Estado de los programas de optimización del uso de antimicrobianos en hospitales: resultados de una Encuesta Nacional 2022 en Perú

Introducción: Los programas de Optimización de Antimicrobianos (PROA) en Instituciones Sanitarias son una estrategia implementada en diversos países. El estudio: Nuestro objetivo fue realizar una encuesta electrónica en los establecimientos de salud que cuentan con servicios de hospitalización en el Perú. Hallazgos: Ciento setenta establecimientos (38.4%) respondieron la encuesta entre MINSA (90%), ESSALUD (4.2%), FFAA PNP (2.9%) y Privados (2.9%). Solo 49 (28.8%) contaba con PROA funcionando dentro de su institución. El 83.7% contaban con una Resolución directoral que respalda sus funciones y el 38.8% referían contar con un plan de actividades PROA. Los problemas más frecuentemente identificados son la falta de recursos humanos capacitados (24.6%), la falta de capacitación y asistencia técnica (13.1%) y la falla en la prescripción de antibióticos (11.5%). Conclusión: Es prioritario seguir fortaleciendo los PROA en hospitales en el corto plazo con actividades que estimulen el uso racional de antimicrobianos.

Background: The Antimicrobial Optimization Programs (PROA in Spanish) in Health Institutions are a strategy implemented in different countries. The study: Our objective was to carry out an electronic survey in health establishments that have hospitalization services in Peru. Findings: One hundred seventy establishments (38.4%) responded to the survey between MINSA (90%), ESSALUD (4.2%), Armed Forces PNP (2.9%) and Private (2.9%). Only 49 (28.8%) had PROA working within their institution. 83.7% had a Director Resolution that supported their functions and 38.8% reported having a PROA activity plan. The most frequent problems identified are the lack of trained human resources (24.6%), the lack of training and technical assistance (13.1%) and the failure to prescribe antibiotics (11.5%). Conclusion: It is a priority to continue strengthening the PROA in hospitals in the short term with activities that stimulate the rational use of antimicrobials.

Uso ambulatorio de cefalosporinas en una población colombiana: estudio de prescripción-indicación / Outpatient cephalosporin use in a Colombian population: prescription-indication study

INTRODUCCIÓN: El uso indebido de cefalosporinas puede provocar resistencia de las bacterias. OBJETIVO: Determinar el perfil de prescripción e indicación de cefalosporinas en un grupo de pacientes afiliados al Sistema de Salud de Colombia. MÉTODOS: Estudio transversal. A partir de una base de datos poblacional se obtuvo una muestra aleatoria de pacientes atendidos en consulta ambulatoria para identificar las indicaciones de cefalosporinas en registros clínicos. Se evaluaron variables farmacológicas relacionadas con formulación no indicada según guías de práctica clínica. RESULTADOS: En 381 pacientes, con edad media 41,2 ± 15,4 años, el 61,4% (n = 234) eran mujeres. Cefalexina fue la más utilizada (n=318; 83,5%), con duración media del tratamiento de 7,3 ± 3,2 días, seguida de cefradina (n = 43, 11,3%) y ceftriaxona (n = 20, 5,2%). Se prescribieron para infecciones de piel y tejidos blandos (n = 177; 46,4%, de las cuales 47,5% eran purulentas), del tracto urinario (n = 70; 18,4%), de vías respiratorias superiores (n = 57; 15,0%), e infecciones de transmisión sexual (n = 21; 5,5%). Estaban indicadas en 169 pacientes (44,4%), pero sólo 103 (60,9%) tenían prescripciones que cumplían las recomendaciones de dosificación. CONCLUSIONES: Más de la mitad de pacientes prescritos con cefalosporinas en un contexto ambulatorio tenían prescripciones consideradas no indicadas, en particular por su uso en infecciones de piel y tejidos blandos purulentas.

BACKGROUND: Misuse of cephalosporins can lead to bacterial resistance. Aim: To determine the prescription profile and indication of cephalosporins in the patients affiliated to the Colombian Health System. METHODS: Cross-sectional study. From a population database, a random sample of patients treated in an outpatient consultation was obtained, to identify the indications of the prescribed cephalosporins in their clinical record. Pharmacological variables, and those related to non-indicated formulations were evaluated according to the clinical practice guidelines. RESULTS: In 381 patients, the mean age was 41.2 ± 15.4 years, and 61.4% (n = 234) were women. Cefalexin was the most widely used (n=318; 83.5%), with a mean duration of treatment of 7.3 ± 3.2 days; followed by cefradine (n = 43; 11.3%), and ceftriaxone (n = 20; 5.2%). The most common uses were for skin and soft tissue infections (n = 177; 46.4% of which 47.5% were purulent), urinary tract infections (n = 70; 18.4%), upper respiratory airway infections (n = 57; 15.0%) and sexually transmitted diseases (n = 21; 5.5%). The use was considered indicated in 169 patients (44.4%), but only 103 (60.9%) had prescriptions that met the dosage recommendations from the clinical practice guidelines. CONCLUSIONS: More than half of the patients prescribed with cephalosporins in the outpatient setting had prescriptions considered not indicated, particularly for their use in purulent skin and soft tissue infections.

