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1.
Med. infant ; 28(1): 38-42, Marzo 2021. Tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1283476

ABSTRACT

Últimamente, se están detectando mutaciones en las proteínas ligadoras de penicilina (PBP) de los estreptococos beta-hemolíticos que corresponden a sitios que en Streptococcus pneumoniae han determinado sensibilidad disminuida a los antibióticos beta-lactámicos. Primero, se describieron cepas con sensibilidad intermedia a penicilina en Streptococcus agalactiae (estreptococos del grupo B), luego en Streptococcus dysgalactiae subsp. equisimilis (mayormente grupos C y G) y, más recientemente, cepas con sensibilidad disminuida a aminopenicilinas y cefalosporinas de tercera generación en Streptococcus pyogenes (grupo A). El costo biológico de estas modificaciones nos permite pensar que los niveles de resistencia no han de ser tan elevados como para comprometer por ahora la efectividad clínica de los beta-lactámicos (AU)


Recently, mutations in penicillin-binding proteins (PBPs) of beta-hemolytic streptococci have been detected corresponding to sites that in Streptococcus pneumoniae have been determined to have decreased sensitivity to beta-lactam antibiotics. First, strains with intermediate sensitivity to penicillin were described in Streptococcus agalactiae (group B streptococci), subsequently in Streptococcus dysgalactiae subsp. equisimilis (mainly groups C and G) and, more recently, strains with decreased sensitivity to third-generation aminopenicillins and cephalosporins were found in Streptococcus pyogenes (group A). The biological cost of these modifications suggests that, for now, resistance levels are not high enough to compromise the clinical effectiveness of beta-lactams (AU)


Subject(s)
Streptococcus agalactiae/drug effects , Streptococcus pyogenes/drug effects , Penicillin Resistance , Microbial Sensitivity Tests , beta-Lactam Resistance , beta-Lactams/pharmacology , Anti-Bacterial Agents/pharmacology
2.
Rev. Soc. Bras. Med. Trop ; 53: e20200413, 2020. tab, graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136893

ABSTRACT

Abstract Consumption of carbapenem has increased due to extended-spectrum beta-lactamase-producing bacteria spreading. Ertapenem has been suggested as a not carbapenem-resistance inducer. We performed a scoping review of carbapenem-sparing stewardship with ertapenem and its impact on the antibiotic resistance of Gram-negative bacilli. We searched PubMed for studies that used ertapenem as a strategy to reduce resistance to carbapenems and included epidemiologic studies with this strategy to evaluate susceptibility patterns to cephalosporins, quinolones, and carbapenems in Gram-negative-bacilli. The search period included only studies in English, up to February 2018. From 1294 articles, 12 studies were included, mostly from the Americas. Enterobacteriaceae resistance to quinolones and cephalosporins was evaluated in 6 studies and carbapenem resistance in 4 studies. Group 2 carbapenem (imipenem/meropenem/doripenem) resistance on A. baumannii was evaluated in 6 studies. All studies evaluated P. aeruginosa resistance to Group 2 carbapenem. Resistance profiles of Enterobacteriaceae and P. aeruginosa to Group 2 carbapenems were not associated with ertapenem consumption. The resistance rate of A. baumannii to Group 2 carbapenems after ertapenem introduction was not clear due to a lack of studies without bias. In summary, ertapenem as a strategy to spare use of Group 2 carbapenems may be an option to stewardship programs without increasing resistance of Enterobacteriaceae and P. aeruginosa. More studies are needed to evaluate the influence of ertapenem on A. baumannii.


Subject(s)
Carbapenems/pharmacology , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/pharmacology , Microbial Sensitivity Tests , Drug Resistance, Bacterial , beta-Lactams/pharmacology , Ertapenem
3.
Braz. j. microbiol ; 49(3): 569-574, July-Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-951794

ABSTRACT

Abstract Multidrug-resistant microorganisms are of great concern to public health. Genetic mobile elements, such as plasmids, are among the most relevant mechanisms by which bacteria achieve this resistance. We obtained an Escherichia coli strain CM6, isolated from cattle presenting severe diarrheic symptoms in the State of Querétaro, Mexico. It was found to contain a 70 kb plasmid (pMEX01) with a high similarity to the pHK01-like plasmids that were previously identified and described in Hong Kong. Analysis of the pMEX01 sequence revealed the presence of a blaCTX-M-14 gene, which is responsible for conferring resistance to multiple β-lactam antibiotics. Several genes putatively involved in the conjugative transfer were also identified on the plasmid. The strain CM6 is of high epidemiological concern because it not only displays resistance to multiple β-lactam antibiotics but also to other kinds of antibiotics.


