An Emergent Change in Epidemiologic and Microbiological Characteristics of Bloodstream Infections in Adults With Febrile Neutropenia Resulting From Chemotherapy for Acute Leukemia and Lymphoma at Reference Centers in Chile, Ecuador, and Peru.

Background: Febrile neutropenia is a life-threatening condition commonly observed in patients with hematologic malignancies. The aim of this article is to provide updated knowledge about bloodstream infections in febrile neutropenia episodes within the Andean region of Latin America. Method: This retrospective study was based in 6 hospitals in Chile, Ecuador, and Peru and included adult patients with acute leukemia or lymphoma and febrile neutropenia between January 2019 and December 2020. Results: Of the 416 febrile neutropenia episodes, 38.7% had a bloodstream infection, 86% of which were caused by gram-negative rods, with Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa being the most frequently identified bacteria. K pneumoniae isolates were more frequently resistant than E coli to cefotaxime (65% vs 39.6%), piperacillin-tazobactam (56.7% vs 27.1%), and imipenem (35% vs 2.1%) and were more frequently multidrug resistant (61.7% vs 12.5%). Among P aeruginosa, 26.7% were resistant to ceftazidime, piperacillin-tazobactam, and imipenem, and 23.3% were multidrug resistant. Overall 30-day mortality was 19.8%, being higher with vs without a bloodstream infection (26.7% vs 15.3%, P = .005). Fever duration was also significantly longer, as well as periods of neutropenia and length of hospital stay for patients with bloodstream infection. Additionally, the 30-day mortality rate was higher for episodes with inappropriate vs appropriate empirical antibiotic therapy (41.2% vs 26.6%, P = .139). Conclusions: Considering the high rates of bacteria-resistant infection and 30-day mortality, it is imperative to establish strategies that reduce the frequency of bloodstream infections, increasing early identification of patients at higher risks of multidrug bacteria resistance, and updating existing empirical antibiotic recommendations.

Impact of Adding a Rapid PCR-Based Blood Culture Identification Panel to the Antimicrobial Stewardship Program of Patients with Febrile Neutropenia in a Peruvian Referral Hospital.

The addition of Biofire® FilmArray® Blood Culture Identification panel 2 (BCID2) to the antimicrobial stewardship program (ASP) could improve outcomes in bloodstream infections (BSI) of patients with febrile neutropenia (FN). A pre- and post-quasi-experimental single-center study was conducted at a reference hospital in Peru. Three groups were considered: patients with BSI before ASP intervention (control group), patients with BSI after ASP intervention (group 1), and patients with BSI after ASP intervention plus BCID2 PCR Panel implementation (group 2). Overall, 93 patients were identified (32 control, 30 group 1, 31 group 2). The median time to effective therapy was significantly shorter in group 2 compared to group 1 and control group, respectively (3.75 vs. 10 h, p = 0.004; 3.75 vs. 19 h, p < 0.001). No significant differences in terms of relapse of bacteremia, in-hospital mortality (all cause), and 30-day-all-cause hospital readmission between the three study periods were found. The appropriateness of empirical antimicrobial use, adding or change, and the following de-escalation or discontinuation was significant when the two intervention periods were compared with the control group (p < 0.001). In addition to the lack of local studies documenting the microbiological profile of FN episodes, adding syndromic panels-based testing could allow for the consolidation of ASP strategies.

First Clinical Cases of OXA-48-Producing Klebsiella pneumoniae in Peru / Primeros casos clínicos de infecciones por Klebsiella pneumoniae productora de OXA-48 en Perú

Background: Carbapenemase-producing Enterobacteriaceae(CPE) represents a global public health concern and systemic infectionsassociatedwithOXA-48 carbapenemase are increasingly being reported in Latin America. Here, we present the first 2 cases of systemic infections by OXA-48-ProducingKlebsiellapneumoniaein Peru. A favorable clinical response was observed after targeted treatment with colistin as a backbone.

