Publications by authors named "Daniela De La Rosa-Zamboni"

20 Publications

  • Page 1 of 1

Sensitivity of the Molecular Test in Saliva for Detection of COVID-19 in Pediatric Patients With Concurrent Conditions.

Front Pediatr 2021 12;9:642781. Epub 2021 Apr 12.

Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.

The reference standard for the molecular diagnostic testing for COVID-19 is the use of nasopharyngeal or combined nasopharyngeal and oropharyngeal (NP/OP) swabs. Saliva has been proposed as a minimally invasive specimen whose collection reduces the risks for health care personnel. To assess the suitability of saliva for COVID-19 diagnosis as a replacement of the reference standard NP/OP swab in the setting of a tertiary care pediatric unit. A paired study based in the prospective cohort design in patients suspected of having COVID-19. RT-PCR was used to detect SARS-CoV-2 in paired samples of saliva and NP/OP swab collected from May through August 2020 from 156 pediatric participants, of whom 128 has at least one comorbidity and 91 showed clinical symptoms related to SARS-CoV-2 infection. Additionally, we studied a group of 326 members of the hospital staff, of whom 271 had symptoms related to SARS-CoV-2 infection. In the group of pediatric participants the sensitivity of the diagnostic test in saliva was 82.3% (95% CI 56.6-96.2) and the specificity 95.6% (95% CI 90.8-98.4). The prevalence of COVID-19 was 10.9% (17/156). In 6 of the 23 participants who tested positive for SARS-CoV-2 in at least one specimen type, the virus was detected in saliva but not in NP/OP swab, while in 3 participants the NP/OP swab was positive and saliva negative. In the group of adults, the sensitivity of the test in saliva was 77.8% (95% CI 67.2-86.3) and prevalence 24.8% (81/326). Discordant results between the two types of specimens showed a significant association with low viral load in the pharynx of adults but not of pediatric participants. In the context of a pediatric tertiary care hospital, the sensibility of the test in saliva is not high enough to replace the use of NP/OP swab for COVID-19 diagnosis. Neither NP/OP swab nor saliva could detect all the participants infected with SARS-CoV-2.
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http://dx.doi.org/10.3389/fped.2021.642781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071854PMC
April 2021

Implementation of guidelines to integrate the caregiver as a coassistant of health-care personnel during the hospital stay of COVID-19 pediatric patients: adaptation in a Mexican public pediatric hospital.

Bol Med Hosp Infant Mex 2021 03 3;78(2):102-109. Epub 2021 Mar 3.

Red Latinoamericana de Psicología Pediátrica. Mexico City, Mexico.

This paper describes the experience in a public pediatric hospital when implementing the Mexican Health Ministry's recommendations on the inclusion and importance of a chosen caregiver during the hospitalization of a coronavirus disease 2019 (COVID-19) pediatric patient. The implementation includes the adjustments, observations, and limitations made in real practice and process. In conclusion, the value and benefits of the accompaniment of hospitalized children with COVID-19 by a primary or chosen caregiver are evidenced and supported by family-centered care. Furthermore, the recommendations mentioned result in comprehensive bio-psycho-social care for the benefit of pediatric patients.
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http://dx.doi.org/10.24875/BMHIM.20000256DOI Listing
March 2021

Risk conditions in healthcare workers of a pediatric coronavirus disease center in Mexico City.

Bol Med Hosp Infant Mex 2021 01 19;78(2):110-115. Epub 2021 Jan 19.

Dirección General. Hospital Infantil de México Federico Gómez, Mexico City, Mexico.

Background: The new evere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by its high capacity to transmit. Health-care personnel is highly susceptible to becoming infected. This study aimed to determine the characteristics and known risk factors for contagion and severe outcomes of SARS-CoV-2 disease in health-care personnel of a pediatric coronavirus disease (COVID) center in Mexico City.

Methods: In the last week of March 2020 (at the beginning of phase 2 of the Ministry of Health's national campaign in Mexico), a study was conducted on healthcare workers of a pediatric COVID hospital in Mexico City. Using a virtual interview, we evaluated comorbidities, mobility, areas and functions where they carry out the activities, protection measures, contact history, and vaccination. According to their activities, healthcare workers were classified into the following areas: medical, nursing, other health-care personnel (researchers, nutritionists, rehabilitation, imaging, and laboratory), administrative, and other services. We compared the variables between the groups of healthcare workers with the X2 test.

Results: We included 812 participants. The mean age was 41 ± 11 years, and 33% were overweight or obese, 18% were over 60 years old, and 19% had high blood pressure. Medical and nursing personnel presented a higher proportion in the use of standard protection measures.

