Determinación de genes que codifican la resistencia de betalactamasas de espectro extendido en bacilos Gram negativos aislados de urocultivos / Determination of genes encoding beta-lactamase resistance spread spectrum Gram negative bacteria isolated from urine cultures

Introducción. Las betalactamasas de espectro extendido (BLEE) son un grupo de enzimas que confieren resistencia bacteriana a un amplio espectro de antibióticos betalactámicos codificados en plásmidos y que deben estudiarse como herramientas de vigilancia del comportamiento de microorganismos frente al uso de antibióticos. Objetivo. Determinar los genes que codifican la resistencia en bacilos gramnegativos con fenotipo BLEE aislados de urocultivos, en una institución prestadora de servicios de salud del departamento de Boyacá. Métodos. Se llevó a cabo un estudio observacional, descriptivo y de corte transversal. Se identifica-ron 19 cepas resistentes con fenotipo BLEE, siguiendo los lineamientos del Clinical and Laboratory Standards Institute (CLSI M100-S23), y se estableció el índice de concordancia para la identificación microbiológica. Por medio de la estandarización de la técnica de reacción en cadena de la polimerasa (PCR), se determinó la presencia de los genes blaTEM, blaSHV, blaCTX y Amp-C en estas 19 cepas. Resultados. Se encontró que las 19 cepas con fenotipo BLEE (100 %) presentaban resistencia a la ampicilina; 12 (63,2 %) a la ampicilina-sulbactam; 17 (89,5 %) a la cefalotina; 16 (84,2 %) a la cefuroxima; 17 (89,5%) a la cefotaxima; 17 (89,5 %) a la ceftriaxona y 14 (73,7%) al cefepime. En 18 aislamientos se hizo amplificación de los genes, de los cuales 12 (61,11 %) posiblemente presentaron el gen blaCTX; 10 (55,6 %) el gen AmpC; 9 (50 %) el gen blaSHV y 7 (38,88 %) el gen blaTEM. Conclusión. La presencia de los genes blaCTX, AmpC, blaSHV y blaTEM presenta importancia epide-miológica, probablemente por la capacidad para movilizar la información genética de la resistencia en el ambiente hospitalario, donde tienen un claro potencial epidémico.

Introduction: Extended spectrum beta lactamases (ESBL) are a group of enzymes that confers bacterial resistance to a wide spectrum of betalactam antibiotics. These are coded in plasmids and should be studied as surveillance tools to watch the behavior of microorganisms towards the use of antibiotics. Objective: To determine the resistance coding genes in gram-negative bacilli with ESBL phenotype isolated from urine cultures, in a health services institution in the department of Boyacá. Methods: An observational, descriptive, cross-sectional study was carried out. Nineteen different strains with ESBL phenotype were identified, by following the Clinical and Laboratory Standards Institute (CLSI M100-S23) guidelines; and the microbiological identification concordance index was established. Through polimerase chain reaction (PCR) technique standardization, the presence of blaTEM, blaSHV, blaCTX, and Amp-C genes was determined for the 19 strains mentioned. Results: All of the nineteen strains with ESBL phenotype (100%) were found to be resistant to ampiciline; 12 (63,2%) resistant to ampicilin sulbactam; 17 (89,5%) to cephalothin; 16 (84,2 %) to cefuroxime; 17 (89,5%) to cefotaxime; 17 (89,5%) to ceftriaxione, and 14 (73,7%) to cefepime. Gene amplification was performed on 18 isolates, 12 (61,11%) of them possibly presented the blaCTX gene; 10 (55,6%) the AmpC gene; 9 (50 %) the blaSHV gene, and 7 (38,88%) the blaTEM gene. Conclusion: The presence of blaCTX, AmpC, blaSHV, and blaTEM genes represents epidemiological importance, probably because of its capacity to mobilize genetic resistance information inside the hospitalary environment in which they have a clear epidemic potential.

Caracterización fenotípica de bacilos Gram negativos con betalactamasas de espectro extendido y carbapenemasas / Phenotypic characterization of gram negative bacilli with extended-spectrum beta-lactamases and carbapenemases

