Rituximab is a monoclonal antibody that increases the disease-free and overall survival of patients with non-Hodgkin lymphoma (NHL) CD20+. The objective of this study is to describe the prevalence ...and spectrum of infections in patients with NHL receiving rituximab-containing chemotherapy and the impact on survival.
From January 2011 to December 2012, all patients diagnosed with NHL who received at least one dose of rituximab were included.
During the study period, 265 patients received rituximab; 108 (40.8%) males; the mean age was 60 ± 15 years. There were 177 infections in 85 patients, being the most common febrile neutropenia (n = 38; 21.5%) and mucosal barrier injury-related infections (n = 28; 15.8%). In 88 events (49%), there was a microbiologic diagnosis, being bacterial infection the most frequent (39.6%), but tuberculosis (TB) was developed in 4 cases (1.5%; incidence rate 721/100,000 person-year). During follow-up, 71 patients died (27%); in 35 cases, it was related to infection. There were no differences in follow-up between those who died due to infection versus those who died from another cause (p = 0.188). Multivariate analysis for mortality showed that age >60 years, failure to achieve a complete response, and development of an infectious complication increased the risk of death.
It is important to perform a screening test for TB in all patients who will receive rituximab and maintain a constant monitoring to detect an infectious process and begin treatment as soon as possible.
The objective of the study was to detect multidrug-resistant
sp. and
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
sp. and 248
sp. were identified. The highest frequency of
sp. isolation was in spring and summer (n = 129, 70.8%), and for
sp. it was in autumn and winter (n = 143, 57.7%). Sixteen isolates of
sp. and sixty-three of
sp. persisted during WWTP treatments. Thirteen species of staphylococci and seven species of enterococci were identified. Thirty-one isolates of
sp. and ninety-four of
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
sp. and
sp. resistant to antibiotics of last choice of clinical treatment, in community and hospital wastewater and their ability to survive WWTP treatment systems.
The objective of this study was to investigate the presence and persistence of carbapenemase-producing
spp. isolated from wastewater and treated wastewater from two tertiary hospitals in Mexico. We ...conducted a descriptive cross-sectional study in two hospital wastewater treatment plants, which were sampled in February 2020. We obtained 30
spp. isolates. Bacterial identification was carried out by the Matrix-Assisted Laser Desorption/Ionization-Time of Flight mass spectrometry (MALDI-TOF MS
) and antimicrobial susceptibility profiles were performed using the VITEK2
automated system. The presence of carbapenem resistance genes (CRGs) in
spp. isolates was confirmed by PCR. Molecular typing was determined by pulsed-field gel electrophoresis (PFGE). High rates of
spp. resistance to cephalosporins and carbapenems (80%) were observed in isolates from treated wastewater from both hospitals. The molecular screening by PCR showed the presence of
and
genes. The PFGE pattern separated the
isolates into 19 patterns (A-R) with three subtypes (C1, D1, and I1). Microbiological surveillance and identification of resistance genes of clinically important pathogens in hospital wastewater can be a general screening method for early determination of under-detected antimicrobial resistance profiles in hospitals and early warning of outbreaks and difficult-to-treat infections.
This study assessed the microbiology, clinical syndromes, and outcomes of oncologic patients with viridans group streptococci isolated from blood cultures between January 1st, 2013 and December 31st, ...2016 in a referral hospital in Mexico using the Bruker MALDI Biotyper. Antimicrobial sensitivity was determined using BD Phoenix 100 according to CLSI M100 standards. Clinical information was obtained from medical records and descriptive analysis was performed.
Forty-three patients were included, 22 females and 21 males, aged 42 ± 17 years. Twenty (46.5%) patients had hematological cancer and 23 (53.5%) a solid malignancy. The viridans group streptococci isolated were Streptococcus mitis, 20 (46.5%); Streptococcus anginosus, 14 (32.6%); Streptococcus sanguinis, 7 (16.3%); and Streptococcus salivarius, 2 (4.7%). The main risk factors were pyrimidine antagonist chemotherapy in 22 (51.2%) and neutropenia in 19 (44.2%) cases, respectively. Central line associated bloodstream infection was diagnosed in 18 (41.9%) cases. Septic shock occurred in 20.9% of patients, with an overall mortality of 18.6%. Only four S. mitis revealed penicillin-resistance.
