ABSTRACT
BACKGROUND: PRONARES (Programa Nacional de Vigilancia de Resistencia) is a national surveillance program for antimicrobial susceptibility, focused in different syndromes and among these, urinary tract infections. The work is done in a laboratory net that uses common protocols and whose data are centrally analyzed using the WHONET program. AIM: To analyze the pattern of antimicrobial susceptibility of agents causing urinary infections in children in the period 1997-1999. MATERIAL AND METHODS: In the study period, 5,525 strains were analyzed. Of these, 2,307 came from pediatric patients (1,495 hospitalized and 803 ambulatory). RESULTS: The most common causative agent was E. coli in 74.2% of cases, followed by Klebsiella spp in 8.2% and other agents in a lower frequency. Of E. coli strains, 74% were resistant to ampicillin, 52% to clotrimoxazole and 30% to first generation cephalosporins. These strains were sensitive to second and third generation cephalosporins, aminoglycosides, ciprofloxacin and nitrofurantoin. Strains from nosocomial or community infections had similar antimicrobial susceptibility. Klebsiella spp had a high rate of antimicrobial resistance (over 40%), that was even higher among nosocomial strains. It was 90% susceptible to ciprofloxacin and 100% to imipenem. All centers from which strains came had a similar pattern of susceptibility, with the exception of a pediatric center that had significantly higher resistance levels. CONCLUSIONS: The current therapeutic recommendations for urinary tract infections in children caused by E coli, are still pertinent, but the use of first generation cephalosporins must be cautious. The treatment of Klebsiella spp requires an individual antibiogram.
Subject(s)
Anti-Bacterial Agents/pharmacology , Drug Resistance, Multiple , Gram-Negative Bacteria/drug effects , Urinary Tract Infections/microbiology , Adolescent , Child , Child, Preschool , Chile , Drug Resistance, Microbial , Escherichia coli/drug effects , Escherichia coli/isolation & purification , Female , Humans , Infant , Infant, Newborn , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/isolation & purification , Longitudinal Studies , Male , Microbial Sensitivity TestsABSTRACT
BACKGROUND: The computer program WHONET generates a common database to analyze local or general antimicrobial resistance of bacteria. A surveillance of agents causing urinary tract infections in Chile has been performed using this program. AIM: To report the results after 12 months of urinary tract infection agent surveillance. MATERIAL AND METHODS: Since November, 1997, a surveillance of in vitro antimicrobial resistance, using agar diffusion techniques, has been performed in 20 to 40 bacterial strains per month, isolated from 11 hospitals in the country. Results have been analyzed using WHONET program. RESULTS: In first 12 months, 3144 strains, 1625 coming from outpatients, have been studied. Seventy four percent of isolated strains were E coli, 19% were other enterobacteria, 4.1% were non fermenting bacilli and 2.1% were Gram (+) cocci. Sixty five percent of E coli strains were resistant to ampicillin, 11% to cefazolin, 2.5% to cefuroxime, 19% to ceftriaxone, 9% to ceftazidime, 4.2% to gentamicin 1.3% to amikacin, 5.6% to ciprofloxacin, 8.4% to grepafloxacin, 4.3% to nitrofurantoin and 43% to trimeproprim/sulphamethoxazole. Eighty two percent of other enterobacteria strains were resistant to ampicillin, 45.5% to cefazolin, 33.5% to cefuroxime, 26.6% to ceftriaxone, 21.5% to ceftazidime, 30.3% to gentamicin 17.2% to amikacin, 21% to ciprofloxacin, 16.3% to grepafloxacin, 48.2% to nitrofurantoin and 44.6% to trimeproprim/sulphamethoxazole. There were differences in betalactamic resistance among hospitals. CONCLUSIONS: Noteworthy is the high resistance rates to third generation cephalosporins, evidenced when the new cutoff values for E coli and Klebsiella spp are used. This national surveillance provides updated information on antimicrobial resistance of agents causing urinary tract infections.
