RESUMO
In 2011, Chile experienced an increase in the number of cases of IMD caused by Neisseria meningitidis group W. This epidemiological scenario prompted authorities to implement prevention strategies. As part of these strategies, the Institute of Public Heath of Chile conducted a cross-sectional study to determine the prevalence of pharyngeal carriage of N. meningitidis in a representative sample of healthy children and adolescents aged 10-19 years. The identification of presumptive N. meningitidis strains was performed by testing carbohydrate utilization in the National Reference Laboratory at the ISP. Association of meningococcal carriage with risk factors was analyzed by calculating the Odds Ratio. Selected variables were included in a logistic model for risk analyses. The prevalence of carriage of N. meningitidis was 6.5% (CI: 5.7-7.3%). Older age (carriers: 14.2±0.29 vs. non-carriers: 13.8±0.08 years old; p=0.009), cohabitation with children (carriers: 0.9±0.13 vs. non-carriers: 0.7±0.03; p=0.028), number of smoking cohabitants (carriers: 0.55±0.13 vs. non-carriers: 0.44±0.03) and frequent attendance to crowded social venues (carriers: 49% vs. non-carriers: 37%; p=0.008) were determined to favor carriage. Statistical modeling showed that meningococcal carriage was associated with older age (OR: 1.077, p-value: 0.002) and cohabitation with children (OR: 1.182, p-value: 0.02).
Assuntos
Portador Sadio/epidemiologia , Infecções Meningocócicas/epidemiologia , Nasofaringe/microbiologia , Neisseria meningitidis/isolamento & purificação , Adolescente , Criança , Chile , Estudos Transversais , Feminino , Humanos , Masculino , Modelos Estatísticos , Prevalência , Fatores de Risco , Adulto JovemRESUMO
Serogroup W Neisseria meningitidis was the main cause of invasive meningococcal disease in Chile during 2012. The case-fatality rate for this disease was higher than in previous years. Genotyping of meningococci isolated from case-patients identified the hypervirulent lineage W:P1.5,2:ST-11, which contained allele 22 of the fHbp gene.
Assuntos
Meningite Meningocócica/epidemiologia , Meningite Meningocócica/microbiologia , Neisseria meningitidis/classificação , Chile/epidemiologia , Genes Bacterianos , História do Século XXI , Humanos , Meningite Meningocócica/história , Tipagem Molecular , Neisseria meningitidis/genética , Vigilância da População , SorotipagemRESUMO
Background: 10-valent pneumococcal vaccine (PCV-10) was introduced in 2011 to the National Immunization Program in Chile. It was administered in 4 doses, but in 2012 it was modified to a 3 dose program. This article shows the results of the Laboratory Surveillance System for Streptococcus pneumoniae isolated of invasive disease from 2007 to 2012 and compares the incidence of invasive pneumococcal disease (IPD) by age groups in the prevaccinal (2007-2010) and postvaccinal period (2012). Methods: Descriptive study of S. pneumoniae surveillance in invasive diseases cases confirmed at the National Reference Laboratory of the Institute of Public Health of Chile from 2007 to 2012. Results: Global incidence of laboratory confirmed IPD cases decreased 27.8% from 2007 to 2012 and showed a lower risk for IPD in 2012 compared with 2007. Incidence in children aged 1 year or less decreased from 56.1 to 16.3 per 100,000 and from 42.0 to 19.9 per 100,000 in children aged 12 to 23 months in the same period. Highest decreases were observed in IPD cases caused by serotypes 4 (100%), 19F (93.3%), 23F (90.9%), 14 (81.1%), 6B (70%), 18C (58.3%) and 1(81.8%) in children aged 2 years or less. Conclusion: Surveillance System detects S.pneumoniae isolated from invasive diseases, contributing with information about laboratory confirmed IPD trends, prevalent serotypes and replacement effects. These results can be used as evidence in healthcare decision making for pneumococcal vaccines.
