Molecular epidemiology and antimicrobial susceptibility of Campylobacter coli clinical isolates.

INTRODUCTION: Campylobacter spp. is a major cause of acute bacterial diarrhea in humans worldwide, and C. coli is responsible for 10% of the cases. MATERIALS AND METHODS: A study was made of the antimicrobial susceptibility using the E-test(®), and the clonal relationship using PCR-RFLP, of the flaA gene, as well as PFGE techniques on 43 C. coli clinical isolates. RESULTS: Only 49% and 2% of the isolates were susceptible to erythromycin and ciprofloxacin, respectively. Imipenem and clindamyicn, with 100% and 84% of the strains, respectively, being susceptible, were the most active antimicrobials. The PCR-RFLP of flaA gene technique grouped fourteen isolates into six clusters, while the PFGE technique grouped eleven isolates into five clusters. CONCLUSION: Ciprofloxacin and erythromycin are not suitable for the treatment of C. coli infections. Clindamycin could be considered as a therapeutic alternative in cases of enteritis, while imipenem is the best alternative for extra-intestinal infections. Both PFGE and PCR-RFLP can be useful to detect clones.

[Neisseria gonorrhoeae: antimicrobial resistance and study of population dynamics. Situation in Barcelona in 2011]. / Neisseria gonorrhoeae: resistencias antimicrobianas y estudio de la dinámica poblacional. Situación en 2011 en Barcelona.

BACKGROUND: Due to the high rates of antimicrobial resistance to certain antibiotics, together with the emergence of Neisseria gonorrhoeae (NG) with reduced susceptibility and resistance to third-generation cephalosporins, gonococcal infection is becoming a public health problem. The objectives of the study were: To keep track of the antimicrobial susceptibility of NG strains obtained from January to August 2011. To study the population dynamics. METHODS: The antimicrobial susceptibility was studied by disk-diffusion and E-test. The genotyping was performed by NG-MAST method. RESULTS: Of a total of 100strains studied, 59% showed intermediate sensitivity to penicillin and 9% were resistant. According to EUCAST, we detected 3gonococci with reduced susceptibility to ceftriaxone, 10 to cefixime and one with high-level resistance to both antibiotics (MIC 1.5µg/ml). MIC50 and MIC90 to cefixime were 0.016 and 0.125µg/ml, respectively, whereas to ceftriaxone they were <0.016 and 0.064µg/ml, respectively. Almost all (99%) of the strains were resistant to doxycycline, 53% to ciprofloxacin, 3% to azithromycin, and 1% to spectinomycin. The most prevalent ST was ST1407, predominantly associated to resistance or reduced sensitivity to cephalosporins or macrolides. CONCLUSIONS: NG has developed significant rates of resistance to various antibiotics. One strain has been detected with high level resistance to third generation cephalosporins, and several strains with reduced susceptibility. An increase in MIC50 and MIC90 to these antibiotics has also been observed. NG population structure remains stable and common to the rest of Europe, although two new ST (ST7226 and ST7227) have been identified that could be selected and acquire high levels of resistance to cephalosporins.

Reporting antimicrobial susceptibilities and phenotypes of resistance to vancomycin in vancomycin-resistant Enterococcus spp. clinical isolates: A nationwide proficiency study.

INTRODUCTION: The ability of Spanish microbiology laboratories to (a) determine antimicrobial susceptibility (AS), and (b) correctly detect the vancomycin resistance (VR) phenotype in vancomycin-resistant Enterococcus spp. (VRE) was evaluated. METHODS: Three VRE isolates representing the VanA (E. faecium), VanB (E. faecium) and VanC (E. gallinarum) VR phenotypes were sent to 52 laboratories, which were asked for: (a) AS method used; (b) MICs of ampicillin, imipenem, vancomycin, teicoplanin, linezolid, daptomycin, ciprofloxacin, levofloxacin and quinupristin-dalfopristin, and high-level resistance to gentamicin and streptomycin; (c) VR phenotype. RESULTS: (a) The most frequently used system was MicroScan; (b) according to the system, the highest percentage of discrepant MICs was found with gradient strips (21.3%). By antimicrobial, the highest rates of discrepant MICs ranged 16.7% (imipenem) to 0.7% (linezolid). No discrepant MICs were obtained with daptomycin or levofloxacin. Mayor errors (MEs) occurred with linezolid (1.1%/EUCAST) and ciprofloxacin (5.0%/CLSI), and very major errors (VMEs) with vancomycin (27.1%/EUCAST and 33.3%/CLSI) and teicoplanin (5.7%/EUCAST and 2.3%/CLSI). For linezolid, ciprofloxacin, and vancomycin, discrepant MICs were responsible for these errors, while for teicoplanin, errors were due to a misassignment of the clinical category. An unacceptable high percentage of VMEs was obtained using gradient strips (14.8%), especially with vancomycin, teicoplanin and daptomycin; (c) 86.4% of the centers identified VanA and VanB phenotypes correctly, and 95.0% the VanC phenotype. CONCLUSION: Most Spanish microbiology laboratories can reliably determine AS in VRE, but there is a significant percentage of inadequate interpretations (warning of false susceptibility) for teicoplanin in isolates with the VanB phenotype.

Epidemiology and in vitro antimicrobial susceptibility of aerobic Actinomycetales in a clinical setting.

