La humanidad enfrenta un desastre: la resistencia antimicrobiana / Humanity faces disaster: antimicrobial resistance

Introducción: La resistencia bacteriana pone en peligro la salud y la supervivencia de los seres humanos, aumenta la carga económica de la sociedad y los pacientes. Es un fenómeno global por lo que Cuba no queda exenta. Objetivos: Exponer el impacto social y económico de la resistencia antimicrobiana desde el punto de vista filosófico y describir el rol de una medida preventiva en la contención de la resistencia antimicrobiana. Material y Métodos: Se realizó una revisión de fuentes bibliográficas que fueron localizadas mediante la base de datos Pubmed, Portal Regional de la Biblioteca Virtual de Salud y el motor de búsqueda Google Académico. Desarrollo: Se analizan los aspectos sociales, económicos y éticos relacionados con la resistencia bacteriana y se ejemplifica una medida preventiva en la contención de la resistencia antimicrobiana. Además, se analiza la relación entre fármacos antibacterianos, resistencia bacteriana y medidas de prevención y control desde el punto de vista de ciencia-tecnología-sociedad. Conclusiones: La sociedad humana se desarrolla y progresa constantemente bajo la promoción de la ciencia y la tecnología. En pocas décadas, los antibióticos han pasado de ser "drogas milagrosas de gran impacto para la salud" a ser "un recurso no renovable en vías de extinción". Se deben adoptar las acciones pertinentes para frenar el desarrollo de la resistencia bacteriana con un enfoque multisectorial. Se requiere una gobernanza, optimización del uso de antibióticos, apoyos de políticas de salud y un fortalecimiento de los programas de prevención y control de infecciones(AU)

Introduction: Bacterial resistance endangers the health and survival of human beings and increases the economic burden on society and patients. It is a global phenomenon; therefore, Cuba is not exempted from it. Objective: To present the social and economic impact of antimicrobial resistance from a philosophical point of view as well as to describe the role of a preventive measure to stop antimicrobial resistance. Material and Methods: A review of bibliographic sources was carried out in databases such as PubMed and the Regional Portal of the Virtual Health Library; Google Scholar search engine was also used. Development: Social, economic and ethical aspects related to bacterial resistance are analyzed. A preventive measure to stop antimicrobial resistance is described. In addition, the relationship between antibacterial drugs, bacterial resistance and prevention and control measures is analyzed from the point of view of science-technology-society. Conclusions: Human society is constantly developing and progressing under the promotion of science and technology. In just a few decades, antibiotics have gone from being "miracle drugs of great impact on health" to being "a non-renewable resource in danger of extinction". Necessary measures such as the optimization of the use of antibiotics, a health policy support, and a health strategy for the prevention and control of infections must be taken to stop the development of bacterial resistance(AU)

The effect of the lactic acid bacteria culturing conditions on their antagonistic activity to pathogens of tuberculosis

It has been found that the antagonistic activity of lactic acid bacteria depends on the composition of the nutrient medium and the temperature of culturing. It has been shown that the best antimicrobial effect to mycobacteria is achieved by the cultivation of lactic acid bacteria on the MRS nutrient media and a combined nutrient medium with the use of lactulose or glucose as a source of carbon. The optimum temperature for culturing an association of lactic acid bacteria for achieving high antagonistic activity to mycobacteria is 300C, and the duration of cultivation is 24 hours.

Enumeration, identification and safety proprieties of lactic acid bacteria isolated from pork sausage / Enumeração, identificação e propriedades de segurança de bactérias ácido-lácticas isoladas de linguiça suína

