Comparative genomic analysis of Pseudomonas aeruginosa strains susceptible and resistant to carbapenems and aztreonam isolated from patients with healthcare-associated infections in a Mexican hospital.

Pseudomonas aeruginosa (PA) is an important opportunistic pathogen that causes different infections on immunocompromised patients. Within PA accessory genome, differences in virulence, antibiotic resistance and biofilm formation have been described between strains, leading to the emergence of multidrug-resistant strains. The genome sequences of 17 strains isolated from patients with healthcare-associated infections in a Mexican hospital were genomically and phylogenetically analyzed and antibiotic resistance genes, virulence genes, and biofilm formation genes were detected. Fifteen of the 17 strains were resistant to at least two of the carbapenems meropenem, imipenem, and the monobactam aztreonam. The antibiotic resistance (mexA, mexB, and oprM) and the biofilm formation (pslA and pslD) genes were detected in all strains. Differences were found between strains in accessory genome size. The strains had different sequence types, and seven strains had sequence types associated with global high risk epidemic PA clones. All strains were represented in two groups among PA global strains. In the 17 strains, horizontally acquired resistance genes to aminoglycosides and beta-lactams were found, mainly, and between 230 and 240 genes that encode virulence factors. The strains under study were variable in terms of their accessory genome, antibiotic resistance, and virulence genes. With these characteristics, we provide information about the genomic diversity of clinically relevant PA strains.

Percepción de la simulación clínica como experiencia de aprendizaje en estudiantes de Licenciatura en Enfermería / Perception of Clinical Simulation as a Learning Experience in Undergraduate Nursing Students / Percepção da simulação clínica como experiência de aprendizagem em discentes de Licenciatura em Enfermagem

Introducción: la simulación clínica es una herramienta de aprendizaje que integra conocimiento, destreza, participación y compromiso del estudiante, permite la reproducción, retroalimentación, valoración y reflexión. Supone una oportunidad para generar competencias que favorecen la formación de un pensamiento crítico, razonamiento y juicio clínico, habilidades de comunicación, trabajo en equipo, resolución de problemas y toma de decisiones. Objetivo: identificar la percepción de los estudiantes de la Licenciatura en Enfermería sobre la simulación clínica como experiencia de aprendizaje en una institución pública universitaria en el noreste de México. Metodología: se empleó un enfoque cuantitativo, diseño descriptivo y transversal en 477 estudiantes de enfermería. Se utilizó el cuestionario "Percepción de los estudiantes de enfermería respecto a la simulación clínica como experiencia de aprendizaje". Se consideraron aspectos éticos normativos establecidos en México. Resultados: la percepción de los estudiantes acerca de la simulación clínica como herramienta de aprendizaje fue muy buena en 49,5 % y buena en 44,9 %, lo que indica que fue una experiencia positiva. Conclusiones: la percepción de la simulación clínica como experiencia de aprendizaje mostrada por los estudiantes fue positiva. Esta favoreció la actitud para trabajar en equipo, fortaleció el liderazgo, comunicación, integración de la teoría y generación de pensamiento crítico.

Introduction: clinical simulation is a learning tool that integrates knowledge, skills, participation and commitment of the student, allows reproduction, feedback, assessment and reflection. It is an opportunity to generate competencies that favor the formation of critical thinking, clinical reasoning and judgment, communication skills, teamwork, problem solving and decision making. Objective: to identify the perception of undergraduate nursing students on clinical simulation as a learning experience in a public university institution in northeastern Mexico. Methodology: a quantitative approach, descriptive and cross-sectional design was used in 477 nursing students. The questionnaire "Nursing students' perception of clinical simulation as a learning experience" was used. Ethical normative aspects established in Mexico were considered. Results: students' perception of clinical simulation as a learning tool was very good in 49.5% and good in 44.9%, indicating that it was a positive experience. Conclusions: the perception of clinical simulation as a learning experience shown by students was positive. It favored the attitude to work in a team, strengthened leadership, communication, integration of theory and generation of critical thinking.

