Clostridioides difficile-associated diarrhea in surgical service patients in Mexico. / Diarrea asociada a Clostridioides difficile en pacientes de servicios quirúrgicos en México.

INTRODUCTION: Clostridioides difficile is the first cause of healthcare-associated diarrhea in developed countries. In recent years the incidence of C. difficile infection (CDI) has increased worldwide. There is not much information on the topic in Mexico, and little is known about the risk factors for the infection in patients that are hospitalized in surgical services. MATERIALS AND METHODS: A case-control study was conducted that compared the epidemiologic findings and risk factors between surgical patients with PCR-confirmed CDI, surgical patients with diarrhea and a negative PCR test, and surgical patients with no diarrhea. The statistical analysis was carried out using the SPSS version 22.0 program. RESULTS: The majority of the surgical patients with CDI belonged to the areas of neurosurgery, cardiac surgery, orthopedics, and general surgery. A total of 53% of the CDI cases were associated with the hypervirulent CD NAP1/027 strain. The presence of mucus in stools (OR: 1.5, P=.001), fever (OR: 1.4, P=.011), leukocytes in stools (OR: 3.2, P<.001), hospitalization within the past 12weeks (OR: 2.0, P<.001), antibiotic use (OR: 1.3, P=.023), and ceftriaxone use (OR: 1.4, P=.01) were independent risk factors for the development of CDI. CONCLUSIONS: C. difficile-induced diarrhea in the surgical services is frequent at the Hospital Civil de Guadalajara "Fray Antonio Alcalde".

Acinetobacter baumannii infections in a tertiary care hospital in Mexico over the past 13 years.

BACKGROUND: Acinetobacter baumannii has evolved from an opportunistic pathogen into a common and persistent nosocomial bacterium capable of causing severe infections during endemic and epidemic periods. METHODS: The study period extended from January 1999 to December 2011 and involved patients hospitalized at the Hospital Civil de Guadalajara, Fray Antonio Alcalde, Jalisco, Mexico. From each patient, a single isolate was obtained, and a total of 3,680 unique isolates were collected. Susceptibility tests were performed according to the guidelines of the Clinical and Laboratory Standards Institute. RESULTS: A. baumannii has disseminated throughout the Hospital Civil de Guadalajara, Fray Antonio Alcalde, since 1999. A. baumannii isolates obtained from patients treated in the adult intensive care unit represent the majority of the isolates that have been collected. In addition, A. baumannii was isolated from the adult neurosurgical ward and the adult internal medicine ward, and these isolates were frequently obtained from secretions. A persistent decrease in the susceptibility of A. baumannii isolates to meropenem (92% in 1999 to 12% in 2011), imipenem and amikacin has been observed. CONCLUSIONS: A. baumannii became an endemic nosocomial pathogen during the study period at the Hospital Civil de Guadalajara, Fray Antonio Alcalde, and has exhibited a persistent decrease in susceptibility to all categories of antimicrobial agents over the past 13 years.

Staphylococcal cassette chromosome mec (SCC mec) in methicillin-resistant coagulase-negative staphylococci. A review and the experience in a tertiary-care setting.

Coagulase-negative staphylococci (CNS) are increasingly recognized to cause clinically significant infections, with S. epidermidis often cited as the third most common cause of nosocomial sepsis. Among CNS, there is a high prevalence of methicillin resistance associated with staphylococcal cassette chromosome (SCCmec) elements. Although identical SCCmec types can exist in S. aureus and CNS, some novel classes of SCCmec may be unique to CNS. Differences in the accuracy of identification of CNS species and use of non-standardized methods for the detection of methicillin resistance have led to confusing data in the literature. In addition to the review of SCCmec in CNS, in this paper we report a 2-year surveillance of methicillin-resistant CNS in a tertiary-care hospital in Guadalajara, Mexico.

Metallo-beta-lactamase gene bla(IMP-15) in a class 1 integron, In95, from Pseudomonas aeruginosa clinical isolates from a hospital in Mexico.

During 2003, 40 carbapenem-resistant Pseudomonas aeruginosa clinical isolates collected in a Mexican tertiary-care hospital were screened for metallo-beta-lactamase production. Thirteen isolates produced IMP-15, and 12 had a single pulsed-field gel electrophoresis pattern. The bla(IMP-15) gene cassette was inserted in a plasmid-borne integron with a unique array of gene cassettes and was named In95.

Molecular characterisation of a dominant methicillin-resistant Staphylococcus aureus (MRSA) clone in a Mexican hospital (1999-2003).

