Publicado

2019-07-01

Antimicrobial resistance trends in methicillin-resistant and methicillin-susceptible Staphylococcus aureus and Staphylococcus epidermidisisolates obtained from patients admitted to intensive care units. 2010-2015

Tendencias de resistencia antimicrobiana en Staphylococcus aureus y Staphylococcus epidermidis resistentes y susceptibles a meticilina aislados, obtenidos en unidades de cuidados intensivos, 2010-2015

Palabras clave:

Staphylococcus aureus, Staphylococcus epidermidis, Infecciones estafilocócicas, Resistencia a la meticilina, Staphylococcus aureus resistente a meticilina, Farmacorresistencia microbiana, Unidades de cuidados intensivos (en)
Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcal Infections, Methicillin Resistance, Methicillin-Resistant Staphylococcus aureus, Intensive Care Units (es)

Descargas

Autores/as

  • Raimundo Castro-Orozco Universidad de San Buenaventura - Cartagena Campus - Faculty of Health Sciences | Universidad de Cartagena - Faculty of Economics
  • Claudia Consuegra-Mayor Universidad de San Buenaventura - Cartagena Campus - Faculty of Health Sciences
  • Gloria Mejía-Chávez Universidad de San Buenaventura - Cartagena Campus - Faculty of Health Sciences
  • Jacqueline Hernández-Escolar Universidad de San Buenaventura - Cartagena Campus - Faculty of Health Sciences
  • Nelson Alvis-Guzmán Universidad de Cartagena - Faculty of Economics | Universidad de la Costa (CUC) - Economics Department

Introducción. La aparición y la diseminación de cepas resistentes en hospitales, principalmente en unidades de cuidado intensivo (UCI), se han convertido en un serio problema de salud pública.

Objetivo. Analizar la tendencia de los fenotipos de resistencia de Staphylococcus aureus y Staphylococcus epidermidis resistentes y susceptibles a meticilina aislados en pacientes atendidos en UCI de un hospital de alta complejidad de Cartagena, Colombia, del 2010 al 2015.

Materiales y métodos. Estudio analítico transversal realizado entre enero de 2010 y diciembre de 2015. Se utilizaron aislamientos de S. aureus y S. epidermidis meticilino-susceptibles y meticilino-resistentes (SARM, SASR, SERM y SESM). La técnica de susceptibilidad empleada fue el método microdilución en caldo para la detección de la concentración mínima inhibitoria.

Resultados. Se identificaron 313 aislamientos de Staphylococcus spp., la mayoría resistentes a meticilina (63.6%). Las cepas SARM y SERM correspondieron al 13.7% y al 27.8% del total de aislamientos, respectivamente. Los mayores porcentajes de resistencia en SARM y SERM correspondieron a eritromicina (57.6% y 81.2%, respectivamente), clindamicina (54.6% y 71.0%), ciprofloxacina (48.4% y 36.4%) y trimetoprima-sulfametoxazol (36.4% y 51.4%).

Conclusión. Los resultados encontrados sugieren el replanteamiento de las estrategias de control de la resistencia antimicrobiana en el hospital objeto de estudio.

Introduction: The emergence and spread of antimicrobial-resistant strains in hospitals, mainly in intensive care units (ICU), has become a serious public health problem.

Objective: To analyze the temporal trends of bacterial resistance phenotypes of methicillin-resistant and methicillin-susceptible Staphylococcus aureus and Staphylococcus epidermidis isolates obtained from ICU patients of a tertiary hospital in Cartagena, Colombia, between 2010 and 2015.

Methods: A cross-sectional study was carried out between January 2010 and December 2015. Methicillin-resistant and Methicillin-susceptible S. aureus and S. epidermidis isolates (MRSA, MSSA, MRSE and MSSE) were used. Culture medium microdilution technique was used to detect minimal inhibitory concentration (MIC).

Results: 313 Staphylococcus spp. isolates were identified, and most of there were methicillin-resistant (63.6%). Methicillin-resistant S. aureus (MRSA) and methicillin-resistant S. epidermidis (MRSE) strains represented 13.7% and 27.8%, respectively, of the total sample. The highest antibiotic resistance values in MRSA and MRSE isolates were observed for the following antibiotics: erythromycin (57.6% and 81.2%, respectively), clindamycin (54.6% and 71.0%), ciprofloxacin (48.4% and 36.4%) and trimethoprim-sulfametoxazole (36.4% and 51.4%).