Introducción: La vacuna neumocóccica 10 valente fue incorporada al Programa Nacional de Inmunizaciones (PNI) desde enero de 2011 para lactantes mediante un esquema de cuatro dosis, y desde 2012, con un esquema de tres dosis. El objetivo de esta publicación es dar a conocer el resultado de la vigilancia de laboratorio de Streptococcus pneumoniae aislado de enfermedad invasora (ENI) desde el año 2007 al 2012 y comparar la incidencia de esta enfermedad según grupos de edades en un período prevacunal (2007-2010) con el postvacunal (2012). Materiales y Métodos: Estudio descriptivo de los resultados de la vigilancia de S. pneumoniae en los casos de ENI confirmados microbiológicamente en Chile, en el Laboratorio Biomédico Nacional de Referencia del Instituto de Salud Pública de Chile (ISP) durante los años 2007 a 2012. Resultados: La evolución de la incidencia global de S. pneumoniae en casos de ENI muestra un menor riesgo en los años estudiados (OR 2011 vs 2007-2010: 0,82 (IC 95%: 0,75-0,89); OR 2012 vs 2007-2010: 0,76 (IC 95%: 0,70-0,82)). En niños bajo un año de edad, la incidencia disminuyó desde 56,1 a 16,3 por 100.000 y en niños de 12 meses a 23 meses desde 42,0 a 19,9 por 100.000, en el mismo período. Los mayores porcentajes de disminución en los menores de 2 años se observaron en los casos de ENI producidos por los serotipos 4 (100%), 19F (93,3%), 23F (90,9%), 14 (81,1%), 6B (70%), 18C (58,3%) y 1(81,8%). Conclusión: El sistema de vigilancia permite detectar cepas de S. pneumoniae aisladas de enfermedad invasora en nuestro país, lo que aporta información respecto de la tendencia de la ENI confirmada microbiológicamente en Chile, los serotipos prevalentes y el posible efecto de reemplazo de ellos descrito en otros países, aportando a la autoridad de salud una herramienta adicional para la toma de decisiones respecto del tipo de vacuna a usar en el PNI con la mejor evidencia disponible.
Assuntos
Adolescente , Idoso , Criança , Pré-Escolar , Humanos , Lactente , Pessoa de Meia-Idade , Infecções Pneumocócicas/epidemiologia , Vacinas Pneumocócicas/administração & dosagem , Streptococcus pneumoniae , Chile/epidemiologia , Incidência , Vigilância da População , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/prevenção & controleRESUMO
BACKGROUND: Laboratory surveillance of Invasive Meningococcal Disease (IMD) is performed by the Institute of Public Health of Chile. It confirms identification, classifies in serogroups and analyzes the genetic profiles of Neisseria meningitidis isolates from laboratories throughout the country. AIM: To show the results of this surveillance from 2006 to 2012. METHODS: A descriptive data analysis of the confirmed cases of IMD and serological characterization, susceptibility and genetic profiles of the isolates. The analysis was disaggregated by serogroup, age and region. RESULTS: From 2006 to 2012, 486 isolates of N. meningitidis were confirmed. In 2011 a rise in IMD rates was observed due to an increase in W serogroup cases, mainly affecting children aged 5 years or less. Serogroup W became the most prevalent during 2012 (58.3%), replacing the historically prevalent serogroup B. Predominating strains belonged to ST-32 complex/ET-5 complex (40, 4% of strains) and ST-41/44 complex/ Lineage 3 (45, 9% of strains). CONCLUSIONS: Laboratory surveillance has allowed the early detection of increasing IMD caused by serogroup W, which is emergent in Chile. This information has reinforced the daily monitoring of new cases, in collaboration with all the clinical laboratories of the country.
Assuntos
Infecções Meningocócicas/epidemiologia , Neisseria meningitidis , Vigilância da População , Adolescente , Adulto , Antibacterianos/farmacologia , Técnicas de Tipagem Bacteriana , Criança , Pré-Escolar , Chile/epidemiologia , Monitoramento Epidemiológico , Genótipo , Humanos , Incidência , Lactente , Infecções Meningocócicas/microbiologia , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Neisseria meningitidis/efeitos dos fármacos , Neisseria meningitidis/genética , Adulto JovemRESUMO
Background: Laboratory surveillance of Invasive Meningococcal Disease (IMD) is performed by the Institute of Public Health of Chile. It confirms identification, classifies in serogroups and analyzes the genetic profiles of Neisseria meningitidis isolates from laboratories throughout the country. Aim: To show the results of this surveillance from 2006 to 2012. Methods: A descriptive data analysis of the confirmed cases of IMD and serological characterization, susceptibility and genetic profiles of the isolates. The analysis was disaggregated by serogroup, age and region. Results: From 2006 to 2012, 486 isolates of N. meningitidis were confirmed. In 2011 a rise in IMD rates was observed due to an increase in W serogroup cases, mainly affecting children aged 5 years or less. Serogroup W became the most prevalent during 2012 (58.3%), replacing the historically prevalent serogroup B. Predominating strains belonged to ST-32 complex/ET-5 complex (40, 4% of strains) and ST-41/44 complex/ Lineage 3 (45, 9% of strains). Conclusions: Laboratory surveillance has allowed the early detection of increasing IMD caused by serogroup W, which is emergent in Chile. This information has reinforced the daily monitoring of new cases, in collaboration with all the clinical laboratories of the country.