Methicillin-resistant Staphylococcus aureus (MRSA) isolates (n = 216), collected between January 1999 and May 2003 in a tertiary-care university hospital in Guadalajara, Mexico, were characterised by antibiotype, pulsed-field gel electrophoresis (PFGE) of SmaI macrorestriction fragments, and hybridisation of ClaI digests with mecA- and Tn554-specific DNA probes. Representatives of the single clonal type found were analysed by spa typing, multilocus sequence typing and staphylococcal chromosomal cassette mec (SCCmec) typing, and were tested for the presence of 22 virulence determinants and agr type. A single PFGE pattern was identified, with minor variations over time, with spa type 2, sequence type 5, SCCmec type II, agr type 2 and the presence of the enterotoxin genes seg and sei, the gamma-haemolysin variant gene hlg-v and the leukocidin lukE-lukD genes. In addition, the isolates showed antimicrobial resistance to beta-lactams, macrolides, chloramphenicol and imipenem, and susceptibility to gentamicin, rifampicin, trimethoprim-sulphamethoxazole and vancomycin. Following its appearance in 1997, this clone spread within the hospital, and is now present in most of the hospital units and wards.

Comparison of the efficacy and safety of isepamicin and amikacin in the treatment of skin and skin structure infections.

Two hundred and three patients with skin and skin structure infections were treated with isepamicin once daily or amikacin twice daily in an open, randomised, comparative multicentre trial. Patients were randomised to treatment with isepamicin or amikacin in a 2:1 ratio. Severe infections (63 patients) were treated with isepamicin 15 mg/kg once daily (n = 15) or amikacin 7.5 mg/kg twice daily (n - 18), less severe infections (140 patients) with isepamicin 8 mg/kg once daily (n = 93) or amikacin 7.5 mg/kg twice daily (n = 47). The overall clinical response rate at the end of treatment was excellent in all treatment groups (94-96% cured or improved) with no significant differences between isepamicin and amikacin in patients with either server or less severe infections. The most commonly isolated target pathogens were Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis and Staphylococcus aureus. Overall, in patients who had a valid target pathogen isolated prior to treatment and who met other evaluability criteria, bacteriological eradication was achieved in over 90% of patients; amikacin patients with severe infections had a somewhat lower eradication rate (82%). Over all infections, 4/110 (4%) patients in the isepamicin group and 5/54 (9%) patients in the amikacin had organisms which persisted. Adverse events were reported in 12% of patients in the isepamicin group and 6% in the amikacin group. The most frequently reported adverse event in the isepamicin group as headache. Two patients (one in each treatment group), both of whom experienced skin rashes, were withdrawn. Potentially clinically significant changes in serum creatinine occurred in two patients, who received isepamicin and one who received amikacin (who was withdrawn from the study). Ototoxicity was rare, occurring in one patient treated with isepamicin.

[Beta-lactamase production and the patterns of bacterial resistance, 1988-1991]. / Producción de betalactamasas y patrones de resistencia bacteriana, 1988-1991.

The adequate use of antimicrobial agents depends to a great degree on the results obtained from the continuous surveillance of bacterial resistance patterns. In order to determine these resistance patterns of bacterial pathogens responsible for community and nosocomial infections a sentinel surveillance program was started in 1988. An analysis of both pediatric and adult cases revealed 4942 bacteria isolated from different sites. Most samples from community infections were obtained from out patients seen in the infections disease clinic of the Hospital Civil de Guadalajara. Of the bacteria identified, 3584 were derived from community infections. Of those 1138 were gram positive and 2446 were gram-negative. The study also included 1350 nosocomial isolated of which 509 were gram-positive bacteria and 849 were gram-negative bacteria. Overall the gram-negative bacteria were more frequently Beta-lactamase producers than the gram-positive bacteria. Resistance to beta-lactam antibiotics ranged from 64-100% in gram negative bacteria and from 81.96% in some gram positive bacteria. During the last 2 years the resistance to third generation cephalosporins, imipenem and quinolones in gram-negative bacteria has steadily increased. Only through the continuous surveillance of bacterial resistance and the implementation of programs to combat bacterial resistance will the use of valuable antibiotics be prolonged and the activity of other ones be preserved for future use.

Once-daily azithromycin in the treatment of adult skin and skin-structure infections.

The aim of this prospective, blinded, randomized study was to demonstrate the efficacy and safety of oral azithromycin and dicloxacillin in the treatment of adults with acute skin and skin-structure infections. Sixty-two patients were included in the intent-to-treat group and 60 were evaluable for analysis. Azithromycin was given as a 500 mg once-daily dose for three days and dicloxacillin as 250 mg qid for seven days. Isolated pathogens included primarily Staphylococcus aureus, Streptococcus spp., and coagulase-negative staphylococci. Clinical resolution was 83.3% in the azithromycin group and 83.9% in the dicloxacillin group, with bacteriological eradication of 90.0% in the azithromycin group and 87.1% in the dicloxacillin group. Persistence of infection was recorded in one patient in the dicloxacillin group and superinfection in one patient in the azithromycin group. Azithromycin appears to be a safe and effective antibiotic for the treatment of adult patients with acute skin and skin-structure infections.

