[Gram-negative bacteria of critical priority in ICU patients from a tertiary care hospital]. / Bacterias Gram-negativas de prioridad crítica en pacientes de las UCI de un hospital de tercer nivel.

Background: Intensive care units (ICU) are the epicenter of antimicrobial resistance (AMR), and patients' infections are mainly caused by Gram-negative bacteria (GNB). Objective: To describe the frequency and trends in AMR of GNB deriving from the clinical samples of ICU patients at a tertiary care hospital in Mérida, Yucatán. Material and methods: Study which included the review of laboratory reports of all bacteriological samples collected from patients admitted to neonatal, pediatric and adult ICU from January 1 2019 to December 31 2021. Results: 433 GNB isolates were recovered, with Klebsiella pneumoniae being the most predominant isolate (n = 117; 27.02%). The majority of GNB were recovered from bronchial secretions (n = 163). Overall, GNB showed high resistance rates to ampicillin (89.48%), ampicillin/sulbactam (66.85%), cephalosporins (58.52-93.81%), tobramycin (58.06%), and tetracycline (61.73%). Among GNB, 73.90% and 68.53% exhibited multidrug-resistant, and highly resistant microorganisms' profiles, respectively, and 47.54% of Acinetobacter baumannii exhibited an extensively drug-resistant profile. A total of 80.33% of A. baumannii was carbapenem-resistant, and 83.76% of K. pneumoniae strains were ESBL-producing. Conclusion: Our data could be helpful to improve the empirical therapy and the infection-control program.

Introducción: las unidades de cuidados intensivos (UCI) son el epicentro de la resistencia a los antimicrobianos (RAM) y las infecciones en estas áreas son causadas principalmente por bacterias Gram-negativas (BGN). Objetivo: describir la frecuencia y los patrones de RAM en BGN aisladas de muestras clínicas de pacientes de las UCI de un hospital de tercer nivel en Mérida, Yucatán. Material y métodos: estudio que incluyó la revisión de los reportes de laboratorio de las muestras bacteriológicas obtenidas de pacientes ingresados en las UCI neonatal, pediátrica y adulta del 1 de enero de 2019 al 31 de diciembre de 2021. Resultados: se identificaron 433 BGN y Klebsiella pneumoniae fue el patógeno más prevalente (n = 117; 27.02%). La mayoría de las BGN aisladas se obtuvieron de secreciones bronquiales (n = 163). En general, las BGN mostraron altas tasas de resistencia a ampicilina (89.48%), ampicilina/sulbactam (66.85%), cefalosporinas (58.52-93.81%), tobramicina (58.06%) y tetraciclina (61.73%). El 73.90% y el 68.53% de las BGN exhibieron perfiles multidrogorresistentes y microorganismos altamente resistentes a fármacos, respectivamente, y 47.54% de los aislamientos de Acinetobacter baumannii mostró perfil de drogorresistencia extendida. El 80.33% de los A. baumannii fue resistente a carbapenémicos y el 83.76% de las K. pneumoniae fueron productoras de BLEE. Conclusión: nuestros datos podrían mejorar la terapia antimicrobiana empírica y el programa de control de infecciones.

Caracterización de ß-lactamasas de espectro extendido en aislamientos clínicos colombianos de Salmonella enterica no tifoidea de 1997 a 2022 / Characterization of extended spectrum ß-lactamases in Colombian clinical isolates of non-typhoidal Salmonella enterica between 1997 and 2022

Introducción. Salmonella spp. es un agente patógeno zoonótico transmitido al humano por el agua o los alimentos contaminados. La presencia de ß-lactamasas de espectro extendido es un creciente problema para la salud pública debido a que estas enzimas confieren resistencia contra las cefalosporinas de tercera y cuarta generación. Objetivo. Caracterizar las ß-lactamasas de espectro extendido en aislamientos de Salmonella spp. recibidos por el programa de vigilancia de enfermedad diarreica aguda o enfermedad transmitida por alimentos del Grupo de Microbiología del Instituto Nacional de Salud. Materiales y métodos. Entre enero de 1997 y junio de 2022, se recibieron 444 aislamientos de Salmonella spp. resistentes, por lo menos, a una de las cefalosporinas de tercera generación. El fenotipo de las ß-lactamasas de espectro extendido se identificó con la prueba de doble disco. El ADN se extrajo por ebullición y mediante PCR se amplificaron los genes bla CTX-M, bla SHVy : ' a ILM. Resultados. Todos los aislamientos fueron positivos para la prueba de ß-lactamasas de espectro extendido. Los resultados de la amplificación por PCR fueron: bla CTX-M + bla TLM (n=200), bla CTX-M (n=177), bla SHV(n=16), bla SHV + bla CTX-M (n=6), bla TLM (n=13) y bla SHV + bla CTX-M + bla TLM (n=3). Del total, 26 aislamientos fueron negativos para los genes evaluados. Los aislamientos positivos para ß-lactamasas de espectro extendido se identificaron en Bogotá y en 21 departamentos: Chocó, Magdalena, Meta, Bolívar, Casanare, Cesar, Córdoba, Quindío, Atlántico, Tolima, Cauca, Cundinamarca, Huila, Boyacá, Caldas, Norte de Santander, Risaralda, Antioquia, Nariño, Santander y Valle del Cauca. Conclusión. La resistencia a las cefalosporinas de tercera generación en aislamientos de Salmonella spp. fue generada principalmente por bla CTX-M. El 44 % (197/444) de los aislamientos presentó resistencia a ampicilina, tetraciclina, cloranfenicol y trimetoprim- sulfametoxazol Los serotipos portadores de ß-lactamasas de espectro extendido más frecuentes fueron S. Typhimurium y S. Infantis.

Introduction. Salmonella spp. is a zoonotic pathogen transmitted to humans through contaminated water or food. The presence of extended-spectrum ß-lactamases is a growing public health problem because these enzymes are resistant to third and fourth generation cephalosporins. Objective. To characterize extended-spectrum ß-lactamases in Salmonella spp. isolates received by the acute diarrheal disease/foodborne disease surveillance program of the Grupo de Microbiología of the Instituto Nacional de Salud. Materials and methods. A total of 444 Salmonella spp. isolates, resistant to at least one of the cephalosporins, were obtained between January 1997 and June 2022. The extended- spectrum ß-lactamases phenotype was identified by the double disk test. DNA extraction was carried out by the boiling method, and the bla CTX-M, bla SHV, and bla TLM genes were amplified by PCR. Results. All the isolates were positive for the extended-spectrum ß-lactamases test. The genes identified were: bla CTX-M + ba TLM (n=200), bla CTX-M (n=177), bla SHV(n=16), bla SHV + bla CTX-M (n=6), bla TLM (n=13) and bla SHV + bla CTX-M + bla TLM (n=3). Twenty-six isolates were negative for the evaluated genes. Positive extended-spectrum ß-lactamases isolates were identified in Bogotá and 21 departments: Chocó, Magdalena, Meta, Bolívar, Casanare, Cesar, Córdoba, Quindío, Atlántico, Tolima, Cauca, Cundinamarca, Huila, Boyacá, Caldas, Norte de Santander, Risaralda, Antioquia, Nariño, Santander y Valle del Cauca. Conclusion. Resistance to third generation cephalosporins in Salmonella spp. isolates was mainly caused by bla CTX-M. Isolates were resistant to ampicillin, tetracycline, chloramphenicol, and trimethoprim-sulfamethoxazole (44 %; 197/444). The most frequent extended-spectrum ß-lactamases-expressing serotypes were Salmonella Typhimurium and Salmonella Infantis.