Introducción: La vigilancia de laboratorio de enfermedad meningocócica invasora (EMI) que realiza el Instituto de Salud Pública de Chile, confirma, seroagrupa y estudia el perfil genético de las cepas de Neisseria meningitidis provenientes de los laboratorios del país. Objetivo: En este artículo se muestra los resultados de esta vigilancia entre los años 2006 a 2012. Materiales y Métodos: Se realizó un análisis descriptivo de los casos confirmados de EMI, caracterización serológica, el análisis de susceptibilidad antimicrobiana y el estudio de subtipo genético de la cepa. El análisis se desagregó por serogrupo, edad y región. Resultados: En el período 2006-2012 fue confirmado un total de 486 cepas de N. meningitidis. A partir del año 2011 se observó un alza en la tasa de EMI dado por el número de casos del serogrupo W, afectando principalmente a niños bajo 5 años de edad. El W se transformó en el serogrupo prevalente el año 2012 (58,3%), desplazando al serogrupo B, el cual históricamente había sido prevalente. Predominaron principalmente las cepas pertenecientes al complejo clonal ST-32 complex/ET-5 complex (40,4% de las muestras) y el ST-41/44 complex/Lineage 3 (45,9% de las muestras). Conclusiones: El sistema de vigilancia de laboratorio ha permitido la identificación del serogrupo W, emergente en Chile. Esta información nos ha obligado a estar en permanente alerta y monitoreo de casos diarios, mediante la participación activa de todos los laboratorios clínicos del país.
Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Pessoa de Meia-Idade , Adulto Jovem , Infecções Meningocócicas/epidemiologia , Neisseria meningitidis , Vigilância da População , Antibacterianos/farmacologia , Técnicas de Tipagem Bacteriana , Chile/epidemiologia , Monitoramento Epidemiológico , Genótipo , Incidência , Testes de Sensibilidade Microbiana , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/efeitos dos fármacos , Neisseria meningitidis/genéticaRESUMO
BACKGROUND: 10-valent pneumococcal vaccine (PCV-10) was introduced in 2011 to the National Immunization Program in Chile. It was administered in 4 doses, but in 2012 it was modified to a 3 dose program. This article shows the results of the Laboratory Surveillance System for Streptococcus pneumoniae isolated of invasive disease from 2007 to 2012 and compares the incidence of invasive pneumococcal disease (IPD) by age groups in the prevaccinal (2007-2010) and postvaccinal period (2012). METHODS: Descriptive study of S. pneumoniae surveillance in invasive diseases cases confirmed at the National Reference Laboratory of the Institute of Public Health of Chile from 2007 to 2012. RESULTS: Global incidence of laboratory confirmed IPD cases decreased 27.8% from 2007 to 2012 and showed a lower risk for IPD in 2012 compared with 2007. Incidence in children aged 1 year or less decreased from 56.1 to 16.3 per 100,000 and from 42.0 to 19.9 per 100,000 in children aged 12 to 23 months in the same period. Highest decreases were observed in IPD cases caused by serotypes 4 (100%), 19F (93.3%), 23F (90.9%), 14 (81.1%), 6B (70%), 18C (58.3%) and 1(81.8%) in children aged 2 years or less. CONCLUSION: Surveillance System detects S.pneumoniae isolated from invasive diseases, contributing with information about laboratory confirmed IPD trends, prevalent serotypes and replacement effects. These results can be used as evidence in healthcare decision making for pneumococcal vaccines.
