Epidemiología de la faringitis estreptocócica. Período enero de 2018 - diciembre de 2021 / Epidemiology of streptococcal pharyngitis. January 2018 - December 21

La faringoamigdalitis es uno de los motivos más frecuentes de consulta en pediatría. Aproximadamente un 70-80% de las faringoamigdalitis son de etiología viral. El 20-30% restante son de origen bacteriano. El agente causal más frecuente es Streptococcus pyogenes (estreptococo ß-hemolítico del grupo A). El rol de Streptococcus dysgalactiae subsp. equisimilis, (estreptococos ß-hemolíticos grupos C y G) fue claramente establecido como agente etiológico en la faringitis bacteriana, tanto en niños como en adultos. Se realizó un análisis descriptivo y retrospectivo entre enero 2018 y diciembre de 2021. Se evaluó la prevalencia de faringitis estreptocócica, la edad, el período estacional, los agentes etiológicos y la resistencia a macrólidos durante los períodos pre-COVID-19 (2018-2019) y COVID-19 (2020-2021). Se analizaron 11 396 muestras de exudados de fauces de pacientes con sospecha de faringitis bacteriana; las mismas se procesaron mediante el uso de técnicas microbiológicas convencionales. En el período estudiado el porcentaje de positividad de los cultivos de exudados de fauces se mantuvo constante. Al comparar los períodos pre-COVID-19 (2018-2019) y COVID-19 (2020-2021) se observó una disminución en el número de aislados de S. pyogenes con un aumento de S. dysgalactiae subsp. equisimilis, mientras que la resistencia a macrólidos encontrada fue superior en S. pyogenes y para S. dysgalactiae subsp. equisimilis se mantuvo constante. Es importante realizar el cultivo para la identificación del agente etiológico y determinar la sensibilidad antibióticapara continuar con la vigilancia epidemiológica de la resistencia a los macrólidos, porque representan una opción en pacientes alérgicos a ß-lactámicos (AU)

Pharyngotonsillitis is one of the most frequent reasons for consultation in children. Approximately 70-80% of pharyngotonsillitis are of viral etiology. The remaining 20-30% are bacterial in origin. The most frequent causative agent is Streptococcus pyogenes (group A ß-hemolytic streptococcus). Streptococcus dysgalactiae subsp. equisimilis (ß-hemolytic streptococcus groups C and G) was clearly established as an etiologic agent in bacterial pharyngitis in both children and adults. A descriptive and retrospective analysis was conducted between January 2018 and December 2021. The prevalence of streptococcal pharyngitis, age, seasonal period, etiologic agents, and macrolide resistance during the pre-COVID-19 (2018-2019) and COVID-19 (2020-2021) periods were evaluated. We analyzed 11 396 specimens of swabs from patients with suspected bacterial pharyngitis. Conventional microbiological techniques were used. In the study period, the percentage of positivity of swab cultures remained constant. When comparing the preCOVID-19 (2018-2019) and COVID-19 (2020-2021) periods, a decrease in the number of S. pyogenes isolates was observed with an increase in S. dysgalactiae subsp. equisimilis, while the resistance to macrolides found was higher for S. pyogenes and remained constant for S. dysgalactiae subsp. equisimilis. The identification of the etiologic agent and determination of antibiotic sensitivity are important for epidemiological surveillance of macrolide resistance, as they are a treatment option in patients who are allergic to ß-lactams (AU)

Antimalarials and macrolides: a review of off-label pharmacotherapies during the first wave of the SARS-CoV-2 pandemic

Abstract We critically analyzed clinical trials performed with chloroquine (CQ) and hydroxychloroquine (HCQ) with or without macrolides during the first wave of COVID-19 and discussed the design and limitations of peer-reviewed studies from January to July 2020. Seventeen studies were eligible for the discussion. CQ and HCQ did not demonstrate clinical advantages that justified their inclusion in therapeutic regimens of free prescription for treatment or prophylactic purposes, as suggested by health authorities, including in Brazil, during the first wave. Around August 2020, robust data had already indicated that pharmacological effects of CQ, HCQ and macrolides as anti-SARS-CoV-2 molecules were limited to in vitro conditions and largely based on retrospective trials with low quality and weak internal validity, which made evidence superficial for decision-making. Up to that point, most randomized and nonrandomized clinical trials did not reveal beneficial effects of CQ or HCQ with or without macrolides to reduce lethality, rate of intubation, days of hospitalization, respiratory support/mechanical ventilation requirements, duration, type and number of symptoms, and death and were unsuccessful in increasing virus elimination and/or days alive in hospitalized or ambulatory patients with COVID-19. In addition, many studies have demonstrated that side effects are more common in CQ-or HCQ-treated patients.

Indicación y prescripción de macrólidos en una población colombiana / Study of the indications for macrolide prescriptions in a Colombian population

Introducción. El uso inadecuado de antibióticos se asocia con aumento de la resistencia antimicrobiana, mayores costos de atención médica, más efectos adversos y peores resultados clínicos. Objetivo. Determinar los patrones de prescripción y las indicaciones aprobadas y no aprobadas para macrólidos en un grupo de pacientes en Colombia. Materiales y métodos. Se hizo un estudio de corte transversal sobre las indicaciones de uso de macrólidos en pacientes ambulatorios a partir de una base de datos de dispensación de medicamentos de 8,5 millones, aproximadamente, de personas afiliadas al sistema de salud de Colombia. Se consideraron variables sociodemográficas, farmacológicas y clínicas. Resultados. Se encontraron 9.344 pacientes que habían recibido prescripción de macrólidos; su mediana de edad era de 40,1 años (rango intercuartílico: 27,1-53,3 años) y el 58,3 % correspondía a mujeres. El macrólido más prescrito fue la azitromicina (38,8 %) y los usos más frecuentes fueron el tratamiento de la infección por Helicobacter pylori (15,9 %) y la neumonía (15,8 %). El 31,3 % de las prescripciones correspondía a indicaciones no aprobadas, destacándose el resfriado común (7,8 %), la Covid-19 (4,0 %) y la bronquitis aguda (3,5 %). La residencia en la región Caribe (OR=1,17; IC95% 1,05-1,31), las prescripciones odontológicas (OR=2,75; IC95% 1,91-3,96), las comorbilidades respiratorias crónicas (OR=1,30; IC95% 1,08-1,56), y la prescripción de eritromicina (OR=3,66; IC95% 3,24-4,14) o azitromicina (OR=2,15; IC95% 1,92 2,41), se asociaron con una mayor probabilidad de recibir macrólidos para indicaciones no aprobadas, en tanto que tener entre 18 y 64 años (OR=0,81; IC95% 0,71-0,93), 65 o más años (OR=0,77; IC95% 0,63-0,94) y residir en Bogotá-Cundinamarca (OR=0,74; IC95% 0,65 0,85) reducían dicho riesgo. Conclusiones. La mayoría de los pacientes recibieron macrólidos para infecciones del sistema respiratorio; la eritromicina y la azitromicina se prescribieron en indicaciones no aprobadas en menores de 18 años y en quienes presentaban enfermedades respiratorias crónicas.

