Resistencia a aminoglucósidos en Enterobacteriaceae

Abstract

INTRODUCTION: Aminoglycosides have been losing their place in the therapeutic arsenal for combating enterobacterial infections, partly due to the emergence of other antibiotics greater spectrum and lower toxicity, such as cephalosporins or 3rd and 4th generation fluoroquinolones, and partly the increase of resistance, mainly due to the presence of aminoglycoside modifying enzymes (AME). However, after the emergence of multi-resistant strains for which therapeutic options are very limited, aminoglycosides regained importance in the treatment of infections, especially in hospitals. In the Clinical Microbiology Laboratory aminoglycoside antibiotics represent a group that is difficult for the interpretative reading of disk diffusion antibiogram. OBJECTIVES: To determine the prevalence of aminoglycoside resistance in Enterobacteriaceae in our area, the prevalence of AME genes and phenotypic characteristics of the inhibition zone edge. To determine the association between resistance by disk diffusion technique, the presence of AME genes and phenotypic features of the inhibition zone edge, creating rules to assist the interpretative reading of disk diffusion antibiogram of aminoglycosides in Enterobacteriaceae METHODS: We performed an observational descriptive study which analyzed 788 isolates of Enterobacteriaceae isolated between January 1, 2006 and March 31, 2006 at the Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Study of sensitivity to kanamycin, gentamicin, tobramycin, amikacin, netilmicin, neomycin, streptomycin and spectinomycin by disk diffusion technique, detection of genes aph (3")-Ia, aph (3")-Ib, ant (3")-Ia, aph (3')-Ia, ant (2")-Ia, aac (3)-IIa, aac (6')-Ia, aac (6')-Ib, aac (6')-Ic , aac (3)-Ia, aac (3)-Ib, aac (2')-Ia by the technique of polymerase chain reaction (PCR). Study of clonal relationships of isolates by ERIC-PCR and PFGE. RESULTS AND CONCLUSIONS: The antimicrobial susceptibility in Enterobacteriaceae between 2004 and 2006 in the Hospital de la Santa Creu i Sant Pau, Barcelona, Spain has remained stable in the beta-lactam group, while resistance to fluoroquinolones increased up to 30%, and has appeared amikacin resistance, while resistance to gentamicin and tobramycin continued below 10%. The most prevalent aminoglycoside resistance pattern was caused by aph (3'')-Ib conferring resistance to streptomycin, present in one third of the isolates resistant to one of the aminoglycosides studied. Of patterns affecting aminoglycosides in clinical use, the most prevalent was caused by aac (3)-IIa: resistance to gentamicin and tobramycin, present in 60% of isolates with resistance to aminoglycosides in clinical use. The presence of phenotypic features in the inhibition zone edge (sharper zone and colonies inside inhibition zone) was significantly associated with the presence of AME genes in the 8 aminoglycosides tested.

Date of Award	13 May 2011
Original language	Spanish
Supervisor	Beatriz Mirelis Otero (Director) & Ferran Navarro Risueño (Director)