Morfín OR, Esparza AS, Atilano DG, Pinto TD, Heredia CJ, Rodríguez CJJ, Rodríguez NE

Language: Spanish
References: 34
Page: 222-226
PDF size: 54.66 Kb.

ABSTRACT

Background: Enterococci have become one of the main causes of nosocomial infections. Enterococci are intrinsically resistant to various antimicrobial agents and can become multiple-drug resistant through the acquisition of resistance-encoding genes. The treatment of enterococcal infection including those caused by E. faecalis and E. faecium is extremely difficult. Objective: To analyze the susceptibility of clinical isolates of enterococci. Material and methods: The study was conducted at the Hospital Civil de Guadalajara, a university affiliated tertiary care center. All enterococcal strains isolated from clinical sites from 1991 to 1993, and from 1996 to June 1999 were included. A total of 681 strains were analyzed: 471 were E. faecalis and 210 E. faecium. Isolates were identified using microdilution method and all were tested for antimicrobial susceptibility using a microdilution method. Results: Resistance to ampicillin, rifampin, and vancomycin was stable during the period in E. faecalis. High-level resistance to aminoglycosides and resistance to ciprofloxacin increased in E. faecalis to 30 and 40%, respectively. E. faecium isolates demonstrated increasing high-level resistance to aminoglycosides, ampicillin and ciprofloxacin (37, 58, and 56%). Vancomycin resistance in E. faecium was noticed in 1999 isolates. Conclusions: The increasing resistance to most available antibiotics in E. faecalis and E. faecium represents a challenge.

REFERENCES

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

2. Moellering RC Jr, Wennersten C, Medrek T, Weinberg HN. Prevalence of high-level resistance to aminoglycosides in clinical isolates of Enterococci. Antimicrob Agents Chemother 1970;1:335-40.

3. Mederski-Samoraj BD, Murray BE. High-level resistance to gentamicin in clinical isolates of Enterococci. J Infect Dis 1983;147:751-7.

4. Bush LM, Calmon J, Cherney CL, Wendeler M, Pitsakis P, Poupard J, et al. High-level penicillin resistance among clinical isolates of Enterococci. Ann Intern Med 1989;110:515-20.

5. Sapico FL, Canawati HN, Ginunas VJ, Gilmore DS, Montgomerie JZ, Tuddenham WJ, et al. Enterococci highly resistant to penicillin and ampicillin: An emerging clinical problem? J Clin Microbiol 1989;27:2091-5.

6. Oster SE, Chirurgi VA, Goldberg AA, Aiken C, McCabe RE. Ampicillin-resistant enterococcal species in an acute-care hospital. Antimicrob Agents Chemother 1990;34:1821-3.

7. Grayson ML, Eliopoulos GM, Wennersten CB, Ruoff KL, De Girolami PC, Ferraro MJ, et al. Increasing resistance to blactam antibiotics among clinical isolates of Enterococcus faecium: A 22-year review at one Institution. Antimicrob Agents Chemother 1991;35:2180-4.

8. Enterococcal Study Group, Gordon S, Swenson JM, Jill BC, Pigott NE, Facklam RR, et al. Antimicrobial susceptibility patterns of common and unusual species of Enterococci causing infections in the United States. J Clin Microbiol 1992;30:2373-8.

9. Moellering RC Jr. Emergence of Enterococcus as a significant pathogen. Clin Infect Dis 1992;14:1173-8.

10. MMWR. Nosocomial Enterococci resistant to vancomycin United States, 1989-1993. Morb Mortal Wkly Rep 1993;42:597- 9.

11. Clark NC, Cooksey RC, Hill BC, Swenson JM, Tenover FC. Characterization of glycopeptide-resistant Enterococci from US Hospitals. Antimicrob Agents Chemother 1993;37:2311- 7.

12. Moellering RC Jr. Problems with antimicrobial resistance in gram-positive cocci. Clin Infect Dis 1998;26:1177-8.

13. Moellering RC Jr. Vancomycin-resistant Enterococci. Clin Infect Dis 1998;26:1196-9.

14. Wells VD, Wong ES, Murray BE, Coudron PE, Williams DS,Markowitz SM. Infections due to beta-lactamase-producing, high-level gentamicin-resistant Enterococcus faecalis. Ann Intern Med 1992;116:285-97.