Nanopartículas como transportadores de fármacos: una herramienta prometedora contra la tuberculosis / Nanoparticles as drug transporters: a promising tool against tuberculosis

RESUMEN La Organización Mundial de la Salud (OMS) ubica a la tuberculosis (TB) como uno de los problemas de salud más preocupantes en la actualidad, y señala que se requieren de acciones novedosas para controlar su expansión y, de esta manera, alcanzar una de las metas establecidas en los Objetivos de Desarrollo Sostenible: reducir para 2030 la morbilidad e incidencia de TB. Para lograr este objetivo, está claro que las herramientas empleadas actualmente para su diagnóstico y tratamiento ya no son las adecuadas. En este sentido, es necesario desarrollar nuevos medicamentos y vacunas, así como novedosos procedimientos de administración de fármacos que generen una mejor respuesta, disminuyan el tiempo y optimicen los tratamientos. La nanotecnología ha incorporado en los últimos años un gran número de nuevas herramientas que incrementan considerablemente, la diversidad de mecanismos para la administración de tratamientos antituberculosos. Dicho esto, la presente revisión describe brevemente el estado actual de la farmacorresistencia en TB, así como las características generales de las nanopartículas que están evaluándose como herramientas para transportar antibióticos antituberculosos.

ABSTRACT The World Health Organization (WHO) places Tuberculosis (TB) as one of the most important health problems today. According to the WHO, this disease requires novel actions to control its expansion and, in this way, achieve one of the goals established in the sustainable development goals: to reduce TB morbidity and incidence by 2030 and regain control. To achieve this goal, the tools currently used for diagnosis and treatment are no longer adequate. In this sense, it is necessary to develop new drugs and vaccines, as well as novel drug administration procedures that generate a better response, reduce times, and optimize treatments. Nanotechnology has incorporated in recent years a considerable number of new tools that significantly increase the diversity of mechanisms for the administration of anti-tuberculosis drugs. Therefore, the present review briefly describes the current state of drug resistance in tuberculosis, as well as the general characteristics of nanoparticles being evaluated as tools to transport new antibiotics against tuberculosis.

Nanopartículas como transportadores de fármacos: una herramienta prometedora contra la tuberculosis / Nanoparticles as drug transporters: a promising tool against tuberculosis

RESUMEN La Organización Mundial de la Salud (OMS) ubica a la tuberculosis (TB) como uno de los problemas de salud más preocupantes en la actualidad, y señala que se requieren de acciones novedosas para controlar su expansión y, de esta manera, alcanzar una de las metas establecidas en los Objetivos de Desarrollo Sostenible: reducir para 2030 la morbilidad e incidencia de TB. Para lograr este objetivo, está claro que las herramientas empleadas actualmente para su diagnóstico y tratamiento ya no son las adecuadas. En este sentido, es necesario desarrollar nuevos medicamentos y vacunas, así como novedosos procedimientos de administración de fármacos que generen una mejor respuesta, disminuyan el tiempo y optimicen los tratamientos. La nanotecnología ha incorporado en los últimos años un gran número de nuevas herramientas que incrementan considerablemente, la diversidad de mecanismos para la administración de tratamientos antituberculosos. Dicho esto, la presente revisión describe brevemente el estado actual de la farmacorresistencia en TB, así como las características generales de las nanopartículas que están evaluándose como herramientas para transportar antibióticos antituberculosos.

ABSTRACT The World Health Organization (WHO) places Tuberculosis (TB) as one of the most important health problems today. According to the WHO, this disease requires novel actions to control its expansion and, in this way, achieve one of the goals established in the sustainable development goals: to reduce TB morbidity and incidence by 2030 and regain control. To achieve this goal, the tools currently used for diagnosis and treatment are no longer adequate. In this sense, it is necessary to develop new drugs and vaccines, as well as novel drug administration procedures that generate a better response, reduce times, and optimize treatments. Nanotechnology has incorporated in recent years a considerable number of new tools that significantly increase the diversity of mechanisms for the administration of anti-tuberculosis drugs. Therefore, the present review briefly describes the current state of drug resistance in tuberculosis, as well as the general characteristics of nanoparticles being evaluated as tools to transport new antibiotics against tuberculosis.

Frecuencia de resistencia a la colistina en Pseudomonas aeruginosa: primer reporte en el Perú

El objetivo del estudio fue determinar la frecuencia de resistencia a la colistina en Pseudomonas aeruginosa provenientes de tres establecimientos de salud de Lima, criopreservados en el banco de cepas del Laboratorio de Resistencia a Antimicrobianos e Inmunopatología de la Universidad Peruana Cayetano Heredia (UPCH). El método de elución de discos de colistina en caldo fue empleado para la identificación fenotípica de la resistencia a la colistina; la detección de la expresión del gen mcr-1 se realizó mediante el método fenotípico de difusión de discos combinados de colistina y ácido etilendiaminotetraacético (EDTA) y la reacción en cadena de la polimerasa (PCR) para la identificación molecular del gen. De los 97 aislados estudiados, 7 (7,2%) fueron resistentes a la colistina y ninguno fue portador del gen mcr-1. Este estudio constituye el primer reporte en el Perú de aislados clínicos de Pseudomonas aeruginosa resistentes a la colistina, lo que implica la necesidad de implementar metodologías apropiadas para la vigilancia epidemiológica de patógenos resistentes a la colistina.

This study aimed to determine the frequency of colistin resistance in Pseudomonas aeruginosa isolates obtained from three healthcare facilities in Lima and cryopreserved at the Laboratorio de Resistencia Antimicrobianos e Inmunopatología of the Universidad Peruana Cayetano Heredia (UPCH). The colistin broth disk elution method was used for the phenotypic identification of colistin resistance. We detected the expression of the mcr-1 gene by using the phenotypic diffusion method with combined colistin and ethylenediaminetetraacetic acid (EDTA) disks; and polymerase chain reaction (PCR) was used for molecular identification of the gene. Of the 97 isolates, 7 (7.2%) were resistant to colistin; however, none carried the mcr-1 gene. This is the first report from Peru on clinical isolates of colistin-resistant Pseudomonas aeruginosa, which suggests the need for implementation of appropriate methodologies for the epidemiological surveillance of colistin-resistant pathogens.

