Caracterización de los plásmidos de cepas de escherichia coli aislados de coprocultivos de niños sanos / Characterization of plasmids of escherichia coli strains isolated from stool culture of healthy children

La microbiota intestinal representa una reserva potencial de organismos resistentes a los antimicrobianos, y el sitio donde los genes de resistencia pueden ser transferidos desde la microbiota comensal a los microorganismos virulentos. En este trabajo se caracterizaron los perfiles fenotípicos de resistencia a diversos agentes antimicrobianos, en aislados de Escherichia coli, obtenidos de niños sanos, menores de 5 años de edad, y la capacidad de transmisibilidad de esos determinantes de resistencia, mediante ensayos de conjugación. Los aislados de E. coli se obtuvieron partir de coprocultivos de niños sanos mediante el uso de placas de Mc Conkey suplementadas con ampicilina y se les determinó el perfil de resistencia a diversos antibióticos, para luego realizar ensayos de conjugación. A partir de 90 coprocultivos, fueron aisladas 33 cepas de E. coli resistentes a algún antibiótico, presentándose un 66,6% del total de las cepas resistentes en al menos dos antibióticos. Luego de los ensayos de conjugación, se encontró que un 47,4% de las cepas presenta plásmidos conjugativos, transfiriendo marcadores de resistencia. Los patrones generados por enzimas de restricción fueron distintos entre ellos. Estos resultados nos permiten sugerir que estos elementos extracromosomales sean los responsables de la rápida diseminación de la resistencia a los antimicrobianos en la población bacteriana de niños sanos.

Gastrointestinal microbiota represents the potential reserve of antimicrobial-resistant organisms, and the site where resistance genes can be transferred from the commensally microbiota to virulent microorganisms. In this work we characterized the phenotypic resistance profiles to various antimicrobial agents in strains of Escherichia coli isolated from healthy children, less than 5 years of age, and the ability of these determinants of resistance to be mobilized by conjugation. The isolation of E. coli strains from stool culture from healthy children was made through the use of Mc Conkey media supplemented with ampicillin. The profile of resistance to various antibiotics was determined and then conjugation was carried out. From 90-stool culture 33 strains of E. coli resistant to some antibiotic were isolated, 63.6% of bacteria were resistant to -at least- two antibiotic. It have be demonstrated that 47.4% of the isolates harbored conjugative plasmids, which can mobilize markers of resistance. Restriction profiles analysis showed that all patterns were different. These results allow us to suggest that these extracromosomals elements are responsible for the rapid spread of resistance to antimicrobials in the bacterial population of healthy children.

Plásmido conjugativo portador de integrón clase 1 responsable de la resistencia a los antibióticos en aislados de vibrio cholerae O1 en Venezuela / Conjugative plasmid and a class 1integron responsible for the resistance to antibiotics in vibrio cholerae O1 isolates in Venezuela

Se han descrito aislados de Vibrio cholerae resistentes a una amplia variedad de antibióticos. En Venezuela, durante el brote de cólera ocurrido entre noviembre de 1998 y enero 2000 fueron reportados por primera vez aislados de V. cholerae O1 resistentes a ampicilina, trimetoprim-sulfametoxazole. Usando experimentos de conjugación se determinó la capacidad de transferir los determinantes de resistencia a ampicilina y trimetoprim-sulfametoxazole en 11 aislados. La visualización de plásmidos se realizó utilizando la digestión con nucleasa S1 y electroforesis en campo pulsante. La presencia de integrones de clase 1 fue establecida por PCR y se obtuvo la secuencia de la región variable del integrón. Los determinantes de resistencia fueron transferidos en un plásmido conjugativo de aproximadamente 170 kbp, común a todos los aislados. La resistencia a trimetoprim esta codificada en el gen dfra15, el cual se encuentra en un integrón clase 1 presente en el plásmido. En este estudio, se caracterizó la localización genética de los determinantes que codifican la resistencia a los antibióticos, y al conocer el mecanismo probable de dispersión de los determinantes de resistencia se podrán implementar medidas de control más adecuadas.

Vibrio cholerae has been reported to be resistant to a wide range of antibiotics. V. Cholerae O1 strains resistant to ampicillin, trimethoprim-sulfamethoxazole were isolated for the first time in Venezuela during a cholera outbreak that occurred between November 1998 and January 2000. Using conjugation experiments, the capacity of transfer of the resistance determinants in 11 strains resistant to ampicillin and trimethoprim-sulfamethoxazole was investigated. Plasmid analysis was done by S1 nuclease digestion and pulsed field gel electrophoresis. The presence of class 1 integrons was determined by PCR and the sequence of the gene harbored in the variable region of the integron was obtained. The antibiotic resistance determinants were transferred by a conjugative plasmid of approximately 170 kbp, common to all the isolates. Resistance to trimethoprim is encoded by the dfra15 gene that is harbored by a class 1 integron present in the plasmid. In this study, the genetic location of the determinants that code for resistance to antibiotics was characterized, and knowing the probable mechanism of dispersion of the determinants of resistance, control measures can be implemented most appropriate

[blaTEM, blaSHV y blaCTX-M genes in extended-spectrum beta-lactamases producing enterobacterias isolated from patients with hospital-acquired infections]. / Genes blaTEM, blaSHV y blaCTX-M en enterobacterias productoras de beta-lactamasas de espectro extendido aisladas de pacientes con infección intrahospitalaria.

