Resistencia antimicrobiana, una pandemia silenciosa / Antimicrobial resistance, a silent pandemic / Resistência antimicrobiana, uma pandemia silenciosa

Introducción: la resistencia a los antimicrobianos ha sido una problemática creciente a nivel global, la problemática afecta no solo la salud de personas, animales y el ambiente en general, sino que ha generado impactos de índole productivo y comercial. Una de las estrategias para abordar esta problemática es el enfoque de una salud. Este enfoque destaca la participación multidisciplinaria para combatir la resistencia antimicrobiana; y es así que cada profesión o actividad laboral genera unas responsabilidades innatas para la profesión veterinaria. Los veterinarios tienen un rol fundamental para este propósito, ya que son ellos quienes integran la aplicabilidad de estrategias de promoción y prevención a nivel agropecuario, y de consolidación e interlocución entre los diferentes componentes del enfoque (animal, humano, ambiente) desde el ámbito de la salud pública veterinaria. Materiales y Método: se realizó una búsqueda de la literatura en diferentes bases de datos, con el objetivo de realizar una revisión actualizada sobre la resistencia antimicrobiana. Resultados: dentro de las principales estrategias se debería fomentar un uso adecuado y bajo prescripción de antimicrobianos en la producción animal. Promover buenas prácticas de higiene, bioseguridad y vacunación, facilitando un correcto diagnóstico de enfermedades infecciosas en animales. Discusión: la adopción de normas internacionales para el uso responsable de los antibióticos y las directrices establecidas por la Organización Mundial de la Salud y Organización de las Naciones Unidas para la Alimentación y la Agricultura, a través del Codex Alimentarius y la Organización Mundial de Sanidad Animal, son fundamentales para hacer frente al desafío que representa el problema de la resistencia a los antimicrobianos.

Introduction: Antimicrobial resistance has been a growing problem at a global level, affecting not only the health of people, animals and the environment in general, but it has also generated impacts of a productive and commercial nature. One of the strategies to address this problem is the one-health approach. This approach emphasizes multidisciplinary participation to combat antimicrobial resistance; and thus, each profession or work activity generates innate responsibilities for the veterinary profession. Veterinarians have a fundamental role for this purpose, since they are the ones who integrate the applicability of promotion and prevention strategies at the agricultural level, and of consolidation and interlocution between the different components of the approach (animal, human, environment) from the field of veterinary public health. Materials and Method: a literature search was carried out in different databases, with the aim of carrying out an updated review on antimicrobial resistance. Results: one of the main strategies should be to promote an adequate use and under prescription of antimicrobials in animal production. Promote good hygiene, biosecurity and vaccination practices, facilitating a correct diagnosis of infectious diseases in animals. Discussion: the adoption of international standards for the responsible use of antibiotics and the guidelines established by the World Health Organization and the Food and Agriculture Organization of the United Nations, through Codex Alimentarius and the World Organization for Animal Health, are fundamental to face the challenge posed by the problem of antimicrobial resistance.

Introdução: A resistência antimicrobiana tem sido um problema crescente em todo o mundo, afetando não apenas a saúde dos seres humanos, dos animais e do meio ambiente em geral, mas também causando impactos na produção e no comércio. Uma das estratégias para lidar com esse problema é a abordagem One Health. Essa abordagem enfatiza o envolvimento multidisciplinar no combate à resistência antimicrobiana, com cada profissão ou atividade de trabalho gerando responsabilidades inatas à profissão veterinária. Os veterinários têm um papel fundamental nesse sentido, pois são eles que integram a aplicabilidade das estratégias de promoção e prevenção em nível agropecuário e de consolidação e interlocução entre os diferentes componentes da abordagem (animal, humano, ambiental) do campo da saúde pública veterinária. Materiais e Métodos: foi realizada uma pesquisa bibliográfica em diferentes bases de dados, com o objetivo de realizar uma revisão atualizada sobre a resistência antimicrobiana. Resultados: uma das principais estratégias deve ser a promoção do uso adequado e com baixa prescrição de antimicrobianos na produção animal. Promover boas práticas de higiene, biossegurança e vacinação, facilitando o diagnóstico correto de doenças infecciosas em animais. Discussão: A adoção de padrões internacionais para o uso responsável de antibióticos e as diretrizes estabelecidas pela Organização Mundial da Saúde e pela Organização das Nações Unidas para Agricultura e Alimentação, por meio do Codex Alimentarius e da Organização Mundial de Saúde Animal, são essenciais para enfrentar o desafio representado pelo problema da resistência antimicrobiana.

Clinical characteristics and prognostic factors of patients with Klebsiella pneumoniae bloodstream infection / 中华全科医师杂志

Objective:To analyze the clinical characteristics, antibiotic resistance and prognostic risk factors of patients with Klebsiella pneumoniae bloodstream infection (Kp BSI).Methods:The clinical data of 188 patients diagnosed with Kp BSI from January 1，2017 to December 1，2021 in Beijing Shijitan Hospital, Capital Medical University were retrospectively analyzed.There were 118 patients males (62.8%) with a median age 77.0(63.0, 85.0) years old. The median length of hospital stay was 20.0 days, and 78 patients (41.5%) were admitted to intensive care unit(ICU). There were 121 cases with carbapenem-sensitive Klebsiella pneumoniae (64.4%, CSKP group) and 67 cases with carbapenem-resistant Klebsiella pneumoniae (35.6%, CRKP group).Fifty six patients died within 28 days after admission (death group), and 132 patients survived (survival group).The clinical characteristics and bacterial drug resistance of Kp BSI patients were analyzed, and univariate analysis and multivariate logistic regression analysis were used to explore factors related to the CRKP infection and patient mortality.Results:The most common infection sites were respiratory system, abdominal cavity and biliary tract accounting for 39.4% (74/188), 18.1% (34/188) and 14.4% (27/188), respectively.The common comorbidities were coronary heart disease, hypertension, chronic kidney disease and diabetes, accounting for 63.8% (120/188), 59.6% (112/188), 46.3% (87/188) and 43.1% (81/188), respectively and 118 patients (62.8%) had 3 or more comorbidities. Most patients (146 cases, 77.7%) underwent ≥1 invasive procedures before bloodstream infection;and 90 patients (47.9%) had a history of antibiotic use. CRKP strains showed higher resistance rates to piperacillin, quinolones, cephalosporins and carbapenems. Univariate analysis showed that there were statistically significant differences in age (69.0 vs. 83.0 years), ICU admission 25.6%(31/121) vs. 70.1%(47/67)], invasive procedures [67.8%(82/121) vs. 95.5 %(64/67)], and antibiotic use [37.2% (45/121) vs. 67.2%(45/67)] between the CSKP group and the CRKP group ( Z=-5.73, χ 2=35.22, χ 2=19.15, χ 2=15.53, all P<0.001). Multivariate logistic regression analysis showed that age, ICU admission, invasive procedures and antibiotic use in recent 30 days were independent risk factors for CRKP infection( OR=1.06, P<0.001; OR=3.22, P=0.003; OR=5.93, P=0.009; OR=2.40, P=0.022). The total fatality rate was 29.8%(56/188). Univariate analysis showed that there were statistically significant differences in CRKP infection [19.7%(26/132) vs. 73.2% (41/56)], albumin level (32.6 vs. 27.8 g/L) and sequential organ failure assessment score (SOFA score, 2 vs. 8 score) between the survival group and the death group (χ 2=49.10, Z=-4.64, Z=-10.36,all P<0.001). Multivariate logistic regression analysis suggested that CRKP infection, low albumin and high SOFA score on the day of bloodstream infection were risk factors for death of Kp BSI patients( OR=5.13, P=0.021; OR=0.86, P=0.044; OR=3.04, P<0.001). Conclusion:Kp BSI patients have a high fatality rate and fairly severe drug resistance. CRKP infection, low albumin, high SOFA score on the day of bloodstream infection are associated with poor prognosis in Kp BSI patients.