INTRODUCTION: The incidence of infections caused by aerobic actinomycetes is increasing. Recent changes in taxonomy and the variability in susceptibility patterns among species make necessary a proper identification and antibiotic susceptibility testing. MATERIAL AND METHODS: Fifty-three strains of aerobic actinomycetes were identified by MALDI-TOF MS using the VITEK MS Mycobacterium/Nocardia kit (bioMérieux, France) in a tertiary hospital in Spain during a six-year period. Antimicrobial susceptibility testing of the isolates was performed using the Sensititre Rapmycoi microdilution panel (Thermo Fisher Scientific, Massachusetts, USA). RESULTS: Forty strains of Nocardia spp. were identified in the study, being N. farcinica and N. cyriacigeorgica the most prevalent ones. All isolates were susceptible to linezolid and the resistance to amikacin was only observed in one isolate of Gordonia sputi. Resistance to cotrimoxazole was only found in five isolates. CONCLUSIONS: Routine identification and antimicrobial susceptibility testing of aerobic actinomycetes is advisable for an efficient identification of species and effective treatment.

Epidemiology and in vitro antimicrobial susceptibility of aerobic Actinomycetales in a clinical setting.

INTRODUCTION: The incidence of infections caused by aerobic actinomycetes is increasing. Recent changes in taxonomy and the variability in susceptibility patterns among species make necessary a proper identification and antibiotic susceptibility testing. MATERIAL AND METHODS: Fifty-three strains of aerobic actinomycetes were identified by MALDI-TOF MS using the VITEK MS Mycobacterium/Nocardia kit (bioMérieux, France) in a tertiary hospital in Spain during a six-year period. Antimicrobial susceptibility testing of the isolates was performed using the Sensititre Rapmycoi microdilution panel (Thermo Fisher Scientific, Massachusetts, USA). RESULTS: Forty strains of Nocardia spp. were identified in the study, being N. farcinica and N. cyriacigeorgica the most prevalent ones. All isolates were susceptible to linezolid and the resistance to amikacin was only observed in one isolate of Gordonia sputi. Resistance to cotrimoxazole was only found in five isolates. CONCLUSIONS: Routine identification and antimicrobial susceptibility testing of aerobic actinomycetes is advisable for an efficient identification of species and effective treatment.

Epidemiologic study of Haemophilus influenzae causing invasive and non-invasive disease in Paraguay (1999-2017). / Estudio epidemiológico de Haemophilus influenzae causante de enfermedad invasiva y no invasiva en Paraguay (1999-2017).

INTRODUCTION: Haemophilus influenzae is a cause of mild and severe invasive infections, especially among children under 5 years old. Serotype b (Hib) was very frequent before the introduction of the vaccine, which was introduced in Paraguay in 2004. METHODS: A total of 523 isolates of H. influenzae obtained from 1999 to 2017 and referred to the National Reference Laboratory in Paraguay were studied by conventional microbiological methods and molecular techniques. RESULTS: The most frequent serotype was non-typeable (HiNT) (51.8%; 271/523), followed by Hib (43%; 225/523), Hia and Hif (1.5%; 8/523, respectively), Hic (1%; 5/523), Hie (0.8%; 4/523), and Hid (0.4%; 2/523). A total of 48.4% invasive infections were caused by HiNT, and 46.1% by Hib; 88.6% of isolates corresponded to meningitis, 70.8% to sepsis and 50.9% to pneumonia in children under 5 years. A total of 84% (181/217) of isolates corresponded to invasive infections caused by Hib in children under 5 years, with the highest proportion observed between 2001 and 2003. The most prevalent biotypes were biotype I (29%), biotype II (12%), biotype III (24%), and biotype IV (13%). Among the total of isolates, 13% (68/523) of isolates were resistant to ampicillin. CONCLUSION: After the introduction of the Hib vaccine in Paraguay, the number of invasive Hib cases decreased in children under 5 years old, although we observed an increase of HiNT in children over 5 years. Continuous surveillance is necessary in order to monitor the effectiveness of the vaccine and for the development of preventive interventions.

Evaluation of a mass spectrometry and Vitek 2 combined protocol for rapid identification and susceptibility testing of Enterobacterales directly from positive blood cultures.

OBJECTIVE: The aim was to evaluate a rapid method which would combine identification and susceptibility testing directly from positive blood cultures for Gram-negative bacilli of the Enterobacterales. MATERIAL AND METHODS: Gram-negative rods from blood cultures were directly identified by MALDI-TOF. Samples with Enterobacterales were selected for direct antimicrobial susceptibility testing by Vitek 2. The results were compared to those obtained with our laboratory's standard method. RESULTS: MALDI-TOF directly from blood cultures identified correctly 83% of the samples. Enterobacterales (n=68) were identified at gender and species level in 85% of blood cultures with a score >1.7. In general, MICs were obtained after 7h. MICs of amoxicillin-clavulanate, amikacin and ciprofloxacin showed in almost 50% of the cases after 5h. CONCLUSIONS: A simple procedure with low cost and reduced working time makes it possible to integrate both identification and susceptibility testing directly from blood cultures. Thus, this protocol could offer advantages when it comes to selection and cost of treatment and patients' clinical outcomes.

Epidemiological surveillance study of gonococcal infection in Northern Spain.

BACKGROUND: Treatment of gonorrhoea is threatened by antimicrobial resistance, and decreased susceptibility to recommended therapies is emerging. Thus, gonococcal infection (GI) is becoming a public health problem. The objectives of the present study were to monitor the antimicrobial sensitivity in Neisseria gonorrhoeae (NG) during 2011-2015 and to study their genogroups. METHODS: Antimicrobial susceptibility was studied by disc diffusion, in addition to the agar dilution method for cefixime and ceftriaxone and the Etest® for azithromycin. Genotyping was performed by the NG multi-antigen sequence typing (NG-MAST) method. Genogroups of closely related sequence types (STs) were defined. RESULTS: All the strains were susceptible to cefixime, ceftriaxone and gentamicin and 1.8% of the strains were resistant to azithromycin. A total of 531 STs and 6 genotypes (Gs) were identified during 2012-2015 period. G2992 was the largest and was associated with resistance to azithromycin, and with men who have sex with men (MSM), alongside G2400. G1407 and G2400 strains were related to high minimum inhibitory concentration (MICs) to cefixime and G1407 also to ceftriaxone. For the first time, G1861 and G2018 were described and associated with ciprofloxacin resistance and G2018 also with high MICs to ceftriaxone. CONCLUSION: Molecular typing is a useful tool to predict antimicrobial resistance. These results show the need to develop novel antimicrobials or to design new antimicrobial therapies based on drugs that show their efficacy against GI. This also highlights the importance of developing sexually transmitted infection (STI) surveillance in homosexual populations.

