Infection related to Klebsiella pneumoniae producing carbapenemase in renal transplant patients / Infección relacionada con Klebsiella pneumoniae productora de carbapenemasa en pacientes trasplantados renales

ABSTRACT Objective: To evaluate the risk factors related to Klebsiella pneumoniae carbapenemase infection after renal transplantation. Methods: This was a retrospective epidemiological (case-control) study, conducted from October 2011 to march 2016. Transplanted patients with infection by this bacteria during hospitalization were selected as cases. The controls were paired by age, sex, type of donor and transplant time. The proportion of cases and controls was 1:2. Results: Thirty hundred and five patients were included in the study (45 cases and 90 controls). The risk factors found for infection by KPC were: time of hospitalization after the transplant (OR: 4.82; CI95% 2.46-9.44), delayed kidney function (OR: 5.60; CI95% 1.91-11.01) and previous infectious for another microorganism ( OR: 34.13 CI95% 3.52-132.00). Conclusion: The risk of acquisition of this bacterium was directly related to invasive procedures and exposure to the hospital environment. The findings reinforce the importance of prevention measures and control of infection by this microorganism.

RESUMEN Objetivo: Evaluar los factores de riesgo relacionados con la infección por Klebsiella pneumoniae carbapenemasa después del trasplante renal. Método: Estudio retrospectivo epidemiológico (caso-control), realizado de octubre de 2011 a marzo de 2016. Pacientes transplantados con infección por esa bacteria durante la internación fueron seleccionados como casos. Los controles se parearon por edad, sexo, tipo de donante y tiempo de trasplante. La proporción de casos y controles fue de 1: 2. Resultados: Treinta y cinco pacientes fueron incluidos en el estudio (45 casos y 90 controles). Los factores de riesgo para la infección encontrados por KPC fueron: tiempo de hospitalización después del trasplante (OR: 4,82, IC95% 2,46-9,44), función renal retardada (OR: 5,60, IC95% 1, 91-11,01) y anterior infecciosa para otro microorganismo (OR: 34,13 IC95% 3,52-132,00). Conclusión: El riesgo de adquisición de esta bacteria estuvo directamente relacionado a procedimientos invasivos y exposición al ambiente hospitalario. Los hallazgos refuerzan la importancia de medidas de prevención y control de la infección por ese microorganismo.

Alergia a ß-lactámicos en niños / Allergy to Betalactams in children

Allergy to Betalactams is a widely suspected pathology, which is not regularly studied in Chile, leading to a misusage of antibiotics of other families. In this article a case report in a pediatric patient will be described, and a discussion about the studies needed for this pathology, and treatment will be made in accordance to the experiences and tools available in Chile, and specifically in University of Chile Clinical Hospital. In our Hospital we study these cases following international guidelines for the diagnosis of allergy to Betalactams. (AU)

Carbapenem resistance in gram-negative bacilli isolates in an Iranian 1000-bed tertiary hospital

Carbapenems are beta-lactamase antibiotics, presently considered as most potent agents for treatment of infections caused by Gram-negative bacilli. The aim of this study was to determine resistance of Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumonniae as prevalent nosocomial agents to commonly used antibiotics including carbapenems such as imipenem and meropenem. A total of 202 gram-negative bacilli including K. pneumoniae, P aeruginosa and A. baumannii isolated from hospitalized patients in Milad hospital of Tehran were subject for susceptibility testing. Susceptibility testing was performed by disk diffusion and MIC methods as recommended by Clinical Laboratory Standards Institute [CLSI]. All isolates of K. pneumonia were susceptible to imipenem and meropenem. Resistance in non-fermenting gram-negative bacilli [NFGB] was prevalent. P. aeruginosa isolates exhibited 7.5% and 40.2% resistance to imipenem and meropenem respectively. The majority isolates of Acinetobacter baumannii were multi-drug resistant and resistance of this organism to imipenem and meropenem was 27.7% and 38.5% respectively. Our study revealed that in spite of resistance of K. pneumoniae to commonly used antibiotics, all isolates were susceptible to imipenem and meropeem. More than 80% isolates of A. bammanni were resistant to commonly used antibiotics. About 40.2% isolates of P. aeruginosa and [38.5%] isolates of A. baumannii were resistant to meropenem respectively

Inactivación de ß-lactamasas por sulbactam en presencia de anticoagulante y en anaerobiosis / ß-lactamase inactivation by sulbactam in aerobiosis and anticoagulant

Se aislaron cepas de Staphylococcus aureus resistentes a penicilina y productoras de ß-lactamasas. Mediante el método de dilución en tubos, se calculó la concentración inhibitoria CIM para amoxicilina-sulbactam, con diferente tensión de oxígeno y frente a heparina. Los valores de CIM se redujeron significativamente al sumar sulbactam al antibiótico. La disminución del oxígeno no afectó la capacidad inhibidora de ß-lactamasas del sulbactam, del mismo modo que la presencia de heparina no interfirió en su efecto protector sobre la amoxicilina. Estos resultados reafirmaron el concepto de efectividad de la combinación amoxicilina-sulbactam sobre los procesos infecciosos a S. aureus productores de ß-lactamasas, aun en afecciones donde se genera anaerobiosis relativa y también en enfermos con tratamiento simultáneo con heparina