Introduction: The inappropriate use of antibiotics is associated with a greater risk for antimicrobial resistance, high health care costs, adverse events, and worse clinical outcomes. Objective: To determine the prescription patterns and approved and nonapproved indications for macrolides in a group of patients from Colombia. Materials and methods: This was a cross-sectional study on the indications for the use of macrolides in outpatients registered in a drug-dispensing database of approximately 8.5 million people affiliated with the Colombian health system. Sociodemographic, pharmacological, and clinical variables were considered. Results: A total of 9.344 patients had received a macrolide prescription; their median age was 40.1 years (interquartile range: 27.1-53.3 years) and 58.3% were women. The most commonly prescribed macrolide was azithromycin (38.8%) most frequently for Helicobacter pylori infection (15.9%) and pneumonia treatment (15.8%). A total of 31.3% of the prescriptions were used for unapproved indications: common cold (7.8%), COVID-19 (4.0%), and acute bronchitis (3.5%). Residence in the Caribbean region (OR=1.17; 95%CI 1.05-1.31), dental prescriptions (OR=2.75; 95%CI 1.91-3.96), presence of chronic respiratory comorbidities (OR=1.30; 95%CI 1.08-1.56), and prescription of erythromycin (OR=3.66; 95%CI 3.24-4.14) or azithromycin (OR=2.15; 95%CI 1,92-2.41) were associated with a higher probability of macrolide use for unapproved indications while being 18-64 years old (OR=0.81; 95%CI 0.71-0.93) or 65 years or older (OR=0.77; 95%CI 0.63-0.94) and residing in Bogotá-Cundinamarca (OR=0.74; 95%CI 0.65-0.85) were associated with reduced risk. Conclusions: Most patients received macrolides for respiratory tract infections; erythromycin and azithromycin were used for unapproved indications in people under 18 years of age and those with chronic respiratory diseases.

Infección por Staphylococcus lugdunensis: descripción de 44 casos / Staphylococcus lugdunensis infection: report of 44 cases

INTRODUCCIÓN: Staphylococcus lugdunensis, es un estafilococo coagulasa negativa (SCN) con características de virulencia y de sensibilidad antimicrobiana que lo hacen más parecido a Staphylococcus aureus que a otros SCN. OBJETIVOS: Conocer las características clínicomicrobiológicas de los aislados de S. lugdunensis identificados en nuestra institución. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo de los aislados de S. lugdunensis entre los años 2017 y 2019 en el Servicio de Microbiología del Hospital Universitario San Jorge de Huesca (España). Se revisaron las historias clínicas correspondientes a los pacientes con aislamiento de S. lugdunensis, considerándose las siguientes variables: edad, sexo, tipo de muestra, servicio de procedencia y enfermedad de base. La identificación bacteriana se realizó con MALDI-TOF VITEK MS (BioMérieux, Francia). Así mismo, se estudió su patrón de susceptibilidad antimicrobiana in vitro mediante microdilución en placa. RESULTADOS: Se obtuvieron 44 aislados de S. lugdunensis: 12 procedían de heridas, 10 fueron abscesos, 8 úlceras, 7 orinas, 4 frotis cutáneos, 2 exudados óticos, y 1 exudado vaginal. En relación con la enfermedad de base destacaron cinco pacientes con procesos tumorales y diez con diabetes mellitus. En 17 pacientes existían antecedentes de cirugía o traumatismo reciente. La mayoría de las cepas fueron sensibles a los antimicrobianos estudiados. En 19 de ellas se observó producción de β-lactamasa, dos fueron resistentes a macrólidos y tres a clindamicina. Todas las cepas fueron sensibles a oxacilina, gentamicina y cotrimoxazol. CONCLUSIONES: Aunque S. lugdunensis mantiene una buena sensibilidad a la mayoría de los antimicrobianos, su tendencia a producir abscesos y que exprese factores de virulencia más parecido a S. aureus que a otros SCN, hace necesaria una correcta identificación en el laboratorio con el fin de que su incidencia no quede subestimada.

BACKGROUND: Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CNS) with virulence and antibiotic sensitivity characteristics which makes it more similar to Staphylococcus aureus than other CNS. AIM: To know the microbiological and clinical characteristics of S. lugdunensis isolates identified from our health sector. METHODS: A retrospective study of S. lugdunensis isolates was carried out between 2017 and 2019 in the Microbiology Service of the San Jorge University Hospital in Huesca (Spain). The clinical records of patients with S. lugdunensis isolation were reviewed, considering the following factors: age, sex, sample type, service and underlying disease. Bacterial identification was performed using MALDI-TOF VITEK MS (BioMérieux, France). The pattern of antibiotic susceptibility was studied by means of plate microdilution. RESULTS: 44 isolates of S. lugdunensis were obtained: 12 corresponded to wounds, 10 were abscesses, 8 ulcers, 7 urine samples, 4 skin smears, 2 otic exudates, and 1 vaginal exudate. Regarding the underlying disease, five patients had a tumor processes and ten had diabetes mellitus. In 17 patients there was a history of recent surgery or trauma. Most of the strains were susceptible to the antibiotics studied. Production of beta-lactamase was observed in 19 of them, two were resistant to macrolides and three to clindamycin. None of the isolates were resistant to oxacillin, gentamicin or cotrimoxazole. CONCLUSIONS: Although S. lugdunensis maintains a good sensitivity to most antibiotics, its tendency to produce abscesses and that it expresses virulence factors more similar to S. aureus than to other CNS requires a correct identification in the laboratory so that its incidence is not underestimated.

Uso de macrólidos en niños hospitalizados en unidades de cuidados moderados e intensivos durante 2018 / Use of macrolides in children hospitalized in Intensive and moderate care units in 2018 / Uso de macrólidos em crianças hospitalizadas em unidades de cuidados intermediários e intensivos no 2018

Introducción: se describe a nivel mundial un aumento en la prescripción de macrólidos en niños y adolescentes, generando el riesgo de emergencia de cepas resistentes. Objetivo: caracterizar el uso de macrólidos en niños de 1 mes a 14 años hospitalizados en cuidados moderados e intensivos del Hospital Pediátrico del Centro Hospitalario Pereira Rossell (HP-CHPR). Metodología: estudio descriptivo transversal de niños hospitalizados tratados con macrólidos en el HP-CHPR en 2018. Variables: tipo de macrólido, duración del tratamiento, estudios y hallazgos microbiológicos y diagnóstico al egreso. Resultados: recibieron macrólidos 334 niños, mediana de edad 13 meses, 58,4% varones. 71,0% en Unidad de Terapia Intensiva (UTI). Predominó la prescripción de claritromicina (72,8%), durante los dos últimos cuatrimestres del año (77,5%) y por patología respiratoria (94%): bronquiolitis (23,3%), infección aguda no especificada de las vías respiratorias inferiores (21,9%) y crisis asmática (19,1%). Mediana de tratamiento con azitromicina y claritromicina 5 y 8 días respectivamente. Se realizaron estudios microbiológicos en 96,1% sin determinarse microorganismo en 58,3%. Conclusiones: se destaca el uso de macrólidos principalmente en la UTI y por patología respiratoria. La prescripción por fuera de las recomendaciones nacionales vigentes y la baja confirmación microbiológica que apoye el uso fueron los mayores problemas detectados, por lo que parece fundamental establecer estrategias tendientes a promover un uso racional de estos antibióticos.