Molecular characteristics of antibiotic-resistant Escherichia coli and Klebsiella pneumoniae isolates obtained from urine samples of patients with urinary tract infection in Lima and Callao, Peru / Características moleculares de aislamientos de Escherichia coli y Klebsiella pneumoniae resistentes a antibióticos obtenidos de muestras de orina de pacientes con infección del trato urinario en Lima y Callao, Perú

Abstract Introduction: Urinary tract infections (UTI) are the second most frequent disease caused by bacteria, mainly Escherichia coli and Klebsiella pneumoniae. Furthermore, the emergence of multidrug-resistant extended-spectrum ß-lactamases (ESBL)-producing bacteria is a serious public health issue. Objective: To describe the molecular characteristics of ESBL-producing E. coli and K. pneumoniae isolates obtained from urinary samples of Peruvian patients with UTI. Materials and methods: Retrospective, descriptive, cross-sectional study, in which 118 isolates obtained from urine cultures of patients with UTI treated at 2 hospitals located in the province of Lima and 1 in the province of Callao between April and August, 2019, were analyzed. A MicroScan™ automated system and a conventional polymerase chain reaction (PCR) test were used to identify resistance profiles and detect ESBL genes, respectively. Results: All the bacteria isolated in the 3 hospitals were multi-drug resistant (105 E. coli and 13 K. pneumoniae). Coexistence of ESBL genes (blarEM, blacrx-M, blasHv) was observed in 32.20% of the isolates (28.57% of E. coli and 61.53% of K. pneumoniae isolates). Coexistence of 2 and 3 genes was found in 12.71 % and 21.18 % of isolates, respectively. In addition, blarEM was the ESBL gene most frequently expressed in the isolates (45.76%). Conclusions: Multiple drug resistance was found in all isolates analyzed. Additionally, coexistence of ESBL genes was observed in almost one third of the isolates, showing that antibiotic resistance is a real problem in public hospitals in the provinces of Lima and Callao.

Resumen Introducción. Las infecciones del tracto urinario (ITU) son la segunda enfermedad más frecuente causada por bacterias, principalmente por Escherichia coli y Klebsiella pneumoniae; además, la aparición de bacterias multidrogorresistentes productoras de betalactamasas de espectro extendido (BLEE) representa un serio problema de salud pública. Objetivo. Describir las características moleculares de aislamientos de E. coli y K. pneumoniae productoras de BLEE obtenidos de muestras de orina de pacientes peruanos con ITU. Materiales y métodos. Estudio retrospectivo, transversal y descriptivo. Se analizaron 118 aislamientos de urocultivos de pacientes con ITU atendidos en 2 hospitales de la provincia de Lima y 1 de la provincia del Callao procesados entre abril y agosto del 2019. Los perfiles de resistencia se identificaron utilizando el sistema automatizado MicroScan™ y para la detección de los genes BLEE se empleó una prueba de reacción de cadena de la polimerasa convencional. Resultados. El 100% de las bacterias aisladas en los tres hospitales fueron multidrogorresistentes (105 de E. coli y 13 de K. pneumoniae). La coexistencia de genes BLEE (blarEM, blacrx-M, blasHv) se observó en 32.20% de los aislamientos (28.57% de los de E. coli y 61.53% de los de K. pneumoniae), hallándose coexistencia de 2 genes y 3 genes en 12.71% y 21.18%, respectivamente; además, blarEM fue el gen BLEE más frecuentemente expresado en los aislamientos (45.76%). Conclusiones. Se halló multidrogoresistencia en todos los aislamientos analizados. Además, se observó coexistencia de genes BLEE en casi un tercio de todos los aislamientos, lo que evidencia que la resistencia a los antibióticos es una problemática real en los hospitales públicos de las provincias de Lima y Callao.

Rats as sources of multidrug-resistant Enterobacteriaceae in animal production environments.

Rattus norvegicus and Rattus rattus are commensal pest rodents, considered reservoirs and vectors of zoonotic pathogens. In livestock farms, the wide use of antimicrobials and their release into the environment lead to high long-term residual concentrations, which may in turn lead to the occurrence of antimicrobial resistance (AMR). Farm environments serve as AMR sources, resulting in the transmission of antimicrobial-resistant bacteria and their AMR genes of livestock origin into wildlife. This study aimed to analyse the profile of enterobacteria carrying AMR determinants in rats captured in livestock farms to determine their potential vectors as for the spread of AMR. To this end, 56 rats (52 R. norvegicus and 4 R. rattus) were live-trapped on 11 farms (pig, dairy, poultry and mixed farms) located in central Argentina, from spring 2016 to autumn 2017. From 50 of the R. norvegicus individuals and three of the R. rattus individuals found in 10 of the farms, we isolated 53 Escherichia coli and five Salmonella strains. Susceptibility to antimicrobials, genotypic profiles, minimal inhibitory concentration of colistin and the presence of mcr-1 and genes encoding extended-spectrum ß-lactamase (ESBL) were determined. Of the 58 isolates not susceptible to different antimicrobial classes, 28 of the E. coli strains and two of the Salmonella strains were defined as multi-drug resistant (MDR). S. Westhampton and S. Newport recovered were not susceptible to ampicillin or all the cephems tested. One of the E. coli obtained showed resistance to colistin and harboured the mcr-1 gene, demonstrated by PCR and conjugation. In two ESBL-producing Salmonella isolated from rats, CTX-M-2 genes were responsible for the observed resistance to third-generation cephalosporins. The MDR E. coli isolates showed several different resistance patterns (23), although some of them were the same in different individuals and different farms, with six resistance patterns, evidencing the dispersion of strains. These findings suggest that rats play a role in the dissemination of AMR determinants between animal, humans and environmental reservoirs.

Otitis externa maligna con diseminación hematógena de Pseudomonas aeruginosa resistente a carbapenémicos

Pseudomonas aeruginosa en una bacteria Gram negativa no fermentadora que produce diversos tipos de infecciones severas en inmunocompetentes e inmunodeprimidos. Una de estas infecciones es la otitis externa maligna, la cual se presenta principalmente en personas con diabetes mellitus y puede tener una evolución tórpida cursando con osteomielitis de base de cráneo y parálisis de nervios craneales. El tratamiento es individualizado y principalmente conservador con antibioticoterapia guiada por cultivo. La bacteria aislada en la mayoría de los casos reportados es sensible a los antibióticos anti-pseudomónicos. Reportamos un caso de presentación inusual de otitis externa maligna por Pseudomonas aeruginosa resistente a carbapenémicos con evidencia sugerente de compromiso bilateral y en el cual se aisló al mismo germen en urocultivo y hemocultivos, lo que indicaría una diseminación hematógena del microorganismo.

Pseudomonas aeruginosa is a non-fermenting Gram-negative bacterium that produces several types of severe infections in immunocompetent and immunosuppressed patients. One of these infections is malignant otitis externa, which occurs mainly in people with diabetes mellitus and can have a torpid evolution coursing with osteomyelitis of skull base and cranial nerve palsies. Treatment is individualized and mainly conservative with culture-guided antibiotic therapy, with isolated pseudomonas being sensitive to anti-pseudomonal antibiotics in the majority of reported cases. We report a case of unusual presentation of malignant otitis externa caused by Pseudomonas aeruginosa resistant to carbapenems with suggestive evidence of bilateral involvement and in which the same germ was isolated in urine and blood cultures, which would indicate hematogenous dissemination of the microorganism.

Resistencia antimicrobiana, una pandemia silenciosa / Antimicrobial resistance, a silent pandemic / Resistência antimicrobiana, uma pandemia silenciosa

Introducción: la resistencia a los antimicrobianos ha sido una problemática creciente a nivel global, la problemática afecta no solo la salud de personas, animales y el ambiente en general, sino que ha generado impactos de índole productivo y comercial. Una de las estrategias para abordar esta problemática es el enfoque de una salud. Este enfoque destaca la participación multidisciplinaria para combatir la resistencia antimicrobiana; y es así que cada profesión o actividad laboral genera unas responsabilidades innatas para la profesión veterinaria. Los veterinarios tienen un rol fundamental para este propósito, ya que son ellos quienes integran la aplicabilidad de estrategias de promoción y prevención a nivel agropecuario, y de consolidación e interlocución entre los diferentes componentes del enfoque (animal, humano, ambiente) desde el ámbito de la salud pública veterinaria. Materiales y Método: se realizó una búsqueda de la literatura en diferentes bases de datos, con el objetivo de realizar una revisión actualizada sobre la resistencia antimicrobiana. Resultados: dentro de las principales estrategias se debería fomentar un uso adecuado y bajo prescripción de antimicrobianos en la producción animal. Promover buenas prácticas de higiene, bioseguridad y vacunación, facilitando un correcto diagnóstico de enfermedades infecciosas en animales. Discusión: la adopción de normas internacionales para el uso responsable de los antibióticos y las directrices establecidas por la Organización Mundial de la Salud y Organización de las Naciones Unidas para la Alimentación y la Agricultura, a través del Codex Alimentarius y la Organización Mundial de Sanidad Animal, son fundamentales para hacer frente al desafío que representa el problema de la resistencia a los antimicrobianos.