[Recommendations on the diagnosis and treatment of urinary tract infection]. / Recomendaciones sobre el diagnóstico y tratamiento de la infección urinaria.

Urinary tract infection (UTI) is defined as the growth of microorganisms in a sterile urine culture in a patient with compatible clinical symptoms. The presence of bacteria without any symptoms is known as asymptomatic bacteriuria, and does not require any treatment. In neonates and infants, fever is the guiding sign to suspecting a UTI. Classic urinary tract symptoms become more important in older children. Urine cultures collected before starting antibiotics is always required for diagnosis. Clean-catch (midstream) specimens should be collected for urine culture. In the case of non-toilet-trained children, specimens must be obtained by urinary catheterisation, or suprapubic puncture in neonates and infants. Specimens collected by urine bag should not be used for urine culture. There are no significant differences in the clinical evolution and prognosis between oral versus short intravenous followed by oral antibiotic. Empirical antibiotic therapy should be guided by local susceptibility patterns. Second-generation cephalosporin (children under 6 years) and fosfomycin trometamol (over 6 years), are the empiric therapy recommended in this consensus. In the case of pyelonephritis, recommended antibiotic treatment are third-generation cephalosporins (outpatient care) or, if admission is required, aminoglycosides. Ampicillin should be added in infants less than 3 months old. Antibiotic de-escalation should be always practiced once the result of the urine culture is known.

Infecciones causadas por Staphylococcus aureus de la Comunidad. Estudio de sensibilidad y tendencias en población pediátrica. Años 2015 a 2020

Introducción: Staphylococcus aureus (SA) puede ocasionar cuadros infecciosos severos y muerte. La emergencia de cepas resistentes a meticilina constituye un desafío terapéutico. Objetivos: determinar el perfil de resistencia antimicrobiana de: Staphylococcus aureus adquirido en la comunidad (SA-CA), obtenidos de muestras biológicas de niños, entre 2015 a 2020. Material y Método: estudio descriptivo, observacional y retrospectivo. Las muestras para cultivos se extrajeron al ingreso hospitalario del paciente. Para determinación de resistencia y sensibilidad se utilizó normas de CSLI. Resultados: 244 aislamientos de SA-CA. Masculinos 99 (59%), menores de un año: 42 (25%), de 2 a 5 años: 34 (20%), de 6 a 11 años: 50 (30%) y entre 12 a 15 años: 42 (25%). De los aislados, 72% fueron SAMR (121/168) y 28% SAMS (47/168). Se observó un incremento de tasas anuales de aislamientos SAMR en infecciones de la comunidad desde el 2015 al 2020. Los aislamientos se originaron en piel y partes blandas 53,2 %; sangre 37,4%, orina 3,5%, LCR 2,4%, liquido articular 1,7%, abscesos profundos 1,2% y liquido pleural 0,6%. La prevalencia de SAMR-CA fue de 60,5 en el 2015, 59,6 %, 61,5%, 72,2 %, 67,3% y 75,5 % en los años sucesivos. No se aisló ninguna cepa resistente a la vancomicina. El 10,1% de las cepas estudiadas presentó resistencia inducida a la clindamicina. Conclusión: El SAMR se ha establecido como patógeno de la comunidad. La resistencia inducida por clindamicina fue del 10,1%. Un tercio de las infecciones fueron causadas por SAMS. Las prevalencias de SAMS muestran tendencia a la disminución.

Introduction: Staphylococcus aureus (SA) can cause severe infectious conditions and death. The emergence of methicillin-resistant strains constitutes a therapeutic challenge. Objectives: to determine the antimicrobial resistance profile of: Staphylococcus aureus acquired in the community (SA-CA), obtained from biological samples of children, between 2015 and 2020. Material and Method: descriptive, observational and retrospective study. The samples for cultures were extracted upon hospital admission of the patient. To determine resistance and sensitivity, CSLI standards were used. Results: 244 isolates of SA-CA. Males 99 (59%), under one-year-old: 42 (25%), from 2 to 5 years old: 34 (20%), from 6 to 11 years old: 50 (30%) and between 12 and 15 years old: 42 (25%). Of the isolates, 72% were SAMR (121/168) and 28% SAMS (47/168). An increase in annual rates of MRSA isolates in community infections was observed from 2015 to 2020. The isolates originated in skin and soft parts 53.2 %; blood 37.4%, urine 3.5%, CSF 2.4%, joint fluid 1.7%, deep abscesses 1.2% and pleural fluid 0.6%. The prevalence of MRSA-CA was 60.5 in 2015, 59.6%, 61.5%, 72.2%, 67.3%, and 75.5% in subsequent years. No vancomycin resistant strain was isolated. 10.1% of the strains studied presented induced resistance to clindamycin. Conclusion: MRSA has been established as a community pathogen. The resistance induced by clindamycin was 10.1%. One third of the infections was caused by SAMS. The prevalence of SAMS shows a downward trend.

Antimicrobial susceptibility of microorganisms that cause urinary tract infections in pediatric patients.

