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Méndez-Sotelo BJ, Delgado-Beltrán M, Hernández-Durán M, Colín-Castro CA, Esquivel-Bautista J, Ortega-Oliva SA, Ortiz-Álvarez J, García-Contreras R, Franco-Cendejas R, Lopez Jacome LE. In vitro activity of ceftazidime/avibactam, cefiderocol, meropenem/vaborbactam and imipenem/relebactam against clinical strains of the Stenotrophomonas maltophilia complex. PLoS One 2024; 19:e0298577. [PMID: 38635685 PMCID: PMC11025899 DOI: 10.1371/journal.pone.0298577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/28/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Infections caused by Stenotrophomonas maltophilia and related species are increasing worldwide. Unfortunately, treatment options are limited, whereas the antimicrobial resistance is increasing. METHODS We included clinical isolates identified as S. maltophilia by VITEK 2 Compact. Ceftazidime/avibactam, meropenem/vaborbactam, imipenem/relebactam, cefiderocol, quinolones, and tetracycline family members were evaluated by broth microdilution method and compared with first-line treatment drugs. Minimum inhibitory concentrations (MICs) were reported for all antibiotics. We sequenced the Whole Genome of cefiderocol resistant strains (CRSs) and annotated their genes associated with cefiderocol resistance (GACR). Presumptive phylogenetic identification employing the 16S marker was performed. RESULTS One hundred and one clinical strains were evaluated, sulfamethoxazole and trimethoprim, levofloxacin and minocycline showed susceptibilities of 99.01%, 95.04% and 100% respectively. Ceftazidime was the antibiotic with the highest percentage of resistance in all samples (77.22%). Five strains were resistant to cefiderocol exhibiting MIC values ≥ 2 μg/mL (4.95%). The β-lactamase inhibitors meropenem/vaborbactam and imipenem/relebactam, failed to inhibit S. maltophilia, preserving both MIC50 and MIC90 ≥64 μg/mL. Ceftazidime/avibactam restored the activity of ceftazidime decreasing the MIC range. Tigecycline had the lowest MIC range, MIC50 and MIC90. Phylogeny based on 16S rRNA allowed to identify to cefiderocol resistant strains as putative species clustered into Stenotrophomonas maltophilia complex (Smc). In these strains, we detected GARCs such as Mutiple Drug Resistance (MDR) efflux pumps, L1-type β-lactamases, iron transporters and type-1 fimbriae. CONCLUSION Antimicrobial resistance to first-line treatment is low. The in vitro activity of new β-lactamase inhibitors against S. maltophilia is poor, but avibactam may be a potential option. Cefiderocol could be considered as a potential new option for multidrug resistant infections. Tetracyclines had the best in vitro activity of all antibiotics evaluated.
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Affiliation(s)
- Braulio Josué Méndez-Sotelo
- Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | | | - Melissa Hernández-Durán
- Clinical Microbiology Laboratory, Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Claudia Adriana Colín-Castro
- Clinical Microbiology Laboratory, Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - José Esquivel-Bautista
- Centro Nacional de Referencia de Inocuidad y Bioseguridad Agroalimentaria, Servicio Nacional de Sanidad, Inocuidad y Calidad Agroalimentaria (SENASICA), Tecámac, Mexico State, Mexico
| | - Sandra Angélica Ortega-Oliva
- Centro Nacional de Referencia de Inocuidad y Bioseguridad Agroalimentaria, Servicio Nacional de Sanidad, Inocuidad y Calidad Agroalimentaria (SENASICA), Tecámac, Mexico State, Mexico
| | - Jossue Ortiz-Álvarez
- Programa “Investigadoras e Investigadores por México”, Consejo Nacional de Humanidades, Ciencias y Tecnologías (CONAHCYT), Mexico City, Mexico
| | - Rodolfo García-Contreras
- Medicine Faculty, Bacteriology Laboratory, Microbiology and Parasitology Department, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Rafael Franco-Cendejas
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Biomedical Research Subdirection, Mexico City, Mexico
| | - Luis Esau Lopez Jacome
- Clinical Microbiology Laboratory, Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