Factors associated with multidrug-resistant bacteria in healthcare-associated infections: a pediatric intensive care unit case-control study

ABSTRACT Objective To investigate the prevalence of factors related to healthcare-associated infections, caused by multidrug-resistant bacteria, in a pediatric intensive care unit. Methods A retrospective case-control study conducted from January 1, 2007 to December 31, 2018, in São Paulo (SP), Brazil. The study was carried out at the pediatric intensive care unit of a high-complexity, tertiary care general hospital. The study included patients aged 1 month to 19 years, admitted to the pediatric intensive care unit, diagnosed as healthcare-associated infections. Results There was significant evidence of infection by multidrug-resistant bacteria associated with immunosuppressed patients (p<0.001), in whom the likelihood of multidrug-resistant bacteria infection was estimated to be nine-fold higher than among non-immunosuppressed patients (OR 8.97; 95%CI 2.69-29.94). In the analysis of multiple logistic regression model, we observed that immunosuppressed patients had an 8.5-fold higher chance of multidrug-resistant bacteria infection when compared to non-immunosuppressed patients (OR 8.48; 95%CI 2.54-28.35; p=0.001). There is evidence of association between the Case Group and presence of Gram-positive (p=0.007), coagulase-negative Staphylococcus (p<0.001), and Gram-negative (p=0.041) microorganisms. Conclusion The immunocompromised-state variable is a factor related to healthcare-associated infections caused by multidrug-resistant bacteria, and the Case Group presented higher proportions of Gram-positive microorganisms and coagulase-negative Staphylococcus.

Determinants of late neonatal nosocomial infection: a case-control study in Ceará / Determinantes de infecção nosocomial tardia neonatal: estudo de caso-controle no Ceará

ABSTRACT OBJECTIVES To assess the determining factors of late healthcare-associated infections (HAIs) and bacterial multiple drug resistance in neonatal intensive care. METHODS This is a case-control study, conducted between January 2013 and December 2017, in a neonatal intensive care unit in the state of Ceará, Brazil. Newborns showing late HAIs were considered cases and those without infection, the control. Variables with p-values ≤ 0.05 in our initial bivariate regressive analysis were included in a non-conditional hierarchical logistic model for multivariate analysis. P-values below 0.01 were considered significant. RESULTS Of the 1,132 participants, 427 (37.7%) showed late healthcare-associated infections. Of these, 54 (12.6%), positive blood cultures, of which 14.9% contained multidrug-resistant bacteria. Bivariate analysis showed the protective effect of the feminine phenotype (OR = 0.71; 95%CI: 0.56-0.90) and of gestational ages ≥ 34 weeks (OR = 0.48; 95%CI: 0.30-0.75). In earlier-born preterm infants, late infections were 18 times more likely in those with less than 30 week-gestations (OR = 18.61; 95%CI: 9.84-35.22) and four times higher in those weighing less than 1,500 g (OR = 4.18; 95%CI: 3.12-5.61). Mechanical ventilation increased infection odds by more than seven times (OR = 7.14; 95%CI: 5.26-9.09); as did parenteral nutrition (OR = 5.88; 95%CI: 4.54-7.69); central venous catheters (OR = 10.00; 95%CI: 6.66-16.66); the number of catheters used (OR = 3.93; 95%CI: 3.02-5.12); surgery (OR = 4.00; 95%CI: 2.27-7.14); and hospitalization time (OR = 1.06; 95%CI: 1.05-1.07). The association between preterm infants with less than 30 week-gestations (OR = 5.62; 95%CI: 1.83-17.28); mechanical ventilation (OR = 1.84; 95%CI: 1.26-2.68); central venous catheters (OR = 2.48; 95%CI: 1.40-4.37); and hospitalization time (OR = 1.06; 95%CI: 1.05-1.07) remained significant after adjustment. Among deaths, 41 (55.4%) were associated with late infections. CONCLUSION Better practices should be adopted in caring for the premature, as well as in the rational use of procedures, to avoid late healthcare-associated infections, preventable deaths, and risks of bacterial multiple drug resistance and environmental contamination.

RESUMO OBJETIVO Identificar os fatores determinantes para infecções relacionadas à assistência à saúde (IRAS) tardias em terapia intensiva neonatal e multirresistência bacteriana. MÉTODOS Estudo caso-controle em unidade de terapia intensiva neonatal do Estado do Ceará, entre janeiro de 2013 e dezembro de 2017. Considerado caso o recém-nascido notificado como IRAS tardia e, controle, aquele sem infecção. Variáveis com valor de p ≤ 0,05 em análise regressiva bivariada inicial foram incluídas em modelo logístico hierarquizado não condicional para análise multivariada. Valores de p menores que 0,01 foram considerados significativos. RESULTADOS Dos 1.132 participantes, 427 (37,7%) tiveram infecções tardias relacionadas a assistência à saúde, com 54 (12,6%) hemoculturas positivas e 14,9% dessas foram bactérias multirresistentes. Na análise bivariada observou-se efeito protetor do sexo feminino (OR = 0,71; IC95% 0,56-0,90) e recém-nascido ≥ 34 semanas (OR = 0,48; IC95% 0,30-0,75). Nos mais prematuros, as infecções tardias tiveram chance dezoito vezes maior em menores do que 30 semanas (OR = 18,61; IC95% 9,84-35,22); e nos menores de 1.500g, quatro vezes maior (OR = 4,18; IC95% 3,12-5,61). O uso de ventilação mecânica aumentou em mais de sete vezes a chance (OR = 7,14; IC95% 5,26-9,09); o mesmo aconteceu com o recurso da nutrição parenteral (OR = 5,88; IC95% 4,54-7,69), com o cateter venoso central (OR = 10,00; IC95% 6,66-16,66); o número de cateteres utilizado (OR = 3,93; IC95% 3,02-5,12); a realização de cirurgia (OR = 4,00; IC95% 2,27-7,14) e o tempo de internamento (OR = 1,06; IC95% 1,05-1,07). Permaneceram significativos após ajuste: prematuro menor do que 30 semanas (OR = 5,62; IC95% 1,83-17,28); uso de ventilação (OR = 1,84; IC95% 1,26-2,68); uso de cateter venoso central (OR = 2,48; IC95% 1,40-4,37) e tempo de internamento (OR = 1,06; IC95% 1,05-1,07). Dentre os óbitos, 41 (55,4%) foram associados às infecções tardias. CONCLUSÃO Melhores práticas devem ser adotadas no cuidado da prematuridade e o uso racional de procedimentos, para evitar infecções tardias relacionadas a assistência à saúde, óbitos preveníveis e riscos de multirresistência bacteriana e contaminação ambiental.

