RESUMO
Regional antimicrobial surveillance programs might help to guide empiric antimicrobial therapy. This study reports the antimicrobial susceptibility patterns of 2198 isolates from bloodstream infections in a period of 1997 to 2002. Susceptibility testing was performed by broth microdilution methods. The most frequent organism was Staphylococcus aureus (23.4%) with an oxacillin-resistance rate of 41.8%. Extended Spectrum Beta Lactamases phenotype was presented in 10.0% of Escherichia coli and 49.4% in Klebsiella pneumoniae isolates. Imipenem and meropenem were active against 74.3% and 84.0% of Acinetobacter spp. and Pseudomonas aeruginosa, respectively. Bacterial resistance continues to be a great problem in Argentinean medical centers.
Assuntos
Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Bacteriemia/terapia , Bactérias Gram-Negativas/isolamento & purificação , Imipenem , Oxacilina , Staphylococcus aureus/isolamento & purificação , Streptococcus pneumoniae/isolamento & purificação , Argentina/epidemiologia , Resistência Microbiana a Medicamentos , Testes de Sensibilidade MicrobianaRESUMO
En América Latina (AL) son trascendentes los productores de betalactamasas de espectro extendido (BLEE) en infecciones hospitalarias. Los datos de API y SENTRY revelan una incidencia del 22 a 55. En AL y frecuentemente en el Cono Sur predominan las BLEE de la familia CTX-M contrariamente a EUA y Europa donde prevalecen las derivadas de TEM. Las CTX-M afectan cefotaxima, ceftriaxona y cefepima con más frecuencia que ceftacidima. El tratamiento depende del empleo de carbapenemes con el riesgo de seleccionar resistencia en bacilos gram negativos no fermentadores. El uso de otros betalactámicos particularmente cefepima no es aconsejable por las frecuentes fallas observadas en nuestro medio debido al efecto inóculo por aislados productores de CTX-M-2. Describimos un brote por Klebsiella pneumoniae (Kp) ocurrido entre junio-julio 2004. En el período previo, sólo un paciente presentó una infección debida a Kp productora de BLEE y en el posterior, lo presentaron dos pacientes Se determinó la CIM por microdilución en agar. El fenotipo BLEE se sospechó por ensayo del efecto del clavulanato unido a cefalosporinas de 3ª generación (C3G). Se determinó el punto isoeléctrico (pI) y la detección por PCR del tipo molecular por métodos convencionales. Se comprobaron dos bandas pI 5.4 y 8.2 con ampicilina y ceftriaxona en todas las cepas excepto en dos. Todas las cepas revelaron producción de CTX-M-2 excepto en dos cepas que se identificaron como productoras de SHV-5. Los estudios clonales se correspondieron con los moleculares identificándose dos clones. El brote se resolvió usando dos importantes medidas: 1) lavado de manos y otras medidas de barrera y 2) restringiendo el uso de C3G y ciprofloxacina
Assuntos
Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Humanos , Infecção Hospitalar/metabolismo , Infecção Hospitalar/microbiologia , Klebsiella pneumoniae/isolamento & purificação , Farmacorresistência Bacteriana , beta-Lactamases/isolamento & purificação , Células ClonaisRESUMO
The in vitro activity of piperacillin-tazobactam and several antibacterial drugs commonly used in Argentinean hospitals for the treatment of severe infections was determined against selected but consecutively isolated strains from clinical specimens recovered from hospitalized patients at 17 different hospitals from 9 Argentinean cities from different geographic areas during the period November 2001-March 2002. Out of 418 Enterobacteriaceae included in the Study 84% were susceptible to piperacillin-tazobactam. ESBLs putative producers were isolated at an extremely high rate since among those isolates obtained from patients with hospital acquired infections 56% of Klebsiella pneumoniae, 32% of Proteus mirabilis and 25% Escherichia coli were phenotypically considered as ESBLs producers Notably P.mirabilis is not considered by for screening for ESBL producers. ESBLs producers were 100% susceptible to imipenem and 70% were susceptible to piperacillin-tazobactam whereas more than 50% were resistant to levofloxacin. The isolates considered as amp C beta lactamase putative producers showed 99% susceptibility to carbapenems while 26.7% were resistant to piperacillin-tazobactam and 38.4% to levofloxacin. Noteworthy only 4% of the Enterobacteriaceae isolates were resistant to amikacin. Piperacillin-tazobactam was the most active agent against Pseudomonas aeruginosa isolates (MIC(90): 128 microg/ml; 78% susceptibility) but showed poor activity against Acinetobacter spp (MIC(90):>256 microg/ml; 21.7% susceptibility). Only 41.7% Acinetobacter spp isolates were susceptible to ampicillin-sulbactam. Piperacillin-tazobactam inhibited 100% of Haemophilus influenzae isolates (MIC(90) < 0.25 microg/ml) but only 16.6% of them were ampicillin resistant. The activity of piperacillin-tazobactam against oxacillin susceptible Staphylococcus aureus or coagulase negative staphylococci was excellent (MIC(90) 2 microg/ml; 100% susceptibility). Out of 150 enterococci 12 isolates (8%) were identified as E.faecium and only three isolates (2%), 2 E.faecium and 1 E.faecalis were vancomycin resistant. All the enterococci isolates were susceptible to linezolid. Piperacillin-tazobactam showed excellent activity (MIC(90) 2 microg/ml; 92% susceptibility). Regarding pneumococci all the isolates showed MICs of 16 microg/ml for piperacillin-tazobactam. Among 34 viridans group streptococci only 67% were penicillin susceptible and 85.2% ceftriaxone susceptible whereas piperacillin-tazobactam was very active (MIC(90) 4 microg/ml).Piperacillin-tazobactam is therefore a very interesting antibacterial drug to be used, preferably in combination (IE: amikacin-vancomycin) for the empiric treatment of severe infections occurring in hospitalized patients in Argentina. Caution must be taken for infections due to ESBL producers considering that the inoculum effect MICs can affect MIC values.
Assuntos
Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/farmacologia , Piperacilina/farmacologia , Adulto , Antibacterianos/farmacologia , Argentina , Resistência Microbiana a Medicamentos , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Hospitalização , Humanos , Masculino , Testes de Sensibilidade Microbiana , Sensibilidade e Especificidade , TazobactamRESUMO
A total of 230 isolates were collected from clinical specimens of patients attending five health centers of the Buenos Aires, Argentina. ABT-773 was compared to erythromycin, azithromycin and clindamycin against bacterial isolates responsible for community-acquired respiratory tract infections and viridans streptococci showing different resistance patterns. Time-kill curves were also performed against selected resistant isolates. All but one of the 105 pneumococcal isolates were susceptible to ABT-773. Among the erythromycin resistant S. pyogenes isolates, all the M type and inducible isolates were susceptible to ABT-773. ABT-773 showed excellent activity against macrolide, azalide, lincosamide (MAL) inducible S. aureus producers but was inactive against constitutive producers. ABT-773 activity against viridans streptococci was also excellent.ABT-773 exerted bactericidal activity against selected isolates of S. pneumoniae, M. catarrhalis and H. influenzae, however, it was only bacteriostatic against methicillin-susceptible S. aureus.