The objective of the present investigation was to identify the blaTEM, blaSHV, and blaCTX-M genes on extended-spectrum beta-lactamases (ESBL) producing Enterobacteriaceae from clinical isolates, collected between September and November 2005. In addition to third-generation cephalosporin resistance, the isolates also showed resistance to chloramphenicol (59.2%), amikacin (37.0%) and gentamicin (40.7%), and demonstrated sensitivity to imipenem and meropenem. Nine strains were capable of transferring third-generation cephalosporin resistance, as well as the production of ESBL. In the clinical isolates, the genes blaSHV, blaTEM and blaCTX-M were detected, being more prevalent the types blaTEM-1, blaSHV-1, blaSHV-5 blaSHV-5-2a and blaCTX-M-1; while in the trans-conjugated only blaTEM-1, blaSHV-5 y blaSHV-5-2awere found. In total, seven types of genes were identified, five of which were codifying genes for ESBL-type enzymes. This demonstrates that in the hospital center, resistance to third-generation cephalosporin is mediated by several enzymes.

Genes blaTEM, blaSHV y blaCTX-M en enterobacterias productoras de b-lactamasas de espectro extendido aisladas de pacientes con infección intrahospitalaria / blaTEM, blaSHV y blaCTX-M genes in extended-spectrum b-lactamases producing enterobacterias isolated from patients with hospital-acquired infections

El objetivo de este estudio fue identificar los genes blaTEM, blaSHV y blaCTX-M en aislados clínicos de enterobacterias productoras de b-lactamasas de espectro extendido (BLEE), recolectadas entre septiembre y noviembre de 2005. Además de la resistencia a las cefalosporinas de tercera generación, los aislados también mostraron resistencia a cloranfenicol (59,2%) amikacina (37,0%) y gentamicina (40,7%) y se mostraron sensibles a imipenem y meropenem. Nueve cepas lograron transferir la resistencia a las cefalosporinas de tercera generación, así como la producción de BLEE. En los aislados clínicos se detectaron los genes blaSHV, blaTEM y blaCTX-M, donde los tipos blaTEM-1, blaSHV-1, blaSHV-5 blaSHV-5-2a y blaCTX-M-1 fueron los prevalentes; mientras que en las transconjugantes sólo se detectaron blaTEM-1, blaSHV-5 y blaSHV-5-2a. Se identificaron en total siete tipos de genes, de los cuales cinco eran codificantes de enzimas tipo BLEE, lo que demuestra que en el centro hospitalario la resistencia a las cefalosporinas de tercera generación es debida a diversas enzimas.

The objective of the present investigation was to identify the blaTEM, blaSHV and blaCTX-M genes on extended-spectrum b-lactamases (ESBL) producing Enterobacteriaceae from clinical isolates, collected between September and November 2005. In addition to third-generation cephalosporin resistance, the isolates also showed resistance to chloramphenicol (59.2%), amikacin (37.0%) and gentamicin (40.7%), and demonstrated sensitivity to imipenem and meropenem. Nine strains were capable of transferring third-generation cephalosporin resistance, as well as the production of ESBL. In the clinical isolates, the genes blaSHV, blaTEM and blaCTX-M were detected, being more prevalent the types blaTEM-1, blaSHV-1, blaSHV-5 blaSHV-5-2a and blaCTX-M-1; while in the trans-conjugated only blaTEM-1, blaSHV-5 y blaSHV-5-2a were found. In total, seven types of genes were identified, five of which were codifying genes for ESBL-type enzymes. This demonstrates that in the hospital center, resistance to third-generation cephalosporin is mediated by several enzymes.

Frequency and diversity of CTX-M enzymes among extended-spectrum beta-lactamase-producing Enterobacteriaceae isolates from Caracas, Venezuela.

