RESUMO
Vancomycin-resistant enterococci (VRE) have an important impact on pediatric oncology population. The objectives of this study were: to know the prevalence of VRE intestinal colonization in oncology patients, to identify the risk factors that predispose hospitalized patients to VRE intestinal colonization, and to determine the VRE resistance profile to different antimicrobial agents. We studied all children with oncological disease aged 1 month to 16 years that had joined the protocol and had been hospitalized from October 2006 to April 2007. VRE intestinal colonization was analyzed when the patient was admitted to hospital, 72 hours later, and weekly during hospitalization. A total of 333 samples were taken from 67 patients. From these, VRE were isolated in 12 patients, with a prevalence of 17.9%. Of the 28 isolates studied, taking one per patient, 10 were Enterococcus faecium and 2 Enterococcus faecalis, both with resistance phenotype VanA (CIM90 512 microg/ml to vancomycin and CIM90 256 microg/ml to teicoplanin). The use of vancomycin (p = 0.02), duration of neutropenia greater than 7 days (p = 0.03) and prolonged hospitalization (42.8 days on average) (p = 0.0001) were risk factors significantly related to VRE colonization. We considered it necessary to carry out an epidemiological surveillance and to implement prevention and control measures.
Assuntos
Enterococcus/efeitos dos fármacos , Intestinos/microbiologia , Neoplasias/microbiologia , Resistência a Vancomicina , Adolescente , Antibacterianos/farmacologia , Argentina/epidemiologia , Criança , Pré-Escolar , Infecção Hospitalar/prevenção & controle , Farmacorresistência Bacteriana Múltipla , Enterococcus/isolamento & purificação , Feminino , Infecções por Bactérias Gram-Positivas/prevenção & controle , Hospitais Pediátricos , Humanos , Hospedeiro Imunocomprometido , Lactente , Recém-Nascido , Masculino , Neutropenia/microbiologia , Prevalência , Fatores de RiscoRESUMO
The purpose of our research was to know the frequency of microorganisms causing bacteremia and/or fungemia in oncology patients from Hospital de Niños de Córdoba, as well as to describe the antimicrobial susceptibility patterns of bacteria isolated from January 2006 to April 2007. A total of 59 bacteremia and fungemia cases in 44 patients were studied. From the total number of isolations, 45.8% were gram-negative bacilli, 35.6% were gram-positive cocci, and 18.6% were yeasts. The global distribution of the most prevalent microorganisms was the following: Klebsiella spp. 15.3%; Staphylococcus aureus and Candida parapsilosis 11.9%; coagulase-negative staphylococci 10.2%; Escherichia coli 8.5%, and Pseudomonas aeruginosa 6.8%. More than 40% (41.2%) of enterobacteria showed an extended-spectrum beta-lactamase phenotype, and 20.0% of non-fermenting gram-negative bacilli were multi-resistant to tested antibiotics, while 38.5% of Staphylococcus spp. were methicillin-resistant. In conclusion, the most prevalent microorganisms were gram-negative bacilli, and within this group, enterobacteria evidenced a higher percentage of resistance to tested antibiotics.
