Epidemiología de la candidemia y sensibilidad in vitro frente a azoles, anfotericina B y caspofungina en una institución de salud de Valledupar, Colombia / Epidemiology of candidemia and in vitro susceptibility to azoles, amphotericin B and caspofungin in a health institution of Valledupar, Colombia

Introducción: la candidemia es una enfermedad grave, con elevada morbi-mortalidad y cuyo tratamientono siempre conduce a la cura. La distribución de especies de Candida y la sensibilidad antifúngica varía según el área geográfica, incluso entre centros de salud de una misma región. Objetivo:establecer la distribución de especies de Candida y su sensibilidad in vitro frente a diferentes antifúngicos. Materiales y métodos: se realizó un estudio descriptivo, prospectivo y transversal entre noviembre de 2013 y mayo de 2014 de casos de candidemias en una institución de salud de Valledupar,Colombia. Las Concentraciones Inhibitorias Mínimas (CIM) se determinaron según el protocolo estándar M27-A3-S4. Resultados: Se estudiaron 40 aislados clínicos de Candida spp. obtenidos de sangre (97,5%) y médula ósea (2,5%). Del total, 15 (37,5%) fueron caracterizados como Candida tropicalis, 13 (32,5%) del Complejo Candida albicans, cinco (12,5%) del Complejo Candida glabrata, tres (7,5%) como Candida guilliermondii, tres (7,5%) del Complejo Candida parapsilosis y uno (2,5%) como Candida krusei. No se observó resistencia a la anfotericina B ni al voriconazol en ninguno de los aislados, pero sí al fluconazol en uno (6,6%) de Candida tropicalis y uno (33,3%) del Complejo Candida parapsilosis y a la caspofungina en el aislado de Candida krusei y en uno (20%) del Complejo Candida glabrata...

Introduction: candidemia is a serious disease with high morbidity and mortality whose treatment does not always lead to a cure. Candida species distribution and antifungal susceptibility varies by geographic area, even in health centers in a given region. Objective: To establish Candida species distributionand in vitro susceptibility to different antifungal agents. Material and methods: A descriptive, prospective, and cross-sectional study of candidemia cases was performed at a health institution in Valledupar, Colombia between November 2013 and May 2014. The Minimum Inhibitory Concentrations(MIC) were determined following the M27-A3-S4 standard protocol. Results: 40 isolates of Candida spp. obtained from blood (97.5%) and bone marrow (2.5%) were analyzed. Candida tropicalis, 15 (37.5%), Candida albicans Complex, 13 (32.5%), Candida glabrata Complex, five (12.5%), Candida guilliermondii, three (7.5%), Candida parapsilosis Complex 3 (7.5%) and Candida krusei, one (2.5%) were isolated. No resistance of isolates to amphotericin B and voriconazole was observed; in contrast, one (6.6%) isolate of Candida tropicalis and one (33.3%) of Candida parapsilosisComplex showed resistance to fluconazole and a single isolate of Candida krusei and one (20%) of Candida glabrata Complex to caspofungin...

Analysis on Antimicrobial Resistance of Clinical Bacteria Isolated from County Hospitals and a Teaching Hospital / 华中科技大学学报（医学）（英德文版）

The distinction of antimicrobial resistance of clinical bacteria isolated from county hospitals and a teaching hospital was investigated. Disc diffusion test was used to study the antimicrobial resistance of isolates collected from county hospitals and a teaching hospital. The data was analyzed by WHONET5 and SPSS statistic software. A total of 655 strains and 1682 strains were collected from county hospitals and a teaching hospital, respectively, in the year of 2003. The top ten pathogens were Coagulase negative staphylococci (CNS), E. coli, Klebsiella spp. , S. areus, P. aeruginosa, Enterococcus spp. , Enterobacter spp. , otherwise Salmonella spp. , Proteus spp. , Shigella spp. in county hospitals and Streptococcus spp. , Acinetobacter spp. , X. maltophilia in the teaching hospital. The prevalence of multi-drug resistant bacteria was 5% (4/86) of methicillin-resistant S. areus (MRSA), 12% (16/133) and 15.8 % (9/57) of extended-spectrum β-lactamases producing strains of E. coli and Klebsiella spp. , respectively, in county hospitals. All of the three rates were lower than that in the teaching hospital and the difference was statistically significant (P＜0.01). However, the incidence of methicillin-resistant CNS (MRCNS) reached to 70 % (109/156) in the two classes of hospitals. Generally, the antimicrobial resistant rates in the county hospitals were lower than those in the teaching hospital, except the resistant rates of ciprofloxacin, erythromycin, clindamycin, SMZco which were similar in the two classes of hospitals. There were differences between county hospitals and the teaching hospital in the distribution of clinical isolates and prevalence of antimicrobial resistance. It was the basis of rational use of antimicrobial agents to monitor antimicrobial resistance by each hospital.