CTX-M-type extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae have been previously reported in Venezuela. We assessed the frequency and diversity of CTX-M enzymes among 97 ESBL-producing Enterobacteriaceae isolates as well as to establish the genetic relationship among CTX-M producers collected from six hospitals in Caracas. Polymerase chain reaction (PCR) assays identified the bla(CTX-M) genes in 42 isolates (43.3%). The bla(CTX-M-1) group was the most common in Escherichia coli (91 %) and the bla(CTX-M-2) in Klebsiella pneumoniae (56.6%). Presence of bla(CTX-M-1), bla(CTX-M-2), bla(CTX-M-15), and bla(CTX-M-14) was revealed by sequencing analysis. The CTX-M producers were mainly isolated from urine samples (46%). Antimicrobial susceptibility tests showed that a high proportion of CTX-M-producing isolates was resistant to ciprofloxacin and trimethoprim-sulfamethoxazole. Analysis of enterobacterial repetitive intergenic consensus PCR and repetitive extragenic palindromic PCR profiles revealed several genetic clusters between isolates carrying the bla(CTX-M-1) group, while complete genotypic diversity among isolates carrying the bla(CTX-M-2) group was observed. This study documented that CTX-M has achieved a citywide distribution, with the CTX-M-1 group as the most frequent (66.7%). The CTX-M clusters detected suggest that patient-patient transmission may have played an important role in the widespread and high prevalence of the CTX-M-1 group. To our knowledge, this is the first report of the CTX-M-15 in Venezuela.

Aislamiento e identificación de cepas del género Bifidobacterium presentes en productos lácteos fermentados tipo yogur / Isolation and identification of strains belonging to the Bifidobacterium genus found in fermented yoghurt type milk products

La identificación de microorganismos probióticos del género Bifidobacterium es de gran importancia por su uso como suplemento que favorece la salud del consumidor. En Venezuela son pocos los estudios sobre caracterización microbiológica de estas bacterias y no existen métodos oficiales para su estudio en alimentos. Esta investigación reporta la estandarización de técnicas microbiológicas y moleculares para el aislamiento e identificación de bifidobacterias aisladas de dos productos tipo yogur, I con probiótico y II sin probiótico. Se analizaron 10 muestras de cada yogur, una por semana, aislando 3 colonias por muestra. Los resultados mostraron que de los 60 aislados analizados, 27 colonias del Yogur I y 11 del Yogur II concordaron con las características de bifidobacterias. Se comparó el crecimiento bacteriano en dos medios de cultivo (MRS-m, RCA), sembrando por profundidad en placas y en tubos Miller-Pricket, obteniéndose mejores resultados con el medio MRS-m y las siembras por profundidad en tubos. De las extracciones de ADN se obtuvieron los patrones de ERIC-PCR y REP-PCR, determinándose que 34 aislados eran clones indistinguibles, mostrando el patrón de B. lactis utilizado como control positivo. Esta metodología puede ser utilizada por la industria y los entes encargados del control de la calidad de los productos probióticos.

The identification of probiotic microorganisms belonging to the Bifidobacterium genus is very important due to their use as supplements favorable for consumer’s health. In Venezuela there have been few studies of the microbiological characterization of these bacteria and there are no official methods for their study in food. This investigation reports the standardization of microbiological and molecular techniques for the isolation and identification of bifidobacteria isolated from two yoghurt type products: I with probiotic and II without probiotic. Ten samples from each yoghurt type product were analyzed, one per week, and 3 colonies were isolated per sample. Results showed that of the 60 isolates analyzed, 27 colonies of Yoghurt I and 11 of Yoghurt II coincided with the characteristics of bifidobacteria. Bacterial growth was compared in two culture media (MRS-m, RCA), inoculating in-depth in plates and Miller-Pricket tubes; the best results were obtained with MRS-m medium and in-depth inoculations in tubes. By DNA extraction we obtained ERIC-PCR and REP-PCR patterns, determining that 34 isolates were indistinguishable clones, showing the same pattern of the B. lactis used as positive control. This methodology can be used by the industry and the institutions in charge of quality control of probiotic products.

Evaluación de la resistencia a agentes desinfectantes de bacterias aisladas de ambientes naturales / Evaluation of resistance to disinfectant agents of bacteria isolated from natural environments

Los antisépticos y desinfectantes son utilizados extensivamente para la prevención, vigilancia y control de las infecciones. Entre los más utilizados se encuentran los compuestos catiónicos de amonio cuaternario (QACs). El uso y abuso cotidiano de estos compuestos ha conllevado a la selección de cepas bacterianas resistentes. En este estudio, nos propusimos evaluar la resistencia a agentes desinfectantes en cepas bacterianas, multiresistentes a los antibióticos de uso frecuente, aisladas de ambientes naturales, y bacterias aisladas de pacientes hospitalizados. Se utilizó la prueba de suspensión cuantitativa para evaluar los niveles de resistencia, y ensayos de conjugación bacteriana para examinar la posible asociación de los determinantes de resistencia a moléculas plasmídicas transferibles. Los microorganismos gramnegativos, como Pseudomonas aeruginosa, resultaron ser los más resistentes. Las cepas ambientales presentaron niveles mayores de resistencia en comparación con las hospitalarias. Se obtuvieron transconjugantes con niveles de resistencia semejantes a las respectivas cepas donantes, indicando que estos determinantes de resistencia a desinfectantes están codificados en plásmidos, y cuyo análisis por patrones de restricción demostró que existen, al menos, dos moléculas plasmídicas diseminadas entre las cepas del mismo hábitat. Nuestros resultados representan un aporte que permitirá implementar medidas más exitosas para evitar la diseminación de estas bacterias resistentes.

