Perfiles de resistencia a fluoroquinolonas en aislamientos clínicos de cocos Gram positivos provenientes de hospitales colombianos, 1994-2004

César A. Arias, Marylin Hidalgo, Jinnethe Reyes, Ana María Cárdenas, Lorena Díaz, Sandra Ríncon, Natasha Vanegas, Paula Lucía Díaz, Elizabeth Castañeda, .

Palabras clave: fluoroquinolonas, Streptococcus pneumoniae, Staphylococcus aureus, Enterococcus, resistencia microbiana a los medicamentos, Colombia

Resumen

Introducción. Las fluoroquinolonas son antibióticos de amplio espectro comúnmente utilizados en el manejo de infecciones.
Objetivo. Determinar los patrones de resistencia a fluoroquinolonas en aislamientos colombianos de Streptococcus pneumoniae, Staphylococcus aureus, estafilococos coagulasa negativa y enterococos de centros hospitalarios colombianos, recolectados entre 1994 y 2004.
Materiales y métodos. Se realizó la determinación de concentraciones inhibitorias mínimas frente a ciprofloxacino, moxifloxacino y gatifloxacino a 270 aislamientos clínicos de S. pneumoniae, 348 de S. aureus, 176 de estafilococos coagulasa negativa y 123 de enterococos.
Para los aislamientos de S. aureus resistentes a la meticilina se determinó la concentración inhibitoria mínima frente a levofloxacino y para aislamientos de S. pneumoniae se realizó la prueba de difusión en agar con discos de ofloxacino y levofloxacino.
Resultados. Doscientos sesenta y nueve (99,6%) aislamientos de S. pneumoniae fueron susceptibles a gatifloxacino y moxifloxacino; para levofloxacino y ofloxacino la resistencia fue del 1,5% y 8,9%, respectivamente. El 15,9% de S. pneumoniae tuvo una concentración inhibitoria mínima ³ ³³ ³³4 µg/ml frente a ciprofloxacino. Las prevalencias de resistencia para ciprofloxacino, gatifloxacino y moxifloxacino en los 348 aislamientos de S. aureus fueron 55,4%, 54,9% y 52,6%, y en S. aureus resistentes a meticilina, fueron 92,3%, 91,3% y 87,5% y 91,8% para levofloxacino. En estafilococos coagulasa negativa y enterococos susceptibles a vancomicina se observaron tasas de resistencia entre 25,6% y 31,8%. Todos los aislamientos de enterococos resistente a vancomicina fueron resistentes a los compuestos evaluados.
Conclusión. Los aislamientos colombianos de S. pneumoniae mantienen susceptibilidad a las fluoroquinolonas de última generación. La resistencia a fluoroquinolonas es alta en S. aureus, especialmente en aislamientos resistentes a la meticilina (cercana al 100%).

Descargas

La descarga de datos todavía no está disponible.
  • César A. Arias Unidad de Genética y Resistencia Antimicrobiana, Universidad El Bosque, Bogotá, D. C., Colombia. Division of Infectious Diseases, University of Texas Medical School, Houston, Texas, USA
  • Marylin Hidalgo Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, D. C., Colombia
  • Jinnethe Reyes Unidad de Genética y Resistencia Antimicrobiana, Universidad El Bosque, Bogotá, D. C., Colombia
  • Ana María Cárdenas Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, D. C., Colombia
  • Lorena Díaz Unidad de Genética y Resistencia Antimicrobiana, Universidad El Bosque, Bogotá, D. C., Colombia
  • Sandra Ríncon Unidad de Genética y Resistencia Antimicrobiana, Universidad El Bosque, Bogotá, D. C., Colombia
  • Natasha Vanegas Instituto de Genética Molecular Bacteriana, Universidad El Bosque, Bogotá, D. C., Colombia
  • Paula Lucía Díaz Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, D. C., Colombia
  • Elizabeth Castañeda Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, D. C., Colombia

