RESUMO
El incremento en los últimos 10 años de los episodios de candidemia, la identificación de especies inusuales de Candida usando sistemas fenotípicos, la resistencia intrínseca y emergente en aislados clínicos a distintos antifungicos son elementos que nos conducen a realizar identificaciones más precisas y conocer los perfiles de susceptibilidad de las especies de Candida asociadas a fungemias. Objetivo: Realizamos una caracterización genotípica y fenotípica de los aislados clínicos de levaduras procedentes de muestras de hemocultivos de pacientes hospitalizados en el Hospital del Niño del periodo 2009 al 2010, para determinar la frecuencia de distribución las especies de Candida asociadas a fungemia y sus respectivos perfiles de susceptibilidad. Material y método: Se recolectaron un total de 55 cepas de Candida spp y levaduras relacionadas. Sólo se incluyó pacientes hospitalizados con hemocultivos positivos cuyo agente etiológico fueran levaduras y un sólo episodio por paciente, en las salas de Hemato-Oncología , Neonatología, Quemados, Medicina 6 y la Unidad de Terapia Intensiva del Hospital del Niño en el periodo de mayo 2009 a 2010. Se evaluaron 55 cepas, las cuales fueron identificadas usando el Vitek2, la prueba pagar harina de maíz y el método de PCR fingerprinter. Los patrones de bandas de los aislados clínicos fueron comparados con cepas de referencia para confirmar las identificaciones fenotípicas. Se realizaron pruebas de susceptibilidad para 6 antifúngicos de uso sistémico. Resultados: La distribución global final fue la siguiente: complejo de Candida parapsilosis (40%), Candida tropicalis (29.1%), Candida albicans (20%) Candida guilliermondi (3.6%), Sporobolomyces salmonicolor (1.8%), Saccharomyces cerevisiae (1.8%) y complejo Candida haemulonii (3.6%). Las especies del complejo C.parapsilolis presentó 6.3% resistencia a caspofungina y a itraconazol, mientras que C.albicans resultó con 18.2% de resistencia a caspofungina y anfotericina B, y 9.1% de resistencia a fluconazol, itraconazol y voriconazol. Algunas cepas de C.albicans fueron resistentes a varios antifúngicos. Conclusiones: A pesar de las limitaciones del sistema bioquímico automatizado Vitek2, resulta una herramienta útil para la identificación de los aislados clínicos de Candida app. Las pruebas de susceptibilidad usando el método de difusión con pagar Mullër Hinton dosificado resultó altamente confiable y reproducible. Candida parapsilosis fue la causa de fungemia en el Hospital del Niño durante el periodo de estudio. La resistencia a los distintos antifúngicos de los aislados clínicos de Candida spp. no excedió el 10% excepto por caspofungina.
Introduction: The increase in the last 10 years of episodes of candidemia, identification of unusual Candida species using phenotypic systems, intrinsic and emerging resistance in clinical isolates are different anti fungal elements that lead us to make more accurate identifications and knowing the profiles susceptibility of Candida species associated fungemia. Objetive: We do a genotypic and phenotypic characterization of clinical isolates of yeasts from blood cultures of hospitalized patients in the Hospital del Niño period 2009 to 2010 to determine the frequency distribution of Candida species associated with fungemia and their respective profiles susceptibility. Methods: A total of 55 strains of Candida spp and related yeasts were collected. Only hospitalized patients with positive blood cultures whose etiologic agent were yeasts and one episode per patient, in the halls of Hematology - Oncology, Neonatology, Burned, Medicine 6 and the Intensive Care Unit at Hospital del Niño between May 2009 included 2010. The 55 strains were evaluated, which were identified using the VItek2 system, Cornmeal agar test and PCR method fingerprinter. The banding patterns of clinical isolates were compared with reference strains to confirm phenotypic identifications. Susceptibility test were performed for 6 anti fungal for systemic use. Results: The global final distribution was as follows: Candida parapsilosis complex (40%), Candida tropical (29.1%), Candida albinas (20%), Candida gulliermondi (3.6%), Sporobolomyces salmonicolor (1.8%), Saccharomyces cerevisiae (1.8%), Candida complex haemulonii (3.6%). C.parapsilosis complex species showed 77.3% resistance to caspofungin and itraconazole 4.3%; C.tropicalis presented 6.3% resistance to caspofungin and itraconazole while C.albicans resulted with 18.2% resistance to caspofungin and amphotericin B, and 9.1% resistance to fluconazole, itraconazole and voriconazole. Some strains of C.albicans were resistance to several antifungal. Conclusions: Despite the limitations of automated biochemistry Vitek2 system, is a useful tool for identifying clinical isolates of Candida spp. Susceptibility tests using the agar diffusion method was dosed Muller Hinton highly reliable and reproducible. Candida parapsilosis was the main cause of fungemia in the Hospital del Niño during the study period. Resistance to antifungal different clinical isolates of Candida spp did not exceed 10% except for caspofungin.
RESUMO
BACKGROUND: Tuberculosis continues to be one of the leading causes of death worldwide and in the American region. Although multidrug-resistant tuberculosis (MDR-TB) remains a threat to TB control in Panama, few studies have focused in typing MDR-TB strains. The aim of our study was to characterize MDR Mycobacterium tuberculosis clinical isolates using PCR-based genetic markers. METHODS: From 2002 to 2004, a total of 231 Mycobacterium tuberculosis isolates from TB cases country-wide were screened for antibiotic resistance, and MDR-TB isolates were further genotyped by double repetitive element PCR (DRE-PCR), (GTG)5-PCR and spoligotyping. RESULTS: A total of 37 isolates (0.85%) were resistant to both isoniazid (INH) and rifampicin (RIF). Among these 37 isolates, only two (5.4%) were resistant to all five drugs tested. Dual genotyping using DRE-PCR and (GTG)5-PCR of MDR Mycobacterium tuberculosis isolates revealed eight clusters comprising 82.9% of the MDR-TB strain collection, and six isolates (17.1%) showed unique fingerprints. The spoligotyping of MDR-TB clinical isolates identified 68% as members of the 42 (LAM9) family genotype. CONCLUSION: Our findings suggest that MDR Mycobacterium tuberculosis is highly clustered in Panama's metropolitan area corresponding to Panama City and Colon City, and our study reveals the genotype distribution across the country.
