Perfil de sensibilidad y resistencia antimicrobiana de bacterias ESKAPE en las unidades de internación del Hospital del Norte 2019, La Paz-Bolivia / Antimicrobial sensitivity and resistance profile of ESKAPE bacteria in all inpatient units of the Hospital del Norte 2019, La Paz-Bolivia

INTRODUCCIÓN: la resistencia a los antimicrobianos plantea una amenaza para la salud pública a nivel mundial. Las infecciones por bacterias ESKAPE representan mayores problemas de resistencia, debido a que pueden presentar más de un mecanismo de resistencia y además tienen la facultad de transmitirlo. En Bolivia no existen artículos publicados que muestren la multirresistencia de bacterias ESKAPE en hospitales de tercer nivel. OBJETIVO: describir el perfil de sensibilidad y resistencia antimicrobiana de las bacterias ESKAPE aisladas en todas las unidades de internación del Hospital Del Norte durante la gestión 2019. MATERIAL Y MÉTODOS: estudio observacional, descriptivo, incluyó 836 aislamientos obtenidos de enero a diciembre del 2019 provenientes de pacientes internados en todas las unidades del Hospital del Norte. Se empleó el sistema WHONET y las variables estudiadas fueron: edad, género, tipo de muestra, sala de internación, perfil de sensibilidad y resistencia de cada uno de los microorganismos en estudio. RESULTADOS: Se elaboró y describió el perfil de sensibilidad y resistencia antimicrobiana de las bacterias ESKAPE, encontrándose que los Enterobacterales tienen mayor frecuencia, siendo Escherichia coli el patógeno más prevalente; se determinó que existe mayor frecuencia en pacientes adultos, con mayor prevalencia en el género femenino. La frecuencia por tipo de muestra se observa que los tres primeros lugares lo ocupan las muestras de orina, vías respiratorias bajas y abscesos. Los servicios de Terapia intensiva, Medicina Interna y Cirugía son las áreas más críticas. Se obtuvieron los porcentajes de resistencia que presentan cada uno de los microorganismos estudiados según sala de internación. Los principales mecanismos de resistencia fenotípica encontrados en este estudio, son BLEE y MRSA. CONCLUSIONES: los resultados obtenidos demuestran que el mapa epidemiológico de resistencia antimicrobiana del Hospital del Norte, presenta porcentajes más altos en relación a los mapas epidemiológicos similares de otros hospitales en Latinoamérica.

INTRODUCTION: antimicrobial resistance raises a serious threat to health worldwide. Infections by ESKAPE bacteria represent major resistance problems, since they can present more than one resistance mechanism and also have the ability to transmit other bacteria. In Bolivia, unfortunately, there are no Bolivian authors who have published articles explaining the multi-resistance of ESKAPE Bacteria in third level hospitals. OBJECTIVE: To describe the antimicrobial sensitivity and resistance profile of ESKAPE bacteria isolated in all inpatient units of Hospital Del Norte in 2019. MATERIAL AND METHODS: observational, descriptive study, included 836 isolates obtained from January to December 2019 from patients hospitalized in all units of Hospital del Norte. WHONET software was used and the variables studied were: age, gender, type of sample, hospitalization room and resistance profile of each of the microorganisms under study. RESULTS: the antimicrobial sensitivity and resistance profile of each ESKAPE bacteria was elaborated and described, and it was found that Enterobacteriaceae have a higher frequency, with Escherichia coli is being the most prevalent pathogen; it was determined that there is a higher frequency in adult patients, with a higher prevalence in the female gender. The frequency by type of sample shows that the first three places are occupied by urine, lower respiratory tract and abscess samples. Intensive care, internal medicine, and surgery services are the most critical areas. The percentages of resistance were obtained for each of the microorganisms studied according to the hospitalization room. ESBL and MRSA are the main phenotypic resistance mechanism found in the hospital. CONCLUSIONS: the results obtained show that the epidemiological map of antimicrobial resistance at Hospital del Norte presents higher percentages in relation to similar epidemiological maps of other hospitals in Latin America.