Resistencia a la colistina en cepas de Klebsiella pneumoniae multidrogorresistente del período 2015-2018 en un instituto materno perinatal de Lima, Perú / Colistin resistance in multidrug-resistant Klebsiella pneumoniae strains at a perinatal maternal institute in Lima, Peru, 2015-2018

RESUMEN El objetivo del estudio fue evaluar los niveles y mecanismos de resistencia a la colistina y a los carbapenémicos en cepas de Klebsiella pneumoniae multidrogorresistente aisladas durante el periodo 2015-2018 en el Instituto Materno Perinatal de Lima. Se analizó la sensibilidad mediante difusión en disco y microdilución. La presencia de genes de resistencia a los carbapenémicos y a la colistina se determinó por reacción en cadena de la polimerasa (PCR, por sus siglas en inglés) y se la relacionó con la clonalidad. Se analizaron 36 cepas de K. pneumoniae, cinco (13,8%) fueron resistentes a la colistina, pertenecían a diferentes grupos clonales. Se encontraron dos cepas con carbapenemasas (bla KPC y bla NDM) y no se detectaron genes plasmídicos para la colistina. Los niveles de resistencia al resto de antimicrobianos testados fueron elevados, a excepción de amikacina (13,9%). Los resultados destacan la presencia de cepas resistentes a la colistina (33,3% en 2018), situación preocupante por ser esta parte de las últimas alternativas de tratamiento para las infecciones causadas por patógenos multirresistentes.

ABSTRACT The objective of this study was to evaluate the presence of colistin- and carbapenemic-resistant genes in multidrug-resistant Klebsiella pneumoniae strains isolated at the Instituto Materno Perinatal de Lima (2015-2018). Susceptibility levels were analyzed by disk diffusion and microdilution. The presence of colistin- and carbapenemic-resistant genes was determined by polymerase chain reaction (PCR) and was related to clonality. A total of 36 K. pneumoniae strains were analyzed, 5 (13.8%) were resistant to colistin and belonged to different clonal groups. Only 2 strains were found with carbapenemases (bla KPC and bla NDM), and no colistin plasmid genes were detected. High resistance levels to the other tested antimicrobials were observed, except for amikacin (13.9%). The results highlight the presence of colistin-resistant strains (33.3% in 2018), a worrying situation as they are part of the latest treatment alternatives for infections caused by multiresistant pathogens.

Prevalencia de especies zoonóticas de Arcobacter en cerdos a nivel de matadero en Ecuador / Prevalence of zoonotic Arcobacter species in pigs at slaughterhouse level in Ecuador

RESUMEN Objetivo. Se pretende determinar la prevalencia, la diversidad y la resistencia antimicrobiana de las cuatro especies zoonóticas de Arcobacter en cerdos sanos, a nivel de matadero. Materiales y métodos. Fueron recolectadas, mediante muestreo no probabilístico por conveniencia, 50 muestras fecales obtenidas por hisopado rectal de cerdos sanos a nivel de matadero, antes de su faenamiento. El aislamiento de las cepas de Arcobacter fue realizado por métodos microbiológicos, utilizando enriquecimiento selectivo en caldo y filtración pasiva, mientras que para la identificación de especie fueron utilizadas pruebas bioquímicas y moleculares (multiplex PCR). El comportamiento frente a los antimicrobianos fue determinado por el método de disco difusión. Resultados. Fueron aisladas las cuatro especies zoonóticas, las cuales presentaron las siguientes frecuencias de aislamiento: A. thereius (18.0%), A. skirrowii (18.0%), A. cryaerophilus (6.0%) y A. butzleri (2.0%). Se encontró alta frecuencia de resistencia a ciprofloxacina y en las cuatro especies fueron aisladas cepas multirresistentes (resistentes a más de tres antibióticos).

ABSTRACT Objective. To establish the prevalence, diversity and antimicrobial resistance of the zoonotic species of Arcobacter in healthy pigs at slaughterhouse level. Material and methods. Fifty fecal samples were taken by rectal swabs from healthy pigs, before the beginning of the slaughter at the slaughterhouse of Loja city, Southern Ecuador. Sampling was done by means of a non-probabilistic method for convenience. Isolation of Arcobacter strains was done by microbiological methods and species identification using biochemical and molecular (multiplex PCR) tests. Antimicrobial behavior was performed using the disk diffusion method. Results. The four zoonotic species of Arcobacter were found. The isolation rates were A. thereius (18.0%), A. skirrowii (18.0%), A. cryaerophilus (6.0%) and A. butzleri (2.0%). High resistance to ciprofloxacin was found and multi-resistant strains were isolated from these four species. Conclusions. The fecal carriage of the zoonotic species of Arcobacter was demonstrated in pigs at slaughterhouse level. These species showed high resistance to ciprofloxacin being isolated muti-resistant strains among these four species.