- Chemistry Faculty, Biology Department, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Nieto-Saucedo JR, López-Jacome LE, Franco-Cendejas R, Colín-Castro CA, Hernández-Duran M, Rivera-Garay LR, Zamarripa-Martinez KS, Mosqueda-Gómez JL. Carbapenem-Resistant Gram-Negative Bacilli Characterization in a Tertiary Care Center from El Bajio, Mexico. Antibiotics (Basel) 2023; 12:1295. [PMID: 37627715 PMCID: PMC10451683 DOI: 10.3390/antibiotics12081295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/30/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Carbapenem-resistant Gram-negative bacilli (CR-GNB) are a major public health concern. We aimed to evaluate the prevalence of CR-GNB and the frequency of carbapenemase-encoding genes in a tertiary referral center from El Bajio, Mexico. A cross-sectional study was conducted between January and October 2022; Gram-negative bacilli (GNB) were screened for in vitro resistance to at least one carbapenem. CR-GNB were further analyzed for carbapenemase-production through phenotypical methods and by real-time PCR for the following genes: blaKPC, blaGES, blaNDM, blaVIM, blaIMP, and blaOXA-48. In total, 37 out of 508 GNB were carbapenem-resistant (7.3%, 95% CI 5.2-9.9). Non-fermenters had higher rates of carbapenem resistance than Enterobacterales (32.5% vs. 2.6%; OR 18.3, 95% CI 8.5-39, p < 0.0001), and Enterobacter cloacae showed higher carbapenem resistance than other Enterobacterales (27% vs. 1.4%; OR 25.9, 95% CI 6.9-95, p < 0.0001). Only 15 (40.5%) CR-GNB had a carbapenemase-encoding gene; Enterobacterales were more likely to have a carbapenemase-encoding gene than non-fermenters (63.6% vs. 30.8%, p = 0.08); blaNDM-1 and blaNDM-5 were the main genes found in Enterobacterales; and blaIMP-75 was the most common for Pseudomonas aeruginosa. The mcr-2 gene was harbored in one polymyxin-resistant E. cloacae. In our setting, NDM was the most common carbapenemase; however, less than half of the CR-GNB showed a carbapenemase-encoding gene.
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Affiliation(s)
- Jose Raul Nieto-Saucedo
- Fellow of the General Directorate of Quality and Education in Health, Ministry of Health, Mexico City 06696, Mexico
- Department of Medicine and Nutrition, Universidad de Guanajuato, Leon 37670, Mexico
| | - Luis Esaú López-Jacome
- Infectious Diseases Laboratory, Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City 14389, Mexico
- Biology Department, Chemistry Faculty, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Rafael Franco-Cendejas
- Biomedical Research Subdirection, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City 14389, Mexico
| | - Claudia Adriana Colín-Castro
- Infectious Diseases Laboratory, Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City 14389, Mexico
| | - Melissa Hernández-Duran
- Infectious Diseases Laboratory, Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City 14389, Mexico
| | | | | | - Juan Luis Mosqueda-Gómez
- Department of Medicine and Nutrition, Universidad de Guanajuato, Leon 37670, Mexico
- Hospital Regional de Alta Especialidad del Bajío, Leon 37660, Mexico
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3
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Garza-Ramos U, Silva-Sánchez J, López-Jácome LE, Hernández-Durán M, Colín-Castro CA, Sánchez-Pérez A, Rodríguez-Santiago J, Morfín-Otero R, Rodriguez-Noriega E, Velázquez-Acosta MDC, Vázquez-Larios MDR, Feliciano-Guzmán JM, Rojas-Larios F, Ponce-De-Leon A, Lozano-Garcia M, Choy-Chang EV, López-Gutiérrez E, Molina-Jaimes A, Gil-Veloz M, Corte-Rojas RE, López-Ovilla I, Ramirez-Mis JL, Rodríguez-Balderas DE, Molina-Chavarria A, Padilla-Ibarra C, Quevedo-Ramos MA, Mireles-Dávalos CD, Rodríguez-Medina N, Rubio-Mendoza D, Córdova-Fletes C, Cruz-López F, Becerra-Montejano DA, Mercado-Longoria R, Martínez-Villarreal RT, Barlandas-Rendón NRE, Mena-Ramírez JP, Couoh-May CA, Alcaraz-Espejel M, Adame-Alvarez C, Hernández-Vicente L, Garza-González E. Carbapenemase-Encoding Genes and Colistin Resistance in Gram-Negative Bacteria During the COVID-19 Pandemic in Mexico: Results from the Invifar Network. Microb Drug Resist 2022. [PMID: 36595348 DOI: 10.1089/mdr.2022.0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
