[Etiology and antimicrobial resistance of uncomplicated urinary tract infections]. / Etiología y resistencia a antimicrobianos de la infección no complicada del tracto urinario.

Uncomplicated urinary tract infections rank among the most frequent bacterial infections in women in the outpatient setting and represent a major cause of antimicrobial prescription. The aims of this study were to assess frequencies and antimicrobial resistance of current uropathogens causing uncomplicated urinary tract infection. In a prospective multicenter study, patients were recruited in ambulatory settings of four participating hospitals between June 2011 and December 2013. We analyzed 138 patients that met clinical and bacteriological diagnostic criteria. The mean age was 28 years. Cystitis was defined in 70% (n: 97) and pyelonephritis in 30% (n: 41). Frequencies of isolated microorganisms were: Escherichia coli 70% (n: 97), Staphylococcus saprophyticus 17% (n: 24), Proteus spp. 7% (n: 10), Klebsiella spp. 4% (n: 5), Enterococcus spp. and Pseudomonas aeruginosa 1 (0.7%) each. The antimicrobial resistance was: ampicillin-sulbactam 37% (n: 51) cephalexin 28% (n: 39), trimethoprim/sulfamethoxazole 22% (n: 31), nitrofurantoin 12% (n: 17), gentamicin 7% (n: 10) and ciprofloxacin 5% (n: 7). The levels of resistance found for ampicillin-sulbactam, trimethoprim/sulfamethoxazole and cephalexin were higher than those previously reported in Argentina. A better knowledge of the etiology and local antimicrobial susceptibility allows the design of more adequate guidelines for empirical treatment.

Etiología y resistencia a antimicrobianos de la infección no complicada del tracto urinario / Etiology and antimicrobial resistance of uncomplicated urinary tract infections

La infección urinaria no complicada en mujeres es un motivo frecuente de consulta e indicación de antimicrobianos. El objetivo de este estudio fue definir etiología y resistencia a antimicrobianos en episodios de infección urinaria no complicada. Este estudio prospectivo incluyó mujeres premenopáusicas no embarazadas, con infección urinaria no complicada, que consultaron en un hospital público y tres centros privados de las ciudades de Buenos Aires y La Plata (2011-2013). La edad media de 138 pacientes con infección confirmada por urocultivo fue 28 años. El diagnóstico fue cistitis en 97 (70%) y pielonefritis en 41 (30%). Las frecuencias de los microorganismos aislados fueron: Escherichia coli 97 (70%), Staphylococcus saprophyticus 24 (17%), Proteus spp. 10 (7%), Klebsiella spp. 5 (4%), Enterococcus spp. 1 (0.7%) y Pseudomonas aeruginosa 1 (0.7%). Las frecuencias de resistencia a antimicrobianos fueron: ampicilina-sulbactam 51 (37%), cefalexina 39 (28%), trimetoprima/sulfametoxazol 31 (22%), nitrofurantoína 17 (12%), gentamicina 10 (7%) y ciprofloxacina 7 (5%). La frecuencia de resistencia a ampicilina-sulbactam, trimetoprima/sulfametoxazol y cefalexina es mayor que las previamente publicadas en Argentina, lo que limita su recomendación para el tratamiento empírico. Una mejor comprensión de la etiología y la susceptibilidad antimicrobiana local permite el diseño de pautas más adecuadas para el tratamiento empírico.

Uncomplicated urinary tract infections rank among the most frequent bacterial infections in women in the outpatient setting and represent a major cause of antimicrobial prescription. The aims of this study were to assess frequencies and antimicrobial resistance of current uropathogens causing uncomplicated urinary tract infection. In a prospective multicenter study, patients were recruited in ambulatory settings of four participating hospitals between June 2011 and December 2013. We analyzed 138 patients that met clinical and bacteriological diagnostic criteria. The mean age was 28 years. Cystitis was defined in 70% (n: 97) and pyelonephritis in 30% (n: 41). Frequencies of isolated microorganisms were: Escherichia coli 70% (n: 97), Staphylococcus saprophyticus 17% (n: 24), Proteus spp. 7% (n: 10), Klebsiella spp. 4% (n: 5), Enterococcus spp. and Pseudomonas aeruginosa 1 (0.7%) each. The antimicrobial resistance was: ampicillin-sulbactam 37% (n: 51) cephalexin 28% (n: 39), trimethoprim/sulfamethoxazole 22% (n: 31), nitrofurantoin 12% (n: 17), gentamicin 7% (n: 10) and ciprofloxacin 5% (n: 7). The levels of resistance found for ampicillin-sulbactam, trimethoprim/sulfamethoxazole and cephalexin were higher than those previously reported in Argentina. A better knowledge of the etiology and local antimicrobial susceptibility allows the design of more adequate guidelines for empirical treatment.

