RESUMO
Introduction: Extended-spectrum-β-lactamases (ESBL) are plasmid-encoded enzymes that confer resistance to multiple antimicrobials. ESBL-producing enterobacteria that cause bacteremia limit therapeutic options and increase mortality. Objective: To perform a clinical and molecular description of bacteremia caused by ESBL-producing enterobacteria. Method: We retrospectively studied the cases of bacteremia due to ESBL-producing Escherichia coli, Klebsiella pneumoniae and Proteus spp in adults admitted to a university hospital during the years 2004-2007. We reviewed the clinical records and antimicrobial susceptibility patterns. Molecular typing was performed by polymerase chain reaction and study of clonality by pulsed-field electrophoresis. Results: We found a prevalence of 9.8 percent ESBL in enterobacteria causing bacteremia. Decreased susceptibility to quinolones and aminoglycosides was observed, without resistance to carbapenems. The predominant ESBL types were CTX-M (96 percent), TEM (62 percent) and GES (28 percent). 79 percent of the strains presented more than one type of ESBL. Clinical analysis revealed high prevalence of risk factors, previous use of antimicrobials and of invasive devices. There was no significant clonality. Conclusion: The presence of ESBLs in bloodstream infections is a clinical problem that must be considered when choosing empiric therapy.
Introducción: β-lactamasas de espectro extendido (BLEE) son enzimas plasmidiales que confieren resistencia a múltiples antimicrobianos. Las bacteriemias por enterobacterias productoras de BLEE restringen las opciones terapéuticas y aumentan la mortalidad. Objetivo: Realizar una descripción clínica y molecular de las bacteriemias causadas por enterobacterias productoras de BLEE. Método: Se estudiaron retrospectivamente los casos de bacteriemia por Escherichia coli, Klebsiella pneumoniae y Proteus spp. confirmadas para BLEE, en adultos ingresados en un hospital universitario durante los años 2004-2007. Se revisaron los registros clínicos y de susceptibilidad. Se realizó tipificación molecular por reacción de polimerasa en cadena y estudio de clonalidad por electroforesis de campo pulsado. Resultados: Se identificó una prevalencia de BLEE de 9,8 por ciento en enterobacterias causantes de bacteriemias. Se observó susceptibilidad disminuida a quinolonas y aminoglucósidos, sin resistencia a carbapenémicos. Los tipos de BLEE predominantes fueron CTX-M (96 por ciento), TEM (62 por ciento) y GES (28 por ciento). El 79 por ciento de las cepas presentó más de un tipo de BLEE. El análisis clínico reveló alta frecuencia de patologías de riesgo, uso previo de antimicrobianos y uso de dispositivos invasores. No se encontró clonalidad significativa. Conclusión: La presencia de BLEE en bacteriemias constituye un problema clínico que debe ser considerado al elegir la terapia empírica.
Assuntos
Adulto , Idoso , Humanos , Bacteriemia/microbiologia , Infecções por Escherichia coli/microbiologia , Infecções por Klebsiella/microbiologia , Infecções por Proteus/microbiologia , beta-Lactamases/metabolismo , Antibacterianos/farmacologia , Eletroforese em Gel de Campo Pulsado , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Escherichia coli/genética , Hospitais Universitários , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/genética , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase , Prevalência , Proteus/efeitos dos fármacos , Proteus/enzimologia , Proteus/genética , Estudos Retrospectivos , beta-Lactamases/genéticaRESUMO
INTRODUCTION: Extended-spectrum-ß-lactamases (ESBL) are plasmid-encoded enzymes that confer resistance to multiple antimicrobials. ESBL-producing enterobacteria that cause bacteremia limit therapeutic options and increase mortality. OBJECTIVE: To perform a clinical and molecular description of bacteremia caused by ESBL-producing enterobacteria. METHOD: We retrospectively studied the cases of bacteremia due to ESBL-producing Escherichia coli, Klebsiella pneumoniae and Proteus spp in adults admitted to a university hospital during the years 2004-2007. We reviewed the clinical records and antimicrobial susceptibility patterns. Molecular typing was performed by polymerase chain reaction and study of clonality by pulsed-field electrophoresis. RESULTS: We found a prevalence of 9.8% ESBL in enterobacteria causing bacteremia. Decreased susceptibility to quinolones and aminoglycosides was observed, without resistance to carbapenems. The predominant ESBL types were CTX-M (96%), TEM (62%) and GES (28%). 79% of the strains presented more than one type of ESBL. Clinical analysis revealed high prevalence of risk factors, previous use of antimicrobials and of invasive devices. There was no significant clonality. CONCLUSION: The presence of ESBLs in bloodstream infections is a clinical problem that must be considered when choosing empiric therapy.
