49 research outputs found
High sporulation and overexpression of virulence factors in biofilms and reduced susceptibility to vancomycin and linezolid in recurrent Clostridium [Clostridioides] difficile infection isolates
Clostridium [Clostridioides] difficile infection (CDI) is one of the leading causes of diarrhea associated with medical care worldwide, and up to 60% of patients with CDI can develop a recurrent infection (R-CDI). A multi-species microbiota biofilm model of C. difficile was designed to evaluate the differences in the production of biofilms, sporulation, susceptibility to drugs, expression of sporulating (sigH, spo0A), quorum sensing (agrD1, and luxS), and adhesion-associated (slpA and cwp84) pathway genes between selected C. difficile isolates from R-CDI and non-recurrent patients (NR-CDI). We obtained 102 C. difficile isolates from 254 patients with confirmed CDI (66 from NR-CDI and 36 from R-CDI). Most of the isolates were biofilm producers, and most of the strains were ribotype 027 (81.374%, 83/102). Most C. difficile isolates were producers of biofilm (100/102), and most were strongly adherent. Sporulation was higher in the R-CDI than in the NR-CDI isolates (p = 0.015). The isolates from R-CDI patients more frequently demonstrated reduced susceptibility to vancomycin than isolates of NR-CDI patients (27.78% [10/36] and 9.09% [6/66], respectively, p = 0.013). The minimum inhibitory concentrations for vancomycin and linezolid against biofilms (BMIC) were up to 100 times and 20 times higher, respectively, than the corresponding planktonic MICs. Expression of sigH, spo0A, cwp84, and agrD1 was higher in R-CDI than in NR-CDI isolates. Most of the C. difficile isolates were producers of biofilms with no correlation with the ribotype. Sporulation was greater in R-CDI than in NR-CDI isolates in the biofilm model of C. difficile. The R-CDI isolates more frequently demonstrated reduced susceptibility to vancomycin and linezolid than the NR-CDI isolates in both planktonic cells and biofilm isolates. A higher expression of sporulating pathway (sigH, spo0A), quorum sensing (agrD1), and adhesion-associated (cwp84) genes was found in R-CDI than in NR-CDI isolates. All of these factors can have effect on the recurrence of the infection.Peer reviewe
Circulation of Highly Drug-Resistant Clostridium difficile Ribotypes 027 and 001 in Two Tertiary-Care Hospitals in Mexico
© 2018, Mary Ann Liebert, Inc.OBJECTIVE: To assess drug susceptibility and characterize Clostridium difficile ribotypes in isolates from two tertiary-care hospitals in Mexico. METHODS: Isolates were evaluated for genotyping, antimicrobial susceptibility testing and detection of mutations associated with drug resistance. PCR ribotyping was performed using a combination of gel-based and capillary electrophoresis-based approaches. RESULTS: MIC50 and MIC90 were ≥128 mg/L for ciprofloxacin, erythromycin, clindamycin, and rifampicin. There was no reduced susceptibility to metronidazole or tetracycline; however, reduced susceptibility to vancomycin (≥4 mg/L) and fidaxomicin (≥2 mg/L) was detected in 50 (40.3%) and 4 (3.2%) isolates, respectively. Furthermore, the rpoB Arg505Lys mutation was more frequently detected in isolates with high minimum inhibitory concentration (MIC) to rifampicin (≥32 mg/L) (OR = 52.5; 95% CI = 5.17-532.6; p < 0.000). Of the 124 C. difficile isolates recovered, 84 (66.7%) were of ribotype 027, 18 (14.5%) of ribotype 001, and the remainder were other ribotypes (353, 255, 220, 208, 176, 106, 076, 020, 019, 017, 014, 012, 003, and 002). CONCLUSION: Ribotypes 027 and 001 were the most frequent C. difficile isolates recovered in this study, and demonstrated higher MICs. Furthermore, we found four isolates with reduced susceptibility to fidaxomicin, raising a concern since this drug is currently unavailable in Mexican Hospitals.Peer reviewedFinal Accepted Versio
Molecular and microbiological report of a hospital outbreak of NDM-1-carrying Enterobacteriaceae in Mexico
Abstract
Objectives
To characterize the microbiological, molecular and epidemiological data of an outbreak of carbapenem-resistant Enterobacteriaceae (CRE) in a tertiary-care hospital in Mexico.
