ABSTRACT
PROTEKT (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin) is a global surveillance study established in 1999 to monitor antibacterial resistance of respiratory tract organisms. Thirteen centers from Argentina, Brazil and Mexico participat ed during 1999-2000; they collected 1,806 isolates (Streptococcus pneumoniae 518, Haemophilus influenzae 520, Moraxella catarrhalis 140, Staphylococcus aureus 351, S. pyogenes 277). Overall, 218 (42.1 percent) of the S. pneumoniae isolates had reduced susceptibility to penicillin, 79 (15.3 percent) were penicillin-resistant and 79 (15.3 percent) were erythromycin-resistant. Mexico had the highest prevalence of penicillin (76.5 percent) and erythromycin (31.2 percent) resistance. Of 77 erythromycin-resistant S. pneumoniae tested for resistance genotype, 43 possessed mef(A), 33 possessed erm(B) and 1 possessed both erm(B) and mef(A) mechanism. All S. pneumoniae isolates were fully susceptible to telithromycin, linezolid, teicoplanin and vancomycin. Among H. influenzae isolates, 88 (16.9 percent) produced b-lactamase, ranging from 11 percent (Brazil) to 24.5 percent (Mexico). Among M. catarrhalis isolates, 138 (98.6 percent) produced b-lactamase. Twenty-four (8.7 percent) of the S. pyogenes isolates were erythromycin-resistant; resistance being attributable to mefA (n=18), ermTR (n=5) and ermB (n=1). All H. influenzae, M. catarrhalis and S. pyogenes were fully susceptible to telithromycin. Methicillin resistance was found in 26.5 percent of the S. aureus isolates (Argentina 15 percent; Mexico 20 percent; Brazil 31.3 percent). Telithromycin was effective against 97.7 percent of methicillin-susceptible isolates. PROTEKT confirms that antibacterial resistance is an emerging problem in Latin America. The previously reported high levels of pneumococcal resistance to the b-lactam and macrolides were exceeded. New agents that do not induce resistance or that exert low selective pressure, e.g. telithromycin, are essential to safeguard future antibacterial efficacy
Subject(s)
Humans , Anti-Bacterial Agents/therapeutic use , Erythromycin/therapeutic use , Penicillin Resistance , Respiratory Tract Infections/drug therapy , Anti-Bacterial Agents/pharmacology , Argentina/epidemiology , Brazil/epidemiology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Community-Acquired Infections/microbiology , Drug Resistance, Multiple , Erythromycin/pharmacology , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Haemophilus influenzae/drug effects , Haemophilus influenzae/isolation & purification , Microbial Sensitivity Tests , Mexico/epidemiology , Moraxella catarrhalis/drug effects , Moraxella catarrhalis/isolation & purification , Population Surveillance , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/microbiology , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purification , Streptococcus pneumoniae/drug effects , Streptococcus pneumoniae/isolation & purification , Streptococcus pyogenes/drug effects , Streptococcus pyogenes/isolation & purificationABSTRACT
"Los problemas pulmonares constituyen una de las causas más frecuentes de morbilidad en los pacientes infectados con el VIH en estadios avanzados. En pacientes con criterios de SIDA, la frecuencia de problemas infecciosos pulmonares es mayor al 50 porciento y es definitorio de SIDA en el 70 porciento de los casos. Los agentes infecciosos incluyen virus, bacterias, parásitos y hongos. La gran mayoría de los problemas pulmonares son reversibles con tratamiento. Apartados del artículo: Manifestaciones clínicas. Abordaje de los problemas pulmonares. Tratamiento. Problemas específicos. Pneumocystis carinii. Citomegalovirus. Tuberculosis. Profilaxis para tuberculosis en pacientes con infección por VIH