Genomic insights of Leclercia adecarboxylata strains linked to an outbreak in public hospitals in Mexico.

BACKGROUND: Leclercia adecarboxylata is a bacteria closely related to Escherichia coli according to its biochemical characteristics and is commonly considered non-pathogenic although a growing number of publications classify it as an emerging pathogen. Fosfomycin resistance is a common trait for L. adecarboxylata encoded by fosALA gene. OBJECTIVE: To analyze genomic traits of sixteen L. adecarboxylata strains isolated from blood culture and a bottle of total parenteral nutrition. METHODS: Twenty-eight L. adecarboxylata strains isolated from blood culture and a bottle of total parenteral nutrition were identified biochemically with a Vitek ® automated system. The strains were phenotyped by their growth on Eosin Methylene Blue agar or MacConkey agar plates. Additionally, Pulsed field gel electrophoresis (PFGE) was performed to establish the clonal relationship. The genomic DNA of sixteen strains was obtained using a Qubit ® dsDNA HS Assay Kit and sequenced on an Illumina ® MiSeq instrument. Draft genomes were assembled using PROKKA and Rast. Assemblies were submitted to Resfinder and PathogenFinder from the Center for Genomic Epidemiology in order to find resistance genes and pathogenic potential. IslandViewer4 was also used to find Pathogenicity and Phage Islands. For identification of the fosA gene, manual curation and Clustal analysis was performed. A novel FosA variant was identified. Finally, phylogenetic analysis was performed using VAMPhyRE software and Mega X. RESULTS: In this paper, we report the genomes of sixteen strains of Leclercia adecarboxylata causing an outbreak associated with parenteral nutrition in public hospitals in Mexico. The genomes were analyzed for genetic determinants of virulence and resistance. A high pathogenic potential (pathogenicity index 0.82) as well as multiple resistance genes including carbapenemics, colistin and efflux pumps were determined. Based on sequence analysis, a new variant of the fosALA gene was described. Finally, the outbreak was confirmed by establishing the clonal relationship among the sixteen genomes obtained. CONCLUSIONS: Commensal strains of L. adecarboxylata may acquire genetic determinants that provide mechanisms of host damage and go unnoticed in clinical diagnosis. L. adecarboxylata can evolve in a variety of ways including the acquisition of resistance and virulence genes representing a therapeutic challenge in patient care.

Impacto de la rehabilitación cardiopulmonar en paciente con secuelas poscovid-19 Reporte de caso clínico

El SARS-CoV-2 es un virus de la familia Coronaviridae que posee un ácido ribonucleico envuelto y monocatenario positivo. Este virus ha sido el responsable de una suma considerable de muertes a nivel mundial, y produce la enfermedad llamada covid-19, esta ocasiona compromisos multisistémicos en los pacientes, de los cuales la gran mayoría resulta con secuelas en el músculo esquelético, cardiocirculatorias, y pulmonares. La rehabilitación cardiopulmonar es un programa con múltiples componentes que pueden revertir las condiciones fisiopatológicas que sean consecuencias por el virus SARS-CoV-2. Los autores describen su experiencia con un caso clínico, con un paciente de 53 años, que ameritó internamiento por más de un mes, con diagnóstico de covid-19 -neumonía de focos múltiples con sobreinfección bacteriana-, y que durante su estadía requirió ventilación mecánica asistida, eventualmente, con traqueostomía, y que a su egreso se mantenía con dependencia de oxígeno suplementario, así como marcada disnea y sarcopenia. El paciente fue referido para rehabilitación pulmonar poscovid-19, y tras 12 semanas de rehabilitación el paciente es egresado del programa en aire ambiente, con capacidad para realizar ejercicio de moderada a alta intensidad, con saturación superior a 95 %, además de una marcada mejoría en los resultados de capacidad funcional. La rehabilitación cardiopulmonar es un programa multifacético, con diferentes componentes que logran una atención integral, capaz de recuperar al paciente para que logre su adherencia, no solo en su estado físico, sino también en su entorno psicosocial, de tal manera que se reintegra a la sociedad y se disminuyen los costos por atención y tratamientos médicos.

Summary SARS-CoV-2 is a virus of the Coronaviridae family, which has a positive single-stranded, enveloped ribonucleic acid. This virus has been responsible for a considerable number of deaths worldwide, and produces the disease called covid-19, which causes multisystemic compromise in patients, resulting in a vast majority with skeletal muscle, cardiocirculatory, and pulmonary sequelae. Cardiopulmonary rehabilitation is a program with multiple components that can reverse the pshysiopathological conditions that are consequences of the SARS-CoV-2 virus. The authors describe their experience with a clinical case, a 53-year-old patient, who required hospitalization for more than a month, diagnosed with covid-19 -Multiple focus of pneumonia with bacterial infection-, and who required ventilation during hospitalization. mechanically assisted, eventually with tracheostomy, and that at discharge remained dependent on supplemental oxygen, as well as marked dyspnea and sarcopenia. The patient was referred for postcovid-19 pulmonary rehabilitation, and after 12 weeks of rehabilitation the patient is discharged from the program in room air, with the ability to perform moderate to high intensity exercise, saturation greater than 95%, and with marked improvement. in VO2 max and 6MWT results. Cardiopulmonary rehabilitation is a multifaceted program, with different components that achieve comprehensive care, capable of recovering the patient so that he achieves his adherence, not only in his physical state but also in his psychosocial environment, reintegrating him into society and reducing the costs for medical care and treatment.

Antimicrobial resistance and antibiotic consumption in a third level pediatric hospital in Mexico City.