Achromobacter: an emerging nosocomial pathogen

Background: Achromobacter is a ubiquitous, non-fermenting, Gram-negative bacterium that lives in soil and aquatic environments. In recent years, many studies have shown its potential as opportunistic pathogen. It can colonize various items used in hospital and can survive various disinfectants. The infections get complicated due to its vast spectrum of intrinsic and extrinsic resistance to antimicrobial agents and disinfectants. Achromobacter spp. is an emerging pathogen and is becoming a reservoir for horizontal genetic transfer elements involved in spreading antibiotic resistance. This study was conducted to assess the extent of the Achromobacter related infection in our hospital setting and to set a baseline for future studies.Methods: This study was conducted over a period of one year (January to December 2018) in our tertiary care hospital. All specimens submitted for aerobic culture and sensitivity were analyzed and the bacterial identification and antibiotic sensitivity of the isolates was carried out using automated method (Vitek 2 Compact, bioMerieux).Results: Achromobacter species was reported from 0.46% (63/13831) specimens, 40% of them were isolated from suction tips. Achromobacter denitrificans amounted for 47/63 (74.6%) while Achromobacter xylosoxidans was identified in 16/63 (25.4%).Conclusions: Studying the organisms in order to observe their changing trends

Microrganismos multirresistentes nas mãos de profissionais de saúde em Unidades de Terapia Intensiva / Multidrug-resistant microorganisms in Intensive Care Units hands of health care workers / Microorganismos multirresistentes en las manos de profesionales de salud en Unidades de Cuidado Intensivo

Justificativa e Objetivos: A relação dos microrganismos multirresistentes com as infecções hospitalares deixam poucas expectativas para o futuro, por isso este estudo teve como objetivo identificar os microrganismos presentes nas mãos dos profissionais em Unidades de Terapia Intensiva (UTI) e seu papel nas infecções hospitalares. Métodos: Foram coletadas amostras das mãos dos profissionais de saúde de UTI adulto e neonatal, utilizando o método do saco estéril de polietileno seguido de análises microbiológicas. Resultados: Foi coletado um total de 51 amostras, 26 de UTI adulto e 25 de UTI neonatal, sendo 56,8% de profissionais da enfermagem. Foi realizado o isolamento de bactérias, em que cerca de 60% dos voluntários apresentaram contaminação das mãos por microrganismos da microbiota transitória, e em sua maioria resistentes aos ß-lactâmicos, inclusive com perfil ESBL (54,5%), principalmente Enterobacter spp., Klebsiella pneumoniae e Pseudomonas aeruginosa. Conclusão: Estes resultados demonstram que microrganismos associados às infecções hospitalares estão presentes nas mãos dos profissionais de saúde, e que, para tanto, a higienização das mãos está sendo deficiente ou negligenciada. Para diminuir as taxas de infecção hospitalar são necessários vários fatores, como educação continuada, monitoramento da adesão à pratica de higiene das mãos, manutenção e instalação de equipamentos, além do uso racional de antibióticos.(AU)

Background and Objectives: The relation of multidrug-resistant organisms with nosocomial infections leave few expectations for the future, so this study aimed to identify the microorganisms present in the hands of professionals in intensive care units (ICU) and their role in hospital infections. Methods: Samples from the hands of adult and neonatal ICUs health professionals were collected using the method of sterile polyethylene bag followed by microbiological analyses. Results: A total of 51 samples were collected, 26 of the adult ICU and 25 of the neonatal ICU, of which 56.8% were nursing staff. Isolation of bacteria was carried out, in which approximately 60% of the volunteers presented contamination of the hands by microorganisms of the transient microbiota, and most of them resistant to ß-lactams, including ESBL (54.5%), mainly Enterobacter spp., Klebsiella pneumoniae and Pseudomonas aeruginosa. Conclusion: These results demonstrate that microorganisms associated with nosocomial infections are present in the hands of health care professionals, and that hence, the hands hygiene is being deficient or neglected. To the reduction of nosocomial infection rates are needed several factors such as continuing education, monitoring of adherence to the practice of hand hygiene, maintenance, equipment installation and rational use of antibiotics.(AU)

Justificación y Objetivos: La relación entre los microorganismos multirresistentes y las infecciones hospitalarias dejan pocas expectativas para el futuro, por lo que este estudio tuvo como objetivo identificar los microorganismos presentes en las manos de los profesionales en unidades de cuidados intensivos (UCI) y su papel en las infecciones hospitalarias. Métodos: Se recogieron muestras de las manos de los profesionales de salud de UCI de adultos y neonatal, utilizando el método de la bolsa estéril de polietileno seguido de análisis microbiológicos. Resultados: Se recogió un total de 51 muestras, 26 de UCI de adultos y 25 de UCI neonatal, siendo el 56,8% de profesionales de enfermería. Se realizó el aislamiento de bacterias, en el que cerca del 60% de los voluntarios tenían las manos contaminadas por microorganismos de la microflora transitoria, y su mayoría eran resistentes a betalactámicos, incluyendo el perfil ESBL (54,5%), principalmente Enterobacter spp., Klebsiella pneumoniae y Pseudomonas aeruginosa. Conclusión: Los resultados demuestran que microorganismos asociados a las infecciones hospitalarias están presentes en las manos de los profesionales de salud, y que la higienización de las manos está siendo deficiente o descuidada. Para reducir las tasas de infección hospitalarias necesitan varios factores, tales como la formación continua, el seguimiento de la adherencia a la práctica de la higiene de las manos, el mantenimiento, la instalación de equipos y el uso razonable de los antibióticos.(AU)

Multiplex PCR analysis of virulence genes and their influence on antibiotic resistance in Enterococcus spp. isolated from broiler chicken