The use of quinolones in developing countries.

The size of the antibiotic market in developing countries is double that seen in developed countries. There are some valid reasons for this difference, one of which is the higher frequency of diverse infections in the developing world. However, other factors are involved: for example, antibiotics are available without prescription, package insert information is poor, and there is no national antibiotic usage programme, all of which encourage inappropriate antibacterial use. When an antibiotic becomes widely prescribed by physicians, this is interpreted by the general public as meaning that the antibiotic is useful for all types of infections and the process of automedication begins. The newer quinolones, other new antibiotics, and indeed all antimicrobials should be available only by prescription. A package insert that includes all pertinent information should be provided, and each country should implement a comprehensive national antibiotic usage programme. Only through these measures will bacterial resistance be controlled and the effectiveness of each antibiotic class be maintained.

Comparison of the safety and efficacy of lomefloxacin and amoxicillin in the treatment of acute exacerbations of chronic bronchitis: Results from a Latin American multicenter study.

The aim of this study was to compare the safety and efficacy of lomefloxacin, a new difluornated quinolone, with those of amoxicillin in the treatment of acute exacerbations of chronic bronchitis caused by Gram-negative bacteria. The study was conducted as a multicenter, randomized, single-blind comparison in four countries (Argentina, Colombia, Mexico and Venezuela). In total, 163 evaluable patients were assessed-82 in the lomefloxacin group and 81 in the amoxicillin group. Patients received oral therapy with either 40 mg lomefloxacin once daily or 500 mg amoxicillin three times daily for 10 days. The most frequent bacterial pathogens isolated included: Haemophilus influenzae, Moraxella catarrhalis, Pseudomonas aeruginosa and Klebsiella pneumoniae. The overall clinical success rates (cure plus improvement) were 93.9% in the lomefloxacin group and 81.5% in the amoxicillin group. The eradication rate was 81.7% in the lomefloxacin group and 75.3% in the amoxicillin group. Most of the clinical and bacteriological failures in both groups were associated with P. aeruginosa in baseline sputum cultures. In conclusion, once-daily lomefloxacin is a safe and effective treatment for acute exacerbations of chronic bronchitis caused by Gram-negative pathogens.

Safety and efficacy of lomefloxacin and cefaclor in the treatment of skin and skin structure infections.

The purpose of this study was to compare the safety and efficacy of lomefloxacin with that of cefaclor in the treatment of adult secondary bacterial skin and skin structure infections. The study was conducted as a randomized, single-blind comparison. Eighty patients enrolled in the study, of which 74 were evaluable: 37 patients in the lomefloxacin group and 37 in the cefaclor group. Patients received either 400 mg of lomefloxacin orally once daily or 250 mg of cefaclor orally three times daily for 12 days. The most frequent pathogens isolated included Staphylococcus aureus, Streptococcus pyogenes, coagulase-negative staphylococci, and Escherichia coli. The clinical response was similar in both groups (89.1%). The bacteriologic eradication rate was 100% in the lomefloxacin group and 94.5% in the cefaclor group. Adverse events were minimal. Once-daily lomefloxacin is a safe and effective treatment for secondary bacterial skin and skin structure infections caused by susceptible pathogens.

Comparison of the safety and efficacy of lomefloxacin and trimethoprim/sulfamethoxazole in the treatment of uncomplicated urinary tract infections: results from a multicenter study.

Lomefloxacin, a new difluorinated quinolone, and trimethoprim/sulfamethoxazole (TMP/SMX) were compared in the treatment of adults with uncomplicated urinary tract infections. The study was conducted as a multicenter, controlled, prospectively randomized, single-blind study in five countries (Argentina, Belgium, Brazil, Mexico, and Venezuela). A total of 254 patients were enrolled: 129 in the lomefloxacin group and 125 in the TMP/SMX group. Patients received either 400 mg lomefloxacin orally once daily or 160 mg/800 mg TMP/SMX orally twice daily for 7-10 days. Escherichia coli and Proteus mirabilis were the pathogens most frequently isolated. At 5-9 days post-therapy, satisfactory bacteriologic results were noted in 98.4% of patients treated with lomefloxacin and in 95.8% of patients in the TMP/SMX group (p = 0.2153). Clinical success 5-9 days post-therapy was noted in 99.2% of patients in the lomefloxacin group and in 98.3% of patients in the TMP/SMX group (p = 0.5138). Adverse events probably related to treatment occurred in 6% of those treated with lomefloxacin and in 7% of patients treated with TMP/SMX. Once-daily oral lomefloxacin is a well-tolerated and effective treatment of uncomplicated urinary tract infections caused by susceptible pathogens.