Assuntos
Infecções Pneumocócicas/epidemiologia , Vacinas Pneumocócicas/administração & dosagem , Streptococcus pneumoniae , Adolescente , Idoso , Criança , Pré-Escolar , Chile/epidemiologia , Humanos , Incidência , Lactente , Pessoa de Meia-Idade , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/prevenção & controle , Vigilância da PopulaçãoRESUMO
The epidemiologic behavior of the Invasive Meningococcal Disease (IMD) in Chile has changed. At the end of 2011, the W135 serogroup belonging to the hypervirulent clone ST-11 emerged. It affected diverse countries of the world, after the Mecca pilgrimage in 2000. In Chile, there have been 133 IMD cases during 2012. These figures represent an incidence of 0.7 per 100,000 inhabitants, which is 30% higher than expected. Eighty eight percent of cases were confirmed by the National Reference Laboratory at the Chilean Public Health Institute. The serogroup was determined in 103 strains and 58% belonged to the W135 serogroup, surpassing for the first time the B serogroup (37%). The Metropolitan Region concentrated 80% of these cases, and the remaining 20% affected other seven regions of the country. Forty seven percent of cases corresponded to children less than 5 years of age. The predominant clinical presentation of the W135 serogroup was a sepsis in 67% of cases. The fatality ratio of IDM during 2012 was 27%, the highest in the past 20 years. With this information, the Chilean Ministry of Health decreed a sanitary alert and implemented an integrated approach to control and prevent W-135 IDM, denominated "W-135 Action Plan".
Assuntos
Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Meningite Meningocócica/epidemiologia , /classificação , Chile/epidemiologia , Eletroforese em Gel de Campo Pulsado , Monitoramento Epidemiológico , Incidência , Meningite Meningocócica/diagnóstico , Meningite Meningocócica/microbiologia , Tipagem de Sequências Multilocus , /genética , SorotipagemRESUMO
BACKGROUND: With the upcoming licensure of Outer Membrane Protein-based vaccines against meningococcal disease, data on disease incidence and molecular characteristic of circulating N. meningitidis strains in Latin American countries is needed. Chile is, to date, one of the few countries in the region that has performed this type of work in a comprehensive collection of disease-associated strains from two consecutive years, 2010-2011. METHODS: A total of 119 N. meningitidis strains isolated from patients with invasive disease in Chile in 2010-2011 were characterized by the National Reference Laboratory. Serogroup determination, MLST and porA typing were performed. RESULTS: Serogroup B was predominant in both study years, but W135 experienced a noticeable increase in 2011 compared to 2010. ST-11 complex, ST-41/44 complex ST-32 complex were the most prevalent among the isolates, and were strongly associated with serogroups W135 (ST-11 Complex) and B (ST-41/44 and ST-32 complexes). Likewise, the major porA types detected were strongly associated with these three clonal complexes: P1.5,2 was found exclusively among W135:ST-11 isolates, whereas P1.7, 2-3 was only detected in C:ST-11. ST-41/44 isolates mainly had P1.10-8, and ST-32 complex were associated with a P1.18-8 porA. CONCLUSIONS: Our data show disease-associated N. meningitidis circulating in Chile are similar to those found in other parts of the world. The increase on W135:ST-11 isolates observed in 2011 foretold the unusual epidemiological situation experienced in the country in 2012, and MLST data show that this strain is indistinguishable from the one linked to the global Hajj 2000-related outbreak that occurred in 2001. Finally, this work demonstrates the importance of maintaining a strong national surveillance program integrating clinical, epidemiological and laboratory data and incorporating gold standard diagnostic and characterization techniques that allow the data to be compared all over the world.