Mapa epidemiológico de resistencia antimicrobiana de los agentes bacterianos aislados en el Hospital Santa Bárbara / Antimicrobial resistance epidemiological map of bacterial agents isolated at Santa Bárbara Hospital

El incremento de la resistencia bacteriana a nivel mundial convierte a este fenómeno en uno de los mayores retos para la Salud Pública. Así en Sucre, se realizó un estudio descriptivo transversal, con el objetivo de elaborar el mapa epidemiológico de resistencia antimicrobiana de los agentes bacterianos aislados de pacientes atendidos en el Hospital Santa Bárbara durante el primer semestre de la gestión 2017. La población en estudio fueron todos los cultivos de muestras microbiológicas con aislamiento de un patógeno registrados en el laboratorio de microbiología. Para la sistematización de la información se utilizó el software WHONET 5.6 y el análisis de datos se realizó de acuerdo al documento "Análisis y Presentación de Datos de Pruebas de Susceptibilidad Antimicrobiana Acumulada" aprobado por CLSI. Se elaboró el mapa epidemiológico de resistencia lográndose establecer la prevalencia de los agentes bacterianos circulantes a nivel intrahospitalario, su distribución de acuerdo al fenotipo de resistencia y al servicio hospitalario; además, se determinaron los porcentajes de resistencia frente a antimicrobianos de uso habitual. Los resultados obtenidos demuestran que el mapa epidemiológico de resistencia antimicrobiana del Hospital Santa Barbara, presenta porcentajes más altos en relación a los mapas epidemiológicos similares de otros hospitales en Latinoamérica.

The increase in bacterial resistance worldwide makes this phenomenon one of the biggest challenges for Public Health. A descriptive cross-sectional study was carried out, with the aim of preparing the epidemiological map of antimicrobial resistance of bacterial agents isolated from patients treated at the Santa Barbara Hospital in the city of Sucre during the first half of the 2017. The population under study were all cultures of microbiological samples with isolation of a pathogen registered in the Microbiology Laboratory. For the systematization of the data, the WHONET 5.6 software was used and the data analysis was performed according to the document "Analysis and Presentation of Accumulated Antimicrobial Susceptibility Test Data" approved by CLSI. The epidemiological map of resistance was drawn up, establishing the prevalence of circulating bacterial agents at the hospital level, their distribution according to the resistance phenotype and the hospital service; In addition, the percentages of resistance against antimicrobials of habitual use were determined. The results obtained show that the epidemiological resistance map of the Santa Barbara Hospital has higher resistance percentages than the epidemiological maps of other hospitals in Latin America.

Sistemas de efluxo multidrogas em Escherichia coli e uso de inibidores como possíveis adjuvantes na terapia da mastite bovina / Multidrug efflux systems in Escherichia coli and the use of inhibitors as possible adjuvant therapy in bovine mastitis

Vinte e sete isolados de Escherichia coli provenientes de leite de bovinos com mastite clínica foram submetidos a teste de sensibilidade aos principais antimicrobianos usados no tratamento desta doença. Avaliou-se também a efetividade in vitro de dois inibidores de sistemas de efluxo multidrogas, fenilalanina arginyl ß naftilamida (PAβN) e 1-(1-Naphthylmethyl)-piperazine (NMP), utilizando-se a concentração inibitória mínima (CIM) como referência. A CIM e o sistema de efluxo foram detectados com base nas curvas de crescimento, utilizando-se a densidade óptica (D.O550), em diferentes concentrações da droga e na presença e ausência dos inibidores. Apenas quatro isolados apresentaram resistência à ampicilina e ao sulfametoxazol∕trimetoprim, simultaneamente, enquanto todos os 27 foram sensíveis aos demais antimicrobianos. Observaram-se valores para ampicilina variando de 6µg/mL a 250µg/mL e para sulfametoxazol∕trimetoprim de 12µg/mL a 1500µg/mL. Houve redução das CIMs desses antimicrobianos em todos os isolados na presença dos inibidores, exceto para sulfametoxazol∕trimetoprim na presença de NMP. Conclui-se que esses isolados possuem um estreito perfil de resistência e que PAßN apresentou melhor efeito inibitório em relação à ampicilina e ao sulfametoxazol∕trimetoprim, apresentando-se como um candidato a adjuvante no tratamento da mastite...