Our results are similar to those of other series, identifying these bacteria as emerging pathogens with significant morbidity and mortality in oncologic patients. The MALDI-TOF system increased the rate of viridans group streptococci isolation in this population.
•SARS-CoV-2 positivity rate in hospital Non-Covid in México was 9.6%.•Men, administrative staff and employees who had relatives also working in the same hospital had higher risk of infection.•Active ...surveillance help to detect a significant number of asymptomatic infections, is necessary to reinforce preventive measures in non-medical staff to prevent nosocomial transmission.
Healthcare workers are at increased risk of SARS-CoV-2 infection. The positivity rates in hospitals that do not receive patients with COVID-19, such as the National Cancer Institute (INCan) in Mexico, and the associated factors are unknown.
To assess the incidence and factors associated with SARS-CoV-2 infection in health workers at INCan.
A cohort study of 531 workers who were followed for 6 months. RT-PCR analysis of saliva and nasopharyngeal swab samples were used in the baseline and to confirm cases during follow-up The incidence rate ratio was calculated according to the measured characteristics and the associated factors were calculated using logistic regression models.
Out of 531 workers, 9.6% tested positive for SARS-CoV-2, Being male (RR: 2.07, 95% CI: 1.1-3.8, P = .02), performing administrative tasks (RR: 1.99, 95% CI: 1.0-3.9, P = .04), and having relatives also working at INCan (RR: 3.7, 95% CI: 1.4-9.5, P < .01) were associated with higher positivity rates.
Incidence of positive cases in health workers were similar to that reported in non-COVID hospitals from other countries.
Even though active surveillance helped to detect a significant number of asymptomatic infections, it is still necessary to reinforce preventive measures in non-medical staff to prevent nosocomial transmission.
•Rapid antigen tests for COVID-19 can give clinically valuable results•During an outbreak in Mexico, specificity of the Panbio rapid antigen test was 98%•But, sensitivity was 69% during the first ...week of symptoms•A positive Panbio rapid antigen test confirms COVID-19•A negative Panbio rapid antigen test does not rule out SARS-COV-2 infection
Point-of-care rapid tests to identify SARS-CoV-2 can have clinical benefits.
A cross-sectional study in adults visiting emergency services or screening sites of referral hospitals for COVID-19 to validate the diagnostic performance of a rapid antigen test for SARS-CoV-2 (Abbott's Panbio) compared with reverse transcription-polymerase chain reaction (RT-PCR) testing. Tests were performed by health personnel in a routine situation during a COVID-19 outbreak.
A total of 1060 participants (mean age 47, 46% with a self-reported comorbidity) were recruited from 8 hospitals in Mexico. Participants provided 1060 valid Panbio rapid test-RT-PCR test pairs with 45% testing positive in the RT-PCR. Overall sensitivity of the Panbio test was 54.2% (95% CI 51%–57%), and 69.1% (95% CI 66%–73%) for patients during the first week of symptoms. Sensitivity depended on viral load (cycle threshold (Ct) of RT-PCR) and days of symptoms. With a Ct ≤25, sensitivity was 82% (95% CI, 76%–87%). Specificity of the Panbio test was >97.8% in all groups.
The Panbio rapid antigen test for SARS-CoV-2 had good specificity but low sensitivity. A negative test requires confirmation with RT-PCR, especially for testing after the first week of symptoms.
To describe the distribution of pneumococcal serotypes causing infectious diseases in patients with hematological malignancies and solid tumors and their antimicrobial susceptibility before and after ...introduction of pneumococcal conjugate vaccine (PCV7) in Mexico.
Consecutive pneumococcal isolates from hospitalized patients from the SIREVA-network were serotyped using the Quellung reaction and antimicrobial susceptibility was performed using the broth microdilution method.