[Aerobic etiology of acute appendicitis in adults. Multicenter study of abdominal sepsis in Argentina]. / Etiología aerobia de apendicitis aguda en adultos. Estudio multicéntrico de la sepsis abdominal en Argentina.

Antibiotic treatment for acute appendicitis is empirically chosen, based on epidemiological information. Resistance rates are different between regions and there are limited data on the situation in Argentina. As a part of a multicenter, observational study of abdominal infections, we performed the analysis of adult patients diagnosed with appendicitis, enrolled in 16 centers of 5 provinces, between Jan/01/2014 and Jun/30/2015. The aim was to analyze the prevalent aerobic pathogens, their resistance rates and the antimicrobial prescription pattern. On a total of 131 appendicitis cases analyzed, we found 184 aerobic pathogens (1.4 bacteria/episode): Escherichia coli 106 (57.6%), Klebsiella spp 16 (8.7%), Pseudomonas aeruginosa 19 (10.3%), Enterobacter spp. 2 (1%), other Gram negative bacilli 5 (2.7%); Enterococcus spp. 16 (8.7%) and other Gram positive cocci 20 (10.9%). The resistance rate of E. coli and enterobacteria to ampicillin/sulbactam was greater than 34% and greater than 31% to ciprofloxacin. However, the resistance of enterobacteria to piperacillin/tazobactam was 4.8%, to ceftriaxone 9.5%, to amikacin 3.6% and 8.2% to gentamicin. No resistance to carbapenems was found. The choice of quinolones or ampicillin/sulbactam for the treatment of appendicitis should be discouraged in our context, due to the high rates of resistance found in this prevalent etiology. Aminoglycoside-based treatments should be considered, given the findings of high antibiotic susceptibility and their low impact on the induction of resistance.

Etiología aerobia de apendicitis aguda en adultos: Estudio multicéntrico de la sepsis abdominal en Argentina / Aerobic etiology of acute appendicitis in adults. Multicenter study of abdominal sepsis in Argentina

El tratamiento antibiótico de las apendicitis agudas se decide empíricamente basándose en la información epidemiológica. Las resistencias son variables entre regiones y los datos de Argentina son escasos. En el contexto de un estudio multicéntrico, observacional, de infecciones abdominales, se efectuó el análisis de los pacientes adultos con diagnóstico de apendicitis, incorporados al estudio entre enero 2014 y junio 2015, en 16 centros de 5 provincias argentinas. El objetivo fue analizar los gérmenes aeróbicos prevalentes, su resistencia a antibióticos y el patrón de prescripción antimicrobiana. Se estudiaron 131 apendicitis. Se aislaron 184 bacterias aerobias (1.4 bacterias/episodio): Escherichia coli 106 (57.6%), Klebsiella spp 16 (8.7%), Pseudomonas aeruginosa 19 (10.3%), Enterobacter spp. 2 (1%), otros bacilos Gram negativos 5 (2.7%). Enterococcus spp. 16 (8.7%) y otros cocos Gram positivos 20 (10.9%). La resistencia de E. coli y enterobacterias a ampicilina/sulbactam fue mayor a 34% y a ciprofloxacina mayor a 31%. En cambio, la resistencia de enterobacterias a piperacilina/tazobactam fue 4.8%, a ceftriaxona 9.5% y no se halló resistencia a carbapenemes. Respecto a amikacina fue 3.6% y a gentamicina 8.2%. En función de los resultados, el uso de quinolonas o de ampicilina/sulbactam para el tratamiento de las apendicitis debiera ser desaconsejado. Los esquemas basados en aminoglucósidos debieran ser jerarquizados en función de la sensibilidad hallada y su bajo impacto en la inducción de resistencias.

Antibiotic treatment for acute appendicitis is empirically chosen, based on epidemiological information. Resistance rates are different between regions and there are limited data on the situation in Argentina. As a part of a multicenter, observational study of abdominal infections, we performed the analysis of adult patients diagnosed with appendicitis, enrolled in 16 centers of 5 provinces, between Jan/01/2014 and Jun/30/2015. The aim was to analyze the prevalent aerobic pathogens, their resistance rates and the antimicrobial prescription pattern. On a total of 131 appendicitis cases analyzed, we found 184 aerobic pathogens (1.4 bacteria/episode): Escherichia coli 106 (57.6%), Klebsiella spp 16 (8.7%), Pseudomonas aeruginosa 19 (10.3%), Enterobacter spp. 2 (1%), other Gram negative bacilli 5 (2.7%); Enterococcus spp. 16 (8.7%) and other Gram positive cocci 20 (10.9%). The resistance rate of E. coli and enterobacteria to ampicillin/sulbactam was greater than 34% and greater than 31% to ciprofloxacin. However, the resistance of enterobacteria to piperacillin/tazobactam was 4.8%, to ceftriaxone 9.5%, to amikacin 3.6% and 8.2% to gentamicin. No resistance to carbapenems was found. The choice of quinolones or ampicillin/sulbactam for the treatment of appendicitis should be discouraged in our context, due to the high rates of resistance found in this prevalent etiology. Aminoglycoside-based treatments should be considered, given the findings of high antibiotic susceptibility and their low impact on the induction of resistance.