Assuntos
Neisseria meningitidis/genética , Técnicas de Tipagem Bacteriana , Chile , Humanos , Infecções Meningocócicas/microbiologia , Tipagem de Sequências Multilocus , Neisseria meningitidis/classificação , Neisseria meningitidis/patogenicidade , SorotipagemRESUMO
The epidemiologic behavior of the Invasive Meningococcal Disease (IMD) in Chile has changed. At the end of 2011, the W135 serogroup belonging to the hypervirulent clone ST-11 emerged. It affected diverse countries of the world, after the Mecca pilgrimage in 2000. In Chile, there have been 133 IMD cases during 2012. These figures represent an incidence of 0.7 per 100,000 inhabitants, which is 30% higher than expected. Eighty eight percent of cases were confirmed by the National Reference Laboratory at the Chilean Public Health Institute. The serogroup was determined in 103 strains and 58% belonged to the W135 serogroup, surpassing for the first time the B serogroup (37%). The Metropolitan Region concentrated 80% of these cases, and the remaining 20% affected other seven regions of the country. Forty seven percent of cases corresponded to children less than 5 years of age. The predominant clinical presentation of the W135 serogroup was a sepsis in 67% of cases. The fatality ratio of IDM during 2012 was 27%, the highest in the past 20 years. With this information, the Chilean Ministry of Health decreed a sanitary alert and implemented an integrated approach to control and prevent W-135 IDM, denominated "W-135 Action Plan".
Assuntos
Meningite Meningocócica/epidemiologia , Neisseria meningitidis Sorogrupo W-135/classificação , Idoso , Criança , Pré-Escolar , Chile/epidemiologia , Eletroforese em Gel de Campo Pulsado , Monitoramento Epidemiológico , Feminino , Humanos , Incidência , Lactente , Masculino , Meningite Meningocócica/diagnóstico , Meningite Meningocócica/microbiologia , Tipagem de Sequências Multilocus , Neisseria meningitidis Sorogrupo W-135/genética , SorotipagemRESUMO
La enfermedad meningocócica es de distribución mundial y presenta brotes de gran magnitud en el cinturón de la meningitis (África Subsahariana). A partir de 2001, la tendencia de la enfermedad en Chile disminuye, cambiando su presentación a baja endemia. Así, en el 2010 presentó una incidencia de 0,5 por cien mil habitantes. El grupo más afectado son los menores de 5 años, y de éstos, los menores de un año. Además, desde 1994 el serogrupo C fue considerado reemergente, produciendo brotes en 1999 y 2002. Esta enfermedad es de vigilancia universal e inmediata, cuyo sistema de vigilancia contempla indicadores de calidad, que evalúan los componentes clínico, epidemiológico y laboratorio. Este artículo analiza la situación epidemiológica de la enfermedad en Chile y su tendencia mundial, así como el fundamento para el cumplimiento de indicadores que requieren una respuesta oportuna frente al caso sospechoso sin esperar la confirmación de laboratorio.
Meningococcal disease has worldwide distribution and present large-scale outbreaks on the meningitis belt (sub-Saharian Africa). Since 2001, disease trend in Chile decreases, changing its presentation to low endemicity. Thus, 2010 registered an incidence of 0.5 per 100 thousand habitants. The most affected group was < 5 years old, specifically < 1 year old. Besides,since 1994, serogroup C was considered re-emergent, causing outbreaks in 1999 and 2002. This disease considersimmediate and universal surveillance and comprise quality indicators that assess clinical, epidemiological and laboratory components. This article analyze the epidemiological situation in Chile and its world trend, also the fundamental basis for indicator fullfilments that requires a fast response against a suspected case, without waiting for laboratory confirmation.
Assuntos
Humanos , Lactente , Pré-Escolar , Meningite Meningocócica/epidemiologia , Neisseria meningitidis , Notificação de Abuso , Monitoramento Epidemiológico , ChileRESUMO
Objetivo: Conocer y proveer de evidencia acerca de la sensibilidad de la flora bacteriana normal de la superficie ocular aislada en dos diferentes grupos sociales y etáreos de pacientes prontos a someterse a cirugía de Catarata y LASIK en nuestro país. Materiales y Métodos: Se cultivaron muestran conjuntivales de 221 pacientes previo a LASIK y de 180 pacientes de un grupo de Cataratas. De haber un cultivo positivo se realizó aislamiento e identificación bacteriana utilizando la técnica de difusión en disco de Kirby-Bauer para doce antibióticos. El análisis estadístico se hizo con chi-cuadrado y el test exacto de Fisher. Resultados: Hubo 66,8 por ciento de cultivos positivos, más frecuentemente gran positivos. SCN fue el aislado en mayor porcentaje (92,2 por ciento) y mostró una alta sensibilidad a Cloramfenicol, Tobramicina, Moxifloxacino y Gatifloxacino, intermedia para Levofloxacino, Gentamicina y Ciprofloxacino y menor para Eritromicina, Oxacilina, Cefalotina y Ceftriaxona (p<0,01). Todos los cultivos fueron sensibles a Vancomicina. No hubo diferencia estadísticamente significativa entre ambos grupos. Conclusiones: 1. Por primera vez nuestros resultados muestran que la flora y sensibilidad antibiótica son similares en pacientes a ser sometidos a LASIK y Catarata, siendo los SCN los más frecuentemente encontrados en ambos grupos de pacientes. 2. Las bacterias más comúnmente aisladas permanecen altamente sensibles a Cloramfenicol, Tobramicina, Moxifloxacino y Gatifloxacino.