Introduction: literature has described a global increase in the prescription of macrolides to children and adolescents , which has increased the risk of emergence of resistant strains. Objective: to characterize the use of macrolides in children from 1 month to 14 years of age hospitalized at the moderate and intensive care units of the Pereira Rossell Pediatric Hospital Center (HP-CHPR). Methodology: descriptive cross-sectional study of hospitalized children treated with macrolides at the HP-CHPR in 2018. Variables: macrolide type, treatment duration, microbiological studies and findings, and diagnosis at discharge. Results: 334 children received macrolides, median age 13 months, 58.4% males. 71.0% hospitalized atnan Intensive Care Unit (ICU). Clarithromycin was mainly prescribed in 72.8% of the cases, during the last two quarters of the year (77.5%), due to respiratory disease (94%): bronchiolitis (23.3%), lower respiratory tract unspecified acute infection (21.9%) and asthma crisis (19.1%). Median treatment included Azithromycin and Clarithromycin for 5 and 8 days respectively. Microbiological studies were carried out in 96.1% of the cases and 58.3% did not show the presence of microorganisms. Conclusions: the use of macrolides stands out, mainly at ICUs and due to respiratory pathologies. The main problems identified were prescriptions made outside the framework of the present national recommendations and the low microbiological confirmation for their use, which suggests it is essential to set strategies to promote a more rational use of these antibiotics.

Introdução: a literatura descreve um aumento a nível global na prescrição de macrolídeos para crianças e adolescentes, o que tem aumentado o risco de surgimento de cepas resistentes. Objetivo: caracterizar o uso de macrolídeos em crianças de 1 mês a 14 anos de idade internadas nas unidades de terapia moderada e intensiva do Centro Hospitalar Pediátrico Pereira Rossell (HP-CHPR). Metodologia: estudo transversal descritivo de crianças hospitalizadas tratadas com macrolídeos no HP-CHPR em 2018. Variáveis: tipo de macrolídeo, duração do tratamento, estudos e achados microbiológicos e diagnóstico no momento da alta. Resultados: 334 crianças receberam macrolídeos, idade mediana de 13 meses, 58,4% do sexo masculino. 71,0% internados em Unidade de Terapia Intensiva (UTI). A Claritromicina foi prescrita principalmente em 72,8% dos casos, nos últimos dois trimestres do ano (77,5%), devido a doença respiratória (94%): bronquiolite (23,3%), infecção aguda não especificada do trato respiratório inferior (21,9%) e crise de asma (19,1%). O tratamento médio incluiu Azitromicina e Claritromicina por 5 e 8 dias, respectivamente. Estudos microbiológicos foram realizados em 96,1% dos casos e 58,3% não evidenciaram a presença de microrganismos. Conclusões: destaca-se o uso de macrolídeos, principalmente em UTIs, e devido a patologias respiratórias. Os principais problemas identificados foram as prescrições feitas fora das atuais recomendações nacionais e a baixa confirmação microbiológica para sua utilização, o que sugere que é essencial definir estratégias para promover uma utilização mais racional destes antibióticos.

Proteomics study of Mycoplasma pneumoniae pneumonia reveals the Fc fragment of the IgG-binding protein as a serum biomarker and implicates potential therapeutic targets / 医学前沿

Macrolide and corticosteroid resistance has been reported in patients with Mycoplasma pneumoniae (MP) pneumonia (MPP). MP clearance is difficult to achieve through antibiotic treatment in sensitive patients with severe MPP (SMPP). SMPP in children might progress to airway remodeling and even bronchiolitis/bronchitis obliterans. Therefore, identifying serum biomarkers that indicate MPP progression and exploring new targeted drugs for SMPP treatment require urgency. In this study, serum samples were collected from patients with general MPP (GMPP) and SMPP to conduct proteomics profiling. The Fc fragment of the IgG-binding protein (FCGBP) was identified as the most promising indicator of SMPP. Biological enrichment analysis indicated uncontrolled inflammation in SMPP. ELISA results proved that the FCGBP level in patients with SMPP was substantially higher than that in patients with GMPP. Furthermore, the FCGBP levels showed a decreasing trend in patients with GMPP but the opposite trend in patients with SMPP during disease progression. Connectivity map analyses identified 25 possible targeted drugs for SMPP treatment. Among them, a mechanistic target of rapamycin kinase (mTOR) inhibitor, which is a macrolide compound and a cell proliferation inhibitor, was the most promising candidate for targeting SMPP. To our knowledge, this study was the first proteomics-based characterization of patients with SMPP and GMPP.

Caracterización molecular de genes de virulencia (lmb, bca y rib) y de resistencia a macrólidos (ermB, ermTR y mefA) en aislamientos clínicos de Streptococcus agalactiae / Molecular characterization of virulence (lmb, bca and rib) and macrolid resistance genes (ermB, ermTR and mefA) in clinical isolates of Streptococcus agalactiae

RESUMEN El objetivo del estudio fue identificar molecularmente los genes de virulencia y resistencia a macrólidos en aislamientos clínicos de Streptococcus agalactiae (EGB), recuperados en 2019 a partir de secreción vaginal (n=9) y orina (n=22), en dos establecimientos de salud de Lima. La identificación y susceptibilidad antimicrobiana se determinaron por el sistema automatizado Vitek® 2, se confirmó la identificación fenotípicamente; la resistencia a macrólidos por el método D-test; la identificación de genes de virulencia (lmb, bca y rib) y de resistencia a macrólidos (ermB, ermTR y mefA) por reacción en cadena de la polimerasa (PCR). El fenotipo y genotipo de resistencia a macrólidos predominante fue cMLSb (12/31) y ermB (11/31), y el gen de virulencia más frecuente fue lmb (23/31). Todos fueron sensibles a penicilina, ampicilina y vancomicina. Estos hallazgos muestran la necesidad de implementar estudios de epidemiología molecular que permitan un adecuado conocimiento y seguimiento de EGB en el Perú.

