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Fecha Publicación: 2007-12-21
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del Río G., J. A., Arango Álvarez del Pino, R., Buriticá A., O. C., & Estrada, G. I. (2007). Producción bacteriana de betalactamasas de espectro extendido en pacientes de la unidad de cuidados intensivos del Hospital de Caldas, 2003. Biosalud, 6, 69–83. Recuperado a partir de https://revistasojs.ucaldas.edu.co/index.php/biosalud/article/view/5846
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La resistencia bacteriana a los antimicrobianos va en aumento, lo que implica generación de problemas a las instituciones de salud y la comunidad en general como: elevación del gasto para medicamentos, sobreinfecciones, alteración de la microflora y la macroflora, y disminución en la calidad de atención en salud. Esta resistencia es más marcada cuando hay presencia de microorganismos gram negativos productores de betalactamasas de espectro extendido (BLEE). En el presente trabajo se buscó determinar el tipo, la frecuencia y la distribución de microorganismos productores de BLEE, por técnicas tradicionales y moleculares, y determinar los factores médicos o quirúrgicos asociados con dicha producción, en la Unidad de Cuidados Intensivos (UCI) del Hospital de Caldas, con el fin de aportar la información necesaria para tomar medidas epidemiológicas y plantear estrategias sobre el uso apropiado de los antibióticos y el tratamiento de las infecciones más frecuentes. Se realizó un estudio analítico de casos y controles: 11 pacientes (5 casos y 6 controles), con infección primaria o intrahospitalaria, en quienes se realizó aislamiento de microorganismos productores de BLEE, resistentes o no, a las cefalosporinas de tercera generación, respectivamente. Estas muestras se sometieron a análisis microbiológico, isoenzimático y molecular. Se identificaron dos cepas de Eschericcia. coli, P. aeruginosa y Acinetobacter baumanii sospechosas de producir BLEE; sin embargo, no fueron confirmadas con otras pruebas como VITEK, puntos isoeléctricos y reacción en cadena de la polimerasa. No hubo diferencias significativas para los factores de riesgo en los casos y los controles.
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Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev. 2005; 18(4):657-86.2.
Livermore DM, Canton R, Gniadkowski M, Nordmann P, Rossolini GM, Arlet G, et.al. Woodford N. CTX-M: changing the face of ESBLs in Europe. J Antimicrob Chemoter 2007; 59(2):165-74.
Shah AA, Hasan F, Ahmed S, Hameed A. Characteristics, epidemiology and clinical importance of emerging strains of Gram-negative bacilli producing extended-spectrum beta-lactamases. microbiol 2004; 155(6):409-21.
Edmond MB, Wenzel RP. Nosocomial infections. In: Mandell GL, Benett JL, Dolin R. Principles and practice of infectious diseases. USA: Churchill Livingstone, 2000: 2988-3074.
Clark NM, Patterson J, Lynch JP 3rd. Antimicrobial resistance among gram-negative organisms in the intensive care unit. Curr Opin Crit Care 2003; 9(5):413-23.
McGowan JE Jr. Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum. Am J Med. 2006; 119(6 Suppl 1):S29-36.
Bassetti M, Cruciani M, Righi E, Rebesco B, Fasce R, Costa A, et al. Antimicrobial Use and Resistance Among Gram-negative Bacilli in an Italian Intensive Care Unit (ICU). J Chemother 2006; 18(3):261-7.
Hernández J, Muarra H, Villamil K. Resistencia bacteriana a gérmenes grannegativos en la unidad de cuidados intensivos. Mediciego 2004; 10(supl.2).
Weldhagen GF, Poirel L, Nordmann P. Ambler. Class A Extended-Spectrum Beta-Lactamases in Pseudomonas. Antimicrobial Agents Chemother 2003; 47(8): 2385-92.
Denton M. Enterobacteriaceae. Int J Antimicrob Agents 2007; 29 (Suppl 3):S9-S22.
Sturenburg E, Mack D. Extended-Spectrum Beta-Lactamases: implications for the clinical microbiology laboratory, therapy and infection control. J Infect 2003; 47(4): 237-95.
Paterson DL. Resistance in gram-negative bacteria: Enterobacteriaceae. Am J Infect Control 2006; 34 (5 Suppl 1):S20-8.
Hernández JR, Pascual A, Cantón R, Martínez-Martínez L. Grupo de Estudio de Infección Hospitalaria. GEIH. [Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in spanish hospitals (GEIH-BLEE Project 2002)]. Enferm Infecc Microbiol Clin 2003; 21(2):77-82.
