Presencia de genes fimH y afa en aislamientos urinarios de Escherichia coli productora de betalactamasas de espectro extendido en Lima, Perú / Presence of fimH and afa genes in urinary isolates of extended-spectrum beta-lactamases producing Escherichia coli in Lima, Peru

RESUMEN Con el objetivo de determinar la presencia de los genes fimH y afa en aislamientos urinarios de Escherichia coli productoras de betalactamasas de espectro extendido (BLEE), se realizó un estudio descriptivo, con aislamientos del cepario del proyecto TO-06/09 del Instituto Nacional de Salud del Niño en Lima, Perú. Se incluyeron 75 aislamientos urinarios de Escherichia coli. La identificación de genes se realizó por reacción en cadena de la polimerasa. De los 75 aislamientos, 74 (98,7%) fueron positivos para el gen fimH y 6 (8,0%) fueron positivos para el gen afa. Se evidenció la presencia de los factores de virulencia producidos por los genes fimH y afa en aislamientos urinarios de Escherichia coli productoras de BLEE.

ABSTRACT Descriptive study conducted in order to determine the presence of the fimH and afa genes in urinary isolates of extended-spectrum beta-lactamases (ESBL) producing Escherichia coli. Isolates from project TO-06/09 of the Instituto Nacional de Salud del Niño in Lima, Peru were used. A total of 75 urinary isolates of Escherichia coli were included. Gene identification was performed by polymerase chain reaction. From the 75 isolates, 74 (98.7%) were positive for the fimH gene and 6 (8.0%) were positive for the afa gene. Virulence factors produced by the fimH and afa genes were evident in urinary isolates of ESBL producing Escherichia coli.

Prevalencia de Escherichia coli productor de betalactamasas de espectro extendido (BLEE) y otras resistencias en urocultivos en un hospital general de Ica, Perú / Prevalence of Escherichia coli producing extended-spectrum beta-lactamase (ESBL) and other resistance urinecultures at a general hospital in Ica, Peru

Objetivo: Determinar la prevalencia de Escherichia coli BLEE y otras resistencias en urocultivos realizados en el Hospital Regional de Ica, durante el periodo 2013 al 2014. Materiales y métodos: Estudio descriptivo, observacional y retrospectivo que comprendió el estudio de 2792 urocultivos realizados durante el periodo 2013 y 2014 en el Hospital Regional de Ica, de los cuales se recolectó información. Los análisis se realizaron usando la estadística descriptiva y la prueba chi2 con un nivel de confianza del 95% (p<0,05). Resultados: La prevalencia de Escherichia coli BLEE fue de 4% hallando asociación signficativa con sexo y servicio hospitalario. Se identificó que la población positiva a E. coli BLEE se encontraba mayormente en mujeres (78%) así como el servicio hospitalario con mayor positividad fue medicina interna con un 54% de frecuencia, el grupo etario donde esta infección fue más frecuente estuvo comprendido entre 30 y 59 años, sin embargo no mostró significancia estadística. Se halló un predominio de resistencia a cefalosporinas como la ceftriaxona (60%), mientras que en otras resistencias fue predominante la gentamicina (88%) seguido por sulfatrimetropin (74%). Conclusión: La prevalencia de Escherichia coli BLEE y el tipo de resistencia a los antibióticos reportados en este estudio sugieren la presencia de una cepa de Escherichia coli BLEE diferente a las reportadas en nuestro país, por lo que se sugiere mayor investigación ya que es un serio problema de salud pública. (AU)

Objective: To determine the prevalence of Escherichia coliand ESBL resistance in other cultures made in the Ica Regional Hospital during the period 2013 to 2014. Materials and methods: retrospective observational study involving 2792 study cultures made during the period 2013 and 2014 in the Regional Hospital of Ica, of which data were collected. Analyses were performed using descriptive statistics and chi 2 test with a confidence level of 95% (p <0.05).Results: The prevalence of Escherichia coli ESBL was 4% finding signficativa association with sex and hospitable service. It was identified that the positive E. coli ESBL population was mostly women (78%) and hospital services more positivity was internal medicine with 54% frequency, the age group where the infection was most common was between 30 and 59, but did not show statistical significance. a predominance of cephalosporin resistance as ceftriaxone (60%) was found,where as in other gentamicin resistance was predominantly (88%) followed by sulfatrimetropin (74%).Conclusion: The prevalence of E. coli ESBL and type of antibiotic resistance reported in this study suggest the presence of a strain of E. coli other than those reported in our country ESBL, so further research is suggested because it is a serious public health problem. (AU)

Extended-spectrum beta-lactamase-positive Escherichia coli causing complicated upper urinary tract infection: urologist should act in time