ABSTRACT The aim of the study was to molecularly identify virulence and macrolide resistance genes in clinical isolates of Streptococcus agalactiae (GBS), recovered in 2019 from vaginal discharge (n=9) and urine (n=22), from two health facilities in Lima. Identification and antimicrobial susceptibility were determined by the Vitek® 2 automated system, identification was confirmed phenotypically; macrolide resistance was determined by the D-test method. Identification of virulence genes (lmb, bca and rib) and macrolide resistance genes (ermB, ermTR and mefA) was carried out by polymerase chain reaction (PCR). The predominant macrolide resistance phenotype and genotype were cMLSb (12/31) and ermB (11/31); the most frequent virulence gene was lmb (23/31). All were sensitive to penicillin, ampicillin and vancomycin. These findings show the need to implement molecular epidemiology studies that allow adequate knowledge and follow-up of GBS in Peru.

Anthelmintic resistance in Creole horses in the South of Rio Grande do Sul, Brazil / [Resistência anti-helmíntica em equinos da raça Crioula no sul do Rio Grande do Sul, Brasil]

The objective of the study was to evaluate the antiparasitic resistance against horse nematodes in the South of Rio Grande do Sul, Brazil. The results concerning the tests of anthelmintic efficacy on horses, stored in the database of the Parasitic Diseases Study Group (GEEP) - Veterinary Faculty, at the Federal University of Pelotas (UFPel), were carried out in the laboratory from 2018 to 2019. Stool samples were received from farms with breeding of adult female and male Criollo horses naturally infected, located in municipalities in the country's southern region. The antiparasitic agents tested were Triclorfon + Fenbendazole, Closantel + Albendazole, Ivermectin + Praziquantel, Fenbendazole, Ivermectin, Doramectin, Mebendazole and Moxidectin. Techniques such as Gordon and Whitlock, Coproculture and Fecal Egg Count Reduction Test were performed. Of all the antiparasitic drugs tested, it was observed that only treatments with Ivermectin 2% showed desired values. The observed results indicate that resistance to macrocyclic lactones is usual in equine parasites in this Brazilian region, despite the results with isolated Ivermectin.(AU)

O objetivo deste estudo é avaliar a resistência antiparasitária contra nematodeos de equinos no sul do Rio Grande do Sul, Brasil. Os resultados referentes aos testes de eficácia anti-helmíntica em cavalos, armazenados no banco de dados do Grupo de Estudos de Doenças Parasitárias (GEEP) - Faculdade de Veterinária, da Universidade Federal de Pelotas (UFPel), foram realizados em laboratório, no período de 2018 a 2019. Amostras de fezes foram recebidas de fazendas com criação de cavalos Crioulos adultos fêmeas e machos naturalmente infectados, localizadas em municípios da região Sul do país. Os agentes antiparasitários testados foram triclorfon + fenbendazol, closantel + ivermectina + praziquantel, fenbendazol, ivermectina, doramectina, mebendazol e moxidectina. Técnicas como Gordon e Whitlock, coprocultura e teste de redução da contagem de ovos fecais foram realizadas. De todos os antiparasitários testados, observou-se que apenas os tratamentos com ivermectina 2% apresentaram os valores desejados. Os resultados indicam que a resistência às lactonas macrocíclicas é comum em parasitas equinos nessa região brasileira, apesar dos resultados com ivermectina isolada.(AU)

Advances in biodegradation of macrolide antibiotics / 生物工程学报

Macrolide antibiotics are a class of broad-spectrum antibiotics with the macrolide as core nucleus. Recently, antibiotic pollution has become an important environmental problem due to the irregular production and abuse of macrolide antibiotics. Microbial degradation is one of the most effective methods to deal with antibiotic pollution. This review summarizes the current status of environmental pollution caused by macrolide antibiotics, the degradation strains, the degradation enzymes, the degradation pathways and the microbial processes for degrading macrolide antibiotics. Moreover, the critical challenges on the biodegradation of macrolide antibiotics were also discussed.

Advances in metabolic engineering of macrolide antibiotics / 生物工程学报

14- to 16-membered macrolide antibiotics (MA) are clinically important anti-infective drugs. With the rapid emergence of bacterial resistance, there is an urgent need to develop novel MA to counter drug-resistant bacteria. The targeted optimization of MA can be guided by analyzing the interaction between the MA and its ribosomal targets, and the desired MA derivatives can be obtained efficiently when combining with the rapidly developed metabolic engineering approaches. In the past 30 years, metabolic engineering approaches have shown great advantages in engineering the biosynthesis of MA to create new derivatives and to improve their production. These metabolic engineering approaches include modification of the structural domains of the polyketide synthase (PKS) and post-PKS modification enzymes as well as combinatorial biosynthesis. In addition, the R&D (including the evaluation of its antimicrobial activities and the optimization through metabolic engineering) of carrimycin, a new 16-membered macrolide drug, are described in details in this review.

Macrólidos para el tratamiento de COVID-19: una revisión sistemática viva / Macrolides for the treatment of COVID-19: a living, systematic review

OBJETIVO Proporcionar un resumen oportuno, riguroso y continuamente actualizado de la evidencia disponible sobre el papel de los macrólidos para el tratamiento de pacientes con COVID-19. DIDEÑO Revisión Sistemática Viva. BASE DE DATOS: La búsqueda de evidencia se realizó en el repositorio centralizado L·OVE (Living OVerview of Evidence) COVID-19; una plataforma que mapea las preguntas PICO para identificar la evidencia en la base de datos Epistemonikos. En respuesta a la emergencia de COVID-19, L·OVE se adaptó para ampliar el rango de evidencia que cubre y hoy se mantiene a través de búsquedas regulares en 39 bases de datos. MÉTODOS: Se incluyeron estudios experimentales que evaluaban el efecto de los macrólidos, como monoterapia o en combinación con otros fármacos, versus placebo o ningún tratamiento en pacientes con sospecha o confirmación de COVID-19. Se buscó identificar experimentos clínicos aleatorizados que evaluaran macrólidos en infecciones causadas por otros coronavirus, como MERS-CoV y SARS-CoV. Dos revisores examinaron de forma independiente la elegibilidad de cada estudio, extrajeron los datos y evaluaron el riesgo de sesgo. Se evaluó el efecto de los macrólidos sobre la mortalidad por todas las causas; necesidad de ventilación mecánica invasiva; oxigenación por membrana extracorpórea, duración de la estancia hospitalaria, insuficiencia respiratoria, eventos adversos graves, tiempo hasta la negatividad de la RT-PCR del SARS-CoV-2. La certeza de la evidencia para cada desenlace se evaluó siguiendo la aproximación GRADE. Esta revisión se mantendrá viva y disponible abiertamente durante la pandemia de COVID-19. Se someterán actualizaciones de su publicación cada vez que cambien las conclusiones o cuando haya actualizaciones sustanciales. RESULTADOS: Se identificó un experimento clínico aleatorio que evaluó el uso de azitromicina en combinación con hidroxicloroquina en comparación con el uso de hidroxicloroquina sola, en pacientes hospitalizados por COVID 19. Las estimaciones para todos los resultados evaluados resultaron en un poder estadístico insuficiente para llegar a conclusiones válidas. La calidad de la evidencia para los resultados principales fue baja a muy baja. CONCLUSIONES: El uso de macrólidos en el tratamiento de pacientes con COVID 19 no ha mostrado efectos beneficiosos en comparación con el tratamiento estándar. La evidencia para todos los desenlaces no es concluyente. Se necesitan estudios sobre un mayor número de pacientes con COVID 19, para determinar los efectos del uso de macrólidos sobre los desenlaces relacionados con la enfermedad.