Antiseptics and disinfectants are widely used for prevention, surveillance and control of infections. Among those most used are quaternary ammonium cationic compounds (QACs). The daily use and abuse of these compounds has resulted in the selection of resistant bacterial strains. In this study we decided to evaluate the resistance to disinfectant agents of bacterial strains multiresistant to frequently used antibiotics, both isolated from natural environments and isolated from hospital patients. The quantitative suspension test was used to evaluate resistance levels, and bacterial conjugation assays to examine the possible association of resistance determinants to transferable plasmid molecules. Gram negative microorganisms such as Pseudomonas aeruginosa appeared to be the most resistant. Environmental strains showed higher resistance levels as compared with hospital strains. We obtained transconjugants with resistance levels similar to those of the respective donor strain, indicating that these determinants of resistance to disinfectants are coded in plasmids; when analyzed by restriction patterns they showed that there were at least two plasmid molecules disseminated among the strains of the same habitat. Our results represent a contribution that will allow to implement more successful measures to avoid the dissemination of these resistant bacteria.

Regulación de la dispensación de medicamentos y su efecto en el consumo de antibióticos en Venezuela / Regulations governing the dispensing of medications and their effect on antibiotic consumption in Venezuela

Objetivo. Determinar las variaciones en la tendencia de consumo de los antibióticos regulados y no regulados en Venezuela, entre el período antes (2005) y después (2006–2008) de introducir la regulación de su venta por receta. Métodos. Se obtuvo información sobre consumo de antibióticos en Venezuela de los datos aportados por International Marketing Services. El consumo se expresó en dosis diarias definidas por 1 000 habitantes por día. Se realizaron análisis de varianzas (ANOVA) con un intervalo de confianza de 95% para conocer las diferencias entre los períodos estudiados. Resultados. Los antibióticos regulados de mayor consumo fueron ciprofloxacina y azitromicina. Las clases de antibióticos no regulados de mayor consumo fueron penicilinas y cefalosporinas de primera generación, aminoglucósidos, diaminopiridinas-sulfamidas y tetraciclinas. El consumo total de las categorías de antibióticos de libre dispensación fue el doble del de las categorías de venta regulada, tanto antes como después de haberse aplicado la regulación. Conclusiones. No se encontraron diferencias estadísticamente significativas en el consumo de antibióticos, ya fueran regulados o de libre dispensación, ni antes ni después de aplicarse la medida regulatoria de dispensación de antibióticos.

Objective. Determine the variations in consumption trends for regulated and unregulated antibiotics in Venezuela in the period before (2005) and after (2006–2008) the regulation of prescription sales was introduced. Methods. Information on antibiotic consumption in Venezuela was obtained from the data provided by International Marketing Services. Consumption was expressed in daily doses per 1 000 inhabitants. Analyses of variance (ANOVA) were performed, with a 95% confidence interval, to identify the differences between the periods studied. Results. The regulated antibiotics with the highest consumption were ciprofloxacin and azithromycin. The classes of unregulated antibiotics with the highest consumption were penicillins and first-generation cephalosporins, aminoglycosides, diaminopyridine- sulfonamides, and tetracyclines. Total consumption in the categories of antibiotics with unregulated dispensing was twice as high as in the categories with regulated sales, both before and after introduction of the regulation. Conclusions. There were no statistically significant differences in antibiotic consumption with regulated or unregulated dispensing, either before or after the introduction of measures regulating the dispensing of antibiotics.

[Regulations governing the dispensing of medications and their effect on antibiotic consumption in Venezuela]. / Regulación de la dispensación de medicamentos y su efecto en el consumo de antibióticos en Venezuela.

OBJECTIVE: Determine the variations in consumption trends for regulated and unregulated antibiotics in Venezuela in the period before (2005) and after (2006-2008) the regulation of prescription sales was introduced. METHODS: Information on antibiotic consumption in Venezuela was obtained from the data provided by International Marketing Services. Consumption was expressed in daily doses per 1,000 inhabitants. Analyses of variance (ANOVA) were performed, with a 95% confidence interval, to identify the differences between the periods studied. RESULTS: The regulated antibiotics with the highest consumption were ciprofloxacin and azithromycin. The classes of unregulated antibiotics with the highest consumption were penicillins and first-generation cephalosporins, aminoglycosides, diaminopyridine-sulfonamides, and tetracyclines. Total consumption in the categories of antibiotics with unregulated dispensing was twice as high as in the categories with regulated sales, both before and after introduction of the regulation. CONCLUSIONS: There were no statistically significant differences in antibiotic consumption with regulated or unregulated dispensing, either before or after the introduction of measures regulating the dispensing of antibiotics.