Introducción: La resistencia bacteriana de los bacilos Gram negativos tiene un importante impacto económico y social en salud pública. Ha incrementado la morbilidad y la mortalidad en los últimos años, conllevando incremento de costos en salud; es un hecho significativo que orienta la implementación de acciones de prevención y estudio, mediante la identifi-cación de los perfiles regionales como estrategia de vigilancia y contención de la resistencia. Objetivo: Caracterizar fenotípicamente la resistencia en cepas de bacilos Gram negativos aislados de infecciones, en un centro hospitalario de segundo nivel en el departamento de Boyacá, Colombia. Métodos: Se hizo un estudio descriptivo de corte transversal. La identificación bacteriana y las pruebas de sensibilidad se determinaron mediante el método automatizado VITEK®. Los fenotipos de resistencia a ß-lactamasas de espectro extendido y carbapenemasas, se confir-maron siguiendo la metodología del Clinical and Laboratory Standards Institute (CLSI). Resultados: Se procesaron 458 cultivos durante cuatro meses, de los cuales 298 fueron negativos y 160 mostraron aislamientos bacterianos positivos; 127 eran procedentes de uro-cultivo. El patógeno prevalente fue Escherichia coli. De las cepas de estudio, se confirmó el fenotipo ß-lactamasa en 11 aislamientos y uno para el fenotipo ß-lactamasa/carbapenemasa. Conclusiones: Los hallazgos del presente estudio evidencian que E. coli es el microorganis-mo predominante a partir de los aislamientos que presentan un fenotipo multirresistente. La identificación de este tipo de cepas bacterianas, que son una amenaza en el ambiente hospitalario y el comunitario, amerita un cambio en las estrategias de contención de la mul-tirresistencia; igualmente, los resultados identifican el panorama epidemiológico regional.

Introduction: Bacterial resistance has a big impact economically and socially, great public health importance among which the extended-spectrum beta-lactamases and carbapenemases, have increased morbidity and mortality in the last years, significant fact that guides the imple-mentation of prevention and control through national and international monitoring. Objective: To characterize phenotypically the resistance of Gram negative bacilli strains iso-lated from infections in a second level hospital in the department of Boyacá, Colombia. Methods: A descriptive transversal study was conducted. Bacterial identification and suscep-tibility testing were determined through an automated method, VITEK®; resistance pheno-types extended spectrum beta-lactamases and carbapenemases were confirmed following standards of the Clinical and Laboratory Standards Institute (CLSI). Results: Four hundred and fifty eight cultures were processed during four months, 298 were negative, and 160 with positive bacterial isolates; 127 were isolated from urine culturea, Escherichia coli was the prevalent pathogen. From strains of the study 11 beta-lactamase phenotype isolates and one beta-lactamase/carbapenemase phenotype were confirmed. Conclusions: The findings of this study show that E. coli is the predominant organism from isolates which show a phenotype with multiple antibiotics resistance. The identification of this kind of bacterial strains proposes a change in the strategies of containment of multidrug resistance, being a threat in the hospital and community environment; the results also iden-tify the regional epidemiological overview.

Current status of the programs for detection of hearing loss in children younger than six months in Cali / Estado actual de los programas de detección de pérdidas auditivasen niños menores de seis meses en Cali

Background: Data is scarce in Colombia when dealing with the current circumstances of programs for detectinghearing loss in children younger than six months and, therefore, statistical data is limited on congenital or earlyacquireddeafness. Studies have been conducted in the country on detection and prevention of hearing problems inthe healthcare institutions in Antioquia, Quindío, Cauca, Valle, and Risaralda. All these studies were carried outbetween 1993 and 1995 and included children older than one year of age, which shows evidence of the lack ofknowledge about the importance of early detection in the hearing-communicative health of children.Objective: To identify the current procedures and protocols to detect hearing loss in children younger than sixmonths in Cali through a descriptive research in different healthcare institutions of the city. Methods: A descriptive study was carried out with a population of 722 private, public and/or mixed Health Service Providing Institutions from the city of Cali, registered in the database of the Department of Health of Valle del Cauca,Colombia in February 2007. A list was filled out to determine which of these institutions had services like delivery room and/or growth-development programs and/or audiology services and it was found that these aspects were met in 151 institutions that constituted the research sample. Thereafter, a survey was applied in these institutions to identify theprocedures utilized for hearing loss detection, the health professionals that carry this out, and the follow up and thespeech-language treatment performed to the children detected. Results: 95% of the healthcare institutions surveyed (144 institutions) do not perform procedures to detect hearing loss in children younger than six months. Only six of the private-sector institutions in Cali performed such procedures. The procedures used by these six institutions are all performed with equipment and protocols forobjective tests.

Kinesiterapia respiratoria en quiste hidatídico pulmonar / Respiratory kinesictherapy in pulmonary hydatid cyst

En este artículo se da un enfoque kinésico esquemático del tratamiento del Quiste Hidatídico Pulmonar, incluyendo las etapas pre y postoperatorias como son realizadas en el Hospital Regional de Temuco. Las técnicas kinésicas están basadas en evidencias científicas en relación a la disminución de complicaiones postoperatorias, dando énfasis también a la reeducaión física general del paciente