medigraphic.com
Instituto Nacional de Salud Pública

2003, Número 2

<< Anterior Siguiente >>

salud publica mex 2003; 45 (2)


Susceptibilidad antimicrobiana in vitro en aislamientos clínicos de Enterococcus species

Calderón-Jaimes E, Arredondo-García JL, Aguilar-Ituarte F, García-Roca P

Idioma: Ingles.
Referencias bibliográficas: 42
Paginas: 96-101
Archivo PDF: 59.13 Kb.


RESUMEN

Objectivo. Describir la actividad antimicrobiana de varios antibióticos, contra 97 cepas de Enterococcus spp., consideradas como aislamientos clínicamente significativos. Material y métodos. En un estudio prospectivo de dos años, (enero de 1998 a diciembre de 1999) hecho en el Instituto Nacional de Pediatría en la Ciudad de México, se procesaron 97 cepas de Enterococcus (60 de Enterococcus faecalis y 37 de Enterococcus faecium, contra 11 antibióticos. La prueba de susceptibilidad se elaboró con agar, de acuerdo con los estándares del Comité Nacional para el Laboratorio Clínico (NCCLS). Todos los aislamientos fueron probados para determinar la resistencia elevada en contra de β-lactámicos, aminoglucósidos y glicopéptidos. Asimismo, se determinó el fenotipo de resistencia hacia la vancomicina. Se evaluaron diferencias de proporciones con χ2 o prueba exacta de Fisher. Resultados. La resistencia en general hacia los antibióticos probados fue 17/97 (17.5%) a penicilina, ampicilina, amoxicilina-clavulanato e imipenem. No se encontró resistencia elevada ni presencia de producción de β-lactamasas; 74/97 (48.4%) fueron resistentes a eritromicina, 60% resistentes a ciprofloxacina, 31/97 (32%) resistentes a gentamicina y 55/97 (56.7%) resistentes a estreptomicina. Siete cepas fueron resistentes a vancomicina, todas ellas E. faecium; 5/7 con el fenotipo A y 2/7 con el fenotipo B. Todas las cepas aisladas fueron susceptibles al linezolid. La diferencia en la susceptibilidad antimicrobiana entre las especies fue significativa. Conclusiones. La resistencia antimicrobiana múltiple de Enterococcus spp. es un problema real y es necesaria su vigilancia. El laboratorio de microbiología es la primera línea de defensa en contra de la diseminación de enterococos con resistencia múltiple en el ambiente hospitalario. Todas las cepas aisladas deberían ser probadas en contra de ampicilina, estreptomicina, gentamicina y glicopéptidos.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Schaberg DR, Culver DH, Gaynes RP. Mayor trends in the microbial etiology of nosocomial infection. Am J Med 91;(suppl 3B):72S-75S.

  2. Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin-United States, 1989-1993. MMWR Morb Mortal Wkly Rep 1993;42:597-599.

  3. Tornieporth N, Roberts RB, John J, Hafnier A, Riley LW. Risk factors associated with vancomycin-resistant Enterococcus faecium infection or colonization in 145 matched case patients and control patients. Clin Infect Dis 1996;23:767-772.

  4. Edmond MB, Ober JF, Dawson JD, Weinbaurri DC, Wenzel RP. Vancomycin- resistant enterococcal bacteremia: Natural history and attributable mortality. Clin Infect Dis 1996;23:1234-1239.

  5. Eliopoulos GM. Vancomycin-resistant enterococci: Mechanism and clinical relevance. Infect Dis Clin North Am 1997;11:851-865.

  6. Murray BE. The life and times of the enterococcus. Clin Microbiol Rev 1990;3:45-65.

  7. Rubin L, Tucci V, Cerenado E, Elioponlos G, Isenberg H. Vancomycinresistant Enterococcus faecium in hospitalized children. Infect Control Hosp Epidemiol 1992;13:700-705.

  8. Fridkin SK, Gaynes RP. Antimicrobial resistance in intensive care units. Clin Chest Med 1999;20:303-316.

  9. Patterson JE, Sweeney AH, Simms M, Carley N, Mangi R, Sabetta J et al. An analysis of 110 serious enterococcal Infections. Epidemiology, antibiotic susceptibility, and outcome. Medicine 1995;74:191-200.

  10. Ross TW. Infectious disease challenge: Vancomycin-resistant enterococcus and staphylococcus. Drug Topics 1998;142:76-83.

  11. Murray BE. Vancomycin-resistant enterococci. Am J Med 1997;102: 284-293.

  12. Murray BE. Diversity among multidrug-resistant enterococci. Emerg Infect Dis 1998;4:37-47.

  13. Gold HS. Vancomycin-resistant enterococci: Mechanisms and clinical observations. Clin Infect Dis 2001;33:210-219.

  14. Huycke MM, Sahm DF, Gilmore MS. Multiple-drug resistant enterococci: The nature of the problem and an agenda for the future. Emerg Infect Dis 1998;4:239-249.

  15. Hodges TR, Zighelboim-Daum S, Eliopulus GM, Wennerstein CB, Moellering RC. Antimicrobial susceptibility changes in Enterococcus faecalis following various penicillin exposure regimens. Antimicrob Agents Chemother 1992;36:121-125.

