In vitro activity of cefiderocol and other newly approved antimicrobials against multi-drug resistant Gram-negative pathogens recovered in intensive care units in Spain and Portugal / Actividad in vitro de cefiderocol y otros antimicrobianos recientemente aprobados frente a gramnegativos multirresistentes aislados en unidades de cuidados intensivos en España y Portugal

Introduction. The antimicrobial resistance is a significant public health threat, particularly for healthcare-associated infections caused by carbapenem-resistant Gram-negative pathogens which are increasingly reported worldwide. The aim of this study was to provide data on the in vitro antimicrobial activity of cefiderocol and that of commercially available comparator antibiotics against a defined collection of recent clinical multi-drug resistant (MDR) microorganisms, including carbapenem resistant Gram-negative bacteria collected from different regions in Spain and Portugal. Material and methods. A total of 477 clinical isolates of Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia were prospectively (n=265) and retrospectively (n=212) included (2016-2019). Susceptibility testing was performed using standard broad microdilution and results were interpreted using CLSI-2021 and EUCAST-2021 criteria. Results. Overall, cefiderocol showed a good activity against Enterobacterales isolates, being 99.5% susceptible by CLSI and 94.5% by EUCAST criteria. It also demonstrated excellent activity against P. aeruginosa and S. maltophilia isolates, all being susceptible to this compound considering CLSI breakpoints. Regarding A. baumannii (n=64), only one isolate was resistant to cefiderocol. Conclusions. Our results are in agreement with other studies performed outside Spain and Portugal highlighting its excellent activity against MDR gram-negative bacteria. Cefiderocol is a therapeutic alternative to those available for the treatment of infections caused by these MDR bacteria. (AU)

Introducción. La resistencia a los antimicrobianos constituye una importante amenaza para la salud pública, especialmente en el caso de las infecciones relacionadas con la asistencia sanitaria causadas por patógenos gramnegativos resistentes a los carbapenémicos, las cuales están aumentando en todo el mundo. El objetivo de este estudio fue proporcionar datos sobre la actividad antimicrobiana in vitro de cefiderocol y la de antibióticos comparadores disponibles en el arsenal terapéutico frente a una colección definida de microorganismos multirresistentes (MDR) obtenidos de muestras clínicas, incluidas bacterias gramnegativas resistentes a carbapenemas procedentes de diferentes regiones de España y Portugal. Material y métodos. Se recogieron un total de 477 aislados clínicos de Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii y Stenotrophomonas maltophilia de forma prospectiva (n=265) y retrospectiva (n=212) (2016-2019). El estudio de sensibilidad se realizó por microdilución standard y los resultados se analizaron empleando criterios del CLSI de 2021 y de EUCAST de 2021. Resultados. En general, cefiderocol demostró una buena actividad frente a aislados de Enterobacterales, siendo 99,5% sensible según criterios del CLSI y 94,5% según los de EUCAST. Cefiderocol demostró una excelente actividad frente a aislados de P. aeruginosa y S. maltophilia, siendo todos ellos sensibles a este compuesto considerando los puntos de corte del CLSI. En relación a A. baumannii (n=64), sólo un aislado fue resistente a cefiderocol. Conclusiones. Nuestros resultados concuerdan con los de otros estudios realizados fuera de España y Portugal en los que se destaca la excelente actividad de cefiderocol frente a bacterias gramnegativas MDR. Cefiderocol constituye una alternativa terapéutica a las disponibles en el tratamiento de las infecciones causadas por estos microorganismos. (AU)

Sequencing and multiple antimicrobial resistance of Pseudomonas fluorescens isolated from Nile tilapia fish in Egypt / Sequenciamento e resistência antimicrobiana múltipla de Pseudomonas fluorescens isoladas de tilápia-do-nilo no Egito

Pseudomonas fluorescens is one of the main causes of septicemic diseases among freshwater fish, causing severe economic losses and decreasing farm efficiency. Thus, this research was aimed to investigate the occurrence of P. fluorescens in Nile Tilapia (O. niloticus) fish in Egypt, gene sequencing of 16SrDNA gene, and antimicrobial susceptibility. P. fluorescens strains were detected in 32% (128/400) of apparently healthy (9%; 36/400) and diseased (23%; 92/400) Nile tilapia fish. The highest prevalence was observed in gills of fish, 31.3% followed by intestine 26.9%, liver 24.2%, and kidneys 17.6%. The PCR results for the 16SrDNA gene of P. fluorescens showed 16SrDNA gene in 30% of examined isolates. Moreover, Homogeny and a strong relationship between strains of P. fluorescens was confirmed using 16SrDNA sequences. Beside the responsibility of 16SrDNA gene on the virulence of P. fluorescens. The results of antimicrobial susceptibility tests revealed that all strains were resistant to piperacillin (100%), followed by ceftazidime (29.7%), and cefepime (25.8%). The strains of P. fluorescence were highly sensitive to cefotaxime (74.2%), followed by ceftriaxone and levofloxacin (70.3% each). Interestingly, 29.7% of strains of P. fluorescens were multiple antimicrobial-resistant (MAR).

Pseudomonas fluorescens é uma das principais causas de doenças septicêmicas em peixes de água doce, causando graves perdas econômicas e diminuindo a eficiência da fazenda. Assim, esta pesquisa teve como objetivo investigar a ocorrência de P. fluorescens em peixes de tilápia-do-nilo (O. niloticus) no Egito, sequenciamento do gene 16S rDNA e suscetibilidade antimicrobiana. Cepas de P. fluorescens foram detectadas em 32% (128/400) de peixes tilápia-do-nilo aparentemente saudáveis ​​(9%; 36/400) e doentes (23%; 92/400). A maior prevalência foi observada nas brânquias dos peixes, 31,3%, seguida pelo intestino 26,9%, fígado 24,2% e rins 17,6%. Os resultados da PCR para o gene 16SrDNA de P. fluorescens mostraram o gene 16SrDNA em 30% dos isolados examinados. Além disso, a homogeneidade e uma forte relação entre cepas de P. fluorescens foi confirmada usando sequências de 16SrDNA. Além da responsabilidade do gene 16SrDNA na virulência de P. fluorescens. Os resultados dos testes de suscetibilidade antimicrobiana revelaram que todas as cepas foram resistentes à piperacilina (100%), seguida pela ceftazidima (29,7%) e cefepima (25,8%). As cepas de P. fluorescens foram altamente sensíveis à cefotaxima (74,2%), seguida pela ceftriaxona e levofloxacina (70,3% cada). Curiosamente, 29,7% das cepas de P. fluorescens eram multirresistentes a antimicrobianos (MAR).

