ABSTRACT
Introducción: Se analizó la evolución de la resistencia a cefalosporinas de 3.a generación, imipenem y otros antibióticos en aislamientos invasivos de Klebsiella pneumoniae (K. pneumoniae) según resultados de EARS-Net entre 2010 y 2014 en España. Métodos: Participaron 42 hospitales de 16 Comunidades Autónomas, con una cobertura poblacional aproximada del 33%. Resultados: Se aislaron 7.140 cepas de K. pneumoniae de un mismo número de pacientes. Las resistencias globales (I+R) fueron: cefotaxima 15,8%, ceftazidima 13,7%, imipenem 1,7%, ciprofloxacina 20,1%, tobramicina 14,1%, gentamicina 10,4% y amikacina 1,9%. La resistencia a cefalosporinas de 3.a generación aumentó desde el 9,8% (2010) al 19% (2014); la de ciprofloxacina desde el 15,4% (2010) al 19,6% (2014); la de gentamicina desde el 6,2% (2010) al 10,3% (2014) y la de tobramicina desde el 7,1% (2010) al 14,2% (2014) (p< 0,001 en todos los casos). Las cepas resistentes a la vez a cefalosporinas de 3.a generación, ciprofloxacina y aminoglucósidos aumentaron desde el 3,3% (2010) al 9,7% (2014) (p<0,001). La resistencia a imipenem aumentó desde el 0,27% (2010) al 3,46% (2014) (p< 0,001); 121 aislados fueron resistentes a imipenem, de los cuales 104 (86%) produjeron carbapenemasas: 74 OXA-48, 14 VIM, 9 KPC (6 KPC-2 y 3 KPC-3), 6 IMP y 1 GES. Conclusiones: En un periodo de 5 años (2010-2014), la resistencia a cefalosporinas de 3.a generación en K. pneumoniae invasivas en España se ha duplicado; la resistencia combinada a cefalosporinas de 3.a generación, ciprofloxacina y aminoglucósidos se ha triplicado; la resistencia a imipenem ha aumentado casi 13 veces, principalmente por la diseminación de aislados productores de carbapenemasas (AU)
Introduction: An analysis was made about the evolution of resistance to 3rd generation cephalosporins, imipenem, and other antibiotics in invasive isolates of Klebsiella pneumoniae (K. pneumoniae)according to the Spanish EARS-Net database (2010-2014). Methods: Forty-two hospitals from 16 Autonomous Communities with an approximate population coverage of 33% participated. Results: A total 7,140 pneumoniae corresponding to the same number of patients were studied. Overall resistance percentages (I+R) were: cefotaxime 15.8%, ceftazidime 13.7%, imipenem 1.7%, ciprofloxacin 20.1%, tobramycin 14.1%, gentamicin 10.4%, and amikacin 1.9%. Resistance to 3rd generation cephalosporins increased from 9.8% (2010) to 19% (2014); to ciprofloxacin from 15.4% (2010) to 19.6% (2014); to gentamicin from 6.2% (2010) to 10.3% (2014) and to tobramycin from 7.1% (2010) to 14.2% (2014) (p<.001 in all cases). Combined resistance to 3rd generation cephalosporins, ciprofloxacin, and aminoglycosides increased from 3.3% (2010) to 9.7% (2014) (p<.001). Resistance to imipenem also increased from 0.27% (2010) to 3.46% (2014) (p<.001). A total of 121 isolates were resistant to imipenem, of which 104 (86%) produced carbapenemases: 74 OXA-48, 14 VIM, 9 KPC (6 KPC-2 and 3 KPC-3), 6 IMP, and 1 GES. Conclusions: Over the 5 year period (2010-2014), resistance to 3rd generation cephalosporins in invasive K. pneumoniae in Spain has doubled. The combined resistance to 3rd generation cephalosporins, ciprofloxacin, and aminoglycosides has tripled, and imipenem resistance has increased almost 13 times, mostly due to the spread of carbapenemase-producing isolates (AU)
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Young Adult , Adult , Middle Aged , Aged , Cephalosporin Resistance , Klebsiella pneumoniae/isolation & purification , Klebsiella Infections/drug therapy , Imipenem/pharmacology , Microbial Sensitivity Tests , Blood Culture/statistics & numerical data , Spain/epidemiology , Drug Resistance, Microbial , Data Analysis/statistics & numerical data , 28599ABSTRACT