[Characterization of the variable region within class 1 integrons in Klebsiella pneumoniae nosocomials strains]. / Caracterización de la región variable de integrones clase 1 presentes en cepas nosocomiales de Klebsiella pneumoniae.

BACKGROUND: Integrons are responsible for the capture and dissemination of resistance genes in Gram-negative bacteria. AIM: To characterize the variable region within class 1 integrons in nosocomial strains of Klebsiella pneumoniae. MATERIAL AND METHODS: Twenty-nine Klebsiella pneumoniae strains isolated from hospitalized patients were analyzed. The variable region of class 1 integrons was characterized by polymerase chain reaction and direct sequencing. Genetic localization of class 1 integrons was determined by bacterial conjugation. RESULTS: Ten strains contained class 1 integrons, with sizes ranging from 750 to 2000 base pairs. One integrant element was present in nine strains and two elements in one single strain. Integrons were associated to plasmids. Cassettes aadA, aac(6)-Iq, orfD, dfrA]7, aadA5 and aadB were found. CONCLUSIONS: The presence of class 1 integrons may play an important role in the dissemination of hospital resistance against amino glycosides.

Caracterización de la región variable de integrones clase 1 presentes en cepas nosocomiales de Klebsiella pneumoniae / Characterization of the variable region within class 1 integrons in Klebsiella pneumoniae nosocomials strains

Background: Integrons are responsible for the capture and dissemination of resistance genes in Gram-negative bacteria. Aim: To characterize the variable region within class 1 integrons in nosocomial strains of Klebsiella pneumoniae. Material and Methods: Twenty-nine Klebsiella pneumoniae strains isolated from hospitalized patients were analyzed. The variable region of class 1 integrons was characterized by polymerase chain reaction and direct sequencing. Genetic localization of class 1 integrons was determined by bacterial conjugation. Results: Ten strains contained class 1 integrons, with sizes ranging from 750 to 2000 base pairs. One integrant element was present in nine strains and two elements in one single strain. Integrons were associated to plasmids. Cassettes aadA, aac(6)-Iq, orfD, dfrA]7, aadA5 and aadB were found. Conclusions: The presence of class 1 integrons may play an important role in the dissemination of hospital resistance against amino glycosides.

Colera y Vibrio cholerae / Cholera and Vibrio cholerae

El Colera es una diarrea infecciosa aguda producida por Vibrio cholerae. La transmision se produce predominantemente a traves de agua o alimentos contaminados. La administracion de antibioticos puede disminuir la severidad de los sintomas. A partir de 1977, se han caracterizado cepas de V.cholerae O1 con resistencia multiple a los antibioticos. Los determinantes de resistencia han sido reportados principalmente asociados a plasmidos e integrones. Historicamente, solo las cepas del serogrupo O1 habian sido asociadas con epidemias de Colera. En 1992, un nuevo serogrupo, O139, emergio como la cepa causante de un gran brote de Colera. La diarrea masiva es causada por la toxina colerica (CT). El operon que codifica CT forma parte del genoma de un bacteriofago lisogenizado en la bacteria el cual permite interconversion de cepas. Se ha demostrado que el "quorum-sensing" regula negativamente la expresion de los genes de viru len cia en V. cholerae. El genoma de V. cholerae El Tor consiste en dos cromosomas circulares y con una pronunciada asimetria en la distribucion de los genes, en el cual se han detectado varias islas patogenicas (PAIs). Se ha reportado la existencia de V.cholerae "viable no cultivable" en ambientes acuaticos. Este fenomeno representa una nueva perspectiva en la vision de la "sobrevivencia" de V.cholerae en el ambiente e incorpora nuevas implicaciones epidemiologicas. El Colera ha sido catalogado como una "enfermedad emergente y reemergente", que amenaza a los paises en desarrollo. Los resultados de distintos grupos de investigadores han establecido que la transferencia horizontal de genes tiene influencia en la patogenicidad y ha sido importante en la evolucion de V. cholerae. Todavia permanecen sin descifrar algunos misterios en el origen de las cepas patogenas, pero, con las nuevas tecnologias seguro se develaran datos significativos que puedan dar luces sobre el origen de la patogenicidad de este organismo, que fue en ...

