Background Point prevalence surveys (PPSs) on antibiotic use are useful for understanding different aspects related to prescription patterns in hospitals. Methods An adaptation of the WHO methodology for a PPS on antibiotic use was applied. Hospital wards were divided into medical (MED), surgical (SUR), ICUs, gynaecology and obstetrics (GO), high-risk (HR) and mixed wards (MIX). A web application (RedCap©) through a mobile device was used for data collection. Results Between December 2018 and August 2019, 5444 patients in 33 hospitals in five countries were included (10 hospitals in Cuba, 7 in Paraguay, 6 in El Salvador, 5 in Mexico and 5 in Peru). Of these patients, 54.6% received at least one antibiotic, with variations between and within hospitals and countries. Antibiotics were more frequently used in ICUs (67.2%), SUR (64.5%) and MED wards (54.2%), with 51.2% of antibiotics prescribed for community-acquired infections (CAIs), 22.9% for healthcare-associated infections (HAIs), 11.1% for surgical prophylaxis and 6.1% for unknown reasons. Adherence to guidelines was observed in 68.6% of cases (72.8% for CAIs, 72.4% for HAIs and 44.3% for prophylaxis). Third-generation cephalosporins were the class of antibiotics most frequently used (26.8%), followed by carbapenems (10.3%) and fluoroquinolones (8%). Targeted treatments were achieved in 17.3% of cases. Conclusions Antibiotic use was generally higher than that published in other studies. There is an urgent need to promote and strengthen the antimicrobial stewardship programmes in Latin America.

Objetivos: Estandarizar una prueba RT-LAMP in house para la detección de SARS-CoV-2 y validarla con muestras de laboratorio y de campo en pacientes con sospecha clínica de COVID-19. Materiales y métodos: Se estandarizó una prueba molecular RT-LAMP in house para la detección de SARS-CoV-2 estableciéndose el límite de detección con células Vero de cepas peruanas aisladas de SARS-CoV-2. Se validó la prueba en laboratorio con 384 muestras de hisopado nasal y faríngeo (HNF) obtenidas entre marzo y julio de 2020. Para la validación de campo se obtuvieron muestras de HNF de 383 casos sintomáticos sospechosos de COVID-19. Todas las muestras fueron evaluadas por RT-LAMP y RT-qPCR. Para la validación de laboratorio y de campo se consideró como estándar de referencia al RT-qPCR, se calcularon medidas de concordancia y rendimiento diagnóstico. Resultados: El límite de detección fue consistente en los casos con umbral de ciclo (Ct) Ct 30 en ambas pruebas, mostrando eficiencia para detectar hasta 1000 copias/μL del gen diana. Se evidenció robustez con la mitad de las concentraciones de cebadores y 20 μL de volumen final. Se identificó ausencia de amplificación para otros coronavirus humanos. La concordancia en laboratorio obtuvo un Kappa de 0,88 (IC 95%: 0,83–0,93) y en campo fue de 0,89 (IC 95%: 0,84−0,94); la sensibilidad en laboratorio fue de 87,4% (IC 95%: 80,8−92,4) y en campo fue de 88,1% (IC 95%: 81,6−92,9), la especificidad en ambos escenarios fue de 98,8% (IC 95%: 96,4−99,7). Conclusiones: La prueba RT-LAMP in house fue validada por presentar una adecuada robustez, sin reacciones cruzadas, buena concordancia y rendimiento diagnóstico comparado con el RT-qPCR.

Objectives The objective of this study was to analyse the cost-effectiveness (C-E) of ceftazidime/avibactam (CAZ/AVI)-based therapy versus colistin (COL)-based therapy for pneumonia and bacteraemia caused by carbapenem-resistant enterobacteria (CRE) adjusted to Peruvian context. Methods A Markov decision model was extrapolated from literature to evaluate the clinical and economic consequences of CAZ/AVI-based therapy compared to COL-based therapy for a hypothetical cohort of patients with CRE pneumonia or bacteraemia according to Peruvian context. It was adopted a 5-year time horizon and a Markov-cycle length of 1 year. All patients in the model were assigned to CRE pneumonia or bacteraemia state and may transit through four different health states: home-care, long-term care without dialysis, long-term care with dialysis or death. Key findings Intervention with CAZ/AVI becomes progressively more cost-effective from a threshold of S/ 24,000 or US$ 6666 (equivalent to 1 Gross Domestic Product-per cápita [GDP-pc]). The model simulation allowed to calculate an average total cost of S/ 2’971,582 (US$ 825,440) for CAZ/AVI against S/2’056,488 (US$ 571.247) for COL treatment, yielding an incremental cost of S/ 915,094 (US$ 254,193). The cost/QALY for CAZ/AVI treatment against COL therapy approaches to S/23,154 (US$ 6432), something less than 1 annual GDP-pc. There were additional benefits associated with CAZ/AVI in the 5-year horizon, such as: 21 deaths avoided, 86 hospital days avoided, 1 CRF5 avoided and a NMB of S/6649 (US$ 1847). Conclusions The present transferability model demonstrates the C-E of CAZ/AVI over COL for the treatment of bacteraemia and CRE pneumonia according to peruvian payment thresholds.

