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In the first decade of the twenty-first century, Latin America experienced a so-called left turn that sought either to reform or eliminate the neoliberal institutions established during the 1980s and 1990s. However, although Peru has electoral, economic, and social processes similar to those of its neighbors, the neoliberal institutions established in Peru by the 1993 Constitution remain firmly in place. This article aims to understand the mechanisms sustaining Peru's neoliberal regime since its creation. Why have these institutions survived and grown in strength in a regional environment that has been hostile to neoliberal legacies? The article answers that question, emphasizing the evolution of the balance of power between the precarious Peruvian political class and the empowered technocrats and bureaucrats within the state. The reformist politicians are too weak and amateurish to challenge the technobureaucrats within the state. Moreover, the article analyzes the different strategies deployed by technocrats and bureaucrats in order to ensure the continuity and stability of the neoliberal regime and its policies. Theoretically, the article suggests that institutional stability can arise from a daily process gradually shaped by actors and their strategies.
Although Peru’s political system has long been depicted as a “democracy without parties,” several recent studies have suggested that Fujimorismo might posses the assets to become the sole Peruvian political party. In this chapter, we evaluate this proposition using the conceptual framework set out by volume’s editors. We find that Fujimorismo is a loose electoral coalition that, in vertical terms, lacks the stable social links required to aggregate interests. In horizontal terms, Fujimorismo can only coordinate politicians to a limited degree. Finally, our study suggests that even when Fujimorismo performs both horizontal and vertical functions, it is a party that has shown a tendency to use its organizational assets to erode democracy and not to strengthen it.
To perform active targeted prospective surveillance to measure device-associated infection (DAI) rates, attributable mortality due to DAI, and the microbiological and antibiotic resistance profiles of infecting pathogens at 10 intensive care units (ICUs) in 9 hospitals in Colombia, all of which are members of the International Infection Control Consortium.
We conducted prospective surveillance of healthcare-associated infection in 9 hospitals by using the definitions of the US Centers for Disease Control and Prevention National Nosocomial Surveillance System (NNIS). DAI rates were calculated as the number of infections per 100 ICU patients and per 1,000 device-days.
During the 3-year study, 2,172 patients hospitalized in an ICU for an aggregate duration of 14,603 days acquired 266 DAIs, for an overall DAI rate of 12.2%, or 18.2 DAIs per 1,000 patient-days. Central venous catheter (CVC)–related bloodstream infection (BSI) (47.4% of DAIs; 11.3 cases per 1,000 catheter-days) was the most common DAI, followed by ventilator-associated pneumonia (VAP) (32.3% of DAIs; 10.0 cases per 1,000 ventilator-days) and catheter-associated urinary tract infection (CAUTI) (20.3% of DAIs; 4.3 cases per 1,000 catheter-days). Overall, 65.4% of all Staphylococcus aureus infections were caused by methicillin-resistant strains; 40.0% of Enterobacteriaceae isolates were resistant to ceftriaxone and 28.3% were resistant to ceftazidime; and 40.0% of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones, 50.0% were resistant to ceftazidime, 33.3% were resistant to piperacillin-tazobactam, and 19.0% were resistant to imipenem. The crude unadjusted attributable mortality was 16.9% among patients with VAP (relative risk [RR], 1.93; 95% confidence interval [CI], 1.24-3.00; P = .002); 18.5 among those with CVC-associated BSI (RR, 2.02; 95% CI, 1.42-2.87; P<.001); and 10.5% among those with CAUTI (RR, 1.58; 95% CI, 0.78-3.18; P = .19).
The rates of DAI in the Colombian ICUs were lower than those published in some reports from other Latin American countries and were higher than those reported in US ICUs by the NNIS. These data show the need for more-effective infection control interventions in Colombia.
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