What's new in mechanisms of antibiotic resistance in bacteria of clinical origin?

The discovery, commercialization and administration of antibiotics revolutionized the world of medicine in the middle of the last century, generating a significant change in the therapeutic paradigm of the infectious diseases. Nevertheless, this great breakthrough was soon threatened due to the enormous adaptive ability that bacteria have, through which they are able to develop or acquire different mechanisms that allow them to survive the exposure to antibiotics. We are faced with a complex, multifactorial and inevitable but potentially manageable threat. To fight against it, a global and multidisciplinary approach is necessary, based on the support, guidance and training of the next generation of professionals. Nevertheless, the information published regarding the resistance mechanisms to antibiotics are abundant, varied and, unfortunately, not always well structured. The objective of this review is to structure the, in our opinion, most relevant and novel information regarding the mechanisms of resistance to antibiotics that has been published from January 2014 to September 2019, analysing their possible clinical and epidemiological impact.

Is it possible to extrapolate the rates of resistance of Escherichia coli from asymptomatic bacteriuria in pregnant women to those of E. coli in uncomplicated community-acquired UTI? / ¿Es posible extrapolar las tasas de resistencia de Escherichia coli de bacteriurias asintomáticas en gestantes a las de E. coli en ITU no complicada adquirida en la comunidad?

OBJECTIVE: Treatment of uncomplicated urinary tract infections in primary care is generally empirical without requesting urine culture and based on biased resistance data collected from selected patients, most of them having risk factors for the isolation of resistant microorganisms. In order to overcome the lack of information on the real resistance rates in uncomplicated UTI, we compared antimicrobial phenotype and genotype of Escherichia coli isolated from pregnant women with asymptomatic bacteriuria (culture always performed) with those from women with uncomplicated acute cystitis (culture rarely performed) of different age groups. MATERIAL AND METHODS: Between September 2017 and March 2018, 103 urines were randomly collected from pregnant women aged between 16 and 47 with asymptomatic bacteriuria (AB) (n=42), not hospitalized women in the same age range with uncomplicated acute cystitis (UAC) (n=31) and women older than 47 not hospitalized with UAC (n=30). Bacteria identification was performed using mass spectrometry and the antibiogram by broth microdilution. Genetic typification was carried out by pulsed-field gel electrophoresis. RESULTS: There are no significant differences between the groups of patients in the antibiotic susceptibility. Likewise, as expected, a wide genetic diversity is observed among the strains of E. coli studied without significant differences between the three groups. CONCLUSIONS: We propose a simple model that could provide better guidance for selection of empirical antimicrobial therapy for non-pregnant women with UAC than do generic hospital antibiogram data based on reliably extrapolating the susceptibility data of strains isolated from pregnant women with AB as representation of women with community-acquired UAC

OBJETIVOS: El tratamiento en atención primaria de las infecciones del tracto urinario no complicadas es generalmente empírico sin solicitar urocultivo y basado en datos de resistencia sesgados procedentes de pacientes seleccionados, muchos de ellos con factores de riesgo de aislamiento de microorganismos resistentes. Con el fin de solventar el déficit de información sobre las tasas de resistencia reales en ITU no complicada, comparamos el fenotipo antimicrobiano y genotipo de aislados de Escherichia coli procedentes de mujeres embarazadas con bacteriuria asintomática (cultivo siempre realizado) con aquellos procedentes de mujeres con cistitis aguda no complicada (cultivo raramente realizado) de diferentes grupos de edad. MATERIAL Y MÉTODOS: Entre septiembre de 2017 y marzo de 2018 se recogieron aleatoriamente 103 orinas de mujeres embarazadas con edades entre 16 y 47 años con bacteriuria asintomática (BA) (n=42), mujeres no hospitalizadas en el mismo rango de edad con cistitis aguda no complicada (CANC) (n=31) y mujeres mayores de 47 años no hospitalizadas con CANC (n=30). La identificación bacteriana se realizó por espectrometría de masas y el antibiograma por microdilución en caldo. La tipificación genética se llevo a cabo por electroforesis en gel por campo pulsado. RESULTADOS: No hay diferencias significativas en la sensibilidad antibiótica entre los grupos de pacientes. De igual forma, y según lo esperado, se observó una amplia diversidad genética entre las cepas de E. coli estudiadas sin diferencias significativas entre los diferentes grupos. CONCLUSIONES: Proponemos un modelo sencillo que podría orientar mejor que los datos generales del hospital en la selección del tratamiento antimicrobiano empírico de mujeres no embarazadas con CANC, basado en extrapolar los datos de sensibilidad de cepas aisladas de mujeres embarazadas con BA como representación de mujeres con CANC adquirida en la comunidad