Effects of targeted surveillance combined with cluster management on isolation protector use rate and hand hygiene qualification rate in caregivers of patients with respiratory tract multidrug-resistant bacterial infections / 中国基层医药

Objective:To investigate the targeted surveillance combined with cluster management on isolation protector use rate and hand hygiene qualification rate in caregivers of patients with respiratory tract multidrug-resistant bacterial infections.Methods:Second Hospital of Shanxi Medical University began to perform targeted surveillance combined with cluster management among caregivers of patients with multidrug-resistant bacterial infections in July 2019. The caregivers of 50 patients with respiratory tract multidrug-resistant bacterial infections who were admitted before targeted surveillance combined with cluster management were included in the pre-implementation group. The caregivers of 50 patients with respiratory tract multidrug-resistant bacterial infections who were admitted after targeted surveillance combined with cluster management were included in the post-implementation group. Multidrug-resistant bacterial infections in caregivers, isolation protector use rate, environmental disinfection and hand hygiene qualification rate were compared between before and after 6 months of targeted surveillance combined with cluster management. The application value of targeted surveillance combined with cluster management in the prevention of respiratory tract multidrug-resistant bacterial infections was analyzed.Results:The number of caregivers with respiratory tract multidrug-resistant bacterial infections in the post-implementation group was lower than that in the pre-implementation group (5 vs. 13, P < 0.05). The proportion of caregivers who wear a mask (94.11%), isolation clothes (80.39%) and gloves (98.03%) in the post-implementation group was significantly higher than that in the pre-implementation group (70.00%, 62.00%, 78.00%, χ2 = 10.027, 4.911, 9.683, all P < 0.05). The proportion of caregivers who were qualified in terms of hand hygiene (82.35%), object surface (76.47%), and keeping the air fresh in the post-implementation group was significantly higher than that in the pre-implementation group (64.00%, 58.00%, 64.00%, χ2 = 4.341, 3.915, 5.450, all P < 0.05). Conclusion:Targeted surveillance combined with cluster management can effectively help prevent respiratory tract multidrug-resistant bacterial infections in caregivers and increase isolation protector use rate and hand hygiene qualification rate.

Factores de éxito del tratamiento de la tuberculosis multidrogorresistente relacionados con el paciente y el personal sanitario en Colombia / Patient- and provider-related factors in the success of multidrug tuberculosis treatment in Colombia / Fatores de êxito do tratamento da tuberculose multirresistente relacionados com o paciente e com a equipe de saúde na Colômbia

RESUMEN Objetivo. Identificar los factores asociados con el éxito del tratamiento de tuberculosis multidrogorresistente (TB-MDR) relacionados con los pacientes y el personal sanitario en seis municipios de Colombia con mayor número de casos. Métodos. Mediante regresiones logísticas bifactorial y multifactorial se analizó la asociación entre el tratamiento exitoso (curación o cumplimiento del tratamiento) y las características de los pacientes, y de los médicos, profesionales de enfermería y psicólogos vinculados al tratamiento. Se exploró la importancia del conocimiento en el manejo de los casos de TB-MDR mediante grupos focales con esos profesionales. Resultados. De los 128 casos con TB-MDR, 63 (49,2%) tuvieron un tratamiento exitoso. Solo 52,9% de los médicos y profesionales de enfermería tenía conocimientos satisfactorios sobre TB-MDR. La regresión logística mostró que ser negativo al VIH, estar afiliado al régimen de aseguramiento de salud contributivo, estar atendido por un médico del sexo masculino y por profesionales de enfermería con conocimientos suficientes se asociaron con un desenlace exitoso del tratamiento (p ≤ 0,05). El análisis cualitativo mostró la necesidad de profundizar y sistematizar la capacitación del personal sanitario que atiende los casos de TB-MDR. Conclusiones. En el éxito del tratamiento de los casos de TB-MDR influyen algunas características de los pacientes y el personal sanitario. Se requiere fortalecer los conocimientos sobre TB-MDR de médicos y enfermeros, y reforzar el seguimiento de los pacientes con TB-MDR positivos al VIH y de los que pertenecen al régimen subsidiado, dada su menor probabilidad de éxito al tratamiento.

ABSTRACT Objective. To identify patient- and provider-related factors associated with the success of multidrug-resistant tuberculosis (MDR-TB) treatment in the six municipalities of Colombia with the highest number of MDR-TB cases. Methods. Bivariate and multivariate logistic regressions were used to analyze the association between treatment success (cure or treatment completion) and characteristics of the patients and physicians, nursing professionals, and psychologists involved in their treatment. The importance of knowledge in the management of MDR-TB cases was explored through focus groups with these providers. Results. Of 128 cases of TB-MDR, 63 (49.2%) experienced treatment success. Only 52.9% of the physicians and nursing professionals had satisfactory knowledge about MDR-TB. Logistic regression showed that being HIV negative, being affiliated with the contributory health insurance scheme, being cared for by a male physician, and being cared for by nursing professionals with sufficient knowledge were associated with a successful treatment outcome (p ≤ 0.05). Qualitative analysis showed the need for in-depth, systematic training of health personnel who care for patients with MDR-TB. Conclusions. Some characteristics of patients and healthcare providers influence treatment success in MDR-TB cases. Physicians' and nurses' knowledge about MDR-TB must be improved, and follow-up of MDR-TB patients who are living with HIV and of those affiliated with the subsidized health insurance scheme in Colombia must be strengthened, as these patients have a lower likelihood of a successful treatment outcome.