Introducción: Las enterobacterias productoras de carbapenemasas (EPC) representan un problema de salud pública y cada vez hay más reportes de infecciones sistémicas asociadas con la carbapenemasa OXA-48 en America Latina. Presentamos los primeros 2 casos de infecciones sistémicas por Klebsiella pneumoniae productora de OXA-48 en Perú. Se observó una respuesta clínica favorable luego del tratamiento dirigido con colistina como base.

Primer reporte de Candida auris en Perú

Candida auris es un hongo emergente, con gran relevancia en corto tiempo, como problema de salud pública mundial. Se reporta por primera vez en el Perú la presencia de Candida auris en 3 pacientes adultos internados en un hospital nacional de alta complejidad en el último trimestre del año 2020, durante la pandemia COVID-19. Los pacientes fueron hospitalizados en UCI; sin embargo, solo en 2 pacientes se aisló dicho germen durante su internamiento en UCI. Los pacientes tuvieron varias comorbilidades y tiempos prolongados de hospitalización desde su admisión hasta tener el primer cultivo positivo a C. auris. Todos los pacientes adquirieron una infección nosocomial bacteriana en algún momento de su hospitalización y recibieron antibióticos de amplio espectro. Todas las cepas aisladas fueron resistentes a fluconazol. El equipo de control de infecciones del hospital reforzó las medidas de contención y el Ministerio de Salud del Perú emitió una alerta epidemiológica.

Candida auris is an emerging fungus that has gained great relevance as a global public health problem in a short time. The presence of Candida auris in 3 adult patients admitted to a national hospital of high complexity in the last quarter of 2020 in the midst of the COVID-19 pandemic is reported for the first time in Peru. The patients were hospitalized in the ICU, however, this germ was isolated in only 2 patients while they were hospitalized in the ICU. The patients had various comorbidities and long hospitalization times from admission to having their first culture positive for C. auris. All patients acquired a bacterial nosocomial infection at some point during their hospitalization and received broad-spectrum antibiotics. All isolates were resistant to fluconazole. The hospital's infection control team reinforced containment measures and the Ministry of Health of Peru issued an epidemiological alert.

[Assessment of dot blot tests and latex agglutination for cysticercosis diagnostic in Peru]. / Evaluación de las pruebas dot blot y aglutinación de látex para el diagnóstico de cisticercosis en Perú

In order to evaluate dot blot tests and latex agglutination for the detection of human cysticercosis with liquid antigen of Taenia solium cysticerci, 125 human sera were used, of which 60 were from people with cysticercosis confirmed by Western Blot, 45 with other parasitic diseases and 20 apparently healthy. The optimal concentration of antigen to impregnate dot blot strips was 0.01 ug/uL, and to impregnate the latex particles was 0.092 ug/uL. For the dot blot test, a sensitivity of 100% and specificity of 87.7% was found. For latex agglutination, a sensitivity of 93.3% and specificity of 89.2% was found. Both tests may be useful and feasible to implement alternatives of serological diagnosis in laboratories in endemic areas of Peru.

Evaluación de las pruebas dot blot y aglutinación de látex para el diagnóstico de cisticercosis en Perú / Assessment of dot blot tests and latex agglutination for cysticercosis diagnostic in Peru

Con el objetivo de evaluar las pruebas dot blot y aglutinación de látex para la detección de cisticercosis humana con antígeno de líquido de cisticerco de Taenia solium, se usaron 125 sueros humanos, de los cuales 60 procedían de personas con cisticercosis confirmada por Western Blot, 45 de personas con otras enfermedades parasitarias y 20 de personas aparentemente sanas. La concentración óptima del antígeno para impregnar las tiras dot blot fue de 0,01 ug/uL, y para impregnar las partículas de látex fue de 0,092 ug/uL. Para la prueba dot blot se encontró una sensibilidad del 100% y especificidad del 87,7%; para la aglutinación de látex una sensibilidad del 93,3% y especificidad del 89,2%. Ambas pruebas podrían ser de utilidad y factibles de implementar como alternativas de diagnóstico serológico en laboratorios de áreas endémicas del Perú.