Subject(s)
Drug Resistance, Microbial , Urinary Tract Infections/microbiology , Chile , Drug Resistance, Multiple , Escherichia coli/drug effects , Female , Humans , Male , Microbial Sensitivity Tests , Population SurveillanceABSTRACT
We compared the incidence of nasopharyngeal colonization by Streptococcus pneumoniae, the serotypes causing mucosal and invasive diseases, and the antibiotic resistance of these strains in patients admitted to three large hospitals and children attending day care centers in two Chilean cities (Santiago and Temuco). The populations in both cities were similar in ethnic background, socioeconomic status, family size, and access to medical care. Significant differences in nasopharyngeal colonization rates, in serotypes causing infections, and in antibiotic resistance were found between the two cities. In children 0 to 2 years of age, 42% were colonized with S. pneumoniae in Santiago compared to 14% in Temuco. A total of 41 serotypes were identified in both Chilean cities studied. Six serotypes were found only in Santiago; 14 serotypes were found only in Temuco. Antibiotic-resistant serotypes 6A, 6B, 14, 19F, and 23F were detected only in Santiago. We show that important differences in the incidence of nasopharyngeal carriage, infection, and S. pneumoniae serotypes can exist in similar populations in different areas of the same country. Our findings are relevant for prevention strategies, antibiotic usage, and vaccine design.
Subject(s)
Drug Resistance, Microbial/genetics , Pneumococcal Infections/microbiology , Streptococcus pneumoniae/isolation & purification , Adolescent , Child , Child, Preschool , Chile/epidemiology , Humans , Infant , Pneumococcal Infections/epidemiology , Serotyping , Streptococcus pneumoniae/drug effects , Streptococcus pneumoniae/geneticsABSTRACT
Sparfloxacin is a new antimicrobial that, while maintaining a good activity against gram negative bacilli, has a better in vitro activity against gram positive bacteria such as S pneumoniae, intracellular pathogens and anaerobic bacteria. The aim of this work was to study the in vitro activity of sparfloxacin against bacteria isolated from patients with community acquired respiratory infections between October 1994 and January 1995. Using the E-test technique, we studied the susceptibility to sparfloxacin, ciprofloxacin, ampicillin, amoxicillin/clavulanic acid, cefuroxime, cefotaxime, erythromycin, methicillin and nalidixic acid of 50 strains of S pneumoniae, 50 strains of H. influenzae, 50 strains of S aureus and 50 strains of S pyogenes. Sparfloxacin was active against 100% of S pneumoniae, H influenzae and S pyogenes strains. Twenty two percent of S aureus strains were resistant and the MIC 90 was 12 micrograms/ml. Sparfloxacin showed the best in vitro activity against H influenzae and S aureus, a similar activity with ampicillin and cefotaxime against S pneumoniae and a similar activity with ampicillin but superior to all other studied antimicrobial against S pyogenes. It is concluded that sparfloxacin is a good antimicrobial for bacteria isolated from patients with respiratory infections.
Subject(s)
Anti-Bacterial Agents/pharmacology , Antitubercular Agents/pharmacology , Fluoroquinolones , Respiratory Tract Infections/drug therapy , Drug Resistance, Microbial , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Humans , In Vitro Techniques , Quinolones/pharmacologyABSTRACT
The aim of this study was to compare in vitro activity, measuring minimal inhibitory concentration, of amoxicillin or its combination with clavulanic acid against 109 strains of Acinetobacter baumanii, 104 strains of Hemophilus influenzae and 94 strains of Staphylococcus aureus. All these were obtained from different hospitals of the Santiago Metropolitan Region. Amoxicillin-clavulanic acid association did not improve the activity of amoxicillin against Acinetobacter. The association was not active against methicillin resistant strains of S aureus; instead, it significantly increased the activity of amoxicillin against methicillin susceptible strains. All the H influenzae strains were susceptible to the combination.
Subject(s)
Acinetobacter/drug effects , Drug Therapy, Combination/pharmacology , Haemophilus influenzae/drug effects , Staphylococcus aureus/drug effects , Amoxicillin/pharmacology , Clavulanic Acids/pharmacology , Drug Resistance, MicrobialABSTRACT
In a previous study we observed that 6% of adult and 18% of children contacts of H. influenzae infected patients became carriers of the bacillus. We studied 1296 adults involved in children care, 398 from day care centers and 898 from hospitals in Santiago. A pharyngeal sample was cultured in chocolate agar plus bacitracin (300 mg/ml) and incubated at 37 degrees C in a 5-10% CO2 atmosphere for 18-24 h. Isolates of H influenzae were biotypified and serogrouped according to international recommendations. We observed that 2.4% of subjects were H influenzae carriers. Thirty carriers were treated with 2 doses of enoxacin, 440 mg. All became free of H influenzae at a 30-day follow-up.
