Browsing by Author "Peters, Anne"
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- ItemAntibiotic Consumption During the Coronavirus Disease 2019 Pandemic and Emergence of Carbapenemase-Producing Klebsiella pneumoniae Lineages Among Inpatients in a Chilean Hospital: A Time-Series Study and Phylogenomic Analysis(2023) Allel, Kasim; Peters, Anne; Conejeros, Jose; Martinez, Jose R. W.; Spencer-Sandino, Maria; Riquelme-Neira, Roberto; Rivas, Lina; Rojas, Pamela; Orellana Chea, Cristian; Garcia, Patricia; Araos, Rafael; McGovern, Olivia; Patel, Twisha S.; Arias, Cesar A.; Lessa, Fernanda C.; Undurraga, Eduardo A.; Munita, Jose M.The increased usage of carbapenems and broad-spectrum & beta;-lactams during the COVID-19 pandemic was associated with a higher prevalence of carbapenemase-producing Klebsiella pneumoniae in a public hospital in Chile. We observed emergence and spread of bla(NDM) ST45 during the pandemic.
- ItemCost-effectiveness analysis: fluticasone furoate/umeclidinium/vilanterol for the treatment of moderate to severe chronic obstructive pulmonary disease from the perspective of the Chilean public health system(2022) Balmaceda, Carlos; Espinoza, Manuel A.; Abbott, Tomas; Peters, AnneBackground Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease characterized by long-term breathing problems and airflow limitations. International guidelines recommend using bronchodilators like long-acting beta- and muscarinic antagonists, and inhalational corticosteroids. Objectives The cost-effectiveness of single-inhaler triple therapy containing fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) was compared to the treatments Fluticasone Furoate/Vilanterol (FF/VI), Umeclidinio/Vilanterol (UMEC/VI) and Fluticasone Propionate 250 mcg/Salmeterol 25mcg + Tiotropio 18 mcg (FP/SAL/TIO) for patients with COPD from the Chilean public health system perspective. Methods A cost-effectiveness analysis was performed, including a deterministic and probabilistic sensitivity analysis over a 25-year time horizon. Two scenarios were assessed to study the effect of a 3%-discount for costs and outcomes on FF/UMEC/VI. Results The incremental cost-effectiveness (ICER) of FF/UMEC/VI versus FF/VI was $10,076/QALY, being a cost-effective alternative to a threshold of one Gross Domestic Product per capita (GDPpc), while versus FP/SAL/TIO the ICER increased to $50,288/QALY, showing to be a non-cost effective alternative to 1 GDPpc, but at a threshold of 3 GDPpc. Conclusion FF/UMEC/VI appears to be a cost-effective intervention for treating COPD compared to FF/VI. However, FF/UMEC/VI compared to FP/SAL/TIO showed an ICER above the threshold of 1 GDPpc, but, in comparison with lower price, the ICER was below 3 GDPpc.
- ItemCreation of the first national biorepository of multi-resistant bacteria available for the study of bacterial resistance in Chile(2022) Garcia, Patricia; Rivas, Lina; Peters, Anne; Henriquez, Paola; Castillo, Loriana; Illesca, Vijna; Maripani, Andrea; Moreno, Juan; Muhlhauser, Margareta; Porte, Lorena; Rioseco, Maria Luisa; Rojas, Pamela; Silva, Francisco; Suazo, Patricio; Munita, Jose M.The availability of bacterial strains for the study of bacterial resis-tance is key to advances in basic and clinical research. There are few biobanks of bacteria with known resistance mechanisms, isolated from clinically significant infections. A review of the literature reveals that only in the United States of America is there a biobank of resistant isolates. This publication shows the creation of the first biorepository of resistant bacteria Chile associated with the MICROB-R Laboratory Network, with the participation of 11 centers distributed throughout the country, which to date has more than 3,500 bacterial isolates studied phenotypically and genotypically, available to the Chilean scientific community.
