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OBJECTIVES: The use of cephalosporins combined with clavulanate for the treatment of ESBL-harbouring Enterobacteriaceae has been scarcely described. We aimed to describe the effect of different concentrations of clavulanate in the MIC of cefixime and ceftibuten of ESBL-producing Escherichia coli and Klebsiella pneumoniae. METHODS: ESBL-producing E. coli and K. pneumoniae isolates were studied. Fixed concentrations of cefixime and ceftibuten (ranges of 32-0.25 and 64-0.5 ng/ml, respectively) were used. Combinations of cefixime/clavulanate and ceftibuten/clavulanate in different ratios (1:0, 1:1, 2:1, 4:1, 8:1, 16:1, 32:1) were tested. MIC were determined by broth microdilution. RESULTS: A total of 6 ESBL-producing E. coli, 6 ESBL-producing K. pneumoniae and 2 control E. coli were tested. When different quantities of clavulanate were added to cefixime and ceftibuten, greater than two-fold decreases in the MIC were observed. When testing the 1:1 cefixime/clavulanate ratio, 10/12 isolates were susceptible. When the ratios 2:1, 4:1, 8:1 and 16:1 were tested, susceptibility was noted for 9/12, 8/12, 4/12 and 5/12 isolates, respectively. Only 2/12 K. pneumoniae isolates were susceptible when the ratio 32:1 was tested. When testing ceftibuten/clavulanate, all isolates remained susceptible across all experiments. CONCLUSIONS: Clavulanic acid has a favourable effect in reducing the MIC of cefixime and ceftibuten in isolates of ESBL-producing E. coli and K. pneumoniae. Combining clavulanate with ceftibuten or cefixime could be a useful treatment strategy.
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The objective of the study was to detect multidrug-resistant Staphylococcus sp. and Enterococcus sp. isolates in municipal and hospital wastewater and to determine their elimination or persistence after wastewater treatment. Between August 2021 and September 2022, raw and treated wastewater samples were collected at two hospital and two community wastewater treatment plants (WWTPs). In each season of the year, two treated and two raw wastewater samples were collected in duplicate at each of the WWTPs studied. Screening and presumptive identification of staphylococci and enterococci was performed using chromoagars, and identification was performed with the Matrix Assisted Laser Desorption Ionization Time of Flight mass spectrometry (MALDI-TOF MS®). Antimicrobial susceptibility was performed using VITEK 2® automated system. There were 56 wastewater samples obtained during the study period. A total of 182 Staphylococcus sp. and 248 Enterococcus sp. were identified. The highest frequency of Staphylococcus sp. isolation was in spring and summer (n = 129, 70.8%), and for Enterococcus sp. it was in autumn and winter (n = 143, 57.7%). Sixteen isolates of Staphylococcus sp. and sixty-three of Enterococcus sp. persisted during WWTP treatments. Thirteen species of staphylococci and seven species of enterococci were identified. Thirty-one isolates of Staphylococcus sp. and ninety-four of Enterococcus sp. were multidrug-resistant. Resistance to vancomycin (1.1%), linezolid (2.7%), and daptomycin (8.2%/10.9%%), and a lower susceptibility to tigecycline (2.7%), was observed. This study evidences the presence of Staphylococcus sp. and Enterococcus sp. resistant to antibiotics of last choice of clinical treatment, in community and hospital wastewater and their ability to survive WWTP treatment systems.
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ABSTRACT Introduction: Nontuberculous mycobacteria (NTM) comprise several pathogens with a complex profile of virulence, diverse epidemiological and clinical patterns as well as host specificity. Recently, an increase in the number of NTM infections has been observed; therefore, the objective of this study was to evaluate the clinical characteristics and outcomes of these infections. Methods: We included patients with NTM infections between 2001-2017 and obtained risk factors, clinical features and outcomes; finally, we compared this data between slowly growing (SGM) and rapidly growing mycobacteria (RGM). Results: A total of 230 patients were evaluated, 158 (69%) infected and 72 (31%) colonized/pseudoinfected. The average annual incidence in the first 11 years of the study was 0.5 cases per 1000 admissions and increased to 2.0 cases per 1000 admissions later on. The distribution of NTM infections was as follows: bloodstream and disseminated disease 72 (45%), lung infection 67 (42%), skin and soft tissue infection 19 (12%). Mycobacterium avium complex was the most common isolate within SGM infections, and HIV-infected patients were the most affected. Within RGM infections, M. fortuitum was the most common isolate from patients with underlying conditions such as cancer, type-2 diabetes mellitus, presence of invasive devices, and use of immunosuppressive therapy. We did not find significant differences in deaths and persistent infections between disseminated SGM infection when compared to disseminated RGM infection (42% vs. 24%, p = 0.22). However, disseminated SGM infection required a longer duration of therapy than disseminated RGM infection (median, 210 vs. 42 days, p = 0.01). NTM lung disease showed no significant differences in outcomes among treated versus non-treated patients (p = 0.27). Conclusions: Our results show a significant increase in the number of Non-tuberculosis-mycobacteria infections in our setting. Patients with slow-growing-mycobacteria infections were mainly persons living with human immunodeficiency virus . Older patients with chronic diseases were common among those with rapidly-growing-mycobacteria infections. For non-tuberculosis-mycobacteria lung infection, antibiotic therapy should be carefully individualized.
