An epidemiological and molecular study regarding the spread of vancomycin-resistant Enterococcus faecium in a teaching hospital in Bogotá, Colombia 2016.

BACKGROUND: Enterococcus faecium is ranked worldwide as one of the top ten pathogens identified in healthcare-associated infections (HAI) and is classified as one of the high priority pathogens for research and development of new antibiotics worldwide. Due to molecular biology techniques' higher costs, the approach for identifying and controlling infectious diseases in developing countries has been based on clinical and epidemiological perspectives. Nevertheless, after an abrupt vancomycin-resistant Enterococcus faecium dissemination in the Méderi teaching hospital, ending up in an outbreak, further measures needed to be taken into consideration. The present study describes the vancomycin-resistant Enterococcus faecium pattern within Colombian's largest installed-bed capacity hospital in 2016. METHODS: Thirty-three vancomycin-resistant Enterococcus faecium isolates were recovered during a 5-month period in 2016. Multilocus variable-number tandem-repeat analysis was used for molecular typing to determine clonality amongst strains. A modified time-place-sequence algorithm was used to trace VREfm spread patterns during the outbreak period and estimate transmission routes. RESULTS: Four clonal profiles were identified. Chronological clonal profile follow-up suggested a transitional spread from profile "A" to profile "B", returning to a higher prevalence of "A" by the end of the study. Antibiotic susceptibility indicated high-level vancomycin-resistance in most isolates frequently matching vanA gene identification. DISCUSSION: Transmission analysis suggested cross-contamination via healthcare workers. Despite epidemiological control of the outbreak, post-outbreak isolates were still being identified as having outbreak-related clonal profile (A), indicating reduction but not eradication of this clonality. This study supports the use of combined molecular and epidemiological strategies in an approach to controlling infectious diseases. It contributes towards a more accurate evaluation of the effectiveness of the epidemiological measures taken regarding outbreak control and estimates the main cause related to the spread of this microorganism.

Anti-microbial sensitivity of enterobacteria identified in community-acquired urinary tract infection in pregnant women in 9 Colombian hospitals / Susceptibilidad antimicrobiana de enterobacterias identificadas en infección urinaria adquirida en la comunidad, en gestantes en nueve hospitales de Colombia

ABSTRACT Objective: To identify sensitivity profiles of the main anti-microbial agents used in the management of community-acquired urinary tract infection in pregnant women, and to make the molecular characterisation in order to confirm the existence of bacterial resistance in this population group. Materials and methods: Descriptive crosssectional study that included pregnant women with community-acquired urinary tract infection requiring admission to hospital. They were part of a study conducted in the general population. The microbiological results of the urine cultures were analysed. Isolates of Escherichia coli, Klebsiella spp. And Proteus mirabilis were identified over a period of 12 months in 9 Colombian hospitals, and their sensitivity profiles were determined using microdilution broth and gradient diffusion tests, and the presence of extended spectrum beta-lactamases was characterised using microbiological and molecular methods.The sociodemographic and clinical characteristics of these patients are presented. Results: Overall, 74 isolates were collected (64 E. coli, 7 Klebsiella spp. and 3 P. mirabilis isolates) in 73 patients. Prior use of antibiotics was documented in 58% of the patients. Resistance to ampicillin/sulbactam, cefazolin and ceftriaxone was 15.6%, 17.2% and 4.7%, respectively. There was extended spectrum beta-lactamase expression in three of the isolates, 2 of E. coli and 1 of Klebsiella spp. (3.1% E. coli and 14.3% Klebsiella spp.) One E. coli isolate expressed enzymes of the AmpC type. Conclusion: The presence of resistant strains to antibiotics used as first-line empirical treatment and to third-generation cephalosporins was confirmed in enterobacteria responsible for community-acquired urinary tract infection in pregnant women, produced by type CTX M-15 and AmpC extended spectrum betalactamase enzymes.

RESUMEN Objetivo: determinar los perfiles de susceptibilidad a los principales agentes antimicrobianos utilizados en el manejo de infección de vías urinarias adquirida por gestantes en la comunidad, y caracterizarlos molecularmente para confirmar la existencia de resistencia bacteriana en este grupo poblacional. Materiales y métodos: Estudio de corte transversal, descriptivo, en el que se incluyeron gestantes con infección urinaria adquirida en la comunidad que requirieron hospitalización. Estas hacían parte de un estudio realizado en población general. Se analizaron los resultados microbiológicos de los urocultivos. Se identificaron los aislamientos de Escherichia coli, Klebsiella spp. y Proteus mirabilis durante 12 meses en 9 hospitales de Colombia, y se determinó su perfil de susceptibilidad por microdilución en caldo y pruebas de difusión por gradiente; se caracterizó la presencia de betalactamasas de espectro extendido, con métodos microbiológicos y moleculares. Se presentan las características sociodemográficas y clínicas de estas pacientes. Resultados: se recogieron 74 aislamientos (64 de E. coli, 7 de Klebsiella spp. y 3 de P. mirabilis) en 73 pacientes. En 58 % de las pacientes se reportó uso previo de antibióticos. La resistencia a ampicilina/sulbactam, cefazolina y ceftriaxona fue de 15,6, 17,2 y 4,7 %, respectivamente. Tres aislamientos, dos de E. coli y uno de Klebsiella spp., expresaron betalactamasas de espectro extendido (3,1 % en E. coli y 14,3 % Klebsiella spp.). Un aislamiento de E. coli expresó enzimas tipo AmpC. Conclusión: se confirmó la presencia de cepas resistentes a antibióticos utilizados de primera línea de manera empírica, y a cefalosporinas de tercera generación en enterobacterias responsables de infección del tracto urinario adquirida en la comunidad en embarazadas, producida por enzimas de tipo betalactamasas de espectro extendido tipo CTX M-15 y AmpC.

