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Velazquez-Meza ME, Galarde-López M, Cornejo-Juárez P, Carrillo-Quiroz BA, Velázquez-Acosta C, Bobadilla-del-Valle M, Ponce-de-León A, Alpuche-Aranda CM. Multidrug-Resistant Staphylococcus sp. and Enterococcus sp. in Municipal and Hospital Wastewater: A Longitudinal Study. Microorganisms 2024; 12:645. [PMID: 38674590 PMCID: PMC11051902 DOI: 10.3390/microorganisms12040645] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/12/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
The objective of the study was to detect multidrug-resistant Staphylococcus sp. and Enterococcus sp. isolates in municipal and hospital wastewater and to determine their elimination or persistence after wastewater treatment. Between August 2021 and September 2022, raw and treated wastewater samples were collected at two hospital and two community wastewater treatment plants (WWTPs). In each season of the year, two treated and two raw wastewater samples were collected in duplicate at each of the WWTPs studied. Screening and presumptive identification of staphylococci and enterococci was performed using chromoagars, and identification was performed with the Matrix Assisted Laser Desorption Ionization Time of Flight mass spectrometry (MALDI-TOF MS®). Antimicrobial susceptibility was performed using VITEK 2® automated system. There were 56 wastewater samples obtained during the study period. A total of 182 Staphylococcus sp. and 248 Enterococcus sp. were identified. The highest frequency of Staphylococcus sp. isolation was in spring and summer (n = 129, 70.8%), and for Enterococcus sp. it was in autumn and winter (n = 143, 57.7%). Sixteen isolates of Staphylococcus sp. and sixty-three of Enterococcus sp. persisted during WWTP treatments. Thirteen species of staphylococci and seven species of enterococci were identified. Thirty-one isolates of Staphylococcus sp. and ninety-four of Enterococcus sp. were multidrug-resistant. Resistance to vancomycin (1.1%), linezolid (2.7%), and daptomycin (8.2%/10.9%%), and a lower susceptibility to tigecycline (2.7%), was observed. This study evidences the presence of Staphylococcus sp. and Enterococcus sp. resistant to antibiotics of last choice of clinical treatment, in community and hospital wastewater and their ability to survive WWTP treatment systems.
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Affiliation(s)
- Maria Elena Velazquez-Meza
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca City 62100, Mexico; (M.E.V.-M.); (M.G.-L.); (B.A.C.-Q.)
| | - Miguel Galarde-López
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca City 62100, Mexico; (M.E.V.-M.); (M.G.-L.); (B.A.C.-Q.)
| | - Patricia Cornejo-Juárez
- Departamento de Infectología, Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (P.C.-J.); (C.V.-A.)
| | - Berta Alicia Carrillo-Quiroz
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca City 62100, Mexico; (M.E.V.-M.); (M.G.-L.); (B.A.C.-Q.)
| | - Consuelo Velázquez-Acosta
- Departamento de Infectología, Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (P.C.-J.); (C.V.-A.)
| | - Miriam Bobadilla-del-Valle
- Laboratorio Nacional de Máxima Seguridad para el Estudio de Tuberculosis y Enfermedades Emergentes, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City 14080, Mexico; (M.B.-d.-V.); (A.P.-d.-L.)
| | - Alfredo Ponce-de-León
- Laboratorio Nacional de Máxima Seguridad para el Estudio de Tuberculosis y Enfermedades Emergentes, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City 14080, Mexico; (M.B.-d.-V.); (A.P.-d.-L.)
| | - Celia Mercedes Alpuche-Aranda
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca City 62100, Mexico; (M.E.V.-M.); (M.G.-L.); (B.A.C.-Q.)
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Rodríguez-Medina N, Rodríguez-Santiago J, Alvarado-Delgado A, Sagal-Prado A, Silva-Sánchez J, De la Cruz MA, Ares MA, Sánchez-Arias M, Morfín-Otero R, Hernández-Castro R, Cornejo-Juárez P, Jiménez-Villanueva E, Sánchez-Francia D, Garza-Ramos U. Comprehensive study reveals phenotypic heterogeneity in Klebsiella pneumoniae species complex isolates. Sci Rep 2024; 14:5876. [PMID: 38467675 PMCID: PMC10928225 DOI: 10.1038/s41598-024-55546-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/25/2024] [Indexed: 03/13/2024] Open
Abstract
Here, we conducted a comprehensive analysis of 356 Klebsiella pneumoniae species complex (KpSC) isolates that were classified as classical (cl), presumptive hypervirulent (p-hv) and hypermucoviscous-like (hmv-like). Overall, K. pneumoniae (82.3%), K. variicola (2.5%) and K. quasipneumoniae (2.5%) were identified. These isolates comprised 321 cl-KpSC, 7 p-hv-KpSC and 18 hmv-like-KpSC. A large proportion of cl-KpSC isolates were extended-spectrum-β-lactamases (ESBLs)-producers (64.4%) and 3.4% of isolates were colistin-resistant carrying carbapenemase and ESBL genes. All p-hv-KpSC showed an antibiotic susceptible phenotype and hmv-like isolates were found to be ESBL-producers (8/18). Assays for capsule production and capsule-dependent virulence phenotypes and whole-genome sequencing (WGS) were performed in a subset of isolates. Capsule amount differed in all p-hv strains and hmv-like produced higher capsule amounts than cl strains; these variations had important implications in phagocytosis and virulence. Murine sepsis model showed that most cl strains were nonlethal and the hmv-like caused 100% mortality with 3 × 108 CFUs. Unexpectedly, 3/7 (42.9%) of p-hv strains required 108 CFUs to cause 100% mortality (atypical hypervirulent), and 4/7 (57.1%) strains were considered truly hypervirulent (hv). Genomic analyses confirmed the diverse population, including isolates belonging to hv clonal groups (CG) CG23, CG86, CG380 and CG25 (this corresponded to the ST3999 a novel hv clone) and MDR clones such as CG258 and CG147 (ST392) among others. We noted that the hmv-like and hv-ST3999 isolates showed a close phylogenetic relationship with cl-MDR K. pneumoniae. The information collected here is important to understand the evolution of clinically important phenotypes such as hypervirulent and ESBL-producing-hypermucoviscous-like amongst the KpSC in Mexican healthcare settings. Likewise, this study shows that mgrB inactivation is the main mechanism of colistin resistance in K. pneumoniae isolates from Mexico.
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Affiliation(s)
- Nadia Rodríguez-Medina
- Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana, Instituto Nacional de Salud Pública (INSP), Av. Universidad # 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - Jonathan Rodríguez-Santiago
- Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana, Instituto Nacional de Salud Pública (INSP), Av. Universidad # 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - Alejandro Alvarado-Delgado
- Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana, Instituto Nacional de Salud Pública (INSP), Av. Universidad # 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - Alan Sagal-Prado
- Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana, Instituto Nacional de Salud Pública (INSP), Av. Universidad # 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - Jesús Silva-Sánchez
- Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana, Instituto Nacional de Salud Pública (INSP), Av. Universidad # 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - Miguel A De la Cruz
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Miguel Angel Ares
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Margarita Sánchez-Arias
- Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana, Instituto Nacional de Salud Pública (INSP), Av. Universidad # 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - Rayo Morfín-Otero
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Instituto de Patología Infecciosa y Experimental, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | | | | | | | - Ulises Garza-Ramos
- Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana, Instituto Nacional de Salud Pública (INSP), Av. Universidad # 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico.
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Islas-Muñoz B, Volkow-Fernández P, Silva-Zamora J, Ramírez-Ibarguen A, Cornejo-Juárez P. Mortality in patients with hematological malignancies, febrile neutropenia, and septic shock. J Infect Dev Ctries 2024; 18:235-242. [PMID: 38484344 DOI: 10.3855/jidc.17451] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/05/2023] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Patients with severe neutropenia who develop septic shock (SS) have high mortality. This study aimed to evaluate the risk factors and mortality of SS in patients with HM and febrile neutropenia. METHODOLOGY We included all patients with hematological malignancies (HM) who presented fever and severe neutropenia, admitted to an oncological tertiary care center in Mexico City for one year. RESULTS Two hundred ninety-two episodes of fever and severe neutropenia were documented; 68 patients (23.2%) developed SS. Documented clinical infection was different between SS and non-SS patients (94.1% vs. 63.4%, p < 0.001); pneumonia was the most frequent infection (36.8% vs. 23.2%, p = 0.02). Also, in SS vs. non-SS, there were more positive cultures (69.1% vs. 38.4%, p < 0.001), higher frequency of Gram-negative bacteria (89.3% vs. 63.9%, p < 0.001), particularly Escherichia coli (68% vs. 44.2%) and Klebsiella spp. (23.4% vs. 15.1%). There were no differences when multidrug-resistant (MDR) microorganisms were compared. In the multivariate analysis, associated risk factors for SS were: prolonged neutropenia, a documented site of infection, and having received highly myelosuppressive chemotherapy. Risk factors for mortality at 30 days were: older patients, prolonged neutropenia, and SS. CONCLUSIONS Severe and prolonged neutropenia was associated with SS development and mortality at 30 days. ICU management should be offered to all critically ill patients with HM if long-term survival of the underlying malignancy is expected.
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Affiliation(s)
- Beda Islas-Muñoz
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Alcaldía Tlalpan, 14000 Mexico City
| | - Patricia Volkow-Fernández
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Alcaldía Tlalpan, 14000 Mexico City
| | - Jorge Silva-Zamora
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Alcaldía Tlalpan, 14000 Mexico City
| | - Ana Ramírez-Ibarguen
- Hematology Department, Instituto Nacional de Cancerología (INCan), Alcaldía Tlalpan, 14000 Mexico City, Mexico
| | - Patricia Cornejo-Juárez
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Alcaldía Tlalpan, 14000 Mexico City
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Barragán-Reyes A, Jácome LEL, Perales-Martínez D, Nava-Ruiz A, Hernández MDLG, Cornejo-Juárez P, Rincón-Zuno J, Camacho A, Cendejas RF, Guzmán JMF, Rivera-Martínez NE, Ontañón-Zurita D, Reséndiz-Sánchez J, Juárez-Hernández E, Aguilar-Zapata D. Fusariosis in Mexico: A 10-year retrospective series. Med Mycol 2023; 61:myad112. [PMID: 37944000 DOI: 10.1093/mmy/myad112] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
Fusarium species represent an opportunistic fungal pathogen. The data in Mexico about Fusarium infections in humans are scarce. Here, we present a retrospective series of patients with a confirmed diagnosis of fusariosis in eight different hospitals in Mexico from January 2010 to December 2019. The diagnosis of proven fusariosis was made according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORT/MSG) criteria. A total of 49 cases were identified in our series. Most patients had burn injuries (49%), and 37% had hematological malignancies. Most patients had fire injuries (40%), followed by electric injuries (8%), febrile neutropenia (10%), and pancytopenia (6%). Patients had skin and soft tissue involvement in 49%, followed by blood culture isolation and biopsies from different sites of the body (lung, sinuses, bone tissue, and eyes). Febrile neutropenia (10%) and fungemia (8%) were the most common clinical syndromes in immunosuppressed patients. Most patients received monotherapy (67%), where voriconazole was used in 30% of the cases, followed by conventional amphotericin B (16%), and lipidic formulations of amphotericin B in 10% (either liposomal amphotericin B or amphotericin B lipid complex). Combination therapy was used in 20% of the cases, and the most common combination therapy was triazole plus any lipidic formulation of amphotericin B (10%). Mortality related to Fusarium infection occurred in 22% of patients. Fusariosis is a serious threat. Burn injuries and hematologic malignancies represent the most common causes of infection in this small series from Mexico.
