RESUMO
INTRODUCTION: Urinary tract infections (Uti) are one of the most common infections that affec thumans throughout their lives and are a common healthproblem both at the community and at the nosocomial level. Knowing microbiological characteristics, sensitivity profile and risk factors allow to optimize the management of Utis minimizing the increase of antibiotic resistance (AR) and establishing early treatments to reduce the morbidity and severity of infection. This study aims to establish which microorganisms are responsible for urinary tract infections in our community and determine their AR. PATIENTS AND METHODS: An observational, descriptive, cross-sectional, retrospective study of all patients with the first episode of UTI recorded at the Sanatorio Allende in the city of Cordoba, Argentina, who were requested to under go urine culture (URC), from January 2016 to December 2017. RESULTS: 3636 positive URC were analyzed, of which1740 met the inclusion criteria. Of the total analyzed 90.2 % (n=1570) were female. The average age was 37.8 years (SD=15.2). Escherichia coli was the microorganism most frequently isolated in 80.3% followed by S. saprophyticus in 8.0%. The age group of 18-30 years (40.1%) showed the highest proportion of microorganisms, where we observed the highest prevalence of E. coli and S. saprophyticus. The following acquired resistances were obtained from the total isolations: 47.6% of the microorganisms were resistant to ampicillin, 29.6% to cotrimoxazole, 15.2% to ciprofloxacin, 4.6% to first generation of cephalosporins, 3.4% to cefixime, 2.3% to amoxicillin-clavulanic, 1,2% to gentamicin and 1% to nitrofurantoin. CONCLUSION: E. Coli was the most prevalent pathogenin our environment, with high rates of resistance to ampicillin, fluoroquinolones and trimethoprim-sulfamethoxazole, confirming the need for periodic studiesto determine the most optimal empirical antibiotic treatment.
INTRODUCCIÓN: Las infecciones del tracto urinario (ITU) son una de las infecciones más comunes que afectan al ser humano a lo largo de su vida y constituyen un problema de salud frecuente tanto en el ámbito comunitario como nosocomial. El conocimiento de las características microbiológicas, perfil de sensibilidad y factores de riesgo permiten optimizar el manejo de las ITU minimizando el incremento de resistencia antibiótica (RA), estableciendo tratamientos precoces para reducir la morbilidad y la gravedad de la infección. Este estudio tiene como objetivo establecer cuáles son los microorganismos responsables de las infecciones urinarias de la comunidad en nuestro medio y determinar su RA.PACIENTES Y MÉTODOS: Estudio observacional, descriptivo, transversal, retrospectivo de todos los pacientes con primer episodio de ITU registrado en el Sanatorio Allende de la ciudad de Córdoba, Argentina a los cuales se les solicitó urocultivo (URC), desde enero de 2016 a diciembre 2017.RESULTADOS: Se analizaron 3636 URC positivos de los cuales 1740 cumplieron con los criterios de inclusión. Del total analizado 90,2% (n=1570) fueron de sexo femenino. El promedio de edad fue 37,8 años (DE=15,2).Escherichia coli fue el microorganismo aislado en mayor frecuencia en un 80,3% seguido de S. saprophyticus en un 8,0 %. El grupo etario de 18-30 años (40,1%) demostró la mayor proporción de microorganismos, en donde observamos mayor prevalencia de E. coli y S. saprophyticus. Del total de aislamientos se obtuvieron las siguientes resistencias adquiridas: 47,6% de los microorganismos fueron resistentes a ampicilina, 29,6% a cotrimoxazol, 15,2% a ciprofloxacina, 4,6% a cefalosporinas de 1° generación, 3,4% a cefixima, 2,3% a amoxicilina-clavulánico, 1,2% a gentamicina y 1% anitrofurantoína.CONCLUSIÓN: E. Coli fue el patógeno más frecuente en nuestro entorno, con altas tasas de resistencia a ampicilina, fluoroquinolonas y TMS, confirmando la necesidad de estudios periódicos para determinar el tratamiento antibiótico empírico más óptimo.
