medigraphic.com
Boletín Médico del Hospital Infantil de México

2013, Number 3

<< Back Next >>

Bol Med Hosp Infant Mex 2013; 70 (3)

Institutional vigilance of antimicrobial susceptibility in pathogens of clinical interest

López-Martínez B, Alcázar-López V, Castellanos-Cruz MC, Franco-Hernández MI, Jiménez-Tapia Y, De León-Ham A, Mejía-Albarrán ME, Pichardo-Villalón L, Tapia-Madrigal ML, Moreno-Espinosa S, Calderón-Jaimes E

Language: Spanish
References: 28
Page: 222-229
PDF size: 230.32 Kb.


ABSTRACT

Background. The increased resistance of microorganisms to antibiotics has led to an increase in morbidity and mortality from infections, increased use of antibiotics and excessive hospitalization costs. Therefore, the aim of this study was to describe the frequency of pathogens and bacterial susceptibility patterns in cultures of blood, urine and other bodily fluids in a tertiary care pediatric hospital. We also aimed to determine the patterns of resistance in pathogens of clinical interest isolated in blood, urine and other sterile liquids in a pediatric teaching center and third-level hospital.
Methods. The Institutional Antimicrobial Surveillance Program was established to monitor the predominant pathogens and antimicrobial susceptibility patterns of infections such as bacteremia, pneumonia and urinary infections. The species of each isolate was determined according to routine methodology and Vitek system from January 2010 to June 2011. Antimicrobial agents and susceptibility testing were determined using the Vitek 2XL according to the Clinical and Laboratory Standards Institute.
Results. We recovered 7,708 isolates from 27,209 cultures (28.3%). Gram negative represented 52.7%. A rank order showed coagulase-negative Staphylococcus, Escherichia coli, Enterococcus spp., Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae and others. The antimicrobial susceptibility of the most frequently encountered pathogens was variable. E. coli showed the highest resistance to trimethoprim-sulfamethoxazole and ampicillin-sulbactam (74 and 68%, respectively) finding the best option to be nitrofurantoin and imipenem with 84 and 100% sensitivity, respectively. Enterococcus faecium resistance was 58% vancomycin, and Streptococcus pneumoniae showed 100% sensitivity to vancomycin.
Conclusions. This study emphasizes the problem of resistance and the needs to select an appropriate broad-spectrum empirical regimen guided by the knowledge of pathogen occurrences and local/regional/global resistance patterns. Such practices require the interrelation between clinical microbiology laboratories and hospital pharmacies.


REFERENCES

  1. Rempel OR, Laupland KB. Surveillance for antimicrobial resistant organisms: potential sources and magnitude of bias. Epidemiol Infect 2009;137:1665-1673.

  2. 2. Diekema DJ, Pfaller MA, Jones RN, Doern GV, Winocur PL, Gales AC, et al. Survey of bloodstream infections due to gram-negative bacilli: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, and Latin America for the SENTRY Antimicrobial Surveillance Program, 1997. Clin Infect Dis 1999;29:595-607.

  3. 3. Fluit AC, Jones ME, Schmitz FJ, Acar J, Gupta R, Verhoef J. Antimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Europe from the SENTRY Antimicrobial Surveillance Program, 1997 and 1998. Clin Infect Dis 2000;30:454-460.

  4. 4. Diekema DJ, Pfaller MA, Jones RN, Doern GV, Kugler KC, Beach ML, et al. Trends in antimicrobial susceptibility of bacterial pathogens isolated from patients with bloodstream infections in USA, Canada, and Latin America. SENTRY Participants Group. Int J Antimicrob Agents 2000;13:257-271.

  5. 5. Jones RN. Global epidemiology of antimicrobial resistance among community-acquired and nosocomial pathogens: a five-year summary from the SENTRY Antimicrobial Surveillance Program (1997-2001). Sem Respir Crit Care Med 2003;24:121-134.

  6. 6. Harbarth S, Samore MH. Antimicrobial resistance determinants and future control. Emerg Infec Dis 2005;11:794-801.

  7. 7. Cornaglia G, Akova M, Amicosante G, Cantón R, Cauda R, Docquier JD, et al. ESCMID Study Group for Antimicrobial Resistance Surveillance (ESGARS). Metallo-b-lactamases as emerging resistance determinants in Gram-negative pathogens: open issues. Int J Antimicrob Agents 2007;29:380-388.

  8. 8. Miriagou V, Cornaglia G, Eldestein M, Galani I, Giske CG, Gniadkowski M, et al. Aquired carbapenemases in Gram-negative bacterial pathogens: detection and surveillance issues. Clin Microbiol Infect 2010;16:112-122.

  9. 9. Bush K, Jacobi GA. Updated functional classification of β-lactamases. Antimicrob Agents Chemother 2010;54:969-976.