INTRODUCTION: Cumulative susceptibility reports are a valuable tool for the empirical treatment of urinary tract infections, especially in the current context of increasing resistance rates. Our objective was to analyze the antimicrobial susceptibility of bacterial isolates in urine cultures of pediatric patients during a five-year period. METHODS: Retrospective study of urine cultures from 2011 to 2015. Identification and antimicrobial susceptibility tests were performed using the Vitek-2 system (BioMérieux®) and categorized according to EUCAST criteria. Antimicrobial susceptibility data were analyzed by gender and age groups (neonates, 1 month to 5 years, 5-15 years) before being compared with data obtained from patients over the age of 15 years. RESULTS: During the study period, 17164 urine cultures were processed from 7924 patients under 16 years of age. Antimicrobial susceptibility rates in these patients were: ampicillin 36.3%, amoxicillin/clavulanic acid 75.3%, cefuroxime 83.2%, co-trimoxazole 68.9%, ciprofloxacin 85.3%, fosfomycin 85.5%, nitrofurantoin 84.4% and 3rd generation cephalosporins 89-91%. Aminoglycosides (>92%) and carbapenems (95%) maintained the highest susceptibility rates. The prevalence of ESBL-producing isolates was significantly lower in children under the age of 16 years (1.5% vs. 4.1%). In patients under the age of 16 years, Escherichia coli isolates in girls were significantly more sensitive (p<0.0001) to ampicillin (41% vs. 30%) and amoxicillin/clavulanic acid (82% vs. 72%) than in boys. CONCLUSIONS: The compilation of cumulative susceptibility reports disaggregated by age or gender reveals significant differences. In our setting, cefuroxime may be considered the first-line empirical treatment in pediatric patients.

Sensibilidad antimicrobiana y mortalidad intrahospitalaria de infecciones comunitarias y nosocomiales en la Unidad de Cuidados Intensivos del Hospital Ángeles del Carmen / Antimicrobial susceptibility and mortality of community and nosocomial acquired infections in the Intensive Care Unit at Hospital Ángeles del Carmen / Susceptibilidade antimicrobiana e mortalidade hospital por infecções comunitárias e nosocomiais na Unidade de Terapia Intensiva do Hospital Ángeles del Carmen

Resumen: Introducción: el manejo de antibióticos en las unidades de cuidados intensivos (UCI) es un tema prioritario. Conocer la epidemiología bacteriana y su sensibilidad es fundamental para aumentar la sobrevida de nuestros pacientes. Material y métodos: se realizó un estudio tipo cohorte retrospectiva en la Unidad de Cuidados Intensivos del Hospital Ángeles del Carmen durante el periodo de 2018 a 2020 en pacientes con infección documentada y con cultivo positivo. Se obtuvo el patrón de sensibilidad antimicrobiana y se analizó de acuerdo al origen Gram, tipo de infección, reactantes de fase aguda y mortalidad. Se realizó comparación de medias y proporciones con χ2, t de Student y ANOVA. Se obtuvieron razones de desventajas (OR) para identificar variables asociadas a resolución. Se consideró un valor de p < 0.05 para significancia estadística. Resultados: se analizaron 308 cultivos bacterianos obtenidos de 188 pacientes, principalmente de origen respiratorio, urinario y torrente sanguíneo (76.7%), de origen nosocomial (65.3%), con predominio de gram-negativos (65%) multidrogorresistentes. La procedencia comunitaria se asoció más a infección que la nosocomial (85 versus 61.7%, OR 3.5, IC 95% 1.93-6.45, p < 0.001). El porcentaje de infección fue mayor en gram-negativos (71.8 versus 66%, OR 1.10, IC 95% de 0.91-1.32, p = 0.297). Las infecciones por gram-positivos tuvieron menor porcentaje de mortalidad que aquéllas por gram-negativos (17.9 versus 30.7%, OR 0.49, IC 95% de 0.27-0.88, p = 0.016) así como las infecciones comunitarias en comparación con nosocomiales (17.8 versus 30.8%, OR 0.48, IC 95% de 0.27-0.86, p = 0.013). Conclusión: las bacterias predominantes en nuestra unidad de cuidados críticos son bacilos gram-negativos multidrogorresistentes, provenientes de infecciones respiratorias, urinarias y de torrente sanguíneo. Las infecciones por gram-positivos y adquiridas en la comunidad se asociaron a menor riesgo de mortalidad.

Abstract: Introduction: local identification of antimicrobial susceptibility and resistance patterns must be a priority in intensive care units. Material and methods: a cohort study was conducted in the intensive care unit from 2018 to 2020, identifying patients with an infectious diagnosis and a positive culture, with prospective clinical and laboratory follow-up. Antimicrobial resistance patterns were analyzed according to source, gram, type of infection, acute phase reactants and outcome, comparing means and proportions with χ2, Student t and ANOVA. OR were obtained to identify resolution-associated variables. A p < 0.05 value was considered as statistically significant. Results: 308 cultures were analyzed, obtained from 188 patients. Primary souces were respiratory, urinary and bloodstream (76.7%), 65.3% were from in-hospital infections, and 65% were caused by gram-negative multi-drug resistant bacteria. Community cultures were more associated with infection compares with in-hospital cultures (85 vs 61.7%, OR 3.5, 95% CI 1.93-6.45, p < 0.001). Gram-negative bacteria had a greater association with infection compared with gram-positive (71.8 vs 66%, OR 1.10, 95% CI 0.91-1.32, p = 0.297), but infections caused by gram-positive bacteria had a greater association with resolution (82.1 vs 68.8%, OR 2.07, 95% CI 1.16-3.70, p = 0.019), as well as community infections (82.2 vs 68.7%, OR 2.11, 95% CI 1.18-3.77, p = 0.016). Conclusion: multi-drug resistant gram-negative bacteria were the principal isolates found in respiratory, urine and bloodstream infections in our intensive care unit. Community infections and gram-positive isolates were associated with greater resolution rates.