  16. Moellering RC. Vancomycin-resistant enterococci. Clin Infect Dis 1998;26:1196-1199.

  17. Gold HS, Moellering RC. Drug therapy: Antimicrobial-drug resistance. N Engl J Med 1996;335:1445-1454.

  18. Centinkaya Y, Falk P, Mayhall CG. Vancomycin-resistant enterococci. Clin Microbiol Rev 2000;13:686-707.

  19. Perl TM. The threat of vancomycin resistance. Am J Med. 1999;106: 26S-37S.

  20. Facklam RR, Sham DF, Teixeira LM. Enterococcus. En: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RA, ed. Manual of clinical microbiology.

  21. 7th ed. Washington, DC: American Society for Microbiology, 1999:297-305.

  22. Facklam RR, Collin MD. Identification of Enterococcus species isolated from human infections by a conventional test scheme. J Clin Microbiol 1989;27:731-734.

  23. National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Approved standard-5th ed. Wayne (PA): NCCLS, 2000; Document M7- A-5, 27.

  24. National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing. Twelfth Informational Supplement. Wayne (PA): NCCLS, 2002; Document M100-S12.

  25. Bonten MJ, Slaughter S, Ambergen AW, Hayden MK, van Voorhis J, Nathan C et al. The role of “colonization pressure” in the spread of vancomycin- resistant enterococci: An important infection control variable. Arch Intern Med 1998;158:1127-1132.

  26. Palmer SM, Ryback MJ. Vancomycin-resistant enterocci. Pharmacotherapy 1996;16:819-829.

  27. Miranda G, Lee L, Kelly C, Solórzano F, Leaños B, Muñoz O et al. Antimicrobial resistance from enterococci in a pediatric hospital. Plasmids in Enterococcus faecalis isolates with high-level gentamicin and streptomycin resistance. Arch Med Res 2001;32:159-163.

  28. Sifuentes-Osornio J, Ponce deLeón A, Muñoz-Trejo T, Villalobos-Zapata Y, Ontiveros-Rodríguez C, Gómez-Roldan C. Antimicrobial susceptibility patterns and high-level gentamicin resistance among enterococci isolated in a Mexican tertiary care center. Rev Invest Clin 1996;48:91-96.

  29. Pfaller MA, Jones RN, Doern GV, Kugler K, the SENTRY participants Group. Bacterial pathogens isolated from patients with blood stream infections: Frequencies of ocurrence and antimicrobial susceptibility patterns from the SENTRY Antimicrobial Surveillance Program (United States and Canada, 1997). Antimicrob Agents Chemother 1998;42:1762-1770.

  30. Sader HS, Jones RN, Gales AC, Winokur P, Kugler KC, Pfaller MA et al. Antimicrobial susceptibility patterns for pathogens isolated from patients in Latin American medical centers with a diagnosis of pneumonia: Analysis of results from the SENTRY. Antimicrobial Surveillance Program (1997), SENTRY Latin American Study Group. Diagn Microbiol Infect Dis 1998;32:289-301.

  31. Gales AC, Jones RN, Pfaller MA, Gordon KA, Sader HS, Sampaio J et al. Two-year assessment of the pathogen frequency and antimicrobial resistance patterns among organisms isolated from skin and soft tissue infections in Latin American hospitals: Result from the SENTRY Antimicrobial Surveillance Program,1997-98. Int J Infect Dis 2000;4:75-84.

  32. Arthur M, Reynolds PE, Depardieu F, Corvalin P. Mechanisms of glycopeptide resistance in enterococci. J Infect Dis 1996;32:11-16.

  33. Ferretti JJ, Gilmore KS, Courvalin P. Nucleotide sequence analysis of the gene specifying the bifunctional 6’-aminoglycoside acetyltransferase

  34. 2”-aminoglycoside phosphotransferase enzyme in Streptococcus faecalis and identification and cloning of gene regions specifying the two activities. J Bacteriol 1986;167:631-638.

  35. Weinstein MP. Comparative evaluation of penicillin, ampicillin, and imipenem MICs and susceptibility breakpoints for vancomycin-susceptible and vancomycin-resistant Enterococcus faecalis and Enterococcus faecium. J Clin Microbiol 2001;39:2729-2731.

  36. Herman DJ, Gerdin DN. Screening and treatment of infections caused by resistant enterococci. Antimicrob Agent Chemother 1991;35:215-219.

  37. Quintiliani R, Evers S, Courvalin P. The van B gene confers various levels of self-transferable resistance to vancomycin in enterococci. J Infect Dis 1993;167:1220-1223.

  38. Garbutt J. Ventrapragada M, Littenberg B, Mundy LM. Association between resistance to vancomycin and death in cases of Enterococcus faecium bacteremia. Clin Infect Dis 2000;30:466-472.

  39. Lautenback E, Bilker WB, Brennan PJ. Enterococcal bacteremia: Ris factors for vancomycin resistance and predictors of mortality. Infect Control Hosp Epidemiol 1999;20:318-323.

  40. Lucas G, Lechtzin N, Puryear W, Yaul, Flexner C, Moore R. Vancomycinresistant and vancomycin-susceptible enterococcal bacteremia: Comparison of clinical features and outcomes. Clin Infect Dis 1998;26:1127-1133.

  41. Naskin GA, Siddiqui F, Stosor V, Hacek D, Peterson LR. In vitro activities of linezolid against important gram-positive bacterial pathogens including vancomycin-resistant enterococci. Antimicrob Agents Chemother 1999;43:2059-2062

  42. Clement D, Markham A. Linezolid. Drug 2000;59: 815-827.




2020     |     www.medigraphic.com