RESUMO
RESUMEN: El aumento de la resistencia y la escasez de nuevos antibacterianos ha requerido la reintroducción de antiguos antimicrobianos entre ellos colistín. OBJETIVO: Caracterizar la utilización de colistín durante el año 2017 en un hospital universitario, mediante la descripción de los pacientes, los tratamientos, la microbiología asociada y efectos adversos. PACIENTES Y MÉTODOS: Trabajo observacional retrospectivo. Se revisaron los datos de todos los pacientes que recibieron colistín intravenoso (IV) por al menos 48 horas, durante el año 2017. RESULTADOS: Se incluyeron 53 pacientes, equivalentes a 91 tratamientos. El foco respiratorio fue el principal (46,2%). El 68,1% de los tratamientos fue iniciado en la UCI. La mayoría de los pacientes tenía una hospitalización reciente (83,5%), y presentaban uso previo de antibacterianos (89%). Los dos patógenos mayoritariamente identificados fueron Pseudomonas aeruginosa y Klebsiella spp. El consumo promedio de colistín fue de 2,4 DDD/100 camas/día. El servicio que más consumió colistín fue la UCI, con 45,5 DDD/100 camas/día, usando generalmente la dosis de 3 MUI cada 8 horas IV y con una baja utilización de dosis de carga. CONCLUSIÓN: Colistín corresponde a un antimicrobiano de uso restringido a infecciones sospechadas o confirmadas por agentes bacterianos multi resistentes. En esta serie, su uso inicial fue principalmente empírico, en pacientes con factores de riesgo para resistencia antibacteriana; se usó en forma asociada a otros antimicrobianos, siendo el foco principal el respiratorio.
BACKGROUND: The increase in resistance and the shortage of new antibiotics has led to the reintroduction of old antimicrobials such as colistin. AIM: To evaluate the use of colistin during 2017 in a university hospital, through the characterization of patients and treatment, associated microbiology, response to treatment and adverse effects. METHODS: Retrospective observational design. The data of all patients who received colistin for at least 48 hours during the year 2017 were reviewed. RESULTS: 55 patients were included, equivalent to 144 treatments. The respiratory focus was the main one (57.9%). 64% of the treatments began in the ICU, while 7% in the ward. Most of the patients has a recent hospitalization (86.8%) and has previous use of antibiotics (90.4%). The two main pathogens identified were Pseudomonas aeruginosa and Klebsiella spp. In 87.1% of the cases with microbiological justifications for the use of colistin, a favorable response was obtained. The average consumption of colistin was 2.4 DDD/100 beds/day. The department that consumed the most colistin was the ICU, with 45,5 DDD/100 beds/day, generally using a dose of 3 MIU every 8 hours IV and with low use of loading doses. CONCLUSION: Colistin corresponds to an antibiotic whose use is restricted to infections suspected or confirmed by multi-resistant bacterial agents. Its initial use in this serie was mainly empirical, in patients with risk factors for antibiotics resistance, it was used in association with other antimicrobials, being the respiratory the main infectious focus.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Colistina/administração & dosagem , Farmacorresistência Bacteriana Múltipla , Antibacterianos/administração & dosagem , Pseudomonas aeruginosa/isolamento & purificação , Pseudomonas aeruginosa/efeitos dos fármacos , Infecções Bacterianas/tratamento farmacológico , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Fatores de Risco , Colistina/efeitos adversos , Administração Intravenosa , Klebsiella/isolamento & purificação , Klebsiella/efeitos dos fármacos , Antibacterianos/efeitos adversosRESUMO
INTRODUCCIÓN: En las últimas décadas, se ha incrementado la prevalencia de infecciones por bacilos gramnegativos resistentes a carbapenémicos. OBJETIVO: Determinar los tipos y la frecuencia de las distintas carbapenemasas en aislados de Klebsiella spp. y Pseudomonas aeruginosa, en seis hospitales de alta complejidad de Bogotá-Colombia. MÉTODOS: Estudio observacional descriptivo en seis hospitales de la ciudad de Bogotá, en el período de enero de 2017 a agosto de 2018. Se realizaron RPC para genes de KPC, GES, VIM, NDM, IMP y OXA-48 en cepas de Klebsiella spp y P aeruginosa resistentes a carbapenémicos. RESULTADOS: 52 aislados de P aeruginosa amplificaron para una carbapenemasa, de los cuales 39 (75%) fueron positivos para KPC, 11 (21%) para VIM y 2 co-producciones de KPC y VIM. En cuanto a Klebsiella spp., 165 cepas amplificaron al menos para una carbapenemasa, 98% expresaron KPC y 4 aislados tuvieron co-producciones de metalo-beta-lactamasas y KPC. DISCUSIÓN: Este estudio aporta información valiosa, como el incremento de producción de KPC en P. aeruginosa y la co-producción de KPC y metalo-beta-lactamasas, locual tiene una implicancia tanto en la selección del tratamiento, las medidas de aislamiento de contacto y el pronóstico de los pacientes.
BACKGROUND: In the last decades, the prevalence of infections by carbapenem resistant gram-negative bacilli has been increased. OBJECTIVE: To determine types and frequency of the different carbapenemases in Klebsiella spp. and Pseudomonas aeruginosa, in six hospitals in Bogotá-Colombia. METHODS: Descriptive and observational study, in six hospitals in the city of Bogotá, in the period ftom January 2017 to August 2018. PCR were performed for KPC, GES, VIM, NDM, IMP and OXA-48 genes, in carbapenem resistant Klebsiella spp. and P aeruginosa. RESULTS: 52 P aeruginosa isolates amplified a carbapenemase gene, of which 39 (75%) were positive for KPC, 11 (21%) for VIM and two co-productions of KPC and VIM. Regarding Klebsiella spp. 165 strains amplified at least one carbapenemase gene, 98% expressed KPC and four isolates had co-productions of metallo-P-lactamases and KPC. DISCUSSION: This study provides valuable information, such as the increased production of KPC in P. aeruginosa información valiosa, como el incremento de producción de KPC en P. aeruginosa and the co-production of KPC plus metallobetalactamases, which has an implication both in treatment selection, isolation precautions and patient prognosisy.