Introduction: Antimicrobial resistance has been a growing problem at a global level, affecting not only the health of people, animals and the environment in general, but it has also generated impacts of a productive and commercial nature. One of the strategies to address this problem is the one-health approach. This approach emphasizes multidisciplinary participation to combat antimicrobial resistance; and thus, each profession or work activity generates innate responsibilities for the veterinary profession. Veterinarians have a fundamental role for this purpose, since they are the ones who integrate the applicability of promotion and prevention strategies at the agricultural level, and of consolidation and interlocution between the different components of the approach (animal, human, environment) from the field of veterinary public health. Materials and Method: a literature search was carried out in different databases, with the aim of carrying out an updated review on antimicrobial resistance. Results: one of the main strategies should be to promote an adequate use and under prescription of antimicrobials in animal production. Promote good hygiene, biosecurity and vaccination practices, facilitating a correct diagnosis of infectious diseases in animals. Discussion: the adoption of international standards for the responsible use of antibiotics and the guidelines established by the World Health Organization and the Food and Agriculture Organization of the United Nations, through Codex Alimentarius and the World Organization for Animal Health, are fundamental to face the challenge posed by the problem of antimicrobial resistance.

Introdução: A resistência antimicrobiana tem sido um problema crescente em todo o mundo, afetando não apenas a saúde dos seres humanos, dos animais e do meio ambiente em geral, mas também causando impactos na produção e no comércio. Uma das estratégias para lidar com esse problema é a abordagem One Health. Essa abordagem enfatiza o envolvimento multidisciplinar no combate à resistência antimicrobiana, com cada profissão ou atividade de trabalho gerando responsabilidades inatas à profissão veterinária. Os veterinários têm um papel fundamental nesse sentido, pois são eles que integram a aplicabilidade das estratégias de promoção e prevenção em nível agropecuário e de consolidação e interlocução entre os diferentes componentes da abordagem (animal, humano, ambiental) do campo da saúde pública veterinária. Materiais e Métodos: foi realizada uma pesquisa bibliográfica em diferentes bases de dados, com o objetivo de realizar uma revisão atualizada sobre a resistência antimicrobiana. Resultados: uma das principais estratégias deve ser a promoção do uso adequado e com baixa prescrição de antimicrobianos na produção animal. Promover boas práticas de higiene, biossegurança e vacinação, facilitando o diagnóstico correto de doenças infecciosas em animais. Discussão: A adoção de padrões internacionais para o uso responsável de antibióticos e as diretrizes estabelecidas pela Organização Mundial da Saúde e pela Organização das Nações Unidas para Agricultura e Alimentação, por meio do Codex Alimentarius e da Organização Mundial de Saúde Animal, são essenciais para enfrentar o desafio representado pelo problema da resistência antimicrobiana.

Epidemiology of antimicrobial resistance in bacteria isolated from inpatient and outpatient samples, Ecuador, 2018.

Objective: To compare the epidemiology of antimicrobial resistance in bacteria isolated from inpatient and outpatient samples in Ecuador. Methods: A secondary analysis was done of data on bacteria isolated from inpatient and outpatient samples. Data were taken from the 2018 national antimicrobial resistance surveillance database of the National Reference Center for Antimicrobial Resistance. The variables included were: age, sex, inpatient versus outpatient setting, type of specimen, bacterial species identified, pattern of resistance to antibiotics, and geographic area. Results: Data from 57 305 bacterial isolates were included in the study: 48.8% were from hospitalized patients, 55.7% were from women, and 60.1% were from patients older than 45 years. Urine (42.9%) and blood (12.4%) were the most common clinical samples. Overall, 77.1% of bacterial isolates were gram-negative (83% and 71% in outpatients and inpatients, respectively). The most common gram-positive and gram-negative species were Staphylococcus aureus and Escherichia coli, respectively. Antimicrobial resistance levels were high (up to 80% for some antimicrobial drugs), and were higher in hospitalized patients compared with outpatients. A variety of carbapenemases were found to confer resistance to carbapenems (antibiotics of last resort) in gram-negative bacteria. Conclusions: The study findings provide an important baseline on antimicrobial resistance in Ecuador. This will allow the strengthening of guidelines of the surveillance system, the creation of public policies for standardization of laboratory methodologies, the proper handling of information, and the development of empirical therapy guidelines based on local epidemiology.

Challenges of Multidrug-resistant New Delhi Metallo-beta-Lactamase (NDM-1)-producing Enterobacteriaceae in Kidney Transplant Patients / Desafios da Enterobacteriaceae produtora de New Delhi Metalo-beta-Lactamase (NDM-1) multirresistente em pacientes com transplante renal

Abstract Background: The emergence of multidrug-resistant NDM-1-producing enterobacteriaceae strains has become a threat to inpatients, especially to immunosuppressed ones, such as kidney transplant recipients. NDM-1 is a carbapenemase that makes gram-negative bacteria resistant to many types of antibiotics. The incidence of carbapenemase-producing enterobacteria infection in solid organ transplant recipients is around 3 to 10%, with a mortality rate of up to 30%. Methods: We present a case series of 4 patients with NDM-1-producing enterobacteria isolated in urine cultures or rectal swabs. We also conducted a cross-sectional study 30 days after patient identification, collecting surveillance cultures (rectal swab) from all inpatients to assess the extent of spread of this resistance mechanism; a total of 101 patients were included. Results: Two patients were adequately treated with negative control cultures. The other two patients were not treated because they were asymptomatic and had subsequent negative urine cultures. No new colonization was identified in the cross-sectional screening, and no new cases of urinary NDM-1 infection were recorded after a 4-year follow-up. Conclusion: Surveillance for infections caused by multidrug-resistant strains in hospitals treating immunosuppressed patients should be continued and prompt action should be taken in cases of outbreaks of multidrug-resistant infections.

Resumo Histórico: O surgimento de cepas multirresistentes de enterobacteriaceae produtoras de NDM-1 tornou-se uma ameaça para pacientes hospitalizados, especialmente para os imunossuprimidos, como os receptores de transplante renal. NDM-1 é uma carbapenemase que torna as bactérias gram-negativas resistentes a muitos tipos de antibióticos. A incidência de infecção por enterobactérias produtoras de carbapenemas em receptores de transplante de órgãos sólidos é de cerca de 3 a 10%, com uma taxa de mortalidade de até 30%. Métodos: Apresentamos uma série de casos de 4 pacientes com enterobactérias produtoras de NDM-1 isoladas em culturas de urina ou esfregaços retais. Também realizamos um estudo transversal 30 dias após a identificação do paciente, coletando culturas de vigilância (esfregaço retal) de todos os pacientes internados para avaliar a extensão de disseminação deste mecanismo de resistência; foram incluídos um total de 101 pacientes. Resultados: Dois pacientes foram tratados adequadamente com culturas de controle negativo. Os outros dois pacientes não foram tratados porque eram assintomáticos e tiveram culturas de urina negativas subsequentes. Não foi identificada nenhuma nova colonização na triagem transversal, e não foram registrados novos casos de infecção urinária por NDM-1 após um acompanhamento de 4 anos. Conclusão: A vigilância de infecções causadas por cepas multirresistentes em hospitais que tratam pacientes imunossuprimidos deve ser continuada e devem ser tomadas medidas imediatas em casos de surtos desses tipos de infecções.