Colodner R. Extended-spectrum beta-lactamases: a challenge for clinical microbiologist and infection control specialists. Am J Infect Control 2005; 33(2): 104-7.
Giamanellou H. Multidrug resistance in Gram-negative bacteria that produce Extended-Spectrum Beta-Lactamases. Clin Microbiol Infect 2005; 11 (Suppl 4): 1-16.
Gootz TD. Global disemination of beta-lactamases medianting resistance to cephalosporinas and carbapenem. Expert Rev Anti Infect Ther 2004; 2(2): 317-26.
Moland ES, Hanson ND, Black JA, Hossain A, Song W, Thomson KS. Prevalence of newer betalactamases in gram-negative clinical isolates collected in the United States from 2001 to 2002. J Clin Microbiol 2006; 44(9):3318-24.
Daoud Z, Moubareck, Hakime N, Doucet-Populaire F. Extended spectrum beta-lactamase producing Enterobacteriaceae in Lebanese ICU patients: epidemiology and patterns of resistance. J Gen Appl Microbiol 2006; 52(3):169-78.
Wu TL, Chia JH, Su LH, Chu C, Kuo AJ, Chiu CH. Dissemination of extended-spectrum beta-lactamaseproducing Enterobacteriaceae in intensive care units of a medical center in Taiwan. Microb Drug Resist 2006; 12(3):203-9.
Yu WL, Chuang YC, Walther-Rasmussen J. Extended-spectrum beta-lactamases in Taiwan: epidemiology, detection, treatment and infection control. J Microbiol Immunol Infect 2006; 39(4):264-77.
Mantilla JR, Valenzuela EM, González EB, Méndez AM, Leal AL, Sierra P, et al. Alta prevalencia de cefotaximasas del grupo CTX-M-1 en Enterobacteria-ceae asociadas a infección intrahospitalaria en Bogotá. Infectio 2004; 8:143.
Valenzuela EM, Mantilla JR, Reguero MT, González EB, Pulido IY, Llerena ID, et al. Detection of CTXM-1, CTX-M-15, and CTX-M-2 in clinical isolates of Enterobacteriaceae in Bogotá, Colombia. J Clin Microbiol 2006; 44:1919-20.
Rupp ME, Fery PD. Extended-Spectrum Beta-Lactamase producing Enterobacteriaceae: considerations for diagnosis, prevention and drug treatment. Drugs 2003; 63(4): 353-65.
Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 2005; 18(4): 657-86.
Bush K. New beta-lactamases in gram negative bacteria: diversity and impact on the selection of antimicrobial therapy. Infect Dis 2001; 32(7): 1085-9.
Majiduddin FK, Materon IC, Palzkill TG. Molecular analysis of beta-lactamase structure and function. Int J Med Microbiol 2002; 292(2): 127-137.
Larson LL, Ramphal R. Extended-spectrum beta-lactamases. Semin Respir Infect 2002; 17(3): 189-94.
Bradford PA. Extended-Spectrum Beta-lactamases in the 21st Century: Characterization, Epidemiology and Detection of this Important Resistance Threat. Clin Microbiol Rev 2001; 14(4): 933-951.
Alpuche CM, Daza CA. Infecciones nosocomiales por bacterias Gram negativas resistentes a Cefalosporinas de espectro extendido: asociación de 2 peligrosos enemigos. Enf Infec y Micro 2002; 22(4): 192-199.
Opal SM, Mayer KH, Medeiros AA. Mechanisms of bacterial antibiotic resistance. In: principles and practice of infectious diseases. Mandell GL, Bennett JE, Dolin R. Fifth Ed. Churchill Livingstone, USA. 2000; 2: 236-252.
Mendelson G, Hait V, Ben-Israel J, Gronich D, Granot E, Raz R. Prevalence and risk factors of extendedspectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in an Israeli long-term care facility. Eur J Clin Microbiol Infect Dis. 2005; 24(1):17-22.
Ariffin H, Navaratnam P, Kee TK, Balan G. Antibiotic resistance patterns in nosocomial gram-negative bacterial infections in units with heavy antibiotic usage. J Trop Pediatr. 2004; 50(1):26-31.
Rosslini GM, Docquier JD. New beta-lactamases: a paradigm for the rapid response of bacterial evolution in the clinical setting. Future Microbiol 2006;1:295-308.
