Sensibilidad de Streptococcus pneumoniae en niños portadores sanos en Murcia (España) / Antibiotic susceptibility of Streptococcus pneumoniae in healthy carrier children in Murcia (Spain)

INTRODUCCIÓN Y OBJETIVOS: Streptococcus pneumoniae (SP) es un patógeno que causa un elevado consumo de antibióticos. OBJETIVOS: conocer la sensibilidad a antibióticos de uso habitual, los factores epidemiológicos asociados y favorecer el uso racional de antibióticos. PACIENTES Y MÉTODOS: En verano del 2009 y el invierno del 2010 realizamos un estudio multicéntrico en Atención Primaria (AP). Se recogió una muestra nasofaríngea y se cumplimentó una encuesta epidemiológica en 1.562 niños de 1 y 4 años. RESULTADOS: El 31,3% (489/1.562) eran portadores nasales (PN). Se realizó un estudio de sensibilidad en 376 aislados, y se serotipificaron 343. El 61,7% (964/1.562) habían recibido al menos una dosis de vacuna antineumocócica conjugada heptavalente (PCV7). El 12,8% (44/343) correspondía a serotipos vacunales (SV). La resistencia a penicilina (criterio meningitis CMI>0,06mg/l) fue del 28%, siendo del 54% para los SV. Para infecciones no meníngeas, el 100% de los aislados eran sensibles a penicilina parenteral (CMI ≤ 2mg/l). Existe un alto nivel de resistencias para eritromicina (45,8%). Fueron factores favorecedores de resistencia haber tomado antibióticos el mes previo y ser portador de SV tanto para penicilina como para cefotaxima y la edad de 4 años un factor de protección. Los serotipos 14, 35B, 19A, 15A y 19F fueron los menos susceptibles a penicilina. CONCLUSIONES: La amoxicilina por vía oral para pacientes ambulatorios y la penicilina o ampicilina por vía intravenosa para pacientes ingresados son excelentes opciones para el tratamiento de infecciones neumocócicas no meníngeas, en entornos como el nuestro, con una baja incidencia de aislados con alto nivel de resistencia a penicilina (CMI ≥ 2mg/l)

INTRODUCTION AND OBJECTIVES: Streptococcus pneumoniae (SP) is a human pathogen that involves a high use of antibiotics. The objective of the study was to determine the susceptibility to commonly used antibiotics and their associated risk factors, in order to promote rational use of antibiotics. PATIENTS AND METHODS: In A multicentre study was conducted in summer 2009 and winter 2010 on children attending paediatric clinics in the Region of Murcia. A nasopharyngeal sample was collected and an epidemiological questionnaire was completed. The study included 1562 children aged 1 and 4 years old. RESULTS: Almost one-third (31.3%, 489/1562) of children were nasal carriers. A sensitivity study was carried out on 376 isolates, of which 343 were serotyped. Almost two-thirds (61.7%, 964/1562) of children had received at least one dose of PCV7 heptavalent pneumococcal conjugate vaccine), and 12.8% (44/343) of the isolates belonged to PCV7 serotypes. The prevalence rates of penicillin resistance (meningitis infections criteria CMI>0.06mg/L) were 28.1%; however, this percentage was 54% in PCV7 serotypes. None of the isolates had (MIC >2mg/L), so prevalence rates of susceptibility with non-meningitis infections criteria were 100%. There was a high percentage of erythromycin resistance (45.7%). The factors favouring resistance to penicillin and cefotaxime were the consumption of antibiotics in the previous month and the carrying of vaccine serotypes. On the other hand, the age of 4 years old was a protective factor of resistance. The 14, 35B, 19A, 15A, and 19F serotypes were less susceptible to penicillin. CONCLUSIONS: Both oral amoxicillin given to outpatients and intravenous penicillin or ampicillin to hospitalized patients are excellent options for the treatment of non-meningeal infections, as seen with pneumonia in these kinds of environments, where there is low incidence of isolates highly resistant to penicillin (CMI ≥ 2mg/L)

[Antibiotic susceptibility of Streptococcus pneumoniae in healthy carrier children in Murcia (Spain)]. / Sensibilidad de Streptococcus pneumoniae en niños portadores sanos en Murcia (España).

INTRODUCTION AND OBJECTIVES: Streptococcus pneumoniae (SP) is a human pathogen that involves a high use of antibiotics. The objective of the study was to determine the susceptibility to commonly used antibiotics and their associated risk factors, in order to promote rational use of antibiotics. PATIENTS AND METHODS: In A multicentre study was conducted in summer 2009 and winter 2010 on children attending paediatric clinics in the Region of Murcia. A nasopharyngeal sample was collected and an epidemiological questionnaire was completed. The study included 1562 children aged 1 and 4 years old. RESULTS: Almost one-third (31.3%, 489/1562) of children were nasal carriers. A sensitivity study was carried out on 376 isolates, of which 343 were serotyped. Almost two-thirds (61.7%, 964/1562) of children had received at least one dose of PCV7 (heptavalent pneumococcal conjugate vaccine), and 12.8% (44/343) of the isolates belonged to PCV7 serotypes. The prevalence rates of penicillin resistance (meningitis infections criteria CMI>0.06mg/L) were 28.1%; however, this percentage was 54% in PCV7 serotypes. None of the isolates had (MIC >2mg/L), so prevalence rates of susceptibility with non-meningitis infections criteria were 100%. There was a high percentage of erythromycin resistance (45.7%). The factors favouring resistance to penicillin and cefotaxime were the consumption of antibiotics in the previous month and the carrying of vaccine serotypes. On the other hand, the age of 4 years old was a protective factor of resistance. The 14, 35B, 19A, 15A, and 19F serotypes were less susceptible to penicillin. CONCLUSIONS: Both oral amoxicillin given to outpatients and intravenous penicillin or ampicillin to hospitalized patients are excellent options for the treatment of non-meningeal infections, as seen with pneumonia in these kinds of environments, where there is low incidence of isolates highly resistant to penicillin (CMI ≥ 2mg/L).