RESUMO Objetivo. Identificar os fatores associados ao êxito do tratamento da tuberculose multirresistente (TBMR) relacionados ao paciente e à equipe de saúde nos seis municípios da Colômbia com o maior número de casos. Métodos. Mediante regressão logística bifatorial e multifatorial, analisou-se a associação entre o êxito do tratamento (cura ou completude do tratamento) e as características dos pacientes e dos médicos, profissionais de enfermagem e psicólogos envolvidos neste. Explorou-se a importância do conhecimento no manejo de casos de TBMR mediante grupos focais com os mesmos profissionais. Resultados. Dos 128 casos de TBMR, 63 (49.2%) lograram êxito no tratamento. Somente 52.9% dos médicos e profissionais de enfermagem tinham conhecimentos satisfatórios sobre TBMR. A regressão logística demonstrou que soronegatividade para o HIV, cobertura pelo sistema de saúde sob o regime de contribuinte, atendimento por um médico do sexo masculino e atendimento por profissionais de enfermagem com conhecimento suficiente foram fatores associados ao êxito do tratamento (p ≤ 0,05). A análise qualitativa demonstrou necessidade de aprofundar e sistematizar a capacitação do pessoal de saúde que atende casos de TBMR. Conclusões. Algumas características do paciente e da equipe de saúde influenciam no êxito do tratamento de casos de TBMR. É preciso fortalecer os conhecimentos dos médicos e profissionais de enfermagem sobre a TBMR e reforçar o seguimento dos pacientes com TBMR que vivem com HIV e os filiados ao sistema de saúde colombiano pelo regime subsidiado, os quais têm menor probabilidade de êxito do tratamento.

Infecciones del Tracto Urinario: métodos diagnósticos, tratamiento empírico y multirresistencia en una Unidad de Adultos Área de Emergencias / Urinary Tract Infections: diagnostic methods, empirical treatment and multidrug resistance in an Adult Emergency Area Unit

INTRODUCCIÓN. Las infecciones del tracto urinario por variedad de bacterias uropatógenas multiresistentes se deben al uso de tratamiento empírico o automedicación. OBJETIVO. Describir en las infecciones de tracto urinario los métodos diagnósticos, tratamiento empírico y la multirresistencia. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo, retrospectivo. Población y muestra de 73 Historias Clínicas de pacientes atendidos en la Unidad de Adultos Área de Emergencias del Hospital de Especialidades Carlos Andrade Marín en el período enero a diciembre 2018. Se incluyeron pacientes mayores de 18 años, de ambos sexos, con diagnóstico clínico y por laboratorio de infección del tracto urinario superior e inferior. La información se obtuvo mediante la base de datos AS400, y se procesó en Epi-info y Excel. RESULTADOS. El 71,23% (52; 73) de mujeres tuvieron infección del tracto urinario. Escherichia coli fue frecuente en un 48,39% (15; 31), con mayor resistencia al Clotrimoxazol. El tratamiento empírico con Ciprofloxacino fue utilizado en 27,40% (20; 73). DISCUSIÓN: Se observó controversia en los tipos de estudios de imagen solicitados para el diagnóstico acorde a la clase de infección de tracto urinario así como el tratamiento empírico por factores propios de cada localidad que evitaron resistencia. CONCLUSIÓN. Escherichia coli se aisló de manera frecuente y registró mayor resistencia al Clotrimoxazol; el principal antibiótico prescrito como tratamiento empírico fue la Ciprofloxacina; el examen más solicitado fue la Urotomografía.

INTRODUCTION. Urinary tract infections due to a variety of multi-resistant uropathogenic bacteria are due to the use of empirical treatment or self-medication. OBJECTIVE. Describe diagnostic methods, empirical treatment and multidrug resistance in urinary tract infections. MATERIALS AND METHODS. Observational, descriptive, retrospective study. Population and sample of 73 Medical Records of patients treated in the Emergency Area Adult Unit of the Carlos Andrade Marín Specialty Hospital in the period january to december 2018. Patients older than 18 years of age, of both sexes, with clinical diagnosis and due to upper and lower urinary tract infection laboratory. The information was obtained through the AS400 database, and was processed in Epi-info and Excel. RESULTS. 71,23% (52; 73) of women had urinary tract infection. Escherichia coli was frequent in 48,39% (15; 31), with greater resistance to Clotrimoxazole. Empirical treatment with Ciprofloxacin was used in 27,40% (20; 73). DISCUSSION: Controversy was observed in the types of imaging studies requested for diagnosis according to the class of urinary tract infection as well as the empirical treatment due to factors specific to each locality that prevented resistance. CONCLUSION. Escherichia coli was frequently isolated and showed greater resistance to Clotrimoxazole; the main antibiotic prescribed as empirical treatment was Ciprofloxacin; the most requested examination was the Urotomography.

Aislamientos de Acinetobacter spp. en infecciones asociadas a la asistencia sanitaria / Isolation of Acinetobacter spp. in infections associated with health care

Introducción: El Acinetobacter spp. se ha convertido en un germen de gran relevancia clínica, resulta un verdadero paradigma de las infecciones nosocomiales multirresistentes. Objetivo: Caracterizar los aislamientos microbiológicos de Acinetobacter spp. en infecciones asociadas a la asistencia sanitaria. Métodos: Estudio descriptivo que incluyó 280 aislamientos de Acinetobacter spp. de las muestras provenientes de pacientes hospitalizados, en el periodo de tres años (del 2016 al 2018) en el Hospital Comandante "Manuel Fajardo Rivero". Las variables del estudio fueron: salas de procedencia del aislamiento, tipo de muestra, factor predictivo, diagnóstico infectológico, susceptibilidad antimicrobiana in vitro y multidrogorresistencia, Resultados: El mayor número de aislamientos de Acinetobacter spp. se obtuvo en la unidad de cuidados intensivos (78,9 por ciento), las secreciones respiratorias fueron las muestras con más aislamientos (58,9 por ciento), la ventilación mecánica resultó el factor predictivo más frecuente (67,9 por ciento) y como diagnóstico infectológico, la neumonía asociada al ventilador (66,8 por ciento). Se encontró un porcentaje elevado de cepas con multidrogorresistencia (73,6 por ciento). Conclusiones: El Acinetobacter spp. se encuentra vinculado a las infecciones asociadas a los servicios de salud, fundamentalmente en los cuidados intensivos. Los antimicrobianos probados evidenciaron altos porcentajes de resistencia, con predominio de las cepas multidrogorresistentes(AU)

