The aim of this study was to characterize carbapenem-resistant Klebsiella pneumoniae (CR-Kp) isolates recovered from adults and children with severe bacteremia in a Peruvian Hospital in June 2018. Antimicrobial susceptibility was determined by disc/gradient diffusion and broth microdilution when necessary. Antibiotic resistance mechanisms were evaluated by PCR and DNA sequencing. Clonal relatedness was assessed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Plasmid typing was performed with a PCR-based method. Thirty CR-Kp isolates were recovered in June 2018. All isolates were non-susceptible to all β-lactams, ciprofloxacin, gentamicin and trimethoprim-sulfamethoxazole, while mostly remaining susceptible to colistin, tigecycline, levofloxacin and amikacin. All isolates carried the blaNDM-1 gene and were extended spectrum β-lactamase (ESBL) producers. PFGE showed four different pulsotypes although all isolates but two belonged to the ST348 sequence type, previously reported in Portugal. blaNDM-1 was located in an IncFIB-M conjugative plasmid. To our knowledge, this is the first report of an New Delhi metallo-β-lactamase (NDM)-producing K. pneumoniae recovered from both children and adults in Lima, Peru, as well as the first time that the outbreak strain ST348 is reported in Peru and is associated with NDM. Studies providing epidemiological and molecular data on CR-Kp in Peru are essential to monitor their dissemination and prevent further spread.
Sr. Editor. En el año 2017 la Organización Mundial de la Salud publicó una lista de bacterias con alta resistencia a antimicrobianos e hizo un especial llamado para la búsqueda de nuevos fármacos para luchar contra la resistencia (1). En la lista, se incluye al Campylobacter como un patógeno de alta prioridad debido a su progresiva, alarmante y alta resistencia a fluoroquinolonas a nivel global. Así también, en Perú se ha descrito este fenómeno de resistencia a fluoroquinolonas durante la década pasada (2) , lo cual se constituye en un riesgo y preocupación para la salud. Asimismo, se debe tener en cuenta que la campylobacteriosis es la infección bacteriana más común a nivel mundial y se presenta cada vez mayor frecuencia de resistencia a drogas de uso frecuente (macrólidos y Cartas al editor
In patients with human immunodeficiency virus (HIV), opportunistic infections occur that could compromise the health of patients. In order to determine the frequency of fungal opportunistic and superficial infections in HIV-positive men-who-have-sex-with-men (MSM) patients at the Hospital Nacional Guillermo Almenara, we conducted a cross-sectional retrospective study. We include Peruvian patients >18 years-old, derived from infectious or gynecological offices, with or without antiretroviral treatment.One hundred thirteen patients were enrolled (36.7±10, range: 21 to 68 years), which 46 (40.7%) has an opportunistic fungal infection, mainly by candidiasis (23.9%), pneumocystosis (8.7%), and cryptococcosis (6.5%). Six (13%) patients had fungal coinfections, mainly by oral candidiasis and ringworm (Tinea pedis) (4.3%), and opportunistic infections have an incidence of 15.9%. Of the 17 cases of dermatophytosis, 12 (70.6%) were from Tinea pedis, 5 (29.4%) from Tinea corporis, 3 (17.6%) from Tinea unguium, and two (11.8%) from Tinea versicolor. We found significant difference between the year of HIV-infection and the year of fungal infection (p=0.001).The frequency of opportunistic fungal infections was determined in the fourth-and-six percent of Peruvian MSM HIV-positive patients, where candidiasis, pneumocystosis, and cryptococcosis were the most frequent. We raise the importance of fungal infections in the current framework of Venezuelan migration, since this could be a new risk factor and imply changes in incidence rates, which implies new challenges for Peruvian Public Health.
Objetivo: Determinar los factores de riesgo en adultos con COVID-19 en población rural andina durante 2020. Métodos: En este estudio de cohorte retrospectivo multicéntrico, incluimos a 184 pacientes adultos (≥18 años) con pruebas serológicas y moleculares para COVID- 19 de tres hospitales de la sierra peruana (Ancash y Apurímac) incluidos con sospecha clínica entre abril y junio. Se utilizó análisis descriptivos y regresión logística univariable para explorar los factores de riesgo asociados a los pacientes con COVID-19. Resultados: Del total de pacientes, 14 (7.6%) tuvieron SARS-CoV-2. En los pacientes infectados 12 (85.7%) fueron varones con promedio de edad de 47.3±21 años. Las comorbilidades estuvieron presentes en cerca de la tercera parte de pacientes, siendo la hipertensión y diabetes las más frecuentes (ambas 14.3%), y la sintomatología más frecuentes fueron fiebre y cefalea (57.2%). La regresión univariable mostró mayores probabilidades de infección con SARS-CoV-2 en la población rural andina asociada con la edad avanzada (OR: 1.1 IC95% 0.7-1.8; p=0,019), comorbilidades previas (OR: 1.7, IC95% 0.32–9.39; p=0,006), y sintomatología previa (OR: 49.8, IC95% 5.6–436.9; p=0,0011). Conclusiones: Los posibles factores de riesgo como la edad avanzada, las comorbilidades y sintomatología previas están relacionados con el desarrollo de COVID- 19 en población rural andina de Perú.
Background: Cytological samples are cleared with xylene in two or three baths during a Pap test, however, this solvent has a high degree of toxicity, and being a controlled reagent infers high costs for its purchase and implications for environmental pollution. We estimated the impact of xylene during the Pap test in terms of the number of liters and cost of two baths of xylene, and also estimated the impact with three baths Methods: This cross-sectional study was carried out in four hospitals of EsSalud in Peru in two stages. First, the analysis of the impact due to the use of two baths of xylene was conducted during the period 2015–2019, and second, the estimates were calculated based on the assumption of three baths of xylene for the years 2020–2025. The assumption was based on the recommendations of the 2018 EsSalud cytology guideline. The monthly amount of xylene was ~10 liters per bath/month and the cost per liter was estimated at 8.13 USD (27 soles). Results: For the staining of 594,898 cytology tests, 7,848 liters of xylene were necessary, resulting in a cost of 60,861 USD (202,068 soles) during the period 2015–2019. The estimates showed a maximum assumption of 9,483 liters and 77,110 USD (256,040 soles) for the use of three baths of xylene in the four EsSalud hospitals (p = 0.0025) during the period 2020–2025. Conclusions: We determined that there was a high economic impact of using xylene with two baths from 2015 to 2019 and a dramatic increase in costs with the possible use of three baths of xylene in the Pap test for the following five years.
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