Conclusions: Among healthcare workers, there are risk conditions for the development of complications in case of SARS-CoV-2 infection. Most medical and nursing personnel use standard protective measures.
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http://dx.doi.org/10.24875/BMHIM.20000355DOI Listing
January 2021

Control of Methicillin-Resistant Strains Associated With a Hospital Outbreak Involving Contamination From Anesthesia Equipment Using UV-C.

Front Microbiol 2020 14;11:600093. Epub 2020 Dec 14.

Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico.

Methicillin-resistant (MRSA) is considered an opportunistic pathogen in humans and is mainly associated with healthcare-associated infections (HCAIs). This bacterium colonizes the skin and mucous membranes of healthy people and causes frequent hospital outbreaks. The aim of this study was to perform molecular typing of the staphylococcal cassette chromosome (SCC) and loci as wells as to establish the pulsotypes and clonal complexes (CCs) for MRSA and methicillin-sensitive . (MSSA) outbreaks associated with the operating room (OR) at a pediatric hospital. Twenty-five clinical strains of (19 MRSA and 6 MSSA strains) were recovered from the outbreak (patients, anesthesia equipment, and nasopharyngeal exudates from external service anesthesia technicians). These clinical . strains were mainly resistant to benzylpenicillin (100%) and erythromycin (84%) and were susceptible to vancomycin and nitrofurantoin. The SCC type II was amplified in 84% of the . strains, and the most frequent type of the locus was , which was amplified in 72% of the strains; however, the and genes were mainly detected in MSSA strains. A pulsed-field gel electrophoresis (PFGE) analysis grouped the 25 strains into 16 pulsotypes (P), the most frequent of which was P1, including 10 MRSA strains related to the anesthesia equipment, external service anesthesia technicians, and hospitalized patients. Multilocus sequence typing (MLST) identified 15 sequence types (STs) distributed in nine CCs. The most prevalent ST was ST1011, belonging to CC5, which was associated with the SCC type II and type. We postulate that the external service anesthesia technicians were MRSA carriers and that these strains were indirectly transmitted from the contaminated anesthesia equipment that was inappropriately disinfected. Finally, the MRSA outbreak was controlled when the anesthesia equipment disinfection was improved and hand hygiene was reinforced.
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http://dx.doi.org/10.3389/fmicb.2020.600093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767929PMC
December 2020

Restructuring of a pediatric hospital in the face of the COVID-19 pandemic.

Bol Med Hosp Infant Mex 2020 11;78(1):3-9

Dirección General. Hospital Infantil de México Federico Gómez, Mexico City, Mexico.

Overview of the pandemic In December 2019, a new virus named SARS-CoV-2 was reported in Wuhan province, China. The first case of COVID-19 in Mexico was confirmed on February 28, 2020, and the World Health Organization declared the pandemic on March 11.
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http://dx.doi.org/10.24875/BMHIM.20000265DOI Listing
November 2020

Molecular Epidemiology of - Complex Isolated From Children at the Hospital Infantil de México Federico Gómez.

Front Microbiol 2020 15;11:576673. Epub 2020 Oct 15.

Laboratorio de Investigación en Bacteriología Intestinal, Subdirección de Gestión de la Investigación, Hospital Infantil de México Federico Gómez, CDMX, Mexico.

The - () complex is regarded as a group of phenotypically indistinguishable opportunistic pathogens responsible for mainly causing hospital-acquired pneumonia and bacteremia. The aim of this study was to determine the frequency of isolation of the species that constitute the complex, as well as their susceptibility to antibiotics, and their distribution at the Hospital Infantil de Mexico Federico Gomez (HIMFG). A total of 88 strains previously identified by Vitek 2®, 40 as and 48 as complex were isolated from 52 children from 07, January 2015 to 28, September 2017. accounted for 89.77% (79/88) of the strains; , 6.82% (6/88); and , 3.40% (3/88). Most strains were recovered mainly from patients in the intensive care unit (ICU) and emergency wards. Blood cultures (BC) provided 44.32% (39/88) of strains. The 13.63% (12/88) of strains were associated with primary bacteremia, 3.4% (3/88) with secondary bacteremia, and 2.3% (2/88) with pneumonia. In addition, 44.32% (39/88) were multidrug-resistant (MDR) strains and, 11.36% (10/88) were extensively drug-resistant (XDR). All strains amplified the gene; 51.13% (45/88), the gene; 4.54% (4/88), the gene; and 2.27% (2/88), the gene. Plasmid profiles showed that the strains had 1-6 plasmids. The strains were distributed in 52 pulsotypes, and 24 showed identical restriction patterns, with a correlation coefficient of 1.0. Notably, some strains with the same pulsotype were isolated from different patients, wards, or years, suggesting the persistence of more than one clone. Twenty-seven sequence types (STs) were determined for the strains based on a Pasteur multilocus sequence typing (MLST) scheme using massive sequencing; the most prevalent was ST 156 (27.27%, 24/88). The Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-Cas I-Fb system provided amplification in and strains (22.73%, 20/88). This study identified an increased number of MDR strains and the relationship among strains through molecular typing. The data suggest that more than one strain could be causing an infection in some patient. The implementation of molecular epidemiology allowed the characterization of a set of strains and identification of different attributes associated with its distribution in a specific environment.
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http://dx.doi.org/10.3389/fmicb.2020.576673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7593844PMC
October 2020

