Publications by authors named "Rodolfo Norberto Jiménez-Juárez"

12 Publications

  • Page 1 of 1

Association of Empiric Antibiotic Regimen Discordance With 30-Day Mortality in Neonatal and Pediatric Bloodstream Infection-A Global Retrospective Cohort Study.

Pediatr Infect Dis J 2021 Feb;40(2):137-143

Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.

Background: While there have been studies in adults reporting discordant empiric antibiotic treatment associated with poor outcomes, this area is relatively unexplored in children and neonates despite evidence of increasing resistance to recommended first-line treatment regimens.

Methods: Patient characteristics, antibiotic treatment, microbiology, and 30-day all-cause outcome from children <18 years with blood-culture-confirmed bacterial bloodstream infections (BSI) were collected anonymously using REDCap™ through the Global Antibiotic Prescribing and Resistance in Neonates and Children network from February 2016 to February 2017. Concordance of early empiric antibiotic treatment was determined using European Committee on Antimicrobial Susceptibility Testing interpretive guidelines. The relationship between concordance of empiric regimen and 30-day mortality was investigated using multivariable regression.

Results: Four hundred fifty-two children with blood-culture-positive BSI receiving early empiric antibiotics were reported by 25 hospitals in 19 countries. Sixty percent (273/452) were under the age of 2 years. S. aureus, E. coli, and Klebsiella spp. were the most common isolates, and there were 158 unique empiric regimens prescribed. Fifteen percent (69/452) of patients received a discordant regimen, and 7.7% (35/452) died. Six percent (23/383) of patients with concordant regimen died compared with 17.4% (12/69) of patients with discordant regimen. Adjusting for age, sex, presence of comorbidity, unit type, hospital-acquired infections, and Gram stain, the odds of 30-day mortality were 2.9 (95% confidence interval: 1.2-7.0; P = 0.015) for patients receiving discordant early empiric antibiotics.

Conclusions: Odds of mortality in confirmed pediatric BSI are nearly 3-fold higher for patients receiving a discordant early empiric antibiotic regimen. The impact of improved concordance of early empiric treatment on mortality, particularly in critically ill patients, needs further evaluation.
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http://dx.doi.org/10.1097/INF.0000000000002910DOI Listing
February 2021

Descriptive study of adverse drug reactions in a tertiary care pediatric hospital in México from 2014 to 2017.

PLoS One 2020 24;15(3):e0230576. Epub 2020 Mar 24.

Clinical Research Department, Hospital Infantil de México Federico Gómez, Ciudad de México, México.

Introduction: In Pediatrics, adverse drug reactions (ADRs) affect morbidity and mortality. In Mexico, the characteristics of ADRs and suspect drugs have not been described in hospitalized children.

Objective: To estimate the frequency of ADRs and describe them, as well as suspect drugs, in a tertiary care pediatric hospital in Mexico.

Methods: A total of 1,649 Hospital Infantil de Mexico Federico Gómez ADR reports were analyzed. Completeness of the information was assessed, and ADRs severity and seriousness were assigned based on NOM-220-SSA1-2012, with causality being established according to the Naranjo algorithm. ADRs were classified with WHO Adverse Drug Reaction Terminology (WHO-ART). The drugs involved in ADRs were categorized according to the Anatomical Therapeutic Chemical (ATC) classification. Descriptive analysis was performed using the SPSS 20 statistical package.

Results: Of all the reports, 5.8% lacked sufficient information for the analysis (grade 0). ADRs frequency ranged from 2.12% to 8.07%. ADRs occurred most commonly in children (56.9%), in the female gender (52%), in subjects with normal BMI Z-score (46.6%) and malnutrition (35.3%), diagnosed with neoplasms (72.2%) and in the Emergency Department (70.0%). ADRs were severe in 14.4% of cases, in 81.0% they were serious and 2.1% were classified as definite. Most common serious ADR was febrile neutropenia (44.5%). The 0.7% of patients recovering with sequelae; 1.1% died (with the medication being associated) and 70.3% were admitted to the hospital as a result of an ADR. Antineoplastic and immunomodulating agents were more commonly associated with serious ADRs.