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ABSTRACT Objectives: To determine the factors associated with Mycobacterium tuberculosis complex-positive blood culture. Methods: Case-control study. Sociodemographic, clinical and laboratory data were collected from 2000 to 2015. Results: We reviewed medical records of 533 patients with culture-proven tuberculosis, of whom 27.2% (145/533) had blood culture available. Patients with mycobacteremia presented more frequently with abdominal tuberculosis, body mass index <18 kg/m2, and had lower hemoglobin and albumin levels. No differences were observed regarding HIV status. Conclusions: Few studies have reported on the characteristics associated with Mycobacterium tuberculosis complex bacteremia, especially among Human Immunodeficiency Virus-negative patients. Out of 145 tuberculosis-infected patients with blood culture results available, 21 turned out positive. Anemia, hypoalbuminemia, and a body mass index < 18 kg/m2 were associated with mycobacteremia.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Tuberculosis/microbiología , Infecciones por VIH/microbiología , Bacteriemia/microbiología , Mycobacterium tuberculosis/aislamiento & purificación , Valores de Referencia , Tuberculosis/sangre , Infecciones por VIH/sangre , Estudios Retrospectivos , Bacteriemia/sangre , Estadísticas no Paramétricas , Centros de Atención Terciaria , Cultivo de Sangre , MéxicoRESUMEN
Abstract: Objective: To describe the seroprevalence and associated factors for brucellosis among dairy farm workers. Materials and methods: We performed a secondary analysis of a data set and sera from a previous cross-sectional study in a dairy farm. Sera were tested for Brucella spp. antibodies by the slide agglutination test. Seropositivity was defined as a titer ≥1:40; recent infection was titers ≥1:160. Results: We tested 331 human sera. Seroprevalence of brucellosis was 18.1% (60/331; 95% CI 14.1-22.7); 13.3% of them (8/60; 95% CI 5.9 24.5) corresponded to recent infection. Highexposure occupation (calf caretaker; OR 3.3; 95%CI 1.1 - 9.7), daily hours in contact with cows (OR 1.1; 95%CI 1.03 - 1.2), and living on-site (OR 2.2; 95% CI 1.1 - 4.4) remained independently associated with seropositivity. Conclusions: We found a high seroprevalence of brucellosis among dairy farm workers, as well as a significant association among those with prolonged and close contact with cattle.
Resumen: Objetivos: Describir la seroprevalencia y factores asociados con la brucelosis en los trabajadores de una cuenca lechera. Material y métodos: Se realizó un análisis secundario de datos y sueros obtenidos en una cuenca lechera. Se buscaron anticuerpos contra Brucella spp. en los sueros por medio de la prueba de aglutinación en placa. Se definió seropositividad a partir de un título ≥1:40, e infección reciente con títulos ≥1:160. Resultados: Se analizaron 331 sueros humanos. La seroprevalencia de brucelosis fue de 18.1% (60/331; IC 95% 14.1-22.7); el 13.3% (8/60; IC 95% 5.9 24.5) correspondieron a infección reciente. Alta exposición (becerrero; RM 3.3; IC 95% 1.1 - 9.7), horas diarias en contacto con vacas (RM 1.1; IC 95% 1.03 - 1.2), y vivir en el establo (RM 2.2; IC 95% 1.1 - 4.4) estuvieron asociadas independientemente con seropositividad. Conclusiones: Se encontró alta seroprevalencia de brucelosis en trabajadores de una cuenca lechera, y asociación en aquellos con contacto cercano y prolongado con vacas.