Molecular Epidemiology, Antibiotic Resistance, and Virulence Traits of Strains Associated With an Outbreak in a Mexican Tertiary Care Hospital.

Front Cell Infect Microbiol 2020 18;10:50. Epub 2020 Feb 18.

Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México "Federico Gómez", Ciudad de México, Mexico.

, an emerging opportunistic pathogen, is widely distributed in the environment the resistance mechanisms, and virulence factors of this bacterium facilitate its dissemination in hospitals. This study aimed to characterize the molecular epidemiology of strains associated with an outbreak in the Children's Hospital of México Federico Gómez (HIMFG). Twenty-one clinical strains were recovered from cultures of blood and urine samples from 10 pediatric patients at the emergency department, and nine environmental strains recovered from faucets in the same area were also included. Two of the 10 patients were related with health care-associated infections (HCAIs), and the other eight patients (8/10) were infected with environmental strains. The outbreak was controlled by monthly disinfection of the faucets in the emergency department. Typing using pulsed-field gel electrophoresis (PFGE) showed a 52% genetic diversity with seven pulsotypes denoted P1-P7 among all strains. Three pulsotypes (P2, P3, and P7) were identified among both the clinical and environmental strains and associated with two type sequences (STs), namely, ST304 and ST24. Moreover, 80% (24/30) of the strains exhibited resistance mainly to tetracycline, 76.66% (23/30) to trimethoprim-sulfamethoxazole, and 23.33% (7/30) to the extended-spectrum β-lactamase (ESBL) phenotype. The main resistance genes identified by multiplex PCR were in 100% (30/30), in 86.66% (26/30), and in 80% (24/30) of the samples, respectively. Furthermore, the , and genes were identified in 96.6% (29/30), 90% (27/30), and 83.33% (25/30) of the samples, respectively. Additionally, 76.66% (23/30) of the strains exhibited high swimming motility, 46.66% (14/30) showed moderate biofilm formation capacity, 43.33% (13/30) displayed moderate twitching motility, and 20% (6/30) exhibited high adherence. The clinical strains isolated from blood most strongly adhered to HTB-9 cells. In conclusion, the molecular epidemiology and some of the features such as resistance, and virulence genes associated with colonization patterns are pathogenic attributes that can promote dissemination, persistence, and facilitate the outbreak that occurred in the HIMFG. This study supports the need for faucet disinfection as a control strategy for clinical outbreaks.
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http://dx.doi.org/10.3389/fcimb.2020.00050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040173PMC
February 2020

Amino acid changes in HA and determinants of pathogenicity associated with influenza virus A H1N1pdm09 during the winter seasons 2015-2016 and 2016-2017 in Mexico.

Virus Res 2019 10 21;272:197731. Epub 2019 Aug 21.

Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.

Biennial H1N1pdm09 influenza A virus (IAV) epidemics have been associated with major severity of respiratory disease in Mexico. Atypically and in contrast with what happened in USA, Canada and Europe during 2017, an increase of infections due to the H1N1pdm09 pandemic virus instead of H3N2 was observed. In order to determine the viral contribution to severe acute respiratory disease, we characterized the pathogenicity determinants of IAV in Mexico during the 2015-2016 and 2016-2017 seasons. The RNA segments of 20 IAV samples were sequenced by NGS platform and phylogenetic analysis was conducted. The analysis of the hemagglutinin (HA) sequences established that all virus samples, except one, belong to clade (6B.1). The IAVs presented the substitution S162 N, which introduces a new glycosylation site in the hemagglutinin. We also found the D222 G substitution, which has been associated with a higher tropism towards the lower respiratory tract, and a non-reported insertion of one Ile in NS1 (Ile113). The IAVs from 2016 to 2017 in Mexico belong to the new clade 6B.1. The new glycosylation site in HA (S162 N) is a major change that may affect the efficacy of the current vaccine. We detected in several patients pathogenicity determinants associated with the severity of the respiratory disease.
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http://dx.doi.org/10.1016/j.virusres.2019.197731DOI Listing
October 2019

The impact of tooth brushing versus tooth brushing and chlorhexidine application to avoid postoperative pneumonia in children.

