Antibiotics and antimicrobial resistance in the COVID-19 era: Perspective from resource-limited settings.

The dissemination of COVID-19 around the globe has been followed by an increased consumption of antibiotics. This is related to the concern for bacterial superinfection in COVID-19 patients. The identification of bacterial pathogens is challenging in low and middle income countries (LMIC), as there are no readily-available and cost-effective clinical or biological markers that can effectively discriminate between bacterial and viral infections. Fortunately, faced with the threat of COVID-19 spread, there has been a growing awareness of the importance of antimicrobial stewardship programs, as well as infection prevention and control measures that could help reduce the microbial load and hence circulation of pathogens, with a reduction in dissemination of antimicrobial resistance. These measures should be improved particularly in developing countries. Studies need to be conducted to evaluate the worldwide evolution of antimicrobial resistance during the COVID-19 pandemic, because pathogens do not respect borders. This issue takes on even greater importance in developing countries, where data on resistance patterns are scarce, conditions for infectious pathogen transmission are optimal, and treatment resources are suboptimal.

Clinical characteristics and prognosis of infections caused by OXA-48 carbapenemase-producing Enterobacteriaceae in patients treated with ceftazidime-avibactam.

BACKGROUND: Ceftazidime-avibactam has in vitro activity against Gram-negative bacilli that produce Class A, C and some D ß-lactamases, and has been successfully used in the treatment of infections caused by cephalosporin and carbapenem-resistant Enterobacteriaceae. However, actual experience in the treatment of OXA-48 carbapenemase-producing Enterobacteriaceae (CPE) is limited. OBJECTIVE: To review the characteristics and prognosis of OXA-48 CPE infections treated with ceftazidime-avibactam since introduction of the drug to the current centre during the period October 2014 to December 2016. METHODS: Retrospective assessment of episodes of infection caused by OXA-48 CPE treated with ceftazidime-avibactam, analysing data collected from infection diagnosis until 90 days after the end of treatment. RESULTS: Twenty-four episodes were analysed. Ceftazidime-avibactam was given as the initial definitive treatment in 15 (62.5%) and as salvage therapy in nine (37.5%). Intraabdominal (seven, 29%), urinary (six, 25%) and respiratory (five, 21%) were the most common sources. The 30-day and 90-day mortality rates were 8.3% and 20.8%, respectively. Clinical cure at 30 days was achieved in 62.5% of episodes. Four (16.7%) patients had adverse events, two of them were related to impaired renal function. Among patients who finished the treatment with ceftazidime-avibactam, seven (35%) were diagnosed with infection recurrence within 90 days of the end of treatment. CONCLUSIONS: From experience, ceftazidime-avibactam is an effective drug for treating infections due to OXA-48 CPE. From these results a better safety profile than the current best available therapy could be expected.

Medición del grado de sensibilidad frente al enfoque basado en derechos humanos y la perspectiva de género en intervenciones psicosociales / Measurement of sensibility towards human rights based approach and gender perspective in psychosocial interventions

Las intervenciones psicosociales para promover el desarrollo humano y social de los países en desarrollo, frecuentemente, se enmarcan en el Enfoque Basado en Derechos Humanos (EBDH) y la Perspectiva de Género (PG). Dado que poco se sabe sobre la preparación y disposición que tiene el personal encargado de dichas intervenciones para trabajar desde estos referentes normativos, diseñamos un instrumento para medir conocimientos y actitudes relacionadas con el EBDH y la PG como indicadores de sensibilidad frente a estos marcos conceptuales. En el diseño se utilizó una aproximación de métodos mixtos. Los resultados de entrevistas cognitivas fueron utilizados para definir una versión preliminar del instrumento, que fue sometida a una prueba piloto con 88 participantes de Colombia, España, Nicaragua y EEUU. La versión final del instrumento está compuesta por 39 ítems estructurados en cuatro dimensiones: Conocimientos-EBDH (13 ítems; α = .75), Actitudes-EBDH (6 ítems; α = .79), Conocimientos-PG (8ítems; α = .75) y Actitudes-PG (12 ítems; α = .84). El instrumento puede ser utilizado para detectar necesidades de entrenamiento y para evaluar intervenciones de capacitación en estos temas. También es útil en la identificación de agentes clave para la implementación de intervenciones psicosociales basadas en estos marcos de referencia (AU)