Subject(s)
Animals , Cattle , Plasmids/genetics , Cattle Diseases/microbiology , Drug Resistance, Bacterial , beta-Lactams/pharmacology , Escherichia coli/drug effects , Escherichia coli/genetics , Escherichia coli Infections/veterinary , Anti-Bacterial Agents/pharmacology , Plasmids/metabolism , beta-Lactamases/genetics , beta-Lactamases/metabolism , Microbial Sensitivity Tests , Escherichia coli Proteins/genetics , Escherichia coli Proteins/metabolism , Escherichia coli/metabolism , Escherichia coli Infections/microbiology , Mexico
4.
J. appl. oral sci ; 26: e20170065, 2018. graf
Article in English | LILACS, BBO | ID: biblio-893689

ABSTRACT

Abstract Considering oral diseases, antibiofilm compounds can decrease the accumulation of pathogenic species such as Streptococcus mutans at micro-areas of teeth, dental restorations or implant-supported prostheses. Objective To assess the effect of thirteen different novel lactam-based compounds on the inhibition of S. mutans biofilm formation. Material and methods We synthesized compounds based on γ-lactones analogues from rubrolides by a mucochloric acid process and converted them into their corresponding γ-hydroxy-γ-lactams by a reaction with isobutylamine and propylamine. Compounds concentrations ranging from 0.17 up to 87.5 μg mL-1 were tested against S. mutans. We diluted the exponential cultures in TSB and incubated them (37°C) in the presence of different γ-lactones or γ-lactams dilutions. Afterwards, we measured the planktonic growth by optical density at 630 nm and therefore assessed the biofilm density by the crystal violet staining method. Results Twelve compounds were active against biofilm formation, showing no effect on bacterial viability. Only one compound was inactive against both planktonic and biofilm growth. The highest biofilm inhibition (inhibition rate above 60%) was obtained for two compounds while three other compounds revealed an inhibition rate above 40%. Conclusions Twelve of the thirteen compounds revealed effective inhibition of S. mutans biofilm formation, with eight of them showing a specific antibiofilm effect.


Subject(s)
Streptococcus mutans/drug effects , Biofilms/drug effects , beta-Lactams/pharmacology , Lactones/pharmacology , Anti-Bacterial Agents/pharmacology , Plankton/growth & development , Plankton/drug effects , Streptococcus mutans/growth & development , Microscopy, Electron, Scanning , Colony Count, Microbial , Microbial Sensitivity Tests , Reproducibility of Results , Analysis of Variance , Biofilms/growth & development , beta-Lactam Resistance/drug effects , beta-Lactams/chemical synthesis , Dose-Response Relationship, Drug , Microbial Viability/drug effects , Gentian Violet , Lactones/chemical synthesis , Anti-Bacterial Agents/chemical synthesis
5.
Braz. j. microbiol ; 48(3): 509-514, July-Sept. 2017. tab
Article in English | LILACS | ID: biblio-889143

ABSTRACT

Abstract The production of KPC (Klebsiella pneumoniae carbapenemase) is the major mechanism of resistance to carbapenem agents in enterobacterias. In this context, forty KPC-producing Enterobacter spp. clinical isolates were studied. It was evaluated the activity of antimicrobial agents: polymyxin B, tigecycline, ertapenem, imipenem and meropenem, and was performed a comparison of the methodologies used to determine the susceptibility: broth microdilution, Etest® (bioMérieux), Vitek 2® automated system (bioMérieux) and disc diffusion. It was calculated the minimum inhibitory concentration (MIC) for each antimicrobial and polymyxin B showed the lowest concentrations for broth microdilution. Errors also were calculated among the techniques, tigecycline and ertapenem were the antibiotics with the largest and the lower number of discrepancies, respectively. Moreover, Vitek 2® automated system was the method most similar compared to the broth microdilution. Therefore, is important to evaluate the performance of new methods in comparison to the reference method, broth microdilution.