Assuntos
Humanos , Pseudomonas aeruginosa/genética , Klebsiella , Proteínas de Bactérias/genética , beta-Lactamases/genética , Testes de Sensibilidade Microbiana , Carbapenêmicos/farmacologia , Colômbia/epidemiologia , Hospitais , Antibacterianos/farmacologiaRESUMO
Colon diseases, such as colorectal cancer (CRC), are multifactor diseases that affect more than one million people per year; recently, the microbiota has been associated with an etiologic factor, specifically bacterial cyclomodulin positivity (CM+). Unfortunately, there are no studies from Mexico that detail the presence of bacterial CM+ in patients with colon diseases. We therefore performed a comprehensive study to investigate the associations and prevalence of cyclomodulin-positive Diarrheagenic E. coli (DEC), non-DEC, and Klebsiella spp. strains isolated from Mexican subjects with colon diseases. In this work, we analyzed 43 biopsies, 87 different bacteria were isolated, and E. coli was the most frequently noted, followed by Klebsiella spp., and Enterococcus spp. E. coli, non-DEC, and EPEC belonging to phylogroup B2 were the most prevalent. More than 80% of E. coli and Klebsiella were CM+. pks, cdt, cnf, and cif were identified. cdt was associated with non-DEC, cif and its combinations with EPEC, as well as cdt and psk with Klebsiella. Lastly, all the CM+ bacteria were resistant to at least one antibiotic (34% were MDR, and 48% XDR). In conclusion, the high prevalence of bacterial CM+ in colon disease patients suggests that these bacteria play an important role in the genesis of these diseases.
RESUMO
O impacto global do surgimento de bactérias multirresistentes leva a necessidade de maiores pesquisas para seu controle, vigilância, identificação, descolonização e novos tratamentos, com destaque para Klebsiella spp., devido sua importância clínica, virulência e alta prevalência. Pacientes de Unidades de Terapia Intensiva são mais vulneráveis a essa ameaça, necessitando medidas rígidas de controle, identificação precoce, profilaxias e tratamento. Dentro desse contexto uma estratégia é a utilização de culturas de sangue, urina, secreção traqueal, swab anal, axilar e nasal, para identificação do agente bacteriano, mas não é validado cultura de saliva, que por sua vez é meio de cultura para diversos tipos de bactérias, além da microbiota oral participa de diversos tipos fisiopatológicos como pneumonia de aspiração e endocardite mostrando sua disseminação pela corrente sanguínea, essas características conferem relevância clínica. A proposta desse trabalho é validar a cultura de saliva em ambiente de unidade de terapia intensiva determinando seu valor diagnóstico para infecção, sendo a metodologia usada análise estatística com busca de correlações dos resultados de hemoculturas e culturas de saliva proveniente do banco de dados do Serviço de Controle de Infecções Relacionadas à Assistência à Saúde de um hospital particular de São José dos Campos. Foram avaliados os resultados de cultura de vigilância do período de 16/01/2018 a 04/06/2021 totalizando 323 culturas pareadas entre saliva, secreção traqueal, sangue e urina provenientes de pacientes que estavam em mais de 5 dias de internação hospitalar e se encontravam na unidade de terapia intensiva. Foi analisado através de método estatístico a relação entre a presença de Klebsiella ssp. na cultura de saliva e hemocultura além correlacionando com dados de identificação, gravidade e desfecho. Sendo observado que a cultura de saliva infere os resultados de hemoculturas em relação Klebsiella spp em 0.25313 (ï²) (p 0,001) demonstrando que existe relação entre esses dois sítios de culturas.
The global impact of the emergence of multi-resistant bacteria leads to the need for further research for its control, surveillance, identification, decolonization and new treatments, with emphasis on Klebsiella spp., due to its clinical importance, virulence and high prevalence. Intensive Care Unit patients are more vulnerable to this threat, requiring strict control measures, early identification, prophylaxis and treatment. Within this context, a strategy is to use cultures of blood, urine, tracheal secretion, anal, axillary and nasal swab to identify the bacterial agent, but saliva culture is not validated, which in turn is a culture medium for different types. of bacteria, in addition to the oral microbiota participates in several pathophysiological types such as aspiration pneumonia and endocarditis showing its dissemination through the bloodstream, these characteristics confer clinical relevance. The purpose of this work is to validate the culture of saliva in an intensive care unit setting, determining its diagnostic value for infection, and the methodology used will be statistical analysis with the search for correlations of the results of blood cultures and saliva cultures from the Service's database. of Infection Control Related to Health Care at a private hospital in São José dos Campos. Surveillance culture results were obtained from 01/16/2018 to 06/04/2021, totaling 323 paired cultures between saliva, tracheal secretion, blood and urine from patients who had been hospitalized for more than 5 days and if found in the intensive care unit. The relationship between the presence of Klebsiella ssp. in saliva and blood cultures was analyzed using a statistical method, in addition to correlating with identification, severity and outcome data. Being observed that the saliva culture infers the results of blood cultures in relation to Klebsiella spp in 0.25313 (ï²) (p 0.001) demonstrated that there is a relationship between these two culture sites.