Methods
From September 2014 to July 2015, all CRE clinical isolates recovered during an outbreak in the Hospital Civil "Fray Antonio Alcalde" in Jalisco, Mexico were screened for antimicrobial susceptibility, carbapenemase production, carbapenemase-encoding genes, and plasmid profiles. Horizontal transfer of imipenem resistance; and clonal diversity by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST); as well as biofilm production and the presence of 14 virulence genes were analyzed in selected isolates.
Results
Fifty-two carbapenem-resistant isolates corresponding to 5 species were detected, i.e., Klebsiella pneumoniae (n = 46), Enterobacter cloacae (n = 3), Escherichia coli (n = 1), Providencia rettgeri (n = 1) and Citrobacter freundii (n = 1) with carbapenemase encoding genes blaNDM-1 (n = 48), blaVIM (n = 3), blaIMP (n = 1) and blaKPC (n = 1) detected in these isolates. The blaNDM-1 gene was detected in plasmids from 130- to 170-kb in K. pneumoniae (n = 46); E. cloacae (n = 3), E. coli (n = 1) and P. rettgeri (n = 1). The transfer of plasmids harboring the blaNDM-1 gene was obtained in eight transconjugants. One plasmid restriction pattern was detected, with the blaNDM-1 identified in different restriction fragments. Predominant clone A of K. pneumoniae isolates archived 28/46 (60%) isolates and belongs to ST392. Besides, ST307, ST309, ST846, ST2399, and ST2400 were detected for K. pneumoniae; as well as E. cloacae ST182 and E. coli ST10.
The fimA and uge genes were more likely to be identified in K. pneumoniae carbapenemsusceptible isolates (p =<0.001) and biofilm production was more liable to be observed in carbapenem-resistant isolates (p =<0.05).
Conclusions Four Enterobacteriaceae species harboring the blaNDM-1 gene were detected in a nosocomial outbreak in Mexico; horizontal transfer and strain transmission were demonstrated for the blaNDM-1 gene. Given the variation in the size of the plasmid harboring blaNDM-1, complex rearrangements must also be occurring
Diarrea asociada a Clostridioides difficile en pacientes de servicios quirúrgicos en México
Introducción: Clostridioides difficile (CD) es la primera causa de diarrea asociada al cuidadode salud en los países desarrollados. En los últimos a˜nos, la incidencia de la infección asociadaa CD (ICD) ha aumentado en el ámbito mundial. En México, la información al respecto es escasay se conoce poco sobre los factores de riesgo para esta enfermedad en pacientes hospitalizadosen servicios quirúrgicosMaterial y métodos: Estudio de casos y controles. Se compararon hallazgos epidemiológicos yfactores de riesgo entre pacientes quirúrgicos con ICD confirmada por PCR contra pacientes qui-rúrgicos con diarrea PCR negativa y contra pacientes quirúrgicos sin diarrea. Se realizó análisisestadístico mediante el paquete estadístico SPSS versión 22.0.Resultados: La mayoría de los pacientes quirúrgicos con ICD correspondían a las áreas de neu-rocirugía, cardiocirugía, ortopedia y cirugía general. El 53% de los casos de ICD se asociaron a lacepa hipervirulenta de CD NAP1/027. La presencia de moco en heces (RM 1.5, p = 0.001), fiebre(RM 1.4, p = 0.011), leucocitos en heces (RM 3.2, p = < 0.001), hospitalización en las últimas12 semanas (RM 2.0, p = < 0.001), uso de antibióticos (RM 1.3, p = 0.023) y uso de ceftriaxona(RM 1.4, p = 0.01) constituyeron factores de riesgo independientes para el desarrollo de ICD.
