Caracterización clínico y epidemiológica en pacientes con infección por Enterobacteriaceae productoras de B lactamasas de espectro extendido (BLEE), Hospital Escuela Universitario, Tegucigalpa, Honduras, Año 2013

Previous studies demonstrate that the prevalence of Enterobacteriaceae producing B spread spectrum lactamases (ESBL) has increased worldwide increasing the risk of mortality in patients infected with this type of bacteria. Objective: To determine the clinical and epidemiological characteristics in patients with Enterobacteriaceae infection producing B spread-spectrum lactamases (ESBL) at the University´s School Hospital in Tegucigalpa, Honduras in the year 2013. Methodology: Descriptive cross-sectional study in patients with ESBL-producing Escherichia coli and Klebsiella pneumoniae positive cultures. Positive cultures were identified through hospital bacteriology laboratory records from June to August 2013. Positive samples were analyzed using the Kirby-Bauer method and the commercial E-test for Minimum Inhibitory Concentration (MIC). Clinical records were reviewed to obtain clinical and epidemiological information. Data analysis was performed in Epi info 7. Results: 50 samples of E. coli positive cultures and 49 samples of K pneumoniae were collected during the period. The mean age of patients with E. coli was 33.6 years ± 26.5 1DE and 26.5 years ± 26.4 DE with K. pneumoniae. Samples were collected at 10.0 days in average hospitalization for patients with E. coli and 21.8 days for K. pneumoniae patients and differences were significant (p = 0.02). E. coli was resistant to 9 of the 11 antibiotics, K. pneumoniae to 10 of the 11 antibiotics studied and the differences were significant (p = 0.00002), the most frequent type of sample where E. coli was isolated was urine (62.0 %) And K. pneumoniae only 34.7% of urine followed by hemoculture (16.3%) and ICU was where the highest percentage of K. pneumoniae was isolated whereas E. coli was in outpatient clinic. Conclusions / Recommendations: The results of this study show the existence of BLEE Enterobacteriaceae, highly resistant, essentially to the third generation cephalosporins and should be redefined the antibiotic therapy schemes for the improvement of the quality of hospital medical care.Revista Ciencia y Tecnología No.20, junio 2017; 50-66Antecedentes. La prevalencia de Enterobacteriaceae productoras de B lactamasas de espectro extendido (BLEE) se ha incrementado a nivel mundial aumentado el riesgo de mortalidad en los pacientes infectados con este tipo de bacterias. Objetivo: Determinar las características clínico y epidemiológica en pacientes con infección por Enterobacteriaceae productoras de B lactamasas de espectro extendido (BLEE) en el Hospital Escuela Universitario. Tegucigalpa, Honduras. Año 2013.Metodología: Estudio transversal descriptivo en pacientes con cultivos positivos por Escherichia coli y Klebsiella pneumoniae productoras de BLEE. Los cultivos positivos se identificaron a través de los registros del laboratorio de bacteriología del hospital de junio a agosto del 2013. Las muestras positivas fueron analizadas por medio del método Kirby-Bauer y la prueba comercial E-test para Concentración Mínima Inhibitoria (MIC). Se revisaron los expedientes clínicos para obtener la información clínico y epidemiológica. El análisis de la información se realizó en Epi info 7. Resultados: en el periodo se recolectaron 50 muestras de cultivos positivos por E. coli y 49 muestras por K pneumoniae. La media de edad de los pacientes con E. coli fue 33.6 años ± 26.5 1DE y 26.5 años ± 26.4 DE con K. pneumoniae. Las muestras fueron recolectada a los 10.0 días en promedio de hospitalización para los pacientes con E. coli y 21.8 días para los de K. pneumoniae y las diferencias fueron significativas (p=0.02). E. coli presentó resistencia a 9 de los 11 antibióticos, K. pneumoniae a 10 de los 11 antibióticos estudiados y las diferencias fueron significativas (p=0.00002), el tipo de muestra más frecuente donde se aisló E. coli fue de orina (62.0%) y K. pneumoniae solo un 34.7% de orina seguido de hemocultivo (16.3%) y UCI fue donde se aisló el mayor porcentaje de K. pneumoniae en cambio E. coli fue en consulta externa. Conclusiones/ Recomendaciones: los resultados de este estudio muestran la existencia de Enterobacteriaceae BLEE, altamente resistentes, esencialmente a las cefalosporinas de tercera generación y se deben redefinir los esquemas de antibioticoterapia para el mejoramiento de la calidad de atención médica hospitalaria.

Drug resistance-related mutations in multidrug-resistant Mycobacterium tuberculosis isolates from diverse geographical regions

Background: Drug resistance in Mycobacterium tuberculosis is associated with chromosomal mutations in selected genes. These mutations can be screened for an early warning system for drug-resistant tuberculosis. The prevalence of individual mutations differs geographically, which must be considered in developing globally applicable screening tests. Methods: In order to analyse the geographical distribution and frequency of mutations conferring resistance to rifampicin, isoniazid and fluoroquinolones, the researchers investigated the presence of mutations in the rpoB gene, the katG gene, the mabA-inhA promoter region and the gyrA gene in clinical isolates of multidrug-resistant tuberculosis (MDR-TB) from Belarus, China, Iran/Iraq, Honduras, Romania and Uganda. For each study site, the researchers described the distribution of specific mutations in 20 clinical MDR-isolates. Results: The distribution of resistance-related mutations varied significantly between the study sites. Settings with a high incidence of MDR-TB, such as Belarus, showed a narrower spectrum of mutations related to rifampicin and isoniazid resistance and also a higher prevalence of fluoroquinolone resistance than study sites with a lower MDR-TB prevalence. Conclusion: This study confirms that there are significant geographical differences in the distribution of resistance-related mutations and suggests that an increased understanding of such differences in the specific distribution of resistance conferring mutations is crucial for development of new, generally applicable, molecular tools for rapid diagnosis of drug-resistant TB. The fact that a narrower distribution of mutations in high MDR-TB prevalence settings was seen suggests that much of the problems in these settings can be a result of an ongoing transmission of certain MDR-TB strains