Objetivo. Describir los genotipos de las carbapenemasas reportadas de aislamientos microbiológicos de pacientes en Perú. Métodos. Se realizó una búsqueda sistemática de la literatura biomédica publicada desde el 1 enero de 2000 hasta el 15 de setiembre de 2019 en las bases de datos PubMed, SCOPUS, Biblioteca Virtual de Salud, Biblioteca Virtual de CONCYTEC, Google Scholar y otras fuentes de publicaciones de resúmenes o póster en congresos nacionales o internacionales sobre carbapenemasas con confirmación genotípica; la selección y extracción de datos fue por pares. Resultados. Se incluyeron 14 estudios en los que se realizó la caracterización genotípica de 313 carbapenemasas. Ciento tres de estos reportes pertenecían a estudios efectuados en enterobacterias; de estos, 74 fueron en Klebsiella pneumoniae, 11 en Proteus mirabilis, 7 en Enterobacter cloacae y 11 en otras. Sesenta y una de estas 103 corresponden a blaNDM, 39 a blaKPC y 3 a blaIMP. Según su estructura molecular, 64 son metalobetalactamasas y 39 son serinbetalactamasas. En Pseudomonas aeruginosa se incluyeron 84 reportes, 79 corresponden a blaIMP, 4 a blaVIM, y 1 a blaGES. En Acinetobacter baumannii 126 reportes, 55 corresponden a blaOXA-23, 66 a blaOXA24, 3 a blaNDM y 2 a blaOXA-143. Conclusiones. Existe un número escaso de publicaciones respecto a carbapenemasas de pacientes en Perú; los reportes genotípicos provienen en su mayoría de hospitales de la capital del país. Esta es la primera revisión que intenta conocer los tipos de carbapenemasas reportadas en enterobacterias, P. aeruginosa y A. baumannii.

Lactoferrin (LF) has in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to determine the effect of bovine lactoferrin (bLF) in the prevention of SARS-CoV-2 infection in health care personnel. A randomized, double-blinded, placebo-controlled clinical trial was conducted in two tertiary hospitals that provide care to patients with SARS-CoV-2 infection in Lima, Peru. Daily supplementation with 600 mg of enteral bLF versus placebo for 90 days was compared. Participants were weekly screened for symptoms suggestive of SARS-CoV-2 infection and molecular testing was performed on suspected episodes. A serological test was obtained from all participants at the end of the intervention. The main outcome included symptomatic and asymptomatic cases. A sub-analysis explored the time to symptomatic infection. Secondary outcomes were the severity, frequency, and duration of symptomatic infection. The study was prematurely cancelled due to the availability of vaccines against SARS-CoV-2 in Peru. 209 participants were enrolled and randomized, 104 received bLF and 105 placebo. SARS-CoV-2 infection occurred in 11 (10.6%) participants assigned to bLF and in 9 (8.6%) participants assigned to placebo without significant differences (Incidence Rate Ratio = 1.23, 95%CI 0.51–3.06, p-value = 0.64). There was no significant effect of bLF on time to symptomatic infection (Hazard Ratio = 1.61, 95%CI 0.62–4.19, p-value = 0.3). There were no significant differences in secondary outcomes. A significant effect of bLF in preventing SARS-CoV-2 infection was not proven. Further studies are needed to assess the effect of bLF supplementation on SARS-CoV-2 infection. Clinical trial registration ClinicalTrials.gov Identifier: NCT04526821, https://clinicaltrials.gov/ct2/show/NCT04526821?term=LACTOFERRIN&cond=COVID-19&cntry=PE&city=Lima&draw=2&rank=1 . Supplementary Information The online version contains supplementary material available at 10.1007/s10534-022-00477-3.