susceptibilidad antimicrobiana y bases genéticas de la resistencia de cepas de enterococcus causantes de infecciones en cuba antimicrobial susceptibility and genetic bases for resistance of infection-causing enterococcus strains in cuba

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ID: 240058
2011
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Abstract
OBJETIVO: Identificar las especies de Enterococcus causantes de infecciones en hospitales cubanos, su susceptibilidad a los antimicrobianos y sus mecanismos de resistencia. MÉTODOS: Se estudiaron 687 aislamientos de Enterococcus procedentes de 30 hospitales cubanos de nueve provincias del país durante el período de 2000 a 2009. La identificación de las especies se realizó mediante el método convencional y sistema automatizado API®. La concentración inhibitoria mínima se determinó para 13 antimicrobianos según las recomendaciones del Instituto de Estándares Clínicos y de Laboratorio. Se determinaron los genes de resistencia a aminoglucósidos, eritromicina, tetraciclina y glucopéptidos mediante reacción en cadena de la polimerasa. La presencia de betalactamasa se determinó por el método de la cefalosporina cromógena. RESULTADOS: Las especies más prevalentes fueron Enterococcus faecalis (82,9%) y Enterococcus faecium (12,2%). La resistencia a los glucopéptidos (1,0%) estuvo mediada por los genes vanA y vanB y las cepas resistentes a ampicilina (6%) no produjeron betalactamasas. Se observó un alto porcentaje de resistencia a los aminoglucósidos: gentamicina (31,0%) y estreptomicina y amikacina (29,1%) mediada por los genes aac(6')Ie-aph(2")Ia, aph(3')-IIIa, ant(6)Ia, ant(3")(9). Hubo correlación entre la resistencia a tetraciclina (56,0%) y la presencia de los genes tet(M) (75,1%) y tet(L) (7,0%), mientras que la resistencia a eritromicina (34,1%) obedeció al gen erm(B) (70,9%). CONCLUSIONES: La resistencia a vancomicina es infrecuente en Cuba, a diferencia del alto nivel de resistencia a los aminoglucósidos, que sugiere posibles fracasos terapéuticos. El laboratorio de microbiología constituye un pilar fundamental de la vigilancia de las infecciones por cepas de Enterococcus y el monitoreo continuo de su susceptibilidad a los antimicrobianos, dado el incremento de la resistencia de ese microorganismo en el tiempo.
OBJECTIVE: To identify infection-causing Enterococcus species in Cuban hospitals and determine their susceptibility to antimicrobial drugs, as well as their resistance mechanisms. METHODS: A total of 687 Enterococcus isolates from 30 Cuban hospitals in nine provinces of the country were studied over the period 2000-2009. The species were identified using both the conventional method and the automatic API® system. The minimum inhibitory concentration was determined for 13 antimicrobial drugs following the standards recommended by the Clinical Laboratory and Standards Institute. The polymerase chain reaction technique was used to characterize the genes that were resistant to aminoglycosides, erythromycin, tetracycline, and glucopeptides. The presence of beta-lactamase was determined by the chromogenic cephalosporin test. RESULTS: The most prevalent species were Enterococcus faecalis (82.9%) and E. faecium (12.2%). Resistance to glucopeptides (1.0%) was mediated by the vanA and vanB genes. The strains resistant to ampicillin (6%) did not produce beta-lactamases. A high percentage of resistance to aminoglycosides was observed. Gentamicin (31.0%) and streptomycin and amikacin (29.1%) were mediated by the aac(6')Ie-aph(2")Ia, aph(3')-IIIa, ant(6)Ia, and ant(3")(9) genes. A correlation was found between resistance to tetracycline (56.0%) and presence of the tet(M) (75.1%) and tet(L) genes (7.0%), while resistance to erythromycin (34.1%) was due to the erm(B) gene (70.9%). CONCLUSIONS: Resistance to vancomycin is infrequent in Cuba, as opposed to a high level of resistance to aminoglycosides, which may be indicative of treatment failures. The microbiology laboratory is a cornerstone of Enterococcus infection surveillance, along with ongoing monitoring of the susceptibility of these infections to antimicrobial drugs at a time when resistance of this microorganism is on the rise.
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Authors ;Dianelys Quiñones Pérez;Miriam Abreu Capote;Deisy Marrero;Ana Bertha Alvarez;Cecilia Ortiz;Francisco Salomé;Alina Llop;Rosa del Campo
Journal communications on pure and applied analysis
Year 2011
DOI
DOI not found
URL
http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011001200009
Keywords
Drug resistance enterococcus Bacterial tropical medicinepublic aspects of medicine cuba farmacorresistencia bacteriana

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