In order to evaluate dot blot tests and latex agglutination for the detection of human cysticercosis with liquid antigen of Taenia solium cysticerci, 125 human sera were used, of which 60 were from people with cysticercosis confirmed by Western Blot, 45 with other parasitic diseases and 20 apparently healthy. The optimal concentration of antigen to impregnate dot blot strips was 0.01 ug/uL, and to impregnate the latex particles was 0.092 ug/uL. For the dot blot test, a sensitivity of 100% and specificity of 87.7% was found. For latex agglutination, a sensitivity of 93.3% and specificity of 89.2% was found. Both tests may be useful and feasible to implement alternatives of serological diagnosis in laboratories in endemic areas of Peru.

Estandarización y evaluación de la técnica Dot blot para el tamizaje de cisticercosis humana / Standardization and evaluation of the Dot blot technique for screening human cysticercosis Standardization and evaluation of the technique Dot blot for the screening of human cysticercosis

Con el propósito de obtener una técnica altamente sensible y de bajo costo para el tamizaje de cisticercosis humana en zonas endémicas, se evaluó la prueba de Dot blot para la detección de anticuerpos en suero de personas infectadas por esta parasitosis. Para evaluar la eficiencia de la técnica, se emplearon sueros confirmados por Western blot, de los cuales, 60 procedían de pacientes con cisticercosis, 45 de pacientes con otras parasitosis y 20 de personas sanas, estos últimos para evaluar reacciones cruzadas. Se usó papel de nitrocelulosa, en el que el antígeno total de líquido vesicular de cisticercosis de Taenia solium fue fijado. A continuación, la tira fue incubada con el suero problema y luego con anti-IgG humano marcado con una enzima. El suero que tenia anticuerpos, al agregar un sustrato cromógeno, originó un producto insoluble que precipitó formando un punto en la zona donde se produjo la reacción antígeno-anticuerpo. La sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo de la prueba Dot blot fue de: 100 por ciento, 83 por ciento, 84 por ciento y 100 por ciento respectivamente. El índice de Kappa obtenido fue 0,98, lo que la califica como una prueba que tiene muy buena concordancia con el western blot. Por su alta sensibilidad, el uso de la prueba Dot blot parece ser un enfoque adicional para el descarte de cisticercosis, con la ventaja de la simplicidad y rapidez, susceptible de prepararse en regiones endémicas del país, constituyendo una buena alternativa como prueba de tamizaje y para estudios epidemiológicos, recomendándose por tanto su uso.

With the intention of obtaining a highly sensitive technology and of low cost for screening human cysticercosis in endemic zones, Dot blot test was evaluated for the detection of antibodies in persons' whey infected by this parasitosis. To evaluate the efficiency of the technique, there were used serums confirmed by Western blot, of which, 60 were coming from patients with cysticercosis, 45 of patients with other parasitosis and 20 of healthy persons, the above mentioned to evaluate crossed reactions. Nitrocellulose paper was used, in that the total antigen of liquid vesicular of cysticercosis of Taenia solium was fixed. Next, the strip was incubated with serum and then with anti-human IgG labeled with an enzyme. The serum had antibodies, by adding a suitable chromogenic substrate, resulted in an insoluble product which precipitated forming a point in the area where there was a reaction antigen-antibody. The sensibility, specificity, predictive positive value and predictive negative value of the test Dot blot was of: 100 per cent, 83 per cent, 84 per cent and 100 per cent respectively. The Kappa index obtained was 0.98, which qualifies it as a test that has very good conformity with the western blot. For his high sensibility, the use of the test Dot blot seems to be an additional approach for the discarded cards of cysticercosis with the advantage of the simplicity and rapidity, capable of to prepare in endemic regions of the country, constituting a good alternative as a screening test and for epidemiological studies, his use being recommended.