Lactic Acid Bacteria (LAB) are indigenous microorganisms occurring in pork sausages. The utilization of selected autochthonous LAB may improve the safety of meat products. This study aims to enumerate and identify LAB in pork sausage and to characterize their safety properties, such as antimicrobial susceptibility and antibacterial activity. A total of 189 sealed packages of pork sausages were collected in seven municipalities (27 samples in each city) of Minas Gerais, Brazil. Microbiological analyses were performed to enumerate LAB. Two pre-selection criteria were applied to 567 isolates of LAB: catalase activity and tolerance to pH 2. A total of 32 strains of UFLA SAU were selected, characterized phenotypically and identified through 16S rDNA region sequencing. The susceptibility to antimicrobial and antibacterial activities of isolates was evaluated. The LAB count ranged from 3.079 to 8.987 log10 CFU/g. Lactobacillus plantarum and Lactobacillus paracasei were identified in the samples. UFLA SAU 11, 20, 34, 86, 131 and 258 showed a profile of susceptibility to four antimicrobials: erythromycin, ampicillin, chloramphenicol and gentamycin. In the antibacterial activity test, with exception of UFLA SAU 1, all other strains showed efficiency in inhibiting Escherichia coli, Salmonella Typhiand Listeria monocytogenes. In the statistical analysis there was interaction among strains of Lactobacillus against the pathogens tested. L. monocytogenes (P=0.05) was more sensitive to Lactobacillus strains and the highest inhibitory activity against this pathogen was achieved by strains UFLA SAU 135, 226, 238 and 258. Thus, UFLA SAU 11, 20, 34, 86, 131, 135, 226, 238 and 258 possess safety characteristics for application in meat products.

Bactérias ácido-lácticas (BAL) são microrganismos indígenas em linguiças. A utilização de selecionadas BAL autóctones pode melhorar a segurança dos produtos cárneos. Este estudo objetivou enumerar e identificar BAL em linguiças suínas e caracterizar suas propriedades de segurança, como a susceptibilidade antimicrobiana e a atividade antibacteriana. Um total de 189 embalagens fechadas de linguiça suína foi adquirido em sete municípios (27 amostras em cada cidade) de Minas Gerais, Brasil. Análises microbiológicas para a enumeração de BAL foram realizadas. Dois critérios de pré-seleção foram aplicados para os 567 isolados de BAL: atividade catalase e tolerância ao pH 2. Um total de 32 estirpes UFLA SAU foi selecionado, caracterizado fenotipicamente e identificado por meio do sequenciamento da região 16S rDNA. A susceptibilidade a antimicrobianos e a atividade antimicrobiana dos isolados foram avaliadas. Nas linguiças, a contagem de BAL variou de 3,079 a 8,987log10 UFC/g. Lactobacillus plantarum e Lactobacillus paracasei foram identificados nas amostras. UFLA SAU 11, 20, 34, 86, 131 e 258 apresentaram um perfil de suscetibilidade a quatro antimicrobianos: eritromicina, ampicilina, cloranfenicol e gentamicina. No teste de atividade antibacteriana, com exceção da UFLA SAU 1, todas as outras estirpes mostraram eficiência em inibir Escherichia coli, Salmonella Typhi e Listeria monocytogenes. Na análise estatística, houve interação entre estirpes de Lactobacillus contra os patógenos testados. L. monocytogenes (P=0,05) foi mais sensível às estirpes de Lactobacillus, e a maior atividade inibitória contra este patógeno foi apresentada por estirpes UFLA SAU 135, 226, 238 e 258. Assim, estirpes UFLA SAU 11, 20, 34, 86, 131, 135, 226, 238 e 258 possuem características de segurança para aplicação em produtos cárneos.

Resistencia bacteriana de cepas aisladas en el Hospital Hermanos Ameijeiras / Bacterial resistance of isolated strains at Hermanos Ameijeiras Hospital

Se incrementó el porcentaje de resistencia de las cepas aisladas durante el año 2006, procedentes de pacientes ingresados en el hospital en general y de la Unidad de Cuidados Intensivos, en particular, al comparar con los resultados del 2002. Se halló predominio en el 2006, del aislamiento de bacterias gramnegativas y, en particular, bacilos no fermentadores como el Acinetobacter sp. y Pseudomonas sp., tanto para el hospital en general como para la UCI, con un incremento casi generalizado de los patrones de resistencia de los principales microoganismos aislados. Los grampositivos están representados por estafilococos, tanto coagulasa negativa como S. aureus, con franca resistencia al oxacillín, pero 100 por ciento sensibles a la vancomicina. Los valores de resistencia más sugerentes para el 2006 son: E.coli resistente a ciprofloxacina (71 por ciento para el hospital y 85,71 para la UCI), S. aureus (68 y 76 por ciento) para el oxacillín, Acinetobacter para ceftriaxone (88,24 y 96,20) y frente al meropenem (55 y 62 por ciento).