Sequencing and multiple antimicrobial resistance of Pseudomonas fluorescens isolated from Nile tilapia fish in Egypt

Abstract Pseudomonas fluorescens is one of the main causes of septicemic diseases among freshwater fish, causing severe economic losses and decreasing farm efficiency. Thus, this research was aimed to investigate the occurrence of P. fluorescens in Nile Tilapia (O. niloticus) fish in Egypt, gene sequencing of 16SrDNA gene, and antimicrobial susceptibility. P. fluorescens strains were detected in 32% (128/400) of apparently healthy (9%; 36/400) and diseased (23%; 92/400) Nile tilapia fish. The highest prevalence was observed in gills of fish, 31.3% followed by intestine 26.9%, liver 24.2%, and kidneys 17.6%. The PCR results for the 16SrDNA gene of P. fluorescens showed 16SrDNA gene in 30% of examined isolates. Moreover, Homogeny and a strong relationship between strains of P. fluorescens was confirmed using 16SrDNA sequences. Beside the responsibility of 16SrDNA gene on the virulence of P. fluorescens. The results of antimicrobial susceptibility tests revealed that all strains were resistant to piperacillin (100%), followed by ceftazidime (29.7%), and cefepime (25.8%). The strains of P. fluorescence were highly sensitive to cefotaxime (74.2%), followed by ceftriaxone and levofloxacin (70.3% each). Interestingly, 29.7% of strains of P. fluorescens were multiple antimicrobial-resistant (MAR).

Resumo Pseudomonas fluorescens é uma das principais causas de doenças septicêmicas em peixes de água doce, causando graves perdas econômicas e diminuindo a eficiência da fazenda. Assim, esta pesquisa teve como objetivo investigar a ocorrência de P. fluorescens em peixes de tilápia-do-nilo (O. niloticus) no Egito, sequenciamento do gene 16S rDNA e suscetibilidade antimicrobiana. Cepas de P. fluorescens foram detectadas em 32% (128/400) de peixes tilápia-do-nilo aparentemente saudáveis (9%; 36/400) e doentes (23%; 92/400). A maior prevalência foi observada nas brânquias dos peixes, 31,3%, seguida pelo intestino 26,9%, fígado 24,2% e rins 17,6%. Os resultados da PCR para o gene 16SrDNA de P. fluorescens mostraram o gene 16SrDNA em 30% dos isolados examinados. Além disso, a homogeneidade e uma forte relação entre cepas de P. fluorescens foi confirmada usando sequências de 16SrDNA. Além da responsabilidade do gene 16SrDNA na virulência de P. fluorescens. Os resultados dos testes de suscetibilidade antimicrobiana revelaram que todas as cepas foram resistentes à piperacilina (100%), seguida pela ceftazidima (29,7%) e cefepima (25,8%). As cepas de P. fluorescens foram altamente sensíveis à cefotaxima (74,2%), seguida pela ceftriaxona e levofloxacina (70,3% cada). Curiosamente, 29,7% das cepas de P. fluorescens eram multirresistentes a antimicrobianos (MAR).

A systematic review on extensively drug-resistant tuberculosis from 2009 to 2020: special emphases on treatment outcomes / Una revisión sistemática sobre la tuberculosis extremadamente resistente de 2009 a 2020: énfasis especial sobre los resultados del tratamiento

Objectives: Extensively drug-resistant tuberculosis (XDR-TB) has raised a great threat to human health globally, especially in developing countries. The objective of the present study is to collate and contrast the proportions of treatment outcome in the previously published XDR-TB articles. Material and methods: By considering inclusion criteria and search engines, a total of 22 articles were enrolled. Results. Our findings revealed that the overall favorable treatment outcome was 24.04%. From the cohort of enrolled studies 19.76% (397) and 43.35% (871) patients were cured and died respectively. In 90.9% of enrolled articles, the investigators performed drug-susceptibility testing at the baseline. The overall treatment outcome was improved by the use of new drugs (linezolid, bedaquiline, ciprofloxacin, clofazimine) in the treatment regimen of XDR-TB showing linezolid and bedaquiline better results i.e. 59.44 and 78.88%, respectively. Moreover, use of antiretroviral treatment in XDR-TB patients with HIV infection have not shown any significant difference in the treatment outcome. Conclusions: XDR-TB treatment success can be achieved by implying standardized definitions, upgraded diagnostic procedures, and novel drugs. (AU)

Objetivos: La tuberculosis extremadamente resistente (XDR-TB) ha planteado una gran amenaza para la salud humana a nivel mundial, especialmente en los países en desarrollo. El objetivo del estudio es recopilar y contrastar las proporciones del resultado del tratamiento en los artículos de XDR-TB publicados.Material y métodos: Teniendo en cuenta los criterios de inclusión y los motores de búsqueda un total de 22 artículos fueron incluidos. Resultados. Nuestros hallazgos revelaron que el resultado total del tratamiento favorable fue del 24,04%. De la cohorte de estudios inscritos, el 19,76% (397) y el 43,35% (871) de los pacientes se curaron y murieron, respectivamente. En el 90,9% de los artículos, los investigadores realizaron pruebas de sensibilidad. El resultado total del tratamiento mejoró mediante el uso de nuevos medicamentos (linezolid, bedaquilina, ciprofloxacino, clofazimina) en el régimen de tratamiento de XDR-TB, mostrando linezolid y bedaquilina los mejores resultados, 59,44 y 78,88%, respectivamente. Además, el uso del tratamiento antirretroviral en pacientes con XDR-TB y con infección por VIH no mostró ninguna diferencia significativa en el resultado del tratamiento. Conclusiones: El éxito del tratamiento de la XDR-TB se puede lograr implicando definiciones estandarizadas, procedimientos de diagnóstico mejorados y nuevos medicamentos. (AU)

El dilema en los laboratorios de Koch, ¿Cultivar o no Cultivar? / The Dilemma in Koch's Laboratories, To Cultivate or Not to Cultivate?

La nueva norma técnica para el control y la eliminación de la tuberculosis es un gran avance para el diagnóstico de este microorganismo en Chile. Actualmente la principal técnica microbiológica para el diagnóstico de laboratorio es la biología molecular, que reduce el tiempo del resultado a tan solo un par de horas. La normativa actual indica que en el paciente caso presuntivo de tuberculosis (CPT) la técnica exclusiva a realizar es Biología molecular. La literatura indica que la detección a través de amplificación de material genético de la micobacteria tiene un límite de detección de 15,6 UFC/ ml, por tanto, todas las muestras bajo ese límite umbral potencialmente podrían no ser diagnosticadas bajo esta estructura emanada por el ministerio de Salud en Chile. Nuestra recomendación es continuar con el estudio de cultivo en medios líquidos o sólidos para todas las muestras hasta obtener literatura que avale lo contrario

The new technical standard for the control and elimination of tuberculosis in Chile is a great advance for the diagnosis of this microorganism. Currently the main microbiological technique for laboratory diagnosis is PCR, which reduces the time to result to just a couple of hours. The current regulations indicate that in the patient with a presumptive case of tuberculosis (CPT) t he exclusive technique to be performed is PCR. The literature indicates that the detection through amplification of genetic material of the mycobacterium has a detection limit of 15.6 CFU/ml, therefore, all samples under this threshold limit could potentially not be diagnosed under this structure emanated by the Ministry of Health in Chile. Our recommendation is to continue with the study of culture in liquid or solid media for all samples until literature confirms otherwise

