Meningite bacteriana: uma revisão / Bacterial meningitis: a review

A meningite bacteriana é uma inflamação das leptomeninges que envolvem o Sistema Nervoso Central. Essa patologia, que possui diversos agentes etiológicos, apresenta-se na forma de síndrome, com quadro clínico grave. Entre as principais bactérias que causam a meningite, estão a Neisseria meningitis e Streptococcus pneumoniae. A transmissão ocorre através das vias aéreas por meio de gotículas, sendo a corrente sanguínea a principal rota para as bactérias chegarem à barreira hematoencefálica e, a partir dessa, até as meninges. Atualmente existem vários métodos de diagnóstico precisos, onde a cultura de líquido cefalorraquidiano (LCR) é o método padrão ouro. Ademais, a melhora na qualidade do tratamento com beta-lactâmicos e a maior possibilidade de prevenção, devido à elevação do número e da eficácia de vacinas, vem contribuindo para redução dos casos da doença e de sua gravidade. Porém, apesar desses avanços, ainda há um elevado número de mortalidades e sequelas causadas por essa síndrome.

Bacterial meningitis is an inflammation of the leptomeninges that surround the Central Nervous System. This pathology, which has several etiological agents, is presented as a syndrome with a severe clinical scenario. The main bacteria causing meningitis include Neisseria meningitis and Streptococcus pneumoniae. It can be transmitted by droplets through the airways, with the bacteria using the bloodstream as the main route to reach the blood-brain barrier, and from there to the meninges. There are currently several accurate diagnostic methods, with CSF culture being the gold standard. In addition, the improvement in the quality of beta-lactam treatment and the greater possibility of prevention due to the increased number and effectiveness of vaccines have contributed to reducing the number of cases and severity of the disease. Nevertheless, despite these advances, this syndrome still presents a high number of mortalities and sequelae.

Uso de beta-lactámicos como alternativa del tratamiento empírico actual de sepsis neonatal tardía: revisión temática / Use of beta-lactams as an alternative to the current empirical treatment of late neonatal sepsis: review

OBJETIVO: Analizar el uso de beta-lactámicos en sepsis neonatal tardía, en comparación con el tratamiento empírico actual con vancomicina, mediante la revisión de artículos científicos. METODOLOGÍA: Revisión temática en Bases LILACS y PubMed. La selección de los artículos se realizó mediante la lectura de título, abstract y texto completo. Criterios de búsqueda: Estudios en humanos, artículos por abstract y texto completo, en inglés y español, y de no más de 10 años. RESULTADOS: No hay relación en la duración ni en la mortalidad de la sepsis al utilizar un betalactámico, o al utilizar vancomicina. Además, cepas resistentes a beta-lactámico, respondieron bien al usar un beta-lactámico como terapia empírica inicial, sin la necesidad de recurrir a vancomicina, excepto en casos de no mejoría clínica. CONCLUSIONES: Beta-lactámicos pueden ser utilizados como terapia empírica inicial en sepsis neonatal tardía como alternativa al tratamiento actual con vancomicina, restringiendo el uso de vancomicina a casos de resistencia, o cuando no haya mejoría clínica del recién nacido que está utilizando un beta-lactámico como tratamiento.

OBJECTIVE: To analyze the use of beta-lactams in late- onset neonatal sepsis, compared with empirical treatment with vancomycin used currently, through the revision of scientific articles. METHODOLOGY: Thematic review in LILACS and PubMed. The articles were selected by reading the title, abstract and full text. Searching criteria: Human studies, articles by abstract and full text, in English and Spanish, and no more than 10 years since published. RESULTS: There is no relationship in duration or mortality in Sepsis when using beta-lactam, or using vancomycin. In addition, resistant strains to beta-lactam responded well in using betalactam as initial empirical therapy, without the need to resort to vancomycin, except in cases of non-clinical improvement. CONCLUSIONS: Beta-lactams may be used as initial empirical therapy in late-onset neonatal sepsis as an alternative to current vancomycin therapy, restricting the use of vancomycin to resistance cases, or when there is no clinical improvement in the neonate, who is using a beta-lactam as a treatment.

