain largely unknown. Here we present a pan-Amazonian assessment of how and why trees die, analysing over 120,000 trees representing &gt; 3800 species from 189 long-term&nbsp;RAINFOR forest plots. While tree mortality rates vary greatly Amazon-wide, on average trees are as likely to die standing as they are broken or uprooted—modes of death with different ecological consequences. Species-level growth rate is the single&nbsp;most important predictor of tree death in Amazonia, with faster-growing species being at&nbsp;higher risk. Within species, however, the slowest-growing trees are at greatest risk while the effect of tree size varies across the basin. In the driest Amazonian region&nbsp;species-level bioclimatic distributional patterns also predict the risk of death, suggesting that these forests are experiencing climatic conditions beyond their adaptative limits. These results provide not only a&nbsp;holistic pan-Amazonian picture of tree death but large-scale&nbsp;evidence for the overarching importance of the growth–survival trade-off in driving tropical&nbsp;tree mortality

2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.Peer reviewe