Assuntos
Humanos , Saliva , Resistência a Múltiplos Medicamentos , Cuidados Críticos , Hemocultura , Saliva/microbiologia , Controle de Infecções , Unidades de Terapia IntensivaRESUMO
To evaluate trends and the immediate and late impact of antimicrobial consumption on carbapenem-resistant Acinetobacter spp. (CRAs), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Klebsiella spp. (CRKs) over a 10-year period. An ecological study was conducted at the teaching hospital in São Paulo, Brazil, from 2007 to 2016. Consumption and resistance data were collected from the supply sector and central laboratory of the institution, respectively. Associations between consumption and resistance were analyzed in the same year, 1 year later, and 2 years later by linear regression of mixed effects. A total of 22,041 isolates were analyzed. Among these, 9988 corresponded to the gram-negatives in this study [3682 (36.9%) were Klebsiella spp., 3169 (31.7%) were P. aeruginosa, and 3137 (31.4%) were Acinetobacter spp.]. An increasing trend of consumption was observed, except for fourth-generation cephalosporins. Carbapenems were the most used antimicrobial class; CRKs presented a substantial increase over this period (from 1.4 to 67.0%; p = 0.001). Increased consumption of third-generation cephalosporins reduced CRAs [- 2.43%, 95% confidence interval (CI), - 3.30 to - 1.57; p < 0.001] and increased CRPA [26.67%, 95% CI, 2.99 to 50.35; p = 0.034] in the same year. Increased consumption of ß-lactam/ß-lactamase inhibitors increased CRKs with a 1-year delay [5.13%, 95% CI, 2.40 to 7.86; p = 0.001]. Our study demonstrated high antimicrobial consumption and growing carbapenem-resistance rates among gram-negative bacteria, especially Klebsiella spp., and the immediate and later effects of consumption of multiple antimicrobials on carbapenem resistance.
Assuntos
Infecções por Enterobacteriaceae/epidemiologia , Hospitais de Ensino , Klebsiella/efeitos dos fármacos , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Resistência beta-Lactâmica , Antibacterianos/farmacologia , Brasil/epidemiologia , Carbapenêmicos/farmacologia , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Humanos , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologiaRESUMO
Abstract This study was conducted in Iran in order to assess the distribution of CTX-M type ESBLs producing Enterobacteriaceae. From January 2012 to December 2013, totally 198 E. coli, 139 Klebsiella spp, 54 Salmonella spp and 52 Shigella spp from seven hospitals of six provinces in Iran were screened for resistance to extended-spectrum cephalosporins. After identification and susceptibility testing, isolates presenting multiple-drug resistance (MDR) were evaluated for ESBL production by the disk combination method and by Etest using (cefotaxime and cefotaxime plus clavulanic acid). All isolates were also screened for bla CTX-M using conventional PCR. A total of 42.92%, 33.81%, 14.81% and 7.69% of the E. coli, Klebsiella spp, Salmonella spp and Shigella spp isolates were MDR, respectively. The presence of CTX-M enzyme among ESBL-producing isolates was 85.18%, 77.7%, 50%, and 66.7%, in E. coli, Klebsiella spp, Salmonella spp and Shigella spp respectively. The overall presence of CTX-M genes in Enterobacteriaceae was 15.4% and among the resistant isolates was 47.6%. This study indicated that resistance to β-lactams mediated by CTX-M enzymes in Iran had similar pattern as in other parts of the world. In order to control the spread of resistance, comprehensive studies and programs are needed.
Assuntos
Humanos , Salmonella/enzimologia , Shigella/enzimologia , beta-Lactamases/metabolismo , Infecção Hospitalar , Infecções por Enterobacteriaceae/microbiologia , Infecções por Enterobacteriaceae/epidemiologia , Escherichia coli/enzimologia , Klebsiella/enzimologia , Salmonella/efeitos dos fármacos , Shigella/efeitos dos fármacos , beta-Lactamases/genética , Testes de Sensibilidade Microbiana , Estudos Transversais , Escherichia coli/efeitos dos fármacos , Irã (Geográfico)/epidemiologia , Klebsiella/efeitos dos fármacos , Antibacterianos/farmacologiaRESUMO
This study was conducted in Iran in order to assess the distribution of CTX-M type ESBLs producing Enterobacteriaceae. From January 2012 to December 2013, totally 198 E. coli, 139 Klebsiella spp, 54 Salmonella spp and 52 Shigella spp from seven hospitals of six provinces in Iran were screened for resistance to extended-spectrum cephalosporins. After identification and susceptibility testing, isolates presenting multiple-drug resistance (MDR) were evaluated for ESBL production by the disk combination method and by Etest using (cefotaxime and cefotaxime plus clavulanic acid). All isolates were also screened for bla CTX-M using conventional PCR. A total of 42.92%, 33.81%, 14.81% and 7.69% of the E. coli, Klebsiella spp, Salmonella spp and Shigella spp isolates were MDR, respectively. The presence of CTX-M enzyme among ESBL-producing isolates was 85.18%, 77.7%, 50%, and 66.7%, in E. coli, Klebsiella spp, Salmonella spp and Shigella spp respectively. The overall presence of CTX-M genes in Enterobacteriaceae was 15.4% and among the resistant isolates was 47.6%. This study indicated that resistance to -lactams mediated by CTX-M enzymes in Iran had similar pattern as in other parts of the world. In order to control the spread of resistance, comprehensive studies and programs are needed.(AU)
Assuntos
Klebsiella/isolamento & purificação , Salmonella/isolamento & purificação , Shigella/isolamento & purificação , Escherichia coli/isolamento & purificação , Inibidores de beta-Lactamases/análise , Resistência a Múltiplos Medicamentos/imunologia , HospitaisRESUMO
This study was conducted in Iran in order to assess the distribution of CTX-M type ESBLs producing Enterobacteriaceae. From January 2012 to December 2013, totally 198 E. coli, 139 Klebsiella spp, 54 Salmonella spp and 52 Shigella spp from seven hospitals of six provinces in Iran were screened for resistance to extended-spectrum cephalosporins. After identification and susceptibility testing, isolates presenting multiple-drug resistance (MDR) were evaluated for ESBL production by the disk combination method and by Etest using (cefotaxime and cefotaxime plus clavulanic acid). All isolates were also screened for blaCTX-M using conventional PCR. A total of 42.92%, 33.81%, 14.81% and 7.69% of the E. coli, Klebsiella spp, Salmonella spp and Shigella spp isolates were MDR, respectively. The presence of CTX-M enzyme among ESBL-producing isolates was 85.18%, 77.7%, 50%, and 66.7%, in E. coli, Klebsiella spp, Salmonella spp and Shigella spp respectively. The overall presence of CTX-M genes in Enterobacteriaceae was 15.4% and among the resistant isolates was 47.6%. This study indicated that resistance to ß-lactams mediated by CTX-M enzymes in Iran had similar pattern as in other parts of the world. In order to control the spread of resistance, comprehensive studies and programs are needed.
