ABSTRACT
INTRODUCCIÓN: la resistencia a los antimicrobianos plantea una amenaza para la salud pública a nivel mundial. Las infecciones por bacterias ESKAPE representan mayores problemas de resistencia, debido a que pueden presentar más de un mecanismo de resistencia y además tienen la facultad de transmitirlo. En Bolivia no existen artículos publicados que muestren la multirresistencia de bacterias ESKAPE en hospitales de tercer nivel. OBJETIVO: describir el perfil de sensibilidad y resistencia antimicrobiana de las bacterias ESKAPE aisladas en todas las unidades de internación del Hospital Del Norte durante la gestión 2019. MATERIAL Y MÉTODOS: estudio observacional, descriptivo, incluyó 836 aislamientos obtenidos de enero a diciembre del 2019 provenientes de pacientes internados en todas las unidades del Hospital del Norte. Se empleó el sistema WHONET y las variables estudiadas fueron: edad, género, tipo de muestra, sala de internación, perfil de sensibilidad y resistencia de cada uno de los microorganismos en estudio. RESULTADOS: Se elaboró y describió el perfil de sensibilidad y resistencia antimicrobiana de las bacterias ESKAPE, encontrándose que los Enterobacterales tienen mayor frecuencia, siendo Escherichia coli el patógeno más prevalente; se determinó que existe mayor frecuencia en pacientes adultos, con mayor prevalencia en el género femenino. La frecuencia por tipo de muestra se observa que los tres primeros lugares lo ocupan las muestras de orina, vías respiratorias bajas y abscesos. Los servicios de Terapia intensiva, Medicina Interna y Cirugía son las áreas más críticas. Se obtuvieron los porcentajes de resistencia que presentan cada uno de los microorganismos estudiados según sala de internación. Los principales mecanismos de resistencia fenotípica encontrados en este estudio, son BLEE y MRSA. CONCLUSIONES: los resultados obtenidos demuestran que el mapa epidemiológico de resistencia antimicrobiana del Hospital del Norte, presenta porcentajes más altos en relación a los mapas epidemiológicos similares de otros hospitales en Latinoamérica.
INTRODUCTION: antimicrobial resistance raises a serious threat to health worldwide. Infections by ESKAPE bacteria represent major resistance problems, since they can present more than one resistance mechanism and also have the ability to transmit other bacteria. In Bolivia, unfortunately, there are no Bolivian authors who have published articles explaining the multi-resistance of ESKAPE Bacteria in third level hospitals. OBJECTIVE: To describe the antimicrobial sensitivity and resistance profile of ESKAPE bacteria isolated in all inpatient units of Hospital Del Norte in 2019. MATERIAL AND METHODS: observational, descriptive study, included 836 isolates obtained from January to December 2019 from patients hospitalized in all units of Hospital del Norte. WHONET software was used and the variables studied were: age, gender, type of sample, hospitalization room and resistance profile of each of the microorganisms under study. RESULTS: the antimicrobial sensitivity and resistance profile of each ESKAPE bacteria was elaborated and described, and it was found that Enterobacteriaceae have a higher frequency, with Escherichia coli is being the most prevalent pathogen; it was determined that there is a higher frequency in adult patients, with a higher prevalence in the female gender. The frequency by type of sample shows that the first three places are occupied by urine, lower respiratory tract and abscess samples. Intensive care, internal medicine, and surgery services are the most critical areas. The percentages of resistance were obtained for each of the microorganisms studied according to the hospitalization room. ESBL and MRSA are the main phenotypic resistance mechanism found in the hospital. CONCLUSIONS: the results obtained show that the epidemiological map of antimicrobial resistance at Hospital del Norte presents higher percentages in relation to similar epidemiological maps of other hospitals in Latin America.
