Publications by authors named "Rafael Franco-Cendejas"

34 Publications

Probable Case of Vertical Transmission of SARS-CoV-2 in a Newborn in Mexico.

Neonatology 2021 May 6:1-4. Epub 2021 May 6.

Pediatric Cardiology Department, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada.

Background: Much remains unknown about the transmission of the SARS-CoV-2 virus. Pregnant women are considered part of the risk population, and vertical transmission of other coronaviruses has been suggested; however, this type of transmission in SARS-CoV-2 is believed to be unlikely.

Case Report: A newborn delivered in term via cesarean section to an asymptomatic but COVID-19-positive 35-year-old woman started with respiratory distress in the first 30 min of life. A chest radiograph revealed pneumothorax and ground glass opacities. Ventilatory support with continuous positive airway pressure was needed. Given the respiratory failure and the positive test from the mother, the patient was sampled for SARS-CoV-2 (RT-PCR) at minute 30 of life, with a positive result reported at 36 h of life. No complications had been present during pregnancy, and cardiac screening and blood cultures revealed no other etiologies.

Conclusion: Vertical transmission was highly likely in this case. Clinicians should be alert and report similar cases.
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http://dx.doi.org/10.1159/000514710DOI Listing
May 2021

Drug resistance phenotypes and genotypes in Mexico in representative gram-negative species: Results from the infivar network.

PLoS One 2021 17;16(3):e0248614. Epub 2021 Mar 17.

Laboratorio de Análisis Bioquímico Clínicos "Louis Pasteur" Toluca, Estado de México, Mexico.

Aim: This report presents phenotypic and genetic data on the prevalence and characteristics of extended-spectrum β-lactamases (ESBLs) and representative carbapenemases-producing Gram-negative species in Mexico.

Material And Methods: A total of 52 centers participated, 43 hospital-based laboratories and 9 external laboratories. The distribution of antimicrobial resistance data for Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, Acinetobacter baumannii complex, and Pseudomonas aeruginosa in selected clinical specimens from January 1 to March 31, 2020 was analyzed using the WHONET 5.6 platform. The following clinical isolates recovered from selected specimens were included: carbapenem-resistant Enterobacteriaceae, ESBL or carbapenem-resistant E. coli, and K. pneumoniae, carbapenem-resistant A. baumannii complex, and P. aeruginosa. Strains were genotyped to detect ESBL and/or carbapenemase-encoding genes.

Results: Among blood isolates, A. baumannii complex showed more than 68% resistance for all antibiotics tested, and among Enterobacteria, E. cloacae complex showed higher resistance to carbapenems. A. baumannii complex showed a higher resistance pattern for respiratory specimens, with only amikacin having a resistance lower than 70%. Among K. pneumoniae isolates, blaTEM, blaSHV, and blaCTX were detected in 68.79%, 72.3%, and 91.9% of isolates, respectively. Among E. coli isolates, blaTEM, blaSHV, and blaCTX were detected in 20.8%, 4.53%, and 85.7% isolates, respectively. For both species, the most frequent genotype was blaCTX-M-15. Among Enterobacteriaceae, the most frequently detected carbapenemase-encoding gene was blaNDM-1 (81.5%), followed by blaOXA-232 (14.8%) and blaoxa-181(7.4%), in A. baumannii was blaOXA-24 (76%) and in P. aeruginosa, was blaIMP (25.3%), followed by blaGES and blaVIM (13.1% each).

Conclusion: Our study reports that NDM-1 is the most frequent carbapenemase-encoding gene in Mexico in Enterobacteriaceae with the circulation of the oxacillinase genes 181 and 232. KPC, in contrast to other countries in Latin America and the USA, is a rare occurrence. Additionally, a high circulation of ESBL blaCTX-M-15 exists in both E. coli and K. pneumoniae.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248614PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968647PMC
March 2021

Ocular surface characteristics and colonization in a burn center: A prospective cohort study.

J Burn Care Res 2021 Mar 1. Epub 2021 Mar 1.

Center for Population Health Research. Instituto Nacional de Salud Pública. Cuernavaca, Morelos, Mexico.

We aimed to evaluate the characteristics and colonization by pathogenic microorganisms of the ocular surface in patients in a burn center and to determine their association with sedation, mechanical ventilation, and periocular burn. We prospectively evaluated 40 patients during an eight-month period. Five evaluations where performed, at baseline and weekly on four more occasions or until hospital discharge or death. On each visit, we assessed periocular burn, lid position, Bell's phenomenon, Schirmer's test, presence of chemosis, conjunctival hyperemia, and exposure keratopathy; conjunctival fornix swabs were taken for microbiology culture. Also, we documented the level of sedation, mechanical ventilation status, and systemic and ocular treatment. Absent Bell's phenomenon and chemosis were significantly different at baseline in patients under mechanical ventilation, sedation, and in those with periocular burn. The cumulative incidence of exposure keratopathy was 22.5% and the cumulative incidence of ocular surface colonization by pathogenic microorganisms was 32.5%. Both outcomes were associated with mechanical ventilation and periocular burn. The most frequent pathogenic microorganisms in the ocular surface were Candida parapsilosis, Acinetobacter baumanii, and Pseudomonas aeuroginosa. We did not observe any case of persistent epithelial defect, infectious keratitis, corneal perforation or corneal opacity in this cohort. Results from our study may benefit future patients by allowing better risk stratification and treatment strategies for the ocular surface care in burn units.
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http://dx.doi.org/10.1093/jbcr/irab040DOI Listing
March 2021

Synovial fluid analysis for the enhanced clinical diagnosis of crystal arthropathies in a tertiary care institution.

Clin Rheumatol 2021 Feb 17. Epub 2021 Feb 17.

Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra-Ibarra (INR-LGII), Calzada México-Xochimilco 289, Colonia Arenal de Guadalupe, 14389, Mexico City, Tlalpan, Mexico.

Introduction/objectives: Few studies have addressed the detection and clinical impact of different crystals in patients with diverse rheumatologic diagnoses in Latin America. The aim of this study was to assess the consistency between the clinical referring diagnosis and the identification of crystals, such as monosodium urate (MSU) and calcium pyrophosphate (CPP), in the synovial fluid (SF) of patients from a Mexican tertiary care institution.

Methods: We reviewed the results of 264 SF analyses to identify any changes in diagnosis upon SF analysis. We reported patient medical file data on sex, age, diagnosis, and microscopic SF analysis results. We performed consistency analyses between referring diagnoses and SF findings with McNemar's test.

Results: The prevalence of MSU crystals in SF was noted in 89.1% of gout cases and 9.09% of cases of calcium pyrophosphate disease (CPPD). CPP crystals were present in 54.5% of CPPD cases, 42.9% of osteoarthritis (OA) cases, and 7.27% of gout cases. Calcium hydroxyapatite (HA) crystals were identified in 5.45% of gout cases, 33.3% of rheumatoid arthritis (RA) cases, 57.1% of OA cases, and 63.6% of CPPD cases. Cholesterol and lipid crystals were present in small proportions in RA cases. Glucocorticoid crystals were observed in 1.85% of gout cases, 44.4% of RA cases, and 42.9% of OA cases. We observed an association of MSU identification with clinical suspicion of gout (P = 0.08), CPP with OA (P = 0.26) and CPPD (P = 0.50). An association was noted between HA and the diagnosis of CPPD (P = 0.84) and OA (P > 0.99). The number of initial diagnoses that changed upon SF analysis was 14.3%.

Conclusions: SF analysis has major diagnostic value regarding MSU crystals and gout. Our findings underscore the importance of SF crystal analysis in identifying the prevalence of crystals in the Mexican population. SF analysis provides for better diagnosis of crystal arthropathies and improves the quality of the medical care that the patient receives. Key Points • Synovial fluid analysis in laboratories from developing countries has been scarce. • In some cases, the initial diagnosis is modified after of synovial fluid analysis. • This study confirmed that synovial fluid analysis exhibits major diagnostic value for urate crystals and gout.
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http://dx.doi.org/10.1007/s10067-021-05610-0DOI Listing
February 2021

Association of TLR4 gene polymorphisms with sepsis after a burn injury: findings of the functional role of rs2737190 SNP.

Genes Immun 2021 May 2;22(1):24-34. Epub 2021 Feb 2.

Laboratory of Genomic Medicine, Department of Genetics, National Center for Research and Care for Burns (CENIAQ), Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City, Mexico.

Sepsis is a life-threatening organ dysfunction condition caused by a dysregulated response to an infection that is common among patients with moderate to severe burn injury. Previously, genomic variants in Toll-like receptor 4 (TLR4), a key innate immunity receptor, have been associated with sepsis and infection susceptibility. In this study, the association of six TLR4 SNPs with sepsis after burn injury was tested in the Mexican mestizo population. We found that the rs2737190 polymorphism is associated with sepsis after burn trauma. Interestingly, the G allele and GG genotype were associated with a lower risk of developing sepsis. Since the rs2737190 SNP is in the promoter region of the TLR4 gene, we analyzed the possibility that this polymorphism regulates the TLR4 pathway. We cultured peripheral blood mononuclear cells from different genotype carriers and found, after stimulation with LPS, that carriers of the GG genotype showed a higher expression of TLR4, IL6, and TNFα than AA genotype carriers. The results suggest that the GG genotype produces an increase in the TLR4 expression, and therefore an improvement in the immune response. We conclude that the rs2737190 polymorphism may become a useful marker for genetic studies of sepsis in patients after a burn injury.
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http://dx.doi.org/10.1038/s41435-021-00121-zDOI Listing
May 2021

Escherichia fergusonii in a patient with a traumatic amputation of the right pelvic limb.

Cir Cir 2020 ;88(Suppl 1):51-53

Laboratorio de Infectología, Instituto Nacional de Rehabilitación, Ciudad de México, México.

El nombre de Escherichia fergusonii es en honor del microbiólogo William H. Ferguson. Es un bacilo gramnegativo, móvil, oxidasa negativo, catalasa positivo, reductor de nitrato y fermentador, oportunista que se asocia a infecciones de sitio quirúrgico. Una niña de 12 años fue remitida a un servicio de urgencias ortopédicas en la Ciudad de México con amputación traumática de la extremidad pélvica derecha. Tenía exposición ósea y requirió varios desbridamientos quirúrgicos. En el hueso y el tejido muscular se aisló E. fergusonii solo resistente a trimetoprima-sulfametoxazol y ampicilina, más otros gérmenes. Recibió un mes de ertapenem más ampicilina, con marcada mejoría.

The name of Escherichia fergusonii was in honor of the microbiologist William H. Ferguson. It is a gram-negative rod, motile, oxidase negative,catalase positive, nitrate reducing and fermenter. Opportunistic that is associated with surgical site infections. A 12-year-old girl was referred to an orthopedic emergency department in Mexico City with a traumatic amputation of the right leg, she had bone exposure and required several surgical debridements. From bone and soft tissue samples we isolated E. fergusonii only resistant to trimethoprim sulfamethoxazole and ampicillin, and other germs. She received a month of ertapenem plus ampicillin with marked improvement.
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http://dx.doi.org/10.24875/CIRU.20001455DOI Listing
January 2020

Surveillance of antimicrobial resistance in Serratia marcescens in Mexico.