Phenotypes and Interpretive Reading of Antimicrobial Susceptibility Tests for Clinical Isolates of Several Species / 대한임상미생물학회지

BACKGROUND: In recent years, knowledge of bacterial resistance to antimicobials has expanded in important ways. Availability of an increasing number of antibiotics allows more precise individualization of resistance phenotypes and recording susceptibility results as patterns or phenotypes is valuable for both surveillance and patient care. If the patterns of resistance to panels of related antimicrobials are considered the underlying mechanisms can often be inferred. And the inferred mechanisms make the clinician to be advised to use alternative treatment. Interpretation of resistance phenotypes is based on the comparison of clinical isolates with prototype susceptible bacteria belonging to the same species. But interpretative reading of antimicrobial susceptibility tests requires an immense knowledge of antibiotics. Such interpretative reading is best achieved by computerized expert systems. METHODS: The authors attempt to determine phenotypes for the clinically isolated strains for each class of drugs tested by the Vitek 2 systemTM(bioMerieux, Marcy I'Etoile, France) using the Advanced Expert SystemTM(AES, bioMerieux, Marcy I'Etoile, France). A total of 91, 107, 89, 65, 251, 113, 47, 33, 23, 122 and 110 isolates of Staphylococcus aureus, coagulase negative staphylococci, Enterococcus faecalis, Enterococcus facium, Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, Enterobacter cloacae, Enterobacter aerogenes, Pseudomonas aeruginosae and Acinetobacter baumannii, were examined respectively. RESULTS: Biological correction based on the phenotype was recommended from 2.2% of E. faecalis to 46.8% of S. marcescens and therapeutic correction, from 7.3% of A. baumannii to 60.9% of E. aerogenes. A total of 25, 26, 18, 19, 22, 22, 15, 15, 17, 19, 19 phenotypes of S. aureus, coagulase negative staphylococci, E. faecalis, E. facium, E. coli, K. pneumoniae, S. marcescens, E. cloacae, E. aerogenes, P. aeruginosa and A. baumannii, were detected respectively. Association of resistance mechanism from S. aureus, coagulase negative staphylococci, E. coli, K. pneumoniae, S. marcescens, show 10, 11, 6, 4 and 3 pairs from resistant phenotypes, respectively. CONCLUSION: Vitek AES potentially provides a tool to assist the development of antimicrobial susceptibility interpretation in the clinical microbiology laboratory. The inferred mechanisms make the clinician to be advised to use alternative treatment.

Biochemical, Serological and Virulence-associated Characteristics of Yersinia enterocolitica Isolated in Korea / 감염

BACKGROUND: Yersinia enterocolitica is an inhabitant in lower intestinal tract of many domestic and wild animals as well as in nature. Of the several forms of diseases by Y. enterocolitica, acute enteritis, especially in young children, is most common. Infection of the bacteria is usually occurred through fecal-oral route by contaminated foods or water, especially mountainspring water. Therefore, we isolated Y. enterocolitica from feces of pigs and mountainspring water and investigated the biochemical, serological, genetical and virulence-associated characteristics of the bacteria for the epidemiological analysis. METHODS: Fifty-one strains of Y. enterocolitica were isolated from the samples and identified by biochemical tests and VITEK system. We performed antimicrobial susceptibility test, in vitro virulence-associated characteristics, biotyping, serotyping, and PCR-ribotyping and compared the methods, such as biotype, serotype and PCR-ribotyping, to differentiate the isolates. RESULTS: Biochemical properties of the isolates were very similar to those of reference strains. They were susceptible to chloramphenicol, tetracycline, norfloxacin, but resistant to bacitracin, ampicillin in antimicrobial susceptibility test. In vitro virulence-associated tests, the positive strains were 27 isolates (52.9%) in CRMOX+, 10 isolates (19.6%) in CV+, 30 isolates (58.8%) in CD+, 20 isolates (39.2%) in esculin+ and 20 isolates in salicin+ (39.2%). Thirty-one strains of 51 isolates (61%) harbored about 70 kb plasmid presumably associated with virulence factor. Biotypes and serotypes of the strains were 3B, 3A, 4 and O:3, O:13, O:16 in order, respectively. Type I having 700 and 800 bps products was the most common type of PCR-ribotypes. CONCLUSION: Biochemical properties, biotypes and serotypes of the isolates were similar with previously reports in Korea. PCR-ribotyping, a genetical method, could be a more effective tool for differentiating isolates of Yersinia enterocolitica than conventional methods such as serotype, biotype.