ABSTRACT
Introducción. Las betalactamasas de espectro extendido (BLEE) son un fenómeno de resistencia emergente de particular incidencia en América Latina. En Colombia existe poca información sobre los factores de riesgo asociados con su adquisición. Objetivo. Determinar los factores de riesgo que están asociados a la infección o colonización por Escherichia coli o Klebsiella pneumoniae productoras de BLEE en pacientes mayores de 18 años. Materiales y métodos. Se llevó a cabo un estudio de casos y controles con relación 1:1 en pacientes con aislamientos de E. coli o K. pneumoniae productoras de BLEE en cualquier tipo de muestra durante el periodo de enero de 2009 a noviembre de 2011 en el Hospital Universitario de San José. Resultados. Se estudiaron 110 casos y 110 controles; 62,7 % correspondió a E. coli y 37,3 %, a K. pneumoniae . Como factores de riesgo independiente en el análisis multivariado se encontraron la insuficiencia renal crónica (OR=2,99; IC 95%, 1,10-8,11; p=0,031), la cirugía urológica (OR=4,78; IC 95%, 1,35-16,87; p=0,015), el antecedente de uso de antibióticos en los tres meses anteriores (OR=2,24; IC 95%, 1,09-4,60; p=0,028), el origen hospitalario de la infección (OR=2,92; IC 95%, 1,39-6,13; p=0,004) y la hospitalización previa (OR=1,59; IC 95%, 1,03-2,46; p=0,036). Conclusión. Anticiparse al patrón de resistencia del microorganismo que infecta a un paciente con base en los factores de riesgo asociados permitiría la elección de un tratamiento antibiótico empírico apropiado, con el fin de lograr la disminución de la morbimortalidad de los pacientes.
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Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Anti-Bacterial Agents/pharmacology , Drug Resistance, Multiple, Bacterial , Escherichia coli Infections/microbiology , Escherichia coli/enzymology , Klebsiella Infections/microbiology , Klebsiella pneumoniae/enzymology , beta-Lactams/pharmacology , Anti-Bacterial Agents/metabolism , Case-Control Studies , Colombia , Cross Infection/epidemiology , Cross Infection/microbiology , Drug Resistance, Multiple, Bacterial/genetics , Escherichia coli Infections/epidemiology , Escherichia coli/drug effects , Escherichia coli/genetics , Escherichia coli/isolation & purification , Immunocompromised Host , Klebsiella Infections/epidemiology , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/genetics , Klebsiella pneumoniae/isolation & purification , Postoperative Complications/microbiology , Retrospective Studies , Risk Factors , Tertiary Care Centers , beta-Lactam Resistance/genetics , beta-Lactams/metabolismABSTRACT
SHV-28, an extended spectrum beta-lactamase from a clinical isolate of Klebsiella pneumoniae , had an isoelectric point of 7.6 and a substrate profile showing preferential hydrolysis for cefotaxime over ceftazidime. It differed from SHV-1 by one amino acid substitution. The conserved S-T-F-K and K-T-G motifs were identified by SHV-28 protein sequencing.
Subject(s)
Aged , Amino Acid Sequence , Amino Acid Substitution/genetics , Bacterial Proteins/biosynthesis , Base Sequence , DNA, Bacterial/chemistry , Humans , India , Isoelectric Point , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , Male , Microbial Sensitivity Tests , Molecular Sequence Data , Sequence Analysis, DNA , Substrate Specificity , beta-Lactamases/biosynthesis , beta-Lactams/metabolismABSTRACT
Search for anti-beta-lactamase and synthesis of newer penicillin were suggested to overcome resistance to penicillin in chemotherapy. It was found that clavulanic acid, an ant-beta-lactamase was ineffective due to its structural modification by bacteria. Thus, there is a need for the synthesis of newer pencillins. Retro-synthesis was inspired by the success of forward reaction i.e.conversion of penicillin G to 6-aminopenicillanic acid (6-APA) by biological process. In the present study a better enzymatic method of synthesis of newer pencillin by a beta-lactamase-free penicillin amidase produced by Alcaligenes sp. is attempted. Antibacterial and toxicological evaluation of the enzymatically synthesized beta-lactams are reported. Condensation of 6-APA with acyl donor was found to be effective when the reaction is run in dimethyl formamide (DMF 50% v/v) in acetate buffer (25 mM pH 5.0) at 37 degrees C. Periplasm entrapped in calcium alginate exihibited the highest yield (approximately 34%) in synthesis. The minimum inhibitory concentration of the synthetic products against Staphylococcus aureus and Salmonella typhi varied between 20-80 microg/ml. Some of the products exhibited antibacterial activity against enteric pathogens. It was interesting to note that product A was potent like penicillin G. LD50 value of three products (product A, B and C) was more than 12 mg/kg. Furthermore, these synthetic beta-lactams did not exihibit any adverse effect on house keeping enzymes viz., serum glutamate oxalacetate-trans-aminase, serum glutamate pyruvate -trans-aminase, acid phosphatase, alkaline phosphatase of the test animals. The hematological profile (RBC and WBC) of the test animals also remained unaffected.