Assuntos
Bacteriemia/complicações , Bacteriemia/microbiologia , Fungemia/complicações , Fungemia/microbiologia , Neoplasias/complicações , Bacteriemia/epidemiologia , Criança , Pré-Escolar , Feminino , Fungemia/epidemiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , PrevalênciaRESUMO
El objetivo del presente trabajo fue conocer la distribución y frecuencia de los microorganismos causantes de bacteriemias y fungemias en los pacientes oncológicos internados en el Hospital de Niños de Córdoba, así como describir sus patrones de sensibilidad a los antimicrobianos. Se estudiaron 59 episodios de bacteriemias y fungemias ocurridos entre enero de 2006 y abril de 2007 en 44 pacientes. Del total de los aislamientos recuperados, el 45,8% fueron bacilos gram-negativos, el 35,6% cocos gram-positivos y el 18,6% levaduras. La distribución global de los microorganismos más prevalentes fue: Klebsiella spp. 15,3%; Staphylococcus aureus 11,9%; Candida parapsilosis 11,9%; estafilococos coagulasa negativos 10,2%; Escherichia coli 8,5% y Pseudomonas aeruginosa 6,8%. El 41,2% de las enterobacterias aisladas presentó un fenotipo compatible con la presencia de alguna b-lactamasa de espectro extendido, y el 20,0% de los bacilos gram-negativos no fermentadores presentó multirresistencia a los antibióticos ensayados. En cuanto a los cocos gram-positivos, el 38,5% de los Staphylococcus spp. fue resistente a meticilina. Se puede concluir que los microorganismos más prevalentes en la población estudiada fueron los bacilos gram-negativos; dentro de este grupo las enterobacterias fueron las que presentaron mayor porcentaje de resistencia a los antibióticos ensayados.
The purpose of our research was to know the frequency of microorganisms causing bacteremia and/or fungemia in oncology patients from Hospital de Niños de Córdoba, as well as to describe the antimicrobial susceptibility patterns of bacteria isolated from January 2006 to April 2007. A total of 59 bacteremia and fungemia cases in 44 patients were studied. From the total number of isolations, 45.8% were gram-negative bacilli, 35.6% were gram-positive cocci, and 18.6% were yeasts. The global distribution of the most prevalent microorganisms was the following: Klebsiella spp. 15.3%; Staphylococcus aureus and Candida parapsilosis 11.9%; coagulase-negative staphylococci 10.2%; Escherichia coli 8.5%, and Pseudomonas aeruginosa 6.8%. More than 40% (41.2%) of enterobacteria showed an extended-spectrum b-lactamase phenotype, and 20.0% of non-fermenting gram-negative bacilli were multi-resistant to tested antibiotics, while 38.5% of Staphylococcus spp. were methicillin-resistant. In conclusion, the most prevalent microorganisms were gram-negative bacilli, and within this group, enterobacteria evidenced a higher percentage of resistance to tested antibiotics.
Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Masculino , Bacteriemia/complicações , Bacteriemia/microbiologia , Fungemia/complicações , Fungemia/microbiologia , Neoplasias/complicações , Bacteriemia/epidemiologia , Fungemia/epidemiologia , Testes de Sensibilidade Microbiana , PrevalênciaRESUMO
The aim of the present study was to investigate the presence of extended-spectrum beta-lactamases (ESBL) in Klebsiella pneumoniae isolated at the "Hospital de Niños de Córdoba". The strains were collected from inpatients between January 1996 and July 2000. A total of 150 ESBL producer isolates were detected. During 1996 the prevalence of ESBL producer K. pneumoniae was 20%, but since 1998 the values have increased to approximately 60%. Phenotypic analysis such as isoelectric point (pl) and antibiotyping performed in 32 randomly selected isolates showed two different enzyme profiles: 81% had ESBL with pl = 7.9 and preferential activity against cefotaxime, while 19% showed ESBL with pl = 5.4 and preferential activity against ceftazidime. No isolates resistant to imipenem or ciprofloxacin were detected. Susceptibility to other antimicrobial agents varied, but resistance to gentamicin was strongly associated with ESBL producer isolates. Resistance determinants could be transferred to Escherichia coli by conjugation assays.