Assuntos
Infecção Hospitalar , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Escherichia coli/enzimologia , Klebsiella/enzimologia , Salmonella/enzimologia , Shigella/enzimologia , beta-Lactamases/metabolismo , Antibacterianos/farmacologia , Estudos Transversais , Escherichia coli/efeitos dos fármacos , Humanos , Irã (Geográfico)/epidemiologia , Klebsiella/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Salmonella/efeitos dos fármacos , Shigella/efeitos dos fármacos , beta-Lactamases/genéticaRESUMO
Introducción: Klebsiella pneumoniae y el complejo Acinetobacter baumannii-calcoaceticus constituyen importantes patógenos nosocomiales a nivel mundial siendo más susceptibles los pacientes ingresados en neonatología y unidades de cuidados intensivos. Objetivos: caracterizar, desde el punto de vista clínico-microbiológico los aislamientos de los géneros Klebsiella y Acinetobacter causantes de infecciones en hospitales pediátricos cubanos. Métodos: se realizó un estudio descriptivo-longitudinal durante el período de Junio 2011-Septiembre 2012 que incluyó 152 aislamientos clínicos (102 de Klebsiella spp. y 50 de Acinetobacter spp) causantes de infecciones nosocomiales en niños y que fueron remitidos al Laboratorio Nacional de Referencia de Microbiología del Instituto Pedro Kourí. La identificación de esta especie se realizó mediante pruebas bioquímicas. Se determinó la susceptibilidad a 18 antimicrobianos, la producción de ß;-lactamasas de espectro extendido (BLEE) y la de metalo-ß;-lactamasas (MBLs) según las normas del Instituto de Estandarización de Laboratorio Clínico (CLSI, por sus siglas en inglés). Resultados: las muestras más frecuentes de recuperación de Acinetobacter y Klebsiella fueron sangre, secreción endotraqueal y lesiones de piel. Klebsiella pneumoniae (96 por ciento) y el complejo Acinetobacter baumannii-calcoaceticus (90 por ciento) fueron las especies más prevalentes y se aislaron con mayor frecuencia en servicios de terapias, neonatología y quemado. Ambos patógenos mostraron elevada resistencia a las cefalosporinas con 57 por ciento de producción de BLEE para el género Klebsiella spp. La resistencia a carbapenémicos solo se detectó en Acinetobacter spp (61 por ciento) mediada por la producción de metalo-&-lactamasas en un 2 por ciento de los aislamientos. La mayor susceptibilidad de este género se encontró para las tetraciclinas, mientras que el género Klebsiella spp. fue más susceptible a la ciprofloxacina. En ambos se observó resistencia elevada para los aminoglucósidos (66 por ciento-75 por ciento) y el trimetoprim-sulfametoxazol (45 por ciento-60 por ciento). Conclusiones: Klebsiella pneumoniae y el Complejo Acinetobacter baumannii-calcoaceticus constituyen un peligro potencial en servicios pediátricos con escasas opciones terapéuticas quedando como únicas alternativas los carbapenémicos para las infecciones por Klebsiella spp multidrogorresistentes y la colistina para las infecciones por Acinetobacter spp con extrema drogorresistencia(AU)
Introduction: Klebsiella pneumoniae and the Acinetobacter baumannii-calcoaceticus complex represent important nosocomial pathogens worldwide. The patients admitted to the neonatology and the intensive care unit services suffer infections very frequently. Objectives: to characterize clinically and microbiologically Klebsiella and Acinetobacter isolates causing infections in Cuban pediatric hospitals. Methods: a descriptive longitudinal study of 152 clinical isolates (102 Klebsiella spp and 50 Acinetobacter spp), which caused nosocomial infections in children and were sent to the national reference laboratory of microbiology in Pedro Kouri Institute. The study was conducted from June 2011 to September 2012. The species were identified by biochemical tests. The susceptibility to 18 antimicrobials, the production of extended spectrum ß-lactamase (ESBL) and metallo-ß-lactamases were determined according to the Clinical and Laboratory Standards Institute. Results: the most frequent infections in infants and children by Acinetobacter and Klebsiella were found in blood, endotracheal secretion and skin lesions.. Klebsiella pneumoniae (96 percent) and Acinetobacter baumannii-calcoaceticus complexes (90 percent) were the most prevalent species and were frequently isolated in intensive care, neonatology and burned patient wards. Both pathogens showed high resistance to cephalosporins with 57 percent of extended-spectrum betalactamase production in Klebsiella spp. Resistance to carbapenems was only detected in Acinetobacter (61 percent) with 2 percent of metallobetalactamse production. Acinetobacter spp. was more susceptible to tetracyclines and cholistin where Klebsiella spp was more susceptible to ciprofloxacin. In both pathogens, a high resistance to aminoglycosides (66 percent -75 percent) and trimethoprim-sulfamethoxazole (45 percent-60 percent) was observed. Conclusions: Klebsiella pneumoniae and Acinetobacter baumannii-calcoaceticus complex represent a potential threat in pediatric services with few therapeutic options. The carbapenems remain the only alternative to severe infections caused by multidrug resistant Klebsiella spp and cholistin is the only choice to treat extreme multidrug resistant Acinetobacter spp infections(AU)