Mycoplasma genitalium in Spain: prevalence of genital infection and frequency of resistance to macrolides / Mycoplasma genitalium en España: prevalencia de infección genital y frecuencia de resistencia a macrólidos

Introduction: The aim of this study was to determine the prevalence of Mycoplasma genitalium infection and the resistance to macrolides within a general population in Madrid in 2015. Methods: We collected 359 urine samples from a general population with symptoms of sexually transmitted infections (STIs). All samples underwent a real-time PCR. For the detection of macrolide resistance, a 283bp fragment of region V of the 23S rRNA gene of M. genitaliumwas amplified and sequenced. Results: We found a prevalence of 3.34% of M. genitalium and a macrolide resistance rate of 20%. In males, the prevalence was 6.62% and in women 0.96%, being significantly higher in males. Conclusions: The prevalence obtained shows that it is a pathogen to consider in our environment. These findings stress the need for routine testing of M. genitalium infections and would seem to suggest the advisability of resistance testing (AU)

Introducción: El objetivo de este estudio fue determinar en 2015 en una población general de Madrid la prevalencia de infección por Mycoplasma genitalium (M. genitalium) y la resistencia a macrólidos. Métodos: Se recogieron 359 muestras de orina procedentes de una población general con síntomas de infección de transmisión sexual. A todas las muestras se les realizó una PCR a tiempo real. Para la detección de resistencias a macrólidos, se amplificó y secuenció un fragmento de 283 pb de la región V del gen 23S rRNA de M. genitalium. Resultados: Se encontró una prevalencia de un 3,34% de M. genitalium y un 20% de resistencia a macrólidos. En varones la prevalencia fue del 6,62% y en mujeres del 0,96%, siendo significativamente superior en varones. Conclusión: La prevalencia obtenida muestra que es un patógeno a considerar en nuestro entorno. Estos hallazgos hacen hincapié en la necesidad de realizar pruebas de rutina de infección por M. genitalium y argumentan que es recomendable realizar pruebas de resistencia (AU)

Mycoplasma genitalium in Spain: prevalence of genital infection and frequency of resistance to macrolides.

INTRODUCTION: The aim of this study was to determine the prevalence of Mycoplasma genitalium infection and the resistance to macrolides within a general population in Madrid in 2015. METHODS: We collected 359 urine samples from a general population with symptoms of sexually transmitted infections (STIs). All samples underwent a real-time PCR. For the detection of macrolide resistance, a 283bp fragment of region V of the 23S rRNA gene of M. genitalium was amplified and sequenced. RESULTS: We found a prevalence of 3.34% of M. genitalium and a macrolide resistance rate of 20%. In males, the prevalence was 6.62% and in women 0.96%, being significantly higher in males. CONCLUSIONS: The prevalence obtained shows that it is a pathogen to consider in our environment. These findings stress the need for routine testing of M. genitalium infections and would seem to suggest the advisability of resistance testing.

Survey of Carbapenemase-Producing Enterobacteriaceae in Companion Dogs in Madrid, Spain.

We found a low prevalence (0.6%) of carbapenemase-producingEnterobacteriaceae(CPE) in fecal microbiota of companion dogs. A single VIM-1-producingKlebsiella pneumoniaeisolate belonging to sequence type (ST) 2090 was detected.blaVIM-1was carried on a class 1 integron and an untypeable ∼48-kb plasmid. Emergence and spread of CPE in this group of animals may be a threat to public health in human and veterinary medicine. This finding supports the need for active surveillance studies in companion animals that live close to humans, as interspecies transmission may occur within the same household.