New Microbiol 2020 Jan 13;43(1):34-37. Epub 2019 Dec 13.

Departamento de Microbiología, Facultad de Medicina y Hospital Universitario "Dr José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.

Antimicrobial resistance is a global public health threat. Therefore, surveillance studies are important tools to help direct antimicrobial use. The aim of this study was to investigate antimicrobial resistance in Serratia marcescens isolates collected in 2016-2017 at eight medical centers from two regions of Mexico. Selected S. marcescens isolates were further tested by polymerase chain reaction to detect the presence of genes encoding the β-lactamases, SHV, TEM or CTX. Antimicrobial resistance continues to be high in Mexico, particularly to ciprofloxacin and aminoglycosides. Also, a widespread prevalence of blaTEM was detected in S. marcescens isolates.
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January 2020

Comparative Analysis of Virulence Profiles of Isolated from Diverse Clinical Origins in Mexican Patients.

Surg Infect (Larchmt) 2020 Sep 23;21(7):608-612. Epub 2020 Apr 23.

Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Mexico.

is an enteric bacterium with increasing incidence in clinical settings, attributed mainly to the opportune expression of diverse virulence determinants plus a wide intrinsic and acquired antibiotic resistance. The aim of this study was to compare the virulence factor profiles of 185 isolates from different clinical origins. In vitro proteolytic and hemolytic activities, biofilm formation, and motility were assessed in each strain. Additionally, the pathogenicity of four hypervirulent strains was analyzed in vivo in . We found that bacterial isolates from wound/abscess and respiratory tract specimens exhibited the highest protease activity along with a strong biofilm production, while uropathogenic isolates showed the highest hemolytic activity. Swarming and swimming motilities were similar among all the strains. However, respiratory tract isolates showed the most efficient motility. Two hyperhemolytic and two hyperproteolytic strains were detected; the latter were more efficient killing with a 50%-60% larval mortality 48 hours after challenge. A correlation was found between biofilm formation and proteolytic and hemolytic activities in biopsy specimens and bloodstream isolates, respectively. Overall, it becomes critical to evaluate and compare the clinical strains virulence diversity in order to understand the underlying mechanisms that allow the establishment and persistence of opportunistic bacterial infections in the host.
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http://dx.doi.org/10.1089/sur.2020.029DOI Listing
September 2020

The Evolution of Antimicrobial Resistance in Mexico During the Last Decade: Results from the INVIFAR Group.

Microb Drug Resist 2020 Nov 6;26(11):1372-1382. Epub 2020 Feb 6.

Hospital Regional de Alta Especialidad de Oaxaca, Oaxaca, Mexico.

Surveillance of antimicrobial resistance (AMR) requires an international approach with national and local strategies. Our aim was to summarize a retrospective 10-year report of antibiotic resistance of gram-positive and gram-negative bacteria in Mexico. A total of 46 centers from 22 states of Mexico participated. Databases of AMR from January 2009 to December 2018 were included for most species. The 10-year period was divided into five 2-year periods. For a decrease in resistance in all specimens was observed for erythromycin and oxacillin ( < 0.0001 for each). For spp., resistance to meropenem increased for urine specimens ( = 0.0042). For spp., increased drug resistance in specimens collected from blood was observed for trimethoprim/sulfamethoxazole, gentamicin, tobramycin ( < 0.0001 for each), meropenem ( = 0.0014), and aztreonam ( = 0.0030). For complex, high drug resistance was detected for almost all antibiotics, including carbapenems, except for tobramycin, which showed decreased resistance for urine, respiratory, and blood isolates ( < 0.0001 for each), and for amikacin, which showed a decrease in resistance in urine specimens ( = 0.0002). An increase in resistance to cefepime was found for urine, respiratory, and blood specimens ( < 0.0001 for each). For , aztreonam resistance increased for isolates recovered from blood ( = 0.0001). This laboratory-based surveillance of antibiotic resistance shows that resistance is increasing for some antibiotics in different bacterial species in Mexico and highlights the need for continuous monitoring of antibiotic resistance.
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http://dx.doi.org/10.1089/mdr.2019.0354DOI Listing
November 2020

Origin of OXA-23 Variant OXA-239 from a Recently Emerged Lineage of Acinetobacter baumannii International Clone V.

mSphere 2020 01 8;5(1). Epub 2020 Jan 8.

Programa de Genómica Evolutiva, Centro de Ciencias Genómicas, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, Mexico

Over the last few decades, carbapenemase-producing has become a major cause of nosocomial infections all over the world. However, the genome identity of lineages of this species in Latin America has not been studied as much as in developed countries. Here, through a population genomics approach considering the whole genomes of 148 isolates (almost 40 from Mexico and Honduras), we describe the recent emergence of the lineage sequence type 758 (ST758), which belongs to the international clone V and has spread out to Canada, Mexico, Honduras, and Colombia. Notably, this lineage was found to coexist with other lineages in hospitals in Mexico and Honduras. Isolates from this lineage show considerable variation in antibiotic resistance profiles, but most of them are resistant to carbapenems. Moreover, we found a variety of acquired oxacillinase (OXA) families within this lineage and tracked the very recent inception, and subsequent horizontal transmission, of the OXA-239 carbapenemase. This work highlights the urgent need to investigate recently emerged lineages of this species in Latin America and elsewhere, as these might harbor novel antibiotic resistance genes. is a major cause of nosocomial infections all over the world. Although many isolates from developed countries have been studied in terms of their genome sequence, isolates from Latin America have been much less studied. In this study, using a population genomics approach considering the whole genomes of 148 isolates, we describe the recent emergence of the lineage ST758 endemic to Latin America and the inception of the OXA-239 carbapenemase. Our study highlights the urgent need to investigate recently emerged lineages of this species in Latin America and elsewhere, as these might harbor novel antibiotic resistance genes.
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http://dx.doi.org/10.1128/mSphere.00801-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952199PMC
January 2020

Genotypic and phenotypic changes of Staphylococcus epidermidis during relapse episodes in prosthetic joint infections.

