Browsing by Author "Araos, Rafael"
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- ItemDaptomycin: pharmacological characteristics and its role in the treatment of gram positive infections(SOC CHILENA INFECTOLOGIA, 2012) Araos, Rafael; Garcia, Patricia; Chanqueo, Leonardo; Labarca, JaimeDaptomycin recently made available in Chile, belongs to a new family of antimicrobials known as lypopeptides. Daptomycin has a unique mechanism of action and a potent bactericidal activity over susceptible agents. It is active against a number of clinically significant Gram positive cocci, including strains of Staphylococcus aureus and Enterococcus spp., both susceptible and resistant to classic antimicrobials. Daptomycin has been approved for clinical use in skin and soft tissue infections, and for S. aureus bacteremia in adult patients. Ongoing trials suggest that daptomycin is also useful in the treatment of other infections such as osteomyelitis, biofilm producing infections, and in immunocompromised patients, particularly onco-hematologic patients. The main adverse reaction associated with daptomycin use is myopathy, usually mild and reversible.
- ItemEffectiveness and duration of a second COVID-19 vaccine booster(2022) Jara, Alejandro; Cuadrado, Cristobal; Undurraga Fourcade, Eduardo Andrés; García, Christian; Najera, Manuel; Bertoglia, María Paz; Vergara, Verónica; Fernández, Jorge; García, Heriberto; Araos, RafaelUsing a prospective national cohort of 3.75 million individuals aged 20 or older, we evaluated the effectiveness against COVID-19 related ICU admissions and death of mRNA-based second vaccine boosters for four different three-dose background regimes: BNT162b2 primary series plus a homologous booster, and CoronaVac primary series plus an mRNA booster, a homologous booster, and a ChAdOx-1 booster. We estimated the vaccine effectiveness weekly from February 14 to August 15, 2022, by estimating hazard ratios of immunization over non-vaccination, accounting for relevant confounders. The overall adjusted effectiveness of a second mRNA booster shot was 88.2% (95%CI, 86.2-89.9) and 90.5% (95%CI 89.4-91.4) against ICU admissions and death, respectively. Vaccine effectiveness showed a mild decrease for all regimens and outcomes, probably associated with the introduction of BA.4 and BA.5 Omicron sub-lineages and immunity waning. The duration of effectiveness suggests that no additional boosters are needed six months following a second booster shot.
- ItemEffectiveness of an inactivated SARS-CoV-2 vaccine in children and adolescents: a large-scale observational study(ELSEVIER, 2023) Jara, Alejandro; Undurraga, Eduardo A.; Flores, Juan Carlos; Zubizarreta, Jose R.; Gonzalez, Cecilia; Pizarro, Alejandra; Ortuno-Borroto, Duniel; Acevedo, Johanna; Leo, Katherinne; Paredes, Fabio; Bralic, Tomas; Vergara, Veronica; Leon, Francisco; Parot, Ignacio; Leighton, Paulina; Suarez, Pamela; Rios, Juan Carlos; Garcia-Escorza, Heriberto; Araos, RafaelBackground Policymakers urgently need evidence to adequately balance the costs and benefits of mass vaccination against COVID-19 across all age groups, including children and adolescents. In this study, we aim to assess the effectiveness of CoronaVac's primary series among children and adolescents in Chile. Methods We used a large prospective national cohort of about two million children and adolescents 6-16 years to estimate the effectiveness of an inactivated SARS-CoV-2 vaccine (CoronaVac) in preventing laboratory-confirmed symptomatic SARS-CoV-2 infection (COVID-19), hospitalisation, and admission to an intensive care unit (ICU) associated with COVID-19. We compared the risk of individuals treated with a complete primary immunization schedule (two doses, 28 days apart) with the risk of unvaccinated individuals during the follow-up period. The study was conducted in Chile from June 27, 2021, to January 12, 2022, when the SARS-CoV-2 Delta variant was predominant but other variants of concern were co-circulating, including Omicron. We used inverse probability-weighted survival regression models to estimate hazard