Introducción: Durante los XX últimos años, Acinetobacter baumannii se ha posicionado como una de las principales infecciones intrahospitalarias resistentes a antibióticos. A. baumannii multidrogoresistente (MDR) está considerado por la OMS dentro del grupo más crítico de resistencia. Uno de los mecanismos de resistencia identificados en dicho patógeno son las bombas de eflujo, por lo que, se han desarrollado inhibidores de las mismas, generando así menos resistencia por parte de las bacterias hacia los antibióticos. Objetivos: En nuestro estudio, el objetivo fue evaluar el efecto de la adición del inhibidor de bomba de eflujo CCCP sobre la actividad bactericida de imipenem y cefepime en cepas de A. baumannii Métodos: 49 cepas aisladas como A. baumannii fueron obtenidas en el Hospital Regional de Cajamarca. Mediante técnicas moleculares en el laboratorio de Biología Molecular de la Universidad Peruana de Ciencias Aplicadas (UPC) se confirmaron 47 cepas positivas para A. baumannii. Se utilizó PCR- en tiempo real para identificar el gen blaOXA-51-like y para la determinación de la CMI el método de microdilución en caldo. Finalmente se añadió el inhibidor CCCP para poder evaluar si efecto sobre los antibióticos Resultados: Un total de 49 cepas aisladas de A. baumannii fueron obtenidas en el Hospital Regional de Cajamarca. Se determinó la susceptibilidad antimicrobiana mediante la concentración mínima inhibitoria y la actividad de la bomba de eflujo fue evaluada usando CCCP. Conclusiones: Las bombas de eflujo puede jugar un rol importante en la resistencia antibiótica de A. baumannii. El inhibidor CCCP junto a imipenem y cefepime, mejora la sensibilidad antibiótica. Asimismo, nuevas estrategias terapéuticas son requeridas para eliminar el transporte de eflujo de las cepas resistentes que causan infecciones nosocomiales / Introduction: In the last years the rapid expansion of multidrug-resistant A. baumannii strains have become a major health problem. Efflux pumps are a group of transport proteins that contribute to the development of antibiotic resistance. The aim of this study was to evaluate the effect of the efflux pump inhibitor carbonyl cyanide 3-chlorophenylhydrazone (CCCP) on the antimicrobial action of imipenem and cefepime on clinical strains of A. baumannii. Materials and methods: A total of 49 non-duplicate clinical samples were collected during January through December of 2018 from patients hospitalized in the Hospital Regional Docente de Cajamarca. Of the 49 samples obtained, the confirmatory identification of A. baumannii was performed on 47 samples by molecular methods. The amplification of the blaOXA-51-like gene was carried out by polymerase chain reaction (PCR). The determination of the minimum inhibitory concentration (MIC) was calculated using the microdilution method in culture broth. The susceptibility to both antibiotics (cefepime and imipenem) was evaluated in the presence and absence of the inhibitor carbonyl cyanide 3-chlorophenylhydrazone (CCCP). Results: A total of 47 strains of A. baumannii were isolated: 97.87% (46/47) were resistant to Imipenem, 2.13% (1/47) of them were classified as intermediate and none of these strains were susceptible. On the other hand, 51.06% (24/47) of isolates were resistant to cefepime; 19.15% (9/47) intermediate and 29.79% (14/47) susceptible. We considered a significant difference in antibiotic susceptibility if the MIC changed at least 4 dilutions, after the addition of the inhibitor. In the case of CCCP in addition to imipenem, 2.1% (1/47) had a significant change of 4 or more reductions in MIC, 59.6% (28/47) achieved a change equal or less than 3 dilutions and 17.0% (8/47) did not have any change. In the case of CCCP with cefepime the percentage of strains with the significant change of MIC was 8.5% (4/47). On the other hand, 53.2% (24/47) presented a reduction equal or less than 3 dilutions and 12.8% (6/47) did not show changes. Conclusion: In conclusion, our results demonstrate that the use of CCCP may improve the antibiotic effect of imipenem and cefepime on clinical strains of A. baumannii. The relevance of this study is that it provides evidence that this efflux pump inhibitor may be an alternative treatment against multidrug-resistant A. baumannii. / Tesis