Braz J Microbiol 2020 Jun 11;51(2):601-612. Epub 2019 Dec 11.

Microbiology and Immunology Departments of Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Carpio y Plan de Ayala S/N, Col. Santo Tomas, Mexico City, Mexico.

Staphylococcus epidermidis is a coagulase-negative bacterium capable of causing recurrent relapses in prosthetic joint infection (PJI). The aim of this study was to determine if Staphylococcus epidermidis isolates from patients with recurrent relapses of prosthetic joint infection (PJI) changed genotypically (pulsed-field gel electrophoresis (PFGE) pattern analysis and genes involved in biofilm formation) and phenotypically (antimicrobial resistance, biofilm formation) during the different episodes. Four patients with PJI recurrent relapses were evaluated clinically and microbiologically. Genotypic and phenotypic characteristics of 31 S. epidermidis isolates were determined. In all cases, PJI was treated with antimicrobial therapy and resection of the prosthesis without reimplantation. Months later, all patients had a relapse episode and treated with rifampin plus vancomycin and surgical debridement. Changes in the antibiotics resistance profile in isolates from patients 1 and 2 were observed in the two episodes. Patient 1 had four clones A, B, C, and D that were distributed differentially in the two episodes. Similarly, patients 2 and 3 had two clones and subclones (E-E1 and F-F1, respectively), and patient 4 had only the clone G in both episodes. The clone F formed small-colony variants (SCVs). High level of biofilm formation was found in all clones, except for clones D and G. Clones/subclones showed a genotypic variation in icaA, sdrF, bap, sesI, and embp genes. The principal coordinate analysis showed that all clones/subclones were different. These results showed that the initial infective clone of S. epidermidis from PJI, changed genotypically and phenotypically after a second relapse as a response to the treatment.
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http://dx.doi.org/10.1007/s42770-019-00190-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203359PMC
June 2020

AiiM Lactonase Strongly Reduces Quorum Sensing Controlled Virulence Factors in Clinical Strains of Isolated From Burned Patients.

Front Microbiol 2019 14;10:2657. Epub 2019 Nov 14.

Laboratorio de Bacteriología, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.

is an opportunistic bacterium associated with healthcare infections in intensive care units (ICUs), ventilator-associated pneumonia (VAP), surgical site infections, and burns. This bacterium causes 75% of death in burned patients, since it can develop a persistent biofilm associated with infections, express several virulence factors, and antibiotic-resistance mechanisms. Some of these virulence factors are proteases such as elastase and alkaline protease, or toxic metabolites such as pyocyanin and is one of the few microorganisms able to produce cyanide, which inhibits the cytochrome oxidase of host cells. These virulence factors are controlled by quorum sensing (QS). In this work, 30 clinical strains isolated from burned patients from a tertiary hospital in Mexico City were studied. Antibiotic susceptibility tests were done, and virulence factors (elastase, alkaline protease, HCN, and pyocyanin) were determined in presence of an N-acylhomoserine lactonase, AiiM able to hydrolyze a wide range of acyl homoserine lactones. The treatment reduced significantly the activities of elastase and alkaline protease, and the production of pyocyanin and HCN in all producer strains but not the secretion of toxins through the type III secretion system. Our work suggests that AiiM treatment may be an effective therapy to combat infection in burn patients.
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http://dx.doi.org/10.3389/fmicb.2019.02657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868103PMC
November 2019

Microbiology and Infection Profile of Electric Burned Patients in a Referral Burn Hospital in Mexico City.

J Burn Care Res 2020 02;41(2):390-397

Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilico #289 Col, Arenal de Guadalupe, Alc. Tlalpan, Mexico City, Mexico.

Electrical burn injuries are one of the most severe forms of trauma. This study aims to investigate the infection complications in electrical burn patients in a referral hospital in Mexico City. A longitudinal retrospective study was conducted, involving electrical burn patients admitted from April 2011 to December 2016. Demographic and clinical data including type of electric burns, infection complications, and mortality was sought. Data were collected at admission and daily until discharge. Number and type of infections and microorganism isolations were sought. Risk factors for death were analyzed. A total of 111 patients were included, of which 96.4% were males, mean age of 31.6±16.22, most injuries were high voltage associated. The total body surface area average was 27.8% ± 19.63. The overall infection rate was 72.9 cases per 100 patients. Mortality was observed in 4 (3.6%) patients. About 59.1% (443/749) had growth for Gram-negative bacteria. Multidrug-resistant Pseudomonas aeruginosa was the most frequent microorganism isolated. Fungi were present in 4.9% of cases. Electrical burn injuries occurred in young males in our study. Infection was frequent, most of them caused by Gram-negative rods with an important rate of antimicrobial resistance; however, an important microbial diversity was present.
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http://dx.doi.org/10.1093/jbcr/irz177DOI Listing
February 2020

An alternative disk diffusion test in broth and macrodilution method for colistin susceptibility in Enterobacteriales.

J Microbiol Methods 2019 12 30;167:105765. Epub 2019 Oct 30.

Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico. Electronic address:

Colistin and polymyxin B are old drugs that have been reintroduced to treat Gram-negative infections lacking other treatment options; however, colistin resistance have been reported. To know the correct susceptibility pattern is mandatory for multidrug resistant bacteria. Broth microdilution method is the gold standard to evaluate colistin and polymyxin B susceptibility; nevertheless, it is time consuming and needs expertise to be performed. Disk diffusion method on Müeller-Hinton agar is no longer recommended to evaluate polymyxins susceptibility. In this study we evaluated two methods (disk diffusion in broth and broth macrodilution) as alternative options to identify polymyxin resistance in an easy way. A total of 536 Enterobacteriales isolates were assessed for colistin susceptibility. All non-wild type Enterobacteriales (41) were chosen and 31 wild type bacteria were randomly selected, were used to perform disk diffusion tests in broth and for broth macrodilution tests. We found 100% of concordance between both tested methods and broth microdilution. In conclusion, these two methods are reliable and easier options that complement as initial screening susceptibility for colistin in Enterobacteriales in microbiology laboratories lacking personnel and infrastructure to perform broth microdilution method.
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http://dx.doi.org/10.1016/j.mimet.2019.105765DOI Listing
December 2019

Seeding Public Goods Is Essential for Maintaining Cooperation in .

Front Microbiol 2019 9;10:2322. Epub 2019 Oct 9.

Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.

Quorum sensing in controls the production of costly public goods such as exoproteases. This cooperative behavior is susceptible to social cheating by mutants that do not invest in the exoprotease production but assimilate the amino acids and peptides derived by the hydrolysis of proteins in the extracellular media. In sequential cultures with protein as the sole carbon source, these social cheaters are readily selected and often reach equilibrium with the exoprotease producers. Nevertheless, an excess of cheaters causes the collapse of population growth. In this work, using the reference strain PA14 and a clinical isolate from a burn patient, we demonstrate that the initial amount of public goods (exoprotease) that comes with the inoculum in each sequential culture is essential for maintaining population growth and that eliminating the exoprotease in the inoculum leads to rapid population collapse. Therefore, our results suggest that sequential washes should be combined with public good inhibitors to more effectively combat infections.
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http://dx.doi.org/10.3389/fmicb.2019.02322DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794470PMC
October 2019

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 Nov 25;26(12):3883-3891. Epub 2019 Jul 25.

Department of Infectious Diseases, Instituto Nacional de Cancerologia, Mexico City, Mexico.

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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http://dx.doi.org/10.1245/s10434-019-07631-1DOI Listing
November 2019

Prevalence and virulence factors of coagulase negative Staphylococcus causative of prosthetic joint infections in an orthopedic hospital of Mexico.

Cir Cir 2019 ;87(4):428-435

Departamento de Microbiología e Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional. Ciudad de México, México.

Objective: To determine the prevalence and virulence factors of coagulase-negative Staphylococci (CNS) in prosthetic joint infections (PJI).

Method: CNS were isolated of 66 hip and knee PJI from Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, México City. Antimicrobial susceptibility and biofilm formation in CNS were determined; icaADBC, aap, bap and embp genes were determined by PCR.

Results: Staphylococcus and Staphylococcus hominis were the most prevalent with 82 y 80% respectively. Staphylococcus lugdunensis, Staphylococcus haemolyticus, Staphylococcus capitis, Staphylococcus caprae, Staphylococcus sciuri and Staphylococcus lentus were less frequent. The majority of isolates were resistant to β-lactam antibiotics, fluoroquinolone, and erythromycin. 41% of CNS were biofilm former and 59% were non-biofilm former (p = 0.0551). Biofilm former Staphylococcus epidermidis showed a high presence of icaADBC, aap and embp operons compared to the non-biofilm former isolates (p < 0.05). In contrast, non-S. epidermidis CNS had only the aap gen.

Conclusion: S. haemolyticus, S. sciuri and S. lentus are new isolates of PJI not previously reported with virulence factors similar to CNS isolates.
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http://dx.doi.org/10.24875/CIRU.19000690DOI Listing
January 2020

The race between drug introduction and appearance of microbial resistance. Current balance and alternative approaches.

Curr Opin Pharmacol 2019 10 26;48:48-56. Epub 2019 May 26.

Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico. Electronic address:

As current levels of antimicrobial resistance are alarming, the World Health Organization urged the development of new antimicrobials to fight infections produced by multidrug resistant bacteria. Antibiotics impose severe selective pressure for the development of resistance, and currently bacteria resistant to all of them exist. In this review, we discuss the release and development of new antibacterial drugs and their properties as well as the current advances in the development of alternative approaches to combat bacterial infections, including the repurposing of drugs, anti-virulence therapies, the use of photosensitizers, phage therapy, and immunotherapies, with an emphasis on what is currently known about the possible development of bacterial resistance against them.
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http://dx.doi.org/10.1016/j.coph.2019.04.016DOI Listing
October 2019

sesA, sesB, sesC, sesD, sesE, sesG, sesH, and embp genes are genetic markers that differentiate commensal isolates of Staphylococcus epidermidis from isolates that cause prosthetic joint infection.

Infect Dis (Lond) 2019 06 22;51(6):435-445. Epub 2019 Apr 22.

b Departments of Microbiology, Zoology and Immunology, Escuela Nacional de Ciencias Biológicas , Instituto Politécnico Nacional , Mexico City , Mexico.

Objectives: Staphylococcus epidermidis can cause prosthetic joint infections. Strategies to differentiate between healthy skin and prosthetic joint infections isolates are relatively ineffective, which makes necessary to search for new differential biomarkers. Staphylococcus epidermidis has eleven surface proteins, denoted as Ses proteins. In this work, ses genes are used as biomarkers to differentiate between prosthetic joint infections and healthy skin isolates.

Methods: All prosthetic joint infections (n = 51) and healthy skin (n = 51) isolates were genotyped by pulsed-field gel electrophoresis. icaA, embp, sesA-I, and sdrF genes were determined by PCR. The phenotypic data included biofilm production and antibiotic resistance.