Conclusiones: La diarrea por CD en servicios quirúrgicos es frecuente en nuestra institución(Hospital Civil de Guadalajara Fray Antonio Alcalde)
Risk factors and outcome associated with the acquisition of linezolid-resistant Enterococcus faecalis
Objectives: Linezolid is a synthetic oxazolidinone antibiotic frequently used to treat vancomycin-resistant
enterococcal infections. Vancomycin-susceptible Enterococcus faecalis can develop resistance to linezolid
in environments with excessive linezolid use. The aim of this study was to define risk factors and outcome
associated with the acquisition of linezolid-resistant E. faecalis (LREfs).
Methods: A retrospective case–control study was designed including patients hospitalised from January
2014 to October 2017 at Hospital Civil de Guadalajara ‘Fray Antonio Alcalde’ in Guadalajara, Mexico. A
total of 50 patients culture-positive for LREfs and 100 control patients hospitalised in the same room and
time as the cases were included. Clinical and demographic data were collected and analysed.
Results: Risk factors for the presence of LREfs included prior linezolid use [odds ratio (OR) = 6.74], prior
clindamycin use (OR = 6.72) and previous surgery (OR = 5.79). The mortality rate was 18% for LREfs cases
versus 9% for controls.
Conclusion: LREfs has emerged and spread in our hospital, an environment in which linezolid use is
considerable. Risk factors for LREfs are prior antibiotic use, including linezolid, and previous surgery
Clostridioides difficile-associated diarrhea in surgical service patients in Mexico
Introduction: Clostridium difficile is the first cause of healthcare-associated diarrhea in developed
countries. In recent years the incidence of C. difficile infection (CDI) has increased
worldwide. There is not much information on the topic in Mexico, and little is known about
the risk factors for the infection in patients that are hospitalized in surgical services.
Materials and methods: A case-control study was conducted that compared the epidemiologic
findings and risk factors between surgical patients with PCR-confirmed CDI, surgical patients
with diarrhea and a negative PCR test, and surgical patients with no diarrhea. The statistical
analysis was carried out using the SPSS version 22.0 program.
Results: The majority of the surgical patients with CDI belonged to the areas of neurosurgery,
cardiac surgery, orthopedics, and general surgery. A total of 53% of the CDI cases were associated
with the hypervirulent CD NAP1/027 strain. The presence of mucus in stools (OR: 1.5, p = 0.001),
fever (OR: 1.4, p = 0.011), leukocytes in stools (OR: 3.2, p < 0.001), hospitalization within the
past twelve weeks (OR: 2.0, p < 0.001), antibiotic use (OR: 1.3, p = 0.023), and ceftriaxone use
(OR: 1.4, p = 0.01) were independent risk factors for the development of CDI
Clostridium difficile outbreak caused by NAP1/BI/027 strain and non-027 strains in a Mexican hospital
Background: Clostridium difficile infections caused by the NAP1/B1/027 strain are more severe,
difficult to treat, and frequently associated with relapses.
Methods: A case–control study was designed to examine a C. difficile infection (CDI) outbreak
over a 12-month period in a Mexican hospital. The diagnosis of toxigenic CDI was confirmed
by real-time polymerase chain reaction, PCR (Cepheid Xpert C. difficile/Epi).
Results: During the study period, 288 adult patients were evaluated and 79 (27.4%) patients
had confirmed CDI (PCR positive). C. difficile strain NAP1/B1/027 was identified in 31 (39%) of
the patients with confirmed CDI (240 controls were included). Significant risk factors for CDI
included any underlying disease (p < 0.001), prior hospitalization (p < 0.001), and antibiotic
(p < 0.050) or steroid (p < 0.001) use. Laboratory abnormalities included leukocytosis (p < 0.001)
and low serum albumin levels (p < 0.002). Attributable mortality was 5%. Relapses occurred
in 10% of patients. Risk factors for C. difficile NAP1/B1/027 strain infections included prior
use of quinolones (p < 0.03).
Risk factors for CDI caused by non-027 strains included chronic cardiac disease (p < 0.05),
chronic renal disease (p < 0.009), and elevated serum creatinine levels (p < 0.003). Deaths and
relapses were most frequent in the 027 group (10% and 19%, respectively).