Antibiotic resistance is one of the greatest global threats we face today. Human overuse ofantibiotics is a contributing factor and major behaviour change around antibioticconsumption is needed, but several challenges exist in communicating antibiotic resistanceto the public. In 2018 the UK Government relaunched a national television advertisement aspart of the ‘Keep Antibiotics Working’ campaign which aimed to raise awareness of antibioticresistance and reduce public demand for antibiotics. This study evaluates what role theframing of antibiotic resistance in the advertisement played in increasing publicunderstanding of antibiotic resistance and motivating behaviour change. The study isgrounded in behaviour change and health communication theory from the field ofCommunication for Development, and health and social psychology theory, reflecting theneed for multidisciplinary approaches to addressing antibiotic resistance. A textual analysisidentified how the issue was framed in the advertisement and surveys and interviews wereconducted with members of the target audience groups to analyse what effect theadvertisement had on their understanding of, and attitude towards antibiotic resistance.The findings show that the framing of antibiotic resistance in the TV advertisement led to anincrease in misunderstandings of what becomes resistant to antibiotics. The advertisementwas helpful in highlighting the vulnerability of antibiotics and for creating a new social normaround being a responsible antibiotic user, however was interpreted as childish byparticipants. It did not communicate the severity of antibiotic resistance or specific risk ofantibiotic overuse to the audience, or accurately reflect the audience’s existing knowledge ofantibiotic resistance and current behaviours. As the severity of antibiotic resistance was notconveyed, the advertisement did not motivate a change in antibiotic seeking behaviours orattitude amongst the majority of participants. The findings did highlight knowledge gapsamongst study participants including the importance of completing a course of antibiotics asprescribed, and that it is the bacteria itself, not the person, that develops resistance, andhopes this research can inform the development of future campaigns.

La résistance bactérienne aux antibiotiques est un problème de santé publique majeur, touchant plus particulièrement les enfants dans les pays en développement (PED).Nous avons effectué une revue systématique de la littérature pour quantifier le niveau de résistance aux antibiotiques chez les enfants âgés de moins de 2 ans dans les PED. De manière générale, les données sur la résistance aux antibiotiques dans la population étudiées sont rares. Selon les publications identifiées, Staphylococcus aureus, Escherichia coli, et Klebsiella spp. apparaissent comme les causes les plus fréquentes d’infections néonatales sévères. Chez les enfants âgés de 1 à 24 mois, Streptococcus pneumoniae et Salmonella spp. apparaissent comme les causes les plus fréquentes d’infections bactériennes invasives.Dans une seconde revue systématique, nous avons examiné les méthodologies actuelles utilisées pour mesurer la consommation d’antibiotiques dans les PED.Nos résultats montrent qu’aucunes des méthodologiesne permet, à elle seule, de répondre aux besoins de ces pays en terme de données.Nous avons conduit une enquête en population à Madagascar et au Sénégal afin d’examiner les modalités de consommation d’antibiotiques chez des enfants de moins de 2 ans. Dans les 2 pays, la plupart des antibiotiques étaient achetés en pharmacie sur présentation d’une ordonnance. Une proportion élevée des antibiotiques était utilisée pour le traitement d’infections probablement d’origine virale. Des facteurs tels que la disponibilité de centres de santé, de pharmacies, l’existence de programmes de remboursement ou encore la formation du personnel pourraient influencer la fréquence de consommations d’antibiotiques au niveau national.Les résultats issus de ces travaux de recherche ajoutent des données essentielles à la littérature existante et mettent en évidence des leçons importantes pour la lutte contre la résistance aux antibiotiques dans les PEDs. / Antimicrobial resistance is a growing threat across the world and is likely to disproportionately affect children in low-income countries (LICs).To estimate the burden of antibiotic resistance in the community among children under two in LICs we undertook a review of published literature. Common isolates in neonatal