- ItemExcess burden of antibiotic-resistant bloodstream infections: evidence from a multicentre retrospective cohort study in Chile, 2018–2022(2024) Allel, Kasim; Peters, Anne; Haghparast-Bidgoli, Hassan; Spencer-Sandino, Maria; Conejeros Pavez, José Daniel Hernán; García Cañete, Patricia; Pouwels, Koen B.; Yakob, Laith; Munita, José M.; Undurraga Fourcade, Eduardo AndrésBackground: Antibiotic-resistant bloodstream infections (ARB BSI) cause an enormous disease and economic burden. We assessed the impact of ARB BSI caused by high- and critical-priority pathogens in hospitalised Chilean patients compared to BSI caused by susceptible bacteria. Methods: We conducted a retrospective cohort study from 2018 to 2022 in three Chilean hospitals and measured the association of ARB BSI with in-hospital mortality, length of hospitalisation (LOS), and intensive care unit (ICU) admission. We focused on BSI caused by Acinetobacter baumannii, Enterobacterales, Staphylococcus aureus, Enterococcus species, and Pseudomonas aeruginosa. We addressed confounding using propensity scores, inverse probability weighting, and multivariate regressions. We stratified by community- and hospital-acquired BSI and assessed total hospital and productivity costs. Findings: We studied 1218 adult patients experiencing 1349 BSI episodes, with 47.3% attributed to ARB. Predominant pathogens were Staphylococcus aureus (33% Methicillin-resistant ‘MRSA’), Enterobacterales (50% Carbapenem-resistant ‘CRE’), and Pseudomonas aeruginosa (65% Carbapenem-resistant ‘CRPA’). Approximately 80% of BSI were hospital-acquired. ARB was associated with extended LOS (incidence risk ratio IRR = 1.14, 95% CI = 1.05–1.24), increased ICU admissions (odds ratio OR = 1.25; 1.07–1.46), and higher mortality (OR = 1.42, 1.20–1.68) following index blood culture across all BSI episodes. In-hospital mortality risk, adjusted for time-varying and fixed confounders, was 1.35-fold higher (1.16–1.58) for ARB patients, with higher hazard ratios for hospital-acquired MRSA and CRE at 1.37 and 1.48, respectively. Using a societal perspective and a 5% discount rate, we estimated excess costs for ARB at $12,600 per patient, with an estimated annual excess burden of 2270 disability-adjusted life years (DALYs) and $9.6 (5.0–16.4) million. Interpretation: It is urgent to develop and implement interventions to reduce the burden of ARB BSIs, particularly from MRSA and CRE. Funding: Agencia Nacional de Investigación y Desarrollo ANID, Chile.
- ItemHigh Burden of Intestinal Colonization With Antimicrobial-Resistant Bacteria in Chile: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study(2023) Araos, Rafael; Smith, Rachel M.; Styczynski, Ashley; Sánchez Barría, Felipe Andrés; Acevedo, Johanna; Maureira, Lea; Paredes, Catalina; Gonzalez, Maite; Rivas, Lina; Spencer-Sandino, Maria; Peters, Anne; Khan, Ayesha; Sepulveda, Dino; Rojas Wettig, Loreto; Rioseco, Maria Luisa; Usedo, Pedro; Rojas Soto, Pamela; Huidobro, Laura Andrea; Ferreccio Readi, Catterina; Park, Benjamin J.; Undurraga Fourcade, Eduardo Andrés; D'Agata, Erika M. C.; Jara Vallejos, Alejandro Antonio; Munita, Jose M.We report a high colonization burden resulting from antimicrobial-resistant Gram-negative bacteria in hospitals and a community in Chile. Strikingly, 29% (95% confidence interval, 24-34) of community-dwelling adults carried extended-spectrum cephalosporin-resistant Enterobacterales, highlighting the magnitude of the community reservoir of antimicrobial resistance., Background Antimicrobial resistance is a global threat, heavily impacting low- and middle-income countries. This study estimated antimicrobial-resistant gram-negative bacteria (GNB) fecal colonization prevalence in hospitalized and community-dwelling adults in Chile before the coronavirus disease 2019 pandemic. Methods From December 2018 to May 2019, we enrolled hospitalized adults in 4 public hospitals and community dwellers from