Am J Infect Control 2019 11 16;47(11):1340-1345. Epub 2019 Jul 16.

Hospital Infantil de México Federico Gómez, México City, Mexico.

Background: The pathogenesis of postsurgical pneumonia is a complicated and multifactorial process, in which elements like oral bacteria, orotracheal intubation, and dental hygiene play an important role. The objective of this study was to evaluate the efficacy of 2 types of oral hygiene interventions in decreasing cases of postsurgical pneumonia.

Methods: In pediatric patients scheduled for surgery, a quasi-experimental study was carried out over a 2-year period to evaluate the efficacy of 2 types of oral hygiene interventions. There were 2 groups of intervention with 1 group for comparison. Intervention groups were tooth brushing by a dentist (intervention group 1) and dental brushing by parents + chlorhexidine gluconate (intervention group 2). Data from the year with no oral hygiene interventions were used as the baseline group.

Results: A total of 2,535 surgical procedures were followed. Baseline group incidence of postoperative pneumonia was 10 per 1,000 surgeries, 0.2 per 1,000 surgeries in the intervention group 1 (P = .04), and 0.8 per 1,000 surgeries in the intervention group 2. Intervention group 1 was protective against postoperative pneumonia (odds ratio, 0.06; P = .02; 95% confidence interval, 0.033-0.079), but there was no benefit with intervention group 2 (odds ratio, 0.87; P = .599; 95% confidence interval, 0.52-1.46).

Conclusions: Dental brushing performed before surgery by a pediatric dentist was effective in reducing the incidence of postoperative pneumonia in pediatric patients.
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http://dx.doi.org/10.1016/j.ajic.2019.05.018DOI Listing
November 2019

Healthcare-Associated Pneumonia: Don't Forget About Respiratory Viruses!

Front Pediatr 2019 16;7:168. Epub 2019 May 16.

Epidemiology Department, Federico Gómez Children's Hospital of Mexico, Mexico City, Mexico.

Healthcare-associated infections are an important cause of morbidity and mortality, are among the most common adverse events in healthcare, and of them, pneumonia is the most commonly reported. Our objective was to evaluate the incidence and clinical outcome of respiratory viruses in hospital-acquired pneumonia (HAP). This was a prospective cohort study, include patients aged between 0 and 18 who fulfilled Centers for Diseases Control and Prevention (CDC) criteria for HAP. Demographic and clinical data were obtained, and a nasopharyngeal swab specimen was taken for the detection of respiratory viruses. All included patients were monitored until discharge to collect data on the need for mechanical ventilation, intensive care unit (ICU) admission, and mortality. All-cause 30-day mortality was also ascertained. Four thousand three hundred twenty-seven patients were followed for 42,658 patient-days and 5,150 ventilator-days. Eighty-eight patients (2.03%) met the CDC criteria for HAP, 63 patients were included, and clinical and epidemiological characteristics showed no statistically significant differences between patients with virus associated healthcare-associated pneumonia (VAHAP) and those with non-viral healthcare-associated pneumonia (NVHAP). At least one respiratory virus was detected in 65% [95% CI (53-77)] of episodes of HAP, with a single viral pathogen observed in 53.9% and coinfection with 2 viruses in 11.1% of cases. The outcome in terms of ICU admission, mechanical ventilation and the 30-day mortality did not show a significant difference between groups. In two-thirds of the patients a respiratory virus was identified. There was no difference in mortality or the rest of the clinical outcome variables. About half of the patients required mechanical ventilation and 10% died, which emphasizes the importance of considering these pathogens in nosocomial infections, since their identification can influence the decrease in hospital costs and be taken into account in infection control policies.
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http://dx.doi.org/10.3389/fped.2019.00168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532533PMC
May 2019

Seroprevalence of Bordetella pertussis in pediatric healthcare workers at the Hospital Infantil de México Federico Gómez.

Bol Med Hosp Infant Mex 2019 ;76(3):120-125

Hospital Infantil de México Federico Gómez, Ciudad de México, México.

Background: Bordetella pertussis is the causative agent of pertussis, a disease that is preventable by vaccination but has a high mortality, particularly in children < 6 months. Reports of pertussis outbreaks in hospitals show that the index case is usually an adult. In adults, the disease manifests mainly with persistent cough. The purpose of this study was to determine the seroprevalence of B. pertussis in the health personnel of a pediatric hospital in a country where vaccination of this staff is not considered mandatory.