Results: 10 pulsed-field gel electrophoresis profiles were identified: four profiles were exclusive of prosthetic joint infections isolates, three profiles presented a higher proportion in prosthetic joint infections isolates and three profiles presented a higher proportion in healthy skin isolates. sesA, sesB, sesC, sesD, sesE, sesG, and sesH genes were more prevalent in healthy skin isolates than in prosthetic joint infections isolates (p < .05). Prosthetic joint infections isolates were more resistant to oxacillin (78%), ciprofloxacin (60%), levofloxacin (60%), and moxifloxacin (57%). The principal coordinate analysis and a discriminant analysis found that prosthetic joint infections isolates had as discriminant biomarker the biofilm formation, the icaA gene, oxacillin, ciprofloxacin, levofloxacin, moxifloxacin, and gentamicin resistance. In contrast, the healthy skin isolates had as discriminant biomarkers the embp, sesA, sesB, sesC, sesD, sesE, sesG, and sesH genes.

Conclusions: These data suggest that ses genes can be considered biomarkers to differentiate between S. epidermidis commensal and prosthetic joint infections clinical.
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http://dx.doi.org/10.1080/23744235.2019.1597276DOI Listing
June 2019

A snapshot of antimicrobial resistance in Mexico. Results from 47 centers from 20 states during a six-month period.

PLoS One 2019 26;14(3):e0209865. Epub 2019 Mar 26.

Hospital para el Niño Poblano, Puebla, Puebla, Mexico.

Aim: We aimed to assess the resistance rates of antimicrobial-resistant, in bacterial pathogens of epidemiological importance in 47 Mexican centers.

Material And Methods: In this retrospective study, we included a stratified sample of 47 centers, covering 20 Mexican states. Selected isolates considered as potential causatives of disease collected over a 6-month period were included. Laboratories employed their usual methods to perform microbiological studies. The results were deposited into a database and analyzed with the WHONET 5.6 software.

Results: In this 6-month study, a total of 22,943 strains were included. Regarding Gram-negatives, carbapenem resistance was detected in ≤ 3% in Escherichia coli, 12.5% in Klebsiella sp. and Enterobacter sp., and up to 40% in Pseudomonas aeruginosa; in the latter, the resistance rate for piperacillin-tazobactam (TZP) was as high as 19.1%. In Acinetobacter sp., resistance rates for cefepime, ciprofloxacin, meropenem, and TZP were higher than 50%. Regarding Gram-positives, methicillin resistance in Staphylococcus aureus (MRSA) was as high as 21.4%, and vancomycin (VAN) resistance reached up to 21% in Enterococcus faecium. Acinetobacter sp. presented the highest multidrug resistance (53%) followed by Klebsiella sp. (22.6%) and E. coli (19.4%).

Conclusion: The multidrug resistance of Acinetobacter sp., Klebsiella sp. and E. coli and the carbapenem resistance in specific groups of enterobacteria deserve special attention in Mexico. Vancomycin-resistant enterococci (VRE) and MRSA are common in our hospitals. Our results present valuable information for the implementation of measures to control drug resistance.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209865PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435111PMC
November 2019

Corrigendum to 'Repurposing the anticancer drug mitomycin C for the treatment of persistent Acinetobacter baumannii infections' [International Journal of Antimicrobial Agents 49/1 (2017) 88-92].

Int J Antimicrob Agents 2018 12 29;52(6):868. Epub 2018 Oct 29.

Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Av. Universidad 3000, Coyoacán, Copilco Universidad, 04510 Mexico City, DF, Mexico. Electronic address:

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http://dx.doi.org/10.1016/j.ijantimicag.2018.10.001DOI Listing
December 2018

From traditional biochemical signals to molecular markers for detection of sepsis after burn injuries.

Burns 2019 02 23;45(1):16-31. Epub 2018 May 23.

Laboratory of Genomic Medicine, Department of Genetics, National Center for Research and Care for Burns (CENIAQ), Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City, Mexico. Electronic address:

Sepsis is a life-threatening organ-dysfunction condition caused by a dysregulated response to an infectious condition that can cause complications in patients with major trauma. Burns are one of the most destructive forms of trauma; despite the improvements in medical care, infections remain an important cause of burn injury-related mortality and morbidity, and complicated sepsis predisposes patients to diverse complications such as organ failure, lengthening of hospital stays, and increased costs. Accurate diagnosis and early treatment of sepsis may have a beneficial impact on clinical outcome of burn-injured patients. In this review, we offer a comprehensive description of the current and traditional markers used as indicative of sepsis in burned patients. However, although these are markers of the inflammatory post-burn response, they usually fail to predict sepsis in severely burned patients due to that they do not reflect the severity of the infection. Identification and measurement of biomarkers in early stages of infection is important in order to provide timely response and effective treatment of burned patients. Therefore, we compiled important experimental evidence, demonstrating novel biomarkers, including molecular markers such as genomic DNA variations, alterations of transcriptome profiling (mRNA, miRNAs, lncRNAs and circRNAs), epigenetic markers, and advances in proteomics and metabolomics. Finally, this review summarizes next-generation technologies for the identification of markers for detection of sepsis after burn injuries.
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http://dx.doi.org/10.1016/j.burns.2018.04.016DOI Listing
February 2019

Absence of Measles Virus Detection from Stapes of Patients with Otosclerosis.

Otolaryngol Head Neck Surg 2018 01 3;158(1):158-162. Epub 2017 Oct 3.