The Cholera is an acute infectious diarrhea produced by Vibrio cholerae. Mainly the transmission takes place through contaminated water or foods. Antibiotic administration during the acute phase of the disease can reduce the severity of the symptoms. Since 1977, strains of V. cho lerae O1 with multiple antibiotic resistances have been characterized. The resistance determinants have been reported mainly associated to plasmids and integrones. Historically, the serogrupo O1 had been associated with epidemics of Cholera. In 1992, a new serogrupo, designated O139, emerged as the strain of cause from a big Cholera outbreak. The massive diarrhea is caused by the choleric toxin (CT). Operon ctxAB, that codifies the CT, is carried in lisogenic filamentous bacteriophage in the bacterium. "Quorum-sensing" negatively regulates the expression of the virulence genes in V.cholerae. The genome of V.cholerae El Tor consists of two circular chromosomes with a pronounced asymmetry in the distribution of the genes. Several patogenics islands (PAIs) have been detected in the genome of V.cholerae. In aquatic environments the existence of "viable but non cultivable" V.cholerae, has been reported. This phenomenon represents a new perspective in the role in survival in the natural environment with new epidemiological implications. The Cho lera has been catalogued as an "emergent, re-emergent disease" that threatens developing countries. The results of different investigators groups have established that horizontal transference of genes had influence in the pathogenicity and has been important in the evolution of V.cholerae. Several mysteries in the origin of the pathogenics clones still remain, but, the new technologies will reveal significant data about the origin of this pathogen, former an estuary innocuous bacterium.

Caracterización de ß-lactamasas de espectro extendido (BLEE) en cepas nosocomiales de K. pneumoniae Sucre-Venezuela / Characterization of extended-spectrum ß-lactamases in nosocomial strains of Klebsiella pneumoniae Sucre Venezuela

En este estudio, 25 cepas de K. pneumoniae aisladas de pacientes con infección nosocomial durante el periodo agosto 2002 a diciembre de 2003 fueron examinadas para determinar su susceptibilidad antimicrobiana, perfil plasmídico, transferencia de determinantes de resistencia y los tipos de genes blaTEM , blaSHV , blaCTX-M. Diecinueve cepas presentaron susceptibilidad disminuida a las cefalosporinas de tercera generación y al aztreonam y fueron productoras de ß-lactamasas de espectro extendido (BLEE). Todas las cepas presentaron plásmidos transferibles con una frecuencia de conjugación de 10-3 a 10-4 transconjugantes/célula donante. El análisis de los patrones de restricción reveló la presencia de tres tipos de plásmidos. Las cepas E. coli transconjugantes, además de ser productoras de BLEE, expresaron resistencia a aminoglucósidos y cloranfenicol. Se encontró la presencia del gen blaTEM en todos los plásmidos transferibles y los genes blaSHV y blaCTX en plásmidos transferibles y no transferibles. Las enzimas identificadas fueron TEM-1, SHV-5-2a y CTX-M-2. Los plásmidos presentes en las cepas de K. pneumoniae, juegan un papel importante en la diseminación de los genes que codifican resistencia a los ß-lactámicos y otros antimicrobianos.

In this study, 25 strains of K. pneumoniae, isolated from patients with nosocomial infections from August 2002 to December 2003, were examined to determine their antimicrobial susceptibility, plasmid profile, transfer capacity of resistance determinants and blaTEM, blaSHV, and blaCTX-M genes. Nineteen nosocomial strains revealed a weakened susceptibility to third-generation cephalosporins and aztreonam, and were extended-spectrum ß-lactamases (ESBLs) producers. All strains presented conjugable plasmids with a conjugation frequency of 10-3 to 10-4 transconjugants/donor cell. The analysis of restriction patterns revealed the presence of three differents plasmids. The Escherichia coli transconjugants were ESBLs producers and expressed resistance for aminoglucosides and chloramphenicol. The blaTEM gen was found in all transferables plasmids and the blaSHV and blaCTX genes were found in transferables and no transferables plasmids. The enzymes identified in the isolates were TEM-1 SHV-5-2a and CTX-M-2. The plasmids present in the K. pneumoniae strains play an important role in the dissemination of the genes encoding resistance to ß-lactams and other antimicrobial agents.

Alcances y limitaciones de los métodos de epidemiología molecular basados en el análisis de ácidos nucleicos / Scope and limitations of molecular methods applied to epidemiological studies

La Epidemiología es la rama de la ciencia que se dedica al estudio del origen, la distribución y el control de las enfermedades que afectan a las poblaciones. La Epidemiología Molecular es una nueva rama de la ciencia en la cual se implementan técnicas moleculares en los estudios epidemiológicos. Diversos métodos de genotipificación molecular pueden ser empleados para clasificar a los microorganismos en grupos estrechamente relacionados o divergentes. Entre los métodos de genotipificación más usados están: la electroforesis de campo pulsado, la prueba de PCR, la secuenciación del genoma y la hibridación con sondas de DNA. Cada técnica ha ofrecido una alternativa para la investigación epidemiológica; sin embargo, también tienen aplicabilidades limitadas. El presente trabajo tiene como objetivo la revisión de las fortalezas y debilidades de éstas técnicas moleculares utilizadas para la genotipificación.