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Acinetobacter/isolamento & purificação , Resistência Microbiana a Medicamentos/efeitos dos fármacos , Infecção Hospitalar/prevenção & controle , Testes Laboratoriais/métodos , Klebsiella pneumoniae/isolamento & purificação , Epidemiologia Descritiva , Estudos LongitudinaisRESUMO
Introducción: el género Klebsiella causa brotes hospitalarios, por cepas multidrogorresistentes en diferentes continentes y conlleva a un aumento en la morbimortalidad. Objetivos: identificar las especies de Klebsiella causantes de infecciones en hospitales cubanos, determinar la procedencia de los aislamientos según el servicio, y la susceptibilidad antimicrobiana, conocer la prevalencia de aislamientos productores de ß-lactamasas de espectro extendido (BLEE), y tipos, así como la susceptibilidad de los mismos a diferentes antimicrobianos de interés terapéutico. Métodos: se realizó un estudio descriptivo en 448 aislamientos de Klebsiella spp. recibidos en el Laboratorio Nacional de Referencia de Microbiología del IPK (LRNM/IPK) procedentes de 40 hospitales de 12 provincias del país durante el período de 2010 a 2012. La identificación de las especies se realizó mediante pruebas bioquímicas convencionales y por la técnica de Espectrometría de masas MS MALDI-TOF. Se determinó la susceptibilidad a 15 antimicrobianos mediante el método E-test y la producción de BLEE mediante el método de discos combinados según las recomendaciones del Instituto de Estándares Clínicos y de Laboratorio. Los genes blaESBL se determinaron mediante la reacción en cadena de la polimerasa según protocolo descrito previamente. Resultados: la especie prevalente fue Klebsiella pneumoniae (95,1 %), seguida por K. oxytoca (4,5 %) y K. ozaenae (0,4 %). Los aislamientos procedieron, principalmente, de los servicios de Unidades de Cuidados Intensivos (26,3 %), cirugía (22 %) y neonatología (13 %). La mayor resistencia se observó para las cefalosporinas (48-52 %), trimetoprim-sulfametoxazol (49 %), gentamicina (43 %), ácido nalidíxico (38 %) y tetraciclina (34 %). El 52 % de los aislamientos fueron productores de BLEE y prevaleció la enzima CTX-M (82 %) y la TEM (70 %). Conclusiones: se evidencia la repercusión clínica de Klebsiella spp. en hospitales cubanos con elevada resistencia a diferentes antimicrobianos. La producción de BLEE es un mecanismo de resistencia importante en esta bacteria en las que los carbapenémicos, la piperacilina-tazobactam, la colistina, y la tigeciclina juegan un rol terapéutico importante.
Introduction: the Klebsiella genus gives rise to many hospital outbreaks due to multi-drug-resistant strains on different continents and leads to increased morbidity and mortality. Objectives: to identify the Klebsiella species causing infections in Cuban hospitals, to determine the origin of isolates per service, their antimicrobial susceptibility and, to determine the production and type of extended-spectrum ß-lactamases (ESBLs) and the susceptibility of these isolations to several antimicrobials of therapeutic interest. Methods: a descriptive study was conducted on 448 Klebsiella spp. Isolates that were received in the national reference microbiology laboratory of "Pedro Kouri" Institute of Tropical Medicine from 40 hospitals located in 12 Cuban provinces during the 2010-2012 period. Species identification was based on conventional biochemical tests and mass spectrometry technique called MS MALDI-TOF. The susceptibility to 15 antimicrobials and the extended spectrum ß-lactamase production were determined by the E-test method and by the combined disks method, respectively, according to recommendations of the Institute of Clinical and Laboratory Standards. The polymerase chain reaction made it possible the detection of BlaESBL genes as indicated in the previously described protocol. Results: Klebsiella pneumoniae (95.4 %) was the prevalent species, followed by K. oxytoca (4.1%), and K. ozaenae (0.5 %). The isolates were mainly from the intensive care units (26.3 %), surgery (22 %), and neonatology (13%) services. The highest resistance rate was observed for cephalosporins (48-52 %), trimethoprim-sulfamethoxazole (49 %), gentamicin (43 %), nalidixic acid (38 %), and tetracycline (34 %). Fifty-two percent of the isolates were extended spectrum ß-lactamase producers, with CTX-M (82 %) and TEM (70 %) enzymes prevailing. Conclusions: This study shows the clinical impact of Klebsiella spp in Cuban hospitals, which is highly resistant to different antimicrobials. The production of extended spectrum ß-lactamases provides a significant resistance mechanism in Klebsiella in which carbapenems, piperacillin-tazobactam, cholistin and tigecycline play an important therapeutic role.