2 Infectious Disease Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.

Objective To determine molecularly the presence of measles virus genetic material in the stapes of patients with otosclerosis. Study Design A cross-sectional study. Setting A tertiary referral hospital. Subjects and Methods Genetic material was extracted from the stapes of patients with otosclerosis (n = 93) during the period from March 2011 to April 2012. The presence of viral measles sequences was evaluated by the real-time reverse transcriptase polymerase chain reaction (RT-PCR). The expression of the CD46 gene was determined. Results Ninety-three patients were included in the study. No sample was positive for any of 3 measles virus genes (H, N, and F). Measles virus RNA was not detected in any sample by real-time RT-PCR. CD46 levels were positive in 3.3% (n = 3) and negative in 96.7% (n = 90). Conclusion This study does not support the theory of measles virus as the cause of otosclerosis. It is necessary to do more research about other causal theories to clarify its etiology and prevention.
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http://dx.doi.org/10.1177/0194599817733674DOI Listing
January 2018

Impact of the Mk VI SkinSuit on skin microbiota of terrestrial volunteers and an International Space Station-bound astronaut.

NPJ Microgravity 2017 7;3:23. Epub 2017 Sep 7.

School of Pharmacy, University College London, London, UK.

Microgravity induces physiological deconditioning due to the absence of gravity loading, resulting in bone mineral density loss, atrophy of lower limb skeletal and postural muscles, and lengthening of the spine. SkinSuit is a lightweight compression suit designed to provide head-to-foot (axial) loading to counteract spinal elongation during spaceflight. As synthetic garments may impact negatively on the skin microbiome, we used 16S ribosomal RNA (rRNA) gene amplicon procedures to define bacterial skin communities at sebaceous and moist body sites of five healthy male volunteers undergoing SkinSuit evaluation. Each volunteer displayed a diverse, distinct bacterial population at each skin site. Short (8 h) periods of dry hyper-buoyancy flotation wearing either gym kit or SkinSuit elicited changes in the composition of the skin microbiota at the genus level but had little or no impact on community structure at the phylum level or the richness and diversity of the bacterial population. We also determined the composition of the skin microbiota of an astronaut during pre-flight training, during an 8-day visit to the International Space Station involving two 6-7 h periods of SkinSuit wear, and for 1 month after return. Changes in composition of bacterial skin communities at five body sites were strongly linked to changes in geographical location. A distinct ISS bacterial microbiota signature was found which reversed to a pre-flight profile on return. No changes in microbiome complexity or diversity were noted, with little evidence for colonisation by potentially pathogenic bacteria; we conclude that short periods of SkinSuit wear induce changes to the composition of the skin microbiota but these are unlikely to compromise the healthy skin microbiome.
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http://dx.doi.org/10.1038/s41526-017-0029-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5589758PMC
September 2017

Higher In vitro Proliferation Rate of Rhizopus oryzae in Blood of Diabetic Individuals in Chronic Glycaemic Control Compared with Non-diabetic Individuals.

Mycopathologia 2017 Dec 6;182(11-12):1005-1014. Epub 2017 Jul 6.

Department of Infectious Diseases and Hospital Epidemiology, Hospital General Dr Manuel Gea González, Mexico City, Mexico.

Metabolic control improves outcomes associated with mucormycosis. The aim of this study was to compare the in vitro proliferation of Rhizopus oryzae in blood of individuals with and without diabetes at different glycaemic levels. Ninety-five individuals were included. Blood samples from each participant were incubated with sporangiospores of R. oryzae. The germination, filamentation and growth of R. oryzae were compared at different time points. Four groups were defined, one without (group A, n = 30) and three with diabetes: group B (HbA1c ≤7%, N = 24), group C (HbA1c 7.1-9%, N = 20) and group D (HbA1c > 9%, N = 21). The percentage of germinated sporangiospores was higher in the group A after 6 h (group A 56% ± 3, group B 35% ± 4, group C 48% ± 4, group D 46% ± 1.4, p = 0.01), 12 h (group A 54% ± 1.4, group B 19% ± 4, group C 16% ± 1, group D 9.5% ± 5, p < 0.001) and 24 h (group A 29% ± 1, group B 12% ± 4, group C 13.5% ± 3.5, group D 12% ± 1, p < 0.01). The filamentation was higher in groups with diabetes. Group B showed higher filamentation grade than group A at 6 h (0.4 ± 0.04 vs 1 ± 0.09, p < 0.001) and 24 h (1.6 ± 0.05 vs 2.1 ± 0.1, p = 0.05). In conclusion, R. oryzae proliferation was higher among diabetic individuals, including good glycaemic control, than among non-diabetic individuals.
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http://dx.doi.org/10.1007/s11046-017-0174-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684257PMC
December 2017

Leuconostoc mesenteroides periprosthetic knee infection, an unusual fastidious Gram-positive bacteria: a case report.

BMC Infect Dis 2017 03 23;17(1):227. Epub 2017 Mar 23.

Hip and Knee Reconstruction Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico.

Background: Periprosthetic joint infections are mainly caused by Gram-positive cocci. Leuconostoc mesenteroides is a rare microorganism mainly causing bloodstream infections. At times, it might be confused with another type of cocci and give rise to misdiagnosed infections. Molecular diagnosis and biofilm production comprise important techniques to guide antibiotic treatment.

Case Presentation: A 68-year-old Hispanic female with a previous history of bilateral knee arthroplasty presented with acute right-knee inflammation and gait impairment. Blood tests showed inflammatory response and knee x-ray revealed no prosthesis loosening. Irrigation and debridement was performed. Gram-positive cocci were obtained from cultures, and then biochemical and molecular identification revealed L. mesenteroides. Susceptibility and biofilm production were performed. The patient was treated with IntraVenous (IV) Ceftriaxone for ten days and was then switched to Amoxicillin-Clavulanate for 3 months with clinical and laboratory success.