Citas

1. Lesher GY, Froelich EJ, Gruett MD, Bailey JH, Brundage RP. 1,8-Naphthyridine derivates: a new class of chemotherapeutic agents. J Med Pharm Chem. 1962;5:1063-5.
2. Hopper DC. New uses for new and old quinolones and challenge of resistance. Clin Infect Dis. 2000;30:243-54.
3. Hooper DC. Fluoroquinolone resistance among Gram-positive cocci. Lancet Infect Dis. 2002;2:530-8.
4. Saravolatz LD, Leggett J. Gatifloxacin, gemifloxacin, and moxifloxacin: the role of 3 newer fluoroquinolones. Clin Infect Dis. 2003;37:1210-5.
5. Jacoby GA. Mechanisms of resistance to quinolones. Clin Infect Dis. 2005;41:S120-6.
6. Schmitz FJ, Higgins PG, Mayer S, Fluit AC, Dalhof A. Activity of quinolones against Gram positive cocci: Mechanisms of drug action and bacterial resistance. Eur J Clin Microbiol Infect Dis. 2002;21:647-59.
7. Tran JH, Jacoby GA. Mechanism of plasmid-mediated quinolone resistance. Proc Natl Acad Sci USA. 2002;99: 5638-42.
8. Ruiz J. Mechanisms of resistance to quinolones: target alterations, decreased accumulation and DNA gyrase protection. J Antimicrob Chemother. 2003;51:1109-17.
9. Arsene S, Leclercq R. Role of a qnr-like gene in the intrinsic resistance of Enterococcus faecalis to fluoroquinolones. Antimicrob Agents Chemother. 2007;51:3254-8.
10. Arias CA, Reyes J, Zuñiga M, Cortés L, Cruz C, Rico CL, et al. Multicentre surveillance of antimicrobial resistance in enterococci and staphylococci from Colombian hospitals, 2001-2002. J Antimicrob Chemother. 2003;51:59-68.
11. Álvarez C, Cortés J, Arango A, Correa C, Leal A, Grupo para el Control de la Resistencia Bacteriana en Bogotá. Antimicrobial resistance in intensive care units in Bogotá, Colombia, 2001-2003. Rev Salud Pública (Bogotá). 2006;8(Suppl.1):86-101.
12. Grupo de Microbiología. Streptococcus pneumoniae aislamientos invasores. Consultado: 19 de septiembre 2006.Disponible en: http://www.ins.gov.co/pdf_investiga/Microbiologia_spn_005.pdf.
13. Organización Panamericana de la Salud. Programa de Vigilancia de los serotipos y resistencia antimicrobiana de Streptococcus pneumonaie y Haemophilus influenzae. Manual de Procedimientos. Consultado: 3 de marzo de 2006. Disponible en:http://www.paho.org/Spanish/AD/THS/EV/LABS-manual-vigilancia-serotipos.pdf.
14. Agudelo CI, Moreno J, Sanabria OM, Ovalle MV, Di Fabio JL, Castañeda E, et al. Streptococcus pneumoniae: evolución de los serotipos y los patrones de susceptibilidad antimicrobiana en aislamientos invasores en 11 años de vigilancia en Colombia (1994- 2004). Biomédica. 2006;26:234-49.
15. Martineau F, Picard FJ, Lansac N, Ménard C, Roy PH, Ouellette M, et al. Correlation between the resistance genotype determined by multiplex PCR assays and the antibiotic susceptibility patterns of Staphylococcus aureus and Staphylococcus epidermidis. Antimicrob Agents Chemother. 2000;44: 231-8.
16. Dutka-Malen S, Evers S, Courvalin P. Detection of glycopeptide resistance genotypes and identification to the species level of clinically relevant enterococci by PCR. J Clin Microbiol. 1995;33:24-7.
17. Woodford N, Egelton CM, Morrison D. Comparison of PCR with phenotypic methods for the speciation of enterococci. Adv Exp Med Biol. 1997;418:405-8.
18. Reyes J, Hidalgo M, Díaz L, Rincón S, Moreno J, Vanegas N, et al. Characterization of macrolide resistance in Gram-positive cocci from Colombian hospitals: a countrywide surveillance. Int J Infect Dis. 2007;11:329-36.
19. Cruz C, Moreno J, Renzoni A, Hidalgo M, Reyes J, Schrenzel J, et al. Tracking methicillin-resistant Staphylococcus aureus clones in Colombian hospitals over 7 years (1996-2003): emergence of a new dominant clone. Int J Antimicrob Agents. 2005;26:457-62.
20. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: Fifteenth Informational Supplement. M7-A6 Methods for dilution antimicrobial susceptibility test for bacteria that grow aerobically: Approved Standard. Sixth Edition. Wayne, Pennsylvania: CLSI; 2005.
21. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: Fifteenth Informational Supplement. M2-A8 Performance standards for antimicrobial disk susceptibility test; Approved standard. Eighth edition. Wayne, Pennsylvania: CLSI; 2005.
22. López H, Sader H, Amábile C, Pedreira W, Muñoz-Bellido JL, García-Rodríguez JA, et al. in vitro activity of moxifloxacin against respiratory pathogens in Latin America. Rev Esp Quimioter. 2002;15:325-34
23. Adam HJ, Schurek KN, Nichol KA, Hoban CJ, Baudry TJ, Laing DJ, et al. Molecular characterization of increasing fluoroquinolone resistance in Streptococcus pneumoniae in Canada 1997 to 2005. Antimicrob Agents Chemother. 2007;51:198-207.
24. Song JH, Jung SI, Ko KS, Kim NY, Son JS, Chang HH, et al. High prevalence of antimicrobial resistance among clinical Streptococcus pneumoniae isolates in Asia (an ANSORP study). Antimicrob Agents Chemother. 2004;48:2101-7.
25. Ip M, Chau SSL, Chi F, Cheuk ES, Ma H, Lai RW, et al. Longitudinally tracking fluoroquinolone resistance and its determinants in penicillin-susceptible and non-susceptible Streptococcus pneumoniae isolates in Hong Kong, 2000-2005. Antimicrob Agents Chemother. 2007; 51:2192-4.
26. Pérez-Trallero E, Fernández-Mazarrasa C, García-Rey C, Bouza E, Aguilar L, García-de-Lomas J, et al. Spanish Surveillance Group for Respiratory Pathogens. Antimicrobial susceptibilities of 1,684 Streptococcus pneumoniae and 2,039 Streptococcus pyogenes isolates and their ecological relationships: results of a 1-year (1998-1999) multicenter surveillance study in Spain. Antimicrob Agents Chemother. 2001;45: 3334-40.
27. Mandell LA, Bartlett JG, Dowell SF, File TM, Musher DM, Whitney C, et al. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis. 2003;37: 1405-33.
28. Ambrose PG, Bast D, Doern GV, Iannini PB, Jones RN, Klugman KP, et al. Fluoroquinolone-resistant Streptococcus pneumoniae, an emerging but unrecognized public health concern: is it time to resight the goalposts? Clin Infect Dis. 2004;39:1554-6.
29. Fuller JD, Low D. A review of Streptococcus pneumoniae infection treatment failures associated with fluoroquinolone resistance. Clin Infect Dis. 2005;41: 118-21.
30. Legg JM, Bint AJ. Will pneumococci put quinolones in their place? J Antimicrob Chemother. 1999;44:425-7.
31. Niederman MS. Challenges in the management of community-acquired pneumonia: the role of quinolones and moxifloxacin. Clin Infect Dis. 2005;41:S158-66.
32. Dobay O, Rozgonyi F, Ghidán A, Matuz M, Nagy K, Amyes SG. The first steps towards fluoroquinolone resistance in Hungarian pneumococci. J Chemother. 2006;18:624-7.
33. Dias R, Louro D, The Antimicrobial Resistance Surveillance Program in Portugal, Caniça M. Antimicrobial susceptibility of invasive Streptococcus pneumoniae isolates in Portugal over an 11-Year Period. Antimicrob Agents Chemother. 2006;50:2098-105.
34. Jones ME, Blosser-Middleton RS, Thornsberry C, Karlowsky JA, Sahm DF. The activity of levofloxacin and other antimicrobials against clinical isolates of Streptococcus pneumon iae collected worldwide during 1999-2002. Diagn Microbiol Infect Dis. 2003;47:579- 86.
35. Ho PL, Yung RW, Tsang DN, Que TL, Ho M, Seto WH. Increasing resistance of Streptococcus pneumoniae to fluoroquinolones: results of a Hong Kong multicentre study in 2000. J Antimicrob Chemother. 2001; 48:659-65.
36. Richter SS, Heilmann KP, Beekmann SE, Miller NJ, Rice CL, Doern GV. The molecular epidemiology of Streptococcus pneumoniae with quinolone resistant mutations. Clin Infect Dis. 2005;40:225-35.
37. Karlowsky JA, Jones ME, Draghi DC, Thornsberry C, Sahm DF, Volturo GA. Prevalence and antimicrobial susceptibilities of bacteria isolated from blood cultures of hospitalized patients in the United States in 2002. Ann Clin Microbiol Antimicrob. 2004;10:3-7.