The percentage of resistance of the isolated strains from patients admitted in the hospital in general and in the ICU, in particular, increased during 2006 on comparing them with the results obtained in 2002. In 2006, it was observed a predominance of the isolation of Gram-negative bacteria and, particularly, of non-fermentating bacilli, such as Acinetobacter sp and Pseudomonas sp in the hospital in general and in the ICU, with almost a generalized growth of the resistance patterns of the main isolated microorganisms. The Gram-positive are represented by staphilococcus as negative coagulase and S. aureus, with an evident resistance to oxacillin, but 100 percent sensitive to vancomicine. The most suggesting resistance values for 2006 are: E.coli resistant to ciprofloxacin (71 percent for the hospital and 85.71 for the ICU, S. aureus (68 y 76 percent) to oxacillin, Acinetobacter to ceftriaxone (88.24 y 96.20) and to meropenem (55 y 62 percent).

Streptococcus pneumoniae: estudo das cepas isoladas de liquor / Streptococcus pneumoniae: a study of strains isolated from cerebrospinal fluid

OBJETIVO: Determinar a freqüência dos sorotipos capsulares e a susceptibilidade antimicrobiana de cepas de Streptococcus pneumoniae, assim como dar suporte à indicação de vacinas disponíveis e ao uso de antimicrobianos. MÉTODOS: Neste estudo retrospectivo, foram adotadas metodologias padronizadas para identificar, sorotipar e determinar a susceptibilidade à penicilina, cefotaxima e vancomicina. O estudo foi realizado com cepas de pneumococo isoladas de liquor em pacientes atendidos nos hospitais públicos e em três hospitais particulares do Distrito Federal no período de janeiro de 1995 a dezembro de 2004. A identificação e a determinação de susceptibilidade a antimicrobianos foi realizada no Laboratório Central de Saúde Pública no Distrito Federal. A sorotipagem foi realizada no Instituto Adolfo Lutz. RESULTADOS: Foram isoladas 232 cepas de pneumococo, compreendendo 126 cepas (54,31 por cento) de pacientes do sexo masculino. A idade dos pacientes variou de 0 a 62 anos, sendo agrupados em faixas etárias de 0 a 5, 6 a 17, 18 a 50 e acima de 50 anos. Identificaram-se 36 sorotipos distintos. Desses destacaram-se oito: 14, 6B, 18C, 5, 19F, 23F, 9V e 6A. O teste de oxacilina caracterizou 67 cepas resistentes à penicilina; dessas, 47 foram confirmadas pelo E teste com resistência de nível intermediário. Nenhuma cepa apresentou resistência de alto nível. CONCLUSÃO: A resistência do pneumococo à penicilina apresentou um aumento gradativo nos últimos 10 anos no Distrito Federal. Os sorotipos mais isolados na faixa etária de 0 a 5 anos foram também os mais envolvidos na resistência à penicilina, e estão incluídos na vacina 7-valente.

OBJECTIVE: To determine the frequency of capsular serotypes and the antimicrobial susceptibility of strains of Streptococcus pneumoniae, as well as to provide recommendations on the use of available vaccines and antimicrobial drugs. METHODS: In this retrospective study, standard procedures were followed to identify, serotype, and determine bacterial susceptibility to penicillin, cefotaxime, and vancomycin. Pneumococcal strains were isolated from the cerebrospinal fluid (CSF) of patients admitted to nine public and three private hospitals in Distrito Federal, Brazil, between January 1995 and December 2004. Identification and antimicrobial susceptibility tests were carried out at the Central Laboratory of Public Health (Laboratório Central de Saúde Pública). Serotyping was performed at Instituto Adolfo Lutz. RESULTS: A total of 232 pneumococcal strains were isolated, including 126 (54.31 percent) strains from male patients. Patients had an age range of 0 to 62 years and were distributed into four age groups: 0 to 5, 6 to 17, 18 to 50, and above 50. From the 36 distinct serotypes identified, eight were more prevalent: 14, 6B, 18C, 5, 19F, 23F, 9V, and 6A. The oxacillin test identified 67 penicillin-resistant strains, out of which 47 were confirmed by the E test as having intermediate level of resistance. None of the strains exhibited high-level resistance. CONCLUSIONS: Pneumococcal resistance to penicillin has gradually increased over the last 10 years in Distrito Federal. Serotypes more frequently isolated in the 0 to 5 years age group were the same involved in penicillin-resistance, all of which are covered by the 7-valent vaccine.