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.

Guía de Práctica Clínica para el manejo de pacientes con Leucemia Linfoblástica Aguda en el Seguro Social del Perú (EsSalud) / Clinical practice guideline for the management of patients with acute lymphoblastic leukemia in Peruvian Social Security (EsSalud)

RESUMEN El presente artículo resume recomendaciones clínicas basadas en evidencia para la evaluación y el manejo de pacientes con Leucemia Linfoblástica Aguda (LLA) en EsSalud. Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 8 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios en PubMed y CENTRAL durante el 2019. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y el flujograma de evaluación y manejo. La presente GPC abordó 8 preguntas clínicas, divididas en cuatro temas: diagnóstico, medidas generales, manejo quimioterápico de LLA, y trasplante. En base a dichas preguntas se formuló 5 recomendaciones (3 recomendaciones fuertes y 2 recomendaciones condicionales), 20 puntos de buena práctica clínica, y 3 flujogramas.

ABSTRACT This paper summarizes the evidence-based clinical recommendations for the assessment and management of patients with acute lymphoblastic leukemia (ALL) in Peruvian Social Security (EsSalud). A guide writing team (GWT) was convened, which included specialized physicians and methodologists. The GWT asked 8 clinical questions to be responded by the Clinical Practice Guidelines (CPG). Detailed searches of systematic reviews and - when it was considered as pertinent - primary studied featured in PubMed and CENTRAL during 2019 were performed. Evidence for responding each of the proposed clinical questions was selected. Certainty of the evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In scheduled workshops, the GWT used the GRADE methodology for reviewing the evidence and propose recommendations, the points for good clinical practice, and the assessment and management flowcharts. This CPG worked on 8 clinical questions, which were divided in 4 topics: diagnosis, general measures, chemotherapy management for ALL, and transplantation. On the basis of these questions, 5 recommendations were formulated (3 strong recommendations and 2 conditional recommendations), 20 points for good clinical practice, and 3 flow charts.

Leucemia/Linfoma de células T del adulto y criptococosis sistémica: Reporte de dos casos en un hospital peruano / Adult T-cell leukemia/lymphoma and systemic cryptococcosis: report of two cases in a Peruvian hospital

La leucemia/linfoma de células T adulto (LLCTA) es una neoplasia linfoide causada por el virus linfotrópico humano de células T tipo 1 (HTLV-1), retrovirus endémico en nuestro país. Tiene una presentación heterogénea, con variedades de pobre pronóstico e infecciones oportunistas que lo ensombrecen aún más. Se presentan dos casos de pacientes con variedades agresivas de la enfermedad (aguda y linfomatosa) complicadas con criptococosis sistémica. Reforzamos la necesidad de un enfoque diagnóstico completo y un monitoreo continuo de agentes oportunistas en el paciente con LLCTA adaptado a nuestro contexto epidemiológico

Adult T-cell leukemia/lymphoma (ATLL) is a lymphoid neoplasm caused by the human T-cell lymphotropic virus type 1 (HTLV-1), an endemic retrovirus in our country. It has a heterogeneous presentation, with sub types of poor prognosis, and opportunistic infections that worsen the prognosis. We present two cases with aggressive varieties of the disease (acute and lymphomatous) complicated by systemic cryptococcosis. It is necessary to conduct a complete diagnostic approach and continuous monitoring of opportunistic agents in patients with ATL adapted to our epidemiological context.