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Affiliation(s)
| | - Luis Esaú López Jácome
- Instiuto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Clinical microbiology laboratory. Infectious diseases division,Mexico City, Mexico
| | - Diana Perales-Martínez
- Hospital Ángeles San Luis, San Luis Potosí, México / Hospital Regional de Alta Especialidad del Bajío, Leon. Infectious diseases and hospital epidemiology division, Mexico
| | - Alejandra Nava-Ruiz
- Hospital de Especialidades Pediáricas, Pediatric infectious diseases, Tuxtla Gutiérrez, Chiapas, Mexico
| | - María de Lourdes García Hernández
- Instiuto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Clinical microbiology laboratory. Infectious diseases division,Mexico City, Mexico
| | | | - Joaquín Rincón-Zuno
- Instituto materno Infantil del Estado de México, Infectious diseases department, Toluca, Mexico
| | - Adrián Camacho
- Hospital Universitario Dr. José Eleuterio González, Hospital epidemiology and infectious diseases division, Monterrey, Mexico
| | - Rafael Franco Cendejas
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Clinical microbiology laboratory. Infectious diseases division. Mexico City, Mexico
| | - José M Feliciano Guzmán
- Hospital de Especialidades Pediáricas, Pediatric infectious diseases, Tuxtla Gutiérrez, Chiapas, Mexico
| | - Norma E Rivera-Martínez
- Hospital regional de alta especialidad de Oaxaca, Infectious diseases division, Oaxaca, Mexico
| | - Diego Ontañón-Zurita
- Instituto Nacional de Cancerología, Infectious diseases division, Mexico City, Mexico
| | | | - Eva Juárez-Hernández
- Hospital Médica Sur, Infectious diseases. Translational Research Unit, Mexico City, Mexico
| | - Daniel Aguilar-Zapata
- Hospital Médica Sur, Infectious diseases. Translational Research Unit, Mexico City, Mexico
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Thirión-Romero I, Fernández-Plata R, Pérez-Kawabe M, Meza-Meneses PA, Castro-Fuentes CA, Rivera-Martínez NE, Barrón-Palma EV, Sánchez-Sandoval AL, Cornejo-Juárez P, Sepúlveda-Delgado J, Torres-Erazo DS, Pérez-Padilla JR. SARS-CoV-2 Vaccine Effectiveness in Hospitalized Patients: A Multicenter Test-Negative Case-Control Study. Vaccines (Basel) 2023; 11:1779. [PMID: 38140183 PMCID: PMC10747324 DOI: 10.3390/vaccines11121779] [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: 10/18/2023] [Revised: 11/12/2023] [Accepted: 11/18/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Phase III clinical trials have documented the efficacy of the SARS-CoV-2 vaccines in preventing symptomatic COVID-19. Nonetheless, it is imperative to continue analyzing the clinical response to different vaccines in real-life studies. Our objective was to evaluate the effectiveness of five different vaccines in hospitalized patients with COVID-19 during the third COVID-19 outbreak in Mexico dominated by the Delta variant. METHODS A test-negative case-control study was performed in nine tertiary-care hospitals for COVID-19. We estimated odds ratios (OR) adjusted by variables related a priori with the likelihood of SARS-CoV-2 infection and its severity. RESULTS We studied 761 subjects, 371 cases, and 390 controls with a mean age of 53 years (SD, 17 years). Overall, 51% had a complete vaccination scheme, and an incomplete scheme (one dose from a scheme of two), 14%. After adjustment for age, gender, obesity, and diabetes mellitus, we found that the effectiveness of avoiding a SARS-CoV-2 infection when hospitalized with at least one vaccination dose was 71% (OR 0.29, 95% CI 0.19-0.45), that of an incomplete vaccination scheme, 67% (OR 0.33, 95% CI 0.18-0.62), and that of any complete vaccination scheme, 73% (OR 0.27, 95% CI 0.17-0.43). CONCLUSIONS The SARS-CoV-2 vaccination program showed effectiveness in preventing SARS-CoV-2 infection in hospitalized patients during a Delta variant outbreak.
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Affiliation(s)
- Ireri Thirión-Romero
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Calz. de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, Mexico City 14080, Mexico; (I.T.-R.); (R.F.-P.)
| | - Rosario Fernández-Plata
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Calz. de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, Mexico City 14080, Mexico; (I.T.-R.); (R.F.-P.)
| | - Midori Pérez-Kawabe
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Calz. de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, Mexico City 14080, Mexico; (I.T.-R.); (R.F.-P.)
| | - Patricia A. Meza-Meneses
- Hospital Regional de Alta Especialidad Ixtapaluca (HRAEI), Carretera Federal México-Puebla Km. 34.5, Pueblo de Zoquiapan, Ixtapaluca 56530, Mexico; (P.A.M.-M.); (C.A.C.-F.)
| | - Carlos Alberto Castro-Fuentes
- Hospital Regional de Alta Especialidad Ixtapaluca (HRAEI), Carretera Federal México-Puebla Km. 34.5, Pueblo de Zoquiapan, Ixtapaluca 56530, Mexico; (P.A.M.-M.); (C.A.C.-F.)
| | - Norma E. Rivera-Martínez
- Hospital Regional de Alta Especialidad Oaxaca (HRAEO), C. Aldama s/n, Paraje El Tule, San Bartolo Coyotepec 71294, Oaxaca, Mexico;
| | - Eira Valeria Barrón-Palma
- Hospital General de México (HGM) Eduardo Liceaga, Dr. Balmis 148, Doctores, Cuauhtémoc, Mexico City 06720, Mexico; (E.V.B.-P.)
| | - Ana Laura Sánchez-Sandoval
- Hospital General de México (HGM) Eduardo Liceaga, Dr. Balmis 148, Doctores, Cuauhtémoc, Mexico City 06720, Mexico; (E.V.B.-P.)
| | - Patricia Cornejo-Juárez
- Instituto Nacional de Cancerología (INCAN), Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, Mexico City 14080, Mexico;
| | - Jesús Sepúlveda-Delgado
- Hospital Regional de Alta Especialidad Ciudad Salud (HRAECS), Carretera Tapachula Puerto Madero S/N km. 15 + 200, Carretera Federal 225, Col. Los Toros, Tapachula 30830, Chiapas, Mexico;
| | - Darwin Stalin Torres-Erazo
- Hospital Regional de Alta Especialidad Península de Yucatán (HRAEPY), C. 20 119, Col. Altabrisa, Merida 97130, Yucatán, Mexico;
| | - José Rogelio Pérez-Padilla
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Calz. de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, Mexico City 14080, Mexico; (I.T.-R.); (R.F.-P.)
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Alatorre-Fernández CP, Cornejo-Juárez P, Velázquez-Acosta C, Volkow-Fernández P. Bacteremia caused by Aeromonas species in patients with cancer: Clinical manifestations and outcomes. J Infect Dev Ctries 2023; 17:359-366. [PMID: 37023428 DOI: 10.3855/jidc.17530] [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: 10/11/2022] [Accepted: 12/20/2022] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Oncologic patients can have severe infections due to Aeromonas. This study aims to investigate the clinical characteristics and outcomes of cancer patients with bloodstream infections (BSI) caused by Aeromonas. METHODOLOGY We included patients with bacteremia caused by Aeromonas species from 2011 to 2018. RESULTS Seventy-five BSI events in the same number of patients were identified. Forty patients were men (53.3%); the mean age was 49 years (IQR 28-61). A. caviae was the most frequent isolate (n = 29, 38.6%), followed by A. hydrophila (n = 23, 30.6%), A. sobria (n = 15, 20%), and A. veronii (n = 8, 10.6%). The most frequent underlying diagnosis was hematologic malignancy (n = 33, 44%), followed by breast cancer (n = 12, 16%) and gastrointestinal tract cancer (n = 8, 10.6%). The most frequent type of bacteremia was CRBSI in 32 cases (42.6%), followed by mucosal barrier injury-laboratory confirmed BSI (n = 20, 26.7%). Sixteen (26.2%) were hospital-acquired BSI. Attributable mortality occurred in 11 patients (14.6%). In univariate analysis A. hydrophila bacteremia, liver failure, skin/soft tissue infection, septic shock, inappropriate antimicrobial treatment, and relapse or cancer progression were associated with 30-day mortality. In multivariate analysis, only septic shock, inappropriate antimicrobial treatment, and relapse or cancer progression were associated with 30-day mortality. CONCLUSIONS Aeromonas species should be considered one of the causative pathogens of healthcare-associated bacteremia, especially in immunocompromised patients. In addition, it can be associated with high fatality, particularly in patients with severe clinical infections.
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Volkow P, Lárraga-Mancilla V, Mendoza MJ, Cornejo-Juárez P, Islas-Muñoz B, Pérez-Jiménez C, Alatorre-Fernández P, Martin-Onraet A. Impact of COVID-19 pandemic in the care of people living with HIV and cancer at an oncologic center in Mexico. Int J STD AIDS 2023; 34:159-167. [PMID: 36527188 PMCID: PMC9760499 DOI: 10.1177/09564624221142364] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND People living with HIV(PLWH) and cancer are among the most vulnerable patients and require constant access to medical services. We compared the characteristics of PLWH and cancer in Mexico, before and during the COVID-19 pandemic. METHODS Patients admitted 1 year before (pre-pandemic) and 1 year after the start of the pandemic (pandemic) were included. Clinical characteristics, HIV-related variables, and 90-day mortality were compared. Data are described a proportions (N,%) and central tendency measures. A multiple regression model for variables associated with 90-day mortality was performed. RESULTS Seventy-nine patients were seen in the pre-pandemic period; 92 during the pandemic. Main diagnoses were Kaposi Sarcoma and lymphoma. CD4+ cell count at diagnosis was lower during the pandemic: 81 cells/mm3 vs. 128 cells/mm3, p = .035. CD4+<100 cells/mm3 at first consultation increased from 41% to 58% during the pandemic (p = .041). Only BMI <20 kg/m2 was associated to death (aOR 8.27, 95%CI 1.74-39.25) (p = .008). The pandemic period was not associated with a higher 90-day mortality. CONCLUSIONS PLWH and cancer presented to care with advanced disease overall. This was more pronounced during the pandemic period. Mortality was associated with AIDS-related variables regardless of study period. This underscores the need for strategies to maintain in-person access to health-care services for PLWH.
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Affiliation(s)
| | | | | | | | | | | | | | - Alexandra Martin-Onraet
- Alexandra Martin-Onraet, Infectious
Diseases Department, Instituto Nacional de Cancerología (INCan), Av. San
Fernando No. 22, Col. Belisario Domínguez, Sección XVI, Tlalpan, Ciudad de
México 14080, México.
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Cornejo-Juárez P, Volkow-Fernández P, Vázquez-Marín CL, Álvarez-Romero N, García-Pineda B, Chavez-Chavez T, Vilar-Compte D. Impact of coronavirus disease 2019 (COVID-19) pandemic in hospital-acquired infections and bacterial resistance at an oncology hospital. Antimicrob Steward Healthc Epidemiol 2023; 3:e70. [PMID: 37113204 PMCID: PMC10127242 DOI: 10.1017/ash.2023.148] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 04/29/2023]
Abstract
Objective Hospital-acquired infection (HAI) rates were negatively affected by the the coronavirus disease 2019 (COVID-19) pandemic. We describe the incidence of HAIs, main pathogens, and multidrug-resistant organisms (MDROs) isolated in cancer patients before and during the pandemic. Design This retrospective, comparative study included patients with HAIs. We compared 2 periods: the prepandemic period (2018, 2019, and the first 3 months of 2020) with the pandemic period (April-December 2020 and all of 2021). Setting Instituto Nacional de Cancerología, a tertiary-care oncology public hospital in Mexico City, Mexico. Methods Patients with the following HAIs were included: nosocomial pneumonia, ventilator-associated pneumonia (VAP), secondary bloodstream infection (BSI), central-line-associated bloodstream infection (CLBSI), and Clostridioides difficile infection (CDI). Demographic data, clinical characteristics, pathogens isolated, and MDRO data were included. Results We identified 639 HAIs: 381 (7.95 per 100 hospital discharges) in the prepandemic period and 258 (7.17 per 100 hospital discharges) in the pandemic period. Hematologic malignancy was documented in 263 (44.3%) patients; 251 (39.2%) were in cancer progression or relapse. Nosocomial pneumonia was more frequent during the pandemic period (40.3% vs 32.3%; P = .04). Total episodes of VAP were not different between the 2 periods (28.1% vs 22.1%; P = .08), but during the pandemic period, the VAP rate was higher among COVID-19 patients than non-COVID-19 patients (72.2% vs 8.8%; P < .001). Escherichia coli, Stenotrophomonas maltophilia, and Staphylococcus aureus bacteremia cases were more frequent in the pandemic period. Extended-spectrum β-lactamases (ESBL)-E. coli was the only MDRO that occurred more frequently during the pandemic period. Conclusions In cancer patients, nosocomial pneumonia was more frequent during the pandemic period. We did not observe a significant impact on other HAIs. MDROs did not significantly increase during the pandemic.
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Affiliation(s)
- Patricia Cornejo-Juárez
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Carla L. Vázquez-Marín
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Nancy Álvarez-Romero
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Bertha García-Pineda
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Tania Chavez-Chavez
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Diana Vilar-Compte
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
- Author for correspondence: Diana Vilar-Compte, MD, MSc, Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22, Col. Sección XVI, Alcaldía Tlalpan, 14000 Ciudad de México (CDMX), México. E-mail:
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Gutiérrez CI, Guerrero-del-Cueto F, Román-López C, Nuñez-Luna L, Cornejo-Juárez P, Vilar-Compte D. 1379. Idiopathic Granulomatous Mastitis: Experience at a Cancer Referral Center. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1208] [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: 12/23/2022] Open
Abstract
Abstract
Background
Idiopathic granulomatous mastitis (IGM) is challenging as it is a rare disease with unknown etiology, risk factors difficult to establish, and controversies regarding its treatment. Here we describe demographic and clinical characteristics of patients with IGM diagnosed at a cancer referral center, as well as the microbial isolates and treatment.
Methods
We reviewed the clinical charts of patients with IGM, diagnosed from 2004 to 2019. Males were excluded. Demographic data, past medical history, signs and symptoms, clinical examination findings, radiological and microbiological results, and treatments were retrieved. Frequencies were calculated for qualitative variables and measures of central tendency and dispersion for quantitative variables. Association between categorical variables was explored with a logistic regression to identify risk factors associated with treatment response.