Introduction: Acinetobacter spp. has become a germ of great clinical relevance, it is a true paradigm of multiresistant nosocomial infections. Objective: To characterize the microbiological isolates of Acinetobacter spp. in infections associated with health care. Methods: Descriptive study that included 280 isolates of Acinetobacter spp. from the samples of hospitalized patients, in the period of three years (from 2016 to 2018) in the Hospital Comandante "Manuel Fajardo Rivero". The variables of the study were: wards of origin of the isolation, type of sample, predictive factor, infectious diagnosis, antimicrobial susceptibility in vitro and multidrug resistance. Results: The highest number of isolates of Acinetobacter spp. was obtained in the intensive care unit (78.9 percent), the respiratory secretions were the samples with the most isolations (58.9 percent), mechanical ventilation was the most frequent predictor (67.9 percent) and as an infectious diagnosis, ventilator-associated pneumonia (66.8 percent). A high percentage of strains with multidrug resistance (73.6 percent) was found. Conclusions: Acinetobacter spp. is linked to infections associated with health services, mainly in intensive care. The antimicrobials tested showed high percentages of resistance, with a predominance of multidrug resistant strains(AU)

Analysis on risk factors for multidrug-resistant bacterial infections in patients in neurosurgical intensive care unit / 中国医师杂志

Objective@#To analyze the risk factors of multidrug-resistant bacteria (MDRO) infection in patients in Neurosurgical intensive care unit (NSICU), and to provide reference for clinical prevention and treatment.@*Methods@#1 251 patients with NSICU in our hospital from January 2012 to March 2018 were selected as the study subjects. The bacterial specimens were extracted. 380 patients with MDRO infection were the observation group, and 871 patients with non-MDRO infection in NSICU were the control group. The patients' medical records and clinical information were retrospectively analyzed, and multivariate logistic regression analysis was used to analyze the risk factors of MDRO infection in NSICU patients.@*Results@#There was no significant difference in the gender, age and body mass index (BMI) between the observation group and the control group (P>0.05). There was statistical significance in the proportion of hospitalization time, operation, use of urethra tube, mechanical ventilation, serious basic diseases and rational use of antibiotics between the observation group and the control group (P<0.05). According to the analysis on proportion of colony samples, the highest proportion in the observation group was sputum samples, accounted for 45.00%, followed by urine samples (21.58%), and the lowest proportion was other types of samples, accounted for 1.84%. The results of MDRO test showed that the highest proportion of pathogens was methicillin-resistant staphylococcus aureus (MRSA), accounted for 33.69%, followed by pseudomonas aeruginosa (PA), carbapenem-resistant acinetobacter baumannii (CR-AB), and the lowest proportion was stenotrophomonas maltophilia (SM), accounted for 1.58%. Logistic regression analysis showed that surgery, catheterization, mechanical ventilation, serious basic diseases and abuse of antibiotics were risk factors for MDRO infection in NSICU patients (P<0.05).@*Conclusions@#Invasive manipulation and antimicrobial abuse are the main risk factors for MDRO infection in NSICU patients, among which respiratory tract infection is the most serious and MRSA strain infection is the most common. The management of drugs and therapeutic devices should be scientific, rational and standardized in order to reduce the infection rate of MDRO.

Analysis on risk factors for multidrug-resistant bacterial infections in patients in neurosurgical intensive care unit / 中国医师杂志

Objective To analyze the risk factors of multidrug-resistant bacteria (MDRO) infection in patients in Neurosurgical intensive care unit (NSICU),and to provide reference for clinical prevention and treatment.Methods 1 251 patients with NSICU in our hospital from January 2012 to March 2018 were selected as the study subjects.The bacterial specimens were extracted.380 patients with MDRO infection were the observation group,and 871 patients with non-MDRO infection in NSICU were the control group.The patients'medical records and clinical information were retrospectively analyzed,and multivariate logistic regression analysis was used to analyze the risk factors of MDRO infection in NSICU patients.Results There was no significant difference in the gender,age and body mass index (BMI) between the observation group and the control group (P ＞ 0.05).There was statistical significance in the proportion of hospitalization time,operation,use of urethra tube,mechanical ventilation,serious basic diseases and rational use of antibiotics between the observation group and the control group (P ＜ 0.05).According to the analysis on proportion of colony samples,the highest proportion in the observation group was sputum samples,accounted for 45.00％,followed by urine samples (21.58％),and the lowest proportion was other types of samples,accounted for 1.84％.The results of MDRO test showed that the highest proportion of pathogens was methicillin-resistant staphylococcus aureus (MRSA),accounted for 33.69％,followed by pseudomonas aeruginosa (PA),carbapenem-resistant acinetobacter baumannii (CR-AB),and the lowest proportion was stenotrophomonas maltophilia (SM),accounted for 1.58％.Logistic regression analysis showed that surgery,catheterization,mechanical ventilation,serious basic diseases and abuse of antibiotics were risk factors for MDRO infection in NSICU patients (P ＜ 0.05).Conclusions Invasive manipulation and antimicrobial abuse are the main risk factors for MDRO infection in NSICU patients,among which respiratory tract infection is the most serious and MRSA strain infection is the most common.The management of drugs and therapeutic devices should be scientific,rational and standardized in order to reduce the infection rate of MDRO.

Multidrug-Resistant, Gram-Negative Bacteria in Hospitalized Elderly Patients from Non-Hospital Long-Term Care Facilities / 대한내과학회지

BACKGROUND/AIMS: We investigated the risk of multidrug-resistant, gram-negative bacteria (MDRGNB) in hospitalized elderly patients from non-hospital long-term care facilities (LTCFs) and the antibiotic prescription pattern. METHODS: All clinical cultures obtained within 48 hours of hospitalization from elderly patients of at least 55 years of age arriving at a 623-bed, public teaching hospital in Seoul, Republic of Korea from LTCFs between April 1, 2011 and April 1, 2012 were collected retrospectively. RESULTS: During this period, 365 elderly persons from 13 LTCFs were hospitalized. This study enrolled 135 patients who had cultures performed. In this group, 27.4% harbored MDRGNB at hospitalization. The presence of MDRGNB during prior hospitalization was the only risk factor that predicted harboring it (p = 0.043, odds ratio = 5.00, confidence interval = 1.049-23.834). Combinations of antibiotics or carbapenems were used initially in 35.6% of the patients, and this did not affect the mortality rate in this population. CONCLUSIONS: Hospitalized elderly patients from non-hospital LTCFs need more attention. Judicious antibiotic selection is needed according to the risk factor of harboring MDRGNB for antibiotics stewardship.