Prevalência e perfil de suscetibilidade aos antimicrobianos de Escherichia coli em uroculturas de pacientes atendidos em um hospital de ensino / Prevalence and antimicrobial susceptibility profile of Escherichia coli in urine cultures from patients treated at a teaching hospital

Introdução: As infecções do trato urinário (ITU) são geralmente causadas por bactérias da ordem Enterobacterales, principalmente por Escherichia coli uropatogênica (UPEC). Esta linhagem apresenta fatores de virulência que a torna capaz de colonizar e infectar o trato urinário. Apesar da maioria dos quadros de ITU ser solucionado com terapia antimicrobiana, linhagens de UPEC resistentes aos antimicrobianos representam uma séria ameaça à saúde pública. Objetivo: Avaliar a prevalência de Escherichia coli em uroculturas de pacientes atendidos em um hospital de ensino, bem como seu perfil de suscetibilidade aos antimicrobianos e os fenótipos de resistência. Material e Métodos: Trata-se de um estudo descritivo que analisou uroculturas de pacientes ambulatoriais e hospitalares atendidos em um hospital de ensino localizado no município de Juiz de Fora, Minas Gerais, Brasil, no período de janeiro de 2020 a dezembro de 2021. Resultados: Entre as uroculturas analisadas, 858 foram positivas para bactérias, sendo Escherichia coli a espécie predominante, com 27,2% (n= 233) dos isolados. Das 858 uroculturas: 608 foram de pacientes hospitalizados, com 124 (20,4%) isolados de UPEC; 250 foram de pacientes ambulatoriais, com 109 (43,6%) isolados de UPEC. O perfil de resistência aos antimicrobianos das linhagens isoladas nas amostras hospitalares e ambulatoriais, foi, respectivamente: 65% e 32% para ampicilina; 56% e 26% para amoxicilina + ácido clavulânico; 50% e 26% para ciprofloxacino; 42% e 33% para sulfazotrim; 38% e 20% para cefepime; 17% e 8% para gentamicina; 2,5% e 0,4% para ertapenem, meropenem e imipenem. Das linhagens de Escherichia coli resistentes aos beta-lactâmicos, 43 (18%) apresentaram fenótipos de resistência do tipo beta lactamase de espectro ampliado (ESBL) e 7 (3%) foram produtoras de carbapenemases. Conclusão: Escherichia coli foi a espécie mais isolada das uroculturas. UPEC apresentou taxas de resistência a todos os antimicrobianos testados, produzindo fenótipos do tipo ESBL e carbapenemase, principalmente em amostras de pacientes hospitalizados.

Introduction: Urinary tract infections (UTI) are usually caused by bacteria of the Enterobacterales order, mainly by uropathogenic Escherichia coli (UPEC). This strain has virulence factors that make it able to colonize and infect the urinary tract. Although most cases of UTI are resolved with antimicrobial therapy, antimicrobial-resistant UPEC strains pose a serious threat to public health. Objective: To assess the prevalence of Escherichia coli in urine cultures of patients treated at a teaching hospital, as well as their antimicrobial susceptibility profile and resistance phenotypes. Material and Methods: This is a descriptive study that analyzed urine cultures of outpatient and hospital patients treated at a teaching hospital located in the city of Juiz de Fora, Minas Gerais, Brazil from January 2020 to December 2021. Results: Among the analyzed urine cultures, 858 were positive for bacteria, with Escherichia coli being the predominant species, with 27.2% (n= 233) of the isolates. Of the 858 urine cultures: 608 were from hospitalized patients, with 124 (20.4%) UPEC isolates; 250 were from outpatients, with 109 (43.6%) UPEC isolates. The antimicrobial resistance profile of the strains isolated from hospital and outpatient samples was, respectively: 65% and 32% for Ampicillin; 56% and 26% for Amoxicillin+Clavulanic acid; 50% and 26% for Ciprofloxacin; 42% and 33% for Sulfazotrim; 38% and 20% for Cefepime; 17% and 8% for Gentamicin; 2.5% and 0.4% for Ertapenem, Meropenem and Imipenem. Of the Escherichia coli strains resistant to beta-lactams, 43 (18%) showed extended-spectrum beta-lactamase (ESBL) resistance phenotypes and 7 (3%) were carbapenemases producers.Conclusion: Escherichia coli was the most isolated species from urine cultures. UPEC showed rates of resistance to all tested antimicrobials, producing ESBL and carbapenemase-like phenotypes, mainly in samples from hospitalized patients.

Cálculo de los Días de Terapia Antimicrobiana (DOT) en Cuidados Intensivos Pediátricos: una propuesta de metodología basada en el sistema informático de dispensación de medicamentos / Days of Antimicrobial Therapy (DOT) calculation in Pediatric Intensive Care: a methodology proposal based on the electronic records from the pharmacy dispensation system

INTRODUCCIÓN: El método recomendado para la medición de consumo de antimicrobianos (AMB) en pediatría es el cálculo del indicador Días de Terapia estandarizado por ocupación (DOT-std). Sin embargo, en hospitales que no cuentan con fichas electrónicas, obtener el numerador de los días de terapia (DOT) requiere revisión directa de las indicaciones del paciente, dificultando su aplicabilidad. OBJETIVOS: Validar el sistema de registros electrónicos de dispensación de medicamentos desde farmacia como fuente para el cálculo de DOT y DOT-std en la Unidad de Cuidados Intensivos Pediátrica (UCIP). MATERIALES Y MÉTODOS: Se revisaron las prescripciones de AMB desde la ficha clínica (método manual) y se compararon con los registros de dispensación de AMB a la UCIP (método informático) obtenidos del sistema de medicamentos de farmacia. Se evaluó la concordancia entre los DOT obtenidos mediante el Coeficiente de Correlación Intraclase. RESULTADOS: Los AMB más utilizados fueron vancomicina, meropenem y piperacilina/tazobactam. En 9 de 12 AMB se encontró concordancia significativa entre ambos métodos. CONCLUSIONES: Tras un proceso de validación local, los registros del sistema informático de dispensación de medicamentos desde farmacia podrían utilizarse para el cálculo de DOT en pediatría en hospitales que no cuenten con una ficha electrónica que permita su cálculo directo.

BACKGROUND: The recommended indicator for measuring antimicrobial (AMB) consumption in pediatric patients is the Days of Therapy indicator (DOT), which is then standardized by hospital occupancy rates (DOT-std). However, in hospitals that do not have electronic health records, obtaining the DOT requires a direct review of each pharmacological indication, which is not feasible in the long term. AIMS: To validate electronic records from the pharmacy dispensation system as a source for calculating DOT and estimating DOT-std in a Pediatric Intensive Care Unit (PICU). METHODS: AMB prescriptions at the PICU of a university hospital were directly reviewed (manual method) and compared with AMB dispensation records (computer method) obtained from the hospital pharmacy system. The Intraclass Correlation Coefficient was used to evaluate the agreement between the DOT obtained by both methods. RESULTS: The most used AMB were vancomycin, meropenem, and piperacillin/tazobactam. A significant agreement between the DOT obtained by using manual and computer methods was found in 9 of 12 evaluated AMB. CONCLUSIONS: After a local validation process, the electronic records of the pharmacy drug dispensation system could be considered a valid source for calculating DOT in PICUs in hospitals where electronic health records with prescription data are not yet available.

Epidemiology of antimicrobial resistance in bacteria isolated from inpatient and outpatient samples, Ecuador, 2018 / Características epidemiológicas de la resistencia antimicrobiana en cepas bacterianas aisladas en pacientes de servicios hospitalarios y ambulatorios de Ecuador, 2018 / Epidemiologia da resistência aos antimicrobianos em bactérias isoladas de amostras hospitalares e ambulatoriais no Equador, 2018

ABSTRACT Objective. To compare the epidemiology of antimicrobial resistance in bacteria isolated from inpatient and outpatient samples in Ecuador. Methods. A secondary analysis was done of data on bacteria isolated from inpatient and outpatient samples. Data were taken from the 2018 national antimicrobial resistance surveillance database of the National Reference Center for Antimicrobial Resistance. The variables included were: age, sex, inpatient versus outpatient setting, type of specimen, bacterial species identified, pattern of resistance to antibiotics, and geographic area. Results. Data from 57 305 bacterial isolates were included in the study: 48.8% were from hospitalized patients, 55.7% were from women, and 60.1% were from patients older than 45 years. Urine (42.9%) and blood (12.4%) were the most common clinical samples. Overall, 77.1% of bacterial isolates were gram-negative (83% and 71% in outpatients and inpatients, respectively). The most common gram-positive and gram-negative species were Staphylococcus aureus and Escherichia coli, respectively. Antimicrobial resistance levels were high (up to 80% for some antimicrobial drugs), and were higher in hospitalized patients compared with outpatients. A variety of carbapenemases were found to confer resistance to carbapenems (antibiotics of last resort) in gram-negative bacteria. Conclusions. The study findings provide an important baseline on antimicrobial resistance in Ecuador. This will allow the strengthening of guidelines of the surveillance system, the creation of public policies for standardization of laboratory methodologies, the proper handling of information, and the development of empirical therapy guidelines based on local epidemiology.