Subject(s)
Bacteria , Escherichia coli , Inpatients , Public Health , Internal MedicineABSTRACT
Introducción: Las infecciones asociadas al cuidado de la salud representan un problema de salud pública y la transmisión horizontal supone un incremento en la morbimortalidad y los costos en la atención. La vigilancia activa es costosa y tiene alto riesgo de omitir la detección de brotes, mientras que la virtual (modelos matemáticos) permite la búsqueda sistemática de alertas de brotes. El objetivo de este estudio es evaluar la relación costo-efectividad del uso de la herramienta SaTScan-Whonet para la detección temprana de infecciones bacterianas, comparada con la vigilancia tradicional en una institución de alta complejidad de Colombia. Metodología: En un hospital universitario de alta complejidad se realizó un estudio retrospectivo, se identificó un brote bacteriano, se caracterizó clínicamente y por biología molecular. Se extrajeron las bases de datos de los sistemas automatizados de identificación y susceptibilidad microbiológica. Se realizaron análisis retrospectivos de SaTScan-Whonet, así como simulaciones diarias para el primer semestre de 2011 de manera prospectiva; también se identificó la fecha para la alerta de detección de brote, tanto en la vigilancia activa como en la virtual. Resultados: Se aislaron 4.584 microorganismos en los servicios de hospitalización tanto UCI como no UCI entre 2010 y 2011 (2.288 y 2.296 respectivamente). Por vigilancia activa se notificó un brote por Enterococcus faecium el 28 de marzo de 2011, que fue caracterizado por biología molecular con la presencia del gen Van A, que confiere resistencia a glucopéptidos. Se identificó de manera retrospectiva una alerta de brote para E. faecium entre el 14 de marzo y el 10 de mayo de 2011 con un intervalo de recurrencia de 609.384. En los análisis prospectivos simulados se identificó la primera alerta de brote de esta bacteria el 13 de abril de 2011 con un intervalo de recurrencia de 3.897 (p = 0,0002655). Conclusión: La utilización de dicha herramienta de manera prospectiva no fue superior a la vigilancia activa en cuanto a oportunidad en la detección. Los análisis retrospectivos tuvieron un alto rendimiento diagnóstico y podrían ser de utilidad para los sistemas de vigilancia y control de los entes reguladores.
Background: Healthcare-associated infections represent a public health problem, and horizontal transmission has led to an increase in morbidity and mortality as well as higher health care costs. Active surveillance is expensive and carries high risk of failing to detect outbreaks. Virtual surveillance (mathematical models) allows a systematic search for alerts to outbreaks. The objective of this study is to evaluate the cost-effectiveness of the SaTScan-Whonet tool for the early detection of outbreaks of bacterial infection, compared with traditional surveillance, in an institution of high complexity in Colombia. Methodology: In a university hospital of high complexity a retrospective study was performed, identifying a bacterial outbreak that was characterised clinically and by molecular biology techniques. Databases of automated systems of identification and microbiological susceptibility were extracted. Retrospective analyses were performed using SaTScan-Whonet and daily simulations during the first semester of 2011 in a prospective manner. The date for the alert to the detection of the outbreak for both active and virtual surveillance was also identified. Results: A total of 4,584 microorganisms were isolated both inside and outside the ICU bet-ween 2010 and 2011 (2,288 and 2,296, respectively). An outbreak of Enterococcus faecium was identified by active surveillance on March 28, 2011. Using molecular biology techniques, the outbreak was characterised, showing the presence of the vanA gene, which confers resistance to glycopeptides. An alert to an Enterococcus faecium outbreak was retrospectively identified between March 14 and May 10, 2011 with a recurrence interval of 609,384. The first alert to outbreak for this bacterium was identified in a prospective simulated analysis on April 13, 2011 with a recurrence interval of 3,897 (P=.0002655). Conclusion: The use of such a tool prospectively is not superior to active surveillance in regard to timely detection of bacterial outbreaks. Retrospective analyses have high diagnostic ability and could be very helpful in systems of surveillance and control of regulatory entities.
Subject(s)
Humans , Drug Resistance, Microbial , Laboratory Equipment , Disease Outbreaks , Recovery Room , Cross Infection , Enterococcus faecium , Intensive Care UnitsABSTRACT
BACKGROUND: In hospital laboratory using Microscan, the search for an isolate or the analysis for antimicrobial susceptibility rates were obtained by the Data Management System (DMS) software. However, it is hard to convert DMS database to other file formats in addition to some limitation in using the database. We applied BacLink 2 and WHONET 5.1 softwares to convert and analyse DMS database for the utilization of the isolate profiles and the antimicrobial resistance rates. METHODS: Specimen and microbial data were printed as 'Short report form', an ASCII text file, from Microscan DMS. BacLink 2 software was used to convert the printed file to dBASE format file. Statistical analyses were performed using WHONET 5.1 software. RESULTS: Data of isolates were obtained as 'Short report form' in one month intervals. This file could be converted to other database file using BacLink 2 software. The antimicrobial resistant profiles were obtained, and the susceptibility, intermediate resistant, and resistant rates for each isolates could be analyzed. CONCLUSIONS: In this study, BacLink 2 and WHONET 5.1 software were successfully applied for the conversion of the database. Analysis of isolate profiles and antimicrobial resistant rates could be performed in other personal computer systems. The database management by BacLink 2 and WHONET 5.1 software could be applicable for the convenient statistical analysis in microbiology laboratories using Microscan.