Subject(s)
Humans , Anti-Bacterial Agents/pharmacology , Bacterial Proteins/metabolism , beta-Lactamases/metabolism , Enterobacteriaceae Infections/microbiology , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , Microbial Sensitivity Tests/methods , Bacterial Proteins/genetics , beta-Lactamases/genetics , beta-Lactams/pharmacology , Drug Resistance, Bacterial , Enterobacter/drug effects , Enterobacter/genetics , Enterobacter/isolation & purification , Klebsiella pneumoniae/classification , Klebsiella pneumoniae/genetics , Klebsiella pneumoniae/isolation & purification , Polymyxin B/pharmacology
6.
Braz. j. microbiol ; 47(supl.1): 31-37, Oct.-Dec. 2016. tab
Article in English | LILACS | ID: biblio-839327

ABSTRACT

ABSTRACT During the last 30 years there has been a dissemination of plasmid-mediated β-lactamases in Enterobacteriaceae in Brazil. Extended spectrum β-lactamases (ESBL) are widely disseminated in the hospital setting and are detected in a lower frequency in the community setting. Cefotaximases are the most frequently detected ESBL type and Klebsiella pneumoniae is the predominant species among ESBL producers. Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae became widely disseminated in Brazil during the last decade and KPC production is currently the most frequent resistance mechanism (96.2%) in carbapenem resistant K. pneumoniae. To date KPC-2 is the only variant reported in Brazil. Polymyxin B resistance in KPC-2-producing K. pneumoniae has come to an alarming rate of 27.1% in 2015 in São Paulo, the largest city in Brazil. New Delhi metallo-β-lactamase was detected in Brazil in 2013, has been reported in different Brazilian states but are not widely disseminated. Antimicrobial resistance in Enterobacteriaceae in Brazil is a very serious problem that needs urgent actions which includes both more strict adherence to infection control measures and more judicious use of antimicrobials.


Subject(s)
Humans , Drug Resistance, Bacterial , Enterobacteriaceae/drug effects , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae Infections/epidemiology , Anti-Infective Agents/pharmacology , Plasmids/genetics , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , beta-Lactamases/genetics , beta-Lactamases/metabolism , Brazil/epidemiology , Polymyxins/therapeutic use , Polymyxins/pharmacology , beta-Lactams/therapeutic use , beta-Lactams/pharmacology , Enterobacteriaceae/enzymology , Enterobacteriaceae/genetics , Anti-Infective Agents/therapeutic use , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/pharmacology
7.
Rev. ADM ; 73(5): 227-234, sept.-oct. 2016. tab
Article in Spanish | LILACS | ID: biblio-835299

ABSTRACT

Los antibióticos betalactámicos son los que más se usan en el tratamientoy profilaxis de las infecciones odontogénicas. Con frecuenciaes necesario prescribir un segundo antibiótico que incremente el efectodel primero. Debido a ello se hizo una revisión de los antibióticos y otros medicamentos que administrados simultáneamente o en forma secuencial con betalactámicos producen efectos deseados (sinergismo, potenciación) o indeseados (antagonismo) o provocan efectos adversos en el organismo.


Beta-lactams are the most commonly used antibiotics in the treatmentand prophylaxis of odontogenic infections. It is often necessary toprescribe a second antibiotic to increase the eff ect of the fi rst. For thisreason, we performed a review of antibiotics and other medicationswhich, when administered simultaneously or sequentially with betalactams,produce desirable (synergism, potentiation) or undesirable(antagonism) eff ects or provoke adverse eff ects in the organism.


Subject(s)
Humans , beta-Lactams/administration & dosage , beta-Lactams/pharmacokinetics , beta-Lactams/pharmacology , Drug Interactions , beta-Lactams/adverse effects , Cephalosporins/pharmacology , Drug Antagonism , Drug Synergism , Food-Drug Interactions
8.
Article in English | WPRIM | ID: wpr-34961

ABSTRACT

BACKGROUND: The development of new drugs or alternative therapies effective against methicillin-resistant Staphylococcus aureus (MRSA) is of great importance, and various natural anti-MRSA products are good candidates for combination therapies. We evaluated the antibacterial activities of a Phellinus baumii ethyl acetate extract (PBEAE) and its synergistic effects with beta-lactams against MRSA. METHODS: The broth microdilution method was used to determine the minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) of the PBEAE. The PBEAE synergistic effects were determined by evaluating the MICs of anti-staphylococcal antibiotic mixtures, with or without PBEAE. Anti-MRSA synergistic bactericidal effects of the PBEAE and beta-lactams were assessed by time-killing assay. An ELISA was used to determine the effect of the PBEAE on penicillin binding protein (PBP)2a production. RESULTS: The MICs and MBCs of PBEAE against MRSA were 256-512 and 1,024-2,048 microg/mL, respectively. The PBEAE significantly reduced MICs of all beta-lactams tested, including oxacillin, cefazolin, cefepime, and penicillin. However, the PBEAE had little or no effect on the activity of non-beta-lactams. Time-killing assays showed that the synergistic effects of two beta-lactams (oxacillin and cefazolin) with the PBEAE were bactericidal in nature (Deltalog10 colony forming unit/mL at 24 hr: 2.34-2.87 and 2.10-3.04, respectively). The PBEAE induced a dose-dependent decrease in PBP2a production by MRSA, suggesting that the inhibition of PBP2a production was a major synergistic mechanism between the beta-lactams and the PBEAE. CONCLUSIONS: PBEAE can enhance the efficacy of beta-lactams for combined therapy in patients infected with MRSA.


