RESUMEN
BACKGROUND: Due to its increased non-susceptibility rates, Klebsiella pneumoniae has emerged as one of the most problematic pathogens. METHODS: The level of resistance to 25 antimicrobials of K. pneumoniae isolates from a teaching hospital in Greece and the evolution trends during 2 decades were examined. RESULTS: A statistically significant increase in non-susceptibility rates was found for almost all antimicrobials examined. During 2008, the isolates presented non-susceptibility rates to aminoglycosides >50% and to quinolones >60%. Nowadays, 1 out of 10 isolates is non-susceptible to colistin. Moreover, the isolates non-susceptible to imipenem were almost doubled between 2007 (29%) and 2008 (50%). Among the imipenem-resistant isolates, 1 out of 4 was also resistant to colistin. CONCLUSION: The effectiveness of carbapenems has been compromised and the increase in resistance to colistin is rapid and steep.
Asunto(s)
Antibacterianos/farmacología , Carbapenémicos/farmacología , Colistina/farmacología , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/aislamiento & purificación , Antibacterianos/uso terapéutico , Carbapenémicos/uso terapéutico , Colistina/uso terapéutico , Farmacorresistencia Bacteriana Múltiple/fisiología , Grecia/epidemiología , Hospitales Universitarios , Humanos , Infecciones por Klebsiella/tratamiento farmacológico , Infecciones por Klebsiella/epidemiología , Pruebas de Sensibilidad MicrobianaRESUMEN
The aim of this study was to investigate the clinical and epidemiological characteristics of five consecutive cases of infection with vancomycin-resistant enterococci (VRE) and the prevalence of faecal carriage of VRE among patients admitted to a 700-bed university hospital where no VRE had been isolated previously. In a 2-month period, five consecutive patients infected with VRE were detected. Three VanB+ Enterococcus faecium isolates were obtained from three patients, while two VanA+ E. faecium isolates, one VanA+ Enterococcus faecalis isolate and one VanC1+ Enterococcus gallinarum isolate were obtained from the other two patients. Of 218 faecal specimens from all hospital wards, 41 (18.8%) were found to contain VRE. Forty-two isolates of VRE were obtained, comprising one (2%) E. faecalis, 11 (27%) E. faecium, 24 (57%) E. gallinarum and six (14%) Enterococcus casseliflavus/flavescens. Four isolates carried the vanA gene, eight carried vanB, 24 carried vanC1, and six carried vanC2/C3. Use of glycopeptides, the presence of central venous catheters and renal dialysis all correlated with VRE colonisation. The prevalence rates were among the highest reported in the literature.
Asunto(s)
Portador Sano/epidemiología , Enterococcus/efectos de los fármacos , Hospitales , Intestinos/microbiología , Resistencia a la Vancomicina/genética , Adulto , Anciano , Proteínas Bacterianas/genética , Portador Sano/microbiología , Enfermedades Transmisibles Emergentes/epidemiología , Enfermedades Transmisibles Emergentes/microbiología , Enterococcus/clasificación , Enterococcus/aislamiento & purificación , Enterococcus faecalis/efectos de los fármacos , Enterococcus faecium/efectos de los fármacos , Femenino , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Grecia/epidemiología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , PrevalenciaRESUMEN
In order to determine the resistance patterns and evolution trends of four common Enterobacteriaceae (Escherichia coli, Proteus spp., Klebsiella spp. and Enterobacter spp.), aminoglycoside resistance phenotypes of 8917 non-repetitive strains, isolated over an 8-year period, were analysed. Phenotypes were defined by examining the susceptibility of the strains to a panel of aminoglycosides, using disk diffusion method. A large diversity of different resistance phenotypes was encountered. A significant progressive increase in the proportions of wild-type E. coli strains was noted. Among resistant strains of Enterobacter spp. and Klebsiella spp., the incidence of phenotype KTANt (kanamycin, tobramycin, amikacin and netilmicin), indicative of AAC(6')-I production, was very high (66.7 and 46.5%, respectively). Phenotypes indicative for gentamicin-modifying enzymes as well as broad-spectrum combinations (combinations of gentamicin-modifying enzymes with AAC(6')-I) were infrequent.
