[Case report of Guillain-Barré Syndrome after COVID BNT162b2 mRNA vaccine]. / Reporte de caso de síndrome de Guillain-Barré posterior a la vacuna COVID BNT162b2 mRNA.

INTRODUCTION: Guillain-Barré syndrome (GBS) is a rare immune disorder that affects peripheral nerves and the cause is not known completely, but it is associated with infections by viruses or bacteria. CASE REPORT: We report the case of a 23-year-old male patient, a health student, who start 24 hours after received the second dose of COVID-19 vaccine, with proximal weakness of the right upper limb, later on the left side with descending and distal progression. DISCUSSION: GBS cases related to COVID-19 vaccines have been published, the most common being BNT162b2, which is mRNA, there are also cases published after the AZD1222 (ChAdOx1) vaccine, which is a non-replicating viral vector. The incidence of GBS is estimated at 0.43 per 100.00 doses applied, under registered national incidence of 1.1-1.8 per 100,000 persons per year. CONCLUSIONS: It is important to mention that although GBS can occur after vaccination against COVID-19, this incidence is much lower than which occurs in the community in Mexico associated with other diseases, considering more common the presence of cases related to infectious gastrointestinal diseases.

Implementation of control measures against an outbreak due to Clostridioides difficile producing toxin B in a tertiary hospital in Mexico.

INTRODUCTION: To describe the outbreak of Clostridioides difficile infection (CDI), and the impact of the prevention and control measures that were implemented in the "Hospital Juárez de México" (HJM) for its control. METHODS: A cross-sectional, descriptive, observational, and retrospective study was designed. All information on the hospital outbreak and on health care-associated infections (HCAI) was obtained from the files of the Hospital Epidemiological Surveillance Unit (HESU) of the HJM. RESULTS: A total of 15 cases of CDI were detected from February 20th to May 22nd, 2018, which represented 55.6% and 44.4% for the male and female gender, respectively, with an average age of 56 years and a range of 24 to 86 years old. It was possible to identify six failures and deficiencies that involved health personnel and hospital logistics through analyses based on the situational diagnosis in the services involved and through the construction of cause-effect diagrams. Additionally, through the detection of the outbreak by means of laboratory tests and timeline, the HESU team implemented measures and prospective surveillance to control and prevent the emergence of new cases. CONCLUSIONS: The implementation of basic quality tools, control measures, and the prospective epidemiological surveillance had a positive impact on the control against the outbreak of C. difficile producing toxin B.

Klebsiella pneumoniae blaNDM-1 carrying a class 1 integron causing a hospital outbreak in a Mexican attention center.

INTRODUCTION: Infections acquired in hospitals are the cause of high morbidity and mortality and with the emergence of resistant bacteria, the problem is greater. The aim of this work was to determine the genetic characteristics and timeline of Klebsiella pneumoniae blaNDM-1 carrying a class 1 integron involved in an intrahospital outbreak. METHODOLOGY: Investigation was made from the first detection of K. pneumoniae blaNDM-1, strain "466", and the last clone "423". 16S rRNA gene analysis showed that 466 strain and clones were related to K. pneumoniae. Extended-spectrum ß-lactamases (ESBL) was detected according to the Clinical and Laboratory Standards Institute (CLSI) and real time-PCR. Typing of K. pneumoniae blaNDM-1 strains was carried by ERIC-PCR and sequencing the variable region of the integrons were performed. RESULTS: A cluster of six resistant isolates of K. pneumoniae blaNDM-1 was detected in intensive care unit (ICU), internal medicine (IM) and orthopedics (OT). Timeline revealed that the first bacterial identification was in ICU and the last clone in OT service. The array genetic of variable region was "IntI/aadA5-drfA17/qacEΔ1-Sul1". CONCLUSIONS: The evidences highlight the importance of the epidemiological surveillance of Extended-spectrum ß-lactamases (ESBL) strains, as well as the need for molecular epidemiological studies to identify the routes of transmission and the contamination sources within health personnel.

Clonal dispersion of Acinetobacter baumannii in an intensive care unit designed to patients COVID-19.