RESUMEN Objetivo. Comparar las características epidemiológicas de la resistencia a los antimicrobianos en cepas bacterianas aisladas de muestras de pacientes de servicios hospitalarios y ambulatorios en Ecuador. Métodos. Se realizó un análisis secundario de los datos sobre cepas bacterianas aisladas en muestras de pacientes de servicios hospitalarios y ambulatorios. Se recogieron los datos de la base de datos nacional del 2018 para la vigilancia de la resistencia a los antimicrobianos del Centro de Referencia Nacional para la Resistencia a los Antimicrobianos. Las variables incluidas fueron: edad, sexo, entorno hospitalario frente a entorno ambulatorio, tipo de muestra, especies bacterianas detectadas, patrón de resistencia a los antibióticos y zona geográfica. Resultados. En el estudio se incluyeron datos de 57 305 cepas aislamientos bacterianos: 48,8% fueron de pacientes hospitalizados, 55,7% fueron de mujeres y 60,1% fueron de pacientes mayores de 45 años. La orina (42,9%) y la sangre (12,4%) fueron las muestras clínicas más comunes. En general, 77,1% de las cepas bacterianas aisladas fueron gramnegativas (83% y 71% en pacientes de servicios ambulatorios y hospitalarios, respectivamente). Las especies grampositivas y gramnegativas más comunes fueron Staphylococcus aureus y Escherichia coli, respectivamente. Los niveles de resistencia a los antimicrobianos fueron elevados (hasta 80% en el caso de algunos fármacos antimicrobianos) y fueron más elevados en los pacientes de servicios hospitalarios en comparación con los pacientes de servicios ambulatorios. Se encontró que una variedad de carbapenemasas confiere resistencia a los carbapenémicos (antibióticos de último recurso) en bacterias gramnegativas. Conclusiones. Los resultados del estudio proporcionan una línea de base importante sobre la resistencia a los antimicrobianos en Ecuador, que permitirá el fortalecimiento de las directrices del sistema de vigilancia, la creación de políticas públicas para la estandarización de los métodos de laboratorio, una adecuada gestión de la información y la elaboración de orientaciones de tratamiento empírico basadas en las características epidemiológicas locales.

RESUMO Objetivo. Comparar a epidemiologia da resistência aos antimicrobianos em bactérias isoladas de amostras hospitalares e ambulatoriais no Equador. Métodos. Foi feita uma análise secundária de dados sobre bactérias isoladas de amostras hospitalares e ambulatoriais. Os dados foram obtidos do banco de dados nacional de vigilância da resistência aos antimicrobianos de 2018 do Centro Nacional de Referência para a Resistência aos Antimicrobianos. As variáveis incluídas foram: idade, sexo, ambiente hospitalar versus ambiente ambulatorial, tipo de espécime, espécies bacterianas identificadas, padrão de resistência a antibióticos e área geográfica. Resultados. Foram incluídos no estudo os dados de 57 305 isolados bacterianos: 48,8% eram de pacientes hospitalizados, 55,7% eram de mulheres e 60,1% eram de pacientes com mais de 45 anos. As amostras clínicas mais comuns foram urina (42,9%) e sangue (12,4%). No total, 77,1% dos isolados bacterianos eram gram-negativos (83% e 71% em pacientes ambulatoriais e pacientes internados, respectivamente). As espécies gram-positivas e gram-negativas mais comuns foram Staphylococcus aureus e Escherichia coli, respectivamente. Os níveis de resistência aos antimicrobianos foram elevados (até 80% para alguns antimicrobianos) e foram mais elevados em pacientes hospitalizados em comparação com pacientes ambulatoriais. Foram encontradas várias carbapenemases que conferem resistência aos carbapenêmicos (antibióticos de último recurso) em bactérias gram-negativas. Conclusões. Os resultados do estudo fornecem uma importante linha de base sobre a resistência aos antimicrobianos no Equador. Isto permitirá o fortalecimento das diretrizes do sistema de vigilância, a criação de políticas públicas para padronização de metodologias laboratoriais, o manejo adequado de informações e o desenvolvimento de diretrizes para a antibioticoterapia empírica com base na epidemiologia local.

Resistência bacteriana consecutiva do uso indiscriminado de antibióticos: revisão integrativa / Consecutive bacterial resistance from the indiscriminate use of antibiotic: integrative review / Resistencia bacteriana consecutiva al uso indiscriminado de antibióticos: revisión integrativa

O abandono do tratamento de tuberculose é uma questão relevante e preocu- pante na saúde pública mundial. Mediante uma revisão integrativa, esse estudo busca identificar os possíveis fatores que levam ao abandono do tratamento. Foi realizada pes- quisa em estudos indexados nas bases de dados: Biblioteca Virtual em Saúde (BVS) e Scientific Eletronic Library Online (SciELO), no período de 2017 a 2021, utilizando-se os seguintes descritores (DeCS): tuberculose, agente antituberculose e tuberculose pul- monar. Ao fim, foram selecionados onze estudos, publicados nos idiomas português, es- panhol e inglês. Os resultados mostraram que o abandono está relacionado a fatores de diversas esferas, com destaque para as esferas social, da saúde e a do próprio tratamento. Como perfil das pessoas dos casos de abandono, em geral, observou-se que elas são eco- nomicamente ativas, com faixa etária entre 15 e 49 anos, possuem baixa escolaridade, baixa renda e é comum que os usos abusivos de álcool e drogas sejam apresentados como comorbidades relevantes. Portanto, o trabalho evidenciou os principais fatores associados ao abandono do tratamento de tuberculose e a importância da participação de diferentes atores como forças que somarão para diminuir a ocorrência do problema em questão.

Introduction: Currently, it is understood that bacterial resistance is an ecological event arising from mutations, or selection, occurring as a response to the use of antibiotics and their presence in the environment, causing the change of genes. Objective: To evaluate how the indiscriminate use of antibiotics affects bacterial resistance. Materials and Methods: This is a bibliographical research of the integrative literature review type. Results: The practice and indiscriminate use of medication result from sociocultural factors, economic conditions, access to health services, malpractice in medication prescription and lack of surveillance when purchasing medication. The presence of "home pharmacies" in the study was considered alarming, being a risk factor for the self-medication of antibiotics, such stored drugs show a possible non-completion of a treatment in an adequate period, justified by the absence of pain symptoms, or by individuals who did not consider the drug to be effective. Conclusion: It is necessary to comply with existing legislation in order to regulate the sale of antibiotics and prevent the irrational use of drugs.

Introducción: Actualmente, se entiende que la resistencia bacteriana es un evento ecológico derivado de mutaciones, o selección, que ocurre como respuesta al uso de antibióticos y su presencia en el ambiente, provocando el cambio de genes. Objetivo: Evaluar cómo el uso indiscriminado de antibióticos afecta la resistencia bacteriana. Materiales y Métodos: Se trata de una investigación bibliográfica del tipo revisión integradora de literatura. Resultados: La práctica y uso indiscriminado de medicamentos resultan de factores socioculturales, condiciones económicas, acceso a los servicios de salud, mala práctica en la prescripción de medicamentos y falta de vigilancia en la compra de medicamentos. Se consideró alarmante la presencia de "farmacias domiciliarias" en el estudio, siendo un factor de riesgo para la automedicación de antibióticos, tales medicamentos almacenados evidencian una posible no finalización de un tratamiento en un período adecuado, justificado por la ausencia de síntomas de dolor , o por personas que no consideraron que el fármaco fuera eficaz. Conclusión: Es necesario cumplir con la legislación vigente para regular la venta de antibióticos y prevenir el uso irracional de medicamentos.