Recently, many articles reported increased incidence of urinary tract infection [UTI] due to Extended-Spectrum Beta-Lactamase [ESBL]-producing E. coli. No data are available to date regarding patients presenting with complicated upper ESBL-positive E. coli UTI and sepsis. We report the clinical presentation, management, and outcomes in seven cases. This prospective study was carried out between January 2008 and September 2011. Follow-ups varied in patients according to their disease presentation and clinical outcomes. All strains were cultured and identified by the Clinical Microbiology Laboratory and were recovered from blood and urine cultures. In-vitro presence of ESBL was confirmed with Clinical and Laboratory Standard Institute double disc method. In the study period, 49 patients needed hospitalization for upper UTI. Overall, in 25 patients [51%], cultures were negative. In the remaining, seven patients [14.3%] presented positive blood and urine-culture for ESBL + E. coli. Of these, four were female and three were male. Their median age was 73 years [range 66-84]. The median hospital stay of these patients was 23 days [range 13 to 45 days]. The current situation of multiple bacterial antibiotic resistance has become a worrisome issue in UTI. Multi-drug-resistant E. coli can be readily encountered in hospital settings during daily clinical practice, and urologist should act timely. The management of such infections is extremely important for the future, with particular reference to prevention of new antibiotic resistance patterns

High occurrence of blaCMY-1 AmpC lactamase producing Escherichia coli in cases of complicated urinary tract infection (UTI) from a tertiary health care centre in north India.

AmpC beta lactamase producing Gram-negative bacteria have emerged worldwide. It is important to distinguish plasmid mediated AmpC β lactamases from chromosomally mediated enzymes for surveillance, epidemiology and hospital infection control as plasmid mediated genes can spread to other organisms. Occurrence of blaCMY-1 AmpC β-lactamase, a plasmid mediated cephamycinase was studied in 100 consecutive isolates of Escherichia coli from cases of complicated urinary tract infection (UTI). Screening for AmpC production was done by modified Hodge test, three dimensional test and AmpC disk test. All isolates showing a positive result by 2 out of 3 tests were then tested for blaCMY-1 gene by PCR. Fifty nine isolates were positive for AmpC β lactamase production, 56.6 per cent were positive by PCR. Eight out of 13 isolates which were negative by EDTA disk method were positive by PCR, whereas none of the isolates negative by 3D and modified Hodge test was positive by PCR. Among admitted patients urinary catheterisation was the major risk factor followed by obstructive uropathy, three patients developed urosepsis. High occurrence of blaCMY-1 AmpC β-lactamase warrants health care workers to endorse good hospital practices.

Prevalence of extended spectrum beta-lactamases production among resistant gram negative bacteria in samples of intensive care unit patients

The rapid emergence and dissemination of antimicrobial resistant microorganisms in hospitals worldwide is a problem of crisis dimensions. Although infections caused by drug resistant bacteria can strike anyone, they are especially grave for immune-compromised patients whose such as the hospitalized in Intensive Care Units [ICUs]. Extended Spectrum beta Lactamases [ESBLs] is a neglected health care crisis that is intended to provoke a debate. This study aimed to determine the prevalence of extended spectrum beta-lactamases multidrug resistant isolates of Enterobacteriacea in all samples [urine, respiratory, surgical and body fluid, blood] collected in ICU patients at El Damardash Hospital. Also, to study the antibiogram profiles of the ESBLs organisms isolated. A total of 1065 different samples collected from patients admitted to the surgical long term care nad ICUs were cultured. The antibiogram carried out for the possible ESBLs gram negative isolatles by screening preliminary method, thereafter confirmed for Klebsiella pneumonia [K.pneumoniae], Escherichia coli [E. coli] and Proteus mirabilis [P.mirabilis]. Out of the 1065 samples the total positive urine, respiratory, surgical and blood cultures were 434, 202, 352, and 77, respectively, where 670 gram negative organisms were isolated from the urine, respiratory, surgical and body fluid and the blood specimens were 299, 164, 187 and 20, respectively. The isolated Gram negative bacteria were 273 E. coli, 114 K. pneumoniae and 20 Proteus mirabilis isolates. The Gram negative organisms isolated from the urine culture was 68.9% [299/434], 64% [190/299] of the gram negative organisms were E. coli, 13.2% [25/190] were ESBL producers, 14% [41/299] the gram negative organism isolated from urine were K. penumoniae, 9.8% [4/41] were ESBL producers. About 4% [11/299] of the gram negative organisms were P. mirabilis and they were all non ESBLs producers. As regards, the gram negative organisms isolated from the respiratory specimens were 81.2% [164/202], 12% [20/164] of the gram negative organisms were E.coli, 15% [3/20] were ESBL producers, 19.5% [32/164] of gram negative organisms were K. penumoniae, 3% [1/32] of them were ESBL producers and 1.8% [3/164] of gram negative respiratory cultures were Proteus mirabilis, 33% [1/3] were ESBL producers. ESBLs is a neglected healthcare crisis in Egypt that needs strategies to treat, prevent and control the rising rate. In addition, clinical laboratories need to have adequate funding, equipment and expertise to provide a rapid and clinically relevant antibiotic testing service. Besides, the controlled use of 3[rd] generation cephalosporin along with implementation of infection control measures are the most effective means of controlling and decreasing the spread of ESBL isolates