Características clínicas y pronóstico de la neumonía adquirida en la comunidad causada por Staphylococcus aureus resistente a la meticilina / Clinical features and outcome of community-acquired methicillin-resistant Staphylococcus aureus pneumonia

INTRODUCCIÓN: El presente estudio tiene como objetivo describir las características epidemiológicas, clínicas, el tratamiento y el pronóstico de una serie de casos de neumonía adquirida en la comunidad (NAC) por Staphylococcus aureus resistente a la meticilina (SARM) de 2 zonas geográficas con una frecuencia muy diferente de infecciones por SARM comunitario (SARM-Co). MÉTODOS: Estudio descriptivo de pacientes ingresados en 2 instituciones de Argentina y España entre marzo de 2008 y junio de 2012. RESULTADOS: Se documentaron 16 casos de NAC causada por SARM. La frecuencia fue de 15 de 547 (2,7%) casos totales de NAC en el Hospital Rodolfo Rossi y uno de 1.258 (0,08%) en el Hospital de Bellvitge (p ≤ 0,001). La mayoría de pacientes fueron jóvenes y no presentaban comorbilidades. La afectación multilobar, la cavitación y la afectación cutánea fueron frecuentes. Todos los pacientes presentaron hemocultivos positivos. Cinco pacientes requirieron ingreso en la UCI. La mortalidad precoz (≤ 48 h) fue del 18,7%, y la global (≤ 30 días), del 25%. CONCLUSIONES: La NAC causada por SARM causa una elevada morbimortalidad y debe sospecharse en áreas con alta prevalencia de infección por SARM comunitario, en especial en pacientes jóvenes sin comorbilidades que presentan una NAC multilobar con cavitación. La mortalidad se asocia a shock séptico e insuficiencia respiratoria y en la mayoría de los casos fue precoz

INTRODUCTION: The aim of this study is to describe the epidemiological and clinical features, treatment and prognosis of community-acquired pneumonia (CAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) in two different geographic regions where community-acquired MRSA (CA-MRSA) infections have different frequencies. METHODS: Observational study of patients admitted to two hospitals (one in Argentina, the other in Spain) between March 2008 and June 2012. RESULTS: We documented 16cases of CAP caused by MRSA. MRSA accounted for 15 of 547 (2.7%) cases of CAP in Hospital Rodolfo Rossi and 1 of 1258 (0,08%) cases at the Hospital Universitari de Bellvitge (P ≤ .001). Most patients were young and previously healthy. Multilobar infiltrates, cavitation and skin and soft tissue involvement were frequent. All patients had positive blood cultures. Five patients required admission to the intensive care unit. Early mortality (≤ 48 hours) was 19%, and overall mortality (≤ 30 days) was 25%. CONCLUSION: CAP caused by MRSA causes high morbidity and mortality rates. It should be suspected in areas with a high prevalence of CA-MRSA infections, and especially in young and healthy patients who present with multilobar pneumonia with cavitation. Mortality is mainly related to septic shock and respiratory failure and occurs early in most cases

[Clinical features and outcome of community-acquired methicillin-resistant Staphylococcus aureus pneumonia]. / Características clínicas y pronóstico de la neumonía adquirida en la comunidad causada por Staphylococcus aureus resistente a la meticilina.

INTRODUCTION: The aim of this study is to describe the epidemiological and clinical features, treatment and prognosis of community-acquired pneumonia (CAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) in two different geographic regions where community-acquired MRSA (CA-MRSA) infections have different frequencies. METHODS: Observational study of patients admitted to two hospitals (one in Argentina, the other in Spain) between March 2008 and June 2012. RESULTS: We documented 16 cases of CAP caused by MRSA. MRSA accounted for 15 of 547 (2.7%) cases of CAP in Hospital Rodolfo Rossi and 1 of 1258 (0,08%) cases at the Hospital Universitari de Bellvitge (P ≤ .001). Most patients were young and previously healthy. Multilobar infiltrates, cavitation and skin and soft tissue involvement were frequent. All patients had positive blood cultures. Five patients required admission to the intensive care unit. Early mortality (≤ 48 hours) was 19%, and overall mortality (≤ 30 days) was 25%. CONCLUSION: CAP caused by MRSA causes high morbidity and mortality rates. It should be suspected in areas with a high prevalence of CA-MRSA infections, and especially in young and healthy patients who present with multilobar pneumonia with cavitation. Mortality is mainly related to septic shock and respiratory failure and occurs early in most cases.