Assuntos
Bacteriemia/microbiologia , Infecções por Escherichia coli/microbiologia , Infecções por Klebsiella/microbiologia , Infecções por Proteus/microbiologia , beta-Lactamases/metabolismo , Adulto , Idoso , Antibacterianos/farmacologia , Eletroforese em Gel de Campo Pulsado , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Escherichia coli/genética , Hospitais Universitários , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/genética , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase , Prevalência , Proteus/efeitos dos fármacos , Proteus/enzimologia , Proteus/genética , Estudos Retrospectivos , beta-Lactamases/genéticaRESUMO
Streptococcus pneumoniae infections constitute a public health problem. In our country there is scarce information regarding isolates from bacteraemic episodes in adult population. The antibiotic susceptibility, serotypes and clonal relationship of 56 isolates of S. pneumoniae from adult patients with bacteraemic infections in Concepcion-Talcahuano, Bio-Bio Region, Chile, were studied. Resistance to tetracycline (21.4%), trimethoprim/ sulfamethoxazole (18%), erythromycin (18%), chloramphenicol (7%) and 1 penicillin resistant isolate from a meningeal focus (2%) was found. Also, all the isolates were susceptible to cefotaxime, levofloxacin, moxifloxacin and vancomycin. A wide variety of capsular serotypes was demonstrated, with predominance of serotypes 1, 5, 23F, 7F and 3. The macrorestriction analysis by pulse field electrophoresis revealed 31 electrophoretic patterns and 12 clonal groups, discarding a predominant clone. According to the results, at least, 80% of the S. pneumoniae serotypes isolated from bacteraemic adult patients are included in the available commercial vaccine.
Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Infecções Pneumocócicas/tratamento farmacológico , Streptococcus pneumoniae/efeitos dos fármacos , Adolescente , Adulto , Chile/epidemiologia , Cloranfenicol/uso terapêutico , Eletroforese em Gel de Campo Pulsado , Eritromicina/uso terapêutico , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções Pneumocócicas/epidemiologia , Sorotipagem , Streptococcus pneumoniae/classificação , Tetraciclina/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto JovemAssuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Infecções Pneumocócicas/tratamento farmacológico , Streptococcus pneumoniae/efeitos dos fármacos , Chile/epidemiologia , Cloranfenicol/uso terapêutico , Eletroforese em Gel de Campo Pulsado , Eritromicina/uso terapêutico , Testes de Sensibilidade Microbiana , Infecções Pneumocócicas/epidemiologia , Sorotipagem , Streptococcus pneumoniae/classificação , Tetraciclina/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto JovemRESUMO
Las infecciones ocasionadas por Streptococcus pneumoniae constituyen un problema de salud pública. En nuestro país existe escasa información sobre aislados de procesos bacteriémicos en población adulta. Se estudió la susceptibilidad, serotipos y relación clonal de 56 aislados de S. pneumoniae desde hemocultivos, entre enero 2005 y agosto 2006, de pacientes adultos de la intercomuna Concepción-Talcahuano, Región del Bío-Bío, Chile. Se encontró resistencia a tetraciclina (21,4 por ciento), cotrimoxazol (18 por ciento), eritromicina (18 por ciento), cloranfenicol (7 por ciento) y a penicilina en un solo aislado procedente de un foco meníngeo (2 por ciento). La totalidad mostró susceptibilidad a cefotaxima, levofloxacina, moxifloxacina y vancomicina. Se demostró una amplia variedad de serotipos capsulares, con predominio de los serotipos 1, 5, 23F, 7F y 3. El análisis de macrorestricción y electroforesis en campo pulsado reveló 31 patrones electroforéticos con 12 grupos clona-les, descartando un clon predominante. De acuerdo a los resultados, al menos 80 por ciento de los serotipos de aislados de S. pneumoniae de procesos bacteriémicos están incluidos en la vacuna comercial disponible.
