Increase of antimicrobial resistance in bacteremias. Report of a reference center
Keywords:
Bacterial Infections, Bacteremia, Drug Resistance, Staphylococcus aureus, Methicillin ResistantAbstract
Background: Sepsis is a life-threatening organic dysfunction caused by an unregulated host response to infection. Management includes a prompt antibiotic treatment. Incorrect treatment can negatively influence in survival.
Objective: To describe the pattern of antimicrobial resistance of the main isolated microorganisms in blood cultures of patients with sepsis in a reference center of Mexico City.
Material and methods: Observational, retrospective, descriptive, cross-sectional study. Data from blood cultures performed in patients diagnosed with sepsis were analyzed during the period from January 1, 2015, to December 31, 2018.
Results: 450 positive blood cultures were identified. Escherichia coli (34.5%) and Staphylococcus aureus (24.4%) were the most frequently isolated bacteria. E. coli and Klebsiella pneumoniae showed resistance to third generation cephalosporins of 75 and 80%, respectively. For K. pneumoniae it was reported resistance to carbapenems in 12.7%. For Enterococcus faecium it was reported a resistance to vancomycin in 60%. Multidrug resistance within the group of non-fermenting bacteria was reported in 88.1% for Acinetobacter baumannii and 48.8% in Pseudomonas aeruginosa. The resistance to methicillin in S. aureus was 23.6%.
Conclusions: A high proportion of beta-lactamase producing Enterobacteriaceae was observed, as well as a higher proportion of multidrug-resistant non-fermenting bacteria.
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Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10. doi:https://doi.org/10.1001/jama.2016.0287
Xu J, Murphy SL, Kochanek KD, Bastian B, Arias E. Deaths:final data for 2016. National Vital Statistics Reports. 2018;Vol. 67, No. 5. Disponible en:https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_05.pdf
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky M, et al. Epidemiology of severe sepsis in the United States:analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303-10. doi:https://doi.org/10.1097/00003246-200107000-00002
Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis:for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-74. doi:https://doi.org/10.1001/jama.2016.0288
Rhodes A, Evans L, Alhazzani W, Levy M, Antonelli M, Ferrer R, et al. Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016. Intensive Care Med. 2017;43:304-77. doi:https://doi.org/10.1097/CCM.0000000000002255
Norma Oficial Mexicana Nom-045-SSA2-2005, Para la vigilancia epidemiológica, prevención y control de las infecciones nosocomiales. México, DF:Diario Oficial de la Federación;20 de noviembre de 2009. Disponible en:http://www.dof.gob.mx/normasOficiales/3896/salud/salud.htm
Kumar A, Ellis P, Arabi Y, Roberts D, Light B, Parrillo J, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest. 2009;136(5):1237-48. doi:https://doi.org/10.1378/chest.09-0087
Schumacher M, Wangler M, Wolkewitz M, Beyersmann J. Attributable mortality due to nosocomial infections. A simple and useful application of multistate models. Methods Inf Med. 2007;46(5):595-600.
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32. doi:https://doi.org/10.1016/j.ajic.2008.03.002
Rosenthal VD, Maki DG, Mehta Y, Leblebicioglu H, Ahmed M, Al-Mousa HH, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module. Am J Infect Control. 2014;42(9):942-56. doi:https://doi.org/10.1016/j.ajic.2014.05.029
Rice LB. Federal Funding for the Study of Antimicrobial Resistance in Nosocomial Pathogens:No ESKAPE. J Infect Dis. 2008;197(8):1079-81. doi:https://doi.org/10.1086/533452
Akova M. Epidemiology of antimicrobial resistance in bloodstream infections. Virulence. 2016;7(3):252-66.
Ventola CL. The antibiotic resistance crisis. Part 1:causes and threats. P T. 2015;40(4):277-83.
World Health Organization. Global Action Plan on Antimicrobial Resistance. World Health Organization. Geneva, Switzerland:WHO;2015. Disponible en:https://apps.who.int/iris/bitstream/handle/10665/193736/9789241509763_eng.pdf?sequence=1
Centers for Disease Control and Prevention (CDC). Antibiotic resistance threats in the United States 2013. Atlanta, Georgia:CDC;2013. Disponible en:https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf
Casellas JM. Resistencia a los antibacterianos en América Latina:consecuencias para la infectología. Rev Panam Salud Publica. 2011;30(6):519-28.