Conhecimento de enfermeiros de hospital universitário sobre bactérias multirresistentes / Nurses knowledge about multidrug resistant bacteria in a teaching hospital

Objetivo identificar o conhecimento de enfermeiros de hospital de ensino universitário sobre bactérias multirresistentes. Métodos estudo transversal e prospectivo, com participação de 109 enfermeiros. Coleta de dados por meio de questionário com questões abertas e fechadas. A análise estatística, seu deu por meio do programa Statistical Package for the Social Sciences. Resultados 67,0% dos participantes consideraram o conhecimento adquirido na graduação relativo a bactérias multirresistentes insuficiente para o enfrentamento destas, com predomínio dos formados anterior ao ano de 2005; do processo de transmissão, predominaram os profissionais mais jovens. Conclusão o conhecimento sobre bactérias multirresistentes foi maior entre profissionais mais jovens, de formação mais recente, com iniciativa individual para expandir o conhecimento sobre o tema e participação em treinamentos em serviço. O Serviço de Controle de Infecção Hospitalar foi a principal fonte provedora de conhecimentos para os enfermeiros participantes do estudo.

Objective to identify the knowledge of nurses of a teaching hospital about multidrug resistant bacteria. Methods cross-sectional and prospective study with the participation of 109 nurses. Data collection used a questionnaire with open and objective questions. Statistical analysis used the Statistical Package for the Social Sciences software. Results 67.0% of the participants considered the knowledge acquired in the graduation regarding multi-resistant bacteria insufficient to deal with them, with a predominance of professionals graduated before the year 2005; in the transmission process, younger professionals predominated. Conclusion knowledge about multidrug-resistant bacteria was higher among younger, more recently graduated professionals, with proactive enough to expand knowledge about the subject and to participate in in-service training. The Hospital Infection Control Service was the main source of knowledge for nurses participating in the study.

Management of multi-drug resistant organisms in healthcare settings

Antimicrobial resistance is an important global threat to public health. Hospitals, in particular, are increasingly faced with the emergence and transmission of multidrug-resistant organisms (MDROs). In hospitals, MDROs are transmitted via the hands of healthcare workers, from the contaminated environment, or directly from person to person. Although the transmission of MDROs is frequently recognized in acute care facilities, all healthcare settings are affected by MDROs. Given the evolving epidemiology of MDROs and the complexity of managing them across heterogeneous healthcare settings, multimodal strategies should be adopted to control and prevent the transmission of MDROs. It is fundamental to ensure adherence to evidence-based healthcare-associated infection prevention strategies, including hand hygiene, antimicrobial stewardship, and adequate environmental cleaning, and to ensure the reliable performance of basic infection prevention practices known to mitigate the transmission of MDROs. Healthcare-associated infections and MDROs should be surveilled in a standardized manner in order to detect outbreaks and newly introduced MDROs in healthcare facilities. When epidemiologically important pathogens newly emerge in healthcare facilities or to control outbreaks of specific pathogens, active surveillance cultures combined with preemptive isolation and contact precautions can also be implemented. Healthcare facilities should make sure that appropriate strategies are fully implemented, regularly evaluated for effectiveness, and adjusted as needed. Successful prevention and control of MDROs can be accomplished by administrative leadership, financial and human resource commitments by individual healthcare facilities, and continuous governmental efforts to make resources available for infection prevention and control.

Análisis del uso de antibióticos en antibiogramas de urocultivos realizados por un laboratorio clínico de la región centro-occidental de Colombia / Analysis of the use of antibiotics in antibiograms of urine carried out by a clinical laboratory of the central-western region of Colombia

Resumen Introducción: Los antibióticos son moléculas bactericidas/bacteriostáticas que controlan infecciones bacterianas, su uso incorrecto favorece multirresistencia o falla terapéutica en el caso de cepas bacterianas naturalmente resistentes, generando así un riesgo para la salud. Objetivo: Analizar el uso de antibióticos en antibiogramas de urocultivos realizados por un laboratorio clínico (región centro-occidental, Colombia). Materiales y métodos: Estudio descriptivo-retrospectivo. Se tomaron datos de urocultivos y antibiogramas realizados entre abril de 2014 a junio de 2015 por un laboratorio clínico de la región centro-occidental de Colombia. Los datos obtenidos fueron confrontados con los protocolos descritos por el Instituto Nacional de Salud de Colombia. Resultados: Se analizaron 1815 reportes de urocultivos y antibiogramas, identificando 18 especies bacterianas. En el 22,3%(403) de casos se evaluaron y reportaron antibióticos sobre microorganismos naturalmente resistentes. Pseudomonas aeruginosa presentó mayor resistencia, el antibiótico con mayor resistencia fue ácido nalidíxico (66,7%). Conclusión: El estudio mostró que existe un problema en cuanto al manejo, reporte e interpretación de antibiogramas frente a microorganismos naturalmente resistentes, que podría favorecer el desarrollo de multirresistencia en microorganismos sensibles de la flora bacteriana. Una revisión de la bibliografía nacional e internacional, mostró reportes similares; ningún autor menciona resistencias intrínsecas, por lo que los datos de antibiótico resistencia serían sobreevaluados.

Abstract Introduction: Antibiotics are bactericidal/bacteriostatic molecules that control bacterial infections, its misuse favors multidrug or therapeutic failure in the case of naturally resistant bacterial strains, thus generating a health risk. Objective: To analyze the use of antibiotics in urine antibiograms carried out by a clinical laboratory (central-western region, Colombia). Materials and methods: A descriptive-retrospective study was made. Urine and antibiograms data were collected from April 2014 to June 2015 by a clinical laboratory in the central-western region of Colombia. The obtained data was confronted with the protocols described by the National Institute of Health of Colombia. Results: 1815 reports of urine and antibiograms were analyzed, identifying 18 bacterial species. In the 22.3% (403) of cases, antibiotics were evaluated and reported on naturally resistant microorganisms. Pseudomonas aeruginosa showed greater resistance and the antibiotic with the highest resistance was nalidixic acid (66.7%). Conclusion: The study showed that there is a problem in managing, reporting and interpreting antibiograms against naturally resistant microorganisms, which could favor the development of multidrug in sensitive microorganisms of bacterial flora. A review of national and international bibliography showed similar reports; however, no author mentions intrinsic resistances, so the data of antibiotic resistance would be over evaluated.

Progress in the research of integron in bacterial resistance / 中华检验医学杂志

Integron was a novel bacterial resistance gene horizontal transmission element.In recent years, many researchers made a lot of research on the resistance mechanism of pathogen.In this paper, the detection and the novel discovery of the integron gene cassette were summarized , including Enterobacteria, Acinetobacter baumanii, Pseudomonas aeruginosa and other bacteria , on the basis of the multidrug resistance mechanism mediated by integron.The prospect the research was descixbed and more attention should be paid to the prevention and control of multidrug resistant bacteria.