Streptococcus pneumoniae infections constitute a public health problem. In our country there is scarce information regarding isolates from bacteraemic episodes in adult population. The antibiotic susceptibility, sero-types and clonal relationship of 56 isolates of S. pneumoniae from adult patients with bacteraemic infections in Concepcion-Talcahuano, Bio-Bio Region, Chile, were studied. Resistance to tetracycline (21.4 percent), trimethoprim/ sulfamethoxazole (18 percent), erythromycin (18 percent), chloramphenicol (7 percent) and 1 penicillin resistant isolate from a meningeal focus (2 percent) was found. Also, all the isolates were susceptible to cefotaxime, levofloxacin, moxifloxacin and vancomycin. A wide variety of capsular serotypes was demonstrated, with predominance of serotypes 1, 5, 23F, 7F and 3. The macrorestriction analysis by pulse field electrophoresis revealed 31 electrophoretic patterns and 12 clonal groups, discarding a predominant clone. According to the results, at least, 80 percent of the S. pneumoniae serotypes isolated from bacteraemic adult patients are included in the available commercial vaccine.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Infecções Pneumocócicas/tratamento farmacológico , Streptococcus pneumoniae/efeitos dos fármacos , Chile/epidemiologia , Cloranfenicol/uso terapêutico , Eletroforese em Gel de Campo Pulsado , Eritromicina/uso terapêutico , Testes de Sensibilidade Microbiana , Infecções Pneumocócicas/epidemiologia , Sorotipagem , Streptococcus pneumoniae/classificação , Tetraciclina/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto JovemRESUMO
Los sistemas multidrogas bacterianos contribuyen al desarrollo del fenotipo de multi-resistencia presentado por cepas de Acinetobacter baumannü, patógeno intrahospi-talario, que durante los últimos años ha incrementado su importancia por la creciente resistencia a carbapenémicos. El fenotipo de multi-resistencia está otorgado por la combinación de varios mecanismos de resistencia entre los cuales se encuentran estos sistemas de bombas de expulsión. El sistema multidroga AdeABC se ha detectado en muchas de estas cepas multi-resistentes de A. baumannü y, se ha relacionado con resistencia a diversos grupos de antimicrobianos, incluidos tigeciclina y meropenem. La inhibición de dichos sistemas multidrogas permitiría aumentar la eficacia de la terapia antimicrobiana. La siguiente revisión se enfoca en las bombas de expulsión multidrogas presentes en A. baumannü, con particular énfasis en el sistema AdeABC.
Bacterial multi-drugs systems contribute to the development of multi-resistance patterns of Acinetobacter baumannii, a nosocomial pathogen of increasing importance due to its emerging resistance to carbapenems. The multi-resistance phenomena is generated by a combination of mechanisms, one of which the efflux pump system. Many of these multiresistant isolates of A. baumannii harbor genes for the AdeABC multi-drug efflux system, related with resistance to various groups of antibacterial agents, including tygecicline and meropenem. Inhibition of these systems would allow to increase the efficacy of this antimicrobial. This review focuses on the multi-drug efflux pump system oí A. baumanni with special emphasis in the AdeABC system.
Assuntos
Acinetobacter baumannii/metabolismo , Antibacterianos/farmacocinética , Proteínas de Bactérias/metabolismo , Farmacorresistência Bacteriana Múltipla/fisiologia , Proteínas de Membrana Transportadoras/metabolismo , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/farmacologiaRESUMO
BACKGROUND: Metallo-beta-lactamases (MBL) confer high resistance to carbapenems in Pseudomonas aeruginosa (Psae). They are encoded in mobile elements of different genes (VIM, IMP, SMP, GIM), along with other resistance genes. AIM: To detect the presence of MBL in imipenem resistant Psae strains. MATERIAL AND METHODS: Fifty-nine imipenem resistant Psae strains isolated from January 2004 to August 2005 in a University Clinical Hospital, were included. The presence of MBL was studied by Etest (phenotypic) and genotypic polymerase chain reaction (PCR) methods. To rule out a nosocomial outbreak, MBL positive strains were studied by pulse field gel electrophoresis. RESULTS: The presence of MBL was detected in eleven strains. AH were type VIM and were not clonally related. There was no concordance between phenotypic and genotypic MBL detecting methods. All the strains were also multiresistant. CONCLUSIONS: The presence of MBL was detected in 19% of imipenem resistant Psae strains.