Methods: Nursing staff and resident doctors who were involved in direct treatment with hospitalized patients participated in the study. Each participant was screened for immunoglobulin G anti-pertussis toxin antibodies (anti-PT), and a questionnaire was applied for clinical and demographic data.

Results: Ninety-three individuals were included, of which 85% were nurses, median age 35 years (interquartile range: 29-42.5). The participants worked in the emergency department (21.5%), in the Pediatric Intensive Care Unit (8.6%), and in the Neonatal Intensive Care Unit (6.5%). Detectable titers of anti-TP antibodies were found in 18.3%, of which 53% presented titles suggestive of recent infection and only 23.5% cough > 2 weeks of duration.

Conclusions: Health personnel are at risk of suffering from the disease and be potential transmitters to infants, who may die from this cause. This study suggests that the current vaccination policies in health personnel should be modified to determine the compulsory nature of the vaccination, especially in those individuals in charge of the care of the pediatric population.
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http://dx.doi.org/10.24875/BMHIM.19000130DOI Listing
February 2020

Everybody hands-on to avoid ESKAPE: effect of sustained hand hygiene compliance on healthcare-associated infections and multidrug resistance in a paediatric hospital.

J Med Microbiol 2018 Dec 29;67(12):1761-1771. Epub 2018 Oct 29.

2​Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México.

Purpose: Hand hygiene is the most important strategy for preventing healthcare-associated infections (HCAIs); however, the impact of hand hygiene in middle-income countries has been poorly described. In this work, we describe the impact of the programme 'Let's Go for 100' on hand hygiene adherence, HCAIs rates and multidrug-resistant (MDR) bacteria, including the molecular typing of methicillin-resistant Staphylococcus aureus (MRSA) strains.

Methodology: A multimodal, hospital-wide hand hygiene programme was implemented from 2013. 'Let's Go for 100' involved all healthcare workers and encompassed education, awareness, visual reminders, feedback and innovative strategies. Monthly hand hygiene monitoring and active HCAI surveillance were performed in every ward. Molecular typing of MRSA was analysed by pulsed-field gel electrophoresis (PFGE).Results/Key findings. Hand hygiene adherence increased from 34.9 % during the baseline period to 80.6 % in the last 3 months of this study. The HCAI rate decreased from 7.54 to 6.46/1000 patient-days (P=0.004). The central line-associated bloodstream infection (CLABSIs) rate fell from 4.84 to 3.66/1000 central line-days (P=0.05). Negative correlations between hand hygiene and HCAIs rates were identified. The attack rate of MDR-ESKAPE group bloodstream infections decreased from 0.54 to 0.20/100 discharges (P=0.024). MRSA pulsotypes that were prevalent during the baseline period were no longer detected after the 5 quarter, although new strains were identified.

Conclusions: A multimodal hand hygiene programme in a paediatric hospital in a middle-income country was effective in improving adherence and reducing HCAIs, CLABSIs and MDR-ESKAPE bloodstream infections. Sustaining hand hygiene adherence at a level of >60 % for one year limited MRSA clonal transmission.
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http://dx.doi.org/10.1099/jmm.0.000863DOI Listing
December 2018

Surveillance for the identification of cases of acute respiratory infection by enterovirus D68 in children in a tertiary level care hospital during 2014-2016.

Bol Med Hosp Infant Mex 2018 ;75(1):23-30

Hospital Infantil de México Federico Gómez. Secretaría de Salud, Ciudad de México, México.

Background: The reemergence of enterovirus D68 (EV-D68) infections in the United States was reported from August-October 2014 (691 cases). In Mexico, an outbreak at the National Institute of Respiratory Diseases was reported (24 cases). The results of epidemiological surveillance of Enterovirus sp. (EV) and other respiratory viruses in a national pediatric tertiary care level hospital are presented.

Methods: Following the alert issued by the reemergence of EV-D68 in 2014, epidemiological surveillance -which only detected respiratory viruses by PCR in patients with influenza-like illness using nasopharyngeal swabs- expanded to include children with asthma exacerbation or acute respiratory distress. Positive samples to EV were confirmed and typed by sequencing. Subsequent sequencing was used to obtain the complete viral genome.

Results: Of 1705 samples, 13 were positive to EV. Patients with EV presented the following comorbidities: chronic lung disease (7.7%), neoplastic disease (15.4%), allergic asthma/rhinitis (23%), recurrent pneumonia (23%), and other (23%). Of the 13 samples positive for EV, three were positive for EV-D68. These cases required invasive mechanical ventilation, presented no neurological involvement and survived.