High antimicrobial resistance in Salmonella spp. and Escherichia coli isolates from swine fecal samples submitted to a veterinary diagnostic laboratory in Colombia

Background: Commensal microflora such as Escherichia coli and Enterococcus spp. are representative indicators of antimicrobial resistance (AMR) as they are part of the normal intestinal microflora and can acquire and disseminate AMR to pathogenic or zoonotic bacteria like Salmonella spp. Objective: To investigate the state of AMR among E. coli and Salmonella spp., potential pathogens in humans, isolated from cecal contents of pigs submitted to a veterinary diagnostic laboratory in Colombia from 2016 to 2019. Methods: Susceptibility testing was conducted using the Kirby-Bauer disk diffusion method according to the Clinical and Laboratory Standards Institute guidelines for antimicrobial zone diameter breakpoints. An E. coli strain (ATCC 25922) was used as the quality control organism. Isolates showing resistance to three or more antimicrobial classes were classified as multidrug-resistant (MDR) as defined by a joint group of the European Centre for Disease prevention and Control and the Center for Disease Control and Prevention of the USA. Results: A total of 112 E. coli and 192 Salmonella spp. colonies were isolated from 557 samples received between 2016 and 2019. In order of decreasing frequency, E. coli was resistant to tetracycline (100%), sulfamethoxazol-trimethoprim (97.5%), amoxicillin (86.4%), enrofloxacin (82.6%), tylosin (82.1%), doxycycline (59%), neomycin (50%), ciprofloxacin (45.5%), ceftiofur (35%), gentamicin (30%), tilmicosin (29%), and fosfomycin (12.5%). When compared with E. coli, Salmonella spp. was generally resistant to the same agents with slightly less resistance (between 10-30%) to eight of the antimicrobials tested. Salmonella spp. showed <20% resistance to three antimicrobials, as follows: neomycin (17%), gentamicin (16%), and fosfomycin (14%). Multi-resistance occurred in 68.7% (77/112) of E. coli and 70.3% (135/192) of Salmonella spp. isolates. Resistance of Salmonella spp. was alarming to all the critically important antimicrobials tested: fluoroquinolones (enrofloxacin, ciprofloxacin), ceftiofur (third- generation cephalosporin), and macrolides (tylosin). Conclusions: According to our results, there is a high level of multi- drug resistance (MDR) in E. coli and Salmonella spp. It is necessary to implement a nationwide antimicrobial resistance monitoring program in Colombia, together with proper antimicrobial prescribing guidelines for pigs. The indiscriminate use of antimicrobial growth promoters by the swine industry is generating widespread bacterial resistance and should be discontinued.

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Antecedentes: Flora comensal como espécies de Escherichia coli e Enterococcus são tipicamente escolhidas como indicadores representativos de la resistência antimicrobiana (AMR), pois fazem parte da flora intestinal normal e podem adquirir e disseminar AMR a bactérias patogênicas ou zoonóticas como Salmonella spp. Objetivo: Investigar o estado da AMR entre E. coli e Salmonella spp. isolados do conteúdo cecal de porcos colombianos submetidos ao Laboratório de Diagnóstico Veterinário de 2016 a 2019, ambos sendo patógenos potenciais em humanos. Métodos: O teste de suscetibilidade foi conduzido usando o método de difusão em disco Kirby-Bauer de acordo com as diretrizes do Instituto de Padrões Clínicos e Laboratoriais para pontos de quebra de diâmetro da zona antimicrobiana. A cepa de E. coli (ATCC 25922) foi usada como organismo de controle de qualidade. Os isolados que apresentam resistência a três ou mais classes de antimicrobianos foram classificados como multirresistentes (MDR), conforme definido por um grupo conjunto do Centro Europeu para Prevenção e Controle de Doenças e Centro para Controle e Prevenção de Doenças dos EUA. Resultados: Um total de 112 E. coli e 192 Salmonella spp. foram isolados de 557 amostras submetidas entre 2016 e 2019. Em ordem decrescente de frequência, a resistência a E. coli foi: tetraciclina (100%), sulfametoxazol-trimetoprim (97,5%), amoxicilina (86,4%), enrofloxacina (82,6%), tilosina (82,1%), doxiciclina (59%), neomicina (50%), ciprofloxacina (45,5%), ceftiofur (35%), gentamicina (30%), tilmicosina (29%) e fosfomicina (12,5%). Quando comparada com E. coli, Salmonella spp. foi geralmente resistente aos mesmos agentes com resistência ligeiramente menor (entre 10-30%) a oito dos antimicrobianos. Apenas três antimicrobianos apresentaram resistência a Salmonella spp. abaixo de 20% da seguinte forma: neomicina (17%), gentamicina (16%) e fosfomicina (14%). Multi-resistência ocorreu em 68,7% (77/112) de E. coli e 70,3% (135/192) de Salmonella spp. isolados. Resistência de Salmonella spp. foi alarmante para todos os antimicrobianos criticamente importantes testados: fluoroquinolonas (enrofloxacina, ciprofloxacina), ceftiofur (cefalosporina de terceira geração) e macrolídeos (tilosina). Conclusões: Esses resultados indicam um alto nível de resistência a múltiplos medicamentos (MDR) e que um Programa Nacional de Monitoramento da Resistência Antimicrobiana é necessário para a Colômbia, juntamente com a implementação de diretrizes de prescrição de antimicrobianos para suínos. O uso indiscriminado de antimicrobianos para promoção de crescimento na indústria suína está claramente promovendo resistência generalizada e deve ser interrompido.

Characterization of a Coliphage AS1 isolated from sewage effluent in Pakistan / Caracterização de um colifago AS1 isolado de efluente de esgoto no Paquistão

The emergence of multi-drug resistant (MDR) bacterial strains, which are posing a global health threat has developed the interest of scientists to use bacteriophages instead of conventional antibiotics therapy. In light of an increased interest in the use of phage as a bacterial control agent, the study aimed to isolate and characterize lytic phages from sewage effluent. During the current study, bacteriophage AS1 was isolated from sewage effluent against E.coli S2. The lytic activity of phageAS1 was limited to E.coli S2 strain showing monovalent behavior. The calculated phage titer was 3.5×109 pfu/ml. PhageAS1 was stable at a wide range of pH and temperature. The maximum stability was recorded at 37ºC and pH 7.0, while showing its normal lytic activity at temperature 60ºC and from pH 5.0 to11.0 respectively. At temperature 70ºC, phage activity was somewhat reduced whereas, further increase in temperature and decrease or increase in pH completely inactivated the phage. From the current study, it was concluded that waste water is a best source for finding bacteriophages against multi-drug resistant bacterial strains and can be used as bacterial control agent.