Antibiotics resistance of Proteus mirabilis isolated from patients with acute diarrhea / 天津医药

Objective To investigate antibiotics resistance of Proteus mirabilis isolated from stools of patients with acute diarrhea for the prevention and treatment of its infection and the rational use of antibiotics. Methods Stool samples of acute diarrhea patients were collected in the diarrhea outpatient clinic of the Second Hospital of Tianjin Medical University and Tianjin Medical University General Hospital from 2013 to 2014. Enrichment culture and biochemical identification were used to isolate and identify Proteus mirabilis, which were further performed antimicrobial susceptibility testing and class 1 integron detection. Extended spectrum β-lactamases (ESBLs) phenotype and ESBLs genes (TEM, OXA and CTX-M) were amplified by polymerase chain reaction (PCR), and sequencing were carried on in parts of suspected isolates. ESBLs-positive strains were analyzed by pulsed-field gel electrophoresis (PFGE). Results A total of 277 strains of non-repetitive Proteus mirabilis were isolated, and 268 of them were performed antimicrobial susceptibility testing (the remaining 9 strains failed to recover). Relative higher resistant rates were trimethoprim/sulfamethoxazole (30.2%), ampicillin (25.4%), nalidixic acid (25.7%), streptomycin (21.6%) and chloramphenicol (21.3%). The multiple drug resistance rate was 24.6% (66/268). The positive rate of class 1 integron was 22.8%(61/268). Resistance rates to third-generation cephalosporin, ciprofloxacin and imipenem were less than 10%, but 4 isolates were resistant to imipenem, third-generation cephalosporin, fluoroquinolones, trimethoprim/sulfamethoxazole, and chloramphenicol simultaneously. Three cefotaxime-resistant strains (1062, 1505 and 1650) were positive for ESBLs phenotype and harbored CTX-M extended-spectrum β-lactamase genes, among them 2 strains also carried TEM and/or OXA β-lactamase genes. The clustering analysis of pulsed-field gel electrophoresis (PFGE) displayed that the similarities between 1505 and 1650 were 85.7%, and the similarity with 1062 was 58.1%. Conclusion Proteus mirabilis isolated from patients with acute diarrhea in our city show significant multidrug resistance, high positive rate of class 1 integron, and emergence of ESBLs-positive strains resistant to imipenem and fluoroquinolones, which pose a threat to public health. Rational use of antibiotics is important in both clinical and nonclinical settings.

Risk factors associated with multidrug-resistant tuberculosis in Espírito Santo, Brazil / Fatores associados à tuberculose resistente no Espírito Santo, Brasil

ABSTRACT OBJECTIVE To analyze the prevalence and factors associated with multidrug-resistant tuberculosis in Espírito Santo, Brazil. METHODS This is a cross-sectional study of cases of tuberculosis tested for first-line drugs (isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin) in Espírito Santo between 2002 and 2012. We have used laboratory data and registration of cases of tuberculosis – from the Sistema Nacional de Agravos de Notificação and Sistema para Tratamentos Especiais de Tuberculose. Individuals have been classified as resistant and non-resistant and compared in relation to the sociodemographic, clinical, and epidemiological variables. Some variables have been included in a logistic regression model to establish the factors associated with resistance. RESULTS In the study period, 1,669 individuals underwent anti-tuberculosis drug susceptibility testing. Of these individuals, 10.6% showed resistance to any anti-tuberculosis drug. The rate of multidrug resistance observed, that is, to rifampicin and isoniazid, has been 5%. After multiple analysis, we have identified as independent factors associated with resistant tuberculosis: history of previous treatment of tuberculosis [recurrence (OR = 7.72; 95%CI 4.24–14.05) and re-entry after abandonment (OR = 3.91; 95%CI 1.81–8.43)], smoking (OR = 3.93; 95%CI 1.98–7.79), and positive culture for Mycobacterium tuberculosis at the time of notification of the case (OR = 3.22; 95%CI 1.15–8.99). CONCLUSIONS The partnership between tuberculosis control programs and health teams working in the network of Primary Health Care needs to be strengthened. This would allow the identification and monitoring of individuals with a history of previous treatment of tuberculosis and smoking. Moreover, the expansion of the offer of the culture of tuberculosis and anti-tuberculosis drug susceptibility testing would provide greater diagnostic capacity for the resistant types in Espírito Santo.

RESUMO OBJETIVO Analisar a prevalência e fatores associados à tuberculose resistente no Espírito Santo. MÉTODOS Estudo transversal dos casos de tuberculose testados para fármacos de primeira linha (isoniazida, rifampicina, pirazinamida, etambutol e estreptomicina) no Espírito Santo entre 2002 e 2012. Foram utilizados dados laboratoriais e de registro de casos de tuberculose – Sistema Nacional de Agravos de Notificação e Sistema para Tratamentos Especiais de Tuberculose. Os indivíduos foram classificados em resistentes e não resistentes, e comparados para variáveis sociodemográficas, clínicas e epidemiológicas. Algumas variáveis foram inclusas em um modelo de regressão logística para estabelecimento de fatores associados à resistência. RESULTADOS No período do estudo, 1.669 indivíduos tiveram o teste de sensibilidade aos fármacos antituberculose realizado. Destes, 10,6% apresentaram resistência a qualquer droga antituberculose. A taxa de multirresistência observada, isto é, à rifampicina e isoniazida, foi de 5%. Após a análise múltipla, foram identificados como fatores associados independentes para tuberculose resistente: história de tratamento prévio para tuberculose [Recidiva (OR = 7,72; IC95% 4,24–14,05) e reingresso após abandono (OR = 3,91; IC95% 1,81–8,43)], tabagismo (OR = 3,93; IC95% 1,98–7,79) e cultura positiva para Mycobacterium tuberculosis no momento da notificação do caso (OR = 3,22; IC95% 1,15–8,99). CONCLUSÕES É necessário o fortalecimento da parceria entre os programas de controle de tuberculose e as equipes de saúde que atuam na rede de Atenção Primária à Saúde. Isso possibilitaria identificar e acompanhar indivíduos com história de tratamento prévio para tuberculose e tabagismo. Além disso, a ampliação da oferta de cultura e Teste de Sensibilidade a fármacos antituberculose proporcionaria maior capacidade diagnóstica para as formas resistentes no Espírito Santo.