Enterococcus spp. are opportunistic pathogens that cause lameness in broiler chickens, resulting in serious economic losses worldwide. Virulence of Enterococcus spp. is associated with several putative virulence genes including fsr, efm, esp, cylA, cad1, ace, gelE, and asa1. In this study, multiplex polymerase chain reaction (PCR) for the simultaneous detection of these virulence genes in Enterococcus spp. was developed, and detection limits for E. faecium, E. faecalis, and E. hirae were 64.0 pg/µL, 320.0 pg/µL, and 1.6 ng/µL DNA, respectively. Among 80 Enterococcus isolates tested, efm and cad1 were detected in all 26 E. faecium samples, and only cad1 was observed in E. hirae. Additionally, the presence of virulence genes in 25 E. faecalis isolates were 100% for cad1, 88.0% for gelE, 64.0% for fsr, 44.0% for asa1, 16.0% for cylA, and 4.0% for esp. No virulence genes were found in E. gallinarum isolates. A total of 49 isolates were resistant to tigecycline and to at least 2 different classes of antibiotics. The most prevalent resistance was to ciprofloxacin (73.5%), quinupristin/dalfopristin (55.1%), and tetracycline (49.0%). No strains were resistant to vancomycin or linezolid. This is the first multiplex PCR assay to simultaneously detect eight virulence genes in Enterococcus spp., and the method provides diagnostic value for accurate, rapid, and convenient detection of virulence genes. Additionally, we report the prevalence of virulence genes and antimicrobial resistance in Enterococcus isolates from commercial broiler chickens suffering lameness.

Cepas E-ESKAPE multidrogorresistentes aisladas en hemocultivos de pacientes con cáncer / Multidrug resistance E-ESKAPE strains isolated from blood cultures in patients with cancer

Resumen: Objetivo: Describir la tendencia de cepas multidrogorresistentes (MDR) aisladas en hemocultivos de pacientes con cáncer durante el periodo de 2005 a 2015. Material y métodos: Análisis retrospectivo en el que se procesaron 33 127 hemocultivos. La identificación y la sensibilidad antimicrobianas se realizaron a través de métodos automatizados WaLK away (Siemens Laboratory Diagnostics) y BD Phoenix (Becton, Dickinson and Company). Se determinaron cepas resistentes de acuerdo con la concentración mínima inhibitoria, según los parámetros del Clinical and Laboratory Standards Institute (CLSI). Resultados: 5604 (16.9%) aislamientos fueron positivos, con 6397 aislamientos, 3732 (58.4%) bacilos gramnegativos, 2355 (36.9%) cocos grampositivos, 179 (2.7%) levaduras y 126 (1.9%) bacilos grampositivos. Escherichia coli (n=1 591, 24.5%) fue la bacteria más frecuente, 652 (41%) productoras de beta-lactamasas de espectro-extendido (BLEE); Enterococcus faecium 143 (2.1%), 45 (31.5%) resistente a vancomicina; Staphylococcus aureus 571 (8.7%), 121 (21.2%) resistentes a meticilina (SARM); Klebsiella pneumoniae 367 (5.6%), 41 (11.2%) BLEE, Acinetobacter baumannii 96 (1.4%), 23 (24%) MDR; Pseudomonas aeruginosa 384 (5.6%), 43 (11.2%) MDR. Las cepas MDR se aislaron más frecuentemente en pacientes con neoplasias hematológicas en comparación con tumores sólidos; SARM (RM=4.48, IC95% 2.9-6.8); E. coli BLEE (RM=1.3, IC95% 1.10-1.65) y A. baumannii-MDR (RM=3.2, IC95% 1.2-8.3). Conclusiones. Se observó un aislamiento significativamente mayor de cepas E-ESKAPE MDR en pacientes con neoplasias hematológicas.

Abstract: Objective: To describe the trend of multidrug resistant (MDR) strains isolated from blood in patients with cancer from 2005 to 2015. Materials and methods: 33 127 blood cultures were processed by retrospective analysis. Identification and antimicrobial sensitivity were performed through automated methods: WaLK away (Siemens Laboratory Diagnostics) and BD Phoenix (Becton, Dickinson and Company). Resistant strains were determined according to the minimum inhibitory concentration, following the parameters of the Clinical and Laboratory Standards Institute (CLSI). Results: Of 6 397 isolates, 5 604 (16.9%) were positive; 3 732 (58.4%) Gram- bacilli; 2 355 (36.9%) Gram+ cocci; 179 (2.7%) yeasts, and 126 (1.9%) Gram+ bacilli. Escherichia coli (n=1 591, 24.5%) was the most frequent bacteria, with 652 (41%) strains being extended-spectrum beta-lactamases producers (ESBL); of Enterococcus faecium (n=143, 2.1%), 45 (31.5%) were vancomycin resistant; of Staphylococcus aureus (n=571, 8.7%), 121 (21.2%) methicillin resistant (MRSA); of Klebsiella pneumoniae (n=367, 5.6%), 41 (11.2%) ESBL; of Acinetobacter baumanii (n=96, 1.4%), 23 (24%) MDR, and of Pseudomonas aeruginosa (n=384, 5.6%), 43 (11.2%) MDR. MDR strains were significantly more frequent in patients with hematological malignancies, compared to those with solid tumors: MRSA (OR=4.48, 95%CI 2.9-6.8), ESBL E. coli (OR=1.3, 95%CI 1.10-1.65) and MDR Acinetobacter baumanii (OR=3.2, 95%CI 1.2-8.3). Conclusions: We observed significantly higher isolations of E-ESPAKE MDR strains in patients with hematological malignancies.

Antimicrobial Resistance of Helicobacter pylori Isolates in Korea / 대한Helicobacter연구학회지

Antimicrobial resistance is a growing problem in the eradication of Helicobacter pylori. A combination therapy with proton pump inhibitor, clarithromycin, and amoxicillin is recommended as the first-line treatment regimen in Korea. However, the eradication rate with a standard triple therapy has been unsatisfactory in the last decade, and one of the main reasons for treatment failure is the increasing prevalence of strains resistant to antimicrobials. Therefore, comprehensive and detailed information on antimicrobial resistance is mandatory to optimize the strategy of eradication treatment. The antimicrobial resistance of H. pylori is reported to vary according to study population, geographical region, and test methods. In this review, the prevalence of antimicrobial resistance of H. pylori isolates in Korea is summarized on the basis of recent studies.