Conclusions: The results reported here suggest the need to rethink the control strategies designed to minimize antibiotic resistance in the hospital in which this study was conducted.

Descargas

Los datos de descargas todavía no están disponibles.

Citas

Morillo-Garcia A, Aldana-Espinal JM, Olry de Labry-Lima A, Valencia-Martín R, López-Márquez R, Loscertales-Abril M, et al. Hospital costs associated with nosocomial infections in a pediatric intensive care unit. Gac Sanit. 2015;29(4):282-7. http://doi.org/f3gxt9.

Lee CR, Cho IH, Jeong BC, Lee SH. Strategies to minimize antibiotic resistance. Int J Environ Res Public Health. 2013;10(9):4274-305. http://doi.org/gchm6p.

Friedman ND, Temkin E, Carmeli Y. The negative impact of antibiotic resistance. Clinic Microbiol Infect. 2016;22(5):416-422. http://doi.org/f8n8mp.

Morales FE, Villa LA, Fernández PB, López MA, Mella S, Muñoz M. Evolución del consumo de antimicrobianos de uso restringido y tendencia de la susceptibilidad in vitro en el Hospital Regional de Concepción, Chile. Rev Chilena Infectol. 2012;29(5):492-8. http://doi.org/c4c8.

Brusselaers N, Vogelaers D, Blot S. The rising problem of antimicrobial resistance in the intensive care unit. Ann Intensive Care. 2011;1:47. http://doi.org/dfvghv.

Briceño I, Suarez ME. Resistencia Bacteriana en la Unidad de Cuidados Intensivos del Hospital Universitario de Los Andes. MEDICRIT. 2006 [cited 2019 Apr 10];3(2):30-42. Available from: https://bit.ly/2KlBmdA.

López-Pueyo MJ, Barcenilla-Gaite F, Amaya-Villar R, Garnacho-Montero J. Multirresistencia antibiótica en unidades de críticos. Med Intensiva. 2011;35(1):41-53. http://doi.org/dx2x87.

De Waele JJ, Akova M, Antonelli M, Canton R, Carlet J, De Backer D, et al. Antimicrobial resistance and antibiotic stewardship programs in the ICU: insistence and persistence in the fight against resistance. A position statement from ESICM/ESCMID/WAAAR round table on multi-drug resistance. Intensive Care Med. 2018;44(2):189-96. http://doi.org/gc4xmn.

Bassetti M, Poulakou G, Timsit JF. Focus on antimicrobial use in the era of increasing antimicrobial resistance in ICU. Intensive Care Med. 2016;42(6):955-8. http://doi.org/c4c9.

Castro-Orozco R, Barreto-Maya AC, Guzmán-Álvarez H, Ortega-Quiroz RJ, Benítez-Peña L. [Antimicrobial resistance pattern for gram-negative uropathogens isolated from hospitalised patients and outpatients in Cartagena, 2005-2008]. Rev Salud Pública. 2010;12(6):1010-9.

Cook E, Marchaim D, Kaye KS. Building a successful infection prevention program: key components, processes, and economics. Infect Dis Clin North Am. 2011;25(1):1-19. http://doi.org/b3m92z.

De Santis V, Gresoiu M, Corona A, Wilson AP, Singer M. Bacteraemia incidence, causative organisms and resistance patterns, antibiotic strategies and outcomes in a single university hospital ICU: continuing improvement between 2000 and 2013. J Antimicrob Chemother. 2015;70(1):273-8. http://doi.org/f63zzp.

Tukenmez Tigen E, Dogru A, Koltka EN, Unlu C, Gura M. Device-associated nosocomial infection rates and distribution of antimicrobial resistance in a medical-surgical intensive care unit in Turkey. Jpn J Infect Dis. 2014;67(1):5-8.

Rodrigues-Moreira MR, Guimarães MP, de Araujo-Rodrigues AA, Gontijo-Filho PP. Antimicrobial use, incidence, etiology and resistance patterns in bacteria causing ventilator-associated pneumonia in a clinical-surgical intensive care unit. Rev Soc Bras Med Trop. 2013;46(1):39-44. http://doi.org/f4rfsw.