Introdução: a simulação clínica é uma ferramenta de aprendizagem que integra conhecimento, destreza, participação e comprometimento do discente, permite reprodução, retroalimentação, valoração e reflexão. Oportuniza a geração de competências que favorecem a formação de pensamento crítico, razoamento e julgamento clínico, habilidades de comunicação, trabalho em equipe, solução de problemas e tomada de decisão. Objetivo: identificar a percepção dos alunos da Licenciatura em Enfermagem sobre a simulação clínica como experiência de aprendizagem em uma instituição pública universitária no nordeste do México. Metodologia: usou-se enfoque quantitativo, de desenho descritivo e transversal em 477 discentes de enfermagem. Foi utilizado o questionário "Percepção dos discentes de enfermagem sobre a simulação clínica como experiência de aprendizagem". Aspectos éticos normativos estabelecidos no México foram considerados. Resultados: a percepção dos alunos sobre a simulação clínica como ferramenta de aprendizagem foi muito boa em 49,5 % e boa em 44,9 %, indicando que foi uma experiência positiva. Conclusões: a percepção da simulação clínica como experiência de aprendizagem mostrada pelos alunos foi positiva. Isso favoreceu a atitude para trabalhar em equipe, fortaleceu a liderança, comunicação, integração da teoria e geração de pensamento crítico.

Primer reporte de Enterobacterales dobles productores de carbapenemasas en hospitales de Paraguay. Año 2021

RESUMEN Las carbapenemasas se encuentran ampliamente distribuidas en nuestro país, tanto en bacilos gramnegativos fermentadores como no fermentadores. Durante 2021, se ha reportado incremento de cepas con estas enzimas. Con el objetivo de evaluar la doble producción de carbapenemasas en Enterobacterales y comunicar su circulación, fue puesta a punto una PCR convencional múltiple. Estudio retrospectivo en 128 aislamientos provenientes de 20 centros colaboradores de la Red Nacional de Vigilancia de la RAM (Capital, Central e interior del país), remitidos al LCSP entre febrero y setiembre de 2021, para confirmación y genotipificación de carbapenemasas. Se realizaron pruebas fenotípicas y colorimétricas con sustratos específicos, y pruebas genotípicas (PCR convencional múltiple) para la detección simultánea de varios genes de resistencia (bla NDM, bla KPC, bla OXA-48-like, bla IMP y bla VIM). De los 128 aislamientos estudiados, 107 correspondieron a Klebsiella pneumoniae, 14 a Enterobacter cloacae complex, entre otros; aislados en mayor frecuencia de muestras de orina (30%), respiratorias (30%), sangre y catéter (24%). Los genes de resistencia a los carbapenemes detectados fueron: bla NDM (77,3%), bla KPC (17,2%); siendo confirmada la doble producción de carbapenemasas en 7 aislamientos (5,5%) provenientes de 4 centros diferentes de la capital de país y uno de Central; 6 de ellas (K. pneumoniae) con bla NDM+bla KPC y 1 (E. cloacae complex) con bla NDM+bla OXA-48-like; confirmando circulación de Enterobacterales dobles productores de carbapenemasas en el país (KPC+NDM y OXA+NDM); hallazgos que obligan a proveer de capacidades de detección, de manera a que se puedan tomar medidas oportunas y eficaces de contención y control.

ABSTRACT Carbapenemases are widely distributed in our country, both in fermenting and non-fermenting gram-negative bacilli. During 2021, an increase in strains with these enzymes has been reported. In order to evaluate the double production of carbapenemases in Enterobacterales and communicate their circulation, a multiple conventional PCR was set up. Retrospective study carried out in 128 isolates from 20 collaborating centers of the National AMR Surveillance Network (Capital, Central and interior of the country), sent to the LCSP between February and September 2021, for confirmation and genotyping of carbapenemases. Phenotypic and colorimetric tests were performed with specific substrates, as well as genotypic tests (multiple conventional PCR) for the simultaneous detection of several resistance genes (blaNDM, blaKPC, blaOXA-48-like, blaIMP and blaVIM). Of the 128 isolates studied, 107 corresponded to Klebsiella pneumoniae, 14 to Enterobacter cloacae complex, among others; isolated in higher frequency from urine (30%), respiratory (30%), blood and catheter (24%) samples. The genes for resistance to carbapenems detected were: blaNDM (77.3%), blaKPC (17.2%); the double production of carbapenemases was confirmed in 7 isolates (5.5%) from 4 different centers in the capital of the country and one in Central; 6 of them (K. pneumoniae) with blaNDM + blaKPC and 1 (E. cloacae complex) with blaNDM + blaOXA-48-like; confirming circulation of double Enterobacterales producers of carbapenemases in the country (KPC + NDM and OXA + NDM); findings that require the provision of detection capabilities, so that timely and effective containment and control measures can be taken.