Resumo: Introdução: a gestão de antibióticos em Unidades de Cuidados Intensivos é uma questão prioritária. Conhecer a epidemiologia bacteriana e sua suscetibilidade é essencial para aumentar a sobrevida de nossos pacientes. Material e métodos: foi realizado um estudo de coorte retrospectivo na Unidade de Terapia Intensiva do Hospital Ángeles del Carmen durante o período de 2018 a 2020, em pacientes com infecção documentada e com cultura positiva. O padrão de sensibilidade antimicrobiana foi obtido e analisado segundo origem, grama, tipo de infecção, reagentes de fase aguda e mortalidade. A comparação de médias e proporções foi feita com χ2, teste t de Student e ANOVA. Razões de desvantagem (OR) foram obtidas para identificar variáveis ​​associadas à resolução. Um valor de p < 0.05 foi considerado para significância estatística. Resultados: foram analisadas 308 culturas bacterianas obtidas de 188 pacientes, principalmente de origem respiratória, urinária e sanguínea (76.7%), de origem nosocomial (65.3%), com predominância de gram-negativos (65%) multirresistentes. A origem comunitária foi mais associada à infecção do que a nosocomial (85 vs 61.7%, OR 3.5, IC 95% 1.93-6.45, p < 0.001). A porcentagem de infecção foi maior para gram-negativos (71.8 vs 66%, OR 1.10, IC 95% 0.91-1.32, p = 0.297). As infecções Gram-positivas tiveram uma taxa de mortalidade menor do que as infecções Gram-negativas (17.9 vs 30.7%, OR 0.49, IC 95% de 0.27-0.88, p = 0.016), bem como infecções comunitárias em comparação com as nosocomiais (17.8 vs 30.8%, OR 0.48, IC 95% de 0.27-0.86, p = 0.013). Conclusão: as bactérias predominantes em nossa unidade de terapia intensiva são bacilos gram-negativos multirresistentes, originários de infecções respiratórias, urinárias e de corrente sanguínea. As infecções gram-positivas e adquiridas na comunidade foram associadas a um menor risco de mortalidade.

Aislamiento del estreptococo beta-hemolítico en niños asintomáticos / Isolation of the beta-hemolytic streptococcus in asymptomatic children

Introducción: las faringoamigdalitis se encuentran entre las enfermedades infecciosas que más afectan a los niños en edad escolar, cuya primera causa bacteriana es el estreptococo beta-hemolítico del grupo A. Objetivo: determinar la presencia de dicha bacteria en exudados faríngeos de niños asintomáticos. Métodos: se realizó un estudio transversal y descriptivo de 80 niños de ambos sexos en el Círculo Infantil Alberto Fernández de Santiago de Cuba, durante el año 2014. Resultados: se obtuvo un elevado porcentaje de infectados por bacterias potencialmente patógenas, con predominio del estreptococo beta-hemolítico del grupo A, así como una mayor frecuencia de niños en las edades de 4 y 5 años y del sexo masculino; asimismo, los antibióticos de mayor sensibilidad fueron la penicilina y amoxicilina, mientras que la kanamicina fue el de mayor resistencia. Conclusiones: esta investigación posibilitó conocer las características de colonización de esta bacteria, así como su sensibilidad antimicrobiana

Introduction: pharyngotonsillitis is among the infectious diseases that most affect children in school age whose first bacterial cause is the group A beta-hemolytic streptococcus. Objective: to be determine the presence of this bacteria in throat swabs of asymptomatic children. Methods: a cross-sectional and descriptive study of 80 children from both sexes was carried out in Alberto Fernández day care center in Santiago de Cuba, during 2014. Results: a high percentage of infected children by potentially pathogens bacterias was obtained, with prevalence of group A beta-hemolytic streptococcus, as well as a higher frequency of children of the male sex aged 4 and 5; also, the antibiotics of more sensitivity were penicillin and amoxicillin, while kanamycin was that of higher resistance. Conclusions: with this investigation the colonization characteristics of this bacteria were known, as well as its antimicrobian sensitivity

Perfil de Sensibilidad y Resistencia Antimicrobiana de Acinetobacter spp. en el Hospital Municipal Boliviano Holandés / Sensitivity profile and antimicrobial resistance of Acinetobacter spp. in the Bolivian Dutch Municipal Hospital

Objetivo: Observar el perfil de sensibilidad y resistencia antimicrobiana de Acinetobacter spp., aislado en pacientes hospitalizados en el Hospital Municipal Boliviano Holandés durante el año 2010 al 2014. Material y métodos: Se revisaron un total de 167 cultivos positivos de Acinetobacter spp. Se realizó un estudio observacional no experimental, descriptivo, retrospectivo, de corte transversal. Resultados: En el antibiograma de los cultivos positivos de Acinetobacter spp. se utilizaron ocho antimicrobianos y se identificó la siguiente sensibilidad y resistencia: a) amikacina, sensibilidad de 25%, sensibilidad intermedia de 2% y resistencia 73%; b) ampicilina más sulbactam, sensibilidad de 22%, intermedia de 8% y resistencia 70%; c) ceftazidime, sensibilidad de 9%, intermedia de 4% y resistencia 87%; d) ciprofloxacina sensibilidad 19%, intermedia 1% y resistencia 80%; e) gentamicina, sensibilidad de 21%, intermedia 0% y resistencia 79%; f) SMX-TMP, sensibilidad de 14%, intermedia de 1% y resistencia 85%; g) imipenem sensibilidad de 61%, intermedia de 1% y resistencia 38%; h) meropenem con sensibilidad de 57%, intermedia 4% y resistencia 39%. Se observó una resistencia absoluta a 6 antimicrobianos. La multidrogoresistencia se identificó en el 41%, la misma que se incrementó progresivamente en los últimos años. Así, en el 2010 se encontró solo 3% de multidrogoresistencia, el 2011 6%, el 2012 y 2013 19% y en el año 2014 53%. Conclusiones: La incidencia de infecciones por Acinetobacter spp., un agente nosocomial de gran importancia clínica, se incrementó de manera progresiva en los últimos años en nuestro hospital al igual que su resistencia. Por ello, se aconseja un uso racional de antimicrobianos y mejorar las medidas de bioseguridad en nuestro nosocomio y en el personal de salud.