Assuntos
Proteínas de Bactérias/isolamento & purificação , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , Resistência beta-Lactâmica , beta-Lactamases/isolamento & purificação , Antibacterianos/metabolismo , Antibacterianos/farmacologia , Argentina/epidemiologia , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Criança , Conjugação Genética , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla/genética , Hospitais Pediátricos , Humanos , Ponto Isoelétrico , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificação , Fenótipo , Prevalência , Estudos Retrospectivos , Especificidade por Substrato , Resistência beta-Lactâmica/genética , beta-Lactamases/genética , beta-Lactamases/metabolismo , beta-LactamasRESUMO
El objetivo de este estudio fue investigar la presencia de ß-lactamasas de espectro extendido (BLEE) en Klebsiella pneumoniae aisladas en el Hospital de Niños de Córdoba. Las cepas fueron obtenidas de pacientes internados entre enero de 1996 y julio de 2000. Se encontró un total de 150 aislamientos productores de BLEE. En el año 1996 la prevalencia de BLEE en K.pneumoniae fue del 20 por ciento, mientras que desde 1998 se ha mantenido en valores próximos al 60 por ciento. Estudios fenotípicos como la determinación del punto isoeléctrico (pl) y el antibiotipo realizados sobre un grupo de 32 aislamientos seleccionados al azar demostraron la presencia de dos tipos de enzimas. El 81 por ciento mostró una BLEE con pl=7,9 y mayor actividad sobre cefotaxima y el 19 por ciento restante presentó una BLEE con pl=5,4 y mayor actividad sobre ceftacidima. No se detectaron aislamientos resistentes a imipenem ni a ciprofloxacina. La sensibilidad a otras drogas fue variable, siendo muy frecuente la resistencia asociada a gentamicina. Los determinantes de resistencia pudieron transferirse por conjugación a Escherichia coli.
Assuntos
Criança , Argentina , beta-Lactamases , Cefalosporinas , Resistência Microbiana a Medicamentos , Klebsiella pneumoniaeRESUMO
El objetivo de este estudio fue investigar la presencia de ß-lactamasas de espectro extendido (BLEE) en Klebsiella pneumoniae aisladas en el Hospital de Niños de Córdoba. Las cepas fueron obtenidas de pacientes internados entre enero de 1996 y julio de 2000. Se encontró un total de 150 aislamientos productores de BLEE. En el año 1996 la prevalencia de BLEE en K.pneumoniae fue del 20 por ciento, mientras que desde 1998 se ha mantenido en valores próximos al 60 por ciento. Estudios fenotípicos como la determinación del punto isoeléctrico (pl) y el antibiotipo realizados sobre un grupo de 32 aislamientos seleccionados al azar demostraron la presencia de dos tipos de enzimas. El 81 por ciento mostró una BLEE con pl=7,9 y mayor actividad sobre cefotaxima y el 19 por ciento restante presentó una BLEE con pl=5,4 y mayor actividad sobre ceftacidima. No se detectaron aislamientos resistentes a imipenem ni a ciprofloxacina. La sensibilidad a otras drogas fue variable, siendo muy frecuente la resistencia asociada a gentamicina. Los determinantes de resistencia pudieron transferirse por conjugación a Escherichia coli. (AU)
Assuntos
Criança , Klebsiella pneumoniae , beta-Lactamases , Resistência Microbiana a Medicamentos , Cefalosporinas , ArgentinaRESUMO
The aim of the present study was to investigate the presence of extended-spectrum beta-lactamases (ESBL) in Klebsiella pneumoniae isolated at the [quot ]Hospital de Niños de Córdoba[quot ]. The strains were collected from inpatients between January 1996 and July 2000. A total of 150 ESBL producer isolates were detected. During 1996 the prevalence of ESBL producer K. pneumoniae was 20
, but since 1998 the values have increased to approximately 60
. Phenotypic analysis such as isoelectric point (pl) and antibiotyping performed in 32 randomly selected isolates showed two different enzyme profiles: 81
had ESBL with pl = 7.9 and preferential activity against cefotaxime, while 19
showed ESBL with pl = 5.4 and preferential activity against ceftazidime. No isolates resistant to imipenem or ciprofloxacin were detected. Susceptibility to other antimicrobial agents varied, but resistance to gentamicin was strongly associated with ESBL producer isolates. Resistance determinants could be transferred to Escherichia coli by conjugation assays.