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Humanos , Animales , Masculino , Femenino , Adulto , Persona de Mediana Edad , Brucelosis/epidemiología , Industria Lechera , Enfermedades Profesionales/epidemiología , Brucelosis/diagnóstico , Pruebas de Aglutinación , Bovinos , Zoonosis/epidemiología , Estudios Seroepidemiológicos , Estudios Transversales , Mataderos , Enfermedades Endémicas , México/epidemiología , Anticuerpos Antibacterianos/sangre , Enfermedades Profesionales/diagnósticoRESUMEN
The opportunistic fungal pathogen Candida glabrata is the second most common isolate from bloodstream infections worldwide and is naturally less susceptible to the antifungal drug fluconazole than other Candida species. C. glabrata is a haploid yeast that contains three mating-type like loci (MTL), although no sexual cycle has been described. Strains containing both types of mating information at the MTL1 locus are found in clinical isolates, but it is thought that strains containing type a information are more common. Here we investigated if a particular combination of mating type information at each MTLlocus is more prevalent in clinical isolates from hospitalized patients in Mexico and if there is a correlation between mating information and resistance to fluconazole and 5-fluorocytosine. We found that while both types of information at MTL1 are equally represented in a collection of 64 clinical isolates, the vast majority of isolates contain a-type information at MTL2 and α-type at MTL3. We also found no correlation of the particular combination of mating type information at the three MTL loci and resistance to fluconazole.
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Humanos , Antifúngicos/farmacología , Candida glabrata , Fluconazol/farmacología , Flucitosina/farmacología , Genes del Tipo Sexual de los Hongos/genética , Candida glabrata/efectos de los fármacos , Candida glabrata/genética , Genotipo , México , Pruebas de Sensibilidad MicrobianaRESUMEN
Se describen los resultados de investigación del Consorcio Mexicano contra la Tuberculosis, en la Jurisdicción Sanitaria de Orizaba, Veracruz, entre 1995 y 2008. Las aportaciones principales de los trabajos se refieren a los siguientes rubros: 1. Epidemiología convencional y molecular (medición de la carga de la enfermedad, tendencias, factores de riesgo y grupos vulnerables; descripción de las consecuencias de la farmacorresistencia e identificación de factores que favorecen la transmisión en la comunidad y en los hospitales). 2. Desarrollo de técnicas rápidas para conservación de muestras respiratorias que permitan el aislamiento y diagnóstico de farmacorresistencia de M. tuberculosis en campo. 3. Evaluación de la prueba tuberculínica, respuesta inmunológica al Bacilo de Calmette-Guerin (BCG), biomarcadores de la respuesta inmunitaria y medidas de control. 4. Comentarios en torno a aspectos éticos de la investigación en tuberculosis. Además se describe el impacto en políticas públicas, la transferencia de tecnología, la formación de recursos humanos y las perspectivas a futuro.
This study describes the achievements of the Mexican Consortium against Tuberculosis, in the Sanitary District of Orizaba, Veracruz, Mexico between 1995 and 2008. In brief, the main results can be classified as follows: 1) Conventional and molecular epidemiology (measurement of burden of disease, trends, risk factors and vulnerable groups, consequences of drug resistance, identification of factors that favor nosocomial and community transmission); 2) Development of diagnostic techniques to detect drug resistance, description of circulating clones and adaptation of simple techniques to be used in the field; 3) Evaluation of usefulness of tuberculin skin test, immunologic responses to BCG, impact of directly observed therapy for tuberculosis (DOTS), and study of immunological biomarkers and 4) Comments on ethical aspects of tuberculosis research. Additionally, we describe the impact on public policies, transference of technology, capacity building and future perspectives.
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Humanos , Tuberculosis/epidemiología , México/epidemiología , Epidemiología Molecular , Factores de TiempoRESUMEN
Objetivo: El presente trabajo plantea el estudio fenotípico y genotípico de cinco aislados de Histoplasma capsulatum obtenidos de pacientes mexicanos con hostoplasmosis asociada a síndrome de inmunodeficiencia adquirida (SIDA), con procedencia geográfica bien establecida. Material y métodos: Se utilizaron para relacionar estos aislados clínicos, electrofóresis en geles de poliacrilamida dodecil sulfato de sodio (SDS-PAGE) y electroinmunotransferencia (EIT) para la fenotipificacion, y el polimorfismo del DNA amplificado al azar por la reacción en cadena de la polimerasa (RAPD-PCR) para la genotificación. Las relaciones enter los patrones electoforéticos y polimórficos de todos los aislado se procesaron en el programa SPSS/PC+ versión 2.3. Resultados y discusión: Por SDS-PAGE se observó que todos los aislados se relacionaron en un 86 por ciento. Por EIT se evidenció que todos los aislados revelaron tres bandas de 43, 28 y 18 kDa con suero inmune específico. Por RAPD-PCR, cuatro aislados se relacionaro en 94 por ciento y el último (EH-319) presentó 77 por ciento de relación con los anteriores. Conclusión: El análisis por RAPD.PCR permitió discriminar ligeras diferencias entre los aislados de pacientes mexicanos con histoplasmosis asociada a SIDA, en comparación con los métodos de caracterizacion fenotípica (SDS-PAGE y EIT)