Bataar O, Khuderchuluun C, Lundeg G, Chimeddorj S, Brunauer A, Gradwohl-Matis I, et al. Rate and pattern of antibiotic resistance in microbiological cultures of sepsis patients in a low-middle-income country’s ICU. Middle East J Anaesthesiol. 2013 [CITED 2019 Apr 10];22(3):293-300. Available from: https://bit.ly/2YVighE.

Villalobos-Rodríguez AP, Díaz-Ortega MH, Barrero-Garzón LI, Rivera-Vargas SM, Henríquez-Iguarán DE, Villegas-Botero MV, et al. [Trends of bacterial resistance phenotypes in high-complexity public and private hospitals in Colombia]. Rev Panam Salud Pública. 2011;30(6):627-33.

Hoerlle JL, Brandelli A. Antimicrobial resistance of Staphylococcus aureus isolated from the intensive care unit of a general hospital in southern Brazil. J Infect Dev Ctries. 2009;3(7):504-10. http://doi.org/bqbqv7.

Zhanel GG, DeCorby M, Laing N, Weshnoweski B, Vashisht R, Tailor F, et al. Antimicrobial-resistant pathogens in intensive care units in Canada: results of the Canadian National Intensive Care Unit (CAN-ICU) study, 2005-2006. Antimicrob Agents Chemother. 2008;52(4):1430-7. http://doi.org/cp4jmv.

Leal AL, Eslava-Schmalbach J, Alvarez C, Buitrago G, Méndez M, Grupo para el Control de la Resistencia Bacteriana en Bogotá (GREBO). [Endemic tendencies and bacterial resistance markers in third-level hospitals in Bogotá, Colombia]. Rev Salud Pública. 2006;8 Suppl 1:59-70.

Espinosa CJ, Cortés JA, Castillo JS, Leal AL. [Systematic review of antimicrobial resistance among Gram positive cocci in hospitals in Colombia]. Biomédica. 2011;31(1):27-34.

Villalobos AP, Barrero LI, Rivera SM, Ovalle MV, Valera D. [Surveillance of healthcare associated infections, bacterial resistance and antibiotic consumption in high-complexity hospitals in Colombia, 2011]. Biomédica. 2014;34 Suppl 1:67-80.

Cantón R. [Interpretive reading of the antibiogram: a clinical necessity]. Enferm Infecc Microbiol Clin. 2010;28(6):375-85. http://doi.org/dbw48z.

Clinical and Laboratory Standards Institute (CLSI). M100-S25. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fifth Informational Supplement. Wayne: Clinical and Laboratory Standards Institute; 2015.

Gaskin CJ, Happell B. Power, effects, confidence, and significance: an investigation of statistical practices in nursing research. Int J Nurs Stud. 2014;51(5):795-806. http://doi.org/c4dg.

Krumperman PH. Multiple antibiotic resistance indexing of Escherichia coli to identify high-risk sources of fecal contamination of foods. Appl Environ Microbiol. 1983;46(1):165-70.

Colombia. Ministerio de Salud. Resolución 8430 de 1993 (octubre 4): Por la cual se establecen las normas científicas, técnicas y administrativas para la investigación en salud. Bogotá D.C.; octubre 4 de 1993 [cited 2019 Apr 10]. Available from: https://bit.ly/2nH9STI.

Asociación Médica Mundial. Declaración de Helsinki de la Asociación Médica Mundial. Principios éticos para las investigaciones médicas en seres humanos. Fortaleza: 64.a Asamblea General de la AMM; 2013 [cited 2019 Apr 10]. Available from: https://bit.ly/2r2W2cs.

Argudín MA, Vanderhaeghen W, Vandendriessche S, Vandecandelaere I, André FX, Denis O, et al. Antimicrobial resistance and population structure of Staphylococcus epidermidis recovered from animals and humans. Vet Microbiol. 2015;178(1-2):105-13. http://doi.org/c4dh.

Rincón S, Panesso D, Díaz L, Carvajal LP, Reyes J, Munita JM, et al. Resistencia a antibióticos de última línea en cocos Gram positivos: la era posterior a la vancomicina. Biomédica. 2014;34 Suppl 1:191-208. http://doi.org/c4dj.

Cabrera CE, Gómez RF, Zuñiga AE, Corral RH, López B, Chávez M. Epidemiology of nosocomial bacteria resistant to antimicrobials. Colomb Med. 2011 [cited 2019 Apr 10];42(1):117-25. Available from: https://bit.ly/2VCScG3.