Assuntos
Humanos , Recém-Nascido , Lactente , Acinetobacter/isolamento & purificação , Farmacorresistência Bacteriana/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Infecção Hospitalar/prevenção & controle , Epidemiologia Descritiva , CubaRESUMO
Milk that is adequate for consumption must be of hygienic quality, nutritional value, and should maintain its organoleptic properties. Isolation of fecal and/or total coliforms from bovine milk is considered an indicator of hygiene and good management practices, and can be used as a quality indicator. This study aimed to isolate, identify, and assess the resistance profile of coliforms isolated from collective bulk tanks and individual milk tanks. A total of 89 milk samples were collected from collective bulk tanks and, from these, 21 Klebsiella spp., one E. coli, and 29 Enterobacter spp. were isolated, whereas 102 milk samples from individual tanks showed isolation of one Klebsiella spp. and seven Enterobacter spp. In collective bulk tanks, at least 47% of Klebsiella spp. and Enterobacter spp. were resistant to cephalexin and 30% to ampicillin. From these, at least 24% showed multidrug resistance. Among the microorganisms isolated from the individual tanks, 85% or more were resistant to ampicillin. The ESBL phenotype and the blaTEM gene were detected in strains of Klebsiella spp. isolated from both tanks. It was concluded that contamination of milk with resistant total coliforms, and especially the storage of raw milk from several small producers in the collective bulk tank increase the risk of contamination.
O leite adequado ao consumo deve possuir qualidade higiênica, valor nutritivo e a manutenção das propriedades organolépticas. O isolamento de coliformes totais e/ou fecais de leite bovino é considerado um indicador de sanidade e de boas práticas de manejo, podendo ser usado como indicador de qualidade. Este estudo teve como objetivo isolar, identificar e observar o perfil de resistência de coliformes presentes em tanques de refrigeração coletivos e individuais de acondicionamento de leite. Foram colhidas 89 amostras de leite de tanques coletivos e isolados 21 Klebsiella spp., uma Escherichia coli (E. coli) e 29 Enterobacter spp., e 102 amostras de leite de tanques individuais das quais foram isolados uma Klebsiella spp. e sete Enterobacter spp. Dos tanques coletivos, aproximadamente 47% de Klebsiella spp. e Enterobacter spp. foram resistentes para cefalexina e 30% para ampicilina. Destes, no mínimo 24% apresentaram multirresistência. Entre os isolados de tanques individuais, 85% ou mais apresentaram resistência para ampicilina. O fenótipo ESBL e o gene blaTEM foram detectados em linhagens de Klebsiella spp. isoladas de ambos os tanques. Constatou-se contaminação do leite com coliformes totais resistentes e, principalmente, que o armazenamento do leite cru de vários pequenos produtores em tanques coletivos potencializa o risco de contaminação.
Assuntos
Coliformes , Farmacorresistência Bacteriana , Leite , Controle de Qualidade , Enterobacter , Escherichia coli , Klebsiella , Normas de Qualidade de Alimentos , RefrigeraçãoRESUMO
Milk that is adequate for consumption must be of hygienic quality, nutritional value, and should maintain its organoleptic properties. Isolation of fecal and/or total coliforms from bovine milk is considered an indicator of hygiene and good management practices, and can be used as a quality indicator. This study aimed to isolate, identify, and assess the resistance profile of coliforms isolated from collective bulk tanks and individual milk tanks. A total of 89 milk samples were collected from collective bulk tanks and, from these, 21 Klebsiella spp., one E. coli, and 29 Enterobacter spp. were isolated, whereas 102 milk samples from individual tanks showed isolation of one Klebsiella spp. and seven Enterobacter spp. In collective bulk tanks, at least 47% of Klebsiella spp. and Enterobacter spp. were resistant to cephalexin and 30% to ampicillin. From these, at least 24% showed multidrug resistance. Among the microorganisms isolated from the individual tanks, 85% or more were resistant to ampicillin. The ESBL phenotype and the blaTEM gene were detected in strains of Klebsiella spp. isolated from both tanks. It was concluded that contamination of milk with resistant total coliforms, and especially the storage of raw milk from several small producers in the collective bulk tank increase the risk of contamination.(AU)
O leite adequado ao consumo deve possuir qualidade higiênica, valor nutritivo e a manutenção das propriedades organolépticas. O isolamento de coliformes totais e/ou fecais de leite bovino é considerado um indicador de sanidade e de boas práticas de manejo, podendo ser usado como indicador de qualidade. Este estudo teve como objetivo isolar, identificar e observar o perfil de resistência de coliformes presentes em tanques de refrigeração coletivos e individuais de acondicionamento de leite. Foram colhidas 89 amostras de leite de tanques coletivos e isolados 21 Klebsiella spp., uma Escherichia coli (E. coli) e 29 Enterobacter spp., e 102 amostras de leite de tanques individuais das quais foram isolados uma Klebsiella spp. e sete Enterobacter spp. Dos tanques coletivos, aproximadamente 47% de Klebsiella spp. e Enterobacter spp. foram resistentes para cefalexina e 30% para ampicilina. Destes, no mínimo 24% apresentaram multirresistência. Entre os isolados de tanques individuais, 85% ou mais apresentaram resistência para ampicilina. O fenótipo ESBL e o gene blaTEM foram detectados em linhagens de Klebsiella spp. isoladas de ambos os tanques. Constatou-se contaminação do leite com coliformes totais resistentes e, principalmente, que o armazenamento do leite cru de vários pequenos produtores em tanques coletivos potencializa o risco de contaminação.(AU)
Assuntos
Leite , Farmacorresistência Bacteriana , Coliformes , Controle de Qualidade , Normas de Qualidade de Alimentos , Refrigeração , Escherichia coli , Enterobacter , KlebsiellaRESUMO
INTRODUÇÃO: As espécies de Klebsiella spp. podem causar vários tipos de infecções, principalmente hospitalares, e têm merecido destaque pelos seus variados e emergentes mecanismos de resistência. OBJETIVOS: Determinar a frequência de isolamento e a caracterização do perfil de resistência de Klebsiella spp. em um hospital universitário durante um período de 10 anos e, ainda, avaliar a tendência para o crescimento dessa resistência. Material e método: Fez-se um estudo descritivo e retrospectivo a partir de dados coletados nos livros de registro do Laboratório de Microbiologia Clínica do hospital investigado, correspondentes ao período de janeiro de 1999 a dezembro de 2008. RESULTADO: A frequência de isolamento de Klebsiella spp. foi de 13,4 por cento com predominância em uroculturas (56,4 por cento). Houve aumento significativo na resistência para a maioria dos antimicrobianos testados ao longo do período analisado com tendência para o crescimento da mesma. Nesse período, isolou-se 23 por cento de Klebsiella spp. com fenótipo produtor de betalactamases de amplo espectro (ESBL). DISCUSSÃO: O isolamento de Klebsiella spp. resistente a antimicrobianos em amostras de origem clínica e a detecção da tendência do crescimento da resistência, inclusive às drogas de reserva terapêutica, são motivos de grande preocupação. Nesse hospital, a implantação de métodos de triagem e de confirmatórios para os mecanismos de resistência de Klebsiella spp. poderiam auxiliar no diagnóstico e no tratamento das infecções causadas por esse microrganismo. CONCLUSÃO: A tendência de crescimento na resistência aos antibióticos detectada neste estudo reforça a importância de monitoramentos contínuos. Estes elucidam características locais, orientando para melhores medidas de controle.