Assuntos
Antibacterianos/farmacologia , Imipenem/farmacologia , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/enzimologia , beta-Lactamases/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/genética , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla/genética , Eletroforese em Gel de Campo Pulsado , Feminino , Genes Bacterianos/efeitos dos fármacos , Genes Bacterianos/genética , Humanos , Imipenem/análise , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Infecções por Pseudomonas/genética , Pseudomonas aeruginosa/efeitos dos fármacos , Adulto Jovem , Resistência beta-Lactâmica/efeitos dos fármacos , Resistência beta-Lactâmica/genética , beta-Lactamases/análiseRESUMO
Background: Metallo-ß-lactamases (MBL) confer high resistance to carbapenems in Pseudomonas aeruginosa (Psae). They are encoded in mobile elements of different genes (VIM, IMP, SMP, GIM), along with other resistance genes. Aim: To detect the presence of MBL in imipenem resistant Psae strains. Material and methods: Fifty-nine imipenem resistant Psae strains isolated from January 2004 to August 2005 in a University Clinical Hospital, were included. The presence of MBL was studied by Etest (phenotypic) and genotypic polymerase chain reaction (PCR) methods. To rule out a nosocomial outbreak, MBL positive strains, were studied by pulse field gel electrophoresis. Results: The presente of MBL was detected in eleven strains. AH were type VIM and were not clonally related. There was no concordance between phenotypic and genotypic MBL detecting methods. AH the strains were also multiresistant. Conclusions: The presence of MBL was detected in 19 percent of imipenem resistant Psae strains.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Antibacterianos/farmacologia , Imipenem/farmacologia , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/enzimologia , beta-Lactamases/genética , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/genética , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla/genética , Eletroforese em Gel de Campo Pulsado , Genes Bacterianos/efeitos dos fármacos , Genes Bacterianos/genética , Imipenem/análise , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase , Infecções por Pseudomonas/genética , Pseudomonas aeruginosa/efeitos dos fármacos , Adulto Jovem , Resistência beta-Lactâmica/efeitos dos fármacos , Resistência beta-Lactâmica/genética , beta-Lactamases/análiseRESUMO
BACKGROUND: A progressive frequency of resistance to fluoroquinolones is observed among Gram-negative bacilli. AIM: To investigate the mechanism of resistance to fluoroquinolones mediated by mutations affecting gyrA and gyrB genes in strains of Gram negative bacüli isolated from CMean hospitals. MATERIAL AND METHOD: Minimal inhibitory concentration of fluoroquinolones was determined in 91 randomly selected nalidixic acid-resistant strains of Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa, isolated from hospitals of 12 Chilean cities. Quinolone resistance determining region (QRDR) was amplified by PCR and mutations were determined by restriction fragment length polymorphism (RFLP) and DNA sequencing. RESULTS: Strains with mutation in codon 83 of gyrA showed decreased susceptibility to ciprofloxacin with MICs ranging from 0.25 to 1024 fig/ml. The sequencing of PCR products for gyrA indicated amino acid changes in the QRDR region. One strain ofE. coli presented a double mutation, in codon 83 Ser to Leu as well as in codon 87 Asp to Asn. In strains ofK. pneumoniae, however, the change of codon 83 was Ser to Tyr, in A. baumannii was Ser to Leu and in P. aeruginosa was Thr to He. No strains with mutations affecting gyrB were found. CONCLUSIONS: Mutations in codon 83 of gyrA is a frequent genetic event involved in the mechanism leading to decreased susceptibility to fluoroquinolone in strains of Gram-negative bacilli.
Assuntos
Antibacterianos/farmacologia , Proteínas de Bactérias/genética , DNA Girase/genética , Farmacorresistência Bacteriana/genética , Fluoroquinolonas/farmacologia , Bactérias Gram-Negativas , Mutação/genética , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/genética , Chile , Códon/genética , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Frequência do Gene , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/genética , Hospitais , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/genéticaRESUMO
Background: A progressive frequency of resistance to fluorquinolones is observed among Gram-negative bacilli. Aim: To investigate the mechanism of resistance to fluoroquinolones mediated by mutations affecting gyrA and gyrB genes in strains of Gram negative bacüli isolated from CMean hospitals. Material and method: Minimal inhibitory concentration of fluoroquinolones was determined in 91 randomly selected nalidixic acid-resistant strains of Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa, isolated from hospitals of 12 Chilean cities. Quinolone resistance determining region (QRDR) was amplified by PCR and mutations were determined by restriction fragment length polymorphism (RFLP) and DNA sequencing. Results: Strains with mutation in codon 83 of gyrA showed decreased susceptibility to ciprofloxacin with MICs ranging from 0.25 to 1024 fig/ml. The sequencing of PCR products for gyrA indicated amino acid changes in the QRDR region. One strain ofE. coli presented a double mutation, in codon 83 Ser to Leu as well as in codon 87 Asp to Asn. In strains ofK. pneumoniae, however, the change of codon 83 was Ser to Tyr, in A. baumannii was Ser to Leu and in P. aeruginosa was Thr to He. No strains with mutations affecting gyrB were found. Conclusions: Mutations in codon 83 of gyrA is a frequent genetic event involved in the mechanism leading to decreased susceptibility to fluoroquinolone in strains of Gram-negative bacilli.