Changes in Antimicrobial Resistance and Etiology of Blood Culture Isolates: Results of a Decade (2010-2019) of Surveillance in a Northern Region of Colombia.

Background: Bloodstream infections (BSI) are important causes of morbidity and mortality worldwide. Antimicrobial surveillance is essential for identifying emerging resistance and generating empirical treatment guides, the purpose of this study is to analyze trends in antimicrobial susceptibility of BSI from 2010 to 2019 in healthcare institutions from Medellin and nearby towns in Colombia. Methods: A Whonet database was analyzed from the GERMEN antimicrobial surveillance network; frequency and antibiotic susceptibility trends were calculated on more frequent microorganisms using Mann Kendall and Sen's Slope Estimator Test. Results: 61,299 isolates were included; the three microorganisms more frequent showed a significant increasing trend through time E. coli (Sen's Slope estimator = 0.7 p = <0.01) S. aureus (Sen's Slope estimator = 0.60 p = <0.01) and K. pneumonia (Sen's Slope estimator = 0.30 p = <0.01). E. coli showed a significant increase trend in cefepime and ceftazidime resistance, while K. pneumoniae showed a significant increase in resistance to cefepime, ciprofloxacin, and gentamicin. P. aeruginosa increases its susceptibility to all analyzed antibiotics and S. aureus to oxacillin. No increasing trend was observed for carbapenem resistance. Conclusion: An upward trends was observed in more frequent microorganisms and resistance to third and fourth-generation cephalosporins for E. coli and K pneumoniae; in contrast, not increasing trends in antibiotic resistance was observed for P. aeruginosa and S. aureus. The essential role of AMR-surveillance programs is to point out and identify these trends, which should improve antibiotic resistance control.

Actividad antibacteriana de actinomicetos frente a Escherichia coli y Staphylococcus aureus multirresistentes de origen hospitalario / Antibacterial activity of actimycetes against multiresistant Escherichia coli and Staphylococcus aureus isolated from a hospital

Introducción: La resistencia a los antimicrobianos (RAM) es un problema de salud pública que manifiesta la disminuida eficacia de estos agentes en la prevención y tratamiento de una proporción cada vez más amplia de patologías. Los actinomicetos son un grupo bacteriano importante de productores de metabolitos activos contra patógenos. Objetivo: Aislar actinomicetos del bosque tropical de Nariño, con potencial producción de metabolitos inhibitorios contra bacterias multidrogo-resistentes. Materiales y métodos: Se tomaron muestras de suelo de Bosque Tropical Húmedo de la Reserva Natural del Río Ñambí, se analizaron microbiológica y molecularmente. Se estimuló la producción in vitro de metabolitos secundarios y evaluó el efecto inhibitorio de estos extractos contra las bacterias multidrogo-resistentes Escherichia coli y Staphylococcus aureus. Resultados: Se obtuvieron 11 aislados presuntivos, se confirmó que cuatro de ellos correspondieron al género Streptomyces sp. Las pruebas de inhibición contra bacterias multidrogo-resistentes E. coli y S. aureus, permitieron verificar que el aislado P3772 fue el más eficiente en la inhibición de los patógenos. Conclusiones: Todos los actinomicetos evaluados presentan actividad antibacteriana contra al menos una de las bacterias patógenas estudiadas; destacando el aislado P3772, que inhibe a E. coli y S. aureus. Se espera caracterizar los compuestos vinculados a la actividad antibacteriana.

Introduction: Antimicrobial resistance (AR) is a public health problem that reveals the diminished efficacy of these agents in the prevention and treatment of an increasingly larger number of pathologies. Actinomycetes are an important bacterial producer group of metabolites that are active against pathogens. Objective: To isolate actinomycetes from the tropical forest of Nariño (Colombia), which have the potential to produce inhibitory metabolites against multi-drug resistant bacteria. Materials and methods: Soil samples were taken from the Humid Tropical Forest of the Río Ńambí Natural Reserve and analyzed through microbiological and molecular assays. In vitro production of secondary metabolites was first stimulated, followed by the assessment of the inhibitory effect of these extracts against multi-drug resistant Escherichia coli and Staphylococcus aureus. Results: 11 presumptive isolates were obtained, confirming that four of them corresponded to the Streptomyces sp. genus. The bacterial isolate P3772 was identified as the one with the highest inhibitory effect against multi-drug resistant E. coli and S. aureus. Conclusions: All the actinomycetes evaluated presented antibacterial activity. The isolate P3772 stands out, which inhibited both E. coli and S. aureus. The compounds associated with this antibacterial activity will be characterized in future studies.

Caracterización de la tuberculosis multidrogorresistente y resistente a rifampicina en Colombia / Characterization of rifampin-resistant/multidrug-resistant tuberculosis in Colombia

RESUMEN Objetivo Caracterizar la población afectada por tuberculosis multidrogorresistente y resistente a rifampicina (TB-MDR/RR) en Colombia. Métodos Estudio transversal a partir de la información nominal de los pacientes con TB-MDR/RR tratados y reportados en Colombia desde 2009 hasta 2020, usando la totalidad de las fuentes de información oficiales. Se compararon, además, las tasas de TB-MDR/RR de diferentes grupos de riesgo con la de la población general y se evaluaron variables asociadas a la TB-MDR/RR extrapulmonar y a resistencias medicamentosas. Resultados La TB-MDR/RR ha aumentado progresivamente durante la última década y se ha concentrado en hombres (64% vs. 36%, p<0,001), edades medias (mediana: 39,5 años; RIC: 27) y zonas de mayor densidad poblacional (59% de los casos en Antioquia, Valle del Cauca y Santiago de Cali). Además, al compararlas con las poblaciones de referencia que aplicaran, se evidenciaron tasas 2, 10 y 200 veces mayores en población indígena (9,45/1 000 000 vs. 4,31/1 000 000; p=0,02), prisioneros (169/1 000 000 vs. 16,9/1 000 000; p<0,001) y habitantes de calle (21/100000 vs. 0,1/100 000; p<0,001), respectivamente. Conclusiones El aumento en los casos de TB-MDR/RR y sus grupos de riesgo deben tenerse en cuenta para la planeación de políticas, distribución de recursos y atención clínica.

ABSTRACT Objective To describe the population affected by rifampin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB) in Colombia. Methods Cross-sectional study on all the patients treated for RR/MDR-TB in Colombia between 2009 and 2020, using all the official sources of information. In addition, a comparison was made between the rates of RR/MDR-TB in some higher-risk groups and average population. Finally, the variables associated to pulmonary versus extrapulmonary RR/MDR-TB and those associated to resistance to other drugs were evaluated. Results RR/MDR-TB cases have progressively increased during the last decade. These cases were concentrated in men (64% vs. 36%, p<0.001), middle aged adults (median: 39.5 years old; IQR: 27), and in geographic regions with higher population density (59% of cases in Antioquia, Valle del Cauca and Santiago de Cali). Also, the rate of RR/MDR-TB was 2, 10 and 200 times higher in indigenous (9.45/1 000 000 vs. 4.31/1 000 000; p=0.02), prisoners (169/1 000 000 vs. 16.9/1 000 000; p<0.001), and homeless population (21/100 000 vs. 0.1/100 000; p<0.001), respectively. Conclusions The increase in RR/MDR-TB cases and their concentration in higher-risk groups must be kept in mind to make better policies, a more efficient distribution of resources, and better patient care.