Neutropenia febril posterior a quimioterapia de consolidación en pacientes pediátricos con leucemia linfoblástica aguda del Hospital Nacional Guillermo Almenara Irigoyen durante 2008-2010 / Febrile Neutropenia after consolidation Chemotherapy in Pediatric Patients with acute Lymphoblastic Leukemia in Hospital Nacional Guillermo Almenara Irigoyen during 2008 - 2010

Estudio de serie de casos de pacientes entre 28 días y 18 años de edad con diagnóstico de LLA tipo B que desarrollaron al menos un evento de NF-QTC. Se estudiaron 21 pacientes que desarrollaron 38 eventos de NF-QTC. La frecuencia hallada fue 60,32% con foco infeccioso principal respiratorio (28,21%). Entre las características predominantes se hallaron: género femenino (52,38%), niñez (2-9 años) (76,19%), alto riesgo de LLA (71,43%), uso de acceso venoso periférico (96,54%), alta precoz (78,95%) y aislamiento de gérmenes grampositivos (10,26%); aunque no se registró cultivos en 82,05%. Terapia antibiótica empírica ceftazidima-amikacina (71,79%).(AU)

Case series study of patients between 28 days and 18 years of age diagnosed with type B ALLwho developed at least one event of NF-QTC. We studied 21 patients who developed 38 eventsof NF-QTC. The rate found was 60.32% with primary respiratory focus of infection (28.21%). Among the predominant features were found: female gender (52.38%), childhood (2-9 years) (76.19%), high risk of ALL (71.43%), use of peripheral venous access (96.54 %), high early (78.95%) and isolation of Gram-positive (10.26%), although there was no crop at 82.05%.Empiric antibiotic therapy ceftazidime￾amikacin (71.79%).(AU)

A single apheresis procedure in the donor may be enough to complete an allograft using the "Mexican method" of non-ablative allografting.

BACKGROUND: Since 1999, in Mexico we have been using a regimen to conduct allografts that involves non-myeloablative conditioning and peripheral blood stem cells (PBSC) and have introduced some changes with the main goal of decreasing the cost of the procedure. MATERIALS AND METHODS: We analysed the salient apheresis features of a group of 175 allogeneic peripheral blood stem cell transplants conducted in two institutions in a 7-year period. The grafts were conducted using the "Mexican" non-myelo ablative conditioning regimen employing oral busulphan, i.v. cyclophosphamide and i.v. fludarabine. In all instances, the apheresis machine employed was the Baxter CS3000 Plus and donors were mobilised with filgrastim. The apheresis procedures were performed on days 0, +1 and +2, the end-point of collection being 5,000 mL of blood/m2 in each procedure. Three apheresis sessions were planned but the number was adjusted according to the cell yield. RESULTS: The final number of allografted CD34 cells ranged between 0.5 and 25.4 x 10(6)/Kg of the recipient's body weight (median, 5.2 x 10(6)/Kg). One to three apheresis procedures were needed to obtain a product containing more than 0.5 x 10(6) CD34 cells/Kg of the recipient, the median being two procedures; in 72 cases (41%) a single apheresis procedure was sufficient to obtain the target number of CD34 cells. The volumes of apheresis ranged between 50 and 600 mL (median, 400 mL). CONCLUSIONS: Since the median cost of each apheresis procedure is 900 USD, the fact that two apheresis procedures was spared in 72 cases and one apheresis was spared in another 65 cases, led to a total saving of approximately 188,100 USD. It can be concluded that, in many cases, allogeneic transplants can be completed with a single apheresis session and that there are considerable financial benefits from this practice.

Leucemia aguda como manifestación de una segunda neoplasia / Acute leukemia as manifestation of a second neoplastia

Se reportan tres casos de Leucemia aguda secundaria a otra neoplasia. Los casos corresponden a dos pacientes, mujeres con Leucemia Mieloide aguda diagnosticada 19 y 30 meses después de haber recibido tratamiento con radioterapia más agentes alquilantes, por ser protadora de Ca de mama estadio III y Mieloma Múltiple respectivamente. La sobrevida después de la aparición de la Leucemia Mieloide aguda fue de cuatro meses en el 1§ caso y de nueve y medio meses en el 2§ caso. El 3§ caso corresponde a una paciente mujer diagnosticada de Ca de mama primario, quién recibe tratamiento con radioterapia y cirugía radical sin presentar reactivación, pero que 234 meses después presenta Leucemia Mieolide Crónica la cuál es controlada.