RESUMO
The wide variety of prevalence of antimicrobial resistant Streptococcus pneumoniae in different countries confirms the importance of determining local patterns of resistance. From 1992 to 2000, we studied the pattern of antimicrobial resistance in S. pneumoniae and its evolution along the years, using 468 strains isolated in the Hospital de Niños de Córdoba. A total of 177 isolates (37.8%) were not susceptible to penicillin, with 19% intermediate and 18.8% resistant strains. High and intermediate resistance levels to cefotaxime were 4.9% and 10.9%, respectively. Decreased susceptibility to trimethoprim/sulfamethoxazole (TMS), erythromycin, chloramphenicol, and rifampin was found in 194 isolates (41.5%), 32 (6.8%), 13 (2.8%) and 3 (0.6%), respectively. No isolates resistant to vancomycin were detected. The most commonly combined resistance patterns were: penicillin/TMS (35.6%) and penicillin/TMS/cefotaxime (11.8%). This study highlights the increased rate of drug resistant S. pneumoniae during the last years, and the importance of antimicrobial resistance surveillance of adequate empirical therapy involving local and regional susceptibility patterns.
Assuntos
Infecção Hospitalar/microbiologia , Resistência Microbiana a Medicamentos , Infecções Estreptocócicas/microbiologia , Streptococcus pneumoniae/efeitos dos fármacos , Adolescente , Argentina/epidemiologia , Líquidos Corporais/microbiologia , Cefotaxima/farmacologia , Criança , Pré-Escolar , Resistência ao Cloranfenicol , Infecção Hospitalar/epidemiologia , Eritromicina/farmacologia , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Testes de Sensibilidade Microbiana , Resistência às Penicilinas , Estudos Retrospectivos , Rifampina/farmacologia , Infecções Estreptocócicas/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Vancomicina/farmacologiaRESUMO
The wide variety of prevalence of antimicrobial resistant Streptococcus pneumoniae in different countries confirms the importance of determining local patterns of resistance. From 1992 to 2000, we studied the pattern of antimicrobial resistance in S. pneumoniae and its evolution along the years, using 468 strains isolated in the Hospital de Niños de Córdoba. A total of 177 isolates (37.8) were not susceptible to penicillin, with 19 intermediate and 18.8 resistant strains. High and intermediate resistance levels to cefotaxime were 4.9 and 10.9, respectively. Decreased susceptibility to trimethoprim/sulfamethoxazole (TMS), erythromycin, chloramphenicol, and rifampin was found in 194 isolates (41.5), 32 (6.8), 13 (2.8) and 3 (0.6), respectively. No isolates resistant to vancomycin were detected. The most commonly combined resistance patterns were: penicillin/TMS (35.6) and penicillin/TMS/cefotaxime (11.8). This study highlights the increased rate of drug resistant S. pneumoniae during the last years, and the importance of antimicrobial resistance surveillance of adequate empirical therapy involving local and regional susceptibility patterns.