Pan American Health Organization/Florida International University. Recommendations for Implementing Antimicrobial Stewardship Programs in Latin America and the Caribbean:Manual for Public Health Decision-Makers. Washington, D.C. PAHO/FIU;2018. Disponible en http://iris.paho.org/xmlui/handle/123456789/49645. Consultado el 10 de octubre de 2018.
Rodríguez-Noriega E. La evolución de la resistencia bacteriana en México, 1973-2013. Biomédica. 2014;34(Supl 1):181-90. https://doi.org/10.7705/biomedica.v34i0.2142
Amábile-Cuevas CF. Antibiotic resistance in Mexico:a brief overview of the current status and its causes. J Infect Dev Ctries. 2010;4(3):126-31. https://doi.org/10.3855/jidc.427
Ponce de León S. Programa Universitario de Investigación en Salud. Estado actual de la resistencia antimicrobiana en México. Reporte de los Hospitales de la Red del PUCRA:resistencia antimicrobiana y consumo de antibióticos. Ciudad de México:Universidad Nacional Autónoma de México;agosto de 2018. Disponible en:http://www.puis.unam.mx/slider_docs/reporte-ucradigital.pdf
Garza E, Morfín R, Mendoza S, Bocanegra P, Flores S, Rodriguez E. A snapshot of antimicrobial resistance in Mexico. Results from 47 centers from 20 states during a six-month period. PLoS One. 2019;14(3):e0209865. https://doi.org/10.1371/journal.pone.0209865
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas M, Giske S. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria:an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81.
Weiner LM, Webb A, Limbbago B, Dudeck M, Patel J, Kallen A, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections:summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014. Infect Control Hosp Epidemiol. 2016;37(11):1288-301.
Red de Vigilancia de la Resistencia a los Antimicrobianos, WHONET-Argentina. Mapa de resistencia antimicrobiana. Argentina:Red WHONET/Red SIREVA II;2017. Disponible en:http://antimicrobianos.com.ar/ATB/wp-content/uploads/2019/09/Mapas-de-Resistencia-Antimicrobiana-2017.-Red-WHONET-Argentina.-v2.pdf
Ponce-de León A, Rodriguez N, Morfin R, Cornejo D, Tinoco J, Martínez G, et al. Antimicrobial susceptibility of Gram-negative bacilli isolated from intra-abdominal and urinary-tract infections in Mexico from 2009 to 2015:results from the Study for Monitoring Antimicrobial Resistance Trends (SMART). PLoS One. 2018;13(6):e019↭.
López-Martínez B, Alcázar-López V, Castellanos-Cruz MC, Franco-Hernández MI, Jimenez-Tapia Y, de León-Ham A, et al. Vigilancia institucional de la susceptibilidad antimicrobiana en patógenos de interés clínico. Bol Med Hosp Infant Mex. 2016;70(3):222-9.
The Center for Disease Dynamics Economics &Policy. ResistanceMap:Antibiotic resistance. 2018. Washington, DC:CDDEP;2018. Disponible en:https://resistancemap.cddep.org/. Consultado el 10 de octubre de 2018.
Rodríguez J, Terrazas J, Urdez E, Hernández E, Sánchez S. Resistencia a meticilina y susceptibilidad a vancomicina de Staphylococcus aureus aislados de sangre. Rev Med Inst Mex Seguro Soc. 2016;54(1):48-51.
Bocanegra P, Flores S, Camacho A, Morfin R, Villarreal L, Llaca J, et al. Phenotypic and genotypic characterization of vancomycin-resistant Enterococcus faecium clinical isolates from two hospitals in Mexico:first detection of VanB phenotype-vanA genotype. Enferm Infecc Microbiol Clin. 2015;34(7):415-21. https://doi.org/10.1016/j.eimc.2015.09.011.
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