Antimicrobial resistance in Enterobacteriaceae in Brazil: focus on ß-lactams and polymyxins

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.

Outpatient parenteral antimicrobial therapy for orthopedic infections – a successful public healthcare experience in Brazil

Abstract Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions of Brazil and Latin America.

Meningitis por Listeria monocytogenes en niñas inmunocompetentes: queso no pasteurizado como probable causa de infección / Listeria monocytogenes meningitis in immunocompetent children: unpasteurized cheese likely cause of infection

Listeria meningoencephalitis is a rare condition, occurring mainly in immunocompromised patients. We present two cases of Listeria monocytogenes meningoencephalitis in immunocompetent children, with successful treatment with betalactam/aminoglycoside combination. Unpasteurized cheese was postulated as the source of infection.

La meningoencefalitis por Listeria spp. es una infección infrecuente, principalmente en pacientes con algún tipo de inmunosupresión. Presentamos dos casos clínicos de meningitis por Listeria monocytogenes en niñas inmunocompetentes con tratamiento exitoso con β lactámicos combinados con aminoglucósidos; se identificó la ingesta de queso no pasteurizado como probable fuente de infección.

Antimicrobial resistance profile of Staphylococcus aureus isolates obtained from skin and soft tissue infections of outpatients from a university hospital in Recife -PE, Brazil / Perfil de resistência antimicrobiana de isolados de Staphylococcus aureus provenientes de infecções de pele e tecidos moles de pacientes ambulatoriais de um hospital universitário em Recife - PE, Brasil

BACKGROUND: Staphylococcus aureus has a notable ability to acquire resistance to antibiotics, and methicillin resistance represents a growing public health problem. Methicillin-resistant S. aureus (MRSA) has also become important outside the hospital environment, particularly in the United States. In Brazil, since 2005, cases of community skin infections caused by MRSA have been reported, but resistance studies involving outpatients are scarce. OBJECTIVE: To know the resistance profile of S. aureus involved in skin and soft tissue infections of patients seen at the Dermatology outpatient clinic of a university hospital in Recife, Pernambuco State, northeastern Brazil. METHODS: Prospective study involving 30 patients with skin and soft tissue infections, seen at the Dermatology outpatient clinic from May until November 2011. To evaluate the susceptibility of S. aureus to antibiotics, the disk diffusion method and oxacillin screening agar were used. RESULTS: From a total of 30 samples of skin lesions, 19 (63%) had positive culture for S. aureus. The following resistance patterns of S. aureus were observed: penicillin, 95%; tetracycline, 32%; erythromycin, 21%; gentamicin, 16%; cefoxitin, 11%; oxacillin, 11%; trimethoprim-sulfamethoxazole, 11%; chloramphenicol, 11%; clindamycin, 5% ; and ciprofloxacin, 0%. One of the identified MRSA was obtained from a patient without risk factors for its acquisition, and was resistant, beyond to the beta-lactams, only to tetracycline. CONCLUSIONS: With regard to the resistance patterns of S. aureus, resistances to tetracycline, erythromycin and gentamicin were the highest. It was documented, for the first time in Pernambuco, a case of skin infection caused by community-associated MRSA.