Subject(s)
Acetates/chemistry , Agaricales/chemistry , Anti-Infective Agents/chemistry , Drug Synergism , Enzyme-Linked Immunosorbent Assay , Methicillin-Resistant Staphylococcus aureus/drug effects , Microbial Sensitivity Tests , Penicillin-Binding Proteins/analysis , Plant Extracts/chemistry , beta-Lactams/pharmacology
9.
Braz. j. microbiol ; 46(4): 1155-1159, Oct.-Dec. 2015. tab
Article in English | LILACS | ID: lil-769667

ABSTRACT

Abstract The antibiotic susceptibility profile was evaluated in 71 Enterobacteriaceae isolates obtained from outpatient urine cultures in July 2010 from two health institutions in Santa Fe, Argentina. The highest rates of antibiotic resistance were observed for ampicillin (AMP) (69%), trimethoprim/sulfamethoxazole (TMS) (33%), and ciprofloxacin (CIP) (25%). Meanwhile, 21% of the isolates were resistant to three or more tested antibiotics families. Thirty integron-containing bacteria (42.3%) were detected, and a strong association with TMS resistance was found. Third generation cephalosporin resistance was detected in only one Escherichia coli isolate, and it was characterized as a blaCMY-2 carrier. No plasmid-mediated quinolone resistance (PMQR) was found. Resistance to fluoroquinolone in the isolates was due to alterations in QRDR regions. Two mutations in GyrA (S83L, D87N) and one in ParC (S80I) were observed in all CIP-resistant E. coli. It was determined to be the main phylogenetic groups in E. coli isolates. Minimum Inhibitory Concentration (MIC) values against nalidixic acid (NAL), levofloxacin (LEV), and CIP were determined for 63 uropathogenic E. coli isolates as MIC50 of 4 μg/mL, 0.03125 μg/mL, and 0.03125 μg/mL, respectively, while the MIC90 values of the antibiotics were determined as 1024 μg/mL, 64 μg/mL, and 16 μg/mL, respectively. An association between the phylogenetic groups, A and B1 with fluoroquinolone resistance was observed. These results point to the importance of awareness of the potential risk associated with empirical treatment with both the families of antibiotics.


Subject(s)
Humans , Anti-Bacterial Agents/pharmacology , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae/drug effects , Enterobacteriaceae/isolation & purification , Quinolones/pharmacology , Urinary Tract Infections/microbiology , beta-Lactams/pharmacology , Argentina , Drug Resistance, Bacterial , Enterobacteriaceae/classification , Enterobacteriaceae/genetics , Genotype , Microbial Sensitivity Tests , Molecular Typing , Outpatients , Phylogeny , Plasmids/analysis
10.
Rev. Soc. Bras. Med. Trop ; 48(5): 539-545, Sept.-Oct. 2015. tab, graf
Article in English | LILACS | ID: lil-763339

ABSTRACT

ABSTRACTINTRODUCTION: Monte Carlo simulations have been used for selecting optimal antibiotic regimens for treatment of bacterial infections. The aim of this study was to assess the pharmacokinetic and pharmacodynamic target attainment of intravenous β-lactam regimens commonly used to treat bloodstream infections (BSIs) caused by Gram-negative rod-shaped organisms in a Brazilian teaching hospital.METHODS: In total, 5,000 patients were included in the Monte Carlo simulations of distinct antimicrobial regimens to estimate the likelihood of achieving free drug concentrations above the minimum inhibitory concentration (MIC; fT > MIC) for the requisite periods to clear distinct target organisms. Microbiological data were obtained from blood culture isolates harvested in our hospital from 2008 to 2010.RESULTS: In total, 614 bacterial isolates, including Escherichia coli, Enterobacterspp., Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa, were analyzed Piperacillin/tazobactam failed to achieve a cumulative fraction of response (CFR) > 90% for any of the isolates. While standard dosing (short infusion) of β-lactams achieved target attainment for BSIs caused by E. coliand Enterobacterspp., pharmacodynamic target attainment against K. pneumoniaeisolates was only achieved with ceftazidime and meropenem (prolonged infusion). Lastly, only prolonged infusion of high-dose meropenem approached an ideal CFR against P. aeruginosa; however, no antimicrobial regimen achieved an ideal CFR against A. baumannii.CONCLUSIONS:These data reinforce the use of prolonged infusions of high-dose β-lactam antimicrobials as a reasonable strategy for the treatment of BSIs caused by multidrug resistant Gram-negative bacteria in Brazil.


