ABSTRACT
Background: Peru has one of the highest mortality rates due to COVID-19 in the world. Aim: To describe the clinical features, evolution and explore factors associated with mortality in patients with moderate to severe Covid-19. Material and Methods: Prospective analytical study. The clinical, laboratory, imaging, and mortality data of patients admitted at a COVID service of the Santa Rosa de Piura Hospital were recorded from April to June 2020. Results: Data from 391 patients with a median age of 60 years (70% women) was gathered. The time lapse between the onset of the disease and hospitalization was seven days. The most common alteration in the blood count was Neutrophilia in 78% of patients. The median PaO2/FiO2 ratio was 77. The distribution of tomographic patterns was Ground glass in 91% of patients, interstitial involvement in 57%, consolidation in 43%. Sixteen percent of patients had at least one complication, the most common was an increase in transaminases in 2%. Four percent were admitted to the intensive care unit and 53% died (94% during hospitalization and 5.8% during ICU stay). In the bivariate analysis, an association was found between a higher mortality and older age (p = 0.01), having fewer days of illness (p = 0.03), fewer days of hospital stay (p < 0.01), having at least one comorbidity (p = 0.02), lymphopenia (p = 0.02), neutrophilia (P = 0.03) and lower PaO2/ FiO2 ratio (p < 0.01). Conclusions: Fifty percent of these patients died. Age, rapid progression, having comorbidities and other laboratory alterations were associated with mortality.
ABSTRACT
Con el objetivo de determinar la frecuencia de aislamientos de Staphylococcus aureus meticilinorresistente adquirido en la comunidad (MRSA-AC) y describir el patrón de resistencia antimicrobiana y de genotipo, se realizó un estudio transversal en el 2017 en el Hospital Nacional Cayetano Heredia en Lima, Perú. De los 115 aislamientos de S. aureus analizados, se determinó una frecuencia de MRSA del 46,1%, la mayoría provenientes de secreciones de diferentes tipos (26,4%) y sangre (18,9%). Se encontró alta corresistencia (>75%) a clindamicina, eritromicina, gentamicina y ciprofloxacina entre los aislamientos de MRSA. Según la tipificación de SCCmec, la mayoría correspondían a cepas de MRSA adquirido en un hospital (MRSA-AH) y, solo un pequeño grupo (2,6%) correspondían a MRSA-AC. A pesar de la baja frecuencia descrita con relación a países vecinos (27%), es necesario mantener una adecuada vigilancia epidemiológica local para evitar la propagación local de MRSA-AC.
In order to determine the frequency of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) isolates and to describe the antimicrobial resistance pattern and genotype, a cross-sectional study was conducted in 2017 at the Hospital Nacional Cayetano Heredia in Lima, Peru. We found a MRSA prevalence of 46.1% in the 115 analyzed S. aureus isolates; most were reported from different secretions (26.4%) and blood (18.9%). We found high co-resistance (>75%) to clindamycin, erythromycin, gentamicin and ciprofloxacin. Regarding SSCmec typification, most of the isolates were identified as hospital-acquired MRSA (HA-MRSA) and a minority of them as CA-MRSA (2.6%). Despite its low prevalence when compared to other Latin American countries (27%), epidemiological surveillance is recommended to control local CA-MRSA dissemination.