INTRODUCTION: An analysis was made about the evolution of resistance to 3rd generation cephalosporins, imipenem, and other antibiotics in invasive isolates of Klebsiella pneumoniae (K. pneumoniae) according to the Spanish EARS-Net database (2010-2014). METHODS: Forty-two hospitals from 16 Autonomous Communities with an approximate population coverage of 33% participated. RESULTS: A total 7,140 pneumoniae corresponding to the same number of patients were studied. Overall resistance percentages (I+R) were: cefotaxime 15.8%, ceftazidime 13.7%, imipenem 1.7%, ciprofloxacin 20.1%, tobramycin 14.1%, gentamicin 10.4%, and amikacin 1.9%. Resistance to 3rd generation cephalosporins increased from 9.8% (2010) to 19% (2014); to ciprofloxacin from 15.4% (2010) to 19.6% (2014); to gentamicin from 6.2% (2010) to 10.3% (2014) and to tobramycin from 7.1% (2010) to 14.2% (2014) (p<.001 in all cases). Combined resistance to 3rd generation cephalosporins, ciprofloxacin, and aminoglycosides increased from 3.3% (2010) to 9.7% (2014) (p<.001). Resistance to imipenem also increased from 0.27% (2010) to 3.46% (2014) (p<.001). A total of 121 isolates were resistant to imipenem, of which 104 (86%) produced carbapenemases: 74 OXA-48, 14 VIM, 9 KPC (6 KPC-2 and 3 KPC-3), 6 IMP, and 1 GES. CONCLUSIONS: Over the 5 year period (2010-2014), resistance to 3rd generation cephalosporins in invasive K. pneumoniae in Spain has doubled. The combined resistance to 3rd generation cephalosporins, ciprofloxacin, and aminoglycosides has tripled, and imipenem resistance has increased almost 13 times, mostly due to the spread of carbapenemase-producing isolates.
Subject(s)
Anti-Bacterial Agents/pharmacology , Bacteremia/microbiology , Cephalosporins/pharmacology , Cross Infection/microbiology , Drug Resistance, Multiple, Bacterial , Imipenem/pharmacology , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , Adolescent , Adult , Aged , Aged, 80 and over , Aminoglycosides/pharmacology , Bacteremia/epidemiology , Bacterial Proteins/metabolism , Catchment Area, Health , Child , Child, Preschool , Ciprofloxacin/pharmacology , Cross Infection/epidemiology , Female , Humans , Infant , Infant, Newborn , Klebsiella Infections/epidemiology , Klebsiella pneumoniae/enzymology , Male , Middle Aged , Population Surveillance , Spain/epidemiology , Young Adult , beta-Lactam Resistance , beta-Lactamases/metabolismABSTRACT
OBJECTIVES: To understand the role of Gemella species as a pathogen causing extra-abdominal infections in the Hospital General Universitario Gregorio Marañón. MATERIALS AND METHODS: Between 1994 and 1998, one or more isolates of Gemella sp. were found in 128 patients. The 113 patients with isolates from nonsignificant specimens or representing intra-abdominal infections were excluded. The clinical records of the remaining 15 patients were reviewed as well as the more recent literature. RESULTS: Mean age of patients was 41 years. The underlying conditions most frequently noted were intravenous drug users (n=6; 3 positive for human immunodeficiency virus), alcoholism (n=2), cardiovascular disease (n=2), chronic lung disease (n=2), diabetes (n=1), kidney transplant (n=1). The extra-abdominal infections were skin and soft tissue abscess (n=5), empyema (n=4), brain abscess (n=2), primary bacteremia (n=1), lung abscess (n=1), septic thrombophlebitis (n=1), complicated urinary tract infection (n=1). The infection was monomicrobial in six and polymicrobial in nine cases. Surgical drainage and betalactam antibiotics were used. The outcome was favorable in almost all cases. CONCLUSIONS: Gemella sp. should be included as a cause of localized soft-tissue abscesses, empyema, and bloodstream infection. No case of infective endocarditis was found. Although it is susceptible to several antibiotics, Gemella sp. requires a careful microbiologic diagnosis and a subtle clinical interpretation.
