[Prevention of an outbreak of Acinetobacter baumannii in intensive care units: study of the efficacy of different mathematical methods]

INTRODUCTION

Although in past decades, Acinetobacter baumanni infections have been sporadically identified in hospitals, nowadays the nosocomial infections due to this pathogen have notably increased. Its importance is due to its multidrug- resistance, morbidity and mortatility in healthcare settings. Consequently, it is important to predict the evolution of these outbreaks in order to stablish the most efficient control measures. There are several experimental studies shown that the compliance with hand and environmental hygiene and the efficient management of the healthcare work help to control the evolution of these outbreaks. The goal of this work is to formally proof these experimental results by means of the analysis of the results provided by the model.

METHODS

A stochastic mathematical model based on cellular automata was developed. The variables and parameters involved in it have been identified from the knowledge of the epidemiology and main characteristics of Acinetobacter infections.

RESULTS

The model provides several simulations from different initial conditions. The analysis of these results proofs in a formal way that the compliance with hand and environmental hygiene and an efficient plannification of the work of healtcare workers yield a decrease in the colonized patients. Moreover, this is the unique model proposed studying the dynamics of an outbreak of A. baumanni.

CONCLUSIONS

The computational implementation of the model provides us an efficient tool in the management of outbreaks due to A. baumanni. The analysis of the simulations obtained allows us to obtain a formal proof of the behaviour of the measures for control and prevention.

[Polio, the long walk to the endgame]

Although the WHO original target date for the global eradication of poliomyelitis was the year 2000 -thanks to vaccination and institutional, public and private, resources for that purpose-, in 2013 the disease remained endemic in three countries, Afghanistan, Pakistan and Nigeria, and some cases were described in five others. The circulation of wild type 1 poliovirus in Israel, Gaza and the West Bank and the cases in Syria were a wakeup call, as at that time there were polioviruses derived from the oral vaccine that are still circulating among the human population and can cause the development of the disease. Travelling "from" and "to" endemic areas are factors to consider in poliovirus exportation and in its spread when it reaches areas with poor immunogenicity. Wars, terrorism, intolerance, lack of culture and proliferation of anti-vaccine groups and the rise of the anti-vaccination movement are important factors in the maintenance and expansion of the virus and in the "non-vaccination" against it. Based on the international situation to date, the Emergency Committee of WHO met in May 2014 to address the problem. It is still necessary to enhance the knowledge of the disease and its agent. In the first case to perform a differential diagnosis of flaccid paralysis and to continue vaccination programs, and in the second case to keep studying and looking for the poliovirus in environmental samples, which is a model for the study of many other viruses.

[Matematical modeling of antibiotic resistance: perspectives from a meta-analysys]

The antibiotic resistance is one of the greatest challenges of the international health community. The study of antibiotic resistance must be a multidisciplinary task and, in this sense, the main goal of this work is to analyze the role that Mathematical Modeling can play in this scenario. A qualitative and cuantitative analysis of the works published in the scientific literature is done by means of a search in the most important databases: MEDLINE, SCOPUS and ISI Web of Science. Consequently, there are few papers related to our topic but the existing works have been published in high-quality and impact international journals. Moreover, we can state that mathematical models are a very important and useful tool to analyze and study both the treatments protocols for resistance prevention and the assesment of control strategies in hospital environtment, or the prediction of the evolution of diseases due to resistant strains.

In vitro activity of BAY y 3118, and nine other antimicrobial agents against anaerobic bacteria

The antibacterial activity of BAY y 3118, a new chlorofluoroquinolone, was determined against 257 strains of anaerobic bacteria and compared with the activities of ofloxacin, ciprofloxacin, sparfloxacin, imipenem, cefoxitin, clindamycin, chloramphenicol, metronidazole, and ornidazole. Overall, BAY y 3118 was the most active agent tested against the Bacteroides fragilis group. Its activity (MIC90, 0.5 mg/L) was 16-fold lower than that of sparfloxacin (MIC90, 8 mg/L), and more than 100-fold lower than that of ofloxacin (MIC90, 64 mg/L) and ciprofloxacin (MIC90, 128 mg/L) against the group. No strains belonging to this group were resistant to metronidazole (MICs range, 0.12-2 mg/L) and ornidazole (MICs range, 0.12-4 mg/L). BAY y 3118 was more active than those quinolones against Prevotella and Porphyromonas spp., Fusobacterium spp., Clostridium perfringens and C. difficile (MIC90, 0.12, 0.06, 0.12 and 0.25 mg/L, respectively). The activity of BAY y 3118 against Peptostreptococcus spp. (MIC90, 1 mg/L) was slightly lower than that of the other Gram-positive bacteria tested. In general, BAY y 3118 was more active than cefoxitin, and it was superior to antianaerobic chemical agents like metronidazole, ornidazole and clindamycin. Pharmacokinetic and clinical trials are required to define the role of BAY y 3118 in the treatment of anaerobic infections.