Detección y caracterización molecular de metalo-B-lactamasas en aislamientos de Pseudomonas aeruginosa recuperados en un Instituto especializado pediátrico de Lima - Perú

Detecta y caracteriza molecularmente las metalo-β-lactamasas (MβLs) responsables de la resistencia a carbapenemes en aislamientos de Pseudomonas aeruginosa. Fueron evaluados un total de 46 aislamientos de P. aeruginosa, resistentes a ceftazidima y con sensibilidad reducida a los carbapenemes; en dos periodos (enero/febrero y julio/agosto), de pacientes hospitalizados en el Instituto Nacional de Salud del Niño (INSN) durante el año 2010. Las pruebas de sensibilidad se realizaron mediante la técnica de disco difusión, de acuerdo a los criterios del "Clinical and Laboratory Standards Institute" (CLSI) (2011). El ensayo fenotípico para la detección de MβLs se realizó utilizando el método de aproximación de los discos con sustratos (ceftazidima, imipenem y meropenem) y el inhibidor de las MβLs (EDTA). La detección de genes MβLs, para las familias más ampliamente diseminadas, se realizó mediante PCR multiple. A través del método fenotípico se detectaron MβLs en 6 de 46 aislamientos (13%). La detección de genes reveló la presencia del gen blaIMP codificantes de enzimas tipo IMP en 6 aislamientos, estos correspondieron a los mismos que fueran detectados por el ensayo de detección fenotípica empleando EDTA, lo que indica una sensibilidad y especificidad del ensayo de detección fenotípica del 100%. Los 6 aislamientos positivos para enzimas tipo IMP, fueron también positivos a la detección de integrones de clase 1 por amplificación de intI1. Los ensayos de tipificación molecular mostraron que la diseminación no se trataba de un único clon o de una línea clonal. En conclusión de los 46 aislamientos de P. aeruginosa recuperadas de pacientes hospitalizados en el INSN, solo el 13 % presentan la producción de MβLs indicando que este no es el principal mecanismo de resistencia a los carbapenémicos presentado por P. aeruginosa en el INSN, y refuerzan la necesidad de revisar las medidas de control de la infección en la institución.Tesi

Bacterial coinfections causing acute diarrhea, at the Instituto Nacional de Salud del Niño

En pleno siglo XXI, las enfermedades diarreicas continúan representando un importante problema de salud pública. Según los registros de la Organización Mundial de la Salud (OMS), en los países en desarrollo los niños menores de 5 años experimentan un promedio de 3,2 episodios de diarrea anualmente (1,2). La enfermedad diarreica aguda (EDA), principalmente infecciosa, constituye un problema de salud pública en el Perú debido a su alto costo económico, social y familiar; siendo una de las principales causas de morbilidad y mortalidad en la niñez (3).In the XXI century, diarrheal diseases continue to represent a major public health problem. According to the records of the World Health Organization (WHO) in developing countries children under 5 years experience an average of 3.2 episodes of diarrhea per year (1,2). Acute diarrheal disease (ADD), mainly infectious, is a public health problem in Peru because of its high economic, social and family costs; being one of the leading causes of morbidity and mortality in childhood (3)

Urocultivo con removedor de antibióticos: mitos y verdades

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Identificación de enterobacterias multirresistentes a antibióticos en muestras de heces de lactantes residentes en Talara, Piura, Perú

La colonización fecal en lactantes por bacterias resistentes a los antimicrobianos es un potencial riesgo para futuras terapias antibióticas. Nuestro objetivo fue determinar la frecuencia y características sociodemográficas de lactantes portadores fecales de enterobacterias resistentes a ciprofloxacina (PFRC) y sus genes de resistencia asociados. Analizamos muestras fecales de 41 niños lactantes residentes en el distrito de Talara-Piura, Perú, en 2019. Evaluamos la presencia de 3 genes de resistencia a quinolonas: aac(6’)-Ib-cr, qnrB y oqxA y 2 de betalactamasas: blaCTX-M, blaPER-2.El 68% de lactantes fueron PFRC, Escherichia coli (83,3%) fue el más frecuente. El análisis genotípico detectó: oqxA (41,1%), qnrB (26,7%) y aac(6’)-Ib-cr (20%) y al gen blaCTX-M en el 93,3% de los aislados con betalactamasas. La elevada frecuencia de PFRC nos alertan sobre el potencial riesgo en la pérdida de utilidad de esta familia antibiótica en el área de estudio

Phenotypic detection of plasmid-mediated colistin resistance in Enterobacteriaceae

The aim of this work was to evaluate an easy-to-perform assay basedupon inhibition of mobile colistin resistance (MCR) activity by EDTA. We included 92nonrelated isolates of Enterobacteriaceae (74 Escherichia coli, 17 Klebsiella pneumoniae,and 1 Serratia marcescens). Our proposed method is based on a modificationof the colistin agar-spot screening test (CAST), a plate containing 3 g/ml colistin,by adding an extra plate of colistin agar-spot supplemented with EDTA (eCAST).Bacterial growth was evaluated after 24 h of incubation at 35°C. All the colistinresistantisolates showed development on the CAST plates. Colistin-resistant K. pneumoniaewithout mcr-1 and S. marcescens also grew on the eCAST plates. In contrast,colistin-resistant MCR-producing E. coli was not able to grow in eCAST plates. Thecombined CAST/eCAST test could provide a simple and easy-to-perform method todifferentiate MCR-producing Enterobacteriaceae from those in which colistin resistanceis mediated by chromosomal mechanisms.Fil: Gonzales Escalante, Edgar. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Microbiología; ArgentinaFil: Yauri Condor, Katherine. Universidad Nacional Mayor de San Marcos; PerúFil: Di Conza, José Alejandro. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Microbiología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Gutkind, Gabriel Osvaldo. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Microbiología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentin

Bacteriemia por Campylobacter coli en paciente con inmunodeficiencia primaria

Letters to editorCartas al edito

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Coinfecciones bacterianas causantes de enfermedad diarreica aguda, en el Instituto Nacional de Salud del Niño

En pleno siglo XXI, las enfermedades diarreicas continúan representando un importante problema de salud pública. Según los registros de la Organización Mundial de la Salud (OMS), en los países en desarrollo los niños menores de 5 años experimentan un promedio de 3,2 episodios de diarrea anualmente (1,2). La enfermedad diarreica aguda (EDA), principalmente infecciosa, constituye un problema de salud pública en el Perú debido a su alto costo económico, social y familiar; siendo una de las principales causas de morbilidad y mortalidad en la niñez (3).In the XXI century, diarrheal diseases continue to represent a major public health problem. According to the records of the World Health Organization (WHO) in developing countries children under 5 years experience an average of 3.2 episodes of diarrhea per year (1,2). Acute diarrheal disease (ADD), mainly infectious, is a public health problem in Peru because of its high economic, social and family costs; being one of the leading causes of morbidity and mortality in childhood (3)