Purpose: To know and provide a background on antibiotic susceptibility of normal ocular surface bacterial flora isolated from two different social and age groups of patients undergoing LASIK and cataract surgery in our country. Material and Methods: Conjunctival samples of 221 patients in a LASIK group and 180 patients in a cataract surgery group were cultivated. When there were a positive cultures, isolation and identification of the bacteria were made and antibiotic susceptibility tests were carried out, using the Kirby-Bauer disc diffusion technique for twelve antibiotics. Statistical analysis was performed using chi-square and exact Fisher test. Results: There were 66.8 percent of positive cultures, most of them gram positives. The most frequently isolated bacteria were the CNS (92,2 percent) that showed high sensitivity for Chloramphenicol, Tobramycin, Moxifloxacin and Gatifloxacin, intermedia for Levofloxacin, Gentamicin and Ciprofloxacin and lowest for Erytomycin, Oxacillin, Cefalotin and Ceftriaxone (p<0,01). All the cultures were susceptible to Vancomycin. There was not statistically difference between LASIK and cataract group. Conclusions: 1. For the first time, our results have shown that the conjunctival flora and its sensitivity to antibiotics are similar in the conjunctival flora of the patients undergoing LASIK surgery and Cataract, being CNS the bacterium most frequently found in both different groups of patients. 2. The most frequently isolated conjunctival bacteria remained highly sensitive to Chloramphenicol, Tobramycin, Moxifloxacin and Gatifloxacin.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Antibacterianos/farmacologia , Bactérias/isolamento & purificação , Bactérias , Túnica Conjuntiva/microbiologia , Fatores Etários , Bactérias Gram-Positivas/isolamento & purificação , Bactérias Gram-Positivas , Distribuição de Qui-Quadrado , Catarata/microbiologia , Cloranfenicol/farmacologia , Farmacorresistência Bacteriana , Testes de Sensibilidade Microbiana , Cuidados Pré-Operatórios , Quinolinas/farmacologia , Fatores Socioeconômicos , Tobramicina/farmacologiaRESUMO
OBJETIVO. Determinar la evolución de la resistencia a la eritromicina, el cloranfenicol, el trimetoprim-sulfametozaxol (SXT) y la vancomicina de aislamientos invasores de Streptococcus pneumoniae obtenidos de niños de 10 países de América Latina y del Caribe en seis años de vigilancia. MÉTODOS. Se analizaron 8 993 aislamientos de S. pneumoniae recuperados entre 2000 y 2005 de niños menores de 6 años con infecciones invasoras, procedentes de Argentina, Brasil, Chile, Colombia, Cuba, México, Paraguay, República Dominicana, Uruguay y Venezuela. La sensibilidad a los antibióticos se determinó mediante los métodos establecidos y estandarizados en el proyecto SIREVA. La resistencia a múltiples antibióticos se definió como la resistencia a tres o más familias de antibióticos, de los no betalactámicos analizados en este estudio o de los betalactámicos evaluados en un estudio previo en el que 37,8% de estos aislamientos presentaron sensibilidad disminuida a la penicilina. RESULTADOS. Se encontró algún grado de resistencia al SXT y la eritromicina (56,4% y 15,4% de los aislamientos estudiados, respectivamente) y 4,6% presentó alta resistencia al cloranfenicol. Todos los aislamientos fueron sensibles a la vancomicina. Se observó la mayor frecuencia de resistencia al SXT en los aislamientos de neumonía y a la eritromicina en los casos de sepsis (61,6% y 25,5%, respectivamente; P < 0,01). La mayor frecuencia de resistencia al SXT se observó en Brasil (71,9%) y a la eritromicina en México (38,2%) y Venezuela (32,9%). Los serotipos 14, 6B, 19F y 23F fueron los que más frecuentemente se asociaron con la resistencia a los antibióticos estudiados. CONCLUSIONES. Se observó una elevada y creciente frecuencia de aislamientos resistentes al SXT y la eritromicina, y una disminución en la proporción de aislamientos resistentes al cloranfenicol. Estas tendencias mostraron diferencias entre los países estudiados.
