ABSTRACT
Las betalactamasas de espectro extendido (BLEE) son enzimas producidas por bacilos gram negativos capaces de hidrolizar las cefalosporinas de amplio espectro y los monobactámicos. La mayoría pertenece a la familia de Enterobacteriae, tales como Klebsiella pneumoniae y Escherichia coli: Sin embargo, se asocian también con otras bacterias como Proteus, Serratia, Salmonella, Pseudomonas aeruginosa y Acinetobacter. Las enterobacterias productoras de carbapenemasas no sólo han sido aisladas en el ambiente hospitalario, sino que también provienen de la comunidad. Se presenta una paciente de sexo femenino con antecedentes de sida y osteomielitis secundaria a artritis séptica producida por una Klebsiella pneumoniae BLEE de la comunidad. Un tratamiento oportuno y eficaz puede evitar la opción quirúrgica, disminuyendo la morbimortalidad asociada con esta afección
Extended-spectrum beta-lactamases (ESBL) are enzymes produced by gram-negative rods capable of hydrolyzing broad-spectrum cephalosporins and monobactams. Most belong to the Enterobacteriae family, such as Klebsiella pneumoniae and Escherichia coli. However, they are also associated with other bacteria such as Proteus, Serratia, Salmonella, Pseudomonas aeruginosa and Acinetobacter. Carbapenemase-producing Enterobacteriaceae have not only been isolated from the hospital environment, but also from the community. We present a female patient with a history of AIDS and secondary osteomyelitis to septic arthritis caused by a community Klebsiella pneumoniae ESBL. It is concluded that a timely and effective treatment can avoids the surgical option, reducing the morbidity and mortality of this condition.
Subject(s)
Humans , Female , Adult , Osteomyelitis/immunology , Klebsiella Infections/therapy , Arthritis, Infectious/therapy , Imipenem/therapeutic use , AIDS-Related Opportunistic Infections/immunology , Arthrocentesis , Knee Injuries/therapyABSTRACT
Drug resistance is the major cause of increase in morbidity and mortality in neonates. The emergence of antibiotic-resistant bacterial strains requires the exploration of alternative antibacterial therapies and the concern that human kind in re-entering the 'pre-antibiotic era' has become very real and the development of alternative anti-infection modalities has become one of the highest priorities of modern medicine and biotechnology. This has spurred biomedical researchers to expand their efforts to identify new technologies and products that employ novel mechanism of action against the "super-bugs". One of such alternatives stems up from an old idea is the bacteriophage therapy, which led our group to study the ability of bacterial viruses (bacteriophages or phages) to rescue septicemic mice with multidrug resistant (MDR) Klebsiella pneumoniae isolated from neonatal septicemia. The phage strain used in this study had lytic activity against a wide range of clinical isolates of MDR Klebsiella pneumoniae. One of these MDR Klebsiella strain was used to induce septicemia in mice by intraperitoneal (i.p.) injection of 10(9) CFU. The resulting bacteremia was fatal within 48 h. A single i.p. injection of 3x10(8) PFU of the phage strain administered 45 min after the bacterial challenge, was sufficient to rescue 100% of the animals. Even when treatment was delayed to the point where all animals were moribund, approximately 50% of them were rescued by a single injection of this phage preparation. The ability of this phage to rescue septicemic mice was demonstrated to be due to the functional capabilities of the phage and not to a nonspecific immune effect. The rescue of septicemic mice could be affected only by phage strains able to grow in vitro on the bacterial host used to infect the animals and when such strains are heat inactivated they lose their ability to rescue the infected mice.
Subject(s)
Animals , Bacteremia/therapy , Bacteriophages , Drug Resistance, Multiple, Bacterial , Klebsiella Infections/therapy , Klebsiella pneumoniae/pathogenicity , Male , Mice , Mice, Inbred BALB CABSTRACT
Se trata de un lactante menor masculino de 10 meses de edad, desnutrido, sin vacunas, hijo de una madre de 16 años, analfabeta, viviendo en condiciones de pobreza crítica, el cual inicia su enfermedad actual una semana antes de su ingreso a ese hospital con cuadro respiratorio y diarréico severo, sin recibir tratamiento médico y cuando decide consultar sus condiciones eran graves; y a pesar de los múltiples tratamientos, su evolución fue muy tórpida y para sorpresa nuestra en el hemocultivo, coprocultivo y cultivo de secreción bronquial, creció Klebsiella Pneumoniae muy resistente a los antibióticos usuales, afortunadamente respondió al Cloramfenicol+Amikacina y en la Rx de Toráx se apreciaban imágenes en panal de abeja, lo que nos ayudó a sospechar la presencia de esta bacteria.
Subject(s)
Infant , Humans , Male , Klebsiella Infections/diagnosis , Klebsiella Infections/therapy , Pneumonia/therapyABSTRACT
La infección urinaria (ITU) en pediatria es frecuente y el tratamiento antibiotico inicial es empirico, basada en la sensibilidad conocida de las bacterias del medio. Para averiguar dicha sensibilidad, se seleccionaron 61 pacientes entre 4 meses y 13 años, que acudieron al Servicio de Emergencia Pediátrica del Hospital Nacional Cayetano Heredia, con cuadro clínico de ITU y urocultivo positivo. Las bacterias aisladas fueron: E. coli, en 49 cultivos(80.3 por ciento), Klebsiella sp. en 10 cultivos (16.4 por ciento) y Proteus mirabilis en 2 casos (3.3 por ciento). La sensibilidad in vitro fue de un 100 por ciento a la Gentamicina, ceftriaxone, ceftazidime, y norfloxacina; 95.9 por ciento a amikacina, 94.1 por ciento a nitrofurantoina, 91.4 por ciento a acido nalidixico, 81.7 por ciento a cefalotina, 46.6 por ciento a cotrimoxazole y 18.8 por ciento a ampicilina
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Pediatrics , Urinary Tract Infections/etiology , Urinary Tract Infections/therapy , Proteus Infections/diagnosis , Urine/microbiology , Klebsiella Infections/diagnosis , Klebsiella Infections/therapy , Microbial Sensitivity Tests , Microbial Sensitivity Tests , Escherichia coli Infections/diagnosis , Escherichia coli Infections/therapyABSTRACT
Nestes experimentos, estudou-se a atividade protetora da vacina produzida a partir da bactéria Klebsiella pneumoniae, em camundongos infectados com K. pneumoniae. A vacina foi administrada imediatamente após a injeçäo da bactéria, sendo portanto usada como adjuvante da quimioterapia. Os resultados mostram que a vacina, nestas circunstâncias, näo apresenta efeito protetor. Investigou-se a seguir o desenvolvimento da resposta imune tipo humoral nas condiçöes acima descritas, usando-se o método de formaçäo de placa de Jerne para detecçäo do número de células formadoras de anticorpos