Análise da terapia antimicrobiana empírica em infecção de correntesanguínea por Pseudomonas aeruginosa em um hospital universitário / Analysis of empirical antimicrobial therapy in Pseudomonas aeruginosabloodstream infections in a university hospital

Justificativa e Objetivo: Infecções de corrente sanguínea causadas por Pseudomonas aeruginosa apresentam significantes taxas de morbidade, mortalidade e custos hospitalares. A terapia empírica adequada impacta significativamente na mortalidade, porém, a escolha do antibiótico empírico apropriado contra uma infecção causada por P. aeruginosa é um desafio para os clínicos devido a resistência à diversos antimicrobianos. O presente estudo teve como objetivo analisar a adequação da terapia antimicrobiana empírica e correlacioná-la com a mortalidade em 30 dias. Métodos: Foi realizado um estudo coorte retrospectivo com pacientes que apresentaram infecção de corrente sanguínea por P. aeruginosa no período de Janeiro a Dezembro de 2011. Foram analisadas variáveis epidemiológicas e clínicas destes pacientes correlacionando-as com a mortalidade em 30 dias. Resultados: Vinte e nove pacientes foram incluídos no estudo. A média de idade dos pacientes que tiveram óbito foi de 66 anos e dos sobreviventes foi de 72 anos (p=0,37). Foi detectada uma elevada mortalidade hospitalar (21 de 29 pacientes, 72,4%) entre os pacientes com infecção de corrente sanguínea por P. aeruginosa. Meropenem isoladamente foi o antimicrobiano mais utilizado (34,5%). Houve inadequação na terapia empírica em oito pacientes (27,5%). Em relação às variáveis analisadas, nenhuma teve correlação estatisticamente significante com a mortalidade em 30 dias. Conclusão Nosso estudo encontrou uma elevada taxa de mortalidade entre paciente com bacteremia por P. aeruginosa. Nenhuma variável foi preditora de mortalidade em 30 dias. Estudos com uma maior casuística são necessários para um melhor entendimento das variáveis relacionadas à mortalidade entre estes pacientes

Background and Purpose: Bloodstream infections caused by Pseudomonas aeruginosa presents significant morbidity, mortality and hospital costs. Appropriate empirical antimicrobial therapy significantly impacts on mortality however the choice of adequate antibiotic therapy is a challenge for clinicians due to bacterial resistance. This study aimed to analyze the adequacy of empirical antimicrobial therapy among patients with BSI caused by Pseudomonas aeruginosa and to correlate it with the 30-day mortality. Methods: We performed a retrospective cohort study of patients with bloodstream infections caused by P. aeruginosa from January 1st, 2011 to December 31, 2011. We analyzed demographic and clinical variables of those patients correlating them with the 30-day mortality. Results: Twenty-nine patients were included in the study. The average age of patients who died and survived was 66 years and 72 years, respectively (p=0.37). A high hospital mortality rate (21 of 29 patients, 72.4%) was detected. Meropenem was the most used antibiotic during the study period (34.5%). There was inadequate empirical antimicrobial therapy in eight patients (27.5%). No statistically significant difference was observed with regard to 30-day mortality among the variables analyzed. Conclusion: Our study found a high mortality rate among patients with BSI caused by Pseudomonas aeruginosa. No variable was found to be predictor of 30-day mortality in this cohort of patients. Further studies with larger samples are needed for a better understanding of variables related to mortality among these patients.

Resistance and infection analysis of multidrug-resistant Acinetobacter baumannii in intensive care unit / 中华检验医学杂志

Objective In order to prevent the infection of Acinetobacter baumannii and use antibiotics rationally,the clinical infection and drug resistant data of multi-drug resistance Acinetobacter baumannii (MRAB)detected in intensive care unit (ICU)of Beijing Friendship Hospital from 2011 to 2013were analyzed.Methods This study is a retrospective study.One hundred and eighty five strains of MRAB were collected from the patients in ICU from January 2011 to December 2013.Identificationand antibiotic susceptibility of strains were determined with Vitek-2 Compact automatic bacteria identification system.The annual infection rate of MRAB was counted.PCR was used to detect the resistance genes.The clinical features of the patients with MRAB were analyzed.The average age,acute physiology and chronic health evaluation (APACHE) Ⅱ score,duration in ICU and mortality ratio of the MRAB patients were compared with the patients without MRAB.Rank-sum test was used to analyze the average age,APACHE Ⅱ score and duration in ICU.Chi-squared test was used to analyze the mortality ratio and annual infection rate.Results The average age [(67 ± 17)vs (59-± 19) years old,Z =-5.365,P =0],APACHE Ⅱ score [(25.68±7.93) vs (17.62±8.39),Z=-14.821,P=0],duration in ICU [(27 ±29) vs (5 ±8) d,Z =-4.342,P =0] and mortality ratio [10.82％ (53/185) vs 28.65％ (147/1 359),x2 =45.92,P =0] of the patients infected by MRAB were significantly higher than those without the infection.The MRAB was found mostly in sputum and bronchial precipitates (83.78％,155/185).Though detection rate reduced yearly and there was a significant reduction in 2013 compared with 2011 [11.07％ (69/469) vs 8.37％ (52/621),x2 =8.755,P =0.003],the drug resistant rate was in high level and did not show any change in the 3 years.OXA-23 and OXA-51 were detected in all MRAB.Conclusions The main drug resistant mechanism of MRAB in ICU is related to OXA-23.More active methods of coutrol and prevention of MRAB should be used in elderly aud severely pneumonic patients.Intensive disinfection and isolation measures can decrease MRAB detection rate.Combined antibiotics should be used in patients with MRAB infection.

Mecanismos de resistência antimicrobiana em pseudomonasaeruginosa / Mechanisms responsible for antimicrobial resistance in pseudomonas aeruginosa

Pseudomonas aeruginosa é uma bactéria de grande importância para indivíduos imunocomprometidos. No Brasil, ela é um dos principais agentes em infecções hospitalares e pode provocar diversos tipos de processos clínicos. Atualmente, um dos maiores desafios em infecções provocadas por P. aeruginosa é a resistência apresentada diante de inúmeros antimicrobianos. Além da resistência intrínseca de P.aeruginosa, essa bactéria facilmente desenvolve mecanismos de resistência adicionais, através de mutações e da aquisição de elementos genéticos móveis, por exemplo. Dessa forma, P. aeruginosa é considerada um patógeno multirresistente, o que limita as alternativas terapêuticas capazes de combatê-lo. Portanto, compreender osmecanismos que levam a essa resistência é de extrema importância para enfrentar as infecções por P. aeruginosa.

Pseudomonas aeruginosa is a bacterium of great importance forimmunocompromised individuals. In Brazil, it is one of the leadingcauses of hospital infections and can cause many types of infections.Currently, one of the biggest challenges in infections caused by P.aeruginosa is the resistance presented against numerousantimicrobials. In addition to the intrinsic resistance of P. aeruginosa,inherent in the species, this bacterium easily acquire additionalmechanisms of resistance via mutation and acquisition of mobilegenetic elements, for example. Accordingly, P. aeruginosa isconsidered a multidrug-resistant pathogen, which limits thetherapeutic alternatives able to fight it. Therefore, understanding themechanisms that lead to this resistance is of utmost importance totackle infections by P. aeruginosa.