Resistance of uropathogenic bacteria to first-line antibiotics in mexico city: A multicenter susceptibility analysis

AbstractBackgroundGrowing antibiotic resistance demands the constant reassessment of antimicrobial efficacy, particularly in countries with wide antibiotic abuse, where higher resistance prevalence is often found. Knowledge of resistance trends is particularly important when prescribing antibiotics empirically, as is usually the case for urinary tract infections (UTIs). Currently, in Mexico City, ampicillin, cotrimoxazole (trimethoprim/sulfamethoxazole), and ciprofloxacin are used as “first-line” antibiotic treatment for UTI.ObjectiveThe aim of this study was to analyze the resistance of bacterial isolates to antibiotics, with a focus on first-line antibiotics, in Mexican pediatric patients and sexually active or pregnant female outpatients.MethodsIn this multicenter susceptibility analysis, bacterial isolates from urine samples collected from pediatric patients and sexually-active or pregnant female outpatients presenting with acute, uncomplicated UTIs in Mexico City from January 2006 through June 2006, were included in the study. Samples were tested for susceptibility to 10 antibiotics by the disk-diffusion method.ResultsFour-hundred and seventeen bacterial isolates were derived from sexually active or pregnant female outpatients (324 Escherichia coli) and pediatric patients (93 Klebsiella pneumoniae). We found a high prevalence of resistance towards the drugs used as “first-line” when treating UTIs: ampicillin, cotrimoxazole, and ciprofloxacin (79%, 60%, and 24% resistance, respectively). Ninety-eight percent of K pneumoniae isolates were resistant to ampicillin, whereas 66% of the E coli isolates were resistant to cotrimoxazole. Resistance towards third-generation cephalosporins was also high (6%–8% of E coli and 10%–28% of K pneumoniae). This was possibly caused by chromosomal β-lactamases, as 30% of all isolates were also resistant to amoxicillin/clavulanate. In contrast, 98% of the E coli isolates and 84% of the K pneumoniae strains (96% of all isolates) were found to be susceptible to nitrofurantoin, which has been in clinical use for much longer than most other drugs in this study.ConclusionIn these urine samples from laboratories in Mexico City, resistance of K pneumoniae and E coli isolates to first-line treatment (ampicillin, cotrimoxazole, or ciprofloxacin) of UTI was high, whereas most E coli and K pneumoniae isolates were susceptible to nitrofurantoin and the fourth-generation cephalosporin cefepime. (Curr Ther Res Clin Exp. 2007;68:120–126) Copyright © 2007 Excerpta Medica, Inc

XI Congreso Paraguayo de Infectología

Temas como: Situación epidemiológica de TB en Paraguay; Avances en el diagnostico de la TB; Manejo del paciente con coinfección TB/VIH; y Tratamiento actual de la Tuberculosis multirresistente se abordaron en la oportunidad.CONACYT - Consejo Nacional de Ciencias y TecnologíaPROCIENCI

Methicillin-resistant S. aureus colonization in Mexican children attending day care centres

Purpose: To determine MRSA carriage rates and genetic relationships of S. aureus strains in children attending day care centres in 14 cities from three geographic regions in Mexico. Materials and methods: Cross-Sectional Study performed in apparently healthy children aged from 6 mo to 6 yr attending day care centres (DCCs). From September 2002 To January 2003, 2345 nasopharyngeal specimens from a similar number of children were collected. Nasopharyngeal samples for bacterial isolation were obtained by standard methods. Antimicrobial susceptibility was determined and genetic relatedness of all MRSA isolates was determined by pulsed field gel electrophoresis (PFGE). Results: S. aureus was identified in 237 children (10.1%), twenty-two children had MSRA for an overall prevalence of MRSA carriage of 0.93%. Children attending DCCs from cities located in the north and south of Mexico showed higher prevalence than children from DCCs in the central region; 1.75%, and 1.71 vs. 0.08%, respectively (P < 0.05). PFGE demonstrated six different restriction profiles of MRSA with a predominant pattern. Conclusions: We documented the presence of MRSA strain colonizing children attending DCCs in Mexico, mainly in the south and north regions of the country. Clone A and B which are closely related represented 45 % of the total of MRSA isolates. We found both, SCCmec type II and type IV strains in the three regions

Cost-effectiveness analysis of pneumococcal conjugate vaccine introduction in Paraguay.

OBJECTIVE: To describe a cost-effectiveness analysis of 10- or 13-valent pneumococcal conjugate vaccine (PCV10 or 13) introduction in Paraguay compared to no vaccination. METHODS: The integrated TRIVAC vaccine cost-effectiveness model (version 2.0) jointly developed by the Pan American Health Organization's ProVac Initiative and the London School of Hygiene & Tropical Medicine was applied from the government and societal perspectives to estimate the cost-effectiveness (CE) of PCV introduction during 2010 and 2011. The cost-effectiveness ratios of PCV10 and PCV13 were separately compared to non-vaccination. The model calculated health and economic benefits of vaccination for 10 birth cohorts of children <5 years of age. A base case scenario with two primary doses at 2 and 4 months and a booster dose at 12 months (2+1 schedule) and alternate scenarios with varying parameters were considered. RESULTS: With PCV10 introduction, the incremental costs of the vaccination program would be approximately US$67 million to vaccinate all 10 cohorts of children; with PCV13, US$ 87 million. Health services costs avoided by the government with PCV10 would be US$19.5 million; with PCV 13, US$ 17.7 million. From the societal perspective, savings were much greater: with PCV10, US$43 million; with PCV13, US$ 35 million. For the higher priced PCV13, the average cost-effectiveness ratio was better than for PCV10 when compared to no vaccination, but regardless both were cost effective for government and society based on a threshold of 3× GDP per capita in Paraguay (2009 US$ 2516). The number of averted meningitis and all-cause pneumonia cases and deaths was greater with PCV13 than with PCV10 when compared to no vaccination. CONCLUSION: The introduction of either PCV10 or PCV13 would be cost effective when compared to no vaccination, and in some scenarios, highly cost effective in Paraguay. The outcomes of these analyses demonstrate that a pneumococcal vaccine could substantially reduce morbidity and mortality in children <5 years in Paraguay