Results
Two hundred cases of IGM, with a median age of 38 years, were reviewed. Concerning past medical history data, 66 patients (33.8%) were obese; 45 (30.4%) had used hormonal therapy; 6 (3.4%) had an autoimmune disease; 158 (89.8%) had been pregnant and 100 (77.5%) had breastfed. The most common signs were skin induration (65%), a delimited mass (64.5%), and suppuration (52%). On imaging findings, 53.8% was suspicious for malignancy. Culture was performed on 88 patients (44%), 32 had a microorganism isolated, most commonly Staphylococcus spp. (n=16; 51.6%) and Corynebacterium spp. (n=7; 22.6%). The most common treatment was an antibiotic regimen (n=84, 42%). Improvement was noted with the first-line therapy in 92 patients (46%). Fourteen patients (7%) had persistent symptoms and 46 (23%), relapsed. The presence of fever (OR 11.94; CI95% 1.33-106.80; p=0.027) or induration (OR 2.78; CI95% 1.25-6.19; p=0.012) were associated with a poor response.
Conclusion
We describe one of the largest IGM series in Latin America, on a population similar to those from other resource-limited countries. Fever and induration were associated to a greater risk of failure to initial treatment. The isolation of Corynebacterium spp. has also been described in other series. The variation of initial therapeutic strategies is an opportunity to standardize treatment by the means of prospective studies.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
| | | | - Cristina Román-López
- Instituto Nacional de Cancerología , CIUDAD DE MEXICO, Distrito Federal , Mexico
| | - Luis Nuñez-Luna
- Instituto Nacional de Cancerología , CIUDAD DE MEXICO, Distrito Federal , Mexico
| | | | - Diana Vilar-Compte
- Instituto Nacional de Cancerología , CIUDAD DE MEXICO, Distrito Federal , Mexico
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10
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De-la-Rosa-Martinez D, Rivera-Buendía F, Cornejo-Juárez P, García-Pineda B, Nevárez-Luján C, Vilar-Compte D. Risk factors and clinical outcomes for Clostridioides difficile infections in a case control study at a large cancer referral center in Mexico. Am J Infect Control 2022; 50:1220-1225. [PMID: 35172185 DOI: 10.1016/j.ajic.2022.02.011] [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: 11/03/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Clostridioides difficile infection (CDI) is recognized as the leading cause of nosocomial diarrhea. This study describes CDI's clinical characteristics, risk factors, and outcomes in the cancer population. METHODS We conducted a case-control study on cancer patients from 2015-2018 at the Instituto Nacional de Cancerologia in Mexico. CDI case was defined as diarrhea episode and positive polymerase chain reaction (PCR) for toxigenic strains. Controls were cancer diagnosis-matched patients with diarrhea and negative PCR. Healthcare Facility-Onset (HO-CDI) and Community-Onset, Healthcare Facility-Associated (CO-HCFA-CDI) rates were calculated. For assessing associations, univariate and multivariate logistic regression analyses were conducted. RESULTS We included 148 CDI cases and 148 controls. The CDI rate was 4.1 per 10,000 patient-days and 2.1 per 1,000 patient admissions for HO-CDI and CO-HCFA-CDI episodes, respectively. Clinical characteristics associated with CDI were fever, abdominal pain, and ≥4 episodes of diarrhea/24h. Previous use of proton pump inhibitors (P=.003), fluoroquinolones (P=.016), and cephalosporins (P=.026) increased the risk for CDI acquisition, while higher age (P=.022) and male gender (P=.015) were related to severe episodes. Thirty-day all-cause mortality was higher among CDI patients (18%) than controls (9%). CONCLUSION The CDI rate was lower compared to other series. The incidence of CO-HCFA-CDI episodes increased, and HO-CDI cases decreased from 2016 to 2018. Risk factors for acquisition and severe infection were similar to those reported in non-cancer populations.
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Affiliation(s)
| | - Frida Rivera-Buendía
- Instituto Nacional de Cancerologia, Department of Infectious Diseases, Mexico City, Mexico
| | | | - Bertha García-Pineda
- Instituto Nacional de Cancerologia, Department of Infectious Diseases, Mexico City, Mexico
| | - Carolina Nevárez-Luján
- Instituto Nacional de Cancerologia, Department of Infectious Diseases, Mexico City, Mexico
| | - Diana Vilar-Compte
- Instituto Nacional de Cancerologia, Department of Infectious Diseases, Mexico City, Mexico.
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Volkow-Fernández P, Islas-Muñoz B, Alatorre-Fernández P, Cornejo-Juárez P. Cellulitis in patients with chronic lower-limb lymphedema due to HIV-related Kaposi sarcoma. Int J STD AIDS 2021; 33:296-303. [PMID: 34965797 DOI: 10.1177/09564624211059359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/17/2022]
Abstract
OBJECTIVE Chronic Lower Limb Lymphedema (CL-LL) secondary to Kaposi sarcoma (KS) has not been recognized as a risk factor for cellulitis. The aim was to describe the clinical spectrum and use of antimicrobial prophylaxis in patients with cellulitis and CL-LL due to KS. METHODS HIV patients with KS, CL-LL, and at least one episode of cellulitis seen at the AIDS Cancer Clinic at INCan in Mexico from 2004 to 2019 were included. Demographic and clinical data were obtained from medical records. RESULTS Thirty-nine men all with CL-LL were included. Clinical factors associated with cellulitis were groin and/or lymph-node KS infiltration (69.2%), onychomycosis and/or tinea pedis (44.7%), ulcerated lesions (38.4%), and obesity (2.5%). Eighteen (46.1%) were hospitalized in the first episode and eight (20.5%) in recurrence. Six (25.3%) died, two of toxic shock syndrome (TSS), and one of septic shock. Fourteen (35.8%) had at least one recurrent episode of cellulitis. Twenty-five (64.1%) received prophylaxis. Patients without prophylaxis had significantly more unfavorable outcomes (hospitalization and recurrences) than those with prophylaxis. CONCLUSIONS CL-LL due to KS is a risk factor for cellulitis and severe complications in patients with a long life expectancy. Antimicrobial prophylaxis needs to be explored as it could prevent complications.
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Affiliation(s)
| | - Beda Islas-Muñoz
- Department of Infectious Diseases, 42597Instituto Nacional de Cancerología (INCan), México
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12
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Zumaya-Estrada FA, Ponce-de-León-Garduño A, Ortiz-Brizuela E, Tinoco-Favila JC, Cornejo-Juárez P, Vilar-Compte D, Sassoé-González A, Saturno-Hernandez PJ, Alpuche-Aranda CM. Point Prevalence Survey of Antimicrobial Use in Four Tertiary Care Hospitals in Mexico. Infect Drug Resist 2021; 14:4553-4566. [PMID: 34754203 PMCID: PMC8572044 DOI: 10.2147/idr.s327721] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/26/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To describe the antimicrobial use in four tertiary care hospitals in Mexico. PATIENTS AND METHODS Point prevalence surveys (PPSs) were conducted on medical records of hospitalized patients with prescribed antimicrobials (AMs) in four tertiary care hospitals in Mexico in 2019. Prevalence estimates and descriptive statistics were used to present the collected data on antimicrobial prescribing and microbiological studies. RESULTS The prevalence of patients with prescribed AMs among the hospitals ranged from 47.1% to 91.3%. Antibiotics for systemic use (J01s) were the most prescribed (84.6%, [95% CI: 81.5-87.3]), mainly extended-spectrum J01s: third-generation cephalosporins 19.8% [95% CI: 16.8-23.1], and carbapenems 17.0% [95% CI: 14.2-20.2]. Antibiotic treatments were largely empirical, with no planned duration or review dates. The ceftriaxone use was excessive and prolonged. No formal reference guidelines for antimicrobial prescribing were available in the hospitals. Multidrug-resistant Escherichia coli and ESKAPE pathogens were identified in all hospitals. CONCLUSION This study describes the extensive use of antimicrobials and broad-spectrum antibiotics for systemic use in Mexican hospitals, along with the presence of resistant pathogens to the antibiotics frequently used in the hospitals surveyed.
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Affiliation(s)
- Federico A Zumaya-Estrada
- Center for Infectious Diseases Research (CISEI), National Institute of Public Health (INSP), Cuernavaca, C.P. 62100, Morelos, México
| | - Alfredo Ponce-de-León-Garduño
- Infectology Department, National Institute of Medical Sciences and Nutrition “Salvador Zubirán”, Ciudad de México, C.P. 14080, México
| | - Edgar Ortiz-Brizuela
- Infectology Department, National Institute of Medical Sciences and Nutrition “Salvador Zubirán”, Ciudad de México, C.P. 14080, México
| | - Juan Carlos Tinoco-Favila
- Infectology Department, Hospital General 450, Secretary of Health of Durango, Durango, C.P. 34206, Durango, México
| | - Patricia Cornejo-Juárez
- Infectious Diseases Department, National Institute of Cancer (INCan), Ciudad de México, C.P. 14080, México
| | - Diana Vilar-Compte
- Infectious Diseases Department, National Institute of Cancer (INCan), Ciudad de México, C.P. 14080, México
| | - Alejandro Sassoé-González
- Epidemiological Intelligence Unit, High Specialty Regional Hospital of Ixtapaluca, Estado de México, C.P. 56530, México
| | - Pedro Jesus Saturno-Hernandez
- Center for Evaluation and Surveys Research (CIEE), National Institute of Public Health (INSP), Cuernavaca, C.P. 62100, Morelos, México
| | - Celia M Alpuche-Aranda
- Center for Infectious Diseases Research (CISEI), National Institute of Public Health (INSP), Cuernavaca, C.P. 62100, Morelos, México
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Rodríguez-Santiago J, Cornejo-Juárez P, Silva-Sánchez J, Garza-Ramos U. Polymyxin resistance in Enterobacterales: overview and epidemiology in the Americas. Int J Antimicrob Agents 2021; 58:106426. [PMID: 34419579 DOI: 10.1016/j.ijantimicag.2021.106426] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/09/2021] [Revised: 08/07/2021] [Accepted: 08/15/2021] [Indexed: 12/30/2022]
Abstract
The worldwide spread of carbapenem- and polymyxin-resistant Enterobacterales represents an urgent public-health threat. However, for most countries in the Americas, the available data are limited, although Latin America has been suggested as a silent spreading reservoir for isolates carrying plasmid-mediated polymyxin resistance mechanisms. This work provides an overall update on polymyxin and polymyxin resistance and focuses on uses, availability and susceptibility testing. Moreover, a comprehensive review of the current polymyxin resistance epidemiology in the Americas is provided. We found that reports in the English and Spanish literature show widespread carbapenemase-producing and colistin-resistant Klebsiella pneumoniae in the Americas determined by the clonal expansion of the pandemic clone ST258 and mgrB-mediated colistin resistance. In addition, widespread IncI2 and IncX4 plasmids carrying mcr-1 in Escherichia coli come mainly from human sources; however, plasmid-mediated colistin resistance in the Americas is underreported in the veterinary sector. These findings demonstrate the urgent need for the implementation of polymyxin resistance surveillance in Enterobacterales as well as appropriate regulatory measures for antimicrobial use in veterinary medicine.
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Affiliation(s)
- J Rodríguez-Santiago
- Instituto Nacional de Salud Pública (INSP), Centro de Investigación sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana, Cuernavaca, Morelos, México; Programa de Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - P Cornejo-Juárez
- Departamento de Infectología, Instituto Nacional de Cancerología (INCan), Ciudad de México, México
| | - J Silva-Sánchez
- Instituto Nacional de Salud Pública (INSP), Centro de Investigación sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana, Cuernavaca, Morelos, México
| | - U Garza-Ramos
- Instituto Nacional de Salud Pública (INSP), Centro de Investigación sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana, Cuernavaca, Morelos, México.
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Rivera-Díaz C, Volkow-Fernández P, Villalobos JL, Cornejo-Juárez P. Prevalence of osteoporosis and osteopenia in a cohort of HIV positive women with a history of treated neoplasms. SAGE Open Med 2021; 9:20503121211037471. [PMID: 34394933 PMCID: PMC8358488 DOI: 10.1177/20503121211037471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/19/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction: Higher prevalence of osteopenia and osteoporosis in HIV positive patients compared to non-infected population has been recognized. However, cancer patients have a higher risk of bone loss and fractures that is multifactorial. The aim of the study was to describe the prevalence of osteopenia and osteoporosis in HIV positive women with history of treated cancer. Methods: Between January 2018 and December 2019, women aged >40 years, HIV+ with a history of cancer diagnosis, who attended the AIDS Cancer Clinic at Instituto Nacional de Cancerología, Mexico City, and who had a dual X-ray absorptiometry performed during the study period were included. Two control groups (CG)—HIV negative women with history of cancer (CG1) and non-HIV, non-cancer women (CG2)—were matched by age 1:1. Results: Forty-eight patients in each group were included; the mean age was 51.1 ± 8.1 years. Osteopenia was found in femoral neck in 54.2% (HIV+), 37.5% (CG1), and 27.1% (CG2), p = 0.02; in spine was 35.7%, 47.9%, and 31.2%, respectively, p = 0.442. Osteoporosis in femoral neck was documented in 12.5%, 2.1%, and 0% in HIV+, CG1, and CG2 (p = 0.03), and in the spine was 47.9%, 16.7%, and 14.6%, respectively (p = 0.002). Conclusion: HIV patients with a history of treated cancer have a much higher prevalence of osteoporosis when compared with same-aged HIV-uninfected women with and without cancer. It is necessary to monitor Bone Mineral Density periodically, and all patients should be encouraged to make lifestyle changes, such as avoid tobacco and alcohol, and to increase exercising.