Koksal F, Yasar H, Samasti M. Antibiotic resistance patterns of coagulase-negative staphylococcus strains isolated from blood cultures of septicemic patients in Turkey. Microbiol Res. 2009;164(4):404-10. http://doi.org/c55qcr.

Hernández-Carrillo M, Revelo-Motta JP, Posada-España PA, Benavidez-Solarte PA, Ramírez-Serrato SV, Benítez-Soto CA, et al. Prevalencia de resistencia bacteriana a los antibióticos en una UCI neonatal de Nariño, Colombia. Rev Colomb Salud Libre. 2015;10(1):16-25.

Mateus JE, León FJ, González GM, Narváez E. Resistencia a los antibióticos en dos unidades de cuidados intensivos de Bucaramanga (Colombia). Salud Soc Uptc. 2014;1(1):12-8.

Cortes JA, Leal AL, Montañez AM, Buitrago G, Castillo JS, Guzman L, Grupo para el Control de la Resistencia Bacteriana en Bogotá (GREBO). Frequency of microorganisms isolated in patients with bacteremia in intensive care units in Colombia and their resistance profiles. Braz J Infect Dis. 2013;17(3):346-52. http://doi.org/f2j339.

Morales GI, Yaneth MC, Chávez KM. Caracterización de la resistencia in vitro a diferentes antimicrobianos en cepas de Staphylococcus spp. en una institución hospitalaria de la ciudad de Valledupar entre enero y julio de 2009. Rev Cienc Salud. 2012 [cited 2019 Apr 10];10(2):169-77. Available from: https://bit.ly/2UGDv7K.

Sosa-Ávila LM, Machuca-Pérez MA, Sosa-Ávila CA, González-Rugeles CI. Infecciones por Staphylococcus aureus meticilino resistente en niños en Bucaramanga Colombia. Salud UIS. 2010;42(3):248-55.

Arias CA, Reyes J, Zúniga M, Cortés L, Cruz C, Rico CL, et al., Colombian Antimicrobial Resistance Group (RESCOL). Multicentre surveillance of antimicrobial resistance in enterococci and staphylococci from Colombian hospitals, 2001-2002. J Antimicrob Chemother. 2003;51(1):59-68. http://doi.org/dnhjmr.

Jaramillo E. Resistencia bacteriana a los antibióticos en la Unidad de Cuidados Intensivos, Hospital de Caldas, 1992-1994. Colombia Med. 1996 [cited 2019 Apr 10];27(2):69-76. Available from: https://bit.ly/2GfeDfj.

Lona-Reyes JC, Verdugo-Robles MA, Pérez-Ramírez RO, Pérez-Molina JJ, Ascencio-Esparza EP, Benítez-Vázquez EA. Etiology and antimicrobial resistance patterns in early and late neonatal sepsis in a Neonatal Intensive Care Unit. Arch Argente Pediatr. 2015;113(4):317-23. http://doi.org/c4dk.

Custovic A, Smajlovic J, Hadzic S, Ahmetagic S, Tihic N, Hadzagic H. Epidemiological surveillance of bacterial nosocomial infections in the surgical intensive care unit. Mater Sociomed. 2014;26(1):7-11. http://doi.org/c4dm.

Urzedo JE, Levenhagen MM, Pedroso RS, Abdallah VO, Sabino SS, Brito DV. Nosocomial infections in a neonatal intensive care unit during 16 years: 1997-2012. Rev Soc Bras Med Trop. 2014;47(3):321-6. http://doi.org/f6cj9s.

Fajardo-Olivares M, Hidalgo-Orozco R, Rodríguez-Garrido S, Gaona-Álvarez C, Sánchez-Silos RM, Hernández-Rastrollo R, et al. [Activity of vancomycin, teicoplanin and linezolid in methicillin resistant coagulase-negative Staphylococci isolates from paediatric blood cultures]. Rev Esp Quimioter. 2012;25(1):25-30.

Brito DV, Brito CS, Resende DS, Moreira do OJ, Abdallah VO, Gontijo-Filho PP. Nosocomial infections in a Brazilian neonatal intensive care unit: a 4-year surveillance study. Rev Soc Bras Med Trop. 2010;43(6):633-7. http://doi.org/dtgx24.