OBJECTIVE This living, systematic review aims to provide a timely, rigorous, and continuously updated summary of the evidence available on the role of macrolides for treating patients with COVID-19. DESIGN: a living, systematic review. DATABASE: We conducted searches in the centralized repository L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from the Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customized to group all COVID-19 evidence in one place. Today it is maintained through regular searches in 39 databases.METHODS: We included randomized trials evaluating the effect of macrolides ­ as monotherapy or in combination with other drugs ­ versus placebo or no treatment in patients with COVID-19. Randomized trials evaluating macrolides in infections caused by other coronaviruses, such as MERS-CoV and SARS-CoV, and non-randomized studies in COVID-19 were searched in case we found no direct evidence from randomized trials. Two reviewers independently screened each study for eligibility, extracted data, and assessed the risk of bias. Measures included all-cause mortality; the need for invasive mechanical ventilation; extracorporeal membrane oxygenation, length of hospital stay, respiratory failure, serious adverse events, time to SARS-CoV-2 RT-PCR negativity. We applied the GRADE approach to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates. RESULTS: The search in the L·OVE platform retrieved 424 references. We considered 260 as potentially eligible and were reviewed in full texts. We included one randomized clinical trial that evaluated the use of azithromycin in combination with hydroxychloroquine compared to hydroxychloroquine alone in hospitalized patients with COVID 19. The estimates for all outcomes evaluated resulted in insufficient power to draw conclusions. The quality of the evidence for the main outcomes was low to very low. CONCLUSIONS: Macrolides in the management of patients with COVID 19 showed no beneficial effects compared to standard of care. The evidence for all outcomes is inconclusive. Larger trials are needed to determine the effects of macrolides on pulmonary and other outcomes in COVID-19 patients.

Coinfección por Mycobacterium abscessus y Mycobacterium tuberculosis en un paciente con síndrome de Cushing exógeno y otras comorbilidades / Mycobacterium abscessus and Mycobacterium tuberculosis coinfection in a patient with exogenous Cushing syndrome and other comorbilities

RESUMEN Mycobacterium abscessus es una micobacteria no tuberculosa de crecimiento rápido, que produce infección pulmonar, cutánea, diseminada y otras, sobre todo en pacientes con comorbilidades. El diagnóstico se basa en la identificación de la micobacteria por medios de cultivo o por pruebas moleculares. El tratamiento con macrólidos y amikacina continúa siendo el ideal, aunque depende de la localización y de la gravedad de la infección, sin embargo, se han identificado genes de resistencia en algunas subespecies que limitan la eficacia antibiótica. Presentamos el caso de un paciente con coinfección cutánea por Mycobacterium abscessus y Mycobacterium tuberculosis, quien presenta un síndrome de Cushing exógeno, factor predisponente para estas infecciones. Además, se identificaron hidatidosis y aspergilosis pulmonares. El tratamiento antituberculoso del paciente se ajustó para manejar ambas micobacterias, y su evolución fue favorable.

ABSTRACT Mycobacterium abscessus is a fast-growing non-tuberculous mycobacterium that causes lung, skin, disseminated and other infections, mainly in patients with comorbidities. The diagnosis is based on the identification of the mycobacterium by culture media or molecular tests. Treatment with macrolides and amikacin remains the optimal choice, although it depends on the location and severity of the infection; however, resistance genes have been identified in some subspecies that limit antibiotic efficacy. We present the case of a patient with cutaneous coinfection by Mycobacterium abscessus and Mycobacterium tuberculosis, who presented exogenous Cushing syndrome, a predisposing factor for these infections. In addition, hydatidosis and pulmonary aspergillosis were identified. The patient's anti-tuberculosis treatment was adjusted to manage both mycobacteria, resulting in a favorable evolution.

Macrolide-lincosamide-streptogramin B resistance phenotypes and their associated genotypes in Staphylococcus aureus isolates from a tertiary level public hospital of Uruguay / Fenotipos de resistencia a macrólidos lincosamidas-estreptograminas B y sus genotipos asociados en Staphylococcus aureus aislados en un hospital público de nivel terciario en Uruguay

Abstract This study was undertaken to investígate the resistance phenotypes to macrolide-lincosamide-streptogramin B (MLSb) antibiotics and their associated genotypes in isolates of Staphylococcus aureus. We analyzed one hundred, consecutive, non-duplicate isolates (methicillin-susceptible MSSA, n = 53 and methicillin-resistant MRSA, n =47) obtained from var-ious clinical samples between July 2012 to December 2013. The resistance profile to MLSb antibiotics was determined by phenotypic methods and the resistance genes were detected by PCR assays. All of the isolates were subjected to pulsed-field gel electrophoresis (SmaI-PFGE). The overall prevalence of resistance to MLSb antibiotics was 38% and the resistance phenotype distribution was as follows: cMLSb, 22%; iMLSB, 10%; MSb, 5% and L, 1%. We detected ermA, ermC, ermB and mrsA/B genes in these resistant isolates. The single ermA gene was commonly observed mainly in those with a cMLSb R phenotype, whereas the combination ermA and ermC was more commonly observed in isolates with inducible expression. The patterns of SmaI-PFGE suggest a great genetic diversity in both MRSA and MSSA resistant to MLSb antibiotics. The results demonstrate the local presence of S. aureus resistant to MLSb antibiotics and its most frequently described responsible genes. Some of these isolates, especially those with the iMLSB phenotype, may be associated with therapeutic failure. Therefore, efforts should be directed to the correct detection of all MLSb resistant isolates using appropriate laboratory tests. PFGE results reveal a wide spread of resistance genes rather than the circulation of S. aureus clones resistant to MLSb antibiotics.