Conclusions: The impact of the population studied by EV-D68 was lower than that reported in Mexico during the same period. Cases of EV-D68 infection had multiple comorbidities, but few pulmonary comorbidities, which could explain the low attack rate. The epidemiological surveillance and infection prevention system may have contained the outbreak.
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http://dx.doi.org/10.24875/BMHIM.M18000002DOI Listing
August 2019

Influenza-like illness in healthcare personnel at a paediatric referral hospital: Clinical picture and impact of the disease.

Influenza Other Respir Viruses 2018 07 19;12(4):475-481. Epub 2018 Apr 19.

Hospital Infantil de México Federico Gómez, Ciudad de México, México.

Introduction: Healthcare personnel (HP) are frequently exposed to influenza and can be a source of transmission to patients and other workers, resulting in high-cost outbreaks for healthcare institutions.

Objectives: To analyse the presentation of HP with influenza-like illness (ILI) and the differences between individuals with influenza confirmed by polymerase chain reaction (PCR) and those with a negative test. The secondary objective was to evaluate the duration of symptomatology and work absenteeism as well as the vaccination rate of HP at a paediatric referral hospital.

Methods: A cross-sectional, descriptive study was conducted at a paediatric referral hospital. Clinical and epidemiological data on HP with ILI were collected between January and April 2016. Nasopharyngeal swab for influenza PCR was obtained from one in every three workers with ILI. Telephone follow-up was conducted to document duration of symptoms, complications and absenteeism.

Results: A total of 164 ILI episodes were evaluated in 162 HP. A swab was obtained in 59 cases, and influenza was detected in 30 cases. The clinical picture of HP with confirmed influenza was similar to that of HP with a negative PCR. Arthralgia was more common in those with influenza (90% vs 58%), with a tendency towards statistical significance. No HP required hospitalization, and 78.5% were absent from work at least 1 day.

Conclusions: Influenza causes significant morbidity and absenteeism among HP. Influenza infection was confirmed in only half of HP with an ILI on whom a PCR was performed, suggesting that other respiratory viruses can cause a similar pattern.
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http://dx.doi.org/10.1111/irv.12553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005608PMC
July 2018

Identification of extensive drug resistant Pseudomonas aeruginosa strains: New clone ST1725 and high-risk clone ST233.

PLoS One 2017 2;12(3):e0172882. Epub 2017 Mar 2.

Laboratorio de Infectología, Hospital Infantil de México Federico Gómez, México City, México.

Several microorganisms produce nosocomial infections (NIs), among which Pseudomonas aeruginosa stands out as an opportunist pathogen with the capacity to develop multiresistance to first-choice antibiotics. From 2007 to 2013, forty-six NIs produced by P. aeruginosa were detected at a pediatric tertiary care hospital in Mexico with a significant mortality rate (17.39%). All isolates (n = 58/46 patients) were characterized by evaluating their response to several antibiotics as panresistant (PDR), extensively resistant (XDR), multiresistant (MDR) or sensitive (S). In addition, all isolates were typified through multilocus sequencing of seven genes: acsA, aroE, guaA, mutL, nuoD, ppsA and trpE. Furthermore, to establish the genetic relationships among these isolates, we carried out a phylogenetic inference analysis using maximum likelihood to construct a phylogenetic network. To assess evolutionary parameters, recombination was evaluated using the PHI test, and the ratio of nonsynonymous to synonymous substitutions was determined. Two of the strains were PDR (ST1725); 42 were XDR; four were MDR; and ten were S. Twenty-one new sequence types were detected. Thirty-three strains exhibited novel sequence type ST1725. The ratio of nonsynonym to synonym substitutions was 1:1 considering all genes. Phylogenetic analysis showed that the genetic relationship of the PDR, XDR and MDR strains was mainly clonal; however, the PHI test and the phylogenetic network suggest that recombination events occurred to produce a non-clonal population. This study aimed not only to determine the genetic diversity of clinical P. aeruginosa but also to provide a warning regarding the identification and spreading of clone ST1725, its ability to cause outbreaks with high mortality rates, and to remain in the hospital environment for over seven years. These characteristics highlight the need to identify clonal outbreaks, especially where high resistance to most antibiotics is observed, and control measures are needed. This study also represents the first report of the PDR ST1725.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0172882PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333833PMC
September 2017

Multidrug- and Extensively Drug-Resistant Uropathogenic Clinical Strains: Phylogenetic Groups Widely Associated with Integrons Maintain High Genetic Diversity.

Front Microbiol 2016 21;7:2042. Epub 2016 Dec 21.

Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez Mexico City, Mexico.

