RESUMO
A descriptive design was carried out studying the correlation between antimicrobial consumption and resistance profiles of ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) in a Peruvian hospital, including the surgical, clinical areas and the intensive care unit (ICU) during the time period between 2015 and 2018. There was a significant correlation between using ceftazidime and the increase of carbapenem-resistant Pseudomonas aeruginosa isolations (R = 0.97; p < 0.05) and the resistance to piperacillin/tazobactam in Enterobacter spp. and ciprofloxacin usage (R = 0.97; p < 0.05) in the medical wards. The Pseudomonas aeruginosa resistance to piperacillin/tazobactam and amikacin in the intensive care unit (ICU) had a significant reduction from 2015 to 2018 (67% vs. 28.6%, 65% vs. 34.9%, p < 0.001). These findings give valuable information about the rates and dynamics in the relationship between antibiotic usage and antimicrobial resistance patterns in a Peruvian hospital and reinforce the need for continuous support and assessment of antimicrobial stewardship strategies, including microbiological indicators and antimicrobial consumption patterns.
RESUMO
Se presenta el caso de un paciente varón de seis años de edad, con síndrome hemofagocítico secundario a infección por virus de Epstein-Barr. El paciente inició el cuadro con fiebre, hepatoesplenomegalia, falla hepática, trastornos de la coagulación, ferritina, triglicéridos y disminución de todas las líneas celulares hematológicas. El aspirado de médula ósea evidenció la presencia de citofagocitosis, por lo que inició tratamiento específico según protocolo HLH 2004, respondiendo favorablemente luego de cuatro semanas. Actualmente, el paciente continúa sus controles por la especialidad sin recaída de enfermedad, con adecuado desarrollo y crecimiento. En nuestro país, son escasos los reportes de síndrome hemofagocítico; sin embargo, puede resultar una patología más frecuente de la que estimamos por lo que, es importante reportar estos casos y más aún el éxito del tratamiento a fin de continuar mejorando su manejo y reporte.
We present the case of a six-year old male patient who presented with hemophagocytic syndrome secondary to Epstein Barr virus infection. The patient had fever, hepatosplenomegaly, liver failure, coagulation, ferritin, and triglyceride disorders, as well as a significant reduction of all blood cell populations. Bone marrow aspirate revealed the presence of autophagocytosis, so specific therapy according to the HLH 2004 protocol was started, and the patient satisfactorily responded after four weeks. Nowadays the patient still attends his control appointments, no relapse has been detected, and both his development and growth are adequate. Few reports on hemophagocytic syndrome have been published in Peru; however, this condition may be more frequent than previously thought. Therefore, it is important to report such cases, particularly successful experiences, aiming to improve management of this condition.
