Browsing by Author "Rojas, Pamela"

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    A Multicenter Study To Evaluate Ceftaroline Breakpoints : Performance in an Area with High Prevalence of Methicillin-Resistant Staphylococcus aureus Sequence Type 5 Lineage
    (2019) Khan, Ayesha; Rivas, Lina M.; Spencer, María; Martínez, Rodrigo; Lam, Marusella; Rojas, Pamela; Porte, Lorena; Silva, Francisco; Braun, Stephanie; García Cañete, Patricia; Valdivieso, Francisca; Mvlhauser, Margareta; Lafourcade, Mónica; Miller, William R.; Arias, César A.; Munita, José M.
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    Association between zinc nutritional status and glycemic control in individuals with well-controlled type-2 diabetes
    (2018) Perez, Alvaro; Rojas, Pamela; Carrasco, Fernando; Basfi-Fer, Karen; Perez-Bravo, Francisco; Codoceo, Juana; Inostroza, Jorge; Galgani Fuentes, José; Gilmore, L. Anne; Ruz, Manuel
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    Critical analysis of an article: antibiotics in acute media otitis, are they necessary? Is there any subgroup that benefits?
    (SOC MEDICA SANTIAGO, 2012) Rojas, Pamela; Rada, Gabriel
    Background: Acute otitis media (AOM) is one of the most common diseases in early infancy and childhood. Antibiotic use for AOM varies from 56% in the Netherlands to 95% in the USA and Australia. Objectives: To assess the effects of antibiotics for children with AOM. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008, issue 2) which contains the Acute Respiratory Infections (ART) Group's Specialized Register; MEDLINE (1966 to June week 42008); OLDMEDLINE (1958 to 1965); EMBASE (January 1990 to July 2008); and Current Contents (1966 to July 2008). Selection criteria: Randomised controlled trials comparing 1) antimicrobial drugs with placebo 2) immediate antibiotic treatment with observational treatment approaches ill children with AOM. Data collection and analysis: Three review authors independently assessed trial quality and extracted data. Main results: We found 10 trials (2928 children) from high income countries with low risk of bias. Pain was not reduced by antibiotics at 24 hours, but was at two to seven days, (relative risk (RR) 0.72; 95% confidence interval 0.62 to 0.83). However four trials (1271 children) comparing antibiotics prescribed immediately rather than initial observation found no difference at three to seven days. Antibiotics did not reduce tympanometry, perforation or recurrence. The only case of mastoiditis was in an antibiotic treated child. Vomiting, diarrhoea or rash was higher in children taking antibiotics (RR 1.37; 95% CI 1.09 to 1.76). Individual patient data meta-analysis of a subset of the included trials found antibiotics to be most beneficial in children: aged less than two; with bilateral AOM and with both AOM and otorrhoea. Authors' conclusions: Antibiotics slightly reduce the number of children with acute middle ear infection experiencing pain after a few days. However, most (78%) settle spontaneously in this time, meaning 16 children must be treated to prevent one suffering ear pain. This benefit must be weighed against the possible harms: 1 in 24 children experience symptoms caused by antibiotics. Antibiotics are most useful in children under two years of age, with bilateral AOM, and with both AOM and discharging ears. For most other children with mild disease, an expectant observational approach seems justified. We have no data on populations with higher risks of complications.
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    Real-World Performance of Susceptibility Testing for Ceftolozane/Tazobactam against Non-Carbapenemase- Producing Carbapenem-Resistant Pseudomonas aeruginosa
    (2022) Rivas, Lina; Martinez, José R.W.; Munita, José M.; Alcalde-Rico, Manuel; Olivares Pacheco, Jorge; García Cañete, Patricia; Olivares-Pacheco J.; Moreno, María Victoria; Rojas, Pamela; Wozniak Banchero, Aniela; Miller, William; Arias, Cesar A.; Khan, Ayesha
    Ceftolozane/tazbactam (C/T) is a potent anti-pseudomonal agent that has clinical utility against infections caused by non-carbapenemase, producing-carbapenemresistant Pseudomonas aeruginosa (non-CP-CR-PA). Accurate, precise, and reliable antimicrobial susceptibility testing (AST) is crucial to guide clinical decisions. However, studies assessing the performance of different AST methods against non-CP-CR-PA (the main clinical niche for C/T), are lacking. Here, we evaluated performance of gradient strips (Etest and MIC test strip [MTS], and disk diffusion [DD]) using CLSI breakpoints. Additionally, we assessed the performance of DD using EUCAST breakpoints. For all susceptibility tests, we used a collection of 97 non-CP-CR-PA clinical isolates recovered from 11 Chilean hospitals. Both gradient strips and DD had acceptable performance when using CLSI breakpoints, yielding a categorical agreement (CA) of .90% and 92%, respectively. In contrast, DD using EUCAST breakpoints performed suboptimally (CA 81%). MTS yielded a higher essential agreement (EA, .90%) than Etest (84%). Importantly, the performance of all methods varied significantly when the isolates were stratified by their degree of susceptibility to other anti-pseudomonal b-lactams. All methods had 100% CA when testing isolates that were pan-susceptible to all b-lactams (Pan-β-S). However, the CA markedly decreased when testing isolates resistant to all b-lactams (Pan-β-R). Indeed, the CA was 81% for Etest (six errors), 78% for MTS (seven errors), and 78% and 56% for DD when using CLSI (seven errors) or EUCAST breakpoints (14 errors), respectively. Our results suggest that all manual AST methods have strikingly decreased performance in the context of Pan-β-R P. aeruginosa with potentially major clinical implications.