Estructura genética de cepas de Mycobacterium tuberculosis farmacorresistentes en Perú con base en haplotipos obtenidos de un ensayo de sonda lineal / Genetic structure of drug-resistant strains of Mycobacterium tuberculosis in Peru based on haplotypes obtained from a linear probe assay

RESUMEN Objetivo. Determinar la estructura genética de las cepas drogorresistentes de Mycobacterium tuberculosis que circularon en todo el Perú durante los años 2011-2015 a través de haplotipos obtenidos de un ensayo con sondas en línea. Materiales y métodos. Se analizaron 6589 muestras que ingresaron al Instituto Nacional de Salud para el diagnóstico rutinario mediante el ensayo GenoType® MTBDRplus v2, durante el periodo de estudio. Se crearon haplotipos resistentes mediante la concatenación de 21 sitios polimórficos de los genes evaluados por el ensayo con sondas en línea, y se realizó el análisis de asociación con fenotipos obtenidos por el método de proporciones agar 7H10. Resultados. Las mutaciones de mayores frecuencias fueron: rpoB S531L (55,4%) y rpoB D516V (18,5%) para la resistencia a rifampicina, y katG S315T (59,5%) e inhA c-15t (25,7%) para la resistencia a isoniacida. Se obtuvieron 13 haplotipos representativos (87,8% de muestras analizadas) de los cuales seis correspondieron al genotipo multidrogorresistente, cuatro al genotipo monorresistente a isoniacida y tres al genotipo monorresistente a rifampicina. Dieciocho departamentos, y la provincia del Callao, presentaron una alta diversidad haplotípica; cuatro presentaron moderada diversidad y dos presentaron baja diversidad. Conclusiones. Existe una alta diversidad haplotípica en la mayoría de los departamentos, además de una concentración de las cepas de Mycobacterium tuberculosis drogorresistentes en las ciudades de Lima y Callao. Asimismo, las cepas de Mycobacterium tuberculosis con perfil drogorresistente que circulan en el Perú contienen principalmente los marcadores genéticos de mayor prevalencia a nivel mundial asociados con la resistencia frente a rifampicina e isoniacida.

ABSTRACT Objective. To determine the genetic structure of drug-resistant strains of Mycobacterium tuberculosis that circulated throughout Peru during the years 2011-2015, by using haplotypes obtained from a line probe assay. Materials and methods. A total of 6589 samples that were admitted to the Instituto Nacional de Salud for routine diagnosis using the GenoType® MTBDRplus v2 assay were analyzed during the study period. Resistant haplotypes were created by concatenating 21 polymorphic sites of the evaluated genes using the line probe assay; and the association analysis was carried out with phenotypes obtained by the 7H10 agar ratio method. Results. The most frequent mutations were: rpoB S531L (55.4%) and rpoB D516V (18.5%) for rifampicin resistance, and katG S315T (59.5%) and inhA c-15t (25.7%) for isoniazid resistance. We obtained 13 representative haplotypes (87.8% of analyzed samples), 6 corresponded to the multidrug-resistant genotype, 4 to the isoniazid mono-resistant genotype and 3 to the rifampicin mono-resistant genotype. Eighteen regions and the province of Callao showed high haplotype diversity; four showed moderate diversity and two showed low diversity. Conclusions. Most regions showed high haplotype diversity; in addition, most drug-resistant strains of Mycobacterium tuberculosis were concentrated in the cities of Lima and Callao. Likewise, drug-resistant Mycobacterium tuberculosis strains circulating in Peru mainly contain the genetic markers with the highest prevalence worldwide, which are associated with resistance to rifampicin and isoniazid.

Antimicrobial resistance patterns of the Enterobacteriaceae family isolated from urinary tract infections from a Peruvian high-Andean region / Patrones de resistencia antimicrobiana de la familia enterobacteriaceae aisladas de infecciones del tracto urinario de una región alto-andina peruana

Background: Antibiotic resistance is considered to be the next worldwide epidemic. Urinary tract infections (UTI) are the second most common cause of infection, which also has the highest resistance frequency. Nevertheless, in high Andean regions, little is known about the antibiotic resistance. Objectives: Determine the antimicrobial resistance patterns of the enterobacteriaceae family isolated from urinary tract infections of a Peruvian Andean region. Material and Methods: Aretrospective cross-sectional review of 1717 records from the microbiology service of a private health institution from Puno - Peru, was done between the years 2014 and 2017. Antibiotic resistance by uropathogens was studied among different age groups. Statistical analysis included Chi2 test with a p<0.05. Poisson regression was used to calculate the prevalence ratio (PR) with a 95% confidence interval. Results: There was a wide distribution of antibiotic resistance among all the antibiotics, mainly in Escherichia coli and Proteus spp. The elderly had the highest prevalence of antibiotic resistance. As age increased, resistance to all drugs also increased (p<0.01). Furthermore, the elderly had a risk probabilityofresistanceof1.22,1.42,1.20and1.32topenicillins, cephalosporins, quinolones and other antibiotics respectively. Conclusion: The antimicrobial resistance patterns of the Peruvian Andean region were lower than national and international patterns.

Introducción: La resistencia a antibióticos es considerada la próxima epidemia mundial. Las infecciones del tracto urinario (ITU) son la segunda causa más común de infecciones y la que presenta mayor frecuencia de resistencia. Sin embargo, poco se ha reportado en regiones altos-andinas. Objetivo: Evaluar los patrones de resistencia antimicrobiana de la familia enterobacteriaceae aisladas de infecciones del tracto urinario de pacientes ambulatorios de una región altoandina peruana y sus factores asociados. Material y Métodos: Estudio transversal analítico retrospectivo, a partir de 1717 registros del Servicio de Microbiología de una institución de salud en la región Puno ­ Perú, entre los años 2014 al 2017. Se estudió la resistencia a antibióticos según uropatógeno en diferentes grupos etarios. Se empleó la prueba de Chi2 de Pearson y un modelo de regresión de Poisson para calcular la razón de prevalencias (RP). En todos los análisis se consideró un valor de p<0.05 como significativo y se estimaron intervalos de confianza al 95%. Resultados: Se presentó una amplia distribución de resistencia en todos los fármacos evaluados, siendo mayor en Escherichia coli y Proteus spp. El grupo etario, ≥ 60 años, presentó la mayor prevalencia de resistencia bacteriana. A medida que la edad aumentaba, la resistencia a todos los fármacos estudiados también aumentó (p <0.01). Así mismo, los pacientes ≥ 60 años presentaron mayor probabilidad de presentar resistencia bacteriana a penicilinas, cefalosporinas y quinolonas. Conclusión: El patrón de resistencia a los antibióticos utilizados en ITUs en la zona altoandina peruana incrementa con la edad.

Prevalencia de infección del tracto urinario y perfil de susceptibilidad antimicrobiana en Enterobacterias

Resumen Las Infecciones del Tracto Urinario (ITU), constituyen uno de los principales motivos de consulta en el ámbito de atención primaria, debido al aumento de la resistencia antibacteriana. Objetivo . Caracterizar la prevalencia de infección del tracto urinario y el perfil de susceptibilidad antimicrobiana in vitro en Enterobacterias en los pacientes de la provincia de Santa Elena - Ecuador. Método . Esta investigación fue descriptiva de diseño documental. La población fue de 827 registros de urocultivos, recopilados de la base de datos del laboratorio de microbiología del Centro de Especialidades IESS La Libertad, en el período comprendido desde agosto 2019 hasta marzo de 2020. Los datos fueron procesados mediante estadística descriptiva, análisis de frecuencia y chi cuadrado. Resultados . De este estudio indican que la prevalencia de ITU fue 22,1%; los principales agentes etiológicos fueron: E. coli (76,0%), Klebsiella oxytoca (6,5%), Klebsiella pneumoniae (5,8%) y Proteus mirabilis (3,9%). La ITU y la infección por E. coli fueron estadísticamente mayores en mujeres y adultos mayores. La mayor frecuencia de resistencia de E. coli fue para ácido nalidíxico (81,2%), ampicilina (79,9%), ciprofloxacina (72,6%) y sulfametoxazol trimetoprima (61,5%); en Klebsiella oxytoca fue ampicilina (80,0%), sulfametoxazol trimetoprima (70,0%), ácido nalidíxico (60,0%) y ciprofloxacina (40,0%). Mientras que en Klebsiella pneumoniae se halló una resistencia del (100%) para ampicilina y cefalotina, amoxicilina y ácido clavulánico (66,7%), ciprofloxacina (55,6%), ácido nalidíxico (44,4%), meropenem e imipenem (11,1%). Conclusiones. La E. coli continúa siendo el microorganismo más frecuente en ITU. El tratamiento empírico de ITU debería incluir amikacina, nitrofurantoina y piperacilina tazobactam.