INTRODUCTION: SARS-CoV2 pandemic marks the need to pay attention to bacterial pathogens that can complicate the hospital stay of patients in the intensive care unit (ICU). ESKAPE bacteria which includes Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter cloacae are considered the most important, because of their close relationship with the development of ventilator-associated pneumonia (VAP). The aim of this work was to identify and characterize ESKAPE bacteria and to detect their possible clonal spread in medical devices, patients, and medical personnel of the ICU for COVID-19 patients of the Hospital Juarez de Mexico. METHODOLOGY: Genetic identification of ESKAPE bacteria was performed by analyzing the 16S rRNA gene. Resistance assays were performed according to the CLSI guidelines. Assembly of AdeABCRS operon and inhibition assays of pumps efflux in Acinetobacter baumannii isolates were performed. Associated gene involved in biofilm formation (icaA) was performed in isolates belonging to the Staphylococcus genus. Finally, typing by ERIC-PCR and characterization of mobile genetic element SCCmec were done. RESULTS: Heterogeneous distribution of ESKAPE and non-ESKAPE bacteria was detected in various medical devices, patients, and medical personnel. Acinetobacter baumannii and Staphylococcus aureus were the predominant ESKAPE members. The analysis of intergenic regions revealed an important clonal distribution of A. baumannii (AdeABCRS+). Genotyping of SCCmec mobile genetic elements and the icaA gene showed that there is no clonal distribution of S. aureus. CONCLUSIONS: Clonal spread of A. baumannii (AdeABCRS+) highlights the importance of adopting good practices for equipment disinfection, surfaces and management of COVID-19 patients.

Economic and Epidemiological Impact of an Improvement Plan for the Decrease of Ventilator-Associated Pneumonia in a Tertiary Hospital in Mexico.

INTRODUCTION: The objective of this work is to measure the economic and epidemiological impact of the implementation of a comprehensive quality improvement plan (CQIP) for the prevention and reduction of ventilator-associated pneumonia (VAP) in the adult intensive care unit in a Mexican hospital. MATERIALS AND METHODS: A cross-sectional, ambispective, comparative, analytical, observational study was conducted with epidemiological data on cases of health care-associated infections and with information from the Hospital Epidemiological Surveillance Unit from August 2017 to July 2018. RESULTS: Before to the implementation of the CQIP, there were a total of 26 VAPs, with a rate of 32.2 per 1000 ventilator-days. After the implementation of CQIP, there were 14 VAPs, with a rate of 23.4 per 1000 ventilator-days, with a 46.2% decrease in incidence (P = 0.02). Before the installation of the interventions, the expense was $4,471,073.80, with an average cost per case of $171,964.38. The total cost per bed-day in the adult intensive care unit was $331,280.00, and for hospitalization, the cost was $192,038.00; for the use of antimicrobials, an expense of $749,689.20 was calculated, and for the use of mechanical ventilation, the cost was $2,974,275.60. The percentage of decrease in the cost of VAP after CQIP implementation was 46.5%. CONCLUSIONS: The implementation of CQIP based on the risk evaluation factors of VAP resulted in their decrease, which is reflected in a patient safety and quality care improvement.

[Results of the Program for the Rational Use of Antimicrobials in a Mexican hospital, 2013-2018Resultados de um programa para o uso racional de antimicrobianos num hospital no México, 2013-2018]. / Resultados del Programa de Uso Racional de Antimicrobianos en un hospital de México, 2013-2018.

OBJECTIVE: Describe the results of the Program for the Rational Use of Antimicrobials at Mexico's Juárez Hospital. METHODS: An observational, cross-sectional, retrospective, descriptive study was designed. For the consumption of antimicrobial agents, data from January 2013 to December 2018 were analyzed by calculating the defined daily dose (DDD). For the cost analysis, a traditional costing calculation was used. RESULTS: For the group of carbapenem agents, there was a sizeable reduction in the consumption of imipenem / cilastatin: the DDD declined from 2.3 in 2013 to 0.7 in 2018, a decrease of 70%. By contrast, for the other two agents, increases were observed. The consumption of meropenem increased by 2% (from 2.4 in 2013 to 2.5 in 2018); the consumption of ertapenem increased by 75% (from 1 in 2013 to 1.8 in 2018). The total expenditure on antimicrobial agents was USD 930 556.46 during 2013, compared to USD 856 079.10 during 2018, representing a difference of 8% or USD 74 905.61 of the total expenditure. CONCLUSIONS: Programs for the rational use of antimicrobials need to be evaluated continuously, by monitoring both consumption of agents by patients and related institutional expenditures.