Subject(s)
Humans , Anti-Bacterial Agents/administration & dosage , Drug Resistance, Multiple, Bacterial/drug effects , Gram-Negative Bacteria/drug effects , Gram-Negative Bacterial Infections/drug therapy , beta-Lactams/administration & dosage , Administration, Intravenous , Anti-Bacterial Agents/pharmacokinetics , Anti-Bacterial Agents/pharmacology , Brazil , Gram-Negative Bacteria/classification , Gram-Negative Bacterial Infections/metabolism , Gram-Negative Bacterial Infections/microbiology , Hospitals, Teaching , Microbial Sensitivity Tests , Monte Carlo Method , Time Factors , beta-Lactams/pharmacokinetics , beta-Lactams/pharmacology
11.
Braz. j. microbiol ; 46(3): 639-640, July-Sept. 2015.
Article in English | LILACS | ID: lil-755828

ABSTRACT

Pseudomonas aeruginosa (P. aeruginosa) bacteremia causes significant mortality rate due to emergence of multidrug resistant (MDR) nosocomial infections. We report the draft genome sequence of P. aeruginosa strain VRFPA09, a human bloodstream isolate, phenotypically proven as MDR strain. Whole genome sequencing on VRFPA09, deciphered betalactamase encoding blaveb-1 and blaOXA-10genes and multiple drug resistance, virulence factor encoding genes.

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Subject(s)
Humans , Bacteremia/microbiology , Bacterial Proteins/genetics , Drug Resistance, Multiple, Bacterial/genetics , Pseudomonas aeruginosa , Pseudomonas Infections/microbiology , beta-Lactamases/genetics , Anti-Bacterial Agents/pharmacology , Base Sequence , DNA, Bacterial/genetics , Microbial Sensitivity Tests , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/genetics , Pseudomonas aeruginosa/isolation & purification , Sequence Analysis, DNA , beta-Lactams/pharmacology
12.
Braz. j. infect. dis ; 18(5): 512-517, Sep-Oct/2014. tab, graf
Article in English | LILACS | ID: lil-723083

ABSTRACT

Since antimicrobial resistance among uropathogens against current first line agents has affected the management of severe urinary tract infection, we determined the likelihood that antibiotic regimens achieve bactericidal pharmacodynamic exposures using Monte Carlo simulation for five antimicrobials (ciprofloxacin, ceftriaxone, piperacillin/tazobactam, ertapenem, and meropenem) commonly prescribed as initial empirical treatment of inpatients with severe community acquired urinary tract infections. Minimum inhibitory concentration determination by Etest was performed for 205 Brazilian community urinary tract infection Escherichia coli strains from 2008 to 2012 and 74 E. coli bloodstream strains recovered from a surveillance study. Pharmacodynamic exposure was modeled via a 5000 subject Monte Carlo simulation. All isolates were susceptible to ertapenem and meropenem. Piperacillin/tazobactam, ceftriaxone and ciprofloxacin showed 100%, 97.5% and 83.3% susceptibility among outpatient isolates and 98.6%, 75.7% and 64.3% among inpatient isolates, respectively. Against outpatient isolates, all drugs except ciprofloxacin (82.7% in aggressive and 77.6% in conservative scenarios) achieved high cumulative fraction of response: car-bapenems and piperacillin/tazobactam cumulative fraction of responses were close to 100%, and ceftriaxone cumulative fraction of response was 97.5%. Similar results were observed against inpatients isolates for carbapenems (100%) and piperacillin/tazobactam (98.4%), whereas ceftriaxone achieved only 76.9% bactericidal cumulative fraction of response and ciprofloxacin 61.9% (aggressive scenario) and 56.7% (conservative scenario) respectively. Based on this model, standard doses of beta-lactams were predicted to deliver sufficient pharmacodynamic exposure for outpatients. However, ceftriaxone should be avoided for inpatients and ciprofloxacin empirical prescription should be avoided in both inpatients and outpatients with complicated urinary tract infection.