Caracterización molecular de carbapenemasas en bacilos gramnegativos circulantes en hospitales de Paraguay. Primer cuatrimestre 2021 / Molecular characterization of carbapenemases in Gram-negative bacilli circulating in hospitals of Paraguay. First quarter of 2021

La resistencia a los antimicrobianos (RAM), representa un grave problema por el uso indiscriminado de antimicrobianos de amplio espectro. En nuestro país, durante el primer cuatrimestre del año, se observó un aumento inusual en el número de aislamiento de gérmenes multirresistentes, sobre todo de bacilos gramnegativos, los cuales fueron remitidos al laboratorio de referencia con el objetivo de caracterizar los genes de resistencia a los carbapenemes. Estudio observacional y prospectivo de corte transversal en 456 aislamientos de bacilos gramnegativos provenientes de 11 centros colaboradores de la Red Nacional de Vigilancia de la RAM, remitidos al Laboratorio Central de Salud Pública entre enero y abril de 2021, para la detección molecular (reacción en cadena de la polimerasa múltiple) de los genes de resistencia enzimática bla OXA-51, bla OXA-23, bla OXA-24, bla OXA-48, bla OXA-58, bla NDM, bla KPC, bla IMP, bla VIM. Trescientos sesenta correspondieron a bacilos gramnegativos no fermentadores: 346 Acinetobacter baumannii y 14 Pseudomonas aeruginosa; 96 fueron miembros de Enterobacterales, siendo prevalente Klebsiella pneumoniae (81). Todos los aislamientos de Acinetobacter baumannii resultaron ser productores de carbapenemasas: OXA-23 (94%), NDM (4%), NMD+OXA-58 (2%); en Pseudomonas aeruginosa, 7 de los 14 aislamientos (50%) fueron portadores de metalobetalactamasa del genotipo NDM (100%). Los genotipos NDM (92%) y KPC (8%) fueron confirmados en Enterobacterales. La resistencia plasmídica a carbapenemes es endémica en nuestro país, siendo prevalentes los genotipos OXA-23 en Acinetobacter baumannii y NDM en Pseudomonas aeruginosa y Enterobacterales

Antimicrobial resistance (AMR) represents a serious problem due to the indiscriminate use of broad-spectrum antimicrobials. During the first quarter of the year, an unusual increase in the number of isolation multi-resistant germs, especially gram-negative bacilli was observed, specially of Gram-negative bacilli which were referred to the reference laboratory in order to characterize the carbapenems resistance genes. Observational and prospective cross-sectional study in 456 isolates of Gram-negative bacilli from 11 collaborating centers of the National AMR Surveillance Network, referred to the Central Public Health Laboratory (LCSP) between January and April 2021, for molecular detection (multiple polymerase chain reaction) targeting the enzymatic resistance genes: bla OXA-51, bla OXA-23, bla OXA-24, bla OXA-48, bla OXA-58, bla NDM, bla KPC, bla IMP, bla VIM. Of the 456 isolates studied, 360 corresponded to non-fermenting Gram-negative bacilli, of which 346 were confirmed as Acinetobacter baumannii and 14 Pseudomonas aeruginosa; 96 were Enterobacterales, being Klebsiella pneumoniae (81) the most prevalent. All isolates of Acinetobacter baumannii carried genes encoding carbapenemases, being the OXA-23 (94%) followed by NDM (4%) and NDM +OXA-58 (2%). In Pseudomonas aeruginosa strains, 7 of the 14 isolates (50%) were carriers of NDM metallobetalactamase (100%). No carbapenemase gene was detected in the remaining 7. In all Enterobacterales strains, the presence of carbapenemases of the NDM (92%) and KPC (8%) genotypes were confirmed. Plasmid resistance to carbapenems is endemic in our country, being the OXA-23 genotypes prevalent in Acinetobacter baumannii and NDM in Pseudomonas aeruginosa and Enterobacterales

Commensal and virulent Escherichia coli strains of vaginal origin are reservoirs of resistance cassettes in class 1 integrons.

INTRODUCTION: Antimicrobial resistance in Escherichia coli, one of the causal agents of aerobic vaginitis, leads to the persistence of the infection. The investigation of integrons acquires relevance, since they are elements that are responsible for the acquisition of resistance to antibiotics. The aim of this work was to describe the structural diversity of class 1 integrons in virulent and commensal strains of E. coli isolated from patients with vaginal infection. METHODOLOGY: Ninety-two strains of E. coli were isolated from patients with aerobic vaginitis. Resistance profile against 19 antibiotics and class 1 integrons were detected by PCR. The identity and arrangement of cassettes was determined by sequencing. ERIC-PCR assays were carried out in strains with identical arrays. Finally, genotyping by Clermont algorithm and serotyping were performed. Seventeen strains showed integrons located in plasmids. RESULTS: Ten different gene cassette arrays were identified in 30 strains of E. coli. Cassettes corresponding to genes coding for adenylyltransferases (aadA), dihydrofolate reductases (dfrA), and oxacillinases (blaOXA) were detected. Array dfrA17-aadA5 was predominantly prevalent over the other arrays identified. Phylogenetic group A was the most predominant, followed by group B2 and D. CONCLUSIONS: This study demonstrates the presence of E. coli of vaginal origin carrying class 1 integrons, which are main genetic elements of capture of resistance genes, with the possibility of capturing new resistance cassettes. These evidences should serve for the modification of protocols in the diagnosis and treatment of aerobic vaginitis, and the development of policies for the rational use of antimicrobials.