Assuntos
Humanos , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , DNA Girase/genética , Farmacorresistência Bacteriana/genética , Fluoroquinolonas/farmacologia , Bactérias Gram-Negativas , Mutação/genética , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/genética , Chile , Códon/genética , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Frequência do Gene , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/genética , Hospitais , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/genéticaRESUMO
Background: Infectious diseases produced by Enterococcus spp, must be treated with a synergistic combination between a penicillin and an aminoglycoside. High level resistance to aminoglycosides is a serious therapeutic problem, since it predicts the loss of synergistic activity of this antimicrobial combination. Aim: To investigate the presence of genes encoding aminoglycoside-modifying enzymes (AMEs) among strains of Enterococcus spp with high level of resistance to aminoglycosides. Material and methods: The genes encoding some of the AMEs were investigated among 305 aminoglycoside-resistant strains of Enterococcus spp isolated in hospitals of the VIII region of Chile, by dot blot hybridization and Polymerase Chain Reaction (PCS). Results: High level resistance to some aminoglycosides was observed in 104 strains (34.1 percent) and 93 of these harbored at íeast one of the genes encoding the investigated AMEs. Three genes were detected: aac(6)Ie-aph(2")Ia (14.8 percent) encoding for the enzyme AAC(6)Ie-APH(2")Ia (resistance to all aminoglycosides, except streptomycin); aph(3)IIIa (26 percent), and ant(6)la (28.5 percent) encoding for the phosphorylating enzymes APH(3)Ilia (resistance to kanamycin, amikacin and neomycin), and ANT(6)-la (resistance only to streptomycin), respectively. None of the strains harbored the gene ant (4) which encode for the enzyme ANT (4). Conclusion: The low frequency of strains harbouring the bifunctional enzyme (<15 percent), conferring an extended resistance profile to aminoglycosides, allows us to propose the empirical use of aminoglycoside-aminocyclitols, associated to a penicillin, in the treatment of serious infections produced by species of enterococci.
Assuntos
Humanos , Aminoglicosídeos/metabolismo , Antibacterianos/metabolismo , Farmacorresistência Bacteriana/genética , Enterococcus/enzimologia , Acetiltransferases/genética , Aminoglicosídeos/farmacologia , Antibacterianos/farmacologia , Chile , Enterococcus/efeitos dos fármacos , Enterococcus/genética , Infecções por Bactérias Gram-Positivas/microbiologia , Hospitais , Dados de Sequência Molecular , Fosfotransferases (Aceptor do Grupo Álcool)/genéticaRESUMO
The resistance of Acinetobacter baumannii to ss-lactam antibiotics is mainly due to the synthesis of ss-lactamases. From a clinical point of view, this bacteria and others, grouped under the acronym SPACE (S: Serratia, P: Pseudomonas, A: Acinetobacter, C: Citrobacter, E: Enterobacter) are essentially Amp-C ss-lactamases producers. There is no local information about ESBL presence in Acinetobacter. We studied ESBL production using the Ho and col. technique modified by adding cloxacillin as chromosomal ss-lactamases inhibitor. From 69 isolates, with resistance to at least one third generation cephalosporin, only 7 showed positive synergy test. Four of these amplified for TEM family gene, and one of these amplified also for the OXA family. Our study found a low ESBL production percentage, which agrees with the premise of Amp-C as the main mechanism of resistance to ss-lactam antibiotics in A. baumannii. However, the ESBL description in these bacteria emphasizes the capacity of expressing multiple resistance mechanisms.