In this study, we report the carbapenemase-encoding genes and colistin resistance in Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa in the second year of the COVID-19 pandemic. Clinical isolates included carbapenem-resistant K. pneumoniae, carbapenem-resistant E. coli, carbapenem-resistant A. baumannii, and carbapenem-resistant P. aeruginosa. Carbapenemase-encoding genes were detected by PCR. Carbapenem-resistant K. pneumoniae and carbapenem-resistant E. coli isolates were analyzed using the Rapid Polymyxin NP assay. mcr genes were screened by PCR. Pulsed-field gel electrophoresis and whole-genome sequencing were performed on representative isolates. A total of 80 carbapenem-resistant E. coli, 103 carbapenem-resistant K. pneumoniae, 284 carbapenem-resistant A. baumannii, and 129 carbapenem-resistant P. aeruginosa isolates were recovered. All carbapenem-resistant E. coli and carbapenem-resistant K. pneumoniae isolates were included for further analysis. A selection of carbapenem-resistant A. baumannii and carbapenem-resistant P. aeruginosa strains was further analyzed (86 carbapenem-resistant A. baumannii and 82 carbapenem-resistant P. aeruginosa). Among carbapenem-resistant K. pneumoniae and carbapenem-resistant E. coli isolates, the most frequent gene was blaNDM (86/103 [83.5%] and 72/80 [90%], respectively). For carbapenem-resistant A. baumannii, the most frequently detected gene was blaOXA-40 (52/86, 60.5%), and for carbapenem-resistant P. aeruginosa, was blaVIM (19/82, 23.2%). For carbapenem-resistant A. baumannii, five indistinguishable pulsotypes were detected. Circulation of K. pneumoniae New Delhi metallo-β-lactamase (NDM) and E. coli NDM was detected in Mexico. High virulence sequence types (STs), such as K. pneumoniae ST307, E. coli ST167, P. aeruginosa ST111, and A. baumannii ST2, were detected. Among K. pneumoniae isolates, 18/101 (17.8%) were positive for the Polymyxin NP test (two, 11.0% positive for the mcr-1 gene, and one, 5.6% with disruption of the mgrB gene). All E. coli isolates were negative for the Polymyxin NP test. In conclusion, K. pneumoniae NDM and E. coli NDM were detected in Mexico, with the circulation of highly virulent STs. These results are relevant in clinical practice to guide antibiotic therapies considering the molecular mechanisms of resistance to carbapenems.
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Affiliation(s)
| | | | - Luis Esaú López-Jácome
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, Mexico
| | | | | | | | | | - Rayo Morfín-Otero
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Eduardo Rodriguez-Noriega
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | | | | | - Fabián Rojas-Larios
- Laboratorio de Ecología y Microbiología, Facultad de Medicina, Universidad de Colima, Colima, Mexico
| | - Alfredo Ponce-De-Leon
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de Mexico, Mexico
| | | | | | | | - Aarón Molina-Jaimes
- Hospital Regional de Alta Especialidad Bicentenario de la Independencia, Tultitlán de Mariano Escobedo, Estado de México, Mexico
| | - Mariana Gil-Veloz
- Hospital Regional de Alta Especialidad del Bajío, Leon, Guanajuato, Mexico
| | | | | | | | | | | | | | | | | | | | - Daira Rubio-Mendoza
- Facultad de Medicina, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Carlos Córdova-Fletes
- Facultad de Medicina, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Flora Cruz-López
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | | | - Roberto Mercado-Longoria
- Facultad de Medicina, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | | | | | - Juan Pablo Mena-Ramírez
- Hospital General de Zona N. 21 IMSS, Centro Universitario de los Altos CUALTOS, Tepatitlán de Morelos, Jalisco, Mexico
| | | | | | | | | | - Elvira Garza-González
- Facultad de Medicina, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
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Mendez-Sotelo BJ, Rodriguez-Zulueta P, López-Jácome LE, Hernández-Durán M, Colín-Castro CA, Martínez-Zavaleta G, Rivera-Buendía F, Velásquez-Acosta C, Morfin-Otero R, Franco-Cendejas R. 649. Evaluation of the NG-Test CARBA 5® in Enterobacteriaceae and P. aeruginosa from Clinical Isolates. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Identification of carbapenemase-producing organisms like Enterobacteriaceae and P. aeruginosa is important for treatment decisions and infection control. Identification methods require time and technical training. Lateral flow immunoassay NG-Test CARBA 5® exempt these needs. In Mexico there is no evaluation of it on clinical isolates. It is important to define their diagnostic accuracy.