ratios of complete immunization over the unvaccinated status, accounting for time-varying vaccination exposure and adjusting for relevant demographic, socioeconomic, and clinical confounders.Findings The estimated adjusted vaccine effectiveness for the inactivated SARS-CoV-2 vaccine in children aged 6-16 years was 74.5% (95% CI, 73.8-75.2), 91.0% (95% CI, 87.8-93.4), 93.8% (95% CI, 87.8-93.4) for the prevention of COVID-19, hospitalisation, and ICU admission, respectively. For the subgroup of children 6-11 years, the vaccine effectiveness was 75.8% (95% CI, 74.7-76.8) for the prevention of COVID-19 and 77.9% (95% CI, 61.5-87.3) for the prevention of hospitalisation.Interpretation Our results suggest that a complete primary immunization schedule with the inactivated SARS-CoV-2 vaccine provides effective protection against severe COVID-19 disease for children 6-16 years.Copyright & COPY; 2023 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
- ItemEffectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile(MASSACHUSETTS MEDICAL SOC, 2021) Jara, Alejandro; Undurraga, Eduardo A.; Gonzalez, Cecilia; Paredes, Fabio; Fontecilla, Tomas; Jara, Gonzalo; Pizarro, Alejandra; Acevedo, Johanna; Leo, Katherine; Leon, Francisco; Sans, Carlos; Leighton, Paulina; Suarez, Pamela; Garcia Escorza, Heriberto; Araos, RafaelInactivated SARS-CoV-2 Vaccine in Chile In a national prospective cohort study involving 10.2 million participants in Chile, the effectiveness of an inactivated SARS-CoV-2 vaccine, which had been developed in China and administered in two doses 28 days apart, was estimated. Effectiveness among fully immunized persons was estimated at 65.9% for Covid-19 and at 87.5% for hospitalization, 90.3% for ICU admission, and 86.3% for death.
- ItemEffectiveness of an Inactivated SARS-CoV-2 Vaccine REPLY(MASSACHUSETTS MEDICAL SOC, 2021) Jara, Alejandro; Undurraga, Eduardo A.; Araos, Rafael
- ItemEffectiveness of an Inactivated SARS-CoV-2 Vaccine. Reply(2021) Jara Vallejos, Alejandro Antonio; Undurraga Fourcade, Eduardo Andrés; Araos, Rafael
- ItemEffectiveness of CoronaVac in children 3-5 years of age during the SARS-CoV-2 Omicron outbreak in Chile(NATURE PORTFOLIO, 2022) Jara, Alejandro; Undurraga, Eduardo A.; Zubizarreta, Jose R.; Gonzalez, Cecilia; Acevedo, Johanna; Pizarro, Alejandra; Vergara, Veronica; Soto-Marchant, Mario; Gilabert, Rosario; Flores, Juan Carlos; Suarez, Pamela; Leighton, Paulina; Eguiguren, Pablo; Carlos Rios, Juan; Fernandez, Jorge; Garcia-Escorza, Heriberto; Araos, RafaelThe outbreak of the B.1.1.529 lineage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Omicron) has caused an unprecedented number of Coronavirus Disease 2019 (COVID-19) cases, including pediatric hospital admissions. Policymakers urgently need evidence of vaccine effectiveness in children to balance the costs and benefits of vaccination campaigns, but, to date, the evidence is sparse. Leveraging a population-based cohort in Chile of 490,694 children aged 3-5 years, we estimated the effectiveness of administering a two-dose schedule, 28 days apart, of Sinovac's inactivated SARS-CoV-2 vaccine (CoronaVac). We used inverse probability-weighted survival regression models to estimate hazard ratios of symptomatic COVID-19, hospitalization and admission to an intensive care unit (ICU) for children with complete immunization over non-vaccination, accounting for time-varying vaccination exposure and relevant confounders. The study was conducted between 6 December 2021 and 26 February 2022, during the Omicron outbreak in Chile. The estimated vaccine effectiveness was 38.2% (95% confidence interval (CI), 36.5-39.9) against symptomatic COVID-19, 64.6% (95% CI, 49.6-75.2) against hospitalization and 69.0% (95% CI, 18.6-88.2) against ICU admission. The effectiveness against symptomatic COVID-19 was modest; however, protection against severe disease was high. These results support vaccination of children aged 3-5 years to prevent severe illness and associated complications and highlight the importance of maintaining layered protections against SARS-CoV-2 infection.