Subject(s)
Humans , Anti-Bacterial Agents/pharmacology , Escherichia coli/drug effects , Anti-Bacterial Agents/pharmacokinetics , Ceftriaxone/pharmacokinetics , Ceftriaxone/pharmacology , Ciprofloxacin/pharmacokinetics , Ciprofloxacin/pharmacology , Escherichia coli Infections/drug therapy , Escherichia coli Infections/microbiology , Escherichia coli/isolation & purification , Monte Carlo Method , Microbial Sensitivity Tests/methods , Penicillanic Acid/analogs & derivatives , Penicillanic Acid/pharmacokinetics , Penicillanic Acid/pharmacology , Piperacillin/pharmacokinetics , Piperacillin/pharmacology , Pyelonephritis/microbiology , Severity of Illness Index , Thienamycins/pharmacokinetics , Thienamycins/pharmacology , Urinary Tract Infections/drug therapy , Urinary Tract Infections/microbiology , beta-Lactams/pharmacokinetics , beta-Lactams/pharmacology
13.
Biomédica (Bogotá) ; 34(supl.1): 16-22, abr. 2014. tab
Article in Spanish | LILACS | ID: lil-712417

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/metabolism
14.
EMHJ-Eastern Mediterranean Health Journal. 2013; 19 (11): 947-952
in English | IMEMR | ID: emr-159123

ABSTRACT

The emergence and rapid spread of antibiotic-resistant Klebsiella pneumoniae isolates harbouring the bla[KPC] gene that encodes for carbapenemase production have complicated the management of patient infections. This study in a tertiary care hospital in Egypt used real-time PCR assay to test ertapenem-nonsusceptible isolates of K. pneumoniae for the presence of the bla[KPC] gene and compared the results with modified Hodge test. Antibiotic sensitivity was performed by standard methods, and interpreted following both the old CLSI breakpoints [M100-S19] for carbapenems and the revised breakpoints [M100-S22]. From the 45 non-duplicate isolates of K. pneumoniae recovered from different clinical specimens, a high prevalence of ertapenem-nonsusceptible isolates [44.4%] was reported using the new lower CLSI breakpoints. The bla[KPC] gene was confirmed in 14/20 [70.0%] of these isolates. The high prevalence of ertapenem nonsusceptibility at a tertiary care hospital in Egypt was predominantly attributed to K. pneumoniae carbapenemase-mediated resistance mechanisms in K. pneumoniae isolates


Subject(s)
Klebsiella pneumoniae/genetics , beta-Lactams/pharmacology , Carbapenems/pharmacology , Microbial Sensitivity Tests , Polymerase Chain Reaction , Prospective Studies , Klebsiella pneumoniae/enzymology
15.
Clinics ; 67(12): 1427-1431, Dec. 2012. ilus, tab
Article in English | LILACS | ID: lil-660471

ABSTRACT

OBJECTIVE: Enterobacteriaceae bacteria harboring Klebsiella pneumoniae carbapenemase are a serious worldwide threat. The molecular identification of these pathogens is not routine in Brazilian hospitals, and a rapid phenotypic screening test is desirable. This study aims to evaluate the modified Hodge test as a phenotypic screening test for Klebsiella pneumoniae carbapenemase. METHOD: From April 2009 to July 2011, all Enterobacteriaceae bacteria that were not susceptible to ertapenem according to Vitek2 analysis were analyzed with the modified Hodge test. All positive isolates and a random subset of negative isolates were also assayed for the presence of blaKPC. Isolates that were positive in modified Hodge tests were sub-classified as true-positives (E. coli touched the ertapenem disk) or inconclusive (distortion of the inhibition zone of E. coli, but growth did not reach the ertapenem disk). Negative results were defined as samples with no distortion of the inhibition zone around the ertapenem disk. RESULTS: Among the 1521 isolates of Enterobacteriaceae bacteria that were not susceptible to ertapenem, 30% were positive for blaKPC, and 35% were positive according to the modified Hodge test (81% specificity). Under the proposed sub-classification, true positives showed a 98% agreement with the blaKPC results. The negative predictive value of the modified Hodge test for detection was 100%. KPC producers showed high antimicrobial resistance rates, but 90% and 77% of these isolates were susceptible to aminoglycoside and tigecycline, respectively. CONCLUSION: Standardizing the modified Hodge test interpretation may improve the specificity of KPC detection. In this study, negative test results ruled out 100% of the isolates harboring Klebsiella pneumoniae carbapenemase 2. The test may therefore be regarded as a good epidemiological tool.