Asunto(s)
Aminoglicósidos/farmacología , Farmacorresistencia Bacteriana , Bacterias Gramnegativas/efectos de los fármacos , Aminoglicósidos/metabolismo , Aminoglicósidos/uso terapéutico , Evolución Molecular , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Grecia , Humanos , FenotipoRESUMEN
During a 5-year period (1995-1999) a total of 7090 stool samples obtained from patients with acute diarrhoea, mostly community-acquired, were examined for bacterial pathogens, in the Greek island of Crete. One or more enteric pathogens were isolated from 987 patients (14%). Salmonella enterica were the most commonly isolated bacteria (6%), followed by Campylobacter spp. (4.2%), and enteropathogenic Escherichia coli (EPEC) (1.8%). Yersinia enterocolitica (0.6%), Shigella spp. (0.3%), and Aeromonas hydrophila (0.04%), were less frequently isolated. Clostridium difficile was isolated from 65 out of 451 diarrhoeal specimens examined (14.4%). Toxin B was detected in all cases. No verotoxigenic E. coli strains were identified. Resistance to ampicillin was observed in 31.5% of the Salmonella, 58.3% of the Shigella and 31.5% of the EPEC isolates. Resistance to trimethoprim-sulfamethoxazole was observed in 4.4% of the Salmonella, 30.5% of the Shigella, and 18.5% of the EPEC isolates. High percentages of resistance to quinolones (44.5% to norfloxacin, and 40.5% to ciprofloxacin), were found among Campylobacter isolates, while resistance to erythromycin was observed in 14.9% of them. With the present study we continue the surveillance of bacterial pathogens associated with diarrhoeal disease on the island of Crete.
Asunto(s)
Antibacterianos/farmacología , Infecciones Bacterianas/epidemiología , Diarrea/tratamiento farmacológico , Diarrea/microbiología , Farmacorresistencia Bacteriana , Enterobacteriaceae/efectos de los fármacos , Enterobacteriaceae/aislamiento & purificación , Enfermedad Aguda , Adolescente , Aeromonas hydrophila/efectos de los fármacos , Aeromonas hydrophila/aislamiento & purificación , Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Campylobacter coli/efectos de los fármacos , Campylobacter coli/aislamiento & purificación , Niño , Preescolar , Clostridioides difficile/efectos de los fármacos , Clostridioides difficile/aislamiento & purificación , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Enterobacteriaceae/clasificación , Femenino , Grecia/epidemiología , Humanos , Lactante , Masculino , Prevalencia , ViajeRESUMEN
The susceptibility to 11 antibiotics was determined for 52 strains of Shigella isolated from patients with diarrheal disease in Crete, Greece, during the period 1991-1995. Forty-six percent of the isolates were resistant to ampicillin, 48% to tetracycline, 44.2% to chloramphenicol, and 28.8% to cotrimoxazole. Shigella flexneri was more resistant than S. sonnei to ampicillin (82 vs 4.3%), to tetracycline (82 vs 8.7%) and to cotrimoxazole (42.8 vs 13%). Overall, 82% of all S. flexneri isolates were resistant to the three or four antimicrobial agents tested. The beta-lactamases produced by shigellae were identified by isoelectric focusing and were found to be OXA-1, TEM-1, and a low-level beta-lactamase with a pI>8. The results from the present study, which is the first carried out in Crete, emphasize the need for continuous surveillance of resistance and control of antibiotic usage.
Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Microbiana , Shigella/efectos de los fármacos , Shigella/enzimología , beta-Lactamasas/análisis , Diarrea/microbiología , Disentería Bacilar/microbiología , Grecia , Humanos , Focalización Isoeléctrica , Pruebas de Sensibilidad Microbiana , Reacción en Cadena de la Polimerasa , Shigella/genéticaRESUMEN
Stool specimens from 3,600 diarrhoeal patients from the island of Crete, Greece, were examined for bacterial pathogens, during a three-year period (1992-1994). One or more pathogens were identified in 826 patients (22.9%), more often from children. Salmonella spp. were the most frequently isolated organisms in 13.6% of the patients, followed by Campylobacter in 4.7%, and enteropathogenic Escherichia coli (EPEC) in 3.9%. Yersinia enterocolitica was found in 0.7%, Shigella spp. in 0.7% and Aeromonas hydrophila in 0.05%. Vibrio spp. and enterohaemorragic E. coli were not identified in the stools tested. Resistance to ampicillin was observed in 36% of the Salmonella, 62% of the Shigella, and 27% of the EPEC isolates. Cotrimoxazole resistance was observed in 42% of the Shigella and 12% of the EPEC isolates, while tetracycline and the quinolones were inactive against almost half and erythromycin against 20% of the Campylobacter isolates. This is the first study investigating bacterial pathogens associated with diarrhoea on the island of Crete.