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Affiliation(s)
- Cecilia Rivera-Díaz
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - P Volkow-Fernández
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - José Luis Villalobos
- Imaging Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - P Cornejo-Juárez
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
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Cornejo-Juárez P, Islas-Muñoz B, Ramírez-Ibarguen AF, Rosales-Pedraza G, Chávez-Mazari B, Martínez-Orozco A, Volkow-Fernández P. Bone Marrow Culture Yield for the Diagnosis of Opportunistic Diseases in Patients with AIDS and Disseminated Kaposi Sarcoma. Curr HIV Res 2021; 18:277-282. [PMID: 32493198 DOI: 10.2174/1570162x18666200603145640] [Citation(s) in RCA: 1] [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] [Received: 11/06/2019] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Disseminated Kaposi sarcoma (DKS) is present in patients with advanced HIV infection in whom co-infection with other opportunistic pathogens can occur. Bone marrow (BM) aspirate and biopsy comprise a robust diagnostic tool in patients with fever, cytopenias, and abnormal liver tests. However, the yield in patients with DKS has not been determined. OBJECTIVE The aim of this study was to evaluate the utility of BM aspirate and biopsy in patients with DKS. METHODS We included 40 male patients with a recent diagnosis of DKS. BM aspirate and biopsy was performed as part of the workup to rule out co-infections. RESULTS In four patients, Mycobacterium avium complex (MAC) was recovered from culture. In other four patients, intracellular yeasts were observed in the Grocott stain, diagnosed as Histoplasma. The yield of BM was calculated in 20%. Only 12 patients (30%) had fever and 11 (27.5%) had pancytopenia. Alkaline phosphatase (ALP) above normal values and C-reactive protein (CRP) were higher in patients with positive results for BM than in those with negative results (63% vs. 21.9%, and 3.0 vs. 1.2 mg/L; p = 0.03 in both comparisons). No differences were found when complete blood-count abnormalities were compared. CONCLUSION We recommend performing a BM aspirate for stains, culture, and biopsy in all HIV patients with DKS, as this will permit the early diagnosis of co-infections and prevent further complications in those who receive chemotherapy.
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Affiliation(s)
- P Cornejo-Juárez
- Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - B Islas-Muñoz
- Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - G Rosales-Pedraza
- Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - B Chávez-Mazari
- Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - A Martínez-Orozco
- Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - P Volkow-Fernández
- Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City, Mexico
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Cornejo-Juárez P, González-Oros I, Mota-Castañeda P, Vilar-Compte D, Volkow-Fernández P. Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria. World J Crit Care Med 2020; 9:43-53. [PMID: 32844090 PMCID: PMC7416360 DOI: 10.5492/wjccm.v9.i3.43] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/22/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation (MV). The emergence of multidrug resistant bacteria (MDRB) has become a public health problem, creating a new burden on medical care in hospitals, particularly for patients admitted to the intensive care unit (ICU).
AIM To describe risk factors for ventilator-acquired pneumonia (VAP) in patients with cancer and to evaluate the impact of MDRB.
METHODS A retrospective study was performed from January 2016 to December 2018 at a cancer referral center in Mexico City, which included all patients who were admitted to the ICU and required MV ≥ 48 h. They were classified as those who developed VAP versus those who did not; pathogens isolated, including MDRB. Clinical evolution at 60-d was assessed. Descriptive analysis was carried out; comparison was performed between VAP vs non-VAP and MDRB vs non-MDRB.
RESULTS Two hundred sixty-three patients were included in the study; mean age was 51.9 years; 52.1% were male; 68.4% had solid tumors. There were 32 episodes of VAP with a rate of 12.2%; 11.5 episodes/1000 ventilation-days. The most frequent bacteria isolated were the following: Klebsiella spp. [n = 9, four were Extended-Spectrum Beta-Lactamase (ESBL) producers, one was Carbapenem-resistant (CR)]; Escherichia coli (n = 5, one was ESBL), and Pseudomonas aeruginosa (n = 8, two were CR). One Methicillin-susceptible Staphylococcus aureus was identified. In multivariate analysis, the sole risk factor associated for VAP was length of ICU stay (OR = 1.1; 95%CI: 1.03-1.17; P = 0.003). Sixty-day mortality was 53% in VAP and 43% without VAP (P = 0.342). There was not higher mortality in those patients with MDRB.
CONCLUSION This study highlights the high percentage of Gram-negative bacteria, which allows the initiation of empiric antibiotic coverage for these pathogens. In this retrospective, single center, observational study, MDRB VAP was not directly linked to increased mortality at 60 days.
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Affiliation(s)
- Patricia Cornejo-Juárez
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Ivan González-Oros
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Paola Mota-Castañeda
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Diana Vilar-Compte
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Patricia Volkow-Fernández
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
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Cornejo-Juárez P, González-Oros I, Mota-Castañeda P, Vilar-Compte D, Volkow-Fernández P. Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria. World J Crit Care Med 2020. [DOI: 10.5492/wjccm.v9.i3.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Gómez-Gómez B, Volkow-Fernández P, Cornejo-Juárez P. Bloodstream Infections Caused by Waterborne Bacteria. Curr Treat Options Infect Dis 2020. [DOI: 10.1007/s40506-020-00234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Volkow-Fernández P, Lome-Maldonado C, Quintero-Buenrostro H, Islas-Muñoz B, Cornejo-Juárez P. HIV-associated multicentric Castleman disease: a report of 19 cases at an oncology institution. Int J STD AIDS 2020; 31:318-325. [PMID: 32089093 DOI: 10.1177/0956462420905277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The aim of this study is to describe the clinical characteristics and outcome of multicentric Castleman disease (MCD) in HIV-infected patients at an oncological referral center in Mexico. Clinical records at the HIV-AIDS clinic of all patients diagnosed with MCD from 1994 to 2018 were reviewed. There were 19 patients, mean age was 31.3 ± 8.4 years, and 17 (89.5%) were males. Fifteen patients (79%) had also Kaposi sarcoma (KS). Main clinical characteristics were multiple lymphadenopathy (95%), systemic symptoms (63%), and hepatosplenomegaly (50%). Computed tomography scan and 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography showed multiple lymphadenopathy, inversion of the liver:spleen uptake ratio, with an increase in SUVmax (5.7). The histopathology report described plasma cells in 58%, mixed type in 26%, and hyaline vascular in 16%. Eleven patients (57.9%) received different chemotherapy regimens. Seven patients died (36.8%): four related to MCD progression or chemotherapy complications, median survival was eight months. For those patients who survived, median, follow-up was 28 months (p < 0.001). The incidence of MCD in people living with HIV is probably underestimated. In patients with lymphadenopathy, B symptoms, deranged inflammatory markers, and/or disseminated KS, a biopsy of an enlarged lymph node is warranted, and the histology should be reviewed by an experienced pathologist.
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Affiliation(s)
- P Volkow-Fernández
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - C Lome-Maldonado
- Pathology Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - H Quintero-Buenrostro
- Pathology Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - B Islas-Muñoz
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - P Cornejo-Juárez
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
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Meza-Meneses P, Cornejo-Juárez P, Vilar-Compte D, Volkow-Fernández P. INFECTIOUS COMPLICATIONS AS A PREDICTOR OF MORTALITY IN PATIENTS WITH NON-HODGKIN LYMPHOMA RECEIVING RITUXIMAB-CONTAINING CHEMOTHERAPY. Rev Invest Clin 2020; 71:275-282. [PMID: 31448779 DOI: 10.24875/ric.19002982] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Rituximab is a monoclonal antibody that increases the disease-free and overall survival of patients with non-Hodgkin lymphoma (NHL) CD20+. The objective of this study is to describe the prevalence and spectrum of infections in patients with NHL receiving rituximab-containing chemotherapy and the impact on survival. Materials and Methods From January 2011 to December 2012, all patients diagnosed with NHL who received at least one dose of rituximab were included. Results During the study period, 265 patients received rituximab; 108 (40.8%) males; the mean age was 60 ± 15 years. There were 177 infections in 85 patients, being the most common febrile neutropenia (n = 38; 21.5%) and mucosal barrier injury-related infections (n = 28; 15.8%). In 88 events (49%), there was a microbiologic diagnosis, being bacterial infection the most frequent (39.6%), but tuberculosis (TB) was developed in 4 cases (1.5%; incidence rate 721/100,000 person-year). During follow-up, 71 patients died (27%); in 35 cases, it was related to infection. There were no differences in follow-up between those who died due to infection versus those who died from another cause (p = 0.188). Multivariate analysis for mortality showed that age >60 years, failure to achieve a complete response, and development of an infectious complication increased the risk of death. Conclusions It is important to perform a screening test for TB in all patients who will receive rituximab and maintain a constant monitoring to detect an infectious process and begin treatment as soon as possible.
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Affiliation(s)
- Patricia Meza-Meneses
- Department of Infectious Diseases, Hospital Regional de Alta Especialidad de Ixtapaluca, Edo. de México
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de la Cruz-Hernández I, Cornejo-Juárez P, Tellez-Miranda O, Barrera-Pérez L, Sandoval-Hernández S, Vilar-Compte D, Velázquez-Acosta C, Volkow P. Microbiology and prevalence of E 2SKAPE-resistant strains in catheter-related bloodstream infections in patients with cancer. Am J Infect Control 2020; 48:40-45. [PMID: 31395288 DOI: 10.1016/j.ajic.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/08/2019] [Accepted: 06/09/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Central venous catheters (CVCs) are essential for treating cancer patients, but infection is a risk associated with their use, particularly by multidrug-resistant (MDR) bacteria. The aim of this study was to describe the microbiology of catheter-related bloodstream infections (CRBSIs) in cancer patients and to compare the prevalence of MDR ESKAPE microorganisms (Enterococcus faecium, Staphylococcus spp, Klebsiella spp, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp) plus Escherichia coli (E2SKAPE). METHODS Based on data from 2013 to 2015 from a prospective survey of CRBSIs by the intravenous therapy team, we describe the microbiology and compare the prevalence of MDR E2SKAPE strains between hospitalized patients and outpatients. RESULTS A total of 469 episodes of CRBSI were diagnosed: 261 (62%) were in women; 87 (18.6%) occurred in hospitalized patients, and 382 (81.4%) in ambulatory patients; 27.5% of patients had a hematologic malignancy and 72.5% a solid tumor. The median time between CVC insertion and CRBSI was 116 days (interquartile range [IQR], 48-207). The most common bacteria isolated were Staphylococcus epidermidis (18.1%), S aureus (10.9%), E coli (7.7%), and Klebsiella spp (8.6%). E2SKAPE accounted for 35.6%. Methicillin-resistant Staphylococcus aureus (MRSA) (odds ratio [OR], 16.4; 95% confidence interval [CI], 1.6-114; P = .01), extended-spectrum beta-lactamase (ESBL) Klebsiella spp (OR, 26; 95% CI, 2-286; P = .007), and ESBL E coli (OR, 26; 95% CI, 2-286; P = .007) were significantly more frequently isolated from hospitalized vs ambulatory patients. CONCLUSIONS MRSA, ESBL E. coli and ESBL Klebsiella spp were significantly more frequently isolated from hospitalized patients with CRBSI.
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Affiliation(s)
| | | | | | - Laura Barrera-Pérez
- Intravenous Therapy Team, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Diana Vilar-Compte
- Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Patricia Volkow
- Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City, Mexico.
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Ángeles-Sistac D, Martin-Onraet A, Cornejo-Juárez P, Volkow P, Pérez-Jimenez C, Vilar-Compte D. Influenza in patients with cancer after 2009 pandemic AH1N1: An 8-year follow-up study in Mexico. Influenza Other Respir Viruses 2019; 14:196-203. [PMID: 31747133 PMCID: PMC7040981 DOI: 10.1111/irv.12704] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 08/09/2019] [Accepted: 10/21/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Immunosupressed patients are at high risk of influenza-related complications. Influenza AH1N1 has been hypothesized to induce worse outcomes in patients with malignancies, but after the A(H1N1)pdm09 few publications have analyzed the presentation and complications related to influenza afterward. OBJECTIVES We aimed to describe the characteristics, risk factors, and outcomes of influenza in an oncologic center after the 2009 pandemic and to compare our case distribution to the National community acquired influenza databases in Mexico and the United States. METHODS We reviewed the cases of confirmed influenza in patients with cancer from an oncological center in Mexico from April 2009 to April 2017. Data on severity and influenza type, malignancy, comorbidities, and outcomes were recorded. We correlated data between the Centers for Disease Control and Prevention (CDC) in the United States and SISVEFLU (Influenza Surveillance Program) in Mexico. RESULTS One hundred eighty-eight patients were included; 75 (39.9%) had a solid neoplasm and 113 (60.1%) had hematologic malignancies. AH1N1 was the most frequent influenza type (54.2%). Patients with hematologic malignancies had more pneumonia (55% vs 25%, P < .001), needed more hospitalizations (75% vs 39% P < .001), had higher all-cause mortality at 30 days (20% vs 9% P = .048) and influenza-associated mortality (17% vs 7% P = .041). Thirty (16%) patients died within 30 days, and 24 (12.7%) were related to influenza. Influenza type was not associated with worse outcomes. Yearly occurrence of influenza reported by the CDC and SISVEFLU showed a significant correlation (ρ = 0.823, P = .006). CONCLUSIONS AH1N1 was the dominant serotype. Patients with hematologic malignancies had more severe influenza and presented worse outcomes. Annual SISVEFLU and CDC surveillance information showed a similar distribution of cases along time but influenza serotypes did not match for all seasons.