INTRODUCTION: Klebsiella spp. species can cause several infections, particularly nosocomial ones. Furthermore, its multiple emerging resistance mechanisms have been widely described. OBJECTIVES: To determine the isolation frequency and resistance profile of Klebsiella spp. at a university hospital during a ten-year period as well as to assess the increase in its resistance. Material and method: A retrospective and descriptive study was carried out based on data collected from the record books of the Laboratory of Clinical Microbiology of the investigated Hospital from January 1999 to December 2008. RESULTS: The isolation frequency of Klebsiella spp. was 13.4 percent, predominantly in urine cultures (56.4 percent). There was a significant increase in resistance to most antimicrobials tested over the analyzed period; 23 percent of Klebsiella spp. with ESBL phenotype was isolated over this period. DISCUSSION: Multi-resistant Klebsiella spp. isolates from clinical samples as well as its growing trend in resistance mechanisms, including to reserve drugs, are cause for great concern. The implementation of screening and confirmatory methods of bacterial resistance could aid in the diagnosis and treatment of infections caused by this microorganism. CONCLUSION: The increase in resistance to antibiotics reinforces the importance of continuous monitoring, which elucidates local characteristics and allows more suitable control measures.
Assuntos
Farmacorresistência Bacteriana , Resistência Microbiana a Medicamentos , Infecção Hospitalar/epidemiologia , Klebsiella/isolamento & purificaçãoRESUMO
Objective: To evaluate the association between Escherischia Coli (E. Coli) and Klebsiella spp bacteremia, both of which produce Extended Spectrum beta-lactamases (ESBL), and the use of third generation cephalos-porines (TGC) during 30 days prior to the development of the infection. Patients and Methods: Case study of all patients hospitalized between 2004 and 2007 at Hospital de Niños Roberto del Río, who presented E. coli y Klebsiella spp bacteremia. Results: 212 episodes of E. coli o Klebsiella spp bacteremias were found; 205 contained all necessary data, 47 of which were cases and 158 were controls. The use of TGC showed a statistically significant correlation with the finding of ESBL in those patients' bacteremias (OR 2,5; IC95 percent 1,26-5). In addition, an independent statistically significant association was found with hospital acquired infections (OR 8,2; IC95 percent 2,7-27,1), and the use of Central Venous Catheter (OR 38,9; IC95 percent 14,3-106,0) became close to statistical significance. Conclusions: This study shows a statistically significant association between ESBL bacteremias and use of TGC within 30 days prior to the infection, confirming other literature reports.
Objetivo: Estudiar la asociación entre bacteriemia por E. coli y Klebsiella spp productoras de beta-lactamasas de espectro extendido (BLEE) y el uso de cefalosporinas de tercera generación (CTG) durante los 30 días previos al desarrollo de la infección. Método: Estudio caso control encestado desarrollado entre los años 2004 y 2007 en el Hospital de Niños Roberto del Río, con análisis retrospectivo de los pacientes con bacteriemias por E. coli y Klebsiella spp. Resultados: Se registraron 212 episodios de bacteriemias por E. coli o Klebsiella spp, en 205 de ellos se contó con los registros necesarios, 47 fueron casos y 158 controles. El uso de CTG se asoció de modo estadísticamente significativo con la probabilidad de aislar cepas BLEE de bacteriemias en estos pacientes (OR 2,5; IC95 por ciento 1,26-5). Además, se observó asociación independiente y estadísticamente significativa con Infección Intrahospitalaria (OR 8,2; IC95 por ciento 2,7-27,1), y el uso de Catéter Venoso Central (OR 38,9; IC95 por ciento 14,3-106,0) se acercó a la significancia estadística. Conclusiones: Nuestro trabajo establece la asociación estadística entre bacteriemia por cepas BLEE y el uso de CTG dentro de los 30 días previos al desarrollo de la infección, confirmando lo sugerido por la literatura.