Conocimiento, actitud y barreras en enfermeras hacia las medidas de prevención de úlceras por presión / Knowledge, attitude and barriers in nurses towards prevention measures of pressure ulcers

RESUMEN Objetivo: Identificar el nivel de conocimiento, actitud y barreras hacia las medidas de prevención de las úlceras por presión en el personal de enfermería que labora en servicios de hospitalización adultos. Material y método: Estudio descriptivo y transversal realizado en un hospital de Seguridad Social, en una muestra de 119 enfermeras y auxiliares de enfermería que laboran con pacientes adultos en riesgo de desarrollar úlceras por presión. Se aplicaron tres cuestionarios autocumplimentados: Valoración de conocimientos hacia la prevención de úlceras por presión (PUKAT); Actitud hacia la prevención de las úlceras por presión (APuP) y un apartado de Barreras de prevención e intervención. Se respetó el reglamento de la Ley General de Salud en Materia de Investigación de México. Resultados: Se identificó un 53,78% de respuestas correctas, lo que mostró un conocimiento bajo hacia las medidas de prevención. La actitud mostrada fue positiva con una media de 40,1 DE 3,5. Las barreras identificadas en prevención fueron "falta de personal" (81,51%), "pacientes que no cooperan" (67,22%) y "falta de tiempo" (64,70%); en intervención: "falta de ayudantes para la movilización" (91,59%), "falta de enfermeras" (80,67%) y "falta de tiempo" (72,26%). Conclusiones: Las enfermeras y auxiliares de enfermería mostraron un conocimiento bajo hacia las medidas de prevención de las úlceras por presión, con una actitud positiva. El personal de enfermería que labora en UCI y Medicina interna mostró tener una mejor actitud y las barreras más identificadas corresponden a falta de enfermeras, tiempo y personal que las asista en la movilización.

ABSTRACT Objective: To identify the level of knowledge, attitude and barriers in nursing staff working in adult in patient services towards prevention measures of pressure ulcers. Material and Methods: Quantitative, descriptive and transversal study conducted in a hospital of Social Security, in a sample of 119 nurses and nursing assistants who work with adult patients at risk of developing pressure ulcers. For data collection three self-filled questionnaires were applied: "Knowledge Rating of the pressure ulcers prevention"(PUKAT); "Attitude towards prevention of pressure ulcers" (APuP) and a section of barriers to prevention and intervention. The guidelines about informed consent and risks for research in Mexico were complied. Results: 56.63 % of correct answers were identified, which showed a low awareness towards prevention measures. Positive attitude was shown, with a mean of 40.10. The barriers identified in prevention were "lack of staff" (81.51%), "uncooperative patients" (67.22%), "lack of time" (64.70%); and in intervention: "lack of helpers for mobilization" (91.59%), "lack of nurses" (80.67%) and "lack of time" (72.26%). Conclusions: Nurses and nursing assistants showed low knowledge, but showed positive attitude, nursing staff working in ICU and internal medicine showed a better attitude, and the main identified barriers in the study are a lack of nurses, time and personnel that assist in the mobilization.

Characteristics of KPC-2-producing Klebsiella pneumoniae (ST258) clinical isolates from outbreaks in 2 Mexican medical centers.

The KPC-producing Klebsiella pneumoniae sequence type 258 (ST258) is an important pathogen widely spread in nosocomial infections. In this study, we identified the KPC-2-producing K. pneumoniae clinical isolates of 2 unrelated outbreaks that corresponded to pandemic strain ST258. The isolates showed high resistance to cephalosporins, carbapenems, quinolones, and colistin. The KPC-2-producing K. pneumoniae isolates were compared to the previously studied KPC-3-producing K. pneumoniae isolates from an outbreak in Mexico; they showed an unrelated pulsed-field gel electrophoresis fingerprinting pattern and a different plasmid profile. The KPC-2 carbapenemase gene was identified in two 230- and 270-kb non-conjugative plasmids; however, 1 isolate transferred the KPC-2 gene onto an 80-kb plasmid. These findings endorse the need of carrying out a continuous molecular epidemiological surveillance of carbapenem-resistant isolates in hospitals in Mexico.