Conclusion: ADRs affected morbidity and mortality, which is why strengthening pharmacovigilance programs in Mexican pediatric hospitals is necessary.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230576PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092985PMC
June 2020

Successful posaconazole salvage therapy for rhinocerebral mucormycosis in a child with leukemia. Review of the literature.

Rev Iberoam Micol 2019 Jul - Sep;36(3):160-164. Epub 2019 Sep 25.

Pediatric Infectious Diseases Department, Hospital Infantil de México Federico Gómez, Mexico.

Background: Mucormycosis is a fungal infection caused by species of the Mucorales order. These microorganisms are angioinvasive, with rapid disease progression and potentially lethal in its rhinocerebral form.

Case Report: We present the case of a 12-year-old female with trisomy 21, acute lymphoblastic leukemia and diabetes, with fever and neutropenia who developed rhinocerebral mucormicosis. After treatment with amphotericin B lipid complex and extensive surgery, disease progressed and posaconazole was added as salvage treatment with full remission of the infection. Four years after diagnosis the patient continues without relapse of mucormycosis or leukemia.

Conclusions: This case highlights the use of posaconazole as either monotherapy or combined therapy. Although it is still debated, it can be considered an option for salvage treatment in children with non-responding mucormycosis, despite lack of standard dosage in pediatric patients.
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http://dx.doi.org/10.1016/j.riam.2018.07.008DOI Listing
May 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

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

Economic burden of varicella complications in two referral centers in Mexico.

Hum Vaccin Immunother 2018 23;14(12):2950-2954. Epub 2018 Oct 23.

b Departamento de Infectología , Hospital Infantil de México Federico Gómez , México City , México.

Varicella-zoster virus causes varicella (chicken-pox), mainly in young children. Most cases are mild but serious complications can occur, resulting in significant morbidity and mortality. The objective of this study was to estimate the cost burden of varicella hospitalizations in two pediatric reference hospitals in Mexico. This retrospective observational study collected data on patients aged <18 years admitted to two third-level referral hospitals in Mexico. Cases were identified from hospital records using International Classification of Diseases Ninth Revision (ICD-9) codes 052 Chickenpox, or Tenth Revision (ICD-10) codes B01 Varicella (chickenpox). Data on demographic and clinical characteristics and resource use were collected from hospital records. Costs for hospital stay and interventions were obtained from the Mexican Institute for Social Security for 2015 and updated to 2017 costs. A total of 172 hospitalized varicella clinically-confirmed cases and 121 varicella- contacts (with epidemiological linkage to a clinically-confirmed case) were included. Thirty eight of the 172 cases (22.0%) experienced complications. There were no deaths. The median duration of hospitalization was 12 days for cases and 23 days for contacts. The median hospitalization cost was MXN 82,572 (USD 4,434) per case, and MXN 89,453 (USD 4,804) per contact. Although considered a mild disease, varicella was associated with a substantial cost burden in two Mexican third-level referral hospitals.
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http://dx.doi.org/10.1080/21645515.2018.1504541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343601PMC
October 2018

Case report: Respiratory syncytial virus

Rev Med Inst Mex Seguro Soc 2018 Mar-Apr;56(2):207-210

Instituto Mexicano del Seguro Social, Hospital General Centro Médico Nacional “La Raza”, Unidad de Cuidados Intensivos Pediátricos. Ciudad de México, México

Background: The Respiratory Syncytial Virus (RSV) is the most important viral pathogen in children under 2 years of age, which warrants hospitalization for a low respiratory infection. 0.5% of children under 5 with RSV infection require hospitalization. The aim of this case is to reaffirm the importance of this virus as a cause of severe disease and to emphasize the importance of adequate diagnosis and management to improve prognosis.

Clinical Case: Child of 1 year 3 months old, without risk factors for severe infection by respiratory viruses. A 3-day course of respiratory failure, requiring mechanical ventilation with a pulmonary protection strategy due to the development of intra-pulmonary ARDS, was considered a mixed infection and received antibacterial treatment. During his hospitalization, RSV infection was documented. He was graduated without pulmonary sequelae.

