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      Detección de beta-lactamasas de espectro extendido en Escherichia coli y Klebsiella pneumoniae aislados en una clínica de Villavicencio, Colombia Translated title: Detection of extended spectrum beta-lactamases (ESBL) in Escherichia coli and Klebsiella pneumoniae isolated in a clinic in Villavicencio, Colombia

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          Abstract

          Objetivo. Determinar la presencia de betalactamasas de espectro extendido (BLEE) y su prevalencia en aislamientos de Escherichia coli y Klebsiella pneumoniae causa de infección hospitalaria en una clínica de Villavicencio. Metodología. Se analizaron 50 aislamientos, 29 de E. coli y 21 de K. pneumoniae provenientes de pacientes hospitalizados en una clínica de segundo nivel de la ciudad de Villavicencio; se emplearon los métodos de difusión de disco de CLSI y el método confirmatorio para la detección de las BLEE de MicroScan® ESBL. Resultados. De 50 aislamientos, 3 (6%) presentaban BLEE, 2 K. pneumoniae y 1 E. coli. Estos aislamientos también mostraron resistencia con las fluoroquinolonas y el trimetoprim-sulfametoxazol. Los métodos de difusión de disco de CLSI y MicroScan® ESBL fueron concordantes en los resultados para la confirmación de la producción de BLEE. Conclusiones. El estudio permitió demostrar la producción de BLEE en K. pneumoniae y E. coli en una clínica de Villavicencio. Aunque es baja la frecuencia de BLEE, se sugiere seguir el uso restringido de cefalosporinas de tercera generación y fortalecer los mecanismos de control de la infección.

          Translated abstract

          Introduction: Multirresistant microorganisms that produce ESBL are one of the main problems in hospitals. Objective: To establish the presence of extended spectrum ß-lactamases (ESBL) in Klebsiella pneumonia and Escherichia coli that produce nosocomial infections in a clinic in Villavicencio, Colombia. Methods: 50 strains were studied, 29 K. pneumoniae and 21 E. coli, from patients with nosocomial infections at a clinic in Villavicencio; CLSI disk diffusion of the test and ESBL MicroScan® as the confirmatory method were used. Results: ESBL producers were determined in 3 of 50 (6%) isolates, 2 of 21 K. pneumoniae and 1 of 29 E. coli. The disk diffusion procedure recommended by CLSI and MicroScan ® ESBL were in agreement about production and confirmation of ESBL (p>0.05). Conclusions: The study showed low ESBL producers in K. pneumoniae and E. coli in a second level clinic in Villavicencio. These results suggest restricting the use of broad spectrum β-lactamases cefalosporins to prevent ESBL dissemination at hospital level.

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          Extended-Spectrum β-Lactamases: a Clinical Update

          Extended-spectrum β-lactamases (ESBLs) are a rapidly evolving group of β-lactamases which share the ability to hydrolyze third-generation cephalosporins and aztreonam yet are inhibited by clavulanic acid. Typically, they derive from genes for TEM-1, TEM-2, or SHV-1 by mutations that alter the amino acid configuration around the active site of these β-lactamases. This extends the spectrum of β-lactam antibiotics susceptible to hydrolysis by these enzymes. An increasing number of ESBLs not of TEM or SHV lineage have recently been described. The presence of ESBLs carries tremendous clinical significance. The ESBLs are frequently plasmid encoded. Plasmids responsible for ESBL production frequently carry genes encoding resistance to other drug classes (for example, aminoglycosides). Therefore, antibiotic options in the treatment of ESBL-producing organisms are extremely limited. Carbapenems are the treatment of choice for serious infections due to ESBL-producing organisms, yet carbapenem-resistant isolates have recently been reported. ESBL-producing organisms may appear susceptible to some extended-spectrum cephalosporins. However, treatment with such antibiotics has been associated with high failure rates. There is substantial debate as to the optimal method to prevent this occurrence. It has been proposed that cephalosporin breakpoints for the Enterobacteriaceae should be altered so that the need for ESBL detection would be obviated. At present, however, organizations such as the Clinical and Laboratory Standards Institute (formerly the National Committee for Clinical Laboratory Standards) provide guidelines for the detection of ESBLs in klebsiellae and Escherichia coli . In common to all ESBL detection methods is the general principle that the activity of extended-spectrum cephalosporins against ESBL-producing organisms will be enhanced by the presence of clavulanic acid. ESBLs represent an impressive example of the ability of gram-negative bacteria to develop new antibiotic resistance mechanisms in the face of the introduction of new antimicrobial agents.
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            Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat.

            Beta-lactamases continue to be the leading cause of resistance to beta-lactam antibiotics among gram-negative bacteria. In recent years there has been an increased incidence and prevalence of extended-spectrum beta-lactamases (ESBLs), enzymes that hydrolyze and cause resistance to oxyimino-cephalosporins and aztreonam. The majority of ESBLs are derived from the widespread broad-spectrum beta-lactamases TEM-1 and SHV-1. There are also new families of ESBLs, including the CTX-M and OXA-type enzymes as well as novel, unrelated beta-lactamases. Several different methods for the detection of ESBLs in clinical isolates have been suggested. While each of the tests has merit, none of the tests is able to detect all of the ESBLs encountered. ESBLs have become widespread throughout the world and are now found in a significant percentage of Escherichia coli and Klebsiella pneumoniae strains in certain countries. They have also been found in other Enterobacteriaceae strains and Pseudomonas aeruginosa. Strains expressing these beta-lactamases will present a host of therapeutic challenges as we head into the 21st century.
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              The impact of antimicrobial resistance on health and economic outcomes.

              Despite an increasing prevalence of antimicrobial-resistant pathogens, the health and economic impact of colonization and infection with these organisms has not been fully elucidated. We explore how antimicrobial resistance can affect patient outcomes by enhancing virulence, causing a delay in the administration of appropriate therapy, and limiting available therapy. Next, we examine the different perspectives held by hospitals, third-party payers, patients, and society on the impact of resistance. Finally, we review methodological issues in designing and assessing studies that address the clinical outcomes for patients infected or colonized with resistant pathogens, including adjustment for important confounding variables, control group selection, and the quantification of economic outcomes.
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                Author and article information

                Journal
                inf
                Infectio
                Infect.
                Asociación Colombiana de Infectología. (Bogotá, Distrito Capital, Colombia )
                0123-9392
                September 2008
                : 12
                : 3
                : 193-200
                Affiliations
                [02] Montería Córdoba orgnameUniversidad de Córdoba orgdiv1Instituto de Investigaciones Biológicas del Trópico
                [01] Villavicencio orgnameUniversidad Cooperativa de Colombia orgdiv1Facultad de Medicina
                Article
                S0123-93922008000300004 S0123-9392(08)01200304
                8f2e5f6b-41c0-459a-a0c3-071cdff83cc6

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 21 July 2008
                : 28 May 2008
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 24, Pages: 8
                Product

                SciELO Colombia

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                Artículos originales

                beta-lactamasas,espectro extendido,infección hospitalaria,Escherichia coli,Klebsiella pneumoniae,Villavicencio,extended spectrum β-lactamases,nosocomial

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