central Chile, who provided fecal specimens and epidemiological information. Samples were plated onto MacConkey agar with ciprofloxacin or ceftazidime added. All recovered morphotypes were identified and characterized according to the following phenotypes: fluoroquinolone-resistant (FQR), extended-spectrum cephalosporin-resistant (ESCR), carbapenem-resistant (CR), or multidrug-resistant (MDR; as per Centers for Disease Control and Prevention criteria) GNB. Categories were not mutually exclusive. Results A total of 775 hospitalized adults and 357 community dwellers were enrolled. Among hospitalized subjects, the prevalence of colonization with FQR, ESCR, CR, or MDR-GNB was 46.4% (95% confidence interval [CI], 42.9-50.0), 41.2% (95% CI, 37.7-44.6), 14.5% (95% CI, 12.0-16.9), and 26.3% (95% CI, 23.2-29.4). In the community, the prevalence of FQR, ESCR, CR, and MDR-GNB colonization was 39.5% (95% CI, 34.4-44.6), 28.9% (95% CI, 24.2-33.6), 5.6% (95% CI, 3.2-8.0), and 4.8% (95% CI, 2.6-7.0), respectively. Conclusions A high burden of antimicrobial-resistant GNB colonization was observed in this sample of hospitalized and community-dwelling adults, suggesting that the community is a relevant source of antibiotic resistance. Efforts are needed to understand the relatedness between resistant strains circulating in the community and hospitals.
- ItemImpact of inappropriate empirical antibiotic therapy on in-hospital mortality: a retrospective multicentre cohort study of patients with bloodstream infections in Chile, 2018–2022(2024) Allel, Kasim; Peters, Anne; Furuya-Kanamori, Luis; Spencer-Sandino, Maria; Pitchforth, Emma; Yakob, Laith; Munita, José M.; Undurraga Fourcade, Eduardo AndrésIntroduction: Empirical antibiotic therapy is essential for treating bloodstream infections (BSI), yet there is limited evidence from resource-limited settings. We quantified the association of inappropriate empirical antibiotic therapy (IEAT) with in-hospital mortality and the associated burden on BSI patients in Chile. Methods: We used a retrospective multicentre cohort study of BSI cases in three Chilean tertiary hospitals (2018–2022) to assess the impact of IEAT on 30-day and overall in-hospital mortality and quantify excess disease and economic burdens associated with IEAT. We determined the appropriateness of pathogen-antimicrobial pairings based on in vitro susceptibilities and pathogen-corresponding antibiotic treatment, allowing a 48-hour window after the initial blood culture. We addressed confounding using propensity scores and inverse probability weights (IPW). We used IPW-weighted logistic competing-risk survival models, including time-varying independent variables after blood tests as controls. Results: Among 1323 BSI episodes, 432 (33%) received IEAT, with an average time to adequate therapy of 4.6 days. Compared with adequate treatment, IEAT was associated with 30-day and overall mortality risks that were 1.31 and 1.24 times higher, respectively. These risks were further inflated between twofold and fourfold when antibiotic-resistant bacteria (ARB) was included. Competing-risk models showed associations between IEAT and IEAT-ARB combinations with in-hospital mortality. Accounting for time-varying variables yielded similar results. The economic burden of IEAT resulted in an additional cost of ~US$9900 from premature mortality and 0.46 disability-adjusted life-years per patient with BSI. Conclusión: Approximately one in three patients received IEAT, often associated with ARB. IEAT was linked to increased mortality risk and higher economic costs. Timely appropriate treatment, early pathogen detection and resistance profiling are likely to improve health and financial outcomes at the population level.
- ItemLives lost and disease burden related to antimicrobial resistance in the Americas can no longer be ignored(2023) Undurraga Fourcade, Eduardo Andrés; Peters, Anne; Arias, Cesar A.; Munita, Jose M.