Objective: To observe the sensitivity profile and antimicrobial resistance of Acinetobacter spp, isolated from patients hospitalized in the Bolivian Dutch Municipal Hospital during 2010 to 2014. Material and Methods: A total of 167 positive cultures of Acinetobacter spp were reviewed a non-experimental, descriptive, retrospective, observational cross-sectional study was conducted. Results: In the susceptibility testing of positive cultures of Acinetobacter spp. eight antimicrobials were used and the following sensitivity and resistance was identified: a) amikacin, sensitivity of 25%, 2% intermediate sensitivity and resistance 73%; b) ampicillin-sulbactam, sensitivity of 22%, 8% and intermediate resistance 70%; c) ceftazidime, sensitivity of 9%, 4% and intermediate resistance 87%; d) Ciprofloxacin sensitivity 19%, 1% and intermediate resistance 80%; e) gentamicin, sensitivity of 21%, intermediate resistance 0% and resistance 79%; f) TMP-SMX, sensitivity of 14%, intermediate 1% and resistance 85%; g) 61% sensitivity imipenem, intermediate 1% and resistance 38%; h) meropenem with sensitivity of 57%, intermediate resistance and 4% resistance 39%, absolute resistance to 6 antimicrobials was observed. multidrug resistense identified in 41%, the same as it was progressively increased in recentyears. Thus, in 2010 he found only 3% of multidrug, 6% in 2011,2012 and 2013 19% and in 2014 53%. Conclusions. The incidence of infections Acinetobacter spp, a nosocomial agent of great clinical importance, gradually increased in recent years in our hospital as their resistance. Therefore, it is advisable rational use of antimicrobials and improves bio-security measures in our hospital and health personnel.

Agentes etiológicos y su sensibilidad antimicrobiana en urocultivos confirmatorios de infección urinaria en un servicio de urgencia de pediatría / Etiological agents and its antimicrobial sensitivity in confirmatory urine cultures in a pediatric emergency service

La infección del tracto urinario (ITU) es una patología frecuente en pediatría. Su diagnóstico ytratamiento precoz son fundamentales. Para un adecuado tratamiento, es importante conocer la sensibilidadantimicrobiana local. Objetivo: Identificar los agentes etiológicos más frecuentes y su sensibilidad antimicrobiana en urocultivos confirmatorios de ITU, solicitados en Servicio de Urgencia de Pediatría (SUP) del Hospital San Martin de Quillota (HSMQ). Materiales y métodos: Se analizaron todos los urocultivos solicitados desde el SUP del HSMQ entre enero 2013 – julio 2014. Se efectuó análisis por sexo y grupos etarios. La etiología y susceptibilidad microbiana se analizó con la técnica de difusión en agar. Resultados: Se analizaron 298 urocultivos, de los cuales el 80,5 por ciento correspondieron a mujeres. La bacteria encontrada más frecuente, en un 87,4 por ciento fue la Escherichia coli. La sensibilidad antibiótica de E.coli para ampicilina, cefalotina, cefixime, ciprofloxacino, ceftriaxona, gentamicina, nitrofurantoina y cotrimoxazol, correspondieron a un 23,3 por ciento; 32,8 por ciento; 96,6 por ciento; 92,7 por ciento; 97,7 por ciento; 94,5 por ciento; 99,6 por ciento; y 71,9 por ciento, respectivamente. Conclusión: El agente etiológico más frecuente en urocultivos confirmatorios solicitados en el SUP del HSMQ fue E. coli. Respecto a su sensibilidad antimicrobiana demostró una alta resistencia y sensibilidad intermedia a cefalosporinas de primera generación y una alta sensibilidad a cefalosporinas de tercera generación, nitrofurantoína, gentamicina y fluoroquinolonas...

Urinary tract infection (UTI) is a common pediatric disease. Early diagnosis and treatment are essential. For proper treatment, it is important to know the local antimicrobial susceptibility. Objective: Identify the most common etiologic agents and their antimicrobial susceptibility in urine cultures in Pediatrics Emergency Service (PES) of San Martin Hospital, Quillota. Summary of work: All the urine cultures requested from the PES between January 2013 and July 2014 were analyzed by sex and age groups. The etiology and microbial susceptibility was analyzed with the agar diffusion technique. Summary of Results: 298 urine cultures were analyzed, 80.5 percent were women. The most common bacteria found was Escherichia coli with 87.4 percent.The antimicrobial susceptibility of E.coli to ampicillin, cephalothin, cefixime, ciprofloxacin, ceftriaxone, gentamicin, cotrimoxazole and nitrofurantoin were 23.3 percent; 32.8 percent; 96.6 percent; 92.7 percent; 97.7 percent; 94.5 percent; 99.6 percent; and 71.9 percent, respectively. Conclusion: The most common etiologic agent in urine cultures requested in PES was E. coli. The antimicrobial susceptibility showed a high resistance and intermediate susceptibility to first generation cephalosporins and high susceptibility to thirdgeneration cephalosporins, nitrofurantoin, gentamicin andfluoroquinolones...