FUNDAMENTOS: O Staphylococcus aureus possui uma notável habilidade de adquirir resistência antimicrobiana, sendo a resistência à meticilina um problema de saúde pública crescente. O S. aureus resistente à meticilina (MRSA) vem se tornando importante também fora do ambiente hospitalar, particularmente nos Estados Unidos. No Brasil, desde 2005, têm sido relatados casos de infecções cutâneas comunitárias causadas por MRSA, porém estudos de resistência envolvendo pacientes ambulatoriais são escassos. OBJETIVO: Conhecer o perfil de resistência de S. aureus envolvidos em infecções de pele e partes moles de pacientes atendidos no ambulatório de Dermatologia de um hospital universitário de Recife, Pernambuco. MÉTODO: Estudo prospectivo envolvendo 30 pacientes com infecções de pele e tecidos moles atendidos no ambulatório de Dermatologia de maio a novembro de 2011. Para avaliação da suscetibilidade dos S. aureus aos antibióticos foram utilizados teste de disco-difusão e placa de screening de oxacilina. RESULTADOS: Das 30 amostras analisadas, 19 (63%) tiveram cultura positiva para S. aureus. Os seguintes padrões de resistência dos S. aureus foram observados: penicilina, 95%; tetraciclina, 32%; eritromicina, 21%; gentamicina, 16%; cefoxitina, 11%; oxacilina, 11%; sulfametoxazol-trimetoprima, 11%; clorafenicol, 11%; clindamicina, 5%; e ciprofloxacina, 0%. Um dos MRSA identificados foi obtido de paciente sem fatores de risco para sua aquisição, e além de aos betalactâmicos, mostrou-se resistente apenas à tetraciclina. CONCLUSÕES: Em relação aos padrões de resistência dos S. aureus, destacaram-se as resistências à tetraciclina, eritromicina e gentamicina. Documentou-se, pela primeira vez em Pernambuco, um caso de infecção cutânea causada por MRSA associado à comunidade.

Comparison of Ertapenem and Ceftriaxone Therapy for Acute Pyelonephritis and Other Complicated Urinary Tract Infections in Korean Adults: A Randomized, Double-Blind, Multicenter Trial

The efficacy and safety of ertapenem, 1 g once daily, were compared with that of ceftriaxone, 2 g once daily, for the treatment of adults with acute pyelonephritis (APN) and complicated urinary tract infections (cUTIs) in a prospective, multicenter, double-blinded, randomized study. After > or = 3 days of parenteral study therapy, patients could be switched to an oral agent. Of 271 patients who were initially stratified by APN (n = 210) or other cUTIs (n = 61), 66 (48.9%) in the ertapenem group and 71 (52.2%) in the ceftriaxone group were microbiologically evaluable. The mean duration of parenteral and total therapy, respectively, was 5.6 and 13.8 days for ertapenem and 5.8 and 13.8 days for ceftriaxone. The most common pathogen was Escherichia coli. At the primary efficacy endpoint 5-9 days after treatment, 58 (87.9%) patients in the ertapenem group and 63 (88.7%) in the ceftriaxone had a favorable microbiological response. When compared by stratum and severity, the outcomes in the two groups were equivalent. The frequency and severity of drug-related adverse events were generally similar in both treatment groups. The results indicate that ertapenem is highly effective and safe for the treatment of APN and cUTIs.

Prosthetic aortic valve endocarditis due to Ochrobactrum anthropi.

Ochrobactrum anthropi is an emerging pathogen increasingly affecting the immunocompromised host. Only four cases of infective endocarditis have been documented in literature. Therapeutic approach is a rising challenge as it is resistant to most of the currently available beta lactam antibiotics with the exception of carbapenems. We report a case of prosthetic valve endocarditis secondary to Ochrobactrum anthropi infection; the host was temporarily immunocompromised due to disseminated herpes zoster after surgery.

Farmacodermia em um cão após administração de antibióticos do grupo betalactâmico: relato de caso / Pharmacodermia in a dog after administration of beta-lactam antibiotics: case report

A severe cutaneous reaction in a female dog after administration of penicillin and cephalexin is described, in which the main signs presented by the patient were fever, lack of appetite, and detachment of epidermis in the dorsal region of body.The established treatment was surgical debridement of the region, topical application of Aloe Vera with sugar, and systemic antibiotic therapy with ciprofloxacin, resulting in the recovery and wound closure in approximately 45 days.

Invasive pneumococcal disease in a third level pediatric hospital in Mexico City: epidemiology and mortality risk factors / Enfermedad neumocócica invasora en un hospital pediátrico de tercer nivel en la Ciudad de México: características epidemiológicas y factores de riesgo asociados con mortalidad

