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

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)

Changes in MIC Within a Global Collection of Acinetobacter baumannii Collected as Part of the Tigecycline Evaluation and Surveillance Trial, 2004 to 2009

Wyeth Inc.; Pfizer Inc.; Pfize

The use of quinolones in developing countries.

The size of the antibiotic market in developing countries is double that seen in developed countries. There are some valid reasons for this difference, one of which is the higher frequency of diverse infections in the developing world. However, other factors are involved: for example, antibiotics are available without prescription, package insert information is poor, and there is no national antibiotic usage programme, all of which encourage inappropriate antibacterial use. When an antibiotic becomes widely prescribed by physicians, this is interpreted by the general public as meaning that the antibiotic is useful for all types of infections and the process of automedication begins. The newer quinolones, other new antibiotics, and indeed all antimicrobials should be available only by prescription. A package insert that includes all pertinent information should be provided, and each country should implement a comprehensive national antibiotic usage programme. Only through these measures will bacterial resistance be controlled and the effectiveness of each antibiotic class be maintained

Beta-lactamase production and the patterns of bacterial resistance, 1988-1991 [Producción de betalactamasas y patrones de resistencia bacteriana, 1988-1991.]

The adequate use of antimicrobial agents depends to a great degree on the results obtained from the continuous surveillance of bacterial resistance patterns. In order to determine these resistance patterns of bacterial pathogens responsible for community and nosocomial infections a sentinel surveillance program was started in 1988. An analysis of both pediatric and adult cases revealed 4942 bacteria isolated from different sites. Most samples from community infections were obtained from out patients seen in the infections disease clinic of the Hospital Civil de Guadalajara. Of the bacteria identified, 3584 were derived from community infections. Of those 1138 were gram positive and 2446 were gram-negative. The study also included 1350 nosocomial isolated of which 509 were gram-positive bacteria and 849 were gram-negative bacteria. Overall the gram-negative bacteria were more frequently Beta-lactamase producers than the gram-positive bacteria. Resistance to beta-lactam antibiotics ranged from 64-100% in gram negative bacteria and from 81.96% in some gram positive bacteria. During the last 2 years the resistance to third generation cephalosporins, imipenem and quinolones in gram-negative bacteria has steadily increased. Only through the continuous surveillance of bacterial resistance and the implementation of programs to combat bacterial resistance will the use of valuable antibiotics be prolonged and the activity of other ones be preserved for future use

Beta-lactamase production and the patterns of bacterial resistance, 1988-1991 [Producción de betalactamasas y patrones de resistencia bacteriana, 1988-1991.]

The adequate use of antimicrobial agents depends to a great degree on the results obtained from the continuous surveillance of bacterial resistance patterns. In order to determine these resistance patterns of bacterial pathogens responsible for community and nosocomial infections a sentinel surveillance program was started in 1988. An analysis of both pediatric and adult cases revealed 4942 bacteria isolated from different sites. Most samples from community infections were obtained from out patients seen in the infections disease clinic of the Hospital Civil de Guadalajara. Of the bacteria identified, 3584 were derived from community infections. Of those 1138 were gram positive and 2446 were gram-negative. The study also included 1350 nosocomial isolated of which 509 were gram-positive bacteria and 849 were gram-negative bacteria. Overall the gram-negative bacteria were more frequently Beta-lactamase producers than the gram-positive bacteria. Resistance to beta-lactam antibiotics ranged from 64-100% in gram negative bacteria and from 81.96% in some gram positive bacteria. During the last 2 years the resistance to third generation cephalosporins, imipenem and quinolones in gram-negative bacteria has steadily increased. Only through the continuous surveillance of bacterial resistance and the implementation of programs to combat bacterial resistance will the use of valuable antibiotics be prolonged and the activity of other ones be preserved for future use

The use of quinolones in developing countries.

The size of the antibiotic market in developing countries is double that seen in developed countries. There are some valid reasons for this difference, one of which is the higher frequency of diverse infections in the developing world. However, other factors are involved: for example, antibiotics are available without prescription, package insert information is poor, and there is no national antibiotic usage programme, all of which encourage inappropriate antibacterial use. When an antibiotic becomes widely prescribed by physicians, this is interpreted by the general public as meaning that the antibiotic is useful for all types of infections and the process of automedication begins. The newer quinolones, other new antibiotics, and indeed all antimicrobials should be available only by prescription. A package insert that includes all pertinent information should be provided, and each country should implement a comprehensive national antibiotic usage programme. Only through these measures will bacterial resistance be controlled and the effectiveness of each antibiotic class be maintained

[Evolution of bacterial resistance to antibiotics in Mexico, 1973-2013]

INTRODUCTION: Bacterial resistance to antibiotics is a worldwide public health concern. Research priorities for the study and control of this emerging problem include country-wide surveillance. OBJECTIVE: To review and comment on the contributions by Mexican investigators towards a greater understanding of the mechanisms of bacterial antibiotic resistance. MATERIALS AND METHODS: A comprehensive search of the medical literature on Medline/PubMed between 1973 and July 2013 was performed. RESULTS: The contributions of Mexican investigators have included descriptions of resistance in enteric pathogens, such as Salmonella Typhi, publications on the production of extended spectrum beta-lactamases, metallo-beta-lactamases, and carbapenemases, resistance mechanisms of Pseudomonas aeruginosa , and the evolution of resistance in Gram-positive pathogens, including Streptococcus pneumoniae , Staphylococcus aureus , and Enterococcus spp. CONCLUSION: The Mexican literature on mechanisms of bacterial resistance is relevant for the development of plans to control the antibiotic resistance crisis