Erdem I, Ozgultekin A, Sengoz-Inan A, Ozturk-Engin D, Senbayrak-Akcay S, Turan G, et al. Bloodstream infections in a medical-surgical intensive care unit: incidence, aetiology, antimicrobial resistance patterns of Gram-positive and Gram-negative bacteria. Clin Microbiol Infect. 2009;15(10):943-6. http://doi.org/cnfg7q.

Fraimow HS, Tsigrelis C. Antimicrobial resistance in the intensive care unit: mechanisms, epidemiology, and management of specific resistant pathogens. Crit Care Clin. 2011;27(1):163-205. http://doi.org/cpcw5d.

Kolár M, Urbánek K, Látal T. Antibiotic selective pressure and development of bacterial resistance. Int J Antimicrob Agents. 2001;17(5):357-63. http://doi.org/ckkvqz.

Dal-Bó K, da Silva RM, Sakae TM. Nosocomial infections in a neonatal intensive care unit in South Brazil. Rev Bras Ter Intensiva. 2012;24(4):381-5. http://doi.org/c4dq.

Coronell W, Rojas J, Escamilla-Gil MA, Manotas MC, Sánchez MA. Infección nosocomial en unidades de cuidados intensivos neonatales. CCAP. 2009;9(3):30-9.

Mendoza-Tascón LA, Arias-Guatibonza MD. Susceptibilidad antimicrobiana en una Unidad de Cuidados Intensivos Neonatales: experiencia de 43 meses. Rev Enfer Infec Pediatr. 2010 [cited 2019 Apr 10];23(93):13-24. Available from: https://bit.ly/2Ggw2Ej.

Shimabuku R, Velásquez P, Yábar J, Zerpa R, Arribasplata G, Fernández S, et al. Etiología y susceptibilidad antimicrobiana de las infecciones neonatales. An Fac Med. 2004 [cited 2019 Apr 10];65(1):19-24. Available from: https://bit.ly/2UamD4K.

Álvarez M, Velazco E, Nieves B, Alviarez E, Araque M, Salazar E, et al. Caracterización fenotípica de cepas de Staphylococcus coagulasa negativa aisladas de una unidad de alto riesgo neonatal. Kasmera. 2008;36(1):7-16.

Marchant EA, Boyce GK. MG, Sadarangani M, Lavoie PM. Neonatal sepsis due to coagulase-negative staphylococci. Clin Dev Immunol. 2013:1-10. http://doi.org/gb7dkm.

Saiman L. Risk factors for hospital-acquired infections in the neonatal intensive care unit. Semin Perinatol. 2002;26(5):315-21. http://doi.org/bzvk3x.

Allegranzi B, Luzzati R, Luzzani A, Girardini F, Antozzi L, Raiteri R, et al. Impact of antibiotic changes in empirical therapy on antimicrobial resistance in intensive care unit-acquired infections. J Hosp Infect. 2002;52(2):136-40. http://doi.org/b86ssw.

Castillo JS, Leal AL, Cortes JA, Alvarez CA, Sanchez R, Buitrago G, et al., Grupo para el Control de la Resistencia Bacteriana en Bogotá (GREBO). Mortality among critically ill patients with methicillin-resistant Staphylococcus aureus bacteremia: a multicenter cohort study in Colombia. Rev Panam Salud Pública. 2012;32(5):343-50. http://doi.org/f4m36z.

Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis. 2006;42 Suppl 2:S82-9. http://doi.org/cm7xw3.

Álvarez C, Cortes J, Arango A, Correa C, Leal A, Grupo para el Control de la Resistencia Bacteriana en Bogotá (GREBO). [Anti-microbial resistance in intensive care units in Bogotá, Colombia, 2001-2003]. Rev Salud Pública. 2006;8 Suppl 1:86-101. http://doi.org/d975n4.

Vanegas M, Correa N, Morales A, Martínez A, Rúgeles L, Jiménez F. Resistencia a antibioticos de bacterias aisladas de biopelículas en una planta de alimentos. Rev MVZ Córdoba. 2009;14(2):1677-83.

Rossi F, Diaz L, Wollam A, Panesso D, Zhou Y, Rincon S, et al. Transferable vancomycin resistance in a community-associated MRSA lineage. N Engl J Med. 2014;370(16):1524-31. http://doi.org/c4dr.

Licencia

Derechos de autor 2019 Revista de la Facultad de Medicina

Creative Commons License

Esta obra está bajo una licencia Creative Commons Reconocimiento 3.0 Unported.

-