Subject(s)
Humans , Bacterial Proteins/genetics , Klebsiella Infections/microbiology , Klebsiella pneumoniae/isolation & purification , beta-Lactamases/genetics , Anti-Bacterial Agents/pharmacology , DNA, Bacterial/analysis , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/enzymology , Microbial Sensitivity Tests/methods , Predictive Value of Tests , beta-Lactam Resistance/drug effects , beta-Lactam Resistance/genetics , beta-Lactams/pharmacology
16.
Einstein (Säo Paulo) ; 10(4): 439-441, Oct.-Dec. 2012.
Article in English | LILACS | ID: lil-662468

ABSTRACT

OBJECTIVE: To evaluate ertapenem disk performance to predict Klebsiella pneumonie carbapenemase production by Gram-negative bacilli. METHODS: All Gram-negative bacilli isolated between January 2010 and June 2011 were tested by disk diffusion (OxoidTM) for sensitivity to ertapenem, meropenem and imipenem. Resistant or intermediate sensitivity strains (diameter <22 mm for ertapenem) were also tested for the blaKPC gene by polymerase chain reaction. Disk predictive positive value for Klebsiella pneumoniae carbapenemase and specificity were calculated. RESULTS: Out of the 21839 cultures performed, 3010 (13.78%) were positive, and Gram-negative bacilli were isolated in 708 (23.52%) of them. Zone of inhibition diameter for ertapenem disk was <22 mm for 111 isolates, representing 15.7% of all Gram-negative isolates. The PCR assay for blaKPC detected 40 Klebsiella pneumoniae carbapenemase-producing strains. No strains intermediate or resistant to meropenem and imipenem were sensitive to ertapenem. The ertapenem disk presented a positive predictive value of 36% to predict blaKPC and 89% specificity. CONCLUSION: The resistance of Gram-negative bacilli detected by disk diffusion against ertapenem does not predict Klebsiella pneumoniae carbapenemase production. Other mechanisms, such as production of other betalactamases and porin loss, may be implicated. The need to confirm the presence of the blaKPC is suggested. Therefore, ertapenem was a weak predictor for discriminating strains that produce Klebsiella pneumoniae carbapenemase.


OBJETIVO: Avaliar o desempenho do disco de ertapenem para predizer micro-organismos produtores de Klebsiella pneumoniae carbapenemase. MÉTODOS: Bacilos Gram-negativos isolados em cultura entre janeiro de 2010 e junho de 2011 foram testados por disco-difusão (OxoidTM) para ertapenem, meropenem e imipenem. As cepas consideradas intermediárias ou resistentes (halo<22mm) para ertapenem foram encaminhadas para a pesquisa do blaKPC por reação em cadeia da polimerase. Calcularam-se o valor preditivo positivo e a especificidade do disco. RESULTADOS: Foram realizadas 21.839 culturas nesse período, sendo 3.010 (13,78%) positivas. Bacilos Gram-negativos foram isolados em 708 (23,52%) destas. A zona de inibição do disco de ertapenem foi <22mm para 111 (15,67%) dos isolados. A pesquisa do blaKPC caracterizou 40 cepas produtoras de Klebsiella peneumoniae carbapenemase. Não houve nenhum caso de disco intermediário ou resistente para meropenem ou imipenem com ertapenem sensível. O valor preditivo positivo foi de 36% e a especificidade calculada do disco de ertapenem para produção de Klebsiella pneumoniae carbapenemase foi de 89% em nosso serviço. CONCLUSÃO: A resistência ao disco de ertapenem não define bacilo produtor de Klebsiella pneumoniae carbapenemase. Mecanismos, como produção de outras betalactamases e perda de porinas, podem estar implicados. Sugerese a necessidade da confirmação da presença do gene blaKPC. O ertapenem, portanto, mostrou-se fraco preditor para discriminar cepas produtoras de Klebsiella pneumoniae carbapenemase.