Assuntos
Humanos , Masculino , Adolescente , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Bacteriemia/microbiologia , Cefalosporinas/efeitos adversos , Infecções por Escherichia coli/etiologia , Infecções por Klebsiella/etiologia , beta-Lactamases/metabolismo , Resistência beta-Lactâmica , Bacteriemia/epidemiologia , Estudos de Casos e Controles , Infecção Hospitalar , Cateterismo Venoso Central/efeitos adversos , Cefalosporinas/uso terapêutico , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/epidemiologia , Infecções por Klebsiella/epidemiologia , Klebsiella/isolamento & purificação , Fatores de RiscoRESUMO
Neste estudo estimou-se a distribuição e prevalência de β-lactamases de espectro estendido pertencentes às famílias TEM, SHV e CTX-M entre amostras de Escherichia coli e Klebsiella spp. no Hospital Universitário de Santa Maria, Rio Grande do Sul. Durante 14 meses, 90 microrganismos foram selecionados como prováveis produtores de ESBL. Os isolados foram submetidos a testes fenotípicos confirmatórios para a presença de ESBL. A seguir, os tipos de ESBLs presentes em cada microrganismo foram determinados através da pesquisa dos respectivos genes através da reação em cadeia da polimerase. Empregando-se o método do disco combinado, a presença de ESBLs foi confirmada em 55 (61,1 por cento) amostras; quando o método do duplo disco foi utilizado, 57 (63,3 por cento) amostras foramprodutoras de ESBLs. Com base na PCR, as ESBLs do tipo TEM e SHV foram mais presentes em Klebsiella pneumoniae enquanto que ESBL do tipo CTX-M foram mais presentes em Klebsiella oxytoca.
In this study, the distribution and prevalence of extended-spectrum β-lactamases belonging to the TEM, SHV and CTX-M families were estimated among samples of Escherichia coli and Klebsiella spp. at the university hospital of Santa Maria, Rio Grande do Sul. Over a 14-month period, 90 microorganisms were selected as likely ESBL producers. The isolates were subjected to confirmatory phenotype tests for the presence of ESBL. Through investigating the respective genes using the polymerase chain reaction, the ESBL types present in each microorganism were then determined. Fifty-five samples (61.1 percent) were confirmed as ESBL-positive by means of the combined disc method, and 57 (63.3 percent) were found to be ESBL producers by means of the double disc method. From the polymerase chain reaction, ESBLs of TEM and SHV types were more frequently present in Klebsiella pneumoniae, while ESBL of CTX-M type was more frequently present in Klebsiella oxytoca.
Assuntos
Humanos , Escherichia coli/enzimologia , Klebsiella/enzimologia , beta-Lactamases/genética , Cefalosporinas/farmacologia , DNA Bacteriano/análise , Escherichia coli/efeitos dos fármacos , Hospitais Universitários , Klebsiella/classificação , Testes de Sensibilidade Microbiana , Fenótipo , Reação em Cadeia da Polimerase , Prevalência , beta-Lactamases/análiseRESUMO
The conjunctive is exposed continuously to infectious agents as virus, bacterias and fungi. It has the function to prevent the cornea drying, increasing eyelids and eyeball mobility as well as acting as a barrier against microorganisms and strange bodies. The aim of this work was to evaluate aerobic conjunctive ocular microflora of foxes (Cerdocyon thous azarae) clinically healthy to an ophthalmic exam. Using sterile swabs, sampies of both conjunctive sacks were obtained from four foxes and submitted to bacteriological exams. The most of the ísolated microorganisms were Gram negative: Escherichia cofi (36.4%), Klebsiella spp (18.2%) and other Gram-negative microorganisms (9.1%). Bacillus spp (31.8%) and Staphylococcus sp (4.5%) were the Gram-positive organisms isolated.
A conjuntiva é exposta continuamente a agentes infecciosos como vírus, bactérias e fungos. Previne o ressecamento da córnea, aumenta a mobilidade das pálpebras e globo ocular e serve como barreira contra microrganismos e corpos estranhos. Neste trabalho o objetivo foi avaliar a microbiota aeróbia da conjuntiva ocular de raposas (Cerdocyon thous azarae), clinicamente saudáveis ao exame oftálmíco. Foram utilizadas quatro raposas, das quais amostras de ambos os sacos conjuntivais foram obtidas por meio de swabs estéreis e submetidas a exames bacteriológicos. A maioria das bactérias isoladas foram Gram-negativas, das quais: 36,4% para Escherichia coli, 18,2% para Klebsiella spp e 9,1% para outras Enterobacteriáceas. Dentre os Gram-positivos foram isolados Bacillus spp (31,8%) e Staphylococcus sp (4,5%).
RESUMO
The conjunctive is exposed continuously to infectious agents as virus, bacterias and fungi. It has the function to prevent the cornea drying, increasing eyelids and eyeball mobility as well as acting as a barrier against microorganisms and strange bodies. The aim of this work was to evaluate aerobic conjunctive ocular microflora of foxes (Cerdocyon thous azarae) clinically healthy to an ophthalmic exam. Using sterile swabs, sampies of both conjunctive sacks were obtained from four foxes and submitted to bacteriological exams. The most of the ísolated microorganisms were Gram negative: Escherichia cofi (36.4%), Klebsiella spp (18.2%) and other Gram-negative microorganisms (9.1%). Bacillus spp (31.8%) and Staphylococcus sp (4.5%) were the Gram-positive organisms isolated.
A conjuntiva é exposta continuamente a agentes infecciosos como vírus, bactérias e fungos. Previne o ressecamento da córnea, aumenta a mobilidade das pálpebras e globo ocular e serve como barreira contra microrganismos e corpos estranhos. Neste trabalho o objetivo foi avaliar a microbiota aeróbia da conjuntiva ocular de raposas (Cerdocyon thous azarae), clinicamente saudáveis ao exame oftálmíco. Foram utilizadas quatro raposas, das quais amostras de ambos os sacos conjuntivais foram obtidas por meio de swabs estéreis e submetidas a exames bacteriológicos. A maioria das bactérias isoladas foram Gram-negativas, das quais: 36,4% para Escherichia coli, 18,2% para Klebsiella spp e 9,1% para outras Enterobacteriáceas. Dentre os Gram-positivos foram isolados Bacillus spp (31,8%) e Staphylococcus sp (4,5%).