Detección de microorganismos anaerobios en pacientes con pericoronaritis y sensibilidad a los antimicrobianos / Anaerobic microorganisms detection in patients with pericoronaritis and antimicrobial susceptibility

El propósito de este estudio fue la identificación de microorganismos anaerobios más frecuentemente encontrados en pericoronaritis y realizar pruebas de sensibilidad a los antimicrobianos. Se estudiaron los sacos pericoronarios del tercer molar en 20 pacientes. De las muestras recogidas en los 20 pacientes que presentaron pericoronaritis, solo en 7 (35%) hubo crecimiento de microorganismos anaerobios estrictos mientras que en los 13 restantes (65%) no se detectaron estos. En cuanto a las 12 cepas aisladas del saco pericoronario de los 7 pacientes, el microorganismo más frecuentemente encontrado fue Bifidobacterium spp en 5 casos (42%), Bifidobacterium adolescentis en 2 casos (17%), Veillonella spp en dos casos también (17%), Prevotella melaninogenica en 1 caso (8%), 1 caso Prevotella loescheii (8%) y en 1 caso a Prevotella oralis (8%). De los resultados obtenidos las bacterias anaerobias estrictas detectadas a partir de muestras de sacos pericoronarios fueron: Bifidobacterium spp., B. adolescentis, Veillonella spp, P. loeschii, P. melaninogenica y P. oralis.

Evaluación del potencial antibacterial in vitro de Croton lechleri frente a aislamientos bacterianos de pacientes con úlceras cutáneas / In vitro evaluation of antibacterial potential of Croton lechleri against bacterial isolates from patients with skin ulcers

Esta investigación tuvo como objetivo la evaluación del potencial antibacterial in vitro de Croton lechleri frente a aislamientos bacterianos aeróbicos de pacientes con úlceras cutáneas del Sanatorio de Agua de Dios, Cundinamarca, Colombia. La metodología utilizada incluyó el aislamiento e identificación de los aislamientos bacterianos utilizando el sistema automatizado BBL-CrystalTM. Para la evaluación de la susceptibilidad antimicrobiana in vitro, se realizaron pruebas de difusión en disco, dilución en agar y difusión en pozo, métodos estandarizados por The Clinical and Laboratory Standards Institute (CLSI); usando como sustratos el extracto etanólico y de éter de petróleo de Croton lechleri. Se obtuvieron siete aislamientos bacterianos a partir de las úlceras cutáneas de pacientes del sanatorio, el estudio también incluyó ensayos con cepas de referencia ATCC: Staphylococcus aureus (ATCC) y de Escherichia coli (ATCC) como control. En los ensayos de sensibilidad antimicrobiana in vitro, se evidencio que los extractos de Croton lechleri fueron efectivos frente a la mayoría de aislamientos bacterianos del estudio, siendo el extracto etanólico el de mayor potencial antibacterial y la técnica de difusión en pozo la que presento mejor sensibilidad y reproducibilidad.

This study evaluated the in vitro antibacterial potential of Croton lechleri against aerobic bacterial isolates from patients with skin ulcers from Agua de Dios Sanitarium, (Cundinamarca, Colombia). Bacterial isolates were isolated and identified using the BBL-CrystalTM automated system. In vitro antimicrobial susceptibility was evaluated through disk diffusion, agar dilution and well diffusion, using standardized methods from the Clinical and Laboratory Standards Institute (CLSI). Ethanol extract and petroleum ether from Croton lechleri were used as substrates. Bacterial isolates were obtained from skin ulcers of patients in the hospital. ATCC reference strains were included in the assays as controls: Staphylococcus aureus (ATCC) and Escherichia coli (ATCC). The antimicrobial sensitivity tests demonstrated that Croton lechleri extracts were effective against almost all strains included in this study. Ethanol extract showed the greater antibacterial potential. The technique that showed the best sensitivity and reproducibility in vitro was the diffusion well.

Lectura interpretada del antibiograma / Construed reading of the antibiogram

La resistencia bacteriana a los antibióticos es un grave problema actual de salud, que obliga a cambiar conceptos establecidos en cuanto a la interpretación de los resultados de las pruebas de susceptibilidad, por lo que se impone conocer y aplicar una lectura interpretada del antibiograma. El propósito de este trabajo es actualizar y divulgar los conocimientos existentes sobre esta temática. Además, dar a reconocer los beneficios de su aplicación, entre los que se encuentran: la detección de nuevos mecanismos de resistencia, conocimiento de la epidemiología de la resistencia, mejor adecuación de los tratamientos antimicrobianos y, por ende, mejor calidad y gestión de los resultados. La lectura interpretada del antibiograma debe plantearse como una necesidad clínica del microbiólogo en el laboratorio y para el médico de asistencia.

Bacterial resistance to antimicrobials is a serious health problem at present, which compels us to change set concepts about the interpretation of the results from susceptibility tests, so it is essential to know and to apply a construed reading of the antibiogram. The purpose of this paper was to update and to disseminate existing knowledge about this topic, in addition to disclosing the benefits of put such pieces of knowledge into practice. Some of them are detection of new mechanisms of resistance, knowledge on the resistance epidemiology, better adequacy of antimicrobial treatments, and hence, better quality and management of results. The construed reading of an antibiogram must be a clinical requirement for the microbiologist at the lab and for the attending physician.