Assuntos
Infecções por Escherichia coli , Infecções Urinárias , Adolescente , Adulto , Antibacterianos/uso terapêutico , Argentina/epidemiologia , Estudos Transversais , Farmacorresistência Bacteriana , Escherichia coli , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/epidemiologia , Feminino , Humanos , Estudos Retrospectivos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Adulto JovemRESUMO
Corynebacterium pseudodiphtheriticum forma parte de la microbiota normal de orofaringe y de piel. Sin embargo, en las últimas décadas está emergiendo como oportunista causante de infecciones clínicamente significativas en pacientes con algún compromiso previo. Se refiere el caso clínico de una paciente de 76 años con antecedentes de hipertensión arterial, hipotiroidismo, diabetes tipo 2 e insuficiencia renal crónica, que presentó neumonía durante su estadía en terapia intensiva. El examen directo del esputo inducido (coloración de Gram) reveló una muestra representativa con abundante microbiota monomicrobiana constituida por bacilos gram positivos pleomórficos corineformes y el cultivo presencia de C. pseudodiphtheriticum. La paciente recibió medicación empírica con cefalosporina de tercera generación con evolución favorable.
Microorganisms of the genera Corynebacterium, specie pseudodiphtheriticum are a part of the indigenous microbiota of human skin and oropharinx. Nevertheless in recent decades these bacilli are emerging as opportunistic pathogens causing clinically significant infections in patients with previous compromise. We report the case of a 76 years old female patient, with a history of hypertension, hypothyroidism, type 2 diabetes and chronic renal failure, who presented pneumonia during their stay at the intensive care unit. The induced sputum revealed a representative sample with monomicrobial gram positive pleomorphic coryneform rods (Gram stain) and cultures demonstrated the presence of C. pseudodiphtheriticum as the only bacteria recovered. The pacient received an empirical third generation cephalosporin medication with a succesfull recovery.
Assuntos
Humanos , Feminino , Idoso , Pneumonia Bacteriana/diagnóstico , Corynebacterium/patogenicidade , Escarro/microbiologia , Infecções Oportunistas/diagnóstico , Corynebacterium/isolamento & purificaçãoRESUMO
La bacteriemia por Enterococcus adquirió un papel relevante en los últimos años, debido al incremento de casos intrahospitalarios. Nuestro objetivo fue describir los episodios ocurridos en pacientes adultos de nuestro hospital. Entre enero del 2000 y diciembre del 2013 se registraron 117 episodios. El 61% eran varones y el 39% mujeres. La edad promedio fue 68 años. El 91% presentaba condiciones predisponentes. El principal foco fue intraabdominal. Enterococcus faecalis fue responsable del 65% de los casos, Enterococcus faecium del 28% y otras especies del 7%. El 34% fueron bacteriemias polimicrobianas. Todas las cepas de E. faecalis fueron sensibles a ampicilina y vancomicina. El 88% de los aislamientos de E. faecium fue resistente a ampicilina y el 54% a vancomicina y teicoplanina. En nuestro hospital, el enterococo es el sexto patógeno causante de bacteriemia intrahospitalaria y predomina E. faecium resistente a ampicilina y vancomicina.
Enterococcal bacteremia has acquired considerable importance in recent years, mainly due to an increased number of cases that occur during hospital admission. We describe the episodes of enterococcal bacteremia in adult patients recorded at our hospital. Between January 2000 and December 2013, 117 episodes were analyzed. Sixty one percent (61%) of the patients were male and 39% female. The mean age was 68. Predisposing factors were present in 91% of patients. The primary source of infection was intraabdominal. Enterococcus faecalis was responsible for 65% of the cases; E. faecium for 28%; and other species for 7%. Thirty four percent (34%) of cases were polymicrobial bacteremia. All E. faecalis isolates were susceptible to ampicillin and vancomycin. Eighty eight percent (88%) of E. faecium were resistant to ampicillin and 54% to vancomycin and teicoplanin. In our hospital, Enterococcus is the sixth pathogen causing nosocomial bacteremia, with high incidence of ampicillin and vancomycin-resistant E. faecium.