Subject(s)
Carrier State/epidemiology , Child Day Care Centers , Enoxacin/therapeutic use , Haemophilus Infections/epidemiology , Haemophilus influenzae , Hospitals, Pediatric , Pharyngeal Diseases/epidemiology , Adult , Carrier State/drug therapy , Carrier State/microbiology , Child , Child Day Care Centers/statistics & numerical data , Child, Preschool , Chile/epidemiology , Drug Evaluation , Drug Tolerance , Female , Haemophilus Infections/drug therapy , Haemophilus Infections/microbiology , Haemophilus influenzae/isolation & purification , Hospitals, Pediatric/statistics & numerical data , Humans , Male , Pharyngeal Diseases/drug therapy , Pharyngeal Diseases/microbiology , Prevalence , WorkforceABSTRACT
A foremost mechanism of bacterial resistance to penicillin and its derivatives is the chromosomal or plasmid mediated production of B-lactamase. Inhibitors of these enzymes like sulbactam may help overcome this problem. We tested the in vitro activity of ampicillin alone or in association with sulbactam (1:1 ratio) against enterobacteriaceae, aeromonae, Hemophilus influenzae, staphylococci and Streptococcus fecalis, isolated from patients suffering different infectious diseases. The Kirby-Bauer method was used to evaluate susceptibility and MIC was determined by agar dilution techniques. Most enterobacteriaceae and aeromonae were resistant to ampicillin. The association was effective against shigellae and Yersinia enterocolitica. 28% of H. influenzae strains were resistant to ampicillin alone but were susceptible to the association. 30% of resistant staphylococci became sensitive to the association.
Subject(s)
Ampicillin/therapeutic use , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Sulbactam/therapeutic use , Drug Resistance, Microbial , Drug Therapy, Combination/therapeutic use , In Vitro TechniquesSubject(s)
Carrier State/epidemiology , Haemophilus Infections/epidemiology , Adolescent , Adult , Anti-Bacterial Agents/pharmacology , Child , Child, Preschool , Chile , Drug Resistance, Microbial , Female , Haemophilus influenzae/drug effects , Haemophilus influenzae/isolation & purification , Humans , Infant , MaleABSTRACT
Con el propósito de determinar la prevalencia de los diferentes dermatofitos involucrados como agentes etiológicos de tinea pedis en estudiantes con signología de dermatofitosis y en portadores interdigitales en nuestra población adolescente, se practicó estudio micológico (examen directo y cultivo) en 237 escolares cuya edad fluctuaba entre 14 y 20 años, procedentes de 3 colegios de nivel socio económico medio del área Oriente de Santiago. De las muestras obtenidas por raspado interdigital de ambos pies, se aisló dermatofitos en 14,8% de los alumnos, correspondió un 8% a estudiantes sin lesiones y 6,8% con lesiones descamativas. Se pesquisó un 12,8% de portadores. Hubo una estrecha correlación entre el examen directo y el cultivo. La frecuencia de los agentes aislados fue la siguiente: Trichophyton rubrum 77.1%, Trichophyton mentagrophytes 20%, Epidermophyton floccosum 2.9%, se observó un predominio de dermatofitos estadísticamente significativo en el sexo masculino (p<0.05)
Subject(s)
Adolescent , Adult , Humans , Male , Female , Arthrodermataceae/isolation & purification , Chile , Cross-Over Studies , Tinea Pedis/epidemiologyABSTRACT
Con el propósito de determinar la prevalencia de los diferentes dermatofitos involucrados como agentes etiológicos de tinea pedis en estudiantes con signología de dermatofitosis y en portadores interdigitales en nuestra población adolescente, se practicó estudio micológico (examen directo y cultivo) en 237 escolares cuya edad fluctuaba entre 14 y 20 años, procedentes de 3 colegios de nivel socio económico medio del área Oriente de Santiago. De las muestras obtenidas por raspado interdigital de ambos pies, se aisló dermatofitos en 14,8% de los alumnos, correspondió un 8% a estudiantes sin lesiones y 6,8% con lesiones descamativas. Se pesquisó un 12,8% de portadores. Hubo una estrecha correlación entre el examen directo y el cultivo. La frecuencia de los agentes aislados fue la siguiente: Trichophyton rubrum 77.1%, Trichophyton mentagrophytes 20%, Epidermophyton floccosum 2.9%, se observó un predominio de dermatofitos estadísticamente significativo en el sexo masculino (p<0.05) (AU)