O surgimento de cepas bacterianas multirresistentes (MDR), que representam uma ameaça global à saúde, desenvolveu o interesse dos cientistas em usar bacteriófagos em vez da terapia convencional com antibióticos. Diante do crescente interesse no uso de fago como agente de controle bacteriano, o estudo visou isolar e caracterizar fagos líticos de efluente de esgoto. Durante o estudo atual, o bacteriófago AS1 foi isolado de efluente de esgoto contra E. coli S2. A atividade lítica de phageAS1 foi limitada à cepa E. coli S2, apresentando comportamento monovalente. O título de fago calculado foi de 3,5 x 109 ufp/ml. PhageAS1 foi estável em uma ampla faixa de pH e temperatura. A estabilidade máxima foi registrada a 37ºC e pH 7,0, enquanto mostrou atividade lítica normal em temperatura de 60ºC e pH 5,0 a 11,0, respectivamente. Na temperatura de 70ºC, a atividade do fago foi um pouco reduzida, enquanto o aumento adicional da temperatura e a diminuição ou aumento do pH inativaram completamente o fago. Com base no estudo atual, concluiu-se que a água residual é a melhor fonte para encontrar bacteriófagos contra cepas bacterianas multirresistentes e pode ser usada como agente de controle bacteriano.

Characterization of a Coliphage AS1 isolated from sewage effluent in Pakistan / Caracterização de um colifago AS1 isolado de efluente de esgoto no Paquistão

The emergence of multi-drug resistant (MDR) bacterial strains, which are posing a global health threat has developed the interest of scientists to use bacteriophages instead of conventional antibiotics therapy. In light of an increased interest in the use of phage as a bacterial control agent, the study aimed to isolate and characterize lytic phages from sewage effluent. During the current study, bacteriophage AS1 was isolated from sewage effluent against E.coli S2. The lytic activity of phageAS1 was limited to E.coli S2 strain showing monovalent behavior. The calculated phage titer was 3.5×109 pfu/ml. PhageAS1 was stable at a wide range of pH and temperature. The maximum stability was recorded at 37ºC and pH 7.0, while showing its normal lytic activity at temperature 60ºC and from pH 5.0 to 11.0 respectively. At temperature 70ºC, phage activity was somewhat reduced whereas, further increase in temperature and decrease or increase in pH completely inactivated the phage. From the current study, it was concluded that waste water is a best source for finding bacteriophages against multi-drug resistant bacterial strains and can be used as bacterial control agent.

O surgimento de cepas bacterianas multirresistentes (MDR), que representam uma ameaça global à saúde, desenvolveu o interesse dos cientistas em usar bacteriófagos em vez da terapia convencional com antibióticos. Diante do crescente interesse no uso de fago como agente de controle bacteriano, o estudo visou isolar e caracterizar fagos líticos de efluente de esgoto. Durante o estudo atual, o bacteriófago AS1 foi isolado de efluente de esgoto contra E. coli S2. A atividade lítica de phageAS1 foi limitada à cepa E. coli S2, apresentando comportamento monovalente. O título de fago calculado foi de 3,5 x 109 ufp/ml. PhageAS1 foi estável em uma ampla faixa de pH e temperatura. A estabilidade máxima foi registrada a 37ºC e pH 7,0, enquanto mostrou atividade lítica normal em temperatura de 60ºC e pH 5,0 a 11,0, respectivamente. Na temperatura de 70ºC, a atividade do fago foi um pouco reduzida, enquanto o aumento adicional da temperatura e a diminuição ou aumento do pH inativaram completamente o fago. Com base no estudo atual, concluiu-se que a água residual é a melhor fonte para encontrar bacteriófagos contra cepas bacterianas multirresistentes e pode ser usada como agente de controle bacteriano.

Characterization of a Coliphage AS1 isolated from sewage effluent in Pakistan

Abstract The emergence of multi-drug resistant (MDR) bacterial strains, which are posing a global health threat has developed the interest of scientists to use bacteriophages instead of conventional antibiotics therapy. In light of an increased interest in the use of phage as a bacterial control agent, the study aimed to isolate and characterize lytic phages from sewage effluent. During the current study, bacteriophage AS1 was isolated from sewage effluent against E.coli S2. The lytic activity of phageAS1 was limited to E.coli S2 strain showing monovalent behavior. The calculated phage titer was 3.5×109 pfu/ml. PhageAS1 was stable at a wide range of pH and temperature. The maximum stability was recorded at 37ºC and pH 7.0, while showing its normal lytic activity at temperature 60ºC and from pH 5.0 to11.0 respectively. At temperature 70ºC, phage activity was somewhat reduced whereas, further increase in temperature and decrease or increase in pH completely inactivated the phage. From the current study, it was concluded that waste water is a best source for finding bacteriophages against multi-drug resistant bacterial strains and can be used as bacterial control agent.

Resumo O surgimento de cepas bacterianas multirresistentes (MDR), que representam uma ameaça global à saúde, desenvolveu o interesse dos cientistas em usar bacteriófagos em vez da terapia convencional com antibióticos. Diante do crescente interesse no uso de fago como agente de controle bacteriano, o estudo visou isolar e caracterizar fagos líticos de efluente de esgoto. Durante o estudo atual, o bacteriófago AS1 foi isolado de efluente de esgoto contra E. coli S2. A atividade lítica de phageAS1 foi limitada à cepa E. coli S2, apresentando comportamento monovalente. O título de fago calculado foi de 3,5 x 109 ufp/ml. PhageAS1 foi estável em uma ampla faixa de pH e temperatura. A estabilidade máxima foi registrada a 37ºC e pH 7,0, enquanto mostrou atividade lítica normal em temperatura de 60ºC e pH 5,0 a 11,0, respectivamente. Na temperatura de 70ºC, a atividade do fago foi um pouco reduzida, enquanto o aumento adicional da temperatura e a diminuição ou aumento do pH inativaram completamente o fago. Com base no estudo atual, concluiu-se que a água residual é a melhor fonte para encontrar bacteriófagos contra cepas bacterianas multirresistentes e pode ser usada como agente de controle bacteriano.