Psychosocial interventions to promote social and human development in developing countries frequently use the Human Rights Based Approach (HRBA) and the Gender Perspective (GP) frameworks. Given that little is known about the preparation and willingness to work with these frameworks among people in charge of designing, implementing and evaluating these interventions, we designed a questionnaire to measure knowledge and attitudes about HRBA and GP. The questionnaire was developed using a mixed methods approach. Results from cognitive interviews were used to define a preliminary version that was pilot-tested with 88 participants from Colombia, Spain, Nicaragua and USA. Data analysis yielded a final version with 39 items structured in four dimensions: Knowledge-HRBA (13 items; α = 0.75),Attitudes-HRBA (6 items; α = 0.79), Knowledge-GP (8 items; α = 0.75) and Attitudes-GP (12 items; α =0.84). The questionnaire can be used to detect training needs and to evaluate training interventions. It isalso helpful in the identification of key partners for implementing interventions based on these frameworks (AU)

Q fever endocarditis in Spain. Clinical characteristics and outcome

Objectives To describe the clinical presentation of a large number of Q fever endocarditis (QFE) and its management considering the role of serology. Patients and methods Eighty-three patients with definite QFE (56 native and 27 prosthetic valve) with a long-term follow-up after stopping treatment (median: 48 months) were included. Final outcome (cure or relapse) was compared according with the serological titre at the end of therapy: less than 1:400 of phase I Ig G antibodies by indirect immunofluorescence (group 1, N=23) or more than 1:400 (group 2, N=30).Results Eleven patients (13.2%) died from QFE and other 8 died for other reasons not related to endocarditis during follow-up. Surgery was performed in 61 (73.5%) patients and combined antimicrobial treatment was long (median: 23 months, IQR: 12 – 36). Seven relapses were observed, but five of them had received an initial incomplete antibiotic regimen. In patients who completed the programmed treatment (range: 12 – 89 months), serological titres at the end of therapy were not useful for predicting the final outcome: one relapse in each group. Conclusions QFE requires a prolonged antimicrobial treatment, but serological titres are not useful for determining its duration (AU)

Objetivos Describir la presentación clínica de la endocarditis por fiebre Q (EFQ) y su manejo terapéutico, así como el papel de la serología en este aspecto. Pacientes y método Se incluyeron 83 casos de EFQ definidas (56 nativas y 27 protésicas) con un seguimiento prolongado después de la finalización del tratamiento (mediana de 48 meses). La evolución final (curación o recidiva) se comparó dividiendo los casos en dos grupos según el título serológico al final del tratamiento: menos de 1:400 para Ac Ig G en fase I mediante inmunofluorescencia indirecta (grupo 1, N=23) o más de 1:400 (grupo 2, N=30).Resultados Once pacientes (13.2%) murieron por EFQ y otros 8 lo hicieron durante el seguimiento por diversas razones no relacionadas con la endocarditis. Fueron operados 61 (73.5%) pacientes y el tratamiento antimicrobiano fue muy prolongado (mediana: 23 meses, RIQ: 12 – 36). Siete pacientes recidivaron al cesar el tratamiento, pero cinco de ellos no habían completado el inicialmente programado. En los pacientes que sí completaron el tratamiento antimicrobiano (rango: 12 – 89 meses), los títulos serológicos observados al final del mismo no fueron útiles para predecir la evolución final, observándose una recidiva en cada uno de los grupos. Conclusiones La EFQ requiere un tratamiento antimicrobiano prolongado, pero los títulos serológicos no son un instrumento útil para determinar su duración (AU)