ABSTRACT
Background: PRONARES (Programa Nacional de Vigilancia de Resistencia) is a national surveillance program for antimicrobial susceptibility, focused in different syndromes and among these, urinary tract infections. The work is done in a laboratory net that uses common protocols and whose data are centrally analyzed using the WHONET program. Aim: To analyze the pattern of antimicrobial susceptibility of agents causing urinary infections in children in the period 1997-1999. Material and methods: In the study period, 5,525 strains were analyzed. Of these, 2,307 came from pediatric patients (1,495 hospitalized and 803 ambulatory). Results: The most common causative agent was E. coli in 74,2 percent of cases, followed by Klebsiella spp in 8,2 percent and other agents in a lower frequency. Of E. coli strains, 74 percent were resistant to ampicillin, 52 percent to clotrimoxazole and 30 percent to first generation cephalosporins. These strains were sensitive to second and third generation cephalosporins, aminoglycosides, ciprofloxacin and nitrofurantoin. Strains from nosocomial or community infections had similar antimicrobial susceptibility. Klebsiella spp had a high rate of antimicrobial resistance (over 40 percent), that was even higher among nosocomial strains. It was 90 percent susceptible to ciprofloxacin and 100 percent to imipenem. All centers from which strains came had a similar pattern of susceptibility, with the exception of a pediatric center that had significantly higher resistance levels. Conclusions: The current therapeutic recommendations for urinary tract infections in children caused by E coli, are still pertinent, but the use of first generation cephalosporins must be cautious. The treatment of Klebsiella spp requires an individual antibiogram
Subject(s)
Humans , Male , Female , Urinary Tract Infections , Drug Resistance, Microbial , Anti-Infective Agents, Urinary , Outpatients , Proteus mirabilis , Urinary Tract Infections , Chile , Longitudinal Studies , Infection Control , Escherichia coli , Klebsiella pneumoniae , Cross Infection/etiology , Cross Infection/drug therapyABSTRACT
Background: the computer program WHONET generates a common database to analyze local or general antimicrobial resistance of bacteria. A surveillance of agents causing urinary tract infections in Chile has been performed using this program. Aim: to report the results after 12 months of urinary tract infection agent surveillance. Material and methods: since november, 1997, a surveillance of in vitro antimicrobial resistance, using agar diffusion techniques, has been performed in 20 to 40 bacterial strains per month, isolated from 11 hospitals in the country. Results have been analyzed using WHONET program. Results: in first 12 months, 3144 strains, 1625 coming from outpatients, have been studied. Seventy four percent of isolated strains were E. coli, 19 percent were other enterobacteria, 4.1 percent were non fermenting bacilli and 2.1 percent were Gram (+) cocci. Sixty five percent of E coli strains were resistant to ampicillin, 11 percent to cefazolin, 2.5 percent to cefuroxime, 19 percent to ceftriaxone, 9 percent to ceftazidime, 4.2 percent to gentamicin 1.3 percent to amikacin, 5.6 percent to ciprofloxacin, 8.4 percent to grepafloxacin, 4.3 percent to nitrofurantoin and 43 percent to trimeproprim/sulphamethoxazole. Eighty two percent of other enterobacteria strains were resistant to ampicillin, 45.5 percent to cefazolin, 33.5 percent to cefuroxime, 26.6 percent to ceftriaxone, 21.5 percent to ceftazidime, 30.3 percent to gentamicin 17.2 percent to amikacin, 21 percent to ciprofloxacin, 16.3 percent to grepafloxacin, 48.2 percent to nitrofurantoin and 44.6 percent to trimeproprim/sulphamethoxazole. There were differences in betalactamic resistance among hospitals. Conclusions: noteworthy is the high resistance rates to third generation cephalosporins, evidenced when the new cutoff values for E coli and klebsiella spp are used. This national surveillance provides updated information on antimicrobial resistance of agents causing urinary tract infections
Subject(s)
Humans , Male , Female , Adolescent , Child, Preschool , Infant , Adult , Middle Aged , Urinary Tract Infections/drug therapy , Drug Resistance, Microbial , Urinary Tract Infections/etiology , Ceftriaxone/pharmacology , Ampicillin Resistance , Age Factors , Enterobacteriaceae/drug effects , Escherichia coli/drug effects , Ampicillin/pharmacology , Hospitals, PublicABSTRACT
Se analizan aspectos clínicos y microbiológicos de 200 pacientes con diagnóstico clínico de septicemia, hospitalizados en el Servicio de Medicina y en la Unidad de Cuidados Intensivos del Hospital San Juan de Dios entre 1975 y 1985. Los hemocultivos fueron positivos en 178 casos (89%), aislándose con mayor frecuencia Escherichia coli (39,3%); Klebsiella sp. (26,4%); Staphylococcus aureus (12,9%); Proteus sp. (5,1%); Pseudomona aeruginosa (3,9%); flora polimicrobiana (4,5%) y otros en menores porcentajes. En 141 (79,2%) de los 178 casos con confirmación bacteriológica, se precisó el foco primario, siendo lo más frecuente el urinario (48,2%); el vascular (14,2%) y el cutáneo (10,6%). La mortalidad global de la casuística estudiada fue de 47,2% y aumentó a 86,4% si se consideran los pacientes con hemocultivos negativos. La menor mortalidad correspondió a las septicemias por Escherichia coli (38,6%)