Análisis del valor predictivo de los criterios de aislamiento preventivo en una unidad de cuidados intensivos / Analysis of the predictive value of preventive isolation criteria in the intensive care unit

Objetivo Evaluar la precisión diagnóstica de los criterios empleados para detectar al paciente realmente portador de microrganismos multirresistentes (MMR). Diseño Estudio prospectivo, observacional de mayo de 2014 a mayo de 2015. Ámbito Unidad de cuidados intensivos polivalente. Pacientes Cohorte de pacientes ingresados de forma consecutiva que cumplían los siguientes criterios de aislamiento preventivo basados en el proyecto «Resistencia Zero»: hospitalización de más de 4 días en los últimos 3 meses («hospital»); antibioterapia durante una semana en el último mes («antibiótico»), pacientes institucionalizados o en contacto con cuidados sanitarios («institución o cuidado»); portador de MMR los últimos 6 meses («MMR previo»). Variables Variables demográficas, resultados de los cultivos obtenidos con presencia o no de MMR y tiempo de aislamiento. Se realizó un análisis multivariable con regresión logística múltiple entre cada uno de los factores de riesgo y el que el paciente fuera portador de MMR. Resultados Durante el periodo de estudio ingresaron 575 pacientes y cumplieron los criterios de aislamiento un 28%. De los 162 pacientes con criterios 51 (31%) eran portadores de MMR y de los que no cumplían criterios 29 (7%) sí que eran portadores. En el análisis multivariable la única variable asociada de forma independiente con el ser portador fue «MMR previo», con una OR 12,14 (IC 95%: 4,24–34,77). Conclusiones El único criterio que se asoció de forma independiente con la capacidad de detectar los pacientes con MMR al ingreso en la UCI fue haber presentado un «MMR previo». (AU)

Objective To assess the diagnostic accuracy of the criteria used to detect patients carrying multiresistant microorganisms (MRMs). Design A prospective observational study was carried out from May 2014 to May 2015. Setting Polyvalent Intensive Care Unit. Patients A cohort of consecutively admitted patients meeting the following criteria for preventive isolation according to the “Zero Resistance” project: hospital length of stay>4 days in the last three months (“hospital”); antibiotherapy during one week in the last month (“antibiotic”); institutionalized patients or recurrent contact with healthcare (“institution or care”); MRM carrier in the last 6 months (“previous MRM”). Variables Demographic data, culture results and isolation time. A multivariate analysis was performed using multiple logistic regression between each of the risk factors and patient MRM carrier status. Results During the study period, 575 patients were admitted, of which 28% met the isolation criteria (162). Fifty-one (31%) were MRM carriers. Of the patients who did not meet the criteria, 29 (7%) were carriers. In the multivariate analysis, the only variable independently associated to carrier status was “previous MRM”, with OR=12.14 (95%CI 4.24-34.77). Conclusions The only criterion independently associated with the ability to detect patients with MRMs upon admission to the ICU was the existence of “previous MRM”. (AU)

Factores de riesgo para infección por pseudomonas aeruginosa multirresistente en pacientes con neumonía asociada a ventilación mecánica de la unidad de cuidados intensivos. Estudio multicéntrico / Risk factors for multi-resistant aeruginous pseudomonas infection in patients with pneumonia associated with mechanical ventilation of the intensive care unit. Multicentric study

Objetivo:Determinar los factores de riesgo de infección para Pseudomonas aeruginosa multirresistente en pacientes con Neumonía asociada a ventilación de la unidad de cuidados intensivos.:Serealizóunestudioobservacional,analítico, MaterialyMétodosretrospectivo, de casos y controles en el cual se seleccionaron mediante aleatorización simple 84 historias clínicas de pacientes con edad ≥ 18 años, con diagnóstico de neumonía asociada a ventilación mecánica en el Hospital Alta Complejidad Virgen de la Puerta (HACVP) y Hospital Belén de Trujillo (HBT) durante el periodo de enero-2014 a diciembre-2019. En el análisis de datos se utilizó la prueba Chi-cuadrado para determinar la significancia estadística de asociación en las variables de estudio. :La edad, uso de antibioticoterapia previa Resultadosde amplio espectro, uso de sonda vesical, tiempo de uso de sonda vesical y postoperado de cirugía abdominal, se asociaron significativamente (P<0,05) a infección por Pseudomonas aeruginosa multirresistente en pacientes con neumonía asociada a ventilación mecánica de la unidad de cuidados intensivos. El tiempo de exposición de sonda vesical es factor de riesgo para infección por Pseudomonas aeruginosa multirresistente (p<0.001). : El Conclusionestiempo de uso de sonda vesical por más de 7 días sin recambio de sonda es un factor de riesgo para infección por Pseudomonas aeruginosa multirresistente en pacientes con neumonía asociada a ventilación mecánica.

Objective:Determine the risk factors for multidrug-resistant Pseudomonas aeruginosa infection in patients with pneumonia associated with mechanical ventilation in the intensive care unit. :An observational, analytical, retrospective, case-control Material and Methodsstudy was carried out in which 84 medical records of patients aged ≥ 18 years with a diagnosis of ventilator-associatedpneumoniawereselectedbysimplerandomizationattheAlta Complejidad Hospital Virgen de la Puerta (HACVP) and Hospital Belén de Trujillo (HBT) during the period from January-2014 to December-2019. In the data analysis, the Chi-square test was used to determine the statistical significance of association in the study variables. :ResultsAge, use of prior broad-spectrum antibiotic therapy, use of urinary catheter, time of urinary catheter use, and postoperative abdominal surgery were significantly associated (P<0,05) with multidrug-resistant Pseudomonas aeruginosa infection in patients with pneumonia associated with intensive care unit mechanical ventilation. Urinary catheter exposure time is a risk factor for multidrug-resistant Pseudomonas aeruginosa infection (p <0.001). :The time Conclusionsof use of the urinary catheter for more than 7 days without change the catheter is a risk factor for infection by multidrug-resistant Pseudomonas aeruginosa in patients with pneumonia associated with mechanical ventilation.

Antimicrobial resistance of Escherichia coli isolates from spray‑chilled sheep carcasses during cooling / Resistencia antimicrobiana en aislados de Escherichia coli de canales de ovejas asperjadas durante la refrigeración / Resistência antimicrobiana de isolados de Escherichia coli de carcaças ovinas aspergidas durante o resfriamento

Abstract Background: Multidrug-resistant bacteria present in food of animal origin raise human and animal health concerns. Objective: To assess antimicrobial resistance of Escherichia coli isolates from sheep carcasses subjected to spray-chilling with water (4 and 10 hours) during cooling. Methods: Thirty surface swabs were collected from carcasses before and after the last water spray in two slaughter periods. In a first assessment (1st sampling), three spray-chilled carcasses (4 hours), three non-sprayed and one control carcass were sampled. In a second assessment (2nd sampling), the same number of carcasses and treatments were maintained, but spray-chilling was extended to 10 hours. All samples collected were isolated and submitted to susceptibility test using 16 (1st sampling) and 17 (2nd sampling) antimicrobials, respectively. Results: Overall, E. coli isolates were resistant most antimicrobials. Spray-chilled and control carcasses (10 hours) showed resistance to meropenem. Conclusion: E. coli isolates from carcasses subjected to spray-chilling with water for 10 hours had higher antimicrobial resistance to one, two, and four antimicrobial classes, characterizing a multidrug resistance profile. These results highlight the need to monitor health status throughout the meat production processes.