Toltzis P, Blumer JL. Nosocomial acquisition and transmission of antibiotic resistant Gram negative organisms in the pediatric intensive care unit. Pediatric Infect Dis J 2001; 20: 612-18.
Winokur PL, Canton R, Casellas JM, Legakis. Variations in the prevalence of strains expressing an extended spectrum beta-lactamase phenotype and characterization of isolates from Europe, the Americas, and the Western Pacific Region. CID 2001; 32(Suppl. 2): S94-S103.
National Committee for Clinical Laboratory Standards. 2005. Performance standards for antimicrobial susceptibility testing; 15th informational supplement (M100–S15). National Committee for Clinical Laboratory Standards, Wayne, Pa.
Shah AA, Hasan F, Ahmed S, Hameed A. Extended-spectrum beta-lactamases (ESBLs): characterization, epidemiology and detection. Crit Rev Microbiol. 2004; 30(1):25-32.
Crespo MP. La lectura interpretativa del antibiograma: Una herramienta para predecir la resistenciabacteriana en el laboratorio de microbiología de rutina. Colombia Médica 2002; 33(4):179-193.
Correa A. Informe de resultados de caracterización molecular de mecanismos de resistencia bacteriana de cepas gram negativas. Cali: Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM); 2003.
Rosenau A, Cattier B, Gousset N, Harriau P, Philippon A, Quentin R. Capnocytophaga ochracea: characterization of a plasmid-encoded extended-spectrum TEM-17 β-lactamase in the phylum Flavobacter-Bacteroides. Antimicrob Agents Chemother 2000; 44: 760–762.
Strateva T, Ouzounova-Raykova V, Markova B, Todorova A, Marteva-Proevska Y, Mitov I. Problematic clinical isolates of Pseudomonas aeruginosa from the university hospitals in Sofia, Bulgaria: current status of antimicrobial resistance and prevailing resistance mechanisms. J Med Microbiol 2007; 56(Pt 7):956-63.
Edmiston CE, Hennen C, Jeabrook GR. The importance of beta-lactamase resistance in surgical infections. Surg Infect 2001; 2 (Suppl1): S13-22.
Radice M, Power P, Di Conza J, Gutkind G. Early dissemination of CTX-M-derived enzymes in South America. Antimicrob. Agents Chemother 2002; 46:602–604. 334.
Gniadkowsky M. Evolution and epidemiology of extended-spectrum beta-lactamases and ESBLproducing microorganisms. Clin Microbiol Infect 2001; 7(11): 597-608.
Guzmán-Blanco M, Casellas JM, Silva SH. Bacterial resistance to antimicrobial agents in Latin America. The giant is awakening. Infectious Disease Clinics of North America 2000; 14: 67-81.
Aranque M, Nieves B, Lauretti L, Rossolini GM. Molecular basis of extended spectrum beta-lactamase production in nosocomial isolates of Klebsiella pneumoniae from M inverted question Markerida, Venezuela. Int J Antimicrob Agents 2000; 15: 37-42.
John JF, Rice LB. The microbial genetics of antibiotic cycling. Infect Control Hosp Epidemiol 2000; 21: S22–S31.
Wong-Beringer A. Therapeutic challenges associated with extended-spectrum beta-lactamases producing E. coli and K. pneumoniae. Pharmacotherapy 2001; 21(5): 583-92.
Livermore DM, Canton R, Gniadkowski M, Nordmann P, Rossolini GM, Arlet G, et.al. Woodford N. CTX-M: changing the face of ESBLs in Europe. J Antimicrob Chemoter 2007; 59(2):165-74.
Shah AA, Hasan F, Ahmed S, Hameed A. Characteristics, epidemiology and clinical importance of emerging strains of Gram-negative bacilli producing extended-spectrum beta-lactamases. microbiol 2004; 155(6):409-21.
Edmond MB, Wenzel RP. Nosocomial infections. In: Mandell GL, Benett JL, Dolin R. Principles and practice of infectious diseases. USA: Churchill Livingstone, 2000: 2988-3074.
Clark NM, Patterson J, Lynch JP 3rd. Antimicrobial resistance among gram-negative organisms in the intensive care unit. Curr Opin Crit Care 2003; 9(5):413-23.
McGowan JE Jr. Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum. Am J Med. 2006; 119(6 Suppl 1):S29-36.
Bassetti M, Cruciani M, Righi E, Rebesco B, Fasce R, Costa A, et al. Antimicrobial Use and Resistance Among Gram-negative Bacilli in an Italian Intensive Care Unit (ICU). J Chemother 2006; 18(3):261-7.