Assuntos
Humanos , Masculino , Feminino , Bacteriemia/microbiologia , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Enterococcus faecium/efeitos dos fármacos , Enterococcus faecalis/efeitos dos fármacos , Anti-Infecciosos/uso terapêuticoRESUMO
Microorganisms of the genera Corynebacterium, specie pseudodiphtheriticum are a part of the indigenous microbiota of human skin and oropharinx. Nevertheless in recent decades these bacilli are emerging as opportunistic pathogens causing clinically significant infections in patients with previous compromise. We report the case of a 76 years old female patient, with a history of hypertension, hypothyroidism, type 2 diabetes and chronic renal failure, who presented pneumonia during their stay at the intensive care unit. The induced sputum revealed a representative sample with monomicrobial gram positive pleomorphic coryneform rods (Gram stain) and cultures demonstrated the presence of C. pseudodiphtheriticum as the only bacteria recovered. The pacient received an empirical third generation cephalosporin medication with a succesfull recovery.
Assuntos
Infecções por Corynebacterium/microbiologia , Corynebacterium/isolamento & purificação , Infecções Oportunistas/microbiologia , Pneumonia Bacteriana/microbiologia , Idoso , Infecções por Corynebacterium/complicações , Cuidados Críticos , Diabetes Mellitus Tipo 2/complicações , Suscetibilidade a Doenças , Feminino , Humanos , Falência Renal Crônica/complicações , Pneumonia Bacteriana/complicaçõesRESUMO
Enterococcal bacteremia has acquired considerable importance in recent years, mainly due to an increased number of cases that occur during hospital admission. We describe the episodes of enterococcal bacteremia in adult patients recorded at our hospital. Between January 2000 and December 2013, 117 episodes were analyzed. Sixty one percent (61%) of the patients were male and 39% female. The mean age was 68. Predisposing factors were present in 91% of patients. The primary source of infection was intraabdominal. Enterococcus faecalis was responsible for 65% of the cases; E. faecium for 28%; and other species for 7%. Thirty four percent (34%) of cases were polymicrobial bacteremia. All E. faecalis isolates were susceptible to ampicillin and vancomycin. Eighty eight percent (88%) of E. faecium were resistant to ampicillin and 54% to vancomycin and teicoplanin. In our hospital, Enterococcus is the sixth pathogen causing nosocomial bacteremia, with high incidence of ampicillin and vancomycin-resistant E. faecium.
Assuntos
Bacteriemia/microbiologia , Enterococcus/isolamento & purificação , Infecções por Bactérias Gram-Positivas/microbiologia , Adulto , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Argentina/epidemiologia , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Coinfecção , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Comorbidade , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Suscetibilidade a Doenças , Farmacorresistência Bacteriana Múltipla , Enterococcus/efeitos dos fármacos , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecalis/isolamento & purificação , Enterococcus faecium/efeitos dos fármacos , Enterococcus faecium/isolamento & purificação , Feminino , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologiaRESUMO
Bacteremia is an important cause of morbimortality. This study describes the episodes of communityacquired bacteremia in adult patients registered at our hospital. Between January 2005 and December 2013, 645 episodes were studied. A total of 51% of patients were male and 49% female. The mean age was 67. The most frequent comorbidities were: diabetes (18%), neoplasia (15%), heart disease (10%) and HIV infection (6%). The focus was: urinary (22%), respiratory (18%), cutaneous (15%), abdominal (13%), and others (4%). Gram-negative bacteria prevailed (51.88%). The most frequent microorganisms were Escherichia coli (30.29%), Streptococcus pneumoniae (15.51%), y Staphylococcus aureus (14.06%). Bacteremia was polymicrobial in 7.14% of the cases. Forty percent of E. coli isolates were resistant to ciprofloxacin and 6% to ceftazidime. Fifteen percent of S. aureus strains were resistant to methicillin whereas only 7% of S. pneumoniae expressed high resistance to penicillin with MICs = 2 µg/ mL, according to meningitis breakpoints.