[Antimicrobial susceptibility profile in urinary pathogens causing community-acquired infections in diabetic patients in Colombia].

INTRODUCTION: Urinary tract infection is the most common pathology in diabetic patients, and an important determinant of morbidity and mortality among them. The increasing resistance of uropathogens acquired in the community to commonly used antibiotics is alarming. OBJECTIVE: To identify the profile of antibiotic susceptibility of uropathogens responsible for communityacquired infections among diabetic patients in hospitals in Colombia. MATERIALS AND METHODS: We conducted a descriptive study in a subgroup of diabetic patients in the framework of a larger study in adults with urinary tract infection acquired in the community. Over one year, we collected Escherichia coli, Klebsiella spp. and Proteus mirabilis isolates from nine hospitals in Colombia. Their susceptibility profile was determined using microbiological and molecular methods to establish the presence of extended-spectrum AmpC betalactamases and KPC carbapenemases. RESULTS: We collected 68 isolates (58 E. coli, nine Klebsiella spp. and one Proteus mirabilis). Four (6.9%) of the E. coli isolates expressed extended spectrum betalactamases, two (3.4%) of them belonged to the phylogenetic group B2 and to ST131 clone and expressed the TEM-1 and CTM-X-15 betalactamases. The AmpC phenotype was found in four (6.9%) of the E. coli isolates, three of which produced TEM-1 and CMY-2 betalactamases. One K. pneumoniae isolate expressed the KPC-3 carbapenemase. CONCLUSION: The presence of extended spectrum betalactamases and carbapenemases in uropathogens responsible for community-acquired infection was confirmed in diabetic patients.

Emergencia de Providencia rettgeri NDM-1 en dos departamentos de Colombia, 2012-2013 / Emergence of Providencia rettgeri NDM-1 in two departments of Colombia, 2012-2013

Introducción: En Colombia, entre 2012 y 2013 se identificaron 19 aislamientos con NDM, de los cuales 14 correspondían a Providencia rettgeri. Métodos: Los aislamientos se identificaron con Vitek-2, y la sensibilidad antimicrobiana se evaluó por microdilución en caldo. Las carbapenemasas se determinaron fenotípicamente con test de Hodge modificado y pruebas de sinergia con EDTA/SMA y APB, genotípicamente por PCR usando iniciadores específicos para KPC, GES, IMP, VIM, OXA-48 y NDM, y las relaciones genéticas se establecieron con Diversilab. Resultados: Los aislamientos fueron resistentes a carbapenémicos, cefalosporinas de tercera generación, piperacilina-tazobactam, amicacina, gentamicina y tigeciclina, excepto a aztreonam. Todos los aislamientos fueron positivos para EDTA/SMA y NDM-1 y negativos para APB y otras carbapenemasas. Se definieron 2 grupos genéticos: grupo 1 (n = 9 aislamientos), grupo 2 (n = 4 aislamientos), y un aislamiento no relacionado genéticamente. Conclusión: Este trabajo describe la circulación de grupos de P. rettgeri productores de NDM-1 en Colombia (AU)

Introduction: In Colombia, between 2012 and 2013, 19 isolates with NDM were identified, of which 14 corresponded to Providencia rettgeri. Methods: The isolates were identified by Vitek-2, and antimicrobial susceptibility was evaluated by broth microdilution. The carbapenemase phenotypes were determined with Modified Hodge Test and synergy tests with EDTA/SMA and APB, the genotypes by PCR using specific primers for KPC, GES, IMP, VIM, OXA-48 and NDM, and genetic relationships were established with DiversiLab. Results: The isolates were resistant to carbapenems, third-generation cephalosporins, piperacillintazobactam, amikacin, gentamicin and tigecycline, except aztreonam. All isolates were positive for EDTA/SMA and NDM-1, and negative for APB and other carbapenemases. Two genetic groups, group 1 (n = 9 isolates), group 2 (n = 4 isolates) and an isolate defined as not genetically related. Conclusion: This work describes the circulating of NDM-1-producing P. rettgeri in Colombia (AU)

Emergence of Providencia rettgeri NDM-1 in two departments of Colombia, 2012-2013. / Emergencia de Providencia rettgeri NDM-1 en dos departamentos de Colombia, 2012-2013.

INTRODUCTION: In Colombia, between 2012 and 2013, 19 isolates with NDM were identified, of which 14 corresponded to Providencia rettgeri. METHODS: The isolates were identified by Vitek-2, and antimicrobial susceptibility was evaluated by broth microdilution. The carbapenemase phenotypes were determined with Modified Hodge Test and synergy tests with EDTA/SMA and APB, the genotypes by PCR using specific primers for KPC, GES, IMP, VIM, OXA-48 and NDM, and genetic relationships were established with DiversiLab. RESULTS: The isolates were resistant to carbapenems, third-generation cephalosporins, piperacillin-tazobactam, amikacin, gentamicin and tigecycline, except aztreonam. All isolates were positive for EDTA/SMA and NDM-1, and negative for APB and other carbapenemases. Two genetic groups, group 1 (n=9 isolates), group 2 (n=4 isolates) and an isolate defined as not genetically related. CONCLUSION: This work describes the circulating of NDM-1-producing P. rettgeri in Colombia.