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Affiliation(s)
- Diego Ángeles-Sistac
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | - Patricia Volkow
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Carolina Pérez-Jimenez
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Diana Vilar-Compte
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Mexico City, 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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Velázquez-Acosta C, Cornejo-Juárez P, Volkow-Fernández P. [Multidrug resistance E-ESKAPE strains isolated from blood cultures in patients with cancer]. Salud Publica Mex 2019; 60:151-157. [PMID: 29738654 DOI: 10.21149/8767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/15/2017] [Accepted: 12/08/2017] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To describe the trend of multidrug resistant (MDR) strains isolated from blood in patients with cancer from 2005 to 2015. MATERIAL AND METHODS 33 127 blood cultures were processed by retrospective analysis. Identification and antimicrobial sensitivity were performed through automated methods: WaLK away (Siemens Labora- tory Diagnostics) and BD Phoenix (Becton, Dickinson and Company). Resistant strains were determined according to the minimum inhibitory concentration, following the parameters of the Clinical and Laboratory Standards Institute (CLSI). RESULTS Of 6 397 isolates, 5 604 (16.9%) were positive; 3 732 (58.4%) Gram- bacilli; 2 355 (36.9%) Gram+ cocci; 179 (2.7%) yeasts, and 126 (1.9%) Gram+ bacilli. Escherichia coli (n=1 591, 24.5%) was the most frequent bacteria, with 652 (41%) strains being extended-spectrum beta-lactamases producers (ESBL); of Enterococcus faecium (n=143, 2.1%), 45 (31.5%) were vancomycin resistant; of Staphylococcus aureus (n=571, 8.7%), 121 (21.2%) methicillin resistant (MRSA); of Klebsiella pneumoniae (n=367, 5.6%), 41 (11.2%) ESBL; of Acinetobacter baumanii (n=96, 1.4%), 23 (24%) MDR, and of Pseudomonas aeruginosa (n=384, 5.6%), 43 (11.2%) MDR. MDR strains were significantly more frequent in patients with hematological malignancies, compared to those with solid tumors: MRSA (OR=4.48, 95%CI 2.9-6.8), ESBL E. coli(OR=1.3, 95%CI 1.10-1.65) and MDR Acinetobacter baumanii (OR=3.2, 95%CI 1.2-8.3). CONCLUSIONS We observed significantly higher isolations of E-ESPAKE MDR strains in patients with hematological malignancies.
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Soto-Noguerón A, Carnalla-Barajas MN, Cornejo-Juárez P, Volkow-Fernández P, Velázquez-Meza ME, Echániz-Aviles G. Streptococcus pneumoniae: distribution of serotypes and antimicrobial susceptibility in patients with cancer. Salud Publica Mex 2018; 60:21-28. [PMID: 29689653 DOI: 10.21149/8159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/23/2016] [Accepted: 10/06/2017] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To describe the distribution of pneumococcal serotypes causing infectious diseases in patients with hematological malignancies and solid tumors and their antimicrobial susceptibility before and after introduction of pneumococcal conjugate vaccine (PCV7) in Mexico. MATERIALS AND METHODS Consecutive pneumococcal isolates from hospitalized patients from the SIREVA-network were serotyped using the Quellung reaction and antimicrobial susceptibility was performed using the broth microdilution method. RESULTS A total of 175 pneumococcal isolates were recovered, 105 from patients with hematological malignancies and 70 with solid tumors. Serotypes 19A (22.7%), 19F (20.4%), and 35B (17.7%) were the most frequent isolates in the first group and serotypes 3 (27.2%) and 19A (28.6%) in the second group. No decreased susceptibility to beta-lactams or TMP/SMX was observed after introduction of PCV7. CONCLUSIONS An increase in non-vaccine types is observed without significate changes in antimicrobial susceptibility after introduction of PCV7.
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Affiliation(s)
- Araceli Soto-Noguerón
- Departamento de Evaluación de Vacunas, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - María Noemí Carnalla-Barajas
- Departamento de Evaluación de Vacunas, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | | | | | - María Elena Velázquez-Meza
- Departamento de Evaluación de Vacunas, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | | | - Gabriela Echániz-Aviles
- Departamento de Evaluación de Vacunas, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
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Rivera-Buendía F, Franco-Cendejas R, Román-López CG, Cornejo-Juárez P, Bargalló-Rocha E, Medina-Franco H, Vilar-Compte D. 2122. Can Chlorhexidine Reduce Bacterial Colonization in Surgical Drains and Surgical Site Infections After Breast Cancer Surgery? A Randomized Controlled Trial. Open Forum Infect Dis 2018. [PMCID: PMC6252534 DOI: 10.1093/ofid/ofy210.1778] [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: 12/02/2022] Open
Abstract
Background Breast surgery is considered a clean surgery; however, surgical site infection (SSI) rates are higher than predicted. Postoperative drains remain in situ for several days with an inevitable bacterial colonization and increased risk of SSI. Methods We conducted a randomized controlled trial from October 2016 to January 2018 in a Mexican cancer center with high SSI prevalence. We included women with elective breast cancer surgery. Patients were randomized to control (standard drain care) or intervention (occlusive dressing with chlorhexidine 2% at the drain exit site). Perioperative management was standardized for both groups. Patient follow-ups were performed on a weekly basis for at least 30 days. Fluid cultures were performed at the first and second week as standardized in the laboratory. At the time of drain removal, the inner portion was sectioned and cultured by Maki’s semi-quantitative technique. Bacterial quantification was performed using 16 s rRNA-qPCR assay. Culture results of drain fluid and tubing were compared between groups. Results We included 104 patients with 167 surgical drains. Patients’ clinical characteristics (i.e., age, body mass index, comorbidities, clinical stage, preoperative risk, neoadjuvant therapy) were similar in both groups, with no statistical differences. Bulb fluid cultures at the first postoperative week were positive in 42.9% of the control group compared with 27.6% of the antiseptic group (P = 0.04). Cultures from the second week assessment were positive in 79.4% of the control group vs. 53.5% of the antiseptic arm (P = 0.001). Cultures from drain-tubes were positive in 70.2 and 43.8% (P = 0.001) of the control and antiseptic group, respectively (Figure 1). Eleven patients developed an SSI, three (15.4%) from the intervention group, and eight (15.8%) from the control group (P = 0.11). Eighty-four pathogens were isolated from the control group samples at week 1 vs. 52 from the intervention group. Staphylococci spp. were the most common microorganisms in Week 1, 61.9% control and 35% intervention group. Conclusion Local antiseptics provide an opportunity to test simple, safe, and low-cost interventions that may reduce drain bacterial colonization after breast surgery and potentially decrease infectious complications. Our microbiology findings question breast tissue sterility. ![]()
Disclosures F. Rivera-Buendía, 3M: Donated the dressings used, Research support. D. Vilar-Compte, 3M: Donated the dressings used, Research support.
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Affiliation(s)
| | | | | | | | | | - Heriberto Medina-Franco
- Surgical Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Diana Vilar-Compte
- Infectious Diseases, Instituto Nacional de Cancerologia, Mexico City, Mexico
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Ko JH, Kang CI, Cornejo-Juárez P, Yeh KM, Wang CH, Cho SY, Gözel MG, Kim SH, Hsueh PR, Sekiya N, Matsumura Y, Lee DG, Cho SY, Shiratori S, Kim YJ, Chung DR, Peck KR. Fluoroquinolones versus trimethoprim-sulfamethoxazole for the treatment of Stenotrophomonas maltophilia infections: a systematic review and meta-analysis. Clin Microbiol Infect 2018; 25:546-554. [PMID: 30448331 DOI: 10.1016/j.cmi.2018.11.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [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: 07/02/2018] [Revised: 10/05/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Fluoroquinolones are a popular alternative to trimethoprim-sulfamethoxazole for Stenotrophomonas maltophilia infections. OBJECTIVES To compare the effects of fluoroquinolones and trimethoprim-sulfamethoxazole on mortality of S. maltophilia infections. DATA SOURCES PubMed and EMBASE. STUDY ELIGIBILITY CRITERIA Clinical studies reporting mortality outcomes of S. maltophilia infections. PARTICIPANTS Patients with clinical infections caused by S. maltophilia. INTERVENTIONS Fluoroquinolone monotherapy in comparison with trimethoprim-sulfamethoxazole monotherapy. METHODS Systematic review with meta-analysis technique. RESULTS Seven retrospective cohort and seven case-control studies were included. Three cohort studies were designed to compare the two drugs, whereas others had other purposes. A total of 663 patients were identified, 332 of which were treated with trimethoprim-sulfamethoxazole (50.1%) and 331 with fluoroquinolones (49.9%). Three cohort studies were designed to compare the effect of the two drugs, whereas the others had other purposes. Levofloxacin was most frequently used among fluoroquinolones (187/331, 56.5%), followed by ciprofloxacin (114/331, 34.4%). The overall mortality rate was 29.6%. Using pooled ORs for the mortality of each study, fluoroquinolone treatment (OR 0.62, 95% CI 0.39-0.99) was associated with survival benefit over trimethoprim-sulfamethoxazole treatment, with low heterogeneity (I2 = 18%). Specific fluoroquinolones such as ciprofloxacin (OR 0.44, 95% CI 0.17-1.12) and levofloxacin (OR 0.78, 95% CI 0.48-1.26) did not show a significant difference in comparison with trimethoprim-sulfamethoxazole. In the sub-group analyses of adult and bacteraemic patients, significant differences in mortality were not observed between fluoroquinolones and trimethoprim-sulfamethoxazole. CONCLUSIONS Based on a meta-analysis of non-randomized studies, fluoroquinolones demonstrated comparable effects on mortality of S. maltophilia infection to trimethoprim-sulfamethoxazole, supporting the use of fluoroquinolones in clinical S. maltophilia infections. Although the pooled analysis of overall studies favoured fluoroquinolones over trimethoprim-sulfamethoxazole, the studies included were observational, and sub-group analyses of certain fluoroquinolone agents did not show statistical differences with trimethoprim-sulfamethoxazole. Randomized clinical studies are needed to address these issues.
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Affiliation(s)
- J-H Ko
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - C-I Kang
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - P Cornejo-Juárez
- Departamento de Infectología, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - K-M Yeh
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defence Medical Centre, Taipei, Taiwan
| | - C-H Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defence Medical Centre, Taipei, Taiwan
| | - S Y Cho
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - M G Gözel
- Department of Microbiology Reference Laboratories, Ministry of Health, Public Health, Turkey
| | - S-H Kim
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - P-R Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - N Sekiya
- Department of Infection Prevention and Control, Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Centre Komagome Hospital, Tokyo, Japan
| | - Y Matsumura
- Kyoto University Graduate School of Medicine, Department of Clinical Laboratory Medicine, Kyoto, Japan
| | - D-G Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, St Mary's Hospital, Seoul, Republic of Korea
| | - S-Y Cho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, St Mary's Hospital, Seoul, Republic of Korea
| | - S Shiratori
- Department of Haematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Y-J Kim
- Division of Infectious Diseases, Department of Paediatrics, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - D R Chung
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - K R Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Cornejo-Juárez P, Cavildo-Jerónimo D, Volkow-Fernández P. Non-AIDS defining cancer (NADC) among HIV-infected patients at an oncology tertiary-care center in Mexico. AIDS Res Ther 2018; 15:16. [PMID: 30368240 PMCID: PMC6204055 DOI: 10.1186/s12981-018-0202-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/10/2018] [Indexed: 01/21/2023] Open
Abstract
Background Non-AIDS defining cancers (NADCs) have been an increasing cause of morbidity and mortality in patients with HIV. There is no data on the spectrum of NADCs in Mexico. We describe the type of neoplasms, clinical characteristics, and outcomes of HIV-infected patients with NADCs. Methods We conducted a retrospective study of all patients with confirmed diagnosis of NADC attending the HIV/AIDS clinic at the National Cancer Institute in Mexico City (a tertiary-care center for adult patients with cancer) from January 1990 to December 2016. Results From 1126 HIV-positive individuals seen at the institute since 1990, 127 (11.3%) were diagnosed with NADCs; seven patients developed two NADCs during their follow-up. At diagnosis of NADC median age was 43.7 ± 10.9 years; 101 (79.5%) were male; median CD4 was 273 cells/mm3, 70 patients had a CD4 count of > 200 cells/mm3, 73 had undetectable HIV viral load and 82 had taken combined antiretroviral therapy (cART) for more than 1 year. The most frequent NADCs were in men, Hodgkin lymphoma (34.3%) followed by anal cancer (15.7%), whereas in women, were vulvo-vaginal cancers associated to human papilloma virus (HPV) (51.8%), followed by breast cancer (25.9%). The main risk factor associated with death was cancer progression or relapse (OR, 28.2, 2.5–317.1; p = 0.007). Conclusions HL- and HPV-related neoplasms are the commonest NADC in a cancer referral hospital from a middle-income country with universal access to cART since year 2005. Screening for early anogenital lesions should be emphasized in patients with HIV. It is essential to establish multidisciplinary groups involving Hemato-oncologists, Oncologists, Gynecologists, and HIV Specialists in the treatment of these patients.