Assuntos
Acinetobacter baumannii/enzimologia , Antibacterianos/farmacologia , Proteínas de Bactérias/biossíntese , Resistência beta-Lactâmica , beta-Lactamases/biossíntese , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/isolamento & purificação , Chile , Farmacorresistência Bacteriana , Humanos , Focalização Isoelétrica , Testes de Sensibilidade MicrobianaRESUMO
The resistance of Acinetobacter baumannii to ß-lactam antibiotics is mainly due to the synthesis of ß-lactamases. From a clinical point of view, this bacteria and others, grouped under the acronym SPACE (S: Serratia, P: Pseudomonas, A: Acinetobacter, C: Citrobacter, E: Enterobacter) are essentially Amp-C ß-lactamases producers. There is no local information about ESBL presence in Acinetobacter. We studied ESBL production using the Ho and col. technique modified by adding cloxacillin as chromosomal ß-lactamases inhibitor. From 69 isolates, with resistance to at least one third generation cephalosporin, only 7 showed positive synergy test. Four of these amplified for TEM family gene, and one of these amplified also for the OXA family. Our study found a low ESBL production percentage, which agrees with the premise of Amp-C as the main mechanism of resistance to ß-lactam antibiotics in A. baumannii. However, the ESBL description in these bacteria emphasizes the capacity of expressing multiple resistance mechanisms.
La resistencia de Acinetobacter baumannii a antimicrobianos ß-lactámicos se debe fundamentalmente a la síntesis de ß-lactamasas. Del punto de vista clínico se considera que esta bacteria, y otras agrupadas en el acrónimo SPACE (Serratia, Pseudomonas, Acinetobacter, Citrobacter, Enterobacter), son predominantemente productoras de ß-lactamasas tipo AmpC. No hay información en nuestro país sobre presencia de ß-lactamasas de espectro extendido (BLEE) en Acinetobacter. Se estudió la producción de BLEE en cepas de Acinetobacter, mediante una modificación de la técnica de Ho y col adicionando cloxacilina como inhibidor de ß-lactamasas cromosomales. De 69 cepas con resistencia al menos a una cefalosporina de tercera generación, sólo siete presentaron sinergia positiva. Cuatro cepas amplificaron por RPC un fragmento intragénico de genes de familia TEM y una de ellas amplificó, además, para el gen de la familia OXA. Se evidenció un bajo porcentaje de producción de BLEE, lo que confirma que la producción de Amp-C es el principal mecanismo de resistencia de A. baumannii a ß-lactámicos. Sin embargo, la descripción de BLEE en esta bacteria, enfatiza su capacidad de albergar múltiples mecanismos de resistencia.
Assuntos
Humanos , Acinetobacter baumannii/enzimologia , Antibacterianos/farmacologia , Resistência beta-Lactâmica , Proteínas de Bactérias/biossíntese , beta-Lactamases/biossíntese , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/isolamento & purificação , Chile , Farmacorresistência Bacteriana , Focalização Isoelétrica , Testes de Sensibilidade MicrobianaRESUMO
BACKGROUND: Klebsiella pneumoniae is an important pathogenic bacterium, frequently isolated from nosocomial samples, that exhibits wide antimicrobial resistance profiles, including third generation cephalosporins (3GC), aminoglycosides and quinolones. The resistance to 3GC is mainly due to the synthesis of extended spectrum beta lactamases (ESBL), encoded by conjugative plasmids. AIM: To investigate the potential transference of resistance to 3GC from nosocomial strains of K. pneumoniae to other clinical strains of various species of Enterobacteriaceae. MATERIAL AND METHODS: The mating experiments were carried out in liquid media and three nosocomial strains of K. pneumoniae were used as donors. These strains were ESBL-producers and resistant to, at least, one of the 3GC assayed. One strain of Citrobacter freundii, Salmonella typhimurium, Serratia marcescens and Escherichia coli, isolated from clinical specimens, were used as recipients. The presence of bla genes was investigated by PCR. RESULTS: The three nosocomial strains of K. pneumoniae were able to transfer the resistance to 3GC and the genes encoding the ESBL to the susceptible recipient strains of enterobacteria. The frequency of transference was as high as 3.2 x 10-2 transconjugants/recipient cell when the strain of Citrobacter freundii was used as recipient. All transconjugants exhibited high level of resistance to the 3GC assayed. CONCLUSIONS: Strains of K. pneumoniae isolated from Chilean hospitals are able to disseminate the ESBL genes to clinical strains of others species of Enterobacteriaaceae.