Conclusions: Respiratory syncytial virus is the respiratory virus that causes a greater burden of disease, even above influenza. Unfortunately for children without risk factors for severe infection there are no options for prevention or treatment, so in subjects with severe disease the only option is the management of support in specialized units and the timely detection of bacterial overinfection. The development of a vaccine is necessary.
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November 2018

Streptococcus pneumoniae: prevalence in nasopharyngeal carriers of more than 50-years-old, in a Mexican rural community.

Enferm Infecc Microbiol Clin 2019 01 7;37(1):41-44. Epub 2018 May 7.

Institute of Ophthalmology Foundation, "Conde de Valencia", Ciudad de México, México.

Introduction: Streptococcus pneumoniae (Sp) is the main cause of community-acquired pneumonia in the elderly, hence the importance to establish the prevalence of nasopharyngeal colonization by different Sp serotypes in adults.

Methods: from December 2009 to June 2010, nasopharyngeal cultures were taken from adults living in rural communities in Mexico for the isolation and serotyping of Sp by the Quellung reaction. Penicillin and ceftriaxone susceptibility tests were performed by the microdilution method.

Results: two hundred and thirty-six adults over 50 years old, were included. The prevalence of colonization by Sp was 21.6%. The most frequent serotypes were 19A (21%), 6A (13%), 6B and 11A (11%). All isolates were susceptible to ceftriaxone, and 52.8% of the isolates showed penicillin minimal inhibitory concentrations ≥0.12mg/L.

Conclusion: this is the first study analyzing the nasopharyngeal colonization by Sp in adults in Mexico. Serotypes not included in any of the pneumococcal vaccines were frequently identified.
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http://dx.doi.org/10.1016/j.eimc.2018.03.008DOI Listing
January 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

A saprophytic fungus ( Sepedonium) associated with fatal pneumonia in a patient undergoing stem cell transplantation.

J Int Med Res 2017 Aug 12;45(4):1430-1434. Epub 2017 Jun 12.

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

Sepedonium sp . is a saprophytic fungus that inhabits soil and plant material. Few cases of infection with this fungus have been reported. We describe a case of a child who received haploidentical stem cell transplantation. The patient developed Sepedonium sp . infection after graft failure accompanied by cytomegalovirus infection. This was associated with two genotypes corresponding to a gB1 and gB3 mixture, which suggested involvement of two strains. Throughout the clinical course, immunosuppression and subsequent development of the fungal infection was observed. Our findings add to the available evidence regarding the potential for acquisition of fungal infection from the environment in patients at high risk because of immunosuppression. To the best of our knowledge, this is the first case of Sepedonium sp . infection following graft failure accompanied by previous cytomegalovirus infection in a patient with hematopoietic stem cell transplantation.
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http://dx.doi.org/10.1177/0300060517708103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5625535PMC
August 2017

[Streptococcus pneumoniae serotype replacement in nasopharyngeal colonization in children vaccinated with PCV7 in Mexico].

Salud Publica Mex 2010 Jan-Feb;52(1):4-13

Hospital General Manuel Gea González, México, DF, México.

Objective: To assess the impact of pneumococcal conjugate vaccine (PCV7) immunization on pneumococcal nasopharyngeal colonization with S. pneumoniae (SPN).

Material And Methods: We studied two groups with different vaccination schedules, group I (2-6 months of age) 3+1 and group II (7 -11 months) 2+1, with a booster at 15 months. Nasopharyngeal cultures were obtained before administering each vaccination dose and after booster. Paired and global analyses were carried out of the proportions of children colonized by SPN, vaccine serotype, no vaccine serotype and resistance to penicillin.

Results: A total of 183 children were enrolled; 93 in group I and 90 in group II. In group I, there was a decrease in vaccine serotypes in the third sample. In group II, there was an increase in non-vaccine serotypes and a decrease in vaccine serotypes before booster. Both groups showed a trend toward decreased resistance to penicillin.

Conclusion: PCV7 caused serotype replacement in nasopharyngeal colonization before the booster.
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http://dx.doi.org/10.1590/s0036-36342010000100003DOI Listing
August 2010