Epidemiology is a science dedicated to the study of the origin, distribution and control of diseases that affect populations. Molecular Epidemiology is a new branch of science that uses molecular techniques in epidemiological studies. Several molecular genotyping methods can be used to classify microorganisms in closely related or divergent groups. Pulsed-field gel electrophoresis, the PCR test, genomic sequencing, and DNA probe hybridization are the most used techniques in genotyping. Each technique offers an alternative for epidemiological investigation; nevertheless, they also have limited applications. The objective of this work was to review the strengths and weaknesses of these molecular techniques used for genotyping.

Microorganismos presentes en las diferentes etapas de la progresión de la lesión de Caries dental

La caries dental es una enfermedad infecciosa de etiología multifactorial, donde los microorganismos organizados en una biopelícula, denominada Placa Dental, constituyen un factor determinante en el desarrollo de la lesión de caries, y esta representa el signo tardío de la enfermedad. La etapa inicial de la lesión se aprecia clínicamente como una mancha blanca, y a medida que progresa se desarrolla una cavidad con la dentina expuesta al medio bucal. En cada etapa de progresión de la lesión predominan especies microbianas, como resultado de una sucesión de microorganismos. En el caso de sujetos sanos libres de caries se ha podido observar el predominio de microorganismos distintos a aquellos asociados con la enfermedad, tal como Streptococcus sanguinis. Sin embargo, en sujetos afectados por la caries dental los estreptococos pertenecientes al grupo mutans han sido los preponderantes durante el inicio y progresión de la lesión, especialmente Streptococcus mutans, mientras que Lactobacillus y Bifidobacterium predominan en las etapas avanzadas de la lesión.

Dental caries is a multifactorial disease, where the microorganisms as a main ethological factor are organized in a biofilm called Dental Plaque. This constitutes the main factor in the development of the carious lesion, which clinically is seen as a white spot and may progresses to develop a cavity with dentine exposed to oral cavity. At each stage of progression different microbial species lead as a result of a bacterial succession. In the case of caries free subjects, the presence of bacterial species other than those associated with the disease, such as S. sanguinis, had been observed. Whereas, at the onset and progression of the lesion species belong to the Mutans Streptococci group, especially Streptococcus mutans, are the main micoorganisms. Lactobacillus and Bifidobacterium dominate in the advanced stages of the disease.

[Characterization of extended-spectrum beta-lactamases in nosocomial strains of Klebsiella pneumoniae]. / Caracterización de beta-lactamasas de espectro extendido (BLEE) en cepas nosocomiales de K. pneumoniae. Sucre-Venezuela.

In this study, 25 strains of K. pneumoniae, isolated from patients with nosocomial infections from August 2002 to December 2003, were examined to determine their antimicrobial susceptibility, plasmid profile, transfer capacity of resistance determinants and bla(TEM), bla(SHV), and bla(CTX-M) genes. Nineteen nosocomial strains revealed a weakened susceptibility to third-generation cephalosporins and aztreonam, and were extended-spectrum beta-lactamases (ESBLs) producers. All strains presented conjugable plasmids with a conjugation frequency of 10(-3) to 10(-4) transconjugants/donor cell. The analysis of restriction patterns revealed the presence of three differents plasmids. The Escherichia coli transconjugants were ESBLs producers and expressed resistance for aminoglucosides and chloramphenicol. The bla(TEM) gen was found in all transferables plasmids and the bla(SHV) and bla(CTX) genes were found in transferables and no transferables plasmids. The enzymes identified in the isolates were TEM-1 SHV-5-2a and CTX-M-2. The plasmids present in the K. pneumoniae strains play an important role in the dissemination of the genes encoding resistance to beta-lactams and other antimicrobial agents.

Identificación bioquímica y PCR especie-específica de cepas de Burkholderia cepacia de origen hospitalario y ambiental en Venezuela / Biochemical and specie-specific PCR identification of Burkholderia cepacia strains from hospital and environmental sources in Venezuela

Burkholderia cepacia es un bacilo gramnegativo no fermentador (BGNNF) reconocido como un patógeno oportunista para humanos y como agente causante de daño en cultivos vegetales. Su identificación es difícil y laboriosa confundiéndose a menudo con taxones relacionados. En este trabajo se examina, mediante técnicas bioquímicas y PCR especie-específica, una colección de 74 cepas de BGNNF de origen hospitalario y ambiental, con el objetivo de evaluar las condiciones para la identificación de rutina de B. cepacia en el medio hospitalario. El empleo de métodos comerciales automatizados, pruebas bioquímicas convencionales y una selección de pruebas complementarias permitió la identificación satisfactoria de 28 (37,8%) como B. cepacia, 15 (20,3%) S. maltophilia, 9 (12.2 %) A. xylosoxidans, 19 (25.6%) especies de Pseudomonas, 1 Ralstonia (1,4%) y 2 no identificadas. El empleo de PCR permitió confirmar la identificación del género Burkholderia y la caracterización de las especies o genomovares dentro del Complejo B. cepacia (CBc). La mayoría (12) pertenece al genomovar I (B. cepacia), 5 al II (B. multivorans); 3 al III (B. cenocepacia), 1 al IV (B. stabilis), y 7 al grupo V (B. vietnamiensis). El uso combinado de estas metodologías permitió la identificación precisa de miembros del CBc en muestras de origen hospitalario y ambiental.