OBJETIVO: Descrever os resultados do Programa para o Uso Racional de Antimicrobianos no Hospital Juárez de México. MÉTODOS: Elaboramos um estudo observacional, transversal, retrospectivo e descritivo. Analisamos o consumo de antimicrobianos de janeiro de 2013 a dezembro de 2018 pelo cálculo da dose diária definida (DDD); para a análise de custos, realizamos um cálculo de custos tradicional. RESULTADOS: No grupo dos carbapenens, a redução do consumo de imipenem/cilastatina foi notável: passou-se de uma DDD de 2,3 em 2013 para 0,7 em 2018, uma redução de 70%. Por outro lado, observou-se um aumento no uso dos dois outros medicamentos: no caso do meropenem, foi registrado um aumento de 2% (de 2,4 em 2013 a 2,5 em 2018); no consumo de ertapenem o aumento foi de 75% (de 1 em 2013 a 1,8 em 2018). No total, as despesas com antimicrobianos foram de USD 930 556,46 em 2013 e de USD 856 079,10 em 2018, uma diferença de 8%, o que equivale a uma redução de USD 74 905,61 nas despesas totais. CONCLUSÕES: É necessário avaliar continuamente os programas para o uso racional de antimicrobianos pelo monitoramento do consumo e das despesas derivadas.

Resultados del Programa de Uso Racional de Antimicrobianos en un hospital de México, 2013-2018

[RESUMEN]. Objetivo. Describir los resultados del Programa de Uso Racional de Antimicrobianos en el Hospital Juárez de México. Métodos. Se diseñó un estudio de tipo observacional, transversal, retrospectivo y descriptivo. Se analizó el consumo de antimicrobianos de enero de 2013 a diciembre de 2018 a través del cálculo de la dosis diaria definida (DDD); para el análisis de costos se realizó un cálculo de costeo tradicional. Resultados. En el grupo de los carbapenémicos, es notable la reducción en el consumo de imipenem/cilastina: se pasó de una DDD en el 2013 de 2,3 a 0,7 en el 2018, con una reducción de 70%. En cambio, en los otros dos fármacos, se ha observado un incremento. En meropenem se registró de 2% (de 2,4 en 2013 a 2,5 en 2018); en el consumo de ertapenem el incremento es de 75% (de 1 en 2013 a 1,8 en 2018). En total, el gasto de antimicrobianos durante 2013 fue de $930 556,46, mientras que en 2018 fue de $856 079,10, con una diferencia de 8%, lo que equivale a $74 905,61 del gasto total (los valores se expresan en dólares estadounidenses). Conclusiones. Se necesita evaluar de manera constante los programas para el uso racional de antimicrobianos, mediante el monitoreo del consumo y el gasto derivado.

[ABSTRACT]. Objective. Describe the results of the Program for the Rational Use of Antimicrobials at Mexico’s Juárez Hospital. Methods. An observational, cross-sectional, retrospective, descriptive study was designed. For the consumption of antimicrobial agents, data from January 2013 to December 2018 were analyzed by calculating the defined daily dose (DDD). For the cost analysis, a traditional costing calculation was used. Results. For the group of carbapenem agents, there was a sizeable reduction in the consumption of imipenem / cilastatin: the DDD declined from 2.3 in 2013 to 0.7 in 2018, a decrease of 70%. By contrast, for the other two agents, increases were observed. The consumption of meropenem increased by 2% (from 2.4 in 2013 to 2.5 in 2018); the consumption of ertapenem increased by 75% (from 1 in 2013 to 1.8 in 2018). The total expenditure on antimicrobial agents was USD 930 556.46 during 2013, compared to USD 856 079.10 during 2018, representing a difference of 8% or USD 74 905.61 of the total expenditure. Conclusions. Programs for the rational use of antimicrobials need to be evaluated continuously, by monitoring both consumption of agents by patients and related institutional expenditures.

[RESUMO]. Objetivo. Descrever os resultados do Programa para o Uso Racional de Antimicrobianos no Hospital Juárez de México. Métodos. Elaboramos um estudo observacional, transversal, retrospectivo e descritivo. Analisamos o consumo de antimicrobianos de janeiro de 2013 a dezembro de 2018 pelo cálculo da dose diária definida (DDD); para a análise de custos, realizamos um cálculo de custos tradicional. Resultados. No grupo dos carbapenens, a redução do consumo de imipenem/cilastatina foi notável: passou-se de uma DDD de 2,3 em 2013 para 0,7 em 2018, uma redução de 70%. Por outro lado, observou-se um aumento no uso dos dois outros medicamentos: no caso do meropenem, foi registrado um aumento de 2% (de 2,4 em 2013 a 2,5 em 2018); no consumo de ertapenem o aumento foi de 75% (de 1 em 2013 a 1,8 em 2018). No total, as despesas com antimicrobianos foram de USD 930 556,46 em 2013 e de USD 856 079,10 em 2018, uma diferença de 8%, o que equivale a uma redução de USD 74 905,61 nas despesas totais. Conclusões. É necessário avaliar continuamente os programas para o uso racional de antimicrobianos pelo monitoramento do consumo e das despesas derivadas.