Methods
We collected 103 clinical strains of Enterobacteriaceae and P. aeruginosa resistant to carbapenems, from 2019 to 2020 from: National Institute of Rehabilitation (INR), National Institute of Cancerology, General Hospital Dr. Manuel Gea González and Hospital Civil de Guadalajara Fray Antonio Mayor. Analyzed in INR’s microbiology laboratory, resistance was corroborated with broth Microdilution Method (CLSI 2020). The carbapenemases was demonstrated by phenotypic methods (CLSI 2021). A homemade PCR was done and sequencing for encoding genes: NDM, KPC, GES, VIM, IMP and OXA-48-like. We analyzed concordance of the NG-Test CARBA 5® versus PCR with kappa coefficient.
Results
Seven discarded, 96 strains entered the analysis: Enterobacteriaceae (73%), P. aeruginosa (27%) (Table1). The carbapenemase-producing organisms were: 1) 56 Enterobacteriaceae, 30% Class B; 2) 23 P. aeruginosa, 90% Class B. NG-Test CARBA 5® for Enterobacteriaceae demonstrated greater sensitivity, specificity, and NPV (table 2). Kappa coefficient of concordance was 0.92 for Enterobacteriaceae and 0.59 for P. aeruginosa (table 2), and discrepancies in table 3. Sequencing of carbapenemase-producing organisim can be find in table 4.
Title 1. Clinical isolates by hospital
N: No carbapenem-producing, Gea: General Hospital Dr. Manuel Gea González, Civil GDL: Hospital Civil de Guadalajara, INCAN: National Institute of Cancerology, INR: National Institute of Rehabilitation.
Table 3. Discrepancies
Enzyme gene secuencing
Conclusion
The most frequent enzyme were Ambler Class B, consistent with national reports. Sensitivity and specificity was like reported in other series. In P. aeruginosa, errors have already been reported in IMP-type enzymes, ours mainly with IMP-75. To our knowledge there are no reports of the following enzyme variants identified by NG-Test CARBA 5®: KPC-82, VIM-67, IMP-62, and IMP-75. NG-Test CARBA 5® showed high concordance with PCR for Enterobacteriaceae, it has the advantage of being a quick and easy-to-use detection tool. In P. aeruginosa despite the results without solid evidence, we recommend complementing the test with other phenotypic identification tests.