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Guerrero-Del-Cueto F, Ibanes-Gutiérrez C, Velázquez-Acosta C, Cornejo-Juárez P, Vilar-Compte D. Microbiology and clinical characteristics of viridans group streptococci in patients with cancer. Braz J Infect Dis 2018; 22:323-327. [PMID: 30025903 PMCID: PMC9428031 DOI: 10.1016/j.bjid.2018.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/09/2018] [Accepted: 06/12/2018] [Indexed: 11/05/2022] Open
Abstract
This study assessed the microbiology, clinical syndromes, and outcomes of oncologic patients with viridans group streptococci isolated from blood cultures between January 1st, 2013 and December 31st, 2016 in a referral hospital in Mexico using the Bruker MALDI Biotyper. Antimicrobial sensitivity was determined using BD Phoenix 100 according to CLSI M100 standards. Clinical information was obtained from medical records and descriptive analysis was performed. Forty-three patients were included, 22 females and 21 males, aged 42 ± 17 years. Twenty (46.5%) patients had hematological cancer and 23 (53.5%) a solid malignancy. The viridans group streptococci isolated were Streptococcus mitis, 20 (46.5%); Streptococcus anginosus, 14 (32.6%); Streptococcus sanguinis, 7 (16.3%); and Streptococcus salivarius, 2 (4.7%). The main risk factors were pyrimidine antagonist chemotherapy in 22 (51.2%) and neutropenia in 19 (44.2%) cases, respectively. Central line associated bloodstream infection was diagnosed in 18 (41.9%) cases. Septic shock occurred in 20.9% of patients, with an overall mortality of 18.6%. Only four S. mitis revealed penicillin-resistance. Our results are similar to those of other series, identifying these bacteria as emerging pathogens with significant morbidity and mortality in oncologic patients. The MALDI-TOF system increased the rate of viridans group streptococci isolation in this population.
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Affiliation(s)
| | - Cyntia Ibanes-Gutiérrez
- Instituto Nacional de Cancerología, Departamento de Enfermedades Infecciosas, Ciudade de México, Mexico
| | | | - Patricia Cornejo-Juárez
- Instituto Nacional de Cancerología, Departamento de Enfermedades Infecciosas, Ciudade de México, Mexico
| | - Diana Vilar-Compte
- Instituto Nacional de Cancerología, Departamento de Enfermedades Infecciosas, Ciudade de México, Mexico.
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Islas-Muñoz B, Volkow-Fernández P, Ibanes-Gutiérrez C, Villamar-Ramírez A, Vilar-Compte D, Cornejo-Juárez P. Bloodstream infections in cancer patients. Risk factors associated with mortality. Int J Infect Dis 2018; 71:59-64. [PMID: 29649549 DOI: 10.1016/j.ijid.2018.03.022] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/16/2018] [Accepted: 03/30/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical characteristics and risk factors associated with mortality in cancer patients with bloodstream infections (BSI), analyzing multidrug resistant bacteria (MDR). METHODS We conducted a prospective observational study at a cancer referral center from August 2016 to July 2017, which included all BSI. RESULTS 4220 patients were tested with blood cultures; 496 were included. Mean age was 48 years. In 299 patients with solid tumors, secondary BSI and Central Line-Associated BSI (CLABSI) were the most common (55.9% and 31.8%, respectively). In 197 hematologic patients, primary and mucosal barrier injury (MBI) BSI were the main type (38.6%). Gram-negative were the most frequent bacteria (72.8%), with Escherichia coli occupying the first place (n=210, 42.3%), 48% were Extended-Spectrum Beta-Lactamase (ESBL) producers, and 1.8% were resistant to carbapenems. Mortality at day 30, was 22%, but reached 70% when patients did not receive an appropriate antimicrobial treatment. Multivariate analysis showed that progression or relapse of the oncologic disease, inappropriate antimicrobial treatment, and having resistant bacteria were independently associated with 30-day mortality. CONCLUSIONS Emergence of MDR bacteria is an important healthcare problem worldwide. Patients with BSI, particularly those patients with MDR bacteria have a higher mortality risk.
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Affiliation(s)
- Beda Islas-Muñoz
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22, Col. Sección XVI, Del. Tlalpan, 14000 Mexico City, Mexico.
| | - Patricia Volkow-Fernández
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22, Col. Sección XVI, Del. Tlalpan, 14000 Mexico City, Mexico.
| | - Cynthia Ibanes-Gutiérrez
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22, Col. Sección XVI, Del. Tlalpan, 14000 Mexico City, Mexico.
| | - Alberto Villamar-Ramírez
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22, Col. Sección XVI, Del. Tlalpan, 14000 Mexico City, Mexico.
| | - Diana Vilar-Compte
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22, Col. Sección XVI, Del. Tlalpan, 14000 Mexico City, Mexico.
| | - Patricia Cornejo-Juárez
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22, Col. Sección XVI, Del. Tlalpan, 14000 Mexico City, Mexico.
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César-Arce A, Volkow-Fernández P, Valero-Saldaña LM, Acosta-Maldonado B, Vilar-Compte D, Cornejo-Juárez P. Infectious Complications and Multidrug-Resistant Bacteria in Patients With Hematopoietic Stem Cell Transplantation in the First 12 Months After Transplant. Transplant Proc 2018; 49:1444-1448. [PMID: 28736021 DOI: 10.1016/j.transproceed.2017.03.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/17/2017] [Revised: 03/14/2017] [Accepted: 03/30/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) has been used as treatment in different hematologic and solid malignancies. The aim of this study was to describe the frequency of infectious complications, microbiology, and outcome in patients undergoing HSCT in Mexico during the pre-engraftment period and the impact on mortality rates at 12 months. METHODS We conducted a retrospective study of all hematologic malignancies that received HSCT from January 2009 and December 2014, at an oncology reference center. RESULTS We included 210 patients: 144 autologous (69%) and 66 allogeneic HSCT (31%). There were 184 infections documented in 109 patients; incidence rate was 47.2 per 1000 neutropenia/days and 22.4 per 1000 hospitalization/days. The main infections reported were pneumonia (n = 40, 19%), bloodstream infections (n = 36, 17.1%), and central line-associated bloodstream infections (n = 28, 13.3%). There were 110 bacteria isolated, 31 were multidrug-resistant (26 were extended-spectrum beta-lactamase; Escherichia coli). There were 25 disseminated or complicated viral infections and 20 invasive fungal diseases. Fourteen patients died in the first 30 days (all related to the infectious process). In multivariate analysis leukemia, more than 2 chemotherapy regimens before transplant and pneumonia were related to 12-month mortality rates. CONCLUSIONS Even though infectious processes are frequent in patients with HSCT, multidrug-resistant bacteria were not as frequent as supposed; however, when these microorganisms are involved, mortality rate is increased. It is important to be alert that patients with pneumonia have a significantly increased mortality risk in the first year.
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Affiliation(s)
- A César-Arce
- Department of Infectious Disease, Instituto Nacional de Cancerología (INCan), México City, México
| | - P Volkow-Fernández
- Department of Infectious Disease, Instituto Nacional de Cancerología (INCan), México City, México
| | - L M Valero-Saldaña
- Department of Hematology, Instituto Nacional de Cancerología (INCan), México City, México
| | - B Acosta-Maldonado
- Department of Hematology, Instituto Nacional de Cancerología (INCan), México City, México
| | - D Vilar-Compte
- Department of Infectious Disease, Instituto Nacional de Cancerología (INCan), México City, México
| | - P Cornejo-Juárez
- Department of Infectious Disease, Instituto Nacional de Cancerología (INCan), México City, México.
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Velázquez-Acosta C, Zarco-Márquez S, Jiménez-Andrade MC, Volkow-Fernández P, Cornejo-Juárez P. Stenotrophomonas maltophilia bacteremia and pneumonia at a tertiary-care oncology center: a review of 16 years. Support Care Cancer 2018; 26:1953-1960. [PMID: 29307014 DOI: 10.1007/s00520-017-4032-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 08/07/2017] [Accepted: 12/25/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to describe the clinical characteristics and antimicrobial patterns of Stenotrophomonas maltophilia bloodstream infections (BSI) and pneumonia episodes in patients with cancer. METHODS Patients with S. maltophilia BSI or pneumonia admitted from 1 Jan. 2000 to 31 Dec. 2016 were identified at the Instituto Nacional de Cancerología (INCan), a tertiary-care oncology hospital in Mexico City. RESULTS During the study period, there were 171 isolates identified. The mean age of the whole group was 46.9 ± 17.4 years; 99 (57.9%) were women. There were 95 BSI: 64 ambulatory catheter-related BSI (CRBSI), 20 nosocomial CRBSI, and 11 secondary BSI. Mortality was higher in nosocomial CRBSI (40%) vs. that in ambulatory CRBSI (7.8%) (p = 0.001). There were 76 pneumonia episodes; all were nosocomial acquired; 46 (60.5%) ventilator-associated. From all the group, nine strains (5.2%) were resistant to sulfamethoxazole/trimethoprim/(SMX/TMP). At the first month, 54 patients (31.6%) have died, 38 due to pneumonia (70%) and 16 due to BSI (30%, p < 0.001). Multivariate analysis showed that removal of central venous catheter was associated with a favorable outcome in patients with bacteremia. For patients with pneumonia, age ≥ 65 years and inappropriate antimicrobial treatment were risk factors associated with 30-day mortality. CONCLUSIONS S. maltophilia related with ambulatory CRBSI have a better prognosis than other sources of BSI. Older patients with pneumonia who do not receive appropriate antibiotics have higher mortality. SMX/TMP is still the antibiotic of choice.
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Affiliation(s)
| | - Sugehily Zarco-Márquez
- Laboratorio de Microbiología, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Mari Carmen Jiménez-Andrade
- Departamento de Infectología, INCan, Av. San Fernando No. 22, Col. Sección XVI, Del. Tlalpan, 14000, Mexico City, Mexico
| | - Patricia Volkow-Fernández
- Departamento de Infectología, INCan, Av. San Fernando No. 22, Col. Sección XVI, Del. Tlalpan, 14000, Mexico City, Mexico
| | - Patricia Cornejo-Juárez
- Departamento de Infectología, INCan, Av. San Fernando No. 22, Col. Sección XVI, Del. Tlalpan, 14000, Mexico City, Mexico.
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González-Lara MF, Torres-González P, Cornejo-Juárez P, Velázquez-Acosta C, Martinez-Gamboa A, Rangel-Cordero A, Bobadilla-Del-Valle M, Ostrosky-Zeichner L, Ponce-de-León A, Sifuentes-Osornio J. Impact of inappropriate antifungal therapy according to current susceptibility breakpoints on Candida bloodstream infection mortality, a retrospective analysis. BMC Infect Dis 2017; 17:753. [PMID: 29212442 PMCID: PMC5719515 DOI: 10.1186/s12879-017-2846-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/21/2017] [Indexed: 12/29/2022] Open
Abstract
Background The mortality of Candida Bloodstream Infection (CBSI) remains high. Antifungal susceptibility breakpoints were recently updated for Candida species, the impact remains unknown. In this study we evaluated the impact of inappropriate antifungal treatment according to recent breakpoints on 30-day mortality of CBSI. Methods From June 2008 to July 2014, data on CBSI episodes from two tertiary-care centers, treated > 72 h were analyzed. Antifungal therapy and 30-day mortality were registered. Inappropriate antifungal treatment according to current Clinical & Laboratory Standards Institute (CLSI) breakpoints was adjusted with 30-day mortality-related co-variates. Results One hundred forty-nine episodes of CBSI were analyzed. The most frequent species were: C. albicans (40%), C. tropicalis (23%) and C. glabrata complex (20%). According to the 2012 CLSI, 10.7% received inappropriate treatment. The 30-day mortality was 38%; severe sepsis [Odds ratio (OR) 3.4; 95% CI 1.3–8.4], cirrhosis (OR 36; 95% CI 12.2–605), early central venous catheter removal (OR 0.23; 95% CI 0.08–0.66) and previous antifungal therapy (OR 0.15; 95%CI 0.03–0.62), were associated with 30-day mortality by multivariate analysis. Inappropriate antifungal treatment was not (OR 0.19; 95% CI 0.03–1.2). Conclusions Appropriate antifungal therapy according to CLSI 2012 did not have an impact on mortality. Mortality of CBSI remains high due to disease severity and comorbidities; early antifungal therapy and catheter removal may reduce it.
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Affiliation(s)
- María Fernanda González-Lara
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Zip Code 14080, Mexico City, Mexico
| | - Pedro Torres-González
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Zip Code 14080, Mexico City, Mexico
| | - Patricia Cornejo-Juárez
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Ave. San Fernando 22, Belisario Dominguez Sección XVI, Zip code 14080, Mexico City, Mexico
| | - Consuelo Velázquez-Acosta
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Ave. San Fernando 22, Belisario Dominguez Sección XVI, Zip code 14080, Mexico City, Mexico
| | - Areli Martinez-Gamboa
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Zip Code 14080, Mexico City, Mexico
| | - Andrea Rangel-Cordero
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Zip Code 14080, Mexico City, Mexico
| | - Miriam Bobadilla-Del-Valle
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Zip Code 14080, Mexico City, Mexico
| | - Luis Ostrosky-Zeichner
- University of Texas Health Science Center at Houston, 6431 Fannin. MSB 2.112, Houston, TX, 77030, USA
| | - Alfredo Ponce-de-León
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Zip Code 14080, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Zip Code 14080, Mexico City, Mexico.