Abstract Urinary Tract Infections (UTI) are one of the main reasons for consultation in the primary care setting, due to the increase in antibacterial resistance. Objective . To characterize the prevalence of urinary tract infection and the in vitro antimicrobial susceptibility profile of Enterobacteriaceae in patients in the province of Santa Elena - Ecuador. Method. This was a descriptive research of documentary design. The population was 827 urine culture records, collected from the database of the microbiology laboratory of the Centro de Especialidades IESS La Libertad, in the period from August 2019 to March 2020. The data were processed using descriptive statistics, frequency analysis and chi-square. Results . From this study indicate that the prevalence of UTI was 22.1%; the main etiological agents were: E. coli (76.0%), Klebsiella oxytoca (6.5%), Klebsiella pneumoniae (5.8%) and Proteus mirabilis (3.9%). UTI and E. coli infection were statistically higher in women and older adults. The highest frequency of E. coli resistance was for nalidixic acid (81.2%), ampicillin (79.9%), ciprofloxacin (72.6%) and trimethoprim sulfamethoxazole (61.5%); in Klebsiella oxytoca it was ampicillin (80.0%), trimethoprim sulfamethoxazole (70.0%), nalidixic acid (60.0%) and ciprofloxacin (40.0%). While in Klebsiella pneumoniae, 100% resistance was found for ampicillin and cephalothin, amoxicillin and clavulanic acid (66.7%), ciprofloxacin (55.6%), nalidixic acid (44.4%), meropenem and imipenem (11.1%). Conclusions . E. coli continues to be the most frequent microorganism in UTI. Empirical treatment of UTI should include amikacin, nitrofurantoin and piperacillin tazobactam.

Resumo As infecções do trato urinário (IU) são um dos principais motivos de consulta no âmbito dos cuidados primários, devido ao aumento da resistência antibacteriana. Objetivo . Caracterizar a prevalência da infecção do trato urinário e o perfil de suscetibilidade antimicrobiana in vitro de Enterobacteriaceae em pacientes da província de Santa Elena - Equador. Método . Esta foi uma pesquisa descritiva do projeto documental. A população era de 827 registros de cultura de urina, coletados do banco de dados do laboratório de microbiologia do Centro de Especialidades IESS La Libertad, no período de agosto de 2019 a março de 2020. Os dados foram processados utilizando estatísticas descritivas, análise de freqüência e qui-quadrado. Resultados. Deste estudo indicam que a prevalência de UTI foi de 22,1%; os principais agentes etiológicos foram: E. coli (76,0%), Klebsiella oxytoca (6,5%), Klebsiella pneumoniae (5,8%) e Proteus mirabilis (3,9%). A infecção por UTI e E. coli foi estatisticamente maior nas mulheres e nos adultos mais velhos. A maior freqüência de resistência do E. coli foi para o ácido nalidíxico (81,2%), ampicilina (79,9%), ciprofloxacina (72,6%) e trimetoprim sulfametoxazol (61,5%); em Klebsiella oxytoca era ampicilina (80,0%), trimetoprim sulfametoxazol (70,0%), ácido nalidíxico (60,0%) e ciprofloxacina (40,0%). Enquanto em Klebsiella pneumoniae, foi encontrada 100% de resistência para ampicilina e cefalotina, amoxicilina e ácido clavulânico (66,7%), ciprofloxacina (55,6%), ácido nalidíxico (44,4%), meropenem e imipenem (11,1%). Conclusões . A E. coli continua sendo o microorganismo mais freqüente na UTI. O tratamento empírico da UTI deve incluir amikacina, nitrofurantoína e piperacilina tazobactam.

Los antibióticos y su impacto en la sociedad / Antibiotics and their impact on society

RESUMEN La introducción de los antibióticos en el siglo pasado ha sido uno de los ejemplos que brinda la historia de intervenciones médicas que cambiaron drásticamente la esperanza de vida de la población. La época dorada de los antibióticos, cuando la aparición de nuevas moléculas era lo habitual, ha dado paso a otra de sequía, en la que es raro el desarrollo de este grupo farmacológico debido al largo período de tiempo que requieren las investigaciones de nuevos fármacos, su elevado costo y al aumento de las exigencias regulatorias. Este progreso médico ganado en décadas pasadas, está amenazado por el aumento de la resistencia de las bacterias a los antibióticos; constituye un grave riesgo mundial por lo que requiere una mayor atención y la coherencia a nivel internacional, nacional y regional. La resistencia bacteriana tiene un gran impacto microbiológico, terapéutico, económico, epidemiológico y en la salud pública; cuesta dinero, medios de subsistencia, vidas humanas y amenaza con socavar la eficacia de los programas de atención a la salud. La presente revisión bibliográfica propone reflexionar sobre los aspectos más significativos del desarrollo de los antibióticos y su impacto en la sociedad.

ABSTRACT The introduction of antibiotics in the last century has been one of the examples that history provides of medical interventions that drastically changed the life expectancy of the population. The golden age of antibiotics, where the appearance of new molecules was what usual, has given way to another of drought, in which the development of this pharmacological group is rare due to the long period of time required for research into new drugs, their high cost and the increase in regulatory requirements. This medical progress gained in past decades is threatened by the increase in the resistance of bacteria to antibiotics, constituting a serious global risk for which it requires greater attention and coherence at the international, national and regional levels. Bacterial resistance has a great microbiological, therapeutic, economic, epidemiological and public health impact; it costs money, livelihoods, human lives, and threatens to undermine the effectiveness of health care programs. This bibliographic review proposes to reflect on the most significant aspects of the development of antibiotics and their impact on society.

Clinical practice guideline for screening of patients at risk of colonization by carbapenemase-producing Enterobacterales and the treatment of infections caused by these bacteria / Guía de práctica clínica para la tamización de pacientes con riesgo de colonización por Enterobacterales productores de carbapenemasasy el manejo de infecciones causadas por estas bacterias

Abstract Carbapenemase-producing Enterobacterales (CPE) infections have increased in recent years. Colombia has become an endemic country for this group of microorganisms, and the infections they cause have a serious impact in terms of morbidity and mortality. The early identification of CPE carriers who are admitted to health care centers as patients is necessary to implement adequate isolation and infection control measures to limit the spread of this type of microorganisms in hospitals. Furthermore, treating these infections is a challenging task due to the limited therapeutic alternatives available and the fact that there are only a few studies proving their effectiveness in this setting. Therefore, the objective of the present work is to develop a clinical practice guideline (CPG) for the screening of patients at risk of CPE colonization and the treatment of inpatients with suspected or confirmed infections caused by this type of bacteria through a CPG adaptation process based on the ADAPTE methodology. With this purpose in mind, evidence-informed recommendations for the screening and timely identification of CPE carriers admitted to hospitals are made, as well as for the adequate pharmacological treatment of CPE infections in this context.

Resumen Las infecciones por Enterobacterales productores de carbapenemasas (EPC) han aumentado en los últimos años. Colombia se ha convertido en un país endémico para este grupo de microorganismos y las infecciones que causan tienen un impacto importante en términos de morbimortalidad. La identificación temprana de los portadores de EPC que ingresan como pacientes a las instituciones de salud es necesaria para implementar medidas de aislamiento y control de infecciones adecuadas que limiten la diseminación de este tipo de microorganismos en los hospitales. Además, el tratamiento de estas infecciones es difícil debido a las limitadas alternativas terapéuticas disponibles y la escasez de estudios que demuestren su efectividad en este escenario. Por lo anterior, el objetivo del presente trabajo es desarrollar una guía de práctica clínica (GPC) para la tamización de pacientes con riesgo de colonización por EPC y para el manejo de pacientes con infecciones, ya sea sospechadas o confirmadas, causadas por este tipo de bacterias, mediante un proceso de adaptación de GPC basado en la metodología ADAPTE. Con este propósito en mente, se hacen recomendaciones informadas en evidencia para realizar la tamización y oportuna identificación de portadores de EPC admitidos en instituciones hospitalarias, así como para el adecuado manejo farmacológico de las infecciones por CPE en este escenario.