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Infecção Hospitalar/microbiologia , Infecções Estreptocócicas/microbiologia , Resistência Microbiana a Medicamentos , Streptococcus pneumoniae , Argentina , Cefotaxima , Resistência ao Cloranfenicol , Eritromicina , Hospitais Pediátricos , Infecção Hospitalar/epidemiologia , Infecções Estreptocócicas/epidemiologia , Líquidos Corporais/microbiologia , Testes de Sensibilidade Microbiana , Resistência às Penicilinas , Estudos Retrospectivos , Rifampina , Streptococcus pneumoniae , Combinação Trimetoprima e Sulfametoxazol/farmacologia , VancomicinaRESUMO
The wide variety of prevalence of antimicrobial resistant Streptococcus pneumoniae in different countries confirms the importance of determining local patterns of resistance. From 1992 to 2000, we studied the pattern of antimicrobial resistance in S. pneumoniae and its evolution along the years, using 468 strains isolated in the Hospital de Niños de Córdoba. A total of 177 isolates (37.8) were not susceptible to penicillin, with 19 intermediate and 18.8 resistant strains. High and intermediate resistance levels to cefotaxime were 4.9 and 10.9, respectively. Decreased susceptibility to trimethoprim/sulfamethoxazole (TMS), erythromycin, chloramphenicol, and rifampin was found in 194 isolates (41.5), 32 (6.8), 13 (2.8) and 3 (0.6), respectively. No isolates resistant to vancomycin were detected. The most commonly combined resistance patterns were: penicillin/TMS (35.6) and penicillin/TMS/cefotaxime (11.8). This study highlights the increased rate of drug resistant S. pneumoniae during the last years, and the importance of antimicrobial resistance surveillance of adequate empirical therapy involving local and regional susceptibility patterns.(AU)
Assuntos
Estudo Comparativo , Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Infecção Hospitalar/microbiologia , Resistência Microbiana a Medicamentos , Infecções Estreptocócicas/microbiologia , Streptococcus pneumoniae/efeitos dos fármacos , Argentina/epidemiologia , Líquidos Corporais/microbiologia , Cefotaxima/farmacologia , Resistência ao Cloranfenicol , Infecção Hospitalar/epidemiologia , Eritromicina/farmacologia , Hospitais Pediátricos , Testes de Sensibilidade Microbiana , Resistência às Penicilinas , Estudos Retrospectivos , Rifampina/farmacologia , Infecções Estreptocócicas/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Vancomicina/farmacologiaRESUMO
The wide variety of prevalence of antimicrobial resistant Streptococcus pneumoniae in different countries confirms the importance of determining local patterns of resistance. From 1992 to 2000, we studied the pattern of antimicrobial resistance in S. pneumoniae and its evolution along the years, using 468 strains isolated in the Hospital de Niños de Córdoba. A total of 177 isolates (37.8
) were not susceptible to penicillin, with 19
intermediate and 18.8
resistant strains. High and intermediate resistance levels to cefotaxime were 4.9
and 10.9
, respectively. Decreased susceptibility to trimethoprim/sulfamethoxazole (TMS), erythromycin, chloramphenicol, and rifampin was found in 194 isolates (41.5
), 32 (6.8
), 13 (2.8
) and 3 (0.6
), respectively. No isolates resistant to vancomycin were detected. The most commonly combined resistance patterns were: penicillin/TMS (35.6
) and penicillin/TMS/cefotaxime (11.8
). This study highlights the increased rate of drug resistant S. pneumoniae during the last years, and the importance of antimicrobial resistance surveillance of adequate empirical therapy involving local and regional susceptibility patterns.
RESUMO
This study analyzed the evolution of antimicrobial resistance in 771 isolates of Shigella spp. obtained from a total of 9,195 feces cultures done between 1990 and 1997 in a children's hospital in Córdoba, Argentina. S. flexneri, which was responsible for 73% of the Shigella infections, was the species with the greatest resistance. The frequency of S. flexneri resistance to the three antibiotics most used (ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol) increased from 10% in 1990 to 58% in 1997 (P < 0.001). Considering each of the drugs individually, the resistance to ampicillin increased from 60% to 100% (P < 0.001), the resistance to chloramphenicol from 13% to 71% (P < 0.001), and the resistance to trimethoprim-sulfamethoxazole from 79% to 84% (P = 0.22). For S. sonnei, the increase in resistance to ampicillin (from 36% in 1990 to 54% in 1997) was not statistically significant (P = 0.20), nor was the reduction in resistance to trimethoprim-sulfamethoxazole, which went from 82% in 1990 to 55% in 1997 (P = 0.08). Only two S. sonnei isolates were found that were resistant to chloramphenicol, one in 1995 and another in 1997; two S. sonnei isolates were found with resistance to all three antibiotics. We consider it essential to carry out susceptibility tests of each Shigella clinical isolate, to detect changes in the resistance profile and thus modify empiric treatment.