- ItemEffectiveness of the second COVID-19 booster against Omicron: a large-scale cohort study in Chile(2023) Jara Vallejos, Alejandro Antonio; Cuadrado, Cristóbal; Undurraga Fourcade, Eduardo Andrés; García, Christian; Nájera, Manuel; Bertoglia, María Paz; Vergara, Verónica; Fernández, Jorge; García-Escorza, Heriberto; Araos, RafaelIn light of the ongoing COVID-19 pandemic and the emergence of new SARSCoV-2 variants, understanding the effectiveness of various booster vaccination regimens is pivotal. In Chile, using a prospective national cohort of 3.75 million individuals aged 20 or older, we evaluate the effectiveness against COVID-19- related intensive care unit (ICU) admissions and death of mRNA based second vaccine boosters for four different three-dose background regimes: BNT162b2 primary series followed by a homologous booster, and CoronaVac primary series followed by an mRNA booster, a homologous booster, and a ChAdOx-1 booster. We estimate the vaccine effectiveness weekly from February 14 to August 15, 2022, by determining hazard ratios of immunization over nonvaccination, accounting for relevant confounders. The overall adjusted effectiveness of a second mRNA booster shot is 88.2% (95%CI, 86.2–89.9) against ICU admissions and 90.5% (95%CI 89.4–91.4) against death. Vaccine effectiveness shows a mild decrease for all regimens and outcomes,probably linked to the introduction of BA.4 and BA.5 Omicron sub-lineages and the waning ofimmunity. Based on our findings, individuals might not need additional boosters for at least 6 months after receiving a second mRNA booster shot in this setting.
- 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.
- ItemIsolation of Ciprofloxacin and Ceftazidime-Resistant Enterobacterales From Vegetables and River Water Is Strongly Associated With the Season and the Sample Type(FRONTIERS MEDIA SA, 2021) Diaz Gavidia, Constanza; Barria, Carla; Rivas, Lina; Garcia, Patricia; Alvarez, Francisca P.; Gonzalez Rocha, Gerardo; Opazo Capurro, Andres; Araos, Rafael; Munita, Jose M.; Cortes, Sandra; Olivares Pacheco, Jorge; Adell, Aiko D.; Moreno Switt, Andrea I.The dissemination of antibiotic-resistant bacteria (ARB) from water used for crop irrigation to vegetables is poorly studied. During a year, five farmer markets in a city in Central Chile were visited, and 478 vegetable samples (parsleys, corianders, celeries, lettuces, chards, and beets) were collected. Simultaneously, 32 water samples were collected from two rivers which are used to irrigate the vegetables produced in the area. Resistant Enterobacterales were isolated and identified. Colistin resistance gene mcr-1 and extended spectrum beta-lactamases (ESBL) were molecularly detected. The association of environmental factors was evaluated, with the outcomes being the presence of Enterobacterales resistant to four antibiotic families and the presence of multidrug resistance (MDR) phenotypes. Parsley, coriander, and celery showed the highest prevalence of resistant Enterobacterales (41.9% for ciprofloxacin and 18.5% for ceftazidime). A total of 155 isolates were obtained, including Escherichia coli (n = 109), Citrobacter sp. (n = 20), Enterobacter cloacae complex (n = 8), Klebsiella pneumoniae (n = 8), and Klebsiella aerogenes (n = 1). Resistance to ampicillin (63.2%) and ciprofloxacin (74.2%) was most frequently found; 34.5% of the isolates showed resistance to third-generation cephalosporins, and the MDR phenotype represented 51.6% of the isolates. In two E. coli isolates (1.29%), the gene mcr-1 was found and ESBL genes were found in 23/62 isolates (37%), with bla(CTX-M) being the most frequently found in 20 isolates (32%). Resistant Enterobacterales isolated during the rainy season were less likely to be MDR as compared to the dry season. Understanding environmental associations represent the first step toward an improved understanding of the public health impact of ARB in vegetables and water.