Percepción de la cultura de la seguridad de los pacientes por personal de enfermería / Nursing perception of patient safety culture

Objetivo: Identificar las áreas de fortaleza y oportunidad de mejora continua, percibidas por el personal de enfermería en relación a la cultura de seguridad en la atención de los pacientes en un Hospital General del Sistema de Salud, en Tampico, Tamaulipas, México. Material y método: estudio cuantitativo, descriptivo con diseño transversal, realizado en un hospital de segundo nivel de atención. Muestra fue de 195 enfermeras, obtenida en un muestreo probabilístico por turnos. La recolección de los datos para el análisis de la cultura de la seguridad fue a través de un indicador tipo encuesta de la Agency for Healthcare Research and Quality-AHQR, validada al contexto de español como Cuestionario sobre seguridad de los pacientes, versión española del Hospital Survey on Patient Safety. Resultados: Las dimensiones percibidas como fortalezas son el trabajo en equipo en la unidad/ servicio y aprendizaje organizacional. Las dimensiones percibidas hacia la mejora continua fueron: dotación de personal, respuesta no punitiva a los errores, apoyo de la gerencia del hospital en la seguridad del paciente, percepción de seguridad, problemas en cambios de turno y transiciones entre servicios/unidades y franqueza de la comunicación. El clima de seguridad fue evaluado con una media de 7,35. El mayor porcentaje no reporta eventos adversos asociados a la atención para la salud. Conclusión: el indicador utilizado permitió identificar la percepción global del personal de enfermería hacia la seguridad en la atención del paciente, identificando seis dimensiones problemáticas con oportunidad hacia la mejora continua; así como dos dimensiones fuertes dentro de la cultura de seguridad.

The aim of the study was to identify areas of strength and opportunity for continuous improvement, as perceived by the nursing staff in relation to safety culture in the care of patients in a General Hospital Health System, in Tampico, Tamaulipas, México. Method: The study was a quantitative and descriptive cross-sectional design, made in a secondary care hospital. The sample consisted of 195 nurses on probability sampling by shifts. The data collection for the analysis of safety culture was through a survey type indicator: Agency for Healthcare Research and Quality-AHQR, validated to the Spanish context as Questionnaire on patient safety: Spanish version of the Hospital Survey on Patient Safety. Results: The dimensions perceived as strengths are teamwork in the unit/service and organizational learning. The dimensions perceived to continuous improvement were: staffing, no punitive response to errors, management support hospital patient safety, perceived safety, problems with shift changes and transitions between departments/units and openness of communication. Safety climate was assessed with an average of 7.35. The highest percentage reported no adverse events associated with health care. Conclusions: The indicator used identifed the global perception of the nursing staff to safety in patient care, identifying six dimensions problem with opportunity for continuous improvement, as well as two strong dimensions within the safety culture.

Detection and genotyping of an infectious pancreatic necrosis virus from asymptomatic rainbow trout (Oncorhynchus mykiss) facilities in Mexico.

BACKGROUND: Infectious pancreatic necrosis virus (IPNV) is a birnavirus that causes a lethal disease in both hatchery-reared juvenile salmonids and other non-salmonid fishes. IPNV has been classified into seven genogroups based on the analysis of the VP2/NS junction region of the viral A RNA segment. METHODS: Ten organisms from two trout-rearing farms were used for viral isolation in RTG-2 cells. Cells were inoculated with samples from spleen, kidneys and pyloric caeca. The viral isolate was initially identified by electron microscopy, and confirmed by a commercial ELISA, RT-PCR and sequencing. A phylogenetic tree was constructed based on the deduced amino acids sequence of VP2. RESULTS: An IPNV genogroup 1, labeled as EdoMex07, was isolated from a pool of renal tissues of five asymptomatic trout. The amino acid sequence analysis of VP2 showed that this IPNV presented the putative VP2 residue (221) already described in asymptomatic trout carriers. CONCLUSIONS: The EdoMex07 IPNV isolate belongs to genogroup 1, and has a VP2 phenotype which has been suggested to be involved in the establishment of the carrier state. This EdoMex07 IPNV is currently used as the standard positive control for detection of IPNV in rainbow trout farms in Mexico.