38. Canton R, Morosini M, Enright MC, Morrissey I. Worldwide incidence, molecular epidemiology and mutations implicated in fluoroquinolone-resistant Streptococcus pneumoniae: data from the global PROTEKT surveillance programme. J Antimicrob Chemother. 2003;52:944-52.
39. Andrews J, Ashby J, Jevons G, Marshall T, Lines N, Wise R. A comparison of antimicrobial resistance rates in Gram-positive pathogens isolated in the UK from October 1996 to January 1997 and October 1997 to January 1998. J Antimicrob Chemother. 2000;45: 285-93.
40. El Kholy A, Baseem H, Hall GS, Procop GW, Longworth DL. Antimicrobial resistance in Cairo, Egypt 1999-2000: a survey of five hospitals. J Antimicrob Chemother. 2003;51:625-30.
41. Decousser JW, Pina P, Picot F, Delalande C, Pangon B, Courvalin P, et al. Frequency of isolation and antimicrobial susceptibility of bacterial pathogens isolated from patients with bloodstream infections: a French prospective national survey. J Antimicrob Chemother. 2003;51:1213-22.
42. Blumberg HM, Rimland D, Carroll DJ, Terry P, Wachsmuth IK. Rapid development of ciprofloxacin resistance in methicillin-susceptible and methicillin-resistant Staphylococcus aureus. J Infect Dis. 1991; 163:1279-85.
43. Zangrillo A, Landoni G, Fumagalli L, Bove T, Bellotti F, Sottocorna O, et al. Methicillin-resistant Staphylococcus species in a cardiac surgical intensive care unit: a 5-year experience. J Cardiothorac Vasc Anesth. 2006;20:31-7.
44. Klevens M. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003 . Clin Infect Dis. 2006;42: 389-91.
45. Reynolds R, Potz N, Colman M, Williams A, Livermore D, MacGowan A, et al. Antimicrobial susceptibility of the pathogens of bacteraemia in the UK and Ireland 2001-2002: the BSAC Bacteraemia Resistance Surveillance Programme. J Antimicrob Chemother. 2004;53:1018-32.
46. Andrade SS, Sader HS, Jones RN, Pereira AS, Pignatari AC, Gales AC. Increased resistance to first-line agents among bacterial pathogens isolated from urinary tract infections in Latin America: time for local guidelines? Mem Inst Oswaldo Cruz. 2006;101:741-8.
47. Deshpande LM, Fritsche TR, Moet GJ, Biedenbach DJ, Jones RN. Antimicrobial resistance and molecular epidemiology of vancomycin-resistant enterococci from North America and Europe: a report from the SENTRY antimicrobial surveillance program. Diagn Microbiol Infect Dis. 2007;58:163-70.
48. Aires De Sousa M, Miragaia M, Sanches IS, Avila S, Adamson I, Casagrande ST, et al. Three-year assessment of methicillin-resistant Staphylococcus aureus clones in Latin America from 1996 to 1998. J Clin Microbiol. 2001;39:2197-205.
49. Weber SG, Gold HS, Hooper DC, Karchmer AW, Carmeli Y. Fluoroquinolones and the risk for methicillin-resistant Staphylococcus aureus in hospitalized patients. Emerg Infect Dis. 2003;9:1415-22.
50. Loo VG, Poirier L, Miller MA, Oughton M, Libman MD, Michaud S, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005;8;353:2442-9.
51. Sanders CC. Mechanisms responsible for cross-resistance and dichotomous resistance among the quinolones. Clin Infect Dis. 2001;32(Suppl.1):S1-8.
52. Rodríguez-Martínez JM. Mechanisms of plasmid-mediated resistance to quinolones. Enferm Infecc Microbiol Clin. 2005;23:25-31.
53. Álvarez CA, Barrientes OJ, Leal AL, Contreras GA, Barrero L, Rincón S, et al. Community-associated methicillin-resistant Staphylococcus aureus, Colombia. Emerg Infect Dis. 2006;12:2000-1. 
Cómo citar
Arias, C. A., Hidalgo, M., Reyes, J., Cárdenas, A. M., Díaz, L., Ríncon, S., Vanegas, N., Díaz, P. L., & Castañeda, E. (1). Perfiles de resistencia a fluoroquinolonas en aislamientos clínicos de cocos Gram positivos provenientes de hospitales colombianos, 1994-2004. Biomédica, 28(2), 284-294. https://doi.org/10.7705/biomedica.v28i2.99
Sección
Artículos originales