Bacteriemia por Escherichia coli resistente a ciprofloxacino: factores de riesgo para resistencia a ciprofloxacino e impacto de recibir tratamiento empírico con este antibiótico / Bacteremia due to ciprofloxacin-resistant E. coli: risk factors for ciprofloxacin resistance and impact of receiving empirical treatment with this antibiotic

Antecedentes y objetivos: La incidencia de Escherichia coli resistente a ciprofloxacino (CIP-R) ha aumentado en el Hospital General Universitario Gregorio Marañón (Madrid) durante la última década. CIP continua siendo utilizado como tratamiento empírico de elección en muchas complicaciones sépticas. Nuestro objetivo es analizar los factores que favorecen la adquisición de resistencia a CIP, y en segundo lugar estudiar las consecuencias de administrar empíricamente este antibiótico en casos de bacteriemia por una cepa CIP-R. Material y Métodos: El estudio se ha realizado en el Hospital General Universitario Gregorio Marañón (Madrid). Se revisaron las historias de 224 pacientes con bacteriemia por E. Coli, diagnosticadas en 2001 y 2002. De ellas, 112 eran CIP-R y 112 CIP-S (sensible a ciprofloxacino). Se han estudiado los factores de riesgo posibles para adquirir resistencia a CIP mediante un estudio de “casos y controles”. En una segunda parte hemos estudiado el impacto de recibir empíricamente esta quinolona en aquellos pacientes que tenían una bacteriemia por una cepa resistente. Resultados: De las 224 bacteriemias por E. coli, 161 (23%) fueron cepas CIP-R; de éstas 161 cepas, el 62,5% habían recibido quinolonas en los seis meses previos. Para el segundo objetivo se dividieron los pacientes en aquellos tratados inadecuadamente con quinolonas al menos 48 horas durante los primeros cuatro días de tratamiento: 28 pacientes (25%), y aquellos tratados adecuadamente: 84 pacientes (75%). Los datos obtenidos fueron los siguientes respectivamente: media de días de tratamiento antibiótico global: 15,6 vs 13,2; media de días de estancia hospitalaria: 21,1 vs 18,9; porcentaje de mortalidad: 28,6 vs 6,0; y porcentaje de mala evolución: 50,0 vs 7,1. Conclusiones: El uso previo de quinolonas constituye un factor de riesgo para desarrollar resistencia. Ciprofloxacino podría dejar de ser una elección idónea como tratamiento empírico de episodios de bacteriemia potencialmente atribuible a E.coli, al menos en aquellos pacientes con riesgo de tener una infección por una cepa resistente. La elección equivocada de antimicrobiano no influye en el alargamiento de estancia hospitalaria, pero sí aumenta la morbimortalidad (AU)

Antecedents and objectives: The incidence of ciprofloxacin-resistant E. coli (CIP-R) has increased in the Hospital General Universitario Gregorio Marañón (Madrid) during the last decade. CIP is still in use as the empirical treatment of choice in many septic complications. Our objective is to analyze the factors that favour the acquisition of CIP resistance, and secondly study the consequences of the empiric administration of this antibiotic in bacteremic cases due to a CIP-R strain. Material and Methods: the study has been carried out in the Hospital General Universitario Gregorio Marañón (Madrid).The clinical histories of 224 patients with E.coli bacteremia diagnosed in 2001 and 2002 were revised. Of these histories 112 were CIP-R and 112 CIP-S (ciprofloxacin-sensitive).The possible risk factors for acquisition of CIP resistance were analyzed through a “case-control” study. In a second part we have studied the impact of empirical treatment with this quinolone in those patients who suffered a bacteremia due to a resistant strain. Results: of the 224 E. coli bacteremias 161 (72 %) were CIP-R strains; of these 161 strains 62.5 % had received quinolones in the previous six months. For the second objective the patients were divided in two groups: those who were treated inadequately with quinolones for at least 48 hours during the first four days of treatment, i.e. 28 patients (25 %) and those adequately treated, i.e. 84 patients (75 %). The data obtained were respectively the following: average duration of antibiotic treatment: 15.5 days vs 13.2 days; average duration of hospital stay: 21.1 days vs 18.9 days; percent mortality rate: 28.6 vs 6.0; and percentage of unsatisfactory evolution: 50.0 vs 7.1. Conclusions: the previous use of quinolones is a risk factor for the appearance of resistance. Ciprofloxacin could stop being the best choice for empirical treatment for bacteremic episodes possibly due to E. coli, at least in those patients who risk having an infection with a resistant strain. The wrong choice of antimicrobial agent does not have an impact on the lengthening of the hospital stay but does increase the morbidity and mortality (AU)