Objective. To assess the epidemiologic characteristics of invasive pneumococcal diseases (IPD) among a population in a pediatric hospital in Mexico City and analyze mortality-related risk factors, serotype distribution and antibiotic susceptibility related to S.pneumoniae. Material and Methods. We performed a retrospective review of IPD cases at a third level pediatric hospital between 1997-2004. Results. A total of 156 patients were included. The mortality rate was 27.5 percent and was associated with six pneumococcal serotypes: 14, 6B, 23F, 6A, 19F and 19A. There was no relationship between mortality and antimicrobial susceptibility pattern. A total of 28.2 percent of isolates were resistant to penicillin and 24.6 percent were resistant to cefotaxime. A statistically significant relationship was observed between mortality and previous underlying disease (CI 95 percent; 2.5-18.3; p< 0.05) using a multivariate logistic regression model. Conclusions. Our outcomes show that IPD mortality in our population is closely related to underlying disease and to six serotypes, five of which are included in the 7-valent pneumococcal conjugate vaccine.

Objetivo. Conocer la epidemiología de la enfermedad neumocócica invasora (ENI) en un hospital pediátrico y analizar los factores de riesgo relacionados con la mortalidad, la distribución de serotipos y el patrón de susceptibilidad de S. pneumoniae. Material y métodos. Revisión retrospectiva de los casos de ENI en un hospital pediátrico de tercer nivel, entre 1997 y 2004. Resultados. En 156 pacientes la mortalidad fue de 27.5 por ciento. Los serotipos de neumococo más frecuentemente relacionados con la mortalidad fueron: 14, 6B, 23F, 6A, 19F y 19A; no hubo relación de mortalidad con la resistencia a antibióticos. El 28.2 por ciento mostró resistencia a penicilina y 24.6 por ciento a cefotaxima. A través del modelo multivariado, se encontró una relación estadísticamente significativa entre la mortalidad y enfermedad previa (IC 95 por ciento; 2.5-18.3; p<0.05). Conclusiones. La mortalidad asociada a la ENI tuvo relación significativa con antecedente de una enfermedad previa y con seis serotipos, cinco incluidos en la vacuna neumocócica conjugada 7-valente.

Mecanismo de resistencia a antibióticos ß-lactámicos en Staphylococcus aureus / Mechanisms of resistance to ß-lactam antibiotics in Staphylococcus aureus

S. aureus ha demostrado un gran poder de adaptación a los agentes antimicrobianos, adquiriendo paso a paso resistencia a todos los antibióticos disponibles para el tratamiento de las infecciones que ocasiona. Existen tres mecanismos de resistencia a los antibióticos ß-lactámicos en S. aureus: resistencia mediada por enzimas (penicilinasas o ß-lactamasas) las cuales desactivan al antibiótico; resistencia intrínseca, que no es debida a la inactivación de drogas y es responsable dela resistencia a meticilina; y la modificación de las proteínas de unión a penicilinas (PBPs). Además, S. aureus puede expresar el fenómeno de tolerancia, en el que ocurre una disociación de las acciones inhibitoria y bactericida de los antibióticos ß-lactámicos. De éstos, el mecanismo más importante, es la resistencia intrínseca que es probablemente más compleja, debido a que varios factores pueden afectar también su expresión

S. aureus has shown a great power of adaptation to antimicrobial agents, acquiring, step-bystep, resistance to all available antibiotics for treatment of the infections it causes. S. aureus has three major mechanisms of resistance to ß-lactam antibiotics: enzyme mediated (penicillinase or ß-lactamase) by which the antibiotic is inactivated; intrinsic resistance, which is not due to drug inactivation and accounts for methicillin resistance; and modifications of penicillin-binding proteins (PBPs). Additionally, S. aureus can express the tolerance phenomenon, in which there is a dissociation of the inhibitory and killing actions of ß-lactam antibiotics. Of these, the most important mechanism is intrinsic resistance, which is probably more complex because several factors can affect its expression

Nosocomial infections in neonatal intensive care units: Profile, risk factor assessment and antibiogram.

