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Alejandro E Macías

Publications and source records attributed to Alejandro E Macías.

6 recordsLinked to original sources
PubMed2004

Nosocomial pediatric bacteremia: the role of intravenous set contamination in developing countries.

OBJECTIVE: To assess the rate of bacterial contamination of intravenous administration sets at their rubber injection ports and matching infusates. DESIGN: Cultures of injection ports and infusate during 26 visits to 4 hospitals. SETTING: Four public general pediatric hospitals in Mexico City with substandard care practices. PATIENTS: Hospitalized pediatric patients receiving intravenous solutions. RESULTS: Overall, 176 of 251 injection ports were contaminated (70.1%; 95% confidence interval [CI95], 64.5% to 75.8%), 35 (13.9%; CI95, 9.7% to 18.2%) with gram-negative rods, primarily of the tribe Klebsielleae. Cultures of infusates were positive in 17 cases (6.8%, CI95, 3.7% to 9.9%), 5 of which grew gram-negative rods (2%; CI95, 0.6% to 4.6%). In 3 cases (1.2%), the same species with gram-negative rods was found in the infusates and on the injection ports. During one visit, 8 clustered cases of injection port contamination with a clonal Enterobacter cloacae were found; this agent was also found in the blood culture, intravenous fluid, and parenteral nutrition of one patient. Inadequate chlorination of tap water, a potential risk factor, was recorded during 22 visits (84.6%). CONCLUSION: These data suggest that external contamination of the intravenous administration set could play a role in infusate contamination.

Blood-Borne Pathogens↗
PubMedDate not supplied

Infection control: old problems and new challenges.

Infection control faces radical changes at the beginning of the third millennium. The first part of this review focuses on problems not yet solved, such as 1) surveillance systems, which should be active and extremely flexible; 2) infection outbreaks in hospitals and strategies to avoid them; 3) hand washing and alternatives such as rapid hand antisepsis; 4) water and food in the hospital as potential reservoirs of nosocomial pathogens; 5) upgrading of infection control programs to turn them into systems to improve the quality of care; 6) fatal Gram-negative bacteremias in hospitals from developing countries, which can be avoided with better standards of care; 7) the elemental role of the microbiology laboratory in the prevention and control of infections; 8) the unprecedented crisis due to the emergence of specific multi-resistant pathogens; 9) the risks for healthcare workers, such as tuberculosis, hepatitis, HIV, SARS, and hemorrhagic fevers; and 10) the need for the consistent application of guidelines. The second part of this review focuses on new challenges for infection control, such as 1) the ever-growing number of immunocompromised patients and basic control measures to avoid opportunistic infections; 2) the concerns about the capacity of the public health systems to deal with terrorist acts; 3) the practice of high-risk procedures in facilities lacking trained personnel, efficient laboratories, and protective items; and 4) gene therapy and its potential infectious complications. Consideration is given to the asymmetric development of infection control globally.

Communicable Disease Control↗
PubMedDate not supplied

[Antibiotic-resistant fecal Escherichia coli in healthy children. Induced by the use of antibiotics?].

OBJECTIVE: To determine the rate of antibiotic resistance of fecal E. coli from healthy children and to infer if it is acquired environmentally or induced by antibiotic use. MATERIAL AND METHODS: Cross sectional study in children from schools and day care centers in Leon, Mexico. Prior antibiotic use (60 days) was questioned to the parents. A single fecal sample was cultured and an isolated colony suggestive of E. coli was submitted to biochemical identification and testing of disk susceptibility to 12 antibiotics. RESULTS: Four hundred fifty-six isolates were studied from children of 10 institutions, with ages ranging from 3 to 72 months (mean, 42.41). Use of antibiotics was referred in 242 children (53.07%). The antibiotics more commonly used were trimethoprim/sulfa, ampicillin, and penicillin (34, 20.5, and 18%). The highest rate of resistance was found for tetracycline, ampicillin, and trimethoprim/sulfa (64.4, 52.63, and 46.05%). The resistance to ciprofloxacin, amikacin, gentamicin, and ceftriaxone was less than 5%. Resistance to five or more antimicrobials was found in 93 isolates (20.39%); this rate was higher in isolates from children who received antibiotics (59/242, 24.38% vs. 34/214, 15.89%) (p = .025; OR 1.71, IC 95% 1.04-2.81). CONCLUSIONS: The study suggests that saprophyte bacteria acquires resistance through both, use of antibiotics and from the environment. These results support the concept that antimicrobial resistance must be considered as a public health problem.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Catalase test (Uriscreen) in the detection of bacteriuria-candiduria in hospitalized adults with Foley catheter].

BACKGROUND: Most urinary pathogens have the catalase enzyme, which has been used recently for detection of bacteriuria-candiduria, by an economic reaction in a tube containing 10% hydrogen peroxide and a catalyzer (Uriscreen). It has not been studied in patients with indwelling urinary catheter. OBJECTIVE: To determine the accuracy of the catalase test (CT) in hospitalized patients with indwelling urinary catheters and to compare it against other rapid tests (nitrites and pyuria detection). METHODS: The gold standard was the culture of urine, with 10(3) colony-forming units/mL as the threshold for significant growth. The nitrite test was determined by dipstick. The pyuria was determined by dipstick and microscopic examination. RESULTS: Of 108 cultures from 57 patients, 62 were positives (57.4%). The values of accuracy of the CT were (%): sensitivity 88.5, specificity 42.6, predictive positive value 66.7, and predictive negative value 74.1. Compared against nitrites detection the CT showed higher sensitivity and specificity. Against pyuria detection, it showed higher sensitivity, but lower specificity. CONCLUSIONS: Our study complements medical literature as it is the first focused in patients with indwelling catheter. The clinical use of the CT is limited and not superior to pyuria detection in this setting. However, because of its high sensitivity and low cost, it could be recommended for ruling out bacteriuria-candiduria in selected patients. A negative CT may prevent the need for expensive cultures.

Bacteriuria↗
PubMedDate not supplied

[Does cranberry juice have bacteriostatic activity?].

BACKGROUND: Cranberry juice is used to prevent urinary infections but it is not known if it inhibits bacterial growth in urine or in bacteriologic broth. OBJECTIVE: Determining if cranberry juice has bacteriostatic properties. METHODS: The urine of 20 female university students was studied before and after drinking cranberry juice. Both specimens were submitted to pH determination and inoculated with a control strain of Escherichia coli. After 1 and 2 hours of incubation with the inoculum, the urine specimens were plated on agar to determine their bacterial counts. Additionally, the growth of 10 E. coli strains were studied in broths with serial dilutions of juice. RESULTS: No inhibitory effect on bacterial growth was observed in urine after drinking cranberry juice. After 1 and two hours of incubation with the E. coli inoculum, control urine grew an average 132.2 and 153 x 10(3) colony-forming units/mL, respectively. After 1 and two hours of incubation with the inoculum, post-intervention urine grew an average 141.4 and 170.6 x 10(3) CFU/mL, respectively (p > 0.05). Against expectations, an increment was observed in urinary pH after drinking the juice (average pH in controls, 5.8 vs. 6.2 in post-intervention specimens; p = 0.043). In vitro analysis did not find a negative trend of E. coli growth in broths with higher concentrations of juice. CONCLUSIONS: Cranberry juice was not associated with bacteriostatic properties and its ingestion was not followed by a drop in urinary pH, which suggests that these are not its potential beneficial effects for the management and the prevention of urinary tract infections.

Administration, Oral↗