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Hernaiz-Leonardo JC, Golzarri MF, Cornejo-Juárez P, Volkow P, Velázquez C, Ostrosky-Frid M, Vilar-Compte D. Microbiology of surgical site infections in patients with cancer: A 7-year review. Am J Infect Control 2017; 45:761-766. [PMID: 28385464 DOI: 10.1016/j.ajic.2017.02.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health care-associated infections (HAIs) have arisen as major sources of multidrug-resistant bacteria. Surgical site infections (SSIs) are the most frequent HAIs in many countries, with high antimicrobial-resistant prevalence. METHODS A 7-year retrospective review (2008-2014) of microbiologic data within a prospective surveillance program on patients with SSI at a cancer hospital in Mexico. RESULTS There were 23,421 surgeries performed during the study period. The SSI rate was 7.9%. Gram-negative bacilli (GNB) were found in 56.5% of samples. Escherichia coli was the most frequent microorganism (27.5%), followed by Staphylococcus aureus (16.3%). SSI caused by S aureus showed a decreasing trend (P = .04). Extended-spectrum β-lactamase (ESBL)-producing E coli increased from 39.5% in 2008 to 72.5% in 2014 (P < .001). Fluoroquinolone resistance also increased in all members of the Enterobacteriaceae. Methicillin-resistant S aureus (MRSA) was isolated in 32% of cases with no significant increase (P value is not significant). CONCLUSIONS GNB caused most SSIs, with an increase of ESBL E coli strains. In breast and thoracic surgery, S aureus remained the most frequent isolate. MRSA remained stable throughout the study period. We observed a decreasing trend in S aureus. These findings show the differences in the microbiology of SSIs in a middle-income country and the increasing trend of ESBL enterobacteria and other multidrug-resistant organisms, such as Enterococcus faecium.
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Affiliation(s)
| | | | | | - Patricia Volkow
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Consuelo Velázquez
- Microbiology Laboratory, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Mauricio Ostrosky-Frid
- Programa de estudios combinados en medicina, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Diana Vilar-Compte
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Mexico City, Mexico.
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Volkow P, Cesarman-Maus G, Garciadiego-Fossas P, Rojas-Marin E, Cornejo-Juárez P. Clinical characteristics, predictors of immune reconstitution inflammatory syndrome and long-term prognosis in patients with Kaposi sarcoma. AIDS Res Ther 2017; 14:30. [PMID: 28558783 PMCID: PMC5450046 DOI: 10.1186/s12981-017-0156-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 05/24/2017] [Indexed: 12/18/2022] Open
Abstract
Objective To investigate the predictive factors for the development of Kaposi sarcoma-related immune reconstitution inflammatory syndrome (KS-IRIS) and long-term prognosis in patients starting combined antiretroviral therapy (cART). Methods We studied a retrospective-cohort of consecutive antiretroviral-naïve patients with KS initiating cART from January 2005 to December 2011 and followed through June 2013. KS-IRIS was defined as ≥2 of the following: abrupt increase in number of KS lesions, appearance or exacerbation of lung-opacities or lymphedema, concomitantly with an increase in CD4+ cell-count ≥50 cells/mm3 and a decrease of >1 log in viral-load once started cART. We compared individuals who met KS-IRIS criteria with those that did not and described the long-term follow-up. Results We included 89 patients, 88 males; 35 (39%) developed KS-IRIS at a median of 10 weeks (IQR 4–16). KS-IRIS patients had more pulmonary-involvement (60% vs. 16.6% of patients; p < 0.0001), eight died attributed to pulmonary-KS. Thrombocytopenia <100,000/mm3 at follow-up occurred in 36% of KS-IRIS vs. 4% in non-KS-IRIS patients (p = 0.0002), 45% KS-IRIS patients with thrombocytopenia died, non without KS-IRIS. Chemotherapy (bleomicyn–vincristine) was more frequently prescribed in KS-IRIS patients (88.6% vs. 29.6%) with no differences in outcome; 80% of all patients achieve KS complete remission, 52% of them never received chemotherapy. No difference between groups in the long-term follow-up (mean 52.4 ± 27.4 months) was found, only one patient developed a secondary malignancy (1.12%). Conclusions Lung-involvement was predictive of IRIS development. Thrombocytopenia in KS-IRIS patients at week 12 follow-up after cART initiation was associated with high mortality. Over a third of patients with KS achieve remission without chemotherapy. Individuals that survive the initial period of KS-IRIS adhere to cART had a good long-term prognosis. Electronic supplementary material The online version of this article (doi:10.1186/s12981-017-0156-9) contains supplementary material, which is available to authorized users.
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Zarco-Márquez S, Volkow-Fernández P, Velázquez-Acosta C, Echániz-Avilés G, Carnalla-Barajas MN, Soto-Noguerón A, Cornejo-Juárez P. Invasive and Complicated Pneumococcal Infection in Patients with Cancer. Rev Invest Clin 2016; 68:221-228. [PMID: 27941957] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND In susceptible patients, Streptococcus pneumoniae can cause complicated pneumonia and invasive pneumococcal disease. The aim of this study was to assess the clinical and antimicrobial features of complicated and invasive pneumococcal disease in patients with cancer. METHODS We conducted a retrospective study including all S. pneumoniae isolates between January 1, 2007 and December 31, 2015 in an oncology center. Capsular serotyping was done in isolates from sterile sites. RESULTS There were 103 episodes: 69 with invasive pneumococcal disease and 34 with complicated pneumonia. Sixty-two patients were male (60%); mean age was 50 years. Eighty-four isolates were susceptible to penicillin (81.6%), 11 (10%) were intermediate, and eight (8.3%) were resistant. Serotyping was performed in 64 isolates; the main serotypes identified were 3 (n = 13) and 19A (n = 11). No patient had a record of vaccination. Mortality at seven days attributed to pneumococcal infection was different in invasive pneumococcal disease (n = 18, 28.6%) vs. pneumonia (n = 3, 8.9%; p = 0.04). Thirty-day mortality related with the infectious process was statistically different between both groups: 21 patients with invasive pneumococcal disease (30.4%) and six with pneumonia (17.6%; p = 0.04). By logistic analysis, the risk factor associated with mortality was not having received appropriate antimicrobial treatment in the first 48 hours. CONCLUSIONS S. pneumoniae is a pathogen related with high mortality in patients with cancer. Pneumococcal immunization needs to be reinforced in this population.
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Affiliation(s)
| | | | | | - Gabriela Echániz-Avilés
- Infectious Diseases Research Center, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, Mexico
| | | | - Araceli Soto-Noguerón
- Infectious Diseases Research Center, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, Mexico
| | - Patricia Cornejo-Juárez
- Department of Infectious Diseases, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
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Velázquez-Acosta C, Cornejo-Juárez P, Volkow-Fernández P. [Bacterial resistance from urine cultures at an oncological center: follow-up to 10 years]. Salud Publica Mex 2016; 58:446-452. [PMID: 27599077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 04/08/2016] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE To describe the incidence and patterns of bacterial resistance in urine samples from a tertiary care oncology hospital in Mexico, from 2004 to 2013. MATERIALS AND METHODS We included the strains obtained from urine cultures, describing separately multidrug-resistant (MDR) bacteria. We analyzed the susceptibility to different antibiotics. RESULTS 51 202 urine cultures were processed during the study; 14 480 (28.3%) cultures were positive. In 11 427 samples Gram negative (79%) were isolated, 2 080 Gram positive (14.4%), and 973 yeasts (6.6%). Escherichia coli was the most frequent bacteria identified (56.1%); 24% of the community strains and 65.7% of the nosocomial were extended-spectrum beta-lactamase producers (ESBL). Klebsiella pneumoniae was isolated in 705 samples (4.8%); 115 were ESBL (16%), 13.1% from community and 29.8% from nosocomial source. Pseudomonas aeruginosa was identified in 593 cultures (4.1%): 9% from community and 51% nosocomial. CONCLUSIONS MDR bacteria were more frequent in nosocomial isolates. It should be a priority to intensify the rational use of antimicrobials in the community and antibiotic stewardship in the hospital.
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Martínez-Hernández L, Vilar-Compte D, Cornejo-Juárez P, Volkow-Fernández P. [Nosocomial pneumonia in patients with haematological malignancies]. GAC MED MEX 2016; 152:465-472. [PMID: 27595249] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION Nosocomial pneumonia (NP) in patients with hematological malignancies (HM) has an attributable mortality over 90%. There are few studies that report the incidence of nosocomial infections in patients with HM. OBJECTIVE To describe the epidemiology and clinical course of NP in a cohort of patients with hematologic malignancies. MATERIAL AND METHODS Single-center study of patients with leukemia, lymphoma or multiple myeloma diagnosed with NP, hospitalized between January 2011 and December 2012. RESULTS One-hundred and five NP were recorded: 51 leukemias (48%) and 45 lymphomas (43%); 50 (48%) were in relapse or progression. Median days for NP development were 13 days (IQ 6-20). Sixty percent of the patients had severe neutropenia. The most frequent symptom was fever 73 (70%). CT scan showed infiltrates in 100% of cases; 45 (43%) with findings suggestive of invasive fungal infection. Seven (7%) had confirmed invasive fungal infection, possible 9 (9%) and 45 (43%) probable. There were 99 cultures taken, 30 blood cultures (67% were positive) and 31 sputum (71% positive). Sixty percent of Gramnegative bacteria were multi-drug resistant and 50% of the Grampositive, E. coli, 19 (30%) was the most frequent isolated, Aspergillus spp. was the third, but the one with the highest associated mortality. Attributable mortality for pneumonia was 50% and 73% in patients that required mechanical ventilation (p = 0.001). CONCLUSIONS We observed a high mortality rate in patients with HM and NP. Standardized diagnostic routes are needed for patients with HM with suspicion of pneumonia. Novel diagnostic techniques to enhance Aspergillus and respiratory viruses diagnosis should be introduced in this setting.
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Affiliation(s)
- Lucía Martínez-Hernández
- Departamento de Infectología, Instituto Nacional de Cancerología, Ciudad de México, México
- Servicio de Infectología, Hospital Español de México (adscripción actual), Ciudad de México, México
| | - Diana Vilar-Compte
- Departamento de Infectología, Instituto Nacional de Cancerología, Ciudad de México, México
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Cornejo-Juárez P, Vilar-Compte D, García-Horton A, López-Velázquez M, Ñamendys-Silva S, Volkow-Fernández P. Hospital-acquired infections at an oncological intensive care cancer unit: differences between solid and hematological cancer patients. BMC Infect Dis 2016; 16:274. [PMID: 27286681 PMCID: PMC4903007 DOI: 10.1186/s12879-016-1592-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 05/25/2016] [Indexed: 02/07/2023] Open
Abstract
Background Cancer patients have a higher risk of severe sepsis in comparison with non-cancer patients, with an increased risk for hospital-acquired infections (HAI), particularly with multidrug resistant bacteria (MDRB). The aim of the study is to describe the frequency and characteristics of HAI and MDRB in critically ill cancer patients. Methods We conducted an 18-month prospective study in patients admitted ≥48 h to an ICU at a cancer referral center in Mexico. Patients with hematological malignancies (HM) were compared with solid tumors. Demographic and clinical data were recorded. Mortality was evaluated at 30-days. Results There were 351 admissions during the study period, among whom 157 (66 %) met the inclusion criteria of the study as follows: 104 patients with solid tumors and 53 with HM. Sixty-four patients (40.7 %) developed 95 episodes of HAI. HAI rate was 4.6/100 patients-days. MDRB were isolated in 38 patients (24 %), with no differences between both groups. Escherichia coli was the main bacteria isolated (n = 24), 78 % were extended spectrum beta-lactamases producers. The only risk factor associated with HAI was the presence of mechanical ventilation for more than 5 days (OR 3.12, 95 % CI 1.6 – 6.2, p = 0.001). At 30-day follow-up, 61 patients (39 %) have died (38 % with solid tumors and 60 % with HM, p < 0.001). No differences were found in mortality at 30-day between patients with HAI (n = 25, 39 %) vs. non-HAI (n = 36, 38.7 %, p = 0.964); neither in those who developed a HAI with MDRB (n = 12, 35.3 %) vs. HAI with non-MDRB (n = 13, 43.3 %, p = 0.51). Conclusions Patients with cancer who are admitted to an ICU, have a high risk of HAI, but there were no differences patients with solid or hematologic malignancies.