A total of 175 pneumococcal isolates were recovered, 105 from patients with hematological malignancies and 70 with solid tumors. Serotypes 19A (22.7%), 19F (20.4%), and 35B (17.7%) were the most frequent isolates in the first group and serotypes 3 (27.2%) and 19A (28.6%) in the second group. No decreased susceptibility to beta-lactams or TMP/SMX was observed after introduction of PCV7.
An increase in non-vaccine types is observed without significate changes in antimicrobial susceptibility after introduction of PCV7.
Acinetobacter junii INC8271 was isolated from a cancer patient with polymicrobial bacteremia after biliary stent placement. The complete genome sequence consisted of a chromosome of 3,530,883 bp (GC ...content, 38.56%) with 3,377 genes, including those encoding 74 tRNAs and 18 rRNAs, and two intact prophage sequences. No antibiotic resistance genes were detected.
Abstract
Background
Cancer patients frequently go to the emergency room (ER) because of fever. Within the approach, blood cultures are taken, and they are often discharged if their clinical condition ...is stable. The objective of the study is to know the epidemiology, clinical characteristics, and outcome of patients with positive blood cultures after discharge from the emergency department.
Methods
Between 2021 and 2022, 178 blood cultures taken in the ER were positive for infection. Of these, 93 cases (38%) corresponded to outpatients who were included. Demographic, clinical, and microbiological data were collected. A bivariate analysis comparing the cohort vs. patients that were admitted (controls) from the ER in the same period was done.
Results
Most frequent oncological diagnosis was breast cancer (21.5%), lymphoma (18.3%), and cervical cancer (11.8%). Forty-nine (53%) had recently been diagnosed with cancer, 52 (55.9%) had received chemotherapy, and 15 (16.1%) had received antibiotics within the previous month. The most frequent reasons for consultation were febrile syndrome (28%), fever after CVC manipulation (20.4%), and fever with urinary symptoms (12%). Antibiotics were prescribed on discharge from the emergency department in 57 patients (61.3%), being adequate in 36.9% of the cases. The isolate was considered to be pathogenic in 84 cases, mainly due to Gram-negative bacilli (n=58, 69%). 72 (77.4%) attended reassessment (due to telephone contact or persistence of symptoms), and 56 (60.2%) were hospitalized. The most frequent bloodstream infections were secondary (n=45, 48.4%) and catheter-related (n=33, 35.5%). Three patients died, and only in one case was it secondary to an infection, compared to 23.5% in the admitted group. The bivariate analysis is reported in Table 1.
Conclusion
Mortality in discharged patients was low (3%); Close monitoring of positive blood cultures, patient follow-up, and identification of risk factors for adverse outcomes, such as neutropenia, inflammatory response syndrome with high C-reactive protein or Procalcitonin, uncontrolled foci of infection, recent hospitalization, or antibiotic treatment should be considered for admission in this high risk population.
Disclosures
All Authors: No reported disclosures
To describe the incidence and patterns of bacterial resistance in urine samples from a tertiary care oncology hospital in Mexico, from 2004 to 2013.
We included the strains obtained from urine ...cultures, describing separately multidrug-resistant (MDR) bacteria. We analyzed the susceptibility to different antibiotics.
51 202 urine cultures were processed during the study; 14 480 (28.3%) cultures were positive. In 11 427 samples Gram negative (79%) were isolated, 2 080 Gram positive (14.4%), and 973 yeasts (6.6%). Escherichia coli was the most frequent bacteria identified (56.1%); 24% of the community strains and 65.7% of the nosocomial were extended-spectrum beta-lactamase producers (ESBL). Klebsiella pneumoniae was isolated in 705 samples (4.8%); 115 were ESBL (16%), 13.1% from community and 29.8% from nosocomial source. Pseudomonas aeruginosa was identified in 593 cultures (4.1%): 9% from community and 51% nosocomial.
MDR bacteria were more frequent in nosocomial isolates. It should be a priority to intensify the rational use of antimicrobials in the community and antibiotic stewardship in the hospital.
PDF