Resumen Los objetivos de este estudio fueron investigar en Staphylococcus aureus la presencia de fenotipos resistentes a los antibióticos macrólidos, lincosamidas y estreptograminas tipoB (MLSb) y conocer sus genotipos responsables. Analizamos 100 aislamientos consecutivos, no duplicados (53 sensibles a meticilina [MSSA] y 47 resistentes a meticilina [MRSA]), obtenidos entre 2012 y 2013 a partir de diferentes muestras clínicas. El perfil de resistencia a los antibióticos MLSb fue determinado por métodos fenotípicos y los genes de resistencia se detectaron por PCR. Todos los aislamientos fueron comparados por SmaI-PFGE. La prevalencia global de resistencia a los antibióticos MLSB fue del 38% y la distribución de los fenotipos de resistencia fue la siguiente: cMLSB, 22%; iMLSB, 10%; MSB, 5%; L, 1%. Se detectaron los genes ermA, ermC y mrsA/B en los aislamientos resistentes. El gen ermA se observó, sobre todo, en aislamientos con fenotipo resistente constitutivo R (cMLSB), mientras que la combinación ermA y ermC se detectó principalmente en aislamientos con resistencia inducible (iMLSB). Los patrones de Smal-PFGE sugieren una gran diversidad genética en los aislamientos resistentes a los antibióticos MLSb, tanto MRSA como MSSA. Los resultados demuestran la presencia local de S. aureus resistentes a los antibióticos MLSB y de sus genes responsables más frecuentemente descritos. Estos cultivos, especialmente aquellos con fenotipo resistente iMLSB, pueden asociarse con fallas terapéuticas. Por lo tanto, los esfuerzos deben dirigirse a la correcta detección de todos los cultivos resistentes a MLSB utilizando pruebas de laboratorio adecuadas. Los resultados de Smal-PFGE sugieren una amplia diseminación de genes de resistencia, más que la circulación de clones resistentes a los antibióticos MLSB.

Comparison of novaluron, pyriproxyfen, spinosad and temephos as larvicides against Aedes aegypti in Chiapas, Mexico / Comparación de novaluron, piriproxifeno, spinosad y temefos como larvicidas contra Aedes aegypti en Chiapas, México

Abstract: Objective: To compare the efficacy of three modern larvicides with the organophosphate temephos for control of Aedes aegypti in water tanks in Chiapas. Materials and methods: Trials were performed to compare the efficacy of pyriproxyfen, novaluron, two formulations of spinosad (granules and tablets) and temephos in oviposition traps and domestic water tanks. Results: Pyriproxyfen and temephos provided 2-3 weeks of complete control of larvae in oviposition traps, whereas spinosad granules and novaluron provided 7-12 weeks of control. Treatment of water tanks resulted in a significant reduction in oviposition by Ae. aegypt in houses (p<0.001). Higher numbers of larvae were present in temephos and pyriproxyfen-treated water tanks compared to novaluron and spinosad tablet treatments during most of the study. Conclusion: Spinosad formulations and novaluron were effective larvicides in this region. The poor performance of temephos may be indicative of reduced susceptibility in Ae. aegypti populations in Chiapas.

Resumen: Objetivo: Comparar la eficacia de tres larvicidas modernos para el control de Aedes aegypti en tanques de agua doméstica en Chiapas. Material y métodos: Se comparó la eficacia de piriproxifeno, novalurón, dos formulaciones de spinosad (gránulos y tabletas) y temefos en ovitrampas y tanques domésticos de agua. Resultados: El piriproxifeno y el temefos proporcionaron de 2 a 3 semanas de control de larvas en ovitrampas, mientras que los gránulos de spinosad y novaluron proporcionaron de 7 a12 semanas. Los tanques de agua tratados produjeron una reducción significativa en la oviposición por Ae. aegypti en las casas (p<0.001). Se encontró gran cantidad de larvas en los tanques tratados con temefos y piriproxifeno en comparación con los tratados con novaluron y tabletas de spinosad durante la mayor parte del estudio. Conclusión: Las formulaciones de spinosad en tabletas y novaluron fueron larvicidas efectivos en esta región. El bajo desempeño de temefos puede indicar una susceptibilidad reducida en poblaciones de Ae. aegypti en Chiapas.

Cardiovascular events related to the use of macrolides in an intensive care unit / Eventos cardiovasculares relacionados con el uso de macrólidos en una unidad de cuidado intensivo

Abstract Introduction and objectives: macrolides are widely used antibiotics for which a greater frequency of cardiovascular events related to increased arrhythmias has been reported. This study seeks to describe some cardiovascular complications of the use of macrolides in ICU patients. Materials and methods: this was a descriptive cross-sectional study which included adult patients admitted to the Medical Intensive Care Unit at the Fundación Cardioinfantil who received antibiotic treatment with clarithromycin in 2013 and 2015. Results: the collected sample was 38 patients. The median age was 64 years, and clarithromycin was most frequently used for treating community-acquired infections, with pneumonia being the most common diagnosis. The frequency of atrial fibrillation or flutter was 7.89%, and ventricular tachycardia 2.63%. The most frequently used concomitant medication was quetiapine at 28.95%. The main cause of death was respiratory failure. Conclusions: the frequency of arrhythmias was high in our study, although the most frequent cause of death was respiratory failure. (Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1336).

Resumen Introducción y objetivos: los macrólidos son antibióticos ampliamente utilizados con los cuales se ha reportado una mayor frecuencia de eventos cardiovasculares relacionados con aumento de arritmias. Mediante este estudio, se busca describir algunas complicaciones cardiovasculares con el uso de macrólidos en pacientes en UCI. Materiales y métodos: se realizó un estudio descriptivo de corte transversal en el que se incluyeron pacientes adultos que ingresaron a la unidad de cuidado intensivo médico de la Fundación Cardioinfantil y que recibieron tratamiento antibiótico con claritromicina durante los años 2013 y 2015. Resultados: la muestra recolectada fue de 38 pacientes, la mediana de edad fue de 64 años y la claritromicina se usó más frecuentemente en el tratamiento de infecciones adquiridas en la comunidad, siendo la neumonía el diagnóstico más común. La frecuencia de arritmias tipo fibrilación o flutter auricular fue de 7.89% y de taquicardia ventricular 2.63%. El medicamento concomitante más frecuentemente usado fue la quetiapina con 28.95%. La principal causa de muerte fue falla respiratoria. Conclusiones: la frecuencia de arritmias fue alta en nuestro, aunque la causa de muerte más frecuente fue falla respiratoria.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1336).

Influence of early use of antimicrobial on the health and performance of Holstein calves in the first month of life / Influência do uso precoce de antimicrobiano na sanidade de bezerras holandesas no primeiro mês de vida

The early use of antimicrobial therapy has been introduced in many farms to prevent diarrhea and respiratory disease in young calves; however, there is controversy about whether this practice has a beneficial effect on the health of these animals. This study evaluated the influence of the early use of antimicrobials on the health and performance of neonatal Holstein calves. Twenty-six Holstein calves were screened and divided into two groups, according to the administration (ATB+), or not (ATB-) of tulathromycin (2.5mg/kg, subcutaneously) within the first 12 hours of life. Calves were evaluated by general clinical examination, fecal score, respiratory score, and external palpation of the umbilical region, besides fecal output of dry matter. Anemia was determined by using an automatic system and, also, using a commercial kit for iron dosage. Diarrhea was diagnosed by a centrifuge-flotation technique using a sugar solution (Cryptosporidium) and multiplex semi-nested RT-PCR (rotavirus/coronavirus). The performance of the calves was estimated by Daily Weight Gain (DWG). The young dairy calves were evaluated within 12 hours of birth (≤12h) and at 3-5th (D3-5), 7-9th (D7-9), 13-15th (D13-15), 20-23rd (D20-23), and 27-30th (D27-30) days of life. No difference was noted between the ATB+ and ATB- groups concerning heart rate, respiratory frequency, and rectal temperature. Erythrogram showed a higher frequency of anemia in ATB- group (P=0.016) at the D3-5 check-up; lower values of serum iron were also observed simultaneously (P=0.051). Thirteen cases of respiratory disease were detected during this study; however, no significant difference was observed between the groups in this regard. The frequency of diarrhea (fecal score 2-3) was high in both groups, peaking at D13-D15. No differences were noted between the groups regarding the frequency of diarrhea when considering the dry fecal matter. The predominant etiological agent for diarrhea was Cryptosporidium spp.. The DWG was similar between groups, with maximum weight reduction on D13-15. The administration of tulathromycin in prophylactic dose (2.5mg/kg) at birth decreased the frequency of anemia but did not influence weight gain or the prevalence of diarrhea.(AU)