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Affiliation(s)
- Patricia Cornejo-Juárez
- Infectious Diseases Department, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico.
| | - Diana Vilar-Compte
- Infectious Diseases Department, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico
| | - Alejandro García-Horton
- Infectious Diseases Department, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico
| | - Marco López-Velázquez
- Infectious Diseases Department, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico
| | - Silvio Ñamendys-Silva
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico
| | - Patricia Volkow-Fernández
- Infectious Diseases Department, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico
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Velázquez-Acosta C, Cornejo-Juárez P, Volkow-Fernández P. Resistencia bacteriana de cultivos de orina en un hospital oncológico:seguimiento a diez años. SALUD PÚBLICA DE MÉXICO 2016. [DOI: 10.21149/spm.v58i4.8025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Cornejo-Juárez P, Vilar-Compte D, Pérez-Jiménez C, Ñamendys-Silva SA, Sandoval-Hernández S, Volkow-Fernández P. The impact of hospital-acquired infections with multidrug-resistant bacteria in an oncology intensive care unit. Int J Infect Dis 2014; 31:31-4. [PMID: 25528484 DOI: 10.1016/j.ijid.2014.12.022] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/08/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To describe overall site-specific hospital-acquired infection (HAI) rates and to describe the microbiological and antibiotic resistance profiles of infecting pathogens, together with their impact on multidrug-resistant (MDR) bacteria-associated mortality. METHODS We conducted a 5-year retrospective descriptive study of HAI in patients in the intensive care unit (ICU) of a cancer center in Mexico from January 2007 to December 2011. The following information was collected: patient characteristics and comorbidities, data related to the neoplasm and its treatment, microbiology, and the resistance pattern of all isolates. RESULTS During the study period, 1418 patients were admitted to the ICU; 134 of them developed 159 infections, with an incidence of 11.2/100 hospitalized patients and 32.2/per 1000 patient-days. Two hundred sixty-six microorganisms were isolated. The overall prevalence of MDR-HAI was 39.5%. The most frequent organisms were as follows: 54 (20%) Escherichia coli (94.4% of these were extended-spectrum beta-lactamase producers), 32 (12%) Staphylococcus aureus (90.6% of these were methicillin-resistant), 32 (12%) Enterococcus faecium (18.7% of these were vancomycin-resistant), and 20 (6%) Acinetobacter baumannii (all were MDR). Among patients admitted to the ICU, 252 (17.8%) died. Death was related to the HAI in 58 (23%) of these patients (p<0.001) and 51 (88%) had a MDR organism isolated (p=0.05). CONCLUSIONS The emergence of MDR bacteria poses a difficult task for physicians, who have limited therapeutic options. Critically ill cancer patients admitted to the ICU are at major risk of a bacterial MDR-HAI that will impact adversely on mortality.
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Affiliation(s)
- P Cornejo-Juárez
- Department of Infectious Disease, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14080 México, D.F., Mexico.
| | - D Vilar-Compte
- Department of Infectious Disease, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14080 México, D.F., Mexico
| | - C Pérez-Jiménez
- Department of Infectious Disease, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14080 México, D.F., Mexico
| | - S A Ñamendys-Silva
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - S Sandoval-Hernández
- Department of Infectious Disease, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14080 México, D.F., Mexico
| | - P Volkow-Fernández
- Department of Infectious Disease, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14080 México, D.F., Mexico
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Cornejo-Juárez P, Vilar-Compte D, Pérez-Jiménez C, González-Ordoñez H, Maldonado-Martínez H, Pérez-Badillo MP, Villaseñor-Navarro Y, Volkow-Fernández P. Idiopathic granulomatous mastitis. Experience at a cancer center. Rev Invest Clin 2014; 66:393-398. [PMID: 25695381] [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] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/08/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a benign breast disease that has been described as a rare granulomatous inflammation (GI). It can mimic inflammatory breast cancer. MATERIAL AND METHODS We included women with a diagnosis of IGM referred to an oncologic hospital between January 01, 2007 and to March 31, 2011, with diagnosis of breast cancer, in whom biopsy reported GI, without other cause related. The aim of this study was to review the clinical, radiologic and pathologic characteristics of a cohort of women with IGM. RESULTS We analyzed 58 patients; mean age was 38 ± 12 years. Mammography showed diffuse asymmetry (n = 19) and focal asymmetry (n = 13); breast ultrasound showed heterogeneous and hypoechoic areas (n = 28) and lumps (n = 21) as the most frequent lesions. All biopsies showed lobulocentric GI. Treatment included antibiotics (n = 20), steroids (n = 8), both treatments (n = 20), surgical excision (n = 3) and observation (n = 7). Forty-three patients (74%) had complete remission; mean time to remission was 9.5 ± 5.8 months. Fifteen (26%) had partial remission. Any patient had progression or relapse. CONCLUSIONS IGM is a benign breast condition that may mimic breast inflammatory cancer. Ultrasonography and mammography findings reveal characteristic data that can be useful for establishing the diagnosis; however, biopsy is the gold standard for its diagnosis and should be taken in any patient even with a mild suspicion of cancer.
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Cornejo-Juárez P, Pérez-Jiménez C, Silva-Sánchez J, Velázquez-Acosta C, González-Lara F, Reyna-Flores F, Sánchez-Pérez A, Volkow-Fernández P. Molecular analysis and risk factors for Escherichia coli producing extended-spectrum β-lactamase bloodstream infection in hematological malignancies. PLoS One 2012; 7:e35780. [PMID: 22540004 PMCID: PMC3335120 DOI: 10.1371/journal.pone.0035780] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/21/2012] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Patients with hematologic malignancies have greater risk-factors for primary bloodstream infections (BSI). METHODS From 2004-2009, we analyzed bacteremia caused by extended-spectrum beta-lactamase Escherichia coli (ESBL-EC) (n = 100) and we compared with bacteremia caused by cephalosporin-susceptible E. coli (n = 100) in patients with hematologic malignancies. OBJECTIVE To assess the clinical features, risk factors, and outcome of ESBL-EC BSI in patients with hematologic malignancies, and to study the molecular epidemiology of ESBL-EC isolates. RESULTS The main diagnosis was acute leukemia in 115 patients (57.5%). Death-related E. coli infection was significantly increased with ESBL-EC (34% vs. control group, 19%; p = 0.03). Treatment for BSI was considered appropriate in 64 patients with ESBL-EC (mean survival, 245 ± 345 days), and in 45 control patients this was 443 ± 613 (p = 0.03). In patients not receiving appropriate antimicrobial treatment, survival was significantly decreased in cases compared with controls (26 ± 122 vs. 276 ± 442; p = 0.001). Fifty six of the ESBL-EC isolates were characterized by molecular analysis: 47 (84%) expressed CTX-M-15, two (3.6%) SHV, and seven (12.5%) did not correspond to either of these two ESBL enzymes. No TLA-1 enzyme was detected. CONCLUSIONS Patients who had been previously hospitalized and who received cephalosporins during the previous month, have an increased risk of ESBL-EC bacteremia. Mortality was significantly increased in patients with ESBL-EC BSI. A polyclonal trend was detected, which reflects non-cross transmission of multiresistant E.coli isolates.
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Affiliation(s)
- Patricia Cornejo-Juárez
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Secretaría de Salud, Mexico City, Mexico.
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Vilar-Compte D, Cornejo-Juárez P, Pérez-Jiménez C, Cerezo O, Salazar-Rojas E, Joffe PA, Volkow P. An outbreak of influenza among physicians during the first wave of Mexico City's 2009 H1N1 epidemic. Salud Publica Mex 2011; 53:105-106. [PMID: 21537799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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Avilés-Salas A, Cornejo-Juárez P, Sobrevilla-Calvo PDJ. Coexistencia de linfoma plasmablástico, sarcoma de Kaposi y enfermedad de Castleman en un paciente con infección por virus de inmunodeficiencia humana. Rev Chilena Infectol 2011. [DOI: 10.4067/s0716-10182011000100015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Avilés-Salas A, Cornejo-Juárez P, Sobrevilla-Calvo PDJ. [Coexistence of plasmablastic lymphoma, Kaposi sarcoma and Castleman disease in a patient with HIV infection]. Rev Chilena Infectol 2011; 28:76-80. [PMID: 21526292] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Plasmablastic lymphoma (PL) is an uncommon B-cell lymphoma that is strongly associated with human immunodeficiency virus (HIV) infection, and displays distinctive affinity for extranodal presentation in the oral cavity. We report the case of a PL involving the stomach in a 36 year-old man HIV+ patient, associated with Kaposi sarcoma (KS) in sections adjacent to lymphoma. He had a positive history of Castleman disease and KS in a lymphoid node biopsy.
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Ñamendys-Silva SA, Pérez-Jiménez C, Cornejo-Juárez P, Vilar-Compte D, Volkow P. Prolonged lymphopenia in a patient with lymphoma and severe Pandemic influenza A H1N1 2009 virus infection. Influenza Other Respir Viruses 2011; 5:167-9. [PMID: 21477135 PMCID: PMC5657011 DOI: 10.1111/j.1750-2659.2010.00193.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/28/2022] Open
Abstract
Please cite this paper as:Ñamendys‐Silva et al. (2011) Prolonged lymphopenia in a patient with lymphoma and severe Pandemic influenza A H1N1 2009 virus infection. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2010.00193.x. Objective To describe the clinical course of a confirmed influenza A Pandemic (H1N1) 2009 virus infection in a patient with lymphoblastic lymphoma on chemotherapy. Design Case report. Setting Instituto Nacional de Cancerología located in Mexico City, a national referral center for cancer patients. Patient and results A 15‐year‐old boy, with lymphoblastic lymphoma on chemotherapy. Oseltamivir 75 mg BID was started within 24 hour of first symptoms. The patient developed respiratory failure despite oseltamivir therapy; he presented a prolonged clinical course with severe lymphopenia and deteriorated every time oseltamivir was stopped while lymphopenia persisted. Oseltamivir was reassumed twice; in the second course, rimatadine was added. Genetic study of the virus showed 100% identity for AH1N1SW, and no H274Y mutation for oseltamivir resistance was found. Clinical recovery was apparent until he presented lymphocyte reconstitution after 35 days of disease while still on antiviral therapy. Conclusion This case exemplifies the need to sustain antiviral therapy while patient continues with severe lymphopenia. Lymphocyte count could be used as a surrogate marker to prolong antiviral therapy in patients with severe lymphopenia and clinically symptomatic Pandemic (H1N1) 2009 infection. This case also highlights the importance of treating patients based on clinical grounds and the variability of rRt‐PCR test for H1N1.
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Affiliation(s)
- Silvio A Ñamendys-Silva
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico
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Cornejo-Juárez P, Volkow-Fernández P, Sifuentes-Osornio J, Echániz-Aviles G, Díaz-Gonzalez A, Velázquez-Acosta C, Bobadilla-Del-Valle M, Gordillo-Molina P, Velazquez-Meza ME. Tracing the source of an outbreak of methicillin-resistant Staphylococcus aureus in a tertiary-care oncology hospital by epidemiology and molecular methods. Microb Drug Resist 2010; 16:203-8. [PMID: 20735171 DOI: 10.1089/mdr.2010.0048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study describes the clinical and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) isolates that emerged after an index case in a tertiary-care oncology hospital in Mexico City and identifies whether these isolates were related with the index case. All MRSA strains isolated from January 2006 until December 2007 were included. The clinical and demographic characteristics of patients were analyzed; molecular typing by pulsed-field gel electrophoresis was used to characterize the isolates. We included 44 MRSA isolates from 55 patients. Thirty-eight patients (86.4%) were classified with nosocomial infection and the remainder with healthcare-related infection. A single pulsed-field gel electrophoresis pattern (C) was identified with minor variations (two subtypes). The isolates analyzed were staphylococcal chromosome cassette mec type II (related with the New York-Japan strain). This case underscores the need to intensify strategies that identify and limit the spread of multiresistant pathogens imported by infected patients referred from other healthcare centers.
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Cornejo-Juárez P, Volkow-Fernández P, Avilés-Salas A, Calderón-Flores E. AIDS and non-Hodgkin's lymphoma. Experience at an oncological center in Mexico. Rev Invest Clin 2008; 60:375-381. [PMID: 19227434] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Non-Hodgkin lymphoma (NHL) associated with HIV became an AIDS-defining condition early in the epidemic and remains the second most common malignancy in patients with AIDS. With the advent of highly active antiretroviral therapy (HAART), the incidence and mortality of AIDS-related opportunistic infections and Kaposi's sarcoma has fallen dramatically, this trend is not observed so clearly for NHL. Our objective was to review the clinical spectrum of patients with AIDS-associated NHL and to analyze the impact of HAART on survival at an oncological tertiary center. MATERIAL AND METHODS We reviewed all medical records and histopathologic tissue of patients with HIV-associated NHL seen from January 1990 to September 2007 at the Instituto Nacional de Cancerologia in Mexico City. Survival or follow-up time was calculated from date of diagnosis to death, or to the date on which the patient was last seen. RESULTS Eighty seven HIV-positive patients were diagnosed with NHL (diffuse large B-cell lymphoma n=69; Burkitt-like n=8; pleomorphic large cell n=7; low-grade n=2, and angiocentric n=1). Twenty eight patients never received HAART, and 59 received HAART. Overall, 38 patients (43.7%) achieved complete response to NHL therapy, including only 14.3% patients in the non-HAART compared with 57.6% in the HAART group (p < or = 0.0001). Two patients (7.1%) in the non-HAART were alive compared with 37 (63.8%) in the HAART group (p < or = 0.0001). Mean survival time for all patients was 11 +/- 16.8 months. Survival was significantly shorter in patients not receiving HAART (4.8 +/- 7.6 months) as compared with those who did (14 +/- 19.2) (p=0.01). CONCLUSIONS Patients with NHL-HIV who were able to receive treatment with HAART and were sufficiently healthy to receive optimal chemotherapy treatment showed a significantly better prognosis.
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