Conclusions: C. difficile NAP1/BI/027 strain and non-027 strains are established pathogens in
our hospital. Accordingly, surveillance of C. difficile infections is now part of our nosocomial
prevention program
Sexually transmitted pathogens, coinfections and risk factors in patients attending obstetrics and gynecology clinics in Jalisco, Mexico
Objetivo. Determinar la frecuencia de nueve patógenos
de transmisión sexual, coinfecciones y factores de riesgo
en pacientes que acudieron a una consulta de ginecología
y obstetricia en Jalisco, México. Material y métodos.
Se analizaron muestras de 662 pacientes que asistieron a la consulta de ginecología y obstetricia. Se detectaron Treponema pallidum, VIH y VHC mediante serología. Se detectó VPH por Reacción de Cadena de Polimerasa (PCR) y sus genotipos se detectaron por Polimorfismos de Longitud de Fragmentos de Restricción (RFLP). Se detectaron Trichomonas vaginalis, VHS-1, VHS-2, Mycoplasma genitalium, Neisseria gonorrhoeae y T. pallidum por PCR múltiple. Resultados. Por serología, la frecuencia de VIH fue 6.8%, de T. pallidum fue 2.26% y de VHC fue 0.15%. Por PCR, la frecuencia más alta fue de VPH (13.9%, el genotipo más frecuente fue el 16, 33.7%), seguida de T. vaginalis (14.2%), VHS-1 (8.5%), M. genitalium (2.41%), N. gonorrhoeae (2.11%), VHS-2 (1.8%) y T. pallidum (1.05%). Los pacientes infectados con T. vaginalis presentaron más probabilidades de tener múltiples coinfecciones (p = 0.01). Conclusiones. La frecuencia de infección por VPH, VHS-1, VHS-2, M. genitalium y
T. vaginalis fue menor a lo reportado. Sin embargo, se detectó una alta frecuencia de VIH, T. pallidum, y N. gonorrhoeae.
ABSTRACT
Objective. To determine the frequency of nine sexually
transmitted pathogens, coinfections and risk factors in patients attending obstetrics and gynecology clinics in Jalisco, Mexico. Materials and methods. Samples from 662
patients attending obstetrics and gynecology clinics were
analyzed. Treponema pallidum, HIV, and HCV were detected
by serology. HPV was detected by Polimerase Chain Reac- tion (PCR), and its genotype was determined by Restriction Fragment Length Polymorphism (RFLP). Trichomonas vaginalis, HSV-1, HSV-2, Mycoplasma genitalium, Neisseria gonorrhoeae and T. pallidum were detected by multiplex PCR. Results. By serology, HIV frequency was 6.8%, T. pallidum was 2.26%, and
HCV was 0.15%. By PCR, HPV frequency was 13.9%, (more
frequent genotype was 16, 33.7%), followed by T. vaginalis (14.2%), HSV-1 (8.5%), M. genitalium (2,41%), N. gonorrhoeae (2.11%), HSV-2 (1.8%), and T. pallidum (1.05%). Patients infected with T. vaginalis were more likely to have multiple coinfections (p = 0.01). Conclusion. The frequency of HPV, HVS-1, HSV-2, M. genitalium and T. vaginalis was lower than
that reported. However, a high frequency of HIV, T. pallidum, and N. gonorrhoeae was detected
International Nosocomial Infection Control Consortium report, datasummary of 50 countries for 2010-2015 : Device-associated module
Q3Artículo original1495-1504Background: We report the results of International Nosocomial Infection Control Consortium (INICC) sur-veillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America,Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.Methods:During the 6-year study period, using Centers for Disease Control and Prevention National Health-care Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregateof 3,506,562 days.Results:Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAIrates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associatedpneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples,frequencies of resistance ofPseudomonasisolates to amikacin (29.87% vs 10%) and to imipenem (44.3%vs 26.1%), and ofKlebsiella pneumoniaeisolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27%vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.Conclusions:Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported inCDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the re-duction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC’s main goal tocontinue facilitating education, training, and basic and cost-effective tools and resources, such as stan-dardized forms and an online platform, to tackle this problem effectively and systematically