Table 2. Kappa Concordance Coefficient of NG-Test CARBA 5® and PCR
Se: sensitivity, Sp: specificity, PPV: positive predictive value, NPV: negative predictive value
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
| | | | - Luis Esaú López-Jácome
- Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Distrito Federal, Mexico
| | - Melissa Hernández-Durán
- Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Distrito Federal, Mexico
| | | | | | | | | | - Rayo Morfin-Otero
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Rafael Franco-Cendejas
- Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Distrito Federal, Mexico
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Fernández-Rodríguez D, García-Hernández MDL, Cerón-González G, Colín-Castro CA, Hernández-Durán M, Cervantes-Hernández MI, López-Jácome LE, Becerra-Lobato N, Mondragón-Eguiluz JA, Vanegas-Rodríguez ES, Franco-Cendejas R. 236. Insight of Polymicrobial Prosthetic Joint Infections at a Referral Hospital. Open Forum Infect Dis 2021. [PMCID: PMC8644215 DOI: 10.1093/ofid/ofab466.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Approximately one-third of the prosthetic joint infections (PJIs) are polymicrobial. They are difficult to treat and there is an urgent need of clinical evidence that help to guide current protocols. We aimed to define the clinical characteristics and outcomes of patients with polymicrobial PJI. Methods We conducted a retrospective cohort study of patients with polymicrobial PJI treated at a referral hospital in Mexico City. Clinical data was retrieved and analyzed. Time to treatment failure, was evaluated for all cases. Results We identified 166 patients with a polymicrobial PJI from July 2011 to October 2020. The median follow-up period was 3.24 years (IQR, 1.45-6.42). Fistulae (77.7%) and pain (76.5%) were frequent. Patients required a median of 2 (IQR, 1-3) hospitalizations and 3 (IQR, 1-5) surgeries. Relapse, reinfection, and amputation ocurred in 21.1% (35), 10.2% (17), and 7.2% (12) of the cases, respectively. At 1-year follow-up 38.47% (63) patients failed to control the infection. At 2 and 5-year follow-up this rate increased to 50% (83) and 68% (112), respectively. The main infecting microorganisms were Staphylococcus epidermidis (51.8%), Enterococcus faecalis (47.6%), and Staphyloccocus aureus (34.9%). Anaerobes were identified in 38 (22.9%) cases. At 1 and 5-year follow-up, 39.31% (34) and 71.1% (61) of patients with S. epidermidis experienced treatment failure. On the other hand, those with S. aureus showed lower rates (log-rank p-value=0.03): 24.85% (14) and 50% (29), accordingly. Patients affected by anaerobes and E. faecalis exhibited similar trends, between them (log-rank p-value=0.73). Table1. Clinical findings of patients with polymicrobial PJI. ![]()
Frequency distributions of sociodemographic factors, comorbidities, clinical presentation, outcomes, out-patient treatment, and etiology in patients with polymicrobial PJI. Data is presented as absolute frequency followed by relative frequency enclosed in parenthesis, otherwise specified. Abbreviations: SXT, Trimethoprim/Sulfamethoxazole. Figure 1. Kaplan‒Meier survivorship curve illustrating the time to treatment failure among patients with polymicrobial PJI. The shaded areas surrounding the gross line represent the 95% CI. ![]()
Figure2. Kaplan‒Meier survivorship curves illustrating the time to treatment failure among patients with polymicrobial PJI, according to the infecting microorganisms.. ![]()
Patients affected by S. epidermidis, E.faecalis, S. aureus, and anaerobes are represented with red, blue, green, and black lines, respectively. Conclusion Our study showed 61.53% of the patients with polymicrobial PJI controlled the infection at 1-year follow-up. This rate decreased over the years. These patients required a considerable number of hospitalizations and surgeries. Likewise, presenting with fistulae and pain ensured a high suspicion of PJI. S. epidermidis, E. faecalis, and S. aureus were the most frequent infecting microorganisms. The stratification of our cohort suggested the microbiology of polymicrobial PJI could have driven to differences in rates of treatment failure. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | | | - Guillermo Cerón-González
- Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Distrito Federal, Mexico
| | | | - Melissa Hernández-Durán
- Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Distrito Federal, Mexico
| | | | - Luis Esaú López-Jácome
- Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Distrito Federal, Mexico
| | - Noé Becerra-Lobato
- Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Distrito Federal, Mexico
| | | | | | - Rafael Franco-Cendejas
- Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Distrito Federal, Mexico