Burkholderia cepacia is a non fermentative grannegative bacilli (NFGNB) known as an opportunists pathogen for human beings and associated with plant diseases. Its identification is a difficult task, being usually confused with related genera. In this work a collection of 74 NFGNB from environmental and hospital sources were examined by biochemical and PCR methods in order to evaluate the conditions for hospital identification of B. cepacia. The use of conventional biochemical methods, and a selection of complementary tests allowed a satisfactory identification of 28 (37,8%) as B. cepacia, 15 (20,3%) S. maltophilia, 9 (12.2 %) A. xylosoxidans, 19 (25,6%) other Pseudomonas, 1 Ralstonia (1,4%) and 2 non identified ((2.7%). By PCR B. cepacia identification was confirmed and the genomovars or species of the B. cepacia complex (BcC) were differenciated. The majority (12) belongs to the genomovar I (B. cepacia), 5 to II (B. multivorans), 3 to III (B. cenocepacia), 1 to IV (B. stabilis), and 7 to the B. vietnamiensis group. The use of biochemical and molecular methods allowed us the identification of BcC members from environmental and hospital sources.

Integrones clase 1 asociados a plásmidos en cepas de Klebsiella pneumoniae / Class 1 integrons associated to plasmids in Klebsiella pneumoniae strains

Los integrones son elementos genéticos captadores de genes de resistencia, usualmente localizados en plásmidos y responsables de la diseminación de la resistencia en bacilos gramnegativos. En el presente trabajo se estudió la presencia de integrones clase 1 y su asociación con plásmidos en 23 cepas de Klebsiella pneumoniae, aisladas de diferentes servicios del Hospital Universitario “Antonio Patricio de Alcalᔠestado Sucre-Venezuela. La transferencia de los determinantes de resistencia fue evaluada mediante conjugación bacteriana y la presencia de integrones clase 1 por la reacción en cadena de la polimerasa. Todos los aislamientos presentaron resistencia para ceftazidima y aztreonan. Los ensayos de conjugación demostraron la presencia de plásmidos conjugativos en todas las cepas de K. pneumoniae analizadas. Los integrones clase 1 fueron detectados en 10 (43,47%) aislamientos. Nueve cepas contenían un integrón y una cepa dos elementos. Todos los integrones identificados están asociados a plásmidos. La presencia de integrones clase 1 en las moléculas plasmídicas juega un papel importante en la epidemiología de la resistencia a los agentes antimicrobianos en las cepas clínicas.

Integrons are genetic elements able to capture resistance genes, usually located in plasmids and responsible for dissemination of resistance in Gram negative bacilli. The presence of class 1 integrons and its association with plasmids in 23 multiresistant Klebsiella pneumoniae strains, isolated from different services of hospital “Antonio Patricio de AlcalᔠSucre-Venezuela was studied. By bacterial conjugation and polymerase chain reaction the transference of resistance determinants and the presence of integrons class 1 were evaluated. All isolates were resistant to ceftazidime and aztreonam. Conjugation assays demonstrated the presence of conjugative plasmids in all K. pneumoniae strains analyzed. Integrons were detected in 10 (43.47%) isolates. One integron element was present in nine strains and two elements in one single strain. Integrons identified were associated a plasmids. The presence of integrons class 1 carried by plamids must play an important role in the epidemiology of antibiotic resistance in clinical strains.

Entry exclusion in the IncHI1 plasmid R27 is mediated by EexA and EexB.

Conjugative plasmids have evolved entry exclusion mechanisms to inhibit redundant DNA transfer from donor cells into recipients harboring isogenic or closely related plasmids. This exclusion phenomenon has been documented in the incompatibility H group (IncH) plasmid R27. A cosmid library representing the majority of the large (180kb) R27 plasmid was transformed into recipient cells and a conjugation assay identified that an operon located in the conjugative transfer region 2 (Tra2) of R27, the Z operon, mediated entry exclusion in the IncH plasmid. Reverse-transcriptase analysis revealed that the Z operon is comprised of four genes, 015, eexB, 017, and eexA. Sub-cloning of the individual genes located within the Z operon and subsequent screening for the entry exclusion phenotype determined that two genes, eexA and eexB, independently inhibit the entry of IncH-related plasmids. Bacterial fractionation studies predominantly localized the EexA protein to the cytoplasmic membrane, and the EexB protein to the outer membrane. Recipient cells expressing EexA and EexB were unable to exclude the entry of R27 plasmids harboring mutations within the IncH entry exclusion genes eexA and eexB. The IncH entry exclusion proteins EexA and EexB likely prevent redundant plasmid transfer by interaction with one another.