15. Handwerger S, Raucher B, Altarac D. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis 1993;16:750-5.

16. Patterson JE, Sweeney AG, Simms M, Carley N, Mangi R, Sabetta J, et al. An analysis of 110 serious enterococcal infections: Epidemiology, antibiotic susceptibility, and outcome. Medicine (Baltimore) 1995;74:191-200.

17. Edmond MB, Ober JF, Dawson JD. Vancomycin-resistant enterococcal bacteremia: Natural history and attributable mortality. Clin Infect Dis 1996;23:1234-9.

18. Linden PK, Pasculle AW, Manez R, Kramer DJ, Fung JJ, Pinna AD, et al. Differences in outcome for patients with bacteremia due to vancomycin-resistant Enterococcus faecium of vancomycin-susceptible E. faecium. Clin Infect Dis 1996;22:663-70.

19. Morfín OR, Heredia CJ, Pinto TD, Rodríguez CJJ, Rodríguez E. E. faecalis and E. faecium resistance patterns, México. (Abstracto C-260) En programa y abstractos de la 92a American Society of Microbiology General Meeting 1992:464.

20. Muñoz TT, Sifuentes OJ, Ponce de León A, Villalobos Y, Ontiveros C, Gómez RC. Identificación y patrón de resistencia en aislados clínicos de enterococos. (Abstracto 59) Programa y resumen 17a Reunión Anual de la Asociación Mexicana de Infectología, 1992.

21. Tenover FC, Tokars J, Swenson J, Paul S, Spitalny K, Jarvis W. Ability of clinical laboratories to detect antimicrobial agentresistant Enterococci. J Clin Microbiol 1993;31:1695-9.

22. NCCLS. Performance standards for antimicrobial susceptibility testing. Ninth informational supplement. M100-S9. NCCLS 1999;19.

23. Moellering RC Jr, Weinberg AN. Studies on antibiotic synergismagainst enterocci. II. Effect of various antibiotics on the uptake of 14 C-Labelled streptomycin by Enterococci. J Clin Invest 1971;50:2580-4.

24. Moellering RC Jr, Korzeniowski OM, Sande MA, Wennersten CB. Species-specific resistance to antimicrobial synergism in Streptococcus faecium and Streptococcus faecalis. J Infect Dis 1979;140:203-8.

25. Krogstad DJ, Korfhagen TR, Moellering RCJ, Wennersten C, Swartz MN, Perzynski S, et al. Aminoglycoside-inactivating enzymes in clinical isolates of Streptococcus faecalis: An explanation for antibiotic synergism. J Clin Invest 1978;62:480- 6.

26. Moellering RC Jr, Murray BE, Schoenbaum SC, Adler J, Wennersten CB. A novel mechanism of resistance to penicillingentamicin synergism in Streptococcus faecalis. J Infect Dis 1980;141:81-86.

27. Murray BE, Mederski-Samoraj B. Transferable b-lactamase: A new mechanism for in vitro penicillin resistance in Streptococcus faecalis. J Clin Invest 1983;72:1168-71.

28. Leclercq R, Deplot E, Doval J, Courvalin P. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med 1988;319:157-61.

29. Murray BE. b-lactamase-producing Enterococci. Antimicrob Agents Chemother 1992;36:2355-9.

30. Fontana R, Aldegheri M, Ligozzi M, López H, Sucari A, Satta G. Overproduction of a low-affinity penicillin-binding protein and high-level ampicillin resistance in Enterococcus faecium. Antimicrob Agents Chemother 1994;38:1980-3.

31. Coque TM, Arduino RC, Murray BE. High-level resistance to aminoglycosides: Comparison of community and nosocomial fecal isolates of Enterococci. Clin Infect Dis 1995;20:1048-51.

32. Ligozzi M, Pitaluga F, Fontana R. Modification of penicillinbinding protein 5 associated whith high-level ampicillin resistance in Enterococcus faecium. Antimicrob Agents Chemother 1996;40:354-7.

33. Zervos MJ, Dembinski S, Mikesell T, Schaberg. High-level resistance to gentamicin in Streptococcus faecalis: Risk factors and evidence for exogenous acquisition of infection. J Infect Dis 1986;153:1075-83.

34. MMWR. Recommendations for preventing the spread of vancomycin resistance. Recommendations of the hospital infection control practices advisory committee (HICPAC). MMWR Morb Mortal Wkly Rep 1995;44. (No. RR-12):1-13.