medigraphic.com

2007, Number 1

<< Back Next >>

Enf Infec Microbiol 2007; 27 (1)

Bacterial resistance in isolates from patients with nosocomial infections

Ruiz LIK, Diemond HJBB, Pacheco RDO, Velázquez CM, Flores RÉM, Miranda NMG

Language: Spanish
References: 24
Page: 15-21
PDF size: 88.33 Kb.


ABSTRACT

Objective. To compare the differences in the resistance patterns of microorganisms causing nosocomial infections in patients in intensive care units and hospitalization areas.
Material and methods. Design: cross-sectional survey. Setting: Hospital de Pediatría del Centro Médico Siglo XXI. From January 2003 to June 2004, data from nosocomial infections and bacterial etiologic agents were reviewed. The resistance patterns were obtained from the registers in the Microbiology section of the Clinical Laboratory. Information was divided according to the hospitalization area for analysis.
Statistical analysis. Descriptive statistics, and inferential by comparison of proportions (square-chi).
Results: 325 isolated bacteria from patients with nosocomial infection were reviewed, 60% corresponded to gram-negative microorganisms. Most frequent isolations were: coagulase-negative Staphylococcus, Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa. Resistance in gram-negatives was higher for amikacin (44% vs 29% p= 0.04), imipenem (26% vs 12% p=0.02), norfloxacin (30% vs 17% p=0.047) and cefepime (30% vs 10% p= 0.001), in hospitalization areas. For gram-positives, the resistance for amikacin was higher in the intensive care units (68% vs 43% p= 0.006). Major resistance problems was observed for enterobacterias producing extended spectrum beta-lactamases, resistance to quinolones, and P. aeruginosa resistant to imipenem.
Conclusions. The resistance was higher for gram-negatives in hospitalization areas, this can be explained in part due to the type of patients assisted in this hospital, mainly with chronic diseases and frequent re-admittances. Even though, it is still necessary to reinforce the control measures for the adequate antimicrobial use.


REFERENCES

  1. Fridkin S. Increasing prevalence of antimicrobial resistance in intensive care units. Crit Care. Med 2001; 29(4): 64-69.

  2. Paterson D, Rice L. Empirical antibiotic choice for the seriously III patient: Are minimization of selection of resistant organisms and maximization of individual outcome mutually exclusive? CID 2003; 36: 1006-1012.

  3. Bonomo R. Multiple antibiotic-resistant bacteria in longterm- care facilities: An emerging problem in the practice of infectious diseases. CID 2000; 31: 1414-1422.

  4. Leclercq R. Mechanisms of resistance to macrolides and lincosamides: Nature of the resistance elements and their clinical implications. CID 2002; 34: 482-492.

  5. Bantar C, Sartori B, Vesco E, Heft C, Saul M, Salamone F, Oliva M. A hospital-wide intervention program to optimize the quality of antibiotic use: Impact of prescribing practice, antibiotic consumption, cost savings, and bacterial resistance. CID 2003; 37: 180-186.

  6. Warren D, Fraser V. Infection control measures to limit antimicrobial resistance. Crit Care Med 2001; 29(4): 128-132.

  7. Sanders Ch. Mechanisms responsible for cross-resistance and dichotomous resistance among the quinolones. CID 2001; 32: 1-8

  8. Leverstein-van Hall M, Block H, Donders R, Paauw A, Verhoef J. Multidrug resistance among enterobacteriaceae is strongly associated with the presence of integrons and Is independent of species or isolate origin. JID 2003; 187(15): 251-259.

  9. Centers for Disease Control and Prevention, Hospital Infections Program. National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986- April 1996, issued May 1996: A report from the NNIS System. Am J Infect Control 1996; 24: 380-388.

  10. Díaz Ramos R, Solórzano-Santos F, Padilla-Barrón G, Miranda-Novales MG, González Robledo R, Trejo y Pérez JA. Infecciones nosocomiales. Experiencia en un hospital pediátrico de tercer nivel. Salud Pública Mex 1999; 41 suppl 1: S12-17.

  11. Querol VJ, Coria LJ. Infecciones nosocomiales y calidad de la atención. Rev Enf Infect Ped 1997; 42(XI): 60-65.

  12. Martínez RH, Anaya GV, Gorbea RMC. Infecciones nosocomiales en un servicio de pediatría de un hospital de tercer nivel. Rev Mex Pediatr 2001; 68(2): 56-65.

  13. Paterson D. Looking for risk factors for the acquisition of antibiotic resistance: A 21st century approach. CID 2002; 34: 1564-1567.

  14. Drusano G. Prevention of resistance: A goal for dose selection for antimicrobial agents. CID 2003; 36(1): 42-50.

  15. Toltzis P, Blumer J. Nosocomial acquisition and transmission of antibiotic-resistant Gram-negative organisms in the pediatric intensive care unit. Pediatr Infect Dis J 2001; 20(6): 612-618.

  16. Ludsky K, Hoyen C, Salvator A, Rice L, Toltzis P. Antibiotic- resistant gram-negative organisms in pediatric chronic- care facilities. CID 2002; 34: 760-766.

  17. CLSI (Clinical and Laboratory Standards Institute). Performance Standards for Antimicrobial Susceptibility Testing. Fifteenth Informational Supplement. CLSI document M100-S15. Pennsylvania 19087-1898. USA, 2005.

  18. Cashat-Cruz M, Silva-Bustamante S. Infecciones nosocomiales en pediatría. Un problema actual. Bol Med Hosp. Infent Méx 1997; 54(2): 91-97.

  19. Salazar HH, Mireles HMC, Moreno DMR, Bustamente LEM. Hospitales nosocomiales en un hospital de segundo nivel. Rev Med IMSS 2002; 40(1): 43-51.

  20. Camacho-Ramírez RI, Ávila-Reyes R, Sánchez-Zapata MH y cols. Epidemiología de las infecciones nosocomiales en un hospital pediátrico de tercer nivel. Enf Infec y Micro 2002; 22(4): 200-205.

  21. Valenzuela FA, Rangel FM, Gutiérrez JG y cols. Vigilancia de infecciones nosocomiales: experiencia de un hospital de cardiología. Cir Ciruj 2004; 72: 41-46.

  22. Morfín OR, Donís HJ, Arredondo JL y cols. Infecciones nosocomiales por bacterias grampositivas multirresistentes: la actividad de nuevos antimicrobianos. Enf Infec y Micro 2002; 22(2): 55-61.

  23. Mendoza RM, Acevedo TJL, Nicté CM y cols. La atención médica como factor de riesgo en las infecciones nosocomiales. Rev Asoc Mex Med Crit y Ter Int 2000; 14(4): 131-141.

  24. Alpuche-Aranda C, Daza-Timaná CA. Infecciones nosocomiales por bacterias gramnegativas, resistentes a cefalosporinas de espectro extendido: asociación de dos peligrosos enemigos. Enf Infec y Micro 2002; 22(4): 192-199.




2020     |     www.medigraphic.com