Objective. To determine the profile and risk factors of neonatal nosocomial infections and determine the antibiotic susceptibilities of these isolates. Methods. Cohort study was conducted at Kasturba Medical College, Mangalore, from July 2005 to September 2006. Neonates admitted for more than forty-eight hours in the NICU, who developed infections/ sepsis as evidenced by the clinical findings were included in the study. Chi-square test, Proportion tests were used, P value of <0.05 was considered significant. Results. Extended spectrum beta lactamase (ESBL) producing Klebsiella species and Methicillin resistant Staphylococcus aureus (MRSA) were the predominant nosocomial pathogens. Significant risk factors included prematurity, low birth weight and increased duration of hospital stay. Conclusion. A revised infection control program with emphasis on handwashing techniques and antibiotic cycling helped to control these hospital infections.

Isolation of Salmonella paratyphi A from renal abscess.

Intrarenal abscesses remain a significant cause of morbidity and mortality as well as a diagnostic dilemma because a plethora of microorganisms can cause this condition. A definitive diagnosis is made by demonstrating the organisms from the aspirate and the success or failure of therapy depends upon the antimicrobial sensitivity pattern. Enteric fever is a multisystem disorder caused by invasive strains of salmonella. Salmonellosis continues to be a major public health problem, especially in developing countries. Classic enteric fever is caused by S. typhi and usually less severe enteric fevers are caused by S. paratyphi A, B, or C. However, at times S. paratyphi is capable of causing serious and often life-threatening infections like infective endocarditis, pericarditis, empyma, sino-venous thrombosis, osteomyelitis, meningitis, bone marrow infiltration, hepatitis and pancreatitis. There are anecdotal case reports in world literature of abscesses being caused by this organism. Renal involvement like bacteriuria, nephrotic syndrome and acute renal failure have been reported due to S. parayphi A. S. paratyphi A has never been implicated in renal abscess, we report one such case that was managed successfully with medical therapy.

Betalactámicos con inhibidores de betalactamasas: Amoxicilina-sulbactam / Betalactam antibiotics combined with bectalactamases inhibitors: Amoxicillin-sulbactam

La producción de betalactamasas constituye uno de los principales mecanismos de resistencia bacteriana a los antibióticos betalactámicos. La utilización de inhibidores de betalactamasas en combinación con antibióticos betalactámicos permite la inactivación de determinadas betalactamasas producidas por gérmenes Gram positivos, Gram negativos, anaerobios, y aun por micobacterias. Los inhibidores de betalactamasas representan una alternativa terapéutica mejorada respecto del resto de los betalactámicos al asegurar, en la mayoría de los casos, un mayor espectro antimicrobiano comparado con el de sus análogos. La actividad enzimática de las betalactamasas está dirigida específicamente a la hidrólisis del anillo betalactámico, con producción de un compuesto sin actividad antibacteriana. De acuerdo con su posición genómica dentro de los microorganismos, las betalactamasas pueden ser cromosómicas o plasmídicas. Actualmente existen tres inhibidores de betalactamasas localmente disponibles: ácido clavulánico, sulbactam y tazobactam. De ellos, sólo el sulbactam posee actividad antimicrobiana intrínseca sobre las proteínas ligadoras de penicilina. La experiencia clínica acumulada durante más de 20 años confirma que las combinaciones de betalactámicos-inhibidores de betalactamasas son efectivas en el tratamiento empírico inicial de infecciones respiratorias, intraabdominales, urinarias y ginecológicas, incluidas las de origen polimicrobiano. En el caso particular de amoxicilina-sulbactam, la evidencia citada indica que esta combinación es efectiva para el tratamiento de absceso periamigdalino, otitis media, sinusitis, neumonía extrahospitalaria, exacerbación aguda de enfermedad pulmonar obstructiva crónica (EPOC), infección del tracto urinario e infecciones ginecoobstétricas. Por su espectro y propiedades farmacológicas, la combinación amoxicilina-sulbactam constituye una excelente opción también para el tratamiento de infecciones de piel y partes blandas e infecciones intraabdominales.