Rational use of intravenous polymyxin B and colistin: A review

@#Polymyxin B and colistin (polymyxin E) were introduced in clinical practice to treat Gram-negative infections in 1950s but their parenteral use waned in 1970s due to toxicity concerns. Resurgence of polymyxins use in Malaysia began approximately in 2009 due to a lack of treatment options for MDR Gram negative superbugs such as Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. However, limited experience and a lack of widespread availability of up-to-date dosing guidelines could potentially result in incorrect use of these last resort antibiotics by managing doctors. The recent report of polymyxin resistant strains is also a cause of concern. Herein, we discuss the importance of preserving the efficacy of polymyxins in hospitals, the similarities and differences between polymyxin B and colistin, issues pertaining to current use of polymxyins and strategies to improve polymyxins’ prescription. Polymyxins should only be used to treat significant infections, in optimum doses and if possible, in combination with other antibiotics.

Clinical Evaluation of QMAC-dRAST for Direct and Rapid Antimicrobial Susceptibility Test with Gram-Positive Cocci from Positive Blood Culture Bottles / 대한임상미생물학회지

BACKGROUND: Timely intervention in the treatment of bloodstream infection is important for prescription of appropriate antimicrobials. With prompt determination of the antimicrobial susceptibility of a causative agent, rapid antimicrobial susceptibility test (AST) can help select the appropriate antimicrobial therapy. This clinical study is for evaluation of the clinical performance of the QMAC-dRAST for rapid AST directly from positive blood culture (PBC)s with Gram-positive cocci. METHODS: A total of 115 PBC samples with Gram-positive organisms (76 Staphylococcus spp. and 39 Enterococcus spp.) were evaluated by the QMAC-dRAST system, and their pure culture isolates were evaluated by the MicroScan WalkAway (Beckman Coulter, USA) as the comparative AST system. Thirteen antimicrobial agents were included, and the agreement and discrepancy rates of the QMAC-dRAST system (Quantamatrix Inc., Republic of Korea) compared to the MicroScan WalkAway were calculated. To resolve discrepancies, the broth microdilution method was performed. RESULTS: The QMAC-dRAST system exhibited a categorical agreement rate of 94.9% (1,126/1,187) and an essential agreement rate of 98.3% (1,167/1,187). The QMAC-dRAST system yielded very major (false-susceptible) errors at 1.0% (5/485), major (false-resistant) errors at 1.3% (9/693), and minor errors at 4.0% (47/1,187) compared to the MicroScan WalkAway. The QMAC-dRAST system significantly eliminated 30 hours of total turnaround time by combination of direct inoculation of PBC and an image-based approach. CONCLUSION: The results of the QMAC-dRAST system were highly accurate. Thereby, the QMAC-dRAST may provide essential information to accelerate therapeutic decisions for earlier and adequate antibiotic treatment and patient management in clinical settings.

Resistencia antibiótica y distribución de serotipos en cepas neumocócicas invasivas en adultos hospitalizados en Lima, Perú / Antibiotic resistance and distribution of serotypes of invasive pneumococcal strains isolated from hospitalized adults in Lima, Peru

RESUMEN Objetivos. Describir las características clínicas, resistencia antibiótica y distribución de serotipos de cepas causantes de enfermedad neumocócica invasiva (ENI) en adultos. Materiales y métodos. Estudio tipo serie de casos. Se recolectaron cepas de neumococo de pacientes adultos hospitalizados con ENI en cinco hospitales nacionales y dos laboratorios de Lima durante los años 2009-2011. Resultados. Se estudiaron datos de 43 pacientes con ENI, el 58,2% fueron mayores de 60 años. Los diagnósticos fueron neumonía 39,5%, meningitis 30,2%, bacteriemia 13,9%, peritonitis 11,6%, artritis séptica 4,8%. El porcentaje de fallecidos fue 28,9%, de los cuales el 72,7% fueron mayores de 60 años. Las cepas de neumococo presentaron la siguiente resistencia: penicilina 0% en cepas no meningitis y 30,8% en cepas meningitis; ceftriaxona 4,5% y 16,7% de resistencia intermedia en cepas no meningitis y cepas meningitis respectivamente; 69% a trimetoprim/sulfametoxazol y 35,7% a eritromicina. Los serotipos más comunes fueron 19F, 23F, 6B, 14 y 6C. El porcentaje de cepas vacunales fue 44,2% para la vacuna conjugada siete-valente (PCV7) y para la PCV10, 51,2% para PCV13 y 60,4% para la vacuna polisacárida veintitrés-valente (PPV23). Conclusiones. El neumococo es un patógeno relevante en adultos, en especial en los adultos mayores, debido a su elevada mortalidad.

ABSTRACT Objectives. To describe the clinical characteristics, antibiotic resistance, and distribution of serotypes of bacterial strains that cause invasive pneumococcal disease (IPD) in adults. Materials and methods. Case series. Pneumococcal strains were isolated from 2009 to 2011 from hospitalized adult patients with IPD in five hospitals and two laboratories located in Lima. Results. The analysis of data from 43 patients with IPD indicated that 58.2% were older than 60 years. The most common complications were pneumonia (39.5%), meningitis (30.2%), bacteremia (13.9%), peritonitis (11.6%), and septic arthritis (4.8%). The mortality rate was 28.9%, and 72.7% of cases involved patients older than 60 years. The pneumococcal strains were resistant to the following antibiotics: penicillin, 0% and 30.8% in non-meningitis and meningitis strains, respectively; ceftriaxone, 4.5% and 16.7% in non-meningitis and meningitis strains, respectively; trimethoprim/sulfamethoxazole, 69.0%; and erythromycin, 35.7%. The most common serotypes were 19F, 23F, 6B, 14, and 6C. The percentage of vaccine strains was 44.2% for the 7-valent conjugate pneumococcal vaccine (PCV7) and PCV10, 51.2% for PCV13, and 60.4% for the 23-valent polysaccharide vaccine (PPV23). Conclusions. Pneumococcus is an important pathogen in adults, particularly in older adults, owing to its high mortality rate.