O uso precoce de antimicrobianos tem sido adotado em muitas fazendas para profilaxia das diarreias e doença respiratória em bezerras, no entanto existem controvérsias sobre os beneficios desta prática na saúde desses animais. Esta pesquisa avaliou a influência do uso precoce de antimicrobiano na sanidade e desempenho de bezerras holandesas recém-nascidas. Para tanto foram selecionadas 26 bezerras Holandesas distribuídas de acordo com a aplicação (ATB+) ou não (ATB-) de tulatromicina (2,5mg/Kg) por via subcutânea até 12h de vida. As bezerras foram examinadas por meio de exame clínico geral, escore fecal, escore respiratório e palpação externa da região umbilical, além da matéria seca fecal. A presença de anemias foi determinada pelo eritrograma utilizando sistema automático e além da dosagem de ferro utilizando kit comercial. O diagnóstico etiológico das diarreias foi investigado por meio da técnica de flutuação em solução saturada de sacarose (Cryptosporidium) e multiplex semi-nested RT-PCR (rotavírus/coronavírus). O desempenho das bezerras foi estimado pelo ganho de peso. As bezerras foram avaliadas até doze horas após o nascimento (≤12h); 3-5º (D3-5); 7-9º (D7-9); 13-15º (D13-15); 20-23º (D20-23); e 27-30º dias de vida (D27-30). Não foram encontradas diferenças entre os grupos ATB+ e ATB- em relação à frequência cardíaca, frequência respiratória e temperatura retal. O eritrograma revelou maior frequência de anemias no grupo ATB- (P=0,016) no D3-5. Neste momento também foram observados menores valores de ferro sérico (P=0,051). Foram detectados treze casos de doença respiratória durante o estudo, no entanto não foi possível detectar diferença entre os grupos. A frequência de diarreias (escore fecal 2 e 3) foi alta em ambos os grupos, observando-se pico no D13-15 (ATB+=92,3%; ATB-=92,3%). Não observamos diferenças entre os grupos em relação a frequência de diarreia considerando-se a matéria seca fecal. O agente etiológico predominante nas diarreias foi o Cryptosporidium. O ganho de peso diário foi igual entre grupos, com intensa redução no GPD no D13-15. A administração de tulatromicina na dose profilática (2,5mg/Kg) ao nascimento diminuiu a frequência de anemias e não influenciou no ganho de peso e prevalência de diarreias.(AU)

Sistema microbiológico de cinco bioensayos para la detección de residuos de antibióticos / Five-assay microbiological system for the screeningf antibiotic residues

Abstract A novel microbiological system in microtiter plates consisting of five bioassays is presented for the detection and classification of antibiotic residues in milk. The bioassays were optimized for the detection of beta-lactams (Bioassay B: Geobacillus stearothermophilus), macrolides (Bioassay M: Bacillus megaterium with fusidic acid), tetracyclines (Bioassay T: B. megaterium with chloramphenicol), quinolones (Bioassay Q: Bacillus licheniformis) and sulfamides (Bioassay QS: B. licheniformis with trimethoprim) at levels near the maximum residue limits (MRL). The response of each bioassay was interpreted visually (positive or negative) after 4-5.5h of incubation. The system detects and classifies beta-lactams (5 pg/l of amoxicillin, 4 pg/l of ampicillin, 36 pg/l of cloxacillin, 22 pg/l of amoxicillin, 3 pg/l of penicillin, 114 pg/l of cephalexin, 89pg/l of cefoperazone and 116 pg/l of ceftiofur), tetracyclines (98 pg/l of chlortetracycline, 92 pg/l of oxytetracycline and 88 pg/l of tetracycline), macrolides (33 pg/l of erythromycin, 44 pg/l of tilmicosin and 50 pg/l of tylosin), sulfonamides (76 pg/l of sulfadiazine, 85 pg/l of sulfadimethoxine, 77 pg/l of sulfamethoxazole and 87pg/l of sulfathiazole) and quinolones (94 pg/l of ciprofloxacin, 98 pg/l of enrofloxacin and 79 pg/l marbofloxacin). In addition, the specificity values were high for B, T, Q (99.4%), M (98.8%) and QS (98.1%) bioassays. The control of antibiotics through this system can contribute to improving the quality and safety of dairy products.

Resumen Se presenta un novedoso sistema microbiológico en placas de microtitulación compuesto por 5 bioensayos para la detección y clasificación de residuos de antibióticos en leche. Los bioensayos fueron optimizados para la detección de betalactámicos (bioensayo B: Geobacillus stearothermophilus), macrólidos (bioensayo M: Bacillus megaterium con ácido fusídico), tetraciclinas (bioensayo T: Bacillus megaterium con cloranfenicol), quinolonas (bioensayo Q: Bacillus licheniformis) y sulfamidas (bioensayo QS: Bacillus licheniformis con trimetoprima), a niveles cercanos a los límites máximos de residuos (LMR). La respuesta de cada bioensayo se interpretó visualmente (positiva o negativa) después de 4 a 5,5 h de incubación. El sistema detecta y clasifica betalactámicos (5 pg/l de amoxicilina, 4 pg/l de ampicilina, 36 pg/l de cloxacilina, 22 pg/l de amoxicilina, 3 pg/l de penicilina, 114 pg/l de cefalexina, 89 pg/l de cefoperazona y 116 pg/l de ceftiofur), tetraciclinas (98 pg/l de clortetraciclina, 92 pg/l de oxitetraciclina y 88 pg/l de tetraciclina), macrólidos (33 pg/l de eritromicina, 44 pg/l de tilmi-cosina y 50 pg/l de tilosina), sulfamidas (76 pg/l de sulfadiacina, 85 pg/l de sulfadimetoxina, 77 pg/l de sulfametoxazol y 87 pg/l de sulfatiazol) y quinolonas (94 pg/l de ciprofloxacina, 98 pg/l de enrofloxacina y 79pg/l de marbofloxacina). Además, los valores de especificidad fueron altos para los bioensayos B, T, Q (99,4%), M (98,8%) y QS (98,1%). El control de residuos de antibióticos mediante este sistema puede contribuir a mejorar la calidad e inocuidad de los productos lácteos.