Resumen Antecedentes: las bacterias multirresistentes presentes en alimentos de origen animal son motivo de alerta para la salud humana y animal. Objetivo: verificar la resistencia a antimicrobianos de aislados de Escherichia coli en canales ovinas sometidas a aspersión (4 y 10 h) durante la refrigeración. Métodos: Luego de dos faenas de sacrificio, treinta hisopos fueron colectados en la superficie de las canales antes y después de la última aspersión. En un primer sacrificio (1era colecta) se recolectaron muestras de tres canales sometidas a aspersión (4 horas), tres sin aspersión y una canal como control. En un segundo sacrificio (2da colecta), el mismo número de canales y tratamientos se mantuvo, y el período de aspersión se extendió a 10 horas. Las muestras recogidas fueron aisladas y sometidas a la prueba de susceptibilidad utilizándo 16 (1.ª colecta) y 17 (2.ª colecta) antimicrobianos, respectivamente. Resultados: los aislamientos de E. coli fueron, en general, resistentes a las principales clases de antimicrobianos. Las canales con aspersión y el control (10 h) presentaron resistencia al meropenem. Conclusión: cuando la asperción duró 10 h, los aislados de E. coli presentaron mayor resistencia para una, dos y cuatro clases de antimicrobianos, es decir, fueron multirresistentes a los fármacos utilizados. Esto resalta la necesidad de monitorear el estado de salud durante todos los procesos de producción de carne.

Resumo Antecedentes: bactérias multirresistentes presentes em alimentos de origem animal são motivo de preocupação e alerta na saúde humana e animal. Objetivo: verificar a resistência antimicrobiana em isolados de Escherichia coli de carcaças de ovinos pulverizadas ou não (4 e 10 horas) durante a refrigeração. Métodos: foram coletados trinta swabs de superfície em carcaças antes e após a última aspersão em dois abates. Em outubro do 2015, três carcaças aspergidas foram amostradas, três sem aspersão e uma carcaça para controle, por um período de 4 horas. Em julho de 2016 (2ª coleta), o mesmo número de carcaças e tratamentos foram mantidos e o período de aspersão foi prolongado em 10 horas. As amostras coletadas foram isoladas e submetidas ao teste de susceptibilidade em 16 (1ª coleta) e 17 (2ª coleta) antimicrobianos, respectivamente. Resultados: isolados de E. coli foram, em geral, resistentes às principais classes de antimicrobianos. As carcaças e o controle aspergidos (10 h) apresentaram resistência ao meropenem. Conclusão: quando a aspersão de água durou 10 horas, os isolados de E. coli apresentaram maior resistência antimicrobiana a uma, duas e quatro classes de antimicrobianos, o que é uma multirresistência aos fármacos testados. Isso alerta para a necessidade de monitorar os aspectos de saúde durante todos os processos de produção de carne.

Factores de riesgo para infección por pseudomonas aeruginosa multirresistente en pacientes con neumonía asociada a ventilación mecánica de la unidad de cuidados intensivos. Estudio multicéntrico / Risk factors for multi-resistant aeruginous pseudomonas infection in patients with pneumonia associated with mechanical ventilation of the intensive care unit. Multicentric study

RESUMEN Objetivo: Determinar los factores de riesgo de infección para Pseudomonas aeruginosa multirresistente en pacientes con Neumonía asociada a ventilación de la unidad de cuidados intensivos. Material y Métodos: Se realizó un estudio observacional, analítico, retrospectivo, de casos y controles en el cual se seleccionaron mediante aleatorización simple 84 historias clínicas de pacientes con edad ≥ 18 años, con diagnóstico de neumonía asociada a ventilación mecánica en el Hospital Alta Complejidad Virgen de la Puerta (HACVP) y Hospital Belén de Trujillo (HBT) durante el periodo de enero-2014 a diciembre-2019. En el análisis de datos se utilizó la prueba Chi-cuadrado para determinar la significancia estadística de asociación en las variables de estudio. Resultados: La edad, uso de antibioticoterapia previa de amplio espectro, uso de sonda vesical, tiempo de uso de sonda vesical y postoperado de cirugía abdominal, se asociaron significativamente (P<0,05) a infección por Pseudomonas aeruginosa multirresistente en pacientes con neumonía asociada a ventilación mecánica de la unidad de cuidados intensivos. El tiempo de exposición de sonda vesical es factor de riesgo para infección por Pseudomonas aeruginosa multirresistente (p<0.001). Conclusiones: El tiempo de uso de sonda vesical por más de 7 días sin recambio de sonda es un factor de riesgo para infección por Pseudomonas aeruginosa multirresistente en pacientes con neumonía asociada a ventilación mecánica.

ABSTRACT Objective: Determine the risk factors for multidrug-resistant Pseudomonas aeruginosa infection in patients with pneumonia associated with mechanical ventilation in the intensive care unit. Material and Methods: An observational, analytical, retrospective, case-control study was carried out in which 84 medical records of patients aged ≥ 18 years with a diagnosis of ventilator-associated pneumonia were selected by simple randomization at the Alta Complejidad Hospital Virgen de la Puerta (HACVP) and Hospital Belén de Trujillo (HBT) during the period from January-2014 to December-2019. In the data analysis, the Chi-square test was used to determine the statistical significance of association in the study variables. Results: Age, use of prior broad-spectrum antibiotic therapy, use of urinary catheter, time of urinary catheter use, and postoperative abdominal surgery were significantly associated (P <0,05) with multidrug-resistant Pseudomonas aeruginosa infection in patients with pneumonia associated with intensive care unit mechanical ventilation. Urinary catheter exposure time is a risk factor for multidrug-resistant Pseudomonas aeruginosa infection (p <0.001). Conclusions: The time of use of the urinary catheter for more than 7 days without change the catheter is a risk factor for infection by multidrug-resistant Pseudomonas aeruginosa in patients with pneumonia associated with mechanical ventilation.

[Analysis of the predictive value of preventive isolation criteria in the intensive care unit]. / Análisis del valor predictivo de los criterios de aislamiento preventivo en una unidad de cuidados intensivos.

OBJECTIVE: To assess the diagnostic accuracy of the criteria used to detect patients carrying multiresistant microorganisms (MRMs). DESIGN: A prospective observational study was carried out from May 2014 to May 2015. SETTING: Polyvalent Intensive Care Unit. PATIENTS: A cohort of consecutively admitted patients meeting the following criteria for preventive isolation according to the "Zero Resistance" project: hospital length of stay>4 days in the last three months ("hospital"); antibiotherapy during one week in the last month ("antibiotic"); institutionalized patients or recurrent contact with healthcare ("institution or care"); MRM carrier in the last 6 months ("previous MRM"). VARIABLES: Demographic data, culture results and isolation time. A multivariate analysis was performed using multiple logistic regression between each of the risk factors and patient MRM carrier status. RESULTS: During the study period, 575 patients were admitted, of which 28% met the isolation criteria (162). Fifty-one (31%) were MRM carriers. Of the patients who did not meet the criteria, 29 (7%) were carriers. In the multivariate analysis, the only variable independently associated to carrier status was "previous MRM", with OR=12.14 (95%CI 4.24-34.77). CONCLUSIONS: The only criterion independently associated with the ability to detect patients with MRMs upon admission to the ICU was the existence of "previous MRM".