Antimicrobial susceptibility profile of Campylobacter spp. isolated from different animal species in Minas Gerais / Perfil de suscetibilidade a antimicrobianos de amostras Campylobacter spp isoladas de diferentes espécies animais em Minas Gerais

Susceptibility pattern of 45 Campylobacter spp.isolates ­ 16 C. jejuni, eight C. coli, and 21 C. fetus isolated from different animal species in Brazil ­ to twelve antimicrobial agents was determined. All Campylobacter spp. isolates were susceptible to gentamicin, sulfadiazine, and sulfamethoxazole. C. jejuni and C. coli were also sensitive to chloramphenicol, whereas all C. fetus strains were susceptible to kanamycin. Cefoperazone showed the highest percentage of resistance among C. jejuni (68.75%), followed by nalidixic acid (31.25%), ampicillin (37.50%), tetracycline (37.50%), erythromycin (12.50%), and kanamycin (6.25%). Likewise, cefoperazone exhibited the highest percentage of resistance among C. coli (75.00%), followed by nalidixic acid (50.00%), tetracycline (50.00%), erythromycin (37.50%), ampicillin (12.50%), and kanamycin (12.50%). Among C. fetus strains, nalidixic acid showed the highest resistance rate (85.71%), followed by cefoperazone (71.43%), tetracycline (42.86%), ampicillin (19.05%), chloramphenicol (9.52%), and erythromycin (4.76%). Therefore, it was found that the majority of Campylobacter spp. isolated from animals was sensitive to gentamycin, chloramphenicol, kanamacyn, and sulfonamides; however, a high proportion of the strains showed reduced susceptibility to nalidixic acid, ampicillin, cefoperazone, and tetracycline. Moreover, C. coli and C. fetus isolates showed a high percentage of multidrug resistant strains.(AU)

O padrão de sensibilidade de 45 amostras de Campylobacter spp, incluindo 16 amostras de C. jejuni, 8 de C. coli e 21 C. fetus, isoladas de diferentes espécies de animais do Brasil, foi determinado para doze antimicrobianos. Todas as amostras de Campylobacter spp foram sensíveis à gentamicina, sulfadiazina e sulfametoxazol. C. jejuni e C. coli foram também sensíveis ao cloranfenicol, enquanto todas as amostras de C. fetus foram sensíveis à canamicina. Cefoperazona mostrou o maior percentual de resistência entre C. jejuni (68,75%), seguido pelo ácido nalidíxico (31,25%), ampicilina (37,50%), tetraciclina (37,50%), eritromicina (12,50%) e canamicina (6,25%). Similarmente, cefoperazona também exibiu o maior percentual de resistência entre as amostras de C. coli (75,00%), seguido pelo ácido nalidíxico (50,00%), tetraciclina (50,00%), eritromicina (37,50%), ampicilina (12,50%) e canamicina (12,50%). Entre os isolados de C. fetus, ácido nalidíxico apresentou maior taxa de resistência (85,71%), seguido de cefoperazona (71,43%), tetraciclina (42,86%), ampicilina (19,05%), cloranfenicol (9,52%) e eritromicina (4,76%). Assim, os nossos resultados mostraram que a maioria das amostras de Campylobacter spp isolados de animais foram sensíveis à gentamicina, cloranfenicol, canamicina e sulfonamidas. No entanto, uma proporção elevada das amostras apresentou susceptibilidade reduzida ao ácido nalidíxico, ampicilina, cefoperazona e tetraciclina. Além disso, C. coli e C. fetus mostraram uma alta porcentagem de amostras resistentes a múltiplas drogas.(AU)

Mechanisms of quinolone resistance in Escherichia coli isolated from companion animals, pet-owners, and non-pet-owners

The present study investigated the prevalence and mechanisms of fluoroquinolone (FQ)/quinolone (Q) resistance in Escherichia (E.) coli isolates from companion animals, pet-owners, and non-pet-owners. A total of 63 E. coli isolates were collected from 104 anal swab samples, and 27 nalidixic acid (NA)-resistant isolates were identified. Of those, 10 showed ciprofloxacin (CIP) resistance. A plasmid-mediated Q resistance gene was detected in one isolate. Increased efflux pump activity, as measured by organic solvent tolerance assay, was detected in 18 NA-resistant isolates (66.7%), but was not correlated with an increase in minimum inhibitory concentration (MIC). Target gene mutations in Q resistance-determining regions (QRDRs) were the main cause of (FQ)Q resistance in E. coli. Point mutations in QRDRs were detected in all NA-resistant isolates, and the number of mutations was strongly correlated with increased MIC (R = 0.878 for NA and 0.954 for CIP). All CIP-resistant isolates (n = 10) had double mutations in the gyrA gene, with additional mutations in parC and parE. Interestingly, (FQ)Q resistance mechanisms in isolates from companion animals were the same as those in humans. Therefore, prudent use of (FQ)Q in veterinary medicine is warranted to prevent the dissemination of (FQ)Q-resistant bacteria from animals to humans.