In recent years, an increase of uropathogenic (UPEC) strains with Multidrug-resistant (MDR) and Extensively Drug-resistant (XDR) profiles that complicate therapy for urinary tract infections (UTIs) has been observed and has directly impacted costs and extended hospital stays. The aim of this study was to determine MDR- and XDR-UPEC clinical strains, their virulence genes, their phylogenetic groups and to ascertain their relationship with integrons and genetic diversity. From a collection of 500 UPEC strains, 103 were selected with MDR and XDR characteristics. MDR-UPEC strains were mainly associated with phylogenetic groups D (54.87%) and B2 (39.02%) with a high percentage (≥70%) of several fimbrial genes (, and II), an iron uptake gene (), and a toxin gene (). In addition, a moderate frequency (40-70%) of other genes (, and A) was observed. XDR-UPEC strains were predominantly associated with phylogenetic groups B2 (47.61%) and D (42.85%), which grouped with ≥80 virulence genes, including II, , and . A moderate frequency (40-70%) of the and genes was observed. The class 1 and 2 integrons that were identified in the MDR- and XDR-UPEC strains were associated with phylogenetic groups D, B2, and A, while the XDR-UPEC strains that were associated with phylogenetic groups B2, D, and A showed an extended-spectrum beta-lactamase (ESBL) phenotype. The modifying enzymes (A1, B, C, 1, A1, A17, and A4) that were identified in the variable region of class 1 and 2 integrons from the MDR strains showed resistance to gentamycin (56.25 and 66.66%, respectively) and trimethoprim-sulfamethoxazole (84.61 and 66.66%, respectively). The MDR- and XDR-UPEC strains were distributed into seven clusters and were closely related to phylogenic groups B2 and D. The diversity analysis by PFGE showed 42.68% of clones of MDR-UPEC and no clonal association in the XDR-UPEC strains. In conclusion, phylogenetic groups including virulence genes are widely associated with two integron classes (1 and 2) in MDR- and XDR-UPEC strains.
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http://dx.doi.org/10.3389/fmicb.2016.02042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174082PMC
December 2016

Detection and characterization of respiratory viruses causing acute respiratory illness and asthma exacerbation in children during three different seasons (2011-2014) in Mexico City.

Influenza Other Respir Viruses 2015 Nov;9(6):287-292

Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.

Background: Viral infections play a significant role in causing acute respiratory infections (ARIs) and exacerbations of chronic diseases. Acute respiratory infections are now the leading cause of mortality in children worldwide, especially in developing countries. Recently, human rhinovirus (HRV) infection has been emerged as an important cause of pneumonia and asthma exacerbation.

Objectives: To determine the role of several viral agents principally, respiratory syncytial virus, and HRV in children with ARIs and their relationship with asthma exacerbation and pneumonia.

Methods: Between October 2011 and March 2014, 432 nasopharyngeal samples of children <15 years of age with ARI hospitalized at a referral hospital for respiratory diseases were tested for the presence of respiratory viruses using a multiplex RT-qPCR. Clinical, epidemiological, and demographic data were collected and associated with symptomatology and viral infections.

Results: Viral infections were detected in at least 59·7% of the enrolled patients, with HRV (26·6%) being the most frequently detected. HRV infections were associated with clinical features of asthma and difficulty in breathing such as wheezing (P = 0·0003), supraesternal (P = 0·046), and xiphoid retraction (P = 0·030). HRV subtype C (HRV-C) infections were associated with asthma (P = 0·02).

Conclusions: Human rhinovirus was the virus most commonly detected in pediatric patients with ARI. There is also an association of HRV-C infection with asthma exacerbation, emphasizing the relevance of this virus in severe pediatric respiratory disease.
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http://dx.doi.org/10.1111/irv.12346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605408PMC
November 2015

Molecular characterization of the predominant influenza A(H1N1)pdm09 virus in Mexico, December 2011-February 2012.

PLoS One 2012 29;7(11):e50116. Epub 2012 Nov 29.

Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.

