CC8 MRSA Strains Harboring SCCmec Type IVc are Predominant in Colombian Hospitals

BACKGROUND: Recent reports highlight the incursion of community-associated MRSA within healthcare settings. However, knowledge of this phenomenon remains limited in Latin America. The aim of this study was to evaluate the molecular epidemiology of MRSA in three tertiary-care hospitals in Medellín, Colombia. METHODS: An observational cross-sectional study was conducted from 2008-2010. MRSA infections were classified as either community-associated (CA-MRSA) or healthcare-associated (HA-MRSA), with HA-MRSA further classified as hospital-onset (HAHO-MRSA) or community-onset (HACO-MRSA) according to standard epidemiological definitions established by the U.S. Centers for Disease Control and Prevention (CDC). Genotypic analysis included SCCmec typing, spa typing, PFGE and MLST. RESULTS: Out of 538 total MRSA isolates, 68 (12.6%) were defined as CA-MRSA, 243 (45.2%) as HACO-MRSA and 227 (42.2%) as HAHO-MRSA. The majority harbored SCCmec type IVc (306, 58.7%), followed by SCCmec type I (174, 33.4%). The prevalence of type IVc among CA-, HACO- and HAHO-MRSA isolates was 92.4%, 65.1% and 43.6%, respectively. From 2008 to 2010, the prevalence of type IVc-bearing strains increased significantly, from 50.0% to 68.2% (p = 0.004). Strains harboring SCCmec IVc were mainly associated with spa types t1610, t008 and t024 (MLST clonal complex 8), while PFGE confirmed that the t008 and t1610 strains were closely related to the USA300-0114 CA-MRSA clone. Notably, strains belonging to these three spa types exhibited high levels of tetracycline resistance (45.9%). CONCLUSION: CC8 MRSA strains harboring SCCmec type IVc are becoming predominant in Medellín hospitals, displacing previously reported CC5 HA-MRSA clones. Based on shared characteristics including SCCmec IVc, absence of the ACME element and tetracycline resistance, the USA300-related isolates in this study are most likely related to USA300-LV, the recently-described 'Latin American variant' of USA300

High frequency of colonization by extended-spectrum beta-lactamase-producing Gram-negative bacilli in hemodialysis patients and their household contacts in Colombia: dissemination between the community and the hospital

OBJECTIVES Increasing colonization by beta-lactam-resistant Gram-negative bacilli (BR-GNB) represents a risk for infections and bacterial resistance spread, both in hospitals and the community. Hemodialysis patients and their household contacts regularly transit between these environments. This study investigated the clinical and epidemiological characteristics of BR-GNB colonization in hemodialysis patients and their household contacts, as well as the genetic relationship between their isolates. METHODS A cross-sectional study was conducted on hemodialysis patients at a hospital-associated dialysis center in Medellín, Colombia and their household contacts. Clinical and epidemiological information was collected. Colonization was assessed from stool or rectal swab samples. Bacterial identification and susceptibility were determined using chromogenic media and Vitek-2. Molecular characterization included beta-lactamase detection by polymerase chain reaction, multiple-locus sequence typing (MLST), pulsed-field gel electrophoresis, and identification of Escherichia coli phylogroups by the Clermont protocol. RESULTS This study included 36 hemodialysis patients and 90 household contacts. Colonization by BR-GNB occurred in 58.3% of patients and 22.2% of household contacts. The main beta-lactamase detected was CTX-M group-1 (40.5%). In 3 of the 9 homes that had more than 1 colonized individual, a genetic relationship was found. MLST showed a high diversity in E. coli isolates, and the most frequent phylogroups were B1 and B2. CONCLUSIONS These results show a high frequency of colonization and the presence of potentially pathogenic BR-GBN both in hospitals and the community. This highlights the importance of populations who move between those 2 environments, and the need to prevent the spread of bacterial resistance outside hospitals

Adverse events during the COVID-19 pandemic in Ecuador: high frequency of healthcare-associated infections and increasing hospital stay and costs

Summary: Background: The COVID-19 pandemic generated high workloads given the high volume of seriously ill patients; conditions that could increase the risk of adverse events (AE). This study analyzed the frequency of AE in patients with COVID-19 and their effect on mortality, hospital stay and costs. Methods: This retrospective cohort study included in-patients with COVID-19 at a single hospital between March 2020–June 2021. Exposure was the occurrence of at least one AE. Hospital stay, costs and death were considered outcomes. Clinical information and direct costs were obtained from medical and billing records. Generalized linear models were used to estimate the association measures. Results: 405 patients were included, 55.8% (n=226) men, median age 56 years (IQR: 41.0–70.0) and with a history of hypertension (26.2%; n=106), diabetes mellitus (13.8%; n=56) and obesity (13.8%; n=56). The incidence of AE was 13.3% (n=54), 29 patients presented more than one AE, for a total of 70 events. Most events (74.3%; n=52) were preventable and the most frequent were healthcare-associated infections (50%; n=35), phlebitis (14.3%; n=10) and pressure ulcers (12.9%; n=9). AE prolonged hospital stay (change rate: 1.57; 95%CI: 1.26–1.95; P=0.001) and increased direct healthcare costs (change rate: 1.20; 95% CI: 1.03–1.39, P=0.019). Likewise, the risk of death was 56% higher in patients with AE. Conclusion: Pandemics are unexpected events that present challenges to safe healthcare. Improving quality policies, monitoring compliance with protocols and providing ongoing education are strategies to prevent AE such as healthcare-associated infections, which increase hospital costs and stay