  10. Gales AC, Jones RN, Forward KR, Liñares J, Sader HS, Verhoef J. Emerging importance of multidrug-resistant Aci

  11. netobacter species and Stenotrophomonas maltophilia as a pathogens in seriously ill patients: geographic patterns, epidemiological features, and trends in the SENTRY Antimicrobial Surveillance Program (1997-1999). Clin Infect Dis 2001;32(suppl 2):S104-S113.

  12. Gales AC, Jones RN, Turnidge J, Ronnie R, Ramphal R. Characterization of Pseudomonas aeruginosa isolates: ocurrence rates, antimicrobial susceptibility patterns, and molecular typing in the global SENTRY Antimicrobial Surveillace Program, 1997-1999. Clin Infect Dis 2001;32(suppl 2):S146-155.

  13. Low DE, Keller N, Barth A, Jones RN. Clinical prevalence, antimicrobial susceptibility, and geographic resistance patterns of Enterococci: results from the SENTRY Antimicrobial Surveillance Program, 1997-1999. Clin Infect Dis 2001;32(suppl 2):S133-S145.

  14. Milstone AM, Goldner BW, Ross T, Shepard JW, Carroll KC, Perl TH. Methicillin-resistant Staphylococcus aureus colonization and risk of subsequent infection in critically ill children: importance of preventing nosocomial methicillin-resistant Staphylococcus aureus transmission. Clin Infect Dis 2011;53:853-859.

  15. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RL, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis 2011;52:285-292.

  16. Hoban DJ, Doern GV, Fluit AC, Roussel-Delvallez M, Jones RN. Worldwide prevalence of antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the SENTRY Antimicrobial Surveillace Program, 1997-1999. Clin Infect Dis 2001;32(suppl 2):S81-S93.

  17. Cornaglia G, Giamarellou H, Rossolimi GM. Metallo-b-lactamases: a last frontier for b-lactams? Lancet Infect Dis 2011;11:381-393.

  18. Winokur PL, Canton R, Casellas JM, Legakis N. Variations in the prevalence of strains expressing an extended-spectrum b-lactamase phenotype and characterization of isolates from Europe, the Americas, and the Western Pacific Region. Clin Infect Dis 2001;32(suppl 2):S94-S103.

  19. Pfaller MA, Acar J, Jones RN, Verhoef J, Turnidge J, Sader HS. Integration of molecular characterization of microorganisms in a global antimicrobial resistance surveillance program. Clin Infec Dis 2001;32(suppl 2):S156-S167.

  20. Burd EM, Kehl KS. A critical appraisal of the role of the clinical microbiology laboratory in the diagnosis of urinary tract infections. J Clin Microbiol 2011;49:S34-S38.

  21. Control de calidad de los frascos de hemocultivo, mielocultivo y líquido peritoneal HIM-LC-BAC-IT.03-2011.

  22. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. Twentieth Informational Supplement. CLSI document M100-S20U. Wayne, PA: Clinical and Laboratory Standards Institute; 2010.

  23. Diekema DJ, Pfaller MA, Jones RN, the SENRY Participants Group. Age-related trends in pathogen frequency and antimicrobial susceptibility of bloodstream isolates in North America: SENTRY Antimicrobial Surveillance Program, 1997-2000. Int J Antimicrob Agents 2002;20:412-418.

  24. Holland TL, Fowler VG Jr. Vancomycin minimum inhibitory concentration and outcome in patients with Staphylococcus aureus bacteremia: pearl or pellet? J Infect Dis 2011;204: 329-331.

  25. Organización Panamericana para la Salud. Informe Regional de SIREVA II, 2010: Datos por país y por grupos de edad sobre las características de los aislamientos de Streptococcus pneumoniae, Haemophilus influenzae y Neisseria meningitidis, en procesos invasores. Washington, DC: OPS; 2011.

  26. Mathai D, Jones RN, Pfaller MA; SENTRY Participant Group North America. Epidemiology and frequency of resistance among pathogens causing urinary tract infections in 1,510 hospitalized patients: a report from the SENTRY Antimicrobial Surveillance Program (North America). Diagn Microbiol Infect Dis 2001;40:129-136.

  27. Sahuaquillo-Arce JM, Selva M, Perpiñan H, Gobernado M, Armero C, López-Quílez A, et al. Antimicrobial resistance in more than 100,000 Escherichia coli isolates according to culture site and patient age, gender, and location. Antimicrob Agents Chemother 2011;55:1222-1228.

  28. Finnell SM, Carroll AE, Downs SM; Subcommittee on Urinary Tract Infection. Diagnosis and management of on initial UTI in febrile infants and young children. Pediatrics 2011;128:e749-e770.




2020     |     www.medigraphic.com