sepsis cases included Staphylococcus aureus, Escherichia coli, and Klebsiella. Among children 1 mo. to 2 yrs., Streptococcus pneumonia and Salmonella were most often reported. Information on antibiotic resistance was sparse and often relied on few isolates.We reviewed methods to measure antibiotic consumption in LICs from published literature and showed that current techniques used in isolation are insufficient to respond to all the data needs in LICs. Integrating study techniques and starting with community surveys may respond more adequately to this issue in LICs and lead to more actionable results.To investigate patterns of antibiotic consumption and related factors among children under two in Madagascar and Senegal we undertook community surveys in two sites in Madagasgar (Antananarvo and Moramanga) and one site in Senegal. Results showed relatively high levels of antibiotic use among children. The majority of antibiotics were purchased in pharmacies with a prescription in both countries. Data suggest a high proportion of use for likely viral infections. Local contexts including the availability of health care facilities, availability of pharmacies, national payment schemes, and provider training seemed to play a role in country usage rates.Results from this work add essential data to the literature where relatively little data exists and reveal important lessons about studying and combating antibiotic resistance in LICs.

Introduktion: Antibiotikaresistens är ett globalt hot mot folkhälsan. Resistensen gör att det blir svårare att bota infektioner och sjukdomar. Idag är det även lättare att resa mellan olika länder, vilket underlättar smittspridningen av resistenta bakterier. Personer utsätter sig för onödiga risker när de reser, framför allt gällande resor till länder med stor problematik av antibiotikaresistenta bakterier. Syfte: Syftet med studien var att undersöka vuxna personers resvanor och deras samband med kunskap om antibiotikaresistenta bakterier. Metod: En enkätstudie delades på sociala medier som 80 st vuxna män och kvinnor besvarade. För att analysera materialet användes chi-två test i statistikprogrammet SPSS. Resultat: Det var få signifikanta resultat i studien, men det gick att se att det finns en kunskapsbrist när det kommer till antibiotikaresistenta bakterier. Riskbenägenheten skiljer sig mellan olika åldersgruppen och skulle kunna jämnas ut med mer kunskap. Det är även få som läst information från Folkhälsomyndigheten som är en stor kunskapskälla om resistenta bakterier och en viktig del i sprida kunskap. Slutsats: I studien gick det att se att mer kunskap om resistenta bakterier, dess risker och spridning behövs. Det gick också se att när information om reserestriktiner kom följde större delen av respondenterna detta. Detta skulle kunna betyda att folk lyssnar på råd och följer dem när de vet vad riskerna är. / Introduction: Antibiotic resistance is a global threat to public health. Resistance makes it more difficult to cure infections and diseases. Today, it is also easier to travel between different countries, which facilitates the spread of resistant bacteria. People are exposed to unnecessary risks when they travel, especially to countries with major problems with antibiotic resistance. Aim: The purpose of the study was to investigate adults' travel habits and their connection with knowledge about antibiotic resistant bacteria. Method: A survey was shared on social media, which was answered by 80 adult men and women. To analyze the material, chi-two tests were used in the statistical program SPSS. Results: There were few significant results in the study, but it could be seen that there is a lack of knowledge when it comes to antibiotic resistance. The willingness to take risks differs between different age groups and could be leveled out with more knowledge. There are also few who have read information from the Swedish Public Health Agency, which is a major source of knowledge about resistance and an important part of disseminating knowledge. Conclusion: The study showed that more knowledge about antibiotic resistance, its risks and spread is needed. It was also seen that when information about travel restrictions came, most of the respondents followed this. This could mean that people listen to advice and follow it when they know what the risks are.

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