Increasing Resistance to Extended-Spectrum Cephalosporins, Fluoroquinolone, and Carbapenem in Gram-Negative Bacilli and the Emergence of Carbapenem Non-Susceptibility in Klebsiella pneumoniae: Analysis of Korean Antimicrobial Resistance Monitoring System

BACKGROUND: National surveillance of antimicrobial resistance becomes more important for the control of antimicrobial resistance and determination of treatment guidelines. We analyzed Korean Antimicrobial Resistance Monitoring System (KARMS) data collected from 2013 to 2015. METHODS: Of the KARMS participants, 16 secondary or tertiary hospitals consecutively reported antimicrobial resistance rates from 2013 to 2015. Data from duplicate isolates and institutions with fewer than 20 isolates were excluded. To determine the long-term trends, previous KARMS data from 2004 to 2012 were also considered. RESULTS: The prevalence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium from 2013 to 2015 was 66–72% and 29–31%, respectively. The resistance rates of Escherichia coli to cefotaxime and cefepime gradually increased to 35% and 31%, respectively, and fluoroquinolone resistance reached 48% in 2015. The resistance rates of Klebsiella pneumoniae to cefotaxime, cefepime, and carbapenem were 38–41%, 33–41%, and <0.1–2%, respectively, from 2013 to 2015. The carbapenem susceptibility rates of E. coli and K. pneumoniae decreased from 100% and 99.3% in 2011 to 99.0% and 97.0% in 2015, respectively. The resistance rate of Pseudomonas aeruginosa to carbapenem increased to 35% and the prevalence of carbapenem-resistant Acinetobacter baumannii increased from 77% in 2013 to 85% in 2015. CONCLUSIONS: Between 2013 and 2015, the resistance rates of E. coli to third- and fourth-generation cephalosporins increased continuously, while carbapenem-susceptibility gradually decreased, particularly in K. pneumoniae. The prevalence of carbapenem-resistant P. aeruginosa and A. baumannii increased significantly; therefore, few treatment options remain for these resistant strains.

A Study on Clinical Profile and Antimicrobial Drug Resistance in Infection with Stenotrophomonas maltophilia at a Tertiary Care Hospital of Rural Gujarat, India.

Background & objectives: Stenotrophomonas maltophilia causes opportunistic infections and is emerging as an important hospital-acquired pathogen. Present study was undertaken to investigate the prevalence, clinical profile, associated factors and antimicrobial susceptibility of S. maltophilia. Methods: Cross sectional retrospective study was conducted whereby patients’ details including type of infection, hospital stay, indwelling devices, co-morbid conditions and outcome till discharge were collected from January 2012 to March 2016. Identification and antimicrobial susceptibility were done by using Vitek2-compact-microbiological system. Results: 45 (0.17%) S.maltophilia strains were isolated from 27,132 samples received, forming 1.63% of total non-fermenters. Prevalence of S.maltophilia infection ranged from 0.06% in 2012 to 0.26% in 2015. Common sites involved were respiratory tract i.e. 55.5%, followed by bloodstream (20%), urinary tract (13.3%) and soft tissue (11.1%). 64.4% patients were male, and adults (26.7%) between 51-60 years of age. 66.7% of the isolates were from critical care units followed by wards (33.3%). Co-morbid conditions observed were COPD with respiratory complications i.e. 26.7% followed by cardiovascular diseases 22.2%, malignancy 11.1%, post surgical patients 11.1%, complicated UTI and trauma 8.8% each, CNS complications 6.7%, burns and cellulitis 2.2% each. All patients had exposure to broad-spectrum antibiotics and 66.6% had indwelling devices. 17.8% isolates were resistant to trimethoprim-sulfamethoxazole. Mortality observed was 20%. Interpretation & conclusion: S maltophilia is an emerging pathogen and its prevalence has gradually increased at our hospital. ICUs are the main hospital sites and respiratory infections main clinical condition. [Disha S NJIRM 2016; 7(5):5-8]

Clinical Effectiveness and Nephrotoxicity of Aerosolized Colistin Treatment in Multidrug-Resistant Gram-Negative Pneumonia / 대한구급학회지

BACKGROUND: Colistin (polymyxin E) is active against multidrug-resistant Gram-negative bacteria (MDR-GNB). However, the effectiveness of inhaled colistin is unclear. This study was designed to assess the effectiveness and safety of aerosolized colistin for the treatment of ventilator-associated pneumonia (VAP) caused by MDR-GNB. METHODS: In this retrospective longitudinal study, we evaluated the medical records of 63 patients who received aerosolized colistin treatment for VAP caused by MDR-GNB in the medical intensive care unit (MICU) from February 2012 to March 2014. RESULTS: A total of 25 patients with VAP caused by MDR-GNB were included in this study. The negative conversion rate was 84.6% after treatment, and acute kidney injury (AKI) occurred in 11 patients (44%, AKI group). The average length of MICU stay and colistin treatment- related factors, such as daily and total cumulative doses and administration period, were not significantly different between groups. In-hospital mortality tended to be higher in the AKI group (p = 0.07). Multivariate analysis showed that a body mass index less than 18 was an independent risk factor of mortality (odds ratio [OR] = 21.95, 95% confidence interval [CI] 1.59-302.23; p = 0.02). Notably, AKI occurrence was closely related to the administration of more than two nephrotoxic drugs combined with aerosolized colistin (OR = 15.03, 95% CI 1.40-161.76; p = 0.025) and septic shock (OR = 8.10, 95% CI 1.40-161.76; p = 0.04). CONCLUSIONS: The use of adjunctive aerosolized colistin treatment appears to be a relatively safe and effective option for the treatment of VAP caused by MDR-GNB. However, more research on the concomitant use of nephrotoxic drugs with aerosolized colistin will be necessary, as this can be an important risk factor of development of AKI.