Hernández J, Muarra H, Villamil K. Resistencia bacteriana a gérmenes grannegativos en la unidad de cuidados intensivos. Mediciego 2004; 10(supl.2).
Weldhagen GF, Poirel L, Nordmann P. Ambler. Class A Extended-Spectrum Beta-Lactamases in Pseudomonas. Antimicrobial Agents Chemother 2003; 47(8): 2385-92.
Denton M. Enterobacteriaceae. Int J Antimicrob Agents 2007; 29 (Suppl 3):S9-S22.
Sturenburg E, Mack D. Extended-Spectrum Beta-Lactamases: implications for the clinical microbiology laboratory, therapy and infection control. J Infect 2003; 47(4): 237-95.
Paterson DL. Resistance in gram-negative bacteria: Enterobacteriaceae. Am J Infect Control 2006; 34 (5 Suppl 1):S20-8.
Hernández JR, Pascual A, Cantón R, Martínez-Martínez L. Grupo de Estudio de Infección Hospitalaria. GEIH. [Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in spanish hospitals (GEIH-BLEE Project 2002)]. Enferm Infecc Microbiol Clin 2003; 21(2):77-82.
Colodner R. Extended-spectrum beta-lactamases: a challenge for clinical microbiologist and infection control specialists. Am J Infect Control 2005; 33(2): 104-7.
Giamanellou H. Multidrug resistance in Gram-negative bacteria that produce Extended-Spectrum Beta-Lactamases. Clin Microbiol Infect 2005; 11 (Suppl 4): 1-16.
Gootz TD. Global disemination of beta-lactamases medianting resistance to cephalosporinas and carbapenem. Expert Rev Anti Infect Ther 2004; 2(2): 317-26.
Moland ES, Hanson ND, Black JA, Hossain A, Song W, Thomson KS. Prevalence of newer betalactamases in gram-negative clinical isolates collected in the United States from 2001 to 2002. J Clin Microbiol 2006; 44(9):3318-24.
Daoud Z, Moubareck, Hakime N, Doucet-Populaire F. Extended spectrum beta-lactamase producing Enterobacteriaceae in Lebanese ICU patients: epidemiology and patterns of resistance. J Gen Appl Microbiol 2006; 52(3):169-78.
Wu TL, Chia JH, Su LH, Chu C, Kuo AJ, Chiu CH. Dissemination of extended-spectrum beta-lactamaseproducing Enterobacteriaceae in intensive care units of a medical center in Taiwan. Microb Drug Resist 2006; 12(3):203-9.
Yu WL, Chuang YC, Walther-Rasmussen J. Extended-spectrum beta-lactamases in Taiwan: epidemiology, detection, treatment and infection control. J Microbiol Immunol Infect 2006; 39(4):264-77.
Mantilla JR, Valenzuela EM, González EB, Méndez AM, Leal AL, Sierra P, et al. Alta prevalencia de cefotaximasas del grupo CTX-M-1 en Enterobacteria-ceae asociadas a infección intrahospitalaria en Bogotá. Infectio 2004; 8:143.
Valenzuela EM, Mantilla JR, Reguero MT, González EB, Pulido IY, Llerena ID, et al. Detection of CTXM-1, CTX-M-15, and CTX-M-2 in clinical isolates of Enterobacteriaceae in Bogotá, Colombia. J Clin Microbiol 2006; 44:1919-20.
Rupp ME, Fery PD. Extended-Spectrum Beta-Lactamase producing Enterobacteriaceae: considerations for diagnosis, prevention and drug treatment. Drugs 2003; 63(4): 353-65.
Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 2005; 18(4): 657-86.
Bush K. New beta-lactamases in gram negative bacteria: diversity and impact on the selection of antimicrobial therapy. Infect Dis 2001; 32(7): 1085-9.
Majiduddin FK, Materon IC, Palzkill TG. Molecular analysis of beta-lactamase structure and function. Int J Med Microbiol 2002; 292(2): 127-137.
Larson LL, Ramphal R. Extended-spectrum beta-lactamases. Semin Respir Infect 2002; 17(3): 189-94.
Bradford PA. Extended-Spectrum Beta-lactamases in the 21st Century: Characterization, Epidemiology and Detection of this Important Resistance Threat. Clin Microbiol Rev 2001; 14(4): 933-951.
