[Antimicrobial susceptibility of the bloodstream infections: a study in a nonteaching hospital]. / Estudio de sensibilidad antibiótica en las bacteriemias de un hospital secundario.

BACKGROUND: To try established antimicrobial susceptibility patterns and frequency of both nosocomial and community-acquired bloodstream infections and and to try identified the prognostic factors that can be modified. MATERIAL AND METHODS: A prospective study of 310 bloodstream infections with clinical significance detected in a non teaching hospital over period from October 2000-2001. A blood culture were identified by Bact-Alert system and the confirmation was performed by MicroScan system; an antimicrobial susceptibility test was performed by reference microdilution methods as described by NCCLS. We studied sentinel antimicrobial/organism combinations with potential clinical importance. Data were computerized using SPSS. Qualitative variables were compared using the X2 test or the Fisher exact test, and quantitative variables with t Student or ANOVA. RESULTS: Gram positive and Candida were frequently recovered in nosocomial bloodstreams. The proportion of oxacillin-resistant S. aureus isolates was 24% and the penicillin resistant pneumococci was 14%. Vancomycin was universal active against gram positive. Gram negatives were often recovered in community bloodstream. The proportion of EBSL E. coli isolates was < 2% and the proportion of multiresistance Pseudomonas aeruginosa was higher among UCI isolates. An independent risk factors for death identified after multivariate analysis was the inappropriate antimicrobial therapy OR 2.6. CONCLUSIONS: Ongoing surveillance of microbial pathogens and their resistance profiles is essential on local scale and permit the selection of appropriate antibiotic therapy which would be reduce the mortality.

Estudio de sensibilidad antibiótica en las bacteriemias de un hospital secundario / Antimicrobial susceptibility of the bloodstream infections: a study in a nonteaching hospital

Objetivo: Conocer los patógenos prevalentes y los patrones de resistencia de las bacteriemias nosocomiales y adquiridas. Material y métodos: Estudio prospectivo de 310 bacteriemias "significativas" detectadas en un hospital no universitario en el periodo octubre 2000-2001. Los hemocultivos se detectaron por el sistema Bact-Alert y la identificación definitiva se efectuó con el sistema MicroScan, con estudio de sensibilidad por el método de microdilución de referencia (NCLSS). Se estudiaron combinaciones "centinela" con relevancia clínica. El análisis estadístico utilizó el programa SPSS. El análisis univariante utilizó para variables cuantitativas t Student y para cualitativa test X2 o t Fisher. Resultados: Los gram positivos y las levaduras predominaron en las nosocomiales. Hubo un 24 por ciento de MARSA y un 14 por ciento de neumococos penicilina resistentes. La vancomicina mantuvo una sensibilidad universal. Los gram negativos dominaron en las comunitarias, E. coli (40 por ciento) con una prevalencia de EBSL < 2 por ciento. Destacamos las tasas de multiresistencia para P. aeruginosa en las unidades de agudos. Un análisis de regresión logística reveló al tratamiento empírico inadecuado como un factor independiente de mortalidad (OR 2,6). Conclusiones: La necesidad de un sistema de vigilancia que permita conocer la prevalencia y resistencia de los microorganimos locales y establecer terapéuticas empíricas adecuadas que permitan reducir la mortalidad (AU)