Assuntos
Antibacterianos/farmacologia , Resistência às Cefalosporinas/genética , Cefalosporinas/farmacologia , Klebsiella pneumoniae/enzimologia , Transformação Bacteriana/genética , beta-Lactamases/biossíntese , Citrobacter freundii/efeitos dos fármacos , Citrobacter freundii/enzimologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase , Salmonella typhimurium/efeitos dos fármacos , Salmonella typhimurium/enzimologia , Serratia marcescens/efeitos dos fármacos , Serratia marcescens/enzimologia , beta-Lactamases/genéticaRESUMO
Background: Klebsiella pneumoniae is an important pathogenic bacterium, frequently isolated from nosocomial samples, that exhibits wide antimicrobial resistance profiles, including third generation cephalosporins (3GC), aminoglycosides and quinolones. The resistance to 3GC is mainly due to the synthesis of extended spectrum beta lactamases (ESBL), encoded by conjugative plasmids. Aim: To investigate the potential transference of resistance to 3GC from nosocomial strains of K. pneumoniae to other clinical strains of various species of Enterobacteriaceae. Material and methods: The mating experiments were carried out in liquid media and three nosocomial strains of K. pneumoniae were used as donors. These strains were ESBL-producers and resistant to, at least, one of the 3GC assayed. One strain of Citrobacter freundii, Salmonella typhimurium, Serratia marcescens and Escherichia coli, isolated from clinical specimens, were used as recipients. The presence of bla genes was investigated by PCR. Results: The three nosocomial strains of K. pneumoniae were able to transfer the resistance to 3GC and the genes encoding the ESBL to the susceptible recipient strains of enterobacteria. The frequency of transference was as high as 3.2 x 10-2 transconjugants/recipient cell when the strain of Citrobacter freundii was used as recipient. All transconjugants exhibited high level of resistance to the 3GC assayed. Conclusions: Strains of K. pneumoniae isolated from Chilean hospitals are able to disseminate the ESBL genes to clinical strains of others species of Enterobacteriaaceae.
Assuntos
Humanos , Antibacterianos/farmacologia , Resistência às Cefalosporinas/genética , Cefalosporinas/farmacologia , Klebsiella pneumoniae/enzimologia , Transformação Bacteriana/genética , beta-Lactamases/biossíntese , Citrobacter freundii/efeitos dos fármacos , Citrobacter freundii/enzimologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase , Salmonella typhimurium/efeitos dos fármacos , Salmonella typhimurium/enzimologia , Serratia marcescens/efeitos dos fármacos , Serratia marcescens/enzimologia , beta-Lactamases/genéticaRESUMO
Los antimicrobianos aminoglucósidos-aminociclitoles constituyen una de las familias de agentes antibacterianos de mayor actividad sobre bacilos gramnegativos aeróbicos. Estos compuestos están característicamente formados por la combinación de un alcohol cíclico aminado (aminociclitol) y aminoazúcares (aminoglucósidos) unidos por enlaces glucosídicos. La potente actividad bactericida de estos compuestos parece no sólo explicarse por su capacidad de inhibición de la síntesis proteica, sino que también por un efecto sumatorio y pleiotrópico que altera la permeabilidad de la membrana citoplasmática. La penetración de estos antibacterianos en células bacterianas ocurre mediante tres fases bien definidas, siendo las dos últimas dependientes de la fuerza protón motriz (FPM). Este hecho explica la ausencia de actividad de estos compuestos sobre bacterias anaeróbicas. La resistencia bacteriana a este grupo de antibacterianos se debe, principalmente, a la producción de enzimas modificantes de aminoglucósidos. Estas enzimas son normalmente codificadas por elementos extracromosomales tales como plßsmidos y transposones. Sin embargo, se han identificados nuevos mecanismos y elementos genÚticos que participarían en los fenómenos de resistencia. Recientemente se ha descrito la metilación de bases involucradas en la unión entre el ARN 16S y el aminoglucósido, lo que implicaría un nuevo mecanismo de resistencia contra esta familia de antimicrobianos. Por otra parte, los cassettes genéticos adquieren una creciente importancia ya que albergan genes de resistencia a múltiples familias de antibacterianos, entre ellos, los aminoglucósidos-aminociclitoles. Estos cassettes genÚticos se encuentran asociados a integrones, los cuales son capaces de captar estos determinantes de resistencia.