Twenty-seven isolates of Escherichia coli from cattle with clinical mastitis were subjected to sensitivity tests regarding main antimicrobials used in the treatment of this disease. We also evaluated in vitro effectiveness of two inhibitors of multidrug efflux systems, fenilalanina arginyl ß naftilamida (PAβN) and 1-(1-Naphthylmethyl)-piperazine (NMP), using the minimum inhibitory concentration (MIC) as a reference. MIC and multidrug efflux systems were detected in the growth curves, using optical density (D.O550) at different drug concentrations and the presence and absence of inhibitors. Only four isolates of E. coli were resistant to ampicillin and trimethoprim/sulfamethoxazole, simultaneously. However, all isolates were sensitive to the other antimicrobials. Were observed values ranging from 6mg to 250mg ampicillin/mL, and 12mg to 1500mg/mL trimethoprim/sulfamethoxazole. There was a reduction of the MIC of antimicrobials for all isolates in the presence of inhibitors, except for trimethoprim/sulfamethoxazole in the presence of NMP. In conclusion, these isolates have a narrow resistance profile and PAßN showed better inhibitory effect against ampicillin and trimethoprim/sulfamethoxazole, and is a candidate for the adjuvant treatment of mastitis...

Variability of filtration and food assimilation rates, respiratory activity and multixenobiotic resistance (MXR) mechanism in the mussel Perna perna under lead influence

The economic importance that myticulture is conquering in Santa Catarina State (South of Brazil) explains the crescent search for new coastal sites for farming. Physiological and biochemical studies of the mussel Perna perna are important to the establishment of methodologies for program assessment and environmental monitoring, allowing to infer about site quality and possible influences of xenobiotic agents on coastal areas. In order to evaluate effects caused by lead poisoning (1.21 mumol.L-1), the mussels were maintained at constant temperature (25ºC) and fed with Chaetoceros gracilis for 15 days. The control group was acclimatized in sea water 30‰. At the end of this period time, physiological measurements were carried out along with statistic analysis for filtration rates, lead assimilation and overall respiratory activity. The mechanism of multixenobiotic resistance (MXR) was particularly evaluated in standardized gill fragments using rhodamine B accumulation and its quantification under fluorescence optical microscopy. Regarding the control group, results had shown that the mussels maintenance in a lead-poisoned environment caused higher filtration rates (1.04 and 2.3 and L.h-1.g-1; p 0.05) and lower assimilation rates (71.96% and 54.1%, respectively). Also it was confirmed a lesser rhodamine B accumulation in the assays under influence of lead, suggesting that this metal induces the MXR mechanism expression in mussel P. perna. These results indicate that such physiological and biochemical alterations in the mussels can modify the energy fluxes of its metabolism, resulting in possible problems on the coastal systems used as cultivating sites.

A importância sócio-econômica que a mitilicultura conquistou no Estado de Santa Catarina explica a crescente procura por novos sítios costeiros para o seu uso. Estudos fisiológicos e bioquímicos do mexilhão Perna perna se apresentam como metodologias viáveis para programas de avaliação e monitoramento ambiental, permitindo inferir sobre a qualidade dos sítios e possíveis influências de agentes xenobióticos nas áreas costeiras. Com o objetivo de determinar a existência de variabilidade nesses parâmetros evocada pelo chumbo (1.21 mimol.L-1), mexilhões Perna perna foram mantidos à temperatura constante e alimentados com Chaetoceros gracilis por 15 dias. O grupo controle foi aclimatado em água do mar a 30‰. No final desse período foram realizados experimentos estáticos fisiológicos de filtração, respiração e assimilação, como também foi quantificada a atividade do mecanismo MXR em fragmentos de brânquias, pelo acúmulo de rodamina B, por microscopia óptica de fluorescência. Em relação ao grupo controle, a manutenção dos organismos em solução de chumbo causou maiores taxas de filtração (1,04 e 2,3 e L.h-1.g-1; p 0,05) e menores taxas de assimilação (71,96 e 54,1%, respectivamente). Também foi confirmado menor acúmulo de rodamina nos organismos sob influência do chumbo, sugerindo que este metal induz a expressão do mecanismo MXR no mexilhão Perna perna. Os resultados indicam que tais alterações fisiológicas e bioquímicas do mexilhão podem alterar os fluxos de energia no metabolismo, resultando em possíveis problemas nos sistemas costeiros utilizados como sítios de cultivos.