Betalactamases production is one of the main bacterial resistance mechanisms to betalactam antibiotics. The use of bectalactamases inhibitors combined with betalactam antibiotics allows the inactivation of certain betalactamases produced by Gram positive, Gram negative and anaerobic organisms, and even by mycobacteria. Betalactamases inhibitors are an improved therapeutic alternative compared with the other betalactam since, in most cases, they cover a wider antimicrobial spectrum than their analogues. Betalactamases enzimatic activity is specifically directed to the betalactam ring hydrolisis, producing a compound without antibacterial activity. According to their genomic position within microorganisms, betalactamases can be either chromosomic or plasmidic. Currently there are three betalactamases inhibitors locally available: clavulanic acid, sulbactam and tazobactam. Of them, only sulbactam has an intrinsic antimicrobial activity against penicillin binding proteins. The clinical experience from over 20 years confirms that the combination of betalactam antibiotics is effective in the empirical initial treatment of respiratory, intraabdominal, urinary tract and gynecologic infections, including those of polymicrobial origin. In the specific case of amoxicillin-sulbactam, experiences have shown the effectiveness of the combination in the treatment of peritonsillar abscess, otitis media, sinusitis, community acquired pneumonia, acute exacerbation of chronic obstructive pulmonar disease (COPD), urinary tract infection and obstetric/ gynecologic infections. The spectrum and pharmacologic properties of this combination makes it also an excellent option for the treatment of skin/soft tissue and intraabdominal infections.

Prevalence of Extended-Spectrum beta-lactamases in Escherichia coli and Klebsiella pneumoniae from Daejeon / 대한진단검사의학회지

BACKGROUND: Extended-spectrum beta-lactamases (ESBLs) are cephalosporinases that confer resistance to a wide variety of oxyimino cephalosporins and create serious therapeutic problems. Although ESBLs have been reported with increasing frequency in Korea, their prevalence and genotypic distribution in Daejeon remain unknown. This study was designed to evaluate the occurrence and genotypic distributions of ESBL-producing Escherichia coli and Klebsiella pneumoniae in Daejeon. METHODS: We tested a total of 427 isolates of E. coli and K. pneumoniae at Chungnam National University Hospital during the period from March to September 2006. ESBL production was determined by the Clinical and Laboratory Standards Institute ESBL confirmatory test; minimum inhibitory concentrations of beta-lactam antibiotics were determined by the broth dilution method. The ceftazidime or cefotaxime resistance of the ESBL-producers was transferred to azide-resistant E. coli J53 by conjugation. Searches for ESBL genes were performed by PCR amplification, and the genotypes of ESBLs were determined by direct nucleotide sequence analysis of the amplified products. The pIs of ESBL were determined by isoelectric focusing. RESULTS: The proportion of ESBL-producers was 10% of the E. coli and 28% of the K. pneumoniae isolates. The prevalence of ESBL-positive isolates was 60% in the intensive care units and 18.7% in the general wards. The most prevalent ESBL genotype in E. coli isolates was blaCTX-M and in K. pneumoniae was blaSHV-12. CONCLUSIONS: E. coli and K. pneumoniae isolates producing SHV-12 or CTX-M-type ESBLs are widespread in Daejeon.

La producción de betalactamasas y su inhibición / Lactamase production and its inhibition

La presencia de infecciones bucodentales constituye un hecho rutinario en la práctica odontológica, que en la mayor parte de los casos impone la realización de exodoncias, muchas veces por razones económicas. Este tratamiento se ve complementado con la utilización de agentes antimicrobianos. Después de la aparición de los antimicrobianos, hace más de 60 años, se advirtió sobre el uso y abuso equivocado con las consecuencias cada vez más problemáticas, por la aparición de bacterias resistentes que atenúan la eficacia de dichos agentes. Los seres vivos se resisten a morir y nadie tan determinado a seguir con vida como las bacterias. Es ampliamente conocido que el betalactámico de primera elección más utilizada en odontología es la amoxicilina, la cual hoy por problemas de automedicación e inframedicación, presenta gran resistencia bacteriana, la mayor parte de las cuales son causadas por las betalactamasas producidas por bacterias de la flora oral. El presente trabajo tiene como objetivo presentar el mecanismo de acción de los antibióticos betalactámicos y un breve estudio sobre la producción de betalactamasas, lo que contribuirá al conocimiento y utilización de los inhibidores de las mismas, tratando algunos aspectos referente a la microbiología oral, la resistencia bacteriana, las indicaciones y contraindicaciones, sus efectos benéficos y colaterales.