OBJECTIVE. To examine the development of resistance to erythromycin, chloramphenicol, trimethoprim-sulfamethoxazole (TMP-SMZ), and vancomycin of the invasive isolates of Streptococcus pneumoniae obtained from children in 10 Latin American/Caribbean countries during six years of surveillance. METHODS. Analysis of 8 993 isolates of S. pneumoniae recovered in 20002005 from children with invasive infections, who were less than 6 years of age, and from Argentina, Brazil, Chile, Colombia, Cuba, Dominican Republic, Mexico, Paraguay, Uruguay, or Venezuela. Antibiotic susceptibility was determined through the methods established and standardized by the SIREVA project. Multidrug resistance was defined as: resistance to three or more antibiotics of the same class; to the non-beta-lactams analyzed by this study; or, to the beta-lactams evaluated by a previous study, in which 37.8% of these isolates showed decreased susceptibility to penicillin. RESULTS. Some degree of resistance was found to TMP-SMZ and erythromycin (56.4% and 15.4% of the isolates studied, respectively), with 4.6% highly resistant to chloramphenicol. All isolates were susceptible to vancomycin. The highest prevalence of TMP-SMZ resistance was observed in the pneumonia isolates; and that of erythromycin, in cases of sepsis (61.6% and 25.5%, respectively; P < 0.01). The highest prevalence of TMP-SMZ resistance was found in Brazil (71.9%), and that of erythromycin, in Mexico (38.2%) and Venezuela (32.9%). The 14, 6B, 19F, and 23F serotypes were most often associated with resistance to the antibiotics in the study. CONCLUSIONS. High and increasing rates of isolates resistant to TMP-SMZ and erythromycin were observed, as well as a decreasing percentage of isolates resistant to chloramphenicol. These trends highlight differences among the countries studied
Assuntos
Humanos , Farmacorresistência Bacteriana , Streptococcus pneumoniae/efeitos dos fármacos , América Latina , Testes de Sensibilidade MicrobianaRESUMO
This study assessed the performance of the national norm for laboratory surveillance of invasive Streptococcus pneumoniae in adults of the Metropolitan Region (Chile). Material and Methods. We reviewed all notifications of isolates from patients > 15 years of age received by the Institute of Public Health of Chile during the period 2000-2006, submitted by health care facilities of the study region. We also reviewed the original records of sterile fluid cultures, in 14 public adult hospitals. Results. We found documentation of 1429 invasive S. pneumoniae isolates recovered from adult patients, including 1095 reported and 334 not-reported isolates. A 33% under-reporting rate was estimated for the 14 hospitals where local laboratory records were inspected. Age and clinical diagnosis were omitted in 23% and 78% of the notifications, respectively. Among 303 isolates from patients > 65 years of age that were investigated with Quellung reaction, 235 (78%) had capsular serotypes represented in the 23-valent polysaccharide vaccine. Conclusions. The Ministry of Health of Chile announced implementation of 23-valent vaccine immunization program for the elderly. In the perspective of future evaluations of the impact of this intervention, the results of this study indicate the need of reinforcing adherence and improving the quality of notifications of invasive S. pneumoniae.
Assuntos
Laboratórios/normas , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Adulto , Idoso , Chile , Notificação de Doenças/normas , Notificação de Doenças/estatística & dados numéricos , Hospitais Públicos , Humanos , Incidência , Laboratórios/estatística & dados numéricos , Pessoa de Meia-Idade , Infecções Pneumocócicas/epidemiologia , Estudos Retrospectivos , Sorotipagem , População UrbanaRESUMO
The study of susceptibility to 11 antimicrobial by agar difusion method of 561 Shigella strains at the Enteric Reference Laboratory of I.S.P., is informed. We found 18.7 percent of resistance, a lower value than the described in the literature of other countries