- ItemReduced microbial diversity of the nasopharyngeal microbiome in household contacts with latent tuberculosis infection(NATURE PORTFOLIO, 2023) Ruiz-Tagle Seguel, Cinthya Grace; Ugalde, Juan A.; Naves Pichuante, Rodrigo Antonio; Araos, Rafael; Garcia Canete, Patricia Del Carmen; Balcells Marty, Maria ElviraThe upper respiratory tract is an obliged pathway for respiratory pathogens and a healthy microbiota may support the host's mucosal immunity preventing infection. We analyzed the nasopharyngeal microbiome in tuberculosis household contacts (HHCs) and its association with latent tuberculosis infection (TBI). A prospective cohort of HHCs was established and latent TBI status was assessed by serial interferon-& gamma; release assay (IGRA). Nasopharyngeal swabs collected at baseline were processed for 16S rRNA gene sequencing. The 82 participants included in the analysis were classified as: (a) non-TBI [IGRA negative at baseline and follow-up, no active TB (n = 31)], (b) pre-TBI [IGRA negative at baseline but converted to IGRA positive or developed active TB at follow-up (n = 16)], and (c) TBI [IGRA positive at enrollment (n = 35)]. Predominant phyla were Actinobacteriota, Proteobacteria, Firmicutes and Bacteroidota. TBI group had a lower alpha diversity compared to non-TBI (p(adj) = 0.04) and pre-TBI (p(adj) = 0.04). Only TBI and non-TBI had beta diversity differences (p(adj) = 0.035). Core microbiomes' had unique genera, and genus showed differential abundance among groups. HHCs with established latent TBI showed reduced nasopharyngeal microbial diversity with distinctive taxonomical composition. Whether a pre-existing microbiome feature favors, are a consequence, or protects against Mycobacterium tuberculosis needs further investigation.
- ItemTool for Estimating the Probability of Having COVID-19 With 1 or More Negative RT-PCR Results(2021) Jara, Alejandro ; Undurraga, Eduardo A. ; Araos, Rafael
- ItemTransmission of gram-negative antibiotic-resistant bacteria following differing exposure to antibiotic-resistance reservoirs in a rural community: a modelling study for bloodstream infections(NATURE PORTFOLIO, 2022) Allel, Kasim; Gosce, Lara; Araos, Rafael; Toro, Daniel; Ferreccio, Catterina; Munita, Jose M.; Undurraga, Eduardo A.; Panovska-Griffiths, JasminaExposure to community reservoirs of gram-negative antibiotic-resistant bacteria (GN-ARB) genes poses substantial health risks to individuals, complicating potential infections. Transmission networks and population dynamics remain unclear, particularly in resource-poor communities. We use a dynamic compartment model to assess GN-ARB transmission quantitatively, including the susceptible, colonised, infected, and removed populations at the community-hospital interface. We used two side streams to distinguish between individuals at high- and low-risk exposure to community ARB reservoirs. The model was calibrated using data from a cross-sectional cohort study (N = 357) in Chile and supplemented by existing literature. Most individuals acquired ARB from the community reservoirs (98%) rather than the hospital. High exposure to GN-ARB reservoirs was associated with 17% and 16% greater prevalence for GN-ARB carriage in the hospital and community settings, respectively. The higher exposure has led to 16% more infections and attributed mortality. Our results highlight the need for early-stage identification and testing capability of bloodstream infections caused by GN-ARB through a faster response at the community level, where most GN-ARB are likely to be acquired. Increasing treatment rates for individuals colonised or infected by GN-ARB and controlling the exposure to antibiotic consumption and GN-ARB reservoirs, is crucial to curve GN-ABR transmission.