Disinfection of N95 masks artificially contaminated with SARS-CoV-2 and ESKAPE bacteria using hydrogen peroxide plasma: Impact on the reutilization of disposable devices.

INTRODUCTION: One of the serious consequences of the SARS-CoV-2 pandemic is the shortage of protective equipment for health personnel. N95 masks are considered one of the essential protective equipment in the management of patients with COVID-19. The shortage of N95 masks implies potential health risks for health personnel and significant economic losses for the health institution. The objective of this work was to investigate the disinfection of N95 masks artificially contaminated with SARS-CoV-2 and ESKAPE bacteria by using hydrogen peroxide plasma. MATERIAL AND METHODS: We examined the disinfection capacity of hydrogen peroxide plasma against the SARS-CoV-2 and 2 members of the ESKAPE bacteria (Acinetobacter baumannii and Staphylococcus aureus) through a study of artificial contamination in situ of N95 masks. Amplification of specific genes by real-time reverse transcription polymerase chain reaction of SARS-CoV-2 and microbiological culture of ESKAPE bacteria was performed before and after the disinfection process. RESULTS: SARS-CoV-2 was not detected in all assays using 5 different concentrations of the virus, and A baumannii and S aureus were not cultivable with inoculums of 102 to 106 CFU after disinfection tests of N95 masks with hydrogen peroxide plasma. CONCLUSION: Disinfection of N95 masks by using the hydrogen peroxide plasma technology can be an alternative for their reuse in a shortage situation. Implications for the use of disinfection technologies of N95 masks and the safety of health personnel are discussed.

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.

Incidence and costs of ventilator-associated pneumonia in the adult intensive care unit of a tertiary referral hospital in Mexico.

BACKGROUND: Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs after 48 hours of endotracheal intubation and initiation of mechanical ventilation. The aim of this work was to use a micro-costing method to calculate the costs generated in 2017 for the care of patients with VAP at the Hospital Juárez de México. METHODS: We performed a cross-sectional, retrospective, analytical, and observational study of the databases of the registry of health care-associated infections (HAIs) in 2017, in addition to a micro-costing study. RESULTS: We studied 48 VAP cases in an adult intensive care unit (AICU). In this period, 1668 ventilator days were identified, with an incidence rate of 28.8 per 1000 days. All cases were caused by multidrug-resistant (MDR) bacteria and the costs of their care exceeded the average costs for the use of antimicrobials. By calculating the profit on return as an association measure, we found that VAP caused by MDR bacteria confers 9 times the risk of increasing the costs of care above the expected average. CONCLUSIONS: The cost for a case of VAP in the AICU is high and has an impact on the institutional budget. Control measures to prevent the spread of bacteria, particularly MDR bacteria, must be put into place in order to avoid increases in hospital stay costs and mortality.

Importancia de la higiene de manos para prevenir la sepsis en la atención de la salud / Importance of hand hygiene to prevent sepsis in health care / Importância da higiene das mãos para impedir a sepse em cuidados da saúde

Resumen: La higiene de manos es la medida más importante para la prevención y control de las infecciones asociadas a la atención de la salud (IAAS), las cuales pueden derivar en una respuesta inflamatoria desproporcionada en el organismo, mejor conocida como sepsis. Cada año, el día 5 de mayo la Organización Mundial de la Salud dirige y celebra el Día Mundial de la Higiene de Manos, y para este 2018 el lema es «Está en sus manos, prevenir la sepsis en la atención de la salud¼.

Abstract: Hand hygiene is the most important measure for the prevention and control the healthcare associated infections (HAI), which can lead to a disproportionate inflammatory response in the body, better known as sepsis. Every year, on May 5th the World Health Organization, directs and celebrates the World Hand Hygiene Day, which for this 2018 slogan is «It's in your hands - prevent sepsis in health care¼.

Resumo: A higienização das mãos é a medida mais importante para a prevenção e controle de infecções associadas à assistência à saúde (IAAS), que pode levar a uma resposta inflamatória desproporcional no organismo, mais conhecida como sepse. Todos os anos, no dia 5 de maio, a Organização Mundial de Saúde dirige e celebra o Dia Mundial da Higiene das Mãos que para este 2018 o lema é «Está nas suas mãos prevenir a sepse nos cuidados da saúde¼.