Subject(s)
Humans , Anti-Bacterial Agents/pharmacology , Bacterial Proteins/biosynthesis , Disk Diffusion Antimicrobial Tests/methods , Klebsiella pneumoniae/enzymology , beta-Lactamases/biosynthesis , beta-Lactams/pharmacology , beta-Lactam Resistance , Brazil , Bacterial Proteins/analysis , Gram-Negative Bacteria/isolation & purification , Klebsiella pneumoniae/drug effects , Microbial Sensitivity Tests , Polymerase Chain Reaction , Predictive Value of Tests , beta-Lactamases/analysis
18.
Rev. peru. med. exp. salud publica ; 28(4): 648-656, dic. 2011. ilus, tab
Article in Spanish | LIPECS, LILACS, LIPECS | ID: lil-611697

ABSTRACT

La resistencia antibiótica es un problema emergente a nivel mundial presente en diversas bacterias, en especial en la Escherichia coli, que tiene altos porcentajes de resistencia hacia ampicilina, trimetoprim-sulfametoxazol, tetraciclina, cloramfenicol y ácido nalidíxico, lo que supone grandes complicaciones en el tratamiento antibiótico cuando este es requerido. Este aumento de resistencia antibiótica se debe a la adquisición de diferentes mecanismos moleculares de resistencia mediante mutaciones puntuales a nivel cromosómico o transferencia horizontal de material genético entre especies relacionadas o diferentes, facilitada por algunos elementos genéticos tales como los integrones. Esta revisión discute los efectos de los mecanismos moleculares de resistencia más comunes en E.coli: inactivación enzimática, alteraciones en el sitio blanco y alteraciones de la permeabilidad. El conocer los mecanismos de resistencia implicados, como lo recomienda la Organización Mundial de la Salud, permitirá optimizar la vigilancia de resistencia y las políticas de control y uso de antibióticos a nivel nacional.


Antibiotic resistance is an emerging problem worldwide present in many bacteria, specially in Escherichia coli, which has high percentages of resistance to ampicilline, thrimethoprim-sulfamethoxazole, tetracycline, chloramphenicol and nalidixic acid, which implies important complications in antibiotic treatment when required. The increasing antibiotic resistance is due to the acquisition of different molecular mechanisms of resistance through point chromosomal mutations and /or horizontal transfer of genetic material between related or different species facilitated by some genetic elements such as integrons. This review discusses the effects of the most common molecular mechanisms of antibiotic resistance in E. coli: enzymatic inactivation, changes in the target site and permeability disturbances. Getting to know the mechanisms of resistance which are involved, as the World Health Organization recommends, will allow us to improve the surveillance of the antibiotic resistance, the control policies and the antibiotic utilization at a national level.


Subject(s)
Humans , Diarrhea/microbiology , Drug Resistance, Bacterial/genetics , Escherichia coli/drug effects , Escherichia coli/genetics , Integrons , Quinolones/pharmacology , Tetracyclines/pharmacology , beta-Lactams/pharmacology
19.
Indian J Med Microbiol ; 2011 Apr-June; 29(2): 161-164
Article in English | IMSEAR | ID: sea-143801

ABSTRACT

Purpose: The present study was carried out to characterize the ESBL types and evaluated their in vitro activity against a collection of Gram negative bacteria (GNB) from a multicentric Indian surveillance study. Material and Methods: During January 2005 to June 2006, six tertiary care centres in India forwarded 778 non-duplicate GNB to our reference laboratory. Three hundred GNB from this collection were selected based on clinical significance and were used in the present study. Tested isolates included Escherichia coli (167), Klebsiella spp. (122) and Enterobacter spp. (11). ESBL screening and confirmation was performed for all the isolates. Minimum inhibitory concentration of imipenem, meropenem, ertapenem, levofloxacin, amikacin, piperacillin/tazobactam and ceftriaxone was determined by the E-test method. Molecular typing of the ESBLs was performed by polymerase chain reaction among the 121 selected isolates. Results: The study showed excellent susceptibility among the strains to imipenem (100%), meropenem (100%) and ertapenem (98.7%); good susceptibility to amikacin (89.7%) and piperacillin/tazobactam (85.3%) was observed. TEM and CTX-M were predominantly found in E. coli (39.2%) while, among the Klebsiella spp., TEM, SHV and CTX-M occurred together in 42.6% of the isolates. Conclusion: More than one ESBL was produced by many strains, and this was correlated with increased resistance levels. Carbapenems continue to show good in vitro activity and ertapenem is a potential alternative to imipenem and meropenem. Continued antimicrobial resistance surveillance is warranted in light of these findings.


Subject(s)
Anti-Bacterial Agents/pharmacology , Enterobacteriaceae/classification , Enterobacteriaceae/drug effects , Enterobacteriaceae/enzymology , Enterobacteriaceae/isolation & purification , Enterobacteriaceae Infections/microbiology , Humans , India , Microbial Sensitivity Tests , Molecular Typing , Polymerase Chain Reaction , beta-Lactamases/genetics , beta-Lactamases/metabolism , beta-Lactams/pharmacology
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