Caracterización fenotípica de enterobacterias aisladas en pacientes con el virus de la inmunodeficiencia humana/sida / Phenotypic characterization of enterobacteria isolated from patients with human immunodeficiency virus infection/AIDS

Introducción: en pacientes con el virus de la inmunodeficiencia humana/sida se incrementa el riesgo de padecer infecciones por enterobacterias. Objetivo: caracterizar fenotípicamente las enterobacterias causantes de infecciones en estos pacientes. Métodos: se realizó un estudio descriptivo prospectivo, en el Instituto Pedro Kourí, de marzo de 2010 a marzo de 2011. Se procesaron muestras de esputo, lavado bronquial, secreciones faríngeas, óticas y vaginales, orina, fecales, lesiones de piel, sangre y catéteres, en 65 pacientes (ambulatorios y hospitalizados). La identificación bacteriológica y la susceptibilidad antimicrobiana de los 73 aislamientos, se determinaron mediante sistema VITEK 2 Compact (bioMérieux, Francia). Resultados: se identificaron Escherichia coli (30), Klebsiella spp. (19), Enterobacter spp. (15), Proteus spp. (7) y Serratia spp. (2). Prevalecieron las sepsis en pacientes hospitalizados (87,7 porciento). Menos de 50 porciento de las enterobacterias resultaron resistentes a las cefalosporinas, excepto Klebsiella spp. y Enterobacter spp. (68,4 porciento y 93,3 porciento de resistencia a cefepima y cefoxitina, respectivamente), y más del 80 porciento se mostró sensible a la amikacina. Se observó resistencia a piperazilina/tazobactam y ciprofloxacina en 27,3 porciento y 15 porciento, respectivamente. Se detectó 34,2 porciento de cepas productoras de betalactamasas de espectro extendido. Conclusiones: Escherichia coli y Klebsiella spp. causan frecuentemente infecciones en pacientes VIH/sida. El estudio de la sensibilidad antimicrobiana por VITEK 2 Compact, sugiere que las cefalosporinas, aminoglucósidos, quinolonas y piperacilina/tazobactam, pudieran constituir una alternativa terapéutica en estos casos

Introduction: the risk of infections caused by enterobacteria increases in HIV patients. Objective: to phenotypically characterize the enterobacteria responsible for infections in these patients. Methods: a prospective and descriptive study was conducted in Pedro Kourí Institute from March 2010 to March 2011. Samples of sputum, bronchial lavage, pharyngeal, ear and vaginal secretions, urine, stool, skin lesions, blood and catheters taken from 65 patients (ambulatory and hospital) were processed. Bacterial identification and antimicrobial susceptibility of 73 isolates were determined by automated system VITEK 2 Compact (bioMérieux, France). Results: Escherichia coli (30), Klebsiella spp. (19), Enterobacter spp. (15), Proteus spp. (7) and Serratia spp. (2) were identified. Sepsis in hospitalized patients (87.7 percent) was prevalent. Less than 50 percent of Enterobacteriaceae were resistant to cephalosporins, except Klebsiella spp. and Enterobacter spp. (68.4 percent and 93.3 percent resistance to cefepime and cefoxitin, respectively) and over 80 percent were sensitive to amykacin. Resistance to piperacillin/tazobactam and ciprofloxacin was observed in 27.3 percent and 15 percent of cases, respectively. In the study, 34.2 percent of extended-spectrum beta-lactamases- producing strains was detected. Conclusions: Escherichia coli and Klebsiella spp. often cause infections in HIV patients. The study of antimicrobial susceptibility by using VITEK 2 Compact system, suggests that cephalosporins, aminoglycosides, quinolones and piperacillin/tazobactam, could be effective therapeutic alternatives in these cases

Etiología bacteriana de la infección urinaria en niños / Bacterial etiology of the urinary tract infection in children

Objetivos: describir el comportamiento etiológico de los principales microorganismos causantes de infección urinaria y la susceptibilidad antimicrobiana del principal agente causal. Métodos: estudio observacional, descriptivo, retrospectivo, en el laboratorio de microbiología del Hospital Pediátrico Juan Manuel Márquez en el período comprendido entre 1 de enero y 31 de diciembre de 2010. Se revisó el registro de urocultivos del citado laboratorio y se tomaron los 579 urocultivos positivos, procedentes de niños con diagnóstico presuntivo de infección del tracto urinario y que conformaron el universo de estudio. Resultados: los microorganismos uropatógenos más frecuentes encontrados fueron: Escherichia coli con franco predominio en ambos sexos, seguido por Klebsiella spp., también en ambos sexos, Proteus spp., en varones y Serratia spp., en hembras. El principal agente causal, Escherichia coli, tuvo una susceptibilidad por encima del 80 porciento a meropenem, cloranfenicol, nitrofurantoína, amikacina, gentamicina, cefuroxima, ceftriaxona y amoxicilina/clavulánico; la susceptibilidad a cotrimoxazol y ampicilina fue de 62 y 33 porciento respectivamente. Conclusiones: la Escherichia coli es el principal causante de infección en el tracto urinario en niños, de ahí que el conocimiento de su comportamiento ante diferentes antibióticos, permite al médico orientarse en su práctica diaria al iniciar el tratamiento empírico, sin confirmación bacteriológica de la enfermedad

Objectives: To contribute to the knolewdge about the etiologic behavior of the most frequent microorganisms causing urinary tract infection and the antimicrobial susceptibility to the antibiotics of the main causative agent. Methods: retrospective, observational, and descriptive study conducted in the microbiology laboratory of Juan Manuel Márquez pediatric hospital in the period of January 1st through December 31st, 2010. The register of urine cultures of the mentioned laboratory was revised, from which the 579 positive cultures from presumptively diagnosed children with urinary tract infection were taken. They made up the universe of study. Results: the most frequent microorganisms found were Escherichia coli followed by Klebsiella spp., with clear predominance in both sexes; Proteus spp. in males and Serratia spp. in females. The main causal agent, Escherichia coli, showed over 80 percent susceptibility to meropenem, chloramphenicol, nitrofurantoin, amykacin, gentamycin, cefuroxime, ceftriaxone and amoxycillin/clavulanic acid, whereas susceptibility to cotrimoxazole and to ampicillin was 62 percent and 33 percent respectively. Conclusions: Escherichia coli is the main causative agent of urinary tract infection at Juan Manuel Márquez hospital, so the knowledge of its susceptibility to various antibiotics can guide the doctor in its daily practice at the time of beginning the empiric treatment, prior to the bacteriological confirmation of the illness