Assuntos
Antibacterianos/uso terapêutico , Aminoglicosídeos/química , Farmacorresistência Bacteriana/genéticaRESUMO
BACKGROUND: Klebsiella pneumoniae is a pathogenic bacterium frequently isolated from nosocomial samples, specially the subspecie pneunonlae, with extensive antibiolic resistance profiles, including third generation cepbhalosporiis, aminoglycosides and quinolones. This is specially true for those strains producing extended spectrum beta lactamases (ESBL). AIM: To investigate the susceptibility to gentamicin, amikacin and ciprofloxacin and the presence of some aminogloycoside modifying enzyme (AMEs) among nosocomial strains of K pneumoniae subspecie pneumoniae producing ESBL. MATERIAL AND METHODS: The antibiotic resistant patterns and the level of resistance (minimal inhibitory concentration, MIC) of 100 strains, isoklted from sel ,eal bospitals of dcifferent Chilean cities, were deterl,in,ed. Tbe presence of some aminoglycosides modifying enzyme (AMEs) was investigated by PCR. RESULTS: Sixty five percent of strains were resistant to gentamicin, 47% were resistant to amikacin, and 29% were resistant to ciprofloxacin. The most frequent AMEs genes detected were the aac(6')-Ib gene (6'N-Acetyltransferase type Ib enzyme) in 69% of strains, conferring resistance to amikacin, kanamycin, tobramycin, and nieoniycin, and the gene aac(3)-IIa (3-Acetyltransferase type 3-IIa enzyme), in 36% of strains, conferring resistance to gentamlicin. CONCLUSIONS: Among nosocomial strains of K pneumoniae subspecie pneumoniae isolaterd from Chilean hospitals, there is an association between the production of ESBL and the resistance to others antimicrobial agents, especially aminoglycosides. Nevertheless, 71% of isolates are susceptible to ciprofloxacin.
Assuntos
Humanos , Anti-Infecciosos , Aminoglicosídeos/farmacologia , Ciprofloxacina/farmacologia , Klebsiella pneumoniae/efeitos dos fármacos , Farmacorresistência Bacteriana , beta-Lactamases/biossíntese , Antibacterianos/farmacologia , Amicacina/farmacologia , Aminoglicosídeos/metabolismo , Gentamicinas/farmacologia , Infecção Hospitalar/microbiologia , Klebsiella pneumoniae/metabolismoRESUMO
Bacteria have developed sophisticated and successful genetic mechanisms to evade the action of antimicrobials. Bacterial multiresistance has caused serious problems in the treatment of nosocomial infections. Integrons and gene cassettes are considered the main genetic elements in the evolution of plasmids and transposons that actively participate in the mobilization of genes, codifying different bacterial resistance mechanisms. This article reviews the historical and structural aspects of integrons and resistance gene cassettes and the presence of these structures in Gram negative bacteria isolated from Chilean hospitals in the last ten years (Rev MÚd Chile 2004; 132: 619-26).
Assuntos
Integrons/genética , Farmacorresistência Bacteriana/genética , Testes de Sensibilidade Microbiana , Farmacorresistência Bacteriana Múltipla/genéticaRESUMO
Las cefalosporinas son uno de los grupos de mayor importancia dentro de los ß-lactámicos. Existen diversas clasificaciones de esta moléculas, siendo la más utilizada aquella que agrupa a estos compuesto de acuerdo a propiedades estructurales, microbiológicas y desarrollo histórico: primera a cuarta generación. Las cefalosporinas de tercera generación han sido ampliamente utilizadas, pero la emergencia de resistencia bacteriana fundamentalmente derivada de la producción de ß-lactamasas tanto cromosomales como plasmidiales, ha limitado el uso de estos compuestos. Las cefalosporinas de cuarta generación se caracterizan por la presencia de un nitrógeno cuaternario en C, además de mantener el grupo metoxi-imino aminotiazolil en C. Presentan una elevada penetración intracelular a través de la membrana externa de bacilos Gram negativos y tienen una baja afinidad por enzimas que degradan cefalosporinas de tercera generación. Cefepime, una cefalosporina de cuarta generación, demostró una mayor actividad inhibitoria sobre cepas chilenas de Klebsiella pneumoniae y Escherichia coli productoras de ß- lactamasa de espectro extendido, que cefotaxima y ceftazidima