When the A(H1N1)pdm09 pandemic influenza virus moved into the post-pandemic period, there was a worldwide predominance of the seasonal influenza A(H3N2) and B viruses. However, A(H1N1)pdm09 became the prevailing subtype in the 2011-2012 influenza season in Mexico and most of Central America. During this season, we collected nasopharyngeal swabs of individuals presenting with influenza-like illness at our institution in Mexico City. Samples were tested for seasonal A(H3N2) and B influenza viruses, as well as A(H1N1)pdm09 by real-time reverse transcription-polymerase chain reaction. Of 205 samples tested, 46% were positive to influenza, all of them A(H1N1)pdm09. The clinical characteristics of patients showed a similar pattern to the 2009 pandemic cases. Using next generation sequencing, we obtained whole genome sequences of viruses from 4 different patients, and in 8 additional viruses we performed partial Sanger sequencing of the HA segment. Non-synonymous changes found in the Mexican isolates with respect to the prototype isolate H1N1 (A/California/04/2009) included HA S69T, K163R and N260D unique to 2012 Mexican and North American isolates and located within or adjacent to HA antigenic sites; HA S143G, S185T, A197T and S203T previously reported in viruses from the 2010-2011 season, located within or adjacent to HA antigenic sites; and HA E374K located in a relevant site for membrane fusion. All Mexican isolates had an oseltamivir-sensitive genotype. Phylogenetic analysis with all 8 influenza gene segments showed that 2012 Mexican sequences formed a robust, distinct cluster. In all cases, 2012 Mexican sequences tended to group with 2010-2011 Asian and European sequences, but not with 2009 Mexican sequences, suggesting a possible recent common ancestor between these latter regions and the 2012 Mexican viruses. It remains to be defined if these viral changes represent an important antigenic drift that would enable viral immune evasion and/or affect influenza vaccine effectiveness.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0050116PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510220PMC
June 2013

Severe 2009 pandemic influenza A (H1N1) infection and increased mortality in patients with late and advanced HIV disease.

AIDS 2011 Feb;25(4):435-9

Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico.

Objective: To describe the clinical course of infection by 2009 (H1N1) influenza virus in different stages of HIV disease.

Design: Prospective, observational study.

Methods: During the pandemic period, HIV-infected patients presenting respiratory symptoms at a third level referral hospital in Mexico City were tested for 2009 influenza A (H1N1) viral RNA. Clinical files were prospectively analyzed.

Results: Infection by H1N1 was confirmed in 30 (23.8%) of the total 126 HIV-infected patients studied. In the group of patients with 2009 H1N1 virus infection, 16 (53.3%) were hospitalized, 12 (40%) had active opportunistic infections and six (20%) died. In the group of 96 patients not infected with 2009 H1N1 virus, 54 (56.25%) were hospitalized with opportunistic infections and 12 (12.5%) died. For all hospitalized patients, being on HAART and having undetectable HIV viral loads at hospitalization was associated with higher survival (P = 0.019). Patients with 2009 H1N1 virus infection had a higher mortality rate, even after adjusting for HAART (P = 0.043). Coinfection by HIV and H1N1 2009 virus was more severe in patients with opportunistic infections, as shown by longer hospital stays (P = 0.0013), higher rates of hospitalization (P < 0.0001), use of mechanical ventilation (P = 0.0086) and death (P = 0.026). Delayed administration of oseltamivir in hospitalized patients was significantly associated with mortality (P = 0.0022).

Conclusion: Our data suggest that infection by 2009 H1N1 is more severe in HIV-infected patients with late and advanced HIV disease than in well controlled patients under HAART.
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http://dx.doi.org/10.1097/QAD.0b013e3283434844DOI Listing
February 2011

Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico.

N Engl J Med 2009 Aug 29;361(7):680-9. Epub 2009 Jun 29.

National Institute of Respiratory Diseases, Mexico City, Mexico.

Background: In late March 2009, an outbreak of a respiratory illness later proved to be caused by novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in Mexico. We describe the clinical and epidemiologic characteristics of persons hospitalized for pneumonia at the national tertiary hospital for respiratory illnesses in Mexico City who had laboratory-confirmed S-OIV infection, also known as swine flu.

Methods: We used retrospective medical chart reviews to collect data on the hospitalized patients. S-OIV infection was confirmed in specimens with the use of a real-time reverse-transcriptase-polymerase-chain-reaction assay.

Results: From March 24 through April 24, 2009, a total of 18 cases of pneumonia and confirmed S-OIV infection were identified among 98 patients hospitalized for acute respiratory illness at the National Institute of Respiratory Diseases in Mexico City. More than half of the 18 case patients were between 13 and 47 years of age, and only 8 had preexisting medical conditions. For 16 of the 18 patients, this was the first hospitalization for their illness; the other 2 patients were referred from other hospitals. All patients had fever, cough, dyspnea or respiratory distress, increased serum lactate dehydrogenase levels, and bilateral patchy pneumonia. Other common findings were an increased creatine kinase level (in 62% of patients) and lymphopenia (in 61%). Twelve patients required mechanical ventilation, and seven died. Within 7 days after contact with the initial case patients, a mild or moderate influenza-like illness developed in 22 health care workers; they were treated with oseltamivir, and none were hospitalized.

Conclusions: S-OIV infection can cause severe illness, the acute respiratory distress syndrome, and death in previously healthy persons who are young to middle-aged. None of the secondary infections among health care workers were severe.
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http://dx.doi.org/10.1056/NEJMoa0904252DOI Listing
August 2009