ABSTRACT
Introduction: Antimicrobial resistance of pathogens causing urinary tract infection (UTI) is a growing problem, which complicates their effective treatment. Surveillance is needed to guide appropriate empiric therapy. Aim: to describe the susceptibility patterns of Gram-negative bacteria isolated of patients with UTI to twelve antibiotics as part of the Study for Monitoring Antimicrobial Resistance Trends in Venezuela. Materials and Methods: Between 2009-2012 a total of 472 Gram-negative bacteria were isolated from hospitalized patients with UTI. The isolates were sent to Central Laboratory (Central Laboratory of International Health Management Associates) to confirm their identification, and to make susceptibility testing as recommended by the Clinical and Laboratory Standards Institute. Enterobacteriacea comprised 96.6% of the total, where Escherichia coli (76.9%) and Klebsiellapneu-moniae (10.6%) were the most frequent. Extended-spectrum β-lactamases (ESBL) was detected in 21.6% of isolates. Top antimicrobial activity were ertapenem, imipenem, and amikacin (> 90.0%), slightly lower for amikacin (85.1%) in ESBL-producing strains. Resistance rates to fluoroquinolones and ampicillin/sulbactam were high (40 y 64%, respectively). Conclusions: These data suggest a necessary revision of the therapeutic regimens for the empirical treatment of UTI in Venezuela.
Introducción: La resistencia antimicrobiana de patógenos causantes de infecciones del tracto urinario (ITU) es un problema creciente, que complica su tratamiento efectivo. La vigilancia es necesaria para orientar la terapia empírica apropiada. Objetivo: Documentar los patrones de susceptibilidad de bacterias gramnegativas aisladas de pacientes con ITU a doce antimicrobianos como parte del Estudio de Monitoreo de Patrones de Resistencia en Venezuela (SMART). Materiales y Métodos: Entre 2009-2012, un total de 472 bacterias gramnegativas fueron aisladas de pacientes hospitalizados con ITU. Los aislados fueron enviados a un Laboratorio Central (Central Laboratory of International Health Management Associates) para confirmar su identificación y realizar pruebas de susceptibilidad según recomendaciones del Instituto de Estándares Clínicos y de Laboratorio. Resultados: Enterobacteriacea comprendió 96,6% del total, donde Escherichia coli (76,9%) y Klebsiela pneumoniae (10,6%) fueron las más frecuentes. En 21,6% de los aislados fueron detectadas β-lactamasas de espectro extendido (BLEE). Los antimicrobianos con mejor actividad fueron ertapenem, imipenem y amikacina (> 90,0%); ligeramente menor para amikacina (85,1%) en cepas productoras de BLEE. Las tasas de resistencia a quinolonas y ampicilina/ sulbactam fueron elevadas (40 y 64%, respectivamente). Conclusiones: Estos datos sugieren una necesaria revisión de los esquemas terapéuticos para el tratamiento empírico de las ITU en Venezuela.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult , Anti-Bacterial Agents/pharmacology , Gram-Negative Bacteria/drug effects , Gram-Negative Bacterial Infections/microbiology , Urinary Tract Infections/microbiology , Gram-Negative Bacteria/classification , Gram-Negative Bacteria/isolation & purification , Microbial Sensitivity Tests , VenezuelaABSTRACT
INTRODUCTION: Antimicrobial resistance of pathogens causing urinary tract infection (UTI) is a growing problem, which complicates their effective treatment. Surveillance is needed to guide appropriate empiric therapy. AIM: to describe the susceptibility patterns of Gram-negative bacteria isolated of patients with UTI to twelve antibiotics as part of the Study for Monitoring Antimicrobial Resistance Trends in Venezuela. MATERIALS AND METHODS: Between 2009-2012 a total of 472 Gram-negative bacteria were isolated from hospitalized patients with UTI. The isolates were sent to Central Laboratory (Central Laboratory of International Health Management Associates) to confirm their identification, and to make susceptibility testing as recommended by the Clinical and Laboratory Standards Institute. Enterobacteriacea comprised 96.6% of the total, where Escherichia coli (76.9%) and Klebsiella pneumoniae (10.6%) were the most frequent. Extended-spectrum ß-lactamases (ESBL) was detected in 21.6% of isolates. Top antimicrobial activity were ertapenem, imipenem, and amikacin (> 90.0%), slightly lower for amikacin (85.1%) in ESBL-producing strains. Resistance rates to fluoroquinolones and ampicillin/sulbactam were high (40 y 64%, respectively). CONCLUSIONS: These data suggest a necessary revision of the therapeutic regimens for the empirical treatment of UTI in Venezuela.
Subject(s)
Anti-Bacterial Agents/pharmacology , Gram-Negative Bacteria/drug effects , Gram-Negative Bacterial Infections/microbiology , Urinary Tract Infections/microbiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Gram-Negative Bacteria/classification , Gram-Negative Bacteria/isolation & purification , Humans , Infant , Male , Microbial Sensitivity Tests , Middle Aged , Venezuela , Young AdultABSTRACT
BACKGROUND: Methicillin-resistant Staphylococus aureus (MRSA) is an important nosocomial and community-associated (CA) pathogen. Recently, a variant of the MRSA USA300 clone emerged and disseminated in South America, causing important clinical problems. METHODS: S. aureus isolates were prospectively collected (2006-2008) from 32 tertiary hospitals in Colombia, Ecuador, Peru, and Venezuela. MRSA isolates were subjected to antimicrobial susceptibility testing and pulsed-field gel electrophoresis and were categorized as health care-associated (HA)-like or CA-like clones on the basis of genotypic characteristics and detection of genes encoding Panton-Valentine leukocidin and staphylococcal cassette chromosome (SCC) mec IV. In addition, multilocus sequence typing of representative isolates of each major CA-MRSA pulsotype was performed, and the presence of USA300-associated toxins and the arcA gene was investigated for all isolates categorized as CA-MRSA. RESULTS: A total of 1570 S. aureus were included; 651 were MRSA (41%)--with the highest rate of MRSA isolation in Peru (62%) and the lowest in Venezuela (26%)--and 71%, 27%, and 2% were classified as HA-like, CA-like, and non-CA/HA-like clones, respectively. Only 9 MRSA isolates were confirmed to have reduced susceptibility to glycopeptides (glycopeptide-intermediate S. aureus phenotype). The most common pulsotype (designated ComA) among the CA-like MRSA strains was found in 96% of isolates, with the majority (81%) having a < or =6-band difference with the USA300-0114 strain. Representative isolates of this clone were sequence type 8; however, unlike the USA300-0114 strain, they harbored a different SCCmec IV subtype and lacked arcA (an indicator of the arginine catabolic mobile element). CONCLUSION: A variant CA-MRSA USA300 clone has become established in South America and, in some countries, is endemic in hospital settings.