INTRODUCTION: The increasing resistance to antibiotics is a public health problem and an imminent therapeutic challenge in hospitals. In this report we aimed to analyze the relationship between antimicrobial resistance and antibiotic consumption in a third-level pediatric hospital. METHODOLOGY: A cross-sectional analysis was conducted using the information from the microbiology and pharmacy databases of the Pediatric Hospital "Doctor Silvestre Frenk Freund", during the period 2015-2018. Prevalence of antimicrobial resistance by microorganisms and dispensed grams of selected antibiotics were calculated annually. Antibiotic resistance trend over the time was evaluated using the Chi-square trends test and to assess the correlation between the dispensed grams of antibiotics with their antimicrobial resistance prevalence, we calculated the Pearson's coefficient (r). RESULTS: A total of 4,327 isolated bacterial samples were analyzed (56.5% Gram-positive and 44.5% Gram-negative). Most frequently isolated microorganisms were coagulase-negative staphylococci (CoNS), E. coli, K. pneumoniae, P. aeruginosa and S. aureus. We found a significant increase in resistance to clindamycin and oxacillin for CoNS and significant decrease in nitrofurantoin and amikacin resistance for E. coli and K. pneumoniae. We observed a strong positive and statistically significant correlation between amikacin resistance prevalence and amikacin dispensed grams for P. aeruginosa (r = 0.95, p = 0.05). CONCLUSIONS: The antibiotic resistance profile showed by our study highlights the need of an appropriate antibiotic control use in the Hospital setting.

Infant multiple mandibular fracture: case report / Fractura múltiple mandibular en infante: reporte de caso

Infant facial fracture incidence is low. Most reported cases affect the jaw and are single fractures. We present a twenty-two-month old patient, who had a high-energy car accident. Among other injures, she suffered a multiple mandibular fracture: bicondylar, left body and right parasymphyseal. Stable internal fixation of parasymphyseal and body mandibular fracture was performed on the third day. Condylar fractures had a functional treatment with switching elastic traction to prevent ankylosis. Computed tomography (CT) showed mandibular condyles remodelling after six months. Clinical examination showed that mandibular movement ranges were preserved without alteration. Successful treatment of paediatric patients is based on the achievement of an adequate anatomic reduction and the stability of the fracture, allowing opportune form and function recovery, in order to assure further development of dental and facial structures...

La incidencia de fracturas faciales en infantes es baja. Los casos reportados muestran que afectan principalmente a la mandíbula y corresponden a fracturas únicas. Presentamos una paciente de 22 meses de edad, que sufre accidente automovilístico. Resulta entre otros, con múltiples frac-turas mandibulares: bicondílea, de cuerpo izquierdo y parasinfisiaria derecha. Al tercer día se realiza fijación interna estable en fractura parasinfisiaria y de cuerpo mandibular y tratamiento funcional de las frac-turas condíleas a través de tracción elástica alterna-da, para prevenir la anquilosis. Tomografía computa-da a los seis meses muestra remodelación de los cóndilos mandibulares. Al examen clínico los rangos de movimiento mandibular están conservados y sin alteración. El éxito del tratamiento en pacientes pediátricos se basa en obtener una adecuada reducción anatómica y estabilidad de la fractura, que permita recuperar oportunamente forma y función, asegurando el futuro desarrollo de las estructuras dentarias y faciales.

The supraspinatus distension sign: an indicator of supraspinatus integrity.

PURPOSE: To determine if direct contact between the biceps tendon and supraspinatus in patients undergoing shoulder arthroscopy performed in the lateral decubitus position has predictive value in evaluating full-thickness and articular-sided, partial-thickness rotator cuff tears. METHODS: Five hundred sixty-three consecutive shoulder arthroscopies in the lateral decubitus position were performed by a single surgeon between September 2005 and September 2007. The presence or absence of distance between the biceps tendon and supraspinatus was evaluated upon entering the joint. A diagnostic arthroscopy of the glenohumeral and subacromial spaces then ensued to determine the presence and extent of rotator cuff tear. RESULTS: The biceps-supraspinatus interval was preserved in 211 of 232 (90.9%) of the articular-sided, partial-thickness tears. The biceps-supraspinatus space was absent in 76 of 77 (98.7%) of the full-thickness tears. After excluding cases of concomitant adhesive capsulitis, all 211 articular-sided, partial-thickness rotator cuff tears and only 1 of 75 (1.3%) full-thickness rotator cuff tears was associated with a preserved biceps-supraspinatus interval (false negative). CONCLUSIONS: Our study further validates the high sensitivity and specificity of using the loss of supraspinatus distension for predicting full-thickness rotator cuff tears. We also report the reliable preservation of supraspinatus distension with articular-sided, partial-thickness rotator cuff tears. These articular-sided partial-thickness tears typically do not lead to sufficient egress of arthroscopic fluid from the glenohumeral joint to cause a loss of supraspinatus distension. LEVEL OF EVIDENCE: Level IV, prognostic case series.

Subacromial pain pump use with arthroscopic shoulder surgery: a short-term prospective study of complications in 583 patients.

Pain pumps containing local anesthetics, with or without opioids, can be used for perioperative analgesia after arthroscopic shoulder surgery to reduce pain. Although several smaller studies have demonstrated the analgesic properties, no large series to date has reported the short-term complication rate of subacromial pain pumps. We prospectively studied (2005 to 2007) 583 patients who underwent arthroscopic shoulder surgery at a single outpatient surgery center and had intraoperative placement of a pain pump catheter into the subacromial space. Patients had at least 1 month of follow-up. No patient received perioperative brachial plexus regional anesthesia. There were no cases of infection, internal catheter breakage, pump failure, or hospital admission for pain control. The only complication was external catheter breakage that occurred when a patient attempted to remove the pump without removing the tape fastening the catheter at the skin. Subacromial pain pumps used for arthroscopic shoulder procedures are safe in the short-term.