Efectividad de un programa multidisciplinario para el manejo de la obesidad: cambio en la calidad de vida y en los parámetros clínicos, fisiológicos y antropométricos

Resumen: Introducción: la obesidad es una enfermedad que se ha convertido en una preocupación importante de salud pública. El objetivo de esta investigación, fue analizar los cambios en la calidad de vida y en los parámetros clínicos, fisiológicos y antropométricos en los pacientes con obesidad, pertenecientes a un programa multidisciplinario para pérdida de peso. Materiales y métodos: estudio observacional de cohorte retrospectivo que incluyó pacientes con obesidad en un programa multidisciplinario. La comparación de las variables cuantitativas al ingreso y egreso del programa se realizó con la prueba de rangos con signo de Wilcoxon, mientras que las variables cualitativas fueron comparadas con la prueba de McNemar. El análisis estadístico fue realizado en el programa STATA V.15. Resultados: se analizaron 323 pacientes, se observó que la mediana del peso disminuyó 4,4 kg (p < 0,001). La adherencia a la actividad física aumentó de 30% (n = 97) a 90% (n = 289) (p < 0,001). De igual modo, la mediana del VO2 max aumentó de 23,6 (RIC 19,7-30,4) al ingreso a 32,9 (RIC 27,8–38,0) al egreso. En cuanto a la calidad de vida, el autocuidado fue una de las dimensiones con mayor impacto durante el programa, con una disminución en el reporte de dificultades extremas de 17,7% a 0,3%. Asimismo, la escala visual análoga (EVA) aumento la mediana de 50 (RIC 50-70) a 80 (RIC 70-90) (p < 0,001). Conclusión: el abordaje multidisciplinario de la obesidad ofrece un enfoque integral al paciente, impactando no solo los aspectos físicos, sino psicológicos y emocionales del problema mejorando su calidad de vida. Abstract: Introduction: Obesity is a disease that has become a major public health concern. The objective of this research was to analyze the changes in the quality of life and in clinical, physiological, and anthropometric parameters in patients with obesity, belonging to a multidisciplinary program for weight loss. Materials and methods: Observational retrospective cohort study that included obese patients in a multidisciplinary program. The comparison of quantitative variables at admission and discharge from the program was performed with the Wilcoxon signed rank test, while the qualitative variables were compared with the McNemar test. Statistical analysis was performed in the STATA V.15 program. Results: 323 patients were analyzed; it was shown that the median weight decreased 4.4 kg (p < 0.001). Adherence to physical activity increased from 30% (n = 97) to 90% (n = 289) (p < 0.001). Similarly, the median VO2 max increased from 23.6 (IQR 19.7-30.4) on admission to 32.9 (IQR 27.8-38) on discharge. Regarding quality of life, self-care was one of the dimensions with the greatest impact during the program, with a decrease in the report of extreme difficulties from 17.7% to 0.3%. Likewise, the visual analogue scale (VAS) increased the median from 50 (RIC 50-70) to 80 (RIC 70-90) (p < 0.001). Conclusion: The multidisciplinary approach to obesity offers a comprehensive approach to the patient, impacting not only physical, but also psychological and emotional aspects of the problem, improving her quality of life

Classification of MRSA infections according to CDC epidemiological criteria.

a<p>A: Largest hospital, B: Medium-sized hospital, C: Cardiologic hospital.</p>b<p>CA-MRSA: community-associated methicillin-resistant <i>Staphylococcus aureus.</i></p>c<p>HA-MRSA: healthcare-associated methicillin-resistant <i>Staphylococcus aureus.</i></p>d<p>HACO-MRSA: healthcare-associated, community-onset MRSA.</p>e<p>HAHO-MRSA: healthcare-associated, hospital-onset MRSA.</p

Molecular characteristics of MRSA isolates.

a<p>The most prevalent <i>sp</i>a type and SCC<i>mec</i> type are shown in boldface.</p>b<p>Number and percentage of isolates with a specific clonal complex (CC) and SCC<i>mec</i> type combination.</p>c<p>SCC<i>mec</i> IV subtype could not be determined.</p>d,e,f,g,h,i,j<p>MLST was performed on representative strains bearing these <i>spa</i> types, with the following results: ^dST5 (<i>n</i> = 15), ^eST923 (<i>n</i> = 2), ^fST8 (<i>n</i> = 33), ^gST30 (<i>n</i> = 1) ^hST59 (<i>n</i> = 1) ⁱST72 (<i>n</i> = 1) and ^jST188 (<i>n</i> = 1) (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038576#pone.0038576.s001" target="_blank">Table S1</a>).</p