RESUMO
ABSTRACT The emergence of resistance mechanisms not only limits the therapeutic options for common bacterial infections but also worsens the prognosis in patients who have conditions that increase the risk of bacterial infections. Thus, the effectiveness of important medical advances that seek to improve the quality of life of patients with chronic diseases is threatened. We report the simultaneous colonization and bacteremia by multidrug-resistant bacteria in two hemodialysis patients. The first patient was colonized by carbapenem- and colistin-resistant Klebsiella pneumoniae, carbapenem-resistant Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA). The patient had a bacteremia by MRSA, and molecular typing methods confirmed the colonizing isolate was the same strain that caused infection. The second case is of a patient colonized by extended-spectrum beta-lactamases (ESBL)-producing Escherichia coli and carbapenem-resistant Pseudomonas aeruginosa. During the follow-up period, the patient presented three episodes of bacteremia, one of these caused by ESBL-producing E. coli. Molecular methods confirmed colonization by the same clone of ESBL-producing E. coli at two time points, but with a different genetic pattern to the strain isolated from the blood culture. Colonization by multidrug-resistant bacteria allows not only the spread of these microorganisms, but also increases the subsequent risk of infections with limited treatments options. In addition to infection control measures, it is important to establish policies for the prudent use of antibiotics in dialysis units.
RESUMO O surgimento de mecanismos de resistência não apenas limita as opções terapêuticas para infecções bacterianas comuns, mas também piora o prognóstico em indivíduos com condições que aumentam o risco de infecções bacterianas. Assim, a eficácia de importantes avanços médicos que buscam melhorar a qualidade de vida de pacientes com doenças crônicas está ameaçada. Relatamos a colonização e bacteremia simultâneas por bactérias multirresistentes em dois pacientes em hemodiálise. O primeiro paciente foi colonizado por Klebsiella pneumoniae resistente a carbapenem e colistina, Pseudomonas aeruginosa resistente a carbapenem e Staphylococcus aureus resistente a meticilina (MRSA). O paciente apresentou bacteremia por MRSA, e os métodos de tipagem molecular confirmaram que o isolado colonizador era a mesma cepa que estava causando infecção. O segundo caso é de um paciente colonizado por Escherichia coli produtora de beta-lactamases de espectro estendido (ESBL) e Pseudomonas aeruginosa resistente ao carbapenem. Durante o período de seguimento, o paciente apresentou três episódios de bacteremia, um deles causado por E. coli produtora de ESBL. Os métodos moleculares confirmaram a colonização pelo mesmo clone de E. coli produtora de ESBL em dois momentos, mas com um padrão genético diferente da cepa isolada da hemocultura. A colonização por bactérias multirresistentes aumenta o potencial não apenas da disseminação desses microrganismos, mas também do risco subsequente de infecções com opções limitadas de tratamentos. Além das medidas de controle de infecção, é importante estabelecer políticas para o uso prudente de antibióticos nas unidades de diálise.
Assuntos
Humanos , Bacteriemia/tratamento farmacológico , Staphylococcus aureus Resistente à Meticilina , Qualidade de Vida , Diálise Renal , Escherichia coli , Antibacterianos/uso terapêutico , Antibacterianos/farmacologiaRESUMO
The emergence of resistance mechanisms not only limits the therapeutic options for common bacterial infections but also worsens the prognosis in patients who have conditions that increase the risk of bacterial infections. Thus, the effectiveness of important medical advances that seek to improve the quality of life of patients with chronic diseases is threatened. We report the simultaneous colonization and bacteremia by multidrug-resistant bacteria in two hemodialysis patients. The first patient was colonized by carbapenem- and colistin-resistant Klebsiella pneumoniae, carbapenem-resistant Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA). The patient had a bacteremia by MRSA, and molecular typing methods confirmed the colonizing isolate was the same strain that caused infection. The second case is of a patient colonized by extended-spectrum beta-lactamases (ESBL)-producing Escherichia coli and carbapenem-resistant Pseudomonas aeruginosa. During the follow-up period, the patient presented three episodes of bacteremia, one of these caused by ESBL-producing E. coli. Molecular methods confirmed colonization by the same clone of ESBL-producing E. coli at two time points, but with a different genetic pattern to the strain isolated from the blood culture. Colonization by multidrug-resistant bacteria allows not only the spread of these microorganisms, but also increases the subsequent risk of infections with limited treatments options. In addition to infection control measures, it is important to establish policies for the prudent use of antibiotics in dialysis units.
Assuntos
Bacteriemia , Staphylococcus aureus Resistente à Meticilina , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Escherichia coli , Humanos , Qualidade de Vida , Diálise RenalRESUMO
Introduction. While colonization by Staphylococcus aureus in haemodialysis patients has been assessed, knowledge about colonization by beta-lactam-resistant Gram-negative bacilli is still limited.Aim. To describe clinical and molecular characteristics in haemodialysis patients colonized by S. aureus (MSSA-MRSA) and beta-lactam-resistant Gram-negative bacilli in an ambulatory renal unit.Methodology. The study included patients with central venous catheters in an outpatient haemodialysis facility in Medellín, Colombia (October 2017-October 2018). Swab specimens were collected from the nostrils and skin around vascular access to assess colonization by S. aureus (MSSA-MRSA). Stool samples were collected from each patient to evaluate beta-lactam-resistant Gram-negative bacilli colonization. Molecular typing included PFGE, multilocus sequence typing (MLST), spa typing and enterobacterial repetitive intergenic consensus-PCR (ERIC). Clinical information was obtained from medical records and personal interview.Results. A total of 210 patients were included in the study. S. aureus colonization was observed in 33.8â% (n=71) of the patients, 4.8â% (n=10) of which were colonized by methicillin-resistant S. aureus. Stool samples were collected from 165 patients and of these 41.2â% (n=68) and 11.5â% (n=19) were colonized by extended-spectrum-beta-lactamase-producing (ESBL) and carbapenem-resistant bacilli, respectively. Typing methods revealed high genetic diversity among S. aureus and ESBL-producing Gram-negative bacilli (ESBL-GNB). Antibiotic use and hospitalization in the previous 6 months were observed in more than half of the studied population.Conclusion. The high colonization by ESBL-GNB in haemodialysis patients shows evidence for the need for stronger surveillance, not only for S. aureus but also for multidrug-resistant bacilli in order to avoid their spread. Additionally, the high genetic diversity suggests other sources of transmission outside the renal unit instead of horizontal transmission between patients.