Características clínicas y epidemiológicas de las muertes por dengue durante un brote en el norte del Perú / Clinical-epidemiological characteristics of dengue deaths during an outbreak in northern Peru

Con el objetivo de describir las características clínicas y epidemiológicas de los pacientes fallecidos por dengue durante el 2017 en Piura, se realizó un estudio retrospectivo de revisión de 24 historias clínicas. El 67% de los casos fueron mujeres y tres (12,5%) estaban embarazadas. La diabetes (12,5%) y la hipertensión (16,7%) fueron las comorbilidades más frecuentes. Sólo en el 12,5% se reportó dengue previo. El tiempo transcurrido desde asistencia sanitaria hasta la muerte fue de 4,10 (DE: 5,34) días. Se hicieron transfusiones de glóbulos rojos en el 45,8% de los casos, plasma en el 25%, plaquetas en el 16,8% y crioprecipitado en el 16,8%. También fueron frecuentes la terapia con cristaloides (91,7%) y el tratamiento con fármacos vasoactivos (70,8%). En conclusión, la mortalidad del dengue grave fue mayoritaria en las mujeres adultas y el tiempo de atención desde el primer establecimiento de salud hasta una unidad especializada fue prolongada.

Objective: To describe the clinical-epidemiological characteristics of patients who died from dengue during 2017. Methods: We conducted a retrospective study of the information related to cases of dengue deaths in the department of Piura. Results: We reviewed 24 medical records. Sixty-seven percent were women and 3 (12.5%) were pregnant. Diabetes (12.5%) and hypertension (16.7%) were the most frequent comorbidities. Previous dengue fever was reported in only 12.5%. The time from health care and death was 4.10 ± 5.34 days. Red blood cell transfusions were performed in 45.8%, plasma in 25%, platelets in 16.8% and cryoprecipitate in 16.8% of cases. Crystalloid therapy (91.7%) and treatment with vasoactive drugs (70.8%) were also frequent. In conclusion, mortality from severe dengue fever was predominantly in adult women, and the time of care from the first health facility to a specialized unit was prolonged.

Evolution of the prevalence and antimicrobial resistance among Escherichia coli isolated as a cause of infection in patients admitted to a iv-level hospital in Lima, Peru

The levels and evolution of antimicrobial resistance of Escherichia coli during 01/2009-06/2010 (Period 1), 01/2012-06-2013 (Period 2) and 07/2013-12/2014 (Period 3) were analyzed. Identification, susceptibility levels to 13 antibiotics and the presence of extendedspectrum ß-lactamases (ESBLs) were determined. Overall, 9,918 microorganisms were isolated as a cause of infection. Of these 3,016 (30.4%) were E. coli, with 1,770 (59%), 992 (33%) and 254 (8%), from the Medicine and the Surgery Departments and the Intensive Care Unit (ICU), respectively. There was a significant increase (p=0.0002) of E. coli throughout considered periods. The isolates presented high levels of resistance (>60%) to cephalosporins, ciprofloxacin and cotrimoxazole, being only susceptible to imipenem (0.3% of resistance) and tigecycline. Overall the analysis of evolution of antimicrobial resistance showed that resistance to cephalosporins and amikacin significantly increased, while, the ones of piperacillintazobactam, cotrimoxazole and gentamicin had significantly decreased. Nevertheless, the ICU isolates showed an inverse scenario for cephalosporins. These findings agree with an increase of ESBLs on the Medicine (56% to 66%; p<0.0001) and on the Surgery (54% to 62%; p=0.0197) departments, with a parallel decrease in the ICU (76% to 68%). In summary, high levels of antimicrobial resistance have been reported among E. coli, with worrisome levels of ESBL. A continuous surveillance of antimicrobial resistance levels in the area is needed.