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Rivera-Buendía F, Franco-Cendejas R, Román-López CG, Colín-Castro CA, Becerra-Lobato N, García-Hernández MDL, Cornejo-Juárez P, Bargalló-Rocha JE, Medina-Franco H, Vilar-Compte D. Randomized Controlled Trial to Reduce Bacterial Colonization of Surgical Drains with the Use of Chlorhexidine-Coated Dressings After Breast Cancer Surgery. Ann Surg Oncol 2019; 26:3883-3891. [PMID: 31346895 DOI: 10.1245/s10434-019-07631-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Breast surgery is considered a clean surgery. However, surgical-site infection (SSI) rates are currently higher than predicted. Postoperative drains remain in situ for several days, with inevitable bacterial colonization and increased SSI risk. METHODS This randomized controlled trial from October 2016 to January 2018 analyzed patients undergoing breast cancer surgery. The patients were randomized to either the standard drain care group or the antiseptic dressing group (3M® Tegaderm® CHG). Drain samples taken on postoperative days (PODs) 7 and 14 were cultured as standardized in the laboratory. Colonization rates and SSI were compared between the two groups. RESULTS The study enrolled 104 patients with 167 surgical drains. The patients' clinical characteristics were similar in the two groups, with no statistically significant differences. Bulb fluid cultures at postoperative week (POW) 1 were positive for 42.9% of the control group and 28.9% of the antiseptic group (p = 0.06). Cultures from the POW 2 assessment were positive for 79.7% of the control group versus 54.9% of the antiseptic group (p = 0.001). Cultures from drain tubes were positive for 79.8% of the control group and 50.7% of the antiseptic group (p = < 0.001). In 11 patients, an SSI developed, 3 (5.8%) from the intervention and 8 (15.4%) from the control procedure (p = 0.11). CONCLUSION The study findings demonstrated that the use of antiseptics at the drain exit site significantly reduced bacterial colonization of the closed drainage system in breast cancer surgery. Semi-permeable occlusive chlorhexidine-impregnated dressings provide an opportunity to test simple, safe, and low-cost interventions that may reduce drain bacterial colonization and SSI after breast surgery.
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Affiliation(s)
- Frida Rivera-Buendía
- Department of Infectious Diseases, Instituto Nacional de Cancerologia, Mexico City, Mexico.,MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Salvador Zubirán, Mexico City, Mexico
| | - Rafael Franco-Cendejas
- Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | | | - Claudia Adriana Colín-Castro
- Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Noé Becerra-Lobato
- Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | | | | | | | - Heriberto Medina-Franco
- Division of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Diana Vilar-Compte
- Department of Infectious Diseases, Instituto Nacional de Cancerologia, Mexico City, Mexico.
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7
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Flores-García MDL, Colín-Castro CA, Hernández-Palestina MS, Sánchez-Larios R, Franco-Cendejas R. Absence of Measles Virus Detection from Stapes of Patients with Otosclerosis. Otolaryngol Head Neck Surg 2017; 158:158-162. [PMID: 28971731 DOI: 10.1177/0194599817733674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To determine molecularly the presence of measles virus genetic material in the stapes of patients with otosclerosis. Study Design A cross-sectional study. Setting A tertiary referral hospital. Subjects and Methods Genetic material was extracted from the stapes of patients with otosclerosis (n = 93) during the period from March 2011 to April 2012. The presence of viral measles sequences was evaluated by the real-time reverse transcriptase polymerase chain reaction (RT-PCR). The expression of the CD46 gene was determined. Results Ninety-three patients were included in the study. No sample was positive for any of 3 measles virus genes (H, N, and F). Measles virus RNA was not detected in any sample by real-time RT-PCR. CD46 levels were positive in 3.3% (n = 3) and negative in 96.7% (n = 90). Conclusion This study does not support the theory of measles virus as the cause of otosclerosis. It is necessary to do more research about other causal theories to clarify its etiology and prevention.
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Affiliation(s)
- María de Lourdes Flores-García
- 1 Department of Otorhinolaryngology and Head and Neck Surgery, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Claudia Adriana Colín-Castro
- 2 Infectious Disease Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Mario Sabas Hernández-Palestina
- 1 Department of Otorhinolaryngology and Head and Neck Surgery, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Roberto Sánchez-Larios
- 1 Department of Otorhinolaryngology and Head and Neck Surgery, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Rafael Franco-Cendejas
- 2 Infectious Disease Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
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