Conclusions: Microbiology diagnosis of fastidious microorganisms is mandatory to treat periprosthetic joint infections adequately. L. mesenteroides may infect non-immunocompromised persons; however, treatment guidelines are lacking.
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http://dx.doi.org/10.1186/s12879-017-2315-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364644PMC
March 2017

[Incidence of hip and knee prosthetic infections in a specialized center of Mexico City].

Cir Cir 2017 Nov - Dec;85(6):485-492. Epub 2016 Dec 18.

Subdirección de Epidemiología Hospitalaria y Control de la Calidad de la Atención Médica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.

Background: Hip and knee prosthetic replacements have proven to be the most appropriate treatment in the joints that do not benefit from medical or arthroscopic interventions; however, infections are the most feared complication. It is recommended that the incidence of infection should not exceed 2%.

Material And Methods: This was an observational, prospective, longitudinal and observational study conducted in patients fitted with a prosthetic joint from August 2011 to July 2012. Patients were followed up pre and post-surgery for one year to identify a prosthetic infection, diagnosed using international parameters. We calculated the incidence of prosthetic infection, as well as the incidence density.

Results: A total of 339 patients (179 hip and 160 knee) were included. Variations in the time of pre-operative antibiotics' administration were observed. Six prosthetic infections were identified with an incidence rate of 1.79/339 arthroplasties, 2.2/179 hip procedures, and 1.25/160 knee arthroplasties. An incidence density of 0.02/year for hip arthroplasties and 0.11/year for knee procedures was identified. There were 4 infections of hip and 2 of knee. Five infections were acute and one chronic. The isolated microorganisms were E. faecalis, S. epidermidis (2), S. mitis, S. aureus and P. stomatis.

Conclusions: The incidence of prosthetic joint infection in the first year of follow-up at our centre is within the recommended parameters. Surgical techniques and organizational practices influence the results.
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http://dx.doi.org/10.1016/j.circir.2016.10.032DOI Listing
August 2018

Repurposing the anticancer drug mitomycin C for the treatment of persistent Acinetobacter baumannii infections.

Int J Antimicrob Agents 2017 Jan 7;49(1):88-92. Epub 2016 Oct 7.

Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Av. Universidad 3000, Coyoacán, Copilco Universidad, 04510 Mexico City, DF, Mexico. Electronic address:

Acinetobacter baumannii is an emergent opportunistic bacterial pathogen responsible for recalcitrant infections owing to its high intrinsic tolerance to most antibiotics; therefore, suitable strategies to treat these infections are needed. One plausible approach is the repurposing of drugs that are already in use. Among them, anticancer drugs may be especially useful due their cytotoxic activities and ample similarities between bacterial infections and growing tumours. In this work, the effectiveness of four anticancer drugs on the growth of A. baumannii ATTC BAA-747 was evaluated, including the antimetabolite 5-fluorouracil and three DNA crosslinkers, namely cisplatin, mitomycin C (MMC) and merphalan. MMC was the most effective drug, having a minimum inhibitory concentration for 50% of growth in Luria-Bertani medium at ca. 7 µg/mL and completely inhibiting growth at 25 µg/mL. Hence, MMC was tested against a panel of 21 clinical isolates, including 18 multidrug-resistant (MDR) isolates, 3 of which were sensitive only to colistin. The minimum inhibitory concentrations and minimum bactericidal concentrations of MMC in all tested strains were found to be similar to those of A. baumannii ATCC BAA-747, and MMC also effectively killed stationary-phase, persister and biofilm cells. Moreover, MMC was able to increase survival of the insect larvae Galleria mellonella against an otherwise lethal A. baumannii infection from 0% to ≥53% for the antibiotic-sensitive A. baumannii ATCC BAA-747 strain and the MDR strains A560 and A578. Therefore, MMC is highly effective at killing the emergent opportunistic pathogen A. baumannii.
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http://dx.doi.org/10.1016/j.ijantimicag.2016.08.022DOI Listing
January 2017

[Microbiological characteristics and patterns of resistance in prosthetic joint infections in a referral hospital].

Cir Cir 2015 Sep-Oct;83(5):371-7. Epub 2015 Jul 2.

Laboratorio de Infectología, Instituto Nacional de Rehabilitación, México, D.F., México.

Background: The prosthetic joint infection is the most feared and catastrophic complication for cause severe physical damage to patients and, generates high economic costs.

Objectives: To describe the microbiological characteristics and to determine the resistance pattern in prosthetic joint infections in a reference hospital in Mexico.

Material And Methods: Patients whose prosthetic devices were withdrawn due to suspicion of septic and aseptic loosening were included. Cultures were performed to identify microorganisms and susceptibility analysis.

Results: Of the 111 patients included, 55% were diagnosed with prosthetic joint infection, with the most frequent prosthesis being of the hip (43%). Positive cultures were obtained in 97% of the infected cases, of which 75% were monomicrobial infections. The most frequent bacterial species isolated were: Staphylococcus epidermidis (31%), Enterococcus faecalis (16%), Staphylococcus aureus (13%), and Escherichia coli (8%). The resistance patterns for the Staphylococcus genus were: oxacillin (79%), erythromycin (45%) and ciprofloxacin (37%). Enterococcus faecalis showed a high percentage of resistance to erythromycin and clindamycin (86%), and fluoroquinolones (43%). The large majority (86%) of Escherichia coli were extended spectrum beta-lactamases positive, in addition to having high resistance to fluoroquinolones (86%), trimethoprim/sulfamethoxazole (86%) and gentamicin (72%).

Conclusion: The microbiological characteristics found in prosthetic joint infections vary according to the hospitals. In this series, a high proportion of coagulase-negative Staphylococci and Enterococcus spp. were found, as well as a high bacterial resistance.
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http://dx.doi.org/10.1016/j.circir.2015.05.030DOI Listing
July 2016