Bronquiectasias no fibrosis quística: desde la infancia a la adultez: enfoque diagnostico y terapéutico / Bronchiectasis no cystic fibrosis: from childhood to adult: diagnostic and therapeutic approach

Bronchiectasis is a suppurative lung disease with heterogeneous phenotypic characteristics. It is defined as abnormal dilation of the bronchi, losing the existing relationship between bronchial sizes and accompanying artery. According to their form, they can be cylindrical, varicose, saccular or cystic. According to its location, they could be diffuse or localized. The diagnosis of bronchiectasis is usually suspected in patients with chronic cough, mucopurulent bronchorrea, and recurrent respiratory infections. The etiology can be varied, being able to classify in cystic fibrosis bronchiectasis, when there is cystic fibrosis transmembrane regulator (CFTR) gene mutation and not cystic fibrosis, being post infectious the most frequent. Its relationship with childhood is unknown. Severe respiratory infections can predispose in a susceptible subject the so-called theory of the "vicious circle" and the development of these. Persistent bacterial bronchitis in children has been described as a probable cause of not cystic fibrosis bronchiectasis in adults. The treatment is based on the management of symptoms and the prevention of exacerbations. The evidence is poor and many treatments are extrapolated from cystic fibrosis bronchiectasis. We are going to describe the diagnostic and therapeutic approach of non-cystic fibrosis bronchiectasis in adults.

La bronquiectasia es una enfermedad pulmonar supurativa con características fenotípicas heterogéneas. Se define como la dilatación anormal de los bronquios, perdiendo la relación existente entre tamaño bronquial y arteria que acompaña. Según su forma, pueden ser clasificadas en cilíndricas, varicosas, saculares o quísticas y según su etiología presentarse de forma difusa o localizada. El diagnóstico de bronquiectasias se sospecha generalmente en pacientes con tos crónica, broncorrea mucosa, mucupurulenta e infecciones respiratorias recurrentes. La etiología es variada, pudiendo clasificarse en bronquiectasias fibrosis quística, aquellas que se encuentran en el contexto de la mutación del gen regulador transmembrana de fibrosis quística (CFTR) y no fibrosis quística, de etiologías diversas, siendo post infecciosas la gran mayoría. No se conoce con certeza su relación con la infancia, es sabido que infecciones respiratorias severas pueden predisponer en un sujeto susceptible, a la llamada teoría del "circulo vicioso" y el desarrollo de estas. La bronquitis bacteriana persistente en niños se ha descrito como una causa probable del desarrollo de bronquiectasias no fibrosis quística en adultos. El tratamiento se basa en el manejo de los síntomas y la prevención de las exacerbaciones. La evidencia es escasa y la mayoría de las terapias se han investigado en las bronquiectasias tipo fibrosis quística. En este trabajo se explicará el enfrentamiento diagnóstico y terapéutico de los adultos portadores de bronquiectasias no fibrosis quística.

Susceptibilidad antimicrobiana en muestras urogenitales de ureaplasma urealyticum, el principal agente en infección intramaniótica / Antimicrobial susceptibility in urogenital samples of ureaplasma urealyticum, the main agent in intramaniotic infection

RESUMEN OBJETIVO: Ureaplasma urealyticum es el agente más frecuentemente aislado en infección intraamniótica. Los macrólidos son los antimicrobianos de primera elección en embarazadas. Se ha descrito el aumento de resistencia, pudiendo limitar las opciones terapéuticas durante la gestación. El propósito del estudio es evaluar susceptibilidad antimicrobiana de Ureaplasma urealyticum aislado en mujeres en edad fértil, que se atienden en Clínica Alemana Temuco, Araucanía, Chile. METODO: Se estudian todas las muestras de orina y flujo vaginal para cultivo de U. urealyticum, de pacientes entre 18 y 40 años, recibidas en el Laboratorio de Microbiología Clínica Alemana Temuco, en período Abril 2013 a Enero 2015. Se procesan las muestras con kit Mycoplasma IST 2 de Biomerieux. En las que resultan positivas, se estudia susceptibilidad a macrólidos, tetraciclinas y quinolonas. RESULTADOS: 426 muestras de orina y flujo vaginal (390 pacientes). 197 pacientes resultaron positivas para U. urealyticum. (50,5%). La susceptibilidad fue 88,4% (174 pctes) a Eritromicina, 87,9% (173 pctes) a Claritromicina y 91,9% (181 pctes) a Azitromicina (NS). 15 de 197 pacientes (7,6%) fueron resistentes a los 3 macrólidos. La susceptibilidad a Quinolonas fue 55,3% a Ciprofloxacino, y 94% a Ofloxacino. El 100% resultó susceptible a Tetraciclinas. CONCLUSIONES: Cerca del 10% de U. urealyticum aislados en nuestra serie son resistentes a macrólidos, contribuyendo a la no erradicación de la infección en tratamientos empíricos. Dentro de ellos, azitromicina aparece con la mayor efectividad. El aumento de resistencia limitará opciones terapéuticas, con gran impacto perinatal en futuro. La vigilancia de susceptibilidad en cada hospital es fundamental para elección terapéutica.

ABSTRACT INTRODUCTION: Ureaplasma urealyticum is the most frequently isolated microorganism in intra-amniotic infection. The macrolides are the first choice antimicrobials for treat this infection in pregnancy. The increasing resistance has been described worldwide, seriously limiting therapeutic options in pregnancy. The aim of the study is to evaluate antimicrobial susceptibility of U. urealyticum aislated in fertile-age women in Clínica Alemana Temuco, Araucania region, Chile. METHOD: Urine and vaginal samples were analyzed for U. urealyticum, from every 18 to 40 years old patients, received at Microbiology Laboratory of Clínica Alemana Temuco, between April 2013 to January 2015. The samples are processed with Mycoplasma IST 2 kit of Biomerieux. If they became positives, susceptibility to macrolides, tetracyclines and quinolones was studied. RESULTS: 426 urine and vaginal samples were collected (390 patients). 197 patients were positive for U. urealyticum (50.5%). The susceptibility was 88.4% (174 pts) to Erythromicyn, 87.9% (173 pts) to Clarithromycin and 91.9% (181 pts) to Azithromycin (NS). Resistance to all macrolides was observed in 15 out of 197 patients (7.6%). The susceptibility to Quinolones was 55.3% to Ciprofloxacin, and 94% to Ofloxacin. The 100% was susceptible to Tetracyclines. DISCUSSION: Near to 10% of isolated Ureaplasma spp in our serie were resistant to some macrolide, being a factor for failing to eradicate the infection in empirical treatment. Azithromycin was the most effective. The increasing resistance will limit therapeutic options, with great perinatal impact in the future. Susceptibility surveillance in each hospital is very important for therapeutic options.