Alpuche CM, Daza CA. Infecciones nosocomiales por bacterias Gram negativas resistentes a Cefalosporinas de espectro extendido: asociación de 2 peligrosos enemigos. Enf Infec y Micro 2002; 22(4): 192-199.
Opal SM, Mayer KH, Medeiros AA. Mechanisms of bacterial antibiotic resistance. In: principles and practice of infectious diseases. Mandell GL, Bennett JE, Dolin R. Fifth Ed. Churchill Livingstone, USA. 2000; 2: 236-252.
Mendelson G, Hait V, Ben-Israel J, Gronich D, Granot E, Raz R. Prevalence and risk factors of extendedspectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in an Israeli long-term care facility. Eur J Clin Microbiol Infect Dis. 2005; 24(1):17-22.
Ariffin H, Navaratnam P, Kee TK, Balan G. Antibiotic resistance patterns in nosocomial gram-negative bacterial infections in units with heavy antibiotic usage. J Trop Pediatr. 2004; 50(1):26-31.
Rosslini GM, Docquier JD. New beta-lactamases: a paradigm for the rapid response of bacterial evolution in the clinical setting. Future Microbiol 2006;1:295-308.
Toltzis P, Blumer JL. Nosocomial acquisition and transmission of antibiotic resistant Gram negative organisms in the pediatric intensive care unit. Pediatric Infect Dis J 2001; 20: 612-18.
Winokur PL, Canton R, Casellas JM, Legakis. Variations in the prevalence of strains expressing an extended spectrum beta-lactamase phenotype and characterization of isolates from Europe, the Americas, and the Western Pacific Region. CID 2001; 32(Suppl. 2): S94-S103.
National Committee for Clinical Laboratory Standards. 2005. Performance standards for antimicrobial susceptibility testing; 15th informational supplement (M100–S15). National Committee for Clinical Laboratory Standards, Wayne, Pa.
Shah AA, Hasan F, Ahmed S, Hameed A. Extended-spectrum beta-lactamases (ESBLs): characterization, epidemiology and detection. Crit Rev Microbiol. 2004; 30(1):25-32.
Crespo MP. La lectura interpretativa del antibiograma: Una herramienta para predecir la resistenciabacteriana en el laboratorio de microbiología de rutina. Colombia Médica 2002; 33(4):179-193.
Correa A. Informe de resultados de caracterización molecular de mecanismos de resistencia bacteriana de cepas gram negativas. Cali: Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM); 2003.
Rosenau A, Cattier B, Gousset N, Harriau P, Philippon A, Quentin R. Capnocytophaga ochracea: characterization of a plasmid-encoded extended-spectrum TEM-17 β-lactamase in the phylum Flavobacter-Bacteroides. Antimicrob Agents Chemother 2000; 44: 760–762.
Strateva T, Ouzounova-Raykova V, Markova B, Todorova A, Marteva-Proevska Y, Mitov I. Problematic clinical isolates of Pseudomonas aeruginosa from the university hospitals in Sofia, Bulgaria: current status of antimicrobial resistance and prevailing resistance mechanisms. J Med Microbiol 2007; 56(Pt 7):956-63.
Edmiston CE, Hennen C, Jeabrook GR. The importance of beta-lactamase resistance in surgical infections. Surg Infect 2001; 2 (Suppl1): S13-22.
Radice M, Power P, Di Conza J, Gutkind G. Early dissemination of CTX-M-derived enzymes in South America. Antimicrob. Agents Chemother 2002; 46:602–604. 334.
Gniadkowsky M. Evolution and epidemiology of extended-spectrum beta-lactamases and ESBLproducing microorganisms. Clin Microbiol Infect 2001; 7(11): 597-608.
Guzmán-Blanco M, Casellas JM, Silva SH. Bacterial resistance to antimicrobial agents in Latin America. The giant is awakening. Infectious Disease Clinics of North America 2000; 14: 67-81.
Aranque M, Nieves B, Lauretti L, Rossolini GM. Molecular basis of extended spectrum beta-lactamase production in nosocomial isolates of Klebsiella pneumoniae from M inverted question Markerida, Venezuela. Int J Antimicrob Agents 2000; 15: 37-42.
John JF, Rice LB. The microbial genetics of antibiotic cycling. Infect Control Hosp Epidemiol 2000; 21: S22–S31.
Wong-Beringer A. Therapeutic challenges associated with extended-spectrum beta-lactamases producing E. coli and K. pneumoniae. Pharmacotherapy 2001; 21(5): 583-92.
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