Gangrenous mastitis in sheep caused by multidrug-resistant Staphylococcus haemolyticus / Mastite gangrenosa em ovinos causada por Staphylococcus haemolyticus multirresistente

Mastitis is a multifactorial disease and considered one of the most critical problems in the dairy industry worldwide. The condition is characterized by reduced milk and several abnormalities in the mammary gland. This study aimed to report an outbreak of gangrenous mastitis caused by multidrug-resistant Staphylococcus haemolyticus in a Santa Inês sheep herd. Eighteen sheep were affected, and five of them with severe clinical pictures were examined. The clinical and pathological picture were variable and characterized by apathy, anorexia, emaciation, opaque and brittle hair, apparent and congested episcleral vessels, and hyperthermia. These ewes had enlarged, firm, and painful mammary glands. Macroscopically, these lesions consisted of severe gangrenous mastitis, and microscopically, the primary lesions consisted of necrosis, thrombosis, and fibrosis of the mammary parenchyma. Milk samples from one of the five severely affected ewes were collected and cultured under aerobic or microaerophilic incubation at 37°C for 24 hours on sheep blood agar. The obtained colonies were then submitted to MALDI-TOF for speciation. The colonies were also submitted to an antimicrobial susceptibility test, genotyping of virulence factors and resistance genes were also performed. The isolates showed antimicrobial multiresistance since they were resistant to seven out of 13 tested antibiotics. The isolates were also positive for two staphylococcal enterotoxigenic genes (sec and see) and fibronectin-binding protein B (fnbB).(AU)

A mastite é uma doença multifatorial e é considerada um dos problemas mais importantes na indústria de laticínios no mundo todo. A condição é caracterizada pela redução de leite e várias anormalidades na glândula mamária. O objetivo deste estudo foi relatar um surto de mastite gangrenosa causada por Staphylococcus haemolyticus multirresistente em um rebanho ovino Santa Inês. Dezoito ovelhas foram afetadas e cinco delas com quadro clínico severo foram examinadas. O quadro clínico-patológico era variável quanto a severidade e consistia em apatia, anorexia, magreza, pelos opacos e quebradiços e vasos episclerais aparentes e ingurgitados. As ovelhas apresentavam glândulas aumentadas, firmes e dolorosas. Macroscopicamente, as principais lesões consistiam em mastite gangrenosa e microscopicamente havia necrose do parênquima glandular, trombose e fibrose. Amostras de leite de uma das cinco ovelhas severamente afetadas foram coletadas e cultivadas sob incubação aeróbica ou microaerofílica a 37°C por 24 horas em ágar sangue de ovelha. As colônias obtidas foram então submetidas ao MALDI-TOF para especiação. Além disso, as colônias foram submetidas a um teste de suscetibilidade antimicrobiana e foi realizada a genotipagem de fatores de virulência e genes de resistência. Os isolados apresentaram multirresistência antimicrobiana por serem resistentes a sete dos 13 antibióticos testados. Os isolados também foram positivos para dois genes enterotoxigênicos estafilocócicos (sec e see) e proteína B de ligação à fibronectina (fnbB).(AU)

The impact of medical interventions for reducing ototoxicity during treatment for multi-drug resistant tuberculosis.

INTRODUCTION: The impact of medical interventions for reducing ototoxicity requires focus in contexts where safe non-ototoxic alternative drugs are not yet available. OBJECTIVES: The goal was to investigate the impact of medical intervention strategies for reducing the ototoxic effects of long-term use of aminoglycosides for the treatment of Multi-Drug Resistant Tuberculosis (MDR-TB) in adults at a rural hospital in the Eastern Cape, South Africa. METHODS: A retrospective record review with a control group design was used, with audiological and medical record reviews of all participants' files over a six-month period. A total of 86 participants (intervention group n=32 and control group n=54) were included. Descriptive and inferential statistics were used to analyze the data. RESULTS: Results revealed progressive hearing loss in both groups, with worsening of thresholds at each subsequent assessment session. The progression of the hearing loss, however, was much slower in the intervention group, with degree of hearing loss being more severe in the control group in the final session of assessment (36.78-71.74dB), when compared to the intervention group (33-44.39dB). Furthermore, the hearing loss in the intervention group remained in the high frequencies while that in the control group progressed to involve the lower frequencies on the audiogram. The most common medical intervention strategies employed in the current study were to reduce the dosage of the ototoxic drug (61%), with the daily dosage reduced to 800mg in 39% of participants, while the administration of the drug was reduced from daily to thrice weekly in 22% of participants. CONCLUSIONS: The results reveal better hearing sensitivity over the treatment period in the intervention group when compared to the control group; thus suggesting that early medical strategies implemented had a significant preventive impact. Current findings are relevant to the audiological, medical and pharmaceutical fields, particularly within the South African context where resource constraints are a consideration in all treatment measures.

Contaminación ambiental por microorganismos multirresistentes y el efecto de la limpieza y desinfección en una unidad de cuidados intensivos / Environmental contamination by multi-resistant microorganisms and the effect of cleaning and disinfection in an intensive care unit / Contaminação ambiental por micro-organismos multirresistentes e o efeito de limpeza e desinfecção em unidade de terapia intensiva

Conocer el rol del medio ambiente es fundamental para evitar las infecciones intra-hospitalarias. Con ese objetivo, se planteó evaluar la prevalencia de contaminación ambiental por microorganismos multirresistentes (MMR) antes y después de la limpieza terminal de habitaciones de pacientes colonizados y establecer si la aparatología de uso común actuaba como reservorio de estos en la unidad de cuidados intensivos (UTI). Se obtuvieron muestras ambientales de las habitaciones, 48 h posteriores a la detección de colonización y luego de las limpiezas. Los resultados mostraron que luego de ambos procedimientos de limpieza se logró reducir de 28,2% a 2,6% la contaminación por Acinetobacter spp. multirresistente (AMR). También, se tomaron muestras de aparatología de uso común encontrándose entre 1,8 y 5,4% de contaminación por MMR. La limpieza y desinfección reducen significativamente la contaminación ambiental. Sin embargo, la colonización de equipos por MMR y el incumplimiento de precauciones universales representan una posibilidad de transmisión cruzada.

It is essential to understand the role of the environment in order to avoid intrahospital infections. To achieve this objective, this research proposes to assess the prevalence of the environmental contamination caused by multi-resistant microorganisms (MRM) before and after terminal disinfection in rooms with colonized patients, but also to establish whether the commonly used device acts as a reservoir of those micro-organisms in an intensive care unit (ICU). Environmental samples were obtained from the rooms, 48 hours after detecting colonization and also after the first and second final cleaning. The results showed that after both procedures, there was a reduction from 28.2% to 2.6% of contamination caused by multi-resistant Acinetobacter spp. (AMR). Samples from appliances and supplies were taken as well, in which case, between 1.8 and 5.4% of contamination levels induced by MMR were found. Cleaning and disinfecting significantly reduce environmental contamination. However, both MMR bacterial colonization and the lack of universal precautions enforcement represent a possibility of cross-transmission.

É essencial conhecer o papel do meio ambiente para evitar as infecções intra-hospitalares. Com esse objetivo, planejou-se avaliar a prevalência de contaminação ambiental por microorganismos multirresistentes (MMR) antes e depois da limpeza final dos quartos de pacientes colonizados e estabelecer se os aparelhos de uso comum atuavam como um reservatório deles na unidade de terapia intensiva (UTI). Obtiveram-se amostras ambientais dos quartos 48 horas após a detecção da colonização e logo após as limpezas finais. Os resultados mostraram que depois dos dois procedimentos de limpeza se obteve uma redução de 28,2% para 2,6% da contaminação por Acinetobacter spp. multirresistente (AMR). Foram obtidas também amostras de aparelhos de uso comum onde se encontraram entre 1,8% e 5,4% de contaminação por MMR. A limpeza e a desinfecção reduzem significativamente a contaminação ambiental. Contudo, a colonização de equipamentos por MMR e o não cumprimento de providências universais representam uma possibilidade de transmissão cruzada.

Tigecycline therapy in pediatric patients with multidrug resistant bacteremia.

INTRODUCTION: Multidrug resistance among bacteria increases the need for new therapeutic options. Tigecycline is one candidate drug, due to property of a wider anti-bacterial spectrum to multi-drug resistant (MDR) pathogens. However, it has still not been approved for use in pediatric patients. METHODS: In this study the effectiveness and safety of tigecycline in children was assessed retrospectively. RESULTS: A total of 36 pediatric patients, received tigecycline therapy with a median of 13 days (2-32 days). Tigecycline was used as a combination therapy in all cases. Microbiological eradication was achieved in 27 patients (75%) and clinical response was observed in 30 patients (83%). There were six cases (17%) of relapse. CONCLUSION: Our findings suggest that tigecycline may be an option for children with severe infections due to multidrug resistant bacteria.

Colonización por microorganismos multirresistentes en servicio de oncología de Hospital de Niños Roberto del Río durante el 2016 / Colonization by multiresistant microorganisms in oncology service of Roberto del Río Children's Hospital during 2016

Los pacientes inmunocomprometidos presentan un riesgo aumentado de colonización e infecciones por microorganismos multirresistentes (MOR), entre ellos Enterococcus spp resistentes a vancomicina (ERV) y bacterias productoras de betalactamasas de espectro extendido (BLEE), las cuales son causa importante de morbimortalidad. OBJETIVO: Describir la prevalencia de MOR en Servicio de Oncología del Hospital Roberto del Río. MÉTODO: Se realizó un estudio descriptivo retrospectivo de los niños hospitalizados en el servicio de oncología desde enero a diciembre del 2016 a los cuales se les realizó vigilancia de portación de ERV y BLEE. RESULTADOS: De los 97 pacientes hospitalizados, se identificó un 8% de portación de ERV, un 13,7% de BLEE y un 6,8% presentó portación de ambos microorganismos. DISCUSIÓN: Entre enero 2012 a diciembre del 2013 se observó en nuestro centro que un 52% de los pacientes hospitalizados en oncología estaban colonizados por ERV, la disminución significativa de la portación podría deberse a la mejor adherencia de normas de prevención de infecciones asociadas a la atención en salud (IAAS), programa de uso racional de antimicrobianos y a la nueva infraestructura del servicio.

The inmunosupressed patients are at increased risk of colonization and infection with vancomycin resistant Enterococci (VRE) and extended- spectrum b-lactamase producing Enterobacteriaceae (ESBL), which can cause substantial morbidity and mortality. OBJECTIVE: Describe the prevalence of VRE and ESBL in the Oncology Unit of Roberto del Río Hospital. METHODS: Descriptive and retrospective study of hospitalized children since January to December 2016 in the Oncology Unit, that underwent VRE and ESBL colonization surveillance. RESULTS: From the 97 hospitalized patients, there were 8% of VRE colonization, 13.7% of ESBL and 6.8% of colonization from both microorganism. DISCUSSION: Between January 2012 and December 2013, we observed that 52% of hospitalized patients in the Oncology Unit were colonized by VRE. The significant decrease in colonization may be due to better fulfillment of healthcare-associated infections (HAI) normative, antibiotics stewardship and new infraestructure of our unit.

Colistina intraventricular en infección postoperatoria por Pseudomonas aeruginosa multiresistente:Reporte de un caso / Intraventricular Colistin in postoperative infection by resistant Pseudomonas aeruginosa: Report of a pediatric case.

Introducción: El surgimiento de bacterias Gram negativas multirresistentes y la aparición de infecciones post quirúrgicas, ha representado un desafío en el manejo antimicrobiano. Las características estructurales de estas bacterias, la formación de biofilms en los dispositivos internos y la presencia de infecciones en órganos de difícil acceso antimicrobiano como el sistema nervioso central, ha obligado a retomar el uso de antibióticos como Colistina por vías de administración poco utilizadas. Caso clínico: Presentamos el caso clínico de un paciente de 2 años de edad con meningo-ventriculitis postquirúrgica causada por Pseudomonas aeruginosa multirresistente manejado con tratamiento combinado de Colistina intraventricular e intravenoso, resultando en éxito terapéutico para el paciente. No se reportó ninguna reacción adversa a la medicación local ni sistémica. Tampoco se reportó recaídas infecciosas posterior al alta. Conclusiones: Los aspectos claves en el manejo de este tipo de infecciones deben ser consideradas: eliminación de la derivación ventrículo peritoneal infectada, óptima cobertura antimicrobiana y elección de la vía de administración más efectiva.

Introduction: The emergence of multi-resistant Gram-negative bacteria and the emergence of post-operative infections has represented a challenge in antimicrobial management. The structural characteristics of these bacteria, the formation of biofilms in internal devices and the presence of infections in organs of difficult antimicrobial access such as the central nervous system, has forced to consider the use of antibiotics such as Colistine through little-used administration routes. Clinical case: We present the clinical case of a 2-year-old patient with post-surgical meningo-ventriculitis caused by multiresistant Pseudomonas aeruginosa managed with combined treatment of intraventricular and intravenous Colistin, resulting in therapeutic success for the patient. No adverse reaction to local or systemic medication was reported. No infectious relapses were reported after discharge. Conclusions: The key aspects in the management of this type of infection have been considered: elimination of the infected peritoneal ventricle derivation, optimal antimicrobial coverage and choice of the most effective route of administration.